Differences in the prospective association between individual plasma phospholipid saturated fatty acids and incident type 2 diabetes: the EPIC-InterAct case-cohort study
Open accessAbstract
BACKGROUND: Conflicting evidence exists regarding the association between saturated fatty acids (SFAs) and type 2 diabetes. In this longitudinal case-cohort study, we aimed to investigate the prospective associations between objectively measured individual plasma phospholipid SFAs and incident type 2 diabetes in EPIC-InterAct participants. METHODS: The EPIC-InterAct case-cohort study includes 12,403 people with incident type 2 diabetes and a representative subcohort of 16,154 individuals who were selected from a cohort of 340.234 European participants with 3·99 million person-years of follow-up (the EPIC study). Incident type 2 diabetes was ascertained until Dec 31, 2007, by a review of several sources of evidence. Gas chromatography was used to measure the distribution of fatty acids in plasma phospholipids (mol%); samples from people with type 2 diabetes and subcohort participants were processed in a random order by centre, and laboratory staff were masked to participant characteristics. We estimated country-specific hazard ratios (HRs) for associations per SD of each SFA with incident type 2 diabetes using Prentice-weighted Cox regression, which is weighted for case-cohort sampling, and pooled our findings using random-effects meta-analysis. FINDINGS: SFAs accounted for 46% of total plasma phospholipid fatty acids. In adjusted analyses, different individual SFAs were associated with incident type 2 diabetes in opposing directions. Even-chain SFAs that were measured (14:0 [myristic acid], 16:0 [palmitic acid], and 18:0 [stearic acid]) were positively associated with incident type 2 diabetes (HR [95% CI] per SD difference: myristic acid 1·15 [95% CI 1·09-1·22], palmitic acid 1·26 [1·15-1·37], and stearic acid 1·06 [1·00-1·13]). By contrast, measured odd-chain SFAs (15:0 [pentadecanoic acid] and 17:0 [heptadecanoic acid]) were inversely associated with incident type 2 diabetes (HR [95% CI] per 1 SD difference: 0·79 [0·73-0·85] for pentadecanoic acid and 0·67 [0·63-0·71] for heptadecanoic acid), as were measured longer-chain SFAs (20:0 [arachidic acid], 22:0 [behenic acid], 23:0 [tricosanoic acid], and 24:0 [lignoceric acid]), with HRs ranging from 0·72 to 0·81 (95% CIs ranging between 0·61 and 0·92). Our findings were robust to a range of sensitivity analyses. INTERPRETATION: Different individual plasma phospholipid SFAs were associated with incident type 2 diabetes in opposite directions, which suggests that SFAs are not homogeneous in their effects. Our findings emphasise the importance of the recognition of subtypes of these fatty acids. An improved understanding of differences in sources of individual SFAs from dietary intake versus endogenous metabolism is needed. FUNDING: EU FP6 programme, Medical Research Council Epidemiology Unit, Medical Research Council Human Nutrition Research, and Cambridge Lipidomics Biomarker Research Initiative.
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Dairy fat may have potential benefits for diabetes.
“that dairy fat may have potential benefits for diabetes;59-61”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [61]
In cohorts utilizing objective blood biomarkers, greater dairy fat consumption is associated with lower incidence of diabetes and CHD, with mixed findings for stroke.
“In cohorts utilizing objective blood biomarkers, greater dairy fat consumption is associated with lower incidence of diabetes59-61, 242, 243 and CHD,39, 244, 245 with mixed findings for stroke.246”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [61]
Saturated fat represents a highly heterogeneous category, with fatty acid chain lengths ranging from 6 to 24 carbons, deriving from diverse foods, and possessing dissimilar biology.
“Saturated fat represents a highly heterogeneous category, with fatty acid chain lengths ranging from 6 to 24 carbons, deriving from diverse foods, and possessing dissimilar biology.”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [61]
Palmitic acid (16:0) exhibits in vitro adverse effects; whereas medium-chain (6:0-12:0), odd-chain (15:0, 17:0), and very long-chain (20:0-24:0) saturated fats may have metabolic benefits.
“For instance, palmitic acid (16:0) exhibits in vitro adverse effects; whereas medium-chain (6:0-12:0), odd-chain (15:0, 17:0), and very long-chain (20:0-24:0) saturated fats may have metabolic benefits.61, 338, 339”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [61]
Tissue levels of even-chain saturated fatty acids (e.g., 14:0, 16:0), that appear most harmful, commonly result from endogenous hepatic synthesis in response to dietary carbohydrate; 14:0 and 16:0 blood levels correlate more with dietary starches and added sugars than meats or dairy.
