Total Flavonoid Intake Research Articles

Increased habitual flavonoid intake predicts attenuation of cognitive ageing in twins

BackgroundAlthough the pathophysiology of cognitive decline is multifactorial, and modifiable by lifestyle, the evidence for the role of diet on cognitive function is still accumulating, particularly the potentially preventive role of constituents of plant-based foods.MethodsWe aimed to determine whether higher habitual intake of dietary flavonoids, key components of plant-based diets, were associated with improved cognition and medial temporal lobe volumes using three complementary approaches (longitudinal, cross-sectional and co-twin analyses). In 1126 female twins (n=224 with a 10-year follow-up of diet and cognition data) aged 18–89 years, habitual intakes of total flavonoids and seven subclasses (flavanones, anthocyanins, flavan-3-ols, flavonols, flavones, polymeric flavonoids (and proanthocyanidins separately)) were calculated using validated food frequency questionnaires. Cognition was assessed using the Cambridge Neuropsychological Test Automated Battery test. Hippocampal volumes were measured in a subset using magnetic resonance imaging (16 monozygotic-twin pairs). Statistical models were adjusted for a range of diet and lifestyle factors.ResultsHigher intakes of flavanones (tertile (T)3-T1=0.45, 95%CI 0.13,0.77; p=0.01) and anthocyanins (T3-T1=0.45, 95%CI 0.08,0.81; p=0.02) were associated with improvements in age-related cognition score over 10 years. In cross-sectional analysis higher intake of flavanones (T3-T1= 0.12, 95% CI 0.02, 0.21; p=0.02) and proanthocyanidins (T3-T1= 0.13, 95% CI 0.02, 0.24; p=0.02) were associated with improved paired-associates learning. Higher intake of anthocyanins was significantly associated with improved executive function (T3-T1= −0.52, 95% CI 0.19, 0.84; p=0.001) and with faster simple reaction times (T3-T1= −18.1, 95% CI −35.4, −0.7; p=0.04). In co-twin analysis, those with higher anthocyanin (2.0%, p=0.01) and proanthocyanidin (2.0%, p=0.02) intakes at baseline had the largest left hippocampal volumes after 12 years.ConclusionSmall increases in habitual intake of flavonoid-rich foods (containing anthocyanins, flavanones and proanthocyanidins; equivalent to approximately two servings of oranges and blueberries per day) over long time periods have the potential to attenuate cognitive ageing.

Application of the Database of Flavonoid Values for USDA Food Codes 2007–2010 in assessing intake differences between the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study and What We Eat in America (WWEIA), NHANES

Flavonoids are polyphenolic plant compounds whose biological activities may promote human health. It is worthwhile to examine whether flavonoid intake varies between populations with differing prevalence of diet-related diseases. This study compared flavonoid intakes in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study with nationally representative estimates from What We Eat in America (WWEIA), NHANES stratified by sex, age (30−49, 50−64 years), and poverty status (income <125 %,>125 % of the 2004 HHS Poverty Guidelines). Flavonoid intakes from both surveys were estimated using the Database of Flavonoid Values for USDA Food Codes 2007–2010. Across all subpopulations analyzed, intake of anthocyanidins was lower in HANDLS (p < 0.01). Intakes of total flavonoids and all or most flavonoid classes were lower in HANDLS for men overall and in both age groups and for both men and women with poverty status <125 %. These findings of lower flavonoid intakes in HANDLS, particularly among men and those with the lowest incomes, suggest that flavonoid intake may be a factor in the high prevalence of diet-related disease in populations represented by HANDLS. This research illustrates how any survey using USDA’s food codes can utilize the Flavonoid Database in comparing flavonoid intakes.

Long-term Dietary Flavonoid Intake and Subjective Cognitive Decline in US Men and Women.

