The Effects of Fruit-Derived Polyphenols on Cognition and Lung Function in Healthy Adults: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Eligibility Criteria
2.2. Data Sources and Search Strategy
2.3. Data Extraction
2.4. Quality and Risk of Bias Assessment
2.5. Statistical Analysis
3. Results
3.1. Study Selection
3.2. Study Design and Supplementation
3.2.1. Cognition
3.2.2. Lung Function
3.3. Subject Characteristics
3.3.1. Cognition
3.3.2. Lung
3.4. Meta-Analysis Results
3.4.1. Polyphenol Intake and Lung Function
3.4.2. Polyphenol Intake and Executive Function
3.4.3. Polyphenol Intake and Attention
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Reference | Study Design | Sample Size | Population Details | Study Duration & Outcome Measured | Intervention | Cognitive/Mood Outcomes | Results |
---|---|---|---|---|---|---|---|
Nilsson, et al. (2017) [35] | RCT, crossover Chronic | 40 | Adults 50–70 years, 30 female, 10 male. | 15 weeks: 5 weeks intervention, 5 weeks control, 5 weeks washout between trials. Final dose 9.5–10 h pre. | 200 mL Berry mixture (total polyphenol 1234.9 ± 103.2, anthocyanins 414.2 ± 32.8 mg/L, Flavanols 155.9 ± 8.7) or control (matched CHO and pH) consumed 3× per day. | WM, SA | Increased WM at 30 min in BC group. Pronounced learning effect in selective attention. |
Whyte, et al. (2019) [36] | Single-blind, RCT, parallel groups Acute | 40 | Adults 20–30 years | Two consecutive days. Practice on day 1 of full cognitive test battery. Test 1 pre-treatment, then 2, 4 and 6 h following intervention. | 400 mL berry ‘smoothie’ (total polyphenol 14.3 g) or PL (matched CHO and Vit C). | MANT, TST, PANAS-NOW. | IncreasedMANT accuracy at 6 h with berry. Faster performance in MANT. TST response time decreased in berry between 2 h and 6 h. |
Cook, et al. 2020 [37] | Double-blind, RCT, crossover Chronic + 2 h pretesting. | 14 | Adults, 12 males, 2 females, 69 ± 4 years | Four lab visits. Physical measures, cognitive assessment and 6 min walk test completed. Visits 1 and 2 familiarisation sessions, maximum of 7-days apart. | 300 mg capsules twice daily taken 8 h apart for 6 days PL (cellulose) or NZBC extract (105 mg). Two capsules (600 mg), 2-h prior to arriving at laboratory on day 7. Seven-day washout between trials. | Cambridge neuropsychological test automated battery: RT, SWM, RVIP, PAL. | No difference in RT, SWM, RVIP, PAL. |
Bell, et al. (2020) [38] | Double-blind, RCT, parallel groups Acute-on-chronic | 60 | Adults, aged 18– 30 years, PL = 3 male/27 female, Intervention = 6 male/24 female. | Acute: Tested at baseline, 2, 4, and 6 h post consumption. Chronic: tested at baseline, 6 weeks, and 12 weeks. | Grape seed polyphenol extract (GSPE) (400 mg mix of purified grape seed derived polyphenols) or PL (400 mg maltodextrin) taken daily in capsules. | 45 min test in fixed order. AVLT, SSTT, SSTT, MANT, Finger tapping (simple and complex), TST, PANAS-NOW, mental fatigue (Likert scale) | Acute: Faster reaction time with GSPE in switching task and RT in ANT. Better AVLT total recall (p < 0.05), switching task accuracy (p < 0.1) with PL. Chronic: GSPE improved simple finger tapping score between week 6 and 12 (p = 0.005). Limited cognitive benefits from GSPE (acute or chronic). |
Watson, et al. (2018) [39] | Double-blind, RCT, crossover Acute | 9 | Adults, 3 male, 6 female), 23 years | Drink after first cycle of cognitive battery, 45 min post three cycles of cognitive battery completed. 5-day washout in between visits. | 96.96 mL Cold pressed blackcurrant juice (BC, 500 mg polyphenols) or PL (sugar, vitamin C, flavour matched). | CogTrack system: RT, DV, CRT. Mood assessment VAS post-completion of cognitive battery, baseline, and end of each repetition of attention tests. | No change in Mood scores. Significant effect for CRT with BC (p = 0.028). No change in SRT or DV. |