“Furthermore, tissue levels of even-chain saturated fatty acids (e.g., 14:0, 16:0), that appear most harmful, commonly result from endogenous hepatic synthesis in response to dietary carbohydrate;46 14:0 and 16:0 blood levels correlate more with dietary starches and added sugars than meats or dairy.61”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [61]
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- Authors
- Forouhi, N. G., Koulman, A., Sharp, S. J., Imamura, F., Kröger, J., Schulze, M. B., Crowe, F. L., Huerta, J. M., Guevara, M., Beulens, J. W., van Woudenbergh, G. J., Wang, L., Summerhill, K., Griffin, J. L., Feskens, E. J., Amiano, P., Boeing, H., Clavel-Chapelon, F., Dartois, L., Fagherazzi, G., Franks, P. W., Gonzalez, C., Jakobsen, M. U., Kaaks, R., Key, T. J., Khaw, K.-T., Kühn, T., Mattiello, A., Nilsson, P. M., Overvad, K., Pala, V., Palli, D., Quirós, J. R., Rolandsson, O., Roswall, N., Sacerdote, C., Sánchez, M.-J., Slimani, N., Spijkerman, A. M., Tjonneland, A., Tormo, M.-J., Tumino, R., van der A, D. L., van der Schouw, Y. T., Langenberg, C., Riboli, E., & Wareham, N. J.
- Affiliations
- University of Cambridge (GB)
- MRC Elsie Widdowson Laboratory (GB)
- German Institute of Human Nutrition (DE)
- University of Oxford (GB)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
- University Medical Center Utrecht (NL)
- Wageningen University & Research (NL)
- Basque Government (ES)
- Université Paris-Sud (FR)
- Lund University (SE)
- Institut Català d'Oncologia (ES)
- Aarhus University (DK)
- German Cancer Research Center (DE)
- Federico II University Hospital (IT)
- Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
- Istituto per lo Studio e la Prevenzione Oncologica (IT)
- Gobierno del Principado de Asturias (ES)
- Umeå University (SE)
- Danish Cancer Society (DK)
- Italian institute for Genomic Medicine (IT)
- Instituto de Investigación Biosanitaria de Granada (ES)
- Centre international de recherche sur le cancer (FR)
- National Institute for Public Health and the Environment (NL)
- Corresponding author
- Forouhi, Nita G
- ORCID
- Forouhi, Nita G
- Koulman, Albert
- Sharp, Stephen J
- Imamura, Fumiaki
- Kröger, Janine
- Schulze, Matthias B
- Crowe, Francesca L
- Huerta, José María
- Guevara, Marcela
- Beulens, Joline WJ
- Wang, Laura
- Griffin, Julian L
- Feskens, Edith JM
- Amiano, Pilar
- Boeing, Heiner
- Fagherazzi, Guy
- Franks, Paul W
- Gonzalez, Carlos
- Jakobsen, Marianne Uhre
- Kaaks, Rudolf
- Key, Timothy J
- Khaw, Kay-Tee
- Mattiello, Amalia
- Nilsson, Peter M
- Overvad, Kim
- Pala, Valeria
- Palli, Domenico
- Rolandsson, Olov
- Roswall, Nina
- Sacerdote, Carlotta
- Sánchez, María-José
- Slimani, Nadia
- Tumino, Rosario
- Langenberg, Claudia
- Wareham, Nicholas J
- Venue
- The Lancet Diabetes & Endocrinology
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 2
- Issue
- 10
- Pages
- 810-818
- ISSN
- 2213-8587 (ISSN-L)
- PMC
- PMC4196248
- OpenAlex
- W2168530080
- Cited by
- 557
- References
- 31
- Citations by year
- 2026: 29 · 2025: 23 · 2024: 37 · 2023: 49 · 2022: 53 · 2021: 62 · 2020: 59 · 2019: 52 · 2018: 50 · 2017: 47 · 2016: 48 · 2015: 41 · 2014: 7
- FWCI
- 43.53
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Diabetes & Endocrinology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- VBN Forskningsportal (Aalborg Universitet) (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- Socio-Environmental Systems Modeling (acceptedVersion, cc-by)
- DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
- Lund University Publications (Lund University) (submittedVersion, other-oa)
- Research Portal (Queen's University Belfast) (submittedVersion)
- Rivm (National Institute for Public Health and the Environment) (submittedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
- Funders
- Ministerie van Volksgezondheid, Welzijn en Sport
- Agentschap NL (IGE05012)
- Hjärt-Lungfonden
- World Cancer Research Fund
- Västerbotten Läns Landsting
- Kræftens Bekæmpelse
- NIHR Imperial Biomedical Research Centre
- Medical Research Council (MC_UU_12015/1, MC_UU_12015/5)
- Cancer Research UK
- Novo Nordisk
- Vetenskapsrådet
- Consejería de Salud y Familias, Junta de Andalucía
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Keywords
- type 2 diabetes, saturated fatty acids, plasma phospholipids, myristic acid, palmitic acid, stearic acid, pentadecanoic acid, heptadecanoic acid, even-chain fatty acids, odd-chain fatty acids, dietary fatty acids, case-cohort study, hazard ratio
- MeSH terms
- Diabetes Mellitus, Type 2, Fatty Acids, Female, Humans, Male, Middle Aged, Phospholipids, Prospective Studies, Case-Control Studies
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