Biogenic Amines in Plant-Origin Foods: Are They Frequently Underestimated in Low-Histamine Diets?

In Vitro and In Vivo Antioxidant and Immune Stimulation Activity of Wheat Product Extracts

BACKGROUND/OBJECTIVES

Inflammation and oxidative stress are the main pathogenetic pathways involved in the development of several chronic degenerative diseases. Our study is aimed at assessing the antioxidant and anti-inflammatory activity of hydroalcoholic extracts obtained from wheat and its derivatives.

METHODS

The content of total phenolic and total flavonoid compounds and antioxidant activity were carried out by ABTS and DPPH assays. The ability of wheat extracts to promote microglia polarization towards an anti-inflammatory phenotype was evaluated analyzing the increased expression of anti-inflammatory markers by real-time qPCR and immunofluorescence assays. Antioxidant activity of all the extracts was evaluated in C. elegans by analyzing ROS levels and the expression of the antioxidant enzymes GST-4 and SOD-3 by real-time qPCR and fluorescence experiments. The expression of key genes involved in the innate immune response and stress resistance pathways-daf-16, sek-1, and pmk-1-was evaluated by real-time qPCR.

RESULTS

Wheat extracts showed the ability to polarize microglia cells towards an anti-inflammatory phenotype, even after the addition of LPS. An antioxidant response was detected both in microglia and in Caenorhabditis elegans nematode, where the extracts also implemented an anti-stress resilience response and stimulated the innate immunity.

CONCLUSIONS

The present study shows that wheat seeds, flour, chaff, and pasta present anti-inflammatory as well as antioxidant activities and may be considered as prospective positive health agents for the preparation of functional foods. Moreover, the valorization of by-products from agricultural and agro-industrial activities would also have significant implications in terms of circular economy.

The Factors Influencing the Concentration of Histamine in Jarred Baby Foods Containing Fish, Considering Evaluation of Daily Histamine Intake

Histamine is one of the biogenic amines produced naturally in the human body, but also in foods, especially those rich in protein. Exogenous and endogenous histamine is subject to degradation in vivo, but in the case of sensitive groups, including children, these degradation processes may be less intense, resulting in adverse health effects from histamine excess. The aim of the study was to determine the histamine content in jarred baby foods containing fish, taking into account the selected product characteristics and storage conditions. The study included 140 meals with added fish, intended for infants and young children, from 5 leading manufacturers available in Poland. The infant meals were analyzed on the day of opening, after 24 h and 48 h of storage in the refrigerator and at room temperature. Histamine concentration was determined by ELISA. The THQ was calculated from the EDI values for histamine. Histamine was present in all analyzed baby foods. On the day of opening, the products had a lower content of this monoamine (Me = 2.59 mg/kg), which increased systematically during storage. Samples taken at 2 °C after 48 h showed an average histamine content of 4.4 mg/kg, while products stored at 22 °C at the same time showed a 1.8-fold higher concentration of this monoamine (Me = 7.9 mg/kg). Dishes containing tuna and sea fish had higher histamine levels on average than those containing pollock. The storage conditions of the children's food had a significant effect on histamine concentration. The level of histamine in baby foods was related to the amount and type of fish in certain products. The results indicate the need for increased awareness of the risks associated with histamine, especially in a group of people with increased sensitivity to this amine, which may include infants and young children.

Histamine Intolerance: Symptoms, Diagnosis, and Beyond

Histamine intolerance is a condition characterized by the accumulation of histamine to a point that exceeds the body's capacity to eliminate it. Researchers have attributed several reasons to this condition, such as genetic factors, alcohol, and dietary deficiencies, among other elements. Symptoms of histamine intolerance have been found to extend beyond the gastrointestinal tract and to the whole body, with these symptoms being sporadic and non-specific. This review will explore various aspects related to histamine intolerance, such as its causes, symptoms, diagnosis, and information related to management.

The correlation between the frequent intake of dietary migraine triggers and increased clinical features of migraine (analytical cross-sectional study from Egypt)

Despite the high prevalence of primary headaches, the role of food in modifying clinical characteristics among migraine patients is often overlooked. The aim is to detect the correlation between adopting unhealthy dietary habits and migraine severity and identify foods that have a greater chance of triggering specific subtypes of migraine. The present study was a cross-sectional analytical study that was conducted at Kasralainy Hospital, Cairo University, headache clinic at Alexandria University Hospital, and Al-Azhar University Hospitals from January to June 2020. We included 124 patients fulfilling the ICHD-3 criteria for migraine. A full clinical profile for migraine headaches was reported using a headache sheet applied to the Al-Azhar University headache unit. A nutritionist obtained data collected about dietary habits using many reliable scales and questionnaires such as food frequently sheets questionnaire. Logistic regression and Pearson correlation coefficients have been used to identify foods that are more likely to be associated with increased clinical features of migraine. Our participants reported that the fried meat, fried chicken, processed meats, fava beans, falafel, aged cheese "Pottery salted cheese" and "Rummy cheese", salted-full fatty cheese "Damietta cheese", citrus fruits, tea, coffee, soft drinks, nuts, pickles, chocolate, canned foods, sauces, ice cream, smoked herring, in addition to the stored food in the refrigerator for many days were significantly associated with the diagnosis of chronic migraine CM compared to episodic migraine (EM). Margarine, pickles, and smoked herring were significantly associated with the diagnosis of migraine with aura (MA) compared to migraine without aura (MO). Adopting unhealthy eating habits was a more prevalent dietary consumption pattern among people with chronic migraines compared to those with episodic migraine.

