Antioxidant and anti-atherosclerotic potential of Banana (Musa spp): A review of biological mechanisms for prevention and protection against atherosclerosis

Document Type : Review Article

Author

Institute of Biological and Health Sciences (ICBS), Federal University of Mato Grosso (UFMT), Barra do Garças, Brazil

Abstract

Objective: To review the antioxidant and anti-atherosclerotic potential of whole banana, banana flour, and its bioactive compounds.
Materials and Methods: A non-systematic review of the literature covering the past 20 years, using the following databases and searching bases: PUBMED/MEDLINE: https://www.ncbi.nlm.nih.gov/pubmed/; Google Scholar: https://scholar.google.com.br/; and “Literatura Latinoamericana em Ciências da Saúde”/Latin American Literature in Life Sciences [LILACS]: http://lilacs.bvsalud.org/, was done. Studies with incomplete methodology and design were excluded.
Results: Bananas from different species are a good source of carbohydrates, dietary fiber, proteins, polyunsaturated fatty acids, potassium, carotenoids, flavonoids, vitamin C and E, phytosterols, gallocatechin, catechin, and other polyphenols. Some of these compounds play trigger important biological roles as antioxidants or anti-atherosclerotic and cardiovascular protective substances. This review summarizes and explains thirteen protective biological mechanisms of banana bioactive compounds and banana products.
Conclusion: Including banana and its products in dietary menus, in food products and nutraceuticals should improve cardiovascular health of the populations.

Keywords


Ahmad BA, Zakariyya UA, Abubakar M, Sani
MM, Ahmad MA. 2019. Pharmacological
activities of Banana. In: Jideani AIO,
Anyasi, TA (Eds.). Banana NutritionFunction and Processing Kinetics, pp.1-
20, London, IntechOpen.
Akinlolu AA, Ghazali OK, Salau BA, Otulana
JO, Omowunmi M. 2013. Musa
sapientum attenuates total antioxidant and
lipid profile values in rats with
indomethacin-induced gastric ulceration.
Cel Memb Free Rad Res, 5: 236-243.
Al Amri FS, Hossain MA. 2018. Comparison
of total phenols, flavonoids, and
antioxidant potential of local and
imported ripe bananas. Egypt J Bas Appl
Sci, 5: 245-251.
Anyasi TA, Jideani ALO, Mchau GRA. 2018.
Phenolics and essential mineral profile of
organic acid pretreated unripe banana
flour. Food Res Int, 104: 100-109.
Aquino CF, Salomão LC, Pinheiro-Sant‟ana
HM, Ribeiro SMR, De Siqueira DL,
Cecon PR. 2018. Carotenoids in the pulp
and peel from 15 cultivars in two ripening
stages. Rev Ceres, 65: 217-226.
Arora A, Choudhary D, Agarwal G, Singh VP.
2008. Compositional variation in bcarotene content, carbohydrate and
antioxidant enzymes in selected banana
cultivars. Int J Food Sci Technol, 43:
1913-1921.
Ayala A, Muñoz MF, Argüeles S. 2014. Lipid
peroxidation: production, metabolism,
and signaling mechanisms of
malondialdehyde and 4-hydroxy-2-
nonenal. Oxid Med Cel Longev, 2014:
360438.
Babu MA, Suriyakala MA, Gothandam KM.
2012. Varietal impact on phytochemical
contents and antioxidant properties of
Musa acuminata (Banana). J Pharm Sci
Res, 4: 1950-1955.
Baldi A, Pandit MK, Ranka P. 2012.
Amelioration of in-vivo antioxidant
activity by banana extracts. Int J Pharm
Biol Arch, 3: 157-161.
Bakour M, El Menyiy N, El Ghouizi A,
Lyoussi B. 2021. Hypoglycemic,
hypolipidemic, and hepato-protective
effect of bee bread in streptozotocininduced diabetic rats. Avicenna J
Phytomed, 11: 343-352.
Bhaskar JJ, Mahadevama S, Chilkunda ND,
Salimath PV. 2012. Banana (Musa sp.
var. elakki bale) flower and pseudostem:
dietary fiber and associated antioxidant
capacity. J Agric Food Chem, 60: 427-
432.
