Saturday, December 14, 2013

ADA Position Statement On Nutrition Therapy For Diabetes: Fat

The American Diabetes Association (ADA) recently published their new Position Statement on nutrition therapy for people with diabetes:
Nutrition Therapy Recommendations for the Management of Adults With Diabetes, Diabetes Care, Published online ahead of print, 9 October 2013.
This post focuses on fat. Previous posts focused on carbohydrate and protein. The carbohydrate post summarized the grading system that the ADA used to rate their evidence.

Keeping with their recommendations for carbohydrate and protein, the panel did not designate a particular amount of fat to consume. They noted that people with diabetes eat about 36-40% of their calories from fat - an observation, not a recommendation.

For people without diabetes, the Institute of Medicine states that an acceptable amount of fat to consume (acceptable macronutrient distribution range or AMDR) is 20-35%, and that there is "evidence for increased obesity and its complications [e.g. heart disease] at high intakes of fat." Echoing this, the ADA said:
"Individuals with diabetes should be encouraged to moderate their fat intakes to be consistent with their goals to lose or maintain weight."
Here are the ADA's grades for total fat intake:
Evidence is inconclusive for an ideal amount of total fat intake for people with diabetes; therefore, goals should be individualized. Grade C

Fat quality appears to be far more important than quantity. Grade B
Regarding fat quality, the ADA recommended substituting saturated fat with monounsaturated and polyunsaturated fat: "PUFAs and MUFAs are recommended substitutes for saturated or trans fat."
In people with type 2 diabetes, a Mediterranean-style, MUFA-rich eating pattern may benefit glycemic control and CVD risk factors and can therefore be recommended as an effective alternative to a lower-fat, higher-carbohydrate eating pattern. Grade B
Nuts and olive oil are good sources of monounsaturated fat.

Omega-3 fatty acids are polyunsaturated fatty acids or PUFAs. The panel preferred omega-3-rich food over omega-3 supplements:
Evidence does not support recommending omega-3 (EPA and DHA) supplements for people with diabetes for the prevention or treatment of cardiovascular events. Grade A

As recommended for the general public, an increase in foods containing long-chain omega-3 fatty acids (EPA and DHA) (from fatty fish) and omega-3 linolenic acid (ALA) is recommended for individuals with diabetes because of their beneficial effects on lipoproteins, prevention of heart disease, and associations with positive health outcomes in observational studies. Grade B

The recommendation for the general public to eat fish (particularly fatty fish) at least two times (two servings) per week is also appropriate for people with diabetes. Grade B
About saturated fat, they said:
The amount of dietary saturated fat, cholesterol, and trans fat recommended for people with diabetes is the same as that recommended for the general population. Grade C
They note that the general population should be aiming for less than 10% of calories from saturated fatty acids (SFAs) and less than 300 mg cholesterol/day:
"The Dietary Guidelines for Americans, 2010 recommends consuming less than 10% of calories from SFAs to reduce [cardiovascular disease (CVD)] risk. Consumers can meet this guideline by replacing foods high in SFA (i.e., full-fat dairy products, butter, marbled meats and bacon, and tropical oils such as coconut and palm) with items that are rich in MUFA and PUFA (i.e., vegetable and nut oils including canola, corn, safflower, soy, and sunflower; vegetable oil spreads; whole nuts and nut butters, and avocado).

CVD is a common cause of death among people with diabetes. As a result, individuals with diabetes are encouraged to follow nutrition recommendations similar to the general population to manage CVD risk factors. These recommendations include reducing SFAs to less than 10% of calories, aiming for less than 300 mg dietary cholesterol/day, and limiting trans fat as much as possible."