Comprehensive Strategies for Metabolic Syndrome: How Nutrition, Dietary Polyphenols, Physical Activity, and Lifestyle Modifications Address Diabesity, Cardiovascular Diseases, and Neurodegenerative Conditions.

Several hallmarks of metabolic syndrome, such as dysregulation in the glucose and lipid metabolism, endothelial dysfunction, insulin resistance, low-to-medium systemic inflammation, and intestinal microbiota dysbiosis, represent a pathological bridge between metabolic syndrome and diabesity, cardiovascular, and neurodegenerative disorders. This review aims to highlight some therapeutic strategies against metabolic syndrome involving integrative approaches to improve lifestyle and daily diet. The beneficial effects of foods containing antioxidant polyphenols, intestinal microbiota control, and physical activity were also considered. We comprehensively examined a large body of published articles involving basic, animal, and human studie, as well as recent guidelines. As a result, dietary polyphenols from natural plant-based antioxidants and adherence to the Mediterranean diet, along with physical exercise, are promising complementary therapies to delay or prevent the onset of metabolic syndrome and counteract diabesity and cardiovascular diseases, as well as to protect against neurodegenerative disorders and cognitive decline. Modulation of the intestinal microbiota reduces the risks associated with MS, improves diabetes and cardiovascular diseases (CVD), and exerts neuroprotective action. Despite several studies, the estimation of dietary polyphenol intake is inconclusive and requires further evidence. Lifestyle interventions involving physical activity and reduced calorie intake can improve metabolic outcomes.

Early and accurate diagnosis of steatotic liver by artificial intelligence (AI)-supported ultrasonography.

OBJECTIVES: Steatotic liver disease is the most frequent chronic liver disease worldwide. Ultrasonography (US) is commonly employed for the assessment and diagnosis. Few information is available on the possible use of artificial intelligence (AI) to ameliorate the diagnostic accuracy of ultrasonography. MATERIALS AND METHODS: An AI-based algorithm was developed using a dataset of US images. We prospectively enrolled 134 patients for algorithm validation. Patients underwent abdominal US and Proton Density Fat Fraction MRI scans (MRI-PDFF), assumed as reference technique. The hepatorenal index was manually calculated (HRIM) by 4 operators. An automatic hepatorenal index (HRIA) was obtained by the algorithm. The accuracy of HRIA to discriminate steatosis grades was evaluated by ROC analysis using MRI-PDFF cut-offs. RESULTS: Overweight was 40 % of subjects (BMI 26.4 kg/cm2). The median HRIA was 1.11 (IQR 0.32) and the average of 4 manually calculated HRIM was 1.08 (IQR 0.26), with a 15 % inter-operator variability. Both HRIA (R = 0.79, P < 0.0001) and HRIM (R = 0.69, P < 0.0001) significantly correlated with liver fat percentage (MRI-PDFF). According to MRI-PDFF, 32 % of enrolled subjects had steatosis. Discrimination capacity by AUC between patient with steatosis and patient without steatosis was better for HRIA than HRIM (AUC: 0.87 vs. 0.82, respectively). ROC analysis showed an AUC = 0.98 for HRIA with 1.64 cut-off in distinguishing between mild and moderate/severe groups. CONCLUSIONS: The use of AI improves accuracy and speed of ultrasonography in the diagnosis of liver steatosis. Further studies should evaluate the routine use of this technique in the management of liver steatosis at high cardio-metabolic risk.

Ramadan intermittent fasting reduces visceral fat and improves gastrointestinal motility.

BACKGROUND: Ramadan is a model of intermittent fasting linked with possible beneficial effects. Scarce information, however, is available about the combined effects of Ramadan intermittent fasting (RIF) on anthropometric and metabolic indices, gastrointestinal symptoms, and motility. METHODS: In 21 healthy Muslims, we assessed the impact of RIF on caloric intake, physical activity, gastrointestinal symptoms and motility (gastric/gallbladder emptying by ultrasonography, orocaecal transit time by lactulose breath test), anthropometric indices, subcutaneous and visceral fat thickness (ultrasonography), glucose and lipid homeostasis. RESULTS: Mean caloric intake decreased from a median of 2069 kcal (range 1677-2641) before Ramadan to 1798 kcal (1289-3126) during Ramadan and increased again to 2000 kcal (1309-3485) after Ramadan. Although physical activity remained stable before, during, and after RIF, body weight, body mass index and waist circumference decreased in all subjects and in both genders, together with a significant decrease in subcutaneous and visceral fat thickness and insulin resistance. The postprandial gastric emptying speed was significantly faster after than before RIF. Fasting gallbladder volume was about 6% smaller after, than before Ramadan, with a stronger and faster postprandial gallbladder contraction. After RIF, lactulose breath test documented increased microbiota carbohydrate fermentation (postprandial H2 peak), and faster orocaecal transit time. RIF also significantly improved gastric fullness, epigastric pain and heartburn. CONCLUSIONS: RIF generates, in healthy subjects, multiple systemic beneficial effects in terms of fat burden, metabolic profile, gastrointestinal motility and symptoms. Further comprehensive studies should assess the potential beneficial effects of RIF in diseased people.

