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A systematic review of the evidence for cranberries and blueberries in UTI prevention
Abstract
In this review we assess the effectiveness of cranberry and blueberry products in preventing symptomatic urinary tract infections (UTIs). Selection criteria were randomised or quasi-randomised controlled trials of cranberry or blueberry juice/products for the prevention of symptomatic UTIs. A comprehensive search was undertaken in November 2006 whereupon two reviewers independently assessed and extracted data. Quality was assessed using Cochrane criteria. Relative risks (RR) were calculated where appropriate; otherwise a narrative synthesis was undertaken. No relevant trials of blueberry products were identified. Nine trials of cranberry products met the inclusion criteria. In four good quality randomised controlled trials (RCTs), cranberry products significantly reduced the incidence of symptomatic UTIs in 12 months (overall RR 0.65, 95% CI: 0.46-0.90) compared with placebo/control. Five trials were not included in the meta-analyses due to the lack of appropriate data. However, only one reported a significant result. Side effects were common, and losses to followup/withdrawals in several of the trials were high (> 40%). There is some evidence from four good quality RCTs that cranberry juice may decrease the number of symptomatic UTIs over a 12-month period, particularly in women with recurrent UTIs. It is uncertain whether it is effective in other susceptible groups.
... Additionally, berries of the Vaccinium genus have shown potential for use in urinary tract infections (UTI). Anthocyanins extracted from cranberries are widely known as an adjuvant in preventing or treating UTI [14][15][16][17][18]. Blueberries (Vaccinium corymbosum L.) present a significantly higher concentration (32-407 mg/100 g fresh weight (FW)) and diversity of anthocyanins (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) compared to other berry fruits, such as strawberries, grapes and raspberries (27-48 mg/100 g FW; seven to seventeen different compounds) [19][20][21][22][23][24][25][26][27]. ...
... Additionally, berries of the Vaccinium genus have shown potential for use in urinary tract infections (UTI). Anthocyanins extracted from cranberries are widely known as an adjuvant in preventing or treating UTI [14][15][16][17][18]. Blueberries (Vaccinium corymbosum L.) present a significantly higher concentration (32-407 mg/100 g fresh weight (FW)) and diversity of anthocyanins (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) compared to other berry fruits, such as strawberries, grapes and raspberries (27-48 mg/100 g FW; seven to seventeen different compounds) [19][20][21][22][23][24][25][26][27]. Among common fruits, blueberries, therefore, are one of the richest sources of anthocyanins, making them extremely interesting fruits in terms of bioactive potential, with a remarkable antioxidant capacity [28,29]. ...
... Similar to cranberries, blueberries are rich in anthocyanins, but their efficacy as an adjuvant in preventing or treating UTI is still in doubt and unclear [18,56]. Only a few in vitro studies have tested their effect against uropathogenic E. coli strains isolated from the urine of human patients diagnosed with UTI, and only one against Pseudomonas aeruginosa [50,57,58]. ...
Anthocyanins are extensively studied for their health-related properties, including antibacterial activity against urinary tract infections (UTI). Among common fruits, blueberries, with their remarkable antioxidant capacity, are one of the richest sources. Anthocyanin-rich extracts were obtained from four varieties: Snowchaser, Star, Stella Blue and Cristina Blue, grown in the hot climate of Southern Spain. Their total anthocyanins contents (TAC) were determined spectrophotometrically, and the anthocyanin profile by ultra high performance liquid chromatography-tandem mass spectrometer (UHPLC-MS/MS). Their antioxidant activity was assessed by oxygen radical absorbance capacity (ORAC) assay, while antibacterial activity against strains isolated from UTI patients was assessed in vitro, helping to select the varieties with the highest bioactive potential. Star showed the highest TAC and antioxidant activity (1663 ± 159 mg of cyanidin-3-O-glucoside (cy-3-O-glu) equivalents/100 g fresh weight (FW), 6345 ± 601 μmol Trolox equivalents (TE)/100 g FW, respectively), followed by Cristina Blue, Stella Blue and Snowchaser. As far as we know, this is the first time that cyanidin-3-rutinoside has been identified in blueberries. The extracts inhibited all the tested strains, MICs ranging from 0.4 mg/mL (for Stella Blue extract against UTI P. aeruginosa) to 9.5 mg/mL (for all extracts against UTI K. pneumoniae ssp. pneumoniae). This is the first study that assessed in vitro the antibacterial activity of blueberries against Klebsiella pneumoniae, Providencia stuartii and Micrococcus spp. strains isolated from UTI.
... Epidemiological studies have shown that polyphenols penetrate particularly the tissues in which they are metabolized, such as the liver and the gastrointestinal tract [Cutler] while the anthocyanins' blueberries are able to penetrate the blood-brain barrier by acting directly on the brain [9,10] and their excretion occurs through urine and bile [8]. A significant number of studies demonstrated the antioxidant, antiinflammatory impact of their 'aggressive' polyphenols, competing oxidative stress [11][12][13] and relevant diseases, such as cardiovascular disease [14,15] diabetes [16,17] high blood pressure [18,19] cancer [20] autoimmune diseases [21], [22], premature aging [23], memory [24], Alzheimer disease [25], obesity [26,27] as well as preventing urinary tract infections [28,29] LDL lipoproteins [30] and muscle recovery after exercise [31] etc. However, the protection provided by the consumption of these fruits will have to be further investigated in humans, as numerous studies are based on animal experiments [32][33][34][35][36][37]. ...
... Yield of the antioxidant capacity of berries in the phenolic compounds Yield of the antioxidant capacity of blueberries in the phenolic compounds [26] Healthy male (n= 21), 1, 2, 4, and 6 h after consumption of blueberry containing 766, 1278, and 1791 mg total blueberry polyphenols -In vivo Improvement of vascular function [29] Postmenopausal women (n = 48), daily consumption of 22 g freeze-dried blueberry powder for 8 weeks -In vivo Improvement of blood pressure and arterial stiffness [15] Men and postmenopausal women (n= 25) aged 18-50 years, daily consumption of a portion of 250g blueberries for 6 weeks -In vivo ...
Background: The ever-growing concern about achieving quality of life and longevity leads scientists to the search of natural wellness resources. Also, prevention of diseases through food is considered as the driving force of the organism. The beneficial effects of superfoods, such as blueberries, on human health are expected to be proved, putting these effects under the microscope. Objective: Evaluating the effect of blueberries consumption in humans, in order to draw relevant conclusions for their beneficial effect and thus develop food policies and launch target in future searches. Methods: Comprehensive review of published studies of the last decade, using keyword combinations which are derived from the available database. Results: Based on the cited studies, that blueberries consumption reduces degenerative damage caused by free radicals, increases the natural killer cells and inflammatory cytokines, and provides evidence for cellular antioxidant defense against DNA damage, playing also an important role in the anti-cancer nutritional preventive treatment. Moreover, the blueberries consumption protects the elderly from neurodegenerative diseases, which are associated with oxidative stress and aging, improves gait performance, vascular function and insulin sensitivity. It also benefits school-age children’s cognitive function. The blueberries consumption also positively influences certain bifidobacterial populations, affects the recovery of visual acuity and operates as a complementary therapeutic factor to reduce the severity of juvenile idiopathic arthritis. Conclusion: The consumption of blueberries is a supplementary function to prevent and cure chronic inflammatory diseases, providing an admirable medical therapy support in order to reduce degenerative damage. However, further studies conducted on larger populations are strongly recommended.
... Yaban mersininden izole edilen antosiyaninler, kersetin ve resveratrol gibi izole edilmiş biyoaktif özler, antioksidan, anti-inflamatuar, kanser hücresi bloke etme ve kalbi korumada etkiler göstermektedir (Kalt ve McDonald, 1996). Yaban mersini takviyesinin yaşa bağlı davranışsal eksiklikleri giderebileceği (Carey vd., 2014), idrar yolu enfeksiyonlarını önleyebileceği (Jepson ve Craig, 2007), beyin yaşlanmasını geciktirebileceği (Goyarzu vd., 2004), hiperglisemiyi azaltabileceği (Murray, 1997;Grace vd., 2009), kanseri önleyebileceği (Skupień vd., 2006;Neto, 2007), insülin duyarlılığını iyileştirebileceği (Vuong vd., 2009;Lee vd., 2018), bağırsak florasını iyi yönde değiştirebileceği (Lee vd., 2018) ve antianjiyogenik özellik gösterdiği (Atalay vd., 2003) yapılan deneysel çalışmalar ile kanıtlanmıştır. ...
... vitisidaea) and blueberry (V. myrtillus) [25]. Cranberry contains an array of active constituents, but a number of studies have suggested that proanthocyanidins (PAC) and fructose are the main active ingredients to prevent bacterial adhesion to the urinary tract [26]. ...
The use of antibiotics in the treatment of UTIs is contributing to resistance. Hence, the outcome of human clinical trials of nonantibiotic remedies for preventing or treating UTI is of significant interest. This systematic review aimed to identify, summarise and evaluate the evidence for the outcomes of different nonantibiotic options including cranberry, D-mannose and non-steroidal anti-inflammatory drugs (NSAIDs). PubMed, Embase and Scopus were searched for manuscripts relating to nonantibiotic treatment of UTI including cranberry, mannose and NSAIDs. After title and abstract screening, data were extracted from 21 papers that were published in English and related to the treatment or prevention of uncomplicated UTI in adult women. We identified twelve papers examining the effects of cranberry, two papers examining D-mannose, two papers examining combination treatments (cranberry and D-mannose) and five manuscripts investigating the effects of NSAIDs. There is low-level evidence, from a small number of studies, supporting the use of D-mannose or combination treatments for potentially preventing UTIs in adult women without producing burdening side effects. However, larger and more randomised double-blinded trials are needed to confirm this. In comparison, the multiple studies of cranberry and NSAIDs produced conflicting evidence regarding their effectiveness.
... Because antibiotics can be relatively expensive and may require prescriptions from physicians, there is a great deal of interest in alternative approaches to preventing or treating UTIs [13][14][15] . These include the use of over-the-counter plant preparations such as those derived from fruits like cranberries or various herbs [17][18][19] . Curcumin (1,7-bis-(4-hydroxy-3-methoxyphenyl)hepta-1,6-diene-3,5-dione) and its derivatives are the active components of turmeric, a herbal preparation derived from the rhizomes of Curcuma longa [20][21] . ...
... Proanthocyanidins that are present in the blue berries are crucial for preventing urinary tract infections that are caused by E. coli. The phenolic acids which are present in berries are the hydroxylated derivatives of cinnamic acid and benzoic acid (Hisano et al. 2012;Jepson and Craig 2007). Studies revealed that there is a strong correlation between antioxidant activity and the total phenolics. ...
Immunity is the major mechanism of host defence system against infectious and chronic diseases. The recent global concern of recent viral infection of SARS-CoV-19 has raised the demand of functional foods, nutraceuticals and fruits that can boost immunity. This will help in managing the overall physiological health and prevention of infectious and chronic diseases. Medicinal plants and fruits can help in boosting immunity through modulation of immune system and changing the types of immune response such as involvement of the induction, expression or amplification of the genes and proteins in inflammation and antioxidant system. The traditional medicine systems have used a wide variety of plants and fruits as supplement for immunomodulation including those for stimulation of immune system as well as immune compromisation deemed per se. Some of the plants that have been listed for immune boosting abilities included Curcuma longa, Withania somnifera, Phyllanthus emblica, Azadirachta indica, Panax ginseng, Rhododendron spiciferum, Caesalpinia bonducella, Tinospora cordifolia, Capparis zeylanica, Asparagus racemosus, Nelumbo nucifera, Arnica montana, Calendula officinalis, Echinacea purpurea and Euphorbia tirucalli. Reports indicate that a wide variety of phytochemicals like polysaccharide, alkaloids, flavonoids, terpenoids, lactones and glycoside have shown immunomodulatory properties under different pathophysiological conditions. Amongst the diverse chemical profile of plant extracts, polysaccharides are the water-soluble molecules that could activate immune responses when interacting directly with immune cells, while hydrophobic compounds like flavonoids such as quercetin and luteolin and terpenoids such as sesquiterpene lactones and curcumin showed potent immunomodulatory effects. Growing evidences suggest that phytochemicals from functional foods and fruits may be useful in maintaining the cytokine and chemokine balance, regulating oxidative status of cells, and targeting the specific cellular receptors as therapeutic targets. This chapter comprehensively enlists the plant resources with immune boosting abilities and explore their phytochemical characterization and molecular mechanism behind their protective effects.KeywordsFunctional foodFruitsNutraceuticalsAntioxidantAnti-inflammationImmune-stimulating
... Putative health benefits of PAC include a decreased risk of heart disease and dyslipidemia for PAC in grape seed extract or pine bark (Schoonees, Visser, Musekiwa, & Volmink, 2012;Sahebkar, 2014;Haili Zhang, Liu, Li, Liu, Liu, Mi, et al., 2016), and a decreased risk of urinary tract infections (UTIs) for PAC in cranberry. However, meta-analysis results of clinical trials on UTI prevention are often conflicted, with associations between PAC intake and health benefits in the trials being confounded due to use of unstandardized product forms that lack compositional analysis, doses that may be subefficacious, and little to no mechanistic guidance for selection of subjects and study design (Jepson & Craig, 2007;Jepson, Williams, & Craig, 2012). ...
