Nutritional and physicochemical characteristics of innovative high energy and protein fruit- and date-based bars

With the increasing global nutritional bar market, developing and formulating innovative high-energy and protein bars to compensate for nutrients using date fruits is beneficial for health-conscious individuals. The current research was undertaken to study the composition and physicochemical characteristics of innovative high-energy and high-protein bars using two combinations of Sukkari dates or fruit mixtures as a base. Fifty percent of either Sukkari date paste or dried fruit mixture (25% raisin, 12.5% fig, and 12.5% apricot) combined with other different ingredients was used to produce a date-based bar (DBB) or fruit-based bar (FBB). Proximate composition, sugar content, amino and fatty acid profiles, minerals and vitamins, phytochemicals, antioxidant activity, and visual color parameters of the DBB and the FBB were determined and statistically compared. Proximate analysis revealed higher moisture and fat content in the FBB than the DBB, while ash and crude fiber were higher in the DBB than the FBB. The protein content in the DBB and the FBB was not statistically different. Both prepared bars exuded around 376–378 kcal 100 g−1 fresh weight. Sugar profile analysis of the DBB and the FBB showed dependable changes based on date or fruit content. Fructose, glucose, and maltose contents were higher in the FBB than in the DBB, while sucrose content was higher in the DBB than in the FBB. The DBB showed significantly higher content in Ca, Cu, Fe, Zn, Mn, and Se and significantly lower content in Mg, K, and Na than the FBB, with no variation in phosphorus content. The DBB and the FBB contained both essential (EAA) and non-essential (NEAA) amino acids. The DBB scored higher Lysine, Methionine, Histidine, Threonine, Phenylalanine, Isoleucine, and Cystine contents than the FBB, while the FBB scored only higher Leucine and Valine contents than the DBB. Seventeen saturated fatty acids were identified in the DBB and the FBB, with Palmitic acid (C16:0) as the predominant fatty acid. Oleic acid (C18:1n9c) was predominant among seven determined monounsaturated fatty acids. Linoleic fatty acid (C18:2n6c) was predominant among eight identified polyunsaturated fatty acids. In addition, α-Linolenic (C18:3n3) was detected in a considerable amount. However, in both the DBB and the FBB, the content and distribution of fatty acids were not remarkably changed. Regarding phytochemicals and bioactive compounds, the FBB was significantly higher in total phenolic content (TPC), total flavonoids (TF), and total flavonols (TFL) contents and scavenging activity against DPPH and ABTS free radicals than the DBB. The DBB and the FBB showed positive a* values, indicating a reddish color. The b* values were 27.81 and 28.54 for the DBB and the FBB, respectively. The DBB is affected by the lower L* value and higher browning index (BI) to make its color brownish. Sensory evaluation data showed that panelists significantly preferred the DBB over the FBB. In conclusion, processing and comparing these bars indicated that using Sukkari dates is a nutrient-dense, convenient, economical, and better sugar alternative that helps combat the calorie content. Thus, scaling up the use of dates instead of fruits in producing high-energy and protein bars commercially is highly recommended

An evaluation of enteral nutrition practices and nutritional provision in children during the entire length of stay in critical care

<b>Background</b> Provision of optimal nutrition in children in critical care is often challenging. This study evaluated exclusive enteral nutrition (EN) provision practices and explored predictors of energy intake and delay of EN advancement in critically ill children.<p></p> <b>Methods</b> Data on intake and EN practices were collected on a daily basis and compared against predefined targets and dietary reference values in a paediatric intensive care unit. Factors associated with intake and advancement of EN were explored.<p></p> <b>Results</b> Data were collected from 130 patients and 887 nutritional support days (NSDs). Delay to initiate EN was longer in patients from both the General Surgical and congenital heart defect (CHD) Surgical groups [Median (IQR); CHD Surgical group: 20.3 (16.4) vs General Surgical group: 11.4 (53.5) vs Medical group: 6.5 (10.9) hours; p <= 0.001]. Daily fasting time per patient was significantly longer in patients from the General Surgical and CHD Surgical groups than those from the Medical group [% of 24 h, Median (IQR); CHD Surgical group: 24.0 (29.2) vs General Surgical group: 41.7 (66.7) vs Medical group: 9.4 (21.9); p <= 0.001]. A lower proportion of fluids was delivered as EN per patient (45% vs 73%) or per NSD (56% vs 73%) in those from the CHD Surgical group compared with those with medical conditions. Protein and energy requirements were achieved in 38% and 33% of the NSDs. In a substantial proportion of NSDs, minimum micronutrient recommendations were not met particularly in those patients from the CHD Surgical group. A higher delivery of fluid requirements (p < 0.05) and a greater proportion of these delivered as EN (p < 0.001) were associated with median energy intake during stay and delay of EN advancement. Fasting (31%), fluid restriction (39%) for clinical reasons, procedures requiring feed cessation and establishing EN (22%) were the most common reasons why target energy requirements were not met.<p></p> <b>Conclusions</b> Provision of optimal EN support remains challenging and varies during hospitalisation and among patients. Delivery of EN should be prioritized over other "non-nutritional" fluids whenever this is possible.<p></p&gt

