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The poor hydrophilicity of raw starch limits its applications, resulting in increased processing complexity. Ethanol-induced V-type granular starch (EVGS), a type of cold-water swelling starch, can be prepared through ethanol-aqueous heat treatment (EAHT). Four types of native starch with three crystalline structures were used to prepare EVGS. At 70 % ethanol, the preparation process was divided into temperature gradients to explore the EVGS formation process. X-ray diffraction (XRD), DSC (Differential Scanning Calorimetry) and non-isothermal kinetics analysis revealed three stages in the formation process: destruction of the native crystalline structure, formation of composite crystalline structure, and complete formation of V-type crystalline structure. The observed "blocklets" structure of EVGS suggested that the crystalline structure transformation might be based on this structural unit. A water phase gradient dispersion method was used to monitor the cold-water swelling behavior of EVGS: as the dispersion time increased, short-chain amylose leached first, followed by long-chain amylose, accompanied by the enhanced hydrophilicity of amylopectin, the "blocklets" structure limited EVGS swelling extent and prevented complete granules rupture, contributing to its cold paste stability. Overall, this study further elucidated the formation process and the multi-scale structure of EVGS and proposed an interpretation of cold-water swelling process for EVGS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

In this study, we present a computational framework designed to evaluate virtual scenarios of cardiac resynchronization therapy (CRT) and compare their effectiveness based on relevant clinical biomarkers. Our approach involves electro-mechanical numerical simulations personalized, for patients with left bundle branch block, by means of a calibration obtained using data from Electro-Anatomical Mapping System (EAMS) measures acquired by cardiologists during the CRT procedure, as well as ventricular pressures and volumes, both obtained pre-implantation. We validate the calibration by using EAMS data coming from right pacing conditions. Three patients with fibrosis and three without are considered to explore various conditions. Our virtual scenarios consist of personalized numerical experiments, incorporating different positions of the left electrode along reconstructed epicardial veins; different locations of the right electrode; different ventriculo-ventricular delays. The aim is to offer a comprehensive tool capable of optimizing CRT efficiency for individual patients. We provide preliminary answers on optimal electrode placement and delay, by computing some relevant biomarkers such as d P / d t max , ejection fraction, stroke work. From our numerical experiments, we found that the latest activated segment during sinus rhythm is an effective choice for the non-fibrotic cases for the location of the left electrode. Also, our results showed that the activation of the right electrode before the left one seems to improve the CRT performance for the non-fibrotic cases. Last, we found that the CRT performance seems to improve by positioning the right electrode halfway between the base and the apex. This work is on the line of computational works for the study of CRT and introduces new features in the field, such as the presence of the epicardial veins and the movement of the right electrode. All these studies from the different research groups can in future synergistically flow together in the development of a tool which clinicians could use during the procedure to have quantitative information about the patient's propagation in different scenarios., Competing Interests: Declarations Conflict of interest The authors declare to have no conflict of interest. Ethical approval and consent to participate Ethical review board approval and informed consent were obtained from all patients., (© 2024. The Author(s).)

Purpose: A strategy to reduce starch digestibility is to limit its accessibility to α-amylase by preserving the integrity of cells where starch is encapsulated. Coarse flour is rich in intact cells and can be used for this purpose. However, making bread with coarse flour negatively affects crumb cohesiveness, which may increase the gastric disintegration rate, and enhance starch accessibility. Therefore, this study aimed to assess the combined effect of coarse semolina and its 20% gluten substitution in bread in healthy volunteers on glycemic and insulinemic responses, oral processing and bolus characteristics., Methods: Apparently, healthy volunteers (n = 16) randomly consumed bread made with coarse semolina and 20% gluten substitution (80CS_20G), its counterpart with fine semolina (80FS_20G), and bread with fine semolina and 5% gluten (95FS_5G). The glycemic and insulinemic responses were measured over 2 h after bread consumption. Mastication behaviour, bolus properties and reducing sugar were also evaluated., Results: No differences in glycemic responses and mastication were observed among the samples. 80CS_20G and 80FS_20G exhibited similar textural properties but 80CS_20G released less reducing sugars and elicited a lower insulin response at 30 min than 80FS_20G, probably due to intact cells that limit starch accessibility. Also, 95FS_5G released lower reducing sugars and had lower insulin peak than 80FS_20G. The compact structure of 95FS_5G may have delayed starch hydrolysis by restricting α-amylase accessibility., Conclusion: Combining gluten and coarse semolina resulted in bread with a lower release of reducing sugars, a reduced insulinemic peak and textural properties similar to the counterpart with fine semolina., Clinical Trial Registration Number: The trial is registered at ClinicalTrials.gov: NCT06152874., Competing Interests: Declarations Ethical approval The study was approved by the Institutional Review Board of the Department of Agricultural, Food, Environmental and Animal Sciences of the University of Udine (protocol number: 0003800 on July 18th 2023). Informed consent to participate All participants signed the informed consent according to the Helsinki Declaration on human rights. Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Enrichment of staple foods with proteins can be a solution to tackle protein-energy malnutrition in the elderly. For instance, bread can be enriched with pea proteins that are cheap, sustainable and easily digestible. Non-conventional technologies, such as high pressure homogenization (HPH), can improve the digestibility of plant proteins. To characterize the health functionality of pea-enriched bread, a functional bread tailored to elderly consumers was developed by substituting 5% wheat flour with untreated or HPH-treated pea protein concentrate. Protein digestibility and colon fermentability were assessed by mimicking elderly in vitro gastrointestinal and gut microbiota conditions and compared with adult conditions. Bread reformulation with pea proteins affected physical and chemical properties and produced an increase in hardness, which is one of the key features for the acceptability of bread by the elderly. The highest hardness value was observed for pea protein bread, followed by HPH-treated pea protein bread and wheat bread. In vitro protein digestibility and fermentability were affected by reformulation and by physiological digestive conditions, with lower digestibility under elderly conditions compared to adult ones. The obtained results may contribute to a better understanding of food digestibility under different gastrointestinal conditions and its dependence on physiological and formulation factors, and ultimately would help to design age-tailored foods.