Cranberry (Vaccinium macrocarpon Aiton) is a native fruit crop of northeastern North America. In 2017, cranberry production in the United States was estimated at $251 million, resulting in annual sales of fresh and marketed cranberry products that exceeded $3.5 billion dollars. These sales come as a result of the putative health benefits associated with the consumption of cranberry products, specifically the proanthocyanidins (PAC) with A-type interflavan bonds. This increased demand for healthy products on the part of consumers combined with the expensive cost of cranberry compared to other botanical sources and lack of regulatory policies on the part of the Food and Drug Administration (FDA) have resulted in unethical manufacturers to adulterate cranberry products. The lack of standardization and authentication undermines the market of cranberry products and erodes consumer confidence and the perception of health benefits. For this reason, there is a need for rapid, precise, and accurate analytical methods capable of providing reliable quantification and characterization of cranberry proanthocyanidins (c-PAC). However, current analytical methods used by the industry are obsolete and time-consuming. Thus, cranberry products marketed to consumers may lack A-type PAC, contain lower quantities, or contain adulterants, which results in ineffective products.
In this dissertation, c-PAC standard isolated from cranberry fruit, which reflects the structural heterogeneity and complexity of PAC, was used for an inter-laboratory validation of 4- (dimethylamino)cinnamaldehyde (DMAC) assay for quantification of soluble PAC (Chapter 1). Commercial standards such as procyanidin A2 and B2 lead to an underestimation of the PAC content because the heterogeneity and complexity of PAC are not reflected in these commercial standards. c-PAC exists not only as simple oligomers or polymers of flavan-3-ols but also contains anthocyanin-flavan-3-ol oligomers, which may introduce analytical error due to the change in the stoichiometry and kinetics of reaction. Results indicate that the use of both procyanidin A2 and c- PAC standards meets the standard method performance requirements (SMPR) 2017.003 established by the Association of Official Analytical Chemist (AOAC). Nevertheless, the use of procyanidin A2 standard underestimates the PAC content by at least 3.14-fold compared to c-PAC standard. Despite the DMAC assay providing reliable information on the PAC content, it is not selective and does not differentiate between A- and B-type interflavan bonds. Thus, a complementary technique such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) that differentiates A- and B-type interflavan bonds is needed.
MALDI-TOF MS has demonstrated that the structural heterogeneity and complexity of PAC can be characterized without the problem arising from the formation of multiply charged molecular ions that occurs when electrospray ionization mass spectrometry (ESI-MS) is used. Spectra analysis is less cumbersome in MALDI-TOF MS compared to ESI-MS, because this technique detects single-charged molecular ions. MALDI-TOF MS and the deconvolution method were used for identifying A-type PAC in cranberry products from other botanical sources containing B-type PAC (Chapter 2). Results indicate that both MALDI-TOF MS and the deconvolution method were able to identify the presence of A-type PAC in cranberry products from other botanical sources with a probability greater than 90% and a confidence of 95%. Classification models can be built based on the percentage of A- and B-type PAC because deconvolution of the overlapping isotope pattern of MALDI-TOF MS spectra determines the percentage of A- and B-type PAC at each degree of polymerization (DP).
The growing demand for cranberry products and the lack of policies by regulatory organizations has caused some companies to adulterate their cranberry products with cheaper sources of PAC. MALDI-TOF MS spectra data combined with multivariate analysis was used to build classification models capable of determining authenticity in mixtures of c-PAC with apple-PAC (a-PAC) or peanut skins-PAC (p-PAC) (Chapter 3). Results indicate that MALDI-TOF MS spectra data combined with principal component analysis (PCA) and linear discriminant analysis (LDA) offer the possibility to differentiate and to discriminate amongst sources of PAC. The method is able to determine the adulteration of mixtures of c-PAC with a-PAC or p-PAC, within 5% (w/w) with a confidence level of 95%. Overall, our two previous studies demonstrated that MALDI-TOF MS has the capability to characterize PAC from different botanical sources.
Previous studies have indicated that 96% of PAC from V. macrocarpon contain one or more A- type interflavan bonds. However, the Vaccinium genus contains about 450 species, most of which have unknown PAC composition. The PAC composition from three tropical Vaccinium species (V. consanguineum, V. floribundum, and V. poasanum) from Costa Rica were characterized by MALDI-TOF MS, nuclear magnetic resonance (NMR), and attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) (Chapter 4). Results indicate that PAC from the three tropical Vaccinium species are mainly composed of procyanidins with a cis configuration. In addition, results indicate that B- and not A-type interflavan bonds are the predominant bonds but greater than 74% of the oligomer contain one or more A-type interflavan bonds.
As previously mentioned, PAC analysis is constrained by the lack of analytical methods. In addition, an understanding of the interaction between PAC and their putative health benefits is still lacking. Previously, PAC was fluorescently labeled with 5-([4,6-dichlorotriazin-2-yl]amino) fluorescein (DTAF). However, auto-fluorescence at the excitation wavelength of fluorescein creates difficulties in distinguishing signal-to-noise in fluorescent microscopy using DTAF tagged PAC. We were able to synthesis PAC with cinnamaldehyde and four cinnamaldehyde derivatives, which produced fluorescent proanthocyanidins-cinnamaldehydes pyrylium products (PCPP) for microscopic detection of interaction with extra-intestinal pathogenic Escherichia coli (Chapter 5). Synthesized PCPP were detected and characterized by MALDI-TOF MS. Fluorescent microscopy showed that PCPP exhibited higher excitation and emission wavelengths than PAC and each cinnamaldehyde condensation product exhibited different fluorescent properties, providing a useful tool to trace the fate of PAC and study the interaction between PAC and their putative health benefits.
Overall, this dissertation presents research on the development and use of analytical tools to quantify and characterize PAC that help solve problems associated with the lack of authenticity, standardization, and efficacy of products from cranberries and other sources of PAC.
... Therefore, the clinical benefi t of cranberry consumption for various types of UTI is actively being investigated. Jepson and Craig (2007) systematically have reviewed clinical trials focused on this topic. Using rigorous criteria, which included only randomized controlled trials (RCT), Jepson and Craig (2008) used meta-analysis to examine selected types of RCT, participants, interventions and outcome measures. ...
This book has 19 chapters focusing on the beneficial effects of the consumption of fruits and vegetables on human health. Some of the most common fruits and vegetables, their biologically active constituents and their medicinal properties are discussed. Some methodologies used for the extraction, isolation, characterization and quantification of these biologically active compounds and evaluation of their in vitro and in vivo activities are also presented.
... 18,19,20 Recently, vaginal probiotics / lactobacilli, immuno-stimulation / vaccines, inhibitors of bacterial adhesion, inhibitors of bacterial bio films, stimulation of cyclic adenosine / forskolin, hormone therapy and instillation of attenuated bacteria into the urinary bladder are being tried. 21,22,23 O bj e c t i ve s To study the prevalence of various risk factors, clinical profile and aetiology of acute pyelonephritis in a tertiary teaching hospital in Kerala in adult patients. ...
BACKGROUND
Acute pyelonephritis (APN) is one of the most severe forms of urinary tract
infections (UTI) with a higher incidence among females compared to males.
Escherichia coli is the commonest causative organism isolated in 80 % of the cases
in Kerala. Risk factors like structural or functional abnormalities of urogenital
system, immunosuppression, comorbidities and virulence & resistance of
microorganism play vital roles in predicting the prognosis. Our aim was to study
the prevalence of various risk factors of acute pyelonephritis in adult patients, the
clinical profile, aetiological agents and their sensitivity to antibiotics, and related
complications on their usage.
METHODS
In a cross-sectional observational study, 100 adult patients with acute
pyelonephritis admitted in a tertiary teaching hospital in Kerala were studied
between January 2016 and January 2017. Detailed history and clinical examination
were carried out. Complete haemogram, random blood sugar, renal function test,
urine culture and sensitivity, and ultrasonogram of abdomen and pelvis were done.
RESULTS
The most common age group was 40 - 49 years with a male to female ratio of
2:3. Dysuria was observed in 82 % of patients followed by increased frequency of
micturition in 65 % and vomiting in 42 %. Diabetes mellitus was observed in 55
% of patients and recurrent UTI in 44 %. Escherichia coli was found in 66 % of
patients followed by Klebsiella in 23 %. Culture showed that 85 % of the bacteria
were sensitive to piperacillin-tazobactam. 44 % of the patients did not respond to
the empirical antibiotic, and the failure rate was higher among those empirically
treated with ciprofloxacin. 41 % of the patients developed acute kidney injury,
which necessitated haemodialysis in 23 %. 14 % of the patients developed septic
shock and the mortality was 10 %.
CONCLUSIONS
Certain risk factors such as diabetes, hypertension, chronic kidney disease and
indwelling catheters were associated with increased incidence of complications.
Hence, in presence of such risk factors appropriate treatment and preventive
measures should be initiated promptly. Among the pathogens, 85 % of the
organisms were sensitive to piperacillin–tazobactam. Hence, piperacillintazobactam can be recommended as the first line empirical antibiotic.
... Yaban mersini, üriner sistem enfeksiyonları üzerinde kızılcığa benzer aktiviteler gösterir. 38,39 Yapılan çalışmalarda gebe kadınların, üriner sistem enfeksiyonlarının tedavisinde, yaban mersininden yararlandıkları belirlenmiştir. [40][41][42] Gebelik döneminde, üriner sistem enfeksiyonlarının önlenmesinde ve tedavisinde aromaterapiden faydalanılabilir. ...
... Flavonoids play a wide range of important roles in plants, including pigmentation, UV protection, signaling, and defense; all of which glyphosate may compromise (Mathesius 2018). Flavonoids can also have beneficial effects for plant consumers such as anti-oxidative and anti-inflammatory properties which are thought to protect against various degenerative diseases, such as cardiovascular disease and neurological disorders (Reed 2002;Moyer et al. 2002;Jepson and Craig 2007;Su and Chien 2010;Grosso et al. 2013). A change in flavonoid proportion and/or concentration could therefore have consequences up the food chain. ...
Glyphosate-based herbicides are widely used in Canadian silviculture to control competing vegetation, particularly broadleaf plants, and non-target, understory plants are often exposed to sub-lethal doses. Understory plants such as red raspberry (Rubus idaeus) and highbush cranberry (Viburnum edule) play many integral ecological roles, which may be altered by glyphosate.
To determine the effects of sub-lethal glyphosate on raspberry and cranberry plant growth and health, experimental plots were established in the central interior of British Columbia, Canada, using a nested design. Plots were treated with 0.3% VisionMax™ after which, leaf dimensions were quantified and leaf formation assessed, and chlorophyll fluorescence, total flavonoid and rutin concentrations were measured on a weekly basis.
Treated cranberry plants produced new leaves that were smaller overall, while treated raspberry plants had narrower leaves. There were a higher proportion of abnormal leaves in treated plants. Photosynthetic performance was hampered in all treated plants; cranberry plants appeared to recover more quickly however. Flavonoid concentration was largely unaffected although rutin concentration increased in treated cranberry leaves.
The two species responded differently to sublethal glyphosate in their morphology and physiology, and that likely altered overall growth and health. We discuss the ecological consequences of such alterations on forage availability and habitat quality.
... -Evitar la retención de orina y promover la micción post-coito -Evitar el uso de diafragmas con cremas espermicidas como método anticonceptivo -Evitar el estreñimiento -La recomendación del uso de arándanos en jugo o comprimidos se ve limitada no solo por la inconsistencia de su eficacia sino también por la alta tasa de abandonos en tratamientos prolongados y las interacciones con otros medicamentos como warfarina 64,65 -Estrógenos tópicos: en diversos estudios todas las preparaciones de estrógeno vaginal (óvulos, crema, anillos vaginales) disminuyeron el número de ITU en comparación con placebo o en comparación con la condición basal (número de infecciones antes de comenzar el estudio o presencia de bacteriuria) 66 -Estrógenos sistémicos: En ningún estudio se observó reducción significativa en los episodios de ITU en comparación con placebo 67,68 -D-manosa: Los manósidos son moléculas pequeñas biodisponibles por vía oral y muestran acción inhibitoria sobre la adhesión bacteriana al uroepitelio 69 . En un estudio se demostró que la administración de 2 g de D-manosa por día redujo el riesgo de recurrencia de ITU en forma similar al tratamiento con nitrofurantoina. ...
The Argentine Society of Infectious Diseases and other scientific societies have updated these recommendations based on data on urinary tract infections in adults obtained from a prospective multicenter study conducted in Argentina during 2016-2017. Asymptomatic bacteriuria should be treated only in pregnant women, who should also be systematically investigated; the antibiotics of choice are nitrofurantoin, amoxicillin, clavulanic/amoxicillin, cephalexin and trimethoprim-sulfamethoxazole. In procedures involving injury to the urinary tract with bleeding, it is recommended to request urine culture and, in the presence of bacteriuria, antimicrobial treatment according to sensitivity should be prescribed from immediately before up to 24 hours after the intervention. In women, cystitis can be treated with nitrofurantoin, cephalexin or fosfomycin, while trimethoprim-sulfamethoxazole and fluoroquinolones are not recommended; pyelonephritis can be treated with ciprofloxacin, cefixime or cephalexin in ambulatory women or ceftriaxone, cefazolin or amikacin in those who are hospitalized. In men, urinary tract infections are always considered complicated; nitrofurantoin or cephalexin are recommended for 7 days, alternatively fosfomycin should be given in a single dose. In men, ciprofloxacin, ceftriaxone or cefixime are suggested for pyelonephritis on ambulatory treatment whereas ceftriaxone or amikacin are recommended for hospitalized patients. Acute bacterial prostatitis can be treated with ceftriaxone or gentamicin. Fluoroquinolones were the choice treatment for chronic bacterial prostatitis until recently; they are no longer recommended due to the increasing resistance and recent concerns regarding the safety of these drugs; alternative antibiotics such as fosfomycin are to be considered.
