Safe Treatment of Urinary Tract Infections by American Cranberry

Abstract

Cranberry fruit (Vaccinium macrocarpon) grows on evergreen shrubs that are native to North America. Cranberry is a term derived from the contraction of ‘‘crane berry.’’ This name is derived from the nickname of the bilberry flower, which, when it withers, is similar in appearance to the head and neck of the sand crane, a bird that often feeds on the berries of this plant. The cranberry is part of the Ericaceae family and naturally grows in acidic swamps full of peat moss in humid forests. Cranberries are composed of water (88%), organic acids (including salicylate), fructose, vitamin C (high levels, i.e., 200 mg/kg of fresh berries), flavonoids, anthocyanidins, catechins, and triterpinoids. The chemical constituents responsible for their taste are the iridoid glycosides. The anthocyanidins and proanthocyanidins (PAC) are tannins (stable polyphenols) found only in vaccinium berries and function as a natural plant defense system against microbes. Common preparations with cranberries include fresh, whole berries, gelatinized products, juices (usually 10-25% pure juice) and capsules. Pure juice is too acidic (pH, 2.5) and unpalatable, even with sweeteners .Despite cranberry presentation, it is generally recommended to consume cranberries just prior or two hours after meals; it is also important to drink lots of water, mainly after preparations from dehydrated juices. Cranberry juice, predominantly in the form of a juice cocktail drink with approximately 25% cranberry juice, has been the traditional choice of most women seeking to prevent Urinary Tract Infections (UTIs). American cranberry has a complex and rich phytochemical composition, particularlyflavan-3-ols, A-type procyanidins (PACs), anthocyanins, benzoic acid, and ursolic acid. Cranberryflavan-3-ols are present as monomers, oligomers, and polymers). These oligomers and polymers are also referred to as PACs or condensed tannins and representw85% of the total flavan-3-ols on a weight basis. Cranberry is the main source of peonidin among 100 foods commonly consumed in the United States. Quercetin 3-galactoside is the predominant form, but at least 11 other glycosides are present in lower concentrations. Some of these, such as quercetin-3-acetylrhamnoside are rare in berries. In the Phenol Explorer database, the flavonol content of plant foods is usually <3 mg/100 g FW, although bilberry, black-berry, and blueberry contain 3.2–17 mg/kg. Cranberry fruit is classed as a functional food due to the naturally high content of compounds, such as polyphenols, which are believed to have antioxidant and therefore health-promoting properties. Health benefits of cranberry consumption range from cardio protective effects due to improved cholesterol profiles to aiding digestive health. Cranberry exists in various forms, including the raw fruit (fresh and dried), cranberry juice and cranberry extract in capsule/tablet formulations. Cranberry extract could be a potential alternative to antibiotics to treat acute uncomplicated UTIs. Proanthocyanidin (PAC) with A-type linkages, or their metabolites, is believed to be the active ingredient in cranberry, preventing Escherichia coli (E. coli) from binding to the bladder uroepithelium and thereby reducing the ability of E. coli to cause and sustain a UTI. Cranberries have also been found to improve lipid profile, improve endothelial function, and lower several markers of cardio metabolic risk. Nowadays, growing evidence suggests an important role of cranberries in maintaining digestive health. In addition to the anti-inflammatory effects, cranberries may also influence intestinal barrier integrity, which is another essential element of intestinal health. Cranberry was reported as the main source of peonidin among 100 foods commonly consumed in the United States. However, in the majority of studies, the total anthocyanin content is re-ported rather than amounts of individual anthocyanins. This approach may change because the bioavailability and health effects of anthocyanins seem to be affected by the structures of the aglyconesor the glycosidicmoieties . Quercetin 3-galactoside is the predominant form, but at least 11 other glycosides are present in lower concentrations. Some of these, such as quercetin-3-acetylrhamnoside are rare in berries. As shown in the Phenol Explorer database, the flavonol content of plant foods is usually <3 mg/100 g FW, although bilberry, black-berry, and blueberry contain 3.2–17 mg/kg.

Full text

J. Nutrition and Food Processing Copy rights@ Muhammad Arshad Ullah, et al
Auctores Publishing LLC – Volume 6(4)-138 www.auctoresonline.org
ISSN: 2637-8914 Page 1 of 7
Safe Treatment of Urinary Tract Infections by American
Cranberry
Muhammad Arshad Ullah 1*, Ali Hassan 2 and Ameer Hamza 3
1 Pakistan Agricultural Research Council, Islamabad, Pakistan.
2 PMAS- University of Arid Agriculture, Rawalpindi, Pakistan.
3 COMSATS- Biosciences Department, Islamabad Campus, Pakistan.
*Corresponding author: Muhammad Arshad Ullah, Pakistan Agricultural Research Council, Islamabad, Pakistan.
Received date: April 14, 2023; Accepted date: June 12, 2023; Published date: June 26, 2023
Citation: Muhammad A. Ullah, Ali Hassan and Ameer Hamza (2023), Safe Treatment of Urinary Tract Infections by American Cranberry, J.
Nutrition and Food Processing, 6(5); DOI:10.31579/2637-8914/138
Copyright: © 2023, Naseem Zahra. This is an open access article distributed under the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract:
Cranberry fruit (Vaccinium macrocarpon) grows on evergreen shrubs that are native to North America. Cranberry is
a term derived from the contraction of ‘‘crane berry.’’ This name is derived from the nickname of the bilberry flower,
which, when it withers, is similar in appearance to the head and neck of the sand crane, a bird that often feeds on the
berries of this plant. The cranberry is part of the Ericaceae family and naturally grows in acidic swamps full of peat
moss in humid forests. Cranberries are composed of water (88%), organic acids (including salicylate), fructose,
vitamin C (high levels, i.e., 200 mg/kg of fresh berries), flavonoids, anthocyanidins, catechins, and triterpinoids. The
chemical constituents responsible for their taste are the iridoid glycosides. The anthocyanidins and proanthocyanidins
(PAC) are tannins (stable polyphenols) found only in vaccinium berries and function as a natural plant defense system
against microbes. Common preparations with cranberries include fresh, whole berries, gelatinized products, juices
(usually 10-25% pure juice) and capsules. Pure juice is too acidic (pH, 2.5) and unpalatable, even with sweeteners
.Despite cranberry presentation, it is generally recommended to consume cranberries just prior or two hours after
meals; it is also important to drink lots of water, mainly after preparations from dehydrated juices. Cranberry juice,
predominantly in the form of a juice cocktail drink with approximately 25% cranberry juice, has been the traditional
choice of most women seeking to prevent Urinary Tract Infections (UTIs). American cranberry has a complex and
rich phytochemical composition, particularlyflavan-3-ols, A-type procyanidins (PACs), anthocyanins, benzoic acid,
and ursolic acid. Cranberryflavan-3-ols are present as monomers, oligomers, and polymers). These oligomers and
polymers are also referred to as PACs or condensed tannins and representw85% of the total flavan-3-ols on a weight
basis.
