Is There a Role for Conjugated Linoleic Acid to Aid in the Prevention of Type 2 Diabetes?

AbstractObjectiveTo assess the association of dietary fatty acids with cardiovascular disease mortality and total mortality among patients with type 2 diabetes.DesignProspective, longitudinal cohort study.SettingHealth professionals in the United States.Participants11 264 participants with type 2 diabetes in the Nurses’ Health Study (1980-2014) and Health Professionals Follow-Up Study (1986-2014).ExposuresDietary fat intake assessed using validated food frequency questionnaires and updated every two to four years.Main outcome measureTotal and cardiovascular disease mortality during follow-up.ResultsDuring follow-up, 2502 deaths including 646 deaths due to cardiovascular disease were documented. After multivariate adjustment, intake of polyunsaturated fatty acids (PUFAs) was associated with a lower cardiovascular disease mortality, compared with total carbohydrates: hazard ratios comparing the highest with the lowest quarter were 0.76 (95% confidence interval 0.58 to 0.99; P for trend=0.03) for total PUFAs, 0.69 (0.52 to 0.90; P=0.007) for marine n-3 PUFAs, 1.13 (0.85 to 1.51) for α-linolenic acid, and 0.75 (0.56 to 1.01) for linoleic acid. Inverse associations with total mortality were also observed for intakes of total PUFAs, n-3 PUFAs, and linoleic acid, whereas monounsaturated fatty acids of animal, but not plant, origin were associated with a higher total mortality. In models that examined the theoretical effects of substituting PUFAs for other fats, isocalorically replacing 2% of energy from saturated fatty acids with total PUFAs or linoleic acid was associated with 13% (hazard ratio 0.87, 0.77 to 0.99) or 15% (0.85, 0.73 to 0.99) lower cardiovascular disease mortality, respectively. A 2% replacement of energy from saturated fatty acids with total PUFAs was associated with 12% (hazard ratio 0.88, 0.83 to 0.94) lower total mortality.ConclusionsIn patients with type 2 diabetes, higher intake of PUFAs, in comparison with carbohydrates or saturated fatty acids, is associated with lower total mortality and cardiovascular disease mortality. These findings highlight the important role of quality of dietary fat in the prevention of cardiovascular disease and total mortality among adults with type 2 diabetes.

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Abstract MP42: Dietary Linoleic Acid Intake Is Inversely Associated With Type 2 Diabetes Risk In Three Large Prospective Cohort Studies Of U.s. Men And Women.

Circulation ◽

10.1161/circ.137.suppl_1.mp42 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Geng Zong ◽

Gang Liu ◽

Anne J Wanders ◽

Marjan Alssema ◽

Peter L Zock ◽

...

Keyword(s):

Type 2 Diabetes ◽

Fatty Acids ◽

Linoleic Acid ◽

Total Energy ◽

Disease Incidence ◽

Self Report ◽

Health Study ◽

Refined Carbohydrates

Introduction: Recent studies reported inverse associations between circulating levels of n-6 polyunsaturated fatty acids (PUFAs) and type 2 diabetes (T2D) risk, although whether intake of these fatty acids is associated T2D risk remains to be elucidated. Hypothesis: We examined the hypothesis that long-term intake of n-6 PUFAs, especially linoleic acid (LA), is associated with lower T2D risk. Methods: Diet was assessed using validated food-frequency questionnaires every 4 years in women participating in Nurses' Health Study (NHS, n=83,648) and NHSII (n=88,610), and men participating in the Health Professionals Follow-Up Study (n=41,771). Incident T2D was identified by self-report and confirmed by a supplemental questionnaire. Results: N-6 PUFAs accounted for 4.7-6.8% total energy on average, and 98% of n-6 PUFA intake was from LA. We identified 18,442 T2D cases during 4.93 million person-years of follow-up. In multivariate-adjusted models, HRs (95%CIs) of T2D comparing extreme quintiles (high vs low) were 0.92 (0.88, 0.97; P trend =0.01) for LA intake, and 1.14 (1.08, 1.20; P trend <0.001) for arachidonic acid (AA) intake. It was further estimated that T2D risk were 6% lower when SFAs (2% of total energy) were iso-calorically replaced by LA intake ( table below). For each 2% energy from LA intake, T2D risk was 17% lower for iso-calorically replacing trans fats, and 4% lower for iso-calorically replacing total carbohydrates, and refined carbohydrates (All P values <0.05). These findings remained after adjusting for baseline BMI instead updated BMI, further adjusting for incident hypertension and hypercholesterolemia, or placing a 4-year lag between dietary assessments and disease incidence. Conclusion: Higher LA consumption is associated with a lower T2D risk, especially when substituting for SFAs, trans fats, or refined carbohydrates. AA mainly comes from poultry and meats, and is associated with higher T2D risk.

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