Nutritional and health effects of the consumption of breadfruit

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52 Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016
Nutritional and health effects of the consumption of
breadfruit
Sa’eed Halilu Bawa1,2, Marquitta Webb1
1Department of Agricultural Economics and Extension, Faculty of Food and Agriculture, The University
of the West Indies, St Augustine Campus, The Republic of Trinidad and Tobago
2Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life
Sciences, Warsaw, Poland
Corresponding author email: Sa’eed.Bawa@sta.uwi.edu
Breadfruit constitutes not only an important crop in many parts of the world, but it is also a rich source of several
nutrients. The purpose of this review paper is to demonstrate the nutritional and health benefits of the consumption of
breadfruit due to its rich nutrient profile. Breadfruit is an important energy food, because it contains starch and sugar,
which are a readily available source of energy. Depending on the degree of ripeness, breadfruit may contain ample
amount of carotenoids, the precursors to vitamin A. Both carotenoids and vitamin A play an important role in
maintaining the functions of immune system and eyesight. Breadfruit contains both soluble and insoluble dietary fiber,
which is important in the maintenance of a healthy gut. Breadfruit, particularly some unseeded varieties, can be a good
source of vitamin C, which helps not only in fighting infections by boosting the immune system, but also plays a
significant role in maintaining the integrity of bones. Depending on the variety, breadfruit seeds can be a moderate source
of protein, which is important for growth and development. Breadfruit also contains relatively high amounts of
potassium, which are necessary for nerve and muscle function as well as decreasing blood pressure. The fermented form
of breadfruit may contain probiotics, which are important in the prevention and management of both communicable and
non-communicable diseases. Further, breadfruit is believed to possess many medicinal properties; for example,
practitioners of folk medicine have used the slightly yellow leaves to brew a tea that is taken to reduce high blood
pressure. It is thought that the tea also controls diabetes. Hence, breadfruit is an excellent staple option when compared to
refined foods.
Keywords: macronutrients, minerals, vitamins, bioactive components, prebiotics, probiotics, non-communicable
diseases
Non-communicable diseases (NCDs),
especially cardiovascular diseases (CVDs),
cancer, obesity and type 2 diabetes mellitus,
currently kill more people every year than any
other cause of death. Fruit and vegetables are
an important component of a healthy diet and,
if consumed daily in sufficient amounts, could
help prevent major diseases, such as CVDs
and certain cancers. According to The World
Health Report 2002, low fruit and vegetable
intake is estimated to cause about 31% of
ischaemic heart disease and 11% of stroke
worldwide (WHO 2002).
The recent Joint FAO/WHO Expert
Consultation on diet, nutrition and the
prevention of chronic diseases, recommended
the intake of a minimum of 400 g of fruit and
vegetables per day (excluding potatoes and
other starchy tubers) for the prevention of
chronic diseases such as heart disease, cancer,
diabetes and obesity, as well as for the
prevention and alleviation of several
micronutrient deficiencies, especially in less
developed countries (WHO 2003).
The consumption of fruit and vegetables
among the people of the Pacific islands as well
as the Caribbean islands, where breadfruit is a
staple, fall far below the minimum amounts
recommended by the WHO. Therefore, the
high prevalence of NCDs in the Pacific islands
and the Caribbean islands can be attributed to
low consumption of fruit and vegetables,
probably because of abandoning traditional
diets and foods, including breadfruit.
Breadfruit is one of the low-fat, low-calorie
foods with unique nutrients and phytochemical
profiles and is particularly rich in dietary fiber,
potassium, phosphorous, magnesium, copper,

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016 53
vitamin C, thiamin, riboflavin, niacin,
pantothenic acid, B6, and folate as well as
bioactive components, such as polyphenols
and carotenoids, especially β-carotene and
lutein. A diet rich in fiber helps to control
blood sugar in diabetics, reduce unfavorable
blood lipids (a risk CVDs) and control weight.
Therefore, due to favorable nutrient profile and
the presence of bioactive components, the
daily incorporation of breadfruit to a diet may
help in improving its quality and subsequently
reduce the risk for the development of chronic
non-communicable diseases, such as obesity,
diabetes, atherosclerosis, hypertension, cancer
and neurological disorders as well as neural
tube defects.
Nutrient profile and bioactive
components of breadfruit and their
health effects
As can be noticed in Tables 1 and 3,
breadfruit is a plant characterized by low
energy density, but high nutrient density,
because it contains many essential vitamins
and minerals. These nutrients may confer a
number of health advantages, including a
decreased risk for the development of chronic
non-communicable diseases, such as obesity,
diabetes, hypertension, hypercholesterolemia,
CHD, cancers and gastrointestinal disorders.
Dietary fiber
Dietary fiber is one of the most important
bioactive components present in vegetables,
including breadfruit. A 100 g serving of raw,
unseeded breadfruit and roasted seeded
breadfruit provide more approximately 5
grams and 6 grams of dietary fiber,
respectively. This amount supplies
approximately 20% and 24%, respectively of
the U.S. Department of Agriculture's
recommended daily allowance of fiber for
healthy adult men and women consuming a
2,000-calorie diet.
Breadfruit contains both soluble and
insoluble fiber. Dietary fiber provides a
multitude of health benefits and has been
recommended by the Institute of Medicine
(IOM) and the American Heart Association
(AHA) as an essential component of a healthy
diet (King et al. 2012). The U.S. Department
of Agriculture (USDA) and other national
health agencies as well as WHO recognize the
health benefits of fiber, and provides
guidelines based on factors such as sex, age
and energy intake for daily fiber intake
(Chucktan et al. 2012). Table 2 below shows
the recommended daily intake of dietary fiber
for both genders and various age groups
Table 1: Energy content and macronutrient composition of seeded and unseeded breadfruit
[100 g serving]
Energy/nutrient
Unseeded, raw
%DV
Seeded, roasted
%DV
Kcal
103
5%
207
10%
From carbohydrates
97.5
163
From fat
1.9
22.5
From protein
3.6
21.5
Carbohydrates
Total carbohydrates
27.1g
9%
40.1
13
Dietary fibre
4.9
20%
6 g
24%
Sugars
11 g
Protein
Protein
1.1 g
2%
6.2 g
12%
Source: USDA SR-21 Nutrient Database, 2015

