Potential of Moringa oleifera to Improve Glucose Control for the Prevention of Diabetes and Related Metabolic Alterations: A Systematic Review of Animal and Human Studies

Supplementation with Moringa oleifera Lam leaf and seed flour during the pregnancy and lactation period of Wistar rats: Maternal evaluation of initial and adult neurobehavioral development of the rat progeny

ETHNOPHARMACOLOGICAL RELEVANCE

Moringa oleifera Lam. (M. oleifera) is a tree species of Indian origin popularly known as the "tree of life". In various cultures, it is used by pregnant women to increase milk production, yet studies on its effects during pregnancy and lactation are lacking.

AIM OF THE STUDY

To evaluate the nutraceutical aspects of flours produced from the leaves and seeds of M. oleifera, and to evaluate the effect of supplementation of pregnant Wistar rats during the gestation and lactation period, with the aim of studying the weight gain and neonatal parameters of the pregnant rats, as well as effects on the neurobehavioral development and memory in their offspring.

MATERIALS AND METHODS

The flour supplementation was conducted at a concentration of 100 mg per kg of animal body weight. For the memory tests, the Open Field Habituation test was performed and repeated after seven days. The Object Recognition test was conducted with the animal exposed to the open field in short and long familiarization sessions. The data obtained were analyzed using Kruskal-Wallis tests for non-parametric data and one-way and two-way ANOVA for parametric data.

RESULTS

Flour produced from both the leaf and seed of M. oleifera was found to contain significant amounts of nutrients (protein, fibre, carbohydrates, etc.), making them suitable for supplementation. The exposure of pregnant rats to M. oleifera leaf and seed flours did not affect weight gain, did not have harmful effects on the birth of offspring, and did not result in abortions or mutations in the offspring. Regarding the supplemented group's offspring, early maturation of the senses in the offspring compared to the control group was observed in all tests were conducted; indicating that supplementation positively impacted cognitive development. Further, the offspring of the supplemented rats presented reduced locomotion and greater exploration of new objects compared to the control group offspring, indicating positive effects on learning.

CONCLUSION

This study describes for the first time the beneficial effects on pregnant Wistar rats and their offspring of maternal supplementation with flour products from the leaves and seeds of M. oleifera.

Exploratory review on the evidence of Andean crops with hypoglycemic effect and their bioactive components

Diabetes is a chronic disease that affects several people around the world. Some domesticated crops in South America have been reported to be a promising source of bioactive compounds with possible hypoglycemic effects. In this review we aimed to explore and synthesize the existing evidence in the scientific literature on the hypoglycemic effect of Andean crops and their bioactive components. We included different types of primary studies from three databases (Scopus, Pubmed and Web of Science) during June 2023, without restrictions, by means of controlled and uncontrolled language, according to the PICO strategy. We found 30 studies conducted between 2005 and 2022 that reported a hypoglycemic effect, through enzymatic inhibition in in vitro studies and significant glucose reduction in preclinical studies and clinical trials. This effect was attributed to different bioactive components that were identified with independent mechanisms related to glucose reduction and enzymatic inhibition. The most commonly used cultures were Smallanthus sonchifolius (9/30), Lupinus mutabilis (5/30) and Solanum tuberosum (4/30). The hypoglycemic effect was assigned to bioactive components such as polyphenols, flavonoids, phenolic acid subclasses, fructans, alkaloids, hydrolysates, anthocyanins and dietary fiber. Despite encouraging results from different types of studies, further research on their mechanisms of action, their efficacy compared to conventional treatments and their long-term safety is required for these to be considered safe and effective treatments.

Moringa oleifera seed based green synthesis of copper nanoparticles: Characterization, environmental remediation and antimicrobial activity

