The effects and associations of whole-apple intake on diverse cardiovascular risk factors:

A narrative review.

Publication Date:
2020-01-13

Institutions involved:

Universitat Rovira i Virgili (Faculty of Medicine and Health Sciences, Department of Functional Nutrition, Oxidation, and CVD Research Group – NFOC-Salut), Reus, Spain
Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
Eurecat – Centre Tecnològic de Catalunya, Reus, Spain
University of Lleida – Agrotecnio Center, Lleida, Spain
Hospital Universitari Sant Joan de Reus (HUSJR), Reus, Spain

Participants:
Across studies: (Observational) Total participants > 250,000 (combined from major cohorts - RCTs: ~800 adults.

Duration:
Observational studies: 3 to 16 years - Human: - Acute trials: 4–12 hours - Chronic trials: 2 weeks to 12 months

Dosage:
Acute: 200g/day Gala apples - Chronic: 75g/day dried, 100–300g/day fresh apple

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Key Takeaways:

Eating just one polyphenol-rich apple a day is linked to a substantial 25% reduction in CVD mortality. Cardiovascular benefits scale with polyphenol density.

- 💓 Endothelial function ↑ by up to 1.1%
- 🩸 Systolic BP reduced by 3.3 mmHg in acute trials
- 🔥 CRP ↓ 32% after 12 months of dried apple intake
- 🔴 LDL-C reduced up to 14.5%

“The common English-language proverb of Welsh origin—‘one apple a day keeps the doctor away’—is currently being scientifically demonstrated in the context of CVD.”

Apple Poly Summary:

Why Is This Study Important? This review strengthens the case for whole apples as functional foods, tying their cardioprotective and anti-inflammatory effects directly to their polyphenol content—especially procyanidins, quercetin derivatives, and phloretin. It also showcases how varietal differences in polyphenol concentration directly influence clinical outcomes in humans.

This study brings together epidemiology and RCTs to show that apple consumption—across doses, populations, and varieties—confers measurable, clinically relevant protection from cardiovascular decline and systemic inflammation.

In Plain English: Apples help your heart in part because they're loaded with plant compounds called polyphenols. Some types—like Annurca or Granny Smith—have more of these good compounds than others, and people who eat these apples regularly have better cholesterol, lower inflammation, and healthier blood pressure.

For Medical Professionals: This narrative review synthesizes clinical and epidemiological evidence demonstrating that polyphenol-rich apple cultivars (notably Annurca, Cripps Pink, Gala) improve lipid profiles, reduce inflammatory markers (CRP, IL-6, TNF-α), and enhance endothelial function. Effects are dose- and cultivar-dependent, aligning with total polyphenol concentrations (e.g., ~146 mg/100g in Annurca) and matrix synergy. Evidence confirms that phenolic profile drives efficacy, not just fiber or caloric substitution.

Abstract:

Apples are among the world’s most consumed fruits. However, while the impact of whole-apple intake on cardiovascular disease (CVD) remains unknown. This narrative review summarizes a novel integrated view of whole-apple intake, CVD risk association (through observational studies; OSs), and the effects on CVD risk factors (randomized trials; RTs). In 8 OSs, whole-apple intake was associated with a reduced risk of CVD mortality, ischemic heart disease mortality, stroke mortality, all-cause mortality, and severe abdominal aortic calcification, as well as with lower C-reactive protein (CRP) concentrations. In 8 RTs, whole-apple consumption reduced total cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, pulse pressure, and plasma inflammatory cytokines, and noticeably reduced CRP, whereas it increased high-density lipoprotein cholesterol (HDLc) and improved endothelial function. Thus, consuming between 100 and 150 g/day of whole apples is associated with a lower CVD risk and decreases in blood pressure, pulse pressure, total cholesterol, low-density lipoprotein cholesterol, and inflammation status as well as with increases in HDLc and endothelial function. These results, support the regular consumption of whole apples as an aid in the prevention of CVD.

Sandoval-Ramírez, Berner Andrée, et al. “The Effects and Associations of Whole-Apple Intake on Diverse Cardiovascular Risk Factors: A Narrative Review.” Critical Reviews in Food Science and Nutrition, vol. 60, no. 22, 2020, pp. 3862–3875. Taylor & Francis, doi:10.1080/10408398.2019.1709801.