C H A P T E R

18
Green Leafy Vegetables:
A Health Promoting Source
Muhammad Atif Randhawa, BSc, MSc, PhD,
Ammar Ahmad Khan, BSc, MSc, Muhammad Sameem Javed, BSc, MSc,
Muhammad Wasim Sajid, BSc, MSc
University of Agriculture, Faisalabad, Pakistan

INTRODUCTION meal, comprising five vegetable servings a day, is essen-

tial for attaining and retaining a decent health. It is that
Man has had a tremendous pressure on green leafy part of food that mainly provides the noncaloric portion
vegetables (GLVs) since the start of civilization and these and gives health benefits. Vitamins, fiber, antioxidants,
vegetables can survive in adverse environmental condi- minerals, and other bioactive compounds play a major
tions such as droughts. Traditional vegetables are valu- role in the nutritive significance of vegetables.
able sources of nutrition in rural areas where exotic spe- Vegetables are the fresh and edible parts of herba-
cies (sp.) are not available. They provide good nutrition ceous plants. They are an essential foodstuff and ex-
at low cost, in contrast to the costly exotic sp. Different tremely valuable for health maintenance and disease
parts of the world have a valuable heritage of various prevention. They comprise valuable foodstuff that can
indigenous leafy vegetables and some of them are also be effectively used for the development and repair of
used as medicinal plants traditionally (Table 18.1). Forest different parts of the body. Vegetables are a very valu-
dwellers are still using wild edible plants for sustainable able material for maintaining the alkaline reserve of the
edible values and also for culinary purposes. Therefore, human body. Vegetables are mainly appreciated due to
they are enjoying a healthier life [1]. their high vitamins, carbohydrates, and especially their
Nutrition is a basic human need and a prerequisite mineral content. Vegetables of different kinds, including
for a healthy life. It is a discipline that gives informa- leaves, edible roots, fruits, stems, or seeds, are available
tion about the different aspects of food composition and and every group contributes in its own way to the diet.
presents many approaches to get the appropriate nour- Vitamins known as organic compounds are present
ishment from food. The agricultural sector and public in naturally available foods particularly in vegetables
organizations extensively use nutritional information or present as “precursors.” Vitamins are required for
to encourage fresh food consumption by the masses. A the maintenance and proper functioning of vision, mu-
proper diet is very much essential for all the stages of hu- cous membranes, bones, hairs, teeth, and the skin. They
man life from the fetus to old age. Nowadays, people are support the body for proper absorption of phosphorous
becoming well aware of the nutritional benefits of fresh and calcium required for the growth and maintenance of
vegetables and fruits, and thereby searching for more di- bones. Vitamins play a very important role for the nor-
versity in their food to get the utmost nutrition. The main mal working of endocrine glands, the nervous system,
focus of consumers is on those foods that are rich in vi- and clotting of blood. They are also required for mac-
tamins (A, C, and E), antioxidants, and minerals like po- romolecule metabolism. Half of the recommended dai-
tassium (K), calcium (Ca), and magnesium (Mg). It is be- ly ­allowance (RDA) for some vitamins (C, E, B9) and
lieved that GLVs and fresh fruits are gaining a significant b-carotene, Ca, and Fe can be achieved by 60 g of spin-
place in the food pyramid, being a good source of trace ach, 50 g of lettuce, and 100 g of broccoli. As a whole, veg-
elements and other bioactive compounds [2]. A diverse etables are considered as a natural reserve of nutrients

Handbook of Fertility. http://dx.doi.org/10.1016/B978-0-12-800872-0.00018-4

Copyright © 2015 Elsevier Inc. All rights reserved.

205
206 18. Green Leafy Vegetables: A Health Promoting Source

TABLE 18.1 Popular Green Leafy Vegetables Grown in Different Continents

Common name Botanical name

Americas Turnip greens Brassica rapa

Swiss chard Beta vulgaris

Spinach Spinacia oleracea

Mustard greens Brassica juncea

Broccoli Brassica oleracea

Romaine lettuce L. sativa

Australia Broccoli B. oleracea

Asparagus Asparagus densiflorus

Bok Choy Brassica chinensis

Spinach S. oleracea

Silver beet Be. vulgaris

Brussels sprouts B. oleracea

Cauliflower B. oleracea

snow peas B. chinensis

Lettuce L. sativa

Africa Taro Colocasia esculenta

Eru G. africanum

Cow pea Vigna unguiculata

Horseradish Moringa oleifera

Groundcherry Physalis viscose

Gherkin Cucumis angora

Hell’s curse Amaranthus cruentus

African cabbage Cleome gynandra

Chinese cabbage B. rapa

Nightshade Solanum nigrum

Jew’s mallow plant Cor. olitorius

bitter water melon Citrullus lanatus

Asia Spinach S. oleracea

Fenugreek Leaves Trigonella foenum

Water spinach Aranthus tricolor

Amaranth Amaranthus spinosus

Matar saag T. foenum-graecum

Mustard greens B. juncea

Sorel leaves Hibiscus cannabinus

Colocacia or taro leaves Col. esculenta

Cabbages B. oleracea

Bok choy B. chinensis

Choy sum B. rapa

Tatsoi B. narinosa

D. Nutrition and Reproduction

 Therapeutic value and health benefits of green leafy vegetables 207
TABLE 18.1 Popular Green Leafy Vegetables Grown in Different Continents (cont.)
Common name Botanical name
Asia Mizuna B. japonica

Kang kong Ipomoea aquatica

Europe Italian rucola (Eruca sativa)

