TY - JOUR
AU - Wightman, JoLynne, D
AB - Abstract (Poly)phenol-rich diets have been associated with reduced risk of various diseases. Coffee and tea are typically identified as dietary sources of chlorogenic acid and flavan-3-ols; however, 100% fruit juice greatly contributes to anthocyanin, flavonol, flavan-3-ols, and flavanone intake, making them complementary sources of dietary (poly)phenols. Thus, the aim of this narrative review was to provide an overview of fruit (poly)phenols and their potential health benefits. Fruit (poly)phenols have been associated with several health benefits (eg, reduced risk of cardiovascular disease and neurocognitive benefits). Although perspectives on 100% fruit juice consumption are controversial due to the perception of sugar content, growing evidence supports the role of fruit in whole and 100% juice forms to provide consumer benefits in alignment with dietary guidance. However, differences in (poly)phenol profiles and bioavailability likely exist between whole fruit and 100% fruit juice due to processing and the presence/absence of fiber. Ongoing studies are better defining similarities and differences between whole fruit and 100% fruit juice to elucidate protective mechanisms and align with processing and consumer products. cardiovascular, diabetes, exercise, fruit (poly)phenol, 100%, juice, neurocognitive, obesity, performance INTRODUCTION Whole fruit and 100% fruit juice are rich sources of bioactive (poly)phenols and have been associated with reduced risk of select chronic and degenerative diseases.1 More recently, they have also been linked to beneficial health effects, including the potential to improve cognitive function/memory.2 Unlike other well-known (poly)phenol-rich beverages (eg, coffee and tea), 100% fruit juice exists in the context of current dietary guidance3 as a key source of fruit servings. Driven in part by considerations about fiber content, existing policy favors consumption of whole fruit over 100% fruit juice. However, differences between these (poly)phenol-rich fruit sources may not be so wide. Whole fruit contains more fiber, but the role of 100% fruit juice in disease prevention has been downplayed despite its role in meeting dietary guidance for fruit servings and in delivering biologically active (poly)phenols. In this context, the possibility of missing an opportunity to deliver both on dietary guidance and broader health benefits is real. The goal of this narrative review is to provide an overview of (poly)phenols with a specific focus on those derived from dark-colored whole fruit and 100% fruit juice (eg, grapes, berries, pomegranate, and cranberry). Orange and apple will also be discussed because these are commonly consumed fruits/100% fruit juices in the United States. It is important to note that potential health benefits of dark-colored fruits are not solely due to their anthocyanin content because they contain other (poly)phenols (eg, flavonols, flavan-3-ols). For simplicity, the term “dark-colored” is used in this review to refer broadly to fruits such as berries but is not meant to limit health benefits to anthocyanins. Epidemiological evidence that links health outcomes to (poly)phenols is discussed as related to fruit and 100% fruit juice. Comparisons of (poly)phenol profiles and bioavailability between 100% fruit juice and whole fruit are provided based on existing literature. Overall, this provides some context for establishing equivalencies between whole fruit and fruit juice servings in regards to effective (poly)phenol doses that are associated with specific health outcomes. Definitions (Poly)phenols, more appropriately referred to broadly as “phenolic compounds,” represent a diverse class of secondary plant metabolites that, as the name suggests, contain either single or multiple phenol groups (ie, ≥1 aromatic ring and ≥1 hydroxyl group). In nature, phenolic compounds range from simple mono-phenolic molecules (eg, phenolic acids), to structures with more phenolic groups (eg, flavonoids, stilbenoids), to polymeric structures (eg, proanthocyanidins and tannins).4 Major (poly)phenol classes include phenolic acids, flavonoids, stilbenes, and tannins/ellagitannins5 (Figures 1 and2). Flavonoids can be further subcategorized as flavan-3-ols, flavonols, flavones, flavanones, isoflavones, and anthocyanidins (Figure 2). Dark-colored fruits, such as berries and grapes, are rich in anthocyanidins/anthocyanins (aglycone/glycoside),6 which are primarily found in the skin because they are responsible for the reddish-purple hues of the fruit. Flavan-3-ols in berries can also be found in the seeds and in some skins, as well as flavanones in citrus products. Figure 1 Open in new tabDownload slide Major classes of phenolic compounds. Figure 1 Open in new tabDownload slide Major classes of phenolic compounds. Figure 2 Open in new tabDownload slide Chemical structures of flavonoids and nonflavonoid (poly)phenols. Figure 2 Open in new tabDownload slide Chemical structures of flavonoids and nonflavonoid (poly)phenols. Major dietary sources of (poly)phenols Dietary (poly)phenol intake is estimated at the population level by translating food intake (eg, national food surveys) with (poly)phenol databases (eg, Phenol-Explorer,7–10 USDA Database for the Flavonoid Content of Selected Foods,11 USDA Database for the Proanthocyanidin Content of Selected Foods12) to generate average intake data and identify major food sources. Although this process provides a sound foundation, it remains challenging to accurately estimate dietary (poly)phenol intake due to limitations in assessment tools, differing precision across quantification methods, and variations of (poly)phenol content in plants and final food products that may not be accounted for in many databases.13 Intake estimation heavily depends on the quantity and quality of available data. The USDA Database for Flavonoid Content of Selected Foods was reportedly the most frequently used resource for (poly)phenol intake estimation at the population level (for investigators in and outside the United States).14 Many studies use > 1 source of information to compensate for factors and adapt levels based on regional food of the corresponding population. For example, neither the USDA flavonoid11 or proanthocyanidin12 databases contain other (poly)phenols such as phenolic acids, which are in 2 of the most commonly consumed foods in the United States, ie, coffee and potatoes.10,11 There is no universal gold standard for measuring phytochemical consumption,14 but database expansion can improve estimation and the ability to broadly compare intake over time. Data from the National Health and Nutrition Examination Survey (NHANES) estimate the mean (poly)phenol intake in the United States at approximately 200 mg/day.15,16 Coffee, tea, fruit (citrus and berries), and fruit juice have been identified as major (poly)phenol contributors in the US diet.17–21 However, the types and quantities of (poly)phenols depend on the food/beverage. Coffee contains primarily chlorogenic acids, and tea contains catechins (flavan-3-ols) and larger, polymerized/oxidized catechins (theaflavins and thearubigens) in “fermented” or processed teas (ie, oolong and black tea).18,22,23 Fruit (poly)phenol profiles differ depending on the fruit type, genetic pedigree, growing conditions, and postharvest process.24 Dark-colored fruit contain anthocyanins, flavonols, and flavan-3-ol polymers (procyanidins/proanthocyanidins), whereas citrus fruits are most well known for flavanone (eg, naringenin and hesperetin) content.25 HEALTH OUTCOMES RELATED TO FRUIT (POLY)PHENOLS Beneficial health effects have been associated with (poly)phenol-rich diets for > 40 years. In 1992, Renaud and Lorgeril26 reported on the French paradox suggesting that higher wine intake from high-fat French diets is protective against coronary heart disease risk. Several interpretations of this work exist,27–29 but evidence has continued to surface supporting a role of (poly)phenols, including resveratrol, as modulators of coronary heart disease risk factors.30–35 Since then, associations between other (poly)phenol-rich food/beverages and beneficial health outcomes have emerged.36 Compared with coffee, tea, and cocoa, fewer studies have focused on (poly)phenols from whole fruit and 100% fruit juice, despite the original associations and experimental studies on grape-derived wine. The following sections focus on relevant peer-reviewed publications related to fruit polyphenol consumption. Epidemiological studies and meta-analyses (following PRISMA, PROSPERO, or appropriate guidelines) were included to introduce what has been published in the literature. Where relevant, in vitro and animal studies are cited to supplement the discussion on potential mechanisms. However, the primary focus of this narrative review is on clinical studies (published between 2010 and 2018) that investigated the effects of dark-colored fruits (grape, blueberry, cranberry, pomegranate, tart cherry), commonly consumed fruits (apple and orange), and 100% fruit juice. These studies are summarized in Tables 1–4. Clinical trials were extracted from literature using the PubMed database. Keywords involved the fruit name (apple, orange, berry, grape, pomegranate, cherry) and terms related to the health/disease state (cardiovascular, cancer, exercise, performance, diabetes, obesity). Supplemental literature searches included reviewing reference lists in relevant studies and pertinent review articles. Studies that used reconstituted fruit powders were included if the powder was made from whole fruit (ie, freeze-dried fruit powder). Studies that used extracts or isolated (poly)phenols were excluded. Table 1 Summary of select recent human clinical trials that investigated the effects of fruit (poly)phenols on cardiovascular disease Indicator . Study design and duration (per arm) . Treatment . Control . Approximate US cup equivalent . Daily (poly)phenol dose (mg) and specific classes mentioned . Participants . Outcome from treatment . Reference . Oxidative stress, vascular function RCT, CO, 6 wk Blueberries, freeze-dried (wild)a Placebo (250 mL water, 7.5 g fructose, 7 g glucose, 0.5 g citric acid, and 0.03 g blueberry flavor) 1 ND (375 mg anthocyanins) n = 18 (18 male), 36–56 y Improved (decreased) oxidative stress (endogenous and H2O2-induced DNA damage), no effect on vascular function (PWA) Riso et al (2013)37 Vascular function RCT, DB, CO, 6 h Blueberries, freeze-dried (wild)a Baseline 1.6–3 766, 1278, 1791 (total anthocyanins 129–727 mg) n = 21 (21 male), 18–40 y Improved vascular function (FMD) Rodriguez-Mateos et al (2013)38 Blood pressure RCT, 8 wk Blueberries, freeze-drieda Control (water) 2.4 1624 (742 mg anthocyanins) n = 48 (4 male, 44 female), obese, with metabolic syndrome Improved (decreased) blood pressure Basu et al (2010)39 Blood pressure, vascular function RCT, DB, 8 wk Blueberries, freeze-drieda Placebo (maltodextrin, fructose, artificial flavors, colors, citric acid, and silica dioxide) 1 844 (469 mg anthocyanins) n = 48 (48 female), 45–65 y (postmenopausal), hypertensive Improvements in blood pressure and vascular function (brachial ankle pulse and nitric oxide) Johnson et al (2015)40 Blood pressure RCT, 6 wk Blueberries, freeze-drieda Placebo (maltodextrin, flavoring, coloring, fructose, citric acid, and silica) 1.7 ND n = 25, 18–50 y, sedentary Improved blood pressure Mcanulty et al (2014)41 Blood pressure, vascular function RCT, 120 min Blueberries, fresh-frozen Control (300 mL water with sugar) 2.0 726 n = 16 (16 male), 20–26 y, smokers Improved systolic blood pressure and vascular function (reactive hyperemia) arterial stiffness not affected Del Bo et al (2014)42 Vascular function RCT, CO, P, 1 d Blueberries, fresh-frozen Control (300 mL water with 16.4 g glucose + 10.6 g fructose) 2.0 726 n = 24 (24 male), 20–30 y, 12 nonsmokers, 12 smokers Improved vascular function (reactive hyperemia index) Del Bo et al (2017)43 Vascular function, antioxidant protection, oxidative stress RCT, CO, 1 d Blueberries, fresh-frozen Placebo (jelly with 20 g gelatin with 16.4 g glucose + 10.7 g fructose) 2.0 726 n = 10 (10 male) 19–22 ye Improved oxidative stress, no effects on vascular function (arterial function, nitric oxide levels) Del Bo et al (2013)44 Blood pressure, vascular function RCT, CO, 1 wk Blueberry juice (wild) Placebo (240 mL matched for color, flavor, and energy) 1.0 2138 (314 mg anthocyanins) n = 19 (19 female), 39–64 y, at risk for type 2 diabetes Improved nitrate and nitrites, nonsignificant improvements in systolic blood pressure Stote et al (2017)45 Vascular function RCT, DB, CO, LS, 5 h Cherry, Montmorency tart cherry concentrate Placebo (sugar matched) 1.8 ND (40.8 mg cyanidin-3-glucoside) n = 30 (20 male, 10 female), 45–60 y Improved systolic blood pressure Keane et al (2016)46 Vascular function RCT, DB, 8 h Cranberry juice concentrate Placebo (drink containing 2.9 mg (poly)phenols/dose, no anthocyanins) ND (450 mL drink) 409, 787, 1238, 1534, 1910 n = 10 (10 male), 18–35 y Improvements in vascular function (FMD) at 2 h Rodriguez-Mateos et al (2016)47 Vascular function P, 4 h Cranberry juice (double strength) Baseline 2.0 835 (94 mg anthocyanins) n = 15 (13 male, 2 female), 54–70 y, with stable coronary artery disease Improved vascular function (FMD) Dohadwala et al (2011)48 Blood pressure, vascular function RCT, CO, 4 wk Cranberry juice (double strength) Placebo (drink, kcal and carbohydrate matched) 2.0 835 (94 mg anthocyanins) n = 44 (30 male, 14 female), 50–72 y, with stable coronary artery disease Improved vascular function (carotid PWV), no effects on blood pressure, FMD (carotid radial PWV) Dohadwala et al (2011)48 Vascular function RCT, DB, 4 mo Cranberry juice (double strength) Placebo (isocaloric, cranberry-free beverage) 1.9 ND n = 84 (32 male, 52 female), 33–66 y, with CVD risk Improved osteocalcin, no effect on peripheral vascular function Flammer et al (2013)49 Blood pressure, triglycerides, glucose RCT, DB, parallel arm, 8 wk Cranberry juice (low calorie) Placebo (beverage, kcal and ascorbic acid matched, 124 mg (poly)phenols per day, no anthocyanins or proanthocyanidins) 2.0 346 (20.6 mg anthocyanins; 236 mg proanthocyanidins) n = 56 (26 male, 30 female) Improved diastolic blood pressure, fasting plasma glucose, and serum triglycerides Novotny et al (2015)50 Oxidative stress, inflammation CT, 60 d Cranberry juice (low calorie) Control group (no changes in diet) 2.9 ND (231 mg proanthycyanidins) n = 56 (14 male, 42 female), 18–60 y, with metabolic syndrome Improvements in oxidative stress (decreases in homocysteine, lipoperoxidation, protein oxidation ). No significant changes in inflammatory markers (TNF-α, IL-1, IL-6, and cytokines) Name et al (2013)51 Blood pressure, inflammation, oxidative stress RCT, DB, 8 wk Cranberry juice (low energy) Placebo (beverage, kcal, ascorbic acid, flavor and aroma-matched, no (poly)phenols) 2.0 458 (24.8 mg anthocyanins) n = 31 (31 female), with metabolic syndrome (exhibiting >3 of 5 features of metablic syndrome) Improved oxidative stress (lipid oxidation and plasma antioxidant capacity). No effect on blood pressure, C-reactive protein, IL-6, glucose, or lipid profiles Basu et al (2011)52 Vascular function RCT, 1 mo Grape or pomegranate juice Baseline Grape: ND (18 mL/kg body weight (grape juice) Pomegranate: 1.0 ND n = 30, 12–15 y, with metabolic syndrome Improved vascular function (FMD) with both treatments Hashemi et al (2010)53 Blood pressure, biochemical profile RCT, DB, CO, 8 wk Grape juice (Concord) Placebo (beverage, flavor, color, kcal, sugar matched) 2.1 ND n = 64 (44 male, 20 female), 28–54 y, with modestly elevated blood pressure No effect on blood pressure. Improved glucose homeostasis Dohadwala et al (2010)54 Inflammation, fibrinolytic impairment RCT, DB, CO, 2 wk Grape juice (Concord) Placebo (“grapefruit” beverage, kcal, flavor, color, sugar profile matched, no (poly)phenols) ND (7 mL/kg bodyweight/d) ND (∼13.79 mg/kg bodyweight) n = 26 (10 male, 16 female), 26.34 ± 4.93 y, smokers Improved inflammatory (sICAM) and fibrinolytic (PAI-1) status Kokkou et al (2016)55 Vascular function RCT, DB, CO, 2 wk Grape juice (Concord) Placebo (“grapefruit” beverage, kcal, flavor, color, sugar profile matched, no (poly)phenols) Approximately 2.1 (assuming 71.1 kg body weight mean) ND (∼13.79 mg/kg bodyweight) n = 26 (10 male, 16 female), smokers Improved vascular function (FMD) Siasos et al (2014)56 Vascular function RCT, CO, P, 4 wk Grape juice, purple (compared against apple juice) Control (apple juice, similar in kcal, ”without” flavonoids) 1.5 ND n = 24, (17 male, 7 female), 10–22 y, cancer survivors No changes in vascular function (PWA) Blair et al (2014)57 Blood pressure RCT, 28 d Grape juice, red Baseline 0.4 (for females), 0.63 (for males) ND n = 26 (9 male, 17 female), 40–59 y, with hypertension Improvements in resting blood pressure Miranda Neto et al (2017)58 Vascular Function, inflammation, blood lipids RCT, DB, CO, 30 d Grape, freeze-dried powdera Placebo (macronutrient, appearance, taste, and texture matched, no (poly)phenols) 1.7 266.8 n = 24 (24 male), 30–70 y, with metabolic syndrome Improved systolic blood pressure, vascular function (FMD), and inflammatory markers. No significant changes in serum lipids, glucose, body weight Barona et al (2012)59 Carotid intima-media thickness RCT, DB, parallel, 18 mo Pomegranate juice Control (beverage with similar color and kcal) 1.0 ND n = (146), 45–74 y with coronary heart disease risk factor Improved (lower) anterior wall/carotid intima-media thickness Davidson et al (2009)60 Blood pressure, inflammation RCT, DB, CO, 1 wk Pomegranate juice Placebo (beverage with similar taste, color, kcal, no (poly)phenols) 2.1 ND (141.5 mg flavonoids; 50.23 mg anthocyanins) n = 30 (14 male, 18 female), 41–61 y, metabolic syndrome Improved blood pressure (diastolic and systolic) and high sensitivity C-reactive protein. Increased triglyceride and VLDL-C Moazzen et al (2017)61 Blood pressure, lipid profile RCT, DB, 12 mo Pomegranate juice Placebo (beverage with no (poly)phenols, aspartame and acesulfame as sugar substitutes) ND (100 mL 3 times per wk) ND (0.7 mM (poly)phenols 3 times per wk) n = 101 (55 male, 45 female), 54–78 y, on dialysis Improved systolic blood pressure, triglycerides, HDL, and pulse pressure Greater effects in subjects with hypertension, low HDL, and high blood triglycerides Shema-Didi et al (2014)62 Blood pressure, glucocorticoids RCT, CO, 4 wk Pomegranate juice Placebo (beverage with 500 mL of water, kcal and carbohydrate-matched, consumed from a dark container) 2.1 842.5 n = 28 (12 males, 16 females) Improved blood pressure, fasting plasma insulin and homeostasis, urinary and salivary cortisol/cortisone ratio Tsang et al (2012)63 Blood pressure, oxidative stress, inflammation CT, P, 8 wk Pomegranate juice (70%) and grape juice (30%) mixture Baseline 0.9 238.4 n = 28 (14 male, 14 female) 25–33 y Improved oxidation status (higher plasma antioxidant capacity and lower plasma lipid oxidation). No changes in lipid profile, glycemia, blood pressure, and inflammation Díaz-Rubio et al (2015)64 Blood pressure, lipid profile RCT, parallel, 12 wk Tart cherry juicea Placebo (unsweetened, (poly)phenol-free, black cherry flavored Kool-Aid, sugar, energy matched) 4.9 450.6 n = 37 (17 male, 20 female), 65–85 y Improved systolic blood pressure and LDL cholesterol Chai et al (2018)65 Blood pressure, vascular function RCT, CO, 1 wk Apple Control (low flavonoid apple containing only flesh) 0.8b ND (184 mg quercetin and 180 mg (-)-epicatechin) n = 30 (6 male, 24 female), 47.3 ± 13.6 y Improved blood pressure and vascular function (FMD) Bondonno et al (2012)66 Nitric oxide CO, 2 Apple puree Control (flavored water) 1.2b ND (70 mg epicatechin) n = 14 (6 male, 7 female) 45–70 y Nonsignificant improvements (increase) in nitric oxide excretion Hollands et al (2013)67 Platelet reactivity RCT, CO, 5 h Orange juice (compared against dose-matched hesperidin drink) Placebo drink (flavanone-free, volume, sugar, vitamin c- matched) 3.2 ND (320 mg hesperidin) n = 16, 51–69 y No changes in CVD risk biomarkers Schar et al (2015)68 Blood pressure RCT, CO, 4 wk Orange juice or placebo with added hesperidin Placebo capsule (146 mg starch) 2.1 ND (292 mg hesperidin, 47.5 mg narirutin, 2.4 mg other flavonoids) n = 24 (24 male), 50–65 y, overweight Improved diastolic blood pressure (for both treatments) Morand et al (2011)69 Indicator . Study design and duration (per arm) . Treatment . Control . Approximate US cup equivalent . Daily (poly)phenol dose (mg) and specific classes mentioned . Participants . Outcome from treatment . Reference . Oxidative stress, vascular function RCT, CO, 6 wk Blueberries, freeze-dried (wild)a Placebo (250 mL water, 7.5 g fructose, 7 g glucose, 0.5 g citric acid, and 0.03 g blueberry flavor) 1 ND (375 mg anthocyanins) n = 18 (18 male), 36–56 y Improved (decreased) oxidative stress (endogenous and H2O2-induced DNA damage), no effect on vascular function (PWA) Riso et al (2013)37 Vascular function RCT, DB, CO, 6 h Blueberries, freeze-dried (wild)a Baseline 1.6–3 766, 1278, 1791 (total anthocyanins 129–727 mg) n = 21 (21 male), 18–40 y Improved vascular function (FMD) Rodriguez-Mateos et al (2013)38 Blood pressure RCT, 8 wk Blueberries, freeze-drieda Control (water) 2.4 1624 (742 mg anthocyanins) n = 48 (4 male, 44 female), obese, with metabolic syndrome Improved (decreased) blood pressure Basu et al (2010)39 Blood pressure, vascular function RCT, DB, 8 wk Blueberries, freeze-drieda Placebo (maltodextrin, fructose, artificial flavors, colors, citric acid, and silica dioxide) 1 844 (469 mg anthocyanins) n = 48 (48 female), 45–65 y (postmenopausal), hypertensive Improvements in blood pressure and vascular function (brachial ankle pulse and nitric oxide) Johnson et al (2015)40 Blood pressure RCT, 6 wk Blueberries, freeze-drieda Placebo (maltodextrin, flavoring, coloring, fructose, citric acid, and silica) 1.7 ND n = 25, 18–50 y, sedentary Improved blood pressure Mcanulty et al (2014)41 Blood pressure, vascular function RCT, 120 min Blueberries, fresh-frozen Control (300 mL water with sugar) 2.0 726 n = 16 (16 male), 20–26 y, smokers Improved systolic blood pressure and vascular function (reactive hyperemia) arterial stiffness not affected Del Bo et al (2014)42 Vascular function RCT, CO, P, 1 d Blueberries, fresh-frozen Control (300 mL water with 16.4 g glucose + 10.6 g fructose) 2.0 726 n = 24 (24 male), 20–30 y, 12 nonsmokers, 12 smokers Improved vascular function (reactive hyperemia index) Del Bo et al (2017)43 Vascular function, antioxidant protection, oxidative stress RCT, CO, 1 d Blueberries, fresh-frozen Placebo (jelly with 20 g gelatin with 16.4 g glucose + 10.7 g fructose) 2.0 726 n = 10 (10 male) 19–22 ye Improved oxidative stress, no effects on vascular function (arterial function, nitric oxide levels) Del Bo et al (2013)44 Blood pressure, vascular function RCT, CO, 1 wk Blueberry juice (wild) Placebo (240 mL matched for color, flavor, and energy) 1.0 2138 (314 mg anthocyanins) n = 19 (19 female), 39–64 y, at risk for type 2 diabetes Improved nitrate and nitrites, nonsignificant improvements in systolic blood pressure Stote et al (2017)45 Vascular function RCT, DB, CO, LS, 5 h Cherry, Montmorency tart cherry concentrate Placebo (sugar matched) 1.8 ND (40.8 mg cyanidin-3-glucoside) n = 30 (20 male, 10 female), 45–60 y Improved systolic blood pressure Keane et al (2016)46 Vascular function RCT, DB, 8 h Cranberry juice concentrate Placebo (drink containing 2.9 mg (poly)phenols/dose, no anthocyanins) ND (450 mL drink) 409, 787, 1238, 1534, 1910 n = 10 (10 male), 18–35 y Improvements in vascular function (FMD) at 2 h Rodriguez-Mateos et al (2016)47 Vascular function P, 4 h Cranberry juice (double strength) Baseline 2.0 835 (94 mg anthocyanins) n = 15 (13 male, 2 female), 54–70 y, with stable coronary artery disease Improved vascular function (FMD) Dohadwala et al (2011)48 Blood pressure, vascular function RCT, CO, 4 wk Cranberry juice (double strength) Placebo (drink, kcal and carbohydrate matched) 2.0 835 (94 mg anthocyanins) n = 44 (30 male, 14 female), 50–72 y, with stable coronary artery disease Improved vascular function (carotid PWV), no effects on blood pressure, FMD (carotid radial PWV) Dohadwala et al (2011)48 Vascular function RCT, DB, 4 mo Cranberry juice (double strength) Placebo (isocaloric, cranberry-free beverage) 1.9 ND n = 84 (32 male, 52 female), 33–66 y, with CVD risk Improved osteocalcin, no effect on peripheral vascular function Flammer et al (2013)49 Blood pressure, triglycerides, glucose RCT, DB, parallel arm, 8 wk Cranberry juice (low calorie) Placebo (beverage, kcal and ascorbic acid matched, 124 mg (poly)phenols per day, no anthocyanins or proanthocyanidins) 2.0 346 (20.6 mg anthocyanins; 236 mg proanthocyanidins) n = 56 (26 male, 30 female) Improved diastolic blood pressure, fasting plasma glucose, and serum triglycerides Novotny et al (2015)50 Oxidative stress, inflammation CT, 60 d Cranberry juice (low calorie) Control group (no changes in diet) 2.9 ND (231 mg proanthycyanidins) n = 56 (14 male, 42 female), 18–60 y, with metabolic syndrome Improvements in oxidative stress (decreases in homocysteine, lipoperoxidation, protein oxidation ). No significant changes in inflammatory markers (TNF-α, IL-1, IL-6, and cytokines) Name et al (2013)51 Blood pressure, inflammation, oxidative stress RCT, DB, 8 wk Cranberry juice (low energy) Placebo (beverage, kcal, ascorbic acid, flavor and aroma-matched, no (poly)phenols) 2.0 458 (24.8 mg anthocyanins) n = 31 (31 female), with metabolic syndrome (exhibiting >3 of 5 features of metablic syndrome) Improved oxidative stress (lipid oxidation and plasma antioxidant capacity). No effect on blood pressure, C-reactive protein, IL-6, glucose, or lipid profiles Basu et al (2011)52 Vascular function RCT, 1 mo Grape or pomegranate juice Baseline Grape: ND (18 mL/kg body weight (grape juice) Pomegranate: 1.0 ND n = 30, 12–15 y, with metabolic syndrome Improved vascular function (FMD) with both treatments Hashemi et al (2010)53 Blood pressure, biochemical profile RCT, DB, CO, 8 wk Grape juice (Concord) Placebo (beverage, flavor, color, kcal, sugar matched) 2.1 ND n = 64 (44 male, 20 female), 28–54 y, with modestly elevated blood pressure No effect on blood pressure. Improved glucose homeostasis Dohadwala et al (2010)54 Inflammation, fibrinolytic impairment RCT, DB, CO, 2 wk Grape juice (Concord) Placebo (“grapefruit” beverage, kcal, flavor, color, sugar profile matched, no (poly)phenols) ND (7 mL/kg bodyweight/d) ND (∼13.79 mg/kg bodyweight) n = 26 (10 male, 16 female), 26.34 ± 4.93 y, smokers Improved inflammatory (sICAM) and fibrinolytic (PAI-1) status Kokkou et al (2016)55 Vascular function RCT, DB, CO, 2 wk Grape juice (Concord) Placebo (“grapefruit” beverage, kcal, flavor, color, sugar profile matched, no (poly)phenols) Approximately 2.1 (assuming 71.1 kg body weight mean) ND (∼13.79 mg/kg bodyweight) n = 26 (10 male, 16 female), smokers Improved vascular function (FMD) Siasos et al (2014)56 Vascular function RCT, CO, P, 4 wk Grape juice, purple (compared against apple juice) Control (apple juice, similar in kcal, ”without” flavonoids) 1.5 ND n = 24, (17 male, 7 female), 10–22 y, cancer survivors No changes in vascular function (PWA) Blair et al (2014)57 Blood pressure RCT, 28 d Grape juice, red Baseline 0.4 (for females), 0.63 (for males) ND n = 26 (9 male, 17 female), 40–59 y, with hypertension Improvements in resting blood pressure Miranda Neto et al (2017)58 Vascular Function, inflammation, blood lipids RCT, DB, CO, 30 d Grape, freeze-dried powdera Placebo (macronutrient, appearance, taste, and texture matched, no (poly)phenols) 1.7 266.8 n = 24 (24 male), 30–70 y, with metabolic syndrome Improved systolic blood pressure, vascular function (FMD), and inflammatory markers. No significant changes in serum lipids, glucose, body weight Barona et al (2012)59 Carotid intima-media thickness RCT, DB, parallel, 18 mo Pomegranate juice Control (beverage with similar color and kcal) 1.0 ND n = (146), 45–74 y with coronary heart disease risk factor Improved (lower) anterior wall/carotid intima-media thickness Davidson et al (2009)60 Blood pressure, inflammation