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Faysal M, Dehbia Z, Zehravi M, Sweilam SH, Haque MA, Kumar KP, Chakole RD, Shelke SP, Sirikonda S, Nafady MH, Khan SL, Nainu F, Ahmad I, Emran TB. Flavonoids as Potential Therapeutics Against Neurodegenerative Disorders: Unlocking the Prospects. Neurochem Res 2024; 49:1926-1944. [PMID: 38822985 DOI: 10.1007/s11064-024-04177-x] [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: 07/17/2023] [Revised: 04/13/2024] [Accepted: 05/22/2024] [Indexed: 06/03/2024]
Abstract
Neurodegeneration, the decline of nerve cells in the brain, is a common feature of neurodegenerative disorders (NDDs). Oxidative stress, a key factor in NDDs such as Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and Huntington's disease can lead to neuronal cell death, mitochondria impairment, excitotoxicity, and Ca2+ stress. Environmental factors compromising stress response lead to cell damage, necessitating novel therapeutics for preventing or treating brain disorders in older individuals and an aging population. Synthetic medications offer symptomatic benefits but can have adverse effects. This research explores the potential of flavonoids derived from plants in treating NDDs. Flavonoids compounds, have been studied for their potential to enter the brain and treat NDDs. These compounds have diverse biological effects and are currently being explored for their potential in the treatment of central nervous system disorders. Flavonoids have various beneficial effects, including antiviral, anti-allergic, antiplatelet, anti-inflammatory, anti-tumor, anti-apoptotic, and antioxidant properties. Their potential to alleviate symptoms of NDDs is significant.
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Affiliation(s)
- Md Faysal
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, 1207, Bangladesh
| | - Zerrouki Dehbia
- Laboratory of Agro - Biotechnology and Nutrition in Semi-Arid Zones, Faculty of Nature and Life Sciences, University of Ibn Khaldoun, Tiaret, Algeria
| | - Mehrukh Zehravi
- Department of Clinical Pharmacy, College of Dentistry & Pharmacy, Buraydah Private Colleges, Buraydah, 51418, Saudi Arabia.
| | - Sherouk Hussein Sweilam
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, Egyptian Russian University, Cairo-Suez Road, Badr City, 11829, Cairo, Egypt
| | - M Akiful Haque
- Department of Pharmaceutical Analysis, School of Pharmacy, Anurag University, Ghatkesar, Hyderabad, 500088, India
| | - Kusuma Praveen Kumar
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University (DPSRU), Govt. of N.C.T. of Delhi, Pushpvihar, New Delhi, 110017, India
| | - Rita D Chakole
- Department of Pharmaceutical Chemistry, Government College of Pharmacy, Karad, 415124, Maharashtra, India
| | - Satish P Shelke
- Department of Pharmaceutical Chemistry, Rajarshi Shahu College of Pharmacy, Buldana, 443001, Maharashtra, India
| | - Swapna Sirikonda
- Department of Pharmaceutics, School of Pharmacy, Anurag University, Ghatkesar, 500088, Hyderabad, India
| | - Mohamed H Nafady
- Faculty of Applied Health Science Technology, Misr University for Science and Technology, Giza, 12568, Egypt
| | - Sharuk L Khan
- Department of Pharmaceutical Chemistry, N.B.S. Institute of Pharmacy, Ausa, 413520, Maharashtra, India
| | - Firzan Nainu
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, Indonesia
| | - Irfan Ahmad
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Talha Bin Emran
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, 1207, Bangladesh.
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh.
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Missong H, Joshi R, Khullar N, Thareja S, Navik U, Bhatti GK, Bhatti JS. Nutrient-epigenome interactions: Implications for personalized nutrition against aging-associated diseases. J Nutr Biochem 2024; 127:109592. [PMID: 38325612 DOI: 10.1016/j.jnutbio.2024.109592] [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: 10/15/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
Aging is a multifaceted process involving genetic and environmental interactions often resulting in epigenetic changes, potentially leading to aging-related diseases. Various strategies, like dietary interventions and calorie restrictions, have been employed to modify these epigenetic landscapes. A burgeoning field of interest focuses on the role of microbiota in human health, emphasizing system biology and computational approaches. These methods help decipher the intricate interplay between diet and gut microbiota, facilitating the creation of personalized nutrition strategies. In this review, we analysed the mechanisms related to nutritional interventions while highlighting the influence of dietary strategies, like calorie restriction and intermittent fasting, on microbial composition and function. We explore how gut microbiota affects the efficacy of interventions using tools like multi-omics data integration, network analysis, and machine learning. These tools enable us to pinpoint critical regulatory elements and generate individualized models for dietary responses. Lastly, we emphasize the need for a deeper comprehension of nutrient-epigenome interactions and the potential of personalized nutrition informed by individual genetic and epigenetic profiles. As knowledge and technology advance, dietary epigenetics stands on the cusp of reshaping our strategy against aging and related diseases.
