Fiber Intake and Plasminogen Activator Inhibitor-1 in Type 2 Diabetes: Look AHEAD (Action for Health in Diabetes) Trial Findings atBaseline and Year 1

L. Maria Belalcazar, Andrea M. Anderson, Wei Lang, Dawn C. Schwenke, Steven M. Haffner, Hiroshi Yatsuya, Julia Rushing, Mara Z. Vitolins, Rebecca Reeves, F. Xavier Pi-Sunyer, Russell P. Tracy, Christie M. Ballantyne

Research output: Contribution to journalArticle

4 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1800-1810.e2
JournalJournal of the Academy of Nutrition and Dietetics
Issue number11
StatePublished - Nov 1 2014



  • Cardiovascular disease risk
  • Fibrinolysis
  • Lifestyle intervention
  • Obesity
  • Weight loss

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics

Cite this

Belalcazar, L. M., Anderson, A. M., Lang, W., Schwenke, D. C., Haffner, S. M., Yatsuya, H., Rushing, J., Vitolins, M. Z., Reeves, R., Pi-Sunyer, F. X., Tracy, R. P., & Ballantyne, C. M. (2014). Fiber Intake and Plasminogen Activator Inhibitor-1 in Type 2 Diabetes: Look AHEAD (Action for Health in Diabetes) Trial Findings atBaseline and Year 1. Journal of the Academy of Nutrition and Dietetics, 114(11), 1800-1810.e2.