Adansonia digitata L. (Baobab) Bioactive Compounds, Biological Activities, and the Potential Effect on Glycemia: A Narrative Review.

Adansonia digitata L. fruit, also known as baobab, has been used traditionally throughout the world for its medicinal properties. Ethnopharmacological uses of various plant parts have been reported for hydration, antipyretic, antiparasitic, antitussive, and sudorific properties and also in the treatment of diarrhea and dysentery in many African countries. Several studies have revealed that in addition to these applications, baobab has antioxidant, anti-inflammatory, analgesic, and antimicrobial activities. The health benefits of baobab have been attributed to its bioactive compounds, namely phenols, flavonoids, proanthocyanins, tannins, catechins, and carotenoids. Baobab fruit is also an important source of vitamin C and micronutrients, including zinc, potassium, magnesium, iron, calcium, and protein, which may reduce nutritional deficiencies. Despite scientific studies revealing that this fruit has a wide diversity of bioactive compounds with beneficial effects on health, there is a gap in the review of information about their mechanisms of action and critical analysis of clinical trials exploring, in particular, their effect on glycemia regulation. This work aims to present a current overview of the bioactive compounds, biological activities, and effects of A. digitata fruit on blood glucose, highlighting their potential mechanisms of action and effects on glycemia regulation, evaluated in recent animal and human trials.

The Effect of Ginger (Zingiber officinale Roscoe) Aqueous Extract on Postprandial Glycemia in Nondiabetic Adults: A Randomized Controlled Trial.

Ginger has shown beneficial effects on blood glucose control due to its antioxidant and anti-inflammatory properties. The present study investigated the effect of ginger aqueous extract on postprandial glucose levels in nondiabetic adults and characterized its antioxidant activity. Twenty-four nondiabetic participants were randomly assigned into two groups (NCT05152745), the intervention group (n = 12) and the control group (n = 12). Both groups were administered 200 mL of an oral glucose tolerance test (OGTT), after which participants in the intervention group ingested 100 mL of ginger extract (0.2 g/100 mL). Postprandial blood glucose was measured while fasting and after 30, 60, 90, and 120 min. The total phenolic content, flavonoid content, and antioxidant activity of ginger extract were quantified. In the intervention group, the incremental area under the curve for glucose levels decreased significantly (p < 0.001) and the maximum glucose concentration significantly reduced (p < 0.001). The extract possessed a polyphenolic content of 13.85 mg gallic acid equivalent/L, a flavonoid content of 3.35 mg quercetin equivalent/L, and a high superoxide radical inhibitory capacity (45.73%). This study showed that ginger has a beneficial effect on glucose homeostasis under acute conditions and encourages the use of ginger extract as a promising source of natural antioxidants.

An anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols diet improved patient reported outcomes in fibromyalgia: A randomized controlled trial.

Background: Fibromyalgia (FM) has been associated with dysbiosis and low-grade inflammation. Studies have reported that diet influences clinical features in FM. Objective: To evaluate the effect of an anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols (FODMAP) diet on clinical outcomes of patients with FM. Methods: This two arms Randomized Controlled Trial (NCT04007705) included 46 female patients with FM. The intervention group (n = 22) adopted an anti-inflammatory diet for 3 months, excluding gluten, dairy, added sugar, and ultra-processed foods, along with a low FODMAPs diet in the first month. The control group (n = 24) followed general healthy eating recommendations. Both diets were applied by a certified dietitian. Before and after the intervention, participants were assessed regarding pain, fatigue, gastrointestinal symptoms, quality of sleep, and quality of life, through the Revised Fibromyalgia Impact Questionnaire (FIQR), Visual Analogue Pain Scale (VAS), Visual Analog Scale from gastrointestinal symptoms (VAS GI), Brief Pain Inventory (BPI), Pittsburg Sleep Quality Index (PSQI), Fatigue Severity Survey (FSS), and The Short Form Health Survey (SF-36). A blood sample was collected and high-sensitive C-Reactive Protein and Erythrocyte Sedimentation Rate were quantified. Paired Samples t-test/Wilcoxon and independent samples t-test/Mann-Whitney were used to compare variables between groups. Results: After intervention, there was an improvement in intervention group scores of FIQR (p = 0.001), VAS (p = 0.002), BPI (p = 0.011), FSS (p = 0.042), VAS_GI (p = 0.002), PSQI (p = 0.048), and SF36 (p = 0.045) compared to control group. Inflammatory biomarkers (hs-CRP, ESR) did not change in both groups. The intervention was beneficial in the intervention group, regardless of age, disease duration, body mass index variation, and body fat change between baseline and post-intervention. Conclusion: An anti-inflammatory and low-FODMAP diet improved clinical features in patients with FM and may be useful as a complement to pharmacological therapy. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT04007705], identifier [NCT04007705].

