Ranking the dietary interventions by their effectiveness in the management of polycystic ovary syndrome: a systematic review and network meta-analysis.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a common condition in women, characterised by reproductive and metabolic dysfunction. While dietary approaches have been evaluated as a first-line treatment for patients with PCOS, there is limited evidence to support preference for a specific dietary composition. This systematic review and network meta-analysis was performed with the objective of comparing different dietary interventions in terms of positive impact. Metformin, the currently preferred treatment, was also compared. METHODS: The latest systematic search was performed on the 20th of March, 2023. Eligible randomised controlled trials (RCTs) included patients with PCOS and compared the dietary approach with another intervention or a standard diet. Outcomes were expressed via anthropometric measurements and hormonal, glycemic, and lipid levels. The Bayesian method was used to perform a network meta-analysis and to calculate the surface under the cumulative ranking curve (SUCRA) values in order to rank the dietary interventions. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS: 19 RCTs were identified, comprising data from 727 patients who were variously treated with 10 types of dietary interventions and metformin. The Dietary Approaches to Stop Hypertension (DASH) diet was the most effective in reducing Homeostatic Model Assessment of Insulin Resistance (SUCRA 92.33%), fasting blood glucose (SUCRA 85.92%), fasting insulin level (SUCRA 79.73%) and triglyceride level (SUCRA 82.07%). For body mass index (BMI), the most effective intervention was the low-calorie diet (SUCRA 84.59%). For weight loss, the low-calorie diet with metformin (SUCRA 74.38%) was the most effective intervention. Metformin produced the greatest reductions in low-density lipoprotein cholesterol (SUCRA 78.08%) and total testosterone levels (SUCRA 71.28%). The low-carb diet was the most effective intervention for reducing cholesterol levels (SUCRA 69.68%), while the normal diet (SUCRA 65.69%) ranked first for increasing high-density lipoprotein cholesterol levels. CONCLUSION: Dietary interventions vary in their effects on metabolic parameters in women with PCOS. Based on our results, the DASH diet is the most effective dietary intervention for treating PCOS. Registration PROSPERO ID CRD42021282984.

Galactomannans are the most effective soluble dietary fibers in type 2 diabetes: a systematic review and network meta-analysis.

BACKGROUND: Soluble dietary fibers are known to reduce the levels of blood glucose and lipids in patients with type 2 diabetes mellitus (type 2 diabetes). Although several different dietary fiber supplements are utilized, to our knowledge, no previous study has ranked their efficacy yet. OBJECTIVES: We performed this systematic review and network meta-analysis to rank the effects of different types of soluble dietary fibers. METHODS: We performed our last systematic search on November 20, 2022. Eligible randomized controlled trials (RCTs) included adult patients with type 2 diabetes and compared the intake of soluble dietary fibers with that of another type of dietary fiber or no fiber. The outcomes were related to glycemic and lipid levels. The Bayesian method was used to perform a network meta-analysis and calculate the surface under the cumulative ranking (SUCRA) curve values to rank the interventions. The Grading of Recommendations Assessment, Development, and Evaluation system was applied to evaluate the overall quality of the evidence. RESULTS: We identified 46 RCTs, including data from 2685 patients who received 16 types of dietary fibers as intervention. Galactomannans had the highest effect on reducing the levels of HbA1c (SUCRA: 92.33%) and fasting blood glucose (SUCRA: 85.92%). With regard to fasting insulin level, HOMA-IR, ß-glucans (SUCRA: 73.45%), and psyllium (SUCRA: 96.67%) were the most effective interventions. Galactomannans were ranked first in reducing the levels of triglycerides (SUCRA: 82.77%) and LDL cholesterol (SUCRA: 86.56%). With regard to cholesterol and HDL cholesterol levels, xylo-oligosaccharides (SUCRA: 84.59%) and gum arabic (SUCRA: 89.06%) were the most effective fibers. Most comparisons had a low or moderate certainty of evidence. CONCLUSIONS: Galactomannans were the most effective dietary fiber for reducing the levels of HbA1c, fasting blood glucose, triglycerides, and LDL cholesterol in patients with type 2 diabetes. This study was registered at PROSPERO as ID CRD42021282984.

