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Biomedical Sciences, Biomed Biopharm Res., 2022; 19(2):278-298
doi: 10.19277/bbr.19.2.294; PDF version here [+] Portuguese html version [PT]  

Supplementation with Moringa oleifera leaves flour prevents fructose-based metabolic disorders in young rats

Izabel Carolina Bousfield Terranova 1, Izabelle Coelho Souza 2, Isadora Simas Ribeiro 2, Milena Fronza Broering 1, Aline De Faveri 1, Marina Jagielski Goss 1, Ana Mara de Oliveira Silva 3, Rivaldo Niero 1, Eduardo Augusto Steffens 1, Larissa Benvenutti 1, Luciano Vitali 4, Samantha Gonçalves 4, Isabel Daufenback Machado 5, Nara Lins Meira Quintão 1, José Roberto Santin 1*

1Postgraduate Program in Pharmaceutical Science, Universidade do Vale do Itajaí, Itajaí, SC, Brazil; 2School of Heath Sciences, Nutrition Course, Universidade do Vale do Itajaí, Itajaí, SC, Brazil.; 3Nutrition Department (DNUT), Universidade Federal de Sergipe, São Cristóvão, SE, Brazil; 4Department of Chemistry, Federal University of Santa Catarina, Florianópolis, SC, Brazil; 5Postgraduate Program in Biodiversity, Fundação Universidade Regional de Blumenau, Blumenau, SC, Brazil

corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Abstract

Moringa oleifera leaves flour is amply used to treat metabolic conditions. The aim was to assess the M. oleifera flour (MOF) on metabolic changes induced by fructose. Phenolic compounds were determined by LC-ESI-MS/MS. Wistar rats were distributed in groups: 1) Control (normal-chow + water); 2) Fructose (normal-chow + fructose (20%) in water) and 3) Feed with MOF20% + fructose (20%) in water. At the end of the 4th week of treatment, the animals were submitted to insulin resistance (IR) test, blood collection and histological evaluation. MOF contains phenolic compounds such as quercetin and chlorogenic acid. MOF supplementation promotes reduction in glycemia, insulin, triglycerides. The supplementation improved the insulin sensitivity. In the histological analysis, MOF supplementation reduced the adipocyte hypertrophy and the lipid deposition in the liver. The data obtained showed that MOF supplementation presented a protective effect against the harmful consequences of excessive fructose consumption.  

Keywords: Moringa oleifera, metabolic syndrome, diabetes, fructose, mice

Received: 24/08/2022; Accepted: 21/11/2022

 

Introduction 

Fructose is a common type of sugar in the American diet. A major source of fructose is high fructose corn syrup (HFCS), an inexpensive substitute for cane sugar that was introduced in the 1970s. It is now used to sweeten a variety of foods, including soda, candy, baked goods, and cereals. Studies in humans have linked excessive consumption of HFCS and other added sugars leads to insulin resistance, lipid abnormalities, obesity, hypertension, and renal dysfunction health (1,2). High fructose intake was associated with higher blood pressure and uric acid concentrations among adults in the United States without a history of hypertension. Furthermore, the same metabolic disease prevalence has been observed in younger population, as well as in children (2).

Fructose is metabolized mainly in hepatocytes by fructokinase that rapidly phosphorylates fructose to generate fructose-1-phosphate (2). The metabolism pathway consists of various other steps, resulting in primary metabolites and secondary products including glucose, lactate, free fatty acid, very low-density lipoprotein (VLDL) and uric acid (3).

Moringa oleifera Lam. is a specie within the Moringaceae family, commonly known as Moringa. The flour produced from its leaves is amply used in folk medicine to treat diabetes and other metabolic conditions. In fact, the Moringa leaves are the most used part of the plant, and present a great number of bioactive compounds, mainly phenolic compounds, such as quercetin, chlorogenic acid and caffeic acid (4).

M. oleifera has been extensively studied in vivo in several conditions, as it may provide hepatoprotective (5) and hypoglycemic (6,7) effects (8), be protective against diet-induced metabolic diseases (9), and have anti-obesity and in vitro antioxidant effects (10).

Flavonoids and saponins present in the plant are reported to increase HDL (High Density Lipoprotein) and to reduce total cholesterol, LDL (Low Density Lipoprotein), and VLDL cholesterol (11). Phytocompounds phenolic acids, including chlorogenic acid (CGA) identified in M. oleifera leaves (12), have been shown to have antioxidant and anti-hyperglycemic properties (13–15).

Considering the increased prevalence of diet-induced metabolic dysfunction by fructose consumption, this study was designed to investigate the phenolic compounds in Moringa oleifera leaf flour (MOF) and the protective effects of the oral supplementation of MOF on initial metabolic changes induced by fructose consumption in young rats.

Material and Methods

Sample

The M. oleifera flour obtained from leaves (MOF) was purchased from an industry in São Paulo, SP, Brazil (registration number 0111.0820.08R-1). The flour was kept in the refrigerator at 4°C in dark hermetically sealed jars throughout the period of the experiment. To produce the extract, the flour (200 g) was subjected to static maceration in methanol for 7 days, and was then subject to phytochemical profile analysis.

Identification of phenolic compounds by LC-ESI- MS/MS

The analysis was performed in a high-performance liquid chromatography (HPLC) system (Agilent Technologies, Germany) and a Phenomenex® Synergi 4 μ Polar-RP 80A column (150 mm x 2 mm ID, particle size of 4.6 μm) at a temperature of 30 ºC. The mobile phase used was composed of solvent A (95% methanol in water) and solvent B (0.1% formic acid in water). The separations were conducted using segmented elution gradient as follows: 0–5 min, 10% A; 5–7 min, 90% A; 7–10 min, 90% A; 10–17 min, 10% A. The flow rate and sample injection volume were 250 μL/min and 10 μL, respectively. The LC system was coupled to a mass spectrometry system consisting of a hybrid triple quadrupole/linear ion trap mass spectrometer (Qtrap® 3200, Applied Biosystems/MDS SCIEX, Waltham, MA, USA, with Turbo Ion Spray® as the ionization source) in negative ionization mode. The MS/MS parameters used were: ion spray interface quadrupole at 400°C; voltage of -4500 V; curtain gas, 10 psi; nebulizer gas, 45 psi; auxiliary gas, 45 psi; collision gas, medium. The Multiple Reaction Monitoring (MRM) mode was used for analysis. For the identification of phenolic compounds, forty-five standards were dissolved in methanol and analyzed under the same conditions described above. The software Analyst® (version 1.5.1) was used to record and process the data.

Antioxidant activity

The determination of reduction potential of the MOF extract was performed by the ferric reducing/antioxidant power (FRAP) assay. Briefly, in a microplate well, 9 μL of extract at concentrations of 3, 10, 30, 100, 300 and 1000 μg/mL or 6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid (Trolox) (100 μg/mL) were added to 27 μL of distilled water and 270 μL of freshly prepared FRAP solution (acetate buffer pH 3.6 (0.3 mmol/L), 2,4,6-tripyridyl-s-triazine (10 mmol/L) and ferric (FeCl3)). The reaction mixture was incubated at 37 °C for 30 min, after which the absorbance was measured at 595 nm. A standard curve for FeSO4 was plotted and used to calculate the reducing power of the extract.

The antioxidant capacity was measured against the 2,2-diphenyl-1-picrylhydrazyl radical (DPPH). Briefly, a reaction mixture containing 50 μL of MOF extract at 10, 30, 100, 300 and 1000 μg/mL or Trolox (100 μg/mL) added with 150 μL DPPH stock solution (24 μg/mL) were incubated at room temperature in the dark for 30 min and measured at 517 nm. All determinations were accompanied by a control (blank) without the antioxidant samples. The decrease in the absorbance values of the samples was correlated to the control and the percentage of scavenging of the DPPH radical was expressed by the equation: % of scavenging = ((Abscontrol – Abssample)/Abscontrol) x 100. The results were expressed as percentage of DPPH scavenging activity. 

Animals and treatment

Male Wistar rats, 21-day-year old, were obtained from the vivarium of the Universidade do Vale do Itajaí. Animals were allowed free access to water and food. The rats were housed in three animals per cage and acclimatized to laboratory conditions (20–23 ºC, humidity 60%, 12 h light/dark cycle) for at least one week before each study. All procedures were performed according to the Brazilian Society of Science of Laboratory Animals’ guidelines for the proper care and use of experimental animals. All procedures were approved by the local Ethics Committee of the Universidade do Vale Do Itajaí, Brazil (protocol no. 017/17).

All rats were weighed, and the consumption of water and feeds were quantified every two days. Fructose was supplied in the drinking water at a concentration of 20%. Twenty-seven rats were distributed in different groups (n=9): (1) control: water and standard feed; (2) water with 20% fructose solution (w/v, prepared every two days) and normal feed; (3) water with 20% fructose solution and standard feed supplemented with 20% of MOF for four weeks. The methodology concerning the amount of M. oleifera flour added to chow was based on previous work with flour of vegetable products (16,17), and the amount of fructose supplemented in water was proposed by Mamikutty et al. (2014) (18).

Abdominal circumference

The abdominal circumference of animals was measured at the beginning of the experiment and at the end of the fourth week. The measurement was performed with the animal in the prone position with a tape measure in the region corresponding to the line above the iliac crest. The initial and final measurements were considered in the calculation of the percentage of increase in abdominal circumference.

Insulin Resistance Test (IRT)

The ITT was performed using a method previously described for rats (19). The food was removed from the cages at 08:00 a.m. on the study day, and the procedure was initiated at 1:00 p.m. Human insulin (Humulin®) was administered intraperitoneally in rats at a dose of 0.75 U/kg body weight. Tail blood was collected at 0 (before insulin infusion), 30, 60, 90, and 120 min (post infusion). Blood glucose levels were measured with a glucometer (Accu-chek® Active, Roche Diagnosis, Basel, Switzerland) at each time point. The area under the glucose decay curve (AUC) was calculated for each mouse and the mean was calculated for each group (20).

Biochemical parameters

The biochemical analysis was performed with the blood samples collected at the end of the experiment. After the fasting protocol, the animals were anaesthetized (ketamine and xylazine) and their blood samples were taken from the brachial artery. The samples were centrifuged at 4,000 g, at 4 °C for 10 min to separate the serum. The total cholesterol (CT), high density lipoprotein-cholesterol (HDL-c), no-HDL cholesterol, triglyceride, glucose, and the activity of aspartate transaminase (AST), alanine transaminase (ALT) and alkaline phosphatase (ALP) concentrations were measured using corresponding commercial kits (Labtest, Lagoa Santa, MG, Brazil) by spectrophotometry and serum insulin concentration was measured by electrochemiluminescence assay.

Histological analysis

Small samples of hepatic, pancreatic and adipose tissues, extracted at the end of the experiment were fixed in 10% formalin. Then, followed the dehydration protocol, they were embedded in paraffin, sliced and stained using hematoxylin-eosin (HE). Images of the histological sections were taken using an optical microscope (Olympus CBA, Bartlett, TN, USA). For analysis of the pancreas, 15 images were captured for each animal in each group using a 10x objective. The image analysis was determined using Image J software, which quantified the areas of the respective functional units of each tissue. The results were expressed in µm/field. For the adipose tissue, 10 images of each animal in each group were captured using 10x objective, and the images were analyzed using Adiposoft Software (CIMA/Universidade de Navarra, Spain) (21)

Extraction of hepatic lipids

The liver cholesterol and triglyceride were extracted according Folch’s method (1957) (22). At the end of the experiment, fresh livers were extracted and homogenized using chloroform/methanol (2:1, 3.75 mL). Chloroform and distilled water were then added to the homogenate and the solution was vortexed. After centrifugation (1500 g for 10 min), the lower organic phase was transferred to a new glass tube and lyophilized. The lyophilized powder was dissolved in a chloroform:methanol (1:2) mixture and then stored at −20 °C. Cholesterol and triglyceride concentrations were determined spectrophotometrically using commercial diagnostic kits (Labtest, Lagoa Santa, MG, Brazil).

