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Impact of the quantity and flavonoid content of fruits and vegetables on markers of intake in adults with an increased risk of cardiovascular disease: the FLAVURS trial

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Abstract

Purpose

Limited robust randomised controlled trials investigating fruit and vegetable (F&V) intake in people at risk of cardiovascular disease (CVD) exist. We aimed to design and validate a dietary strategy of increasing flavonoid-rich versus flavonoid-poor F&V consumption on nutrient biomarker profile.

Methods

A parallel, randomised, controlled, dose–response dietary intervention study. Participants with a CVD relative risk of 1.5 assessed by risk scores were randomly assigned to one of the 3 groups: habitual (control, CT), high-flavonoid (HF) or low-flavonoid (LF) diets. While the CT group (n = 57) consumed their habitual diet throughout, the HF (n = 58) and LF (n = 59) groups sequentially increased their daily F&V intake by an additional 2, 4 and 6 portions for 6-week periods during the 18-week study.

Results

Compliance to target numbers and types of F&V was broadly met and verified by dietary records, and plasma and urinary biomarkers. Mean (±SEM) number of F&V portions/day consumed by the HF and LF groups at baseline (3.8 ± 0.3 and 3.4 ± 0.3), 6 weeks (6.3 ± 0.4 and 5.8 ± 0.3), 12 weeks (7.0 ± 0.3 and 6.8 ± 0.3) and 18 weeks (7.6 ± 0.4 and 8.1 ± 0.4), respectively, was similar at baseline yet higher than the CT group (3.9 ± 0.3, 4.3 ± 0.3, 4.6 ± 0.4, 4.5 ± 0.3) (P = 0.015). There was a dose-dependent increase in dietary and urinary flavonoids in the HF group, with no change in other groups (P = 0.0001). Significantly higher dietary intakes of folate (P = 0.035), non-starch polysaccharides (P = 0.001), vitamin C (P = 0.0001) and carotenoids (P = 0.0001) were observed in both intervention groups compared with CT, which were broadly supported by nutrient biomarker analysis.

Conclusions

The success of improving nutrient profile by active encouragement of F&V intake in an intervention study implies the need for a more hands-on public health approach.

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Abbreviations

CVD:

Cardiovascular disease

CT:

Control

HF:

High-flavonoid

LF:

Low-flavonoid

NSP:

Non-starch polysaccharide

F&V:

Fruits and vegetables

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Acknowledgments

FLAVURS trial was supported by the Food Standards Agency, UK, Project no.: N02039/F5234012; Clinical trial registration number: ISRCTN47748735. The FLAVURS team would like to thank the FLAVURS participants for their time and dedication, without whom this study would not have been possible, and to Sainsbury’s for their advice on F&V storage and delivery. In addition, Anna Macready deserves thanks for her help with editing the manuscript, for designing the bespoke food ordering system used in the study and for delivering the fruit and vegetables. We would also like to acknowledge the invaluable help from the following individuals: Recruitment—Jan Luff, Melissa Knight-Adams; Sample analysis—Saran Waroonphan, Paulina Garcia-Macias; Delivery drivers—Franscesca Fava, Fisseha Tesfay Welderufael, Mohammed Al Khusaibi, Nasser Al-Habsi, Ben Cruickshank, Stacey Lockyer, Heather Ferris, Xenofon Tzounis; Advice on F&V storage- Emma Schofield; Dietary analysis —Melissa Knight-Adams, Claire Hester, Anna David, Jana Majdoub, Niloofar Hadizadeh Yazdi, Xenofon Tzounis; Statistical analysis—Alberto Vidal.

Conflict of interest

MF Chong, TW George, D Alimbetov, Y Jin, M Weech and AL Macready have no conflicts of interest. MH Gordon has received in kind donations of foods and research funding for previous studies from GSK. JA Lovegrove sits on Government advisory committees which have members of the food industry as members. She has received in kind donations of foods and has had previous research studies and PhD studentships sponsored by Unilever Bestfoods, Jordans and Ryvita Company Ltd, GSK and Nutricia. AM Minihane has ongoing PhD studentships sponsored by Unilever Bestfoods. JP Spencer has ongoing studies sponsored by Mars and Pepsico.

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Author notes

  1. Anne-Marie Minihane

    Present address: Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK

Authors and Affiliations

  1. Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, PO Box 266, Reading, Berkshire, RG6 6AP, UK

    Mary F. Chong, Trevor W. George, Dauren Alimbetov, Yannan Jin, Michelle Weech, Anna L. Macready, Jeremy P. E. Spencer, Orla B. Kennedy, Anne-Marie Minihane, Michael H. Gordon & Julie A. Lovegrove

  2. Institute for Cardiovascular and Metabolic Research (ICMR), University of Reading, Whiteknights, PO Box 266, Reading, Berkshire, RG6 6AP, UK

    Mary F. Chong, Trevor W. George, Dauren Alimbetov, Yannan Jin, Michelle Weech, Anna L. Macready, Jeremy P. E. Spencer, Orla B. Kennedy, Michael H. Gordon & Julie A. Lovegrove

  3. Department of Psychology, University of Reading, Whiteknights, PO Box 266, Reading, Berkshire, RG6 6AP, UK

    Anna L. Macready

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  1. Mary F. Chong
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Correspondence to Julie A. Lovegrove.

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Chong, M.F., George, T.W., Alimbetov, D. et al. Impact of the quantity and flavonoid content of fruits and vegetables on markers of intake in adults with an increased risk of cardiovascular disease: the FLAVURS trial. Eur J Nutr 52, 361–378 (2013). https://doi.org/10.1007/s00394-012-0343-3

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