Cinnamon as a Complementary Therapeutic Approach for Dysglycemia and Dyslipidemia Control in Type 2 Diabetes Mellitus and Its Molecular Mechanism of Action: A Review.

The scientific evidence that cinnamon may exert beneficial effects on type 2 diabetes mellitus due to the biological activity of its bioactive compounds has been increasing in recent years. This review provides an overview of the effects of cinnamon on clinical parameters of diabetes and summarizes the molecular mechanisms of action of cinnamon on glucose and lipid metabolism. Search criteria include an electronic search using PubMed, Medline, and Cochrane Library databases. English literature references from 2000 up to 2022 were included. Following title and abstract review, full articles that met the inclusion criteria were included. The results from the available evidence revealed that cinnamon improved glycemic and lipidemic indicators. Clinical trials clarified that cinnamon also possesses an anti-inflammatory effect, which may act beneficially in diabetes. Based on in vitro and in vivo studies, cinnamon seems to elicit the regulation of glucose metabolism in tissues by insulin-mimetic effect and enzyme activity improvement. Furthermore, cinnamon seems to decrease cholesterol and fatty acid absorption in the gut. The current literature search showed a considerable number of studies on diabetic subjects. Some limitations in comparing published data should be highlighted, including variability in doses, extracts and species of cinnamon, administration forms, and antidiabetic therapy.

Effect of Aqueous Cinnamon Extract on the Postprandial Glycemia Levels in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial.

Cinnamon is a spice used in traditional cuisine that has been investigated due to hypoglycemic properties. The objective of this study was to investigate the effect of aqueous cinnamon extract on postprandial glycemia levels in type 2 diabetes mellitus (DM2) adults. This clinical trial enrolled 36 adults with DM2, randomly allocated in two groups: the control group (n = 18) took only an oral glucose tolerance test (OGTT) and the intervention group (n = 18) took OGTT immediately followed by aqueous cinnamon extract (6 g/100 mL) ingestion. Blood glucose levels were measured on fasting and after 30, 60, 90 and 120 min in both groups. The chemical analysis of the aqueous cinnamon extract included total phenols content determination and antioxidant activity assessment through FRAP and DPPH methods. The data reveal that aqueous cinnamon extract ingestion did not show a significant difference in the incremental area under the curve (p = 0.834), maximum glucose concentration (p = 0.527) and glucose concentration variation (p = 0.873) compared with the control group. Cinnamon extract possess a total phenol content of 1554.9 mg/L gallic acid equivalent and a strong antioxidant capacity, revealed by the DPPH (5125.0 µmol Trolox/L) and FRAP (3658.8 µmol Trolox/L) tests. Aqueous cinnamon extract did not significantly influence postprandial glucose response in diabetic patients during an OGTT.

Adansonia digitata L. (Baobab Fruit) Effect on Postprandial Glycemia in Healthy Adults: A Randomized Controlled Trial.

Baobab fruits have been traditionally used in Africa due to their therapeutic properties attributed to their high polyphenol content. The aim of the study was to investigate the effect of baobab fruit on postprandial glycaemia in healthy adults and to measure its bioactive compounds and antioxidant activity. The study (NCT05140629) was conducted on 31 healthy subjects. The participants were randomly allocated in the control group (oral glucose tolerance test (OGTT); n = 16) and in the intervention group (OGTT, followed by administration of 250 mL baobab aqueous extract (BAE); n = 15). Total phenols, proanthocyanins, hydrolyzable tannins, and antioxidant activity (FRAP, DPPH, ABTS, and inhibition of O2•- and NO• methods) were quantified. Repeated measures ANOVA of mixed type and independent samples t-test were used. Glycemia incremental area under the curve (p = 0.012) and glucose maximum concentration (p = 0.029) was significantly lower in the intervention group compared to the control group. The BAE revealed high total contents of phenols, proanthocyanins, and hydrolyzable tannins, as well as a strong capacity to scavenge superoxide anions and nitric oxide radicals and a high antioxidant activity. In conclusion, this study encourages the use of this food component as a promising source of natural antioxidants and a hypoglycemic agent under glucose load acute conditions.

A study protocol for a randomized controlled trial of an anti-inflammatory nutritional intervention in patients with fibromyalgia.

