Associations of phospholipid fatty acids with incidence of type 2 diabetes: a CARRS nested case-control study Open Access

Abstract

Aims: Higher burden of type 2 diabetes mellitus (T2DM) in South Asians could be explained using biomarkers such as fatty acids (FAs). We aimed to investigate whether certain FA combinations are associated with incidence T2DM in the CARRS study cohorts.

Methods: We employed a nested case-control approach to select participants from CARRS-1 (N diabetes-incident-cases=200, N controls=200 from N=4,017) and CARRS-2 (N diabetes-incident-cases =200, N controls=200 from N=4,802). Participants in both the cohorts were followed up for up to 5-years and incident diabetes cases were ascertained based upon self-report and no-medication use, fasting glucose ≥126mg/dl and HbA1c≥6.5%. Controls were age- and sex-matched individuals who were diabetes-free at baseline and follow-up. In cases and controls, serum phospholipid FAs including polyunsaturated fatty acids (PUFA), monounsaturated fatty acids, total fatty acids, omega-6 FAs, omega-3 FAs, saturated fatty acids (SFA), unsaturated FAs, linoleic acid and docosahexaenoic acid were measured using nuclear magnetic resonance imaging. Principal component (PC) analysis was performed to decompose data from many correlated FA variables into composite variables. First PC with eigen value greater than 1 was chosen to represent and called as FA pattern score which was loaded with PUFA, omega-6 FA, and SFA. The association of FA pattern score was then investigated with incidence of T2DM while adjusting for potential confounders.

Results: We observed a weak protective effect of FA pattern-score in association with incidence of T2DM (OR 0.94, 95% CI 0.88-1.02, p-value: 0.14) after adjusting for potential confounders. This association was strengthened by further adjusting for BMI (OR 0.91, 95% CI 0.83-1.00, p-value: 0.04) and HDL-C and triglycerides (OR 0.88, 95% CI 0.80-0.97, p-value: 0.01). In obesity stratified analysis (BMI < 18.5 kg/m², BMI 18.5 – 24.9 kg/m², BMI ≥25 kg/m²), the protective effect of FA pattern-score in association with incident T2DM was only observed among normal weight participants (OR 0.83, 95% CI 0.72 – 0.97, p-value: 0.016).

Conclusions: Our study demonstrated that an FA pattern-score characterized by a combination of PUFA, omega-6 FAs, and SFA was associated with a lower risk of T2DM in South Asians and this association was more pronounced in normal weight individuals. 

Table of Contents

Introduction 1

Materials and Methods 4

Results 8

Discussion 11

Ethics approval 14

Tables and Figures 15

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology Health Sciences, Medicine and Surgery
Keyword	Fatty acids combination; Type 2 Diabetes; South Asians; fatty acids
Committee Chair / Thesis Advisor	Dr. Mohammed K. Ali, MD, MSc, MBA, Emory University
Committee Members	Dr Shafqat Ahmad, PhD, Uppsala University Sweden
Partnering Agencies	International governmental organization (e.g., Agency for International Development, etc.) Emory University schools, faculty or affiliated programs US (Federal) agency other than CDC

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