Improving the estimation of flavonoid intake for study of health outcomes

A novel Nutrient Rich Food (NRFa11.3) score uses flavonoids and carotenoids to identify antioxidant-rich spices, herbs, vegetables, and fruit

Introduction

Nutrient profiling (NP) models designed to evaluate the healthfulness of plant-based foods ought to incorporate bioactive phytochemicals. Herbs and spices are one food group of current interest.

Methods

Two new versions of the well-established Nutrient Rich Food (NRF) index were applied to spices, herbs, vegetables, fruit, and other plant-based foods. Analyses used the US Department of Agriculture (USDA) SR-28 nutrient composition database merged with the USDA Expanded Flavonoid database 3.3. The NRF4.3 model was based on protein, fiber, potassium, and vitamin C. The NRFa11.3 model was based on micronutrients with reported antioxidant activity (vitamin C, vitamin E, selenium, copper, and zinc), carotenoids (alpha and beta carotene, beta-cryptoxanthin, lycopene, lutein/zeaxantin) and flavonoids. Saturated fat, added sugar, and sodium were nutrients to limit. The NRF algorithm was based on sums of percent daily values (%DVs) capped at 100%.

Results

The NRF4.3 model awarded high scores to herbs and spices, cocoa powder, and nuts, but did not discriminate well among vegetables and fruit. The NRFa11.3 model performed better. Green leafy, red orange and cruciferous vegetables had the highest carotenoid content. Highest in flavonoids were cocoa powder, herbs and spices, and berries. Highest combined NRFa11.3 values were observed for herbs and spices, green leafy vegetables, cocoa, nuts, and red-orange and cruciferous vegetables.

Discussion

Fresh and dry herbs and spices, often ignored by NP models, were particularly nutrient-rich and may provide non-negligible amounts of key phytonutrients to the human diet.

The effects of flavonoid supplementation on the mental health of postpartum parents

Introduction

During the postpartum period, parents face psychological challenges and consequently, changes in mood and associated mood disorders have become increasingly prevalent in the 6-months following birth. Dietary flavonoids have been found to benefit mood and are therefore an appealing non-pharmacological option for potentially treating mood disorders in the postpartum. The aim of this study was to investigate whether a two-week dietary flavonoid intervention would improve mothers' and fathers' mental health in the immediate 6-month postpartum period.

Method

The study employed a randomised, parallel groups, controlled design to explore the effects of a flavonoid intervention vs. control group on several outcomes, including mood (PANAS), postpartum depression (EPDS), postpartum anxiety (PSAS-RSF-C) and quality of life (WHOQOL). Sixty participants (mothers n = 40, fathers n = 20) in the 6-month post-partum period were randomised to either a "flavonoid" or "control" condition. The flavonoid group were asked to add two flavonoid-rich foods (approximate flavonoid intake 218 mg/day) into their daily diet whilst controls (n = 23) were asked to continue with their usual diet for two-weeks (ClinicalTrials.gov (NCT04990622).

Results

Significant effects were found in the flavonoid group where mothers reported higher positive affect and lower postpartum depression after the two-week intervention relative to baseline. This finding is especially relevant as a clinical reduction in postpartum depression scores in the flavonoid group by an average 2.6 scoring points was observed, which equated to a reduction from "possible depression" at baseline to "little or no depression" at 2-weeks, which was not observed in the control group. Fathers' data was not analysed due to non-compliance with the intervention.

Discussion

This study provides evidence for the benefits of a dietary flavonoid intervention for mood and mental health in new mothers, supporting the utility of non-pharmacological, self-administrable changes to the diet for improving positive mood outcomes and reducing symptoms of postpartum depression in mothers during an especially challenging time. Further research for the effect of dietary interventions on paternal mental health is needed.

Clinical Trial Registration

ClinicalTrials.gov, identifier NCT04990622.

Role of Flavonoids in Modulation of Mitochondria Dynamics during Oxidative Stress

BACKGROUND

Flavonoids are a widespread category of naturally occurring polyphenols distinguished by the flavan nucleus in plant-based foods and beverages, known for their various health benefits. Studies have suggested that consuming 150-500 mg of flavonoids daily is beneficial for health. Recent studies suggest that flavonoids are involved in maintaining mitochondrial activity and preventing impairment of mitochondrial dynamics by oxidative stress.

OBJECTIVE

This review emphasized the significance of studying the impact of flavonoids on mitochondrial dynamics, oxidative stress, and inflammatory response.

METHODS

This review analysed and summarised the findings related to the impact of flavonoids on mitochondria from publicly available search engines namely Pubmed, Scopus, and Web of Science.

DESCRIPTION

Any disruption in mitochondrial dynamics can contribute to cellular dysfunction and diseases, including cancer, cardiac conditions, and neurodegeneration. Flavonoids have been shown to modulate mitochondrial dynamics by regulating protein expression involved in fission and fusion events. Furthermore, flavonoids exhibit potent antioxidant properties by lowering the production of ROS and boosting the performance of antioxidant enzymes. Persistent inflammation is a characteristic of many different disorders. This is because flavonoids also alter the inflammatory response by controlling the expression of numerous cytokines and chemokines involved in the inflammatory process. Flavonoids exhibit an impressive array of significant health effects, making them an effective therapeutic agent for managing various disorders. Further this review summarised available mechanisms underlying flavonoids' actions on mitochondrial dynamics and oxidative stress to recognize the optimal dose and duration of flavonoid intake for therapeutic purposes.

CONCLUSION

This review may provide a solid foundation for developing targeted therapeutic interventions utilizing flavonoids, ultimately benefiting individuals afflicted with various disorders.

Bioavailable Microbial Metabolites of Flavanols Demonstrate Highly Individualized Bioactivity on In Vitro β-Cell Functions Critical for Metabolic Health

Dietary flavanols are known for disease preventative properties but are often poorly absorbed. Gut microbiome flavanol metabolites are more bioavailable and may exert protective activities. Using metabolite mixtures extracted from the urine of rats supplemented with flavanols and treated with or without antibiotics, we investigated their effects on INS-1 832/13 β-cell glucose stimulated insulin secretion (GSIS) capacity. We measured insulin secretion under non-stimulatory (low) and stimulatory (high) glucose levels, insulin secretion fold induction, and total insulin content. We conducted treatment-level comparisons, individual-level dose responses, and a responder vs. non-responder predictive analysis of metabolite composition. While the first two analyses did not elucidate treatment effects, metabolites from 9 of the 28 animals demonstrated significant dose responses, regardless of treatment. Differentiation of responders vs. non-responder revealed that levels of native flavanols and valerolactones approached significance for predicting enhanced GSIS, regardless of treatment. Although treatment-level patterns were not discernable, we conclude that the high inter-individual variability shows that metabolite bioactivity on GSIS capacity is less related to flavanol supplementation or antibiotic treatment and may be more associated with the unique microbiome or metabolome of each animal. These findings suggest flavanol metabolite activities are individualized and point to the need for personalized nutrition practices.

