Insulin resistance mediate the association between leucine intake, dietary glycemic index, and type 2 diabetes in secondary cardiovascular prevention: path analysis from Brazilian cardioprotective nutritional (BALANCE) program.

Purpose: Insulin resistance (IR) is an important mediator of the relationship between food intake and the development of type 2 diabetes mellitus (T2DM). Most of the few studies that have evaluated this relationship relied on the triglyceride-glucose index (TyG index) tool. Here, we evaluated the association between leucine intake, glycemic index, and T2DM with related mediators in individuals throughout secondary cardiovascular prevention.

Methods: Sociodemographic, anthropometric, clinical, and food intake data were recorded from the baseline of the trial Brazilian Cardioprotective Nutritional (BALANCE) Program. Path analysis was used to explore the relationships between variables.

Results: This study enrolled 2,247 participants (median age of 63.0 (45-91) years; 58.8% males). The TyG index showed positive association with T2DM (SC = 0.356; p < 0.001) and negative association with leucine intake (SC= -0.046; p = 0.028). The glycemic index (GI) was positively associated with BMI (SC = 0.072; p = 0.001), and BMI had an indirect positive effect on T2DM mediated by the TyG index (SC = 0.078; p < 0.001). Leucine intake had indirect negative effect on T2DM, mediated by the TyG index (SC= -0.016; p = 0.029), while GI had indirect positive effect on T2DM mediated by BMI and TyG index (SC = 0.006; p = 0.002).

Conclusion: Leucine intake and GI showed indirect association with T2DM, mediated by TyG and BMI, in individuals on secondary cardiology prevention, reinforcing the importance of assessing food consumption and promotin food quality improvements for cardiometabolic control by different pathways. TRIAL REGISTRATION CLINICALTRIALS.

Gov identifier: NCT01620398. Registered 15 June 2012.