Textile dyes and heavy metals like hexavalent chromium [Cr(VI)] are considered major water pollutants. In addition, microbial contamination also seriously threatens potable water availability. The present study used Moringa oleifera seed aqueous extract to synthesize copper nanoparticles (MOS-CuNPs). MOS-CuNPs were characterized by various spectroscopy and microscopic techniques. MOS-CuNPs were shown to be effectual at removal of Cr(VI). The initial concentration of Cr(VI), contact time, pH, and temperature all impacted the removal of Cr(VI) by different concentrations of MOS-CuNPs. At low concentrations of MOS-CuNPs (0.3 mg/ml) pseudo-first order and high concentrations of MOS-CuNPs (0.4 and 0.5 mg/ml), pseudo-second order kinetics were obeyed. Thermodynamic analysis revealed that Cr(VI) was removed spontaneously, and the reaction was exothermic. In adsorption isotherm, equilibrium data followed Langmuir equation for Cr(VI) adsorption by MOS-CuNPs and maximum uptake capacity calculated was 38.6 mg/g. MOS-CuNPs efficiently removed cationic (rhodamine B, malachite green and methylene blue and) and anionic (congo red, titan yellow and methyl orange) dyes within 10 min of contact time. Further MOS-CuNPs showed antimicrobial activity against human pathogenic bacteria and fungi. Altogether, MOS-CuNPs could be used for environmental (water treatment) and biological applications.

Anti-fatigue properties of the ethanol extract of Moringa oleifera leaves in mice

BACKGROUND

Moringa oleifera (M. oleifera) leaves are rich in nutrients and bioactive ingredients. This study was aimed at evaluating the anti-fatigue effect of the ethanol extract of M. oleifera leaves (MLEE) on mice and its primary mechanism of action using a weight-loaded forced swimming test. In the present study, MLEE was prepared by ultrasound-assisted extraction, and its anti-fatigue effect and antioxidant capacity were evaluated in mice. Mice were administrated MLEE (320 mg kg^-1 body weight) for 15 days.

RESULTS

MLEE supplementation significantly increased levels of glucose and non-esterified fatty acids (NEFA), while decreasing levels of lactate and blood urea nitrogen in serum (P < 0.05); the levels of glycogen in the liver and muscle were also increased, as was the activity of glycogen synthase and the level of NEFA in muscle (P < 0.05). According to a Western blot analysis, MLEE increased the expression of AMPKα1, JNK, AKT and STAT3 in the muscle of mice.

CONCLUSION

Our findings indicate that MLEE has an anti-fatigue effect via the AMPK-linked route, which enables it to control energy metabolism and enhance antioxidant enzyme activity. © 2023 Society of Chemical Industry.

Moringa oleifera Lam Leaf Extract Stimulates NRF2 and Attenuates ARV-Induced Toxicity in Human Liver Cells (HepG2)

The World Health Organization (WHO) reported that there are 37 million individuals living with the human immunodeficiency virus (HIV) worldwide, with the majority in South Africa. This chronic disease is managed by the effective use of antiretroviral (ARV) drugs. However, with prolonged use, ARV drug-induced toxicity remains a clinically complex problem. This study investigated the toxicity of ARV drugs on mitochondria and the NRF2 antioxidant pathway and its possible amelioration using Moringa oleifera Lam (MO) leaf extracts. This medicinal plant has a range of functional bioactive compounds. Liver (HepG2) cells were treated with individual ARV drugs: Tenofovir disoproxil fumarate (TDF), Emtricitabine (FTC), and Lamivudine (3TC) for 96 h, followed by MO leaf extracts for 24 h. Intracellular ROS, cytotoxicity, lipid peroxidation, total and reduced glutathione (GSH), ATP, and mitochondrial polarisation were determined. Finally, protein (pNRF2, NRF2, SOD2, CAT, and Sirt3) and mRNA (NRF2, CAT, NQO1 SOD2, Sirt3, and PGC1α) expression were measured using Western blot and qPCR, respectively. TDF, FTC, and 3TC significantly increased intracellular ROS and extracellular levels of both MDA and LDH. ARVs also reduced the GSH and ATP levels and altered the mitochondrial polarization. Further, ARVs reduced the expression of NRF2 SOD2, Sirt3, CAT, NQO1, UCP2 and PGC1α mRNA and consequently pNRF2, NRF2, SOD2, Sirt3 and CAT protein. In contrast, there was a significant reduction in the extracellular MDA and LDH levels post-MO treatment. MO significantly reduced intracellular ROS while significantly increasing GSH, ATP, and mitochondrial membrane polarization. The addition of MO to ARV-treated cells significantly upregulated the expression of NRF2, SOD2, Sirt3, CAT, UCP2, PGC1α, and NQO1 mRNA and pNRF2, NRF2, SOD2, Sirt3 proteins. Thus, MO ameliorates ARV-induced hepatotoxicity by scavenging oxidants by inducing the NRF2 antioxidant pathway. MO shows great therapeutic potential and may be considered a potential supplement to ameliorate ARV drug toxicity.

