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The Protective Effect of Habitual Tea Consumption on Hypertension
Abstract
Tea has long been believed to possess hypotensive effects in popular Chinese medicine. However, conflicting results have been shown among human trials and animal studies on the relation between tea consumption and blood pressure. Epidemiological evidence about the long-term effect of tea on hypertensive risk is also inconsistent.
We examined the effect of tea drinking, measured in detail for the past decades, on the risk of newly diagnosed hypertension in 1507 subjects (711 men and 796 women), 20 years or older, who did not have a hypertensive history during 1996 in Taiwan.
Six hundred subjects (39.8%) were habitual tea drinkers, defined by tea consumption of 120 mL/d or more for at least 1 year. Compared with nonhabitual tea drinkers, the risk of developing hypertension decreased by 46% for those who drank 120 to 599 mL/d and was further reduced by 65% for those who drank 600 mL/d or more after carefully adjusting for age, sex, socioeconomic status, family history of hypertension, body mass index, waist-hip ratio, lifestyle factors (total physical activity, high sodium intake, cigarette smoking, alcohol consumption, and coffee drinking), and dietary factors (vegetable, fruit, unrefined grain, fish, milk, visible-fat food, and deep fried food intake). However, tea consumption for more than 1 year was not associated with a further reduction of hypertension risk.
Habitual moderate strength green or oolong tea consumption, 120 mL/d or more for 1 year, significantly reduces the risk of developing hypertension in the Chinese population.
... 12 A growing body of evidence has indicated consumption of black or green tea and, in particular, its polyphenolic flavonoids could lead to preventing occurrence and progression of atherosclerosis as well as CVDs. 8,9,11,[13][14][15] Based on the findings of a prospective cohort study on more than 40,000 subjects, the consumption of green tea was reported to be related to a reduced risk of CVD mortality. 16 There has been much interest in studying the effects of tea intake on HTN that is known to be a particular risk factor for CVDs. ...
... [17][18][19] Further, several epidemiological studies have provided evidence for the protective effects of tea consumption on HTN. 13,[20][21][22] For example, a survey of 1507 individuals aimed to investigate the impact of tea drinking habits in the previous decade prior to study on BP. It was suggested that consumption of ≥120 mL/d green tea or oolong tea for at least a year notably attenuate HTN incidence. ...
... It was suggested that consumption of ≥120 mL/d green tea or oolong tea for at least a year notably attenuate HTN incidence. 13 Also, a large Norwegian study on nearly 20,000 participants noted that the SBP of males and females who consumed ≥5 cups of tea/ day was 2.1 mmHg and 3.5 mmHg lower than the others, respectively. 21 The consumption of green or black tea as a beverage is typical among different populations. ...
Objective
As a popular beverage, there has been much interest in studying the effects of tea intake on hypertension (HTN), a particular risk factor for cardiovascular disorders (CVDs). We have thus aimed to isolate the randomized controlled trials investigating the efficacy of black or green tea as a beverage in subjects with elevated blood pressure (BP), or HTN.
Methods
PubMed, Scopus, Web of Science, and ProQuest dissertations and theses databases were searched from February 1, 1995, up to July 20, 2019, to identify relevant studies.
Results
The search strategy generated 1119 trials, of which finally five trials fulfilled the criteria for being included in the current study. Three out of 5 articles showed a low risk of bias. According to nine measurements derived from 5 trials on 408 individuals, it was found that regular tea intake resulted in the reduction in SBP (weighted mean difference(WMD):-4.81 mmHg,95%CI:-8.40to-1.58,P = .004) and DBP (WMD:-1.98 mmHg,95%CI:-3.77to-0.20,P = .029); however, excluding the most heterogeneous trials showed that regular tea intake might reduce SBP and DBP by about -3.53 and -0.99 mmHg, respectively. Based on meta-regression findings, we found the longer the duration of tea intake(> = 3months), the higher the decrease in both SBP and DBP. Categorized studies, according to the tea type, revealed that the hypotensive effects of green tea were more pronounced compared to black tea. None of the studies reported any side effects.
Conclusion
These results suggest the positive effects of regular tea intake on BP in subjects with elevated BP or HTN. Hence, it may be applicable to physicians, health care providers, and particularly HTN patients.
... Current smoking was defined as someone who had smoked more than 100 cigarettes and was still smoking [21]. Current drinking was defined someone as who had drunk 3 or more units of alcohol in one day for more than 6 months before the study [18,22]. A unit of alcohol was defined as equivalent to 10 g of alcohol. ...
... NHIRD is one of the Current smoking was defined as someone who had smoked more than 100 cigarettes and was still smoking [21]. Current drinking was defined someone as who had drunk 3 or more units of alcohol in one day for more than 6 months before the study [18,22]. A unit of alcohol was defined as equivalent to 10 g of alcohol. ...
Purpose:
A treatment gap exists in vertebral fracture (VF) patients. An outpatient visit is a necessary step to initiate treatment. The study aimed to evaluate factors associated with an outpatient visit following a VF diagnosis, and the association between the interval of an outpatient visit after VF diagnosis and its impact on prescribing of anti-osteoporosis medications (AOMs).
Methods:
Subjects 65 years and older from Tianliao Township in Taiwan with newly diagnosed VF between 2009 and 2010 were included. Information about outpatient visits and AOMs prescriptions were derived from the National Health Insurance Research database and followed up for 2 years. Factors associated with outpatient visits and the initiation of AOMs were assessed using the multivariable Cox proportional regression model analysis. The receiver operating characteristic curve (ROC curve) was analyzed to determine the predictive effects of the interval between an outpatient visit following the diagnosis of a new VF on initiating AOMs and the potential optimal cutoff point.
Results:
Of 393 participants, 42.2% had outpatient visits within 2 years after a new VF diagnosis, for which the mean interval was 4.8 ± 4.8 months. Patients who were female and reported a current use of supplements were positively associated with visits after a new VF diagnosis, but the bone mineral density (BMD) T-score was negatively associated with visits. Furthermore, 140 (35.6%) patients had initiated AOMs within 2 years after the diagnosis of a new VF. It was found that a higher BMD T-score and a longer interval between an outpatient visit following diagnosis was negatively associated with initiation of AOMs. The ROC curve analysis showed outpatient visits within 3 months after a VF diagnosis had the highest Youden index and maximum area under the curve.
Conclusions:
Patients who were female, were currently taking supplements, and those who had a lower BMD T-score were more likely to visit doctors after being diagnosed with a new VF. Furthermore, a lower BMD T-score and a shorter interval, within 3 months and not more than 8 months, between an outpatient visit following the diagnosis of VF increased the likelihood of being prescribed AOMs.
... The amount of tea consumption was assessed by a questionnaire that has been used in other research [13]. Subjects were classified as habitual tea drinkers if they gave a positive answer to the first question: Do you drink tea habitually once a week for at least 6 months? ...
... Third, recall bias on the information of tea consumption is another possible limitation. However, for a simple behavioral habit of tea consumption, compared to some more complicated behaviors or more distant past recall, the self-report questionnaire used in this study seems reliable, based on our previous works [13,39]. Fourth, no detailed information was available on family history of gallstones, oral contraceptive use, number of pregnancies, or menopausal status, which are known risk factors for gallstones. ...
Background/objectives:
The aim of the present study was to investigate the relationship between tea drinking and gallstones, specifically to evaluate the amount and time of tea consumption by gender.
Subjects/methods:
A total of 14,555 eligible adults receiving health examinations were included. The participants were divided into three subgroups with tea consumption of none, <240/day and ≥240 ml/day. We defined 120 ml for each traditional Chinese teapot as a "cup," and the variable "cup-year" was obtained by multiplying the cups per day by the years of tea consumption. Based on the findings of abdominal ultrasound examination, gallstones was defined by the presence of movable or gravity-dependent intraluminal hyperechoic foci that attenuated ultrasound transmission.
Results:
Among the participants, 1040 (7.1%) had gallstones. In multivariate analysis, the inverse relationship between tea drinking habit and gallstones was significant (OR = 0.807; 95% CI = 0.685-0.951, p = 0.010). Daily consumption of 1-240 ml (OR = 0.741; 95% CI = 0.584-0.941, p = 0.014), but not ≥240 ml, was associated with reduced risk of gallstones. In addition, the 1-19 cup-year group had significantly lower associated risk of gallstones (OR = 0.677; 95% CI = 0.534-0.857, p = 0.001), while the ≥19 cup-year group did not. By gender, subjects with tea consumption of 1-19 cup-year exhibited a low associated risk of gallstones in both males (OR = 0.678; 95% CI = 0.504-0.913, p = 0.010) and females (OR = 0.671; 95% CI = 0.453-0.994, p = 0.047), while subjects with ≥19 cup-years did not.
Conclusions:
Appropriate tea drinking if less than 240 ml/day or 19 cup-years was associated with a decreased risk of gallstones in both genders.
... This study underscores the potential protective effect of green tea against cardiovascular disease in a real-world setting [61,[63][64][65]. Cross-sectional research found that, compared to people who consumed less than 120 ml per day, those who drank between 120 and 599 ml of green tea daily for at least a year had a 46% lower risk of hypertension and a 65% lower risk [76]. Additionally, in participants undergoing coronary angiography, a negative correlation was shown between daily consumption of more than two cups of green tea and coronary atherosclerosis [62]. ...
A preventive effect for tea and its bio active components in cardiovascular health has been suggested by the results of several epidemiological studies, treatments utilizing randomized controlled trials, and mechanistic investigations. Therefore, scientific interest in green tea's ability to prevent cardiovascular diseases (CVDs) is growing. Green tea benefits for the metabolic syndrome, which includes diabetes and hypertension but may also raise cholesterol levels. Additionally, green tea reduces the mortality from any cause, arrhythmia, stroke, coronary heart disease, heart failure, and other conditions.
... In black tea, most catechins are oxidized into the thearubigins and theaflavins with weak antioxidant capacity during the fermentation process [18,19]. In addition, the amount, duration, and frequency of tea consumption may also affect the antihypertensive effect [20][21][22]. On the other hand, while some studies showed that tea consumption was not associated with a reduced risk of hypertension [23][24][25], others even demonstrated an increased risk [26]. In addition, most of these studies focused on green tea and black tea. ...
Objectives
Prior research on the effect of tea consumption on blood pressure (BP) generated inconsistent findings. The objective of this study was to explore the effects of different types of tea consumption on BP.
Methods
We included 76,673 participants aged 30–79 from the baseline data of the China Multi-Ethnic Cohort (CMEC) study. Binary logistic regression was used to analyze the influences of different types of tea consumption on the risk of hypertensive BP. Moreover, multiple linear regression was used to examine the association between tea drinking and BP.
Results
Tea consumption was associated with a reduced risk of hypertensive BP by 10% (AOR: 0.90, 95%CI: 0.86–0.94). While dark tea was related to a 1.79–5.31 mmHg reduction in systolic blood pressure (SBP) and a 0.47–1.02 mmHg reduction in diastolic blood pressure (DBP), sweet tea, regardless of the duration, frequency, or amount of consumption, significantly was associated with a reduced SBP by 3.19–7.18 mmHg. Green tea also was associated with a reduced SBP by 1.21–2.98 mmHg. Although scented tea was related to reduced SBP by 1.26-2.48 mmHg, the greatest effect came from the long duration (> 40 years:β=-2.17 mmHg, 95%CI=-3.47 mmHg --0.87 mmHg), low frequency (1–2 d/w: β = -2.48 mmHg, 95%CI=-3.76 mmHg–-1.20 mmHg), and low amount (≤ 2 g/d: β=-2.21 mmHg, 95%CI=-3.01 mmHg–-1.40 mmHg). Additionally, scented tea was correlated to a decrease in DBP at the frequency of 1–2 d/w (β=-0.84 mmHg, 95%CI=-1.65 mmHg–-0.02 mmHg). Drinking black tea only was associated with lowered SBP. The protective effect of black tea on SBP was characterized by the long-duration (> 15 years, -2.63–-5.76 mmHg), high frequency (6–7 d/w, -2.43 mmHg), and medium amount (2.1-4.0 g/d, -3.06 mmHg).
Conclusion
Tea consumption was associated with lower SBP and a reduced risk of hypertensive BP. The antihypertensive effect varies across types of tea consumed.
... Tisanes have long since been used in many traditional medicinal systems to reduce the burden of diseases (Tandon and Yadav, 2017;Ritch-Krc et al., 1996;Yang et al., 2004;McKay and Blumberg, 2006;Gohil et al., 2010;Ponnachan et al., 1993;Sachdewa et al., 2001). There are several kinds of tisanes (infusions/decoctions), which are consumed for energizing and reducing tension and anxiety. ...