Philip, et al. (2019) [40] | Double-blind, RCT, crossover Acute | 30 | Adults, 14 male, 16 female, 22 ± 1.7 years. | V1 seven days after V0, and V2 following a 7 ± 2 days washout period. Testing 90 min post drink consumption. | 600 mg (2 × 300 mg capsules) of Polyphenol-rich active extract made from grape and wild blueberry (flavan-3-ols, flavanols, anthocyanins = 43.4%) or PL (maltodextrin). | Cognitive demand battery: SSTT, SSTS, RVIP, subjective rating using VAS. | Significant effect of treatment on SSTT: total answers (p = 0.001), correct answers (p = < 0.001), errors (p = 0.041), % correct answers (p = 0.001). No significant effect for RVIP or SSTS. Self-reported cognitive performance significantly higher in PEGB (p = 0.033). |
Gibson, et al. (2020) [41] | Double-blind, RCT, crossover Chronic + Acute | 23 | Rugby league players, 28 ± 5 years. | 7-day supplementation with treatment or PL, followed by 10-day washout. | 250 mL Blackcurrant drink (BD) (Arepa–total polyphenols 1162 mg, anthocyanins 387.5 mg) or PL. Cognitive testing 90 min following ingestion and after fatiguing exercise. | Stroop, subjective mental state measured by mental toughness assessment (MTQ48). | BC - Increase in total Stroop scores (p = 0.001), accuracy (p = 0.003), and response (p = 0.043). |
Jackson, et al. (2020) [42] | Double-blind, RCT, crossover Acute | 32 | Adults, 6 male, 26 female, 22.2 ± 4.2 years. | 1 x screening and four test visits. Minimum 7 days between test visits. Treatment drink within 5 min of first CDB. Cognitive assessment conducted 60-, 180-, and 360-min post-dose. | Four treatments: Placebo, Blueberry, Apple, Coffee Berry. Each drink (295 mL) contained one of three polyphenol extracts: Blueberry (BE) (2.49 g blueberry extract, 300 mg blueberry anthocyanins), Apple (AE) (275 mg apple extract, 234 mg flavanols as epicatechin equivalents), or coffee berry (CB) (1.1 g extract, 440 mg chlorogenic acid). | COMPASS Software. Four x 10-min CDB. SSTT, SSTS, RVIP, Stroop, peg and ball, Immediate and delayed word recall, word recognition, picture recognition. Mood assessed by Bond-Lader, mental fatigue and alertness VAS (total test time 40 min per assessment). | No difference in cognitive performance after post-hoc analysis. Alertness significantly higher with AE compared to placebo (p = 0.049), as well as lower ratings of mental fatigue (p = 0.002) in AE and CB (p = 0.003). |
Alharbi, et al. (2016) [29] | Double-blind, RCT, crossover Acute | 22 | Healthy males, 51 ± 6.6 years | Screening visit and each test day separated by 2-week washout. Baseline cognitive battery (CB) followed by consumption of either FR or PL. Cognitive testing at 2 h and 6 h post drink consumption. | 240 mL flavonoid rich orange juice (FR, 272 mg flavonoids) or PL matched for volume, taste, appearance, energy, and glucose. | Cognitive battery: Immediate word recall, simple and complex finger tapping, DSST, CPT, SSTS, PANAS, contrast sensitivity, delayed word recall. Total test time: 45 min | Significant increase in simple finger tapping following FR 2 h post (p < 0.01) and 6 h post (p < 0.05). Significant drink x time observed for CPT accuracy (p < 0.05) at 6 h. Subjective alertness ratings significantly higher following FR (p = 0.05). |
Khalid, et al. (2017). [40] | Double-blind, RCT, crossover Acute | 21 | Young adults, 20.14 ± 1.01 years. | Three testing sessions separated by minimum 3-day washout period. Screening day all received placebo. Two subsequent testing either PL or WBB. Each visit, baseline mood measures conducted, and 2 h post drink consumption. | 250 mL Flavonoid-rich wild blueberry (WBB, 253 mg anthocyanins) or PL (matched for Vit C and sugars). | PANAS-NOW | Increase in positive Affect (PA) after WBB consumption (p = 0.001). |