Cranberry is the main source of peonidin among 100 foods commonly consumed in the United States. Quercetin 3-
galactoside is the predominant form, but at least 11 other glycosides are present in lower concentrations. Some of
these, such as quercetin-3-acetylrhamnoside are rare in berries. In the Phenol Explorer database, the flavonol content
of plant foods is usually <3 mg/100 g FW, although bilberry, black-berry, and blueberry contain 3.2–17 mg/kg.
Cranberry fruit is classed as a functional food due to the naturally high content of compounds, such as polyphenols,
which are believed to have antioxidant and therefore health-promoting properties. Health benefits of cranberry
consumption range from cardio protective effects due to improved cholesterol profiles to aiding digestive health.
Cranberry exists in various forms, including the raw fruit (fresh and dried), cranberry juice and cranberry extract in
capsule/tablet formulations. Cranberry extract could be a potential alternative to antibiotics to treat acute
uncomplicated UTIs. Proanthocyanidin (PAC) with A-type linkages, or their metabolites, is believed to be the active
ingredient in cranberry, preventing Escherichia coli (E. coli) from binding to the bladder uroepithelium and thereby
reducing the ability of E. coli to cause and sustain a UTI. Cranberries have also been found to improve lipid profile,
improve endothelial function, and lower several markers of cardio metabolic risk. Nowadays, growing evidence
suggests an important role of cranberries in maintaining digestive health. In addition to the anti-inflammatory effects,
cranberries may also influence intestinal barrier integrity, which is another essential element of intestinal health.
Cranberry was reported as the main source of peonidin among 100 foods commonly consumed in the United States.
Open Access
Review Article
Journal of Nutrition and Food Processing
Muhammad Arshad Ullah *
AUCTORES
Globalize your Research

J. Nutrition and Food Processing Copy rights@ Muhammad Arshad Ullah, et al
Auctores Publishing LLC – Volume 6(4)-138 www.auctoresonline.org
ISSN: 2637-8914 Page 2 of 7
However, in the majority of studies, the total anthocyanin content is re-ported rather than amounts of individual
anthocyanins. This approach may change because the bioavailability and health effects of anthocyanins seem to be
affected by the structures of the aglyconesor the glycosidicmoieties . Quercetin 3-galactoside is the predominant form,
but at least 11 other glycosides are present in lower concentrations. Some of these, such as quercetin-3-
acetylrhamnoside are rare in berries. As shown in the Phenol Explorer database, the flavonol content of plant foods is
usually <3 mg/100 g FW, although bilberry, black-berry, and blueberry contain 3.2–17 mg/kg.
Key words: anthocyanidins; catechins; triterpinoids; proanthocyanidin and anthocyanin
Introduction
Cranberry is a term derived from the contraction of ‘‘crane berry.’’ This
name is derived from the nickname of the bilberry flower, which, when it
withers, is similar in appearance to the head and neck of the sand crane, a
bird that often feeds on the berries of this plant (Guay, 2009). The
cranberry is part of the Ericaceae family and naturally grows in acidic
swamps full of peat moss in humid forests (Bruyere, 2006). The American
cranberry (Vaccinium macrocarpon) was historically used by North
American Indians to treat UTIs (Guay, 2009). There are other relatives of
the cranberry family (European cranberry – V. oxycoccus; lingonberry –
V. vitisidaea; blueberry – V. myrtillus) that share some of the cranberry’s
basic components, but research evidence for a role in prevention is limited
(Kontiokari et al., 2001 and Jepson and Craig, 2007).
Cranberries are composed of water (88%), organic acids (including
salicylate), fructose, vitamin C (high levels, i.e., 200 mg/kg of fresh
berries), flavonoids, anthocyanidins, catechins, and triterpinoids (Guay,
2009). The chemical constituents responsible for their taste are the iridoid
glycosides. The anthocyanidins and proanthocyanidins (PAC) are tannins
(stable polyphenols) found only in vaccinium berries and function as a
natural plant defense system against microbes (Guay, 2009 and Cimolai
and Cimolai, 2007).
Common preparations with cranberries include fresh, whole berries,
gelatinized products, juices (usually 10-25% pure juice) and capsules
(Guay, 2009; Bruyere, 2006; Kontiokari et al., 2001; Jepson and Craig,
2007; Gupta et al., 2007 and Di Martino et al., 2006). Pure juice is too
acidic (pH, 2.5) and unpalatable, even with sweeteners (Guay,
2009).Despite cranberry presentation, it is generally recommended to
consume cranberries just prior or two hours after meals; it is also
important to drink lots of water, mainly after preparations from
dehydrated juices (Bruyere, 2006). Cranberry juice, predominantly in the
form of a juice cocktail drink with approximately 25% cranberry juice,
has been the traditional choice of most women seeking to prevent Urinary
Tract Infections (UTIs). Cranberries have been tested for their clinical
relevance in many different conditions. They have been evaluated in the
treatment of UTIs but were deemed ineffective (Cimolai and Cimolai,
2007 and Lavigne et al., 2007).
Cranberries were also studied for UTI prophylaxis chiefly in women, but
also in children and men; additionally, they have been studied in
conditions such as neurogenic bladder and pregnancy, (Kontiokari et al.,
2001; Stothers, 2002; Barbosa-Cesnik et al., 2011; McMurdo et al., 2005;
2009; Wing et al., 2008; Lee et al., 2007; McGuinness et al., 2002; Waites
et al., 2004 and Ferrara et al., 2008). Most clinical interest in the use of
cranberries is for cystitis prevention. In the 2008 Cochrane Database of
Systematic Reviews, there were ten randomized trials regarding UTI
prevention on a total of 1,049 patients. They concluded that there is some
evidence that cranberry juice may decrease the number of symptomatic
UTIs over a 12 month period, particularly, and only, for women with
recurrent UTIs (Jepson and Craig, 2008).Whereas berries are noted
simply as good sources of potassium or fiber, recent research suggests
that berry fruits are a rich source of numerous phytochemicals with a
broad array of bioactivity and an impact on human health (Paredes-López
et al., 2010; Côté et al., 2010; Basu and Lyons, 2012; Wang et al., 2012
and Kaspar and Khoo, 2013).
