Associations of dietary flavonoids and subclasses with total and cardiovascular mortality among 369,827 older people: The NIH-AARP Diet and Health Study

Abstract

Background and aimsThis study aimed to investigate the associations between flavonoid intake and total and cardiovascular mortality in the older participants from the prospective National Institute of Health-American Association of Retired Persons Diet and Health Study. MethodsWe included 369,827 eligible participants (mean age 61.2 ± 5.4 years) who were free of cardiovascular diseases (CVDs), cancers, diabetes, and end-stage renal disease at baseline. Dietary flavonoids and major subclasses (flavan-3-ols, flavones, anthocyanidins, flavonones, and flavonols) were assessed using a validated food frequency questionnaire. ResultsDuring a median follow-up of 23.5 years, we identified 143,403 deaths, of which 40,660 from CVDs. After adjustment for major confounders, total dietary flavonoids and most flavonoid subclasses were related to significantly lower total mortality (hazard ratios: 0.87–0.94), comparing the highest and lowest quintiles. Besides, higher intakes of total flavonoids, flavonols, anthocyanidins, and flavones were consistently associated with lower risks of death from all CVDs (hazard ratios: 0.90–0.93), ischemic heart disease (hazard ratios: 0.89–0.94), cerebrovascular disease (hazard ratios: 0.84–0.89), and peripheral artery disease (hazard ratios: 0.79–0.81). Subgroup analysis revealed that the inverse relationships between dietary flavonoids and total and CVD mortality were more evident in former/current smokers than in never-smokers. ConclusionsIn conclusion, high intakes of flavonoids were linked to lower total and CVD mortality among older people. Our results extended the current evidence that frequent consumption of flavonoids could be a practical approach to improving cardiovascular health during aging.