Determination of Thiobarbituric Acid Reactive Substances (TBARS) in the liver

The evaluation of lipid peroxidation was determined by the concentration of malondialdehyde in the liver tissue. The amount of present TBARS were determined as described by Uchiyama and Mihara (1978) (23). Livers were removed and 10 % homogenates were prepared in 15 % KCl solution. To 0.5 mL of 10 % homogenate was added 3.0 mL 1% H3PO4 and 1 mL 0.6% thiobarbituric acid solution. Each mixture was heated for 45 min, cooled, and extracted with n-butanol and the absorbance of the color at 535 nm was measured. The results were expressed as nmol MDA/mg tissue.

Statistical analysis

Results are presented as mean ± standard error mean (SEM) of 9 rats per group (n=9). For weight evolution analysis and insulin resistance tests, two-way ANOVA was used followed by Bonferroni test. All other statistical comparisons were performed using one-way analyses of variance (one way-ANOVA) followed by Tukey’s test. P-values less than 0.05 (p < 0.05) were considered significant. All analyses were performed using GraphPad PRISM 6® (GraphPad Software, San Diego, CA, USA).

Results

Characterization of MOF extract by determination of total phenol content and LC-ESI- MS/MS analysis

Total phenol content in MOF extract was 122.96 ± 0.18 mg of gallic acid equivalent (GAE) per gram of extract, showing 2.27 ± 0.33 g EAG/100 g MOF. The phytochemical profile of MOF presented several compounds, seven of which could be identified (Figure 1 and Table 1). The seven major phenolic compounds were identified as (1) protocatechuic acid, (2) chlorogenic acid, (3) caffeic acid, (4) p-coumaric acid, (5) rutin, (6) quercetin, (7) eriodictyol, and the concentration of each was determined (Table 1). Among the identified compounds, the major compound of the extract is the compound 6, identified as quercetin with 103.01 mg/g, followed by protocatechuic and chlorogenic acid with 4.03 and 1.03 mg/g, respectively.

In vitro antioxidant activity of MOF methanolic extract

The extract was evaluated for antioxidant activity in vitro by the DPPH radical assay and ferric reducing antioxidant power (FRAP) assay. Figure 2A shows that the MOF methanolic extract significantly decreased the DPPH radical from of 300 –1000 μg/mL. Trolox (100 μg/mL) also significantly reduced the DPPH radical in comparison to the system. Data presented in Figure 2B demonstrates that MOF methanolic extract significantly increased the reducing potential from of 300–1000 μg/mL, when compared with the system. Trolox (100 μg/mL) also presented this activity (p<0.001). Taken together, the data shows that MOF extract has antioxidant activity, probably due to the presence of phenolic compounds in the plant.

Effect of MOF in weight gain and abdominal circumference measurement

Figure 3 demonstrates that MOF and fructose supplementation did not interfere with weight gain after 4-week period of intervention (Figure 3A and 3B). Additionally, abdominal circumference was unaffected (Figure 3C).

Effect of MOF on insulin and glucose sensitivity, fasting blood glucose, and pancreatic parameters

The results obtained showed that rats supplemented with fructose for four weeks developed insulin resistance (Figure 4A and 4B) with increased fasting blood glucose (Figure 4C). Corroborating to this data, the animals also presented increased insulin levels (Figure 4D) and Langerhans islets hypertrophy (Figure 4F), which was confirmed by the measurement of Langerhans islets area (Figure 4E). On the other hand, the animals that received MOF supplementation presented a reduction in the glucose levels, without other metabolic changes correlated to insulin metabolism (Figure 4A, 4B and 4D). In fact, the histological evaluation of the pancreas in MOF-treated animals was very similar the animals from control group (Figure 4F). Moreover, in this group, the Langerhans islets cell volume remained close to normal (Figure 4E and F).

Effect of MOF on serum lipid profile

The effect of the MOF supplementation on serum lipid profile is demonstrated in Figure 5. The triglycerides (TGL) concentration was significantly decreased (p<0.05) (Figure 5A), while high density lipoprotein cholesterol (HDL-C) concentration increased significantly compared to fructose group (p<0.01) (Figure 5C). The fructose group demonstrated a decrease in HDL values, as expected, and had a considerable increase in TGL when compared to both groups (Figure 5A). Total cholesterol and non-HDL cholesterol values did not show differences between groups (Figures 5B and 5D respectively).

Characterization of liver tissue lipids

The data presented in Figure 6 shows the hepatic lipid profile following the four-week period of intervention. The histological analysis of H&E-stained hepatocytes (magnification x 400) demonstrated lower deposition of lipids in the hepatic tissue in animals that received MOF supplementation (Figure 6A). The hepatocytes from the fructose-treated group presented plaques separated by irregular blood sinusoids. The areas were characterized as histological manifestation of intracytoplasmic lipids, close to the central lobular vein (Figure 6A). No such abnormalities were found in the MOF supplementation group, indicating that MOF supplementation prevented the deleterious effect of fructose on hepatic lipid storage. In fact, the biochemical analysis demonstrated that MOF supplementation prevented the increase of hepatic cholesterol and TGL concentrations (Figures 6B and C).

In addition, the lipid peroxidation was evaluated according to appropriate methods through malondialdehyde (MDA) measurement. As expected, liver tissue samples from rats that consumed only fructose revealed increase in MDA compared to both other groups. Moreover, MOF addition improved oxidative stress, reducing hepatic MDA formation (Figure 6D).

Effect of MOF on adipose tissue parameters

The fructose group presented an increase in the absolute weight of visceral and epididymal adipose tissue (Figures 7A and 7D) after 4-week treatment period, as shown in Figure 7. However, no significant difference was observed between the relative weight for both tissues (Figures 7B and 7E). Noteworthy, the histology (Figure 7C) and morphometry (Figure 7F) from epididymal adipose tissue showed that fructose induces a higher cellular volume in the adipocytes. However, animals treated with MOF exhibited cellular area size similar to the control group.

Discussion 

M. oleifera is an edible plant and contains not only nutrients, but also bioactive compounds such as alkaloids, sterols, glucosinolates, isothiocyanates, phenolic glycosides and flavonoids (24,25). In fact, our results showed that MOF extract is rich in phenolic compounds, as previously published (26). LC-ESI- MS/MS profile analysis enabled the identification of various active compounds within the extract. The detection of quercetin, as the majority compound, followed by protocatechuic, chlorogenic acid, caffeic acid, p-coumaric acid, rutin and eriodictyol in MOF agrees with previous studies (27).

Antioxidants are not only reducing agents used as preventatives to inhibit the oxidation of other molecules, but they may also be used to treat health complications from metabolic conditions caused by oxidative stress (3). MOF phytochemical analysis demonstrated the presence of phenolics compounds and flavonoids, which are known to be efficient antioxidants (28). In this context, the presence and synergy of these compounds in MOF explains the efficient antioxidant properties in vitro and in vivo.

Several researchers have demonstrated that excessive fructose consumption can lead to metabolic disturbances, especially related to insulin metabolism and metabolic syndrome (29,30). In fact, our data demonstrates that adding 20% fructose in the water given to the animals for four weeks promotes metabolic changes, mainly related to insulin resistance and liver lipid accumulation, without promoting alterations in the weight gain, abdominal circumference, and abdominal visceral fat deposition. Additionally, the data obtained in the histological analysis of the adipose tissue showed that the adipocyte’s area increased in the fructose-treated animals. This data corroborates with the literature, which shows that the fructose consumption is associated with the adipocyte hypertrophy (31). In contrast, adipocyte hypertrophy was prevented with the incorporation of MOF into the diet, when compared to fructose treated animals.

From the above findings, the insulin resistance was observed in animals that received fructose. The insulin resistance is a fundamental aspect of the etiology of type 2 diabetes and plays important role not only in the development of hyperglycemia of non-insulin dependent diabetes but also in the pathogenesis of long-term complications such as hypertension, nephropathy, and hyperlipidemia. The high consumption of large(r) amounts of fructose facilitates the hepatic triacylglycerol production, in a process called de novo lipogenesis. This process leads to a “selective insulin resistance”, in which the inhibited-glucose metabolism by insulin signaling pathways is impaired while those that stimulates lipid metabolism are preserved, resulting in the devastating co-existence of hyperglycemia and hypertriglyceridemia (33,34).

Corroborating, our results show that fructose consumption promotes high triglycerides and insulin levels, increases the Langerhans islets area, altering glycemic behavior in response to exogenous insulin administration and fasting hyperglycemia, moving towards the impairment of insulin signaling cascade. In contrast, rats that received MOF incorporated to their diet presented normalized triglycerides, glucose metabolism and normal Langerhans islets area in the histopathological analysis. These results are consistent with recent studies that demonstrated the role of M. oleifera leaves in modulating hepatic key genes of the insulin signaling, reducing the hyperglycemia by minimizing gluconeogenesis, up-regulating the expression of hepatic IR and IRS-1, supporting the regeneration of damaged hepatocytes and pancreatic cells in rats (35,36). This effect could be in part related to the presence of chlorogenic acid that enhances insulin activity by triggering the AMP-activated protein kinase (AMPK) and by flavonoids that can promote the glucose uptake stimulation in peripheral tissues (37).

As previously cited, the liver histological analysis demonstrates that fructose promotes accumulation of triglycerides and cholesterol. This effect was previously reported by other studies (38,39) However, interestingly, triglyceride accumulation in the liver of fructose treated rats occurred in the absence of increased body weight or adiposity. According to Fabbrini et al. (2009) (40), intra-hepatic lipid content is a better predictor of metabolic abnormalities than body adiposity. Ectopic lipid deposition induced by fructose is attributed to the activation of the transcription factor ChREBP and SREBP1c, which occurs during the fructose metabolism, and these transcription factors regulate the expression of several enzymes responsible for the fatty acid synthesis (41). It is believed that elevation in hepatic diacylglycerol (DAG) levels lead to protein kinase C (PKC) activation and its consequent translocation to the cell membrane, which results in inhibition of hepatic insulin signaling and development of hepatic insulin resistance.

In contrast, MOF diet supplementation was able to prevent the effect of fructose on hepatic lipid stores, probably due to its bioactive compounds such as quercetin which have been shown to alter gene expression of major regulators of hepatic cholesterol and triglycerides synthesis and uptake. The accumulation of liver lipids overloads the mitochondrial electron transport chain, which in turn leads to the increase of ROS and lipid peroxidation products. The increase of these mediators impairs mitochondrial function and reduces lipid β-oxidation, promoting even greater hepatic lipid deposition from this vicious cycle, creating a state of oxidative stress as a result of free radical production (42). Our results have shown an elevation in the hepatic MDA, an important biomarker of lipid peroxidation, and an impairment in the antioxidant defense system. As expected, the MOF supplementation induced lower levels of hepatic MDA, being itself a key antioxidant at the hub of numerous competing reactions.

As quercetin is the major compound of MOF, it is important to mention that according to literature data, only 5.3% of unchanged quercetin is bioavailable. Quercetin is ingested in the form of glycosides, and the glycosyl groups are released during mastication, digestion, and absorption. Afterwards, quercetin glycosides are converted to aglycone in the intestine before being absorbed into enterocytes by the action of glycosidases enzymes. Furthermore, more recent studies demonstrate that the biotransformation products of polyphenols can reach the tissues, and these metabolites are indeed found in higher concentrations than their “parent compounds” (43).

Together, these findings demonstrated an efficient protective effect of MOF supplementation against adverse effects of fructose diet-induced metabolic syndrome and its first initial metabolic changes, like insulin resistance and associated cardiovascular disorders. The present results also highlight the deleterious effects of fructose consumption in early life which may lead to adults with severe metabolic syndrome and co-morbidities.

Strengths and limitations of the study

Although there are different murine models to mimic the metabolic syndrome, the decision about which model to use for a particular experiment is often multifactorial. The advantage of the model used in our study (over the genetic models) is that not the entire population is genetically affected and will develop metabolic syndrome. Another important point is the type of sugar used in the diet. We decided to use fructose because many studies have reported that the chronic consumption is strongly associated with a variety of related metabolic diseases, including obesity, systemic insulin resistance, metabolic syndrome, and type 2 diabetes mellitus.

The (unfortunately) wide consumption of soft drinks, which are mostly sweetened with high fructose syrup (60% + 40% sucrose), was another determinant in our selection of fructose.

Although this study was focused on the evaluation of MOF supplementation to prevent fructose metabolic disorders, one of the limitations of this work is the lack of knowledge of the mechanism through which MOF can modulate the metabolism to avoid the effects of high fructose diet. Another limitation of the study is related to the lack of quantification of sugars in the diet. In this context, is important to mention that the data here obtained in vitro and in vivo are preliminary, and further research is required to elucidate these points.

