Flavonoid Intake and Cardiovascular Disease Mortality Among US Adults, Data from Third National Health and Nutrition Examination Survey Linked Mortality File (P18-013-19)

Abstract Objectives The objective of this research was to examine the association between total flavonoid intake and flavonoid sub-classes and CVD mortality among a nationally representative sample of US adults aged 40+ years at baseline and free of CVD. Methods A nationally representative sample of adults from the NHANES III data (1988–1994; n = 7900; age > = 40 years) were matched with mortality data reported by the National Death Index through 2015 to examine associations between estimated usual intakes of total flavonoid intake and flavonoid sub-classes and CVD mortality. Cox Proportional Hazards regression models were constructed to estimate hazard ratios and 95% confidence intervals for CVD mortality. Up to four 24-hour recalls were used to estimate total flavonoid intake and flavonoid sub-class intake for participants at baseline. Results During a median follow-up of 17.9 years, there were 4245 death; 1629 CVD deaths (767 males, 862 females) documented. Mean flavonoid intake was 247.7 mg/day for males and 216 mg/day for males. We did not observe an inverse association between total flavonoid intake and CVD mortality for males (HR: 0.95, 95% CI 0.87, 1.03) or females (HR: 1.03, 95% CI 0.93, 1.14), after adjustments for demographic, lifestyle, clinical and dietary quality variables. We also did not find significant associations between intake of flavonoid sub-classes and CVD mortality. However, for males only, intake of flavanones was inversely associated with CVD mortality after adjustments for demographic variables, lifestyle, clinical variables and diet quality (HR: 0.93, 95% CI 0.87, 0.99, p-value < 0.04). Conclusions In this nationally representative study, with detailed information on flavonoid intake and CVD mortality data, we did not find an inverse association between total flavonoid intake and most flavonoid sub-classes and CVD mortality for adults aged 40+ years at baseline; however our findings do indicate a marginally significant inverse association between flavanone intake and CVD mortality for males only, after controlling for confounders. Funding Sources No funding sources to declare.

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Abstract P320: Dietary Flavonoid Intake and Ischemic Stroke

Circulation ◽

10.1161/circ.131.suppl_1.p320 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Margarethe Goetz ◽

Viola Vaccarino ◽

Terry Hartman ◽

Bill McClellan ◽

Aaron Anderson ◽

...

Keyword(s):

Ischemic Stroke ◽

Cox Regression ◽

Statistical Significance ◽

Caloric Intake ◽

Population Based ◽

Total Flavonoid ◽

Total Flavonoids ◽

Inverse Association ◽

Flavonoid Intake ◽

Dietary Flavonoid

Introduction: Diets rich in plant-based foods have been associated with lower stroke risk. Plant-based foods contain a variety of potentially cardioprotective compounds, including flavonoids. We assessed the hypothesis that total flavonoid and flavonoid subclass intakes are associated with incident ischemic stroke in a population-based cohort oversampled for non-Hispanic blacks and Stroke Belt residents. Methods: Between 2003 and 2007, REGARDS enrolled black and white Americans age ≥ 45 years. Participants were 20,413 men and women who completed a Block 98 food frequency questionnaire (FFQ) and without stroke at baseline. Total flavonoid and flavonoid subclass (anthocyanidin, flavan-3-ol, flavanone, flavonol, flavone, proanthocyanidin and isoflavone) intakes were estimated using the food consumption reported by the FFQ and the flavonoid contents of each food using USDA databases. Incident strokes were captured by participant report and adjudicated by experts. Quintiles of flavonoid intake were examined as predictors of incident stroke using Cox regression models using the first quintile as the referent. Tests for trend used the quintile medians. Results: Adjusting for age and caloric intake, there was a statistically significant inverse association between total flavonoid intake and ischemic stroke (Q5 v Q1: HR=0.68; 95% CI=0.51, 0.90; p-trend=0.04) however, this association weakened after additional adjustment for demographic, socioeconomic and health behavior factors as well as self-reported CHD at baseline (Q5 v Q1: HR=0.77; 95% CI=0.58, 1.03; p-trend=0.31). A similar pattern was seen for flavanones (age, energy adjusted HR=0.74; 95% CI= 0.57, 0.95; p-trend=0.02; fully adjusted HR= 0.82; 95%CI=0.65, 1.05; p-trend=0.06). Effect estimates for total flavonoids, flavanones, proanthocyanidins, and isoflavones, suggested a protective, though nonlinear association with risk reduction emerging at the second quintile, though these did not achieve statistical significance (total flavonoids, fully adjusted HR (95% CI): Q2= 0.80 (0.61, 1.04); Q3= 0.85 (0.65, 1.11); Q4=0.92 (0.70, 1.19); Q5= 0.77 (0.58, 1.03)). Total flavonoid and flavanone intake were significantly associated with IS in fully adjusted models in women (total: Q5 v Q1 HR=0.62; 95% CI= 0.41, 0.94; p-trend=0.15; flavanones HR=0.65; 95% CI=0.44, 0.95; p-trend=0.03) but not in men (total: Q5 v Q1 HR=0.95; 95% CI= 0.63, 1.42; flavanones HR=0.80; 95% CI=0.58, 1.09; p-interaction=0.67). There was no effect modification by race or region of residence. Conclusion: Total dietary flavonoids and flavanones are associated with a reduction in risk of incident ischemic stroke, particularly in women. The emergence of a protective effect at the second quintile for total flavonoids, flavanones, proanthocyanidins and isoflavones is consistent with previous studies of dietary flavonoid intake and CVD mortality.