Binsack R, Boersma BJ, Patel RP, Kirk M,
White CR, Darley-Usmar V, Barnes S,
Zhou F, Parks DA. 2001. Enhanced
antioxidant activity after chlorination of
Ferrari
AJP, Vol. 13, No. 3, May-Jun 2023 250
quercetin by hypochlorous acid. Alcohol
Clin Exp Res, 25: 434-443.
Borah M, Das S. 2017. Antidiabetic,
antihyperlipidemic, and antioxidant
activities of Musa balbisiana Colla. in
type 1 diabetic rats. Indian J Pharmacol,
49: 71-76.
Caimi G, Canino B, Montana M, Urso C,
Calandrino V, Lo Presti R, Hopps E.
2019. Lipid peroxidation, protein
oxidation, gelatinases, and their inhibitors
in a group of adults with obesity. Horm
Metab Res, 51: 389-395.
Carnevale R, Loffredo L, Nocella C,
Bartimoccia S, Bucci T, De Falco E,
Peruzzi M, Chimenti I, Biondi-Zoccai G,
Pignatelli P, Violli F, Frati G. 2014.
Epicatechin and catechin modulate
endothelial activation induced by platelets
of patients with peripheral artery disease.
Oxid Med Cell Longev, 2014: 691015.
China R, Dutta S, Sen S, Chakrabarti R,
Bhowmik D, Ghosh S, Dhar P. 2011. In
vitro antioxidant activity of different
cultivars of banana flower (Musa
paradicicus L.) extracts available in India.
J Food Sci, 76: C1292-C1299.
Chistiakov DA, Melnichenko AA,
Myasoedova VA, Grechko AV, Orekhov
AN. 2017. Mechanisms of foam cell
formation in atherosclerosis. J Mol Med,
95: 1153-1165.
Chung RWS, Leanderson P, Lundberg AK,
Jonasson L. 2017. Lutein exerts antiinflammatory effects in patients with
coronary artery disease. Atherosclerosis,
262: 87-93.
Cressey R, Kumsaiyai W, Mangklabruks A.
2014. Daily consumption of banana
marginally improves blood glucose and
lipid profile in hypercholesterolemic
subjects and increases serum adiponectin
in type 2 diabetic patients. Indian J Exp
Biol, 52: 1173-1181.
Darsini DTP, Maheshu V, Vishnupriya M,
Sasikumar JM. 2012. In vitro antioxidant
activity of banana (Musa spp. ABB cv.
Pisang Awak). Indian J Biochem
Biophys, 49: 124-129.
Dikshit P, Tyagi MK, Shukla K, Gambhir JK,
Shukla R. 2016.
Antihypercholesterolemic and antioxidant
effect of sterol rich methanol extract of
stem of Musa sapientum (banana) in
cholesterol fed Wistar rats. J Food Sci
Technol, 53: 1690-1697.
Dreschler M, Megens RTA, van Zandvoort M,
Weber C, Soehnlein O. 2010.
Hyperlipidemia-triggered neutrophilia
promotes early atherosclerosis.
Circulation, 122: 1837-1845.
Dwyer JH, Navab M, Dwyer KM, Hassan K,
Sun P, Shircore A, Hama-Levy S, Hough
G, Wang X, Drake T, Merz CN,
Fogelman AM. 2001. Oxygenated
carotenoid lutein and progression of early
atherosclerosis. The Los Angeles
Atherosclerosis Study. Circulation, 103:
2922-2927.
Edenta C, James DB, Owolabi OA, Okoduwa
SIR. 2014. Hypolipidemic effects of
aqueous extract of three cultivars of Musa
sapientum fruit peel on poloxamer-407
induced hyperlipidemic Wistar rats. Int J
Pharma Sci Res, 5: 1049-1054.
Egert S, Bosy-Westphal A, Seiberl J, Kürbitz
C, Settler U, Plachta-Danielzik S, Wagner
AE, Frank J, Schrezenmeier J, Rimbach
G, Wolffram S, Müller MJ. 2009.
Quercetin reduces systolic blood pressure
and plasma oxidised low-density
lipoprotein concentrations in overweight
subjects with a high-cardiovascular
disease risk phenotype: a double-blinded,
placebo-controlled cross-over study. Br J
Nutr, 102: 1065-1074.
Englberger L, Lyons G, Foley W, Daniells J,
Aalbersberg B, Dolodolotawake U,
Watoto C, Iramu E, Taki B, Wehi F,
Warito P, Taylor M. 2010. Carotenoid
and riboflavin content of banana cultivars
from Makira, Solomon islands. J Food
Composit Anal, 23: 624-632.
