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The Cochrane Database of Systematic... Jul 2020Foot ulcers in people with diabetes are non-healing, or poorly healing, partial, or full-thickness wounds below the ankle. These ulcers are common, expensive to manage... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Foot ulcers in people with diabetes are non-healing, or poorly healing, partial, or full-thickness wounds below the ankle. These ulcers are common, expensive to manage and cause significant morbidity and mortality. The presence of a wound has an impact on nutritional status because of the metabolic cost of repairing tissue damage, in addition to the nutrient losses via wound fluid. Nutritional interventions may improve wound healing of foot ulcers in people with diabetes.
OBJECTIVES
To evaluate the effects of nutritional interventions on the healing of foot ulcers in people with diabetes.
SEARCH METHODS
In March 2020 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that evaluated the effect of nutritional interventions on the healing of foot ulcers in people with diabetes.
DATA COLLECTION AND ANALYSIS
Two review authors, working independently, assessed included RCTs for their risk of bias and rated the certainty of evidence using GRADE methodology, using pre-determined inclusion and quality criteria.
MAIN RESULTS
We identified nine RCTs (629 participants). Studies explored oral nutritional interventions as follows: a protein (20 g protein per 200 mL bottle), 1 kcal/mL ready-to-drink, nutritional supplement with added vitamins, minerals and trace elements; arginine, glutamine and β-hydroxy-β-methylbutyrate supplement; 220 mg zinc sulphate supplements; 250 mg magnesium oxide supplements; 1000 mg/day omega-3 fatty acid from flaxseed oil; 150,000 IU of vitamin D, versus 300,000 IU of vitamin D; 250 mg magnesium oxide plus 400 IU vitamin E and 50,000 IU vitamin D supplements. The comparator in eight studies was placebo, and in one study a different dose of vitamin D. Eight studies reported the primary outcome measure of ulcer healing; only two studies reported a measure of complete healing. Six further studies reported measures of change in ulcer dimension, these studies reported only individual parameters of ulcer dimensions (i.e. length, width and depth) and not change in ulcer volume. All of the evidence identified was very low certainty. We downgraded it for risks of bias, indirectness and imprecision. It is uncertain whether oral nutritional supplement with 20 g protein per 200 mL bottle, 1 kcal/mL, nutritional supplement with added vitamins, minerals and trace elements, increases the proportion of ulcers healed at six months more than placebo (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.42 to 1.53). It is also uncertain whether arginine, glutamine and β-hydroxy-β-methylbutyrate supplement increases the proportion of ulcers healed at 16 weeks compared with placebo (RR 1.09, 95% CI 0.85 to 1.40). It is uncertain whether the following interventions change parameters of ulcer dimensions over time when compared with placebo; 220 mg zinc sulphate supplement containing 50 mg elemental zinc, 250 mg magnesium oxide supplement, 1000 mg/day omega-3 fatty acid from flaxseed oil supplement, magnesium and vitamin E co-supplementation and vitamin D supplementation. It is also uncertain whether 150,000 IU of vitamin D, impacts ulcer dimensions when compared with 300,000 IU of vitamin D. Two studies explored some of the secondary outcomes of interest for this review. It is uncertain whether oral nutritional supplement with 20 g protein per 200 mL bottle, 1 kcal/mL, nutritional supplement with added vitamins, minerals and trace elements, reduces the number of deaths (RR 0.96, 95% CI 0.06 to 14.60) or amputations (RR 4.82, 95% CI 0.24 to 95.88) more than placebo. It is uncertain whether arginine, glutamine and β-hydroxy-β-methylbutyrate supplement increases health-related quality of life at 16 weeks more than placebo (MD -0.03, 95% CI -0.09 to 0.03). It is also uncertain whether arginine, glutamine and β-hydroxy-β-methylbutyrate supplement reduces the numbers of new ulcers (RR 1.04, 95% CI 0.71 to 1.51), or amputations (RR 0.66, 95% CI 0.16 to 2.69) more than placebo. None of the included studies reported the secondary outcomes cost of intervention, acceptability of the intervention (or satisfaction) with respect to patient comfort, length of patient hospital stay, surgical interventions, or osteomyelitis incidence. One study exploring the impact of arginine, glutamine and β-hydroxy-β-methylbutyrate supplement versus placebo did not report on any relevant outcomes.
