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Published in: Diabetologia 4/2009

01-04-2009 | Article

Serum saturated fatty acids containing triacylglycerols are better markers of insulin resistance than total serum triacylglycerol concentrations

Authors: A. Kotronen, V. R. Velagapudi, L. Yetukuri, J. Westerbacka, R. Bergholm, K. Ekroos, J. Makkonen, M.-R. Taskinen, M. Orešič, H. Yki-Järvinen

Published in: Diabetologia | Issue 4/2009

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Abstract

Aims/hypothesis

The weak relationship between insulin resistance and total serum triacylglycerols (TGs) could be in part due to heterogeneity of TG molecules and their distribution within different lipoproteins. We determined concentrations of individual TGs and the fatty acid composition of serum and major lipoprotein particles and analysed how changes in different TGs and fatty acid composition are related to features of insulin resistance and abdominal obesity.

Methods

We performed lipidomic analyses of all major lipoprotein fractions using two analytical platforms in 16 individuals, who exhibited a broad range of insulin sensitivity.

Results

We identified 45 different TGs in serum. Serum TGs containing saturated and monounsaturated fatty acids were positively, while TGs containing essential linoleic acid (18:2 n−6) were negatively correlated with HOMA-IR. Specific serum TGs that correlated positively with HOMA-IR were also significantly positively related to HOMA-IR when measured in very-low-density lipoproteins (VLDLs), intermediate-density lipoproteins (IDLs) and LDL, but not in HDL subfraction 2 (HDL2) or 3 (HDL3). Analyses of proportions of esterified fatty acids within lipoproteins revealed that palmitic acid (16:0) was positively related to HOMA-IR when measured in VLDL, IDL and LDL, but not in HDL2 or HDL3. Monounsaturated palmitoleic (16:1 n−7) and oleic (18:1 n−9) acids were positively related to HOMA-IR when measured in HDL2 and HDL3, but not in VLDL, IDL or LDL. Linoleic acid was negatively related to HOMA-IR in all lipoproteins.

