Flavonoids and overall well-being -
While each has its own nutritional benefits, many provide antioxidants and carotenoids, which help with eye health. They can also be cooked lightly and used as sides for any dish. Take your fruits and veggies to the next nutritious level with a range of herbs and spices.
Many of your favorite seasonings contain flavonoids and antioxidants. In particular, saffron, dill, oregano, parsley, fennel, and celery have been found to have the highest amount of flavonoids. Cinnamon is also a great flavonoid-filled alternative to sugar for incorporating some additional flavor and color into your desserts," says Groux.
Aside from adding a splash of flavor to sweet drinks, desserts, and other dishes, citrus fruits like oranges and lemons are also full of fiber and provide many vitamins and minerals. They are another flavonoid-rich and vitamin C-enhanced option for brightening up drinks, sauces, sides, fish, and more.
Adding legumes to your diet is an excellent way to increase fiber and protein. Many legumes and pulses the edible seeds of legume plants are also full of flavonoids. Add them to salads, chilis, or soups for a hearty meal that tastes good and keeps you feeling full," suggests Groux.
As they're plant products, drinking tea and wine in moderation can provide some health benefits. In addition to boasting high levels of flavonoids, experts recommend chamomile tea for its soothing powers.
If you do sip on red wine for its purported antioxidants, remember to enjoy it in moderation—there is, of course, such a thing as diminishing returns with excessive wine consumption.
Lastly, add a decadent touch to any meal or drink with a piece of flavonoid-rich chocolate or a dash of powdered cocoa. Yes, certain types of chocolate can provide health benefits.
In particular, dark chocolate has a high amount of flavonoids, with some studies showing it to contain more than red wine or black tea. In other words, the darker and more bitter the chocolate i. Batra P, Sharma AK. Anti-cancer potential of flavonoids: recent trends and future perspectives. Ullah A, Munir S, Badshah SL, et al.
Important Flavonoids and Their Role as a Therapeutic Agent. Published Nov doi: Schwarz D, Lipoldová M, Reinecke H, Sohrabi Y. Targeting inflammation with collagen. Clin Transl Med. Li Y, Yao J, Han C, Yang J, et al. Quercetin, inflammation and immunity. Mattioli R, Francioso A, Mosca L, Silva P.
Anthocyanins: a comprehensive review of their chemical properties and health effects on cardiovascular and neurodegenerative diseases. Kooti W, Daraei N. A review of the antioxidant activity of celery Apium graveolens L.
J Evid Based Complementary Altern Med. Abdel-Aal el-SM, Akhtar H, Zaheer K, Ali R. Dietary sources of lutein and zeaxanthin carotenoids and their role in eye health. Published Apr 9. Yashin A, Yashin Y, Xia X, Nemzer B. Antioxidant Activity of Spices and Their Impact on Human Health: A Review.
Antioxidants Basel. In general, adjustments for potential lifestyle and dietary confounders model 3 slightly attenuated the association and HRs for all flavonoid subclasses were not substantially lower beyond quintile 3. The association of total flavonoid intake with all-cause and cause-specific mortality.
Hazard ratios are based on Cox proportional hazards models adjusted for age, sex, BMI, smoking status, physical activity, alcohol intake, hypertension, hypercholesterolemia, social economic status income , and prevalent disease and are comparing the specific level of flavonoid intake horizontal axis to the median intake for participants in the lowest intake quintile.
The association between flavonoid subclass intakes and all-cause mortality. Intakes above those in quintile 1 for total flavonoids and all flavonoid subclasses were associated with a lower risk of both CVD- and cancer-related mortality after adjustment for potential lifestyle and dietary confounders.
The associations between flavonoid intake and both all-cause and cause-specific mortality differed according to smoking status, alcohol intake, and BMI, but not by sex, level of physical activity, or presence of prevalent diabetes.
As there was no difference in association between flavonoid intake and mortality for never vs. former smokers, these were collapsed into one subgroup.
Evidence of a dose—response association can be seen in Supplementary Fig. Similar, although less clear, interactions between flavonoid intake and both smoking intensity and alcohol intake were seen for CVD-related mortality.