Anonna crassiflora suppresses colonic carcinogenesis through its antioxidant effects, bioactive amines, and phenol content in rats

Marolo (Annona crassiflora) is an underutilized Brazilian Cerrado fruit with few reports in the literature about its bioactive compounds and functional properties. In this context, the chemoprevention against the carcinogen 1,2-dimethylhydrazine (DMH)-induced pre-neoplastic lesions in Wistar rat colon was investigated and correlated with marolo's antioxidant activity and the contents of phenolic compounds and bioactive amines. Total phenolic compounds (TPC) and total flavonoids compounds (TFC) were determined in the marolo pulp extract by spectrophotometric and Ultra-Performance Liquid Chromatography and diode array detection (UPLC-DAD) analysis. Free bioactive amines were determined by High Performance Liquid Chromatography and fluorescence detection (HPLC-FLD) after post column derivatization with o-phthalaldehyde. In addition, the in vitro antioxidant activity was determined by DPPH, and ABTS. Wistar rats were treated orally with marolo pulp at 0.7, 1.4 and 2.8 g/kg body weight (bw)/day added to a standard ration. Four subcutaneous injections of DMH (40 mg/kg bw) were used to induce a pre-neoplastic lesion that was assessed by the aberrant crypt foci (ACF) assay. The marolo pulp (fresh weigh) showed high content of total phenolic compounds (9.16 mg GAE/g), with predominance of chlorogenic acid (1.86 µg/g) and epicatechin (0.99 µg/g), and total flavonoids (7.26 mg CE/g), ∼85 % of the TPC. The marolo pulp had significant contents of tyramine (31.97 mg/kg), putrescine (20.65 mg/kg), and spermidine (6.32 mg/kg). The marolo pulp inhibited (p < 0.05) pre-neoplastic lesions induced by DMH administration at the all concentrations tested. These findings indicate that marolo pulp has a colon carcinogenesis chemopreventive effect, which could be due to, at least in parts, its antioxidant action associated with its phenolics and flavonoids content as well of spermidine.

How Many Hungarian Consumers Choose Lactose- and Gluten-Free Food Products Even When They Do Not Necessarily Need to?

The popularity of "free-from" food products (FFFPs), which exclude several ingredients such as lactose, gluten, or sugar, is increasing globally. However, experts agree that avoiding these ingredients without medical reasons can lead to nutritional deficiencies. A representative consumer survey was conducted in Hungary (n = 1002); it focused on behaviors related to FFFPs, particularly lactose- and gluten-free products. This study revealed that consumers often consider "free-from" claims during shopping. Lactose- and gluten-free foods were popular, even among those without specific dietary needs. A distinct "free-from consumer group" (7.8% of the sample, predominantly women) was identified, who consume both lactose- and gluten-free foods frequently. However, only 15.4% of the group had medical reasons for their preference, such as lactose intolerance or gluten sensitivity. The majority (75.6%) chose these products without medical justification, relying on self-diagnosis, through the involvement of family members, or the belief that they were healthier. This consumer group accounts for nearly 6% of Hungary's adult population, exceeding 470,000 individuals. Extrapolating these figures to other European countries suggests that 25-30 million EU citizens might be in a similar situation, highlighting the need for improved health education and awareness-raising campaigns to prevent imbalanced nutrition and foster the recognition and treatment of real health problems.

Evaluation of Serum Diamine Oxidase as a Diagnostic Test for Histamine Intolerance

Histamine intolerance (HIT) is a clinical condition caused by decreased intestinal degradation of ingested histamine, primarily due to reduced enzyme diamine oxidase (DAO) activity, leading to histamine accumulation and causing various clinical manifestations. The measurement of serum DAO is commonly used as the main diagnostic test for HIT, although its diagnostic use is still uncertain. In this retrospective study, we aimed to assess the validity of DAO determination in patients with clinically suspected HIT. We measured DAO levels in 249 patients with suspected HIT and 50 healthy adult controls without HIT-related problems. Based on five clinical criteria, we divided patients into two groups: high (all five inclusion criteria; 41 patients) and low probability of HIT (≤4 inclusion criteria; 208 patients). Patients with a "high probability of HIT" had the lowest DAO (median: 8 U/mL, IQR: 6-10) in comparison to patients with a "low probability of HIT (median: 10 U/mL, IQR: 7-16, p = 0.0006) and healthy controls (median: 18 U/mL, IQR: 14-22, p < 0.0001). The specificity and sensitivity for DAO levels < 3/< 10 U/mL (manufacturer's set cut-off) to discriminate between patients with ''high probability of HIT'' and healthy controls were 100%/92% and 2%/71%. On the other hand, the specificity and sensitivity to discriminate between patients with ''high probability of HIT'' and ''low probability of HIT'' were 97%/61% and 2%/71%, respectively. Serum DAO determination represents an additional asset to the diagnosis of HIT based on clinical evaluation and assessment, but the diagnosis should not solely rely on DAO measurements.

The inhibitory effects of plant additives on biogenic amine formation in fermented foods - a review

Fermented food has unique properties and high nutritional value, and thus, should constitute a basic element of a balanced and health-promoting diet. However, it can accumulate considerable amount of biogenic amines (BAs), which ingested in excess can lead to adverse health effects. The application of plant-derived additives represents a promising strategy to ensure safety or enhance the functional and organoleptic properties of fermented food. This review summarizes currently available data on the application of plant-origin additives with the aim to reduce BA content in fermented products. The importance of ensuring fermented food safety has been highlighted considering the growing evidence of beneficial effects resulting from the consumption of this type of food, as well as the increasing number of individuals sensitive to BAs. The examined plant-origin additives reduced the BA concentration to varying degrees, and their efficacy depended on the type of additive, matrix, autochthonous, and inoculated microorganisms, as well as the manufacturing conditions. The main mechanisms of action include antimicrobial effects and the inhibition of microbial decarboxylases. Further research on the optimization of bioactive substances extraction, standardization of their chemical composition, and development of detailed procedures for its use in fermented products manufacturing are needed.

Acute and post-acute sequelae of SARS-CoV-2 infection: a review of risk factors and social determinants

SARS-CoV-2 infection leading to Coronavirus Disease 2019 (COVID-19) has caused more than 762 million infections worldwide, with 10-30% of patients suffering from post-acute sequelae of SARS-CoV-2 infections (PASC). Initially thought to primarily affect the respiratory system, it is now known that SARS-CoV-2 infection and PASC can cause dysfunction in multiple organs, both during the acute and chronic stages of infection. There are also multiple risk factors that may predispose patients to worse outcomes from acute SARS-CoV-2 infection and contribute to PASC, including genetics, sex differences, age, reactivation of chronic viruses such as Epstein Barr Virus (EBV), gut microbiome dysbiosis, and behavioral and lifestyle factors, including patients' diet, alcohol use, smoking, exercise, and sleep patterns. In addition, there are important social determinants of health, such as race and ethnicity, barriers to health equity, differential cultural perspectives and biases that influence patients' access to health services and disease outcomes from acute COVID-19 and PASC. Here, we review risk factors in acute SARS-CoV-2 infection and PASC and highlight social determinants of health and their impact on patients affected with acute and chronic sequelae of COVID-19.

