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Dietary Intakes of Individual Flavanols and Flavonols Are Inversely Associated with Incident Type 2 Diabetes in European Populations

  • 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
  • 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
  • M. Luisa Redondo
  • Fulvio Ricceri
  • Olov Rolandsson
  • Isabelle Romieu
  • Nina Roswall
  • Augustin Scalbert
  • Matthias Schulze
  • Nadia Slimani
  • Annemieke M. W. Spijkerman
  • Anne Tjonneland
  • Maria Jose Tormo
  • Marina Touillaud
  • Rosario Tumino
  • Daphne L. van der A
  • Geertruida J. van Woudenbergh
  • Claudia Langenberg
  • Elio Riboli
  • Nicholas J. Wareham
Publishing year: 2014
Language: English
Pages: 335-343
Publication/Series: Journal of Nutrition
Volume: 144
Issue: 3
Document type: Journal article
Publisher: American Society for Nutrition

Abstract english

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.


  • Nutrition and Dietetics


  • Genetic and Molecular Epidemiology
  • Internal Medicine
  • ISSN: 1541-6100
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