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Lancet Diabetes Endocrinol. 2014 Oct;2(10):810-8. doi: 10.1016/S2213-8587(14)70146-9. Epub 2014 Aug 5.

Differences in the prospective association between individual plasma phospholipid saturated fatty acids and incident type 2 diabetes: the EPIC-InterAct case-cohort study.

Author information

1
MRC Epidemiology Unit, University of Cambridge, Cambridge, UK. Electronic address: nita.forouhi@mrc-epid.cam.ac.uk.
2
MRC Human Nutrition Research, Cambridge, UK.
3
MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
4
German Institute of Human Nutrition Potsdam-Rehbruecke, Potsdam, Germany.
5
Nuffield Department of Medicine, University of Oxford, Oxford, UK.
6
Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Murcia, Spain.
7
CIBER Epidemiología y Salud Pública (CIBERESP), Murcia, Spain; Navarre Public Health Institute (ISPN), Pamplona, Spain.
8
University Medical Center Utrecht, Utrecht, Netherlands.
9
Wageningen University, Wageningen, Netherlands.
10
CIBER Epidemiología y Salud Pública (CIBERESP), Murcia, Spain; Public Health Division of Gipuzkoa, San Sebastian, Spain; Instituto BIO-Donostia, Basque Government, San Sebastian, Spain.
11
Inserm, CESP, U1018, Villejuif, France; Univ Paris-Sud, UMRS 1018, Villejuif, France; Gustave Roussy Institute, F-94800 Villejuif, France.
12
Lund University, Malmö, Sweden; Umeå University, Umeå, Sweden.
13
Catalan Institute of Oncology (ICO), Barcelona, Spain.
14
Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.
15
German Cancer Research Centre (DKFZ), Heidelberg, Germany.
16
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
17
Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
18
Lund University, Malmö, Sweden.
19
Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark; Aalborg University Hospital, Aalborg, Denmark.
20
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
21
Cancer Research and Prevention Institute (ISPO), Florence, Italy.
22
Public Health Directorate, Asturias, Spain.
23
Umeå University, Umeå, Sweden.
24
Danish Cancer Society, Copenhagen, Denmark.
25
Unit of Cancer Epidemiology, Citta' della Salute e della Scienza Hospital-University of Turin and Centre for Cancer Prevention (CPO), Turin, Italy; Human Genetics Foundation (HuGeF), Turin, Italy.
26
CIBER Epidemiología y Salud Pública (CIBERESP), Murcia, Spain; Andalusian School of Public Health, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Granada.ibs), Granada, Spain.
27
International Agency for Research on Cancer, Lyon, France.
28
National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
29
Danish Cancer Society Research Center, Copenhagen, Denmark.
30
Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Murcia, Spain; Department of Health and Social Sciences, Universidad de Murcia, Spain.
31
Associazione Italiana Registri Tumori, Dipartimento di Prevenzione Medica, Azienda Sanitaria Provinciale, Ragusa, Italy; Aire Onlus, Ragusa, Italy.
32
School of Public Health, Imperial College London, London, UK.

Abstract

BACKGROUND:

Conflicting evidence exists regarding the association between saturated fatty acids (SFAs) and type 2 diabetes. In this longitudinal case-cohort study, we aimed to investigate the prospective associations between objectively measured individual plasma phospholipid SFAs and incident type 2 diabetes in EPIC-InterAct participants.

METHODS:

The EPIC-InterAct case-cohort study includes 12,403 people with incident type 2 diabetes and a representative subcohort of 16,154 individuals who were selected from a cohort of 340.234 European participants with 3·99 million person-years of follow-up (the EPIC study). Incident type 2 diabetes was ascertained until Dec 31, 2007, by a review of several sources of evidence. Gas chromatography was used to measure the distribution of fatty acids in plasma phospholipids (mol%); samples from people with type 2 diabetes and subcohort participants were processed in a random order by centre, and laboratory staff were masked to participant characteristics. We estimated country-specific hazard ratios (HRs) for associations per SD of each SFA with incident type 2 diabetes using Prentice-weighted Cox regression, which is weighted for case-cohort sampling, and pooled our findings using random-effects meta-analysis.

FINDINGS:

SFAs accounted for 46% of total plasma phospholipid fatty acids. In adjusted analyses, different individual SFAs were associated with incident type 2 diabetes in opposing directions. Even-chain SFAs that were measured (14:0 [myristic acid], 16:0 [palmitic acid], and 18:0 [stearic acid]) were positively associated with incident type 2 diabetes (HR [95% CI] per SD difference: myristic acid 1·15 [95% CI 1·09-1·22], palmitic acid 1·26 [1·15-1·37], and stearic acid 1·06 [1·00-1·13]). By contrast, measured odd-chain SFAs (15:0 [pentadecanoic acid] and 17:0 [heptadecanoic acid]) were inversely associated with incident type 2 diabetes (HR [95% CI] per 1 SD difference: 0·79 [0·73-0·85] for pentadecanoic acid and 0·67 [0·63-0·71] for heptadecanoic acid), as were measured longer-chain SFAs (20:0 [arachidic acid], 22:0 [behenic acid], 23:0 [tricosanoic acid], and 24:0 [lignoceric acid]), with HRs ranging from 0·72 to 0·81 (95% CIs ranging between 0·61 and 0·92). Our findings were robust to a range of sensitivity analyses.

INTERPRETATION:

Different individual plasma phospholipid SFAs were associated with incident type 2 diabetes in opposite directions, which suggests that SFAs are not homogeneous in their effects. Our findings emphasise the importance of the recognition of subtypes of these fatty acids. An improved understanding of differences in sources of individual SFAs from dietary intake versus endogenous metabolism is needed.

FUNDING:

EU FP6 programme, Medical Research Council Epidemiology Unit, Medical Research Council Human Nutrition Research, and Cambridge Lipidomics Biomarker Research Initiative.

PMID:
25107467
PMCID:
PMC4196248
DOI:
10.1016/S2213-8587(14)70146-9
[Indexed for MEDLINE]
Free PMC Article

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