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The Role of Dietary Factors in Accumulation of Pericardial Adipose Tissue Volume in the Coronary Artery Calcification in Type 1 Diabetes Study

Individuals with type 1 diabetes (T1D) are at a significantly higher risk of cardiovascular disease (CVD) compared to non‐diabetics. The mortality rate from ischemic heart disease in T1D is higher than in the general population in both men and women, but the relative risk is increased to a greater extent in women than in men with T1D, and the mechanisms for this increased risk are not fully understood. Regional fat depots around the heart have received increasing attention because of a shared origin with abdominal visceral fat and influence on cardiometabolic risk. Specifically, pericardial adipose tissue (PAT) volume has been associated with severity of atherosclerosis and incident CVD. The Coronary Artery Calcification in Type 1 Diabetes (CACTI) study cohort has prospectively followed 652 men and women with T1D and 764 non‐diabetic controls over the last 16 years. We examined PAT volume, measured from cardiac CT scans, at baseline and after 3 and 6 years of follow‐up, along with dietary factors from food frequency questionnaires using linear mixed effects models. Models were adjusted for potential confounders including age, race/ethnicity, BMI, HDL cholesterol, triglycerides, and systolic blood pressure. We hypothesized that specific dietary factors would be associated with the degree of PAT accumulation over time. Overall, we found a strong sex by diabetes status by time interaction on PAT volume, with men accumulating more PAT than women, and men with T1D accumulating less PAT than non‐diabetic men while women with T1D accumulated a similar amount of PAT when compared to non‐diabetic women. There were no interactions by diabetes status for any of the dietary factors. Higher fiber (P<0.001) and Vitamin D (P=.0386) intake were associated with less PAT accumulation. Surprisingly, higher intake of total sugar (P=.0016), sucrose (P=.0275), and glycemic load (P=.0121) were each associated with less PAT accumulation, and there was no association found between total fat (P=.095) nor the ratio of unsaturated/saturated fat in the diet (P=.3981) and PAT accumulation. These latter findings require further investigation, including looking at multiple dietary factors simultaneously with the development and application of a more holistic dietary quality score.