Associations between Dietary Polyphenols and Type 2 Diabetes in a Cross-Sectional Analysis of the PREDIMED-Plus Trial: Role of Body Mass Index and Sex

Abstract

Overweight and obesity are important risk factors for type 2 diabetes (T2D). Moving towards healthier diets, namely, diets rich in bioactive compounds, could decrease the odds of suffering T2D. However, those individuals with high body mass index (BMI) may have altered absorption or metabolism of some nutrients and dietary components, including polyphenols. Therefore, we aimed to assess whether high intakes of some classes of polyphenols are associated with T2D in a population with metabolic syndrome and how these associations depend on BMI and sex. This baseline cross-sectional analysis includes 6633 participants from the PREDIMED-Plus trial. Polyphenol intakes were calculated from food frequency questionnaires (FFQ). Cox regression models with constant time at risk and robust variance estimators were used to estimate the prevalence ratios (PRs) for polyphenol intake and T2D prevalence using the lowest quartile as the reference group. Analyses were stratified by sex and BMI groups (overweight and obese) to evaluate potential effect modification. Catechins, proanthocyanidins, hydroxybenzoic acids, and lignans were inversely associated with T2D. Hydroxycinnamic acids were directly related in men. These associations were different depending on sex and BMI, that is, women and overweight obtained stronger inverse associations.

Polyphenols in Urine and Cardiovascular Risk Factors: A Cross-Sectional Analysis Reveals Gender Differences in Spanish Adolescents from the SI! Program

“…In a previous clinical trial, a high intake of polyphenol-rich foods for 8 weeks reduced glucose concentrations in plasma and increased insulin secretion in adults at high cardiovascular risk [ 39 ]. Moreover, in the PREDIMED trial, a higher intake of total polyphenols, total flavonoids, stilbenes, and some flavonoid subclasses was inversely and linearly associated with the incidence of type 2 diabetes [ 40 ], and in the PREDIMED-Plus trial, high intakes of some polyphenols were inversely associated with the prevalence of type 2 diabetes in adults with metabolic syndrome, particularly in overweight subjects [ 41 ].…”

Dietary Strategies for Metabolic Syndrome: A Comprehensive Review

“…MetS is associated with a pro-inflammatory state, and it has been proposed that a low-fat dietary intervention inducing weight loss slightly reduces inflammatory biomarkers such as high-sensitive c-reactive protein (CRP), interleukin−6 (IL) and tumor necrosis factor alpha (TNF-α) levels [ 16 , 127 , 128 , 129 ]. These results are inconclusive, and the effects observed depend on weight loss and diet composition, particularly dietary fiber, fruits and vegetables [ 16 , 128 ]. Additionally, some studies observed that low-fat dietary interventions could improve the microbiome dysbiosis linked to MetS by increasing α-diversity [ 130 , 131 ].…”

“…Regarding the prevention of MetS, Godos et al also conducted a meta-analysis to demonstrate the preventive role of the promotion of healthy dietary patterns to reduce the prevalence of MetS [ 15 ]. Furthermore, some sub-studies from the PREDIMED-Plus cohort showed associations between some dietary components of the traditional Mediterranean Diet (MedDiet) and improvement in MetS components [ 16 , 17 , 18 , 19 , 20 ]. The aim of the present review was to analyze the potential benefits of different dietary approaches on MetS status and their use as efficient strategies to prevent and treat MetS and its comorbidities.…”

The Diverse Efficacy of Food-Derived Proanthocyanidins for Middle-Aged and Elderly Women

“…This baseline cross-sectional analysis included 6633 participants from the PREDIMED-Plus trial. They found in a case of proanthocyanidins for elderly Spanish women that there were significant and linear inverse associations in comparing extreme quartiles for overweight and obesity, recognized as important risk factors for T2D [ 30 ]. In another cohort study in Korea, Kim et al investigated the association between dietary flavonoid intake and the prevalence of obesity using body mass index (BMI), waist circumference, and percent body fat (%BF) among elderly Korean females.…”