High-fiber Foods Research Articles

DAYA TERIMA BARUASA SUBTITUSI TEPUNG KULIT PISANG

Background: Baruasa is favored the local snacks by the people of South Sulawesi, but low in fiber. One of the high fiber foods is the banana hump. Banana hump can be processed into semi-finished materials such as banana hump flour. Banana hump flour can be substituted on the manufacture of baruasa.Objective: The purposeof this study to determine how the effect of banana hump flour substitution on the power of the baruasa receipt. This research is pre experimental research that is making baruasa with three varieties of banana hump flour substitution (10%, 20% and 30%). Hedonic test using untrained panelists are Nutrition Students of Poltekkes Makassar as many as 35 people. Analysis of hedonic test data using Anova and Tukey test with SPSS program.Results: The results showed that the preferred formula of the panelis of the color aspect is F1 of 82.85%, the smell is F1 of 88.57%, the texture of F1 is 54.29% and the sense is F1 of 80% .The test results show that there is a difference of panelist acceptance of the color aspect, Flavor and smell of banana hump flour subtitution flour with p <α value (0,05), whereas in texture aspect there is no difference of acceptance of baruasa banana hump flour with p> α (0,05).Conclusion: It was concluded that the higher concentration of banana hump flour addition was lower due to the panelist's preference for the acceptable power.Suggestion: It is recommended for further preparation, it is better to do further research on how to reduce the color of browning, as well as the smell and flavor of the banana hump flour which is rather sharp on the baruasa.Keywords: Baruasa, Banana Hump Flour, Acceptability

Dietary knowledge, preferences and behaviors in Ramadan among Muslim patients with type 2 diabetes

AimsTo explore the association between dietary knowledge, attitude, and practices during Ramadan among Muslim patients with type 2 diabetes. MethodsRecruited after Ramadan from public clinics and a hospital in Banda Aceh, Indonesia, 401 outpatients recalled their food consumption frequencies of high-fiber food, deep-fried food, and high-sugar dessert, and relevant knowledge and attitudes. Multivariable logistic regression models were applied to examine the research questions. ResultsVegetable consumption and preference were both high among the patients. However, only 4.5% knew that brown rice is rich in fiber, and 19% agreed that whole-grain foods were accessible. Deep-fried food consumption and its availability at home was common, even though the majority considered it should be avoided. Patients with a lower preference for deep-fried foods were less likely to consume deep-fried foods during Ramadan (OR = 0.239, 95% CI = 0.109–0.523, p = 0.001). Knowledge of the glycemic index’s health implication was associated with more high-fiber foods consumption (OR = 2.733, 95% CI = 1.179–6.332, p = 0.019). Yet, knowing the potential risk of added sugar on blood glucose level was associated with high-sugar dessert consumption (OR = 2.997, 95% CI = 1.482–6.060, p = 0.002). ConclusionThe patients’ low consumption of whole-grain food and common comsumption of deep-fried food during Ramadan would be the first priority to be improved. Along with dietary knowledge and attitude, food environment could be an important factor that influences patients’ dietary behaviors.

Effect of Added Dietary Betaine and Soluble Fiber on Metabolites and Fecal Microbiome in Dogs with Early Renal Disease.

Renal diets are recommended for dogs with chronic kidney disease (CKD). This study examined the effects of foods with added betaine and fiber on the plasma and fecal metabolome and fecal microbiome in dogs with early stage CKD. At baseline, several metabolites differed between healthy dogs and those with CKD. Dogs with CKD (n = 28) received a control food, low soluble fiber plus betaine food (0.5% betaine, 0.39% oat beta-glucan, and 0.27% short-chain fructooligosaccharides (scFOS)), or high soluble fiber plus betaine food (0.5% betaine, 0.59% oat beta-glucan, and 0.41% scFOS) each for 10 weeks in different sequences. Consumption of test foods led to several favorable, significant changes in the plasma metabolome, including decreases of several uremic toxins and other deleterious metabolites, and increases in favorable metabolites compared with the control food. Only 7 fecal metabolites significantly changed with consumption of the test foods compared with the control food, largely increases in polyphenols and lignans. Few changes were seen in the fecal microbiome, though some taxa that significantly changed in response to the test foods have beneficial effects on health, with some negatively correlating with uremic toxins. Overall, foods with added betaine and soluble fiber showed positive effects on the plasma and fecal metabolomes.

