Effect of Sechium edule var. nigrum spinosum (Chayote) on Oxidative Stress and Pro-Inflammatory Markers in Older Adults with Metabolic Syndrome: An Exploratory Study

Li-Fraumeni Syndrome: Narrative Review Through a Case Report with Ten Years of Primary Tumor Remission Associated with Sechium H387 07 Supplementation

There are hereditary mutations that predispose individuals to cancer development, such as pathogenic variants in the germ line of the tumor protein 53 (TP53) suppressor gene. This leads to a rare condition known as Li-Fraumeni syndrome (LFS), characterized by a high risk of developing multiple cancers throughout life by the precancerous niche that promotes the tumor microenvironment. LFS presents a significant challenge due to its limited therapeutic and chemoprophylactic options. Recently, protocols involving metformin as a prophylactic medication have been developed to target precancerous niches. However, this approach is still in the clinical phase, and no established therapeutic regimen is available. Therefore, new alternatives are needed to impact this disease effectively. Novel studies suggest that Sechium extract, rich in polyphenols, exhibits chemoprophylactic, antineoplastic, anti-inflammatory, and antioxidant activities, all involved in the tumor microenvironment of LFS. However, the specific role of Sechium extract in preventing recurrent neoplastic development in LFS remains unclear. We conducted this research through a case report of an LFS-diagnosed patient who has experienced multiple malignancies and cutaneous neoformations. This patient received a chemoprophylactic supplementation based on Sechium H387 07 extract over 11 years without reporting new primary malignancy events or recurrences, as evidenced by laboratory and positron emission tomography/computed tomography (PET/CT) studies. An extensive literature review on the disease, precancerous niche, tumor microenvironment, and potential mechanisms of Sechium H387 07 extract components was conducted to explain cancer absence in LFS. This review promotes the research and use of polyphenols as powerful chemoprophylactic agents to prevent and treat proliferative diseases like LFS.

The consumption of Sechium edule (chayote) has antioxidant effect and prevents telomere attrition in older adults with metabolic syndrome

OBJECTIVE

To determine the effect of the consumption of Sechium edule (1.5 g/day) for six months on oxidative stress (OxS) and inflammation markers and its association with telomere length (TL) in older adults with metabolic syndrome (MetS).

METHODS

The study was conducted in a sample of 48 older adults: placebo (EP) and experimental (EG) groups. Lipoperoxides, protein carbonylation, 8-OHdG, total oxidant status (TOS), SOD, GPx, H₂O₂ inhibition, total antioxidant status (TAS), inflammatory cytokines (IL6, IL10, TNF-α), and TL were measured before and six months post-treatment.

RESULTS

We found a significant decrease in the levels of lipoperoxides, protein carbonylation, 8-OHdG, TOS in the EG in comparison PG. Likewise, a significante increase of TAS, IL-6, and IL-10 levels was found at six months post-treatment in EG in comparison with PG. TL showed a statistically significant decrease in PG compared to post-treatment EG.

CONCLUSIONS

Our findigns showed that the supplementation of Sechium edule has antioxidant, and anti-inflammatory effects, and diminushion of shortening of telomeric DNA in older adults with MetS. This would be the first study that shows that the intervention with Sechium edule has a possible geroprotective effect by preventing telomeres from shortening as usually happens in these patients. Therefore, suggesting a protection of telomeric DNA and genomic DNA.

The Supplementation of Sechium edule var. nigrum spinosum (Chayote) Promotes Nrf2-Mediated Antioxidant Protection in Older Adults with Metabolic Syndrome

