Five Nutritious Foods with an Unexpectedly High Sugar Content

Five Nutritious Foods with an Unexpectedly High Sugar Content

Food labels that make claims like “gluten-free,” “keto-friendly,” or “natural” may deceive consumers into believing that a product is healthier than it actually is. These statements may not always imply that a food is healthful, even when they might point to a decreased carbohydrate content or the lack of wheat.

MAY 16,2024

BY NR.BALOCH

HEALTHY FOODS 

While defining what exactly qualifies as healthy food might be difficult, the majority of nutritious foods have similar qualities. Nutritious foods typically have high vitamin and mineral content, enough amounts of fiber, protein, and good fats, and few empty calories. Empty calories are calories that have little to no nutritious value, such as those from added sugar and saturated fat. Regretfully, a lot of meals that are frequently thought of as “healthy” really have a lot more added sugar than you might think.Food labels that make claims like “gluten-free,” “keto-friendly,” or “natural” may deceive consumers into believing that a product is healthier than it actually is. These statements may not always imply that a food is healthful, even when they might point to a decreased carbohydrate content or the lack of wheat. It turns out that many of these goods have higher

First, canned soup

Canned soups can provide a great lunch alternative for people looking for something quick and nourishing. They may, however, be hiding more sugar than you might think. For instance, a single serving of Campbell’s Condensed Tomato Soup, or just ½ cup, has 8 grams of added sugar. That implies 20 grams of sugar can come from a single can of soup. Seek for soups that have no added sugar, three grams of fiber, and at least ten grams of protein.

2. Bars of Granola

Granola bars, which are frequently eaten as a quick lunch or snack, can also have surprisingly high added sugar content. For example, Nature Valley Oats and Honey Granola Bars include modest levels of protein and fiber and eleven grams of added sugar. Choose bars that have

3. Quick Oatmeal

Instant oatmeal that has been flavored can be highly sugar-laden, even though oatmeal is normally a healthful choice. For instance, the Cinnamon & Spiced Oatmeal from Quaker Oats has 10 grams of added sugar. Because it has 35% less added sugar than regular tastes, Quaker’s lower-sugar instant oatmeal is a good option.

 

4. Yogurt with Less Fat

While there are less fat calories in lower-fat yogurt than in full-fat varieties, many options make up for this by adding extra sugar. For example, each 6-ounce container of Yoplait’s blueberry-flavored yogurt has 13 grams of added sugar. Seek for protein-rich Greek yogurt or comparable products with less than 5 grams of added sugar.

 

5. Cereal Made Whole Grain

Although whole-grain cereals are generally thought to be healthy options, some of them may have significant added sugar content. Make sure the cereal you choose is high in protein and fiber and low in sugar.

Common Health Foods: The Inconspicuous Sources of Added Sugar
A popular option for a simple and quick breakfast or as a side dish for yogurt is cereal. Even cereals that advertise themselves as healthy options frequently have hidden sugars. One seemingly healthy whole-grain product from Raisin Bran, for example, has up to nine grams of added sugar per serving; eating more than one cup of this product can add a substantial amount of added sugar to your daily intake. With several little or nonexistent additional

A Complete Guide to Creating a Well-Balanced Meal for People with Type 2 Diabetes

MAY 14,2024

BY NR.BALOCH

 

 

 

After receiving a type 2 diabetes diagnosis, you must change your dietary patterns to better manage the condition. A nutritious, well-balanced diet can help you live a longer, better life, and keep your blood sugar levels stable. It can also reduce your risk of developing health problems. This in-depth guide explains how to put up healthy meals that take diabetes into account, with an emphasis on cutting back on sugar and bad fats.

 

How Do You Build a Plate That Considers Health?

Divide Your Plate Into Four Parts.

1. Set aside a quarter of your plate for items high in protein, a quarter more for carbohydrates with a low to moderate GI, and the other half of your plate for a variety of salads and vegetables. This helps with portion management and guarantees a balance of nutrients. Reducing the size of the plate can also help significantly reduce the portion size.

