Join Us | Latest Articles | Contact

Journal Home


Editorial Board


Recent Articles


Submit to this journal


Special Issues


Current issue

International Journal of Sports and Exercise Medicine





DOI: 10.23937/2469-5718/1510046



Energy Restoration by an Original Fruits & Vegetables Juice Intake in a Cohort of Elderly People Affected by Sarcopenia

Maria Vadalà1,2*, Beniamino Palmieri1,2 and Carmen Laurino1,2


1Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Italy
2Network of the Second Opinion, Italy


*Corresponding author: Maria Vadalà, Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Via del Pozzo, 71, Modena, 41124, Italy, Tel: 39-3397695748, 39-0594222483, E-mail: mary.vadala@gmail.com
Int J Sports Exerc Med, IJSEM-2-046, (Volume 2, Issue 4), Research Article; ISSN: 2469-5718
Received: July 08, 2016 | Accepted: November 17, 2016 | Published: November 21, 2016
Citation: Vadalà M, Palmieri B, Laurino C (2016) Energy Restoration by an Original Fruits & Vegetables Juice Intake in a Cohort of Elderly People Affected by Sarcopenia. Int J Sports. Exerc Med 2:046. 10.23937/2469-5718/1510046
Copyright: © 2016 Vadalà M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Abstract

Objective: To assess the efficacy of fruits & vegetables juice consumption on daily energy balance in a homogenous cohort of sarcopenic old patients.

Methods: 30 participants (27 women and 3 men) affected by sarcopenia were prescribed to drink a fixed volume of fruits & vegetables juice for 3 months. In this anecdotal and retrospective observational study, we filled questionnaire (0-5 rating) describing subjective well-being feelings, psycho-neurological traits, gastrointestinal, musculoskeletal, and cardiovascular as well as any untoward effects. Muscle strength and antioxidant saliva status were the parameters investigated by means of a non-invasive and practical hand dynamometer "FH-500" (Rupac Srl, Milan, Italy) and Point of Care FRAS 4 Evolvo SAT Test (H&D, Parma, Italy), respectively.

Data were statistically analyzed by Mann-Whitney test (continuous variables not normally distributed) and chi squared test (categorical variables).

Results: All parametric data (body weight and BMI) were not significantly different between 1-day and 90-day average for all the patients. On the contrary, significant improvement (p < 0.02) between 1 and 90-day based on the clinical questionnaire were found in the all the patients: specifically, increased ratings for energy level, athletic performance, quality of sleep, ease of awakening and spontaneous sleep induction, ability to focus on activities, mental acuity. The administered juice reduced significantly also asthenia and stress. No significant changes in gastrointestinal, musculoskeletal or cardiovascular system were observed. The main isometric strength values, as well as the antioxidant saliva status, were increased in all the patients at the end of the treatment (p < 0.03).

Conclusion: The results definitely showed that daily consumption of fruits & vegetables juice for 90-days increases the subjective feelings of general well-being, and improves some neurological/psychological performances. The protocol had very high performance compliance and no drop out, supporting the hypothesis of a possible prescription even in the clinical practice.


Keywords

Antioxidant, Energetic, Fruit, Vegetable, Juice, Sarcopenia


Introduction

In the recent years, several epidemiological studies showed that a high intake of fruits and vegetables is associated with a decreased risk of chronic diseases, such as cardiovascular, neurodegenerative and cancer [1-8]. This benefit has been mainly related to the antioxidant activity of the bioactive components of the foods, including Vitamin C, E, carotenoids, and phenolic compounds (e.g. flavonoids) that quench free radicals and reduce oxidative damage to cell structures, and DNA [9-11].