In addition, there is a lack of knowledge about the pharmacokinetics of MOF compounds to better understanding the metabolization and the delivery of metabolites to the tissues. In this context, further analyses are necessary to elucidate this point.

Conclusion

Taken together, the data herein presented show that Moringa oleifera flour prevents the high-fructose intake-initiated metabolic disorders. Phytochemical study of MOF demonstrated a series of phenolic compounds, which can be correlated with its in vitro antioxidant activity. In vivo, MOF prevented insulin resistance, dyslipidemia, and adipocyte hypertrophy. However, more studies are necessary to elucidate the mechanisms involved.

Authors Contributions Statement

Data collection: ICBC, ICZ, IRS, MFB, ADF, MJG, EAS, LB and SG; statistical analysis: ICBC, LB, JRS, RN, LV, NLMQ and IDM; analysis and interpretation of the data: JRS, NLMQ, IDM, AMOS and LV; drafting the manuscript: JRS, IDM and NLMQ; critical revision of the manuscript: JRS.

Acknowledgments

This work was supported by grants from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, grant number: 429505/2018-3) and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, cod. 001). I.C.B.T and M.F.B were Master students and are recipients of CAPES (Cod. 001) grants during the study. N.L.M.Q. and J.R.S. are CNPq researchers (process numbers 305550/2018-7 and 310326/2020-6).

Conflict of Interests

The authors declare there are no financial and/or personal relationships that could present a potential conflict of interests.

 

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Biopharmaceutical Sciences, Biomed Biopharm Res., 2022; 19(2):410-423

doi: 10.19277/bbr.19.2.299; PDF version here [+] Portuguese html version [PT]  

 

Evaluation of the influence of the application of a cosmetic formulation on the skin morphological characteristics by Reflectance Confocal Microscopy

Patrícia Maria Berardo Gonçalves Maia Campos* & Gabriela Maria D’Angelo Costa

School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil. Av do Café, s/nº, Monte Alegre, Ribeirão Preto, SP, Brazil 14040-903

corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

Reflectance Confocal Microscopy (RCM) is a non-invasive imaging technique with near-histological resolution that allows evaluation of the morphological and structural characteristics of the skin. In this context, the aim of the study was to evaluate the influence of the application of a cosmetic formulation on the skin morphological characteristics by RCM. The study included six female subjects, aged 40 to 50 years. Measurements in terms of epidermis thickness, dermal papillae depth (DPD), interkeratinocytes brightness (IB), furrows morphology, skin surface homogeneity (SSH), honeycomb pattern, skin hyperpigmentation, dermal papillae and dermis morphology were performed using RCM before and after a 90-day period of formulation application on the face. The studied formulation showed a significance increase of DPD after the 90 day period, showing an improvement on the dermal-epidermal junction (DEJ). In addition, an increase of IB in the granular layer and an improvement of dermis morphology were observed after the treatment. In conclusion, the obtained results by RCM showed an improvement of morphological characteristics of the skin after application of the studied cosmetic formulation for 90 day period when compared to the initial baseline, as it improved epidermis and dermoepidermal junction morphology.

Keywords: Clinical efficacy, Reflectance Confocal Microscopy, cosmetic formulation

Received: 13/11/2022; Accepted: 31/12/2022

Introduction

The search for active ingredients to improve the characteristics of skin aging is important for innovation in the cosmetic area. Thus, clinical efficacy studies are necessary to prove the effectiveness of cosmetic formulations containing these active ingredients (1,2,3).

Skin aging is a process induced by intrinsic and extrinsic factors (4). The changes of intrinsic aging are the presence of a thinner epidermis, decreased depth of the dermoepidermal junctions that compromise skin nutrition, and decrease basal cell proliferation (5,6). Solar radiation significantly contributes to accelerated skin aging by promoting photoaging, which results in skin changes such as an increased of collagen degradation, presence of solar elastosis and hyperpigmentations regardless of chronological age or sex (7,8).

There are active ingredients that can improve aged skin conditions. Peptides have been used in cosmetics since they have presented potential for the skin care (9). In addition, di- and tripeptides extracted from rice (Orysza sativa) are compatible with the skin and present potential for application in cosmetic formulation for the treatment of aging skin (10).

A previous study of our research group (Maia Campos et al., 2019) showed that a cosmetic formulation with di- e tripeptides from rice was effective in the improvement of skin elasticity and dermis density for women aged 40 to 50 years (10). Another study from our research group, Shirata et al (2021), showed that cosmetic formulations containing rice di- and tripeptides were effective for the improvement of skin hydration and the prevention of skin photodamage in young age groups (11). Thus, the evaluation of skin morphological and structural characteristics is very important to elucidate the efficacy of cosmetics in dermis epidermal junction, dermal papillae and collagen morphology in the papillary dermis.

Clinical studies using instrumental measurements such as non-invasive imaging techniques are very important to evaluate the efficacy of cosmetic products in real conditions of use (3,7,10,12). Reflectance Confocal Microscopy (RCM) is a non-invasive advanced imaging technique with near to histological resolution that allows evaluation of morphological and structural skin characteristics in real time. It is a technique widely used in dermatology and can be applied in the cosmetic area to characterize different types of skin and evaluate the effectiveness of cosmetics without the need for biopsies (12, 13).

In this context, the application of RCM to evaluate the clinical efficacy of cosmetic formulations can bring an important contribution to elucidate the benefits of application of these formulations in the treatment of photoaged skin.

Thus, the aim of the study was to evaluate the influence of the application of a cosmetic formulation containing di-and tripeptides of hydrolyzed rice protein on the skin morphological characteristics by Reflectance Confocal Microscopy.

Materials and methods

Study Design

After approval by Ethnics Committee of Faculty of Pharmaceutical Sciences of Ribeirão Preto – University of Sao Paulo (CEP/FCFRP no339), six female subjects, aged 40-55 years (mean age 48 ± SD: 4.95 years), skin Fitzpatrick Phototypes II and III, Caucasian descent were enrolled. (mean age: 48.09 ± SD: 4.85 years)

A cosmetic formulation based on hydroxyethylcellulose (1.8%), methylphenyl polysiloxane (2.0%), cyclomethicone (1.5%), cyclomethicone and crosspolymer dimethicone (1.5%), hydrosoluble filter UVA/UVB (7.5%), propylene glycol (2.5%), glycerin, 2‐Phenoxyethanol (And) Methylisothiazolinone (0.8%), (And) Aqua/Water was added to 4% of the di-and tripeptides of hydrolyzed rice protein and applied on the face twice a day by subjects for a 90 day period. Instrumental measurements by RCM were performed before (baseline) and after 90 days of the application of studied formulation in the periorbital region of the face. The subjects were required to remain in the laboratory [located in the School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Brazil (21°100 S, 47°480 W)] with controlled climatic conditions of 21.5 ± 1oC and 50 ± 5% of relative humidity for 20 minutes before the beginning of the measurements.

Skin imaging technique - RCM

Reflectance Confocal Microscopy (VivaScope® 1500, Lucid, New York, USA) emits a low-powered laser (22 mW) with a wavelength close to the infrared (830 nm). This equipment obtains several microscopic images captured as horizontal sections with a field of view of 500 x 500 µm and a high-resolution of 1000 x 1000 pixels. The VivaStack® program allows the capture of images in depth from the stratum corneum to the papillary dermis. The depth of the layers, dermal papillae depth and epidermis thickness is calculated with the “z-depth” (Table 1). Analyzes of interkeratinocyte brightness, furrows morphology and skin surface homogeneity were performed using a standardized score in our NEATEC (Center of Advanced Studies in Cosmetic Technology) research group (14).

In addition, other scores adapted from Longo et al. (2013) were assessed as honeycomb pattern, skin hyperpigmentation, dermal papillae morphology, dermis morphology (15). The score definitions are shown in Table 2.

Statistical analysis

The normal distribution of the data was evaluated by the Shapiro-Wilk test in the OriginPro® 8 software. After defining whether the data were parametric or non-parametric, the paired Student's t or Wilcoxon tests were performed, respectively. GraphPad Prism® 5 software was used to perform the statistical analyses. The value of p <0.05 was considered statistically significant.

Results

The results showed a significant increase (p=0.0328) of dermal papillae depth after the use of studied formulation for 90 days. In addition, an increase in the total epidermis thickness was observed after the 90 day period, which is according to improvement of dermal papillae depth (Table 3).

The results of RCM score analyses are shown in Figures 1 to 7.

The skin surface homogeneity score analysis showed an improvement of skin regularity of stratum corneum since the participants with Score 1 increased after 90 days of treatment (Figure 1A). This improvement can be seen in representative RCM images (Figure 1B).

 

The furrows morphology score improved after the 90 day formulation application period as the Score 0 (regular) increased (Figure 2A). Representative RCM images showed an improvement in the furrow morphology noted as straighter edges of the furrows relative to the baseline (Figure 2B).

The interkeratinocyte brightness score analysis showed an increase after 90 days of treatment with the studied formulation. The score represents the low interkeratinocyte brightness (Figure 3A). An increase of interkeratinocyte brightness in the granular layer is demonstrated in representative RCM images after 90 days of treatment (Figure 3B).

The score analysis of the honeycomb pattern showed better homogeneity of keratinocytes with a more defined honeycomb pattern, as a Score 1 was found in 100% of the subjects after 90 days of treatment with the formulation (Figure 4A). The improvement in the honeycomb pattern is observed in representative RCM images (Figure 4B) in which the keratinocytes are homogeneous in size and shape and with defined cell borders after the treatment period.

 


The score analysis of the skin hyperpigmentation showed a reduction after the use of the formulation under study for 90 days, with an increase in participants with Score 1 (Figure 5A). The basal layer observed in the representative RCM images (Figure 5B) shows a reduction of basal layer brightness after 90 days of treatment.

The score analysis of the dermal papillae morphology showed an improvement after the use of the formulation as Score 2 was observed in 100% of participants after 90 days of treatment (Figure 6A). Representative RCM images showed an improvement in the dermal papillae morphology after 90 days of treatment, in which the dermal papillae were rounded and partially outlined rings contours instead of polycyclic papillae (Figure 6B).

The score analysis of the dermis morphology showed an improvement of collagen after the use of the studied formulation for 90 days. The presence of coarse collagen (Score 3) was presented in 50% of participants after 90 days of treatment (Figure 7A). The dermis morphology was represented as coarse and huddled collagen at the initial time and was observed as coarse collagen after the treatment period (Figure 7B).

Discussion

In order to prove the effectiveness of the topical peptides, clinical study is important for the development of effective and innovative cosmetic formulations (16). For that, the RCM imaging analysis is essential to evaluate the effects of the active ingredients in skin depth as it evaluates the morphological and structural characteristics of the epidermis in real time and in a non-invasive way (12).

According to the results obtained, improvements of regularity of stratum corneum, furrow morphology and increase of interkeratinocyte brightness were oberved after the use of the formulation under study for 90 days. These findings corroborated with the study of Manfredini et al. (2013) that suggested an increase of skin hydration due to a decrease in the irregularity of the skin surface, an improvement in the morphology of furrows and an increase in the interkeratinocytes brightness after application of the cosmetic formulations (17). In addition, Shirata and Maia Campos (2021) showed a significant increase in the granular layer thickness in photoaged skin after a 90 day application period of a formulation containing di- and tri peptides, which suggest an increase of skin hydration (11).

Moreover, the improvement in the honeycomb pattern suggests an improvement in the skin conditions, since the irregularity of the honeycomb pattern is present in skin photoaging (7,18).

A significant increase of dermal papillae depth and the improvement of dermal papillae morphology after 90 days of treatment with the formulation under study suggests that the formulation was effective for the treatment of alterations in the aged skin since the improvement in the dermo-epidermal junction can increase the skin nutrition and basal cell proliferation that are compromised with skin aging (5).

Another finding that suggests the efficacy of the studied formulation on aged skin was the improvement of the collagen morphology, since there was a decrease of huddled collagen and increase of coarse collagen after the use of the proposed formulation for 90 days (15).

These findings are very important since the aging process cause changes in the layers of dermis, superficial papillary layer and deeper reticular layer, which have distinct collagen fibrils and fibroblast properties (19). However, the papillary layer shows more remarkable changes with aging than the reticular layer (20).

