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Pushpass RAG, Alzoufairi S, Mancini A, Quilter K, Fava F, Delaiti S, Vrhovsek U, Christensen C, Joyce SA, Tuohy KM, Jackson KG, Lovegrove JA. Chronic consumption of probiotics, oats, and apples has differential effects on postprandial bile acid profile and cardiometabolic disease risk markers compared with an isocaloric control (cornflakes): a randomized trial. Am J Clin Nutr 2023; 117:252-265. [PMID: 36811563 DOI: 10.1016/j.ajcnut.2022.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/11/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Dietary components that impact the gut microbiota may beneficially affect cardiometabolic health, possibly by altered bile acid metabolism. However, impacts of these foods on postprandial bile acids, gut microbiota, and cardiometabolic risk markers are unclear. OBJECTIVES The aim of this study was to determine the chronic effects of probiotics, oats, and apples on postprandial bile acids, gut microbiota, and cardiometabolic health biomarkers. METHODS Using an acute within chronic parallel design, 61 volunteers (mean ± SD: age 52 ± 12 y; BMI 24.8 ± 3.4 kg/m2) were randomly assigned to consume 40 g cornflakes (control), 40 g oats or 2 Renetta Canada apples each with 2 placebo capsules per day or 40 g cornflakes with 2 Lactobacillus reuteri capsules (>5 × 109 CFU) per day, for 8 wk. Fasting and postprandial serum/plasma bile acids and cardiometabolic health biomarkers, fecal bile acids, and gut microbiota composition were determined. RESULTS At week 0, oats and apples significantly decreased postprandial serum insulin [area under the curve (AUC): 25.6 (17.4, 33.8) and 23.4 (15.4, 31.4) vs. 42.0 (33.7, 50.2) pmol/L × min and incremental AUC (iAUC): 17.8 (11.6, 24.0) and 13.7 (7.7, 19.8) vs. 29.6 (23.3, 35.8) pmol/L × min] and C-peptide responses [AUC: 599 (514, 684) and 550 (467, 632) vs. 750 (665, 835) ng/mL × min], whereas non-esterified fatty acids were increased [AUC 135 (117, 153) vs. 86.3 (67.9, 105) and iAUC 96.2 (78.8, 114) vs. 60 (42.1, 77.9) mmol/L × min] after the apples vs. control (P ≤ 0.05). Postprandial unconjugated [AUC: predicted means (95% CI) 1469 (1101, 1837) vs. 363 (-28, 754) μmol/L × min and iAUC: 923 (682, 1165) vs. 22.0 (-235, 279) μmol/L × min)] and hydrophobic [iAUC: 1210 (911, 1510) vs. 487 (168, 806) μmol/L × min] bile acid responses were increased after 8 wk probiotic intervention vs. control (P ≤ 0.049). None of the interventions modulated the gut microbiota. CONCLUSIONS These results support beneficial effects of apples and oats on postprandial glycemia and the ability of the probiotic Lactobacillus reuteri to modulate postprandial plasma bile acid profiles compared with control (cornflakes), with no relationship evident between circulating bile acids and cardiometabolic health biomarkers.
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Affiliation(s)
- Rose-Anna Grace Pushpass
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, Institute for Food, Nutrition and Health, and Institute for Cardiovascular and Metabolic Research, University of Reading, Harry Nursten Building, Reading, UK
| | - Shouq Alzoufairi
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, Institute for Food, Nutrition and Health, and Institute for Cardiovascular and Metabolic Research, University of Reading, Harry Nursten Building, Reading, UK
| | - Andrea Mancini
- Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Karena Quilter
- School of Biochemistry and Cell Biology, Biosciences Institute, University College Cork, Ireland; APC Microbiome Ireland, University College Cork, Ireland
| | - Francesca Fava
- Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Simone Delaiti
- Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Urska Vrhovsek
- Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Camilla Christensen
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, Institute for Food, Nutrition and Health, and Institute for Cardiovascular and Metabolic Research, University of Reading, Harry Nursten Building, Reading, UK
| | - Susan A Joyce
- School of Biochemistry and Cell Biology, Biosciences Institute, University College Cork, Ireland; APC Microbiome Ireland, University College Cork, Ireland
| | - Kieran M Tuohy
- Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Kim G Jackson
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, Institute for Food, Nutrition and Health, and Institute for Cardiovascular and Metabolic Research, University of Reading, Harry Nursten Building, Reading, UK
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, Institute for Food, Nutrition and Health, and Institute for Cardiovascular and Metabolic Research, University of Reading, Harry Nursten Building, Reading, UK.
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2
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Zarifi SH, Bagherniya M, Banach M, Johnston TP, Sahebkar A. Phytochemicals: A potential therapeutic intervention for the prevention and treatment of cachexia. Clin Nutr 2022; 41:2843-2857. [PMID: 36403384 DOI: 10.1016/j.clnu.2022.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 09/26/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
Cachexia, a multifactorial and often irreversible wasting syndrome, is often associated with the final phase of several chronic disorders. Although cachexia is characterized by skeletal muscle wasting and adipose tissue loss, it is a syndrome affecting different organs, which ultimately results in systemic complications and impaired quality of life. The pathogenesis and underlying molecular mechanisms of cachexia are not fully understood, and currently there are no effective standard treatments or approved drug therapies to completely reverse cachexia. Moreover, adequate nutritional interventions alone cannot significantly improve cachexia. Other approaches to ameliorate cachexia are urgently needed, and thus, the role of medicinal plants has received considerable importance in this respect due to their beneficial health properties. Increasing evidence indicates great potential of medicinal plants and their phytochemicals as an alternative and promising treatment strategy to reduce the symptoms of many diseases including cachexia. This article reviews the current status of cachexia, the molecular mechanisms of primary events driving cachexia, and state-of-the-art knowledge that reports the preventive and therapeutic activities of multiple families of phytochemical compounds and their pharmacological mode of action, which may hold promise as an alternative treatment modality for the management of cachexia. Based on our review of various in vitro and in vivo models of cachexia, we would conclude that phytochemicals may have therapeutic potential to attenuate cachexia, although clinical trials are required to unequivocally confirm this premise.
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Affiliation(s)
- Sudiyeh Hejri Zarifi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Bagherniya
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
| | - Thomas P Johnston
- Division of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; School of Medicine, The University of Western Australia, Perth, Australia; Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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3
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Phenol metabolic fingerprint and selection of intake biomarkers after acute and sustained consumption of red-fleshed apple versus common apple in humans. The AppleCOR study. Food Chem 2022; 384:132612. [DOI: 10.1016/j.foodchem.2022.132612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/26/2022] [Accepted: 02/28/2022] [Indexed: 01/30/2023]
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4
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Pang L, Jiang X, Lian X, Chen J, Song EF, Jin LG, Xia ZY, Ma HC, Cai Y. Caloric restriction-mimetics for the reduction of heart failure risk in aging heart: with consideration of gender-related differences. Mil Med Res 2022; 9:33. [PMID: 35786219 PMCID: PMC9252041 DOI: 10.1186/s40779-022-00389-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
The literature is full of claims regarding the consumption of polyphenol or polyamine-rich foods that offer some protection from developing cardiovascular disease (CVD). This is achieved by preventing cardiac hypertrophy and protecting blood vessels through improving the function of endothelium. However, do these interventions work in the aged human hearts? Cardiac aging is accompanied by an increase in left ventricular hypertrophy, along with diastolic and systolic dysfunction. It also confers significant cardiovascular risks for both sexes. The incidence and prevalence of CVD increase sharply at an earlier age in men than women. Furthermore, the patterns of heart failure differ between sexes, as do the lifetime risk factors. Do caloric restriction (CR)-mimetics, rich in polyphenol or polyamine, delay or reverse cardiac aging equally in both men and women? This review will discuss three areas: (1) mechanisms underlying age-related cardiac remodeling; (2) gender-related differences and potential mechanisms underlying diminished cardiac response in older men and women; (3) we select a few polyphenol or polyamine rich compounds as the CR-mimetics, such as resveratrol, quercetin, curcumin, epigallocatechin gallate and spermidine, due to their capability to extend health-span and induce autophagy. We outline their abilities and issues on retarding aging in animal hearts and preventing CVD in humans. We discuss the confounding factors that should be considered for developing therapeutic strategies against cardiac aging in humans.
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Affiliation(s)
- Lei Pang
- Department of Anesthesiology, the First Hospital of Jilin University, Changchun, 130021, China
| | - Xi Jiang
- Health Promotion Center, the First Hospital of Jilin University, Changchun, 130021, China
| | - Xin Lian
- Department of Urology, the First Hospital of Jilin University, Changchun, 130021, China
| | - Jie Chen
- Henry Fok School of Biology and Agriculture, Shaoguan University, Shaoguan, 512000, Guangdong, China
| | - Er-Fei Song
- Department of Metabolic and Bariatric Surgery, Jinan University First Affiliated Hospital, Guangzhou, 510630, China.,Department of Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Lei-Gang Jin
- Department of Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China.,State Key Laboratory of Pharmaceutical Biotechnology, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Zheng-Yuan Xia
- State Key Laboratory of Pharmaceutical Biotechnology, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China.,Department of Anesthesiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524000, Guangdong, China
| | - Hai-Chun Ma
- Department of Anesthesiology, the First Hospital of Jilin University, Changchun, 130021, China.
| | - Yin Cai
- Department of Health Technology and Informatics, the Hong Kong Polytechnic University, Hong Kong, China.