The aim was to determine the effect of Sechium edule var. nigrum spinosum (chayote) on gene expression related to antioxidant protection mechanisms and the inflammatory process in older adults with metabolic syndrome (MetS). A quasi-experimental study was carried out in a convenience sample of 46 older adults diagnosed with MetS: (i) placebo group (PG; n = 20); (ii) experimental group (EG; n = 26). The clinical, biochemical, anthropometric parameters and SOD, GPx, and CAT enzyme activity, alongside total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), cytokines (IL-6, IL-8 and TNF-α), and mRNA expression of SOD, GPx, CAT, IL-6, IL-8, TNF-α, Nrf2, NFkB p50, and NFkB p65, were measured at baseline and 6 months post-intervention. A statistically significant decrease was observed in TOS (baseline, 28.9 ± 3.6 vs. post, 23.7 ± 3.4, p < 0.01) and OSI (baseline, 24.1 ± 3.8 vs. post, 17.7 ± 4), as well as an increase in IL-6 (baseline, 10.7 ± 1.1 vs. post, 12.3 ± 2, p = 0.03), SOD activity (baseline, 167.1 ± 11.9 vs. post, 180.6 ± 7.6, p < 0.05), CAT activity (baseline, 1.0 ± 0.2 vs. post, 1.3 ± 0.2, p < 0.01), and TAS (baseline, 1.1 ± 0.1 vs. post, 1.4 ± 0.1, p < 0.01) in the EG compared to the PG. Regarding the expression of Nrf2, SOD, and IL-6, the EG showed a significant increase vs. basal levels (47%, 44%, and 43%, respectively). Our findings suggest that Sechium edule supplementation promotes the antioxidant response and decreases oxidative stress via Nrf2.

Current Advances in Bovine In Vitro Maturation and Embryo Production Using Different Antioxidants: A Review

In vitro maturation (IVM) is one of the most important steps in in vitro embryo production (IVEP). It is a complicated procedure in which nuclear and cytoplasmatic changes in oocytes appear. In order to carry out the in vitro maturation procedure correctly, it is necessary to provide the oocytes with as close to a natural (in vivo) environment as possible. Many factors contribute to the overall poor quality of in vitro-matured oocytes. One important factor may be oxidative stress (OS). The generation of oxidants, such as reactive oxygen species, is common under culture conditions. The solution for OC treatment and prevention is antioxidants. In the last 5 years, many studies have examined different antioxidants and their effects on in vitro maturation of oocytes and embryo production. The aim of this systematic review was to present the achievements of scientific research in the last five years, in which the effects of many antioxidants were tested on bovine oocyte maturation and embryo production.

Antiproliferative Effect of Sechium edule (Jacq.) Sw., cv. Madre Negra Extracts on Breast Cancer In Vitro

Sechium edule shows a wide biological diversity. Hybrids and varieties of Sechium edule have been created, producing fruits of different shapes, sizes, colors, tastes, and textures. These hybrids and varieties have been used as food and in traditional medicine. In this research, the antiproliferative activity of the Madre Negra™ genotype of Sechium edule var. amarus silvestrys on the MCF7 breast cancer cell line was assessed. Different extracts in hexane, methanol, and dichloromethane were obtained to perform a bio-guided study. The dichloromethane extract showed the largest significant inhibitory activity (p < 0.05). This extract was separated into 92 fractions, which were reduced to eight fractions by chromogenic identity. Of the eight fractions, two recorded significant antiproliferative activity (p < 0.05) on MCF7, an even higher activity than the total extract. The active metabolites were identified as flavonoids, tannins, and terpenes, of which cucurbitacins I, B, D, and E stood out. The present paper can be considered as preliminary results of our research work.

Antioxidant and Anti-Inflammatory Effect of the Consumption of Powdered Concentrate of Sechium edule var. nigrum spinosum in Mexican Older Adults with Metabolic Syndrome

Metabolic syndrome (MetS) has a high prevalence in older adults and is a risk factor for cardiovascular diseases and complications of old age. It has also been related to oxidative stress (OxS) and chronic inflammation (CI) and their consequent alterations. Therefore, it is important to propose therapeutic alternatives such as the consumption of Sechium edule (Chayote), since hypoglycemic, hypotensive, and lipogenesis inhibitor properties are attributed to it. We carried out a study in 81 older adults (OA) with MetS to determine the effect of consumption of chayote powder concentrate (500 mg, three times a day) for six months, with a baseline measurement, at three and six months in an experimental group (EG) (n = 41) and a placebo group (PG) (n = 40), all with a diagnosis of MetS according to the criteria of National Adult Treatment Panel of the National Cholesterol Program III (NCEP/ATP III). Anthropometric, biochemical, OxS markers, and inflammation measurements were performed on all participants, basal, three, and six months after. A statistically significant decrease was found in the concentration of lipoperoxides (TBARS), 8-isoprostanes, 8-OHdG, oxidative stress score (OSS), HbA1c, blood pressure, and in the number of MetS diagnostic criteria, as well as an increase in total antioxidant status (TAS), antioxidant gap (GAP), superoxide dismutase (SOD), interleukin 10 (IL-10), and HDL-cholesterol in EG. The results suggest that the consumption of Sechium edule powder has a hypotensive, hypoglycemic, antioxidant, and anti-inflammatory effect in OA with MetS and reduced the percentage of patients with MetS.

