Nutrients for Money: The Relationship between Portion Size, Nutrient Density and Consumer Choices

*Rebecca L. Haslam, Rachael Taylor, Jaimee Herbert and Tamara Bucher*

## **Abstract**

Overweight and obesity are major risk factors for chronic disease and in the past 40–50 years portion sizes of offered foods, especially energy-dense, nutrient poor varieties, have dramatically increased along with global rates of overweight and obesity. Studies have shown that offering larger portion sizes result in increased food intake, known as the 'portion size effect'. This is likely due to consumption norms, the expected satiation and satiety of larger portions and the effect of unit bias. In addition, inconsistencies between serving sizes on nutrition information labelling compared to national dietary guidelines, makes it difficult for consumers to estimate and select appropriate portion sizes. Consumers find larger portion sizes more appealing due to their perceived value for money however, the nutritive value of the food is most often not acknowledged. Nutrient profiling models, which classify foods based on their nutrient density per unit cost may help consumers make healthier food choices. This narrative review aims to provide an overview of the portion size effect and discusses the application of nutrient profile score-based labels as a means of promoting nutrient density as value for money to influence consumer choices.

**Keywords:** energy density, nutrient density, portion size, portion size effect, serving size

## **1. Introduction**

Globally, non-communicable diseases are the leading cause of mortality and morbidity, contributing to 73% of total deaths and 62% of disability adjustedlife years (DALYs) [1]. Overweight and obesity are a leading risk factor for the development of non-communicable diseases [2]. It is widely accepted that diet is a major contributor to an energy imbalance by which energy intake exceeds energy expenditure over an accumulative period of time, leading to the development of overweight and obesity [3]. Limiting the consumption of energy-dense, nutrient poor foods to manage energy intake is a strategy recommended for regulating body weight and preventing non-communicable diseases [4, 5]. The energy density of food refers to the proportion of energy compared to the total mass weight (i.e. kilojoules per grams), which is influenced by the macronutrient and water content of the food [6].

Over the past 40–50 years, offered portion-sizes have significantly increased in food retail, restaurants and cookbook recipes [7–13]. Young et al. [7] reported that the portion size of energy-dense, nutrient-poor ready-to-eat foods exceeded government recommended standard serve sizes by up to 700% [14, 15]. This increase in offered portion sizes is driven by consumers seeking value for money. After taste, consumers regard price as the most important factor determining food choices. Larger portions appear more attractive by offering more food for a lower unit price [13]. From a producer's perspective, offering larger portions is therefore profitable. The cost of the extra food product is often negligible compared to the cost of the food packaging and offering a bigger unit may only slightly increase production costs. In addition, by offering a larger product, a producer can increase consumer satisfaction and is likely to have an advantage compared to a competitor offering smaller units. Therefore, in many settings, prices per gram are lower for large packages compared to small packages. This phenomenon is known as value size pricing.

Offering larger portions of foods to adults and children has been shown to increase the amount of food consumed and total energy intake [16, 17]. This relationship between offered portion size and amount of food consumed is known as the 'portion-size effect' [16–18]. Kling et al. [19] found that doubling the meal portion size offered to children aged 3–5 years increased energy intake by 24%. This study also found that increasing the energy density of the meal did not reduce amount of food consumed [19]. Therefore, serving larger portions of food, especially energy-dense, nutrient-poor varieties, in the long-term may be an important mediator for overweight and obesity and non-communicable diseases. The mechanisms underlying the portion size effect are unclear [20], however value for money has been identified as an incentive for consumers to choose larger portion sizes, which drives the marketing of larger packet sizes by food producers [13, 21]. Additional contributing factors such as appropriateness, unit bias, expected satiation and satiety, visual cues and bite size have also been identified and will be discussed later in this narrative review.

Consumers lack nutritional knowledge and skills to identify appropriate portion sizes and make healthy food choices [22, 23]. To overcome these barriers the European Commission proposed the concept of nutrition profiling, which categorises foods based on their nutritional composition [24]. Nutrient profiling has been used in a number of educational and regulatory strategies including translating nutrition information to consumers via front-of-pack labelling systems [25], identifying foods for re-formulation to improve nutrient density, directing food advertising to specific sub-populations, regulating where specific foods are distributed and informing tax policies of unhealthy foods [25, 26]. Nutrient profiling can also help consumers identify nutrientdense foods for their unit price [27]. This application may help mitigate the portion size effect by shifting value to nutrients for money, rather than size for money [28].

The scope of this narrative review is to define the portion size effect, discuss the underlying mechanisms of the phenomena and identify the limitations of using a portion size approach when making food choices. This review will define nutrient profiling and its application for consumers, with a particular emphasis on the use of Nutrient Profile models in identifying nutrient-dense foods for their unit price.

**137**

*2.1.2 Unit bias*

*Nutrients for Money: The Relationship between Portion Size, Nutrient Density and Consumer…*

Understanding the definition of a 'portion size' and where the term sits in relation to other health terminology is a key challenge for consumers and food manufacturers [29, 30]. Definitions on what is considered a 'portion size' oscillate between the amount of food consumed at a single eating occasion and the amount of food served by an individual, food-outlet or manufacturer [31]. The distinction between a 'portion size', a 'serving size' and a 'serve' is also unclear, with the terms found to be used interchangeably on food labels to describe the recommended amount of product to eat [32]. For the purpose of clarity, this review will discuss 'portion size' as defined by Benton et al. [31] as the amount of food offered to consumers (of all ages) as well the amount of food selected and consumed. Portion size is then clearly distinguished from a 'serving size' which is defined as 'the amount (e.g. grams, millilitres) of a food or beverage item listed on the nutrition informa-

tion label and specified in national dietary guidelines for consumers' [31].

Contributing factors to the portion size effect will be discussed below.

**2.1 Contributing factors to the portion size effect (PSE)**

*2.1.1 Appropriateness or consumption norms*

Evidence indicates that serving larger portions increases the amount of food consumed in a specific meal and also subsequent energy intake [20]. This association has been termed the portion size effect [20]. Evidence indicates that offered food portion sizes can contribute to a difference in energy intake [33] however, the relationship is curvilinear. Doubling the amount of food offered can lead to a 35% increase in consumption but as portions continue to increase the portion size effect decreases [16]. This indicates that when conservative and excessive portion sizes of food are offered, additional factors such as physiological satiety cues and consumption norms may be stronger predictors for the amount of food consumed [16].

The concept 'appropriateness' is a widely cited explanation for the portion size effect [13, 34]. This concept explains that portion sizes perceived as 'appropriate' or normal provide an important cue for determining how much food will be consumed [35, 36]. Lewis et al. [37] examined food portion sizes in relation to social and personal norms using 12 food computer-based images presented in 17 different portion sizes. Adults (aged 18–60 years) (n = 60) responded more or less to each image to indicate their portion size preference or perceived portion sizes of others [37]. Overall, this study found that portion sizes for personal norms exceeded social norms for most foods [37]. Personal norms for portion size were found to be significantly larger in obese individuals compared to lean individuals (β = 0.076, p = 0.026), especially in males (β = 0.177, p < 0.001) [37]. Personal norms were also larger for foods with a higher liking rating (β = 0.142, p < 0.001) [37]. Other studies have also confirmed that portion size norms are influenced by weight status and gender, as well as socio-demographics, childhood experiences and personal motivational factors including dietary restraint [38–40]. Further evidence suggests that individuals perceive a wide range of portion sizes related to a particular food to be the 'norm', which suggests that significant confusion exist around estimating appropriate portion sizes [23].

Herman et al. [36] suggested that the amount of food consumed may not only be influenced by the portion size, but also by the number of units or single servings

**2. Defining the 'Portion Size Effect': offered and consumed** 

*DOI: http://dx.doi.org/10.5772/intechopen.90776*

**amounts of food**

*Nutrients for Money: The Relationship between Portion Size, Nutrient Density and Consumer… DOI: http://dx.doi.org/10.5772/intechopen.90776*

## **2. Defining the 'Portion Size Effect': offered and consumed amounts of food**

Understanding the definition of a 'portion size' and where the term sits in relation to other health terminology is a key challenge for consumers and food manufacturers [29, 30]. Definitions on what is considered a 'portion size' oscillate between the amount of food consumed at a single eating occasion and the amount of food served by an individual, food-outlet or manufacturer [31]. The distinction between a 'portion size', a 'serving size' and a 'serve' is also unclear, with the terms found to be used interchangeably on food labels to describe the recommended amount of product to eat [32]. For the purpose of clarity, this review will discuss 'portion size' as defined by Benton et al. [31] as the amount of food offered to consumers (of all ages) as well the amount of food selected and consumed. Portion size is then clearly distinguished from a 'serving size' which is defined as 'the amount (e.g. grams, millilitres) of a food or beverage item listed on the nutrition information label and specified in national dietary guidelines for consumers' [31].

Evidence indicates that serving larger portions increases the amount of food consumed in a specific meal and also subsequent energy intake [20]. This association has been termed the portion size effect [20]. Evidence indicates that offered food portion sizes can contribute to a difference in energy intake [33] however, the relationship is curvilinear. Doubling the amount of food offered can lead to a 35% increase in consumption but as portions continue to increase the portion size effect decreases [16]. This indicates that when conservative and excessive portion sizes of food are offered, additional factors such as physiological satiety cues and consumption norms may be stronger predictors for the amount of food consumed [16]. Contributing factors to the portion size effect will be discussed below.

### **2.1 Contributing factors to the portion size effect (PSE)**

#### *2.1.1 Appropriateness or consumption norms*

The concept 'appropriateness' is a widely cited explanation for the portion size effect [13, 34]. This concept explains that portion sizes perceived as 'appropriate' or normal provide an important cue for determining how much food will be consumed [35, 36]. Lewis et al. [37] examined food portion sizes in relation to social and personal norms using 12 food computer-based images presented in 17 different portion sizes. Adults (aged 18–60 years) (n = 60) responded more or less to each image to indicate their portion size preference or perceived portion sizes of others [37]. Overall, this study found that portion sizes for personal norms exceeded social norms for most foods [37]. Personal norms for portion size were found to be significantly larger in obese individuals compared to lean individuals (β = 0.076, p = 0.026), especially in males (β = 0.177, p < 0.001) [37]. Personal norms were also larger for foods with a higher liking rating (β = 0.142, p < 0.001) [37]. Other studies have also confirmed that portion size norms are influenced by weight status and gender, as well as socio-demographics, childhood experiences and personal motivational factors including dietary restraint [38–40]. Further evidence suggests that individuals perceive a wide range of portion sizes related to a particular food to be the 'norm', which suggests that significant confusion exist around estimating appropriate portion sizes [23].

#### *2.1.2 Unit bias*

Herman et al. [36] suggested that the amount of food consumed may not only be influenced by the portion size, but also by the number of units or single servings

*The Health Benefits of Foods - Current Knowledge and Further Development*

phenomenon is known as value size pricing.

discussed later in this narrative review.

of the food [6].

weight and preventing non-communicable diseases [4, 5]. The energy density of food refers to the proportion of energy compared to the total mass weight (i.e. kilojoules per grams), which is influenced by the macronutrient and water content

Over the past 40–50 years, offered portion-sizes have significantly increased in food retail, restaurants and cookbook recipes [7–13]. Young et al. [7] reported that the portion size of energy-dense, nutrient-poor ready-to-eat foods exceeded government recommended standard serve sizes by up to 700% [14, 15]. This increase in offered portion sizes is driven by consumers seeking value for money. After taste, consumers regard price as the most important factor determining food choices. Larger portions appear more attractive by offering more food for a lower unit price [13]. From a producer's perspective, offering larger portions is therefore profitable. The cost of the extra food product is often negligible compared to the cost of the food packaging and offering a bigger unit may only slightly increase production costs. In addition, by offering a larger product, a producer can increase consumer satisfaction and is likely to have an advantage compared to a competitor offering smaller units. Therefore, in many settings, prices per gram are lower for large packages compared to small packages. This

Offering larger portions of foods to adults and children has been shown to increase the amount of food consumed and total energy intake [16, 17]. This relationship between offered portion size and amount of food consumed is known as the 'portion-size effect' [16–18]. Kling et al. [19] found that doubling the meal portion size offered to children aged 3–5 years increased energy intake by 24%. This study also found that increasing the energy density of the meal did not reduce amount of food consumed [19]. Therefore, serving larger portions of food, especially energy-dense, nutrient-poor varieties, in the long-term may be an important mediator for overweight and obesity and non-communicable diseases. The mechanisms underlying the portion size effect are unclear [20], however value for money has been identified as an incentive for consumers to choose larger portion sizes, which drives the marketing of larger packet sizes by food producers [13, 21]. Additional contributing factors such as appropriateness, unit bias, expected satiation and satiety, visual cues and bite size have also been identified and will be

Consumers lack nutritional knowledge and skills to identify appropriate portion sizes and make healthy food choices [22, 23]. To overcome these barriers the European Commission proposed the concept of nutrition profiling, which categorises foods based on their nutritional composition [24]. Nutrient profiling has been used in a number of educational and regulatory strategies including translating nutrition information to consumers via front-of-pack labelling systems [25], identifying foods for re-formulation to improve nutrient density, directing food advertising to specific sub-populations, regulating where specific foods are distributed and informing tax policies of unhealthy foods [25, 26]. Nutrient profiling can also help consumers identify nutrientdense foods for their unit price [27]. This application may help mitigate the portion size effect by shifting value to nutrients for money, rather than size for

The scope of this narrative review is to define the portion size effect, discuss the underlying mechanisms of the phenomena and identify the limitations of using a portion size approach when making food choices. This review will define nutrient profiling and its application for consumers, with a particular emphasis on the use of Nutrient Profile models in identifying nutrient-dense foods for

**136**

money [28].

their unit price.

presented by food packaging (e.g. 1 can of soft drink, 1 packet of chips). Studies have shown that individuals consume smaller amounts when food is divided into several smaller units rather than fewer larger units [41]. Geier et al. [42] described these phenomena as 'unit bias'. Other factors may also drive the amount of food consumed including cost, availability and convenience of the food unit size [42].

