Abstract P203: Lipoprotein Particle Number and Particle Size Profile in Impaired Fasting Glucose or Impaired Glucose Tolerance Are Similar to Those With Diabetes: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Authors: Bensenor Isabela M , Goulart Alessandra C , Santos Itamar S , Jones Steven , Santos Raul D , Blaha Michael , Toth Peter P , Lotufo Paulo A 
Published: March 2019

Introduction:
Although studies have evaluated the association between the lipid profile measured by nuclear magnetic resonance (NMR) and the diagnosis of diabetes, scarce data are available addressing the association of lipoprotein particles and lipoprotein size among people with impaired fasting glucose and impaired glucose tolerance.

Hypothesis:
People with impaired fasting glucose and impaired glucose tolerance have a more atherogenic lipid profile measured by lipoprotein particle concentration and size compared to subjects without glucose homeostasis alterations and with a similar pattern of to people with 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). We measured lipids and lipoproteins subfractions using NMR spectroscopy (LabCorp): 5 triglyceride-rich lipoprotein particles (TRL-P, from very large to very small), 3 LDL-P and 3 HDL-P (large, medium, small) subclasses. Diabetes was defined: fasting plasma glucose ≥126 mg/dl, 2h post-load glucose ≥200 mg/ dl, HbA1c ≥6.5 % or treatment for diabetes; impaired fasting glucose as fasting plasma glucose <126 and >110 mg/dl; impaired glucose tolerance as 2h post-load 75g-glucose between 140-199 mg/dl. Pre-diabetes was defined when one condition impaired fasting glucose or impaired glucose tolerance was identified. We used generalized linear regression models adjusted by sociodemographic/cardiovascular risk factors and lipids measured by enzymatic methods to compare the mean values of each lipoprotein variable.

Results:
Of the 4,095 subjects (mean age 50± 8.7years-old; 53% women), 706 subjects were diagnosed with diabetes, 365 with impaired fasting glucose, 904 with impaired glucose tolerance, and 2,120 had no glucose homeostasis change (reference group for all comparisons). People with pre-diabetes and diabetes had higher levels of large triglyceride-rich particles (P<0.0001 for all). Subjects with diabetes had lower levels of medium TRL-P; and people with diabetes and impaired glucose tolerance had lower levels of small TRL-P (respectively, P<0.0001, P=0.02). All groups had higher levels of both total LDL-P (P<0.0001 for all) small LDL-P (P<0.0001 for all). HDL particles (total and small) were lower only among subjects with diabetes. Compared with the participants without glucose homeostasis change, the participants with diabetes and pre-diabetes had higher TRL-P sizes (P<0.0001 for all), lower HDL-P sizes (P<0.04 for all), but lower LDL-P sizes were observed for persons with diabetes and impaired glucose tolerance. (P<0.009 for all).

Conclusions:
Our results suggest that people with impaired fasting glucose or impaired glucose tolerance had a proatherogenic profile of lipoprotein particles compared to people with normal glucose homeostasis and similar to subjects with diabetes.