Exploring the Impact of Cyanidin-3-Glucoside on Inflammatory Bowel Diseases: Investigating New Mechanisms for Emerging Interventions

Cyanidin-3-O-glucoside (C3G), the most widely distributed anthocyanin (ACN) in edible fruits, has been proposed for several bioactivities, including anti-inflammatory, neuro-protective, antimicrobial, anti-viral, anti-thrombotic and epigenetic actions. However, habitual intake of ACNs and C3G may vary widely among populations, regions, and seasons, among individuals with different education and financial status. The main point of C3G absorption occurs in the small and large bowel. Therefore, it has been supposed that the treating properties of C3G might affect inflammatory bowel diseases (IBD), such as ulcerative colitis (UC) and Crohn's disease (CD). IBDs develop through complex inflammatory pathways and sometimes may be resistant to conventional treatment strategies. C3G presents antioxidative, anti-inflammatory, cytoprotective, and antimicrobial effects useful for IBD management. In particular, different studies have demonstrated that C3G inhibits NF-κB pathway activation. In addition, C3G activates the Nrf2 pathway. On the other hand, it modulates the expression of antioxidant enzymes and cytoprotective proteins, such as NAD(P)H, superoxide dismutase, heme-oxygenase (HO-1), thioredoxin, quinone reductase-oxide 1 (NQO1), catalase, glutathione S-transferase and glutathione peroxidase. Interferon I and II pathways are downregulated by C3G inhibiting interferon-mediating inflammatory cascades. Moreover, C3G reduces reactive species and pro-inflammatory cytokines, such as C reactive protein, interferon-γ, tumor necrosis factor-α, interleukin (IL)-5, IL-9, IL-10, IL-12p70, and IL-17A in UC and CD patients. Finally, C3G modulates gut microbiota by inducing an increase in beneficial gut bacteria and increasing microbial abundances, thus mitigating dysbiosis. Thus, C3G presents activities that may have potential therapeutic and protective actions against IBD. Still, in the future, clinical trials should be designed to investigate the bioavailability of C3G in IBD patients and the proper therapeutic doses through different sources, aiming to the standardization of the exact clinical outcome and efficacy of C3G.

Association of Dietary Intake of Flavonols With Changes in Global Cognition and Several Cognitive Abilities

BACKGROUND AND OBJECTIVES

Previous research has examined the association between cognition and flavonoids: bioactives found in foods, known to possess anti-inflammatory and antioxidant properties. We extend this research by investigating associations of dietary intakes of total flavonols and constituents (kaempferol, quercetin, myricetin, and isorhamnetin) on the change in cognitive performance in global cognition, episodic memory, semantic memory, visuospatial ability, perceptual speed, and working memory.

METHODS

The study was conducted using 961 participants (aged 60-100 years) of the Rush Memory and Aging Project, a prospective cohort of community-dwelling Chicagoans who were followed for an average of 6.9 years. Diet was assessed using a validated semiquantitative food frequency questionnaire. Cognitive performance was assessed annually with a battery of 19 standardized tests. Flavonol intake was analyzed as a continuous variable using linear mixed-effects models. Cognitive domain scores were regressed on baseline calorie-adjusted flavonol variables.

RESULTS

Higher dietary intakes of total flavonols and flavonol constituents were associated with a slower rate of decline in global cognition and multiple cognitive domains. In continuous models adjusted for age, sex, education, APOE ɛ4, late-life cognitive activity, physical activity, and smoking, total flavonol intake was associated with slower decline in global cognition β estimate = 0.004 (95% CI 0.001-0.006), episodic memory β = 0.004 (95% CI 0.002-0.006), semantic memory β = 0.003 (95% CI 0.001-0.007), perceptual speed β = 0.003 (95% CI 0.001-0.004), and working memory β = 0.003 (95% CI 0.001-0.005) and marginally associated with visuospatial ability β = 0.001 (95% CI -0.001 to 0.003). Analyses of individual flavonol constituents demonstrated that intakes of kaempferol and quercetin were associated with slower global cognitive decline (β = 0.01 [95% CI 0.006-0.02] and β = 0.004 [95% CI 0.0005-0.007]), respectively. Myricetin and isorhamnetin were not associated with global cognition.

DISCUSSION

Results suggest that dietary intakes of total flavonols and several flavonol constituents may be associated with slower decline in global cognition and multiple cognitive abilities with older age.

Comparison of Flavonoid Intake Assessment Methods Using USDA and Phenol Explorer Databases: Subcohort Diet, Cancer and Health-Next Generations-MAX Study

Flavonoids are bioactive plant compounds that are widely present in the human diet. Estimating flavonoid intake with a high degree of certainty is challenging due to the inherent limitations of dietary questionnaires and food composition databases. This study aimed to evaluate the degree of reliability among flavonoid intakes estimated using four different approaches based on the two most comprehensive flavonoid databases, namely, United States Department of Agriculture (USDA) and Phenol Explorer (PE). In 678 individuals from the MAX study, a subcohort of the Diet, Cancer and Health-Next Generations cohort, dietary data were collected using three 24-h diet recalls over 1 year. Estimates of flavonoid intake were compared using flavonoid food content from PE as (1) aglycones (chromatography with hydrolysis), (2) aglycones transformed (converted from glycosides by chromatography without hydrolysis), (3) as they are in nature (glycosides, aglycones, and esters), and 4) using flavonoid content from USDA as aglycones (converted). Spearman's intra-class correlation (ICC) coefficient and weighted kappa (K) coefficient were calculated for the reliability analysis. When comparing PE total aglycones to USDA total aglycones, there was a moderate reliability when a continuous variable was used [ICC: 0.73, 95% confidence interval (CI): 0.70-0.76] and an excellent reliability when flavonoid intake was modeled as a categorical variable (K: 0.89, 95% CI: 0.88-0.90). The degree of reliability among all methods of estimated flavonoid intakes was very similar, especially between database pairs, for the flavanol subclass, while larger differences were observed for flavone, flavonol, and isoflavone subclasses. Our findings indicate that caution should be taken when comparing the results of the associations between flavonoid intakes and health outcomes from studies, when flavonoid intakes were estimated using different methods, particularly for some subclasses.

Transport and Interactions of Co-incubated Bi-functional Flavonoids through Inhibiting the Function of P-Glycoprotein (P-gp) Using KB/Multidrug-Resistant (MDR) Cells and Rat Everted Gut Sacs

This study aims to evaluate the interaction of flavonoid-flavonoid by inhibiting the function of P-glycoprotein (P-gp). The cellular uptake of seven substrates and eleven co-incubated inhibitors was measured in KB/MDR cells. The effect of galangin or morin on the absorption of silibinin or wogonin was carried out in the rat everted gut sacs. Docking was performed to evaluate the interactions between inhibitors and P-gp. Most substrates were greatly enhanced by at least five co-incubated inhibitors. Conversely, the increased uptake of substrates coincided with a decrease or without affecting the uptake of inhibitors, implying a competitive/non-competitive inhibition on P-gp. The enhancement effect by galangin or morin on the transport of silibinin or wogonin was verified in everted gut sacs. Docking explained the inhibition of flavonoids on P-gp by competitively binding to the ATP site. These results provide a strategy for increasing the absorption of flavonoids by co-administration.

