Assessing Psychological Disorders in Turkish Adolescents with Transfusion-Dependent Thalassemia.

We investigated depression and anxiety levels and related psychological disorders in adolescents with transfusion-dependent thalassemia (TDT) in this study. The study was conducted in two pediatric hematology outpatient clinics and included adolescents with TDT (14.8 ± 2.4 years, n = 40) in the study and compared them with the healthy age-matched control group (14.3 ± 2.3 years, n = 62). The Turkish version of the Revised Child Anxiety and Depression Scale (RCADS) was used to determine depression, anxiety, and related psychologic disorders (obsession, panic disorder, social phobia). Depression, anxiety, obsession, panic disorder, and social phobia scores were significantly higher in the patient group compared with the control (all p < 0.05). Ferritin levels were positively correlated with total depression, general anxiety, separation anxiety, and social phobia scores, but transfusion frequency and young age were the confounding factors. Patients in early adolescence and those who require more frequent blood transfusions are at higher risk of developing psychological disorders; routine screening for mood disorders should be warranted. Serum ferritin level may be a good warning indicator for early recognition of psychologic disorders in TDT patients.

Closing the Fibre Gap-The Impact of Combination of Soluble and Insoluble Dietary Fibre on Bread Quality and Health Benefits.

Dietary fibre (DF) is important for overall health and disease prevention. However, the intake of DF in Westernised countries is below the recommended level, largely due to the excessive consumption of low-fibre foods. Fortifying staple foods, such as bread, with dietary fibre ingredients is one approach to closing the fibre gap in our diet. However, incorporating purified and chemically modified fibre ingredients into food is challenging. This study unveils interactions between soluble-fermentable (arabinoxylan), insoluble-fermentable (resistant starch type IV) and insoluble-unfermentable (cellulose) fibre ingredients and their impact on bread quality using Response Surface Methodology. This resulted in an optimised mixture of these fibre ingredients that can coexist within a bread matrix while maintaining quality characteristics comparable to white wheat bread. The partial replacement of flour with fibre ingredients led to an interference with the gluten network causing a reduction in gluten strength by 12.4% and prolonged gluten network development time by 24.4% compared to the control (no fibre addition). However, the CO2 retention coefficient during dough fermentation was not affected by fibre ingredient inclusion. The fibre content of the white bread was increased by 128%, with only a marginal negative impact on bread quality. Additionally, the fibre-fortified bread showed a lower release of reducing sugars during in vitro starch digestion. This study illustrates the synergy of different types of fibre ingredients in a bread system to advance in closing the fibre gap.

Body image and social appearance anxiety in patients with cancer undergoing radiotherapy: Across-sectional study.

BACKGROUND: The body image of patients with cancer can be negatively affected due to treatment toxicities. Changes in body image may cause patients to experience social appearance anxiety. This study aimed to evaluate the body image and social appearance anxiety of patients with cancer undergoing radiotherapy. METHODS: The cross-sectional study was conducted with 153 patients with cancer undergoing radiotherapy in a university hospital. The data were collected with a Patient Information Form, the Body Image Scale, and the Social Appearance Anxiety Scale and the Radiation Therapy Oncology Group Skin Toxicity Criteria. RESULTS: Patients' mean body image score was 15.18 ± 8.26 (min = 0, max = 30), mean social appearance anxiety score was 45.29 ± 14.50 (min = 16, max = 80). Patients with low education levels and low-income levels had higher body image and social appearance anxiety scores (p < 0.01). Body image and social appearance anxiety scores were found to be higher in patients with advanced cancer, grade III-IV skin toxicity, pain, fatigue, and constipation (p < 0.05). CONCLUSIONS: Radiotherapy may negatively affect body image and social appearance anxiety. Assessments of body image and social appearance anxiety regularly before, during, and after treatment are essential. Psychosocial support should be provided to patients to reduce body image and social appearance anxiety and increase their well-being. Patients with cancer especially those who have low income and education levels, advanced cancer stage and skin toxicity, and suffer from pain, fatigue, constipation, etc. should be supported by methods such as counseling and social support groups.

