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Journal of Nutrition and Health (J Nutr Health) 2017; 50(3): 203 ~ 216
http://dx.doi.org/10.4163/jnh.2017.50.3.203
pISSN 2288-3886 / eISSN 2288-3959
A Comprehensive review of raisins and raisin components and their relationship
to human health
*
Schuster, Margaret J.1 · Wang, Xinyue2 · Hawkins, Tiffany3 · Painter, James E.4†
1Food & Nutrition Department, Whidbey Health Medical Center, WA 98239, United States of America
2College of Agriculture, California State Polytechnic University, Pomona, CA 91768, United States of America
3Department of Nutrition and Exercise Physiology, University of Missouri, MO 65211, United States of America
4School of Public Health, University of Texas -Houston, TX 77030, United States of America
Introduction
Raisins (dried grapes), fall into the traditional dried fruit
category as they typically contain no added sugar.1 Raisins
constituted the largest global production of a single dried
fruit category at 1,234,000 metric tons (MT) in 2015/2016;
296,000 metric tons were produced by the United States,
constituting 25% of global production, Turkey produced
196,000 MT, and China and Iran each produced 165,000
MT.2 Raisin production is expected to be 1.25 million MT
in the 2016/17 season. In 2015 raisin supply also had the
highest global value of the traditional dried fruits (dates,
prunes, dried figs, and dried apricots) at 2,776 million
United States Dollars. Worldwide consumption of raisins in
2016/2017 is expected to be 1.23 million tons.3
Several recent papers have reviewed various nutritional
and metabolic aspects of raisins. A 2013 review article by
Anderson et al.4 found that raisins reduce glycemia,
insulinemia and CVD risk factors. The synergistic effect of
raisins and nuts on human health has also been studied.
Carughi et al.5 found numerous health benefits when
consuming both raisins and nuts together. Restani’s6 2016
review found support for “the suitability of raisins as a
source of healthy compounds for human diet”.
In 2011, Bell reviewed the effects of dietary fiber, specifically
the fiber found in raisins, on CVD risk, T2DM, cancer, non-
cancer bowel disease, and general bowel health. Bell noted that
raisins “consumed as a part of a nutrient-dense healthy diet,
helped reduce CVD risk”.7 Kundu et al. conducted a review of
the cancer chemoprevention effects of dried fruits and found
the antioxidant and anti-inflammatory effects of raisins
promising.8 This paper provides a comprehensive review of
ABSTRACT
Purpose: This literature review was performed to assess the effect of raisins on human health. Methods: A review of
Medline was conducted using the keywords:
‘
raisins, raisins and health, raisins and cardiovascular disease (CVD),
raisins and cancer, raisins and diabetes, raisins and fiber, raisins and colon health, raisins and antioxidants, raisins and
inflammation, raisins and dental caries
’
. The reference lists from previous review articles on raisins and human health and
the California Raisin Marketing Board files were reviewed for additional studies. Results: Raisins have one of the highest
polyphenolic content and antioxidant ORAC levels compared to other traditional dried fruits. Many of the polyphenols in
raisins are well assimilated and bioavailable. Raisin consumption reduces low density lipoprotein (LDL) cholesterol, blood
pressure and blood sugar, when compared to equal caloric carbohydrate snacks and is associated with a reduced risk of
CVD. The anti-inflammatory and cancer chemopreventive effects of raisins are mixed. Raisin consumption reduces intestinal
transit time and positively affects gut microbiota. Raisins produce sustained energy during long term athletic competitions
equal to traditional sports energy gels, shots and jelly beans. Raisins produce a non-cariogenic oral environment and do
not fit the American Academy of Pediatrics criteria to be considered a choking hazard. Conclusions: Based on the review
of literature, consumption of raisins provide numerous health benefits for promoting general wellness and in the prevention
of many chronic diseases including: CVD, type 2 diabetes mellitus (T2DM) gastrointestinal diseases, and dental caries.
KEY WORDS: raisins, health, diabetes, cardiovascular disease, antioxidants
Received: May 17, 2017 / Revised: May 29, 2017 / Accepted: June 1, 2017
*This work was supported by grants from the Raisin Administrative Committee.
†
To whom correspondence should be addressed.
tel: +1-217-549-3275, E-mail: jimpainterphd@gmail.com
© 2017 The Korean Nutrition Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creative-
commons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided
the original work is properly cited.
Review
204 / Raisins and their relationship to human health
raisins and human health.
Methods
A literature review was conducted in Medline using the
following descriptors: raisins, raisins and health, raisins
and CVD, raisins and cancer, raisins and diabetes, raisins
and fiber, raisins and colon health, raisins and antioxidants,
raisins and inflammation, raisins and dental caries. The
archives of the California Raisin Marketing Board were
also reviewed. References in previously published raisin
review articles were also reviewed for research on raisins.
Results & Discussion
Antioxidants in raisins
Content in whole raisins
Raisins are source of polyphenols in the diet, compounds
that act as antioxidants in the body.9,10 The polyphenolic
compounds in raisins were assessed by Karadeniz11 in
2000. Raisin samples (n = 20) included sun-dried (n = 10),
dipped (n = 5), and golden (n = 5). Polyphenolics were
separated by high-performance liquid chromatography
(HPLC), and characterized by their UVvis spectra, and
their concentrations measured. Procyanidins and flavan-3-
ols were completely degraded in all raisin samples while
flavonols remained intact. Raisins were found to be a good
dietary source of flavonol glycosides and phenolic acids.
Hydroxycinnamates (caftaric and coutaric acids) in sun-
dried, dipped, and golden raisins were partially oxidized
but were highest in golden raisins treated with sulfur
dioxide. Resveratrol was not detected in either grapes or
raisins. Yilmaz et al.12 reported the total phenolic contents
and antioxidant activities of pulp, seed and skin of 22 grape
varieties. The antioxidant activity was highest in seeds
followed by skins and pulp. Breksa13 assayed total phenolic
compounds for 16 grape varietals and found that trans-
Caftaric acid was the predominant compound in all samples.