In cereal products, the use of flour containing clusters of intact cells has been indicated as a potential strategy to decrease starch digestion. Rye possesses more uniform and thicker cell walls than wheat but its protective effect against starch digestion has not been elucidated. In this study, rye flours with three different particle sizes, large (LF) (∼1700 μm), medium (MF) (∼1200 μm), and small (SF) (∼350 μm), were used to produce model bread. The textural properties of these breads were analysed using Textural Profile Analysis (TPA). The starch digestibility of both the flour and the bread was measured using Englyst's method, while the presence of intact cell clusters was examined using Confocal Laser Scanning Microscopy (CLSM). Additionally, the disintegration of bread digesta during simulated digestion was assessed through image analysis. CLSM micrographs revealed that bread made with MF and LF retained clusters of intact cells after processing, whereas bread made with SF showed damaged cell walls. Starch digestibility in LF and MF was lower (p ≤ 0.05) than that in SF. Bread produced with MF and LF exhibited the least (p ≤ 0.05) cohesive and resilient texture, disintegrated more during digestion, and exhibited higher starch digestibility (p ≤ 0.05) than bread made with SF. These results highlight the central role of bread texture on in vitro starch digestibility., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Children with Down syndrome (DS) experience more difficulties with oral motor skills, including chewing, drinking, and swallowing. The present study attempts to measure the preliminary effectiveness of Global Intensive Feeding Therapy (GIFT) in DS. GIFT is a new rehabilitation program addressing the specific difficulties and needs of each child, focusing on sensory and motor oral abilities. It follows an intensive schedule comprising 15 sessions over 5 consecutive days, with 3 sessions per day. The principles of GIFT are applied with specific objectives for DS., Methods: GIFT was preliminarily implemented among 20 children diagnosed with DS. To measure the efficacy of GIFT, the Karaduman Chewing Performance Scale (KCPS), the International Dysphagia Diet Standardization Initiative (IDDSI), and the Pediatric Screening-Priority Evaluation Dysphagia (PS-PED) were used. Data were analyzed using the Wilcoxon signed-rank test before (T0) and after intervention (T1) and at one-month follow-up (T2). The effect size was also measured for specific outcomes, using Kendall's W., Results: Our findings revealed that children with DS showed no risk of dysphagia according to the PS-PED (mean score 2.80). Furthermore, statistically significant improvements in chewing performance were observed, as measured by the KCPS ( p < 0.01), as well as in texture acceptance and modification, as measured by the IDDSI post-intervention ( p < 0.01). For both the KCPS and IDDSI, a large effect size was found (Kendall's W value > 0.8). Parents/caregivers continued using GIFT at home, and this allowed for a positive outcome at the one-month follow-up., Conclusions: GIFT proved to be effective in the rehabilitation of feeding and swallowing disorders in children with DS, as well as for food acceptance.

In recent years, the role of microbial tryptophan (Trp) catabolism in host-microbiota crosstalk has become a major area of scientific interest. Microbiota-derived Trp catabolites positively contribute to intestinal and systemic homeostasis by acting as ligands of aryl hydrocarbon receptor and pregnane X receptor, and as signaling molecules in microbial communities. Accumulating evidence suggests that microbial Trp catabolism could be therapeutic targets in treating human diseases. A number of bacteria and metabolic pathways have been identified to be responsible for the conversion of Trp in the intestine. Interestingly, many Trp-degrading bacteria can benefit from the supplementation of specific dietary fibers and polyphenols, which in turn increase the microbial production of beneficial Trp catabolites. Thus, this review aims to highlight the emerging role of diets and food components, i.e., food matrix, fiber, and polyphenol, in modulating the microbial catabolism of Trp and discuss the opportunities for potential therapeutic interventions via specifically designed diets targeting the Trp-microbiome axis.

The current consumption trends, combined with the expected demographic growth in the coming years, call for a protein transition, i.e., the partial substitution of animal protein-rich foods with foods rich in proteins produced in a more sustainable way. Here, we have discussed some of the most common and promising protein sources alternative to animal proteins, namely: legumes, insects, and microorganisms (including microalgae and fungi). The primary objective was to assess their nutritional quality through the collection of digestible indispensable amino acid score (DIAAS) values available in the scientific literature. Protein digestibility corrected amino acid score (PDCAAS) values have been used where DIAAS values were not available. The ecological impact of each protein source, its nutritional quality and the potential applications in traditional foods or novel food concepts like meat analogues are also discussed. The data collected show that DIAAS values for animal proteins are higher than all the other protein sources. Soybean proteins, mycoproteins and proteins of some insects present relatively high DIAAS (or PDCAAS) values and must be considered proteins of good quality. This review also highlights the lack of DIAAS values for many potentially promising protein sources and the variability induced by the way the proteins are processed.

This study explored differences in microbial lipid metabolites among sunflower seeds, soybeans, and walnuts. The matrices were subjected to in vitro digestion and colonic fermentation. Defatted digested materials and fiber/phenolics extracted therefrom were added to sunflower oil (SO) and also fermented. Targeted and untargeted lipidomics were employed to monitor and tentatively identify linoleic acid (LA) metabolites. Walnut fermentation produced the highest free fatty acids (FFAs), LA, and conjugated LAs (CLAs). Defatted digested walnuts added to SO boosted FFAs and CLAs production; the addition of fibre boosted CLAs, whereas the addition of phenolics only increased 9e,11z-CLA and 10e,12z-CLA. Several di-/tri-hydroxy-C18-FAs, reported as microbial LA metabolites for the first time, were annotated. Permutational multivariate analysis of variance indicated significant impacts of food matrix presence and type on lipidomics and C18-FAs. Our findings highlight how the food matrices affect CLA production from dietary lipids, emphasizing the role of food context in microbial lipid metabolism., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The effect of two processing methods of Jack beans ( i.e. cooked bean (CB) and cooked tempeh (CT)) on the in vitro digestibility of protein and starch, as well as the production of short chain fatty acids (SCFAs), γ-aminobutyric acid (GABA), and tryptophan (Trp) metabolites after in vitro colonic fermentation, was investigated. CT was obtained by fungal fermentation after cooking under acidic conditions. CT had significantly higher protein, lower digestible starch, lower total fiber, higher free phenolic compounds, and higher ash content compared to CB. CT exhibited better in vitro protein digestibility than CB and less glucose release during in vitro digestion than CB. A comparable concentration of total SCFAs and GABA was produced after in vitro fermentation of CB and CT, but CB produced more indole than CT, resulting in higher amounts of total Trp metabolites. In summary, our findings show that tempeh fermentation improves the nutritional quality of Jack beans and describe the impact of fermentation on the digestibility of nutrients and the formation of metabolites during colonic fermentation.

The aim of this study was to investigate the effects of carrot shape (cube vs. julienne) and oral processing behaviour, specifically chewing time, on bolus properties and bioaccessibility of β-carotene in raw carrots. Participants (n = 20) consumed raw carrot cubes (15 × 15 × 15 mm, 4.2 g/bite) and raw carrot julienne (2 × 3 × 90 mm, 4.2 g/bite) with normal (cube: 20 s/bite; julienne: 28 s/bite) and short (cube: 10 s/bite; julienne: 14 s/bite) chewing time. Expectorated boli were collected and characterized for number and mean area of carrot bolus particles. The proportion of easily extractable β-carotene of the carrot bolus was taken as an approximate indicator of the potentially bioaccessible β-carotene. Longer chewing time resulted in significantly more and smaller carrot bolus particles, larger particle surface area (p < 0.01) and higher proportion of easily extractable β-carotene than shorter chewing of raw carrots of both shapes (Cube&#95;Normal vs. Cube&#95;Short: 29 ± 7 % vs. 23 ± 7 %; Julienne&#95;Normal vs. Julienne Short: 31 ± 8 % vs. 26 ± 6 %, p < 0.05). Carrot shape significantly influenced number and size of bolus particles (p < 0.01) with carrot julienne generating more and smaller carrot bolus particles than carrot cubes. These differences in bolus properties between carrot julienne and cubes did not influence the proportion of easily extractable β-carotene (p > 0.05). We conclude that differences in oral processing behaviour and the corresponding differences in bolus properties produce only modest differences in β-carotene bioaccessibility of raw carrots regardless of carrot shape., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Lipids in almonds are naturally encapsulated by cell walls which may reduce the actual metabolizable energy content of almonds. Oral processing increases the accessibility of lipids to digestive enzymes by grinding the almond matrix. This study aimed to investigate the effect of adding accompanying foods (chocolate and iceberg lettuce) to almonds on oral processing behaviour, bolus properties and predicted lipid release. Natural chewing times of four almond model foods including one almond (1.3 g), four almonds (4.6 g), one almond with chocolate (4.3 g) and one almond with iceberg lettuce (4.3 g) were collected from n = 59 participants in duplicate. Expectorated boli at the moment of swallowing were characterized for number and mean area of almond bolus particles. Predicted lipid bioaccessibility was estimated using a previously validated model. At similar bite size (4.3-4.6 g), the addition of chocolate and iceberg lettuce to almonds significantly decreased ( p < 0.05) chewing time and significantly increased ( p < 0.05) eating rate compared to consumption of almonds alone. Almond bolus particle sizes were similar for almonds consumed alone (one and four almonds) and with chocolate, while consuming almonds with lettuce generated significantly fewer and larger almond bolus particles ( p < 0.05). Predicted lipid bioaccessibility of almonds consumed with iceberg lettuce was significantly lower ( p < 0.05) than for almonds consumed alone (one and four almonds) and almonds consumed with chocolate. Eating rate correlated significantly and positively with the mean area of bolus particles and significantly and negatively with predicted lipid release. In conclusion, combining almonds with other foods such as chocolate and lettuce influences oral processing behaviour and bolus properties and consequently predicted lipid bioaccessibility of almonds, highlighting the impact of food matrix and consumption context on these aspects.