BACKGROUND: This study aims to analyze the effects of a potentially anti-inflammatory nutritional intervention in disease assessment parameters, inflammatory markers, and quality of life of fibromyalgia (FM) patients. METHODS: A sample of 100 female patients diagnosed with FM, followed up at Portuguese Institute of Rheumatology (IPR) in Lisbon, is being randomly allocated in two groups. Patients in the intervention group are adopting an anti-inflammatory diet, characterized by the exemption of the intake of foods containing gluten, dairy, sugar, and ultra-processed foods, during 3 months. During the first month, a low fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) diet is implemented, along with the anti-inflammatory diet, followed by the reintroduction of all fruits and vegetables over a consecutive period of 2 months. Patients in the control group are adopting a diet based on general recommendations for healthy eating. The outcomes are pain, fatigue, quality of sleep, quality of life, gastrointestinal symptoms, and inflammation. Before and after the 3 months intervention, and also 1 month after beginning the intervention, the following questionnaires are applied: Revised Fibromyalgia Impact Questionnaire, visual analog pain scale, Brief Pain Inventory,visual analog scale from a list of common gastrointestinal and extraintestinal symptoms in FM, Short Form 36, Fatigue Severity Survey, and Pittsburg Sleep Quality Index. Ultra-sensitive serum C-reactive protein, eritrocyte sedimentation rate, and interleukin-8 are determined. Age, physical activity, anthropometric parameters, and body composition are being collected. Student's t test will assess the association between the disease evaluation parameters, the inflammatory markers, and the dietary interventions. DISCUSSION: The results of this study are expected to determine whether a change in patient nutrition helps to alleviate symptoms, which would optimize medical intervention. TRIAL REGISTRATION: www.ClinicalTrials.gov NCT04007705 . Registered on July 5, 2019.

Dietary interventions in fibromyalgia: a systematic review.

Fibromyalgia (FM) is a chronic non-degenerative disease, whose nutritional therapy seems controversial. This systematic review aimed to synthesize the knowledge about the effect of dietary interventions on patient-reported outcomes (PRO) and inflammation in patients with FM. Six electronic databases - PubMed, BioMed Central, Cochrane library, EMBASE, LILACS and ISI - were searched for clinical trials, in which a dietary intervention in patients with FM diagnosed was conducted. Quality of evidence assessment was measured in accordance with GRADE methodology. Seven clinical trials - 3 randomized controlled trials, 1 unrandomized clinical trial and 3 uncontrolled clinical trials were identified. Dietary approaches included gluten-free diet (n = 1), raw vegetarian diet (n = 2), low Fermentable oligo-, di- and monossacharides, alcohols and polyols (FODMAPs) diet (n = 1), hypocaloric diet (n = 2) and monosodium glutamate- and aspartame-free diet interventions (n = 1). The major PRO were pain and functional repercussion, with 5 out of 7 studies reporting an improvement. The progress in secondary outcomes was reported for fatigue (2/5 studies), sleep quality (2/3 studies), depression and anxiety (3/6 studies), quality of life (4/5 studies), gastrointestinal symptoms (1/2 studies) and inflammatory biomarkers (1/1 study). However, according to Cochrane Risk of Bias, these studies had poor statistical quality. Well-designed studies should be performed to investigate the dietary interventions effect on FM. Key messages Fibromyalgia (FM) is a chronic non-degenerative disease, whose nutritional therapy seems controversial but promising. Pain and functional repercussion in FM patients seem to improve with a hypocaloric diet, a raw vegetarian diet or a low FODMAPs diet, as much as quality of life, quality of sleep, anxiety and depression and inflammatory biomarkers. Existing studies in this subject are scarce and low quality, which does not allow conclusions to be drawn.

IL-6 and TNF-α salivary levels according to the periodontal status in Portuguese pregnant women.

BACKGROUND: Periodontitis is associated with increased concentration of inflammatory markers and saliva has been proposed as a non-invasive diagnostic fluid in oral and systemic diseases. The levels of salivary biomarkers, such as cytokines, could potentially be used to distinguish periodontal healthy individuals from subjects with periodontal disease. The purpose of this study was to characterize the salivary levels of two inflammatory biomarkers associated with periodontitis, interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α), in order to assess whether these cytokines salivary levels could potentially be used to complement periodontitis pregnant women diagnose. METHODS: Forty-four pregnant women were distributed into three groups, according to their periodontal status: healthy, mild/moderate periodontitis and severe periodontitis. Unstimulated saliva was collected and analysis of TNF-α and IL-6 salivary levels were performed with Immulite®. RESULTS: Women with periodontitis exhibited significantly higher levels (p = 0.001) of salivary IL-6 and TNF-α compared with the healthy group: 25.1 (±11.2) pg/mL vs. 16.3 (±5.0) pg/mL and 29.7 (±17.2) pg/mL vs. 16.2 (±7.6) pg/mL, approximately 1.5 and 1.8 times more, respectively. Additionally, cytokines were significantly increased (p < 0.05) in severe periodontitis compared to periodontal healthy pregnant women. CONCLUSIONS: These results revealed that IL-6 and TNF-α salivary biomarkers provide high discriminatory capacity for distinguishing periodontal disease from periodontal health in pregnant women.