Antidiabetic properties of mango in animal models and humans: A systematic review

Mango has long been an attractive source of nutrition and pharmacological therapeutics. The mango plant (Mangifera indica L.) contains bioactive compounds that may have antidiabetic properties. This systematic review investigated the evidence for antidiabetic properties of the different parts of the mango plant in managing type 2 diabetes mellitus in animal models and humans. The electronic databases PubMed, FSTA, Web of Science, CINAHL, MEDLINE, and Cochrane Library were systematically searched to identify articles with clear objectives and methodologies available in the English language with publication date limits up to December 2020. Twenty-eight of 1001 animal and human studies met the inclusion criteria that investigated antidiabetic properties of mango from leaf (31%), flesh (38%), seed-kernel (7%), peel (14%), stem-bark (7%), and by-product (3%). Results support the glucose-lowering properties of mango in both animals and human. Proposed antidiabetic mechanisms of action include inhibition of α-amylase and α-glucosidase, improved antioxidant status, improved insulin sensitivity, facilitated glucose uptake, and gene regulation of glucose transporter type 4, insulin receptor substrate 1, and phosphoinositide 3-kinase. The animal and randomized control trial findings suggest that mango may be beneficial as an antidiabetic agent. Although these studies hold promise, additional observational studies and randomized control trials are required because human studies are significantly fewer in number, use mango flesh almost exclusively, and had modest blood glucose effects. Additional research gaps include identifying the mechanisms of action for the different components of the mango plant.

Moringa oleifera leaf ethanolic extract benefits cashmere goat semen quality via improving rumen microbiota and metabolome

Background

Artificial insemination (AI) is an effective reproductive technique to improve the performance of cashmere goats and prevent the spread of diseases, and the quality of the semen determines the success of AI. The potential of Moringa oleifera leaf powder (MOLP) and Moringa oleifera leaf ethanolic extract (MOLE) to improve semen quality has been reported, but the underlying mechanisms remain unclear. For the purpose, 18 mature male cashmere goats were randomly assigned into three groups: the control (CON), MOLP, and MOLE groups. The CON group received distilled water orally; the MOLP group was orally treated with 200 mg/kg body weight (BW) MOLP; and the MOLE group was orally treated with 40 mg/kg BW MOLE.

Results

Results showed that MOLE contained long-chain fatty acids and flavonoids. Treatment with MOLP and MOLE increased the activities of the serum catalase, superoxide dismutase, and glutathione peroxidase (P < 0.05), enhanced the total antioxidant capacity (P < 0.05), and reduced the serum malondialdehyde level (P < 0.05). At the same time, MOLE increased the contents of serum gonadotropin releasing hormone and testosterone (P < 0.05). Moreover, MOLE significantly increased sperm concentration, motility, and viability (P < 0.05). Meanwhile, MOLE raised the Chao1 index (P < 0.05) and altered the composition of the rumen microbiota; it also raised the relative abundance of Treponema (P < 0.05) and Fibrobacter (P < 0.05) and reduced the relative abundance of Prevotella (P < 0.1). Correlation analysis revealed the genus Prevotella was significantly negatively correlated with sperm concentration, as well as sperm motility and viability. Furthermore, MOLE significantly increased the rumen levels of the steroid hormones testosterone and dehydroepiandrosterone (P < 0.05), as well as the polyunsaturated fatty acids (PUFAs) alpha-Linolenic acid, gamma-Linolenic acid, docosapentaenoic acid, and 9-S-Hydroperoxylinoleicacid (P < 0.05).

Conclusions

Oral MOLE supplementation can improve semen quality by increasing the antioxidant capacity and altering the rumen microbiota and metabolites of cashmere goats. Moreover, the MOLP supplementation could enhance the antioxidant capacity of cashmere goats.

