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Plasma Concentrations of the Flavonoids Hesperetin, Naringenin

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Plasma Concentrations of the Flavonoids Hesperetin, Naringenin European Journal of Clinical Nutrition (2002) 56, 891–898 ß 2002 Nature Publishing Group All rights reserved 0954–3007/02 $25.00 www.nature.com/ejcn ORIGINAL COMMUNICATION Plasma concentrations of the flavonoids hesperetin, naringenin and quercetin in human subjects following their habitual diets, and diets high or low in fruit and vegetables I Erlund1*, ML Silaste2, G Alfthan1, M Rantala2, YA Kesa¨niemi2 and A Aro1 1Biomarker Laboratory, National Public Health Institute (KTL), Helsinki, Finland; and 2Department of Internal Medicine and Biocenter Oulu, University of Oulu, Oulu, Finland Objectives: To determine the fasting plasma concentrations of quercetin, hesperetin and naringenin in human subjects consuming their habitual diets, and diets either high or low in fruit and vegetables. To investigate whether plasma concentrations of flavanones can serve as biomarkers of their intake. Design: This was a cross-over, strictly controlled dietary intervention consisting of a 2 week baseline period, and two 5 week dietary periods with a 3 week wash-out period in between. The low-vegetable diet contained few fruit and vegetables and no citrus fruit. The high-vegetable diet provided various fruits and vegetables daily including on average one glass of orange juice, one-half orange and one-half mandarin. Subjects: Thirty-seven healthy females. Results: The high-vegetable diet provided 132 mg of hesperetin and 29 mg of naringenin. The low-vegetable diet contained no flavanones. The mean plasma hesperetin concentration increased from 12.2 nmol=l after the low-vegetable diet to 325 nmol=l after the high-vegetable diet. The respective increase for naringenin was from < 73.5 nmol=l for all subjects to a mean value of 112.9 nmol=l. The mean plasma quercetin concentration was 52 nmol=l after the baseline period, during which habitual diets were consumed, and it did not change significantly during the intervention. Interindividual variation in the plasma levels of hesperetin and naringenin was marked and, after the baseline and wash-out periods, and the low-vegetable diet, a majority of the samples had plasma flavanone levels below the limit of detection. After the high-vegetable diet, hesperetin and naringenin were detectable in 54 and 22% of all samples. Quercetin was detectable in nearly all samples after all study periods. Conclusion: Hesperetin, naringenin and quercetin are bioavailable from the diet, but the plasma concentrations of hesperetin and naringenin are poor biomarkers of intake. European Journal of Clinical Nutrition (2002) 56, 891 – 898. doi:10.1038/sj.ejcn.1601409 Keywords: flavonoids; hesperetin; naringenin; quercetin; human; bioavailability Introduction cular diseases and cancer. What role individual compounds Epidemiological studies suggest that a diet high in vegetables play in this protection and to what extent they account for and fruit protects against chronic diseases such as cardiovas- the decreased risk of diseases is not known. Fruit and vege- tables contain a variety of potentially beneficial nutrients such as vitamins C and E, but also many so called non- *Correspondence: I Erlund, Biomarker laboratory, National Public Health nutrients such as flavonoids. Institute (KTL), Mannerheimint. 166 F, 00300 Helsinki, Finland. Several epidemiological studies indicate an inverse asso- E-mail: iris.erlund@ktl.fi ciation between the intake of flavonols (a subgroup of Guarantors: A Aro and YA Kesa¨niemi. Contributors: MLS, MR, YAK and AA designed the dietary flavonoids) and the risk of cardiovascular disease (Hertog intervention. IE performed chromatographic and statistical analyses, et al, 1993, 1995; Knekt et al, 1996; Yochum et al, 1999). The and wrote the manuscript. MLS performed intake calculations. GA most abundant flavonol in the diet is quercetin, which and AA supervised chemical analyses and the writing of the possesses biological activities such as antioxidative (Chopra manuscript. All contributors read and commented on the manuscript. Received 19 June 2001; revised 13 December 2001; et al, 2000; Fuhrman & Aviram, 2001), anticarcinogenic accepted 14 December 2001 (Pereira et al, 1996; Caltagirone et al, 1997) and enzyme- Plasma concentrations of flavonoids I Erlund et al 892 inhibiting activities (Siess et al, 1995; Agullo et al, 1997; either low or high in fruit and vegetables. We also wanted to Conseil et al, 1998). Other flavonoid subgroups of interest study the possibility of using plasma concentrations of are for instance the flavanones. Flavanones also possess flavanones as biomarkers of their intake. The diets were promising biological properties and their dietary intake is originally designed to be high or low in folate, vitamin C, quite high in individuals consuming citrus products regu- vitamin E and carotenoids, and the biochemical effects of larly. The main dietary flavanones are hesperetin and nar- the