Vitamin C (ascorbic acid) is a water-soluble free radical scavenger, that reduces the risk of arteriosclerosis, cardiovascular diseases and cancer [12,13]. Moreover, it regenerates vitamin E in cell membranes in combination with Glutathione (GSH) or compounds capable of donating reducing equivalents [14,15]. Vitamin E (α-tocopherol) acts as 'chain breaker' during lipid peroxidation in cell membranes and various lipid particles including low-density lipoprotein (LDL). It blocks lipid peroxyl radicals (LOO-) and terminates the lipid peroxidation chain reactions [16]. Carotenoids (Lycopene and β-carotene) are well known to scavenge the peroxyl radicals, disrupting the reaction sequence and preventing the damage to cellular lipids [17]. Lastly, flavonoids, a group of natural benzo-γ-pyran derivatives, have a protective effect on the DNA damage induced by the hydroxyl radicals, probably due to the involvement of the chelating metal ions, such as copper or iron, that complexed with the flavonoids prevent the generation of the ROS [18]. A high daily intake of these bioactive components can be easily achieved adding fruits & vegetables concentrate to the daily diet. Indeed, some clinical trials evidenced that this concentrate mix formula (juice or capsules) reduced the markers of oxidative stress, including plasma carbonyl groups on protein (CP) and malondialdehyde concentrations in 41 trained male cyclists and in 48 aerobically trained men after controlled exercise periods (6 capsules/day for 28 and 2 weeks, respectively) [19]. Moreover, a regular fruits & vegetables concentrate intake (4 capsules/day for 11 weeks) in 59 untrained men significantly improved some markers of immune function and oxidative stress, increasing T cells and plasma oxygen radical absorbance capacity while decreasing the plasma cytokine, IFN-γ [20]. Asgary and coworkers enhanced the antioxidant effect of the orange juice (by high volume intake: 500 mL/twice a day for 4 weeks) in 22 healthy volunteers (18-59 yrs), probably by the combined synergy of two flavonoids (hesperidin and naringenin) that may decrease diastolic blood pressure and might represent a potentially safe energy source [21].

The work hypothesis of our study started by the anecdotal finding of potential energetic benefit of fruits & vegetables juice, supposedly able to interact with the striated muscle mass, thus reducing some expression of sarcopenia (the term sarcopenia describes an age-associated loss of voluntary muscles volume with subsequent measurable reduced performance), a very common finding in the elderly (old people) (Table 1) [22]. This multifactorial disorder encloses age-related mesenchymal and neurological changes, reduced secretion of trophic hormones [23], decrease in muscle innervation and capillary density [24], smoking toxicity [25], extremely sedentary life style, and a quali-quantitative inadequate nutrition [26]; especially a low protein intake or protein metabolism alteration (Table 2 and Table 3) [27]. As to the epidemiology, 25% of people over 70 and 40% of over 80-years-old are found sarcopenic [28].



Table 1: The sarcopenia diagnosis requires documentation of criterion 1 plus documentation of either criterion 2 or criterion 3: View Table 1



Table 2: Mechanism that may be involved in the onset and progression of sarcopenia. View Table 2


To date, pharmacological therapies showed limited efficacy in the treatment of sarcopenia, but a multi-ingredient nutrition strategy may offer additional therapeutic potential by targeting multiple factors associated with the development and consequences of sarcopenia, including both physical and cognitive parameters [29].



Table 3: Stages of sarcopenia syndrome, according to the European Working Group on Sarcopenia in Older People (EWGSOP). View Table 3


Indeed several studies defined the benefits between single nutrient intake such as proteins [1-1.2 g/Kg (body weight)/day] [30-34], vitamins, including 800-1000 IU/day of Vitamin D [35], minerals, including Calcium (500 mg/day) [36], and antioxidants (e.g. 160 mg daily of Vitamin E) [37], and reduction of sarcopenia. However, the link between diets and sarcopenia is far from being definitely defined.

The objective of present study has been to assess the energetic effect of fruits & vegetables juice intake in a homogeneous cohort of patients with sarcopenia over an extended period of time (three months).


Materials and Methods

The anecdotal and retrospective observational study recruited an a homogenous cohort of 30 patients (27 males and 3 females, age 70-85 years) referred to our "Second Opinion Medical Network" (Modena, Italy) with sarcopenia and weakness during daily activity (Table 1). The "Second Opinion Medical Network" is a consultation referral web and Medical Office System involving a wide panel of specialists to which patients affected by different diseases not adequately satisfied in terms of diagnosis and treatment can apply for a clinical update [38]. Most of the patients, nowadays in fact, often wander around the medical Web-sites, looking for proper answers to their health problems, but this screening is often excessive, compulsive, and sometimes obsessive, leading to the "Web Babel Syndrome (this term expresses a doctor-patient communication gap that especially when affected by multiple synchronous pathologies, feeds back heterogeneous and misleading informations and prescriptions with the risk of a confusionary state [39,40]). To solve this problem, the "Second Opinion Network" represents a useful decision-support tool not only in order to achieve a re-evaluation of the patient's case with a consequent optimization of treatment and prognosis [41], but also to avoid un-necessary investigational procedures, undue unhelpful and expensive medical and surgical treatments [42].

