Authors

Jason H Y Wu, University of New South Wales
Matti Marklund, Uppsala Universitet
Fumiaki Imamura, University of Cambridge
Nathan L. TintleFollow
Andres V Ardisson Korat, Harvard T. H. Chan School of Public Health
Janette de Goede, Wageningen University
Xia Zhou, University of Minnesota - Twin Cities
Wei-Sin Yang, National Taiwan University
Marcia C de Oliveira Otto, University of Texas Health at Houston
Janine Kroger, German Institute of Human Nutrition
Waqas Qureshi, Wake Forest University
Jyrki K. Virtanen, University of Eastern Finland
Julie K. Bassett, Cancer Council Victoria
Alexis C. Frazier-Wood, Children's Nutrition Research Center
Maria Lankinen, University of Eastern Finland
Rachel A. Murphy, University of British Columbia
Kalina Rajaobelina, University of Bordeaux
Liana C. Del Gobbo, Stanford University School of Medicine
Nita G. Forouhi, University of Cambridge
Robert Luben, University of Cambridge
Kay-Tee Khaw, University of Cambridge
Nick Wareham, University of Cambridge
Anya Kalsbeek, Dordt College
Jenna Veenstra, Dordt College
Juhua Luo, Indiana University - Bloomington
Frank B. Hu, Harvard T. H. Chan School of Public Health
Hung-Ju Lin, National Taiwan University Hospital
David S. Siscovick, The New York Academy of Medicine
Heiner Boeing, German Institute of Human Nutrition
Tzu-An Chen, Children's Nutrition Research Center
Brian Steffen, University of Minnesota - Twin Cities
Lyn M. Steffen, University of Minnesota - Twin Cities
Allison Hodge, Cancer Council Victoria
Gudny Eriksdottir, Icelandic Heart Institute
Albert V. Smith, Icelandic Heart Institute
Vilmunder Gudnason, Icelandic Heart Institute
Tamara B. Harris, National Institute on Aging
Ingeborg A. Brouwer, Vrije University
Claudine Berr, Montpellier University
Catherine Helmer, University of Bordeaux
Cecilia Samieri, University of Bordeaux
Markku Laakso, University of Eastern Finland
Michael Y. Tsai, University of Minnesota - Twin Cities
Graham G. Giles, Cancer Council Victoria
Tarja Nurmi, University of Eastern Finland
Lynne Wagenknecht, Wake Forest University
Matthias B. Schulze, German Institute of Human Nutrition
Rozenn N. Lemaitre, University of Washington - Seattle Campus
Kuo-Liong Chien, National Taiwan University Hospital
Sabita S. Soedamah-Muthu, Wageningen University
Johanna M. Geleijnse, Wageningen University
Qi Sun, Harvard T. H. Chan School of Public Health
William S. Harris, University of Sioux Dakota
Lars Lind, Uppsala University
Johan Arnlov, Karolinska Institute
Ulf Riserus, Uppsala University
Renata Micha, Tufts University
Dariush Mozaffairian, Tufts University

Document Type

Article

Publication Date

10-11-2017

Department

Mathematics, Statistics, and Computer Science

Keywords

fatty acids, omega-6, biochemical biomarkers, diabetes, cohort analysis

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/m(2), 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; I(2)=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; I(2)=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.

Comments

Access article on publisher's site:

ttp://dx.doi.org/10.1016/S2213-8587(17)30307-8

Source Publication Title

The Lancet Diabetes & Endocrinology

Publisher

Elsevier

Volume

5

Issue

10

DOI

10.1016/S2213-8587(17)30307-8

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