To prospectively examine the associations between long-term dietary flavonoids and subjective cognitive decline (SCD). We followed 49,493 women from the Nurses' Health Study (NHS) (1984-2006) and 27,842 men from the Health Professionals Follow-Up Study (HPFS) (1986-2002). Poisson regression was used to evaluate the associations between dietary flavonoids (flavonols, flavones, flavanones, flavan-3-ols, anthocyanins, polymeric flavonoids, and proanthocyanidins) and subsequent SCD. For the NHS, long-term average dietary intake was calculated from 7 repeated semiquantitative food frequency questionnaires (SFFQs), and SCD was assessed in 2012 and 2014. For the HPFS, average dietary intake was calculated from 5 repeated SFFQs, and SCD was assessed in 2008 and 2012. Higher intake of total flavonoids was associated with lower odds of SCD after adjustment for age, total energy intake, major nondietary factors, and specific dietary factors. In a comparison of the highest vs the lowest quintiles of total flavonoid intake, the pooled multivariable-adjusted odds ratio (OR) of 3-unit increments in SCD was 0.81 (95% confidence interval [CI] 0.76, 0.89). In the pooled results, the strongest associations were observed for flavones (OR 0.62 [95% CI 0.57, 0.68]), flavanones (0.64 [0.58, 0.68)]), and anthocyanins (0.76 [0.72, 0.84]) (p trend <0.001 for all groups). The dose-response curve was steepest for flavones, followed by anthocyanins. Many flavonoid-rich foods such as strawberries, oranges, grapefruits, citrus juices, apples/pears, celery, peppers, and bananas, were significantly associated with lower odds of SCD. Our findings support a benefit of higher flavonoid intakes for maintaining cognitive function in US men and women.

Habitual flavonoid intake and ischemic stroke incidence in the Danish Diet, Cancer, and Health Cohort

ABSTRACTBackgroundFlavonoid-rich foods have antiinflammatory, antiatherogenic, and antithrombotic properties that may contribute to a lower risk of ischemic stroke.ObjectivesWe aimed to investigate the relationship between habitual flavonoid consumption and incidence of ischemic stroke in participants from the Danish Diet, Cancer and Health Study.DesignIn this prospective cohort study, 55,169 Danish residents without a prior ischemic stroke [median (IQR) age at enrolment of 56 y (52–60)], were followed for 21 y (20–22). We used Phenol-Explorer to estimate flavonoid intake from food frequency questionnaires obtained at study entry. Incident cases of ischemic stroke were identified from Danish nationwide registries and restricted cubic splines in Cox proportional hazards models were used to investigate relationships with flavonoid intake.ResultsDuring follow-up, 4237 individuals experienced an ischemic stroke. Compared with participants in Q1 and after multivariable adjustment for demographics and lifestyle factors, those in Q5—for intake of total flavonoids, flavonols, and flavanol oligo + polymers—had a 12% [HR (95% CI): 0.88 (0.81, 0.96)], 10% [0.90 (0.82, 0.98)], and 18% [0.82 (0.75, 0.89)] lower risk of ischemic stroke incidence, respectively. Multivariable (demographic and lifestyle) adjusted associations for anthocyanins and flavones with risk of ischemic stroke were not linear, with moderate but not higher intakes associated with lower risk [anthocyanins Q3 vs. Q1 HR (95% CI): 0.85 (0.79, 0.93); flavones: 0.90 (0.84, 0.97)]. Following additional adjustment for dietary confounders, similar point estimates were observed; however, significance was only retained for anthocyanins and flavanol oligo + polymers [anthocyanins Q3 vs. Q1 HR (95% CI): 0.86 (0.79, 0.94); flavanol oligo + polymers Q5 vs. Q1 0.86 (0.78, 0.94)].ConclusionsThese findings suggest that moderate habitual consumption of healthy flavonoid-rich foods is associated with a lower risk of ischemic stroke and further investigation is therefore warranted.

Assessment of dietary intake of bioactive food compounds according to income level in the Brazilian population.

There is an inverse association between bioactive compounds intake and disease risk. The knowledge of its consumption according to socio-economic strata is important, which allows identification of potential intervention targets. Thus, we aimed to investigate bioactive compounds intake according to income level in Brazilian population. Data were obtained from the Brazilian Household Budget Survey, a cross-sectional survey which included data on individual food intake of 34,003 subjects aged 10 years and over collected using two 24-h dietary records. Polyphenol and carotenoid content of foods was identified using published databases. Total polyphenol and carotenoid intake were determined according to per capita income, as well as main food sources. Total polyphenols and flavonoids intake increased with income level, and subjects with lower income showed higher phenolic acids intake than individuals in highest income (p = 0.0001). Total carotenoids and classes intake (with exception to β-cryptoxanthin and zeaxanthin) were higher among subjects in highest income quartile, compared to the lowest quartile (p = 0.0001). Coffee was major source to total polyphenols and phenolic acids intake, and orange juice was main flavonoid provider in individuals from all income levels. In the upper income quartile, total carotenoid was supplied mainly by tomato and kale, and fruits had important contribution to carotenoid intake in the lowest income quartile. There is important influence of income level on diet quality regarding intake of foods with bioactive compounds, and individuals with lower income may experience lower quality diets due to less availability of foods with bioactive compounds.

