Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Mar;144(3):335-43.
doi: 10.3945/jn.113.184945. Epub 2013 Dec 24.

Dietary Intakes of Individual Flavanols and Flavonols Are Inversely Associated With Incident Type 2 Diabetes in European Populations

Free PMC article

Dietary Intakes of Individual Flavanols and Flavonols Are Inversely Associated With Incident Type 2 Diabetes in European Populations

Raul Zamora-Ros et al. J Nutr. .
Free PMC article


Dietary flavanols and flavonols, flavonoid subclasses, have been recently associated with a lower risk of type 2 diabetes (T2D) in Europe. Even within the same subclass, flavonoids may differ considerably in bioavailability and bioactivity. We aimed to examine the association between individual flavanol and flavonol intakes and risk of developing T2D across European countries. The European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study was conducted in 8 European countries across 26 study centers with 340,234 participants contributing 3.99 million person-years of follow-up, among whom 12,403 incident T2D cases were ascertained and a center-stratified subcohort of 16,154 individuals was defined. We estimated flavonoid intake at baseline from validated dietary questionnaires using a database developed from Phenol-Explorer and USDA databases. We used country-specific Prentice-weighted Cox regression models and random-effects meta-analysis methods to estimate HRs. Among the flavanol subclass, we observed significant inverse trends between intakes of all individual flavan-3-ol monomers and risk of T2D in multivariable models (all P-trend < 0.05). We also observed significant trends for the intakes of proanthocyanidin dimers (HR for the highest vs. the lowest quintile: 0.81; 95% CI: 0.71, 0.92; P-trend = 0.003) and trimers (HR: 0.91; 95% CI: 0.80, 1.04; P-trend = 0.07) but not for proanthocyanidins with a greater polymerization degree. Among the flavonol subclass, myricetin (HR: 0.77; 95% CI: 0.64, 0.93; P-trend = 0.001) was associated with a lower incidence of T2D. This large and heterogeneous European study showed inverse associations between all individual flavan-3-ol monomers, proanthocyanidins with a low polymerization degree, and the flavonol myricetin and incident T2D. These results suggest that individual flavonoids have different roles in the etiology of T2D.

Conflict of interest statement

Author disclosures: R. Zamora-Ros, N. G. Forouhi, S. J. Sharp, C. A. González, B. Buijsse, M. Guevara, Y. T. van der Schouw, P. Amiano, H. Boeing, L. Bredsdorff, G. Fagherazzi, E. J. Feskens, P. W. Franks, S. Grioni, V. Katzke, T. J. Key, K.-T. Khaw, T. Kühn, G. Masala, A. Mattiello, E. Molina-Montes, P. M. Nilsson, K. Overvad, F. Perquier, M. L. Redondo, F. Ricceri, O. Rolandsson, I. Romieu, N. Roswall, A. Scalbert, M. Schulze, N. Slimani, A. M. W. Spijkerman, A. Tjonneland, M. J. Tormo, M. Touillaud, R. Tumino, D. L. van der A, G. J. van Woudenbergh, C. Langenberg, E. Riboli, and N. J. Wareham, no conflicts of interest.

Similar articles

See all similar articles

Cited by 40 articles

See all "Cited by" articles


    1. Cooper AJ, Forouhi NG, Ye Z, Buijsse B, Arriola L, Balkau B, Barricarte A, Beulens JW, Boeing H, Buchner FL, et al. Fruit and vegetable intake and type 2 diabetes: EPIC-InterAct prospective study and meta-analysis. Eur J Clin Nutr. 2012;66:1082–92. - PMC - PubMed
    1. InterAct Consortium. Tea consumption and incidence of type 2 diabetes in Europe: the EPIC-InterAct case-cohort study. PLoS ONE. 2012;7:e36910. - PMC - PubMed
    1. Nettleton JA, Harnack LJ, Scrafford CG, Mink PJ, Barraj LM, Jacobs DR., Jr Dietary flavonoids and flavonoid-rich foods are not associated with risk of type 2 diabetes in postmenopausal women. J Nutr. 2006;136:3039–45. - PMC - PubMed
    1. Beulens JW, Stolk RP, van der Schouw YT, Grobbee DE, Hendriks HF, Bots ML. Alcohol consumption and risk of type 2 diabetes among older women. Diabetes Care. 2005;28:2933–8. - PubMed
    1. Zamora-Ros R, Forouhi NG, Sharp SJ, González CA, Buijsse B, Guevara M, van der Schouw YT, Amiano P, Boeing H, Bredsdorff L, et al. The association between dietary flavonoid and lignan intakes and incident type 2 diabetes in European population: the EPIC-InterAct study. Diabetes Care. 2013;36:3961–70. - PMC - PubMed

Publication types

MeSH terms