Lettuce L. sativa
Spinach S. oleracea
Chicory Cichorus intybus
Arugula E. sativa
Mache Valerianella locusta
Glasswort Salicornia europaea
Common purslane P. oleracea
Pepper leaf Capsicum annumm

gifted by God to human beings, such as carrots, a good and cardiovascular diseases (CVDs) [21–23]. GLVs are
vitamin A source, which is required for normal vision a rich source of phytochemicals and have an enormous
function. Similarly, spinach and other leafy vegetables amount of antioxidants (Table 18.2) [24].
have sufficient amounts of vitamin C to prevent and In all plant cells, secondary metabolites of bioactive
cure scurvy. Some vegetables have a high dietary fiber compounds are present, and their concentration varies
amount, such as spinach, cabbage, and lettuce, to pre- based on the different parts of plants, climates, particular
vent constipation. growth phase, and seasons. The accumulation of these
compounds is very high in leaves and is very benefi-
cial too [25,26]. In test samples, the majority of second-
THERAPEUTIC VALUE AND ary metabolites identified (steroids, flavonoids, tannins,
HEALTH BENEFITS OF GREEN LEAFY alkaloids, and saponins) are phyto-protectants and are
VEGETABLES very necessary for body building and cell growth and re-
pair [27]. The role of vegetables as medicine is due to the
GLVs play a very significant role in our nutrition and availability of chemical compounds that have the abil-
diet and have also been used as medicine since ancient ity to produce a physiological action in the human body
times; they are also important sources of protective with the help of antibacterial, antiviral, antioxidant, anti-
foods [3]. They are the best instant accessible sources inflammatory, and detoxification activities, and immune
of essential amino acids, minerals, vitamins, and fiber system repair (Table 18.3) [28].
[4,5]. Their bioactive elements have a variety of biologi- There are many studies that strongly prove that diets
cal usage, such as antimicrobial and antioxidant activi- rich in vegetables and fruits have a good effect on human
ties [6–9], and very supportive for managing age-related health, providing protection against age-related degener-
ailments and oxidative strains [10]. Vegetables contain ative diseases such as CVD, Alzheimer’s disease, several
huge amounts of ascorbic acid, folic acids, carotenes, ri- forms of cancers, and cataracts [29–34]. Besides the major
boflavin, and minerals like iron, phosphorous, and cal- constituents of food (carbohydrate, protein, and fat) and
cium [11]. Due to their photosynthetic material, higher micronutrients (minerals, vitamins, and trace elements),
amounts of vitamin K are present in GLVs as compared there are many compounds in fruits and vegetables that
to other vegetables and fruits due to the direct involve- are suggested to be a part of health-promoting effects.
ment of vitamin K in the photosynthetic process. Usually, These compounds include groups of phytochemicals
less toxic effects are involved when vegetables are used (Fig. 18.1) like flavonoids, carotenoids and other poly-
as medicine [12,13]. Vegetables also have the capability phenols, glucosinolates, isothiocyanates, allylic sulfides,
to produce many other secondary metabolites of com- phytosterols, monoterpenes dietary fibers, and phenolic
paratively complex structure having the ability to work acids [35,36].
as antimicrobial agents [14–16]. GLVs are also rich in Gupta and coworkers [37] reported that several GLVs
compounds having antidiabetic [17], antihistaminic [18], are rich sources of antioxidant vitamins. Vegetables are
anticarcinogenic [19], and hypolipidemic [20] features, a great source of phytochemicals, and some antinutri-
and having the ability to work as curative and preventive tional content, like saponins and so on, have potential
agents against aging, insomnia, obesity, hypertension, in reducing some diseases in man [38]. Some of these

D. Nutrition and Reproduction

208 18. Green Leafy Vegetables: A Health Promoting Source

TABLE 18.2 Phenolics, Antioxidant Activity, Ascorbic Acid, and Carotenoids Contents of Some Green Leafy Vegetables
Total phenolic Ascorbic acid
Vegetable content Antioxidant activity content Carotenoids References

L. sativa 75.88 ± 0.54 mg 69.50 ± 1.00 mg 7.3 mg/100 g 2.22 mg/100 g Zdravkovic et al. [174]
GA/g AA/g

T. foenum-graecum 158.33 ± 20.41 mg of 1,292.28 ± 92.86 (%) 101.36 ± 0.00 mg/ 34.78 ± 0.01 Gupta and Prakash [175]
tannic acid/100 g mmol of ascorbic 100 g mg/100 g
acid/g

Murayya koenigii 387.50 ± 30.62 mg of 2,691.78 ± 91.73 (%) 29.31 ± 0.00 mg/ 64.51 ± 0.00 Gupta and Prakash [175]
tannic acid/100 g mmol of ascorbic 100 g mg/100 g
acid/g

Centella asiatica 150.00 ± 0.00 mg of 623.78 ± 34.46 (%) 15.18 ± 0.80 mg/ 36.40 ± 0.01 Gupta and Prakash [175]
tannic acid/100 g mmol of ascorbic 100 g mg/100 g
acid/g

M. oleifera 208.5 ± 42.5 mg 4.12 ± 0.16 mmol TE 162 + 63 mg/ 1286 + 689 mg (1) Mathiventhan and
TAE/100 g(1) g-1(1) 100 g (2) RAE (2) Sivakanesan [176],
(2) Yang et al. [177]

S. oleracea 397.00 ± 1.00 mg 21.83 ± 0.76 m mol 14.22 + 1.04  mg/ 36.96 + 1.74 mg/g (1)Yadav et al. [178],
GAE/g (1) trolax /g (1) 100 g (2) (2) (2) Melo et al. [179]

C. sativum 1.12 mg GAE/100 26.82% (DPPH) (1) 361 mg/ 51.4 mg/g (2) (1) Al-Juhaimi and Ghafoor
mL (1) 100 g (2) [180], (2) Clyde et al.
[181]

P. crispum 1.22 mg GAE/100 30.35% (DPPH) (1) 133 mg/ 56.7 mg/100 g (3) (1) Al-Juhaimi and Ghafoor
mL (1) 100 g (2) [180], (2) Caunii et al.
[182], (3) Yahia et al. [183]

