Palatability Issues Research Articles

Replacement of fishmeal with a microbial single-cell protein induced enteropathy and poor growth outcomes in barramundi (Lates calcarifer) fry.

Fish meal (FM) replacement is essential for the sustainable expansion of aquaculture. This study focussed on the feasibility of replacing FM with a single-cell protein (SCP) derived from methanotrophic bacteria (Methylococcus capsulatus, Bath) in barramundi fry (Lates calcarifer). Three isonitrogenous and isoenergetic diets were formulated with 0%, 6.4% and 12.9% inclusion of the SCP, replacing FM by 0%, 25% and 50%. Barramundi fry (initial body weight 2.5 ± 0.1 g) were fed experimental diets for 21 days to assess growth performance, gut microbiome composition and gut histopathology. Our findings revealed that both levels of SCP inclusion induced detrimental effects in barramundi fry, including impaired growth and reduced survival compared with the control group (66.7% and 71.7% survival in diets replacing FM with SCP by 25% and 50%, respectively; p < .05). Both dietary treatments presented mild necrotizing enteritis with subepithelial oedema and accumulation of PAS positive, diastase resistant droplets within hepatocytes (ceroid hepatopathy) and pancreatic atrophy. Microbiome analysis revealed a marked shift in the gut microbial community with the expansion of potential opportunistic bacteria in the genus Aeromonas. Reduced overall performance in the highest inclusion level (50% SCP) was primarily associated with reduced feed intake, likely related to palatability issues, albeit pathological changes observed in gut and liver may also play a role. Our study highlights the importance of meticulous optimization of SCP inclusion levels in aquafeed formulations, and the need for species and life-stage specific assessments to ensure the health and welfare of fish in sustainable aquaculture practices.

Exploring Sustainable Aquafeed Alternatives with a Specific Focus on the Ensilaging Technology of Fish Waste

The global increase in population has placed significant pressure on food security, leading to the emergence of aquaculture as a vital source of aquatic foods. However, rising costs and limited fish meal availability in aquafeeds have driven the search for alternative protein sources. While plant-based ingredients have been integrated into commercial aquafeeds, they come with challenges such as low protein content, palatability issues, and the presence of antinutritional factors. In this context, fish silage, made from fish waste and discarded fish, stands out as a promising alternative technology due to its cost-effectiveness and sustainability attributes. The production of fish silage involves the addition of organic/inorganic acids or lactic acid bacteria to homogenized fish waste, yielding a valuable mixture rich in peptides and free amino acids, offering significant nutritional benefits for animal diets. This review aims to promote sustainable practices in the aquaculture industry by analyzing research results related to ensiling technology, appraising the advantages and disadvantages of using fish silage as a feed ingredient, and focusing on emerging trends in this field.

Application of 3D printing technology for the development of dose adjustable geriatric and pediatric formulation of celecoxib

Developing safe and effective formulations for the geriatric and pediatric population is a challenging task due to issues of swallowability and palatability. The lack of standardized procedures for pediatric formulations further complicates the process. Manipulating adult formulations for children can lead to suboptimal efficacy and safety concerns. To overcome these challenges, minitablets or spinklets are preferred for the geriatric and pediatric population due to their smaller size and flexible dose adjustment. The aim of this study is the development of a 3D printed spinklets formulation of celecoxib, a nonsteroidal anti-inflammatory drug, using hot melt extrusion to address the limitations of traditional manufacturing methods. Three different formulations of celecoxib were prepared using Poly-2-ethyl-tetra-oxazoline (Aquazol) with and without surfactant. Subsequently, the mechanical properties and solubility of the drug-loaded filaments were evaluated. Solid state characterization confirmed the drug conversion into an amorphous form during the extrusion process, Computer-aided design software facilitate sprinklets design for fused deposition modeling and scanning electron microscopy assess the surface morphology. Sophorolipids plasticize better than TPGS, resulting in lowering processing temperatures during melt extrusion. In vitro drug release showed successful enhancements in the dissolution of oral medications for pediatric patients, considering their distinctive physiological characteristics. Overall, this study demonstrates the successful development of PEtOx-based 3D printed celecoxib sprinklets by coupling hot-melt extrusion and 3D printing technology. Future exploration holds the potential to revolutionize pharmaceutical production and advance personalized medication formulations.

