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Consuming a high flavanol diet may lead to lower blood pressure

First study to use objective measure to look at 25,000 people’s diet

Release date: October 21, 2020

Consuming a diet including flavanol-rich foods and drinks, including tea, apples or berries, could lead to lower blood pressure, according to the first study using objective measures of thousands of UK residents’ diet.

The findings, published in Nature Scientific Reports, studied the diet of more than 25,000 people in Norfolk, UK and compared what they ate with their blood pressure. In contrast to most other studies investigating links between nutrition and health, the researchers did not rely on study participants reporting their diet, but instead measured flavanol intake objectively using nutritional biomarkers  – indicators of dietary intake, metabolism or nutritional status that are present in our blood.

The difference in blood pressure between those with the lowest 10% of flavanol intake and those with the highest 10% of intake was between 2 and 4 mmHg. This is comparable to meaningful changes in blood pressure observed in those following a Mediterranean diet or Dietary Approaches to Stop Hypertension (DASH) diet. Notably, the effect was more pronounced in participants with hypertension.

Professor Gunter Kuhnle, a nutritionist at the University of Reading who led the study said: “Previous studies of large populations have always relied on self-reported data to draw conclusions, but this is the first epidemiological study of this scale to objectively investigate the association between a specific bioactive compound and health. We are delighted to see that in our study, there was also a meaningful and significant association between flavanol consumption and lower blood pressure.

“What this study gives us is an objective finding about the association between flavanols – found in tea and some fruits – and blood pressure. This research confirms the results from previous dietary intervention studies and shows that the same results can be achieved with a habitual diet rich in flavanols. In the British diet, the main sources are tea, cocoa, apples and berries.

“The methodology of the study is of equal importance. This is one of the largest ever studies to use nutritional biomarkers to investigate bioactive compounds. Using nutritional biomarkers to estimate intake of bioactive food compounds has long been seen as the gold standard for research, as it allows intake to be measured objectively. The development, validation and application of the biomarker was only possible because of the long-term commitment of all collaborators. In contrast to self-reported dietary data, nutritional biomarkers can address the huge variability in food composition. We can therefore confidently attribute the associations we observed to flavanol intake.”

An international team from the University of Reading, Cambridge University, the University of California Davis, and Mars, Incorporated studied 25,618 participants from the European Prospective Investigation into Cancer (EPIC) Norfolk study and found that the biggest difference was observed in participants with the highest blood pressure. This suggests if the general public increased its flavanol intake, there could be an overall reduction in cardiovascular disease incidence.

Hagen Schroeter, Chief Science Officer at Mars Edge, added: “This study adds key insights to a growing body of evidence supporting the benefits of dietary flavanols in health and nutrition. But, perhaps even more exciting was the opportunity to apply objective biomarkers of flavanol intake at a large scale. This enabled the team to avoid the significant limitations that come with past approaches which rely on estimating intake based on self-reported food consumption data and the shortcomings of current food composition databases.”

The study was supported with an unrestricted grant from Mars, Incorporated, and two co-authors are employees of Mars. The study worked with the EPIC Norfolk population cohort, which acknowledges funding from the Medical Research Council and Cancer Research UK.

Full citation: Ottaviani, J. I. et al. Biomarker-estimated flavan-3-ol intake is associated with lower blood pressure in cross-sectional analysis in EPIC Norfolk. Sci Rep 10, 17964 (2020).


Tim Mayo, University of Reading
+44 (0)118 378 5757

Lucy Kittow, Kekst CNC
+44 (0)203 755 1630

About Reading University

The University of Reading is one of the UK's leading research-intensive universities and is in the top 30 universities in the UK (QS World University Rankings 2020). Our Food research spans all aspects of food and nutrition from farm to fork and beyond. We focus on improving the quality and safety of food and diet to deliver health benefits for society. We offer interdisciplinary research projects within a world-leading environment. With strong international links to industry and other institutions, you be can assured that your PhD will put you at the very centre of the world of food and nutritional sciences.

About Mars Edge

Mars Edge is a new segment of Mars, Incorporated dedicated to human health and wellness through targeted nutrition. It is set up to use the latest science, data and technology to create easy, enjoyable and tailored nutrition solutions. It offers evidence-based products for wider groups of people with shared nutritional and health needs, delivered by brands such as COCOAVIA®, and is creating a business in personalized nutrition with FOODSPRING®. In doing so, Mars Edge is partnering with start-up companies, academia and philanthropic organizations to bring ideas to life. Mars Edge’s purpose is to contribute to better lives through nutrition. For more information, please visit:

About the European Prospective Investigation into Cancer (EPIC) Norfolk study

The EPIC-Norfolk study is one of the two UK contributing cohorts to the European Prospective Investigation into Cancer and Nutrition (EPIC) study, one of the largest cohort studies in the world, with more than half a million (521,000) participants recruited across 10 European countries. The EPIC-Norfolk study is a prospective population-based cohort study which recruited more than 30,000 men and women aged 40-79 years at baseline between 1993 and 1997 from 35 participating general practices in Norfolk. Individuals provided information about lifestyle behavioural factors, and attended a baseline health check including the provision of blood samples for concurrent and future analysis. They provided consent to future linkage to medical record information and a wide range of follow-up studies for different disease endpoints – including incident type 2 diabetes (T2DM) – have subsequently been undertaken. Between 1998 and 2018 participants were re-invited to attend a series of four additional health checks at which baseline measures were repeated and additional measurements were added.