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Daily Apple versus Dried Plum: Impact on Cardiovascular Disease Risk Factors in Postmenopausal Women

      Abstract

      Background

      Evidence suggests that consumption of apple or its bioactive components modulate lipid metabolism and reduce the production of proinflammatory molecules. However, there is a paucity of such research in human beings.

      Objective

      Women experience a lower rate of cardiovascular disease before menopause compared with men. However, after the onset of menopause, the risk of cardiovascular disease increases drastically due to ovarian hormone deficiency. Hence, we conducted a 1-year clinical trial to evaluate the effect of dried apple vs dried plum consumption in reducing cardiovascular disease risk factors in postmenopausal women.

      Design

      One-hundred sixty qualified postmenopausal women were recruited from the greater Tallahassee, FL, area during 2007-2009 and were randomly assigned to one of two groups: dried apple (75 g/day) or dried plum (comparative control). Fasting blood samples were collected at baseline, 3, 6, and 12 months to measure various parameters. Physical activity recall and 7-day dietary recall were also obtained.

      Results

      Neither of the dried fruit regimens significantly affected the participants' reported total energy intake throughout the study period. On the contrary, women who consumed dried apple lost 1.5 kg body weight by the end of the study, albeit not significantly different from the dried plum group. In terms of cholesterol, serum total cholesterol levels were significantly lower in the dried apple group compared with the dried plum group only at 6 months. Although dried plum consumption did not significantly reduce serum total cholesterol and low-density lipoprotein cholesterol levels, it lowered their levels numerically by 3.5% and 8%, respectively, at 12 months compared with baseline. This may explain the lack of significance observed between the groups. However, within the group, women who consumed dried apple had significantly lower serum levels of total cholesterol and low-density lipoprotein cholesterol by 9% and 16%, respectively, at 3 months compared with baseline. These serum values were further decreased to 13% and 24%, respectively, after 6 months but stayed constant thereafter. The within-group analysis also reported that daily apple consumption profoundly improved atherogenic risk ratios, whereas there were no significant changes in lipid profile or atherogenic risk ratios as a result of dried plum consumption. Both dried fruits were able to lower serum levels of lipid hydroperoxide and C-reactive protein. However, serum C-reactive protein levels were significantly lower in the dried plum group compared with the dried apple group at 3 months.

      Conclusions

      There were no significant differences between the dried apple and dried plum groups in altering serum levels of atherogenic cholesterols except total cholesterol at 6 months. However, when within treatment group comparisons are made, consumption of 75 g dried apple (about two medium-sized apples) can significantly lower atherogenic cholesterol levels as early as 3 months. Furthermore, consumption of dried apple and dried plum are beneficial to human health in terms of anti-inflammatory and antioxidative properties.