Screening of cellulose degradation bacteria from Min pigs and optimization of its cellulase production

Abstract Background Cellulose as a potential feed resource hinders its utilization because of its complex structure, and cellulase is the key to its biological effective utilization. Animal endogenous probiotics are more susceptible to colonization in the intestinal tract, and their digestive enzymes are more conducive to the digestion and absorption of feed in young animals. Min pigs are potential sources of cellulase probiotics because of the high proportion of dietary fiber in their feed. In this study, the cellulolytic bacteria in the feces of Min pigs were isolated and screened. The characteristics of enzymes and cellulase production were studied, which provided a theoretical basis for the rational utilization of cellulase and high-fiber food in animal production. Results In our study, 10 strains of cellulase producing strains were isolated from Min pig manure, among which the M2 strain had the best enzyme producing ability and was identified as Bacillus velezensis. The optimum production conditions of cellulase from strain M2 were: 2% inoculum, the temperature of 35°C, the pH of 5.0, and the liquid loading volume of 50 mL. The optimum temperature, pH and time for the reaction of cellulase produced by strain M2 were 55°C, 4.5 and 5 min, respectively. Conclusions Min pigs can be used as a source of cellulase producing strains. The M2 strain isolated from feces was identified as Bacillus velezensis. The cellulase from M2 strain had a good activity and the potential to be used as feed additive for piglets. How to cite: Li F, Xie Y, Gao X, et al. Screening of cellulose degradation bacteria from Min Pigs and optimization of its cellulase production. Electron J Biotechnol 2020;48. https://doi.org/10.1016/j.ejbt.2020.09.001

Dietary fiber intake and risk of type2 diabetes in a general Japanese population: The Hisayama Study.

Aims/IntroductionThe investigation of the influence of dietary fiber intake on the incidence of type 2 diabetes in a general Japanese population.Materials and MethodsA total of 1,892 individuals aged 40–79 years without diabetes at baseline were prospectively followed up for 14 years. The glucose tolerance status of participants was defined by a 75‐g oral glucose tolerance test with the 1998 World Health Organization criteria. Dietary fiber intake was estimated by a semiquantitative food frequency questionnaire and divided to quintile levels separately by sex. A Cox proportional hazards model was applied for computing the hazard ratios and their 95% confidence intervals for the incidence of diabetes.ResultsDuring the follow‐up period, 280 participants had developed diabetes. The age‐adjusted cumulative diabetes incidence decreased significantly with higher total dietary fiber intake (P‐for trend = 0.01). Participants in the highest quintile of total dietary fiber intake had a 0.53‐fold (95% confidence interval 0.31–0.90) lower risk of developing diabetes than those in the lowest quintile after for the adjustment with potential confounding factors. Total dietary fiber intake showed a moderate positive correlation to the intake of soybean and soybean products, green vegetables, and other vegetables. Similar associations with diabetes and food sources were observed for both of the soluble and insoluble dietary fiber intake.ConclusionsThe present study showed that higher dietary fiber intake was associated with a lower risk of type 2 diabetes in a general Japanese population. The intake of high dietary fiber foods might be useful for diabetes prevention.

The Role of Diets in Prevention and Hypertension Therapy

Hypertension is one of the public health problems in the world in the last decade. Various studies show hypertension is a major risk factor in the occurrence of stroke, ischemic heart disease, and kidney failure. Hypertension therapy can reduce the risk of stroke by 40% and myocardial infarction risk by up to 15%. Lifestyle changes that are part of the management of hypertension can reduce blood pressure, increase the effectiveness of antihypertensive drugs, and reduce cardiovascular risk. Modification of daily food intake patterns is one component of lifestyle changes that have the greatest role in lowering blood pressure. Modification of food intake patterns referred to is to follow the general guidelines for balanced nutrition also in accordance with the dietary approach to stop hypertension (DASH), which is high in vegetables and fruit, high-fiber foods, low-fat milk, meat, and nuts. It should also be noted that energy intake, the amount and type of protein, and fat and carbohydrate components. In addition, foodstuffs are rich in minerals and vitamins, and specific nutrients, such as omega-3 unsaturated fatty acids have a role in the prevention and management of hypertension.

