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Madkour M, Aboelenin MM, Habashy WS, Matter IA, Shourrap M, Elolimy AA, Aboelazab O. Effects of oregano and/or rosemary extracts on growth performance, digestive enzyme activities, cecal bacteria, tight junction proteins, and antioxidants-related genes in heat-stressed broiler chickens. Poult Sci 2024; 103:103996. [PMID: 39024691 DOI: 10.1016/j.psj.2024.103996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/06/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
The study examined the impact of adding oregano extract and/or rosemary to broiler diets to counteract the growth inhibition caused by heat stress (HS). It also investigated the effects on the activity of digestive enzymes, microbiological composition, and the expression of antioxidant and tight junction-related proteins. Three hundred- and fifty-day-old male broilers, were randomly assigned to 7 treatment groups, with each group comprising 5 replicates, and each replicate containing 10 chicks in a cage. The diets were: 1) a basal diet, 2) a diet supplemented with 50 mg/kg of rosemary, 3) a diet supplemented with 100 mg/kg of rosemary, 4) a diet supplemented with 50 mg/kg of oregano, 5) a diet supplemented with 100 mg/kg of oregano, 6) a combination diet containing 50 mg/kg each of rosemary and oregano, and 7) a combination diet containing 100 mg/kg each of rosemary and oregano. Dietary oregano extract enhanced the growth and feed utilization of heat-stressed birds, especially at a concentration of 50 mg/kg. Moreover, oregano extract improved jejunal protease and amylase activities. The extracts of rosemary and oregano significantly reduced IgG and IgM levels. Dietary 50 mg oregano extract significantly upregulated intestinal integrity-related genes including jejunal CLDNI, ZO-1, ZO-2, and MUC2. Dietary 50 mg oregano extract significantly downregulated hepatic NADPH oxidase 4 (NOX4) and nitric oxide synthase 2 (NOS2) expressions. Our results suggest that incorporating oregano leaf extract into the diet at a concentration of 50 mg/kg improves the growth performance of broilers exposed to heat stress. This improvement could be attributed to enhanced gut health and the modulation of genes associated with oxidative stress and tight junction proteins.
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Affiliation(s)
- Mahmoud Madkour
- Animal Production Department, National Research Centre, Dokki, Giza 12622, Egypt.
| | | | - Walid S Habashy
- Department of Animal and Poultry Production, Damanhour University, Damanhour, Al-Behira, Egypt
| | - Ibrahim A Matter
- Agricultural Microbiology Department, National Research Centre, Dokki, Giza 12622, Egypt
| | - Mohamed Shourrap
- Poultry Production Department, Faculty of Agriculture, Ain Shams University, Shoubra El-Kheima, Cairo 11241, Egypt
| | - Ahmed A Elolimy
- Animal Production Department, National Research Centre, Dokki, Giza 12622, Egypt; Department of Integrative Agriculture, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al Ain, Abu Dhabi, 15551, United Arab Emirates.
| | - Osama Aboelazab
- Animal Production Department, National Research Centre, Dokki, Giza 12622, Egypt
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Madkour M, Abdel-Fattah SA, Ali SI, Ali NGM, Shourrap M, Hosny M, Elolimy AA. Impact of in ovo feeding of grape pomace extract on the growth performance, antioxidant status, and immune response of hatched broilers. Poult Sci 2024; 103:103914. [PMID: 38905757 PMCID: PMC11246045 DOI: 10.1016/j.psj.2024.103914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 06/23/2024] Open
Abstract
Delivering natural antioxidants via in ovo feeding holds promise for enhancing the antioxidant status and performance of chickens. Therefore, The objective of this study was to evaluate the impacts of in ovo feeding during early embryonic development using grape pomace extract as a natural antioxidant on hatchability, productive performance, immune response, and antioxidant status in broilers. A total of 900 fertile broiler eggs from the Arbor Acres strain were utilized. Each egg was individually weighed, with egg weights ranging from 61.88 ± 3 g. On the 17.5th d of incubation (DOI), the fertile eggs were divided into 6 groups. The first treatment group was untreated and designated as the control (C). The second group was the sham group (Sh), receiving a simulated injection. The third group, designated as the vehicle group (V), was injected with 100 µl of dimethyl sulfoxide (DMSO). The fourth group received an injection of 100 µL of grape pomace dissolved in DMSO at a concentration of 2 mg (T2). Similarly, the fifth and sixth groups were injected with 100 µL of grape pomace dissolved in DMSO at concentrations of 4 mg and 6 mg, (T4), (T6) respectively. Subsequently, all groups