Abstract
Premature aging, as denoted by a reduced telomere length (TL), has been observed in several chronic inflammatory diseases, such as obesity and type 2 diabetes mellitus (T2DM). However, no study to date has addressed the potential inflammatory influence of the gut-derived Gram-negative bacterial fragments lipopolysaccharide, also referred to as endotoxin, and its influence on TL in low-grade inflammatory states such as type 2 diabetes mellitus (T2DM). The current study therefore investigated the influence of endotoxin and inflammatory factors on telomere length (TL) in adults with (T2DM: n = 387) and without (non-diabetic (ND) controls: n = 417) obesity and T2DM. Anthropometric characteristics were taken, and fasted blood samples were used to measure biomarkers, TL, and endotoxin. The findings from this study highlighted across all participants that circulating endotoxin (r = −0.17, p = 0.01) was inversely associated with TL, noting that endotoxin and triglycerides predicted 18% of the variance perceived in TL (p < 0.001). Further stratification of the participants according to T2DM status and sex highlighted that endotoxin significantly predicted 19% of the variance denoted in TL among male T2DM participants (p = 0.007), where TL was notably influenced. The influence on TL was not observed to be impacted by anti-T2DM medications, statins, or anti-hypertensive therapies. Taken together, these results show that TL attrition was inversely associated with circulating endotoxin levels independent of the presence of T2DM and other cardiometabolic factors, suggesting that low-grade chronic inflammation may trigger premature biological aging. The findings further highlight the clinical relevance of mitigating the levels of circulating endotoxin (e.g., manipulation of gut microbiome) not only for the prevention of chronic diseases but also to promote healthy aging.
Highlights
More than half of all participants were obese in both groups, which was undertaken to match groups and was not significantly different between the two groups even considering stratification according to sex
It has been established that chronic diseases such as obesity and type 2 diabetes mellitus (T2DM) contribute to premature aging, and this study has added to our understanding of what may mediate the inflammatory insult in part to cause this effect, as this study shows for the first time that endotoxin appears to negatively influence telomere length (TL) in an adult Arabian population across varying degrees of insulin resistance
Stratification of the participants according to metabolic state and sex shows that endotoxin may further predict 19% of the variance denoted in TL among male T2DM participants
Summary
Obesity is considered to be a key risk factor in T2DM pathology, partly as adipose tissue expansion leads to changes in how the tissue regulates metabolism and responds to systemic factors, such as nutrients and inflammatory insults [6]. In conditions such as obesity, adipose tissue can mediate an exacerbated inflammatory response, which promotes insulin resistance and pathogenesis of T2DM [7,8]. Obesity and inflammation play pivotal roles in increasing susceptibility to T2DM, the specific mediators contributing to this pathology and associated premature aging have been less apparent
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