The effects and associations of whole-apple intake on diverse cardiovascular risk factors. A narrative review

Nutritional attributes of traditional and commercial apple cultivars growing in West Himalaya, India

Apple is a deciduous fruit crop commonly grown worldwide in temperate regions, however, systematic exploration of apple cultivars growing in the Indian Himalayan landscape is poorly known. Therefore, present attempts focused on enumerating the nutritional attributes of traditional and commercial apple cultivars growing in major fruit belts of Uttarakhand. A varied range of carbohydrates (1.56-6.58 mg/g), proteins (0.64-3.29 mg/g), iron (2.50-12.33 ppb), manganese (0.06-3.59 ppb), chromium (0.12-0.90 ppb), copper (0.13-0.54 ppb), sodium (0.29-1.93 ppb) and potassium (7.35-28.35 ppb) fresh weight, respectively were recorded. The outcomes of the present study indicate that traditional and commercial apple cultivars growing (> 2200 m asl) in mid to higher altitude regions, namely Khabrar, Satbunga, Mukhwa were good sources of various nutritional constituents. Among cultivars, Rymer, Red Delicious emerged as an affluent source of mineral-nutritional contents, therefore, food industries should use these cultivars for the preparation of nutritional products, which will help reduce the deficiency of malnutrition. Outcomes will be useful for the horticulture department and breeders who are looking for the most promising apple cultivars. Their large-scale cultivation in the Himalayan landscape will benefit the production of fruits, conservation of traditional and commercial apple cultivars, and generate employment opportunities for mountainous communities of Himalaya.

The influence of different forms of apple products on all-cause mortality in patients with hypertension

Objective

Apple consumption has a positive effect on human health. Some studies have shown that an appropriate amount of apple intake can reduce the incidence of hypertension. However, few studies have investigated whether eating different forms of apples has the same benefits as eating whole apples. This study is aimed to evaluate the effect of different forms of apple on all-cause mortality in patients with hypertension.

Methods

The study included 2,368 patients with hypertension. All participants were followed up for at least 10 years. Cox regression model was constructed to analyze the correlation between apple, apple juice, and apple sauce consumption and all-cause mortality in patients with hypertension.

Results

The consumption of apples 3-6 times/week was associated with a 48% reduction in the risk of all-cause mortality in patients with hypertension (HR = 0.52, 95% CI: 0.37-0.72, p < 0.001). However, the consumption of apple juice (HR = 1.02, 95% CI: 0.67-1.56, p = 0.930) and sauce (HR = 1.28, 95% CI: 0.59-2.74, p = 0.531) tended to increase the risk of death in patients with hypertension, although this study did not obtain a statistically result.

Conclusion

Moderate consumption of whole apples is associated with a reduced risk of all-cause death in patients with hypertension, whereas apple juice and sauce may increase the risk of death.

A red-fleshed apple rich in anthocyanins improves endothelial function, reduces inflammation, and modulates the immune system in hypercholesterolemic subjects: the AppleCOR study

The study determines the sustained and acute effects of a red-fleshed apple (RFA), rich in anthocyanins (ACNs), a white-fleshed apple (WFA) without ACNs, and an infusion from Aronia melanocarpa (AI) with an equivalent content of ACNs as RFA, on different cardiometabolic risk biomarkers in hypercholesterolemic subjects. A randomized, parallel study was performed for 6 weeks and two dose-response studies were performed at the baseline and after intervention. At 6 weeks, RFA consumption improved ischemic reactive hyperemia and decreased C-reactive protein and interleukine-6 compared to WFA consumption. Moreover, at 6 weeks, AI decreased P-selectin compared to WFA and improved the lipid profile. Three products reduced C1q, C4 and Factor B, and RFA and AI reduced C3. Although both RFA and AI have a similar ACN content, RFA, by a matrix effect, induced more improvements in inflammation, whereas AI improved the lipid profile. Anti-inflammatory protein modulation by proteomic reduction of the complement system and immunoglobulins were verified after WFA, AI and RFA consumption.