Infant milk formula, produced by membrane filtration, promotes mucus production in the upper small intestine of young pigs.

Human breast milk promotes maturation of the infant gastrointestinal barrier, including the promotion of mucus production. In the quest to produce next generation infant milk formula (IMF), we have produced IMF by membrane filtration (MEM-IMF). With a higher quantity of native whey protein, MEM-IMF more closely mimics human breast milk than IMF produced using conventional heat treatment (HT-IMF). After a 4-week dietary intervention in young pigs, animals fed a MEM-IMF diet had a higher number of goblet cells, acidic mucus and mucin-2 in the jejunum compared to pigs fed HT-IMF (P < 0.05). In the duodenum, MEM-IMF fed pigs had increased trypsin activity in the gut lumen, increased mRNA transcript levels of claudin 1 in the mucosal scrapings and increased lactase activity in brush border membrane vesicles than those pigs fed HT-IMF (P < 0.05). In conclusion, MEM-IMF is superior to HT-IMF in the promotion of mucus production in the young gut.

Association of problems, coping styles, and preferred online activity with depression, anxiety, and other psychological disorders in Turkish adolescents diagnosed with chronic kidney disease.

BACKGROUND: To assess depression, anxiety, and other psychological disorders in adolescents with chronic kidney disease (CKD) and determine the significant factors and the effect of digital media use on its scores among these patient groups. METHODS: The study was conducted as a cross-sectional study and included 84 adolescents with CKD and 68 healthy controls. The participants completed the Revised Child Anxiety and Depression Scale (RCADS). We recorded their age, gender, the most problematic issue in their lives, coping methods with problems, and online applications they prefer in their leisure time. RESULTS: Elevated rates (scores > 70) of separation anxiety, panic disorder, obsession, depression, total anxiety, and total depression scales were statistically higher in the CKD group. Separation anxiety, panic disorder, obsession, total anxiety, and total depression scales were higher in girls, and panic disorder, obsession, depression, total anxiety, and total depression scores were higher in younger ages in multivariate analysis. In the CKD group, family issues/problems increased panic disorder, obsession, depression, total anxiety, and total depression scales. Crying in tears/yelling response in children while facing a problem was associated with increased separation anxiety and social phobia rates. Also, preferring video applications was associated with separation anxiety and messaging applications with depression, total anxiety, and total depression. CONCLUSIONS: Adolescents with CKD are at risk for depression, anxiety, obsession, and panic disorders. Also, crying in tears/yelling response may be at greater risk for anxiety among CKD adolescents. Early psychiatric evaluation and routine psychiatric follow-ups initiated early may improve the mental health of this vulnerable population.

Commercial Egg Replacers in Pound Cake Systems: A Comprehensive Analysis of Market Trends and Application.

Replacing eggs without influencing pound cakes' texture, appearance, and taste is challenging. Ovalbumin, the major protein in egg white, contributes to the structures of cakes by providing SH Groups that form a firm gel during baking. However, there is a shift in the consumers' behaviour regarding health, well-being, animal welfare standards, and environmental concerns. To meet upcoming trends and consumer needs, 102 egg replacement products were launched globally to the best of the authors' knowledge, with 20 of them advertised as suitable for baking applications. Ten locally available commercial egg replacers with a range of protein contents were chosen and applied in a pound cake model system to evaluate their functionality by evaluating cake and cake batter quality. Three different categories of egg replacements were chosen: replacers containing no protein (R1-R3), a low amount of protein (1-10 g/100 g; R4-R5), and a high amount of protein (>10 g/100 g; R6-R10). Those were compared to three control cakes containing powdered whole egg, fresh egg, and liquid whole egg. All the analysed egg replacers significantly differed from the control cakes, including low-protein egg replacement R4. Despite R4 achieving the highest specific volume (1.63 ± 0.07 mL/g) and comparable texture values, none of the examined egg replacers compared favourably with the egg control cakes regarding appearance, physical and textural properties, and nutritional value.

