Association of flavonoids and flavonoid-rich foods with all-cause mortality: The Blue Mountains Eye Study

Nicola P. Bondonno, Joshua R. Lewis, Lauren C. Blekkenhorst, Catherine P. Bondonno, John HC Shin, Kevin D. Croft, Richard J. Woodman, Germaine Wong, Wai H. Lim, Bamini Gopinath, Victoria M. Flood, Joanna Russell, Paul Mitchell, Jonathan M. Hodgson

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Higher intakes of flavonoids provide health benefits, however, the importance of each flavonoid class and which population groups may receive the greatest protection from higher flavonoid intake warrants further investigation. Objective: To explore the associations of flavonoid and flavonoid-rich wholefood intakes with all-cause mortality and the moderating effects of early mortality risk factors. Design: The study included 2349 participants of The Blue Mountains Eye Study, with a mean ± SD age at baseline of 64.7 ± 9.2 years. Flavonoid intake was calculated from baseline food frequency questionnaires using US Department of Agriculture food composition databases. Associations were examined using adjusted Cox proportional hazards models. Results: After 14 years of follow-up, 677 participants died. There was a flavonoid threshold effect with the greatest risk reduction seen between low and moderate intakes of total flavonoids, flavonoid classes and flavonoid-rich foods. Amongst the whole cohort, participants in the highest tertile of anthocyanidin intake had a significantly lower risk of all-cause mortality [multivariable adjusted HR (95%CI): 0.76 (0.61, 0.94)] when compared to those in the lowest tertile. Amongst participants with at least one early mortality risk factor (smoking, high alcohol consumption, no regular exercise or obesity), risk of all-cause mortality was lower in those in the highest intake tertile for total flavonoids [adjusted HR: 0.77 (0.59, 1.00)], flavan-3-ols [0.75 (0.58, 0.98)], anthocyanidins [0.70 (0.54, 0.92)], and proanthocyanidins [0.69 (0.52, 0.92)], compared to those in the lowest tertile. No similar associations were observed among those without any risk factors. Similarly, consumption of apples, tea and the individual flavonoid compounds, quercetin and epicatechin, were associated with a lower risk of all-cause mortality among participants with at least one risk factor, but not amongst other participants. Conclusion: Moderate to high intakes of flavonoids and certain flavonoid subclasses may provide health benefits, particularly for individuals with at least one early mortality risk factor.

Original languageEnglish
JournalClinical Nutrition
DOIs
Publication statusE-pub ahead of print - 1 Jan 2019

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Flavonoids
Food
Mortality
Anthocyanins
Insurance Benefits
United States Department of Agriculture
Proanthocyanidins
Catechin
Quercetin
Malus
Tea
Risk Reduction Behavior
Population Groups
Proportional Hazards Models
Alcohol Drinking
Obesity
Smoking
Databases
Exercise

Cite this

@article{da864a5eb7514adb98668b0818427684,
title = "Association of flavonoids and flavonoid-rich foods with all-cause mortality: The Blue Mountains Eye Study",
abstract = "Background: Higher intakes of flavonoids provide health benefits, however, the importance of each flavonoid class and which population groups may receive the greatest protection from higher flavonoid intake warrants further investigation. Objective: To explore the associations of flavonoid and flavonoid-rich wholefood intakes with all-cause mortality and the moderating effects of early mortality risk factors. Design: The study included 2349 participants of The Blue Mountains Eye Study, with a mean ± SD age at baseline of 64.7 ± 9.2 years. Flavonoid intake was calculated from baseline food frequency questionnaires using US Department of Agriculture food composition databases. Associations were examined using adjusted Cox proportional hazards models. Results: After 14 years of follow-up, 677 participants died. There was a flavonoid threshold effect with the greatest risk reduction seen between low and moderate intakes of total flavonoids, flavonoid classes and flavonoid-rich foods. Amongst the whole cohort, participants in the highest tertile of anthocyanidin intake had a significantly lower risk of all-cause mortality [multivariable adjusted HR (95{\%}CI): 0.76 (0.61, 0.94)] when compared to those in the lowest tertile. Amongst participants with at least one early mortality risk factor (smoking, high alcohol consumption, no regular exercise or obesity), risk of all-cause mortality was lower in those in the highest intake tertile for total flavonoids [adjusted HR: 0.77 (0.59, 1.00)], flavan-3-ols [0.75 (0.58, 0.98)], anthocyanidins [0.70 (0.54, 0.92)], and proanthocyanidins [0.69 (0.52, 0.92)], compared to those in the lowest tertile. No similar associations were observed among those without any risk factors. Similarly, consumption of apples, tea and the individual flavonoid compounds, quercetin and epicatechin, were associated with a lower risk of all-cause mortality among participants with at least one risk factor, but not amongst other participants. Conclusion: Moderate to high intakes of flavonoids and certain flavonoid subclasses may provide health benefits, particularly for individuals with at least one early mortality risk factor.",
keywords = "All-cause mortality, Flavonoid-rich foods, Flavonoids, Prospective cohort study",
author = "Bondonno, {Nicola P.} and Lewis, {Joshua R.} and Blekkenhorst, {Lauren C.} and Bondonno, {Catherine P.} and Shin, {John HC} and Croft, {Kevin D.} and Woodman, {Richard J.} and Germaine Wong and Lim, {Wai H.} and Bamini Gopinath and Flood, {Victoria M.} and Joanna Russell and Paul Mitchell and Hodgson, {Jonathan M.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.clnu.2019.01.004",
language = "English",
journal = "Clinical Nutrition",
issn = "0261-5614",
publisher = "Churchill Livingstone",

}

Association of flavonoids and flavonoid-rich foods with all-cause mortality : The Blue Mountains Eye Study. / Bondonno, Nicola P.; Lewis, Joshua R.; Blekkenhorst, Lauren C.; Bondonno, Catherine P.; Shin, John HC; Croft, Kevin D.; Woodman, Richard J.; Wong, Germaine; Lim, Wai H.; Gopinath, Bamini; Flood, Victoria M.; Russell, Joanna; Mitchell, Paul; Hodgson, Jonathan M.