The protective effects of dietary intake of flavonoids and its subclasses on metabolic syndrome incidence

This study aimed to evaluate the association between the intake of total flavonoids and flavonoid subclasses and metabolic syndrome (MetS) risk and to assess the modulating effects of lifestyle factors on these associations. A total of 1915 participants from the Tehran Lipid and Glucose Study were followed-up during 2006–2008 and 2016–2018. Their dietary intake was assessed by a food frequency questionnaire at baseline and within three-year intervals afterward. Moreover, the modifying effect of weight gain on the association between total flavonoids and MetS was assessed by Cox regression analysis. Participants in the highest tertile of flavonoid, flavonol, and flavone had a significantly lower MetS risk as compared to those in the lowest tertile. Also, in participants with weight gain <7%, all flavonoid subclasses had a more pronounced risk-reducing effect. Overall, the total flavonoid, flavonol, and flavone reduced the risk of MetS; this association could be modified by weight gain.

A Prospective Study of Dietary Flavonoid Intake and Risk of Glioma in US Men and Women

Abstract Objectives Flavonoids are a diverse group of plant constituents with demonstrated neuroprotective and anti-tumor effects. Flavonoid intake may decrease glioma risk, an association that has not yet been investigated in humans. The objective of this study was to evaluate the association between dietary flavonoid consumption and glioma risk in participants in the female Nurses’ Health Study (1984–2014, n = 81,688) and Nurses’ Health Study II (1991–2017, n = 95,228), and the male Health Professionals Follow-up Study (1986–2014, n = 49,884). Methods Exposure was average long-term (up to 30 years) and recent (up to 12 years) intake of total flavonoids and six flavonoid subclasses, derived from validated quadrennial food frequency questionnaires. The primary outcome was incident glioma, confirmed by medical record review. Results We documented 536 incident cases of glioma across 5,936,386 person-years of follow-up. Long-term total flavonoid, flavan-3-ol, and polymer intake was associated with decreased glioma risk in pooled analyses comparing highest to lowest quintile of consumption (total flavonoid hazard ratio (HR) = 0.79, 95% CI: 0.59–1.05, P-trend = 0.04; flavan-3-ol HR = 0.76, 95% CI: 0.57–1.01, P-trend = 0.04; polymer HR = 0.82, 95% CI: 0.61–1.09, P-trend = 0.05). Associations with recent intake were weaker and not statistically significant. There were no associations with other flavonoid subclasses. After additional adjustment for tea consumption, there was no significant association between flavan-3-ol or polymer consumption and glioma. Conclusions Increased dietary intake of flavan-3-ol and polymeric flavonoids, especially those predominant in tea, was associated with decreased glioma risk in a prospective cohort of men and women. Habitual consumption of foods and beverages containing flavan-3-ols and polymeric flavonoids may protect against the development of glioma. Funding Sources This work was supported by the U.S. National Institutes of Health.

Abstract MP66: Higher Habitual Flavonoid Intakes Are Associated With A Lower Incidence Of Diabetes

