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

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/m 2), 45 obese nondiabetics (F/M: 16/29, BMI: 29.5 ± 2.6 kg/m 2) and 78 lean subjects (F/M: 28/50, BMI: 23.7 ± 2.2 kg/m 2) 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.