Apples and apple-based products in the modulation of cardiometabolic and functional markers: a systematic review of human intervention studies.

Clinical Snapshot

Key Findings

• P Value: Not reported at review level — individual study p-values not synthesised

• Effect Size: No pooled effect size calculated; narrative synthesis indicates apparent beneficial effects on postprandial glycaemia, plasma antioxidant capacity, and vascular endothelial function in short-term studies; apparent improvement in gut microbiota composition in medium/long-term studies

• Primary Outcome: Modulation of cardiometabolic and functional health markers by apple and apple-based product consumption in human intervention studies

• Nnt Or Sensitivity: Not applicable — no meta-analysis or diagnostic accuracy data; no NNT calculable from narrative synthesis

• Confidence Interval: Not calculable — no meta-analysis performed

Clinical Application

Apple consumption is highly feasible, widely available, low-cost, and culturally acceptable across most populations. No pharmaceutical-grade extracts or specialised products are required for dietary recommendations. However, the review does not identify an effective dose or specific product form, limiting precise dietary prescription. Apples are among the most widely consumed fruits in Australia and are consistent with Eat for Health Australian Dietary Guidelines recommendations for 2 serves of fruit per day. Apple polyphenol extracts are not currently listed on the PBS and are not TGA-approved therapeutic products. RACGP guidelines for cardiovascular risk reduction and diabetes prevention emphasise fruit and vegetable intake as part of a healthy dietary pattern, which is consistent with the review's conclusions. The evidence does not support recommending apple-specific supplementation over general fruit intake recommendations. Australian clinicians can confidently reinforce apple consumption as part of a balanced diet without overstating cardiometabolic benefit beyond general fruit intake guidance. Adult humans across a spectrum of health statuses; findings most relevant to individuals with or at risk of cardiometabolic disease, though current evidence is insufficient to make specific clinical recommendations for high-risk subgroups

Abstract

Apple is one of the most widely consumed fruits worldwide, yet its effects on human health remain the subject of ongoing debate. The aim of the present review was to examine evidence from human intervention studies evaluating the impact of apples and apple-based products on functional and metabolic health markers. A total of 38 studies were included: 13 postprandial interventions, 22 medium- or long-term interventions, and 3 assessing both postprandial and chronic effects. Postprandial studies predominantly investigated the effects of apple consumption on blood glucose levels and plasma antioxidant capacity, whereas medium- or long-term interventions assessed a broader range of biomarkers related to cardiometabolic health, oxidative stress, vascular function, inflammation, and gut function. Overall, the findings suggest that apples and apple-based products may beneficially modulate glycaemia, antioxidant capacity, and vascular endothelial function mainly in short-term interventions, while medium/long-term studies reported an apparent improvement in gut microbiota composition. However, the current evidence remains insufficient to draw definitive conclusions. Additionally, substantial heterogeneity in study design, populations, and products tested limits the ability to generalize results. Nonetheless, apple consumption, consistent with fruit intake in general, represents an important component of a healthy and balanced diet, providing valuable nutrients and bioactive compounds whose intake should be encouraged. Therefore, further well-designed intervention studies, particularly in populations with cardiometabolic risk factors, are warranted to better clarify the role of apples and apple-derived products in human health. Future research should also aim to identify the effective amounts and specific bioactive components responsible for the observed effects, as well as to determine whether these benefits may vary according to the health status of the target population.

References

1. 1.Del Bo', C., Martini, D., Giancristofaro, A., Rendine, M., Marino, M., Casiraghi, M. C., & Riso, P. (2026). Apples and apple-based products in the modulation of cardiometabolic and functional markers: a systematic review of human intervention studies. Food & Function. https://doi.org/10.1039/d5fo05460e