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Affiliation(s)
- Hemi Missong
- Laboratory of Translational Medicine and Nanotherapeutics, Department of Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, Punjab, India
| | - Riya Joshi
- Laboratory of Translational Medicine and Nanotherapeutics, Department of Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, Punjab, India
| | - Naina Khullar
- Department of Zoology, Mata Gujri College, Fatehgarh Sahib, Punjab, India
| | - Suresh Thareja
- Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda, Punjab, India
| | - Umashanker Navik
- Department of Pharmacology, Central University of Punjab, Bathinda, Punjab, India
| | - Gurjit Kaur Bhatti
- Department of Medical Lab Technology, University Institute of Applied Health Sciences, Chandigarh University, Mohali, Punjab, India.
| | - Jasvinder Singh Bhatti
- Laboratory of Translational Medicine and Nanotherapeutics, Department of Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, Punjab, India.
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Messina MJ, Messina V, Nagata C. Perspective: Observational Studies Involving Low-Soy Intake Populations Have Limited Ability for Providing Insight into the Health Effects of Soybean Isoflavones. Adv Nutr 2024; 15:100210. [PMID: 38484974 PMCID: PMC10992291 DOI: 10.1016/j.advnut.2024.100210] [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: 12/28/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 04/01/2024] Open
Abstract
Isoflavones are naturally occurring plant compounds found in uniquely high amounts in soybeans and foods made from this legume. These soybean constituents have been proposed to exert several health benefits and as such they have been the subject of an enormous amount of research. This research includes randomized controlled trials (RCTs) and epidemiologic investigations. Although statistically significant associations between isoflavone intake and a wide range of health outcomes have been identified in cohorts involving low-isoflavone intake populations, we suggest that these associations are unlikely to have a causal basis because exposure is too low for isoflavones to exert physiologic effects. In cohorts involving predominantly non-Asian, non-vegetarian populations, the highest isoflavone intake category is typically ≤3 mg/d, an amount of isoflavones provided by ∼30 mL (2 tablespoons) of soymilk made from whole soybeans. In comparison, mean isoflavone intake in the upper intake categories in observational studies involving high-isoflavone intake populations is typically ≥50 mg/d. In RCTs, intervention doses of isoflavones typically range between 40 and 100 mg/d. Health professionals advising patients and clients about soy food and isoflavone intake need to be aware of the limitations of epidemiologic research involving low-isoflavone intake populations. Intake recommendations are best based on the results of RCTs using clinically relevant doses of isoflavones and epidemiologic studies involving populations for whom soy foods are a habitual part of the diet.
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Affiliation(s)
- Mark J Messina
- Soy Nutrition Institute Global, Jefferson City, MO, United States.
| | | | - Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
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Capra ME, Monopoli D, Decarolis NM, Giudice A, Stanyevic B, Esposito S, Biasucci G. Dietary Models and Cardiovascular Risk Prevention in Pediatric Patients. Nutrients 2023; 15:3664. [PMID: 37630854 PMCID: PMC10458109 DOI: 10.3390/nu15163664] [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: 07/18/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Nutritional intervention is worldwide recognized as a first step treatment for subjects with increased cardiovascular risk and it is of utmost importance especially for children and adolescents. Currently scientific evidence supports the role of dietary patterns instead of simple single nutrients or foods in cardiovascular risk prevention. Indeed, the American Heart Association dietary guidelines have expanded beyond nutrients to dietary pattern, that comprise not only single food items but also behavioral or cultural habits of specific populations. The aim of our narrative review is to analyze the most frequently adopted dietary patterns in children and adolescents and to evaluate their effect on cardiovascular risk factors and in cardiovascular risk prevention. Literature review showed that children cannot be considered as little adults: nutritional intervention must always grant adequate growth and neurodevelopment before reaching the proposed goals, therefore dietary patterns considered heart-healthy for adult subjects might not be suitable for pediatric patients. Mediterranean diet, DASH diet, Nordic diet and some plant-based diets seem to be the most promising dietary patterns in terms of cardiovascular health in the developmental age, even if further studies are needed to better standardize and analyze their effect on growing up individuals.
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Affiliation(s)
- Maria Elena Capra
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (M.E.C.); (G.B.)
- Società Italiana di Nutrizione Pediatrica, 20126 Milan, Italy
| | - Delia Monopoli
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy; (D.M.); (N.M.D.); (A.G.); (B.S.)
| | - Nicola Mattia Decarolis
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy; (D.M.); (N.M.D.); (A.G.); (B.S.)
| | - Antonella Giudice
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy; (D.M.); (N.M.D.); (A.G.); (B.S.)
| | - Brigida Stanyevic
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy; (D.M.); (N.M.D.); (A.G.); (B.S.)
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy; (D.M.); (N.M.D.); (A.G.); (B.S.)
| | - Giacomo Biasucci
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (M.E.C.); (G.B.)
