Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: LIFESTYLE| 5-19

FATS

Fat provides 20 to 35% of daily energy requirements.

Less than 10% of fat ingested will be converted to glucose in the bloodstream and, therefore, one would not expect intake of fat to significantly impact BG. However, addition of a small amount of fat to a meal may slow gastric emptying and delay a rise in postprandial BG levels (75). In clinical practice, it has been observed that higher-fat meals may result in acceptable BG levels postprandially, but higher BG several hours later. As for the general population, total fat should be limited to a range of 20-35% of daily energy requirements. The type of fat has been shown to be more important than the quantity of fat to reduce the risk of cardiovascular disease. Diets low in trans fats are associated with less coronary heart disease. Studies have shown that restricting saturated fats to less than 9% of total energy intake decreased combined cardiovascular events. Some studies suggest replacing the saturated fats with mixed omega-3/omega-6 PUFA sources, such as soybean oil and canola oil (76). Other studies suggest replacing the saturated fats with high quality sources of monounsaturated fatty acids (MUFA) from olive oil, canola oil, avocado, nuts and seeds, and high quality sources of carbohydrates from whole grains and low-GI index carbohydrate foods is associated with decreased incidence of coronary heart disease (CHD) (77,78). Diabetes Canada suggests replacing trans fats and saturated fats with polyunsaturated fatty acids (PUFA), particularly mixed n-3/n-6 sources, monounsaturated fatty acids (MUFA) from plant sources, whole grains or low-GI carbohydrates (35). When considering the type of fat, the food source of the saturated fatty acids is another important factor. Meat as a food source of saturated fatty acids has been reliably established to have adverse associations, but the same associations have not been shown for some other food sources of saturated fatty acids, such as dairy products and plant fats from palm and coconut (79). A comprehensive review of current literature has indicated that there is neither a cardiovascular nor a glycemic benefit of supplementation with omega-3 fatty acids (80). The Outcome Reduction with Initial Glargine Intervention (ORIGIN) trial failed to show a CV or mortality benefit of supplementation with omega-3 fatty acids in people with prediabetes or type 2 diabetes (81). The Study of Cardiovascular Events in Diabetes (ASCEND) will provide more data on the outcomes of supplementation with omega-3 fatty acids in people with diabetes.