Development of Protein- and Fiber-Enriched, Sugar-Free Lentil Cookies: Impact of Whey Protein, Inulin, and Xylitol on Physical, Textural, and Sensory Characteristics.

Gluten-free (GF) diets often become nutritionally imbalanced, being low in proteins and fibers and high in sugars. Preparing GF foods with improved nutritional value is therefore a key challenge. This study investigates the impact of different combinations of whey protein (11.9%), inulin (6.0%) as dietary fiber, and xylitol (27.9%) as a sweetener used in the enrichment of green- and red-lentil-based gluten-free cookies. The cookies were characterized in terms of baking loss, geometric parameters, color, texture, and sensory profile. The results showed that these functional ingredients had different impacts on the lentil cookies made of different (green/red) lentils, especially regarding the effect of fiber and xylitol on the volume (green lentil cookies enriched with fiber: 16.5 cm3, sweetened with xylitol: 10.9 cm3 vs. 21.2 cm3 for control; red lentil cookies enriched with fiber: 21.9 cm3, sweetened with xylitol: 21.1 cm3 vs. 21.8 cm3 for control) and color (e.g., b* for green lentil cookies enriched with fiber: 13.13, sweetened with xylitol: 8.15 vs. 16.24 for control; b* for red lentil cookies enriched with fiber: 26.09, sweetened with xylitol: 32.29 vs. 28.17 for control). Regarding the textural attributes, the same tendencies were observed for both lentil products, i.e., softer cookies were obtained upon xylitol and whey protein addition, while hardness increased upon inulin enrichment. Stickiness was differently influenced by the functional ingredients in the case of green and red lentil cookies, but all the xylitol-containing cookies were less crumbly than the controls. The interactions of the functional ingredients were revealed in terms of all the properties investigated. Sensory analysis showed that the addition of whey protein resulted in less intensive "lentil" and "baked" aromas (mostly for red lentil cookies), and replacement of sugar by xylitol resulted in crumblier and less hard and crunchier products. The application of different functional ingredients in the enrichment of lentil-based gluten-free cookies revealed several interactions. These findings could serve as a starting point for future research and development of functional GF products.

Lentil (Lens culinaris Medik.) Flour Varieties as Promising New Ingredients for Gluten-Free Cookies.

Monotony in a gluten-free (GF) diet can be a challenge because of a limited choice of acceptable cereal sources. This study investigates the potential of five types of differently coloured lentils in the development of GF cookies using rice flour as a reference. Raw materials (lentil flours) and cookies were characterised in terms of physicochemical parameters (e.g., crude protein content, total phenolics and flavonoids, antioxidant properties, colour, pH); additionally, geometry, baking loss and texture profile were determined for the cookies. A sensory acceptance test was also conducted to find out consumer preferences regarding rice versus different lentil cookies. Results showed that lentil cookies were superior to rice control in terms of higher crude protein (12.1−14.8 vs. 3.8 g/100 g), phenolic (136.5−342.3 vs. 61.5 mg gallic acid equivalents/100 g) and flavonoid (23.8−75.9 vs. 13.1 mg catechin equivalents/100 g) content and antioxidant capacity (0.60−1.81 vs. 0.35 mmol trolox equivalents/100 g), as well as lower hydroxymethyl-furfural content (<1 vs. 26.2 mg/kg). Consumers preferred lentil cookies to rice ones (overall liking: 6.1−7.0 vs. 5.6, significant differences for red and brown lentils), liking especially their taste (6.3−7.0 vs. 5.5). Depending on the target parameter, whether physicochemical or sensory, these lentil flours can be promising raw materials for GF bakery products.