The effect of chayote leaves (Sechium edule)’s flavonoid fraction on the reduction of the serum uric acid levels through the inhibition of xanthine oxidase activity

Uric acid is the final product of purine metabolism and is categorized as hyperuricemia when it reaches >6.0 mg.dL-1 for women and >7.0 mg.dL-1 for men. The chayote leaves (Sechium edule) contain a high amount of flavonoid and might be used as an alternative to reduce hyperuricemia. The purpose of this study is to analyze the effect of chayote leaves (Sechium edule)’s flavonoid fraction on the level of uric acid and the activity of xanthine oxidase (XO) in Sprague Dawley Rats. The flavonoid fraction (FF) was obtained by extracting the chayote leaves, fractionating with n-hexane, hydrolyzing with HCl, and finally re-fractionating with ethyl acetate. Thirty male Sprague Dawley rats were induced for hyperuricemia by potassium oxonate and broth block for 21 days, and the interventions were given orally for 14 days. The rats were divided randomly into five groups: normal control (K-), hyperuricemia control (K+), hyperuricemia with FF dose 50 mg.200g-1 body weight (P1), hyperuricemia with FF dose 100 mg.200g-1 body weight (P2) and hyperuricemia with allopurinol 1.8 mg.200g-1 body weight. Xanthine oxidase activity was measured by CheKineTM Xanthine Oxidase Assay Kit, with simple colorimetry methods. The statistical analysis for XO activity was done using Kruskal-Wallis followed by Mann Whitney. The results showed that chayote leaves (Sechium edule)’s flavonoid fraction contains apigenin, apigenin o-glucoside, and luteolin. It also has antioxidant activity with 98.45% inhibition.  There was a significant reduction in xanthine oxidase activity in groups treated with FF (p <0.005). The best dose of FF affecting XO activity was 100 mg.200g-1 body weight. The combination of FF and allopurinol can be more effective in decreasing uric acid levels by inhibiting XO activity.

Partial characterization of novel inulin-like prebiotic fructooligosaccharides of Sechium edule (Jacq.) Sw. (Cucurbitaceae) tuberous roots

The fruits and aerial parts of Sechium edule (Jacq.) Sw. (Cucurbitaceae) are a popular cook vegetable being used in different parts of the world with ethnomedicinal and pharmacological values. However, the beneficial health attributes of the tuberous roots have been less exploited. The present study aimed to determine the prebiotic potentiality of the storage carbohydrates from this part. The carbohydrate fractions were harvested by hot-water, cold-water, hot-acid, hot-alkali, and hot 80% ethanol treatments following the standard protocol. The fractions were tested for in vitro prebiotic efficacy, hypocholesterolemic and antioxidant potentials, and in vivo health attributes in Swiss albino mice. The partial characterization was performed by high-performance thin-layer chromatography (HPTLC) and spectroscopic analyses by Fourier-transform infrared spectroscopy (FT-IR) and electrospray ionization mass spectrometry (ESI-MS). The highest prebiotic index was observed in hot-water and ethanol (Et-OH) fractions with the antioxidant IC₅₀ values of 35.46 ± 0.33 and 32.56 ± 0.48 µg/ml, respectively. The HPTLC, FT-IR, and ESI-MS analyses showed that the hot-water and Et-OH carbohydrate fractions are rich in low-degree polymerizing inulin-like fructooligosaccharides (FOS). The fractions had a significant prebiotic index, hypocholesterolemic, and antioxidant activities. The synbiotic combination of the fractions with the probiotic LAB improved gut colonization and gut immune enhancement with significantly lowered triglycerides, serum LDL, and serum VLDL cholesterols. A significantly enhanced HDL cholesterol level proves its health beneficial attributes comparable to the commercial inulin prebiotics. Thus, this plant's novel inulin-like FOS may substitute the high-cost commercial prebiotics for our daily life. PRACTICAL APPLICATIONS: Prebiotics are low-degree polymerizing oligosaccharide food ingredients having multifaceted health benefits. For this reason, there is an ever-increasing global demand for such novel prebiotics. Therefore, finding out some novel prebiotic from conventional food sources may provide an alternative dietary source to fulfill the consumer demand. Sechium edule is a famous cook vegetable used by many ethnic communities across the globe. For the first time, the study revealed novel inulin-like fructooligosaccharides in the tuberous roots having hypocholesterolemic and synbiotic efficacy with GRAS lactic acid bacteria.

