Dietary Flavonoid and Lignan Intake and Mortality in Prospective Cohort Studies: Systematic Review and Dose-Response Meta-Analysis

Am J Epidemiol. 2017 Jun 15;185(12):1304-1316. doi: 10.1093/aje/kww207.


Recent evidence has suggested that flavonoid and lignan intake may be associated with decreased risk of chronic and degenerative diseases. The aim of this meta-analysis was to assess the association between dietary flavonoid and lignan intake and all-cause and cardiovascular disease (CVD) mortality in prospective cohort studies. A systematic search was conducted in electronic databases to identify studies published from January 1996 to December 2015 that satisfied inclusion/exclusion criteria. Risk ratios and 95% confidence intervals were extracted and analyzed using a random-effects model. Nonlinear dose-response analysis was modeled by using restricted cubic splines. The inclusion criteria were met by 22 prospective studies exploring various flavonoid and lignan classes. Compared with lower intake, high consumption of total flavonoids was associated with decreased risk of all-cause mortality (risk ratio = 0.74, 95% confidence intervals: 0.55, 0.99), while a 100-mg/day increment in intake led to a (linear) decreased risk of 6% and 4% of all-cause and CVD mortality, respectively. Among flavonoid classes, significant results were obtained for intakes of flavonols, flavones, flavanones, anthocyanidins, and proanthocyanidins. Only limited evidence was available on flavonoid classes and lignans and all-cause mortality. Findings from this meta-analysis indicated that dietary flavonoids are associated with decreased risk of all-cause and CVD mortality.

Keywords: all-cause mortality; cardiovascular disease mortality; flavonoids; lignans; meta-analysis; prospective studies.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality*
  • Cardiovascular Diseases / prevention & control
  • Dietary Supplements / statistics & numerical data*
  • Dose-Response Relationship, Drug
  • Female
  • Flavonoids / administration & dosage*
  • Humans
  • Lignans / administration & dosage*
  • Male
  • Middle Aged
  • Neurodegenerative Diseases / etiology
  • Neurodegenerative Diseases / mortality*
  • Neurodegenerative Diseases / prevention & control
  • Odds Ratio
  • Prospective Studies
  • Risk Factors


  • Flavonoids
  • Lignans