The Role of Fruit and Vegetable Concentrates in Alleviating the Growing Burden of Cardiovascular Diseases in USA: Evidence from a Simulation Study

Abstract

BackgroundPromoting fruit and vegetable consumption has been one of the key points in WHO's Global Strategy on Diet, Physical Activity and Health. The recommendation for fruit and vegetable (FV) consumption, as set by the panel of WHO/FAO experts, is 400gr/day minimum, however different studies show that the majority of individuals do not comply to the suggested intake levels. One of the measure proposed to help individuals improve their intake of FV is the adoption of FV concentrates, which contain a well‐balanced mixture of bioactive compounds. The aim of this study was to collect and analyze scientific material on FV concentrates and their effectiveness in mitigating important risk factors for selected Noncommunicable diseases (NCDs). Findings about the FV effectiveness are illustrated through a simulation exercise, which shows a potential relief in public health burden in terms of reduction of cases of NCDs and their respective economic cost.MethodsRelevant articles about the FV concentrates were collected and analyzed in terms of their impact on measurable physiological outcomes (total cholesterol, low‐density lipoprotein, plasmatic homocysteine, systolic blood pressure, body mass index and tumour necrosis factor alpha), widely accepted in literature as risk factors for cardiovascular NCDs. Literature review results provided input for Markov chain simulation model. The model provides a simulation, using USA population projections, of potential reduction in morbidity and direct public health cost associated with different FV concentrates supplementation regimes.ResultsThe literature review has revealed a significant research gap about the effect of FV supplementation on NCDs. Building upon the (modest) evidence documented in literature, we show that FV concentrates have important potential in lowering NCD burden. A combined FV concentrate, such as Juice plus, appears to yield a significant gain in terms of lowering the risk of CHD in general population. Artichoke leaf juice concentrate and cherry juice concentrate produce non‐negligible effects in lowering the risk of stroke in vulnerable population (individuals with metabolic syndrome and hypertension). We found less evidence for heart failure, though the literature suggests effectiveness of fruit and vegetable juice.ConclusionIn conclusion, FV concentrates appear to play a non‐negligible role in prevention of cardiovascular diseases in healthy and vulnerable populations, and this is particularly relevant because of the increasing tendency to consume less fresh fruit and vegetables. Despite the documented potential benefits, FV supplements are still poorly debated in scientific research: high quality and long‐term studies are necessary to understand their effect on human well‐being and their potential for health care system.