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October 23, 2025BMC Nutrition1 citationsOpen Access

A systematic review of the mechanisms of cardiovascular disease reduction by dietary flavonoids: the impact of anthocyanins on flow-mediated dilation and blood rheology

SKShiva KhaniJSJeremy P.E. Spencer

Key Result

Anthocyanin-rich meals or extracts significantly improved flow-mediated dilation (P < 0.05) in healthy adults, with most studies reporting benefits within two hours of ingestion.

Study Design

Type

Systematic Review

Structured PICO

Does dietary anthocyanin consumption improve flow-mediated dilation in healthy adults aged 20 to 65 years?

P
Population
A systematic review of 15 randomized controlled trials evaluating the effects of anthocyanin-rich foods or extracts on flow-mediated dilation in healthy adults aged 20 to 65 years.
I
Intervention
Dietary anthocyanin or anthocyanin-rich extracts (raw fruits, juices, smoothies, or capsules) administered acutely or chronically (2-12 weeks).
C
Comparator
Control group (placebo, matched drinks/foods with anthocyanin totally or partially excluded).
O
Outcome
Flow-mediated dilation (FMD)surrogate

Dietary anthocyanin consumption improves endothelial function as measured by flow-mediated dilation in healthy adults, supporting its potential role in cardiovascular disease prevention.

Main Result

p-value: p=<0.05

Limitations

  • Small sample sizes in included studies
  • Varying anthocyanin doses and formulations
  • Short intervention periods
  • Diversity in study methods preventing meta-analysis
  • Inconsistent use of control foods leading to potential bias
  • Inconsistent use of anthocyanin treatments (whole foods vs extracts)
  • Individual differences in gut flora, genetics, age, sex, nutrition, and health state
  • Small sample sizes
  • Varying anthocyanin doses

Abstract

BACKGROUND: Epidemiological studies have suggested that anthocyanin, a dietary flavonoid found in a variety of foods, may protect against cardiovascular disease (CVD). The purpose of this review is to assess the effects of anthocyanin and anthocyanin-rich extracts on flow-mediated dilation (FMD), a vascular function marker, in healthy people and investigate their potential significance. METHOD: A thorough search of databases, including PubMed and Web of Science, was done to locate randomised controlled trials (RCTs) published before July 1st, 2024. The evaluation concentrated on English-language RCTs involving persons aged 20 to 65 years. Studies that did not examine anthocyanin or had insignificant results were eliminated. Data extraction comprised study characteristics, participant demographics, interventions, and results. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias in Rob 2 tool. RESULTS: 15 studies out of 381 were found to meet the inclusion criteria. Anthocyanin-rich meals or extracts significantly improved flow-mediated dilation (FMD) (P < 0.05), with most studies reporting significant benefits within two hours of ingestion. However, some research found no significant differences, underscoring the diversity of the results. CONCLUSION: This comprehensive systematic review supports the idea that anthocyanin-rich foods or extracts can improve vascular function in healthy people, as evidenced by FMD. However, small sample sizes, varying anthocyanin doses, short intervention periods, and diversity in study methods limit the present body of evidence. Future studies should concentrate on well-powered, long-term randomised controlled trials using standardised anthocyanin formulations and dose regimens together with studies across varied demographics to improve generalisability in order to create unambiguous clinical guidelines.

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Cite This Study

Khani et al. (2025) conducted a systematic review in Healthy adults. Anthocyanin and anthocyanin-rich extracts vs. Placebo or control was evaluated on Flow-mediated dilation (FMD) (p=<0.05). Anthocyanin-rich meals or extracts significantly improved flow-mediated dilation (P < 0.05) in healthy adults, with most studies reporting benefits within two hours of ingestion.

synapsesocial.com/papers/6a63ffe0b5b214049b7a8749https://doi.org/10.1186/s40795-025-01086-2
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