PSI-9 Efficacy of Electrolyte Chews in Horses

Abstract Oral supplementation with electrolytes is commonly practiced among horse owners. However, practical ease of administration can be challenging due to palatability issues. The objective of this study was to investigate the efficacy of a novel electrolyte product form during routine exercise. Protocol approval (21-029) by Southern Illinois University Institutional Animal Care and Use Committee was obtained before initiation of this work. Privately-owned local foxhunting horses (n = 15) were evaluated. Treatment groups were identified based on voluntary consumption of chews and include control (CON) = 0 chews; light (LIG) 6 to 9 chews; and moderate (MOD) 15 to 20 chews. Jugular venipuncture and vitals assessments were completed 30 minutes before and 30 minutes following a 2-hour ride. Electrolyte chews were offered in two sessions: 30 minutes pre-ride and immediately post-ride. Serology values for Na, K, Cl, Ca, HCO−3, Mg were measured as well as respiratory rate (RR), skin turgor (SKN), and rectal temperature (BT). Categorical variables included body condition score (BCS), sex, and breed (BRD). Data were analyzed via PROC GLM, PROC FREQ and PROC CORR dependent on test with SAS (v. 9.5). Significance for all tests was set at P &amp;lt; 0.05. Serological values were unaffected by electrolyte consumption (P &amp;gt; 0.05). Body temperature was significantly higher for all horses following exercise, regardless of treatment group (P = 0.0005). Skin turgor showed significantly more time before return to original state during post-ride evaluation (P = 0.0013). Respiratory rate was noted to decrease post-exercise, suggesting an increased baseline due to recent transport (P = 0.0158). Directional serum changes between Cl and K were correlated (P = 0.0227) as well as Mg and Cl (P = 0.0316). Correlations of relational change between Ca and HCO−3 in addition to Ca and Na were approaching significance (P = 0.0707; P = 0.0800). Mares demonstrated a greater ability to maintain lower post-ride serum calcium levels than geldings (P = 0.013). Preliminary effect of breed on serological calcium change may also be considered (P = 0.0312). To conclude, differences in sex may alter electrolyte use pathways, such as calcium. The exercise challenge was sufficient based on vitals assessments. These data suggest key factors associated with chewable electrolyte form administration. Further research is needed to identify the impacts of electrolyte form on efficacy as well as improve palatability.

Self-fermented agro-wastes as antioxidant enriched maize grain replacer for sustainable animal feeding

Piles of agro-wastes resulting from quantum agro-industrial growth can be best utilized as animal feed, reducing envionmental impact by 50–95% depending on their nutritive value. However, palatability issues have limited their use, which can be addressed by combining them based on their nutritional value. Thus present three-phase study aimed to utilize these waste materials as animal feed by utilizing a self-fermentation approach. Six combinations of apple pomace (AP), spent mushroom compost (SMC) and wheat straw were self-fermented and analysed for quality in phase-I. Phase-II assessed the best combination obtained from phase-I as an antioxidant-enriched maize replacer (AEMR) by replacing maize (0–32%) in total mixed ration (TMR) under in-vitro ruminal conditions and two best TMR were assessed for nutrient utilization under metabolic trial. In phase-III, the three-month feeding effect of AEMR on the overall growth performance of male Gaddi goat kids was assessed. Findings showed that 85:7.5:7.5 proportion had optimal pH (3.92), significantly higher lactic acid (5.29 g 100−1 g DM), water soluble carbohydrates (2.29 g 100−1 g DM) and oxidative and microbial stability (Lactobacillus: 8.38 log10 cfu g−1). Fermentation also resulted in significant increase in antioxidant activities. AEMR exhibited a significant reduction in CH4 and NH3–N and higher volatile fatty acid production under in-vitro conditions at 32% level with no adverse effects on nutrient utilization. AEMR feeding also exhibited significantly improved feed conversion ratio (FCR) and serum lipid and oxidative profiles. In conclusion, AP and SMC in combined form can be utilized as an AEMR through self-fermentation at 32% level in TMR which may serve as a promising and sustainable approach for reducing environmental footprints and boosting eco-friendly livestock production.

The impact of drug palatability on prescribing and dispensing of antibiotic formulations for paediatric patients: a cross-sectional survey of general practitioners and pharmacists.