Dietary Flavonoids and Insulin Signaling in Diabetes and Obesity

Type 2 diabetes (T2D) and obesity are relevant worldwide chronic diseases. A common complication in both pathologies is the dysregulation of the insulin-signaling pathway that is crucial to maintain an accurate glucose homeostasis. Flavonoids are naturally occurring phenolic compounds abundant in fruits, vegetables and seeds. Rising evidence supports a role for the flavonoids against T2D and obesity, and at present, these compounds are considered as important potential chemopreventive agents. This review summarizes in vitro and in vivo studies providing data related to the effects of flavonoids and flavonoid-rich foods on the modulation of the insulin route during T2D and obesity. Notably, few human studies have evaluated the regulatory effect of these phenolic compounds at molecular level on the insulin pathway. In this context, it is also important to note that the mechanism of action for the flavonoids is not fully characterized and that a proper dosage to obtain a beneficial effect on health has not been defined yet. Further investigations will contribute to solve all these critical challenges and will enable the use of flavonoids to prevent, delay or support the treatment of T2D and obesity.

Association between health risk factors and dietary flavonoid intake in cohort studies

The aim of this study was to identify the health risk factors associated with flavonoid intake in cohort studies investigating the association between dietary polyphenols and the risk of cardiovascular disease (CVD). A systematic search of the PubMed and EMBASE databases was performed. Prospective studies with the background characteristics given for categories of flavonoid intake were eligible to inclusion. A bivariate meta-analysis summarising the intercepts and slopes of the linear regression and a dose-response meta-analysis of differences in means were used to analyse the relationships. The intake of total flavonoids was inversely associated with BMI, alcohol consumption, saturated fat intake, and current smoking, and positively associated with vitamin E, folate, fibre, beta-carotene intake, multivitamin supplement use, and high physical activity. The results of this study underline the importance of considering the association between dietary flavonoid consumption and CVD risk in the context of a healthy lifestyle.

Therapeutic Potential of Quercetin to Alleviate Endothelial Dysfunction in Age-Related Cardiovascular Diseases

The vascular endothelium occupies a catalog of functions that contribute to the homeostasis of the cardiovascular system. It is a physically active barrier between circulating blood and tissue, a regulator of the vascular tone, a biochemical processor and a modulator of coagulation, inflammation, and immunity. Given these essential roles, it comes to no surprise that endothelial dysfunction is prodromal to chronic age-related diseases of the heart and arteries, globally termed cardiovascular diseases (CVD). An example would be ischemic heart disease (IHD), which is the main cause of death from CVD. We have made phenomenal advances in treating CVD, but the aging endothelium, as it senesces, always seems to out-run the benefits of medical and surgical therapies. Remarkably, many epidemiological studies have detected a correlation between a flavonoid-rich diet and a lower incidence of mortality from CVD. Quercetin, a member of the flavonoid class, is a natural compound ubiquitously found in various food sources such as fruits, vegetables, seeds, nuts, and wine. It has been reported to have a wide range of health promoting effects and has gained significant attention over the years. A growing body of evidence suggests quercetin could lower the risk of IHD by mitigating endothelial dysfunction and its risk factors, such as hypertension, atherosclerosis, accumulation of senescent endothelial cells, and endothelial-mesenchymal transition (EndoMT). In this review, we will explore these pathophysiological cascades and their interrelation with endothelial dysfunction. We will then present the scientific evidence to quercetin's anti-atherosclerotic, anti-hypertensive, senolytic, and anti-EndoMT effects. Finally, we will discuss the prospect for its clinical use in alleviating myocardial ischemic injuries in IHD.

Dietary Assessment Methods to Estimate (Poly)phenol Intake in Epidemiological Studies: A Systematic Review

Nutritional epidemiological studies have frequently reported associations between higher (poly)phenol intake and a decrease in the risk or incidence of noncommunicable diseases. However, the assessment methods that have been used to quantify the intakes of these compounds in large-population samples are highly variable. This systematic review aims to characterize the methods used to assess dietary (poly)phenol intake in observational studies, report the validation status of the methods, and give recommendations on method selection and data reporting. Three databases were searched for publications that have used dietary assessment methods to measure (poly)phenol intake and 549 eligible full texts were identified. Food-frequency questionnaires were found to be the most commonly used tool to assess dietary (poly)phenol intake (73%). Published data from peer-reviewed journals were the major source of (poly)phenol content data (25%). An increasing number of studies used open-access databases such as Phenol-Explorer and USDA databases on flavonoid content since their inception, which accounted for 11% and 23% of the data sources, respectively. Only 16% of the studies reported a method that had been validated for measuring the target (poly)phenols. For future research we recommend: 1) selecting a validated dietary assessment tool according to the target compounds and target period of measurement; 2) applying and combining comprehensive (poly)phenol content databases such as USDA and Phenol-Explorer; 3) detailing the methods used to assess (poly)phenol intake, including dietary assessment method, (poly)phenol content data source; 4) follow the Strengthening the Reporting of Observational Studies in Epidemiology-Nutritional Epidemiology (STROBE-nut) framework; and 5) complementing dietary intake assessment based on questionnaires with measurement of (poly)phenols in biofluids using appropriate and validated analytical methods.

Extractable and Non-Extractable Antioxidants Composition in the eBASIS Database: A Key Tool for Dietary Assessment in Human Health and Disease Research

The antioxidant properties of foods are crucial in nutrition, food chemistry, and medicine studies but are often underestimated, with significant amounts of bioactive compounds containing physiological and biochemical properties remaining in the residue from extraction as non-extractable antioxidants. Over the last decade, extractable and non-extractable compounds have become key in the evaluation/determination of the antioxidant properties of food matrices because of their relevance in human health. This has led to the need to include extractable and non-extractable antioxidants in comprehensive and harmonized food composition databases for a wide range of applications within research, food, pharmaceutical, nutraceutical, and cosmeceutical areas. Additionally, the databases are invaluable as part of the health claims application process. eBASIS, (Bioactive Substances in Food Information System) a comprehensive database containing quality-evaluated scientific data, covering the composition of bioactive compounds present in foods, has flexible structures, allowing it to be extended to include newly emerging data on extractable and non-extractable compounds. Search criteria were developed and defined for compiling suitable peer-reviewed literature. Data quality assessment methods were established for the addition of composition data and antioxidant activity, with a focus on various parameters including: the extraction procedure, the antioxidant measurements, the expression of results. A total of 437 quality-evaluated datapoints on the composition of extractable and/or non-extractable compounds were entered into the database. This database update represents one of the first examples of building a database dedicated to antioxidant properties. This expansion of eBASIS provides a novel and unique tool for nutritionists, dietitians, researchers to use for a wide range of applications, such as dietary assessment, exposure studies and epidemiological studies, and may contribute to an increase in high-bioactive food consumption by consumers.

