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Systematic Review of Pears and Health
Holly Reiland, BS
Joanne Slavin, PhD, RD
Fruit consumption is universally promoted, yet consump-
tion of fruit remains low in the United States. We con-
ducted a systematic review on pear consumption and
health outcomes searching both PubMed and Agricola
from 1970 to present. The genus Pyrus L. consists of spe-
cies of pears cultivated in Europe, parts of Asia, South
America, and North America. Like most fruit, pears are
concentrated in water and sugar. Pears are high in dietary
fiber, containing 6 g per serving. Pears, similar to apples,
are concentrated in fructose, and the high fiber and fruc-
tose in pears probably explain the laxative properties. Pears
contain antioxidants and provide between 27 and 41 mg
of phenolics per 100 g. Animal studies with pears sug-
gest that pears may regulate alcohol metabolism, protect
against ulcers, and lower plasma lipids. Human feeding
studies with pears have not been conducted. In epidemi-
ological studies, pears are combined with all fresh fruits or
with apples, because they are most similar in composition.
The high content of dietary fiber in pears and their effects
on gut health set pears apart from other fruit and deserves
study. Nutr Today. 2015;50(6):301Y305
Fruit consumption is universally promoted in dietary
guidance, yet consumption of fruit remains low in
the United States.
1
Little is published on the health
outcomes associated with consumption of fruit, especially
individual fruits.
Pears are 1 of the oldest plants cultivated by man. Fresh pear
(Pyrus species) fruit is consumed throughout the world and
also commonly found in processed products such as drinks,
candy, preserved fruits, and jam.Pears have been used as a
traditional folk remedy in China for more than 2000 years
because of their reported anti-inflammatory, antihypergly-
cemic, and diuretic activities. Other traditional uses of pears
include use as remedies for alcohol hangovers, to relieve
cough, and constipation.
Pears are a member of the Rosaceae (Rose) family, and are
often called pome fruitsVa fruit with a characteristic com-
partmented core. Pears are natives of Europe and West Asia
and were introduced to North America in the 17th century.
Commercial pear production is concentrated in the
Northwest United States with 75% of the nation’s supply
coming from Washington, California, and Oregon. There
are several thousand varieties of pears in the world, but
only about 100 varieties are grown commercially. Three
basic types of pears are grown in the United States. The
European or French pears include poplar varieties such as
Bartlett, Bosc, and D’Anjou.Asian pears are alsoknown as
‘‘apple pears,’’ because of their apple-like texture. Oriental
hybrid varieties range from gritty in texture to dessert
quality.
2
The 10 main varieties grown in the United States
are Green and Red Anjou, Bartlett and Red Bartlett, Bosc,
Comice, Forelle, Seckel, Starkrimson, and Concorde.
In 2012, US per-capita consumption of fresh pears was 2.8 lb,
according to the US Department of Agriculture National
Agricultural Statistics Service. Per-capita consumption of all
pear products was about 7 lb in 2010. About 60% of the US
pear crop is sold as fresh, and 40% is processed, primarily in
the form of canned product. The United States is a net ex-
porter of pears. The largest marketforfreshpearsisMexico,
followed by Canada, Brazil, and Russia.
Bates et al
3
examined dietary patterns and gender differ-
ences in food choices in a representative sample of older
people living in Britain. Women ate more pears than did
men and also had higher intakes of vitamin C.
Locke et al
4
found that pear consumption was highest dur-
ing fall harvest. They suggest that epidemiologic investi-
gations and public health intervention that examine the
consumption of fruits, such as pears, must consider sea-
sonal variation in consumption patterns, making it difficult
to get accurate exposure data.
NUTRIENT COMPOSITION OF PEARS
Pears are a source of many nutrients, including fiber, vitamin
C, and potassium. Pears are also a source of phytochemicals,
especially antioxidants. Pears contain fructose and sorbitol,
which have been linked to issues of diarrhea in children.
5
Food and Nutrition
Volume 50, Number 6, November/December 2015 Nutrition Today
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301
Holly Reiland, BS, is a Food Science graduate at the University of Minnesota,
St Paul, and completed this review as part of an undergraduate research project.
Joanne Slavin, PhD, RD, is a professor in the Department of Food
Science and Nutrition, University of Minnesota, St Paul. She grew up on a
dairy farm in Walworth, Wisconsin,which she still owns with her 2 sisters.
