Postprandial endotoxemia may influence the development of type 2 diabetes mellitus: From the CORDIOPREV study.
Level 3 - non-randomized controlled study
Prospective cohort study with longitudinal follow-up
PubMed 29685478 · doi:10.1016/j.clnu.2018.03.016
What was done
The authors evaluated the prospective association between postprandial endotoxemia and the onset of type 2 diabetes mellitus (T2DM) in 462 non-diabetic baseline participants from the CORDIOPREV study (NCT00924937). Participants were followed for a median of 60 months. During follow-up, 107 patients developed T2DM according to American Diabetes Association criteria, while 355 did not. Baseline postprandial lipopolysaccharide (LPS) fold changes were evaluated as predictors of incident T2DM and compared against the FINDRISC score.
What was found
Patients who developed T2DM exhibited a significant baseline postprandial increase in LPS levels (P < 0.001), whereas non-diabetic controls did not show postprandial LPS modification. Baseline postprandial LPS fold change was associated with incident T2DM with a hazard ratio of 2.076 (95% CI 1.149-3.750), compared to 1.384 (95% CI 0.740-2.589) for the FINDRISC score alone. Combining high postprandial LPS fold change with a high FINDRISC score showed a hazard ratio of 3.835 (95% CI 1.323-11.114).
Why it matters
These findings suggest that elevated postprandial endotoxemia precedes the development of T2DM and may enhance existing clinical risk prediction tools.
Limits
The study is nested within the CORDIOPREV cohort, which consists of patients with established coronary heart disease, potentially limiting generalizability to the general population. Meal composition, dietary adherence, and adjustments for metabolic covariates are not detailed in the abstract.
Cited by
- partial The CardioPrevent Study followed 480 pre-diabetic individuals over 60 months and found serum LPS was the only marker predictive of developing type 2 diabetes with over a 98% confidence.