nutritional content and therapeutic potential of …
TRANSCRIPT
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Manjula et al. World Journal of Pharmacy and Pharmaceutical Sciences
NUTRITIONAL CONTENT AND THERAPEUTIC POTENTIAL OF
KIWIFRUIT
Deepak Kumar Puri and S. N. Manjula*
Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher
Education & Research, Shivarathreeshwara Nagara, Mysuru-570015.
ABSTRACT
Kiwifruit belongs to the genus Actinidia (Actinidiaceae) and is derived
from a deciduous woody, fruiting vine. It consists of various species
and cultivars which exhibit different characteristics and sensory
attributes. Kiwi plants have been grown for centuries in China, where
they are known as mihoutau. Seeds of kiwi plant were brought to New
Zealand in the early 20th century, where it was eventually
domesticated and sold all over the world. At present, commercial
growth of the fruit has spread to many countries including the United
States, Italy, Chile, France, Greece, India and Japan. Kiwifruit extracts
have been reported for its use in traditional medicine for relief of
symptoms of numerous disorders. In light of growing consumer
acceptance of kiwifruits worldwide, there has been an increased
attention given to identifying health benefits associated with its
consumption. Potential benefits include a rich source of antioxidants, improvement of
gastrointestinal laxation, lowering of blood lipid levels, and alleviation of skin disorders.
Some individuals report allergic symptoms to kiwifruit, and a considerable research effort is
being focused on characterizing kiwifuit‘s allergenicity among various populations of people.
Along with vitamin C, kiwifruit is also rich in other nutrients such as folate, potassium, and
dietary fiber. This fruit‘s content of nutrients and biologically active phytochemicals has
stimulated investigations into its antioxidant and anti-inflammatory actions that might then
help prevent cardiovascular disease, cancer, and other degenerative disorders.
KEYWORDS: Kiwifruit, therapeutic potential, constituents.
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES
SJIF Impact Factor 7.421
Volume 7, Issue 6, 536-565 Review Article ISSN 2278 – 4357
Article Received on
13 April 2018,
Revised on 03 May 2018,
Accepted on 23 May 2018
DOI: 10.20959/wjpps20186-11800
*Corresponding Author
S. N. Manjula
Department of
Pharmacology, JSS College
of Pharmacy, JSS Academy
of Higher Education &
Research,
Shivarathreeshwara Nagara,
Mysuru-570015.
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Manjula et al. World Journal of Pharmacy and Pharmaceutical Sciences
INTRODUCTION
Although the therapeutic benefits of consuming fruit are well known[1]
, kiwifruit for its
nutrient density, health benefits, and consumer appeal stands out.[2]
Along with vitamin C, it
also has other nutrients that add to it health benefits. Various bioactive components act
together and helps in metaboic and physiological processes. Increasing number of scientific
research supports its therapeutic benefits in health metabolism, iron content, digestive
potential, antioxidant property and also immune function.[3]
Kiwifruit is a derivative of deciduous, woody, fruiting vine and belong to the genus Actinidia
(Actinidiaceae). It possess variety of physical characteristics and sensory attributes as it is
composed of different species and cultivars. Originally the plants were grown in mountainous
region of China (as Chinese gooseberry), where they were commonly called as mihoutau.[2,4]
Later in 20th
century, the seeds were brought to New Zealand from where it was sold
throughout the world. As of now the fruit is grown in many countrie including Italy, US,
France, Greece, Japan and Chile.[5–7]
While there are several species belonging to the genus Actinidia, the main cultivars of
Kiwifruit are Actinidia deliciosa and Actinidia chinensis.[8]
Among both, Actinidia deliciosa
is the widely marketed cultivar commercially. Actinidia deliciosa fruit has semi-transparent
green edible flesh, black seeds and is covered by brown hairy skin. On the other hand
Actinidia chinensis (Hort 16A) has yellowish flesh and is covered by hairess skin. The
ZESPRI GOLD variant of Actinidia chinensis has bright yellow flesh, while other cultivars
have reddish flesh(3,5). Another unique species Actinidia arguta or ‗‗hardy kiwifruit‘‘ can
actually be eaten whole, as it is grape-sized (weighing 5-15g) and is covered by a smooth,
hairless, edible skin. It is more sweet, aromatic and has an intense flavour due to the
composition of several volatile compounds.[9]
Like Actinidia arguta, other variants such as
Actinidia kolomikta and Actinidia polygama have been grown an ornamental plants and is
emerged as frost-resistant in some northern regions. In India, kiwifruit (Actinidia deliciosa) is
usually grown in the hills of Himachal Pradesh, Jammu & Kashmir and in Arunachal
Pradesh.[10]
Almost 90% of Vitamin C in our diet is obtained from fruits and vegetables.[11]
Kiwifruit is a
rich source of ascorbic acid and polyphenols. As an antioxidant, ascorbic acid aids in
lowering the risk of arteriosclerosis, cardiovascular diseases, and some forms of cancer.[12]
Whereas polyphenolic compounds (flavonoids) also have antioxidant properties and can
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account for some benefits associated with the consumption of fruits and vegetables.[13]
Kiwifruits are used for the treatment of several types of cancers, such as, stomach, lung, and
liver cancer[14]
in folk medicine. As per some studies, the extracts of kiwifruit helps in
inhibiting growth of cancer cell[15]
and also protect the cells in-vitro from oxidative DNA
damage.[16]
The main objective of this review is to provide an overview of the scientific
evidence about the emerging health benefits associated with consumption of kiwifruit.