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
54 Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016
Table 2: Adequate dietary fiber intake by gender and age
Sex
Age (years)
Fiber Intake (total fiber)
Women
19-30
25 g/day
31-50
25 g/day
51-70
21 g/day
>70
21 g/day
Men
19-30
38 g/day
31-50
38 g/day
51-70
30 g/day
>70
30 g/day
Source: IOM, 2005
Fiber-rich diets and/or foods, such as
breadfruit are usually characterized by lower
energy density due to lower content of fat and
added sugar. High-fiber foods provide bulk,
are more satiating and have been linked to
lower body weights or decreased weight gain
(ADA 2008).
There are multiple mechanisms, whereby
fiber-rich foods, such as breadfruit, exert and
impact on satiation and satiety (Slavin and
Green 2007). Greater satiation may be a
product of the increased time required to
chew certain fiber-rich foods. Increased time
chewing promotes saliva and gastric acid
production, which requires energy and may
increase gastric distention. Some soluble or
viscous types of dietary fiber bind water,
which also may increase distention. Stomach
distension is believed to trigger afferent vagal
signals of fullness, which likely contributes to
satiation during meals and satiety in the post-
meal period.
Furthermore, certain types of dietary fiber
may slow gastric emptying and decrease the
rate of glucose absorption in the small
intestine. When glucose is released slowly,
the insulin response may also be blunted.
Slow, steady post-prandial glucose and
insulin responses are sometimes correlated
with satiation and satiety.
The short-chained fatty acids (SFCAs),
which are released after the fermentation of
soluble or viscous fiber, present among others
in breadfruit, can suppress cholesterol
synthesis by the liver and may reduce serum
levels of low-density lipoprotein cholesterol
(LDL-C) and triglycerides (Anderson et al.
1991). Soluble or viscous fibers are also
thought to exert their hypocholesterolemic
action by increasing fecal sterol excretion and
stimulating hepatic bile acid synthesis
(Marlett 2001).
Fiber-rich foods, including breadfruit, can
help reduce constipation by adding bulk to the
stool. Bulky feces move through the gut
faster, resulting in an increased stool weight
and improved regularity. The increase in
fecal bulk also “dilutes” the effect of toxic
substances in the colon. Increased bulking and
decreased transit time are considered as the
most widely known beneficial effects of
consuming fiber-rich diets and foods.
Fermentation of breadfruit has been
practised for ages in the Pacific island for
conservation purposes. Presently, we know
that the fermentation of breadfruit not only
preserves, but also increases the protein and
fat content of this vegetable. However,
fermentation has been shown to the decrease
the level of most minerals, except magnesium
(Appiah et al. 2011). Furthermore, the product
of breadfruit fermentation can be regarded as
a synbiotic as it contains both prebiotic and
probiotic, that is, soluble dietary fiber and
lactic acid bacteria.

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016 55
Breadfruit consumption and diabetes
mellitus
Traditionally, breadfruit has been used as an
alternative treatment for diabetes (Seaforth et
al. 1983). The anti-diabetic effects of
breadfruit may be due to the presence of large
amounts of dietary fiber, including soluble
dietary fiber, which retards glucose absorption
from the gastrointestinal tract.
Similar to lowering cholesterol levels,
soluble of viscous dietary fiber also decreases
the absorption of glucose and can lower the
glycemic impact of foods, thereby causing
lower rise in blood glucose levels. Unlike
foods comprising carbohydrates that are
rapidly digested and absorbed in the small
intestine, foods containing dietary fiber, such
as breadfruit, are associated with a much
slower rise in serum glucose that does not
reach as high a maximum level. Similarly, the
decline in serum glucose levels after reaching
the peak is less rapid. Reduced post-prandial
blood glucose levels are considered one of the
traditional beneficial physiological effects
related to consumption of foods that are rich in
viscous dietary fiber.
Many types of dietary fiber lower the
glycemic impact of foods, because they
substitute for high glycemic flours and sugars
in food formulations. Thus, the possible
interaction of the soluble dietary fiber fraction
of breadfruit with oral metformin is a matter of
concern because this vegetable is being widely
used by the people with diabetes mellitus as an
adjunction to the treatment of this metabolic
disorder. It is also believed that breadfruit tea,
brewed from the yellow leaves can also help in
the control of both glycemia and high blood
pressure (Seaforth et al. 1983 Ragone 1997).
Minerals in breadfruit and their role
in the prevention and management of
non-communicable diseases
Calcium, phosphorous, potassium and
magnesium are found in both seeded and
unseeded breadfruits, the seeded varieties
contain more of these minerals, with a 100g
serving providing about 9%, 18%, 31% and
16%, respectively of the daily value for
individuals on a 2000-calorie diet ( Table 3).
Calcium and phosphorous are well known for
their functions not only in maintaining bone
and teeth health, but are also critical to cell
signaling, blood clotting, muscle contraction
and nerve function. Dietary potassium intake
has been demonstrated to significantly lower
blood pressure (BP) in a dose-responsive
manner in both hypertensive and normotensive
individuals in different types of studies (Sacks
and Campos 2010; Dickinson et al. 2006).
Table 3: Mineral content of unseeded and seeded breadfruit [100 g]
Mineral
Unseeded, raw
%DV
Seeded, roasted
%DV
Calcium
17 mg
2%
86 mg
9%
Iron
0.5 mg
5%
0.9 mg
5%
Magnesium
25 mg
6%
62 mg
16%
Phosphorous
30 mg
3%
175 mg
18%
Potassium
490 mg
18%
1082 mg
31%
Sodium
2 mg
2%
28 mg
1%
Zinc
0.1 mg
1%
1 mg
7%
Copper
0.1 mg
4%
1.3 mg
66%
Manganese
0.1 mg
3%
0.2 mg
8%
Selenium
0.6 mcg
6%
-
-
Source: USDA SR-21 Nutrient Database, 2015

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
56 Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016
In hypertensive patients, the linear dose-
response relationship is a 1.0 mm Hg
reduction in systolic BP and a 0.52 mm Hg
reduction in diastolic BP per 0.6 g per day
increase in dietary potassium intake that is
independent of baseline potassium deficiency
(Appel 2010). The average reduction in BP
with 4.7 g (120 mmol) of dietary potassium
per day is 8.0/4.1 mm Hg, depending on race
and on the relative intakes of other minerals
such as sodium, magnesium, and calcium. If
the dietary sodium chloride intake is high,
there is a greater BP reduction with an
increased intake of dietary potassium. Blacks
have a greater decrease in BP than Caucasians
with an equal potassium intake (Appel 2010).
Potassium-induced reduction in BP
significantly lowers the incidence of stroke,
being a cerebrovascular accident (CVA),
coronary heart disease, myocardial infarction,
and other cardiovascular events. However,
potassium also reduces the risk of CVA
independent of BP reductions. Increasing
consumption of potassium to 4.7 g per day
predicts lower event rates for future
cardiovascular disease, with estimated
decreases of 8% to 15% in CVA and 6% to
11% in myocardial infarction (WHO 2012).
Potassium-induced reduction in BP
significantly lowers the incidence of stroke,
being a cerebrovascular accident (CVA),
coronary heart disease, myocardial infarction,
and other cardiovascular events. However,
potassium also reduces the risk of CVA
independent of BP reductions. Increasing
consumption of potassium to 4.7 g per day
predicts lower event rates for future
cardiovascular disease, with estimated
decreases of 8% to 15% in CVA and 6% to
11% in myocardial infarction (WHO 2012).
There are many mechanisms whereby
potassium protects from high BP. The
metabolism of sodium and potassium plays a
significant role in endothelium-dependent
vasodilatation (Fujiwara et al. 2000). Sodium
retention decreases the synthesis of nitric
oxide, an arteriolar vasodilator elaborated by
endothelial cells, and increases the plasma
level of asymmetric dimethyl L-arginine, an
endogenous inhibitor of nitric oxide
production (Fujiwara et al. 2000). Sodium
restriction induces the opposite effects.
A diet rich in potassium and increases in
serum potassium (even within the physiologic
range) cause endothelium-dependent
vasodilatation by hyperpolarizing the
endothelial cell through stimulation of the
sodium pump and opening of potassium
channels (Haddy et al. 2006). Endothelial
hyperpolarization is transmitted to the
vascular smooth-muscle cells, resulting in
decreased cytosolic calcium, which in turn
promotes vasodilatation. In contrast,
experimental potassium depletion inhibits
endothelium-dependent vasodilatation (Haddy
et al. 2006).
As mentioned earlier, seeded breadfruit is
a good source of magnesium with a 100 g
serving providing 62 mg. Magnesium is an
essential mineral critical for many metabolic
functions in the body. Magnesium is primarily
found in many unprocessed foods, such as
whole grains, green leafy vegetables and
some fruit varieties, including breadfruit as
well as legumes and nuts (Vaquero 2002).
The Recommended Dietary Allowances
(RDA) for magnesium is 420 mg per day for
adult men and 320 mg per day for women.
Magnesium requirement increases during
pregnancy and lactation.

