Effects of tualang honey supplementation on oxidative stress status, inflammation and lipid profiles in chronic smokers

Elevated oxidative stress, inflammation and alteration in lipid profiles in smokers have been proposed as among the major factors that contribute to the development of smoking-related cardiovascular disease. However, the possible beneficial effect of Tualang honey that has antioxidant, anti-inflammatory and antilipid properties among smokers has yet been reported. The aims of this study, therefore, to determine the effects of Tualang Honey supplementation on oxidative stress markers, inflammatory markers and lipid profiles in smokers. A total of 36 non smokers and 72 smokers were recruited. The smokers were then randomly divided into 2 groups namely smokers without supplementation and smokers with honey supplementation at the dose of 20 gram/day for 12 weeks. Blood was obtained for determination of oxidative stress markers, inflammatory markers and lipid profiles from all groups at pre-intervention and from smokers group at post-intervention. At pre-intervention, smokers had significantly higher levels of F2-isoprostanes, total antioxidant status (TAS) and catalase (CAT) activity compared to non smokers. Meanwhile, the activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx) were significantly lower in smokers than non smokers. A significantly higher level of high sensitivity C-reactive protein (hsCRP) was found in smokers compared to non smokers. However, no significant differences were found for the levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). Furthermore, significantly lower high-density lipoprotein (HDL) as well as higher total cholesterol (TC), low-density lipoprotein (LDL) and triglyceride (TG) levels were observed in smokers compared to non smokers. In smokers, Tualang honey supplementation significantly decreased the level of F2-isoprostanes as well as increased the levels/activities of TAS, CAT and GPx. Tualang honey also significantly increased the level of TNF-α and decreased the level of hsCRP. Apart from that, Tualang honey significantly decreased the levels of TC and LDL. These observations might suggest a beneficial effect of Tualang honey against cigarette smoke-induced oxidative stress, inflammation as well as alteration in lipid profiles among smokers which may provide an effect in reducing the atherothrombosis formation and subsequent risk of cardiovascular disease. These beneficial effects could be, partly attributed to its various components which include phenolic acids and flavonoid compounds that have antioxidant, anti-inflammatory and antilipid properties. However, further studies are required to elucidate the exact mechanism of action on these benefical effects of Tualang hone

Effects of cocoa flavanols on peripheral blood flow and symptoms in primary Raynaud’s phenomenon

Primary Raynaud’s phenomenon (PRP) is characterised by the periodic vasospasm of the digits precipitated by exposure to cold/emotional stimuli. PRP may involve vascular endothelium dysfunction, abnormalities in neural control of vascular tone and/or increases in circulating mediators which promote vasoconstriction. Cocoa products have been shown to promote vasodilation, and therefore could mitigate PRP symptoms. The work described in this thesis investigates the effects of cocoa flavanols on peripheral blood flow, thermoregulation and symptoms in people with PRP. The acute effects of high flavanol cocoa (HFC) consumption on cardiovascular parameters and peripheral thermoregulation was compared between people with PRP and control participants using a double blind, cross over design. The chronic effects of 3 months daily consumption of HFC was then investigated using a double blind, placebo-controlled, parallel group design in people with PRP. The experiencing of Raynaud’s symptoms, their duration and level of pain, and an assessment of Raynaud’s Condition Score were documented by participants in a symptoms diary throughout the intervention. Dietary macronutrient composition as well as total flavanol and epicatechin intake, were assessed monthly using diet diaries and Food Frequency Questionnaires, respectively, with Physical and Mental Health status being determined at these time points using the SF-36TM. A Finometer was used to measure cardiovascular variables and Laser Doppler Flowmetry used to assess skin blood flow before and after the supplementation period. In pilot studies, FMD was used to determine endothelial function following HFC consumption. Data from the pilot studies found that acute consumption of a HFC drink induces a greater vasodilatory response to a shear stress stimulus at 1hr compared to a LFC drink. In acute supplementation studies, it was found that consumption of a HFC drink did not impact peripheral thermoregulation in either PRP participants or controls. Meanwhile, consumption of HFC capsules in a chronic supplementation study reduced total peripheral resistance and increased cardiac output, but these beneficial effects were not accompanied by an increase in skin blood flow, or improvements in Raynaud’s symptoms among PRP participants. It was also observed that in this cohort, having PRP did not appear to negatively impact mental or physical wellbeing, compared to a general population. The thesis proposes that it is feasible to recruit, retain, and provide follow-up with the participants for a full randomised control trial involving individuals with PRP in the future. The findings from acute supplementation studies demonstrated no differential effect of HFC drink on cardiovascular measures and skin blood flow in either PRP participants or controls, while data from chronic supplementation study found no differential effect of HFC capsules on skin blood flow and Raynaud’s symptoms among PRP participants. Therefore, it is important that people with PRP are aware that cocoa flavanols probably will not help to reduce their symptoms, despite studies that suggest their consumption improves the compliance of resistance vessels and microvasculature in healthy individuals