Nutritional traits of kiwifruit
Data on nutritional attributes of kiwifruit can be found in the USDA National Nutrient
Database for Standard Reference[17]
and the New Zealand Food Composition Database
(NZFCD).[18]
The analysis are usually carried out on ripened fruit so as to obtain a reflective
data. Usually, Actinidia deliciosa (green) and Actinidia chinensis (gold) cultivars are eaten
with the outer skin peeled. As per a recent update from NZFCD, the skin has nutritional
composition and a growing number of people like to consume the fruit along with the skin,
usually the gold cultivars as it is smooth, thin and hairless. Consuming whole SunGold
variety (including the skin) increases the fibre, vitamin E and folate contents by 50, 32 and
34%, respectively.[19]
Vitamin C
The total vitamin C content of kiwifruit is its most characteristic nutritional composition.[18]
Green cultivars have levels that usually liesbetween 80-120mg/100g of fresh fruit.[20]
This
variation in the amount of ascorbic acid in fruits is mainly due to several factors like
cultivation region, fertilizers used, harvesting time, storage conditions and also ripening of
the fruit.[11]
Based on scoring models, kiwifruit for its nutritional value stands out against
many other fruit.
In terms of nutritional value, using scoring models that rank and compare the amount of
important nutrients present in foods, kiwifruit score well against other fruit. This provides a
useful means for communicating those nutritional benefits to consumers, and should be noted
that the high nutrient density score is largely driven by their high vitamin C content.[18]
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Fig. 1: Graph comparing the vitamin C content of kiwifruit with other commonly
consumed fruit.
The US recommended daily allowance for vitamin C is 90 mg for men and 75 mg for women.
This means one daily kiwi fulfills our vitamin C needs. It's better to leave the skins on
because they contain valuable fiber.
Vitamin E
Kiwifruit contain relatively high levels of vitamin E[2,18]
, compared to other commonly
consumed fruit. SunGold and green kiwifruit contain 1.40 and 1.46 mg per 100 g[17]
,
respectively, of the main form, α-tocopherol present in the flesh.[21]
These levels are
sufficient to permit the use of nutrient function claims for Vitamins E in the EU. According
to Fiorentino et al., α-tocopherol is found in the flesh of kiwifruit, which is possibly
associated with cell membranes and are therefore potentially bioavailable. Fiorentino et al.,
also identified a new form of vitamin E in kiwifruit, δ-tocomonoenol, noting that its radical
scavenging and antioxidant capacity contributed to the total antioxidant activity of kiwifruit.
Studies showing that the consumption of both green and gold kiwifruit correlates with
increased plasma vitamin E concentrations, suggest the vitamin E in kiwifruit is
bioavailable.[19,22]
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Folate
Kiwifruit are often referred to as being a good source of dietary folate. The folate content of
31 μg per 100 g in gold kiwifruit meets the criteria of EU Regulation to make a ―source‖
claim as it exceeds the 15% of the Reference Intake of 200 μg/day. In other countries, where
the recommended daily intake is often higher (e.g., 400–500 μg/day in Nordic counties, 400–
600 μg/day in the USA Australia and NZ), such nutrient content claims cannot be made. The
authorised health claims in the EU for folate nutrient functions are shown in Table 2. As
folate is extremely labile and its presence in green leafy vegetables is easily destroyed by
cooking, fresh kiwifruit can make a useful contribution to the total diet, especially during
pregnancy when it is difficult to meet folate requirements. During pregnancy, folate
requirements are 600 μg/day, which can be safely achieved through the use of conventional
foods, foods with added nutrients and food supplements.[23]
Potassium
Green and gold kiwifruit are good sources of potassium, containing typically around 301–315
mg per 100g. These amounts are sufficient to meet the criteria of EU Regulation (EC) no.
1924/2006 on nutrition and health claims made on foods to make a natural ―source‖ claim, as
it exceeds the 15% of the Reference Intake of 2000 mg/day. The potassium content of
kiwifruit compared to other fruit is shown in Fig. 3. In other countries, where the
recommended daily intake is often higher, such content claims cannot be made. Fresh foods
such as fruits and green vegetables are generally good sources of potassium and low in
sodium. The sodium content of kiwifruit is only 3 mg per 100 g and can be described as
naturally low in sodium. The sodium to potassium ( Na+/K+) ratio of kiwifruit is consistent
with recommendations to increase potassium intake through increased consumption of fruit
and vegetables, and is amongst the more favourable Na+/ K+ balance of selected fruits[24]
.