Comparison with other fruits
Raisins compare favorably to other fruits in antioxidant
capacity. ORAC values for 12 common fruits in descending
order are: 10450, 4302, 3406, 3049, 2103, 1922, 1837, 1640,
1346, 795, 385, and 142, units per 100 g (taken from the
United States Department of Agriculture (USDA) database)
for golden raisins, strawberries, seedless raisins, apples with
skin, oranges, peaches, red grapes, grapefruit, lemons, bananas,
pineapples, and watermelon respectively.14 Fig. 1 shows the
total phenolic content of several fruits.15 Chang et al.16
reviewed the phytochemical compositions, antioxidant
efficacies, and potential health benefits of nine dried fruits. Of
these, raisins contained the highest total phenolic count
(2,414 mg AAE/100 g), followed by dried apricots,
cranberries, peaches, figs, pears, and prunes. Raisins and
dates had the highest and lowest ORAC values respectively,
(10,450 µmol TE/100 g and 2,387 µmol TE/100 g). Jeszka-
Skowron et al.17 compared antioxidant properties of goji
berries, cranberries, and raisins. Goji berries had the highest
antioxidant properties of the three, being at least 4-fold
higher than the extracts obtained from dried cranberries or
raisins. The antioxidant activity of cranberries and raisins
was not significantly different.
Activity of antioxidants
Kaliora et al.18 found that extracts of sultanas and currants
exhibited 1,1-diphenyl-2-picrylhydrazyl scavenging activity
Fig. 1.
Total polyphenols in different fruits (per serving) adapted from Karakaya et al.
15
Journal of Nutrition and Health (J Nutr Health) 2017; 50(3): 203 ~ 216 / 205
and inhibited tert-butylhydroperoxide (tBHP)-induced
antioxidant cytotoxicity, decreased LDL oxidation and
increased apoptosis. The antioxidant activity was correlated
to the polyphenolic content.18 Kelebek assessed the total
phenolic and antioxidant activity of three white (Besni
beyazi-BBR, Hatun parmagi-HPR and Sultaniye-SR) and
two red (Antep karasi-AKR and Besni karasi-BKR) Turkish
raisin varieties. Twenty-seven phenolic compounds: four
flavan-3-ols, six phenolic acids, four flavonols and 13
anthocyanins were identified and quantified. The most
abundant phenolics were: flavanol, (+)-Catechin (range,
5.63-41.9 mg/100 g), phenol acid, trans-caftaric acid (range,
2.05-11.4 mg/100 g), flavonol, quercetin-3-O-glucoside
(range, 0.28-1.28 mg/100 g), anthocyanin and malvidin-3-O-
(6-O-p-coumaroyl)-glucoside (range, 1.68-2.26 mg/100 g).
Antioxidant capacity was 40.74-077.41 mmol Trolox kg−1
as determined by ORAC assays.19
Bioavailability
Although the phenolic content and ORAC values of fruit
are important, it is equally necessary that the compounds are
absorbable and bioavailable. Williamson et al.10 reviewed the
polyphenol, phenolic acid, and tannin (PPT) composition of
raisins and predicted their likely bioavailability. Fig. 2 shows
the phenolic content of raisins from the USDA nutrient
database. Caffeoyl tartaric acid (CTA) and Quercetin 3-0-
glucuronide are both found in high amounts in raisins. They
proposed pathways of metabolism and assimilation for
Caffeoyl tartaric acid and Quercetin 3-0-glucuronide. In the
small intestine Quercetin 3-0-glucuronide is converted to
Quercetin in the brush border cells by lactase phlorizin
hydrolase, and in the colon, both Caffeoyl tartaric acid and
Quercetin 3-0-glucuronide are metabolized by gut
microflora.
Parker et al.20 compared the antioxidant capacity and
phenolic content of Thompson seedless grapes in three
forms: green grapes, sun-dried raisins and golden raisins.
The ORAC values (µmol TE/g ± SD) of: golden raisins
104.5 ± 8.7, sun-dried raisins 37.4 ± 3.7 and fresh grapes 10.8
± 0.49, were all significantly different (p < 0.0001). Fifteen
healthy human males consumed 50 g of raisins or 250 g of
grapes for 4 weeks in a cross-over design. Although there was
no significant change (p > 0.05) in total serum phenolics,
serum ORAC values increased significantly (p < 0.05) for
grapes after 2 weeks and golden raisins after 3 weeks. The
authors hypothesized that the lack of significant findings may
be the result of insufficient raisin consumption in the
typical diet to overcome postprandial oxidation effect of
high carbohydrate consumption, but raisins may have
beneficial antioxidant effects over time.
After consuming 5.5 oz of raisins per day plasma
antioxidant capacity was significantly (p < 0.05) increased
Fig. 2.
Polyphenols from raisins have similar bioavailability to those from grapes & wine. Values are mg/100 g “wet” weight.
10
Unshaded
bars indicate sun-dried raisins; light gray bars, golden raisins; dark gray bars, raisins; and black bars, green grapes.
206 / Raisins and their relationship to human health
as assessed by the FRAP assay, plasma TRAP values were
not altered in a study by Barnes et al.21 The quantity of the
bioavailable phenolic compounds in raisins has been
assessed by Kanellos et al.22 Fifteen healthy volunteers
consumed 144 g of raisins followed by blood collection at 0
and 1, 2, 3 and 4 hours post consumption. Twenty-five
phytochemicals were identified and quantified in raisins;
oleanolic acid, a triterpenoid, was found in the highest
concentration. Seventeen phytochemicals were found in
the plasma: sixteen phenolics and oleanolic acid. Thirteen
of the seventeen peaked 1 hour after raisin consumption.
Liu et al.23 recently determined the chemical identity of
bioactive constituents of raisins using bioactivity-guided
fractionation. Three novel triterpenoids, were isolated and
identified: 3β,13β-dihydroxy-12,13-dihydrooleanolic acid
(DOA), 3β,12β,13β-trihydroxy-12,13-dihydrooleanolic acid
(TOA), and 3β,13β-dihydroxy-12,13-dihydroursolic acid
(DUA).
