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Dietary fats and mortality among patients with type 2 diabetes: analysis in two population based cohort studies.

ABSTRACT: OBJECTIVE:To assess the association of dietary fatty acids with cardiovascular disease mortality and total mortality among patients with type 2 diabetes. DESIGN:Prospective, longitudinal cohort study. SETTING:Health professionals in the United States. PARTICIPANTS:11?264 participants with type 2 diabetes in the Nurses' Health Study (1980-2014) and Health Professionals Follow-Up Study (1986-2014). EXPOSURES:Dietary fat intake assessed using validated food frequency questionnaires and updated every two to four years. MAIN OUTCOME MEASURE:Total and cardiovascular disease mortality during follow-up. RESULTS:During 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 ?-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. CONCLUSIONS:In 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.

SUBMITTER: Jiao J

PROVIDER: S-EPMC6603712 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Dietary fats and mortality among patients with type 2 diabetes: analysis in two population based cohort studies.

Jiao Jingjing J Liu Gang G Shin Hyun Joon HJ Hu Frank B FB Rimm Eric B EB Rexrode Kathryn M KM Manson JoAnn E JE Zong Geng G Sun Qi Q

BMJ (Clinical research ed.) 20190702

<h4>Objective</h4>To assess the association of dietary fatty acids with cardiovascular disease mortality and total mortality among patients with type 2 diabetes.<h4>Design</h4>Prospective, longitudinal cohort study.<h4>Setting</h4>Health professionals in the United States.<h4>Participants</h4>11 264 participants with type 2 diabetes in the Nurses' Health Study (1980-2014) and Health Professionals Follow-Up Study (1986-2014).<h4>Exposures</h4>Dietary fat intake assessed using validated food frequ ...[more]

PMID: 31266749

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Project description:Background: Little is known about the inter-relationship among fruit and vegetable intake, gut microbiota and metabolites, and type 2 diabetes (T2D) in human prospective cohort study. The aim of the present study was to investigate the prospective association of fruit and vegetable intake with human gut microbiota and to examine the relationship between fruit and vegetable-related gut microbiota and their related metabolites with type 2 diabetes (T2D) risk.Methods: This study included 1879 middle-age elderly Chinese adults from Guangzhou Nutrition and Health Study (GNHS). Baseline dietary information was collected using a validated food frequency questionnaire (2008-2013). Fecal samples were collected at follow-up (2015-2019) and analyzed for 16S rRNA sequencing and targeted fecal metabolomics. Blood samples were collected and analyzed for glucose, insulin, and glycated hemoglobin. We used multivariable linear regression and logistic regression models to investigate the prospective associations of fruit and vegetable intake with gut microbiota and the association of the identified gut microbiota (fruit/vegetable-microbiota index) and their related fecal metabolites with T2D risk, respectively. Replications were performed in an independent cohort involving 6626 participants.Results: In the GNHS, dietary fruit intake, but not vegetable, was prospectively associated with gut microbiota diversity and composition. The fruit-microbiota index (FMI, created from 31 identified microbial features) was positively associated with fruit intake (p?<?0.001) and inversely associated with T2D risk (odds ratio (OR) 0.83, 95%CI 0.71-0.97). The FMI-fruit association (p?=?0.003) and the FMI-T2D association (OR 0.90, 95%CI 0.84-0.97) were both successfully replicated in the independent cohort. The FMI-positive associated metabolite sebacic acid was inversely associated with T2D risk (OR 0.67, 95%CI 0.51-0.86). The FMI-negative associated metabolites cholic acid (OR 1.35, 95%CI 1.13-1.62), 3-dehydrocholic acid (OR 1.30, 95%CI 1.09-1.54), oleylcarnitine (OR 1.77, 95%CI 1.45-2.20), linoleylcarnitine (OR 1.66, 95%CI 1.37-2.05), palmitoylcarnitine (OR 1.62, 95%CI 1.33-2.02), and 2-hydroglutaric acid (OR 1.47, 95%CI 1.25-1.72) were positively associated with T2D risk.Conclusions: Higher fruit intake-associated gut microbiota and metabolic alteration were associated with a lower risk of T2D, supporting the public dietary recommendation of adopting high fruit intake for the T2D prevention.