- Società Italiana di Nutrizione Pediatrica, 20126 Milan, Italy
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Yap B, Rajaram N, Ho WK, Khor GL, Teo SH. Perceptions, attitudes and beliefs towards soya among healthy Asian women participating in a soya randomised controlled trial. J Nutr Sci 2023; 12:e69. [PMID: 37457681 PMCID: PMC10345781 DOI: 10.1017/jns.2023.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 07/18/2023] Open
Abstract
The soya-breast cancer risk relationship remains controversial in Asia due to limited and inconsistent research findings and is exacerbated by difficulties in recruiting and retaining participants in intervention trials. Understanding public perceptions towards soya is important for designing effective intervention trials. Here, we administered a close-ended, quantitative survey to healthy, peri- and post-menopausal Asian women in the Malaysian Soy and Mammographic Density (MiSo) Study to assess perception towards soya and explore motivators and barriers that affect study adherence using the Capability, Opportunity, Motivation and Belief (COM-B) Model and Theoretical Domains Framework (TDF). Of 118 participants, the majority reported the belief that soya promotes good health (Supplement = 85⋅7 %, Diet = 90⋅0 %, Control = 87⋅9 %). Most participants reported obtaining information about soya from the internet (Supplement = 61⋅0 %, Diet = 55⋅3 %, Control = 35⋅9 %), while health professionals were least reported (Supplement = 9⋅8 %, Diet = 7⋅9 %, Control = 5⋅1 %). Stratified analyses by study completion and adherence status yielded comparable findings. By the end of the study, dietary arm participants reported a strong belief that soya has no impact on their health (Supplement = 7⋅1 % v. Diet = 20⋅0 % v. Control = 0⋅0 %, P = 0⋅012). Motivation and opportunity strongly facilitated soya consumption, while psychological capability was the most common barrier to consumption though less evident among dietary arm participants. While most Asian women have a positive perception towards soya, theory-based intervention trials are warranted to understand the perception-study adherence relationship and to accurately inform the public of the health effects of soya.
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Affiliation(s)
- Beverley Yap
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
| | - Nadia Rajaram
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
- School of Mathematical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor 43500, Malaysia
| | - Weang Kee Ho
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
- School of Mathematical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor 43500, Malaysia
| | - Geok Lin Khor
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Soo Hwang Teo
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
- Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur 50603, Malaysia
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Yang J, Shen H, Mi M, Qin Y. Isoflavone Consumption and Risk of Breast Cancer: An Updated Systematic Review with Meta-Analysis of Observational Studies. Nutrients 2023; 15:2402. [PMID: 37242286 PMCID: PMC10224089 DOI: 10.3390/nu15102402] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
RATIONALE Epidemiological studies that focus on the relationship between dietary isoflavone intake and the risk of breast cancer still lead to inconsistent conclusions. Herein, we conducted a meta-analysis of the latest studies to explore this issue. METHOD We performed a systematic search using Web of Science, PubMed, and Embase from inception to August 2021. The robust error meta-regression (REMR) model and generalized least squares trend (GLST) model were used to establish dose-response relationships between isoflavones and breast cancer risk. RESULTS Seven cohort studies and 17 case-control studies were included in the meta-analysis, and the summary OR for breast cancer was 0.71 (95% CI 0.72-0.81) when comparing the highest to the lowest isoflavone intake. A subgroup analysis further showed that neither menopausal status nor ER status has a significant influence on the association between isoflavone intake and breast cancer risk, while the isoflavone intake doses and study design does. When the isoflavones exposure was less than 10 mg/day, no effects on breast cancer risk were detected. The inverse association was significant in the case-control studies but not in the cohort studies. In the dose-response meta-analysis of the cohort studies, we observed an inverse association between isoflavone intake and breast cancer: a 10 mg/day increase in isoflavone intake was related to reductions of 6.8% (OR = 0.932, 95% CI 0.90-0.96) and 3.2% (OR = 0.968, 95% CI 0.94-0.99) in breast cancer risk when using REMR and GLST, respectively. In the dose-response meta-analysis of the case-control studies, the inverse association for every 10 mg/day isoflavone intake was associated with breast cancer risk reductions by 11.7%. CONCLUSION present evidence demonstrated that taking in dietary isoflavone is helpful in reducing the breast cancer risk.
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Affiliation(s)
- Jining Yang
- Research Center for Nutrition and Food Safety, Institute of Military Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Hui Shen
- Research Center for Nutrition and Food Safety, Institute of Military Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Mantian Mi
- Chongqing Medical Nutrition Research Center, Chongqing 400038, China
| | - Yu Qin
- Research Center for Nutrition and Food Safety, Institute of Military Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing 400038, China
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Bensaada S, Chabrier F, Ginisty P, Ferrand C, Peruzzi G, Valat M, Bennetau-Pelissero C. Improved Food-Processing Techniques to Reduce Isoflavones in Soy-Based Foodstuffs. Foods 2023; 12:foods12071540. [PMID: 37048361 PMCID: PMC10093994 DOI: 10.3390/foods12071540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
Soy is a growing protein source; however, the isoflavones it contains are of concern, as they exhibit estrogenic activities whose toxicological limits might be exceeded. Reducing their concentrations to safe levels while preserving nutritional quality in soy foodstuffs is therefore a matter of public health. The main objective of this paper is to develop at pilot scale a process for isoflavones’ extraction from soybeans, and to show its feasibility and efficiency. The study was conducted by first optimizing the previously obtained laboratory treatment key factors. These data were then transposed to the pilot level. Finally, the process was adjusted to technical constraints which appeared at pilot scale: the mandatory use of drenching and the exploration of granulometry analysis. The involved steps were validated by monitoring the genistein and daidzein content variations through statistical analysis of the data of an ELISA and a Folin–Ciocalteu assay. Additionally, isoflavones’ recovery from treatment waters for their valorisation and the water cleaning by means of filtration, centrifugation and resin adsorption were carried out. The results showed that the most successful pilot treatment developed involved soybean dehulling, drenching, washing and drying and almost halved isoflavones while preserving the main nutritional characteristics. A combination of techniques led to almost complete recovery of isoflavones from process waters.
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Affiliation(s)
- Souad Bensaada
- Campus Carreire, Pharmacy Faculty, Department Sciences and Technology, University of Bordeaux, 33076 Bordeaux, France
- ARNA (Nucleic Acids: Natural and Artificial Regulations), U1212 Inserm, UMR CNRS 5320, University of Bordeaux, 33076 Bordeaux, France
- Biopress, 47400 Tonneins, France
| | | | - Pascal Ginisty
- IFTS (Institute of Filtration and Separative Techniques), 47510 Foulayronnes, France
| | - Carine Ferrand
- Campus Carreire, Pharmacy Faculty, Department Sciences and Technology, University of Bordeaux, 33076 Bordeaux, France
- BFP (Fruit Biology and Pathology), UMR CNRS 1332, INRA Bordeaux-Aquitaine, University of Bordeaux, 33140 Villenave-d’Ornon, France
| | | | - Marc Valat
- Campus Carreire, Pharmacy Faculty, Department Sciences and Technology, University of Bordeaux, 33076 Bordeaux, France
- I2M (Mechanical and Engineering Institute), UMR CNRS 5295, University of Bordeaux, 33405 Talence, France
| | - Catherine Bennetau-Pelissero
- Campus Carreire, Pharmacy Faculty, Department Sciences and Technology, University of Bordeaux, 33076 Bordeaux, France
- ARNA (Nucleic Acids: Natural and Artificial Regulations), U1212 Inserm, UMR CNRS 5320, University of Bordeaux, 33076 Bordeaux, France
- Bordeaux Sciences Agro, 33175 Gradignan, France
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Validation of ELISAs for Isoflavones and Enterolactone for Phytoestrogen Intake Assessment in the French Population. Nutrients 2023; 15:nu15040967. [PMID: 36839324 PMCID: PMC9967075 DOI: 10.3390/nu15040967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Phytoestrogens are dietary compounds with low estrogenic activity. The two main categories in the French diet are isoflavones from pulses and enterolignans metabolized by the gut flora from various lignans found in fruits, vegetables, grains, and beverages. Isoflavones and lignans have different effects on human physiology and can antagonize each other. Comprehensive lists of phytoestrogen sources were constructed based on measurements and literature data. The 24 h and 48 h dietary recalls were proposed to the volunteers of the ISOLED cohort (NCT03421184). Urine and plasma samples from these volunteers were assayed for genistein, daidzein, equol, and enterolactone. A dietary score was constructed considering the pharmacokinetic characteristics of these compounds. Correlation analyses were applied to fluid concentrations associated with dietary scores. Pearson correlations reached 0.921 (p < 0.001) for urineIF, 0.900 (p < 0.001) for plasmaIF, 0.764 (p < 0.001) for urineENL, and 0.723 (p < 0.001) for plasmaENL. ELISAs associated with careful intake assessments proved to be good tools for phytoestrogens' exposure estimation.
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Phytoestrogens and Health Effects. Nutrients 2023; 15:nu15020317. [PMID: 36678189 PMCID: PMC9864699 DOI: 10.3390/nu15020317] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/10/2023] Open
Abstract
Phytoestrogens are literally estrogenic substances of plant origin. Although these substances are useful for plants in many aspects, their estrogenic properties are essentially relevant to their predators. As such, phytoestrogens can be considered to be substances potentially dedicated to plant-predator interaction. Therefore, it is not surprising to note that the word phytoestrogen comes from the early discovery of estrogenic effects in grazing animals and humans. Here, several compounds whose activities have been discovered at nutritional concentrations in animals and humans are examined. The substances analyzed belong to several chemical families, i.e., the flavanones, the coumestans, the resorcylic acid lactones, the isoflavones, and the enterolignans. Following their definition and the evocation of their role in plants, their metabolic transformations and bioavailabilities are discussed. A point is then made regarding their health effects, which can either be beneficial or adverse depending on the subject studied, the sex, the age, and the physiological status. Toxicological information is given based on official data. The effects are first presented in humans. Animal models are evoked when no data are available in humans. The effects are presented with a constant reference to doses and plausible exposure.