Effects of cocoa flavanols on peripheral blood flow and symptoms in primary Raynaud’s phenomenon

Primary Raynaud’s phenomenon (PRP) is characterised by the periodic vasospasm of the digits precipitated by exposure to cold/emotional stimuli. PRP may involve vascular endothelium dysfunction, abnormalities in neural control of vascular tone and/or increases in circulating mediators which promote vasoconstriction. Cocoa products have been shown to promote vasodilation, and therefore could mitigate PRP symptoms. The work described in this thesis investigates the effects of cocoa flavanols on peripheral blood flow, thermoregulation and symptoms in people with PRP. The acute effects of high flavanol cocoa (HFC) consumption on cardiovascular parameters and peripheral thermoregulation was compared between people with PRP and control participants using a double blind, cross over design. The chronic effects of 3 months daily consumption of HFC was then investigated using a double blind, placebo-controlled, parallel group design in people with PRP. The experiencing of Raynaud’s symptoms, their duration and level of pain, and an assessment of Raynaud’s Condition Score were documented by participants in a symptoms diary throughout the intervention. Dietary macronutrient composition as well as total flavanol and epicatechin intake, were assessed monthly using diet diaries and Food Frequency Questionnaires, respectively, with Physical and Mental Health status being determined at these time points using the SF-36TM. A Finometer was used to measure cardiovascular variables and Laser Doppler Flowmetry used to assess skin blood flow before and after the supplementation period. In pilot studies, FMD was used to determine endothelial function following HFC consumption. Data from the pilot studies found that acute consumption of a HFC drink induces a greater vasodilatory response to a shear stress stimulus at 1hr compared to a LFC drink. In acute supplementation studies, it was found that consumption of a HFC drink did not impact peripheral thermoregulation in either PRP participants or controls. Meanwhile, consumption of HFC capsules in a chronic supplementation study reduced total peripheral resistance and increased cardiac output, but these beneficial effects were not accompanied by an increase in skin blood flow, or improvements in Raynaud’s symptoms among PRP participants. It was also observed that in this cohort, having PRP did not appear to negatively impact mental or physical wellbeing, compared to a general population. The thesis proposes that it is feasible to recruit, retain, and provide follow-up with the participants for a full randomised control trial involving individuals with PRP in the future. The findings from acute supplementation studies demonstrated no differential effect of HFC drink on cardiovascular measures and skin blood flow in either PRP participants or controls, while data from chronic supplementation study found no differential effect of HFC capsules on skin blood flow and Raynaud’s symptoms among PRP participants. Therefore, it is important that people with PRP are aware that cocoa flavanols probably will not help to reduce their symptoms, despite studies that suggest their consumption improves the compliance of resistance vessels and microvasculature in healthy individuals

Effects of honey supplementation on inflammatory markers among chronic smokers: a randomized controlled trial

Abstract Background Honey has been demonstrated to possess anti-inflammatory property. This is a randomized, controlled, open-label trial to determine the effects of 12-week honey oral supplementation on plasma inflammatory markers such as high sensitive C-reactive protein, interleukin-6 and tumor necrosis factor-α among chronic smokers. Methods/design A total of 32 non-smokers and 64 chronic smokers from Quit Smoking Clinic and Health Campus, Universiti Sains Malaysia participated in the study. Smokers were then randomized into 2 groups: smokers with honey group that received Malaysian Tualang honey (20 g/day daily for 12 weeks) and smokers without honey group. Blood was obtained from non-smokers and smokers at pre-intervention, and from smokers at post-intervention for measurement of the inflammatory markers. Results At pre-intervention, smokers had significantly higher high sensitive C-reactive protein than non-smokers. In smokers with honey group, tumor necrosis factor-α was significantly increased while high sensitive C-reactive protein was significantly reduced at post-intervention than at pre-intervention. Conclusion This study suggests that honey supplementation has opposite effects on tumor necrosis factor-α and high sensitive C-reactive protein indicating the inconclusive effect of honey on inflammation among chronic smokers which needs further study on other inflammatory markers. Trial registration The Trial has been registered in the Australian New Zealand Clinical Trials Registry: ACTRN12615001236583 . Registered 11 November 2015 (Retrospectively Registered)

Systematic review: Surfactant protein-D, diabetes mellitus, oxidative stress, infections and inflammation on the crossroad