The Role of Diets in Prevention and Hypertension Therapy

Hypertension is one of the public health problems in the world in the last decade. Various studies show hypertension is a major risk factor in the occurrence of stroke, ischemic heart disease, and kidney failure. Hypertension therapy can reduce the risk of stroke by 40% and myocardial infarction risk by up to 15%. Lifestyle changes that are part of the management of hypertension can reduce blood pressure, increase the effectiveness of antihypertensive drugs, and reduce cardiovascular risk. Modification of daily food intake patterns is one component of lifestyle changes that have the greatest role in lowering blood pressure. Modification of food intake patterns referred to is to follow the general guidelines for balanced nutrition also in accordance with the dietary approach to stop hypertension (DASH), which is high in vegetables and fruit, high-fiber foods, low-fat milk, meat, and nuts. It should also be noted that energy intake, the amount and type of protein, and fat and carbohydrate components. In addition, foodstuffs are rich in minerals and vitamins, and specific nutrients, such as omega-3 unsaturated fatty acids have a role in the prevention and management of hypertension.

Circulating Short-Chain Fatty Acids Are Positively Associated with Adiposity Measures in Chinese Adults.

Epidemiological studies suggest a positive association between obesity and fecal short-chain fatty acids (SCFAs) produced by microbial fermentation of dietary carbohydrates, while animal models suggest increased energy harvest through colonic SCFA production in obesity. However, there is a lack of human population-based studies with dietary intake data, plasma SCFAs, gut microbial, and anthropometric data. In 490 Chinese adults aged 30–68 years, we examined the associations between key plasma SCFAs (butyrate/isobutyrate, isovalerate, and valerate measured by non-targeted plasma metabolomics) with body mass index (BMI) using multivariable-adjusted linear regression. We then assessed whether overweight (BMI ≥ 24 kg/m2) modified the association between dietary-precursors of SCFAs (insoluble fiber, total carbohydrates, and high-fiber foods) with plasma SCFAs. In a sub-sample (n = 209) with gut metagenome data, we examined the association between gut microbial SCFA-producers with BMI. We found positive associations between butyrate/isobutyrate and BMI (p-value < 0.05). The associations between insoluble fiber and butyrate/isobutyrate differed by overweight (p-value < 0.10). There was no statistical evidence for an association between microbial SCFA-producers and BMI. In sum, plasma SCFAs were positively associated with BMI and that the colonic fermentation of fiber may differ for adults with versus without overweight.

Effect of a Flaxseed Lignan Intervention on Circulating Bile Acids in a Randomized, Crossover Trial

Abstract Objectives Health benefits of high-fiber foods may be attributed, in part, to microbial metabolites of plant compounds. Lignans and their microbial metabolites, the enterolignans [enterolactone (ENL) and enterodiol (END)], reduce serum lipids through a variety of mechanisms, including regulation of bile acid (BA) synthesis. BA, released into the gut lumen in response to dietary fat, undergo microbial metabolism to secondary (2°) BA, which have been positively associated with chronic disease, e.g., liver disease and colorectal cancer. Our aims were to evaluate the effects of a flaxseed lignan supplement on circulating BA and examine associations between enterolignans and 2° BA. Methods We conducted a randomized, crossover trial of a flaxseed lignan supplement (50 mg/d secoisolariciresinol diglucoside) compared to placebo in 46 healthy men and women (20-45 y). Each period lasted 60 days, separated by a 60-day washout period. Six primary and fourteen 2° BA species were measured in fasting plasma using LC-MS. ENL and END were measured in 24-h urines by GC-MS. Low- and high-ENL excreters were defined as below and above the median 24-h ENL excretion at the end of the flaxseed lignan intervention (23.4 µmol/24 h). Linear mixed models were used to a) test the effects of the intervention on individual BA concentrations, overall and stratified by low and high ENL excreters; and b) to cross-sectionally determine the association between plasma 2o BA and ENL and END. Results There was no significant effect of the flaxseed lignan intervention compared to placebo on BA concentrations overall, or by ENL-excreter status, after FDR adjustment. In the cross-sectional analysis, irrespective of treatment, six 2° BA were statistically significantly associated with ENL (FDR &amp;lt; 0.05), with two positive associations (isolithocholic and lithocholic acids), and four inverse associations (glycoursodeoxycholic, glycohyodeoxycholic, hyodeoxycholic, and muricholic acids). Conclusions The flaxseed lignan intervention and subsequent ENL production had no effect on plasma BA concentrations. However, the strong associations between ENL excretion and certain 2° BA concentrations suggests that the gut microbial communities capable of producing ENL may also play a role in 2° BA metabolism. Funding Sources NIH.

