TY - JOUR
T1 - Dietary intakes of individual flavanols and flavonols are inversely associated with incident type 2 diabetes in European populations
AU - Zamora-Ros, Raul
AU - Forouhi, Nita G.
AU - Sharp, Stephen J.
AU - González, Carlos A.
AU - Buijsse, Brian
AU - Guevara, Marcela
AU - van der Schouw, Yvonne T.
AU - Amiano, Pilar
AU - Boeing, Heiner
AU - Bredsdorff, Lea
AU - Fagherazzi, Guy
AU - Feskens, Edith J.
AU - Franks, Paul W.
AU - Grioni, Sara
AU - Katzke, Verena
AU - Key, Timothy J.
AU - Khaw, Kay Tee
AU - Kühn, Tilman
AU - Masala, Giovanna
AU - Mattiello, Amalia
AU - Molina-Montes, Esther
AU - Nilsson, Peter M.
AU - Overvad, Kim
AU - Perquier, Florence
AU - Redondo, M. Luisa
AU - Ricceri, Fulvio
AU - Rolandsson, Olov
AU - Romieu, Isabelle
AU - Roswall, Nina
AU - Scalbert, Augustin
AU - Schulze, Matthias
AU - Slimani, Nadia
AU - Spijkerman, Annemieke M.W.
AU - Tjonneland, Anne
AU - Tormo, Maria Jose
AU - Touillaud, Marina
AU - Tumino, Rosario
AU - van der A., Daphne L.
AU - van Woudenbergh, Geertruida J.
AU - Langenberg, Claudia
AU - Riboli, Elio
AU - Wareham, Nicholas J.
PY - 2014/3/1
Y1 - 2014/3/1
N2 - 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% CI: 0.71, 0.92; P-trend = 0.003) and trimers (HR: 0.91; 95% CI: 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% CI: 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.
AB - 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% CI: 0.71, 0.92; P-trend = 0.003) and trimers (HR: 0.91; 95% CI: 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% CI: 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.
UR - http://www.scopus.com/inward/record.url?scp=84894237371&partnerID=8YFLogxK
U2 - 10.3945/jn.113.184945
DO - 10.3945/jn.113.184945
M3 - Article
C2 - 24368432
AN - SCOPUS:84894237371
SN - 0022-3166
VL - 144
SP - 335
EP - 343
JO - Journal of Nutrition
JF - Journal of Nutrition
IS - 3
ER -