title: Fiber intake and plasminogen activator inhibitor-1 in type 2 diabetes: Look AHEAD (Action for Health in Diabetes) trial findings at baseline and year 1.
abstract: Plasminogen activator inhibitor 1 (PAI-1) is elevated in obese individuals with type 2 diabetes and may contribute, independently of traditional factors, to increased cardiovascular disease risk. Fiber intake may decrease PAI-1 levels. We examined the associations of fiber intake and its changes with PAI-1 before and during an intensive lifestyle intervention (ILI) for weight loss in 1,701 Look AHEAD (Action for Health in Diabetes) participants with dietary, fitness, and PAI-1 data at baseline and 1 year. Look AHEAD was a randomized cardiovascular disease trial in 5,145 overweight/obese patients with type 2 diabetes, comparing ILI (goal of ≥7% reduction in baseline weight) with a control arm of diabetes support and education. ILI participants were encouraged to consume vegetables, fruits, and grain products low in sugar and fat. At baseline, median fiber intake was 17.9 g/day. Each 8.3 g/day higher fiber intake was associated with a 9.2% lower PAI-1 level (P=0.008); this association persisted after weight and fitness adjustments (P=0.03). Higher baseline intake of fruit (P=0.019) and high-fiber grain and cereal (P=0.029) were related to lower PAI-1 levels. Although successful in improving weight and physical fitness at 1 year, the ILI in Look AHEAD resulted in small increases in fiber intake (4.1 g/day, compared with -2.35 g/day with diabetes support and education) that were not related to PAI-1 change (P=0.34). Only 31.3% of ILI participants (39.8% of women, 19.1% of men) met daily fiber intake recommendations. Increasing fiber intake in overweight/obese individuals with diabetes interested in weight loss is challenging. Future studies evaluating changes in fiber consumption during weight loss interventions are warranted.
authors.forename: L Maria
authors.initials: LM
authors.lastname: Belalcazar
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Anderson
authors.forename: Wei
authors.initials: W
authors.lastname: Lang
authors.forename: Dawn C
authors.initials: DC
authors.lastname: Schwenke
authors.forename: Steven M
authors.initials: SM
authors.lastname: Haffner
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yatsuya
authors.forename: Julia
authors.initials: J
authors.lastname: Rushing
authors.forename: Mara Z
authors.initials: MZ
authors.lastname: Vitolins
authors.forename: Rebecca
authors.initials: R
authors.lastname: Reeves
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Pi-Sunyer
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
mesh_terms: D001521:Behavior Therapy; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000178:diet therapy / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D058065:Diabetic Cardiomyopathies / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D004038:Diet, Reducing; D004043:Dietary Fiber / Q000627:therapeutic use*; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000097:blood / Q000150:complications / Q000178:diet therapy / Q000628:therapy*; D010349:Patient Compliance; D010809:Physical Fitness; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D012306:Risk; D013781:Texas / Q000453:epidemiology; D015431:Weight Loss
chemical_list: D004043:Dietary Fiber; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human
keywords: Cardiovascular disease risk; Fibrinolysis; Lifestyle intervention; Obesity; Weight loss