Conclusions/interpretation

Serum concentrations of specific TGs, such as TG(16:0/16:0/18:1) or TG(16:0/18:1/18:0), may be more precise markers of insulin resistance than total serum TG concentrations.
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Literature
1.
go back to reference Reaven GM, Hollenbeck C, Jeng CY, Wu MS, Chen YD (1988) Measurement of plasma glucose, free fatty acid, lactate, and insulin for 24 h in patients with NIDDM. Diabetes 37:1020–1024PubMedCrossRef Reaven GM, Hollenbeck C, Jeng CY, Wu MS, Chen YD (1988) Measurement of plasma glucose, free fatty acid, lactate, and insulin for 24 h in patients with NIDDM. Diabetes 37:1020–1024PubMedCrossRef
2.
go back to reference Alberti KG, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group (2005) The metabolic syndrome—a new worldwide definition. Lancet 366:1059–1062PubMedCrossRef Alberti KG, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group (2005) The metabolic syndrome—a new worldwide definition. Lancet 366:1059–1062PubMedCrossRef
3.
go back to reference Kotronen A, Yki-Jarvinen H (2008) Fatty liver: a novel component of the metabolic syndrome. Arterioscler Thromb Vasc Biol 28:27–38PubMedCrossRef Kotronen A, Yki-Jarvinen H (2008) Fatty liver: a novel component of the metabolic syndrome. Arterioscler Thromb Vasc Biol 28:27–38PubMedCrossRef
4.
go back to reference Malmstrom R, Packard CJ, Watson TD et al (1997) Metabolic basis of hypotriglyceridemic effects of insulin in normal men. Arterioscler Thromb Vasc Biol 17:1454–1464PubMed Malmstrom R, Packard CJ, Watson TD et al (1997) Metabolic basis of hypotriglyceridemic effects of insulin in normal men. Arterioscler Thromb Vasc Biol 17:1454–1464PubMed
5.
go back to reference Malmstrom R, Packard CJ, Caslake M et al (1997) Defective regulation of triglyceride metabolism by insulin in the liver in NIDDM. Diabetologia 40:454–462PubMedCrossRef Malmstrom R, Packard CJ, Caslake M et al (1997) Defective regulation of triglyceride metabolism by insulin in the liver in NIDDM. Diabetologia 40:454–462PubMedCrossRef
6.
go back to reference Rashid S, Watanabe T, Sakaue T, Lewis GF (2003) Mechanisms of HDL lowering in insulin resistant, hypertriglyceridemic states: the combined effect of HDL triglyceride enrichment and elevated hepatic lipase activity. Clin Biochem 36:421–429PubMedCrossRef Rashid S, Watanabe T, Sakaue T, Lewis GF (2003) Mechanisms of HDL lowering in insulin resistant, hypertriglyceridemic states: the combined effect of HDL triglyceride enrichment and elevated hepatic lipase activity. Clin Biochem 36:421–429PubMedCrossRef
7.
go back to reference Ferrannini E, Balkau B, Coppack SW et al (2007) Insulin resistance, insulin response, and obesity as indicators of metabolic risk. J Clin Endocrinol Metab 92:2885–2892PubMedCrossRef Ferrannini E, Balkau B, Coppack SW et al (2007) Insulin resistance, insulin response, and obesity as indicators of metabolic risk. J Clin Endocrinol Metab 92:2885–2892PubMedCrossRef
8.
go back to reference Vance DE, Vance JE (2008) Biochemistry of lipids, lipoproteins and membranes, 5th edn. Elsevier, Hungary Vance DE, Vance JE (2008) Biochemistry of lipids, lipoproteins and membranes, 5th edn. Elsevier, Hungary
9.
go back to reference Tremblay AJ, Despres JP, Piche ME et al (2004) Associations between the fatty acid content of triglyceride, visceral adipose tissue accumulation, and components of the insulin resistance syndrome. Metabolism 53:310–317PubMedCrossRef Tremblay AJ, Despres JP, Piche ME et al (2004) Associations between the fatty acid content of triglyceride, visceral adipose tissue accumulation, and components of the insulin resistance syndrome. Metabolism 53:310–317PubMedCrossRef
10.
