Intake Of Apples Research Articles

A flavonoid-rich diet is associated with lower risk and improved imaging biomarkers of nonalcoholic fatty liver disease: a prospective cohort study

BackgroundMechanistic studies and short-term randomized trials suggest higher intakes of dietary flavonoids may protect against nonalcoholic fatty liver disease (NAFLD). ObjectivesWe aimed to perform the first population-based study with long-term follow-up on flavonoid consumption, incident NAFLD, and validated NAFLD biomarkers. MethodsIn a prospective study, we assessed the associations between flavonoid intake based on ≥2 24-h dietary assessments and NAFLD risk among 121,064 adults aged 40–69 y by multivariable Cox regression analyses. We further assessed the associations between flavonoid intake and magnetic resonance imaging-derived liver fat (a subset of n = 11,435) and liver-corrected T1 values (cT1; a subset of n = 9570), a marker of steatosis, more sensitive to inflammatory pathology. ResultsOver 10 y of follow-up, 1081 cases of NAFLD were identified. Participants in the highest quartile (Q4) of the flavodiet score reflecting the consumption of foods high in flavonoids, had a 19% lower risk of NAFLD compared to the lowest quartile (Q1) [hazard ratio (HR) (95% confidence interval (CI): 0.81 (0.67, 0.97), P-trend = 0.02)]. Moreover, participants in the Q4 of the flavodiet score had lower liver fat and cT1 values than those in Q1 (liver fat: relative difference Q1 compared with Q4: –5.28%, P-trend = <0.001; cT1: relative difference Q1 compared with Q4: –1.73%, P-trend = <0.001). When compared to low intakes, high intakes of apples and tea were associated with lower NAFLD risk [apples: HR (95% CI): 0.78 (0.67, 0.92), P-trend = <0.01; tea: HR (95% CI): 0.86 (0.72, 1.02), P-trend = 0.03)]. Additionally, when compared to low intakes, high apple, tea, and dark chocolate intakes were significantly associated with lower liver fat values, whereas high tea and red pepper intakes were significantly associated with lower cT1 values. ConclusionsThe consumption of flavonoid-rich foods was associated with a reduced risk of NAFLD among middle-aged adults.

Flavonoid intakes, chronic obstructive pulmonary disease, adult asthma, and lung function: a cohort study in the UK Biobank

BackgroundGiven their antioxidative stress, anti-allergic, anti-inflammatory, and immune-modulating effects, flavonoids are hypothesized to play a role in preventing chronic obstructive pulmonary disease (COPD) and asthma. ObjectivesThis cohort study aimed to examine associations between flavonoid intake and COPD, asthma, and lung function. MethodsAmong 119,466 participants of the UK Biobank, median [interquartile range] age of 60 [53, 65] y, we estimated intakes of flavonoids, flavonoid-rich foods, and a flavodiet score from 24-h diet assessments. Prospective associations with both incident COPD and asthma and cross-sectional associations with measures of lung function [%predicted forced expiratory volume in 1s (FEV1); and FEV1/forced vital capacity (FVC)] were examined using multivariable-adjusted Cox proportional hazards and linear regression models, respectively. We investigated mediation by inflammation––represented by the INFLA score––and stratified analyses by smoking status. ResultsCompared with low intakes, moderate intakes of total flavonoids, flavonols, theaflavins + thearubigins, and flavanones, and moderate-to-high intakes of flavanol monomers, proanthocyanidins, anthocyanins, flavones, and the flavodiet score were associated with up to an 18% lower risk of incident COPD {e.g., [hazard ratio (95% confidence interval) for total flavonoids: 0.83 (0.75, 0.92)]} but not incident asthma. Furthermore, compared with low intakes, higher intakes of all flavonoid subclasses (except theaflavins + thearubigins), and the flavodiet score were associated with better percent predicted FEV1 baseline. Associations were most apparent in ever (current or former) smokers. Flavonoid intakes were inversely associated with the INFLA score, which appeared to mediate 11%–14% of the association between intakes of proanthocyanidins and flavones and incident COPD. ConclusionsModerate-to-high flavonoid intakes were associated with a lower risk of COPD and better lung function, particularly among ever smokers. Promoting intakes of healthy flavonoid-rich foods, namely, tea, apples, and berries, may improve respiratory health and lower COPD risk, particularly in individuals with a smoking history.