Telomere Length and Oxidative Stress and Its Relation with Metabolic Syndrome Components in the Aging

A great amount of scientific evidence supports that Oxidative Stress (OxS) can contribute to telomeric attrition and also plays an important role in the development of certain age-related diseases, among them the metabolic syndrome (MetS), which is characterised by clinical and biochemical alterations such as obesity, dyslipidaemia, arterial hypertension, hyperglycaemia, and insulin resistance, all of which are considered as risk factors for type 2 diabetes mellitus (T2DM) and cardiovascular diseases, which are associated in turn with an increase of OxS. In this sense, we review scientific evidence that supports the association between OxS with telomere length (TL) dynamics and the relationship with MetS components in aging. It was analysed whether each MetS component affects the telomere length separately or if they all affect it together. Likewise, this review provides a summary of the structure and function of telomeres and telomerase, the mechanisms of telomeric DNA repair, how telomere length may influence the fate of cells or be linked to inflammation and the development of age-related diseases, and finally, how the lifestyles can affect telomere length.

Combined genomic, transcriptomic, and metabolomic analyses provide insights into chayote (Sechium edule) evolution and fruit development

Chayote (Sechium edule) is an agricultural crop in the Cucurbitaceae family that is rich in bioactive components. To enhance genetic research on chayote, we used Nanopore third-generation sequencing combined with Hi-C data to assemble a draft chayote genome. A chromosome-level assembly anchored on 14 chromosomes (N50 contig and scaffold sizes of 8.40 and 46.56 Mb, respectively) estimated the genome size as 606.42 Mb, which is large for the Cucurbitaceae, with 65.94% (401.08 Mb) of the genome comprising repetitive sequences; 28,237 protein-coding genes were predicted. Comparative genome analysis indicated that chayote and snake gourd diverged from sponge gourd and that a whole-genome duplication (WGD) event occurred in chayote at 25 ± 4 Mya. Transcriptional and metabolic analysis revealed genes involved in fruit texture, pigment, flavor, flavonoids, antioxidants, and plant hormones during chayote fruit development. The analysis of the genome, transcriptome, and metabolome provides insights into chayote evolution and lays the groundwork for future research on fruit and tuber development and genetic improvements in chayote.

Origin, Evolution, Breeding, and Omics of Chayote, an Important Cucurbitaceae Vegetable Crop

Chayote (Sechium edule), a member of the Cucurbitaceae family, is cultivated throughout tropical and subtropical regions of the world and utilized in pharmaceutical, cosmetic and food industries because it is an excellent source of minerals, dietary fibers, protein, vitamins, carotenoids, polysaccharides, phenolic and flavonoid compounds, and other nutrients. Chayote extracts process various medicinal properties, such as anti-cardiovascular, antidiabetic, antiobesity, antiulcer, and anticancer properties. With the rapid advancements of molecular biology and sequencing technology, studies on chayote have been carried out. Research advances, including molecular makers, breeding, genomic research, chemical composition, and pests and diseases, regarding chayote are reviewed in this paper. Future exploration and application trends are briefly described. This review provides a reference for basic and applied research on chayote, an important Cucurbitaceae vegetable crop.

The effects of six months Persicaria minor extract supplement among older adults with mild cognitive impairment: a double-blinded, randomized, and placebo-controlled trial

BACKGROUND

Persicaria minor extract exhibits antioxidant and anti-inflammatory properties and has potential effects on cognitive function and mood. However, the effects of P.minor on brain activation and biomarkers have not been studied among older adults. This multicentre, randomized, double-blinded, placebo-controlled study aimed to investigate the effect of 6 months P.minor extract supplement (Biokesum®) on cognition, mood, biomarkers, and brain activation among older adults with Mild Cognitive Impairment (MCI).

