Intake of Total Polyphenols and Some Classes of Polyphenols Is Inversely Associated with Diabetes in Elderly People at High Cardiovascular Disease Risk123

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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

Cited by (0)

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This study was supported by The Interministerial Commission on Science and Technology, CICYT (AGL2013-49083-C3-1-R) from the Spanish Ministry of Economy and Competitiviness, the Generalitat de Catalunya (2014 SGR 773), and the Instituto de Salud Carlos III (ISCIII) (CIBEROBN). CIBEROBN is an initiative of ISCIII, Spain. AT-R received support from ISCIII (FI10/00265). The Fundación Patrimonio Comunal Olivarero, the California Walnut Commission, Borges SA, and Morella Nuts SA donated the olive oil, walnuts, almonds, and hazelnuts, respectively, used in the study.

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Author disclosures: J Salas-Salvadó served on the board of and received grant support through his institution from the International Nut and Dried Fruit Council, received consulting fees from Danone, and received grant support through his institution from Eroski and Nestle. F Arós received payment for the development of educational presentations from Menarini and AstraZeneca. E Ros received travel support and grant support through his institution from the California Walnut Commission; served on the board of the Flora Foundation (Unilever); received lecture fees from Roche; served on the board of and received grant support through his institution from Amgen; received consulting fees from Damm and Abbott Laboratories; received consulting fees, lecture fees, and grant support through his institution from Merck; received lecture fees from Danone, Pace, AstraZeneca, and Rottapharm; received lecture fees, payment for the development of educational presentations and grant support through his institution from Ferrer; received payment for the development of educational presentations from Recordati; and received grant support through his institution from Sanofi-Aventis, Takeda, Daiichi Sankyo, Nutrexpa, Feiraco, Unilever, and Karo Bio. L Serra-Majem served on the boards of the Mediterranean Diet Foundation and the Beer and Health Foundation. X Pintó served on the board of, received payment for the development of educational presentations from, and received grant support through his institution from Ferrer; received consulting fees from Abbott Laboratories; received lecture fees, and grant support through his institution from Merck, Menarini, Unilever, and Roche; received lecture fees from Esteve, Lacer, and AstraZeneca; received payment for the development of educational presentations from Rubio; and received grant support through his institution from Sanofi-Aventis, Amgen, Pfizer, and Boehringer Ingelheim. R Estruch served on the board of and received lecture fees from the Research Foundation on Wine and Nutrition, served on the boards of the Beer and Health Foundation and the European Foundation for Alcohol Research, received lecture fees from Cerveceros de España and Sanofi-Aventis, and received grant support through his institution from Novartis. RM Lamuela-Raventós served on the board of and received lecture fees from the Research Foundation on Wine and Nutrition, received lecture fees from Cerveceros de España, and received lecture fees and travel support from PepsiCo. A Tresserra-Rimbau, M Guasch-Ferré, E Toledo, D Corella, O Castañer, X Guo, E Gómez-Gracia, J Lapetra, M Fiol, M Fitó, N Babio, MA Martínez-González, JV Sorli, and MC López-Sabater, no conflicts of interest. None of the funding sources played a role in the design, collection, analysis or interpretation of the data or in the decision to submit the manuscript for publication

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Supplemental Table 1 is from the “Online Supporting Material” link in the online posting of the article and from the same link in the online table of contents at http://jn.nutrition.org.