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BACKGROUND: Although treatment targets for the consumption of dietary fat in patients with type 2 diabetes mellitus are well accepted, little is known about the actual fat consumption by newly diagnosed patients or the dietary adjustments that they make in the following years. AIMS: To measure fat intake in patients with type 2 diabetes in general practice at diagnosis, shortly after dietary consultation, and after 4 years. DESIGN OF STUDY: A prospective cohort study. SETTING: Thirty-three general practices in The Netherlands. METHOD: One hundred and forty-four patients with newly diagnosed type 2 diabetes were referred to a dietician, and fat consumption (the main outcome measure) was assessed with a 104-item food frequency questionnaire at diagnosis, 8 weeks following diagnosis, and after 4 years. Reference values for fat consumption were obtained from an age-matched sample of a population-based survey. RESULTS: At diagnosis, total energy intake was 10.6 MJ/day and cholesterol intake was 300 mg/day. Total fat consumption was 40.9% of energy intake, with saturated fatty acids 15.0%, monounsaturated fatty acids 14.3%, and polyunsaturated fatty acids 9.2% of energy intake. All levels, except for polyunsaturated fatty acids, were significantly unfavourable compared with those for the general population. After 8 weeks, consumption of saturated fatty acids had decreased to a lower level than in the general population and all other levels measured were similar to those for the general population. After 4 years there was a slight increase in the consumption of total fat and monounsaturated fatty acids, but cholesterol and saturated fatty acid consumption had decreased further. CONCLUSIONS: Patients with newly diagnosed type 2 diabetes have an unfavourable fat consumption at diagnosis. They adapt to a more desirable consumption shortly after diagnosis, and this improved dietary behaviour is sustained for 4 years. Recommendations regarding consumption of total and saturated fat are, in contrast to those for cholesterol, not met by patients in general practice.