Nutritional issues and impact of treatment in patients with phenylketonuria

In the early days of PKU, micronutrient deficiencies, undernutrition and growth failure were common features of patients with the condition. This was mainly due to the limited availability of engineered special low protein foods (SLPF) and PKU protein substitutes to use. Nowadays, SLPF foods and micronutrient-enriched PKU protein substitutes have become widely available and are free on prescription in most countries. These SLPF are high in carbohydrates and often in fat content, have a higher glycaemic index and provide more energy per weight compared with the protein-containing equivalent normal foods. Advancement in the PKU management, including dietary practices, led to nutritional problems that had never been reported before, but have become more frequent in the recent years. Overweight and obesity, rather than undernutrition, have become increasingly reported in patients with PKU, with some studies suggesting higher prevalence in females than males. Data on body composition in patients with PKU are inconsistent with some studies showing that patients with PKU have higher FM and lower FFM compared to healthy controls. This suggests that for a given body weight and height, patients with PKU might be fatter and look bigger. However, there is very little research looking at the determinants of nutrient status, body composition and obesity in patients with PKU. Hence, among the aims of this thesis was to investigate the impact of a PKU SLPF-based meal on appetite ratings, gut appetite hormones, thermic effect of feeding (TEF) and fat oxidation (Chapter 2). Twenty-three healthy adults (mean ± SD age: 24.3 ± 5.1 years; BMI: 22.4 ± 2.5 kg/m2) participated in a randomised crossover study. Each participant conducted two (PKU and Control) experimental trials which involved consumption of a PKU SLPF-based meal and protein substitute drink or an isocaloric and weight matched ordinary meal and protein-enriched milk drink. Appetite, metabolic rate, fat oxidation measurements and blood collections were conducted for the duration of 300 minutes. On completion of the measurements, an ad libitum buffet dinner was served. Responses of appetite ratings, plasma concentrations of GLP-1 and PYY (P>0.05, trial effect, two-way ANOVA) and energy intake during ad libitum buffet dinner (P>0.05, paired t-test) were not significantly different between the two trials. The TEF (PKU, 10.2 ±1.5%; Control, 13.2 ± 1.0%) and the total amount of fat oxidised (PKU, 18.90 ± 1.10 g; Control, 22.10 ± 1.10 g) were significantly (P<0.05, paired t-tests) lower in the PKU than in the Control trial. The differences in TEF and fat oxidation were significant (P<0.05, paired t-tests) for the post-meal period. Therefore, from this first study we concluded that consumption of a meal composed of SLPF has no detrimental impact on appetite and appetite hormones but produces a lower TEF and postprandial fat oxidation than an ordinary meal. We hypothesised that these metabolic alterations may contribute to the increased prevalence of obesity reported in patients with PKU on contemporary dietary management. In the second experimental chapter, we tested the hypothesis generated from the study above and measured TEF, fasting and postprandial fat and CHO oxidation in 13 patients with PKU and 10 healthy controls of similar age and BMI. Participants in the PKU group were provided an SLPF-based meal while those in the Control group were provided an isocaloric normal meal. It was found that TEF, and postprandial fat and CHO oxidation were not signifcantly different between the PKU and the Control groups. In addition, this study compared body composition characteristics (measured by Deuterium Oxide dilution technique) between PKU patients and healthy controls and revealed that differences in body composition are not significant between the two groups despite a tendency of PKU patients having higher percentage of body fatness (P=0.08). However, data generated from this study should be interpreted with caution and requires confirmation from studies with larger sample size. Micronutrient imbalance has been noted in patients with PKU despite their high provision through the PKU protein substitutes. Recent studies showed high blood levels of vitamin B12 and folate, but simultaneously deficient plasma levels of selenium and zinc in PKU patients prescribed with micronutrient-enriched PKU protein substitutes. Factors associated with micronutrient imbalance have rarely been studied in the literature. Therefore, the last chapter of this thesis aimed to evaluate the micronutrient status of children with PKU and explore factors associated with micronutrient imbalances and deficiencies. This was analysis of a large clinical dataset with serial measurements obtained from PKU children (≤16 years) attending the metabolic medicine clinic at the Glasgow Royal Hospital for Sick Children between 1990 and 2013. The study included 81 patients who provided a total of 512 blood samples for their routine annual micronutrient screening. Data on blood micronutrient measurements was available for vitamins A, B12, D, E, serum folate, and erythrocyte folate and the trace elements copper, selenium, zinc and serum ferritin as a biomarker of iron stores. Status of vitamin B12, E, and serum and erythrocyte folate measurements were above the normal range (NR) in 27%, 54%, 46% and 35% of the blood samples, respectively. However, 44% of selenium and 14% of zinc measurements were below the NR. Moreover, when we compared results with those from the UK National Dietary and Nutritional Survey, selenium and zinc deficiencies were specific to PKU condition and not a reflection of the epidemiology in the general UK population. In our PKU sample, poor metabolic control, PKU severity, and low adherence to PKU protein substitutes predicted low selenium status; while deficient zinc status was solely predicted by low adherence to PKU protein substitutes. Yet, these predictors, collectively, explained a small (5.8 – 8.8 %) variation in the status of selenium and zinc in this group of patients. Selenium and zinc deficiencies are common in PKU patients despite high levels of other nutrients including vitamin B12, E and folate. The findings of this study suggest that selenium and zinc deficiencies reported in patients with PKU may be attributed to other factors which we were unable to measure in this retrospective study, such as low bioavailability of these nutrients from the artificial PKU protein substitutes