The association of total flavonoid intake with all-cause mortality, stratified by risk factors. Multivariable-adjusted association between total flavonoid intake and all-cause mortality stratified by current smoking status, alcohol intake and BMI.
All analyses were standardized for age, sex, BMI, physical activity, alcohol intake, hypertension, hypercholesterolemia, smoking status, social economic status income , and prevalent disease, not including the stratification variable for the subgroups.
Neither including energy intake in model 2, nor removing hypertension, hypercholesterolemia, and prevalent diseases from model 2, or adjusting for medication use substantively altered the hazard ratios Supplementary Table 2.
When stratifying by tertiles of total fruit and vegetable intake, evidence of an association between total flavonoid intake and all-cause mortality remained amongst participants in the highest intake tertile Supplementary Table 3.
There is great potential to improve population health through improved dietary behaviors, with tailored recommendations focusing on specific dietary components and population subgroups. In this prospective cohort study of 56, Danes, we provide evidence that an achievable dietary intake of total and individual flavonoid subclasses is associated with a lower risk of all-cause, CVD-related, and cancer-related mortality.
We demonstrate that inverse associations are strongest for current smokers and individuals with high alcohol consumption, and that a lower risk is seen for higher intakes in these groups.
The present study has many strengths including a large adult population followed for 23 years with a plethora of participant characteristics captured at baseline. Another strength is the limited loss to follow-up; all deaths and emigrations are captured in the Danish registries.
Furthermore, the data allowed us to adjust for many potential dietary and lifestyle confounders and our findings are strengthened with a falsification endpoint analysis, which showed no association with total flavonoid intake. Despite these strengths some limitations apply.
As this is an observational study, we are not able to infer causality. The possibility of flavonoids being a marker of other unobserved and potentially protective dietary factors cannot be discounted, although, in this study the associations between total flavonoid intake and mortality rates remained even after adjusting for other major indicators of a healthy diet as well as within the highest tertile of total fruit and vegetable intake.
However, this misclassification would most likely have attenuated the power to detect an association. Common FFQ limitations apply in that not all flavonoid-rich foods, for example berries, were captured.
Furthermore, potential confounders were only assessed at baseline; it is unclear how changes in the trajectories of these confounders may have impacted upon the observed associations.
CVD- and cancer-related mortality findings warrant further investigation as the Danish Register of Causes of Death are based on clinical adjudication and are susceptible to misclassification bias.
For this reason, we only used broad definitions of cause-specific mortality Further caution should be taken when extrapolating these findings to populations outside of this cohort as the Danish population is more homogenous than many other countries; participants would most likely have been Caucasian.
While previous studies have demonstrated that higher flavonoid intake is associated with a lower risk of all-cause mortality, CVD mortality, and cancer mortality 11 , 12 , this is the first observational study to show that this association is present for all subclasses after adjustment for lifestyle and dietary confounders.
This is likely attributable to our large cohort size, high number of events, comprehensive estimation of flavonoid intake and high prevalence of smoking and high alcohol consumption. The theory, that there exists a threshold after which higher intakes afford no added benefit is not new 12 , However, a critical gap in our knowledge has been what intake of total and specific flavonoids is required to achieve maximum benefit That the thresholds for each of the flavonoid subclasses approximately sum to the threshold for total flavonoid intake is consistent with the idea that all are important and afford added benefit.
In this population it is likely that tea, chocolate, wine, apples, and pears were the main food sources of flavonoids There is growing evidence from preclinical and intervention studies that flavonoids have growth inhibitory effects on various cancer cell types 19 and that they may ameliorate the above mentioned intermediate risk factors for early mortality 14 , 20 , This may explain the stronger association observed in smokers and heavy drinkers.
Interestingly, and in accordance with our results, a meta-analysis of flavonoid intake showed an inverse association with smoking-related cancer incidence The implications that dietary flavonoid intake may partially mitigate harmful carcinogenic, metabolic, inflammatory, and vascular effects of smoking and excess alcohol consumption should not dissuade population health centers from anti-smoking or alcohol awareness campaigns.
Even with high flavonoid consumption, these individuals remain at a much higher risk of early mortality.