In: Clinical Nutrition, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of flavonoids and flavonoid-rich foods with all-cause mortality

T2 - The Blue Mountains Eye Study

AU - Bondonno, Nicola P.

AU - Lewis, Joshua R.

AU - Blekkenhorst, Lauren C.

AU - Bondonno, Catherine P.

AU - Shin, John HC

AU - Croft, Kevin D.

AU - Woodman, Richard J.

AU - Wong, Germaine

AU - Lim, Wai H.

AU - Gopinath, Bamini

AU - Flood, Victoria M.

AU - Russell, Joanna

AU - Mitchell, Paul

AU - Hodgson, Jonathan M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Higher intakes of flavonoids provide health benefits, however, the importance of each flavonoid class and which population groups may receive the greatest protection from higher flavonoid intake warrants further investigation. Objective: To explore the associations of flavonoid and flavonoid-rich wholefood intakes with all-cause mortality and the moderating effects of early mortality risk factors. Design: The study included 2349 participants of The Blue Mountains Eye Study, with a mean ± SD age at baseline of 64.7 ± 9.2 years. Flavonoid intake was calculated from baseline food frequency questionnaires using US Department of Agriculture food composition databases. Associations were examined using adjusted Cox proportional hazards models. Results: After 14 years of follow-up, 677 participants died. There was a flavonoid threshold effect with the greatest risk reduction seen between low and moderate intakes of total flavonoids, flavonoid classes and flavonoid-rich foods. Amongst the whole cohort, participants in the highest tertile of anthocyanidin intake had a significantly lower risk of all-cause mortality [multivariable adjusted HR (95%CI): 0.76 (0.61, 0.94)] when compared to those in the lowest tertile. Amongst participants with at least one early mortality risk factor (smoking, high alcohol consumption, no regular exercise or obesity), risk of all-cause mortality was lower in those in the highest intake tertile for total flavonoids [adjusted HR: 0.77 (0.59, 1.00)], flavan-3-ols [0.75 (0.58, 0.98)], anthocyanidins [0.70 (0.54, 0.92)], and proanthocyanidins [0.69 (0.52, 0.92)], compared to those in the lowest tertile. No similar associations were observed among those without any risk factors. Similarly, consumption of apples, tea and the individual flavonoid compounds, quercetin and epicatechin, were associated with a lower risk of all-cause mortality among participants with at least one risk factor, but not amongst other participants. Conclusion: Moderate to high intakes of flavonoids and certain flavonoid subclasses may provide health benefits, particularly for individuals with at least one early mortality risk factor.

AB - Background: Higher intakes of flavonoids provide health benefits, however, the importance of each flavonoid class and which population groups may receive the greatest protection from higher flavonoid intake warrants further investigation. Objective: To explore the associations of flavonoid and flavonoid-rich wholefood intakes with all-cause mortality and the moderating effects of early mortality risk factors. Design: The study included 2349 participants of The Blue Mountains Eye Study, with a mean ± SD age at baseline of 64.7 ± 9.2 years. Flavonoid intake was calculated from baseline food frequency questionnaires using US Department of Agriculture food composition databases. Associations were examined using adjusted Cox proportional hazards models. Results: After 14 years of follow-up, 677 participants died. There was a flavonoid threshold effect with the greatest risk reduction seen between low and moderate intakes of total flavonoids, flavonoid classes and flavonoid-rich foods. Amongst the whole cohort, participants in the highest tertile of anthocyanidin intake had a significantly lower risk of all-cause mortality [multivariable adjusted HR (95%CI): 0.76 (0.61, 0.94)] when compared to those in the lowest tertile. Amongst participants with at least one early mortality risk factor (smoking, high alcohol consumption, no regular exercise or obesity), risk of all-cause mortality was lower in those in the highest intake tertile for total flavonoids [adjusted HR: 0.77 (0.59, 1.00)], flavan-3-ols [0.75 (0.58, 0.98)], anthocyanidins [0.70 (0.54, 0.92)], and proanthocyanidins [0.69 (0.52, 0.92)], compared to those in the lowest tertile. No similar associations were observed among those without any risk factors. Similarly, consumption of apples, tea and the individual flavonoid compounds, quercetin and epicatechin, were associated with a lower risk of all-cause mortality among participants with at least one risk factor, but not amongst other participants. Conclusion: Moderate to high intakes of flavonoids and certain flavonoid subclasses may provide health benefits, particularly for individuals with at least one early mortality risk factor.

KW - All-cause mortality

KW - Flavonoid-rich foods

KW - Flavonoids

KW - Prospective cohort study

UR - http://www.scopus.com/inward/record.url?scp=85060846872&partnerID=8YFLogxK

U2 - 10.1016/j.clnu.2019.01.004

DO - 10.1016/j.clnu.2019.01.004

M3 - Article

JO - Clinical Nutrition

JF - Clinical Nutrition

SN - 0261-5614

ER -