Background:
Tisanes are a potential source of phytochemicals to reduce disease risk conditions and are used to protect from non-communicable diseases, globally. A few tisanes have gained more popularity than others depending on their chemical composition based on the geographical origin of the used herb. Several Indian tisanes have been claimed to have traits beneficial to people with or at a high risk of type 2 diabetes mellitus. Under the concept, the literature was reviewed and compiled into a document to highlight the chemical uniqueness of popular Indian traditional tisanes to be more informative and potent as per modern medicine to overcome type 2 diabetes mellitus.
Methods:
An extensive literature survey was conducted using computerized database search engines, such as Google Scholar, PubMed, ScienceDirect, and EMBASE (Excerpta Medica database) for herbs that have been described for hyperglycemia, and involved reaction mechanism, in-vivo studies as well as clinical efficacies published since 2001 onwards using certain keywords. Compiled survey data used to make this review and all findings on Indian traditional antidiabetic tisanes are tabulated here.
Results:
Tisanes render oxidative stress, counter the damage by overexposure of free radicals to the body, affect enzymatic activities, enhance insulin secretion, etc. The active molecules of tisanes also act as anti-allergic, antibacterial, anti-inflammatory, antioxidant, antithrombotic, antiviral, antimutagenicity, anti-carcinogenicity, antiaging effects, etc. WHO also has a strategy to capitalize on the use of herbals to keep populations healthy through effective and affordable alternative means with robust quality assurance and strict adherence to the product specification.
... Yang et al. [110] conducted a cohort study on 1507 participants in Taiwan. The results showed that the risk of hypertension decreased by 46% among individuals who consumed 120-599 mL of tea per day at least for 1 year and by 65% among those who consumed 600 mL/day. ...
Plant polyphenols have various health effects. Genistein, which is abundant in soybeans, and epigallocatechin-3-gallate, which is abundant in green tea, are major flavonoids, a subclass group of polyphenols. Several epidemiological studies have shown that these flavonoids have beneficial effects against cancer and cardiovascular diseases. However, other studies did not show such effects. Several confounding factors, including recall bias, are related to these inconsistent findings, and the determination of metabolites in the urine may be useful in reducing the number of confounding factors. Equipment, which can be used by research participants to collect samples from a portion of voided urine within 24 h without the help of medical workers, has been developed for epidemiological investigations. Previous studies, in which flavonoid metabolites in these urine samples were measured, revealed that soy intake was correlated with a reduced risk of certain types of cancer and cardiovascular diseases worldwide. Although soybeans and green tea consumption may have protective effects against cancer and cardiovascular diseases, further clinical studies that consider different confounding factors are required to provide evidence for the actual impact of dietary flavonoids on human diseases, including cancer and cardiovascular diseases. One possible mechanism involved is discussed in relation to the downregulation of reactive oxygen species and the upregulation of 5′-adenosine monophosphate-activated protein kinase elicited by these flavonoids.
... EGCG promotes heart health by reducing blood pressure, cholesterol, and plaque accumulation in blood vessels, which are triggers of cardiac diseases [62,63]. Catechins are also associated with the development of lung, gastric, and breast cancers [64][65][66]. A well-established connectivity between diabetes, improved immunity, and green tea is well-documented [67][68][69][70][71][72]. ...
In an era where humanity is reinstating its lost hope and expectation on natural products, green tea occupies quite a position for what it has proven to be, in its endeavors for human welfare and health. Epigallocatechin-3-gallate (EGCG) is the key to the vast biological activities of green tea. Green tea is no longer in the backdrop; it has emerged as the most viral, trending bioactive molecule when it comes to health benefits for human beings. This review focuses on the use of various analytical techniques for the analysis of EGCG. That which has been achieved so far, in terms of in vitro, pure component analysis, as well as those spikes in biological fluids and those in vivo in animal and human samples, was surveyed and presented. The use of MS-based techniques for the analysis of EGCG is elaborately reviewed and the need for improvising the applications is explained. The review emphasizes that there is plenty of room to explore matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) applications in this subject area.
... Accumulating studies have indicated that tea has shown remarkable effects in preventing and managing hypertension (12). The epidemiological and population-based cohort results show that drinking GT or OLT can significantly reduce the risk of hypertension (14). Moreover, intervention studies of many hypertensive patients and animal models have shown that black tea and GT have a significant antihypertensive effect and can protect the cardiovascular system (15,16). ...
Green tea (GT) and oolong tea (OLT) are widely consumed beverages, and their preventive and regulatory effects on hypertension have been reported. However, the interventional effects of GT and OLT on hypertension induced by a high-salt diet and its mechanism have not been fully explored. This study evaluated the anti-hypertensive effects of GT and OLT and their underlying mechanisms. The in vivo anti-hypertensive effects of GT and OLT and their capability to prevent hypertension and regulate the intestinal microbiota in Wistar rats fed with a high-salt diet were evaluated. Our results show that GT and OLT supplementations could regulate oxidative stress, inflammation, gene expression, and parameter levels related to blood pressure (BP) and prevent the increase in BP induced by a high-salt diet. Furthermore, both GT and OLT boosted the richness and diversity of intestinal microbiota, increased the abundance of beneficial bacteria and reduced the abundance of harmful bacteria and conditionally pathogenic bacteria, and regulated the intestinal microbial metabolism pathway related to BP. Among them, OLT presented better effects than GT. These findings indicate that GT and OLT can prevent hypertension caused by high-salt diets, which may be due to the regulation of intestinal flora by GT and OLT.
... [4][5][6] Many epidemiological studies have shown that tea consumption was related to lower risk of CVD. [4,7,8] One potential mechanism is that tea consumption might lower blood pressure (BP), thereby mediating the protective effect of tea on CVD. However, existing evidence remains inconclusive as to the association between tea consumption and hypertension risk. ...
Background:
Association between tea consumption and incident hypertension remains uncertain. This study conducted to examine the health effects of tea consumption on blood pressure progression and hypertension incidence.
Methods:
A population-based cohort of 38,913 Chinese participants without hypertension at baseline were included in the current study. Information on tea consumption was collected through standardized questionnaires. Associations of tea consumption with blood pressure progression and incident hypertension were analyzed using logistic regression models and Cox proportional hazards regression models, respectively.
Results:
During a median follow-up of 5.9 years, 17,657 individuals had experienced progression to a higher blood pressure stage and 5,935 individuals had developed hypertension. In multivariate analyses, habitual tea drinkers (≥ 3 times/week for at least six months) had a 17% lower risk for blood pressure progression [odds ratio (OR) = 0.83, 95% CI: 0.79-0.88] and a 14% decreased risk for incident hypertension [hazard ratio (HR) = 0.86, 95% CI: 0.80-0.91] compared with non-habitual tea drinkers. Individuals in different baseline blood pressure groups could obtain similar benefit from habitual tea drinking. In terms of tea consumption amount, an inverse, linear dose-response relation between monthly consumption of tea leaves and risk of blood pressure progression was observed, while the risk of incident hypertension did not reduce further after consuming around 100 g of tea leaves per month.
Conclusions:
Our study demonstrated that habitual tea consumption could provide preventive effect against blood pressure progression and hypertension incidence.
... The results of studies aiming to investigate the effect of green tea on the risk of hypertension have been mixed. Although a large number of studies have pointed out that it is beneficial for healthy individuals to take green tea as a daily beverage [1,14,15], others have found the opposite [3,16]. One possible explanation is the different compounds that are extracted from green tea, such as caffeine, which is considered to significantly increase the risk of hypertension. ...
Background
Green tea has been one of the most popular beverages in China since ancient times. Mixed results concerning the effect of green tea consumption on the incidence of hypertension have been published over the past decades. However, no previous studies have focused on longevous individuals in China and the sex differences in the association between habitual green tea intake and hypertension.
Methods
The data extracted from the database of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018 were used for a secondary analysis. Logistic regression models were employed to examine the odds ratio (OR) of daily green tea consumption on the incidence of hypertension by sex.
Results
A total of 9277 individuals were included in the analysis (39.8% were men). The included individuals had a mean age of 80.9 and 84.8 years for those who drank green tea daily and those who had never, respectively ( p < 0.001). The incidence of hypertension varied at baseline according to green tea drinking habit and sex. For women who had a habitual green tea intake or had never drunk green tea, the incidence of hypertension was 47.3 and 43.9%, respectively ( p = 0.241), whereas it was 51.6 and 39.7% for men ( p < 0.001). After adjusting for potential confounders, a 38% increase in the risk of hypertension was observed in men who consumed green tea daily (OR, 1.38; 95% CI, 1.15–1.67; p < 0.001).
Conclusions
Chinese longevous men had a 38% higher risk of developing hypertension when drinking green tea daily. However, no effect of green tea consumption on the incidence of hypertension in women was found. More attention should be paid to the lifestyle of longevous individuals for health promotion, and a sex-specific approach to deliver care for very elderly people is warranted.
... And higher tea intake lowers the incidence of coronary artery disease [28] . It was found that habitual moderate green or oolong tea consumption, 120 mL/day or more for at least 1 year, significantly reduced the risk of developing hypertension by 46% −65% in Chinese population [29] . In animal, green tea extract decreased the generation of superoxide anion to prevent hypertension and target organ damage of rat induced by a high dosage of angiotensin II [30] . ...
Senile hypertension affects the life quality of aged population. Dietary intervention plays a pivotal role in the prevention of hypertension. There are few reports concerning the effects and mechanisms of green tea supplementation preventing age related hypertension. The current study investigated the effect and mechanism of dietary supplement of Huangshan Maofeng green tea (HSMF) on prevention of hypertension induced by deoxycorticosterone acetate (DOCA) and salt in old C57BL/6 mice. Our results showed that HSMF dose-dependently prevented the increase of systolic blood pressure and diastolic blood pressure induced by DOCA plus salt (DS) at 51-week-old mice. And HSMF significantly reduced the agonists' stimulated contraction of mesenteric arteries isolated from the old mice. The expression of vasoconstrictor genes and inflammatory cytokines in aorta were suppressed observably by HSMF supplementation compared with DS group. The protein expression of PKCα in the aorta was dose-dependently decreased by HSMF compared to DS group. The phosphorylation level of MYPT1, CPI-17and MLC20 was also restrained by HSMF in the aorta. Furthermore, HSMF protected kidney by maintaining integrity of glomeruli and tubules and remarkably decreased the NGAL level in plasma. HSMF also suppressed the kidney inflammation by decreasing inflammatory cytokines expression and the macrophage infiltration. Our results proved that dietary supplement of HSMF remarkably improved the vascular functions and protected kidney injury, and thus prevented hypertension induced by DS in older C57BL/6 mice. Our data indicated that the dietary supplement of HSMF may potentially be used as a food additive for preventing hypertension for aged people.
... Our results supported the theory of Chinese medicine, that multiple ingredients at specific ratio contribute to the outcome. Herbal teas have been used as therapeutic vehicles in China, India and other countries for a long time [2,3]. Future research to clarify the effects of herbal tea would be valuable. ...
Chinese herbal tea has a long history in China, and is one of the most consumed beverage products as of now. However, whether herbal tea can really promote health and be considered as a functional food is still a question. The objective of this work was to assess the beneficial effect of herbal tea on health using Drosophila as the model. Adding commercially available herbal tea to food could increase average life span of fruit flies for more than 50%. Further tests showed that the effect of herbal tea was not dependent on specific single ingredient. The present results suggest that Chinese herbal tea may have beneficial effects to human health.
... Reactive species are molecules or atoms that have an electronic instability and highly reactive. The uncontrolled amount of oxygen free radicals and the unbalanced mechanism of antioxidant scavenging results in the onset of many diseases, such as cancer, diabetes, Alzheimer's, heart diseases and aging [1], [2], [3], [4]. ...
Aim:
Free radicals produce from metabolism or enviromental which interact continously with biological system. Picria fel-terrae Lour. herbs have been used as antioxidant and treat various diseases. The aim of this study was to evaluate cytoprotective activity of ethylacetate fraction (EAF) of Picria fel-terrae Lour. herbs.
Methods:
Cytoprotective activity were determined by MTT asay and flow cytometry assay on Vero cells which induced with H2O2 0.8 mM.
Results:
EAF at 100 µg/mL were showed highest viability (88.83 ± 2.90%) and ROS expression (66.75%) on Vero cells.
Conclusion:
EAF of Picria fel-terrae Lour. herbs have cytoprotective activity.
