DIETARY polyphenols, naturally occurring bioactive compounds in fruits, vegetables, tea, coffee, and olive oil, have been linked to cardiovascular protection in observational studies. However, most evidence relies on dietary recall, with limited investigation of objective biomarkers. The TwinsUK cohort study aimed to evaluate the association between polyphenol-rich dietary patterns, corresponding urinary metabolites, and longitudinal cardiovascular disease (CVD) risk.
Cohort and Metabolite Analysis
The study included 3,110 participants from the TwinsUK cohort with an average follow-up of 11.2±7.0 years. Dietary intake was assessed using the EPIC-Norfolk Food Frequency Questionnaire to calculate a polyphenol-rich dietary score (PPS-D). In a subset of 200 participants, 114 urinary polyphenol metabolites were quantified using ultra-high-performance liquid chromatography–mass spectrometry (UHPLC-MS), providing an objective measure of polyphenol exposure (PPS-M). Associations between PPS-D/PPS-M and cardiovascular risk scores (atherosclerotic CVD [ASCVD] and HeartScore), blood pressure, and lipid profiles were assessed using linear mixed models, adjusting for relevant covariates and false discovery rate.
Dietary and Metabolomic Associations with CVD
Higher PPS-D scores were inversely associated with ASCVD (stdBeta: −0.05; 95% CI: −0.07, −0.04) and HeartScore (stdBeta: −0.03; 95% CI: −0.04, −0.01; FDR-adjusted p<0.01). In the metabolite subset, elevated urinary flavonoids, phenolic acids, and tyrosols correlated with lower diastolic blood pressure, lower ASCVD and HeartScore, and higher HDL cholesterol. These findings suggest that polyphenol-rich dietary patterns exert measurable cardioprotective effects, detectable both through self-reported intake and metabolite profiling.
Polyphenol-Rich Diet For Cardiovascular Prevention
The study reinforces the role of polyphenols in primary prevention of CVD. Clinicians may consider advising patients to increase consumption of polyphenol-rich foods, such as berries, citrus, tea, olive oil, and nuts, as part of lifestyle interventions to improve cardiovascular outcomes. Urinary metabolite profiling could serve as an objective tool for monitoring polyphenol intake and adherence in future clinical studies.
Reference
Li Y et al. Higher adherence to (poly)phenol-rich diet is associated with lower CVD risk in the TwinsUK cohort. BMC Med. 2025;23(1):645.