Gut microbiota and anti-aging: Focusing on spermidine

The human gut microbiota plays numerous roles in regulating host growth, the immune system, and metabolism. Age-related changes in the gut environment lead to chronic inflammation, metabolic dysfunction, and illness, which in turn affect aging and increase the risk of neurodegenerative disorders. Local immunity is also affected by changes in the gut environment. Polyamines are crucial for cell development, proliferation, and tissue regeneration. They regulate enzyme activity, bind to and stabilize DNA and RNA, have antioxidative properties, and are necessary for the control of translation. All living organisms contain the natural polyamine spermidine, which has anti-inflammatory and antioxidant properties. It can regulate protein expression, prolong life, and improve mitochondrial metabolic activity and respiration. Spermidine levels experience an age-related decrease, and the development of age-related diseases is correlated with decreased endogenous spermidine concentrations. As more than just a consequence, this review explores the connection between polyamine metabolism and aging and identifies advantageous bacteria for anti-aging and metabolites they produce. Further research is being conducted on probiotics and prebiotics that support the uptake and ingestion of spermidine from food extracts or stimulate the production of polyamines by gut microbiota. This provides a successful strategy to increase spermidine levels.

Naphthalene-2,3-dicarboxaldehyde as a pulsed-post column derivatization reagent; comparison with two alternative o-phthalaldehyde based chemistries for the determination of histamine

In the present study, naphthalene-2,3-dicarboxaldehyde (NDA) was used in on-line post column derivatization (PCD) coupled to liquid chromatography under the new concept of Pulsed-PCD. In Pulsed-PCD, the reagents are introduced into the flowing stream of the mobile phase under precise timing overlapping the eluted analyte. The consumption of the reagents is minimized to a few microliters, resulting in a significant advantage, that is the use of expensive reagents in PCD. For this reason, NDA-CN chemistry was used for the determination of histamine in food samples, such as eggplant and spinach. Two additional methods were developed based on the reaction of histamine with o-phthalaldehyde (OPA), namely the classic OPA - nucleophilic compound reaction and the specific OPA - histamine reaction in alkaline medium. The chromatographic conditions and the Pulsed-PCD conditions were investigated, while the analytical figures of merit were satisfactory. In all three methods, a pulse of 50 μL was used (OPA/NDA + Buffer), reducing dramatically the consumption of PCD reagents.

A Multimethodological Approach for the Valorization of "Senatore Cappelli" Wheat Milling By-Products as a Source of Bioactive Compounds and Nutraceutical Activity

Wheat is the third most cultivated cereal in the world and represents the major contributor to human nutrition. Milling wheat by-products such as husks (17-20% of the total processing output weight), even if still containing high-value-added bioactive compounds, are often left untreated or unused, thus resulting in environmental and human health burdens. In these regards, the present study is aimed at evaluating in a multimethodological approach the nutraceutical properties of durum wheat husks belonging to the ancient cultivar "Senatore Cappelli", thus assessing their potential as bioactive compound sources in terms of phytochemical, cytotoxic, and nutraceutical properties. By means of HPLC-FD analyses, wheat husk samples analyzed revealed a higher content of serotonin, amounting to 35% of the total BAs, and were confirmed to occur at biogenic amines quality index (BAQI) values <10 mg/100 g. In addition, spectrophotometric assays showed a significant variable content in the phenolic (189.71-351.14 mg GAE/100 g) and antioxidant compounds (31.23-37.84 mg TE/100 g) within the wheat husk samples analyzed, according to the different cultivar areas of origin. Considering wheat husk extracts' anti-inflammatory and antioxidant activity, in vitro analyses were performed on BV-2 murine microglia cells cultured in the presence or absence of LPS, thus evaluating their ability to promote microglia polarization towards an anti-inflammatory phenotype. Cytotoxicity assays showed that wheat extracts do not affect microglia viability. Wheat husks activity on microglial polarization was assessed by analyzing the expression of M1 and M2 markers' mRNA by RT-PCR. Wheat husk antioxidant activity was assessed by analysis of NRF2 and SOD1 mRNA expression. Moreover, the sustainability assessment for the recovery of bioactive components from wheat by-products was carried out by applying the life cycle assessment (LCA) methodology using SimaPro v9.2.2. software.

Dietary strategies for chronic spontaneous urticaria: an evidence-based review

Although the relationship between diet and chronic spontaneous urticaria (CSU) remains elusive, several patients seek dietary modifications as they are easy and cost-effective. Adequate patient education and counseling are crucial as modified diets may be beneficial for a subset of antihistamine refractory CSU patients, and no modality currently exists to identify these patients. Elimination of food items based exclusively on patient history may lead to unnecessary restrictions in most cases resulting in nutritional deficiencies and impaired quality of life. Several dietary strategies have been tried till date with varying rates of success and evidence. This review highlights the various dietary strategies along with their levels of evidence, which may help the treating dermatologists and physicians to counsel CSU patients and make evidence-based treatment decisions. There is grade A recommendation for the elimination of food additives (artificial pseudoallergens), personalized diets, vitamin D supplementation, Diamine oxidase supplementation and probiotics (in children), grade B recommendation for dietary elimination of red meat, fish and their products, natural pseudoallergens (fruits, vegetables, and spices), and low-histamine diet, while dietary elimination of gluten (with concomitant celiac disease) has grade C recommendation. Notably, elimination diets should be continued for at least 3 consecutive weeks to assess their effectiveness.

Secondary Metabolites in Nectar-Mediated Plant-Pollinator Relationships

In recent years, our understanding of the complex chemistry of floral nectar and its ecological implications for plant-pollinator relationships has certainly increased. Nectar is no longer considered merely a reward for pollinators but rather a plant interface for complex interactions with insects and other organisms. A particular class of compounds, i.e., nectar secondary compounds (NSCs), has contributed to this new perspective, framing nectar in a more comprehensive ecological context. The aim of this review is to draft an overview of our current knowledge of NSCs, including emerging aspects such as non-protein amino acids and biogenic amines, whose presence in nectar was highlighted quite recently. After considering the implications of the different classes of NSCs in the pollination scenario, we discuss hypotheses regarding the evolution of such complex nectar profiles and provide cues for future research on plant-pollinator relationships.