Flavonoid-Rich Fruit Intake in Midlife and Late-Life and Associations with Risk of Dementia: The Framingham Heart Study

BackgroundFruits are an important source of flavonoids, and greater intake of dietary flavonoids in older adults has been shown to be associated with decreased risk of dementia. It is unclear whether this relationship is similar or different between younger adults and older adults.ObjectivesWe examined for associations between midlife and late-life intake of flavonoid-rich fruits and incident dementia. We hypothesized that greater total cumulative intake of flavonoid-rich fruits in midlife and late-life adults would be associated with reduced risk of all-cause dementia.DesignLongitudinal, cohort study design.SettingFramingham Heart Study, which is a longitudinal, multi-generational community-based cohort based in Framingham, Massachusetts, USA.ParticipantsParticipants from the Framingham Heart Study Offspring cohort were included (n = 2,790) who attended the fifth core exam between 1991 to 1995, and were dementiafree and at least 45 years of age at that time, as well as had valid food frequency questionnaires from the fifth to ninth core exams.MeasurementsConsumption of fruits with high flavonoid content or are important contributors to overall flavonoid intake was collected via food frequency questionnaire. Flavonoid-rich fruits from the food frequency questionnaire included raisins or grapes, prunes, bananas, fresh apples or pears, apple juice or cider, oranges, orange juice, grapefruit, grapefruit juice, strawberries, blueberries, and peaches, apricots, or plums. Dementia ascertainment was based on a multidisciplinary consensus committee, and included all-cause dementia and Alzheimer’s disease dementia diagnoses based on research criteria. Cox models were used to examine associations between cumulative fruit intake and incident dementia, stratified by midlife (45–59 years; n = 1,642) and late-life (60–82 years; n = 1,148).ResultsGreater cumulative total fruit intake in midlife, but not late-life, was significantly associated with a 44% decreased risk of all-cause dementia (HR = 0.56; 95% CI = 0.32–0.98; p = 0.044). Decreased risk of all-cause dementia was also associated with higher intake of apples or pears in midlife and late-life, as well as higher intake of raisins or grapes in midlife only, and higher intake of oranges, grapefruit, blueberries, and peaches, apricots, or plums in late-life only.ConclusionsAmong participants from the Framingham Heart Study, greater overall consumption of flavonoid-rich fruits in midlife was associated with reduced risk of dementia, though intake of specific fruits in midlife and late-life may have a protective role against developing dementia. These findings may help to inform future recommendations on when dietary interventions may be most beneficial to healthy brain aging across the life course.

Impact of midlife intake of flavonoid‐rich fruits on dementia risk in the Framingham Heart Study

AbstractBackgroundConsumption of foods with high flavonoid content may be protective against dementia in older adults, but it is unclear whether this relationship is consistent earlier in life. We investigated the relationship between consumption of flavonoid‐rich fruits in midlife and risk of dementia, including Alzheimer’s disease (AD).Method1,642 participants from the Framingham Heart Study Offspring cohort who were aged 45‐59 years and did not have prevalent dementia at Exam 5 (1991‐1995), and had a valid food frequency questionnaire data were included. Intake of 12 fruit items with high flavonoid content or are important contributors to overall flavonoid intake at Exam 5 were examined. Total fruit intake was calculated by summing intake of each fruit item. Diagnoses of all‐cause dementia and AD dementia were adjudicated by a multi‐disciplinary consensus committee through 2019. Cox models were used to evaluate the association between higher intake (&gt;30th percentile) versus lower intake (≤30th percentile) of total fruit consumption, as well for each fruit item, and incident dementia, adjusting for demographic, behavior and lifestyle, dietary, genetic, and clinical factors.ResultThe sample was, on average, 52 years of age, 53% female, and had 14 years of education, with an average follow up time of 24 years in the study. Higher intake of total fruits was associated with decreased risk of all‐cause dementia (HR = 0.56; 95% CI = 0.32 – 0.98), but not with AD dementia. Decreased risk of all‐cause dementia was associated with higher intake of apples or pears (HR = 0.47; 95% CI = 0.27 – 0.81), and oranges (HR = 0.55; 95% CI = 0.32 – 0.95). Higher intakes of apples or pears (HR = 0.50; 95% CI = 0.25 – 1.00), and oranges (HR = 0.43; 95% CI = 0.22 – 0.85), were also associated with decreased risk of AD dementia. Sex modified the association between total fruit intake in midlife and dementia risk (HRfemale = 0.46; 95% CI = 0.21 – 0.97; HRmale = 0.65; 95% CI = 0.27 – 1.60).ConclusionGreater consumption of flavonoid‐rich fruits in midlife, particularly apples or pears, as well as oranges, were significantly associated with reduced dementia risk.

