Skip to main content Accessibility help
×
×
Home

Dietary flavonoid intakes and CVD incidence in the Framingham Offspring Cohort

  • Paul F. Jacques (a1) (a2), Aedin Cassidy (a3), Gail Rogers (a1), Julia J. Peterson (a2) and Johanna T. Dwyer (a1) (a2) (a4)...
Abstract

This study examines the relationship between long-term intake of six flavonoid classes and incidence of CVD and CHD, using a comprehensive flavonoid database and repeated measures of intake, while accounting for possible confounding by components of a healthy dietary pattern. Flavonoid intakes were assessed using a FFQ among the Framingham Offspring Cohort at baseline and three times during follow-up. Cox proportional hazards regression was used to characterise prospective associations between the natural logarithms of flavonoid intakes and CVD incidence using a time-dependent approach, in which intake data were updated at each examination to represent average intakes from previous examinations. Mean baseline age was 54 years, and 45 % of the population was male. Over an average 14·9 years of follow-up among 2880 participants, there were 518 CVD events and 261 CHD events. After multivariable adjustment, only flavonol intake was significantly associated with lower risk of CVD incidence (hazard ratios (HR) per 2·5-fold flavonol increase=0·86, P trend=0·05). Additional adjustment for total fruit and vegetable intake and overall diet quality attenuated this observation (HR=0·89, P trend=0·20 and HR=0·92, P trend=0·33, respectively). There were no significant associations between flavonoids and CHD incidence after multivariable adjustment. Our findings suggest that the observed association between flavonol intake and CVD risk may be a consequence of better overall diet. However, the strength of this non-significant association was also consistent with relative risks observed in previous meta-analyses, and therefore a modest benefit of flavonol intake on CVD risk cannot be ruled out.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Dietary flavonoid intakes and CVD incidence in the Framingham Offspring Cohort
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Dietary flavonoid intakes and CVD incidence in the Framingham Offspring Cohort
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Dietary flavonoid intakes and CVD incidence in the Framingham Offspring Cohort
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
* Corresponding author: P. F. Jacques, fax +1 617 556 3344, email paul.jacques@tufts.edu
References
Hide All
1. Go, AS, Mozaffarian, D, Roger, VL, et al. (2014) Heart disease and stroke statistics – 2014 update: a report from the American Heart Association. Circulation 129, e28e292.
2. Mathers, CD & Loncar, D (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3, e442.
3. World Health Organization (2011) Global Status Report on Noncommunicable Diseases 2010. Geneva: WHO.
4. De Lorgeril, M, Salen, P, Martin, JL, et al. (1999) Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 99, 779785.
5. Appel, LJ, Moore, TJ, Obarzanek, E, et al. (1997) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 336, 11171124.
6. Estruch, R, Ros, E, Salas-Salvado, J, et al. (2013) Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 368, 12791290.
7. He, FJ, Nowson, CA & MacGregor, GA (2006) Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet 367, 320326.
8. He, FJ, Nowson, CA, Lucas, M, et al. (2007) Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies. J Hum Hypertens 21, 717728.
9. Dauchet, L, Amouyel, P & Dallongeville, J (2005) Fruit and vegetable consumption and risk of stroke: a meta-analysis of cohort studies. Neurology 65, 11931197.
10. Dauchet, L, Amouyel, P, Hercberg, S, et al. (2006) Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr 136, 25882593.
11. Peterson, JJ, Dwyer, JT, Jacques, PF, et al. (2012) Associations between flavonoids and cardiovascular disease incidence or mortality in European and US populations. Nutr Rev 70, 491508.
12. Clarke, R, Lewington, S, Donald, A, et al. (2001) Underestimation of the importance of homocysteine as a risk factor for cardiovascular disease in epidemiological studies. J Cardiovasc Risk 8, 363369.
13. Lewington, S, Thomsen, T, Davidsen, M, et al. (2003) Regression dilution bias in blood total and high-density lipoprotein cholesterol and blood pressure in the Glostrup and Framingham prospective studies. J Cardiovasc Risk 10, 143148.
14. Dawber, TR & Kannel, WB (1958) An epidemiologic study of heart disease: the Framingham study. Nutr Rev 16, 14.
15. Feinleib, M, Kannel, WB, Garrison, RJ, et al. (1975) The Framingham Offspring Study. Design and preliminary data. Prev Med 4, 518525.
16. Rimm, EB, Giovannucci, EL, Stampfer, MJ, et al. (1992) Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol 135, 11141126.
17. Cassidy, A, O’Reilly, EJ, Kay, C, et al. (2011) Habitual intake of flavonoid subclasses and incident hypertension in adults. Am J Clin Nutr 93, 338347.
18. US Department of Agriculture (2007) USDA Database for the Flavonoid Content of Selected Foods. Release 2.1. Washington, DC: US Department of Agriculture.
19. US Department of Agriculture (2004) USDA Database for the Proanthocyanidin Content of Selected Food. Washington, DC: US Department of Agriculture.
20. Nechuta, SJ, Caan, BJ, Chen, WY, et al. (2012) Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies of US and Chinese women. Am J Clin Nutr 96, 123132.