Studies have provided evidence that potassium rich diets or interventions with potassium can
lower blood pressure, especially in individuals with hypertension[25,26]
, however, more
recently the dietary Na+/ K+ ratio has been shown to be more strongly associated with an
increased risk of hypertension and CVD-related mortality than the risk associated with either
sodium or potassium alone.[27,28]
Dietary fibre
The dietary fibre of kiwifruit comes almost entirely from the plant cell walls, and particularly
the polysaccharides that form the major structural components of these walls. Kiwifruit
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contain about 2–3% of fresh weight non-starch polysaccharides[2]
that make up the fruit cell
walls, providing a valuable contribution of both soluble and insoluble fibre to the diet.
Analysis of dietary fibre of green and gold kiwifruit has shown they comprise about one-third
soluble and two-thirds insoluble fibres, although kiwi gold fruit contain considerably less
total fibre than green.[29]
The soluble fibre fraction contains almost exclusively pectic
polysaccharides, whereas the insoluble fibre is mostly cellulose and hemicelluloses. Changes
occur in the composition and structure of kiwifruit cell walls during development and
ripening. These structural changes in cell wall polysaccharides are reviewed in detail by
Sims, Monro.[30]
Cell wall polysaccharides are generally resistant to digestion and absorption
in the human small intestine and are considered to be delivered to the colon in a chemically
unaltered state. However, even minor chemical or structural changes can impact on the
physicochemical properties and fermentability that determine their impact on health. In the
hind-gut, the physiological benefits of fibre are believed to arise from the products of
bacterial fermentation of the soluble fibre, and from the physicochemical properties of any
fibre that remains unfermented.[31,32]
Among the most important physicochemical properties of kiwifruit fibres are the hydration
properties, which include water retention, capacity and swelling, viscosity (which requires
solubility), and properties that depend on the size, shape and porosity of undigested particles.
Water retention is physiologically relevant because it influences transit time, faecal bulk,
stool consistency and other functional benefits.[32]
The high swelling and water retention of
kiwifruit fibre in comparison with other forms of dietary fibre such as wheat bran,
commercial preparations of sugar beet fibre and apple fibre, accentuate the value of
consuming kiwifruit as a natural whole product that has had minimal processing. Kiwifruit
dietary fibres are susceptible to fermentation, and so many provide benefits through the
production of the short chain fatty acids.[30]
Future studies on the mechanisms by which
kiwifruit dietary fibres, as part of a balanced diet, modulate digestion processes and act as a
substrate for beneficial colonic microbiota, may aid understanding of the actions of fibre in
the gut[33]
and its beneficial effects on human health.
Sugars
As kiwifruit develop and ripen, the concentrations of chemical components in the tissue
change. The most marked change in the physiology of the fruit during ripening leads to a
rapid decrease in starch concentration and a consequent increase in fructose and glucose.
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Kiwifruit tissue is very hard while the fruit is developing on the vine, but flesh firmness
decreases during the later stages of development.[20]
Fortunately, kiwifruit that are
physiologically mature but have barely started to ripen can be harvested and will continue to
ripen successfully off the vine. Cool storage immediately after harvest reduces the rate of
ripening. It is these particular characteristics of kiwifruit that allow producing countries such
as New Zealand to store unripe fruit and ship to it distant markets over an extended period.
Suitable indicators of maturity for kiwifruit are used to ensure that fruit reaches an
appropriate stage of development before harvest. A ―maturity value‖ is important, and three
changes in kiwifruit are taken into account—decreasing flesh firmness, conversion of starch
to sugar and soluble solids concentration (to measure sugar concentration) are all used to
provide an accurate assessment of final eating quality. The predominant sugars present in
Actinidia are glucose and fructose with a small amount of sucrose present when the fruit is
ripe and ready-to-eat. The amount of total sugars and ratios of these sugars vary not only as a
function of maturity but also with the variety of kiwifruit.[5,28]
The ratio of fructose: glucose is
important in terms of digestive health and preferably should be around 1:1 to reduce
symptoms of gastrointestinal discomfort, such as bloating, caused by rapid fermentation by
gut bacteria. Interestingly, as they ripen, many fruits undergo a marked decrease in
chlorophyll content, and carotenoids and anthocyanins become dominant. These visual
changes indicate the stage of ripeness. On the other hand, in green kiwifruit there is little if
any decrease in chlorophyll content and the internal colour remains an attractive bright green
when fruit are ―eating ripe‖. As kiwifruit begins to ripen, starch concentration decreases from
6% of fresh weight to trace amounts, and total sugars increase to 12–15%. The concentration
of soluble solids also increases to reach a plateau of 14–16% before fruit is eating ripe.
Understanding the factors affecting the rate of ripening is of considerable commercial
importance for fruit quality. In fruit that is ready for consumption the sugars provide the
appealing sweet flavour of kiwifruit, which is balanced by the organic acid composition.[5,28]
From a physiological perspective, the sugar content of kiwifruit, like all fruit, may
potentially influence the management of blood sugar levels following their consumption,
however current research suggests the glycaemic response effects of kiwifruit as a whole
food are potentially different to that which could be expected of individual components.[29]
Interestingly the glycaemic index (GI) of kiwifruit is relatively low (green kiwifruit, 39.3 ±
4.8 and gold kiwifruit, 48.5 ± 3.1[34]
). The low GI value of kiwifruit is observed in both
healthy human subjects and thosewith Type 2 diabetes.[35]
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Antioxidants
In addition to the various nutrients in kiwifruit described above, for which there are dietary
intake recommendations and well described physiological functions, kiwifruit contain a
complex network of minor compounds that may also be associated with beneficial
physiological functions. Various Actinidia species have been extensively analysed for their
antioxidant chemical profiles.[36–40]
As well as vitamins C and E, the other antioxidants
include the carotenoids lutein, zeaxanthin and β-carotene, chlorophylls, quinic acid, caffeic
acid glucosyl derivatives, β-sitosterol, chlorogenic acid, phenolics, including flavones and
flavonones, to name but a few.[41–44]
The antioxidant capacity of kiwifruit constituents has
been measured by means of various in vitro chemical assays that monitor the quenching,
scavenging or retarding of free radical generation.[3]
For example, the total antioxidant
capacity of kiwifruit was reported to be higher than apple, grapefruit and pear, but less than
raspberry, strawberry, orange and plum.[45,46]
While these in vitro studies indicate that the
various antioxidants are capable of preventing or delaying some types of cell damage from
the unstable free radicals created every day during normal metabolism, the detailed
mechanism of how this translates to effects in vivo which are directly linked physiological
changes is yet to be fully understood.[47]
In a number of human studies, beneficial changes to
biomarkers of CVD, have been attributed to the antioxidant compounds present in
kiwifruit.[48–54]
The stability of antioxidants during simulated in vitro gastrointestinal
digestion[55,56]
, and their bioaccessibility/bioavailability[57]
provide supportive evidence for
the potential for physiological effects of the antioxidants in kiwifruit. There is significant
variation in the types and levels of antioxidant compounds and total antioxidant activity both
between Actinidia species, and as a function of extraction solvent.[41–43]
Several studies have
explored the influence of growing practices and region on the activity of bioactive and
antioxidant compounds in kiwifruit. Park et al.[58]
found generally higher, but not consistently
significant, levels of bioactive compounds in organically grown kiwifruit, whilst in an Italian
study, the geographical location of orchards did not significantly influence vitamin C or
polyphenolic contents.[59]
Although there are no dietary intake recommendations for
antioxidants in general, the scientific data suggest that eating kiwifruit has the potential to
inhibit oxidative and inflammatory processes, although the supporting data for antioxidant
activities are more substantial than those related to the kiwifruit‘s potential anti-inflammatory
activities. The results of human studies of the antioxidant efficacy of kiwifruit are
inconsistent owing to differences in experimental protocols, the cultivar of kiwifruit used, the
amount and duration of the study as well as the biomarkers used.[3]
Kiwifruit could
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undoubtedly be a useful dietary vehicle for delivering antioxidant nutrients and other
phytonutrients. Future studies on kiwifruit will explore the bioavailability, metabolism, tissue
distribution and biological effects of kiwifruit constituents on relevant disease markers. The
emerging evidence could provide the basis for improved dietary strategies for achieving
dietary antioxidant and anti-inflammatory health benefits in humans.[60]
Actinidin and minor proteins
Kiwifruit contain several unique proteins and the cysteine protease actinidin, the most
abundant protein in kiwifruit, of interest for their bioactive potential. The characterisation and
biochemical properties of actinidin have been extensively studied[61,62]
, and more recently its
potential role in human health.[63,64]
Actinidin is active over a wide range of pH, including
those of the GI tract[65]
thus having the potential to influence protein digestion, and intestinal
permeability.[66]
In contrast to potential benefits, actinidin is also the major kiwifruit
allergen.[59,67]
Green and gold kiwifruit have been known to cause allergic reactions ranging
from mild symptoms localised to the oral mucosa in the majority of individuals to
anaphylactic reactions, particularly in children. Very little information is available in the
literature on the prevalence of kiwifruit allergy, and human intervention studies with kiwifruit
have shown that kiwifruit are well tolerated without any adverse side effects.[22,53,68,69]
The
magnitude and patterns of reactivity to kiwifruit allergens appears to vary with
