Abstract 14657: Fiber Intake and Plasminogen Activator Inhibitor-1 in Obese Persons With Type 2 Diabetes, Findings From the Look Ahead (Action for Health in Diabetes) Study
Background: Look AHEAD is a multicenter clinical trial designed to examine whether a lifestyle intervention for weight loss will reduce cardiovascular events in overweight/obese persons with type 2 diabetes (T2DM). Dietary fiber is associated with cardiovascular benefits. Its association with markers of fibrinolytic capacity and vascular health in obese persons with diabetes is not well understood. Plasminogen activator inhibitor-1 (PAI-1) is elevated in T2DM and may contribute to cardiovascular disease (CVD) by favoring fibrin deposition and affecting vascular remodeling.
Objective: To determine if increased fiber intake in overweight/obese persons with T2DM is associated with lower levels of PAI-1 independently of medication use, adiposity, fitness and alcohol and macronutrient intake.
Methods: A subset of 1,679 Look AHEAD participants with dietary data obtained with a food frequency questionnaire had levels of PAI-1 (latent and active) and fitness (exercise stress test) measured at baseline. The association of energy-adjusted fiber intake and PAI-1 levels was examined using multivariate regression analysis in a model adjusting for fat, carbohydrate, alcohol and total calorie intake. Covariates included demographics, fitness, BMI, HDL-cholesterol, triglycerides, HbA1c, thiazolidinedione, statin and insulin use, hormone replacement in women, T2DM duration, smoking and CVD history.
Results: Participants (41% male, age 57 ± 7.2 years, BMI 36.2 ± 6.1 kg/m2, HbA1c 7.3 ±1.2 % and fitness level under the 20th percentile for their age) had a low total fiber intake of 18.9 ± 8.2 grams/day. Median PAI-1 levels were elevated at 45.4 (interquartile range 25.21 -75.46) ng/mL. In the model, higher fiber intakes were associated with lower PAI-1 levels (B-coefficient -0.007, SE 0.003, p=0.014 for fiber residual and log-transformed PAI-1); whereas fat (p=0.007) and alcohol intake (p=0.016) were positively associated with higher PAI-1 levels. Of the remaining modifiable predictors only HDL-cholesterol (p<0.001) was inversely associated with PAI-1 levels.
Conclusion: Higher fiber intake was associated with lower PAI-1 levels in persons with T2DM, independently of multiple dietary, demographic, metabolic and treatment-related variables.
- © 2010 by American Heart Association, Inc.