Journal
JOURNAL OF NUTRITION
Volume 144, Issue 3, Pages 335-343Publisher
ELSEVIER SCIENCE INC
DOI: 10.3945/jn.113.184945
Keywords
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Funding
- European Union (Framework Programme 6 of the European Community) [LSHM-CT-2006-037197]
- Fondo de Investigacion Santana (FIS) from the Spanish Ministry of Science [CD09/00133]
- Health Research Fund (FIS) of the Spanish Ministry of Health [RTICC DR06/0020/0091]
- Medical Research Council (MRC) Epidemiology Unit [MC_UU_12015/1, MC_UU_12015/5]
- NL Agency from the Board of the UMC Utrecht (Netherlands) [IGE05012]
- Board of the UMC Utrecht (Netherlands)
- Dutch Ministry of Public Health, Welfare, and Sports
- Netherlands Cancer Registry
- LK Research Funds
- Dutch Prevention Funds
- Dutch ZON
- World Cancer Research Fund
- Statistics Netherlands
- Cancer Research UK
- Ligue contre le Cancer
- Institut Gustave Roussy
- Mutuelle Generale de l'Education Nationale
- INSERM
- Ministero della Salute Regione Toscana Progetto Integrato Oncologia-PIO
- Swedish Research Council
- Novo Nordisk
- Swedish Heart Lung Foundation
- Swedish Diabetes Association
- Danish Cancer Society
- Deutsche Krebshilfe
- Associazione Italiana per la Ricerca sul Cancro
- Asturias Regional Government
- Health Research Fund of the Spanish Ministry of Health, CIBER Epidemiology and Public Health (Spain)
- Murcia Regional Government
- AIRE-ONLUS Ragusa, AVIS-Ragusa, the Sicilian Regional Government
- Cancer Research UK [14136, 16491] Funding Source: researchfish
- Medical Research Council [MC_UU_12015/5, G0401527, MC_UU_12015/1, G1000143, MC_UP_A100_1003, MC_U106179471] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0512-10135, NF-SI-0512-10114] Funding Source: researchfish
- MRC [MC_UP_A100_1003, MC_UU_12015/1, MC_UU_12015/5] Funding Source: UKRI
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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% Cl: 0.71, 0.92; P-trend = 0.003) and trimers (HR: 0.91; 95% Cl: 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% Cl: 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.
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