were raised under uniform conditions in terms of management, environment, and nutrition till 5 wk of age. The grape pomace extract (GPE), obtained is rich in total phenolic content (16.07 mg/g), total flavonoid content (7.42 mg/g), and total anthocyanin (8.37 mg/g). Grape pomace extract has exhibited significant antioxidant properties as evidenced by its effectiveness in DPPH scavenging and reducing power assays. Significant improvements in body weight at hatch were observed with in ovo feeding of grape pomace extract, particularly at the 4 mg level, surpassing the effectiveness of the 2 mg and 6 mg grape pomace levels, and this enhancement in body weight continued until the age of 5 wk. GPE injection also led to a significant reduction in cholesterol levels, with the lowest levels recorded for the T4 group. Plasma total Antioxidant Capacity (TAC) levels were significantly elevated in groups treated with T4, T6, and T2 compared to the control group. Conversely, the control group showed a significant increase (P < 0.01) in plasma malondialdehyde (MDA) levels. The immune response of hatched chicks from grape pomace extract-injected groups, especially the T4 group, exhibited improvement through increased IgM and IgG. These findings demonstrate that in ovo feeding of GPE, particularly at a dosage of 4 mg, enhances growth performance, immune response, and antioxidant status in hatched chicks. Thus, administering natural antioxidants, such as grape pomace extract, to developing broiler embryos via in ovo feeding could serve as a valuable strategy for enhancing the subsequent post-hatch productive performance, as well as bolstering the antioxidant and immunological status of broiler chicks.
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Affiliation(s)
- Mahmoud Madkour
- Animal Production Department, National Research Centre, Dokki, 12622, Giza, Egypt
| | - Sayed A Abdel-Fattah
- Poultry Production Department, Faculty of Agriculture, Ain Shams University, Shoubra El-Kheima, 11241, Cairo, Egypt
| | - Sami I Ali
- Plant Biochemistry Department, National Research Centre, Dokki, 12622, Giza, Egypt
| | - Nematallah G M Ali
- Poultry Production Department, Faculty of Agriculture, Ain Shams University, Shoubra El-Kheima, 11241, Cairo, Egypt
| | - Mohamed Shourrap
- Poultry Production Department, Faculty of Agriculture, Ain Shams University, Shoubra El-Kheima, 11241, Cairo, Egypt
| | - Mohamed Hosny
- Department of Animal Production, Faculty of Agriculture, Al-Azhar University, Assiut 71524, Egypt
| | - Ahmed A Elolimy
- Animal Production Department, National Research Centre, Dokki, 12622, Giza, Egypt; Department of Integrative Agriculture, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates.
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Alagawany M, Lestingi A, Abdelzaher HA, Elnesr SS, Madkour M, El-Baz FK, Alfassam HE, Rudayni HA, Allam AA, Abd El Hack ME. Dietary supplementation with Dunaliella salina microalga promotes quail growth by altering lipid profile and immunity. Poult Sci 2024; 103:103591. [PMID: 38471224 PMCID: PMC11067772 DOI: 10.1016/j.psj.2024.103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
The goals of the current research are to ascertain the impacts of Dunaliella salina (DS) on quail growth, carcass criteria, liver and kidney functions, lipid profile, and immune response. Two hundred and forty 7-day-old quail chicks were divided equally into 4 separate groups with 6 replicates with 10 birds each. The groups were as follows: 1) control diet (the basal feed without DS), 2) control diet enriched with 0.25 g DS/kg, 3) control diet enriched with 0.50 g DS/kg, and 4) control diet enriched with 1.00 g DS/kg. Results elucidated that the birds which consumed 0.5 and 1 g DS/kg diet performed better than other birds in terms of live body weight (LBW), body weight gain (BWG), and feed conversion ratio (FCR). There were no significant changes in feed intake (FI) and carcass characteristics due to different dietary DS levels. Compared to the control group, DS-treated groups had better lipid profile (low total cholesterol and LDL values and high HDL values) and immune response (complement 3 values). The quails consumed feeds with different levels of DS had greater (P < 0.038) C3 compared to control. Adding 0.5 and 1 g DS/kg lowered blood concentrations of triglycerides and total protein (TP) values. The high level of DS (1 g/kg) had higher albumin values and lower AST values than other groups (P < 0.05). The creatinine values were at the lowest levels in the group consumed 0.50 g DS/kg feed. No changes (P > 0.05) were demonstrated among experimental groups in the ALT, urea, and lysozyme values. In conclusion, adding D. salina to growing quail diets enhanced growth, immune system, blood lipid profile, and kidney and liver function.