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Dressler J, Storz MA, Müller C, Kandil FI, Kessler CS, Michalsen A, Jeitler M. Does a Plant-Based Diet Stand Out for Its Favorable Composition for Heart Health? Dietary Intake Data from a Randomized Controlled Trial. Nutrients 2022; 14:4597. [PMID: 36364858 PMCID: PMC9656677 DOI: 10.3390/nu14214597] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 08/27/2023] Open
Abstract
A plant-based diet (PBD) can provide numerous health benefits for patients with cardiovascular risk factors. However, an inadequately planned PBD also bear the potential for deficiencies in certain macro- and micronutrients. The present study analyzed nutrient profiles of individuals who adopted a PBD as part of the CardioVeg study. Participants with cardiovascular risk factors were randomly assigned to either a whole-food PBD intervention (n = 36; eight 90 min group meetings including two 120 min cooking sessions) or a control group asked to maintain an omnivorous diet (n = 34) for eight weeks. Food intake data were collected using three-day weighed food records and analyzed with NutriGuide software, including the German Nutrient Data Base (German: Bundeslebensmittelschlüssel). Nutrient intake was compared before and after eight weeks as well as between the groups. The results for both groups were then contrasted to the current dietary recommendations published by the societies for nutrition in Germany, Austria, and Switzerland. Moreover, anthropometric/laboratory data and ambulatory blood pressure monitoring were determined at baseline and after 8 weeks. Data of a subsample (n = 18 in the PBD group and n = 19 in the control group) were used for the present analyses of the dietary intake data. A PBD yielded several benefits including (but not limited to) a lower energy density, a lower intake of cholesterol and saturated fat, an increased consumption of fiber, and a lower intake of salt. Recommended intakes of most vitamins and minerals were generally met, except for vitamin B12 in the PBD group. A low intake of several other critical nutrients (vitamin D, iodine) was observed in both groups. Compared with the control group, PBD resulted in a significant decrease in body weight, body mass index, waist circumference, HbA1c, and fasting blood glucose after 8 weeks. Overall, it can be concluded that a PBD had a more favorable nutrient composition for cardiovascular health than the omnivorous dietary pattern of the control group.
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Affiliation(s)
- Justina Dressler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humbolt-Universität zu Berlin, 10117 Berlin, Germany
| | - Maximilian Andreas Storz
- Department of Internal Medicine II, Center for Complementary Medicine, Freiburg University Hospital, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Carolin Müller
- Institute of Social Medicine, Epidemiology and Health Economics, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humbolt-Universität zu Berlin, 10117 Berlin, Germany
| | - Farid I. Kandil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humbolt-Universität zu Berlin, 10117 Berlin, Germany
| | - Christian S. Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humbolt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, 14109 Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humbolt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, 14109 Berlin, Germany
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humbolt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, 14109 Berlin, Germany
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Bensaada S, Raymond I, Breton M, Pellegrin I, Viallard JF, Bennetau-Pelissero C. Development of an Assay for Soy Isoflavones in Women's Hair. Nutrients 2022; 14:nu14173619. [PMID: 36079877 PMCID: PMC9460668 DOI: 10.3390/nu14173619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 12/02/2022] Open
Abstract
Soy isoflavones, at adequate dosages, have estrogenic and anti-thyroidal effects in animals and humans, which can either be beneficial or adverse, depending on the consumer’s physiological status. Hence, this study presents an assay of soy isoflavones in hair, aiming to give new information about a person’s exposure to isoflavones, when health issues related to estrogenic or thyroidal effects are observed. Aqueous or organic extraction procedures following acidic, basic, or enzymatic digestions were tested on 60 hair samples (from volunteers) from a hairdresser, and a clinical trial 2017T2-29. The acidic digestion method was the most efficient regarding isoflavones. A specific inquiry was developed to assess the dietary habits of French consumers based on the analysis of 12,707 food labels from France. It was used to check for the reliability of the new assay method. A score for the consumer exposures to isoflavones was built considering, among other parameters, soy-based diets and foodstuff containing soy as an ingredient, i.e., “hidden-soy”. The correlation between this score and isoflavone measurements in hair reached 0.947; p < 0.001. Therefore, providing that relevant data are considered to assess isoflavone exposure, hair that smoothens daily isoflavone intake variations, is a relevant tissue to assess human isoflavone exposure for subsequent health analyses.