Ultrasonic-Cellulase Synergistic Extraction of Crude Polysaccharides from Moringa oleifera Leaves and Alleviation of Insulin Resistance in HepG2 Cells

Moringa oleifera leaves (MOL) are a new food resource, rich in functional factors. MOL polysaccharides are important active macromolecules within MOL. However, there are problems, such as low extraction rates and lack of evidence for functional activity. Therefore, in this experiment, single-factor experiments were carried out using MOL powder as the raw material, and the Plackett-Burman test was used to screen the significantly influential test factors. The extraction process of MOL polysaccharide was optimized by response surface methodology. The insulin resistance alleviating activity of MOLP polysaccharides was initially explored. The results showed that the extraction of Moringa oleifera leaves crude polysaccharides (MOLP) by ultrasonic assisted cellulase enzymatic digestion was (17.03 ± 1.03)%, and the obtained MOLP was a crude polysaccharide with an average molecular weight (Mw) of 279.48 kDa, consisting of fucose, rhamnose, arabinose, galactose, glucose, xylose, mannose, galacturonic acid, and glucuronic acid. MOLP had an IC50 value of 8.02 mg/mL for α-glucosidase and scavenging activity against free radicals such as ABTS, DPPH, hydroxyl radicals, and superoxide anion with an IC50 value of 0.21 mg/mL 0.31 mg/mL 0.97 mg/mL 0.49 mg/mL. At the same time, MOLP significantly enhanced the glucose consumption, glycogen synthesis, CAT, SOD, GSH-Px activity, and reduced the MDA and ROS content in high glucose-induced insulin-resistant HepG2 (IR-HepG2) cells. This experiment improved the extraction rate of MOLP and demonstrated that MOLP has antioxidant activity and α-glucosidase inhibitory activity, which can alleviate the insulin resistance of high glucose-induced HepG2 cells. It provides partial data support for the possible hypoglycemic effect of MOLP by alleviating oxidative stress, and also provides new ideas for the in-depth study of basic research and industrial application of MOLP.

Anti-inflammatory and antioxidant effect of Moringa oleifera against bisphenol-A-induced hepatotoxicity

Background

Non-pharmacological exposure or pharmacological drug-induced hepatic injury is the most common cause of hepatotoxicity. This study was conducted to evaluate the effect of Moringa oleifera leaf extract against bisphenol-A (BPA)-induced hepatic toxicity in rats.

Methods

Rats (n=56) were randomized into 7 groups (8 rats/each). Control groups: rats received olive oil or Moringa oleifera (400mg/kg) orally for 42 days. Hepatotoxicity groups: rats received BPA (50mg/kg BW) orally in a 1-ml olive oil for 42 days. Reversal groups: rats received Moringa oleifera (200 or 400mg/kg) and BPA (50mg/kg BW) for 42 days. Preventive groups: rats received Moringa oleifera (200 or 400mg/kg) for 30 days followed by BPA (50mg/kg BW) for 14 days. At the end of the experiments, blood samples were collected for glucose and liver function assay, while the liver tissue samples were collected and homogenated for measuring the inflammatory/oxidant and antioxidant markers.

Results

Rats with BPA-induced hepatotoxicity have significantly increased serum aspartate transaminase (AST), alanine transaminase (ALT), and glucose; liver lysate malondialdehyde (MDA); tumor necrosis factor (TNF-α); and macrophage migrating inhibitory factor (MIF) but significantly decreased levels of liver lysate reduced glutathione (GSH) and total antioxidant capacity (TAC) levels. The administration of Moringa oleifera (especially 400mg/kg BW) in both reversal and preventive groups ameliorate the toxic effects of BPA in rats, as it decreased the activities of AST, ALT, glucose, MDA, TNF-α, and MIF levels and increased the antioxidant levels of GSH and TAC.

Conclusion

Moringa oleifera has hepatoprotective effects against BPA-induced liver damage through the regulation of antioxidants and inflammatory biomarkers.