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016 57
Table 4: Magnesium requirement
RDA
Life stage
Age
Males (mg/d)
Females (mg/d)
Children
1-3 years
80
80
Children
4-8 years
130
130
Children
9-13 years
240
240
Adolescent
14-18 years
410
380
Adult
19-30 years
400
310
Adult
31-50 years
420
320
Adult
>51years
420
350
Pregnant
19-30 years
-
350
Pregnant
31-50 years
-
360
Lactating
19-30 years
-
310
Lactating
31-50 years
-
320
IOM, 2005
Suboptimal intake of dietary magnesium has
long been observed in the general population
of both developing and industrialized
countries (Ford and Mokdad 2003). Because
magnesium content is low in diets high in
meats and dairy products and tends to be lost
substantially during the refining and
processing of foods, the adoption of a
“Western diet” characterized by low
consumption of fruit and vegetables,
including breadfruit, but by high intakes of
red meat, dairy products and other highly
refined or prepared foods, is believed to
contribute to the decline in magnesium intake
during the 20th and 21st centuries.
Magnesium is a cofactor for hundreds of
enzymes, particularly for those cellular reactions
involved in the transfer, storage, and utilization
of energy. Low intakes of magnesium as well as
abnormalities in intracellular magnesium
homeostasis have been linked to the increase risk
for the development of insulin resistance, type 2
diabetes mellitus, hypertension and CVD
(Shechter 2010). The beneficial effects of
magnesium intake may be explained by several
mechanisms, including improvement of glucose
and insulin homeostasis, lipid metabolism,
vascular or myocardial contractility,
endothelium-dependent vasodilation,
antiarrhythmic effects, and anti-coagulant or
antiplatelet effects, which are partly presently in
Figure 1 below (Khan et al. 2010).
Breadfruit, as a good source of
magnesium can be incorporated in the diet of
patients with hypertension, since mineral has
been shown to be very effective in reducing
blood pressure (BP). One of the mechanisms
by which magnesium lowers BP is by acting
like a natural calcium channel blocker.
Magnesium competes with sodium for
binding sites on vascular smooth muscle cells,
increases prostaglandin E1 (PGE1), binds to
potassium in a cooperative manner, induces
endothelial-dependent vasodilation, improves
endothelial dysfunction in hypertensive and
diabetic patients, decreases intracellular
calcium and sodium, and reduces BP
(Barbagallo et al. 2010). Magnesium is more
effective in reducing BP when administered
as multiple minerals in a natural form and as a
combination with magnesium, potassium, and
calcium than when given alone (Preuss 1997).
Magnesium is also an essential cofactor for
the delta-6-desaturase enzyme, which is the
rate-limiting step for the conversion of linoleic
acid (LA) to gamma-LA (GLA) (Das 2006).
GLA, in turn, elongates to form DGLA
(dihomo-gamma-lineleic acid), the precursor for
PGE1, is both a vasodilator and platelet
inhibitor (Das 2006). Low magnesium states
lead to insufficient amounts of PGE1, causing
vasoconstriction and increased BP (Das 2006).

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
58 Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016
Figure 1: Mechanisms of the role of magnesium and calcium in development of hypertension,
diabetes mellitus and atherosclerosis
Copper (Cu)
Seeded breadfruit is an excellent dietary
source copper (Cu), with just a 100 g serving
providing 1.3 mg, which is approximately
66% of the daily requirement for this
essential microelement. Cu is an essential
trace element for both humans and animals
and is a critical functional component of
several essential enzymes known as
cuproenzymes (Prohaska 2011). Some of the
physiologic functions known to be copper-
dependent as well as consequences of copper
deficiency are presented in Table 5.
Copper plays an important role in the
development and maintenance of immune
system function, which exact mechanism
awaits elucidation. Marginal copper
imbalance has been linked to impaired
immune function, bone demineralization, and
increased risk of cardiovascular and
neurodegenerative diseases.
Neutropenia (abnormally low number of
white blood cells known as neutrophils) is a
clinical sign of copper deficiency in the
human organism. Adverse effects of copper
deficiency on immune function are most
pronounced in infants. Infants with Menkes
disease (a genetic disorder that results in
severe copper deficiency), which causes
severe copper deficiency, suffer from
frequent and severe infections (Percival
1998). For this reason, it seems prudent to
incorporate breadfruit, especially the seeded
varieties into the diet of patients with
Menkes disease as well as individuals with
high risk for the development of copper
deficiency.
Mg
Ca
Heart
Vascular
smooth muscle
Endothelium
Platelet
Skeletal muscle
adipose tissue
Left ventricular
hypertrophy
Vasoconstriction
Endothelial
dysfunction
Aggregability
thromboxane
PDGF
Insulin
resistance
Hypertension
Atherosclerosis
Diabetes mellitus

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016 59
Table 5: Copper-binding proteins and their functions
Enzyme/protein
Function
Consequence of Cu deficiency
Cu/Zn superoxide
dismutase
Superoxide radical scavenging,
signaling
Oxidative stress and its implications,
hepatocellular carcinoma, neurodegeneration
Cytochrome oxidase
Mitochondrial oxidative
phosphorylation, ATP production
Respiratory deficiency, cardiomyopathy,
lethality
Tyrosinase/laccase
Melanin synthesis, virulence and
pathogenicity in fungi, innate
immunity
Pigmentation defects/albinism, reduced fungal
virulence
Peptidylglycine α-imidating
monooxygenase
Peptide imidation/maturation
Heart rate defects, endocrine dysfunction,
lethality
Dopamine β-hydroxylase
Norepinephrine synthesis
Hypoglycemia, hypotension
Ceruloplasmin
Ferroxidase, Fe loading onto
transferrin
Aceruloplasminemia, progressive anemia,
neurodegeneration, diabetes
Hephaestin
Ferroxidase for ferroportin-
mediated iron efflux
Anemia, impaired Fe absorption by peripheral
tissues
Lysyl oxidase
Covalent crosslinking of collagen
and elastin
Aortic aneurisms, cardiovascular dysfunction
Lysyl oxidase-like protein
Oxidation of snail transcription
factor resulting in E-cadherin
silencing and promoting EMT
Altered cell-cell contacts
Coagulation factors V and
VIII
Blood clotting
Hemophilia
Nitrous oxide reductase
Catalyzes reduction of N2O to N2
in denitrification pathway of
bacteria
Respiratory deficiency, imbalance in nitrogen
cycle
Ethylene receptor
Ethylene signal transduction
Plant senescence, fruit ripening, growth
XIAP
Inhibitor of apoptosis
Copper deficiency in mouse knock-out
Acel
S. cerevisiae transcription factor
active under conditions of high
intracellular copper
Inability to grow
Copper amine oxidase
Deamination of primary amines
to aldehydes
Impaired immune response (in AOC3 knock-
out mouse), reduced fat deposition in obese
mice
Source: Michelle and Dennis (2009) and Prohaska (2011)
Cu may confer protection against osteoporosis
– a non-communicable chronic disease of the
bones affecting 200 million women
worldwide (Kanis 2007). Lifestyle factors,
including deficiencies of both macro- and
micronutrients have been shown to increase
the risk for the development of osteoporosis.
Copper-containing enzyme lysyl oxidase
is required for the development (cross-
linking) of collagen, which is a key element in
the organic matrix of bone. Osteoporosis
occurs in children and adults with severe
copper deficiency, but it is not clear whether
copper deficiency contributes to the
manifestation and development of the disease
(Marquardt et al. 2012). Serum levels of
copper in elderly patients with hip fractures
were found to be significantly lower than
these of controls (Conlan et al. 1990). Studies
in healthy adult men and women showed that
copper supplements significantly increased
bone density (Baker et al. 1999).

