Dates fruits effects on blood glucose among patients with diabetes mellitus: A review and meta-analysis

Dates fruit effects on dyslipidemia among patients with Type-2 diabetes mellitus: A systematic review and meta-analysis of randomized trials

OBJECTIVES

Dyslipidemias are major risk factors for cardiovascular disease, and other comorbidities. The focus on food and nutrition to prevent and treat cardiovascular risk factors including dyslipidemia is a paradigm shift. This is the first meta-analysis to assess the association of dates fruit and dyslipidemia in Type-2 diabetes. The study aimed to assess the same among patients with Type-2 diabetes.

METHODS

Six databases were searched for relevant articles from inception to March 2024. We included randomized trials, studies with other methods, and those conducted among healthy people were excluded. A structured checklist including the author's name, country, year of publication, study type, duration of the study, lipid profile at baseline and after-dates fruit consumption, age, and gender of participants, type of dates, and the amount consumed.

RESULTS

Out of the 448 studies retrieved, fourteen cohorts from four studies (298 participants with Type-2 diabetes) were included. Dates fruit reduced cholesterol, odd ratio, -0.87, 95% CI, -1.39--0.35, P-value, 0.001, and I2 for heterogeneity=90%. No significant changes were observed on low-density lipoprotein (odd ratio, -0.31, 95% CI, -0.65-0.03, and P-value, 0.08), triglycerides (odd ratio, -0.77, 95% CI, -2.17--0.63, P-value 0.28), and high-density lipoproteins (odd ratio, 0.03, 95% CI, -0.13-0.19, P-value, 0.69). The I2 for heterogeneity were=99%, 95%, and 65% respectively.

CONCLUSION

Dates fruit could reduce total cholesterol, with a non-significant reduction in low-density lipoproteins. No significant effect was evident regarding triglycerides and high-density lipoproteins. Further larger studies with a high selection of controls and dates are needed.

Effect of dates on blood glucose and lipid profile among patients with type 2 diabetes

Poor fruit and vegetable consumption is one of the 10 major risk factors for mortality. There is a misconception regarding the consumption of dates among patients with diabetes. This manuscript assessed the effects of date consumption on fasting and postprandial blood glucose, glycated hemoglobin, total cholesterol, triglycerides, low-density lipoproteins, high-density lipoproteins, and microbial markers. Four literature databases were searched for relevant articles. Of the 595 studies retrieved, 24 assessed the effects of dates on glycemic control and lipids. Overall, the evidence suggests that dates have a lowering effect on blood glucose. Dates reduce total cholesterol and triglyceride levels and increase high-density lipoprotein levels. Dates also promote the abundance of beneficial gut microbiota. Therefore, patients with diabetes and dyslipidemia can consume dates to reduce their blood glucose, cholesterol, and triglycerides.

TinyML-Sensor for Shelf Life Estimation of Fresh Date Fruits

Fresh dates have a limited shelf life and are susceptible to spoilage, which can lead to economic losses for producers and suppliers. The problem of accurate shelf life estimation for fresh dates is essential for various stakeholders involved in the production, supply, and consumption of dates. Modified atmosphere packaging (MAP) is one of the essential methods that improves the quality and increases the shelf life of fresh dates by reducing the rate of ripening. Therefore, this study aims to apply fast and cost-effective non-destructive techniques based on machine learning (ML) to predict and estimate the shelf life of stored fresh date fruits under different conditions. Predicting and estimating the shelf life of stored date fruits is essential for scheduling them for consumption at the right time in the supply chain to benefit from the nutritional advantages of fresh dates. The study observed the physicochemical attributes of fresh date fruits, including moisture content, total soluble solids, sugar content, tannin content, pH, and firmness, during storage in a vacuum and MAP at 5 and 24 ∘C every 7 days to determine the shelf life using a non-destructive approach. TinyML-compatible regression models were employed to predict the stages of fruit development during the storage period. The decrease in the shelf life of the fruits begins when they transition from the Khalal stage to the Rutab stage, and the shelf life ends when they start to spoil or ripen to the Tamr stage. Low-cost Visible-Near-Infrared (VisNIR) spectral sensors (AS7265x-multi-spectral) were used to capture the internal physicochemical attributes of the fresh fruit. Regression models were employed for shelf life estimation. The findings indicated that vacuum and modified atmosphere packaging with 20% CO2 and N balance efficiently increased the shelf life of the stored fresh fruit to 53 days and 44 days, respectively, when maintained at 5 ∘C. However, the shelf life decreased to 44 and 23 days when the vacuum and modified atmosphere packaging with 20% CO2 and N balance were maintained at room temperature (24 ∘C). Edge Impulse supports the training and deployment of models on low-cost microcontrollers, which can be used to predict real-time estimations of the shelf life of fresh dates using TinyML sensors.

