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Dietary intakes of individual flavanols and flavonols are inversely associated with incident type 2 diabetes in European populations.


Type

Article

Change log

Authors

Zamora-Ros, Raul 
Forouhi, Nita G 
Sharp, Stephen J 
González, Carlos A 
Buijsse, Brian 

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 < 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.

Description

Keywords

Adult, Diabetes Mellitus, Type 2, Diet, Europe, Female, Flavonoids, Flavonols, Follow-Up Studies, Humans, Incidence, Life Style, Male, Middle Aged, Motor Activity, Multivariate Analysis, Nutritional Status, Proanthocyanidins, Proportional Hazards Models, Prospective Studies, Risk Factors, Socioeconomic Factors, Surveys and Questionnaires, White People

Journal Title

J Nutr

Conference Name

Journal ISSN

0022-3166
1541-6100

Volume Title

144

Publisher

Elsevier BV
Sponsorship
Medical Research Council (G1000143)
Medical Research Council (MC_UU_12015/1)
Medical Research Council (MC_UU_12015/5)
Medical Research Council (G0401527)
Medical Research Council (MC_U106179471)
The EPIC-InterAct Study was supported by the European Union (Integrated Project LSHM-CT-2006-037197 in the Framework Programme 6 of the European Community). In addition, InterAct investigators acknowledge funding from the following agencies: R.Z.-R. was supported by a postdoctoral program Fondo de Investigación Sanitaria (FIS; no. CD09/00133) from the Spanish Ministry of Science; R.Z.-R. and C.A.G. were supported by the Health Research Fund (FIS) of the Spanish Ministry of Health (RTICC DR06/0020/0091); core support from the Medical Research Council (MRC) Epidemiology Unit is acknowledged for program MC_UU_12015/1 and MC_UU_12015/5; Y.T.v.d.S. was supported by NL Agency grant IGE05012 and an Incentive Grant from the Board of the UMC Utrecht (Netherlands); A.M.W.S. and D.L.v.d.A. were supported by the Dutch Ministry of Public Health, Welfare, and Sports, Netherlands Cancer Registry, LK Research Funds, Dutch Prevention Funds, Dutch ZON, World Cancer Research Fund, and Statistics Netherlands; T.J.K. and K.-T.K. were supported by Cancer Research UK; G.F., M.T., and F.P. were supported by Ligue contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, INSERM; G.M. was supported by Ministero della Salute Regione Toscana Progetto Integrato Oncologia–PIO; P.W.F. was supported by the Swedish Research Council, Novo Nordisk, the Swedish Heart Lung Foundation, and the Swedish Diabetes Association; L.B., K.O., N.R., and A.T. were supported by the Danish Cancer Society; V.K. and T.K. were supported by Deutsche Krebshilfe; A.M. was supported by Associazione Italiana per la Ricerca sul Cancro; M.L.R. was supported by the Asturias Regional Government; M.G., P.A., E.M.-M., and M.J.T. were supported by the Health Research Fund of the Spanish Ministry of Health, CIBER Epidemiology and Public Health (Spain); M.J.T. was supported by the Murcia Regional Government; and R.T. was supported by AIRE-ONLUS Ragusa, AVIS-Ragusa, the Sicilian Regional Government.