... The American Heart Association recommends eating a healthy diet low in sodium, exercising regularly, maintaining a healthy weight, managing stress, and avoiding tobacco smoke to prevent hypertension. Regular consumption of green tea also may reduce the risk of hypertension (Yang et al., 2004, Cassileth, 2011. ...
In 1900, life expectancy in the U.S. was 47 years and infectious diseases were the leading cause of mortality; today, life expectancy in the U.S. is almost 80 years and chronic diseases are the leading causes of mortality. Eighty percent of adults 65 and older have multiple chronic health conditions, which are costly to treat. Offering older adults an evidence-based self-management program can reduce medical costs and improve patient outcomes and quality of life. Research has shown that self-efficacy is a key factor in effective self-management programs. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based program that helps patients to boost their self-efficacy and improve their disease self-management, under the supervision of a physician. In addition, the use of evidence-based complementary modalities is recommended as part of an integrative approach to self-management to help patients manage the daily anger, fear, and depression that frequently accompany living with an incurable disease.
... Herbal teas have long-since been used as therapeutic vehicles in Chinese, Indian and other indigenous medical systems [8][9][10]. Chamomile and peppermint are the basis of some of the most popular herbal teas, with the anti-inflammatory and anti-mutagenic responses to chamomile, and relaxation effects of peppermint oil on the gastrointestinal tract being characterised [11,12]. ...
Herbal teas are used as therapeutic vehicles in many forms of traditional medicine and are a popular global beverage. The purpose of this scoping review was to examine the evidence relating to the clinical efficacy and safety of herbal teas, and to identify the main research themes and gaps in knowledge to inform further work. A scoping review methodology was followed that set out the research question and described the sourcing, selection and analysis of studies. Overall, a total of 145 research publications were retrieved from global bibliographic databases, and after applying exclusion criteria, 21 remained. These studies looked at herbal tea use in female health, diabetes, heart disease and weight loss, with plant species including lavender, chamomile, fenugreek, stinging nettle, spearmint, hibiscus, yerba maté, echinacea and combinations of herbs. Observational studies explored associations between herbal tea consumption and cancer risk, liver health, and the risks linked to the consumption of environmental contaminants in the plant material. Despite plant materials being the basis for drug discovery, and the popularity of herbal teas, the number of articles exploring clinical efficacy and safety is small. In this review we discuss how herbal teas may be beneficial in some areas of clinical and preventative health, and what further research is required to understand whether regular consumption can contribute to healthy living more generally.
... Therefore, these higher levels of green tea catechins could be the driving factor for the lower levels of hypertension in this population sample, and similar findings have been reported in different population settings. For example, in Taiwanese men and women [49], habitual intake of green or oolong tea over 120 mL/day was associated with a reduced risk of developing hypertension. A recent systematic literature review with meta-analysis analyzed studies where green tea extracts high in catechins reduce systolic blood pressure, and total and LDL cholesterol levels [45]. ...
Tea is one of the most-widely consumed beverages in the world with a number of different beneficial health effects, mainly ascribed to the polyphenolic content of the tea catechins. The aim of this study was to examine the consumption of green, black, or no tea, in relation to the previously validated successful ageing index (SAI; higher values "healthier" ageing) in a combined analysis of adults aged >50 years old from the ATTICA (n = 1128 adults from Athens, Greece metropolitan area) and the MEDiterranean Islands Study (MEDIS) (n = 2221 adults from various Greek island and Mani) studies. After adjusting for age, sex, smoking, and coffee consumption, green tea was positively associated with SAI (b ± SE: 0.225 ± 0.055, p < 0.001), while black tea was negatively associated with SAI (unstandardized b coefficient ± Standard error: −0.807 ± 0.054, p < 0.001). Green tea (vs black tea) consumption, had higher odds of a SAI of over 3.58 out of 10 (OR: 1.77, 95% CI: 1.38-2.28). Green tea consumption was also associated with higher levels of physical activity (p < 0.001) and reduced likelihood of hypertension (p = 0.006) compared with black tea. Two possible mechanisms are that green tea possesses high levels of catechins such as (−)-epigallocatechin 3-gallate and l-theanine compared with black tea. Therefore, the present analysis supports both the role of green tea constituents in successful ageing, as well as its role as an important component of an overall healthy diet in adults aged 50 years and over from these two epidemiological studies.
Chin-shin oolong tea is the most widely planted variety in Taiwan. This study fermented eight whole grains fermentation starter (EGS) with light (LOT), medium (MOT), and fully (FOT) oxidized Chin-shin oolong teas for ten weeks. Comparing the three fermentation beverages, it was found that LOT fermentation can obtain the highest catechins (1644.56 ± 60.15 ppm) among the functional and antioxidant components. MOT can obtain the highest glucuronic acid (19,040.29 ± 2903.91 ppm), tannins, total phenols, flavonoids, and angiotensin-converting enzyme (ACE) inhibitory activity. FOT can obtain the highest GABA (1360.92 ± 123.24 ppm). In addition, both the LOT and MOT showed a significant increase in their ability to scavenge DPPH radicals after fermentation. EGS fermented with lightly or moderately oxidized Chin-shin oolong tea may be considered a novel Kombucha.
This Research Topic highlighted the need for discussion within the healthcare providing community to develop effective nutritional strategies, intended to promote healthier food consumption habits by reducing disease burden and improving oral health for all age range.
Objectives:
Whether the protective effects of tea consumption interact with the status of alcohol consumption remains unknown. The present study aimed to investigate the relationship between tea consumption and mortality and blood pressure changes between alcohol consumers and non-consumers in a Chinese population.
Methods:
This study was conducted with a cohort of 6387 participants from the China Health and Nutrition Survey data between 1993 and 2011. Group-based trajectory modeling was conducted to identify distinct tea consumption trajectories. Kaplan-Meier and Cox regression methods were used to estimate the cumulative rate of all-cause mortality. Restricted cubic spline was performed to determine the nonlinear relationships between mean tea consumption and mortality. Generalized linear mixed-effects models (GLMM) were conducted to assess the blood pressure changes among tea consumption trajectories.
Results:
We identified three tea consumption trajectories. After a median follow-up of 17.9 y, 580 (9.1%) participants died. The association between tea consumption and death interacted with alcohol drinking status. A lower morality risk for the high tea consumption trajectory was observed only in non-alcohol drinkers (hazard ratio, 0.56; 95% confidence interval, 0.40-0.77). The tea-mortality association was linear in current alcohol drinkers (Plinear = 0.002), demonstrating that mortality increased with increasing tea consumption. The results of GLMM showed that alcohol intake masked the protective effect against blood pressure progression.
Conclusions:
The results of this study demonstrated that individuals with a long-term high tea consumption trajectory had a lower risk for all-cause mortality and a slower blood pressure growth rate. The beneficial effects of tea consumption were attenuated by alcohol intake or even harmful to health.
Spices are indigenous plants flourishing well in Indonesia contain lots of bioactive compounds. It is potential to be developed as functional food products. The aims of this study are to examine the physicochemical properties of spice syrups composed of different ratios of cardamom and clove. This study employed an experimental design by identifying the effects of different ratios of cardamom and clove in spice syrup colored by teleng flowers (Clitoria ternatea). The collected data were then analyzed using the Independent Sample T-Test. Results showed that syrup with a higher ratio of cloves had a higher a- value (redness). Meanwhile, the L and b+ values were not different. The higher ratio of cloves used was also affected in accordance with chemical analysis results of beta-carotene, gallic acid, kaempferol, and quercetin that showed a higher value of syrup parameter. It can be summarized that using the ratio of cardamom and cloves has a significant effect on the physicochemical properties of spice syrup.
The immune system plays a key role in the defense and protection of the human being, and its protection and stability is fundamental to a good functioning of it. The regulation of this system is complex but highly structured and synchronized. Several phytomolecules can act as booster of this complex system promoting the proper functioning and performance of the immune system. New trends in this research topic are focused on finding bioactive molecules and phytochemicals to modulate the biologic immune response and enhance the ability to resist disease. Among these relevant bioactive molecules, catechin and epigallocatechin-3-gallate stand out for their bioactivity, specificity, and reactivity, being the point of analysis, and discussion of this chapter that aims to describe the important biological activity of both compounds as booster of the immune system.
Background and Objectives
Previous trials conducted on patients with type 2 diabetes mellitus (T2DM) showed controversial results regarding the efficacy of green tea (GT) in improving blood pressure (BP). We conducted a review and meta-analysis of randomized controlled trials (RCTs) to summarize the effect of GT supplementation on BP among patients with T2DM.
Methods and Study Design
Online databases, including PubMed/Medline, Scopus, and ISI web of science, were searched up to March 2021 to retrieve RCTs that examined the effect of GT on BP in patients with T2DM. Meta-analyses were carried out using a random effects model. The I2 index was used to evaluate the heterogeneity.
Results
Among the initial 854 studies identified from electronic databases search, ten trials, which included 681 participants, were eligible. Pooled effect size from 10 studies indicated that supplementary intake of GT had no significant effect on systolic blood pressure (SBP) (Mean Difference (MD): 0.00 mmHg, 95% CI: (-0.01, 0.01), p=0.997), with no significant heterogeneity between the studies (I2= 8.8%, p=0.356) and diastolic blood pressure (DBP) (MD: -0.90 mmHg, 95% CI: (-2.21, 0.41), p=0.178), with significant heterogeneity among the studies (I2=55.6%, p=0.006). Subgroup analysis revealed that GT supplementation lowers DBP when intervention is conducted on patients with elevated DBP.
Conclusion
Our meta-analysis revealed that although GT supplementation has no significant effect on general BP in patients with T2DM, it may significantly improve DBP in patients with T2DM who have high DBP.
The cardiovascular system (CVS) is made up of heart, blood vessels and blood. The fundamental function of the CVS is to transport substances to and from all parts of the body. The heart is the major pumping organ, pressurizing blood for circulation through the blood vessels and blood is propelled away from the heart in the arteries and returns to the heart through the veins. Cardiovascular diseases (CVD) is an umbrella word for a number of inter-linked diseases, generally defined as coronary artery disease (CAD), cerebrovascular disease, high blood pressure (BP), peripheral arterial disease, rheumatic and congenital heart diseases, venous thromboembolism and arrhythmia. Globally, Cardiovascular diseases (CVDs) are the leading cause of deaths and according to the estimation of the World Health Organization (WHO), about 17.9 million people died from CVDs in 2019, counting 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke. About 75% of CVD deaths occur in low-and middle-income countries. The burden of CVDs can be decreased by careful risk reduction (as such, modification of lifestyle, smoking & alcohol cessation, weight optimization by dieting, and physical exercise), and proper medical treatments including herbal components. The prevention of CVDs can reduce the occurrence of major cardiovascular events, thereby reducing premature disability, morbidity and mortality whilst prolonging survival and quality of life.
Oolong tea is one of the world's most popular non-alcoholic beverages, particularly in coastal Southeast China. Hitherto, epidemiological studies on the association between oolong tea consumption and the risk of patients with oral squamous cell carcinoma (OSCC) are very limited. This study aimed to evaluate the potential effect of oolong tea consumption on OSCC risk in Southeast China. From January 2010 to October 2020, face-to-face interviews were conducted for 744 newly diagnosed OSCC patients and 1,029 healthy controls to collect information on demographics, oolong tea consumption behaviors, and other lifestyle factors. Propensity score matching (PSM), inverse probability of treatment weight (IPTW), and stabilized inverse probability of treatment weight (SIPTW) were utilized to minimize confounding effects. Multivariate, conditional, and weighted logistic regression was used to evaluate the associations of oolong tea consumption behaviors with OSCC risk. Participants who drank oolong tea showed a lower risk of OSCC when compared to their non-drink counterparts [PSM population, OR (95%CI): 0.69 (0.49–0.97); SIPTW population, OR (95%CI): 0.74 (0.58–0.94)]. Moreover, the reduced risk was found to be significantly associated with certain tea-drinking habits (consumed amount over 500 mL per day, a duration of <20 years, age at initiation older than 30 years, and warm and moderately concentrated tea). Similar results were yielded in the sensitivity analyses (Multivariate adjustment and the IPTW analysis). Furthermore, subgroup analysis revealed that the negative association of oolong tea drinking with OSCC risk was more evident among those with poor oral hygiene. This study provides supportive evidence that oolong tea consumption may have a potentially beneficial effect in preventing OSCC, especially for those with poor oral hygiene.
