Abstract P196: Unhealthful Dietary Intake Pattern Identified by Reduced Rank Regression is Associated with Increased Arterial Stiffness among Youth with Type 1 Diabetes

Abstract

Introduction: Youth with type 1 diabetes (T1DM) are at substantially increased risk for adverse vascular outcomes, but little is known about the influence of dietary behavior on cardiovascular disease (CVD) risk profile and outcomes. Objective: We applied reduced rank regression (RRR) to identify a specific dietary pattern that explained the maximum amount of variation in CVD risk factors, and was strongly associated with markers of arterial stiffness (AS) in a cohort of youth with T1DM. Methods: Baseline diet data from a food frequency questionnaire and CVD risk factors (triglycerides, LDL-cholesterol, systolic blood pressure, hemoglobin A1c, C-reactive protein and waist circumference) were available for 1,153 youth aged ≥10 years with T1DM from the SEARCH for Diabetes in Youth Study. Dietary intake patterns were identified using 33 food-groups as predictors and six CVD risk factors as responses in an RRR analysis. AS outcomes were measured on average 18.9±7.1 months after the baseline diet assessment and were available only in a subset of participants from the SEARCH CVD pilot study. Associations between the RRR-derived dietary pattern explaining the maximum variation in CVD risk factors and AS measures [augmentation index(AIx75),n=229; pulse wave velocity(PWV),n=237; and brachial distensibility(BrachD),n=228] were then assessed using linear regression. Results: The RRR-derived pattern of interest was characterized by high intakes of sugar-sweetened beverages (SSB) and diet soda, eggs, potatoes and high-fat meats, and low intakes of sweets/desserts and low-fat dairy; major contributors were SSB and diet soda. This pattern captured the largest variability in the adverse CVD risk profile and was subsequently positively associated with AIx75 in the final model (β=0.47; p<0.01). The mean difference in AIx75 concentration between the highest and the lowest dietary pattern quartiles was 4.3% in fully adjusted model. Associations of the dietary pattern with the other measures of AS, PWV and BrachD, were attenuated and became non-significant after adjustment for potential confounders. Conclusions: Intervention strategies to reduce consumption of unhealthful foods and beverages among youth with T1DM may significantly improve CVD risk profile and ultimately reduce the risk for AS. Future studies with larger samples are needed to explore the associations between the derived dietary pattern and other measures of AS (PWV and BrachD), which can provide further insights into possible pathways linking diet to AS in this high risk population.