The selected patients were informed, via individual interview, and informed consent previously approved by the Local Institutional Review Board under the Helsinki Declaration. Contemporarily, background information regarding dietary habit (coffee, tea, and alcohol consumption), smoking, and disease history was recorded for each participant.

The specific inclusion criteria were: 1) no smoke, 2) three balanced meals a day (40% proteins, 35% carbohydrates and 25% fats with average 1800 calories/day, to maintain the body weight), 3) no reported food allergies or any food restrictions, namely for the milk proteins and soy lecithin, 4) no drug or nutraceutical admitted affecting appetite or food intake, 5) a body mass index (BMI) within the normal limits (between 20 and 30 Kg/m2), 6) no diabetes. The following exclusion criteria were: 1) pregnant or lactating women, 2) subjects eating more than average levels of fruit and vegetables (more of 800 grm per day).

The patients were prescribed to drink 20 mL/day (10 mL after lunch and 10 mL after dinner in 120 mL of water/dose) of "Vita Vitale plus" fruits & vegetables juice (Medicura Naturprodukte AG, Burglauer, Germany), composed by fruits concentrate (including lemon, orange, passion fruit, white grape, pomegranate, cranberry), vegetables concentrate (including carrot, celery, broccoli), mare's milk, and aromatic plants extracts (Tables 4, Table 5 and Table 6) for the treatment of three months (two bottles/month). We established the daily intake recommended by the German Company.



Table 4: Baseline characteristics of patients. View Table 4



Table 5: Ingredients of fruit & vegetable juice. View Table 5


Body weight and BMI were recorded before supplementation, on the day 30, day 60 and at the end of treatment (day 90), using a digital instrument for the weight measurement (Kg/m2).



Table 6: Micronutrient composition of the fruit & vegetable juice (per 20 ml). Energy for 20 mL of juice is 150 kj/35 kcal. View Table 6


All subjects had to fill a 20 items questionnaire, divided into physical and psychological fatigue-related symptoms (fatigue, short-term memory, insomnia, depression), gastrointestinal symptoms, possible side effects (nausea, abdominal and stomach pain, vomiting, skin rashes); for which the subjects scored on a 5-point scale (0 for "not at all", 1 for "a little bit", 2 for "somewhat", 3 for "quite a bit", 4 for "a great deal", 5 for "a very great deal"), before and at the end of treatment.

The fatigability severity (energy level) is evaluated (at 1-day and 90-day average) using a standardized athletic performance assessment, such as a 10-minute walk, based on the change a subject perceived in their self-reported energy level over time at the point they stopped walking (i.e. estimate of distance walked, walking speed). Subjects were asked to walk at their self-selected pace for up to 10 minutes. Prior to the walking assessment, each participant was asked to rate their current level of tiredness (e.g. "How tired are you right now?") on a seven-point scale from 7 (extremely tired) to 1 (extremely energetic).

The maximum isometric muscular strength was quantitatively measured by a digital dynamometer "FH-500" (Rupac Srl, Milan, Italy) before and after juice supplementation. Each patient was required to squeeze the muscles as much as possible performing a maximal voluntary isometric contraction for 6 seconds followed by limb relaxation [43]. We carried out four measurements for each patient (elbow extension, hip abduction, knee extension, and ankle dorsiflexion strength) that were repeated three times with intervals of 1 minute, on both right and left sides, and the highest value, expressed in Newton (N), was recorded. All the measurements were performed by the same observer and the means of three readings were reported (Figure 1 and Figure 2).


.
Figure 1: Left elbow extension. View Figure 1



.




.
Figure 2: Right ankle dorsiflexion. View Figure 2



.




To evaluate the antioxidant effect of fruits & vegetables juice intake in these patients, we used an easy and quick Point of Care Test: Saliva Antioxidant Test (SAT) of FRAS 4 Evolvo (H&D, Parma, Italy). In this test, the sample is prepared chewing for 1 min a cotton square weighing 300 mg and then squeezing the saliva into a small plastic container: 40 μL of R2 reagent (iron solution) is added to the microcuvette containing R1 reagent (thiocyanate derivate pre-dosed solution), followed by 10 μL of the saliva sample. Results are scored by a photometer v505 nm, following a 1-minute incubation period at 37 °C. The principle of SAT test is based on the capacity of an iron solution [solution of ferric ions (Fe3+) bound to a specific chromogen] to discolour when the Fe3+ ions are reduced to ferrous ions (Fe2+) in the presence of phosphates [44]. The reduced ferrous ions are thus quantified, expressing the reducing antioxidant status of the saliva in μmol/L of Vitamin C (reference standard used as ferrous-reducing agent). The normal SAT values range are between 1001-1500 μmol/L Vit C, values < 1000 μmol/L Vit C indicate severe shortage of antioxidant status (AS).