      Keywords

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      References

        • Lloyd-Jones D.
        • Adams R.
        • Carnethon M.
        • et al.
        Heart disease and stroke statistics—2009 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
        Circulation. 2009; 119: 480-486
        • Baksu B.
        • Davas I.
        • Agar E.
        • Akyol A.
        • Uluocak A.
        Do different delivery systems of estrogen therapy influence serum lipids differently in surgically menopausal women?.
        J Obstet Gynaecol Res. 2007; 33: 346-352
        • Miller V.T.
        Lipids, lipoproteins, women and cardiovascular disease.
        Atherosclerosis. 1994; 108: S73-S82
        • Hjortland M.C.
        • McNamara P.M.
        • Kannel W.B.
        Some atherogenic concomitants of menopause: The Framingham Study.
        Am J Epidemiol. 1976; 103: 304-311
        • Piche M.E.
        • Lemieux S.
        • Weisnagel S.J.
        • Corneau L.
        • Nadeau A.
        • Bergeron J.
        Relation of high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-alpha, and fibrinogen to abdominal adipose tissue, blood pressure, and cholesterol and triglyceride levels in healthy postmenopausal women.
        Am J Cardiol. 2005; 96: 92-97
        • Ridker P.M.
        • Hennekens C.H.
        • Buring J.E.
        • Rifai N.
        C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women.
        N Engl J Med. 2000; 342: 836-843
        • Bednarek-Tupikowska G.
        • Tupikowski K.
        • Bidzinska B.
        • et al.
        Serum lipid peroxides and total antioxidant status in postmenopausal women on hormone replacement therapy.
        Gynecol Endocrinol. 2004; 19: 57-63
        • Signorelli S.S.
        • Neri S.
        • Sciacchitano S.
        • et al.
        Duration of menopause and behavior of malondialdehyde, lipids, lipoproteins and carotid wall artery intima-media thickness.
        Maturitas. 2001; 39: 39-42
        • Alsheikh-Ali A.A.
        • Ambrose M.S.
        • Kuvin J.T.
        • Karas R.H.
        The safety of rosuvastatin as used in common clinical practice: A postmarketing analysis.
        Circulation. 2005; 111: 3051-3057
      1. Consumer Reports Best Buy Drug.
        (Accessed November 15, 2010)
        • Anderson E.
        Cellular homeostasis and the breast.
        Maturitas. 2004; 48: S13-S17
        • Rossouw J.E.
        • Anderson G.L.
        • Prentice R.L.
        • et al.
        Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial.
        JAMA. 2002; 288: 321-333
        • Arjmandi B.H.
        • Ahn J.
        • Nathani S.
        • Reeves R.D.
        Dietary soluble fiber and cholesterol affect serum cholesterol concentration, hepatic portal venous short-chain fatty acid concentrations and fecal sterol excretion in rats.
        J Nutr. 1992; 122: 246-253
        • Arjmandi B.H.
        • Craig J.
        • Nathani S.
        • Reeves R.D.
        Soluble dietary fiber and cholesterol influence in vivo hepatic and intestinal cholesterol biosynthesis in rats.
        J Nutr. 1992; 122: 1559-1565
        • Lucas E.A.
        • Juma S.
        • Stoecker B.J.
        • Arjmandi B.H.
        Prune suppresses ovariectomy-induced hypercholesterolemia in rats.
        J Nutr Biochem. 2000; 11: 255-259
        • Tinker L.F.
        • Schneeman B.O.
        • Davis P.A.
        • Gallaher D.D.
        • Waggoner C.R.
        Consumption of prunes as a source of dietary fiber in men with mild hypercholesterolemia.
        Am J Clin Nutr. 1991; 53: 1259-1265
        • Wolk A.
        • Manson J.E.
        • Stampfer M.J.
        • et al.
        Long-term intake of dietary fiber and decreased risk of coronary heart disease among women.
        JAMA. 1999; 281: 1998-2004
        • Aprikian O.
        • Duclos V.
        • Guyot S.
        • et al.
        Apple pectin and a polyphenol-rich apple concentrate are more effective together than separately on cecal fermentations and plasma lipids in rats.
        J Nutr. 2003; 133: 1860-1865
        • Gonzalez M.
        • Rivas C.
        • Caride B.
        • Lamas M.A.
        • Taboada M.C.
        Effects of orange and apple pectin on cholesterol concentration in serum, liver and faeces.