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Kim SJ, Anh NH, Jung CW, Long NP, Park S, Cho YH, Yoon YC, Lee EG, Kim M, Son EY, Kim TH, Deng Y, Lim J, Kwon SW. Metabolic and Cardiovascular Benefits of Apple and Apple-Derived Products: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Nutr 2022; 9:766155. [PMID: 35449537 PMCID: PMC9016272 DOI: 10.3389/fnut.2022.766155] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Quantitative evidence of the metabolic and cardiovascular effects of apples (Malus domestica) is lacking in interventional studies. This study aimed to summarize the available evidence of the beneficial effects of apples and apple-derived products (ADPs) on metabolic and cardiovascular markers. Methods Peer-reviewed randomized controlled trials (RCTs) were identified from four databases on May 3, 2021 and regularly updated until the end of May 2021. Demographic characteristics, intervention types, and evaluation parameters were extracted. A meta-analysis on the mean difference of change scores was conducted on commonly presented outcomes in the RCTs. Results The metabolic and cardiovascular effects of diverse regimens, including whole apple, apple extract, and apple juice, were examined in 18 eligible RCTs. Nine common evaluation outcomes were eventually introduced to the meta-analysis, including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, glucose, insulin, C-reactive protein, and systolic/diastolic blood pressures. The levels of TC (−2.69 mg/dL; 95% CI: −5.43, 0.04 mg/dL) and LDL (−2.80 mg/dL; 95% CI: −5.78, 0.17 mg/dL) showed a non-significant decreasing tendency after at least a week of apple consumption. Further subgroup analysis, particularly, a comparison with placebo as a control, showed a significant reduction in TC and LDL levels. When stratified by the baseline level, subjects with high TC and LDL level were shown to have more benefits from the apple intake. Intriguingly, apple and ADPs significantly reduced HDL levels to a small extent (−1.04 mg/dL; 95% CI: −1.79, −0.29 mg/dL). The other markers were mostly unaffected by the intervention. Conclusion Our investigation revealed that apples could improve blood cholesterol levels. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/], identifier [CRD42020215977].
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Affiliation(s)
- Sun Jo Kim
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Nguyen Hoang Anh
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Cheol Woon Jung
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Nguyen Phuoc Long
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Seongoh Park
- Department of Statistics, Sungshin Women's University, Seoul, South Korea
| | - Young Hyun Cho
- Department of Statistics, Seoul National University, Seoul, South Korea
| | - Young Cheol Yoon
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Eun Goo Lee
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Mina Kim
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Eui Young Son
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Tae Ha Kim
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Yingqian Deng
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Johan Lim
- Department of Statistics, Seoul National University, Seoul, South Korea
| | - Sung Won Kwon
- College of Pharmacy, Seoul National University, Seoul, South Korea.,Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea.,Plant Genomics and Breeding Institute, Seoul National University, Seoul, South Korea
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Liddle DM, Lin X, Cox LC, Ward EM, Ansari R, Wright AJ, Robinson LE. Daily apple consumption reduces plasma and peripheral blood mononuclear cell-secreted inflammatory biomarkers in adults with overweight and obesity: a 6-week randomized, controlled, parallel-arm trial. Am J Clin Nutr 2021; 114:752-763. [PMID: 33964852 DOI: 10.1093/ajcn/nqab094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/05/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Obesity-associated low-grade inflammation contributes to the development of cardiovascular disease (CVD). Apples are rich in anti-inflammatory bioactives including polyphenols and fiber. OBJECTIVES We aimed to determine the effects of regular apple consumption on fasting plasma biomarkers of inflammation (primary outcome), endotoxemia, carbohydrate and lipid metabolism (glucose, insulin, triacylglycerol; secondary outcomes), and peripheral blood mononuclear cell (PBMC)-secreted cytokines (secondary outcome) in individuals with overweight and obesity. METHODS A randomized, controlled, parallel-arm trial was conducted with n = 46 participants. After avoiding foods and beverages rich in polyphenols and fiber for 2 wk, participants consumed 3 whole Gala apples (∼200 g edible parts)/d as part of their habitual diet (n = 23) or avoided apples (control, n = 23) for 6 wk. All participants limited consumption of polyphenols and fiber during the 6-wk trial. Fasting blood samples were collected before and after 6 wk for analysis of plasma biomarkers and isolation of PBMCs, which were cultured for 24 h unstimulated or stimulated with LPS (10 ng/mL). RESULTS Forty-four participants completed the trial (30 female, 14 male; mean ± SEM age: 45.4 ± 2.2 y; BMI: 33.4 ± 0.9 kg/m2). After ANCOVA and correcting for multiple comparisons, apples decreased fasting plasma C-reactive protein by 17.0% (range: 14.3%-19.6%, P = 0.005), IL-6 by 12.4% (range: 6.7%-17.5%, P < 0.001), and LPS-binding protein by 20.7% (range: 14.1%-26.4%, P < 0.001) compared with control. Apples also decreased PBMC-secreted IL-6 by 28.3% (range: 22.4%-33.5%, P < 0.001) and IL-17 by 11.0% (range 5.8-15.6%, P = 0.003) in the unstimulated condition compared with control. Exploratory analysis showed apples also increased plasma total antioxidant capacity by 9.6% (range: 1.7-18.9%, P = 0.002) compared with control. However, apples had no effect on anthropometric or other CVD risk markers. CONCLUSIONS Six-week daily whole Gala apple consumption may be an effective dietary strategy to mitigate the obesity-associated inflammation that exacerbates CVD risk, without weight loss. This trial was registered at clinicaltrials.gov as NCT03523403.
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Affiliation(s)
- Danyelle M Liddle
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Xinjie Lin
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Liam C Cox
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Emily M Ward
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Rufaida Ansari
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Amanda J Wright
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Lindsay E Robinson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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Recent Molecular Mechanisms and Beneficial Effects of Phytochemicals and Plant-Based Whole Foods in Reducing LDL-C and Preventing Cardiovascular Disease. Antioxidants (Basel) 2021; 10:antiox10050784. [PMID: 34063371 PMCID: PMC8157003 DOI: 10.3390/antiox10050784] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/19/2022] Open
Abstract
Abnormal lipid metabolism leads to the development of hyperlipidemia, a common cause of multiple chronic disorders, including cardiovascular disease (CVD), obesity, diabetes, and cerebrovascular disease. Low-density lipoprotein cholesterol (LDL-C) currently remains the primary target for treatment of hyperlipidemia. Despite the advancement of treatment and prevention of hyperlipidemia, medications used to manage hyperlipidemia are limited to allopathic drugs, which present certain limitations and adverse effects. Increasing evidence indicates that utilization of phytochemicals and plant-based whole foods is an alternative and promising strategy to prevent hyperlipidemia and CVD. The current review focuses on phytochemicals and their pharmacological mode of actions for the regulation of LDL-C and prevention of CVD. The important molecular mechanisms illustrated in detail in this review include elevation of reverse cholesterol transport, inhibition of intestinal cholesterol absorption, acceleration of cholesterol excretion in the liver, and reduction of cholesterol synthesis. Moreover, the beneficial effects of plant-based whole foods, such as fresh fruits, vegetables, dried nuts, flax seeds, whole grains, peas, beans, vegan diets, and dietary fibers in LDL-C reduction and cardiovascular health are summarized. This review concludes that phytochemicals and plant-based whole foods can reduce LDL-C levels and lower the risk for CVD.
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Two apples a day modulate human:microbiome co-metabolic processing of polyphenols, tyrosine and tryptophan. Eur J Nutr 2020; 59:3691-3714. [PMID: 32103319 DOI: 10.1007/s00394-020-02201-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Validated biomarkers of food intake (BFIs) have recently been suggested as a useful tool to assess adherence to dietary guidelines or compliance in human dietary interventions. Although many new candidate biomarkers have emerged in the last decades for different foods from metabolic profiling studies, the number of comprehensively validated biomarkers of food intake is limited. Apples are among the most frequently consumed fruits and a rich source of polyphenols and fibers, an important mediator for their health-protective properties. METHODS Using an untargeted metabolomics approach, we aimed to identify biomarkers of long-term apple intake and explore how apples impact on the human plasma and urine metabolite profiles. Forty mildly hypercholesterolemic volunteers consumed two whole apples or a sugar and energy-matched control beverage, daily for 8 weeks in a randomized, controlled, crossover intervention study. The metabolome in plasma and urine samples was analyzed via untargeted metabolomics. RESULTS We found 61 urine and 9 plasma metabolites being statistically significant after the whole apple intake compared to the control beverage, including several polyphenol metabolites that could be used as BFIs. Furthermore, we identified several endogenous indole and phenylacetyl-glutamine microbial metabolites significantly increasing in urine after apple consumption. The multiomic dataset allowed exploration of the correlations between metabolites modulated significantly by the dietary intervention and fecal microbiota species at genus level, showing interesting interactions between Granulicatella genus and phenyl-acetic acid metabolites. Phloretin glucuronide and phloretin glucuronide sulfate appeared promising biomarkers of apple intake; however, robustness, reliability and stability data are needed for full BFI validation. CONCLUSION The identified apple BFIs can be used in future studies to assess compliance and to explore their health effects after apple intake. Moreover, the identification of polyphenol microbial metabolites suggests that apple consumption mediates significant gut microbial metabolic activity which should be further explored.