The Relative Importance of the Small Intestine and the Liver in Phase II Metabolic Transformations and Elimination of p-Nitrophenol Administered in Different Doses in the Rat

Intestinal and hepatic function have been investigated in phase II metabolic reactions and elimination of p-nitrophenol (PNP) in the rat. A jejunal loop was cannulated and recirculated with isotonic solutions containing PNP in different concentrations (0, 20, 100, 500, 1000 µM). Samples were obtained from the perfusate at given intervals. To investigate the metabolic and excretory functions of the liver, the bile duct was cannulated, and the bile was collected. Metabolites of PNP were determined by validated HPLC (high pressure liquid chromatography) methods. The results demonstrated the relative importance of the small intestine and the liver in phase II metabolic transformations and elimination of PNP. There were significant differences between the luminal and biliary appearances of p-nitrophenol-glucuronide (PNP-G) and p-nitrophenol–sulfate (PNP-S). The PNP-G appeared in the intestinal lumen at the lower PNP concentrations (20 µM and 100 µM) at higher rate than in the bile. No significant difference was found between the intestinal and the biliary excretion of PNP-G when PNP was administered at a concentration of 500 µM. However, a reverse ratio of these parameters was observed at the administration of 1000 µM PNP. The results indicated that both the small intestine and the liver might play an important role in phase II metabolic reactions and elimination of PNP. However, the relative importance of the small intestine and the liver can be dependent on the dose of drugs.

A new category-specific nutrient rich food (NRF9f.3) score adds flavonoids to assess nutrient density of fruit

Nutrient profiling (NP) models, intended to capture the full nutritional value of plant-based foods, ought to incorporate bioactive phytochemicals, including flavonoids, in addition to standard nutrients. The well-established Nutrient Rich Food (NRF9.3) score is based on 9 nutrients to encourage (protein, fiber, vitamins A, C, D and calcium, iron, potassium, magnesium) and 3 nutrients to limit (saturated fat, added sugar, sodium). The new category-specific NRF9f.3 score kept the same algorithm based on sums of percent daily values (%DVs) but swapped vitamin D for total flavonoids from the USDA database. NRF9f.3 was applied to the USDA fruit group categories, comparing nutrient density of citrus fruit, citrus juice, dried fruit, raw and cooked fruit, berries, fruit mixtures, fruit salads, non-citrus fruit juice, and fruit nectars. Adding total flavonoids to NRF9f.3 allowed for a recalibration of fruit total nutritional value. Citrus fruits and juices had significantly higher flavanones, berries had significantly higher anthocyanidins, and dried fruit and berries had significantly higher flavan-3-ols, than other fruits (all p < 0.05). Citrus fruit, citrus juice and berries had significantly higher NRFf9.3 scores than all other fruit subcategories (p < 0,05), but were not different from each other. The more innovative NP models are both category specific and make effective use of new nutrient composition databases. NRF9.3 when applied to the fruit group discriminates primarily on fiber, vitamin C, and added sugar content. Incorporating flavonoid and polyphenol data modernizes NP models to better capture nutrient density of plant foods that can aid in dietary guidance and policy development to improve diversity and nutritional value of the diet.

Brás N, Mateus N, de Freitas V, Fernandes I. Anthocyanins as Antidiabetic Agents-In Vitro and In Silico Approaches of Preventive and Therapeutic Effects

Many efforts have been made in the past two decades into the search for novel natural and less-toxic anti-diabetic agents. Some clinical trials have assigned this ability to anthocyanins, although different factors like the food source, the amount ingested, the matrix effect and the time of consumption (before or after a meal) seem to result in contradictory conclusions. The possible mechanisms involved in these preventive or therapeutic effects will be discussed-giving emphasis to the latest in vitro and in silico approaches. Therapeutic strategies to counteract metabolic alterations related to hyperglycemia and Type 2 Diabetes Mellitus (T2DM) may include: (a) Inhibition of carbohydrate-metabolizing enzymes; (b) reduction of glucose transporters expression or activity; (c) inhibition of glycogenolysis and (d) modulation of gut microbiota by anthocyanin breakdown products. These strategies may be achieved through administration of individual anthocyanins or by functional foods containing complexes of anthocyanin:carbohydrate:protein.

An overview and update on the epidemiology of flavonoid intake and cardiovascular disease risk

There is an accumulating body of literature reporting on dietary flavonoid intake and the risk of cardiovascular disease (CVD) in prospective cohort studies. This makes apparent the need for an overview and update on the current state of the science. To date, at least 27 prospective cohorts (in 44 publications) have evaluated the association between estimated habitual flavonoid intake and CVD risk. At this time, the totality of evidence suggests long-term consumption of flavonoid-rich foods may be associated with a lower risk of fatal and non-fatal ischemic heart disease (IHD), cerebrovascular disease, and total CVD; disease outcomes which are principally, though not exclusively, composed of cases of atherosclerotic CVD (ASCVD). To date, few studies have investigated outcome specific ASCVD, such as peripheral artery disease (PAD) or ischemic stroke. Of the flavonoid subclasses investigated, evidence more often implicates diets rich in anthocyanins, flavan-3-ols, and flavonols in lowering the risk of CVD. Although inferences are restricted by confounding and other inherent limitations of observational studies, causality appears possible based on biological plausibility, temporality, and the relative consistency of the reported associations. However, whether the associations observed represent a benefit of the isolated bioactives per se, or are a signal of the bioactives acting in concert with the co-occurring nutrient matrix within flavonoid-bearing foods, are issues of consideration. Thus, the simple interpretation, and the one most relevant for dietary advice, is that consumption of flavonoid-rich foods or diets higher in flavonoids, appear nutritionally beneficial in the prevention of CVD.

Potential health benefits of (poly)phenols derived from fruit and 100% fruit juice

(Poly)phenol-rich diets have been associated with reduced risk of various diseases. Coffee and tea are typically identified as dietary sources of chlorogenic acid and flavan-3-ols; however, 100% fruit juice greatly contributes to anthocyanin, flavonol, flavan-3-ols, and flavanone intake, making them complementary sources of dietary (poly)phenols. Thus, the aim of this narrative review was to provide an overview of fruit (poly)phenols and their potential health benefits. Fruit (poly)phenols have been associated with several health benefits (eg, reduced risk of cardiovascular disease and neurocognitive benefits). Although perspectives on 100% fruit juice consumption are controversial due to the perception of sugar content, growing evidence supports the role of fruit in whole and 100% juice forms to provide consumer benefits in alignment with dietary guidance. However, differences in (poly)phenol profiles and bioavailability likely exist between whole fruit and 100% fruit juice due to processing and the presence/absence of fiber. Ongoing studies are better defining similarities and differences between whole fruit and 100% fruit juice to elucidate protective mechanisms and align with processing and consumer products.

