Association between dietary flavonoid intake and anxiety: data from NHANES 2017–2018

Abstract Background Anxiety disorders are among the most prevalent mental health conditions, characterized by excessive fear, tension, avoidance behaviors, and heightened threat perception. Approximately 1 in 14 individuals meets the diagnostic criteria for an anxiety disorder. Flavonoids, bioactive...

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Main Authors: Liuyin Jin, Linman Wu, Guidong Zhu, Lijuan Yang, Dan Zhao, Jue He, Yan Zhang
Format: Article
Language:English
Published: BMC 2025-04-01
Series:BMC Public Health
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Online Access:https://doi.org/10.1186/s12889-025-22621-7
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author Liuyin Jin
Linman Wu
Guidong Zhu
Lijuan Yang
Dan Zhao
Jue He
Yan Zhang
author_facet Liuyin Jin
Linman Wu
Guidong Zhu
Lijuan Yang
Dan Zhao
Jue He
Yan Zhang
author_sort Liuyin Jin
collection DOAJ
description Abstract Background Anxiety disorders are among the most prevalent mental health conditions, characterized by excessive fear, tension, avoidance behaviors, and heightened threat perception. Approximately 1 in 14 individuals meets the diagnostic criteria for an anxiety disorder. Flavonoids, bioactive compounds found in fruits, vegetables, and tea, possess antioxidant, anti-inflammatory, and neuroprotective properties. However, evidence on the relationship between flavonoid intake and anxiety risk remains limited. This study examines the association between flavonoid intake and anxiety risk and explores the effects of specific flavonoid subclasses. Methods This study utilized data from the National Health and Nutrition Examination Survey (NHANES). Individual flavonoid intake was assessed using two-day 24-hour dietary recalls, and anxiety status was evaluated through a standardized anxiety questionnaire. To assess the relationship between flavonoid intake and anxiety risk, weighted logistic regression analysis was performed. Additionally, restricted cubic spline (RCS) analysis was employed to evaluate potential nonlinear associations. We conducted subgroup analyses for flavonoids that showed significant associations in the logistic regression, including theaflavin-3-gallate, total flavones, total flavanones, total isoflavones, and naringenin. These analyses aimed to explore the moderating effects of demographic characteristics such as sex, age, marital status, smoking status, and body mass index (BMI). Results We analyzed data from 1,637 participants in the NHANES. Significant differences were observed between the anxious and non-anxious groups in age, poverty-income ratio (PIR), BMI, smoking status, marital status, education level, and flavonoid intake. The anxious group had higher age (47.12 vs. 42.81 years, P < 0.0001), PIR (P < 0.0001), and BMI (P = 0.01). They also had a higher proportion of females, unmarried individuals, and current smokers (P < 0.0001). Logistic regression analysis showed that genistein, petunidin, naringenin, apigenin, and total flavones were significantly associated with reduced anxiety risk (P < 0.05). Subgroup analysis confirmed protective effects in males, married individuals, participants with General Educational Development (GED)-level education, and specific ethnic groups. RCS analysis suggested nonlinear relationships, with total flavones, total flavanones, and naringenin showing protective effects at low intake levels (P < 0.05). All models demonstrated good fit (P < 0.001). Conclusion Flavonoid intake is inversely associated with anxiety risk, particularly Theaflavin-3-gallate, Total Flavones, Total Flavanones, Total Isoflavones, and Naringenin. Further studies are needed to confirm optimal intake levels and underlying mechanisms.