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9
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Koutsos A, Riccadonna S, Ulaszewska MM, Franceschi P, Trošt K, Galvin A, Braune T, Fava F, Perenzoni D, Mattivi F, Tuohy KM, Lovegrove JA. Two apples a day lower serum cholesterol and improve cardiometabolic biomarkers in mildly hypercholesterolemic adults: a randomized, controlled, crossover trial. Am J Clin Nutr 2020; 111:307-318. [PMID: 31840162 PMCID: PMC6997084 DOI: 10.1093/ajcn/nqz282] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/21/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Apples are rich in bioactive polyphenols and fiber. Evidence suggests that consumption of apples or their bioactive components is associated with beneficial effects on lipid metabolism and other markers of cardiovascular disease (CVD). However, adequately powered randomized controlled trials are necessary to confirm these data and explore the mechanisms. OBJECTIVE We aimed to determine the effects of apple consumption on circulating lipids, vascular function, and other CVD risk markers. METHODS The trial was a randomized, controlled, crossover, intervention study. Healthy mildly hypercholesterolemic volunteers (23 women, 17 men), with a mean ± SD BMI 25.3 ± 3.7 kg/m2 and age 51 ± 11 y, consumed 2 apples/d [Renetta Canada, rich in proanthocyanidins (PAs)] or a sugar- and energy-matched apple control beverage (CB) for 8 wk each, separated by a 4-wk washout period. Fasted blood was collected before and after each treatment. Serum lipids, glucose, insulin, bile acids, and endothelial and inflammation biomarkers were measured, in addition to microvascular reactivity, using laser Doppler imaging with iontophoresis, and arterial stiffness, using pulse wave analysis. RESULTS Whole apple (WA) consumption decreased serum total (WA: 5.89 mmol/L; CB: 6.11 mmol/L; P = 0.006) and LDL cholesterol (WA: 3.72 mmol/L; CB: 3.86 mmol/L; P = 0.031), triacylglycerol (WA: 1.17 mmol/L; CB: 1.30 mmol/L; P = 0.021), and intercellular cell adhesion molecule-1 (WA: 153.9 ng/mL; CB: 159.4 ng/mL; P = 0.028), and increased serum uric acid (WA: 341.4 μmol/L; CB: 330 μmol/L; P = 0.020) compared with the CB. The response to endothelium-dependent microvascular vasodilation was greater after the apples [WA: 853 perfusion units (PU), CB: 760 PU; P = 0.037] than after the CB. Apples had no effect on blood pressure or other CVD markers. CONCLUSIONS These data support beneficial hypocholesterolemic and vascular effects of the daily consumption of PA-rich apples by mildly hypercholesterolemic individuals.This trial was registered at clinicaltrials.gov as NCT01988389.
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Affiliation(s)
- Athanasios Koutsos
- Hugh Sinclair Unit of Human Nutrition and the Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Reading, United Kingdom
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Samantha Riccadonna
- Unit of Computational Biology, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Maria M Ulaszewska
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Pietro Franceschi
- Unit of Computational Biology, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Kajetan Trošt
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - Amanda Galvin
- Hugh Sinclair Unit of Human Nutrition and the Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Reading, United Kingdom
| | - Tanya Braune
- Hugh Sinclair Unit of Human Nutrition and the Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Reading, United Kingdom
| | - Francesca Fava
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Daniele Perenzoni
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Fulvio Mattivi
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
- Department of Physics, University of Trento, Povo, Italy
| | - Kieran M Tuohy
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition and the Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Reading, United Kingdom
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10
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Sandoval-Ramírez BA, Catalán Ú, Calderón-Pérez L, Companys J, Pla-Pagà L, Ludwig IA, Romero MP, Solà R. The effects and associations of whole-apple intake on diverse cardiovascular risk factors. A narrative review. Crit Rev Food Sci Nutr 2020; 60:3862-3875. [PMID: 31928209 DOI: 10.1080/10408398.2019.1709801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Apples are among the world's most consumed fruits. However, while the impact of whole-apple intake on cardiovascular disease (CVD) remains unknown. This narrative review summarizes a novel integrated view of whole-apple intake, CVD risk association (through observational studies; OSs), and the effects on CVD risk factors (randomized trials; RTs). In 8 OSs, whole-apple intake was associated with a reduced risk of CVD mortality, ischemic heart disease mortality, stroke mortality, all-cause mortality, and severe abdominal aortic calcification, as well as with lower C-reactive protein (CRP) concentrations. In 8 RTs, whole-apple consumption reduced total cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, pulse pressure, and plasma inflammatory cytokines, and noticeably reduced CRP, whereas it increased high-density lipoprotein cholesterol (HDLc) and improved endothelial function. Thus, consuming between 100 and 150 g/day of whole apples is associated with a lower CVD risk and decreases in blood pressure, pulse pressure, total cholesterol, low-density lipoprotein cholesterol, and inflammation status as well as with increases in HDLc and endothelial function. These results, support the regular consumption of whole apples as an aid in the prevention of CVD.
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Affiliation(s)
- Berner Andrée Sandoval-Ramírez
- Faculty of Medicine and Health Sciences, Medicine and Surgery Department, Functional Nutrition, Oxidation, and CVD Research Group (NFOC-Salut), Universitat Rovira i Virgili, Reus, Catalonia, Spain
| | - Úrsula Catalán
- Faculty of Medicine and Health Sciences, Medicine and Surgery Department, Functional Nutrition, Oxidation, and CVD Research Group (NFOC-Salut), Universitat Rovira i Virgili, Reus, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Catalonia, Spain
| | - Lorena Calderón-Pérez
- Faculty of Medicine and Health Sciences, Medicine and Surgery Department, Functional Nutrition, Oxidation, and CVD Research Group (NFOC-Salut), Universitat Rovira i Virgili, Reus, Catalonia, Spain.,Eurecat, Centre Tecnològic de Catalunya, Unitat de Nutrició i Salut, Reus, Catalonia, Spain
| | - Judit Companys
- Faculty of Medicine and Health Sciences, Medicine and Surgery Department, Functional Nutrition, Oxidation, and CVD Research Group (NFOC-Salut), Universitat Rovira i Virgili, Reus, Catalonia, Spain.,Eurecat, Centre Tecnològic de Catalunya, Unitat de Nutrició i Salut, Reus, Catalonia, Spain
| | - Laura Pla-Pagà
- Faculty of Medicine and Health Sciences, Medicine and Surgery Department, Functional Nutrition, Oxidation, and CVD Research Group (NFOC-Salut), Universitat Rovira i Virgili, Reus, Catalonia, Spain.,Eurecat, Centre Tecnològic de Catalunya, Unitat de Nutrició i Salut, Reus, Catalonia, Spain
| | - Iziar A Ludwig
- Faculty of Medicine and Health Sciences, Medicine and Surgery Department, Functional Nutrition, Oxidation, and CVD Research Group (NFOC-Salut), Universitat Rovira i Virgili, Reus, Catalonia, Spain
| | - Ma Paz Romero
- Food Technology Department, XaRTA-TPV, Agrotecnio Center, Escola Tecnica Superior d'Enginyeria Agraria, University of Lleida, Lleida, Catalonia, Spain
| | - Rosa Solà
- Faculty of Medicine and Health Sciences, Medicine and Surgery Department, Functional Nutrition, Oxidation, and CVD Research Group (NFOC-Salut), Universitat Rovira i Virgili, Reus, Catalonia, Spain.,Hospital Universitari Sant Joan de Reus (HUSJR), Reus, Catalonia, Spain
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Polyphenols in human nutrition: from the in vitro antioxidant capacity to the beneficial effects on cardiometabolic health and related inter-individual variability - an overview and perspective. Br J Nutr 2019; 123:241-254. [PMID: 31658907 DOI: 10.1017/s0007114519002733] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Oxidative damage of cells and tissues is broadly implicated in human pathophysiology, including cardiometabolic diseases. Polyphenols, as important constituents of the human diet and potent in vitro free radical scavengers, have been extensively studied for their beneficial effects on cardiometabolic health. However, it has been demonstrated that the in vivo antioxidant activity of polyphenols is distinct from their in vitro free radical-scavenging capacity. Indeed, bioavailability of nutritional polyphenols is low and conditioned by complex mechanisms of absorption, distribution, metabolism and excretion. Nowadays, it is commonly accepted that the cellular antioxidant activity of polyphenols is mainly carried out via modification of transcription of genes involved in antioxidant defence. Importantly, polyphenols also contribute to cardiometabolic health by modulation of a plethora of cellular processes that are not directly associated with antioxidant enzymes, through nutri(epi)genomic mechanisms. Numerous human intervention studies have demonstrated beneficial effects of polyphenols on the key cardiometabolic risk factors. However, inconsistency of the results of some studies led to identification of the inter-individual variability in response to consumption of polyphenols. In perspective, a detailed investigation of the determinants of this inter-individual variability will potentially lead us towards personalised dietary recommendations. The phenomenon of inter-individual variability is also of relevance for supplementation with antioxidant (pro)vitamins.
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Relation of Fruits and Vegetables with Major Cardiometabolic Risk Factors, Markers of Oxidation, and Inflammation. Nutrients 2019; 11:nu11102381. [PMID: 31590420 PMCID: PMC6835769 DOI: 10.3390/nu11102381] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 12/15/2022] Open
Abstract
Noncommunicable diseases (NCDs) are considered to be the leading cause of death worldwide. Inadequate fruit and vegetable intake have been recognized as a risk factor for almost all NCDs (type 2 diabetes mellitus, cancer, and cardiovascular and neurodegenerative diseases). The main aim of this review is to examine the possible protective effect that fruit and vegetable consumption or their bioactive compounds may have on the development of NCDs such as atherosclerosis. The accumulated evidence on the protective effects of adequate consumption of fruits and vegetables in some cases, or the lack of evidence in others, are summarized in the present review. The main conclusion of this review is that well-designed, large-scale, long-term studies are needed to truly understand the role fruit and vegetable consumption or their bioactive compounds have in atherosclerosis.