... Vaccinium myrtillus is a species of the genus Vaccinium from the family Ericaceae [20]. Fruit and aerial parts of plant are known as a natural source of food and drink due to their richness in nutritional and antioxidant compounds and can also be integrated into food supplements and pharmaceuticals for preventing urinary tract infections [21] and cerebral vascular accidents [22]. Bilberry has several effects such as prevention or even reversal in a considerable degree of age-related object memory decline of rats [23] and antioxidant [24,25], anti-inflammatory, anticancer, anti-neurodegenerative, and cardioprotective effects [26,27] due to their phenolic compounds, including proanthocyanidins, flavonoids, stilbenoids, phenolcarboxylic acid derivatives, and flavonol glycosides [20]. ...
Simple Summary: In poultry, diet composition influences growth performance, egg production, as well as digestion. In this study, the effects of dietary additives obtained from bilberry and walnut leaves powder on the digestive performances of Tetra SL hens were evaluated by histologic and morphometric analyses of the intestinal mucosa as well as by the enzymatic activity measurements of alpha-amylase, invertase, maltase, and trypsin correlated with cecum microbiota. Abstract: The purpose of this study was to examine the effects of dietary inclusion of two additives at the final concentration of 0.5% bilberry (E1) and 1% walnut (E2) leaves powder in the basal diet on digestive health of hens. A total number of 90 Tetra SL hens were divided into two experimental groups (E1 and E2) and one control group (C) consisting of 30 hens each. After four weeks, 10 hens of each group were sacrificed and tissue samples and intestinal content were taken from the duodenum, jejunum, and cecum in order to perform histological, enzymatic, and microbiota analyses. In groups E1 and E2, the histological analysis showed a significant increase of villus height, resulting probably in increased absorption of nutrients in duodenum and jejunum. A decrease in the specific activity of alpha-amylase and trypsin in E1 and E2 for both duodenum and jejunum compared to the control one was also recorded. In addition, the maltase and invertase specific activity in duodenum increased, a tendency that was kept for maltase but not for invertase in jejunum. The cecal microbiota of E1 and E2 individuals was characterized by an increase of Firmicutes and Lactobacilli and a decrease of Enterobacteriaceae. In conclusion, our results indicate that bilberry and walnut leaves additives in feed may improve the health status of the poultry gastrointestinal tract.
... vitisidaea, Blueberry -V. myrtillus) have some of the basic ingredients of cranberry, but there are few research findings that support prevention [10,11]. Cranberry consists of water (88%), organic acids (including salicylates), fructose, vitamin C (high content, ie 200 mg / kg fresh berries), flavonoids, anthocyanins, catechins and triterpenoids compound [8]. ...
Lower urinary tract infection (UTI) is very common diseases. Recurrent UTI remain challenging to treat because the main treatment option is long-term antibiotic and this poses a risk for the emergence of bacterial resistance. Some options to avoid this risk are available, including the use of cranberry and elderberry products (herbal products extract). However, this can lead to the advent of bacterial resistance. The cross sectional study was designed to evaluated the efficacy of above products. The study was conducted from 23 October 2019 to 28 October 2019 in Arif Memorial Teaching Hospital, Lahore, Pakistan. The subjects were outpatients aged 20 to 65 years. UTI symptoms were recorded in the daily diary before, during and after treatment and assessed by the Jackson score. Following approval by the Ethics Committee of Rashid Latif Pharmacy College, the questionnaire (ROUTE2-002) was compiled and information of UTI patients using cranberry and elderberry extracts (Berdi® Sachet) was collected. Compliance and tolerability were considerable obstacles in this study. A total of 67 patients were screened for participation; 12 were unwilling to participate and 55 were enrolled for clinical trial and all patients had urinary tract irritation. In this study 55 (100%) UTI patients were cured with cranberry and elderberry extracts (Berdi® Sachet). Further investigation is needed to confirm this effect and to evaluate the health benefits of cranberries and elderberry.
... Jepson R., and Craig J. 2007 [67]. ...
... In post-menopausal women with recurrent UTIs, the use of topical estrogen has been shown to reduce the events of UTIs, improving vaginal atrophia and increasing vaginal lactobacilli [79]. Several evidences suggest the use of cranberry juice for patients with chronic recurrent post-transplant UTIs in order to prevent the adhesion of uropathogenic micro-organisms to the urothelium [80]; however, the role of these products is still controversial, as a recent Cochrane systematic review and meta-analysis points out that cranberry juice is less effective than previously indicated [81]. Moreover, d-mannose have shown promising results in reducing the risk for UTIs, inhibiting the attachment of bacterial type 1 fimbriae to cell surfaces and reducing their ability to infect the host, but its efficacy has not been evaluated in RCTs yet [82]. ...
Urinary tract infection (UTI) represents the most common infection after kidney transplantation; it is associated with an increased risk for acute kidney rejection and impaired graft function in the early post-transplant period. Kidney transplant recipients with UTIs are often clinically asymptomatic due to the immunosuppressive therapy; however, asymptomatic bacteriuria may progress to acute pyelonephritis, bacteremia and urosepsis, particularly in the early post-transplant period, that are independent risk factors for short and long-term graft and patient survival. This article reviews the definitions, incidence, risk factors and the management of UTI in kidney transplant recipients; furthermore, the main controversial and still unanswered questions, regarding the causes of recurrent UTIs, adequate use of antibiotics to avoid antibiotic resistance, dosing and timing for prophylaxis and treatment of symptomatic infections, are also discussed. The emerging definition of urinary microbiota introduces new concepts in understanding the complexity of the disease and might represent the future target for therapeutic interventions.
... Otherwise, also European cranberry (V. oxycoccos), lingonberry, and blueberry contain bioactive compounds effective against E. coli but their evidence in urinary infection prevention is still in doubt and not exactly clear [93,94,103]. The positive effects of cranberry extract have been correlated to A-type linkage proanthocyanidins. ...
Lesser known fruits or underutilized fruit species are recently of great research interest due to the presence of phytochemicals that manifest many biological effects. European cranberry, Vaccinium oxycoccos fruit, as an important representative of this group, is a valuable source of antioxidants and other biologically active substances, similar to American cranberry (V. macrocarpon) which is well known and studied. European cranberry fruit is rich especially in polyphenolic compounds anthocyanins (12.4–207.3 mg/100 g fw), proanthocyanins (1.5–5.3 mg/100 g fw), and flavonols, especially quercetin (0.52–15.4 mg/100 g fw), which mostly contribute to the antioxidant activity of the fruit. Small cranberry is also important due to its various biological effects such as urinary tract protection (proanthocyanidins), antibacterial and antifungal properties (quercetin, proanthocyanidins, anthocyanins), cardioprotective (proanthocyanidins) and anticancer activities (proanthocyanidins), and utilization in food (juice drinks, jams, jellies, sauces, additive to meat products) and pharmacological industries, and in folk medicine.
... Cranberries contain complex mixtures of sugars, flavonoids, and anthocyanins (Howell, 2007), and have been shown to have a number of beneficial health effects. They have been shown to inhibit urinary tract infections (Bailey, Dalton, Daugherty, & Tempesta, 2007;Henig & Leahy, 2000;Jepson & Craig, 2007). Cranberries also support oral and gastrointestinal health (Burger et al., 2000;Lin, Kwon, Labbe, & Shetty, 2005), improve cardiovascular function (Dohadwala et al., 2010;McKay & Blumberg, 2007), reduce neurological problems (Dong, Mitchell, & Colquhoun, 2015), regulate glucose levels (Shidfar et al., 2012) and even may prevent cancer (Neto, 2007;Neto, Amoroso, & Liberty, 2008;Singh, Wilson, Kalk, Cheong, & Vorsa, 2009). ...
... [7] Cranberry juice has long been associated with the potential of preventing urinary tract infections, a property linked to the anti-adhesion effects of cranberry proanthocyanidins (PACs) and poly-flavan-3-ols against certain pathogenic Escherichia coli strains. [8][9][10] Cranberry constituents have been shown to suppress the growth of a www.advancedsciencenews.com www.mnf-journal.com variety of cancer cells in vitro, e.g., lung, colon, breast, oral, ovarian, and prostate cancer cells. ...
Scope
There are growing interests in using whole food‐based approach to prevent chronic diseases due to potential synergistic interactions among different bioactive components within the whole foods. North American cranberry (Vaccinium macrocarpon), a polyphenol‐rich fruit, has been shown to exert multiple beneficial health effects.
Methods and results
: For the first time, we determined the protective effects of whole cranberry powder (WCP) against colitis‐associated mouse colon tumorigenesis induced by azoxymethane (AOM) and dextran sulfate sodium (DSS). The results showed that dietary administration of WCP (1.5%, w/w in the diet) significantly suppressed colon tumorigenesis as indicated by the reduced tumor incidence, multiplicity, burden and average tumor size in WCP‐fed mice compared to the positive control mice. Both gene and protein expression levels of pro‐inflammatory cytokines IL‐1β, IL‐6 and TNF‐α were markedly attenuated by WCP treatment in the colon of AOM/DSS‐treated mice. Moreover, WCP profoundly modulated multiple signaling pathways/proteins related to inflammation, cell proliferation, apoptosis, angiogenesis and metastasis in the colon, which was closely associated with the inhibitory effects of WCP on colon tumorigenesis.
Conclusion
Overall, our results demonstrated chemopreventive effects of WCP on colon tumorigenesis in mice, providing a scientific basis for using the whole cranberry as a functional food to promote colon health in humans.
This article is protected by copyright. All rights reserved
... Critical reviews, including meta-analyses, generally support the efficacy of cranberry in the aforementioned indication. [12][13][14] However, a 2012 review indicated that methodological flaws in the design of the clinical studies and insufficient characterization of the administered cranberry products impede a reliable assessment. 15 Other health benefits and actions of cranberry which have been investigated include prevention of gastric ulcers (caused by H. pylori), and activities related to periodontal disease, cancer prevention, glycemic response, antiviral activities, and a reduction of cardiovascular risk factors. ...
Goal: The goal of this bulletin is to provide timely information and/or updates on issues of adulteration of cranberry fruit (Vaccinium macrocarpon) extract to the international herbal products industry and extended natural products community in general. It is intended to present the available data on the occurrence of adulteration , the market situation, and consequences for the consumer and the industry.
... Byproducts (pomaces) from the berry juice industry: including blueberry (Vaccinium corymbosum) and blackberry (Rubus fruticosus), are major sources of phenolics that have roles in health improvement through anti-inflammatory, antimicrobial, anti-carcinogenic, anti-oxidant, and vasodilatory along with other beneficial properties (Boivin et al., 2007;Jepson and Craig, 2007;Tzounis et al., 2011;Salaheen et al., 2014). Dietary supplementation of plant phenolic extracts has been demonstrated to enhance growth performance in broilers but the mechanism of action has not yet been elucidated (Hernández et al., 2004). ...
Antibiotic growth promoters (AGPs) are frequently used to enhance weight-gain in poultry production. However, there has been increasing concern over the impact of AGP on the emergence of antibiotic resistance in zoonotic bacterial pathogens in the microbial community of the poultry gut. In this study, we adopted mass-spectrophotometric, phylogenetic, and shotgun-metagenomic approaches to evaluate bioactive phenolic extracts (BPE) from blueberry (Vaccinium corymbosum) and blackberry (Rubus fruticosus) pomaces as AGP alternatives in broilers. We conducted two trials with 100 Cobb-500 broiler chicks (in each trial) in four equal groups that were provided water with no supplementation, supplemented with AGP (tylosin, neomycin sulfate, bacitracin, erythromycin, and oxytetracycline), or supplemented with 0.1 g Gallic acid equivalent (GAE)/L or 1.0 g GAE/L (during the last 72 h before euthanasia) of BPE for 6 weeks. When compared with the control group (water only), the chickens supplemented with AGP and 0.1 g GAE/L of BPE gained 9.5 and 5.8% more body weight, respectively. The microbiomes of both the AGP- and BPE-treated chickens had higher Firmicutes to Bacteroidetes ratios. AGP supplementation appeared to be associated with higher relative abundance of bacteriophages and unique cecal resistomes compared with BPE supplementation or control. Functional characterization of cecal microbiomes revealed significant animal-to-animal variation in the relative abundance of genes involved in energy and carbohydrate metabolism. These findings established a baseline upon which mechanisms of plant-based performance enhancers in regulation of animal growth can be investigated. In addition, the data will aid in designing alternate strategies to improve animal growth performance and consequently production.
... Cranberry fruits have gained interest as rich sources of prohealthy compounds, displaying high nutritive and biological value. They are a good source of vitamins, minerals, organic acids, fiber, and sugars [1,2]. The most important groups of phytochemical compounds in cranberry fruit are polyphenolic and triterpene compounds, exhibiting strong antioxidant properties and the ability to alleviate chronic diseases [3][4][5] and influence their sensory attributes [1,6,7]. ...