The Impact of Za'atar Antioxidant Compounds on the Gut Microbiota and Gastrointestinal Disorders: Insights for Future Clinical Applications.

Since the gut microbiota plays a pivotal role in host homeostasis and energy balance, changes in its composition can be associated with disease states through the promotion of immune-mediated inflammatory disorders and increasing intestinal permeability, ultimately leading to the impairment of intestinal barrier function. Za'atar is one of the most popular plant-based foods in the Eastern Mediterranean region. Za'atar is a mixture of different plant leaves, fruits, and seeds and contains hundreds of antioxidant compounds, especially polyphenols, and fiber, with pre-clinical and clinical evidence suggesting health-promoting effects in cardiovascular and metabolic disease. Za'atar compounds have also been studied from a gastrointestinal perspective, concerning both gut microbiota and gastrointestinal diseases. Antioxidants such as Za'atar polyphenols may provide beneficial effects in the complex interplay between the diet, gut microbiota, and intestinal permeability. To our knowledge, no studies have reported the effects of the whole Za'atar mixture, however, based on the pre-clinical studies published on components and single compounds found in Za'atar, we provide a clinical overview of the possible effects on the gastrointestinal tract, focusing mainly on carvacrol, rosmarinic acid, gallic acid, and other polyphenols. We also cover the potential clinical applications of Za'atar mixture as a possible nutraceutical in disorders involving the gastrointestinal tract.

The Potential of the Mediterranean Diet to Improve Mitochondrial Function in Experimental Models of Obesity and Metabolic Syndrome.

The abnormal expansion of body fat paves the way for several metabolic abnormalities including overweight, obesity, and diabetes, which ultimately cluster under the umbrella of metabolic syndrome (MetS). Patients with MetS are at an increased risk of cardiovascular disease, morbidity, and mortality. The coexistence of distinct metabolic abnormalities is associated with the release of pro-inflammatory adipocytokines, as components of low-to-medium grade systemic inflammation and increased oxidative stress. Adopting healthy lifestyles, by using appropriate dietary regimens, contributes to the prevention and treatment of MetS. Metabolic abnormalities can influence the function and energetic capacity of mitochondria, as observed in many obesity-related cardio-metabolic disorders. There are preclinical studies both in cellular and animal models, as well as clinical studies, dealing with distinct nutrients of the Mediterranean diet (MD) and dysfunctional mitochondria in obesity and MetS. The term "Mitochondria nutrients" has been adopted in recent years, and it depicts the adequate nutrients to keep proper mitochondrial function. Different experimental models show that components of the MD, including polyphenols, plant-derived compounds, and polyunsaturated fatty acids, can improve mitochondrial metabolism, biogenesis, and antioxidant capacity. Such effects are valuable to counteract the mitochondrial dysfunction associated with obesity-related abnormalities and can represent the beneficial feature of polyphenols-enriched olive oil, vegetables, nuts, fish, and plant-based foods, as the main components of the MD. Thus, developing mitochondria-targeting nutrients and natural agents for MetS treatment and/or prevention is a logical strategy to decrease the burden of disease and medications at a later stage. In this comprehensive review, we discuss the effects of the MD and its bioactive components on improving mitochondrial structure and activity.

Complex interactions and different possible pathways among functional components of the aquatic microbial world in Farasan Archipelago, Southern Red Sea, Saudi Arabia.

This work aims to outline the dynamics of trophic links between the three main microbial components (bacteria, nanoflagellates, and ciliates) of the Farasan Archipelago in order to establish a baseline for future research in this area. The Farasan Archipelago lies along the southwestern coast of the Saudi Arabia, southern Red Sea between 16°20'-17°10'N and 41°30'-42°30'E and had been declared as marine and terrestrial reserve by the year 1996. Three different sites were chosen for this study, with each site visited bimonthly for 18 months from September 2016 to February 2018. Bacteria, nanoflagellates and ciliates were enumerated in order to explore the complex interactions between the main microbial categories in sea waters of the Farasan Archipelago. High abundances were recorded during the present study for bacteria (8.7 × 106 bacteria ml-1), nanoflagellates (3.7 × 104 TNAN ml-1) and ciliates (40.4 ciliates ml-1). The paper discusses the various potential pathways controlling the complex interactions between these microbial groups in this part of the southern Red Sea. It is concluded that a linear trophic chain consisting of bacteria; heterotrophic nanoflagellates; filter feeding ciliates is a major route by which the production of bacteria is transferred to the higher consuming levels, thereby confirming the high importance of t bottom-up control (food supply), alongside top-down control (predation) in regulating bacterial abundances in the Farasan Archipelago. During the present investigation, each nanoflagellate ingested between 11 and 87 bacteria in one hour, while each ciliate consumed between 20 and 185 nanoflagellates every hour. These calculated grazing rates of protistan eukaryotes confirmed the role of heterotrophic nanoflagellates as the main consumers of bacteria, and the role of ciliates as the major control for the heterotrophic nanoflagellate population dynamics, and thus the top predators within the microbial plankton assemblage in the Farasan Archipelago.

