title: Impact of the quantity and flavonoid content of fruits and vegetables on markers of intake in adults with an increased risk of cardiovascular disease: the FLAVURS trial.
abstract: OBJECTIVE
  Limited robust randomised controlled trials investigating fruit and vegetable (F&V) intake in people at risk of cardiovascular disease (CVD) exist. We aimed to design and validate a dietary strategy of increasing flavonoid-rich versus flavonoid-poor F&V consumption on nutrient biomarker profile.
  
  
  METHODS
  A parallel, randomised, controlled, dose-response dietary intervention study. Participants with a CVD relative risk of 1.5 assessed by risk scores were randomly assigned to one of the 3 groups: habitual (control, CT), high-flavonoid (HF) or low-flavonoid (LF) diets. While the CT group (n = 57) consumed their habitual diet throughout, the HF (n = 58) and LF (n = 59) groups sequentially increased their daily F&V intake by an additional 2, 4 and 6 portions for 6-week periods during the 18-week study.
  
  
  RESULTS
  Compliance to target numbers and types of F&V was broadly met and verified by dietary records, and plasma and urinary biomarkers. Mean (± SEM) number of F&V portions/day consumed by the HF and LF groups at baseline (3.8 ± 0.3 and 3.4 ± 0.3), 6 weeks (6.3 ± 0.4 and 5.8 ± 0.3), 12 weeks (7.0 ± 0.3 and 6.8 ± 0.3) and 18 weeks (7.6 ± 0.4 and 8.1 ± 0.4), respectively, was similar at baseline yet higher than the CT group (3.9 ± 0.3, 4.3 ± 0.3, 4.6 ± 0.4, 4.5 ± 0.3) (P = 0.015). There was a dose-dependent increase in dietary and urinary flavonoids in the HF group, with no change in other groups (P = 0.0001). Significantly higher dietary intakes of folate (P = 0.035), non-starch polysaccharides (P = 0.001), vitamin C (P = 0.0001) and carotenoids (P = 0.0001) were observed in both intervention groups compared with CT, which were broadly supported by nutrient biomarker analysis.
  
  
  CONCLUSIONS
  The success of improving nutrient profile by active encouragement of F&V intake in an intervention study implies the need for a more hands-on public health approach.
authors.affiliation: Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, PO Box 266, Reading, Berkshire, RG6 6AP, UK.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Chong
authors.forename: Trevor W
authors.initials: TW
authors.lastname: George
authors.forename: Dauren
authors.initials: D
authors.lastname: Alimbetov
authors.forename: Yannan
authors.initials: Y
authors.lastname: Jin
authors.forename: Michelle
authors.initials: M
authors.lastname: Weech
authors.forename: Anna L
authors.initials: AL
authors.lastname: Macready
authors.forename: Jeremy P E
authors.initials: JP
authors.lastname: Spencer
authors.forename: Orla B
authors.initials: OB
authors.lastname: Kennedy
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Minihane
authors.forename: Michael H
authors.initials: MH
authors.lastname: Gordon
authors.forename: Julie A
authors.initials: JA
authors.lastname: Lovegrove
mesh_terms: D000273:Adipose Tissue; D001205:Ascorbic Acid / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood* / Q000652:urine; D015992:Body Mass Index; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002338:Carotenoids / Q000008:administration & dosage; D004032:Diet; D015930:Diet Records; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D005247:Feeding Behavior; D005260:Female; D005419:Flavonoids / Q000008:administration & dosage* / Q000097:blood; D005492:Folic Acid / Q000008:administration & dosage; D005638:Fruit; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D008875:Middle Aged; D010349:Patient Compliance; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014675:Vegetables; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D015415:Biomarkers; D004040:Dietary Carbohydrates; D005419:Flavonoids; D018977:Micronutrients; D014815:Vitamins; D002338:Carotenoids; D005492:Folic Acid; D001205:Ascorbic Acid