The findings of various epidemiological studies, interventions using randomized controlled trials and mechanistic experiments have suggested a protective role of tea and its bioactive components in cardiovascular health. The potential of tea in the prevention of cardiovascular diseases (CVDs) has therefore attracted increasing research interest. Polyphenols, in particular flavonoids, found in both green and black tea, have been suggested to play a primary role in the reduction of CVD risk. While promising results regarding the effects of tea on blood pressure and other CVD-related biomarkers have been found in preclinical experiments, the effects demonstrated in human studies are modest and less satisfactory. This discrepancy may be explained, at least in part, by different research strategies used in human and animal research. However, since tea is globally one of the most commonly consumed beverages, even small beneficial effects in humans may shift the population distribution of CVD risk, with major implications for public health. However, research conducted to date does not yield sufficiently robust evidence to allow a recommendation as to an optimal level of tea consumption as an element of health policies seeking to prevent hypertension and improve cardiovascular health.
Cardiovascular disease is a chronic multifactorial health complication that is either directly or indirectly associated with pathophysiological mechanisms, including pro-oxidation, pro-inflammation, vascular and endothelial dysfunction, impaired platelet function, thrombosis, and others. The therapeutic options to circumvent cardiovascular complications include several phytomedicines, including green tea polyphenols. However, while many experimental and clinical studies report distinct mechanisms by which the polyphenols of green tea elicit a beneficial role in cardiometabolic health, the translation and applications of green tea polyphenols in clinics have yet to gain their optimal use on the broader population. This review critically appraises the various reported mechanisms of green tea polyphenols in modulating cardio-metabolic health and associated phyto-genomic challenges. Further, our review highlights the probability of gene polymorphic associated therapeutic variations in individuals using green tea for cardio-metabolic effects and the necessity to personalize green tea for clinical use, thereby improvising the risk-benefit ratio.
Statistical and international health organizations state that about 31% of all deaths worldwide are caused by cardiovascular disease (CVD), which represents the main cause of death associated with noncommunicable disease. Various researches performed in the last 10 years have shown the beneficial effects induced by polyphenolic compounds in reducing the risk factors for CVD, thus acting either as preventive factors and also, in some cases, as reparative ones, supporting the treatment of patients with chronic cardiovascular impairments. However, larger cohort of studies are still necessary in order to assess and integrate the potential beneficial effects along with data regarding the low bioavailability of the compounds and also with their potential to interfere with the chronic pharmacological treatment of the selected patients.KeywordsCardiovascular disease (CVD)BioavailabilityPolyphenolic compoundsPharmacological treatment
Free radicals also play a role in the pathology of various degenerative diseases such as cancer, rheumatism, coronary heart disease, cataracts, and others. Free radicals can come from within the body (endogenous) and outside the body (exogenous). Litsea cubeba (Lour,) is a Lauraceae family plant which have contents volatile oils which used as antimicrobial, anticancer on breast cancer, pesticide, antideppressants, antiinflammation, antioxidant, and neuro pharmacology. The extract was prepared using water with the soxhletation method. The antioxidant activity was determined with the 1,1-diphenyl-2-picrylhydrazyl (DPPH), 2,2’-Azinobis [3-ethylbenzothiazoline-6)-sulfonic acid] -diammonium salt (ABTS) and Ferric Reducing Antioxidant Power (FRAP) methods. Total flavonoid and total phenolic content were determined with colorimetric methods. Antioxidant activity measured as IC 50 was 23.37 ± 0.42 µg/mL; 111.21 ± 0.42 and 109.01 ± 0.28 respectively. The extract was found to contain high levels of total phenolic (282.93 ± 0.33 mg GAE/g) and total flavonoid 7.49 ± 0.51 mg QE/g). The results reveal that ethanol extract of Litsea cubeba Lour. Bark has antioxidant potential. The further analysis is to isolation antioxidant compound.
Purpose
It is argued that COVID-19 patients show various neuropsychiatric symptoms, including fatigue, depression and anxiety. On the other hand, epidemiological and experimental evidence indicated that green tea could potentially have antiviral effects and ameliorate psychiatric disorders. However, there is a lack of clinical evidence. The purpose of this study was to investigate whether drinking green tea can clinically improve psychiatric complications of COVID-19 infection.
Design/methodology/approach
This study included 40 patients with laboratory confirmed mild-to-moderate COVID-19 disorder in the current randomized open-label controlled trial. Patients were instructed to include three cups/day of green tea (intervention) or black tea (control) to their usual diet for four weeks immediately after diagnosis of the disease. At the study baseline and after the intervention, the enrolled patients’ fatigue, depression and anxiety were assessed by the Chalder Fatigue Scale, Beck Depression Inventory-Fast Screen and State-Trait Anxiety Inventory questionnaires.
Findings
A total of 19 COVID-19 cases in the intervention group (mean age = 52 years) and 14 cases (mean age = 50 years) in the control group completed the study. Analysis of covariance adjusted for baseline levels, and confounders revealed that those who consumed three cups/day of green tea compared to the patients who received black tea experienced significantly lower fatigue, depression and state and trait anxiety levels (adjusted means for fatigue = 12.3 vs 16.2 ( P = 0.03), depression = 0.53 vs 1.8 ( P = 0.01), 37.4 vs 45.5 ( P < 0.01) and 37.9 vs 45.2 ( P < 0.01)).
Research limitations/implications
The open-label design may bias the evaluation of the self-reported status of fatigue, depression or anxiety as the main outcomes assessed. Moreover, as this study did not include patients with severe COVID-19, this might affect the generalizability of the present results. Thus, the recommendation of daily drinking green tea may be limited to the subjects diagnosed with mild-to-moderate type of infection or those with long-term neuropsychiatric complications owing to COVID-19. Besides, considering the ethical issues, this study could not exclude the drug therapy’s confounding effects; thereby, this point should be considered when interpreting the current results. Besides, it is worth noting that Guilan province in the north of Iran is recognized as a tea (and particularly green tea) producing region; thereby, it is an available and relatively inexpensive product. Considering this issue, the recommendation to consume this medicinal plant in adjunct to the routine treatment approach among patients with mild-to-moderate COVID-19 based on its beneficial effects may be widely accepted.
Practical implications
Green tea consumption could be considered an option to combat COVID-19 associated psychological complications, including fatigue, depression and anxiety among patients suffering from mild-to-moderate type of this viral infection.
Originality/value
To the best of the authors’ knowledge, in this study, for the first time, the effects of green tea compared to black tea on COVID-19 associated fatigue, depression and anxiety status within an open-label controlled trial have been investigated.
Blood pressure (BP) and the incidence and severity of hypertension are affected by the intake of many nutrients as well as the person’s nutritional status, and particularly the presence or absence of obesity. Excessive energy intake and obesity are major causes of hypertension. Obesity is associated with alterations of many physiological processes that promote hypertension. These include increased activity of the renin–angiotensin–aldosterone and sympathetic nervous systems, probably increased activity of other mineralocorticoids, insulin resistance, salt-sensitive hypertension, excessive intake of sodium and chloride, and kidney disease that can reduce the glomerular filtration rate. High sodium chloride intake also strongly predisposes to hypertension. Excessive imbibing of ethyl alcohol may acutely elevate BP. On the other hand, higher intakes of potassium, polyunsaturated fatty acids, protein, and possibly vitamin D and physical exercise may lower BP. Other studies, of a less conclusive nature, suggest that certain amino acids, tea, green coffee bean extract, dark chocolate, and foods high in nitrates may reduce BP. Short-term studies indicate that specialized diets may prevent or ameliorate mild hypertension, most notably the dietary approaches to stop hypertension (DASH) diet, which is high in fruits, vegetables, and low-fat dairy products and the DASH low-sodium diet, which may lower BP even further. The Mediterranean diet is also reported to lower BP. This diet consists mainly of vegetables, fresh fruit, whole grains, fish and other kinds of seafood, legumes, nuts, olive oil, and red wine. However, long-term adherence to the foregoing diets may not be easy for many people because of food preferences. Growing evidence indicates that for many obese individuals with hypertension, bariatric surgery in association with lifestyle and diet counseling provides a reliable and effective method for reducing their BP.
The epimers of catechin include epicatechin, epigallocatechin and epigallocatechin gallate, and others. They are important bioactives that have salutary effects, and hence are valuable. For ascertaining biologically-safe and green extraction methods that are non-thermal, this review evaluates the efficiencies of ultrasound assisted extraction (UAE) and supercritical (SC) fluid extraction (with CO2). Standalone SC-CO2 could be preferred over UAE, given its selectivity (purer product, no co-extracts) and absence of downstream processing. GRAS solvents as water and ethanol or a hydro-alcoholic mix are preferable for UAE. However, considering the core competency of ultrasound in disrupting cell organelles, a tandem approach with sequential SC extraction is recommended to justify process economics and ensure quality yield of catechin using green technologies.
Polyphenols are dietary components extensively studied for their involvement in preventing cardiovascular disease, comorbidities of metabolic syndrome, age-related neurodegeneration, malignancies, etc., since populations that consume diets rich in fruits, vegetables, and fibers seem to have lower incidences such diseases compared to Western populations. Research shows that redox impairments and chronic low-grade inflammation generate a vicious biochemical self-propagating cycle, constituting the molecular pathological root of these diseases, and polyphenols are involved in mitigating them. Reviewing the molecular pathways modulated by these compounds, and integrating them with preclinical and, most of all, clinical data regarding the effects of these natural compounds are essential in gathering evidence supporting the potential use of polyphenols (supplements or through diet) for better control of cardiovascular risk.
Metabolic syndrome (MetS) increases the risk of cardiovascular disease (CVD) risk. Several epidemiological studies observed a negative association between polyphenol intake and MetS and CVD incidence rates. Additionally, several data suggest that polyphenol intake can alleviate MetS components by decreasing body weight, blood pressure, blood glucose levels, and improving lipid metabolism. Therefore a high intake of polyphenol-rich foods may prevent the development and progression of MetS and CVD. However, long-term randomized trials are required to develop public health strategies. This chapter has focused on the roles of polyphenols in preventing MetS and CVD.
Jackfruit leaves herbal drink is a functional beverage that contains a high antioxidant value. The addition of cinnamon and clove could improve the colour and aroma of jackfruit leaves herbal drink. The utilization of jackfruit leaves in herbal tea product is helpful to upgrade the usability of jackfruit leaves. This research aims to know the antioxidant capacity and antioxidant content (phenolics, flavonoids, tannins, saponins, gallic acid, kaempferol and quercetin) from 0.50%, 1% and 1.50% of jackfruit leaves. Herbal drink with the lowest hedonic score is 1 and the highest is 5. This research is including experiment research using Completely Random Design (CRD) with three kinds of treatment. The analyzed data using One Way ANOVA, if the treatments show a significant difference, then the analyzed data should be proceeded by Duncans Multiple Range Test with 5% confidence interval. The result is, the highest value of antioxidant capacity content (80.00 ppm), phenolics antioxidant (411.90 mg/l), flavonoids antioxidant (321.84 mg/l), tannin antioxidant (30.28 mg/l) saponin antioxidant (1.00 mg/l), gallic acid antioxidant (75.25 microgram/g), kaempferol antioxidant (22.38 microgram/g), quercetin antioxidant (32.33 microgram/g) in 1,5% Artocarpus heterophyllus drink. Base on the result, it can be concluded that the jackfruit leaves herbal drink product proven as a functional drink which contains a high antioxidant value.
This study aimed to investigate the chronic effects of green tea (GT) extract and resistance training (RT) on ambulatory and office blood pressure (BP), heart rate (HR), and rate‐pressure product (RPP) in a sample of Iranian women with high‐normal/stage 1 hypertension. Forty‐four middle‐aged sedentary women participated in this randomized, double‐blind, placebo‐controlled study. They were randomly assigned to one of four groups: GT and RT (GR, n = 11), RT (n = 10), GT (n = 10), or control (n = 13). Three weeks of GT consumption were followed by six weeks of the interaction with RT. GR and RT groups performed two circuits of RT at %50 of 1RM two days per week. RT and control groups also received placebo (maltodextrin) with the same timing. The changes of each variable from baseline to post‐intervention were compared between the groups using the ANOVA test, and effect size (ES) statistic was also calculated. In comparison with the control group, significant reductions were found for office systolic BP (SBP, 8%, ES = 1.22), and 24 h‐SBP (5%, ES = 1.2) in the RT group. However, GR group showed significant decreases in office SBP (10.5%, ES = 1.45), mean BP (8%, ES = 1.11), RPP (13%, ES = 1.47), 24 h‐SBP (5%, ES = 1.21), and 24 h‐RPP (10%, ES = 1.15). The interaction of regular RT and GT consumption seems to induce more beneficial effects on some important parameters including MBP and RPP when compared to RT or GT alone.