The American cranberry (Vaccinium macrocarpon) is a particularly rich
source of (poly)phenols, which have been associated in vitro with
antibacterial, antiviral, antimu-tagenic, anticarcinogenic,
antitumorigenic, antiangiogenic, anti-inflammatory, and antioxidant
properties (Côté et al., 2010; McKay and Blumberg, 2007 and Del Rio et
al., 2013). In vivo, animal models reveal that cranberry extracts can
reduce C-reactive protein (CRP) and proinflammatory interleu-kins and
increase NO synthesis (Kim et al., 2011); decrease angiotensin-
converting enzyme, angiotensin II, and angiotensin II type 1 receptor
(Yung et al., 2011); suppress Helicobacter pyloriinfection (Xiao and Shi,
2003); and improve pancreaticb-cell glucose responsiveness and
functionalb-cell mass (Zhu et al., 2011). Some of these actions may un-
derlie the results from clinical studies showing that cranberry products
can lower LDL cholesterol (LDL-C) and total cholesterol (Lee et al.,
2008), increase HDL cholesterol (HDL-C) while lowering the oxidative
modification of LDL-C (Ruel et al., 2006), improve endothelial function
(Dohadwala et al., 2011 and Flammer et al., 2011), lower glycemic
responses (Wilson et al., 2010), elevate plasma antioxidant capacity (Ruel
et al., 2005; Duthie et al., 2006 and Vinson et al., 2008), modulate
ulcerogenic gastric H. pyloricolonization (Gotteland et al., 2008 and
Shmuely et al., 2007), decrease cariogenic Streptococcus mutans and total
bacterial counts in saliva (Weiss et al., 2004), reduce biomarkers of
metabolic syndrome (Basu and Lyons, 2012 and Basu et al., 2011), and
protect against urinary tract infections (UTIs) (Wang et al., 2012 and
Vasileiou et al., 2013).
American cranberry has a complex and rich phytochemical composition,
particularlyflavan-3-ols, A-type procyanidins (PACs), anthocyanins,
benzoic acid, and ursolic acid. Cranberryflavan-3-ols are present as
monomers, oligomers, and polymers) (Pappas and Schaich, 2009). These
oligomers and polymers are also referred to as PACs or condensed tannins
and representw85% of the total flavan-3-ols on a weight basis (White et
al., 2011and Gu et al., 2004).
Cranberry was reported as the main source of peonidin among 100 foods
commonly consumed in the United States (Wu et al., 2006). However, in
the majority of studies, the total anthocyanin content is re-ported rather
than amounts of individual anthocyanins. This approach may change
because the bioavailability and health effects of anthocyanins seem to be
affected by the structures of the aglyconesor the glycosidicmoieties(
Crozier et al., 2010 and Czank et al., 2013).Quercetin 3-galactoside is the
predominant form, but at least 11 other glycosides are present in lower
concentrations (Pappas and Schaich, 2009 and Côté et al., 2008). Some
of these, such as quercetin-3-acetylrhamnoside are rare in berries
(Mikulic-Petkovsek et al., 2012). As shown in the Phenol Explorer
database, the flavonol content of plant foods is usually <3 mg/100 g FW,
although bilberry, black-berry, and blueberry contain 3.2–17 mg/kg
(Mikulic-Petkovsek et al., 2012 and Harnly et al., 2006).
The other species are blueberry (Vaccinium angustifolia) and bil-berry
(Vaccinium myrtillus). Cranberry typically grows in bogs and is a
member of the same family as blueberry and bilberry. Massachusetts and
Wisconsin are the main areas of present-day commercial production of
cranberry (Nova Scotia Department of Agriculture and Fisheries, 2004).
Cranberry has been found to specifically inhibit hemagglutination of E.

J. Nutrition and Food Processing Copy rights@ Muhammad Arshad Ullah, et al
Auctores Publishing LLC – Volume 6(4)-138 www.auctoresonline.org
ISSN: 2637-8914 Page 3 of 7
coli by expression of types (Nova Scotia Department of Agriculture and
Fisheries, 2004) and P adhesion through the component compounds
fructose and proanthocyanidins.In the United States, one of every five
women has been reported to have a lifetime incidence of UTI. Of these
women, 3 percent experience recurrent disease. Eleven million women
receive medication for UTIs annually (Foxman et al., 2000).A recent
Cochrane Database systematic review Jepson et al. (2004) found no
randomized trials assessing the effectiveness of cranberry juice in the
treatment of UTIs and concluded that there is no evidence to support its
use. There is much greater evidence-based information available for the
use of cranberry in UTI prophylaxis.A Cochrane Database systematic
review, Jepson et al. (2004) citing small sample sizes and the poor quality
of available trials, determined that there was no reliable evidence of
effectiveness of cranberry in UTI prophylaxis.
However, since 2001, two good-quality studies have been published. The
first trial18 of 150 women consisted of three arms: (Nova Scotia
Department of Agriculture and Fisheries, 2004) cranberry/lingon berry
juice, pro-biotic supplementation with Lactobacillus GG drink; and no
intervention for 12 months. Findings were a statistically significant 20
percent reduction in absolute risk of infection in women receiving
cranberry (number needed to treat: 5) compared with no effect in the
probiotic-supplementation and no-intervention groups (Kontiokari et al.,
2001).Most recently, a randomized, placebo-controlled trial, a single
experimental study showed that the “high-molecular-weight constituent”
of cranberry juice that inhibits the adherence of E. coli was effective in
reversing and inhibiting the coaggregation of a large portion of dental
plaque bacteria. Cranberry also has been recommended as an adjunctive
treatment for Candida infections (Stothers, 2002). A small study found a
significant rise in urinary oxalate levels, prompting a caution that regular
use of cranberry may increase the risk of kidney stone formation in
patients with a history of oxalate calculi (Terris et al., 2001).