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
60 Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016
Most important vitamins in breadfruit
Table 6: Vitamin content of unseeded and seeded breadfruit [100 g]
Vitamin
Unseeded, raw
%DV
Seeded, roasted
%DV
Vitamin A
0.0 IU
0%
294 IU
6%
Vitamin C
29 mg
48%
7.6 mg
13%
Vitamin E (α-tocopherol)
0.1 mg
1%
-
-
Vitamin K
0.5 mcg
1%
-
-
Thiamin
0.1 mg
7%
0.4 mg
27%
Riboflavin
Small amount
2%
0.2 mg
15%
Niacin
0.9 mg
4%
7.4 mg
37%
Vitamin B6
0.1 mg
5%
0.4 mg
21%
Folate
14 mcg
3%
59 mcg
15%
Pantothenic acid
0.5 mg
10%
1 mg
20%
Choline
9.8 mg
-
Source: USDA SR-21 Nutrient Database, 2015
Vitamin C
100 g serving of raw unseeded breadfruit and
roasted seeded breadfruit provides 29 mg and
7.6 mg of this vitamin, respectively, which
covers 48% and 13% daily recommended
intake of this nutrient for individuals on a
2000-calorie diet.
Vitamin C plays significant functions in
the human body, though its function at the
cellular level is not very clear. Vitamin C is
needed for collagen synthesis, the protein that
serves so many connective functions in the
body. Among the body’s collagen-containing
materials and structures are the framework of
bone, gums and binding materials in skin
muscle or scar tissue. Production of certain
hormones and of neurotransmitters and the
metabolism of some amino acids and vitamins
require vitamin C. This vitamin also helps the
liver in the detoxification of toxic substances
in the system, and the blood in fighting
infections. Ascorbic acid is important in the
proper function of the immune system. As an
antioxidant, it reacts with compounds like
histamines and peroxides to reduce
inflammatory symptoms. Its antioxidant
property is associated with the reduction of
cancer incidences (Arrigoni and De Tullio
2002).
Claims for a positive link between vitamin
C intake and health status are frequently
made, but results from intervention studies are
inconsistent. Low plasma levels of vitamin C
have been reported in patients with diabetes
(Afkhami-Ardekani and Shojaoddiny-
Ardekani 2007), but the relative contribution
of diet and stress to these situations is
uncertain. Epidemiological studies indicate
that diets with high vitamin C content, such as
breadfruit have been associated with lower
cancer risk, especially for cancers of the oral
cavity, oesophagus, stomach, colon, and lung.
However, there appears to be no effect of
consumption of vitamin C supplements on the
development of colorectal adenoma and
stomach cancer, and data on the effect of
vitamin C supplementation on coronary heart
disease and cataract development are
conflicting (Li and Schellhorn 2007).
Currently there is no consistent evidence from
population studies that heart disease, cancers
or cataract development are specifically
associated with vitamin C status. This of
course does not preclude the possibility that
other components in vitamin C-rich fruits and
vegetables, such as phytochemicals provide
health benefits, but it is not yet possible to

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016 61
isolate such effects from other factors such as
lifestyle patterns of people who have a high
vitamin C intake.
Thiamin (vitamin B1)
Thiamin (or thiamine) is one of the water-
soluble B vitamins commonly known as
vitamin B1. Thiamin is naturally present in
some foods, added to some food products, and
available as a dietary supplement. Seeded
breadfruit can be considered as a good source
of thiamine, because a 100 g serving of this
vegetable provides 0.4 mg, which is 27% of
recommended daily intake for this vitamin for
individuals on a 2000-calorie diet.
Thiamin pyrophosphate (TPP), the active
form of thiamin, is involved in several
enzyme functions associated with the
metabolism of carbohydrates, branched-chain
amino acids, and fatty acids and, therefore, in
the growth, development, and function of
cells (Said 2010).
Adequate intakes of vitamin B1 may
reduce the risk for the development of
cataract and diabetes complications as well as
in the management of Alzheimer’s disease
(AD), congestive failure and cancer. For
example, a cross-sectional study carried out in
Australian men and women aged 49 years
found that those in the highest quintile of
thiamin intake were 40% less likely to have
nuclear cataracts than those in the lowest
quintile (Cumming et al. 2000).
Low plasma concentrations and high renal
clearance of thiamin have been observed in
diabetic patients compared to healthy subjects
(Thornalley et al. 2007), suggesting that
individuals with type 1 or type 2 diabetes
mellitus are at increased risk for thiamin
deficiency. Two thiamin transporters, thiamin
transporter-1 (THTR-1) and THTR-2, are
involved in thiamin uptake by enterocytes in
the small intestine and re-uptake in the
proximal tubules of the kidneys.
Some elderly people are at increased risk
for developing subclinical thiamin deficiency
secondary to poor dietary intake, reduced
gastrointestinal absorption, and multiple
medical conditions (Ito et al. 2012). Since
thiamin deficiency can result in a form of
dementia called Wernicke-Korsakoff
syndrome, its relationship to AD and other
forms of dementia have been investigated.
AD is characterized by a decline in cognitive
function in elderly people, accompanied by
pathologic features that include β-amyloid
plaque deposition and tangles formed by
phosphorylated Tau protein (Prvulovic and
Hampel 2011).
Thiamin deficiency has been linked to
increased β-amyloid production in cultured
neuronal cells and to plaque formation in
animal models (Zhang et al. 2011). These
pathological hallmarks of AD could be
reversed by thiamin supplementation,
suggesting that thiamin could be protective in
AD.
Thiamin deficiency has been observed in
some cancer patients with rapidly growing
tumors. Research in cell culture and animal
models indicates that rapidly dividing cancer
cells have a high requirement for thiamin
(Comin-Anduix et al. 2001). All rapidly
dividing cells require nucleic acids at an
increased rate, and some cancer cells appear
to rely heavily on the TPP-dependent enzyme,
transketolase, to provide the ribose-5-
phosphate necessary for nucleic acid
synthesis.
Riboflavin (vitamin B2)
Riboflavin is naturally present in some foods,
added to some food products, and available as
a dietary supplement. Unseeded breadfruit
contains negligible amount of vitamin B2, but
100 g serving of roasted seeded breadfruit
supplies 0.2 mg of this vitamin, which is 15%
of the daily recommended intake for
individuals on a 2000-calorie diet.
Riboflavin is an essential component of
two major coenzymes, flavin mononucleotide
(FMN; also known as riboflavin-5'-

