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Dietary fat and the development of type 2 diabetes.

The recent release of results from the Finnish Diabetes Prevention Study (FDPS) (1) and the Diabetes Prevention Program (DPP) (2) strongly confirm the hypothesis that interventions that alter diet and physical activity to achieve weight loss can prevent or postpone the development of type 2 diabetes in high-risk individuals. The next challenge will be to translate these impressive results into clinical practice. It seems relevant in this context to ask, “What is the best dietary intervention strategy to improve insulin action and prevent diabetes?” In the current issue of Diabetes Care , van Dam et al. (3) assess the association between diet and development of diabetes over a 12-year period in the Health Professionals Follow-up Study (HPFS). They find that consumption of a high-fat diet and high intakes of saturated fat are associated with an increased risk of type 2 diabetes. However, this association disappears when they adjust for BMI. They also find that frequent consumption of processed meats is associated with an increased risk for diabetes. Does this study alter the recommendations we make to individuals at risk for developing diabetes?

A large body of experimental data generated in laboratory animals strongly supports the notion that high-fat diets are associated with impaired insulin action. It appears from animal studies that saturated fats, in particular, have the most detrimental effects. Based on this information, along with the known risks of high saturated fat intake on cardiovascular disease risk, professional organizations such as the American Diabetes Association, the American Heart Association, and the U.S. Department of Agriculture have made recommendations that Americans aim for a total fat intake of no more than 30% of calories and choose foods low in saturated fat. However, some authors have criticized the evidence on which these public health recommendations have been based (4), and it …