Cranberries have historically been associated with urinary tract health,
particularly among women with rUTIs (Raz et al., 2004; Guay, 2009 and
Pérez-López et al., 2009). Results from several clinical studies have
suggested that cranberries may decrease rUTIs in healthy women (Guay,
2009; Vasileiou et al., 2013; Caljouw et al., 2014; Stapleton et al., 2012
and Takahashi et al., 2013). In addition, in vitro and ex vivo research has
suggested that cranberry-derived compounds such as A-type
proanthocyanidins and other polyphenols may interfere with adhesion of
bacteria (including multidrug-resistant Escherichia coli) to epithelial cells
of the urinary tract, attenuate the development of uropathogen reservoirs
(i.e., in the gastrointestinal tract and intracellular pods within the
urothelium), and sup-press inflammatory cascades (Vasileiou et al., 2013;
Gupta et al., 2012 and Blumberg et al., 2013).
Specifically, a meta-analysis by Wang and colleagues published in 2012
concluded that “cranberry products were associated with protective
effects against UTIs (RR: 0.62; 95% CI: 0.49, 0.80), particularly for
women with Recurring Urinary Tract Infections (rUTIs) (RR: 0.53; 95%
CI: 0.33, 0.83)” (Wang et al., 2012). In contrast, a meta-analysis by the
Cochrane Collaboration, also published in 2012, concluded that
“.cranberry juice is less effective than previously indicated. Cranberry
juice cannot currently be recommended for the prevention of UTIs”
(Jepson et al., 2012). It is interesting that the Cochrane analysis was an
up-date of a 2008 report that resulted in a conclusion similar to that
derived by Wang et al., indicating a shift in the conclusions from this
group (Jepson et al., 2008 and 2012).In theory, meta-analysis of results
from randomized clinical trials examines the consistency of data across
studies and is considered to be the strongest level of evidence that guides
relevant practice decisions (Melnyk, 2004).
Cranberry fruit (Vaccinium macrocarpon) grows on evergreen shrubs that
are native to North America (Polashock et al., 2014). Cranberry fruit is
classed as a functional food due to the naturally high content of
compounds, such as polyphenols, which are believed to have antioxidant
and therefore health-promoting properties (Szajdek and Borowska, 2008).
The reported health benefits of cranberry consumption range from cardio
protective effects due to improved cholesterol profiles (Ruel et al., 2006)
to aiding digestive health (Pappas et al., 2009). Cranberry exists in various
forms, including the raw fruit (fresh and dried), cranberry juice and
cranberry extract in capsule/tablet formulations (Bodet et al., 2008).
Cranberry extract could be a potential alternative to antibiotics to treat
acute uncomplicated UTIs. Proanthocyanidin (PAC) with A-type
linkages, or their metabolites, is believed to be the active ingredient in
cranberry, preventing Escherichia coli (E. coli) from binding to the
bladder uroepithelium (Howell et al., 2005) and thereby reducing the
ability of E. coli to cause and sustain a UTI. Systematic reviews assessing
the use of cranberry in the management of recurrent UTIs provide mixed
evidence for benefit (Wang et al., 2012 and Luís et al., 2017). A 2012
Cochrane review of 24 trials (n = 4473) of men, women and children
found that cranberry did not significantly reduce recurrent UTI compared
with placebo, advice to increase water intake or no treatment. A subgroup
analysis of women with recurrent UTI found that cranberry consumption
resulted in a non-significant reduction in recurrent UTIs (Jepson et al.,
2012). Whilst many studies have evaluated the effectiveness of cranberry
extract in reducing recurrent UTI, few have assessed effects on symptoms
of acute UTIs (Vicariotto, 2014).Cranberries for the prevention of UTIs
in susceptible populations are examined in another review by the same
authors (Jepson and Craig, 2008).
Cranberries are among a few foods that contain A-type
proanthocyanidins. Unlike B-type proanthocyanidins, A-type
proanthocyanidins have an additional ether interflavan bond between
C2→O→C7 (Prior and Gu, 2005).It was suggested that A-type
proanthocyanidins have greater bioactivity compared to B-type (Howell
et al., 2005).Two recent studies suggested that cranberry oligosaccharides
might also play a role in preventing UTIs because xyloglucan
oligosaccharides were found to be a new cranberry bioactive component
with E. coli anti-adhesion] activity (Hotchkiss et al., 2015 and Sun et al.,
2015).
Cranberries have also been found to improve lipid profile, improve
endothelial function, and lower several markers of cardio metabolic risk
(Paquette et al., 2017; Lee et al., 2008 and Novotny et al., 2015).
Nowadays, growing evidence suggests an important role of cranberries in
maintaining digestive health (Anhe et al., 2015 and Denis et al.,
2015).Two 250 mL bottles of cranberry juice daily for 90 days was found
to suppress H. Pylori infection in the stomach of susceptible population
(Zhang et al., 2005). In addition to the anti-inflammatory effects,
cranberries may also influence intestinal barrier integrity, which is
another essential element of intestinal health (Contreras et al., 2015 and
Pierre et al., 2014).
In the early 2000s, Kontiokari et al. (2001) and Stothers et al. (2002)
investigated the effects of cranberry juice or tablets, respectively, on UTI
prevention. The subjects were healthy, sexually active women, aged 21–
72 years, with a history of UTI. Both studies showed a significantly
decreased number of patients experiencing at least one episode of UTI per
year. In a very recent randomized, double-blind, placebo-controlled,
multicenter clinical trial, 28373healthywomen with a recent UTI history
were recruited to consume a 240 mL low-calorie cranberry juice cocktail
daily for 24 weeks. Cranberry juice consumption significantly reduced the
number of UTIs by 39%.
Urinary tract infection is a common bacterial infection in children (Habib,
2012). One serving of 50 mL cranberry juice was given to the children to
drink once per day for 6 months (Ferrara et al., 2009). This trial had a
relatively large sample size (n=84) and low dropout rate, 3.5% in the
cranberry group versus 6.8% in the control group. Cranberry juice, with
or without proanthocyanidins, was randomly assigned to 40 children for
one year (Afshar et al., 2012). A 65% reduction in the risk of UTIs was
obtained during a 12-month follow up. The compliance level was 70% for

J. Nutrition and Food Processing Copy rights@ Muhammad Arshad Ullah, et al
Auctores Publishing LLC – Volume 6(4)-138 www.auctoresonline.org
ISSN: 2637-8914 Page 4 of 7
both groups. Both studies suggested that cranberry juice was effective in
preventing the recurrence of pediatric UTI. Salo et al. (2012) conducted a
double-blinded randomized placebo-controlled trial in 2012.