The phenolic compounds present in high amounts in
raisins seem to have bioavailability similar to wine and
grapes according to Carughi et al.25 Blood concentration of
polyphenols after intake of 100 g of raisins, 400 g of grapes
(equivalent amount), and 300 mls of wine, as seen in Fig. 3,
is approximately the same.24,25
The majority of phenolics in raisins are preserved during
processing as seen in the preparation of raisin jam from raisins
in study by Rababah et al.26 Raisin jam was produced by
combin ing 83.6 g whole raisins with 412.8 g water and boiled
for a minimum of 30 minutes. Total phenolics for raisins and
raisin jam were 331.6 ± 12.3 and 281.2 ± 11.9 mg GAE/100 g
respectively, 85% conserved during processing, and
anthocyanins in raisins and raisin jam were 34.5 ± 1.6 and
23.5 ± 1.5 mg cya3-glu/100 g respectively, 68% conserved
during processing.26
Methods for elucidation
Zhao27 found that pH and extraction solvent affected the
phenolic content and antioxidant activity of raisin extract.
The type of solvent (methanol, ethanol, or acetone) and
solvent/water ratio affected the total phenolic content
(TPC); ethanol:water (60:40, v/v) had the highest TPC of
375 mg GAE/100 g. The higher pH5 solvent produced
more of the lower molecular weight flavonoids (catechin and
epicatechin) and phenolic acids: caftaric acid, gallic acid,
protocatechuic acid which had the greatest antioxidant
activity. The lower pH3 extract produced more of the
higher molecular weight flavonoids: rutin, resveratrol, and
kaempferol, which showed poor antioxidant activity.
Condensed tannins showed antioxidant activity in some
extracts.27 The variation seen in the reported phenolic
content and antioxidant activity of raisins may be due to the
method of extraction used.
Inflammation and Cancer chemoprevention
In vitro studies
Due to their high antioxidant content, the anti-inflammatory
and cancer chemopreventive effects of raisins have been
assessed. Kaliora et al.28 investigated the anti-inflammatory
effect of methanol extracts of four varieties of raisins: three
different varieties of currants from Greece (Vostizza,
Fig. 3.
The amount (pmol) of ferulic acids conjugates (polyphenolic metabolites) in urine after consumption of wine, grapes and rai-
sins
24,25
Journal of Nutrition and Health (J Nutr Health) 2017; 50(3): 203 ~ 216 / 207
Nemea and Messinia) and Sultanas from Crete on gastric
cancer cell lines. All four extracts of dried raisins at 500 μg
suppressed cell proliferation, the effect was significant for
Sultanas (p < 0.05) and currants from Nemea (p = 0.02).
Cretan sultanas, Nemea currants, and Messinia currants at 500
μg dried product/mL significantly increased apoptosis (p = 0.03),
(p = 0.02) and (p = 0.03), respectively. Inflammatory markers,
protein and mRNA levels of Intercellular Adhesion Molecule
1 (ICAM-1) in Tumor Necrosis Factor-alpha (TNF-α)
stimulated cells decrease significantly (p < 0.05) in all four
500 μg extracts. There was no significant (p > 0.05)
decrease in IL-8 protein levels or IL-8 mRNA.28
Kountouri et al.29 studied the effect of methanol extracts
from currants and sultanas on HT29 colon cancer cells.
Both extracts decreased cell proliferation and IL-8 levels
while NF-kappaB p65 activation was also observed.
Antioxidant and anti-inflammatory effects were dose and
time dependent. Additionally, both extracts exhibited anti-
radical activity in vitro as well as cancer preventive efficacy
on colon cancer cells. Authors hypothesized the beneficial,
anticancer effects may be due to the high content of
phenolic compounds.29
Weyant et al.30 also studied the effect of (+)-catechin on
intestinal tumor cells using an animal model. Administration
of (+)-catechin at 0.1 and 1% decreased intestinal tumor
number by 75 and 71% respectively.30 This compound
shows promise as a cancer chemopreventive agent.
Di Lorenzo et al.31 found mixed results when examining
five raisin varieties. Only the Turkish variety showed a
decrease in plasma TNF-α induced IL-8 release, which
appeared to be related to the presence of seeds in the
Turkish variety raisins which were not present in other
varieties. The authors concluded that while raisins in
general showed activity in decreasing the IL-8 and NF-κB
pathway, raisins with seeds exhibited a significant reduction
in inflammatory risk factors.31
Liu et al.23 found three novel triterpenoids, DOA, TOA,
and DUA which all exhibited anti-proliferative activity
against MCF-7/DOX cells. TOA showed the highest activity,
with a median effective concentration (EC50) value of 3.60 ±
0.55 μM, and the cytotoxic mechanisms of action was
investigated by targeting the mitochondrial and protein
tyrosine kinase signaling (Ras/Raf/ERK).
In vivo
Rankin et al.32 studied the effect of daily raisin con-
sumption on oxidative stress and inflammation. Seventeen
overweight men and women consumed 90 g of raisins or an
isocaloric placebo (264 kcal/day) for 14 days in a
randomized, crossover design while following a low-
flavonoid diet. Inflammation and oxidative stress markers
were tested pre and post intervention. Consuming raisins
moderately increased serum antioxidant capacity as shown
by ORAC values, but there was no change seen in
inflammatory markers between the intervention and the
control.32
Conversely, Puglisi et al.33 found that raisins had a
significant effect on plasma lipids and inflammatory
cytokines. Following a 2-week run-in period, 17 men and
17 postmenopausal women were randomly assigned to one
of three groups: group 1 consumed 1 cup of raisins, group
2 increased the amount of steps walked, and group 3
consumed raisins and increased amount of steps, for
6 weeks. Plasma Interleukin-8 (IL-8) and Monocyte
Chemoattractant Protein-1 (MCP-1) did not change in any
group; a trend for a decrease was seen in raisins for MCP-1
(p = 0.078). Plasma TNF-α was decreased from 3.5 ng/L to
2.1 ng/L in the raisin group (p < 0.025 for time and group ×
time effect). All subjects had a reduction in plasma ICAM-
1 (p < 0.01).33 The lack of consistent findings may be a
function of the amount of raisins or raisin extracts
administered and the varietal of raisin studied.