Introduction: The promotion of evidence-based diets is an important s trategy to mitigate the global health and economic burden of diabetes. Higher flavonoid intakes are associated with a lower risk of obesity and diabetes. Less clear are associations of the flavonoid subclasses with diabetes, the mediating impact of body fat, and the identification of subpopulations that may receive the greatest benefit. Hypothesis: Higher flavonoid intakes will be associated with lower body fat at baseline and a lower risk of diabetes during follow-up. Methods: Incident diabetes was assessed in 54,787 participants of the Danish Diet, Cancer, and Health Study followed-up for 23 years. Dietary intake and objective measures of body fat were assessed at baseline; habitual flavonoid intake was calculated using the Phenol-Explorer database and body fat was objectively assessed using bioelectrical impedance. Incidence of diabetes was obtained using Danish National Patient and Prescription Registries. Cross-sectional associations between flavonoid intakes and body fat were assessed using multivariable-adjusted linear regression models. Non-linear associations between flavonoid intake and incident diabetes were examined using restricted cubic splines based on multivariable-adjusted Cox proportional hazards models. Results: Among 54,787 participants without diabetes at baseline (median [IQR] age of 56 [52 - 60] years; (47.3%) men), 6,700 individuals were diagnosed with diabetes. Participants in the highest total flavonoid intake quintile (median, 1,202 mg/d) had a 1.52 kg lower body fat (95% CI: -1.74, -1.30) and a 19% lower risk of diabetes [HR (95% CI): 0.81 (0.75, 0.87)] after multivariable adjustments and compared to participants in the lowest intake quintile (median, 174 mg/d). Body fat mediated 51.6% of the association between flavonoid intake and incident diabetes. Neither smoking status, BMI, nor sex appeared to modify the association between total flavonoid intake and incident diabetes. However, the difference (flavonoid intake quintile 5 - quintile 1) in the 20-year estimated absolute risk of diabetes was greatest for current smokers (males: 2.19%, females: 1.65%) and those with a BMI ≥30 kg/m 2 (males: 5.56%, females: 4.59%), likely owing to the higher prevalence of diabetes in these “at risk” subgroups. Moderate to high intakes of flavonols, flavanol monomers, flavanol oligo+polymers, and anthocyanins, and the individual compounds within these subclasses, were associated with a lower risk of diabetes. Conclusion: In this Danish prospective cohort study, we observed that higher flavonoid intakes were cross-sectionally associated with lower body fat, and longitudinally associated with a lower risk of diabetes. Our results suggest that promoting a diet abundant in flavonoid-rich foods may help to ameliorate diabetes risk, in part through a reduction in body fat.

Antioxidants Such as Flavonoids and Carotenoids in the Diet of Bogor, Indonesia Residents

Due to the strong antioxidant activity of flavonoids and carotenoids, daily consumption of these bioactive compounds has the potential for reducing the risk of many chronic and degenerative diseases caused by or contributed to by oxidative stress. Currently, the available research results related to the flavonoid and carotenoid intake in Asian countries are very limited, especially for Indonesian population. The present study was conducted in Bogor City and Bogor District, West Java, Indonesia. Food consumption data was obtained through the food frequency questionnaire (FFQ) method, involving 200 respondents aged 25–65 years old. Flavonoids and carotenoids contents of the consumed food items were determined by referring to the databases developed by the United States Department of Agriculture (USDA), scientific journals, and calculation based on the recipes recorded in the survey. The total flavonoid intake of Bogor adults was estimated as 149.5 mg/day, consisting of 49.4% isoflavones, 24.0% flavonols, 9.4% flavanones, 7.0% flavan-3-ols, 6.0% flavones, and 4.2% anthocyanidins, and was contributed to mainly by legumes (70.7%), vegetables (10.1%), and fruits (7.3%). At the same time, the estimated total carotenoid intake reached 7.6 mg/day, and was contributed to mainly by vegetables (53.9%), fruits (20.2%), and snacks (14.4%), with β-carotene consumed in the highest proportion (49.9%), followed by lycopene (19.9%), lutein and zeaxanthin (13.5%), α-carotene (6.9%), and β-cryptoxanthin (2.6%). The effects of different respondents’ characteristics, such as area of residence (city vs. district), gender (male vs. female), and age (25–40, 41–55, and 56–65 years old) on the flavonoid and carotenoid intake varied widely, due to the differences in the overall consumption patterns of the respective respondents’ groups.

Association between health risk factors and dietary flavonoid intake in cohort studies

The aim of this study was to identify the health risk factors associated with flavonoid intake in cohort studies investigating the association between dietary polyphenols and the risk of cardiovascular disease (CVD). A systematic search of the PubMed and EMBASE databases was performed. Prospective studies with the background characteristics given for categories of flavonoid intake were eligible to inclusion. A bivariate meta-analysis summarising the intercepts and slopes of the linear regression and a dose-response meta-analysis of differences in means were used to analyse the relationships. The intake of total flavonoids was inversely associated with BMI, alcohol consumption, saturated fat intake, and current smoking, and positively associated with vitamin E, folate, fibre, beta-carotene intake, multivitamin supplement use, and high physical activity. The results of this study underline the importance of considering the association between dietary flavonoid consumption and CVD risk in the context of a healthy lifestyle.

Dietary Flavonoids and Cardiovascular Disease: A Comprehensive Dose-Response Meta-Analysis.