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
62 Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016
phosphate) and flavin adenine dinucleotide
(FAD). These coenzymes play major roles in
energy production, cellular function, growth,
and development as well as in the metabolism
of fat, drugs, and steroids (Said and Ross
2014). The conversion of the amino acid
tryptophan to niacin requires FAD (Said and
Ross 2014). Similarly, the conversion of
vitamin B6 to the coenzyme pyridoxal 5'-
phosphate needs FMN. In addition, riboflavin
helps maintain normal levels of
homocysteine, an amino acid in the blood
(Said and Ross 2014).
Riboflavin possesses antioxidant functions
because of its activity in activating
glutathione reductase (GR). GR is an FAD-
dependent enzyme that participates in the
redox cycle of glutathione. The glutathione
redox cycle plays a major role in protecting
organisms from reactive oxygen species, such
as hydroperoxides. GR requires FAD to
regenerate two molecules of reduced
glutathione from oxidized glutathione.
Riboflavin deficiency has been associated
with increased oxidative stress (Powers
1999).
Several studies have indicated the
potentials of riboflavin in the prevention of
cataracts, cardiovascular disease and cancer.
A case-control study found significantly
decreased risk of age-related cataract (33% to
51%) in men and women in the highest
quintile of dietary riboflavin intake (median
of 1.6 to 2.2 mg/day) compared to those in the
lowest quintile (median of 0.08 mg/day in
both men and women) (Mares-Perlman et al.
1995). Because of its role in decreasing the
concentration of homocysteine, riboflavin can
play a role in the prevention of CVD. For
many years, elevated homocysteine levels in
plasma have been considered to be a risk
factor for CVD, although this has recently
become somewhat controversial (McNulty et
al. 2012). Plasma homocysteine is responsive
to the lowering effects of interventions with
folate and metabolically related B vitamins,
including riboflavin. Riboflavin acts as a
cofactor for methylenetetrahydrofolate
reductase (MTHFR) and is therefore needed
to generate 5-methyltetrahydrofolate required
in the remethylation of homocysteine to
methionine. These B vitamins, however, may
have roles in the prevention of CVD that are
independent of their effects on homocysteine.
As mentioned above, riboflavin intake is
one of the determinants of homocysteine
concentration. This suggests that riboflavin
status can influence MTHFR activity and the
metabolism of folate, thereby potentially
affecting cancer risk (Wen et al. 2013). MTHFR
converts 5,10-methylenetetrahydrofolate to 5-
methyltetrahydrofolate, which is necessary for
the re-methylation of homocysteine to
methionine. The conversion of homocysteine to
methionine is of importance for homocysteine
detoxification and for the production of S-
adenosylmethionine (SAM), the methyl donor
for the methylation of DNA and histones.
Aberrant methylation changes are known
to alter the structure and function of DNA and
histones during cancer development
(McGlynn et al. 2013). Since MTHFR
controls the detoxification of homocysteine
and the supply of methyl groups for SAM
synthesis, a reduction in its activity can affect
homocysteine metabolism and disturb cellular
methylation processes. The substitution of a
cytosine by a thymine in position 677
(c.677C>T) in the MTHFR gene is a
polymorphism that affects the binding of
FAD and leads to an increased propensity for
MTHFR to lose its flavin coenzyme (Wen et
al. 2013). Individuals homozygous for this
mutation (i.e., MTHFR 677TT genotype)
exhibit reduced MTHFR activity, and some
evidence shows that such individuals are at
increased risk of cancer at various sites (Wen
et al. 2013); however, the nature of the
association between this common
polymorphism and cancer risk remains
unclear.
Numerous studies have demonstrated that
riboflavin may play an important role in the
management of several clinical conditions,

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016 63
especially migraine headaches and metabolic
disorders.
Some, but not all, of the few small studies
conducted to date have found evidence of a
beneficial effect of riboflavin supplements on
migraine headaches in adults and children. In a
randomized trial in 55 adults with migraine, 400
mg/day riboflavin reduced the frequency of
migraine attacks by two per month compared to
placebo (Schoenen et al. 1998).
The Quality Standards Subcommittee of the
American Academy of Neurology and the
American Headache Society concluded that
riboflavin is probably effective for preventing
migraine headaches and recommended offering
it for this purpose (Holland et al. 2012).
Pantothenic acid (vitamin B5)
Pantothenic acid is available in a variety of
foods, usually as a component of coenzyme A
(CoA) and 4’-phosphopantetheine. Upon
ingestion, dietary coenzyme A and
phosphopantetheine are hydrolyzed to
pantothenic acid prior to intestinal absorption
(Miller and Rucker 2012). Animal liver and
kidney, fish, shellfish, pork, chicken, egg yolk,
milk, yogurt, legumes, mushrooms, avocados,
broccoli, breadfruit, and sweet potatoes are
good sources of pantothenic acid. A 100 g
serving of raw unseeded and roasted seeded
breadfruit provide 0.5 mg and 1.0 mg of
vitamin B5, respectively; this translates to 10%
and 20% of the recommended daily intake of
this vitamin for individuals on a 2000-calorie
diet (see Table 6 above).
In its active form pantothenic acid is a
constituent of coenzyme A, which is the
coenzyme for acetylation reactions. As such
pantothenic acid is essential to several
fundamental reactions in metabolism. One
example is combination of coenzyme A with
acetate to form ‘active acetate’ or acetyl
coenzyme A. It can be utilized directly by
combination with oxaloacetic acid to form citric
acid and enter the tricarboxylic acid (TCA)
cycle. In this manner acetic acid derived from
carbohydrates, fats, and many of the amino
acids undergoes further metabolic breakdown.
Coenzyme derivatives are also involved in the
synthesis of heme. Coenzyme A has also an
essential function in lipid metabolism. Acetyl
coenzyme A is a precursor of cholesterol and
thus of the steroid hormones (Bauerly and
Rucker 2007).
Vitamin B6
Seeded breadfruit is one of the best plant dietary
sources of vitamin B6, since a 100 g serving of
this vegetable provides 0.4 mg, which is 21% of
recommended daily intake for this vitamin for
individuals on a 2000-calorie diet.
Vitamin B6 is a mixture of 6 inter-related
forms pyridoxine (or pyridoxol), pyridoxal,
pyridoxamine and their 5’-phosphates. Inter-
conversion is possible between all forms (Da
Silva et al. 2012). The active form of the
vitamin is pyridoxal phosphate (PLP), which
plays a vital role in the function of over 100
enzymes that catalyze essential chemical
reactions in the human body. The many
biochemical reactions catalyzed by PLP-
dependent enzymes are involved in essential
biological processes, such as hemoglobin and
amino acid biosynthesis, as well as fatty acid
metabolism (Da Silva et al. 2012). Of note, PLP
also functions as a coenzyme for glycogen
phosphorylase, an enzyme that catalyzes the
release of glucose from stored glycogen. Much
of the PLP in the human body is found in
muscle bound to glycogen phosphorylase. PLP
is also a coenzyme for reactions that generate
glucose from amino acids, a process known as
gluconeogenesis (Da Silva et al. 2012).
Adequate intakes of vitamin B6 has been
reported to play an important role in the
prevention of immune dysfunction, CVD,
inflammation, dementias, depression, cancer
and kidney stones.
High levels of circulating homocysteine,
which is derived from methionine metabolism,
are associated with an increased risk of CVD.
Randomized controlled trials have