TABLE 18.3 Medicinal Uses of Some Popular Green Leafy Vegetables

Sr no. Leafy vegetable Medicinal use References

1. Basella rubra (spinach) Fertility enhancement in women Mensah et al. [26]

2. B. oleracea Acephala (kale) Help to manage type 2 diabetes and is a terrific addition to any Kimiywe et al. [184]
weight-loss plan

3. Lettuce Prevent arthritis, cataracts, and macular degeneration Cai et al. [185]

4. Ba. rubra L. (sag) Reduce the risk of heart disease, enhance memory, and Sonkar et al. [186]
­improve mood,

5. B. oleracea (Collard Greens) Prevent bone fractures Mensah et al. [26]

6. C. sativum L. Antianxiety activity used for Vitamin deficiency and disorders Mahendra and Bisht [187]

7. Mu. koenigii L. Spreng Antiulcer, antimicrobial, cytotoxic activity, phagocytic activity. Handral et al. [188]
(currry leaves) Good for bones and eyes in children. Reduce depression and
supply calcium to brain

8. T. foenum-graecum L. (fenugreek) Antidiabetic, anticarcinogenic, anti-inflammatory, antioxidant Toppo et al. [189]

9. Allium sativum (garlic green) Antioxidant, antimicrobial, cholesterol-lowering and Blumenthal [190]
­blood-thinning

10. B. oleracea L. var.botrytis L. Anticancer Reddy et al. [191]

(broccoli)

11. Mentha spicata L. (mint) Prevent hysteria Raju et al. [192]

D. Nutrition and Reproduction

 Therapeutic value and health benefits of green leafy vegetables 209

FIGURE 18.1 Classification of dietary phytochemicals.

diseases include high blood pressure, heart disease, significantly contributes against chronic diseases to pro-
stroke, and other CVDs [39]. Despite the health benefits tect living cells [46]. Protection against age-related dis-
of GLVs, they can also absorb pesticide residues during orders can be achieved by consuming more amounts of
growing in the field or green house, and so on. Fortu- vegetables and fruits [47]. Most of the antioxidants, like
nately, the fast growing nature of most of the leafy veg- b-carotene and vitamins C and E, play a positive role
etables dissipates the pesticide residues quickly and res- against age-related disorders.
idues at harvest are mostly within maximum a­ llowable
limits [40,41]. Furthermore, these pesticide residues in-
curred from the fields can be removed from vegetables Antidiabetic Properties
by thorough washing with potable tap water [42,43]. Diabetes mellitus is a noncommunicable disease and
The pesticide residues can also be very effectively re- is found in most countries of the world. In 1995, about
moved from vegetables by dipping the vegetables in or- 135 million people were affected by this disease globally
ganic acid solutions [44,45]. and the number is estimated to rise to about 300 million
The bulk in diet is provided by the fiber in vegetables people by 2025 [53]. There are two main types of diabetes
and helps to decrease the starchy food intake, prevent mellitus: type 1 and 2. Type 1 diabetes mellitus is also
constipation, enhance gastrointestinal function, and de- known as juvenile onset disease or insulin-dependent
crease the chance of metabolic diseases like hypercholes- diabetes. This type is recognized by an autoimmune-
terolemia and diabetes mellitus. Many vegetables have mediated destruction of beta cells of the pancreas. The
the ability to act as antibiotics, blood-building agents, rate of destruction is fast in some individuals and slow
and antihypertensive agents. Vegetables also increase in others [54]. Type 2 diabetes is also known as adult-
fertility in females when used as a soup [26]. onset diabetes or non-insulin-dependent diabetes. In
Vegetables also contain many non-nutritive com- this type patients have a relative deficiency of insulin.
pounds besides their major nutrients like carbohydrate, Individuals with type 2 diabetes are frequently resistant
proteins, and fat, which play a significant role against to the action of insulin [55,56]. Type 2 diabetes mellitus
chronic diseases. Those compounds have very low is considered as the most familiar disease and in 2010 its
amount of fat contents like all other plants or contain presence among adults was about 6.4% in the world. The
no cholesterol. In vegetable crops, many phytochemi- prevalence of type 2 diabetes mellitus will increase up to
cals are present in very low amounts. However, when 7.7% by 2030 [57].
a sufficient amount of vegetables is consumed, a rea- The most common feature of this disorder is known as
sonable amount of phytochemicals is obtained and it hyperglycemia. Different drugs are used in ­controlling