ethnic/geographical/cultural differences, age of subjects and other clinical characteristics of
individuals exposed to kiwifruit.[3]
Lucas, Atkinso[70]
have provided a detailed review of
unresolved issues regarding kiwifruit and have suggested requirements to be met prior to
designation of allergens to a database. Processing may diminish the risk of allergic symptoms
in those with allergies to raw kiwifruit.[71,72]
Kiwellin is another protein in kiwifruit, that as a
function of ripening stage and postharvest treatment of the fruit is susceptible to actinidin
activity, producing the peptide kissper, and and KiTH.[73,74]
Kissper is of particular interest
for human health as it displays a range of beneficial activities, including anti-inflammatory
response, reducing oxidative stress at the GI mucosal interface[75]
, and pHdependent and
voltage-gated pore-forming activity, together with anion selectivity and channelling. This
suggests that kissper is a member of a new class of pore-forming peptides with potential
beneficial effects on human health, including a potential effect on gastrointestinal
physiology.[76]
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Health benefits and medicinal importance
Medicinal and health benefits of this fruit have been discussed as under:
Digestive health
Kiwifruit contains enermous amount of actinidin, a proteolytic protein-dissolving enzyme
which enhances protein digestion and can help digest a meal much like the papain in papaya
or bromelain in pineapple. It facilitates smooth traffic through the digestive system.
Historically, green kiwifruit have been well acknowledged for the beneficial effect they have
on digestion and laxation. Recent studies have demonstrated significant results in the
treatment of constipation in healthy elderly[77,78]
and in patients with irritable bowel
syndrome.[79]
Insoluble dietary fibre, with its water-retaining abilities, increases faecal bulk
and softens stools, and it is through this mechanism that kiwifruit appear to act. Green
kiwifruit are high in both soluble and insoluble fibre, comparing favourably with a number of
other popular fruit. However there is some evidence that as the fruit ripens, there is increasing
solubilisation of polymers within the cell walls of kiwifruit, resulting in a unique and greatly
increased ability to hold water.[80]
These ripening-induced changes also result in enhanced
viscosity due to solubilisation of the pectic polysaccharides in the cell walls.[81]
The ensuing
lubricating effect has been identified as an important attribute of soluble fibre in other
effective treatments of constipation.[82]
Kiwifruit also contain a very active proteolytic
enzyme, actinidin, which is postulated to have a beneficial impact on the gastric and intestinal
digestion of proteins. In-vitro studies have shown that actinidin, acting in concert with the
gastric and intestinal proteases pepsin and pancreatin, enhances protein digestion in both the
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stomach and the small intestine.[83]
Rutherfurd et al. (2011) recently showed in an in-vivo
investigation in rats that actinidin from green kiwifruit significantly increased the gastric
digestion of some food proteins. It is therefore reasonable to suggest that kiwifruit as part of a
meal could act as a digestive aid by a variety of actions: more effective digestion of dietary
protein, increased faecal bulking and softness, and better lubrication assisting the propulsion
of contents along the colon.
Kiwifruit supports iron nutrition
Consuming kiwifruit may also be of benefit in treating iron deficiency as recently shown in
our research unit.[68]
Iron deficiency is the most common nutritional deficiency worldwide
and is associated with a number of adverse health consequences.[84]
In a randomised
controlled trial we observed significant improvements in iron status in young women with
mild iron deficiency when 2 gold kiwifruit, compared with a banana, were consumed with an
iron fortified breakfast cereal (16 mg ferrous sulfate) meal daily for 16 weeks. Serum ferritin
increased and soluble transferrin receptor and soluble transferrin receptor : serum ferritin
ratio decreased significantly with the addition of kiwifruit compared with banana.[85]
The
improvement in iron status may be ascribed to the high content of vitamin C, carotenoids,
citric acid, or a combination of synergistic nutritional factors in gold kiwifruit. Vitamin C is a
well-known enhancer of iron absorption[86]
, and citric acid has been shown to be additive to
the effects of vitamin C on iron absorption.[87]
The carotenoids lutein and zeaxanthin have
also been shown to enhance iron absorption.[88]
Further research is needed to confirm these
effects in other population groups at risk of iron deficiency, including pregnant women,
children, and adolescents, but also in those being treated for iron deficiency anaemia.
Common cold and flu
One of the most common illnesses that healthy humans have to deal with on a regular basis is
upper respiratory tract infection (URTI), which typically presents as colds and influenza
(flu).[89]
Adults experience on average 1–4, and children, owing to their developing immune
systems, 4–8 bouts of cold- and flu-like episodes per year.[90,91]
URTI causes major disruption
to daily living and is associated with direct and indirect costs related to health care and loss of
productivity through absence from work and school.[92]
Since no cure exists, optimising the
immune system through adequate nutrition[93–95]
could be an important strategy for the
prevention and treatment of URTI.
