Fasting Plasma Free Fatty Acids and Risk of Type 2 Diabetes

The Atherosclerosis Risk in Communities study

  1. James S. Pankow, PHD1,
  2. Bruce B. Duncan, MD, PHD2,
  3. Maria Inês Schmidt, MD, PHD2,
  4. Christie M. Ballantyne, MD3,
  5. David J. Couper, PHD4,
  6. Ron C. Hoogeveen, PHD3 and
  7. Sherita H. Golden, MD5
  1. 1Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota
  2. 2Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil, and the Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina
  3. 3Department of Medicine, Baylor College of Medicine, Houston, Texas
  4. 4Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, North Carolina
  5. 5Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
  1. Address correspondence and reprint requests to James S. Pankow, Division of Epidemiology, University of Minnesota, 1300 South Second St., Suite 300, Minneapolis, MN 55454. E-mail: pankow{at}epi.umn.edu

Abstract

OBJECTIVE—To evaluate whether plasma levels of free fatty acids (FFAs) are independently associated with incidence of type 2 diabetes.

RESEARCH DESIGN AND METHODS—A case-cohort design was used to randomly select 580 incident cases of diabetes and 566 noncases from 10,275 African-American and white men and women in the Atherosclerosis Risk in Communities study, aged 45–64 years and without prevalent diabetes at the baseline exam. Incident diabetes was ascertained at three exams over 9 years of follow-up. FFA levels were measured in plasma samples collected at the baseline exam.

RESULTS—At baseline, FFA level was inversely associated with height and positively associated with female sex, BMI, waist circumference, waist-to-hip ratio, heart rate, plasma triglycerides, and an inflammation score quantifying levels of six systemic inflammation markers. Relative risks for incident diabetes (fourth vs. first quartile of FFAs) were increased in a basic model adjusted for age, sex, race, and center (hazard ratio 1.68, 95% CI 1.20–2.34) and in a model further adjusted for baseline fasting glucose, insulin, BMI, waist circumference, triglycerides, and the inflammation score (1.63, 1.04–2.57). Relative risks associated with a greater FFA level were lowest among those of normal weight and highest among the obese, but a formal test of interaction between FFAs and BMI was not statistically significant.

CONCLUSIONS—Individuals with higher fasting levels of plasma FFAs were at modestly higher risk of type 2 diabetes in this cohort of middle-aged adults.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted September 15, 2003.
    • Received July 11, 2003.
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  1. doi: 10.2337/diacare.27.1.77 Diabetes Care January 2004 vol. 27 no. 1 77-82
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