This document summarizes a study on the polyphenols found in apples and their potential health benefits. The study assessed public knowledge of apple polyphenols through a survey. The survey found high weekly apple consumption but low awareness of antioxidants as a key component. Analytical tests identified diverse polyphenol classes in apples, with varieties from Northeast Hungary ranking highly. The study concludes there is untapped potential for apple polyphenols to benefit public health due to diseases like obesity and diabetes, but more education is needed for people to understand these nutritional components.

1. Polyphenols in apple: the impact on prevention and public health
Sara Mirani, Zsuzsanna Halasz, University of Debrecen Faculty of Pharmacy, Hungary
Klara Toth, ELTE University Faculty of Life Sciences, Hungary
Kristof Kadar, Semmelweis Univ. School of Dentistry, Hungary
Gabor Pap, MEDIX Clinical  Academic Consulting Services, Hungary
Bela E Toth, University of Debrecen Faculty of Pharmacy, Hungary
Introduction
Polyphenols in fruits in general have been in the focus of research. Chemical
composition and antioxidant-prooxidant potential of a polyphenolicextract and
a proanthocyanidin-richfraction of apple have been identified (Mendoza AM
2016). Nutritional interventions involving polyphenolsare potentially able to
reduce the risk of certain diseases, improve health and were able to arrest or
reverse the age-related health disorders. Treatment with apple polyphenol
extracts in patients with suboptimal values of fasting plasma glucose (100 -125
mg/dL) resulted in improvement in FPG compared to baseline (-10.3%, p <
0,001) and to placebo group (Cicero 2017) and significantly improved impaired
glucose tolerance assessed by a 30-min post-75g OGTT (Shoji 2017) with no
side effects. Apple peel extracts exhibits powerful antioxidant and anti-
inflammatory action in the intestine and is associated with the regulation of
cellular signaling pathwaysand changes in microbiota composition (Denis MC et
al. 2016). Hydroxycinnamic acid derivatives prevent adipocyte differentiation
and lower lipid profile (Alam 2016). Polyphenols are potentially preventing to
develop brain disorders with their potent antioxidant defense mechanism, since
oxidative stress and mitochondrialdysfunction are the key players in triggering
neurodegeneration (Elumalai 2016). Inhibitionof various CYP, (3A, 1A2, 2C9
subfamilies) have been shown by flavonoids(Egert 2011), but also shown
enhance the therapeutic efficacy of doxorubicin(Miles 2014).
Objectives of the present study
• assess the general public knowledge about the value of bioactive
components of apples,
• identify the customer preferences and habits
• assess the potential of natural polyphenolsin apples commercially available
for public in prevention
Analaytical Lab
Survey Results
Conclusion & Significance
Impact on Public Health and Prevention
The potential health benefits due to dietary intake of polyphenolic compounds
depend on methodology of cultivation and consumptionhabits. Present
investigation demonstrated an existing preference on daily/weekly consumption
of apple within Central-Europe. Unrealized potential due to impact in public
health and prevention exists by the apple related natural bioactive compounds
in the area of most frequent chronic diseases of this populationsuch as obesity,
diabetes, cardiovascular, cancer, neurodegenerative or pulmonary disorders .
Information and Patient-education
However, the lack of public understanding and superficial knowledgeon relevant
bioactive ingredients highlighted the need for patient-education programs also
on nutritional components of polyphenols,that could enhance the
consumptionof dietary polyphenols supplements with a potential role in
prevention for public health but also considering the safety of interventions.
Analytical tests were
performed by HPLC (detection
200- 700nm; Purospher C-18
and Nucleosil C-18 columns),
detection of 2 samples each,
ultrasound homogenized and
filtrated whole apple extracts
stored for 24 hrs in water-
methanol solution at SZIE
University Hungary.
25%
35%
40%
Place/Location
Major city
Small city
Countryside
Methodology: Questionnaire designed to capture the
nutrition related user’s informationwas in use to assess
knowledge and preferences. The results of specific
information,and user preferences were stratified by user
profiles, age and health status.
The interim analysis performed on 219 responses, with a
range of 15-78 years (median 35).
Over 78% reported the importance of food and
nutritionals,and 86% of people eat fruits on this purpose.
Most responders (84%) consider the nutritional
elements are important.
30%
35%
24%
11%
Age distribution
0-25
26-40
41-55
56-70
Components of protection
Vitamins (86%) and dietary fibers
(68%) are considered the most of
important elements of fruits.
The lifestyle (48% of responders
claimed „healthy” lifestyle) does
not shift the ratings overall: only
38% marked antioxidant component
for importance.
User preferences on fruits
Assessment of preferences
performed asking to list the top 5
fruits by an open question. Apple
was listed in over 70% but similarly
also by people with good or
excellent health. (the general health
status was rated 18% -Excellent,
45%-Good , 33%-Satisfactory and
3%-Bad)
60%
65%
70%
75%
80%
85%
90%
fruits vegetables
60%
65%
70%
75%
80%
85%
90%
fruits vegetables
60%
65%
70%
75%
80%
85%
90%
fruits vegetables
8%
49%
41%
85%
71%
7%
47%
38%
86%
68%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Other
Minerals
Antioxidant
Vitamins
Dietary fibres
Referred componentsof health protection
healthy lifestylevs. all
All Healthy Life
0%
10%
20%
30%
40%
50%
60%
70%
80%
Selection of Top 5 Fruits
"Well"+"Good" All
Apple is rich in a diverse classes of polyphenols. Score of 15 commercially available
apples based on content of hydroxycinnamic acid, procyanidins dihydrochalcones
and flavonols were measured. The relative biological potential was calculated by a
composite score based on the quantity of the individual polyphenolic components.
The amount of total polyphenols of apples varies in content and composition in
different subtypes. By the scores that we applied, apples from North-East Hungary
were ranked high (among the subtypes of commercially available apples).
Periodicity of internet search on fruits over years
(blueberry, apple, orange and lemon)
Ranking the health-preserving
and protecting potential of
fruits and vegetables
Apple, lemon, orange and grapes
were listed as most important
„healthy” fruits. Garlic, carrot,
beetroot and tomato for ranked
from vegetables.
Regular users of dietary
supplements and vitamins
The 40% of people oriented in
dietary food supplements as regular
users to improve health status. They
considered blueberry, blackberry,
buckthornafter apple and lemon
for importance from fruits. No
major shift in ranking of vegetables.
Assessment on importance by
health status
Only 18% reported „Excellent” and
45% as „ Good” health. Almost no
change in scores. Less than 35% of
people said that the selection of
fruits and vegetables is „Very
important” to health status and
52% as „Somewhat important”.
Quercetin-3-xyloside
Procyanidin B1
Phloretin