Abstract
- Background
Mild hypercholesterolemia is a prevalent, modifiable independent risk factor for the development of atherosclerosis and cardiovascular disease. Dietary strategies rich in bioactive dietary fiber—specifically soluble pectin—alongside diverse polyphenolic antioxidants, have long been recommended for supporting cardiovascular health. Apples (Malus domestica) are widely consumed globally and serve as an exceptionally rich source of dietary polyphenols (including catechins, epicatechins, chlorogenic acid, and quercetin glycosides) and high-quality soluble pectin. While epidemiological data consistently correlate frequent apple consumption with reduced cardiovascular morbidity, robust clinical trials investigating the precise, acute and sustained cardiometabolic impacts of whole apple intake in mildly hypercholesterolemic populations remain limited. This randomized, controlled, crossover clinical trial was designed to evaluate whether daily consumption of two whole apples effectively improves serum lipid profiles, endothelial function, and systemic inflammatory biomarkers in adults with mild hypercholesterolemia.
- Methods
A rigorous, randomized, controlled, crossover clinical intervention trial was conducted involving mildly hypercholesterolemic adult participants. Following appropriate dietary washout phases, subjects were assigned to consume a standardized daily dose of whole apples (equivalent to two medium-sized apples per day) or a matched caloric control beverage/product over consecutive intervention periods under strict dietary monitoring. Primary efficacy endpoints included serial quantitative assessments of fasting serum lipid panels—specifically total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Secondary endpoints encompassed markers of systemic endothelial function, circulating inflammatory cytokines, fasting blood glucose, and vascular adhesion molecules.
- Results
Daily dietary incorporation of two apples per day demonstrated statistically significant improvements in key lipid and cardiometabolic parameters compared to the control period. Participants receiving the active apple intervention exhibited marked reductions in serum total cholesterol and low-density lipoprotein cholesterol (LDL-C) concentrations. Furthermore, evaluations of endothelial function revealed significant enhancements in flow-mediated dilation (FMD), alongside favorable trends in attenuating circulating inflammatory biomarkers and improving systemic vascular reactivity. The whole-fruit intervention was exceptionally well-tolerated, demonstrating high participant compliance and no adverse gastrointestinal events.
- Conclusions
Daily consumption of two apples significantly lowers serum total and LDL cholesterol and improves endothelial and cardiometabolic biomarkers in individuals with mild hypercholesterolemia. These clinical findings establish accessible, whole-fruit dietary interventions as an effective, evidence-based lifestyle strategy for managing mild hypercholesterolemia and mitigating long-term cardiovascular disease risk.
https://ajcn.nutrition.org/article/S0002-9165(22)01006-1/fulltext