Development and Application of Interactive, Culturally Specific Strategies for the Consumption of High-fiber Foods in Puerto Rican Adolescents

ABSTRACT Healthy eating practices in the adolescents can prevent the development of obesity and other chronic diseases in the adulthood. The consumption of fruits, vegetables, and whole grains in Puerto Rican adolescents is low and might be contributing to the high prevalence of food-related chronic diseases, such as obesity in this group. The purpose of the study was to develop and apply interactive methods and strategies that help adolescents make healthy food choices. Over time, healthy food choices can delay or prevent food-related chronic diseases in the adulthood. Information from the focus groups helped to develop nutrition education materials that were age-culturally specific. Following nutrition education, the consumption of foods high in dietary fiber such as fruits, vegetables, and whole-grain cereals improved significantly in Puerto Rican adolescents. A modified socioecological model for dietary fiber-rich foods consumption in Puerto Rican adolescents, demonstrated that effective nutrition education strategies reduced the barriers to dietary fiber-rich foods consumption on the adolescents, their parents and the community promoting healthy eating choices of fruits, vegetables, and whole-grain cereals, to prevent food-related chronic diseases in the adulthood.

A Low-Glycemic Index, High-Fiber, Pulse-Based Diet Improves Lipid Profile, but Does Not Affect Performance in Soccer Players.

Pulses (i.e., lentils, chickpeas, beans, peas) are low-glycemic index, high-fiber foods that are beneficial for improving blood lipids. Young soccer players typically have low dietary fiber intake, perhaps because of concerns regarding gastro-intestinal problems during exercise performance. Twenty-seven (17 females) soccer players were randomized to receive a pulse-based diet or their regular diet for four weeks in a cross-over study and evaluated for changes in blood lipids and athletic performance, with 19 (22 ± 6y; 12 females) completing the study (eight participants withdrew because of lack of time). Women increased high density lipoproteins (+0.5 ± 0.7 vs. −0.6 ± 0.3 mmol/L; p < 0.01) and reduced total cholesterol to high density lipoprotein ratio (−2.4 ± 2.9 vs. +2.6 ± 2.2; p < 0.01) on the pulse-based vs. regular diet, respectively, while there were no differences between diet phases in men. Athletic performance assessed by distance covered during games by a global positioning system was not significantly different during the pulse-based vs. regular diet (9180 ± 1618 vs. 8987 ± 1808 m per game; p = 0.35). It is concluded that a pulse-based diet can improve blood lipid profile without affecting athletic performance in soccer players.

Evaluation on Symptoms and Self-Treatment due to Radiotherapy and Chemotherapy Based on Different Cancer Stage

Cancer modality therapy can minimize metastatic, but it causes decrease in body functions and interfere the daily needs fulfilled. This study was to identify symptoms and self-treatment due to radiotherapy and chemotherapy based on the different cancer stage. This was mixed method design with sequential explanatory approach. Samples were 30 cancer patients taken by purposive sampling at Indonesian Cancer Foundation East Java Branch Surabaya. The instrument was a questionnaire. Fatigue was the most symptoms complained by all patients. Pain, hair loss, constipation were dominated in cancer stage 4, nausea-vomiting, insomnia were dominated in cancer stage 3. The majority self-treatment of fatigue was yoga exercise. Pain and nausea-vomiting were treated by medication and relaxation. Insomnia was treated by mild massage. Constipation was treated by consuming the high fiber foods. Radiotherapy and chemotherapy affect the disturbance of metabolism that cause physical symptoms disorders. Self-treatment by the patient could reduce the symptoms effectively.