21. Chun, OK, Chung, SJ & Song, WO (2009) Urinary isoflavones and their metabolites validate the dietary isoflavone intakes in US adults. J Am Diet Assoc 109, 245254.
22. Greendale, GA, FitzGerald, G, Huang, MH, et al. (2002) Dietary soy isoflavones and bone mineral density: results from the study of women's health across the nation. Am J Epidemiol 155, 746754.
23. De Kleijn, MJ, van der Schouw, YT, Wilson, PW, et al. (2001) Intake of dietary phytoestrogens is low in postmenopausal women in the United States: the Framingham Study. J Nutr 131, 18261832.
24. Feskanich, D, Rimm, EB, Giovannucci, EL, et al. (1993) Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire. J Am Diet Assoc 93, 790796.
25. Lloyd-Jones, DM, Martin, DO, Larson, MG, et al. (1998) Accuracy of death certificates for coding coronary heart disease as the cause of death. Ann Intern Med 129, 10201026.
26. Kannel, WB, Wolf, PA & Garrison, RJ (1987) Some risk factors related to the annual incidence of cardiovascular disease and death in pooled repeated biennial measurements. Framingham Heart Study, 30 year follow-up. Bethesda, MD: US Department of Health and Human Services.
27. Carandang, R, Seshadri, S, Beiser, A, et al. (2006) Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years. JAMA 296, 29392946.
28. Troy, LM, Dwyer, J & Jacques, P (2013) US adults and adherence to the Dietary Guidelines for Americans (DGA). FASEB J 27, 124, 7.
29. Wang, X, Ouyang, YY, Liu, J, et al. (2014) Flavonoid intake and risk of CVD: a systematic review and meta-analysis of prospective cohort studies. Br J Nutr 111, 111.
30. Wang, ZM, Zhao, D, Nie, ZL, et al. (2014) Flavonol intake and stroke risk: a meta-analysis of cohort studies. Nutrition 30, 518523.
31. Arts, IC, Hollman, PC, Feskens, EJ, et al. (2001) Catechin intake might explain the inverse relation between tea consumption and ischemic heart disease: the Zutphen Elderly Study. Am J Clin Nutr 74, 227232.
32. Geleijnse, JM, Launer, LJ, Van der Kuip, DA, et al. (2002) Inverse association of tea and flavonoid intakes with incident myocardial infarction: the Rotterdam Study. Am J Clin Nutr 75, 880886.
33. Hertog, MG, Feskens, EJ & Kromhout, D (1997) Antioxidant flavonols and coronary heart disease risk. Lancet 349, 699.
34. Hertog, MG, Sweetnam, PM, Fehily, AM, et al. (1997) Antioxidant flavonols and ischemic heart disease in a Welsh population of men: the Caerphilly Study. Am J Clin Nutr 65, 14891494.
35. Hirvonen, T, Pietinen, P, Virtanen, M, et al. (2001) Intake of flavonols and flavones and risk of coronary heart disease in male smokers. Epidemiology 12, 6267.
36. Hirvonen, T, Virtamo, J, Korhonen, P, et al. (2000) Intake of flavonoids, carotenoids, vitamins C and E, and risk of stroke in male smokers. Stroke 31, 23012306.
37. Keli, SO, Hertog, MG, Feskens, EJ, et al. (1996) Dietary flavonoids, antioxidant vitamins, and incidence of stroke: the Zutphen study. Arch Intern Med 156, 637642.
38. Knekt, P, Kumpulainen, J, Jarvinen, R, et al. (2002) Flavonoid intake and risk of chronic diseases. Am J Clin Nutr 76, 560568.
39. Rimm, EB, Katan, MB, Ascherio, A, et al. (1996) Relation between intake of flavonoids and risk for coronary heart disease in male health professionals. Ann Intern Med 125, 384389.
40. Sesso, HD, Gaziano, JM, Liu, S, et al. (2003) Flavonoid intake and the risk of cardiovascular disease in women. Am J Clin Nutr 77, 14001408.
41. Lin, J, Rexrode, KM, Hu, F, et al. (2007) Dietary intakes of flavonols and flavones and coronary heart disease in US women. Am J Epidemiol 165, 13051313.
42. Mink, PJ, Scrafford, CG, Barraj, LM, et al. (2007) Flavonoid intake and cardiovascular disease mortality: a prospective study in postmenopausal women. Am J Clin Nutr 85, 895909.
43. Cassidy, A, Rimm, EB, O’Reilly, EJ, et al. (2012) Dietary flavonoids and risk of stroke in women. Stroke 43, 946951.
44. McCullough, ML, Peterson, JJ, Patel, R, et al. (2012) Flavonoid intake and cardiovascular disease mortality in a prospective cohort of US adults. Am J Clin Nutr 95, 454464.
45. Mursu, J, Voutilainen, S, Nurmi, T, et al. (2008) Flavonoid intake and the risk of ischaemic stroke and CVD mortality in middle-aged Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Br J Nutr 100, 890895.
46. Hodgson, JM & Croft, KD (2010) Tea flavonoids and cardiovascular health. Mol Aspects Med 31, 495502.
47. Perez-Vizcaino, F & Duarte, J (2010) Flavonols and cardiovascular disease. Mol Aspects Med 31, 478494.
48. Jacques, PF, Cassidy, A, Rogers, G, et al. (2013) Higher dietary flavonol intake is associated with lower incidence of type 2 diabetes. J Nutr 143, 14741480.
49. Peluso, I, Raguzzini, A & Serafini, M (2013) Effect of flavonoids on circulating levels of TNF-alpha and IL-6 in humans: a systematic review and meta-analysis. Mol Nutr Food Res 57, 784801.
50. US Department of Agriculture (2013) USDA Database for the Flavonoid Content of Selected Foods. Release 3.1. Washington, DC: US Department of Agriculture.
51. Zamora-Ros, R, Knaze, V, Romieu, I, et al. (2013) Impact of thearubigins on the estimation of total dietary flavonoids in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Eur J Clin Nutr 67, 779782.
52. Peterson, JJ, Dwyer, JT, Jacques, PF, et al. (2015) Improving flavonoid intake estimation for the study of health outcomes. Nutr Rev 73, 553573.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed