Abstract
Introduction: Evidence linking flavonoid-rich dietary patterns to the risk of Parkinson's disease (PD) remains limited and inconsistent, and molecular clues to this association remain scarce. This study examined the association between a flavonoid diet score (FDS) and incident hospital-recorded PD and explored related plasma proteomic and cellular expression patterns.</p>
Methods: In this prospective analysis of 123,655 UK Biobank participants, we used multivariable Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between FDS and incident hospital-recorded PD. In an exploratory analysis, we integrated a plasma proteomic screen with publicly available single-cell and single-nucleus transcriptomic data to provide preliminary molecular and cellular context.</p>
Results: During follow-up, 796 incident hospital-recorded PD cases were identified. Higher FDS was associated with a lower risk of incident hospital-recorded PD per 1-standard deviation (SD) increase (HR, 0.93; 95% CI, 0.86-1.00), and the risk was lower in the highest than in the lowest FDS quartile (HR, 0.75; 95% CI, 0.61-0.93). In decomposition analyses, no individual food source or flavonoid subclass remained associated with incident hospital-recorded PD after multiple-testing correction. The inverse association was directionally consistent across most sensitivity analyses and in 1-5-year lag analyses, but the evidence became borderline after adjustment for coffee intake (HR, 0.93; 95% CI, 0.86-1.00) and was no longer statistically supported in 6-10-year lag analyses. In exploratory omics analyses, the proteomic screen prioritized a direction-compatible signature comprising 24 proteins, including proteins related to immune and adhesion processes, while single-cell and single-nucleus transcriptomic data provided peripheral immune and glial-vascular cellular context.</p>
Discussion: In this prospective cohort, higher FDS was modestly associated with a lower incidence of hospital-recorded PD. Residual confounding and reverse causation remain possible, and the proteomic and transcriptomic findings should be considered hypothesis-generating.</p>