The changes of polyphenols and triterpenoids in three cranberry cultivars (‘Pilgrim’, ‘Stevens’, and ‘Ben Lear)’ from different maturity stages, grown in Poland, were determined using ultra-performance liquid chromatography (UPLC) and photodiode detector-quadrupole/time-of-flight mass spectrometry. Fifty-one bioactive compounds were identified in cranberry fruits, including 48 polyphenols (19 flavonols, 8 anthocyanins, 7 phenolic acids, and 14 flavan-3-ol oligomers) and 3 triterpenoids (betulinic, oleanolic, and ursolic acids). The concentrations of individual polyphenolic compounds during ripening were similar, whereas their values differed significantly. Immature fruits showed the lowest level of polyphenolic compounds, which increased in semi-mature cranberry fruits and did not change remarkably in commercially mature cranberry fruits. The quantity of phytochemical compounds during cranberry fruit ripening depended on cultivar, and the cultivar ‘Stevens’ had significantly higher concentrations of bioactive compounds and antioxidant capacity in comparison to the other tested cultivars.
... Because antibiotics also can be relatively expensive and may require prescriptions from physicians, there is a great deal of interest in alternative approaches to prevent- ing or treating UTIs (Reid 1999). These include the use of over-the-counter plant preparations such as those derived from fruits such as cranberries or various herbs (Martin and Ernst 2003;Jepson and Craig 2007;DiPasquale 2008;Flower et al. 2015). ...
Aims:
Urease is a key virulence factor for the Gram-positive urinary tract pathogen Staphylococcus saprophyticus and a potential target for antimicrobial therapy. The enzyme from S. saprophyticus is unusual in that it does not contain cysteine at the active site. The aims of this study were to test fourteen over-the-counter plant preparations as inhibitors of this urease and to determine if they can prevent the increase in pH that normally occurs in bacterial cultures containing urea.
Methods and results:
Urease activity was measured colorimetrically by the formation of ammonium ions. The green tea and Uva Ursi preparations reduced urease activity in a soluble extract of S. saprophyticus by more than 75%. Two herbal mixtures were weakly inhibitory and reduced activity by about 25% but the other products had little or no effect. The green tea and Uva Ursi extracts also inhibited urease activity in whole cells by more than 75%. One of the herbal products (WishGarden UTI) showed some inhibition of urease activity but the other (UTI Clear) did not. The green tea and Uva Ursi preparations prevented the increase in pH that normally occurs when S. saprophyticus is grown in an artificial urine medium but this was due primarily to bacterial death. The WishGarden UTI preparation could partially delay the pH increase while allowing some cells to remain viable.
Conclusions:
These results indicate that only a few of the commercially available over-the-counter plant preparations commonly used for the treatment of urinary tract infections can inhibit the urease activity from S. saprophyticus. This article is protected by copyright. All rights reserved.
... Among the many phenolic compounds, anthocyanins have a great amount of attention since they possess potent antioxidant activity (PRIOR et al., 1998;SEERAM, 2008;VRHOVSEK et al., 2012). Anthocyanins have shown an important role in the prevention of macular degeneration (TREVITHICK & MITTON, 1999), neuronal diseases, cardiovascular diseases, cancer, diabetes (CHAMBERS & CAMIRE, 2003;KRAFT et al., 2005;MARTINEAU et al., 2006;NETO, 2007;SHUKITT-HALE et al., 2008;PATRAS et al., 2010) and urinary tract disorders (KALT & DUFOUR, 1997;HOWELL et al., 2005;JEPSON & CRAIG, 2007). Because of their beneficial role as micronutrients, it is of utmost importance to measure the changes in polyphenolics during processing to better assess the dietary value of the processed products (RAWSON et al., 2011;HOWARD et al., 2012). ...
To obtain blueberry juice with a high content of antioxidants it is necessary to introduce an enzymatic depectinization step into the process. Due to the importance of this step in the final properties of blueberry juice it is critical that the operation conditions be optimized. The aim of this research was to evaluate the effects of temperature, duration of treatment and enzymatic complex concentration on anthocyanin content and juice yield during enzymatic depectinization. Results indicated that the best factor combination was 50ºC during 1.3h and 4mg 100g-1 of LAFASE(r) CLARIFICATION and 8mg 100g-1 of LAFASE(r) HE GRAND CRU enzymatic complex concentration. Under these conditions, blueberry juice with 798.41±8.03mg of cyanidin-3-glucoside L-1 and a juice yield of 87% was obtained. The combination of the response surface and desirability function methodologies enabled the optimization of the blueberry juice during the depectinization step, in terms of anthocyanin content and juice yield.
... These notable bioactive phytochemicals have been considered to be linked to the unique health effects of cranberries. Cranberries are traditionally thought to prevent and treat urinary tract infections (UTI) and scientific verification of this pharmaceutical effect has been reported in recent years (Bailey, Dalton, Daugherty, & Tempesta, 2007;Henig & Leahy, 2000;Jepson & Craig, 2007). Besides the UTI prevention effect, recent studies also suggested that the cranberry may also promote gastrointestinal and oral health (Burger et al., 2000;Lin, Kwon, Labbe, & Shetty, 2005), improve cardiovascular health (Dohadwala et al., 2011;McKay & Blumberg, 2007), mitigate neurological problems (Dong et al., 2012), control blood glucose (Shidfar et al., 2012) and even prevent cancer (Neto, 2007;Neto, Amoroso, & Liberty, 2008;Singh et al., 2009). ...
Storage stability of cranberry purees, processed with hydrothermodynamic (HTD) technology was studied for a period of 285 days. Three different formulations of cranberry puree were investigated: pure cranberry (PC); cranberry processed with natural sweetener (SC); and cranberry processed with natural sweetener and diluted with water (SCW). No significant difference in pH and soluble solid content (Brix) of all samples during storage was observed. The degradation kinetics of the bioactive compounds followed first-order reactions. Compared with other bioactive compounds, anthocyanins were the most stable at a 4 °C storage temperature with t1/2 from 248 to 330 days depending on the puree formulation. At room temperature, the stability of anthocyanins was significantly smaller than that of PACs and polyphenols. Addition of natural sweetener reduced the storage stability of most bioactive compounds. Colour of processed cranberry puree significantly degraded with time, temperature and addition of sweetener. The study suggested refrigerator storage of HTD processed cranberry products in order to increase their storage stability and shelf-life.
... The studied species are rich in anthocyanins and flavonoids. Many reports have suggested that these compounds exhibit a wide range of biological activities, e.g., antioxidant, anti-inflammatory and anticancer effects [12,22,27]. Thus, they are assumed to promote health by protecting one from various degenerative diseases and diabetes as well as enhancing visual function and slowing the progress of neurological disorders. ...
... Since the early 21 century, raw cranberry has been marketed as a "super fruit" due to their excellent nutritional value and health promoting effects. The health benefits of cranberries have been intensively studied in recent years and the reported benefits include prevention of urinary tract infection (Bailey, Dalton, Daugherty, & Tempesta, 2007;Jepson & Craig, 2007;Kontiokari et al., 2001) and gastrointestinal disease (Burger et al., 2000;Lin, Kwon, Labbe, & Shetty, 2005); improvement of cardiovascular health (Dohadwala et al., 2011;McKay & Blumberg, 2007) and neurological health (Heim, Angers, L eonhart, & Ritz, 2012;Yao & Vieira, 2007); control of blood glucose (Shidfar et al., 2012); as well as anticancer (Neto et al., 2005;Neto, Amoroso, & Liberty, 2008;Singh et al., 2009), antivirus (Lipson et al., 2007) and antiinflammation (Bodet, Chandad, & Grenier, 2006;La, Howell, & Grenier, 2010) effects. These benefits appear to be substantially due to the rich bioactive compounds present in cranberries. ...
Proanthocyanidins (PACs) are oligomeric flavan‐3‐ols found in fruits and botanicals that are used as ingredients in dietary supplements due to their putative health benefits. In the United States, consumers spend over $9.6 billion on dietary supplements annually. PAC‐containing dietary supplements lack standardization, may not be authentic and lack research on efficacy. The 4‐(dimethylamino)cinnamaldehyde (DMAC) method for quantifying PACs, is preferred over the vanillin‐HCl and butanol‐HCl due to greater sensitivity, repeatability, and precision. However, the DMAC method has several problems related to accuracy. In this chapter, we discuss our research on the DMAC reaction with PACs in order to illustrate the importance of the choice of standards. We also discuss the DMAC reaction mechanism in relation to the absorbance and fluorescent spectra of the reaction products.
In ancient time people used plants as drugs. They used parts of plants like leaves, fruits, roots, stem, flowers, seeds, bark or whole plant. Traditional medicine is known as the primary health care in the world, about 70% of developing countries depends on the plant based treatment. In current scenarios most of the institutes promoting the use of plant based medicines. For the treatment of kidney stone tribal people uses several plant or juice of the plants for example Momordica charantia, Moringaolieferia, Amnivisnaga, Terbulusterrestris, Dolichosbiflorus, Arvalanata, Cotusspiralis,Vaccinumoxycoccos, Coriendrumsativum, Embelicaofficinalis, Petroselinum crispum, Barosmabetulina etc. Keywords: Kidney Stone, Herbal Treatment, Medicinal Plants, Antioxidants, Uric Acid, UTIs, Cysteine, Struvite, Diuretics
Fruit is an essential part of the human diet and is of great interest because of its richness in phytochemicals. Various fruit extracts from citrus, berries and pomegranates have been shown to possess a broad spectrum of medicinal properties. Fruit phytochemicals are of considerable interest because of their antioxidant properties involving different mechanisms of action, which can act against different pathogenic bacteria. The antioxidant capacity of fruit phytochemicals involves different kinds of reactions, such as radical scavenging and chelation or complexation of metal ions. The interaction between fruit phytochemicals and bacteria has different repercussions: it disrupts the cell envelope, disturbs cell-cell communication and gene regulation, and suppresses metabolic and enzymatic activities. Consequently, fruit phytochemicals can directly inhibit bacterial growth or act indirectly by modulating the expression of virulence factors, both of which reduce microbial pathogenicity. The aim of this review was to report our current knowledge on various fruit extracts and their major bioactive compounds, and determine the effectiveness of organic acids, terpenes, polyphenols, and other types of phenolic compounds with antioxidant properties as a source of antimicrobial agents.
To genus Vaccinium belongs ~400 species of different shrubs and trees. Many Vaccinium genus plants bear berries with excellent taste properties and health benefits and thus are intensively cultivated. The most known Vaccinium genus berries are blueberries, cranberries, and lingonberries. Blueberry cultivation is fast growing worldwide, also in the Mediterranean region, North Africa, and other countries. A significant part of these berries are consumed fresh and used for the production of juices. As the waste of Vaccinium berry processing, their press residues (pomace) are formed. Vaccinium berry waste is acidic, with low calorific value, and finds minimal applications for fruit teas preparation and as additives in the bakery. However, there is major application potential of the Vaccinium berry processing waste biorefinery in the valuable substances, as the berry press residues contain many groups of substances with significant application potential. Berry seeds contain polyunsaturated fatty acids, sterols, and terpenes. Berry skins contain waxes in their outermost layer as well as berry skin lipids. An important group of substances, prospective for Vaccinium berry residue processing are their phenolics and carbohydrates. Considering the application, potential approaches for the valorization of the Vaccinium berry press residues are developed. At first, berry press residues can be milled and used in fruit teas. Their application’s significant potential is the extraction of valuable components, and from the perspective of the market, extraction of phenolics and lipids (oils) are the most prospective. Besides traditional extraction methods, recently environmentally friendly approaches are becoming more popular. To make the berry waste biorefinery realistic, the development of berry waste extract fractionation technologies is important.KeywordsBerriesBiorefineryExtractionPhenolicsLipidsHealth-promoting effects
Nefroloji, temel olarak böbrek hastalıklarıyla ilgilenen bir tıp bilimi dalıdır. Nephros böbrekler, -ology çalışma anlamına gelen Yunanca kökenli bir terimdir. Türkçede böbrek kelimesinin kökeni araştırıldığında, Orhun Yazıtlarında kaburga ve kalça arasındaki boşluğun adının “bögür” olarak geçtiği görülür. Uygurca tıp metinlerindeki kullanımı bügür’dür. Eski Türkçeden beri kullanılagelen bögür kelimesi “böbrek, böğür, yan” anlamındadır. Türkçenin tarihi dönemlerinde, Karahanlıcada bögür, Çağataycada ise bögr şeklindedir. Dîvânu Lugâti't-Türk’te (1070, Kaşgarlı Mahmut) bögür, böbrek adı olarak geçmektedir. 1400’den önce Osmanlı Döneminde muhtemelen böğür kelimesine -ek eki getirilerek böğrek kelimesi böbrek anlamında kullanılmıştır. Halk arasında hâlâ organın bulunduğu yerle ilişkilendirilmek için böğür kelimesi yaygın kullanılsa da, günümüzde artık böbrek olarak ifade edilmektedir.
Günümüzde epidemiyolojik çalışmalar, böbreklerimizi olumsuz etkilediğini bildiğimiz diabetes mellitus, hipertansiyon, obezite, aterosklerotik kalp hastalığı, romatolojik hastalıklar ve kanser gibi sağlık problemlerinin sıklığının giderek arttığını göstermektedir. Ayrıca bunlara primer böbrek hastalıkları ve sekonder olarak böbreği tutan başka birçok sistemik hastalığı da ekleyince günlük hekimlik pratiğinde böbrek rahatsızlığı şüphesi olan ya da bu tanı ile tedavi-izlem altında olan bir çok hasta ile karşılaşmaya devam edeceğimizi öngörebiliriz.