The Potential of Moringa oleifera to Ameliorate HAART-Induced Pathophysiological Complications

Highly active antiretroviral therapy (HAART) comprises a combination of two or three antiretroviral (ARV) drugs that are administered together in a single tablet. These drugs target different steps within the human immunodeficiency virus (HIV) life cycle, providing either a synergistic or additive antiviral effect; this enhances the efficiency in which viral replication is suppressed. HIV cannot be completely eliminated, making HAART a lifetime treatment. With long-term HAART usage, an increasing number of patients experience a broadening array of complications, and this significantly affects their quality of life, despite cautious use. The mechanism through which ARV drugs induce toxicity is associated with metabolic complications such as mitochondrial dysfunction, oxidative stress, and inflammation. To address this, it is necessary to improve ARV drug formulation without compromising its efficacy; alternatively, safe supplementary medicine may be a suitable solution. The medicinal plant Moringa oleifera (MO) is considered one of the most important sources of novel nutritionally and pharmacologically active compounds that have been shown to prevent and treat various diseases. MO leaves are rich in polyphenols, vitamins, minerals, and tannins; studies have confirmed the therapeutic properties of MO. MO leaves provide powerful antioxidants, scavenge free radicals, promote carbohydrate metabolism, and repair DNA. MO also induces anti-inflammatory, hepatoprotective, anti-proliferative, and anti-mutagenic effects. Therefore, MO can be a source of affordable and safe supplement therapy for HAART-induced toxicity. This review highlights the potential of MO leaves to protect against HAART-induced toxicity in HIV patients.

Natural products for the treatment and management of diabetes mellitus in Zimbabwe-a review

Use of medicinal plants and herbs in the treatment and management of diseases, including diabetes mellitus and its complications remains an integral part of African tradition. In Zimbabwe, nearly one million people are living with diabetes mellitus. The prevalence of diabetes mellitus in Zimbabwe is increasing every year due to lifestyle changes, and has accelerated the use of traditional medicines for its treatment and management in urban areas. In addition, the high cost of modern medicine has led many people in rural parts of Zimbabwe to rely on herbal plant medicine for the treatment of diabetes mellitus and its complications. This review highlights a number of studies carried out to evaluate the antidiabetic properties of indigenous plants found in Zimbabwe with the goal of treating diabetes mellitus. Further, we discuss the mechanism of action of various plant extracts in the treatment and management of diabetes mellitus. Together, this review article can open pathways leading to discovery of new plant derived medicines and regularization of use of crude plant remedies to treat diabetes mellitus by the Zimbabwean government and others across Africa.

Effects of Moringa oleifera Lam. Supplementation on Inflammatory and Cardiometabolic Markers in Subjects with Prediabetes

Different parts of the Moringa oleifera Lam. (MO) tree are consumed as food or food supplements for their nutritional and medicinal value; however, very few human studies have been published on the topic. The current work was aimed to provide ancillary analysis to the antidiabetic effects previously reported in a double-blind, randomized, placebo-controlled, parallel group intervention conducted in patients with prediabetes. Thus, the effect of MO leaves on blood and fecal inflammatory markers, serum lipid profile, plasma antioxidant capacity and blood pressure was studied in participants who consumed 6 × 400 mg capsule/day of MO dry leaf powder (MO, n = 31) or placebo (PLC, n = 34) over 12 weeks. Differences between groups were assessed using each biomarker’s change score with, adjustment for fat status and the baseline value. In addition, a decision tree analysis was performed to find individual characteristics influencing the glycemic response to MO supplementation. No differences in the biomarker’s change scores were found between the groups; however, the decision tree analysis revealed that plasma TNF-α was a significant predictor of the subject’s HbA1c response (improvement YES/NO; 77% correct classification) in the MO group. In conclusion, TNF-α seems to be a key factor to identify potential respondents to MO leaf powder.

Formulation, Evaluation of Physical Properties, and In Vitro Antioxidant Activity Test of Moringa Leaf (Moringa oleifera L.) Ethanolic Extract Capsules