Bowtell, et al. (2017) [43] | Double-blind, RCT, parallel groups Chronic | 26 | Adults, 13 female, 13 males, 65–69 years. | Baseline cognitive function testing, with follow up 12 weeks. | 30 mL blueberry concentrate (BBC, 387 mg anthocyanidins) or PL (synthetic apple and blackcurrant cordial) consumed once per day for 12 weeks. | CogState Ltd.: RT, Groton maze and timed chase and learning test, International shopping list task with delayed recall, 1-back, 2-back memory tasks | No difference between BBC and PL. |
Miller, et al. (2018) [44] | Double-blind, RCT, parallel groups Chronic + Acute | 37 | Adults, 13 male, 24 female, 60– 75 years | First dose of supplement taken after testing. On day 45 (visit 3), supplement consumed, and cognitive testing performed (except for CVLT-II and TMT). Day 90 (study visit 4), final supplement dose consumed, and cognitive testing completed. | 12 g lyophilized Tifblue blueberry, twice daily (24 g/day, approx. 36 mg/g total phenolics, 19.2 mg/g anthocyanins), or PL for 90 days. | TST, TMT, CVLT-II, DST, vMWM, ANT, POMS. | Decrease in task switch stimuli errors across trials with blueberry (p = 0.044).Blueberry fewer repetition errors in CVLT on visit 4 than visit 2 (p = 0.032). No difference in any other cognitive measures. |
Keane, et al. (2016) [45] | Double-blind, RCT, crossover Acute | 27 | Healthy adults, 50 ± 6 years. | Three separate visits to lab. Baseline cognitive testing then drink (BC or PL) consumed. Cognitive assessments at 1, 2, 3, and 5 h post consumption. | 60 mL dose Montmorency cherry (MC, 68 mg cyanidin-3-glucoside/L, 160.75 mean gallic acid equiv/L) concentrate or PL (fruit flavoured cordial). | COMPASS software: DVT, RVIP, Stroop x 2. VAS for alertness, fatigue, and level of difficulty. | No difference in any cognitive or mood scores. |
Igwe, et al. (2020) [46] | Double-blind, RCT, crossover Chronic | 28 | Healthy adults, (55 + years) | Baseline testing followed by 8 weeks of dink consumption, 4-week washout. Eight-week consumption of alternate beverage. Total 20 weeks. Data collection at baseline, 4 weeks, 8 weeks, 16 weeks and 20 weeks. | 200 mL Queen Garnet Plum (QGP) nectar (anthocyanin 7.4–10.6 mg C3G* equiv) or PL per day for 8 weeks, then alternate drink for 8 weeks. | Cognitive tasks: RVALT, verbal fluency task, digit-span backwards task, Stroop, counting span. | No difference from baseline or between drinks. |
Reference | Study Design | Sample Size | Population Details | Study Duration & Outcomes Measured | Intervention/Method | Outcomes | Results |
---|---|---|---|---|---|---|---|
Mehta et al. (2016) [21] | Longitudinal analysis. | 839 | Males, 65–68 years | 12 years. FFQ and lung function assessed every 3–5 years. Mean follow-up time: 7.4 y. | Self-administered FFQ. Flavonoid subclasses extracted. Intakes (mg/d) of anthocyanins, flavanones, flavan-3-ols, flavanols, flavones, and polymers. FEV1 (mL), FVC (mL). | FEV1 (mL), FVC (mL). | Higher daily anthocyanin intake (25.3 mg/d) slower rate of FEV1 decline relative to low anthocyanin intakes (1.3 mg/d). FVC had slower rate of decline (37.3 mL/y) with high anthocyanin intake (25.3 mg/d) vs. low intakes (1.3 mg/d). Blueberry intake (≥ 2 servings/week) associated with slower rate of lung function decline in FEV1 (22.5 mL/y) and FVC (37.6 mL/y). |
Vergara, et al. (2015). [49] | Exploratory, uncontrolled study. | 15 | Asymptomatic smokers, with low F&V intake (<200 g/d) and moderate cigarette smoking (8 cigarettes/day). Age 26.4 years. | 2-weeks. Expired breath condensate (EBC) collected before and after administration. | 2 g maqui extract ingested twice daily for 2 weeks. Total polyphenol content of extract: 5.18 ± 2.00 g Gallic Acid Equivalents (GAE)/100g | Hydrogen Peroxide (H2O2) and IL-6 in EBC. | Significant decrease (57.3%) of H2O2 concentration (p = 0.0002), and increase (30.8%) in IL-6 concentrations (p = 0.0032) observed in 92.8% and 80% of smokers respectively. |
