Low Flavonoid Intake Is Associated With Bilateral Hearing Impairment In U.S. Older Adults

Abstract

This study investigated the association between dietary flavonoid intake and hearing impairment in older adults aged ≥70 years, using cross-sectional data from NHANES 2009–2010 and 2017–2018. Flavonoid intake was estimated from two 24-hour dietary recalls and categorized as low or high based on the median intake (85.4 mg/day). Hearing impairment was defined using pure-tone average (PTA) >25 dB in one or both ears. Among the 1,492 participants, 55.7% had bilateral hearing impairment, 15.6% had unilateral hearing impairment, and 28.7% had normal hearing. These categories were mutually exclusive, based on the presence of hearing impairment in one or both ears. After adjusting for sociodemographic, behavioral, and dietary covariates, low flavonoid intake was associated with a 45% greater odds of bilateral hearing impairment (adjusted odds ratio = 1.45; 95% confidence interval: 1.03–2.04; p = 0.034), but not associated with unilateral impairment. Marginal associations were also observed for specific flavonoid subclasses, including flavan-3-ols and catechins. A significant interaction with age was observed, with the positive association between higher flavonoid intake and severe hearing loss evident only in adults aged 70–75 years. These findings suggest that low flavonoid intake may be a modifiable dietary factor associated with age-related bilateral hearing loss. Increasing dietary flavonoid consumption may be associated with benefits for sensory health and could play a modest role in reducing the risk of hearing impairment in older adults, though further research is needed to confirm these findings.