BACKGROUND: Supplements that contain antioxidants may enhance prevention and treatment effects of a wide range of diseases including COVID-19. Quercetin, a flavonoid compound, is a natural antioxidant that can neutralize free radicals. The current study was conducted to formulate Moringa leaf (Moringa oleifera L) ethanol extract capsules and to determine the quercetin antioxidant activity levels of Moringa ethanol extract capsule formulations.  MATERIALS AND METHODS: We tested the total flavonoid levels in solutions with concentrations of 20, 50, 60, 70 and 100 ppm using Thin Layer Chromatography Densitometric method. Evaluation of physical properties of 96% Moringa leaf ethanol extract capsules included moisture content test, granule angle of repose test, granule flow property test, capsule weight uniformity test and capsule disintegration time test. Antioxidant activity test using the DPPH method with two samples, namely 96% Moringa leaf ethanol extract capsules with formulas I, II, III, quercetin as a comparison.  RESULT: The results of the evaluation of 96% Moringa leaf ethanol extract capsules showed that formula II (PVP 50 mg) had good physical properties. Testing the antioxidant activity of capsules of ethanol extract of Moringa leaves formulas I, II, III, quercetin obtained IC50 values of 44.0 ppm, 40.2 ppm, 46.4 ppm, and 4.80 ppm, respectively.  CONCLUSION: The evaluation of the ethanol extract capsules of Moringa leaf formula II, met the parameters of a good capsule evaluation test requirement and had very strong antioxidant activity seen from the acquisition of the IC50 value. The antioxidant properties of Moringa leaf extract capsules may be able to improve the immune system and clinical trials need to be carried out on patients to become candidates for prevention and therapeutic supplement fora range of diseases including COVID-19. 

Moringa oleifera Leaf Supplementation as a Glycemic Control Strategy in Subjects with Prediabetes

Moringa oleifera (MO) is a multipurpose plant with a high polyphenol content, which is being increasingly consumed to lessen the risk of chronic metabolic diseases such as Type 2 diabetes; however, scientific evidence from clinical trials is scarce. A double-blind, randomized, placebo-controlled, parallel group intervention study with MO leaves as a food supplement was conducted in subjects with prediabetes. They consumed six daily capsules of MO dry leaf powder (2400 mg/day) (MO, n = 31) or placebo (PLC, n = 34) over 12 weeks. Glycemia, appetite-controlling hormones and gut microbiota composition were studied. ANCOVA with the fixed factor “treatment” and the basal value as covariate was used to compare the change score between the groups. The results showed significant differences between groups in the rate of change of fasting blood glucose (FBG) and glycated hemoglobin (HbA1c), which showed opposite directions during the intervention, decreasing in MO and increasing in PLC. No different change scores were found between the groups in microbiota, hepatic and renal function markers or the appetite-controlling hormones measured. In conclusion, MO supplementation resulted in favorable changes in glycaemia markers compared to placebo in the subjects with prediabetes studied, suggesting that MO might act as a natural antihyperglycemic agent.

'Old Is Gold': How Traditional Indian Dietary Practices Can Support Pediatric Diabetes Management

Nutrition is crucial for maintaining normal growth, development, and glycemic control in young people with diabetes (PwD). Undue restrictions cause nutrient deficiencies as well as poor adherence to meal plans. Widespread availability of low-cost, ultra-processed, and hyperpalatable food is further damaging. Most families struggle to find ways to provide nutritious, yet attractive, food with a low glycemic index (GI). India is one of the oldest continuous civilizations with a rich and diverse cultural and culinary heritage. Traditional dietary practices, including the centuries-old 'Thali' (meaning plate) concept, emphasize combinations (grains, lentils, vegetables, dairy, spices, prebiotics and probiotics, and fats) of local, seasonal, and predominantly plant-based ingredients. These practices ensure that all of the necessary food groups are provided and fit well with current evidence-based recommendations, including the International Society for Pediatric and Adolescent Diabetes (ISPAD) 2018 Guidelines. Techniques for the preparation, cooking, and preservation of food further impact the GI and nutrient availability. These practices benefit nutrient density, diet diversity, and palatability and thus improve adherence to meal plans and glycemic control. This narrative review describes the ancient wisdom, food composition, and culinary practices from across India which are still valuable today. These may be of benefit worldwide to improve glycemic control as well as quality of life, especially in PwD.

The potential role of plantains, moringa, plantain-moringa combined diets, and other plant-based dietary patterns in controlling glycaemia among T2DM persons, a hospital based cross sectional survey in Ghana

BACKGROUND

Diabetes mellitus (DM) is an independent risk-factor for cardiovascular diseases. Plant-based dietary-patterns have been shown to reverse the effects of these cardiovascular risk-factors. Our study therefore aimed to investigate the potential roles moringa, moringa-plantain combined, and other plant based dietary-patterns could play in controlling glycaemia among persons with type-2-diabetes Mellitus (T2DM).

