Abstract
Background and aim: Mechanistic data suggests several flavonoids may improve kidney function, but no large-scale prospective cohort study has been conducted. As such, we performed a prospective population-based study on flavonoid intakes, chronic kidney disease (CKD) risk, and all-cause mortality among participants with CKD. Methods: We examined associations between a Flavodiet score (FDS), individual flavonoid-rich foods and subclasses (based on ≥2 24-h dietary assessments) and a) CKD risk among 109,711 adults, and b) all-cause mortality among 3,287 participants with CKD at baseline, aged 40–69 years using multivariable Cox regression analyses. Additionally, we used mediation analysis to examine potential mechanisms of action. Results: Over 10.5 y follow-up, 4,257 cases of incident CKD were identified. A higher FDS, characterized by a median of 6 servings of flavonoid-rich foods per day, was associated with a 16 % lower risk of CKD (HR (95%CI) Q4 vs Q1, P trend = 0.84 (0.77, 0.92), <0.001), in part mediated by levels of triglycerides (2.8 %), high-density lipoprotein (5.9 %), glycated hemoglobin (2.2 %), Cystatin-C (16.6 %), and C-reactive protein (2.1 %). Additionally, we observed significant inverse associations between a range of flavonoid-rich foods (apples, oranges, berries, and red wine) and flavonoid subclasses (anthocyanins, proanthocyanidins, flavonols, flavanones, and flavones) and CKD risk. Among participants with prevalent CKD, a higher FDS (median of 6 servings per day) was associated with a 27 % lower risk of all-cause mortality compared to Q1, although the P for trend did not reach statistical significance (HR (95%CI) Q4 vs Q1, P trend: 0.73 (0.54, 0.97), 0.10). Conclusion: A flavonoid-rich diet consisting of a median of 6 servings per day of commonly consumed flavonoid-rich foods such as apples and berries, was associated with a lower risk of CKD, and a lower risk of all-cause mortality in individuals with CKD in middle-aged adults. Simple dietary change to increase intakes of these commonly consumed food and drink items may lower CKD risk, and improve CKD prognosis.
Document Type
Journal Article
Volume
51
Funding Information
Co–Centre for Sustainable Food Systems (funded by Science Foundation Ireland) / UK Research and Innovation / Department of Agriculture, Environment and Rural Affairs / National Health and Medical Research Council
School
Nutrition and Health Innovation Research Institute / School of Medical and Health Sciences
Grant Number
NHMRC Number : APP1159914
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Publisher
Elsevier
Identifier
Nicola P. Bondonno: https://orcid.org/0000-0001-5905-444X
Comments
Bell, W., Thompson, A. S., Bondonno, N. P., Jennings, A., Gaggl, M., Kühn, T., & Cassidy, A. (2025). A flavonoid-rich diet is associated with a lower risk of chronic kidney disease: A prospective cohort study. Clinical Nutrition, 51, 126-135. https://doi.org/10.1016/j.clnu.2025.05.026