angiotensin receptor blockers br Conclusions and future dire

Conclusions and future directions The toxic effects of Aβ1–42 on hippocampal neurons in culture were reversed by d-β-hydroxybutyrate, suggesting that ketone bodies may have neuroprotective efficacy [53]. Some animal studies have shown that high-fat diets are associated with elevated Aβ loads [78,79] while decreased Aβ levels were observed following the administration of a ketogenic diet high in saturated fat and very low in carbohydrates [55]. These seemingly conflicting findings can be explained by the fact that, in the earlier studies, fat was added to the diet without a marked reduction in carbohydrates. Dietary strategies attempting to decrease Aβ levels should therefore consider the interactions of dietary components and their metabolic outcomes, i.e. total calories, carbohydrate levels and the production of ketone bodies need to be taken into account. The translational relevance of these findings should be confirmed in clinical studies with AD patients. Data from clinical trials suggest that medium chain triglycerides improve cognition in patients with mild to moderate AD in ApoE4-negative patients [68,69]. In order to establish the role of medium chain triglycerides in the therapy of AD, genetic screening including ApoE4 carriage status would have to be routinely performed in patients. A novel approach to induce therapeutic hyperketonemia is the administration of ketone monoesters [72]. A case report using this method presented promising results. However, case–control studies need to confirm this observation. Best results of dietary ketogenic approaches in AD may be expected by early presymptomatic treatment [80]. However, a reliable diagnostic identification of individuals with minimal neuropathological alterations would be necessary. It is currently unclear whether or not cognitive decline can be delayed if angiotensin receptor blockers hypometabolism is improved preclinically or early in the course of the disease. Future studies need to demonstrate that the neuroprotective properties of ketone bodies can influence or prevent AD-related impairment of clinically relevant functions such as cognition. In this respect, there is at present only limited evidence of the usefulness of ketogenic diets in AD. However, this novel dietary approach seems to be interesting and deserves further clinical investigations in AD.
Introduction Evidence is increasing regarding a range of a diet-chronic disease link. Thus, nutrition research has shifted from focusing exclusively on alleviating nutrient deficiencies to prevent or reduce morbidity and mortality due to chronic diseases [1,2]. Along with the daily diet, increased fruit and vegetable consumption has been promoted and correlated immensely not only for their nutritional content but also for their potential health functionality against various degenerative diseases such as cancer, cardiovascular, cataract, diabetes, and neurodegenerative diseases like Alzheimer’s and Parkinson’s [3]. This phenomenon has been attributed to the protective effects of antioxidant components contained in fruit, which are a rich source of natural enzymatic and non-enzymatic antioxidants [4]. In addition to the traditional nutrient antioxidants (e.g., vitamins C and E and β-carotene), fruits contain polyphenolic (e.g. flavonoids) compounds, which may play an important role in the overall antioxidant activity of fruits [5]. Manilkara hexandra (Roxb.) Dubard [Synonym: Mimusops hexandra (Roxb.)] belongs to Sapotaceae family. It is a socio-economically important underutilized fruit species characterized by the presence of sticky, usually white latex in the cuts of bark, branches, leaves and fruit. The small to medium sized evergreen trees are mostly found in western and central Indian states of Rajasthan, Gujarat, Madhya Pradesh and Maharastra [6]. The matured fresh fruits are obovoid-oblong to ellipsoid in shape, measuring about 1–1.5cm wide (Fig. 1), one or two seeded, shining yellow colored which is soft and sweet in taste, being a good source of minerals and vitamins with low fat content [7,8]. It is locally known as ‘Rayan’ or ‘Khirni’. The fruit and other parts of the tree (bark, stem bark, root, leaves and latex) are known for their various nutritional and medicinal properties used by the older and tribal peoples of India. It has been shown that, this fruit is nutritionally necessary for a well-balanced diet as the methanolic extract of fruits are reported to have significant hypoglycemic effect and can be use in the management or control of type II diabetes [9]. In addition, the acetone fraction of M. hexandra seed is reported to contain the crude saponin mixture with significant anti-inflammatory activity [10]. The seeds of M. hexandra contain approximately 25% edible oil, which can be used for cooking purposes [11]. It is known to have high remedial value as it is demulcent and emollient [12]. Parikh et al. [13] studied the nutritional profile of an underutilized Indian fruit of Rayan.