Fiber and Gut health
The current US recommendation for Adequate Intake of
dietary fiber is 38 g for males and 21 g for females (age ≥ 19
years) or 14 g/1,000 calories consumed,34 and the Korean
Adequate Intake for dietary fiber is 12 g/1,000 calories
consumed.35 Current average per capita consumption of
dietary fiber in Korean is 12.24 g/1,000 kcals for adults.36
2005~2006 National Health and Nutrition Examination
Survey (NHANES) data shows that average daily con-
sumption of dietary fiber in the United States is 17.6 g and
13.7 g per day for males and females (age ≥ 19 years)
respectively.37 Average daily consumption of fiber in
certain Korean population groups and for the average US
adult falls short of the recommendations.
Dried fruit and raisins are good sources of dietary fiber.
When the Association of Official Analytical Chemists
(AOAC) Analysis Method 2009.01 analytical method was
used to determine the fiber content of raisin, which
included some of the fermentable fibers, one serving of
208 / Raisins and their relationship to human health
raisins contained 10% of the FDA’s daily recommended
fiber.38 The current FDA guidelines for listing fiber on the
nutrition facts label does not include inulin and soluble
fibers, so one serving of raisins (43 g) contains 1.6 g or 6% of
Daily Value for fiber.39
In 2003 Camire and Dougherty40 assessed the dietary
fiber composition per 100 g of three types of raisins.
Soluble fiber composition was 1.42, 1.52, and 1.76,
insoluble fiber composition was 3.63, 3.85, and 3.29, and
total fiber composition was 5.05, 5.37 and 5.05, for natural
sun-dried (SDR), artificially dried (dipped), and sulfur
dioxide treated (golden) raisins g/100 g, respectively.40
Spiller et al.41 evaluated the effect of dietary fiber from
sun-dried raisins on colonic function, bile acid content, and
volatile fatty excretion in healthy adults in a crossover
design study. For nine weeks, thirteen healthy subjects
were daily fed 120 g of sun-dried raisins or 5 g of cream of
tartar, which is equal to the tartaric acid content in raisins.
Intestinal transit time was 42 hours on the baseline diet, 31
hours on cream of tartar diet, and 28 hours on the sun-dried
raisin diet (p > 0.05). Sun-dried raisins increased fecal wt.
(p < 0.05), with no change seen with the cream of tartar diet.
Total bile acid concentration decreased from 1.42 to 1.09
mg per day with sun-dried raisins (p < 0.05), while no
change was seen with cream of tartar subjects. Total short
chain fatty acid excretion measures increased from 5.6 to
7.6 g for 4 days with sun-dried raisin diet.41
Another study also by Spiller et al.42 assessed the effect
of SDR on intestinal transit time. Sixteen healthy adults
were studied in three cycles of two weeks each. Subjects
consumed 84, 126, or 168 g of SDR per day. Fecal weight
increased from 168 g +/-14 g per day without raisins at
baseline to 200 g +/-24 g per day with consumption of 168
g per day of raisins. Transit time decreased from 54 +/-6
hours without raisins to 42 +/-6 hours with consumption of
168 g of raisins.42
Although fructans are not included in the FDA definition
of fiber,43 raisins are a good source providing over 5 g of
fructans per 100 g. Fructans, not found in grapes, are
created through the drying process of producing raisins.40
Fructans have been shown to improve gut microflora by
increasing bifidobacteria and lactobacilli and possibly
decreasing CVD risk through reduction of triglyceride and
cholesterol levels.44
Mandalari et al.45 assessed the effect of SDR on in vitro
composition of gut microbiota using a full model of a
human gastrointestinal tract which included simulated
mastication and dynamic gastric, duodenal and colonic
models. They assessed bacterial counts at 0, 4, 8, and 24 hours
after the addition of either raisins or fructooligosaccharides
compared to a control. At 24 hours the beneficial lactobacilli
bacteria increased in the raisin and fructo-oligosaccharides
(FOS) conditions. Final counts of lactobacilli at 24 hours of
fermentation were 2.24 × 107 colony forming units (CFUs)
lactobacilli per ml-1 for the control, 1.51 × 108 CFUs
lactobacilli for the SDR, and 1.86 × 109 CFUs lactobacilli
for the FOS.45
Wijayabahu et al.46 conducted a raisin feeding study in 13
adult subjects. Subjects consumed one ounce of raisins,
three times a day for fourteen days; adherence to the study
protocol was high. Fecal samples were collected at the
beginning, middle and end of the study period and gut
microbiota composition was assessed. A significant
reduction in the potentially pathogenic, Klebsiella species
was observed from baseline to day fourteen. These findings
suggest that raisins may provide a potential benefit by
reducing enteric inflammation.46
Diabetes and Glycemic control
The American Diabetes Association defines diabetes/
diabetes mellitus as “a group of diseases characterized by
high blood glucose levels that result from defects in the
body's ability to produce and/or use insulin”.47 Glycemic
Index (GI) describes the effect of carbohydrate consumption
on blood glucose levels.48 Although there isn’t a standard
serving size for raisins, 2 tablespoons of raisins is one (fruit)
exchange in the diabetic exchange list. One exchange or
serving of raisins is about 15 grams of carbohydrate and
60 calories.49
Esfahani et al.48 found the glycemic index for raisins was
49 based on the glucose scale. Previous reports of glycemic
index for raisins have ranged from 49~64. This discrepancy
may be due to the populations that were studied. Jenkins et
al.50 first reported the GI of raisins to be 64 from a study
with only six subjects.50 More recently a study by Kim et
al.51 reported GI values of 49 in sedentary individuals, 49 in
individuals with prediabetes and 55 in aerobically trained
adults. Bell52 determined raisins to have a low to moderate
GI based on the studies available, which at that time it was
a reasonable assessment.52
To determine a standard GI reference for raisins, Esfahani
et al.48 conducted a partial randomized, crossover design
Journal of Nutrition and Health (J Nutr Health) 2017; 50(3): 203 ~ 216 / 209
study using standard GI methodology (ISO 26642:2010;
International Organization for Standardization). Subjects
were four males, six females with a mean age of 39 (SD 11)
years and an average BMI of 26.4 (SD 6.2) kg/m2. Blood
was drawn for each subject on four separate days over a
period of 2~8 weeks after a 10~14 hour overnight fast.
