TABLE 2.
Hazard ratios and 95% confidence intervals for associations between main flavonoid exposures and incident nonalcoholic fatty liver disease.
| Exposure |
P-trend | |||||
|---|---|---|---|---|---|---|
| Diet score | Q1 | Q2 | Q3 | Q4 | ||
| Flavodiet score | n/cases | 30,266/308 | 30,266/279 | 30,266/268 | 30,266/226 | |
| Intake (servings/d) | 1.5 (0.0–2.4) | 3.2 (2.4–3.9) | 4.5 (3.9–5.1) | 6.0 (5.1–19.2) | ||
| Model 1 | 1 | 0.87 (0.74, 1.02) | 0.83 (0.70, 0.97) | 0.68 (0.57, 0.81) | <0.001 | |
| Model 2 | 1 | 1.00 (0.84, 1.18) | 0.92 (0.78, 1.10) | 0.81 (0.67, 0.97) | 0.02 | |
| Subclasses | ||||||
| Anthocyanins | n/cases | 30,266/319 | 30,266/268 | 30,266/250 | 30,266/244 | |
| Intake (mg/d) | 3.2 (0.0–7.2) | 13.4 (7.2–20.6) | 29.1 (20.6–40.4) | 58.4 (40.4–307.2) | ||
| Model 1 | 1 | 0.82 (0.69, 0.96) | 0.75 (0.63, 0.88) | 0.72 (0.61, 0.86) | <0.001 | |
| Model 2 | 1 | 0.98 (0.83, 1.16) | 1.01 (0.85, 1.20) | 0.98 (0.82, 1.18) | 0.92 | |
| Proanthocyanidins | n/cases | 30,266/340 | 30,266/258 | 30,266/255 | 30,266/228 | |
| Intake (mg/d) | 162.5 (0.0–230.5) | 285.7 (230.5–336.4) | 387.5 (336.4–447.3) | 536.2 (447.3–2338.3) | ||
| Model 1 | 1 | 0.73 (0.62, 0.85) | 0.71 (0.60, 0.83) | 0.62 (0.53, 0.74) | <0.001 | |
| Model 2 | 1 | 0.85 (0.72, 1.01) | 0.83 (0.70, 0.99) | 0.77 (0.63, 0.93) | <0.01 | |
| Theaflavins and thearubigins | n/cases | 30,266/288 | 30,266/283 | 30,266/273 | 30,266/237 | |
| Intake (mg/d) | 0.00 (0.00–83.02) | 226.62 (83.02–332.08) | 456.61 (332.08–581.14) | 747.18 (581.14–1100.19) | ||
| Model 1 | 1 | 0.94 (0.80, 1.11) | 0.90 (0.76, 1.06) | 0.78 (0.66, 0.93) | <0.01 | |
| Model 2 | 1 | 1.08 (0.91, 1.27) | 1.02 (0.86, 1.22) | 0.78 (0.65, 0.94) | 0.01 | |
| Flavonols | n/cases | 30,266/307 | 30,266/290 | 30,266/250 | 30,266/234 | |
| Intake (mg/d) | 13.4 (0.0–20.3) | 26.3 (20.3–31.8) | 37.3 (31.8–43.5) | 51.5 (43.5–161.6) | ||
| Model 1 | 1 | 0.91 (0.77, 1.07) | 0.77 (0.66, 0.92) | 0.72 (0.61, 0.85) | <0.001 | |
| Model 2 | 1 | 1.03 (0.88, 1.22) | 0.89 (0.74, 1.06) | 0.78 (0.64, 0.95) | <0.01 | |
| Flavones | n/cases | 30,266/332 | 30,266/250 | 30,266/237 | 30,266/262 | |
| Intake (mg/d) | 0.3 (0.0–0.5) | 0.7 (0.5–0.9) | 1.1 (0.9–1.4) | 2.0 (1.4–15.6) | ||
| Model 1 | 1 | 0.74 (0.63, 0.87) | 0.69 (0.59, 0.82) | 0.77 (0.66, 0.91) | <0.01 | |
| Model 2 | 1 | 0.89 (0.76, 1.06) | 0.89 (0.74, 1.06) | 1.03 (0.86, 1.24) | 0.89 | |
| Flavan-3-ols | n/cases | 30,266/303 | 30,266/297 | 30,266/264 | 30,266/217 | |
| Intake (mg/d) | 38.9 (0.0–85.3) | 128.1 (85.3–166.1) | 203.6 (166.1–247.1) | 307.0 (247.1–1903.7) | ||
| Model 1 | 1 | 0.94 (0.80, 1.11) | 0.83 (0.70, 0.98) | 0.68 (0.57, 0.81) | <0.001 | |