        J Physiol Biochem. 1998; 54: 99-104
        • Boyer J.
        • Liu R.H.
        Apple phytochemicals and their health benefits.
        Nutr J. 2004; 3: 5
        • Waladkhani A.R.
        • Clemens M.R.
        Effect of dietary phytochemicals on cancer development (review).
        Int J Mol Med. 1998; 1: 747-753
        • Dragsted L.O.
        • Strube M.
        • Larsen J.C.
        Cancer-protective factors in fruits and vegetables: Biochemical and biological background.
        Pharmacol Toxicol. 1993; 72: 116-135
        • Sallis J.F.
        • Haskell W.L.
        • Wood P.D.
        • et al.
        Physical activity assessment methodology in the Five-City Project.
        Am J Epidemiol. 1985; 121: 91-106
        • Blair S.N.
        • Goodyear N.N.
        • Wynne K.L.
        • Saunders R.P.
        Comparison of dietary and smoking habit changes in physical fitness improvers and nonimprovers.
        Prev Med. 1984; 13: 411-420
        • Taylor C.B.
        • Coffey T.
        • Berra K.
        • Iaffaldano R.
        • Casey K.
        • Haskell W.L.
        Seven-day activity and self-report compared to a direct measure of physical activity.
        Am J Epidemiol. 1984; 120: 818-824
        • Elmore B.G.
        An Evaluation of Five Physical Activity Assessment Methods in a Group of Women.
        Physical Fitness Research Laboratory, University of Illinois, Champaign-Urbana, IL1989
        • Allain C.C.
        • Poon L.S.
        • Chan C.S.
        • Richmond W.
        • Fu P.C.
        Enzymatic determination of total serum cholesterol.
        Clin Chem. 1974; 20: 470-475
        • Roeschlau P.
        • Bernt E.
        • Gruber W.
        Enzymatic determination of total cholesterol in serum.
        Z Klin Chem Klin Biochem. 1974; 12: 226
        • Trinder P.
        Determination of blood glucose using an oxidase-peroxidase system with a non-carcinogenic chromogen.
        J Clin Pathol. 1969; 22: 158-161
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • Obarzanek E.
        • Sacks F.M.
        • Vollmer W.M.
        • et al.
        Effects on blood lipids of a blood pressure-lowering diet: The Dietary Approaches to Stop Hypertension (DASH) Trial.
        Am J Clin Nutr. 2001; 74: 80-89
        • Djousse L.
        • Arnett D.K.
        • Coon H.
        • Province M.A.
        • Moore L.L.
        • Ellison R.C.
        Fruit and vegetable consumption and LDL cholesterol: The National Heart, Lung, and Blood Institute Family Heart Study.
        Am J Clin Nutr. 2004; 79: 213-217
        • Cerda J.J.
        • Robbins F.L.
        • Burgin C.W.
        • Baumgartner T.G.
        • Rice R.W.
        The effects of grapefruit pectin on patients at risk for coronary heart disease without altering diet or lifestyle.
        Clin Cardiol. 1988; 11: 589-594
        • Anderson J.W.
        Dietary fibre, complex carbohydrate and coronary artery disease.
        Can J Cardiol. 1995; 11: 55G-62G
        • Arjmandi B.H.
        • Sohn E.
        • Juma S.
        • Murthy S.R.
        • Daggy B.P.
        Native and partially hydrolyzed psyllium have comparable effects on cholesterol metabolism in rats.
        J Nutr. 1997; 127: 463-469
        • Truswell A.S.
        Dietary fiber and health.
        World Rev Nutr Diet. 1993; 72: 148-164
        • Conceicao de Oliveira M.
        • Sichieri R.
        • Sanchez Moura A.
        Weight loss associated with a daily intake of three apples or three pears among overweight women.
        Nutrition. 2003; 19: 253-256
        • Alvarez-Parrilla E.
        • De La Rosa L.A.
        • Legarreta P.
        • Saenz L.
        • Rodrigo-Garcia J.
        • Gonzalez-Aguilar G.A.
        Daily consumption of apple, pear and orange juice differently affects plasma lipids and antioxidant capacity of smoking and non-smoking adults.
        Int J Food Sci Nutr. 2010; 61: 369-380
        • Setorki M.
        • Asgary S.
        • Eidi A.
        • Rohani A.H.
        • Esmaeil N.
        Effects of apple juice on risk factors of lipid profile, inflammation and coagulation, endothelial markers and atherosclerotic lesions in high cholesterolemic rabbits.
        Lipids Health Dis. 2009; 8: 39
        • Decorde K.
        • Teissedre P.L.
        • Auger C.
        • Cristol J.P.