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A Prospective Study of Dietary Flavonoid Intake and Risk of Glioma in US Men and Women

Current Developments in Nutrition ◽

10.1093/cdn/nzab036_005 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 263-263

Author(s):

Alaina Bever ◽

Aedin Cassidy ◽

Eric Rimm ◽

Meir Stampfer ◽

David Cote

Keyword(s):

Total Flavonoid ◽

Health Study ◽

Men And Women ◽

Funding Sources ◽

Flavonoid Intake ◽

Glioma Risk ◽

Dietary Flavonoid ◽

Incident Cases

Abstract Objectives Flavonoids are a diverse group of plant constituents with demonstrated neuroprotective and anti-tumor effects. Flavonoid intake may decrease glioma risk, an association that has not yet been investigated in humans. The objective of this study was to evaluate the association between dietary flavonoid consumption and glioma risk in participants in the female Nurses’ Health Study (1984–2014, n = 81,688) and Nurses’ Health Study II (1991–2017, n = 95,228), and the male Health Professionals Follow-up Study (1986–2014, n = 49,884). Methods Exposure was average long-term (up to 30 years) and recent (up to 12 years) intake of total flavonoids and six flavonoid subclasses, derived from validated quadrennial food frequency questionnaires. The primary outcome was incident glioma, confirmed by medical record review. Results We documented 536 incident cases of glioma across 5,936,386 person-years of follow-up. Long-term total flavonoid, flavan-3-ol, and polymer intake was associated with decreased glioma risk in pooled analyses comparing highest to lowest quintile of consumption (total flavonoid hazard ratio (HR) = 0.79, 95% CI: 0.59–1.05, P-trend = 0.04; flavan-3-ol HR = 0.76, 95% CI: 0.57–1.01, P-trend = 0.04; polymer HR = 0.82, 95% CI: 0.61–1.09, P-trend = 0.05). Associations with recent intake were weaker and not statistically significant. There were no associations with other flavonoid subclasses. After additional adjustment for tea consumption, there was no significant association between flavan-3-ol or polymer consumption and glioma. Conclusions Increased dietary intake of flavan-3-ol and polymeric flavonoids, especially those predominant in tea, was associated with decreased glioma risk in a prospective cohort of men and women. Habitual consumption of foods and beverages containing flavan-3-ols and polymeric flavonoids may protect against the development of glioma. Funding Sources This work was supported by the U.S. National Institutes of Health.

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Intake of Flavonoids and Odds of Frailty Onset in Adults in the Framingham Offspring Cohort

Innovation in Aging ◽

10.1093/geroni/igab046.3613 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 1018-1018

Author(s):

Thuy Nga Nguyen ◽

Courtney Millar ◽

Douglas Kiel ◽

Marian Hannan ◽

Shivani Sahni

Keyword(s):