Chinese herbal tea, also known as Liang Cha or cooling beverage, is popular in South China. It is regarded as a quick-fix remedy to relieve minor health problems. Hedyotis diffusa Willd. (colloquially Baihuasheshecao) is a common ingredient of cooling beverages. H. diffusa is also used to treat cancer and bacterial infections. Owing to the high demand for H. diffusa, two common adulterants, Hedyotis brachypoda (DC.) Sivar and Biju (colloquially Nidingjingcao) and Hedyotis corymbosa (L.) Lam. (colloquially Shuixiancao), are commonly encountered in the market. Owing to the close similarity of their morphological characteristics, it is difficult to differentiate them. Here, we sequenced the complete chloroplast genomes of the three species of Hedyotis using next-generation sequencing (NGS). By comparing the complete chloroplast genomes, we found that they are closely related in the subfamily Rubioideae. We also discovered that there are significant differences in the number and repeating motifs of microsatellites and complex repeats and revealed three divergent hotspots, rps16-trnQ intergenic spacer, ndhD and ycf1. By using these species-specific sequences, we propose new DNA barcoding markers for the authentication of H. diffusa and its two common adulterants.
Chrysophyllum cainito L. is part of the family Sapotaceae and native to the Greater Antilles and the West Indies. This specie is a medicinal plant used around the world by many cultures, commonly known as “star apple” or “caimito”. Some studies have reported that C. cainito possesses many pharmacological properties as antidiabetic, anti-hypersensitivity, antihypertensive, anti-inflammatory, antimicrobial, antinociceptive, antioxidant, gastroprotective and immunosuppressive. Also, phytochemical evidence has revealed that the main secondary metabolites in C. cainito are alkaloids, tannins, flavonoids, phenols, sterols, coumarins and triterpenes which are responsible for their pharmacological benefits. In vitro and in vivo toxicology studies have suggested human consumption of Chrysophyllum cainito leaves as safe. This chapter includes scientific information of pharmacology, toxicology and phytochemistry of C. cainito seeds, leaves, and fruits with the purpose to contribute valuable scientific information to future research in drug development based on C. cainito as a source of raw material.
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Background and objectives
Tea consumption may contribute to the management of blood pressure; however, evidence from longitudinal studies is lacking. This study aimed to examine the relationship between habitual tea consumption and trajectories of systolic blood pressure in a community-based sample of Chinese adults aged 60 years or older.
Methods
A prospective cohort of 3,870 participants was investigated from 2014 to 2018. Trajectories of systolic blood pressure were identified using latent mixture modeling with the Proc Traj procedure. Multiple logistic regression models were fitted to explore associations between tea consumption habits and trajectories of systolic blood pressure.
Results
In the overall sample, participants were less likely to be habitual tea drinkers if they were in the “moderate-stable” (144.4 – 149.9 mm Hg), “moderate-increasing” (157.2 – 180.0 mm Hg), and “elevated-increasing” (184.7 – 209.8 mm Hg) groups as compared to those in the “low-stable” group (125.3 – 130.0 mm Hg). The “elevated-decreasing” group (170.7 – 167.2 mmHg) consistently showed no significant difference in the likelihood of habitual tea drinking as compared to the “low-stable” group.
Conclusions
This community-based prospective study indicated that habitual tea consumption was associated with relatively favorable long-term systolic blood pressure statuses.
Complementary and alternative medical (CAM) therapies can be defined as medical treatments that are not currently used as standard medical treatments in conventional Western medicine. CAM therapies can be categorized in five major groups: alternative medical systems like naturopathy and acupuncture, mind-body interventions like meditation and hypnotherapy, manipulative and body-based methods like massage therapy and chiropractic, energy therapies like reiki and polarity therapy, and biologically based treatments like herbal remedies and chelation therapy. These types of treatments are not taught widely in United States medical schools and are generally unavailable at U.S. hospitals. However, surveys dating back to 1990 show that the use of CAM therapies has become increasingly more widespread in the United States. As such, the market for such treatments has grown exponentially. For example, a 2001 survey from the Josiah Macy, Jr., Foundation showed that nearly 50% of Americans were using CAM therapies with an estimated 600 million visits to CAM practitioners per year and an estimated market of $30 billion annually. Yet despite the increase in the usage of and expenditure on CAM therapies, many CAM users do not talk to their physicians about CAM treatments. The main reasons given for this are that patients are not aware that they should discuss CAM with their physicians and their physicians do not ask them about CAM therapies. Thus, it is increasingly important for practitioners to gain familiarity with various forms of CAM and to specifically elicit and document a history of CAM usage from patients.
Camellia sinensis yapraklarının toplanarak çeşitli işlemler yapıldıktan sonra elde edilen çay, dünyada sudan sonra en çok tüketilen içecektir. Her zaman yeşil kalan çay, yağmurlu ve ılık iklimde yetişen bir bitkidir. Çayın türleri, koparılan yaprakların farklı işlemlerden geçirilmesiyle elde edilir. Bu işlemler; fermente olan (siyah çay) ile fermente olmayanlar (beyaz ve yeşil çay) ve yarı fermente olanlar (oolong çayı) olmak üzere üç gruba ayrılır. Her çay türü, yaprakların nasıl işlendiğine, olgunlaşma sürecine, coğrafi bölgeye ve tarımsal uygulamalara bağlı olarak ayrı bir bileşime sahiptir. Yapılan epidemiyolojik çalışmalar, çay ve bileşenlerinin özellikle flavonoidlerin, kardiyovasküler sistem üzerinde koruyucu etkileri olduğunu göstermiştir. Theaflavinler, thearubiginler gibi polifenoller ve özellikle kateşinler gibi bileşenler, antioksidan etkilerden sorumludur. Bu nedenle çay hipokolesterolemik, antiaterosklerotik, antibakteriyel, antioksidatif, antimutajenik, antikarsinojenik, antianjiyojenik, apoptotik gibi özellikleri içerir. Yapılan çalışmalar, günde 6-10 fincan (yaklaşık 960-1600 ml) çay tüketiminin kronik hastalıklardaki riski önemli oranda azalttığını göstermektedir. Bu çalışmada, çay içeriğindeki antioksidanların reaktif türlere karşı endojen savunma açısından yetersiz kaldığında oksidatif stres kaynaklı hastalıkların başlangıcını ve ilerlemesini engellemede büyük bir role sahip olduğu belirtilmiştir. Ayrıca çaydaki antioksidanların, kardiyovasküler hastalıklara karşı koruyucu etkileri ile ilgili yeni bulguları araştırmak amaçlanmıştır.
Elevated blood pressure affects a great part of the elderly population and is the leading risk factor for cardiovascular disease. New approaches have been taken in the fight against this growing problem, in the form of diets (Mediterranean, Dietary Approaches to Stop Hypertension (DASH) and intermittent fasting). Recent research has shown the promising results regarding diets and their effect on the prevention and improvement of elevated blood pressure. This review attempts to take this a step further, reviewing 26 studies in the search for dietary elements that may be causing this improvement. Although good evidence was found in favor of lycopene, Docosahexaenoic acid (DHA), fiber and anthocyanin, further evidence is needed before any conclusions can be made. In contrast, the evidence shows that licorice increases blood pressure.
The combined effect of diet and strength training (ST) on blood pressure (BP) seems to be very important for the treatment of prehypertension and hypertension (HT). Therefore, the aim of this study was to determine whether ST alone or combined with nutrition or supplementation has an impact on the arterial pressure reduction in normotensive and hypertensive populations. A systematic computerized literature search was performed according to the PRISMA guidelines using PubMed, Scopus and Google Scholar; only English language studies published from 1999 until 2018 were included. This systematic search identified the results of 303 individuals from nine studies. The ST program alone had a similar effectiveness as the nutrition program (NP) alone; however, their combination did not result in increased effectiveness in terms of a high BP reduction. The consumption of L-citrulline had a similar effect as ST on lowering BP; on the other hand, caffeine led to an increase in BP during the ST session. Our data suggest that a combination of ST 2–3 times a week at moderate intensity and a NP seems to be equally effective in terms of lowering BP (systolic and diastolic) as ST and NP alone.
Background:
Despite accumulating evidence on the protective effect of tea consumption against depression, studies specifically focusing on the elderly population are yet limited. This paper examined the association between the frequency and duration of tea drinking and depressive symptoms of older adults by gender and age groups, based on a nationally representative sample in China.
Method:
The study employed the panel data from 2005, 2008/2009, 2011/2012 and 2014 waves of Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used the frequency and consistency of tea drinking behaviors to identify four types of tea consumption amongst Chinese seniors. Depressive symptoms were assessed by a five-item scale. Linear mixed effects models were applied.
Results:
We found that consistent and frequent tea-drinking was associated with significantly less depressive symptoms, and such impact was partially mediated by socioeconomic status, health behavior, physical health, cognitive function, and social engagement. However, the association was only significant for males and the oldest-old, rather than females and younger elders.
Conclusions:
Consistent and frequent tea-drinking may effectively reduce the risk of depressive symptoms for the Chinese elderly. The promotion of the traditional lifestyle of tea drinking could be a cost-effective way towards healthy aging for China.
Background
Migraine is associated with syncope. We investigated risk factors for syncope and burden of syncope in migraine patients.
Methods
Participants were recruited from a headache clinic. All participants provided information on lifestyle, co-morbidity, syncope, headache and suicide, and completed the MIDAS and HADS questionnaires. Genetic data were available for a subset of participants. Risk of syncope in relation to participant’s characteristics and migraine susceptibility loci, and risks of psychological disorders associated with syncope, were calculated using logistic regression.
Results
Underweight, regular tea intake, diabetes mellitus, and migraine with aura were associated with increased syncope risks, with adjusted ORs of 1.76 (95% CI 1.03–3.03), 1.84 (95% CI 1.22–2.79), 4.70 (95% CI 1.58–13.95), and 1.78 (95% CI 1.03–3.10), respectively. Preliminary results showed that rs11172113 in LRP1 was associated with syncope risks. Comorbid syncope in migraine patients was associated with increased risks of depression (OR 1.95, 95% CI 1.18–3.22) and suicide attempt (OR 2.85, 95% CI 1.48–5.48).
Conclusion
Our study showed the potential roles of vascular risk factors in the association between migraine and syncope. Modifiable risk factors for syncope in patients with migraine include body mass index and tea intake. The debilitating psychological impact of co-morbid syncope in migraine patients warrants clinical attention of treating physicians.
Catechin in green tea might be able to reduce inflammatory mediators; therefore, in this study, we aimed to indicate green tea effects on inflammatory mediators such as tumor necrosis factor‐alpha (TNF‐α), C‐reactive protein (CRP), and interleukin‐6 (IL‐6). The advanced search methods of electronic databases were used to find randomized clinical trials that assessed green tea effect on inflammatory mediators among adult population. Google Scholar, PubMed/Medline, EMBASE, SCOPUS, and ISI Web of Science were searched until January 2019. Delphi checklist was used for assessing the quality of included articles. Mean changes in serum inflammatory biomarkers were calculated by subtracting endpoint values from the baseline in each study arm. Then the effect size for each selected study was estimated as the difference between mean changes in the intervention and control groups. We included 16 articles in our meta‐analysis and 17 articles in systematic review. Our results indicated that green tea could not significantly decrease serum CRP levels and significantly increased IL‐6 and significantly decreased TNF‐α levels. In conclusion, green tea might not be able to change inflammatory mediators especially in diseases with low inflammation, but scientists who want to assess green tea effect on inflammatory mediators should perform their study on patients with high inflammation. Studies exclusive on male or female and considering nutrients intake as a confounding factor are a necessity.
Cardiovascular diseases have overtaken cancers as the number one cause of death. Hypertension is the most dangerous factor linked to deaths caused by cardiovascular diseases. Many researchers have reported that tea has anti-hypertensive effects in animals and humans. The aim of this review is to update the information on the anti-hypertensive effects of tea in human interventions and animal studies, and to summarize the underlying mechanisms, based on ex-vivo tissue and cell culture data. During recent years, an increasing number of human population studies have confirmed the beneficial effects of tea on hypertension. However, the optimal dose has not yet been established owing to differences in the extent of hypertension, and complicated social and genetic backgrounds of populations. Therefore, further large-scale investigations with longer terms of observation and tighter controls are needed to define optimal doses in subjects with varying degrees of hypertensive risk factors, and to determine differences in beneficial effects amongst diverse populations. Moreover, data from laboratory studies have shown that tea and its secondary metabolites have important roles in relaxing smooth muscle contraction, enhancing endothelial nitric oxide synthase activity, reducing vascular inflammation, inhibiting rennin activity, and anti-vascular oxidative stress. However, the exact molecular mechanisms of these activities remain to be elucidated.