go back to reference Ma J, Folsom AR, Shahar E, Eckfeldt JH (1995) Plasma fatty acid composition as an indicator of habitual dietary fat intake in middle-aged adults. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Am J Clin Nutr 62:564–571PubMed Ma J, Folsom AR, Shahar E, Eckfeldt JH (1995) Plasma fatty acid composition as an indicator of habitual dietary fat intake in middle-aged adults. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Am J Clin Nutr 62:564–571PubMed
11.
go back to reference Zock PL, Mensink RP, Harryvan J, de Vries JH, Katan MB (1997) Fatty acids in serum cholesteryl esters as quantitative biomarkers of dietary intake in humans. Am J Epidemiol 145:1114–1122PubMed Zock PL, Mensink RP, Harryvan J, de Vries JH, Katan MB (1997) Fatty acids in serum cholesteryl esters as quantitative biomarkers of dietary intake in humans. Am J Epidemiol 145:1114–1122PubMed
12.
go back to reference Vessby B, Unsitupa M, Hermansen K et al (2001) Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: The KANWU Study. Diabetologia 44:312–319PubMedCrossRef Vessby B, Unsitupa M, Hermansen K et al (2001) Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: The KANWU Study. Diabetologia 44:312–319PubMedCrossRef
13.
go back to reference Corpeleijn E, Feskens EJ, Jansen EH et al (2006) Improvements in glucose tolerance and insulin sensitivity after lifestyle intervention are related to changes in serum fatty acid profile and desaturase activities: the SLIM study. Diabetologia 49:2392–2401PubMedCrossRef Corpeleijn E, Feskens EJ, Jansen EH et al (2006) Improvements in glucose tolerance and insulin sensitivity after lifestyle intervention are related to changes in serum fatty acid profile and desaturase activities: the SLIM study. Diabetologia 49:2392–2401PubMedCrossRef
14.
go back to reference Sjogren P, Basu S, Rosell M et al (2005) Measures of oxidized low-density lipoprotein and oxidative stress are not related and not elevated in otherwise healthy men with the metabolic syndrome. Arterioscler Thromb Vasc Biol 25:2580–2586PubMedCrossRef Sjogren P, Basu S, Rosell M et al (2005) Measures of oxidized low-density lipoprotein and oxidative stress are not related and not elevated in otherwise healthy men with the metabolic syndrome. Arterioscler Thromb Vasc Biol 25:2580–2586PubMedCrossRef
15.
go back to reference Wang L, Folsom AR, Eckfeldt JH (2003) Plasma fatty acid composition and incidence of coronary heart disease in middle aged adults: the Atherosclerosis Risk in Communities (ARIC) Study. Nutr Metab Cardiovasc Dis 13:256–266PubMedCrossRef Wang L, Folsom AR, Eckfeldt JH (2003) Plasma fatty acid composition and incidence of coronary heart disease in middle aged adults: the Atherosclerosis Risk in Communities (ARIC) Study. Nutr Metab Cardiovasc Dis 13:256–266PubMedCrossRef
16.
go back to reference Orešič M, Hänninen V, Vidal-Puig A (2008) Lipidomics: a new window to biomedical frontiers. Trends Biotechnol 26:647–652PubMedCrossRef Orešič M, Hänninen V, Vidal-Puig A (2008) Lipidomics: a new window to biomedical frontiers. Trends Biotechnol 26:647–652PubMedCrossRef
17.
18.
go back to reference Zoeller RA, Grazia TJ, LaCamera P, Park J, Gaposchkin DP, Farber HW (2002) Increasing plasmalogen levels protects human endothelial cells during hypoxia. Am J Physiol Heart Circ Physiol 283:H671–H679PubMed Zoeller RA, Grazia TJ, LaCamera P, Park J, Gaposchkin DP, Farber HW (2002) Increasing plasmalogen levels protects human endothelial cells during hypoxia. Am J Physiol Heart Circ Physiol 283:H671–H679PubMed
19.
go back to reference Kotronen A, Westerbacka J, Bergholm R, Pietilainen KH, Yki-Jarvinen H (2007) Liver fat in the metabolic syndrome. J Clin Endocrinol Metab 92:3490–3497PubMedCrossRef Kotronen A, Westerbacka J, Bergholm R, Pietilainen KH, Yki-Jarvinen H (2007) Liver fat in the metabolic syndrome. J Clin Endocrinol Metab 92:3490–3497PubMedCrossRef
20.