RCT, DB, CO, 1 wk Pomegranate juice Placebo (beverage with similar taste, color, kcal, no (poly)phenols) 2.1 ND (141.5 mg flavonoids; 50.23 mg anthocyanins) n = 30 (14 male, 18 female), 41–61 y, metabolic syndrome Improved blood pressure (diastolic and systolic) and high sensitivity C-reactive protein. Increased triglyceride and VLDL-C Moazzen et al (2017)61 Blood pressure, lipid profile RCT, DB, 12 mo Pomegranate juice Placebo (beverage with no (poly)phenols, aspartame and acesulfame as sugar substitutes) ND (100 mL 3 times per wk) ND (0.7 mM (poly)phenols 3 times per wk) n = 101 (55 male, 45 female), 54–78 y, on dialysis Improved systolic blood pressure, triglycerides, HDL, and pulse pressure Greater effects in subjects with hypertension, low HDL, and high blood triglycerides Shema-Didi et al (2014)62 Blood pressure, glucocorticoids RCT, CO, 4 wk Pomegranate juice Placebo (beverage with 500 mL of water, kcal and carbohydrate-matched, consumed from a dark container) 2.1 842.5 n = 28 (12 males, 16 females) Improved blood pressure, fasting plasma insulin and homeostasis, urinary and salivary cortisol/cortisone ratio Tsang et al (2012)63 Blood pressure, oxidative stress, inflammation CT, P, 8 wk Pomegranate juice (70%) and grape juice (30%) mixture Baseline 0.9 238.4 n = 28 (14 male, 14 female) 25–33 y Improved oxidation status (higher plasma antioxidant capacity and lower plasma lipid oxidation). No changes in lipid profile, glycemia, blood pressure, and inflammation Díaz-Rubio et al (2015)64 Blood pressure, lipid profile RCT, parallel, 12 wk Tart cherry juicea Placebo (unsweetened, (poly)phenol-free, black cherry flavored Kool-Aid, sugar, energy matched) 4.9 450.6 n = 37 (17 male, 20 female), 65–85 y Improved systolic blood pressure and LDL cholesterol Chai et al (2018)65 Blood pressure, vascular function RCT, CO, 1 wk Apple Control (low flavonoid apple containing only flesh) 0.8b ND (184 mg quercetin and 180 mg (-)-epicatechin) n = 30 (6 male, 24 female), 47.3 ± 13.6 y Improved blood pressure and vascular function (FMD) Bondonno et al (2012)66 Nitric oxide CO, 2 Apple puree Control (flavored water) 1.2b ND (70 mg epicatechin) n = 14 (6 male, 7 female) 45–70 y Nonsignificant improvements (increase) in nitric oxide excretion Hollands et al (2013)67 Platelet reactivity RCT, CO, 5 h Orange juice (compared against dose-matched hesperidin drink) Placebo drink (flavanone-free, volume, sugar, vitamin c- matched) 3.2 ND (320 mg hesperidin) n = 16, 51–69 y No changes in CVD risk biomarkers Schar et al (2015)68 Blood pressure RCT, CO, 4 wk Orange juice or placebo with added hesperidin Placebo capsule (146 mg starch) 2.1 ND (292 mg hesperidin, 47.5 mg narirutin, 2.4 mg other flavonoids) n = 24 (24 male), 50–65 y, overweight Improved diastolic blood pressure (for both treatments) Morand et al (2011)69 Abbreviations: CT, controlled study; CO, cross-over study; DB, double-blind; FMD, flow-mediated dilation; H2O2, hydrogen peroxide; HDL, high-density lipoprotein; IL, interleukin; LDL, low-density lipoprotein; LS, Latin square; ND, data not specified in the article; P, pilot; PWA, pulse wave amplitude; PWV, pulse wave velocity; RCT, randomized controlled trial; TNF-α, tumor necrosis factor α; VLDL-C, very-low-density lipoprotein cholesterol. a Reconstituted with water. b Estimated assuming 1 cup = 244 g (USDA Database for Standard Reference, Database no. 09401 for Applesauce). Open in new tab Table 1 Summary of select recent human clinical trials that investigated the effects of fruit (poly)phenols on cardiovascular disease Indicator . Study design and duration (per arm) . Treatment . Control . Approximate US cup equivalent . Daily (poly)phenol dose (mg) and specific classes mentioned . Participants . Outcome from treatment . Reference . Oxidative stress, vascular function RCT, CO, 6 wk Blueberries, freeze-dried (wild)a Placebo (250 mL water, 7.5 g fructose, 7 g glucose, 0.5 g citric acid, and 0.03 g blueberry flavor) 1 ND (375 mg anthocyanins) n = 18 (18 male), 36–56 y Improved (decreased) oxidative stress (endogenous and H2O2-induced DNA damage), no effect on vascular function (PWA) Riso et al (2013)37 Vascular function RCT, DB, CO, 6 h Blueberries, freeze-dried (wild)a Baseline 1.6–3 766, 1278, 1791 (total anthocyanins 129–727 mg) n = 21 (21 male), 18–40 y Improved vascular function (FMD) Rodriguez-Mateos et al (2013)38 Blood pressure RCT, 8 wk Blueberries, freeze-drieda Control (water) 2.4 1624 (742 mg anthocyanins) n = 48 (4 male, 44 female), obese, with metabolic syndrome Improved (decreased) blood pressure Basu et al (2010)39 Blood pressure, vascular function RCT, DB, 8 wk Blueberries, freeze-drieda Placebo (maltodextrin, fructose, artificial flavors, colors, citric acid, and silica dioxide) 1 844 (469 mg anthocyanins) n = 48 (48 female), 45–65 y (postmenopausal), hypertensive Improvements in blood pressure and vascular function (brachial ankle pulse and nitric oxide) Johnson et al (2015)40 Blood pressure RCT, 6 wk Blueberries, freeze-drieda Placebo (maltodextrin, flavoring, coloring, fructose, citric acid, and silica) 1.7 ND n = 25, 18–50 y, sedentary Improved blood pressure Mcanulty et al (2014)41 Blood pressure, vascular function RCT, 120 min Blueberries, fresh-frozen Control (300 mL water with sugar) 2.0 726 n = 16 (16 male), 20–26 y, smokers Improved systolic blood pressure and vascular function (reactive hyperemia) arterial stiffness not affected Del Bo et al (2014)42 Vascular function RCT, CO, P, 1 d Blueberries, fresh-frozen Control (300 mL water with 16.4 g glucose + 10.6 g fructose) 2.0 726 n = 24 (24 male), 20–30 y, 12 nonsmokers, 12 smokers Improved vascular function (reactive hyperemia index) Del Bo et al (2017)43 Vascular function, antioxidant protection, oxidative stress RCT, CO, 1 d Blueberries, fresh-frozen Placebo (jelly with 20 g gelatin with 16.4 g glucose + 10.7 g fructose) 2.0 726 n = 10 (10 male) 19–22 ye Improved oxidative stress, no effects on vascular function (arterial function, nitric oxide levels) Del Bo et al (2013)44 Blood pressure, vascular function RCT, CO, 1 wk Blueberry juice (wild) Placebo (240 mL matched for color, flavor, and energy) 1.0 2138 (314 mg anthocyanins) n = 19 (19 female), 39–64 y, at risk for type 2 diabetes Improved nitrate and nitrites, nonsignificant improvements in systolic blood pressure Stote et al (2017)45 Vascular function RCT, DB, CO, LS, 5 h Cherry, Montmorency tart cherry concentrate Placebo (sugar matched) 1.8 ND (40.8 mg cyanidin-3-glucoside) n = 30 (20 male, 10 female), 45–60 y Improved systolic blood pressure Keane et al (2016)46 Vascular function RCT, DB, 8 h Cranberry juice concentrate Placebo (drink containing 2.9 mg (poly)phenols/dose, no anthocyanins) ND (450 mL drink) 409, 787, 1238, 1534, 1910 n = 10 (10 male), 18–35 y Improvements in vascular function (FMD) at 2 h Rodriguez-Mateos et al (2016)47 Vascular function P, 4 h Cranberry juice (double strength) Baseline 2.0 835 (94 mg anthocyanins) n = 15 (13 male, 2 female), 54–70 y, with stable coronary artery disease Improved vascular function (FMD) Dohadwala et al (2011)48 Blood pressure, vascular function RCT, CO, 4 wk Cranberry juice (double strength) Placebo (drink, kcal and carbohydrate matched) 2.0 835 (94 mg anthocyanins) n = 44 (30 male, 14 female), 50–72 y, with stable coronary artery disease Improved vascular function (carotid PWV), no effects on blood pressure, FMD (carotid radial PWV) Dohadwala et al (2011)48 Vascular function RCT, DB, 4 mo Cranberry juice (double strength) Placebo (isocaloric, cranberry-free beverage) 1.9 ND n = 84 (32 male, 52 female), 33–66 y, with CVD risk Improved osteocalcin, no effect on peripheral vascular function Flammer et al (2013)49 Blood pressure, triglycerides, glucose RCT, DB, parallel arm, 8 wk Cranberry juice (low calorie) Placebo (beverage, kcal and ascorbic acid matched, 124 mg (poly)phenols per day, no anthocyanins or proanthocyanidins) 2.0 346 (20.6 mg anthocyanins; 236 mg proanthocyanidins) n = 56 (26 male, 30 female) Improved diastolic blood pressure, fasting plasma glucose, and serum triglycerides Novotny et al (2015)50 Oxidative stress, inflammation CT, 60 d Cranberry juice (low calorie) Control group (no changes in diet) 2.9 ND (231 mg proanthycyanidins) n = 56 (14 male, 42 female), 18–60 y, with metabolic syndrome Improvements in oxidative stress (decreases in homocysteine, lipoperoxidation, protein oxidation ). No significant changes in inflammatory markers (TNF-α, IL-1, IL-6, and cytokines) Name et al (2013)51 Blood pressure, inflammation, oxidative stress RCT, DB, 8 wk Cranberry juice (low energy) Placebo (beverage, kcal, ascorbic acid, flavor and aroma-matched, no (poly)phenols) 2.0 458 (24.8 mg anthocyanins) n = 31 (31 female), with metabolic syndrome (exhibiting >3 of 5 features of metablic syndrome) Improved oxidative stress (lipid oxidation and plasma antioxidant capacity). No effect on blood pressure, C-reactive protein, IL-6, glucose, or lipid profiles Basu et al (2011)52 Vascular function RCT, 1 mo Grape or pomegranate juice Baseline Grape: ND (18 mL/kg body weight (grape juice) Pomegranate: 1.0 ND n = 30, 12–15 y, with metabolic syndrome Improved vascular function (FMD) with both treatments Hashemi et al (2010)53 Blood pressure, biochemical profile RCT, DB, CO, 8 wk Grape juice (Concord) Placebo (beverage, flavor, color, kcal, sugar matched) 2.1 ND n = 64 (44 male, 20 female), 28–54 y, with modestly elevated blood pressure No effect on blood pressure. Improved glucose homeostasis Dohadwala et al (2010)54 Inflammation, fibrinolytic impairment RCT, DB, CO, 2 wk Grape juice (Concord) Placebo (“grapefruit” beverage, kcal, flavor, color, sugar profile matched, no (poly)phenols) ND (7 mL/kg bodyweight/d) ND (∼13.79 mg/kg bodyweight) n = 26 (10 male, 16 female), 26.34 ± 4.93 y, smokers Improved inflammatory (sICAM) and fibrinolytic (PAI-1) status Kokkou et al (2016)55 Vascular function RCT, DB, CO, 2 wk Grape juice (Concord) Placebo (“grapefruit” beverage, kcal, flavor, color, sugar profile matched, no (poly)phenols) Approximately 2.1 (assuming 71.1 kg body weight mean) ND (∼13.79 mg/kg bodyweight) n = 26 (10 male, 16 female), smokers Improved vascular function (FMD) Siasos et al (2014)56 Vascular function RCT, CO, P, 4 wk Grape juice, purple (compared against apple juice) Control (apple juice, similar in kcal, ”without” flavonoids) 1.5 ND n = 24, (17 male, 7 female), 10–22 y, cancer survivors No changes in vascular function (PWA) Blair et al (2014)57 Blood pressure RCT, 28 d Grape juice, red Baseline 0.4 (for females), 0.63 (for males) ND n = 26 (9 male, 17 female), 40–59 y, with hypertension Improvements in resting blood pressure Miranda Neto et al (2017)58 Vascular Function, inflammation, blood lipids RCT, DB, CO, 30 d Grape, freeze-dried powdera Placebo (macronutrient, appearance, taste, and texture matched, no (poly)phenols) 1.7 266.8 n = 24 (24 male), 30–70 y, with metabolic syndrome Improved systolic blood pressure, vascular function (FMD), and inflammatory markers. No significant changes in serum lipids, glucose, body weight Barona et al (2012)59 Carotid intima-media thickness RCT, DB, parallel, 18 mo Pomegranate juice Control (beverage with similar color and kcal) 1.0 ND n = (146), 45–74 y with coronary heart disease risk factor Improved (lower) anterior wall/carotid intima-media thickness Davidson et al (2009)60 Blood pressure, inflammation RCT, DB, CO, 1 wk Pomegranate juice Placebo (beverage with similar taste, color, kcal, no (poly)phenols) 2.1 ND (141.5 mg flavonoids; 50.23 mg anthocyanins) n = 30 (14 male, 18 female), 41–61 y, metabolic syndrome Improved blood pressure (diastolic and systolic) and high sensitivity C-reactive protein. Increased triglyceride and VLDL-C Moazzen et al (2017)61 Blood pressure, lipid profile RCT, DB, 12 mo Pomegranate juice Placebo (beverage with no (poly)phenols, aspartame and acesulfame as sugar substitutes) ND (100 mL 3 times per wk) ND (0.7 mM (poly)phenols 3 times per wk) n = 101 (55 male, 45 female), 54–78 y, on dialysis Improved systolic blood pressure, triglycerides, HDL, and pulse pressure Greater effects in subjects with hypertension, low HDL, and high blood triglycerides Shema-Didi et al (2014)62 Blood pressure, glucocorticoids RCT, CO, 4 wk Pomegranate juice Placebo (beverage with 500 mL of water, kcal and carbohydrate-matched, consumed from a dark container) 2.1 842.5 n = 28 (12 males, 16 females) Improved blood pressure, fasting plasma insulin and homeostasis, urinary and salivary cortisol/cortisone ratio Tsang et al (2012)63 Blood pressure, oxidative stress, inflammation CT, P, 8 wk Pomegranate juice (70%) and grape juice (30%) mixture Baseline 0.9 238.4 n = 28 (14 male, 14 female) 25–33 y Improved oxidation status (higher plasma antioxidant capacity and lower plasma lipid oxidation). No changes in lipid profile, glycemia, blood pressure, and inflammation Díaz-Rubio et al (2015)64 Blood pressure, lipid profile RCT, parallel, 12 wk Tart cherry juicea Placebo (unsweetened, (poly)phenol-free, black cherry flavored Kool-Aid, sugar, energy matched) 4.9 450.6 n = 37 (17 male, 20 female), 65–85 y Improved systolic blood pressure and LDL cholesterol Chai et al (2018)65 Blood pressure, vascular function RCT, CO, 1 wk Apple Control (low flavonoid apple containing only flesh) 0.8b ND (184 mg quercetin and 180 mg (-)-epicatechin) n = 30 (6 male, 24 female), 47.3 ± 13.6 y Improved blood pressure and vascular function (FMD) Bondonno et al (2012)66 Nitric oxide CO, 2 Apple puree Control (flavored water) 1.2b ND (70 mg epicatechin) n = 14 (6 male, 7 female) 45–70 y Nonsignificant improvements (increase) in nitric oxide excretion Hollands et al (2013)67 Platelet reactivity RCT, CO, 5 h Orange juice (compared against dose-matched hesperidin drink) Placebo drink (flavanone-free, volume, sugar, vitamin c- matched) 3.2 ND (320 mg hesperidin) n = 16, 51–69 y No changes in CVD risk biomarkers Schar et al (2015)68 Blood pressure RCT, CO, 4 wk Orange juice or placebo with added hesperidin Placebo capsule (146 mg starch) 2.1 ND (292 mg hesperidin, 47.5 mg narirutin, 2.4 mg other flavonoids) n = 24 (24 male), 50–65 y, overweight Improved diastolic blood pressure (for both treatments) Morand et al (2011)69 Indicator . Study design and duration (per arm) . Treatment . Control . Approximate US cup equivalent . Daily (poly)phenol dose (mg) and specific classes mentioned . Participants . Outcome from treatment . Reference . Oxidative stress, vascular function RCT, CO, 6 wk Blueberries, freeze-dried (wild)a Placebo (250 mL water, 7.5 g fructose, 7 g glucose, 0.5 g citric acid, and 0.03 g blueberry flavor) 1 ND (375 mg anthocyanins) n = 18 (18 male), 36–56 y Improved (decreased) oxidative stress (endogenous and H2O2-induced DNA damage), no effect on vascular function (PWA) Riso et al (2013)37 Vascular function RCT, DB, CO, 6 h Blueberries, freeze-dried (wild)a Baseline 1.6–3 766, 1278, 1791 (total anthocyanins 129–727 mg) n = 21 (21 male), 18–40 y Improved vascular function (FMD) Rodriguez-Mateos et al (2013)38 Blood pressure RCT, 8 wk Blueberries, freeze-drieda Control (water) 2.4 1624 (742 mg anthocyanins) n = 48 (4 male, 44 female), obese, with metabolic syndrome Improved (decreased) blood pressure Basu et al (2010)39 Blood pressure, vascular function RCT, DB, 8 wk Blueberries, freeze-drieda Placebo (maltodextrin, fructose, artificial flavors, colors, citric acid, and silica dioxide) 1 844 (469 mg anthocyanins) n = 48 (48 female), 45–65 y (postmenopausal), hypertensive Improvements in blood pressure and vascular function (brachial ankle pulse and nitric oxide) Johnson et al (2015)40 Blood pressure RCT, 6 wk Blueberries, freeze-drieda Placebo (maltodextrin, flavoring, coloring, fructose, citric acid, and silica) 1.7 ND n = 25, 18–50 y, sedentary Improved blood pressure Mcanulty et al (2014)41 Blood pressure, vascular function RCT, 120 min Blueberries, fresh-frozen Control (300 mL water with sugar) 2.0 726 n = 16 (16 male), 20–26 y, smokers Improved systolic blood pressure and vascular function (reactive hyperemia) arterial stiffness not affected Del Bo et al (2014)42 Vascular function RCT, CO, P, 1 d Blueberries, fresh-frozen Control (300 mL water with 16.4 g glucose + 10.6 g fructose) 2.0 726 n = 24 (24 male), 20–30 y, 12 nonsmokers, 12 smokers Improved vascular function (reactive hyperemia index) Del Bo et al (2017)43 Vascular function, antioxidant protection, oxidative stress RCT, CO, 1 d Blueberries, fresh-frozen Placebo (jelly with 20 g gelatin with 16.4 g glucose + 10.7 g fructose) 2.0 726 n = 10 (10 male) 19–22 ye Improved oxidative stress, no effects on vascular function (arterial function, nitric oxide levels) Del Bo et al (2013)44 Blood pressure, vascular function RCT, CO, 1 wk Blueberry juice (wild) Placebo (240 mL matched for color, flavor, and energy) 1.0 2138 (314 mg anthocyanins) n = 19 (19 female), 39–64 y, at risk for type 2 diabetes Improved nitrate and nitrites, nonsignificant improvements in systolic blood pressure Stote et al (2017)45 Vascular function RCT, DB, CO, LS, 5 h Cherry, Montmorency tart cherry concentrate Placebo (sugar matched) 1.8 ND (40.8 mg cyanidin-3-glucoside) n = 30 (20 male, 10 female), 45–60 y Improved systolic blood pressure Keane et al (2016)46 Vascular function RCT, DB, 8 h Cranberry juice concentrate Placebo (drink containing 2.9 mg (poly)phenols/dose, no anthocyanins) ND (450 mL drink) 409, 787, 1238, 1534, 1910 n = 10 (10 male), 18–35 y Improvements in vascular function (FMD) at 2 h Rodriguez-Mateos et al (2016)47 Vascular function P, 4 h Cranberry juice (double strength) Baseline 2.0 835 (94 mg anthocyanins) n = 15 (13 male, 2 female), 54–70 y, with stable coronary artery disease Improved vascular function (FMD) Dohadwala et al (2011)48 Blood pressure, vascular function RCT, CO, 4 wk Cranberry juice (double strength) Placebo (drink, kcal and carbohydrate matched) 2.0 835 (94 mg anthocyanins) n = 44 (30 male, 14 female), 50–72 y, with stable coronary artery disease Improved vascular function (carotid PWV), no effects on blood pressure, FMD (carotid radial PWV) Dohadwala et al (2011)48 Vascular function RCT, DB, 4 mo Cranberry juice (double strength) Placebo (isocaloric, cranberry-free beverage) 1.9 ND n = 84 (32 male, 52 female), 33–66 y, with CVD risk Improved osteocalcin, no effect on peripheral vascular function Flammer et al (2013)49 Blood pressure, triglycerides, glucose RCT, DB, parallel arm, 8 wk Cranberry juice (low calorie) Placebo (beverage, kcal and ascorbic acid matched, 124 mg (poly)phenols per day, no anthocyanins or proanthocyanidins) 2.0 346 (20.6 mg anthocyanins; 236 mg proanthocyanidins) n = 56 (26 male, 30 female) Improved diastolic blood pressure, fasting plasma glucose, and serum triglycerides Novotny et al (2015)50 Oxidative stress, inflammation CT, 60 d Cranberry juice (low calorie) Control group (no changes in diet) 2.9 ND (231 mg proanthycyanidins) n = 56 (14 male, 42 female), 18–60 y, with metabolic syndrome Improvements in oxidative stress (decreases in homocysteine, lipoperoxidation, protein oxidation ). No significant changes in inflammatory markers (TNF-α, IL-1, IL-6, and cytokines) Name et al (2013)51 Blood pressure, inflammation, oxidative stress RCT, DB, 8 wk Cranberry juice (low energy) Placebo (beverage, kcal, ascorbic acid, flavor and aroma-matched, no (poly)phenols) 2.0 458 (24.8 mg anthocyanins) n = 31 (31 female), with metabolic syndrome (exhibiting >3 of 5 features of metablic syndrome) Improved oxidative stress (lipid oxidation and plasma antioxidant capacity). No effect on blood pressure, C-reactive protein, IL-6, glucose, or lipid profiles Basu et al (2011)52 Vascular function RCT, 1 mo Grape or pomegranate juice Baseline Grape: ND (18 mL/kg body weight (grape juice) Pomegranate: 1.0 ND n = 30, 12–15 y, with metabolic syndrome Improved vascular function (FMD) with both treatments Hashemi et al (2010)53 Blood pressure, biochemical profile RCT, DB, CO, 8 wk Grape juice (Concord) Placebo (beverage, flavor, color, kcal, sugar matched) 2.1 ND n = 64 (44 male, 20 female), 28–54 y, with modestly elevated blood pressure No effect on blood pressure. Improved glucose homeostasis Dohadwala et al (2010)54 Inflammation, fibrinolytic impairment RCT, DB, CO, 2 wk Grape juice (Concord) Placebo (“grapefruit” beverage, kcal, flavor, color, sugar profile matched, no (poly)phenols) ND (7 mL/kg bodyweight/d) ND (∼13.79 mg/kg bodyweight) n = 26 (10 male, 16 female), 26.34 ± 4.93 y, smokers Improved inflammatory (sICAM) and fibrinolytic (PAI-1) status Kokkou et al (2016)55 Vascular function RCT, DB, CO, 2 wk Grape juice (Concord) Placebo (“grapefruit” beverage, kcal, flavor, color, sugar profile matched, no (poly)phenols) Approximately 2.1 (assuming 71.1 kg body weight mean) ND (∼13.79 mg/kg bodyweight) n = 26 (10 male, 16 female), smokers Improved vascular function (FMD) Siasos et al (2014)56 Vascular function RCT, CO, P, 4 wk Grape juice, purple (compared against apple juice) Control (apple juice, similar in kcal, ”without” flavonoids) 1.5 ND n = 24, (17 male, 7 female), 10–22 y, cancer survivors No changes in vascular function (PWA) Blair et al (2014)57 Blood pressure RCT, 28 d Grape juice, red Baseline 0.4 (for females), 0.63 (for males) ND n = 26 (9 male, 17 female), 40–59 y, with hypertension Improvements in resting blood pressure Miranda Neto et al (2017)58 Vascular Function, inflammation, blood lipids RCT, DB, CO, 30 d Grape, freeze-dried powdera Placebo (macronutrient, appearance, taste, and texture matched, no (poly)phenols) 1.7 266.8 n = 24 (24 male), 30–70 y, with metabolic syndrome Improved systolic blood pressure, vascular function (FMD), and inflammatory markers. No significant changes in serum lipids, glucose, body weight Barona et al (2012)59 Carotid intima-media thickness RCT, DB, parallel, 18 mo Pomegranate juice Control (beverage with similar color and kcal) 1.0 ND n = (146), 45–74 y with coronary heart disease risk factor Improved (lower) anterior wall/carotid intima-media thickness Davidson et al (2009)60 Blood pressure, inflammation RCT, DB, CO, 1 wk Pomegranate juice Placebo (beverage with similar taste, color, kcal, no (poly)phenols) 2.1 ND (141.5 mg flavonoids; 50.23 mg anthocyanins) n = 30 (14 male, 18 female), 41–61 y, metabolic syndrome Improved blood pressure (diastolic and systolic) and high sensitivity C-reactive protein. Increased triglyceride and VLDL-C Moazzen et al (2017)61 Blood pressure, lipid profile RCT, DB, 12 mo Pomegranate juice Placebo (beverage with no (poly)phenols, aspartame and acesulfame as sugar substitutes) ND (100 mL 3 times per wk) ND (0.7 mM (poly)phenols 3 times per wk) n = 101 (55 male, 45 female), 54–78 y, on dialysis Improved systolic blood pressure, triglycerides, HDL, and pulse pressure Greater effects in subjects with hypertension, low HDL, and high blood triglycerides Shema-Didi et al (2014)62 Blood pressure, glucocorticoids RCT, CO, 4 wk Pomegranate juice Placebo (beverage with 500 mL of water, kcal and carbohydrate-matched, consumed from a dark container) 2.1 842.5 n = 28 (12 males, 16 females) Improved blood pressure, fasting plasma insulin and homeostasis, urinary and salivary cortisol/cortisone ratio Tsang et al (2012)63 Blood pressure, oxidative stress, inflammation CT, P, 8 wk Pomegranate juice (70%) and grape juice (30%) mixture Baseline 0.9 238.4 n = 28 (14 male, 14 female) 25–33 y Improved oxidation status (higher plasma antioxidant capacity and lower plasma lipid oxidation). No changes in lipid profile, glycemia, blood pressure, and inflammation Díaz-Rubio et al (2015)64 Blood pressure, lipid profile RCT, parallel, 12 wk Tart cherry juicea Placebo (unsweetened, (poly)phenol-free, black cherry flavored Kool-Aid, sugar, energy matched) 4.9 450.6 n = 37 (17 male, 20 female), 65–85 y Improved systolic blood pressure and LDL cholesterol Chai et al (2018)65 Blood pressure, vascular function RCT, CO, 1 wk Apple Control (low flavonoid apple containing only flesh) 0.8b ND (184 mg quercetin and 180 mg (-)-epicatechin) n = 30 (6 male, 24 female), 47.3 ± 13.6 y Improved blood pressure and vascular function (FMD) Bondonno et al (2012)66 Nitric oxide CO, 2 Apple puree Control (flavored water) 1.2b ND (70 mg epicatechin) n = 14 (6 male, 7 female) 45–70 y Nonsignificant improvements (increase) in nitric oxide excretion Hollands et al (2013)67 Platelet reactivity RCT, CO, 5 h Orange juice (compared against dose-matched hesperidin drink) Placebo drink (flavanone-free, volume, sugar, vitamin c- matched) 3.2 ND (320 mg hesperidin) n = 16, 51–69 y No changes in CVD risk biomarkers Schar et al (2015)68 Blood pressure RCT, CO, 4 wk Orange juice or placebo with added hesperidin Placebo capsule (146 mg starch) 2.1 ND (292 mg hesperidin, 47.5 mg narirutin, 2.4 mg other flavonoids) n = 24 (24 male), 50–65 y, overweight Improved diastolic blood pressure (for both treatments) Morand et al (2011)69 Abbreviations: CT, controlled study; CO, cross-over study; DB, double-blind; FMD, flow-mediated dilation; H2O2, hydrogen peroxide; HDL, high-density lipoprotein; IL, interleukin; LDL, low-density lipoprotein; LS, Latin square; ND, data not specified in the article; P, pilot; PWA, pulse wave amplitude; PWV, pulse wave velocity; RCT, randomized controlled trial; TNF-α, tumor necrosis factor α; VLDL-C, very-low-density lipoprotein cholesterol. a Reconstituted with water. b Estimated assuming 1 cup = 244 g (USDA Database for Standard Reference, Database no. 09401 for Applesauce). Open in new tab Table 2 Summary of select recent human clinical trials that investigated the effects of fruit (poly)phenols on neurocognitive outcomes Indicator . Study design and duration (per arm) . Treatment . Control . Approximate US cup equivalent . (Poly)phenol dose (mg) and specific classes mentioned . Participants . Outcome from treatment . Reference . Memory RCT, CO, P, 2 h Blueberries (star variety)  + semi-skimmed milk and sucrose Control (drink with 100 mL of semi-skimmed milk, sugar, and ascorbic acid matched) 1.4 ND (143 mg anthocyanins) n = 14 (10 male, 4 female), 8–10 y Improvements in delayed recall of previously learned words. Negative impact on encoding new words was observed. No benefit on attention, visuospatial memory, or response inhibition Whyte and Williams (2015)70 Cognitive function RCT, 12 wk Blueberry concentrate Placebo (beverage, synthetic blackcurrant and apple cordial, sugar and kcal matched) ND (30 mL concentrate) ND (387 mg anthocyanins) n = 26 (13 male, 13 female), 66–70 y Improved brain activity (increased gray matter perfusion) Bowtell et al (2017)71 Memory CT, P, 12 wk Blueberry juice Placebo (beverage, not sugar matched) 1.9, 2.3, 2.6 (∼6–9 mL juice/kg body weight) 1056, 1266, 1478 (428, 512, 598 mg anthocyanins) n = 9 (5 male, 4 female), aged 71–81 y, 4, with age-related memory decline Improvements in memory (word recall and paired associate learning) Krikorian et al (2010)72 Cognitive function DB, CO, 6 h Blueberry, freeze-dried blueberry powdera (wild) Placebo (beverage from companion study, no juice or (poly)phenols, color, taste matched, not sugar matched) 0.8, 1.6 ND (127, 253 mg anthocyanins) n = 21 (9 male, 12 female), 7–10 y Improved cognitive performance with both treatments (higher dose was more effective) Whyte et al (2016)73 Mobility and cognitive function RCT, DB, 90 d Blueberry, freeze-dried powderb Placebo (powder, color, and kcal matched) 1 864 (460.8 mg anthocyanins) n = 37 (13 male, 24 female) aged 60–75 y No improvements in mobility (gait or balance), improvements in cognitition (less repetition errors, reduced cost in task switching tests) Miller et al (2018)74 Regional brain activation RCT, DB, 16 wk Blueberry, freeze-dried powderb Placebo (powder, 3.5% (poly)phenol content, 2.4% ORAC, no anthocyanins) 1 ND (269 mg anthocyanins) n = 16, 68–92 y, with awareness of age-related memory decline Improved brain activity (increased blood oxygen level–dependent signal during working memory load conditions), no changes in working memory performance Boespflug et al (2018)75 Mood RCT, DB, 2 h Blueberry, freeze-dried powderb Placebo (beverage, sugar, and ascorbic acid matched, 30 mL of Rocks Orange Squashc in 170 mL water, drinks consumed from an opaque cup and straw) ND (30 g powder) ND (253 mg anthocyanins) n =  52 (23 male, 29 female), 7–10 y Improved mood Khalid et al (2017)76 Mood RCT, DB, 2 h Blueberry, freeze-dried