Effect of fibre fortification of low FODMAP pasta.

Irritable bowel syndrome (IBS) is a condition affecting the digestive system and can be triggered by several different factors, including diet. To ease symptoms of IBS, a diet low in fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) is often recommended. Pasta, as a staple food in the Western World, is naturally high in FODMAPs. This study investigates the impact of insoluble and soluble dietary fibre ingredients in low-FODMAPs pasta. The assessment included physicochemical, sensory, and nutritional quality. Soluble fibre strengthened gluten network, which caused a lower cooking loss and a lower release of sugars during in vitro starch digestion. Insoluble fibre interfered with the gluten network development to a higher extent causing a higher sugar release during digestion. This study reveals the most suitable fibre ingredients for the development of pasta with elevated nutritional value and sensory characteristics compared to commercial products on the market. This type of pasta has a high potential of being suitable for IBS patients.

Impact of different fibre ingredients on a low-FODMAP biscuit model system.

Fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) are carbohydrates which can cause symptoms of irritable bowel syndrome (IBS). Cereal-based products are high in FODMAPs, as they are part of the carbohydrate fraction in flour. Low-FODMAP products are starch-based which leads to a low dietary fibre content. Hence, the fortification with dietary fibre ingredients low in FODMAPs is essential. This study reveals the impact of three different fibre ingredients, resistant starch, cellulose, and arabinoxylan, and their interactions with each other in a low-FODMAP biscuit model system using response surface methodology. All fibre ingredients have an affinity to water which was further increased by their coexistence in the model system. Fibersym RW affected the biscuit hardness by its morphology and potential to recrystallise leading to a maximum inclusion level of 40%. VITACEL L 600-30 also increased biscuit hardness due to its plasticising character leading to a maximum inclusion of 20%. AgriFiber BFG mainly impacted the colour of the product restricting its inclusion to 2.3%. Additionally, it reduced the degree of starch digestibility of the biscuit by the formation of a film imbedding the starch granules and reducing enzyme attack. This research provides an in-depth insight into the integration potential of these fibre ingredients into a low-FODMAP biscuit, their interactions within the system and inclusion levels which allow their coexistence.

Brewers' Spent Grain: An Unprecedented Opportunity to Develop Sustainable Plant-Based Nutrition Ingredients Addressing Global Malnutrition Challenges.

There is an urgent requirement to minimize food waste and create more sustainable food systems that address global increases in malnutrition and hunger. The nutritional value of brewers' spent grain (BSG) makes it attractive for upcycling into value-added ingredients rich in protein and fiber having a lower environmental impact than comparable plant-based ingredients. BSG is predictably available in large quantities globally and can therefore play a role in addressing hunger in the developing world via the fortification of humanitarian food aid products. Moreover, addition of BSG-derived ingredients can improve the nutritional profile of foods commonly consumed in more developed regions, which may aid in reducing the prevalence of dietary-related disease and mortality. Challenges facing the widespread utilization of upcycled BSG ingredients include regulatory status, variability of raw material composition, and consumer perception as low-value waste products; however, the rapidly growing upcycled food market suggests increasing consumer acceptability and opportunities for significant market growth via effective new product innovation and communication strategies.

A Prospective Study of Nurse-Led Oral Mucositis Management: Impact on Health Outcomes of Patients Receiving Radiotherapy for Head and Neck Cancer and Lung Cancer.

OBJECTIVES: The study aimed to evaluate the impact of nurse-led mucositis management on the health outcomes of patients receiving radiotherapy for head and neck cancer and lung cancer. The study adopted a holistic approach that involved the patient in the care process by screening, providing education and counseling about mucositis management and integrating it into daily life by the radiotherapy nurse. DATA SOURCES: In this prospective, longitudinal cohort study, 27 patients were assessed and monitored through use of the WHO Oral Toxicity Scale and Oral Mucositis Follow-up Form and educated on mucositis during their radiotherapy through use of the Mucositis Prevention and Care Guide. At the end of radiotherapy, an evaluation of the radiotherapy process was performed. In this study, each patient was followed for 6 weeks from the start of radiotherapy. CONCLUSION: The worst clinical data for oral mucositis and its variables emerged at week 6 of treatment. While the Nutrition Risk Screening score increased over time, weight decreased was observed to decrease. The mean stress level was 4.74 ± 0.33 in the first week and 5.77 ± 0.35 in the last week. It was observed that 88.9% of the patients showed good compliance with the treatment. IMPLICATIONS FOR NURSING PRACTICE: Nurse-led mucositis management contributes to better patient outcomes during the radiotherapy process. Such an approach improves oral care management in patients receiving radiotherapy for head and neck and lung cancer, demonstrating its positive impact on additional patient-focused outcomes.