Dietary flavonoids have shown potential in the prevention of noncommunicable diseases. The aim of the present study is to conduct a dose-response meta-analysis on the association between dietary intake of total, subclasses and individual flavonoids and risk of cardiovascular disease (CVD). Electronic databases are searched. A total of 39 prospective cohort studies are included, comprising 1 501 645 individuals and a total of 33 637 cases of CVD, 23 664 of coronary heart disease (CHD), and 11 860 of stroke. Increasing dietary intake of total flavonoids is linearly associated with a lower risk of CVD. Among the main classes of flavonoids, increasing intake of anthocyanins and flavan-3-ols is inversely associated with risk of CVD, while flavonols and flavones with CHD. Only increasing flavanones showed a linear inverse association with stroke risk. Catechins showed a favorable effect toward all cardiovascular outcomes. Among individual compounds, intake of quercetin and kaempferol is linearly associated with lower risk of CHD and CVD, respectively. However, higher intake of all the aforementioned compounds is associated, with a various extent, with a lower risk of CVD when considering comparison of extreme categories of consumption. The results of this study provide evidence of potential cardiovascular benefits of a flavonoid-rich diet.

Association between dietary flavonoid intakes and C-reactive protein levels: a cross-sectional study in Taiwan.

Although the intake of specific flavonoid-rich foods may reduce C-reactive protein (CRP) levels, the association between dietary flavonoid intakes and CRP is inconsistent. We aim to describe dietary flavonoid intakes in a Taiwanese nationally representative sample and to investigate the association between flavonoid intakes and CRP. We conducted a cross-sectional study based on 2592 adults from the Nutrition and Health Survey in Taiwan 2005-8. Flavonoid intakes were estimated by linking the 24-h dietary recall with the U.S. Department of Agriculture flavonoid database and divided into quartiles. Adjusted estimates of the flavonoid intakes for the continuous and binary (elevated CRP: >0⋅3 mg/dl) variables were performed by using general linear and logistic regression. We found that tea, orange, tofu and sweet potato leaves/water spinach constituted the major food items of the total flavonoid intake. The total flavonoid intake was lower among women and elderly. Compared with the lowest total flavonoid intake quartile, participants in higher quartiles were associated with a lower CRP status (adjusted odds ratio (OR): 0⋅61, 95 % confidence interval (CI): 0⋅44-0⋅86 for the highest quartiles). The trends were similar for flavonol and flavan-3-ol intakes. Compared with non-consumers, tea consumers were likely to have a lower CRP status (adjusted OR: 0⋅74, 95 % CI: 0⋅57-0⋅97). In brief, a higher total flavonoid intake and tea consumption were inversely associated with CRP levels, indicating that a high-flavonoid diet may contribute to anti-inflammatory effects. A Taiwanese flavonoid content table is necessary for conducting further studies related to flavonoids in Taiwan.

Higher habitual flavonoid intakes are associated with a lower risk of peripheral artery disease hospitalizations

ABSTRACTBackgroundThe role of nutrition in the primary prevention of peripheral artery disease (PAD), the third leading cause of atherosclerotic cardiovascular disease, is undetermined. Flavonoids may attenuate atherosclerosis and therefore persons who consume flavonoid-rich foods may have a lower risk of developing PAD.ObjectivesWe aimed to examine the association between flavonoid intake and PAD hospitalizations and investigate if the association differs according to established risk factors for PAD.MethodsBaseline data from 55,647 participants of the Danish Diet, Cancer, and Health Study without PAD, recruited from 1993 to 1997, were cross-linked with Danish nationwide registries. Flavonoid intake was calculated from FFQs using the Phenol-Explorer database. Associations were examined using multivariable-adjusted restricted cubic splines based on Cox proportional hazards models.ResultsAfter a median [IQR] follow-up time of 21 [20–22] y, 2131 participants had been hospitalized for any PAD. The association between total flavonoid intake and total PAD hospitalizations was nonlinear, reaching a plateau at ∼750–1000 mg/d. Compared with the median flavonoid intake in quintile 1 (174 mg/d), an intake of 1000 mg/d was associated with a 32% lower risk of any PAD hospitalization (HR: 0.68; 95% CI: 0.60, 0.77), a 26% lower risk of atherosclerosis (HR: 0.74; 95% CI: 0.62, 0.88), a 28% lower risk of an aneurysm (HR: 0.72; 95% CI: 0.59, 0.88), and a 47% lower risk of a hospitalization for other peripheral vascular disease (HR: 0.53; 95% CI: 0.42, 0.67). A higher total flavonoid intake was also significantly associated with a lower incidence of revascularization or endovascular surgery and lower extremity amputation. The association between total flavonoid intake and PAD hospitalizations differed according to baseline smoking status, alcohol intake, BMI, and diabetes status.ConclusionsEnsuring the adequate consumption of flavonoid-rich foods, particularly in subpopulations prone to the development of atherosclerosis, may be a key strategy to lower the risk of PAD.