powdera Placebo (beverage, sugar, and ascorbic acid matched, 30 mL of Rocks Orange Squashc in 220 mL water, drinks consumed from an opaque cup and straw) ND (30 g powder) ND (253 mg anthocyanins) n = 21 (2 male, 19 female), 18–21 y Improved mood Khalid et al (2017)76 Cognitive function DB, CO, 3 h Blueberry, freeze-dried powdera Placebo (30 g powder, sugar, and ascorbic acid matched, with 30 mL of Rocks Orange Squashc with 170 mL water, consumed from an opaque cup) ND (30 g powder) ND (253 mg anthocyanins) n = 21 (11 male, 10 female), 7–10 y Improved (faster) performance on cognitively demanding/high load tests and visual cue tasks Whyte et al (2017)77 Memory RCT, DB, 24 wk Blueberry, whole frozenb with and without fish oil Placebo (powder, color, taste, sugar-matched), placebo oil (corn oil) 0.2 417 (269 mg anthocyanins) n = 76 (35 male, 41 female), 62–80 y, mild (self-perceived) age-related cognitive decline Improved cognition (memory discrimination) with both treatments. No synergy observed between fish oil and blueberry Mcnamara et al (2018)78 Cognitive function RCT, DB, CO, LS, 5 h Cherry, Montmorency tart cherry concentrate Placebo (beverage, sugar matched) 1.8 96.45 (40.8 mg anthocyanins) n = 30 (20 male, 10 female), 45–60 y No changes in cognitive function or mood Keane et al (2016)46 Memory RCT, DB, 12 wk Grape juice (Concord) Placebo (beverage, no juice, no (poly)phenols, carbohydrate, kcal, color, and flavormatched) 1.9, 2.3, 2.6 (∼6–9 mL juice/kg body weight) ND n = 12 (8 male, 4 female), 78 ± 5 y (mean age) Improvements in verbal learning, nonsignificant improvements in spatial and verbal recall Krikorian et al (2010)79 Memory RCT, DB, 16 wk Grape juice (Concord) Placebo (glucose: fructose ratio, kcal, color, taste-matched, no juice no (poly)phenols) 1.5, 1.9, 2.6 (∼6.3–7.8 mL juice/kg bw) 742, 928.40, 12 98.51 n = 21 (11 male, 10 female), >65 y, with mild, age-related memory decline Improved performance on memory tasks, higher brain (right hemisphere) Krikorian et al (2012)80 Cognitive function and driving performance RCT, CO, 12 wk Grape juice (Concord) Placebo ((poly)phenol-free, calorie, flavor, and appearance matched) 1.5 777 n = 25 (25 female), 40–50 y Improvements in immediate spatial memory and driving performance Lamport et al (2016)81 Memory (working and episodic), attention, and mood RCT, DB, CO, 20 min Grape juice (Welch's purple grape juice)  + black currant flavor cordial Placebo (white grape juice with 20 mg (poly)phenols, blackcurrant flavor cordial, sugar matched) 0.9 336.34 n = 20 (7 male, 13 female), 18–35 y Improved reaction times (composite attention measure) and calm ratings) Haskell-Ramsay et al (2017)82 Brain metabolism and cognitive function RCT, DB, P, 6 mo Grape powder, freeze-dried Placebo (powder, fructose and glucose, appearance, smell, volume, flavor matched) ND (72g powder, “3 standard servings”) 356.4 n = 10 (5 male, 5 female), 66–82 y, mild decline in cognition Maintained brain metabolism (no changes from baseline), control did not maintain brain metabolism (decreases observed) Lee et al (2017)83 Cognitive function, mood RCT, DB, 8 wk Orange juice Placebo beverage (low flavanone, 37 mg) 2.1 ND (305 mg flavanones, hesperidin and narirutin) n = 37 (13 male, 24 female), 60–81 y Improved global cognitive function with, no significant effects on mood Kean et al (2015)84 Cognitive function RCT, DB, 6 h Orange juice Placebo beverage (kcal matched) 1.0 ND (272 mg flavonoids: 220.46 mg hesperidin, 34.54 mg narirutin, 17.14 mg other flavonoids) n = 6 (6 male), 30–65 y Improvements in psychomotor speed and executive function Alharbi et al (2016)85 Cognitive function, cerebral blood flow RCT, CO, 2 h 100% fruit juice (Tropicana Ruby Breakfast Juice) Placebo drink (kcal, flavor, color matched) 2.1 ND (70.5 mg flavonoids: 42.15 mg hesperidin, 17.25 mg naringin, 6.75 mg narirutin, 4.3 mg caffeic acid) Behavioral arm: n = 28 (4 males, 20 females); Imaging arm: n = 16 (8 males, 8 females) Improved performance on digit symbol substitution test (but not other cognitive tests) and improved (increased) regional perfusion Lamport et al (2017)86 Indicator . Study design and duration (per arm) . Treatment . Control . Approximate US cup equivalent . (Poly)phenol dose (mg) and specific classes mentioned . Participants . Outcome from treatment . Reference . Memory RCT, CO, P, 2 h Blueberries (star variety)  + semi-skimmed milk and sucrose Control (drink with 100 mL of semi-skimmed milk, sugar, and ascorbic acid matched) 1.4 ND (143 mg anthocyanins) n = 14 (10 male, 4 female), 8–10 y Improvements in delayed recall of previously learned words. Negative impact on encoding new words was observed. No benefit on attention, visuospatial memory, or response inhibition Whyte and Williams (2015)70 Cognitive function RCT, 12 wk Blueberry concentrate Placebo (beverage, synthetic blackcurrant and apple cordial, sugar and kcal matched) ND (30 mL concentrate) ND (387 mg anthocyanins) n = 26 (13 male, 13 female), 66–70 y Improved brain activity (increased gray matter perfusion) Bowtell et al (2017)71 Memory CT, P, 12 wk Blueberry juice Placebo (beverage, not sugar matched) 1.9, 2.3, 2.6 (∼6–9 mL juice/kg body weight) 1056, 1266, 1478 (428, 512, 598 mg anthocyanins) n = 9 (5 male, 4 female), aged 71–81 y, 4, with age-related memory decline Improvements in memory (word recall and paired associate learning) Krikorian et al (2010)72 Cognitive function DB, CO, 6 h Blueberry, freeze-dried blueberry powdera (wild) Placebo (beverage from companion study, no juice or (poly)phenols, color, taste matched, not sugar matched) 0.8, 1.6 ND (127, 253 mg anthocyanins) n = 21 (9 male, 12 female), 7–10 y Improved cognitive performance with both treatments (higher dose was more effective) Whyte et al (2016)73 Mobility and cognitive function RCT, DB, 90 d Blueberry, freeze-dried powderb Placebo (powder, color, and kcal matched) 1 864 (460.8 mg anthocyanins) n = 37 (13 male, 24 female) aged 60–75 y No improvements in mobility (gait or balance), improvements in cognitition (less repetition errors, reduced cost in task switching tests) Miller et al (2018)74 Regional brain activation RCT, DB, 16 wk Blueberry, freeze-dried powderb Placebo (powder, 3.5% (poly)phenol content, 2.4% ORAC, no anthocyanins) 1 ND (269 mg anthocyanins) n = 16, 68–92 y, with awareness of age-related memory decline Improved brain activity (increased blood oxygen level–dependent signal during working memory load conditions), no changes in working memory performance Boespflug et al (2018)75 Mood RCT, DB, 2 h Blueberry, freeze-dried powderb Placebo (beverage, sugar, and ascorbic acid matched, 30 mL of Rocks Orange Squashc in 170 mL water, drinks consumed from an opaque cup and straw) ND (30 g powder) ND (253 mg anthocyanins) n =  52 (23 male, 29 female), 7–10 y Improved mood Khalid et al (2017)76 Mood RCT, DB, 2 h Blueberry, freeze-dried powdera Placebo (beverage, sugar, and ascorbic acid matched, 30 mL of Rocks Orange Squashc in 220 mL water, drinks consumed from an opaque cup and straw) ND (30 g powder) ND (253 mg anthocyanins) n = 21 (2 male, 19 female), 18–21 y Improved mood Khalid et al (2017)76 Cognitive function DB, CO, 3 h Blueberry, freeze-dried powdera Placebo (30 g powder, sugar, and ascorbic acid matched, with 30 mL of Rocks Orange Squashc with 170 mL water, consumed from an opaque cup) ND (30 g powder) ND (253 mg anthocyanins) n = 21 (11 male, 10 female), 7–10 y Improved (faster) performance on cognitively demanding/high load tests and visual cue tasks Whyte et al (2017)77 Memory RCT, DB, 24 wk Blueberry, whole frozenb with and without fish oil Placebo (powder, color, taste, sugar-matched), placebo oil (corn oil) 0.2 417 (269 mg anthocyanins) n = 76 (35 male, 41 female), 62–80 y, mild (self-perceived) age-related cognitive decline Improved cognition (memory discrimination) with both treatments. No synergy observed between fish oil and blueberry Mcnamara et al (2018)78 Cognitive function RCT, DB, CO, LS, 5 h Cherry, Montmorency tart cherry concentrate Placebo (beverage, sugar matched) 1.8 96.45 (40.8 mg anthocyanins) n = 30 (20 male, 10 female), 45–60 y No changes in cognitive function or mood Keane et al (2016)46 Memory RCT, DB, 12 wk Grape juice (Concord) Placebo (beverage, no juice, no (poly)phenols, carbohydrate, kcal, color, and flavormatched) 1.9, 2.3, 2.6 (∼6–9 mL juice/kg body weight) ND n = 12 (8 male, 4 female), 78 ± 5 y (mean age) Improvements in verbal learning, nonsignificant improvements in spatial and verbal recall Krikorian et al (2010)79 Memory RCT, DB, 16 wk Grape juice (Concord) Placebo (glucose: fructose ratio, kcal, color, taste-matched, no juice no (poly)phenols) 1.5, 1.9, 2.6 (∼6.3–7.8 mL juice/kg bw) 742, 928.40, 12 98.51 n = 21 (11 male, 10 female), >65 y, with mild, age-related memory decline Improved performance on memory tasks, higher brain (right hemisphere) Krikorian et al (2012)80 Cognitive function and driving performance RCT, CO, 12 wk Grape juice (Concord) Placebo ((poly)phenol-free, calorie, flavor, and appearance matched) 1.5 777 n = 25 (25 female), 40–50 y Improvements in immediate spatial memory and driving performance Lamport et al (2016)81 Memory (working and episodic), attention, and mood RCT, DB, CO, 20 min Grape juice (Welch's purple grape juice)  + black currant flavor cordial Placebo (white grape juice with 20 mg (poly)phenols, blackcurrant flavor cordial, sugar matched) 0.9 336.34 n = 20 (7 male, 13 female), 18–35 y Improved reaction times (composite attention measure) and calm ratings) Haskell-Ramsay et al (2017)82 Brain metabolism and cognitive function RCT, DB, P, 6 mo Grape powder, freeze-dried Placebo (powder, fructose and glucose, appearance, smell, volume, flavor matched) ND (72g powder, “3 standard servings”) 356.4 n = 10 (5 male, 5 female), 66–82 y, mild decline in cognition Maintained brain metabolism (no changes from baseline), control did not maintain brain metabolism (decreases observed) Lee et al (2017)83 Cognitive function, mood RCT, DB, 8 wk Orange juice Placebo beverage (low flavanone, 37 mg) 2.1 ND (305 mg flavanones, hesperidin and narirutin) n = 37 (13 male, 24 female), 60–81 y Improved global cognitive function with, no significant effects on mood Kean et al (2015)84 Cognitive function RCT, DB, 6 h Orange juice Placebo beverage (kcal matched) 1.0 ND (272 mg flavonoids: 220.46 mg hesperidin, 34.54 mg narirutin, 17.14 mg other flavonoids) n = 6 (6 male), 30–65 y Improvements in psychomotor speed and executive function Alharbi et al (2016)85 Cognitive function, cerebral blood flow RCT, CO, 2 h 100% fruit juice (Tropicana Ruby Breakfast Juice) Placebo drink (kcal, flavor, color matched) 2.1 ND (70.5 mg flavonoids: 42.15 mg hesperidin, 17.25 mg naringin, 6.75 mg narirutin, 4.3 mg caffeic acid) Behavioral arm: n = 28 (4 males, 20 females); Imaging arm: n = 16 (8 males, 8 females) Improved performance on digit symbol substitution test (but not other cognitive tests) and improved (increased) regional perfusion Lamport et al (2017)86 Abbreviations: CO, cross-over study; CT, controlled study; DB, double-blind; LS, Latin square; ND, data not specified in the article; P, pilot; RCT, randomized controlled trial. a Reconstituted with water and flavor (low (poly)phenol). b Reconstituted with water. c Rocks Orange Squash contains 13.2 mg flavonoids per 30 mL. Open in new tab Table 2 Summary of select recent human clinical trials that investigated the effects of fruit (poly)phenols on neurocognitive outcomes Indicator . Study design and duration (per arm) . Treatment . Control . Approximate US cup equivalent . (Poly)phenol dose (mg) and specific classes mentioned . Participants . Outcome from treatment . Reference . Memory RCT, CO, P, 2 h Blueberries (star variety)  + semi-skimmed milk and sucrose Control (drink with 100 mL of semi-skimmed milk, sugar, and ascorbic acid matched) 1.4 ND (143 mg anthocyanins) n = 14 (10 male, 4 female), 8–10 y Improvements in delayed recall of previously learned words. Negative impact on encoding new words was observed. No benefit on attention, visuospatial memory, or response inhibition Whyte and Williams (2015)70 Cognitive function RCT, 12 wk Blueberry concentrate Placebo (beverage, synthetic blackcurrant and apple cordial, sugar and kcal matched) ND (30 mL concentrate) ND (387 mg anthocyanins) n = 26 (13 male, 13 female), 66–70 y Improved brain activity (increased gray matter perfusion) Bowtell et al (2017)71 Memory CT, P, 12 wk Blueberry juice Placebo (beverage, not sugar matched) 1.9, 2.3, 2.6 (∼6–9 mL juice/kg body weight) 1056, 1266, 1478 (428, 512, 598 mg anthocyanins) n = 9 (5 male, 4 female), aged 71–81 y, 4, with age-related memory decline Improvements in memory (word recall and paired associate learning) Krikorian et al (2010)72 Cognitive function DB, CO, 6 h Blueberry, freeze-dried blueberry powdera (wild) Placebo (beverage from companion study, no juice or (poly)phenols, color, taste matched, not sugar matched) 0.8, 1.6 ND (127, 253 mg anthocyanins) n = 21 (9 male, 12 female), 7–10 y Improved cognitive performance with both treatments (higher dose was more effective) Whyte et al (2016)73 Mobility and cognitive function RCT, DB, 90 d Blueberry, freeze-dried powderb Placebo (powder, color, and kcal matched) 1 864 (460.8 mg anthocyanins) n = 37 (13 male, 24 female) aged 60–75 y No improvements in mobility (gait or balance), improvements in cognitition (less repetition errors, reduced cost in task switching tests) Miller et al (2018)74 Regional brain activation RCT, DB, 16 wk Blueberry, freeze-dried powderb Placebo (powder, 3.5% (poly)phenol content, 2.4% ORAC, no anthocyanins) 1 ND (269 mg anthocyanins) n = 16, 68–92 y, with awareness of age-related memory decline Improved brain activity (increased blood oxygen level–dependent signal during working memory load conditions), no changes in working memory performance Boespflug et al (2018)75 Mood RCT, DB, 2 h Blueberry, freeze-dried powderb Placebo (beverage, sugar, and ascorbic acid matched, 30 mL of Rocks Orange Squashc in 170 mL water, drinks consumed from an opaque cup and straw) ND (30 g powder) ND (253 mg anthocyanins) n =  52 (23 male, 29 female), 7–10 y Improved mood Khalid et al (2017)76 Mood RCT, DB, 2 h Blueberry, freeze-dried powdera Placebo (beverage, sugar, and ascorbic acid matched, 30 mL of Rocks Orange Squashc in 220 mL water, drinks consumed from an opaque cup and straw) ND (30 g powder) ND (253 mg anthocyanins) n = 21 (2 male, 19 female), 18–21 y Improved mood Khalid et al (2017)76 Cognitive function DB, CO, 3 h Blueberry, freeze-dried powdera Placebo (30 g powder, sugar, and ascorbic acid matched, with 30 mL of Rocks Orange Squashc with 170 mL water, consumed from an opaque cup) ND (30 g powder) ND (253 mg anthocyanins) n = 21 (11 male, 10 female), 7–10 y Improved (faster) performance on cognitively demanding/high load tests and visual cue tasks Whyte et al (2017)77 Memory RCT, DB, 24 wk Blueberry, whole frozenb with and without fish oil Placebo (powder, color, taste, sugar-matched), placebo oil (corn oil) 0.2 417 (269 mg anthocyanins) n = 76 (35 male, 41 female), 62–80 y, mild (self-perceived) age-related cognitive decline Improved cognition (memory discrimination) with both treatments. No synergy observed between fish oil and blueberry Mcnamara et al (2018)78 Cognitive function RCT, DB, CO, LS, 5 h Cherry, Montmorency tart cherry concentrate Placebo (beverage, sugar matched) 1.8 96.45 (40.8 mg anthocyanins) n = 30 (20 male, 10 female), 45–60 y No changes in cognitive function or mood Keane et al (2016)46 Memory RCT, DB, 12 wk Grape juice (Concord) Placebo (beverage, no juice, no (poly)phenols, carbohydrate, kcal, color, and flavormatched) 1.9, 2.3, 2.6 (∼6–9 mL juice/kg body weight) ND n = 12 (8 male, 4 female), 78 ± 5 y (mean age) Improvements in verbal learning, nonsignificant improvements in spatial and verbal recall Krikorian et al (2010)79 Memory RCT, DB, 16 wk Grape juice (Concord) Placebo (glucose: fructose ratio, kcal, color, taste-matched, no juice no (poly)phenols) 1.5, 1.9, 2.6 (∼6.3–7.8 mL juice/kg bw) 742, 928.40, 12 98.51 n = 21 (11 male, 10 female), >65 y, with mild, age-related memory decline Improved performance on memory tasks, higher brain (right hemisphere) Krikorian et al (2012)80 Cognitive function and driving performance RCT, CO, 12 wk Grape juice (Concord) Placebo ((poly)phenol-free, calorie, flavor, and appearance matched) 1.5 777 n = 25 (25 female), 40–50 y Improvements in immediate spatial memory and driving performance Lamport et al (2016)81 Memory (working and episodic), attention, and mood RCT, DB, CO, 20 min Grape juice (Welch's purple grape juice)  + black currant flavor cordial Placebo (white grape juice with 20 mg (poly)phenols, blackcurrant flavor cordial, sugar matched) 0.9 336.34 n = 20 (7 male, 13 female), 18–35 y Improved reaction times (composite attention measure) and calm ratings) Haskell-Ramsay et al (2017)82 Brain metabolism and cognitive function RCT, DB, P, 6 mo Grape powder, freeze-dried Placebo (powder, fructose and glucose, appearance, smell, volume, flavor matched) ND (72g powder, “3 standard servings”) 356.4 n = 10 (5 male, 5 female), 66–82 y, mild decline in cognition Maintained brain metabolism (no changes from baseline), control did not maintain brain metabolism (decreases observed) Lee et al (2017)83 Cognitive function, mood RCT, DB, 8 wk Orange juice Placebo beverage (low flavanone, 37 mg) 2.1 ND (305 mg flavanones, hesperidin and narirutin) n = 37 (13 male, 24 female), 60–81 y Improved global cognitive function with, no significant effects on mood Kean et al (2015)84 Cognitive function RCT, DB, 6 h Orange juice Placebo beverage (kcal matched) 1.0 ND (272 mg flavonoids: 220.46 mg hesperidin, 34.54 mg narirutin, 17.14 mg other flavonoids) n = 6 (6 male), 30–65 y Improvements in psychomotor speed and executive function Alharbi et al (2016)85 Cognitive function, cerebral blood flow RCT, CO, 2 h 100% fruit juice (Tropicana Ruby Breakfast Juice) Placebo drink (kcal, flavor, color matched) 2.1 ND (70.5 mg flavonoids: 42.15 mg hesperidin, 17.25 mg naringin, 6.75 mg narirutin, 4.3 mg caffeic acid) Behavioral arm: n = 28 (4 males, 20 females); Imaging arm: n = 16 (8 males, 8 females) Improved performance on digit symbol substitution test (but not other cognitive tests) and improved (increased) regional perfusion Lamport et al (2017)86 Indicator . Study design and duration (per arm) . Treatment . Control . Approximate US cup equivalent . (Poly)phenol dose (mg) and specific classes mentioned . Participants . Outcome from treatment . Reference . Memory RCT, CO, P, 2 h Blueberries (star variety)  + semi-skimmed milk and sucrose Control (drink with 100 mL of semi-skimmed milk, sugar, and ascorbic acid matched) 1.4 ND (143 mg anthocyanins) n = 14 (10 male, 4 female), 8–10 y Improvements in delayed recall of previously learned words. Negative impact on encoding new words was observed. No benefit on attention, visuospatial memory, or response inhibition Whyte and Williams (2015)70 Cognitive function RCT, 12 wk Blueberry concentrate Placebo (beverage, synthetic blackcurrant and apple cordial, sugar and kcal matched) ND (30 mL concentrate) ND (387 mg anthocyanins) n = 26 (13 male, 13 female), 66–70 y Improved brain activity (increased gray matter perfusion) Bowtell et al (2017)71 Memory CT, P, 12 wk Blueberry juice Placebo (beverage, not sugar matched) 1.9, 2.3, 2.6 (∼6–9 mL juice/kg body weight) 1056, 1266, 1478 (428, 512, 598 mg anthocyanins) n = 9 (5 male, 4 female), aged 71–81 y, 4, with age-related memory decline Improvements in memory (word recall and paired associate learning) Krikorian et al (2010)72 Cognitive function DB, CO, 6 h Blueberry, freeze-dried blueberry powdera (wild) Placebo (beverage from companion study, no juice or (poly)phenols, color, taste matched, not sugar matched) 0.8, 1.6 ND (127, 253 mg anthocyanins) n = 21 (9 male, 12 female), 7–10 y Improved cognitive performance with both treatments (higher dose was more effective) Whyte et al (2016)73 Mobility and cognitive function RCT, DB, 90 d Blueberry, freeze-dried powderb Placebo (powder, color, and kcal matched) 1 864 (460.8 mg anthocyanins) n = 37 (13 male, 24 female) aged 60–75 y No improvements in mobility (gait or balance), improvements in cognitition (less repetition errors, reduced cost in task switching tests) Miller et al (2018)74 Regional brain activation RCT, DB, 16 wk Blueberry, freeze-dried powderb Placebo (powder, 3.5% (poly)phenol content, 2.4% ORAC, no anthocyanins) 1 ND (269 mg anthocyanins) n = 16, 68–92 y, with awareness of age-related memory decline Improved brain activity (increased blood oxygen level–dependent signal during working memory load conditions), no changes in working memory performance Boespflug et al (2018)75 Mood RCT, DB, 2 h Blueberry, freeze-dried powderb Placebo (beverage, sugar, and ascorbic acid matched, 30 mL of Rocks Orange Squashc in 170 mL water, drinks consumed from an opaque cup and straw) ND (30 g powder) ND (253 mg anthocyanins) n =  52 (23 male, 29 female), 7–10 y Improved mood Khalid et al (2017)76 Mood RCT, DB, 2 h Blueberry, freeze-dried powdera Placebo (beverage, sugar, and ascorbic acid matched, 30 mL of Rocks Orange Squashc in 220 mL water, drinks consumed from an opaque cup and straw) ND (30 g powder) ND (253 mg anthocyanins) n = 21 (2 male, 19 female), 18–21 y Improved mood Khalid et al (2017)76 Cognitive function DB, CO, 3 h Blueberry, freeze-dried powdera Placebo (30 g powder, sugar, and ascorbic acid matched, with 30 mL of Rocks Orange Squashc with 170 mL water, consumed from an opaque cup) ND (30 g powder) ND (253 mg anthocyanins) n = 21 (11 male, 10 female), 7–10 y Improved (faster) performance on cognitively demanding/high load tests and visual cue tasks Whyte et al (2017)77 Memory RCT, DB, 24 wk Blueberry, whole frozenb with and without fish oil Placebo (powder, color, taste, sugar-matched), placebo oil (corn oil) 0.2 417 (269 mg anthocyanins) n = 76 (35 male, 41 female), 62–80 y, mild (self-perceived) age-related cognitive decline Improved cognition (memory discrimination) with both treatments. No synergy observed between fish oil and blueberry Mcnamara et al (2018)78 Cognitive function RCT, DB, CO, LS, 5 h Cherry, Montmorency tart cherry concentrate Placebo (beverage, sugar matched) 1.8 96.45 (40.8 mg anthocyanins) n = 30 (20 male, 10 female), 45–60 y No changes in cognitive function or mood Keane et al (2016)46 Memory RCT, DB, 12 wk Grape juice (Concord) Placebo (beverage, no juice, no (poly)phenols, carbohydrate, kcal, color, and flavormatched) 1.9, 2.3, 2.6 (∼6–9 mL juice/kg body weight) ND n = 12 (8 male, 4 female), 78 ± 5 y (mean age) Improvements in verbal learning, nonsignificant improvements in spatial and verbal recall Krikorian et al (2010)79 Memory RCT, DB, 16 wk Grape juice (Concord) Placebo (glucose: fructose ratio, kcal, color, taste-matched, no juice no (poly)phenols) 1.5, 1.9, 2.6 (∼6.3–7.8 mL juice/kg bw) 742, 928.40, 12 98.51 n = 21 (11 male, 10 female), >65 y, with mild, age-related memory decline Improved performance on memory tasks, higher brain (right hemisphere) Krikorian et al (2012)80 Cognitive function and driving performance RCT, CO, 12 wk Grape juice (Concord) Placebo ((poly)phenol-free, calorie, flavor, and appearance matched) 1.5 777 n = 25 (25 female), 40–50 y Improvements in immediate spatial memory and driving performance Lamport et al (2016)81 Memory (working and episodic), attention, and mood RCT, DB, CO, 20 min Grape juice (Welch's purple grape juice)  + black currant flavor cordial Placebo (white grape juice with 20 mg (poly)phenols, blackcurrant flavor cordial, sugar matched) 0.9 336.34 n = 20 (7 male, 13 female), 18–35 y Improved reaction times (composite attention measure) and calm ratings) Haskell-Ramsay et al (2017)82 Brain metabolism and cognitive function RCT, DB, P, 6 mo Grape powder, freeze-dried Placebo (powder, fructose and glucose, appearance, smell, volume, flavor matched) ND (72g powder, “3 standard servings”) 356.4 n = 10 (5 male, 5 female), 66–82 y, mild decline in cognition Maintained brain metabolism (no changes from baseline), control did not maintain brain metabolism (decreases observed) Lee et al (2017)83 Cognitive function, mood RCT, DB, 8 wk Orange juice Placebo beverage (low flavanone, 37 mg) 2.1 ND (305 mg flavanones, hesperidin and narirutin) n = 37 (13 male, 24 female), 60–81 y Improved global cognitive function with, no significant effects on mood Kean et al (2015)84 Cognitive function RCT, DB, 6 h Orange juice Placebo beverage (kcal matched) 1.0 ND (272 mg flavonoids: 220.46 mg hesperidin, 34.54 mg narirutin, 17.14 mg other flavonoids) n = 6 (6 male), 30–65 y Improvements in psychomotor speed and executive function Alharbi et al (2016)85 Cognitive function, cerebral blood flow RCT, CO, 2 h 100% fruit juice (Tropicana Ruby Breakfast Juice) Placebo drink (kcal, flavor, color matched) 2.1 ND (70.5 mg flavonoids: 42.15 mg hesperidin, 17.25 mg naringin, 6.75 mg narirutin, 4.3 mg caffeic acid) Behavioral arm: n = 28 (4 males, 20 females); Imaging arm: n = 16 (8 males, 8 females) Improved performance on digit symbol substitution test (but not other cognitive tests) and improved (increased) regional perfusion Lamport et al (2017)86 Abbreviations: CO, cross-over study; CT, controlled study; DB, double-blind; LS, Latin square; ND, data not specified in the article; P, pilot; RCT, randomized controlled trial. a Reconstituted with water and flavor (low (poly)phenol). b Reconstituted with water. c Rocks Orange Squash contains 13.2 mg flavonoids per 30 mL. Open in new tab Table 3 Summary of select recent human clinical trials that investigated the effects of fruit (poly)phenols on obesity and diabetes Indicator . Study design and duration (per arm) . Treatment . Placebo . Approximate US cup equivalent . Daily (poly)phenol dose (mg) and specific classes mentioned . Participants . Results . Reference . Cardiometablic biomarkers RCT, CO, 1 wk Blueberry juice (wild) Placebo (240 mL beverage, kcal, color, flavor matched) 1.0 2138 n = 19 (19 female), 39–64 y, at risk for type 2 diabetes No significant changes were observed in insulin and glucose Stote et al (2017)45 Glucose, oxidative status RCT, CO, 4 h Dried cranberriesb Control (meal with 80 g ripe banana, kcal, and carbohydrate matched) 0.5a 178 n = 25 (5 male, 20 female), 50–62 y, with diabetes Improved postprandial glucose, interleukin 18 and malodialdehyde, no differences in lipid profiles, blood pressure, insulin, and insulin resistance (homeostasis model assessment) Schell et al (2017)87 Insulin sensitivity and secretion RCT, 1 mo Pomegranate juice Placebo (details not specified) 0.5 ND n = 20 (sex not specified), 25–55 y, with BMI >30.0 No effect on insulin secretion or sensitivity, weight was maintained (weight gain with control) González-Ortiz et al (2011)88 Triglycerides, cholesterol RCT, DB, CO, 1 wk Pomegranate juice Placebo (beverage with similar taste, color, kcal, no (poly)phenols) 2.1 ND (141.5 mg flavonoids, 50.23 mg anthocyanins) n = 30 (14 male, 18 female), 41–61 y, metabolic syndrome Increased triglycerides and VLDL-C Moazzen et al (2017)61 Glucose, oxidative stress RCT, 6 wk Pomegranate juice Control group (no treatment) 0.9 425 n = 60, (30 male, 30 female) 40–65 y, diabetic No effect on fasting blood glucose, improved oxidative stress (lower LDL and antioxidized LDL antibodies) Sohrab et al (2016)89 Insulin resistance, blood glucose, beta-cell function RCT, 3 h Pomegranate juice (fresh) Control (1.5 mL/kg bodyweight tap water) ND (1.5 mL of juice/kg bodyweight) ND n = 85 (40 male, 45 female; 36 hypertensive and diabetic, 50 healthy), 37–60 y After 3 hr, diabetic participants, but not healthy participants, treated with pomegranate juice exhibited improved (decreased) insulin resistance, fasting serum glucose, and (increased) beta-cell function in diabetic Banihani et al (2014)90 Glycemic pesponse RCT, CO, 3 h Pomegranate juice (vs extract) Control for pomegranate juice (reference meal with 200 mL of water, sugarmatched). Placebo for pomegranate extract (cellulose, sugar was assumed to be negligable in extract) 0.9 ND (71.5 mg punicalin, 12.4 mg punicalagin, 2.8 mg ellagic acid hexose, 4.8 mg ellagic acid) n = 16 (sex not specified), 18–40 y Improved (reduced) postprandial glycemic response with juice but not