In addition, there was a reduction of skin hyperpigmentation after the use of the proposed formulation for 90 days, which can suggest that there was an improvement in the photoaged skin, since hyperpigmentation is present on skin exposed to higher incidence of UV radiation (18). This result corroborate with the findings reported by Shirata e Maia Campos (2021), who observed a significant hyperpigmentation reduction after a 90 day period of use of the cosmetic formulations based on rice peptides in combination with ascorbyl tetraisopalmitate (11).

In addition, the oral and topical use of peptides is commonly used in dermatology for skin care (21). Oral collagen supplements are known to increase skin elasticity, hydration and dermal collagen density (22, 23). In addition, previous studies by our research group have shown a significant increase in dermis echogenicity, hydration and viscoelastic properties of the skin after using formulations containing di- and tripeptides extracted from rice for 90 days of topical or oral treatment (10).

In summary, the present study complements the previous study of our research group since it showed that the proposed cosmetic formulation was effective in the improvement of honeycomb pattern of epidermis, dermoepidermal junction and dermis morphology due to an improvement of collagen morphology after a 90 day period of application.

Finally, the study has as limitations the lack of a control group and the small number of participants in the clinical study.

Conclusion

The results obtained in RCM imaging analyses showed an improvement of morphological characteristics of the skin after 90 days of twice-daily application of the studied cosmetic formulation containing di- and tripeptides extracted from rice when compared to baseline - initial time, before the formulation application, as it improved epidermis and dermoepidermal junction (DEJ) morphology.

Reflectance Confocal Microscopy can be suggested as a valuable tool for evaluating the effectiveness of cosmetic formulations on the skin, in an objective and non-invasive way under the real conditions of use.

Acknowledgement

The authors would like to express their thanks for the financial support of the Fundação de Amparo à do Estado de Sao Paulo - Brasil – FAPESP (grant number 2017/19278-0) and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.

Authors Contributions

The contributions of Patrícia M. B. G. Maia Campos were conceptualization of the study, writing, revision, and editing. The contributions of Gabriela M. D’Angelo Costa were data and image analysis, statistical analysis and writing.

Conflicts of Interest

The Editor involved in the authorship of this manuscript had no participation in the review or decision process. All authors have stated that there are no financial and/or personal relationships that could represent a potential conflict of interest.

 

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19. Korosec, A., Frech, S., Gesslbauer, B., Vierhapper, M., Radtke, C., Petzelbauer, P., & Lichtenberger, B. M. (2019). Lineage Identity and Location within the Dermis Determine the Function of Papillary and Reticular Fibroblasts in Human Skin. The Journal of investigative dermatology139(2), 342–351. https://doi.org/10.1016/j.jid.2018.07.033

20. Mine, S., Fortunel, N. O., Pageon, H., & Asselineau, D. (2008). Aging alters functionally human dermal papillary fibroblasts but not reticular fibroblasts: a new view of skin morphogenesis and aging. PloS one3(12), e4066. https://doi.org/10.1371/journal.pone.0004066

21. Gorouhi, F., & Maibach, H. I. (2009). Role of topical peptides in preventing or treating aged skin. International journal of cosmetic science31(5), 327–345. https://doi.org/10.1111/j.1468-2494.2009.00490.x

22. Choi, F. D., Sung, C. T., Juhasz, M. L., & Mesinkovsk, N. A. (2019). Oral Collagen Supplementation: A Systematic Review of Dermatological Applications. Journal of drugs in dermatology : JDD18(1), 9–16.

23. Maia Campos, P. M. B. G., Franco, R. S. B., Kakuda, L., Cadioli, G. F., Costa, G. M. D., & Bouvret, E. (2021). Oral Supplementation with Hydrolyzed Fish Cartilage Improves the Morphological and Structural Characteristics of the Skin: A Double-Blind, Placebo-Controlled Clinical Study. Molecules (Basel, Switzerland)26(16), 4880. https://doi.org/10.3390/molecules26164880.

Biopharmaceutical Sciences, Biomed Biopharm Res., 2022; 19(2):379-496

doi: 10.19277/bbr.19.2.297; PDF version here [+] ; Portuguese html version [PT]  

 

Oral intake of Bioactive Collagen Peptides in the improvement of skin and hair: clinical studies by instrumental measurements

Patricia M. B. G. Maia Campos*, Maísa Oliveira de Melo, Marina Mendes Fossa Shirata, Marcella Gabarra Leite

Faculdade de Ciências Farmacêuticas de Ribeirão Preto da Universidade de São Paulo. Av. do Café S/N – CEP: 14040-903, Monte Alegre, Ribeirão Preto, Brasil

corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

The effect of collagen peptides on various aspects of skin and hair physiology is known but needs further studies. Thus, the objective of this study was to evaluate the clinical changes in skin and hair after 90 days of treatment with oral supplementation of 5 g/day of collagen peptides. For this, 60 healthy female participants were enrolled, aged 45 to 60 years old, with the primary objective of evaluating the effect of the ingestion of a bioactive collagen peptides-based supplementation in the cutaneous microrelief, reduction of wrinkles, thickness, and echogenicity of the dermis, as well as in the mechanical properties of the hair using biophysical and skin imaging techniques. The present study showed important benefits in relevant skin visual parameters, dermis density, and hair strength with the obtained data. In addition, considering that the aging process affects the hair's mechanical resistance due to hair fiber thinner, the proposed treatment was effective for aged hair. In conclusion, the collagen peptides oral supplementation is essential not only for improving skin conditions but also for hair care once it significantly increases the mechanical hair resistance evaluated by objective measurements.

Keywords: Collagen peptides, skin aging, skin imaging techniques, hair mechanical properties, clinical study

Received: 12/10/2022; Accepted: 07/11/2022

 

Introduction

To be considered a healthy individual, a few different parameters are analyzed, such as physical exercises, sleep habits, presence of addictions, and others, but one of the best-known facts regarding this subject is that overall health is closely associated with nutritional habits. A balanced diet, comprising all necessary macro- and micronutrients, is vital for preventing a myriad of diseases. This is especially true for health problems that are associated with aging, such as cardiovascular disease. In this context, the skin is the first and most apparent indicator to reflect an individual’s health. Smooth, clean, and young-looking skin is perceived as a desirable attribute, so treating the signs of skin aging is an important concern for many and can be a key motivation for a healthy diet. Many micronutrients, such as Vitamin C, E, biotin, and zinc, have been associated with direct benefits for skin physiology and are used as ingredients for dietary supplements with the aim of reducing signs of skin aging (1,2).

During the aging process, the skin becomes less hydrated, losing its elasticity and firmness, along with increased pigmentation, pore size, and other structural changes in the dermis and epidermis. Furthermore, the collagen network in the dermis that provides strength and firmness to the skin becomes thinner and more fragmented (3). An increase in matrix metalloproteinase (MMP) expression accounts for accelerated collagen degradation (1,3). With a less dense and more fragmented network of collagen fibers, the embedded fibroblasts receive fewer mechanical stimuli, a key trigger for their metabolic activity. In addition, the synthesis of new extracellular matrix components from fibroblasts inherently slows down with age. Both processes prevent the degraded matrix from being adequately replaced (4). The elastic fibers of the papillary dermis lose integrity during aging and reach less far into the dermal-epidermal junction. This overall loss in elasticity, hydration, and strength leads to visual characteristics such as sagging and wrinkle formation (1,3).

Targeted enzymatic hydrolysis of collagen produces a natural combination of peptides with a defined mean molecular weight that carries bioactivity in supporting different biological processes that contribute to a healthy aging process. Collagen is the most abundant protein in the body, present in the extracellular matrix of all connective tissues. Thus, evidence at the preclinical and clinical levels is building up for hydrolyzed collagens to support the maintenance of the musculoskeletal system, including bones, ligaments, tendons, and joints. Collagen has a unique amino acid composition with a specifically high abundance of glycine, proline, and hydroxyproline. Upon ingestion, hydrolyzed collagen is digested into free amino acids and di- and tripeptides resistant to further hydrolysis by intracellular or serum peptidases (5). These peptides are transported across the intestinal barrier by a designated transporter, PEPT-1 (6). Hydroxyproline-containing peptides derived from hydrolyzed collagen ingestion have been identified in human serum with a peak of absorption one hour after the ingestion (7). A topic still under discussion is whether peptides longer than two or three amino acids can pass the intestinal barrier. Studies with radioactively labeled collagen-derived peptides demonstrated the efficient transport and uptake into target tissues, such as bone, cartilage, muscle, and skin (8). Astonishingly, these peptides could be detected in the skin up to 14 days after administration (9).

Hydrolyzed collagen can be extracted from different sources and tissues. Bovine collagen can be extracted from the bovine Achilles tendon using different enzymes such as alcalde, pepsin, trypsin, and collagenase produced by Penicillium aurantiogriseum. It is known for having antihypertensive, antioxidant, and antimicrobial activity. When obtained from bovine lung, it has antioxidant and anti-inflammatory activity. Finally, hydrolyzed collagen from the nuchal ligament of bovine can be used as a promising precursor of the angiotensin-I-converting enzyme (ACE)-inhibitory peptides (10).

Collagen obtained from porcine skin is also produced and shows antioxidant, anti-aging, and skin permeation properties.

However, these two collagen sources have some limitations due to health problems such as swine flu and bovine spongiform encephalopathy. Furthermore, religious issues should also be considered. Thus, alternative sources from marine sources have been developed, especially from fish and other invertebrates such as jellyfish or sponges. They present nutraceutical effects due to their functional bioactive properties. In some cases, antioxidant and antimicrobial activity are also present (10).

The effect of hydrolyzed collagen on various aspects of skin physiology has been investigated in preclinical studies. Oral supplementation with hydrolyzed collagen inhibited the loss and the fragmentation of collagen by aging in rats, in part by inducing the expression of type I and type III collagen, as well as inhibiting MMP expression and activity (1,3). In pigs, hydrolyzed collagen intake increased collagen fibrils' density and diameter (11). Similar effects on the stimulation of collagen synthesis were observed in cultured fibroblasts isolated from UV-exposed body areas (12). UV-induced damage to the skin was hampered in mice by inhibiting inflammatory pathways (13). Further, at a cellular level, hydrolyzed collagen has been shown to promote skin fibroblasts' growth and induce fibroblast migration (7).

Several clinical studies using various designs have shown that hydrolyzed collagens effectively improve skin aging parameters. In this line, oral supplementation with hydrolyzed collagen has been reported to improve skin hydration (14-17), elasticity (14,17,18), and dermal collagen density (1,16). In addition, a randomized, controlled trial showed that hydrolyzed collagen supplementation reduced the fragmentation of the collagen network in the dermis, a key denominator of aging, indicating that the collagen network's quality was improved (17,19).

Previous studies from our research group have recently investigated the efficacy of a formulation containing 10 g of bovine collagen peptides, Vitamins A, C, E, and zinc in a Brazilian population (1). Daily supplementation over a period of 90 days demonstrated the improvement of dermal collagen density, skin elasticity, and a reduction of wrinkles and pores.

Furthermore, considering that about 65 to 95% of the hair composition is of proteins, oral supplementation with Bioactive Collagen peptides can also be used to provide benefits to hair fiber. With the aging process, there is a reduction in the quality of the collagen fibers, which is noticed mainly in the skin appearance. The aging process also presents an effect on the hair which can be observed as a reduction in hair diameter, which can promote the weakening of the hair fiber (20,21). This is reflected primarily as a decrease of the hair break force with the aging process and a decrease in shiny hair appearance (21). Thus, the use of collagen peptides can be used as a support to improve the quality of the skin and its appendices.

Oral supplements have been a trend in the cosmetic field to repair skin and hair appearance and structure. Thus, several studies have reported that using collagen supplementation can improve skin functions and delay aging (22). Collagen supplementation has also been reported to positively influence the nails (23). At the same time, there are no reports in the scientific literature regarding the benefits of using collagen to the hair fiber, although this product has already been used for this purpose.

The current scope of clinical research has been predominantly performed in Caucasian (European) (16,18) and Asian (Japanese) (14-17) populations. However, skin aging differs across skin types, and in addition to ethnicity, regional impacts such as the climate can be key factors that determine how the skin ages (24). The alterations in the hair fiber also differ according to ethnicity and hair type, e.g., it has been reported that curly hair presents more fragility to hair breakage than other hair types (21). Thus, the clinical investigation of the benefits of Bioactive Collagen peptides supplementation in the Brazilian population, which presents excellent diversity in its ethnicity, is a significant contribution to the scientific field.