She is a distinguished nutrition scientistwho is best known for her work on
dietary fiber and protein. She was a member of the 2010 Dietary Guide-
lines Committee and gave the WO Atwater lecture at Experimental Biology
2015 in Boston, Massachusetts.
The authors received a grant from USA Pears in the past. The authors
provided their own funding to allow this article to publish as Open Access.
Correspondence: Joanne Slavin, PhD, RD, Department of Food Science
and Nutrition, University of Minnesota, 1334 Eckles Ave, St Paul, MN
55108 (jslavin@umn.edu).
This is an open-access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where
it is permissible to download and share the work provided it is properly
cited. The work cannot be changed in any way or used commercially.
DOI: 10.1097/NT.0000000000000112
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
The only vitamin found in pome fruit is vitamin C, and it
is more concentrated in the skin. The vitamin C content of
pears is about 7 mg, making pears a good source of vita-
min C. Medium-sized pears are also concentrated in fiber
(6 g) and qualify as an excellent source of dietary fiber.
Like all fruits, pears are an important source of potassium
(180 mg). Like dietary fiber, potassium is a shortfall nu-
trient in the US diet.
Kevers et al
6
examined the effect of cultivar, harvest time,
storage conditions, and peeling on the antioxidant ca-
pacity and phenolic and ascorbic acid contents of pears.
Peeling led to a more than 25% decrease in total phenolic
and ascorbic acid content. Harvest time had only a limited
impact, but significant year-to-year variation was observed.
Pears are particularly rich in fructose and sorbitol, as com-
pared with other fruits. Although most fruits contain sucrose,
pears and apples contain 70% fructose, although this infor-
mation is not available in standardized nutrient databases.
1
Pears contain 4.5% fructose, 4.2% glucose, 2.5% sucrose, and
2.5% sorbitol.
7
Comparisons of apples and pears find that
pears are higher in fructose and sorbitol, whereas apples are
higher in glucose and sucrose.
8
Silva et al
9
measured the antioxidant properties and fruit
quality of pears during long-term storage. They found that
under good storage conditions the antioxidant properties
of pears can be maintained for up to 8 months.
Li et al
10
compared the contents of total phenolics, total
flavonoids,and total triterpenes between peel and flesh of
10 different pear cultivars. The monomeric compounds were
analyzed by high-performance liquid chromatography; an-
tioxidant and anti-inflammatory activities were also mea-
sured. Significant differences were found among cultivars. In
addition, all the chemical components found in the pear peel
were approximately 6 to 20 times higher than those in the
flesh of the pear. For the monomeric compounds, arbutin,
oleanolic acid, ursolic acid, chlorogenic acid, epicatechin,
and rutin were the dominant components contained in the
10 pear cultivars both in peel and in flesh.
Russell et al
11
described the phenolic acid content of fruits
consumed and produced in Scotland. Locally produced
fruits had higher content of phenolic acids. The majority
of the phenolic acids were conjugated to other plant com-
ponents, suggesting that any health benefits derived from
these compounds are likely to be after they are released or
metabolized by the colonic microbiota. Pears were excep-
tional in that they were the only fruit that were particularly
rich in methylated phenolic acids, with 70% of the phenolic
acids being dimethylated (syringic and sinapic acid) com-
pared with less than 23% for all of the other fruits analyzed.
Although it is often assumed that fruits are high in pectin
and other soluble fiber, few studies have examined the
specific fibers in fruits. Pears contain 71% insoluble fiber
and 29% soluble fiber.
1
Lignins are the noncarbohydrate
part of dietary fiber and are generally linked to wheat
bran and cereal fibers. Lignins in plants are biotransformed
into lignans, which are phytoestrogens, by the bacteria in the
gut. This type of dietary fiber also functions as an antioxidant
and has been reported to be contained in pears.
12
Li et al
13
compared the chemical composition and anti-
oxidant activities of 8 pear cultivars. Arbutin and catechin
were the dominant polyphenol compounds in the 8 pear
varieties, followed by chlorogenic acid, quercetin, and
rutin. The pears with high total phenolics and total flavo-
noids contents had significantly higher antioxidant and
anti-inflammatory abilities than did those of other species.
