title: The association between dietary flavonoid and lignan intakes and incident type 2 diabetes in European populations: the EPIC-InterAct study.
abstract: OBJECTIVE
  To study the association between dietary flavonoid and lignan intakes, and the risk of development of type 2 diabetes among European populations.
  
  
  METHODS
  The European Prospective Investigation into Cancer and Nutrition-InterAct case-cohort study included 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants from among 340,234 participants with 3.99 million person-years of follow-up in eight European countries. At baseline, country-specific validated dietary questionnaires were used. A flavonoid and lignan food composition database was developed from the Phenol-Explorer, the U.K. Food Standards Agency, and the U.S. Department of Agriculture databases. Hazard ratios (HRs) from country-specific Prentice-weighted Cox regression models were pooled using random-effects meta-analysis.
  
  
  RESULTS
  In multivariable models, a trend for an inverse association between total flavonoid intake and type 2 diabetes was observed (HR for the highest vs. the lowest quintile, 0.90 [95% CI 0.77-1.04]; P value trend = 0.040), but not with lignans (HR 0.88 [95% CI 0.72-1.07]; P value trend = 0.119). Among flavonoid subclasses, flavonols (HR 0.81 [95% CI 0.69-0.95]; P value trend = 0.020) and flavanols (HR 0.82 [95% CI 0.68-0.99]; P value trend = 0.012), including flavan-3-ol monomers (HR 0.73 [95% CI 0.57-0.93]; P value trend = 0.029), were associated with a significantly reduced hazard of diabetes.
  
  
  CONCLUSIONS
  Prospective findings in this large European cohort demonstrate inverse associations between flavonoids, particularly flavanols and flavonols, and incident type 2 diabetes. This suggests a potential protective role of eating a diet rich in flavonoids, a dietary pattern based on plant-based foods, in the prevention of type 2 diabetes.
authors.affiliation: Corresponding author: Nita G. Forouhi, nita.forouhi@mrc-epid.cam.ac.uk.
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authors.lastname: Zamora-Ros
authors.forename: Nita G
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authors.lastname: Forouhi
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authors.lastname: Sharp
authors.forename: Carlos A
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authors.lastname: van der Schouw
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authors.lastname: Clavel-Chapelon
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authors.lastname: Fagherazzi
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authors.forename: Verena
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authors.lastname: Katzke
authors.forename: Timothy J
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authors.lastname: Key
authors.forename: Kay-Tee
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authors.lastname: Khaw
authors.forename: Tilman
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authors.lastname: Kühn
authors.forename: Giovanna
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authors.lastname: Masala
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.forename: Esther
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authors.lastname: Molina-Montes
authors.forename: Peter M
authors.initials: PM
authors.lastname: Nilsson
authors.forename: Kim
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authors.lastname: Overvad
authors.forename: Florence
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authors.lastname: Perquier
authors.forename: J Ramón
authors.initials: JR
authors.lastname: Quirós
authors.forename: Isabelle
authors.initials: I
authors.lastname: Romieu
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.forename: Augustin
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authors.lastname: Scalbert
authors.forename: Matthias
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authors.lastname: Schulze
authors.forename: Nadia
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authors.lastname: Slimani
authors.forename: Annemieke M W
authors.initials: AM
authors.lastname: Spijkerman
authors.forename: Anne
authors.initials: A
authors.lastname: Tjonneland
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Tormo
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Daphne L
authors.initials: DL
authors.lastname: van der A
authors.forename: Claudia
authors.initials: C
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mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000517:prevention & control*; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D005419:Flavonoids / Q000494:pharmacology*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D017705:Lignans / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011159:Population Surveillance; D011446:Prospective Studies
chemical_list: D005419:Flavonoids; D017705:Lignans