Elsevier

Metabolism

Volume 52, Issue 8, August 2003, Pages 1043-1049
Metabolism

Fasting and daylong triglycerides in obesity with and without type 2 diabetes

https://doi.org/10.1016/S0026-0495(03)00106-9Get rights and content

Abstract

Postprandial hypertriglyceridemia associated with insulin resistance is one of the cardiovascular risk factors in obesity and type 2 diabetes. It is not known whether diabetics have a more pronounced postprandial hypertriglyceridemia than obese subjects. Daylong triglyceridemia, representing postprandial lipemia, was determined in obese subjects with and without type 2 diabetes and in lean subjects. Nineteen type 2 diabetics (F/M: 7/12, body mass index [BMI]: 30.6 ± 5.4 kg/m2), 45 obese nondiabetics (F/M: 16/29, BMI: 29.5 ± 2.6 kg/m2) and 78 lean subjects (F/M: 28/50, BMI: 23.7 ± 2.2 kg/m2) measured capillary triglycerides (TGc) during 3 days on 6 fixed time-points each day in an out-of-hospital situation. Daylong TGc profiles were calculated as mean integrated area under the TGc-curve (TGc-AUC). Fasting plasma TG were higher in diabetics and obese nondiabetics (1.81 ± 0.79 and 1.77 ± 0.80 mmol/L) compared with lean subjects (1.23 ± 0.67 mmol/L, P < .001). TGc-AUC was similarly increased in both diabetics and obese nondiabetics (35.0 ± 12.1 and 35.2 ± 10.6 mmol ·1 h/L) compared with lean controls (25.5 ± 12.0 mmol ·1 h/L, P < .001). Self-reported energy intake was not significantly different between the groups. Fasting TGc (r = .87, P < .001) and waist circumference (r = .51, P < .001) were the parameters best associated with TGc-AUC. Using stepwise multiple regression analysis, fasting TGc, BMI, total cholesterol, and high-density lipoprotein (HDL) cholesterol were the best predictors of TGc-AUC, explaining 77% of the variation. The cut-off level for “normal” TGc-AUC, calculated as the 75th percentile of TGc-AUC in lean subjects, was 30.7 mmol ·1 h/L and corresponded with a fasting TGc of 1.8 mmol/L (eg, 1.6 mmol/L in plasma), calculated using univariate regression analysis. In conclusion, daylong triglyceridemia is similarly increased in diabetics and obese nondiabetics compared with lean subjects. Fasting TG and central obesity largely determine daylong triglyceridemia, independent of the presence of type 2 diabetes. Decreasing fasting plasma TG below 1.6 mmol/L could lead to a normalization of postprandial lipemia in obese subjects with and without diabetes.

Section snippets

Subjects

Data were analyzed from 142 subjects who participated in a study aimed to evaluate daylong TG changes in an out-of-hospital situation. Inclusion criteria were age 35 to 65 years and fasting cholesterol < 7 mmol/L. Type 2 diabetic subjects were included from the department of Internal Medicine from the University Medical Center Utrecht and fulfilled the criteria as described by the American Diabetes Association.27 Exclusion criteria for diabetic patients were glycosylated hemoglobin (HbA1c) >

General characteristics

Nine-teen type 2 diabetics, 45 obese nondiabetics and 78 lean subjects were included in this study. Group-wise general characteristics of the participants are listed in Table 1. Fasting plasma TG was higher in diabetics and obese nondiabetics than in lean subjects. Obese nondiabetics had elevated HOMA compared with lean subjects. Body composition and fasting plasma lipids and apolipoproteins were comparable between diabetics and obese nondiabetics. Three diabetic subjects were on insulin

Discussion

Metabolic ward studies have shown that both type 2 diabetics and obese nondiabetics are characterized by postprandial hyperlipidemia compared with healthy subjects.17, 18, 19, 20 However, direct comparisons between groups matched for BMI, with and without diabetes, are scarce. In our study, daylong triglyceridemia was similarly disturbed in diabetic and nondiabetic obese subjects compared with lean controls, suggesting that obesity largely determines postprandial lipemia in both disorders,

Acknowledgements

Roche Diagnostics (Mannheim, Germany) is greatly acknowledged for providing the Accutrend GCT meters with accessories.

References (47)

  • J. Jeppesen et al.

    Effect of variations in oral fat and carbohydrate load on postprandial lipemia

    Am J Clin Nutr

    (1995)
  • F. Abbasi et al.

    High carbohydrate diets, triglyceride-rich lipoproteins, and coronary heart disease risk

    Am J Cardiol

    (2000)
  • J.M. Jakicic

    The role of physical activity in prevention and treatment of body weight gain in adults

    J Nutr

    (2002)
  • A.H. Goris et al.

    Undereating and underrecording of habitual food intake in obese menSelective underreporting of fat intake

    Am J Clin Nutr

    (2000)
  • P.H. Groot et al.

    Postprandial lipoprotein metabolism in normolipidemic men with and without coronary artery disease

    Arterioscler Thromb Vasc Biol

    (1991)
  • J.R. Patsch et al.

    Relation of triglyceride metabolism and coronary artery disease. Studies in the postprandial state

    Arterioscler Thromb Vasc Biol

    (1992)
  • M.S. Weintraub et al.

    Clearance of chylomicron remnants in normolipidaemic patients with coronary artery diseaseCase control study over three years

    BMJ

    (1996)
  • S.D. Proctor et al.

    Retention of fluorescent-labelled chylomicron remnants within the intima of the arterial wall—Evidence that plaque cholesterol may be derived from post-prandial lipoproteins

    Eur J Clin Invest

    (1998)
  • E.E. Calle et al.

    Body-mass index and mortality in a prospective cohort of U.S. adults

    N Engl J Med

    (1999)
  • J.P. Després et al.

    Hyperinsulinemia as an independent risk factor for ischemic heart disease

    N Engl J Med

    (1996)
  • J.B. Meigs et al.

    Risk variable clustering in the insulin resistance syndrome. The Framingham Offspring Study

    Diabetes

    (1997)
  • G.M. Reaven

    Banting lecture 1988. Role of insulin resistance in human disease

    Diabetes

    (1988)
  • W.Y. Fujimoto

    The importance of insulin resistance in the pathogenesis of type 2 diabetes mellitus

    Am J Med

    (2000)
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