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The association of dietary total flavonoids and their subclasses with the risk of type 2 diabetes: a prospective cohort study

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Abstract

Background

Data from mechanistic studies suggest flavonoids may benefit glucose metabolism, but their associations with type 2 diabetes (T2D) remain unclear. This study examined the prospective associations of dietary intake of total, classes, and individual flavonoids, as well as their source foods, with T2D in the CArdioVascular disease Association Study (CAVAS).

Methods

A total of 16,666 Korean men and women were enrolled at baseline, and 953 were newly diagnosed with T2D over a median follow-up of 5.96 years. Intake of flavonoids was cumulatively averaged using all food frequency questionnaires before the censoring events. A Poisson regression model was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs).

Results

Women with higher total flavonoid, flavonol, isoflavone, and proanthocyanidin intake had a lower risk of T2D (fourth vs. first quartile, IRR 0.62; 95% CI 0.44–0.89; P for linearity and non-linearity < 0.05 for total flavonoids), while in men, flavanones, anthocyanins, and proanthocyanidins, but not total flavonoids, were inversely associated with T2D risk (all P interaction for sex > 0.05). The key source foods contributing to flavonoid intake were also different between men and women, except for apples: tangerines and strawberries in men and green leafy vegetables and soy products in women.

Conclusions

A higher intake of total flavonoids, particularly from vegetables, soybeans, and apples, may be associated with lower risk of T2D in women. However, flavonoids from fruits, rather than total flavonoids, may be inversely associated in men. The association between flavonoid intake and the risk of T2D may be contingent upon the dietary sources of flavonoids consumed.

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Data availability

Data described in the manuscript, code book, and analytic code will not be made available because of data protection regulations in the Korea Disease Control and Prevention Agency (KCDA) and cohorts involved.

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Acknowledgements

This work was supported by the Research Program funded by the Korea Centres for Disease Control and Prevention (2004-E71004-00, 2005-E71011-00, 2006-E71009-00, 2007-E71002-00, 2008-E71004-00, 2009-E71006-00, 2010-E71003-00, 2011-E71002-00, 2012-E71007-00, 2013-E71008-00, 2014-E71006-00, 2014-E71006-01, 2016-E71001-00, 2017N-E71001-00) and was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. NRF-2020R1A2C1004815).

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Authors and Affiliations

  1. Department of Preventive Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Medical School Building A-Room 517-2, Sungdong-gu, 04763, Seoul, South Korea

    Hye Won Woo, Mi Kyung Kim, Kong Ji-Sook, Jiseon Lee & Yu-Mi Kim

  2. Institute for Health and Society, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, 04763, Seoul, South Korea

    Hye Won Woo, Mi Kyung Kim, Kong Ji-Sook, Jiseon Lee & Yu-Mi Kim

  3. Department of Preventive Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, 61469, Gwangju, South Korea

    Min-Ho Shin

  4. Department of Preventive Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, 26426, Wonju, South Korea

    Sang Baek Koh

  5. Department of Preventive Medicine, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea

    Hyeon Chang Kim

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Contributions

Formal analysis: HWW. Writing—original draft: HWW, MKK. Writing—review and editing: HWW, MKK. Methodology: HWW, MKK. Investigation: HWW, YMK, HCK, SBK, MHS, MKK. Data curation: HWW, JK, JL. Funding acquisition: HCK, SBK, MHS, and MKK. Supervision: MKK.

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Correspondence to Mi Kyung Kim.

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Woo, H.W., Kim, M.K., Ji-Sook, K. et al. The association of dietary total flavonoids and their subclasses with the risk of type 2 diabetes: a prospective cohort study. Eur J Nutr 63, 1339–1356 (2024). https://doi.org/10.1007/s00394-024-03341-x

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