1131-OR: A Plant-Based Diet Reduces Intramyocellular and Hepatocellular Lipids and Improves Beta-Cell Function in Adults with Type 2 Diabetes: A 16-Week Clinical Trial

Introduction and Objective: The aim of this study was to explore the effects of a low-fat plant-based diet on hepatocellular and intramyocellular lipids, advanced glycation end-products (AGEs), insulin resistance, and beta-cell function in adults with type 2 diabetes. Methods: Participants (n=24) were asked to follow a low-fat vegan diet for 16 weeks. Dual X-ray absorptiometry was used to measure body composition. Hepatocellular and intramyocellular lipids were quantified by 1H magnetic resonance spectroscopy. Tissue accumulation of AGEs was measured, using skin fluorescence. Insulin resistance was assessed with the Homeostasis Model Assessment (HOMA-IR) index and PREDIM (Predicted insulin sensitivity index). Beta-cell function was assessed by a mathematical model after a standard meal, using C-peptide deconvolution. Results: Body weight decreased by 6.0 kg (95% CI -7.0 to -5.1; p<0.001). This was largely due to the reduction in fat mass (-4.2 kg [95% CI -5.7 to -2.7]; p<0.001). Visceral fat volume also fell on the vegan diet (-290 cm3 [95% CI -467 to -114]; p=0.003). Hepatocellular lipids decreased by 33.2% (95% CI -48.8 to -17.6; p<0.001). HbA1c fell by 1.0% (95% CI -1.5 to -0.5; p<0.001). The AGE score decreased by 0.4 (95% CI -0.6 to -0.2; p=0.002). HOMA-IR index, a measure of insulin resistance, fell (-2.5 [95% CI, -4.1 to -0.9]; p=0.004), and PREDIM, a measure of insulin sensitivity, increased on the vegan diet (+1.3 mg/min/kg [95% CI, +0.6 to +2.1]; p=0.002). Several markers of beta-cell improved on the vegan diet. Specifically, insulin secretion at 6 and 7 mmol/L (glucose concentration), glucose sensitivity, rate sensitivity, and potentiation factor all increased. Conclusion: We have demonstrated that an ad libitum low-fat plant-based dietary intervention reduces ectopic fat, particularly visceral and hepatocellular fat, decreases insulin resistance, reduces AGEs, and improves beta-cell function in adults with type 2 diabetes. Disclosure H. Kahleova: None. Funding Physicians Committee for Responsible Medicine.