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Navaei N, Pourafshar S, Akhavan NS, Litwin NS, Foley EM, George KS, Hartley SC, Elam ML, Rao S, Arjmandi BH, Johnson SA. Influence of daily fresh pear consumption on biomarkers of cardiometabolic health in middle-aged/older adults with metabolic syndrome: a randomized controlled trial. Food Funct 2019; 10:1062-1072. [PMID: 30720034 DOI: 10.1039/c8fo01890a] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Previous research suggests potential for fresh pears as a functional food for promoting cardiometabolic health. The purpose of this randomized, open-label, placebo-controlled, crossover clinical trial was to evaluate the influence of daily fresh pear consumption on blood pressure (primary outcome) and other biomarkers of cardiometabolic health in middle-aged/older adults with metabolic syndrome (MetS). Forty men and women aged 45-65 years with MetS were included and randomly assigned to receive either two medium-sized fresh pears (Pear) or a calorie-matched control drink (Control) per day for each 12-week treatment period, each separated by a 4-week washout period. After 12 weeks of daily fresh pear consumption, systolic blood pressure tended to be reduced (130 ± 2 mmHg vs. 134 ± 2 mmHg at baseline, P = 0.07) and pulse pressure was significantly reduced (51 ± 1 vs. 54 ± 1 at baseline, P < 0.05). At 12 weeks, leptin concentrations were lower in the Pear group than Control (52.5 [7.6, 120.5] ng dL-1vs. 53.4 [5.0, 120.5] ng dL-1, respectively, P < 0.05), and there was a significant group by time interaction (P < 0.05). Leptin concentrations were significantly reduced at 12 weeks compared to baseline in the Pear group (52.5 [7.6, 120.5] ng dL-1vs. 54.8 [6.4, 120.5] ng dL-1 at baseline, P < 0.05) but not in the Control group. Waist circumference was significantly reduced at 12 weeks in the Pear group (107.7 ± 2.0 cm vs. 108.4 ± 2 cm at baseline, P < 0.05) with a trend for a group by time interaction (P < 0.1), and significantly lower in the Pear group than Control (108.1 ± 2.0 cm vs. 108.8 ± 2 cm, P < 0.05) at 6 weeks with a significant group by time interaction (P < 0.05). Conversely, values were significantly increased at 6 weeks (108.8 ± 2 cm vs. 108.3 ± 2.0 cm at baseline, P < 0.05) in the Control group and sustained at 12 weeks. Waist-to-hip ratio was significantly reduced (0.92 ± 0.01 vs. 0.93 ± 0.01 at baseline, P < 0.05) at 12 weeks in the Pear group, and significantly lower than Control at 6 weeks (0.93 ± 0.01 vs. 0.93 ± 0.01, respectively, P < 0.05) and 12 weeks (0.92 ± 0.01 vs. 0.93 ± 0.01, P < 0.05). These findings suggest that daily fresh pear consumption may promote modest improvements in cardiometabolic health in middle-aged/older adults with MetS. This trial was registered at clinicaltrials.gov as NCT02228837.
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Affiliation(s)
- Negin Navaei
- Department of Nutrition, Food, and Exercise Sciences, Florida State University, Tallahassee, FL, USA
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De Silva SF, Alcorn J. Flaxseed Lignans as Important Dietary Polyphenols for Cancer Prevention and Treatment: Chemistry, Pharmacokinetics, and Molecular Targets. Pharmaceuticals (Basel) 2019; 12:E68. [PMID: 31060335 PMCID: PMC6630319 DOI: 10.3390/ph12020068] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 02/07/2023] Open
Abstract
Cancer causes considerable morbidity and mortality across the world. Socioeconomic, environmental, and lifestyle factors contribute to the increasing cancer prevalence, bespeaking a need for effective prevention and treatment strategies. Phytochemicals like plant polyphenols are generally considered to have anticancer, anti-inflammatory, antiviral, antimicrobial, and immunomodulatory effects, which explain their promotion for human health. The past several decades have contributed to a growing evidence base in the literature that demonstrate ability of polyphenols to modulate multiple targets of carcinogenesis linking models of cancer characteristics (i.e., hallmarks and nutraceutical-based targeting of cancer) via direct or indirect interaction or modulation of cellular and molecular targets. This evidence is particularly relevant for the lignans, an ubiquitous, important class of dietary polyphenols present in high levels in food sources such as flaxseed. Literature evidence on lignans suggests potential benefit in cancer prevention and treatment. This review summarizes the relevant chemical and pharmacokinetic properties of dietary polyphenols and specifically focuses on the biological targets of flaxseed lignans. The consolidation of the considerable body of data on the diverse targets of the lignans will aid continued research into their potential for use in combination with other cancer chemotherapies, utilizing flaxseed lignan-enriched natural products.
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Affiliation(s)
- S Franklyn De Silva
- Drug Discovery & Development Research Group, College of Pharmacy and Nutrition, 104 Clinic Place, Health Sciences Building, University of Saskatchewan, Saskatoon, Saskatchewan (SK), S7N 2Z4, Canada.
| | - Jane Alcorn
- Drug Discovery & Development Research Group, College of Pharmacy and Nutrition, 104 Clinic Place, Health Sciences Building, University of Saskatchewan, Saskatoon, Saskatchewan (SK), S7N 2Z4, Canada.
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Giaretta AG, Schulz M, Silveira TT, de Oliveira MV, Patrício MJ, Gonzaga LV, Fett R, da Silva EL, Wazlawik E. Apple intake improves antioxidant parameters in hemodialysis patients without affecting serum potassium levels. Nutr Res 2018; 64:56-63. [PMID: 30802723 DOI: 10.1016/j.nutres.2018.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 11/30/2018] [Accepted: 12/20/2018] [Indexed: 12/23/2022]
Abstract
Oxidative stress (OS) is associated with increased morbidity and mortality in hemodialysis (HD) patients, and the consumption of fruits seems to improve OS due to their antioxidant properties. Therefore, we hypothesized that Fuji apple intake improves OS markers in HD patients due to its polyphenolic compounds without increasing serum potassium levels. This trial was a 1-group, pre- and posttest comparison between 16 patients who had been on hemodialysis for at least 3 months without any acute illness or hyperkalemia. Each volunteer consumed 2 Fuji apples (~360 g) per day for 1 week. Blood samples were collected at the baseline period and after 8 days for the measurement of total antioxidant status, ascorbic acid, catalase, glutathione peroxidase, superoxide dismutase, reduced glutathione, total oxidant status, oxidative stress index, potassium, phosphorus, uric acid, glucose, and fructosamine. For tolerance evaluation, participants were asked about their bowel habits. Apple intake increased glutathione peroxidase (P = .006) and superoxide dismutase activities (P = .006) and ascorbic acid levels (P = .002). No significant changes were observed in uric acid, potassium, phosphorus, glucose, and fructosamine levels. Additionally, there was a decrease in the catalase activity (P = .021) and in the total antioxidant status values (P = .004). However, increased total oxidant status (P = .003) and oxidative stress index (P = .033) levels were observed after apple intake. In conclusion, the intake of 2 Fuji apples per day for 1 week was well tolerated and improved antioxidant parameters in HD patients without affecting serum potassium levels.
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Affiliation(s)
- Andréia G Giaretta
- Post-graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Mayara Schulz
- Department of Food Science and Technology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Taís T Silveira
- Post-graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Marina V de Oliveira
- Department of Clinical Analyses, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | | | - Luciano V Gonzaga
- Department of Food Science and Technology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Roseane Fett
- Department of Food Science and Technology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Edson L da Silva
- Post-graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil; Department of Clinical Analyses, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Elisabeth Wazlawik
- Post-graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
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Ulaszewska M, Vázquez-Manjarrez N, Garcia-Aloy M, Llorach R, Mattivi F, Dragsted LO, Praticò G, Manach C. Food intake biomarkers for apple, pear, and stone fruit. GENES AND NUTRITION 2018; 13:29. [PMID: 30519365 PMCID: PMC6267079 DOI: 10.1186/s12263-018-0620-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/06/2018] [Indexed: 12/18/2022]
Abstract
Fruit is a key component of a healthy diet. However, it is still not clear whether some classes of fruit may be more beneficial than others and whether all individuals whatever their age, gender, health status, genotype, or gut microbiota composition respond in the same way to fruit consumption. Such questions require further observational and intervention studies in which the intake of a specific fruit can be precisely assessed at the population and individual levels. Within the Food Biomarker Alliance Project (FoodBAll Project) under the Joint Programming Initiative “A Healthy Diet for a Healthy Life”, an ambitious action was undertaken aiming at reviewing existent literature in a systematic way to identify validated and promising biomarkers of intake for all major food groups, including fruits. This paper belongs to a series of reviews following the same BFIRev protocol and is focusing on biomarkers of pome and stone fruit intake. Selected candidate biomarkers extracted from the literature search went through a validation process specifically developed for food intake biomarkers.
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Affiliation(s)
- Marynka Ulaszewska
- 1Research and Innovation Centre Food Quality and Nutrition, Fondazione Edmund Mach, Via Mach 1, San Michele all'Adige, 38010 Trento, Italy
| | - Natalia Vázquez-Manjarrez
- 2Human Nutrition Unit, Université Clermont Auvergne, INRA, F63000 Clermont-Ferrand, France.,3Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mar Garcia-Aloy
- 4Biomarkers and Nutrimetabolomic Laboratory, Department of Nutrition, Food Sciences and Gastronomy, XaRTA, INSA, Faculty of Pharmacy and Food Sciences, Campus Torribera, University of Barcelona, Barcelona, Spain.,5CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Barcelona, Spain
| | - Rafael Llorach
- 4Biomarkers and Nutrimetabolomic Laboratory, Department of Nutrition, Food Sciences and Gastronomy, XaRTA, INSA, Faculty of Pharmacy and Food Sciences, Campus Torribera, University of Barcelona, Barcelona, Spain.,5CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Barcelona, Spain
| | - Fulvio Mattivi
- 1Research and Innovation Centre Food Quality and Nutrition, Fondazione Edmund Mach, Via Mach 1, San Michele all'Adige, 38010 Trento, Italy.,6Center Agriculture Food Environment, University of Trento, San Michele all'Adige, Trento, Italy
| | - Lars O Dragsted
- 3Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Giulia Praticò
- 3Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Claudine Manach
- 2Human Nutrition Unit, Université Clermont Auvergne, INRA, F63000 Clermont-Ferrand, France
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Cory H, Passarelli S, Szeto J, Tamez M, Mattei J. The Role of Polyphenols in Human Health and Food Systems: A Mini-Review. Front Nutr 2018; 5:87. [PMID: 30298133 PMCID: PMC6160559 DOI: 10.3389/fnut.2018.00087] [Citation(s) in RCA: 615] [Impact Index Per Article: 102.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/30/2018] [Indexed: 12/12/2022] Open
Abstract
This narrative mini- review summarizes current knowledge of the role of polyphenols in health outcomes-and non-communicable diseases specifically-and discusses the implications of this evidence for public health, and for future directions for public health practice, policy, and research. The publications cited originate mainly from animal models and feeding experiments, as well as human cohort and case-control studies. Hypothesized protective effects of polyphenols in acute and chronic diseases, including obesity, neurodegenerative diseases, type 2 diabetes, and cardiovascular diseases, are evaluated. Potential harmful effects of some polyphenols are also considered, counterbalanced with the limited evidence of harm in the research literature. Recent international governmental regulations are discussed, as the safety and health claims of only a few specific polyphenolic compounds have been officially sanctioned. The implications of food processing on the bioavailability of polyphenols are also assessed, in addition to the health claims and marketing of polyphenols as a functional food. Finally, this mini-review asserts the need for increased regulation and guidelines for polyphenol consumption and supplementation in order to ensure consumers remain safe and informed about polyphenols.
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Affiliation(s)
- Hannah Cory
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Simone Passarelli
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - John Szeto
- Massachusetts General Hospital, Charlestown, MA, United States
| | - Martha Tamez
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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Bondonno NP, Bondonno CP, Blekkenhorst LC, Considine MJ, Maghzal G, Stocker R, Woodman RJ, Ward NC, Hodgson JM, Croft KD. Flavonoid-Rich Apple Improves Endothelial Function in Individuals at Risk for Cardiovascular Disease: A Randomized Controlled Clinical Trial. Mol Nutr Food Res 2017; 62. [PMID: 29086478 DOI: 10.1002/mnfr.201700674] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/22/2017] [Indexed: 12/25/2022]
Abstract
SCOPE The cardioprotective effects of apples are primarily attributed to flavonoids, found predominantly in the skin. This study aimed to determine if acute and/or chronic (4 weeks) ingestion of flavonoid-rich apples improves endothelial function, blood pressure (BP), and arterial stiffness in individuals at risk for cardiovascular diseases (CVD). METHODS AND RESULTS In this randomized, controlled cross-over trial, acute and 4 week intake of apple with skin (high flavonoid apple, HFA) is compared to intake of apple flesh only (low flavonoid apple, LFA) in 30 participants. The primary outcome is endothelial function assessed using flow-mediated dilation (FMD) of the brachial artery, while main secondary outcomes are 24 h ambulatory BP and arterial stiffness. Other outcomes include fasting serum glucose and lipoprotein profile, plasma heme oxygenase-1 (Hmox-1), F2 -isoprostanes, flavonoid metabolites, and plasma and salivary nitrate (NO3- ) and nitrite (NO2- ) concentrations. Compared to LFA control, the HFA results in a significant increase in FMD acutely (0.8%, p < 0.001) and after 4 weeks chronic intake (0.5%, p < 0.001), and in plasma flavonoid metabolites (p < 0.0001). Other outcomes are not altered significantly. CONCLUSION A lower risk of CVD with higher apple consumption could be mediated by the beneficial effect of apple skin on endothelial function, both acutely and chronically.
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Affiliation(s)
- Nicola P Bondonno
- School of Medicine, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Catherine P Bondonno
- School of Medicine, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Lauren C Blekkenhorst
- School of Medicine, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Michael J Considine
- School of Molecular Sciences, and the School of Agriculture and Environment, University of Western Australia, Perth, Australia.,The UWA Institute of Agriculture, University of Western Australia, Perth, Australia.,Irrigated Agriculture Division, Department of Primary Industries and Regional Development, South Perth, Australia
| | - Ghassan Maghzal
- Vascular Biology Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Roland Stocker
- Vascular Biology Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Richard J Woodman
- Centre for Epidemiology and Biostatistics, School of Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Natalie C Ward
- School of Medicine, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Biomedical Sciences and Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Jonathan M Hodgson
- School of Medicine, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Kevin D Croft
- School of Medicine, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
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Bahramsoltani R, Ebrahimi F, Farzaei MH, Baratpourmoghaddam A, Ahmadi P, Rostamiasrabadi P, Rasouli Amirabadi AH, Rahimi R. Dietary polyphenols for atherosclerosis: A comprehensive review and future perspectives. Crit Rev Food Sci Nutr 2017; 59:114-132. [PMID: 28812379 DOI: 10.1080/10408398.2017.1360244] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Atherosclerosis is one of the most prevalent reasons for premature death in adults. Despite the several conventional drugs in the market; many patients are not completely treated. Here we comprehensively review current clinical evidence regarding the efficacy of dietary polyphenols in atherosclerosis and related complications. PubMed, Cochrane library and Scopus were searched from inception until August 2016 to obtain clinical trials in which polyphenols were evaluated in cardiovascular parameters related to atherosclerosis. From total of 13031 results, 49 clinical trials were finally included. Tyrosol derivatives from virgin olive oil, catechins and theaflavins from green and black tea, cocoa polyphenols, and red grape resveratrol, as well as anthocyanins were the most studied polyphenolic compounds which could regulate lipid profile, inflammation and oxidative stress, blood pressure, endothelial function, and cell adhesion molecules. The most important limitations of the included trials were small sample size, short follow up, and unqualified methodology. Future well-designed clinical trials are necessary to provide better level of evidence for clinical decision making.
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Affiliation(s)
- Roodabeh Bahramsoltani
- a Department of Traditional Pharmacy, School of Traditional Medicine , Tehran University of Medical Sciences , Tehran , Iran.,b PhytoPharmacology Interest Group (PPIG) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran
| | - Farnaz Ebrahimi
- c Pharmacy Student's Research Committee, School of Pharmacy , Isfahan University of Medical Sciences , Isfahan , Iran
| | - Mohammad Hosein Farzaei
- d Pharmaceutical Sciences Research Center , Kermanshah University of Medical Sciences , Kermanshah , Iran.,e Medical Biology Research Center , Kermanshah University of Medical Sciences , Kermanshah , Iran
| | - Armaghan Baratpourmoghaddam
- c Pharmacy Student's Research Committee, School of Pharmacy , Isfahan University of Medical Sciences , Isfahan , Iran
| | - Pardis Ahmadi
- c Pharmacy Student's Research Committee, School of Pharmacy , Isfahan University of Medical Sciences , Isfahan , Iran
| | | | | | - Roja Rahimi
- a Department of Traditional Pharmacy, School of Traditional Medicine , Tehran University of Medical Sciences , Tehran , Iran.,b PhytoPharmacology Interest Group (PPIG) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran
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Zhao CN, Meng X, Li Y, Li S, Liu Q, Tang GY, Li HB. Fruits for Prevention and Treatment of Cardiovascular Diseases. Nutrients 2017; 9:E598. [PMID: 28608832 PMCID: PMC5490577 DOI: 10.3390/nu9060598] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases (CVDs) are leading global health problems. Accumulating epidemiological studies have indicated that consuming fruits was inversely related to the risk of CVDs. Moreover, substantial experimental studies have supported the protective role of fruits against CVDs, and several fruits (grape, blueberry, pomegranate, apple, hawthorn, and avocado) have been widely studied and have shown potent cardiovascular protective action. Fruits can prevent CVDs or facilitate the restoration of morphology and functions of heart and vessels after injury. The involved mechanisms included protecting vascular endothelial function, regulating lipids metabolism, modulating blood pressure, inhibiting platelets function, alleviating ischemia/reperfusion injury, suppressing thrombosis, reducing oxidative stress, and attenuating inflammation. The present review summarizes recent discoveries about the effects of fruits on CVDs and discusses potential mechanisms of actions based on evidence from epidemiological, experimental, and clinical studies.
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Affiliation(s)
- Cai-Ning Zhao
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Xiao Meng
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Ya Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Sha Li
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China.
| | - Qing Liu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Guo-Yi Tang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Hua-Bin Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
- South China Sea Bioresource Exploitation and Utilization Collaborative Innovation Center, Sun Yat-sen University, Guangzhou 510006, China.
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Clauss S, Scherr J, Hanley A, Schneider J, Klier I, Lackermair K, Hoster E, Vogeser M, Nieman DC, Halle M, Nickel T. Impact of polyphenols on physiological stress and cardiac burden in marathon runners – results from a substudy of the BeMaGIC study. Appl Physiol Nutr Metab 2017; 42:523-528. [DOI: 10.1139/apnm-2016-0457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Both physiologic stress and chronic heart disease are associated with increased systemic levels of chromogranin A (CGA) and NT-proBNP. Marathon running causes physiological stress and imposes a significant cardiac burden. Polyphenol-rich Mediterranean and Asian diets have been demonstrated to exert beneficial effects on the cardiovascular system. In this study we investigated whether pretreatment with a polyphenol beverage could attenuate the physiological and cardiac stress associated with a marathon. In the BeMaGIC trial, 277 athletes were randomized into 2 groups in a double-blinded fashion, receiving 1–1.5 L/day of the same beverages either with (study beverage) or without (placebo) polyphenol enrichment (approximately 400 mg of gallic acid equivalents per day of a complex mixture of polyphenols). Blood samples were taken 3 weeks and 1 day before, and immediately, 24 h, and 72 h after running a marathon. In our current substudy, CGA and NT-proBNP levels were analyzed by ELISA in the fastest 18 and the slowest 22 runners. CGA and NT-proBNP levels increased significantly immediately after the marathon and returned to baseline at 72 h after the marathon. Neither CGA nor NT-proBNP differed significantly between athletes receiving study beverage versus placebo. Separating our cohort into fast and slow runners did not reveal any significant difference regarding CGA or NT-proBNP levels between groups. Our study provides no evidence that polyphenol supplementation attenuates marathon running-induced physiological stress and cardiac burden in fast or slow runners.
