Reduced mortality risk by a polyphenol-rich diet: An analysis from the Moli-sani study

Abstract Objectives The effect of the polyphenolcontent of the human diet on mortality risk is not yet fully understood. The aim of this study was to evaluate the association of a polyphenol-rich diet with mortality rate and a possible mediation effect by inflammation, in what we believe to be a novel, holistic approach. Methods We analyzed 21 302 participants (10 980 women and 10 322 men, aged ≥35 y) from the Moli-sani cohort. The participants were followed up for a median of 8.3 y. The European Prospective Investigationinto Cancerand Nutrition food frequency questionnaire(FFQ) was used for dietary assessment. Flavonol, flavone, flavanone, flavanol, anthocyanin, isoflavone, and lignanintakes were calculated using European Food Information Resource— Bioactive Substancesin Food Information Systems and the polyphenolantioxidant content (PAC)-score was constructed to assess the total content of these nutrients in the diet. Results Participants included in the highest quintile of intake of various polyphenolclasses and subclasses presented a significant lower all-cause mortality risk compared with those in the lowest group of consumption (hazard ratio [HR]  P  0.05). Cox regression analyses adjusted for potential confounders indicated that participants in higher quintiles of PAC-score had lower all-cause mortality risk (HR P  0.05). When cause-specific mortality rates were considered, similar effects were observed for cardiocerebrovascular and cancer mortality (HR P  0.05). Conclusions The polyphenolcontent of the diet was associated with reduced mortality risk in a Mediterranean population, possibly through an antiinflammatory mechanism.