Anthocyanins were correlated to antioxidant capacity in
pears, whereas total triterpenoids were strongly correlated
to anti-inflammatory activity.
SYSTEMATIC REVIEW OF PEAR INTAKE
AND HEALTH OUTCOMES
We conducted a systematic review of the health outcomes
associated with pear consumption. This review was con-
ducted in September 2013 with the systematic review pro-
cess used by the Dietary Guidelines Advisory Committee.
14
An updated search was conducted in April 2014 to include
any additional studies published on health benefits of pears
since this original search. The search process and selection
criteria are similar to those described by Clark and Slavin.
15
As there were no reviews in the literature on pears and
health outcomes, we searched articles from 1970 to pres-
ent. In our initial review, we included any study that ex-
amined pears and a health outcome. We have divided these
articles into animal studies, in vitro studies, clinical studies,
and epidemiologic studies. Only studies published in En-
glish were included. For epidemiologic studies, pears were
often just included as a fruit or were grouped with apples as
a member of the Rose family or pome fruits (fruits with a
characteristic compartmented core).
IN VITRO STUDIES WITH PEARS
In vitro binding of bile acids by bananas, peaches, pine-
apple, grapes, pears, apricots, and nectarines was com-
pared.
16
Binding values were as follows: bananas > peaches =
pineapple > grapes = pears > apricots > nectarines. The
authors suggest that the variability in bile acid binding
between the fruits may be related to their phytonutrients,
antioxidants, polyphenols, flavonoids (anthocyanins, fla-
vonols, and proanthocyanidins), structure, hydrophobicity
of undigested fractions, anionic or cationic nature of the
metabolites produced during digestion, or their inter-
actions with active binding sites.
Barbosa et al
17
investigated the phenolic- compounds in
aqueous and ethanolic extracts of peel and pulp from 8 dif-
ferent freshly harvested and long-termYstored pear varieties.
Total soluble phenolics, 2-2-diphenyl-1-picrylhydrazyl radical
scavengingYbased antioxidant activity, and associated in
302 Nutrition Today
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Volume 50, Number 6, November/December 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
vitro >-glucosidase, >-amylase, and angiotensin IYconverting
inhibitory activities were analyzed. Peel extracts had higher
total soluble phenolic content and related antioxidant ca-
pacity than pulp extracts. Comice variety had the highest
total phenolic contents with positive correlation to total an-
tioxidant activity. Aqueous pulp extracts had high >-amylase
inhibitory activities with no correlation to phenolic content.
The peel ethanolic extracts had the highest >-glucosidase
inhibitory activity with positive correlation to total phenolics.
ANIMAL STUDIES WITH PEARS
The effects of bioactive compounds isolated from pears have
been studied in animal models. Hamauzu et al
18
determined
the effect of pear procyanidins on gastric lesions induced by
HCl/ethanol in rats. Highly polymerized procyanidins ex-
tracted from pear fruit, orally administered, exhibited a
high level of antiulcer capacity, whereas chlorogenic acid
along seems to have a negative effect. The authors suggest
that the antiulcer effect of pear procyanidins may be due to
their strong antioxidant activity.
Leontowicz et al
19
compared bioactive compounds in ap-
ples, peaches, and pears and their effect on lipids and anti-
oxidant capacity in rats. The content of all studied indices in
peels was significantly higher than peeled fruits (P<.05).A
good correlation between the total polyphenols and the total
radical-trapping antioxidative potential values was found in
all fruits. Diets supplemented with apples and to a lesser
extent with peaches and pears improved lipid metabolism
and increased the plasma antioxidant potential especially
in rats fed with added cholesterol.
CLINICAL STUDIES WITH PEARS
Few feeding studies have been conducted with pears in
human subjects. Alvarez-Parrilla et al
20
examined the ef-
fect of daily consumption of apple, pear, and orange juice
on plasma lipids and total plasma antioxidant capacity
(TAC) of smoking and nonsmoking adults. Subjects were
given the fruits and juice daily, and TAC and lipid profile
were measured after 26 days of consumption.
