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March 08, 2022; 98 (10) Research Article

Intake of Flavonoids and Flavonoid-Rich Foods and Mortality Risk Among Individuals With Parkinson Disease

A Prospective Cohort Study

View ORCID ProfileXinyuan Zhang, Samantha A. Molsberry, Tian-Shin Yeh, View ORCID ProfileAedin Cassidy, Michael A. Schwarzschild, Alberto Ascherio, View ORCID ProfileXiang Gao
First published January 26, 2022, DOI: https://doi.org/10.1212/WNL.0000000000013275
Xinyuan Zhang
From the Department of Nutritional Sciences (X.Z., X.G.), Pennsylvania State University, University Park; Departments of Nutrition (S.A.M., T.-S.Y., A.A.) and Epidemiology (T.-S.Y., A.A.), Harvard T.H. Chan School of Public Health; Channing Division of Network Medicine (T.-S.Y., A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Institute for Global Food Security (A.C.), Queen's University Belfast, Northern Ireland; and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston. Dr. Yeh is currently with Nuffield Department of Population Health, Big Data Institute, University of Oxford, UK.
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Samantha A. Molsberry
From the Department of Nutritional Sciences (X.Z., X.G.), Pennsylvania State University, University Park; Departments of Nutrition (S.A.M., T.-S.Y., A.A.) and Epidemiology (T.-S.Y., A.A.), Harvard T.H. Chan School of Public Health; Channing Division of Network Medicine (T.-S.Y., A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Institute for Global Food Security (A.C.), Queen's University Belfast, Northern Ireland; and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston. Dr. Yeh is currently with Nuffield Department of Population Health, Big Data Institute, University of Oxford, UK.
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Tian-Shin Yeh
From the Department of Nutritional Sciences (X.Z., X.G.), Pennsylvania State University, University Park; Departments of Nutrition (S.A.M., T.-S.Y., A.A.) and Epidemiology (T.-S.Y., A.A.), Harvard T.H. Chan School of Public Health; Channing Division of Network Medicine (T.-S.Y., A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Institute for Global Food Security (A.C.), Queen's University Belfast, Northern Ireland; and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston. Dr. Yeh is currently with Nuffield Department of Population Health, Big Data Institute, University of Oxford, UK.
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Aedin Cassidy
From the Department of Nutritional Sciences (X.Z., X.G.), Pennsylvania State University, University Park; Departments of Nutrition (S.A.M., T.-S.Y., A.A.) and Epidemiology (T.-S.Y., A.A.), Harvard T.H. Chan School of Public Health; Channing Division of Network Medicine (T.-S.Y., A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Institute for Global Food Security (A.C.), Queen's University Belfast, Northern Ireland; and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston. Dr. Yeh is currently with Nuffield Department of Population Health, Big Data Institute, University of Oxford, UK.
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Michael A. Schwarzschild
From the Department of Nutritional Sciences (X.Z., X.G.), Pennsylvania State University, University Park; Departments of Nutrition (S.A.M., T.-S.Y., A.A.) and Epidemiology (T.-S.Y., A.A.), Harvard T.H. Chan School of Public Health; Channing Division of Network Medicine (T.-S.Y., A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Institute for Global Food Security (A.C.), Queen's University Belfast, Northern Ireland; and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston. Dr. Yeh is currently with Nuffield Department of Population Health, Big Data Institute, University of Oxford, UK.
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Alberto Ascherio
From the Department of Nutritional Sciences (X.Z., X.G.), Pennsylvania State University, University Park; Departments of Nutrition (S.A.M., T.-S.Y., A.A.) and Epidemiology (T.-S.Y., A.A.), Harvard T.H. Chan School of Public Health; Channing Division of Network Medicine (T.-S.Y., A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Institute for Global Food Security (A.C.), Queen's University Belfast, Northern Ireland; and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston. Dr. Yeh is currently with Nuffield Department of Population Health, Big Data Institute, University of Oxford, UK.
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Xiang Gao
From the Department of Nutritional Sciences (X.Z., X.G.), Pennsylvania State University, University Park; Departments of Nutrition (S.A.M., T.-S.Y., A.A.) and Epidemiology (T.-S.Y., A.A.), Harvard T.H. Chan School of Public Health; Channing Division of Network Medicine (T.-S.Y., A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Institute for Global Food Security (A.C.), Queen's University Belfast, Northern Ireland; and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston. Dr. Yeh is currently with Nuffield Department of Population Health, Big Data Institute, University of Oxford, UK.
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Intake of Flavonoids and Flavonoid-Rich Foods and Mortality Risk Among Individuals With Parkinson Disease
A Prospective Cohort Study
Xinyuan Zhang, Samantha A. Molsberry, Tian-Shin Yeh, Aedin Cassidy, Michael A. Schwarzschild, Alberto Ascherio, Xiang Gao
Neurology Mar 2022, 98 (10) e1064-e1076; DOI: 10.1212/WNL.0000000000013275

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Abstract

Background and Objectives Although flavonoids have the potential to exert neuroprotective benefits, evidence of their role in improving survival rates among individuals with Parkinson disease (PD) remains lacking. We aimed to prospectively study the association between prediagnosis and postdiagnosis flavonoid intakes and risk of mortality among individuals with PD identified from 2 large ongoing cohorts of US men and women.

Methods Included in the current analysis were 599 women from the Nurses' Health Study and 652 men from the Health Professionals Follow-Up Study who were newly diagnosed with PD during follow-up. Dietary intakes of total flavonoid and its subclasses, together with major flavonoid-rich foods (tea, apples, berries, orange and orange juice, and red wine), were repeatedly assessed with a validated food frequency questionnaire every 4 years. Mortality was ascertained via the National Death Index and state vital statistics records.

Results We documented 944 deaths during 32 to 34 years of follow-up. A higher total flavonoid intake before PD diagnosis was associated with a lower future risk for all-cause mortality in men (hazard ratio [HR] comparing 2 extreme quartiles 0.53, 95% confidence interval [CI] 0.39, 0.71; p for trend < 0.001) but not in women (HR 0.93, 95% CI 0.68, 1.28; p for trend = 0.69) after adjustment for age, smoking status, total energy intake, and other covariates. The pooled HR comparing the extreme quartiles was 0.70 (95% CI 0.40, 1.22; p for trend = 0.25) with significant heterogeneity (p = 0.01). For flavonoid subclasses, the highest quartile of anthocyanins, flavones, and flavan-3-ols intakes before diagnosis had a lower mortality risk compared to the lowest quartile (pooled HR 0.66, 0.78, and 0.69, respectively; p < 0.05 for all); for berries and red wine, participants consuming ≥3 servings per week had a lower risk (pooled HR 0.77, 95% CI 0.58, 1.02; and pooled HR 0.68, 95% CI 0.51, 0.91, respectively) compared to <1 serving per month. After PD diagnosis, greater consumptions of total flavonoid, subclasses including flavonols, anthocyanins, flavan-3-ols, and polymers, and berries and red wine were associated with lower mortality risk (p < 0.05 for all).

Discussion Among individuals with PD, higher consumption of flavonoids, especially anthocyanins and flavan-3-ols, and flavonoid-rich food such as berries and red wine was likely to be associated with a lower risk of mortality.

Glossary

CI=
confidence interval;
FFQ=
food frequency questionnaire;
HPFS=
Health Professionals Follow-Up Study;
HR=
hazard ratio;
ICD=
International Classification of Disease;
NHS=
Nurses' Health Study;
PD=
Parkinson disease;
SE=
standard error

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.

  • Received July 16, 2021.
  • Accepted in final form December 21, 2021.
  • © 2022 American Academy of Neurology
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