• Joshua A Bell, Caroline J Bull, Marc J Gunter, David Carslake, Anubha Mahajan, Davey SmithGeorgeGMedical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, U.K.Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K., Nicholas J Timpson, and Emma E Vincent.
• Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, U.K. j.bell@bristol.ac.uk.
• Diabetes Care. 2020 Jul 1; 43 (7): 1537-1545.

ObjectiveType 2 diabetes develops for many years before diagnosis. We aimed to reveal early metabolic features characterizing liability to adult disease by examining genetic liability to adult type 2 diabetes in relation to metabolomic traits across early life.Research Design And MethodsUp to 4,761 offspring from the Avon Longitudinal Study of Parents and Children were studied. Linear models were used to examine effects of a genetic risk score (162 variants) for adult type 2 diabetes on 229 metabolomic traits (lipoprotein subclass-specific cholesterol and triglycerides, amino acids, glycoprotein acetyls, and others) measured at age 8 years, 16 years, 18 years, and 25 years. Two-sample Mendelian randomization (MR) was also conducted using genome-wide association study data on metabolomic traits in an independent sample of 24,925 adults.ResultsAt age 8 years, associations were most evident for type 2 diabetes liability (per SD higher) with lower lipids in HDL subtypes (e.g., -0.03 SD [95% CI -0.06, -0.003] for total lipids in very large HDL). At 16 years, associations were stronger with preglycemic traits, including citrate and with glycoprotein acetyls (0.05 SD; 95% CI 0.01, 0.08), and at 18 years, associations were stronger with branched-chain amino acids. At 25 years, associations had strengthened with VLDL lipids and remained consistent with previously altered traits, including HDL lipids. Two-sample MR estimates among adults indicated persistent patterns of effect of disease liability.ConclusionsOur results support perturbed HDL lipid metabolism as one of the earliest features of type 2 diabetes liability, alongside higher branched-chain amino acid and inflammatory levels. Several features are apparent in childhood as early as age 8 years, decades before the clinical onset of disease.© 2020 by the American Diabetes Association.

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