Habitual dietary intake of flavonoids and all-cause and cause-specific mortality: Golestan cohort study
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RESEARCH
Open Access
Habitual dietary intake of flavonoids and all-cause and cause-specific mortality: Golestan cohort study Jalal Hejazi1,2†, Matin Ghanavati3†, Ehsan Hejazi3* , Hossein Poustchi4, Sadaf G. Sepanlou4, Masoud Khoshnia5, Abdolsamad Gharavi5, Amir Ali Sohrabpour4, Masoud Sotoudeh6, Sanford M. Dawsey7, Paolo Boffetta8, Christian C. Abnet7, Farin Kamangar9, Arash Etemadi7, Akram Pourshams2, Akbar FazeltabarMalekshah2, Paul Brennan10, Reza Malekzadeh2* and Azita Hekmatdoost2,3
Abstract Background and objectives: Flavonoids are the most important group of polyphenols with well-known beneficial effects on health. However; the association of intake of total flavonoid or their subclasses with all-cause or causespecific mortality is not fully understood. The present study aims to evaluate the association between intake of total flavonoid, flavonoid subclasses, and total and cause-specific mortality in a developing country. Methods: A total number of 49,173 participants from the Golestan cohort study, who completed a validated food frequency questionnaire at recruitment, were followed from 2004 till 2018. Phenol-Explorer database was applied to estimate dietary intakes of total flavonoid and different flavonoid subclasses. Associations were examined using adjusted Cox proportional hazards models. Results: During a mean follow-up of 10.63 years, 5104 deaths were reported. After adjusting for several potential confounders, the hazard ratios (HRs) of all-cause mortality for the highest versus the lowest quintile of dietary flavanones, flavones, isoflavonoids, and dihydrochalcones were 0.81 (95% confidence interval = 0.73–0.89), 0.83(0.76– 0.92), 0.88(0.80–0.96) and 0.83(0.77–0.90), respectively. However, there was no association between total flavonoid intake or other flavonoid subclasses with all-cause mortality. In cause-specific mortality analyses, flavanones and flavones intakes were inversely associated with CVD mortality [HRs: 0.86(0.73–1.00) and 0.85(0.72–1.00)] and isoflavonoids and dihydrochalcones were the only flavonoid subclasses that showed a protective association against cancer mortality [HR: 0.82(0.68–0.98)]. Conclusion: The results of our study suggest that certain subclasses of flavonoids can reduce all-cause mortality and mortality rate from CVD and cancer. Keywords: Flavonoids, Mortality, Cardiovascular diseases, Cancer
* Correspondence: [email protected]; [email protected] † Jalal Hejazi and Matin Ghanavati contributed equally to this work. 3 Departments of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2 Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 Internation
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