Orange Juice, Hesperidin and Their Role in Vascular Health Benefit

Orange Juice, Hesperidin and Their Role in Vascular Health Benefit: a Human Double Blind, Randomized, Controlled, Cross Over Study

Although epidemiological studies have associated the consumption of sugary beverages with adverse health effects, experimental studies have demonstrated that the metabolic response of the human body to fruit juice as compared to artificial beverages is substantially different. Fruit juices do not just provide sugars and related calories, but they are rich sources of bioactive compounds especially of flavonoids. Flavanones constitute a class of flavonoids that are specifically and abundantly found in citrus fruits, with hesperidin being the major compound in orange. From prospective cohort studies, higher intakes of flavanones are associated with a lower incidence of mortality by cardiovascular disease (CVD). This relation is supported by results from a number of animal studies demonstrating a slowdown in atherosclerosis development and vascular protective effects in dietary interventions with flavanones. Randomized, controlled clinical trials to corroborate the suggested vasculo-protective effects of orange juice presumably mediated by the flavanones are scarce and available data do not allow to draw firm conclusions about their efficacy. To fill this gap, the "HESPER-HEALTH study" conducted in humans will assess the vascular protective effects of 100% orange juice consumption and evaluate the contribution of hesperidin in these effects.

This human dietary intervention study is a double blind, randomized, placebo controlled, cross over trial with 3 arms, carried out on subjects with predisposition to cardiovascular diseases (CVD) based on age and overweight. This study aims to demonstrate the vascular protective effects (with Flow Mediated Dilatation (FMD) as main criteria) of the consumption of a flavanone rich orange juice or of orange flavanones by comparison with a control sugary drink alone.

The 42 recruited participants will receive the 3 drinks in a random order. For each subject, the study is divided into 3 identical experimental periods of 45 days (period 1,2,3): including 3 days prior to the beginning of the product intake, during which specific dietary guidelines, samplings and measures will be asked to be performed at home followed by a 6 weeks period of consumption of each of the 3 beverages). A period of 4 to 6 weeks of wash-out is planned between each experimental period.

To summarize: Visit 1 (D-14) = inclusion, Visit 2 (D1: baseline) to 3 (D42) = period 1, Visit 3 (D42) to 4 (D70) = wash out 1, Visit 4 (D70) to 5 (D111) = period 2, Visit 5 (D111) to 6 (D139) = wash out 2, Visit 6 (D139) to 7 (D180) = period 3. The wash-out periods (minimum duration: 4 weeks) may be extended until 6 weeks for the convenience of participants.

The protocol includes a total of 7 visits to PIC/CIC Inserm 1405 of the Clermont-Fd University Hospital.

The total duration of the study will be between 28 and 34 weeks

Inclusion Criteria:

• Man or post-menopausal woman ;
• 40-65 years old (inclusive) ;
• Body Mass Index (BMI)≤ 30 ;
• Waist circumference ≥80 cm for women, and ≥94 cm for men ;
• Weight > 46 kg
• Normal biological balance sheet or considered normal by the investigator
• No aversion or intolerance to citrus foods ;
• Accept to limit their total intake of flavonoid rich beverages (tea, coffee, cocoa, wine, fruit juice) to 250 mL/day ;
• Ability to give informed consent to participate in research ;
• Willingness to accept randomization and undergo the testing and intervention procedures and deliver stool, blood and urine samples for testing ;
• Affiliation to Social Security.

Exclusion Criteria:

• Treated pre-diabetic or diabetic ;
• Treated for hypertension ;
• Use of statins or other medications for lowering cholesterol ;
• Treated with antibiotics, antifungals, probiotics or prebiotics in the 3 months before the enrolment ;
• Menopausal hormone replacement therapy ;
• Diagnosed gastrointestinal illness in the judgement of the investigator ;
• Any serious medical condition that precludes safe participation in the study, such as coronary artery disease, peripheral vascular disease, stroke, congestive heart failure, chronic obstructive pulmonary disease, insulin-dependent diabetes, psychiatric disease, renal disease, liver disease, active cancer and anemia ;
• History of eating disorders such as bulimia nervosa, anorexia nervosa and severe binge eating disorder in the last 5 years ;
• Digestive disorders with diarrhea during the 3 months preceding the beginning of the study ;
• Self-declared vegetarian, vegetalian, vegan ;
• History of substance abuse or alcohol abuse ;
• Involvement in a weight loss intervention program (including anti-obesity medication) within the past 3 months or who have had bariatric surgery ;
• Current smokers (within the last 30 days) ;
• Use of dietary supplements (vitamins, antioxidants) currently or in the past one month ;
• Strenuous exercise greater than 6 hours per week ;
• Anyone who in the opinion of the investigator is unlikely to be able to comply with the protocol ;
• Subjects involved in another clinical trial or being in the exclusion period of another study or having received a total compensation greater than 4,500 euros over the 12 months preceding the start of the trial ;
• Subject benefiting from a legal protection measure (curatorship, guardianship, safeguard of justice) ;
• Refusal to participate.