Clinical effects of date palm (Phoenix dactylifera L.): A systematic review on clinical trials

A Sustainable Extraction Approach of Phytochemicals from Date (Phoenix dactylifera L.) Fruit Cultivars Using Ultrasound-Assisted Deep Eutectic Solvent: A Comprehensive Study on Bioactivity and Phenolic Variability

The present study aimed to evaluate the efficacy of natural deep eutectic solvents (NADESs) on the extraction of phytochemicals from eight Algerian date fruit cultivars (Phoenix dactylifera L.). In this study, lactic acid/sucrose-based NADESs were used as an alternative to conventional chemical solvents using the ultrasound-assisted extraction (UAE) method. The obtained extracts were assessed for the determination of bioactive compound contents, phenolic composition, antioxidant activity, and enzyme inhibitory potential. The results showed a considerable variation in phytochemical compositions and related activities between cultivars, where the greatest contents of total phenolics (1288.7 mg GAE/100 g), total flavonoids (53.8 mg QE/100 g), proanthocyanidins (179.5 mg CE/g), and total triterpenoids (12.88 mg OAE/100 g) were detected in the fruits of the Ourous cultivar. The same cultivar displayed the highest antioxidant capacity against DPPH• free radical (595 mg AAE/100 g), ABTS•+ cation radical (839 mg TE/100 g), and ferric reducing antioxidant potential (704 mg AAE/100 g). All extracts manifested moderate antioxidant activities tested by phosphomolybdenum, NO•, and linoleic acid lipid peroxidation assays. These extracts also exhibited interesting levels of in vitro enzyme inhibition; the Ourous cultivar gave the best inhibitory activity against α-amylase and acetylcholinesterase with 45 and 37%, respectively. HPLC-DAD-MS detected a total of five compounds, with phenolic acids and flavonoids being the main phenolics identified in the extract. The phenolic composition exhibited significant variability among cultivars. Notably, the highest amounts were revealed in the Tazizaout cultivar, with the predominance of gallic acid. The results confirmed that the combination of UAE and NADESs provides a novel and important alternative to chemical solvents for sustainable and environmentally friendly extraction and can represent a good alternative in food and pharmaceutical industry applications.

Is oral consumption of dates (Phoenix dactylifera L. fruit) in the peripartum period effective and safe integrative care to facilitate childbirth and improve perinatal outcomes: a comprehensive revised systematic review and dose-response meta-analysis

BACKGROUND

Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this updated systematic review with meta-analysis sought to investigate the efficacy and safety of this integrated intervention in facilitating childbirth and improving perinatal outcomes.

METHODS

Eight data sources were searched comprehensively from their inception until April 30, 2023. Parallel-group randomized and non-randomized controlled trials published in any language were included if conducted during peripartum (i.e., third trimester of pregnancy, late pregnancy, labor, or postpartum) to assess standard care plus oral consumption of dates versus standard care alone or combined with other alternative interventions. The Cochrane Collaboration's Risk of Bias (RoB) assessment tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to evaluate the potential RoB and the overall quality of the evidence, respectively. Sufficient data were pooled by a random-effect approach utilizing Stata software.

RESULTS

Of 2,460 records in the initial search, 48 studies reported in 55 publications were included. Data were insufficient for meta-analysis regarding fetal, neonatal, or infant outcomes; nonetheless, most outcomes were not substantially different between dates consumer and standard care groups. However, meta-analyses revealed that dates consumption in late pregnancy significantly shortened the length of gestation and labor, except for the second labor stage; declined the need for labor induction; accelerated spontaneity of delivery; raised cervical dilatation (CD) upon admission, Bishop score, and frequency of spontaneous vaginal delivery. The dates intake in labor also significantly reduced labor duration, except for the third labor stage, and increased CD two hours post-intervention. Moreover, the intervention during postpartum significantly boosted the breast milk quantity and reduced post-delivery hemorrhage. Likewise, dates supplementation in the third trimester of pregnancy significantly increased maternal hemoglobin levels. The overall evidence quality was also unacceptable, and RoB was high in most studies. Furthermore, the intervention's safety was recorded only in four trials.

CONCLUSION

More well-designed investigations are required to robustly support consuming dates during peripartum as effective and safe integrated care.

TRIAL REGISTRATION

PROSPERO Registration No: CRD42023399626.

Botanicals in health and disease of the testis and male fertility: A scoping review

BACKGROUND

Male factor infertility often results from testicular disorders leading to inadequate sperm quantity and quality. Both beneficial and detrimental effects of botanical products, especially herbal medicines, on testicular functions and male fertility have been reported in the literature.

