ORIGINAL RESEARCH article
Front. Nutr.
Sec. Food Chemistry
Association of Dietary Flavonoid Intake with Incident Atherosclerosis: Cohort Evidence in Middle-Aged and Older Adults
Provisionally accepted
- Harbin Medical University, Harbin, China
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Objective: Cardiovascular disease, largely driven by atherosclerosis, remains a leading cause of global morbidity and mortality. This study aimed to investigate the associations of dietary intake of total flavonoids and their subclasses with the risk of incident atherosclerosis, post-atherosclerosis cardiovascular disease and all-cause mortality in a large prospective cohort. Methods: The study included 207,571 adults without baseline atherosclerosis from the UK Biobank. Risk factors were investigated using a three-level stepwise-adjusted Cox proportional hazards model, alongside subgroup analyses and subclass-specific analyses. Results: The prevalence of atherosclerosis showed a decreasing trend with increasing quartiles of total flavonoid intake (Q1: 0.75% vs Q4: 0.48%, p<0.001). In the fully adjusted model, participants in the highest quartile (Q4) of total flavonoid intake exhibited a significantly lower risk of atherosclerosis compared to those in the lowest quartile (Q1) (HR=0.781, 95% CI: 0.634–0.961, p=0.020). This inverse association persisted across all subgroups, particularly in the age-stratified analysis of individuals aged 55–69 years. Subclass-specific analyses revealed that the protective relationship was primarily driven by flavan-3-ols (HR = 0.660, 95% CI: 0.539–0.807, p < 0.001), anthocyanins (HR = 0.816, 95% CI: 0.685– 0.971, p = 0.022), and flavonols (HR = 0.733, 95% CI: 0.608–0.884, p = 0.002). Conversely, total flavonoid intake showed no significant association with cardiovascular disease risk or all-cause mortality following atherosclerosis diagnosis. Conclusion: Higher consumption of foods rich in flavonoids—such as apples, berries, and tea—was associated with a lower risk of incident atherosclerosis. This inverse association was particularly pronounced among middle-aged and older adults aged 55 to 69. Therefore, incorporating more of these foods into daily diets may be a potential strategy to support cardiovascular health and reduce the burden of subsequent cardiovascular diseases.
Keywords: All-cause mortality, Atherosclerosis, cardiovascular disease, Flavonoid, middle-age
Received: 14 Nov 2025; Accepted: 04 Feb 2026.
Copyright: © 2026 Tian, Wang, Chang and Han. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yi Han
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