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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. Gonzalez
  • Brian Buijsse
  • Marcela Guevara
  • Yvonne T. van der Schouw
  • Pilar Amiano
  • Heiner Boeing
  • Lea Bredsdorff
  • Francoise Clavel-Chapelon
  • Guy Fagherazzi
  • Edith J. Feskens
  • Paul Franks
  • Sara Grioni
  • Verena Katzke
  • Timothy J. Key
  • Kay-Tee Khaw
  • Tilman Kuehn
  • Giovanna Masala
  • Amalia Mattiello
  • Esther Molina-Montes
  • Peter Nilsson
  • Kim Overvad
  • Florence Perquier
  • J. Ramon Quiros
  • 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
Publishing year: 2013
Language: English
Pages: 3961-3970
Publication/Series: Diabetes Care
Volume: 36
Issue: 12
Document type: Journal article
Publisher: American Diabetes Association

Abstract english

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.


  • Endocrinology and Diabetes


  • Genetic and Molecular Epidemiology
  • Internal Medicine
  • ISSN: 1935-5548
Paul Franks
E-mail: paul [dot] franks [at] med [dot] lu [dot] se

Principal investigator

Genetic and Molecular Epidemiology

+46 40 39 11 49



Lund University Diabetes Centre, CRC, SUS Malmö, Entrance 72, House 91:12. SE-205 02 Malmö. Telephone: +46 40 39 10 00