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
64 Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016
demonstrated that supplementation with B
vitamins, including vitamin B6, could
effectively reduce homocysteine levels.
A few observational studies have linked
cognitive decline and Alzheimer's disease (AD)
in the elderly with inadequate status of folate,
vitamin B12, and vitamin B6 (Selhub et al.
2000).
The systematic review of nine prospective
studies found either inverse or positive
associations between vitamin B6 intakes and
colorectal cancer (CRC) risk (Larsson et al.
2010). Inconsistent evidence regarding the link
between vitamin B6 intakes and breast cancer
was also recently reported in a meta-analysis
(Wu et al. 2013).
Bioactive components in breadfruit and their
health effects
Bioactive compounds or phytochemicals, such
as carotenoids and polyphenols have been
found in large amounts in breadfruit
(Englberger et al. 2007; Lako et al. 2007).
Englberger et al. (2007) screened 15 breadfruit
(Artocarpus altilis) cultivars and one preserved
breadfruit product from Micronesia for their
content of carotenoids using high performance
liquid chromatography (HPLC). Ripe fresh
seeded breadfruit (A. mariannensis) and dried
seeded breadfruit paste contained high levels of
β-carotene (up to 868 µg/100 g) and other
carotenoids. Other cultivars contained
significant levels of lutein (up to 750 µg/100 g)
and total carotenoids (up to 1260 µg/100 g).
Lako et al. (2007) analyzed seventy Fiji
grown fruits and vegetables, and some other
commonly consumed products for their total
antioxidant capacity (TAC), total polyphenol
content (TPP), total anthocyanin content (TAT)
as well as the major flavonol and carotenoid
profiles. Breadfruit was found to be among the
staples to possess a high TAC and TPP due to
its high polyphenol content. Orange Ipomoea
batatas (sweet potato) contained much higher
levels of total antioxidant capacity compared to
the other traditional staples consumed in Fiji
(Table 7).
The major groups of phytochemicals that may
contribute to TAC of plant foods include
polyphenols, carotenoids and the traditional
antioxidant vitamins such as vitamin C and
vitamin E. Phytochemicals are bioactive
substances of plants that have been associated in
the protection of human health against chronic
degenerative diseases. Antioxidants are
compounds that help delay and inhibit lipid
oxidation and when added to foods tend to
minimize rancidity, retard the formation of toxic
oxidation products, help maintain the nutritional
quality and increase their shelf-life.
Table 7. Total antioxidant capacity and total polyphenols of selected staples grown in Fiji
Polyphenols [mg/100 g]
Food item
TAC
TPP
Ipomoea batatas var (orange)
64
43
Artocarpus altilis var (local)
35
33
Dioscorea alata var (Veiwa) (red)
33
26
Manihot esculenta (Monroe), (yellow)
28
14
Dioscorea esculenta var (red)
27
38
Dioscorea nummularia
26
47
Colocasia esculenta var (Tausala Samoa)
26
39
Colocasia esculenta var (Wararasa) (greenish)
25
20
Manihot esculenta var (common) (white)
23
11
Musa sp (matured)
18
16
Source: Lako et al. (2007)

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016 65
Numerous epidemiological studies
suggest that diets rich in phytochemicals and
antioxidants execute a protective role in
health and disease. Various hypotheses have
been suggested to explain the lowered risk of
cancer, heart disease, hypertension and stroke
related to frequent consumption of fruits and
vegetables (Wolfe and Liu 2003). An
attractive hypothesis is that vegetables and
fruits contain compounds that have protective
effects, independent of those of known
nutrients and micronutrients. Plant
polyphenols, a large group of natural
antioxidants ubiquitous in a diet high in
vegetables and fruits, certainly are serious
candidates.
In addition to their antioxidant properties,
polyphenols show several interesting effects
in animal models and in vitro systems; they
trap and scavenge free radicals, regulate nitric
oxide, decrease leukocyte immobilization,
induce apoptosis, inhibit cell proliferation and
angiogenesis, and exhibit phytoestrogenic
activity (Higdon and Frei 2003). These effects
may contribute to their potentially protective
role in cancer and CVDs.
As indicated above, breadfruit contains
different types of carotenoids, which, in view
of their antioxidant properties have received
considerable interest by researchers, health
professionals and regulatory agencies.
Fruits and vegetables constitute the major
sources of carotenoids in human diet. They
are present as micro-components in fruits and
vegetables and are responsible for their
yellow, orange and red colors. More than 600
carotenoids have so far been identified in
nature. However, only about 40 are present in
a typical human diet. Of these 40, only about
20 carotenoids have been identified in human
blood and tissues. Close to 90% of the
carotenoids in the diet and human body are
represented by β-carotene, α-carotene,
lycopene, lutein, and cryptoxanthin.
Carotenoids are thought to be responsible
for the beneficial properties of fruits and
vegetables in preventing human diseases
including cardiovascular diseases, cancer and
other chronic diseases (Tanaka et al. 2012).
They are important dietary sources of vitamin
A. In recent years the antioxidant properties
of carotenoids has been the major focus of
research (Tanaka et al. 2012).
As mentioned above, Englberger et al.
(2007) found high concentrations of lutein in
some breadfruit cultivars.
Lutein belongs to the xanthophyll family
of carotenoids, which are synthesized within
dark green leafy plants, such as spinach and
kale, and which specifically protect the eyes
from damage.
The lens and retina of the human eye are
exposed constantly to light and oxygen. In situ
phototransduction and oxidative phosphorylation
within photoreceptors produces a high level of
phototoxic and oxidative related stress. The eye
and brain are especially vulnerable to free
radical attacks because of their high
polyunsaturated fatty acid concentrations and
their high metabolic activity (Sopher et al.
1996). Within the eye, the carotenoids lutein
and zeaxanthin are present in high
concentrations in contrast to other human
tissues.
Lutein protects the neural tissue during
particularly vulnerable periods (such as in
infancy, when the retina and brain are
changing dramatically after birth) and
conditions (such as aging). Neural lutein is
likely protective in nature and may also
influence interneuronal communication and
function through multiple mechanisms.
Although the molecular basis of these
neuroprotective effects of lutein remains
unknown, several mechanisms have been
proposed, such as decreased oxidative stress
and activation of anti-inflammatory pathways.
Lutein can inhibit the formation of damaging
free radicals by physical or chemical quenching
singlet oxygen. Indeed, increased measures of
oxidative stress and inflammation are found early
in age-related macular degeneration, Alzheimer’s
disease, and mild cognitive impairment
(Parmeggiani et al. 2012).

