Plasma activity of the platelet-activating factor acetylhydrolase (PAF-AH) plays an important role in inflammation and atherosclerotic process in chronic diseases. We aimed to evaluate the levels of PAFAH activity and their association with the metabolic profile and chronic complications in patients with type 1 diabetes. The study included 118 outpatients (54 males) aged 27.1±11.3 years with disease duration of 12.3±8.5 years with (n = 38) or without (n = 80) diabetes complications and 96 control subjects (48 males) matched for age, gender, body mass index and smoking habits. The serum levels of PAF-AH activity were higher in patients either with or without chronic complications (16±5.3 and 14±5.4 nmol/(min mL), respectively) than in controls (13±5.1 nmol/(min mL), P = 0.02). In the total population, PAF-AH activity was correlated with age, HDL-cholesterol, total cholesterol and LDL-cholesterol. In patients, PAF-AH activity was correlated with age, HbA1c, uric acid, HDL-cholesterol, cholesterol, LDL-cholesterol, cholesterol/HDL-cholesterol ratio and the LDL-cholesterol/HDL-cholesterol ratio. It is concluded that PAF-AH plasma activity could be a novel candidate for low-grade inflammatory marker in patients with type 1 diabetes.