        • Rouanet J.M.
        Phenolics from purple grape, apple, purple grape juice and apple juice prevent early atherosclerosis induced by an atherogenic diet in hamsters.
        Mol Nutr Food Res. 2008; 52: 400-407
        • Lotito S.B.
        • Frei B.
        Relevance of apple polyphenols as antioxidants in human plasma: Contrasting in vitro and in vivo effects.
        Free Radic Biol Med. 2004; 36: 201-211
        • Osada K.
        • Suzuki T.
        • Kawakami Y.
        • et al.
        Dose-dependent hypocholesterolemic actions of dietary apple polyphenol in rats fed cholesterol.
        Lipids. 2006; 41: 133-139
        • Miura D.
        • Miura Y.
        • Yagasaki K.
        Effect of apple polyphenol extract on hepatoma proliferation and invasion in culture and on tumor growth, metastasis, and abnormal lipoprotein profiles in hepatoma-bearing rats.
        Biosci Biotechnol Biochem. 2007; 71: 2743-2750
        • Auclair S.
        • Silberberg M.
        • Gueux E.
        • et al.
        Apple polyphenols and fibers attenuate atherosclerosis in apolipoprotein E-deficient mice.
        J Agric Food Chem. 2008; 56: 5558-5563
        • Sanchez D.
        • Muguerza B.
        • Moulay L.
        • Hernandez R.
        • Miguel M.
        • Aleixandre A.
        Highly methoxylated pectin improves insulin resistance and other cardiometabolic risk factors in Zucker fatty rats.
        J Agric Food Chem. 2008; 56: 3574-3581
        • Bravo L.
        Polyphenols: Chemistry, dietary sources, metabolism, and nutritional significance.
        Nutr Rev. 1998; 56: 317-333
        • Perrigue M.
        • Carter B.
        • Roberts S.A.
        • Drewnowski A.
        A low-calorie beverage supplemented with low-viscosity pectin reduces energy intake at a subsequent meal.
        J Food Sci. 2010; 75: H300-H305
        • de Oliveira M.C.
        • Sichieri R.
        • Venturim Mozzer R.
        A low-energy-dense diet adding fruit reduces weight and energy intake in women.
        Appetite. 2008; 51: 291-295
        • Barter P.
        • Gotto A.M.
        • LaRosa J.C.
        • et al.
        HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events.
        N Engl J Med. 2007; 357: 1301-1310
        • Hsia S.H.
        • Pan D.
        • Berookim P.
        • Lee M.L.
        A population-based, cross-sectional comparison of lipid-related indexes for symptoms of atherosclerotic disease.
        Am J Cardiol. 2006; 98: 1047-1052
        • Bisoendial R.J.
        • Boekholdt S.M.
        • Vergeer M.
        • Stroes E.S.
        • Kastelein J.J.
        C-reactive protein is a mediator of cardiovascular disease.
        Eur Heart J. 2010; 31: 2087-2091
        • Steinberg D.
        A critical look at the evidence for the oxidation of LDL in atherogenesis.
        Atherosclerosis. 1997; 131: S5-S7
        • Berliner J.A.
        • Heinecke J.W.
        The role of oxidized lipoproteins in atherogenesis.
        Free Radic Biol Med. 1996; 20: 707-727

      Biography

      S. C. Chai is a postdoctoral research associate, Nutrition Research Institute, The University of North Carolina at Chapel Hill; at the time of the study, she was a doctoral research assistant, Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee.

      Biography

      S. Hooshmand is an assistant professor, The School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA; at the time of the study, she was a doctoral research assistant, Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee.

      Biography

      R. L. Saadat is a registered dietitian, Weight Loss Centers, Beverly Hills, CA; at the time of the study, she was a master's level research assistant, Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee.

      Biography

      M. E. Payton is a professor, Department of Statistics, Oklahoma State University, Stillwater.

      Biography

      K. Brummel-Smith is professor and chair, Department of Geriatrics, College of Medicine, The Florida State University, Tallahassee.

      Biography

      B. H. Arjmandi is professor and chair, Department of Nutrition, Food, and Exercise Sciences, and director for the Center for Advancing Exercise and Nutrition Research on Aging, The Florida State University, Tallahassee.