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
66 Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016
Conclusion
Breadfruit is one of the low-fat, low-calorie
foods with unique nutrients and
phytochemical profiles and is particularly
rich in dietary fiber, potassium, phosphorous,
magnesium, copper, vitamin C, thiamin,
riboflavin, niacin, pantothenic acid, B6, and
folate as well as bioactive components, such
as polyphenols and carotenoids, especially β-
carotene and lutein. In fact, seeded breadfruit
can be considered as one of the richest
dietary sources of total carotenoids. Further
studies are needed to identify other important
bioactive components in breadfruit as well as
to find out the mechanism of action of these
compounds at the molecular level.
The daily incorporation of breadfruit to a
diet may help in improving its quality and
subsequently reduce the risk for the
development of chronic non-communicable
diseases, such as obesity, diabetes,
atherosclerosis, hypertension, cancer and
neurological disorders as well as neural tube
defects. Increasing evidence suggests that the
health benefits of whole grains, vegetables
and fruit, including breadfruit as well as
other plant foods are attributed to the
synergy or interactions of bioactive
compounds and other nutrients in whole
foods. Therefore, consumers should obtain
their nutrients, antioxidants, bioactive
compounds, or phytochemicals from their
balanced diet with a wide variety of fruits,
vegetables, whole grains, and other plant
foods for optimal nutrition, health, and well-
being, not from dietary supplements. The
beneficial effects of breadfruit consumption
in relation to disease prevention and
management, especially diabetes were
mostly observational or in vitro studies,
therefore, further research on the health
benefits of breadfruit is warranted, especially
in human subjects.
References
Afkhami-Ardekani, M., and A. Shojaoddiny-
Ardekani. 2007. “Effect of vitamin C on
blood glucose, serum lipids and serum
insulin in type 2 diabetes patients.” Indian
J Med Res. 126:471-74.
American Dietetic Association (ADA). 2008.
“Position of the American Dietetic
Association: health implications of dietary
fiber.” J Am Diet Assoc. 108:1716-31.
Anderson, J.W., N.H. Gilinsky, and D.A.
Deakins. 1991. “Lipid responses of
hypercholesterolemic men to oat-bran and
wheat-bran intake.” Am J Clin Nutr.
54:678-83.
Appel, L.J. 2010. “ASH position paper:
dietary approaches to lower blood
pressure.” J Am Soc Hypertens. 4:79-89.
Appiah F., I. Oduro, and W.O. Ellis. 2011.
“Proximate and Mineral Composition of
Artocarpus altilis Pulp Flour as Affected
by Fermentation.” PJN. 10(7): 653-57.
Arrigoni, O., and M.C. De Tullio, (2002).
“Ascorbic acid: much more than just an
antioxidant.” Biochim Biophys Acta. 1569,
1-9.
Baker, A., L. Harvey, G. Majask-Newman, S.
Fairweather-Tait, A. Flynn, and K.
Cashman. 1999. “Effect of dietary copper
intakes on biochemical markers of bone
metabolism in healthy adult males.” J Clin
Nutr. 53(5): 408-12.
Barbagallo, M., L.J. Dominguez., and A.
Galioto. 2010. “Oral magnesium
supplementation improves vascular
function in elderly diabetic patients.”
Magnes Res. 23:131-37.
Bauerly, K., and R.B. Rucker. 2007.
“Pantothenic acid.” In Handbook of
vitamins. 4th ed, edited by J. Zempleni,
R.B. Rucker, D.B. McCormick, and J.W.
Suttie, 289-314. Boca Raton: CRC Press.
Chaudhri, O.B., and V. Salem. 2008.
“Gastrointestinal satiety signals.” Annu.
Rev. Physiol. 70:239-55.

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016 67
Chucktan, R., G. Fahey, W.L. Wright, and J.
McRorie. 2012. “Viscous versus nonviscous
soluble fiber supplements: mechanisms and
evidence for fiber-specific health benefits.” J
Am Acad Nurse Pract. 24:476-87.
Comin-Anduix, B., J. Boren, and S. Martinez.
2001. “The effect of thiamine
supplementation on tumour proliferation.
A metabolic control analysis study.” Eur J
Biochem. 268:4177-82.
Conlan, D., R. Korula, and D. Tallentire.
1990. “Serum copper levels in elderly
patients with femoral-neck fractures.” Age
Ageing. 19(3): 212-14.
Cumming, R.G., P. Mitchell, and W. Smith.
2000. “Diet and cataract: the Blue
Mountains Eye Study.” Ophthalmology
107:450-56.
Da Silva, V.R., K.A. Russell, and J.F.
Gregory 3rd. 2012. “Vitamin B6.” In
Present Knowledge in Nutrition, 10th ed.,
edited by J.W. Jr. Erdman, I.A.
Macdonald, and S.H. Zeisel, 307-20.
Hoboken, New Jersey: Wiley-Blackwell.
Das, U.N. 2006. “Essential fatty acids:
biochemistry, physiology and pathology.”
Biotechnol J. 1:420-39.
Dickinson, H.O., D.J. Nicolson, and F.
Campbell. 2006. “Potassium
supplementation for the management of
primary hypertension in adults.”
Cochrane Database Syst Rev.
3:CD004641.
Englberger, L., J. Alfred, A. Lorens, and T.
Iuta. 2007. “Screening of selected
breadfruit cultivars for carotenoids and
related health benefits in micronesia.”
Acta Hortic (ISHS) 757:193-2007.
Ford, E.S., and A.H. Mokdad. 2003. “Dietary
magnesium intake in a national sample of
US adults.” J Nutr. 133:2879-82.
Fujiwara, N., T. Osanai, T. Kamada, T.
Katoh, K. Takahashi, and K. Okumura.
2000. “Study on the relationship between
plasma nitrite and nitrate level and salt
sensitivity in human hypertension:
modulation of nitric oxide synthesis by
salt intake.” Circulation 101:856-61.
Haddy, F,J., P.M. Vanhoutte, and M. Feletou.
2006. “Role of potassium in regulating
blood flow and blood pressure.” Am J
Physiol Regul Integr Comp Physiol.
290:R546-52.
Higdon, J.V., and B. Frei. 2003. “Tea
catechins and polyphenols: health effects,
metabolism, and antioxidant functions.”
Crit Rev Food Sci Nutr. 43:89-143.
Holland, S., S.D. Silberstein, F. Freitag, D.W.
Dodick, C. Argoff, and E. Ashman. 2012.
“Evidence-based guideline update: NSAIDs
and other complementary treatments for
episodic migraine prevention in adults:
Report of the Quality Standards
Subcommittee of the American Academy of
Neurology and the American Headache
Society.” Neurology 78:1346-53.
IOM: Institute of Medicine. 2005. “Dietary
Reference Intakes for Energy,
Carbohydrate, Fiber, Fat, Fatty Acids,
Cholesterol, Protein, and Amino Acids.”
Washington, DC: The National
Academies Press. Accessed July 7, 2015.
http://www.nap.edu/openbook.php?isbn=0
309085373.
IOM: Institute of Medicine. 2005. “Dietary
Reference Intakes for vitamins and
minerals.” Washington, DC: The National
Academies Press. http://www.nal.
usda.gov/fnic/DRI/DRI_Tables/RDA_AI_
vitamins_elements.pdf Accessed July 29,
2015
Ito, Y., K. Yamanaka, H. Susaki, and A.
Igata. 2012. “A cross-investigation
between thiamin deficiency and the
physical condition of elderly people who
require nursing care.” J Nutr Sci
Vitaminol. 58:210-16.
Kanis, J.A. 2007. WHO Technical Report.
University of Sheffield, UK: 66.
Khan, A.M., L. Sullivan, E. McCabe, D. Levy,
R.S. Vasan, and T.J. Wang. 2010. “Lack of
association between serum magnesium and
the risks of hypertension and cardiovascular
disease.” Am Heart J. 160:715-20.