Flavonoids with Glutathione Antioxidant Synergy: Influence of Free Radicals Inflow

This report explores the antioxidant interaction of combinations of flavonoid–glutathione with different ratios. Two different 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid radical (ABTS^•+)-based approaches were applied for the elucidation of the antioxidant capacity of the combinations. Despite using the same radical, the two approaches employ different free radical inflow systems: An instant, great excess of radicals in the end-point decolorization assay, and a steady inflow of radicals in the lag-time assay. As expected, the flavonoid–glutathione pairs showed contrasting results in these two approaches. All the examined combinations showed additive or light subadditive antioxidant capacity effects in the decolorization assay. This effect showed slight dilution dependence and did not change when the initial ABTS^•+ concentration was two times as high or low. However, in the lag-time assay, different types of interaction were detected, from subadditivity to considerable synergy. Taxifolin–glutathione combinations demonstrated the greatest synergy, at up to 112%; quercetin and rutin, in combination with glutathione, revealed moderate synergy in the 30–70% range; while morin–glutathione appeared to be additive or subadditive. In general, this study demonstrated that, on the one hand, the effect of flavonoid–glutathione combinations depends both on the flavonoid structure and molar ratio; on the other hand, the manifestation of the synergy of the combination strongly depends on the mode of inflow of the free radicals.

Flavonoids and Mitochondria: Activation of Cytoprotective Pathways?

A large number of diverse mechanisms that lead to cytoprotection have been described to date. Perhaps, not surprisingly, the role of mitochondria in these phenomena is notable. In addition to being metabolic centers, due to their role in cell catabolism, ATP synthesis, and biosynthesis these organelles are triggers and/or end-effectors of a large number of signaling pathways. Their role in the regulation of the intrinsic apoptotic pathway, calcium homeostasis, and reactive oxygen species signaling is well documented. In this review, we aim to characterize the prospects of influencing cytoprotective mitochondrial signaling routes by natural substances of plant origin, namely, flavonoids (e.g., flavanones, flavones, flavonols, flavan-3-ols, anthocyanidins, and isoflavones). Flavonoids are a family of widely distributed plant secondary metabolites known for their beneficial effects on human health and are widely applied in traditional medicine. Their pharmacological characteristics include antioxidative, anticarcinogenic, anti-inflammatory, antibacterial, and antidiabetic properties. Here, we focus on presenting mitochondria-mediated cytoprotection against various insults. Thus, the role of flavonoids as antioxidants and modulators of antioxidant cellular response, apoptosis, mitochondrial biogenesis, autophagy, and fission and fusion is reported. Finally, an emerging field of flavonoid-mediated changes in the activity of mitochondrial ion channels and their role in cytoprotection is outlined.

Examining the health effects and bioactive components in Agaricus bisporus mushrooms: a scoping review

There is evidence from both in vitro and animal models that the consumption of edible mushrooms has beneficial effects on health. It is unclear whether similar effects exist in humans and which bioactive compounds are present. This review synthesises the evidence on the world's most commonly consumed mushroom, Agaricus bisporus to (i) examine its effect on human health outcomes; and (ii) determine the nutrient density of its bioactive compounds, which may explain their health effects. A systematic literature search was conducted on the consumption of A. bisporus, without date and study design limits. Bioactive compounds included ergosterol, ergothioneine, flavonoids, glucans and chitin. Two authors independently identified studies for inclusion and assessed methodological quality. Beneficial effects of A. bisporus on metabolic syndrome, immune function, gastrointestinal health and cancer, with the strongest evidence for the improvement in Vitamin D status in humans, were found. Ultraviolet B (UVB) exposed mushrooms may increase and maintain serum 25(OH)D levels to a similar degree as vitamin D supplements. A. bisporus contain beta-glucans, ergosterol, ergothioneine, vitamin D and an antioxidant compound usually reported as flavonoids; with varying concentrations depending on the type of mushroom, cooking method and duration, and UVB exposure. Further research is required to fully elucidate the bioactive compounds in mushrooms using vigorous analytical methods and expand the immunological markers being tested. To enable findings to be adopted into clinical practice and public health initiatives, replication of existing studies in different population groups is required to confirm the impact of A. bisporus on human health.

Consumption of fruit and vegetables and the risk of type 2 diabetes: a 4-year longitudinal study among Swedish adults

A low intake of fruit and vegetables is a significant contributor to the global burden of disease. The aim of this study was to estimate the size of the risk of type 2 diabetes (T2D) of a low intake and to investigate possible sex differences. In this regard, this study used a longitudinal data from the Stockholm Public Health Cohort located in Sweden, collected in 2010 and 2014. The analysis included 14 718 men and 20 589 women aged 25 to 84 years. Fruit and vegetable intake, separately <2 servings/d or combined <4 servings/d (one serving corresponding to 100 g) was set as a cut-point for low intake. The sex difference at baseline was examined. Sex-stratified logistic regression was performed with onset of T2D as the outcome and fruit and vegetable intake at baseline as the exposure with adjustment for other known risk factors. Results indicate that men consumed significantly (P < 0⋅001) less fruit and vegetables compared with women. A 62 % higher risk to develop T2D over the 4-year period was observed in men who had low vegetable intake compared with high intake after adjusting for age, education, BMI, smoking, alcohol and physical activity (OR 1⋅62; 95 % CI 1⋅00, 2⋅63). In women, a significantly higher risk of T2D was also observed with a low intake of vegetables, but not after adjustment. The present study suggests that higher consumption of vegetables seems to be protective for the onset of T2D in men. Thus, increasing the intake of vegetables in men should be a public health priority.

Estimated intake and major food sources of flavonoids among Australian adolescents

PURPOSE

The consumption of dietary flavonoids from plant-based foods has been related to the prevention of multiple chronic diseases. However, intake data from adolescents are lacking. We aimed to characterise the intake and major sources of dietary flavonoids among Australian adolescents and investigate changes during adolescence.

METHODS

The Raine Study Gen 2 participants completed a 212-item food frequency questionnaire at age 14 years and 17 years, with repeated measures for n = 883. Items were assigned a content for six flavonoid subclasses using the Phenol-Explorer database, which were summed for total flavonoid intake. Daily intakes and sources of flavonoids and flavonoid-subclasses were determined, and change assessed between 14 and 17 years, for males and females.