Participants were instructed to maintain stable dietary and
activity habits throughout the study. Samples were collected
via finger-stick blood at 15, 30, 45, 60, 90 and 120 min. The
glycemic index was determined to be low at 49. The low GI
may be partially explained by the fiber content and sucrose
and fructose ratio, which may enhance hepatic glucose
uptake,49 and the polyphenols, phenolic acid, tannins,
antioxidants, flavonoids, and resveratrol content of
raisins.10,53
Oettlé et al.54 compared processed snack meals and
whole-food snack meals in 10 healthy participants. The
areas under the insulin curve were 68% higher after the
candy-bar than after a raisin-peanut snack, 75% higher
after a cola drink with crisps and 52% higher after a
banana-peanut snack.54
Kanellos et al.55 analyzed the effect of raisin consumption
on fasting glucose, glycated hemoglobin (HbA1c), antioxidant
status, and blood pressure in individuals with T2DM.
Subjects were instructed to consume two fruit servings of
raisins (36 g/d) in place of a snack with similar energy
density. The comparator snack was not defined. A
significant (p < 0.05) reduction was seen in diastolic blood
pressure and an increase in total antioxidant potential in the
raisin group compared with control. No significant
differences were seen in fasting glucose or HbA1c between
the two groups.55
Bays et al.56 conducted a crossover design study of pre-
diabetics at the Louisville Metabolic and Atherosclerotic
Research Center (L-MARC) comparing the effect of raisin
snacks to equal caloric refined grain snacks three times per
day on CVD risk factors. There was a 36 mg/dL (23%)
decrease in postprandial blood glucose, 32 mg/dL (19%)
decrease in fasting glucose, and a 0.12% decrease in HbA1c
levels in the raisin group compared with the control. This
study also showed improvements in systolic blood
pressure.56 The reason for the partial incongruent findings
between Bays56 and Kanellos55 might be the specificity of
the comparator snack. Bays described the comparator
snack to be a highly-refined carbohydrate and Kanellos did
not give any description of the raisins replacement. If the
raisins were substituted for a fruit snack a significant
difference would not necessarily be expected.
The phytonutrients in raisins may protect against
developing diabetes. In a study on T2DM and glycemic
response to grapes or grape products, Zunino57 found that
grapes and products derived from grapes may protect
against inflammation related to T2DM. Resveratrol,
quercetin, catechins and anthocyanins have potential for
reducing hyperglycemia, improving pancreatic β-cell
function and protecting against β-cell loss.57
Cardiovascular disease and Raisins
According to the American Heart Association, heart
disease describes a range of conditions that affect the heart and
is often used interchangeably with the term cardiovascular
disease (CVD).58 Polyphenols in raisins appear to reduce
the absorption of cholesterol and also decrease plasma
triglyceride concentrations .9
Puglisi 200833 found that consuming 1 cup raisins/day +
increased walking produced a significant decrease in: systolic
blood pressure (p = 0.008), plasma total cholesterol by
9.4% (p < 0.005), plasma LDL cholesterol, 13.7% (p <
0.001). This decrease in LDL cholesterol was explained by
a significant (p < 0.001) increase in lipoprotein receptor
messenger RNA abundance.59
Barnes et al.21 assessed the effect of raisins on oxidized
LDL in subjects, (n = 32) that were randomly assigned into
three groups and consumed either 2, 3.5, or 5.5 ounces of
raisins per day for four weeks. Blood samples were drawn
at baseline, 2, and 4 weeks, plasma antioxidant levels and
circulating oxidized LDL levels were measured. Data were
analyzed using the Tukey all pairwise comparison and
Tukey-Kramer tests. Circulating oxidized LDL levels
decreased significantly (p < 0.05) after 4 weeks with 3.5 oz.