2. The Focus Is on Vegetables

Make an effort to include two or three portions of non-starchy vegetables in your meal. Half a cup of cooked vegetables or an entire cup of salad is represented by a single serving. Grated vegetables can add flavor to soups, sauces, and oven-baked dishes; alternatively, they might take center stage instead of playing supporting roles.

 

For every individual:One cup* of cooked non-starchy vegetables, including carrots, broccoli, cauliflower, etc.

Two cups* of mixed salad mixed with bell peppers, tomatoes, lettuce, spinach, etc.

*You are welcome to serve more than these suggested serving sizes.

 

3. Include Lean ProteinEating protein is crucial because it keeps you feeling fuller for longer. Lean meats and dairy should be your goals, and before cooking, make sure to cut off any visible fat.

For every individual:

• Two little (45g) chicken eggs
  

• ½ cup of cooked legumes, such as chickpeas or lentils, or a blend of three beans
  

• 120 grams of tofu
  

• 100g of skinless cooked chicken (125g raw)
  

• 100g of lean meats (125g raw) such as lamb, hog, or beef
  

• 120g of cooked fish (170g raw), such as canned tuna, salmon, or mackerel
  

• 40g of low-fat cheese, or roughly two pieces

4. Add Controlled Portions of High-Quality Carbohydrates

Eat less starchy vegetables in your meal to lower its glycaemic load.

To keep the overall GI of your meal low, choose foods high in fiber yet low to moderate in GI. Choose quinoa, barley, pasta, noodles, grainy breads, and basmati rice. Interestingly, legumes have low GI carbohydrates and are also a source of protein.

For every individual:

• A quarter cup of cooked brown or basmati rice
  

• One cup of cooked noodles or pasta, ideally wholemeal
  

• Two slices of wholegrain bread or one tiny wholegrain bread roll
  

• One cooked medium-sized kumara or tiny potato
  

• One medium-sized corn cob
  

• ½ cup of cooked couscous or quinoa

5. Add a Tiny Amount of Nutritious Fats

Good fats are essential for controlling cholesterol levels and for lowering the GI of your meals. Add modest amounts of heart-healthy fats from avocado, almonds, and seeds, as well as olive oil.It’s important to remember that a range of protein sources, including meat and tofu, can supply enough fat; therefore, adding extra may not always be required.

For every individual:

• two tsp pesto or chopped or crushed nuts
  

• One teaspoon of extra virgin olive oil or another plant-based oil
  

• two tspn of salad dressing or avocado
  

• A single tablespoon of hummu

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11 Thanksgiving Cheese Board Ideas That Your Visitors Will Appreciate

MAY 14,2024

BY NR.BALOCH

 

           

 

You may be under pressure to finalize your holiday menu and make sure everything is ready for the big day because Thanksgiving is just a few days away. Thanksgiving entertaining can be hectic, but one way to lighten the load is to serve a simple yet delicious snack, such as a charcuterie board.A charcuterie board is primarily composed of cheese and preserved meats, although individuals frequently customize it by adding fruits, veggies, dips, and chocolates. Some people have gone so far as to construct completely vegan charcuterie boards by replacing the cheese and meat with plant-based goodies. A charcuterie board is intended to get people mingling, chatting, and looking forward to the main dish.If you

Try the Thanksgiving Cheese Board at Vermont Creamery, which includes sliced turkey, cranberry sauce, and Brussels sprouts—all traditional Thanksgiving fare. Their Goat Cheese Log with Cranberries, Oranges, and Cinnamon goes great with other cheeseboard ingredients like candied pecans, apple butter, and sweet potatoes.

1. Thanksgiving Turkey Cheese Board: Using a red pear, rolled-up meats, cheese, and fruits, create a charming turkey-shaped charcuterie spread.
2. Holiday Charcuterie Board: Make your own by following the recipe from Half-Baked Harvest. It calls for crackers, meats, nuts, fruits, and vegetables in addition to a range of cheeses like blue, goat, and brie.
   