Böbrekler sıvı, elektrolit, asit ve baz dengesini düzenleyen, ilaçlar ve toksinler dahil bir çok endojen ve eksojen atık ürünleri ve fazla sıvıyı kandan filtreleyen karmaşık kan damarı ve tübül ağına sahip boşaltım sisteminin yaşam için hayati önem taşıyan organıdırlar. Nefroloji uzmanları; böbrek yetmezliği, hipertansiyon, elektrolit (sodyum, potasyum, kalsiyum, fosfor vb.) bozuklukları ve idrar anormalliklerinin (hematüri ve proteinüri vb.) nedenlerinin araştırılması, tedavi ve takibi, ayrıca kullandığımız ilaçlara bağlı böbrek toksisitesinin olumsuz etkilerinin önlenmesi konularında rol alırlar.
Kronik böbrek hastalığı dünyada ve Türkiye’de giderek artan önemli bir halk sağlığı sorunu haline gelmiştir. Böbrek hastalığı farkındalığını arttırmak için Uluslararası Nefroloji Derneği (ISN) ile Uluslararası Böbrek Vakıfları Federasyonunun (IFKF) ortak girişimiyle 9 Mart 2006 tarihinde ilk kez “Dünya Böbrek Günü” kutlanmıştır ve o günden bu yana her yıl Mart ayının 2. perşembe günü tüm dünyada “Dünya Böbrek Günü” olarak kutlanmaya devam edilmektedir. Kronik böbrek hastalığının en önemli nedeni diabetes mellitustur. Ülkemizde yapılan taramalara göre erişkinlerde kronik böbrek hastalığı sıklığı %15.7 (~7.5 milyon kişi), böbrek hastalıklarının farkındalığı ise %1.6 düzeyinde tahmin edilmekte ve sorunun boyutunun tahmin edilenin çok üzerinde olduğu görülmektedir. Hâlen tüm dünyada 2 milyondan fazla kişi diyalize girmekte ve böbrek nakli tedavileri ile yaşamını sürdürmektedir. Önümüzdeki 10 yıl içinde bu sayının ikiye katlanacağı, tedavi maliyetlerinin 1.5 trilyon doları aşacağı hesaplanmaktadır. Dolayısıyla temel olarak böbrek sağlığımızı korumak için gerekli önlemleri almak, yani koruyucu hekimlik her zaman daha önemlidir. Kronik böbrek hastalığından korunmak için bireyler; düzenli egzersiz yapmalı, sağlıklı beslenmeli, vücut ağırlığını korumalı, tuzu azaltmalı, yeterli sıvı almalı, sigara içmemeli, alkolden uzak durmalı, ağrı kesici ilaçlardan hekim önerisi olmadığı sürece kaçınmalı, kan basıncını ve kan glukozunu düzenli olarak ölçtürmeli ve risk grubunda ise böbreklerini düzenli olarak kontrol ettirmelidirler.
Diğer mesleklerden insan sağlığı ile uğraştığı için daha kutsal sayılan hekimlik mesleğinin bir diğer özelliği ise sürekli yenilenme ihtiyacının olmasıdır. Modern tıp çağında teşhis ve tanı yöntemleri, görüntüleme teknikleri, cerrahi ve robotik müdahaleler, girişimsel işlemler, özellikle moleküler düzeydeki bilimsel gelişmeler yaygınlaşmaktadır. Bununla birlikte hastadan anamnez almanın ve muayene etmenin yani hastayı dinlemenin, yakınmalarını doğru yorumlamanın ilk önceliğimiz olduğu unutulmamalıdır. Çünkü Hipokrat hekimliği döneminden beri “Hastalık yoktur, hasta vardır.” ilkesi hiç değişmemiştir. Böbrek hastalıklarında da, hastalığın özelliği olan semptom ve bulgular hiçbir zaman hastalar arasında aynı ölçüde görülmemektedir.
The lack of analytical methods to determine authenticity of proanthocyanidins (PAC) in functional foods and dietary supplements is a problem in market regulation and development of efficacious products. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) of PAC structure offers good potential for rapid analysis in authenticity research. We used MALDI-TOF MS and deconvolution to determine the percentage of A- and B-type interflavan bonds in PAC oligomers. Deconvolution works because isotope patterns are repeatable and accurate. Multivariate analysis using relative ratios of A- to B- type interflavan bonds as determined by deconvolution or autoscaled spectra was used to classify and differentiate plant species based on PAC spectral data. Principal component analysis (PCA) of PAC spectra data was able to differentiate botanical sources and linear discriminant analysis (LDA) correctly classified botanical sources, indicating that MALDI-TOF MS combined with multivariate analysis is an effective tool to determine PAC authenticity.
The extracts of leaves and roots of Costus afer plant have been fully investigated in an attempt to determine their phytochemical constituents and antioxidant activities. Phytochemical screening carried out using thin layer chromatography (TLC) revealed the presence of several secondary metabolites in all the selected extracts of the plant. In addition, our results showed that the leaves of C. afer are the richest in polyphenols with an average value of 3416.25 μg EAG/g MS. The total flavonoid assay revealed a highest content in the leaves (8.02 %). Furthermore, studies of the antioxidant activities using 2,2-diphenyl-1-picrylhydrazyl (DPPH•) method showed a significant effect compared to the reference vitamin C. Ethyl acetate extract of the leaves show a higher percentage of inhibition (83 %), followed the roots (69 %).
El consumo de arándanos (Vaccinium corymbosum) despierta, actualmente, un gran interés debido a los efectos beneficiosos que tienen para la salud, relacionado con su alto contenido en componentes antioxidantes, principalmente, en antocianinas. Distintos autores le atribuyen propiedades farmacológicas y funcionales como anticarcinogénesis, reducción de enfermedades coronarias, tratamientos contra desórdenes en el tracto urinario y mejoramiento de la memoria.
Si bien en España, la producción y consumo son reducidos, en Argentina, un excedente de producción obliga a considerarlo como ingrediente para la fabricación de nuevos productos. Por esta razón, en colaboración con la Facultad de Ciencias de la Alimentación de la Universidad Nacional de Entre Ríos de Argentina, se plantea el estudio de la elaboración de un zumo de arándanos con alto contenido en compuestos antioxidantes que pueda ser utilizado para el desarrollo de alimentos funcionales.
En la elaboración de zumo de arándanos se plantea estudiar dos etapas importantes, la despectinización y la homogenización a altas presiones. Los arándanos poseen una alta concentración de pectinas que combinado con su bajo pH, provocan una rápida gelificación durante la etapa de triturado, impidiendo su posterior procesado. Por esta razón, es fundamental realizar una despectinización, utilizando enzimas pectolíticas. En el mercado existen distintos packs enzimáticos con actividad hidrolítica sobre las cadenas pécticas que actualmente se utilizan durante la maceración de vino; además también se plantea la utilización de levaduras con alta capacidad pectolítica que han sido seleccionadas genéticamente por el grupo de investigación en biotecnología del Instituto de Ingeniería de Alimentos para el Desarrollo. Una vez obtenido el zumo, se estudia el efecto de la aplicación de altas presiones de homogenización sobre las propiedades del zumo. Someter el zumo a procesos de altas presiones puede mejorar no solo sus características reológicas, sino también sus características funcionales y su estabilidad microbiológica durante el almacenamiento.
Para el desarrollo de un alimento funcional se utiliza la técnica de impregnación a vacío. El equipo investigador, en el que se integra esta tesis, ha desarrollado un procedimiento que permite incluir cualquier componente con actividad fisiológica en el interior de la matriz de una fruta u hortaliza (Patente P99 02730-5 ¿Procedimiento de impregnación de alimentos naturales con productos nutracéuticos y dispositivo para su puesta en práctica¿. Además, ha demostrado la factibilidad de desarrollo de un alimento funcional mediante esta técnica en distintas tesis doctorales. Aplicando este procedimiento, se puede incluir el zumo de arándanos, dentro de una matriz porosa como rodajas de manzana para producir un alimento tipo snack. Este snack se puede estabilizar por reducción de la actividad de agua, aplicando una operación de secado con aire caliente. De esta manera, se obtiene un producto con atributos funcionales del zumo de arándanos sumados a los atributos nutritivos que posee la manzana.
Cardiovascular disease (CVD) is ranked as one of top leading causes of death in most industrialized countries. Recent research suggests that fruit vinegar beverages (FVB) possess beneficial effects such as antihypertensive properties, reduction of serum cholesterol and triacylglycerols (TAG). FVB made using apple, blueberry, cranberry and tomato were evaluated for their sensory, antioxidant, antihypertensive and lipid lowering properties. All four treatments demonstrated very high in vitro antioxidant and antihypertensive properties. These FVB were further evaluated for their hypolipidemic and antihypertensive properties using a spontaneously hypertensive rats (SHR) model
with diet-induced hyperlipidemia. All four FVB significantly reduced serum TAG, elevated the high density lipoprotein (HDL)-cholesterol compared to the control. Further, all four FVB demonstrated a reduction in the diastolic blood pressure after four weeks of
supplementation. Overall, the FVB exhibited lipid lowering effects and antihypertensive properties in vivo. Confirmation of the beneficial effects of FVB using a clinical trial is needed.
Les maladies infectieuses constituent un sérieux problème de santé publique aussi bien dans les pays en développement que dans les pays industrialisés. Parmi ces maladies infectieuses, les mycoses ont pris des proportions considérables et en particulier celles à Candida dénommées candidoses. Elles sont les plus fréquentes en pathologie humaine et chez les sujets vivant avec le VIH. Cette situation engendre un besoin sans cesse croissant de trouver de nouveaux composés antimicrobiens capables d’inhiber la croissance et les mécanismes de résistances des microorganismes.C’est dans ce cadre que notre équipe a testé différents extraits végétaux (aqueux, hydro-éthanolique, hexanique,acétatique, butanolique et chloroformique) de Eucalyptus torelliana F.Muell. une Myrtaceae sur la croissance in vitro de Candida albicans, Candida tropicalis et Candida glabrata. Tous ces extraits ont montré une activité inhibitrice sur les germes étudiés avec une forte activité pour l’extrait X1-2 (phase aqueuse de la partition hexane-eau). L’optimisation de l’extrait X1-2 par chromatographie sur gel de filtration (sephadex G50), a donné plusieurs fractions dont la plus active est la fraction F5 :Pour C. albicans CMF = 62,5 μg/mL; CI50 = 06,45 μg/mL.Pour C. tropicalis CMF = 62,5 μg/mL; CI50 = 02,70 μg/mL.Pour C. glabrata CMF = 62,5 μg/mL; CI50 = 01,73 μg/mL.La CPG/SM de la fraction F5 a permit d’identifier 15 molécules parmi lesquelles les composés majoritaires sontdes terpènes et des composés phénoliques notamment les tanins.La méthode de préparation de l’extrait (X1-2) par partitions de l’extrait hydro-éthanolique dans un mélange desolvant hexane-eau suivie de chromatographie sur gel de filtration sephadex G50 est une méthode permettant nonseulement de mieux concentrer mais aussi de purifier et d’isoler les principes actifs.
Fruits come in a wide variety of colors, shapes, and flavors. This chapter will cover selected fruits that are known to be healthy and highly nutritious. These fruits were chosen due to their common usage and availability. Since it is not possible to cover all health benefits or essential nutrients and important phytochemicals of the fruit composition, this chapter will focus on the key valuable constituents and their potential health effects.
Corema album (L.) D. Don is a wild maritime shrub endemic to the Iberian Peninsula, which contains bioactive compounds with promising chemoprotective activity. The present work reports the first study of the edible fruits of this potentially health‐beneficial plant by complementary Raman and infrared techniques. Unique vibrational signatures were obtained for each part of the Corema album berries, revealing distinct chemical compositions for the skin (outer and inner) and the seeds, particularly regarding the content in phenolic derivatives, unsaturated fatty acids, and waxy polymers.
Background & aim: Urinary tract infections (UTIs) are the most common medical complication experienced by individuals living with SCI . Several factors are responsible for the high prevalence of UTIs in individual with SCI. Concerns regarding the overuse of antibiotics in individuals with SCI and emerge multi-drug-resistant bacteria , has prompted consideration for consumer –directed alternatives to improve urinary tract health. This study was designed to evaluation of cranberry juice on bacteriuria and pyuria and in spinal cord injured patients with neurogenic bladder in Shahrekord, Iran. Methods: This study was randomized, double-blind, placebo-controlled trial .60 patients (51 male and 9 female) with creatinine levels below 1.5 mg/dl and in the analysis of their urine white blood cell (WBC) counts were greater than 10 in a high-powered field (pyuria) or with a presence of bacteriuria (>= 104 cc/ml) in their urine culture selected in this study. Urine analysis and culture were carried out at before and after intervention.Samples was divided into two two groups of 30.The case patients were given a dose of 250 to 300 ml of cranberry juice cocktail with 30% concentration, daily with meals.The control group was fed the same amount of a placebo cocktail.After two weeks, first morning urine analysis and culture test were done.Data collected and analyzed using K-squared method using the SPSS software and Paired-T test technique. Results: Urine analysis and culture before and after interventions show , Urinary PH in case and control groups did not any significant statistical difference before and after intervention (P>0.05). A change in pyuria and bacteriuria levels in case patients was observed after the treatment which was statistically significant (P<0.05). However, after treatment, the bacterial colony count in the case patients had dropped as a result of the cranberry juice consumption.the urine foul-smell was noticeably reduced in treated case patients (CI>95٪). Conclusion: Consumption of cranberries can be effective in treating SCI patients with UTI under certain conditions. The effectiveness was most profound in patients with normal GFR who did not use urinary catheter for urination. The effectiveness was especially seen in short term reduction of pyuria and bacteriuria levels and in reduction of foul-smelling of patient's urine.
