Dietary flavan-3-ols intake and metabolic syndrome risk in Korean adults

  • Yang, Yoon-Jung ;
  • Kim, You-Jin ;
  • Yang, Yoon-Kyoung ;
  • Kim, Ji-Yeon ;
  • Kwon, O-Ran
  • Received : 2011.08.11
  • Accepted : 2012.01.03
  • Published : 2012.02.29


Flavan-3-ols are a subclass of flavonoids found in a variety of foods including teas. The effects of flavan-3-ols on the risk of metabolic syndrome (MetS) have been investigated, generally focusing on tea catechins or individual flavan-3-ol rich foods, but there is little information on dietary flavan-3-ols intake and risk of MetS in population-based studies. In this cross-sectional study, we examined the association between dietary flavan-3-ols intake and the risk of MetS in Korean adults. Subjects comprised 1,827 men and 2,918 women aged 20-69 years whose data was included in the 2008 Korean National Health and Nutrition Examination Survey. This survey was conducted between January 2008 and December 2008. Total flavan-3-ols intakes were calculated from 24-hour dietary recalls using a flavonoids database. Thirty percent of the male subjects and 24% of the female subjects were reported as having MetS. In the female subjects, flavan3-ols intake was inversely associated with the risk of MetS after adjusting for potential confounders (5th vs. 1st quintile, OR=0.64, 95% CI=0.45-0.91, P for trend=0.384). The main food source of flavan-3-ols was green tea followed by apples and grapes. Among MetS components, flavan-3-ols intake was inversely associated with the risk of high blood pressure after adjusting for potential confounders (5th vs. 1st quintile, OR=0.64, 95% CI=0.45-0.90, P for trend=0.005). No significant association between flavan-3-ols intake and risk of MetS was found in the male subjects. After stratified analysis by obesity (BMI ${\geq}$ 25 or BMI < 25), however, flavan3-ols intake was inversely related to the risk of hypertension in non-obese men. These results suggest that dietary flavan-3-ols intake may have beneficial effects on MetS risk by reducing the risk of hypertension. The effects of flavan-3-ols intake dependent on obesity need further investigation.


