Journal Name:
Am. J. Clin. Nutr.
Article Title:
Dietary cis-monounsaturated fatty acids and metabolic control in type 2 diabetes.
Date Written:
2003
Volume:
78
Number:
3(suppl)
Page:
617S
Author(s):
Ros, E.
Article:
Recommendations for diets for the treatment and prevention of obesity, diabetes, and insulin resistance have stressed low-fat, high-carbohydrate (CHO) diets or moderately low-CHO, high-monounsaturated (MUFA). High-fat diets based on MUFA-rich oils or whole foods have been compared with high-CHO diets for effects on several cardiovascular risk outcomes in diabetic subjects. Early studies using metabolic diets with wide differences in total fat content (15–25% of energy) generally found a beneficial effect of MUFA diets on glycemic control and serum lipids. This paper critically reviews the role of dietary MUFA in diabetes. Scientific evidence is reviewed which considers the effects of CHO and MUFA diets on surrogate cardiovascular risk markers, including postprandial lipemia, LDL subclasses, LDL oxidation, and endothelial dysfunction.
This assessment showed that diets characterized by a difference of ≤ 15% of energy in total fat between low-fat and high-MUFA resulted in similar effects on glycemic profiles. High MUFA diets however were more effective for effects on triacylglycerols and HDL cholesterol. It is unclear whether postprandial fat clearance is impaired by CHO diets and improved by MUFA diets, independent of effects on fasting triacylglycerol concentrations. The 2 dietary approaches were found to have similar effects on LDL oxidation. Low-fat diets, however, are associated with atherogenic, dense LDL particles, while normal, buoyant LDL are found with high-fat diets regardless of fatty acid composition. Limited experimental evidence suggests that MUFA diets favorably influence blood pressure, coagulation, endothelial activation, inflammation, and thermogenic capacity. The data suggests that energy-controlled high-MUFA diets do not promote weight gain and are more acceptable than low-fat diets for weight loss in obese subjects.
The review concludes that there is good scientific support for MUFA diets as an alternative to low-fat diets for medical nutrition therapy in diabetes. There appears to be substantial evidence that in patients with diabetes, diets with a relatively high fat content based on MUFA-rich foods provide a degree of metabolic control that is similar or even better than that obtained with high-CHO diets. There is also limited evidence for a number of anti-atherosclerotic effects of MUFA diets. An added advantage of a high-MUFA diet is palatability, potentially aiding in compliance, which is often a problem with low-fat diets.
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