diets are reported elsewhere (Silaste et al, 2001). ingenin, which occur almost exclusively in citrus fruits. Glycoside forms of these compounds are present in high concentrations (several hundred mg=kg) in many commonly Methods consumed citrus fruits and juices (Rouseff et al, 1987; Mouly Subjects et al, 1998). In Finland, the average intake of hesperetin has Thirty-seven healthy women working at the University Hos- been estimated to be 28.3 mg=day, and for naringenin the pital of Oulu participated in the study. They were between 22 estimate is 8.3 mg=day (Kumpulainen et al, 1999). and 57 y of age (mean 43 y) and their height and weight Some epidemiological studies have suggested a protective ranged from 155 to 172 cm (mean 163 cm) and from 51.8 to association between a high consumption of citrus and dif- 78.0 kg (mean 63.6 kg), respectively. Screening clinical chem- ferent types of cancer (De Stefani et al, 2000; Voorrips et al, istry tests, a physician’s examination and a dietician’s inter- 2000) and ischemic stroke (Joshipura et al, 1999). Experi- view were performed during the baseline period. Inclusion mental studies indicate that hesperetin and naringenin may criteria were as follows; the subject had no gastrointestinal, play a role in this protection. Feeding of orange juice, grape- renal or hepatic disease, had normal blood glucose and lipid fruit juice or pure flavanones has been shown to inhibit concentrations, had a body mass index between 20 and several types of chemically induced carcinogenesis in labora- 29 kg=m2, had no food allergies, consumed alcohol with tory animals (So et al, 1996,Tanaka et al, 1997; Yang et al, moderation, was not a current smoker, pregnant or lactating 1997). The mechanisms of action are unclear, but hesperetin and did not use dietary supplements during the 6 months and=or naringenin have been reported to inhibit estrone preceding the study. Six subjects used oral contraceptives sulfatase (Huang et al, 1997) and cytochrome P-450 isoen- and three subjects were on hormone replacement therapy. zymes (Ghosal et al, 1996), to bind to estrogen receptors Two subjects took antibiotics during the study; one subject (Kuiper et al, 1998; Hunter et al, 1999) and to sex hormone- used flucaconazol during the low-vegetable diet and one binding globulin (Dechaud et al, 1999), and to act as anti- subject took amoxicillin for 10 days during the high-vege- oxidants (van Acker et al, 2000; Fuhrman & Aviram, 2001). table diet (the last dose was taken 17 days before the end of Furthermore, flavanones have been shown to affect choles- diet 2). terol metabolism in rats (Bok et al, 1999) and in HepG2 cells The study was conducted in accordance with the Declara- (Borradaile et al, 1999), and in a recent study, ingestion of tion of Helsinki. Written informed consent was obtained orange juice increased HDL cholesterol levels in hypercho- from all participants, and the study was approved by the lesterolemic human subjects (Kurowska et al, 2000). Ethical Committee of the Faculty of Medicine, University of Flavonoids usually occur in plants as glycosides. Querce- Oulu. tin occurs in several different glycosidic forms in plants, but the flavanone glycosides are less numerous. It has been shown that quercetin is bioavailable from foods such as Study design onions, tea and apples (Hollman et al, 1997), which are its This cross-over study consisted of a 2 week baseline period main dietary sources (Hertog et al, 1995). It has also been and two 5 week intervention periods with a 3 week wash-out shown that hesperetin and naringenin are bioavailable from period in between. During the baseline and wash-out peri- citrus (Ameer et al, 1996; Erlund et al, 2001). It is evident that ods, the subjects followed their habitual diets. At the end of the bioavailability of quercetin, and most likely of other the baseline, the subjects were randomized into two groups. flavonoids as well, is greatly affected by the type and binding One group was first on the low-vegetable diet and then on site of the sugar moieties (Hollman et al, 1999). On the the high-vegetable diet, and the other group had the order of whole, few data are available concerning plasma flavonoid the two diets reversed. All food and beverages were provided concentrations in subjects following their habitual diets. by the hospital kitchen. Lunches and dinners were served at To our knowledge, no information is available about the hospital cafeteria, or the participants could take the plasma flavanone concentrations after long-term consump- packaged meals home. tion of citrus or in subjects consuming their habitual diets, and data on plasma quercetin concentrations are mainly derived from studies in which rather high amounts of Diets quercetin-rich foods were consumed. Both diets were designed on the basis of regular hospital The aim of this study was to determine the plasma con- meals. The low-vegetable diet was designed to provide 60 mg centrations of hesperetin, naringenin and quercetin in of vitamin C, 8 mg of vitamin E and 200 mg of folate per day.
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