Abstract
The aim of this study was to examine the independent association between flavonoid intake and hypo-high-density lipoprotein (HDL)-cholesterolemia and the potential modifying effect of polyunsaturated fatty acid (PUFA) intake on this association among Korean adults. This cross-sectional analysis used data from 10,326 subjects who participated in the 2013–2016 Korean National Health and Nutrition Examination Survey. Multiple logistic regression analyses were used to assess the associations of flavonoid and PUFA intakes with hypo-HDL-cholesterolemia prevalence. Proanthocyanidins intake showed an inverse relationship with hypo-HDL-cholesterolemia only in men (Tertile (T) 3 vs. T1: odds ratio (OR) = 0.74, 95% confidence interval (CI) = 0.59–0.92, p-trend = 0.0330). Total flavonoid and PUFA intakes were not associated with hypo-HDL-cholesterolemia in both men and women. However, when stratified by PUFA intake, there was an inverse relationship between total flavonoid intake and hypo-HDL-cholesterolemia prevalence in men with a high n-3 PUFA intake (total flavonoid intakes T3 vs. T1: OR = 0.59, 95% CI = 0.42–0.82, p-trend = 0.0004) or a low n-6/n-3 PUFA intake ratio (T3 vs. T1: OR = 0.67, 95% CI = 0.48–0.93, p-trend = 0.0053), but not in those with a low n-3 PUFA intake (p-interaction = 0.0038) or a high n-6/n-3 PUFA intake ratio (p-interaction = 0.1772). In women, no association was found between total flavonoid intake and hypo-HDL-cholesterolemia, regardless of PUFA intake. These results imply that the intake of proanthocyanidins might have beneficial effects on the HDL-cholesterol level in Korean men. In addition, n-3 PUFA intake might modify the association of total flavonoid intake with the hypo-HDL-cholesterolemia among Korean men.
Highlights
The World Health Organization Global Burden of Diseases report estimated that 17,858,000 people died of cardiovascular diseases (CVD) in 2016, accounting for 31.4% of all deaths worldwide [1]
We examined the effects of the flavonoid on hypo-High-density lipoprotein (HDL)-cholesterolemia as well as the effect modification of polyunsaturated fatty acid (PUFA) intakes on this association in Korean adults
Total flavonoid intake was not associated with hypo-HDL-cholesterolemia, but the prevalence of hypo-HDL-cholesterolemia was low in men who consumed high amounts of proanthocyanidins
Summary
The World Health Organization Global Burden of Diseases report estimated that 17,858,000 people died of cardiovascular diseases (CVD) in 2016, accounting for 31.4% of all deaths worldwide [1]. High-density lipoprotein (HDL)-cholesterol is a well-known protective factor against CVD as HDL-cholesterol can lower the risk of atherosclerosis through multiple pathophysiologic mechanisms, such as reverse cholesterol transport and antioxidant and anti-inflammatory activities [3,4,5]. Flavonoids, phytochemicals rich in fruits and vegetables, are known to have antioxidant and anti-inflammatory effects that have the potential to increase HDL-cholesterol levels, reducing the risk of CVD [6,7]. A recent meta-analysis of 15 cohort studies concluded that there is an inverse association between flavonoid intake and CVD-associated mortality [8]. A recent systematic review of randomized controlled trials (RCT) demonstrated the positive effects of the intakes of flavonoid supplements, extracts, flavonoid-rich foods, and flavonoid-fortified foods on both the levels and functions of HDL-cholesterol [9]
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