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
68 Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016
King, D.E., A.G. Mainous, and C.A.
Lambourne. 2012. “Trends in dietary fiber
intake in the United States, 1999-2008.” J
Acad Nutr Diet. 112:642-48.
Lako, J., V.C. Trenerry, M. Wahlqvist, N.
Wattanapenpaiboon, S. Sotheeswaran, R.
Premier. 2007. “Phytochemical flavonols,
carotenoids and the antioxidant properties
of a wide selection of Fijian fruit,
vegetables and other readily available
foods.” Food Chem. 101:1727-41.
Li, Y., and H.E. Schellhorn. 2007. “New
Developments and Novel Therapeutic
Perspectives for Vitamin C.” J Nutr.
137:2171-84.
Mares-Perlman, J.A., W.E. Brady, and B.E.
Klein. 1995. “Diet and nuclear lens
opacities.” Am J Epidemiol. 141(4):322-
34.
Marlett, J.A. 2001. “Dietary fiber and
cardiovascular disease.” In Handbook of
Dietary Fiber, edited by S.S. Cho and
M.L. Dreher, 17-30. New York: Marcel
Dekker.
Marquardt, M.L., S.L. Done, M. Sandrock,
W.E. Berdon, and K.W. Feldman. 2012.
“Copper deficiency presenting as
metabolic bone disease in extremely low
birth weight, short-gut infants.” Pediatrics
130(3): e695-98.
McGlynn, A.P., G.R. Wasson, S.L. O'Reilly.
2013. “Low colonocyte folate is
associated with uracil misincorporation
and global DNA hypomethylation in
human colorectum.” J Nutr. 143(1): 27-
33.
McNulty, H., J.J. Strain, K. Pentieva, and M.
Ward. 2012. “C(1) metabolism and CVD
outcomes in older adults.” Proc Nutr Soc.
71(2): 213-21.
Michelle, L.T., and J.T. Dennis. 2009. “New
roles for copper metabolism in cell
proliferation, signaling, and disease.” Biol
Chem. 284(2): 717-21.
Miller, J.W., and R.B. Rucker. 2012.
“Pantothenic acid.” In Present Knowledge
in Nutrition, 10th ed., edited by J.W.J.
Erdman, I.A. Macdonald, and S.H. Zeisel,
375-90. Ames: Wiley-Blackwell.
Parmeggiani, F., M.R. Romano, and C.
Costagliola. 2012. “Mechanism of
inflammation in age-related macular
degeneration.” Mediators Inflamm.
2012:546786. doi:10.1155/2012/546786.
Percival, S.S. 1998. “Copper and immunity.”
Am J Clin Nutr. 67(5 Suppl):1064S-68S.
Powers, H.J. 1999. “Current knowledge
concerning optimum nutritional status of
riboflavin, niacin and pyridoxine.” Proc
Nutr Soc. 58(2):435-40.
Preuss, H.G. 1997. “Diet, genetics and
hypertension.” J Am Coll Nutr. 16:296-
305.
Prohaska, J.R. 2011. “Impact of copper
limitation on expression and function of
multicopper oxidases (ferroxidases).” Adv
Nutr. 2(2): 89-95.
Prvulovic, D., and H. Hampel. 2011.
“Amyloid β (A-β) and phospho-τ (p-τ) as
diagnostic biomarkers in Alzheimer's
disease.” Clin Chem Lab Med. 49:367-74.
Ragone, D. 1997. Breadfruit, Artocarpus
altilis (Parkinson) Fosberg. International
Plant Genetic Resources Institute, Rome.
Sacks, F.M., and H. Campos. 2010. “Dietary
therapy in hypertension.” N Engl J Med.
362:2102-12.
Said, H.M. 2010. “Thiamin.” In Encyclopedia
of Dietary Supplements, edited by M.C.
Paul, M.B. Joseph, R.B. Marc, M.C.
Gordon, L. Mark, M. Joel, and D.W.
Jeffrey, 2nd ed. 748-53. London: Informa
Healthcare.
Said, H.M., and A.C. Ross. 2014.
“Riboflavin.” In Modern Nutrition in
Health and Disease. 11th ed., edited by
A.C. Ross, B. Caballero, R.J. Cousins,
K.L. Tucker, and T.R. Ziegler, 325-30.
Baltimore, MD: Lippincott Williams &
Wilkins.
Schoenen, J., J. Jacquy, and M. Lenaerts.
1998. “Effectiveness of high-dose
riboflavin in migraine prophylaxis. A

Nutritional and health effects of breadfruit; S. Bawa and M. Webb
Trop. Agric. (Trinidad) Special Issue International Breadfruit Conference 2015, July 2016 69
randomized controlled trial.” Neurology
50:466-70.
Seaforth, C.E., C.D. Adams, and Y. Sylvester.
1983. A Guide to the Medicinal Plants of
Trinidad & Tobago London:
Commonwealth Secretariat. ,.
Selhub, J., L.C. Bagley, J. Miller, and I.H.
Rosenberg. 2000. “B vitamins,
homocysteine, and neurocognitive
function in the elderly.” Am J Clin Nutr.
71:614S-20S.
Shechter, M. 2010. “Magnesium and
cardiovascular system.” Magnes Res.
23:60-72.
Slavin, J., and H. Green. 2007. “Dietary fibre
and satiety.” Nutr Bull. 32:32-42.
Sopher, B.L., K. Fukuchi, and T.J. Kavanagh.
1996. “Neurodegenerative mechanisms in
Alzheimer disease. A role for oxidative
damage in amyloid beta protein precursor-
mediated cell death.” Mol Chem
Neuropathol. 29:153-68.
Tanaka, T., M. Shnimizu, and H. Moriwaki.
2012. „Cancer Chemoprevention by
Carotenoids.” Molecules. 17: 3202-42.
Thornalley, P.J., R. Babaei-Jadidi, and H. Al
Ali. 2007. “High prevalence of low
plasma thiamine concentration in diabetes
linked to a marker of vascular disease.”
Diabetologia. 50: 2164-70.
Vaquero, M.P. 2002. “Magnesium and trace
elements in the elderly: intake, status and
recommendations.” J Nutr Health Aging.
6: 147-53.
Wen, Y.Y., S.J. Yang, J.X. Zhang, and X.Y.
Chen. 2013. “Methylenetetrahydrofolate
reductase genetic polymorphisms and
esophageal squamous cell carcinoma
susceptibility: a meta-analysis of case-
control studies.” Asian Pac J Cancer
Prev. 14(1): 21-25.
WHO (World Health Organization). 2002.
“World Health Report, Reducing risks,
promoting health.” Geneva: World Health
Organization.
. 2003. “Diet, nutrition and the prevention
of chronic diseases. Report of a Joint
FAO/WHO Expert Consultation.”
Geneva: World Health Organization, 2003
(WHO Technical Report Series, No. 916).
. 2012. “Effect of Increased Potassium
Intake on Cardiovascular Disease,
Coronary Heart Disease and Stroke.”
Geneva, Switzerland.
Wolfe, K.W.X., and R.H. Liu. 2003.
“Antioxidant activity of apple peels.” J
Agric Food Chem. 51(3): 609-14.
Wu, W., S. Kang, and D. Zhang. 2013.
“Association of vitamin B6, vitamin B12
and methionine with risk of breast cancer:
a dose-response meta-analysis.” Br J
Cancer 109: 1926-44.
Zhang, Q., and G. Yang, and W. Li. 2011.
“Thiamine deficiency increases beta-
secretase activity and accumulation of
beta-amyloid peptides.” Neurobiol Aging.
32: 42-53.