The association between dietary flavonoid and lignan intakes and incident type 2 diabetes in european populations: The EPIC-InterAct study

Raul Zamora-Ros, Nita G. Forouhi*, Stephen J. Sharp, Carlos A. González, Brian Buijsse, Marcela Guevara, Yvonne T. Van Der Schouw, Pilar Amiano, Heiner Boeing, Lea Bredsdorff, Françoise Clavel-Chapelon, Guy Fagherazzi, Edith J. Feskens, Paul W. Franks, Sara Grioni, Verena Katzke, Timothy J. Key, Kay Tee Khaw, Tilman Kühn, Giovanna MasalaAmalia Mattiello, Esther Molina-Montes, Peter M. Nilsson, Kim Overvad, Florence Perquier, J. Ramón Quirós, Isabelle Romieu, Carlotta Sacerdote, Augustin Scalbert, Matthias Schulze, Nadia Slimani, Annemieke M.W. Spijkerman, Anne Tjonneland, Maria Jose Tormo, Rosario Tumino, Daphne L. Van Der A., Claudia Langenberg, Elio Riboli, Nicholas J. Wareham

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

106 Citations (Scopus)


Objective-To study the association between dietary flavonoid and lignan intakes, and the risk of development of type 2 diabetes among European populations. Research design and methods-The European Prospective Investigation into Cancer and Nutrition-InterAct case-cohort study included 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants from among 340,234 participants with 3.99 million person-years of follow-up in eight European countries. At baseline, country-specific validated dietary questionnaires were used. A flavonoid and lignan food composition database was developed from the Phenol-Explorer, the U.K. Food Standards Agency, and the U.S. Department of Agriculture databases. Hazard ratios (HRs) from country-specific Prentice-weighted Cox regression models were pooled using random-effects meta-analysis. Results-In multivariablemodels, a trend for an inverse association between total flavonoid intake and type 2 diabetes was observed (HR for the highest vs. the lowest quintile, 0.90 [95%CI 0.77-1.04]; P value trend = 0.040), but not with lignans (HR 0.88 [95% CI 0.72-1.07]; P value trend = 0.119). Among flavonoid subclasses, flavonols (HR 0.81 [95% CI 0.69-0.95]; P value trend = 0.020) and flavanols (HR 0.82 [95% CI 0.68-0.99]; P value trend = 0.012), including flavan-3-ol monomers (HR 0.73 [95% CI 0.57-0.93]; P value trend = 0.029), were associated with a significantly reduced hazard of diabetes. Conclusions-Prospective findings in this large European cohort demonstrate inverse associations between flavonoids, particularly flavanols and flavonols, and incident type 2 diabetes. This suggests a potential protective role of eating a diet rich in flavonoids, a dietary pattern based on plant-based foods, in the prevention of type 2 diabetes.

Original languageEnglish
Pages (from-to)3961-3970
Number of pages10
JournalDiabetes Care
Issue number12
Publication statusPublished - Dec 2013
Externally publishedYes


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