#### *2.1.3 Expected satiation and satiety*

Expected satiation may also be an important determinant of the portion size selected [20]. Expected satiation is defined as the feeling of fullness that a food or meal is expected to provide immediately after consumption by an individual [20]. Expected satiety is influenced by learnt behaviours and macro-nutrient content of the food [43] and is directly related to food familiarity, whereby familiar foods are expected to be more filling [43]. Expected satiation also varied across food groups (e.g. vegetables, fruit, dairy) with energy-dense nutrient-poor foods being perceived to have a lower expected satiation ratio [43]. Foods with a lower expected satiation are often served in larger portions [44].

#### *2.1.4 Visual cue*

It has been suggested that visual cues such as dishware size, are used as a reference point for judging the amount of food to be consumed. Therefore, larger dishware might promote larger portion size selection and greater food consumption [45]. A meta-analysis (8 publications and 9 experiments) indicated there is some evidence to suggest that larger dishware is associated with greater food consumption, however, this relationship was not statistically significant (p = 0.28, 95% CI −0.35, −0.00) and a high level of heterogeneity was present across the studies [46]. Furthermore, the rim width of the plate may also impact on an individual's ability to estimate the portion size (p < 0.01) [47]. Currently, there is insufficient evidence to determine the impact of visual cues on portion size and food consumption.

#### *2.1.5 Bite size*

Emerging evidence suggests that larger portion sizes increases the amount of food consumed per bite [48–50]. It is hypothesised that larger bite sizes may result in reduced oral exposure time (i.e. an amount of food has less exposure time in the mouth) and less responsiveness to physiological satiety signals and therefore contribute to greater food consumption [51].

## **3. The ambiguity of nutrition labelling and serving sizes**

Food product labelling provides consumers with nutritional information to help them make informed choices. A systematic review, including 36 studies showed that different types of food labels on packages influence consumed portion sizes with effects varying from increased to decreased intake (34).

Worldwide regulations for nutrition labelling on foods products differ considerably. In some countries (e.g. member states of the EU), nutrients listed on the nutrition label must be provided per 100 grams or millilitres, whereas other countries (e.g. US, Brazil) require the nutrient content per serving and some countries require both (e.g. New Zealand, Thailand) [52]. Furthermore, in some countries (e.g. US, Canada), standard serving sizes are defined for specific foods by regulatory bodies, whilst in others (e.g. Australia, New Zealand) food manufacturers define their own

**139**

*Nutrients for Money: The Relationship between Portion Size, Nutrient Density and Consumer…*

serving sizes [52]. Evidence suggests that portion sizes are altered by food manufacturers to present a more favourable nutrition profile for their product, especially for

Some national dietary guidelines (e.g. Japan, Austria) specify standard serve sizes for specific foods within a food group on one eating occasion, as well as the total number of standard serves to be consumed per food group per day [56]. An important point of confusion for consumers is that the labelled serving size of packaged food can vary significantly to the standard serve sizes defined by national dietary guidelines [29]. For example, Yang et al. [57] analysed the nutrition labels of 4046 packaged foods in Australian supermarkets and found that only 24% adopted serving sizes that were similar with the standard serve sizes specified in the Australian Dietary Guidelines. Furthermore, Chan et al. [58] reported that at least 80% of Canadian packaged food (*n* = 1406) did not adopt the Canada's Food Guide Recommended Serving Sizes. These inconsistencies and confusing terminology prevent consumers from correctly interpreting nutrition labelling and making informed choices about appropriate portion sizes [57]. A systematic scoping review of studies conducted between 2010 and 2019 has found that consumers have a poor understanding of the labelled serving size [59]. Consumers frequently interpreted the labelled serving size as the recommended standard serve sizes specified within dietary guidelines for healthy eating rather than a typical consumption unit that is set by the manufacturer or other regulatory authority. A detailed discussion and review how consumers interpret the labelled serving size on food packages and how this information influences consumption behaviour was provided in the studies by

Most national dietary guidelines do not provide standard serve size recommendations in weight or metric cups for 'unhealthy' energy-dense, nutrient-poor foods [61]. Furthermore, the definition of energy-dense, nutrient-poor foods is often ambiguous. For example, the Eat Well Guide, describes energy-dense, nutrient-poor foods, as foods 'high in' fat, salt and sugar without providing quantitative criteria [56]. Consequently, these factors prevent consumers from clearly distinguishing foods of high and low nutrient density as well as estimating appropriate portion sizes.

Consumers often perceive larger portion sizes to be of greater value for money, without considering the nutritive value of the foods in relation to cost [62, 63]. In 1894, the nutrition scientist, Wilbur Atwater, was the pioneer for recognising the need to educate consumers about choosing cost-effective nutrient-dense foods and provided a legacy of studies which contributed to the development of nutrient

Nutrient profiling is an emerging field of nutrition research that aims to classify foods based on their nutrient density using numerical scores or qualitative classifications [65, 66]. Nutrient profiling models calculate the energy and macro and micronutrient content per specified unit [67]. Nutrients typically chosen for nutrient profiling models include protein, dietary fibre, calcium, iron, vitamin A, C and D, which are defined as shortfall nutrients, while saturated fatty acids, total sugars and sodium are identified as nutrients to limit [67]. Foods which contain a higher proportion of shortfall nutrients compared to energy are defined as nutrientdense, while foods that contain a higher proportion of nutrients to limit compared

Depending on the nutrient profiling model used, the nutrient content of a food may be expressed using standard units, which include per 100 g, 100 kcal or per

to energy, are defined as energy-dense, nutrient- poor foods [65].

'unhealthy foods' that are energy-dense and nutrient-poor [53–55].

*DOI: http://dx.doi.org/10.5772/intechopen.90776*

Van der Horst et al. [59] and Bucher et al. [60].

**4. Nutrient profiling**

profiling models [64].

#### *Nutrients for Money: The Relationship between Portion Size, Nutrient Density and Consumer… DOI: http://dx.doi.org/10.5772/intechopen.90776*

serving sizes [52]. Evidence suggests that portion sizes are altered by food manufacturers to present a more favourable nutrition profile for their product, especially for 'unhealthy foods' that are energy-dense and nutrient-poor [53–55].

Some national dietary guidelines (e.g. Japan, Austria) specify standard serve sizes for specific foods within a food group on one eating occasion, as well as the total number of standard serves to be consumed per food group per day [56]. An important point of confusion for consumers is that the labelled serving size of packaged food can vary significantly to the standard serve sizes defined by national dietary guidelines [29]. For example, Yang et al. [57] analysed the nutrition labels of 4046 packaged foods in Australian supermarkets and found that only 24% adopted serving sizes that were similar with the standard serve sizes specified in the Australian Dietary Guidelines. Furthermore, Chan et al. [58] reported that at least 80% of Canadian packaged food (*n* = 1406) did not adopt the Canada's Food Guide Recommended Serving Sizes. These inconsistencies and confusing terminology prevent consumers from correctly interpreting nutrition labelling and making informed choices about appropriate portion sizes [57]. A systematic scoping review of studies conducted between 2010 and 2019 has found that consumers have a poor understanding of the labelled serving size [59]. Consumers frequently interpreted the labelled serving size as the recommended standard serve sizes specified within dietary guidelines for healthy eating rather than a typical consumption unit that is set by the manufacturer or other regulatory authority. A detailed discussion and review how consumers interpret the labelled serving size on food packages and how this information influences consumption behaviour was provided in the studies by Van der Horst et al. [59] and Bucher et al. [60].

Most national dietary guidelines do not provide standard serve size recommendations in weight or metric cups for 'unhealthy' energy-dense, nutrient-poor foods [61]. Furthermore, the definition of energy-dense, nutrient-poor foods is often ambiguous. For example, the Eat Well Guide, describes energy-dense, nutrient-poor foods, as foods 'high in' fat, salt and sugar without providing quantitative criteria [56]. Consequently, these factors prevent consumers from clearly distinguishing foods of high and low nutrient density as well as estimating appropriate portion sizes.

## **4. Nutrient profiling**

*The Health Benefits of Foods - Current Knowledge and Further Development*

*2.1.3 Expected satiation and satiety*

*2.1.4 Visual cue*

*2.1.5 Bite size*

satiation are often served in larger portions [44].

contribute to greater food consumption [51].

presented by food packaging (e.g. 1 can of soft drink, 1 packet of chips). Studies have shown that individuals consume smaller amounts when food is divided into several smaller units rather than fewer larger units [41]. Geier et al. [42] described these phenomena as 'unit bias'. Other factors may also drive the amount of food consumed including cost, availability and convenience of the food unit size [42].

Expected satiation may also be an important determinant of the portion size selected [20]. Expected satiation is defined as the feeling of fullness that a food or meal is expected to provide immediately after consumption by an individual [20]. Expected satiety is influenced by learnt behaviours and macro-nutrient content of the food [43] and is directly related to food familiarity, whereby familiar foods are expected to be more filling [43]. Expected satiation also varied across food groups (e.g. vegetables, fruit, dairy) with energy-dense nutrient-poor foods being perceived to have a lower expected satiation ratio [43]. Foods with a lower expected

It has been suggested that visual cues such as dishware size, are used as a reference point for judging the amount of food to be consumed. Therefore, larger dishware might promote larger portion size selection and greater food consumption [45]. A meta-analysis (8 publications and 9 experiments) indicated there is some evidence to suggest that larger dishware is associated with greater food consumption, however, this relationship was not statistically significant (p = 0.28, 95% CI −0.35, −0.00) and a high level of heterogeneity was present across the studies [46]. Furthermore, the rim width of the plate may also impact on an individual's ability to estimate the portion size (p < 0.01) [47]. Currently, there is insufficient evidence to

determine the impact of visual cues on portion size and food consumption.

**3. The ambiguity of nutrition labelling and serving sizes**

effects varying from increased to decreased intake (34).

Emerging evidence suggests that larger portion sizes increases the amount of food consumed per bite [48–50]. It is hypothesised that larger bite sizes may result in reduced oral exposure time (i.e. an amount of food has less exposure time in the mouth) and less responsiveness to physiological satiety signals and therefore

Food product labelling provides consumers with nutritional information to help them make informed choices. A systematic review, including 36 studies showed that different types of food labels on packages influence consumed portion sizes with

Worldwide regulations for nutrition labelling on foods products differ considerably. In some countries (e.g. member states of the EU), nutrients listed on the nutrition label must be provided per 100 grams or millilitres, whereas other countries (e.g. US, Brazil) require the nutrient content per serving and some countries require both (e.g. New Zealand, Thailand) [52]. Furthermore, in some countries (e.g. US, Canada), standard serving sizes are defined for specific foods by regulatory bodies, whilst in others (e.g. Australia, New Zealand) food manufacturers define their own

**138**

Consumers often perceive larger portion sizes to be of greater value for money, without considering the nutritive value of the foods in relation to cost [62, 63]. In 1894, the nutrition scientist, Wilbur Atwater, was the pioneer for recognising the need to educate consumers about choosing cost-effective nutrient-dense foods and provided a legacy of studies which contributed to the development of nutrient profiling models [64].

