Zamora-Ros, Raul3; Forouhi, Nita G.3; Sharp, Stephen J.3; González, Carlos A.4; Buijsse, Brian26; Guevara, Marcela6; van der Schouw, Yvonne T.7; Amiano, Pilar6; Boeing, Heiner26; Bredsdorff, Lea1; Fagherazzi, Guy8; Feskens, Edith J.9; Franks, Paul W.27; Grioni, Sara11; Katzke, Verena28; Key, Timothy J.13; Khaw, Kay-Tee3; Kühn, Tilman28; Masala, Giovanna14; Mattiello, Amalia15; Molina-Montes, Esther6; Nilsson, Peter M.27; Overvad, Kim16; Perquier, Florence17; Redondo, M. Luisa18; Ricceri, Fulvio19; Rolandsson, Olov20; Romieu, Isabelle29; Roswall, Nina30; Scalbert, Augustin29; Schulze, Matthias26; Slimani, Nadia29; Spijkerman, Annemieke M. W.31; Tjonneland, Anne30; Tormo, Maria Jose6; Touillaud, Marina17; Tumino, Rosario24; van der A, Daphne L.31; van Woudenbergh, Geertruida J.9; Langenberg, Claudia3; Riboli, Elio32; 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 University of Cambridge4 Catalan Institute of Oncology5 German Institute of Human Nutrition6 CIBER Epidemiology and Public Health7 University Medical Centre Utrecht8 Paris South University9 Wageningen University and Research Center10 Lund University11 IRCCS Foundation National Institute of Oncology12 German Cancer Research Center13 University of Oxford14 Cancer Research and Prevention Institute15 University of Naples Federico II16 Aarhus University17 Centre for Research in Epidemiology and Population Health18 Public Health and Health Planning Directorate19 Human Genetic Foundation20 Umeå University21 International Agency for Research on Cancer22 Danish Cancer Society23 National Institute of Public Health and the Environment24 ‘Civile M.P. Arezzo’ Hospital25 Imperial College London26 German Institute of Human Nutrition27 Lund University28 German Cancer Research Center29 International Agency for Research on Cancer30 Danish Cancer Society31 National Institute of Public Health and the Environment32 Imperial College London
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.
Journal of Nutrition, 2014, Vol 144, Issue 3, p. 335-343