Nutritional and Physicochemical Characteristics of Innovative High Energy and Protein Fruit- and Date-Based Bars

With the increasing global nutritional bar market, developing and formulating innovative high-energy and protein bars to compensate for nutrients using date fruits is beneficial for health-conscious individuals. The current research was undertaken to study the composition and physicochemical characteristics of innovative high-energy and high-protein bars using two combinations of Sukkari dates or fruit mixtures as a base. Fifty percent of either Sukkari date paste or dried fruit mixture (25% raisin, 12.5% fig, and 12.5% apricot) combined with other different ingredients was used to produce a date-based bar (DBB) or fruit-based bar (FBB). Proximate composition, sugar content, amino and fatty acid profiles, minerals and vitamins, phytochemicals, antioxidant activity, and visual color parameters of the DBB and the FBB were determined and statistically compared. Proximate analysis revealed higher moisture and fat content in the FBB than the DBB, while ash and crude fiber were higher in the DBB than the FBB. The protein content in the DBB and the FBB was not statistically different. Both prepared bars exuded around 376-378 kcal 100 g-1 fresh weight. Sugar profile analysis of the DBB and the FBB showed dependable changes based on date or fruit content. Fructose, glucose, and maltose contents were higher in the FBB than in the DBB, while sucrose content was higher in the DBB than in the FBB. The DBB showed significantly higher content in Ca, Cu, Fe, Zn, Mn, and Se and significantly lower content in Mg, K, and Na than the FBB, with no variation in phosphorus content. The DBB and the FBB contained both essential (EAA) and non-essential (NEAA) amino acids. The DBB scored higher Lysine, Methionine, Histidine, Threonine, Phenylalanine, Isoleucine, and Cystine contents than the FBB, while the FBB scored only higher Leucine and Valine contents than the DBB. Seventeen saturated fatty acids were identified in the DBB and the FBB, with Palmitic acid (C16:0) as the predominant fatty acid. Oleic acid (C18:1n9c) was predominant among seven determined monounsaturated fatty acids. Linoleic fatty acid (C18:2n6c) was predominant among eight identified polyunsaturated fatty acids. In addition, α-Linolenic (C18:3n3) was detected in a considerable amount. However, in both the DBB and the FBB, the content and distribution of fatty acids were not remarkably changed. Regarding phytochemicals and bioactive compounds, the FBB was significantly higher in total phenolic content (TPC), total flavonoids (TF), and total flavonols (TFL) contents and scavenging activity against DPPH and ABTS free radicals than the DBB. The DBB and the FBB showed positive a* values, indicating a reddish color. The b* values were 27.81 and 28.54 for the DBB and the FBB, respectively. The DBB is affected by the lower L* value and higher browning index (BI) to make its color brownish. Sensory evaluation data showed that panelists significantly preferred the DBB over the FBB. In conclusion, processing and comparing these bars indicated that using Sukkari dates is a nutrient-dense, convenient, economical, and better sugar alternative that helps combat the calorie content. Thus, scaling up the use of dates instead of fruits in producing high-energy and protein bars commercially is highly recommended.

Effect of Arabic Qahwa on Blood Pressure in Patients with Stage One Hypertension in the Eastern Region of Saudi Arabia

Hypertension (HT), which is a condition of increased blood pressure (BP), is a major health problem globally. In Saudi Arabia, morbidity and mortality rates are increasing due to HT. Arabic Qahwa (AQ) is a commonly consumed beverage in Saudi Arabia and has numerous health benefits. We conducted a randomized control trial to investigate the effect of AQ on BP among patients with HT (Stage 1). Based on the inclusion criteria, 140 patients were randomly selected, and 126 patients were followed up. After obtaining demographic information, we assessed the BP, heart rate, and lipid profile before and after the intervention of consuming four cups of AQ daily for four weeks. A paired 't' test was used with a significance level of 5%. In the AQ group, there were significant changes (p = 0.009) in systolic blood pressure (SBP), with means of 134.72 ± 3.23 and 133.14 ± 3.69 observed pre and post-test, respectively. Similarly, the diastolic blood pressure (DBP) pre- and post-test mean scores were 87.08 ± 1.8 and 85.98 ± 1.95, respectively, which also showed significance (p = 0.001). There were also significant changes (p = 0.001) observed in the lipid profile of the AQ group. In conclusion, AQ is effective in reducing SBP and DBP in patients with stage one HT.

