Vol. 84 No: 6

Title:
Isafruit Supplement
Mini-review: The effects of apples on plasma cholesterol levels and cardiovascular risk - a review of the evidence

Authors:
EVA N. JENSEN, TINE BUCH-ANDERSEN, GITTE RAVN-HAREN and LARS O. DRAGSTED

pp: 34-41

Abstract:
Evidence suggests that a high intake of fruits is associated with a reduced risk of cardiovascular disease (CVD) and lowered plasma cholesterol, but the specific effects of individual types of fruit, fruit fractions, and processed fruit are less well-studied. Apples are among the most frequently consumed fruits, and human and animal studies on apple may help to clarify the effect of this fruit on CVD risk markers. The aim of this mini-review is to summarise current evidence for a lowering effect of apple on the risk of CVD and plasma cholesterol levels, and to investigate whether such an effect is influenced by fruit processing or the form of intake. Possible mechanisms behind the cholesterol-lowering effect of apples are also considered. All relevant published experimental studies in humans and animals were identified within the open literature. Nine human studies were identified, of which four concerned the effects of whole apples, two the effects of dried apples, and three the effects of filtered apple juice. Additional studies considered specific apple components. In general, there was a cholesterol-lowering effect, in the range of 5 – 8%, after the intake of approx. three whole apples, whereas the consumption of apple juice (375 – 720 ml) had no effect on plasma cholesterol levels and may result in adverse effects on plasma triglyceride levels. Limitations in the study designs did not allow us to draw conclusions on the effect of the intake of whole, dried apples (15 – 52 g).We also identified a total of nine experimental studies in animal models. Feeding with apple products resulted in decreased levels of plasma (11 – 43%) and liver (23 – 67%) cholesterol in the majority of studies. There was an increased excretion of bile acids (3 – 56%) and cholesterol (5 – 41%) in rats fed with apple products. Based on the current evidence from human observational and intervention studies, it seems likely that a reduction in plasma total and LDL cholesterol occurs after a dietary intake of apples, which could lead to a decreased risk of CVD. On average, a daily intake of approx. three apples resulted in a decrease in total cholesterol of 5 – 8% (approx. 0.5 mmol l^-1). The consumption of filtered apple juice may result in adverse effects on plasma triglyceride levels. Evidence from animal studies suggests that the major mechanism behind the cholesterol-lowering effect of apples involves an increased clearance of plasma cholesterol due to enhanced faecal excretion of bile acids and cholesterol.

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