Date Palm Fruit (<i>Phoenix dactylifera</i>) and Its Promising Potential in Developing Functional Energy Bars: Review of Chemical, Nutritional, Functional, and Sensory Attributes

Snack bars, known as energy bars, are widely consumed worldwide as highly nutritive on-the-go products. Due to the date fruit’s significant nutritional and functional characteristics, it can be an exceptional choice for developing snack bars. Dates contain a wide range of macro- and micronutrients known for their strong bioactive properties. The functional properties of date fruit have been demonstrated in the literature and include antioxidant, anti-inflammatory, anti-tumor, antihypertensive, and antimicrobial activities. This review summarizes the available studies investigating the potential application of dates for developing nutritive and functional snack bars. Date paste was used as a main ingredient at 55–90% concentrations. In addition, protein sources were used to provide protein-rich snack bars, as date fruit is considered high in carbohydrates and low in protein. Skim milk powder was the most common and favorable protein source, delivering significant amounts of protein with limited negative effects on sensory attributes. Incorporating other ingredients, such as cereals or legumes, was also explored; adding such dry ingredients can promote positive nutritional effects along with improving sensory attributes, mainly in terms of the bars’ textures. Dry ingredients can significantly lower moisture content, reducing the bars’ fracturability to acceptable ranges. Reduced moisture content can also significantly enhance the shelf-life stability, as observed by limited microbial growth. Furthermore, the incorporation of bioactive or functional ingredients such as fruit peels, plant seeds, or plant leaf extracts was also reported; such ingredients promoted significant enhancements in the contents of phenolics or flavonoids, for instance, leading to an increase in the bars’ antioxidant potential. Though dates are rich in such bioactive components, incorporating additional bioactive ingredients can boost the dates’ functional properties. In conclusion, this review shows the high potential of the application of dates for developing nutritious and functional snack bars. Taking this into account, the snack bar market has grown remarkably over the past decade; thus, providing well-balanced, nutritious, and functional date-based bars in markets worldwide is expected to show positive consumer acceptance

Effect of Various Intermittent Fasting Protocols on Hyperglycemia-Induced Cognitive Dysfunction in Rats

