Correlation Between Dietary Fat Intake and Atherogenic Indices in Normal, Overweight and Obese Adults with or Without Type 2 Diabetes

Open access


Background and aims: We investigated the association of dietary intake, particularly fat and its constituent fatty acids, with atherogenic indices in adult patients with overweight, obesity and/or type 2 diabetes (T2D). Material and Methods: Two hundred eighty-five outpatients were selected in two cities located in the Northwestern region of Algeria. Anthropometric measurements for body weight, height, body mass index (BMI) and waist circumference were performed. Relationships between dietary intakes, estimated by a 3- days food record, and fasting blood atherogenic indices - total cholesterol-to-high-density lipoprotein cholesterol ratio (TC/HDL-c) and apolipoprotein (apo) B-to-apo A1 ratio, were analysed. Results: Study group included 58.59% overweight/obese T2D patients, 24.91% normal weight T2D patients and 16.49 % overweight/obese patients without diabetes. Higher dietary consumption (p= 0.003) of total fat, saturated fatty acids (SFAs) and polyunsaturated fatty acids (PUFAs), was recorded in the group of overweight/obese T2D patients. Significant positive correlations were observed between apo B/apo A1 and total fat (p= 0.035), total SFAs (p= 0.042) and palmitic acid (p= 0.042) in the group of overweight/obese T2D patients and with ω6 fatty acid (p= 0.030) in the group of overweight/obese patients without diabetes. In the two groups of T2D patients, whether normal weight, overweight/obese, numerous positive correlations with TC/HDL-c were disclosed for PUFAs, ω6 and fatty acids ratios, namely, ω6/ω3, monounsaturated fatty acids (MUFA)/SFAs and (MUFAs+PUFAs)/SFAs. Conclusion: Most adults, whom are either affected by an excess weight or T2D or both together, are prone to cardiovascular risk. Dietary intakes, particularly in fat and its constituent fatty acids, have an important effect on blood lipid atherogenic indices (TC/HDL-c and apo B/apo A1 ratios).

1. Haslam DW, James WP. Obesity. Lancet 366: 1197-209, 2005.

2. Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world--a growing challenge. N Engl J Med 356: 213-5, 2007.

3. D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 117: 743-53, 2008.

4. Grover SA, Kaouache M, Rempel P et al. Years of life lost and healthy life-years lost from diabetes and cardiovascular disease in overweight and obese people: a modelling study. Lancet Diabetes Endocrinol 3: 114-22, 2015.

5. Raynor LA, Pankow JS, Duncan BB et al. Novel risk factors and the prediction of type 2 diabetes in the atherosclerosis risk in communities (ARIC) study. Diabetes Care 36: 70-6, 2013.

6. Després JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature 444: 881-7, 2006.

7. Buttar HS, Li T, Ravi N. Prevention of cardiovascular diseases: role of exercise, dietary interventions, obesity and smoking cessation. Exp Clin Cardiol 10: 229-49, 2005.

8. Walldius G, Jungner I, Holme I, Aastveit AH, Kolar W, Steiner E. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet 358: 2026-33, 2001.

9. Yusuf S, Hawken S, Ounpuu S et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364: 937-52, 2004.

10. Van der Steeg WA, Boekholdt SM, Stein EA et al. Role of the apolipoprotein B-apolipoprotein A-I ratio in cardiovascular risk assessment: a case-control analysis in EPIC-Norfolk. Ann Intern Med 146: 640-8, 2007.

11. Dunder K, Lind L, Zethelius B, Berglund L, Lithell H. Evaluation of a scoring scheme, including proinsulin and the apolipoprotein B/apolipoprotein A1 ratio, for the risk of acute coronary events in middle-aged men: Uppsala Longitudinal Study of Adult Men (ULSAM). Am Heart J 148: 596-601, 2004.

12. Lewington S, Whitlock G, Clarke R et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 370: 1829-39, 2007.

13. Genest J, McPherson R, Frohlich J et al. 2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult - 2009 recommendations. Can J Cardiol 25: 567-79, 2009.

14. Zhao W, Gong W, Wu N et al. Association of lipid profiles and the ratios with arterial stiffness in middle-aged and elderly Chinese. Lipids Health Dis 13:37, 2014.

15. NutriSurvey program 2007 for windows, SEAMEO-TROPMED RCCN-University of Indonesia (NutriSurvey, 2007). Accessed at:, 2014.

16. Bergmeyer HU, Gawehn K. Methods of enzymatic analysis Volume 4. Weinheim : Verlag Chemie, New York ; London, pp 2066-2072, 1974.

17. Tietz NW, Logan NM. Reference ranges. In: Fundamentals of Clinical Chemistry. Tietz NW (3rd ed). W. B. Saunders Company, Philadelphia, pp 944-975, 1987.

18. Lacroix A, Assal JP. L'éducation thérapeutique des patients : nouvelles approches de la maladie chronique. Maloine, Paris, pp 240, 2005.

19. Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases (2002: Geneva, Switzerland). WHO Technical Report Series 916. Accessed at:, 2015.

20. Moreiras TO, Carbajal AÁ, Cabrera L. Tablas de composición de alimentos. Pirámide (ed), Madrid, 2005.

21. Pelkman CL, Fishell VK, Maddox DH, Pearson TA, Mauger DT, Kris-Etherton PM. Effects of moderate-fat (from monounsaturated fat) and low-fat weight-loss diets on the serum lipid profile in overweight and obese men and women. Am J Clin Nutr 79: 204-12, 2004.