In addition, all previously investigated products were of fish or porcine but not of bovine origin. The bovine hide is one of the most important sources of raw material to produce collagen in Brazil due to the country's huge cattle herd, making this type of product more available for Brazilian and South American women than other sources. This way, the present study has an innovative proposal, investigating the efficacy of bovine collagen peptides without the addition of different components and with a lower dose, 5 g/day, not previously studied from the bovine source, and focusing primarily on dose-dependent dermal collagen density results, wrinkles, skin roughness, and hair strength. This final parameter has not been previously evaluated in a study using collagen peptides.

In this context, the objective of this study was to evaluate the clinical changes in skin and hair after 90 days of treatment with oral supplementation of bioactive collagen peptides. In summary, this study has an innovative proposal since it shows the clinical efficacy of collagen peptides oral supplementation in improving skin and hair in a non-invasive way.

Materials and Methods

After the approval by the Ethics Committee in Clinical Research of the School of Pharmaceutical Sciences of Ribeirão Preto/SP (CEP / FCFRP nº439 - CAAE nº 65109317.2.0000.5403), 60 healthy female participants were enrolled, aged 45 to 60 years old (mean age 53.4 ± 4.2 years old), level 3 of the Glogau Scale and Fitzpatrick phototype scale II-III. Most study participants had a small to medium percentage of white hair but used coloring procedures. The main objective was to evaluate the effect of the ingestion of a collagen-based supplementation in the cutaneous microrelief, reduction of wrinkles and thickness, and echogenicity of the dermis, as well as in the mechanical properties of the hair using biophysical and skin imaging techniques.

The study products were maltodextrin for the placebo group and bovine collagen peptides (Peptan® B, Rousselot, Amparo, Brazil) for the treatment group. The study period was 90 days, with three evaluations; one was before (baseline-T0) and the other after 45 and 90 days of treatment. Participants signed the Informed Consent Term before accepting participation in the study after a meeting to elucidate and clarify possible questions of the interested participants. All participants also received the same sunscreen (SPF 60) to use and avoid changes caused by using different products. All participants were also requested to stop using other cosmetic products for 15 days before the start of the study and during the whole treatment.

After assessing the inclusion and exclusion criteria, accepting to participate in the study, and signing the informed consent, the participants were divided into two groups: the placebo group, who ingested 5 g / day of a maltodextrin-based food, and the treatment group, who consumed 5 g / day of the oral supplementation under study. A template was standardized by the research group to ensure that the same area was analyzed after 90 days of treatment.

Hair samples of the participants of the study were collected before the beginning of the treatment (T0) and at the end (T90) to perform the characterization test. The samples were collected as close as possible to the root to evaluate the region of growth of the hair, where the alterations would be more evident. The control sample (without any treatment, T90) was kept to evaluate the hair compared to those that received the treatment after 90 days.

Biophysical and skin imaging techniques

Skin microrelief

The SELS (Surface Evaluation of the Living Skin) method is based on a graphic created of the living skin picture under special illumination. The microrelief parameters were evaluated using Visioscan® VC98 and software SELS 2000 from Courage & Khazaka Electronic Gmbh (Cologne, Germany). The measurement area was 6 × 8 mm2, and the skin image was taken by a built-in CCD camera. The electronic processing and evaluation of this image were conducted according to four clinical parameters: a) Skin Smoothness (Sesm ) - calculated from the average width and depth of wrinkles, b) Skin roughness (Ser) - the skin roughness parameter, calculated by the gray levels above the threshold in comparison with the entire image (reflects the ‘asperity’ of the skin.), c) Wrinkles (Sew) – calculated from the proportion of horizontal and vertical wrinkles and d) Wrinkle depth (Rt) (24). All measurements were made in the malar region of the face.

Measurement of the skin by high-resolution photography

The Visioface® digital photography imaging system (Courage and Khazaka, Germany) was utilized to evaluate facial skin. It consists of a cabin attached to a high-resolution digital camera (10 megapixels) and 200 white LED lights. This device is connected to research software that evaluates visible pores and wrinkles (1). The wrinkle analysis was evaluated on a 5 point scale in both the nasolabial and periorbital regions.

Measurement of dermis echogenicity

To evaluate the dermis echogenicity, 20 MHz ultra-sound equipment (Dermascan® C, Cortex Technology, Aalborg, Denmark) was chosen. It is based on the principle that the ultrasonic wave (speed of 1,580 m/s) is partially reflected by the skin structure, creating echoes of different amplitudes. To calculate the echogenicity, the number of pixels with low echogenicity is measured utilizing the image analysis software and related to the total number of pixels (1). All measurements were also taken in the malar region of the face.

Hair Characterization Studies

Tensile Test

The hair was evaluated in terms of break force and was performed using the equipment TA.XT Plus Texture Analyzer® (Stable Microsystems, Surrey UK). The analysis was performed in a room at a 20-22°C and 50-60% relative humidity (RH). The wire diameters were measured with a dynamometer, and 20 fibers of similar diameter at least 10 cm long were selected. The 20 wires were submitted individually to the rupture test in the Texturometer equipment at 55 mm distance, 10N load, and a constant rate of 300 mm/min (25).

Statistical analysis

Two-way ANOVA and Bonferroni post-test were used to evaluate the results obtained in this study. Statistical differences between placebo and collagen peptides groups were analyzed by the paired student’s T-tests, which as also used for basal and T90 measurements of each parameter (GraphPad Software Inc., La Jolla, CA, USA). Differences were accepted as statistically significant at p < 0.05.

Results

Biophysical and skin imaging techniques

According to the microrelief analysis, it was possible to observe a difference in the parameters related to skin scaliness (Sesc), roughness (Ser), and smoothness (Sesm) only in the collagen peptides treatment group after 90 days of treatment. The only significant parameter was the Sesc. In the placebo group, no significant difference was noted (Figures 1 and 2). Figures 3 and 4 represent participants in each study group.

The high-resolution images obtained allowed the analysis through the score method, which presented a significant reduction of skin wrinkles in the periorbital and nasolabial regions of the face in the collagen peptides group only (Figures 5 and 6).

The dermis echogenicity analysis showed a decrease in the dermis echogenicity ratio (number of low echogenic pixels/number of total echogenic pixels - LEP/TEP), in both groups, after the 90 treatment period.. Figure 7 shows the echogenicity difference percentage between T90 and T0. According to these results, there was a reduction in the echogenicity ratio, therefore, an increase in the dermis echogenicity in the collagen peptides group.

Hair Characterization Studies

Tensile Test  

The tensile test (Figure 8) results showed that after the treatment with collagen peptides, the break stress values increased significantly. At the same time, the break stress values of the participant’s hair in the control group were unaltered.

Discussion

Collagen is one of the most abundant proteins in the human body. It is known that collagen fibers become damaged with the aging process and consequently lose their strength, causing alterations in different structures, such as the appearance of wrinkles in the skin. 

Some diets can influence the skin and hair. For example, malnutrition, like in cases of anorexia nervosa, can lead to skin changes like xerosis, hair effluvium, nail modifications, etc. (26). On the other hand, obesity can also impair skin physiology. Obese people can significantly increase transepidermal water loss, which could alter skin barrier function. It can also affect sebum production, micro and macrocirculation changes, and modify collagen metabolism.

In some studies, a higher acne lesion count was correlated with the increased ratio of saturated to monounsaturated fatty acids of skin triglycerides.

An interesting study by Tanaka et al. has recently evaluated the effect of a vegetarian diet as an alternative therapy for managing Atopic dermatitis. Other studies show that it can also benefit psoriasis (26).

Furthermore, there is an association between sugar and some food processing methods (like grilling, frying, baking, etc.) with skin aging, as there are mechanisms related to advanced skin glycation end products. A high-sugar diet, ultraviolet irradiation, and eating barbecued fried foods can lead to the accumulation of AGEs and acceleration of skin aging (27).

Other studies show that strict control of blood sugar can also be significant for skin health, as four months on this diet can reduce the production of glycosylated collagen by 25%, and low-sugar food prepared by boiling can also reduce the production of AGEs (27).

There are many other effects of food on the skin, but in general reasonable, healthy, and diverse diet with antioxidant-rich foods is essential to maintaining skin health (27).

Most studies utilizing collagen peptides use a dosage of 10 g. However, the efficacy of a lower dose of the same product, without any additives as vitamins and minerals, is still to be reinforced (28). A lower dose with the same efficacy is practical to the consumer, facilitating the ingestion and creating a consumption habit with lower costs. Furthermore, with a lower dose is also easier to introduce the substance in its full dose in other finished products, creating different forms of use.

A recent systematic review and meta-analysis studies utilized a total of 1,125 patients in different studies. A comparative analysis between the placebo and the intervention group showed no difference in the means for elasticity, wrinkles, and transepidermal water loss. There was a significant difference in the dermis density, dermis thickness, and stratum corneum water content (29).

In our study, using specific imaging techniques, we obtained the same improvement in the dermis density, but, likely due to the different methods used, a difference in skin texture and wrinkles was also observed.

This way, the present study was developed to analyze the clinical effects of the consumption of 5 g of collagen peptides, without adding other components, to skin and hair.

The skin microrelief analysis showed an improvement in skin texture only in the collagen peptides study group. This improvement was explained due to changes in the protein turnover in the dermal layer; increasing the amount of collagen and the enhanced fibrillar network leads to better skin integrity and, consequently, improved skin texture. Previous studies also found this result with higher doses of collagen or products added with other substances (1,30). Similar studies have also noted changes in skin dryness, which is directly related to the skin desquamation parameter. Hydrolyzed Collagen ingestion is also known for improving skin hydration, which is inversely associated with the Sesc. Furthermore, changes in the dermal tissue, which is filled with fibroblasts, are stimulated by collagen peptides, producing new collagen, elastin, and hyaluronic acid (30). This shows that a lower dose of collagen containing no other components is effective in improving skin microrelief parameters. As it is more accessible to consumer ingestion, the food industry might develop products using this dose. The other parameters were not significant, likely because of the differences between participants.

High-resolution images provide many parameters in the study of clinical trials. It was possible to observe an improvement in skin wrinkles (in different regions) with the collagen treatment using score analysis. Beyond the mechanism described above, that also improved the skin microrelief efficiently absorbed collagen and can induce an increase of collagen fibers density and diameter (3). The increase in dermis density leads to a better structuration of the skin, with the improvement of the dermal-epidermal junction. These changes can be seen as fewer and more superficial skin wrinkles and pores (1,14).

This increase in dermis density can be confirmed by the dermis echogenicity parameter, done by a high-frequency ultrasound, which presented an improvement after 90 days of treatment with the study product, showing quantitatively and qualitatively that this increase is present. This way, the dermis echogenicity improvement directly relates to the previous parameters in this study since they were consequences of a better dermis density. A denser dermis repairs the present skin damage from different sources, slowing the chronological aging and photoaging process. In addition, the increase of dermis density found in this study with a consumption of 5 g of collagen peptides without the addition of other components per day is also in accordance with previous studies of our research group (1) and others from the literature (16,30)

Collagen is composed of peptides of several sizes, which are degraded into biologically actives di and tri peptides (30) composed of amino acids that, through different types of interactions, resulting in a more complex structure that is present in several tissues in the human body. In this context, considering that the hair fiber is also composed of a majority of proteins, mainly keratin (31), which resulted in the complexation of 20 amino acids that are also common to the collagen amino acids, so the supplementation of collagen peptides can contribute as support of amino acids for the hair fiber development in the hair bulb. After breaking the collagen molecule into less complex structures, these amino acids can contribute to the cellular development of the skin and its appendixes as the hair and nails structure. The loss of proteins in the hair fiber can reduce its resistance to mechanical and chemical processes, to which women are exposed frequently (20).

The hair is an appendage from the epidermis and can be divided into two parts, the hair follicle, and the hair shaft. The hair shaft extends from the root or bulb, which is localized in the follicle passing through the epidermis, and stratum corneum and then continuing with steam (31). 