| Model 2 | 1 | 1.08 (0.92, 1.28) | 0.94 (0.79, 1.12) | 0.74 (0.61, 0.90) | <0.01 | |
| Flavanones |
n/cases | 30,266/289 | 30,266/282 | 30,266/258 | 30,266/252 | |
| Intake (mg/d) | 1.6 (0.0–5.3) | 10.8 (5.3–17.9) | 25.7 (17.9–35.7) | 50.2 (35.7–376.7) | ||
| Model 1 | 1 | 0.96 (0.81, 1.13) | 0.86 (0.72, 1.01) | 0.82 (0.69, 0.97) | <0.01 | |
| Model 2 |
1 |
1.09 (0.92, 1.29) |
1.02 (0.86, 1.21) |
1.01 (0.84, 1.20) |
0.90 |
|
| Flavonoid-rich foods |
Low intake |
Moderate intake |
High intake |
|||
| Tea | n/cases | 22,981/226 | 49,630/461 | 48,453/394 | ||
| Intake (servings/d) | 0.0 (0.0–0.0) | 1.7 (0.2–2.7) | 4.0 (2.8–10.5) | |||
| Model 1 | 1 | 0.91 (0.77, 1.06) | 0.78 (0.67, 0.92) | <0.01 | ||
| Model 2 | 1 | 1.06 (0.90, 1.25) | 0.86 (0.72, 1.02) | 0.03 | ||
| Model 3 | 1 | 1.07 (0.90, 1.25) | 0.86 (0.72, 1.02) | 0.03 | ||
| Berries | n/cases | 77,445/715 | 30,161/257 | 13,458/109 | ||
| Intake (servings/d) | 0.00 (0.00–0.00) | 0.33 (0.10–0.50) | 1.00 (0.60–4.00) | |||
| Model 1 | 1 | 0.92 (0.79, 1.06) | 0.89 (0.73, 1.09) | 0.16 | ||
| Model 2 | 1 | 1.06 (0.92, 1.23) | 1.00 (0.81, 1.24) | 0.70 | ||
| Model 3 | 1 | 1.07 (0.92, 1.24) | 1.00 (0.81, 1.23) | 0.70 | ||
| Apple | n/cases | 53,683/540 | 35,057/308 | 32,324/233 | ||
| Intake (servings/d) | 0.00 (0.00–0.00) | 0.33 (0.10–0.50) | 1.00 (0.60–4.00) | |||
| Model 1 | 1 | 0.86 (0.75, 0.99) | 0.69 (0.59, 0.80) | <0.001 | ||
| Model 3 | 1 | 0.94 (0.81, 1.08) | 0.78 (0.67, 0.92) | <0.01 | ||
| Model 3 | 1 | 0.94 (0.82, 1.09) | 0.79 (0.67, 0.93) | <0.01 | ||
| Red wine | n/cases | 76,567/769 | 23,517/155 | 20,980/157 | ||
| Intake (servings/d) | 0.0 (0.0–0.0) | 0.5 (0.1–0.8) | 1.3 (0.8–6.0) | |||
| Model 1 | 1 | 0.63 (0.53, 0.75) | 0.70 (0.59, 0.83) | <0.001 | ||
| Model 2 | 1 | 0.89 (0.73, 1.07) | 0.90 (0.75, 1.09) | 0.21 | ||
| Model 3 | 1 | 0.89 (0.73, 1.07) | 0.90 (0.74, 1.08) | 0.20 | ||
Abbreviations: BMI, body mass index; Q1–Q4, quantile.
Cox proportional hazard models were used to obtain hazard ratio and 95% confidence interval estimates across categories of flavonoid exposures. P-trend values were obtained by modeling our exposures as continuous in the same test.
Model 1: age as the underlying time variable. Adjusted for sex and further stratified by age (5-y integers).
Model 2: model 1, and further adjusted for sex, education, smoking, deprivation, BMI, physical activity, prevalent type 2 diabetes mellitus, number of dietary assessments completed, total energy intake, fiber intake, total coffee intake, nonred wine alcohol intake.
Model 3: model 2 plus summed intakes of other flavonoid-rich foods (servings/day).
Intakes are reported as median (range).