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Dietary flavonoid intake and weight maintenance: three prospective cohorts of 124 086 US men and women followed for up to 24 years

BMJ 2016; 352 doi: (Published 28 January 2016) Cite this as: BMJ 2016;352:i17
  1. Monica L Bertoia, research associate1 2,
  2. Eric B Rimm, professor of nutrition and epidemiology1 2 3,
  3. Kenneth J Mukamal, associate professor of medicine1 4,
  4. Frank B Hu, professor of nutrition and epidemiology1 2 3,
  5. Walter C Willett, professor of nutrition and epidemiology1 2 3,
  6. Aedín Cassidy, professor of nutrition5
  1. 1Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
  2. 2Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston
  3. 3Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston
  4. 4Department of Medicine, Beth Israel Deaconess Medical Center, Boston
  5. 5Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
  1. Correspondence to: M L Bertoia mbertoia{at}
  • Accepted 11 December 2015


Objective To examine whether dietary intake of specific flavonoid subclasses (including flavonols, flavones, flavanones, flavan-3-ols, anthocyanins, and flavonoid polymers) is associated with weight change over time.

Design Three prospective cohort studies.

Setting Health professionals in the United States.

Participants 124 086 men and women participating in the Health Professionals Follow-up Study (HPFS), Nurses’ Health Study (NHS), and Nurses’ Health Study II (NHS II).

Main outcome measure Self reported change in weight over multiple four year time intervals between 1986 and 2011.

Results Increased consumption of most flavonoid subclasses, including flavonols, flavan-3-ols, anthocyanins, and flavonoid polymers, was inversely associated with weight change over four year time intervals, after adjustment for simultaneous changes in other lifestyle factors including other aspects of diet, smoking status, and physical activity. In the pooled results, the greatest magnitude of association was observed for anthocyanins (−0.23 (95% confidence interval −0.30 to −0.15) lbs per additional standard deviation/day, 10 mg), flavonoid polymers (−0.18 (−0.28 to −0.08) lbs per additional SD/day, 138 mg), and flavonols (−0.16 (−0.26 to −0.06) lbs per additional SD/day, 7 mg). After additional adjustment for fiber intake, associations remained significant for anthocyanins, proanthocyanidins, and total flavonoid polymers but were attenuated and no longer statistically significant for other subclasses.

Conclusions Higher intake of foods rich in flavonols, flavan-3-ols, anthocyanins, and flavonoid polymers may contribute to weight maintenance in adulthood and may help to refine dietary recommendations for the prevention of obesity and its potential consequences.


  • We acknowledge the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School. We thank the participants of the Nurses’ Health and Health Professionals Follow-up Studies for their ongoing dedication.

  • Contributors: MLB, EBR, and AC conceived and designed the experiments. MLB, WCW, FBH, EBR, and AC conducted the experiments. MLB analyzed the data and wrote the first draft of the manuscript. KJM, WCW, FBH, EBR, and AC contributed to the writing of the manuscript. All authors agree with the manuscript’s results and conclusions. MLB is the guarantor.

  • Funding: This study was supported by grants P01 CA87969, R01 CA49449, R01 HL034594, R01 HL088521, UM1 CA176726, R01 CA67262, UM1 CA167552, R01 HL35464, and UM1 CA186107 from the National Institutes of Health; the Biotechnology, Biological Sciences Research Council (BBSRC), UK (reference BB/J004545/1); and the project “Diet and prevention of ischemic heart disease: a translational approach” (DIPI,, which is supported by the Danish Council for Strategic Research (today, Innovation Fund Denmark) (contract 0603-00488B). AC is a Royal Society Wolfson Research Merit Award holder. The funders played no role in the study design, data collection, analysis and interpretation of data, writing of the manuscript, or the decision to submit the article for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: support for the study as described above; ERB and AC have a collaborative grant, unrelated to this project, to conduct observational and experimental studies of blueberries and cardiovascular disease health outcomes from the US Highbush Blueberry Council; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study protocol was approved by the Institutional Review Board of the Brigham and Women's Hospital and by the Harvard T.H. Chan School of Public Health Human Subjects Committee Review Board (ID 2008POOO327). All participants provided voluntary responses to mailed questionnaires that served as informed consent.

  • Transparency declaration: The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Data sharing: Health Professionals Follow-up Study, Nurses’ Health Study, and Nurses’ Health Study II data may be used in collaboration with a principal investigator. Please see the study websites for more information: and

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