Different types of fruit intake and colorectal cancer risk: A meta-analysis of observational studies.

Multiple studies investigating the relationship between intake of different types of fruit and colorectal cancer (CRC) risk have yielded inconsistent results. To perform a meta-analysis of existing studies to assess the association between the intake of different kinds of fruit and the incidence of CRC. We searched online literature databases including PubMed, Embase, WOS, and Cochrane Library for relevant articles available up to August 2022. With data extracted from observational studies, odds ratios (ORs) with 95% confidence intervals (CIs) were assessed using random-effects models. A funnel plot and Egger's test were used to determine publication bias. Furthermore, subgroup analysis and dose-response analysis were performed. All analyses were conducted using R (version 4.1.3). Twenty-four eligible studies involving 1068158 participants were included in this review. The meta-analysis showed that compared to a low intake, a higher intake of citrus, apples, watermelon, and kiwi reduced the risk of CRC by 9% [OR (95%CI) = 0.91 (0.85-0.97)], 25% [OR (95%CI) = 0.75 (0.66-0.85)], 26% [OR (95%CI) = 0.74 (0.58-0.94)], 13% [OR (95%CI) = 0.87 (0.78-0.96)], respectively. No significant association was observed between the intake of other types of fruit and the risk of CRC. In the dose-response analysis, a nonlinear association was found [R (95%CI) = -0.0031 (-0.0047 to -0.0014)] between citrus intake and CRC risk (P < 0.001), with the risk minimized around 120 g/d (OR = 0.85), while no significant dose-response correlation was observed after continued increase in intake. We found that a higher intake of citrus, apples, watermelon, and kiwi was negatively associated with the risk of CRC, while the intake of other types of fruits were not significantly associated with CRC. Citrus intake showed a non-linear dose-response relationship with the risk of CRC. This meta-analysis provides further evidence that a higher intake of specific types of fruit is effective in preventing the occurrence of CRC.

Adherence to Nordic dietary patterns and risk of first-trimester spontaneous abortion.

Evidence on the influence of modifiable risk factors on spontaneous abortion (SAB) is scarce. We investigated associations for adherence to national dietary guidelines and a healthy Nordic diet with first-trimester (≤ 12weeks' gestation) SAB in a Danish cohort of couples trying to conceive. Participants completed a questionnaire on sociodemographics, lifestyle and reproductive history and a validated food frequency questionnaire (FFQ). We ascertained pregnancies from follow-up questionnaires and restricted analyses to 3,043 women who became pregnant. We assessed adherence to the Danish Dietary Guidelines Index (DDGI, range of 0-6, from low to high), covering intake of fruit, vegetables, fish, red and processed meat, whole grains, saturated fat and added sugar. The Healthy Nordic Food Index (HNFI, range 0-6) covered intake of fish, cabbage, rye bread, apples, pears, root vegetables and oatmeal. Pregnancy outcomes were identified through Danish medical registries or self-reported. We used Cox proportional hazards regression to compute hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for sociodemographics and lifestyle. Fifteen percent of participants had a first-trimester SAB. Compared with a DDGI score < 3, adjusted HRs (95% CIs) for scores 3 to < 4, 4 to < 5 and ≥ 5 were 0.85 (0.59-1.23), 0.78 (0.54-1.12) and 0.71 (0.44-1.13), respectively. Compared with an HNFI score < 2, adjusted HRs (95% CIs) for scores 2 to < 3, 3 to < 4, 4 to < 5 and ≥ 5 were 0.84 (0.62-1.15), 0.88 (0.66-1.19), 0.94 (0.69-1.28) and 0.69 (0.49-0.96), respectively. Greater pre-pregnancy adherence to Danish dietary guidelines or a healthy Nordic diet was associated with a lower rate of first-trimester SAB, although estimates were imprecise.

Urinary concentrations and determinants of pyrethroid metabolites in pregnant women from non-rural areas of Yunnan, China.