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Kiwifruit is an excellent source of various nutrients and phytochemicals associated with a
healthy immune system, such as vitamins C, E, and K, folate, carotenoids, potassium, and
polyphenols.[95,96]
A small number of animal, in vitro cell based, and human studies provide
supporting evidence that kiwifruit may enhance immune function and immune responses as
reviewed by Hunter et al (2011) and Skinner et al (2011). In brief, kiwifruit may improve the
markers of innate and adaptive immune function. Phagocytosis and levels of
immunoglobulins (IgA, IgG, and IgM) were increased after supplementing mice with a
kiwifruit extract for 30 days.[97]
An extract prepared from gold kiwifruit pasteurised purée
resulted in significantly enhanced measures of innate and adaptive immune cell function of
human blood cells ex vivo, namely increased phagocytosis, oxidative burst, and natural killer
cell activity (innate), and increased T-cell activation and cytokine production in response to a
recall antigen (adaptive).[98]
Kiwifruit may also affect the immune system through antioxidant effects by protecting
immune cells from oxidative damage and consequent loss of membrane integrity and fluidity
resulting in alterations in signalling within and between immune cells. Two recent New
Zealand studies[99,100]
investigated the effects of regular consumption of gold kiwifruit on the
incidence and symptoms of URTI in older adults (≥65 years)[100]
and pre-school children (2–5
years)[99]
, 2 groups at high risk if they contract colds and flu. Both groups were enrolled in
separate cross-over randomised controlled trials involving consumption of gold kiwifruit
compared with the consuption of banana (control fruit with relatively similar energy content,
but lower nutritional value). The older adults consumed the equivalent of 4 gold kiwifruit or 2
bananas daily[100]
for 4 weeks and the pre-school children consumed 2 servings of gold
kiwifruit or 1 banana for 5 days/week for 4 weeks at the day care facility they attended.[99]
In
older adults, the duration of sore throat and head congestion was significantly reduced when
gold kiwifruit was consumed, compared with banana (sore throat: mean of 2 days compared
with 5.4 days, P = 0.02; head congestion: <1 day compared with 4.7 days, P = 0.03).
Similarly, the severity score for head congestion was significantly lower whilst consuming
gold kiwifruit, compared with banana (1.3 compared with 6.7 out of 10, P = 0.01).[100]
In the
pre-schooler study, the odds of contracting a cold or flu-like illness was reduced by almost
half when kiwifruit were consumed, compared with banana (odds ratio (OR; 95% CI): 0.55
(0.32, 0.94), P = 0.03). Severity scores for physiological and functional symptoms and the
incidence of certain URTI symptoms (poor appetite, feeling unwell, low energy, crying,
headaches, sore throats) were significantly lower when consuming kiwifruit, compared with
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banana.[99]
In the older adult study, consumption of gold kiwifruit resulted in significant
increases in plasma vitamin C, -tocopherol, lutein/ zeaxanthin, and erythrocyte folate
concentrations, which may have contributed to the reduction in duration and severity of URTI
symptoms.[100]
Further research is needed to confirm these results in other at risk groups to
clarify whether these effects of gold kiwifruit on URTI are in fact due to improved immune
function, which nutrients or bioactive compounds are responsible, and whether other
kiwifruit cultivars produce similar effects.
Tolerance and allergic effects of kiwifruit
Green kiwifruit have been recognised as a food allergen for over 2 decades, with the first
acute case of kiwifruit allergy reported in 1981.[101]
Clinical characteristics of kiwifruit
allergy range from mild symptoms localised to the oral mucosa in the majority of individuals,
to severe anaphylactic reactions, particularly in children.[102]
Kiwifruit allergy is also known
to occur as a consequence of cross-reactions with pollens and latex. Several protein
components in kiwifruit have been identified as potential allergenic agents. Actinidin (Act c
1, 30 kDa), the most abundant protein in green kiwifruit, is the most recognised major
kiwifruit allergen.[67]
However, Lucas et al. (2007) failed to show that actinidin was a major
allergen in a UK population, indicating that the major allergenic component may be different
in different populations. Gold kiwifruit is also an allergen source, although it contains very
low levels of actinidin, it shares some other common allergens and immunoglobulin E (IgE)
cross-reactivity with green kiwifruit. Thus, people allergic to green kiwifruit are at risk of
reacting to gold kiwifruit.[103]
Very little information is available in the literature on the
prevalence of kiwifruit allergy. A cross-sectional study among school children in France
suggested that kiwifruit allergy was as common as egg and peanut allergies.[104]
Intervention
studies with kiwifruit showed that the kiwifruit were well tolerated without any adverse side-
effects.[22,53,69,85]
Gammon et al. (2012) reported that the consumption of 2 green kiwifruit
every day for 4 weeks was rated as easy or very easy by the majority of participants (89.4%),
even those who had not regularly consumed kiwifruit before the study. The most common
sideeffect reported, which is also seen as a positive effect, was more frequent bowel
movements.[69,85]
Treatment of skin disease
Pharmacological uses of extracts from Actinidia have been examined for treatment of
inflammatory skin diseases. Kiwifruit possesses a heterogeneous mix of water-soluble
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polysaccharides composed predominantly of neutral galactan and highly acidic
arabinorhamnogalacturonans.[105,106]
Purified preparations of these polysaccharides from
kiwifruit were investigated for their potential use as pharmacological agents in
dermatological treatment strategies.[105]
These fractions were found to stimulate cell
proliferation of human keratinocyte cultures. Furthermore, in an in- vitro 3-dimensional skin
equivalent model, these polysaccharides doubled collagen synthesis of fibroblasts. Kiwifruit
polysaccharides appeared, therefore, to exhibit potential benefit in modulating skin cell
physiology.