Integrated soil-fruit-climate management system to improve apple production stability

Unstable agricultural systems, such as unreliable fruit production, threaten global food security and could negatively impact human nutrition. However, methods of maintaining a stable fruit supply have received little attention. Therefore, this study explored the impact of a systematic service model on the establishment of an integrated soil-fruit-climate management (ISM) approach and stabilization of apple yield based on a fixed-effects model using sample data from Fuji apple farmers in China for six consecutive years (2016-2021). The results showed that the systematic service model dramatically improved the adoption of ISM-based technology. By 2021, the rate of ISM technology adoption among farmers reached 84.4 %, especially pendulous branch-fruiting technology and Osmia pollination, which increased by 82.2 % and 37.8 %, respectively, compared to that in 2016. With the adoption of the ISM approach, apple yields and tree loadings stabilized over time. For example, the yield change rate and tree loading change rate were 14.8 % and 7.3 % lower, respectively, in 2021 than in 2016. We demonstrated through a fixed-effects analysis that the ISM approach exerts a fully mediated effect on the mechanism of action of service measure quantity disclosure, which positively impacted the rate of change in yield and tree loadings. This finding indicated that the six-in-one systematic service model of soil testing, pest and disease diagnosis, course training, meteorological monitoring, on-site guidance, and experimental demonstration established by the Science and Technology Backyard model resolved the information, goal, and hardware gaps that limited the adoption of this technology by farmers and promoted the construction of an integrated soil-fruit-climate management approach, which in turn has stabilized the apple production system.

Association between healthy eating index-2015 and abdominal aortic calcification: A population-based cross-sectional study

Background

An association between the healthy eating index (HEI)-2015 and risk of abdominal aortic calcification (AAC) is unclear in the general population of the United States (U.S.). Therefore, we examined the relationship between HEI-2015 and AAC risk in our research.

Methods

A cross-sectional study of National Health and Nutrition Examination Surveys (NHANES) participants between 2013 and 2014 was conducted. For the analysis of the association between HEI-2015 and AAC, the restricted cubic spline (RCS) plot and multivariable logistic regression models were used. In addition, we also conducted subgroup analysis for the relationship between HEI-2015 and AAC.

Results

There was a total of 1162 individuals. As shown by the RCS plot, HEI-2015 was linked with AAC risk in a U-shaped pattern (P for nonlinearity < 0.05). Taking into account known confounding variables, compared with the lowest quartiles, the odds ratios with 95% confidence intervals for AAC across the quartiles were 0.637 (0.425,0.956), 0.763 (0.499, 1.167), and 0.842 (0.561, 1.265). Based on the results of subgroup analysis, the HEI-2015 and AAC risk were U-curve correlated among all age groups, sex, with or without hypertension or DM, and BMI of <30 kg/m2. The greens and beans, and whole fruits are independent protective factor for AAC.

Conclusions

The U-shaped relationships exist between HEI-2015 and prevalence of AAC in the general U.S. population. Consequently, prevalence of AAC may be mitigated with reasonable and balanced diet.

Comparison of pesticide residue and specific nutrient levels in peeled and unpeeled apples

BACKGROUND

Studies have shown that the consumption of apples has a beneficial effect on cardiovascular diseases and some cancers, largely as a result of their micronutrient and phytoconstituent contents. Apple peel not only contains more polyphenols than the flesh, but also is likely to contain pesticide residues. The present study aimed to compare the contents of certain micronutrients and residual pesticide levels in peeled and unpeeled apples.

RESULTS

Peeled apples contained fewer pesticide residues at lower concentrations than unpeeled apples. However, whether samples were peeled or not, the exposure values for pesticide residues in apples never exceeded the acceptable daily intake (ADI), but ranged between 0.04% and 2.10% of the ADI in adults for food intake estimated at the 95th percentile (277 g per person per day). Determination of polyphenol, fibre, magnesium and vitamin C levels showed that the nutritional differences observed between peeled and unpeeled apples were marginal.

CONCLUSION

The consumption of apples, such as the apples tested in the present study, results in an exposure to pesticides that is low for unpeeled apples, and lower for peeled apples. Moreover, there was no significant loss of nutritional value from eating peeled apples based on the nutrients investigated. © 2022 Society of Chemical Industry.

Interactive Effects of Nutrition Modification and Wet Cupping on Male Patients with Refractory Stable Angina

Objectives

Routine therapies cannot control refractory stable angina, leading to a high economic burden and an impaired quality of life. Persian medicine incorporates exceptional attention to lifestyle and nutrition to prevent and treat various diseases. Previous studies have reported the analgesic and anti-inflammatory effects of wet cupping. The present study aims to determine the effects of nutrition and cupping on refractory stable angina patients.

Methods

Forty male patients with refractory stable angina were randomly allocated to four groups, including nutrition modification based on Persian medicine, wet cupping, nutrition modification along with wet cupping, and control. The primary outcomes were the changes in pain score using a visual analog scale and quality of life using the Seattle angina questionnaire. The secondary outcomes were changes in the exercise test and blood pressure.

Results

The results of the present study revealed that 30 days of treatment with nutrition modification based on Persian medicine, cupping, and modified nutrition and cupping along with standard treatment for stable angina significantly increased the patient’s quality of life and exercise test results while reducing pain, and systolic and diastolic blood pressure.