go back to reference Taskinen MR, Kuusi T, Helve E, Nikkila EA, Yki-Jarvinen H (1988) Insulin therapy induces antiatherogenic changes of serum lipoproteins in noninsulin-dependent diabetes. Arteriosclerosis 8:168–177PubMed Taskinen MR, Kuusi T, Helve E, Nikkila EA, Yki-Jarvinen H (1988) Insulin therapy induces antiatherogenic changes of serum lipoproteins in noninsulin-dependent diabetes. Arteriosclerosis 8:168–177PubMed
21.
go back to reference Havel RJ, Eder HA, Bragdon JH (1955) The distribution and chemical composition of ultracentrifugally separated lipoproteins in human serum. J Clin Invest 34:1345–1353PubMedCrossRef Havel RJ, Eder HA, Bragdon JH (1955) The distribution and chemical composition of ultracentrifugally separated lipoproteins in human serum. J Clin Invest 34:1345–1353PubMedCrossRef
22.
go back to reference Kashyap ML, Hynd BA, Robinson K (1980) A rapid and simple method for measurement of total protein in very low density lipoproteins by the Lowry assay. J Lipid Res 21:491–495PubMed Kashyap ML, Hynd BA, Robinson K (1980) A rapid and simple method for measurement of total protein in very low density lipoproteins by the Lowry assay. J Lipid Res 21:491–495PubMed
23.
go back to reference Katajamaa M, Miettinen J, Oresic M (2006) MZmine: toolbox for processing and visualization of mass spectrometry based molecular profile data. Bioinformatics 22:634–636PubMedCrossRef Katajamaa M, Miettinen J, Oresic M (2006) MZmine: toolbox for processing and visualization of mass spectrometry based molecular profile data. Bioinformatics 22:634–636PubMedCrossRef
24.
go back to reference Seppanen-Laakso T, Laakso I, Hiltunen R (2002) Analysis of fatty acids by gas chromatography, and its relevance to research on health and nutrition. Anal Chim Acta 465:39–62CrossRef Seppanen-Laakso T, Laakso I, Hiltunen R (2002) Analysis of fatty acids by gas chromatography, and its relevance to research on health and nutrition. Anal Chim Acta 465:39–62CrossRef
25.
go back to reference Toivonen E, Hemmila I, Marniemi J, Jorgensen PN, Zeuthen J, Lovgren T (1986) Two-site time-resolved immunofluorometric assay of human insulin. Clin Chem 32:637–640PubMed Toivonen E, Hemmila I, Marniemi J, Jorgensen PN, Zeuthen J, Lovgren T (1986) Two-site time-resolved immunofluorometric assay of human insulin. Clin Chem 32:637–640PubMed
26.
go back to reference Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419PubMedCrossRef Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419PubMedCrossRef
27.
go back to reference Donnelly KL, Smith CI, Schwarzenberg SJ, Jessurun J, Boldt MD, Parks EJ (2005) Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. J Clin Invest 115:1343–1351PubMed Donnelly KL, Smith CI, Schwarzenberg SJ, Jessurun J, Boldt MD, Parks EJ (2005) Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. J Clin Invest 115:1343–1351PubMed
28.
go back to reference Seppala-Lindroos A, Vehkavaara S, Hakkinen AM et al (2002) Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum free fatty acids independent of obesity in normal men. J Clin Endocrinol Metab 87:3023–3028PubMedCrossRef Seppala-Lindroos A, Vehkavaara S, Hakkinen AM et al (2002) Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum free fatty acids independent of obesity in normal men. J Clin Endocrinol Metab 87:3023–3028PubMedCrossRef
29.
go back to reference Adiels M, Taskinen MR, Packard C et al (2006) Overproduction of large VLDL particles is driven by increased liver fat content in man. Diabetologia 49:755–765PubMedCrossRef Adiels M, Taskinen MR, Packard C et al (2006) Overproduction of large VLDL particles is driven by increased liver fat content in man. Diabetologia 49:755–765PubMedCrossRef
30.
go back to reference Fabbrini E, Mohammed BS, Magkos F, Korenblat KM, Patterson BW, Klein S (2008) Alterations in adipose tissue and hepatic lipid kinetics in obese men and women with nonalcoholic fatty liver disease. Gastroenterology 134:424–431PubMedCrossRef Fabbrini E, Mohammed BS, Magkos F, Korenblat KM, Patterson BW, Klein S (2008) Alterations in adipose tissue and hepatic lipid kinetics in obese men and women with nonalcoholic fatty liver disease. Gastroenterology 134:424–431PubMedCrossRef
