Zamora-Ros, Raul3; Forouhi, Nita G.3; Sharp, Stephen J.3; González, Carlos A.4; Buijsse, Brian28; Guevara, Marcela6; van der Schouw, Yvonne T.7; Amiano, Pilar8; Boeing, Heiner28; Bredsdorff, Lea1; Clavel-Chapelon, Françoise9; Fagherazzi, Guy9; Feskens, Edith J.10; Franks, Paul W.29; Grioni, Sara12; Katzke, Verena30; Key, Timothy J.14; Khaw, Kay-Tee15; Kühn, Tilman30; Masala, Giovanna16; Mattiello, Amalia17; Molina-Montes, Esther8; Nilsson, Peter M.29; Overvad, Kim18; Perquier, Florence9; Quirós, J. Ramón19; Romieu, Isabelle31; Sacerdote, Carlotta21; Scalbert, Augustin31; Schulze, Matthias28; Slimani, Nadia31; Spijkerman, Annemieke M.W.32; Tjonneland, Anne33; Tormo, Maria Jose34; Tumino, Rosario25; van der A, Daphne L.26; Langenberg, Claudia3; Riboli, Elio35; Wareham, Nicholas J.3
1 National Food Institute, Technical University of Denmark2 Division of Toxicology and Risk Assessment, National Food Institute, Technical University of Denmark3 Medical Research Council4 Catalan Institute of Oncology5 German Institute of Human Nutrition6 Navarre Public Health Institute7 University Medical Centre Utrecht8 CIBER Epidemiología y Salud Pública9 Centre for Research in Epidemiology and Population Health10 Wageningen University and Research Center11 Lund University12 Istituto Nazionale dei Tumori13 German Cancer Research Center14 University of Oxford15 University of Cambridge16 Cancer Research and Prevention Institute17 University of Naples Federico II18 Aarhus University19 Public Health Directorate20 International Agency for Research on Cancer21 Human Genetic Foundation22 National Institute of Public Health and the Environment23 Danish Cancer Society24 Universidad de Murcia25 ‘Civile M.P. Arezzo’ Hospital26 Murcia Regional Health Council27 Imperial College London28 German Institute of Human Nutrition29 Lund University30 German Cancer Research Center31 International Agency for Research on Cancer32 National Institute of Public Health and the Environment33 Danish Cancer Society34 Universidad de Murcia35 Imperial College London
The EPIC-InterAct study
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.
Diabetes Care, 2013, Vol 36, Issue 12, p. 3961-3970