Project description:BackgroundGlucosinolates are a group of phytochemicals that are abundant in cruciferous vegetables and precursors of the potentially chemopreventive isothiocyanates. Isothiocyanates may reduce oxidative stress and inflammation, but little is known regarding the association between glucosinolate intake and risk of type 2 diabetes (T2D).ObjectiveTo evaluate the association between the intake of glucosinolates and the incidence of T2D in US men and women.DesignThis prospective cohort study investigated 200,907 women and men [71,256 women from the Nurses' Health Study (NHS; 1984-2012), 88,293 women from the NHS II (1991-2013), and 41,358 men from the Health Professionals Follow-Up Study (1986-2012)] who were free of diabetes, cardiovascular disease, and cancer at baseline. Diet was assessed using validated semiquantitative food frequency questionnaires. Self-reported T2D incidence was confirmed by a supplementary questionnaire.ResultsDuring follow-up in the 3 cohorts, we accumulated 4,303,750 person-years and 16,567 incident cases of T2D. After adjustment for major lifestyle and dietary risk factors for T2D, participants in the highest quintile of total glucosinolate intake had a 19% higher risk (95% CI: 13%, 25%; Ptrend < 0.001) of T2D than did those in the lowest quintile. The intake of 3 major glucosinolate subtypes was consistently and significantly associated with T2D risk, with pooled HRs ranging from 1.13 to 1.18 (all Ptrend < 0.001). A significant association was also observed between total cruciferous vegetable consumption and T2D (HR: 1.16; 95% CI :1.07, 1.25; Ptrend < 0.001). These associations persisted in subgroups defined by demographic, lifestyle, and other dietary factors.ConclusionsDietary glucosinolate intake was associated with a moderately higher risk of T2D in US adults. These results need to be replicated in further investigations, including biomarker-based studies. Mechanistic research is also needed to understand the relation between exposures to glucosinolates, isothiocyanates, and other metabolites with T2D risk. This trial was registered at clinicaltrials.gov as NCT03366532.

Project description:IMPORTANCE:Previous studies have shown distinct associations between specific dietary fat and cardiovascular disease. However, evidence on specific dietary fat and mortality remains limited and inconsistent. OBJECTIVE:To examine the associations of specific dietary fats with total and cause-specific mortality in 2 large ongoing cohort studies. DESIGN, SETTING, AND PARTICIPANTS:This cohort study investigated 83?349 women from the Nurses' Health Study (July 1, 1980, to June 30, 2012) and 42?884 men from the Health Professionals Follow-up Study (February 1, 1986, to January 31, 2012) who were free of cardiovascular disease, cancer, and types 1 and 2 diabetes at baseline. Dietary fat intake was assessed at baseline and updated every 2 to 4 years. Information on mortality was obtained from systematic searches of the vital records of states and the National Death Index, supplemented by reports from family members or postal authorities. Data were analyzed from September 18, 2014, to March 27, 2016. MAIN OUTCOMES AND MEASURES:Total and cause-specific mortality. RESULTS:During 3?439?954 person-years of follow-up, 33?304 deaths were documented. After adjustment for known and suspected risk factors, dietary total fat compared with total carbohydrates was inversely associated with total mortality (hazard ratio [HR] comparing extreme quintiles, 0.84; 95% CI, 0.81-0.88; P?<?.001 for trend). The HRs of total mortality comparing extreme quintiles of specific dietary fats were 1.08 (95% CI, 1.03-1.14) for saturated fat, 0.81 (95% CI, 0.78-0.84) for polyunsaturated fatty acid (PUFA), 0.89 (95% CI, 0.84-0.94) for monounsaturated fatty acid (MUFA), and 1.13 (95% CI, 1.07-1.18) for trans-fat (P?<?.001 for trend for all). Replacing 5% of energy from saturated fats with equivalent energy from PUFA and MUFA was associated with estimated reductions in total mortality of 27% (HR, 0.73; 95% CI, 0.70-0.77) and 13% (HR, 0.87; 95% CI, 0.82-0.93), respectively. The HR for total mortality comparing extreme quintiles of ?-6 PUFA intake was 0.85 (95% CI, 0.81-0.89; P?<?.001 for trend). Intake of ?-6 PUFA, especially linoleic acid, was inversely associated with mortality owing to most major causes, whereas marine ?-3 PUFA intake was associated with a modestly lower total mortality (HR comparing extreme quintiles, 0.96; 95% CI, 0.93-1.00; P?=?.002 for trend). CONCLUSIONS AND RELEVANCE:Different types of dietary fats have divergent associations with total and cause-specific mortality. These findings support current dietary recommendations to replace saturated fat and trans-fat with unsaturated fats.

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Dietary fats and mortality among patients with type 2 diabetes: analysis in two population based cohort studies.

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Dietary fats and mortality among patients with type 2 diabetes: analysis in two population based cohort studies.

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