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Association of Apolipoprotein B with Incident Type 2 Diabetes in an Aboriginal Canadian Population¹

¹ Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada;² Center for Studies in Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada;³ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada;⁴ The Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada;⁵ Sandy Lake Health and Diabetes Project, Sandy Lake, Ontario, Canada;⁶ Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;⁷ Robarts Research Institute at the University of Western Ontario, London, Ontario, Canada;⁸ Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada;⁹ Leadership Sinai Centre for Diabetes and¹⁰ Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada;

^aaddress correspondence to this author at: Department of Nutritional Sciences, University of Toronto, FitzGerald Building, 150 College St., Rm. 341, Toronto, Ontario, M5S 3E2 Canada. Fax 416-978-5882; e-mail anthony.hanley{at}utoronto.ca.

Abstract

Background: Expanding evidence indicates that apolipoprotein B (apo B) is superior to LDL cholesterol as a marker of vascular disease. Although traditional lipid measures are known to predict type 2 diabetes, limited data are available regarding apo B. We assessed the association of apo B with incident type 2 diabetes and compared it with traditional lipid variables as a risk predictor in aboriginal Canadians.

Methods: Of an initial cohort of 606 individuals without diabetes in 1993–1995, 540 were contacted for the 10-year follow-up evaluation in 2003–2005. Fasting and 2-h postload glucose concentrations were obtained at baseline and follow-up to determine incident type 2 diabetes. Baseline fasting serum lipids were measured with standard laboratory procedures.

Results: The cumulative 10-year incidence of type 2 diabetes was 17.5%. High concentrations of apo B, triglycerides, and LDL cholesterol, and low concentrations of HDL cholesterol were individually associated with incident type 2 diabetes in univariate analyses. Comparing C statistics of univariate models showed apo B to be a superior determinant of incident diabetes compared with LDL (P = 0.026) or HDL (P = 0.004) cholesterol. With multivariate adjustment including waist circumference, apo B (odds ratio, 1.50; 95% CI, 1.11–2.02) and triglycerides (odds ratio, 1.49; 95% CI, 1.12–1.98) remained associated with incident diabetes, whereas LDL and HDL cholesterol became nonsignificant.

Conclusions: The association of plasma apo B with incident type 2 diabetes and its better prediction of risk compared with LDL or HDL cholesterol suggest the potential for the use of apo B in type 2 diabetes risk communication and prevention.