Statistical Analysis

The statistical analysis was evaluated using Mann-Whitney test (continuous variables not normally distributed) and chi squared test (categorical variables). A commonly-used measure of linear correlation, the Pearson correlation coefficient, denoted by r, was reported. Statistical significance was set at p-value less than 0.05, and all data and graphics were analyzed using the R software, version 3.1.2 [R Core Team, Austria (2015)] [45].


Results

All parametric data, body weight and BMI, showed no differences between the day-1 and day-90 of the treatment. Significant variations (p < 0.02) were found in all the patients as to the clinical items before, during and one month after the treatment. Indeed, the fruits & vegetables juice intake at day-90 significantly reduced stress, morning stiffness and cognitive problems (e.g. concentration problems) and increased the energy level of a each patient previously complaining asthenia and improved sleep quality: 80% of the treated individuals declared less fatigue and more intense athletic performance and 92% expended more energy during the day, measured with a standardized performance assessment, e.g. in walk meters during daily duties (Figure 3).


.
Figure 3: Graphic illustration of the physical and psychological symptoms of the patients at 1-day (before treatment) and at 90th day (after treatment). View Figure 3



.




The four isometric strength values (on both right and left sides for each patient) were significantly increased in all the patients at the end of the treatment compared to measurements performed before juice supplementation (Table 7, p < 0.001).



Table 7: Values (in Newton) of muscle strength of patients, reported as mean ± standard deviation. View Table 7


The saliva antioxidant status of the patients, evaluated by SAT Test, significantly increased (p < 0.03) at day-90, suggesting that fruits & vegetables juice are well absorbed and can counteract the oxidative stress induced sarcopenia.


Discussion

The World Health Organization (WHO) recommends to people 400 g/day fruit and vegetables intake [46] and Denmark advices a minimum of 600 g or 6 servings per day [47]. North America, proposes 5-13 servings of fruits and vegetables each day (rated to the caloric intake) [48], and Canada 8-10 servings for adult males under age 50 yrs. [49]. These variable recommendations show that a minimum daily consumption of 5 or more servings of fruits and vegetables is a public health gold standard advice. Kawashima and coworkers, in a randomized double-blind and placebo-trial, showed that supplementation with fruits & vegetables concentrate over a 28-day period in 60 healthy volunteers, produced significant increases in serum antioxidants, such as α-tocopherol (39, 5%), β-carotene (52, 8%) and lycopene (80, 2%) and significant decrease of plasma homocysteine (p < 0.03) compared to the placebo group at the end of the treatment [50]. Similar findings were confirmed by Samman, et al. [51] who showed in 32 healthy men that mixed fruits & vegetables concentrate administration (4 capsules/day for 6 weeks) decreased plasma lipid concentrations (p < 0.05) by displacing cholesterol-raising constituents of the diet, particularly saturated fat.

Over 250 epidemiological studies, published by the World Cancer Research Fund & American Institute for Cancer Research, suggested the cancer preventive role of fruits & vegetables, due probably to the cumulative role of chemo preventive phytochemicals such as glucosin [52].

Further clinical studies confirmed that consumption of cruciferous and allium vegetables or citrus fruits are linked to antioxidant and antiproliferative effects against specific cancers, including pancreatic, stomach, lung, prostate carcinoma [53-58]. Potential mechanisms for cancer prevention of phytochemicals include prevention of DNA adduct formation [59], enhanced carcinogen elimination [53], inhibition of inflammatory processes [60], interference with tumor angiogenesis [61,62], and a direct cytotoxic effect on tumor cells [63], by folates, polyphenols, anthocyanins, carotenoids, lutein, and lycopene [64-66].

In a further study, a strong reduction of bladder cancer risk was observed in an cohort of population with incident bladder cancer risk (252 men) followed up for ten years period (1986-1996) and consumed (≥ 5 servings/week) cruciferous vegetables, including broccoli, cabbage, Brussels sprouts [58].

