There is low to high ( majority moderate ) certainty for small improvements of unclear clinical importance in plasma glucose , triglycerides , and HDL concentrations favoring low-carbohydrate food at half of the prespecified time points .
There was little to no difference in LDL concentration or any of the secondary outcomes ( body weight , waist circumference , blood pressure , quality of life ) in response to either of the diets ( very-low- to high-certainty evidence ) .
Conclusions Currently available data provide low- to moderate-certainty evidence that dietary carbohydrate restriction to a maximum of 40 % yields slightly better metabolic control of uncertain clinical importance than reduction in fat to a maximum of 30 % in people with T2D .
Background It remains uncertain which diet is best for people with type 2 diabetes ( T2D ) .
Objective We compared the effects of dietary carbohydrate restriction with fat restriction on markers of metabolic syndrome and quality of life in people with T2D .
Why Do Low-Fat High-Carbohydrate Diets Accentuate Postprandial Lipemia in Patients With NIDDM?
OBJECTIVE To underst and why low-fat high-carbohydrate ( CHO ) diets lead to higher fasting and postpr and ial concentrations of triglyceride (TG)-rich lipoproteins in patients with non-insulin-dependent diabetes mellitus ( NIDDM ) . RESEARCH DESIGN AND METHODS Patients with NIDDM were placed r and omly on diets containing either 55 % CHO , 30 % fat , and 15 % protein or 40 % CHO , 45 % fat , and 15 % protein for 6 weeks , followed by crossover to the other diet . Test meals at the end of each diet period were consumed at 8:00 A.M. and 12:00 P.M. ( noon ) and contained 20 and 40 % of daily calories , respectively . Vitamin A was also given at noon , and TG-rich lipoproteins of intestinal origin were identified by the presence of vitamin A esters . Frequent measurements were made throughout the 24-h study period of plasma glucose , insulin , and TG concentrations . Plasma sample s obtained from 12:00 P.M. ( noon ) until 12 A.M. ( midnight ) were subjected to ultracentrifugation , and measurements were made of TG and vitamin A ester concentrations in plasma and in both the Svedberg flotation constant ( Sf ) > 400 ( chylomicron ) and Sf 20 - 400 ( chylomicron remnant ) lipoprotein fractions . In addition , very-low-density lipoprotein (VLDL)-TG turnover rate was estimated by following the decay of [3H]VLDL-TG . Finally , postheparin lipoprotein lipase and hepatic lipase activities were measured at the end of each dietary period . RESULTS Mean ± SE hourly concentrations of glucose ( 8.0 ± 0.8 vs. 7.5 ± 0.7 mmol/1 ) , insulin ( 184 ± 26 vs. 158 ± 19 pmol/1 ) , and TG ( 2.8 ± 0.2 vs. 2.1 ± 0.2 mmol/1 ) were higher ( P < 0.05 - 0.001 ) after the 55 % CHO diet . The 55 % CHO diet also led to an increase ( P < 0.05 - 0.01 ) in the mean ± SE hourly concentrations of vitamin A esters in plasma ( 2.3 ± 0.3 vs. 1.6 ±0.1 μmol/l ) and in both the chylomicron ( 2.0 ± 0.3 vs. 1.4 ±0.1 μmol/l ) and chylomicron remnant fractions ( 0.36 ± 0.04 vs. 0.14 ± 0.03 μmol;/l ) . In addition , the VLDL-TG production rate was higher ( 17.2 ± 1.4 vs. 12.8 ± 1.0 mg · kg−1 · h−1 , P < 0.003 ) and the VLDL-TG fractional catabolic rate lower ( 0.22 ± 0.02 to 0.28 ± 0.02 l/h , P < 0.005 ) after the 55 % CHO diet . Finally , there was an increase in lipoprotein lipase activity ( 7.0 ± 0.8 to 8.1 ± 0.7 μmol free fatty acids released · ml−1 · h−1 , P < 0.02 ) in response to the CHO-enriched diet . CONCLUSIONS A low-fat high-CHO diet in patients with NIDDM led to 1 ) higher day-long plasma glucose , insulin , and TG concentrations ; 2 ) postpr and ial accumulation of TG-rich lipoproteins of intestinal origin ; 3 ) increased production of VLDL-TG ; and 4 ) increased postheparin lipoprotein lipase activity . These data provide a mechanism for the hypertriglycer-idemic effect of CHO-enriched diets in patients with NIDDM and demonstrate that multiple risk factors for coronary heart disease are accentuated when these individuals consume diets recommended to reduce this risk
There is low to high ( majority moderate ) certainty for small improvements of unclear clinical importance in plasma glucose , triglycerides , and HDL concentrations favoring low-carbohydrate food at half of the prespecified time points .
There was little to no difference in LDL concentration or any of the secondary outcomes ( body weight , waist circumference , blood pressure , quality of life ) in response to either of the diets ( very-low- to high-certainty evidence ) .
Conclusions Currently available data provide low- to moderate-certainty evidence that dietary carbohydrate restriction to a maximum of 40 % yields slightly better metabolic control of uncertain clinical importance than reduction in fat to a maximum of 30 % in people with T2D .
Background It remains uncertain which diet is best for people with type 2 diabetes ( T2D ) .
Objective We compared the effects of dietary carbohydrate restriction with fat restriction on markers of metabolic syndrome and quality of life in people with T2D .