Flavonoid subclasses and CHD risk: a meta-analysis of prospective cohort studies

Fan, Zekai; Wang, Chong; Yang, Ting; Li, Xueqi; Guo, Xiaofei; Li, Duo

doi:10.1017/s0007114521003391

Cited by 8 publications

(26 citation statements)

References 53 publications

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“…To eliminate the effects of covariates, multivariate‐adjusted relative risk (RR) with the corresponding 95% confidence interval (CI) was extracted from the original studies. Quality assessment was conducted based on the Newcastle–Ottawa scale (NOS) as previously reported (Fan et al, 2021; Guo, Ruan, Li, & Li, 2019). The scoring system comprises of 9 aspects to each study: 4 for selection, 2 for comparability and 3 for assessment of outcomes.…”

Section: Methodsmentioning

confidence: 99%

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A meta‐analysis of prospective cohort studies of flavonoid subclasses and stroke risk

Wang

Yang

et al. 2022

Phytotherapy Research

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Epidemiological studies indicate that higher intakes of flavonoids are associated with reduced stroke risk, however, which subtypes play significant roles to protect against stroke remain unclear. A systematic literature search in PubMed and Web of Science databases was performed up to Oct. 2021. Flavonoids or their subtypes (flavanol, flavanone, flavone, flavan-3-ol, isoflavone, or anthocyanin) were paired with stoke as the search term. Multivariate-adjusted relative risks (RRs) with 95% confidence intervals (CIs) for the highest versus the lowest category were pooled by using a randomeffects model. Dose-response analysis was implemented by using a restricted cubic spline regression model. Ten independent prospective cohort studies with 387,076 participants and 9,564 events were included. Higher intakes of flavanones were inversely associated with stroke risk (RR = 0.85; 95%CI: 0.78, 0.93). Dose-response analysis showed that 50 mg/day increment of flavanones was associated with 11% reduction in stroke risk (RR = 0.89; 95%CI: 0.84, 0.94). Flavan-3-ols was marginally inversely associated with stroke risk (RR = 0.92; 95%CI: 0.82, 1.02). Dose-response analysis showed that 200 mg/day increment of flavan-3-ols was associated with 14% reduction in stroke risk (RR = 0.86; 95%CI: 0.75, 0.98). The non-significant association was observed with respect to other flavonoid subclasses. This study demonstrated higher intakes of flavanones and flavan-3-ols were associated with a lower risk of stroke. Dietary intakes of lemon and citrus rich in flavanones and flavan-3-ols might have beneficial functions for the protection against stroke. The findings of these associations of the present study need to be confirmed in other regions and ethnic origins.dose-response analysis, flavonoid subclass, meta-analysis, stroke risk | INTRODUCTIONFlavonoids are widely found in fruits, vegetables and other plants. The main food sources of flavonoids include tea, citrus, berries, apples and wine (Kim, Vance, & Chun, 2016). Over the past few decades, plenty of people have recognized the importance of fruits and vegetables for health and are dedicated to knowing which compounds have a significant impact on the prevention of non-communicable diseases (Perez-Vizcaino & Fraga, 2018). Epidemiological studies have shown inverse associations between total flavonoids intake and chronic metabolic diseases, including coronary heart disease (CHD), cancer and stroke

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Section: Methodsmentioning

confidence: 99%

“…Quality assessment was conducted based on the Newcastle-Ottawa scale (NOS) as previously reported (Fan et al, 2021;Guo, Ruan, Li, & Li, 2019). The scoring system comprises of 9 aspects to each study: 4 for selection, 2 for comparability and 3 for assessment of outcomes.…”

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

A meta‐analysis of prospective cohort studies of flavonoid subclasses and stroke risk

Wang

Yang

et al. 2022

Phytotherapy Research

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“…The highest category of anthocyanin intake was associated with a decreased risk of CVD (RR 0.82; 95% CI 0.70, 0.96) [76], CHD (RR 0.90; 95% CI 0.83, 0.98) [74], CVD mortality (RR 0.92; 95% CI 0.87, 0.97) [100], hypertension (RR 0.92; 95% CI 0.88, 0.97) [86] and esophageal cancer (OR 0.60; 95% CI 0.49, 0.74) [87]. However, no association was found with risk of stroke [100], or multiple cancers including breast, liver, lung, pancreatic or gastric [83,84,101] (Table S8).…”

Section: Anthocyaninsmentioning

confidence: 99%

“…All n = 19 MAs for flavones were based on cohort data (1-24 years duration) as measured via the diet (n = 13 MAs) or mixed sources (n = 6 MAs), and two MAs were dose-response analyses (Tables S1 and S7). The highest category of flavones was associated with a decreased risk of all-cause (RR 0.86; 95% CI 0.80, 0.93) and CVD mortality (RR 0.85; 95% CI 0.75, 0.96) [84], breast cancer (RR 0.81; 95% CI 0.68, 0.96) [83,84], CHD (RR 0.94; 95% CI 0.89, 0.99) [74], esophageal cancer (OR 0.78; 95% CI 0.64, 0.95) [87], liver cancer (RR 0.49; 95% CI 0.30, 0.78) [84] and smoking-related cancer (OR 0.77; 95% CI 0.69, 0.85) [80] (Table S7). In dose-response MAs, for each 1 mg/day increase in flavones, the risk of CVD mortality decreased by 7% (RR 0.93; 95% CI 0.90, 0.97) [84].…”

