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Do colonic short-chain fatty acids contribute to the long-term adaptation of blood lipids in subjects with type 2 diabetes consuming a high-fiber diet?^1,2,3

¹ From the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto (TMSW, KBS, JAV, and EBT); the Clinical Nutrition and Risk Factor Modification Centre and the Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto (TMSW); and Kellogg Company, Battle Creek, MI (MIM).

Background: We recently obtained evidence of long-term adaptation of blood lipids to changes in intakes of carbohydrate and fiber in subjects with type 2 diabetes.

Objective: We determined the effect of increased carbohydrate and fiber intakes on serum short-chain fatty acids (SCFAs) and the relation between changes in serum acetate and changes in blood lipids.

Design: Subjects with type 2 diabetes (n = 62) were randomly assigned to receive 10% of energy from low-fiber breakfast cereal (LF diet), high-fiber breakfast cereal (HF diet), or monounsaturated fatty acids (MUFA diet) for 6 mo.

Results: Carbohydrate intakes were higher in the LF and HF groups than in the MUFA group (54% compared with 43%), and more fiber was consumed by the HF group (50 g/d) than by the LF or MUFA group (23 g/d). Fasting serum SCFAs did not change significantly over the first 3 mo. Between 3 and 6 mo, serum acetate tended (NS) to decrease in the LF group (from 69 ± 4 to 59 ± 5 µmol/L) and increase in the HF group (from 100 ± 18 to 107 ± 17 µmol/L), with no significant change in the MUFA group. Serum butyrate did not change significantly in the LF or MUFA group but increased in the HF group (from 2.5 ± 0.5 to 3.1 ± 0.6 µmol/L; P < 0.001). Changes in serum acetate from 0 to 3 mo were not related to changes in lipids. However, changes in serum acetate from 3 to 6 mo were positively related to changes in the ratio of total to HDL cholesterol (P = 0.041) and in fasting (P = 0.013) and postprandial (P = 0.016) triacylglycerols.

Conclusions: In subjects with type 2 diabetes, changes in serum SCFAs in response to changes in carbohydrate and fiber intakes took many months to occur, and the changes in serum acetate were significantly related to the long-term adaptive changes in blood lipids.

Key Words: Type 2 diabetes • short-chain fatty acids • high-fiber diet • acetate • carbohydrate intake • fiber intake

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