RESULTS

Major food sources of flavonoids and each subclass were similar at 14 and 17 years, with fruit juice the major contributor to total flavonoid intake at both time points (providing 44% and 38%, respectively). Citrus flavanones (predominantly hesperitin) were the major subclass at 14 years, while tea flavan-3-ols were a major subclass (predominantly procyanidin dimers) at 17 years. The mean intake of total flavonoids at 14 years was 210 ± 133 mg/day, reducing by 5% (10 mg/day) by 17 years. Females consumed a more flavonoid-dense diet compared to males (104.5 ± 71.5 mg/1000 kcal vs 80.4 ± 50.3 mg/1000 kcal per day; p < 0.001).

CONCLUSION

This study provides a comprehensive estimation of flavonoid intake and their major food sources in a sample of Australian adolescents, which may be useful in the development of practical dietary recommendations.

Flavonoids interference in common protein assays: Effect of position and degree of hydroxyl substitution

Flavonoids interfere with colorimetric protein assays in a concentration- and structure-dependent manner. Degree (≥3) and position (C₃) of -OH substitution was associated with intensified interference (p < 0.05). Significant overestimation of protein (~3-5 folds) could occur at higher flavonoid concentrations (>5 μM) and is particularly evident at lower protein concentrations (25-250 μg/ml). Since, healthy human urinary protein (<200 μg/ml) and flavonoids urinary excretion (0.5-2 μg/ml) levels fall in this range, overestimation of protein concentration with flavonoids consumption in diet, including natural supplements, remains relevant issue for diagnostic and research labs. Protein precipitation by acetone to remove interfering flavonoid successfully resolves the problem.

Distribution of crown hexameric procyanidin and its tetrameric and pentameric congeners in red and white wines

Nineteen red and white wines were screened for the presence of crown (oligomeric cyclic) procyanidins with 4, 5 or 6 (epi)catechin monomers by means of HPLC-HRMS/MS. For the first time, the distribution of crown procyanidins in wines obtained from several grape varieties was discussed including white wines. The ratios between crown and non-cyclic procyanidins allowed the samples to be discriminated by grape variety. The crown hexameric procyanidin was present in the red wines and absent in the white wines analyzed. The crown pentameric procyanidin was absent in Gewürztraminer. In Chardonnay and Sauvignon Blanc, the pentameric procyanidin was present only in the cyclic form. Less oxidized high quality red wines displayed a higher fraction of crown to non-cyclic procyanidins than the other wines. These compounds are proposed as potential complement markers of wine quality and authenticity.

A Selective Role of Dietary Anthocyanins and Flavan-3-ols in Reducing the Risk of Type 2 Diabetes Mellitus: A Review of Recent Evidence

Type 2 diabetes mellitus (T2DM) is the most common form of DM and its prevalence is increasing worldwide. Because it is a progressive disease, prevention, early detection and disease course modification are possible. Diet plays a critical role in reducing T2DM risk. Therapeutic dietary approaches routinely recommend diets high in plant foods (i.e., vegetables, fruits, whole-grains). In addition to essential micronutrients and fiber, plant-based diets contain a wide-variety of polyphenols, specifically flavonoid compounds. Evidence suggests that flavonoids may confer specific benefits for T2DM risk reduction through pathways influencing glucose absorption and insulin sensitivity and/or secretion. The present review assesses the relationship between dietary flavonoids and diabetes risk reduction reviewing current epidemiology and clinical research. Collectively, the research indicates that certain flavonoids, explicitly anthocyanins and flavan-3-ols and foods rich in these compounds, may have an important role in dietary algorithms aimed to address diabetes risk factors and the development of T2DM.

Flavanols are potential anti-obesity agents, a systematic review and meta-analysis of controlled clinical trials

BACKGROUND

The anti-obesity potential of flavonoids has been shown by animal and human studies. In this meta-analysis, we systematically reviewed controlled clinical trials and quantified the effects of flavonoids and flavonoid subclasses on obesity-related anthropometric measures.

METHODS AND RESULTS

PubMed, EMBASE, Scopus, Web of Science, and ProQuest databases were searched to identify trials examining the effect of flavonoids on body mass index (BMI), waist circumference, and body fat percentage. Fifty eight trials passed the eligibility process. Analysis endpoints were calculated as the mean difference between baseline and post-treatment. Flavonoids were in subclasses of flavanols, flavonols, isoflavones, flavanones, anthocyanins, and proanthocyanidins. They were mostly in the form of supplements and dosages varying from 40 to 1300 mg/day. Among flavonoid subclasses, flavanols showed potential for decreasing BMI, in the overall population (mean difference (MD) = -0.28 kg/m², P = 0.04; n = 21) and in the subgroups of Asians (MD = -0.42 kg/m²; P = 0.046; n = 13), ages < 50 years (MD = -0.50 kg/m²; P = 0.008; n = 14), BMI ≥ 25 kg/m² (MD = -0.30 kg/m²; P = 0.049; n = 15), and at doses ≥ 500 mg/day (MD = -0.36 kg/m²; P = 0.049; n = 12). Isoflavones also decreased BMI of non-Asian populations (MD = -0.26 kg/m²; P = 0.035; n = 13) and doses ≥ 75 mg/day (MD = -0.34 kg/m²; P = 0.027; n = 8). In the overall assessment, flavanols also decreased waist circumference (MD = -0.60 cm; P = 0.02; n = 18) but had no significant effect on body fat percentage. The available trials did not reveal significant effects from flavonols, flavanones, and anthocyanins on the specified anthropometric measures.

CONCLUSIONS

Overall results of this meta-analysis showed that flavanols have potential against obesity.

Postdiagnosis Isoflavone and Lignan Intake in Newly Diagnosed Breast Cancer Patients: Cross-Sectional Survey Shows Considerable Intake from Previously Unassessed High-Lignan Foods

BACKGROUND

Isoflavones and lignans (phytoestrogens) are dietary components with potential anticarcinogenic effects. Although the intake of isoflavones and lignans may affect breast cancer treatment and prognosis-and associations may differ by menopausal status-postdiagnosis intake data are limited.

OBJECTIVE

We aimed to describe postdiagnosis isoflavone and lignan intake in newly diagnosed breast cancer patients, examine differences by menopausal status and phytoestrogen type, and inform the assessment of diet and survival in future prognostic studies.

METHODS

Our cross-sectional study included 278 women aged 25-74 y, diagnosed with pathologically confirmed breast cancer in April-May 2010 and identified using the Ontario Cancer Registry. Intake in the previous 2 mo was assessed using questionnaires listing 17 soy and 3 high-lignan foods (flaxseed, flaxseed bread, sesame seeds), completed 71 d after breast cancer diagnosis, on average. Food consumption by menopausal status was examined. Geometric mean and median phytoestrogen intakes were estimated among all patients and in consumers only; differences by menopausal status and phytoestrogen type were assessed.

