Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Systematic Reviews
Published in: Systematic Reviews 1/2018

Open Access 01-12-2018 | Research

Dietary intakes of flavan-3-ols and cardiovascular health: a field synopsis using evidence mapping of randomized trials and prospective cohort studies

Authors: Gowri Raman, Marissa Shams-White, Esther E. Avendano, Fan Chen, Janet A. Novotny, Aedin Cassidy

Published in: Systematic Reviews | Issue 1/2018

Login to get access

Abstract

Background

There is considerable interest in the impact of increased flavan-3-ol intake on cardiovascular disease (CVD) and diabetes outcomes. Through evidence mapping, we determined the extent of the evidence base to initiate a future systematic review investigating the impact of flavan-3-ol intake on CVD and diabetes outcomes.

Methods

We developed a research protocol, convened a technical expert panel (TEP) to refine the specific research questions, conducted a systematic search in multiple databases, double-screened abstracts and full-text articles, performed data extractions, and synthesized the data. We focused on randomized controlled trials (RCTs) and prospective cohort studies which assessed intakes of flavan-3-ol from foods, beverages, and supplement/extract sources on biomarkers and clinical outcomes of CVD and diabetes.

Results

Of 257 eligible articles, 223 and 34 publications contributed to 226 RCTs and 39 prospective cohort studies, respectively. In RCTs, the most frequently studied interventions were cocoa-based products (23.2%); berries (16.1%); tea in the form of green tea (13.9%), black tea (7.2%), or unspecified tea (3.6%); and red wine (11.2%). Mean total flavan-3-ol intake was highest in the cocoa-based trials (618.7 mg/day) and lowest in the interventions feeding red wine (123.7 mg/day). The most frequently reported outcomes were intermediate biomarkers including serum lipid levels (63.4%), blood glucose (50.9%), blood pressure (50.8%), flow-mediated dilation (21.9%), and high-sensitivity C-reactive protein (21.9%). The included 34 prospective cohort studies predominantly examined exposures to flavan-3-ols (26%), cocoa-based products (23.2%), berries (16.1%), and green tea (13.9%) and CVD incidence and mortality.

Conclusion

Through a systematic, evidence-based approach, evidence mapping on flavan-3-ol intake and CVD outcomes demonstrated sufficient data relating to flavan-3ol intake and biomarkers and clinical outcomes of CVD and diabetes. The current evidence base highlights the distribution of available data which both support the development of a future systematic review and identified the research need for future long-term RCTs.