From Waste to Taste: Application of Fermented Spent Rootlet Ingredients in a Bread System.

The process of upcycling and incorporating food by-products into food systems as functional ingredients has become a central focus of research. Barley rootlets (BR) are a by-product of the malting and brewing industries that can be valorised using lactic acid bacteria fermentation. This research investigates the effects of the inclusion of unfermented (BR-UnF), heat-sterilised (BR-Ster), and five fermented BR ingredients (using Weissella cibaria MG1 (BR-MG1), Leuconostoc citreum TR116 (BR-TR116), Lactiplantibacillus plantarum FST1.7 (BR-FST1.7), Lactobacillus amylovorus FST2.11 (BR-FST2.11), and Limosilactobacillus reuteri R29 (BR-R29) in bread. The antifungal compounds in BR ingredients and the impact of BR on dough rheology, gluten development, and dough mixing properties were analysed. Additionally, their effects on the techno-functional characteristics, in vitro starch digestibility, and sensory quality of bread were determined. BR-UnF showed dough viscoelastic properties and bread quality comparable to the baker's flour (BF). BR-MG1 inclusion ameliorated bread specific volume and reduced crumb hardness. Breads containing BR-TR116 had comparable bread quality to BF, while the inclusion of BR-R29 substantially slowed microbial spoilage. Formulations containing BR-FST2.11 and BR-FST1.7 significantly reduced the amounts of sugar released from breads during a simulated digestion and resulted in a sourdough-like flavour profile. This study highlights how BR fermentation can be tailored to achieve desired bread characteristics.

Associating Compositional, Nutritional and Techno-Functional Characteristics of Faba Bean (Vicia faba L.) Protein Isolates and Their Production Side-Streams with Potential Food Applications.

Faba beans (Vicia faba L.) show exciting prospects as a sustainable source of protein and fibre, with the potential to transition to a more sustainable food production. This study reveals the compositional, nutritional and techno-functional characteristics of two protein isolates from faba beans (Vicia faba L.), a high-starch fraction and a high-fibre side-stream. During the analysis of those four ingredients, particular attention was paid to the isolates' protein profile and the side-streams' carbohydrate composition. The isoelectric precipitated protein isolate 1 showed a protein content of 72.64 ± 0.31% DM. It exhibited low solubility but superior digestibility and high foam stability. High foaming capacity and low protein digestibility were observed for protein isolate 2, with a protein content of 71.37 ± 0.93% DM. This fraction was highly soluble and consisted primarily of low molecular weight proteins. The high-starch fraction contained 83.87 ± 3.07% DM starch, of which about 66% was resistant starch. Over 65% of the high-fibre fraction was insoluble dietary fibre. The findings of this study provide a detailed understanding of different production fractions of faba beans, which is of great value for future product development.

Quantitative evaluation of hepatic steatosis using attenuation imaging in a pediatric population: a prospective study.

