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Recommendations Summary

PDM: Type of Fat and Prevention of Type 2 Diabetes 2014

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    PDM: Type of Fat and Prevention of Type 2 Diabetes

    The registered dietitian nutritionist (RDN) should educate individuals who are at high risk for type 2 diabetes that the type of fat consumption alone, without weight loss, may not prevent type 2 diabetes. Most studies regarding the type of fat intake, independent of weight loss, reported no significant impact on outcomes in adults with metabolic syndrome or individuals with prediabetes.

    Rating: Fair
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      Research on synergistic effects of nutrients was not evaluated.

    • Potential Costs Associated with Application

      The costs of medical nutrition therapy (MNT).

    • Recommendation Narrative

      A total of eight studies (10 publications) were included in the evidence analysis for this recommendation:

      • Four positive-quality randomized controlled trials (RCT) (Lindstrom et al, 2006; Muzio et al, 2007; Gulseth et al, 2010; Hartwich et al, 2010; Paniagua et al, 2011; Tierney et al, 2011)
      • Four neutral-quality randomized controlled trials (RCT) (Sarkkinen et al, 1996; Louheranta et al, 2002; Mukuddem-Petersen et al, 2007; Wien et al, 2010).

      In Adults with Metabolic Syndrome

      • Glycemic-related outcomes (FBG, random BG, two-hour post-prandial BG, A1C):
        • Most studies reported no significant impact of the type of fat intake, independent of weight loss, on fasting glucose levels in adults with metabolic syndrome
        • Additional longer-term intervention studies are needed to ascertain an effect of type of fat intake on glycemic-related outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for impaired glucose tolerance and impaired fasting glucose
        • Evidence is based on the following: Mukuddem-Petersen et al, 2007; Muzio et al, 2007; Paniagua et al, 2011; Tierney et al, 2011. 
      • Lipid outcomes (TG, HDL):
        • Most studies report no significant impact of the type of fat intake, independent of weight loss, on triglyceride or HDL cholesterol levels in adults with metabolic syndrome
        • Additional longer-term intervention studies are needed to ascertain an effect of type of fat intake on lipid outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for lipid levels
        • Evidence is based on the following: Mukuddem-Petersen et al, 2007; Muzio et al, 2007; Hartwich et al, 2010; Paniagua et al, 2011; Tierney et al, 2011. 
      • Anthropometric outcomes (WC, WHR):
        • Research reports no significant impact of the type of fat intake, independent of weight loss, on waist circumference in adults with metabolic syndrome
        • Additional longer-term intervention studies are needed to ascertain an effect of type of fat intake on anthropometric outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for anthropometric measures
        • Evidence is based on the following: Mukuddem-Petersen et al, 2007; Muzio et al, 2007; Paniagua et al, 2011; Tierney et al, 2011. 
      • Blood pressure outcomes:
        • Research reports no significant impact of type of fat intake, independent of weight loss, on systolic or diastolic blood pressure in adults with metabolic syndrome.
        • Additional longer-term intervention studies are needed to ascertain an effect of type of fat intake on blood pressure in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for blood pressure
        • Evidence is based on the following: Mukuddem-Petersen et al, 2007; Muzio et al, 2007; Gulseth et al, 2010; Paniagua et al, 2011; Tierney et al, 2011. 
      • Renal outcomes:
        • There were no studies identified to evaluate the impact of type of fat intake, independent of weight loss, on renal outcomes in adults with metabolic syndrome
        • Intervention studies are needed to ascertain an effect of type of fat intake on renal outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for renal measures.

      In Individuals with Prediabetes

      • Glycemic-related outcomes (FBG, random BG, two-hour post-prandial BG, A1C)
        • Limited research reports mixed results regarding the impact of type of fat intake, independent of weight loss, on fasting blood glucose levels in individuals with prediabetes
        • Limited research reports no significant impact of the type of fat intake on A1C
        • Additional longer-term intervention studies are needed to ascertain the effect of type of fat intake on glycemic outcomes in individuals with prediabetes
        • Evidence is based on the following: Sarkkinen et al, 1996; Louheranta et al, 2002; Wien et al, 2010.  
      • Lipid outcomes (TG, HDL):
        • Limited research reports no significant impact of type of fat intake, independent of weight loss, on triglycerides or HDL cholesterol in individuals with prediabetes
        • Additional longer-term intervention studies are needed to ascertain the effect of type of fat intake on lipid outcomes in individuals with prediabetes
        • Evidence is based on the following: Sarkkinen et al, 1996; Wien et al, 2010. 
      • Anthropometric outcomes (WC, WHR)
        • Limited research reports no significant impact of type of fat intake, independent of weight loss, on waist circumference in individuals with prediabetes
        • Additional longer-term intervention studies are needed to ascertain the effect of type of fat intake on anthropometric outcomes in individuals with prediabetes
        • Evidence is based on the following: Lindstrom et al, 2006; Wien et al, 2010. 
      • Blood pressure outcomes:
        • Limited research reports no significant impact of type of fat intake, independent of weight loss, on systolic or diastolic blood pressure in individuals with prediabetes
        • Additional longer-term intervention studies are needed to ascertain the effect of type of fat intake on blood pressure in individuals with prediabetes
        • Evidence is based on the following: Wien et al, 2010. 

    • Recommendation Strength Rationale

      For Adults with Metabolic Syndrome

      • Grade I evidence is available for the conclusion statements regarding the impact of type of fat intake, independent of weight loss, on the following outcomes:
        • Anthropometric measures (WC, WHR)
        • Blood pressure.
      • Grade II evidence is available for the conclusion statements regarding the impact of type of fat intake, independent of weight loss, on the following outcomes:
        • Glycemic-related outcomes (such as fasting blood glucose, random blood glucose, two-hour post-prandial blood glucose, A1C)
        • Lipid (TG, HDL)
        • Grade V evidence is available for the conclusion statement regarding the impact of type of fat intake, independent of weight loss, on the following outcomes: Renal measures.

      For Individuals with Prediabetes

      • Grade III evidence is available for the conclusion statements regarding the impact of type of fat intake, independent of weight loss, on the following outcomes:
        • Glycemic-related outcomes (such as fasting blood glucose, random blood glucose, two-hour postprandial blood glucose, A1C)
        • Lipid (TG, HDL)
        • Anthropometric measures (WC, WHR)
        • Blood pressure.

    • Minority Opinions

      Consensus reached.