Systematic review registration

At present, evidence mapping is not eligible for registration on the international prospective register of systematic reviews (i.e., PROSPERO).
Appendix
Available only for authorised users
Literature
1.
Hooper L, Kroon PA, Rimm EB, Cohn JS, Harvey I, Le Cornu KA, et al. Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2008;88:38–50.CrossRefPubMed
2.
Cassidy A, Minihane AM. The role of metabolism (and the microbiome) in defining the clinical efficacy of dietary flavonoids. Am J Clin Nutr. 2017;105:10–22.CrossRefPubMed
3.
Rodriguez-Mateos A, Vauzour D, Krueger CG, Shanmuganayagam D, Reed J, Calani L, et al. Bioavailability, bioactivity and impact on health of dietary flavonoids and related compounds: an update. Arch Toxicol. 2014;88:1803–53.CrossRefPubMed
4.
Buitrago-Lopez A, Sanderson J, Johnson L, Warnakula S, Wood A, Di AE, et al. Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis. BMJ. 2011;343:d4488.CrossRefPubMedPubMedCentral
5.
Greyling A, Ras RT, Zock PL, Lorenz M, Hopman MT, Thijssen DH, et al. The effect of black tea on blood pressure: a systematic review with meta-analysis of randomized controlled trials. PLoS One. 2014;9:e103247.CrossRefPubMedPubMedCentral
6.
Larsson SC, Virtamo J, Wolk A. Chocolate consumption and risk of stroke: a prospective cohort of men and meta-analysis. Neurology. 2012;79:1223–9.CrossRefPubMed
7.
Shrime MG, Bauer SR, McDonald AC, Chowdhury NH, Coltart CE, Ding EL. Flavonoid-rich cocoa consumption affects multiple cardiovascular risk factors in a meta-analysis of short-term studies. J Nutr. 2011;141:1982–8.CrossRefPubMed
8.
Zhang C, Qin YY, Wei X, Yu FF, Zhou YH, He J. Tea consumption and risk of cardiovascular outcomes and total mortality: a systematic review and meta-analysis of prospective observational studies. Eur J Epidemiol. 2015;30:103–13.CrossRefPubMed
9.
Berends LM, van der Velpen V, Cassidy A. Flavan-3-ols, theobromine, and the effects of cocoa and chocolate on cardiometabolic risk factors. Curr Opin Lipidol. 2015;26:10–9.CrossRefPubMed
10.
Del RD, Rodriguez-Mateos A, Spencer JP, Tognolini M, Borges G, Crozier A. Dietary (poly)phenolics in human health: structures, bioavailability, and evidence of protective effects against chronic diseases. Antioxid Redox Signal. 2013;18:1818–92.CrossRef
11.
Ludwig IA, Clifford MN, Lean ME, Ashihara H, Crozier A. Coffee: biochemistry and potential impact on health. Food Funct. 2014;5:1695–717.CrossRefPubMed
12.
Sarma DN, Barrett ML, Chavez ML, Gardiner P, Ko R, Mahady GB, et al. Safety of green tea extracts : a systematic review by the US Pharmacopeia. Drug Saf. 2008;31:469–84.CrossRefPubMed
13.
Verhelst X, Burvenich P, Van SD, Gabriel C, Lootens M, Baert D. Acute hepatitis after treatment for hair loss with oral green tea extracts (Camellia Sinensis). Acta Gastroenterol Belg. 2009;72:262–4.PubMed
14.
Bragge P, Clavisi O, Turner T, Tavender E, Collie A, Gruen RL. The global evidence mapping initiative: scoping research in broad topic areas. BMC Med Res Methodol. 2011;11:92.CrossRefPubMedPubMedCentral
15.
Hetrick SE, Parker AG, Callahan P, Purcell R. Evidence mapping: illustrating an emerging methodology to improve evidence-based practice in youth mental health. J Eval Clin Pract. 2010;16:1025–30.CrossRefPubMed
16.
17.
18.
19.
Hooper L, Kay C, Abdelhamid A, Kroon PA, Cohn JS, Rimm EB, et al. Effects of chocolate, cocoa, and flavan-3-ols on cardiovascular health: a systematic review and meta-analysis of randomized trials. Am J Clin Nutr. 2012;95:740–51.CrossRefPubMed
20.
Ried K, Sullivan TR, Fakler P, Frank OR, Stocks NP. Effect of cocoa on blood pressure. Cochrane Database Syst Rev. 2012;8:CD008893.
21.
Zhao Y, Asimi S, Wu K, Zheng J, Li D. Black tea consumption and serum cholesterol concentration: systematic review and meta-analysis of randomized controlled trials. Clin Nutr. 2015;34:612–9.CrossRefPubMed
22.