The study assesses the levels of urinary pyrethroid pesticide (PYR) in women during early pregnancy. The factors associated with exposure are also determined. A total of 480 pregnant women from non-rural areas visiting hospital for prenatal examination during early pregnancy were enrolled. A self-designed, structured questionnaire was used to collect data on potential factors of PYR exposure. Urinary PYR metabolite levels were quantified using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The majority of urine samples (98.8%) contained one or more PYR metabolite, although only a few women self-reported pesticide exposure. Urinary 3-phenoxybenzoic acid (3PBA) levels were close to those reported in certain developed countries. However, the levels of 3-(2,2-dibromovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (DBCA) and 4-fluoro-3-phenoxybenzoic acid (4F3PBA) were higher than those reported in previous studies. Urinary PYR levels were positively associated with exposure to pesticides, consumption of bananas and oranges, the number of fruit types the women regularly ate, being multiparous, and cooked frequently. They were negatively associated with early pregnancy body mass index (BMI), unemployment, frequent intake of apples, and washing fruits and vegetables with soda or hot water. Pregnant women in non-rural areas were extensively exposed to low levels of PYRs. Dietary intake may be the primary pathway of exposure. The presented findings highlight the importance of using appropriate methods to reduce pesticide residues in food.

Maternal consumption of vegetables, fruit, and antioxidants during pregnancy and risk for childhood behavioral problems.

The aim of this pre-birth cohort study was to examine the associations between maternal intake of vegetables, fruit, and antioxidants during pregnancy and behavioral problems in Japanese children 5 y of age. Participants were 1199 mother-child pairs. Dietary intake was assessed using a diet history questionnaire. Emotional, conduct, hyperactivity, and peer problems, as well as low prosocial behavior were assessed using the parent version of the Strengths and Difficulties Questionnaire. Adjustment was made for maternal age, gestation at baseline, region of residence, number of children, maternal and paternal education, household income, maternal depressive symptoms during pregnancy, maternal alcohol intake during pregnancy, maternal smoking during pregnancy, child's birth weight, child's sex, breastfeeding duration, and smoking in the household during the child's first year of life. Maternal intake of total vegetables and green and yellow vegetables during pregnancy was independently inversely associated with childhood low prosocial behavior. Maternal intake of other vegetables during pregnancy was independently inversely related to childhood hyperactivity problems and low prosocial behavior. Maternal intake of fruit and apples during pregnancy was independently inversely related to childhood hyperactivity problems. Maternal intake of citrus fruits during pregnancy was independently inversely related to childhood emotional, conduct, and hyperactivity problems. Maternal vitamin C intake during pregnancy was independently inversely associated with childhood conduct and hyperactivity problems and low prosocial behavior. Maternal intake of vegetables, fruit, and vitamin C during pregnancy may be preventive against any of the behavioral problems assessed here except for peer problems in Japanese children 5 y of age.

Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies.

Background: Questions remain about the strength and shape of the dose-response relationship between fruit and vegetable intake and risk of cardiovascular disease, cancer and mortality, and the effects of specific types of fruit and vegetables. We conducted a systematic review and meta-analysis to clarify these associations. Methods: PubMed and Embase were searched up to 29 September 2016. Prospective studies of fruit and vegetable intake and cardiovascular disease, total cancer and all-cause mortality were included. Summary relative risks (RRs) were calculated using a random effects model, and the mortality burden globally was estimated; 95 studies (142 publications) were included. Results: For fruits and vegetables combined, the summary RR per 200 g/day was 0.92 [95% confidence interval (CI): 0.90–0.94, I2 = 0%, n = 15] for coronary heart disease, 0.84 (95% CI: 0.76–0.92, I2 = 73%, n = 10) for stroke, 0.92 (95% CI: 0.90–0.95, I2 = 31%, n = 13) for cardiovascular disease, 0.97 (95% CI: 0.95–0.99, I2 = 49%, n = 12) for total cancer and 0.90 (95% CI: 0.87–0.93, I2 = 83%, n = 15) for all-cause mortality. Similar associations were observed for fruits and vegetables separately. Reductions in risk were observed up to 800 g/day for all outcomes except cancer (600 g/day). Inverse associations were observed between the intake of apples and pears, citrus fruits, green leafy vegetables, cruciferous vegetables, and salads and cardiovascular disease and all-cause mortality, and between the intake of green-yellow vegetables and cruciferous vegetables and total cancer risk. An estimated 5.6 and 7.8 million premature deaths worldwide in 2013 may be attributable to a fruit and vegetable intake below 500 and 800 g/day, respectively, if the observed associations are causal. Conclusions: Fruit and vegetable intakes were associated with reduced risk of cardiovascular disease, cancer and all-cause mortality. These results support public health recommendations to increase fruit and vegetable intake for the prevention of cardiovascular disease, cancer, and premature mortality.