Diabetes mellitus is a highly prevalent metabolic disorder that causes cognitive decline. Here, we investigated the impact of various intermittent fasting protocols on type 2 diabetes mellitus (T2DM)-induced cognitive dysfunction in a rodent model. Male Sprague&ndash;Dawley rats (aged 3 months) were randomly assigned to five groups (n = 6 per group) and T2DM was induced by streptozotocin (60 mg/kg, IM). The control group was untreated. Cognitive function was tested (Y-maze, novel object recognition, and elevated plus maze tests) and glucose was assessed. The T2DM rats exhibited significantly higher blood glucose, which is associated with cognitive dysfunction. Compared to the validated animal model of T2DM in rats, various intermittent fasting protocols decreased blood glucose and improved cognitive function. These results indicate that various intermittent fasting protocols may be a potential strategy for managing the hyperglycemia-associated cognitive dysfunction

Phenolic Profile, Antioxidant Activity, and Ameliorating Efficacy of Chenopodium quinoa Sprouts against CCl4-Induced Oxidative Stress in Rats

Quinoa (Chenopodium quinoa) is classified as one of the pseudo-cereal grains rich in both macronutrients and micronutrients. This study tracks changes in the polyphenol composition of red quinoa (RQ) and yellow quinoa (YQ) seeds during germination. The antioxidant bioactivity of raw and germinated seed was also determined in vitro. Phenolic acids and their derivatives and flavonoids were identified by using HPLC-DAD and quantified after 0, 3, and 6 days of germination. Subsequently, the extracts of 6-day-old quinoa sprouts were prepared to biologically evaluate their functional properties against CCl4-induced oxidative stress in rats. The results indicated that antioxidant activity (AOA) of total phenolic compounds (TPC), and flavonoids significantly increased in RQ and YQ sprouts during germination up to 9 days. RQ sprouts exhibited stronger bioactive compound diversity than YQ sprouts as observed in HPLC analysis. Among the 11 and 8 quantified polyphenols, ferulic acid and quercetin were predominant phenolic acid and flavonoid in RQ and YQ sprouts, respectively. After 6 days of germination, 16 and 8 polyphenols were detected and quantified in RQ and YQ sprouts, respectively. Interestingly, the treatment of rats at a dose of 30 mg of Gallic acid Equivalent (GAE) kg&minus;1 significantly reduced fasting blood glucose (FBG), alanine aminotransferase (ALT), aspartate aminotransferase AST, and total bilirubin (TIBIL) and improved liver inflammation. Furthermore, RQ and YQ sprouts improved the blood profile by significantly decreasing low-density lipoproteins (LDL) and very low-density lipoproteins (VLDL) and increasing high-density lipoproteins (HDL). Moreover, RQ and YQ sprout extracts significantly reduced malonaldehyde (MDA) and efficiently enhanced the reduced glutathione (GSH) and superoxide dismutase (SOD) activities in oxidative stress-induced rats as compared to CCl4-rats. In conclusion, red quinoa sprouts (RQS) and yellow quinoa sprouts (YQS) provide naturally synthesized polyphenols, possessing superior antioxidant activity, and their ethanolic extracts have promising effects and potential health benefits to counter induced oxidative stress. Incorporating quinoa sprouts as functional food ingredients should be considered and scaling-up its production is beneficial

Delivery of enteral nutrition after the introduction of practice guidelines and participation of dietitians in pediatric critical care clinical teams

Provision of optimal nutrition is often difficult to achieve in the critically ill child, but can improve with better nutritional support practices. This study evaluated the joint impact of the introduction of enteral feeding practice guidelines and participation of dietitians in daily ward rounds on enteral nutrition (EN) intake and practices in children in intensive care. Nutritional intake and EN practices were audited before (period A) and after (period B) the introduction of enteral feeding practice guidelines and participation of dietitians in daily ward rounds in a pediatric intensive care unit. Information was collected on a daily basis and nutritional intake was compared with predefined targets and the United Kingdom dietary reference values. There were 65 patients and 477 nutritional support days in period A and 65 patients and 410 nutritional support days in period B. Basal metabolic rate (BMR) energy requirements were achieved in a larger proportion of nutritional support days in period B (BMR achieved [% nutritional support days]; period A: 27% vs period B: 48.9%; P&#60;0.001). In patients admitted for nonsurgical reasons, median energy, protein, and micronutrient intake improved significantly. In the same group, the percentage of daily fluid intake delivered as EN increased post implementation (period A: median=66.8%; interquartile range=40.9 vs period B: median=79.6%; interquartile range=35.2; P&#60;0.001). No significant changes were seen in patients admitted for corrective heart surgery. Implementation of better EN support practice can improve nutritional intake in some patients in critical care, but can have limited benefit for children admitted for corrective heart surgery