Kiwifruit extracts have been studied in vivo in several animal studies as agents for the
treatment of atopic dermatitis (AD), a chronic inflammatory skin disease. Based on previous
evidence that an extract of A arguta (PG102) possessed orally active immune-modulating
activity in mice[107]
, this preparation was subsequently tested as a therapeutic agent for
AD[108]
. In the NC/Nga murine model of human AD, PG102 extract administration
significantly suppressed dermatitis severity and was accompanied by the down-regulation of
immunoglobulin E (IgE) and IgG1 and of inflammatory cytokines involved in skin lesion
progression. Moreover, epidermis/dermis thickening and dermal infiltration of inflammatory
cells were decreased. In another investigation, Kim et al[109]
reported similar beneficial effects
of an orally administered A arguta extract toward chemically induced AD-like skin lesions in
NC/Nga mice. The A arguta extract also modulated biochemical markers of skin
inflammation, an effect that was similar to that of the 2 therapeutic drugs tacrolimus and
dexamethasone, although the doses among the 3 treatments were not equivalent. Another
isolate from A arguta (DA-9102), when administered orally to hairless rats, was reported to
substantially suppress AD-like skin lesions in a magnesium deficiencyYinduced dermatitis
model.[110]
This beneficial skin response was accompanied by decreased levels of several
cellular and biochemicalmediators of inflammation. An oral formulation of DA-9102 has
been approved for a phase II human trial by Dong-A Phar in Korea. Finally, another extract
of A arguta (EFF1001) was observed to be effective when used in adjunctive therapy for the
treatment of mild to moderate AD in dogs.[111]
There is some evidence from a human trial
that oral inositol may improve symptoms in patients with psoriasis.[112]
Although evidence is
accumulating that extracts of kiwifruit have pharmacological use in managing skin disease, it
is unclear whether dietary kiwifruit provides a benefit to those with dermatological
conditions.
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Burn treatment
Two recent rat studies demonstrated an intriguing capacity for a dressing prepared from slices
of fresh kiwifruit to promote healing of acute burn wounds.[113,114]
Specifically, wound
surface area was significantly smaller in rats administered kiwifruit dressings, compared with
controls, and dry scars detached more rapidly in the kiwifruit-treated group. Additionally,
dramatic antibacterial and angiogenic actions of kiwifruit were observed, compared with
controls and with a group of rats treated with silver sulfadiazine cream, an antibacterial
ointment used in topical burn management.[114]
It was noted by the investigators that among
the kiwifruit-treated rodents, there were no positive cultures for Pseudomonas, Streptococcus,
or Staphylococcus. There were, however, inconsistent results between the 2 studies when the
effect of kiwifruit on blood vessel count and inflammation was evaluated. These disparities
likely were due to differences in experimental protocols. A suggested mechanism for the
improved wound debridement involved the beneficial proteolytic action of actinidin and other
degradative enzymes known to be present in kiwifruit. Components responsible for the
antimicrobial, angiogenic, and anti-inflammatory actions of the kiwifruit were not
determined. Further characterization of this wound-healing effect of kiwifruit dressings is
warranted and should include determining what types of wounds exhibit improved healing
and whether different approaches to preparation of the kiwifruit-based dressings are effective.
The fractions/components of the kiwifruit that are responsible for the various beneficial
outcomes need to be identified, and the mechanisms underlying the improved healing need to
be clarified. There remains a considerable challenge in translating this wound-healing action
of kiwifruit to the practical clinical care of human burn patients.