Nutrient profiling is an emerging field of nutrition research that aims to classify foods based on their nutrient density using numerical scores or qualitative classifications [65, 66]. Nutrient profiling models calculate the energy and macro and micronutrient content per specified unit [67]. Nutrients typically chosen for nutrient profiling models include protein, dietary fibre, calcium, iron, vitamin A, C and D, which are defined as shortfall nutrients, while saturated fatty acids, total sugars and sodium are identified as nutrients to limit [67]. Foods which contain a higher proportion of shortfall nutrients compared to energy are defined as nutrientdense, while foods that contain a higher proportion of nutrients to limit compared to energy, are defined as energy-dense, nutrient- poor foods [65].

Depending on the nutrient profiling model used, the nutrient content of a food may be expressed using standard units, which include per 100 g, 100 kcal or per

serve. The standard unit chosen for a model will affect the nutrient density classification [66]. For example, using the standard unit per 100Kcal for foods low in energy such as fruit and vegetables, may result in the nutrient density being classified as disproportionately high in relation to the amounts typically consumed [66]. Another challenge in the field is the validation of nutrient profiling models [65, 68]. A recent systematic review of 78 profiling models identified that only 58% had performed validity testing [67]. The World Health Organisation (WHO) has developed and tested a draft guideline which specifies a series of tests that should be completed for the validation of nutrient profiling models [69]. However, these guidelines are not yet publicly accessible.

## **4.1 Application of nutrient profiling for consumers**

Nutrient profiling has a wide range of applications related to public health including both educational and regulatory strategies [65]. Nutrient profiling can been used to help consumers make healthier food choices by translating nutrition information via front-of-pack labelling systems on food packaging, supermarket shelf labels and through smart-phone applications [25]. Regulatory applications of nutrient profiling have been analysed by Raynor et al., [26] using the '4Ps' of Marketing Theory; Product, promotion, place and price of foods. In applying this theory, nutrient profiling can be used to; identify foods for re-formulation to improve the nutrient-density (product), direct food advertising to suitable subpopulations (promotion), regulate where specific foods are distributed (place) and taxation of unhealthy food (price) [26]. A systematic review indicated that the most common regulatory applications for nutrient profiling were for school food standards or guidelines (*n* = 27), food labelling (*n* = 12) and the regulation of food marketing to children (*n* = 10) [67]. More recently, nutrient profiling has been used as a criteria for the taxation of energy-dense, nutrient-poor foods [70]. For example, in Mexico an 8% taxation has been enforced for foods with an energy density of >1151 KJ (275 kcal)/100 g such as cakes, pies, cookies, chips and snacks [71]. Further development and analysis of these applications in the future will be important for optimising their impact on diet quality of consumers.

Research reports positive findings in regard to the effectiveness of nutrient profile scores for helping consumers make healthier food choices. As an example, the recent 5-year review of the Australian Health Star Rating reported that 70% of Australian consumers agreed that this voluntary front of pack nutrient profile logo helped them to identify healthier options within the same food category [72]. It was also found that two thirds reported that the label influenced purchasing decisions and that the label was driving product reformulation [72]. Furthermore, a randomised controlled trial of adults (*n* = 11,981) indicated that the use of the Five-Colour Nutrition Label enabled participants to choose foods of higher nutritional quality, including less saturated fat and sodium (p < 0.05) [73]. Although, significant challenges remain, nutrient profile scores could be used to promote the sales and consumption of healthier foods by consumer education and regulation. Nutrient Profiling Indices could also help identify foods that are both healthy and affordable [28, 63, 65]. Drewnowski et al. [28] demonstrated this by cross-referencing the Nutrient Rich Food Index with the US Department of Agriculture (USDA) nutrient composition and food prices data sets. The study demonstrated that foods could be characterised according to nutrients per dollar, helping consumers identify affordable, nutrient-dense foods [28], highlighting an area whereby nutrient profiling may contribute to the mitigation of the portion size effect by educating consumers on the nutritive value of foods and shifting preference for large portion sizes to high nutrient-density (**Figure 1**).

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*Nutrients for Money: The Relationship between Portion Size, Nutrient Density and Consumer…*

It is clear that larger portion sizes contribute to greater food consumption and higher energy intake, known as the portion size effect. However, consumers have difficulty in identifying appropriate portion sizes due to inconsistencies between the serving sizes of packaged foods compared to standard serving sizes defined by national dietary guidelines. In addition, consumers find larger portion sizes more appealing due to greater perceived value for money but often do not consider the nutritive value of the food. Pricing strategies were suggested to be an innovative way to counteract the portion size effect [21]. However, experimental research suggests that equalising unit prices alone may not be sufficient to counteract the effect

*Fibre for money. This figure visually represents the volume and cost of two different cereal types of providing 3.3 g dietary fibre each. It demonstrates that to match the amount of fibre in a single serve (30 g) of Weet-Bix, consumers must eat approximately 2.5 cups (82.5 g) of corn flakes to reach the equivalent amount of dietary fibre. This larger portion would cost consumers 3.7 times more, demonstrating the value in emphasising* 

Nutrition profiling has been implemented for public health initiatives including food labelling, food standards and guidelines and the regulation of food marketing. Front of pack labels that are based on nutrient profile scores such as the Health Star Rating help consumers to identify healthier foods. However, these labels could be developed further to better assist consumers in identifying foods of high nutrientdensity per unit cost. Further development of food labelling, consumer education and public health efforts are needed to promote nutrient density as the value for money, which should be driving product development. Specifically, future research is needed to evaluate the long-term impact of nutrient profile scores in real-life contexts (e.g. purchasing behaviour in supermarket) rather a controlled laboratory setting. The ability of nutrient profiling initiatives to effectively communicate nutrition messages to different target groups warrants further investigation. This body of evidence will be important for informing global industry reformulation and food policy development, which has the greatest potential to impact on consumer

*DOI: http://dx.doi.org/10.5772/intechopen.90776*

*nutrients for money rather than volume for money.*

**5. Conclusion**

**Figure 1.**

of larger offered portions [74].

food choices and dietary intake.

*Nutrients for Money: The Relationship between Portion Size, Nutrient Density and Consumer… DOI: http://dx.doi.org/10.5772/intechopen.90776*

#### **Figure 1.**

*The Health Benefits of Foods - Current Knowledge and Further Development*

guidelines are not yet publicly accessible.

**4.1 Application of nutrient profiling for consumers**

serve. The standard unit chosen for a model will affect the nutrient density classification [66]. For example, using the standard unit per 100Kcal for foods low in energy such as fruit and vegetables, may result in the nutrient density being classified as disproportionately high in relation to the amounts typically consumed [66]. Another challenge in the field is the validation of nutrient profiling models [65, 68]. A recent systematic review of 78 profiling models identified that only 58% had performed validity testing [67]. The World Health Organisation (WHO) has developed and tested a draft guideline which specifies a series of tests that should be completed for the validation of nutrient profiling models [69]. However, these

Nutrient profiling has a wide range of applications related to public health including both educational and regulatory strategies [65]. Nutrient profiling can been used to help consumers make healthier food choices by translating nutrition information via front-of-pack labelling systems on food packaging, supermarket shelf labels and through smart-phone applications [25]. Regulatory applications of nutrient profiling have been analysed by Raynor et al., [26] using the '4Ps' of Marketing Theory; Product, promotion, place and price of foods. In applying this theory, nutrient profiling can be used to; identify foods for re-formulation to improve the nutrient-density (product), direct food advertising to suitable subpopulations (promotion), regulate where specific foods are distributed (place) and taxation of unhealthy food (price) [26]. A systematic review indicated that the most common regulatory applications for nutrient profiling were for school food standards or guidelines (*n* = 27), food labelling (*n* = 12) and the regulation of food marketing to children (*n* = 10) [67]. More recently, nutrient profiling has been used as a criteria for the taxation of energy-dense, nutrient-poor foods [70]. For example, in Mexico an 8% taxation has been enforced for foods with an energy density of >1151 KJ (275 kcal)/100 g such as cakes, pies, cookies, chips and snacks [71]. Further development and analysis of these applications in the future will be

important for optimising their impact on diet quality of consumers.

Research reports positive findings in regard to the effectiveness of nutrient profile scores for helping consumers make healthier food choices. As an example, the recent 5-year review of the Australian Health Star Rating reported that 70% of Australian consumers agreed that this voluntary front of pack nutrient profile logo helped them to identify healthier options within the same food category [72]. It was also found that two thirds reported that the label influenced purchasing decisions and that the label was driving product reformulation [72]. Furthermore, a randomised controlled trial of adults (*n* = 11,981) indicated that the use of the Five-Colour Nutrition Label enabled participants to choose foods of higher nutritional quality, including less saturated fat and sodium (p < 0.05) [73]. Although, significant challenges remain, nutrient profile scores could be used to promote the sales and consumption of healthier foods by consumer education and regulation. Nutrient Profiling Indices could also help identify foods that are both healthy and affordable [28, 63, 65]. Drewnowski et al. [28] demonstrated this by cross-referencing the Nutrient Rich Food Index with the US Department of Agriculture (USDA) nutrient composition and food prices data sets. The study demonstrated that foods could be characterised according to nutrients per dollar, helping consumers identify affordable, nutrient-dense foods [28], highlighting an area whereby nutrient profiling may contribute to the mitigation of the portion size effect by educating consumers on the nutritive value of foods and shifting preference for large portion

**140**

sizes to high nutrient-density (**Figure 1**).

*Fibre for money. This figure visually represents the volume and cost of two different cereal types of providing 3.3 g dietary fibre each. It demonstrates that to match the amount of fibre in a single serve (30 g) of Weet-Bix, consumers must eat approximately 2.5 cups (82.5 g) of corn flakes to reach the equivalent amount of dietary fibre. This larger portion would cost consumers 3.7 times more, demonstrating the value in emphasising nutrients for money rather than volume for money.*

## **5. Conclusion**

It is clear that larger portion sizes contribute to greater food consumption and higher energy intake, known as the portion size effect. However, consumers have difficulty in identifying appropriate portion sizes due to inconsistencies between the serving sizes of packaged foods compared to standard serving sizes defined by national dietary guidelines. In addition, consumers find larger portion sizes more appealing due to greater perceived value for money but often do not consider the nutritive value of the food. Pricing strategies were suggested to be an innovative way to counteract the portion size effect [21]. However, experimental research suggests that equalising unit prices alone may not be sufficient to counteract the effect of larger offered portions [74].

Nutrition profiling has been implemented for public health initiatives including food labelling, food standards and guidelines and the regulation of food marketing. Front of pack labels that are based on nutrient profile scores such as the Health Star Rating help consumers to identify healthier foods. However, these labels could be developed further to better assist consumers in identifying foods of high nutrientdensity per unit cost. Further development of food labelling, consumer education and public health efforts are needed to promote nutrient density as the value for money, which should be driving product development. Specifically, future research is needed to evaluate the long-term impact of nutrient profile scores in real-life contexts (e.g. purchasing behaviour in supermarket) rather a controlled laboratory setting. The ability of nutrient profiling initiatives to effectively communicate nutrition messages to different target groups warrants further investigation. This body of evidence will be important for informing global industry reformulation and food policy development, which has the greatest potential to impact on consumer food choices and dietary intake.

## **Author details**

Rebecca L. Haslam1,2, Rachael Taylor1,2, Jaimee Herbert1,2 and Tamara Bucher1,3\*

1 Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, NSW, Australia

2 School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia

3 School of Environmental and Life Sciences, Faculty of Science, The University of Newcastle, NSW, Australia

\*Address all correspondence to: tamara.bucher@newcastle.edu.au

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**143**

*Nutrients for Money: The Relationship between Portion Size, Nutrient Density and Consumer…*

is associated with obesity and other biomarkers of chronic disease in US adults. European Journal of Nutrition.