Objectives: To review the association of surfactant protein-D with type 2 diabetes mellitus, infections, oxidative stress and inflammation, and the changes in oxidative stress markers in type 2 diabetes mellitus. Method: The systematic review was conducted from April to September 2022, and comprised search on PubMed, Web of Sciences, Scopus, Science Direct and Google Scholar databases for relevant studies published in English language between January 1, 2000, and June 30, 2022.  The search was updated in September 2022. After transferring literature to Mendeley, relevant data was extracted from the included studies. Quality assessment for eligible studies was done using Joanna Briggs Institute Critical Appraisal Checklist. Quality of evidences was assessed by using Grading of Recommendations Assessment, Development and Evaluation tool. Results: Of the 203 studies identified, 18(8.9%) were analysed; 16(89%) with humans and 2(11%) with animals as subjects There were 5 (31.25%) studies for SP-D, of which 4 (80%) studies reported lower surfactant protein-D in type 2 diabetes mellitus cases than controls. Its significant negative association with glycated haemoglobin was reported by 1(20%) study and 2(40%) studies with fasting blood glucose levels. Higher surfactant protein-D in type 2 diabetes mellitus cases and its positive association with glycated haemoglobin was reported by 1(20%) study. Recurrent infections were frequent in type 2 diabetes mellitus patients. Malondialdehyde level was higher and superoxide dismutase activity was lower in type 2 diabetes mellitus cases, reflecting oxidative stress. ---Continu

Anti-Atherogenic Effects of Orlistat on Obesity-Induced Vascular Oxidative Stress Rat Model

Obesity is typically linked to oxidative stress and inflammation, which lead to vascular damage and initiate the progression of atherosclerosis. The aim of this study was to determine the anti-atherosclerotic effect of orlistat on obesity-induced vascular oxidative stress in obese male rats. Twenty-four male Sprague–Dawley rats were categorized into two groups: normal (Normal group, n = 6) and high-fat diet (HFD group, n = 12). After six weeks, obese rats in the HFD group were administered either with distilled water (OB group) or orlistat 10 mg/kg/day (OB/OR group) for another six weeks. The OB group had a significant increase in lipid profiles (total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL)) and decrease in high-density lipoprotein (HDL) level compared to the Normal group. The aortic antioxidants enzymes activities (superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GR), glutathione S-transferase (GST), and catalase (CAT)) as well as total glutathione (GSH) and total antioxidant capacity (TAC) of the OB group were significantly decreased compared to the Normal group. Furthermore, pro-inflammatory atherosclerotic markers (tumour necrosis factor-alpha (TNF-α), vascular cell adhesion molecule-1 (VCAM-1), and intercellular cell adhesion molecule-1 (ICAM-1)) expressions were increased significantly, and anti-inflammatory marker (interleukin-10 (IL-10)) was decreased significantly in the OB group compared to the Normal group. Treatment with orlistat significantly improved lipid profile, increased antioxidant enzymes and expression of anti-inflammatory markers, and decreased the expression of the pro-inflammatory marker compared to the OB group. These findings may suggest the therapeutic effect of orlistat in attenuating the progression of the atherosclerotic stage in obesity

Protective and Therapeutic Effects of Orlistat on Metabolic Syndrome and Oxidative Stress in High-Fat Diet-Induced Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) in Rats: Role on Nrf2 Activation

Metabolic dysfunction-associated fatty liver disease (MAFLD) is an excessive buildup of liver lipids closely associated with various kinds of undesirable metabolic effects and oxidative stress. We aimed to investigate the protective and therapeutic effects of orlistat on metabolic syndrome and oxidative stress parameters in high-fat diet (HFD) induced-MAFLD rats. Twenty-four male Sprague-Dawley rats were randomly divided into four groups (n = 6/group), i.e., Normal control (N), HFD, HFD + orlistat (HFD + O) (10 mg/kg/day administered concomitantly for 12 weeks as a protective model), and obese+orlistat (OB + O) (10 mg/kg/day administered 6 weeks after induction of obesity as a therapeutic model) groups. After 12 weeks, the HFD group had significantly increased Lee obesity index, serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total cholesterol, triglyceride, low-density lipoprotein levels, liver total cholesterol and triglyceride levels, insulin resistance and non-alcoholic steatohepatitis (NASH) together with decreased serum high-density lipoprotein level. Additionally, the HFD group also showed increased Nrf2 translocation to the nucleus with high Keap1 expression and increased liver oxidative stress parameters. Orlistat significantly improved all these alterations in HFD rats. We demonstrated that orlistat might have protective and therapeutic effects against HFD-induced MAFLD rats by its activation on Nrf2 signaling pathway, which subsequently improved metabolic syndrome and oxidative stress parameters

Protective and Therapeutic Effects of Orlistat on Metabolic Syndrome and Oxidative Stress in High-Fat Diet-Induced Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) in Rats: Role on Nrf2 Activation

