PMID- 31504087 OWN - NLM STAT- MEDLINE DCOM- 20200402 LR - 20230214 IS - 1938-3207 (Electronic) IS - 0002-9165 (Print) IS - 0002-9165 (Linking) VI - 110 IP - 5 DP - 2019 Nov 1 TI - Dietary intakes of flavan-3-ols and cardiometabolic health: systematic review and meta-analysis of randomized trials and prospective cohort studies. PG - 1067-1078 LID - 10.1093/ajcn/nqz178 [doi] AB - BACKGROUND: Although available data suggest that some dietary flavan-3-ol sources reduce cardiometabolic risk, to our knowledge no review has systematically synthesized their specific contribution. OBJECTIVE: We aimed to examine, for the first time, if there is consistent evidence that higher flavan-3-ol intake, irrespective of dietary source, reduces cardiometabolic risk. METHODS: MEDLINE, Cochrane Central, and Commonwealth Agricultural Bureau abstracts were searched for prospective cohorts and randomized controlled trials (RCTs) published from 1946 to March 2019 on flavan-3-ol intake and cardiovascular disease (CVD) risk. Random-effects models meta-analysis was used. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach assessed the strength of evidence. RESULTS: Of 15 prospective cohorts (23 publications), 4 found highest compared with lowest habitual intakes of flavan-3-ols were associated with a 13% reduction in risk of CVD mortality and 2 found a 19% reduction in risk of chronic heart disease (CHD) incidence. Highest compared with lowest habitual intakes of monomers were associated with a reduction in risk of type 2 diabetes mellitus (T2DM) (n = 5) and stroke (n = 4) (10% and 18%, respectively). No association was found for hypertension. Of 156 RCTs, flavan-3-ol intervention resulted in significant improvements in acute/chronic flow-mediated dilation (FMD), systolic (SBP) and diastolic blood pressure (DBP), total cholesterol (TC), LDL and HDL cholesterol, triglycerides (TGs), hemoglobin A1c (HbA1c), and homeostasis model assessment of insulin resistance (HOMA-IR). All analyses, except HbA1c, were associated with moderate/high heterogeneity. When analyses were limited to good methodological quality studies, improvements in TC, HDL cholesterol, SBP, DBP, HOMA-IR, and acute/chronic FMD remained significant. In GRADE evaluations, there was moderate evidence in cohort studies that flavan-3-ol and monomer intakes were associated with reduced risk of CVD mortality, CHD, stroke, and T2DM, whereas RCTs reported improved TC, HDL cholesterol, SBP, and HOMA-IR. CONCLUSIONS: Available evidence supports a beneficial effect of flavan-3-ol intake on cardiometabolic outcomes, but there was considerable heterogeneity in the meta-analysis. Future research should focus on an integrated intake/biomarker approach in cohorts and high-quality dose-response RCTs. This review was registered at www.crd.york.ac.uk/PROSPERO/ as CRD42018035782. CI - Copyright (c) American Society for Nutrition 2019. FAU - Raman, Gowri AU - Raman G AD - Tufts Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. FAU - Avendano, Esther E AU - Avendano EE AD - Tufts Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. FAU - Chen, Siyu AU - Chen S AD - Tufts Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. AD - Tufts University Friedman School of Nutrition Science and Policy, Boston, MA, USA. FAU - Wang, Jiaqi AU - Wang J AD - Tufts Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. AD - Tufts University Friedman School of Nutrition Science and Policy, Boston, MA, USA. FAU - Matson, Julia AU - Matson J AD - Department of Biology, Brandeis University, Waltham, MA, USA. FAU - Gayer, Bridget AU - Gayer B AD - Tufts Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. AD - Tufts University Friedman School of Nutrition Science and Policy, Boston, MA, USA. FAU - Novotny, Janet A AU - Novotny JA AD - Beltsville Human Nutrition Research Center, Agricultural Research Service, USDA, Beltsville, MD, USA. FAU - Cassidy, Aedin AU - Cassidy A AD - Institute for Global Food Security, Queen's University Belfast, Belfast, United Kingdom. LA - eng PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review PL - United States TA - Am J Clin Nutr JT - The American journal of clinical nutrition JID - 0376027 RN - 0 (Flavonoids) RN - 0 (Lipids) RN - 35HDD3NRIE (flavan-3-ol) RN - IY9XDZ35W2 (Glucose) SB - IM MH - Cardiovascular Diseases/*prevention & control MH - Diabetes Mellitus, Type 2/*prevention & control MH - Endothelium, Vascular/physiology MH - Flavonoids/*administration & dosage MH - Glucose/metabolism MH - Humans MH - Insulin Resistance MH - Lipids/blood MH - Prospective Studies MH - Randomized Controlled Trials as Topic PMC - PMC6821550 OTO - NOTNLM OT - blood pressure OT - cardiovascular OT - diabetes OT - flavan-3-ols OT - flavonoids EDAT- 2019/09/11 06:00 MHDA- 2020/04/03 06:00 PMCR- 2019/08/26 CRDT- 2019/09/11 06:00 PHST- 2019/03/16 00:00 [received] PHST- 2019/07/10 00:00 [accepted] PHST- 2019/09/11 06:00 [pubmed] PHST- 2020/04/03 06:00 [medline] PHST- 2019/09/11 06:00 [entrez] PHST- 2019/08/26 00:00 [pmc-release] AID - S0002-9165(22)01291-6 [pii] AID - nqz178 [pii] AID - 10.1093/ajcn/nqz178 [doi] PST - ppublish SO - Am J Clin Nutr. 2019 Nov 1;110(5):1067-1078. doi: 10.1093/ajcn/nqz178.