Although the hair is considered a dead structure, the region of the bulb localized in the human hair follicle is considered a complex mini-organ which allows the hair to receive nutrients and proteins that are ingested in our diet. Thus, the use of collagen peptides as a dietary supplement or in cosmetic formulations can help the protein restitution on the hair fiber and increase its strength in mechanical processes. 

The results of our study show that using collagen peptides as a dietary supplement improved hair mechanical resistance since they promoted an increase in hair fiber Break Stress. This parameter evaluates the hair's internal structure and the cortex region's strength. This increase suggests that the use of collagen peptides orally promoted the treatment of the inner region (cortex) of the hair fiber, increasing its strength of the hair fiber (32). This way, collagen oral supplementation is important not only for improving skin conditions but also for hair care once significantly an increase of the mechanical hair resistance evaluated by objective measurements is noted. In addition, considering that the aging process affects the hair's mechanical resistance due to hair fiber thinning, the proposed treatment was effective for aged hair.

In summary, the present study, conducted for the time in Brazilian woman, showed important benefits in relevant skin visual parameters, dermis density, and hair strength with a lower dose of 5 g per day of bovine collagen peptides without the addition of other components.

Finally, oral supplementation with collagen peptides is important not only for the improvement of skin conditions but also for hair care once it significantly increases the mechanical hair resistance evaluated by objective measurements. In addition, considering that the aging process affects the hair's mechanical resistance due to hair fiber thinning, the proposed treatment was effective for aged hair.

Study Limitations

The limitation of the study was the difficulty of controlling and monitoring the study participants' diet, mainly in terms of protein intake. Since the aim of the study was oral supplementation, this could be influenced by the participants' dietary habits. In addition, it was not possible to quantitatively analyze the amount of white hair in the participants.

Author Contributions

P.M.B.G Maia Campos: Conceptualization, Funding acquisition, Formal analysis, Methods, Project administration, Research Supervision, Validation, Visualization, Writing - review & editing. M.O. Melo: Formal analysis, methods, writing the original draft, review and editing the text. M.M.F. Shirata: Formal analysis, methods, writing the original draft. M.G.Leite: Formal analysis, writing the original draft, methods.

Acknowledgments

We would like to thank FAPESP - Fundação de Amparo à Pesquisa do Estado de São Paulo, Grant/Award Number: 2017/19278-0

Conflicts of interests

We confirm that no known conflicts of interest are associated with this publication. Furthermore, there has been no significant financial support for this work that could have influenced its results.

 

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Biomedical Sciences, Biomed Biopharm Res., 2022; 19(2):299-313

doi: 10.19277/bbr.19.2.295; PDF version here [+] Portuguese html version [PT]  

 

 

Pilot study of unconventional food plant (UFP): adherence to nasturtium (Tropaeolum majus L.) in the diet and monitoring of biometric and clinical indicators

Sérgio Faloni de Andrade1, Maria da Graça Lopes Serrador1, Alda Pereira da Silva1,3,4, Rejane Giacomelli Tavares1,2, Luis Monteiro Rodrigues1, Maria do Céu Costa1,5

1Universidade Lusófona - CBIOS - Research Center for Biosciences and Health Technologies, Av. Campo Grande, 376, 1749-024, Lisboa, Portugal; 2Universidade Federal de Pelotas- PPGNA- Programa de Pós-Graduação em Nutrição e Alimentos, Rua Gomes Carneiro, 01, 96010-610, Pelotas, RS, Brazil; 3Institute for Preventive Medicine and Public Health, Lisbon School of Medicine, University of Lisbon, Portugal; 4Clinic of General and Family Medicine, Ecogenetics and Human Health Unity, Institute for Environmental Health, ISAMB, Portugal; 5NICiTeS, Polytechnic Institute of Lusophony, ERISA-Escola Superior de Saúde Ribeiro Sanches, Lisboa, Portugal

corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

The flowers of Tropaeolum majus, popularly known as "capuchinha," garden nasturtium, nasturtium, Indian cress, or monks cress, are currently used worldwide as a food supplement and in plant-based diets, being added to smoothies, soups, mayonnaise and salads by consumers in search of sources of substances considered beneficial to human health. Most studies have shown nutritional qualities and beneficial effects of the plant, especially its flowers and respective aqueous extracts in vitro and in animals. Thus, this pilot study was designed to evaluate the acceptance and possible benefits of daily consumption of 20 g T. majus flowers per day for 30 days in healthy participants. Before and after ingestion, body composition, heart rate, blood pressure, and hematological and biochemical parameters were analysed. Results have shown good acceptance and safe use of T. majus flowers in a balanced and varied diet. However, it is important to highlight that this is the first exploratory study regarding these issues in healthy humans, and therefore, despite the widespread consumption described, additional studies are needed to deepen the results in biometric and clinical indicators in a larger number of volunteers.

 

Keywords: Tropaeolum majus, unconventional food plant (UFP), nasturtium, edible flowers

Received: 13/11/2022; Accepted: 09/12/2022

Introduction

Tropaeolum majus L. (Figure 1) is popularly known as garden nasturtium, nasturtium, Indian cress, or monks cress and belongs to the Tropaeolaceae family. It is a native plant of the Andes, mainly from Bolivia and Colombia where it grows wild, however, it was brought to Europe from Peru in the 16th century and is successfully cultivated as an annual decorative plant (1,2). It is currently found in all of Europe, and in some regions of Africa, Asia and Oceania (3).

This species is used in folk medicine to treat several diseases. Its leaves are used to treat asthma, urinary tract infections, cardiovascular disorders, and constipation (4). Pre-clinical studies have shown antihypertensive and diuretic effects (5,6) and in vitro assays using culture cells revealed anti-adipogenic effects of T. majus extracts (7). In addition, several toxicologic studies (chronic and subchronic toxicity, reproductive toxicity, and genotoxicity) have been conducted and demonstrated that T. majus infusions and aqueous extracts are safe (8,9). However, the use of high doses of hydroethanolic extracts should not be recommended to men of reproductive age and to pregnant women because high doses of these extracts (> 300 mg/kg) have interfered with reproductive function and gestation of animals (4,8-10). Pre-treatment with T. majus methanolic alcohol extract provides protection against diethyl maleate-induced blood and liver toxicity in rats, with results confirmed by histological examinations (11). In recent years, T. majus flower has been widely used in culinary as unconventional food plant (UFP) to decorate plates, especially salads, and is characterized by a spicy flavour and as an important source of carotenoids (antheraxanthin, zeaxanthin, lutein, β-cryptoxanthin, zeinoxanthin, α-carotene, β-carotene, violaxanthin) and phenolic compounds (quercetin, myricetin, kaempferol, pelargonidin, delphinidin, cyanidin, derivatives of hydroxycinnamic acid) (12-16).

Terms such as "functional foods" or "nutraceuticals" are widely used in the marketplace. These foods are regulated by the Food and Drug Administration (FDA) under the authority of the Federal Food, Drug and Cosmetic Act, although they are not specifically defined by law. Thus, functional foods are not officially recognised as a regulatory category by the FDA in the United States and the same is true in Europe, where Regulation (EC) No 1924/2006 of the European Parliament and of the Council of 20 December 2006 on nutrition and health claims made on foods applies. "General function" claims under Article 13.1 of the EC Nutrition and Health Claims Regulation refer to the role of a nutrient or substance in growth, development and bodily functions; psychological and behavioural functions; slimming and weight control, satiety or reduction of available energy from the diet. T. majus may be a candidate for a general function claim if a cause-effect relationship is demonstrated for a particular physiologic effect.

Considering its spontaneous worldwide use as an unconventional food plant based on a perceived presumption of safety by the consumer and supported by published information, an exploratory investigation was carried out to evaluate, for the first time, the acceptance of T. majus flowers in a diet by adding it in different plates, as well as their effects on corporal composition, biochemical and haematological parameters in healthy volunteers.

Materials and methods

Participants

The study was made with the voluntary participation of six healthy individuals, both sexes (one man and five women), ages between 21 and 71 years old (mean 52.50 ± 17.28 years old) recruited randomly from a convenience population asked to participate in sensorial tests by the researcher team. The acceptance prior to the study and adherence during the study of T. majus flowers in the diet were assessed through questionnaires in which the volunteers described their opinions on the visual and taste aspects of the prepared meals. The following recipes were included in the acceptance study before the test: soup, meat pie, roast, bread, cod, rice, juice, sweet pie, and gelatin. The parameters questioned were: i) Have you ever heard of unconventional food plants (UFPs)? ii) Do you usually consume (UFPs)? iii) Have you ever tasted this plant? After tasting, how do you describe it? iv) You can use the suggested terms to define the meals: Appearance: pleasant/unpleasant/other; Color; Odor: intense/mild/other; Flavor: bitter/sweet/spicy/other; Texture: velvety/grainy/liquid/pasty/other. All procedures observed the principles of good clinical practices from the Helsinki Declaration and respective amendments (17). The volunteers were included in the study after informed written consent. The inclusion criteria were the acceptance of nasturtium taste as pleasant and willingness to include it in their daily diet for one month. The following exclusion criteria were considered: (i) any possibility of pregnancy, (ii) men of reproductive age, (iii) any pre-existing disease. Additionally, the participants filled out an Informed Consent Form to indicated if they smoked and if they took any medications, and, if so, which ones.

Procedures

Firstly, the volunteers selected in accordance with the criteria described above were given detailed information about the objectives, methods, and their role in the project. After signing informed written consent, data were collected for all participants by applying a semiquantitative food frequency questionnaire (FFQ), already validated for a Portuguese population (18) defining a mean reference portion consumed over one year for all food groups. The questionnaire used was composed of a list of the nutrients belonging to the seven conventional food table/wheel groups (19) and one closed section with five categories of the frequencies of consumption of twelve high-rated items (dairy products, fatty-, lean- and cod- fish, white and red meat, olive oil, whole meal bread and cereals, eggs, sweets, vegetables and legumes, and fruits). Thereafter, the volunteers received the recipes for the preparation of the meals containing T. majus flowers. The ingestion was divided into three meals per day (breakfast, lunch and dinner) such that 20 g of flowers were ingested daily for 30 days. The portion of 20 g per day divided into the main meals was based on the recommendation for intake of salad leaves regularly used by the population (for example, lettuce, rocket), which is a minimum of 12-15 leaves per day (20).

Meals were diversified, for example, salads, soups, cakes, and sandwiches, among other foods. At two time points, one at time zero (before starting the consumption of T. majus) and the second at the end of the study, the body composition of all volunteers were evaluated by dual-energy x-ray absorptiometry (DXA Lunar Prodigy Advance - GE Healthcare, Chicago, Illinois, USA). The parameters measured were Body Fat Percentage (BFP), Visceral Adipose Tissue (VAT), and Subcutaneous Adipose Tissue (TAS). Heart rate and arterial pressure were also measured, and blood and urine samples were collected for clinical analysis (hematological and biochemical) in the Laboratory LEB (Lisbon, Portugal).

During the study, participants were asked for each meal: i) Did you like/dislike the addition of the T. majus flowers? Justify. ii) Do you think it could become a regular option in your diet or not? Justify. In addition, the volunteers were contacted daily by the researchers to report whether they had eaten the entire daily portion or if there were leftovers to quantify (in scoops), and to register their opinion about the meals, as well as to report any unwanted/unexpected effects.

Plant Material

The plant material was collected on 12-July, 2021, at Latitude 38.955834, Longitude - 8.994359, Dr Luis César Pereira Urban Park, Time: 14.40 h. The manual harvest was conducted by one technician and the sample was identified and deposited by the Curator of Vascular Plants, Herbário LISU - Jardim Botânico/Herbarium LISU - Botanical Garden, Museu Nacional de História Natural e da Ciência, Lisboa, Portugal (Voucher number: LISU270425). The material was provided fresh to the volunteers, separated in portions of 20 g (daily portion) and kept at -20 oC until consumption.

Statistics

Data are reported as mean ± standard error of the mean (SEM) were compared by T-test using GraphPadPrism 5® software (GraphPad software, San Diego, CA, USA). A value <0.05 was considered significant in all experiments.

