Dietary intakes of anthocyanins and cardiometabolic health: A systematic review and meta-analysis of randomized trials and prospective cohort studies in healthy participants

Avendano, Esther E., Ellingson, Hannah, Digga, Elise, Velasco Nieves, Andrea, Chen, Linfei, Wu, Mengling, Hanumantha Setty, Sowmyashree, Morley, Samantha, Curtis, Peter ORCID: https://orcid.org/0000-0001-5211-047X, Nirmala, Nanguneri and Cassidy, Aedin (2026) Dietary intakes of anthocyanins and cardiometabolic health: A systematic review and meta-analysis of randomized trials and prospective cohort studies in healthy participants. The American Journal of Clinical Nutrition. ISSN 0002-9165 (In Press)

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Abstract

Background: Meta-analyses support anthocyanins cardiometabolic benefits in heterogenous populations (including diseased), but efficacy in individuals who are ‘healthy’ remains unknown. Objective: Across prospective cohorts, and randomized controlled trials (RCTs; ≥50mg/d anthocyanins from food/extract/supplements), we assessed impacts on surrogate cardiometabolic biomarkers and clinical endpoints. Methods: Database searches (PubMed, Cochrane Central, Commonwealth Agricultural Bureau (CAB), Web of Science) identified eligible cohorts and RCTs (1946-Sept 2024), which reported anthocyanin intake (or data, from which anthocyanin intake could be calculated), and cardiovascular disease (CVD) risk or cardiometabolic biomarkers. Random-effects meta-analysis, and GRADE assessment followed. Results: Across 18 cohorts in 27 publications, highest versus lowest habitual anthocyanin intake showed a risk reductions of 26% CVD incidence (4 studies), 18% myocardial infarction (MI, 5 studies), 11% type 2 diabetes, (T2DM, 8 studies), 9% CVD mortality (10 studies), and 8% hypertension risk (6 studies). GRADE identified moderate evidence for CVD/MI. Stroke risk was unaffected. Across 65 RCTs, chronic anthocyanins (≥1 day) improved flow-mediated dilation (FMD) (net change: 1.41%; 95% CI: 0.90, 1.91), acute anthocyanins (≤1 days) improved FMD (1.50%; 1.16, 1.84), and insulin concentrations (-2.24 pmol/L; -4.22, -0.27). GRADE identified strong evidence for acute FMD and moderate for chronic FMD. Lipids, blood pressure, glucose, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) were unaffected. In sub-analysis, by anthocyanin type, cyanidin improved chronic FMD (1.62%; 1.21, 2.04), while delphinidin improved acute FMD (1.69%; 1.20, 2.18), chronic FMD (1.59%; 1.21, 2.04), chronic PWV (-0.33; -0.62, -0.05), insulin (-2.32 pmol/L; -4.39, -0.26) and triglycerides (-0.10 mmol/L; -0.17, -0.03). Conclusions: Higher anthocyanin intake lowers CVD, MI, hypertension and T2DM risk in cohorts, while RCTs show that dietarily achievable anthocyanin intakes (as low as 50mg/d) improve atherosclerosis and metabolic syndrome biomarkers in individuals who are healthy. These findings provide comprehensive unifying evidence which supports the inclusion of anthocyanins within evidence-based nutrition guidelines for CVD prevention.

Item Type:	Article
Uncontrolled Keywords:	anthocyanins,flavonoids,cardiovascular disease,diabetes,flow mediated dilatation,pulse wave velocity,blood pressure,healthy individuals,sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health Faculty of Medicine and Health Sciences > Research Groups > Nutrition and Preventive Medicine
Depositing User:	LivePure Connector
Date Deposited:	24 Jun 2026 15:56
Last Modified:	24 Jun 2026 15:56
URI:	https://ueaeprints.uea.ac.uk/id/eprint/103486
DOI:	10.1016/j.ajcnut.2026.101304

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