22. Mackay J, Mensah G. Atlas of Heart Disease and Stroke. Geneva: World Health Organization, 1st ed, 2004.

23. Cox-York KA, Sharp TA, Stotz SA, Bessesen DH, Pagliassotti MJ, Horton TJ. The effects of sex, metabolic syndrome and exercise on postprandial lipemia. Metabolism 62: 244-54, 2013.

24. Fogal AS, Franceschini Sdo C, Priore SE, Cotta RM, Ribeiro AQ. Stature estimation using the knee height measurement amongst Brazilian elderly. Nutr Hosp 31: 829-34, 2015.

25. Von Bibra H, Paulus WJ, St John Sutton M, Leclerque C, Schuster T, Schumm-Draeger PM. Quantification of diastolic dysfunction via the age dependence of diastolic function - impact of insulin resistance with and without type 2 diabetes. Int J Cardiol 182: 368-74, 2015.

26. Poehlman ET, Toth MJ, Ades PA, Rosen CJ. Menopause-associated changes in plasma lipids, insulinlike growth factor I and blood pressure: a longitudinal study. Eur J Clin Invest 27: 322-6, 1997.

27. Carroll MD, Lacher DA, Sorlie PD et al. Trends in serum lipids and lipoproteins of adults, 1960-2002. JAMA 294: 1773-81, 2005.

28. Ingelsson E, Schaefer EJ, Contois JH et al. Clinical utility of different lipid measures for prediction of coronary heart disease in men and women. JAMA 298: 776-85, 2007.

29. Leiter LA, Genest J, Harris SB et al. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Dyslipidemia in Adults with Diabetes.Canadian Journal of Diabetes 30: 230-40, 2006. Accessed at:, 2015.

30. Pereira T. Dyslipidemia and Cardiovascular Risk: Lipid Ratios as Risk Factors for Cardiovascular Disease. In: Dyslipidemia - From Prevention to Treatment. Roya Kelishadi (ed). InTech Publisher, Rijeka Croatia, pp 279-302, 2012.

31. Sallé A, Ryan M, Ritz P. Underreporting of food intake in obese diabetic and nondiabetic patients. Diabetes Care 29: 2726-7, 2006.

32. Visockienė Ž, Broom JI, Speakman JR, Johnstone AM. Dietary intake and self-reporting relation to eating behaviour in obese and type 2 diabetes patients. Baltic Endocrinology 2: 24-30, 2006. Accessed at :, 2015.

33. Tounian P. L’obésité de l’enfant, John Libbey Eurotext, Paris, pp 196, 2006.

34. García-Meseguer MJ, Burriel FC, García CV, Serrano-Urrea R. Adherence to Mediterranean diet in a Spanish university population. Appetite 78: 156-64, 2014.

35. Ruhee D, Mahomoodally F. Relationship between family meal frequency and individual dietary intake among diabetic patients. J Diabetes Metab Disord 14 : 66, 2015.

36. Ashwal E, Hod M. Gestational diabetes mellitus: Where are we now?. Clin Chim Acta 451(Pt A):14-20, 2015.

37. Phillips CM, Kesse-Guyot E, McManus R et al. High dietary saturated fat intake accentuates obesity risk associated with the fat mass and obesity-associated gene in adults. J Nutr 142: 824-31, 2012.

38. Risérus U, Arnlöv J, Berglund L. Long-term predictors of insulin resistance: role of lifestyle and metabolic factors in middle-aged men. Diabetes Care 30: 2928-33, 2007.

39. Pérez-Jiménez F, López-Miranda J, Pinillos MD et al. A Mediterranean and a high-carbohydrate diet improve glucose metabolism in healthy young persons. Diabetologia 44: 2038-43, 2001.

40. Badimón JJ, Santos-Gallego CG, Badimón L. Importance of HDL cholesterol in atherothrombosis: how did we get here? Where are we going?. Rev Esp Cardiol 63: 20-35, 2010.

41. Aryal M, Poudel A, Satyal B et al. Evaluation of non-HDL-c and total cholesterol: HDL-c ratio as cumulative marker of cardiovascular risk in diabetes mellitus. Kathmandu Univ Med J (KUMJ) 8: 398-404, 2010.

42. Stępień A, Stępień M, Wlazeł RN, Paradowski M, Banach M, Rysz J. Assessment of the relationship between lipid parameters and obesity indices in nondiabetic obese patients: a preliminary report. Med Sci Monit 20: 2683-8, 2014.

43. Lu M, Lu Q, Zhang Y, Tian G. ApoB/apoA1 is an effective predictor of coronary heart disease risk in overweight and obesity. J Biomed Res 25:266-73, 2011.

44. Jing F, Mao Y, Guo J et al. The value of Apolipoprotein B/Apolipoprotein A1 ratio for metabolic syndrome diagnosis in a Chinese population: a crosssectional study. Lipids Health Dis 13: 81, 2014.

Romanian Journal of Diabetes Nutrition and Metabolic Diseases

The Journal of Romanian Society of Diabetes Nutrition and Metabolic Diseases

Journal Information

CiteScore 2018: 0.19

SCImago Journal Rank (SJR) 2018: 0.128
Source Normalized Impact per Paper (SNIP) 2018: 0.229

Cited By


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 196 159 14
PDF Downloads 106 95 5