D. Nutrition and Reproduction

210 18. Green Leafy Vegetables: A Health Promoting Source

diabetes, including alpha-amylase and beta-amylase in- by the free p ­ olyphenol-rich extract of leafy vegetables
hibitors. These drugs are used orally and help to prevent have been observed. So these vegetables are a safer and
the digestion of complex carbohydrates [58,59]. Differ- cheaper alternative of synthetic drugs that can be used
ent studies were conducted in several areas of India, and for the prevention of hypertension and diabetes mellitus
results showed that there was an increasing trend in the disease [70].
prevalence of diabetes mellitus disease. The Diabetes
Research Centre in Chennai carried out different stud-
ies and findings revealed that the prevalence of this dis- Antimicrobial and Anti-Inflammatory Activity
ease had steadily enhanced in adults of urban areas from GLVs are widely consumed around the world in vari-
5.2% in 1984 to 13.9% in 2000 [60]. ous forms such as fresh and processed. For centuries
Reactive oxygen species and oxygen free radicals these vegetables have been consumed by humans and
are commonly produced in the human body. Oxidative are declared as generally recognized as safe (GRAS).
damage to all biochemicals in the body is usually ac- GLVs are well-known for their esthetic features that
companied in type 2 diabetes patients [61]. Due to ex- involve flavor, color, and so on, and therapeutic values
cessive oxidative stress, lipid peroxidation is increased [71]. Moreover, their bioactive substances and phyto-
under diabetic conditions. Therefore, prevention from nutrients are putative to perform several biological
this oxidative damage was considered to play an impor- processes, which include antimicrobial and antioxidant
tant role in diabetes or its complications that originate activities [72]. Leafy vegetables are being used for their
from peroxidation of lipids [62]. Different GLVs, such as antimicrobial activities in food processing industries.
cabbage, spinach, kale, lettuce, and broccoli, have differ- Their use as antibacterial agents is becoming popular as
ent contents of antioxidants, vitamins, carbohydrates, they have GRAS status. There are several leafy vegeta-
phytochemicals, and minerals. These compounds play a bles that are believed to perform certain pharmacologi-
vital role to protect against CVDs and diabetes. Different cal effects in the body. For example, a few of them have
biological mechanisms are responsible for controlling a very strong tendency to act as antibiotics and some
the risk of diabetes. are beneficial for inducing low blood pressure, while a
GLVs contain high amounts of magnesium, potas- few of them have elucidated their impacts in enhancing
sium, antioxidant vitamins, phytochemicals, and plant fertility in females [26].
proteins, which are also responsible for lowering the risk Leafy vegetables, namely, Coriandrum sativum, Lactuca
of type 2 diabetes in addition to the high fiber content sativa, Mentha piperita, Portulaca oleracea, and Raphanus
and low glycemic loads and low energy intake. Among sativus have high antibacterial activity in alcoholic ex-
overweight women, a high intake of green and dark yel- tract [73]. Antibacterial activities of freeze-dried and ir-
low leafy vegetables may be useful for preventing type radiated parsley (Petroselinum crispum) and cilantro (C.
2 diabetes disease [63]. GLVs are a cheap and rich source sativum) leaves were determined on methanolic and
of phytochemicals and micronutrients with antioxidant aqueous extracts against Bacillus subtilis and Escherichia
properties. Lettuce leaves, reddish leaves, and omum coli. Prooxidant activity of the GLV extracts was signifi-
leaves particularly have high values of these important cant (p < 0.05) on the bacterial cell damage and growth
compounds [64]. inhibition of the studied bacterial species. Leafy vege-
Phenolic compounds possess therapeutic properties tables can be a good source for antimicrobial activity in
and high antioxidant activity including antihypertensive the future. However, there is a need to explore the anti-
and antidiabetic activity [65]. Polyphenolic antioxidants microbial potential of leafy vegetables against different
are mostly present in fruits and GLVs. These antioxidant pathogens in various food systems.
vitamins including alpha-tocopherol, b-carotene, phe- Since the last few decades, it has been elucidated
nolics, and ascorbic acids are most commonly present that the biological effects of phenolics and flavonoids
in vegetables [66–68]. These compounds are present in in green vegetables are attracting increasing demands
fresh GLVs like wild basil, fluted pumpkin, waterleaf, for research. They act like plant hormone regulators, an
bitter leaf, jute, and chaya. Among these vegetables jute integral part of the natural defense system, which pro-
and wild basil have the highest amount of phenolic con- vides protection against certain microbial agents. In ad-
tent while waterleaf has the lowest amount of this com- dition, phenolic compounds have been widely studied
pound. Ferric-reducing properties are also present in to explore their health-promoting benefits, which mainly
these GLVs. Ferric ions accumulate in the islets of Lang- involve anti-inflammatory response. Spinach and the
erhans and in acinar cells, which result in the destruc- mustard plant have good anti-inflammatory potential
tion of beta-cells associated with diabetes mellitus [69]. [74]. Euphorbia hirta and Ipomoea involucrata contain sa-
Lipid peroxidation and alpha-amylase activity is also ponins, which have anti-inflammatory, antifungal/
reduced by the compounds present in GLVs. Inhibition antiyeast, antibacterial, antiparasitic, cytotoxicity, and
of enzymes associated with hypertension and diabetes antitumor, antiviral, and some other biological functions