RESULTS

Among all patients, foods were similarly consumed by menopausal status and isoflavone intakes were low (median: 56 µg/d). Consumers (n = 219) had higher intakes (median isoflavones: 1808 µg/d); 7% of isoflavone and 21% of lignan consumers had intakes ≥10 mg/d. Intakes were higher in premenopausal than in postmenopausal consumers, particularly for lignans, but were not significantly different (median lignans: 4375 compared with 1863 µg/d; P = 0.07). Lignans were significantly higher than isoflavones among most consumers (postmenopausal means: 746 compared with 100 µg/d; P < 0.0001).

CONCLUSIONS

Postdiagnosis lignan intakes from 3 high-content foods may be considerable among newly diagnosed breast cancer patients, yet they have been unassessed in previous prognostic studies. The inclusion of these foods in dietary assessment methods may improve future intake estimates and the distributions on which breast cancer survival analyses are based.

Dietary flavonoid intake in older adults: how many days of dietary assessment are required and what is the impact of seasonality?

BACKGROUND

Within- and between-person variation in nutrient intake is well established, but little is known about variability in dietary flavonoid intake, including the effect of seasonality.

METHODS

Within- and between-individual variability of flavonoid intake, and intake of flavonoid subclasses was examined in older adults (n = 79; mean age 70.1 y (range: 60y-80y)), using three separate 4-day weighed food records (WFR) collected approximately 4 months apart. The effects of seasonality were also examined. Mixed-effects linear regression models were used to estimate within- and between-individual variance components for flavonoids and subclasses. The number of days of dietary assessment required for a high level of hypothetical accuracy was calculated from variance ratios.

RESULTS

Within- and between-individual variability was high for flavonoid intake, and intake of flavonoid subclasses, with variance ratios > 1. It was calculated that six days of WFR data are required for total flavonoid intake, and between 6 and 10 days was required for flavonoid subclasses. There was no effect of seasonality for total flavonoid intake or intake of flavonoid subclasses, with the exception that flavan-3-ol and flavanone intakes which were relatively low in summer, and in summer and winter, respectively.

CONCLUSION

While the effects of seasonality on total flavonoid intake may be small, within- and between-individual variation associated with flavonoid intake assessment appears to be substantial across 12 days of WFR data in older adults. It is recommended that a minimum of 6 days of weighed food records are collected to minimise the impact of within- and between-individual variability on total flavonoid intake assessments in this population.

Intake of Individual Flavonoids and Risk of Carcinogenesis: Overview of Epidemiological Evidence

Several epidemiological findings have demonstrated that specific flavonoids can be responsible for reduction of the risk of certain cancer types. However, these results are still rather limited, inconclusive and controversial. Therefore, in this comprehensive review article the findings reported to date about the associations between dietary intake of individual flavonoid compounds and cancer incidence are compiled and analyzed. Also, the possible reasons for inconsistencies are brought forth and discussed. As diet is a potentially modifiable factor in our behavioral choices, further large-scale prospective studies with longer follow-up times, different populations, various doses and exposure timing as well as diverse well-controlled confounders are highly needed to confirm or disprove the current epidemiological knowledge about the role of flavonoids on cancer risk. Regarding the promising data to date, more research on bioavailability, metabolism and biological action mechanisms of these plant secondary metabolites is also encouraged.

Bioactive Compounds from Mexican Varieties of the Common Bean (Phaseolus vulgaris): Implications for Health

As Mexico is located within Mesoamerica, it is considered the site where the bean plant originated and where it was domesticated. Beans have been an integral part of the Mexican diet for thousands of years. Within the country, there are a number of genotypes possessing highly diverse physical and chemical properties. This review describes the major bioactive compounds contained on the Mexican varieties of the common bean. A brief analysis is carried out regarding the benefits they have on health. The effect of seed coat color on the nutraceutical compounds content is distinguished, where black bean stands out because it is high content of anthocyanins, polyphenols and flavonoids such as quercetin. This confers black bean with an elevated antioxidant capacity. The most prominent genotypes within this group are the "Negro San Luis", "Negro 8025" and "Negro Jamapa" varieties. Conversely, the analyzed evidence shows that more studies are needed in order to expand our knowledge on the nutraceutical quality of the Mexican bean genotypes, either grown or wild-type, as well as their impact on health in order to be used in genetic improvement programs or as a strategy to encourage their consumption. The latter is based on the high potential it has for health preservation and disease prevention.

Relative Validity and Reproducibility of an Interviewer Administered 14-Item FFQ to Estimate Flavonoid Intake Among Older Adults with Mild-Moderate Dementia

There is a large burden on researchers and participants when attempting to accurately measure dietary flavonoid intake using dietary assessment. Minimizing participant and researcher burden when collecting dietary data may improve the validity of the results, especially in older adults with cognitive impairment. A short 14-item food frequency questionnaire (FFQ) to measure flavonoid intake, and flavonoid subclasses (anthocyanins, flavan-3-ols, flavones, flavonols, and flavanones) was developed and assessed for validity and reproducibility against a 24-hour recall. Older adults with mild-moderate dementia (n = 49) attended two interviews 12 weeks apart. With the assistance of a family carer, a 24-h recall was collected at the first interview, and the flavonoid FFQ was interviewer-administered at both time-points. Validity and reproducibility was assessed using the Wilcoxon signed-rank sum test, Spearman's correlation coefficient, Bland-Altman Plots, and Cohen's kappa. Mean flavonoid intake was determined (FFQ1 = 795 ± 492.7 mg/day, 24-h recall = 515.6 ± 384.3 mg/day). Tests of validity indicated the FFQ was better at estimating total flavonoid intake than individual flavonoid subclasses compared with the 24-h recall. There was a significant difference in total flavonoid intake estimates between the FFQ and the 24-h recall (Wilcoxon signed-rank sum p < 0.001; Bland-Altman plots indicated large bias and wide limits of agreement), but they were well correlated (Spearman's correlation coefficient r = 0.74, p < 0.001; Cohen's kappa κ = 0.292, p < 0.001). The FFQ showed good reproducibility, with a small mean percentage difference (12.6%). The Wilcoxon signed-rank sum test showed no significant difference, Spearman's correlation coefficient indicated excellent reliability (r = 0.75, p < 0.001), Bland-Altman plots visually showed small, nonsignificant bias and wide limits of agreement, and Cohen's kappa indicated fair agreement (κ = 0.429, p < 0.001). A 14-item FFQ developed to easily measure flavonoid intake in older adults with dementia demonstrates fair validity against a 24-h recall and good reproducibility.