Greater Adherence to the Alternative Healthy Eating Index Is Associated with Lower Incidence of Physical Function Impairment in the Nurses’ Health Study

Background: Physical function is integral to healthy aging, in particular as a core component of mobility and independent living in older adults, and is a strong predictor of mortality. Limited research has examined the role of diet, which may be an important strategy to prevent or delay a decline in physical function with aging.Objective: We prospectively examined the association between the Alternative Healthy Eating Index-2010 (AHEI-2010), a measure of diet quality, with incident impairment in physical function among 54,762 women from the Nurses’ Health Study.Methods: Physical function was measured by the Medical Outcomes Short Form-36 (SF-36) physical function scale and was administered every 4 y from 1992 to 2008. Cumulative average diet was assessed using food frequency questionnaires, administered approximately every 4 y. We used multivariable Cox proportional hazards models to estimate the HRs of incident impairment of physical function.Results: Participants in higher quintiles of the AHEI-2010, indicating a healthier diet, were less likely to have incident physical impairment than were participants in lower quintiles (P-trend < 0.001). The multivariable-adjusted HR of physical impairment for those in the top compared with those in the bottom quintile of the AHEI-2010 was 0.87 (95% CI: 0.84, 0.90). For individual AHEI-2010 components, higher intake of vegetables (P-trend = 0.003) and fruits (P-trend = 0.02); lower intake of sugar-sweetened beverages (P-trend < 0.001), trans fats (P-trend = 0.03), and sodium (P-trend < 0.001); and moderate alcohol intake (P-trend < 0.001) were each significantly associated with reduced rates of incident physical impairment. Among top contributors to the food components of the AHEI-2010, the strongest relations were found for increased intake of oranges, orange juice, apples and pears, romaine or leaf lettuce, and walnuts. However, associations with each component and with specific foods were generally weaker than the overall score, indicating that overall diet pattern is more important than individual parts.Conclusions: In this large cohort of older women, a healthier diet was associated with a lower risk of developing impairments in physical function.

Intake of apples, peppers and other foods high in flavonoids helps prevent weight gain

Intake of apples, peppers and other foods high in flavonoids helps prevent weight gain

Estimation of Apple Intake for the Exposure Assessment of Residual Chemicals Using Korea National Health and Nutrition Examination Survey Database.

The aims of this study were to develop strategies and algorithms of calculating food commodity intake suitable for exposure assessment of residual chemicals by using the food intake database of Korea National Health and Nutrition Examination Survey (KNHANES). In this study, apples and their processed food products were chosen as a model food for accurate calculation of food commodity intakes uthrough the recently developed Korea food commodity intake calculation (KFCIC) software. The average daily intakes of total apples in Korea Health Statistics were 29.60 g in 2008, 32.40 g in 2009, 34.30 g in 2010, 28.10 g in 2011, and 24.60 g in 2012. The average daily intakes of apples by KFCIC software was 2.65 g higher than that by Korea Health Statistics. The food intake data in Korea Health Statistics might have less reflected the intake of apples from mixed and processed foods than KFCIC software has. These results can affect outcome of risk assessment for residual chemicals in foods. Therefore, the accurate estimation of the average daily intake of food commodities is very important, and more data for food intakes and recipes have to be applied to improve the quality of data. Nevertheless, this study can contribute to the predictive estimation of exposure to possible residual chemicals and subsequent analysis for their potential risks.

Higher Fruit Intake Is Related to TNF-α Hypomethylation and Better Glucose Tolerance in Healthy Subjects