Rather it should be used to inform future clinical trials in these high-risk individuals and contribute to an optimization of dietary guidelines in these high-risk populations, ensuring that flavonoid intake is adequate and taking into consideration that these populations may benefit from higher intakes.
Conversely, the inverse association between flavonoid intake and mortality tended to be weaker in obese participants. These findings go against our a priori hypothesis that flavonoids would be more protective in obese individuals as they have higher levels of inflammation, oxidative stress, and vascular dysfunction.
This is difficult to interpret, as there is evidence that flavonoids impact body composition 23 but may be explained in part by gut microbiome composition. The gut microbiome plays a critical role in flavonoid metabolism and therefore bioactivity 24 , and is dissimilar in obese individuals Due to differences in baseline hazards between obese and non-obese participants, these findings warrant investigation on an absolute scale.
In this Danish prospective cohort study, we demonstrate that a moderate intake of flavonoids is inversely associated with all-cause, CVD-related, and cancer-related mortality, with no added benefit seen for higher intakes in non-smokers and low alcohol consumers.
The strongest associations observed between flavonoids and mortality was in smokers and high alcohol consumers, with higher intakes being more beneficial.
These findings highlight the potential to improve population health through dietary recommendations to ensure adequate consumption of flavonoid-rich foods, particularly in these high-risk populations. From December to May the study recruited 56, participants without cancer prior to enrollment, between the age of 50—65 years, residing in the greater area of Copenhagen and Aarhus, Denmark.
Details of the Danish Diet, Cancer, and Health cohort study, an associated cohort of the European Prospective Investigation into Nutrition and Cancer EPIC , have been published previously All Danish residents are provided with a unique and permanent civil registration number enabling crosslinking between nationwide registers and the Danish Diet, Cancer, and Health cohort on the individual level.
The following databases were crosslinked to the cohort: The Civil Registration System which includes data on age, sex, and vital status; The Integrated Database for Labor Market Research which contains information on annual income since ; The Danish Register of Causes of death with information on cause of death since by International Classification of Diseases ICD codes; and The Danish National Patient Register DNPR which holds information on all hospital admissions in Denmark since All diagnoses were defined by ICD using the 8 th revision ICD-8 until and the 10 th revision ICD since In Denmark, register studies do not require approval from ethics committees.
The Danish Data Protection Agency approved this study Ref no —58— I-Suite nr: , VD Informed consent was obtained from all participants to search for information from medical registries.
Dietary data were collected using a validated item food-frequency questionnaire, mailed out to participants prior to their baseline visit to one of the two study centers Participants were asked to indicate their usual frequency of intake of different food and beverage items over the past 12 months, using a category frequency scale that ranged from never to 8 times or more per day.
Details on the calculation of specific foods and nutrients have been published previously The exposures of interest for this study were intakes of total flavonoids and flavonoid subclasses. An estimate of the flavonoid content of each food and beverage in the food-frequency questionnaire was derived from the Phenol-Explorer database Correlations between levels of 12 flavonoids in hr urine samples and intake of their main food sources has been examined in EPIC subjects, showing significant correlations with their main food sources The effect of food processing on flavonoid content was taken into consideration using retention factors Total flavonoid intake was calculated by summing all flavonoid compounds.
Vital status and date of death for every participant was obtained from the Civil Registration System. Cause of death data was obtained from the National Death Register.
CVD-related mortality was defined as any ICD diagnoses registered as a cause of death related to CVD II99 and cancer-related mortality was defined as any ICD diagnosis registered as a cause of death related to cancer CC99 , dated after participant enrollment.
Information on sex, age, and lifestyle factors such as smoking, alcohol consumption, and daily activity were obtained using the self-administered questionnaire at study enrollment. Clinical measurements such as BMI and total cholesterol were taken at the study centers. Annual income was used as a proxy for socio-economic status and was defined as household income after taxation and interest, for the value of the Danish currency in Income, grouped in quartiles, was estimated as the mean income of 5 years up to and including the year of study inclusion.
Self-reported myocardial infarction and self-reported stroke at baseline were combined with ICD codes Supplementary Table 6 of ischemic heart disease and ischemic stroke, respectively, dated prior to participant enrollment.
