Chronic consumption of flavanone­ rich orange juice is associated with cognitive benefits: an 8­wk, randomized, double­ blind, placebo­controlled trial in healthy older adults

Justin Kyei-Frimpong, PharmD. candidate 2015, Mercer University College of Pharmacy

According to the Centers for Disease Control and Prevention (CDC), in 2013 as many as 5 million Americans were living with Alzheimer’s disease.1 Current guidelines established by the American Psychiatric Association (APA) state the acetylcholinesterase inhibitor donezepil is the first line pharmacologic choice in the treatment of Alzheimer’s disease. According to the package insert, the drug donezepil is associated with various side effects such as tremors, nausea, diarrhea, insomnia, vomiting, muscle cramps and fatigue.2 With the aim of prevention of undesirable side effects from drug treatment, a non-pharmacologic approach would be welcome in cognitive disease treatment. There are a number of animal studies that have examined the non-pharmacologic approach of flavanone use in improving cognition function; however, there are few documented human studies.3 This study attempts to fill this void.

Title: Chronic consumption of flavanone­rich orange juice is associated with cognitive benefits: an 8­wk, randomized, double­blind, placebo­controlled trial in healthy older adults3
Design Randomized, double blind placebo-controlled clinical trial; 37 participants
Objective

(Primary)

To determine whether eight weeks of daily flavanone-rich orange juice consumption was beneficial for cognitive function in healthy older adults
Study Groups Two

·         High Flavanone (HF)

·         Low Flavanone (LF)

 Methods High-flavanone (305 mg) 100% orange juice and an equicaloric low flavanone (37 mg) orange-flavored cordial (500mL) were consumed daily for eight weeks by 37 healthy older adults according to a crossover, double-blind, randomized design separated by a four week washout. Cognitive function, and mood were assessed at baseline and follow-up by using standardized validated tests (Go-NoGo, Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) (immediate verbal recall), Letter Memory, Verbal Paired Associates (VPA) (immediate), CERAD (delayed verbal recall), Serial Sevens, Spatial Working Memory (SWM), Digit Symbol Substitution Test (DSST), Letter Fluency, DSST and Letter Fluency (both tests performed simultaneously), and VPA (delayed).
Duration Eight weeks
Primary outcome measure Global performance (z scores) of HF and LF at 8 weeks
Baseline Characteristics Mean age (67) , Mini mental State Examination (MMSE) scores (29), men (13), women (24),  Body Mass Index (BMI) (26), National Adult reading Test (NART) scores (39)
Results Global performance was significantly better after the HF drink than after the LF drink at eight weeks(t = 2.86, df = 38)
Adverse Events Common Adverse Events: not reported
Serious Adverse Events: not reported
Percentage that Discontinued due to Adverse Events: not reported
Study Author Conclusions Chronic daily consumption of flavanone-rich 100% orange juice over eight weeks is beneficial for cognitive function in healthy older adults. The potential for flavanone-rich foods and drinks to attenuate cognitive decline in aging and the mechanisms that underlie these effects should be investigated.

This study suggests there is some cognitive benefit after consumption of flavanone rich juice in healthy adults. Though the study has promising results, for any clinical benefit to be obtained it has to be applied to healthy young adults and elderly patients with cognitive disease to determine if dietary intake of flavanones helps to maintain or enhance cognitive function. With this application clinical interventions can be determined and adopted into future guidelines and treatment.

References

  1. gov. CDC – Healthy Brain Initiative: Alzheimer’s Disease – Aging. 2015. Available at: http://www.cdc.gov/aging/aginginfo/alzheimers.htm. Accessed March 10, 2015.Fiore, M.C., Jaen, C.R., Baker, T.B., et al. (2008). Treating tobacco use and dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, May 2008.
  2. nlm.nih.gov. DailyMed – ARICEPT- donepezil hydrochloride tablet, film coated ARICEPT ODT- donepezil hydrochloride tablet, orally disintegrating. 2015. Available at: http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=98e451e1-e4d7-4439-a675-c5457ba20975. Accessed March 10, 2015.
  3. Kean R, Lamport D, Spencer J, et al. Chronic consumption of flavanone-rich orange juice is associated with cognitive benefits: an 8-wk, randomized, double-blind, placebo-controlled trial in healthy older adults. American Journal Of Clinical Nutrition [serial online]. March 2015;101(3):506-514. Available from: Environment Complete, Ipswich, MA. Accessed March 9, 2015.
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