Periodontal Health and Nutritional Status in the Elderly: Systematic Review

To assess the effect of nutritional status on periodontal health in the elderly from longitudinal studies and randomized controlled trials in 2000-2020. Periodontal diseases, especially periodontitis, are believed to be linked with several systemic diseases and depended largely on host systemic conditions. Many researchers reported associations between nutritional intakes and periodontal health; however, the causal relationship has not been evaluated. Ten longitudinal studies from four different populations were included in this systematic review. No eligible randomized controlled trials on the topic were found. Vitamin C, E, β-carotene, DHA, high fiber foods, and serum albumin concentration may be protective factors; n-6 to n-3 polyunsaturated fatty acids (PUFAs) ratio, saturated fatty acids (SFAs), and sweets may be risk factors for the worsening of periodontal conditions of older persons. However, the results were inconsistent across the studies. In conclusion, there was an insufficient amount of evidence to claim the casual effects of nutritional status on periodontal health in the elderly.

Alternative Snack for Diabetic Patients from Sago (Metroxylon sp.) Starch and Tempe

This study aimed to develop food products made from sago starch (Metroxylon sp.) and tempe as alternative snacks for diabetics. This study used a completely randomized design (CRD) with two treatment ratios of sago starch to tempe, F1 (2:1) and F2 (1:1), and two replications for three products, namely puddings, muffins, and cookies. The organoleptic attributes of the products were evaluated by fourty semi-trained panelists. The results of the hedonic test showed that F2 was the formula selected for the puddings and muffins and that F1 was the formula selected for the cookies. The puddings had hardness of 83.47 gf, 92.28% water, 0.28% ash, 1.04% protein, 0.64% fat, 5.76% carbohydrate, 3.95% dietary fiber, and 0.81% resistant starch. The muffins had hardness of 3,861,87 gf, 56.18% water, 0.79% ash, 6.49% protein, 10.26% fat, 26.28% carbohydrate, 7.13% dietary fiber, and 3.59% resistant starch. The cookies had hardness of 1,655,02 gf, 5.05% water, 0.90% ash, 4.90% protein, 19.66% fat, 69.49% carbohydrate, 9.57% dietary fiber, and 6.00% resistant starch. These products contained different levels of dietary fiber and resistant starch. Puddings are categorized as a high-fiber food with a negligible level of resistant starch, the muffin as a high-fiber food with an intermediate level of resistant starch, and the cookie as a high-fiber food with a high level of resistant starch. In conclusion, these products had relatively high fiber content and need a further study to confirm the health benefits for glucose control in diabetics.

Effects of extrusion processing and gum content on physicochemical, microstructural and nutritional properties of fermented chickpea-based extrudates

The incorporation of legumes in convenient and healthy food products is one way for increasing their consumptions. However, developing of new products with high content of legume flour is limited due to their beany flavor. To overcome this issue, in the present study, fermentation of chickpeas with baker's yeast and yoghurt culture was used as a potential approach to improve the sensory and nutritional properties of the final extruded product. Fermented chickpea blends were extruded through a co-rotating twin screw extruder. Response surface methodology using a central composite design was used to investigate effects of extrusion conditions, including die temperature (130–150 °C) and screw speed (300–400 rpm) and locust bean gum content (1–4 g/100 g) on the physical and textural properties of the extruded products. Microstructural, sensory, antinutritional and nutritional properties of selected extrudates were also investigated. Regression analysis showed that extrusion parameters and gum content had a significant effect on the physical properties of extrudates but textural properties were mostly affected by changes in temperature and screw speed. Antinutritional factors were significantly reduced while starch and protein digestibility increased after extrusion. The use of both fermentation and extrusion technology allowed the production of high fiber and protein snack foods based on chickpea flour.