Traditionally, both the urinary tract and urine were thought to be sterile. However, recent evidence seems to suggest the presence of a urinary tract microbiome, which is believed to play a significant role in maintaining overall urinary health (Whiteside et al. Nat Rev Urol 12(2):81–90, 2015). Similar to the intestinal microbiome, the urinary tract microbiome likely plays a role in host protection by preventing uropathogens from colonizing and in turn, causing urinary tract infections (UTIs). However, when uropathogens are successful in establishing infection, these infections can be classified into upper or lower UTIs. Lower UTIs involve the bladder (cystitis), urethra (urethritis) and prostate (prostatitis). Upper UTIs involve the kidneys and are also considered ascending infections due to bacteria ascending from the bladder to the kidneys. This chapter will provide an overview of UTIs and discuss some of the most common pathogens involved. Prostatitis will be discussed in a separate chapter.
Some studies have showed that intake of blackberry juice (BBJ)can prevent urinary tract infections. However, there is a lack of studies that evaluate the mechanisms by which BBJ has protective effect. Thus, the aim of current study was to evaluate the effects of BBJ supplementation on cisplatin-induced renal pathophysiology in mice. Mice were supplemented with BBJ (10 mL/kg)for seven days. One hour after the last supplementation with BBJ, mice received cisplatin (10 mg/kg, i.p.). Seventy-two hours after cisplatin administration, blood was collected and biochemical analysis were performed (urea and creatinine), kidney was dissected and utilized in histological and oxidative evaluations. Cisplatin caused severe injury in renal tissue, in markers of renal damage (urea and creatinine)generated increased of plasmatic levels. Besides that, the cisplatin induced decreased of enzymes activities in renal tissue (superoxide dismutase, glutathione S-transferase and catalase). In contrast, BBJ supplementation protected against histopathological alterations through decreased in urea and creatinine levels and modulation of catalase enzyme activity. Thus, BBJ supplementation protected the renal system of mice from deleterious effects. We suggest that high concentrations of Cyanidin 3-O-glucoside and Cyanidin 3-O-rutinoside are responsible for antioxidant role of BBJ supplementation in renal pathophysiology induced by cisplatin exposure. Also, these results reinforcing the importance of including BBJ in the human diet aimed at preventing renal diseases.
V. macrocarpon (canneberge) est traditionnellement associé à la prévention des IU, les mécanismes restant mal élucidés. L'effet d'une préparation commerciale de canneberge sur l'adhésion d'E.coli UTI89 aux cellules urothéliales T24, a montré l'importance de pré-incuber les bactéries avec le composé pour obtenir une inhibition dose-dépendante et réversible de l'adhésion. L'étude du transcriptome (E.coli Gene expression microarray, AgilentTechnologies) montre un effet puissant portant sur de nombreux gènes liés aux adhésines (sauf les fimbriae P), au chémotactisme et au flagelle. L'étude en microscopie électronique confirme un effet sur la taille et les structures de surface (adhésines, flagelles), l'étude de la mobilité en microscopie à champ large montre de moindres capacités de déplacement (distances, linéarité). Chez la souris C57BL/6, la pré-incubation n'a pas d'effet significatif sur la colonisation des vessies, ni sur l'adhésion ex vivo aux cellules T24, des bactéries récupérées dans les vessies. Un modèle intégratif d'étude de V.macrocarpon, basé sur des tests simples in vitro (adhésion, swarming, microscopie à champ large) est défini.
Infectious complications remain a major cause of morbidity and mortality among transplant recipients. Urinary tract infection (UTI) is the most common infectious complication in kidney transplant recipients with a reported incidence from 25% to 75%, varies widely likely due to differences in definition, diagnostic criteria, study design, and length of observation. We sought reviews the incidence and importance of urinary tract infection on graft survival, the microbiology with special emphasis on multidrug resistant microorganisms, the therapeutic management of UTI and the prophylaxis of recurrent UTI among solid organ transplant recipients, highlighting the need for prospective clinical trials to unify the clinical management in this population.
Cranberry has been used traditionally to prevent urinary tract infections (UTIs), primarily among generally healthy women prone to recurrent UTIs. Results from a number of published clinical studies have supported this benefit; however, meta-analyses on cranberry and UTI prevention have reported conflicting conclusions. This article explores the methodological differences that contributed to these disparate findings. Despite similar research questions, the meta-analyses varied in the studies that were included, as well as the data that were extracted. In the 2 most comprehensive systematic reviews, heterogeneity was handled differently, leading to an I2 of 65% in one and 43% in the other. Most notably, the populations influencing the conclusions varied. In one analysis, populations with pathological/physiological conditions contributed 75.6% of the total weight to the summary risk estimate (RR: 0.86; 95% CI: 0.71, 1.04); another weighted the evidence relatively equally across UTI populations (RR: 0.62; 95% CI: 0.49, 0.80); and a third included only women with recurrent UTIs (RR: 0.53; 95% CI: 0.33, 0.83). Because women with recurrent UTIs are the group to whom most recommendations regarding cranberry consumption is directed, inclusion of other groups in the efficacy assessment could influence clinical practice quality. Therefore, conclusions on cranberry and UTIs should consider differences in results across various populations studied when interpreting results from meta-analyses.
Infectious complications remain a major cause of morbidity and mortality among transplant recipients. Urinary tract infection (UTI) is the most common infectious complication in kidney transplant recipients with a reported incidence from 25% to 75%, varies widely likely due to differences in definition, diagnostic criteria, study design, and length of observation. We sought reviews the incidence and importance of urinary tract infection on graft survival, the microbiology with special emphasis on multidrug resistant microorganisms, the therapeutic management of UTI and the prophylaxis of recurrent UTI among solid organ transplant recipients, highlighting the need for prospective clinical trials to unify the clinical management in this population.
The association between current micturition habits and previous urinary tract infection was analysed among 3553 school entrants aged 7 years by means of a questionnaire. A high incidence of urinary infection, confirmed by urine culture, was found (145 (8.4%) in the 1719 girls and 32 (1.7%) in the 1834 boys). There was a significant association between current symptoms that were suggestive of disturbed bladder function and previous urinary tract infection, but only among girls who were over 3 years of age at the time the first episode was diagnosed.
Inhibition of bacterial adherence to bladder cells has been assumed to account for the beneficial action ascribed to cranberry juice and cranberry juice cocktail in the prevention of urinary tract infections (A. E. Sobota, J. Urol. 131:1013-1016, 1984). We have examined the effect of the cocktail and juice on the adherence of Escherichia coli expressing surface lectins of defined sugar specificity to yeasts, tissue culture cells, erythrocytes, and mouse peritoneal macrophages. Cranberry juice cocktail inhibited the adherence of urinary isolates expressing type 1 fimbriae (mannose specific) and P fimbriae [specific for alpha-D-Gal(1----4)-beta-D-Gal] but had no effect on a diarrheal isolate expressing a CFA/I adhesin. The cocktail also inhibited yeast agglutination by purified type 1 fimbriae. The inhibitory activity for type 1 fimbriated E. coli was dialyzable and could be ascribed to the fructose present in the cocktail; this sugar was about 1/10 as active as methyl alpha-D-mannoside in inhibiting the adherence of type 1 fimbriated bacteria. The inhibitory activity for the P fimbriated bacteria was nondialyzable and was detected only after preincubation of the bacteria with the cocktail. Cranberry juice, orange juice, and pineapple juice also inhibited adherence of type 1 fimbriated E. coli, most likely because of their fructose content. However, the two latter juices did not inhibit the P fimbriated bacteria. We conclude that cranberry juice contains at least two inhibitors of lectin-mediated adherence of uropathogens to eucaryotic cells. Further studies are required to establish whether these inhibitors play a role in vivo.
To assess whether consumption of 500 ml of blueberry juice or cranberry juice by healthy female subjects increased plasma phenolic content and antioxidant capacity.
Latin square arrangement to eliminate ordering effects. After an overnight fast, nine volunteers consumed 500 ml of blueberry juice, cranberry juice or a sucrose solution (control); each volunteer participated on three occasions one week apart, consuming one of the beverages each time. Blood samples were obtained by venipuncture at intervals up to four hours after consumption of the juices. Urine samples were also obtained four hours after consuming the juice.
Consumption of cranberry juice resulted in a significant increase in the ability of plasma to reduce potassium nitrosodisulphonate and Fe(III)-2,4, 6-Tri(2-pyridyl)-s-triazine, these measures of antioxidant capacity attaining a maximum after 60-120 min. This corresponded to a 30% increase in vitamin C and a small but significant increase in total phenols in plasma. Consumption of blueberry juice had no such effects.
The increase in plasma antioxidant capacity following consumption of cranberry juice could mainly be accounted for by an increase in vitamin C rather than phenolics. This also accounted for the lack of an effect of the phenolic-rich but vitamin C-low blueberry juice. Sponsorship: Funded by the Scottish Executive Rural Affairs Department and the Danish Government.
To determine whether recurrences of urinary tract infection can be prevented with cranberry-lingonberry juice or with Lactobacillus GG drink. Design: Open, randomised controlled 12 month follow up trial.
Health centres for university students and staff of university hospital.
150 women with urinary tract infection caused by Escherichia coli randomly allocated into three groups. Interventions: 50 ml of cranberry-lingonberry juice concentrate daily for six months or 100 ml of lactobacillus drink five days a week for one year, or no intervention. Main outcome measure: First recurrence of symptomatic urinary tract infection, defined as bacterial growth >/=10(5 )colony forming units/ml in a clean voided midstream urine specimen.
The cumulative rate of first recurrence of urinary tract infection during the 12 month follow up differed significantly between the groups (P=0.048). At six months, eight (16%) women in the cranberry group, 19 (39%) in the lactobacillus group, and 18 (36%) in the control group had had at least one recurrence. This is a 20% reduction in absolute risk in the cranberry group compared with the control group (95% confidence interval 3% to 36%, P=0.023, number needed to treat=5, 95% confidence interval 3 to 34).
Regular drinking of cranberry juice but not lactobacillus seems to reduce the recurrence of urinary tract infection.
To determine, from a societal perspective, the effectiveness and cost effectiveness of concentrated cranberry tablets, versus cranberry juice, versus placebo used as prophylaxis against lower urinary tract infection (UTI) in adult women.
One hundred fifty sexually active women aged 21 through 72 years were randomized for one year to one of three groups of prophylaxis: placebo juice + placebo tablets versus placebo juice + cranberry tablets, versus cranberry juice + placebo tablets. Tablets were taken twice daily, juice 250 ml three times daily. Outcome measures were: (1) a >50% decrease in symptomatic UTI's per year (symptoms + >or= 100 000 single organisms/ml) and (2) a >50% decrease in annual antibiotic consumption. Cost effectiveness was calculated as dollar cost per urinary tract infection prevented. Stochastic tree decision analytic modeling was used to identify specific clinical scenarios for cost savings.
Both cranberry juice and cranberry tablets statistically significantly decreased the number of patients experiencing at least 1 symptomatic UTI/year (to 20% and 18% respectively) compared with placebo (to 32%) (p<0.05). The mean annual cost of prophylaxis was $624 and $1400 for cranberry tablets and juice respectively. Cost savings were greatest when patients experienced >2 symptomatic UTI's per year (assuming 3 days antibiotic coverage) and had >2 days of missed work or required protective undergarments for urgency incontinence. Total antibiotic consumption was less annually in both treatment groups compared with placebo. Cost effectiveness ratios demonstrated cranberry tablets were twice as cost effective as organic juice for prevention.
Cranberry tablets provided the most cost-effective prevention for UTI.
To determine whether antibacterial effects of cranberry extract will reduce or eliminate bacteriuria and pyuria in persons with spinal cord injury (SCI).
Randomized, double-blind, placebo-controlled study.
Participants were people with SCI residing in the community who were 1 year or longer postinjury with neurogenic bladder managed by intermittent catheterization or external collection device and a baseline urine culture demonstrating at least 10(5) colonies per milliliter of bacteria.
Each participant ingested 2 g of concentrated cranberry juice or placebo in capsule form daily for 6 months. Baseline urinalysis and cultures were performed at the time of the initial clinic visit and monthly for 6 months. Microbiologic data were evaluated using analysis of variance with repeated measures.
Twenty-six persons received cranberry extract and 22 persons received placebo. There were no differences or trends detected between participants and controls with respect to number of urine specimens with bacterial counts of at least 10(4) colonies per milliliter, types and numbers of different bacterial species, numbers of urinary leukocytes, urinary pH, or episodes of symptomatic urinary tract infection.
Cranberry extract taken in capsule form did not reduce bacteriuria and pyuria in persons with SCI and cannot be recommended as a means to treat these conditions.
cranberry juice is often given to older people in hospital to prevent urinary tract infection (UTI), although there is little evidence to support its use.
to assess whether cranberry juice ingestion is effective in reducing UTIs in older people in hospital.
randomised, placebo-controlled, double-blind trial.