Biscuits Enriched with Monofloral Bee Pollens: Nutritional Properties, Techno-Functional Parameters, Sensory Profile, and Consumer Preference.

Bee pollens are potential functional food ingredients as they contain essential nutrients and a wide range of bioactive compounds. The aim of this study was to investigate the effects of enrichment with monofloral bee pollens on the nutritional properties, techno-functional parameters, sensory profile, and consumer preference of biscuits. Biscuits were prepared according to the AACC-approved method by substituting wheat flour with pollens of rapeseed (Brassica napus L.), phacelia (Phacelia tanacetifolia Benth.) and sunflower (Helianthus annuus L.) at 2%, 5% and 10% levels. The macronutrient composition of the biscuits was determined: crude protein content (Kjeldahl method), crude fat content (Soxhlet extraction), ash content (carbonization), moisture content (drying), carbohydrate content (formula). Their total phenolic content (TPC) and in vitro antioxidant capacity (FRAP, TEAC, DPPH) were determined spectrophotometrically. The colour of the biscuits was measured using a tristimulus-based instrument, and their texture was characterized by using a texture analyser. Sensory profile of biscuits was determined by qualitative descriptive analysis (QDA). The consumer acceptance and purchase intention of the biscuits were also evaluated, based on the responses of 100 consumers. Additionally, an external preference map was created to illustrate the relationship between consumer preference and the sensory profile of the biscuits, and penalty analysis was conducted to identify directions for product development. Phacelia pollen appeared to be the most effective for improving the nutritional quality of biscuits. The addition of phacelia pollen at the 10% substitution level increased the protein content and TPC of the control biscuit by 21% and 145%, respectively. Significant changes (p < 0.05) were also observed regarding the colour and texture of biscuits. The results of the QDA revealed that biscuits containing pollens of different botanical sources have heterogeneous sensory attributes. The biscuit containing sunflower pollen at the 2% substitution level was preferred the most (overall liking = 6.9 ± 1.6), and purchase intentions were also the highest for this product. Based on the results of the present study, it is recommended to use sunflower pollen for developing pollen-enriched foods in the future.

Effects of various polysaccharides (alginate, carrageenan, gums, chitosan) and their combination with prebiotic saccharides (resistant starch, lactosucrose, lactulose) on the encapsulation of probiotic bacteria Lactobacillus casei 01 strain.

The probiotics are extremely sensitive to various environmental factors, which imposes limitation on their health and functional effectiveness. Thus, development of delivery system for protection of viable cells while passing through different stages of the human digestion system is key factor in application of probiotic products. In our study, the effects of several polysaccharides such as alginate, κ-carrageenan, locust bean gum, gellan gum, xanthan gum and their combination with various prebiotic components (resistant starch, lactulose, lactosucrose) on encapsulation of probiotic Lactobacillus casei 01 strain were studied. Both regular and unregular beads with size distributions from 2 mm up to 5 mm were obtained. The encapsulation efficiencies varied from 64.4% up to 79%. Based on the texture's profiles, the capsules can be grouped into 5 clusters with squared Euclidean distance 3.5. Meanwhile, the starch-alginate and the lactosucrose LS55L - alginate beads were found to be the most stable and to have massive textural properties, whereas the gellan gum - xanthan gum and the chitosan coated alginate beads emerged as the softest. Encapsulation significantly improved the degree of gastric tolerance of probiotic cells even in the presence of pepsin. The INFOGEST in vitro digestion protocol was adapted to investigate the protection effects of different capsules. The highest survival (with loss rate of lower than 1 log CFU/g) was observed in the case of the cells encapsulated in starch-alginate beads. Moreover, the alginate microcapsules combined with lactosucrose LS55L also provided very promising shield for probiotics from the low pH of gastric conditions. Our findings suggest that incorporation of prebiotics into alginate-base encapsulation would be good idea in development of micro delivery systems that helps the survival of probiotics and their delivery to the target sites of action in human body.