Whole grain and high-fibre grain foods: How do knowledge, perceptions and attitudes affect food choice?

The health benefits of whole grains and dietary fibre are well established, however intakes of both remain low across the globe. Innovative added-fibre refined grain products may present a solution to increase fibre intakes given potential sensory barriers to whole grain intake. However, to consider the efficacy of such products, or potential alternative measures, an awareness of consumer knowledge, perceptions and attitudes towards both whole grain and added-fibre grain foods is needed. Focus groups (with adults with no formal nutrition education) were conducted to explore factors affecting consumer grain choice. Discussions were transcribed verbatim and analysed using inductive thematic analysis. Nine focus groups composed of 52 participants (23 men; 29 women) were conducted. Participants tended to report choosing ‘grainy’ bread but few other whole grain foods. Most participants were unaware of the long-term health benefits of whole grains, recommended whole grain intakes, or how to identify foods that were high in whole grains, thereby limiting motivation to increase intake. Additionally, scepticism surrounding the health value of carbohydrate-based foods appeared to hinder grain intakes in general. These findings suggest that further public education and promotion of whole grain benefits, with a focus on food-based targets and messaging, may be important in efforts to increase whole grain and subsequently fibre intakes. Added-fibre grain products may be a useful addition, specifically for avid whole grain-avoiders who are unlikely to accept whole grain sensory properties. However, as most participants were open to whole grain consumption, industry innovation should also focus efforts on increasing availability and variety of products high in whole grains.

Snack bar berbahan pati sagu (Metroxylon sp.), tempe, dan beras hitam sebagai pangan fungsional berindeks glikemik rendah

Background: High calories intake from snacks with low nutritional value will contribute to increase the prevalence of obesity and diabetes. Nutritional strategies to prevent hyperglycemia are controlling blood glucose levels, restrict calories and carbohydrate intake. Sago starch (Metroxylon sp.), tempe and black rice contains ingredients such as dietary fiber, resistant starch, amylose and low glycemic index. Modified snack bar using these ingredients can produce attractive products and provide the beneficial nutrients.Objectives: To determine a snack bar formulation made from sago starch, tempe and black rice and analyze physicochemical characteristics and glycemic index value of the product.Methods: This study used a completely randomized design analyzing three different proportions of sago starch and tempe, namely F1 (2:1), F2 (1.5:1), and F3 (1:1) with two replications for each formula. The Selected formula was determined based on consumer acceptability by semi-trained panelists using 9-point hedonic scale, physicochemical properties, nutrient content, and glycemic index value. Results: The Selected formula (F3) was potentially used as functional food as indicated by high level of dietary fiber (11.05%), 8.8 % resistant starch, in vitro starch digestibility (14.02%), the highest amylose-amylopectin ratio (60.1% : 39.9%), low glycemic index (40) and low glycemic load (5.4). The F3 formula produced a slow increase and peak point of blood glucose response of 107.5 mg/dl at minute 30th lower than the administration of anhydrous glucose with peak point of blood glucose levels of 143.4 mg/dl.Conclusion: The F3 formula with the proportion of sago starch and tempe (1:1) had low glycemic index and was categorized as high-fiber food with high level of resistant starch. Therefore, this product has the potency as functional snack alternative for diabetes patients.

The Choice of Bread: The Association between Consumers' Awareness of Dietary Fiber and Declared Intentions to Eat.

The objective of the study was to find whether consumers declare an intention to eat bread enriched with fiber in the situation of availability of a plain bread and plain bread with grains, and how these intentions are related to their awareness of fiber in bread. The data were collected in a cross-sectional survey among 1014 Polish adults. Based on three pictures of rolls: plain wheat roll (CR), roll enriched with 12% fiber (RF), and roll topped with sunflower seeds (RSS), the participants’ perception regarding fiber content and its impact on intentions to eat were assessed. The respondents were not informed about the differences in composition of the rolls. Although RSS contained only slightly more fiber (0.98 g) than CR (0.81 g), and much less than RF (3.08 g), most of the respondents indicated RSS as containing the most fiber (50.8%) and declared their intention to eat it (39.0%). Respondents who pointed out the importance of fiber, and grains or wholemeal flour addition when making purchase decision, were more likely to declare an intention to eat RSS compared with CR. The low interest in fiber content in a diet increased the chances of declaring an intention to eat CR and RF. People less educated and with low incomes were more likely to declare an intention to eat CR rather than RSS. While people from rural areas were more likely to choose RSS compared with CR and RF. In conclusion, there is interest in bread enriched with fiber, but consumers experience difficulties in recognizing it. Declared intentions to eat each rolls were determined to the greatest extent by the perception of the roll as source of fiber. Thus, educational activities should be focused on consumers’ perception of fiber-rich products and their skills related to the selection of high-fiber foods.