Biological Assessment of Stevioside and Sucralose as Sucrose Substitutes for Diabetics on STZ-Induced Diabetes in Rats

Numerous food organizations have identified excessive calorie consumption and accompanying ailments as significant health risks associated with high sugar consumption. Administering stevioside (ST), sucralose (SU), and the two synergically (SU+ST) affected normal rats’ weight gain. In the current study, SU showed the highest undesired effect. Indeed, administering the three treatments to diabetic rats (DR) did not improve the rats’ weight gain. Although, insulin injection synergically with the treatments improved the weight gain, as recorded after three weeks. The best-improving rate was observed in the ST group. After the administration of ST and ST+SU to the DR, the blood glucose level (GL) was positively affected, with SU having no effects on reducing the GL. A considerable reduction in serum insulin (SIL) was noted in the DR+SU group. On the contrary, ST did not negatively affect the SIL, rather an improvement was recorded. In addition, giving SU did not significantly affect the ALT level in the DR or normal rats (NR). A significant improvement in total bilirubin (TBILI) was observed when insulin was injected with ST or SU in DR groups. Further, triglycerides (TG) after administering ST, SU, or ST+SU to NR had no significant difference compared to the control group (NR). Although, the three treatments markedly but not significantly lowered TG in the DR. For total cholesterol (CHO), both DR and NR had no significant effect after the three treatments. No histopathological alterations were recorded in the NR group. Diffuse and severe atrophy of the islands of Langerhans due to depletion of their cells and mild papillary hyperplasia of the pancreatic ducts were represented by a slightly folded ductal basement membrane and newly formed ductules in STZ-DR. Simultaneous atrophy and absence of the cells of islands of Langerhans besides ductal hyperplasia were evident in DR+SU. Hyperplastic ductal epithelium and atrophic Langerhans cells were seen in DR+SU+In. Degeneration and mild atrophy were observed in the islands of Langerhans structures. There was essentially no noticeable change after utilizing ST. A slight shrinkage of the Langerhans’ islets was detected in DR+ST. In DR+ST+In, no histopathological alterations in the islands of Langerhans were recorded. Congestion in the stromal blood vessels associated with degenerative and necrotic changes in the cells of the islands of Langerhans in DR+SU+ST was observed. In NR+SU, congestion of the blood vessels associated with mild atrophy in the islands of Langerhans and dilatation in stromal blood vessels was noticed. In conclusion, ST is safe, and SU should be taken cautiously, such as mixing with ST and/or taken at a very low concentration to avoid its drastic effect on the human body

Gastroprotective Effects of Spirulina platensis, Golden Kiwifruit Flesh, and Golden Kiwifruit Peel Extracts Individually or in Combination against Indomethacin-Induced Gastric Ulcer in Rats