Blumberg JB, Camesano TA, Cassidy A, Kris-Etherton P, Howell A, Manach C, et al. Cranberries and their bioactive constituents in human health. Adv Nutr. 2013;4:618–32.CrossRefPubMedPubMedCentral
23.
McCullough ML, Peterson JJ, Patel R, Jacques PF, Shah R, Dwyer JT. Flavonoid intake and cardiovascular disease mortality in a prospective cohort of US adults. Am J Clin Nutr. 2012;95:454–64.CrossRefPubMedPubMedCentral
24.
Ivey KL, Lewis JR, Prince RL, Hodgson JM. Tea and non-tea flavonol intakes in relation to atherosclerotic vascular disease mortality in older women. Br J Nutr. 2013;110:1648–55.CrossRefPubMed
25.
Tresserra-Rimbau A, Medina-Remon A, Perez-Jimenez J, Martinez-Gonzalez MA, Covas MI, Corella D, et al. Dietary intake and major food sources of polyphenols in a Spanish population at high cardiovascular risk: the PREDIMED study. Nutr Metab Cardiovasc Dis. 2013;23:953–9.CrossRefPubMed
26.
Zamora-Ros R, Jimenez C, Cleries R, Agudo A, Sanchez MJ, Sanchez-Cantalejo E, et al. Dietary flavonoid and lignan intake and mortality in a Spanish cohort. Epidemiology. 2013;24:726–33.CrossRefPubMed
27.
Cassidy A, Mukamal KJ, Liu L, Franz M, Eliassen AH, Rimm EB. High anthocyanin intake is associated with a reduced risk of myocardial infarction in young and middle-aged women. Circulation. 2013;127:188–96.CrossRefPubMedPubMedCentral
28.
Kay CD, Hooper L, Kroon PA, Rimm EB, Cassidy A. Relative impact of flavonoid composition, dose and structure on vascular function: a systematic review of randomised controlled trials of flavonoid-rich food products. Mol Nutr Food Res. 2012;56:1605–16.CrossRefPubMed
29.
Dower JI, Geleijnse JM, Gijsbers L, Zock PL, Kromhout D, Hollman PC. Effects of the pure flavonoids epicatechin and quercetin on vascular function and cardiometabolic health: a randomized, double-blind, placebo-controlled, crossover trial. Am J Clin Nutr. 2015;101:914–21.CrossRefPubMed
30.
Gutierrez-Salmean G, Meaney E, Lanaspa MA, Cicerchi C, Johnson RJ, Dugar S, et al. A randomized, placebo-controlled, double-blind study on the effects of (-)-epicatechin on the triglyceride/HDLc ratio and cardiometabolic profile of subjects with hypertriglyceridemia: unique in vitro effects. Int J Cardiol. 2016;223:500–6.CrossRefPubMed
31.
Livingston KA, Chung M, Sawicki CM, Lyle BJ, Wang DD, Roberts SB, et al. Development of a publicly available, comprehensive database of fiber and health outcomes: rationale and methods. PLoS One. 2016;11:e0156961.CrossRefPubMedPubMedCentral
32.
Wang DD, Shams-White M, Bright OJ, Parrott JS, Chung M. Creating a literature database of low-calorie sweeteners and health studies: evidence mapping. BMC Med Res Methodol. 2016;16:1.CrossRefPubMedPubMedCentral
Metadata
Title
Dietary intakes of flavan-3-ols and cardiovascular health: a field synopsis using evidence mapping of randomized trials and prospective cohort studies
Authors
Gowri Raman
Marissa Shams-White
Esther E. Avendano
Fan Chen
Janet A. Novotny
Aedin Cassidy
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2018
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-018-0764-z

Other articles of this Issue 1/2018

Systematic Reviews 1/2018 Go to the issue

Protocol

Evaluating the current state of Mendelian randomization studies: a protocol for a systematic review on methodological and clinical aspects using neurodegenerative disorders as outcome

Protocol

The impact of body mass index on mortality in patients with acute kidney injury: a systematic review protocol

Protocol

Mobility and increased risk of HIV acquisition in South Africa: a mixed-method systematic review protocol

Protocol

Evidence of factors influencing self-medication with antibiotics in LMICs: a systematic scoping review protocol

Protocol

Evaluation of the reliability, usability, and applicability of AMSTAR, AMSTAR 2, and ROBIS: protocol for a descriptive analytic study

Protocol

T cell activation and cardiovascular risk in type 2 diabetes mellitus: a protocol for a systematic review and meta-analysis