title: Flavanone Intake Is Inversely Associated with Risk of Incident Ischemic Stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.
abstract: BACKGROUND
  Flavonoids may have beneficial cerebrovascular effects, but evidence from racially and geographically representative cohorts in comprehensive flavonoid databases is lacking. Given racial and geographic disparities in stroke incidence, representative cohort studies are needed.
  
  
  OBJECTIVE
  We evaluated the association between flavonoid intake and incident ischemic stroke in a biracial, national cohort using updated flavonoid composition tables and assessed differences in flavonoid intake by sex, race, and region of residence.
  
  
  METHODS
  We evaluated 20,024 participants in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a biracial prospective study. Participants with stroke history or missing dietary data were excluded. Flavonoid intake was estimated by using a Block98 food frequency questionnaire and the USDA's Provisional Flavonoid Addendum and Proanthocyanidin Database. Associations between quintiles of flavonoid intake and incident ischemic stroke were evaluated by using Cox proportional hazards models, adjusting for confounders.
  
  
  RESULTS
  Over 6.5 y, 524 acute ischemic strokes occurred. Flavanone intake was lower in the Southeastern United States but higher in blacks than in whites. After multivariable adjustment, flavanone intake was inversely associated with incident ischemic stroke (HR: 0.72; 95% CI: 0.55, 0.95; P-trend = 0.03). Consumption of citrus fruits and juices was inversely associated with incident ischemic stroke (HR: 0.69; 95% CI: 0.53, 0.91; P-trend = 0.02). Total flavonoids and other flavonoid subclasses were not associated with incident ischemic stroke. There was no statistical interaction with sex, race, or region for any flavonoid measure.
  
  
  CONCLUSIONS
  Greater consumption of flavanones, but not total or other flavonoid subclasses, was inversely associated with incident ischemic stroke. Associations did not differ by sex, race, or region for the association; however, regional differences in flavanone intake may contribute to regional disparities in ischemic stroke incidence. Higher flavanone intake in blacks suggests that flavanone intake is not implicated in racial disparities in ischemic stroke incidence.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, megoetz@emory.edu.
authors.forename: Margarethe E
authors.initials: ME
authors.lastname: Goetz
authors.affiliation: Department of Epidemiology, Rollins School of Public Health.|Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL; and.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Judd
authors.affiliation: Department of Epidemiology, Rollins School of Public Health.|Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Terryl J
authors.initials: TJ
authors.lastname: Hartman
authors.affiliation: Department of Epidemiology, Rollins School of Public Health.|Renal Division and.
authors.forename: William
authors.initials: W
authors.lastname: McClellan
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Anderson
authors.affiliation: Department of Epidemiology, Rollins School of Public Health.|Division of Cardiology, Department of Medicine, and.
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004032:Diet; D005247:Feeding Behavior; D044950:Flavanones / Q000008:administration & dosage*; D005502:Food / Q000145:classification; D005504:Food Analysis; D006801:Humans; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D044469:Racial Groups; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D044950:Flavanones; C028610:flavanone
keywords: epidemiology; flavonoid; ischemic stroke; plant-based diet; polyphenol