Medicine for the Elderly assessment and rehabilitation hospital wards.
376 older patients in hospital.
participants were randomised to daily ingestion of 300 ml of cranberry juice or matching placebo beverage. The primary outcome was time to onset of first UTI. Secondary outcomes were adherence to beverage drinking, courses of antibiotics prescribed, and organisms responsible for UTIs.
a total of 21/376 (5.6%) participants developed a symptomatic UTI: 14/189 in the placebo group and 7/187 in the cranberry juice group. These between-group differences were not significant, relative risk (RR) 0.51 [95% CI 0.21-1.22, P = 0.122). Although there were significantly fewer infections with Escherichia coli in the cranberry group (13 versus 4) RR 0.31 [95% CI 0.10-0.94, P = 0.027], this should be interpreted with caution as it was a secondary outcome.
despite having the largest sample size of any clinical trial yet to have examined the effect of cranberry juice ingestion, the actual infection rate observed was lower than anticipated, making the study underpowered. This study has confirmed the acceptability of cranberry juice to older people. Larger trials are now required to determine whether it is effective in reducing UTIs in older hospital patients.
Urinary tract infections (UTIs) in adults are common. Women are affected much more frequently than men. The major clinical syndromes seen in clinical practice are cystitis, pyelonephritis and prostatitis. Treatment should be varied according to the clinical syndrome that the patient presents with. Adequate urine culture is required for the successful diagnosis of each urinary tract condition. Increasing fluid intake to achieve good urine flows, together with antibiotic therapy, is an essential aspect of treatment.
Strategies to prevent urinary tract infections (UTIs) are used in a wide variety of clinical scenarios (Table 1). Patients in whom true prophylaxis may be indicated include premenopausal and postmenopausal women with frequent recurrent UTIs and patients about to undergo a urologic procedure. In the former situation, bacteria causing infection originate in the fecal flora, colonize the vagina and periurethral introitus, and may then ascend to the urethra and bladder. The goal of prophylaxis in these otherwise healthy premenopausal or postmenopausal women is to interrupt this dynamic. Although the indications for prophylaxis in patients who are about to undergo a urologic procedure are controversial, the purpose of such strategies is twofold: (1) to prevent bacteria that are colonizing the periurethral area from entering the bladder and (2) to avoid placing a catheter into an already infected space. Prophylaxis for urologic procedures is discussed in the article by Dembry and Andriole. Among renal transplant recipients, the goal of prophylaxis is to prevent unacceptably high morbidity and mortality rates associated with UTIs in this population. 28 An important distinction must be made between indications for true prophylaxis and clinical situations in which antimicrobial therapy is instituted to suppress a persistent urinary focus of bacterial infection or colonization, as in chronic prostatitis or with infected renal stones. These clinical situations, considered complicated UTIs, are covered in the article by Hooton and Stamm. Preventive strategies may also be indicated for children and some adults with structural abnormalities of the urinary tract, in some patients with spinal cord injury or neurogenic bladder, and in some patients using urinary catheters in other clinical situations. In some of these patients, antimicrobial therapy is truly prophylactic, but in others in whom sterile urine cannot be achieved by a limited course of treatment, the therapeutic goal is suppression of bacteriuria. This article focuses on the prevention of recurrent uncomplicated urinary tract infections in healthy premenopausal and postmenopausal women and in pregnant women. Prophylaxis or suppression of UTI in other clinical situations is discussed elsewhere in this issue, as described in Table 1.
Objective.
—To determine the effect of regular intake of cranberry juice beverage on bacteriuria and pyuria in elderly women.Design.
—Randomized, double-blind, placebo-controlled trial.Subjects.
—Volunteer sample of 153 elderly women (mean age, 78.5 years).Intervention.
—Subjects were randomly assigned to consume 300 mL per day of a commercially available standard cranberry beverage or a specially prepared synthetic placebo drink that was indistinguishable in taste, appearance, and vitamin C content but lacked cranberry content.Outcome Measures.
—A baseline urine sample and six clean-voided study urine samples were collected at approximately 1-month intervals and tested quantitatively for bacteriuria and the presence of white blood cells.Results.
—Subjects randomized to the cranberry beverage had odds of bacteriuria (defined as organisms numbering ≥105/mL) with pyuria that were only 42% of the odds in the control group (P=.004). Their odds of remaining bacteriuric-pyuric, given that they were bacteriuric-pyuric in the previous month, were only 27% of the odds in the control group (P=.006).Conclusions.
—These findings suggest that use of a cranberry beverage reduces the frequency of bacteriuria with pyuria in older women. Prevalent beliefs about the effects of cranberry juice on the urinary tract may have microbiologic justification.(JAMA. 1994;271:751-754)
Ethyl acetate extracts of Sephadex LH20-purified proanthocyanidins of American cranberry (Vaccinium macrocarpon Ait.) exhibited potent biological activity by inhibiting adherence of uropathogenic isolates of P-fimbriated Escherichia coli bacteria to cellular surfaces containing α-Gal(1 → 4)β-Gal receptor sequences similar to those on epithelial cells in the urinary tract. The chemical structures of the proanthocyanidins were determined by NMR, electrospray mass spectrometry, matrix-assisted laser absorption time-of-flight mass spectrometry and by acid catalyzed degradation with phloroglucinol. The proanthocyanidin molecules consisted predominantly of epicatechin units with mainly DP of 4 and 5 containing at least one A-type linkage. The procyanidin A2 was the most common terminating unit occurring about four times as frequently as the epicatechin monomer.
Background Cranberries (particularly in the form of cranberry juice) have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). The aim of this review is to assess the effectiveness of cranberries in treating such infections. Objectives To assess the effectiveness of cranberries for the treatment of UTIs. Search strategy The search strategy developed by the Cochrane Renal Group was used. Also, companies involved with the promotion and distribution of cranberry preparations were contacted; electronic databases and the Internet were searched using English and non English language terms; reference lists of review articles and relevant studies were also searched. Date of last search: December 2007 Selection criteria All randomised controlled trials (RCTs) or quasi-RCTs of cranberry juice or cranberry products for the treatment of UTIs. Studies of men, women or children were included. Data collection and analysis Titles and abstracts of studies that were potentially relevant to the review were screened by one author, RJ, who discarded studies that were clearly ineligible but aimed to be overly inclusive rather than risk losing relevant studies. Authors RJ and LM independently assessed whether the studies met the inclusion criteria. Further information was sought from the authors where papers contained insufficient information to make a decision about eligibility. Main results No studies were found which fulfilled all of the inclusion criteria. Two studies were excluded because they did not have any relevant outcomes and two studies are currently being undertaken. Authors' conclusions After a thorough search, no RCTs which assessed the effectiveness of cranberry juice for the treatment of UTIs were found. Therefore, at the present time, there is no good quality evidence to suggest that it is effective for the treatment of UTIs. Well-designed parallel group, double blind studies comparing cranberry juice and other cranberry products versus placebo to assess the effectiveness of cranberry juice in treating UTIs are needed. Outcomes should include reduction in symptoms, sterilisation of the urine, side effects and adherence to therapy. Dosage (amount and concentration) and duration of therapy should also be assessed. Consumers and clinicians will welcome the evidence from these studies.
The purpose of this study was to investigate the efficacy of cranberry juice and ascorbic acid in acidifying the urine of subjects with multiple sclerosis. The major hypothesis for the study was that cranberry juice and ascorbic acid would lower the pH values of the urine more than orange juice and ascorbic acid. The difference in the pH values between morning and evening observations was also questioned. Eight subjects consumed 12 oz of cranberry juice and 1000 mg of ascorbic acid for 20 days of treatment and 12 oz of orange juice and 1000 mg of ascorbic acid for 20 days of control. Serving as their own control, the subjects were randomly assigned to begin the study with the cranberry juice or the orange juice treatment. Urinary pH values were measured using pHydrion paper. Recordings of the pH values were made by the subject or his or her family in the morning and in the evening. Using analysis of variance, it was found that the cranberry juice was significantly more effective than orange juice (p < .001) in acidifying the urine and the evening pH values were significantly (p
Twenty-one female and 19 male subjects who had normal physical and laboratory examinations were randomly assigned into four groups of 10 subjects each. Each group was then randomly assigned a number (150, 180, 210, 240) which determined the amount of cranberry juice, in milliliters, members of that group would ingest with each meal during the experimental phase of the study. The study took place over a 12-day period. A one-group before-and-after design was used, with each subject serving as his or her own control. Diet was controlled; menus on days 1 through 6 were repeated on days 7 through 12 with the addition of cranberry juice at each meal. Subjects used nitrazine pH tape to measure the pH of midstream urine at each voiding. There were significant (.01 level) differences in mean urinary pH between each control group and its corresponding experimental group. Anticipated problems with increased number of bowel movements, weight gain, increased voiding frequency, and subject pH measurement inaccuracy did not occur.
One thousand bacterial isolates from consecutive suprapublic aspirations of urine in two groups of patients with symptomatic urinary tract infection and two groups with asymptomatic bacteriuria were studied. Staphylococci accounted for 13 and 27% of the isolates from symptomatic patients but for only 3 and 4% of strains from asymptomatic bacteriuria. Conversely, 18 and 30% of Escherichia coli isolates from asymptomatic bacteriuria were auto-agglutinable when tested with antisera to the common urinary O-serogroups, whereas such strains accounted for only 5 and 7% of the E. coli from symptomatic patients. The high prevalence of auto-agglutinable E. coli in asymptomatic bacteriuria was accompanied by a reduction in the frequency of the common uninary O-serogroups rather than other smooth strains.
In a previous investigation it was demonstrated that cranberry juice cocktail was able to inhibit adherence in 77 clinical isolates of Escherichia coli obtained from patients with diagnosed urinary tract infections. This work has been extended to include clinical isolates of E. coli, Proteus, Klebsiella, Enterobacter and Pseudomonas isolated from urine, sputum, wound and stool. Bacterial strains isolated from urine adhere in greater numbers to urinary tract epithelial cells than organisms isolated from sputum, stool and wound sources. E. coli, isolated from urine, adheres to urinary epithelial cells, in numbers three times greater than E. coli isolated from other clinical sources, and thus appears to represent a unique population of cells in terms of adherence. Cranberry juice cocktail and urine and urinary epithelial cells obtained after drinking the cocktail all demonstrate antiadherence activity against Gram-negative rods isolated from urine and other clinical sources. Drinking the cocktail may be useful in managing urinary tract infections in certain patients.
1. The material consists of 5% consecutive cases of primary (first onset) urinary tract infections appearing from birth up to 16 years of age and which were examined and treated at the Childrens' Hospital in Goteborg. The infections occurred during a seven‐year period within a defined population. The circumstances under which the study was conducted suggest that most symptomatic infections occurring during the study period and for whom the parents sought medical advice, were
2. The total morbidity risk at I 1 years of age of symptomatic UTI was 3.0% for girlsand 1.1 % for boys. These are minimum figures. The morbidity risk is highest during the first month of life and then decreases, more rapidly in boys than in girls.
Possible interpretations of the reason for decreasing risk with increasing age of falling ill with a first infection are suggested. The male/female ratio starts at 2.5: 1 during the first month and then successively changes to 1:20.There was no seasonal variation of the time of onset in either sex.
3. Presentation with fever was most common in the first year, after which it slowly decreased. Failure to thrive was a rare symptom. Certain pther age and sex differences in presenting symptoms were recorded. Most infections within the first year of life probablyinvolved the renal parenchyma.
4. The etiology varied with age and sex. If infections reach the urinary tract by theascending route, this could indicate differences in the environmental conditions in the periurethral region and may be a clue to a better understanding of the pathogenesis.
5. Obstructive malformations were found in 10% of boys and 1–2% of girls, and cannotexplain the high frequency of early infantile infections in either sex.
6. Narrowing of the bladder neck was common in males during the first year of life, the frequency declining with age. It disappeared spontaneously during follow‐up of individual cases, and was not regarded as an obstructive malformation.
7. Duplication of the collecting system was seen in 10 % of girls and in 5 % in boys, which is more than expected. The cause and nature of the association between infection and duplication are not known.
8. In 13 % of boys and 4.5 % of girls a reduction of the renal parenchyma was seen either at the first investigation or developed later, probably owing to infection. AlthoughUTI was more frequent in females than in males, the total number of patients with parenchymal damage was equal in both sexes, even during childhood. In boys, the kidneys might bemore vulnerable than in girls.
9. The immediate cure rate after 10 days' therapy was 97%. Recurrences were usually reinfections.
10. Recurrent infections were often difficult to diagnose. Pyuriaand symptoms of UTI were associated with insignificant bacteriuria in 10 % (30 of 300) of suspected recurrences.
11. Susceptibility to recurrence was studied in relation to various parameters. Girlswere at greater risk than boys, and the risk was in both sexes greatest during the first 2–3 months after a previous infection. Boys rarely had a recurrence more than one year after the primary infection, while girls often continued to have recurrences for many years. The risk seemed to increase with the increasing number of previous recurrences. No correlation was found between the frequency of recurrences and age at onset of primary infection or with symptomatology, etiology, reflux, or duration of therapy.
12. The risk of recurrence was many times greater in a patient who had had one infection than in a previously healthy patient. The possibility that the degree of susceptibility to UTI might depend, to some extent, on genetic factors should be examined.
