Associations Between Polyphenol Intake, Cardiometabolic Risk Factors and Metabolic Syndrome in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Renata A Carnauba; Flavia M Sarti; Camille P Coutinho; Neuza Ma Hassimotto; Dirce M Marchioni; Paulo A Lotufo; Isabela M Bensenor; Franco M Lajolo

doi:10.1016/j.tjnut.2024.11.016

Associations Between Polyphenol Intake, Cardiometabolic Risk Factors and Metabolic Syndrome in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

J Nutr. 2024 Nov 26:S0022-3166(24)01185-4. doi: 10.1016/j.tjnut.2024.11.016. Online ahead of print.

Authors

Renata A Carnauba¹, Flavia M Sarti², Camille P Coutinho³, Neuza Ma Hassimotto³, Dirce M Marchioni⁴, Paulo A Lotufo⁵, Isabela M Bensenor⁶, Franco M Lajolo³

Affiliations

¹ Department of Food Science and Experimental Nutrition, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil; Food Research Center, CEPID-FAPESP (Research Innovation and Dissemination Centers, São Paulo Research Foundation), São Paulo, Brazil. Electronic address: [email protected].
² Center for Research in Complex Systems Modeling, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil.
³ Department of Food Science and Experimental Nutrition, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil; Food Research Center, CEPID-FAPESP (Research Innovation and Dissemination Centers, São Paulo Research Foundation), São Paulo, Brazil.
⁴ Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
⁵ Center for Clinical and Epidemiological Research, University of Sao Paulo, São Paulo, Brazil.
⁶ Department of Internal Medicine, School of Medicine, University of Sao Paulo, São Paulo, Brazil.

PMID: 39608609
DOI: 10.1016/j.tjnut.2024.11.016

Abstract

Background: Fruit- and vegetable-rich diets may protect against metabolic syndrome (MetS), partly due to their high polyphenol content.

Objectives: This study examined the association between dietary polyphenol intake, MetS risk, and cardiometabolic factors in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods: A total of 6387 participants (mean age 49.8 y, 65% female) were included. Food intake was assessed via a semiquantitative Food Frequency Questionnaire with polyphenol content from the Phenol-Explorer database. MetS was defined using the Joint Interim Statement. Logistic regressions assessed associations between polyphenol intake tertiles and cardiometabolic risk factors, as well as the odds of MetS during the follow-up period.

Results: During a median of 8.19 y follow-up, 2031 cases of MetS occurred. The second and third tertiles of total polyphenol intake were associated with 22% and 23% lower odds of MetS, respectively, after adjusting for sociodemographic, lifestyle, and dietary factors (T2 vs. T1, odds ratio [OR] 0.78 [95% confidence interval {CI}: 0.68, 0.90]; T3 vs. T1, OR 0.77 [0.66, 0.90]). Inverse associations were also found between phenolic acids, lignans, stilbenes, other polyphenols, and the odds of MetS. Although no significant link was observed for total flavonoids, flavan-3-ols showed inverse associations with MetS (monomers: T3 vs. T1, OR 0.92 [0.80, 0.94]; dimers to polymers: T3 vs. T1, OR 0.82 [0.70, 0.96]). Total polyphenol intake was also inversely associated with waist-hip ratio, diastolic blood pressure, systolic blood pressure, HOMA-IR, triglycerides, and C-reactive protein, and positively associated with total cholesterol, LDL cholesterol, and HDL cholesterol.

Conclusions: Higher intakes of dietary polyphenols, particularly phenolic acids, lignans, stilbenes, other polyphenols, and flavan-3-ols, were inversely associated with the odds of MetS and its components. These findings suggest that promoting polyphenol-rich diets could be a valuable strategy in reducing cardiometabolic risk and preventing MetS in the population, potentially informing dietary guidelines and public health interventions.

Keywords: blood pressure; dyslipidemia; flavonoids; hyperglycemia; lignans; metabolic syndrome; phenolic acids; polyphenols; proanthocyanidins; stilbenes.