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[9] Young LR, Nestle M. Reducing portion sizes to prevent obesity: A call to action. American Journal of Preventive

[11] Benson C. Increasing portion size in Britain. Society, Biology and Human

Biltoft-Jensen A, Beck AM, Ovesen L. Size makes a difference. Public Health

[13] Steenhuis IH, Vermeer WM. Portion

Medicine. 2012;**43**(5):565-568

[10] Wrieden W, Gregor A, Barton K. Have food portion sizes increased in the UK over the last 20 years? Proceedings of the Nutrition Society. 2008;**67**(OCE6):E211

Affairs. 2009;**74**(2):4-20

[12] Matthiessen J, Fagt S,

Nutrition. 2003;**6**(1):65-72

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size: Review and framework for interventions. International Journal of Behavioral Nutrition and Physical

[14] McCrory MA, Harbaugh AG, Appeadu S, Roberts SB. Fast-food offerings in the United States in 1986, 1991, and 2016 show large increases in food variety, portion size, dietary energy, and selected micronutrients. Journal of the Academy of Nutrition and

Dietetics. 2019;**119**(6):923-933

[7] Young LR, Nestle M. The contribution of expanding portion sizes to the US obesity epidemic. American Journal of Public Health.

2015;**54**(1):59-65

2002;**92**(2):246-249

*DOI: http://dx.doi.org/10.5772/intechopen.90776*

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1 Priority Research Centre for Physical Activity and Nutrition, The University of

2 School of Health Sciences, Faculty of Health and Medicine, The University of

\*Address all correspondence to: tamara.bucher@newcastle.edu.au

3 School of Environmental and Life Sciences, Faculty of Science, The University of

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

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**Author details**

Newcastle, NSW, Australia

Newcastle, NSW, Australia

Newcastle, NSW, Australia

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Australian families. Health Promotion Journal of Australia. 2015;**26**(2):83-88

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2017;**76**(3):230-236

2008;**138**(6):1107-1113

2010;**91**(4):1095S-1101S

2015;**88**:1-4

Proceedings of the Nutrition Society.

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programming. The Journal of Nutrition.

American Journal of Clinical Nutrition.

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2019;**72**:77-85

2006;**49**:9-25

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[73] Ducrot P, Julia C, Mejean C, Kesse-Guyot E, Touvier M, Fezeu LK, et al. Impact of different front-of-pack nutrition labels on consumer purchasing intentions: A randomized controlled trial. American Journal of Preventive Medicine. 2016;**50**(5):627-636

[74] Zuraikat FM, Smethers AD, Rolls BJ. Potential moderators of the portion size effect. Physiology & Behavior. 2019;**204**:191-198

*DOI: http://dx.doi.org/10.5772/intechopen.90776*

[62] Vermeer WM, Steenhuis IH, Seidell JC. Portion size: A qualitative study of consumers' attitudes toward point-of-purchase interventions aimed at portion size. Health Education Research. 2010;**25**(1):109-120

[63] Drewnowski A. The cost of US foods as related to their nutritive value. The American Journal of Clinical Nutrition. 2010;**92**(5):1181-1188

[64] Atwater WO. Foods: Nutritive Value and Cost. Washington, DC: Government

[65] Fulgoni VL III, Drewnowski A. Nutrient density: Principles and evaluation tools. The American Journal of Clinical Nutrition. 2014;**99**(5):1223S-1228S

[66] Drewnowski A, Maillot M,

Darmon N. Should nutrient profiles be based on 100g, 100kcal or serving size? European Journal Of Clinical Nutrition.

[67] Franco-Arellano B, Gladanac B, Labonté M-È, Ahmed M, Poon T, L'Abbé MR, et al. Nutrient profile models with applications in government-led nutrition policies aimed at Health promotion and noncommunicable disease prevention: A systematic review. Advances in Nutrition. 2018;**9**(6):741-788

[68] Garsetti M, de Vries J, Smith M, Amosse A, Rolf-Pedersen N. Nutrient profiling schemes: Overview and comparative analysis. European Journal

[69] World Health Organization (WHO). Guiding Principles and Framework Manual for the Development or Adaptation of Nutrient Profile Models. Geneva, Switzerland: World Health

[70] Nnoaham KE, Sacks G, Rayner M, Mytton O, Gray A. Modelling income

of Nutrition. 2007;**46**(2):15-28

Organisation (WHO); 2011

Printing Office; 1894

2008;**63**:898

*Nutrients for Money: The Relationship between Portion Size, Nutrient Density and Consumer… DOI: http://dx.doi.org/10.5772/intechopen.90776*

[62] Vermeer WM, Steenhuis IH, Seidell JC. Portion size: A qualitative study of consumers' attitudes toward point-of-purchase interventions aimed at portion size. Health Education Research. 2010;**25**(1):109-120

*The Health Benefits of Foods - Current Knowledge and Further Development*

[54] Cleanthous X, Mackintosh A-M, Anderson S. Comparison of reported nutrients and serve size between private label products and branded products in Australian supermarkets. Nutrition and

Dietetics. 2011;**68**(2):120-126

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[55] Kliemann N, Kraemer MVS,

[56] National Health and Medical

[57] Yang S, Gemming L, Rangan A. Large variations in declared serving sizes of packaged foods in Australia: A need for serving size standardisation?

[58] Chan JYM, Scourboutakos MJ, L'Abbe MR. Unregulated serving sizes on the Canadian nutrition facts table - an invitation for manufacturer manipulations. BMC Public Health.

[59] Van der Horst K, Bucher T, Duncanson K, Murawski B, Labbe D. Consumer understanding, perception and interpretation of serving size information on food labels: A scoping review. Nutrients. 2019;**11**(9):2189

[60] Bucher T, Murawski B,

Appetite. 2018;**128**:50-57

Duncanson K, Labbe D, Van der Horst K. The effect of the labelled serving size on consumption: A systematic review.

[61] Food and Agriculture Organization of the United Nations (FAO). Food Based Dietary Guidelines 2019. Available from: http://www.fao.org/nutrition/ education/food-dietary-guidelines/en/

Nutrients. 2018;**10**(2):139

2017;**17**(1):418

Research Council (NHMRC). Australian Dietary Guidelines. Canberra: National Health and Medical Research Council;

Scapin T, Rodrigues VM, Fernandes AC, Bernardo GL, et al. Serving size and nutrition Labelling: Implications for nutrition information and nutrition claims on packaged foods. Nutrients.

Hardman CA, et al. Will smaller plates lead to smaller waists? A systematic review and meta-analysis of the effect that experimental manipulation of dishware size has on energy consumption. Obesity Reviews.

[47] McClain AD, van den Bos W, Matheson D, Desai M, McClure SM, Robinson TN. Visual illusions and plate design: The effects of plate rim widths and rim coloring on perceived food portion size. International Journal of

Obesity. 2014;**38**(5):657-662

2003;**77**(5):1164-1170

2015;**139**:297-302

1988;**44**(6):727-733

[52] Hawkes C, World

Environment; 2004

[51] Rolls BJ, Hetherington M, Burley VJ. Sensory stimulation and energy density in the development of satiety. Physiology & Behavior.

Health O. Nutrition Labels and Health Claims: The Global Regulatory

[53] Kliemann N, Veiros MB, Gonzalez-Chica DA, Proenca RP. Serving size on nutrition labeling for processed foods sold in Brazil: Relationship to energy value. Revista de

Nutrição. 2016;**29**(5):741-750

[48] Orlet Fisher J, Rolls BJ, Birch LL. Children's bite size and intake of an entrée are greater with large portions than with age-appropriate or selfselected portions. The American Journal of Clinical Nutrition.

[49] Burger KS, Fisher JO, Johnson SL. Mechanisms behind the portion size effect: Visibility and bite size. Obesity (Silver Spring). 2011;**19**(3):546-551

[50] Almiron-Roig E, Tsiountsioura M, Lewis HB, Wu J, Solis-Trapala I, Jebb SA. Large portion sizes increase bite size and eating rate in overweight women. Physiology & Behavior.

2014;**15**(10):812-821

**146**

[63] Drewnowski A. The cost of US foods as related to their nutritive value. The American Journal of Clinical Nutrition. 2010;**92**(5):1181-1188

[64] Atwater WO. Foods: Nutritive Value and Cost. Washington, DC: Government Printing Office; 1894

[65] Fulgoni VL III, Drewnowski A. Nutrient density: Principles and evaluation tools. The American Journal of Clinical Nutrition. 2014;**99**(5):1223S-1228S

[66] Drewnowski A, Maillot M, Darmon N. Should nutrient profiles be based on 100g, 100kcal or serving size? European Journal Of Clinical Nutrition. 2008;**63**:898

[67] Franco-Arellano B, Gladanac B, Labonté M-È, Ahmed M, Poon T, L'Abbé MR, et al. Nutrient profile models with applications in government-led nutrition policies aimed at Health promotion and noncommunicable disease prevention: A systematic review. Advances in Nutrition. 2018;**9**(6):741-788

[68] Garsetti M, de Vries J, Smith M, Amosse A, Rolf-Pedersen N. Nutrient profiling schemes: Overview and comparative analysis. European Journal of Nutrition. 2007;**46**(2):15-28

[69] World Health Organization (WHO). Guiding Principles and Framework Manual for the Development or Adaptation of Nutrient Profile Models. Geneva, Switzerland: World Health Organisation (WHO); 2011

[70] Nnoaham KE, Sacks G, Rayner M, Mytton O, Gray A. Modelling income

group differences in the health and economic impacts of targeted food taxes and subsidies. International Journal of Epidemiology. 2009;**38**(5):1324-1333

[71] Batis C, Rivera JA, Popkin BM, Taillie LS. First-year evaluation of Mexico's tax on nonessential energydense foods: An observational study. PLoS Medicine. 2016;**13**(7):e1002057

[72] MP Consulting. Health Star Rating System - Five Year Review Draft Report; 2019

[73] Ducrot P, Julia C, Mejean C, Kesse-Guyot E, Touvier M, Fezeu LK, et al. Impact of different front-of-pack nutrition labels on consumer purchasing intentions: A randomized controlled trial. American Journal of Preventive Medicine. 2016;**50**(5):627-636

[74] Zuraikat FM, Smethers AD, Rolls BJ. Potential moderators of the portion size effect. Physiology & Behavior. 2019;**204**:191-198

**149**

**Chapter 7**

**Abstract**

presented.

health problems

**1. Introduction**

Stress, Natural Antioxidants and

Stress can exist by a variety of daily challenges related to obesity, other eating disorders, long-term health issues and immune system suppression. Free radicals derived from oxygen, called reactive oxygen species, reactive nitrogen species and similarly antioxidants are part of the body's natural functioning. Oxidative stress occurs when free radicals and antioxidants are out of balance. The prooxidantantioxidant balance is assessed by determination of both oxidant and antioxidant status, which can be measured simultaneously in blood and tissue. Dietary or natural antioxidants play an important role in helping the endogenous antioxidants in scavenging the excess of free radicals. Antioxidant supplements include several important substances such as beta carotene, lutein, phycocyanin and zeaxanthin, which are rich in vegetables, fruits and natural foods. All these contents have a key role in growth, immunity and lifetime quality. Still, high dose of the natural foods can cause the organism, not to assimilate the wastes by the mechanism. In this chapter, we'll inquire to explain the oxidative and antioxidative mechanisms and balance via importance of the natural antioxidants to life quality. For this purpose, oxidative stress, related diseases, antioxidants and their importance will be reviewed, and the correlation between natural antioxidants and health will be

**Keywords:** stress, oxidant-antioxidant balance, diet, natural antioxidants,

Stress is a complex phenomenon that correlates with oxidative and antioxidative status in organism. The physiological stress responses include several biological mechanisms such as digestion, reproduction, hormone and immunity. In common, physical or psychological stresses cause stress and disrupt homeostasis. Likewise, environmental factors and diseases can be a threat of some impending conditions (malnutrition, weakness, cancer, etc.). Oxidative stress is defined as imbalance between oxidants and antioxidants, and with aging, endogenous antioxidant defenses decrease and production of reactive oxygen species increases [1]. Nevertheless, antioxidant defense system and protection mechanisms are important in maintaining the organism against the oxidative stress, and thereby homeostasis can be observed. Keeping a stable homeostasis requires, besides a better environment and gene structure, we should need to know what nutrients are needed to maintain hemostasis. Nutrition especially dietary antioxidants

Future Perspectives

*Nilay Seyidoglu and Cenk Aydin*

## **Chapter 7**

## Stress, Natural Antioxidants and Future Perspectives

*Nilay Seyidoglu and Cenk Aydin*

## **Abstract**

Stress can exist by a variety of daily challenges related to obesity, other eating disorders, long-term health issues and immune system suppression. Free radicals derived from oxygen, called reactive oxygen species, reactive nitrogen species and similarly antioxidants are part of the body's natural functioning. Oxidative stress occurs when free radicals and antioxidants are out of balance. The prooxidantantioxidant balance is assessed by determination of both oxidant and antioxidant status, which can be measured simultaneously in blood and tissue. Dietary or natural antioxidants play an important role in helping the endogenous antioxidants in scavenging the excess of free radicals. Antioxidant supplements include several important substances such as beta carotene, lutein, phycocyanin and zeaxanthin, which are rich in vegetables, fruits and natural foods. All these contents have a key role in growth, immunity and lifetime quality. Still, high dose of the natural foods can cause the organism, not to assimilate the wastes by the mechanism. In this chapter, we'll inquire to explain the oxidative and antioxidative mechanisms and balance via importance of the natural antioxidants to life quality. For this purpose, oxidative stress, related diseases, antioxidants and their importance will be reviewed, and the correlation between natural antioxidants and health will be presented.