A 2008 Cochrane review, (Jepson and Craig, 2008) which included five
cross-over and five parallel designed studies, reported that cranberry
products significantly reduced the incidence of UTIs at 12 months
compared to the placebo/control group. Cranberry-containing products
were found to be associated with preventative effects on recurrent UTIs
in another systematic review of 13 randomized controlled trials (Wang et
al., 2012).The most recent meta-analysis and trial sequential analysis
evaluated 28 clinical trials and concluded that the use of cranberry
products significantly reduced the incidence of UTIs (Luis et al., 2017).
However, meta-analysis in the 2012 Cochrane review36concluded that
cranberry products did not significantly reduce the occurrence of
symptomatic UTI overall compared to placebo, water, or no treatment.
This review had substantial heterogeneity in the results.
Several factors contribute to the conflicting results obtained from clinical
trials. The major factors are low compliance due to the as tringency and
bitterness of cranberry juice, high withdrawal rate, inconsistency of
dosage, and lack of standardization of cranberry content in testing
products. Cranberry capsules were used to overcome the undesired taste
of cranberry juice. However, in two trials using cranberry capsules, the
withdrawal rates were more than 40%, partly due to the side effects
(Linsenmeyer et al., 2004 and Waites et al., 2004). Quite a few trials were
not randomized, double blind, or placebo controlled, or had short duration
time (less than 6 months). In addition, the optimum dosage and
formulation were not established in previous studies (Guay, 2004).
References
1. Afshar, K., Stothers, L., Scott, H. and MacNeily, A.E., 2012.
Cranberry Juice for the prevention of pediatric urinary tract
infection: a randomized controlled trial. JUrol1, 88:1584–1587.
2. Anhe, F.F., Roy, D., Pilon, G., Dudonne, S., Matamoros, S.,
Varin. T.V. et al., 2015. A polyphenol-rich cranberry extract
protects from diet-induced obesity, insulin resistance and
intestinal inflammation in association with increased
Akkermansia spp. population in the gut microbiota of mice.
Gut, 64:872–883.
3. Barbosa-Cesnik, C., Brown, M.B., Buxton, M., Zhang, L.,
DeBusscher, J., Foxman, B., 2011. Cranberry juice fails to
prevent recurrent urinary tract infection: results from a
randomized placebo-controlled trial. Clin Infect Dis., 52(1):23-
30.
4. Basu, A., Betts, N.M., Ortiz, J., Simmons, B., Wu, M., Lyons,
T.J., 2011 Low-energy cranberry juice decreases lipid oxidation
and increases plasma antioxidant capacity in women with
metabolic syndrome. Nutr. Res., 31:190–6.
5. Basu, A., Lyons, T.J., 2012. Stawberries, blueberries, and
cranberries in the metabolic syndrome: clinical perspectives. J.
Agric. Food Chem., 60: 5687–92.
6. Blumberg, J.B., Camesano ,T.A., Cassidy, A., Kris-Etherton,
P., Howell, A,. Manach, C., Ostertag, L.M., Sies, H., Skulas-
Ray, A., Vita, J.A, 2013. Cranberries and their bioactive
constituents in human health. Ad . Nutr., 4: 618–32.
7. Bodet, C., Grenier, D., Chandad, F., Ofek, I., Steinberg, D.,
Weiss, E., 2008. Potential oral health benefits of cranberry. Crit.
Rev. Food Sci. Nutr., 48;672–680.
8. Bruyere, F., 2006. Use of cranberry in chronic urinary tract
infections. Med. Mal. Infect., 36(7):358-63,
9. Caljouw, M.A., van den Hout, W.B., Putter, H., Achterberg,
W.P., Cools, H.J., Gussekloo, J., 2014. Effectiveness of
cranberry capsules to prevent urinary tract infections in
vulnerable older persons: a double-blind randomized placebo-
controlled trial in long-termcare facilities. J. Am. Geriatr. Soc.,
62:103–10.
10. Cimolai, N., Cimolai, T., 2007. The cranberry and the urinary
tract. Eur. J. Clin. Microbiol. Infect. Dis., 26(11):767-76.
11. Contreras, T.C., Ricciardi, E., Cremonini, E. and Oteiza, P.I.,
2015. Epicatechin in the prevention of tumor necrosis alpha-
induced loss of Caco-2 cell barrier integrity. Arch.
Biochem.Biophys., 573:84–91.
12. Côté, J., Caillet, S., Doyon, G., Sylvain, J.F., Lacroix, M., 2010.
Analyzing cranberry bioactive compounds. Crit. Rev. Food Sci.
Nutr., 50:872–88.
13. Crozier, A., Del Rio, D., Clifford, M.N., 2010. Bioavailability
of dietary flavo-noids and phenolic compounds. Mol. Aspects
Med., 31:446–67.
14. Czank, C., Cassidy, A., Zhang, Q., Morrison, D.J., Preston, T.,
Kroon, P.A., Botting, N.P., Kay. C.D., 2013. Human
metabolism and excretion of the antho-cyanin, cyanidin-3-
glucoside: a 13C- tracer study. Am. J. Clin. Nutr., 97:995–1003.
15. Del Rio, D., Rodriguez-Mateos, A., Spencer, J.P., Tognolini,
M., Borges, G., Crozier, A., 2013. Dietary (poly)phenolics in
human health: structures, bio-availability, and evidence of
protective effects against chronic diseases. Antioxid Redox
Signal., 18:1818–92.
16. Denis, M.C., Desjardins, Y., Furtos, A., Marcil, V., Dudonne,
S., Montoudis, A. et al., 2015. Prevention of oxidative stress,
inflammation and mitochon-drial dysfunction in the intestine by
different cranberry phenolic fractions.Clin. Sci., (Lond),
128:197–212.
17. Di Martino, P., Agniel, R., David, K., Templer, C., Gaillard,
J.L., Denys, P., et al. 2006. Reduction of Escherichia coli
adherence to uroepithelial bladder cells after consumption of
cranberry juice: a double-blind randomized placebo-controlled
cross-over trial. World J. Urol., 24(1):21-7.
18. Dohadwala, M.M., Holbrook, M,, Hamburg, N,M,, Shenouda,
S,M., Chung, W.B., Titas ,M., Kluge, M.A., Wang, N.,
Palmisano, J., Milbury, P.E., et al. 2011. Effects of cranberry
juice consumption on vascular function in pa-tients with
coronary artery disease. Am. J. Clin. Nutr., 93:934–40.
19. Duthie, S.J., Jenkinson, A.M., Crozier, A., Mullen, W., Pirie,
L., Kyle, J., Yap, L.S., Christen, P., Duthie, G.G., 2006. The
effects of cranberry juice consumption on antioxidant status and
biomarkers relating to heart disease and cancer in healthy
human volunteers. Eur. J. Nutr., 45:113–22.
