Abstract
BACKGROUND: Retinol binding protein 4 (RBP4) has been described as a link between impaired glucose uptake in adipocytes and systemic insulin sensitivity. OBJECTIVE: To determine whether RBP4 fasting levels predict the development of type 2 diabetes. METHODS: Using a case-cohort design, we followed 543 middle-aged individuals who developed diabetes and 537 who did not over ~9 years within the population-based Atherosclerosis Risk in Communities Study. Weighted Cox proportional hazards analyses permitted statistical inference of the RBP4 - incident diabetes associations to the entire cohort. RESULTS: Women in the highest tertile of RBP4 presented greater risk of developing diabetes (HR = 1.74; 95%CI 1.03 - 2.94) in analyses adjusted for age, ethnicity, study center, parental history of diabetes, hypertension, glomerular filtration rate, body mass index, waist-hip ratio, nonesterified fatty acids, adiponectin, leptin, triglycerides and HDL-C. When additionally adjusted for fasting insulin, this association's significance became borderline (HR = 1.68; 95%CI 1.00 - 2.82). No association between RBP4 levels and incident diabetes was found in men. CONCLUSION: These findings suggest that RBP4 levels may be directly involved in the pathogenesis of type 2 diabetes in women.