Free Amino Acids and Biogenic Amines Profiling and Variation in Wild and Sub-Endemic Cardueae Species from Sardinia and Corse

The cardueae are a common species in the Mediterranean area where they grow spontaneously and are traditionally employed as food and for health purposes. In this work, five Cardueae, including two sub-endemic species (four Carduus and three Ptilostemon casabonae (L.) Greuter samples from different locations) were collected from Sardinia and the Corse islands. All the considered plants are characteristic of the area, in particular the sub-endemic species C. cephalanthus and P. casabonae. This work aims to obtain, for the first time, the amino compounds profile (primary metabolites) of these little-studied species to detect for any similarities and differences among the different samples using statistical analyses. A recently developed method was employed, where diethyl ethoxymethylenemalonate (DEEMM) derivatives are detected in a neutral loss scan mode using high performance liquid chromatography in tandem with a mass spectrometry technique. In total, 42 amino compounds were detected, of which 33 were fully identified and semi-quantified. Overall, the results show that DEEMM-derivatized amino compounds are qualitatively similar among the considered samples. Nonetheless, a discrimination at the genus level is possible. This work adds more information regarding the phytochemical composition regarding the primary metabolites of the considered samples, their discriminations and the search for compounds with potential health benefits.

Development of Histamine in Fresh and Canned Tuna Steaks Stored under Different Experimental Temperature Conditions

Among biogenic amines, histamine is most frequently involved in foodborne intoxication. To evaluate histamine formation in tuna, several storage conditions were reproduced. An LC-MS/MS method was used for analytical determinations. Fresh tuna samples (not contaminated and grafted with tuna muscle naturally incurred with histamine at 6000 mg/kg) were stored at 4, 12, and 20 °C, and daily samples were collected for 6 days. The development of histamine was observed only in grafted tuna samples. At 4 °C, histamine formation progressed from 12.8 mg/kg (day 1) up to 68.2 mg/kg (day 6). At 12 °C, higher concentrations developed (23.9 mg/kg on day 1 up to 2721.3 mg/kg on day 6) relative to 20 °C (from 12.0 to 1681.0 mg/kg). It was found that at 4 °C, if grafted tuna was submerged in oil, histamine formation progressed more slowly. In a naturally contaminated sample, it was observed that the histamine distribution was uniform, while the normal cooking process did not affect the histamine level. Furthermore, it was found that the use of histamine-contaminated equipment for food handling may result in histamine formation in food. These results confirm the importance of implementing good hygiene practices and respecting the cold chain.

Starter culture-related changes in free amino acids, biogenic amines profile, and antioxidant properties of fermented red beetroot grown in Poland

Fermentation of two red beet cultivars (Wodan and Alto) with single-strain starter cultures consisting of selected strains of lactic acid bacteria (LAB) of plant origin (Weissella cibaria KKP2058, Levilactobacillus brevis ZF165) and a multi-strain culture (containing W. cibaria KKP2058, L. brevis ZF165, Lactiplantibacillus plantarum KKP1822, Limosilactobacillus fermentum KKP1820, and Leuconostoc mesenteroides JEIIF) was performed to evaluate their impact on betalains, free amino acids, formation of biogenic amines, and antioxidative properties of the juice formed. Next-generation sequencing data analysis used to identify the microbial community revealed that the starter cultures promoted the dominance of the genus Lactobacillus, and decreased the proportion of spoilage bacteria compared to spontaneously fermented juices. Generally, the fermentation process significantly influenced the amount of the analyzed compounds, leading in most cases to their reduction. The observed changes in the studied parameters depended on the starter culture used, indicating different metabolic activities of the LAB strains towards bioactive compounds. The use of multi-strain starter cultures allowed to largely prevent the reduction of betacyanins and histamine formation.

Simple and Reliable Determination of the Histamine Content of Selected Greek Vegetables and Related Products in the Frame of “Low Histamine Diet”

The determination of histamine in Greek foods that should potentially be avoided during a “low histamine diet” is reported herein. Cation exchange chromatography combined to selective post column derivatization proved to be an excellent tool for this type of analysis as well, offering accurate results following minimal sample preparation. Tomato-, eggplant- and spinach-related products have been successfully analyzed and were all found to contain histamine. Higher amounts were quantified in eggplants, eggplant salads and spinach in the range of 15.4–34.2 mg kg⁻¹ and lower in fresh tomatoes and related products (0.8–10.6 mg kg⁻¹). The method is capable of determining as low as 0.5 mg kg⁻¹ histamine without matrix effects, with percent recoveries ranging between 87 and 112% (tomatoes and related products), 95 and 119% (eggplants and related products) and 90 and 106% (fresh and frozen spinach).

Gut bacterial aromatic amine production: aromatic amino acid decarboxylase and its effects on peripheral serotonin production

Colonic luminal aromatic amines have been historically considered to be derived from dietary source, especially fermented foods; however, recent studies indicate that the gut microbiota serves as an alternative source of these amines. Herein, we show that five prominent genera of Firmicutes (Blautia, Clostridium, Enterococcus, Ruminococcus, and Tyzzerella) have the ability to abundantly produce aromatic amines through the action of aromatic amino acid decarboxylase (AADC). In vitro cultivation of human fecal samples revealed that a significant positive correlation between aadc copy number of Ruminococcus gnavus and phenylethylamine (PEA) production. Furthermore, using genetically engineered Enterococcus faecalis-colonized BALB/cCrSlc mouse model, we showed that the gut bacterial aadc stimulates the production of colonic serotonin, which is reportedly involved in osteoporosis and irritable bowel syndrome. Finally, we showed that human AADC inhibitors carbidopa and benserazide inhibit PEA production in En. faecalis.

The Prescriber's Guide to the MAOI Diet-Thinking Through Tyramine Troubles

This review article features comprehensive discussions on the dietary restrictions issued to patients taking a classic monoamine oxidase inhibitor (phenelzine, tranylcypromine, isocarboxazid), or high-dose (oral or transdermal) selegiline. It equips doctors with the knowledge to explain to their patients which dietary precautions are necessary, and why that is so: MAOIs alter the capacity to metabolize certain monoamines, like tyramine, which causes dose-related blood pressure elevations. Modern food production and hygiene standards have resulted in large reductions of tyramine concentrations in most foodstuffs and beverages, including many cheeses. Thus, the risk of consequential blood pressure increases is considerably reduced-but some caution remains warranted. The effects of other relevant biogenic amines (histamine, dopamine), and of the amino acids L-dopa and L-tryptophan are also discussed. The tables of tyramine data usually presented in MAOI diet guides are by nature unhelpful and imprecise, because tyramine levels vary widely within foods of the same category. For this reason, it is vital that doctors understand the general principles outlined in this guide; that way, they can tailor their instructions and advice to the individual, to his/her lifestyle and situation. This is important because the pressor response is characterized by significant interpatient variability. When all factors are weighed and balanced, the conclusion is that the MAOI diet is not all that difficult. Minimizing the intake of the small number of risky foods is all that is required. Many patients may hardly need to change their diet at all.

