The association between dietary flavonoid and lignan intakes and incident type 2 diabetes in european populations: The EPIC-InterAct study

Raul Zamora-Ros, Nita G. Forouhi, Stephen J. Sharp, Carlos A. González, Brian Buijsse, Marcela Guevara, Yvonne T. Van Der Schouw, Pilar Amiano, Heiner Boeing, Lea Bredsdorff, Françoise Clavel-Chapelon, Guy Fagherazzi, Edith J. Feskens, Paul W. Franks, Sara Grioni, Verena Katzke, Timothy J. Key, Kay Tee Khaw, Tilman Kühn, Giovanna MasalaAmalia Mattiello, Esther Molina-Montes, Peter M. Nilsson, Kim Overvad, Florence Perquier, J. Ramón Quirós, Isabelle Romieu, Carlotta Sacerdote, Augustin Scalbert, Matthias Schulze, Nadia Slimani, Annemieke M W Spijkerman, Anne Tjonneland, Maria Jose Tormo, Rosario Tumino, Daphne L. Van Der A., Claudia Langenberg, Elio Riboli, Nicholas J. Wareham

Research output: Contribution to journalArticle


Objective-To study the association between dietary flavonoid and lignan intakes, and the risk of development of type 2 diabetes among European populations. Research design and 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 multivariablemodels, 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.

Original languageEnglish
Pages (from-to)3961-3970
Number of pages10
JournalDiabetes Care
Issue number12
Publication statusPublished - Dec 2013


ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

Zamora-Ros, R., Forouhi, N. G., Sharp, S. J., González, C. A., Buijsse, B., Guevara, M., Van Der Schouw, Y. T., Amiano, P., Boeing, H., Bredsdorff, L., Clavel-Chapelon, F., Fagherazzi, G., Feskens, E. J., Franks, P. W., Grioni, S., Katzke, V., Key, T. J., Khaw, K. T., Kühn, T., ... Wareham, N. J. (2013). The association between dietary flavonoid and lignan intakes and incident type 2 diabetes in european populations: The EPIC-InterAct study. Diabetes Care, 36(12), 3961-3970.