Total Flavonoid ◽

P Value ◽

Offspring Cohort ◽

Plant Foods ◽

Covariate Information ◽

Average Intake ◽

Flavonoid Intake ◽

Disease Indicators ◽

Dietary Flavonoids

Abstract Polyphenols (antioxidants derived from plant-foods) could play a role in inhibition of oxidative stress and frailty reduction, yet data on the polyphenol subclass of dietary flavonoids is limited. This study sought to determine the association between dietary flavonoids and frailty onset in middle-aged and older adults. This prospective cohort study included non-frail individuals from the Framingham Offspring Cohort (FOC) with total flavonoid intake (mg/day; defined as sum flavonols, flavan-3-ols, flavonones, flavones, and anthocyanins via Harvard Food Frequency Questionnaire), frailty (via Fried phenotype), and covariate information measured at baseline (1998-2001). Follow-up frailty was evaluated in 2011-2014. Logistic regression estimated odds ratio (OR) and 95% confidence intervals (95% CI) adjusting for relevant confounders. Participants (n=1,701; 55.5% female) had a mean age of 58.4 years (SD ± 8.3). Mean flavonoid intake was 309 mg/d (SD ± 266). After 12.4 years (SD ± 0.8), 224 (13.2%) individuals exhibited frailty. In age and sex adjusted models, every 50 mg/day of higher total flavonoid intake was associated with 3% reduced odds of frailty [OR (95%CI): 0.97 (0.94-1.00), p-value: 0.05). Further adjustment for smoking, energy and protein intake, and disease indicators did not appreciably change the association, and associations became non-significant (p-value=0.12). Thus, there was no association between flavonoid intake and odds of frailty onset in adults in the FOC. This could be due to participants' higher intake of flavonoids compared to average intake of ~200 mg/d in Americans.

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Dietary energy density: estimates, trends and dietary determinants for a nationally representative sample of the Irish population (aged 5–90 years)

British Journal Of Nutrition ◽

10.1017/s0007114514003420 ◽

2014 ◽

Vol 113 (1) ◽

pp. 172-180 ◽

Cited By ~ 8

Author(s):

Laura O'Connor ◽

Janette Walton ◽

Albert Flynn

Keyword(s):

Energy Density ◽

Representative Sample ◽

Inverse Association ◽

Dietary Energy ◽

Age Group ◽

Irish Population ◽

Fresh Meat ◽

Breakfast Cereals ◽

Nationally Representative ◽

Dietary Energy Density

Higher dietary energy density (DED) has been reported to be associated with weight gain, obesity and poorer dietary quality, yet nationally representative estimates that would allow tracking of secular trends and inter-country comparisons are limited. The aims of the present study were to calculate DED estimates for the Irish population and to identify dietary determinants of DED. Weighed/semi-weighed food records from three cross-sectional surveys (the National Children's Food Survey, the National Teens’ Food Survey and the National Adult Nutrition Survey) were collated to estimate habitual dietary intakes for a nationally representative sample of the Irish population, aged 5–90 years (n2535). DED estimates, calculated using the total diet method, the food only method and a novel method, including foods and solids in beverages, were 3·70 (sd1·09), 7·58 (sd1·72) and 8·40 (sd1·88) kJ/g, respectively. Determinants of DED did not vary by the calculation method used. Variation in the intakes of fruit, vegetables and sugar-sweetened beverages (SSB) across consumer groups contributed to the largest variance in DED estimates, followed by variation in the intakes of potatoes, fresh meat, bread, chips, ready-to-eat breakfast cereals, and confectionery. DED estimates were inversely associated with age group and consistently lower for females than for males. The inverse association of DED with age group was explained by higher intakes of vegetables, fruit, fish, potatoes, fresh meat and brown bread and lower intakes of SSB, chocolate confectionery, ready-to-eat breakfast cereals and savoury snacks in older age groups. Females consumed, on average, 1·5 times more fruit and vegetables combined when compared with males, largely explaining the sex differences in DED estimates. Current DED estimates for adults were similar to those calculated in a previous survey, carried out 10 years earlier. These estimates and determinants serve as a baseline for comparison for other works and public health campaigns.

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Prospective prediction of suicide in a nationally representative sample: religious service attendance as a protective factor

The British Journal of Psychiatry ◽

10.1192/bjp.bp.113.128900 ◽

2014 ◽

Vol 204 (4) ◽

pp. 262-266 ◽

Cited By ~ 59

Author(s):

Evan M. Kleiman ◽

Richard T. Liu

Keyword(s):

