The association between dietary flavonoid and lignan intakes and incident type 2 diabetes in European populations: the EPIC-InterAct study - PubMed (original) (raw)

Multicenter Study

. 2013 Dec;36(12):3961-70.

doi: 10.2337/dc13-0877. Epub 2013 Oct 15.

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 Masala, Amalia 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

Affiliations

Multicenter Study

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

Raul Zamora-Ros et al. Diabetes Care. 2013 Dec.

Abstract

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 multivariable models, 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.

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Figures

Figure 1

Figure 1

HRs (and 95% CIs) for incident type 2 diabetes for a doubling of total flavonoid (A) and lignan (B) intakes across countries in the InterAct study. The pooled HR is based on a random-effects meta-analysis using Prentice-weighted Cox regression analysis with age as the underlying time scale (model 4; see

Statistical analysis

section); stratified by center; and adjusted for sex, educational level, smoking status, physical activity levels, BMI, total energy, and intakes of alcohol, red meat, processed meat, sugar-sweetened soft drinks, coffee, fiber, vitamin C, and magnesium.

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