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Affiliation(s)
- Sebastian Clauss
- Medizinische Klinik und Poliklinik I, University Hospital of Munich, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), DE-81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, DE-80802 Munich, Germany
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Johannes Scherr
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar (MRI), Technische Universität München, DE-80992 Munich, Germany
| | - Alan Hanley
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Jens Schneider
- Department of Cardiology and Angiology II, Universitäts Herz-Zentrum Freiburg−Bad Krozingen, Südring.15, DE-79189 Bad Krozingen, Germany
| | - Ina Klier
- Medizinische Klinik und Poliklinik I, University Hospital of Munich, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), DE-81377 Munich, Germany
| | - Korbinian Lackermair
- Medizinische Klinik und Poliklinik I, University Hospital of Munich, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), DE-81377 Munich, Germany
| | - Eva Hoster
- Institute for Medical Informatics Biometry and Epidemiology, Ludwig-Maximilians-University Munich, DE-81377 Munich, Germany
| | - Michael Vogeser
- Institute for Laboratory Medicine, University Hospital of Munich, Campus Grosshadern, LMU, DE-81377 Munich, Germany
| | - David C. Nieman
- Human Performance Laboratory, Appalachian State University and North Carolina Research Campus, Kannapolis, NC 28081, USA
| | - Martin Halle
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, DE-80802 Munich, Germany
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar (MRI), Technische Universität München, DE-80992 Munich, Germany
| | - Thomas Nickel
- Medizinische Klinik und Poliklinik I, University Hospital of Munich, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), DE-81377 Munich, Germany
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Tomé-Carneiro J, Visioli F. Polyphenol-based nutraceuticals for the prevention and treatment of cardiovascular disease: Review of human evidence. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2016; 23:1145-1174. [PMID: 26776959 DOI: 10.1016/j.phymed.2015.10.018] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND In addition to prescription drugs, nutraceuticals/functional foods/medical foods are being increasingly added as adjunct treatment of cardiovascular disease (CVD), even though most of them have been exclusively studied in vitro. HYPOTHESIS/PURPOSE We review the available evidence (focusing on when the amount of polyphenols' intake was measured) coming from randomized controlled trials (RCTs) of (poly)phenol-based supplements. CONCLUSION We conclude that (poly)phenol-based nutraceuticals and functional foods might be indeed used as adjunct therapy of CVD, but additional long-term RCTs with adequate numerosity and with clinically relevant end points are needed to provide unequivocal evidence of their clinical usefulness.
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Affiliation(s)
- Joao Tomé-Carneiro
- Laboratory of Functional Foods, Madrid Institute for Advanced Studies (IMDEA) - Food, CEI UAM+CSIC, Madrid, Spain
| | - Francesco Visioli
- Laboratory of Functional Foods, Madrid Institute for Advanced Studies (IMDEA) - Food, CEI UAM+CSIC, Madrid, Spain; Department of Molecular Medicine, University of Padova, Viale G. Colombo 3, 35121 Padova, Italy .
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Dietary Phytochemicals: Natural Swords Combating Inflammation and Oxidation-Mediated Degenerative Diseases. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:5137431. [PMID: 27721914 PMCID: PMC5046019 DOI: 10.1155/2016/5137431] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/08/2016] [Accepted: 08/22/2016] [Indexed: 02/08/2023]
Abstract
Cumulatively, degenerative disease is one of the most fatal groups of diseases, and it contributes to the mortality and poor quality of life in the world while increasing the economic burden of the sufferers. Oxidative stress and inflammation are the major pathogenic causes of degenerative diseases such as rheumatoid arthritis (RA), diabetes mellitus (DM), and cardiovascular disease (CVD). Although a number of synthetic medications are used to treat these diseases, none of the current regimens are completely safe. Phytochemicals (polyphenols, carotenoids, anthocyanins, alkaloids, glycosides, saponins, and terpenes) from natural products such as dietary fruits, vegetables, and spices are potential sources of alternative medications to attenuate the oxidative stress and inflammation associated with degenerative diseases. Based on in vitro, in vivo, and clinical trials, some of these active compounds have shown good promise for development into novel agents for treating RA, DM, and CVD by targeting oxidative stress and inflammation. In this review, phytochemicals from natural products with the potential of ameliorating degenerative disease involving the bone, metabolism, and the heart are described.
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Effect of Flavonoids on Oxidative Stress and Inflammation in Adults at Risk of Cardiovascular Disease: A Systematic Review. Healthcare (Basel) 2016; 4:healthcare4030069. [PMID: 27649255 PMCID: PMC5041070 DOI: 10.3390/healthcare4030069] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/02/2016] [Accepted: 09/08/2016] [Indexed: 11/25/2022] Open
Abstract
Oxidative stress (OS) and inflammatory processes initiate the first stage of cardiovascular disease (CVD). Flavonoid consumption has been related to significantly improved flow-mediated dilation and blood pressure. Antioxidant and anti-inflammatory mechanisms are thought to be involved. The effect of flavonoids on markers of oxidative stress and inflammation, in at risk individuals is yet to be reviewed. Systematic literature searches were conducted in MEDLINE, Cochrane Library, CINAHL and SCOPUS databases. Randomised controlled trials in a Western country providing a food-based flavonoid intervention to participants with one or two modifiable risk factors for CVD measuring a marker of OS and/or inflammation, were included. Reference lists were hand-searched. The Cochrane Collaboration Risk of Bias Tool was used to assess study quality. The search strategy retrieved 1248 articles. Nineteen articles meeting the inclusion criteria were reviewed. Eight studies were considered at low risk of bias. Cocoa flavonoids provided to Type 2 diabetics and olive oil flavonoids to mildly-hypertensive women reduced OS and inflammation. Other food sources had weaker effects. No consistent effect on OS and inflammation across patients with varied CVD risk factors was observed. Study heterogeneity posed a challenge for inter-study comparisons. Rigorously designed studies will assist in determining the effectiveness of flavonoid interventions for reducing OS and inflammation in patients at risk of CVD.
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Waldbauer K, Seiringer G, Nguyen DL, Winkler J, Blaschke M, McKinnon R, Urban E, Ladurner A, Dirsch VM, Zehl M, Kopp B. Triterpenoic Acids from Apple Pomace Enhance the Activity of the Endothelial Nitric Oxide Synthase (eNOS). JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2016; 64:185-194. [PMID: 26682617 DOI: 10.1021/acs.jafc.5b05061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Pomace is an easy-accessible raw material for the isolation of fruit-derived compounds. Fruit consumption is associated with health-promoting effects, such as the prevention of cardiovascular disease. Increased vascular nitric oxide (NO) bioavailability, for example, due to an enhanced endothelial nitric oxide synthase (eNOS) activity, could be one molecular mechanism mediating this effect. To identify compounds from apple (Malus domestica Borkh.) pomace that have the potential to amplify NO bioavailability via eNOS activation, a bioassay-guided fractionation of the methanol/water (70:30) extract has been performed using the (14)C-L-arginine to (14)C-L-citrulline conversion assay (ACCA) in the human endothelium-derived cell line EA.hy926. Phytochemical characterization of the active fractions was performed using the spectrophotometric assessment of the total phenolic content, as well as TLC, HPLC-DAD-ELSD, and HPLC-MS analyses. Eleven triterpenoic acids, of which one is a newly discovered compound, were identified as the main constituents in the most active fraction, accompanied by only minor contents of phenolic compounds. When tested individually, none of the tested compounds exhibited significant eNOS activation. Nevertheless, cell stimulation with the reconstituted compound mixture restored eNOS activation, validating the potential of apple pomace as a source of bioactive components.
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Affiliation(s)
- Katharina Waldbauer
- Department of Pharmacognosy and ‡Department of Pharmaceutical Chemistry, University of Vienna , Althanstrasse 14, 1090 Vienna, Austria
| | - Günter Seiringer
- Department of Pharmacognosy and ‡Department of Pharmaceutical Chemistry, University of Vienna , Althanstrasse 14, 1090 Vienna, Austria
| | - Dieu Linh Nguyen
- Department of Pharmacognosy and ‡Department of Pharmaceutical Chemistry, University of Vienna , Althanstrasse 14, 1090 Vienna, Austria
| | - Johannes Winkler
- Department of Pharmacognosy and ‡Department of Pharmaceutical Chemistry, University of Vienna , Althanstrasse 14, 1090 Vienna, Austria
| | - Michael Blaschke
- Department of Pharmacognosy and ‡Department of Pharmaceutical Chemistry, University of Vienna , Althanstrasse 14, 1090 Vienna, Austria
| | - Ruxandra McKinnon
- Department of Pharmacognosy and ‡Department of Pharmaceutical Chemistry, University of Vienna , Althanstrasse 14, 1090 Vienna, Austria
| | - Ernst Urban
- Department of Pharmacognosy and ‡Department of Pharmaceutical Chemistry, University of Vienna , Althanstrasse 14, 1090 Vienna, Austria
| | - Angela Ladurner
- Department of Pharmacognosy and ‡Department of Pharmaceutical Chemistry, University of Vienna , Althanstrasse 14, 1090 Vienna, Austria
| | - Verena M Dirsch
- Department of Pharmacognosy and ‡Department of Pharmaceutical Chemistry, University of Vienna , Althanstrasse 14, 1090 Vienna, Austria
| | - Martin Zehl
- Department of Pharmacognosy and ‡Department of Pharmaceutical Chemistry, University of Vienna , Althanstrasse 14, 1090 Vienna, Austria
| | - Brigitte Kopp
- Department of Pharmacognosy and ‡Department of Pharmaceutical Chemistry, University of Vienna , Althanstrasse 14, 1090 Vienna, Austria
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Abstract
Atherosclerotic lesions initiate in regions characterized by low shear stress and reduced activity of endothelial atheroprotective molecules such as nitric oxide, which is the key molecule managing vascular homeostasis. The generation of reactive oxygen species from the vascular endothelium is strongly related to various enzymes, such as xanthine oxidase, endothelial nitric oxide synthase and nicotinamide-adenine dinucleotide phosphate oxidase. Several pharmaceutical agents, including angiotensin converting enzyme inhibitors, angiotensin receptors blockers and statins, along with a variety of other agents, have demonstrated additional antioxidant properties beyond their principal role. Reports regarding the antioxidant role of vitamins present controversial results, especially those based on large scale studies. In addition, there is growing interest on the role of dietary flavonoids and their potential to improve endothelial function by modifying the oxidative stress status. However, the vascular-protective role of flavonoids and especially their antioxidant properties are still under investigation. Indeed, further research is required to establish the impact of the proposed new therapeutic strategies in atherosclerosis.