Effects of whole foods on the microbial production of tryptophan-derived aryl hydrocarbon receptor (AhR) ligands in the intestine were investigated in a pig model. Ileal digesta and faeces of pigs after feeding of eighteen different foods were analyzed. Indole, indole-3-propionic acid, indole-3-acetic acid, indole-3-lactic acid, kynurenine, tryptamine, and indole-3-aldehyde were identified in ileal digesta, which were also identified in faeces but at higher concentrations except indole-3-lactic acid, together with skatole, oxindole, serotonin, and indoleacrylic acid. The panel of tryptophan catabolites in ileal digesta and faeces varied across different foods. Eggs induced the highest overall concentration of catabolites in ileal digesta dominated by indole. Amaranth induced the highest overall concentration of catabolites in faeces dominated by skatole. Using a reporter cell line, we observed many faecal samples but not ileal samples retained AhR activity. Collectively, these findings contribute to food selection targeting AhR ligands production from dietary tryptophan in the intestine., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Because of its high protein content, Jack bean (Canavalia ensiformis) is a promising alternative protein source. However, the utilization of Jack bean is limited due to the long cooking time to achieve palatable softness. We hypothesize that the cooking time may influence protein and starch digestibility. In this study, we characterized seven Jack bean collections with different optimal cooking times in terms of their proximate composition, microstructure and protein and starch digestibility. Kidney bean was included as a reference for microstructure and protein and starch digestibility. Proximate composition showed that Jack bean collections have a protein content ranging from 28.8 to 39.3%, a starch content ranging from 31 to 41%, a fiber content from 15.4 to 24.6%, and a concanavalin A content in the range 35-51 mg/g dry cotyledon. Particle sizes ranging between 125 and 250 µm were chosen as a representative sample of the whole bean to characterize microstructure and digestibility of the seven collections. Confocal laser microscopy (CLSM) revealed that Jack bean cells have an oval shape and contain starch granules embedded in a protein matrix similar to kidney bean cells. The diameter of Jack bean cells was measured by image analysis of CLSM micrographs and ranged from 103 to 123 µm, while the diameter of starch granules was 31-38 µm, comparatively larger than that of the kidney bean starch granules. Isolated intact cells were used to determine the starch and protein digestibility in the Jack beans collections. The digestion kinetics of starch followed a logistic model, whereas the digestion kinetics of protein followed a fractional conversion model. We found no correlation between optimal cooking time and kinetic parameters of protein and starch digestibility, implying that optimal cooking time is not predictive of protein and starch digestibility. In addition, we tested the effect of reduced cooking times on protein and starch digestibility on one Jack bean collection. The result showed that reducing cooking time significantly reduces starch digestibility, but not protein digestibility. The present study contributes to our understanding of the effect of food processing on protein and starch digestibility in legumes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This study investigated the effect of high-fiber-low-protein (HF) and high-protein-low-fiber (HP) diets on microbial catabolism of tryptophan in the proximal colon (PC) and distal colon(DC) compartments of the Simulator of the Human Intestinal Microbial Ecosystem. The microbiota in PC and DC was dominated by Bacteroidetes and Firmicutes, in which Bacteroidetes were more abundant in DC (∼60% versus 50%) and Firmicutes were more abundant in PC (∼40% versus 25%). Most of the tryptophan catabolites were determined at a higher concentration in PC samples than in DC samples, but the overall concentration of tryptophan catabolites was over 10-fold higher in DC samples than that in PC samples. Interestingly, indole-3-propionic acid and oxindole were only identified in DC samples. A two-week dietary intervention by the HF diet enriched the abundance of Firmicutes in PC, whereas the HP diet enriched the abundance of Proteobacteria. Compared to the HP diet, the HF diet favored the microbial production of indole-3-acetic acid, indole-3-lactic acid, indole-3-aldehyde, and indole-3-propionic acid in both PC and DC compartments. To conclude, these findings increase the understanding of the effect of diets on the microbial production of tryptophan catabolites in the colon.

Feeding and swallowing disorders (FSD) are common during childhood, with a prevalence of 85% in children with neurodevelopmental disorders. A comprehensive screening is essential to identify FSD and improve health outcomes in a clinical setting. This study aims to develop a new Pediatric Screening tool capable of identifying FSD. This screening tool was developed in three steps: selecting variables based on clinical experience, searching the literature and finding agreement between experts with a two-round Delphi study. This process, which reached 97% of agreement between experts, led to the development of the Pediatric Screening-Priority Evaluation Dysphagia (PS-PED). PS-PED comprises 14 items divided into three main domains: clinical history, health status and feeding condition. We also carried out a pilot test for measuring internal consistency, as measured with Cronbach Coefficient alpha. Concurrent validity, as measured with Pearson correlation coefficient, was tested using a videofluoroscopy swallow study (VFSS) classified with the Penetration Aspiration Scale (PAS). The pilot test was conducted on 59 children with different health conditions. Our findings showed good internal consistency (alpha = 0.731), and a strong linear correlation with PAS (Pearson 0.824). Furthermore, comparing PS-PED and PAS scores, we find preliminary strong discriminant validity to identify children with FSD ( p < 0.01). Our results provide evidence on using the 14-item PS-PED as a screening tool for FSD in a clinical sample of children with heterogeneous disease.