Background/Aim: This study hypothesized an association between healthy dietary patterns, hypermethylation of the tumor necrosis factor-α (TNF-α) promoter and decreased risk of metabolic changes. Methods: Forty normal-weight young women were involved in this cross-sectional study. DNA was isolated from white blood cells, and CpG site methylation in TNF-α was analyzed by Sequenom EpiTyper. The quality of the diet was assessed by Healthy Eating Index (HEI-2005). Results: Contradicting our hypothesis, HEI-2005 score was negatively associated with CpG5 (r = -0.460, p = 0.003) and TNF-α total methylation (r = -0.355, p = 0.026). A higher intake of fruits was related to lower insulin, HOMA-IR, and TNF-α methylation. No other dietary pattern was related to TNF-α methylation. TNF-α total methylation correlated positively with systolic blood pressure (r = 0.323; p = 0.042) and CpG5 methylation with body mass index (r = 0.333, p = 0.036). Furthermore, fiber intake was negatively associated with the CpG5 (r = -0.324, p = 0.041) and TNF-α total methylation (r = -0.434, p = 0.005), whereas vitamin C intake was negatively associated with TNF-α total methylation (r = -0.411, p = 0.009). Intakes of apples and citrus fruits were negatively associated with TNF-α total methylation. Conclusion: A healthy dietary pattern and higher fruit intake (particularly apples and citrus fruits) were related to better glucose tolerance in healthy subjects, which could be mediated by lower TNF-α methylation.

Higher dietary anthocyanin and flavonol intakes are associated with anti-inflammatory effects in a population of US adults

Background: Although growing evidence from trials and population-based studies has supported a protective role for flavonoids in relation to risk of certain chronic diseases, the underlying mechanisms remain unclear. Several previous studies focused on individual inflammatory biomarkers, but because of the limited specificity of any individual marker, an assessment of a combination of biomarkers may be more informative.Objective: We used an inflammation score (IS) that integrated 12 individual inflammatory biomarkers for the examination of associations with intakes of different flavonoid classes.Design: The study was a cross-sectional analysis of 2375 Framingham Heart Study Offspring Cohort participants. Intakes of total flavonoids and their classes (anthocyanins, flavonols, flavanones, flavan-3-ols, polymers, and flavones) were calculated from validated food-frequency questionnaires. Individual inflammatory biomarkers were ranked, standardized, and summed to derive an overall IS and subgroup scores of functionally related biomarkers.Results: In multivariate analyses, an inverse association between higher anthocyanin and flavonol intakes and IS was observed with a mean ± SE difference between quintile categories 5 and 1 of −1.48 ± 0.32 (P-trend ≤ 0.001) and −0.72 ± 0.33 (P-trend = 0.01), respectively. Results remained significant after additional adjustment for physical activity and vitamin C and fruit and vegetable intakes. Higher anthocyanin intake was inversely associated with all biomarker subgroups, whereas higher flavonol intake was associated only with lower cytokine and oxidative stress biomarker concentrations. In food-based analyses, higher intakes of apples and pears, red wine, and strawberries were associated with a lower IS with differences between quintiles 5 and 1 of −1.02 ± 0.43 (P = 0.006), −1.73 ± 0.39 (P < 0.001), and −0.44 ± 0.88 (P = 0.02), respectively. Although intakes of other classes were not associated with a reduction in overall IS, higher intakes of flavan-3-ols and their polymers were associated with a significant reduction in oxidative stress biomarkers.Conclusion: These findings provide evidence to suggest that an anti-inflammatory effect may be a key component underlying the reduction in risk of certain chronic diseases associated with higher intakes of anthocyanins and flavonols. The Framingham Offspring Study was registered at clinicaltrials.gov as NCT00005121 (Framingham Heart Study).

Intake of whole apples or clear apple juice has contrasting effects on plasma lipids in healthy volunteers

Fruit consumption is associated with a decreased risk of CVD in cohort studies and is therefore endorsed by health authorities as part of the '5 or more a day' campaigns. A glass of fruit juice is generally counted as one serving. Fruit may cause protection by affecting common risk factors of CVD. Apples are among the most commonly consumed fruits and were chosen for a comprehensive 5 × 4 weeks dietary crossover study to assess the effects of whole apples (550 g/day), apple pomace (22 g/day), clear and cloudy apple juices (500 ml/day), or no supplement on lipoproteins and blood pressure in a group of 23 healthy volunteers. The intervention significantly affected serum total and LDL-cholesterol. Trends towards a lower serum LDL-concentration were observed after whole apple (6.7%), pomace (7.9%) and cloudy juice (2.2%) intake. On the other hand, LDL-cholesterol concentrations increased by 6.9% with clear juice compared to whole apples and pomace. There was no effect on HDL-cholesterol, TAG, weight, waist-to-hip ratio, blood pressure, inflammation (hs-CRP), composition of the gut microbiota or markers of glucose metabolism (insulin, IGF1 and IGFBP3). Apples are rich in polyphenols and pectin, two potentially bioactive constituents; however, these constituents segregate differently during processing into juice products and clear juice is free of pectin and other cell wall components. We conclude that the fibre component is necessary for the cholesterol-lowering effect of apples in healthy humans and that clear apple juice may not be a suitable surrogate for the whole fruit in nutritional recommendations.