Palatability is a key element of paediatric acceptability for medicines. Many patient and drug factors are considered when choosing an antibiotic for a child. Pharmacists report that they receive questions about the palatability of oral liquid antibiotics for children. This study aimed to explore the experiences of GPs and pharmacists concerning palatability of oral liquid antibiotics for children. A questionnaire about the impact of palatability on the choice of antibiotic formulation for children was emailed to all community pharmacists in Ireland and to GPs and trainee GPs in the Cork region and posted on social media. Survey items were not compulsory; therefore, percentage responses were calculated based on the number of responses to that item. GP and pharmacist responses were analysed independently. Responses were received from 244 participants (59 GPs, 185 pharmacists). Clinical guidelines and availability of supply were the most important factors considered when choosing an oral liquid antibiotic formulation for children by GP (79.7%) and pharmacist (66.5%) respondents respectively. Forty GP respondents (76.9%) reported ensuring adherence was the most common palatability-related reason leading to deviation from guidelines. Pharmacist respondents (52%) reported advising a parent/caregiver to manipulate the required antibiotic dose to improve acceptability. The least palatable oral liquid antibiotics reported were flucloxacillin (16% GPs, 18% pharmacists) and clarithromycin (17% of each profession). This study identified palatability issues associated with oral liquid antibiotics for children reported by GPs and pharmacists. Pharmaceutical approaches to adapting oral liquid antibiotic formulations must be developed to improve palatability and thus paediatric acceptability.

Formulation and in vitro Evaluation of Tablet Dosage form of Unani Anti-diabetic Powder Containing Gymnema sylvestre R. Br, Syzygium cuminii Linn. and Zingiber officinale Rosc.

Pharmacognosy Research,2023,15,3,566-577.DOI:10.5530/pres.15.3.060Published:June 2023Type:Original Article Authors:Gazi Jahangeer Rather, Hamiduddin, Mohd Ikram, and Md. Naquibuddin Author(s) affiliations:Gazi Jahangeer Rather, Hamiduddin*, Mohd Ikram, Md. Naquibuddin Department of Ilmul Saidla (Unani Pharmacy), National Institute of Unani Medicine (NIUM), Bangalore, Karnataka, INDIA. Abstract:Background and Objectives: Diabetes Mellitus (DM) is one of the leading causes of end stage renal disease, adult blindness etc. The side effects and resistance of conventional medicines for DM had put forward a need to develop an effective antidiabetic formulation with the aid of traditional medicine. Modification of dosage form in traditional system of medicine for palatability and portability is the need of hour. The antidiabetic safoof(powder) formulation containing Gurmar buti(Gymnema sylvestre R.Br), Jamun (Syzygium cuminii Linn.) and Zanjabeel (Zingiber officinale Rosc.) is having inconvenience to follow the accurate dose, palatability and stability issues due to surface area of powder. To rectify this problem the Safoof is modified into tablet dosage form with documentation of standard manufacturing procedure, its physicochemical analysis and in vitro antidiabetic evaluation. Materials and Methods: For process standardization total 10 batches were generated for the optimum working process related to the powder size, quantity of binder, wetting, granulation, time for drying and compression by trial and error. Ideal batch was selected on the basis of set parameter (friability, hardness and disintegration time), its physicochemical standards including HPLC as well as α-amylase and α-glucosidase inhibition activity were established. Results: With excipients 5% Gum acacia, 5% CMC, 1% SSG, 0.5% Mg stearate and 0.5% Talc, the mean value of the hardness, friability and disintegration time of tablet were found to be 4.83 ± 0.17, 0.29 ± 0.01 and 14.24 ± 0.05 respectively. Physico-chemical data with HPLC quantification of Gymnemagenin, 6-Gingerol, 8-Gingerol, 6-Shogaol and 10-Gingerol were set in. The heavy metals and microbial contaminations are within permissible limit. Antidiabetic activity through α-amylase and α-glucosidase inhibition were 0.00 ± 0.00 at the 2500 μg/ml and 84.28 ± 0.58% at the 3000 μg/ml concentration respectively. Conclusion: Classical powder is modified effectively in tablet dosage form with in vitro evaluation of its antidiabetic activity particularly α-glucosidase inhibition of crude powder and standardization data was also set in. Keywords:Diabetes mellitus, Physico-chemical standardization, Powder, Tablets, α-glucosidase.View:PDF (488.18 KB)

Factors affecting the decision-making process of using insect-based products in animal feed formulations

