Although controversy continues to exist regarding the optimal diet for individuals with diabetes, most health care diabetes specialists use the nutrition recommendations issued by the American Diabetes Association. These latest guidelines (57) specify that protein supply 10 to 20% of total caloric intake, saturated fatty acids less than 10% of total calories, and polyunsaturated fatty acids less than 10% of total calories. Thus, 60 to 70% of total calories remain to be divided between carbohydrate (CHO) and monounsaturated fatty acid (MUFA) intake. The distribution is individualized based on nutritional assessment and treatment goals. Nevertheless, individuals who are at a healthy weight and have normal lipid levels are encouraged to use the nutrition recommendations of the National Cholesterol Education Program, in which individuals over 2 years of age are advised to limit fat intake to <30% of total calories (58,59). The rationale for these recommendations is the desire to lower saturated fat and cholesterol intake to reduce cardiovascular risk (60), and this is often difficult to achieve in a "typical" diet without lowering total fat intake. Most standard enteral formulas now available comply with these recommendations. However, tube feeding or dietary supplementation with standard liquid medical nutritional products can compromise the metabolic control of patients with abnormal glucose tolerance. This occurs because rapid gastric emptying of liquid formulas and efficient absorption of nutrients supplied by these products result in a rapid elevation of blood glucose. Standard enteral formulas empty from the stomach at least twice as fast as an isocaloric solid-food meal (61) and have been shown to produce a peak blood glucose response equivalent to that seen when an equivalent solution of pure glucose is fed (62). Rapid gastric emptying of formulas and rapid absorption of nutrients can complicate metabolic control of hyperglycemic patients. A number of clinical studies have shown that high-carbohydrate, low-fat diets may be inappropriate for many patients with diabetes (6365). Moreover, recent research has demonstrated that substitution of MUFA for CHO can significantly improve gly-cemic control, lower serum triglycerides, and maintain or increase high density lipoprotein (HDL)-cholesterol, and raise the HDL-cholesterol to low density lipoprotein (LDL)-cholesterol ratio (66-68). Therefore, carbohydrate-reduced, high-monounsaturated fat formula seems a reasonable choice for patients with abnormal glucose tolerance.

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