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Association of flavonoid intake with coronary artery disease risk in the older population based on the National Health and Nutrition Examination Survey

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Abstract

We investigated the association between flavonoid intake and coronary artery disease (CAD) risk in older adults. Data were extracted from the National Health and Nutrition Examination Survey (age ≥ 70 years; 2007–2010 and 2017–2018; n = 2 417). The total flavonoid and flavonoid subclass intake was calculated using validated food frequency questionnaires. The association between flavonoid intake and CAD risk was examined using generalized linear models with restricted cubic spline models. After multivariate adjustment, anthocyanin intake was positively associated with CAD risk; no significant associations were observed between other flavonoid subcategories and endpoint outcomes. Anthocyanins exhibited a non-linear association with CAD risk, and threshold effect analysis showed an inflection point of 15.8 mg/day for anthocyanins. Per unit increase in anthocyanins, the odds of CAD on the left of the inflection point decreased by 2%, while the odds on the right increased by 35.8%. Excessive flavonoid intake may increase CAD risk in the older population.

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Data availability

The data used in this study can be obtained from the NHANES database (NHANES — National Health and Nutrition Examination Survey Homepage [cdc.gov]).

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Acknowledgements

The authors thank the patients and investigators who participated in the NHANES for providing the data. The authors appreciate the contribution of Jiajin Chen (Department of Biostatistics, School of Public Health, Nanjing Medical University) for statistical guidance.

Funding

This work was supported by the Key Program of the National Natural Science Foundation of China, grant number 81730106.

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Author notes

  1. Qixin Guo, Luyang Wang, and Qiang Qu contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

    Qixin Guo, Luyang Wang, Qiang Qu, Iokfai Cheang, Xinli Li, Hui Pang & Shengen Liao

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  1. Qixin Guo
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  2. Luyang Wang
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Contributions

Material preparation, data collection, and analysis were performed by Quixin Guo, Qiang Qu, and Luyang Wang. The first draft of the manuscript was written by Qixin Guo. Iokfai Cheang, Xinli Li, Sitong Chen. Shengen Liao and Xinli Li are mainly responsible for the idea conception and supervision of the experiment. All authors commented on previous versions of the manuscript, as well as read and approved the final manuscript.

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Correspondence to Shengen Liao.

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The National Centre for Health Statistics’ Research Ethics Review Board approved the study protocols.

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All participants provided informed consent.

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Responsible Editor: Lotfi Aleya

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Supplementary Information

Below is the link to the electronic supplementary material.

11356_2023_31347_MOESM1_ESM.pdf

Supplementary file1 2D structure of six major flavonoids. (A) Isoflavones. (B) Anthocyanidins. (C) Flavan-3-ols. (D) Flavanones. (E) Flavones. (F) Flavonols (PDF 264 KB)

11356_2023_31347_MOESM2_ESM.pdf

Supplementary file2 Restricted cubic spline plots of associations between flavonoid intake and coronary heart disease risk. (1) Isoflavones. (2) Anthocyanidins. (3) Flavan-3-ols. (4) Flavanones. (5) Flavones. (6) Flavonols. (7) All flavonoids (PDF 938 KB)

Supplementary file3 Forest maps for subgroup analysis (Model 2) (PDF 162 KB)

Supplementary file4 Forest maps for subgroup analysis (Model 3) (PDF 162 KB)

Supplementary file5 Definition of covariates (XLSX 9 KB)

Supplementary file6 Mapping of potential mechanisms of flavonoid association with coronary heart disease (PDF 323 KB)

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Guo, Q., Wang, L., Qu, Q. et al. Association of flavonoid intake with coronary artery disease risk in the older population based on the National Health and Nutrition Examination Survey. Environ Sci Pollut Res 31, 3815–3827 (2024). https://doi.org/10.1007/s11356-023-31347-1

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