BACKGROUND: Obesity and fatty-liver disease are increasingly common in children. Hepatic steatosis is becoming the most common cause of chronic liver disease during childhood. There is a need for noninvasive imaging methods that are easily accessible, safe and do not require sedation in the diagnosis and follow-up of the disease. OBJECTIVE: In this study, the diagnostic role of ultrasound attenuation imaging (ATI) in the detection and staging of fatty liver in the pediatric age group was investigated using the magnetic resonance imaging (MRI)-proton density fat fraction as the reference. MATERIALS AND METHODS: A total of 140 children with both ATI and MRI constituted the study group. Fatty liver was classified as mild (S1, defined as ≥ 5% steatosis), moderate (S2, defined as ≥ 10% steatosis), or severe (S3, defined as ≥ 20% steatosis) according to MRI-proton density fat fraction values. MRI studies were performed on the same 1.5-tesla (T) MR device without sedation and contrast agent. Ultrasound examinations were performed independently by two radiology residents blinded to the MRI data. RESULTS: While no steatosis was detected in half of the cases, S1 steatosis was found in 31 patients (22.1%), S2 in 29 patients (20.7%) and S3 in 10 patients (7.1%). A strong correlation was found between attenuation coefficient and MRI-proton density fat fraction values (r = 0.88, 95% CI 0.84-0.92; P < 0.001). The area under the receiver operating characteristic curve values of ATI were calculated as 0.944 for S > 0, 0.976 for S > 1 and 0.970 for S > 2, based on 0.65, 0.74 and 0.91 dB/cm/MHz cut-off values, respectively. The intraclass correlation coefficient values for the inter-observer agreement and test-retest reproducibility were calculated as 0.90 and 0.91, respectively. CONCLUSION: Ultrasound attenuation imaging is a promising noninvasive method for the quantitative evaluation of fatty liver disease.

Functional Properties of Brewer's Spent Grain Protein Isolate: The Missing Piece in the Plant Protein Portfolio.

Plant protein sources, as a part of developing sustainable food systems, are currently of interest globally. Brewer's spent grain (BSG) is the most plentiful by-product of the brewing industry, representing ~85% of the total side streams produced. Although nutritionally dense, there are very few methods of upcycling these materials. High in protein, BSG can serve as an ideal raw material for protein isolate production. This study details the nutritional and functional characteristics of BSG protein isolate, EverPro, and compares these with the technological performance of the current gold standard plant protein isolates, pea and soy. The compositional characteristics are determined, including amino acid analysis, protein solubility, and protein profile among others. Related physical properties are determined, including foaming characteristics, emulsifying properties, zeta potential, surface hydrophobicity, and rheological properties. Regarding nutrition, EverPro meets or exceeds the requirement of each essential amino acid per g protein, with the exception of lysine, while pea and soy are deficient in methionine and cysteine. EverPro has a similar protein content to the pea and soy isolates, but far exceeds them in terms of protein solubility, with a protein solubility of ~100% compared to 22% and 52% for pea and soy isolates, respectively. This increased solubility, in turn, affects other functional properties; EverPro displays the highest foaming capacity and exhibits low sedimentation activity, while also possessing minimal gelation properties and low emulsion stabilising activity when compared to pea and soy isolates. This study outlines the functional and nutritional properties of EverPro, a brewer's spent grain protein, in comparison to commercial plant protein isolates, indicating the potential for the inclusion of new, sustainable plant-based protein sources in human nutrition, in particular dairy alternative applications.

Co-fermentation of non-Saccharomyces yeasts with Lactiplantibacillus plantarum FST 1.7 for the production of non-alcoholic beer.