The Effects of Different Processing Methods on the Levels of Biogenic Amines in Zijuan Tea

This study aimed to evaluate the effects of processing methods on the content of biogenic amines in Zijuan tea by using derivatization and hot trichloroacetic acid extraction with HPLC-UV. The results showed that the most abundant biogenic amine in the original leaves was butylamine, followed by ethylamine, methylamine, 1,7-diaminoheptane, histamine, tyramine, and 2-phenethylamine. However, during the process of producing green tea, white tea, and black tea, the content of ethylamine increased sharply, which directly led to their total contents of biogenic amines increasing by 184.4%, 169.3%, and 178.7% compared with that of the original leaves, respectively. Unexpectedly, the contents of methylamine, ethylamine, butylamine, and tyramine in dark tea were significantly reduced compared with those of the original leaves. Accordingly, the total content of biogenic amines in dark tea was only 161.19 μg/g, a reduction of 47.2% compared with that of the original leaves, indicating that the pile-fermentation process could significantly degrade the biogenic amines present in dark tea.

Functional and Nutraceutical Compounds of Tomatoes as Affected by Agronomic Practices, Postharvest Management, and Processing Methods: A Mini Review

Tomatoes and their by-products are indisputable sources of substances with antioxidants properties. Several factors limit the production and influence the nutritional and antioxidant quality of tomato fruit. However, consumers can benefit from the effects of environmental factors, such as water and hydric stress, UV radiation, agronomic practices, among others, which lead to changes in the content of secondary metabolites in tomatoes. Molecules as phenolic compounds, carotenoids, and biogenic amines are often formed in response to environmental adversities. In this way, the consumption of tomato fruits or their by-products with higher levels of antioxidants may be important adjuvants in the prevention or reduction of diseases. In this mini-review, we will present how pre- and postharvest conditions may influence the content of some bioactive compounds in tomatoes. Furthermore, we will present how some heat processing methods may change the antioxidant content, as well as, the functional and nutritional properties of the final product.

Histamine Intolerance-A Kind of Pseudoallergic Reaction

Histamine intolerance (HIT) is a common disorder associated with impaired histamine metabolism. Notwithstanding, it is often misdiagnosed as other diseases because of its lack of specific clinical manifestations. HIT did not gain traction until the early 21st century. In this review, we will focus on the latest research and elaborate on the clinical manifestations of HIT, including its manifestations in special populations such as atopic dermatitis (AD) and chronic urticaria (CU), as well as the latest understanding of its etiology and pathogenesis. In addition, we will explore the latest treatment strategies for HIT and the treatment of specific cases.

Fate of Bioactive Compounds during Lactic Acid Fermentation of Fruits and Vegetables

Consumption of lactic acid fermented fruits and vegetables has been correlated with a series of health benefits. Some of them have been attributed to the probiotic potential of lactic acid microbiota, while others to its metabolic potential and the production of bioactive compounds. The factors that affect the latter have been in the epicenter of intensive research over the last decade. The production of bioactive peptides, vitamins (especially of the B-complex), gamma-aminobutyric acid, as well as phenolic and organosulfur compounds during lactic acid fermentation of fruits and vegetables has attracted specific attention. On the other hand, the production of biogenic amines has also been intensively studied due to the adverse health effects caused by their consumption. The data that are currently available indicate that the production of these compounds is a strain-dependent characteristic that may also be affected by the raw materials used as well as the fermentation conditions. The aim of the present review paper is to collect all data referring to the production of the aforementioned compounds and to present and discuss them in a concise and comprehensive way.

Food intolerances and the small intestine

The article presents an analysis of the literature on food intolerance (FS) associated with the presence in the diet of fermentable oligodimosaccharides and polyols FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols), histamine and food additives. The relationship between FS and insufficient activity of enzymes of the small intestine mucosa, in particular, in patients with irritable bowel syndrome, is discussed. FS often noted in them forces them to strictly adhere to the elimination diet and significantly impair the quality of life due to dissatisfaction with the results of treatment. Analysis of the literature has confirmed in many patients with irritable bowel syndrome an etiotropic relationship with poor food tolerance and dictates the need for randomized studies to further study the pathogenetic mechanisms of increasing food tolerance under the influence of cytoprotective therapy.

Inhibition of Human Monoamine Oxidases A and B by Specialized Metabolites Present in Fresh Common Fruits and Vegetables

Diets rich in fruits and vegetables are associated with better psychological wellbeing and cognitive functions, although it is unclear which molecules and mechanisms are involved. One potential explanation is the inhibition of monoamine oxidases (MAOs), which have been linked to several neurological disorders. The present study investigated the ability of kiwifruit to inhibit MAO-A and MAO-B, refining an in vitro assay to avoid confounding effects. Ultra-performance liquid chromatography/mass spectrometry (UPLC-QTOF) and nuclear magnetic resonance spectroscopy (NMR) were used to select individual kiwifruit metabolites for further analysis. Moreover, extracts of other common fruits and vegetables were screened to identify promising candidate inhibitors. Multiple extracts and compounds inhibited both enzymes, and the selective inhibition of MAO-B by the major kiwifruit specialized metabolite D-(−)-quinic acid was observed. These results suggest that fruits and vegetables contain metabolites that inhibit the activity of MAO-A and -B, offering a potential natural option for the treatment of neurological disorders, in which MAOs are involved.

The cold chain and the COVID-19 pandemic: an unusual increase in histamine content in fish samples collected in Southern Italy during lockdown

Objectives

We analysed 900 samples of fresh (250) and processed (650) fish products collected in Sicily (Southern Italy) in 2020 during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (hereafter: COVID-19).

Materials and methods

The samples were divided temporally based on five phases relating to the various restrictions imposed by the Italian government in this period. The validated method of ultra-high performance liquid chromatography (UHPLC) combined with a diode array detector (DAD) was then employed for the analysis.