Insect meals are promising alternative feed ingredients although their application is still not commonplace. Their inclusion requires the consideration of various factors to optimise growth, animal welfare, and feed costs. The insect meal form (whole or defatted) impacts the level of inclusion, in particular in feeds where low amount of lipids is needed (e.g. poultry). From a nutritional point of view, the factors that influence the insect meal characteristics include insect species, rearing substrates and production processes. Processing (drying, defatting) can dramatically influence the nutrient digestibility and availability that requires assessment through in vivo or in vitro trials, with differences being observed in relation to the entity of the defatting process as well. The inclusion of full-fat or defatted meal may impact the final product quality (fatty acid profile). Low digestibility of chitin is also a limiting factor. Studies to increase the digestibility of insect meals using additives are ongoing. For these reasons, when different insect protein suppliers are used for feed production, chemical analyses need to be performed. In addition to the nutritional aspect, in some species (i.e. fish), a physical evaluation of the feed is necessary. In particular, the high fat content of whole larvae meal may increase the mixture viscosity and decrease the pellet stability, resulting in nutrient loss. Palatability affects feed ingestion; though insect meals seem well accepted, some palatability issues have been reported at high inclusion levels. It is however not clear if these issues are due to the level of inclusion or to some intrinsic characteristics of the meal used. Finally, the crucial factor for the future practical incorporation of insect meals in animal feeds is the availability and consistency of the supply. Without large and consistent quantities, it will be difficult for feed producers to incorporate these alternative ingredients within their production processes.

A randomized controlled comparative clinical trial on Jwarahara effect of Mukkaamukkatukaadi Syrup with Kiratatikta Syrup in Febrile Children

Ayurvedic classics have described many diseases amongst which Jwara stands first because of its uniqueness to make everyone suffer, since birth to death. Jwara being one of the commonest symptoms which accompanies almost all constitutional diseases has been coined with the term Rogadhipathi. Fever is defined as temperature in rectum more than 100.4°F (38°C), in oral cavity above 99.5°F (37.5°C) or in axilla above 99°F (37. 2°C). If we don’t treat fever in its earlier stage, there will be more chances of hyperpyrexia which may cause febrile convulsions which leads to brain damage. Therefore, it is necessary to control fever at its earlier stage. One such Jwarahara formulation is Mukkaamukkatukaadi Gulika and Kiratatikta which is converted into syrup form to overcome the palatability issues. A sample size of 30 patients was selected by simple random sampling method and 15 patients were allotted in two groups. It was planned to compare the result between Mukkaamukkatukaadi syrup in Group A study group for STG and LTG and Kiratatikta syrup in Group B control group for STG and LTG. On STG comparison, the difference in mean in Group A and Group B were 0.49,0.44 before treatment changed to 0.96 and 0.98 after treatment respectively. On LTG comparison, the difference in mean in Group A and Group B were 0.49, 0.44 before treatment changed to 2.02 and 1.96 after follow up respectively. This depicts both the formulations effective when consumed for longer duration. From the results and observations it can be concluded that Group A and Group B are equally effective and equally significant on reducing the temperature in both STG and LTG. No adverse drug reaction was found during the study.

Using dietary additives to improve palatability of diets containing single‐cell protein from methanotrophic bacteria in yellowtail kingfish ( Seriola lalandi ) diets

Single-cell protein (SCP) derived from methanotrophic bacteria has significant potential as a fishmeal alternative in aquafeeds. However, SCP has known palatability issues, to overcome these issues tuna hydrolysate and garlic powder were tested as palatability enhancers against basal diets without these additives. This study tested the inclusion of SCP at four dietary levels of 0%, 10%, 20% and 30%, representing 0%, 25%, 50% and 75% fishmeal replacement in juvenile yellowtail kingfish (Seriola lalandi) (YTK) diets. YTK were fed these diets in triplicate over 35 days. Compared with the control diet, fish fed the SCP10% diet ate less feed, but had equal growth and subsequently an improved FCR. Feed intake decreased with increasing SCP inclusion, and the palatability enhancers were ineffective at improving intake. Despite the significant reduction in feed intake, FCR was equal across all SCP inclusion levels, demonstrating that the reduced growth performance at these higher inclusion levels was a function of only the reduced intake. Data showing equal protein retention efficiency and apparent digestibility coefficients across diets support this finding. This study showed that SCP derived from methanotrophic bacteria can replace 25% of fishmeal in a 400 g/kg FM diet and suggests if palatability issues can be overcome then higher inclusion of SCP could be achieved in YTK diets.

