Differences in dietary intakes, food sources and determinants of total flavonoids between Mediterranean and non-Mediterranean countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Abstract

A greater adherence to the traditional Mediterranean (MED) diet is associated with a reduced risk of developing chronic diseases. This dietary pattern is based on higher consumption of plant products that are rich in flavonoids. We compared the total flavonoid dietary intakes, their food sources and various lifestyle factors between MED and non-MED countries participating in the EPIC study. Flavonoid intakes and their food sources for 35 628 subjects, aged 35–74 years and recruited between 1992 and 2000, in twenty-six study centres were estimated using standardised 24 h dietary recall software (EPIC-Soft®). An ad hoc food composition database on flavonoids was compiled using analytical data from the United States Department of Agriculture and Phenol-Explorer databases. Moreover, it was expanded to include using recipes, estimations of missing values and flavonoid retention factors. No significant differences in total flavonoid mean intake between non-MED countries (373·7 mg/d) and MED countries (370·2 mg/d) were observed. In the non-MED region, the main contributors were proanthocyanidins (48·2 %) and flavan-3-ol monomers (24·9 %) and the principal food sources were tea (25·7 %) and fruits (32·8 %). In the MED region, proanthocyanidins (59·0 %) were by far the most abundant contributor and fruits (55·1 %), wines (16·7 %) and tea (6·8 %) were the main food sources. The present study shows similar results for total dietary flavonoid intakes, but significant differences in flavonoid class intakes, food sources and some characteristics between MED and non-MED countries. These differences should be considered in studies about the relationships between flavonoid intake and chronic diseases.

Flavonoid and lignan intake and pancreatic cancer risk in the European prospective investigation into cancer and nutrition cohort

“…23 and 24.Main food sources were: Total flavonoids: fruits (40%), Flavanols: tea (44%), Flavan‐3‐ols: tea (84%), Proanthocyanidins: fruits (53%), theaflavins: tea (100%), Anthocyanidins: fruits (52%), Flavonols: tea (26%), Flavanones: fruits, (50%), Flavones: tea (30%), Isoflavones: soya products (40%), lignans: vegetables (24%).EPIC: European Prospective Investigation into Cancer and Nutrition study.IQR: interquartile range.European Commission (DG‐SANCO); International Agency for Research on Cancer; Danish Cancer Society (Denmark); Ligue Contre le Cancer; Institut Gustave Roussy; Mutuelle Générale de l'Education Nationale; Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid; German Cancer Research Center (DKFZ); Federal Ministry of Education and Research (BMBF); Deutsche Krebshilfe; Deutsches Krebsforschungszentrum; Federal Ministry of Education and Research (Germany); the Hellenic Health Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro‐AIRC‐Italy; National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS); Netherlands Cancer Registry (NKR); LK Research Funds; Dutch Prevention Funds; Dutch ZON (Zorg Onderzoek Nederland); World Cancer Research Fund (WCRF); Nordforsk; Nordic Centre of Excellence Programme on Food, Nutrition and Health (Norway); Swedish Cancer Society; Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden)…”

“…The influence of prediagnostic disease on the associations is unlikely since exclusion of cases diagnosed within the first 2 years of follow‐up did not alter the associations. Our study also benefits from an exhaustive quantification of intake of flavonoids, at a combined and individual basis for seven subclasses 23. This study also presents several limitations.…”

“…The regression calibration approach to correct measurement error was, however, not suitable given that flavonoids and lignans are contained in specific foods only 44. It is also possible that intake of flavonoids and lignans is underestimated due to incomplete information on their content in some foods, such as thearubigins for tea, or unknown compositional data of some lignans,23 and because we could not consider dietary supplements (herbs/plants or their constituents) as another source of intake. The latter should not have affected our results as these types of products represented 8–17% of the supplements used in the EPIC study 45.…”

“…Information on dietary flavonoids and lignans was available for 1,877 food items. More details on the estimation of the dietary intake of flavonoids and lignans have been described elsewhere 23, 24…”

Dietary flavonoid, lignan and antioxidant capacity and risk of hepatocellular carcinoma in the European prospective investigation into cancer and nutrition study

“…In a Greek case-control study, flavone intake was inversely associated with HCC risk in both chronic hepatitis virus positive (highest versus lowest quintile, OR 5 0.50, 95% CI: 0.27-0.94; p trend 5 0.049) and negative cases (highest versus lowest quintile, OR 5 0.41, 95% CI: 0.16-1.06; p trend 5 0.084). 19 Furthermore, there is some evidence suggesting that fruits, the main food source of flavonoids in Western diets, 20 protect against HCC. 5 To our knowledge, there are no studies evaluating the association between NEAC and HCC risk.…”