A wide variety of phytochemicals but also water-insoluble molecules (including lycopene found in tomato puree and β-carotene found in yellow, orange, and green leafy fruits and carrot, spinach, and broccoli powder) are the basic components of our natural juice, with a potential cancer preventive role actually outside of the scope of the study. We limited the investigation to the energetic effect by specific clinical questionnaire and dynamometer data.

The prescribed fruits & vegetables juice intake displayed a significant benefit by the antioxidant micronutrients contents, including alpha lipoic acid (present in spinach and broccoli powder), Vitamin E (present in green leafy vegetables), curcumin (present in curcuma powder), supposing that this intake can optimize mitochondrial energy stores, and protect synaptic membranes from lipid peroxidation.

The polyphenols (such as the tannic acid from tea extract) are reported as "sticky" agents binding to the surfaces of the oral cavity (including tongue, palate, gingival epithelium, the teeth and the microbial flora) and neutralizing the oxidative stress [67,68] from the very first tract lumen contact before absorption; this has been clearly shown by the measured salivary antioxidant levels (SAT test).


Conclusions

High dietary intake of antioxidants, especially if joined with healthy lifestyle and physical exercise, can improve the life quality in sarcopenic old patients, reducing asthenia, improving energy level and sleep. Our protocol has been proven effective to relieve the symptoms usually requiring a complex chronically administered drug regimen.

In the tested juice, we find a well balanced tailored integration of vitamins and natural phytocomplexes, with the specific claim to fulfill the ancient aphorism: "The food will be your primary drug" in the prominent concept to take care of an healthy oral intake, namely with a regular vitamin level, which is often reduced especially in elderly people frequently complaining of malabsorption and food restriction.

Our easy & safe diet integration is low-moderate-cost effective treatment that can be used in combination with usual drug therapies of the old ages, with no reported side effects.


Competing Interest

The authors declare that they have no competing interests.


Acknowledgements

The authors thank the Company Medicura Naturprodukte AG (Burglauer, Germany) for the fruits & vegetable juice.


References
  1. Gosslau A, Chen KY (2004) Nutraceuticals, apoptosis, and disease prevention. Nutrition 20: 95-102.

  2. Gundgaard J, Nielsen JN, Olsen J, Sørensen J (2003) Increased intake of fruit and vegetables: estimation of impact in terms of life expectancy and healthcare costs. Public Health Nutr 6: 25-30.

  3. Ness AR, Powles JW (1997) Fruit and vegetables, and cardiovascular disease: a review. Int J Epidemiol 26: 1-13.

  4. Chen L, Hu FB, Yeung E, Tobias DK, Willett WC, et al. (2012) Prepregnancy consumption of fruits and fruit juices and the risk of gestational diabetes mellitus: a prospective cohort study. Diabetes Care 35: 1079-1082.

  5. Rohrmann S, Giovannucci E, Willett WC, Platz EA (2007) Fruit and vegetable consumption, intake of micronutrients, and benign prostatic hyperplasia in US men. Am J Clin Nutr 85: 523-529.

  6. Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, et al. (2006) Fruit and vegetable intakes, C-reactive protein, and the metabolic syndrome. Am J Clin Nutr 84: 1489-1497.

  7. Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL (2006) Fruit and vegetable consumption and risk of cholecystectomy in women. Am J Med 119: 760-767.

  8. Michels KB, Giovannucci E, Chan AT, Singhania R, Fuchs CS, et al. (2006) Fruit and vegetable consumption and colorectal adenomas in the Nurses' Health Study. Cancer Res 66: 3942-3953.

  9. Prior RL, Cao G (1999) Antioxidant capacity and polyphenolic components of teas: implications for altering in vivo antioxidant status. Proc Soc Exp Biol Med 220: 255-261.

  10. Paganga G, Miller N, Rice-Evans CA (1999) The polyphenolic content of fruit and vegetables and their antioxidant activities. What does a serving constitute?. Free Radic Res 30: 153-162.

  11. Halvorsen BL, Holte K, Myhrstad MC, Barikmo I, Hvattum E, et al. (2002) A systematic screening of total antioxidants in dietary plants. J Nutr 132: 461-471.

  12. Sies H (1997) Oxidative stress: oxidants and antioxidants. Exp Physiol 82: 291-295.

  13. Palmieri B, Pollastri F, Scafati M (2006) Vitamin C. Its clinical use and state of the art. Minerva Med 97: 419-436.

  14. Niki E1 (1991) Action of ascorbic acid as a scavenger of active and stable oxygen radicals. Am J Clin Nutr 54: 1119S-1124S.

