Very long-chain ceramides in muscle associate with insulin resistance independent of obesity

Lipids, in particular ceramides and diacylglycerols (DAGs), are implicated in insulin resistance, however their precise roles remain unclear. We leverage natural genetic variation to examine muscle lipids and systemic insulin resistance (IR) in 399 Diversity Outbred Australia mice. Adipose mass was associated with 55% of muscle lipids and IR, with DAGs as the only enriched lipid class. To disentangle adiposity and muscle lipid contributions, we used two approaches: (1) linear modelling of muscle lipids corrected for adipose mass on systemic IR, and (2) stratifying mice into insulin sensitivity quartiles within adiposity bins. Both revealed that very long-chain ceramides, but not DAGs, were linked to IR. Transcriptomic and proteomics further associated these ceramides with cellular and mitochondrial stress. DAGs correlated with leptin expression in muscle, suggesting they originate from muscle-residing adipocytes. We propose that many muscle lipids, including DAGs, associate with IR due to adipose accumulation rather than directly influencing muscle insulin sensitivity. By addressing the relationship between adiposity and metabolic state, we identified very long-chain muscle ceramides as highly associated with IR independently of adiposity.