D. Nutrition and Reproduction

 Therapeutic value and health benefits of green leafy vegetables 211
[75]. ­According to Guil-Guerrero and coworkers [76], the the cell membranes. Vitamin E and b-carotene put in pro-
leaf e­ xtracts of Urtica dioica could induce an anti-inflam- tecting actions against harmful free radicals within the
matory response as it dissipates the activation of NF-6B, lipid-soluble parts of the body, while vitamin C balances
which is involved in many inflammatory processes. it out within the water-soluble parts of the body. Together
they provide wonderful benefits to people struggling with
asthma, heart diseases, and menopausal symptoms.
Antioxidant Activity The amount of polyphenol content in cabbage and
Most of the cellular organelles are sensitive to oxida- spinach varies from 5 mg/100 g to 69.5 mg/100 g, re-
tive damage. All substances, like lipids, proteins, nucleic spectively. The order of leafy vegetables that terminates
acids, and carbohydrates, can undergo oxidative modifi- the free radical chain reactions is spinach < cabbage <
cations. The lipid peroxidation process is initiated when coriander leaves < hongone leaves. Leafy vegetables also
the hydrogen atom is removed from the unsaturated fat- have a capability to provide a protective effect on per-
ty acyl chain and initiates a chain reaction. This is why oxide formation while storing heated oils. Furthermore,
lipid peroxidation inhibition is very essential in diseases leafy vegetables are good antioxidant agents that remain
that involve free radicals [77]. The antioxidants have the stable at high temperatures and could act as substitutes
tendency to play a crucial role in the protection against for synthetic antioxidants [86].
oxidative damage disorders. The term “antioxidant” re-
fers to compounds that can prolong or diminish the oxi-
Cardiovascular Disease and Leafy Vegetables
dation of lipids by inhibiting the promotion of oxidative
chain reaction [78]. In the United States, adolescent and childhood obe-
It has been suggested in a number of studies that nat- sity has reached an endemic extent, and the rate of this
ural antioxidants from plant materials can replace syn- condition continues to increase in an immense man-
thetic ones. It is assumed that natural antioxidants are ner. In South Africa and other African countries, obe-
safe to use and they are widely distributed in all parts of sity among adolescents and children is increasing due
the plants such as the stem, leaves, flowers, and seeds. to Western influence and vegetable consumption and
Certain typical compounds that could involve antioxi- decline in physical activity with age [87]. The com-
dant activity are vitamins, carotenoids, and phenolic monness of chronic diseases, such as obesity, can be
compounds. Therefore, the regular daily intake of veg- decreased with regular use of leafy vegetables in the
etables and fruits that are naturally enriched with these sense of weight loss and it is confirmed through differ-
nutrients should be recommended in the diet to avoid ent research studies [88]. Fiber intake from GLVs and
several pathological complications and to improve the the chances of the development of coronary heart dis-
overall health standard [79–82]. Vitamin C has been des- ease (CHD)show an inverse relationship, so CHD risk
ignated as a powerful biological antioxidant and it was decreases with the consumption of fiber from these
explored that it can act as a chain-breaking scavenger for vegetables. Research also indicates that there is an in-
peroxy radicals as well as act in synergy with vitamin E. verse relationship between the occurrence of stroke
Vitamin E can also act as a chain-breaking oxidant and is and vegetable consumption and this concept supports
very important in quenching the singlet oxygen. the consumption of vegetables and fruits for prevent-
Metabolic carcinogen stimulation is free radical de- ing CVDs [89]. Daucher and coworkers [90] conducted
pendent and DNA damage by mediated free radicals meta-analysis studies and revealed that by the intake of
plays a key role in carcinogenesis [83,84]. Regular con- an additional portion of fruits and vegetables per day
sumption of dietary oxidants, which are found in leafy the risk of developing CVD reduces by about 4%.
vegetables and fruits, could be very helpful in reducing
cancer-related oxidative damage. Some studies have re- Carotenoids
vealed that there are some phytochemicals present in A well-known class of pigments known as carot-
common vegetables and fruits and they can perform enoids is responsible for imparting orange, red, and
many functions, which include stimulation of the im- yellow color to plants. b-Carotene, lycopene, zeaxan-
mune system, scavenging of oxidative agents, gene ex- thin, and lutein are some examples of this class and
pression regulation in cell proliferation, and apoptosis these compounds are a very important part of the hu-
and antimicrobial effects [85]. man diet. For best absorption of carotenoids in the body,
GLVs are a good source of antioxidants because they are cooking with little fat makes these compounds para-
a rich source of ascorbic acids, carotenoids, and phenolic mount for consumption, after they have been pureed or
contents and these all contribute to the antioxidant activity chopped. Vitamin A is best obtained from carotenoids.
of leafy vegetables. Mustard greens, coriander, and spin- Research studies have been done for determining the
ach are abundant in vitamin E, C, and A. These nutrients role of carotenoids in cancer, eye disease, and heart dis-
team up to feed on the free radicals, which u
­ sually ­damage ease. In some fruits and tomatoes, lycopene imparts the

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212 18. Green Leafy Vegetables: A Health Promoting Source

TABLE 18.4 Nutritive Constituents of Green Leafy Vegetables that have a Positive Impact on Human Health and their Sources
Constituent Source Established or proposed effects on human wellness

1. Vitamin C Broccoli, cabbage, spinach, leafy greens, chard, turnip Protect scurvy, aids wound healing, healthy
(ascorbic acid) greens ­immune-system, CVDs

2. Vitamin A Dark-green vegetables such as collards, broccoli, Night blindness prevention, chronic fatigue,
(carotenoids) arugula, spinach, turnip greens ­psoriasis, heart disease, stroke, cataracts

3. Vitamin K Lettuce, spinach, lentils, green onions, crucifers Synthesis of procoagulant factors, osteoporosis
­(cabbage, broccoli, Brussels sprouts), leafy greens

4. Vitamin E Kale, spinach, salad greens, dark-green leafy Heart disease, LDL oxidation, immune system,
(tocopherols) ­vegetables diabetes, cancer

5. Fiber Most fresh vegetables such as Brussels sprouts, Diabetes, heart disease
­cabbage, broccoli, cooked dry beans, and peas

6. Folate (folicin or Dark-green leafy vegetables (such as spinach, Birth defects, cancer, heart disease, nervous system
folic acid) ­mustard greens, butterhead lettuce, broccoli,
­Brussels sprouts,), asparagus

7. Calcium Vegetables (such as beans greens, okra, and Osteoporosis, muscular/skeletal, teeth, blood
­tomatoes) peas, cauliflower ­pressure

8. Magnesium Spinach, collard, cabbage Osteoporosis, nervous system, teeth, immune system

red color. Lycopene is most commonly obtained from Alonso et al. [96]. wherein the consumption of vegetables
­processed and cooked tomato products. This compound and fruits decreases blood pressure. He et al. [89] report-
also plays a vital role in p
­ reventing heart disease and ed that the risk of stroke development decreases with
cancer. Lutein and zeaxanthin in the human diet are the higher consumption of fruits and vegetables. Utili-
obtained from dark green and leafy vegetables. These zation of individual fruits and vegetables by 600 g/day
two compounds are also very important for preventing can decrease the threat of CVD by 31% and the risk of
age-related macular degeneration, oxidative damage to stroke by 19%.
eyes, and CVD (Table 18.4).