Effects of Formulation on the Palatability and Efficacy of In-Feed Praziquantel Medications for Marine Finfish Aquaculture.

Praziquantel (PZQ) provides an effective treatment against monogenean parasitic infestations in finfish. However, its use as an in-feed treatment is challenging due to palatability issues. In this study, five formulations of PZQ beads (1–4 mm) were developed using marine-based polymers, with allicin added as a flavouring agent. All formulations attained PZQ loading rates ≥74% w/w, and the beads were successfully incorporated into fish feed pellets at an active dietary inclusion level of 10 g/kg. When tested for palatability and digestibility in small yellowtail kingfish, the PZQ-loaded beads produced with alginate-chitosan, alginate-Cremophor® RH40, and agar as carriers resulted in high consumption rates of 99–100% with no digesta or evidence of beads in the gastrointestinal tract (GIT) of fish fed with diets containing either formulation. Two formulations produced using chitosan-based carriers resulted in lower consumption rates of 68–75%, with undigested and partly digested beads found in the fish GIT 3 h post feeding. The PZQ-loaded alginate-chitosan and agar beads also showed good palatability in large (≥2 kg) yellowtail kingfish infected with gill parasites and were efficacious in removing the parasites from the fish, achieving >90% reduction in mean abundance relative to control fish (p < 0.001). The two effective formulations were stable upon storage at ambient temperature for up to 18 months, showing residual drug content >90% compared with baseline levels. Overall, the palatability, efficacy and stability data collected from this study suggest that these two PZQ particulate formulations have potential applications as in-feed anti-parasitic medications for the yellowtail kingfish farming industry.

Dosage Forms Suitability in Pediatrics: Acceptability of Analgesics and Antipyretics in a German Hospital.

Although medicine acceptability is likely to have a significant impact on the patient’s adherence in pediatrics and therefore on therapy success, there is still little data even for common therapeutic areas. For analgesics/antipyretics, healthcare professionals face a wide variety of products and need knowledge to select the best adapted product for each patient. We investigated acceptability of those products most used at the University Children’s Hospital Düsseldorf, Germany. Based on 180 real-life observer reports of medicine intake, we used the acceptability reference framework to score acceptability of six distinct medicines. Both ibuprofen and paracetamol tablets, mainly used in adolescents, were positively accepted. This was not the case for the solution for injection of metamizole sodium. Regarding syrups, mainly used in children under 6 years of age, ibuprofen flavored with strawberry and provided with an oral syringe was positively accepted, while paracetamol flavored with orange and provided with a measuring cup was not. Suppository appeared to be an alternative to oral liquids in infants and toddlers with palatability and administration issues. Differences appeared to be driven by dosage forms and formulations. These findings improve knowledge on acceptability drivers and might help formulating and prescribing better medicines for children.

DOP68 CD-TREAT diet induces remission and improves quality of life in an open label trial in children and adults with active Crohn’s Disease

Abstract Background Exclusive enteral nutrition (EEN) is an established induction treatment for active Crohn’s disease (CD) with a proposed mechanism of action involving the gut microbiome. We have previously shown that CD-TREAT diet, a food-based diet with similar dietary profile to EEN, improves rat ileitis and replicates the effect of EEN on the gut microbiome of healthy volunteers and animal models. Here, we test the efficacy of CD-TREAT diet to induce clinical remission in active CD. Methods This is an open-label study in children (wPCDAI≥12.5) and adults (HBI≥5) with active CD. Primary outcome was clinical response (wPCDAI fall≥17.5; HBI fall≥3) or clinical remission (wPCDAI&amp;lt; 12.5; HBI&amp;lt;5) after 8 week treatment with CD-TREAT. Secondary outcomes included improvement of quality of life (QoL) and reduction in faecal calprotectin (FC) levels. Since CD-TREAT diet is gluten-free, adherence to treatment was assessed by the detection of the gluten immunogenic peptide (GIP) in faeces. Data are presented with median (IQR). Results 25 children, [age, 14.4 (12.5,15.7) years] and 32 adults, [age, 32.6 (24.2,43.9) years] were treated. 7 (12%) failed treatment and n=10 (18%) dropped out during the first 2 weeks of treatment due to palatability issues. In patients who completed 8 weeks of CD-TREAT course (n=40), 85% and 78% achieved clinical response and remission, respectively. CD-TREAT diet improved QoL in children [IMPACT-III score, baseline: 136 (122,143) vs 8weeks: 148 (133,153), p&amp;lt;0.01] and in adults [sIBDq score, baseline: 30 (26,45) vs 8weeks: 60 (48, 64), p&amp;lt;0.001]. Faecal GIP decreased during treatment [ng/g stool, baseline: 1250 (589, 1250), 4weeks: 0 (0,269), 8weeks: 0 (0,329), mg/mg, p&amp;lt;0.001 for both] showing adherence with the CD-TREAT diet. However, 33% and 40% of the patients had detectable faecal GIP at 4 and 8 weeks, respectively, revealing at least partial non-adherence. 30% of patients who completed CD-TREAT (n=12/40) experienced &amp;gt;50% FC reduction. Median FC levels decreased significantly? in the group of patients (n=22) who had undetectable GIP at 4 or 8 weeks [mg/kg FC, baseline: 1190 (361,1129); 8weeks: 534 (92,1230), p&amp;lt;0.01]. Conclusion CD-TREAT diet improved disease activity indices and QoL in the majority of patients who completed treatment and decreased FC in those who were most likely to be compliant. Future RCT should aim to compare CD-TREAT with other induction treatments and improve meal variety and palatability to improve compliance and reduce drop-out rates.

