6th International Conference on Polyphenols and Health
University of Buenos Aires, Argentina
19 October 2013
The Road to Evidence-based Dietary Recommendations
for Flavonoids: How Do We Get There?
From Data to Databases to Adequate Intakes
Jeffrey Blumberg, PhD, FASN, FACN, CNS
Friedman School of Nutrition Science and Policy
Jean Mayer USDA Human Nutrition Research Center on Aging
Tufts University
Boston, MA USA
Disclosures for:
Jeffrey B. Blumberg
AFFILIATION
FINANCIAL INTERESTS
CORPORATE ORGANIZATION
Grants/Research Support
None
Scientific Advisory Board
Herbalife, GlaxoSmithKline,
Pharmavite
Speakers Bureau
None
Stock Shareholder
None
Other Financial or Material None
Support/Honorarium
Why Develop Reference Values for Flavonoids?
• Provide consumers with guidance about healthy
food choices via education and food product labeling
• Provide the nutrition industry with definitions to guide
innovative product development as well as truthful
and non-misleading communications about products
Knowing is not enough; we must apply
Willing is not enough; we must do.
- Johann Wolfgang von Goethe
(1749-1832)
IOM FNB. DRI Coverpage 2000
From Data to Databases
Data
analytical methods
experimental design
nomenclature
quality control
reporting
From Data to Databases
Data
Food Composition Analysis
cultivar
environment
geography
post-harvest
preparation
sample size
replication
From Data to Databases
Data
Food Composition Analysis
Database Classification and Organization
accuracy
analytical methodology
aglycone vs. glycone
nomenclature
incompleteness
Flavonoid Databases
USDA ARS Database for the Flavonoid Content
of Selected Foods
USDA ARS Database for the Proanthocyanidin
Content of Selected Foods
USDA ARS Database for the Isoflavone Content
of Selected Foods
European Food Information Resource (EuroFIR)
Bioactive Substances in Food Plants
Information System (BASIS)
French National Institute for Agricultural Research
Phenol-Explorer
From Data to Databases
Data
Food Composition Analysis
Database Classification and Organization
Dietary Intake
assessment tools
bioavailability
reliability
Dietary Intake of Polyphenols in French Adults
SU.VI.MAX
Pérez-Jiménez et al. Am J Clin Nutr 2011
From Data to Databases
Data
Food Composition Analysis
Database Classification and Organization
Dietary Intake
Validation of Exposure
matrix (blood, urine)
pharmacokinetics
single vs. multiple exposures
Urinary (not Dietary) Polyphenols Are
Associated with Decreased Mortality
InCHIANTI Study
Total Urinary Polyphenols
Zamora-Ros et al. J Nutr 2013
Total Dietary Polyphenols
From Databases to Function
Range of Intake
usual
national vs. international
duration in cohort
From Databases to Function
Range of Intake
Function
maintenance of physiological function
modification of intermediary biomarkers
reduction of disease risk
Cocoa Flavanols Reduce Prehypertension
Systolic Blood Pressure
RCT:
• 15 trial arms
• 2 wk
• 18-70 y
• 168-902 mg
flavanols
• 30-1008 mg
polyphenols
Ried et al. BMC Med 2010
Diastolic Blood Pressure
• n=156,957
• 25-75 y
• 14 y F/U
Intake mg/d
• Q1= 5.7
• Q5= 21.9
Multivariate Relative Risk
Anthocyanins Reduce the Risk
of Incident Hypertension
NHS II
NHS I
HPFS
Pooled
RR: 0.92
95% CI:0.86-0.98, P<0.03
Quintiles
Cassidy et al. Am J Clin Nutr 2011
Intake of Anthocyanins and Polymers
Reduce the Risk of Myocardial Infarction
Nurses Health Study II
Intake, mg/d
Anthocyanins
Polymers*
1
2
3
4
5
2.5
5.0
8.4
13.5
25.1
1.0
--
0.80
0.60-1.07
0.71
0.52-0.97
0.85
0.63-1.15
0.68
0.49-0.96
65.4
110.1
160.9
256.7
578.6
1.0
--
0.89
0.66-1.19
0.80
0.59-1.08
0.64
0.46-0.89
0.83
0.62-1.11
* Polymers: proanthocyanidins, theaflavins, thearubigins
Cassidy et al. Circulation 2013
P
0.047
0.051
• n=93,600
• 25-42 y
• 18 y F/U
From Databases to Function
Range of Intake
Function
Flavonoid Reference Value
frameworks for reference and risk
FAO/WHO Codex Alimentarius
U.S. Institute of Medicine
From Function to Reference Values
IOM framework – DRI: EAR, AI, RDA, UL
Codex framework – NRV
Adequate Intake: When sufficient evidence is not
available to set an EAR, the AI is a goal for the
intake of individuals. The AI is expected to cover
the needs of most all people.
From Function to Reference Values
IOM Tolerable Upper Intake Level (UL): The
highest level of daily intake likely to pose no risk
of adverse health effects to almost all individuals
in the general population.
FAO/WHO Highest Observed Intake (HOI): Where no
toxicity has been observed, the highest dose tested
that can be confidently concluded as safe.
Le mieux est l'ennemi du bien
The perfect is the enemy of the good
- Voltaire (François-Marie Arouet)
1694-1778