Garcia-Larsen, et al. (2018). [22] | Multi-national, population-based, cross-sectional | 2599 | Adults, 15–75 years. | 2008–2009. | GA2LEN FFQ to assess dietary intakes across Europe. Six main flavonoid subclasses measured: Anthocyanins, flavanones, flavan-3-ols, flavanols, flavones, and polymers. Total flavonoid was the sum of all six subclasses. | FEV1/FVC ratio, FVC (mL). | 53% lower risk of FVC < lower limit of normal (LLN) in adults with highest anthocyanin and pro-anthocyanidins intake (p = 0.04), 42% lower risk of FVC < LLN in those in highest quintile of flavonoid intake (p = 0.07). |
Tabak, et al. (2001). [23] | Cross-sectional | 13651 | Adults, 20–59 years | 1994–1997 | Semiquantitative FFQ questionnaire. Flavonoid intake calculated using specific food composition tables. | COPD symptoms questionnaire, FEV1 | Total intake of catechins (not from tea), flavanols and flavones positively associated with FEV1, and inversely associated with COPD (adjustment for smoking reduced the observations). |
Pounis, et al. (2018). [24] | Cross-sectional | 9659, (4551 women, 5108 men) | Adults, ≥ 35 years | March 2005–April 2010 | FEV1, FVC (mL), FEV1/FVC ratio. Pulmonary symptoms determined by questionnaire at recruitment. EPIC-FFQ to determine nutritional intakes in the past year. | Total intakes: flavanols, flavones, flavanones, anthocyanidins, isoflavones, lignans, all as mg/day. Dietary index PAC score, FEV1, FVC (mL), FEV1/FVC ratio. | Increase in PAC score associated with increase in all pulmonary function parameters in women p < 0.05), and FEV1 % predicted and FVC % predicted in men (p < 0.05). |
Garcia-Larsen, et al. (2015). [50] | Cross-sectional | 1187 | Adults, 22–28 years | January 2001– April 2003 | Semi-quantitative FFQ of 65 food items. Total F&V intake, nutrient estimates, and flavonoid content of foods assessed: flavanols, flavones and catechins. | FEV1, FVC (mL), FEV1/FVC ratio | Higher FVC observed in highest vs lowest quintile of flavanol (80 mL higher), and catechin intake (70 mL). Significant association between FVC and total intake of fruits between highest and lowest quintiles (p = 0.006); catechins after adjustment (p = 0.02), but not vegetables. |
Butland, et al. (200). [25] | Cross-sectional | 2512 | Adult males, 45–49 years | 1979–1983 | Phase I data collection and self-administered semi-quantitative FFQ, as well as lung function tests. Phase II after 5 years, dietary data collected through slightly modified FFQ and respiratory function tests. | FEV1, FVC (mL) | Lung function positively associated with citrus fruit when adjusted for age and height but not after full adjustment. Lung function higher for those eating 5 or more apples a week compared to non-consumers. |
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Morton, L.; Braakhuis, A.J. The Effects of Fruit-Derived Polyphenols on Cognition and Lung Function in Healthy Adults: A Systematic Review and Meta-Analysis. Nutrients 2021, 13, 4273. https://doi.org/10.3390/nu13124273
Morton L, Braakhuis AJ. The Effects of Fruit-Derived Polyphenols on Cognition and Lung Function in Healthy Adults: A Systematic Review and Meta-Analysis. Nutrients. 2021; 13(12):4273. https://doi.org/10.3390/nu13124273
Chicago/Turabian StyleMorton, Lillian, and Andrea J. Braakhuis. 2021. "The Effects of Fruit-Derived Polyphenols on Cognition and Lung Function in Healthy Adults: A Systematic Review and Meta-Analysis" Nutrients 13, no. 12: 4273. https://doi.org/10.3390/nu13124273