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Affiliation(s)
- Souad Bensaada
- Carreire Campus, Sciences and Technology Department, Pharmacy Faculty, University of Bordeaux, 33076 Bordeaux, France
- ARNA, U1212 Inserm, 5320 CNRS, Pharmacy Faculty, 33076 Bordeaux, France
| | - Isabelle Raymond
- Carreire Campus, Sciences and Technology Department, Pharmacy Faculty, University of Bordeaux, 33076 Bordeaux, France
- CHU Bordeaux, USN B0-Hôpital Haut Lévêque, 33604 Pessac, France
| | - Malena Breton
- Carreire Campus, Sciences and Technology Department, Pharmacy Faculty, University of Bordeaux, 33076 Bordeaux, France
| | - Isabelle Pellegrin
- Carreire Campus, Sciences and Technology Department, Pharmacy Faculty, University of Bordeaux, 33076 Bordeaux, France
- CHU Bordeaux, Laboratory of Immunology and Immunogenetics, Resources Biological Center (CRB), 33000 Bordeaux, France
| | - Jean-François Viallard
- Carreire Campus, Sciences and Technology Department, Pharmacy Faculty, University of Bordeaux, 33076 Bordeaux, France
- CHU Bordeaux, USN B0-Hôpital Haut Lévêque, 33604 Pessac, France
| | - Catherine Bennetau-Pelissero
- Carreire Campus, Sciences and Technology Department, Pharmacy Faculty, University of Bordeaux, 33076 Bordeaux, France
- ARNA, U1212 Inserm, 5320 CNRS, Pharmacy Faculty, 33076 Bordeaux, France
- Bordeaux Sciences Agro, 33175 Gradignan, France
- Correspondence: ; Tel.: +33-(0)-557-571-271
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12
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Messina M, Duncan A, Messina V, Lynch H, Kiel J, Erdman JW. The health effects of soy: A reference guide for health professionals. Front Nutr 2022; 9:970364. [PMID: 36034914 PMCID: PMC9410752 DOI: 10.3389/fnut.2022.970364] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/25/2022] [Indexed: 11/22/2022] Open
Abstract
Soy is a hotly debated and widely discussed topic in the field of nutrition. However, health practitioners may be ill-equipped to counsel clients and patients about the use of soyfoods because of the enormous, and often contradictory, amount of research that has been published over the past 30 years. As interest in plant-based diets increases, there will be increased pressure for practitioners to gain a working knowledge of this area. The purpose of this review is to provide concise literature summaries (400-500 words) along with a short perspective on the current state of knowledge of a wide range of topics related to soy, from the cholesterol-lowering effects of soy protein to the impact of isoflavones on breast cancer risk. In addition to the literature summaries, general background information on soyfoods, soy protein, and isoflavones is provided. This analysis can serve as a tool for health professionals to be used when discussing soyfoods with their clients and patients.
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Affiliation(s)
- Mark Messina
- Soy Nutrition Institute Global, Washington, DC, United States
| | - Alison Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | | | - Heidi Lynch
- Kinesiology Department, Point Loma Nazarene University, San Diego, CA, United States
| | - Jessica Kiel
- Scientific and Clinical Affairs, Medifast Inc., Baltimore, MD, United States
| | - John W. Erdman
- Division of Nutritional Sciences and Beckman Institute, Department of Food Science and Human Nutrition, University of Illinois at Urbana/Champaign, Urbana, IL, United States
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13
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Lee A, Bensaada S, Lamothe V, Lacoste M, Bennetau-Pelissero C. Endocrine disruptors on and in fruits and vegetables: Estimation of the potential exposure of the French population. Food Chem 2022; 373:131513. [PMID: 34776310 DOI: 10.1016/j.foodchem.2021.131513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 01/18/2023]
Abstract
Fruits and vegetables are considered to be healthy compared to fats, carbohydrates, and meats. However, their production involves plant protection products (PPPs) or they can contain phytoestrogens which may exhibit endocrine effects. Thus, the exposure to the main PPPs and to phytoestrogens known as endocrine disruptors (EDs) is estimated. PPPs include fungicides, growth substances, herbicides, and insecticides authorised in France. ED-PPPs exposure is estimated from the maximum residue limits (MRLs) of 70 potential ED-PPPs used in France on 64 fruits and vegetables. The estimated exposure to potential ED-PPPs is 509 µg/d and involves agonist and antagonist substances in complex mixtures. Anti-androgens are preeminent, at 353 µg/d. Exposure to genistein and daidzein is calculated from 140 measurements in 9 categories of food-items containing soy. The global exposure to isoflavones in France is evaluated at 6700 µg/d. Phytoestrogen exposure is much higher than that of ED-PPPs. Their endocrine effects should be considered.
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Affiliation(s)
- Alexandre Lee
- University of Bordeaux, 33070 Bordeaux France; Bordeaux Sciences Agro, 33175 Gradignan France
| | - Souad Bensaada
- University of Bordeaux, 33070 Bordeaux France; U1212 Inserm, UMR Inserm U1212, CNRS 5320, University of Bordeaux, 33070 Bordeaux France
| | - Valérie Lamothe
- University of Bordeaux, 33070 Bordeaux France; Bordeaux Sciences Agro, 33175 Gradignan France
| | - Melissa Lacoste
- University of Bordeaux, 33070 Bordeaux France; Bordeaux Sciences Agro, 33175 Gradignan France
| | - Catherine Bennetau-Pelissero
- University of Bordeaux, 33070 Bordeaux France; Bordeaux Sciences Agro, 33175 Gradignan France; U1212 Inserm, UMR Inserm U1212, CNRS 5320, University of Bordeaux, 33070 Bordeaux France.
