The Association Between Dietary Flavonoid and Lignan Intakes and Incident Type 2 Diabetes in European Populations: The EPIC-InterAct Study

Raul Zamora-Ros; 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; Carl Martin Peter 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

doi:10.2337/dc13-0877

The Association Between Dietary Flavonoid and Lignan Intakes and Incident Type 2 Diabetes in European Populations: The EPIC-InterAct Study

Raul Zamora-Ros
, 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, Carl Martin Peter 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

Department of Public Health - Department of Epidemiology

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

124 Citations (Scopus)

Abstract

OBJECTIVETo study the association between dietary flavonoid and lignan intakes, and the risk of development of type 2 diabetes among European populations.RESEARCH DESIGN AND METHODSThe 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.RESULTSIn 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.CONCLUSIONSProspective 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.

Original language	English
Journal	Diabetes Care
Volume	36
Issue	12
Pages (from-to)	3961-70
ISSN	0149-5992
DOIs	https://doi.org/10.2337/dc13-0877
Publication status	Published - Dec 2013

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Zamora-Ros, R., Forouhi, N. G., Sharp, S. J., González, C. A., Buijsse, B., Guevara, M., van der Schouw, Y. T., Amiano, P., Boeing, H., Bredsdorff, L., Clavel-Chapelon, F., Fagherazzi, G., Feskens, E. J., Franks, P. W., Grioni, S., Katzke, V., Key, T. J., Khaw, K.-T., Kühn, T., ... Wareham, N. J. (2013). The Association Between Dietary Flavonoid and Lignan Intakes and Incident Type 2 Diabetes in European Populations: The EPIC-InterAct Study. Diabetes Care, 36(12), 3961-70. https://doi.org/10.2337/dc13-0877

@article{9cbc6a93219645bda7833706dc6245e1,

title = "The Association Between Dietary Flavonoid and Lignan Intakes and Incident Type 2 Diabetes in European Populations: The EPIC-InterAct Study",

abstract = "OBJECTIVETo study the association between dietary flavonoid and lignan intakes, and the risk of development of type 2 diabetes among European populations.RESEARCH DESIGN AND METHODSThe 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.RESULTSIn 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.CONCLUSIONSProspective 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.",

author = "Raul Zamora-Ros and Forouhi, \{Nita G\} and Sharp, \{Stephen J\} and Gonz{\'a}lez, \{Carlos A\} and Brian Buijsse and Marcela Guevara and \{van der Schouw\}, \{Yvonne T\} and Pilar Amiano and Heiner Boeing and Lea Bredsdorff and Fran{\c c}oise Clavel-Chapelon and Guy Fagherazzi and Feskens, \{Edith J\} and Franks, \{Paul W\} and Sara Grioni and Verena Katzke and Key, \{Timothy J\} and Kay-Tee Khaw and Tilman K{\"u}hn and Giovanna Masala and Amalia Mattiello and Esther Molina-Montes and Nilsson, \{Carl Martin Peter\} and Kim Overvad and Florence Perquier and Quir{\'o}s, \{J Ram{\'o}n\} and Isabelle Romieu and Carlotta Sacerdote and Augustin Scalbert and Matthias Schulze and Nadia Slimani and Spijkerman, \{Annemieke M W\} and Anne Tjonneland and Tormo, \{Maria Jose\} and Rosario Tumino and \{van der A\}, \{Daphne L\} and Claudia Langenberg and Elio Riboli and Wareham, \{Nicholas J\}",

year = "2013",

month = dec,

doi = "10.2337/dc13-0877",

language = "English",

volume = "36",

pages = "3961--70",

journal = "Diabetes Care",

issn = "0149-5992",

publisher = "American Diabetes Association Inc.",

number = "12",

}

Zamora-Ros, R, Forouhi, NG, Sharp, SJ, González, CA, Buijsse, B, Guevara, M, van der Schouw, YT, Amiano, P, Boeing, H, Bredsdorff, L, Clavel-Chapelon, F, Fagherazzi, G, Feskens, EJ, Franks, PW, Grioni, S, Katzke, V, Key, TJ, Khaw, K-T, Kühn, T, Masala, G, Mattiello, A, Molina-Montes, E, Nilsson, CMP, Overvad, K, Perquier, F, Quirós, JR, Romieu, I, Sacerdote, C, Scalbert, A, Schulze, M, Slimani, N, Spijkerman, AMW, Tjonneland, A, Tormo, MJ, Tumino, R, van der A, DL, Langenberg, C, Riboli, E & Wareham, NJ 2013, 'The Association Between Dietary Flavonoid and Lignan Intakes and Incident Type 2 Diabetes in European Populations: The EPIC-InterAct Study', Diabetes Care, vol. 36, no. 12, pp. 3961-70. https://doi.org/10.2337/dc13-0877

The Association Between Dietary Flavonoid and Lignan Intakes and Incident Type 2 Diabetes in European Populations: The EPIC-InterAct Study. / Zamora-Ros, Raul; Forouhi, Nita G; Sharp, Stephen J et al.
In: Diabetes Care, Vol. 36, No. 12, 12.2013, p. 3961-70.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - The Association Between Dietary Flavonoid and Lignan Intakes and Incident Type 2 Diabetes in European Populations

T2 - The EPIC-InterAct Study

AU - Zamora-Ros, Raul

AU - Forouhi, Nita G

AU - Sharp, Stephen J

AU - González, Carlos A

AU - Buijsse, Brian

AU - Guevara, Marcela

AU - van der Schouw, Yvonne T

AU - Amiano, Pilar

AU - Boeing, Heiner

AU - Bredsdorff, Lea

AU - Clavel-Chapelon, Françoise

AU - Fagherazzi, Guy

AU - Feskens, Edith J

AU - Franks, Paul W

AU - Grioni, Sara

AU - Katzke, Verena

AU - Key, Timothy J

AU - Khaw, Kay-Tee

AU - Kühn, Tilman

AU - Masala, Giovanna

AU - Mattiello, Amalia

AU - Molina-Montes, Esther

AU - Nilsson, Carl Martin Peter

AU - Overvad, Kim

AU - Perquier, Florence

AU - Quirós, J Ramón

AU - Romieu, Isabelle

AU - Sacerdote, Carlotta

AU - Scalbert, Augustin

AU - Schulze, Matthias

AU - Slimani, Nadia

AU - Spijkerman, Annemieke M W

AU - Tjonneland, Anne

AU - Tormo, Maria Jose

AU - Tumino, Rosario

AU - van der A, Daphne L

AU - Langenberg, Claudia

AU - Riboli, Elio

AU - Wareham, Nicholas J

PY - 2013/12

Y1 - 2013/12

N2 - OBJECTIVETo study the association between dietary flavonoid and lignan intakes, and the risk of development of type 2 diabetes among European populations.RESEARCH DESIGN AND METHODSThe 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.RESULTSIn 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.CONCLUSIONSProspective 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.

AB - OBJECTIVETo study the association between dietary flavonoid and lignan intakes, and the risk of development of type 2 diabetes among European populations.RESEARCH DESIGN AND METHODSThe 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.RESULTSIn 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.CONCLUSIONSProspective 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.

U2 - 10.2337/dc13-0877

DO - 10.2337/dc13-0877

M3 - Journal article

C2 - 24130345

SN - 0149-5992

VL - 36

SP - 3961

EP - 3970

JO - Diabetes Care

JF - Diabetes Care

IS - 12

ER -

The Association Between Dietary Flavonoid and Lignan Intakes and Incident Type 2 Diabetes in European Populations: The EPIC-InterAct Study

Abstract

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