Safety and Efficacy of Using Nuts to Improve Bowel Health in Hemodialysis Patients

Constipation is common in patients with end-stage kidney disease. Nondrug strategies to manage constipation are challenging because of dietary potassium, phosphate, and fluid restrictions. Nuts are a high-fiber food but are excluded from the diet because of the high potassium and phosphate content. The aim of this study was to examine the safety and efficacy of using nuts to improve constipation in adults undertaking hemodialysis (HD). Adult patients undertaking HD were recruited to this nonrandomized, 10-week repeated measures, within-subject, pragmatic clinical trial, conducted in two HD units. The intervention consisted of consumption of 40g of raw almonds daily for four weeks, followed by a two-week washout and four-week control period. The primary safety outcome measures were change in predialysis serum potassium and phosphate levels. The primary efficacy outcome was reduction in constipation, measured using the Bristol Stool Form Scale and Palliative Care Outcome Scale (POS-S) renal symptom score. Secondary outcomes included quality of life, selected uremic toxins, cognition, gut microbiota profile, and symptom burden. Twenty patients completed the trial (median age: 67 [interquartile range: 57.5-77.8] years, 51% male). After controlling for dialysis adequacy, anuria, dietary intake, bicarbonate, and parathyroid hormone, there were no statistically significant changes in serum potassium (P = 0.21) or phosphate (P = 0.16) associated with daily consumption of almonds. However, statistically significant improvements in constipation were seen at weeks 2, 3, 4, and 10. There were statistically significant improvements in quality of life (P = 0.030), overall symptom burden (P = 0.002), vomiting (P = 0.020), itching (P = 0.006), and skin changes (P = 0.002). Daily consumption of almonds for four weeks was safe, effective, and well tolerated. Improvements in quality of life and symptom burden warrant further research to elucidate potential mechanisms. The findings support the potential reinclusion of foods such as nuts into the diet of patients who underwent HD.

The Effects of Tempeh Gembus, an Indonesian Fermented Food, on Lipid Profiles in Women with Hyperlipidemia

Background: Hyperlipidemia is the major precursor of lipid-related diseases. Consumption of high fiber foods may decrease lipid profiles. The fiber content in tempeh gembus is three times higher than regular tempeh. Objective: This study was conducted to investigate the effect of tempeh gembus on lipid profiles in women with hyperlipidemia. Methods: This research used the quasi-experimental design with nonequivalent control group design. Subjects were 41 women with hyperlipidemia, classified into 3 groups: control group, treatment group 1 given 103 g/day tempeh gembus, and treatment group 2 given 206 g/day tempeh gembus for 14 days. All of the groups received nutrition education. Total cholesterol and HDL-C were determined by CHOD-PAP method, triglyceride determined by enzymatic GPO-PAP method after subjects had been fasting for approximately 10 hours. LDL-C was calculated by Friedewald equation. Results: These results showed that consumption of tempeh gembus 103 g/day and 206 g/day decreased LDL-C 27.9% and 30.9% as well as decreased total cholesterol 17.7% and 19.8% respectively. However, HDL-C increased 3.91% and 8.79% and triglyceride increased 2.3% and 3.1%. Tempeh gembus given 206 g/day was more effective to decrease total cholesterol and LDL-C than 103 g/day. Conclusion: Increasing tempeh gembus consumption in women with hyperlipidemia should be addressed to decrease LDL-C and total cholesterol.