**Keywords:** stress, oxidant-antioxidant balance, diet, natural antioxidants, health problems

## **1. Introduction**

Stress is a complex phenomenon that correlates with oxidative and antioxidative status in organism. The physiological stress responses include several biological mechanisms such as digestion, reproduction, hormone and immunity. In common, physical or psychological stresses cause stress and disrupt homeostasis. Likewise, environmental factors and diseases can be a threat of some impending conditions (malnutrition, weakness, cancer, etc.). Oxidative stress is defined as imbalance between oxidants and antioxidants, and with aging, endogenous antioxidant defenses decrease and production of reactive oxygen species increases [1]. Nevertheless, antioxidant defense system and protection mechanisms are important in maintaining the organism against the oxidative stress, and thereby homeostasis can be observed. Keeping a stable homeostasis requires, besides a better environment and gene structure, we should need to know what nutrients are needed to maintain hemostasis. Nutrition especially dietary antioxidants

decreases the adverse effects of reactive oxygen species and regulates the stress. Consequently, it is necessary to understand how antioxidants in nutrients exert its health protective effects.

Antioxidants, natural or synthetic, may protect cell damages during oxidative stress. New researches showed that natural antioxidants in foods are commonly belonged with a better health and life quality. At that place, there are several natural antioxidants, which can reduce oxidation in cell or lipid peroxidation. Several studies have been stated that natural antioxidants such as medicinal herbs, alga, ginger, curcuma, cloves and vitamins can be utilized for health maintenance. They have important biological activities which attributed to their compounds named carotenoids, polyphenols, phycocyanin and flavonoids. The biological actions of these antioxidants are anti-inflammatory, enzyme detoxification, cell damage prevention, gene regulation and antimicrobial, which have been conducted with human and animal studies [2, 3]. Besides, natural antioxidants are shown to possess the antioxidant activity in organism and maintain the normal physiological condition. Thereby, they can be applied for protective health as well as for therapeutic conditions.

Increasing world population impacts on the environmental stress like of biodiversity, air and water contamination. Physicochemical stress results from environmental agents and such effects result in chronic infections, autoimmune diseases and other physiological disorders. Because of this reason, regulation of homeostasis should be backed up by natural antioxidants. This chapter, we will attempt to explain the stress, oxidative-antioxidative balance and natural antioxidants with evaluating the association of natural antioxidants and health.

## **2. Stress mechanism and oxidative-antioxidative balance**

Free radicals are called the reactive oxygen species (ROS), and they also include a subgroup of reactive nitrogen species (RNS) which are the products of normal cellular metabolism. Overwhelming production of these molecules leads to oxidative stress damage to lipids, proteins and DNA [4].

A balance between free radicals and antioxidants is necessary for proper function. If free radicals overwhelm the organism's ability to regulate the stress, a circumstance is known as stress. The mechanisms of stress could be explained with two parts as acute and chronic. Acute stress is termed as an emergency response of organism, which affects by short term stressors. In response to acute stress, sympathetic nervous system is triggered due to release of hormones and the response prepares the body to either fight or flight response. The sympathetic nervous system has signaled to adrenal glands for releasing epinephrine and cortisol hormones, which act on endocrine, cardiovascular, respiratory, musculoskeletal and gastrointestinal systems. All the same, the parasympathetic nervous system regulates rest and digests functions. It works without conscious control of cardiac muscle, smooth muscle and exocrine and endocrine glands, which regulate the blood pressure, glucose and thermoregulation, etc. On the other hand, chronic stress is induced by stress over a prolonged time and conducts the stress hormones to release in a long period. Also, hypothalamicpituitary-adrenal axis is kept active by chronic stress. This can have several symptoms either physical or psychological. Chronic stress is linked the risk of certain illnesses and lower life expectancy, such as obesity, cholesterol, anxiety and depression, and so on.

**151**

*Stress, Natural Antioxidants and Future Perspectives DOI: http://dx.doi.org/10.5772/intechopen.91167*

status in vivo.

peroxidation process [10].

especially from fruits and vegetables [13].

**3. Antioxidants in health and disease**

Oxygen is one of the most abundant and essential elements for all the life forms on the earth. It is critical for the energy production in both prokaryotes and eukaryotes via electron transport chain [4]. As a result of stress in cellular metabolism, reactive oxygen species are produced and these molecules can damage the proteins, carbohydrates, nucleic acids and lipids, which are the important cell structures. This situation is termed oxidative stress. Oxidative stress causes to increase of free radicals production and reduction of antioxidant defense system. According to this issue, within the consumption of antioxidant, either increase or decrease of oxidant and antioxidant amounts should be assessed for determining the oxidative status [5]. The free radical effect of fatty acids is to stimulate the lipid peroxidation and thereby several damages occur. The most important molecule of lipid peroxidation is malondialdehyde (MDA), which takes in an ability to inactive the cellular proteins by forming protein linkages [6]. In additionally, MDA level increases during oxidative stress and so, in clinical studies, the measurement of the MDA on biological fluids such as plasma or tissue should be taken out for reflection oxidative stress

Antioxidant molecules are classified as enzymatic and nonenzymatic by structures, endogen or exogen by sources, water-soluble and lipid-soluble by resolution, and intracellular and extracellular antioxidants by placement in organism. The enzymatic antioxidants called as glutathione (GSH, GST), glutathione peroxidase (GPx), catalase (CAT) and super oxide dismutase (SOD) have a big role in eliminating free radicals. They can restrain the negative effects of free radicals on DNA, proteins and lipids [7]. The nonenzymatic antioxidants, Vitamin C and E, beta carotene and polyphenol have an efficiency of free radical chain reactions by catching the oxygen molecules [8]. Measurement antioxidant response in biological fluids should be necessary for evaluating the oxidative stress. However, besides individual oxidant and antioxidant molecules, total oxidant and antioxidant status has been important to reflect the cumulative effect of oxidative stress in the organism [9]. Endogenous and exogenous antioxidants act synergistically to maintain or reestablish the redox homeostasis, such as during regeneration of vitamin E by glutathione or vitamin C to prevent the lipid

The oxidant-antioxidant balance is associated with increasing free radicals, inactivation or insufficiency of antioxidants and accumulation of oxidant molecules. Also, maintaining the balance between beneficial and harmful effects of reactive oxygen species is very important. Antioxidants encounter low concentrations of oxidant substances or inhibit the oxidation of target molecules [11]. They reduce the activation of oxidants or convert these molecules to weaker new molecule. Likewise, they can bind the oxidants and act on a reaction chain as in break/repair balance. Thereby, cellular prevention occurs and immunity is balanced [12]. There are both endogenous and exogenous defense against oxidative stress but endogenous defense mechanism is insufficient to completely protect against reactive oxygen species. Exogenous defense comes from the diet in the form of antioxidants,

The relationship between free radicals and antioxidants shows the unbalance of oxidant-antioxidant status. If antioxidant levels decrease, oxidant levels increase in *Stress, Natural Antioxidants and Future Perspectives DOI: http://dx.doi.org/10.5772/intechopen.91167*

*The Health Benefits of Foods - Current Knowledge and Further Development*

health protective effects.

conditions.

decreases the adverse effects of reactive oxygen species and regulates the stress. Consequently, it is necessary to understand how antioxidants in nutrients exert its

Antioxidants, natural or synthetic, may protect cell damages during oxidative stress. New researches showed that natural antioxidants in foods are commonly belonged with a better health and life quality. At that place, there are several natural antioxidants, which can reduce oxidation in cell or lipid peroxidation. Several studies have been stated that natural antioxidants such as medicinal herbs, alga, ginger, curcuma, cloves and vitamins can be utilized for health maintenance. They have important biological activities which attributed to their compounds named carotenoids, polyphenols, phycocyanin and flavonoids. The biological actions of these antioxidants are anti-inflammatory, enzyme detoxification, cell damage prevention, gene regulation and antimicrobial, which have been conducted with human and animal studies [2, 3]. Besides, natural antioxidants are shown to possess the antioxidant activity in organism and maintain the normal physiological condition. Thereby, they can be applied for protective health as well as for therapeutic

Increasing world population impacts on the environmental stress like of biodiversity, air and water contamination. Physicochemical stress results from environmental agents and such effects result in chronic infections, autoimmune diseases and other physiological disorders. Because of this reason, regulation of homeostasis should be backed up by natural antioxidants. This chapter, we will attempt to explain the stress, oxidative-antioxidative balance and natural antioxidants with

Free radicals are called the reactive oxygen species (ROS), and they also include a subgroup of reactive nitrogen species (RNS) which are the products of normal cellular metabolism. Overwhelming production of these molecules leads to oxidative

A balance between free radicals and antioxidants is necessary for proper function. If free radicals overwhelm the organism's ability to regulate the stress, a circumstance is known as stress. The mechanisms of stress could be explained with two parts as acute and chronic. Acute stress is termed as an emergency response of organism, which affects by short term stressors. In response to acute stress, sympathetic nervous system is triggered due to release of hormones and the response prepares the body to either fight or flight response. The sympathetic nervous system has signaled to adrenal glands for releasing epinephrine and cortisol hormones, which act on endocrine, cardiovascular, respiratory, musculoskeletal and gastrointestinal systems. All the same, the parasympathetic nervous system regulates rest and digests functions. It works without conscious control of cardiac muscle, smooth muscle and exocrine and endocrine glands, which regulate the blood pressure, glucose and thermoregulation, etc. On the other hand, chronic stress is induced by stress over a prolonged time and conducts the stress hormones to release in a long period. Also, hypothalamicpituitary-adrenal axis is kept active by chronic stress. This can have several symptoms either physical or psychological. Chronic stress is linked the risk of certain illnesses and lower life expectancy, such as obesity, cholesterol, anxiety

evaluating the association of natural antioxidants and health.

stress damage to lipids, proteins and DNA [4].

**2. Stress mechanism and oxidative-antioxidative balance**

**150**

and depression, and so on.

Oxygen is one of the most abundant and essential elements for all the life forms on the earth. It is critical for the energy production in both prokaryotes and eukaryotes via electron transport chain [4]. As a result of stress in cellular metabolism, reactive oxygen species are produced and these molecules can damage the proteins, carbohydrates, nucleic acids and lipids, which are the important cell structures. This situation is termed oxidative stress. Oxidative stress causes to increase of free radicals production and reduction of antioxidant defense system. According to this issue, within the consumption of antioxidant, either increase or decrease of oxidant and antioxidant amounts should be assessed for determining the oxidative status [5]. The free radical effect of fatty acids is to stimulate the lipid peroxidation and thereby several damages occur. The most important molecule of lipid peroxidation is malondialdehyde (MDA), which takes in an ability to inactive the cellular proteins by forming protein linkages [6]. In additionally, MDA level increases during oxidative stress and so, in clinical studies, the measurement of the MDA on biological fluids such as plasma or tissue should be taken out for reflection oxidative stress status in vivo.

