Plasma branched chain/aromatic amino acids, enriched Mediterranean diet and risk of type 2 diabetes: case-cohort study within the PREDIMED Trial

Research output: Contribution to journalJournal articleResearchpeer-review

  • Miguel Ruiz-Canela
  • Estefanía Toledo
  • Clary B. Clish
  • Cristina Razquin
  • Liming Liang
  • Dong D. Wang
  • Dolores Corella
  • Ramón Estruch
  • Álvaro Hernáez
  • Edward Yu
  • Enrique Gómez-Gracia
  • Yan Zheng
  • Fernando Arós
  • Dora Romaguera
  • Courtney Dennis
  • Emilio Ros
  • José Lapetra
  • Lluis Serra-Majem
  • Christopher Papandreou
  • Olga Portoles
  • Montserrat Fitó
  • Jordi Salas-Salvadó
  • Frank B. Hu
  • Miguel A. Martínez-González

Aims/hypothesis: Branched-chain amino acids (BCAAs) and aromatic amino acids (AAAs) are associated with type 2 diabetes. However, repeated measurements of BCAA/AAA and their interactions with dietary interventions have not been evaluated. We investigated the associations between baseline and changes at 1 year in BCAA/AAA with type 2 diabetes in the context of a Mediterranean diet (MedDiet) trial. Methods: We included 251 participants with incident type 2 diabetes and a random sample of 694 participants (641 participants without type 2 diabetes and 53 overlapping cases) in a case-cohort study nested within the PREvención con DIeta MEDiterránea (PREDIMED) trial. Participants were randomised to a MedDiet+extra-virgin olive oil (n = 273), a MedDiet+nuts (n = 324) or a control diet (n = 295). We used LC-MS/MS to measure plasma levels of amino acids. Type 2 diabetes was a pre-specified secondary outcome of the PREDIMED trial. Results: Elevated plasma levels of individual BCAAs/AAAs were associated with higher type 2 diabetes risk after a median follow-up of 3.8 years: multivariable HR for the highest vs lowest quartile ranged from 1.32 for phenylalanine ([95% CI 0.90, 1.92], p for trend = 0.015) to 3.29 for leucine ([95% CI 2.03, 5.34], p for trend<0.001). Increases in BCAA score at 1 year were associated with higher type 2 diabetes risk in the control group with HR per SD = 1.61 (95% CI 1.02, 2.54), but not in the MedDiet groups (p for interaction <0.001). The MedDiet+extra-virgin olive oil significantly reduced BCAA levels after 1 year of intervention (p = 0.005 vs the control group). Conclusions/interpretation: Our results support that higher baseline BCAAs and their increases at 1 year were associated with higher type 2 diabetes risk. A Mediterranean diet rich in extra-virgin olive oil significantly reduced the levels of BCAA and attenuated the positive association between plasma BCAA levels and type 2 diabetes incidence. Clinical trial number: SRCTN35739639 (www.controlled-trials.com).

Original languageEnglish
JournalDiabetologia
Volume61
Issue number7
Pages (from-to)1560-1571
Number of pages12
ISSN0012-186X
DOIs
Publication statusPublished - 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

    Research areas

  • Aromatic amino acids, Branched-chain amino acids, Mediterranean diet, Type 2 diabetes

ID: 358106341