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September 07, 2021; 97 (10) Research Article

Long-term Dietary Flavonoid Intake and Subjective Cognitive Decline in US Men and Women

View ORCID ProfileTian-Shin Yeh, Changzheng Yuan, Alberto Ascherio, Bernard A. Rosner, Walter C. Willett, Deborah Blacker
First published July 28, 2021, DOI: https://doi.org/10.1212/WNL.0000000000012454
Tian-Shin Yeh
From the Departments of Epidemiology (T.-S.Y., A.A., W.W., D.B.), Nutrition (T.-S.Y., A.A., W.W., C.Y.), and Biostatistics (B.R.), Harvard T.H. Chan School of Public Health, Harvard University; Channing Division of Network Medicine (T.-S.Y., A.A., W.W., C.Y., B.R.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; School of Public Health (C.Y.), Zhejiang University, Hangzhou, China; Department of Medicine (B.R.), Harvard Medical School; and Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School, Boston.
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  • ORCID record for Tian-Shin Yeh
Changzheng Yuan
From the Departments of Epidemiology (T.-S.Y., A.A., W.W., D.B.), Nutrition (T.-S.Y., A.A., W.W., C.Y.), and Biostatistics (B.R.), Harvard T.H. Chan School of Public Health, Harvard University; Channing Division of Network Medicine (T.-S.Y., A.A., W.W., C.Y., B.R.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; School of Public Health (C.Y.), Zhejiang University, Hangzhou, China; Department of Medicine (B.R.), Harvard Medical School; and Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School, Boston.
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Alberto Ascherio
From the Departments of Epidemiology (T.-S.Y., A.A., W.W., D.B.), Nutrition (T.-S.Y., A.A., W.W., C.Y.), and Biostatistics (B.R.), Harvard T.H. Chan School of Public Health, Harvard University; Channing Division of Network Medicine (T.-S.Y., A.A., W.W., C.Y., B.R.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; School of Public Health (C.Y.), Zhejiang University, Hangzhou, China; Department of Medicine (B.R.), Harvard Medical School; and Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School, Boston.
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Bernard A. Rosner
From the Departments of Epidemiology (T.-S.Y., A.A., W.W., D.B.), Nutrition (T.-S.Y., A.A., W.W., C.Y.), and Biostatistics (B.R.), Harvard T.H. Chan School of Public Health, Harvard University; Channing Division of Network Medicine (T.-S.Y., A.A., W.W., C.Y., B.R.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; School of Public Health (C.Y.), Zhejiang University, Hangzhou, China; Department of Medicine (B.R.), Harvard Medical School; and Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School, Boston.
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Walter C. Willett
From the Departments of Epidemiology (T.-S.Y., A.A., W.W., D.B.), Nutrition (T.-S.Y., A.A., W.W., C.Y.), and Biostatistics (B.R.), Harvard T.H. Chan School of Public Health, Harvard University; Channing Division of Network Medicine (T.-S.Y., A.A., W.W., C.Y., B.R.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; School of Public Health (C.Y.), Zhejiang University, Hangzhou, China; Department of Medicine (B.R.), Harvard Medical School; and Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School, Boston.
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Deborah Blacker
From the Departments of Epidemiology (T.-S.Y., A.A., W.W., D.B.), Nutrition (T.-S.Y., A.A., W.W., C.Y.), and Biostatistics (B.R.), Harvard T.H. Chan School of Public Health, Harvard University; Channing Division of Network Medicine (T.-S.Y., A.A., W.W., C.Y., B.R.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; School of Public Health (C.Y.), Zhejiang University, Hangzhou, China; Department of Medicine (B.R.), Harvard Medical School; and Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School, Boston.
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Long-term Dietary Flavonoid Intake and Subjective Cognitive Decline in US Men and Women
Tian-Shin Yeh, Changzheng Yuan, Alberto Ascherio, Bernard A. Rosner, Walter C. Willett, Deborah Blacker
Neurology Sep 2021, 97 (10) e1041-e1056; DOI: 10.1212/WNL.0000000000012454

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This article has a correction. Please see:

  • Long-term Dietary Flavonoid Intake and Subjective Cognitive Decline in US Men and Women - December 07, 2021
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Abstract

Objective To prospectively examine the associations between long-term dietary flavonoids and subjective cognitive decline (SCD).

Methods We followed 49,493 women from the Nurses' Health Study (NHS) (1984–2006) and 27,842 men from the Health Professionals Follow-Up Study (HPFS) (1986–2002). Poisson regression was used to evaluate the associations between dietary flavonoids (flavonols, flavones, flavanones, flavan-3-ols, anthocyanins, polymeric flavonoids, and proanthocyanidins) and subsequent SCD. For the NHS, long-term average dietary intake was calculated from 7 repeated semiquantitative food frequency questionnaires (SFFQs), and SCD was assessed in 2012 and 2014. For the HPFS, average dietary intake was calculated from 5 repeated SFFQs, and SCD was assessed in 2008 and 2012.

Results Higher intake of total flavonoids was associated with lower odds of SCD after adjustment for age, total energy intake, major nondietary factors, and specific dietary factors. In a comparison of the highest vs the lowest quintiles of total flavonoid intake, the pooled multivariable-adjusted odds ratio (OR) of 3-unit increments in SCD was 0.81 (95% confidence interval [CI] 0.76, 0.89). In the pooled results, the strongest associations were observed for flavones (OR 0.62 [95% CI 0.57, 0.68]), flavanones (0.64 [0.58, 0.68)]), and anthocyanins (0.76 [0.72, 0.84]) (p trend <0.001 for all groups). The dose-response curve was steepest for flavones, followed by anthocyanins. Many flavonoid-rich foods such as strawberries, oranges, grapefruits, citrus juices, apples/pears, celery, peppers, and bananas, were significantly associated with lower odds of SCD.

Conclusion Our findings support a benefit of higher flavonoid intakes for maintaining cognitive function in US men and women.

Glossary

AD=
Alzheimer disease;
CI=
confidence interval;
CVD=
cardiovascular disease;
HPFS=
Health Professionals Follow-Up Study;
NHS=
Nurses' Health Study;
OR=
odds ratio;
SCD=
subjective cognitive decline;
SFFQ=
semiquantitative food frequency questionnaire;
SU.VI.MAX=
Supplementation en Vitamines et Mineraux Antioxydants;
USDA=
US Department of Agriculture

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • CME Course: NPub.org/cmelist

  • Received February 7, 2021.
  • Accepted in final form June 10, 2021.
  • © 2021 American Academy of Neurology
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Letters: Rapid online correspondence

  • Author Response: Long-term Dietary Flavonoid Intake and Subjective Cognitive Decline in US Men and Women
    • Tian-Shin Yeh, Postdoctoral Research Fellow, Harvard T.H. Chan School of Public Health
    • Changzheng Yuan, Research Professor, School of Public Health, Zhejiang University, Hangzhou, China
    • Alberto Ascherio, Professor of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health
    • Bernard A. Rosner, Professor in the Department of Biostatistics, Harvard T.H. Chan School of Public Health
    • Walter C. Willett, Professor of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health
    • Deborah Blacker, Professor in the Department of Epidemiology, Harvard T.H. Chan School of Public Health, MGH
    Submitted September 02, 2021
  • Reader Response: Long-term Dietary Flavonoid Intake and Subjective Cognitive Decline in US Men and Women
    • Kazuo Abe, Neurology, Hyogo College of Medicine Hospital
    Submitted August 22, 2021
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