Antimicrobial actions
Extracts and proteins isolated from A chinensis and other kiwifruits have been reported to
possess inhibitory activity toward a variety of bacterial and fungal agents.[115–119]
In contrast,
one investigation reported only modest antimicrobial effects of hexane, acetone, or water-
methanol fractions of gold kiwifruit. No fractions were active against Helicobacter pylori.[4]
Two reports observed anti-HIV activity of a methanol fraction isolated from gold
kiwifruit.[4,120]
In contrast to other plant cysteine proteases, no antihelminthic efficacy of
kiwifruit proteases has been observed.[121–123]
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Anticancer actions
Kiwifruit extracts have been reportedly used for centuries in traditional Chinese medicine to
treat numerous cancers.[4,124]
However, documented efficacy and possible mechanisms of
action in these human cancer applications remain unknown. Otherwise, kiwifruit uses in the
prevention and therapy of human cancer development have not been routinely evaluated.
Rather, the impact of kiwifruit on putative human biomarkers of cancer has been
investigated. For example, 3 human intervention studies suggest that kiwifruit may protect
DNA from damage that could lead to the initiation of neoplasia.[125]
In a short-term crossover
study, 6 volunteers were given 500 mL of homogenized kiwifruit (equivalent to ~8 fruits).
Blood subsequently was collected over a 24-h period, and lymphocytes isolated.
Measurement by the comet assay of endogenous DNA damage in isolated lymphocytes
showed no difference between the treatment group and the water controls. However, another
ex vivo measurement indicated that kiwifruit intake was associated with increased resistance
of lymphocyte DNA to H2O2-induced oxidative damage, compared with controls. In another
investigation, 14 volunteers supplemented their diets with 1, 2, or 3 kiwifruits per day for 3
wk in a crossover design study with a 2-wk washout period between doses.[126]
Subsequent ex
vivo analysis of lymphocyte DNA by the comet assay indicated that kiwifruit intake was
associated with a marked decrease in levels of endogenous oxidation of pyrimidines and
purines, as well as a substantial increase in DNA repair capacity. An 8-wk intervention
trial[125,127]
in which 33 volunteers consumed 3 kiwifruits per day, confirmed that intake of
this fruit was associated with a 13% decrease in DNA strand breaks using the comet assay.
However, additional, specific evaluation of kiwifruit‘s effects on nucleotide excision repair
and base excision repair capacities yielded inconsistent results. It would be worthwhile to
examine the time- and dose-dependent effects of kiwifruit intake on other cancer biomarkers
in humans. In light of the content of dietary fiber in kiwifruit and its actions on fecal bulk and
transit time, it would be of interest to determine whether this fruit may act as a dietary
antimutagen by reducing the fecal content of potential mutagens and carcinogens.[128]
Miscellaneous effects
Two publications report that extracts of Actinidia species attenuated liver injury induced in
rats by carbon tetrachloride.[129,130]
This action of one of the extracts was attributed to its
oleanolic acid content.[129]
There are preliminary findings that kiwifruit extracts have the
potential to modulate the immune system. For example, Actinidia extracts significantly
increased overall immune function in mice[131]
and promoted bone marrow cell proliferation
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Manjula et al. World Journal of Pharmacy and Pharmaceutical Sciences
in vitro.[132]
Catechin isolated from A arguta Planch protected mice from myelosuppression
induced by 5-fluorouracil.[133]
These latter findings suggest that kiwifruit might have benefits
in reducing toxic adverse effects of chemotherapeutic agents[128]
. Feeding a gold kiwifruit
puree to mice improved an antigen-specific immune response, which led the authors to
suggest that kiwifruit might be a new type of functional food ingredient.[134]
It has been
suggested that water-soluble extracts (PG102) prepared from hardy kiwifruit, A arguta, may
actually have potential use as orally active immune activators for the therapy of allergic
diseases.[107,135]
In an exploratory clinical trial, an extract of A arguta suppressed serum total
IgE levels even in asymptomatic subjects with atopy[136]
. Another possible use of kiwifruit
was identified when an A chinensis-supplemented sports drink was provided to 25 athletes
training in hot environments.[137]
For those consuming the beverage containing kiwifruit,
work time prior to exhaustion was lengthened. Furthermore, the blood volume of kiwifruit-
drinking subjects was expanded, blood glucose levels during extended training were
maintained, and vitamin C status of study participants was improved, compared with
controls.
In another human study, a randomized controlled trial of 89 healthy women with low iron
stores, consumption of gold kiwifruit along with an iron-fortified breakfast cereal meal
improved iron status, compared with controls.[68]
In a study of Chinese subjects‘ consumption
of 2 kiwifruits 1 hour before bedtime for 4 wk improved sleep onset, duration, and efficiency
in 24 adults with self-reported sleep disturbances.[138]
Regarding food uses of kiwifruit
constituents, actinidin, in light of its proteolytic capacity, has been used to tenderize meat as
well as to improve emulsion stability, texture, and organoleptic properties of sausage
products.[139]
Kiwifruit phenolics also have been evaluated for their interactions with
functional bread components during dough development and bread baking.[140]
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