This study was conducted to investigate the therapeutic effect of hydro-alcoholic extract of Spirulina platensis (SP), golden kiwifruit (Actinidia chinensis) flesh (KF), and golden kiwifruit peel (KP) individually or in combination (SFP) on indomethacin-induced gastric ulcer in rats. Negative control rats (GI) were orally administered distilled water in parallel with other treatments. The positive control rat group (GII) was administered 30 mg kg−1 indomethacin to induce gastric ulcers. The KF and KF extracts were used individually or together with SP in treating indomethacin-induced gastric ulcerated rat groups. Gastric ulcerated rat’s groups GIII, GIV, GV, GVI, and GVII were orally administered at 30 mg kg−1 rat body weight as total phenolic content (TPC) equivalent from SP, KF, KP, SPF extracts, and Lansoprazole (30 mg kg−1, as reference drug) daily up to 14 days, respectively. The relevant biochemical parameters, antioxidant biomarkers, and histopathological examination were examined. Remarkably, treating rats with SP, KF, KP, and SFP extracts markedly reduced gastric juice and stomach volume expansion induced by indomethacin. The SP significantly retrieved the pH of gastric juice to a regular rate compared to GI. The ulcer index (UI) was significantly attenuated by SP, KF, KP, and SFP administration. The protection index percentage (PI %) was 80.79, 54.51, 66.08, 75.74, and 74.86% in GIII, GIV, GV, GVI, and GVII, respectively. The gastric mucin content was significantly better attenuated by 95.7 in GIII compared to its content in GI. Lansoprazole increased mucin content by 80.3%, which was considerably lower than SP and SFP. SP, KF, KP, SFP, and Lansoprazole improved the reform of gastric mucosal-increased secreted mucus by 95.6, 61.3, 64.8, 103.1, and 80.2% in GIII, GIV, GV, GVI, and GVII, respectively. Interestingly, SFP efficiently increased vit. B12 level by 46.0% compared to other treatments. While Lansoprazole administrating did not significantly attenuate vit. B12 level. The SP and SFP improved iron and Hemoglobin (HB) levels depending on treatment. SP, KF, KP, and SFP significantly decreased the malondialdehyde (MDA) and increased reduced glutathione (GSH) as well as superoxide dismutase (SOD) levels in blood and stomach tissues. The most potent effect was observed with SP, and SFP was even better than Lansoprazole. Histopathologically, treating rats with SP extract showed a marked reduction of gastric damage and severity changes induced by indomethacin. KP was much better than KF in lessening gastric histopathological damages caused by indomethacin. SFP significantly alleviates gastric histopathological alterations. The lansoprazole-treated group (GVII) greatly relieved the gastric histopathological changes and recorded mild focal necrosis and desquamation of the mucosa in addition to mild oedema in the serosal layer. In conclusion, the presented results proved the antiulcer potential of SP and A. chinensis extracts against an indomethacin-induced gastric ulcer in rats, which may be due to their antioxidant and anti-inflammation efficiency. Thus, these data suggested that SP, KF, KP, and SFP extracts as natural and safe alternatives have a gastroprotective potential against indomethacin-induced gastric ulceration. The antioxidative and anti-inflammatory properties are probable mechanisms

Biological Assessment of Stevioside and Sucralose as Sucrose Substitutes for Diabetics on STZ-Induced Diabetes in Rats

Numerous food organizations have identified excessive calorie consumption and accompanying ailments as significant health risks associated with high sugar consumption. Administering stevioside (ST), sucralose (SU), and the two synergically (SU+ST) affected normal rats&rsquo; weight gain. In the current study, SU showed the highest undesired effect. Indeed, administering the three treatments to diabetic rats (DR) did not improve the rats&rsquo; weight gain. Although, insulin injection synergically with the treatments improved the weight gain, as recorded after three weeks. The best-improving rate was observed in the ST group. After the administration of ST and ST+SU to the DR, the blood glucose level (GL) was positively affected, with SU having no effects on reducing the GL. A considerable reduction in serum insulin (SIL) was noted in the DR+SU group. On the contrary, ST did not negatively affect the SIL, rather an improvement was recorded. In addition, giving SU did not significantly affect the ALT level in the DR or normal rats (NR). A significant improvement in total bilirubin (TBILI) was observed when insulin was injected with ST or SU in DR groups. Further, triglycerides (TG) after administering ST, SU, or ST+SU to NR had no significant difference compared to the control group (NR). Although, the three treatments markedly but not significantly lowered TG in the DR. For total cholesterol (CHO), both DR and NR had no significant effect after the three treatments. No histopathological alterations were recorded in the NR group. Diffuse and severe atrophy of the islands of Langerhans due to depletion of their cells and mild papillary hyperplasia of the pancreatic ducts were represented by a slightly folded ductal basement membrane and newly formed ductules in STZ-DR. Simultaneous atrophy and absence of the cells of islands of Langerhans besides ductal hyperplasia were evident in DR+SU. Hyperplastic ductal epithelium and atrophic Langerhans cells were seen in DR+SU+In. Degeneration and mild atrophy were observed in the islands of Langerhans structures. There was essentially no noticeable change after utilizing ST. A slight shrinkage of the Langerhans&rsquo; islets was detected in DR+ST. In DR+ST+In, no histopathological alterations in the islands of Langerhans were recorded. Congestion in the stromal blood vessels associated with degenerative and necrotic changes in the cells of the islands of Langerhans in DR+SU+ST was observed. In NR+SU, congestion of the blood vessels associated with mild atrophy in the islands of Langerhans and dilatation in stromal blood vessels was noticed. In conclusion, ST is safe, and SU should be taken cautiously, such as mixing with ST and/or taken at a very low concentration to avoid its drastic effect on the human body