Section: Health Effects Of White Bioactive Pigments In Fruits and Veg...mentioning

confidence: 99%

“…When comparing the highest intake or levels with the lowest, flavonols were found to improve the risk of stroke (RR 0.86; 95% CI 0.75, 0.96), CVD (RR 0.85; 95% CI 0.79, 0.91), and CHD (RR 0.88; 95% CI, 0.79, 0.98), as well as CVD-(RR 0.79; 95% CI 0.63, 0.99) and CHD-related death (RR 0.80; 95% CI 0.69, 0.93) [73][74][75][76][77]. High categories of flavonols were also associated with a reduced risk of T2DM (RR 0.92; 95% CI 0.85, 0.98) [78] and risk of breast (RR 0.88; 95% CI 0.80, 0.96), colorectal (RR 0.71; 95% CI 0.63, 0.81), gastric (OR 0.80; 95% CI 0.70, 0.91), ovarian (RR 0.68; 95% CI 0.58, 0.80) and smoking related cancer (OR 0.77; 95% CI 0.63, 0.95) [79][80][81][82][83].…”

Section: Flavonolsmentioning

confidence: 99%

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Should We ‘Eat a Rainbow’? An Umbrella Review of the Health Effects of Colorful Bioactive Pigments in Fruits and Vegetables

et al. 2022

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Health promotion campaigns have advocated for individuals to ‘eat a rainbow’ of fruits and vegetables (FV). However, the literature has only focused on individual color pigments or individual health outcomes. This umbrella review synthesized the evidence on the health effects of a variety of color-associated bioactive pigments found in FV (carotenoids, flavonoids, betalains and chlorophylls), compared to placebo or low intakes. A systematic search of PubMed, EMBASE, CINAHL and CENTRAL was conducted on 20 October 2021, without date limits. Meta-analyzed outcomes were evaluated for certainty via the GRADE system. Risk of bias was assessed using the Centre for Evidence-Based Medicine critical appraisal tools. A total of 86 studies were included, 449 meta-analyzed health outcomes, and data from over 37 million participants were identified. A total of 42% of health outcomes were improved by color-associated pigments (91% GRADE rating very low to low). Unique health effects were identified: n = 6 red, n = 10 orange, n = 3 yellow, n = 6 pale yellow, n = 3 white, n = 8 purple/blue and n = 1 green. Health outcomes associated with multiple color pigments were body weight, lipid profile, inflammation, cardiovascular disease, mortality, type 2 diabetes and cancer. Findings show that color-associated FV variety may confer additional benefits to population health beyond total FV intake.

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Dietary Flavonoids Consumption and Health: An Umbrella Review

Li,

Zeng,

et al. 2024

Molecular Nutrition Food Res

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ScopeThe current evidence between dietary flavonoids consumption and multiple health outcomes is inadequate and inconclusive. To summarize and evaluate the evidence for dietary flavonoids consumption and multiple health outcomes, an umbrella review of meta‐analyses and systematic reviews is conducted.Methods and resultsPubMed, Ovid‐EMBASE, and the Cochrane Database of Systematic Reviews are searched up to January 2024. The study includes a total of 32 articles containing 24 unique health outcomes in this umbrella review. Meta‐analyses are recalculated by using a random effects model. Separate analyses are performed based on the kind of different flavonoid subclasses. The study finds some unique associations such as flavonol and gastric cancer, isoflavone and uterine fibroids and endometrial cancer, total flavonoids consumption and lung cancer, ovarian cancer, and prostate cancer. Overall, the study confirms the negative associations between dietary flavonoids consumption and type 2 diabetes mellitus, cardiovascular diseases, breast cancer, colorectal cancer, lung cancer, and mortality, while positive associations are observed for prostate cancer and uterine fibroids.ConclusionAlthough dietary flavonoids are significantly associated with many outcomes, firm generalizable conclusions about their beneficial or harmful effects cannot be drawn because of the low certainty of evidence for most of outcomes. More well‐designed primary studies are needed.

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Flavonoid subclasses and CHD risk: a meta-analysis of prospective cohort studies

Cited by 8 publications

References 53 publications

A meta‐analysis of prospective cohort studies of flavonoid subclasses and stroke risk

A meta‐analysis of prospective cohort studies of flavonoid subclasses and stroke risk

Should We ‘Eat a Rainbow’? An Umbrella Review of the Health Effects of Colorful Bioactive Pigments in Fruits and Vegetables

Dietary Flavonoids Consumption and Health: An Umbrella Review

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