Phenolic Compounds in Calafate Berries Encapsulated by Spray Drying: Neuroprotection Potential into the Ingredient.

Calafate is a berry rich in anthocyanins that presents higher content of polyphenols than other fruits. Its compounds have been described previously, however, the potential thereof in preventing and treating degenerative disorders has not yet been studied. Due to its astringency, the consumption of this berry in its natural state is limited. To profit from the aforementioned properties and reduce palatability issues, calafate berry extracts were microencapsulated by spray drying, a rapid, cost-effective and scalable process, and were then compared with freeze drying as a control. The stability of its contents and its in-vitro potential, with respect to AChE activity and neuroprotection, were measured from the obtained microcapsules, resulting from temperature treatments and different encapsulant contents. The results indicated that the spray-dried powders were stable, despite high temperatures, and their encapsulation exhibited nearly 50% efficiency. The highest quantity of polyphenols and 3-O-glycosylated anthocyanins was obtained from encapsulation with 20% maltodextrin, at 120 °C. Temperature did not affect the microcapsules’ biological action, as demonstrated by their antioxidant activities. The prevention of Aβ peptide cytotoxicity in PC12 cells (20%) revealed that encapsulated calafate can confer neuroprotection. We conclude that spray-drying is an appropriate technique for scaling-up and producing new value-added calafate formulations with anti-neurodegenerative effects and vivid colors.

Raw Ingredients in Cat Food Manufacturing: Palatability, Digestibility and Halal Issues in Malaysia

Raw ingredients commonly used in the cat food manufacturing are derived fromvarious sources such as meat, meat by products, fish, poultry, vegetables, vegetables byproducts, cereals, fruits, and bones. Meat meal and meat bone meal are unpopular rawingredients since they are manufactured from carcasses and offal of cows, pigs, goats andsheep and may even contain deleterious and unhealthy ingredients. There is the possibility ofthe occurrence of ingredients containing non halal components. There are several types of catfood in the market which are graded based on their ingredients and nutritive values especiallythe protein content. The biological values of the popular protein sources used in cat foodmanufacturing were highlighted. The importance of carbohydrate content, which is mostlynot available on the packaging pack is emphasized and the method of calculation shown.

The Ketogenic Diet Revisited: Beyond Ketones.

