M. G. Wagner1, K. Hert1, L. Myers1, J. Levine2, T. Heck1, Y. Rhee1
1Department
of Health, Nutrition, and Exercise Sciences,
North Dakota State University, Fargo, ND, 2Family Nutrition
Sciences, Concordia College, Moorhead, MN
Abstract
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Introduction: The growing prevalence of overweight and obesity among adults is concerning because
of the numerous health conditions associated with excess weight. Underlying mechanisms believed
to contribute to these detrimental health outcomes are oxidative stress and inflammation.
Fortunately, regulation of oxidative stress and inflammation is possible via antioxidants consumed
through a diet adequate in fruits and vegetables. However, adults’ consumption of fruits and
vegetables is below recommended amounts, which places them at increased risk for chronic diseases.
Purpose: This study was designed to determine the effectiveness of a community-based fruit and
vegetable education program and provision of fruits and vegetables on consumption of fruits,
vegetables, antioxidants, and changes in biomarkers of inflammation and oxidative stress among
overweight and obese adults.
Methods: Forty-seven adults (16 men/31 women; 45.9 ± 11.8 y; body mass index 32.7 ± 7.3 kg/m2)
were randomly assigned to one of three intervention groups. The control group received no
intervention; the education group attended weekly nutrition education sessions; and the fruit and
vegetable group attended weekly nutrition education sessions and received one serving of fruits and
two servings of vegetables per day for 10 weeks. Consumption of fruits, vegetables, and antioxidants
were assessed using three-day food records.
Results: Changes in consumption of fruits, vegetables, and antioxidants among participants were
associated with improvements in biomarkers of inflammation and oxidative stress in those receiving
education but not among control group participants.
Discussion: Adequate and varied consumption of fruits and vegetables is recommended to aid in the
prevention and regulation of inflammation.
Introduction
 Rates of overweight and obesity have reached
epidemic proportions in the U.S. contributing to
increased risk of chronic disease1
 An underlying mechanism believed to contribute
to these detrimental health outcomes is the
inflammatory process2
Introduction
Excess adipose tissue
Accumulation of free radicals
Secretion of proinflammatory cytokines
Chronic low-grade inflammation
Increased risk of chronic disease
Introduction
 Antioxidant systems in the body are responsible
for regulating oxidative stress and subsequent
inflammation3
 Because of their high antioxidant content,
consumption of fruits and vegetables (FV) is
widely encouraged4
 Americans, including overweight and obese
adults, consume the recommended FV servings5
Purpose
 To determine the effectiveness of a communitybased fruit and vegetable education program and
provision of FV on consumption of fruits,
vegetables, antioxidants, and changes in
biomarkers of inflammation and oxidative stress
among overweight and obese adults
Methods
 Study protocol approved by the North Dakota
State University Institutional Review Board
 Participants
 47 adults
 Inclusion
 Age over 18 years
 BMI > 25 kg/m2
 Exclusion
 History of bariatric surgery
 Current smoker
 Pregnant
Methods
 Study Duration
 Pre-testing

 Data Collection
 Demographics
2 weeks
 Intervention
 10 weeks
 Post-testing
 2 weeks
 Dietary Intake
 3-day Food Record
 Laboratory Assessments
 Fasting Blood Draw



Thiobarbituric acid reactive
substances
Tumor necrosis factor-alpha
C-reactive protein
Methods
Control
(n=8)
Education
(n=15)
FV
(n=24)
• No intervention
• Received information on fruits, vegetables,
and antioxidants
• Received same information as education group
+ FV supplementation (one serving of fruits
and two servings of vegetables daily)
Methods
 Statistical Analysis
 PASW version 18.0 (SPSS Inc., Chicago, IL)
 Alpha level < .05
 Descriptive statistics
 T tests
 Pearson correlation
 Analysis of variance
Demographics
Gender
Female
Male
Control
Education
FV
5
3
6
9
5
19
Age (y)
11.9
42.1 ± 14.2
47.7 ± 10.7
46.0 ±
BMI (kg/m2)
7.1
33.0 ± 11.1
32.5 ± 6.0
32.7 ±
Fruit Consumption
Mean servings per day
2.5
2.0
1.5
Pre
1.0
Post
0.5
0.0
Control *
Education
Intervention group
FV *
*Significant difference in mean servings consumed per day from pre-test to post-test
Vegetable Consumption
Mean servings per day
2.5
2.0
1.5
Pre
1.0
Post
0.5
0.0
Control
Education
Intervention group
FV
Beta Carotene Consumption
Amount (micrograms/day)
4000
3500
3000
2500
2000
Pre
1500
Post
1000
500
0
Control
Education
Intervention group
FV^
^Trend toward a significant difference in consumption from pre-test to post-test
Vitamin C Consumption
Amount (milligrams/day)
140
120
100
80
Pre
60
Post
40
20
0
Control
Education
Intervention group
FV
Vitamin E Consumption
Amount (milligrams/day)
6.0
5.0
4.0
3.0
Pre
Post
2.0
1.0
0.0
Control
Education
Intervention group
FV
Selenium Consumption
Amount (micrograms/day)
90.0
80.0
70.0
60.0
50.0
40.0
Pre
30.0
Post
20.0
10.0
0.0
Control
Education
Intervention group
FV
Thiobarbituric Acid Reactive
Substances
Concentration (nmol/mL)
18.0
16.0
14.0
12.0
10.0
Control
8.0
Education
FV ^
6.0
4.0
2.0
0.0
Pre
Post
Time point
^Trend toward a significant difference in consumption from pre-test to post-test
C-Reactive Protein
5.0
Concentration (mg/L)
4.5
4.0
3.5
3.0
2.5
Control
2.0
Education
FV ^
1.5
1.0
0.5
0.0
Pre
Post
Time point
^Trend toward a significant difference in consumption from pre-test to post-test
Discussion
 Supplementation was effective at increasing FV
consumption. This is the first study to examine
effects of FV supplementation on consumption
patterns of overweight and obese adults.
 Decreases in oxidative stress and inflammatory
biomarkers were greatest among participants in
the FV group, which suggests a possible benefit of
FV supplementation on decreased inflammation.3
Conclusions
 A limitation was that a convenience sample was
used, thereby limiting the generalizability of the
results.
 Efforts to increase consumption should focus on
encouraging intake of a variety of FV, particularly
those with the highest antioxidant content.
 It is also necessary to emphasize management of
overall energy intake, including decreased
consumption of high-energy, nutrient poor
foods.
References
1.
Centers for Disease Control and Prevention. Obesity and overweight. U.S.
Department of Health and Human Services. Available at:
http://www.cdc.gov/nchs/fastats/overwt.htm. Accessed November 17, 2011.
2.
Dowd JB, Zajacova A, Aiello AE. Predictors of inflammation in U.S. children
aged 3-16 years. Am J Prev Med. 2010;39(4):314-320.
3.
Jones DP, DeLong MJ. Detoxification and protective functions of nutrients.
In M. H. Stipanuk, Biochemical and Physiological Aspects of Human
Nutrition (pp. 901-916). Philadelphia, PA: W.B. Saunders Company; 2000.
4. Hansen L, Dragsted LO, Olsen A, Christensen J, Tjønneland A, Schmidt E B,
Overvad K. Fruit and vegetable intake and risk of acute coronary syndrome.
Br J Nutr. 2010;104:248-255.
5.
Andreyeva T, Long MW, Henderson KE, Grode GM. Trying to lose weight:
Diet strategies among Americans with overweight or obesity in 1996 and
2003. J Am Diet Assoc. 2010;110(4): 535-542.