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OBJECTIVE - Markers of hemostasis and inflammation such as plasminogen activator inhibitor-1 (PAI-1) and fibrinogen have been associated with risk of type 2 diabetes. We aimed to identify food intake patterns influencing this pathway and evaluate their association with incident diabetes.
RESEARCH DESIGN AND METHODS - The Insulin Resistance Atherosclerosis Study cohort included 880 middle-aged adults initially free of diabetes. At the 5-year follow-up, 144 individuals had developed diabetes. Usual dietary intake was ascertained with a 114-item food frequency questionnaire. Using reduced rank regression, we identified a food pattern maximizing the explained variation in PAI-1 and fibrinogen. Subsequently, the food pattern-diabetes association was evaluated using logistic regression.
RESULTS - High intake of the food groups red meat, low-fiber bread and cereal, dried beans, fried potatoes, tomato vegetables, eggs, cheese, and cottage cheese and low intake of wine characterized the pattern, which was positively associated with both biomarkers. With increasing pattern score, the odds of diabetes increased significantly (P^sub trend^ < 0.01). After multivariate adjustment, the odds ratio comparing extreme quartiles was 4.3 (95% CI 1.7-10.8). Adjustment for insulin sensitivity and secretion and other metabolic factors had little impact (4.9, 1.8-13.7).
CONCLUSIONS - Our findings provide support for potential behavioral prevention strategies, as we identified a food intake pattern that was strongly related to PAI-1 and fibrinogen and independently predicted type 2 diabetes.
Diabetes Care 32:263-268, 2009
Markers of hemostasis and inflammation are considered risk factors in the pathogenesis of type 2 diabetes (1,2). Data from the Insulin Resistance Atherosclerosis Study (IRAS) indicate that the effect of plasminogen activator inhibitor-1 (PAI-1) on diabetes risk is independent not only of adiposity but also of insulin sensitivity (1). In the context of diabetes prevention, these findings challenge us to explore the determinants of the prothrombotic and inflammatory state, particularly modifiable risk factors such as dietary intake.
The importance of food and nutrient intake in the development of diabetes and its precursors is well recognized (3). The Diabetes Prevention Program trial provides evidence for the effectiveness of dietary and lifestyle modification approaches in the prevention of type 2 diabetes among high-risk individuals (4). The focus of the lifestyle intervention in the Diabetes Prevention Program was weight loss via modification of energy and fat intake and physical activity. To...