6th International Conference on Polyphenols and HealthUniversity 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, CNSFriedman School of Nutrition Science and Policy
Jean Mayer USDA Human Nutrition Research Center on AgingTufts UniversityBoston, 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 Support/Honorarium
None
Why Develop Reference Values for Flavonoids?
• Provide consumers with guidance about healthyfood choices via education and food product labeling
• Provide the nutrition industry with definitions to guideinnovative product development as well as truthful and non-misleading communications about products
Knowing is not enough; we must applyWilling is not enough; we must do.
- Johann Wolfgang von Goethe (1749-1832)
IOM FNB. DRI Coverpage 2000
From Data to Databases
Dataanalytical methods
experimental design nomenclature
quality control reporting
From Data to Databases
Data
Food Composition Analysiscultivar
environment geography
post-harvestpreparation sample size replication
From Data to Databases
Data
Food Composition Analysis
Database Classification and Organizationaccuracy
analytical methodologyaglycone 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 Intakeassessment tools
bioavailabilityreliability
Dietary Intake of Polyphenols in French AdultsSU.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 Exposurematrix (blood, urine)pharmacokinetics
single vs. multiple exposures
Urinary (not Dietary) Polyphenols AreAssociated with Decreased Mortality
InCHIANTI Study
Zamora-Ros et al. J Nutr 2013
Total Urinary Polyphenols Total Dietary Polyphenols
From Databases to Function
Range of Intakeusual
national vs. internationalduration in cohort
From Databases to Function
Range of Intake
Functionmaintenance of physiological function
modification of intermediary biomarkersreduction of disease risk
Cocoa Flavanols Reduce PrehypertensionSystolic Blood Pressure
Diastolic Blood Pressure
Ried et al. BMC Med 2010
RCT:• 15 trial arms• 2 wk• 18-70 y
• 168-902 mgflavanols
• 30-1008 mgpolyphenols
Anthocyanins Reduce the Riskof Incident Hypertension
Cassidy et al. Am J Clin Nutr 2011
Mu
ltiv
aria
te R
elat
ive
Ris
k
Quintiles
NHS II NHS I
HPFS Pooled
RR: 0.92 95% CI:0.86-0.98, P<0.03
Intake mg/d
• Q1= 5.7• Q5= 21.9
• n=156,957• 25-75 y• 14 y F/U
Intake of Anthocyanins and PolymersReduce the Risk of Myocardial Infarction
Nurses Health Study II
Intake, mg/d 1 2 3 4 5 P
Anthocyanins 2.5 5.0 8.4 13.5 25.1
1.0--
0.800.60-1.07
0.710.52-0.97
0.850.63-1.15
0.680.49-0.96
0.047
Polymers* 65.4 110.1 160.9 256.7 578.6
1.0--
0.890.66-1.19
0.800.59-1.08
0.640.46-0.89
0.830.62-1.11
0.051
Cassidy et al. Circulation 2013
* Polymers: proanthocyanidins, theaflavins, thearubigins • n=93,600• 25-42 y• 18 y F/U
From Databases to Function
Range of Intake
Function
Flavonoid Reference Valueframeworks for reference and risk
FAO/WHO Codex AlimentariusU.S. Institute of Medicine
From Function to Reference Values
IOM framework – DRI: EAR, AI, RDA, ULCodex framework – NRV
Adequate Intake: When sufficient evidence is notavailable to set an EAR, the AI is a goal for theintake of individuals. The AI is expected to coverthe 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 riskof adverse health effects to almost all individualsin the general population.
FAO/WHO Highest Observed Intake (HOI): Where notoxicity has been observed, the highest dose testedthat 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