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J Nutr. 2016 Mar 9. pii: jn223610. [Epub ahead of print]

Intake of Total Polyphenols and Some Classes of Polyphenols Is Inversely Associated with Diabetes in Elderly People at High Cardiovascular Disease Risk.

Author information

1
Nutrition and Food Science Department, XaRTA (Reference Network in Food Technology), INSA (Nutrition and Food Safety Research Institute), Pharmacy School, and CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain;
2
CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain; Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, IISPV (Pere Virgili Institute for Health Research), Rovira i Virgili University, Reus, Spain;
3
CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain;
4
CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain; Department of Epidemiology, Preventive Medicine, and Public Health, School of Medicine, University of Valencia, Valencia, Spain;
5
CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain; Primary Care Division, Catalan Institute of Health, Barcelona, Spain;
6
Nutrition and Food Science Department, XaRTA (Reference Network in Food Technology), INSA (Nutrition and Food Safety Research Institute), Pharmacy School, and.
7
CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain; Department of Epidemiology, School of Medicine, University of Malaga, Málaga, Spain;
8
CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain; Department of Family Medicine, Primary Care Division of Sevilla, San Pablo Health Center, Sevilla, Spain;
9
CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain; Department of Cardiology, Txangorritxu Hospital, Vitoria, Spain;
10
CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain; University Institute for Health Sciences Investigation, Palma de Mallorca, Spain;
11
CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain; Lipid Clinic, Endocrinology and Nutrition Service, IDIBAPS (August Pi i Sunyer Biomedical Research Institute), Hospital Clinic, Barcelona, Spain;
12
CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain; Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Palmas de Gran Canaria, Spain;
13
CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain; Lipid Unit, Department of Internal Medicine, IDIBELL (Bellvitge Biomedical Research Institute)-Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, FIPEC (Research Foundation for Cardiovascular Disease Prevention), Barcelona, Spain; and.
14
CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain; Cardiovascular Epidemiology Unit, Municipal Institute for Medical Research, Barcelona, Spain.
15
Department of Internal Medicine, Hospital Clínic, IDIBAPS (August Pi i Sunyer Biomedical Research Institute), University of Barcelona, Barcelona, Spain; CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain;
16
Nutrition and Food Science Department, XaRTA (Reference Network in Food Technology), INSA (Nutrition and Food Safety Research Institute), Pharmacy School, and CIBEROBN Fisiopatología de la Obesidad y Nutrición (Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (Carlos III Health Institute), Madrid, Spain; lamuela@ub.edu.

Abstract

BACKGROUND:

Higher consumption of some polyphenols has been associated with a reduced risk of diabetes. However, no studies have evaluated the relation between all polyphenol subclasses and the incidence of diabetes.

OBJECTIVE:

We aimed to prospectively examine the associations between the intake of total polyphenols and different groups of polyphenols (flavonoids, phenolic acids, stilbenes, lignans, and others) on the risk of incident diabetes in the PREDIMED (Prevención con Dieta Mediterránea) trial.

METHODS:

This was an observational cohort analysis of the nondiabetic participants in the PREDIMED trial. This study was a multicenter, controlled, randomized, parallel-group feeding trial to assess the effects of either a Mediterranean diet that was supplemented with extra-virgin olive oil or nuts or advice to adhere to a low-fat control diet on cardiovascular outcomes in elderly men and women at high cardiovascular disease risk. From the 7447 randomly assigned participants, 3430 were selected because they were free of diabetes at baseline and filled out the food-frequency questionnaires (FFQs). Polyphenol intake was calculated by matching food consumption data from repeated FFQs with the Phenol-Explorer database on the polyphenol content of each reported food. HRs and 95% CIs for diabetes according to tertiles of polyphenol intake were estimated with the use of time-dependent Cox proportional hazards models.

RESULTS:

Over a mean of 5.51 y of follow-up (18,900 person-years), there were 314 new cases of diabetes. After multivariable adjustment, we observed a 28% reduction in new-onset diabetes in the highest compared with the lowest tertile of total polyphenol intake (HR: 0.72; 95% CI: 0.52, 0.99; P-trend = 0.05). The intake of subclasses of polyphenols also was inversely associated with diabetes risk, including for total flavonoids (HR: 0.67; 95% CI: 0.48, 0.93; P-trend = 0.02), stilbenes (HR: 0.57; 95% CI: 0.38, 0.84; P-trend = 0.003), dihydroflavonols (HR: 0.59; 95% CI: 0.40, 0.88; P-trend = 0.003), and flavanones (HR: 0.69; 95% CI: 0.49, 0.97; P-trend = 0.03).

CONCLUSIONS:

A high intake of total polyphenols, total flavonoids (specifically flavanones and dihydroflavonols), and stilbenes is associated with a reduced risk of diabetes in elderly persons at high risk of cardiovascular disease. This trial was registered at http://www.controlled-trials.com as ISRCTN35739639.

KEYWORDS:

chronic disease; cox regression; epidemiology; glucose; observational study

PMID:
26962181
DOI:
10.3945/jn.115.223610

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