The EURODIAB IDDM Complications Study, a cross-sectional, clinic-based study examined the fat and cholesterol intakes of European individuals with type 1 diabetes for possible relations to serum lipid levels (total cholesterol, HDL- and LDL-cholesterol, fasting triglycerides) and to the prevalence of cardiovascular disease (past history or electrocardiogram abnormalities). Fat intake (total fat, saturated fat, cholesterol) from 2,868 subjects with type 1 diabetes (mean age 32.9 +/- 10.2 years (range: 14-61 years), mean diabetes duration 14.7 +/- 9.4 years (range: 1-56 years)) was assessed by a standardized 3-day dietary record at the Nutrition Co-Ordinating Centre (Düsseldorf). Serum lipid levels were determined in the central laboratory (London) by standard enzymatic methods. Energy-adjusted total and LDL-cholesterol levels increased significantly with higher intakes of total fat, saturated fat and cholesterol. However, these relations were largely explained by concomitant decreases in dietary fibre intake. For levels of HDL-cholesterol and triglycerides no independent associations were observed with fat or cholesterol intake. Increased intakes of total fat, saturated fat and cholesterol were also related to higher prevalences of cardiovascular disease. These associations were, however, no longer significant after adjustment for dietary fibre intake for which we previously demonstrated independent associations with the serum cholesterol pattern and CVD. Since higher fat intakes are commonly accompanied by lower carbohydrate and fibre intakes we conclude that restricted intakes of cholesterol, saturated fat and total fat combined with higher fibre intakes beneficially affect both the levels of total and LDL-cholesterol and the risk for cardiovascular disease in European individuals with type 1 diabetes.