Epilepsy is a neurological disease characterized by seizures, which affects up to 65 million people worldwide (1). About two-thirds of patients with epilepsy are able to achieve seizure control with current antiseizure medication (ASM) (2), whereas one-third of epilepsy patients are difficult to treat, i.e., patients with drug-resistant epilepsy (DRE). In addition, ASM can induce (serious) adverse events and a significant reduction of the quality of life (QoL), leading to ASM retention rates around 50% (3). DRE can induce neurobiochemical alterations and emotional and physical dysfunctions. The multifaceted status of DRE patients underscores the emphasis on non-pharmacological options, and therapies that target multiple mechanisms are likely to be more effective to treat DRE (4), thereby acting as a “magic shotgun” rather than a “magic bullet.” If epilepsy surgery is not an option in a patient with DRE, vagus nerve stimulation (VNS) (5) or dietary treatments, such as the ketogenic diet (KD), are valuable alternative options (5–7). Initial studies with dietary treatments report on the classical KD, consisting of 80% fat and 20% protein plus carbohydrate (4:1 KD) or 75% fat and 25% protein plus carbohydrate (3:1 KD) (8). A KD using medium-chain triglycerides (MCTs) leads to more ketones/kcal of energy and a more efficient absorption (9). Therefore, the MCT diet is less restrictive since it consists of a lower amount of fat and a higher intake of protein and carbohydrate (10). The modified Atkins diet (MAD) (11) and the low-glycemic index treatment (LGIT) (12) are other dietary therapies mimicking the seizure reduction result of the KD, but they are less restrictive. Clinical studies show that both modalities (VNS and KD) lead to a seizure frequency reduction (SFR) by at least 50% in half of the DRE patients. A recent study proposed a treatment algorithm for pediatric DRE, including non-pharmacological treatment options such as VNS and the KD (13). Interestingly, the KD therapy has some advantages in comparison to VNS: the SFR is slightly higher for patients on the KD (14); the KD is non-invasive, and there are few to no neurotoxic effects when compared to multiple ASM (6). Nevertheless, there are barriers and disadvantages in putting the KD into practice, such as palatability issues, compliance issues, side effects (usually mild), variable response rates, and restrictions to the daily life of the patient (15). Overall, a multidisciplinary team (pediatric neurologist, dietician/nutritionist, and a primary care-giver) is indispensable when dietary treatments are initiated and also during maintenance (16). Currently, we are unable to pinpoint the mechanism(s) of action of the KD, and it is possible that dietary therapies will be classified as “magic shotguns” (17–20). Therefore, our aim was to elaborate on the newest pathways involved, such as the gut microbiome and serine synthesis.

Dietary adherence and program attrition during a severely energy-restricted diet among people with complex class III obesity: A qualitative exploration.

Meal replacement Severely Energy-Restricted Diets (SERDs) produce ≥ 10% loss of body mass when followed for 6 weeks or longer in people with class III obesity (BMI ≥ 40 kg/m2). The efficacy of SERDs continues to be questioned by healthcare professionals, with concerns about poor dietary adherence. This study explored facilitators and barriers to dietary adherence and program attrition among people with class III obesity who had attempted or completed a SERD in a specialised weight loss clinic. Participants who commenced a SERD between January 2016 to May 2018 were invited to participate. Semi-structured in-depth interviews were conducted from September to October 2018 with 20 participants (12 women and 8 men). Weight change and recounted events were validated using the participants' medical records. Data were analysed by thematic analysis using line-by-line inductive coding. The mean age ± SD of participants was 51.2 ± 11.3 years, with mean ± SD BMI at baseline 63.7 ± 12.6 kg/m2. Five themes emerged from participants' recounts that were perceived to facilitate dietary adherence: (1.1) SERD program group counselling and psychoeducation sessions, (1.2) emotionally supportive clinical staff and social networks that accommodated and championed change in dietary behaviours, (1.3) awareness of eating behaviours and the relationship between these and progression of disease, (1.4) a resilient mindset, and (1.5) dietary simplicity, planning and self-monitoring. There were five themes on factors perceived to be barriers to adherence, namely: (2.1) product unpalatability, (2.2) unrealistic weight loss expectations, (2.3) poor program accessibility, (2.4) unforeseeable circumstances and (2.5) externalised weight-related stigma. This study highlights opportunities where SERD programs can be optimised to facilitate dietary adherence and reduce barriers, thus potentially improving weight loss outcomes with such programs. Prior to the commencement of a SERD program, healthcare professionals facilitating such programs could benefit from reviewing participants to identify common barriers. This includes identifying the presence of product palatability issues, unrealistic weight loss expectations, socio-economic disadvantage, and behaviour impacting experiences of externalised weight-related stigma.