PURPOSE

This scoping review aims to map the main clinical evidence on different impacts of botanical entities on the testis and to critically appraise relevant randomized controlled trials (RCTs) published in the recent 5 years, so as to inform the future.

METHODS

Systematic reviews, meta-analyses and RCT reports on botanical impacts on testicular functions and male fertility were retrieved and synthesized from Pubmed, Web of Science, Scopus, Embase, ProQuest, Cochrane Library and Google Scholar up to 10th May 2022. RCTs published since 2018 were critically appraised against good practice guidelines for RCT and for reporting herbal studies.

RESULTS

We identified 24 systematic reviews and meta-analyses published since 2005, by authors from Iran (25%), China (21%), USA (12.5%) and 9 other countries. All but two were published in English. Only 3 systematic review protocols were identified, all published in English from China in the recent 3 years. We identified 125 RCTs published in six languages, mainly English (55%) and Chinese (42%). They were published since 1994 from 23 countries on all the six inhabitable continents, with China (46%), Australia (8%), USA (8%), India (7%) and Iran (5%) being the leading contributors. 72% and 28% RCTs published in English were on efficacy (botanicals vs placebo) and comparative effectiveness (a botanical vs other treatments), respectively. In contrast, 98% RCT reports in Chinese were on comparative effectiveness, with merely 2% on efficacy. Among all the 125 RCTs, 57% were studies in patients with semen abnormality and/or male infertility, 22% investigated herbal effects in healthy men, 14% were on patients with male sexual dysfunction and hypogonadism, and 7% were conducted in men with non-sexual disorders. Since 2018, 32 RCTs have been published, in English (69%) or Chinese (31%). Nineteen RCT reports from China, India, Japan and Korea all studied herbal formulae while the 13 RCT reports from Australia, Brazil, Czech and Italy, Iran, Malaysia, Spain, the UK and the USA all exclusively studied extracts of a single species. Putting geo-cultural differences aside, gossypol and extracts of Tripterygium wilfordii Hook. f. were found to be detrimental to the testis and male fertility, while the extracts of Withania somnifera (L.) Dunal and traditional Chinese medicine Qilin Pill, etc., might improve testosterone levels and semen parameters, thus could be therapeutic for male sexual dysfunction and infertility. However, all still require further evaluation in view of recurring weaknesses in quality control of herbal materials, RCT design and reporting. For example, only 9%-23% of the RCTs published since 2018 provided information on voucher samples, chemical profiling, herbal authentication and herbal extraction.

CONCLUSION

Research on botanicals and the testis has been reported worldwide, demonstrating clear geo-cultural differences in studied plant species, botanical types, study objectives and quality of research design, implementation and reporting. Due to a few recurring weaknesses in the literature, this study is unable to recommend the use of any specific botanicals, however, current evidence does indicate that botanicals can be double-edged swords to the testis and male fertility. To secure better clinical evidence, future studies must faithfully implement existing and emerging good practice guidelines.

Phenolic compounds and polysaccharides in the date fruit (Phoenix dactylifera L.): Comparative study on five widely consumed Arabian varieties

The study analysed polysaccharides and phenolic compounds in widely consumed but little studied date fruits varieties such as Sukkari, Ajwa, Segae, Barrny and Khalas harvested at Tamr stage. The total phenols were in similar amount in the five varieties and ranged from 20 to 50 mg/100 g DW. The decoction and successive centrifugation made it possible to collect two main polysaccharide fractions for all the selected fruits. For each variety the first fraction was more abundant, with a lower swelling capacity and a higher amount of galacturonic acid (28.3% to 40.1%). The second fraction was only soluble in alkaline solution, with an average galacturonic acid content of only 17%. The different structure of the two polysaccharide fractions was also confirmed by the composition in neutral sugars and the degrees of methylation and acetylation. The proposed extraction procedure could be applied for larger scale extraction of the date fruit polysaccharides.

Total phenolic content in ripe date fruits (Phoenix dactylifera L.): A systematic review and meta-analysis

Ripe date fruits contain phenolic compounds which possess a high antioxidant activity. The current review was carried out to evaluate total phenolic content in ripe date fruits. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was followed during the review process. Relevant studies published from inception up to March 2019 were retrieved from three databases. Study selection was performed based on specific inclusion criteria. A total of twenty-two articles were selected and included in the present review. Data collected from these studies were organized, pooled, and analyzed using descriptive statistics. Total phenolic content means and medians have been reported for the collected ripe date fruit samples for each included study and pooled data. The results suggested that ripe date fruits contain a potent total phenolic content that can contribute mainly to their antioxidant properties.