Intakes of apples or apple polyphenols decease plasma values for oxidized low-density lipoprotein/beta2-glycoprotein I complex

Many dietary modifications have been proposed to reduce cardiovascular disease risk, but often, these modifications require substantial effort. In contrast, in healthy middle aged adults, consumption of just one apple/day for 4weeks drastically lowered plasma concentrations of oxidized low-density lipoprotein/beta2-glycoprotein I complex (oxLDL-β2GPI), a proposed contributor to atherosclerosis. OxLDL-β2GPI values were also lowered by capsules of apple polyphenol extract, though not as much as with whole apples. Placebo capsules had no effect. The decrease in OxLDL-β2GPI concentrations in response to intake of apples or apple polyphenol extract were not accompanied by increased erythrocyte activities of superoxide dismutase 1, an antioxidant enzyme that can inhibit lipoprotein oxidation. In summary, an easily accomplished dietary intervention had a major effect on an atherosclerosis risk factor, in part via polyphenols, but not necessarily via superoxide dismutase.

Effect of repeated exposure to either fruits or vegetables during the first 18 days of weaning on fruit and vegetable intake of infants at 12 months

The low vegetable intake in children is probably due to the notion that vegetables are disliked. Because most taste preferences are formed during the first year of life, we started an intervention among weaning infants (n = 101) to increase the liking for vegetables. We expected that starting weaning with exclusively vegetable purees, would increase the infants’ preferences for vegetables and this effect would still be present 7 months after weaning. Half of the infants received exclusively vegetable purees during the first 18 days of weaning (vegetable group), and the other half received exclusively fruit purees (fruit group). At 12 ± 1.4 (mean ± SD) months of age, 82 of the infants participated in a follow-up measurement. Their parents completed a 3-day food diary (n = 71) in which they reported everything their infant consumed during three days. At two separate days in the laboratory we measured ad libitum intake of apples and green beans. The mean vegetable intake at home was significantly higher in the vegetable group than in the fruit group. Also the fruit consumption in the vegetable group was higher, although not significant. The fruit and vegetable groups have similar intakes of apples and green beans. These results show that starting weaning with vegetables has a positive influence on the reported vegetable intake at 12 months.

Moving Beyond Diet and Colorectal Cancer

olorectal cancer (CRC) is third in incidence and mor- tality of all cancers worldwide, with rates parallel- ing economic development and a Westernized life- style (1,2). The majority of CRC cases occur sporadically, with environmental influences such as diet, exercise, al- cohol, and smoking viewed as risk factors. CRC is also associated with increasing age, with the majority of CRC cases diagnosed in individuals who are 60 years or older. CRC develops from precancerous lesions (adenomas or polyps) to malignant adenocarcinoma through genetic mutations altering the cell growth cycle (3). It is believed that it takes 10 to 15 years for an adenoma to develop into an adenocarcinoma, thus highlighting the importance of exposure and time for environmental factors. A recent review by the World Cancer Research Fund/American Institute for Cancer Research states that whereas there is convincing evidence that reduced physical activity, in- creased abdominal adiposity, and increased red meat and processed meat intakes increase CRC risk, evidence of the protective effects of fruits and nonstarchy vegetables on CRC risk is limited (4). Because tumor location (left vs right-sided cancers) is influenced by potential different biological pathways that may be responsible for carcino- genesis (5), studying fruit and vegetable (F/V) intake based on cancer subsites remains to be explored. earlier. Total and subgroups for F/V intakes were quan- tified as daily equivalent frequencies and divided into quartiles. Body mass index (BMI) was calculated from self-reported weight and height (as kg/m 2 ) at age 20 years. Individuals were categorized by diabetes and smoking status, physical activity level, and socioeconomic index. Case and control subjects were frequency matched on age and sex. Odds ratios and a test of trends were calculated across quartiles of F/V intakes, adjusting for covariates. In addition, analyses for all CRC cases were done based on tumor site. Differences between case and control subjects were found. Subjects with proximal cases of colon cancer were older and more likely to be female, whereas cases of rectal cancers were more likely to be male compared with con- trol subjects. Control subjects were also more likely to be underweight (at age 20) compared with all case (tumor site) groups. Participants with distal and rectal cancers drank 30 g more alcohol per day than control subjects. Case subjects also lived in lower socioeconomic regions than did control subjects. Multivariate modeling for overall CRC risk demon- strated no association between total F/V intake (together and separate), but when subgroups were analyzed, intake of apples (highest to lowest quartile) and dark-yellow vegetables (second, third quartiles compared to lowest) was significantly associated with a decreased CRC risk. In contrast, intake of fruit juice (highest to lowest quar- tile) was associated with an increased risk of CRC with significance for trend. When multinomial modeling was done to examine the risks by cancer site, the results seemed similar to the overall CRC risk. Intake of F/V was not associated with proximal colon cancer and rectal cancer risk. In addition, similar to the overall CRC models, intake of dark yellow vegetables (Q4 vs Q1, odds ratio (OR) 0.61 95% confi- dence interval (CI): 0.41 to 0.92) and apples (Q4 vs Q1, OR 0.51 95% CI: 0.34 to 0.77) were significant for a protective effect for distal colon cancers, and fruit juice (Q4 vs Q1, OR 1.74 95% CI: 1.24 to 2.45) was associated with an increased risk for rectal cancers. The exceptions in cancer site risks compared with overall CRC risk were that distal colon cancers exhibited a significance for a protective effect (Q4 vs Q1, OR 0.58 95% CI: 0.36 to 0.93) for total F/V intakes, and intake of brassica vegeta- bles was protective for proximal colon cancer risk (Q4 vs Q1, OR 0.62 95% CI: 0.41 to 0.93). These findings are similar to previous findings in meta- analyses in which weak or no associations were reported (4); however, the analysis by cancer site provides new information. Historically, nutritional epidemiology has relied on using the dietary intake model to assess cancer risk without accounting for other factors involved in the carcinogenesis pathway and also often used self-report for anthropometric data. Information on obesity-related

