Fatty Acid Composition of Serum Lipid Fractions in Type 2 Diabetic Patients With Microalbuminuria

Abstract

OBJECTIVE -To determine the fatty acid composition of serum phospholipid, triglyceride, and cholesterol ester fractions and to analyze the lipid profile of microalbuminuric type 2 diabetic patients. RESEARCH DESIGN AND METHODS-A case-control study was conducted with 72 patients: 37 were normoalbuminuric (urinary albumin excretion rate [UAER] Ͻ20 g/min), and 35 were microalbuminuric (UAER 20 -200 g/min). After 4 weeks of a standardized diet, the fatty acid composition of phospholipid, triglyceride, and cholesterol ester fractions was determined by gas chromatography. Total cholesterol and triglycerides were measured by enzymaticcolorimetric methods; cholesterol HDL by double precipitation with heparin, MnCl 2 , and dextran sulfate; and apolipoprotein B by immunoturbidimetry.RESULTS -Microalbuminuric patients showed a lower proportion of polyunsaturated fatty acids (24.8 Ϯ 11.0%), especially of the n-6 family (21.7 Ϯ 10.5%), in triglyceride fraction than normoalbuminuric patients (34.1 Ϯ 11.3%, P ϭ 0.001 and 31.4 Ϯ 11.5%, P Ͻ 0.001, respectively). Patients with microalbuminuria also presented higher levels of saturated fatty acids in triglyceride fraction (43.4 Ϯ 18.0% vs. 34.7 Ϯ 13.1%, P ϭ 0.022). In the logistic regression analysis, only the proportion of polyunsaturated fatty acids in triglyceride fraction remained significantly associated with microalbuminuria (odds ratio [OR] 0.92, 95% CI 0.85-0.98, P ϭ 0.019). Total cholesterol, HDL cholesterol, triglyceride, and apolipoprotein B levels were similar in normo-and microalbuminuric patients.CONCLUSION -Microalbuminuria in type 2 diabetic patients is associated with low polyunsaturated fatty acid contents in serum triglyceride fraction. This association may represent a risk factor for cardiovascular disease and may contribute to the progression of renal disease. Diabetes Care 26:613-618, 2003M icroalbuminuria is known to be an independent risk factor for cardiovascular death in type 2 diabetic patients (1,2), but the mechanisms underlying this association have not been clarified. It could be that other cardiovascular risk factors that are frequently associated with microalbuminuria, such as hyperglycemia, hypertension (3), and endothelial dysfunction (4), might also contribute to the increased cardiovascular mortality observed in these patients. In addition, dyslipidemia has also been described in type 2 diabetic patients with microalbuminuria (2,5,6). Although those studies did not specifically assess the effect of nutrient intake, the effect of dietary habits on the development of dyslipidemia in these microalbuminuric patients cannot be ruled out.Dietary habits influence serum lipid levels and renal function in patients with diabetes. For example, higher intake of fish protein has been shown to be related to a lower risk for microalbuminuria in type 1 diabetic patients (7), and replacement of red meat with chicken reduces albumin excretion rate and serum cholesterol levels in microalbuminuric type 2 diabetic patients (8). These effects may result from the hig...

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