METHOD

A total of 36 Malaysian community-dwelling older adults with MCI (60-75-year-old) were randomized into Biokesum® (n = 18) and placebo group (n = 18). Each subject consumed one capsule of Biokesum® (250 mg/capsule) or placebo (maltodextrin, 280 mg/capsule) twice daily for 6 months. Cognitive function and mood were assessed at baseline, 3rd, and 6th-month using neuropsychological tests (MMSE, Digit Span, RAVLT, Digit Symbol, and Visual Reproduction) and Profile of Mood State (POMS) questionnaire. Blood lipid profile, fasting blood glucose, and biomarkers (MDA, LPO, COX-2, iNOS, and BDNF) were measured at baseline and 6th month. By the end of the intervention, there were 30 compliers (Biokesum®: N = 15; Placebo: N = 15) and 6 dropouts. For brain activation assessment, 15 subsamples (Biokesum®: N = 8; Placebo: N = 7) completed N-back and Stroop tasks during fMRI scanning at baseline and 6th month. The dorsolateral prefrontal cortex (Brodmann's area 9 and 46) was identified as a region of interest (ROI) for brain activation analysis using SPM software.

RESULTS

Two-way mixed ANOVA analysis showed significant improvements in Visual Reproduction II (p = 0.012, partial η2 = 0.470), tension (p = 0.042, partial η2 = 0.147), anger (p = 0.010, partial η2 = 0.207), confusion (p = 0.041, partial η2 = 0.148), total negative subscales (p = 0.043, partial η2 = 0.145), BDNF (p = 0.020, partial η2 = 0.179) and triglyceride (p = 0.029, partial η2 = 0.237) following 6 months of Biokesum® supplementation. Preliminary finding also demonstrated significant improvement at 0-back task-induced right DLPFC activation (p = 0.028, partial η2 = 0.652) among subsamples in Biokesum® group. No adverse events were reported at the end of the study.

CONCLUSION

Six months Biokesum® supplementation potentially improved visual memory, negative mood, BDNF, and triglyceride levels among older adults with MCI. Significant findings on brain activation at the right DPLFC must be considered as preliminary.

TRIAL REGISTRATION

Retrospectively registered on 30th August 2019 [ ISRC TN12417552 ].

Phytochemical Analysis and Antioxidant and Anti-Inflammatory Capacity of the Extracts of Fruits of the Sechium Hybrid

In addition to their own antioxidants, human cells feed on external antioxidants, such as the phenolic compounds of fruits and vegetables, which work together to keep oxidative stress in check. Sechium edule, an edible species of chayote, has phenolic compounds with antioxidant activity and antineoplastic activity. A Sechium hybrid shows one thousand times greater antineoplastic activity than edible species, but its antioxidant and anti-inflammatory activities and the content of phenolic compounds are unknown. The aim of this study was to determine the antioxidant and anti-inflammatory capacity of the extract of fruits of the Sechium hybrid in vitro and in vivo. Phytochemical analysis using HPLC showed that the extract of the Sechium hybrid has at least 16 phenolic compounds; galangin, naringenin, phloretin and chlorogenic acid are the most abundant. In an in vitro assay, this extract inhibited 2,2-diphenyl-L-picrylhydrazyl (DPPH) activity and protected the dimyristoylphosphatidylethanolamine (DMPE) phospholipid model cell membrane from oxidation mediated by hypochlorous acid (HClO). In vivo, it was identified that the most abundant metabolites in the extract enter the bloodstream of the treated mice. On the other hand, the extract reduces the levels of tumor necrosis factor alpha (TNFα), interferon gamma (IFNγ), and interleukin-6 (IL-6) but increases interleukin-10 (IL-10) and glutathione peroxidase levels. Our findings indicate that intake of the fruits of the Sechium hybrid leads to antioxidant and anti-inflammatory effects in a mouse model. Therefore, these results support the possibility of exploring the clinical effect of this hybrid in humans.

Effect of Sechium edule var. nigrum spinosum (Chayote) on Telomerase Levels and Antioxidant Capacity in Older Adults with Metabolic Syndrome