Metabolic dysfunction-associated fatty liver disease (MAFLD) is an excessive buildup of liver lipids closely associated with various kinds of undesirable metabolic effects and oxidative stress. We aimed to investigate the protective and therapeutic effects of orlistat on metabolic syndrome and oxidative stress parameters in high-fat diet (HFD) induced-MAFLD rats. Twenty-four male Sprague-Dawley rats were randomly divided into four groups (n = 6/group), i.e., Normal control (N), HFD, HFD + orlistat (HFD + O) (10 mg/kg/day administered concomitantly for 12 weeks as a protective model), and obese+orlistat (OB + O) (10 mg/kg/day administered 6 weeks after induction of obesity as a therapeutic model) groups. After 12 weeks, the HFD group had significantly increased Lee obesity index, serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total cholesterol, triglyceride, low-density lipoprotein levels, liver total cholesterol and triglyceride levels, insulin resistance and non-alcoholic steatohepatitis (NASH) together with decreased serum high-density lipoprotein level. Additionally, the HFD group also showed increased Nrf2 translocation to the nucleus with high Keap1 expression and increased liver oxidative stress parameters. Orlistat significantly improved all these alterations in HFD rats. We demonstrated that orlistat might have protective and therapeutic effects against HFD-induced MAFLD rats by its activation on Nrf2 signaling pathway, which subsequently improved metabolic syndrome and oxidative stress parameters

Hepatoprotective Effect of Bee Bread in Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) Rats: Impact on Oxidative Stress and Inflammation

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a pathological accumulation of hepatic lipid closely linked with many metabolic disorders, oxidative stress and inflammation. We aimed to evaluate the hepatoprotective effect of bee bread on oxidative stress and inflammatory parameters in MAFLD rats. Twenty-eight male Sprague-Dawley rats were assigned into four groups (n = 7/group): normal control (NC), high-fat diet (HFD), bee bread (HFD + Bb, HFD + 0.5 g/kg/day bee bread) and orlistat (HFD + Or, HFD + 10 mg/kg/day orlistat) groups. After 12 weeks, the HFD group demonstrated significantly higher body weight gain, serum levels of lipids (TG, TC, LDL), liver enzymes (AST, ALT, ALP) and adiponectin, liver lipids (TG, TC) and insulin resistance (HOMA-IR). Furthermore, the HFD group showed significantly decreased antioxidant enzyme activities (GPx, GST, GR, SOD, CAT) and GSH level, and increased liver oxidative stress (TBARS, NO), translocation of Nrf2 to the nucleus, Keap1 expression and inflammation (TNF-α, NF-κβ, MCP-1) together with histopathological alterations (steatosis, hepatocyte hypertrophy, inflammatory cell infiltration, collagen deposition), which indicated the presence of non-alcoholic steatohepatitis (NASH) and fibrosis. Bee bread significantly attenuated all these changes exerted by HFD feeding. In conclusion, our results suggest that bee bread might have antioxidant, anti-inflammatory, anti-steatotic and anti-fibrotic effects that are beneficial in protecting liver progression towards NASH and fibrosis

Effectiveness of Pulmonary Rehabilitation among COVID-19 Patients: A Systematic Review and Meta-Analysis

Background: Many COVID-19 patients presented with detrimental features, such as impaired respiratory function, physical capacity, and overall poor quality of life. The present study evaluates the effectiveness of pulmonary rehabilitation on COVID-19 patients. Methods: We searched PubMed, Scopus, ScienceDirect, and Google Scholar from 2019 to 2021. The protocol was registered in PROSPERO with the registration number CRD42021273618. We performed statistical analyses via random effects and expressed the outcomes as standardized mean difference (SMD) for continuous variables, with 95% confidence intervals (CI). Results: We included six trials involving 432 patients. The primary outcome showed a significant improvement in physical function (SMD 0.83, 95% CI −0.58 to 1.09; p < 0.001; four trials, 266 participants; high-quality evidence). There was significant difference in anxiety (SMD −0.80, 95% CI −1.23 to −0.37; p = 0.003), physical activity intensity levels (SMD −1.27, 95% CI −2.23 to −0.32; p = 0.009), sleep quality (MD −0.05, 95% CI −0.83 to −0.16; p = 0.004), peripheral muscle performance of lower limbs (SMD 0.90, 95% CI −0.60 to 1.20; p < 0.001), and dyspnoea outcomes (SMD −0.55, 95% CI −0.87 to −0.23; p = 0.007). Conclusions: Pulmonary rehabilitation is an effective adjuvant therapy that minimizes COVID-19 severity in the intervention group compared to the conventional treatment. The findings of this study will need to be considered in the framework of the clinical outcome as observed in the intervention outcome. Additionally, safer data on guideline rehabilitation would be needed to examine whether pulmonary rehabilitation would be a fruitful intervention to reduce COVID-19 severity