Dietary flavonoid intake and colorectal cancer risk in the European prospective investigation into cancer and nutrition (EPIC) cohort

Flavonoids have been shown to inhibit colon cancer cell proliferation in vitro and protect against colorectal carcinogenesis in animal models. However, epidemiological evidence on the potential role of flavonoid intake in colorectal cancer (CRC) development remains sparse and inconsistent. We evaluated the association between dietary intakes of total flavonoids and their subclasses and risk of development of CRC, within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. A cohort of 477,312 adult men and women were recruited in 10 European countries. At baseline, dietary intakes of total flavonoids and individual subclasses were estimated using centre-specific validated dietary questionnaires and composition data from the Phenol-Explorer database. During an average of 11 years of follow-up, 4,517 new cases of primary CRC were identified, of which 2,869 were colon (proximal = 1,298 and distal = 1,266) and 1,648 rectal tumours. No association was found between total flavonoid intake and the risk of overall CRC (HR for comparison of extreme quintiles 1.05, 95% CI 0.93-1.18; p-trend = 0.58) or any CRC subtype. No association was also observed with any intake of individual flavonoid subclasses. Similar results were observed for flavonoid intake expressed as glycosides or aglycone equivalents. Intake of total flavonoids and flavonoid subclasses, as estimated from dietary questionnaires, did not show any association with risk of CRC development.

eBASIS (Bioactive Substances in Food Information Systems) and Bioactive Intakes: Major Updates of the Bioactive Compound Composition and Beneficial Bioeffects Database and the Development of a Probabilistic Model to Assess Intakes in Europe

eBASIS (Bioactive Substances in Food Information Systems), a web-based database that contains compositional and biological effects data for bioactive compounds of plant origin, has been updated with new data on fruits and vegetables, wheat and, due to some evidence of potential beneficial effects, extended to include meat bioactives. eBASIS remains one of only a handful of comprehensive and searchable databases, with up-to-date coherent and validated scientific information on the composition of food bioactives and their putative health benefits. The database has a user-friendly, efficient, and flexible interface facilitating use by both the scientific community and food industry. Overall, eBASIS contains data for 267 foods, covering the composition of 794 bioactive compounds, from 1147 quality-evaluated peer-reviewed publications, together with information from 567 publications describing beneficial bioeffect studies carried out in humans. This paper highlights recent updates and expansion of eBASIS and the newly-developed link to a probabilistic intake model, allowing exposure assessment of dietary bioactive compounds to be estimated and modelled in human populations when used in conjunction with national food consumption data. This new tool could assist small- and medium-sized enterprises (SMEs) in the development of food product health claim dossiers for submission to the European Food Safety Authority (EFSA).

Cyanidin-3-O-glucoside: Physical-Chemistry, Foodomics and Health Effects

Anthocyanins (ACNs) are plant secondary metabolites from the flavonoid family. Red to blue fruits are major dietary sources of ACNs (up to 1 g/100 g FW), being cyanidin-3-O-glucoside (Cy3G) one of the most widely distributed. Cy3G confers a red hue to fruits, but its content in raspberries and strawberries is low. It has a good radical scavenging capacity (RSC) against superoxide but not hydroxyl radicals, and its oxidative potential is pH-dependent (58 mV/pH unit). After intake, Cy3G can be metabolized (phases I, II) by oral epithelial cells, absorbed by the gastric epithelium (1%-10%) and it is gut-transformed (phase II &amp; microbial metabolism), reaching the bloodstream (<1%) and urine (about 0.02%) in low amounts. In humans and Caco-2 cells, Cy3G's major metabolites are protocatechuic acid and phloroglucinaldehyde which are also subjected to entero-hepatic recycling, although caffeic acid and peonidin-3-glucoside seem to be strictly produced in the large bowel and renal tissues. Solid evidence supports Cy3G's bioactivity as DNA-RSC, gastro protective, anti-inflammatory, anti-thrombotic chemo-preventive and as an epigenetic factor, exerting protection against Helicobacter pylori infection, age-related diseases, type 2 diabetes, cardiovascular disease, metabolic syndrome and oral cancer. Most relevant mechanisms include RSC, epigenetic action, competitive protein-binding and enzyme inhibition. These and other novel aspects on Cy3G's physical-chemistry, foodomics, and health effects are discussed.

Comparison of flavonoid intake assessment methods

BACKGROUND

Flavonoids are a diverse group of polyphenolic compounds found in high concentrations in many plant foods and beverages. High flavonoid intake has been associated with reduced risk of chronic disease. To date, population based studies have used the United States Department of Agriculture (USDA) food content database to determine habitual flavonoid intake. More recently, a new flavonoid food content database, Phenol-Explorer (PE), has been developed. However, the level of agreement between the two databases is yet to be explored.

AIM

To compare the methods used to create each database, and to explore the level of agreement between the flavonoid intake estimates derived from USDA and PE data.

DESIGN

The study population included 1063 randomly selected women aged over 75 years. Two separate intake estimates were determined using food composition data from the USDA and the PE databases.

RESULTS

There were many similarities in methods used to create each database; however, there are several methodological differences that manifest themselves in differences in flavonoid intake estimates between the 2 databases. Despite differences in net estimates, there was a strong level of agreement between total-flavonoid, flavanol, flavanone and anthocyanidin intake estimates derived from each database. Intake estimates for flavanol monomers showed greater agreement than flavanol polymers. The level of agreement between the two databases was the weakest for the flavonol and flavone intake estimates.

CONCLUSION

In this population, the application of USDA and PE source data yielded highly correlated intake estimates for total-flavonoids, flavanols, flavanones and anthocyanidins. For these sub-classes, the USDA and PE databases may be used interchangeably in epidemiological investigations. There was poorer correlation between intake estimates for flavonols and flavones due to differences in USDA and PE methodologies. Individual flavonoid compound groups that comprise flavonoid sub-classes had varying levels of agreement. As such, when determining the appropriate database to calculate flavonoid intake variables, it is important to consider methodologies underpinning database creation and which foods are important contributors to dietary intake in the population of interest.

Dietary flavonoid intakes and CVD incidence in the Framingham Offspring Cohort

This study examines the relationship between long-term intake of six flavonoid classes and incidence of CVD and CHD, using a comprehensive flavonoid database and repeated measures of intake, while accounting for possible confounding by components of a healthy dietary pattern. Flavonoid intakes were assessed using a FFQ among the Framingham Offspring Cohort at baseline and three times during follow-up. Cox proportional hazards regression was used to characterise prospective associations between the natural logarithms of flavonoid intakes and CVD incidence using a time-dependent approach, in which intake data were updated at each examination to represent average intakes from previous examinations. Mean baseline age was 54 years, and 45 % of the population was male. Over an average 14·9 years of follow-up among 2880 participants, there were 518 CVD events and 261 CHD events. After multivariable adjustment, only flavonol intake was significantly associated with lower risk of CVD incidence (hazard ratios (HR) per 2·5-fold flavonol increase=0·86, P_trend=0·05). Additional adjustment for total fruit and vegetable intake and overall diet quality attenuated this observation (HR=0·89, P_trend=0·20 and HR=0·92, P_trend=0·33, respectively). There were no significant associations between flavonoids and CHD incidence after multivariable adjustment. Our findings suggest that the observed association between flavonol intake and CVD risk may be a consequence of better overall diet. However, the strength of this non-significant association was also consistent with relative risks observed in previous meta-analyses, and therefore a modest benefit of flavonol intake on CVD risk cannot be ruled out.