Flavonoids Hypertension and Leafy Vegetables

Flavonoids are produced by plants, belonging to the The main cause of CVD is hypertension, and it affects
family of phytochemical compounds. The risk of CVDs about 1 billion individuals in the world [97]. About 72
decreases with the high intake of these compounds million people in the Americas (one in three adults) are
[91]. Different clinical studies have been conducted and expected to have hypertension and only about 34% will
results obtained from these studies highlighted that
­ maintain a normal blood pressure (BP) [98–100]. The risk
the risk factor of CVD, such as dyslipidemia, hyperten- of prehypertension is developing in nearly 70 million
sion, and diabetes, can be reduced by the micro- and adults, and blood pressure is expected to be between
­macronutrients present in fruits and vegetables [92]. 120/80 mmHg and 140/90 mmHg. The possibility of
According to different population studies, a healthy hypertension development, especially systolic elevation,
life style and ample consumption of vegetables and fruits will happen in about 90% of adults in the United States
are correlated well to lowering the incidence of CVD. It by the age of 65 [99]. There is also a relationship between
is generally assumed that people who consume vegeta- the high risk of mortality and morbidity from CHD,
bles and fruits exercise more, smoke less, and are usually stroke cerebrovascular accident (CVA), congestive heart
­better educated than those people not consuming fruits failure, end-stage renal disease, and myocardial infarc-
and vegetables [93]. tion. Low blood pressure control is more dangerous for
A healthy diet pattern that includes high fruits and patients with chronic kidney disease and diabetes [101].
vegetables intake is inversely associated with consump- The most common reason for patient visits to clinics is
tion of fatty foods and also lowers the risk of CVD [94]. hypertension and it is the main cause of antihyperten-
Ness and Powles [95] also discovered evidence about sive medicine use with the cost reaching about $20 bil-
fruits and vegetables intake and the risk of CVD and lion per annum. According to different epidemiological
they showed that there is a considerable inverse rela- studies diet has been recognized as playing a pivotal
tionship between vegetable consumption and incidence role in blood pressure [102–105]. Blood pressure is re-
of CVD. A similar relationship was also reported by duced by dietary therapies like increased potassium and

D. Nutrition and Reproduction

 Therapeutic value and health benefits of green leafy vegetables 213
­ agnesium intake and reduced sodium intake. Various
m neointimal formation, and decrease in NADPH oxidase,
antioxidants, designer foods, and nutritional supple- inflammation, and oxidative stress [120–126].
ments ­present in fruit and vegetable diets are known for
reducing BP [106–110]. Potassium intake is high in in-
Dietary Fiber
dustrialized countries and this intake is inversely related
to CVD and BP [111,112]. Dietary potassium is associated Dietary fibers (DFs) are present naturally in fruits,
with lower risk of stroke and hypertension, while dietary vegetables, nuts, and cereals, and the composition
sodium is related with elevation of blood pressure. The and amount of these fibers vary from one food to an-
­incidence of CVA mortality in young women is inversely other [127]. Different foods without starch give about
related to the increased dietary intake of potassium of 20–35 g fiber/100 g of their dry mass while food that
about 60–80 mmol/day [113]. contain starchy material provides 10 g/100 g of their
A study was conducted on 43,738 US men aged dry weight. The content of dietary fiber in vegetables
40–75 years, which revealed a considerable inverse
­ and fruits is 1.5–2.5 g of their dry mass [128]. Cereals
­relationship between the risk of CVA and the intake are one of the most important sources of dietary fiber
of potassium [114]. Independent of the effect of potas- and in Western countries they contribute about 50% of
sium intake on BP, it has a direct effect on preventing the fiber intake [129]. About 3% from minor sources,
the chance of CVA and different mechanisms used 16% DF may come from fruits and 30–40% from veg-
for this [113,114]. The risk of hypertension is only 1% etables [130,131].
of the population in an isolated society, consuming a DF content in vegetables in the range of 1.5 to 2.5
diet high in fruits and vegetables. While this risk is g/100g of dry matter, and the amount of DF is much
about one third in populations of industrialized coun- higher in some products like red and white beans. Sim-
tries consuming a diet high in trans fats, processed ilarly, fruits also contain a large amount of DF [132].
foods, refined carbohydrates, low fiber, saturated fats, Curry leaves have soluble fiber (4.4%) and insoluble fi-
large amounts of dietary sodium, and reduced dietary ber (55.6%), on the basis of fresh weight of leaves [133].
magnesium and potassium [115]. It is demonstrated Chorus olitorius (jute), containing crude fiber (0.33%),
through epidemiological studies that the populations is a local plant from Australia, South America, some
consuming a primeval diet have lower BP and this re- parts of Europe, and tropical Asia and Africa, and also
duction in BP decreases CVD risk among vegetarians in commonly used in medicines to treat different diseases
industrialized countries [102,103,116]. like tumors, cystitis, fever, and cold [134]. High levels
The homeostasis of potassium and sodium plays a of vitamin C and protein are present in young shoot
­vital role in endothelium-dependent vasodilatation. Syn- tips of this vegetable and it is eaten raw or cooked [135]
thesis of nitric oxide decreases with sodium retention. and also in soup preparation. Another leafy vegetable
Nitric oxide is an arteriolar vasodilator elaborated by known as waterleaf (Talinum triangulare) grown in dif-
epithelial cells and this retention of sodium also increas- ferent parts of ­Nigeria. The leaves of Telifaria accidentlis,
es the plasma level of asymmetric dimethyl l-arginine, along with edible shoots, have crude protein, moisture,
which is an endogenous inhibitor of nitric oxide pro- carbohydrate, iron, oil, and ash. The crude fiber con-
duction [117]. Opposite effects are induced by sodium tents of this vegetable are 0.32%. Amaranthus hybridusis
restriction. Endothelium-dependent vasodilatation by is known to people of southeastern Nigeria as “inene”
hyperpolarizing the endothelial cell through opening of and it belongs to the family Amaranthacae. A. hybri-
potassium channels and stimulation of sodium pumps dusis is widely grown in West Africa, Indonesia, and
occurs due to the diet rich in serum sodium and potas- Malaysia [136]. A. hybridusis is an annual plant, it is
sium [118,119]. Decreased cytosolic calcium, which in spineless and up to 80 m high with grooves. The leaves
turn promotes vasodilatation, happen due to endothelial are green and variable in shape and size. Its fiber con-
hyperpolarization, which is transmitted to the vascular tent is 19.60%. Gnetum africana belongs to the family
smooth muscle cells [118]. Moreover, to increase vasodi- of plants called Gnetaceae. In Nigeria it is known as
lation, some other mechanism by which BP is influenced “Ukazi” or “Afang.” In Southern Nigeria G. africana is
by potassium include alteration in intracellular sodium used for the preparation of soup and salad. The salad is
and tonicity, reduced vasoconstrictive sensitivity to nor- often eaten as a mild laxative and its high fiber content
epinephrine and angiotensin II, natriuresis, increased (27.25%) helps to prevent constipation [137]. As a po-
sodium/potassium ATPase activity, increased serum tent medicinal plant it is used in the treatment of piles
and urinary kallikrein, proliferation in vascular smooth and high blood pressure [138]. Bako and workers [137]
muscle, alteration in DNA synthesis, improved insulin reported that the leaves cure stomach disorder and pre-
sensitivity, sympathetic nervous system cells, reduc- vents constant urination in nursing mothers.
tion in cardiac diastolic dysfunction, reduction in trans­ Raw vegetables, when compared with those eaten
forming growth factor (TGF)-beta, decrease in vascular cooked, have lower total dietary fiber in general. The