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14
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Basson AR, Ahmed S, Almutairi R, Seo B, Cominelli F. Regulation of Intestinal Inflammation by Soybean and Soy-Derived Compounds. Foods 2021; 10:foods10040774. [PMID: 33916612 PMCID: PMC8066255 DOI: 10.3390/foods10040774] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023] Open
Abstract
Environmental factors, particularly diet, are considered central to the pathogenesis of the inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis. In particular, the Westernization of diet, characterized by high intake of animal protein, saturated fat, and refined carbohydrates, has been shown to contribute to the development and progression of IBD. During the last decade, soybean, as well as soy-derived bioactive compounds (e.g., isoflavones, phytosterols, Bowman-Birk inhibitors) have been increasingly investigated because of their anti-inflammatory properties in animal models of IBD. Herein we provide a scoping review of the most studied disease mechanisms associated with disease induction and progression in IBD rodent models after feeding of either the whole food or a bioactive present in soybean.
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Affiliation(s)
- Abigail Raffner Basson
- Division of Gastroenterology & Liver Diseases, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
- Digestive Health Research Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; (S.A.); (B.S.)
- Correspondence:
| | - Saleh Ahmed
- Digestive Health Research Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; (S.A.); (B.S.)
| | - Rawan Almutairi
- Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Brian Seo
- Digestive Health Research Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; (S.A.); (B.S.)
| | - Fabio Cominelli
- Division of Gastroenterology & Liver Diseases, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
- Digestive Health Research Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; (S.A.); (B.S.)
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15
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Messina M, Mejia SB, Cassidy A, Duncan A, Kurzer M, Nagato C, Ronis M, Rowland I, Sievenpiper J, Barnes S. Neither soyfoods nor isoflavones warrant classification as endocrine disruptors: a technical review of the observational and clinical data. Crit Rev Food Sci Nutr 2021; 62:5824-5885. [PMID: 33775173 DOI: 10.1080/10408398.2021.1895054] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Soybeans are a rich source of isoflavones, which are classified as phytoestrogens. Despite numerous proposed benefits, isoflavones are often classified as endocrine disruptors, based primarily on animal studies. However, there are ample human data regarding the health effects of isoflavones. We conducted a technical review, systematically searching Medline, EMBASE, and the Cochrane Library (from inception through January 2021). We included clinical studies, observational studies, and systematic reviews and meta-analyses (SRMA) that examined the relationship between soy and/or isoflavone intake and endocrine-related endpoints. 417 reports (229 observational studies, 157 clinical studies and 32 SRMAs) met our eligibility criteria. The available evidence indicates that isoflavone intake does not adversely affect thyroid function. Adverse effects are also not seen on breast or endometrial tissue or estrogen levels in women, or testosterone or estrogen levels, or sperm or semen parameters in men. Although menstrual cycle length may be slightly increased, ovulation is not prevented. Limited insight could be gained about possible impacts of in utero isoflavone exposure, but the existing data are reassuring. Adverse effects of isoflavone intake were not identified in children, but limited research has been conducted. After extensive review, the evidence does not support classifying isoflavones as endocrine disruptors.
