Associations between explorative dietary patterns and serum lipid levels and their interactions with ApoA5 and ApoE haplotype in patients with recently diagnosed type 2 diabetes

Katharina S Weber, Birgit Knebel, Klaus Strassburger, Jörg Kotzka, Peter Stehle, Julia Szendroedi, Karsten Müssig, Anette E Buyken, Michael Roden, GDS Group, Katharina S Weber, Birgit Knebel, Klaus Strassburger, Jörg Kotzka, Peter Stehle, Julia Szendroedi, Karsten Müssig, Anette E Buyken, Michael Roden, GDS Group

Abstract

Aims: In patients with type 2 diabetes (T2D), responsiveness of serum lipid concentrations to dietary patterns may vary by genotype. The aims of the present study were to identify explorative dietary patterns and to examine their independent associations with serum lipid levels and interactions with apolipoprotein (Apo)A5 and ApoE variants among patients recently diagnosed with T2D.

Methods: Within a cross-sectional analysis, participants of the German Diabetes Study (n = 348) with mean T2D duration of 6 months were investigated for fasting serum lipid levels, ApoA5 and ApoE genotypes; food consumption frequencies were assessed by a food propensity questionnaire. Dietary patterns were derived using principal component analysis (PCA) and reduced rank regression (RRR), which extracts patterns explaining variation in serum lipid concentrations.

Results: PCA yielded interpretable dietary patterns which were, however, not related to serum lipid levels. Relevance of the RRR patterns varied by genotype: a preferred consumption of fruit gum, fruit juice, and potato dumpling, whilst avoiding fruits and vegetables independently associated with higher triglyceride levels among ApoA5*2. Patients in the highest compared to the lowest tertile of pattern adherence had 99 % higher triglycerides. Lower consumption frequencies of butter, cream cake, French fries, or high-percentage alcoholic beverages were independently related to lower LDL-cholesterol among ApoE2 carriers, with those in the highest compared to the lowest tertile of pattern adherence having 40 % lower LDL-cholesterol (both Pinteraction < 0.05).

Conclusions: Our explorative data analyses suggest that associations of dietary patterns with triglycerides and LDL-cholesterol differ by ApoA5 and ApoE haplotype in recently diagnosed T2D. Trial registration Clinicaltrials.gov: NCT01055093. Date of registration: January 22, 2010 (retrospectively registered). Date of enrolment of first participant to the trial: September 2005.

Keywords: ApoA5; ApoE; Apolipoproteins; Food pattern; LDL-cholesterol; Principal component analysis; Reduced rank regression; Triglycerides.

Figures

Fig. 1
Fig. 1
Flow diagram showing the number of patients included in the analyses from those enrolled in the German Diabetes Study
Fig. 2
Fig. 2
Associations of reduced rank regression dietary patterns with serum concentrations of triglycerides, HDL-cholesterol, and LDL-cholesterol. Values are least-squares means with their 95 % CI. P-values for a linear trend based on multiple regression models with dietary pattern scores as continuous variables. Associations of dietary patterns with serum levels of a triglycerides, b HDL-cholesterol, and c LDL-cholesterol. Triglycerides were log-transformed prior to analysis to improve normality and back transformed for presentation in the figure. *P-values still significant when considering multiple testing and applying Bonferroni correction for m = 3 dependent variables to be analyzed, i.e. triglycerides, HDL-, and LDL-cholesterol (significance level P < 0.05/3 ≙ P < 0.017). a, b Adjusted for age, sex, diabetes duration, glucose- and lipid-lowering medication, current employment status, highest school-leaving qualification, and current/former employment position. c Adjusted for age, sex, glucose- and lipid-lowering medication, current employment status, highest school-leaving qualification, and current/former employment position. RRR reduced rank regression; T tertile
Fig. 3
Fig. 3
Interactions between haplotypes of ApoA5 and ApoE for associations with reduced rank regression dietary patterns. Values are least-square means with their 95 % CI. P-values for a linear trend based on multiple regression models with dietary pattern scores as continuous variables. Interaction of (a) RRR 1 pattern and ApoA5 haplotypes on serum lipid concentrations of triglycerides and of (b) RRR 3 pattern and ApoE haplotypes on serum lipid concentrations of LDL-cholesterol. Triglycerides were log-transformed prior to analysis to improve normality and back transformed for presentation in the figure. *P-values still significant when considering multiple testing and applying Bonferroni correction for m = 3 haplotypes, i.e. ApoA5*1, ApoA5*2, ApoA5*3 and ApoE2, ApoE3, ApoE4 (significance level P < 0.05/3 ≙ P < 0.017). a Adjusted for age, sex, diabetes duration, glucose- and lipid-lowering medication, current employment status, highest school-leaving qualification, and current/former employment position. b Adjusted for age, sex, glucose- and lipid-lowering medication, current employment status, highest school-leaving qualification, and current/former employment position. Apo apolipoprotein; Int interaction; RRR reduced rank regression; T tertile

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