Results and Discussion

A healthy diet intended to control the risk of obesity was identified for the study participants based on their dietary habits, characterized by abundant and variable consumption of plant foods, high consumption of cereals, olive oil as the main fat, low intake of red meat, and null to moderate consumption of wine (Table 1). It is well reported that the high consumption of red meat, saturated fatty acids, and cholesterol may be associated with increased risk of diabetes and mortality due to cardiovascular diseases (CVDs) (21-23). Moreover, Alzheimer’s disease protection has been associated with a higher intake of vegetables, fruit, whole grains, fish, and legumes and with a lower intake of high-fat dairy, processed meat, and sweets (24). Epidemiological studies suggest a role of fruits and vegetables in protection against disease risks and aging (25), and for this reason the WHO considers that these should be the main foods to be ingested.

 

The analysis of parameters related to the body composition revealed that there was no observed effect on Body Fat Percentage (BFP), Visceral Adipose Tissue (VAT), and Subcutaneous Adipose Tissue (TAS) after T. majus ingestion (Figure 2).

Kim et al. (7) demonstrated in cell culture (3T3-L1 adipocytes) that ethanolic extract of T. majus decreases lipid accumulation and inhibits the expression of peroxisome proliferator-activated receptor γ (PPARγ), CCAAT/enhancer-binding proteins (CEBPs) and sterol regulatory element-binding transcription factor 1 (SREBF1), which are transcription factors involved in the regulation of the adipogenesis pathway in 3T3-L1 adipocytes. In the present study, neither an effect on lipid accumulation nor a significant reduction in the rate of blood triglyceride content resulting from intake of 20 g daily of T. majus flowers was observed. The results are likely not relatable and concern very different study models and experimental conditions but raise interest in future studies with an intake of T. majus by participants with a higher percentage of fat mass over a longer period of time.

All participants reported that meals prepared using the daily portion of 20 g of T. majus flowers had a pleasant taste and no participant left the study. Mlcek et al., (27) also reported good acceptance of T. majus in a study that involved sensory evaluation of several species of edible flowers. In addition, during daily contact with the researchers responsible by study, no volunteer reported any changes in the number of bowel movements and stool consistency, urinary volume, or any other discomfort or unexpected change/symptom during the 30 days period of T. majus flowers ingestion and within two weeks after study completion. Likewise, no alterations were observed in rate heart and arterial pressure.

No changes were found when the hematological parameters were analyzed (Table 2), nor within the evaluated serum biochemical parameters used to assess liver, kidney, pancreas and metabolic functions (Table 3). The absence of toxicity of T. majus was formerly demonstrated by Araújo et al. (8), in a preclinical study using hydroethanolic extract by 90-day in rodents and lagomorphs. No changes in renal parameters, such as serum urea and serum creatinine, were also reported by Gasparoto Junior et al. (4), using ethanolic extract of T. majus and one of its main constituents, isoquercetin. Only for the biomarker C-Reactive Protein (CRP) a significant decrease was observed after adding T. majus flowers to the diet (Table 3) from 1.18 ± 0.16 mg/dL to 0.73 ± 0.04 mg/dL although in the range of healthy levels. It is well known that CRP is an acute-phase protein that has been associated with response to injury and systemic inflammation (28). Nowadays, epidemiological studies have shown a consistent association between cardiovascular disease risk and CRP concentrations. Elevated levels of CRP are related to inflammatory processes which are related to vascular cell activation, thrombosis, and accumulation of lipids and atherosclerotic process (29). T. majus contains a variety of bioactive compounds which are also known for their anti-inflammatory and antioxidant properties, including ascorbic acid (Vitamin C), flavonoids, carotenoids, and other polyphenolics (30). Furthermore, aqueous extracts of T. majus significantly suppressed the production of inflammatory mediators such as TNF-alpha, Prostaglandin E2 (PGE2), and leukotriene LTB4 in human blood cells (31). Another group of interesting substances from T. majus are the thermostable glucosinolates (32,33), such as glucotropaeolin, which is metabolized into benzyl isothiocyanate and has significant antitumor activity (34, 35). Thus, monitoring CRP before and after ingestion of T. majus for a longer time period and within a more representative group of human volunteers may contribute to a better understanding of the reason and significance of the decrease observed in our study.

Only about 103 plant species are responsible for 90% of the world's food supply despite estimates showing that there are about 27,000 plant food species (36). Hence, there are many species with alimentary potential which are neglected. Many of these species were used in the past, but their use has been abandoned with the industrialization and urbanization processes. In the last years, several of these species, including T. majus, have been highlighted as nutritious UFPs with high impact in Latin- and Ibero-American countries, namely Brazil and Portugal (12). Thus, more studies on its acceptance, safety, and nutritional value are important to understand any benefit/risk relationship for its use in the human diet.

The European Green Deal has the "Farm to Fork" strategy as a central focus to make food systems fair, sustainable, and healthy. The role of UFPs in this path is indisputable, but increasing the adoption of healthy and sustainable diets does not mean adhering to all the available UFPs offered without any criteria (37). Hence, the need to anticipate emerging risks for edible flower consumption has been brought to the EFSA´s (European Food Safety Authority) agenda. The guarantee of clear information is a consumer demand which shall be satisfied, a purpose that should unite universities/researchers and authorities, applying the Qualified Presumption of Safety (QPS) approach for the safety assessment of botanicals and botanical preparations published by EFSA (38). As an example of UFPs approach, we recall that EFSA was asked very recently by the European Commission whether there are duly reasoned safety objections to the placing on the market dried flowers of Clitoria ternatea L. as a traditional food (TF), known as butterfly pea, from a third country within the European Union (39). EFSA noted the in vitro haemolytic and cytotoxic effects reported for some cyclotides (circular proteins) as well as data indicating possible effects on the immune system, and uterus (although these cyclotides responsible for these effects have not been detected in Clitoria ternatea). Given the potential exposure to cyclotides resulting from the use of C. ternatea for the preparation of herbal infusions and the unknown toxicological profile of the cyclotides present in these edible flowers, the EFSA considered that could have some risk to human health. Thus, EFSA raised safety objections to the placing on the EU market of the dried flowers of Clitoria ternatea.

Considering the UFP T. majus, the a priori guidance of the EFSA for the safety assessment of plants and botanical preparations intended to be used as ingredients in food supplements applies (40), which provides that plants or botanical preparations for which an adequate body of knowledge exists can benefit from a 'presumption of safety (QPS)' without the need for further testing. In this situation, the QPS decision for T. majus can be based on available data on the history of safe use at traditional exposure levels, i.e., data regarding the safety of aqueous extracts of T. majus and consumption of the whole flower, with no reports of adverse effects (41).

In the particular case of T. majus flowers, there is evidence for the acceptable safety of its use as a wholly natural ingredient or dietary supplement in daily meals, well supported by studies of aqueous extracts (typical culinary medium) in animals and here in humans for the first time. However, since there are warnings in the literature about potential additional concerns related to the reproductive effects of ethanol extracts, it is advisable that further research should be carried out in search of a substance or group of substances for which a value should be defined as a limit related to observable health effects. Taking into account that the existing quality and toxicity data are insufficient to derive such a value, and T. majus concentrates obtained in alcohol seem unsuitable for unrestricted food use, the safety assessment of T. majus should be further developed for its various extracts.

Finally, it is important to recognize that, as this is a pilot exploratory work, there are some limitations in this study: 1) the limited number of participants (six) whose recruitment has been harmed by a study in pandemic phase; 2) the heterogeneous distribution of sex and age of the participants; 3) the lack of a control group and 4) lack of estimation of energy and nutrient intake, although the frequency of consumption and food portion size were already evaluated.

Conclusion

Results obtained indicate that T. majus flowers are well accepted when added to different meals and corroborate the information in the literature about its use being safe for humans. This is the first exploratory study referring to the safety of consumption of T. majus flowers in healthy humans, alerting to the importance of designing additional, more complete studies to confirm the promising results in a larger number of volunteers.

Authors' Contributions Statement

SFA, MCC, MGLS, and RGT undertook the experimental procedures. SFA, RGT, APS, LMR, and MCC executed and discussed the statistical analysis and wrote and corrected the manuscript in its final version.

Acknowledgements

This research is funded by Fundação para a Ciência e a Tecnologia (FCT) through grant UIDB/04567/2020 to CBIOS. Sérgio Faloni de Andrade is funded by Foundation for Science and Technology (FCT) - Scientific Employment Stimulus contract with the reference number CEEC/CBIOS/PMHD/2018.

Conflict of Interests

Editors involved in this manuscripts’ authorship had no participation in the review or decision process. All authors have stated that there are no financial and/or personal relationships that could represent a potential conflict of interest.

 

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Biopharmaceutical Sciences, Biomed Biopharm Res., 2022; 19(2):397-409

doi: 10.19277/bbr.19.2.298; PDF version here [+] Portuguese html version [PT]  

Supplemental Material - Appendices A-D [+] pdf here - DOI: 10.19277/bbr.19.2.298_Supplemental.pdf

 

Pretest questionnaire for anti-ageing cosmetic claims substantiation: a description of validation of efficacy and sensory perception questionnaires

Mariane Massufero Vergilio 1, Laura Moretti Aiello 2, Tamiris Anselmo 2, Gislaine Ricci Leonardi 1,2*

1Graduate Program in Internal Medicine, School of Medical Sciences - University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St., "Cidade Universitária Zeferino Vaz," 13083-887 Campinas, SP, Brazil; 2School of Pharmaceutical Sciences - University of Campinas (UNICAMP), 200, Cândido Portinari St., "Cidade Universitária Zeferino Vaz," 13083-871 Campinas, SP, Brazil

corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

The application of questionnaires for the assessment and collection of data on target audiences and new products is a very common practice in the field of cosmetics. However, to obtain reliable results, it is essential to pretest the instrument to detect possible problems and inconsistencies. The aim of this study was to demonstrate the entire pre-testing process of two questionnaires used in the cosmetic claims substantiation area; a skin self-assessment questionnaire and a sensory analysis questionnaire for cosmetic formulations. According to the pretest protocol analysis, 15 women were interviewed for each questionnaire. All difficulties were recorded, categorized, and analyzed. Subsequently, the inconsistencies found were corrected in the final version of the instrument. During the validation of the questionnaires, the biggest problem faced was related to the application of scales and technical concepts within the questions. This difficulty means that respondents are unable to represent their real perception of the evaluated product. This problem can be solved by adding detailed explanations in the footer or within the wording of each question. In conclusion, learning and applying the pre-test in questionnaires can ensure greater reliability and clarity in research results in the cosmetic area.

Keywords: Questionnaires, cosmetics, substantiation of claims, self-efficacy, sensory attributes

Received: 25/11/2022; Accepted: 30/12/2022

 

Introduction

Consumption and demand for anti-ageing cosmetic and dermatological strategies have grown exponentially in recent years, due to increased life expectancy and a new culture focused on health care and aesthetics, bringing an improvement in the quality of the population (1–3). Consumers are increasingly concerned about the components of the products they are using, considering quality, effectiveness, safety and sustainability (3).

In this context, cosmetic claims related to aging gain prominence. Different methodologies can be used to provide information to help evaluate the effectiveness of cosmetic products to reverse or prevent the signs of skin aging (4). These include scientific tests based on the consumer's observation of the effectiveness and function of the product, as well as tests in which participants evaluate the sensory properties of a given product (4).

Of the number of available products, consumers give great preference for those which are pleasant to the senses, an extremely important attribute in the choice of the product in view of the numerous existing options that have the same function (5). Allied to sensory parameters, the study of the effectiveness of products, through the perceptions of consumers, is essential to prove their purposes, in addition to providing information for the development and marketing of new cosmetic and dermatological formulations, reformulation of existing products and optimization of the formulation process (6,7).

For these evaluations to present reliable results, it is necessary to use questionnaires elaborated from a validated measurement scale and appropriate to the study (8). Therefore, the development of these instruments is a complex process consisting of several steps toward achieving the proposed objective (9).

Thus, for the structuring of the questionnaire, it is necessary to first specify the information such as the central problem of the instrument, the necessary approach, the issues related to the theme and, principally, the target audience, which exerts great influence on its development (9).

To ensure the correct comprehension of all questions in the questionnaire and to identify possible difficulties, the pretest is an essential step during the development of the instrument. Through this, problems such unfamiliar words to the interviewee, ambiguities, and inappropriate answers to the aim of the research can be evaluated, enabling the adequacy and modification of the preliminary or initial questionnaire. In addition, the pretest also allows verification of structural aspects such as the number of questions, how they are performed, and the order in which they are arranged (10).