This study characterized the effects of regular green tea (GT) and hot water (HW) ingestion on systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and left ventricular hypertrophy (LVH) in two equal, sex‐ and age‐matched groups; Grp1 and Grp2 (n = 100 each; age 53 ± 4 years) of hypertensive patients. Grp1 had regular GT treatment, followed by HW ingestion, whereas Grp2 had HW ingestion followed by GT treatment for periods of 4 months each. Electrocardiographic (ECG) and echocardiographic assessments of LVH were made before and at the end of both periods. SBP was lowered significantly by 6.6%; DBP by 5.1%, and PP by 9.1% by the end of month 4 of GT treatment in Grp1. Upon GT cessation and HW ingestion, SBP, DBP, and PP returned to pretreatment levels over 4 months. In Grp2, SBP, DBP, and PP were reduced insignificantly by 1.5%, 1.0%, and 2.3% by the end of the 4th month of HW ingestion. Conversely, over 4 months of GT treatment, SBP, DBP, and PP were significantly lowered by 5.4%, 4.1%, and 7.7% from the baseline values, respectively. ECG and echocardiographic evidence of LVH was shown in 20% of Grp1 and 24% of Grp2 patients before intervention. This was significantly lowered to 8% and 10% in Grp1 and Grp2 by GT treatment. However, this increased to 16% following HW ingestion in Grp1. HW ingestion did mot induce regression of LVH in Grp2. Thus, regular GT ingestion has cardiovascular protective effects. This study characterized the effects of regular ingestion of green tea on pulse pressure and evaluated its potential influence on inducing regression of left ventricular hypertrophy in hypertensive patients for the first time. The findings of the study empirically suggest reversible protective cardiovascular effects of green tea in hypertension.
Background: Hypertension is a major public health problem worldwide. It is an important risk factor for other
cardiovascular diseases such as coronary artery disease, stroke, heart failure, atrial fibrillation, peripheral vascular
disease, chronic kidney disease, and atherosclerosis.
Purpose: There is strong evidence that excess ROS-derived NADPH oxidase (NOX) is an important agent in
hypertension. It augments blood pressure in the presence of other pro-hypertensive factors such as angiotensin II
(Ang II), an important and potent regulator of cardiovascular NADPH oxidase, activates NOX via AT1 receptors.
NADPH oxidase, a multi-subunit complex enzyme, is considered as a key source of ROS production in the
vasculature. The activation of this enzyme is needed for assembling Rac-1, p40phox, p47phox and p67phox subunits.
Since, hypertensive patients need to control blood pressure for their entire life and because drugs and other
chemicals often induce adverse effects, the use of natural phenolic compounds which are less toxic and potentially
beneficial may be good avenues of addition research in our understand of the underlying mechanism
involved in hypertension. This review focused on several natural phenolic compounds as berberine, thymoquinone,
catechin, celastrol, apocynin, resveratrol, curcumin, hesperidine and G-hesperidine, and quercetin
which are NOX inhibitors. In addition, structure activity relationship of these compounds eventually as the most
inhibitors was discussed.
Methods: This comprehensive review is based on pertinent papers by a selective search using relevant keywords
that was collected using online search engines and databases such as ScienceDirect, Scopus and PubMed. The
literature mainly focusing on natural products with therapeutic efficacies against hypertension via experimental
models both in vitro and in vivo was identified.
Results: It has been observed that these natural compounds prevent NADPH oxidase expression and ROS production
while increasing NO bioavailability. It have been reported that they improve hypertension due to formation
of a stable radical with ROS-derived NADPH oxidase and preventing the assembly of NOX subunites.
Conclusion: It is clear that natural phenolic compounds have some potential inhibitory effect on NADPH oxidase
activity. In comparison to other phenolic plant compounds, the structural variability of the flavonoids should off
THE PURPOSE of the "Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" (JNC VI) is to provide guidance for primary care clinicians. The committee recognizes that the responsible clinician's judgment of the individual patient's needs remains paramount. Therefore, this national guideline should serve as a tool to be adapted and implemented in local and individual situations. Using evidence-based medicine and consensus, the report updates contemporary approaches to hypertension control. Among the issues covered are the important need for prevention of high blood pressure by improving lifestyles, the cost of health care, the use of self-measurement of blood pressure, the role of managed care in the treatment of high blood pressure, the introduction of new combination antihypertensive medications and angiotensin II receptor blockers, and strategies for improving adherence to treatment. The JNC VI report places more emphasis than earlier reports on absolute
Endothelium regulates vascular tone by influencing the contractile activity of vascular smooth muscle. This regulatory effect of the endothelium on blood vessels has been shown to be impaired in atherosclerotic arteries in humans and animals and in animal models of hypertension.
To determine whether patients with essential hypertension have an endothelium-dependent abnormality in vascular relaxation, we studied the response of the forearm vasculature to acetylcholine (an endothelium-dependent vasodilator) and sodium nitroprusside (a direct dilator of smooth muscle) in 18 hypertensive patients (mean age [+/- SD], 50.7 +/- 10 years; 10 men and 8 women) two weeks after the withdrawal of antihypertensive medications and in 18 normal controls (mean age, 49.9 +/- 9; 9 men and 9 women). The drugs were infused at increasing concentrations into the brachial artery, and the response in forearm blood flow was measured by strain-gauge plethysmography.
The basal forearm blood flow was similar in the patients and controls (mean +/- SD, 3.4 +/- 1.3 and 3.7 +/- 0.8 ml per minute per 100 ml of forearm tissue, respectively; P not significant). The responses of blood flow and vascular resistance to acetylcholine were significantly reduced in the hypertensive patients (P less than 0.0001); maximal forearm flow was 9.1 +/- 5 ml per minute per 100 ml in the patients and 20.0 +/- 8 ml per minute per 100 ml in the controls (P less than 0.0002). However, there were no significant differences between groups in the responses of blood flow and vascular resistance to sodium nitroprusside. Because the vasodilator effect of acetylcholine might also be due to presynaptic inhibition of the release of norepinephrine by adrenergic nerve terminals, the effect of acetylcholine was assessed during phentolamine-induced alpha-adrenergic blockade. Under these conditions, it was also evident that the responses to acetylcholine were significantly blunted in the hypertensive patients (P less than 0.03).
Endothelium-mediated vasodilation is impaired in patients with essential hypertension. This defect may play an important part in the functional abnormalities of resistance vessels that are observed in hypertensive patients.
Anecdotes have long suggested that caffeine-containing beverages and other personal habits and excesses trigger palpitations and cardiac extrasystoles. We took the opportunity of a systematic population survey of 7311 men, aged 37–57 yr and free of any history of heart disease or diabetes, to examine the association of ventricular premature beats (VPB) with food and drink, cigarette smoking and sleep habits. Blood pressure and serum cholesterol were also measured and a 2-min rest electrocardiogram recorded at a screening station.In multiple regression analysis a significant relationship with prevalence of VPB was found for age and for the average daily number of cups of tea or coffee consumed, adjusting simultaneously for the influence of other factors. Heavy coffee consumption (≥9 cups/day) was associated with more than twice the likelihood of VPB being present at any age, compared to light consumption (≤2 cups/day) or abstinence.
Hypertension is a major risk factor for coronary artery disease, stroke, renal failure, and peripheral vascular disease. The importance of preventing hypertension and controlling blood pressure in patients with hypertension is well established and is associated with reduced cardiovascular morbidity and mortality rates. Treatment guidelines should consider the merits of dietary changes in addition to pharmacologic therapy in the control of mild hypertension.
Previous reports have indicated that coffee drinking is associated with an unhealthy lifestyle, compared with tea drinking, which may confound the effect in relation to coronary risk factors.
In a population sample of 2,400 25- to 64-year-old men and women, associations of lifestyle factors with coffee and tea consumption were analyzed. Lifestyle factors were related to four realms of behavior: smoking, eating, drinking, and physical activity.
Overall response rate exceeded 77%. Twenty-two behavioral factors were included in the analysis and controlled for age and sex. Mean daily cigarette consumption, the consumption of main fat sources (meat and sausages) and lemonade drinking increased with coffee and decreased with tea consumption. Conversely, intake of fresh fruits, drinking of juice or mineral water, and physical activity on the way to work decreased with coffee and increased with tea. The strongest associations were between coffee, than tea, and cigarette smoking. Controlling smoking (and physical activity) changed trends mainly with respect to alcoholic drinks.
We conclude that drinking coffee is positively associated with factors that promote coronary heart disease, while drinking tea is associated with a preventive lifestyle. Factors supporting these results were found located in all realms of lifestyle for both for coffee and tea. Therefore, investigations on the health effects of coffee and tea must be carefully controlled for confounding behavioral parameters.
Antioxidant flavonols and their major food source, black tea, have been associated with a lower risk of ischemic heart disease (IHD) and stroke in Dutch men. We investigated whether flavonol intake predicted a lower rate of IHD in 1900 Welsh men aged 45-59 y, who were followed up for 14 y. Flavonol intake, mainly from tea to which milk is customarily added, was not related to IHD incidence [relative risk (RR), highest compared with lowest quartile: 1.0; 95% CI: 0.6, 1.6; P for trend = 0.996; n = 186] but was weakly positively related to IHD mortality (RR: 1.6; 95% CI: 0.9, 2.9; P = 0.119; n = 131) and cancer mortality (RR: 1.3; 95% CI: 0.7, 2.3; P = 0.150; n = 104) and strongly related to total mortality (RR: 1.4; 95% CI: 1.0, 2.0; P = 0.014; n = 334). Men with the highest consumption of tea (> 1.2 L, or > 8 cups/d) had an RR of 2.4 (95% CI: 1.5, 3.9) of dying in the follow-up period compared with men consuming < 300 mL/d (< 2 cups/d). We conclude that intake of antioxidant flavonols is not inversely associated with IHD risk in the United Kingdom. Possibly, flavonols from tea to which milk is added are not absorbed; experimental evidence suggests that adding milk to tea abolishes the plasma antioxidant-raising capacity of tea. The apparent association between tea consumption and increased mortality in this population merits further investigation.
Thirty-one men (47 (SD 14) years) and thirty-four women (35 (SD 13) years) took part in a 4-week randomized cross-over trial to compare the effect of six mugs of black tea daily v. placebo (water, caffeine, milk and sugar) on blood lipids, bowel habit and blood pressure, measured during a run-in period and at the end of weeks 2, 3 and 4 of the test periods. Compliance was established by adding a known amount of p-aminobenzoic acid (PABA) to selected tea bags, and then measuring its excretion in urine. Mean serum cholesterol values during run-in, placebo and on tea drinking were 5.67 (SD 1.05), 5.76 (SD 1.11) and 5.69 (SD 1.09) mmol/l (P = 0.16). There were also no significant changes in diet, LDL-cholesterol, HDL-cholesterol, triacylglycerols, and blood pressure in the tea intervention period compared with placebo. Compared with placebo, stool consistency was softened with tea (P = 0.04), and no other differences were found in bowel habit. Results were unchanged when fifteen 'non-compliers', whose PABA excretion indicated that fewer than six tea bags had been used, were excluded from the analysis, and when differences between run-in and tea periods were considered separately for those who were given tea first or second.
Diabetes mellitus is one of the major health care problems in Taiwan, since the mortality rate has increased from 7.91 per 100,000 in 1980 to 35.1 per 100,000 in 1996. To determine the prevalence of diabetes in southern Taiwan and to investigate possible associated factors, a stratified systematic cluster sampling of 1638 subjects (780 men and 858 women) aged > or =20 years living in Tainan city was investigated with a standard 75-g oral glucose tolerance test. The crude prevalence of diabetes in Tainan was 9.0% (10.3% men and 7.9% women) and the age-adjusted prevalence was 9.2% (10.4% men and 8.1% women). The crude prevalence of IGT was 14.0% (13.8% men and 14.1% women), and the age-adjusted prevalence was 15.5% (15.0% men and 15.9% women). The prevalence of diabetes by using the revised new diagnostic criteria was 7.5%. The prevalence of diabetes and IGT increased significantly with age for both genders, although the rises in prevalence of IGT in women was less consistent. Diabetic and IGT subjects were older and had higher levels of BMI, triglyceride, systolic and diastolic blood pressure, and higher prevalence of obesity, hypertension, and dyslipidemia but indulged in less physical activity than non-diabetic subjects. The significant factors associated with the newly diagnosed diabetes were age, family history of DM, BMI, systolic blood pressure, physical activity, and serum triglyceride levels.