  15. Retsky KL, Freeman MW, Frei B (1993) Ascorbic acid oxidation product(s) protect human low density lipoprotein against atherogenic modification. Anti- rather than prooxidant activity of vitamin C in the presence of transition metal ions. J Biol Chem 268: 1304-1309.

  16. Nimse SB, Pal D (2015) Free radicals, natural antioxidants, and their reaction mechanisms. RSC Advances 5: 1-21.

  17. Haila K (1999) Effects of Carotenoids and Carotenoid-Tocopherol Interaction on Lipid Oxidation In Vitro. Academic dissertation 1-4.

  18. Middleton E Jr, Kandaswami C, Theoharides TC (2000) The effects of plant flavonoids on mammalian cells: implications for inflammation, heart disease, and cancer. Pharmacol Rev 52: 673-751.

  19. Bloomer RJ, Goldfarb AH, McKenzie MJ (2006) Oxidative stress response to aerobic exercise: comparison of antioxidant supplements. Med Sci Sports Exerc 38: 1098-1105.

  20. Nantz MP, Rowe CA, Nieves C Jr, Percival SS (2006) Immunity and antioxidant capacity in humans is enhanced by consumption of a dried, encapsulated fruit and vegetable juice concentrate. J Nutr 136: 2606-2610.

  21. Asgary S, Keshvari M, Afshani MR, Amiri M, Laher I, et al. (2014) Effect of fresh orange juice intake on physiological characteristics in healthy volunteers. ISRN Nutr 2014: 405867.

  22. Sadji M, Penelope MPV, Ndiaye NF, Traore A (2015) Enhanced L-citrulline in parboiled paddy rice with watermelon (Citrullus lanatus) juice for preventing Sarcopenia: A preliminary study. African Journal of food science 9: 508-513.

  23. Hashemi R, Motlagh AD, Heshmat R, Esmaillzadeh A, Payab M, et al. (2015) Diet and its relationship to sarcopenia in community dwelling Iranian elderly: a cross sectional study. Nutrition 31: 97-104.

  24. Kim J, Lee Y, Kye S, Chung YS, Kim KM (2015) Association of vegetables and fruits consumption with sarcopenia in older adults: the Fourth Korea National Health and Nutrition Examination Survey. Age Ageing 44: 96-102.

  25. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, et al. (2010) Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 39: 412-423.

  26. Paddon-Jones D, Short KR, Campbell WW, Volpi E, Wolfe RR (2008) Role of dietary protein in the sarcopenia of aging. Am J Clin Nutr 87: 1562S-1566S.

  27. Rolland Y, Lauwers-Cances V, Cristini C, Van Kan GA, Janssen I, et al. (2009) Difficulties with physical function associated with obesity, sarcopenia, and sarcopenic-obesity in community-dwelling elderly women: the EPIDOS (EPI Demiologie del'Osteoporose) Study. Am J Clin Nutr 89: 1895-1900.

  28. Renoud A, Ecochard R, Marchand F, Chapurlat R, Szulc P (2014) Predictive parameters of accelerated muscle loss in men-MINOS study. Am J Med 127: 554-561.

  29. Egan B, Palumbo AS, Moran CN, Stynes H, Hone M, et al. (2016) Effect of six months of daily consumption of a multi-ingredient nutrition supplement containing fish oil, whey protein, vitamin D, and resveratrol on physical and cognitive function in older (> 65 y) Irish adults. ICFSR.

  30. Kim JS, Wilson JM, Lee SR (2010) Dietary implications on mechanisms of sarcopenia: roles of protein, amino acids and antioxidants. J Nutr Biochem 21: 1-13.

  31. Paddon-Jones D, Rasmussen BB (2009) Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care 12: 86-90.

  32. Morais JA, Chevalier S, Gougeon R (2006) Protein turnover and requirements in the healthy and frail elderly. J Nutr Health Aging 10: 272-283.

  33. Mithal A, Bonjour JP, Boonen S, Burckhardt P, Degens H, et al. (2013) Impact of nutrition on muscle mass, strength, and performance in older adults. Osteoporos Int 24: 1555-1566.

  34. Scott D, Blizzard L, Fell J, Giles G, Jones G (2010) Associations between dietary nutrient intake and muscle mass and strength in community-dwelling older adults: the Tasmanian Older Adult Cohort Study. J Am Geriatr Soc 58: 2129-2134.

