Missed Opportunities for Providing Low-fat Dietary Advice to People With Diabetes

Ingrid E. Lobo, MD; Daniel le F. Loeb, MD; Vahram Ghushchyan, PhD; Irene E. Schauer, MD, PhD; Amy G. Huebschmann, MD


Prev Chronic Dis. 2012;9 

In This Article

Abstract and Introduction


Introduction Because cardiovascular disease is closely linked to diabetes, national guidelines recommend low-fat dietary advice for patients who have cardiovascular disease or are at risk for diabetes. The prevalence of receiving such advice is not known. We assessed the lifetime prevalence rates of receiving low-fat dietary advice from a health professional and the relationship between having diabetes or risk factors for diabetes and receiving low-fat dietary advice.

Methods From 2002 through 2009, 188,006 adults answered the following question in the Medical Expenditure Panel Survey: "Has a doctor or other health professional ever advised you to eat fewer high-fat or high-cholesterol foods?" We assessed the association between receiving advice and the following predictors: a diabetes diagnosis, 7 single risk factors for type 2 diabetes, and total number of risk factors.

Results Among respondents without diabetes or risk factors for diabetes, 7.4% received low-fat dietary advice; 70.6% of respondents with diabetes received advice. Respondents with diabetes were almost twice as likely to receive advice as respondents without diabetes or its risk factors. As the number of risk factors increased, the likelihood of receiving low-fat dietary advice increased. Although unadjusted advice rates increased during the study period, the likelihood of receiving advice decreased.

Conclusion Although most participants with diabetes received low-fat dietary advice, almost one-third did not. Low-fat dietary advice was more closely associated with the total number of diabetes risk factors than the presence of diabetes. Increasing rates of diabetes and diabetes risk factors are outpacing increases in provision of low-fat dietary advice.


Cardiovascular disease (CVD) is the leading cause of death in the United States.[1] The risk of CVD has been associated with the intake of total fat, saturated fat, and trans fat.[2,3] The American Heart Association (AHA) and the American Diabetes Association (ADA) recommend people with diabetes consume a low-fat diet.[4] The ADA also recommends reduced intake of dietary fat in people at risk for developing type 2 diabetes.[5]

The AHA and ADA recommend dietary counseling because even brief advice by physicians can improve dietary behavior.[6–9] Despite recommendations, dietary counseling is included in less than half of nonacute primary care visits for patients with diabetes and diabetes risk factors.[5,6,10–13]

The role of multimorbidity — multiple concurrent chronic conditions — in guideline-adherent preventive care of diabetes is unclear. Some research suggests worse guideline-adherent preventive care in patients who have multiple chronic conditions because of competing demands.[14–16] Other studies demonstrate the opposite, especially when the multimorbid conditions require similar management.[17–19] A prominent disease cluster is the cardiometabolic disease cluster of diabetes and risk factors for type 2 diabetes; this disease cluster is likely to be associated with higher rates of reported low-fat dietary advice.

The primary objective of this study was to examine rates of receiving low-fat dietary advice from a health professional. We hypothesized that rates are greater among people who have diabetes or risk factors for diabetes than among people with neither diabetes nor its risk factors. The secondary objective was to determine the relationship between having diabetes or risk factors for diabetes and receiving low-fat dietary advice.