D. Nutrition and Reproduction

214 18. Green Leafy Vegetables: A Health Promoting Source

value of soluble dietary fiber ranges from 0.10 to 0.77% in bowel movement by absorbing water. During preg-
and insoluble dietary fiber value ranges from 0.88 to nancy, the daily recommended intake of fiber is 25–35 g.
3.06% for raw vegetables. TDF varies between 3.50% for However, in some countries of the world the consumed
broccoli and 0.98% for iceberg lettuce [139]. fiber is less than 14 g/day during pregnancy. Sufficient
water intake and hydration is also necessary along with
proper intake of fiber. It is an important part of preg-
EFFECT OF GREEN LEAFY VEGETABLES nancy diet for mother and fetus health. Increase of fiber
ON MOTHER AND FETUS HEALTH content in the diet during pregnancy should be gradual
and should start with soluble fiber to avoid bloating and
During pregnancy women are highly conscious about flatulence. Proper fiber intake prevents constipation and
their diet because a healthy diet is beneficial for the hemorrhoids during pregnancy [146].
mother and the developing fetus. Foods of plant origin Antioxidants balance related to fiber consumption
are abundant in micronutrients such as antioxidants, has a provital role in the development of the fetus
phytochemicals, minerals, vitamins, and dietary fiber. during pregnancy. It has been shown that after con-
The risk of metabolic syndrome, CVD, and inflammation sumption of a fiber-rich diet, the antioxidant capacity
is reduced by a high intake of vegetable in the diet [140]. of superoxide dismutase (SOD) increases significantly
Roman and coworkers [141] studied the impacts of con- but placental MDA (malondialdehyde) level decreases
sumption of vegetables on pregnancy and anthropometric significantly. Moreover, the antioxidant’s scavenging
measures at birth in a general population mother–infant potential of free radicals get increased with a fiber-rich
cohort. A diet composed of large portions of vegetables diet. All these have an effect on normal fetal develop-
had considerable impact on birth weight and length. Lit- ment and health. Oxidative stress is known to effect the
erature has elaborated the fact that vegetable consump- pathogenesis of hypertension and preeclampsia during
tion during pregnancy may have a beneficial effect on pregnancy so it is postulated that the consumption of a
the growth of fetus. More fetus growth and weight gain high amount of fiber and vegetables rich in antioxidants
was observed in mothers consuming leafy vegetables in could be beneficial in ameliorating hypertension. Anti-
comparison with mothers consuming a nonvegetable diet oxidants could pass through the placenta and selenium
[142]. In another study strong association was found for antioxidant has been shown to be effective in the struc-
fruit and vegetable intake of mothers in which infant birth ture of glutathione peroxidase, so it is related to the
weight increased significantly [143]. lower rate of miscarriage and preeclampsia [147–149].
Recently, a study was conducted in India about the Allergies developing in early childhood are a direct
health of pregnant women and special concentration consequence of low fruit and vegetable consumption of
was paid on underweight women. A healthy pregnan- the mother during pregnancy. Pregnant women who had
cy period and optimum birth weight of the fetus are a higher consumption of fiber were shown to have babies
strongly linked with consumption of such foods having with low incidence of developing asthma [150]. Eating
high contents of micronutrients (vitamins A and C, fola- whole grains during pregnancy would reduce the risk of
cin, calcium, and iron). Food rich in energy and protein tube defects, spina bifida, and anencephaly during fetal
content has no considerable impact on the birth size of development.
the infant. Vegetable should be at a necessary proportion
of the diet of pregnant women as it is beneficial for the
proper growth size of the fetus. Women who consumed Folic Acid
leafy vegetables, fruits, and milk products 3–4 times per Folic acid is the term used for naturally occurring
week gave birth to healthy infants. A daily portion of folates referred to as “folate” and also known as ptero-
200 g (2.6 mg of b-carotene) of African eggplant leaves ylmonoglutamic acid. These naturally occurring folates
were given to mothers in the intervention groups for have pteroylmonoglutamic acids with 2–8 glutamic acid
three months while those in the control group did not re- groups attached to the primary structure [151]. Folic acid
ceive any additional vegetables. Mothers receiving leafy and closely related compounds are found abundantly in
vegetables showed a good profile for vitamin A. Dietary GLVs. Folic acid characterized as vitamin B9 was first iso-
modification and nutrition education for women of child- lated from spinach in 1941. It is water-soluble and an es-
bearing age to include natural food sources rich in pro- sential vitamin member of the vitamin B complex [152].
vitamin A may provide a long-term solution to prevent Folic acid is found in abundance in various GLVS like as-
vitamin A deficiency in developing countries [144]. Or- paragus, lettuce, broccoli, lentils, and spinach. Folic acid
ganic food consumption with high sources of vegetables is essential for promoting the transport of amino acids
and fruits is considered healthy during pregnancy [145]. in the protein synthesis process to their specific location
Fiber has a vital importance in human nutrition. The [153]. It is also required for the methylation of amino ac-
human gastrointestinal tract cannot digest fiber. It helps ids, DNA, and RNA [154,155]. Folic acid is requisite in the