extract Kerimi et al (2017)91 Indicator . Study design and duration (per arm) . Treatment . Placebo . Approximate US cup equivalent . Daily (poly)phenol dose (mg) and specific classes mentioned . Participants . Results . Reference . Cardiometablic biomarkers RCT, CO, 1 wk Blueberry juice (wild) Placebo (240 mL beverage, kcal, color, flavor matched) 1.0 2138 n = 19 (19 female), 39–64 y, at risk for type 2 diabetes No significant changes were observed in insulin and glucose Stote et al (2017)45 Glucose, oxidative status RCT, CO, 4 h Dried cranberriesb Control (meal with 80 g ripe banana, kcal, and carbohydrate matched) 0.5a 178 n = 25 (5 male, 20 female), 50–62 y, with diabetes Improved postprandial glucose, interleukin 18 and malodialdehyde, no differences in lipid profiles, blood pressure, insulin, and insulin resistance (homeostasis model assessment) Schell et al (2017)87 Insulin sensitivity and secretion RCT, 1 mo Pomegranate juice Placebo (details not specified) 0.5 ND n = 20 (sex not specified), 25–55 y, with BMI >30.0 No effect on insulin secretion or sensitivity, weight was maintained (weight gain with control) González-Ortiz et al (2011)88 Triglycerides, cholesterol RCT, DB, CO, 1 wk Pomegranate juice Placebo (beverage with similar taste, color, kcal, no (poly)phenols) 2.1 ND (141.5 mg flavonoids, 50.23 mg anthocyanins) n = 30 (14 male, 18 female), 41–61 y, metabolic syndrome Increased triglycerides and VLDL-C Moazzen et al (2017)61 Glucose, oxidative stress RCT, 6 wk Pomegranate juice Control group (no treatment) 0.9 425 n = 60, (30 male, 30 female) 40–65 y, diabetic No effect on fasting blood glucose, improved oxidative stress (lower LDL and antioxidized LDL antibodies) Sohrab et al (2016)89 Insulin resistance, blood glucose, beta-cell function RCT, 3 h Pomegranate juice (fresh) Control (1.5 mL/kg bodyweight tap water) ND (1.5 mL of juice/kg bodyweight) ND n = 85 (40 male, 45 female; 36 hypertensive and diabetic, 50 healthy), 37–60 y After 3 hr, diabetic participants, but not healthy participants, treated with pomegranate juice exhibited improved (decreased) insulin resistance, fasting serum glucose, and (increased) beta-cell function in diabetic Banihani et al (2014)90 Glycemic pesponse RCT, CO, 3 h Pomegranate juice (vs extract) Control for pomegranate juice (reference meal with 200 mL of water, sugarmatched). Placebo for pomegranate extract (cellulose, sugar was assumed to be negligable in extract) 0.9 ND (71.5 mg punicalin, 12.4 mg punicalagin, 2.8 mg ellagic acid hexose, 4.8 mg ellagic acid) n = 16 (sex not specified), 18–40 y Improved (reduced) postprandial glycemic response with juice but not extract Kerimi et al (2017)91 Abbreviations: BMI, body mass index; CO, cross-over study; CT, controlled study; DB, double-blind; LDL, low-density-lipoprotein; LS, Latin square; ND, data not specified in the article; P, pilot; RCT, randomized controlled trial.; VLDL-C, very-low-density cholesterol. a Reconstituted with water. b Assumed 1 cup of dried cranberries = 160 g (USDA Database no. 09079) and that ½ cup dried fruit = 1 cup fresh or 100% fruit juice92 (https://www.choosemyplate.gov/fruit). Open in new tab Table 3 Summary of select recent human clinical trials that investigated the effects of fruit (poly)phenols on obesity and diabetes Indicator . Study design and duration (per arm) . Treatment . Placebo . Approximate US cup equivalent . Daily (poly)phenol dose (mg) and specific classes mentioned . Participants . Results . Reference . Cardiometablic biomarkers RCT, CO, 1 wk Blueberry juice (wild) Placebo (240 mL beverage, kcal, color, flavor matched) 1.0 2138 n = 19 (19 female), 39–64 y, at risk for type 2 diabetes No significant changes were observed in insulin and glucose Stote et al (2017)45 Glucose, oxidative status RCT, CO, 4 h Dried cranberriesb Control (meal with 80 g ripe banana, kcal, and carbohydrate matched) 0.5a 178 n = 25 (5 male, 20 female), 50–62 y, with diabetes Improved postprandial glucose, interleukin 18 and malodialdehyde, no differences in lipid profiles, blood pressure, insulin, and insulin resistance (homeostasis model assessment) Schell et al (2017)87 Insulin sensitivity and secretion RCT, 1 mo Pomegranate juice Placebo (details not specified) 0.5 ND n = 20 (sex not specified), 25–55 y, with BMI >30.0 No effect on insulin secretion or sensitivity, weight was maintained (weight gain with control) González-Ortiz et al (2011)88 Triglycerides, cholesterol RCT, DB, CO, 1 wk Pomegranate juice Placebo (beverage with similar taste, color, kcal, no (poly)phenols) 2.1 ND (141.5 mg flavonoids, 50.23 mg anthocyanins) n = 30 (14 male, 18 female), 41–61 y, metabolic syndrome Increased triglycerides and VLDL-C Moazzen et al (2017)61 Glucose, oxidative stress RCT, 6 wk Pomegranate juice Control group (no treatment) 0.9 425 n = 60, (30 male, 30 female) 40–65 y, diabetic No effect on fasting blood glucose, improved oxidative stress (lower LDL and antioxidized LDL antibodies) Sohrab et al (2016)89 Insulin resistance, blood glucose, beta-cell function RCT, 3 h Pomegranate juice (fresh) Control (1.5 mL/kg bodyweight tap water) ND (1.5 mL of juice/kg bodyweight) ND n = 85 (40 male, 45 female; 36 hypertensive and diabetic, 50 healthy), 37–60 y After 3 hr, diabetic participants, but not healthy participants, treated with pomegranate juice exhibited improved (decreased) insulin resistance, fasting serum glucose, and (increased) beta-cell function in diabetic Banihani et al (2014)90 Glycemic pesponse RCT, CO, 3 h Pomegranate juice (vs extract) Control for pomegranate juice (reference meal with 200 mL of water, sugarmatched). Placebo for pomegranate extract (cellulose, sugar was assumed to be negligable in extract) 0.9 ND (71.5 mg punicalin, 12.4 mg punicalagin, 2.8 mg ellagic acid hexose, 4.8 mg ellagic acid) n = 16 (sex not specified), 18–40 y Improved (reduced) postprandial glycemic response with juice but not extract Kerimi et al (2017)91 Indicator . Study design and duration (per arm) . Treatment . Placebo . Approximate US cup equivalent . Daily (poly)phenol dose (mg) and specific classes mentioned . Participants . Results . Reference . Cardiometablic biomarkers RCT, CO, 1 wk Blueberry juice (wild) Placebo (240 mL beverage, kcal, color, flavor matched) 1.0 2138 n = 19 (19 female), 39–64 y, at risk for type 2 diabetes No significant changes were observed in insulin and glucose Stote et al (2017)45 Glucose, oxidative status RCT, CO, 4 h Dried cranberriesb Control (meal with 80 g ripe banana, kcal, and carbohydrate matched) 0.5a 178 n = 25 (5 male, 20 female), 50–62 y, with diabetes Improved postprandial glucose, interleukin 18 and malodialdehyde, no differences in lipid profiles, blood pressure, insulin, and insulin resistance (homeostasis model assessment) Schell et al (2017)87 Insulin sensitivity and secretion RCT, 1 mo Pomegranate juice Placebo (details not specified) 0.5 ND n = 20 (sex not specified), 25–55 y, with BMI >30.0 No effect on insulin secretion or sensitivity, weight was maintained (weight gain with control) González-Ortiz et al (2011)88 Triglycerides, cholesterol RCT, DB, CO, 1 wk Pomegranate juice Placebo (beverage with similar taste, color, kcal, no (poly)phenols) 2.1 ND (141.5 mg flavonoids, 50.23 mg anthocyanins) n = 30 (14 male, 18 female), 41–61 y, metabolic syndrome Increased triglycerides and VLDL-C Moazzen et al (2017)61 Glucose, oxidative stress RCT, 6 wk Pomegranate juice Control group (no treatment) 0.9 425 n = 60, (30 male, 30 female) 40–65 y, diabetic No effect on fasting blood glucose, improved oxidative stress (lower LDL and antioxidized LDL antibodies) Sohrab et al (2016)89 Insulin resistance, blood glucose, beta-cell function RCT, 3 h Pomegranate juice (fresh) Control (1.5 mL/kg bodyweight tap water) ND (1.5 mL of juice/kg bodyweight) ND n = 85 (40 male, 45 female; 36 hypertensive and diabetic, 50 healthy), 37–60 y After 3 hr, diabetic participants, but not healthy participants, treated with pomegranate juice exhibited improved (decreased) insulin resistance, fasting serum glucose, and (increased) beta-cell function in diabetic Banihani et al (2014)90 Glycemic pesponse RCT, CO, 3 h Pomegranate juice (vs extract) Control for pomegranate juice (reference meal with 200 mL of water, sugarmatched). Placebo for pomegranate extract (cellulose, sugar was assumed to be negligable in extract) 0.9 ND (71.5 mg punicalin, 12.4 mg punicalagin, 2.8 mg ellagic acid hexose, 4.8 mg ellagic acid) n = 16 (sex not specified), 18–40 y Improved (reduced) postprandial glycemic response with juice but not extract Kerimi et al (2017)91 Abbreviations: BMI, body mass index; CO, cross-over study; CT, controlled study; DB, double-blind; LDL, low-density-lipoprotein; LS, Latin square; ND, data not specified in the article; P, pilot; RCT, randomized controlled trial.; VLDL-C, very-low-density cholesterol. a Reconstituted with water. b Assumed 1 cup of dried cranberries = 160 g (USDA Database no. 09079) and that ½ cup dried fruit = 1 cup fresh or 100% fruit juice92 (https://www.choosemyplate.gov/fruit). Open in new tab Table 4 Summary of select recent human clinical trials that investigated the effects of fruit (poly)phenols on exercise performance Indicator . Study design and duration (per arm) . Treatment . Placebo . Approximate US cup equivalent . Daily (poly)phenol dose (mg) and specific classes mentioned . Participants . Outcome from intervention . Reference . Ergogenic effect RCT, 28 d Grape juice, purple Control (beverage, kcal, glycemic, volume matched) ND (10 mL/kg/d (2 doses, prior to and following exercise) ND (1.82 mg (poly)phenols/kg bw) n = 28 (22 male, 6 female), recreational runners Improved (increased) time-to-exhaustion and antioxidant activity Toscano et al (2015)93 Postexercise hypotension RCT, 28 d Grape juice, red Baseline 0.4 (female dose), 0.6 (male dose) ND n = 26 (9 male, 17 female), 40–59 y, with borderline or controlled hypertension Potentiated exercise hypotension in individuals with controlled blood pressure Miranda Neto et al (2017)58 Fitness, muscle injury, perceived health, and mood RCT, DB, 42 d Grape powder, freeze-drieda Placebo (powder, kcal matched) 0.8 ND (145.2 mg/kg malvidin, 125 mg/kg cyanidin, 21.7 mg/kg peonidin, 1.75 mg/kg resveratrol, 19.7 mg/kg catechin, 12.6 mg/kg epicatechin, 32.6 mg/kg quercetin, 5.6 mg/kg kaempferol, 6.8 mg/kg isorhamnetin) n = 40 (20 male, 20 female), recreationally active (engaged in vigorous activities more than 1 time/wk) No effects on muscle injury, fitness, perceived health, or mood O'Connor et al (2013)94 Recovery, muscle soreness, inflammation markers CT, 2 d Pomegranate juice Placebo (beverage with water, citric acid, natural flavor, aspartame, acesulfame K, gum arabic, no (poly)phenols, no vitamins) 3.2 3840 n = 9 (9 male), 20–22 y, elite weightlifters Improved performance, lower perceived exertion, and an improved inflammatory markers after weight-lifting Ammar et al (2016)95 Oxidative stress CT, 10 d Pomegranate juice Placebo (beverage with water, citric acid, natural flavor, aspartame, acesulfame K, gum arabic, no (poly)phenols, no vitamins) 3.2 3840 n = 9 (9 male), 20–22 y, elite weightlifters Improved post-exercise oxidative stress (malnaldehyde, enzymatic and nonenzymatic antioxidant responses) Ammar (2017)96 Strength, recovery (soreness) RCT, DB, CO, 8 d Pomegranate juice Placebo (beverage, carbohydrate, color, flavor matched) 2.1 ND (384 mg/L anthocyanins) n = 17 (17 male) 19–24 y, physically active, resistance trained (>3 mo of weight training, both upper and lower body 2 d/wk) Improved strength (elbow flexion) Reduced soreness (flexor but not knee extensor) Trombold et al (2011)97 Oxidative stress RCT, DB, 21 d Pomegranate juice Control (nonpomegranate juice, kcal matched) 0.4–0.9 1100, 2200 n = 31 (31 male), mean age of 33 y, endurance-based athletes Improved (decreased) oxidative stress (carbonyls and malonaldehyde) Fuster-Munoz et al (2016)98 Strength, recovery DB, CT, 8 d Cherry concentrate (Montmorency) Placebo (mixed berry cordial with 100 mL water, maltodextrin, carbohydrate matched) Approximately 1.8–2.1b 552 n = 16 (16 male), 30 ± 8 y, cyclists Maintained strength (maximum voluntary isometric contraction) and IL-6 and hsCRP Bell et al (2015)99 Recovery RCT, DB, 10 d Cherry, powder, CherryPURE (obtained from freeze-dried Montmorency tart cherry skin) Placebo (carbohydrate-matched capsule) 2.2 993.10 n = 23 (23 male), 20.9 ±  2.6 y, resistance trained Reduced muscle soreness, muscle catabolism, and strength during recovery Levers et al (2015)100 Strength, recovery DB, CT, 7 d (4 d leading up to the trial and each of the 3 subsequent trial days) Cherry concentrate (Montmorency) Placebo (5% fruit cordial, water, maltodextrin, kcal-matched) 1.9 10.728 n = 16 (16 male), semi-professional soccer players Faster recovery and less muscle soreness, attenuated acute inflammatory response (IL-6). No effects on muscle damage and oxidative stress Bell et al (2016)101 Recovery RCT, DB, 10 d Cherry, powder, CherryPURE (obtained from freeze-dried Montmorency tart cherry skin) Placebo (rice flour) 2.2 993.10 n = 27 (18 male, 9 female), 21.8 ± 3.9 y, endurance-trained runners or triathletes Improved muscle catabolic markers (creatinine, urea/blood urea nitrogen, total protein, and cortisol) Improved (lower) inflammatory response and soreness perception Levers et al (2016)102 Performance, recovery RCT, DB, CO, 6 d Cherry concentrate (Montmorency) Placebo (beverage, 40 mL of “off the shelf” lime, cranberry, raspberry cordials, food coloring, and 480 mL water, maltodextrin, color, taste, carbohydrate-matched) 2.6 820.53 n = 9 (9 male), 18.6 ± 1.4 y, water polo athletes No changes in performance or recovery Mccormick et al (2016)103 Performance RCT, DB, CO, 1.5 h Cherry concentrate (Montmorency) Placebo (fruit-flavored cordial, matched for macronutrient content) 1.9 n = 10 (10 males), 28 ± 7 y, trained cyclists Improvements in work completed (during 60-sec of all-out sprinting) and power, no differences in time to exhaustion or nitric oxide Keane et al (2018)104 Muscle protein synthesis response RCT, DB, 2 wk Cherry concentrate (Montmorency) Placebo (cherry flavored, kcal matched) 1.9a ND (540 mg anthocyanins) n = 16 (16 male), 60–75 y, healthy No effect of myofibrillar protein synthesis, no anabolic response Jackman et al (2018)105 Strength, recovery RCT, DB, 8 d Cherry concentrate (Montmorency, CherryActive) Placebo (beverage with whey powder, synthetic fruit flavor, 100 mL water, maltodextrin, negligable phytochemical content) 1.8a 10.73 n = 20 (20 female), 19 ± 1 y, physically active Improved recovery, performance (countermovement jump height), and (higher) pain pressure threshold Brown (2018)106 Indicator . Study design and duration (per arm) . Treatment . Placebo . Approximate US cup equivalent . Daily (poly)phenol dose (mg) and specific classes mentioned . Participants . Outcome from intervention . Reference . Ergogenic effect RCT, 28 d Grape juice, purple Control (beverage, kcal, glycemic, volume matched) ND (10 mL/kg/d (2 doses, prior to and following exercise) ND (1.82 mg (poly)phenols/kg bw) n = 28 (22 male, 6 female), recreational runners Improved (increased) time-to-exhaustion and antioxidant activity Toscano et al (2015)93 Postexercise hypotension RCT, 28 d Grape juice, red Baseline 0.4 (female dose), 0.6 (male dose) ND n = 26 (9 male, 17 female), 40–59 y, with borderline or controlled hypertension Potentiated exercise hypotension in individuals with controlled blood pressure Miranda Neto et al (2017)58 Fitness, muscle injury, perceived health, and mood RCT, DB, 42 d Grape powder, freeze-drieda Placebo (powder, kcal matched) 0.8 ND (145.2 mg/kg malvidin, 125 mg/kg cyanidin, 21.7 mg/kg peonidin, 1.75 mg/kg resveratrol, 19.7 mg/kg catechin, 12.6 mg/kg epicatechin, 32.6 mg/kg quercetin, 5.6 mg/kg kaempferol, 6.8 mg/kg isorhamnetin) n = 40 (20 male, 20 female), recreationally active (engaged in vigorous activities more than 1 time/wk) No effects on muscle injury, fitness, perceived health, or mood O'Connor et al (2013)94 Recovery, muscle soreness, inflammation markers CT, 2 d Pomegranate juice Placebo (beverage with water, citric acid, natural flavor, aspartame, acesulfame K, gum arabic, no (poly)phenols, no vitamins) 3.2 3840 n = 9 (9 male), 20–22 y, elite weightlifters Improved performance, lower perceived exertion, and an improved inflammatory markers after weight-lifting Ammar et al (2016)95 Oxidative stress CT, 10 d Pomegranate juice Placebo (beverage with water, citric acid, natural flavor, aspartame, acesulfame K, gum arabic, no (poly)phenols, no vitamins) 3.2 3840 n = 9 (9 male), 20–22 y, elite weightlifters Improved post-exercise oxidative stress (malnaldehyde, enzymatic and nonenzymatic antioxidant responses) Ammar (2017)96 Strength, recovery (soreness) RCT, DB, CO, 8 d Pomegranate juice Placebo (beverage, carbohydrate, color, flavor matched) 2.1 ND (384 mg/L anthocyanins) n = 17 (17 male) 19–24 y, physically active, resistance trained (>3 mo of weight training, both upper and lower body 2 d/wk) Improved strength (elbow flexion) Reduced soreness (flexor but not knee extensor) Trombold et al (2011)97 Oxidative stress RCT, DB, 21 d Pomegranate juice Control (nonpomegranate juice, kcal matched) 0.4–0.9 1100, 2200 n = 31 (31 male), mean age of 33 y, endurance-based athletes Improved (decreased) oxidative stress (carbonyls and malonaldehyde) Fuster-Munoz et al (2016)98 Strength, recovery DB, CT, 8 d Cherry concentrate (Montmorency) Placebo (mixed berry cordial with 100 mL water, maltodextrin, carbohydrate matched) Approximately 1.8–2.1b 552 n = 16 (16 male), 30 ± 8 y, cyclists Maintained strength (maximum voluntary isometric contraction) and IL-6 and hsCRP Bell et al (2015)99 Recovery RCT, DB, 10 d Cherry, powder, CherryPURE (obtained from freeze-dried Montmorency tart cherry skin) Placebo (carbohydrate-matched capsule) 2.2 993.10 n = 23 (23 male), 20.9 ±  2.6 y, resistance trained Reduced muscle soreness, muscle catabolism, and strength during recovery Levers et al (2015)100 Strength, recovery DB, CT, 7 d (4 d leading up to the trial and each of the 3 subsequent trial days) Cherry concentrate (Montmorency) Placebo (5% fruit cordial, water, maltodextrin, kcal-matched) 1.9 10.728 n = 16 (16 male), semi-professional soccer players Faster recovery and less muscle soreness, attenuated acute inflammatory response (IL-6). No effects on muscle damage and oxidative stress Bell et al (2016)101 Recovery RCT, DB, 10 d Cherry, powder, CherryPURE (obtained from freeze-dried Montmorency tart cherry skin) Placebo (rice flour) 2.2 993.10 n = 27 (18 male, 9 female), 21.8 ± 3.9 y, endurance-trained runners or triathletes Improved muscle catabolic markers (creatinine, urea/blood urea nitrogen, total protein, and cortisol) Improved (lower) inflammatory response and soreness perception Levers et al (2016)102 Performance, recovery RCT, DB, CO, 6 d Cherry concentrate (Montmorency) Placebo (beverage, 40 mL of “off the shelf” lime, cranberry, raspberry cordials, food coloring, and 480 mL water, maltodextrin, color, taste, carbohydrate-matched) 2.6 820.53 n = 9 (9 male), 18.6 ± 1.4 y, water polo athletes No changes in performance or recovery Mccormick et al (2016)103 Performance RCT, DB, CO, 1.5 h Cherry concentrate (Montmorency) Placebo (fruit-flavored cordial, matched for macronutrient content) 1.9 n = 10 (10 males), 28 ± 7 y, trained cyclists Improvements in work completed (during 60-sec of all-out sprinting) and power, no differences in time to exhaustion or nitric oxide Keane et al (2018)104 Muscle protein synthesis response RCT, DB, 2 wk Cherry concentrate (Montmorency) Placebo (cherry flavored, kcal matched) 1.9a ND (540 mg anthocyanins) n = 16 (16 male), 60–75 y, healthy No effect of myofibrillar protein synthesis, no anabolic response Jackman et al (2018)105 Strength, recovery RCT, DB, 8 d Cherry concentrate (Montmorency, CherryActive) Placebo (beverage with whey powder, synthetic fruit flavor, 100 mL water, maltodextrin, negligable phytochemical content) 1.8a 10.73 n = 20 (20 female), 19 ± 1 y, physically active Improved recovery, performance (countermovement jump height), and (higher) pain pressure threshold Brown (2018)106 Abbreviations: CO, cross-over study; CT, controlled study; DB, double-blind; hsCRP, high-sensitivity C-reactive protein; IL, interleukin; LS, Latin square; ND, data not specified in the article; P, pilot; RCT, randomized controlled trial. a Reconstituted with water. b Cup equivalent calculation assumes 30 mL dose = 90–110 tart cherries. Open in new tab Table 4 Summary of select recent human clinical trials that investigated the effects of fruit (poly)phenols on exercise performance Indicator . Study design and duration (per arm) . Treatment . Placebo . Approximate US cup equivalent . Daily (poly)phenol dose (mg) and specific classes mentioned . Participants . Outcome from intervention . Reference . Ergogenic effect RCT, 28 d Grape juice, purple Control (beverage, kcal, glycemic, volume matched) ND (10 mL/kg/d (2 doses, prior to and following exercise) ND (1.82 mg (poly)phenols/kg bw) n = 28 (22 male, 6 female), recreational runners Improved (increased) time-to-exhaustion and antioxidant activity Toscano et al (2015)93 Postexercise hypotension RCT, 28 d Grape juice, red Baseline 0.4 (female dose), 0.6 (male dose) ND n = 26 (9 male, 17 female), 40–59 y, with borderline or controlled hypertension Potentiated exercise hypotension in individuals with controlled blood pressure Miranda Neto et al (2017)58 Fitness, muscle injury, perceived health, and mood RCT, DB, 42 d Grape powder, freeze-drieda Placebo (powder, kcal matched) 0.8 ND (145.2 mg/kg malvidin, 125 mg/kg cyanidin, 21.7 mg/kg peonidin, 1.75 mg/kg resveratrol, 19.7 mg/kg catechin, 12.6 mg/kg epicatechin, 32.6 mg/kg quercetin, 5.6 mg/kg kaempferol, 6.8 mg/kg isorhamnetin) n = 40 (20 male, 20 female), recreationally active (engaged in vigorous activities more than 1 time/wk) No effects on muscle injury, fitness, perceived health, or mood O'Connor et al (2013)94 Recovery, muscle soreness, inflammation markers CT, 2 d Pomegranate juice Placebo (beverage with water, citric acid, natural flavor, aspartame, acesulfame K, gum arabic, no (poly)phenols, no vitamins) 3.2 3840 n = 9 (9 male), 20–22 y, elite weightlifters Improved performance, lower perceived exertion, and an improved inflammatory markers after weight-lifting Ammar et al (2016)95 Oxidative stress CT, 10 d Pomegranate juice Placebo (beverage with water, citric acid, natural flavor, aspartame, acesulfame K, gum arabic, no (poly)phenols, no vitamins) 3.2 3840 n = 9 (9 male), 20–22 y, elite weightlifters Improved post-exercise oxidative stress (malnaldehyde, enzymatic and nonenzymatic antioxidant responses) Ammar (2017)96 Strength, recovery (soreness) RCT, DB, CO, 8 d Pomegranate juice Placebo (beverage, carbohydrate, color, flavor matched) 2.1 ND (384 mg/L anthocyanins) n = 17 (17 male) 19–24 y, physically active, resistance trained (>3 mo of weight training, both upper and lower body 2 d/wk) Improved strength (elbow flexion) Reduced soreness (flexor but not knee extensor) Trombold et al (2011)97 Oxidative stress RCT, DB, 21 d Pomegranate juice Control (nonpomegranate juice, kcal matched) 0.4–0.9 1100, 2200 n = 31 (31 male), mean age of 33 y, endurance-based athletes Improved (decreased) oxidative stress (carbonyls and malonaldehyde) Fuster-Munoz et al (2016)98 Strength, recovery DB, CT, 8 d Cherry concentrate (Montmorency) Placebo (mixed berry cordial with 100 mL water, maltodextrin, carbohydrate matched) Approximately 1.8–2.1b 552 n = 16 (16 male), 30 ± 8 y, cyclists Maintained strength (maximum voluntary isometric contraction) and IL-6 and hsCRP Bell et al (2015)99 Recovery RCT, DB, 10 d Cherry, powder, CherryPURE (obtained from freeze-dried Montmorency tart cherry skin) Placebo (carbohydrate-matched capsule) 2.2 993.10 n = 23 (23 male), 20.9 ±  2.6 y, resistance trained Reduced muscle soreness, muscle catabolism, and strength during recovery Levers et al (2015)100 Strength, recovery DB, CT, 7 d (4 d leading up to the trial and each of the 3 subsequent trial days) Cherry concentrate (Montmorency) Placebo (5% fruit cordial, water, maltodextrin, kcal-matched) 1.9 10.728 n = 16 (16 male), semi-professional soccer players Faster recovery and less muscle soreness, attenuated acute inflammatory response (IL-6). No effects on muscle damage and oxidative stress Bell et al (2016)101 Recovery RCT, DB, 10 d Cherry, powder, CherryPURE (obtained from freeze-dried Montmorency tart cherry skin) Placebo (rice flour) 2.2 993.10 n = 27 (18 male, 9 female), 21.8 ± 3.9 y, endurance-trained runners or triathletes Improved muscle catabolic markers (creatinine, urea/blood urea nitrogen, total protein, and cortisol) Improved (lower) inflammatory response and soreness perception Levers et al (2016)102 Performance, recovery RCT, DB, CO, 6 d Cherry concentrate (Montmorency) Placebo (beverage, 40 mL of “off the shelf” lime, cranberry, raspberry cordials, food coloring, and 480 mL water, maltodextrin, color, taste, carbohydrate-matched) 2.6 820.53 n = 9 (9 male), 18.6 ± 1.4 y, water polo athletes No changes in performance or recovery Mccormick et al (2016)103 Performance RCT, DB, CO, 1.5 h Cherry concentrate (Montmorency) Placebo (fruit-flavored cordial, matched for macronutrient content) 1.9 n = 10 (10 males), 28 ± 7 y, trained cyclists Improvements in work completed (during 60-sec of all-out sprinting) and power, no differences in time to exhaustion or nitric oxide Keane et al (2018)104 Muscle protein synthesis response RCT, DB, 2 wk Cherry concentrate (Montmorency) Placebo (cherry flavored, kcal matched) 1.9a ND (540 mg anthocyanins) n = 16 (16 male), 60–75 y, healthy No effect of myofibrillar protein synthesis, no anabolic response Jackman et al (2018)105 Strength, recovery RCT, DB, 8 d Cherry concentrate (Montmorency, CherryActive) Placebo (beverage with whey powder, synthetic fruit flavor, 100 mL water, maltodextrin, negligable phytochemical content) 1.8a 10.73 n = 20 (20 female), 19 ± 1 y, physically active Improved recovery, performance (countermovement jump height), and (higher) pain pressure threshold Brown (2018)106 Indicator . Study design and duration (per arm) . Treatment . Placebo . Approximate US cup equivalent . Daily (poly)phenol dose (mg) and specific classes mentioned . Participants . Outcome from intervention . Reference . Ergogenic effect RCT, 28 d Grape juice, purple Control (beverage, kcal, glycemic, volume matched) ND (10 mL/kg/d (2 doses, prior to and following exercise) ND (1.82 mg (poly)phenols/kg bw) n = 28 (22 male, 6 female), recreational runners Improved (increased) time-to-exhaustion and antioxidant activity Toscano et al (2015)93 Postexercise hypotension RCT, 28 d Grape juice, red Baseline 0.4 (female dose), 0.6 (male dose) ND n = 26 (9 male, 17 female), 40–59 y, with borderline or controlled hypertension Potentiated exercise hypotension in individuals with controlled blood pressure Miranda Neto et al (2017)58 Fitness, muscle injury, perceived health, and mood RCT, DB, 42 d Grape powder, freeze-drieda Placebo (powder, kcal matched) 0.8 ND (145.2 mg/kg malvidin, 125 mg/kg cyanidin, 21.7 mg/kg peonidin, 1.75 mg/kg resveratrol, 19.7 mg/kg catechin, 12.6 mg/kg epicatechin, 32.6 mg/kg quercetin, 5.6 mg/kg kaempferol, 6.8 mg/kg isorhamnetin) n = 40 (20 male, 20 female), recreationally active (engaged in vigorous activities more than 1 time/wk) No effects on muscle injury, fitness, perceived health, or mood O'Connor et al (2013)94 Recovery, muscle soreness, inflammation markers CT, 2 d Pomegranate juice Placebo (beverage with water, citric acid, natural flavor, aspartame, acesulfame K, gum arabic, no (poly)phenols, no vitamins) 3.2 3840 n = 9 (9 male), 20–22 y, elite weightlifters Improved performance, lower perceived exertion, and an improved inflammatory markers after weight-lifting Ammar et al (2016)95 Oxidative stress CT, 10 d Pomegranate juice Placebo (beverage with water, citric acid, natural flavor, aspartame, acesulfame K, gum arabic, no (poly)phenols, no vitamins) 3.2 3840 n = 9 (9 male), 20–22 y, elite weightlifters Improved post-exercise oxidative stress (malnaldehyde, enzymatic and nonenzymatic antioxidant responses) Ammar (2017)96 Strength, recovery (soreness) RCT, DB, CO, 8 d Pomegranate juice Placebo (beverage, carbohydrate, color, flavor matched) 2.1 ND (384 mg/L anthocyanins) n = 17 (17 male) 19–24 y, physically active, resistance trained (>3 mo of weight training, both upper and lower body 2 d/wk) Improved strength (elbow flexion) Reduced soreness (flexor but not knee extensor) Trombold et al (2011)97 Oxidative stress RCT, DB, 21 d Pomegranate juice Control (nonpomegranate juice, kcal matched) 0.4–0.9 1100, 2200 n = 31 (31 male), mean age of 33 y, endurance-based athletes Improved (decreased) oxidative stress (carbonyls and malonaldehyde) Fuster-Munoz et al (2016)98 Strength, recovery DB, CT, 8 d Cherry concentrate (Montmorency) Placebo (mixed berry cordial with 100 mL water, maltodextrin, carbohydrate matched) Approximately 1.8–2.1b 552 n = 16 (16 male), 30 ± 8 y, cyclists Maintained strength (maximum voluntary isometric contraction) and IL-6 and hsCRP Bell et al (2015)99 Recovery RCT, DB, 10 d Cherry, powder, CherryPURE (obtained from freeze-dried Montmorency tart cherry skin) Placebo (carbohydrate-matched capsule) 2.2 993.10 n = 23 (23 male), 20.9 ±  2.6 y, resistance trained Reduced muscle soreness, muscle catabolism, and strength during recovery Levers et al (2015)100 Strength, recovery DB, CT, 7 d (4 d leading up to the trial and each of the 3 subsequent trial days) Cherry concentrate (Montmorency) Placebo (5% fruit cordial, water, maltodextrin, kcal-matched) 1.9 10.728 n = 16 (16 male), semi-professional soccer players Faster recovery and less muscle soreness, attenuated acute inflammatory response (IL-6). No effects on muscle damage and oxidative stress Bell et al (2016)101 Recovery RCT, DB, 10 d Cherry, powder, CherryPURE (obtained from freeze-dried Montmorency tart cherry skin) Placebo (rice flour) 2.2 993.10 n = 27 (18 male, 9 female), 21.8 ± 3.9 y, endurance-trained runners or triathletes Improved muscle catabolic markers (creatinine, urea/blood urea nitrogen, total protein, and cortisol) Improved (lower) inflammatory response and soreness perception Levers et al (2016)102 Performance, recovery RCT, DB, CO, 6 d Cherry concentrate (Montmorency) Placebo (beverage, 40 mL of “off the shelf” lime, cranberry, raspberry cordials, food coloring, and 480 mL water, maltodextrin, color, taste, carbohydrate-matched) 2.6 820.53 n = 9 (9 male), 18.6 ± 1.4 y, water polo athletes No changes in performance or recovery Mccormick et al (2016)103 Performance RCT, DB, CO, 1.5 h Cherry concentrate (Montmorency) Placebo (fruit-flavored cordial, matched for macronutrient content) 1.9 n = 10 (10 males), 28 ± 7 y, trained cyclists Improvements in work completed (during 60-sec of all-out sprinting) and power, no differences in time to exhaustion or nitric oxide Keane et al (2018)104 Muscle protein synthesis response RCT, DB, 2 wk Cherry concentrate (Montmorency) Placebo (cherry flavored, kcal matched) 1.9a ND (540 mg anthocyanins) n = 16 (16 male), 60–75 y, healthy No effect of myofibrillar protein synthesis, no anabolic response Jackman et al (2018)105 Strength, recovery RCT, DB, 8 d Cherry concentrate (Montmorency, CherryActive) Placebo (beverage with whey powder, synthetic fruit flavor, 100 mL water, maltodextrin, negligable phytochemical content) 1.8a 10.73 n = 20 (20 female), 19 ± 1 y, physically active Improved recovery, performance (countermovement jump height), and (higher) pain pressure threshold Brown (2018)106 Abbreviations: CO, cross-over study; CT, controlled study; DB, double-blind; hsCRP, high-sensitivity C-reactive protein; IL, interleukin; LS, Latin square; ND, data not specified in the article; P, pilot; RCT, randomized controlled trial. a Reconstituted with water. b Cup equivalent calculation assumes 30 mL dose = 90–110 tart cherries. Open in new tab Cardiovascular disease Epidemiology has linked fruit (poly)phenol consumption with cardiovascular disease (CVD) prevention and more broadly “heart health.” Food-frequency data from 30 458 women (aged 35–69 y) indicated that overall fruit intake was associated with reduced risk of CVD and coronary heart disease mortality.107 Additionally, women in the highest intake group for citrus fruits and grapes exhibited a decrease in stroke and CVD risk, respectively. In a 24-year prospective cohort study among 43 880 healthy men (aged 39–77 y), habitual anthocyanin and flavanone intake from fruit was associated with a lower risk of nonfatal myocardial infarction and ischemic stroke, respectively.108 In support of these findings, Cassidy et al1 reported that anthocyanin intake (from berries, red wine, apples, and pears) was inversely associated with inflammatory biomarkers1 (associated risk factors for CVD and other chronic diseases), whereas flavonol intake was only associated with 2 biomarkers (lower oxidative stress and cytokine levels). A number of reviews have described the potential benefits of fruit (poly)phenol consumption in relation to CVD and associated biomarkers.63,109–114 In particular, a review of 42 human intervention studies found that dark-colored fruits reduced blood pressure and increased flow-mediated dilation, whereas flavanone-rich fruit (eg, citrus) primarily acted by lowering blood lipid profiles.111 Clinical studies specifically investigating fruit (poly)phenols and CVD conducted between 2010 and 2018 (Table 1)37–69 have focused on biomarkers such as blood pressure, vascular function (flow-mediated dilation and pulse wave velocity), and blood lipid profiles. Apple intake has been shown to impact nitric oxide status66,67 to provide beneficial implications for CVD. Acute orange juice intake had no effect on CVD biomarkers.68 However, in a 4-week study, consumption of orange juice or a hesperidin-containing beverage significantly (P = 0.02) decreased diastolic blood pressure compared with a placebo.69 Grape juice treatments showed no effect on vascular function, plasma low-density lipoprotein (LDL) or C-reactive protein in adolescent cancer survivors compared with apple juice.57 However, in separate studies investigating the impact of Concord grape juice on smoking-induced inflammation, improved inflammatory and fibrinolytic status55 and flow-mediated dilation56 were observed from 7 mL/kg/day (ie, ∼2 cup equivalent of juice with 956 mg of total (poly)phenols for a 70 kg person). Generally speaking, pomegranates, grapes, and berries, which are rich in anthocyanins, flavonols, and procyanidins, have been found to be effective at lowering blood pressure39–41 and increasing vascular function56 and to have minimal effects on blood lipid profiles.59 Overall there appears to be only limited evidence for 100% fruit juice to increase blood triglycerides and very-low-density lipoproteins (VLDLs).50,59,61,64,110 Pomegranate juice supplementation (∼2 cups/d for 1 wk) increased blood triglyceride and VLDL levels in individuals with metabolic syndrome while still demonstrating improvements in lowering blood pressure.61 Considering the short study duration (1 wk) and findings from a related meta-analysis,115 the authors hypothesized that potential negative effects on blood triglycerides and VLDL would be reduced over time. Clinical studies with longer durations (eg, 1–2 mo) have shown decreases50 or neutral59,64 effects on blood triglycerides with dark-colored fruit and 100% juice supplementation. Discrepancies across studies may be related to differences in the health status of participants (disease state vs healthy) and (poly)phenol dose. Evidence suggests that chronic supplementation of dark-colored fruits may have a profound effect in individuals in disease states compared with healthy individuals.111 Red grape juice has been shown to significantly (P = 0.02) improve resting blood pressure and postexercise hypotension in hypertensive individuals, whereas borderline-hypertensive individuals did not.58 Similarly, Concord grape juice (∼2 cups/d for 8 wk) did not appear to affect ambulatory blood pressure in healthy individuals with slightly elevated blood pressure, although favorable effects on glucose metabolism and nocturnal dip were observed.54 A longer intervention (12 wk) of tart cherry juice consumption was found to lower systolic blood pressure and LDL cholesterol.65 Blumberg et al116 found a strong positive relationship between daily total (poly)phenol dose and relative change in flow-mediated dilation across different clinical studies involving Concord grape juice. Based on this correlational data, the authors concluded that relatively low doses (eg, ∼½ cup of Concord grape juice with 307.6 mg (poly)phenols/d) were capable of initiating improvements.116 Rodriguez-Mateos et al38 observed acute dose- and time-dependent improvements in flow-mediated dilation of healthy male participants with blueberry and cranberry47 treatments. Blueberry treatments exhibited significant (P < 0.05) improvements (compared with baseline) in flow-mediated dilation at 1 (P < 0.001) and 2 and 6 (P = 0.01–0.05) hours.38 Improvements in flow-mediated dilation were observed with cranberry treatment at 4 hours, with 1238 mg of total (poly)phenols exhibiting optimal results.47 Mechanistically, evidence suggests that improvements in vascular function may be related to increased nitric oxide.45 Neurocognitive health In a pattern similar to that observed with CVD risk, epidemiological data has suggested a link between specific dietary patterns and age-related decline. In a population-based prospective cohort study of 1836 Japanese Americans (aged >65 y), fruit/vegetable juice consumption, but not tea consumption, was inversely related to Alzheimer’s disease risk.117 The study did not assess the type of fruit/vegetable juices consumed, but Dai et al117 observed effects independent of vitamin C, E, and β-carotene consumption, potentially indicating that other components in fruit/vegetable juice (eg, [poly]phenols) might be responsible. Other epidemiological studies also investigated the effects of fruit/vegetable consumption118,119 and specifically flavonoid intake119,120 on age-related cognitive decline. Vegetable, but not fruit, consumption was associated with significantly (P = 0.01 for 2.8 servings/d; P = 0.02 for 4.1 servings/d) less cognitive decline after 6 years in a prospective cohort study of 3718 individuals (aged ≥65 y).118 In a 3-city cohort involving 8085 individuals (aged ≥65 y), daily consumption of fruits/vegetables was associated with a decrease in dementia and Alzheimer’s disease risk. Differences in outcomes of fruit consumption between the 2 studies may be related to variation in specific fruits consumed and consideration of the ApoE ɛ4 allele (risk factor for Alzheimer’s disease that has been found to affect dietary associations121,122). A number of reviews have highlighted the potential benefits of (poly)phenol consumption in relation to cognitive function.123–126 Clinical evidence remains limited for commonly consumed fruits. No clinical trials (published between 2010 and 2018) on apple intake and neurocognitive health were found; however both acute85,86 and chronic84 orange juice consumption have shown beneficial cognitive effects, attributed to the hesperidin content. More recently, blueberries and grapes have been the focus of intense investigation for cognitive function and brain health (Table 2).46,70–86 Studies have focused on the effects of 1 cup of fresh equivalents,74,75,78 a “single dose,”70 and chronic blueberry supplementation (Table 2) on memory and cognitive function.71,72,75 Clinical studies suggest that acute 100% fruit juice treatment induces effects on memory at certain developmental stages (ie, in children aged 7–10 y) but not middle-aged or elderly adults.82 Concord grape juice consumption appeared to significantly (P = 0.04) improve verbal learning in elderly participants with mild cognitive impairment (12 wk)79 and performance on memory tasks in a similar population (16 wk).80 Significant (P = 0.047) improvement in reaction times was observed with acute purple grape juice treatment compared with white grape juice,82 suggesting that the specific (poly)phenol profile in dark-colored grape juice may be responsible for effects on the brain. Milbury et al127 were among the first to report blueberry (poly)phenols in brain tissue (18 h after feeding as glucuronides in pigs). Similar findings of apple and grape (poly)phenols were reported by Chen et al128 In both cases modest (poly)phenol concentrations in the brain suggest mechanisms other than direct antioxidant activity are responsible for brain health.127 Previously, blueberry supplementation increased expression of hippocampal Arc, which mediates synaptic strength and potentially impacts cognitive performance and memory.129 (Poly)phenols and their metabolites reportedly act in rodent models by enhancing synaptic plasticity130 and potentially improve memory by altering cellular architecture (long-term potentiation) that would otherwise deteriorate with aging.131,132 Aside from brain-specific mechanisms, evidence suggests that CVD is related to cognitive decline and neurodegeneration.80,133–137 Greater hemodynamic response with Concord grape juice treatment was observed in cortical brain regions of older adults with mild cognitive impairment during working memory tasks.80 This suggests that grape juice supplementation provides benefits for both vascular and neuronal activity with endpoints for working memory. Obesity and diabetes Clinical trials (published between 2010 and 2018) investigating the effects of fruit (poly)phenols on obesity and diabetes are included in Table 3.45,58,61,87–91,93–106 The link between 100% fruit juice and obesity (particularly in children) and diabetes has been the subject of intense debate.138 Despite previous associations with fruit drinks (not limited to 100% juice products), a 2017 meta-analysis by Auerbach et al139 (8 prospective cohort studies; 34 470 participants) found no association between weight gain in children (aged 7–18 y) and 100% fruit juice consumption. Similarly a 2014 meta-analysis by Xi et al140 (4 studies; 191 686 participants, 12 375 with type 2 diabetes) found no association between 100% fruit juice and type 2 diabetes risk. Longitudinal studies have also found an inverse correlation between (poly)phenol intake and both body weight/obesity141 and diabetes risk142 in elderly adults. Some studies have highlighted fruit juice and the potential link to obesity, but these were not exclusive to 100% juice and could therefore include effects confounded by inclusion of sugar-sweetened beverages.143,144 In regards to glycemic control, 100% fruit juice consumption appears to have a neutral or modestly beneficial effect on glucose and insulin sensitivity (Table 3). Studies shown in Table 3 include postprandial studies with short durations. No changes in blood glucose and insulin secretion were observed with pomegranate88 or blueberry juice45 in individuals at risk for type 2 diabetes. Similarly in diabetic participants, pomegranate juice intake exhibited no significant (P > 0.05) effect on fasting plasma glucose,89 although postprandial glucose was significantly (P < 0.05) lower when consuming a high-fat meal with cranberries compared with a meal without.87 In a meta-analysis of chronic consumption (4–12 wk duration), Murphy et al145 reviewed the evidence of the effects of various 100% fruit juices (apple, berry, citrus, grape, pomegranate, and fruit blend) on insulin sensitivity and glucose control and concluded no significant (P > 0.05) effects of 100% fruit juice on insulin resistance (P = 0.28 for HbA1c, P = 0.06 for HOMA-IR), fasting blood insulin (P = 3.05), and fasting blood glucose (P = 0.07), suggesting that 100% fruit juice plays a “neutral role on glucose-insulin homeostasis.” Considering the wide range of fruits incorporated into the meta-analysis, the authors specify that further stratification of the data (and the addition of new studies) could convey potential benefits of juice (poly)phenols on glucose/insulin homeostasis. Epidemiology also indicates an association between dark-colored fruit (poly)phenols with healthy weight and lower diabetes risk. Habitual consumption of dark-colored foods (eg, berries) is associated with lower fat mass, independent of common genetic and environmental factors,146 suggesting the potential of fruit (poly)phenols in mediating obesity-related disease risk factors. Consumption of dark-colored foods147 and fruit/vegetable consumption (in particular blueberries)148 was associated with decreased risk for type 2 diabetes. However, Muraki et al149 found that greater consumption of whole fruits, particularly blueberries, grapes, and apples, was associated with a lower risk of type 2 diabetes, whereas fruit juice (not exclusive to 100% fruit juice) consumption was associated with a higher risk. Interestingly, the authors report that the differences across fruits were independent of glycemic index, implying that the type of fruit may influence the effect. Consumption of foods rich in anthocyanins was associated with a decreased risk of type 2 diabetes although total flavonoid intake was not.147 Fasting blood glucose, beta-cell function, and insulin resistance significantly (P < 0.05) improved in diabetic persons with pomegranate treatment.90 Interestingly, in another study pomegranate juice, but not extract, reduced postprandial glycemic response of bread.91 Based on coupled human clinical and cellular transport studies, the authors hypothesized that microbial metabolites of pomegranate juice modulated sugar metabolism while (poly)phenols in extracts were solubilized in the gastrointestinal tract before reaching the colon. Berry (poly)phenols have been shown to alter starch digestion through inhibition of amylase and glucoamylase150,151 and decrease sucrose absorption in healthy humans, potentially due to delayed glycemic response.150 Similar effects were noted in model systems with grape juice.152 The extent to which anthocyanins or other fruit polyphenols modulate glycemic response or more importantly glycemic control (long term) continues to be the subject of active investigation. It is known that interactions between fruit (poly)phenols and carbohydrate digestion, absorption, and regulation do exist. This implies that fruit-derived carbohydrates may not be metabolized at the same rate or extent as those from sugar-sweetened foods or beverages without similar phenolic profiles. Much remains to be explored in this area. Despite such evidence, whole fruit and 100% fruit juice remain less studied compared with coffee and tea in the area of obesity and diabetes, which have, in meta-analyses, shown the potential for reduction of diabetes risk.153,154 Considering the complexity of metabolic diseases, it remains difficult to draw definitive conclusions on the effect of 100% fruit juice or other (poly)phenol-rich beverages on metabolic impact (ie, obesity and diabetes) due to heterogeneity across studies.155 Exercise and performance Clinical evaluations have been conducted on several endpoints related to physical performance. (Poly)phenol supplementation appears to have benefits related to free-radical quenching; however, the exact benefits to athletes require further investigation.156 Compared with heart and brain health, there are few human clinical studies (published between 2010 and 2018) for exercise and performance, the majority of which focus on oxidative status, recovery, and potential ergogenic effects of acute 100% fruit juice supplementation. Of the dark-colored fruits/100% fruit juices, pomegranate, cherry, and grape are the major fruits studied in recent years (Table 4).58,93–108 No human clinical trials (published between 2010 and 2018) of the effects of apple or orange on exercise were found. Pomegranate juice treatments were shown to reduce post-exercise antioxidant status (malnaldehyde) in elite weightlifters96 and endurance-based athletes,98 improve performance in weightlifters,95 and increase strength/reduce soreness in physically active individuals.97 Trials testing grape (Table 4) have focused on recreationally active individuals for longer (28–42 d) studies. In 1 study, no significant (P > 0.05) effects of grape on fitness, perceived health, or muscle injury were observed94; however, another observed significant (P = 0.002) improvements in endurance (increased time to exhaustion) with grape juice supplementation in recreational runners, potentially due to a reduction of exercise-induced inflammation.93 In a review of 12 randomized controlled trials, Vitale et al157 suggest that tart cherry juice has the best effect for postexercise recovery rather than adaptation. A number of studies on the effects of tart cherry juice or cherry concentrate have investigated the effects on exercise performance and postexercise recovery. Improvements in recovery were observed in endurance runners/triathletes,102 cyclists,99 physically active females,106 and resistance-trained males100 following tart cranberry juice/concentrate dosing of 1.75 cup equivalents/day of concentrate (∼820 mg total phenolics/d) or approximately 2.2 cup equivalents/day of freeze-dried powder (∼993 mg total (poly)phenols/d) for 6–14 days, but no effects were observed in water polo players.103 Although a dose of approximately 800–1000 mg of (poly)phenols/day was able to improve the recovery in different weight-bearing and endurance-based activities, it is possible that the effects of tart cherry are more easily observed in sports that induce inflammation compared with intermittent, weight-supported sports such as water polo.103,157 Anabolic effects of tart cherry (poly)phenols were not observed in older (aged 60–75 y), healthy men with approximately 1.9 cup equivalents/day of tart cherry concentrate,105 although muscle catabolism (creatinine, urea/blood urea nitrogen, cortisol, and total protein) was attenuated in endurance runners with supplementation of approximately 2.2 cup equivalent/day of tart cherry (∼993 mg (poly)phenols/d).102 COMPARISON OF 100% FRUIT JUICE AND FRUIT Whole fruit and 100% fruit juice intake is strongly influenced by public policy. Fruit intake recommendations from the 2015–2020 Dietary Guidelines for Americans3 have been less favorable to 100% fruit juice, primarily due to whole fruit as a major contributor to dietary fiber.158 Current dietary guidelines recommend at least half of all consumed fruit should be from whole fruit.3 Average intake falls within these guidelines because 100% fruit juice comprises roughly one-third of daily fruit intake for adults and roughly one-half of intake for children aged 1–3 y.3 According to data from the 2007–2010 NHANES, it is estimated that <24% of Americans met the guidelines (2 cups/d) for fruit consumption.159 A convenient way to increase total fruit intake is to supplement whole fruit with 100% fruit juice. Despite having comparable nutrient and phytochemical profiles (Tables 5 and 6), mixed opinions remain on the benefits of 100% fruit juice consumption. Evidence indicates that 100% fruit juice can contribute to a healthy diet.138 In a review of 48 studies relating to CVD and cancer, Ruxton et al161 concluded that 100% fruit juices are not “nutritionally inferior” to whole fruit for reducing the risk of disease. Table 5 Nutrient profiles of select common fruits and 100% fruit juices per 100 g, ½ cup Database value . Unit of measurement . Apple . Apple (1/2 cup slices) . Apple juice . Apple juice (1/2 cup) . Orange . Orange (1/2 cup sections without membranes) . Orange juice . Orange juice (1/2 cup) . Grapes . Grapes (16 grapes)a . Grape juice . Grape juice (1/2 cup) . Database numberb 09004 09004 09016 09016 09203 09203 09207 09207 09132 09132 09135 09135 Weight g 100 55 100 124 100 92.5 100 124.5 100 78.4 100 126.5 Macronutrients  Water g 86.67 47.67 88.24 109.42 87.14 80.6 87.72 109.21 80.54 63.14 84.51 106.91  Energy kcal 48 26 46 57 46 43 47 59 69 54 60 76  Protein g 0.27 0.15 0.1 0.12 0.7 0.65 0.68 0.85 0.72 0.56 0.37 0.47  Total lipid (fat) g 0.13 0.07 0.13 0.16 0.21 0.19 0.15 0.19 0.16 0.13 0.13 0.16  Carbohydrate, by difference g 12.76 7.02 11.3 14.01 11.54 10.67 11.01 13.71 18.1 14.19 14.77 18.68  Fiber, total dietary g 1.3 0.7 0.2 0.2 2.4 2.2 0.3 0.4 0.9 0.7 0.2 0.3  Sugars, total g 10.1 5.55 9.62 11.93 9.14 8.45 8.76 10.91 15.48 12.14 14.2 17.96 Minerals  Calcium mg 5 3 8 10 43 40 10 12 10 8 11 14  Iron mg 0.07 0.04 0.12 0.15 0.09 0.08 0.1 0.12 0.36 0.28 0.25 0.32  Magnesium mg 4 2 5 6 10 9 10 12 7 5 10 13  Phosphorus mg 11 6 7 9 12 11 17 21 20 16 14 18  Potassium mg 90 50 101 125 169 156 184 229 191 150 104 132  Sodium mg 0 0 4 5 0 0 4 5 2 2 5 6  Zinc mg 0.05 0.03 0.02 0.02 0.08 0.07 0.04 0.05 0.07 0.05 0.07 0.09 Vitamins  Vitamin C, total ascorbic acid mg 4 2.2 0.9 1.1 45 41.6 30.1 37.5 3.2 2.5 0.1 0.1  Thiamin mg 0.019 0.01 0.021 0.026 0.1 0.092 0.039 0.049 0.069 0.054 0.017 0.022  Riboflavin mg 0.028 0.015 0.017 0.021 0.04 0.037 0.021 0.026 0.07 0.055 0.015 0.019  Niacin mg 0.091 0.05 0.073 0.091 0.4 0.37 0.201 0.25 0.188 0.147 0.133 0.168  Vitamin B6 mg 0.037 0.02 0.018 0.022 0.051 0.047 0.031 0.039 0.086 0.067 0.032 0.04  Folate, DFE µg 0 0 0 0 17 16 24 30 2 2 0 0  Vitamin B12 µg 0 0 0 0 0 0 0 0 0 0 0 0  Vitamin A, RAE µg 2 1 0 0 11 10 9 11 3 2 0 0  Vitamin A, IU IU 38 21 1 1 225 208 175 218 66 52 8 10  Vitamin E (alpha-tocopherol) mg 0.05 0.03 0.01 0.01 0.18 0.17 0.2 0.25 0.19 0.15 0 0  Vitamin D (D2 + D3) µg 0 0 0 0 0 0 0 0 0 0 0 0  Vitamin D IU 0 0 0 0 0 0 0 0 0 0 0 0  Vitamin K (phylloquinone) µg 0.6 0.3 0 0 0 0 0.1 0.1 14.6 11.4 0.4 0.5 Database value . Unit of measurement . Apple . Apple (1/2 cup slices) . Apple juice . Apple juice (1/2 cup) . Orange . Orange (1/2 cup sections without membranes) . Orange juice . Orange juice (1/2 cup) . Grapes . Grapes (16 grapes)a . Grape juice . Grape juice (1/2 cup) . Database numberb 09004 09004 09016 09016 09203 09203 09207 09207 09132 09132 09135 09135 Weight g 100 55 100 124 100 92.5 100 124.5 100 78.4 100 126.5 Macronutrients  Water g 86.67 47.67 88.24 109.42 87.14 80.6 87.72 109.21 80.54 63.14 84.51 106.91  Energy kcal 48 26 46 57 46 43 47 59 69 54 60 76  Protein g 0.27 0.15 0.1 0.12 0.7 0.65 0.68 0.85 0.72 0.56 0.37 0.47  Total lipid (fat) g 0.13 0.07 0.13 0.16 0.21 0.19 0.15 0.19 0.16 0.13 0.13 0.16  Carbohydrate, by difference g 12.76 7.02 11.3 14.01 11.54 10.67 11.01 13.71 18.1 14.19 14.77 18.68  Fiber, total dietary g 1.3 0.7 0.2 0.2 2.4 2.2 0.3 0.4 0.9 0.7 0.2 0.3  Sugars, total g 10.1 5.55 9.62 11.93 9.14 8.45 8.76 10.91 15.48 12.14 14.2 17.96 Minerals  Calcium mg 5 3 8 10 43 40 10 12 10 8 11 14  Iron mg 0.07 0.04 0.12 0.15 0.09 0.08 0.1 0.12 0.36 0.28 0.25 0.32  Magnesium mg 4 2 5 6 10 9 10 12 7 5 10 13  Phosphorus mg 11 6 7 9 12 11 17 21 20 16 14 18  Potassium mg 90 50 101 125 169 156 184 229 191 150 104 132  Sodium mg 0 0 4 5 0 0 4 5 2 2 5 6  Zinc mg 0.05 0.03 0.02 0.02 0.08 0.07 0.04 0.05 0.07 0.05 0.07 0.09 Vitamins  Vitamin C, total ascorbic acid mg 4 2.2 0.9 1.1 45 41.6 30.1 37.5 3.2 2.5 0.1 0.1  Thiamin mg 0.019 0.01 0.021 0.026 0.1 0.092 0.039 0.049 0.069 0.054 0.017 0.022  Riboflavin mg 0.028 0.015 0.017 0.021 0.04 0.037 0.021 0.026 0.07 0.055 0.015 0.019  Niacin mg 0.091 0.05 0.073 0.091 0.4 0.37 0.201 0.25 0.188 0.147 0.133 0.168  Vitamin B6 mg 0.037 0.02 0.018 0.022 0.051 0.047 0.031 0.039 0.086 0.067 0.032 0.04  Folate, DFE µg 0 0 0 0 17 16 24 30 2 2 0 0  Vitamin B12 µg 0 0 0 0 0 0 0 0 0 0 0 0  Vitamin A, RAE µg 2 1 0 0 11 10 9 11 3 2 0 0  Vitamin A, IU IU 38 21 1 1 225 208 175 218 66 52 8 10  Vitamin E (alpha-tocopherol) mg 0.05 0.03 0.01 0.01 0.18 0.17 0.2 0.25 0.19 0.15 0 0  Vitamin D (D2 + D3) µg 0 0 0 0 0 0 0 0 0 0 0 0  Vitamin D IU 0 0 0 0 0 0 0 0 0 0 0 0  Vitamin K (phylloquinone) µg 0.6 0.3 0 0 0 0 0.1 0.1 14.6 11.4 0.4 0.5 Abbreviations: DFE, dietary folate equivalents; NA, data were not available; RAE, retinol activity equivalents. a Based on MyPlate (https://www.choosemyplate.gov/fruit), which specifies that 16 grapes = ½ cup equivalent of fruit. USDA National Nutrient Database for Standard Reference (https://ndb.nal.usda.gov/ndb/)160 indicates that ½ cup of grapes is approximately 15.41 grapes. b Macronutrient, mineral, and vitamin data were obtained from the USDA National Nutrient Database for Standard Reference (https://ndb.nal.usda.gov/ndb/).160 Open in new tab Table 5 Nutrient profiles of select common fruits and 100% fruit juices per 100 g, ½ cup Database value . Unit of measurement . Apple . Apple (1/2 cup slices) . Apple juice . Apple juice (1/2 cup) . Orange . Orange (1/2 cup sections without membranes) . Orange juice . Orange juice (1/2 cup) . Grapes . Grapes (16 grapes)a . Grape juice . Grape juice (1/2 cup) . Database numberb 09004 09004 09016 09016 09203 09203 09207 09207 09132 09132 09135 09135 Weight g 100 55 100 124 100 92.5 100 124.5 100 78.4 100 126.5 Macronutrients  Water g 86.67 47.67 88.24 109.42 87.14 80.6 87.72 109.21 80.54 63.14 84.51 106.91  Energy kcal 48 26 46 57 46 43 47 59 69 54 60 76  Protein g 0.27 0.15 0.1 0.12 0.7 0.65 0.68 0.85 0.72 0.56 0.37 0.47  Total lipid (fat) g 0.13 0.07 0.13 0.16 0.21 0.19 0.15 0.19 0.16 0.13 0.13 0.16  Carbohydrate, by difference g 12.76 7.02 11.3 14.01 11.54 10.67 11.01 13.71 18.1 14.19 14.77 18.68  Fiber, total dietary g 1.3 0.7 0.2 0.2 2.4 2.2 0.3 0.4 0.9 0.7 0.2 0.3  Sugars, total g 10.1 5.55 9.62 11.93 9.14 8.45 8.76 10.91 15.48 12.14 14.2 17.96 Minerals  Calcium mg 5 3 8 10 43 40 10 12 10 8 11 14  Iron mg 0.07 0.04 0.12 0.15 0.09 0.08 0.1 0.12 0.36 0.28 0.25 0.32  Magnesium mg 4 2 5 6 10 9 10 12 7 5 10 13  Phosphorus mg 11 6 7 9 12 11 17 21 20 16 14 18  Potassium mg 90 50 101 125 169 156 184 229 191 150 104 132  Sodium mg 0 0 4 5 0 0 4 5 2 2 5 6  Zinc mg 0.05 0.03 0.02 0.02 0.08 0.07 0.04 0.05 0.07 0.05 0.07 0.09 Vitamins  Vitamin C, total ascorbic acid mg 4 2.2 0.9 1.1 45 41.6 30.1 37.5 3.2 2.5 0.1 0.1  Thiamin mg 0.019 0.01 0.021 0.026 0.1 0.092 0.039 0.049 0.069 0.054 0.017 0.022  Riboflavin mg 0.028 0.015 0.017 0.021 0.04 0.037 0.021 0.026 0.07 0.055 0.015 0.019  Niacin mg 0.091 0.05 0.073 0.091 0.4 0.37 0.201 0.25 0.188 0.147 0.133 0.168  Vitamin B6 mg 0.037 0.02 0.018 0.022 0.051 0.047 0.031 0.039 0.086 0.067 0.032 0.04  Folate, DFE µg 0 0 0 0 17 16 24 30 2 2 0 0  Vitamin B12 µg 0 0 0 0 0 0 0 0 0 0 0 0  Vitamin A, RAE µg 2 1 0 0 11 10 9 11 3 2 0 0  Vitamin A, IU IU 38 21 1 1 225 208 175 218 66 52 8 10  Vitamin E (alpha-tocopherol) mg 0.05 0.03 0.01 0.01 0.18 0.17 0.2 0.25 0.19 0.15 0 0  Vitamin D (D2 + D3) µg 0 0 0 0 0 0 0 0 0 0 0 0  Vitamin D IU 0 0 0 0 0 0 0 0 0 0 0 0  Vitamin K (phylloquinone) µg 0.6 0.3 0 0 0 0 0.1 0.1 14.6 11.4 0.4 0.5 Database value . Unit of measurement . Apple . Apple (1/2 cup slices) . Apple juice . Apple juice (1/2 cup) . Orange . Orange (1/2 cup sections without membranes) . Orange juice . Orange juice (1/2 cup) . Grapes . Grapes (16 grapes)a . Grape juice . Grape juice (1/2 cup) . Database numberb 09004 09004 09016 09016 09203 09203 09207 09207 09132 09132 09135 09135 Weight g 100 55 100 124 100 92.5 100 124.5 100 78.4 100 126.5 Macronutrients  Water g 86.67 47.67 88.24 109.42 87.14 80.6 87.72 109.21 80.54 63.14 84.51 106.91  Energy kcal 48 26 46 57 46 43 47 59 69 54 60 76  Protein g 0.27 0.15 0.1 0.12 0.7 0.65 0.68 0.85 0.72 0.56 0.37 0.47  Total lipid (fat) g 0.13 0.07 0.13 0.16 0.21 0.19 0.15 0.19 0.16 0.13 0.13 0.16  Carbohydrate, by difference g 12.76 7.02 11.3 14.01 11.54 10.67 11.01 13.71 18.1 14.19 14.77 18.68  Fiber, total dietary g 1.3 0.7 0.2 0.2 2.4 2.2 0.3 0.4 0.9 0.7 0.2 0.3  Sugars, total g 10.1 5.55 9.62 11.93 9.14 8.45 8.76 10.91 15.48 12.14 14.2 17.96 Minerals  Calcium mg 5 3 8 10 43 40 10 12 10 8 11 14  Iron mg 0.07 0.04 0.12 0.15 0.09 0.08 0.1 0.12 0.36 0.28 0.25 0.32  Magnesium mg 4 2 5 6 10 9 10 12 7 5 10 13  Phosphorus mg 11 6 7 9 12 11 17 21 20 16 14 18  Potassium mg 90 50 101 125 169 156 184 229 191 150 104 132  Sodium mg 0 0 4 5 0 0 4 5 2 2 5 6  Zinc mg 0.05 0.03 0.02 0.02 0.08 0.07 0.04 0.05 0.07 0.05 0.07 0.09 Vitamins  Vitamin C, total ascorbic acid mg 4 2.2 0.9 1.1 45 41.6 30.1 37.5 3.2 2.5 0.1 0.1  Thiamin mg 0.019 0.01 0.021 0.026 0.1 0.092 0.039 0.049 0.069 0.054 0.017 0.022  Riboflavin mg 0.028 0.015 0.017 0.021 0.04 0.037 0.021 0.026 0.07 0.055 0.015 0.019  Niacin mg 0.091 0.05 0.073 0.091 0.4 0.37 0.201 0.25 0.188 0.147 0.133 0.168  Vitamin B6 mg 0.037 0.02 0.018 0.022 0.051 0.047 0.031 0.039 0.086 0.067 0.032 0.04  Folate, DFE µg 0 0 0 0 17 16 24 30 2 2 0 0  Vitamin B12 µg 0 0 0 0 0 0 0 0 0 0 0 0  Vitamin A, RAE µg 2 1 0 0 11 10 9 11 3 2 0 0  Vitamin A, IU IU 38 21 1 1 225 208 175 218 66 52 8 10  Vitamin E (alpha-tocopherol) mg 0.05 0.03 0.01 0.01 0.18 0.17 0.2 0.25 0.19 0.15 0 0  Vitamin D (D2 + D3) µg 0 0 0 0 0 0 0 0 0 0 0 0  Vitamin D IU 0 0 0 0 0 0 0 0 0 0 0 0  Vitamin K (phylloquinone) µg 0.6 0.3 0 0 0 0 0.1 0.1 14.6 11.4 0.4 0.5 Abbreviations: DFE, dietary folate equivalents; NA, data were not available; RAE, retinol activity equivalents. a Based on MyPlate (https://www.choosemyplate.gov/fruit), which specifies that 16 grapes = ½ cup equivalent of fruit. USDA National Nutrient Database for Standard Reference (https://ndb.nal.usda.gov/ndb/)160 indicates that ½ cup of grapes is approximately 15.41 grapes. b Macronutrient, mineral, and vitamin data were obtained from the USDA National Nutrient Database for Standard Reference (https://ndb.nal.usda.gov/ndb/).160 Open in new tab Table 6 (Poly)phenols in select common fruits and 100% fruit juices per 100 g, ½ cup Database value . Unit of measurement . Applea . Apple (1/2 cup, slices)a . Apple juiceb . Apple juice (1/2 cup)b . Oranges, raw, navels (Citrus sinensis)a . Orange (1/2 cup sections without membranes)a . Juice, orange, chilled, includes from concentratea . Orange juice (1/2 cup)a . Grapes, red, rawa,c . Grapes (16 grapes)a,c . Grape juicea . Grape juice (1/2 cup)a . USDA Database Number/Phenol-Explorer Entry 09504, 09503, 09501, 09502, 09003, and 09500 09504, 09503, 09501, 09502, 09003, and 09500 (Apple [Cider], pure juice) (Apple [Cider], pure juice) 09202 09202 09209 09209 97074 97074 09135, 99436 09135, 99436 Weight g 100 55 100 124 100 92.5 100 124.5 100 78.4d 100 126.5 Anthocyanidins  Cyanidin mg 0–4.9 0–2.695 NA NA 0 0 0 0 0.08–1.16 0.06–0.91 0.04–0.89 0.05–1.13  Delphinidin mg NA NA NA NA 0 0 NA NA 2.27 1.78 0.1–1.92 0.13–2.43  Malvidin mg NA NA NA NA 0 0 NA NA 0.10–39 0.07–30.58 0.08–11.17 0.10–0.13  Pelargonidin mg NA NA NA NA 0 0 NA NA 0.02 0.02 0.02 0–0.03  Peonidin mg NA NA NA NA 0 0 NA NA 0.014–3.62 0.01–2.84 0.17–1.06 0.22–1.34  Petunidin mg NA NA NA NA 0 0 NA NA 1.97 1.54 0.1–1.02 0.127–1.29 Flavan-3-ols  Epicatechin mg 1.8–19.16 0.99–10.54 9.03 11.20 0 0 NA NA 0.01–0.96 0.01–0.75 0–0.56 0–0.71  Catechin mg 0–3.4 0–1.87 4.61 5.7164 0 0 NA NA 0.013–0.82 0.01–0.64 0.17–0.82 0.22–1.04  Gallocatechin mg NA NA 0 0 0 0 NA NA NA NA 0 0  Procyanidinse mg 14.56–93.96 8.01–51.68 9.02–20.47 11.91–27.02 0 0 0 0 46.69 36.60 46.69 59.06 Flavonols  Kaempferol mg NA NA NA NA 0.13 0.12025 NA NA 0.003 0.003 0.01 0.01  Myricetin mg NA NA NA NA 0.15 0.138 NA NA 0.01 0.008 0.7 0.89  Quercetin mg 0.52–19.76 0.29–10.87 1.04 1.2896 0.45 0.42 0.4 0.498 0.021–1.04 0.016–0.815 0.09–0.72 0.11–0.91 Flavanones  Hesperetin mg NA NA NA NA 21.87 20.23 16.38 20.39 NA NA NA NA  Naringenin mg NA NA NA NA 7.1 6.56 2.56 3.187 NA NA NA NA  Naringin mg NA NA NA NA NA NA NA NA NA NA NA NA Stilbenes  Resveratrol mg NA NA NA NA NA NA NA NA 0.001 0.00078 NA NA Database value . Unit of measurement . Applea . Apple (1/2 cup, slices)a . Apple juiceb . Apple juice (1/2 cup)b . Oranges, raw, navels (Citrus sinensis)a . Orange (1/2 cup sections without membranes)a . Juice, orange, chilled, includes from concentratea . Orange juice (1/2 cup)a . Grapes, red, rawa,c . Grapes (16 grapes)a,c . Grape juicea . Grape juice (1/2 cup)a . USDA Database Number/Phenol-Explorer Entry 09504, 09503, 09501, 09502, 09003, and 09500 09504, 09503, 09501, 09502, 09003, and 09500 (Apple [Cider], pure juice) (Apple [Cider], pure juice) 09202 09202 09209 09209 97074 97074 09135, 99436 09135, 99436 Weight g 100 55 100 124 100 92.5 100 124.5 100 78.4d 100 126.5 Anthocyanidins  Cyanidin mg 0–4.9 0–2.695 NA NA 0 0 0 0 0.08–1.16 0.06–0.91 0.04–0.89 0.05–1.13  Delphinidin mg NA NA NA NA 0 0 NA NA 2.27 1.78 0.1–1.92 0.13–2.43  Malvidin mg NA NA NA NA 0 0 NA NA 0.10–39 0.07–30.58 0.08–11.17 0.10–0.13  Pelargonidin mg NA NA NA NA 0 0 NA NA 0.02 0.02 0.02 0–0.03  Peonidin mg NA NA NA NA 0 0 NA NA 0.014–3.62 0.01–2.84 0.17–1.06 0.22–1.34  Petunidin mg NA NA NA NA 0 0 NA NA 1.97 1.54 0.1–1.02 0.127–1.29 Flavan-3-ols  Epicatechin mg 1.8–19.16 0.99–10.54 9.03 11.20 0 0 NA NA 0.01–0.96 0.01–0.75 0–0.56 0–0.71  Catechin mg 0–3.4 0–1.87 4.61 5.7164 0 0 NA NA 0.013–0.82 0.01–0.64 0.17–0.82 0.22–1.04  Gallocatechin mg NA NA 0 0 0 0 NA NA NA NA 0 0  Procyanidinse mg 14.56–93.96 8.01–51.68 9.02–20.47 11.91–27.02 0 0 0 0 46.69 36.60 46.69 59.06 Flavonols  Kaempferol mg NA NA NA NA 0.13 0.12025 NA NA 0.003 0.003 0.01 0.01  Myricetin mg NA NA NA NA 0.15 0.138 NA NA 0.01 0.008 0.7 0.89  Quercetin mg 0.52–19.76 0.29–10.87 1.04 1.2896 0.45 0.42 0.4 0.498 0.021–1.04 0.016–0.815 0.09–0.72 0.11–0.91 Flavanones  Hesperetin mg NA NA NA NA 21.87 20.23 16.38 20.39 NA NA NA NA  Naringenin mg NA NA NA NA 7.1 6.56 2.56 3.187 NA NA NA NA  Naringin mg NA NA NA NA NA NA NA NA NA NA NA NA Stilbenes  Resveratrol mg NA NA NA NA NA NA NA NA 0.001 0.00078 NA NA Abbreviations: NA, data were not available. a Phytochemical values were derived from the USDA Database for the Flavonoid Content of Selected Foods.11 b Phytochemical values were derived from Phenol-Explorer (http://phenol-explorer.eu).10 c Values obtained from O’Connor et al (2013).94 d Based on MyPlate (https://www.choosemyplate.gov/fruit), which specifies that 16 grapes = ½ cup equivalent of fruit. USDA National Nutrient Database for Standard Reference (https://ndb.nal.usda.gov/ndb/)160 indicates that ½ cup of grapes is approximately 15.41 grapes. e Values obtained from the USDA Database for Proanthocyanidin Content of Selected Foods.12 Open in new tab Table 6 (Poly)phenols in select common fruits and 100% fruit juices per 100 g, ½ cup Database value . Unit of measurement . Applea . Apple (1/2 cup, slices)a . Apple juiceb . Apple juice (1/2 cup)b . Oranges, raw, navels (Citrus sinensis)a . Orange (1/2 cup sections without membranes)a . Juice, orange, chilled, includes from concentratea . Orange juice (1/2 cup)a . Grapes, red, rawa,c . Grapes (16 grapes)a,c . Grape juicea . Grape juice (1/2 cup)a . USDA Database Number/Phenol-Explorer Entry 09504, 09503, 09501, 09502, 09003, and 09500 09504, 09503, 09501, 09502, 09003, and 09500 (Apple [Cider], pure juice) (Apple [Cider], pure juice) 09202 09202 09209 09209 97074 97074 09135, 99436 09135, 99436 Weight g 100 55 100 124 100 92.5 100 124.5 100 78.4d 100 126.5 Anthocyanidins  Cyanidin mg 0–4.9 0–2.695 NA NA 0 0 0 0 0.08–1.16 0.06–0.91 0.04–0.89 0.05–1.13  Delphinidin mg NA NA NA NA 0 0 NA NA 2.27 1.78 0.1–1.92 0.13–2.43  Malvidin mg NA NA NA NA 0 0 NA NA 0.10–39 0.07–30.58 0.08–11.17 0.10–0.13  Pelargonidin mg NA NA NA NA 0 0 NA NA 0.02 0.02 0.02 0–0.03  Peonidin mg NA NA NA NA 0 0 NA NA 0.014–3.62 0.01–2.84 0.17–1.06 0.22–1.34  Petunidin mg NA NA NA NA 0 0 NA NA 1.97 1.54 0.1–1.02 0.127–1.29 Flavan-3-ols  Epicatechin mg 1.8–19.16 0.99–10.54 9.03 11.20 0 0 NA NA 0.01–0.96 0.01–0.75 0–0.56 0–0.71  Catechin mg 0–3.4 0–1.87 4.61 5.7164 0 0 NA NA 0.013–0.82 0.01–0.64 0.17–0.82 0.22–1.04  Gallocatechin mg NA NA 0 0 0 0 NA NA NA NA 0 0  Procyanidinse mg 14.56–93.96 8.01–51.68 9.02–20.47 11.91–27.02 0 0 0 0 46.69 36.60 46.69 59.06 Flavonols  Kaempferol mg NA NA NA NA 0.13 0.12025 NA NA 0.003 0.003 0.01 0.01  Myricetin mg NA NA NA NA 0.15 0.138 NA NA 0.01 0.008 0.7 0.89  Quercetin mg 0.52–19.76 0.29–10.87 1.04 1.2896 0.45 0.42 0.4 0.498 0.021–1.04 0.016–0.815 0.09–0.72 0.11–0.91 Flavanones  Hesperetin mg NA NA NA NA 21.87 20.23 16.38 20.39 NA NA NA NA  Naringenin mg NA NA NA NA 7.1 6.56 2.56 3.187 NA NA NA NA  Naringin mg NA NA NA NA NA NA NA NA NA NA NA NA Stilbenes  Resveratrol mg NA NA NA NA NA NA NA NA 0.001 0.00078 NA NA Database value . Unit of measurement . Applea . Apple (1/2 cup, slices)a . Apple juiceb . Apple juice (1/2 cup)b . Oranges, raw, navels (Citrus sinensis)a . Orange (1/2 cup sections without membranes)a . Juice, orange, chilled, includes from concentratea . Orange juice (1/2 cup)a . Grapes, red, rawa,c . Grapes (16 grapes)a,c . Grape juicea . Grape juice (1/2 cup)a . USDA Database Number/Phenol-Explorer Entry 09504, 09503, 09501, 09502, 09003, and 09500 09504, 09503, 09501, 09502, 09003, and 09500 (Apple [Cider], pure juice) (Apple [Cider], pure juice) 09202 09202 09209 09209 97074 97074 09135, 99436 09135, 99436 Weight g 100 55 100 124 100 92.5 100 124.5 100 78.4d 100 126.5 Anthocyanidins  Cyanidin mg 0–4.9 0–2.695 NA NA 0 0 0 0 0.08–1.16 0.06–0.91 0.04–0.89 0.05–1.13  Delphinidin mg NA NA NA NA 0 0 NA NA 2.27 1.78 0.1–1.92 0.13–2.43  Malvidin mg NA NA NA NA 0 0 NA NA 0.10–39 0.07–30.58 0.08–11.17 0.10–0.13  Pelargonidin mg NA NA NA NA 0 0 NA NA 0.02 0.02 0.02 0–0.03  Peonidin mg NA NA NA NA 0 0 NA NA 0.014–3.62 0.01–2.84 0.17–1.06 0.22–1.34  Petunidin mg NA NA NA NA 0 0 NA NA 1.97 1.54 0.1–1.02 0.127–1.29 Flavan-3-ols  Epicatechin mg 1.8–19.16 0.99–10.54 9.03 11.20 0 0 NA NA 0.01–0.96 0.01–0.75 0–0.56 0–0.71  Catechin mg 0–3.4 0–1.87 4.61 5.7164 0 0 NA NA 0.013–0.82 0.01–0.64 0.17–0.82 0.22–1.04  Gallocatechin mg NA NA 0 0 0 0 NA NA NA NA 0 0  Procyanidinse mg 14.56–93.96 8.01–51.68 9.02–20.47 11.91–27.02 0 0 0 0 46.69 36.60 46.69 59.06 Flavonols  Kaempferol mg NA NA NA NA 0.13 0.12025 NA NA 0.003 0.003 0.01 0.01  Myricetin mg NA NA NA NA 0.15 0.138 NA NA 0.01 0.008 0.7 0.89  Quercetin mg 0.52–19.76 0.29–10.87 1.04 1.2896 0.45 0.42 0.4 0.498 0.021–1.04 0.016–0.815 0.09–0.72 0.11–0.91 Flavanones  Hesperetin mg NA NA NA NA 21.87 20.23 16.38 20.39 NA NA NA NA  Naringenin mg NA NA NA NA 7.1 6.56 2.56 3.187 NA NA NA NA  Naringin mg NA NA NA NA NA NA NA NA NA NA NA NA Stilbenes  Resveratrol mg NA NA NA NA NA NA NA NA 0.001 0.00078 NA NA Abbreviations: NA, data were not available. a Phytochemical values were derived from the USDA Database for the Flavonoid Content of Selected Foods.11 b Phytochemical values were derived from Phenol-Explorer (http://phenol-explorer.eu).10 c Values obtained from O’Connor et al (2013).94 d Based on MyPlate (https://www.choosemyplate.gov/fruit), which specifies that 16 grapes = ½ cup equivalent of fruit. USDA National Nutrient Database for Standard Reference (https://ndb.nal.usda.gov/ndb/)160 indicates that ½ cup of grapes is approximately 15.41 grapes. e Values obtained from the USDA Database for Proanthocyanidin Content of Selected Foods.12 Open in new tab Consumption of 100% fruit juice has been shown to help achieve daily fruit recommendations while reducing cost compared with whole fruit consumption.162 Economically, 100% fruit juice provides a path to meeting fruit consumption goals set by the 2015 Dietary Guidelines because whole fruit has a higher impact on diet cost than other fruit products.163 Considering that (poly)phenol intake is estimated to be less in populations with lower income levels,16 100% fruit juice remains a cost-effective solution to supplement whole fruit to achieve adequate daily fruit intake and potentially improve overall diet quality.164 Nutrients From a food composition standpoint, a major difference between whole fruit and 100% fruit juice is fiber due to the removal of certain solids during juice processing. Fiber represents a beneficial component in the diet, but evidence suggests that health benefits associated with fruit are not dependent on the constituents (eg, fiber) that are absent in 100% fruit juices.161 Nicklas et al165 modeled the effect of replacing 100% fruit juice with whole fruit in children’s diets and observed limited impact on overall nutrient intake, but a “trade-off” with higher consumption of fiber at the expense of sugar and vitamin C. Furthermore, fruit juice intake has been associated with a higher overall fiber intake, suggesting fruit juice consumers may have a healthier overall diet.165–168,Table 592,160 provides an estimation of nutrients in 100 g and half a cup of whole fruit or 100% fruit juice. One might assume that whole fruit provides a “whole” package, in the sense that no components are removed during processing. However, the fruit matrix may limit (poly)phenol bioavailability, potentially due to entrapment within fiber or intact cells, competition for uptake with other food matrix components, or increased viscosity due to present fiber.67 (Poly)phenols Table 6 and10–12,92,94,160 Table S1 (see Table S1 in the Supporting Information online) highlight major (poly)phenols in select fruits and fruit juices. Major (poly)phenols present in dark fruits are anthocyanins, flavan-3-ols, and flavonols (Figure 2). Apples, another commonly consumed fruit in the United States, are known to contain anthocyanins (primarily cyanidin in the skin and in the flesh of some varieties), catechins, and flavonols (eg, quercetin).169 Citrus fruits, such as oranges, are well known for flavanones (eg, naringenin and hesperetin) content, specifically as these (poly)phenols, beyond tomatoes (naringenin specifically), are not commonly found in other types of fruit.25 (Poly)phenols are found throughout the fruit but are concentrated in seeds and skin of dark-colored fruits.170 Of these (poly)phenolic compounds, anthocyanins,171 flavonols, flavan-3-ol monomers,172 and proanthocyanidins172,173,174 are reportedly in skins, while the seeds3,174,175 of dark-colored fruits including berries and grapes, are known to contain flavan-3-ol monomers and proanthocyanidins. Major proanthocyanidins found in berries include procyanidins, which are composed of epicatechin units.175 Unlike pomegranate, which is particularly rich in anthocyanins, proanthocyanidins, and ellagitannins,176 blueberries are primarily composed of anthocyanins, procyanidins, chlorogenic acid, and quercetin (flavonol).174 Although fruit seeds are not typically consumed as part of the whole fruit, during commercial juice processing (poly)phenols are extracted from the seed into the juice.177,178 In oranges, commercial orange juicing allows for contact with the albedo (inner part of the peel) and juice sacks.138,179 Because (poly)phenols are concentrated in the peel,180–182 this consequently transfers additional (poly)phenols, which otherwise would not be consumed with whole oranges, into the juice. Hot press (used for some grape and berry juice processing) involves the addition of pectolytic enzyme; heating crushed fruit aids in transferring the pigments from the skin to the juice183 and enhances anthocyanin content in juice compared with cold-press processing.184 Differences in the (poly)phenol composition of 100% fruit juice and whole fruit may also result from processing-induced changes of the phytochemical profile. (Poly)phenols oxidize/react by virtue of their hydroxyl groups,185 which in part contributes to functionality, but also makes it susceptible to oxidation, particularly for those with catechol and galloyl groups. Although processing methods are optimized to retain juice quality, total (poly)phenol content has been shown to decrease with processing steps, such as juice clarification.186 Pasteurization (low-temperature, long-time treatment) was also previously reported to result in an 8%–13% reduction of total anthocyanins in pomegranate juice.187 Aside from processing-induced changes, differences in phytochemical profile between 100% juice and whole fruit may exist due to varietal differences of starting materials. Concord grapes are used in the United States for juice production188 and contain a mixture of primarily (∼46%) anthocyanins (mainly delphinidin-3-O-glucoside among more than 25 different anthocyanins188) with tartaric esters of hydroxycinnamates and skin-/seed-derived flavan-3-ols.189,190 Compared with other grapes, this is a unique profile, which, on average, provides higher concentrations of anthocyanins116 (see Table S1 in the Supporting Information online). An important point of distinction to make here is that grape juice, which contains a high portion of seed and skin (poly)phenols, may provide a more diverse array of (poly)phenols relative to seedless table grapes. In this way, juice may provide more dietary (poly)phenols than whole fruit. Bioavailability To better understand the link between fruit (poly)phenols and their potential health benefits, it is important to consider the processes of digestion, absorption, metabolism, and distribution of these compounds in humans. Bioavailability and metabolism of (poly)phenols has been the subject of several reviews.191–193 The general consensus is that (poly)phenols are first released during normal human digestion, whereby the ingested food/beverage undergoes a series of mechanical and chemical processes to break down food structure and release entrapped compounds. The portion of (poly)phenols that is released from the ingested food or beverage and made available for absorption is considered the bioaccessible fraction. Evidence exists for gastric absorption of certain phenolic acids,194,195 but absorption of (poly)phenols occurs primarily in the small intestine. Bioavailability is the fraction that is absorbed, subsequently passed in circulation and available for biological function in target tissues. Unlike some nutrients, (poly)phenols are not known to accumulate in the body and are extensively metabolized and excreted.191,192 Native fruit (poly)phenols (eg, flavonoid glycosides) are metabolized to conjugated derivatives (glucuronidated, sulfonated, and methylated forms) during small intestinal and hepatic metabolism.196 Nonabsorbed (poly)phenols in the upper small intestine are transferred to the lower intestine and made available for microbial metabolism, from which numerous small-molecular-weight phenolic metabolites and their conjugates are generated.191,197 These make up the majority of circulating metabolites in the human body.191,198 The literature currently lacks specific studies that directly compare bioavailability of (poly)phenols from whole fruit versus 100% fruit juice. However, an in vitro study reported flavonoid bioaccessibility to be higher from orange juice (fresh, flash-pasteurized, and pasteurized) compared with orange fruit.199 Differences in bioavailability likely exist due to varying bioaccessibility and macronutrient profiles. Whole fruit requires mechanical and chemical digestion to release and transfer (poly)phenols to the aqueous intestinal fluid prior to absorption. Thus, a (poly)phenol-rich beverage, such as 100% fruit juice, may be more bioaccessible due to its liquid matrix and may subsequently allow for higher intestinal (poly)phenol absorption compared with a high-fiber, solid matrix, such as whole fruit.200 Additional comparisons and clinical evaluation of these effects across other fruit/juices remain to be conducted. Food matrix factors can impact whole fruit. During digestion of whole fruits, (poly)phenol complexes (eg, cell wall or biopolymer interactions) can form and may potentially limit bioaccessibility and subsequently bioavailability of (poly)phenols in the upper intestines. However, it is also possible that nonabsorbed material can reach the lower intestines and act as a media for colonic fermentation, which produces bioactive microbial metabolites. Some investigators have questioned whether this nondigestable, microbially fermented portion is the “missing link” to explain biological activity of fruit (poly)phenols.201 Recently, Renard et al202 reviewed interactions between (poly)phenols and polysaccharides with a special focus on the effects of food processing and digestion on (poly)phenol extractability and bioavailability. In particular, (poly)phenol-polysaccharide binding (eg, hydrogen bonds, hydrophobic interactions) were spontaneous and occurred rapidly during fruit processing.202 Although not fully understood, these resulting (poly)phenol–biopolymer structures may have unique effects on bioavailability in the upper gastrointestinal tract and/or in the colon with the potential to modify metabolite profiles. Considering these factors, consumption of 100% fruit juice may provide a matrix with enhanced (poly)phenol absorption because it is low in fiber compared with whole fruit.203,204 However, it remains unclear how whole fruit versus 100% fruit juice would compare in terms of microbial metabolism considering changes in overall macronutrient/fiber content. Because juice or fruit may be consumed as part of a broader meal, these effects may be limited. Still they merit further investigation. Considering the complex nutrient and phytochemical profile in fruits, it is also difficult to predict how processing, such as thermal treatment or juicing (and the subsequent change in (poly)phenol profile), actually affects functionality and bioactivity. Rodriguez-Mateos et al205 reported that thermal processing (baking) of blueberries significantly (P < 0.05) altered the (poly)phenol composition and metabolite profile but still resulted in a similar biological response (flow-mediated dilation) compared with unprocessed blueberries. Thus, further research is needed to better elucidate the mechanisms of bioaccessibility, bioavailability, and potential bioactivity of (poly)phenols specifically from whole fruit versus 100% fruit juice. In addition to the above factors, dose response (of fruit and (poly)phenols) and specific bioactivity of (poly)phenols from either whole fruit or 100% fruit juice are dependent on the extent of bioavailability/metabolism because this influences what reaches circulation and/or target tissues (native or metabolized). In a randomized, double-blind, placebo-controlled dose–response study on cranberry juice consumption (n = 10), 12 (poly)phenol metabolites found in circulation (total plasma response) were linearly related to the amount of consumed (poly)phenols.47 Metabolites included glucoronidated caffeic acid, quercetin, and ferulic acid, as well as sulfated ferulic acid, vanillic acid, and γ-valerolactone. Circulating (poly)phenol metabolites were also found to correlate with improved vascular function (flow-mediated dilation) dose-dependently, with maximal effects observed with a 1238-mg dose of total (poly)phenols.47 Interestingly, interindividual variation of metabolic profile was observed, which the authors suggest is due to interindividual variety in microbial metabolism. Intake and potential dose Median fresh cup equivalents of effective doses of dark-colored 100% fruit juice, concentrate, or (poly)phenol-rich fruit (Tables 1–4) were approximately 2 cups for CVD, approximately 1.5 cups for neurocognitive, approximately 1 cup for obesity/diabetes, and approximately 2 cups for exercise performance. Although the reported fresh cup equivalents were similar across most studies, the reported total (poly)phenol dose varied depending on the source. Total (poly)phenol concentration in CVD studies ranged from approximately 238 to 2138 mg/day (∼0.5–3 cup-equivalents/d), with a median dose of 726 mg/day of (poly)phenols. Positive effects for memory/cognition, diabetes/obesity, and exercise were also observed with similar (poly)phenol doses, although studies on exercise also included higher doses (>2500 mg of total (poly)phenols/d) that may be more aligned with supplemental strategies. Taken together, these reported levels, when considering fresh cup equivalents in Tables 1–4, encompass the current dietary guidelines of 2 cups of fruit/day. Further, the estimated (poly)phenol intake obtained from the doses in the studies does not necessarily correspond to general fruit consumption. Roughly estimating the total (poly)phenol content of 3 commonly consumed fruits (apples, grapes, and oranges) by taking the sum of reported (poly)phenols (for whole fruit) from Phenol-Explorer,10 daily fruit (poly)phenol intake of 2 cups of fruit ranges approximately 56–276 mg/day, which is much lower than the effective (poly)phenol doses reported for 1–2 cup equivalents of fruit in Tables 1–4. In order to match the median (poly)phenol dose reported for CVD outcomes (726 mg/day), approximately 2.5–6 cups of apples/grapes/oranges would need to be consumed. This estimate assumes (roughly) total (poly)phenol content of apples, grapes, and oranges to be approximately 56, 91, and 49 mg/100 g (obtained from Phenol-Explorer10), respectively, and assuming 109 (USDA Database no. 09003), 151 (USDA Database no. 09132), and 185 g (USDA Database no. 09203) of fruit per cup. Based on this estimate, foods that are more dense sources of (poly)phenols, such as Concord grape juice (∼494–616 mg total (poly)phenols/cup80,81,116), blueberries (∼363–676 mg total (poly)phenols/cup38,39,42,43,206), or blueberry juice (∼555–2138 mg total (poly)phenols/cup45,72) could help fulfill daily fruit (poly)phenol intake goals within dietary guidance and with less overall servings compared with other common fruits. This estimated (poly)phenol range makes several assumptions. The first assumption is that the total dose was estimated based on the sum of reported (poly)phenol compounds on Phenol-Explorer, which may not represent all compounds in the fruit. Another assumption is that the size and weight of fruit is relatively uniform within each fruit type (independent of varietal and harvest differences). For example, the USDA Food Composition Database for Standard Reference160 and MyPlate92 currently lists 1 cup of grapes as 32 grapes; however, this may not be reflective of all grapes that consumers currently consume. Despite these assumptions, this estimated calculation aligns with epidemiological data. Fruit intake of >7 portions/day (560–1498 g fruit/d or approximately 4.5–6 cups of fruit/d) was associated with a 43% reduced risk of death from CVD in women compared with those who consumed <2.5 portions/day (200–302 g of fruit/d).107 Several recent studies were included for CVD and neurocognitive health (Tables 1–2), yet it is more difficult to recommend an equivalent cup dose of fruit/100% fruit juice based specifically on recent studies for obesity/diabetes and exercise performance (Tables 3–4) because this was relatively less studied. Because negative effects were not observed (only neutral or beneficial effects) with up to 1 cup of dark-colored 100% fruit juice (Table 3), it seems reasonable that daily 100% fruit juice consumption can provide benefits without detrimental effects in most individuals. Some benefits on exercise performance of pomegranate and grape juice (Table 4) were observed with higher doses (and without observed detrimental effects); however, these were tested in athletes or physically active individuals, who may have different dietary needs compared with the general population. Further investigation, such as dose-dependency studies, may provide better insight for recommending fruit (poly)phenol doses for exercise performance. CONCLUSION In addition to providing fruit servings consistent with current dietary guidance, dark-colored fruits and their corresponding 100% fruit juices contribute a unique array of (poly)phenols to the human diet that is not delivered by other commonly consumed (poly)phenol-rich sources (eg, coffee, tea, cocoa). Evidence suggests that blueberries, grapes, pomegranates, tart cherries, and cranberries (as well as their associated 100% fruit juices) provide health benefits associated with CVD, memory/cognition, obesity/diabetes, and exercise performance. Although nutrition policy includes, but does not specifically favor, 100% fruit juice compared with whole fruit, evidence indicates that some 100% fruit juices are (poly)phenol-rich beverages and provide many of the same benefits as whole fruit. Other practical and consumer factors are critical to consider. For example, practical benefits of 100% juice include the consistency and longer shelf-life of these product forms, as well as convenience and affordability which provide access for consumers across the socioeconomic spectrum. Also, the potential for greater bioaccessibility/bioavailability and, in some cases, higher (poly)phenol content (although further investigation is needed to confirm this) provides consumers with an enhanced delivery system for select fruit benefits. Heterogeneity in study types and health status of participants in existing research has made it challenging to draw broad and definitive conclusions across fruit and juice types, but evidence suggests that consumption of approximately 1–2 cups/day of dark-colored whole fruit or 100% fruit juice provides potential benefits to human health (Table 1–4). It is important to know that this range encompasses the current dietary guidance for fruit consumption of 2 cup servings/day but that not all fruits or juices are equivalent in terms of (poly)phenol profile and content. Further research may provide a context for adapting these guidelines and product forms to enhance consumption of fruit and 100% juice products. Acknowledgments The authors greatly acknowledge the support of Michelle Kijek from Food Minds, LLC for her assistance with editorial and logistical preparations of the manuscript. Author contributions. K.K.H.Y.H. wrote the manuscript and contributed substantially to the conception, data collection, data interpretation, and analysis. M.G.F. contributed substantially to the conception, design, and data interpretation and participated in the critical revision of the article. J.D.W. contributed to the work’s conception and data collection and participated in critical review of the manuscript. All authors read and approved the manuscript prior to submission. Funding. This work was supported by an honorarium provided to K.K.H.Y.H by Welch Foods Inc. The funder approved the initial outline/concept of the manuscript, which was developed by M.G.F. and K.K.H.Y.H, and had the authority to approve the final manuscript prior to submission. Declaration of interest. J.D.W. is an employee of Welch’s. M.G.F. has served as a scientific advisor for Welch’s and has received speaker honorarium from both Welch’s and the Juice Products Association in the past 3 years. Supporting Information The following Supporting Information is available through the online version of this article at the publisher’s website. Table S1 (Poly)phenols in select common and dark-colored fruits and 100% juices per 100 g References 1 Cassidy A , Rogers G , Peterson JJ , et al. . Higher dietary anthocyanin and flavonol intakes are associated with anti-inflammatory effects in a population of US adults . Am J Clin Nutr . 2015 ; 102 : 172 – 181 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Spencer JP. The impact of fruit flavonoids on memory and cognition . Br J Nutr. 2010 ; 104 : S40 – S47 . Google Scholar Crossref Search ADS PubMed WorldCat 3 US Department of Health and Human Services, US Department of Agriculture. 2015–2020 Dietary Guidelines for Americans, 8th ed. 2015 . Available at: http://health.gov/dietaryguidelines/2015/guidelines/. Accessed July 2, 2018. 4 Bravo L. Polyphenols: chemistry, dietary sources, metabolism, and nutritional significance . Nutr Rev. 1998 ; 56 : 317 – 333 . Google Scholar Crossref Search ADS PubMed WorldCat 5 Liu RH. Potential synergy of phytochemicals in cancer prevention: mechanism of action 1 . J Nutr . 2004 ; 134 : 3479 – 3485 . Google Scholar Crossref Search ADS WorldCat 6 Khoo HE , Azlan A , Tang ST , et al. . Anthocyanidins and anthocyanins: colored pigments as food, pharmaceutical ingredients, and the potential health benefits . Food Nutr Res . 2017 ; 61 : 1 – 21 . Google Scholar Crossref Search ADS WorldCat 7 Rothwell JA , Perez-Jimenez J , Neveu V , et al. . Phenol-Explorer 3.0: a major update of the Phenol-Explorer database to incorporate data on the effects of food processing on polyphenol content . Database . 2013 ; 2013 : bat070. Google Scholar Crossref Search ADS PubMed WorldCat 8 Rothwell JA , Urpi-Sarda M , Boto-Ordonez M , et al. . Phenol-Explorer 2.0: a major update of the Phenol-Explorer database integrating data on polyphenol metabolism and pharmacokinetics in humans and experimental animals . Database . 2012 ; 2012 : bas031. Google Scholar Crossref Search ADS PubMed WorldCat 9 Neveu V , Perez-Jimenez J , Vos F , et al. . Phenol-Explorer: an online comprehensive database on polyphenol contents in foods . Database . 2010 ; 2010 : bap024. Google Scholar Crossref Search ADS PubMed WorldCat 10 Phenol-Explorer Database Version 3.6. 2015 . Available at: http://phenol-explorer.eu. Accessed July 7, 2018. 11 Bhagwat S , Haytowitz DB , Holden JM. USDA Database for the Flavonoid Content of Selected Foods Release 3.1. Washington, DC: US Department of Agriculture, Agriculture Research Service; 2014 . Available at: https://www.ars.usda.gov/ARSUserFiles/80400525/Data/Flav/Flav_R03-1.pdf. Accessed July 7, 2018. 12 Haytowitz D , Wu X , Bhagwat S. USDA Database for the Proanthocyanidin Content of Selected Foods Release 2.1. Washington, DC: US Department of Agriculture, Agriculture Research Service; 2018 . Available at: https://www.ars.usda.gov/ARSUserFiles/80400525/Data/PA/PA02-1.pdf. Accessed July 7, 2018. 13 Peterson JJ , Dwyer JT , Jacques PF , et al. . Improving the estimation of flavonoid intake for study of health outcomes . Nutr Rev. 2015 ; 73 : 553 – 576 . Google Scholar Crossref Search ADS PubMed WorldCat 14 Probst Y , Guan V , Kent K. A systematic review of food composition tools used for determining dietary polyphenol intake in estimated intake studies . Food Chem . 2018 ; 238 : 146 – 152 . Google Scholar Crossref Search ADS PubMed WorldCat 15 Chun OK , Jin Chung S , Song WO. Estimated dietary flavonoid intake and major food sources of U.S. adults . J Nutr. 2007 ; 137 : 1244 – 1252 . Google Scholar Crossref Search ADS PubMed WorldCat 16 Kim K , Vance TM , Chun OK. Estimated intake and major food sources of flavonoids among US adults: changes between 1999–2002 and 2007–2010 in NHANES . Eur J Nutr. 2016 ; 55 : 833 – 843 . Google Scholar Crossref Search ADS PubMed WorldCat 17 Higdon JV , Frei B. Coffee and health: a review of recent human research coffee and health: a review of recent human research . Crit Rev Food Sci Nutr . 2006 ; 46 : 101 – 123 . Google Scholar Crossref Search ADS PubMed WorldCat 18 Ferruzzi MG. The influence of beverage composition on delivery of phenolic compounds from coffee and tea . Physiol Behav . 2010 ; 100 : 33 – 41 . Google Scholar Crossref Search ADS PubMed WorldCat 19 Ovaskainen M-L , Tö Rrö R , Koponen JM , et al. . Dietary intake and major food sources of polyphenols in Finnish adults . J Nutr. 2008 ; 138 : 562 – 566 . Google Scholar Crossref Search ADS PubMed WorldCat 20 Fukushima Y , Tashiro T , Kumagai A , et al. . Coffee and beverages are the major contributors to polyphenol consumption from food and beverages in Japanese middle-aged women . J Nutr Sci . 2014 ; 3:1–10 . OpenURL Placeholder Text WorldCat 21 El Gharras H. Polyphenols: food sources, properties and applications: a review . Int J Food Sci Technol . 2009 ; 44 : 2512 – 2518 . Google Scholar Crossref Search ADS WorldCat 22 Yassin GH , Grun C , Koek JH , et al. . Investigation of isomeric flavanol structures in black tea thearubigins using ultraperformance liquid chromatography coupled to hybrid quadrupole/ion mobility/time of flight mass spectrometry . J Mass Spectrom. 2014 ; 49 : 1086 – 1095 . Google Scholar Crossref Search ADS PubMed WorldCat 23 Higdon JV , Frei B , Blumberg J. Tea catechins and polyphenols: health effects, metabolism, and antioxidant functions . Crit Rev Food Sci Nutr . 2003 ; 43 : 89 – 143 . Google Scholar Crossref Search ADS PubMed WorldCat 24 Tiwari U , Cummins E. Factors influencing levels of phytochemicals in selected fruit and vegetables during pre- and post-harvest food processing operations . Food Res Int . 2013 ; 50 : 497 – 506 . Google Scholar Crossref Search ADS WorldCat 25 Manach C , Morand C , Gil-Izquierdo A , et al. . Bioavailability in humans of the flavanones hesperidin and narirutin after the ingestion of two doses of orange juice . Eur J Clin Nutr. 2003 ; 57 : 235 – 242 . Google Scholar Crossref Search ADS PubMed WorldCat 26 Renaud S , de Lorgeril M. Wine, alcohol, platelets, and the French paradox for coronary heart disease . Lancet. 1992 ; 339 : 1523 – 1526 . Google Scholar Crossref Search ADS PubMed WorldCat 27 Rozin P , Kabnick K , Pete E , et al. . The ecology of eating: smaller portion sizes in France than in the United States help explain the French paradox . Psychol Sci. 2003 ; 14 : 450 – 454 . Google Scholar Crossref Search ADS PubMed WorldCat 28 Belleville J. The French paradox: possible involvement of ethanol in the protective effect against cardiovascular diseases . Nutrition . 2002 ; 18 : 173 – 177 . Google Scholar Crossref Search ADS PubMed WorldCat 29 Renaud S , De Lorgeril M. The French paradox: dietary factors and cigarette smoking–: related health risks . Ann N Y Acad Sci. 1993 ; 686 : 299 – 309 . Google Scholar Crossref Search ADS PubMed WorldCat 30 Kopp P. Resveratrol, a phytoestrogen found in red wine. A possible explanation for the conundrum of the “French paradox”? Eur J Endocrinol. 1998 ; 138 : 619 – 620 . Google Scholar Crossref Search ADS PubMed WorldCat 31 Vidavalur R , Otani H , Singal PK , et al. . Significance of wine and resveratrol in cardiovascular disease: French paradox revisited . Exp Clin Cardiol . 2006 ; 11 : 217 – 225 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 32 Nishizuka T , Fujita Y , Sato Y , et al. . Procyanidins are potent inhibitors of LOX-1: a new player in the French Paradox . Proc Jpn Acad, Ser B. 2011 ; 87 : 104 – 113 . Google Scholar Crossref Search ADS WorldCat 33 De Curtis A , Murzilli S , Di Castelnuovo A , et al. . Alcohol-free red wine prevents arterial thrombosis in dietary-induced hypercholesterolemic rats: experimental support for the “French paradox.” J Thromb Haemost. 2005 ; 3 : 346 – 350 . Google Scholar Crossref Search ADS PubMed WorldCat 34 Iijima K , Yoshizumi M , Ouchi Y. Effect of red wine polyphenols on vascular smooth muscle cell function-molecular mechanism of the “French paradox” . Mech Ageing Dev . 2002 ; 123 : 1033 – 1039 . Google Scholar Crossref Search ADS PubMed WorldCat 35 Rosenkranz S , Knirel D , Dietrich H , et al. . Inhibition of the PDGF receptor by red wine flavonoids provides a molecular explanation for the “French paradox” . FASEB J . 2002 ; 16 : 1958 – 1960 . Google Scholar Crossref Search ADS PubMed WorldCat 36 Richelle M , Tavazzi I , Offord E. Comparison of the antioxidant activity of commonly consumed polyphenolic beverages (coffee, cocoa, and tea) prepared per cup serving . J Agric Food Chem. 2001 ; 49 : 3438 – 3442 . Google Scholar Crossref Search ADS PubMed WorldCat 37 Riso P , Klimis-Zacas D , Del Bo C , et al. . Effect of a wild blueberry (Vaccinium angustifolium) drink intervention on markers of oxidative stress, inflammation and endothelial function in humans with cardiovascular risk factors . Eur J Nutr. 2013 ; 52 : 949 – 961 . Google Scholar Crossref Search ADS PubMed WorldCat 38 Rodriguez-Mateos A , Rendeiro C , Bergillos-Meca T , et al. . Intake and time dependence of blueberry flavonoid-induced improvements in vascular function: a randomized, controlled, double-blind, crossover intervention study with mechanistic insights into biological activity 1-3 . Am J Clin Nutr . 2013 ; 98 : 1179 – 1191 . Google Scholar Crossref Search ADS PubMed WorldCat 39 Basu A , Du M , Leyva MJ , et al. . Blueberries decrease cardiovascular risk factors in obese men and women with metabolic syndrome . J Nutr . 2010 ; 140 : 1582 – 1587 . Google Scholar Crossref Search ADS PubMed WorldCat 40 Johnson SA , Figueroa A , Navaei N , et al. . Daily blueberry consumption improves blood pressure and arterial stiffness in postmenopausal women with pre- and stage 1-hypertension: a randomized, double-blind, placebo-controlled clinical trial . J Acad Nutr Diet . 2015 ; 115 : 369 – 377 . Google Scholar Crossref Search ADS PubMed WorldCat 41 Mcanulty LS , Collier SR , Landram MJ , et al. . Six weeks daily ingestion of whole blueberry powder increases natural killer cell counts and reduces arterial stiffness in sedentary males and females . Nutr Res . 2014 ; 34 : 577 – 584 . Google Scholar Crossref Search ADS PubMed WorldCat 42 Del Bo C , Porrini M , Fracassetti D , et al. . A single serving of blueberry (V. corymbosum) modulates peripheral arterial dysfunction induced by acute cigarette smoking in young volunteers: a randomized-controlled trial . Food Funct . 2014 ; 5 : 3107 – 3116 . Google Scholar Crossref Search ADS PubMed WorldCat 43 Del Bo C , Deon V , Campolo J , et al. . A serving of blueberry (V. corymbosum) acutely improves peripheral arterial dysfunction in young smokers and non-smokers: two randomized, controlled, crossover pilot studies . Food Funct. 2017 ; 8 : 4108 – 4117 . Google Scholar Crossref Search ADS PubMed WorldCat 44 Del Bo CD , Riso P , Campolo J , et al. . A single portion of blueberry (Vaccinium corymbosum L) improves protection against DNA damage but not vascular function in healthy male volunteers . Nutr Res . 2013 ; 33 : 220 – 227 . Google Scholar Crossref Search ADS PubMed WorldCat 45 Stote KS , Sweeney MI , Kean T , et al. . The effects of 100% wild blueberry (Vaccinium angustifolium) juice consumption on cardiometablic biomarkers: a randomized, placebo- controlled, crossover trial in adults with increased risk for type 2 diabetes . BMC Nutr . 2017 ; 3 : 1 – 11 . Google Scholar Crossref Search ADS WorldCat 46 Keane KM , Haskell-Ramsay CF , Veasey RC , et al. . Montmorency Tart cherries (Prunus cerasus L.) modulate vascular function acutely, in the absence of improvement in cognitive performance . Br J Nutr. 2016 ; 116 : 1935 – 1944 . Google Scholar Crossref Search ADS PubMed WorldCat 47 Rodriguez-Mateos A , Feliciano RP , Boeres A , et al. . Cranberry (poly)phenol metabolites correlate with improvements in vascular function: a double-blind, randomized, controlled, dose-response, crossover study . Mol Nutr Food Res. 2016 ; 60 : 2130 – 2140 . Google Scholar Crossref Search ADS PubMed WorldCat 48 Dohadwala MM , Holbrook M , Hamburg NM , et al. . Effects of cranberry juice consumption on vascular function in patients with coronary artery disease . Am J Clin Nutr . 2011 ; 93 : 934 – 940 . Google Scholar Crossref Search ADS PubMed WorldCat 49 Flammer AJ , Martin EA , Gössl M , et al. . Polyphenol-rich cranberry juice has a neutral effect on endothelial function but decreases the fraction of osteocalcin-expressing endothelial progenitor cells . Eur J Nutr. 2013 ; 52 : 289 – 296 . Google Scholar Crossref Search ADS PubMed WorldCat 50 Novotny JA , Baer DJ , Khoo C , et al. . Cranberry juice consumption lowers markers of cardiometabolic risk, including blood pressure and circulating C-reactive protein, triglyceride, and glucose concentrations in adults . J Nutr . 2015 ; 145 : 1185 – 1193 . Google Scholar Crossref Search ADS PubMed WorldCat 51 Name T , Simão C , Alysson M , et al. . Reduced-energy cranberry juice increases folic acid and adiponectin and reduces homocysteine and oxidative stress in patients with the metabolic syndrome . Br J Nutr. 2013 ; 110 : 1885 – 1894 . Google Scholar Crossref Search ADS PubMed WorldCat 52 Basu A , Betts NM , Ortiz J , et al. . Low-energy cranberry juice decreases lipid oxidation and increases plasma antioxidant capacity in women with metabolic syndrome . Nutr Res . 2011 ; 31 : 190 – 196 . Google Scholar Crossref Search ADS PubMed WorldCat 53 Hashemi M , Kelishadi R , Hashemipour M , et al. . Acute and long-term effects of grape and pomegranate juice consumption on vascular reactivity in paediatric metabolic syndrome . Cardiol Young. 2010 ; 20 : 73 – 77 . Google Scholar Crossref Search ADS PubMed WorldCat 54 Dohadwala MM , Hamburg NM , Holbrook M , et al. . Effects of concord grape juice on ambulatory blood pressure in prehypertension and stage 1 hypertension . Am J Clin Nutr . 2010 ; 92 : 1052 – 1061 . Google Scholar Crossref Search ADS PubMed WorldCat 55 Kokkou E , Siasos G , Georgiopoulos G , et al. . The impact of dietary flavonoid supplementation on smoking-induced inflammatory process and fibrinolytic impairment . Atherosclerosis . 2016 ; 251 : 266 – 272 . Google Scholar Crossref Search ADS PubMed WorldCat 56 Siasos G , Tousoulis D , Kokkou E , et al. . Favorable effects of Concord grape juice on endothelial function and arterial stiffness in healthy smokers . Am J Hypertens . 2014 ; 27 : 38 – 45 . Google Scholar Crossref Search ADS PubMed WorldCat 57 Blair CK , Kelly AS , Steinberger J , et al. . Feasibility and preliminary efficacy of the effects of flavonoid-rich purple grape juice on the vascular health of childhood cancer survivors: a randomized, controlled crossover trial . Pediatr Blood Cancer. 2014 ; 61 : 2290 – 2296 . Google Scholar Crossref Search ADS PubMed WorldCat 58 Miranda Neto M , da Silva TF , de Lima FF , et al. . Whole red grape juice reduces blood pressure at rest and increases post-exercise hypotension . J Am Coll Nutr. 2017 ; 36 : 533 – 540 . Google Scholar Crossref Search ADS PubMed WorldCat 59 Barona J , Aristizabal JC , Blesso CN , et al. . Grape polyphenols reduce blood pressure and increase flow-mediated vasodilation in men with metabolic syndrome . J Nutr . 2012 ; 142 : 1626 – 1632 . Google Scholar Crossref Search ADS PubMed WorldCat 60 Davidson MH , Maki KC , Dicklin MR , et al. . Effects of consumption of pomegranate juice on carotid intima-media thickness in men and women at moderate risk for coronary heart disease . Prev Cardiol . 2009 ; 104 : 936 – 942 . OpenURL Placeholder Text WorldCat 61 Moazzen H , Alizadeh M. Effects of pomegranate juice on cardiovascular risk factors in patients with metabolic syndrome: a double-blinded, randomized crossover controlled trial . Plant Foods Hum Nutr. 2017 ; 72 : 126 – 133 . Google Scholar Crossref Search ADS PubMed WorldCat 62 Shema-Didi L , Kristal B , Sela S , et al. . Does pomegranate intake attenuate cardiovascular risk factors in hemodialysis patients? Nutr J . 2014 ; 13 : 1 – 8 . Google Scholar Crossref Search ADS PubMed WorldCat 63 Tsang C , Smail NF , Almoosawi S , et al. . Intake of polyphenol-rich pomegranate pure juice influences urinary glucocorticoids, blood pressure and homeostasis model assessment of insulin resistance in human volunteers . J Nutr Sci . 2012 ; 1 : 1 – 9 . Google Scholar Crossref Search ADS WorldCat 64 Díaz-Rubio ME , Pérez-Jiménez J , Ángel Martínez-Bartolomé M , et al. . Regular consumption of an antioxidant-rich juice improves oxidative status and causes metabolome changes in healthy adults . Plant Foods Hum Nutr. 2015 ; 70 : 9 – 14 . Google Scholar Crossref Search ADS PubMed WorldCat 65 Chai SC , Davis K , Wright RS , et al. . Impact of tart cherry juice on systolic blood pressure and low-density lipoprotein cholesterol in older adults: a randomized controlled trial . Food Funct. 2018 ; 9 : 3185 – 3194 . Google Scholar Crossref Search ADS PubMed WorldCat 66 Bondonno CP , Yang X , Croft KD , et al. . Flavonoid-rich apples and nitrate-rich spinach augment nitric oxide status and improve endothelial function in healthy men and women: a randomized controlled trial . Free Radic Biol Med . 2012 ; 52 : 95 – 102 . Google Scholar Crossref Search ADS PubMed WorldCat 67 Hollands WJ , Hart DJ , Dainty JR , et al. . Bioavailability of epicatechin and effects on nitric oxide metabolites of an apple flavanol-rich extract supplemented beverage compared to a whole apple puree: a randomized, placebo-controlled, crossover trial . Mol Nutr Food Res. 2013 ; 57 : 1209 – 1217 . Google Scholar Crossref Search ADS PubMed WorldCat 68 Schar MY , Curtis PJ , Hazim S , et al. . Orange juice-derived flavanone and phenolic metabolites do not acutely affect cardiovascular risk biomarkers: a randomized, placebo-controlled, crossover trial in men at moderate risk of cardiovascular disease . Am J Clin Nutr . 2015 ; 101 : 931 – 938 . Google Scholar Crossref Search ADS PubMed WorldCat 69 Morand C , Dubray C , Milenkovic D , et al. . Hesperidin contributes to the vascular protective effects of orange juice: a randomized crossover study in healthy volunteers . Am J Nutr . 2011 ; 93 : 73 – 80 . Google Scholar Crossref Search ADS WorldCat 70 Whyte AR , Williams CM. Effects of a single dose of a flavonoid-rich blueberry drink on memory in 8 to 10 y old children . Nutrition . 2015 ; 31 : 531 – 534 . Google Scholar Crossref Search ADS PubMed WorldCat 71 Bowtell JL , Aboo-Bakkar Z , Conway ME , et al. . Enhanced task-related brain activation and resting perfusion in healthy older adults after chronic blueberry supplementation . Appl Physiol Nutr Metab. 2017 ; 42 : 773 – 779 . Google Scholar Crossref Search ADS PubMed WorldCat 72 Krikorian R , Shidler MD , Nash TA , et al. . Blueberry supplementation improves memory in older adults . J Agric Food Chem. 2010 ; 58 : 3996 – 4000 . Google Scholar Crossref Search ADS PubMed WorldCat 73 Whyte AR , Schafer G , Williams CM. Cognitive effects following acute wild blueberry supplementation in 7- to 10-year-old children . Eur J Nutr. 2016 ; 55 : 2151 – 2162 . Google Scholar Crossref Search ADS PubMed WorldCat 74 Miller MG , Hamilton DA , Joseph JA , et al. . Dietary blueberry improves cognition among older adults in a randomized, double-blind, placebo-controlled trial . Eur J Nutr. 2018 ; 57 : 1169 – 1180 . Google Scholar Crossref Search ADS PubMed WorldCat 75 Boespflug EL , Eliassen JC , Dudley JA , et al. . Enhanced neural activation with blueberry supplementation in mild cognitive impairment . Nutr Neurosci . 2018 ; 21 : 297 – 305 . Google Scholar Crossref Search ADS PubMed WorldCat 76 Khalid S , Barfoot K , May G , et al. . Effects of acute blueberry flavonoids on mood in children and young adults . Nutrients . 2017 ; 9 : 1 – 10 . Google Scholar Crossref Search ADS WorldCat 77 Whyte AR , Schafer G , Williams CM. The effect of cognitive demand on performance of an executive function task following wild blueberry supplementation in 7 to 10 years old children . Food Funct. 2017 ; 8 : 4129 – 4138 . Google Scholar Crossref Search ADS PubMed WorldCat 78 Mcnamara RK , Kalt W , Shidler MD , et al. . Cognitive response to fish oil, blueberry, and combined supplementation in older adults with subjective cognitive impairment . Neurobiol Aging . 2018 ; 64 : 147 – 156 . Google Scholar Crossref Search ADS PubMed WorldCat 79 Krikorian R , Nash TA , Shidler MD , et al. . Concord grape juice supplementation improves memory function in older adults with mild cognitive impairment . Br J Nutr. 2010 ; 103 : 730 – 734 . Google Scholar Crossref Search ADS PubMed WorldCat 80 Krikorian R , Boespflug EL , Fleck DE , et al. . Concord grape juice supplementation and neurocognitive function in human aging . J Agric Food Chem. 2012 ; 60 : 5736 – 5742 . Google Scholar Crossref Search ADS PubMed WorldCat 81 Lamport DJ , Lawton CL , Merat N , et al. . Concord grape juice, cognitive function, and driving performance: a 12-wk, placebo-controlled, randomized crossover trial in mothers of preteen children 1 . Am J Clin Nutr . 2016 ; 103 : 775 – 783 . Google Scholar Crossref Search ADS PubMed WorldCat 82 Haskell-Ramsay CF , Stuart RC , Okello EJ , et al. . Cognitive and mood improvements following acute supplementation with purple grape juice in healthy young adults . Eur J Nutr. 2017 ; 56 : 2621 – 2631 . Google Scholar Crossref Search ADS PubMed WorldCat 83 Lee J , Torosyan N , Silverman DH. Examining the impact of grape consumption on brain metabolism and cognitive function in patients with mild decline in cognition: a double-blinded placebo controlled pilot study . Exp Gerontol . 2017 ; 87 : 121 – 128 . Google Scholar Crossref Search ADS PubMed WorldCat 84 Kean RJ , Lamport DJ , Dodd GF , et al. . Chronic consumption of flavanone-rich orange juice is associated with cognitive benefits: an 8-wk, randomized, double-blind, placebo-controlled trial in healthy older adults . Am J Clin Nutr . 2015 ; 101 : 506 – 520 . Google Scholar Crossref Search ADS PubMed WorldCat 85 Alharbi MH , Lamport DJ , et al. . Flavonoid-rich orange juice is associated with acute improvements in cognitive function in healthy middle-aged males . Eur J Nutr. 2016 ; 55 : 2021 – 2029 . Google Scholar Crossref Search ADS PubMed WorldCat 86 Lamport DJ , Pal D , Macready AL , et al. . The effects of flavanone-rich citrus juice on cognitive function and cerebral blood flow: an acute, randomised, placebo-controlled cross-over trial in healthy, young adults . Br J Nutr. 2017 ; 116 : 2160 – 2168 . Google Scholar Crossref Search ADS WorldCat 87 Schell J , Betts NM , Foster M , et al. . Cranberries improve postprandial glucose excursions in type 2 diabetes . Food Funct. 2017 ; 8 : 3083 – 3090 . Google Scholar Crossref Search ADS PubMed WorldCat 88 González-Ortiz M , Martínez-Abundis E , Espinel-Bermúdez MC , et al. . Effect of pomegranate juice on insulin secretion and sensitivity in patients with obesity . Ann Nutr Metab. 