Abstract
Overweight and obesity are important risk factors for type 2 diabetes (T2D). Moving towards healthier diets, namely, diets rich in bioactive compounds, could decrease the odds of suffering T2D. However, those individuals with high body mass index (BMI) may have altered absorption or metabolism of some nutrients and dietary components, including polyphenols. Therefore, we aimed to assess whether high intakes of some classes of polyphenols are associated with T2D in a population with metabolic syndrome and how these associations depend on BMI and sex. This baseline cross-sectional analysis includes 6633 participants from the PREDIMED-Plus trial. Polyphenol intakes were calculated from food frequency questionnaires (FFQ). Cox regression models with constant time at risk and robust variance estimators were used to estimate the prevalence ratios (PRs) for polyphenol intake and T2D prevalence using the lowest quartile as the reference group. Analyses were stratified by sex and BMI groups (overweight and obese) to evaluate potential effect modification. Catechins, proanthocyanidins, hydroxybenzoic acids, and lignans were inversely associated with T2D. Hydroxycinnamic acids were directly related in men. These associations were different depending on sex and BMI, that is, women and overweight obtained stronger inverse associations.
Highlights
The number of people with diabetes has been increasing over the past few decades and the estimations for the near future are not encouraging
Previous epidemiological studies have investigated the association between intake of polyphenols and type 2 diabetes (T2D), but this is the first study that quantifies the association between the intake of different polyphenol subgroups and T2D accounting for differences by sex and body mass index (BMI)
In a previous longitudinal study conducted in a similar cohort (PREDIMED study), proanthocyanidins and catechins showed the same association with new-onset
Summary
The number of people with diabetes has been increasing over the past few decades and the estimations for the near future are not encouraging. It is well known that plant-based diets including whole grains, fruits, vegetables, legumes, and nuts as well as moderate alcohol consumption have been associated with lowering the risk of T2D, whereas diets rich in refined grains, red or processed meats, and sugar-sweetened beverages increase the risk [2]. Plant foods are usually rich in polyphenols, a large and heterogeneous group of bioactive compounds that constitute the first source of antioxidants in the diet. Polyphenols are usually classified according to their structure into two main groups—flavonoids and non-flavonoids. The flavonoid group, with C6–C3–C6 structured compounds, includes flavones, flavonols, theaflavins, catechins, proanthocyanidins (polymeric forms), flavanones, anthocyanidins, and isoflavones. Some of the mechanisms by which dietary polyphenols and their metabolites exert their effects have been elucidated but others are still unknown [4]
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