Omega-6 fatty acid biomarkers and incident type 2 diabetes: pooled analysis of individual-level data for 39 740 adults from 20 prospective cohort studies
Journal
The Lancet Diabetes and Endocrinology
Journal Volume
5
Journal Issue
12
Pages
965-974
Date Issued
2017
Author(s)
Marklund M.
Imamura F.
Tintle N.
Ardisson Korat A.V.
de Goede J.
Zhou X.
Yang W.-S.
de Oliveira Otto M.C.
Kröger J.
Qureshi W.
Virtanen J.K.
Bassett J.K.
Frazier-Wood A.C.
Lankinen M.
Murphy R.A.
Rajaobelina K.
Del Gobbo L.C.
Forouhi N.G.
Luben R.
Khaw K.-T.
Wareham N.
Kalsbeek A.
Veenstra J.
Luo J.
Hu F.B.
Siscovick D.S.
Boeing H.
Chen T.-A.
Steffen B.
Steffen L.M.
Hodge A.
Eriksdottir G.
Smith A.V.
Gudnason V.
Harris T.B.
Brouwer I.A.
Berr C.
Helmer C.
Samieri C.
Laakso M.
Tsai M.Y.
Giles G.G.
Nurmi T.
Wagenknecht L.
Schulze M.B.
Lemaitre R.N.
Chien K.-L.
Soedamah-Muthu S.S.
Geleijnse J.M.
Sun Q.
Harris W.S.
Lind L.
Ärnlöv J.
Riserus U.
Micha R.
Mozaffarian D.
Cohorts for Heart
Aging Research in Genomic Epidemiology (CHARGE) Fatty Acids
Outcomes Research Consortium (FORCE)
Abstract
Background The metabolic effects of omega-6 polyunsaturated fatty acids (PUFAs) remain contentious, and little evidence is available regarding their potential role in primary prevention of type 2 diabetes. We aimed to assess the associations of linoleic acid and arachidonic acid biomarkers with incident type 2 diabetes. Methods We did a pooled analysis of new, harmonised, individual-level analyses for the biomarkers linoleic acid and its metabolite arachidonic acid and incident type 2 diabetes. We analysed data from 20 prospective cohort studies from ten countries (Iceland, the Netherlands, the USA, Taiwan, the UK, Germany, Finland, Australia, Sweden, and France), with biomarkers sampled between 1970 and 2010. Participants included in the analyses were aged 18 years or older and had data available for linoleic acid and arachidonic acid biomarkers at baseline. We excluded participants with type 2 diabetes at baseline. The main outcome was the association between omega-6 PUFA biomarkers and incident type 2 diabetes. We assessed the relative risk of type 2 diabetes prospectively for each cohort and lipid compartment separately using a prespecified analytic plan for exposures, covariates, effect modifiers, and analysis, and the findings were then pooled using inverse-variance weighted meta-analysis. Findings Participants were 39 740 adults, aged (range of cohort means) 49–76 years with a BMI (range of cohort means) of 23·3–28·4 kg/m2, who did not have type 2 diabetes at baseline. During a follow-up of 366 073 person-years, we identified 4347 cases of incident type 2 diabetes. In multivariable-adjusted pooled analyses, higher proportions of linoleic acid biomarkers as percentages of total fatty acid were associated with a lower risk of type 2 diabetes overall (risk ratio [RR] per interquintile range 0·65, 95% CI 0·60–0·72, p<0·0001; I2=53·9%, pheterogeneity=0·002). The associations between linoleic acid biomarkers and type 2 diabetes were generally similar in different lipid compartments, including phospholipids, plasma, cholesterol esters, and adipose tissue. Levels of arachidonic acid biomarker were not significantly associated with type 2 diabetes risk overall (RR per interquintile range 0·96, 95% CI 0·88–1·05; p=0·38; I2=63·0%, pheterogeneity<0·0001). The associations between linoleic acid and arachidonic acid biomarkers and the risk of type 2 diabetes were not significantly modified by any prespecified potential sources of heterogeneity (ie, age, BMI, sex, race, aspirin use, omega-3 PUFA levels, or variants of the FADS gene; all pheterogeneity?0·13). Interpretation Findings suggest that linoleic acid has long-term benefits for the prevention of type 2 diabetes and that arachidonic acid is not harmful. Funding Funders are shown in the appendix. ? 2017 Elsevier Ltd
SDGs
Other Subjects
acetylsalicylic acid; arachidonic acid; biological marker; cholesterol ester; linoleic acid; lipid; omega 6 fatty acid; phospholipid; arachidonic acid; biological marker; linoleic acid; omega 6 fatty acid; adipose tissue; adult; age; aged; Article; Australia; body mass; cardiometabolic risk; case control study; cohort analysis; controlled study; FADS gene; female; Finland; follow up; France; gene; genetic variability; Germany; human; Iceland; male; Netherlands; non insulin dependent diabetes mellitus; priority journal; prospective study; race; sex; Sweden; Taiwan; United Kingdom; United States; blood; incidence; meta analysis; non insulin dependent diabetes mellitus; procedures; risk factor; statistics; Adult; Arachidonic Acid; Biomarkers; Cohort Studies; Diabetes Mellitus, Type 2; Fatty Acids, Omega-6; Humans; Incidence; Linoleic Acid; Prospective Studies; Risk Factors; Statistics as Topic
Publisher
Lancet Publishing Group
Type
journal article