Flavan-3-ols and Cardiometabolic Health: First Ever Dietary Bioactive Guideline

Abstract

Guideline recommendation for a plant bioactive such as flavan-3-ols is a departure from previous recommendations as it is not based on deficiencies but rather improvement in health outcomes. Nevertheless, there is a rapidly growing body of clinical data reflecting benefits of flavan-3-ol intake that outweigh potential harms. Thus, the objective of the Expert Panel was to develop an intake recommendation for flavan-3-ols and cardiometabolic outcomes to inform multiple stakeholders including clinicians, policymakers, public health entities, and consumers. Guideline development followed the process set forth by the Academy of Nutrition and Dietetics which includes use of Evidence to Decision Framework. Studies informing this guideline (157 randomized controlled trials and 15 cohort studies) were previously reviewed in a recently published systematic review and meta-analysis. Quality and strength-of-evidence along with risk-of-bias in reporting was reviewed. In drafting the guideline, data assessments and opinions by authoritative scientific bodies providing guidance on the safety of flavan-3-ols were considered. Moderate evidence supporting cardiometabolic protection resulting from flavan-3-ol intake in the range of 400-600 mg/d was supported in the literature. Further, increasing consumption of dietary flavan-3-ols may help improve blood pressure, cholesterol levels, and blood sugar. Strength of evidence was strongest for some biomarkers (i.e., systolic blood pressure, total cholesterol, HDL-cholesterol, and insulin/glucose dynamics). It should be noted that this is a food-based guideline and not a recommendation for flavan-3-ol supplements. This guideline was based on beneficial effects observed across a range of disease biomarkers and endpoints. While a comprehensive assessment of available data has been reviewed, evidence gaps identified herein can inform scientists whereby guiding future randomized clinical trials.

Performance of urinary phenyl-γ-valerolactones as biomarkers of dietary flavan-3-ol exposure

“…Much of our work has indicated a beneficial impact of estimated dietary flavan-3-ol intake on CVD risk (23)(24)(25)(26)(27). This in alignment with the recent release of the first ever dietary bioactive guideline for flavan-3-ol intakes and cardiometabolic health (28). Most interestingly, the investigation of health outcomes utilizing PVLs as flavan-3-ol biomarkers has started to gain some traction.…”

Chemical Diversity and In Vitro/In Silico Antiviral Activity of Extracts from Different Parts of Phyllanthus brasiliensis (Aubl.) Poir

“…They are found in various plant-based foods such as tea, cocoa, and berries [73]. Flavan-3-ols are well known due to their several health bene ts, such as improving cardiovascular health and reducing the risk of certain types of cancer [74]. Previous studies have also suggested that avan-3-ols may have antiviral activity [75,76].…”

5‐(3′,4′‐Dihydroxyphenyl)‐γ‐Valerolactone Is a Substrate for Human Paraoxonase: A Novel Pathway in Flavan‐3‐ol Metabolism

“…[1][2][3] Accumulating epidemiological evidence, most notably a recent large-scale randomized clinical study, have shown that flavan-3-ol intake can exert beneficial cardiovascular effects. [4][5][6] These reports supported the creation of dietary recommendations for the consumption of flavan-3-ols, [7] recognizing these bioactives as a valuable tool for primary prevention of cardiovascular disease and the promotion of healthy aging. After intake, flavan-3-ols are extensively transformed into a wide variety of metabolites that are thought to be the actual mediators of the beneficial effects observed after flavan-3-ol intake.…”