Antioxidant molecules are classified as enzymatic and nonenzymatic by structures, endogen or exogen by sources, water-soluble and lipid-soluble by resolution, and intracellular and extracellular antioxidants by placement in organism. The enzymatic antioxidants called as glutathione (GSH, GST), glutathione peroxidase (GPx), catalase (CAT) and super oxide dismutase (SOD) have a big role in eliminating free radicals. They can restrain the negative effects of free radicals on DNA, proteins and lipids [7]. The nonenzymatic antioxidants, Vitamin C and E, beta carotene and polyphenol have an efficiency of free radical chain reactions by catching the oxygen molecules [8]. Measurement antioxidant response in biological fluids should be necessary for evaluating the oxidative stress. However, besides individual oxidant and antioxidant molecules, total oxidant and antioxidant status has been important to reflect the cumulative effect of oxidative stress in the organism [9]. Endogenous and exogenous antioxidants act synergistically to maintain or reestablish the redox homeostasis, such as during regeneration of vitamin E by glutathione or vitamin C to prevent the lipid peroxidation process [10].

The oxidant-antioxidant balance is associated with increasing free radicals, inactivation or insufficiency of antioxidants and accumulation of oxidant molecules. Also, maintaining the balance between beneficial and harmful effects of reactive oxygen species is very important. Antioxidants encounter low concentrations of oxidant substances or inhibit the oxidation of target molecules [11]. They reduce the activation of oxidants or convert these molecules to weaker new molecule. Likewise, they can bind the oxidants and act on a reaction chain as in break/repair balance. Thereby, cellular prevention occurs and immunity is balanced [12]. There are both endogenous and exogenous defense against oxidative stress but endogenous defense mechanism is insufficient to completely protect against reactive oxygen species. Exogenous defense comes from the diet in the form of antioxidants, especially from fruits and vegetables [13].

## **3. Antioxidants in health and disease**

The relationship between free radicals and antioxidants shows the unbalance of oxidant-antioxidant status. If antioxidant levels decrease, oxidant levels increase in an organism during oxidative stress. The initial defense response can be explained with SOD, which modifies the superoxide radicals to less harmful molecular oxygen [14]. Nevertheless, GSH, GPx, and CAT have a protective role on lipid peroxidation. Although GSH and GPx can reduce the hydrogen peroxide and lipid hydrogen peroxide, CAT, which has iron, brings down the hydrogen peroxide on liver and erythrocytes [15, 16].

There are numerous studies that observe the consumption of antioxidants in tissues or blood samples, and also reviewed the correlation between balance and important diseases both for humans and animals. Uzar et al. [17] observed the lower antioxidants in tissues in brain ischemia-reperfusion damage due to the higher oxidant value. Yigiter et al. [18] determined the increase of MDA and decrease of GSH in kidney tissue damage due to increase of DNA oxidation in the kidney. Tok et al. [19] found the higher MDA and MPO and lower GSH and GST levels in oxidative situations [20, 21]. As well, some researchers reported that free radicals were the most important components for ischemia damages in several organs such as brain, heart, liver and lung [22, 23]. Atherosclerosis, hypercholesterolemia and cancer are universally accepted as important diseases due to either antioxidant depletion or unbalance of oxidant and antioxidant status [24, 25]. Generation of antioxidants in oxidative status and correlation with pulmonary, cardiovascular or nutritional diseases were reviewed [26].

The role of oxidative stress in health and disease of animals has been critiqued by some researchers [27, 28]. Metabolic diseases, heat stress and nutrition have been documented as well as performance parameters, immune defense, milk production and energy balance [29, 30]. In addition, some important biological molecules damage by oxidative stress, such as DNA, RNA, cholesterol and proteins. It was reported that high starch nutrition was resulted in an increase of oxidative stress in dairy cows [14]. In horses, it was observed that overload feeding of grains, sugar or fructans was resulted with laminitis which is associated with oxidative stress [31].

**153**

**Table 1.**

*Stress, Natural Antioxidants and Future Perspectives DOI: http://dx.doi.org/10.5772/intechopen.91167*

nant and poultry [32].

**4. Natural antioxidants**

**Antioxidants contents**

Besides, protein oxidation was reported important for meat quality of both rumi-

Insight of this information, if the antioxidant mechanisms in organism are insufficient against oxidative stress, exogenous antioxidant supplements should be added to feed both human and animals for a better health. Antioxidants can be divided into two groups generally as natural and synthetic sources (**Figure 1**). Although synthetic antioxidant is produced from chemical processes, the important

The relationship between food and health has addressed for many years. Diet has an essential part in maintaining our health. Natural antioxidants play decisive roles in risk reduction of so many diseases. Dietary or natural antioxidants play a persuasive role in serving the endogenous antioxidants in scavenging the excess of free radicals. Nonetheless, the dietary antioxidants can only have helpful effects in the radical scavenging if they are present in tissues or body fluids at adequate concentrations. For many dietary components, absorption is limited or metabolism into derivatives that can be easily incorporated reduces the antioxidant capacity. As well, it is important to know that some specific antioxidants have limited function because of their inability to penetrate the blood-brain barrier, poor absorption and

one natural antioxidant is more useful for health due to its natural contents.

conversion to the pro-oxidants under certain physiological conditions [33].

**Natural sources**

blackberries

Zeaxanthin Egg yolks, peas, broccoli, carrots, pumpkin Beta carotene Tomatoes, potatoes, carrots, broccoli, peaches

Phycocyanin Seaweed (algae)

Cysteine Animal protein Peroxidase Mango, fruit

*Some interesting antioxidants sources.*

Flavonoids Oranges, lemons, green tea, berries, grapes, spinach

Vitamin C Vegetables, citrus fruits, strawberries, potatoes, green vegetables Vitamin E Whole grains, fish liver oil, nuts, seeds, green vegetables

Lutein Green leafy vegetables, cooked spinach, cooked kale, egg yolks Glutathione Avocado, fish, meat, grapefruit, peach, broccoli, strawberries, squash

Selenium Fish, shellfish, red meat, grains, chicken, eggs and garlic.

Natural antioxidants are widely spread in food and medicinal plants and exhibit a wide range of anti-inflammatory, anti-aging and anticancer effects. These natural antioxidants from plant materials are mainly polyphenols, carotenoids and vitamins. The most important are those coming from routinely consuming vegetables and fruits, flowers as well as traditional medicinal plant [34–37] (**Table 1**). It has been reported that medicinal plants have been used 70–80% of the world population [38]. Bioactive compounds, which mean phytonutrients as well as named natural antioxidants, are health promoting compounds that can bring down the risk of diseases.

Polyphenols Green tea, strawberries, apples, broccoli, onion, chocolate, coffee, red wine,

**Figure 1.** *Classification of antioxidants.*

*Stress, Natural Antioxidants and Future Perspectives DOI: http://dx.doi.org/10.5772/intechopen.91167*

Besides, protein oxidation was reported important for meat quality of both ruminant and poultry [32].

Insight of this information, if the antioxidant mechanisms in organism are insufficient against oxidative stress, exogenous antioxidant supplements should be added to feed both human and animals for a better health. Antioxidants can be divided into two groups generally as natural and synthetic sources (**Figure 1**). Although synthetic antioxidant is produced from chemical processes, the important one natural antioxidant is more useful for health due to its natural contents.

## **4. Natural antioxidants**

*The Health Benefits of Foods - Current Knowledge and Further Development*

erythrocytes [15, 16].

diseases were reviewed [26].

an organism during oxidative stress. The initial defense response can be explained with SOD, which modifies the superoxide radicals to less harmful molecular oxygen [14]. Nevertheless, GSH, GPx, and CAT have a protective role on lipid peroxidation. Although GSH and GPx can reduce the hydrogen peroxide and lipid hydrogen peroxide, CAT, which has iron, brings down the hydrogen peroxide on liver and

There are numerous studies that observe the consumption of antioxidants in tissues or blood samples, and also reviewed the correlation between balance and important diseases both for humans and animals. Uzar et al. [17] observed the lower antioxidants in tissues in brain ischemia-reperfusion damage due to the higher oxidant value. Yigiter et al. [18] determined the increase of MDA and decrease of GSH in kidney tissue damage due to increase of DNA oxidation in the kidney. Tok et al. [19] found the higher MDA and MPO and lower GSH and GST levels in oxidative situations [20, 21]. As well, some researchers reported that free radicals were the most important components for ischemia damages in several organs such as brain, heart, liver and lung [22, 23]. Atherosclerosis, hypercholesterolemia and cancer are universally accepted as important diseases due to either antioxidant depletion or unbalance of oxidant and antioxidant status [24, 25]. Generation of antioxidants in oxidative status and correlation with pulmonary, cardiovascular or nutritional

The role of oxidative stress in health and disease of animals has been critiqued by some researchers [27, 28]. Metabolic diseases, heat stress and nutrition have been documented as well as performance parameters, immune defense, milk production and energy balance [29, 30]. In addition, some important biological molecules damage by oxidative stress, such as DNA, RNA, cholesterol and proteins. It was reported that high starch nutrition was resulted in an increase of oxidative stress in dairy cows [14]. In horses, it was observed that overload feeding of grains, sugar or fructans was resulted with laminitis which is associated with oxidative stress [31].

**152**

**Figure 1.**

*Classification of antioxidants.*

The relationship between food and health has addressed for many years. Diet has an essential part in maintaining our health. Natural antioxidants play decisive roles in risk reduction of so many diseases. Dietary or natural antioxidants play a persuasive role in serving the endogenous antioxidants in scavenging the excess of free radicals. Nonetheless, the dietary antioxidants can only have helpful effects in the radical scavenging if they are present in tissues or body fluids at adequate concentrations. For many dietary components, absorption is limited or metabolism into derivatives that can be easily incorporated reduces the antioxidant capacity. As well, it is important to know that some specific antioxidants have limited function because of their inability to penetrate the blood-brain barrier, poor absorption and conversion to the pro-oxidants under certain physiological conditions [33].

Natural antioxidants are widely spread in food and medicinal plants and exhibit a wide range of anti-inflammatory, anti-aging and anticancer effects. These natural antioxidants from plant materials are mainly polyphenols, carotenoids and vitamins. The most important are those coming from routinely consuming vegetables and fruits, flowers as well as traditional medicinal plant [34–37] (**Table 1**). It has been reported that medicinal plants have been used 70–80% of the world population [38]. Bioactive compounds, which mean phytonutrients as well as named natural antioxidants, are health promoting compounds that can bring down the risk of diseases.


#### **Table 1.**

*Some interesting antioxidants sources.*

Natural antioxidants have been valued for their contents, antioxidant activities and usage for both humans and animals feeding. Its biochemical compositions and functional attributes of these antioxidants have been important for selection criteria. It is well known that the mainly contents of the natural antioxidants are polyphenols, flavonoids, carotenoids, glutathione and some vitamins (E and C). Carotenoids and polyphenols have greater biological effects on organism such as antibacterial, anti-inflammatory, anticancer, etc. The important compounds of polyphenols are phenolic acids, lignans and flavonoids. It was proven that these contents can serve as metabolites by blocking the oxidation and clean the free radicals in the organism [39, 40]. As well, plants and spices which used for antioxidant properties have a strong hydrogen activity against oxidative stress [41, 42]. It was also reported that absorption of polyphenols in gut barrier can be linked up with increasing antioxidant efficiency [43]. In addition, although phenolic acids can be derived from apples, kiwis or cherries, flavonoids are in several common fruits and vegetables including onion, tea, citrus fruits, grapes, red pepper and broccoli [44, 45]. Carotenoids, which are also nominated as natural pigment, include beta carotene, lutein and zeaxanthin [46]. Among the carotenoids, beta carotene can be found in mango, carrot and nuts. Carotenoids can protect the protein and DNA structure of the organism against oxidative stress [47]. It was reported that carotenoids may inhibit fat oxidation [48]. Also, carotenoids have been reviewed as a health promoter from cancer due to their deactivation effect on ROS, but are not sure. It was seen that the contradictory findings have been related to the variety of carotenoids [47].

In addition, phycocyanin and zeaxanthin can be found in several plants such as microalga, broccoli and peas [46, 49]. Phycocyanin, which is an important extract of microalgae named *Spirulina platensis*, can inhibit the microsomal lipid peroxidation and hydroxyl and peroxyl radicals [47]. It was also observed that phycocyanin can improve the antioxidant activity and support the immunity and wellbeing [50, 51]. Moreover, it was reviewed that ascorbic acid (Vitamin C) and alpha-tocopherol (Vitamin E), which require for nutrition, could change the enzyme system for free radicals and protect the cellular membranes from oxidation [52–54]. Both of these vitamins can diminish the side effects of oxidative molecules with a huge amount. Vitamin E is known as a chain-breaking antioxidant, and it can protect the cell from lipid peroxidation. Also, ascorbic acid can restore the vitamin E. It was known that vitamin C is mainly rich in the peel of fruits such as orange and vitamin E is in candied orange and lemon [55]. Glutathione, which is an another antioxidant, is also produced in the body; several food resources have this important antioxidant naturally, such as melons, avocado, grapefruit, spinach, fishes and so on [56]. Especially, fish and sulfur containing amino acids are evaluated for maintaining and also increase the glutathione levels in organism.

