Intake of Flavonoids and Flavonoid-Rich Foods and Mortality Risk Among Individuals With Parkinson Disease

Abstract

Background and ObjectivesAlthough flavonoids have the potential to exert neuroprotective benefits, evidence of their role in improving survival rates among individuals with Parkinson disease (PD) remains lacking. We aimed to prospectively study the association between pre- and post-diagnosis flavonoid intakes and risk of mortality among individuals with PD identified from two large ongoing cohorts of US men and women.MethodsIncluded in the current analysis were 599 women from the Nurses’ Health Study and 652 men from the Health Professionals Follow-up Study who were newly diagnosed with PD during follow-up. Dietary intakes of total flavonoid and its subclasses together with major flavonoid-rich foods (tea, apples, berries, orange and orange juice, and red wine) were repeatedly assessed based on a validated food frequency questionnaire every 4 years. Mortality was ascertained via the National Death Index and state vital statistics records.ResultsWe documented 944 deaths during 32–34 years of follow-up. A higher total flavonoid intake before PD diagnosis was associated with a lower future risk for all-cause mortality in men (hazard ratio [HR] comparing two extreme quartiles=0.53, 95% CI: 0.39, 0.71; p-trend<0.001) but not in women (HR=0.93, 95% CI: 0.68, 1.28; p-trend=0.69), after adjusting for age, smoking status, total energy intake, and other covariates. The pooled HR comparing the extreme quartiles was 0.70 (95% CI: 0.40, 1.22; p-trend=0.25) with significant heterogeneity (p=0.01). For flavonoid subclasses, the highest quartile of anthocyanins, flavones, and flavan-3-ols intakes before diagnosis had a lower mortality risk compared to the lowest quartile (pooled HR=0.66, 0.78, and 0.69, respectively, p<0.05 for all); for berries and red wine, participants consuming >=3 servings/week had a lower risk (pooled HR=0.77 (95%CI: 0.58, 1.02) and 0.68 (95%CI: 0.51, 0.91), respectively), compared to <1 serving/month. After PD diagnosis, greater consumptions of total flavonoid, subclasses including flavonols, anthocyanins, flavan-3-ols, and polymers, and berries and red wine, were associated with lower mortality risk (p<0.05 for all).DiscussionAmong individuals with PD, higher consumption of flavonoids, especially anthocyanins and flavan-3-ols, and flavonoid-rich food such as berries and red wine, was likely to be associated with a lower risk of mortality.

Association of Diet and Physical Activity With All-Cause Mortality Among Adults With Parkinson Disease

“…This finding is supported by a previous report that a high intake of flavonoids and flavonoid-rich foods, such as berries and red wines, both before and after PD diagnosis, was associated with lower mortality risk. 30 Second, healthier dietary patterns were associated with reduced oxidative stress and consequent metabolic risk factors for PD. 31 , 32 Oxidative stress and neuroinflammation are among the crucial players in the pathophysiological process of neurodegeneration.…”

Identification of structural features of selected flavonoids responsible for neuroprotection using a Drosophila model of Parkinson’s disease

“…Several compounds representing different classes of flavonoids were tested to understand how the structure of these molecules influences their neuroprotective activity in vivo. Numerous epidemiological studies have shown that a diet rich in flavonoids decreases the risk of developing neurodegenerative diseases, including PD (4,8,11,(14)(15)(16)36). Neuroprotective activity of several flavonoids has also been proven in numerous animal studies, however, the molecular mechanism of action of these compounds remains elusive (2,12).…”

“…Polyphenols belong to a class of abundant specialized metabolites that have been often considered as majorly responsible for the beneficial effects of plant-based diets (2, 12, 13). Numerous recent epidemiological studies have shown that people consuming a diet rich in flavonoids, a subclass of polyphenolic compounds have been less likely to develop AD or PD (14-16).…”

“…Numerous recent epidemiological studies have shown that people consuming a diet rich in flavonoids, a subclass of polyphenolic compounds have been less likely to develop AD or PD (14)(15)(16).…”

Evidence for Oxidative Pathways in the Pathogenesis of PD: Are Antioxidants Candidate Drugs to Ameliorate Disease Progression?

“…Dietary polyphenols are associated with reduced risk of dementia [133], cognitive decline [134], and PD [135]. PD locomotor symptoms are significantly delayed by drinking tea containing various flavonoids in a retrospective study [136] and reduction in PD risk was also determined in meta-analyses of tea consumption in case-controlled [137] and prospective cohorts [138] studies. Two additional contemporary prospective studies showed that increased flavonoid consumption, especially the sub-class anthocyanins, are associated with lower mortality in PD [139] and maintenance of cognitive function [140].…”