20. Ferrara, P., Romaniello, L., Vitelli, O., Gatto, A., Serva M.,
Cataldi, L., 2009. Cranberry juice for the prevention of
recurrent urinary tract infections: a randomized controlled trial
in children. Scand. J. Urol. Nephrol., 43(5):369-72.
21. Flammer, A.J., Martin, .EA., Gossl, M., Widmer, R.J., Lennon,
R.J., Sexton, J.A., Loeffler, D., Khosla, S., Lerman, L.O.,
Lerman, A., 2013. Polyphenol-rich cran-berry juice has a
neutral effect on endothelial function but decreases the fraction
of osteocalcin-expressing endothelial progenitor cells. Eur. J.
Nutr., 52:289–96.
22. Foxman, B., Barlow, R., D’Arcy, H., Gillespie, B., Sobel, J.D.,
2000. Urinary tract infection: self-reported incidence and
associated costs. Ann. Epidemiol., 10:509-15.
23. Gotteland, M., Andrews, M., Toledo, M., Muñoz, L., Caceres,
P., Anziani, A., Wittig, E., Speisky, H., Salazar, G., 2008.
Modulation of Helicobacter pylori colonization with cranberry
juice and Lactobacillus johnsoniiLa1 in children. Nutrition.,
24:421–6.
24. Gu, L., Kelm, M.A., 2004. Hammerstone, J.F., Beecher, G.,
Holden, J., Haytowitz, D., Gebhardt, S., Prior, R.L., 2004.
Concentrations of proanthocyanidins in common foods and
estimations of normal consumption. J. Nutr., 134:613–7.

J. Nutrition and Food Processing Copy rights@ Muhammad Arshad Ullah, et al
Auctores Publishing LLC – Volume 6(4)-138 www.auctoresonline.org
ISSN: 2637-8914 Page 5 of 7
25. Guay, D. R,, 2009. Cranberry and urinary tract infections.
Drugs., 69(7):775-807.
26. Gupta, A., Dwivedi, M., Mahdi, A.A., Nagana, Gowda, G.A.,
Khetrapal, C.L., Bhandari, M., 2012. Inhibition of adherence of
multi-drug resistant E. Coli by proanthocyanidin. Urol. Res.,
40:143–50.
27. Gupta, K., Chou, M.Y., Howell, A., Wobbe, C., Grady, R.,
Stapleton, A.E., 2007. Cranberry products inhibit adherence of
p-fimbriated Escherichia coli to primary cultured bladder and
vaginal epithelial cells. J. Urol., 177(6):2357-60.
28. Habib, S., 2012. Highlights for management of a child with a
urinary tract infection. Int. J. Pediatr., 943653 (2012).
29. Harnly, J.M., Doherty, R.F., Beecher, G.R., Holden, J.M.,
Haytowitz, D.B., Bhagwat, S., Gebhardt, S., 2006. Flavonoid
content of US fruits, vegetables, and nuts. J. Agric. Food
Chem., 54:9966–77.
30. Hotchkiss, A.T., Jr., Nunez, A., Strahan, G.D., Chau, H.K.,
White, A.K., Marais, J.P., et al., 2015. Cranberry xyloglucan
structure and inhibition of Escherichia coliadhesion to epithelial
cells. J. Agric. Food Chem., 63:5622–563.
31. Howell, A.B., Reed, J.D., Krueger, C.G.,Winterbottom, R.,
Cunningham, D.G. and Leahy, M., 2005. A-type cranberry
proanthocyanidins and uropathogenic bacterial anti-adhesion
activity. Phytochemistry, 66:2281–2291.
32. Jepson, R.G., Craig, J.C., 2007. A systematic review of the
evidence for cranberries and blueberries in UTI prevention.
Mol. Nutr. Food Res., 51(6):738-45.
33. Jepson, R.G., Mihaljevic, L., Craig, J.C., 2004. Cranberries for
treating urinary tract infections. Cochrane Database Syst. Rev.,
(3):CD001322.
34. Jepson, R.G., Williams G, Craig, J.C., 2012. Cranberries for
preventing urinary tract infections [review]. Cochrane Database
Syst. Rev., 2012; 10:CD001321.
35. Jepson, R.G., Craig, J.C., 2008. Cranberries for preventing
urinary tract infections. Cochrane Database of Systematic
Reviews. 1. Art. No: CD001321. [DOI:
10.1002/14651858.CD001321.pub3]
36. Kaspar, K.L., Khoo, C., 2013. Cranberry polyphenols in the
promotion of uri-nary tract, cardiovascular and emerging health
areas. In: Skinner M, Hunter D, editors. Bioactives in fruit:
health benefits and functional foods. New York: Wiley
Blackwell; 2013. p. 273–92.
37. Kim, M.J., Ohn, J., Kim, J.H., Kwak, H.K., 2011. Effects of
freeze-dried cranberry powder on serum lipids and
inflammatory markers in lipopolysaccha-ride treated rats fed an
atherogenic diet. Nutr. Res. Pract., 5: 404–11.
38. Kontiokari, T., Sundqvist, K., Nuutinen, M., Pokka, T.,
Koskela, M., Uhari, M., 2001. Randomised trial of cranberry-
lingonberry juice and Lactobacillus GG drink for the prevention
of urinary tract infections in women. B.M.J., 322(7302):1571.
39. Lavigne, J.P., Bourg, G., Combescure, C., Botto, H., Sotto, A.,
2008. In-vitro and in-vivo evidence of dose-dependent decrease
of uropathogenic Escherichia coli virulence after consumption
of commercial Vaccinium macrocarpon (cranberry) capsules.
Clin. Microbiol. Infect., 14(4):350-5.
40. Lee, B.B., Haran, M.J., Hunt, L.M., Simpson, J.M., Marial, O.,
Rutkowski, S.B., et al., 2007. Spinal-injured neuropathic
bladder antisepsis (SINBA) trial. Spinal Cord., 45(8):542-50.
41. Lee, I.T., Chan, Y.C., Lin, C.W., Lee, W.J. and Sheu, W. H.H.,
2008. Effect of cranberry extracts on lipid profiles in subjects
with Type 2 diabetes. Diabetic Med., 25:1473–1477.