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spelling doaj-art-91744dfead574c31acea69e56940a0cf2025-08-20T02:30:27ZengBMCBMC Public Health1471-24582025-04-0125111710.1186/s12889-025-22621-7Association between dietary flavonoid intake and anxiety: data from NHANES 2017–2018Liuyin Jin0Linman Wu1Guidong Zhu2Lijuan Yang3Dan Zhao4Jue He5Yan Zhang6Lishui Second People’s HospitalNanchong Mental Health Center of Sichuan ProvinceLishui Second People’s HospitalNanchong Mental Health Center of Sichuan ProvinceNanchong Mental Health Center of Sichuan ProvinceSchool of Mental Health and the Affiliated Kangning Hospital, Wenzhou Key Laboratory for Basic and Translational Research in Mental Health, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou Medical UniversityLishui Second People’s HospitalAbstract Background Anxiety disorders are among the most prevalent mental health conditions, characterized by excessive fear, tension, avoidance behaviors, and heightened threat perception. Approximately 1 in 14 individuals meets the diagnostic criteria for an anxiety disorder. Flavonoids, bioactive compounds found in fruits, vegetables, and tea, possess antioxidant, anti-inflammatory, and neuroprotective properties. However, evidence on the relationship between flavonoid intake and anxiety risk remains limited. This study examines the association between flavonoid intake and anxiety risk and explores the effects of specific flavonoid subclasses. Methods This study utilized data from the National Health and Nutrition Examination Survey (NHANES). Individual flavonoid intake was assessed using two-day 24-hour dietary recalls, and anxiety status was evaluated through a standardized anxiety questionnaire. To assess the relationship between flavonoid intake and anxiety risk, weighted logistic regression analysis was performed. Additionally, restricted cubic spline (RCS) analysis was employed to evaluate potential nonlinear associations. We conducted subgroup analyses for flavonoids that showed significant associations in the logistic regression, including theaflavin-3-gallate, total flavones, total flavanones, total isoflavones, and naringenin. These analyses aimed to explore the moderating effects of demographic characteristics such as sex, age, marital status, smoking status, and body mass index (BMI). Results We analyzed data from 1,637 participants in the NHANES. Significant differences were observed between the anxious and non-anxious groups in age, poverty-income ratio (PIR), BMI, smoking status, marital status, education level, and flavonoid intake. The anxious group had higher age (47.12 vs. 42.81 years, P < 0.0001), PIR (P < 0.0001), and BMI (P = 0.01). They also had a higher proportion of females, unmarried individuals, and current smokers (P < 0.0001). Logistic regression analysis showed that genistein, petunidin, naringenin, apigenin, and total flavones were significantly associated with reduced anxiety risk (P < 0.05). Subgroup analysis confirmed protective effects in males, married individuals, participants with General Educational Development (GED)-level education, and specific ethnic groups. RCS analysis suggested nonlinear relationships, with total flavones, total flavanones, and naringenin showing protective effects at low intake levels (P < 0.05). All models demonstrated good fit (P < 0.001). Conclusion Flavonoid intake is inversely associated with anxiety risk, particularly Theaflavin-3-gallate, Total Flavones, Total Flavanones, Total Isoflavones, and Naringenin. Further studies are needed to confirm optimal intake levels and underlying mechanisms.https://doi.org/10.1186/s12889-025-22621-7FlavonoidsAnxietyNaringeninCross-sectional studyRestricted cubic spline (RCS) analysis
spellingShingle Liuyin Jin
Linman Wu
Guidong Zhu
Lijuan Yang
Dan Zhao
Jue He
Yan Zhang
Association between dietary flavonoid intake and anxiety: data from NHANES 2017–2018
BMC Public Health
Flavonoids
Anxiety
Naringenin
Cross-sectional study
Restricted cubic spline (RCS) analysis
title Association between dietary flavonoid intake and anxiety: data from NHANES 2017–2018
title_full Association between dietary flavonoid intake and anxiety: data from NHANES 2017–2018
title_fullStr Association between dietary flavonoid intake and anxiety: data from NHANES 2017–2018
title_full_unstemmed Association between dietary flavonoid intake and anxiety: data from NHANES 2017–2018
title_short Association between dietary flavonoid intake and anxiety: data from NHANES 2017–2018
title_sort association between dietary flavonoid intake and anxiety data from nhanes 2017 2018
topic Flavonoids
Anxiety
Naringenin
Cross-sectional study
Restricted cubic spline (RCS) analysis
url https://doi.org/10.1186/s12889-025-22621-7
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