Fruit consumption increased TAC in nonsmokers, but not
in smokers. In nonsmokers, total cholesterol, high-density
lipoprotein cholesterol, and low-density lipoprotein cho-
lesterol increased significantly. In smokers, total choles-
terol and low-density lipoprotein cholesterol decreased
with fruit consumption. Thus, smoking status affected the
results; fruit consumption in nonsmokers increased TAC
and cholesterol, whereas in smokers it reduced choles-
terol without changing TAC.
Polyphenols are a diverse group of secondary plant metab-
olites. The main polyphenols are flavonoids, phenolic acids,
phenolic alcohols, stilbenes, and lignans. Flavonoids, the
largest subclass of polyphenols, are divided into 6 subclasses
according to the oxidation state of the central pyran ring: fla-
vonols, flavones, flavanones, isoflavone, anthocyanidins,
and flavanols. Stilbenes are a type of plant-derived poly-
peptides including trans resveratrol and trans piceid.
Flavonoids and stilbenes are common in the human diets,
especially found in fruits, vegetables, and nuts.
Li et al
21
assessed daily flavonoid and stilbene intakes and
evaluated these compounds’ association with cardiovas-
cular risk factors such as serum lipids and carotid intima-
media thickness in Chinese adults. In this cross-sectional
study (n = 1393), dietary flavonoid and stilbene intakes were
assessed with a quantitative food frequency questionnaire.
The relationship between flavonoids and stilbene intake and
cardiovascular risk factors was assessed using either partial
correlation coefficients or analysis of covariance.
The richest sources of flavonoids and stilbenes were the
fruit group including apple, plum, pear, and peach. Higher
dietary flavonoid intake was associated with improved lipid
profile in Chinese women, but not for Chinese men.
Women did report higher consumption of flavonoids.
The effect of adding fruit or oats to the diet of free-living
women on energy consumption and body weight was
evaluated.
22
Women with body mass index greater than
25 kg/m
2
were randomly chosen to add 3 apples, 3 pears,
or 3 oat cookies to their usual diet for 10 weeks. Energy intake
was not controlled, and the oat group consumed more calo-
ries. Apples and pears were associated with weight reduction,
whereas the weight of the oat group was unchanged. The
authors suggest that energy densities of fruits, independent of
their fiber amount, can reduce energy consumption and
body weight over time.
EPIDEMIOLOGIC STUDIES WITH PEAR
AND HEALTH OUTCOMES
Diets high in fruits are widely recommended for their health-
promoting properties. Fruits have historically held a place in
dietary guidance because of their concentrations of vitamins,
especially vitamins C and A; minerals, especially electro-
lytes; and phytochemicals, especially antioxidants. Fruits
also provide dietary fiber.
Although traditionally in nutrition we assume that health
benefits of foods are associated with food components,
vitamins, minerals, and dietary fiber, for example, more
and more evidence suggests that the health benefits of
fruits and other plant foods are attributed to the synergy
or interactions of bioactive compounds and other nutri-
ents in whole foods. These relationships are difficult to
study and provide challenges to design studies to test the
protective properties of whole foods.
Fruits contain mostly carbohydrate in the form of sugar
and dietary fiber. Generally, fruits are quite perishable and
when ripe are difficult to collect and transport. Many fruits
consumed in today’s world are processed, frozen, canned,
Volume 50, Number 6, November/December 2015 Nutrition Today
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303
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
or dried. Few studies exist on nutrient retention in fruits
with processing. Barrett and Lloyd
23
reviewed processing
methods and nutrient losses in fruits and vegetables. Most
research suggests that postharvest processing techniques
do not significantly decrease nutrients in fruits, but there
are limited studies. Also, pears are more shelf stable than
some fruits, but present challenges to get fresh pears to
consumers at the peak of ripeness.
For epidemiologic studies that use food frequency mea-
sures, pears are generally captured as total fruit, either
fresh or canned. Pears and apples are often listed together
on food frequency instruments because they are botani-
cally related and provide similar nutrient profiles. Larsson
et al
24
examined total and specific fruit and vegetable con-
sumption and risk of stroke in a Swedish cohort. They pro-
spectively followed 74 961 participants who had completed
a food frequency questionnaire in the autumn of 1997 and
were free from stroke, coronary heart disease, and cancer
at baseline. Diagnosis of stroke in the cohort during follow-up
was ascertained from the Swedish Hospital Discharge
Registry. A total of 4089 stroke cases were found during
10.2 years of follow-up. Among individual fruit and vege-
table subgroups, inverse associations with total stroke was
observed for apples/pears and green leafy vegetables. The
study found an inverse association of fruit and vegetable
consumptionwithstrokerisk.Particularly consumption of
apples and pears and green leafy vegetables was inversely
associated with stroke.
