Associations between flavonoid-rich food and flavonoid intakes and incident unhealthy aging outcomes in older United States males and females

Nicola P Bondonno; Yan Lydia Liu; Francine Grodstein; Eric B Rimm; Aedín Cassidy

doi:10.1016/j.ajcnut.2025.02.010

Associations between flavonoid-rich food and flavonoid intakes and incident unhealthy aging outcomes in older United States males and females

Am J Clin Nutr. 2025 Feb 15:S0002-9165(25)00078-4. doi: 10.1016/j.ajcnut.2025.02.010. Online ahead of print.

Authors

Nicola P Bondonno¹, Yan Lydia Liu², Francine Grodstein³, Eric B Rimm⁴, Aedín Cassidy⁵

Affiliations

¹ Co-Centre for Sustainable Food Systems and Institute for Global Food Security, Queen's University Belfast, North Ireland; Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia; Danish Cancer Society Research Centre (DCRC), Copenhagen, Denmark.
² Department Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
³ Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States; Department of Internal Medicine, Rush Medical College, Chicago, IL, United States.
⁴ Department Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
⁵ Co-Centre for Sustainable Food Systems and Institute for Global Food Security, Queen's University Belfast, North Ireland. Electronic address: a.cassidy@qub.ac.uk.

PMID: 39961579
DOI: 10.1016/j.ajcnut.2025.02.010

Abstract

Background: Our knowledge of the importance of flavonoid-rich foods in preventing unhealthy aging across its different domains is limited.

Objectives: This study aimed to examine prospective associations between flavonoid-rich food and flavonoid intakes and indicators of unhealthy aging, namely frailty, impaired physical function, and poor mental health.

Methods: We followed up 62,743 females and 23,687 males, all aged ≥60 y, from the Nurses' Health Study (1990-2014) and Health Professionals Follow-up Study (2006-2018), respectively. Both time-updated and change in intakes of a flavodiet score (an aggregate of intakes of major flavonoid-rich foods and beverages) and individual flavonoid-rich foods and beverages and time-updated intakes of total flavonoids and flavonoid subclasses were calculated from food frequency questionnaires collected at baseline and every subsequent 4 y. Associations with incident frailty, impaired physical function, and poor mental health, assessed from self-reported questionnaire responses, were examined with multivariable-adjusted Cox proportional hazards models.

Results: In the Nurses' Health Study, participants with the highest flavodiet scores, compared with the lowest, had a 15% lower risk of frailty (HR_Q5vsQ1: 0.85; 95%CI: 0.80, 0.90), a 12% lower risk of impaired physical function (HR_Q5vsQ1: 0.88; 95% CI: 0.84, 0.91), and a 12% lower risk of poor mental health (HR_Q5vsQ1: 0.88; 95% CI: 0.82, 0.94). Increases in flavodiet scores and both higher intakes and increases in intakes of tea, red wine, apples, blueberries, and oranges tended to be associated with lower risks of all outcomes. Higher intakes of total flavonoids and all flavonoid subclasses tended to be associated with a lower risk of each outcome. Although fewer associations were observed among males in the Health Professionals Follow-up Study, those with the highest flavodiet scores had a lower risk of poor mental health.

Conclusions: High intakes of flavonoid-rich foods may support healthy aging. Further research is needed, including examining sex-specific associations, as incorporating flavonoid-rich foods in the diet may be a simple strategy to support healthy aging.

Keywords: flavodiet score; flavonoids; frailty; healthy aging; mental health; physical function.