Conclusion

Applying complementary Persian medicine methods such as nutrition modification and cupping along with the classical medical treatments may improve outcomes for refractory stable angina patients.

Metabolic and Cardiovascular Benefits of Apple and Apple-Derived Products: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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].

Rosaceae food allergy: a review

This review provides a global overview on Rosaceae allergy and details the particularities of each fruit allergy induced by ten Rosaceae species: almond/peach/cherry/apricot/plum (Amygdaleae), apple/pear (Maleae), and raspberry/blackberry/strawberry (Rosoideae). Data on clinical symptoms, prevalence, diagnosis, and immunotherapies for the treatment of Rosaceae allergy are herein stated. Allergen molecular characterization, cross-reactivity/co-sensitization phenomena, the impact of food processing and digestibility, and the methods currently available for the Rosaceae detection/quantification in foods are also described. Rosaceae allergy has a major impact in context to pollen-food allergy syndrome (PFAS) and lipid transfer protein (LTP) allergies, being greatly influenced by geography, environment, and presence of cofactors. Peach, apple, and almond allergies are probably the ones most affecting the quality of life of the allergic-patients, although allergies to other Rosaceae fruits cannot be overlooked. From patients' perspective, self-allergy management and an efficient avoidance of multiple fruits are often difficult to achieve, which might raise the risk for cross-reactivity and co-sensitization phenomena and increase the severity of the induced allergic responses with time. At this point, the absence of effective allergy diagnosis (lack of specific molecular markers) and studies advancing potential immunotherapies are some gaps that certainly will prompt the progress on novel strategies to manage Rosaceae food allergies.

Red-Fleshed Apples Rich in Anthocyanins and White-Fleshed Apples Modulate the Aorta and Heart Proteome in Hypercholesterolaemic Rats: The AppleCOR Study

The impact of a red-fleshed apple (RFA) rich in anthocyanins (ACNs), a white-fleshed apple (WFA) without ACNs, and an extract infusion from Aronia fruit (AI) equivalent in dose of cyanidin-3-O-galactoside (main ACN) as RFA was determined by the proteome profile of aorta and heart as key cardiovascular tissues. Hypercholesterolaemic Wistar rats were separated into six groups (n = 6/group; three males and three females) and the proteomic profiles were analyzed using nanoliquid chromatography coupled to mass spectrometry. No adverse events were reported and all products were well tolerated. RFA downregulated C1QB and CFP in aorta and CRP in heart. WFA downregulated C1QB and CFP in aorta and C9 and C3 in aorta and heart, among other proteins. AI downregulated PRKACA, IQGAP1, and HSP90AB1 related to cellular signaling. Thus, both apples showed an anti-inflammatory effect through the complement system, while RFA reduced CRP. Regardless of the ACN content, an apple matrix effect was observed that involved different bioactive components, and inflammatory proteins were reduced.

Promising Nutritional Fruits Against Cardiovascular Diseases: An Overview of Experimental Evidence and Understanding Their Mechanisms of Action

Cardiovascular diseases (CVDs) are one of the leading causes of morbidity and mortality in both developed and developing countries, affecting millions of individuals each year. Despite the fact that successful therapeutic drugs for the management and treatment of CVDs are available on the market, nutritional fruits appear to offer the greatest benefits to the heart and have been proved to alleviate CVDs. Experimental studies have also demonstrated that nutritional fruits have potential protective effects against CVDs. The aim of the review was to provide a comprehensive summary of scientific evidence on the effect of 10 of the most commonly available nutritional fruits reported against CVDs and describe the associated mechanisms of action. Relevant literatures were searched and collected from several scientific databases including PubMed, ScienceDirect, Google Scholar and Scopus. In the context of CVDs, 10 commonly consumed nutritious fruits including apple, avocado, grapes, mango, orange, kiwi, pomegranate, papaya, pineapple, and watermelon were analysed and addressed. The cardioprotective mechanisms of the 10 nutritional fruits were also compiled and highlighted. Overall, the present review found that the nutritious fruits and their constituents have significant benefits for the management and treatment of CVDs such as myocardial infarction, hypertension, peripheral artery disease, coronary artery disease, cardiomyopathies, dyslipidemias, ischemic stroke, aortic aneurysm, atherosclerosis, cardiac hypertrophy and heart failure, diabetic cardiovascular complications, drug-induced cardiotoxicity and cardiomyopathy. Among the 10 nutritional fruits, pomegranate and grapes have been well explored, and the mechanisms of action are well documented against CVDs. All of the nutritional fruits mentioned are edible and readily accessible on the market. Consuming these fruits, which may contain varying amounts of active constituents depending on the food source and season, the development of nutritious fruits-based health supplements would be more realistic for consistent CVD protection.