Background:
It is reported that dietary intake of flavonoid compounds can reduce all-cause mortality and mortality from specific vascular diseases and cancers, but whether dietary intake of flavonoid can affect obesity and obesity-related comorbidities is unknown.
Aim:
The main objective is to investigate the relationship between flavonoid intake and all-cause mortality in both obese and non-obese individuals, and in combination with diabetes, non-alcoholic fatty liver disease (NAFLD), cardiovascular disease (CVD), and chronic kidney disease (CKD).
Methods:
This study included NHANES participants from 2007-2010 and 2017-2018. Cox regression analysis evaluated the impact of total flavonoid intake on all-cause mortality among participants with varying comorbidity profiles. Subgroup analysis was conducted by separately analyzing the six sub-classes of total flavonoids (anthocyanidins, flavan-3-ols, flavanones, flavones, flavonols, and isoflavones). Sensitivity analysis investigated the impact of total flavonoid intake on all-cause mortality among patients with different comorbidities.
Results:
During a median follow-up period of 9.92 years (interquartile range (IQR), 5.54-14.29 years), a total of 639 participants died. In comparison to non-obese participants, cox regression analysis revealed a favorable impact of flavonoid intake on all-cause mortality in obese participants with CKD (hazard ratio (HR): 0.22, 95% CI: 0.11-0.44), metabolically healthy obese (MHO) participants (HR: 0.15, 95% CI: 0.07-0.35), obese individuals with diabetes (HR: 0.51, 95% CI: 0.29-0.88), and obese individuals with comorbid CVD (HR: 0.37, 95% CI: 0.17-0.83). Restricted cubic spline (RCS) analysis indicated a non-linear relationship in obese participants, with optimal intake levels ranging from 319.4978 to 448.6907 mg/day. Subgroup analysis revealed varying effects of total flavonoid components in different health conditions, with hazard ratios ranging from 0.06 for higher levels of flavonol to 0.59 for higher levels of anthocyanidins.
Conclusions:
In comparison to unhealthy individuals without obesity, those with unhealthy obesity who consume flavonoids show a reduced risk of all-cause mortality.