Effects of fishmeal replacement, attractants, and taurine removal on juvenile and sub-adult Red Snapper (Lutjanus campechanus)

Four growth trials were conducted to evaluate the effects of fishmeal replacement with various levels of soybean meal (SBM) and poultry byproduct meal (PBM) on growth performance in practical diets for juvenile and sub-adult red snapper, Lutjanus campechanus. In addition, the need for taurine and palatability enhancement (krill meal) were evaluated in the high SBM, low fishmeal diet. Across the trials, ten diets were formulated to contain 36% protein and 10% lipids. All diets except for one included a taurine supplement of 1%. A supplement of 5% krill meal was added as an attractant to one of the low fishmeal and high SBM diets to explore potential palatability issues associated with plant-based proteins. No statistically significant differences were found between the performance of the basal diet and the PBM replacement diets, indicating that PBM is a suitable replacement for fishmeal in red snapper diets. On the contrary, a clear negative linear relationship was observed with increasing levels of SBM replacement. The reduced growth performance of high SBM inclusion diets is unlikely to be due to palatability issues, as no significant difference was observed between the performance of the high SBM diet with krill meal and an identical diet without krill meal. The significant reduction in growth observed in snapper fed a diet lacking a taurine supplement indicates that red snapper have a taurine requirement that is limiting at low (0.2%) levels. Gut samples were taken from fish that received the SBM diets to determine if reduced growth performance could be attributed to inflammation. However, no statistically significant difference was observed, indicating that reduced growth was not necessarily the result of a hypersensitivity reaction. Further investigation will be necessary to determine the optimal taurine requirement and required dietary supplements to improve the performance of low fishmeal feed formulations.

Effects of feeding graded levels of black spruce needles and branches on beef cow performance and health during mid to late gestation

Pregnant beef cows (56; 727 ± 102 kg body weight) in their second trimester were used to examine black spruce (BSP) needles and branches for replacing alfalfa silage in wintering cow diets. Five dietary treatments assessed BSP inclusion rates (0%, 15%, 22.5%, 30%, and 37.5% in the diet) for 92 d up until 2 wk before start of calving using a randomized complete block design (10–12 cows per treatment). There were linear decreases (P &lt; 0.001) in total weight gain, average daily gain, and dry matter intakes (DMI) as amounts of dietary BSP increased. Low DMI feeding BSP may be attributed to palatability issues and lower rates of digestion. Changes in body condition score increased (P &lt; 0.003) as dietary BSP increased. These effects are supported by corresponding linear decreases (P &lt; 0.001) for changes in rump fat cover and increases (P &lt; 0.001) in serum non-esterified fatty acids as dietary BSP increased. After feeding the test diets, there were no dietary treatment differences (P &gt; 0.42) for calf birth and weaning weights as well as cow pregnancy and culling rates. Based on this study, incorporation of BSP into gestating cow diets cannot be recommended.

Acceptability of oral liquid pharmaceutical products in older adults: palatability and swallowability issues

BackgroundIn institutional care, oral liquid pharmaceutical products are widely prescribed for older patients, especially for those with swallowing disorders. As medicines acceptability is a key factor for compliance in the older population, this study investigated the acceptability of oral liquid pharmaceutical products in this targeted population.MethodsAn observational, multicenter, prospective study was conducted in eight geriatric hospitals and eight nursing homes in France. Observers reported several behaviours/events describing the many aspects of acceptability for various pharmaceutical products’ uses in patients aged 65 and older. Acceptability scores of oral liquid pharmaceutical products were obtained using an acceptability reference framework (CAST - ClinSearch Acceptability Score Test®): a 3D-map summarizing the different users’ behaviors, with two clusters defining the positively and negatively accepted profiles materialized by the green and red zones, respectively.ResultsAmong 1288 patients included in the core study and supporting the acceptability reference framework, 340 assessments were related to the administration of an oral liquid pharmaceutical product. The mean age of these patients was 87 (Range [66-104y]; SD = 6.7), 68% were women and 16% had swallowing disorders. Globally, the oral liquid pharmaceutical products were classified as “positively accepted,” the barycenter of the 340 assessments, along with the entire confidence ellipses surrounding it, were positioned on the green zone of the map. Sub-populations presenting a different acceptability profile have also been identified. For patients with swallowing disorders, the oral liquid pharmaceutical products were classified as “negatively accepted,” the barycenter of the 53 assessments along with 87% of its confidence ellipses were associated with this profile. A gender difference was observed for unflavored oral liquids. In women, they were classified “negatively accepted,” the barycenter of the 68 assessments with 75% of its confidence ellipses were located in the red zone, while they were classified “positively accepted” in men.ConclusionThis study showed that oral liquid pharmaceutical products are a suboptimal alternative to solid oral dosage forms in patients with swallowing disorders. To ensure an optimal acceptability, prescribers should also consider the presence of a taste-masker in these oral liquids. As highlighted herein, palatability remains crucial in older populations, especially for women.