Results

The samples collected during the Phase I lockdown period and after it had ended (Phase II) revealed significant increases in the mean histamine levels: 41.89±87.58 mg/kg ^-1 and 24.91±76.76 mg/kg ^-1, respectively. The 11 (1.3% of the total) fresh fish samples that were identified as being non-compliant with EC Reg. 2073/2005 were only found during these two periods. All the processed samples were always compliant. The histamine values decreased as the restrictions eased, achieving a mean value of 11.16±9.3 mgkg ^-1 (Phase III).

Conclusions

There was an increase in the incidence of fish samples that were non-compliant with EC Reg. 2073/2005 compared to previous surveillance data. These results provide a first report on the effect of lockdown measures on food safety and the cold chain. Our findings must cause food safety operators to intensify their controls over fresh fish products in such periods to safeguard consumer health. Further studies are required to evaluate whether the same trend would be observed with other food contaminants.

Accumulation and Transformation of Biogenic Amines and Gamma-Aminobutyric Acid (GABA) in Chickpea Sourdough

In general, sourdough fermentation leads to an improvement in the technological, nutritional, and sensory properties of bakery products. The use of non-conventional flours with a specific autochthonous microbiota may lead to the formation of secondary metabolites, which may even have undesirable physiological and toxicological effects. Chickpea flours from different suppliers have been used to produce sourdoughs by spontaneous and inoculated fermentations. The content of nutritionally undesirable biogenic amines (BA) and beneficial gamma-aminobutyric acid (GABA) was determined by chromatography. Fenugreek sprouts, which are a rich source of amine oxidases, were used to reduce the BA content in the sourdoughs. Spontaneous fermentation resulted in a high accumulation of cadaverine, putrescine, and tyramine for certain flours. The use of commercial starter cultures was not effective in reducing the accumulation of BA in all sourdoughs. The addition of fenugreek sprouts to the suspension of sourdough with pH raised to 6.5 resulted in a significant reduction in BA contents. Enzymatic oxidation was less efficient during kneading. Baking resulted in only a partial degradation of BA and GABA in the crust and not in the crumb. Therefore, it could be suggested to give more importance to the control of sourdough fermentation with regard to the formation of nutritionally undesirable BA and to exploit the possibilities of their degradation.

Safety of water lentil powder from Lemnaceae as a Novel Food pursuant to Regulation (EU) 2015/2283

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on the safety of water lentil powder as a novel food (NF) pursuant to Regulation (EU) 2015/2283. Water lentils refer to aquatic plants belonging to the Araceae family and represented by five genera (Lemna, Wolffia, Wolffiella, Landoltia and Spirodela). The NF is thermally washed and dried water lentils, which are produced as a polyculture crop consisting of species from the Lemna genus (70-100%) and the Wolffia genus (0-30%). The main constituents of the NF are protein, fibre and fat. The Panel notes that the concentration of trace elements and contaminants in the NF is highly dependent on the conditions of cultivation of the plant and the fertiliser composition. The NF is expected to be stable and to comply with the specifications during the suggested shelf life. The NF is intended for human consumption as a food ingredient in herbs, spices and seasonings, sauces, soups and broths, protein products, dietary food for weight control and as a food supplement. The target population is the general population, except for food supplements which are exclusively intended for consumption by adults. The Panel considers that based on the composition of the NF and the proposed intended uses, the NF is not nutritionally disadvantageous, except for the concerns regarding intake of manganese from the NF. No adverse effect was observed in the submitted 90-day subchronic study, at the highest dose, 1,000 mg/kg body weight (bw) per day of NF. The Panel considers that, based on the protein concentration, the consumption of the NF may trigger allergic reactions. The Panel concluded that an increase in manganese intake from the NF used as food ingredient or food supplements is of safety concern and the safety of the NF cannot be established.

Commercial Bio-Packaging to Preserve the Quality and Extend the Shelf-Life of Vegetables: The Case-Study of Pumpkin Samples Studied by a Multimethodological Approach

A multidisciplinary protocol is proposed to monitor the preservation of fresh pumpkin samples (FP) using three commercial polymeric films: A made of biodegradable cellophane from regenerated cellulose pulp; B from corn starch, cassava and eucalyptus, C made of polylactic acid from corn starch, and a polyethylene film used as reference (REF). Chemical, mechanical and microbiological analyses were applied on packaging and fresh and packaged samples at different times. After an 11-day period, NMR spectroscopy results showed a sucrose increase and a malic acid decrease in all the biofilms with respect to FP; fructose, glucose, galactose levels remained quite constant in biofilms B and C; the most abundant amino acids remained quite constant in biofilm A and decreased significantly in biofilm B. From microbiological analyses total microbial count was below the threshold value up to 7 days for samples in all the films, and 11 days for biofilm C. The lactic acid bacteria, and yeasts and molds counts were below the acceptability limit during the 11 days for all packages. In the case of biofilm C, the most promising packaging for microbiological point of view, aroma analysis was also carried out. In this paper, you can find all the analysis performed and all the values found.

Diet Interventions for Irritable Bowel Syndrome: Separating the Wheat from the Chafe

Patients with irritable bowel syndrome (IBS) frequently perceive eating food as a trigger to their gastrointestinal (GI) distress. Several factors involved in driving GI symptoms include malabsorption and fermentation of food substrates, gut microbiota alterations, nocebo and placebo response, and mast cell activation. Nutritional interventions require individualization based on the heterogeneity of symptoms as well as the risk for maladaptive eating patterns that present in those with IBS. Despite the variety of interventions marketed to individuals with IBS, the low Fermentable, Oligo-, Di-Mono-saccharide, and Polyol diet has the most evidence for efficacy in symptom management.

Recovery of Banana Waste-Loss from Production and Processing: A Contribution to a Circular Economy

Banana is a fruit grown mainly in tropical countries of the world. After harvest, almost 60% of banana biomass is left as waste. Worldwide, about 114.08 million metric tons of banana waste-loss are produced, leading to environmental problems such as the excessive emission of greenhouse gases. These wastes contain a high content of paramount industrial importance, such as cellulose, hemicellulose and natural fibers that various processes can modify, such as bacterial fermentation and anaerobic degradation, to obtain bioplastics, organic fertilizers and biofuels such as ethanol, biogas, hydrogen and biodiesel. In addition, they can be used in wastewater treatment methods by producing low-cost biofilters and obtaining activated carbon from rachis and banana peel. Furthermore, nanometric fibers commonly used in nanotechnology applications and silver nanoparticles useful in therapeutic cancer treatments, can be produced from banana pseudostems. The review aims to demonstrate the contribution of the recovery of banana production waste-loss towards a circular economy that would boost the economy of Latin America and many other countries of emerging economies.

