Characteristics of dietary bioactives used as model system of dietary compounds to investigate the limitation of using single-point estimates of to assess intake and investigate health outcomes in nutrition research.

Variability in flavan-3-ol, (–)-epicatechin Rothwell et al. (2013) and nitrate Blekkenhorst et al. (2017) content of foods commonly eaten. Data show range of food content (black) and mean (red).

Study population and baseline-characteristics of 18,684 participants of EPIC Norfolk, for whom all data were available.

Data shown are mean (SD) or absolute number and proportion. Data for urinary nitrate was available for 1027 samples.

Intake of different bioactive compounds in EPIC Norfolk (median and IQR) when determined using different food composition data.

Results are shown for estimates calculated using minimum, mean and maximum food content. and self-reported dietary data based on 24h diet recall (24HDR)

Possible intake ranges of flavan-3-ols, (–)-epicatechin and nitrate in each individual study participant displayed from low to high possible bioactive intake level. Range of bioactive intake was calculated using an approach similar to probabilistic modelling by sampling randomly from the distribution of possible food composition (n=10,000 iterations). Intake based on mean bioactive content, as is common practice, is indicated by a red line. Green line shows median intake of the entire cohort and the green box the inter-quartile range.

Simulation of the effect of variability in food composition on relative intakes of flavanols, (–)-epicatechin and nitrate of EPIC Norfolk participants with low (25th centile, p25), medium (median) and high (75th centile, p75) estimated intake of bioactive (based on 24HDR and mean food content – indicated by black line). Data shown are relative intake (100% is maximum intake) of 10,000 simulations

Comparison of biomarker and 24h dietary recall with food-composition data (24HDR – DD-FCT method) estimated quantiles of intake of flavan-3-ols, (–)-epicatechin and nitrate. Bands of the same colour indicate participants in the same biomarker-estimated quantile of intake. 24h dietary recall estimated quantiles of intake were determined the common approach of using mean content of flavan-3-ols, (–)-epicatechin and nitrate in each food item as reported in databases.

Association between estimated bioactive intake (flavan-3-ols, (–)-epicatechin and nitrate, based on 24h dietary recall and food composition data [DR-FCT method]) and systolic blood pressure at baseline (estimated difference between low [p10] and high [p90] intake and p-value for Wald-test (as -log10(p)) in men (purple), women (green) and all participants (red). Data are based on 10,000 simulations and adjusted for age, BMI, plasma vitamin C, smoking status, physical activity and self-reported health at baseline; additionally for menopausal status for women and sex for nitrate. Results based on intake estimated by simulating food content within minimum and maximum food content reported in databases (circle), intake based on mean food content as reported in databases (diamond) and intake based on biomarker data (|). 95% CI is shown for biomarker only.