Effect of xylo-oligosaccharides (XOS) addition on technological and sensory attributes of cookies.

Xylo-oligosaccharides (XOS) are nondigestible oligosaccharides (NDO) which are recently authorized as novel food ingredients in European Union. Present study introduces the effect of XOS on baking quality of cookies. Color measurements proved that XOS enhance the caramelization during baking. Texture profile, geometry, and baking loss of cookies showed little changes due to XOS addition indicating that XOS are easy to incorporate into baking products. Based on sensory evaluation by expert panel, it was observed that XOS increased the "baked character" of the cookies as indicated by the increased caramel flavor, darker color, and crispier texture. XOS addition also increased the sweet taste and global taste intensity of cookies suggesting that in bakery products XOS evolve a flavor enhancer role. XOS proved to be a promising new alternative to increase dietary fiber content of cereal-based cookies.

Xylo-oligosaccharides as texture modifier compounds in aqueous media and in combination with food thickeners.

Present study introduces the previously not-described rheological properties of a nondigestible oligosaccharide: xylo-oligosaccharide which is a novel food ingredient in Europe. Significant differences were observed among viscosity of solutions of different formulas (liquid or powder) of XOS. Thickening potential of XOS in aqueous media compared to that of sucrose (Suc) or fructo-oligosaccharides strongly depends on utilization level: At low concentration, XOS proved to be weaker while at high concentration to be stronger than fructo-oligosaccharides. Differences in viscosity of XOS, FOS, and sucrose were much higher at below 60°C than at higher temperatures. Storage and loss modulii of xanthan gum gels were not influenced while those of locust bean gum were affected negatively by XOS addition. Addition of XOS at low concentrations did not decrease gelatin gel strength but increased gelatin gel stability against mechanical stress. XOS proved to have different rheological behavior from previously used oligosaccharides.

Oncological Screening of Kidney Transplant Patients: The Role of Ultrasound Examination.

INTRODUCTION: Immunosuppressive therapy used after organ transplantation represents a considerable oncological risk. Abdominal ultrasound examinations play an essential role in the oncological screening of organ transplant patients. Our aim was to study the effectiveness of the ultrasound screening protocol currently used in our clinic. METHODS: Reports of screening abdominal ultrasound examinations of kidney transplant recipients were processed at the Department of Transplantation and Surgery of Semmelweis University from January 2012 to December 2015. RESULTS: In 1478 studies, 14 patients were diagnosed with a malignant tumor, 11 of which were formed in the native shrunken kidney. The mean age for tumor diagnosis was 55.6 ± 12.6 years, and 80% of the patients diagnosed with tumor were male. On average, 7.5 ± 4.6 years passed between the transplantation and recognition of the tumor. All of the kidney tumors were diagnosed at an early stage: histologic examination of removed kidneys showed 73% pT1a- and 17% pT1b-stage tumors. CONCLUSION: In our study, early stage shrunken kidney cancers were outstandingly the most common post-transplant malignancies found by ultrasound screening. Annual ultrasound examinations as part of our current screening protocol allowed the detection of tumors at an early stage in kidney transplant recipients.

Automatic detection and characterization of funnel chest based on spiral CT.

Funnel chest (Pectus excavatum) is the most common deformity of the anterior chest in children. Present paper describes a method to process and classify CT slices representing funnel chest deformities. A manually chosen CT slice was processed to detect the inner curvature of the chest for characterization. Normalized data from the detected inner curvature was gained and saved next to a manually-given deformity type for further classification rule determinations. Based on the multiple correlations of the values gained from the inner curvature, a hierarchical classification was performed on 199 patient data. Results have shown that the calculated values gained from the inner curvature can accurately characterize the deformity type of the chest. Since minimal user interaction was necessary to detect and characterize the inner curvature, our method is considered to be an effective automated procedure for funnel chest deformity classifications.