Flavonoid-rich apple improves endothelial function in individuals at risk for cardiovascular disease: A randomized controlled clinical trial

Authors

Nicola P. Bondonno
Catherine P. Bondonno, Edith Cowan UniversityFollow
Lauren C. BlekkenhorstFollow
Michael J. Considine
Ghassan Maghzal
Roland Stocker
Richard J. Woodman
Natalie C. Ward
Jonathan M. Hodgson, Edith Cowan UniversityFollow
Kevin D. Croft

Document Type

Journal Article

Publication Title

Molecular Nutrition & Food Research

Publisher

Wiley-VCH Verlag

School

School of Medical and Health Sciences

RAS ID

26004

Comments

This is an Author's Accepted Manuscript of:

Bondonno, N. P., Bondonno, C. P., Blekkenhorst, L. C., Considine, M. J., Maghzal, G., Stocker, R., ... & Croft, K. D. (2018). Flavonoid‐Rich Apple Improves Endothelial Function in Individuals at Risk for Cardiovascular Disease: A Randomized Controlled Clinical Trial. Molecular Nutrition & Food Research, 62(3).

https://doi.org/10.1002/mnfr.201700674

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.

DOI

10.1002/mnfr.201700674