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Affiliation(s)
- Mahmoud Alagawany
- Poultry Department, Faculty of Agriculture, Zagazig University, Zagazig, Egypt.
| | - Antonia Lestingi
- Department of Veterinary Medicine, University of Bari Aldo Moro, Valenzano, Bari 70010, Italy
| | - Hagar A Abdelzaher
- Poultry Department, Faculty of Agriculture, Zagazig University, Zagazig, Egypt
| | - Shaaban S Elnesr
- Poultry Production Department, Agriculture Faculty, Fayoum University, Fayoum, Egypt
| | - Mahmoud Madkour
- Animal Production Department, National Research Centre, Dokki, 12622 Giza, Egypt
| | - Farouk K El-Baz
- Plant Biochemistry Department, National Research Centre (NRC), Dokki, Cairo, Egypt
| | - Haifa E Alfassam
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Hassan A Rudayni
- Department of Biology, College of Science, Imam Muhammad Ibn Saud Islamic University, Riyadh 11623, Saudi Arabia
| | - Ahmed A Allam
- Department of Zoology, Faculty of Science, Beni-suef University, Beni-suef 65211, Egypt
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Mahasneh ZMH, Abdelnour S, Ebrahim A, Almasodi AGS, Moustafa M, Alshaharni MO, Algopish U, Tellez-Isaias G, Abd El-Hack ME. Olive oil and its derivatives for promoting performance, health, and struggling thermal stress effects on broilers. Poult Sci 2024; 103:103348. [PMID: 38150829 PMCID: PMC10788279 DOI: 10.1016/j.psj.2023.103348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 12/29/2023] Open
Abstract
Olive oil (OL) production is the most significant agro-industrial business and has a high impact on the economy of numerous Mediterranean countries. However, OL extraction results in massive amounts of byproducts, including a solid residue (olive cake or olive pomace) and an aqueous stage (olive mill wastewater), which have serious environmental effects due to their hazardous nature and excessive organic content. Despite these byproducts causing environmental pollution, they can be applied for animal feeding. According to the literature, OL or its derivatives have been used to promote broiler performance, feed utilization, and health status in broilers as growth promoters or protein sources. Furthermore, using OL and its derivatives could improve heat resistance in stressed broilers via struggling thermal stress effects. In this framework, we highlighted the use of OL and its byproducts in broiler feeding to promote performance and health status. Additionally, the role of these byproducts and OL in combating thermal stress is investigated for sustainable strategy and promoting circular economy in broiler industry.
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Affiliation(s)
- Zeinab M H Mahasneh
- Department of Animal Production, School of Agriculture, the University of Jordan, Amman 11942, Jordan
| | - Sameh Abdelnour
- Department of Animal Production, Faculty of Agriculture, Zagazig University, Zagazig, Egypt.