Esterbauer H. 1993. Cytotoxicity and
genotoxicity of lipid-oxidation
products. Am J Clin Nutr, 57: S779-S786.
Ferrari CKB. 1998. Lipid oxidation in foods
and biological systems: general
mechanisms and nutritional and
pathological implications. Rev Nutr, 11:
3-14.
Ferrari CKB. 2004. Functional foods, herbs
and nutraceuticals: towards biochemical
mechanisms of healthy aging.
Biogerontology, 5: 275-289.
Ferrari CKB. 2013. Functional foods,
nutraceuticals, and herbs: an approach of
cell and molecular anti-ageing
mechanisms. Agro Food Ind High Tech,
24: 10-12.
Banana and cardiovascular protection
AJP, Vol. 13, No. 3, May-Jun 2023 251
Ferrari CKB, Torres EAFS. 2003. Biochemical
pharmacology of functional foods and
prevention of chronic diseases of aging.
Biomed Pharmacother, 57: 251-260.
Ferrari CKB, França EL, Honorio-França AC.
2009. Nitric oxide, health and disease. J
Appl Biomed, 7: 163-173.
Ferrari CKB, Percário S, Silva JCCB, Torres
EAFS. 2016. An apple plus a nut a day
keeps the doctors away: antioxidant
capacity of foods and their health
benefits. Cur Pharm Des, 22: 189-195.
Ferrari CKB. 2020. Anti-atherosclerotic and
cardiovascular protective benefits of
Brazilian nuts. Front Biosci, 12: 38-56.
Gaudreault N, Kumar N, Olivas VR, Eberlé D,
Stephens K, Raffai RL. 2013.
Hyperglycemia impairs atherosclerosis
regression in mice. Am J Pathol, 183:
1981-1992.
Gutteridge JM. 1995. Lipid peroxidation and
antioxidants as biomarkers of tissue
damage. Clin Chem, 41: 1819-1828.
Gutteridge JMC, Halliwell B. 2018. Minireview: oxidative stress, redox stress or
redox success? Biochem Biophys Res
Commun, 502: 183-186.
Han H, Cui W, Wang L, Xiong Y, Liu L, Sun
X, Hao L. 2015. Lutein prevents high fat
diet-induced atherosclerosis in ApoEdeficient mice by inhibiting NADPH
oxidase and increasing PPAR expression.
Lipids, 50: 261-273.
Heng Z, Sheng O, Yan S, Hongxian L,
Motorykin I, Gao H, Li C, Yang Q, Hu C,
Kuang R, Bi F, Dou T, Xie S, Deng G, Yi
G. 2017. Carotenoid profiling in the peel
and pulp of 36 selected Musa varieties.
Food Sci Technol Res, 23: 603-611.
Housseini M, Boskabady MH, Khazdair MR.
2021. Neuroprotective effects of
Coriandrum sativum and its constituent,
linalool: a review. Avicenna J Phytomed,
11: 436-450.
Howard AN, Thurnham DI. 2017. Lutein and
atherosclerosis: Belfast versus Toulouse
revisited. Med Hypoth, 98: 63-68.
Hwang SJ, Kim Y-W, Park Y, Lee H-J, Kim
K-W. 2014. Anti-inflammatory effects of
chlorogenic acid in lipopolysaccharidestimulated RAW 264.7 cells. Inflam Res,
63: 81-90.
Ignarro LJ. 2002. Wein Lun visiting professor
lecture: Nitric oxide in the regulation of
vascular function: a historical overview. J
Card Surg, 17: 301-306.
Izar MCD, Costa ES, França CN, Fonseca
FAH, Kato J, Bianco HT, Freitas T,
Fonseca HAR, Figueiredo-Neto AM.
2018. Beneficial effects of green banana
biomass consumption in patients with prediabetes and diabetes: a randomized
controlled trial. Atherosclerosis, 275:
e196.
Kahlon TS, Smith GE. 2007. In vitro binding
of bile acids by bananas, peaches,
pineapple, grapes, pears, apricots and
nectarines. Food Chem, 101: 1046-1051.
Kandasamy S, Aradhya SM. 2014.
Polyphenolic profile and antioxidant
properties of rhizome of commercial
banana cultivars grown in India. Food
Biosci, 8: 22-32.