AUTHORS' CONCLUSIONS
Evidence for the impact of nutritional interventions on the healing of foot ulcers in people with diabetes compared with no nutritional supplementation, or compared with a different dose of nutritional supplementation, remains uncertain, with eight studies showing no clear benefit or harm. It is also uncertain whether there is a difference in rates of adverse events, amputation rate, development of new foot ulcers, or quality of life, between nutritional interventions and placebo. More research is needed to clarify the impact of nutritional interventions on the healing of foot ulcers in people with diabetes.
Topics: Arginine; Diabetic Foot; Dietary Proteins; Dietary Supplements; Fatty Acids, Omega-3; Female; Glutamine; Humans; Magnesium; Magnesium Oxide; Male; Middle Aged; Minerals; Randomized Controlled Trials as Topic; Trace Elements; Valerates; Vitamins; Wound Healing; Zinc Sulfate
PubMed: 32677037
DOI: 10.1002/14651858.CD011378.pub2 -
Foods (Basel, Switzerland) Mar 2021Persimmon ( L.f.) crop has markedly increased in Spain, and "Rojo Brillante" persimmon is the main cultivated variety. This astringent cultivar requires de-astringency...
Persimmon ( L.f.) crop has markedly increased in Spain, and "Rojo Brillante" persimmon is the main cultivated variety. This astringent cultivar requires de-astringency treatment before commercialization, which may involve an extra cost. Its short commercial season implies handling large volumes of fruits with consequent postharvest losses. Therefore, the development of derived added-value products is of much interest. In this study, astringent and non-astringent "Rojo Brillante" persimmons were dehydrated by following a natural drying method used in Asia. The drying kinetics and physico-chemical properties were analyzed for 81 days. The results indicated subsequent reductions in weight, water content, and water activity throughout the drying process, and the equatorial diameter decreased. All the employed thin-layer mathematical models were suitable for representing the drying characteristics of both products with similar behavior. The effective water diffusivity values were 5.07 × 10 m s and 6.07 × 10 m s for astringent and non-astringent persimmon samples, respectively. The drying treatment significantly decreased the soluble tannins content, and the astringent samples obtained similar values to those obtained for the non-astringent samples in 20 days. The external and internal flesh of the astringent fruit remained orange through the drying period, while brown coloration in the non-astringent fruit was observed after 57 drying days. Therefore, prior de-astringency treatment would not be necessary.
PubMed: 33803816
DOI: 10.3390/foods10030647 -
Asian Pacific Journal of Cancer... Apr 2022Human Papillomavirus is one of the most crucial infectious disease in gynecology disease. To assess the efficacy of supplemental zinc treatment in clearance of HPV... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
Human Papillomavirus is one of the most crucial infectious disease in gynecology disease. To assess the efficacy of supplemental zinc treatment in clearance of HPV infection.
METHODS
Eighty zinc-sufficient women between 21-55 years, with positive HPV DNA testing, and abnormal cervical cytology in Pap test (ASCUS or LISL) were randomly divided to case (n=40) and control group (n=40). Case group received oral tablets of zinc sulfate twice a day for 3 months while control group received no placebo. During follow-up patients underwent repeat HPV DNA test and PAP test and were evaluated for clearance/persistence of HPV infection and regression/progression in the lesion grading.
RESULTS
As far as demographics, serum zinc levels and the relevant risk factors for persistence of HPV were concerned, there was no significant difference between two groups, except for the frequency distribution of HR-HPV which was significantly higher in case group. Zinc treatment for 3 months reduced the risk of persistence of HPV infection and progression from baseline cytology (OR = 0.130) (CI 95% 0.04-0.381; p <0.001) and 0.301 (95% CI 0.777-0.116; p = 0.012), respectively. Age, initial cytology, HPV type, and contraceptive method were not related to persistence of HPV. Serum zinc levels increased in the casr group as a result of oral zinc consumption for 3-month period, though without any statistical significance (p = 0.407).
CONCLUSION
The results of the following study suggested that oral intake of zinc sulfate supplement for 3 months increases the rates of HPV clearance and resolution of pre-existing cervical lesion.