Occurrence of Polyamines in Foods and the Influence of Cooking Processes

Dietary polyamines are involved in different aspects of human health and play an important role in the prevention of certain chronic conditions such as cardiovascular diseases and diabetes. Different polyamines can be found in all foods in variable amounts. Moreover, several culinary practices have been reported to modify the content and profile of these bioactive compounds in food although experimental data are still scarce and even contradictory. Therefore, the aim of this study was to evaluate the occurrence of polyamines in a large range of foods and to assess the effect of different cooking processes on the polyamine content of a few of them. The highest level of polyamines was found in wheat germ (440.6 mg/kg). Among foods of a plant origin, high levels of total polyamines over 90 mg/kg were determined in mushrooms, green peppers, peas, citrus fruit, broad beans and tempeh with spermidine being predominant (ranging from 54 to 109 mg/kg). In foods of an animal origin, the highest levels of polyamines, above all putrescine (42-130 mg/kg), were found in raw milk, hard and blue cheeses and in dry-fermented sausages. Regarding the influence of different domestic cooking processes, polyamine levels in food were reduced by up to 64% by boiling and grilling but remained practically unmodified by microwave and sous-vide cooking.

Histamine Intolerance-The More We Know the Less We Know. A Review

The intake of food may be an initiator of adverse reactions. Food intolerance is an abnormal non-immunological response of the organism to the ingestion of food or its components in a dosage normally tolerated. Despite the fact that food intolerance is spread throughout the world, its diagnosing is still difficult. Histamine intolerance (HIT) is the term for that type of food intolerance which includes a set of undesirable reactions as a result of accumulated or ingested histamine. Manifestations may be caused by various pathophysiological mechanisms or a combination of them. The problem with a "diagnosis" of HIT is precisely the inconstancy and variety of the manifestations in the same individual following similar stimuli. The diagnosing of HIT therefore requires a complex time-demanding multidisciplinary approach, including the systematic elimination of disorders with a similar manifestation of symptoms. Among therapeutic approaches, the gold standard is a low-histamine diet. A good response to such a diet is considered to be confirmation of HIT. Alongside the dietary measures, DAO supplementation supporting the degradation of ingested histamine may be considered as subsidiary treatment for individuals with intestinal DAO deficiency. If antihistamines are indicated, the treatment should be conscious and time-limited, while 2nd or 3rd generation of H1 antihistamines should take precedence.

Effect of Pretreatment Processes on Biogenic Amines Content and Some Bioactive Compounds in Hericium erinaceus Extract

Hericium erinaceus is reported as a source of several nutritional contents and bioactive compounds, especially β-glucan. However, various uncontrolled processes lead to the formation of byproducts that can affect human health, including biogenic amines. These amines are concerning, because their presence is an important indicator of the process of hygiene and food spoilage or quality. A better understanding of various pretreatment processes can control the content of biogenic amines. In this work, we studied the effect of pretreatment processes, i.e., sample size (whole, ripping, and chopping); heating process (non-heating, blanching, and boiling); and drying method (nondrying, hot air drying, and freeze-drying) on biogenic amine contents in H. erinaceus extract. A method of the post-column high-performance liquid chromatography (HPLC) technique was used for the analysis of putrescine (PUT) and spermidine (SPD) in H. erinaceus extract following the acceptable guidelines. In this study, treatment 20 (chopping/non-heating/hot air drying) was suggested as a good choice for the pretreatment process, because low levels of PUT and SPD were shown in the extract while high levels of the bioactive compounds β-glucan and antioxidant activity were presented. This treatment process can be applied to the industry because of its easy operation and cost-saving.

Histamine Intolerance in Children: A Narrative Review

Histamine intolerance is defined as a disequilibrium of accumulated histamine and the capacity for histamine degradation. This clinical term addresses a non-immunologically mediated pathology when histamine ingested with food is not particularly high, however its degradation is decreased. This paper aims to provide a narrative review on etiopathology, epidemiology, possible diagnostic algorithms and diagnostic challenges of histamine intolerance in children. The clinical picture of histamine intolerance in children is similar to that observed in adults apart from male predominance found in paediatric patients. Both in children and adults, a histamine-reduced diet is typically the treatment of choice. Diamine oxidase supplementation offers another treatment option. There is no symptom or test pathognomonic for histamine intolerance. Nevertheless, manifestations of chronic gastrointestinal symptoms, measurements of diamine oxidase deficits, positive results of histamine provocation tests and improvement in symptoms with histamine-reduced diet considerably increase the probability of histamine intolerance diagnosis. These factors have been included in the proposed diagnostic algorithm for histamine intolerance. In children histamine intolerance most likely co-occurs with allergies and bowel diseases, which creates an additional diagnostic challenge. As the evidence for children is poor further research is needed the determine epidemiology, validate diagnostic algorithms and establish possible treatment options regarding histamine intolerance.

Low-Histamine Diets: Is the Exclusion of Foods Justified by Their Histamine Content?

A low-histamine diet is currently the most advised strategy to prevent the symptomatology of histamine intolerance. Conceptually, these diets should be founded on the exclusion of histamine-containing foods, although a certain disparity is found within the list of excluded foods in accordance with the different low-histamine diets available in the literature. This study aimed to critically review low-histamine diets reported in the scientific literature, according to the histamine and other biogenic amine contents of the excluded foods. A total of ten scientific studies that provided specific recommendations on the foods that must be avoided within the framework of a low-histamine diet were found. Overall, the comparative review brought out the great heterogenicity in the type of foods that are advised against for histamine intolerant individuals. Excluded foods were, in most cases, different depending on the considered diet. Only fermented foods were unanimously excluded. The exclusion of 32% of foods could be explained by the occurrence of high contents of histamine. The presence of putrescine, which may interfere with histamine degradation by the DAO enzyme at the intestinal level, could partly explain the reason why certain foods (i.e., citrus fruits and bananas) were also frequently reported in low-histamine diets. Finally, there was a range of excluded foods with an absence or very low levels of biogenic amines. In this case, certain foods have been tagged as histamine-liberators, although the mechanism responsible has not yet been elucidated.