42. Linsenmeyer, T.A., Harrison, B., Oakley, A., Kirshblum, S.,
Stock, J.A. and Millis, S.R., 2004. Evaluation of cranberry
supplement for reduction of urinary tract infections in
individuals with neurogenic bladders secondary to spinal cord
injury. A prospective, double-blinded, placebo-controlled,
cross over study. J. Spinal Cord. Med., 27:29–34.
43. Luís, Â., Domingues, F., Pereira, L., 2017. Can cranberries
contribute to reduce the incidence of urinary tract infections? A
systematic review with meta-analysis and trial sequential
analysis of clinical trials. J. Urol., 198; 614–621.
44. Maki, K.C., Kaspar, K.L., Khoo, C., Derrig, L.H., Schild, A,L,
and Gupta, K., 2016. Consumption of a cranberry juice
beverage lowered the number of clinical urinary tract infection
episodes in women with a recent history of urinary tract
infection. Am. J. Clin.Nutr., 103:1434–1442.
45. McGuinness, S.D., Krone, R., Metz, L.M., 2002. A double-
blind, randomized, placebo-controlled trial of cranberry
supplements in multiple sclerosis. Journal of Neuroscience
Nursing, 34(1):4-7.
46. McKay, D.L., Blumberg, J.B., 2007. Cranberries (Vaccinium
macrocarpon) and cardiovascular disease risk factors. Nutr.
Rev., 65:490–502.
47. McMurdo, M.E., Argo, I., Phillips, G., Daly, F., Davey, P.,
2009. Cranberry or trimethoprim for the prevention of recurrent
urinary tract infections? A randomized controlled trial in older
women. J. Antimicrob. Chemother., 63(2):389-95.
48. McMurdo, M.E., Bissett, L.Y., Price, R.J., Phillips, G.,
Crombie, I.K., 2005. Does ingestion of cranberry juice reduce
symptomatic urinary tract infections in older people in hospital?
A double-blind, placebo-controlled trial. Age Ageing.,
34(3):256-61.
49. Melnyk, B.M., 2004. Integrating levels of evidence into clinical
decision making. Pediatr. Nurs., 30:323–5.
50. Mikulic-Petkovsek, M., Slatnar, A., Stampar, F., Veberic, R.,
2012. HPLC-MSn identification and quantification of flavonol
glycosides in 28 wild and cultivated berry species. Food Chem.,
135:2138–46.
51. Nova Scotia Department of Agriculture and Fisheries., 2004.
Cranberry facts and pointers. Accessed online October 14,
2004.
52. Novotny, J.A., Baer, D.J., Khoo, C., Gebauer, S.K. and
Charrons, C.S., 2015. Cranberry juice consumption lowers
markers of cardio metabolic risk, including blood pressure and
circulating C-reactive protein, triglyceride, and glucose
concentrations in adults. J.Nutr., 145:1185–1193 .
53. Pappas, E., Schaich, K., 2009. Phytochemicals of cranberries
and cranberry products: Characterization, potential health
effects, and processing stability. Crit. Rev. Food Sci. Nutr.,
49;741–781.
54. Paquette, M., Larque, A.S.M., Weisnagel, S.J., Desjardins, Y.,
Marois, J,, Pilon, G., et al., 2017. Strawberry and cranberry
polyphenols improve insulin sensitivity in insulin-resistant,
non-diabetic adults: a parallel, double-blind, controlled and
randomised clinical trial. Br. J. Nutr., 117:519–531.
55. Paredes-López, O., Cervantes-Ceja, M.L., Vigna-Pérez, M.,
Hernández-Pérez, T., 2010. Berries: improving human health
and healthy aging, and promoting quality life—a review. Plant
Foods Hum. Nutr., 65: 299–308.
56. Pérez-López, F.R., Haya, J., 2009. Chedraui P.Vaccinium
macrocarpon: an interesting option for women with recurrent
urinary tract infections and other health benefits. J.Obstet.
Gynaecol. Res., 35:630–9.
57. Pierre, J.F., Heneghan, A.F., Feliciano, R.P.,
Shanmuganayagam, D., Krueger, C.G., Reed, J.D., et al., 2014.
Cranberry proanthocyanidins improve intestinal sIgA during
elemental enteral nutrition. J. Parenter. Enteral. Nutr., 38:107–
114.
58. Polashock, J., Zelzion, E., Fajardo, D., Zalapa, J., Georgi, L.,
Bhattacharya, D., Vorsa, N., 2014. The American cranberry:

J. Nutrition and Food Processing Copy rights@ Muhammad Arshad Ullah, et al
Auctores Publishing LLC – Volume 6(4)-138 www.auctoresonline.org
ISSN: 2637-8914 Page 6 of 7
First insights into the whole genome of a species adapted to bog
habitat. B.M.C. Plant Biol., 14, 165.
59. Prior, R.L. and Gu, L., 2005. Occurrence and biological
significance of proan-thocyanidins in the American diet.
Phytochemistry, 66:2264–2280.
60. Raz, R., Chazan, B., Dan, M., 2004. Cranberry juice and urinary
tract infection. Clin. Infect. Dis., 38:1413–9.
61. Reid,G., 2002. The role of cranberry andprobiotics in intestinal
and urogenital tract health. Crit. Rev. Food Sci. Nutr., 42:293–
300.
62. Ruel, G., Pomerleau, S., Couture, P., Lamarche, B., Couillard,
C., 2005. Changes in plasma antioxidant capacity and oxidized
low-density lipoprotein levels in men after short-term cranberry
juice consumption. Metabolism., 54:856–61.
63. Ruel, G., Pomerleau, S., Couture, P., Lemieux, S., Lamarche,
B., Couillard, C., 2006. Favourable impact of low-calorie
cranberry juice consumption on plasma HDL-cholesterol
concentrations in men. Br. J. Nutr., 96, 357–364.
64. Salo, J., Uhari, M., Helminen, M., Korppi, M., Nieminen, T.,
Pokka, T., et al., 2012. Cranberry juice for the prevention of
recurrences of urinary tract infections in children: a randomized
placebo-controlled trial. Clin. Infect. Dis., 54:340–346.
65. Shmuely, H., Yahav, J., Samra, Z., Chodick, G., Koren, R., Niv,
Y., Ofek, I., 2007. Effect of cranberry juice on eradication of
Helicobacter pyloriin patients treated with antiobiotics and a
proton pump inhibitor. Mol. Nutr .Food Res., 51:746–51.