Topics: Alphapapillomavirus; Dietary Supplements; Female; Humans; Papanicolaou Test; Papillomaviridae; Papillomavirus Infections; Uterine Cervical Neoplasms; Zinc; Zinc Sulfate
PubMed: 35485687
DOI: 10.31557/APJCP.2022.23.4.1285 -
Plants (Basel, Switzerland) Dec 2022Pulses are a group of leguminous crops that are harvested solely for their dry seeds. As the demand for plant-based proteins grows, pulses are becoming important food... (Review)
Review
Pulses are a group of leguminous crops that are harvested solely for their dry seeds. As the demand for plant-based proteins grows, pulses are becoming important food crops worldwide. In addition to being a rich source of nutrients, pulses also contain saponins that are traditionally considered anti-nutrients, and impart bitterness and astringency. Saponins are plant secondary metabolites with great structural and functional diversity. Given their diverse functional properties and biological activities, both undesirable and beneficial, saponins have received growing attention. It can be expected that redirecting metabolic fluxes to control the saponin levels and produce desired saponins would be an effective approach to improve the nutritional and sensory quality of the pulses. However, little effort has been made toward understanding saponin biosynthesis in pulses, and, thus there exist sizable knowledge gaps regarding its pathway and regulatory network. In this paper, we summarize the research progress made on saponin biosynthesis in pulses. Additionally, phylogenetic relationships of putative biosynthetic enzymes among multiple pulse species provide a glimpse of the evolutionary routes and functional diversification of saponin biosynthetic enzymes. The review will help us to advance our understanding of saponin biosynthesis and aid in the development of molecular and biotechnological tools for the systematic optimization of metabolic fluxes, in order to produce the desired saponins in pulses.
PubMed: 36559617
DOI: 10.3390/plants11243505 -
Environmental Sustainability (Singapore) May 2023The cashew apple is a tropical pseudo fruit, with high fiber content, high nutritional value, and therapeutic compositional profile. Consuming cashew apples can help... (Review)
Review
The cashew apple is a tropical pseudo fruit, with high fiber content, high nutritional value, and therapeutic compositional profile. Consuming cashew apples can help with several health-related problems, such as obesity, stomach ulcers, and gastritis. It has even demonstrated anti-tumor and anti-carcinogenic effects, and its antioxidants can help with wound-healing. Despite such benefits, the cashew apple is frequently considered as waste generated by cashew nut industries, since its commercial applications are restricted by the astringency and poor storability. This astringency is primarily due to the presence of tannins; and a lack of proper, efficient, and economical astringency reduction strategy is accountable for major waste generation. This review compiles pieces of information on the causes of astringency, as well as tannin reduction methods, such as clarification, thermal treatments, microfiltration, and fermentation. These methods aim to either just reduce tannin content or to valorize this by-product in a less-astringent better product. Both routes will eventually help with the better utilization of said organic food waste, which is critical for sustainable development.
PubMed: 37363088
DOI: 10.1007/s42398-023-00276-7 -
Attention, Perception & Psychophysics Oct 2022Roughness is a perceptual attribute typically associated with certain stimuli that are presented in one of the spatial senses. In auditory research, the term is... (Review)
Review
Roughness is a perceptual attribute typically associated with certain stimuli that are presented in one of the spatial senses. In auditory research, the term is typically used to describe the harsh effects that are induced by particular sound qualities (i.e., dissonance) and human/animal vocalizations (e.g., screams, distress cries). In the tactile domain, roughness is a crucial factor determining the perceptual features of a surface. The same feature can also be ascertained visually, by means of the extraction of pattern features that determine the haptic quality of surfaces, such as grain size and density. By contrast, the term roughness has rarely been applied to the description of those stimuli perceived via the chemical senses. In this review, we take a critical look at the putative meaning(s) of the term roughness, when used in both unisensory and multisensory contexts, in an attempt to answer two key questions: (1) Is the use of the term 'roughness' the same in each modality when considered individually? and (2) Do crossmodal correspondences involving roughness match distinct perceptual features or (at least on certain occasions) do they merely pick-up on an amodal property? We start by examining the use of the term in the auditory domain. Next, we summarize the ways in which the term roughness has been used in the literature on tactile and visual perception, and in the domain of olfaction and gustation. Then, we move on to the crossmodal context, reviewing the literature on the perception of roughness in the audiovisual, audiotactile, and auditory-gustatory/olfactory domains. Finally, we highlight some limitations of the reviewed literature and we outline a number of key directions for future empirical research in roughness perception.
Topics: Animals; Auditory Perception; Humans; Sound; Touch; Touch Perception; Visual Perception
PubMed: 36028614
DOI: 10.3758/s13414-022-02550-y -
Frontiers in Genetics 2021Phenotypic characterization of postharvest traits is essential for the breeding of high-quality fruits. To compare postharvest traits of different genetic lines, it is...
