Association of Plasma Phospholipid n-3 and n-6 Polyunsaturated Fatty Acids with Type 2 Diabetes: The EPIC-InterAct Case-Cohort Study

N. G. Forouhi, F. Imamura, S. J. Sharp, A. Koulman, M. B. Schulze, I. Sluijs, M. Guevara, J. M. Huerta, J. Kroger, K. Summerhill, E. J. Feskens, A. Affret, P. Amiano, H. Boeing, C. Dow, G. Fagherazzi, P. W. Franks, C. Gonzalez, R. Kaaks, T. J. KeyK. T. Khaw, T. Kuhn, L. M. Mortensen, P. M. Nilsson, K. Overvad, V. Pala, D. Palli, S. Panico, J. R. Quiros, M. Rodriguez-Barranco, O. Rolandsson, C. Sacerdote, A. Scalbert, N. Slimani, A. M. Spijkerman, A. Tjonneland, M. J. Tormo, R. Tumino, A. Dl van der, Y. T. van der Schouw, C. Langenberg, E. Riboli, N. J. Wareham

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Abstract

Background:
Whether and how n-3 and n-6 polyunsaturated fatty acids (PUFAs) are related to type 2 diabetes (T2D) is debated. Objectively measured plasma PUFAs can help to clarify these
associations.
Methods and Findings:
Plasma phospholipid PUFAs were measured by gas chromatography among 12,132 incident T2D cases and 15,919 subcohort participants in the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study across eight European countries.
Country-specific hazard ratios (HRs) were estimated using Prentice-weighted Cox regression and pooled by random-effects meta-analysis. We also systematically reviewed published prospective studies on circulating PUFAs and T2D risk and pooled the quantitative
evidence for comparison with results from EPIC-InterAct. In EPIC-InterAct, among longchain n-3 PUFAs, α-linolenic acid (ALA) was inversely associated with T2D (HR per standard deviation [SD] 0.93; 95% CI 0.88–0.98), but eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were not significantly associated. Among n-6 PUFAs, linoleic acid
(LA) (0.80; 95% CI 0.77–0.83) and eicosadienoic acid (EDA) (0.89; 95% CI 0.85–0.94)
were inversely related, and arachidonic acid (AA) was not significantly associated, while
significant positive associations were observed with γ-linolenic acid (GLA), dihomo-GLA,
docosatetraenoic acid (DTA), and docosapentaenoic acid (n6-DPA), with HRs between
1.13 to 1.46 per SD. These findings from EPIC-InterAct were broadly similar to comparative
findings from summary estimates from up to nine studies including between 71 to 2,499
T2D cases. Limitations included potential residual confounding and the inability to distinguish between dietary and metabolic influences on plasma phospholipid PUFAs.
Conclusions:
These large-scale findings suggest an important inverse association of circulating plant-origin n-3 PUFA (ALA) but no convincing association of marine-derived n3 PUFAs (EPA and
DHA) with T2D. Moreover, they highlight that the most abundant n6-PUFA (LA) is inversely
associated with T2D. The detection of associations with previously less well-investigated
PUFAs points to the importance of considering individual fatty acids rather than focusing on
fatty acid class.
Original languageUndefined/Unknown
Article numbere1002094
Number of pages17
JournalPLoS Medicine
Volume13
Issue number7
DOIs
Publication statusPublished - 19 Jul 2016

Cite this

Forouhi, N. G., Imamura, F., Sharp, S. J., Koulman, A., Schulze, M. B., Sluijs, I., Guevara, M., Huerta, J. M., Kroger, J., Summerhill, K., Feskens, E. J., Affret, A., Amiano, P., Boeing, H., Dow, C., Fagherazzi, G., Franks, P. W., Gonzalez, C., Kaaks, R., ... Wareham, N. J. (2016). Association of Plasma Phospholipid n-3 and n-6 Polyunsaturated Fatty Acids with Type 2 Diabetes: The EPIC-InterAct Case-Cohort Study. PLoS Medicine, 13(7), [e1002094]. https://doi.org/10.1371/journal.pmed.1002094