This research assessed the influence of pickling, fermentation, germination, and tea brewing on lignan content of a variety of food highly consumed in Malaysia. Lignans have been measured by a validated LC-MS/MS method. Secoisolariciresinol (SECO) was the most abundant compound in fermented and germinated samples. Pickling significantly decreased larisiresinol content by approximately 86 %. Fermentation increased lignan content in a mixture of flaxseed and mung beans (799.9 ± 67.4 mg/100 g DW) compared to the unfermented counterpart (501.4 ± 134.6 mg/100 g DW), whereas the fermentation of soybeans and mung beans did not significantly affect the SECO content. Germination increased lignan content, which reached its peak on day 6 of germination for all the tested matrixes. In tea brew, lignans concentration increased with brewing time reaching its highest concentration at 10 min of brewing. The results of this study expand the knowledge on the effect of processing on lignan content in food., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Effects of pectin, inulin, and their combination on the production of microbiota-derived indoles and short-chain fatty acids (SCFAs) from different colon segments were investigated in a batch system inoculated with microbiota from proximal colon (PC) and distal colon (DC) compartments of the Simulator of Human Intestinal Microbial Ecosystem. Bacteria from DC compartment had a higher abundance of Firmicutes and a stronger capacity to produce indoles and SCFAs than bacteria from PC compartment. Fiber supplementation significantly increased the production of SCFAs, indole-3-propionic acid, and indole-3-lactic acid, but decreased the production of oxindole, tryptamine, and serotonin. Pectin specifically promoted the production of indole-3-acetic acid and indole-3-aldehyde. Interestingly, supplementation of pectin or inulin increased the relative abundance of Bacteroidetes whereas supplementation of a mixture of two fibers decreased it. Overall, these results suggest that fiber supplementation and colon segment affect the composition of gut microbiota and the microbial catabolism of tryptophan., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Reduction of starch digestibility in starchy foods is beneficial for lowering the risks for major non-communicable diseases. Preserving cell integrity is known to delay starch digestibility in flour but its effect in bread is not clear. In this study, the effect of increasing particle size on in vitro starch digestibility of durum wheat flour, dough, and bread was investigated. Cell integrity was retained during bread processing for medium (1000 µm-1800 µm), and large (>1800 µm) flour, whereas in small one cell walls were mostly damaged (<350 µm). In vitro starch digestibility of flour decreased increasing particle size, but no difference was found in dough. In bread, instead, a modest decrease of starch digestibility for the bread made by large particle was observed, likely due to its dense structure. In conclusion, a high particle size could limit starch digestibility in durum wheat flour but not in bread., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose: Oral processing behaviour may contribute to individual differences in glycaemic response to foods, especially in plant tissue where chewing behaviour can modulate release of starch from the cellular matrix. The aim of this study was to assess the impact of chewing time of two starch based foods (brown rice and chickpeas) on bolus properties, in vitro starch digestion and postprandial glycaemic excursion in healthy subjects., Methods: In a cross-over trial participants (n = 26) consumed two carbohydrates-identical test meals (brown rice: 233 g; chickpeas: 323 g) with either long (brown rice: 41 s/bite; chickpeas: 37 s/bite) or short (brown rice: 23 s/bite; chickpeas: 20 s/bite) chewing time in duplicate while glycaemic responses were monitored using a continuous glucose monitoring device. Expectorated boli were collected, then bolus properties (number, mean area, saliva amylase activity) and in vitro starch digestion were determined., Results: Longer chewing resulted in significantly (p < 0.05) more and smaller bolus particles, higher bolus saliva uptake and higher in vitro degree of intestinal starch hydrolysis (DH&#95;S chewing time %) than shorter chewing for both foods (brown rice: DH&#95;S% 23 s  = 84 ± 4% and DH&#95;%S 41s  = 90 ± 6%; chickpeas: DH&#95;S% 20 s  = 27 ± 3% and DH&#95;%S 37s  = 34 ± 5%, p < 0.001). No significant effect of chewing time on glycaemic response (iAUC) (p > 0.05) was found for both meals. Brown rice showed significantly and considerably higher in vitro degree of intestinal starch hydrolysis and glycaemic response (iAUC) than chickpeas regardless of chewing time. No significant correlations were observed between bolus properties and in vitro starch hydrolysis or glycaemic response (p > 0.05)., Conclusion: Differences in the innate structure of starch based foods (brown rice compared to chickpeas) have a larger effect on postprandial glucose response than differences in mastication behaviour although oral processing behaviour showed consistent effects on bolus properties and in vitro starch digestion. Trial registration ClinicalTrials.gov identifier: NCT04648397 (First posted: December 1, 2020)., (© 2022. The Author(s).)

This research assessed the influence of fermentation and germination as well as of particle size on lignan bioaccessibility from flaxseed by simulated in vitro gastrointestinal digestion. In vitro simulated colonic fermentation was used to study lignan release and its conversion into enterolignans. In addition, tea was included as a representative sample to investigate the stability of lignans in the gastrointestinal tract. Only secoisolariciresinol (SECO) was detected in flaxseed samples. SECO bioaccessibility in fermented flaxseed was highest among all matrices but limited to ≈1% ( P < 0.001). Lignan bioaccessibility was significantly influenced by particle size too ( P < 0.001 for both). In the colon, fermented flaxseed produced the highest SECO release among all flaxseed samples (≈65%), and the highest conversion of enterolignan (≈1.0%), whereas the conversion of lignans in tea brew was relatively high (≈15%). Lignan conversion varies greatly among donors due to inter-individual differences in microbiota activity. Food fermentation could be a viable strategy for increasing lignan release and conversion to enterolignan.

In this study, the nature of lentil protein-tannic acid (LPTA) interaction and its effect on in vitro pepsin digestion were investigated. LPTA mixtures containing 1% w/v LP and 0.001-0.5% TA were prepared and characterized in terms of particle size, thermal properties, and secondary and tertiary structures. A 20-fold increase in particle size was observed in LPTA0.5% compared to LP control (without TA), indicating aggregation. Static quenching of tryptophan residues within the protein hydrophobic folds was observed. Increasing TA levels also enhanced protein thermal stability. Over 50% reduction in free amino groups of LPTA 0.5%, relative to LP, was observed after pepsin digestion. Cleavage specificity of pepsin and peptidomic profile of LP were modified by the presence of TA in LPTA 0.5%. This study showed that 0.5% w/v TA induced protein aggregation and reduced LP digestibility by hindering the accessibility of pepsin to the protein network, thus modifying the profile of released peptides.

It has been recognized that, next to dietary fibre and proteins, gut microbiota can metabolize lipids producing bioactive metabolites. However, the metabolism of dietary lipids by human gut microbiota has been poorly explored so far. This study aimed to examine the change in lipids, particularly linoleic acid (LA), induced by the chemical form of lipids and the presence of the plant matrix. Short-chain fatty acid (SCFA) production was monitored to get an insight into microbial activity. Free LA, glyceryl trilinoleate and soybean oil as well as digested intact (DS) and broken (BS) soybean cells were subjected to in vitro fermentation using human faecal inoculums. Confocal microscopy was used to visualize the soybean cell integrity. Three LA metabolites, including two conjugated fatty acids (CLAs, 9z,11e and 9e,11e) and 12hydroxy, 9z C18:1, were identified and monitored. Free LA addition improved the LA metabolite production but reduced SCFA concentrations compared to trilinoleate and soybean oil. Breaking cell integrity had impacts on CLA, hydroxy C18:1 and SCFA production and free fatty acid release within the first 24 h of fermentation, but this effect vanished with time. In contrast, soybean oil only increased free LA release and hydroxy C18:1 production. The content of several FAs decreased during fermentation suggesting a substantial conversion in microbial metabolites. Besides, LA metabolites were also identified in the fermentation pellets suggesting the incorporation of microbial FA metabolites into bacterial cells. This study expands our understanding of microbial metabolism of dietary lipids with a special emphasis on the role of food- and diet-related factors.

