Alpha-Linolenic Acid and Mortality Among Adults With Type 2 Diabetes: Findings From Two National Cohorts

Boyang Chen; Qi Wu; Sibo Liu; Hongkun Di; Wen Hu; Tianzhu Qin; Yushuang Wang; Rong Chen; Han Wang; Ying Chen; Xiang Cheng; Jiawei Yin; Liegang Liu; Zhilei Shan

doi:10.1111/1753-0407.70110

Alpha-Linolenic Acid and Mortality Among Adults With Type 2 Diabetes: Findings From Two National Cohorts

J Diabetes. 2025 Jun;17(6):e70110. doi: 10.1111/1753-0407.70110.

Authors

Boyang Chen^{1

2

3}, Qi Wu^{1

2}, Sibo Liu^{1

2}, Hongkun Di^{1

2}, Wen Hu^{1

2}, Tianzhu Qin^{1

2}, Yushuang Wang^{1

2}, Rong Chen^{1

2}, Han Wang^{1

2}, Ying Chen⁴, Xiang Cheng⁵, Jiawei Yin^{6

7}, Liegang Liu^{1

2}, Zhilei Shan^{1

2}

Affiliations

¹ Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Institute of Nutrition and Food Hygiene, Beijing Changping District Center for Disease Control and Prevention, Beijing, China.
⁴ Ministry of Education Key Laboratory of Metabolism and Molecular Medicine, Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.
⁵ Department of Cardiology, Tongji Medical College Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
⁶ Department of Nutrition and Food Hygiene, School of Public Health, Chongqing Medical University, Chongqing, China.
⁷ Nutrition Innovation Platform-Sichuan and Chongqing, School of Public Health, Chongqing Medical University, Chongqing, China.

Abstract

Background: Dietary alpha-linolenic acid (ALA) regulates lipid metabolism and insulin sensitivity, but few studies have investigated the association between ALA and the risk of mortality among adults with type 2 diabetes (T2D). This study examines whether increasing dietary ALA intake contributes to the long-term survival of adults with T2D.

Methods: This cohort study included 9603 participants with T2D, including 7953 adults from the National Health and Nutrition Examination Survey (NHANES; 1999-2018) and 1650 adults from the China Health and Nutrition Survey (CHNS; 1997-2011). Dietary information was collected through 24-h dietary recalls. Cox proportional hazards regression was employed to estimate hazard ratios (HRs) and 95% CIs for mortality from all-cause and cardiovascular disease (CVD).

Results: During 75 535 person-years of follow-up, a total of 2468 deaths were documented. After multivariate adjustment, the pooled HRs (95% CIs) of all-cause mortality were 1.00, 0.87 (0.76-0.99), and 0.79 (0.67-0.94) across tertiles of ALA (p_trend = 0.01). There was a linear inverse relationship between ALA intake and all-cause mortality, demonstrating a 9% (HR: 0.91;95% CI: 0.85_0.97) lower risk of all-cause mortality with each 1 g/day increase of dietary ALA intake in the pooled analysis (p_nonlinear > 0.05). In addition, ALA intake was inversely associated with CVD mortality, and HR comparing the highest with the lowest tertile was 0.68 (0.50-0.91; p_trend = 0.01). Consistent results were observed in both the stratified and sensitivity analyses.

Conclusions: Higher dietary ALA intake was associated with a lower risk of all-cause and CVD mortality among adults with T2D.

Keywords: alpha‐linolenic acid; cardiovascular mortality; cohort analysis; mortality; type 2 diabetes.

MeSH terms

Adult
Aged
Cardiovascular Diseases* / mortality
China / epidemiology
Cohort Studies
Diabetes Mellitus, Type 2* / mortality
Diet
Female
Follow-Up Studies
Humans
Male
Middle Aged
Nutrition Surveys
Risk Factors
United States / epidemiology
alpha-Linolenic Acid* / administration & dosage

Substances

alpha-Linolenic Acid

Abstract

MeSH terms

Substances

Grants and funding