Patients with metabolic syndrome (MetS) have a redox imbalance, due to a decay in antioxidant capacity. Oxidative stress (OxS) is considered an important modulator of telomere shortening and telomerase activity. One of the fruits that has been associated with an antioxidant effect is Sechium edule and although its properties are well established, there is only one exploratory study evaluating its effectiveness in patients with MetS. The present investigation is a much more robust and controlled study, including a placebo group. Hence, we determined the effect of consumption of the dried fruit powder (500 mg, three times per day) for three months. We measured effects on telomerase levels, antioxidant capacity, and markers for OxS. The study was performed in a sample of 75 older adults: placebo group (n = 30) and experimental group (n = 45) with the diagnosis of MetS according to the National Adult Treatment Panel of the National Cholesterol Program III (NCEP/ATP III) criteria. All markers were measured before and after three months of treatment. There was a statistically significant decrease in lipoperoxides and protein carbonylation with an increased superoxide dismutase (SOD), as well as sustained levels of telomerase in patients who consumed Sechium edule. Our findings suggest that consumption of this fruit has a hypoglycemic, hypotensive, and antioxidant effect, without altering telomerase levels, which could suggest better protection against telomere shortening.

Investigating the effect of some fluoroquinolones on C-reactive protein levels and ACh-Induced blood pressure reduction deviations after aging of diabetes in STZ-Induced diabetic wistar rats

The treatment of infections in diabetic patients by fluoroquinolone antibiotics is associated with a reduced risk of coronary artery disease, and may improve endothelium-derived hyperpolarizing factor (EDHF) efficacy. The inflammatory marker C-reactive protein (CRP) is an important predictor of cardiovascular events, and vascular endothelium dysfunction, which makes this marker a target for drug-based treatment. This study aims to investigate the relation between the treatment by fluoroquinolones with CRP plasma levels, as well as acetylecholine (ACh)-induced small conductance calcium-activated potassium channels (SKCa)-dependent blood pressure (BP) reduction deviations in wistar rats after inducing a type 2-like diabetes with aging state after four months of streptozotocin (STZ) injection. Experimental animals were divided into four groups, group 1: diabetic animals were treated with moxifloxacin (n = 15), group 2: diabetic animals were treated with levofloxacin (n = 15), group 3: diabetic control animals (n = 15), and group 4: non-diabetic control animals (n = 6). The levels of plasma CRP, as well as ACh-induced SKCa-dependent BP reduction deviations were compared four months after the development of diabetes, after that; two groups were treated with fluoroquinolones, four months after the treatment; CRP-plasma levels, as well as ACh-induced SKCa-dependent BP reduction deviations were also evaluated and compared for all groups. Sustained hyperglycemia after the induction of diabetes elevated CRP plasma levels, and reduced ACh-induced SKCa-dependent BP reduction, observed diabetes-induced variations were minimal in fluoroquinolones treated diabetic groups compared with diabetic control group, In conclusion, the treatment with fluoroquinolone antibiotics in diabetic wistars may be associated with a lowering in CRP levels progression, and improvement in SKCa vitality, which indicates the importance of treating infections in diabetics by fluoroquinolones to mitigate some vascular complications signs that lead to morbidity and mortality in diabetes.

Oxidative Stress Indexes for Diagnosis of Health or Disease in Humans

Oxidative stress (OS) is the imbalance between oxidant and antioxidant molecules, in favor of oxidants, that causes aging and disease. Many studies have been published that demonstrate the relationship between OS and human health and disease; however, the following questions arise: (i) how are we sure that the OS is present in a biological process? (ii) Is the OS reported in the different investigations equivalent? (iii) What are the best oxidant and antioxidant markers for OS diagnosis? (iv) Can we establish the types and the intensity of the OS? (v) Does OS index could be useful for research and/or application in clinical medicine? In this regard, several indexes have been proposed to measure OS in humans relative to the state of health and disease, among which the following can be highlighted: Oxidative Stress Index (OSI), Tiol Ratios (-SH/TT, -SS/-SH, and-SS/TT), Glutathione Ratio (GSSG/GSH), Oxidative Stress Score (OSS), and OXY-index. Therefore, the aim of this review is to present the state of the art of knowledge about OS indexes for diagnosis of health or disease in humans. We searched for articles in English or Spanish in the PubMed/MEDLINE and Scopus electronic databases published up until May 2019. The keywords used were “oxidative stress,” “index,” and “oxidative stress index.” It was identified 11479 records in both databases, and 490 articles were analyzed. Our review suggests that all indexes analyzed allow diagnose and differentiate the OS related to human health and disease. Also, the studies on OSI, Oxy-score, and OSS indexes have proven to be reliable, practical, and with clinical utility. However, it is necessary to continue with longitudinal studies, especially assess the usefulness of the indexes in the clinical prognosis, and make comparative studies between the different indexes.