Influence of blue maize flour on gluten-free pasta quality and antioxidant retention characteristics

Due to its bioactive compounds, blue maize flour is a valuable ingredient for developing gluten-free products. The incorporation of alternative flours into gluten-free pasta is a challenge as it usually results in products that, despite their enhanced nutraceutical features, show reduced quality characteristics. Composite pasta was prepared with variable (25, 50 and 75%) contents of flours from white and blue maize, chickpea and unripe plantain, following a laboratory-scale process. The composite pasta exhibited acceptable cooking loss (9–11%); pasta with blue maize showed lower hardness and chewiness, but higher adhesiveness than its white maize-based counterpart. Blue maize-based pasta presented dark color. The addition of blue maize flour at 75% conveyed the highest total phenolic content retention after extrusion (80%) and cooking (70%). Pasting profile of blue maize pasta (50 and 75%) showed a defined second viscosity peak due to re-arrangement of starch components upon cooling. The observed retention of phenolic compounds with antioxidant capacity after cooking will be useful for further development (selection of ingredients, formulations and conditions of operation) of gluten-free products with potential health benefits

Functional study of raw and cooked blue maize flour : Starch digestibility, total phenolic content and antioxidant activity

The purpose of this study was to determine the chemical composition and antioxidant capacity of blue maize (BM) (Zea mays L.) flour and to investigate the effects of polyphenol-containing extracts and BM wholegrain flour on starch digestion under uncooked and cooked conditions; commercial white maize flour was used as control. Total phenolic content in BM flour (BMF) (164 ± 14 mg gallic acid/g of dry matter) was higher than white maize (127 ± 7 mg gallic acid/g of dry matter), and the presence of anthocyanins (2.0 ± 0.5 mg cyanidin 3-glucoside/100 g) was detected. Also, an important scavenging activity against ABTS (2,2’-azino-di-(3-ethylbenzothiazoline)-6-sulfonic acid) and DPPH (2,2-diphenyl-1-picrylhydrazyl) radicals and ferric reducing power (FRAP) was determined. Extracts of BMF reduced amylase activity (>90% of inhibition). BMF showed higher slowly digestible and resistant starch contents, thus exhibiting lower predicted glycemic index than white maize. Total anthocyanins (r = −0.89 and r = −0.79, p<0.05), antioxidant capacity (r = −0.86 and r = −0.96, p<0.05), total starch (r = 0.99 and 0.92, p<0.05) and resistant starch content (r = −0.99 and r = −0.92, p<0.05) were correlated with pGI for uncooked and cooked flours, respectively. These results indicate the potential use of BMF and its phenolic-rich extract as functional ingredients to develop antioxidant and indigestible carbohydrate-rich foods with potential health benefits

Incorporation of whole blue maize flour increases antioxidant capacity and reduces in vitro starch digestibility of gluten-free pasta

The development of gluten-free pasta with functional characteristics is an important strategic area for the food industry. The objective of this study was to evaluate the influence of the polyphenols present in blue maize flour (BMF) on the antioxidant properties and starch digestibility of composite gluten-free pasta. Composite pasta was prepared with 25, 50, or 75% BMF in a laboratory-scale process using white maize as the control. The addition of blue maize flour at 50% and 75% imparted high levels of protein, dietary fibre, and bioactive compounds with antioxidant capacity, which resulted in an increase in slowly digestible and resistant starch fractions in the gluten-free pasta. The anthocyanin content in BMF was positively correlated (p < 0.05) with a decrease in the predicted glycaemic index. BMF is a readily available ingredient for the production of gluten-free pasta with high dietary fibre and slowly digestible starch contents that can contribute to reduce the risk for diet-related metabolic diseases

Starch and antioxidant compound release during in vitro gastrointestinal digestion of gluten-free pasta

The microstructure of cooked gluten-free pasta depends on the ingredients used, and this microstructure affects the starch hydrolysis (SH), the release of phenolic compounds (PC) and their antioxidant capacity (AC). The aim of this study was to evaluate the SD and bioaccessibility of PC during in vitro gastrointestinal digestion of gluten-free pasta and its relationship with the microstructure. The highest SH was during the intestinal phase (≈60%), but pasta with the highest content of unripe plantain and chickpea presented the lowest release of PC (≈60%). The insoluble dietary fibre could be responsible (≈12.5%) for these effects. The cooked pasta showed high AC in the intestinal phase. Regions with gelatinized starch granules in a less dense protein network and other regions with intact or swollen granules surrounded by a protein network were observed. The starch digestion and bioaccessibility of PC were related to the structure of the matrix.The authors thank , SIP-IPN, COFAA-IPN, and EDI-IPN for support. One of the authors (GACM) acknowledges scholarships from CONACYT and BEIFI. Authors thank Alberto Peña for useful contributions towards this work. Additionally, authors recognize the experimental support of the CNMN-IPN.Peer reviewe

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research