A higher intake of black tea has been associated with lower cardiovascular disease risk. The antioxidant effects of tea polyphenols may enhance endothelial function and thereby reduce the risk of coronary events. The objective of the present study was to determine whether regular ingestion of black tea can improve brachial artery vasodilator function. The effects of regular ingestion of 5 cups per day of black tea for 4 weeks were compared with control conditions (hot water ingestion) in 21 subjects with mild elevations in serum cholesterol or triacylglycerol (triglyceride) concentrations in a parallel designed study. Endothelial function of the brachial artery was assessed ultrasonographically by measurement of post-ischaemic (endothelium-dependent) dilatation of the brachial artery. Endothelium-independent dilatation of the brachial artery was measured following administration of 400 microg of sublingual glyceryl trinitrate. Regular ingestion of black tea resulted in a significant and consistent increase in endothelium-dependent dilatation (2.3%; P=0.008) and in a significant increase in endothelium-independent dilatation (4.2%; P=0.03), compared with ingestion of hot water. These differences remained after adjustment for age, sex and body mass index. These results suggest that one mechanism by which black tea may reduce cardiovascular risk is via improved vasodilator function of conduit arteries.
Tea is an important dietary source of flavanols and flavonols. In vitro and animal studies provide strong evidence that tea polyphenols may possess the bioactivity to affect the pathogenesis of several chronic diseases, especially cardiovascular disease and cancer. However, the results from epidemiological and clinical studies of the relationship between tea and health are mixed. International correlations do not support this relationship although several, better controlled case-referent and cohort studies suggest an association with a moderate reduction in the risk of chronic disease. Conflicting results between human studies may arise, in part, from confounding by socioeconomic and lifestyle factors as well as by inadequate methodology to define tea preparation and intake. Clinical trials employing putative intermediary indicators of disease, particularly biomarkers of oxidative stress status, suggest tea polyphenols could play a role in the pathogenesis of cancer and heart disease.
Tea is an important dietary source of flavanols and flavonols. In vitro and animal studies provide strong evidence that tea polyphenols may possess the bioactivity to affect the pathogenesis of several chronic diseases, especially cardiovascular disease and cancer. However, the results from epidemiological and clinical studies of the relationship between tea and health are mixed. International correlations do not support this relationship although several, better controlled case-referent and cohort studies suggest an association with a moderate reduction in the risk of chronic disease. Conflicting results between human studies may arise, in part, from confounding by socioeconomic and lifestyle factors as well as by inadequate methodology to define tea preparation and intake. Clinical trials employing putative intermediary indicators of disease, particularly biomarkers of oxidative stress status, suggest tea polyphenols could play a role in the pathogenesis of cancer and heart disease.
This meta-analysis of tea consumption in relation to stroke, myocardial infarction, and all coronary heart disease is based on 10 cohort studies and seven case-control studies. The study-specific effect estimates for stroke and coronary heart disease were too heterogeneous to be summarized (homogeneity p < 0.02 for stroke, p < 0.001 for coronary heart disease). Only the relative risk estimates for myocardial infarction (seven studies) appeared reasonably homogeneous (homogeneity p = 0.20). The incidence rate of myocardial infarction is estimated to decrease by 11% with an increase in tea consumption of 3 cups per day (fixed-effects relative risk estimate = 0.89, 95% confidence interval: 0.79, 1.01) (1 cup = 237 ml). However, evidence of bias toward preferential publication of smaller studies that suggest protective effects urges caution in interpreting this result. The geographic region where the studies were conducted appeared to explain much of the heterogeneity among coronary heart disease, myocardial infarction, and probably stroke results. With increasing tea consumption, the risk increased for coronary heart disease in the United Kingdom and for stroke in Australia, whereas the risk decreased in other regions, particularly in continental Europe. Am J Epidemiol 2001;154:495-503.
The effects of green tea tannin on blood pressure were examined for rats with adenine-induced hypertension and renal failure. The systolic, mean, and diastolic blood pressure values were decreased by green tea tannin administration, whereas the urinary levels of kallikrein, prostaglandin E2, and sodium were increased. No remarkable change was observed in the plasma renin activity. The angiotensin II and aldosterone levels were also unchanged in rats to which green tea tannin was administered. The mechanism for the depressor action of green tea tannin is discussed on the basis of these findings. © 1994, Japan Society for Bioscience, Biotechnology, and Agrochemistry. All rights reserved.
The effect of γ-glutamylmethylamide(GMA), one of the components of green tea extract, on the blood pressure in spontaneously hypertensive rats (SHR) was investigated. The effect of glutamic acid and r-glutamylethylamide (theanine), which is structually similar to GMA, was also examined. When SHR were injected with glutamic acid (2000mg/kg), the blood pressure was not altered. The same dose of theanine decreased it significantly. GMA administration to SHR reduced the blood pressure significantly, and its degree of hypotensive action was more effective than that by theanine administration.
Epidemiological studies have indicated a protective role of dietary flavonoids in cardiovascular disease, but evidence is still conflicting. Tea is the major dietary source for flavonoids in Western populations. We studied the association of tea intake with aortic atherosclerosis in a general population.
The present analysis formed part of the Rotterdam Study, a prospective study of men and women 55 years and older. Dietary intakes were assessed at baseline by a trained dietician who used a semiquantitative food frequency questionnaire. Calcified plaques in the abdominal aorta were radiographically detected after 2 to 3 years of follow-up. Aortic atherosclerosis was classified as "mild," "moderate," or "severe," according to the length of the calcified area (<1 cm, 1-5 cm, and >5 cm, respectively). The association of tea intake with severity of aortic atherosclerosis was studied in 3454 subjects who were free of cardiovascular disease at baseline. Data were analyzed by logistic regression, adjusting for age, sex, body mass index (calculated as weight in kilograms divided by the square of height in meters), smoking, education, and intake of alcohol, coffee, vitamin antioxidants, total fat, and total energy.
Multivariable analyses showed a significant, inverse association of tea intake with severe aortic atherosclerosis. Odds ratios decreased from 0.54 (95% confidence interval [CI], 0.32-0.92) for drinking 125 to 250 mL (1-2 cups) of tea to 0.31 (CI, 0.16-0.59) for drinking more than 500 mL/d (4 cups per day). The associations were stronger in women than in men. The association of tea intake with mild and moderate atherosclerosis was not statistically significant.
This study indicates a protective effect of tea drinking against ischemic heart disease.
Background: The flavonoid components of tea have been associated in epidemiological studies with a decreased risk of cardiovascular disease. Flavonoids have been shown to have antioxidant and vasodilator effects in vitro; we therefore postulated that drinking green or black tea attenuates the well-characterized acute pressor response to caffeine and lowers blood pressure during regular consumption.
Objective: To determine whether green and black tea can attenuate the transient pressor effect of caffeine, or lower blood pressure during regular consumption.
Methods: In the first study, the acute effects of four hot drinks - green tea and black tea (at a dose equivalent to four standard cups), water matched to the teas for caffeine content ('caffeine') and water - were assessed in 20 normotensive men using a Latin-Square designed study. Clinic blood pressure was measured before and 30 and 60 min after each drink had been ingested. In the second study, the effects on blood pressure of regular green and black tea ingestion were examined in 13 subjects with high-normal systolic blood pressure and mild systolic hypertension (systolic blood pressure in the range 130-150 mmHg) using a three-period crossover study. Five cups per day of green tea, black tea and caffeine (in hot water and matched to the teas) were consumed for 7 days each, in random order. Twenty-four hour ambulatory blood pressure was measured at the end of each seven-day intervention. Results are presented as means and 95% confidence intervals (CI).
Results: An acute pressor response to caffeine was observed. Relative to caffeine, there were further acute increases in systolic and diastolic blood pressure at 30 min among those drinking green tea [5.5 mmHg (95%CI -21.4 to 12.4) and 3.1 mmHg (95%CI -0.1 to 6.3), respectively] and black tea [10.7 mmHg (95%CI 4.0 to 17.4) and 5.1 mmHg (95%CI 1.8 to 8.4), respectively]. The changes in blood pressure at 60 min were not significant. The effect on 24-h ambulatory systolic and diastolic blood pressure of regular drinking of green tea [increases of 1.7 mmHg (95%CI -1.6 to 5.0) and 0.9 mmHg (95%CI -1.3 to 3.1), respectively] or black tea [increase of 0.7 mmHg (95%CI -2.6 to 4.0) and decrease of 0.7 mmHg (95%CI -2.9 to 1.5), respectively] was not significant relative to caffeine.
Conclusions: Contrary to our initial hypothesis, tea ingestion caused larger acute increases in blood pressure than caffeine alone. However, any acute effects of tea on blood pressure did not translate into significant alterations in ambulatory blood pressure during regular tea consumption.
Heavy cigarette smoking (current smoking with greater than 15-pack-year smoking history), along with 13 other variables, were tested for their ability to predict death in 196 patients with clinical Stage I melanoma. A stepwise proportional hazards general linear model (Cox multivariate analysis) showed that although heavy cigarette smoking as a single variable is an adverse prognostic marker (P = 0.0065), it has only suggestive prognostic significance once thickness factors are taken into account (P = 0.0747). People who stopped smoking had the same survival as nonsmokers. Clinical Stage I patients with melanoma who were heavy smokers presented with thicker lesions than their nonsmoking counterparts (P = 0.037). Although cigarette smoking may play a role in the biologic behavior of melanoma by mediating an effect on thickness, it need not be considered as an independent stratification criterion when analyzing results of melanoma prognosis or treatment.
Background and methods:
The relation of tea to cholesterol, systolic blood pressure, and mortality from coronary heart disease and all causes was studied in 9,856 men and 10,233 women without history of cardiovascular disease or diabetes. All men and women 35-49 years of age from the county of Oppland (Norway) were invited to participate; the attendance rate was 90%.
Results:
Mean serum cholesterol decreased with increasing tea consumption, the linear trend coefficient corresponded to a difference of 0.24 mmol/liter (9.3 mg/dl) in men and 0.15 mmol/liter (5.8 mg/dl) in women between drinkers of less than one cup and those of five or more cups/day, when other risk factors were taken into account. Systolic blood pressure was inversely related to tea with a difference between the same two tea groups of 2.1 mm in men and 3.5 mm in women. Altogether 396 men and 237 women died from all causes, and of these 141 and 18, respectively, died from coronary heart disease during the 12-year follow-up period. The mortality rate was higher (not statistically significant) among persons drinking no tea or less than one cup compared with persons drinking one or more cups/day. This applies to men and women and to coronary heart disease and all-cause mortality. For men, the relative risk (one or more versus less than one cup) for coronary death from Cox regression was 0.64 (95% CI:0.38, 1.07).
METHODS. The relation between green tea consumption and serum lipid concentrations was examined using cross-sectional data on 1,306 males who received the retirement health examination at the Self-Defense Forces Fukuoka Hospital between October 1986 and December 1988. RESULTS. After adjustment for rank, smoking, alcohol use, physical activity, and body mass index, serum total cholesterol levels were found to be inversely related to the consumption of green tea while no association was noted with serum triglycerides and high-density lipoprotein cholesterol. Adjusted mean concentrations of total cholesterol were 8 mg/dl lower in men drinking nine cups or more per day than in those consuming zero to two cups per day. Serum cholesterol levels were inversely associated with traditional Japanese dietary habits (intake of rice and soy bean paste soup) and positively associated with Westernized habits. Additional adjustment for these dietary variables did not alter the inverse relation between green tea and total cholesterol.
Tea is grown in about 30 countries but is consumed worldwide, although at greatly varying levels. It is the most widely consumed beverage aside from water with a per capita worldwide consumption of approximately 0.12 liter per year. Tea is manufactured in three basic forms. Green tea is prepared in such a way as to preclude the oxidation of green leaf polyphenols. During black tea production oxidation is promoted so that most of these substances are oxidized. Oolong tea is a partially oxidized product. Of the approximately 2.5 million metric tons of dried tea manufactured, only 20% is green tea and less than 2% is oolong tea. Green tea is consumed primarily in China, Japan, and a few countries in North Africa and the Middle East. Fresh tea leaf is unusually rich in the flavanol group of polyphenols known as catechins which may constitute up to 30% of the dry leaf weight. Other polyphenols include flavanols and their glycosides, and depsides such as chlorogenic acid, coumarylquinic acid, and one unique to tea, theogallin (3-galloylquinic acid). Caffeine is present at an average level of 3% along with very small amounts of the other common methylxanthines, theobromine and theophylline. The amino acid theanine (5-N-ethylglutamine) is also unique to tea. Tea accumulates aluminum and manganese. In addition to the normal complement of plant cell enzymes, tea leaf contains an active polyphenol oxidase which catalyzes the aerobic oxidation of the catechins when the leaf cell structure is disrupted during black tea manufacture. The various quinones produced by the enzymatic oxidations undergo condensation reactions which result in a series of compounds, including bisflavanols, theaflavins, epitheaflavic acids, and thearubigens, which impart the characteristic taste and color properties of black tea. Most of these compounds readily form complexes with caffeine. There is no tannic acid in tea. Thearubigens constitute the largest mass of the extractable matter in black tea but their composition is not well known. Proanthocyanidins make up part of the complex. Tea peroxidase may be involved in their generation. The catechin quinones also initiate the formation of many of the hundreds of volatile compounds found in the black tea aroma fraction. Green tea composition is very similar to that of the fresh leaf except for a few enzymatically catalyzed changes which occur extremely rapidly following plucking. New volatile substances are produced during the drying stage. Oolong tea is intermediate in composition between green and black teas.