31.
go back to reference Timlin MT, Parks EJ (2005) Temporal pattern of de novo lipogenesis in the postprandial state in healthy men. Am J Clin Nutr 81:35–42PubMed Timlin MT, Parks EJ (2005) Temporal pattern of de novo lipogenesis in the postprandial state in healthy men. Am J Clin Nutr 81:35–42PubMed
32.
go back to reference Aarsland A, Wolfe RR (1998) Hepatic secretion of VLDL fatty acids during stimulated lipogenesis in men. J Lipid Res 39:1280–1286PubMed Aarsland A, Wolfe RR (1998) Hepatic secretion of VLDL fatty acids during stimulated lipogenesis in men. J Lipid Res 39:1280–1286PubMed
33.
go back to reference Hodge AM, English DR, O’Dea K et al (2007) Plasma phospholipid and dietary fatty acids as predictors of type 2 diabetes: interpreting the role of linoleic acid. Am J Clin Nutr 86:189–197PubMed Hodge AM, English DR, O’Dea K et al (2007) Plasma phospholipid and dietary fatty acids as predictors of type 2 diabetes: interpreting the role of linoleic acid. Am J Clin Nutr 86:189–197PubMed
34.
go back to reference Wang L, Folsom AR, Zheng ZJ, Pankow JS, Eckfeldt JH, ARIC Study Investigators (2003) Plasma fatty acid composition and incidence of diabetes in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 78:91–98PubMed Wang L, Folsom AR, Zheng ZJ, Pankow JS, Eckfeldt JH, ARIC Study Investigators (2003) Plasma fatty acid composition and incidence of diabetes in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 78:91–98PubMed
35.
go back to reference Vessby B, Aro A, Skarfors E, Berglund L, Salminen I, Lithell H (1994) The risk to develop NIDDM is related to the fatty acid composition of the serum cholesterol esters. Diabetes 43:1353–1357PubMedCrossRef Vessby B, Aro A, Skarfors E, Berglund L, Salminen I, Lithell H (1994) The risk to develop NIDDM is related to the fatty acid composition of the serum cholesterol esters. Diabetes 43:1353–1357PubMedCrossRef
36.
go back to reference Ohrvall M, Berglund L, Salminen I, Lithell H, Aro A, Vessby B (1996) The serum cholesterol ester fatty acid composition but not the serum concentration of alpha tocopherol predicts the development of myocardial infarction in 50-year-old men: 19 years follow-up. Atherosclerosis 127:65–71PubMedCrossRef Ohrvall M, Berglund L, Salminen I, Lithell H, Aro A, Vessby B (1996) The serum cholesterol ester fatty acid composition but not the serum concentration of alpha tocopherol predicts the development of myocardial infarction in 50-year-old men: 19 years follow-up. Atherosclerosis 127:65–71PubMedCrossRef
37.
go back to reference Miettinen TA, Naukkarinen V, Huttunen JK, Mattila S, Kumlin T (1982) Fatty-acid composition of serum lipids predicts myocardial infarction. BMJ 285:993–996PubMedCrossRef Miettinen TA, Naukkarinen V, Huttunen JK, Mattila S, Kumlin T (1982) Fatty-acid composition of serum lipids predicts myocardial infarction. BMJ 285:993–996PubMedCrossRef
38.
go back to reference Warensjo E, Riserus U, Vessby B (2005) Fatty acid composition of serum lipids predicts the development of the metabolic syndrome in men. Diabetologia 48:1999–2005PubMedCrossRef Warensjo E, Riserus U, Vessby B (2005) Fatty acid composition of serum lipids predicts the development of the metabolic syndrome in men. Diabetologia 48:1999–2005PubMedCrossRef
39.
go back to reference Warensjo E, Sundstrom J, Vessby B, Cederholm T, Riserus U (2008) Markers of dietary fat quality and fatty acid desaturation as predictors of total and cardiovascular mortality: a population-based prospective study. Am J Clin Nutr 88:203–209PubMed Warensjo E, Sundstrom J, Vessby B, Cederholm T, Riserus U (2008) Markers of dietary fat quality and fatty acid desaturation as predictors of total and cardiovascular mortality: a population-based prospective study. Am J Clin Nutr 88:203–209PubMed