Simultaneous determination of eight biogenic amines in the traditional Chinese condiment Pixian Douban using UHPLC-MS/MS

A UHPLC-MS/MS method was developed to simultaneously determine eight biogenic amines (BAs) in Pixian Douban. Under optimal conditions, the linear ranges of determination were 5-1000 μg/L (that of spermine was 8-1000 μg/L). Correlation coefficients ranged from 0.9955 to 0.9987. The limits of detection were 0.11-5.5 μg/L. The matrix effect and analytical performance of the present method were evaluated, and the eight BAs were analyzed by this method in 19 samples, indicating the potential pollution of BAs in chili oil Pixian Douban.

Impact of Using Organic Yeast in the Fermentation Process of Wine

The aim of this study was to find out what kind of “Bianca” wine could be produced when using organic yeast, what are the dynamics of the resulting alcoholic fermentation, and whether this method is suitable for industrial production as well. Due to the stricter rules and regulations, as well as the limited amount and selection of the permitted chemicals, resistant, also known as interspecific or innovative grape varieties, can be the ideal basic materials of alternative cultivation technologies. Well-designed analytical and organoleptic results have to provide the scientific background of resistant varieties, as these cultivars and their environmentally friendly cultivation techniques could be the raw materials of the future. The role of the yeast in wine production is crucial. We fermented wines from the “Bianca” juice samples three times where model chemical solutions were applied. In our research, we aimed to find out how organic yeast influenced the biogenic amine formation of three important compounds: histamine, tyramine, and serotonin. The main results of this study showed that all the problematic values (e.g., histamine) were under the critical limit (1 g/L), although the organic samples resulted in a significantly higher level than the control wines. The glycerin content correlated with the literature values, since it is well known that the glycerin-pyruvic acid transformation results in a 6–10 g/L concentration.

Food-Drug Interactions with Fruit Juices

Fruit juices contain a large number of phytochemicals that, in combination with certain drugs, can cause food–drug interactions that can be clinically significant and lead to adverse events. The mechanisms behind such interactions are in most cases related to phytochemical interference with the activity of cytochrome P450 metabolizing enzymes (CYPs) or drug transporters. Moreover, alterations in their activity can have a clinical relevance if systemic exposure to the drug is decreased or increased, meaning that the pharmacological drug effects are suboptimal, or the drug will cause toxicity. In general, the common pharmacokinetic parameters found to be altered in food–drug interactions regarding fruit juices are the area under the concentration–time curve, bioavailability, and maximum plasma concentration. In most cases, the results from the drug interaction studies with fruit juices provide only limited information due to the small number of subjects, which are also healthy volunteers. Moreover, drug interactions with fruit juices are challenging to predict due to the unknown amounts of the specific phytochemicals responsible for the interaction, as well as due to the inter-individual variability of drug metabolism, among others. Therefore, this work aims to raise awareness about possible pharmacological interactions with fruit juices.

The Impact of Food Histamine Intake on Asthma Activity: A Pilot Study

Asthma is a complex chronic inflammatory disorder. Diet's impact on asthma symptoms is controversial. The objective of this pilot crossover, randomized, two-period study was to examine the effect of dietary histamine intake on asthma symptoms in twenty-one children with mild intermittent asthma. Children were randomly assigned to either a high- or low-histamine diet, based on the Mediterranean pattern, for 4 weeks. After a 2-week washout period, patients crossed to the alternative diet for 4 additional weeks. Asthma symptoms were assessed at baseline and after the completion of each diet period by a clinician. Daily symptoms and peak flow were recorded throughout the intervention. Adherence to the dietary intervention was assessed via analysis of four random 24-h recalls, for each intervention period. Eighteen children completed the study. Significantly higher mean air flow obstruction was recorded and a trend for prolonged and more severe symptoms was observed during the high-histamine period. Diet may have an active and direct impact on asthma symptoms. Food choice is affected and/or may affect symptoms in children with mild asthma. Diet intervention is promising yet challenging, for asthma control.

Histamine Intolerance: The Current State of the Art

Histamine intolerance, also referred to as enteral histaminosis or sensitivity to dietary histamine, is a disorder associated with an impaired ability to metabolize ingested histamine that was described at the beginning of the 21st century. Although interest in histamine intolerance has considerably grown in recent years, more scientific evidence is still required to help define, diagnose and clinically manage this condition. This article will provide an updated review on histamine intolerance, mainly focusing on its etiology and the existing diagnostic and treatment strategies. In this work, a glance on histamine intoxication will also be provided, as well as the analysis of some uncertainties historically associated to histamine intoxication outbreaks that may be better explained by the existence of interindividual susceptibility to ingested histamine.

Challenges Associated with Byproducts Valorization-Comparison Study of Safety Parameters of Ultrasonicated and Fermented Plant-Based Byproducts

In order to promote the efficient use of byproducts from the production of plant-based beverages, which still contain a large amount of nutritional and functional compounds, microbiological and chemical safety characteristics should be evaluated and, if needed, improved. Many challenges are associated with byproducts valorization, and the most important ones, which should be taken into account at the further steps of valorization, are biological and chemical safety. For safety improving, several technological treatments (biological, physical etc.) can be used. In this study, the influence of low-frequency ultrasonication (US) and fermentation with Lactobacillus casei LUHS210 strain, as physical and biotechnological treatments, on the safety characteristics of the byproducts (BYs) from the processing of rice, soy, almond, coconut, and oat drinks was compared. Ultrasonication, as well as fermentation, effectively improved the microbiological safety of BYs. Ultrasonication and fermentation reduced the concentration of deoxynivalenol, on average, by 24% only in soy BYs. After fermentation, 15-acetyldeoxynivalenol was formed in all samples (<12 µg kg-1), except for soy BYs. The lowest total biogenic amines content was found in fermented rice BYs and ultrasonicated coconut BYs. When comparing untreated and fermented BYs, significant changes in macro- and micro-elements content were found. Ultrasonication at 37 kHz did not significantly influence the concentrations of macro- and micro-elements, while fermentation affected most of the essential micro-elements. Consequently, while ultrasonication and fermentation can enhance the safety of BYs, the specific effects must be taken into account on biogenic amines, mycotoxins, and micro and macro elements.