Effect of increasing fruit and vegetable intake by dietary intervention on nutritional biomarkers and attitudes to dietary change: a randomised trial

Susan J Duthie, Garry G Duthie, Wendy R Russell, Janet A M Kyle, Jennie I Macdiarmid, Vanessa Rungapamestry, Sylvia Stephen, Cristina Megias-Baeza, Joanna J Kaniewska, Lindsey Shaw, Lesley Milne, David Bremner, Karen Ross, Philip Morrice, Lynn P Pirie, Graham Horgan, Charles S Bestwick, Susan J Duthie, Garry G Duthie, Wendy R Russell, Janet A M Kyle, Jennie I Macdiarmid, Vanessa Rungapamestry, Sylvia Stephen, Cristina Megias-Baeza, Joanna J Kaniewska, Lindsey Shaw, Lesley Milne, David Bremner, Karen Ross, Philip Morrice, Lynn P Pirie, Graham Horgan, Charles S Bestwick

Abstract

Purpose: Low fruit and vegetable consumption is linked with an increased risk of death from vascular disease and cancer. The benefit of eating fruits and vegetables is attributed in part to antioxidants, vitamins and phytochemicals. Whether increasing intake impacts on markers of disease remains to be established. This study investigates whether increasing daily intake of fruits, vegetables and juices from low (approx. 3 portions), to high intakes (approx. 8 portions) impacts on nutritional and clinical biomarkers. Barriers to achieving the recommended fruit and vegetable intakes are also investigated.

Method: In a randomised clinical trial, the participants [19 men and 26 women (39-58 years)] with low reported fruit, juice and vegetable intake (<3 portions/day) were randomised to consume either their usual diet or a diet supplemented with an additional 480 g of fruit and vegetables and fruit juice (300 ml) daily for 12 weeks. Nutritional biomarkers (vitamin C, carotenoids, B vitamins), antioxidant capacity and genomic stability were measured pre-intervention, at 4-, 8- and 12 weeks throughout the intervention. Samples were also taken post-intervention after a 6-week washout period. Glucose, homocysteine, lipids, blood pressure, weight and arterial stiffness were also measured. Intake of fruit, fruit juice and vegetables was reassessed 12 months after conducting the study and a questionnaire was developed to identify barriers to healthy eating.

Results: Intake increased significantly in the intervention group compared to controls, achieving 8.4 portions/day after 12 weeks. Plasma vitamin C (35%), folate (15%) and certain carotenoids [α-carotene (50%) and β-carotene (70%) and lutein/zeaxanthin (70%)] were significantly increased (P < 0.05) in the intervention group. There were no significant changes in antioxidant capacity, DNA damage and markers of vascular health. Barriers to achieving recommended intakes of fruits and vegetables measured 12 months after the intervention period were amount, inconvenience and cost.

Conclusion: While increasing fruit, juice and vegetable consumption increases circulating level of beneficial nutrients in healthy subjects, a 12-week intervention was not associated with effects on antioxidant status or lymphocyte DNA damage.

Trial registration: This trial was registered at Controlled-Trials.com; registration ISRCTN71368072.

Keywords: Attitudes; Biomarkers; Dietary change; Fruit; Human intervention; Vegetables.

Figures

Fig. 1
Fig. 1
Trial profile
Fig. 2
Fig. 2
Effect of intervention on number of portions (a) and fruit, and vegetable and juice intake (b). a Values are mean portions consumed daily ± SEM; control (open circles, n = 24) and intervention (closed circles, n = 21). b Relative fruit and vegetable, and juice intake, in each treatment group. Intake was measured before (pre-run-in), throughout the intervention (week 2 and week 12), and post-washout. ***P < 0.0001 refers to significant differences between groups
Fig. 3
Fig. 3
Plasma (a) and whole-blood (b) folate by intervention group. Results are mean ± SEM. Control (open circles,n = 21–24) and intervention (closed circles, n = 19–21). *P < 0.05, **P < 0.01 refer to significant differences between groups
Fig. 4
Fig. 4
Plasma vitamin C (a), a-carotene (b), b-carotene (c), lutein/zeaxanthin (d) and lycopene (e) by intervention group. Results are mean ± SEM. Control (open circles, n = 21–24) and intervention (closed circles, n = 19–21). *P < 0.05, **P < 0.01, ***P < 0.001 refer to significant differences between groups

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