Representative Sample ◽

Protective Factor ◽

Mortality Data ◽

Religious Service ◽

Psychological Autopsy ◽

Religious Service Attendance ◽

Completed Suicide ◽

Religious Services ◽

Nationally Representative ◽

Service Attendance

BackgroundPrevious research into religious service attendance as a protective factor against suicide has been conducted only retrospectively, with psychological autopsy studies using proxy informants of completed suicide, rather than prospectively, with completed suicide as a dependent variable.AimsTo determine whether individuals who frequently attended religious services were less likely to die by suicide than those who did not attend so frequently.MethodWe analysed data from a nationally representative sample (n = 20 014), collected in the USA between 1988 and 1994, and follow-up mortality data from baseline to the end of 2006.ResultsCox proportional hazard regression analysis indicated that those who frequently attended religious services were less likely to die by suicide than those who did not attend, after accounting for the effects of other relevant risk factors.ConclusionsFrequent religious service attendance is a long-term protective factor against suicide.

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Chocolate Consumption in Relation to All-Cause and Cause-Specific Mortality in Women: The Women's Health Initiative

Current Developments in Nutrition ◽

10.1093/cdn/nzaa061_121 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1493-1493

Author(s):

Yangbo Sun ◽

Buyun Liu ◽

Linda Snetselaar ◽

Robert Wallace ◽

Aladdin Shadyab ◽

...

Keyword(s):

Women’S Health ◽

Women's Health ◽

Inverse Association ◽

Women's Health Initiative ◽

Women’S Health Initiative ◽

Health Initiative ◽

Funding Sources ◽

Specific Mortality ◽

Cvd Mortality

Abstract Objectives To examine the association of chocolate consumption with all-cause and cause-specific mortality. Methods We included 84,709 postmenopausal women free of cardiovascular disease (CVD) and cancer at baseline in the prospective Women's Health Initiative cohort who were enrolled during 1993–1998. Chocolate consumption was assessed using a validated food frequency questionnaire. These women were followed through March 2018. Results During 1608,856 person-years of follow up (19.0 years on average [SD = 4.2]), 25,388 deaths occurred, including 7069 deaths from CVD, 7030 deaths from cancer, and 3279 deaths from dementia. After adjustment for a variety of covariates, compared to no chocolate consumption, the HRs (95% CIs) for all-cause mortality were 0.95 (0.92, 0.98), 0.93 (0.89, 0.96), 0.97 (0.90, 1.04) and 0.90 (0.84, 0.97) for <1 serving/week, 1–3 servings/week, 4–6 servings/week and ≥1 serving/day of chocolate consumption, respectively (P for trend = 0.02). For CVD mortality, compared to no chocolate consumption, the HRs (95% CIs) were 0.96 (0.91, 1.01), 0.88 (0.82, 0.95), 0.96 (0.93, 1.12) and 0.92 (0.80, 1.05) for <1 serving/week, 1–3 servings/week, 4–6 servings/week and ≥1 serving/day of chocolate consumption, respectively (P for trend = 0.45). For dementia mortality, compared to no chocolate consumption, the HRs (95% CIs) were 0.91 (0.84, 0.99), 0.89 (0.80, 0.99), 0.97 (0.79, 1.18) and 0.97 (0.80, 1.08) for <1 serving/week, 1–3 servings/week, 4–6 servings/week and ≥1 serving/day of chocolate consumption, respectively (P for trend = 0.95). Chocolate consumption was not associated with cancer mortality. Conclusions Our results suggested modest inverse association of chocolate consumption with mortality from all-causes, CVD or dementia, specifically for a moderate chocolate consumption of ≤3 servings/week. Funding Sources None.

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P3783A higher habitual flavonoid intake is associated with a lower risk of atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz745.0632 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

N Bondonno ◽

K Murray ◽

C P Bondonno ◽

J R Lewis ◽

K D Croft ◽

...

Keyword(s):