Flavonoid intake and incident dementia in the Danish Diet, Cancer, and Health cohort.

IntroductionProspective studies investigating flavonoid intake and dementia risk are scarce. The aims of this study were to examine associations between flavonoid intake and the risk of incident dementia and to investigate whether this association differs in the presence of lifestyle risk factors for dementia.MethodsWe examined associations in 55,985 participants of the Danish Diet, Cancer, and Health Study followed for 23 years. The Phenol‐Explorer database was used to estimate flavonoid intakes. Information on incident dementia and dementia subtypes was obtained using Danish patient and prescription registries. Hazard ratios (HRs) were calculated using restricted cubic splines in multivariable‐adjusted Cox proportional hazards models.ResultsFor incident dementia, moderate compared to low intakes of flavonols (HR: 0.90 [0.82, 0.99]), flavanol oligo+polymers (HR: 0.87 [0.79, 0.96]), anthocyanins (HR: 0.84 [0.76, 0.93]), flavanones (HR: 0.89 [0.80, 0.99]), and flavones (HR: 0.85 [0.77, 0.95]) were associated with a lower risk. For vascular dementia, moderate intakes of flavonols (HR: 0.69 [0.53, 0.89]) and flavanol oligo + polymers (HR: 0.65 [0.51, 0.83]) were associated with lower risk. Flavonoid intakes were not significantly associated with Alzheimer's disease or unspecified dementia. The inverse association between total flavonoid intake and incident dementia was stronger in “ever” smokers than in “never” smokers and in those without hypercholesterolemia versus those with hypercholesteremia. Furthermore, the inverse association of vascular dementia with a moderate total flavonoid intake was stronger in “ever” smokers and those who were “normal” to “overweight” versus “never” smokers or those who were “obese,” respectively.ConclusionA moderate intake of flavonoid‐rich foods may help to reduce dementia risk.

The association of dietary flavonoids, magnesium and their interactions with the metabolic syndrome in Chinese adults: a prospective cohort study.

The aim was to systematically analyse the association of the specific flavonoids, Mg and their interactions from different food sources with the metabolic syndrome (MetS) and its components in a cohort study. A total of 6417 participants aged 20 to 74 years from the Harbin Cohort Study on Diet, Nutrition and Chronic Non-communicable Diseases were included. Multivariate logistic regression analyses, forest plot and restricted cubic spline were performed in the study. After a 5·3-year follow-up, 1283 incident cases of the MetS were reported. Those with a higher total flavonoid intake had a lower risk of the MetS (fourth v. first quartile, relative risk (RR) 0·58; 95 % CI 0·37, 0·93; P = 0·024) and central obesity (RR 0·56; 95 % CI 0·33, 0·95; P = 0·032). Further analysis showed that the specific flavonoids quercetin, kaempferol, isorhamnetin, luteolin, and flavonoids from fruits, potatoes and legumes had the similar associations with risk of the MetS and central obesity (P < 0·05 for all). A higher intake of total flavonoids, quercetin and luteolin combined with a high level of Mg was more strongly associated with a lower risk of the MetS (RR 0·60; 95 % CI 0·45, 0·81 for total; RR 0·61; 95 % CI 0·45, 0·82 for quercetin; RR 0·52; 95 % CI 0·38, 0·71 for luteolin; all Pfor interaction < 0·01). Dose-response effects showed an L-shaped curve between the total intake of five flavonoids and the risk of the MetS. A higher flavonoid intake is associated with a lower risk of the MetS and central obesity; their combination with Mg helps to strengthen their negative association with the MetS.

Association between flavonoid intake and risk of hypertension in two cohorts of Australian women: a longitudinal study.

