title: Polyphenol intake and mortality risk: a re-analysis of the PREDIMED trial.
abstract: BACKGROUND
  Polyphenols may lower the risk of cardiovascular disease (CVD) and other chronic diseases due to their antioxidant and anti-inflammatory properties, as well as their beneficial effects on blood pressure, lipids and insulin resistance. However, no previous epidemiological studies have evaluated the relationship between the intake of total polyphenols intake and polyphenol subclasses with overall mortality. Our aim was to evaluate whether polyphenol intake is associated with all-cause mortality in subjects at high cardiovascular risk.
  
  
  METHODS
  We used data from the PREDIMED study, a 7,447-participant, parallel-group, randomized, multicenter, controlled five-year feeding trial aimed at assessing the effects of the Mediterranean Diet in primary prevention of cardiovascular disease. Polyphenol intake was calculated by matching food consumption data from repeated food frequency questionnaires (FFQ) with the Phenol-Explorer database on the polyphenol content of each reported food. Hazard ratios (HR) and 95% confidence intervals (CI) between polyphenol intake and mortality were estimated using time-dependent Cox proportional hazard models.
  
  
  RESULTS
  Over an average of 4.8 years of follow-up, we observed 327 deaths. After multivariate adjustment, we found a 37% relative reduction in all-cause mortality comparing the highest versus the lowest quintiles of total polyphenol intake (hazard ratio (HR) = 0.63; 95% CI 0.41 to 0.97; P for trend = 0.12). Among the polyphenol subclasses, stilbenes and lignans were significantly associated with reduced all-cause mortality (HR =0.48; 95% CI 0.25 to 0.91; P for trend = 0.04 and HR = 0.60; 95% CI 0.37 to 0.97; P for trend = 0.03, respectively), with no significant associations apparent in the rest (flavonoids or phenolic acids).
  
  
  CONCLUSIONS
  Among high-risk subjects, those who reported a high polyphenol intake, especially of stilbenes and lignans, showed a reduced risk of overall mortality compared to those with lower intakes. These results may be useful to determine optimal polyphenol intake or specific food sources of polyphenols that may reduce the risk of all-cause mortality.
  
  
  BACKGROUND
  ISRCTN35739639.
authors.forename: Anna
authors.initials: A
authors.lastname: Tresserra-Rimbau
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.forename: Alexander
authors.initials: A
authors.lastname: Medina-Remón
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Martínez-González
authors.forename: M Carmen
authors.initials: MC
authors.lastname: López-Sabater
authors.forename: María I
authors.initials: MI
authors.lastname: Covas
authors.forename: Dolores
authors.initials: D
authors.lastname: Corella
authors.forename: Jordi
authors.initials: J
authors.lastname: Salas-Salvadó
authors.forename: Enrique
authors.initials: E
authors.lastname: Gómez-Gracia
authors.forename: José
authors.initials: J
authors.lastname: Lapetra
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.forename: Emili
authors.initials: E
authors.lastname: Ros
authors.forename: Lluis
authors.initials: L
authors.lastname: Serra-Majem
authors.forename: Xavier
authors.initials: X
authors.lastname: Pintó
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Muñoz
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gea
authors.forename: Valentina
authors.initials: V
authors.lastname: Ruiz-Gutiérrez
authors.forename: Ramón
authors.initials: R
authors.lastname: Estruch
authors.affiliation: Nutrition and Food Science Department, XaRTA, INSA, Pharmacy School, University of Barcelona, Barcelona, Spain. lamuela@ub.edu.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Lamuela-Raventós
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000008:administration & dosage; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control*; D002423:Cause of Death; D038441:Diet, Mediterranean; D005260:Female; D005419:Flavonoids / Q000008:administration & dosage; D006801:Humans; D062385:Hydroxybenzoates / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D059808:Polyphenols / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D012306:Risk; D012307:Risk Factors
chemical_list: D000975:Antioxidants; D005419:Flavonoids; D062385:Hydroxybenzoates; D059808:Polyphenols; C017616:phenolic acid