Flavan-3-ols;metabolic syndrome;flavonoids;hypertension;hyperglycaemia


  1. Kalgaonkar S, Nishioka H, Gross HB, Fujii H, Keen CL, Hackman RM. Bioactivity of a flavanol-rich lychee fruit extract in adipocytes and its effects on oxidant defense and indices of metabolic syndrome in animal models. Phytother Res 2010;24: 1223-8.
  2. National Institute of Health and Nutrition in Japan [Internet]. Functional Food Factor. [cited 2008 January 20]. Available from:
  3. National Academy of Agricultural Science. Tables of Food Functional Composition. Suwon: National Academy of Agricultural Science; 2009.
  4. Johannot L, Somerset SM. Age-related variations in flavonoid intake and sources in the Australian population. Public Health Nutr 2006;9:1045-54.
  5. Zamora-Ros R, Andres-Lacueva C, Lamuela-Raventos RM, Berenguer T, Jakszyn P, Barricarte A, Ardanaz E, Amiano P, Dorronsoro M, Larranaga N, Martínez C, Sanchez MJ, Navarro C, Chirlaque MD, Tormo MJ, Quiros JR, Gonzalez CA. Estimation of dietary sources and flavonoid intake in a Spanish adult population (EPIC-Spain). J Am Diet Assoc 2010;110:390-8.
  6. Chun OK, Chung SJ, Song WO. Estimated dietary flavonoid intake and major food sources of U.S. adults. J Nutr 2007;137: 1244-52.
  7. Kim W, Jeong MH, Cho SH, Yun JH, Chae HJ, Ahn YK, Lee MC, Cheng X, Kondo T, Murohara T, Kang JC. Effect of green tea consumption on endothelial function and circulating endothelial progenitor cells in chronic smokers. Circ J 2006;70:1052-7.
  8. Tinahones FJ, Rubio MA, Garrido-Sánchez L, Ruiz C, Gordillo E, Cabrerizo L, Cardona F. Green tea reduces LDL oxidability and improves vascular function. J Am Coll Nutr 2008;27:209-13.
  9. Antonello M, Montemurro D, Bolognesi M, Di Pascoli M, Piva A, Grego F, Sticchi D, Giuliani L, Garbisa S, Rossi GP. Prevention of hypertension, cardiovascular damage and endothelial dysfunction with green tea extracts. Am J Hypertens 2007;20: 1321-8.
  10. Potenza MA, Marasciulo FL, Tarquinio M, Tiravanti E, Colantuono G, Federici A, Kim JA, Quon MJ, Montagnani M. EGCG, a green tea polyphenol, improves endothelial function and insulin sensitivity, reduces blood pressure, and protects against myocardial I/R injury in SHR. Am J Physiol Endocrinol Metab 2007;292:E1378-87.
  11. Miura Y, Chiba T, Tomita I, Koizumi H, Miura S, Umegaki K, Hara Y, Ikeda M, Tomita T. Tea catechins prevent the development of atherosclerosis in apoprotein E-deficient mice. J Nutr 2001;131:27-32.
  12. Lorenz M, Wessler S, Follmann E, Michaelis W, Düsterhöft T, Baumann G, Stangl K, Stangl V. A constituent of green tea, epigallocatechin-3-gallate, activates endothelial nitric oxide synthase by a phosphatidylinositol-3-OH-kinase-, cAMP-dependent protein kinase-, and Akt-dependent pathway and leads to endothelial-dependent vasorelaxation. J Biol Chem 2004;279: 6190-5.
  13. Schewe T, Steffen Y, Sies H. How do dietary flavanols improve vascular function? A position paper. Arch Biochem Biophys 2008;476:102-6.
  14. Anderson RA, Polansky MM. Tea enhances insulin activity. J Agric Food Chem 2002;50:7182-6.
  15. Mizugaki M, Ishizawa F, Yamazaki T, Hishinuma T. Epigallocatechin gallate increase the prostacyclin production of bovine aortic endothelial cells. Prostaglandins Other Lipid Mediat 2000; 62:157-64.
  16. Ikeda I, Tsuda K, Suzuki Y, Kobayashi M, Unno T, Tomoyori H, Goto H, Kawata Y, Imaizumi K, Nozawa A, Kakuda T. Tea catechins with a galloyl moiety suppress postprandial hypertriacylglycerolemia by delaying lymphatic transport of dietary fat in rats. J Nutr 2005;135:155-9.
  17. Ikeda I, Hamamoto R, Uzu K, Imaizumi K, Nagao K, Yanagita T, Suzuki Y, Kobayashi M, Kakuda T. Dietary gallate esters of tea catechins reduce deposition of visceral fat, hepatic triacylglycerol, and activities of hepatic enzymes related to fatty acid synthesis in rats. Biosci Biotechnol Biochem 2005;69:1049-53.
  18. Imai K, Nakachi K. Cross sectional study of effects of drinking green tea on cardiovascular and liver diseases. BMJ 1995;310: 693-6.
  19. Sano J, Inami S, Seimiya K, Ohba T, Sakai S, Takano T, Mizuno K. Effects of green tea intake on the development of coronary artery disease. Circ J 2004;68:665-70.
  20. Kuriyama S, Shimazu T, Ohmori K, Kikuchi N, Nakaya N, Nishino Y, Tsubono Y, Tsuji I. Green tea consumption and mortality due to cardiovascular disease, cancer, and all causes in Japan: the Ohsaki study. JAMA 2006;296:1255-65.
  21. Høstmark AT. The Oslo Health Study: a Dietary Index estimating high intake of soft drinks and low intake of fruits and vegetables was positively associated with components of the metabolic syndrome. Appl Physiol Nutr Metab 2010;35:816-25.
  22. Miura K, Greenland P, Stamler J, Liu K, Daviglus ML, Nakagawa H. Relation of vegetable, fruit, and meat intake to 7-year blood pressure change in middle-aged men: the Chicago Western Electric Study. Am J Epidemiol 2004;159:572-80.
  23. Andrade AC, Cesena FH, Consolim-Colombo FM, Coimbra SR, Benjo AM, Krieger EM, Luz PL. Short-term red wine consumption promotes differential effects on plasma levels of high-density lipoprotein cholesterol, sympathetic activity, and endothelial function in hypercholesterolemic, hypertensive, and healthy subjects. Clinics (Sao Paulo) 2009;64:435-42.
  24. Grassi D, Mulder TP, Draijer R, Desideri G, Molhuizen HO, Ferri C. Black tea consumption dose-dependently improves flowmediated dilation in healthy males. J Hypertens 2009;27:774-81.
  25. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; American Heart Association; National Heart, Lung, and Blood Institute. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433-8.
  26. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, Kim DY, Kwon HS, Kim SR, Lee CB, Oh SJ, Park CY, Yoo HJ. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract 2007;75:72-80.
  27. Beltsville Human Nutrition Research Center, U.S. Department of Agriculture, Agricultural Research Service [Internet]. USDA Database for the Flavonoid Content of Selected Foods. [cited 2007 January 31]. Available from: UserFiles/Place/12354500/Data/Flav/Flav02-1.pdf.
  28. Williamson G, Manach C. Bioavailability and bioefficacy of polyphenols in humans. II. Review of 93 intervention studies. Am J Clin Nutr 2005;81:243S-255S.
  29. Manach C, Williamson G, Morand C, Scalbert A, Remesy C. Bioavailability and bioefficacy of polyphenols in humans. I. Review of 97 bioavailability studies. Am J Clin Nutr 2005;81: 230S-242S.
  30. Yao LH, Jiang YM, Shi J, Tomas-Barberan FA, Datta N, Singanusong R, Chen SS. Flavonoids in food and their health benefits. Plant Foods Hum Nutr 2004;59:113-22.
  31. Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Bonadonna RC, Muggeo M; Bruneck Study. Metabolic syndrome: epidemiology and more extensive phenotypic description. Crosssectional data from the Bruneck Study. Int J Obes Relat Metab Disord 2003;27:1283-9.
  32. Wilson PW, D'Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation 2005;112:3066-72.
  33. Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 2005;28:1769-78.
  34. Sahyoun NR, Jacques PF, Zhang XL, Juan W, McKeown NM. Whole-grain intake is inversely associated with the metabolic syndrome and mortality in older adults. Am J Clin Nutr 2006; 83:124-31.
  35. Liu S, Song Y, Ford ES, Manson JE, Buring JE, Ridker PM. Dietary calcium, vitamin D, and the prevalence of metabolic syndrome in middle-aged and older U.S. women. Diabetes Care 2005;28:2926-32.
  36. Kim JA, Kim SM, Lee JS, Oh HJ, Han JH, Song Y, Joung H, Park HS. Dietary patterns and the metabolic syndrome in Korean adolescents: 2001 Korean National Health and Nutrition Survey. Diabetes Care 2007;30:1904-5.
  37. Kobayashi M, Unno T, Suzuki Y, Nozawa A, Sagesaka Y, Kakuda T, Ikeda I. Heat-epimerized tea catechins have the same cholesterol-lowering activity as green tea catechins in cholesterolfed rats. Biosci Biotechnol Biochem 2005;69:2455-8.

