**3.7. Fat**

A Mediterranean-style, MUFA-rich eating pattern could be recommended as an alternative to a lower fat, higher carbohydrate eating pattern to provide a good glycemic control and decrease the CVD risk factors in type 2 diabetics. The general public recommendation to eat fish (especially fatty fish) at minimum 2 times a week could be applied to diabetic individuals. Diabetic patients should follow nutritional recommendations similar to the general population to CVD risk factors. These recommendations are decreasing in SFA to 10% of total calories, taking 300 mg daily cholesterol and restriction of trans fat as much as possible [32].

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#### **3.8. Fiber**

Fiber-containing foods such as legumes, fiber-rich cereals (≥5 g fiber/serving), fruits, vegetables, and whole grain products are recommended for diabetic patients, since they ensure vitamins, minerals, and other substances important for a healthy life. U.S. Department of Agriculture (USDA) recommends 14 g (1000 kcal) daily dietary fiber and foods containing whole grains (one-half of grain intake) in persons with high risk for T2DM [34]. The insoluble dietary fiber in diet decreases cholesterol, glucose, and insulin levels. A fiber-rich meal promotes satiety, since it is processed more slowly in the gastrointestinal tract [75].

## **3.9. Vitamins**

Elderly diabetics are more prone to risk for deficiency of trace elements, and magnesium and zinc supplementation results may worsen glycemic control. Uncontrolled diabetes leads to increase in oxidative stress. Small-size studies showed vitamins C and E (antioxidants) may positively affect glycemic control [76]. Decreased intake and unbalanced diet may lead to a deficiency of vitamins and minerals. Drugs may decrease absorption of vitamins by affecting hepatic metabolism. Older people cannot eliminate vitamin A that may lead to hypervitaminosis. Decreased dietary consumption and gastrointestinal and renal disease lead to vitamin D deficiency which is associated with osteomalacia, rickets, and myopathy. It also leads to decreased bone density, disability, and higher risk for falls. Vitamin deficiency is common in elderly persons. It may lead to macrocytic anemia, subacute combined degeneration of the spinal cord, neuropathies, ataxia, glossitis, and dementia. Vitamin B12 deficiency is also associated with higher levels of homocysteine that may increase the risk for cardiovascular disorders, decreased bone density, and increased fracture risk [77]. Since elderly persons are prone to deficiencies of vitamin B groups (B1, B2, B12, B6, and folate) that lead to cognitive dysfunction, adequate intake of vitamin and micronutrients is essential in elderly diabetics [78].