Date Palm Fruit (Phoenix dactylifera) and Its Promising Potential in Developing Functional Energy Bars: Review of Chemical, Nutritional, Functional, and Sensory Attributes

Snack bars, known as energy bars, are widely consumed worldwide as highly nutritive on-the-go products. Due to the date fruit's significant nutritional and functional characteristics, it can be an exceptional choice for developing snack bars. Dates contain a wide range of macro- and micronutrients known for their strong bioactive properties. The functional properties of date fruit have been demonstrated in the literature and include antioxidant, anti-inflammatory, anti-tumor, antihypertensive, and antimicrobial activities. This review summarizes the available studies investigating the potential application of dates for developing nutritive and functional snack bars. Date paste was used as a main ingredient at 55-90% concentrations. In addition, protein sources were used to provide protein-rich snack bars, as date fruit is considered high in carbohydrates and low in protein. Skim milk powder was the most common and favorable protein source, delivering significant amounts of protein with limited negative effects on sensory attributes. Incorporating other ingredients, such as cereals or legumes, was also explored; adding such dry ingredients can promote positive nutritional effects along with improving sensory attributes, mainly in terms of the bars' textures. Dry ingredients can significantly lower moisture content, reducing the bars' fracturability to acceptable ranges. Reduced moisture content can also significantly enhance the shelf-life stability, as observed by limited microbial growth. Furthermore, the incorporation of bioactive or functional ingredients such as fruit peels, plant seeds, or plant leaf extracts was also reported; such ingredients promoted significant enhancements in the contents of phenolics or flavonoids, for instance, leading to an increase in the bars' antioxidant potential. Though dates are rich in such bioactive components, incorporating additional bioactive ingredients can boost the dates' functional properties. In conclusion, this review shows the high potential of the application of dates for developing nutritious and functional snack bars. Taking this into account, the snack bar market has grown remarkably over the past decade; thus, providing well-balanced, nutritious, and functional date-based bars in markets worldwide is expected to show positive consumer acceptance.

Anti-Obesity Effects of Formulated Biscuits Supplemented with Date's Fiber; Agro-Waste Products Used as a Potent Functional Food

Superabundant date fruit production in Al-Qassim in the Kingdom of Saudi Arabia (KSA), a plentiful region for producing date syrup resulting in massive amounts of date fiber (DF), causes environmental issues with what is considered dietary waste. However, no food producer or researcher has thought of the valorization of DF by extracting the crude polysaccharides that can be converted to nanoparticles (flours) to increase its functional group and enhance its functionality. Using the DF was the primary goal, with the new biscuits used within the current study investigated as a potent integrated approach for controlling obesity levels and its effects. Obesity is one of the most important human problems worldwide, connected to many metabolic diseases, e.g., diabetes mellitus and cardiovascular disease. Its prevalence has recently increased among Saudi children and adolescents. An investigation of the biological effects of the formulated products was carried out by feeding the formulated biscuits with different DF levels (5, 10 and 15%) to obese albino rats, in addition to positive and negative control groups, to evaluate the effect of a reduced calorie product on controlling their body weight and health stats (lipid profile, blood sugars, kidney and liver functions). The collected data showed that the most positive results were obtained from rats fed diets supplemented with 10% DF biscuits. All TCHO, TrGs, HDL, and HDL were decreased to the best levels in this group compared to the positive control group (148.23, 145.30, 37.50, and 81.67 vs. 238.37, 199.07, 62.57, and 135.99, respectively). To conclude, DF supplementation presented anti-obesity properties in animal models; however, more epidemiological trials are needed.

Effect of Date Fruit Consumption on the Glycemic Control of Patients with Type 2 Diabetes: A Randomized Clinical Trial

Objective. Date fruit has been reported to have benefits in type 2 diabetes (T2D), though there is a concern, given the high sugar content, about its effects on glycemic control. Design and Setting. Prospective, interventional, randomized, parallel study. Participants. In total, 79 patients with T2D (39 male and 40 female). Intervention. Participants were randomly allocated to either 60 g date fruit or 60 g raisins daily of the equivalent glycemic index (amount split, given as midmorning and midafternoon snack) for 12 weeks. Main Outcome Measures. The primary outcome was to investigate the effect of date fruit on HbA1c and fasting blood glucose, and their variability, in patients with T2D in comparison to the same glycemic load of raisins. The secondary outcomes were to determine whether date fruit affected cardiovascular risk by measuring fasting lipids, C-reactive protein (CRP), blood pressure, and insulin resistance (IR) as measured by Homeostatic Model Assessment (HOMA-IR). Results. In total, 61 (27 female and 34 male) of 79 patients completed the study. There was no difference between or within groups for HbA1c or HbA1c variability, fasting glucose or glucose variability, insulin resistance (HOMA-IR), insulin sensitivity (HOMA-S), beta cell function (HOMA-B), the disposition index, lipids, systolic (SBP) or diastolic blood pressure (DBP), or C-reactive protein (CRP) (p > 0.05). Conclusion. No improvement in glycemic indices was seen following supplementation of 60 g daily date fruit or raisins, though neither had a deleterious effect on glycemic control over a 12-week period, indicating their safety when consumed in T2D. Additionally, no beneficial therapeutic effects of date fruit on other cardiovascular indices in T2D were seen.