Effect of Cinnamon Tea on Postprandial Glucose Concentration.

Glycaemic control, in particular at postprandial period, has a key role in prevention of different diseases, including diabetes and cardiovascular events. Previous studies suggest that postprandial high blood glucose levels (BGL) can lead to an oxidative stress status, which is associated with metabolic alterations. Cinnamon powder has demonstrated a beneficial effect on postprandial glucose homeostasis in animals and human models. The purpose of this study is to investigate the effect of cinnamon tea (C. burmannii) on postprandial capillary blood glucose level on nondiabetic adults. Participants were given oral glucose tolerance test either with or without cinnamon tea in a randomized clinical trial. The data revealed that cinnamon tea administration slightly decreased postprandial BGL. Cinnamon tea ingestion also results in a significantly lower postprandial maximum glucose concentration and variation of maximum glucose concentration (p < 0.05). Chemical analysis showed that cinnamon tea has a high antioxidant capacity, which may be due to its polyphenol content. The present study provides evidence that cinnamon tea, obtained from C. burmannii, could be beneficial for controlling glucose metabolism in nondiabetic adults during postprandial period.

Nutritional status assessment in colorectal cancer patients.

The present study intended to evaluate the nutritional status of Portuguese colorectal patients and associated it with surgery type as well as quality of life outcomes. Malnutrition can affect up to 85% of cancer patients and specifically 30-60% in colorectal cancer and can significantly influence health outcomes. A sample of 50 colorectal cancer patients was evaluated in what refers to several anthropometric measures, food intake, clinical history, complications rate before and after surgery procedure. The sample was divided between convention and fast-track procedures. Most of the individuals were overweight or obese but had lost weight on the past six months. Despite mild, there were signs of malnutrition in this sample with high losses of fat free mass, weight and also fat mass during the hospitalization period. These results reinforce the importance of malnutrition assessment in colorectal patients as well as consider weight loss on the past months and body composition in order to complement nutritional status evaluation.

El presente estudio pretende evaluar el estado nutricional de enfermos de cáncer colorectal portugueses teniendo en cuenta el tipo de cirugía y indicativos de calidad de vida. La malnutrición suele afectar hasta 85% de los enfermos de cáncer y 30-60% entre los de cáncer colorectal y puede afectar significativamente las mejorías de salud. Se ha completado una evaluación antropométrica de 50 individuos admitidos en un hospital portugués para cirugía incluido también ingestión alimentaria, historia clínica, complicaciones antes y después de la cirugía. La muestra ha sido dividida entre el procedimento quirúrgico convencional y el fast-track. La mayoría de los individuos era obesa ó tenía sobrepeso pero había perdido peso en los últimos 6 meses antes de entrar en el hospital. Aunque poco severas, tenían señales de malnutrición con grandes pérdidas de masa magra, peso y también grasa corporal durante el período en el hospital. Estés resultados han reenfocado la importancia de una evaluación nutrición en enfermos de cáncer, sobretodo colorectal teniendo en cuenta el peso perdido pero también la composición corporal para que se complete el protocolo de evaluación nutricional.

Nutritional status assessment in colorectal cancer patients / Estado nutricional de los pacientes de cáncer colorrectal

The present study intended to evaluate the nutritional status of Portuguese colorectal patients and associated it with surgery type as well as quality of life outcomes. Malnutrition can affect up to 85% of cancer patients and specifically 30-60% in colorectal cancer and can significantly influence health outcomes. A sample of 50 colorectal cancer patients was evaluated in what refers to several anthropometric measures, food intake, clinical history, complications rate before and after surgery procedure. The sample was divided between convention and fast-track procedures. Most of the individuals were overweight or obese but had lost weight on the past six months. Despite mild, there were signs of malnutrition in this sample with high losses of fat free mass, weight and also fat mass during the hospitalization period. These results reinforce the importance of malnutrition assessment in colorectal patients as well as consider weight loss on the past months and body composition in order to complement nutritional status evaluation (AU)