  35. Visser M, Deeg DJ, Lips P (2003) Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab 88: 5766-5772.

  36. Dawson-Hughes B, Harris SS, Ceglia L (2008) Alkaline diets favor lean tissue mass in older adults. Am J Clin Nutr 87: 662-665.

  37. Semba RD, Blaum C, Guralnik JM, Moncrief DT, Ricks MO, et al. (2003) Carotenoid and vitamin E status are associated with indicators of sarcopenia among older women living in the community. Aging Clin Exp Res 15: 482-487.

  38. Wunsch A, Palmieri B (2013) The role of second opinion in oncology: an update. Mattioli 1885, 18.

  39. Palmieri B, Iannitti T, Capone S, Fistetto G, Arisi E (2011) Second opinion clinic: is the Web Babel Syndrome treatable?. Clin Ter 162: 575-583.

  40. Palmieri B, Iannitti T (2011) The Web Babel syndrome. Patient Educ Couns 85: 331-333.

  41. Palmieri B, Capone S, Fistetto G (2011) Second opinion consultation: is Babel-web syndrome curable?. Recenti Prog Med 102: 43.

  42. Di Cerbo A, Palmieri B (2012) The economic impact of second opinion in pathology. Saudi Med J 33: 1051-1052.

  43. Ramos D, Bertolini GN, Leite MR, Carvalho Junior LC, da Silva Pestana PR, et al. (2015) Is dynamometry able to infer the risk of muscle mass loss in patients with COPD? Int J Chron Obstruct Pulmon Dis 10: 1403-1407.

  44. Benedetti S, Primiterra M, Finco A, Canestrari F, Cornelli U (2014) Validation of a patented method to determine the antioxidant capacity of human saliva based on the reduction of iron: the SAT test. Clin Lab 60: 475-482.

  45. Core R, TR, A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna.

  46. (2003) Diet, nutrition and the prevention of chronic diseases. World Health Organ Tech Rep Ser 916: 1-149.

  47. Administration D.V.a.F (1998) Fruits and vegetables: recommendations for intake. Copenhagen: The Danish Ministry of Food, Agriculture and Fisheries.

  48. (2005) USDA, Dietary guidelines for Americans 2005. Chapter 5, food groups to encourage.

  49. Canada H, Canada's food guide.

  50. Kawashima A, Madarame T, Koike H, Komatsu Y, Wise JA (2007) Four week supplementation with mixed fruit and vegetable juice concentrates increased protective serum antioxidants and folate and decreased plasma homocysteine in Japanese subjects. Asia Pac J Clin Nutr 16: 411-421.

  51. Samman S, Sivarajah G, Man JC, Ahmad ZI, Petocz P, et al. (2003) A mixed fruit and vegetable concentrate increases plasma antioxidant vitamins and folate and lowers plasma homocysteine in men. J Nutr 133: 2188-2193.

  52. Research W.C.R.F.A.I.f.C (1997) Food, nutrition, and the prevention of cancer: A global perspective. Washington, DC: American Institute for Cancer Research,

  53. Talalay P, Fahey JW (2001) Phytochemicals from cruciferous plants protect against cancer by modulating carcinogen metabolism. J Nutr 131: 3027S-33S.

  54. 54. Verhoeven DT, Goldbohm RA, van Poppel G, Verhagen H, van den Brandt PA (1996) Epidemiological studies on brassica vegetables and cancer risk. Cancer Epidemiol Biomarkers Prev 5: 733-748.

  55. Fleischauer AT, Arab L (2001) Garlic and cancer: a critical review of the epidemiologic literature. J Nutr 131: 1032S-40S.

  56. Galeone C, Pelucchi C, Levi F, Negri E, Franceschi S, et al. (2006) Onion and garlic use and human cancer. Am J Clin Nutr 84: 1027-1032.

  57. Milner JA (2001) Mechanisms by which garlic and allyl sulfur compounds suppress carcinogen bioactivation. Garlic and carcinogenesis. Adv Exp Med Biol 492: 69-81.

  58. Crowell PL (1999) Prevention and therapy of cancer by dietary monoterpenes. J Nutr 129: 775S-778S.

  59. Ames BN, Gold LS, Willett WC (1995) The causes and prevention of cancer. Proc Natl Acad Sci U S A 92: 5258-5265.

  60. Surh YJ, Chun KS, Cha HH, Han SS, Keum YS, et al. (2001) Molecular mechanisms underlying chemopreventive activities of anti-inflammatory phytochemicals: down-regulation of COX-2 and iNOS through suppression of NF-kappa B activation. Mutat Res 480-481: 243-268.