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Del Bo' C, Porrini M, Fracassetti D, Campolo J, Klimis-Zacas D, Riso P. A single serving of blueberry (V. corymbosum) modulates peripheral arterial dysfunction induced by acute cigarette smoking in young volunteers: a randomized-controlled trial. Food Funct 2015; 5:3107-16. [PMID: 25263326 DOI: 10.1039/c4fo00570h] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cigarette smoking causes oxidative stress, hypertension and endothelial dysfunction. Polyphenol-rich foods may prevent these conditions. We investigated the effect of a single serving of fresh-frozen blueberry intake on peripheral arterial function and arterial stiffness in young smokers. Sixteen male smokers were recruited for a 3-armed randomized-controlled study with the following experimental conditions: smoking treatment (one cigarette); blueberry treatment (300 g of blueberry) + smoking; control treatment (300 mL of water with sugar) + smoking. Each treatment was separated by one week of wash-out period. The blood pressure, heart rate, peripheral arterial function (reactive hyperemia and Framingham reactive hyperemia), and arterial stiffness (digital augmentation index, digital augmentation index normalized for a heart rate of 75 bpm) were measured before and 20 min after smoking with Endo-PAT2000. Smoking impaired the blood pressure, heart rate and peripheral arterial function, but did not affect the arterial stiffness. Blueberry consumption counteracted the impairment of the reactive hyperemia index induced by smoking (-4.4 ± 0.8% blueberry treatment vs. -22.0 ± 1.1% smoking treatment, p < 0.01) and Framingham reactive hyperemia (+28.3 ± 19.2% blueberry treatment vs. -42.8 ± 20.0% smoking treatment, p < 0.0001), and the increase of systolic blood pressure (+8.4 ± 0.02% blueberry treatment vs. +13.1 ± 0.02% smoking treatment, mmHg, p < 0.05) after cigarette smoking. No effect was observed for arterial stiffness and other vital signs. In conclusion, data obtained suggest a protective role of blueberry on reactive hyperemia, Framingham reactive hyperemia, and systolic blood pressure in subjects exposed to smoke of one cigarette. Future studies are necessary to elucidate the mechanisms involved.
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Affiliation(s)
- Cristian Del Bo'
- Università degli Studi di Milano, Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Milano, Italy.
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29
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Apples and cardiovascular health--is the gut microbiota a core consideration? Nutrients 2015; 7:3959-98. [PMID: 26016654 PMCID: PMC4488768 DOI: 10.3390/nu7063959] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 05/12/2015] [Indexed: 12/20/2022] Open
Abstract
There is now considerable scientific evidence that a diet rich in fruits and vegetables can improve human health and protect against chronic diseases. However, it is not clear whether different fruits and vegetables have distinct beneficial effects. Apples are among the most frequently consumed fruits and a rich source of polyphenols and fiber. A major proportion of the bioactive components in apples, including the high molecular weight polyphenols, escape absorption in the upper gastrointestinal tract and reach the large intestine relatively intact. There, they can be converted by the colonic microbiota to bioavailable and biologically active compounds with systemic effects, in addition to modulating microbial composition. Epidemiological studies have identified associations between frequent apple consumption and reduced risk of chronic diseases such as cardiovascular disease. Human and animal intervention studies demonstrate beneficial effects on lipid metabolism, vascular function and inflammation but only a few studies have attempted to link these mechanistically with the gut microbiota. This review will focus on the reciprocal interaction between apple components and the gut microbiota, the potential link to cardiovascular health and the possible mechanisms of action.
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30
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Blanch N, Clifton PM, Keogh JB. A systematic review of vascular and endothelial function: effects of fruit, vegetable and potassium intake. Nutr Metab Cardiovasc Dis 2015; 25:253-266. [PMID: 25456155 DOI: 10.1016/j.numecd.2014.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 10/02/2014] [Accepted: 10/04/2014] [Indexed: 01/16/2023]
Abstract
AIM To review the relationships between: 1) Potassium and endothelial function; 2) Fruits and vegetables and endothelial function; 3) Potassium and other measures of vascular function; 4) Fruits and vegetables and other measures of vascular function. DATA SYNTHESIS An electronic search for intervention trials investigating the effect of potassium, fruits and vegetables on vascular function was performed in MEDLINE, EMBASE and the Cochrane Library. Potassium appears to improve endothelial function with a dose of >40 mmol/d, however the mechanisms for this effect remain unclear. Potassium may improve measures of vascular function however this effect may be dependent on the effect of potassium on blood pressure. The effect of fruit and vegetables on endothelial function independent of confounding variables is less clear. Increased fruit and vegetable intake may improve vascular function only in high risk populations. CONCLUSION Increasing dietary potassium appears to improve vascular function but the effect of increasing fruit and vegetable intake per se on vascular function is less clear.
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Affiliation(s)
- N Blanch
- School of Pharmacy and Medical Science, University of South Australia, Australia
| | - P M Clifton
- School of Pharmacy and Medical Science, University of South Australia, Australia
| | - J B Keogh
- School of Pharmacy and Medical Science, University of South Australia, Australia.
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31
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Joseph SV, Edirisinghe I, Burton-Freeman BM. Fruit Polyphenols: A Review of Anti-inflammatory Effects in Humans. Crit Rev Food Sci Nutr 2015; 56:419-44. [DOI: 10.1080/10408398.2013.767221] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
Epidemiological studies suggest that high intakes of dietary flavonoids are associated with decreased cardiovascular disease mortality and risk factors. Less is known about the cardioprotective effects of flavonoids from fruit and vegetables. This review summarizes data from studies which examine the effects of commonly consumed fruit and vegetables on cardiovascular disease risk biomarkers in healthy volunteers or at-risk individuals. Although flavonoids from apples, berries, and onions appear to impact positively on blood pressure, vascular function, and serum lipid levels, further research is required to find out the optimal quantity and food matrix for conferring substantial clinical benefit. The benefits from citrus flavonoids are still inconclusive. Further robust, longer-term dietary intervention studies, with the inclusion of placebo or control arms, are required to improve the credibility of the findings and confirm current observations. An improved understanding of the impact of flavonoids from fruit and vegetables can help one make discerning food choices for optimal cardiovascular health.
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Effects of regular consumption of vitamin C-rich or polyphenol-rich apple juice on cardiometabolic markers in healthy adults: a randomized crossover trial. Eur J Nutr 2014; 53:1645-57. [DOI: 10.1007/s00394-014-0670-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
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34
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Ferretti G, Turco I, Bacchetti T. Apple as a Source of Dietary Phytonutrients: Bioavailability and Evidence of Protective Effects against Human Cardiovascular Disease. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/fns.2014.513134] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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35
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Khurana S, Venkataraman K, Hollingsworth A, Piche M, Tai TC. Polyphenols: benefits to the cardiovascular system in health and in aging. Nutrients 2013; 5:3779-827. [PMID: 24077237 PMCID: PMC3820045 DOI: 10.3390/nu5103779] [Citation(s) in RCA: 259] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/25/2013] [Accepted: 08/04/2013] [Indexed: 12/26/2022] Open
Abstract
Numerous studies have demonstrated the importance of naturally occurring dietary polyphenols in promoting cardiovascular health and emphasized the significant role these compounds play in limiting the effects of cellular aging. Polyphenols such as resveratrol, epigallocatechin gallate (EGCG), and curcumin have been acknowledged for having beneficial effects on cardiovascular health, while some have also been shown to be protective in aging. This review highlights the literature surrounding this topic on the prominently studied and documented polyphenols as pertaining to cardiovascular health and aging.