The aryl hydrocarbon receptor (AhR) plays an important role in intestinal homeostasis, and some microbial metabolites of tryptophan are known AhR agonists. In this study, we assessed the impact of tryptophan supplementation on the formation of tryptophan metabolites, AhR activation, and microbiota composition in the simulator of the human intestinal microbial ecosystem (SHIME). AhR activation, microbial composition, and tryptophan metabolites were compared during high tryptophan supplementation (4 g/L tryptophan), control, and wash-out periods. During tryptophan supplementation, the concentration of several tryptophan metabolites was increased compared to the control and wash-out period, but AhR activation by fermenter supernatant was significantly decreased. This was due to the higher levels of tryptophan, which was found to be an antagonist of AhR signaling. Tryptophan supplementation induced most microbial changes in the transverse colon including increased relative abundance of lactobacillus. We conclude that tryptophan supplementation leads to increased formation of AhR agonists in the colon.

Oral processing behaviour can affect the bioavailability of macronutrients. The aim of the present study was to determine the influence of oral processing behaviour on bolus properties and in vitro protein digestion of chicken and soya-based vegetarian chicken. Natural chewing time and chewing frequency of both foods were determined in healthy adults (n 96). While natural chewing time differed considerably between consumers (chicken: 7·7-39·4 s; soya-based vegetarian chicken: 7·8-46·2 s), chewing frequency (1·4 chews/s) did not differ considerably between consumers and was independent of product type. Natural chewing times of 11 and 24 s were found for clusters of consumers showing shortest and longest chewing time for both products. Chicken and soya-based vegetarian chicken were chewed for 11 and 24 s and boli expectorated by n 16 consumers to determine in vitro gastric digestion and by n 7 to determine in vitro intestinal digestion. For both foods, longer chewing time resulted in the formation of significantly (P < 0·05) more and smaller bolus fragments and higher in vitro degree of protein hydrolysis (DH%) than shorter chewing time (chicken: DH%11s = 7 ± 23 % and DH%24s = 89 ± 26 %; soya-based vegetarian chicken: DH%11s = 57 ± 18 % and DH%24s = 70 ± 21 %, P < 0·001). In vitro degree of protein hydrolysis was higher for chicken than that for soya-based vegetarian chicken regardless of chewing time. We conclude that naturally occurring longer chewing time leads to more and smaller bolus particles of chicken and soya-based vegetarian chicken and thereby increases in vitro protein hydrolysis compared with shorter chewing time.

Introduction: Cardio-cerebrovascular (CCV) disease contributes significantly to the global burden of disease, with dramatic consequences in terms of mortality and general health. Mitigate CCV risk factors is the key to reduce individual and population risk of CCV events. Evidence-based medicine and epidemiological investigations of risk factors are essential to optimize actions., Aim: To contribute to the knowledge of the burden of risk factors in determining CCV events in the individual patient and in the community., Methods: Clinical data and risk factors were collected through a longitudinal survey (1999) as part of a larger epidemiology and cardiovascular prevention project, namely the "VIP (Valle dell'Irno Prevention) Project". We assessed the incidence of major cardiovascular events (MACE) and for each risk factor we calculated: prevalence, absolute risk, odds ratio (OR), additional risk (AR) = risk of exposed to the risk factor - risk of non-exposed, population attributable risk (PAR) = additional risk * prevalence, population attributable risk fraction (PAF) = PAR/total incidence of the disease., Results: Comparing the MACE group with the non-MACE group, a statistically significant difference was found for the following: glomerular filtration rate (GFR), glucose and systolic blood pressure (SBP), BMI, diastolic blood pressure (DBP), cholesterol, triglycerides, creatinine and uric acid. GFR, glucose and SBP showed the highest OR. Age, creatinine, glycemia, SBP and uric acid were independent predictor of MACE. When calculating the PAF, the CCV risk factors with the greatest impact on MACE were: SBP (29.6%), triglyceridemia (19.4%) and metabolic syndrome (18.3%)., Conclusion: The burden of risk factors on MACE changes substantially according to whether it is calculated in the single patient or in the population. It is crucial for physicians to take these differences into account when applying their own intervention to reduce CCV events., (© 2021. Italian Society of Hypertension.)

Inhibition of maltase, sucrase, isomaltase and glucoamylase activity by acarbose, epigallocatechin gallate, epicatechin gallate and four polyphenol-rich tea extract from white, green, oolong, black tea, were investigated by using rat intestinal enzymes and human Caco-2 cells. Regarding rat intestinal enzyme mixture, all four tea extracts were very effective in inhibiting maltase and glucoamylase activity, but only white tea extract inhibited sucrase and isomaltase activity and the inhibition was limited. Mixed-type inhibition on rat maltase activity was observed. Tea extracts in combination with acarbose, produced a synergistic inhibitory effect on rat maltase activity. Caco-2 cells experiments were conducted in Transwells. Green tea extract and epigallocatechin gallate show dose-dependent inhibition on human sucrase activity, but no inhibition on rat sucrase activity. The opposite was observed on maltase activity. The results highlighted the different response in the two investigated model systems and show that tea polyphenols are good inhibitors for α-glucosidase activity., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Conventional lung cancer treatments include surgery, chemotherapy and radiotherapy; however, these treatments are often poorly tolerated by patients. Cannabinoids have been studied for use as a primary cancer treatment. Cannabinoids, which are chemically similar to our own body's endocannabinoids, can interact with signalling pathways to control the fate of cells, including cancer cells. We present a patient who declined conventional lung cancer treatment. Without the knowledge of her clinicians, she chose to self-administer 'cannabidiol (CBD) oil' orally 2-3 times daily. Serial imaging shows that her cancer reduced in size progressively from 41 mm to 10 mm over a period of 2.5 years. Previous studies have failed to agree on the usefulness of cannabinoids as a cancer treatment. This case appears to demonstrate a possible benefit of 'CBD oil' intake that may have resulted in the observed tumour regression. The use of cannabinoids as a potential cancer treatment justifies further research., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm caused by the presence of tyrosine kinase BCR-ABL1 fusion protein, which deregulate transcription and mRNA translation. Tyrosine kinase inhibitors (TKIs) are the first-choice treatment. However, resistance to TKIs remains a challenge to cure CML patients. Here, we reveal that the m 6 A methyltransferase complex METTL3/METTL14 is upregulated in CML patients and that is required for proliferation of primary CML cells and CML cell lines sensitive and resistant to the TKI imatinib. We demonstrate that depletion of METTL3 strongly impairs global translation efficiency. In particular, our data show that METTL3 is crucial for the expression of genes involved in ribosome biogenesis and translation. Specifically, we found that METTL3 directly regulates the level of PES1 protein identified as an oncogene in several tumors. We propose a model in which nuclear METTL3/METTL14 methyltransferase complex modified nascent transcripts whose translation is enhanced by cytoplasmic localization of METTL3, independently from its catalytic activity. In conclusion, our results point to METTL3 as a novel relevant oncogene in CML and as a promising therapeutic target for TKI resistant CML., (© 2021. The Author(s).)

In this study, β-glucan interaction with lentil and yellow pea proteins and the effect on in vitro protein digestibility were investigated. Proteins were mixed with β-glucan at mass ratios of 1:0.5, 1:1, and 1:2. The interaction between β-glucan and the proteins was demonstrated by the decrease in transmittance and surface charge and the increase in particle size of the complexes. Bright-field microscopy showed the formation of aggregates between the biopolymers, although increased molecular size was not observed by discontinuous native polyacrylamide gel electrophoresis. Fluorescence microscopy indicated that β-glucan formed aggregates with lentil proteins, while the interaction with yellow pea proteins appeared as distinct phases of protein within the β-glucan network. The in vitro protein digestibility of lentil and pea protein decreased by 27.3 and 34.5%, respectively, in the presence of a β-glucan mass ratio of 1:2. The findings confirm the possibility to modulate protein digestibility by changing the physical characteristics of a food matrix.