D. Nutrition and Reproduction

 Effect of green leafy vegetables on mother and fetus health 215
regeneration of methionine from homocysteine, which due to excessive intake of folate from fortified foods or
in turn is essential to maintain cardiovascular well-being food supplements is very uncommon [170] because the
[156]. It also contributes in cell division, regulation, and excess folic acid present in the body is lost in the urine due
differentiation as well as helps to regulate mood, sleep, to its solubility in water. Elevating the concentration of
appetite, and the central nervous system [157]. these beneficial components to human health in fruits and
Folic acid plays a vital role in the synthesis of nucle- GLVs is the current concern of plant scientists through
ic acids and amino acids and is also required for fetus improved practices of plant breeding and genetics. More-
growth [158]. The risk of having babies with neural tube over, it has been revealed that the use of specific commer-
birth defects, including anencephaly, encephalocele, and cial cultivars by the growers can significantly increase the
spina bifida, can be addressed with sufficient maternal concentration of these health-promoting components as
dietary intake of folic acid before conception and during much as fivefold just by selection of good quality soil type
the early stages of pregnancy [159]. Folic acid is very im- for growing of fruits and vegetables [171,172].
portant for cell proliferation and DNA synthesis among
the nutrients required during gestation.
During gestation folate requirements are 5- to 10-fold Fertility and Green Leafy Vegetables
higher for nonpregnant women. For pregnant women the Dark leafy green vegetables are rich in vital miner-
RDA for folate is 600 mg/day for the development of ma- als, vitamins, antioxidants, fiber, and chlorophyll. They
ternal tissues, placenta, and the fetus [160]. These require- can be eaten raw or cooked; however, eating raw or half
ments for folate can only be met by adequate maternal cooked is better as cooking depletes the vitamins and
dietary intake of folate. Clinical observations [161,162] antioxidants, especially the ones important for fertility
indicate that the fetus can consume the folate stores to a such as zinc, vitamin C, and folate. Greens, such as broc-
point of reduction and as a result maternal folate deficien- coli, Brussels sprouts, and cabbage, contain diindolyl-
cy occurs, which leads to cell death, particularly of high methane, which helps the body to get rid of excess “bad”
proliferative somatic cells, and megaloblastosis arises. estrogen. These types of greens should be eaten at least
This will result in undesirable consequences to the fetus three times a week. Folic acid is very important for the
during gestation. In addition, the time it takes for neural proper development of the fetus. Eating folic acid while
crest cells to migrate to the embryonic neural tube is as a woman is preparing for conception is better, because
short as 5 h; deficiency of folate will result in the most the baby will need this vital nutrient before the woman
intense effects on these neural crest cells particularly dur- is even able to get a positive pregnancy test. Women who
ing the critical stages of fetus development, which will do not get sufficient amounts of iron may suffer anovu-
result in neurocritopathies and neural tube defects such lation and possibly poor egg health, which can inhibit
as spina bifida and anencephaly. In order to avoid birth pregnancy at 60% higher than those with sufficient iron
defects in babies, the current RDA of folate for nonpreg- stores in their blood. GlVs (such as spinach and aspara-
nant women is (400 mg/day). An RDA of 4 mg/day is gus) are rich sources for increasing iron in the body. Vi-
suggested for such women with a history of giving birth tamin C is important for the absorption of iron and helps
to an infant with neural tube defects. to protect the cells from free-radical damage among its
In one study, maternal folate was limited by restrict- many other important functions in the body [173].
ing dietary folate before conception and during preg- Leafy greens and vegetables supply the body with im-
nancy by using a murine model [163], and results were portant minerals and nutrients. The body needs to have
poor reproductive outcomes with decreased fetal weight, a healthy acid/alkaline balance to function at its best.
delay in heart and palate development, and increased fe- Most diets today are very acidic (full of meat, sugar, and
tal deaths [164]. Additionally, a number of earlier studies white processed foods) and need to have more fruits
[165–167] showed that a remarkably increased percentage and vegetables incorporated in them. Spinach is known
of the population in South India is suffering from folate as a super food that provides the body with an enor-
deficiency with the evidence of megaloblastic anemia in mous amount of healthy vitamins and nutrients that are
about 60% of pregnant women. According to a national important for fertility and pregnancy. Spinach is rich in
pilot program on the control of micronutrient malnutri- iron and folic acid, two nutrients that are important for
tion [168], the estimated daily intake of folic acid in wom- reproduction and fetal health. Folic acid is important
en belonging to low economic status [169] in urban and in preventing neural tube defects in the fetus, and iron
rural areas of different Indian states ranged from 75 to helps to promote oxygen levels in cells, organs, and the
167 mg, which is much less than the RDA of 400 mg/day. fetus.
The recommended daily intake is even higher than 400 mg Having a healthy alkaline environment is important
in most countries. Although the risk of neural tube birth for allowing the sperm to survive and make it to the egg.
defect is lowered by folic acid up to 50–75%, these defects A mineral in the vaginal fluids activates the whipping
are not solely due to the deficiency in folic acid. Toxicity of a sperm’s tail so it can begin to travel and make its

D. Nutrition and Reproduction

216 18. Green Leafy Vegetables: A Health Promoting Source

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