raisins/day and after 2 weeks with 5.5 oz. raisins/day.21
In animal model studies by Abdel-Hamid and Ayuob,60
raisins have shown a cardioprotective effect. Wister rats (n
= 40) being fed a high cholesterol diet (HCD) were
randomly divided into four groups (n = 10): control, raisin-
fed, HCD-fed and HCD +raisin fed group. At 13 weeks the
animals were sacrificed, hearts were dissected and a
histopathological examination and blood analysis was
performed. Raisin administration with HCD significantly
(p < 0.05) decreased low density lipoprotein levels from
(86.59 ± 1.2 mg/dl to 34 ± 3.8 mg/dl) compared to the HCD
alone. Blood glucose, insulin, cholesterol, and triglycerides
210 / Raisins and their relationship to human health
all decreased significantly (p < 0.05) in the raisin+HCD
compared to the HCD alone, while high density lipoprotein
levels increased (18.4 ± 2.1, to 25.9 ± 1.3 mg/dl). Positive
hist ological changes were also seen: decreased cardiomyocytes’
degeneration, cellular infiltration, hemorrhages and blood
vessels affection. Immunohistochemical findings were seen
with the HCD+raisins: reduced fibrosis by decreasing the
immunoexpression of alpha smooth muscle actin marker and
significantly increased immuno-expression of endothelial
nitric oxide synthase.60
A study by Anderson et al.61 conducted at the L-MARC
compared the effect of consuming either 90 calories of
raisins or an alternative high carbohydrate snack, three
times per day, on cardiovascular risk factors in mildly
hypercholesterolemic or hypertensive subjects. The CVD
risk factors studied were systolic blood pressure, diastolic
blood pressure and waist circumference. Of the risk factors
studied, those that changed significantly from baseline to
week 12 of the study were: systolic blood pressure [-4.8% to
-7.2% (-6.0 to -10.2 mmHg)], and diastolic pressure [-2.5%
to -6.4% (-2.4 to -5.2 mmHg)]. There was a non-significant
(p > 0.05) decrease in waist circumference of 0.4% in the raisin
group. This same study showed significant improvement in 2-
hour postprandial glucose (-13 mg/dL) and HbA1c (-0.12%) in
the raisin group. The difference in blood pressure may be
partially explained by the large difference in potassium
content between groups. Raisins and high carbohydrate
snacks contained 220 mg and 23 mg per serving
respectively.61
Bruce et al.62 assessed the effect of a high phytochemical-
rich (HPC) diet including three 42 g boxes/d of raisins
versus a refined-food diet on serum antioxidants and
lipoproteins. In a direct crossover design study, women
with hyperlipidemia (n = 12) consumed a refined diet for 4
weeks followed by the HPC diet. There was a decrease in
serum lipids in the HPC diet, total cholesterol 13% (p <
0.05) and LDL cholesterol 16% (p < 0.001).62
Energy and Exercise performance
Raisin consumption has been shown to improve athletic
performance. Sacheck et al.63 compared the effect of three
isocaloric snacks in 115 young soccer players (ages 9.01 ±
0.9) including: a raisin/nut bar, a peanut butter graham bar
or a rice cereal bar. Following a 50 minute game of
moderate to vigorous activity, the only difference subjects
reported was more feelings of fatigue was associated with
consuming the rice cereal (high sugar, low flavonoid) bar
while results for the other two bars were not significantly
different.63
Kern et al.64 compared the effect of commercial
carbohydrate supplements and raisins on cycling performance.
Forty-five minutes prior to exercise, participants (four males,
four females) were randomly given a pre-determined
amount (1 g carbohydrate per kilogram body weight) of
either sports gels or raisins. Participants then completed a
45-minute constant intensity ride followed by a 15-minute
performance ride. Researchers found no difference in
performance between sports gels and raisins and concluded
that sports gels and raisins produce equal work output.64
Endurance athletes have been known to use a wide
variety of carbohydrate supplements like gels, shots, bars
and chews. However, natural foods that are high in
carbohydrate can offer the same benefits during sports
performance as commercial carbohydrate supplements.
Rietschier et al.65 studied the effects of sun-dried raisins
and sports jelly beans as carbohydrate supplements during
10K time trials. Participants (10 male cyclists) were asked
to complete a 2-hour glycogen depletion period followed
by a 10K time trial. During the time trial, cyclists were
given 1 of 2 carbohydrate supplements (sports jelly beans
or sun-dried raisins). The results showed no significant
difference between 10K time trials for the sports jelly beans
or the sun-dried raisins.65
A third study by Too et al.66 conducted at the University
of California Davis tested the effect of sun-dried raisins vs.
sports chews in running performance. Eleven male runners
completed an 80-minute glycogen depletion, exercising
at 75% VO2max, followed by a 5K timed trial. The
participants completed the trial in all three conditions (trials
with water, raisins, and sport chews) separated by seven
days. The researchers found no significant difference
between sun-dried raisins and sports chews for the time to
complete the 5K. Times to complete the 5K were 20.6 ±
2.6, 20.7 ± 2.5 and 21.6 ± 2.7 min for raisins, chews, and
water respectively. Times were significantly shorter (p ≤
0.05) for both raisins and chews compared to the water
control.66
Nutritional analysis by Apfel et al.67 comparing raisins to
sports chews showed that carbohydrate, sugar, fiber,
protein and carbohydrate content was 96 g, 80 g, 6.4 g and
3.2 g respectively for raisins while content of the sports
chew was 96 g, 48 g, 0 g and 0 g respectively. The mineral
Journal of Nutrition and Health (J Nutr Health) 2017; 50(3): 203 ~ 216 / 211
content of the raisins was 32 mg sodium, 952 mg
potassium, 68 mg calcium, 44 mg magnesium, 136 mg
phosphorus and 8 mg folate. The sports chews contained
280 mg sodium, 80 mg potassium, and 0 mg calcium,
magnesium, phosphorus and folate. The vitamin content of
raisins was 3.2 mg vitamin C, 4.8 mg vitamin K and 16 mg
vitamin E while the sports chews were void of these
vitamins. Overall raisins provided a more nutrient dense
alternative to sports chews.67
An additional study by Byrne et al.68 supports the use of
raisins in exercise, as well as in an impaired fasting glucose
population. The researchers analyzed serum glucose and
insulin responses to three pre-exercise snacks before,
during and after exercise. Twenty men with and without
impaired fasting glucose participated in this study. The
snacks compared were a natural fruit snack of raisins, an
energy bar or a glucose solution. This study aimed to
determine if the natural snack would yield more desirable
glucose and insulin concentrations than the other snacks.
Glucose concentrations were higher in the impaired fasting
glucose group with all snacks. The energy bar snack
reduced glycemia but not insulinemia and the raisins
lowered both the postprandial glycemic and insulinemic
responses compared to the glucose solution.68
Kalman et al.69 compared the effects of isocaloric snack
of raisins versus granola bars on feelings of energy in
mothers over a 14-day study period. Moms reported a
significant increase in energy when they consumed raisins
and granola bars as snacks; when comparing the two
snacks, raisins were associated with higher energy scores
for 13 of 14 test days (p = 0.002). Neither snack showed a
change in subject weight.69
Raisins may provide a less expensive, more nutrient
dense, yet equally effective, source of energy during
endurance exercise.