Immature grain represents a precious nutritional source in many rural Africa areas. To optimize processing of immature rice into pepeta (a traditional rice-flakes produced from immature rice grains), immature rice (TXD306 variety) harvested at 18 and 26 days after 50% heading were processed in the laboratory under different soaking (0 and 12 h) and roasting temperature (80, 100 and 120 °C) regimes. Riboflavin, nicotinic acid, nicotinamide and iron concentration increased with severity of roasting temperature, while thiamine has an opposite trend. Heating promoted the transformation of insoluble into soluble dietary fiber, increased lipid digestibility decreasing protein one, which showed the highest value when rice was roasted at 100 °C. Soaking before roasting significantly increased moisture and iron content while slightly increased riboflavin, nicotinic acid and nicotinamide when compared to unsoaked products. Among roasted products, starch digestibility increased with roasting temperature. Microstructure analysis indicated a complete loss of cell wall integrity in cooked rice, determining a complete starch and protein digestion while this is delayed in raw rice and roasted products. We concluded that roasting at 100 °C is the optimum temperature to produce pepeta of the highest protein digestibility and low starch digestibility. Soaking before roasting at 120 °C is best when retaining micronutrients is considered.

Scope: This study aims to investigate the effect of tryptophan sources on tryptophan catabolism by gut microbiota and the aryl hydrocarbon receptor (AhR) activation., Methods and Results: Four substrates (free tryptophan, soybean protein, single and clustered soybean cells) containing an equimolar amount of tryptophan, but with a different bioaccessibility are studied using in vitro batch fermentation. Tryptophan catabolites are identified by LC-MS/MS. AhR activity is measured by HepG2-Lucia AhR reporter cells. The total amount of tryptophan-derived catabolites increases with decreasing level of substrate complexity. Indole is the major catabolite produced from tryptophan and it is the most abundant in the free tryptophan fermentation. Indole-3-acetic acid and indole-3-aldehyde are abundantly generated in the soybean protein fermentation. The soybean cell fermentation produced high concentrations of tryptamine. Interestingly, large amounts of short-chain fatty acids (SCFAs) are also found in the soybean cell and protein fermentation. Both tryptophan-derived catabolites and SCFAs are able to increase AhR reporter activity over time in all four groups., Conclusion: This study illustrates that bacterial catabolism of tryptophan and resulting AhR activation in the gut is modulated by the food matrix, suggesting a role for food design to improve gut health., (© 2021 The Authors. Molecular Nutrition & Food Research published by Wiley-VCH GmbH.)

In the present study we investigated the effect of cellular integrity on microbial utilization of proteins and carbohydrates by gut microbiota. Cotyledon cells from red kidney beans with different levels of structural integrity were fermented in-vitro by microbial communities previously adapted to the conditions of ascending, transverse and descending colon. The effect of bacterial adaptation to substrate was also assessed by using microbiota exposed to a diet rich in bean cells. Microscopy analyses indicate that cell integrity was maintained during fermentation. The amount of gas generated and the rate of total gas production was higher in broken cells compared to intact cells which suggest a faster and more extensive utilization of nutrients when cell wall is broken. A significantly higher butyric and propionic acid level was detected in broken cells at the end of the fermentation. Moreover, adapted bacterial communities were more efficient in fermenting bean cells where higher amounts of butyrate were produced in all colon regions independently of sample integrity. Bacterial communities of the distal colon appeared to be the most efficient in carbohydrate and protein fermentation as witnessed by the higher levels of gas, and short chain fatty acids. It was also found that cell integrity and adaptation to bean cells modulate the hierarchy of nutrient utilization, with non-starch polysaccharides preferred over starch and proteins by microbiota exposed to bean cells. Our results demonstrated that structural aspects of foods, such as cell integrity in plant tissues, may modulate nutrients utilization by gut microbiota.

Background: Vitamin D (25(OH)D) deficiency is a prevalent condition worldwide. However, the highest prevalence rates of 25(OH)D deficiency have been attributed to regions with higher latitude. A close association between 25(OH)D and cardio-cerebrovascular (CCV) risk factors and major health problems has been identified., Aim: To establish the prevalence of 25(OH)D deficiency and to investigate the relationship between 25(OH)D levels and CCV risk factors (blood cholesterol, triglycerides, glucose concentrations, body mass index, and systolic and diastolic blood pressure) in a cohort representative of Southern Italy., Methods: The prevalence of 25(OH)D levels was evaluated in 1200 subjects aged 25-74 years (600 males and 600 females), enrolled in the "VIP" (from Italian for Irno Valley Prevention ) Project, whereas multiple linear regression analysis was used to determine the relationship between 25(OH)D levels and CCV risk factors., Results: Only 13.3% of females and 11.1% of males showed adequate serum concentrations of 25(OH)D (≥30 ng/ml), while 59.3% of females and 55.1% of males showed 25(OH)D deficient levels (<20 ng/ml). We observed an independent association between 25(OH)D concentrations and metabolic syndrome score, LDL cholesterol, HDL cholesterol, and corrected QT (cQT)., Conclusions: We report a high prevalence of 25(OH)D deficiency across the largest Italian adult population studied so far and, in particular, the first across Southern Italy; furthermore, we provide data on the association between 25(OH)D deficiency and higher CCV risk factors., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Rocco Capuano et al.)

Safety of healthcare workers in hospitals is a major concern during the COVID-19 pandemic. Being exposed for several working hours per day to infected patients, nurses dealing with COVID-19 face several issues that lead to physical/psychological breakdown. This study focused on burnout and its associated factors in nurses working in an Italian University Hospital during the first wave of COVID-19 pandemic. We designed a web-based cross-sectional study addressed to nurses working at the University Hospital in Foggia, Italy. The online questionnaire was organized in sections aimed at collecting demographic and occupational variables, including the Maslach Burnout Inventory (MBI) and the Oldenburg Burnout Inventory (OBI). Two hundred and ninety-three nurses agreed to participate. According to MBI, we reported moderate/high emotional exhaustion in 76.5%, depersonalization in 50.2%, and personal gratification in 54.6% of participants. COVID-19-related burnout measured by OBI resulted medium/high in 89.1% of participants. Among demographic and occupational factors, a multivariate regression analysis identified emotional support, consideration of leaving job, and workload as predictive of burnout in nurses. In conclusion, this study suggests that the improvement of employer and family support to nurses, as well as reduction of workload and job-related stress, would contribute to reducing burnout in nurses during COVID-19 pandemics.