Assessing water quality and classifying trophic status for scientifically based managing the water resources of the Lake Timsah, the lake with salinity stratification along the Suez Canal.

Lake Timsah is considered as the biggest water body at Ismailia City with a surface area of 14 km2. It is a saline shallow water basin lies approximately mid-way between the south city of Suez and the north city of Port Said at 30o35'46.55"N and 32o19'30.54″E. Because it receives water with high and low salinities, salinity stratification is producing in the Lake Timsah, with values of 14-40‰ for the surface water and over 40‰ for the bottom water. The temperature of the lake water decreased to below 19 °C in the winter and rose to above 29 °C in the summer; the concentration of dissolved oxygen ranged between 6.5 and 12.2 l-1 and the pH fluctuated between 7.9 in its lower value and 8.2 in its higher value. Water transparency was very low as indicated by Secchi disc readings recorded during this study and varied between 0.3 and 2.7 m. The main chemical nutrient (phosphorus) reached its highest levels of 96 µg l-1 in winter and their lowest values of 24 µg l-1 during summer. This nutrient concentration is high especially by comparing with those of unpolluted marine waters, but is typical of the more eutrophic coastal waters worldwide. The composition and abundance of phytoplankton with dominancy of diatoms and increased population density (20,986 cell l-1) reflect the eutrophic condition of the lake. The intensive growth of phytoplankton was enriched by high concentration of chlorophyll a with annual values ranged between 6.5 and 56 µg l-1. The objective of the present work was quantitative assessment of the quality of the water of the Lake Timsah using different approaches. During the present study, three different approaches were applied for the quantitative assessment of Lake Timsah water quality: the trophic state index (TST); trophic level index (TLI) and water quality index (WQI). Application of the trophic state and trophic level indices (TSI & TLI) revealed that the Lake Timsah has trophic indices of 60 and 5.2 for TSI and TLI, respectively. Both indices reflected the eutrophic condition of the lake waters and confirmed that the eutrophication is a major threat in the Lake Timsah. On the other hand, the WQI calculated for the Lake Timsah during the present study with an average of 49 demonstrated that the water of the Lake Timsah is bad and unsuitable for main and/or several uses. Moreover, WQI allows accounting for several water resource uses and can serve a more robust than TSI and/or TLI and can be used effectively as a comprehensive tool for water quality quantification. In conclusion, the three subjective indices used for the assessment process for the lake water are more suitable and effective for needs of the sustainable water resources protection and management of the Lake Timsah.

Aquatic ecosystem health and trophic status classification of the Bitter Lakes along the main connecting link between the Red Sea and the Mediterranean.

The Bitter Lakes are the most significant water bodies of the Suez Canal, comprising 85% of the water volume, but spreading over only 24% of the length of the canal. The present study aims at investigation of the trophic status of the Bitter Lakes employing various trophic state indices, biotic and abiotic parameters, thus reporting the health of the Lake ecosystem according to the internationally accepted classification criteria's. The composition and abundance of phytoplankton with a dominance of diatoms and a decreased population density of 4315-7376 ind. l-1 reflect the oligotrophic nature of this water body. The intense growth of diatoms in the Bitter Lakes depends on silicate availability, in addition to nitrate and phosphate. If the trophic state index (TSI) is applied to the lakes under study it records that the Bitter Lakes have an index under 40. Moreover, in the total chlorophyll-a measurements of 0.35-0.96 µg l-1 there are more indicative of little algal biomass and lower biological productivity. At 0.76-2.3 µg l-1, meanwhile, the low quantity of Phosphorus is a further measure of low biological productivity. In the Bitter Lakes, TN/TP ratios are high and recorded 147.4, and 184.7 for minimum and maximum ratios, respectively. These values indicate that in Bitter lakes, the limiting nutrient is phosphorus and confirm the oligotrophic status of the Bitter Lakes. The latter conclusion is supported by Secchi disc water clarity measurements, showing that light can penetrate, and thus algae can photosynthesize, as deep as >13 m. This study, therefore, showed that the Bitter Lakes of the Suez Canal exhibit oligotrophic conditions with clear water, low productivity and with no algal blooming.