by Jenna Koroly, MS, RD, CSOWM, CDN
Flavonoids are types of polyphenol compounds. They are classified into six main subclasses based on chemical structure: anthocyanidins, flavan-3-ols, flavonols, flavones, flavanones, and isoflavones. The flavonoid content of fruits and vegetables likely plays a role in the benefits of these foods, including decreased risk of all-cause mortality, cardiovascular disease, and cancer. The below study focuses on flavonoid intake, mortality outcomes, and lifestyle variables including alcohol intake and smoking.
Study
Flavonoid intake is associated with lower mortality in the Danish Diet Cancer and Health Cohort
Journal: Nature Communications
This 4-year prospective cohort study involved over 56,000 individuals ages 50-65 years in the greater area of Copenhagen and Aarhus, Denmark. This Danish Diet, Cancer, and Health cohort study is an associated cohort of the European Prospective Investigation into Nutrition and Cancer (EPIC). To learn more about findings on polyphenol intake and thyroid cancer risk from the EPIC cohort, check out our July Science Nook. In the present study, 192-item food frequency questionnaires were completed at baseline. Flavonoid intake was studied as related to the main outcomes of mortality, cardiovascular (CVD)-related mortality, and cancer-related mortality.
Findings
The authors found:
1. An inverse association between moderate habitual intake of flavonoids and all-cause, CVD-, and cancer-related mortality
2. For CVD-related mortality, this association plateaued beyond intakes of 500 mg/day of total flavonoids
3. For cancer-related mortality, this association plateaued beyond intakes of 1000 mg/day of total flavonoids
4. Inverse associations of flavonoid intake and mortality outcomes were stronger and more linear in smokers than non-smokers, as well as in heavy alcohol consumers than low-moderate alcohol consumers
For the Patient and Caregiver
In this population, the authors write that tea, chocolate, wine, apples, and pears were likely the main food sources of flavonoids. They also outline: “one cup of tea, one apple, one orange, 100 grams of blueberries, and 100 grams of broccoli would provide most of the flavonoid subclasses and over 500 mg of total flavonoids” [i]. This is beneficial information as it demonstrates the maximum amount of flavonoid intake to achieve the most benefit for decreasing CVD-related mortality is realistic within one day of consumption, and double this for maximum benefit for decreasing cancer-related mortality may be doable as well.
For the Healthcare Team
This research supports encouragement of flavonoid intake to patients. It may be particularly beneficial to speak about the benefits to smokers and those who are heavy alcohol drinkers (>20 g/day), while also encouraging these individuals to decrease alcohol intake and provide support methods to quit smoking. The authors also found the inverse association of flavonoid intake and risk of mortality to be weaker in obese participants compared to normal or overweight participants. This may present an additional ground to support weight loss when appropriate.
Reference:
[i] Bondonno NP, Dalgaard F, Kyro C, Murray K, Bondonno CP, Lewis JR, Croft KD…Hodgson JM . (2019). Flavonoid intake is associated with lower mortality in the Danish diet cancer and health cohort. Nature Communications. doi: 10.1038/s41467-019-11622-x
Susan started Savor Health after losing a close friend to a brain tumor and, through that experience, becoming aware of the significant unmet nutritional needs of people with cancer. Struck by the fact that her friend was told “nutrition doesn’t matter” and “eat whatever you want,” Susan read the evidence-based literature on the subject, interviewed oncologists, oncology nurses and oncology dietitians, as well as patients and caregivers, and found that, in fact, nutrition does matter in oncology. Armed with solid scientific evidence supporting the clinical and quality of life benefits of proper nutrition, Susan left Wall Street and created Savor Health, an AI-based provider of personalized and clinically appropriate nutrition solutions for cancer patients, their caregivers and health enterprises. Susan brings to Savor Health over 25 years of industry experience in healthcare and business as well as expertise in strategy, finance and management.
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David Raben, M.D. is currently V.P. and Chief Medical Officer, Bicara Therapeutics. Dr. Raben is also on faculty at the University of Colorado where he is a board-certified Professor of Radiation Oncology and has recently been named a U.S. News Top Doctor. He received a B.A. in Psychology from Duke University in 1985 and completed his M.D. at Wake Forest University/Bowman Grey School of Medicine in 1990. After graduation, he completed residency in Radiation Oncology at the Johns Hopkins Hospital from 1991-1994, serving as a chief resident in 1994. Dr. Raben has developed nationally recognized clinical expertise over the past 20 years in the management of head and neck cancer (HNC), lung cancer and prostate/bladder cancers. Clinically, Dr. Raben has a strong interest in nutritional precision for patients, with an interest in reducing processed foods and sugars in patients with locally advanced cancers, especially ones with high cell turnover. An anti-inflammatory strategy with a Mediterranean dietary approach coupled with reductions in high carbohydrate loading may reduce or slow cancer progression and improve a patient’s intrinsic microbiome to enhance immune response to various therapies including immune enabling drugs like checkpoint inhibitors that have shown dramatic success recently in advanced cancers. From a research perspective, his focus has been on laboratory discoveries and innovative clinical trials in areas such as high risk, heavy smoker HNC patients and has explored approaches that inhibit cancer DNA repair or growth factor signaling. Dr. Raben recently completed the first Phase I clinical trial in the US with and oral DNA repair inhibitor (PARP inhibitor) and radiation for heavy smokers when combined with intensity modulated radiation (IMRT). His efforts currently center around evaluation of TGFb inhibition in HNSCC as well as the use of radiation to stimulate activity of immune enabling drugs. Nationally, Dr. Raben serves on the NRG Oncology head and neck steering committee as well as co-chairing the Developmental Therapeutics Co-Chair at the NRG. He actively serves as an ASCO Ambassador for Multidisciplinary Cancer Management Courses (MCMC) to help educate underserved areas around the world in cancer care. Finally, he serves an ad hoc reviewer for high impact journals such as Journal of Clinical Oncology, Annals of Oncology, JAMA Oncology, Oral Oncology, Head and Neck, Int. Journal of Radiation Oncology Biology Physics, Clinical Cancer Research and Cancer Research. He has authored over 140 publications.
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This is great information Ms Koroly. I never knew so much about flavonoids and I imagine many healthcare professionals do not. One question – in the fruit and vegetable quantities that you mention provide 500mg of flavonoids, is that all of them as a total together or any one of those individually?
Thanks very much.
Marla
Hi Marla,
That is all of them as a total together that provide 500 mg of flavonoids. Thank you for your interest!
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