Previous studies showed that in vitro digestibility of proteins in cooked beans is modulated by heat treatment and that the effect may be different whether proteins are heated in intact cotyledon or in a bean flour. In this study, germinated and non-germinated soybean cotyledons and flour were boiled at 100 °C for varying times (30, 90, or 180 min). After grinding, the level of trypsin inhibitors, protein aggregation, surface hydrophobicity, the secondary structure, and in vitro digestibility were studied. The presence of an intact cell wall during cooking increased protein denaturation temperature by about 10% and reduced the denaturation of trypsin inhibitors, and induced distinct changes in protein surface hydrophobicity and secondary structure. These physicochemical properties translated into an increment in protein degree of hydrolysis (DH, 72%) of protein cooked for 30 min as flour compared to proteins cooked in intact soybean tissues (64%). Increase in cooking times (90 and 180 min) resulted in limited improvement in the protein digestibility and changes in protein physicochemical properties for both boiled cotyledons and flour. Soybean germination resulted in distinct changes in protein physicochemical properties and higher protein DH% of raw soybean (61%) compared to non-germinated raw soybean (36%). An increase in protein digestibility of germinated soybean was also observed after boiling for both cotyledon and flour. However, significant differences in DH% were not observed between proteins boiled in intact cotyledon and in a flour. This work provides extra knowledge of the role of cellular integrity on protein properties in plant foods and suggests that germination or grinding before cooking may increase protein digestibility., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Food digestion may be regarded as a physiological interface between food and health. During digestion, the food matrix is broken down and the component nutrients and bioactive compounds are absorbed through a synergy of mechanical, chemical, and biochemical processes. The food matrix modulates the extent and kinetics to which nutrients and bioactive compounds make themselves available for absorption, hence regulating their concentration profile in the blood and their utilization in peripheral tissues. In this review, we discuss the structural and compositional aspects of food that modulate macronutrient digestibility in each step of digestion. We also discuss in silico modeling approaches to describe the effect of the food matrix on macronutrient digestion. The detailed knowledge of how the food matrix is digested can provide a mechanistic basis to elucidate the complex effect of food on human health and design food with improved functionality.

Consumption of pepeta, a traditionally processed immature rice product, is common in Tanzania, where it contributes to food security as an early rice food i.e. when there is no other food available at the household while the crops in the field not yet fully ripe. Many production steps are needed to guarantee a consistent, good quality pepeta product, and this hinders its utilization in other rice-growing sub-Saharan regions. This study aims to gain insight into the pepeta processing knowledge and final product, and assess variations in the processing conditions and parameters across the study area. A survey among 257 Tanzanian processors and consumers revealed that the pepeta product is widely known, rated second (73.5% respondents) as rice-based food after wali (cooked white rice, (100%)) and linked to traditions of the communities in the study area. Harvest of immature rice grain, roasting, pounding, cleaning, and packing are the main process steps of pepeta production. Method of rice harvest, rice suitability for pepeta production after optimum harvest, dryness of grains and number of pounding as indicator to terminate roasting and pounding process respectively, and packaging materials used varied significantly across respondents in the study area. Reported criteria considered by respondents for product acceptability did not vary significantly across study area. The criteria include colour (76.5%), general appearance (60.8%), texture (64.7%) and taste (52.9%). Immature rice paddy and pepeta were sold at a higher price than mature rice paddy and white rice, respectively, which implies that options to facilitate pepeta processing through, for instance, standardization of processing conditions and parameters could lead to increased income., Competing Interests: The authors have declared that no competing interests exist.

The role of the plant matrix is recognized as the main factor restricting starch digestibility in beans. Several authors have provided insights about the mechanisms behind the reduced starch digestibility in plant matrices. In this study, by means of a mathematical model, we provide a mechanistic explanation of the role played by the cell wall. It was confirmed that starch entrapped within intact cells could only be hydrolysed after α-amylase diffusion through the cell wall. This process is limited by the pores naturally present in the cell wall and the adsorption of α-amylase to the cell wall surface. These factors restrict the concentration of α-amylase available within the cells. The model assumptions are valid under controlled laboratory conditions and were validated with in-vitro digestion data giving very accurate results. The proposed approach provides new information to understand the digestibility of starch, and possibly other macronutrients, in complex food matrices., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

As the COVID-19 pandemic has spread across the globe, questions have arisen about the approach healthcare systems should adopt in order to optimally manage patient influx. With a focus on the impact of COVID-19 on the NHS, we describe the frontline experience of a severely affected hospital in close proximity to London. We highlight a protocol-driven approach, incorporating the use of CT in the rapid triage, assessment and cohorting of patients, in an environment where there was a lack of readily available, onsite RT-PCR testing facilities. Furthermore, the effects of the protocol on the effective streamlining of patient flow within the hospital are discussed, as are the resultant improvements in clinical management decisions within the acute care service. This model may help other healthcare systems in managing this pandemic whilst assessing their own needs and resources.

The effect of the degree of nut mastication on bioavailability of their nutrients has been established previously. In contrast, the effect of incorporation of nuts into composite food matrixes on oral processing behaviour and structural breakdown has been studied scarcely. This study aimed to investigate the effect of incorporation of hazelnuts into bread matrixes in comparison with plain hazelnuts on bolus properties and chewing behaviour. Amount of plain hazelnuts was varied to investigate the effect of portion size on bolus properties and chewing behaviour. Bolus particle size distribution was obtained by image analysis of expectorated boli by n = 20 participants. Median bolus particle diameter (d 50 ) and broadness of particle size distribution (b) were quantified by fitting the cumulative area distribution curve with a modified Rosin-Rammler function. Oral processing behaviour (number of chews, chewing time, chewing frequency) was quantified by means of a stopwatch. Mastication of two hazelnuts resulted in smaller d 50 than mastication of six hazelnuts or mastication of two hazelnuts in white bread or baguette. Chewing time of two hazelnuts was significantly shorter than chewing time of six hazelnuts or chewing time of two hazelnuts in white bread or baguette, while chewing frequency did not differ between foods. d 50 of six hazelnuts did not significantly differ from d 50 of two hazelnuts in either bread matrix. Broadness b of the particle size distribution was significantly smaller for six hazelnuts compared to the other foods. We conclude that d 50 was affected by bite size or bite volume rather than by incorporation of hazelnuts into bread. We suggest that incorporation of hazelnuts into bread matrixes has a relatively small impact on size of hazelnut bolus particles produced upon mastication., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Rice is commonly consumed as fully mature grain, but immature rice is considered to have better nutrient and technological properties. This is attributed to changes in content and profile of nutritional and functional compounds during maturation. This study assessed the effect of maturity on nutrient content of rice grains, and in vitro digestibility of starch and protein, for immature rice grains of TXD306 and Lawama varieties. The effect of processing of immature rice into so-called pepeta, traditionally produced from immature rice grains and widely consumed in Tanzania, was studied as well. The results showed reductions in lipid, protein, ash, thiamine, nicotinic acid, nicotinamide, and soluble and insoluble dietary fibre contents during rice grain development. However, no effect of maturity on in vitro starch and protein digestibility was observed. The contents of protein, ash, lipid, nicotinamide, iron, zinc, and total, soluble and insoluble dietary fibre were higher in pepeta from both varieties than in the corresponding rice grains. Protein digestibility of pepeta flour was 58.9% higher than that of cooked rice for variety TXD306, and 73.8% higher for Lawama. Differential scanning calorimetry indicated that starch of processed immature rice was completely gelatinized whereas its susceptibility to digestion in vitro was slightly lower than for cooked rice, possibly due to the higher cellular integrity retained after processing. These results demonstrate that pepeta-type processing improves the nutritional properties of rice and its potential use as a snack or ingredient in cereal-based formulas.

