The Association of Flavonoid Intake with Mortality in Patients with Hypertension

by | Jun 20, 2024 | 2024, Blood Pressure, Cardiovascular Health, Flavonoids, Recent Articles

Written by Harold Oster, MD. Results suggest that increased flavonoid intake is associated with lower mortality in patients with hypertension.

blood pressureHypertension affects more than 40% of adults in the United States. It is a major risk factor for stroke, cardiovascular disease, and kidney disease1. Flavonoids, natural substances found in fruits and vegetables, have antioxidant and anti-inflammatory properties and may improve outcomes in those at risk for cardiovascular disease and cancer. Subclasses of flavonoids include anthocyanidins, flavonols, flavan-3-ols, and isoflavones2.

Kang Wang et al. studied the association between the intake of flavonoids and flavonoid subclasses and overall, cancer-related, and cardiovascular-related mortality in adults with hypertension. The authors analyzed data gathered between 2007 and 2018 by the National Health and Nutrition Examination Survey (NHANES), a population-based cross-sectional study conducted by the National Center for Health Statistics at the Centers for Disease Control and Prevention3. Hypertension was defined as being diagnosed with the condition by a clinician or having a systolic blood pressure greater than 139 mm/Hg or a diastolic greater than 89 mm/Hg. Participants were placed into quartiles based on daily flavonoid intake, ascertained with dietary questionnaires that were compared to a USDA food component database4. Mortality and cause of death data were gathered from the National Death Index, a database managed by the National Center for Health Statistics5. The authors collected information from the NHANES database on possible covariables, including demographics, medical history, body mass index, dietary intake, smoking, alcohol use, and physical activity level.

The authors noted the following:

  • Based on inclusion criteria, data from 6,110 participants was analyzed for the study.
  • The average age of participants at baseline was 57.7 years.
  • 9% of the participants were female.
  • During 43,977 person-years of follow-up, 1,155 participants died: 282 from cardiovascular disease and 265 from cancer.
  • After adjustment for covariables, participants in the highest quartile of total flavonoid consumption had a lower overall mortality than those in the lowest quartile. (hazard ratio 1 of 0.74)
  • Those with the highest consumption of anthocyanidins (HR of 0.7), flavonols (HR of 0.66), flavan-3-ols (HR of 0.76), and isoflavones (HR of 0.79) had a lower overall mortality than those in the lowest quartile of consumption of these flavonoid subclasses.
  • There was no association between total flavonoid intake and cardiovascular or cancer-related mortality.
  • Participants with the highest consumption of anthocyanidins (HR of 0.55), flavonols (HR of 0.52), and flavan-3-ols (HR of 0.51) had a lower cancer-related mortality than those in the lowest quartile.
  • After adjustment for covariables, there was no association between cardiovascular mortality and intake of specific flavonoid subclasses.

 

Results suggest that a higher intake of flavonoids is associated with decreased overall mortality. Higher intake of some flavonoid subclasses may be associated with decreased cancer-related mortality. Limitations of the study include its observational nature and possible residual confounding.

Source: Wang, Kang, Taotao Lu, Rukai Yang, and Shenghua Zhou. “Associations of Flavonoid Intakes with Mortality among Populations with Hypertension: A Prospective Cohort Study.” Nutrients 16, no. 10 (2024): 1534.

© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/
4.0/).

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Posted June 20, 2024.

Harold Oster, MD graduated from medical school in Miami, Florida in 1992 and moved to Minnesota in 2004. After more than 25 years of practicing Internal Medicine, he recently retired. Dr. Oster is especially interested in nutrition, weight management, and disease prevention. Visit his website at haroldoster.com.

References:

  1. Krist AH, Davidson KW, Mangione CM, et al. Screening for Hypertension in Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement. Jama. Apr 27 2021;325(16):1650-1656. doi:10.1001/jama.2021.4987
  2. Panche AN, Diwan AD, Chandra SR. Flavonoids: an overview. J Nutr Sci. 2016;5:e47. doi:10.1017/jns.2016.41
  3. Dwyer J, Picciano MF, Raiten DJ. Collection of food and dietary supplement intake data: What We Eat in America-NHANES. J Nutr. Feb 2003;133(2):590s-600s. doi:10.1093/jn/133.2.590S
  4. Sebastian RS, Fanelli Kuczmarski M, Wilkinson Enns C, et al. Application of the Database of Flavonoid Values for USDA Food Codes 2007-2010 in Assessing Intake Differences Between the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) Study and What We Eat in America (WWEIA), NHANES. J Food Compost Anal. Dec 2021;104doi:10.1016/j.jfca.2021.104124
  5. Ter-Minassian M, Basra SS, Watson ES, Derus AJ, Horberg MA. Validation of US CDC National Death Index mortality data, focusing on differences in race and ethnicity. BMJ Health Care Inform. Jul 2023;30(1)doi:10.1136/bmjhci-2023-100737