PLoS Medicine (Oct 2017)

A combination of plasma phospholipid fatty acids and its association with incidence of type 2 diabetes: The EPIC-InterAct case-cohort study.

  • Fumiaki Imamura,
  • Stephen J Sharp,
  • Albert Koulman,
  • Matthias B Schulze,
  • Janine Kröger,
  • Julian L Griffin,
  • José M Huerta,
  • Marcela Guevara,
  • Ivonne Sluijs,
  • Antonio Agudo,
  • Eva Ardanaz,
  • Beverley Balkau,
  • Heiner Boeing,
  • Veronique Chajes,
  • Christina C Dahm,
  • Courtney Dow,
  • Guy Fagherazzi,
  • Edith J M Feskens,
  • Paul W Franks,
  • Diana Gavrila,
  • Marc Gunter,
  • Rudolf Kaaks,
  • Timothy J Key,
  • Kay-Tee Khaw,
  • Tilman Kühn,
  • Olle Melander,
  • Elena Molina-Portillo,
  • Peter M Nilsson,
  • Anja Olsen,
  • Kim Overvad,
  • Domenico Palli,
  • Salvatore Panico,
  • Olov Rolandsson,
  • Sabina Sieri,
  • Carlotta Sacerdote,
  • Nadia Slimani,
  • Annemieke M W Spijkerman,
  • Anne Tjønneland,
  • Rosario Tumino,
  • Yvonne T van der Schouw,
  • Claudia Langenberg,
  • Elio Riboli,
  • Nita G Forouhi,
  • Nick J Wareham

DOI
https://doi.org/10.1371/journal.pmed.1002409
Journal volume & issue
Vol. 14, no. 10
p. e1002409

Abstract

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BackgroundCombinations of multiple fatty acids may influence cardiometabolic risk more than single fatty acids. The association of a combination of fatty acids with incident type 2 diabetes (T2D) has not been evaluated.Methods and findingsWe measured plasma phospholipid fatty acids by gas chromatography in 27,296 adults, including 12,132 incident cases of T2D, over the follow-up period between baseline (1991-1998) and 31 December 2007 in 8 European countries in EPIC-InterAct, a nested case-cohort study. The first principal component derived by principal component analysis of 27 individual fatty acids (mole percentage) was the main exposure (subsequently called the fatty acid pattern score [FA-pattern score]). The FA-pattern score was partly characterised by high concentrations of linoleic acid, stearic acid, odd-chain fatty acids, and very-long-chain saturated fatty acids and low concentrations of γ-linolenic acid, palmitic acid, and long-chain monounsaturated fatty acids, and it explained 16.1% of the overall variability of the 27 fatty acids. Based on country-specific Prentice-weighted Cox regression and random-effects meta-analysis, the FA-pattern score was associated with lower incident T2D. Comparing the top to the bottom fifth of the score, the hazard ratio of incident T2D was 0.23 (95% CI 0.19-0.29) adjusted for potential confounders and 0.37 (95% CI 0.27-0.50) further adjusted for metabolic risk factors. The association changed little after adjustment for individual fatty acids or fatty acid subclasses. In cross-sectional analyses relating the FA-pattern score to metabolic, genetic, and dietary factors, the FA-pattern score was inversely associated with adiposity, triglycerides, liver enzymes, C-reactive protein, a genetic score representing insulin resistance, and dietary intakes of soft drinks and alcohol and was positively associated with high-density-lipoprotein cholesterol and intakes of polyunsaturated fat, dietary fibre, and coffee (p ConclusionsA combination of individual fatty acids, characterised by high concentrations of linoleic acid, odd-chain fatty acids, and very long-chain fatty acids, was associated with lower incidence of T2D. The specific fatty acid pattern may be influenced by metabolic, genetic, and dietary factors.