METHODS

Facility-based cross-sectional-study was conducted among 530 T2DM patients from August 2018 to September 2019 in Ghana. Structured-questionnaires were used to collect demographic, anthropometric, and clinical variables. Adherence to plant-based dietary-patterns were assessed using 3-day food record. SPSS version-20 was used to analyse the data.

RESULTS

BMI, HbA1c%, HDL-cholesterol and LDL-cholesterol were significantly correlated with adherence to plant-based dietary-patterns (p-value < 0.05). After adjusting for physical activity, adherence to plantain diets Standardized regression coefficient β (95%CI): -0.098 (-0.321, -0.022), yam β (95%CI): 0.148 (0.066, 0.496), moringa diets β (95%CI): -0.095 (-0.325,-0.011) and bean-diets β (95%CI): -0.112 (-0.577, -0.007) were significantly associated with glycemic control. Adherence to plantain-moriga combined diets β (95%CI): -0.406 (-0.413, -0.049) and plantain-beans combined diets β (95%CI): -0.128 (-0.188, -0.038) were also significantly associated with glycemic control.

CONCLUSION

Adherence to plantain, yam, beans, plantain-moriga combined diets, and plantain-beans combined diets could be associated with glycemic-control. Health care workers should prioritize these plant-based dietary-patterns for disease prevention and health promotion.

Therapeutic Screening of Herbal Remedies for the Management of Diabetes

The study of diabetes mellitus (DM) patterns illustrates increasingly important facts. Most importantly, they include oxidative stress, inflammation, and cellular death. Up to now, there is a shortage of drug therapies for DM, and the discovery and the development of novel therapeutics for this disease are crucial. Medicinal plants are being used more and more as an alternative and natural cure for the disease. Consequently, the objective of this review was to examine the latest results on the effectiveness and protection of natural plants in the management of DM as adjuvant drugs for diabetes and its complex concomitant diseases.

Type 2 diabetes in pediatrics

Type 2 diabetes (T2D) in adolescents has become an increasing health concern throughout the world and its prevention and screening should be implemented in pediatric care. As clinical features at presentation, in some cases can be similar to type 1 diabetes and family history can be in favour of a monogenic form of diabetes, it is pivotal for physicians to be aware of youth-onset T2D specificities to ensure an accurate diagnosis. The global increase of overweight and obesity can complicate the diagnostic process and makes it essential to apply a systematic approach to each new diagnosis. Microvascular complications may be present at the time of diagnosis and chronic complications are frequent and need to be screened regularly. Regular screening of comorbidities should also be performed. Childhood T2D should be followed up by pediatric diabetes units to avoid diagnostic errors and delay in care. A multidisciplinary approach, by an experienced team, is pivotal to provide treatment options targeting the unique needs of pediatric patients. Treatment programs must include the whole family and address all the aspects of the care (lifestyle, pharmacological therapy, psychological aspects, complications and comorbidities). An organized process of transition to adult care is essential.

A new original nutraceutical formulation ameliorates the effect of Tadalafil on clinical score and cGMP accumulation

OBJECTIVE

To assess the efficacy of the combination of Tadalafil 5 mg and nutritional supplements composed by Panax ginseng, Moringa Oleifera and Rutin on erectile function in men with mild and moderate vasculogenic ED.

METHODS

we prospectively enrolled 86 patients divided into two groups A (45), B (33) in this multicenter randomized, doubleblind, placebo-controlled trial . Drop out was 8 patients (3 patients in group A and 5 in Group B). At screening visit patients underwent clinical examination, blood test (hormonal and metabolic profile) and filled out the IIEF-5 questionnaire and the SEP-2, SEP-3. Patients were randomized by a computergenerated list to receive either Tadalafil 5 mg once daily plus nutritional supplement once daily (group A) or Tadalafil 5 mg plus placebo with the same administration schedule (group B) for 3 months. Blood samples, IIEF-5, SEP-2 and SEP-3 have been collected again after 3 months. cGMP was measured in platelets of 38 patients at baseline and after one months.

