Abstract
Background: Cardiovascular disease (CVD) is the leading cause of death in New Zealand and worldwide. Consequently, there is great interest in measures that could contribute to the prevention of CVD. Diet is a key modifiable risk of CVD and is associated with several other CVD risk factors. Flavonoids are an abundant polyphenol found in plants and plant based foods, and consumption of these foods has been shown to play a role in decreasing mortality from CVD, and positively influencing CVD risk markers such as blood lipids and blood pressure.
Objective: To examine the association between total flavonoid and anthocyanin intakes and 5-year CVD risk in the New Zealand men and woman, using ANS participants to represent the New Zealand adult population.
Design: Data from 3132 of the 4721 people in the 2008/09 New Zealand Adult Nutrition Survey (NZANS) were used in the current cross-sectional study. Intakes of total flavonoids and their subclasses (flavones, flavanones, flavonols, anthocyanins, flavan-3-ols and isoflavones) were calculated from 24-hour diet recall data from the NZANS, and by using an updated and extended US Department of Agriculture (USDA) database for flavonoids and the Phenol-Explorer database for instances when the USDA lacked values. NZANS participants were divided into tertiles of CVD risk categories (mild, moderate to high and very high) according to the New Zealand 5-year CVD risk score charts.
Results: The main food source of total flavonoids in the New Zealand adult population was “Sugar and Sweets”, and the overall mean intake of total flavonoids (SE) was 471.07mg (±15.6). The main food source of anthocyanins was the food group “non-alcoholic beverages” with a mean intake of 20.81mg (±1.8).
After adjusting for age, sex, BMI, NZ deprivation score and ethnic group, the odds of being in the highest CVD risk category were significantly lower in those who were in the highest tertile for anthocyanin intake when compared to lowest tertile of anthocyanin intake (OR=0.62, CI 0.41-0.95). Odds of being in the medium-high risk level (category 2) of CVD were also significantly decreased with a high intake of anthocyanins (OR=0.62, CI 0.42-0.91) compared to those who had the lowest intake of anthocyanins.
For total flavonoid intake, after adjustments for age, sex, BMI, NZ deprivation score and ethnicity, being in the highest tertile of flavonoid intake was significantly associated with a decrease in the odds of being in the highest risk category for CVD (OR=0.52, CI 0.29-0.91).
Conclusions: These data suggest that flavonoids, anthocyanins in particular, may play a major role in the prevention of CVD in New Zealand. Consuming a balanced diet that meets the recommendations for servings of fruit and vegetables per day, particularly berries, could increase flavonoid and anthocyanin intake and contribute to a reduction in CVD.