Epidemiological evidence suggests higher dietary flavonoid intake is associated with lower risk of several chronic diseases. This study aimed to investigate the association between intake of flavonoids and their subclasses, and incidence of hypertension among Australian women in two age cohorts. This population-based study included 6599 middle-aged (52.5 ± 1.5years) and 6099 reproductive-aged (27.5 ± 1.5years) women from the Australian Longitudinal Study on Women's Health. Food frequency questionnaires were used to quantify intake of flavonoids by cross-referencing with the Phenol-Explorer food composition database. Generalised Estimating Equation analyses investigated associations with incident hypertension, adjusting for demographic and dietary variables and hypertension risk factors. There were 1645 cases (24.9%) of hypertension during 15years follow-up in the middle-aged cohort and 336 cases (5.5%) during 12years follow-up in the reproductive-aged cohort. Higher intakes of flavones [adjusted relative risk (ARR) for quintile 5 vs. 1: 0.82, 95% CI 0.70-0.97], isoflavones (0.86, 0.75-0.99) and flavanones (0.83, 0.69-1.00) were associated with a lower risk of hypertension in the middle-aged cohort. In the reproductive-aged cohort, higher intakes of flavanols (0.70, 0.49-0.99) were associated with a lower risk of hypertension. Key foods that provided these flavonoids were oranges, orange juice, apples, red wine and soy milk. Higher intakes of total flavonoids and subclasses were associated with a lower risk of hypertension in Australian women. These findings can be used in nutrition messaging and policies for improved cardiovascular health of women.

Habitual dietary intake of flavonoids and all-cause and cause-specific mortality: Golestan cohort study

Background and objectivesFlavonoids are the most important group of polyphenols with well-known beneficial effects on health. However; the association of intake of total flavonoid or their subclasses with all-cause or cause-specific mortality is not fully understood. The present study aims to evaluate the association between intake of total flavonoid, flavonoid subclasses, and total and cause-specific mortality in a developing country.MethodsA total number of 49,173 participants from the Golestan cohort study, who completed a validated food frequency questionnaire at recruitment, were followed from 2004 till 2018. Phenol-Explorer database was applied to estimate dietary intakes of total flavonoid and different flavonoid subclasses. Associations were examined using adjusted Cox proportional hazards models.ResultsDuring a mean follow-up of 10.63 years, 5104 deaths were reported. After adjusting for several potential confounders, the hazard ratios (HRs) of all-cause mortality for the highest versus the lowest quintile of dietary flavanones, flavones, isoflavonoids, and dihydrochalcones were 0.81 (95% confidence interval = 0.73–0.89), 0.83(0.76–0.92), 0.88(0.80–0.96) and 0.83(0.77–0.90), respectively. However, there was no association between total flavonoid intake or other flavonoid subclasses with all-cause mortality. In cause-specific mortality analyses, flavanones and flavones intakes were inversely associated with CVD mortality [HRs: 0.86(0.73–1.00) and 0.85(0.72–1.00)] and isoflavonoids and dihydrochalcones were the only flavonoid subclasses that showed a protective association against cancer mortality [HR: 0.82(0.68–0.98)].ConclusionThe results of our study suggest that certain subclasses of flavonoids can reduce all-cause mortality and mortality rate from CVD and cancer.

Association Between Dietary Flavonoids Intake and Cognitive Function in an Italian Cohort

Background: Diet is one of the leading factors contributing to the prevalence of non-communicable diseases, including neurodegenerative disorders. Dietary polyphenols, antioxidant components and anti-inflammatory agents of plant-based foods rich diets have been shown to modulate neuro-inflammation, adult neurogenesis and brain signaling, all of which are linked to cognitive function. As epidemiological evidence is limited and the results are contradictory, the aim of this study is to explore the association between dietary flavonoid intake and cognitive health among the adult population living in the Mediterranean area. Methods: The demographic and dietary habits of 808 adults living in southern Italy were analyzed. Food frequency questionnaires (FFQs) were used to assess dietary intake. Data on the polyphenol content in foods were estimated using the Phenol-Explorer database. The Short Portable Mental Status Questionnaire was used as a screening tool for cognitive status. Multivariate logistic regression analyses were used to assess the associations. Results: A significant inverse association between higher dietary intake of total flavonoids (Q4 vs. Q1: OR = 0.39, 95% CI: 0.15, 1.00) and impaired cognitive status was found. Among individual subclasses of flavonoids, flavan-3-ols (Q3 vs. Q1: OR = 0.30, 95% CI: 0.11, 0.76), catechins (Q4 vs. Q1: OR = 0.24, 95% CI: 0.08, 0.72), anthocyanins (Q4 vs. Q1: OR = 0.38, 95% CI: 0.14, 1.00) and flavonols (Q3 vs. Q1: OR = 0.30, 95% CI: 0.11, 0.76) were associated with cognitive health. Among individual polyphenols, only quercetin was associated with cognitive health (Q4 vs. Q1: OR = 0.30, 95% CI: 0.10, 0.91). Conclusions: The results of this study suggest that higher dietary intake of flavonoids may be associated with better cognitive health among adult individuals.