To encode the obtained data in the pretest stage, it is very important to analyze the content that consists of a methodology for reading and interpreting the interviewee’s answers, which also does not escape the personal interpretation of the interviewer (11,12). This analysis consists of three phases: the preanalysis, categorization, and treatment of the results (13).

The aim of this study was to describe the pre-testing of skin self-assessment questionnaires and another of sensory analysis, both focused on substantiating anti-ageing cosmetic claims, in order to indicate problems and solutions encountered during their development, to ensure greater reliability and clarity of data collection instruments in studies in the cosmetic area.

Material And Methods

Experimental design

Two initial questionnaires were evaluated, one for the self-evaluation of skin appearance (Supplemental Materials Appendix A) and another for the sensory evaluation of cosmetics (Supplemental Materials Appendix B).

The pretest of each questionnaire was performed through an interview of a sample, nonprobabilistic and for convenience, of 15 participants per questionnaire (n=30) (9). All participants signed an informed consent form. Women between 30 and 60 years old, consumers of anti-ageing cosmetics, were selected.

The protocol analysis process was chosen for the performance of this initial test, in which the interviewee “thinks aloud” when answering the questionnaire, and commonly, the interviewees’ observations were recorded by audio, and analyzed to determine the reactions evoked by different parts of the questionnaire (9). The entire interview was recorded on a cell phone for further analysis. The interviews were partially transcribed, focusing on the moments when the interviewees showed difficulty or some change of mood.

One experienced and one non-experienced interviewer were used. Experienced interviewers quickly detect insecurity, confusion, and resistance from respondents when answering questions. The non-expert identifies problems related to the interviewer, ensuring that the test application is robust, since the result of the research needs to be independent of who is applying the test (9).

The study was approved by the Research Ethics Committee of the School of Medical Sciences of UNICAMP (CAAE: 13367219.5.0000.5404).

Data collection instrument

Self-evaluation of skin appearance questionnaire

The initial structure of the questionnaire can be found in Supplemental Materials Appendix A. This questionnaire was developed with the aim of providing data regarding the appearance of the skin. The parameters evaluated by this questionnaire were hydration, firmness, elasticity, flaccidity, wrinkles and expression lines in the lips/eyes/forehead, luminosity/freshness, signs of tiredness, skin tone uniformity, intensity and number of spots, vitality, apparent pores, presence of dark circles, bags beneath the eyes and lifting effect. Questions were used to collect structured data, using different monodic interval scales to measure attributes, according to the standards of substance of cosmetic claims (14).

Sensory evaluation of cosmetics questionnaire

The initial structure of the questionnaire is found in Supplemental Materials Appendix B. This instrument addresses the sensory profile of a tested cosmetic topical formulation. To obtain the sensory profile of the formulation, the sensory attributes that refer to the product itself were selected during the application process: consistency/texture, perfume/fragrance, absorption time and spreadability. Skin attributes were also selected to be evaluated after the application: stickiness, oiliness and softness (6,15–17).

Data analysis

The answers obtained with the pretest were coded and analyzed (9). For the analysis of the qualitative material obtained in the interviews, the simple method of thematic content analysis was used (18). In relation to the quantitative data analysis process, the following steps were followed: establishment of categories; coding and tabulation; statistical analysis of the data (frequency, arithmetic mean, percentages, standard deviation, with aid of sector charts and others) (10,18).

After identifying and analyzing the problems encountered during the pretest, the questionnaires were edited and corrected (9).

Results

From the qualitative evaluation of the content of the interviews, the difficulties and suggestions pointed out by the participants during the interview were categorized according to Table 1.

The sociodemographic characteristics of the 15 women who pretested each questionnaire (sensory analysis and self-assessment) are described in Table 2.

Self-evaluation of skin appearance questionnaire

The frequencies at which misunderstandings and difficulties occurred in each category during the application of the pretest of questionnaire 1 are shown in Table 3.

As indicated, regarding the conceptual difficulties of questionnaire (Supplemental Materials Appendix A), it is verified that, in the item Medical and General History, the participants presented doubt in the concept of “neoplasia” and in the concept “psoriasis”. For this reason, a simple explanation of the health conditions was added to the question itself: “Neoplasms (tumor)” and “Psoriasis (chronic autoimmune skin disease, characterized by reddish spots covered by whitish scales)”.

Regarding the parameters evaluated by the intensity scale, there was some difficulty in understanding the words “lushness” and “luminosity” (Question 20), since the participants erroneously relate the terms to skin oiliness and sweat. Thus, he chose to remove this question from the questionnaire. In addition, some interviewees reported not knowing the definition of “elasticity” or cold not distinguishing it from the meanings of “firmness” and “flaccidity”. Therefore, we removed the question regarding the flaccid attribute, as it is the most confusing term, according to the respondents, and added the following descriptions to the respective questions: “Firmness is characterized by firm skin, with tonus, consistency, support, opposite of flaccidity” and “Elasticity is characterized by flexibility of the skin, undergoes deformation when subjected to traction, and partially or totally returns to its original shape”. Some participants did not understand the attribute “signs of tiredness” and “skin uniformity”. The questions were considered vague and confusing by the interviewees. In these cases, phrases explaining the meaning of each item were also added.

In the data collection instrument, conditional difficulties were also identified in six questions. In question 10, the elements “aesthetic procedures” and “rejuvenating cosmetics” are evaluated in the same question. However, since only the item “aesthetic procedures” is exemplified in the question, it is not clear whether the use of cosmetics should be described with reference to performing these procedures together or not. To avoid this difficulty, the two elements were evaluated and exemplified in different questions in the modified version of the questionnaire.

The non-specification of a reference period in questions 29 and 30 made it difficult to evaluate the attributes by the volunteers who questioned whether the answers should be given based on the moment the instrument was applied or whether previous times should also be considered. The participants reported that the presence of bags under the eyes and dark circles depends a lot on the time of day and on factors such as sleep and stress. For this reason, time indicators were placed in the questions, such as, “Regarding the bags under the eyes, would you say that in the morning (...)”.

The difficulty of interpretation on the Likert scale was also reported by the participants, especially during the self-assessment of clinical attributes by the numerical scale of 7 and 9 points. In questions 14 and 15, some interviewees questioned the difference in the levels present between these frequency scales. To overcome the difficulties presented, the numerical scales were complemented with the corresponding explanations and numbers at each level.

All changes made in the questionnaire (Supplemental Materials Appendix A) are described in the final version of the manuscript as shown in Supplemental Materials Appendix C.

Sensory evaluation of cosmetics questionnaire

The difficulties identified in the pretest of the sensory assessment instrument (Supplemental Materials Appendix B) are summarized in Table 4.

During the evaluation, the participants identified difficulties in conceptualizing the terms consistency/texture, absorption time, stickiness, and oiliness. To enable a better understanding of the terms, the interviewees suggested the inclusion of the terms “viscous” and “fluid” for better characterization of the attributes “consistency” and “texture” and the inclusion of the expression “drying time” for a clearer description of the attribute “absorption time”. In addition, all sensory parameters were defined in the question header.

Regarding the conceptual difficulties, in Question 6, one of the interviewees found that the alternative “neither weak nor strong” was defined as a negative attribute, when in fact the expression means only indecision on the part of the respondent. Thus, this item was replaced by “appropriate”, transmitting as well as a more impartial adjective.

As observed in Supplemental Materials Appendix B, from questions 3 to 16, the same attribute was evaluated from the interviewee’s opinion with a 9-point scale and from the sensory assessment of this attribute with intensity scales. However, some participants pointed out that they could not differentiate the conditions of references of these two forms of evaluation for the same attribute, indicating a difficulty of conditional character. This same category was identified in question 11. Nonetheless, the interviewee reported not understanding whether the question was a personal and hedonic opinion of the attribute or whether it should be evaluated as if there was an exact and more correct answer. To solve the conditional problems, the question header about the participant’s personal evaluation of the attribute was restructured.

Regarding scale misunderstandings, the participants reported difficulty in understanding both the 7-point and 9-point scale levels. It was observed that the interviewees were often marking only the extremes of the scale, not making use of intermediate levels. To work around this problem, explanations and numbers were added at each level to facilitate their general understanding.

All changes made in Supplemental Materials Appendix B are described in the final version of the version as shown in Supplemental Materials Appendix D.

Discussion

For the questionnaires to present consistent and reliable results, several factors must be considered during their development, such as the social, cultural, and psychological aspects of the target audience. In addition, they should be elaborated in a simple, easy-to-understand manner, avoiding ambiguous questions (19,20).

With the purpose of these requirements being met, the questionnaire should be pretested in a heterogeneous public (but within the target public), with people of different age groups and socio-educational profile in order to know what these characteristics influence in the understanding during the execution of the questionnaire (21). In this way, possible problems and inconsistencies in its completion can be detected, minimizing difficulties during the development of the study (22,23).

This work described five categories of problems that can be encountered during the elaboration of a questionnaire to substantiate cosmetic claims, as well as some options that can solve them.

The semantic validation is essential to ensure the correct understanding of all items by the interviewees, avoiding divergent interpretations of the intention expressed by the researcher. To this end, it is necessary that this step considers the relevance and coherence of all elements for the population to which the instrument is directed (24,25). In this study, it is noted that these semantic difficulties represent an unfamiliarity of technical level, making it impossible to differentiate the particularities of each term; thus, it is important that all attributes evaluated are defined and explained in each question.

Although the interviewee may know the technical definition of the attributes questioned, another difficulty identified was clinical self-assessment. For the questionnaire information to be provided more reliably, it is important that the interviewee has already received a previous diagnosis of the clinical condition evaluated. However, self-assessment can be used as an important tool for measuring the quality of life of participants (26,27).

Based on the analysis of the answers obtained, it was also observed that some participants did not understand the reference condition (conditional category) or the time and frequency (temporal category) at which the parameters should be evaluated. It is, therefore, necessary that the questions be drawn up in a clear, concrete, and precise way. The questions present in the instrument should also consider the reference system of the interviewee, his level of information, in addition to allowing a single interpretation and referring to one idea at time (18,28).

There are reports in the literature of the use of pretests in diverse areas, such as nutrition (22,29), social well-being (30,31), questionnaire adaptation in foreign languages (32,33), marketing and sales of the product (34), economy (35), and sociopolitical (36). There are similarities between this study and the pretest studies found in the literature, such as the need to explain technical terms or their exchange (29,32,35–37), clarify the use of scales and change them for a greater understanding (21,30,34). To assess the intensity of the attributes, numbers and verbal explanations were added to the intensity scales from 5 to 7 points (30). For the hedonic evaluation, the nine-point scale anchored with “Dislike extremely” and “like extremely” was maintained, because despite being more difficult to understand, when it comes to acceptance questions, the nine-point hedonic scale is considered the most reliable, valid and practical scale (4).

In addition, limitations were identified that can be harmful to the final result, such as the number of interviewees being lower than the number of people who will be interviewed with the final questionnaire (22). The importance of performing the pretest process was also scored within these articles, such as an easier understanding (27,33), as well as the fact that corrections prevent the results from being manipulated due to erroneously given answers (37).

Conclusions

The analysis of the pretest is very important to identify any types of errors that prevent the interviewee from fully understanding the instrument, and its correction is important so that the moment of response to the questionnaire does not become an unpleasant moment for the participant. The survey of the difficulties encountered, as well as the changes made to the data collection instrument, lead to a greater understanding of the tool by the respondents, and to the development of a more effective and reliable tool for substantiation of cosmetic claims.

The methodology of how to carry out a pre-test, its applicability and its improvement was also described, which is of great applicability for the cosmiatry sector. The method used here can be used for other questionnaires and extended to the most diverse areas of studies involving humans.

Authors Contributions Statement

MMV, conceptualization and study design; data analysis; drafting, editing and reviewing; LMA, conceptualization and study design; experimental implementation; drafting, editing and reviewing; TA, data analysis; drafting, editing and reviewing; GRL, conceptualization and study design; supervision and final writing.

Funding

This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES No. 88887.489753/2020-00), and the São Paulo Research Foundation (FAPESP No. 2020/08516-0).

Acknowledgements

The authors thank the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), the São Paulo Research Foundation (FAPESP), and the National Council for Scientific and Technological Development (CNPq) for their financial support.

Conflict of Interests

The authors declare there are no financial and/or personal relationships that could present a potential conflict of interests.

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