Natural antioxidants have been extracted by several technological methods, including hot water bath and Soxhlet extraction, and different solvents have been used for the extraction of antioxidants from food and medical plants [57, 58]. Numerous works have been based on medicinal plant extraction and special antioxidant compounds. The extraction techniques, industrial applications, costs and procedures have been considered for getting more and useful extracts. The better the extraction efficiency of antioxidant components from plant materials, different methods have been developed such as ultrasound-assisted extraction, microwaveassisted extraction, enzyme-assisted extraction and electric field extraction. Still, necessity of standardization of sample collection and the analysis method has been reported [59].

**155**

cytokines [77–79].

researchers [88, 89].

*Stress, Natural Antioxidants and Future Perspectives DOI: http://dx.doi.org/10.5772/intechopen.91167*

actually they can act as a radical scavenger [60].

**5. Importance of natural antioxidants for health**

The importance of natural antioxidants has been increasingly investigated for oxidative-antioxidative balance and wellness because of the consumer concern regarding the safety of using synthetic antioxidant and its low cost and strong H donating capacities. Natural antioxidants and their derivatives could be obtained from vegetables, fruits and medicinal plants. So, there have been several researches about these compounds for evaluating the effects on both humans and animals. It is known that natural antioxidants have several physiological roles on organism and

Oxidative stress can be linked to cancer, cardiovascular or respiratory diseases, immune deficiency and inflammatory conditions. Studies have shown that more antioxidant in diets being important and gets more health to the organism (**Table 2**). Nevertheless, there have been contradictory results about the effects of natural antioxidants on health. It was also reported that flavonoids, which can be metabolized by microbiota in the intestine, can be effected in the nervous system, can take down the blood pressure and reduce serum triglyceride [61]. On the other hand, antioxidant effects of polyphenols have not been awarded thus far due to its limited bioavailability in systemic circulations. It has been suggested that polyphenols may not protect oxidative damage directly, but it can be a versatile proactive rather than antioxidants [62, 63]. It was reported that polyphenols in green tea can protect the cardiovascular diseases [64–66], reduce cholesterol [67] and glucose [68], and as well it can be a cardiovascular and an anticancer medicine [69–71] in humans. Phenols have been read widely for human health as well as animals especially flavonoid compound. Researchers reported the increase in villus height [72] and improvement of duodenum health [73] in broiler belong to polyphenol rich feeding. Polyphenols and flavonoids can affect positively on intestinal health due to inhibition of pathogenic bacteria, and thereby can stimulate the animal performance such as monogastric animals, chicken and pigs [73–76]. It was observed that flavonoids (*Ginkgo biloba*) could improve the immune system parameters via expression of the constituents of interleukins and

It was proven that the beta carotene in food could reduce the risk of cardiovascular diseases, although vitamin C could avoid the cardiovascular mortality [80, 81]. It was conducted that beta carotene, vitamin E and vitamin C may improve the mortality ratio [82]. Even so, it was reported by the National Institutes of Health (NIH) that Vitamin C, vitamin E or beta carotene has no effect on cancer and some cardiovascular diseases as heart attack or stroke. This place has been associated with several reasons such as insufficient antioxidants consumed in foods, not given long enough time, lower doses, individual differences and differences in the chemical compounds of antioxidants [83]. Even so, it was determined that vitamin C additive had a great role on germs and bugs in resting mice due to the reduced effect of vitamin C on stress hormones' amounts [84]. Additionally, vitamin E additive in sows showed the similar results in fertility and mating success compared to animals in feeding with polyphenols [85]. Another work, the SOD, GPx and total antioxidant capacity parameters were found higher in chickens fed by either polyphonic or vitamin E [86]. It was indicated that vitamin C additive in animals is related to improvement of osteoclast formation and bone health [87]. Also, in fishes vitamin C helps with proper health was reported by

Natural antioxidants and their products have a vast potential for both human and animal feeding and health [90–94]. Understanding of natural antioxidants

*The Health Benefits of Foods - Current Knowledge and Further Development*

Natural antioxidants have been valued for their contents, antioxidant activities and usage for both humans and animals feeding. Its biochemical compositions and functional attributes of these antioxidants have been important for selection criteria. It is well known that the mainly contents of the natural antioxidants are polyphenols, flavonoids, carotenoids, glutathione and some vitamins (E and C). Carotenoids and polyphenols have greater biological effects on organism such as antibacterial, anti-inflammatory, anticancer, etc. The important compounds of polyphenols are phenolic acids, lignans and flavonoids. It was proven that these contents can serve as metabolites by blocking the oxidation and clean the free radicals in the organism [39, 40]. As well, plants and spices which used for antioxidant properties have a strong hydrogen activity against oxidative stress [41, 42]. It was also reported that absorption of polyphenols in gut barrier can be linked up with increasing antioxidant efficiency [43]. In addition, although phenolic acids can be derived from apples, kiwis or cherries, flavonoids are in several common fruits and vegetables including onion, tea, citrus fruits, grapes, red pepper and broccoli [44, 45]. Carotenoids, which are also nominated as natural pigment, include beta carotene, lutein and zeaxanthin [46]. Among the carotenoids, beta carotene can be found in mango, carrot and nuts. Carotenoids can protect the protein and DNA structure of the organism against oxidative stress [47]. It was reported that carotenoids may inhibit fat oxidation [48]. Also, carotenoids have been reviewed as a health promoter from cancer due to their deactivation effect on ROS, but are not sure. It was seen that the contradictory findings have been related to the variety of

In addition, phycocyanin and zeaxanthin can be found in several plants such as microalga, broccoli and peas [46, 49]. Phycocyanin, which is an important extract of microalgae named *Spirulina platensis*, can inhibit the microsomal lipid peroxidation and hydroxyl and peroxyl radicals [47]. It was also observed that phycocyanin can improve the antioxidant activity and support the immunity and wellbeing [50, 51]. Moreover, it was reviewed that ascorbic acid (Vitamin C) and alpha-tocopherol (Vitamin E), which require for nutrition, could change the enzyme system for free radicals and protect the cellular membranes from oxidation [52–54]. Both of these vitamins can diminish the side effects of oxidative molecules with a huge amount. Vitamin E is known as a chain-breaking antioxidant, and it can protect the cell from lipid peroxidation. Also, ascorbic acid can restore the vitamin E. It was known that vitamin C is mainly rich in the peel of fruits such as orange and vitamin E is in candied orange and lemon [55]. Glutathione, which is an another antioxidant, is also produced in the body; several food resources have this important antioxidant naturally, such as melons, avocado, grapefruit, spinach, fishes and so on [56]. Especially, fish and sulfur containing amino acids are evaluated for maintaining and also increase the

Natural antioxidants have been extracted by several technological methods, including hot water bath and Soxhlet extraction, and different solvents have been used for the extraction of antioxidants from food and medical plants [57, 58]. Numerous works have been based on medicinal plant extraction and special antioxidant compounds. The extraction techniques, industrial applications, costs and procedures have been considered for getting more and useful extracts. The better the extraction efficiency of antioxidant components from plant materials, different methods have been developed such as ultrasound-assisted extraction, microwaveassisted extraction, enzyme-assisted extraction and electric field extraction. Still, necessity of standardization of sample collection and the analysis method has been

**154**

reported [59].

carotenoids [47].

glutathione levels in organism.

## **5. Importance of natural antioxidants for health**

The importance of natural antioxidants has been increasingly investigated for oxidative-antioxidative balance and wellness because of the consumer concern regarding the safety of using synthetic antioxidant and its low cost and strong H donating capacities. Natural antioxidants and their derivatives could be obtained from vegetables, fruits and medicinal plants. So, there have been several researches about these compounds for evaluating the effects on both humans and animals. It is known that natural antioxidants have several physiological roles on organism and actually they can act as a radical scavenger [60].

Oxidative stress can be linked to cancer, cardiovascular or respiratory diseases, immune deficiency and inflammatory conditions. Studies have shown that more antioxidant in diets being important and gets more health to the organism (**Table 2**). Nevertheless, there have been contradictory results about the effects of natural antioxidants on health. It was also reported that flavonoids, which can be metabolized by microbiota in the intestine, can be effected in the nervous system, can take down the blood pressure and reduce serum triglyceride [61]. On the other hand, antioxidant effects of polyphenols have not been awarded thus far due to its limited bioavailability in systemic circulations. It has been suggested that polyphenols may not protect oxidative damage directly, but it can be a versatile proactive rather than antioxidants [62, 63]. It was reported that polyphenols in green tea can protect the cardiovascular diseases [64–66], reduce cholesterol [67] and glucose [68], and as well it can be a cardiovascular and an anticancer medicine [69–71] in humans. Phenols have been read widely for human health as well as animals especially flavonoid compound. Researchers reported the increase in villus height [72] and improvement of duodenum health [73] in broiler belong to polyphenol rich feeding. Polyphenols and flavonoids can affect positively on intestinal health due to inhibition of pathogenic bacteria, and thereby can stimulate the animal performance such as monogastric animals, chicken and pigs [73–76]. It was observed that flavonoids (*Ginkgo biloba*) could improve the immune system parameters via expression of the constituents of interleukins and cytokines [77–79].

It was proven that the beta carotene in food could reduce the risk of cardiovascular diseases, although vitamin C could avoid the cardiovascular mortality [80, 81]. It was conducted that beta carotene, vitamin E and vitamin C may improve the mortality ratio [82]. Even so, it was reported by the National Institutes of Health (NIH) that Vitamin C, vitamin E or beta carotene has no effect on cancer and some cardiovascular diseases as heart attack or stroke. This place has been associated with several reasons such as insufficient antioxidants consumed in foods, not given long enough time, lower doses, individual differences and differences in the chemical compounds of antioxidants [83]. Even so, it was determined that vitamin C additive had a great role on germs and bugs in resting mice due to the reduced effect of vitamin C on stress hormones' amounts [84]. Additionally, vitamin E additive in sows showed the similar results in fertility and mating success compared to animals in feeding with polyphenols [85]. Another work, the SOD, GPx and total antioxidant capacity parameters were found higher in chickens fed by either polyphonic or vitamin E [86]. It was indicated that vitamin C additive in animals is related to improvement of osteoclast formation and bone health [87]. Also, in fishes vitamin C helps with proper health was reported by researchers [88, 89].

Natural antioxidants and their products have a vast potential for both human and animal feeding and health [90–94]. Understanding of natural antioxidants


**Table 2.**

*Functional properties of some natural antioxidants.*

in the context of coordinated oxidative stress and antioxidants and translation of this knowledge to improve animal and human health is a large challenge. In order to attain the health benefits, molecular mechanism of protective effects of fruits and vegetable has been enlightened. Future efforts should be addressed to explain in detail the mechanism of the natural antioxidants health promoting effects, increase in public attention and their utilization in animal and human foods and their recommended dosages, thereby achieving their health advantage and reducing health care expense.

**157**

*Stress, Natural Antioxidants and Future Perspectives DOI: http://dx.doi.org/10.5772/intechopen.91167*

dant strategies or use has been still questionable.

The authors declare no conflict of interest.

**Appendices and nomenclature**

ROS reactive oxygen species RNS reactive nitrogen species MDA malondialdehyde GPx glutathione peroxidase

SOD super oxide dismutase

Stress has been the most important problem in life for years. Nutrition, unhealthy environmental conditions, genetic factors and physiological insufficiency may create the stress. Although oxidative stress is related to diseases, antioxi-

properties are summed in this chapter. At that place, several studies include oxidative stress mechanism and natural antioxidant consumption in both humans and animals. These findings enrich our knowledge of natural antioxidants in both humans and animals, and the scientific evidence suggests that a well-balanced homeostasis should be associated with a good balanced diet that is rich in antioxidants. Besides, future direction studies in oxidative stress and natural antioxidants should be correlated with intake of antioxidants and impression of oxidative stress

Today, there is an increasing intake of the antioxidants, especially natural ones, to maintain the antioxidative status in both humans and animals. Natural antioxidants have several beneficial effects, which are considered to protect the homeostasis of the organism. Assessment of natural antioxidants, extracts and functional

**6. Conclusions**

markers.