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Affiliation(s)
- Sandhya Khurana
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +705-662-7239; Fax: +705-675-4858
| | - Krishnan Venkataraman
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +705-662-7239; Fax: +705-675-4858
| | - Amanda Hollingsworth
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +705-662-7239; Fax: +705-675-4858
| | - Matthew Piche
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +705-662-7239; Fax: +705-675-4858
| | - T. C. Tai
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +705-662-7239; Fax: +705-675-4858
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36
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Identification of apples rich in health-promoting flavan-3-ols and phenolic acids by measuring the polyphenol profile. J Food Compost Anal 2012. [DOI: 10.1016/j.jfca.2011.12.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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37
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Landberg R, Naidoo N, van Dam RM. Diet and endothelial function: from individual components to dietary patterns. Curr Opin Lipidol 2012; 23:147-55. [PMID: 22327611 DOI: 10.1097/mol.0b013e328351123a] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Endothelial dysfunction plays an important role in development and progression of atherosclerosis and may also contribute to the pathogenesis of type 2 diabetes. This review summarizes recent findings on the effects of vitamin D, antioxidant vitamins, polyphenols, polyphenol-rich foods, dietary component combinations and healthy diets on endothelial function. RECENT FINDINGS Dietary patterns rich in fruit, vegetables, fish and nuts appear to have beneficial effects on endothelial function. With regard to specific foods, cacao and green tea consumption have been associated with improvement in endothelial function and this seems to be due to their flavan-3-ol (catechins and epigallocatechin gallate) content. The evidence for beneficial effects of other foods such as citrus fruit, apples and red wine is less consistent. Recent studies have also suggested beneficial effects of vitamin D and anthocyanins on endothelial function and have provided more insight into potential mechanisms underlying the effect of diet on endothelial function. SUMMARY The currently available evidence supports beneficial effects of various dietary compounds on endothelial function. However, in order to obtain strong evidence for relevant health effects that can be used for specific dietary recommendations, more long-term studies using well characterized diets/supplements in a large number of individuals are needed.
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Affiliation(s)
- Rikard Landberg
- Department of Food Science, BioCentre, Swedish University of Agricultural Sciences (SLU), Uppsala, Sweden.
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38
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Bondonno CP, Yang X, Croft KD, Considine MJ, Ward NC, Rich L, Puddey IB, Swinny E, Mubarak A, Hodgson JM. Flavonoid-rich apples and nitrate-rich spinach augment nitric oxide status and improve endothelial function in healthy men and women: a randomized controlled trial. Free Radic Biol Med 2012; 52:95-102. [PMID: 22019438 DOI: 10.1016/j.freeradbiomed.2011.09.028] [Citation(s) in RCA: 198] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 09/23/2011] [Accepted: 09/23/2011] [Indexed: 01/02/2023]
Abstract
Flavonoids and nitrates in fruits and vegetables may protect against cardiovascular disease. Dietary flavonoids and nitrates can augment nitric oxide status via distinct pathways, which may improve endothelial function and lower blood pressure. Recent studies suggest that the combination of flavonoids and nitrates can enhance nitric oxide production in the stomach. Their combined effect in the circulation is unclear. Here, our objective was to investigate the independent and additive effects of flavonoid-rich apples and nitrate-rich spinach on nitric oxide status, endothelial function, and blood pressure. A randomized, controlled, crossover trial with healthy men and women (n=30) was conducted. The acute effects of four energy-matched treatments (control, apple, spinach, and apple+spinach), administered in random order, were compared. Measurements included plasma nitric oxide status, assessed by measuring S-nitrosothiols+other nitrosylated species (RXNO) and nitrite, blood pressure, and endothelial function, measured as flow-mediated dilatation of the brachial artery. Results are means and 95% CI. Relative to control, all treatments resulted in higher RXNO (control, 33 nmol/L, 26, 42; apple, 51 nmol/L, 40, 65; spinach, 86 nmol/L, 68, 110; apple+spinach, 69 nmol/L, 54, 88; P<0.01) and higher nitrite (control, 35 nmol/L, 27, 46; apple, 69 nmol/L, 53, 90; spinach, 99 nmol/L, 76, 129; apple+spinach, 80 nmol/L, 61, 104; P<0.01). Compared to control, all treatments resulted in higher flow-mediated dilatation (P<0.05) and lower pulse pressure (P<0.05), and apple and spinach resulted in lower systolic blood pressure (P<0.05). No significant effect was observed on diastolic blood pressure. The combination of apple and spinach did not result in additive effects on nitric oxide status, endothelial function, or blood pressure. In conclusion, flavonoid-rich apples and nitrate-rich spinach can independently augment nitric oxide status, enhance endothelial function, and lower blood pressure acutely, outcomes that may benefit cardiovascular health.
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Affiliation(s)
- Catherine P Bondonno
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
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39
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Mullen W, Gonzalez J, Siwy J, Franke J, Sattar N, Mullan A, Roberts S, Delles C, Mischak H, Albalat A. A pilot study on the effect of short-term consumption of a polyphenol rich drink on biomarkers of coronary artery disease defined by urinary proteomics. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2011; 59:12850-12857. [PMID: 22070129 DOI: 10.1021/jf203369r] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Polyphenol rich diets have been associated with a reduced risk of cardiovascular disease. We examined the effect of a polyphenol rich (P-R) drink on biomarkers assessed by urinary proteomics. Thirty nine middle aged and overweight subjects were randomized to P-R drink (n = 20) or placebo (n = 19) in addition to their normal diet. After two weeks urine samples were obtained for assessment of the urinary proteome using capillary electrophoresis coupled to a mass spectrometer. A total of 93 polypeptides were found to be candidates for differential distribution with a nominal p-value <0.05, though these differences did not reach significance when multiple testing was accounted for. Sequences were determined in 19 of these demonstrating that they originate from alpha-1 antitrypsin, collagens, fibrinogen alpha and IgG kappa. Levels of 27 polypeptides were greater than 4-fold different between the two groups. Of these, 7 were previously found to be part of a coronary artery disease (CAD) specific urinary biomarker pattern. Their direction of expression was closer to the healthy state in the P-R drink group and closer to CAD state in the placebo group. Our data suggest that the P-R drink may have beneficial effects on urinary biomarkers of CAD. The data encourage the planning of future prospective studies, aimed at investigating significant effects of polyphenol rich dietary products.
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Affiliation(s)
- W Mullen
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom
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40
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Schaffer S, Halliwell B. Do polyphenols enter the brain and does it matter? Some theoretical and practical considerations. GENES AND NUTRITION 2011; 7:99-109. [PMID: 22012276 DOI: 10.1007/s12263-011-0255-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 10/06/2011] [Indexed: 12/26/2022]
Abstract
Although several epidemiological and intervention studies suggest that polyphenols (PPs) and PP-rich foods may improve memory and cognition in animals and humans, PPs' mode of action is only poorly understood. To help distinguish between the different modes of action that have been proposed for PPs, it is obviously important to know how much PPs can accumulate in the brain, if any at all. However, reliable data on PP uptake into the brain of animals are limited as many studies failed to report important control procedures during data acquisition. In this paper, we summarize published data on the penetration of PPs into animal brain and review some hypotheses to explain the biological basis of potentially health-beneficial effects of PPs to the brain. Finally, we highlight promising new approaches, especially those of a hormetic dose-response and gut microbiota-brain interaction, which may allow a better understanding of PPs' mode of action in animals and humans.
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Affiliation(s)
- Sebastian Schaffer
- Department of Biochemistry, Centre for Life Sciences, National University of Singapore, 22 Medical Drive, Singapore, 117456, Singapore
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Landberg R, Sun Q, Rimm EB, Cassidy A, Scalbert A, Mantzoros CS, Hu FB, van Dam RM. Selected dietary flavonoids are associated with markers of inflammation and endothelial dysfunction in U.S. women. J Nutr 2011; 141:618-25. [PMID: 21325476 PMCID: PMC3057665 DOI: 10.3945/jn.110.133843] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Flavonoids show antiinflammatory effects in vitro and human intervention studies have suggested beneficial effects of flavonoid-rich foods on biomarkers of inflammation and endothelial function. In the present study, we assessed the relationship between flavonoid intake and biomarkers of inflammation and endothelial dysfunction in a cross-sectional study of participants from the Nurses' Health Study cohort. Intake of 6 flavonoid subclasses (flavonols, flavones, flavanones, flavan-3-ols, anthocyanidins, and polymeric flavonoids) was assessed using a FFQ administered in 1990. Also, the main food sources of these flavonoids were examined. Blood samples were collected in 1989-1990 and plasma C-reactive protein (CRP), IL-6, IL-18, soluble tumor necrosis factor receptor-2 (sTNF-R2), soluble intercellular adhesion molecule-1, soluble vascular adhesion molecule-1 (sVCAM-1), and E-selectin were measured in 1194-1598 women. The multivariate-adjusted geometric mean of plasma IL-8 were lower for women in the highest intake quintile of flavones, flavanones, and total flavonoids compared with those in the lowest quintiles by 9% (Q1: 264 ng/L, Q5: 241 ng/L; P-trend = 0.019), 11% (Q1: 273 ng/L, Q5: 244 ng/L; P-trend = 0.011), and 8% (Q1: 276 ng/L, Q5: 55 ng/L; P-trend = 0.034), respectively. The multivariate-adjusted geometric mean for women in the highest intake quintile of flavonol compared with those in the lowest quintile was 4% lower for sVCAM-1 (Q1: 578 μg/L, Q5: 557 μg/L; P-trend = 0.012). Among flavonoid-rich foods, higher intake of grapefruit was significantly associated with lower concentrations of CRP and sTNF-R2. In summary, higher intakes of selected flavonoid subclasses were associated with modestly lower concentrations of inflammatory biomarkers. In particular, flavonoids typically found in citrus fruits were modestly associated with lower plasma IL-18 concentrations.
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Affiliation(s)
- Rikard Landberg
- Department of Food Science, Swedish University of Agricultural Sciences, SE-75007 Uppsala, Sweden.
| | - Qi Sun
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115
| | - Eric B. Rimm
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115,Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115,Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115
| | - Aedin Cassidy
- School of Medicine, University of East Anglia, Norwich NR4 7TJ, UK
| | - Augustin Scalbert
- INRA, UMR 1019, Unité de Nutrition Humaine, Centre de Recherche de Clermont-Ferrand/Theix, 63122 Saint-Genes-Champanelle, France
| | - Christos S. Mantzoros
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215
| | - Frank B. Hu
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115,Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115,Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115
| | - Rob M. van Dam
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115,Departments of Epidemiology and Public Health, and Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597
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