Abstract P202: Serum Values of Branched-chain Amino Acids Predict High Triglycerides Among People Free of Diabetes. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Authors: Lotufo Paulo A , Toth Peter P , Blaha Michael , Jones Steven , Bensenor Isabela M 
Published: March 2019

Introduction:
Branched-chain amino acids (isoleucine, leucine, and valine) are associated with new-onset diabetes and incident coronary heart disease and stroke. However, the impact of elevated serum branched-chain amino acids on lipids and lipoproteins remains a matter of investigation.

Hypothesis:
branched-chain amino acids are independent predictors of dyslipidemia among people free of diabetes.

Methods:
We tested this hypothesis among 5060 men and women aged 35 to 74 years-old enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) with a 4-year follow-up. The variable of exposure was serum branched-chain amino acids measured in serum by proton nuclear magnetic resonance (1H NMR) spectroscopy at (LabCorp; Raleigh, NC). The outcome variables were LDL-C greater than 130 mg/dl; HDL-C lower than 40 mg/dl; triglycerides higher than 150 mg/ dl during the reappraisal examination. We excluded participants with any type of dyslipidemia at time of baseline, people who sustained a cardiovascular event, and those receiving lipid-lowering therapy or who had a diagnosis of diabetes. The definition of diabetes was self-reported or use of medicines for diabetes or plasma fasting glucose greater than 126 mg/Dl or 2-hour load plasma glucose greater than 200 mg/dl or glycated hemoglobin greater than 6.5 %. We applied Poisson regression to determine prevalence ratios for dyslipidemia according to a 1-standard deviation of branched-chain amino acids. The final model included age, sex, race, body mass index, waist circumference, a 4-year weight change, insulin resistance (measured by the product of fasting plasma glucose * serum insulin divided by 405), and glycated hemoglobin.

Results:
During the 4-year follow-up, 1373 participants met the criteria of study (median age 47 years; 67% women, 59% white), and 736 (53.6%) developed new-onset dyslipidemia: high triglycerides (120; 8.7%), low HDL-C (332; 24.2%), or high LDL-C (284; 20.7%) The combination of incident high triglycerides and low HDL-C was observed in 44 (3.2%) of participants. After the full adjustment for the covariates, the prevalence ratios (and 95% Confidence Interval) of new-onset dyslipidemia for 1-Standard Deviation (1-SD) of serum branched-chain amino acids were for high triglycerides = 1.25 (1.04 to 1.50), low-HDL-C = 1.08 (0.98 to 1.20), and for high LDL-C = 1.02 (0.91-1.14). The association between 1-SD of branched-chain amino acids and high triglycerides was present for women [1.27 (1.02 to 1.58), but not for men [1.18 (0.90 to 1.53)]. Analyzing separately for the amino acid, the prevalence ratio for high triglycerides for 1-SD of leucine was 1.34 (1.13 to 1.62); for 1-SD of isoleucine was 1.07 (0.90 to 1.28), and for 1-SD of valine was 1.16 (0.96 to 1.38).

Conclusion:
Serum values of branched chain amino acids are associated with incident hypertriglyceridemia among people free of diabetes.