| | - Alia Ebrahim
- Jiangsu Key Laboratory for Microbes and Genomics, School of Life Sciences, Nanjing Normal University, Nanjing 210023, China
| | - Abeer G S Almasodi
- Food Science Department, College of Science, Taif University, Branch of the College at Turbah, Turbah, Saudi Arabia
| | - Mahmoud Moustafa
- Department of Biology, College of Science, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohammed O Alshaharni
- Department of Biology, College of Science, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Uthman Algopish
- Department of Biology, College of Science, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Guillermo Tellez-Isaias
- Department of Poultry Science, Division of Agriculture, University of Arkansas, Fayetteville, AR 72701, USA
| | - Mohamed E Abd El-Hack
- Department of Poultry, Faculty of Agriculture, Zagazig University, Zagazig 44511, Egypt
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El-Sabrout K, Khalifah A, Mishra B. Application of botanical products as nutraceutical feed additives for improving poultry health and production. Vet World 2023; 16:369-379. [PMID: 37041996 PMCID: PMC10082723 DOI: 10.14202/vetworld.2023.369-379] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/23/2023] [Indexed: 02/27/2023] Open
Abstract
Poultry is one of the most consumed sources of animal protein around the world. To meet the global demands for poultry meat and eggs, it is necessary to improve their nutrition to sustain the poultry industry. However, the poultry industry faces several challenges, including feedstuff availability, the banning of antibiotics as growth promoters, and several environmental stressors. Therefore, there is a critical need to include available nutraceuticals in the diet to sustain the poultry industry. Nutraceuticals are natural chemical substances that positively influence animal physiological and productive traits. Botanical products (such as fenugreek seeds, ginger roots, and olive leaves) are among the most commonly used nutraceuticals and are gradually gaining popularity in the poultry industry due to their immense benefits in nutrition and therapeutic properties. They can be added to the diet separately or in combination (as a natural antioxidant and immunostimulant) to improve poultry health and production. Botanical products are rich in essential oils and essential fatty acids, which have multiple benefits on the animal's digestive system, such as activating the digestive enzymes and restoring microbiota balance, enhancing poultry health, and production. These nutraceuticals have been shown to stimulate the expression of several genes related to growth, metabolism, and immunity. In addition, the essential oil supplementation in poultry diets up-regulated the expression of some crucial genes associated with nutrient transportation (such as glucose transporter-2 and sodium-glucose cotransporter-1). Previous studies have suggested that supplementation of botanical compounds increased broiler body weight and hen egg production by approximately 7% and 15%, respectively. Furthermore, the supplementation of botanical compounds enhanced the reproductive efficiency of hens and the semen quality of roosters by 13%. This review article discusses the significant effects of some botanical products in the poultry industry and how they can benefit poultry, especially in light of the ban on antibiotics as growth promoters.
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Affiliation(s)
- Karim El-Sabrout
- Department of Poultry Production, Faculty of Agriculture (El-Shatby), Alexandria University, Alexandria, Egypt
| | - Ayman Khalifah
- Department of Livestock Research, Arid Lands Cultivation Research Institute, City of Scientific Research and Technological Applications (SRTA-City), Borg El Arab, Egypt
| | - Birendra Mishra
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaii at Manoa, 1955 East-West Road, Honolulu, HI, 96822, USA
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Rafeeq M, Bilal RM, Batool F, Yameen K, Farag MR, Madkour M, Elnesr SS, El-Shall NA, Dhama K, Alagawany M. Application of herbs and their derivatives in broiler chickens: a review. WORLD POULTRY SCI J 2023. [DOI: 10.1080/00439339.2022.2151395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Majid Rafeeq
- Center for Advanced Studies in Vaccinology and Biotechnology, University of Balochistan, Quetta, Pakistan
| | - Rana Muhammad Bilal
- Faculty of Veterinary and Animal Sciences, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Fiza Batool
- Faculty of Agriculture, Department of Forestry, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Kashif Yameen
- Department of Poultry, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mayada R. Farag
- Forensic Medicine and Toxicology Department, Veterinary Medicine Faculty, Zagazig University, Zagazig, Egypt
| | - Mahmoud Madkour
- Animal Production Department, National Research Centre, Giza, Egypt
| | - Shaaban S. Elnesr
- Department of Poultry Production, Faculty of Agriculture, Fayoum University, Fayoum, Egypt
| | - Nahed A. El-Shall
- Department of Poultry and Fish Diseases, Faculty of Veterinary Medicine, Alexandria University, Edfna, Egypt
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, India
| | - Mahmoud Alagawany
- Department of Poultry, Faculty of Agriculture, Zagazig University, Zagazig, Egypt
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El-Sabrout K, Aggag S, Mishra B. Advanced Practical Strategies to Enhance Table Egg Production. SCIENTIFICA 2022; 2022:1393392. [PMID: 36349300 PMCID: PMC9637464 DOI: 10.1155/2022/1393392] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/19/2022] [Indexed: 05/31/2023]
Abstract
The global demand for table eggs has increased exponentially due to the growing human population. To meet this demand, major advances in hen genetics, nutrition, and husbandry procedures are required. Developing cost-effective and practically applicable strategies to improve egg production and quality is necessary for the development of egg industry worldwide. Consumers have shown a strong desire regarding the improvement of hens' welfare and egg quality. They also become interested in functional and designer foods. Modifications in the nutritional composition of laying hen diets significantly impact egg nutritional composition and quality preservation. According to previous scientific research, enriched egg products can benefit human health. However, producers are facing a serious challenge in optimizing breeding, housing, and dietary strategies to ensure hen health and high product quality. This review discussed several practical strategies to increase egg production, quality, and hens' welfare. These practical strategies can potentially be used in layer farms for sustainable egg production. One of these strategies is the transition from conventional to enriched or cage-free production systems, thereby improving bird behavior and welfare. In addition, widely use of plant/herbal substances as dietary supplements in layers' diets positively impacts hens' physiological, productive, reproductive, and immunological performances.