The non-alcoholic beer (NAB) sector has experienced steady growth in recent years, with breweries continuously seeking new ways to fulfil consumer demands. NAB can be produced by limited fermentation of non-Saccharomyces yeasts; however, beer produced in this manner is often critiqued for its sweet taste and wort-like off-flavours due to high levels of residual sugars and lack of flavour metabolites. The use of Lactobacillus in limited co-fermentation with non-Saccharomyces yeasts is a novel approach to produce NABs with varying flavour and aroma characteristics. In this study, lab-scale fermentations of Lachancea fermentati KBI 12.1 and Cyberlindnera subsufficiens C6.1 with Lactiplantibacillus plantarum FST 1.7 were performed and compared to a brewer's yeast, Saccharomyces cerevisiae WLP001. Fermentations were monitored for pH, TTA, extract reduction, alcohol production, and microbial cell count. The final beers were analysed for sugar and organic acid concentration, free amino nitrogen content (FAN), glycerol, and levels of volatile metabolites. The inability of the non-Saccharomyces yeasts to utilise maltotriose as an energy source resulted in extended fermentation times compared to S. cerevisiae WLP001. Co-fermentation of yeasts with lactic acid bacteria (LAB) resulted in a decreased pH, higher TTA and increased levels of lactic acid in the final beers. The overall acceptability of the NABs produced by co-fermentation was higher than or similar to that of the beers fermented with the yeasts alone, indicating that LAB fermentation did not negatively impact the sensory attributes of the beer. C. subsufficiens C6.1 and L. plantarum FST 1.7 NAB was characterised as fruity tasting with the significantly higher ester concentrations masking the wort-like flavours resulting from limited fermentation. NAB produced with L. fermentati KBI12.1 and L. plantarum FST1.7 had decreased levels of the undesirable volatile compound diacetyl and was described as 'fruity' and 'acidic', with the increased sourness masking the sweet, wort-like characteristics of the NAB. Moreover, this NAB was ranked as the most highly acceptable in the sensory evaluation. In conclusion, the limited co-fermentation of non-Saccharomyces yeasts with LAB is a promising strategy for the production of NAB.

Resistant Protein: Forms and Functions.

Several global health risks are related to our dietary lifestyle. As a consequence of the overconsumption of ultra-processed and highly digestible protein (150-200% of the recommended value), excess dietary proteins reach the colon, are hydrolysed to peptides and amino acids by bacterial proteases and fermented to various potentially toxic end products. A diet reformulation strategy with reduced protein content in food products appears to be the most effective approach. A potential approach to this challenge is to reduce food digestibility by introducing resistant protein into the diet that could positively influence human health and gut microbiome functionality. Resistant protein is a dietary constituent not hydrolysed by digestive enzymes or absorbed in the human small intestine. The chemical conformation and the amino acid composition strictly influence its structural stability and resistance to in vivo proteolysis and denaturation. Responding to the important gap in our knowledge regarding the digestibility performance of alternative proteins, we hypothesise that resistant proteins can beneficially alter food functionality via their role in improving metabolic properties and health benefits in human nutrition, similar to fibres and resistant starches. A multidisciplinary investigation of resistant protein will generate tremendous scientific impact for other interlinked societal, economic, technological and health and wellbeing aspects of human life.

Lentil-Based Yogurt Alternatives Fermented with Multifunctional Strains of Lactic Acid Bacteria-Techno-Functional, Microbiological, and Sensory Characteristics.

A milk-alternative produced from lentil protein isolate was fermented with three multifunctional strains of lactic acid bacteria, Leuconostoc citreum TR116, Leuconostoc pseudomesenteroides MP070, and Lacticaseibacillus paracasei FST 6.1. As a control, a commercial starter culture containing Streptococcus thermophilus was used. The metabolic performance of these strains and the techno-functional properties of the resulting yogurt alternatives (YA) were studied. Microbial growth was evaluated by cell counts, acidification, and carbohydrate metabolization. The structure of the YA was investigated by textural and rheological analyses and confocal laser scanning microscopy (CLSM). Production of antifungal compounds, the influence of fermentation on the content of FODMAPs, and typical metabolites were analyzed, and a sensory analysis was performed. The results revealed an exponential microbial growth in the lentil base substrate supported by typical acidification, which indicates a suitable environment for the selected strains. The resulting YA showed a gel-like texture typical for non-stirred yogurts, and high water holding capacity. The tested strains produced much higher levels of antifungal phenolic compounds than the commercial control and are therefore promising candidates as adjunct cultures for shelf-life extension. The Leuconostoc strains produced mannitol from fructose and could thus be applied in sugar-reduced YA. Preliminary sensory analysis showed high acceptance for YA produced with Lacticaseibacillus paracasei FST 6.1, and a yogurt-like flavor not statistically different to that produced by the control. Overall, each tested strain possessed promising functionalities with great potential for application in fermented plant-based dairy-alternatives.