Although active oxygen species play important roles in the pathogenesis of various diseases, the molecular mechanism for oxygen toxicity in vascular diseases remains to be elucidated. Since endothelium-derived relaxing factor (EDRF) is inactivated by superoxide radicals in vitro, oxidative stress in and around vascular endothelial cells may affect the circulatory status of animals. To study the role of superoxide radicals and related enzymes, such as superoxide dismutase (SOD), in vascular diseases, we have developed a fusion protein (HB-SOD) consisting of human Cu/Zn-type SOD and a C-terminal basic peptide with high affinity for heparan sulfate on endothelial cells. When injected intravenously, HB-SOD bound to vascular endothelial cells, underwent transcellular transport, and localized within vascular walls by a heparin-inhibitable mechanism. The blood pressure of spontaneously hypertensive rats (SHR) but not normal animals was decreased significantly by HB-SOD. Heparin inhibited the depressor effect of HB-SOD. In contrast, native SOD had no effect on blood pressure of either SHR or normal rats. Neither H2O2-inactivated HB-SOD nor the C-terminal heparin-binding peptide showed such a depressor effect, suggesting that the catalytic function of HB-SOD is responsible for its depressor action. To know the source of superoxide radicals, we determined xanthine oxidase activity in the aorta and uric acid levels in the plasma. Although no appreciable difference in xanthine oxidase activity was found between the two animal groups, uric acid levels were significantly higher in SHR than in normal rats. Oxypurinol, a potent inhibitor of xanthine oxidase, also decreased the blood pressure of SHR but not of normal rats. These findings indicate that superoxide radicals in and around vascular endothelial cells play critical roles in the pathogenesis of hypertension of SHR.
Because of conflicting evidence about the relation of coffee use to coronary artery disease, the authors conducted a new cohort study of hospitalizations among 101,774 white persons and black persons admitted to Kaiser Permanente hospitals in northern California in 1978-1986. In analyses controlled for eight covariates, use of coffee was associated with higher risk of myocardial infarction (p = 0.0002). Compared with nondrinkers of coffee, the following relative risks (RRs) were found: at 1-3 cups/day, RR = 1.14 (95% confidence interval (CI) 0.91-1.42); at 4-6 cups/day, RR = 1.42 (CI 1.10-1.84), p = 0.007; and at greater than 6 cups/day, RR = 1.41 (CI 1.00-1.99), p = 0.05. The relation remained significant when also controlled for blood cholesterol, blood glucose, blood pressure, and adiposity, singly or combined. Tea use was unrelated to myocardial infarction; neither coffee nor tea was related to other coronary diagnoses. Although causality remains unestablished and uncertainty remains, the authors conclude that 1) these data suggest a weak independent relation of coffee use to acute myocardial infarction, not mediated by an effect on blood cholesterol; and 2) persons at risk of myocardial infarction should consider limitation of coffee intake to less than 4 cups/day.
Resistant hypertension has become a less frequently encountered clinical problem. It may be defined as failure to control pressure below levels of 160/100 mm Hg despite adequate nonpharmacological intervention and pharmacotherapy. Adequate therapy is defined as the use of three antihypertensive agents, which includes a diuretic plus two other compounds. Resistant hypertension may be classified as physician resistant, patient resistant, and hypertension resistant. Each of these categories is described, and resolution of the problem of resistance can usually be achieved by improved patient education and adherence to therapy, reevaluation of diagnosis, and consideration of alternative therapeutic programs.
Thirty-four males and 45 females who participated in household surveys 15 or 25 years earlier in rural Denmark were interviewed in 1982 about present and past food habits. Comparison of the information from the survey and the two interviews indicates that recall of past diet is strongly influenced by present dietary habits. As the relative classification of individuals according to their food habits appears to have changed little over time, information on current diet, perhaps supplemented by information on particular changes, can provide useful classification of individuals for epidemiologic purposes.
The effect of theanine, one of the components of green tea, on the blood pressure and brain 5-hydroxyindoles in spontaneously hypertensive rats (SHR) and Wistar Kyoto rats (WKY) was investigated by intraperitoneally administering theanine. The effect of glutamine, which is structurally similar to theanine, was also examined. When SHR were injected with various amounts of theanine (0, 500, 1000, 1500, and 2000 mg/kg), the change was dose-dependent, and a significant decrease in blood pressure was observed with the high doses (1500 and 2000 mg/kg). A dose of 2000 mg/kg of theanine did not alter the blood pressure of WKY, while the same dose to SHR decreased it significantly. On the other hand, glutamine administration to SHR did not change either the blood pressure or the heart rate. The brain 5-hydroxyindole level was significantly decreased by theanine administration to both WKY and SHR, the decrease being dose-dependent.
In a previous study (Am J Physiol 1993;265: H774-8), we found that certain red wines and other grape products caused endothelium-dependent vasorelaxation. In the present study, aqueous extracts of a variety of vegetables, fruits, teas, nuts, herbs, and spices were tested for their endothelium-dependent relaxing ability in vitro. Rings of rat aorta, with or without an intact endothelium, were mounted in tissue baths, contracted with phenylephrine, and then exposed to diluted plant extracts. Many, but not all, extracts exhibited endothelium-dependent relaxations that were reversed by NG-monomethyl-L-arginine, a nitric oxide synthase inhibitor, which suggested involvement of nitric oxide, the endothelium-derived relaxing factor in the response. Furthermore, extracts that caused relaxation also increased tissue levels of cyclic GMP, the mediator of nitric oxide-induced vascular smooth-muscle relaxation. These results may lend further support to mounting evidence that plant foods contain compounds that, if absorbed intact and in sufficient quantities, could conceivably be beneficial in prevention of cardiovascular disease.
The relative antioxidant activities, against radicals generated in the aqueous phase, of a range of plant-derived polyphenolic flavonoids, constituents of fruit, vegetables, tea and wine, have been assessed. The results show that compounds such as quercetin and cyanidin, with 3',4' dihydroxy substituents in the B ring and conjugation between the A and B rings, have antioxidant potentials four times that of Trolox, the vitamin E analogue. Removing the ortho-dihydroxy substitution, as in kaempferol, or the potential for electron delocalisation by reducing the 2,3 double bond in the C ring, as in catechin and epicatechin, decreases the antioxidant activity by more than 50%, but these structures are still more effective than alpha-tocopherol or ascorbate. The relative significance of the positions and extents of hydroxylation of the A and B rings to the total antioxidant activity of these plant polyphenolics is demonstrated.
γ-Aminobutyric acid (GABA) is known to be involved in the regulation of blood pressure by modulating the neurotransmitter release in the central and peripheral sympathetic nervous systems. This study investigated the antihypertensive effect of green tea rich in GABA (GABA-rich tea) in young and old Dahl salt-sensitive (S) rats. GABA-rich tea was made by fermenting fresh green tea leaves under nitrogen gas. In experiment 1, 21 11-month-old rats, fed a 4% NaCl diet for 3 weeks, were given water (group W), an ordinary tea solution (group T), or a GABA-rich tea solution (group G) for 4 weeks. The average GABA intake was 4.0 mg/rat per day. After 4 weeks of the treatment, blood pressure was significantly decreased in group G (176 ± 4; P < .01) compared with group W (207 ± 9) or group T (193 ± 5 mm Hg). Plasma GABA levels were more elevated in group G (111 ± 54) than in group W (not detectable) or group T (14 ± 8 ng/mL; P < .01 v G). In experiment 2, 21 5-week-old rats, fed a 4% NaCl diet, were divided into groups W, T, and G. The average GABA intake was 1.8 mg/rat per day. Body weight or chow and beverage consumption did not differ significantly among the three groups. After 4 weeks of the treatment, although blood pressure was comparable in groups W and T (165 ± 3 v 164 ± 5 mm Hg, mean ± SE), it was significantly lower in group G (142 ± 3 mm Hg) than in the other groups (P < .01). Plasma aldosterone concentration was increased in group G compared to the other groups. Thus, GABA-rich tea seems not only to decrease the established high blood pressure but to prevent the development of hypertension in Dahl S rats fed a high salt diet.
Am J Hypertens (1995) 8, 74–79; doi: 10.1016/0895-7061(94)00141-W
It remains controversial whether the relation between alcohol intake and blood pressure is linear or non-linear.
The relation between alcohol intake and blood pressure was investigated in 2341 male self-defence officials who received a preretirement health examination at the Self-Defense Forces Fukuoka Hospital between October 1986 and December 1990. Average alcohol intake in the past year was ascertained by a self-administered questionnaire. The study excluded past drinkers, and allowed for smoking, body mass index and glucose tolerance.
Blood pressure was higher at higher levels of alcohol intake across the range from 0 to 40-59 ml of alcohol per day, but was not progressively higher in men consuming > or = 60 ml per day. Blood pressure was significantly higher even among light drinkers (< 20 ml per day) compared to non-drinkers; adjusted mean differences were 3.1 mmHg (95% confidence interval (CI): 1.1-5.2) in systolic pressure and 2.1 mmHg (95% CI: 0.7-3.5) in diastolic pressure.
Our findings do not support the existence of a threshold in the relation between alcohol and blood pressure.
Flavonoids are polyphenolic antioxidants naturally present in vegetables, fruits, and beverages such as tea and wine. In vitro, flavonoids inhibit oxidation of low-density lipoprotein and reduce thrombotic tendency, but their effects on atherosclerotic complications in human beings are unknown. We measured the content in various foods of the flavonoids quercetin, kaempferol, myricetin, apigenin, and luteolin. We then assessed the flavonoid intake of 805 men aged 65-84 years in 1985 by a cross-check dietary history; the men were then followed up for 5 years. Mean baseline flavonoid intake was 25.9 mg daily. The major sources of intake were tea (61%), onions (13%), and apples (10%). Between 1985 and 1990, 43 men died of coronary heart disease. Fatal or non-fatal myocardial infarction occurred in 38 of 693 men with no history of myocardial infarction at baseline. Flavonoid intake (analysed in tertiles) was significantly inversely associated with mortality from coronary heart disease (p for trend = 0.015) and showed an inverse relation with incidence of myocardial infarction, which was of borderline significance (p for trend = 0.08). The relative risk of coronary heart disease mortality in the highest versus the lowest tertile of flavonoid intake was 0.42 (95% CI 0.20-0.88). After adjustment for age, body-mass index, smoking, serum total and high-density-lipoprotein cholesterol, blood pressure, physical activity, coffee consumption, and intake of energy, vitamin C, vitamin E, beta-carotene, and dietary fibre, the risk was still significant (0.32 [0.15-0.71]). Intakes of tea, onions, and apples were also inversely related to coronary heart disease mortality, but these associations were weaker. Flavonoids in regularly consumed foods may reduce the risk of death from coronary heart disease in elderly men.
For physical activity surveys that would identify relations to chronic diseases, quality of life, and longevity, the method of choice remains the questionnaire, especially if it can be standardized and administered in uniform fashion to large populations. A sample questionnaire derived largely from epidemiological experience with the Harvard Alumni Health Study is presented that requests anthropometric estimates; physician-diagnosed diseases by year of onset; contemporary physical activities including walking, stair-climbing, and recreational pursuits; food-frequency data that estimate nutrient values and caloric intakes; and social habits affecting health. The questionnaire presents opportunities for cross-sectional, retrospective, and prospective studies. Personal characteristics, physical activities, and other elements of lifestyle may be used as predictor or outcome variables in testing specific hypotheses. Representative surveys are described that have validated and used questionnaires of various complexities, some complemented by measures of physiological fitness. The epidemiological survey questionnaire, when properly designed and administered, can measure effectively energy intake, energy retention, energy expenditure, physiological fitness, quality of life, and health maintenance.
Epidemiological studies suggested that consumption of fruit and vegetables may protect against stroke. The hypothesis that dietary antioxidant vitamins and flavonoids