The association of substituting carbohydrates with total fat and different types of fatty acids with mortality and weight change among diabetes patients

Campmans-Kuijpers, M. J., Sluijs, I., Nöthlings, U., Freisling, H., Overvad, K., Boeing, H., Masala, G., Panico, S., Tumino, R., Sieri, S., Johansson, I., Winkvist, A., Katzke, V. A., Kuehn, T., Nilsson, P. M., Halkjær, J., Tjønneland, A., Spijkerman, A. M., Arriola, L., Sacerdote, C., Barricarte, A., May, A. M. & Beulens, J. W., Oct-2016, In : Clinical Nutrition. 35, 5, p. 1096-1102 7 p.

Research output: Contribution to journalArticleAcademicpeer-review

Copy link to clipboard



  • Marjo J Campmans-Kuijpers
  • Ivonne Sluijs
  • Ute Nöthlings
  • Heinz Freisling
  • Kim Overvad
  • Heiner Boeing
  • Giovanna Masala
  • Salvatore Panico
  • Rosario Tumino
  • Sabina Sieri
  • Ingegerd Johansson
  • Anna Winkvist
  • Verena A Katzke
  • Tilman Kuehn
  • Peter M Nilsson
  • Jytte Halkjær
  • Anne Tjønneland
  • Annemieke M Spijkerman
  • Larraitz Arriola
  • Carlotta Sacerdote
  • Aurelio Barricarte
  • Anne M May
  • Joline W Beulens

BACKGROUND: Substitution of carbohydrates with fat in a diet for type 2 diabetes patients is still debated.

OBJECTIVE: This study aimed to investigate the association between dietary carbohydrate intake and isocaloric substitution with (i) total fat, (ii) saturated fatty acids (SFA), (iii) mono-unsaturated fatty acids (MUFA) and (iv) poly-unsaturated fatty acids (PUFA) with all-cause and cardiovascular (CVD) mortality risk and 5-year weight change in patients with type 2 diabetes.

METHODS: The study included 6192 patients with type 2 diabetes from 15 cohorts of the European Prospective Investigation into Cancer and Nutrition (EPIC). Dietary intake was assessed at recruitment with country-specific food-frequency questionnaires. Cox and linear regression were used to estimate the associations with (CVD) mortality and weight change, adjusting for confounders and using different methods to adjust for energy intake.

RESULTS: After a mean follow-up of 9.2 y ± SD 2.3 y, 791 (13%) participants had died, of which 268 (4%) due to CVD. Substituting 10 g or 5 energy% of carbohydrates by total fat was associated with a higher all-cause mortality risk (HR 1.07 [1.02-1.13]), or SFAs (HR 1.25 [1.11-1.40]) and a lower risk when replaced by MUFAs (HR 0.89 [0.77-1.02]). When carbohydrates were substituted with SFAs (HR 1.22 [1.00-1.49]) or PUFAs (HR 1.29 [1.02-1.63]) CVD mortality risk increased. The 5-year weight was lower when carbohydrates were substituted with total fat or MUFAs. These results were consistent over different energy adjustment methods.

CONCLUSIONS: In diabetes patients, substitution of carbohydrates with SFAs was associated with a higher (CVD) mortality risk and substitution by total fat was associated with a higher all-cause mortality risk. Substitution of carbohydrates with MUFAs may be associated with lower mortality risk and weight reduction. Instead of promoting replacement of carbohydrates by total fat, dietary guideline should continue focusing on replacement by fat-subtypes; especially SFAs by MUFAs.

Original languageEnglish
Pages (from-to)1096-1102
Number of pages7
JournalClinical Nutrition
Issue number5
Publication statusPublished - Oct-2016
Externally publishedYes


  • Body Weight, Cardiovascular Diseases/diet therapy, Diabetes Mellitus, Type 2/diet therapy, Diet, Dietary Carbohydrates/administration & dosage, Dietary Fats/administration & dosage, Fatty Acids/administration & dosage, Fatty Acids, Monounsaturated/administration & dosage, Fatty Acids, Unsaturated/administration & dosage, Female, Follow-Up Studies, Humans, Linear Models, Male, Middle Aged, Nutrition Assessment, Proportional Hazards Models, Prospective Studies, Surveys and Questionnaires

Download statistics

No data available

ID: 127977887