40.
go back to reference Glatz JF, Soffers AE, Katan MB (1989) Fatty acid composition of serum cholesteryl esters and erythrocyte membranes as indicators of linoleic acid intake in man. Am J Clin Nutr 49:269–276PubMed Glatz JF, Soffers AE, Katan MB (1989) Fatty acid composition of serum cholesteryl esters and erythrocyte membranes as indicators of linoleic acid intake in man. Am J Clin Nutr 49:269–276PubMed
41.
go back to reference Nikkari T, Luukkainen P, Pietinen P, Puska P (1995) Fatty acid composition of serum lipid fractions in relation to gender and quality of dietary fat. Ann Med 27:491–498PubMedCrossRef Nikkari T, Luukkainen P, Pietinen P, Puska P (1995) Fatty acid composition of serum lipid fractions in relation to gender and quality of dietary fat. Ann Med 27:491–498PubMedCrossRef
42.
go back to reference Pelikanova T, Kazdova L, Chvojkova S, Base J (2001) Serum phospholipid fatty acid composition and insulin action in type 2 diabetic patients. Metabolism 50:1472–1478PubMedCrossRef Pelikanova T, Kazdova L, Chvojkova S, Base J (2001) Serum phospholipid fatty acid composition and insulin action in type 2 diabetic patients. Metabolism 50:1472–1478PubMedCrossRef
43.
go back to reference Vessby B, Tengblad S, Lithell H (1994) Insulin sensitivity is related to the fatty acid composition of serum lipids and skeletal muscle phospholipids in 70-year-old men. Diabetologia 37:1044–1050PubMedCrossRef Vessby B, Tengblad S, Lithell H (1994) Insulin sensitivity is related to the fatty acid composition of serum lipids and skeletal muscle phospholipids in 70-year-old men. Diabetologia 37:1044–1050PubMedCrossRef
44.
go back to reference Gertow K, Rosell M, Sjogren P et al (2006) Fatty acid handling protein expression in adipose tissue, fatty acid composition of adipose tissue and serum, and markers of insulin resistance. Eur J Clin Nutr 60:1406–1413PubMedCrossRef Gertow K, Rosell M, Sjogren P et al (2006) Fatty acid handling protein expression in adipose tissue, fatty acid composition of adipose tissue and serum, and markers of insulin resistance. Eur J Clin Nutr 60:1406–1413PubMedCrossRef
45.
go back to reference Lovejoy JC, Champagne CM, Smith SR et al (2001) Relationship of dietary fat and serum cholesterol ester and phospholipid fatty acids to markers of insulin resistance in men and women with a range of glucose tolerance. Metabolism 50:86–92PubMedCrossRef Lovejoy JC, Champagne CM, Smith SR et al (2001) Relationship of dietary fat and serum cholesterol ester and phospholipid fatty acids to markers of insulin resistance in men and women with a range of glucose tolerance. Metabolism 50:86–92PubMedCrossRef
46.
go back to reference Merrill AH Jr, Lingrell S, Wang E, Nikolova-Karakashian M, Vales TR, Vance de (1995) Sphingolipid biosynthesis de novo by rat hepatocytes in culture. Ceramide and sphingomyelin are associated with, but not required for, very low density lipoprotein secretion. J Biol Chem 270:13834–13841PubMedCrossRef Merrill AH Jr, Lingrell S, Wang E, Nikolova-Karakashian M, Vales TR, Vance de (1995) Sphingolipid biosynthesis de novo by rat hepatocytes in culture. Ceramide and sphingomyelin are associated with, but not required for, very low density lipoprotein secretion. J Biol Chem 270:13834–13841PubMedCrossRef
Metadata
Title
Serum saturated fatty acids containing triacylglycerols are better markers of insulin resistance than total serum triacylglycerol concentrations
Authors
A. Kotronen
V. R. Velagapudi
L. Yetukuri
J. Westerbacka
R. Bergholm
K. Ekroos
J. Makkonen
M.-R. Taskinen
M. Orešič
H. Yki-Järvinen
Publication date
01-04-2009
Publisher
Springer-Verlag
Published in
Diabetologia / Issue 4/2009
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-009-1282-2

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