66. Stapleton, A.E., Dziura, J., Hooton, T.M., Cox, M.E., Yarova-
Yarovaya, Y., Chen, S., Gupta, K., 2012. Recurrent urinary
tract infection and urinary Escherichia coliin women ingesting
cranberry juice daily: a randomized controlled trial. Mayo Clin.
Proc., 87:143–50.
67. Stothers, L., 2002. A randomized trial to evaluate effectiveness
and cost effectiveness of naturopathic cranberry products as
prophylaxis against urinary tract infection in women. Can. J.
Urol., 9(3):1558-62.
68. Sun, J., Marais, J.P., Khoo, C., LaPlante, K., Vejborg, R.M.,
Givskov, M., et al., 2015.Cranberry (Vaccinium macrocarpon)
oligosaccharides decrease biofilm formation by
uropathogenicEscherichia coli. J. Funct. Foods, 17:235–242.
69. Szajdek, A., Borowska, E., 2008. Bioactive compounds and
health-promoting properties of berry fruits: A review. Plant
Foods Hum. Nutr., 63; 147–156.
70. Takahashi, .S, Hamasuna, R., Yasuda, M., Arakawa, S.,
Tanaka, K., Ishikawa, K., Kiyota, H., Hayami, H., Yamamoto,
S., Kubo, T., et al., 2013. A randomized clinical trial to evaluate
the preventive effect of cranberry juice (UR65) for patients with
recurrent urinary tract infection. J. Infec.t Che.mother., 19:112–
7.
71. Terris, M..K, Issa, M.M., Tacker, .JR., 2001. Dietary
supplementation with cranberry concentrate tablets may
increase the risk of nephrolithiasis. Urology, 57:26-9.
72. Vasileiou, I., Katsargyris, A., Theocharis, .S, Giaginis, C.,
2013. Current clinical status on the preventive effects of
cranberry consumption against urinary tract infections. Nutr.
Res., 33:595–607.
73. Vicariotto, F. Effectiveness of an association of a cranberry dry
extract, D-mannose, and the two microorganisms Lactobacillus
plantarum LP01 and Lactobacillus paracasei LPC09 in women
affected by cystitis: A pilot study. J. Clin. Gastroenterol. 2014,
48, S96–S101.
74. Vinson, J.A., Bose, P., Proch, J., Kharrat, H.A., Samman, N..
2008. Cranberries and cranberry products: powerful in vitro, ex
vivo, and in vivo sources of antioxidants. J. Agric. Food.
Chem., 56:5884–91.
75. Waites, K.B., Canupp, K.C., Armstrong, S., DeVivo,
M.J.,2004. Effect of cranberry extract on bacteriuria and pyuria
in persons with neurogenic bladder secondary to spinal cord
injury. J. Spinal Cord. Med., 27(1):35-40.
76. Wang, C.H., Fang, C.C., Chen, N..C, Liu, S.S., Yu, P.H., Wu,
T.Y., Chen, W.T., Lee, C.C., Chen, S.C., 2012. Cranberry-
containing products for prevention of urinary tract infections in
susceptible populations. Arch. Intern .Med., 172: 988–96.
77. Weiss, E.I., Kozlovsky, A., Steinberg, D., Lev-Dor, R., 2004.
Bar Ness Greenstein R, Feldman M, Sharon N, Ofek I. A high
molecular mass cranberry constituent reduces mutans
streptococci level in saliva and inhibits in vitro adhesion to
hydroxyapatite. F.E.M.S. Microbiol. Lett., 232:89–92.
78. White, B.L., Howard, L.R., Prior, R.L., 2011. Impact of
different stages of juice processing on the anthocyanin,
flavonol, and procyanidin contents of cranberries. J. Agric.
Food Chem., 59:4692–8.
79. Wilson, T., Luebke, J.L., Morcomb, E.F., Carrell, E.J.,
Leveranz, M.C., Kobs, L., Schmidt, T.P., Limburg, P.J., Vorsa,
N., Singh, A.P., 2010. Glycemic responses to sweetened dried
and raw cranberries in humans with type 2 diabetes. J. Food
Sci., 75:H218–23.
80. Wing, D.A., Rumney, P.J., Preslicka, C.W., Chung, J.H., 2008.
Daily cranberry juice for the prevention of asymptomatic
bacteriuria in pregnancy: a randomized, controlled pilot study.
J. Urol., 180(4):1367-72
81. Wu, X., Beecher, G.R., Holden, J.M., Haytowitz, D.B.,
Gebhardt, S.E., Prior, R.L., 2006. Concentrations of
anthocyanins in common foods in the United States and
estimation of normal consumption. J. Agric. Food Chem.,
54:4069–75.
82. Xiao, S.D., Shi, T., 2003. Is cranberry juice effective in the
treatment and prevention of Helicobacter pylori infection of
mice? Chin. J. Dig. Dis., 4:136–9.
83. Yung, L.M., Wong, W.T., Tian, X.Y., Leung, F.P., Yung, L.H.,
Chen, Z.Y., Yao, X., Lau. C.W., Huang Y., 2011. Inhibition of
renin-angiotensin system reverses endothelial dysfunction and
oxidative stress in estrogen deficient rats. PLoS ONE.,
6:e17437.
84. Zhang, L., Ma, J.L., Pan, K.F., Go, V.L.W., Chen, J.S. and You,
W.C., 2005. Efficacy of cranberry juice on Helicobacter pylori
infection: a double-blind, randomized placebo-controlled trial.
Helicobacter, 10:139–145.
85. Zhu,.Y, Xia, M., Yang,Y., Liu, F., Li, Z., Hao, Y., Mi, M., Jin,
T., Ling, W., 2011. Purified anthocyanin supplementation
improves endothelial function via NO-cGMP activation in
hypercholesterolemic individuals. Clin. Chem., 57:1524–33.

J. Nutrition and Food Processing Copy rights@ Muhammad Arshad Ullah, et al
Auctores Publishing LLC – Volume 6(4)-138 www.auctoresonline.org
ISSN: 2637-8914 Page 7 of 7
This work is licensed under Creative
Commons Attribution 4.0 License
To Submit Your Article Click Here: Submit Manuscript
DOI:10.31579/2637-8914/138
Ready to submit your research? Choose Auctores and benefit from:
➢ fast, convenient online submission
➢ rigorous peer review by experienced research in your field
➢ rapid publication on acceptance
➢ authors retain copyrights
➢ unique DOI for all articles
➢ immediate, unrestricted online access
At Auctores, research is always in progress.
Learn more https://auctoresonline.org/journals/nutrition-and-food-processing