Effects of Lifestyle (Diet, Plant Sterols, Exercise) and Glycemic Control on Lipoproteins in Diabetes

Abstract

Although the data are limited, it is reasonable to state that people with diabetes mellitus behave in the same way to lipid modulating dietary components as people without diabetes. Thus saturated fat elevates and polyunsaturated fat reduces LDL-cholesterol levels. Psyllium and oat bran reduce LDL-cholesterol levels. Low-glycemic-index diets have no effect on plasma lipids, but fish oil lowers circulating triglyceride levels, as do exercise, weight loss, and improved glycemic control. HDL-cholesterol levels are most consistently increased by weight loss. Dietary cholesterol appears to be associated with coronary heart disease in people with diabetes, but cholesterol-feeding studies have not been performed in this group. Although theoretically plant sterols and stanols should be less effective at lowering LDL-cholesterol in people with diabetes, because of lower cholesterol absorption, this does not appear to be true. Modest alcohol intake appears to reduce the incidence of diabetes but does not appear to protect people with diabetes from heart disease. There are no data on strokes or peripheral vascular disease (PVD). There appear to be no alcohol intervention studies in people with diabetes. Fructose intake of less than 20 % of energy improves glycemic control without adversely affecting lipid levels. This chapter will review the effects of various lifestyle factors, including diet, weight loss, smoking, and exercise, and various dietary components on the lipoprotein profile in people with diabetes mellitus.