Satiety
Raisins contribute to dietary nutrient density and may
increases satiety compared to other commonly consumed
snacks. Patel et al.70 measured ad libitum consumption of a
variety of snacks, in children ages 8~11 years old. After
receiving standardized breakfasts, morning snacks and
lunches, children were randomly offered one of four
snacks: raisins, grapes, potato chips or chocolate chip
cookies, and told to eat until comfortably full. Satiety
measured before and at 15, 30, and 45 min after snack
consumption showed that children consumed the least
calories from grapes and raisins and the greatest from
cookies. Snacking on grapes and raisins also led to lower
cumulative food intake (calories of all meals combined)
compared to other snacks, while grapes also lowered
appetite compared to all other snacks.70
Patel et al.71 studied the effect a pre-meal snack
containing raisins on total calorie intake in children. In
experiment 1, participants received either an ad libitum
snack (grapes, raisins, almond and nut mixture or water
control) and then were offered an ad libitum pizza meal. In
experiment 1, children consumed significantly lower
cumulative calories when consuming raisins and water
compared to grapes and nut/raisin mixture. In experiment
2, participants were offered a 150-calorie snack (grapes,
raisins, almond and raisin mixture or water control) which
was followed by an ad libitum pizza meal. In experiment 2,
children consumed lower cumulative calories after con-
suming raisins and water. The authors concluded that a pre-
meal snack of raisins reduced total calories consumed at a
meal and did not increase cumulative energy intake.71
Raisins and Dental health
Raisins have been thought to be important in the etiology
of dental caries because of high sugar content and
suspected stickiness. Yet three conditions are required to
promote dental caries: low oral pH, food sticking to teeth,
and active cariogenic bacteria in the biofilm.72 Rivero-
Cruz73 and Wu et al.74 assessed the antimicrobial agents of
Thompson's seedless raisins against select oral pathogens.
Eight compounds derived from raisins that are known to
have oral antimicrobial effect were studied in vitro to
determine their individual antimicrobial effects. They were
assessed as to their impact on Streptococcus mutans (S.
mutans) and Porphyromonas gingivalis (P. gingivalis). The
compounds oleanolic, oleanolic aldehyde, and 5-(hydroxy-
methyl)-2-furfural were active against P. gingivalis, and
those three compounds are found on the skin of grapes and
raisin; in addition to rutin which was effective against S.
mutans.73
Wu74 assessed the effects of grapes on oral health in an in
vitro and an in vivo study. In vitro grape seed extract
reduced demineralization in artificial root carie lesions. In
vivo oleanolic acid suppressed adherence of S. mutans
biofilms. In vivo raisins and raisin containing bran cereal
did not reduce plaque pH below 6.0 in 7~11 year old
212 / Raisins and their relationship to human health
subjects.
Utreja et al.75 conducted a randomized control study in
twenty 7~11 year old children studying the effects of raisin
bran flakes, commercial raisin bran cereal and experimental
raisin bran cereals. The positive control was 10% sucrose and
the negative control was 10% sorbitol. Levels of pH were
measured at 2, 5, 10, 15 and 20 min. Results of this study
found that consumption of raisins and experimental raisin
bran did not reduce pH below 6.0 over the 30-minute
testing period, while bran flakes and sugar-coated raisin
bran flakes significantly reduced the pH after ten min.75
Issa et al.76 conducted research on the enamel demineraliza-
tion properties of eight different whole and juiced fruits and
vegetables. Although the differences in demineralization were
not significant between products, raisins had the lowest amount
of demineralization of all test foods.76
Wong et al.72 conducted a review of literature on raisins
and oral health. This study found that raisin consumption
did not lower oral pH less than 5.5 and consuming raisins
suppressed S. mutans. In addition, raisins even though they
are rated by consumers as being a “sticky” food, do not
stick to teeth and are cleared from the mouth.75,77
Hindi et al.78 investigated the antimicrobial activity of
black raisins against gram positive and gram negative
bacteria and yeast. Gram positive bacteria included:
Staphylococcus aureus, Staphylococcus epidermidis, and
Streptococcus pneumoniae. Gram negative bacteria in-
cluded: Pseudomonas aeruginosa, Salmonella typhi,
Proteus mirabilis, Klebsiella pneumoniae, Enterobacter
spp., Acinetobacter, E. coli, and Serratia spp. In the study,
petri dishes were prepared for analysis of the adhesion of
bacteria on oral epithelial cells. In addition, a biofilm
formation assay was used to determine the anti-biofilm
properties of raisins. There was an inverse correlation
between raisins and gram negative bacteria. The active
components of black raisins that are effective in inhibition
of E. coli bacteria include: Catechin/ Flavonoids, Gallic
acid/ Phenolic acid, and Protocatechuic acid. Flavonoids,
also found in raisins, inhibit Bacillus, Shigella, Salmonella,
Vibrio, and E. coli species. In addition, Ferulic acid/ Phenolic
acid inhibit E. coli and Salmonella spp, Protocatechuic acid
inhibits E. coli spp.78 Although raisins show antibacterial
activities in vitro and against oral pathogens, raisins do not
exhibit anti-adherence properties against E. coli in the
urinary tract as demonstrated with other dried fruits.79
Choking hazard
Raisins have been considered a choking hazard by many
groups, including the American Academy of Pediatrics
(AAP) until their review in 201180 when they removed
raisins from the list of choking hazards. It seems odd that
raisins were ever considered a choking risk as their small
size, irregular shape and malleable texture does not match the
AAP’s statement that “choking is most commonly caused by
any solid, round, cylindrical, or conforming object that has
the same diameter as and fits easily into a child’s upper
airway”.80 In 2008 Altkorn et al.81 published data from
twenty six US and Canadian hospitals concerning
aspiration and choking. Raisins were not reported as a
cause; peanuts and hot dogs caused the highest frequency
of injury and mortality, respectively.81
Observational Data on Raisins and Human Health
Keast and colleagues,82 analyzed the NHANES 1999
~2004 adult data and found that 7% of the population
consumes dried fruit. Dried fruit consumers, defined as
consuming (1/8 cup -equivalent fruit or more per day), had
significantly higher Healthy Eating Index scores (measured
with the Healthy Eating Index-2005) than non-consumers,
with significantly (p < 0 .01) greater consumption of
dietary fiber (+6.6 g/d), vitamins A (+173 μg retinol
activity equivalent per day), E (+1.5 mg α-tocopherol per
day), C (+20 mg/d), and K (+20 mg/d), calcium (+103 mg/
d), phosphorus (+126 mg/d); magnesium (+72 mg/d), and
potassium (+432 mg/d). In addition, dried fruit consumers
ate less solid fats, alcohol, and added sugars. Dried fruit
consumers were also found to have lower BMIs and waist
circumferences.82
McGill et al.83 analyzed the 2003~2008 NHANES data
for children ages 2 to 19 years (n = 9,622) and adults 20+
years (n = 12,251) found that consumers of grape products
(grapes, raisins and grape juice) had higher Healthy Eating
Index-2005 scores and higher intake of total and whole
fruit along with lower intakes of solid fat, added sugar, and
calories compared with non-consumers. Adult consumers
of grape products consumed more total and dark green/
orange vegetables. For both adults and children, grape
product consumers consumed significantly more of the
shortfall nutrients for Americans: dietary fiber, calcium and
potassium and other key nutrients: vitamin A, C, and
magnesium.83
Raisin have been shown to be associated with improved
Journal of Nutrition and Health (J Nutr Health) 2017; 50(3): 203 ~ 216 / 213
diet quality and nutrient intake when consumed with other
grape products or dried fruits. Fulgoni et al.84 examined
raisin consumption alone in adults using data from
NHANES 2001~2012. Raisin consumers (n = 458, 60.1%
female) were defined as reporting consumption of any
amount of raisins during the first 24-hour diet recall.