Kanazawa K, Sakakibara H. 2000. High
content of dopamine, a strong antioxidant,
in Cavendish banana. J Agric Food Chem,
48: 844-848.
Kandasamy S, Ramu S, Aradhya SM. 2016. In
vitro functional properties of crude
extracts and isolated compounds from
banana pseudostem and rhizome. J Sci
Food Agric, 96: 1347-1355.
Kanner J. 1994. Oxidative processes in meat
and meat products: quality
implications. Meat Sci, 36: 169-189.
Krishnan K, Vijayalakshmi NR. 2005.
Alterations in lipids & lipid peroxidation
in rats fed with flavonoid rich fraction of
banana (Musa paradisiaca) from high
background radiation area. Indian J Med
Res, 122: 540-546.
Kulma A, Szopa J. 2007. Cathecolamines are
active compounds in plants. Plant Sci,
172: 433-440.
Kurano M, Hasegawa K, Kunimi M, Hara M,
Yatomi Y, Teramoto T, Tsukamoto K.
2018. Sitosterol prevents obesity-related
chronic inflammation. Biochim Biophys
Acta Mol Cel Biol Lip, 1863: 191-198.
Lei L, Zhu H, Zhang C, Wang X, Ma KY,
Wang L, Zhao Y, Chen Z-Y. 2017.
Dietary β-sitosterol is more potent in
reducing plasma cholesterol than sesamin
in hypercholesterolemia hamsters. Eur J
Lipid Sci Technol, 119: 1600349.
Lobo V, Patil A, Phatak A, Chandra N. 2010.
Free radicals, antioxidants and functional
foods: impact on human health.
Pharmacogn Rev, 4: 118-126.
López GB, Montano FJG. 2014. Propiedades
Ferrari
AJP, Vol. 13, No. 3, May-Jun 2023 252
funcionales del plátano (Musa sp). Rev
Med UV, 14: 22-26.
Lorenz M, Fechner M, Kalkowski J, Fröhlich
K, Trautmann A, Böhm V, Liebisch G,
Lehneis S, Schmitz G, Ludwig A,
Baumann G, Stangl K, Stangl V. 2012.
Effects of lycopene on the initial stage of
atherosclerosis in New Zealand White
(NZW) rabbits. PLOS One, 7: e30808.
Ludovici V, Barthelmes J, Nägele MP,
Flammer AJ, Sudano I. 2018.
Polyphenols: anti-platelet nutraceutical?
Curr Pharm Des, 24: 146-157.
Marinovic MP, Morandi AC, Otton R. 2015.
Green tea catechins alone or in
combination alter functional parameters
of human neutrophils via suppressing the
activation of TLR-4/NFkB p65 signal
pathway. Toxicol in Vitro, 29: 1766-
1778.
Mokbel MS, Hashinaga F. 2005. Antibacterial
and antioxidant activities of Banana
(Musa, AAA cv. Cavendish) fruits peel.
Am J Biochem Biotechnol, 1: 125-131.
Moongngarm A, Tiboonbun W, Sanpong M,
Sriwong P, Phiewtong L, Prakitrum R,
Huychan N. 2014. Resistant starch and
bioactive contents of unripe banana flour
as influenced by harvesting periods and
its application. Am J Agric Biol Sci, 9:
457-465.
Mosa ZM, Khalil AF. 2015. The effect of
banana peels supplemented diet on acute
liver failure rats. Ann Agricult Sci, 60:
373-379.
Moss JWE, Ramji DP. 2016. Nutraceutical
therapies for atherosclerosis. Nat Rev
Cardiol, 13: 513-532.
Navghare VV, Dhawale SC. 2017. In vitro
antioxidant, hypoglycemic and oral
glucose tolerance test of banana peels.
Alexandria J Med, 53: 237-243.
Nguyen D, Nováková A, Spurná K, Hričko J,
Phung H, Viktorová J, Stránska M,
Hajšlová M, Rumi T. 2017. Antidiabetic
compounds in stem juice from banana.
Czech J Food Sci, 35: 407-413.
Orekhov AN, Sobenin IA, Korneev NV,
Kirichenko TV, Myasoedova VA,
Melnichenko AA, Balcells M, Edelman
ER, Bobryshev YV. 2013. Antiatherosclerotic therapy based on
botanicals. Recent Pat Cardiovasc Disc, 8:
56-66.