Phenotypic characterization of postharvest traits is essential for the breeding of high-quality fruits. To compare postharvest traits of different genetic lines, it is essential to use a reference point during fruit development that will be common to all the lines. In this study, we employed a non-destructive parameter of chlorophyll levels to establish a similar physiological age and compared several postharvest traits of ten astringent and seven non-astringent persimmon cultivars. The fruit's traits examined were astringency, weight, total soluble solids (TSS), titratable acidity (TA), chlorophyll levels (I ), color (hue), firmness, color development and firmness loss during storage, crack development, and susceptibility to infection. Although the chlorophyll (I ) index and color (hue) showed a high correlation among mature fruits of all cultivars, the chlorophyll parameter could detect higher variability in each cultivar, suggesting that I is a more rigorous parameter for detecting the developmental stage. The average weight, TSS, and TA were similar between astringent and non-astringent cultivars. Cracks appeared only on a few cultivars at harvest. Resistance to infection and firmness were lower in astringent than in non-astringent cultivars. Only the astringent cultivar "32" was resistant to infection possibly due to the existence of an efficient peel barrier. It was concluded that a high correlation existed between astringency, susceptibility to infection, and firmness. Cracks did not correlate with astringency or firmness. The phenotypic traits evaluated in this work can be used in future breeding programs for elite persimmon fruits.
PubMed: 34163526
DOI: 10.3389/fgene.2021.670929 -
Yakugaku Zasshi : Journal of the... 2024Tannins are a group of polyphenols that possess the ability to precipitate proteins, causing an undesirable astringent taste by interacting with salivary peptides. This... (Review)
Review
Tannins are a group of polyphenols that possess the ability to precipitate proteins, causing an undesirable astringent taste by interacting with salivary peptides. This interaction deactivates the digestive enzymes; therefore, tannins are considered as plant defense substances. The health benefits of tannins and related polyphenols in foods and beverages have been demonstrated by biological and epidemiological studies; however, their metabolism in living plants and the chemical changes observed during processing of foods and medicinal herbs raises some questions. This review summarizes our studies concerning dynamic changes observed in tannins. Ellagitannins present in the young leaves of Camellia japonica and Quercus glauca undergo oxidative degradation as the leaves mature. Similar oxidative degradation is also observed in whiskey when it is kept for aging in oak barrels, and in decaying wood caused by fungi in natural forests. In contrast, ellagitannins have been observed to undergo reduction in the leaves of Carpinus, Castanopsis, and Triadica species as the leaves mature. This phenomenon of reductive metabolism in leaves enabled us to propose a new biosynthetic pathway for the most fundamental ellagitannin acyl groups, which was also supported by biomimetic synthetic studies. Polyphenols undergo dynamic changes during the process of food processing. Catechin in tea leaves undergo oxidation upon mechanical crushing to generate black tea polyphenols. Though detailed production mechanisms of catechin dimers have been elucidated, structures of thearubigins (TRs), which are complex mixtures of oligomers, remain ambiguous. Our recent studies suggested that catechin B-ring quinones couple with catechin A-rings during the process of oligomerization.
Topics: Tannins; Hydrolyzable Tannins; Catechin; Polyphenols; Tea; Oxidation-Reduction
PubMed: 38296496
DOI: 10.1248/yakushi.23-00170 -
Plant Communications Mar 2023Proanthocyanidins (PAs) are natural flavan-3-ol polymers that contribute protection to plants under biotic and abiotic stress, benefits to human health, and bitterness... (Review)
Review
Proanthocyanidins (PAs) are natural flavan-3-ol polymers that contribute protection to plants under biotic and abiotic stress, benefits to human health, and bitterness and astringency to food products. They are also potential targets for carbon sequestration for climate mitigation. In recent years, from model species to commercial crops, research has moved closer to elucidating the flux control and channeling, subunit biosynthesis and polymerization, transport mechanisms, and regulatory networks involved in plant PA metabolism. This review extends the conventional understanding with recent findings that provide new insights to address lingering questions and focus strategies for manipulating PA traits in plants.
Topics: Humans; Proanthocyanidins; Crops, Agricultural
PubMed: 36435967
DOI: 10.1016/j.xplc.2022.100498