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Plant food consumption and flavonoid intake in relation to cardiometabolic health William Henry Bell (24304451) PUREID: 661489732 Flavonoids Flavodiet Score Liver Chronic kidney disease Cox Regression Prospective Cohort Mediation NAFLD non-alcoholic fatty liver disease MASLD Metabolic dysfunction-associated steatotic liver disease Gut Microbiome Inflammation Body Composition Weight Kidney Muscle Epidemiology Nutritional Epidemiology Diet Research Gap Although higher flavonoid intakes are linked to lower risks of cardiovascular disease and diabetes, few studies have examined their role in other cardiometabolic conditions such as liver and kidney disease, or in related factors like body composition. Methods Flavonoid intake was assessed at three levels: (1) dietary quality, using an additive flavodiet score (FDS), (2) food level, and (3) flavonoid subclass level. Included analyses were based on data from the UK Biobank and the German Population-Based Recruitment for Genetics Research (PopGen) cohort. Four empirical studies addressed the research gap outlined above: 1.A large prospective cohort study on flavonoid intake and non-alcoholic fatty liver disease (NAFLD) in the UK Biobank. 2.A cross-sectional study in PopGen examining potential mediation via the gut microbiome. 3.A prospective cohort study on flavonoid intake, chronic kidney disease (CKD), and mortality in participants with CKD in the UK Biobank. 4.A prospective study on flavonoid intake, bodyweight, and body composition in the UK Biobank. Results In large scale prospective studies in the UK Biobank, a higher FDS was associated with lower cardiometabolic disease risk including a lower risk of NAFLD, CKD, and a lower mortality among those with CKD. The PopGen study supported these findings in relation to NAFLD, also suggesting possible mediation by the gut microbiome. Mediation analyses further indicated that associations between FDS and CKD risk may be mediated through impacts on renal function, inflammation, and lipid and glucose metabolism. Apples, tea, oranges, and berries, rich in proanthocyanidins, flavan-3-ols, flavanones, and anthocyanins emerged as key contributors to these associations. Conclusion Flavonoid-rich diets were linked to lower risks of cardiometbolic diseases including NAFLD and CKD, highlighting their potential utility in cardiometabolic disease prevention and supporting the need for future intervention studies. Thesis is embargoed until 31 July 2028. 2026-10-01T16:10:12Z Text Thesis 10.17034/32826185.v1 https://figshare.com/articles/thesis/Plant_food_consumption_and_flavonoid_intake_in_relation_to_cardiometabolic_health/32826185 All Rights Reserved Open Access after 2028-07-31