El presente estudio pretende evaluar el estado nutricional de enfermos de cáncer colorectal portugueses teniendo en cuenta el tipo de cirugía y indicativos de calidad de vida. La malnutrición suele afectar hasta 85% de los enfermos de cáncer y 30-60% entre los de cáncer colorectal y puede afectar significativamente las mejorías de salud. Se ha completado una evaluación antropométrica de 50 individuos admitidos en un hospital portugués para cirugía incluido también ingestión alimentaria, historia clínica, complicaciones antes y después de la cirugía. La muestra ha sido dividida entre el procedimento quirúrgico convencional y el fast-track. La mayoría de los individuos era obesa ó tenía sobrepeso pero había perdido peso en los últimos 6 meses antes de entrar en el hospital. Aunque poco severas, tenían señales de malnutrición con grandes pérdidas de masa magra, peso y también grasa corporal durante el período en el hospital. Estés resultados han reenfocado la importancia de una evaluación nutrición en enfermos de cáncer, sobretodo colorectal teniendo en cuenta el peso perdido pero también la composición corporal para que se complete el protocolo de evaluación nutricional (AU)

Incapacidade funcional dos idosos após fratura da extremidade superior do fémur / Functional disability in the elderly after fracture of the upper extremity of the femur Determinants of patient functional capacity after stroke

Introdução: O envelhecimento representa a passagem do tempo, não uma patologia, sendo um processo natural e fisiológico. No idoso, as fraturas da extremidade superior do fémur, representam um sério problema devido às elevadas incapacidades que causa e as suas consequências. Objetivo: Identificar a incapacidade funcional e em que medida as variáveis sociodemográficas, clínicas e funcionalidade familiar a influenciam. Metodologia: Foi realizado um estudo transversal, analítico e comparativo, empregando uma metodologia do tipo quantitativo, utilizando para o efeito uma amostra não probabilística por conveniência, constituída por 60 idosos do concelho de Viseu com fratura da extremidade superior do fémur há 6 meses. O instrumento de medida utilizado foi um questionário, a Escala de Apgar Familiar e Escala de Barthel Modificada. Resultados: A população estudada é maioritariamente feminina, com uma média de idades de 78,5 anos, casada, residente em meio rural. Têm como habilitações o 1º ciclo de estudos, sem apoio institucional e com baixos rendimentos. No final dos 6 meses após fratura da extremidade superior do fémur, verificamos que 40% dos doentes são independentes na capacidade funcional, 33,3% têm uma dependência elevada, 16,7% uma dependência moderada e apenas uma minoria apresenta um nível de dependência reduzida (5%) e muito elevada (5%). As variáveis que influenciaram significativamente a capacidade funcional são: idade, estado civil, habilitações literárias, apoio institucional, situação económica, tipo de cirurgia e a reabilitação. Conclusão: As variáveis que mais influenciam na capacidade funcional são: a idade, em que com o seu aumento diminui a capacidade funcional; o nº de sessões de reabilitação, pois quantas mais sessões de reabilitação realizarem mais aumenta a sua capacidade funcional.

Introduction: Aging is the passage of time, not a disease, being a natural and physiological process. In the elderly, fractures of the upper end of the femur, is a serious problem due to the high disability that causes and its consequences. Objective: Identify the functional disability and the extent to which sociodemographic, clinical and family functioning influence it. Methods: We conducted a cross-sectional study, analytical and comparative, employing a quantitative methodology, using for this purpose a non-probabilistic sample of convenience consisting of 60 seniors in the municipality of Viseu with fracture of the upper end of the femur for 6 months. The measuring instrument was a questionnaire, the Family Apgar Scale and Modified Barthel Scale. Results: The study population was predominantly female, with a mean age of 78.5 years, married, residing in rural areas. They have qualifications as the 1st cycle of studies, without institutional support and low income. At the end of six months after fracture of the upper end of the femur, we found that 40% of patients were independent in the functional capacity, 33.3% have a high dependence, 16.7% and a moderate dependence and only a fraction has a degree of low dependence (5%) and high dependence (5%). The variables that significantly influenced the functional capacity are: age, marital status, education, institutional support, economic status, type of surgery and rehabilitation. Conclusion: The variables that most influence the functional capacity are: age, that when increases, age decreases the functional capacity; the number of rehabilitation sessions, because as the rehabilitation sessions held increases the more increases its functional capacity.