  61. Lamy S, Gingras D, Beliveau R (2002) Green tea catechins inhibit vascular endothelial growth factor receptor phosphorylation. Cancer Res 62: 381-385.

  62. Tosetti F, Ferrari N, De Flora S, Albini A (2002) Angioprevention': angiogenesis is a common and key target for cancer chemopreventive agents. FASEB J 16: 2-14.

  63. Martin KR (2006) Targeting apoptosis with dietary bioactive agents. Exp Biol Med (Maywood) 231: 117-129.

  64. Heimendinger J, Chapelsky D (1996) The National 5 A Day for Better Health Program. Adv Exp Med Biol 401: 199-206.

  65. McCullough ML, Giovannucci EL (2004) Diet and cancer prevention. Oncogene 23: 6349-6364.

  66. Johnston CS, Taylor CA, Hampl JS (2000) More Americans are eating "5 a day" but intakes of dark green and cruciferous vegetables remain low. J Nutr 130: 3063-3067.

  67. Ginsburg I, Koren E, Shalish M, Kanner J, Kohen R, et al. (2012) Saliva increases the availability of lipophilic polyphenols as antioxidants and enhances their retention in the oral cavity. Arch Oral Biol 57: 1327-1334.

  68. Ginsburg I, Kohen R, Shalish M, Varon D, Shai E, et al. (2013) The oxidant-scavenging abilities in the oral cavity may be regulated by a collaboration among antioxidants in saliva, microorganisms, blood cells and polyphenols: a chemiluminescence-based study. PLoS One 8: e63062.

Go to top
International Journal of Anesthetics and Anesthesiology (ISSN: 2377-4630)
International Journal of Blood Research and Disorders   (ISSN: 2469-5696)
International Journal of Brain Disorders and Treatment (ISSN: 2469-5866)
International Journal of Cancer and Clinical Research (ISSN: 2378-3419)
International Journal of Clinical Cardiology (ISSN: 2469-5696)
Journal of Clinical Gastroenterology and Treatment (ISSN: 2469-584X)
Clinical Medical Reviews and Case Reports (ISSN: 2378-3656)
Journal of Dermatology Research and Therapy (ISSN: 2469-5750)
International Journal of Diabetes and Clinical Research (ISSN: 2377-3634)
Journal of Family Medicine and Disease Prevention (ISSN: 2469-5793)
Journal of Genetics and Genome Research (ISSN: 2378-3648)
Journal of Geriatric Medicine and Gerontology (ISSN: 2469-5858)
International Journal of Immunology and Immunotherapy (ISSN: 2378-3672)
International Journal of Medical Nano Research (ISSN: 2378-3664)
International Journal of Neurology and Neurotherapy (ISSN: 2378-3001)
International Archives of Nursing and Health Care (ISSN: 2469-5823)
International Journal of Ophthalmology and Clinical Research (ISSN: 2378-346X)
International Journal of Oral and Dental Health (ISSN: 2469-5734)
International Journal of Pathology and Clinical Research (ISSN: 2469-5807)
International Journal of Pediatric Research (ISSN: 2469-5769)
International Journal of Respiratory and Pulmonary Medicine (ISSN: 2378-3516)
Journal of Rheumatic Diseases and Treatment (ISSN: 2469-5726)
International Journal of Sports and Exercise Medicine (ISSN: 2469-5718)
International Journal of Stem Cell Research & Therapy (ISSN: 2469-570X)
International Journal of Surgery Research and Practice (ISSN: 2378-3397)
Trauma Cases and Reviews (ISSN: 2469-5777)
International Archives of Urology and Complications (ISSN: 2469-5742)
International Journal of Virology and AIDS (ISSN: 2469-567X)
More Journals

Contact Us

ClinMed International Library | Science Resource Online LLC
3511 Silverside Road, Suite 105, Wilmington, DE 19810, USA
Email: contact@clinmedlib.org
 

Feedback

Get Email alerts
 
Creative Commons License
Open Access
by ClinMed International Library is licensed under a Creative Commons Attribution 4.0 International License based on a work at https://clinmedjournals.org/.
Copyright © 2017 ClinMed International Library. All Rights Reserved.