Cited by

  1. Cardioprotective effects of tea and its catechins vol.05, pp.04, 2013,
  2. Relationship between Dietary Magnesium, Manganese, and Copper and Metabolic Syndrome Risk in Korean Adults: The Korea National Health and Nutrition Examination Survey (2007–2008) vol.156, pp.1-3, 2013,
  3. Dietary Flavonoids and Gastric Cancer Risk in a Korean Population vol.6, pp.11, 2014,
  4. Flavan-3-ols, anthocyanins, and inflammation vol.66, pp.11, 2014,
  5. Association between dietary flavanones intake and lipid profiles according to the presence of metabolic syndrome in Korean women with type 2 diabetes mellitus vol.10, pp.1, 2016,
  6. Estimation of dietary flavonoid intake and major food sources of Korean adults vol.115, pp.03, 2016,
  7. Hop Phytochemicals and Their Potential Role in Metabolic Syndrome Prevention and Therapy vol.22, pp.10, 2017,
  8. Dietary Flavonoid Intake Is Inversely Associated with Cardiovascular Disease Risk as Assessed by Body Mass Index and Waist Circumference among Adults in the United States vol.9, pp.8, 2017,
  9. Relationship between flavonoids intake and metabolic syndrome in Korean women with polycystic ovary syndrome vol.47, pp.3, 2014,
  10. Estimated dietary flavonoids intake of Korean adolescent: Based on the Korea National Health and Nutrition Examination Survey 2007~2012 vol.48, pp.6, 2015,


Supported by : Ewha Womans University