Diet and Paraoxonase 1 Enzymatic Activity in Diabetic Foot Patients from Romania and Belgium: Favorable Association of High Flavonoid Dietary Intake with Arylesterase Activity

Abstract

Background/Aims: The antiatherosclerotic enzyme paraoxonase (PON1) is affected by disease and lifestyle. We investigated the impact of diet in diabetic foot patients from 2 European countries. Methods: Dietary intake and serum PON1 activity, using as substrate paraoxon (paraoxonase) or phenylacetate (arylesterase), were assessed in patients from Bucharest (n = 40) and Antwerp (n = 30) and in 34 healthy controls. Results: The diabetic patients had lower paraoxonase and arylesterase activities than the controls. Arylesterase was lowest in the Bucharest patients, 116 ± 42 U/ml, versus 141 ± 43 and 184 ± 49 U/ml in the Antwerp patients and controls, respectively (p < 0.0005). The Bucharest patients had worse glycemic control, higher blood pressure, lower HDL cholesterol and a diet richer in cholesterol and poorer in monounsaturated fats and fish. In contrast, their median intake of vitamins E and C, folic acid and flavonoids was higher, 82 mg (range: 4–259 mg), versus 28 mg (range: 5–169 mg) aglycone units in Antwerp (p = 0.005). Flavonoid intake predicted arylesterase independently of HDL cholesterol, region and sex (β = 0.27; p = 0.03), and patients with high intake achieved normal levels of arylesterase (30.1 ± 10.0 U/µmol in the highest versus 21.0 ± 8.2 U/µmol total cholesterol in the lowest tertile; p = 0.02). Conclusion: A flavonoid-rich diet is positively associated with PON1 arylesterase activity in diabetic foot patients.