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Dietary Intakes of Individual Flavanols and Flavonols Are Inversely Associated with Incident Type 2 Diabetes in European Populations

Zamora-Ros, Raul; Forouhi, Nita G.; Sharp, Stephen J.; Gonzalez, Carlos A.; Buijsse, Brian; Guevara, Marcela; van der Schouw, Yvonne T.; Amiano, Pilar; Boeing, Heiner and Bredsdorff, Lea, et al. (2014) In Journal of Nutrition 144(3). p.335-343
Abstract
Dietary flavanols and flavonols, flavonoid subclasses, have been recently associated with a lower risk of type 2 diabetes (T2D) in Europe. Even within the same subclass, flavonoids may differ considerably in bioavailability and bioactivity. We aimed to examine the association between individual flavanol and flavonol intakes and risk of developing T2D across European countries. The European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study was conducted in 8 European countries across 26 study centers with 340,234 participants contributing 3.99 million person-years of follow-up, among whom 12,403 incident T2D cases were ascertained and a center-stratified subcohort of 16,154 individuals was defined. We... (More)
Dietary flavanols and flavonols, flavonoid subclasses, have been recently associated with a lower risk of type 2 diabetes (T2D) in Europe. Even within the same subclass, flavonoids may differ considerably in bioavailability and bioactivity. We aimed to examine the association between individual flavanol and flavonol intakes and risk of developing T2D across European countries. The European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study was conducted in 8 European countries across 26 study centers with 340,234 participants contributing 3.99 million person-years of follow-up, among whom 12,403 incident T2D cases were ascertained and a center-stratified subcohort of 16,154 individuals was defined. We estimated flavonoid intake at baseline from validated dietary questionnaires using a database developed from Phenol-Explorer and USDA databases. We used country-specific Prentice-weighted Cox regression models and random-effects meta-analysis methods to estimate HRs. Among the flavanol subclass, we observed significant inverse trends between intakes of all individual flavan-3-ol monomers and risk of T2D in multivariable models (all P-trend < 0.05). We also observed significant trends for the intakes of proanthocyanidin dimers (HR for the highest vs. the lowest quintile. 0.81; 95% Cl: 0.71, 0.92; P-trend = 0.003) and trimers (HR: 0.91; 95% Cl: 0.80, 1.04; P-trend = 0.07) but not for proanthocyanidins with a greater polymerization degree. Among the flavonol subclass, myricetin (HR: 0.77; 95% Cl: 0.64, 0.93; P-trend = 0.001) was associated with a lower incidence of T2D. This large and heterogeneous European study showed inverse associations between all individual flavan-3-ol monomers, proanthocyanidins with a low polymerization degree, and the flavonol myricetin and incident T2D. These results suggest that individual flavonoids have different roles in the etiology of T2D. (Less)
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Journal of Nutrition
volume
144
issue
3
pages
335 - 343
publisher
American Society for Nutrition
external identifiers
  • wos:000332054300014
  • scopus:84894237371
ISSN
1541-6100
DOI
10.3946/jn.113.184945
language
English
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765ca14f-73f1-4f8d-a0c6-72da6e5fc3aa (old id 4417670)
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2014-05-05 07:21:02
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@article{765ca14f-73f1-4f8d-a0c6-72da6e5fc3aa,
  abstract     = {Dietary flavanols and flavonols, flavonoid subclasses, have been recently associated with a lower risk of type 2 diabetes (T2D) in Europe. Even within the same subclass, flavonoids may differ considerably in bioavailability and bioactivity. We aimed to examine the association between individual flavanol and flavonol intakes and risk of developing T2D across European countries. The European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study was conducted in 8 European countries across 26 study centers with 340,234 participants contributing 3.99 million person-years of follow-up, among whom 12,403 incident T2D cases were ascertained and a center-stratified subcohort of 16,154 individuals was defined. We estimated flavonoid intake at baseline from validated dietary questionnaires using a database developed from Phenol-Explorer and USDA databases. We used country-specific Prentice-weighted Cox regression models and random-effects meta-analysis methods to estimate HRs. Among the flavanol subclass, we observed significant inverse trends between intakes of all individual flavan-3-ol monomers and risk of T2D in multivariable models (all P-trend &lt; 0.05). We also observed significant trends for the intakes of proanthocyanidin dimers (HR for the highest vs. the lowest quintile. 0.81; 95% Cl: 0.71, 0.92; P-trend = 0.003) and trimers (HR: 0.91; 95% Cl: 0.80, 1.04; P-trend = 0.07) but not for proanthocyanidins with a greater polymerization degree. Among the flavonol subclass, myricetin (HR: 0.77; 95% Cl: 0.64, 0.93; P-trend = 0.001) was associated with a lower incidence of T2D. This large and heterogeneous European study showed inverse associations between all individual flavan-3-ol monomers, proanthocyanidins with a low polymerization degree, and the flavonol myricetin and incident T2D. These results suggest that individual flavonoids have different roles in the etiology of T2D.},
  author       = {Zamora-Ros, Raul and Forouhi, Nita G. and Sharp, Stephen J. and Gonzalez, Carlos A. and Buijsse, Brian and Guevara, Marcela and van der Schouw, Yvonne T. and Amiano, Pilar and Boeing, Heiner and Bredsdorff, Lea and Fagherazzi, Guy and Feskens, Edith J. and Franks, Paul and Grioni, Sara and Katzke, Verena and Key, Timothy J. and Khaw, Kay-Tee and Kuehn, Tilman and Masala, Giovanna and Mattiello, Amalia and Molina-Montes, Esther and Nilsson, Peter and Overvad, Kim and Perquier, Florence and Luisa Redondo, M. and Ricceri, Fulvio and Rolandsson, Olov and Romieu, Isabelle and Roswall, Nina and Scalbert, Augustin and Schulze, Matthias and Slimani, Nadia and Spijkerman, Annemieke M. W. and Tjonneland, Anne and Jose Tormo, Maria and Touillaud, Marina and Tumino, Rosario and van der A, Daphne L. and van Woudenbergh, Geertruida J. and Langenberg, Claudia and Riboli, Elio and Wareham, Nicholas J.},
  issn         = {1541-6100},
  language     = {eng},
  number       = {3},
  pages        = {335--343},
  publisher    = {American Society for Nutrition},
  series       = {Journal of Nutrition},
  title        = {Dietary Intakes of Individual Flavanols and Flavonols Are Inversely Associated with Incident Type 2 Diabetes in European Populations},
  url          = {http://dx.doi.org/10.3946/jn.113.184945},
  volume       = {144},
  year         = {2014},
}