Orekhov AN. 2013. Direct anti-atherosclerotic
therapy; Development of natural antiatherosclerotic drugs preventing cellular
cholesterol retention. Curr Pharm Des, 19:
5909-5928.
Palozza P, Parrone N, Simone RE, Catalano E.
2010. Lycopene in atherosclerosis
prevention: an integrated scheme of the
potential mechanisms of action from cell
culture studies. Arch Biochem Biophys,
501: 26-33.
Pannala AS, Rice-Evans CA, Halliwell B,
Singh S. 1997. Inhibition of peroxynitritemediated tyrosine nitration by catechin
and polyphenols. Biochem Biophys Res
Commun, 232: 164-168.
Park J-G, Oh GT. 2011. The role of
peroxidases in the pathogenesis of
atherosclerosis. BMB Rep, 44: 497-505.
Patel R, Rinker L, Peng J, Chilian WM. 2017.
Reactive oxygen species: the good and
the bad. In: Cristiana F, Albu E (Eds.).
Reactive oxygen species in living cells,
pp.7-20, London, IntechOpen.
Pereira A, Maraschin M. 2015. Banana (Musa
spp) from peel to pulp:
ethnopharmacology, source of bioactive
compounds and its relevance for human
health. J Ethnopharmacol, 160: 149-163.
Pfeuffer M, Auinger A, Bley U, KrausStojanowic I, Laue C, Winkler P, Rüfer
CE, Frank J, Bösch-Saadatmandi C,
Rimbach G, Schrezenmeier J. 2013.
Effect of quercetin on traits of the
metabolic syndrome, endothelial function
and inflammation in men with different
APOE isoforms. Nutr Metab Cardiovasc
Dis, 23: 403-409.
Pignatelli P, Di Santo S, Buchetti B, Brunelli
A, Violi F. 2006. Polyphenols enhance
platelet nitric oxide by inhibiting protein
kinase C-dependent NADPH oxidase
activation: effect on platelet recruitment.
Faseb J, 20: 1082-1089.
Rahman MM, Kabir SMH. 2003. In: Asiatic
Society of Bangladesh (Ed.),
Banglapedia, Dhaka, p.403.
Rajagopalan S, Meng XP, Ramasamy S,
Harrison DG, Galis ZS. 1996. Reactive
oxygen species produced by macrophagederived foam cells regulate the activity of
vascular matrix metalloproteinases in
vitro. Implications for atherosclerotic
plaque stability. J Clin Invest, 98: 2572-
2579.
Rebello LPG, Ramos AM, Pertuzatti PB,
Banana and cardiovascular protection
AJP, Vol. 13, No. 3, May-Jun 2023 253
Barcia MT, Castillo-Muñoz N, HermosínGutiérrez I. 2014. Flour of banana (Musa
AAA) peel as source of antioxidant
phenolic compounds. Food Res Int, 55:
397-403.
Riccioni G, Mancini B, Di Ilio E, Bucciarelli
T, D‟Orazio N. 2008. Protective effect of
lycopene in cardiovascular disease. Eur
Rev Med Pharm Sci, 12: 183-190.
Ried K, Fakler P. 2011. Protective effect of
lycopene on serum cholesterol and blood
pressure: meta-analyses of intervention
trials. Maturitas, 68: 299-310.
Rissanen T, Voutilainen S, Nyyssönen K,
Salonen JT. 2002. Lycopene,
atherosclerosis, and coronary heart
disease. Exp Biol Med, 227: 900-907.
Shirzad F, Morovatdar N, Rezaee R,
Tsarouhas K, Moghaddam AA. 2021.
Cinnamon effects on blood pressure and
metabolic profile: A double-blind,
randomized, placebo-controlled trial in
patients with stage 1 hypertension.
Avicenna J Phytomed, 11: 91-100.
Sidhu JS, Zafar TA. 2018. Bioactive
compounds in banana fruits and their
health benefits. Food Qual Safet, 2: 183-
188.
Silvestre AJD. 2014. Lipophilic
phytochemicals form banana fruits from
several species. Food Chem, 162: 247-
252.
Sobenin IA, Chistiakov DA, Bobryshev YV,
Postnov AY, Orekhov AN. 2013. Blood
atherogenicity as a target for antiatherosclerotic therapy. Curr Pharm Des,
19: 5954-5962.
Someya S, Yoshiki Y, Okubo K. 2002.
