Dietary Flavonoids in Cardiovascular and Cognitive Health Open Access

Goetz, Margarethe Elisabeth (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/70795800q?locale=en
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Abstract

Flavonoids are bioactive polyphenolic compounds found ubiquitously in vascular plants, which likely have pleiotropic effects, including anti-oxidant and anti-inflammatory activity. The role of dietary flavonoids in cardiovascular and cognitive health has been a topic of research interest for nearly two decades, with recently increasing interest. While progress has been made, existing literature is limited by incomplete dietary flavonoid information and lack of geographic and racial/ethnic diversity of studied populations. Geographic and racial disparities in cardiovascular and cognitive health emphasize the need to address these knowledge gaps, which is the primary objective of this dissertation.

We used data from the REasons for Geographic and Racial Differences in Stroke Study (REGARDS) for all three research aims. In the first study we examined the association between total flavonoid and flavonoid subclass intakes and incident ischemic stroke. Greater flavanone intake, primarily consumed from citrus fruits, was associated with a lower relative risk of incident ischemic stroke. We also found that non-Hispanic black participants in the REGARDS study were less likely to consume flavonoids in general, as compared to their white counterparts, except for flavanones, which black participants consumed more. Stroke belt residents were more likely to reported higher consumption of flavan-3-ols and lower consumption of anthocyanidins, flavones and flavanones than those living outside of the stroke belt. In the second study, we reported that greater anthocyanidin and greater proanthocyanidin intakes were each associated with a lower relative risk of CHD events. Finally, in the third study we found that anthocyanidins, flavones and flavonols were positively associated with global cognitive performance over time. These associations were not modified by sociodemographic factors, including race or region of residence.

The findings of this dissertation project extend the results of previous flavonoid research to non-Hispanic black Americans and Americans across the continental U.S. Specific suggestions about flavonoid subclass consumption are impractical given the complexity of the flavonoid content of foods. Our results highlight the importance of consuming a variety of plant-based foods on a daily basis. Interventional studies designed to test optimal combinations and quantities of flavonoids and flavonoid-rich foods are warranted.

Table of Contents

CHAPTER 1: INTRODUCTION.. 8
CHAPTER 2: BACKGROUND.. 5
Overview of flavonoids and flavonoid subclasses.. 5
Flavonoid subclasses.. 6
Development of the Provisional Flavonoid Addendum.. 13
Flavonoids and proposed pleiotropic effects in cardiovascular disease.. 14
Flavonoids and Pleiotropic effects in Neurodegenerative Disease.. 18
Flavonoids and cardiovascular risk factors in humans .. 21
Epidemiologic studies of flavonoids and cardiovascular disease.. 24
Epidemiologic studies of flavonoids and cognitive health .. 28
Racial and Geographic Disparities in Cardiovascular and Cognitive Health.. 30
Summary.. 35
CHAPTER 3: METHODS.. 37
Overview .. 37
Exposure Assessment.. 37
Data source: The REGARDS Study .. 51
Data analysis plans.. 56
CHAPTER 4. REPORTED FLAVANONE INTAKE IS ASSOCIATED WITH RISK OF INCIDENT ISCHEMIC STROKE IN THE REGARDS STUDY.. 62
Abstract .. 63
Methods .. 66
Results .. 72
Discussion .. 74
Conclusions .. 78
CHAPTER 5: DIETARY FLAVONOID INTAKE AND INCIDENT CORONARY HEART DISEASE: THE REGARDS STUDY .. 103
Abstract .. 104
Introduction .. 105
Methods .. 106
Results .. 112
Discussion .. 114
Conclusion .. 118
CHAPTER 6: DIETARY FLAVONOID INTAKE IS ASSOCIATED WITH COGNITIVE FUNCTION: THE REGARDS STUDY .. 136
Abstract: .. 137
Introduction: .. 138
Methods .. 139
Results .. 145
Discussion .. 148
Take Away Points .. 152
CHAPTER 7: SUMMARY AND FUTURE DIRECTIONS .. 173
Summary .. 173
Future Directions .. 176
REFERENCES .. 183

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