Consumers compared to non-consumers had higher total
Healthy Eating Index scores (61.4 ± 1.0 vs. 49.1 ± 0.2) and
lower BMIs (27.3 ± 0.4 vs. 28.8 ± 0.1 kg/m2) and waist
circumferences (94.1 ± 0.1 vs. 97.8 ± 0.2 cm) respectively.
The nutrients of concern for under consumption were
higher in the raisin consumers vs non-consumers: dietary
fiber (22.1 ± 1 vs. 16.5 ± 0.1 g/d) and potassium (3,084 ± 77
vs. 2,665 ± 10 mg/d) respectively, calcium and vitamin D
were not significantly different. Intakes for raisin consumers
were higher than non-consumers for: vitamin C (117 ± 8 vs.
94.4 ± 1.2 mg/d), vitamin E (8.9 ± 0.5 vs. 7.3 ± 0.1 mg AT/d),
and magnesium (355 ± 11 vs. 290 ± 1 mg/d) respectively, and
lower for intakes of saturated fatty acids (21. 2 ± 0.9 vs. 25.0 ±
0.1 g/day), added sugars (14.9 ± 0.7 vs. 18.0 ± 0.2 tsp
equivalents/day), and sodium (3,190 ± 78 vs. 3,541 ± 17 mg/
day) respectively. Adult raisin consumers were 39% less
likely [odds ratio (OR): 0.61, 99th confidence interval (CI):
0.41, 0.89] to be overweight or obese.84
Raisins and Children
Raisin consumption among children (2~18 years of age)
has also been linked to health benefits.85 Fulgoni et al.
defined raisin consumers (n = 154) as those who consumed
any amount of raisins during a 24-hour period. The Healthy
Eating Index-2010 scores among consumers were higher
than non-raisin consumers (55.5 ± 1.7 vs. 45.1 ± 0.3)
respectively. The largest differences in sub-component
scores for raisin consumers as compared to non-consumers
were for calories from solid fats, added sugars, and alcohol,
(13.7 ± 0.8 vs. 10.2 ± 0.1) and whole fruit (3.8 ± 0.2 vs. 2.1 ±
0.04). Additionally, nutrients of concern for under consumption
in children: dietary fiber (16.3 ± 0.8 vs. 13.2 ± 0.1 g/d),
magnesium (255 ± 7 vs. 228 ± 1 mg/d), and potassium (2,578
± 110 vs. 2,221 ± 15 mg/d) were significantly higher in raisin
consumers compared to non-consumers respectively. Added
sugar, a nutrient of public health concern for overconsump-
tion was lower among raisin consumers compared to non-
consumers (15.7 ± 1.1 vs. 19.7 ± 0.2 tsp equivalents).85
Additionally, recent data analysis of NHANES 2001
~2012 data by Fulgoni et al.86 showed that consumption of
raisin-containing foods (RCFs) was associated with higher
nutrient intake and diet quality in children and adults. Most
notable, Healthy Eating Index-2010 diet scores were
higher in RCFs consumers vs. non-consumers (58.6 ± 0.6
vs. 54.3 ± 0.4) and (50.0 ± 0.5 vs. 45.5 ± 0.2) for adults and
children respectively. Dietary fiber and potassium were
significantly higher while saturated fat and sodium was
significantly lower for RCFs consumers, vitamin A, folate,
iron and magnesium intakes were all significantly higher
for adult consumers.86
Raisins have some of the highest polyphenolic content
and antioxidant ORAC levels compared with traditional
dried fruits and compare favorably with many other fruits
as well.11-1 7 Many of the polyphenols in raisins are well
assimilated and bioavailable.10,18-27 Raisins have sufficient
fiber to reduce transit time and positively affect gut
microbes.38-46 Raisins reduce risk factors for CVD and
T2DM, total and LDL cholesterol, blood pressure and
blood sugar compared to carbohydrate controls.9,21,33,54-62
Raisins improve athletic performance compared to a water
control and perform equal to sports energy gels, shots and
jelly beans at producing sustained energy during long term
athletic competitions.63-69 Although the effect of raisins on
inflammatory markers is mixed, the cancer chemopreven-
tive effects in vitro studies on cancer cell lines is
promising.23,28-33 Raisins produce an oral environment
that is non-cariogenic and do not fit the APP criterion for a
choking hazard.71,73-78,80
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