Hu et al
25
conducted a meta-analysis to summarize evi-
dence from prospective cohort studies about the associ-
ation of fruits and vegetable consumption with risk of
stroke. Twenty prospective cohort studies were included.
They reported protection with fruit and vegetable con-
sumption and suggested that citrus fruits, apples/pears,
and leafy vegetables might contribute to the protection.
Other epidemiological studies measured the relationship
between intake of major flavonoid subclasses and risk of
disease. Wedick et al
26
evaluated whether dietary intakes
of major flavonoid subclasses were associated with risk
of type 2 diabetes in US adults. Combining 3 large co-
horts, they found 12 611 cases of type 2 diabetes during
3 645 585 person-years of follow-up. Consumption of
anthocyanin-rich foods, particularly blueberries and apples/
pears, was associated with a lower risk of type 2 diabetes.
No significant associations were found for total flavonoid
intake or other flavonoid subclasses.
Mink et al
27
determined flavonoid intake and cardio-
vascular disease mortality in postmenopausal women.
Individual flavonoid-rich foods associated with signifi-
cant mortality reduction included apples or pears and
coronary heart disease and cardiovascular disease.
Muraki et al
28
determined whether fruit consumption and
risk of type 2 diabetes were linked by combining results
from 3 longitudinal cohort studies. They reported differ-
ences among the individual fruits. Greater consumption of
specific whole fruits, particularly blueberries, grapes, and
apples/pears, is significantly associated with a lower risk of
type 2 diabetes, whereas greater consumption of fruit juice
is associated with a higher risk.
Although there is much interest in the Mediterranean diet
and improved status, other dietary patterns are also being
studied for their health-promoting effects. Olsen et al
29
developed a food index based on traditional Nordic food
items with expected health-promoting effects and related
that to all-cause mortality in a cohort of Danes (n = 57 053)
aged 50 to 64 years. During 12 years of follow-up, 4126 of
the cohort died. A healthy Nordic food index, consisting
of traditional Nordic food items with expected health-
promoting effects (fish, cabbages, rye bread, oatmeal,
apples and pears, and root vegetables), was extracted and
associated with mortality by Cox proportional hazard
models. Whole-grain rye bread intake was the factor most
consistently associated with lower mortality in men. The
protective effect of the traditional pattern, which included
pears, was stronger in men than in women.
Most recent prospective cohort studies on fruits and
vegetables and cancer protection show limited associa-
tions. Results from the EPIC cohort found that intake of
apples and pears was linked to less lung cancer.
30
A
study in the National Institutes of HealthYAARP Diet and
Health Study found some protection against lung cancer
with higher consumption of fruits from the Rosaceae
group (apples, peaches, nectarines, plums, pears, and
strawberries).
31
Later publications from this group found
no associations between intake of fruits and vegetables
and total cancer incidence.
32
Thus, few studies exist on the unique health benefits of
pears. Apples and pears are generally linked together in
food frequency instruments because of their similar
composition. The protective properties of the apple-pear
intake are generally as good as total fruit and sometime
better in prospective cohort studies.
CONCLUSIONS
&Fruit consumption, including pears, is universally promoted
in dietary guidance.
&Pears are an excellent source of dietary fiber and a good
source of vitamin C. Pears, like most fruit, provide potassium to
the diet. Dietary fiber and potassium are nutrients of concern in
the US diet.
&Pears are rich in fructose and sorbitol. In combination with
dietary fiber, consumption of pears should improve gut health
and prevent constipation.
&Pears provide antioxidants and are concentrated in flavonols,
particularly anthocyanins. Intake of pears/apples in prospec-
tive cohort studies is linked to less type 2 diabetes and stroke.
&The body of evidence for a relationship between pear intake
and health outcomes is sparse and diverse. Intervention
studies with pears that show positive health outcomes, most
likely improvements in gut health, are urgently needed.
304 Nutrition Today
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Volume 50, Number 6, November/December 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
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