ESC Congress 2026 Abstract · Oct 26, 2026
Acylcarnitines as markers of early cardiometabolic dysregulation in a population-based sample of apparently healthy adults
By Maung KK, Borreggine R, Gallart-Ayala H et al.
Background: Acylcarnitines (AC), intermediates of mitochondrial fatty acid oxidation, have been linked to metabolic dysregulation and adiposity; however, evidence in apparently healthy adults remains limited. We aimed to examine associations between circulating AC species and adiposity-related markers and systemic inflammation cross-sectionally, and with 10-year incidence of diabetes in a population-based cohort. Methods: We analysed data from 1,977 apparently healthy participants in our city, Switzerland. Thirty AC species were quantified. Anthropometric markers included weight, body mass index (BMI), waist circumference, waist-to-height ratio (WHtR) and body roundness index (BRI). Inflammatory markers included high-sensitivity C-reactive protein (hs-CRP). Multivariable regression models adjusted for demographic and lifestyle confounders were used. Incident diabetes was defined as HbA1c ≥6.5% or initiation of glucose-lowering medication at follow-up. P-values were corrected using false discovery rate (FDR). Results: Short-chain AC, particularly Propionyl- and Isovalerylcarnitine, together with free carnitine, showed the strongest positive associations with multiple adiposity markers after adjustment, with consistent patterns across BMI, waist circumference, WHtR and BRI. Medium- and long-chain AC displayed weaker or inconsistent associations. Associations with inflammatory markers were modest; only Adipoylcarnitine remained positively associated with hs-CRP after adjustment. Over 10 years, 35 participants developed diabetes. Nominal associations between selected short-chain AC and incident diabetes were observed but were attenuated after adjustment for adiposity and did not remain significant after FDR correction. Conclusion: In apparently healthy adults, short-chain acylcarnitines are consistently associated with adiposity-related phenotypes, supporting their role as markers of early metabolic alterations. Prospective associations with diabetes appear modest and largely adiposity-driven.