RESULTS

Mean age was 59.98 ± 6.90 (range 38-69), mean IIEF-5 score at baseline was 13.59 ± 3.90. After three months of treatment, IIEF-5 score significantly improved in both groups compared to baseline (13.18 ± 3.75 vs 20.48 ± 2.24, p < 0.0001; 14.15 ± 4.09 vs 19.06 ± 4.36, p < 0.0001, in group A and group B respectively). Patients treated with Tadalafil plus nutritional supplement showed a significantly higher increase in IIEF-5 score compared to those who received placebo (7.27 ± 2.20 and 4.9 ± 2.79, respectively; p < 0.0001;). No hormonal differences and metabolic effects were found. According cGMP result, nutritional supplements ameliorates and extends the activity of the chronic treatment.

CONCLUSIONS

IIEF-5 significant increase in group B, can be ascribed to the nutritional supplement properties and antioxidant effects of moringa oleifera, ginseng and rutin and this can enhance the endothelial NO and cGMP production.

Moringa oleifera Lam. in Diabetes Mellitus: A Systematic Review and Meta-Analysis

Plant-derived phytochemicals have been interested in as nutraceuticals for preventing the onset and progress of diabetes mellitus and its serious complications in recent years. Moringa oleifera Lam. is used in vegetables and in herbal medicine for its health-promoting properties against various diseases including diabetes mellitus. This study aimed to examine an effect of Moringa oleifera on diabetic hyperglycemia and dyslipidemia by meta-analyzing the current evidence of diabetic rodent models. Peer-reviewed studies written in English from two databases, PubMed and Embase, were searched to 30 April 2021. Studies reporting blood glucose or lipid levels in diabetic rodents with and without receiving extracts of Moringa oleifera were included. Forty-four studies enrolling 349 diabetic rodents treated with extracts of Moringa oleifera and 350 diabetic controls reported blood glucose levels. The pooled effect size was -3.92 (95% CI: -4.65 to -3.19) with a substantial heterogeneity. This effect was likely to be, at least in part, modified by the type of diabetic models. Moreover, diabetic hypertriglyceridemia and hypercholesterolemia were also significantly improved in diabetic rodent models treated with Moringa oleifera.

Pharmacological reflection of plants traditionally used to manage diabetes mellitus in Tanzania

ETHNOPHARMACOLOGICAL RELEVANCE

The increasing national prevalence of diabetes mellitus (DM) and its complications have overstretched the health care system in Tanzania and influenced patients to use herbal medicines as alternative therapeutic strategies. Therefore, an urgent need exists to validate the safety and efficacy of plants used locally.

AIM OF THE STUDY

To identify plants used for the management of DM in Tanzania and analyses their pharmacological, phytochemistry, and safety evidence with a special focus on the mechanism of action.

METHODS

Researchers searched Medline, web of science, and Scopus for published articles. Also, specialized herbarium documents of Muhimbili Institute of traditional medicine were reviewed. Articles were assessed for relevance, quality, and taxonomical accuracy before being critically reviewed.

RESULTS

We identified 62 plant species used locally for DM management. Moringa oleifera Lam. and Cymbopogon citratus (D.C) stapf were the most mentioned. Fifty-four phytochemicals from 13 species had DM activities. These were mainly; polyphenolics, phytosterols, and triterpenoids. Extracts, fractions, and pure compounds from 18 species had in vitro antidiabetic activities of which 14 had α-glucosidase and α-amylase inhibition effects. The most studied -Momordica charantia L. increased; glucose uptake and adiponectin release in 3T3-L1 adipocytes, insulin secretion, insulin receptor substrate-1 (IRS-1), GLUT-4 translocation, and GLP-1 secretion; and inhibited protein tyrosine phosphatase 1 B (PTP1B). Preclinical studies reported 30 species that lower plasma glucose with molecular targets in the liver, skeletal muscles, adipose tissues, pancreases, and stomach. While three species; Aspilia mossambiscensis (Oliv.) Willd, Caesalpinia bonduc (L.) Roxb, and Phyllanthus amarus Schumach. & Thonn. had mild toxicity in animals, 33 had no report of their efficacy in DM management or toxicity.

CONCLUSION

Local communities in Tanzania use herbal medicine for the management of DM. However, only a fraction of such species has scientific evidence. A. mossambiscensis, C. bonduc., and P. amarus had mild toxicity in animals. Together, our findings call for future researches to focus on in vitro, in vivo, and phytochemical investigation of plant species for which their use in DM among the local communities in Tanzania have not been validated.