2011 ; 58 : 220 – 223 . Google Scholar Crossref Search ADS PubMed WorldCat 89 Sohrab G , Ebrahimof S , Sotoudeh G , et al. . Effects of pomegranate juice consumption on oxidative stress in patients with type 2 diabetes: a single-blind, randomized clinical trial . Int J Food Sci Nutr. 2016 ; 68 : 249 – 255 . Google Scholar Crossref Search ADS PubMed WorldCat 90 Banihani SA , Makahleh SM , El-Akawi Z , et al. . Fresh pomegranate juice ameliorates insulin resistance, enhances β-cell function, and decreases fasting serum glucose in type 2 diabetic patients . Nutr Res . 2014 ; 34 : 862 – 867 . Google Scholar Crossref Search ADS PubMed WorldCat 91 Kerimi A , Nyambe-Silavwe H , Gauer JS , et al. . Pomegranate juice, but not an extract, confers a lower glycemic response on a high-glycemic index food: randomized, crossover, controlled trials in healthy subjects . Am J Clin Nutr. 2017 ; 106 : 1384 – 1393 . Google Scholar Crossref Search ADS PubMed WorldCat 92 US Department of Agriculture. MyPlate: Fruits 2018 . Available at: https://www.choosemyplate.gov/fruit. Accessed June 22, 2018. 93 Toscano LT , Tavares RL , Toscano LT , et al. . Potential ergogenic activity of grape juice in runners . Appl Physiol Nutr Metab. 2015 ; 40 : 899 – 906 . Google Scholar Crossref Search ADS PubMed WorldCat 94 O’Connor PJ , Caravalho AL , Freese EC , et al. . Grape consumption’s effects on fitness, muscle injury, mood, and perceived health . Int J Sport Nutr Exerc Metab . 2013 ; 23 : 57 – 64 . Google Scholar Crossref Search ADS PubMed WorldCat 95 Ammar A , Turki M , Chtourou H , et al. . Pomegranate supplementation accelerates recovery of muscle damage and soreness and inflammatory markers after a weightlifting training session . PLoS One . 2016 ; 11 : 1 – 19 . OpenURL Placeholder Text WorldCat 96 Ammar A , Turki M , Hammouda O , et al. . Effects of pomegranate juice supplementation on oxidative stress biomarkers following weightlifting exercise . Nutrients . 2017 ; 9 : 819. Google Scholar Crossref Search ADS WorldCat 97 Trombold JR , Reinfeld AS , Casler JR , et al. . The effect of pomegranate juice supplementation on strength and soreness after eccentric exercise . J Strength Cond Res . 2011 ; 25 : 1782 – 1788 . Google Scholar Crossref Search ADS PubMed WorldCat 98 Fuster-Munoz E , Roche E , Funes L , et al. . Effects of pomegranate juice in circulating parameters, cytokines, and oxidative stress markers in endurance-based athletes: a randomized controlled trial . Nutrition . 2016 ; 32 : 539 – 545 . Google Scholar Crossref Search ADS PubMed WorldCat 99 Bell PG , Walshe IH , Davison GW , et al. . Recovery facilitation with Montmorency cherries following high-intensity, metabolically challenging exercise . Appl Physiol Nutr Metab. 2015 ; 40 : 414 – 423 . Google Scholar Crossref Search ADS PubMed WorldCat 100 Levers K , Dalton R , Galvan E , et al. . Effects of powdered Montmorency tart cherry supplementation on an acute bout of intense lower body strength exercise in resistance trained males . J Int Soc Sports Nutr . 2015 ; 12 : 1 – 23 . Google Scholar Crossref Search ADS PubMed WorldCat 101 Bell PG , Stevenson E , Davison GW , et al. . The effects of Montmorency tart cherry concentrate supplementation on recovery following prolonged, intermittent exercise . Nutrients . 2016 ; 8 :441. OpenURL Placeholder Text WorldCat 102 Levers K , Dalton R , Galvan E , et al. . Effects of powdered Montmorency tart cherry supplementation on acute endurance exercise performance in aerobically trained individuals . J Int Soc Sports Nutr . 2016 ; 13 : 1 – 23 . Google Scholar Crossref Search ADS PubMed WorldCat 103 Mccormick R , Peeling P , Binnie M , et al. . Effect of tart cherry juice on recovery and next day performance in well-trained water polo players . J Int Soc Sports Nutr . 2016 ; 13 : 1 – 8 . Google Scholar Crossref Search ADS PubMed WorldCat 104 Keane KM , Bailey SJ , Vanhatalo A , et al. . Effects of Montmorency tart cherry (L. Prunus Cerasus) consumption on nitric oxide biomarkers and exercise performance . Scand J Med Sci Sports. 2018 ; 28 : 1746 – 1756 . Google Scholar Crossref Search ADS PubMed WorldCat 105 Jackman SR , Brook MS , Pulsford RM , et al. . Tart cherry concentrate does not enhance muscle protein synthesis response to exercise and protein in healthy older men . Exp Gerontol . 2018 ; 110 : 202 – 208 . Google Scholar Crossref Search ADS PubMed WorldCat 106 Brown MA , Stevenson EJ , Howatson G. Montmorency tart cherry (Prunus cerasus L.) supplementation accelerates recovery from exercise-induced muscle damage in females . Eur J Sport Sci . 2018 ; 19 : 95–102 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 107 Lai HT , Threapleton DE , Day AJ , et al. . Fruit intake and cardiovascular disease mortality in the UK Women’s Cohort Study . Eur J Epidemiol. 2015 ; 30 : 1035 – 1048 . Google Scholar Crossref Search ADS PubMed WorldCat 108 Cassidy A , Bertoia M , Chiuve S , et al. . Habitual intake of anthocyanins and flavanones and risk of cardiovascular disease in men . Am J Clin Nutr . 2016 ; 104 : 587 – 594 . Google Scholar Crossref Search ADS PubMed WorldCat 109 Rasines-Perea Z , Teissedre P-L. Grape polyphenols’ effects in human cardiovascular diseases and diabetes . Molecules . 2017 ; 22 : 1 – 19 . Google Scholar Crossref Search ADS WorldCat 110 Sahebkar A , Ferri C , Giorgini P , et al. . Effects of pomegranate juice on blood pressure: a systematic review and meta-analysis of randomized controlled trials . Pharmacol Res . 2017 ; 115 : 149 – 161 . Google Scholar Crossref Search ADS PubMed WorldCat 111 Chong M-F , Macdonald R , Lovegrove JA. Fruit polyphenols and CVD risk: a review of human intervention studies . Br J Nutr. 2010 ; 104 : S28 – S39 . Google Scholar Crossref Search ADS PubMed WorldCat 112 Wightman JD , Heuberger RA. Effect of grape and other berries on cardiovascular health . J Sci Food Agric. 2015 ; 95 : 1584 – 1597 . Google Scholar Crossref Search ADS PubMed WorldCat 113 Hyson DA. A review and critical analysis of the scientific literature related to 100% fruit juice and human health . Adv Nutr . 2015 ; 6 : 37 – 51 . Google Scholar Crossref Search ADS PubMed WorldCat 114 Blumberg JB , Camesano TA , Cassidy A , et al. . Cranberries and their bioactive constituents in human health . Adv Nutr . 2013 ; 4 : 618 – 632 . Google Scholar Crossref Search ADS PubMed WorldCat 115 Sahebkar A , Gurban C , Serban A , et al. . Effects of supplementation with pomegranate juice on plasma C-reactive protein concentrations: a systematic review and meta-analysis of randomized controlled trials . Phytomedicine . 2016 ; 23 : 1095 – 1102 . Google Scholar Crossref Search ADS PubMed WorldCat 116 Blumberg JB , Vita JA , Oliver Chen CY. Concord grape juice polyphenols and cardiovascular risk factors: dose–response relationships . Nutrients . 2015 ; 7 : 10032 – 10052 . Google Scholar Crossref Search ADS PubMed WorldCat 117 Dai Q , Borenstein AR , Wu Y , et al. . Fruit and vegetable juices and Alzheimer’s disease: the Kame Project . Am J Med . 2006 ; 119 : 751 – 759 . Google Scholar Crossref Search ADS PubMed WorldCat 118 Morris MC , Evans DA , Tangney CC , et al. . Associations of vegetable and fruit consumption with age-related cognitive change . Neurology . 2006 ; 67 : 1370 – 1376 . Google Scholar Crossref Search ADS PubMed WorldCat 119 Lefèvre-Arbogast S , Gaudout D , Bensalem J , et al. . Pattern of polyphenol intake and the long-term risk of dementia in older persons . Neurology . 2018 ; 90 : e1979 – e1988 . Google Scholar Crossref Search ADS PubMed WorldCat 120 Letenneur L , Proust-Lima C , Le Gouge A , et al. . Flavonoid intake and cognitive decline over a 10-year period . Am J Epidemiol . 2007 ; 165 : 1364 – 1371 . Google Scholar Crossref Search ADS PubMed WorldCat 121 Morris M , DA E , JL B , et al. . Consumption of fish and n-3 fatty acids and risk of incident Alzheimer disease . Arch Neurol. 2003 ; 60 : 940 – 946 . Google Scholar Crossref Search ADS PubMed WorldCat 122 Alpérovitch A , Barberger-Gateau P , Raffaitin C , et al. . Dietary patterns and risk of dementia the three-city cohort study* . Neurology . 2007 ; 69 : 1921 – 1930 . Google Scholar Crossref Search ADS PubMed WorldCat 123 Bell L , Lamport DJ , Butler LT , et al. . A review of the cognitive effects observed in humans following acute supplementation with flavonoids, and their associated mechanisms of action . Nutrients . 2015 ; 7 : 10290 – 10306 . Google Scholar Crossref Search ADS PubMed WorldCat 124 Lamport DJ , Saunders C , Butler LT , et al. . Fruits, vegetables, 100% juices, and cognitive function . Nutr Rev. 2014 ; 72 : 774 – 789 . Google Scholar Crossref Search ADS PubMed WorldCat 125 Dunham A , Johnson EJ. Fruits, vegetables, and their components and mild cognitive impairment and dementia: a review . Food Rev Int . 2013 ; 29 : 409 – 440 . Google Scholar Crossref Search ADS WorldCat 126 Lamport DJ , Dye L , Wightman JD , et al. . The effects of flavonoid and other polyphenol consumption on cognitive performance: a systematic research review of human experimental and epidemiological studies . Nutr Aging . 2012 ; 1 : 5 – 25 . Google Scholar Crossref Search ADS WorldCat 127 Milbury PE , Kalt W , Mayer J. Xenobiotic metabolism and berry flavonoid transport across the blood-brain barrier . J Agric Food Chem . 2010 ; 58 : 3950 – 3956 . Google Scholar Crossref Search ADS PubMed WorldCat 128 Chen T-Y , Kritchevsky J , Hargett K , et al. . Plasma bioavailability and regional brain distribution of polyphenols from apple/grape seed and bilberry extracts in a young swine model . Mol Nutr Food Res. 2015 ; 59 : 2432 – 2447 . Google Scholar Crossref Search ADS PubMed WorldCat 129 Williams CM , Abd M , Mohsen E , et al. . Blueberry-induced changes in spatial working memory correlate with changes in hippocampal CREB phosphorylation and brain-derived neurotrophic factor (BDNF) levels . Free Radic Biol . 2008 ; 45 : 295 – 305 . Google Scholar Crossref Search ADS WorldCat 130 Wang J , Tang C , Ferruzzi MG , et al. . Role of standardized grape polyphenol preparation as a novel treatment to improve synaptic plasticity through attenuation of features of metabolic syndrome in a mouse model . Mol Nutr Food Res . 2013 ; 57 : 1 – 21 . OpenURL Placeholder Text WorldCat 131 Spencer J. The impact of flavonoids on memory: physiological and molecular considerations . Chem Soc Rev. 2009 ; 38 : 1152 – 1161 . Google Scholar Crossref Search ADS PubMed WorldCat 132 Wang J , Bi W , Cheng A , et al. . Targeting multiple pathogenic mechanisms with polyphenols for the treatment of Alzheimer’s disease-experimental approach and therapeutic implications . Front Aging Neurosci . 2014 ; 6 : 1 – 10 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 133 Swan GE , Carmelli D , Asenath L. Systolic blood pressure tracking over 25 to 30 years and cognitive performance in older adults . Stroke . 1998 ; 29 : 2334 – 2340 . Google Scholar Crossref Search ADS PubMed WorldCat 134 Kalaria RN. The role of cerebral ischemia in Alzheimer’s disease . Neurobiol Aging. 2000 ; 21 : 321 – 330 . Google Scholar Crossref Search ADS PubMed WorldCat 135 Skoog I , Gustafson D. Hypertension, hypertension-clustering factors and Alzheimer’s disease . Neurol Res . 2003 ; 25 : 675 – 680 . Google Scholar Crossref Search ADS PubMed WorldCat 136 Roher AE , Garami Z , Alexandrov AV , et al. . Interaction of cardiovascular disease and neurodegeneration: transcranial Doppler ultrasonography and Alzheimer’s disease . Neurol Res . 2006 ; 28 : 672 – 678 . Google Scholar Crossref Search ADS PubMed WorldCat 137 Attems J , Jellinger KA. The overlap between vascular disease and Alzheimer’s disease-lessons from pathology . BMC Med. 2014 ; 12 : 206. Google Scholar Crossref Search ADS PubMed WorldCat 138 Clemens R , Drewnowski A , Ferruzzi MG , et al. . Squeezing fact from fiction about 100% fruit juice . Adv Nutr . 2015 ; 6 : 236S – 243S . Google Scholar Crossref Search ADS PubMed WorldCat 139 Auerbach BJ , Wolf FM , Hikida A , et al. . Fruit juice and change in BMI: a meta-analysis . Pediatrics . 2017 ; 139 : e20162454. Google Scholar Crossref Search ADS PubMed WorldCat 140 Xi B , Li S , Liu Z , et al. . Intake of fruit juice and incidence of type 2 diabetes: a systematic review and meta-analysis . PLoS One. 2014 ; 9 : e93471. Google Scholar Crossref Search ADS PubMed WorldCat 141 Guo X , Tresserra-Rimbau A , Estruch R , et al. . Polyphenol levels are inversely correlated with body weight and obesity in an elderly population after 5 years of follow up (the randomised PREDIMED study) . Nutrients . 2017 ; 9 : 452. Google Scholar Crossref Search ADS WorldCat 142 Tresserra-Rimbau A , Guasch-Ferré M , Salas-Salvadó J , et al. . Intake of total polyphenols and some classes of polyphenols is inversely associated with diabetes in elderly people at high cardiovascular disease risk . J Nutr . 2016 ; 146 : 767 – 777 . OpenURL Placeholder Text WorldCat 143 Dennison BA , Rockwell HL , Baker SL. Excess fruit juice consumption by preschool-aged children is associated with short stature and obesity . Pediatrics . 1997 ; 99 : 15 – 22 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 144 Wang YC , Bleich SN , Gortmaker SL. Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988–2004 what’s known on this subject what this study adds . Pediatrics . 2008 ; 121 : 1604 – 1614 . Google Scholar Crossref Search ADS WorldCat 145 Murphy MM , Barrett EC , Bresnahan KA , et al. . 100% Fruit juice and measures of glucose control and insulin sensitivity: a systematic review and meta-analysis of randomised controlled trials . J Nutr Sci . 2017 ; 6 : 1 – 15 . Google Scholar Crossref Search ADS WorldCat 146 Jennings A , Macgregor A , Spector T , et al. . Higher dietary flavonoid intakes are associated with lower objectively measured body composition in women: evidence from discordant monozygotic twins 1, 2 . Am J Clin Nutr. 2017 ; 105 : 626 – 634 . Google Scholar Crossref Search ADS PubMed WorldCat 147 Wedick NM , Pan A , Cassidy A , et al. . Dietary flavonoid intakes and risk of type 2 diabetes in US men and women . Am J Clin Nutr . 2012 ; 95 : 925 – 933 . Google Scholar Crossref Search ADS PubMed WorldCat 148 Mursu J , Virtanen JK , Tuomainen T-P , et al. . Intake of fruit, berries, and vegetables and risk of type 2 diabetes in Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study . Am J Clin Nutr. 2014 ; 99 : 328 – 333 . Google Scholar Crossref Search ADS PubMed WorldCat 149 Muraki I , Imamura F , Manson JE , et al. . Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies . BMJ. 2013 ; 347 : f5001. Google Scholar Crossref Search ADS PubMed WorldCat 150 Törrönen R , Sarkkinen E , Tapola N , et al. . Berries modify the postprandial plasma glucose response to sucrose in healthy subjects . Br J Nutr. 2010 ; 103 : 1094 – 1097 . Google Scholar Crossref Search ADS PubMed WorldCat 151 Hanhineva K , Törrönen R , Bondia-Pons I , et al. . Impact of dietary polyphenols on carbohydrate metabolism . IJMS. 2010 ; 11 : 1365 – 1402 . Google Scholar Crossref Search ADS WorldCat 152 Moser S , Lim J , Chegeni M , et al. . Concord and Niagara grape juice and their phenolics modify intestinal glucose transport in a coupled in vitro digestion/caco-2 human intestinal model . Nutrients . 2016 ; 8 : 1 – 19 . OpenURL Placeholder Text WorldCat 153 Huxley R , Lee CMY , Barzi F , et al. . Coffee, decaffeinated coffee, and tea consumption in relation to incident type 2 diabetes mellitus . Arch Intern Med. 2009 ; 169 : 2053. Google Scholar Crossref Search ADS PubMed WorldCat 154 Ding M , Bhupathriaju SN , Chen M , et al. . Caffeinated and decaffeinated coffee consumption and risk of type 2 diabetes: a systematic review and a dose-response meta-analysis . Diabetes Care . 2014 ; 37 : 569 – 586 . Google Scholar Crossref Search ADS PubMed WorldCat 155 Crowe-White K , Parrott JS , Stote KS , et al. . Metabolic impact of 100% fruit juice consumption on antioxidant/oxidant status and lipid profiles of adults: an evidence-based review . Crit Rev Food Sci Nutr . 2015 ; 57 : 152 – 162 . Google Scholar Crossref Search ADS WorldCat 156 Myburgh KH. Polyphenol supplementation: benefits for exercise performance or oxidative stress? Sports Med. 2014 ; 44 : S57 – S70 . Google Scholar Crossref Search ADS PubMed WorldCat 157 Vitale KC , Hueglin S , Broad E. Tart cherry juice in athletes: a literature review and commentary . Curr Sports Med Rep . 2017 ; 16 : 230 – 239 . Google Scholar Crossref Search ADS PubMed WorldCat 158 Slavin JL , Lloyd B. Health benefits of fruits and vegetables . Adv Nutr . 2012 ; 3 : 506 – 516 . Google Scholar Crossref Search ADS PubMed WorldCat 159 Burton-Freeman BM , Guenther PM , Oh M , et al. . Assessing the consumption of berries and associated factors in the United States using the National Health and Nutrition Examination Survey (NHANES), 2007–2012 . Food Funct . 2018 ; 9 : 2007 – 2012 . Google Scholar Crossref Search ADS WorldCat 160 US Department of Agriculture. USDA Food Composition Database for Standard Reference 2018. Available at: https://ndb.nal.usda.gov/ndb/. Accessed August 1, 2018. 161 Ruxton CHS , Gardner EJ , Walker D. Can pure fruit and vegetable juices protect against cancer and cardiovascular disease too? A review of the evidence . Int J Food Sci Nutr . 2006 ; 57 : 249 – 272 . Google Scholar Crossref Search ADS PubMed WorldCat 162 Rehm CD , Drewnowski A. Dietary and economic effects of eliminating shortfall in fruit intake on nutrient intakes and diet cost . BMC Pediatr . 2016 ; 16 : 1 – 12 . Google Scholar Crossref Search ADS PubMed WorldCat 163 Rehm CD , Monsivais P , Drewnowski A. The quality and monetary value of diets consumed by adults in the United States . Am J Clin Nutr . 2011 ; 94 : 1333 – 1342 . Google Scholar Crossref Search ADS PubMed WorldCat 164 Byrd-Bredbenner C , Ferruzzi MG , Fulgoni VL , et al. . Satisfying America’s fruit gap: summary of an expert roundtable on the role of 100% fruit juice . J Food Sci . 2017 ; 82 : 1523 – 1534 . Google Scholar Crossref Search ADS PubMed WorldCat 165 Nicklas TA , Carol N , Fulgoni VL III . Replacing 100% fruit juice with whole fruit results in a trade off of nutrients in the diets of children . Curr Nutr Food Sci . 2015 ; 11 : 267 – 273 . Google Scholar Crossref Search ADS WorldCat 166 Mozaffarian D , Hao T , Rimm EB , et al. . Changes in diet and lifestyle and long-term weight gain in women and men . N Engl J Med. 2011 ; 364 : 2392 – 2404 . Google Scholar Crossref Search ADS PubMed WorldCat 167 O’neil CE , Nicklas TA , Rampersaud GC , et al. . 100% Orange juice consumption is associated with better diet quality, improved nutrient adequacy, decreased risk for obesity, and improved biomarkers of health in adults: national Health and Nutrition Examination Survey, 2003–2006 . Nutr J . 2012 ; 11 : 1 – 10 . Google Scholar Crossref Search ADS PubMed WorldCat 168 Nicklas TA , O’neil CE , Iii V. Consumption of 100% fruit juice is associated with better nutrient intake and diet quality but not with weight status in children: NHANES 2007–2010 . Int J Child Health Nutr. 2015 ; 4 : 112 – 121 . Google Scholar Crossref Search ADS WorldCat 169 Harnly JM , Doherty RF , Beecher GR , et al. . Flavonoid content of U.S. fruits, vegetables, and nuts . J Agric Food Chem. 2006 ; 54 : 9966 – 9977 . Google Scholar Crossref Search ADS PubMed WorldCat 170 Ivanova V , Stefova M , Chinnici F. Determination of the polyphenol contents in Macedonian grapes and wines by standardized spectrophotometric methods . J Serb Chem Soc. 2010 ; 75 : 45 – 59 . doi:10.2298/JSC1001045I Google Scholar Crossref Search ADS WorldCat 171 Xu Y , Simon JE , Welch C , et al. . Survey of polyphenol constituents in grapes and grape-derived products . J Agric Food Chem. 2011 ; 59 : 10586 – 10593 . Google Scholar Crossref Search ADS PubMed WorldCat 172 Souquet J-M , Cheynier V , Brossaud F , et al. . Polymeric proanthocyanidins from grape skins . Phytochemistry . 1996 ; 43 : 509 – 512 . Google Scholar Crossref Search ADS WorldCat 173 Kennedy JA , Matthews MA , Waterhouse AL. Effect of maturity and vine water status on grape skin and wine flavonoids . Am J Enol Vitic . 2002 ; 53 : 268 – 274 . OpenURL Placeholder Text WorldCat 174 Canals R , Llaudy MC , Valls J , et al. . Influence of ethanol concentration on the extraction of color and phenolic compounds from the skin and seeds of tempranillo grapes at different stages of ripening . J Agric Food Chem. 2005 ; 53 : 4019 – 4025 . Google Scholar Crossref Search ADS PubMed WorldCat 175 Howard LR , Hager TJ. Berry fruit phytochemicals. In: Zhao Y , ed. Berry Fruit: Value-Added Products for Health Promotion . Boca Raton, FL : CRC Press ; 2007 : 73 – 99 . Google Scholar Crossref Search ADS Google Scholar Google Preview WorldCat COPAC 176 Cerdá B , Soto C , Martínez P , et al. . Pomegranate juice supplementation in chronic obstructive pulmonary disease: a 5-week randomized, double-blind, placebo-controlled trial . Eur J Clin Nutr. 2006 ; 60 : 245 – 253 . Google Scholar Crossref Search ADS PubMed WorldCat 177 Gil-Izquierdo A , Gil MI , Ferreres F. Effect of processing techniques at industrial scale on orange juice antioxidant and beneficial health compounds . J Agric Food Chem. 2002 ; 50 : 5107 – 5114 . Google Scholar Crossref Search ADS PubMed WorldCat 178 Manach C , Scalbert A , Morand C , et al. . Polyphenols: food sources and bioavailability . Am J Clin Nutr . 2004 ; 79 : 727 – 747 . Google Scholar Crossref Search ADS PubMed WorldCat 179 Dauthy ME. Fruit and Vegetable Processing. Rome : Food and Agriculture Organization of the United Nations ; 1995 . Available at: http://www.fao.org/docrep/V5030E/V5030E00.htm. Accessed July 12, 2018. Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 180 Iglesias DJ , Cercós M , Colmenero-Flores JM , et al. . Physiology of citrus fruiting . Braz J Plant Physiol. 2007 ; 19 : 333 – 362 . Google Scholar Crossref Search ADS WorldCat 181 Peleg H , Naim M , Rouseff RL , et al. . Distribution of bound and free phenolic acids in oranges (Citrus sinensis) and grapefruits (Citrus paradisi) . J Sci Food Agric. 1991 ; 57 : 417 – 426 . Google Scholar Crossref Search ADS WorldCat 182 Borges G , Mullen W , Mullan A , et al. . Bioavailability of multiple components following acute ingestion of a polyphenol-rich juice drink . Mol Nutr Food Res. 2010 ; 54 , S268 – S277 . Google Scholar Crossref Search ADS PubMed WorldCat 183 Bates RP , Morris JR , Crandall PG. Principles and Practices of Small- and Medium-Scale Fruit Juice Processing . Rome : Food and Agriculture Organization of the United Nations ; 2001 : 135 – 150 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 184 Talcott ST , Lee J-H. Ellagic acid and flavonoid antioxidant content of muscadine wine and juice . J Agric Food Chem. 2002 ; 50 : 3186 – 3192 . Google Scholar Crossref Search ADS PubMed WorldCat 185 Jakobek L. Interactions of polyphenols with carbohydrates, lipids and proteins . Food Chem . 2015 ; 175 : 556 – 567 . Google Scholar Crossref Search ADS PubMed WorldCat 186 Kalaycıog Z , Erim FB. Total phenolic contents, antioxidant activities, and bioactive ingredients of juices from pomegranate cultivars worldwide . Food Chem . 2017 ; 221 : 496 – 507 . Google Scholar Crossref Search ADS PubMed WorldCat 187 Turfan Ö , Türkyılmaz M , Yemis O , et al. . Anthocyanin and colour changes during processing of pomegranate (Punica granatum L., cv. Hicaznar) juice from sacs and whole fruit . J Food Chem . 2011 ; 129 : 1644 – 1651 . Google Scholar Crossref Search ADS WorldCat 188 Concord Grape Association. FAQs. 2014 . Available at: https://www.concordgrape.org/bodyfacts.html. Accessed July 8, 2018. 189 Stalmach A , Edwards CA , Wightman JD , et al. . Identification of (poly)phenolic compounds in concord grape juice and their metabolites in human plasma and urine after juice consumption . J Agric Food Chem. 2011 ; 59 : 9512 – 9522 . Google Scholar Crossref Search ADS PubMed WorldCat 190 Mullen W , Marks SC , Crozier A. Evaluation of phenolic compounds in commercial fruit juices and fruit drinks . J Agric Food Chem. 2007 ; 55 : 3148 – 3157 . Google Scholar Crossref Search ADS PubMed WorldCat 191 Neilson AP , Ferruzzi MG. Influence of formulation and processing on absorption and metabolism of flavan-3-ols from tea and cocoa . Annu Rev Food Sci Technol. 2011 ; 2 : 125 – 151 . Google Scholar Crossref Search ADS PubMed WorldCat 192 Del Rio D , Rodriguez-Mateos A , Spencer JPE , et al. . Dietary (poly)phenolics in human health: structures, bioavailability, and evidence of protective effects against chronic diseases . Antioxidants Redox Signal . 2013 ; 18 : 1818 – 1892 . Google Scholar Crossref Search ADS WorldCat 193 Lewandowska U , Szewczyk K , Bieta Hrabec E , et al. . Overview of metabolism and bioavailability enhancement of polyphenols . J Agric Food Chem. 2013 ; 61 : 12183 – 12199 . Google Scholar Crossref Search ADS PubMed WorldCat 194 Lafay S , Gil-Izquierdo A , Manach C , et al. . Nutrient physiology, metabolism, and nutrient-nutrient interactions . J Nutr . 2006 ; 136 : 1192 – 1197 . Google Scholar Crossref Search ADS PubMed WorldCat 195 Konishi Y , Zhao Z , Shimizu M. Phenolic acids are absorbed from the rat stomach with different absorption rates . J Agric Food Chem. 2006 ; 54 : 7539 – 7543 . Google Scholar Crossref Search ADS PubMed WorldCat 196 Spencer JPE , Abd MM , Mohsen E , et al. . Biomarkers of the intake of dietary polyphenols: strengths, limitations and application in nutrition research . Br J Nutr. 2008 ; 99 : 12 – 22 . Google Scholar Crossref Search ADS PubMed WorldCat 197 Redan BW , Buhman KK , Novotny JA , et al. . Altered transport and metabolism of phenolic compounds in obesity and diabetes: implications for functional food development and assessment . Adv Nutr . 2016 : 7 : 1090 – 1104 . Google Scholar Crossref Search ADS PubMed WorldCat 198 Kay CD. The future of flavonoid research an ever-expanding amount of scientific evidence supports a protective effect of polyphenols on chronic degenerative diseases . Br J Nutr. 2010 ; 104 : S91 – S95 . Google Scholar Crossref Search ADS PubMed WorldCat 199 Aschoff JK , Kaufmann S , Kalkan O , et al. . In vitro bioaccessibility of carotenoids, flavonoids, and vitamin C from differently processed oranges and orange juices [Citrus sinensis (L.) osbeck] . J Agric Food Chem . 2015 ; 63 . doi:10.1021/jf505297t. OpenURL Placeholder Text WorldCat 200 Palafox-Carlos H , Ayala-Zavala JF , González-Aguilar GA. The role of dietary fiber in the bioaccessibility and bioavailability of fruit and vegetable antioxidants . J Food Sci. 2010 ; 76 : R6 – R15 . doi:10.1111/j.1750-3841.2010.01957.x. Google Scholar Crossref Search ADS WorldCat 201 Williamson G , Clifford MN. Colonic metabolites of berry polyphenols: the missing link to biological activity? Br J Nutr. 2010 ; 104 : S48 – S66 . Google Scholar Crossref Search ADS PubMed WorldCat 202 Renard CMGC Watrelot AA , Le Bourvellec C. Interactions between polyphenols and polysaccharides: mechanisms and consequences in food processing and digestion . Trends Food Sci Technol . 2017 ; 60 : 43 – 51 . Google Scholar Crossref Search ADS WorldCat 203 Kris-Etherton PM , Hecker KD , Bonanome A , et al. . Bioactive compounds in foods: their role in the prevention of cardiovascular disease and cancer . Am J Med . 2002 ; 113 : 71S – 88S . Google Scholar Crossref Search ADS PubMed WorldCat 204 Quirós-Sauceda A , Chen C-Y , Blumberg J , et al. . Processing “Ataulfo” mango into juice preserves the bioavailability and antioxidant capacity of its phenolic compounds . Nutrients . 2017 ; 9 : 1082. Google Scholar Crossref Search ADS WorldCat 205 Rodriguez-Mateos A , Pino-García R , Del George TW , et al. . Impact of processing on the bioavailability and vascular effects of blueberry (poly)phenols . Mol Nutr Food Res. 2014 ; 58 : 1952 – 1961 . Google Scholar Crossref Search ADS PubMed WorldCat 206 Johnson MC , Thomas AL , Greenlief CM. Impact of frozen storage on the anthocyanin and polyphenol contents of American elderberry fruit juice . J Agric Food Chem. 2015 ; 63 : 5653 – 5659 . Google Scholar Crossref Search ADS PubMed WorldCat © The Author(s) 2019. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 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TI - Potential health benefits of (poly)phenols derived from fruit and 100% fruit juice
JO - Nutrition Reviews
DO - 10.1093/nutrit/nuz041
DA - 2020-02-01
UR - https://www.deepdyve.com/lp/oxford-university-press/potential-health-benefits-of-poly-phenols-derived-from-fruit-and-100-mx1IRQSp35
SP - 145
VL - 78
IS - 2
DP - DeepDyve
ER -