ICD codes dated prior to participant enrollment were used to identify baseline comorbidities of peripheral artery disease, chronic kidney disease CKD , chronic obstructive pulmonary disease COPD , heart failure, atrial fibrillation, and cancers Supplementary Table 6.
For hypertension and diabetes mellitus, only self-reported prevalence was used due to the low validity of ICD codes in the DNPR Prevalent CVD was defined by the presence of at least one diagnosis of ischemic heart disease, peripheral artery disease, ischemic stroke, heart failure, or atrial fibrillation prior to recruitment.
Participants were followed for a maximum of 23 years, from the date of enrollment until the date of death, emigration, or end of follow-up August, , whichever came first. Potential nonlinear relationships were examined using restricted cubic splines, with hazard ratios HRs based on Cox proportional hazards models.
In all spline analyses, the exposure variables were treated as continuous and individuals with intakes more than four standard deviations above the mean were excluded. The test of nonlinearity used analysis of variance to compare the model with only the linear term to the model that included both the linear and the cubic spline terms.
Cox proportional hazards assumptions were tested using log-log plots of the survival function vs. time and assessed for parallel appearance.
As our aim was to obtain relative estimates for risk factors, deaths from causes other than the outcome of interest were censored rather than treated as a competing risk Covariates were chosen a priori to the best of our knowledge of potential confounders of flavonoid intake and mortality.
As some covariates in model 2 hypertension, hypercholesterolemia and prevalent diseases are potentially on the causal pathway and therefore introduce collider stratification bias, we removed them in a sensitivity analysis. When investigating CVD-related mortality we excluded participants with CVD at baseline.
Using ICD-8 codes, we identified an additional participants with a diagnosis of cancer prior to enrollment; when investigating cancer-related mortality we excluded these participants Fig. We stratified our analyses by sex, BMI, smoking history, alcohol intake, physical activity, and prevalent diabetes to test for potential effect modification.
To account for the possibility of differing dietary habits in those at a high risk of death, we repeated our primary analysis after excluding participants with prevalent diabetes, CVD, COPD, CKD, and cancer.
As we believe crude values of flavonoid intake to be more relevant than energy-adjusted values, we did not include total energy intake as a covariate in any model. However, energy intake was added to model 2 in a sensitivity analysis to assess its impact on the association between flavonoid intake and all-cause mortality.
To determine whether the associations between flavonoid intake and all-cause mortality were independent of fruit and vegetable consumption, we stratified the analysis by tertiles of total fruit and vegetable intake.
In order to assess the likelihood of confounding we used a falsification endpoint which we considered unlikely to be causally affected by flavonoid intake; any emergency, inpatient, or outpatient visit for a burn or foreign object Supplementary Table 6. The funding source had no role in study design, preparation of this manuscript, or decision to submit the paper for publication.
Further information on research design is available in the Nature Research Reporting Summary linked to this article. Due to restrictions related to Danish law and protecting patient privacy, the combined set of data as used in this study can only be made available through a trusted third party, Statistics Denmark.
This state organization holds the data used for this study. University-based Danish scientific organizations can be authorized to work with data within Statistics Denmark and such organization can provide access to individual scientists inside and outside of Denmark.
Aune, D. et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality—a systematic review and dose—response meta-analysis of prospective studies.
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Let's look deeper:. Researchers have found that a daily multivitamin supplement was linked with slowed cognitive aging and improved memory. Dietitians can help you create a more balanced diet or a specialized one for a variety of conditions.
We look at their benefits and limitations. Liquid collagen supplements might be able to reduce some effects of aging, but research is ongoing and and there may be side effects. A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect. What Are Flavonoids?
Everything You Need to Know. Medically reviewed by Miho Hatanaka, RDN, L. Sources Function Health benefits Takeaway Flavonoids are compounds found in many plant products, including teas, citrus fruits, and vegetables. Which foods have flavonoids? What do flavonoids do?
What are the health benefits of flavonoids? How we reviewed this article: Sources. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.
Jul 12, Written By Kathryn Watson. Oct 23, Medically Reviewed By Miho Hatanaka, RDN, L. Share this article. Read this next. What Are Polyphenols? Types, Benefits, and Food Sources. By Alina Petre, MS, RD NL. What Is Vitamin P? Flavonoids Explained.
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