The symptoms, signs, and laboratory findings for 69 women who were seen at a sexually transmitted disease (STD) clinic and who had acute urinary tract infection (UTI) were compared with those for women who had vaginitis, gonorrhea, or chlamydial infection. Escherichia coli and Staphylococcus saprophyticus were the two most common causes of acute cystitis in this population and accounted for 62 (90%) of 69 infections. Forty-three percent of the women had positive tests for antibody-coated bacteria (ACB), an observation implying renal infection although symptoms of upper tract infection were infrequent. Frequency, urgency, dysuria, and suprapubic tenderness were significantly associated with cystitis, whereas vaginal discharge and vulvar itching were associated with vaginitis. There was, however, considerable overlap in symptoms among the four groups of women, and their accurate differentiation required objective information based upon pelvic examination, examination of vaginal fluid, and urinalysis. In the absence of vaginitis on wet mount and mucopurulent cervicitis on examination, pyuria, as determined by examination of centrifuged urine, had an 88% sensitivity, 76% specificity, 61% positive predictive value, and 93% negative predictive value for acute UTI. Because of the high prevalence of positive ACB tests and the possibility that infection with Chlamydia trachomatis and/or Neisseria gonorrhoeae may be mistaken for cystitis, we prefer a five- to seven-day course of antibiotics over single-dose therapy for treatment of patients with possible UTI in the setting of an STD clinic.
To determine the effect of regular intake of cranberry juice beverage on bacteriuria and pyuria in elderly women.
Randomized, double-blind, placebo-controlled trial.
Volunteer sample of 153 elderly women (mean age, 78.5 years).
Subjects were randomly assigned to consume 300 mL per day of a commercially available standard cranberry beverage or a specially prepared synthetic placebo drink that was indistinguishable in taste, appearance, and vitamin C content but lacked cranberry content.
A baseline urine sample and six clean-voided study urine samples were collected at approximately 1-month intervals and tested quantitatively for bacteriuria and the presence of white blood cells.
Subjects randomized to the cranberry beverage had odds of bacteriuria (defined as organisms numbering > or = 10(5)/mL) with pyuria that were only 42% of the odds in the control group (P = .004). Their odds of remaining bacteriuric-pyuric, given that they were bacteriuric-pyuric in the previous month, were only 27% of the odds in the control group (P = .006).
These findings suggest that use of a cranberry beverage reduces the frequency of bacteriuria with pyuria in older women. Prevalent beliefs about the effects of cranberry juice on the urinary tract may have microbiologic justification.
Most research suggests that ingestion of cranberry juice may be useful in preventing urinary tract infections. This pilot study examines the effect of drinking moderate amounts of commercially available cranberry juice cocktail on urinary pH in older, institutionalized adults. The results of the study have implications for home care nurses who have similar patients in their case loads.
Recurrent UTI remains an exceedingly common clinical problem among women of all ages. Among otherwise healthy premenopausal and postmenopausal women, increased susceptibility to recurrences seems to be conferred by intrinsic host factors, such as nonsecretor genotype or estrogen status, and by exogenous exposures or behaviors, such as use of a diaphragm with spermicide, antimicrobial use, and sexual behavior. The natural history of recurrent UTIs is notable for a temporal clustering phenomenon, the tendency of women to revert to a baseline infection pattern after the cessation of preventive interventions, and repeated serial reinfections of the urinary tract from the fecal reservoir, often by genetically identical organisms. Low-dose antimicrobial regimens given daily, three times weekly, or postcoitally are effective in preventing recurrences in most women with a predisposition to frequent infection. Intermittent patient-initiated self-treatment is an appropriate and effective option in some patients with lower recurrence rates. In postmenopausal women, estrogen replacement therapy, particularly vaginally applied estriol creams, may also significantly reduce the rate of recurrent UTI. Ongoing investigations in the areas of microbial ecology of the vaginal flora, the molecular basis for host-parasite interactions within the urinary tract, and vaccine development may eventually lead to improved means to prevent recurrent urinary tract infections more effectively.
To determine the effect of cranberry prophylaxis on rates of bacteriuria and symptomatic urinary tract infection in children with neurogenic bladder receiving clean intermittent catheterization.
Double-blind, placebo-controlled, crossover study of 15 children receiving cranberry concentrate or placebo concentrate for 6 months (3 months receiving one concentrate, followed by 3 months of the other). Weekly home visits were made. During each visit, a sample of bladder urine was obtained by intermittent catheterization. Signs and symptoms of urinary tract infection and all medications were recorded, and juice containers were counted.
During consumption of cranberry concentrate, the frequency of bacteriuria remained high. Cultures of 75% (114 of 151) of the 151 samples obtained during consumption of placebo were positive for a pathogen (>/=10(4) colony-forming units/mL) compared with 75% (120 of 160) of the 160 samples obtained during consumption of cranberry concentrate. Escherichia coli remained the most common pathogen during placebo and cranberry periods. Three symptomatic infections each occurred during the placebo and cranberry periods. No significant difference was observed in the acidification of urine in the placebo group versus the cranberry group (median, 5.5 and 6.0, respectively).
The frequency of bacteriuria in patients with neurogenic bladder receiving intermittent catheterization is 70%; cranberry concentrate had no effect on bacteriuria in this population.
To the Editor: Dr Van Dijk and colleagues¹ found no difference in 12-month cognitive outcomes between patients who underwent either on-pump or off-pump coronary artery bypass grafting (CABG). Although the authors alluded to a possible role of microemboli, they did not provide an explanation for the disturbing frequency and permanency of memory loss and dementia following CABG.
It is possible that patients with extremely low hemoglobin levels may be at higher risk for cognitive deficits following CABG. The current practice of performing cardiac surgery on patients with hematocrits as low as 18% has not been adequately evaluated.² Preoperative transfusions to hematocrits as high as 33% may increase survival.³ Valeri et al⁴ estimated that as many as 40 000 myocardial infarctions per million surgical procedures were caused by undertransfusion.
The objective of the study was to evaluate liquid cranberry products as prophylaxis against bacterial urinary tract infection in a pediatric neuropathic bladder population. Forty cases managed by clean intermittent catheterization with or without pharmacotherapy were enrolled in a randomized single-blind cross-over study. Subjects ingested 15 mL/kg/day of cranberry cocktail or water for six months followed by the reverse for another six months. Initial catheter urine samples and subsequent monthly and interim cultures were obtained. Associated symptoms were recorded along with follow-up attendance/compliance registry. The number of negative culture months to the number of months contributed was tabulated and compared between interventions. Individual, cumulative and antimicrobial subset analysis was performed. Twenty one patients completed the study;12 dropped out for reasons related to the cranberry (taste, caloric load and cost); seven patients dropped out for other reasons (parents too busy, death, no stated reason). Wilcoxon matched-pairs Signed-ranks analysis revealed no difference between intervention periods (2-tailed P=.5566 [whole group]; p=.2845 [antimicrobial subset]) with respect to infection. Fewer infections were observed in nine patients taking cranberry juice and in nine patients given water; no difference was noted in three. Liquid cranberry products, on a daily basis, at the dosage employed, did not have any effect greater than that of water in preventing urinary tract infections in this pediatric neuropathic bladder population.
Cranberries (particularly in the form of cranberry juice) have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). The aim of this review is to assess the effectiveness of cranberries in preventing such infections.
To assess the effectiveness of cranberry juice and other cranberry products in preventing UTIs in susceptible populations.
Electronic databases and the Internet were searched using English and non English language terms; companies involved with the promotion and distribution of cranberry preparations were contacted; reference lists of review articles and relevant trials were searched. Cochrane Central Register of Controlled Trials (CENTRAL - the Cochrane Library, issue 1, 2003) was searched in February 2003.
All randomised or quasi randomised controlled trials of cranberry juice/products for the prevention of urinary tract infections in susceptible populations. Trials of men, women or children were included.
Two reviewers independently assessed and extracted information. Information was collected on methods, participants, interventions and outcomes (urinary tract infections (symptomatic and asymptomatic), side effects and adherence to therapy). RR were calculated where appropriate, otherwise a narrative synthesis was undertaken. Quality was assessed using the Cochrane criteria.
Seven trials met the inclusion criteria (four cross-over, three parallel group). The effectiveness of cranberry juice (or cranberry-lingonberry juice) versus placebo juice or water was evaluated in six trials, and the effectiveness of cranberries tablets versus placebo was evaluated in two trials (one study evaluated both juice and tablets). In two good quality RCTs, cranberry products significantly reduced the incidence of UTIs at twelve months (RR 0.61 95% CI:0.40 to 0.91) compared with placebo/control in women. One trial gave 7.5 g cranberry concentrate daily (in 50 ml), the other gave 1:30 concentrate given either in 250 ml juice or in tablet form. There was no significant difference in the incidence of UTIs between cranberry juice versus cranberry capsules (RR 1.11 95% CI:0.49 to 2.50). Five trials were not included in the meta-analyses due to methodological flaws or lack of available data. However, only one reported a significant result for the outcome of symptomatic UTIs. Side effects were common in all trials, and dropouts/withdrawals in several of the trials were high.
There is some evidence from two good quality RCTs that cranberry juice may decrease the number of symptomatic UTIs over a 12 month period in women. If it is effective for other groups such as children and elderly men and women is not clear. The large number of dropouts/withdrawals from some of the trials indicates that cranberry juice may not be acceptable over long periods of time. In addition it is not clear what is the optimum dosage or method of administration (e.g. juice or tablets). Further properly designed trials with relevant outcomes are needed.
To determine the effectiveness of cranberry supplement at preventing urinary tract infections (UTIs) in persons with spinal cord injury (SCI).
A prospective, double-blinded, placebo-controlled, crossover study.
21 individuals with neurogenic bladders secondary to SCI.
Favorable or unfavorable response of cranberry supplement vs placebo on urinary bacterial counts and white blood cell (WBC) counts and the combination of bacterial and WBC counts.
Individuals with neurogenic bladders due to SCI were recruited and randomly assigned to standardized 400-mg cranberry tablets or placebo 3 times a day for 4 weeks. After 4 weeks and an additional 1-week "washout period," participants were crossed over to the other group. Participants were seen weekly, during which a urine analysis was obtained. UTI was defined as significant bacterial or yeast colony counts in the urine and elevated WBC counts (WBC count > or = 10 per high power field) in centrifuged urine. Participants with symptomatic infections were treated with appropriate antibiotics for 7 days and restarted on the cranberry tablet/ placebo after a 7-day washout period. Urinary pH between the cranberry and placebo groups was compared weekly. Data were analyzed using the Ezzet and Whitehead's random effect approach.
There was no statistically significant treatment (favorable) effect for cranberry supplement beyond placebo when evaluating the 2 treatment groups for bacterial count, WBC count, or WBC and bacterial counts in combination. Urinary pH did not differ between the placebo and cranberry groups.
Cranberry tablets were not found to be effective at changing urinary pH or reducing bacterial counts, urinary WBC counts, or UTIs in individuals with neurogenic bladders. Further long-term studies evaluating specific types of bladder management and UTIs will help to determine whether there is any role for the use of cranberries in individuals with neurogenic bladders.
Extracts from wild blueberry (Vaccinium angustifolium Ait.) were separated into proanthocyanidin-rich fractions using liquid vacuum and open column chromatography on Toyopearl and Sephadex LH-20, respectively. Fractions were characterized using analytical tools including mass spectrometry and NMR spectroscopy; fraction composition was correlated with bioactivity using antiproliferation and antiadhesion in vitro assays. There was a significant positive correlation between proanthocyanidin content of different fractions and biological activity in both the antiproliferation and antiadhesion assays. Two fractions containing primarily 4-->8-linked oligomeric proanthocyanidins with average degrees of polymerization (DPn) of 3.25 and 5.65 inhibited adhesion of Escherichia coli responsible for urinary tract infections. Only the fraction with a DPn of 5.65 had significant antiproliferation activity against human prostate and mouse liver cancer cell lines. These findings suggest both antiadhesion and antiproliferation activity are associated with high molecular weight proanthocyanidin oligomers found in wild blueberry fruits.
Patient enrolment in the 'Non-antibiotic versus antibiotic prophylaxis for recurrent urinary-tract infections' (NAPRUTI) study was started in September 2005. In this study of women with recurrent urinary-tract infections we aim to investigate the effect of 12 months of non-antibiotic prophylaxis in comparison with antibiotic prophylaxis on the rate of recurrence of urinary-tract infections and the development of antibiotic resistance. The study consists of two interlinked, randomised, clinical non-inferiority trials. In one trial, 280 premenopausal women will receive either cranberry capsules (twice daily 500 mg) or standardised antibiotic therapy (once daily 480 mg trimethoprim-sulfamethoxazole). In the other trial, 280 postmenopausal women will receive either oral lactobacilli (twice daily a capsule with > 10(9) colony-forming units of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14) or standardised antibiotic therapy. Non-inferiority of non-antibiotic prophylaxis would be attractive given its potential to reduce the prevalence of microbial resistance to antibiotics significantly.
Reduction of bacteriuria and pyuria with cranberry beverage: A random-ized trial
- J Avorn
- M Monane
- J Gurwitz
- R Glynn
Avorn, J., Monane, M., Gurwitz, J., Glynn, R., Reduction of bacteriuria and pyuria with cranberry beverage: A random-ized trial, J. Am. Geriatr. Soc. 1993, 41, 13.
Reduction of bacteriuria and pyuria with cranberry beverage: A randomized trial
- Avorn J.