The inhibitory effect of tea polyphenols on starch digestibility can contribute to the control of the glycaemic index of starchy food. In this study, wheat bread and gluten-free bread were co-digested in vitro with different amounts of tea polyphenols. The kinetics of starch digestion and polyphenol bio-accessibility during in vitro digestion were monitored. The results showed that co-digestion of bread with tea polyphenols dose-dependently slowed the starch digestion kinetics and this effect is influenced by the types of polyphenols and the presence of gluten. The presence of gluten lowered the inhibitory efficacy of tannins on starch digestibility to 7.4% and 47.5% when 25 mg of tannins were co-digested with wheat bread and gluten-free bread, respectively. In contrast, the presence of gluten had little impact on the inhibitory efficacy of monomeric polyphenols. This study shows that the release of tea polyphenols in the digestive environment is a promising strategy for controlling the glycaemic index of starchy food and that monomeric and polymeric tea polyphenols differently affect starch digestion according to the presence of gluten.

Broccoli is rich in glucosinolates, which can be converted upon chewing and processing into Aryl hydrocarbon Receptor (AhR) ligands. Activation of AhR plays an important role in overall gut homeostasis but the role of broccoli processing on the generation of AhR ligands is still largely unknown. In this study, the effects of temperature, cooking method (steaming versus boiling), gastric pH and further digestion of broccoli on AhR activation were investigated in vitro and in ileostomy subjects. For the in vitro study, raw, steamed (t = 3 min and t = 6 min) and boiled (t = 3 min and t = 6 min) broccoli were digested in vitro with different gastric pH. In the in vivo ileostomy study, 8 subjects received a broccoli soup or a broccoli soup plus an exogenous myrosinase source. AhR activation was measured in both in vitro and in vivo samples by using HepG2-Lucia™ AhR reporter cells. Cooking broccoli reduced the AhR activation measured after gastric digestion in vitro, but no effect of gastric pH was found. Indole AhR ligands were not detected or detected at very low levels both after intestinal in vitro digestion and in the ileostomy patient samples, which resulted in no AhR activation. This suggests that the evaluation of the relevance of glucosinolates for AhR modulation in the gut cannot prescind from the way broccoli is processed, and that broccoli consumption does not necessarily produce substantial amounts of AhR ligands in the large intestine.

The extract of microalga Nitzschia laevis (NLE) is considered a source of dietary fucoxanthin, a carotenoid possessing a variety of health benefits. In the present study, the bioaccessibility and deacetylation of fucoxanthin were studied by simulated in vitro gastrointestinal digestion and colonic batch fermentation. In the gastric phase, higher fucoxanthin loss was observed at pH 3 compared to pH 4 and 5. Lipases are crucial for the deacetylation of fucoxanthin into fucoxanthinol. Fucoxanthinol production decreased significantly in the order: pure fucoxanthin (25.3%) > NLE (21.3%) > fucoxanthin-containing emulsion (11.74%). More than 32.7% of fucoxanthin and fucoxanthinol was bioaccessible after gastrointestinal digestion of NLE. During colon fermentation of NLE, a higher loss of fucoxanthin and changes of short-chain fatty acid production were observed but no fucoxanthinol was detected. Altogether, we provided novel insights on the fucoxanthin fate along the human digestion tract and showed the potential of NLE as a promising source of fucoxanthin.

Apart from the presence of antinutritional factors, digestibility of soybean proteins is limited in intact cells by cell wall permeability to proteolitic enzymes. Food processing may modulate cell wall permeability and hence the accessibility of protease enzymes to intracellular proteins. In this study, soybeans were processed in various ways, e.g. cooking applied alone or with either germination or fermentation processes, and the modification in cell wall permeability was investigated using confocal microscopy to visualize the penetration of FITC-dextran probes into isolated cells/cell clusters. Diffusion of fluorescently labelled trypsin into cells and cell clusters was also monitored. Microscopy observations showed that fermentation and germination as well as proteolitic enzymes increase the permeability of boiled soybean cotyledon cells. The diffusion of trypsin into all the isolated cells was observed at an early stage of simulated in vitro digestion, whereas diffusion into cell clusters was delayed due to a bigger size and limited permeability of cell clusters. A modest, although significant, increase in protein digestibility was observed when boiling was combined with fermentation or germination likely due to pre-digestion of storage proteins and inactivation of trypsin inhibitors. This study highlights the positive role of fermentation and germination in improving protein digestibility in soybeans but overall suggests that cell wall permeability to trypsin plays a minor role in the extent of protein digestion of intact soybean cells.

Acute myeloid leukemia (AML) is often characterized by the expression of fusion or mutant proteins that cause impaired differentiation and enhanced proliferation and survival. The presence of mutant proteins prone to misfolding can render the cells sensitive to endoplasmic reticulum (ER) stress and oxidative stress that could otherwise be overcome. Here, we show that the triple combination of the differentiating agent retinoic acid (RA), the ER stress-inducing drug tunicamycin (Tm), and arsenic trioxide (ATO), able to generate oxidative stress, leads to the death of AML cell lines expressing fusion proteins involving the gene MLL and the internal tandem duplication (ITD) in the FLT3 tyrosine kinase receptor. Importantly, the combination of RA, Tm, and ATO decreased the colony-forming capacity of primary leukemic blasts bearing the FLT-ITD mutation without affecting healthy hematopoietic progenitor cells. We demonstrate in cell lines that combination of these drugs generates ER and oxidative stresses and impairs maturation and causes accumulation of FLT3 protein in the ER. Our data provide a proof of concept that low amounts of drugs that generate ER and oxidative stresses combined with RA could be an effective targeted therapy to hit AML cells characterized by MLL fusion proteins and FLT3-ITD mutation., (© 2019 by The American Society of Hematology.)

Similar to other peripheral artery diseases, vessel narrowing in popliteal artery entrapment syndrome (PAES) reduces the ankle brachial index (ABI). Since the PAES is related to several anatomical or functional variations, we sought to determine if the ABI was correlated with the type of syndrome. Through a systematic review of literature, we identified case reports and series in which the diagnosis of PAES was accompanied by ABI measurement. Twenty-seven studies included in the qualitative synthesis described 87 limbs. The most common types of the syndrome were those caused by an abnormal medial head of the gastrocnemius (type II, n = 35, 40.23%) and aberrant course of the popliteal artery (type I, n = 20, 22.99%). The variation of plantaris muscle ( n = 7, 8.05%) is currently not included in the classification system. The median value of ABI was 0.87 (interquartile range (IQR) = 0.6-1.0). There were no differences among types of syndrome (F = 0.13, p = 0.72). In conclusion, despite clinical recommendations, the ABI remains underused in PAES diagnosis. No correlation was detected between the index score and type of syndrome. The cases of PAES involving structures other than the gastrocnemius or popliteus muscle suggest the need to revisit the current clinical classification system.

Cotyledon cells in kidney beans naturally encapsulate starch and proteins limiting the access of digestive enzymes to their substrates. In this study, we investigated the effect of cell wall on bean protein digestibility and its relationship with starch digestion. Results showed that proteins contained in the cytoplasmic matrix influence the rate at which starch is digested in-vitro. Confocal laser scanning microscopy revealed that storage proteins in the cytoplasm act as a second encapsulation system preventing starch digestion. This microstructural organization only affected starch since no changes in protein digestion rate or extent were observed due to the presence of starch granules. Fourier transform infrared spectroscopy revealed that cellular entrapment limited protein denaturation induced by thermal treatments. High concentrations of a fraction resistant to digestion were found in proteins that were heated when entrapped within intact cotyledon cells, compared to those thermally treated as bean flour., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)