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Affiliation(s)
- Mark Messina
- Department of Nutrition, Loma Linda University, Loma Linda, California, USA
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Aedin Cassidy
- Nutrition and Preventive Medicine, Queen's University, Belfast, Northern Ireland, UK
| | - Alison Duncan
- College of Biological Sciences, University of Guelph, Guelph, Canada
| | - Mindy Kurzer
- Department of Food Science and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Chisato Nagato
- Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Martin Ronis
- Health Sciences Center, Louisiana State University Health Sciences Center, Baton Rouge, New Orleans, USA
| | - Ian Rowland
- Human Nutrition, University of Reading, Reading, England, UK
| | | | - Stephen Barnes
- Department of Pharmacology and Toxicology, University of Alabama, Alabama, USA
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16
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Fardet A, Rock E. Exclusive reductionism, chronic diseases and nutritional confusion: the degree of processing as a lever for improving public health. Crit Rev Food Sci Nutr 2020; 62:2784-2799. [DOI: 10.1080/10408398.2020.1858751] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Anthony Fardet
- INRAE, Université Clermont Auvergne, UNH, Unité de Nutrition Humaine, CRNH Auvergne, F-63000 Clermont-Ferrand, France
| | - Edmond Rock
- INRAE, Université Clermont Auvergne, UNH, Unité de Nutrition Humaine, CRNH Auvergne, F-63000 Clermont-Ferrand, France
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17
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Povey AC, Clyma JA, McNamee R, Moore HD, Baillie H, Pacey AA, Cade JE, Cherry NM. Phytoestrogen intake and other dietary risk factors for low motile sperm count and poor sperm morphology. Andrology 2020; 8:1805-1814. [PMID: 32649041 DOI: 10.1111/andr.12858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/12/2020] [Accepted: 06/29/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Few potentially modifiable risk factors of male infertility have been identified, and while different diets and food groups have been associated with male infertility, evidence linking dietary factors including phytoestrogens and semen quality is limited and contradictory. OBJECTIVES To study the associations between phytoestrogen intake and other dietary factors and semen quality. MATERIALS AND METHODS A case-referent study was undertaken of the male partners, of couples attempting conception with unprotected intercourse for 12 months or more without success, recruited from 14 UK assisted reproduction clinics. A total of 1907 participants completed occupational, lifestyle and dietary questionnaires before semen quality (concentration, motility and morphology) were assessed. Food intake was estimated by a 65-item food frequency questionnaire (FFQ) covering the 12 months prior to recruitment. Analyses of dietary risk factors for low motile sperm concentration (MSC: <4.8 × 106 /mL) and poor sperm morphology (PM: <4% normal morphology) used unconditional logistic regression, accounting for clustering of subjects within the clinics, first without, and then with, adjustment for confounders associated with that outcome. RESULTS High consumption of daidzein (≥13.74 μg/d), a phytoestrogen found in soy products, was a protective factor for MSC with an odds ratio (95%CI) of 0.58 (0.42-0.82) after adjustment for clustering and potential confounding. Dietary risk factors for PM after similar adjustment showed that drinking whole milk (OR 0.67, 95%CI 0.47-0.96) and eating red meat were protective with an OR 0.67 (0.46-0.99) for eating red meat >3 times/wk. DISCUSSION In this case-referent study of men attending an infertility clinic for fertility diagnosis, we have identified that low MSC is inversely associated with daidzein intake. In contrast, daidzein intake was not associated with PM but eating red milk and drinking whole milk were protective. CONCLUSIONS Dietary factors associated with semen quality were identified, suggesting that male fertility might be improved by dietary changes.
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Affiliation(s)
- Andy C Povey
- Epidemiology and Public Health Group, Faculty of Biology, Medicine and Health, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Julie-Ann Clyma
- Epidemiology and Public Health Group, Faculty of Biology, Medicine and Health, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Roseanne McNamee
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Harry D Moore
- Department of Oncology and Metabolism, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK
| | - Helen Baillie
- Jessop Fertility, The Jessop Wing, Sheffield Teaching Hospitals, Tree Root Walk, Sheffield, UK
| | - Allan A Pacey
- Department of Oncology and Metabolism, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Nicola M Cherry
- Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada
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18
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Sakkas H, Bozidis P, Touzios C, Kolios D, Athanasiou G, Athanasopoulou E, Gerou I, Gartzonika C. Nutritional Status and the Influence of the Vegan Diet on the Gut Microbiota and Human Health. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E88. [PMID: 32098430 PMCID: PMC7073751 DOI: 10.3390/medicina56020088] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 02/07/2023]
Abstract
The human gut microbiota is considered a well-known complex ecosystem composed of distinct microbial populations, playing a significant role in most aspects of human health and wellness. Several factors such as infant transitions, dietary habits, age, consumption of probiotics and prebiotics, use of antibiotics, intestinal comorbidities, and even metabolic diseases may continously alter microbiota diversity and function. The study of vegan diet-microbiota interactions is a rapidly evolving field, since plenty of research has been focused on the potential effects of plant-based dietary patterns on the human gut microbiota. It has been reported that well-planned vegan diets and their associated components affect both the bacterial composition and metabolic pathways of gut microbiota. Certain benefits associated with medical disorders but also limitations (including nutritional deficiencies) have been documented. Although the vegan diet may be inadequate in calorific value, it is rich in dietary fiber, polyphenols, and antioxidant vitamins. The aim of the present study was to provide an update of the existing knowledge on nutritional status of vegan diets and the influence of their food components on the human gut microbiota and health.
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Affiliation(s)
- Hercules Sakkas
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (P.B.); (C.G.)
| | - Petros Bozidis
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (P.B.); (C.G.)
| | - Christos Touzios
- Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (C.T.); (D.K.); (G.A.); (E.A.); (I.G.)
| | - Damianos Kolios
- Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (C.T.); (D.K.); (G.A.); (E.A.); (I.G.)
| | - Georgia Athanasiou
- Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (C.T.); (D.K.); (G.A.); (E.A.); (I.G.)
| | - Eirini Athanasopoulou
- Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (C.T.); (D.K.); (G.A.); (E.A.); (I.G.)
| | - Ioanna Gerou
- Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (C.T.); (D.K.); (G.A.); (E.A.); (I.G.)
| | - Constantina Gartzonika
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (P.B.); (C.G.)
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