Antioxidant compounds from bananas
(Musa Cavendish). Food Chem, 79: 351-
354.
Stein JH, Keevil JG, Wiebe DA, Aeschliman
S, Folts JD. 1999. Purple grape juice
improves endothelial function and
reduces the susceptibility of LDL
cholesterol to oxidation in patients with
coronary artery disease. Circulation, 100:
1050-1055.
Steinberg D, Parthasarathy S, Carew TE, Khoo
JC, Witztum JL. 1989. Beyond
cholesterol: modifications of low-density
lipoprotein that increase its
atherogenicity. New Engl J Med, 320:
915-924.
Suwanaruang T. 2016. Analysing lycopene
content in fruits. Agric Agricult Sci
Procedia, 11: 46-48.
Tajik N, Tajik M, Mack I, Enck P. 2017. The
potential effects of chlorogenic acid, the
main phenolic components in coffee, on
health: a comprehensive review of the
literature. Eur J Nutr, 56: 2215-2244.
Thanaraj T, Terry LA. 2011. Tropical fruit
(Banana, pineapple, papaya and mango).
In: Terry LA (Ed.). Health-promoting
properties of fruit and vegetables, pp.352-
370. Oxfordshire, CAB Int.
Tertov W, Orekhov AN, Martsenyuk ON,
Perova NV, Smirnov VN. 1989. Lowdensity lipoproteins isolated from the
blood of patients with coronary heart
disease induce the accumulation of lipids
in human aortic cells. Exp Mol Pathol, 50:
337-347.
Toh PY, Leong FS, Chang SK, Khoo HE, Yim
HS. 2016. Optimization of extraction
parameters on the antioxidant properties
of banana waste. Acta Sci Pol Technol
Aliment, 15: 65-78.
Tsamo CVP, Herent M-F, Tomekpe K, Emaga
TH, Quetin-Leclercq J, Rogez H,
Larondelle Y, Andre C. 2015. Phenolic
profiling in the pulp and peel of nine
plantain cultivars. Food Chem, 167: 197-
204.
Vijayakumar S, Presannakumar G,
Vijayalakshmi NR. 2008. Antioxidant
activity of banana flavonoids. Fitoterapia,
79: 279-282.
Vilela C, Santos SAO, Villaverde JJ, Oliveira
L, Nunes A, Cordeiro N, Freire CSR,
Yang J, Liu RH, Halim L. 2009.
Antioxidant and antiproliferative
activities of common edible nut seeds.
LWT Food Sci Technol, 42: 1-8.
Waddingtol E, Puddey IB, Croft KD. 2004.
Red wine polyphenolic compounds
inhibit atherosclerosis in apolipoprotein
E-deficient mice independently of effects
on lipid peroxidation. Am J Clin Nutr, 79:
54-61.
Wang MX, Jiao JH, Li ZY, Liu RR, Shi Q, Ma
L. 2013. Lutein supplementation reduces
plasma lipid peroxidation and C-reactive
protein in healthy nonsmokers.
Atherosclerosis, 227: 380-385.
Xu X-R, Zou Z-Y, Huang Y-M, Xiao X, Ma
L, Lin X-M. 2012. Serum carotenoids in
relation to risk factors for development of
atherosclerosis. Clin Biochem, 45: 1357-
Ferrari
AJP, Vol. 13, No. 3, May-Jun 2023 254
1361.
Yarahmadi A, Sarabi MM, Sayahi A, Zal F.
2021. Protective effects of quercetin
against hyperglycemia-induced oxidative
stress in hepatic HepG2 cell line.
Avicenna J Phytomed, 11: 269-280.
Youryon P, Supapvanich S. 2017.
Physicochemical quality and antioxidant
changes in „Leb Mue Nang‟ banana fruit
during ripening. Agricult Nat Res, 51: 47-
52.
Zhang H, Tsao R. 2016. Dietary polyphenols:
oxidative stress and antioxidant and antiinflammatory effects. Curr Opin Food
Sci, 8: 33-42.
Zou Z-Y, Xu X-R, Lin X-M, Zhang H-B, Xiao
X, Ouyang L, Huang Y-M, Wang X, Liu
Y-Q. 2014. Effects of lutein and lycopene
on carotid intima-media thickness in
Chinese subjects with subclinical
atherosclerosis: a randomized, doubleblind, placebo-controlled trial. Brit J Nutr,
111: 474-480.