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Affiliation(s)
- Karim El-Sabrout
- Department of Poultry Production, Faculty of Agriculture (El-Shatby), Alexandria University, Alexandria, Egypt
| | - Sarah Aggag
- Department of Genetics, Faculty of Agriculture (El-Shatby), Alexandria University, Alexandria, Egypt
| | - Birendra Mishra
- Department of Human Nutrition Food and Animal Sciences, University of Hawaii at Manoa, 1955 East-West Road, Honolulu, HI, 96822, USA
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Hassan FU, Alagawany M, Jha R. Editorial: Interplay of nutrition and genomics: Potential for improving performance and health of poultry. Front Physiol 2022; 13:1030995. [PMID: 36277192 PMCID: PMC9580459 DOI: 10.3389/fphys.2022.1030995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Faiz-ul Hassan
- Institute of Animal and Dairy Sciences, University of Agriculture, Faisalabad, Pakistan
- *Correspondence: Faiz-ul Hassan,
| | - Mahmoud Alagawany
- Department of Poultry, Faculty of Agriculture, Zagazig University, Zagazig, Al Sharqia, Egypt
| | - Rajesh Jha
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaii at Manoa, Honolulu, HI, United States
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Anetor GO, Nwobi NL, Igharo GO, Sonuga OO, Anetor JI. Environmental Pollutants and Oxidative Stress in Terrestrial and Aquatic Organisms: Examination of the Total Picture and Implications for Human Health. Front Physiol 2022; 13:931386. [PMID: 35936919 PMCID: PMC9353710 DOI: 10.3389/fphys.2022.931386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
There is current great international concern about the contribution of environmental pollution to the global burden of disease particularly in the developing, low- and medium-income countries. Industrial activities, urbanization, developmental projects as well as various increased anthropogenic activities involving the improper generation, management and disposal of pollutants have rendered today’s environment highly polluted with various pollutants. These pollutants include toxic metals (lead, cadmium, mercury, arsenic), polycyclic aromatic hydrocarbons, polychlorinated biphenyls, pesticides and diesel exhaust particles most of which appear to be ubiquitous as well as have long-term environmental persistence with a wide range of toxicities such as oxidative stress among others. Oxidative stress, which may arise from increased production of damaging free radicals emanating from increased pollutant burden and depressed bioavailability of antioxidant defenses causes altered biochemical and physiological mechanisms and has been implicated in all known human pathologies most of which are chronic. Oxidative stress also affects both flora and fauna and plants are very important components of the terrestrial environment and significant contributors of nutrients for both man and animals. It is also remarkable that the aquatic environment in which sea animals and creatures are resident is also highly polluted, leading to aquatic stress that may affect the survival of the aquatic animals, sharing in the oxidative stress. These altered terrestrial and aquatic environments have an overarching effect on human health. Antioxidants neutralize the damaging free radicals thus, they play important protective roles in the onset, progression and severity of the unmitigated generation of pollutants that ultimately manifest as oxidative stress. Consequently, human health as well as that of aquatic and terrestrial organisms may be protected from environmental pollution by mitigating oxidative stress and employing the principles of nutritional medicine, essentially based on antioxidants derived mainly from plants, which serve as the panacea of the vicious state of environmental pollutants consequently, the health of the population. Understanding the total picture of oxidative stress and integrating the terrestrial and aquatic effects of environmental pollutants are central to sustainable health of the population and appear to require multi-sectoral collaborations from diverse disciplinary perspectives; basically the environmental, agricultural and health sectors.
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Affiliation(s)
- Gloria Oiyahumen Anetor
- Department of Human Kinetics and Health Education, National Open University of Nigeria, Abuja, Nigeria
| | - Nnenna Linda Nwobi
- Department of Chemical Pathology, BenCarson School of Medicine, Babcock University, Ilishan, Nigeria
| | - Godwin Osaretin Igharo
- Department of Medical Laboratory Science, School of Basic Medical Sciences, College of Medical Sciences, University of Benin, Benin, Nigeria
| | | | - John Ibhagbemien Anetor
- Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- *Correspondence: John Ibhagbemien Anetor,
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