Fruit and Vegetable Consumption and the Risk of Proximal Colon, Distal Colon, and Rectal Cancers in a Case-Control Study in Western Australia

Background Fruits and vegetables (F/V) have been examined extensively in nutrition research in relation to colorectal cancer (CRC). However, their protective effect is subject to debate, possibly because of different effects on different subsites of the large bowel. Objective To determine whether any association between F/V consumption and risk of CRC differed by subsite of the bowel (proximal colon, distal colon, and rectum). Design The Western Australian Bowel Health Study is a population-based, case-control study conducted between June 2005 and August 2007. Complete food frequency questionnaire data were analysed from 834 CRC cases and 939 controls. Logistic regression analysis was used to estimate the effects of quartiles of F/V intake on risk of CRC at different subsites. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for CRC overall and for the three separate subsites. Results Risk of proximal colon cancer and rectal cancer was not associated with intakes of total F/V, total vegetable, or total fruit. Brassica vegetable intake was inversely related with proximal colon cancer (Q4 vs Q1 OR 0.62; 95% CI 0.41 to 0.93). For distal colon cancer, significant negative trends were seen for total F/V, and total vegetable intake. Distal colon cancer risk was significantly decreased for intake of dark yellow vegetables (Q4 vs Q1 OR 0.61; 95% CI 0.41 to 0.92) and apples (Q4 vs Q1 OR 0.51; 95% CI 0.34 to 0.77). An increased risk for CRC was found to be associated with intake of fruit juice (Q4 vs Q1 OR 1.74; 95% CI 1.24 to 2.45). Conclusions Our results suggest that different F/V may confer different risks for cancer of the proximal colon, distal colon, or rectum. Future studies might consider taking into account the location of the tumor when examining the relation between F/V consumption and risk of CRC.

A comprehensive review of apples and apple components and their relationship to human health.

There has been an increasing appreciation and understanding of the link between dietary fruit and vegetable intake and improved health in humans. The widespread and growing intake of apples and apple juice/products and their rich phytochemical profile suggest their important potential to affect the health of the populations consuming them. This review summarizes current clinical, in vitro, and in vivo data and builds upon earlier published reports that apple may reduce the risk of chronic disease by various mechanisms, including antioxidant, antiproliferative, and cell signaling effects. Exposure to apples and apple products has been associated with beneficial effects on risk, markers, and etiology of cancer, cardiovascular disease, asthma, and Alzheimer's disease. Recent work suggests that these products may also be associated with improved outcomes related to cognitive decline of normal aging, diabetes, weight management, bone health, pulmonary function, and gastrointestinal protection.