**6. Dietary patterns**

#### **6.1. Low-fat diets**

Low-fat diets may improve quality of life and extend life expectancy in healthy people, as well as in patients with overweight issues, diabetes, and CVD [77]. Due to the high risk of CVD in individuals diagnosed with T2DM, the goal in dietary fat intake (amount and type) is similar to that of patients with CVD without diabetes [77]. Certain saturated fatty acids (SFA), trans fatty acids (TFA), conjugated linoleic acids (CLA), and cholesterol adversely affect blood lipid levels, whereas viscous fiber, unsaturated MUFA and PUFA, plant sterols/ stanols, and to a certain extent, polyphenols have favorable effects [113]. Diet recommendations include obtaining 25 to 35% of daily calories from fats, and restricting saturated fats to less than 7% of total calories, TFA less than 1%, and cholesterol to less than 200 mg/day [133]. These levels can be achieved by eating more grain products, vegetables and fruits, low-fat dairy products, and fat-free milk, and by reducing food containing TFA [134]. A randomized controlled trial found that diets containing ≥7% SFA and ≥200 mg/day cholesterol led to a reduction of the LDL-C level by 9–12% compared to baseline values or to a more standard Western-type diet [135].

#### **6.2. Low-carbohydrate diets**

Low-carbohydrate diets are preferable to a low-fat diet in reducing triglycerides (TG) levels and for increasing HDL-C blood levels [77]. A low-carbohydrate diet is defined as consumption of 30–130 g of carbohydrates per day or up to 45% of total calories [136]. There is no justification for the recommendation of very low carbohydrate diets in T2DM. Carbohydrate quantities, sources, and distribution should be selected to facilitate near-normal long-term glycemic control [137]. A two-year international Dietary Intervention Randomized Controlled (DIRECT) study found that compared to the other diets, the low-carbohydrate diet was most effective for weight loss, and changes in biomarkers (TG, HDL-C, glucose, and insulin) [138].