Atrial Fibrillation ◽

Lower Risk ◽

Disease Risk ◽

Smoking Status ◽

Cardiovascular Disease Risk ◽

Cox Proportional Hazards ◽

Total Flavonoid ◽

Health Study ◽

Inverse Association ◽

Flavonoid Intake

Abstract Background Our understanding of how diet affects future risk of atrial fibrillation (AF) is limited. Evidence suggests that higher habitual intakes of flavonoids, bio-active compounds found in plant-based foods and beverages, lower cardiovascular disease risk, attenuate inflammation, and may have anti-arrhythmic properties. Purpose To investigate the association between flavonoid intake and clinically apparent AF in a large cohort of Danish men and women. Methods Baseline data from 55 634 participants without AF of the Danish Diet, Cancer and Health Study, recruited from 1993 to 1997, were cross-linked with Danish nationwide registries. Flavonoid intake was calculated from validated food frequency questionnaires using the Phenol-Explorer database. Associations between flavonoid intake and AF hospitalisation were examined using restricted cubic splines based on Cox proportional hazards models with adjustments for age, sex, BMI, smoking status, physical activity, alcohol intake, income, and hyperthyroidism. Results After a median [IQR] follow-up of 21 [18–22] years, 6 301 participants were hospitalised with AF. Non-linear associations were observed for total flavonoid intake and for all flavonoid sub-classes. For total flavonoid intake, after adjusting for potential lifestyle confounders and compared to participants in quintile 1 (median intake: 173 mg/day), those in quintile 3 (median intake: 320 mg/day) and quintile 4 (median intake: 494 mg/day) had a significantly lower risk of AF, with hazard ratios (95% CI) of 0.93 (0.87, 0.99) and 0.92 (0.86, 0.98), respectively. Compared to median intake in the lowest quintile, a total flavonoid intake of 1000 mg/day was associated with a lower risk of AF in smokers [0.86 (0.77, 0.96)] but not in non-smokers [0.96 (0.88, 1.05)], a lower risk of AF in high alcohol consumers [>20 g/d: 0.84 (0.75, 0.94)] but not in low-to-moderate alcohol consumers [<20 g/d: 0.97 (0.89, 1.06], a trending lower risk of AF in diabetics [0.76 (0.51, 1.14)] but not in non-diabetics [0.95 (0.89, 1.02)], and a trending lower risk of AF in those with ischaemic heart disease [0.84 (0.65, 1.09)] but not in those without [0.96 (0.89, 1.03), Figure 1]. Figure 1 Conclusion We observed an inverse association between total flavonoid intake and AF, most notably in sub-populations with known lifestyle and disease risk factors for AF. This finding warrants investigation in randomised controlled trials. If confirmed, ensuring the adequate consumption of flavonoid-rich foods, particularly in individuals “at risk”, may be an important strategy to mitigate AF risk. Acknowledgement/Funding The Danish Diet, Cancer, and Health Study was funded by the Danish Cancer Society.

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Associations of Accelerometry-Assessed and Self-Reported Physical Activity and Sedentary Behavior With All-Cause and Cardiovascular Mortality Among US Adults

American Journal of Epidemiology ◽

10.1093/aje/kww070 ◽

2016 ◽

Vol 184 (9) ◽

pp. 621-632 ◽

Cited By ~ 67

Author(s):

Kelly R. Evenson ◽

Fang Wen ◽

Amy H. Herring

Keyword(s):

Physical Activity ◽

Confidence Interval ◽

Sedentary Behavior ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Mortality Data ◽

Cox Proportional Hazards Models ◽

Nationally Representative ◽

Reported Data ◽

Cvd Mortality

Abstract The US physical activity (PA) recommendations were based primarily on studies in which self-reported data were used. Studies that include accelerometer-assessed PA and sedentary behavior can contribute to these recommendations. In the present study, we explored the associations of PA and sedentary behavior with all-cause and cardiovascular disease (CVD) mortality in a nationally representative sample. Among the 2003–2006 National Health and Nutrition Examination Survey cohort, 3,809 adults 40 years of age or older wore an accelerometer for 1 week and self-reported their PA levels. Mortality data were verified through 2011, with an average of 6.7 years of follow-up. We used Cox proportional hazards models to obtain adjusted hazard ratios and 95% confidence intervals. After excluding the first 2 years, there were 337 deaths (32% or 107 of which were attributable to CVD). Having higher accelerometer-assessed average counts per minute was associated with lower all-cause mortality risk: When compared with the first quartile, the adjusted hazard ratio was 0.37 (95% confidence interval: 0.23, 0.59) for the fourth quartile, 0.39 (95% confidence interval: 0.27, 0.57) for the third quartile, and 0.60 (95% confidence interval: 0.45, 0.80) second quartile. Results were similar for CVD mortality. Lower all-cause and CVD mortality risks were also generally observed for persons with higher accelerometer-assessed moderate and moderate-to-vigorous PA levels and for self-reported moderate-to-vigorous leisure, household and total activities, as well as for meeting PA recommendations. Accelerometer-assessed sedentary behavior was generally not associated with all-cause or CVD mortality in fully adjusted models. These findings support the national PA recommendations to reduce mortality.

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