Flavonoid Intakes in the US Diet Are Linked to Higher Socioeconomic Status and to Tea Consumption: Analyses of NHANES 2011–16 Data

Many of the health benefits of tea have been attributed to its flavonoid content. Tea consumption in US adults varies by socioeconomic status (SES). The present objective was to explore intakes of total flavonoids and flavonoid subclasses by participant sociodemographics and by patterns of tea consumption. The present analyses were based on 2 d of dietary recalls for 17,506 persons aged >9 y in the 2011-2016 NHANES. The What We Eat in America nutrient composition database was merged with the USDA Expanded Flavonoid database, which included total flavonoids and flavan-3-ols (including catechins), flavanones, flavonols, anthocyanidins, flavones, and isoflavones. Flavonoid intakes were compared by sex, age, race/ethnicity, education, and income-to-poverty ratio (IPR) in univariate analyses. Flavonoid intakes of children and adults were also compared by tea consumption status. Time trends in flavonoid intakes were also examined. Mean total flavonoid intake was 219mg/d, of which flavan-3-ols provided 174mg/d, or 79%. The highest total flavonoid intakes were found in adults aged 51-70y (293mg/d), non-Hispanic whites (251 mg/d) and in groups with college education (251mg/d) and higher income (IPR>3.5: 249mg/d) (P<0.001 for all). The socioeconomic gradient was significant for anthocyanidins, flavonols, and flavones (P<0.001 for all) but not for flavan-3-ols, and persisted across 3 cycles of NHANES. Adult tea consumers had higher intakes of total flavonoids (610mg/d compared with 141mg/d) and flavan-3-ols (542mg/d compared with 97.8mg/d) than did nonconsumers (P<0.001). Time trend analyses showed that both tea consumption and flavonoid intakes were unchanged from 2011 to 2016. Flavonoid intakes in children and adults in the NHANES 2011-16 sample were associated with higher SES and were largely determined by tea consumption. Studies of diet and disease risk need to take sociodemographic gradients and eating and drinking habits into account.

Higher flavonoid intake is associated with a lower progression risk of non-alcoholic fatty liver disease in adults: a prospective study.

Flavonoid-rich foods have shown a beneficial effect against non-alcoholic fatty liver disease (NAFLD) in short-term randomised trials. It is uncertain whether the usual dietary intake of flavonoids may benefit patients with NAFLD. The present study evaluated the association between the usual intake of flavonoids and the risk of progression in NAFLD. The prospective study included 2694 adults from the Guangzhou Nutrition and Health Study. Face-to-face interviews using a seventy-nine-item FFQ were administered to assess habitual dietary flavonoid intake, while abdominal ultrasonography was conducted to evaluate the presence and degree of NAFLD, with measurements conducted 3 years apart. After adjustment for potential confounders, higher flavonoid intakes were gradely associated with reduced risks of worsen NAFLD status. The relative risks of worsening (v. non-worsening) NAFLD in the highest (v. lowest) quintile were 0·71 (95 % CI 0·54, 0·93) for total flavonoids, 0·74 (95 % CI 0·57, 0·95) for flavanones, 0·74 (95 % CI 0·56, 0·96) for flavan-3-ols, 0·90 (95 % CI 0·68, 1·18) for flavonols, 0·73 (95 % CI 0·56, 0·93) for flavones, 0·79 (95 % CI 0·61, 1·02) for isoflavones and 0·74 (95 % CI 0·57, 0·96) for anthocyanins. An L-shaped relationship was observed between total flavonoid intake and the risk of NAFLD progression. Path analyses showed that the association between flavonoids and NAFLD progression was mediated by decreases in serum cholesterol and homeostasis model assessment of insulin resistance. This prospective study showed that higher flavonoid intake was associated with a lower risk of NAFLD progression in the elderly overweight/obese Chinese population.