**Conflict of interest**

CAT catalase

Spirulina algae

Vitamin C ascorbic acid Vitamin E alpha-tocopherol DNA deoxyribonucleic acid

Ginger *Zingiber officinale* Curcuma *Curcuma longa* Cloves *Syzygium aromaticum* Carotenoids tetraterpenoids Vitamins organic compounds Polyphenols micronutrients Phycocyanin pigment of plants

Flavonoids a class of plant and fungus secondary metabolites

## **6. Conclusions**

*The Health Benefits of Foods - Current Knowledge and Further Development*

Minimize the adverse effects of lipid

Polyphenols Antioxidant parameters↑ MDA↑

Flavonoids Anticancer

Phycocyanin Anticancer

Lutein Antioxidant

Glutathione Antioxidant

Selenium Anticancer

Cysteine Antioxidant

Garlic Antioxidant

Ginger Antioxidant

Curcumin Antioxidant,

Saffron Antioxidant

*Functional properties of some natural antioxidants.*

Vitamins (C-E) Total antioxidant↑ GSH↑

peroxidation

Triglyceride↓

Beta carotene Protect DNA structure Anticancer Anti-inflammatory

Antioxidant

capacities

Anti-inflammatory ROS scavenger

Antimicrobial agent

carcinogenesis

Regression of leukoplakia Antioxidant parameters↑ Induces apoptosis

Reduction of cataract and macular degeneration related to age

Protects cells from free radicals

Reduce cancer incidence and mortality

Prophylactic and therapeutic medicinal agent

Reduce or delay the progression of diseases Extracts of ginger have different antioxidant

Blocks oxidants of the free radical

Exert chemopreventive effects on

**Functional properties Reference**

Zeaxanthin Protect DNA structure Mezzomo and Ferrira [46],

Lipinski et al. [86]

Lipinski et al. [86]

Seyidoglu et al. [49]

et al. [50]

et al. [86]

Gengatharan et al. [2], Lipinski

Pinero et al. [50], Karkos et al. [51]

Mezzomo and Ferrira [46], Pinero

Mezzomo and Ferrira [46]

Ashadevi and Gotmare [56]

Ashadevi and Gotmare [56], Helzlsouer et al. [90]

Ashadevi and Gotmare [56]

Elosta et al. [91]

Tohma et al. [92]

Menon and Sudheer [93]

Kakouri et al. [94]

**Natural antioxidants**

in the context of coordinated oxidative stress and antioxidants and translation of this knowledge to improve animal and human health is a large challenge. In order to attain the health benefits, molecular mechanism of protective effects of fruits and vegetable has been enlightened. Future efforts should be addressed to explain in detail the mechanism of the natural antioxidants health promoting effects, increase in public attention and their utilization in animal and human foods and their recommended dosages, thereby achieving their health advantage and reducing

**156**

**Table 2.**

health care expense.

Stress has been the most important problem in life for years. Nutrition, unhealthy environmental conditions, genetic factors and physiological insufficiency may create the stress. Although oxidative stress is related to diseases, antioxidant strategies or use has been still questionable.

Today, there is an increasing intake of the antioxidants, especially natural ones, to maintain the antioxidative status in both humans and animals. Natural antioxidants have several beneficial effects, which are considered to protect the homeostasis of the organism. Assessment of natural antioxidants, extracts and functional properties are summed in this chapter. At that place, several studies include oxidative stress mechanism and natural antioxidant consumption in both humans and animals. These findings enrich our knowledge of natural antioxidants in both humans and animals, and the scientific evidence suggests that a well-balanced homeostasis should be associated with a good balanced diet that is rich in antioxidants. Besides, future direction studies in oxidative stress and natural antioxidants should be correlated with intake of antioxidants and impression of oxidative stress markers.

## **Conflict of interest**

The authors declare no conflict of interest.

## **Appendices and nomenclature**


## **Author details**

Nilay Seyidoglu1 \* and Cenk Aydin2

1 Department of Physiology, Faculty of Veterinary Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey

2 Department of Physiology, Faculty of Veterinary Medicine, Bursa Uludag University, Bursa, Turkey

\*Address all correspondence to: nseyidoglu@nku.edu.tr

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**159**

*Stress, Natural Antioxidants and Future Perspectives DOI: http://dx.doi.org/10.5772/intechopen.91167*

> radical absorbance capacity (ORAC) and ferric reducing antioxidant power (FRAP) assays: A comparative study. Journal of Agricultural and Food

Chemistry. 2002;**50**(11):3122-3128. DOI:

colorimetric method for measuring total oxidant status. Clinical Biochemistry. 2005;**38**:1103-1111. DOI: 10.1016/j.

[11] Gutteridge JMC. Lipid peroxidation and antioxidants as biomarkers of tissue damage. Clinical Chemistry. 1995;**41**:1819-1828. PMID: 7497639

[13] Tanaka K, Miyake Y, Fukushima W, Sasaki S, Kiyohara C, Tsuboi Y, et al. Fukuoka Kinki Parkinson's disease study group. Intake of Japanese and Chinese teas reduces risk of Parkinson's disease. Parkinsonism & Related Disorders. 2011;**17**(6):446-450. DOI: 10.1016/j.

[12] Kleczkowski M, Klucinski W, Sikora J, Zdanowicz M, Dziekan P. Role of antioxidants in the protection against oxidative stress in cattle nonenzymatic mechanism. Polish Journal of Veterinary Sciences. 2003;**6**:301-308. PMID:

10.1021/jf0116606

[9] Erel O. A new automated

clinbiochem.2005.08.008

[10] Bouayed J, Rammal H, Soulimani R. Oxidative stress and anxiety: Relationship and cellular pathways. Oxidative Medicine and Cellular Longevity. 2009;**2**:63-67. DOI:

10.4161/oxim.2.2.7944

14703876

parkreldis.2011.02.016

[14] Buettner GR. Superoxide

10.2174/187152011795677544

[15] Halliwell B, Gutteridge JMC, editors. Free Radicals in Biology and

dismutase in redox biology: The roles of superoxide and hydrogen peroxide. Anti-Cancer Agents in Medicinal Chemistry. 2011;**11**(4):341-346. DOI:

**References**

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Aruoma OI, Hercberg S, Sánchez-García I, Fraga C. Aspects of antioxidant

foods and supplements in health and disease. Nutrition Reviews. 2009;**67**(Suppl 1):S140-S144. DOI: 10.1111/j.1753-4887.2009.00177.x

[2] Gengatharan A, Dykes GA, Choo WS. Betalains: Natural plant pigments with potential application in functional foods. LWT-Food Science and Technology. 2015;**64**:645-649. DOI:

10.1016/j.lwt.2015.06.052

[3] Gandía-Herrero F, Escribano J, García-Carmona F. Biological activities of plant pigments betalains. Critical Reviews in Food Science and Nutrition. 2016;**56**:937-945. DOI: 10.1080/10408398.2012.740103

[4] Bansal M, Kaushal N. Introduction to oxidative stress. In: Oxidative Stress Mechanisms and Their Modulation. New Delhi: Springer; 2014. pp. 1-18. DOI: 10.1007/978-81-322-2032-9

[5] Blumberg J. Use of biomarkers of oxidative stres in research studies. The Journal of Nutrition. 2004;**134**:3188S-3189S. DOI: 10.1093/

[6] Siu GM, Draper HH. Metabolism of malonaldehyde in vivo and in vitro. Lipids. 1982;**17**:349-355. DOI: 10.1007/

[7] Diplock A. Antioxidant nutrients. In: Gurr M, editor. Healthy Lifestyles Nutrition and Physical Activity ILSI Europe Concise Monograph Series. Belgium: International Life Sciences Institute; 1998. pp. 16-21. DOI: 10.3109/09637489809086430

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*Stress, Natural Antioxidants and Future Perspectives DOI: http://dx.doi.org/10.5772/intechopen.91167*

## **References**

*The Health Benefits of Foods - Current Knowledge and Further Development*

**158**

**Author details**

Nilay Seyidoglu1

\* and Cenk Aydin2

\*Address all correspondence to: nseyidoglu@nku.edu.tr

Kemal University, Tekirdag, Turkey

provided the original work is properly cited.

University, Bursa, Turkey

1 Department of Physiology, Faculty of Veterinary Medicine, Tekirdag Namik

2 Department of Physiology, Faculty of Veterinary Medicine, Bursa Uludag

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

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[2] Gengatharan A, Dykes GA, Choo WS. Betalains: Natural plant pigments with potential application in functional foods. LWT-Food Science and Technology. 2015;**64**:645-649. DOI: 10.1016/j.lwt.2015.06.052

[3] Gandía-Herrero F, Escribano J, García-Carmona F. Biological activities of plant pigments betalains. Critical Reviews in Food Science and Nutrition. 2016;**56**:937-945. DOI: 10.1080/10408398.2012.740103

[4] Bansal M, Kaushal N. Introduction to oxidative stress. In: Oxidative Stress Mechanisms and Their Modulation. New Delhi: Springer; 2014. pp. 1-18. DOI: 10.1007/978-81-322-2032-9

[5] Blumberg J. Use of biomarkers of oxidative stres in research studies. The Journal of Nutrition. 2004;**134**:3188S-3189S. DOI: 10.1093/ jn/134.11.3188S

[6] Siu GM, Draper HH. Metabolism of malonaldehyde in vivo and in vitro. Lipids. 1982;**17**:349-355. DOI: 10.1007/ bf02535193

[7] Diplock A. Antioxidant nutrients. In: Gurr M, editor. Healthy Lifestyles Nutrition and Physical Activity ILSI Europe Concise Monograph Series. Belgium: International Life Sciences Institute; 1998. pp. 16-21. DOI: 10.3109/09637489809086430

[8] Ou B, Huang D, Hampsch-Woodill M, Flanagan JA, Deemer EK. Analysis of antioxidant activities of common vegetables employing oxygen radical absorbance capacity (ORAC) and ferric reducing antioxidant power (FRAP) assays: A comparative study. Journal of Agricultural and Food Chemistry. 2002;**50**(11):3122-3128. DOI: 10.1021/jf0116606

[9] Erel O. A new automated colorimetric method for measuring total oxidant status. Clinical Biochemistry. 2005;**38**:1103-1111. DOI: 10.1016/j. clinbiochem.2005.08.008

[10] Bouayed J, Rammal H, Soulimani R. Oxidative stress and anxiety: Relationship and cellular pathways. Oxidative Medicine and Cellular Longevity. 2009;**2**:63-67. DOI: 10.4161/oxim.2.2.7944

[11] Gutteridge JMC. Lipid peroxidation and antioxidants as biomarkers of tissue damage. Clinical Chemistry. 1995;**41**:1819-1828. PMID: 7497639

[12] Kleczkowski M, Klucinski W, Sikora J, Zdanowicz M, Dziekan P. Role of antioxidants in the protection against oxidative stress in cattle nonenzymatic mechanism. Polish Journal of Veterinary Sciences. 2003;**6**:301-308. PMID: 14703876

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[94] Kakouri E, Daferera D, Paramithiotis S, Astraka K, Drosinos EH, Polissiou MG. Crocus sativus L. tepals: The natural source of antioxidant and antimicrobial factors. Journal of Applied Research on Medicinal and Aromatic Plants. 2017;**4**:66-74. DOI: 10.1016/j.jarmap.2016.09.002

## *Edited by Liana Claudia Salanță*

The global market of foods with health claims remains highly dynamic and is predicted to expand even further. Consumers have become increasingly aware of the importance of consuming healthy foods in order to have a well-balanced diet and this has increased the demand for foods with health benefits. On the other hand, the food sector companies are trying to meet the new consumers' expectations while designing a variety of novel, enhanced products. Thus, understanding the potential uses of bioactive compounds in food products, the wide range of therapeutic effects, and the possible mechanisms of action is essential for developing healthier products. Covering important aspects of valuable food molecules, this book revises the current knowledge, providing scientifically demonstrated information about the benefits and uses of functional food components, their applications, and the future challenges in nutrition and diet.

Published in London, UK © 2020 IntechOpen © Julia Paszkiewicz / iStock

The Health Benefits of Foods - Current Knowledge and Further Development

The Health Benefits of Foods

Current Knowledge and Further Development

*Edited by Liana Claudia Salanță*