3. What’s on the Thanksgiving Cheese Board? For Thanksgiving, Gabby Cooking creates a charcuterie board with a “darker” color palette. It comes with a variety of meats, olives, marinated artichokes, persimmons, crackers, and delicious toppings like honeycomb on brie cheese.
   
4. Winter Bruschetta Bar: What’s Gabby Cooking’s Winter Bruschetta Bar elevates classic bruschetta with cheeses including goat cheese, blue cheese, and crème brie, as well as a range of toppings like prosciutto, pomegranate, and red peppers.
   
5. Turkey Snack Board: Unlike charcuterie boards that are mostly composed of meat, the Bakermama’s Turkey Snack Board is lighter and emphasizes fruits, vegetables, and nuts.
   
6. Keto Charcuterie Platter: This platter is ideal if you or your guests are on a low-carb or ketogenic diet. It has mouthwatering meats, cheeses, and nuts, and cheese whisps are used in place of crackers.
   
7. Trader Joe’s Charcuterie Board: You can make this simple and inexpensive charcuterie board from The Bakermama with materials that you can buy at Trader Joe’s, which makes it both convenient and economical.
   
8. Plant-Based Charcuterie Board: Ambitious Kitchen provides a delectable plant-based charcuterie board with a range of vegan cheeses, vegetables, fruits, nuts, olives, chickpeas, and dark chocolate for vegan visitors.
   
9. Mezze Platter for Vegetarians: Astonish your guests with this app from What’s Gabby Cooking, which features feta, olives, tomato pesto, artichokes, hummus, tzatziki, and pita chips with a Mediterranean flair.
   
10. Vegan Charcuterie Board: For a complete holiday experience for your vegan visitors, Minimalist Baker offers a vegan charcuterie board complete with a vegan pimento cheese ball, vegan pepperoni, garlic and herb vegan cheese, hummus, almonds, and chickpeas.Have fun assembling a gorgeous charcuterie platter that will wow your Thanksgiving visitors!

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Really, How Bad Are Ultraprocessed Foods?
They are undoubtedly connected to ill health. However, scientists are still learning the reasons behind this.

MAY 13,2024

NR.BALOCH

Brazilian nutritional epidemiologist Carlos Monteiro saw a concerning trend in the mid-1990s: childhood obesity rates were sharply growing in his nation.

He and his colleagues at the University of São Paulo examined data on Brazilian households’ food purchasing habits to determine if they had altered recently in order to comprehend why. Researchers discovered that consumers were buying more processed goods including sodas, sausages, instant noodles, packaged breads, and cookies and less sugar, salt, cooking oils, and staple foods like grains and beans.

According to Dr. Monteiro, the researchers coined and defined the term “ultraprocessed foods,” or UPFs, to characterize that second category of food. Later, researchers in Brazil would connect UPFs to adult and pediatric weight increase.

Since then, researchers have discovered links between UPFs and a variety of illnesses, such as depression, heart disease, Type 2 diabetes, obesity, gastrointestinal disorders, and obesity, in addition to an earlier mortality.

Experts believe that’s troubling because ultraprocessed foods are now a common component of diets all throughout the world. For example, in the United States, they make up 67% of the calories consumed by children and teenagers.

However, there are still a lot of unanswered questions. Exactly what are ultraprocessed foods? What is the strength of the evidence for their adverse effects? We posed these and other queries to specialists.

Ultraprocessed foods: what are they?

Dr. Monteiro and his colleagues created the Nova food classification system, so named because it combines the Portuguese and Latin words meaning “new,” in order to research foods according to their processing. Since then, researchers from all around the world have embraced it.

Foods are categorized into four groups by the Nova system:

• foods such as fresh or frozen fruits and vegetables, beans, lentils, meat, chicken, fish, eggs, milk, plain yogurt, rice, pasta, maize meal, flour, coffee, tea, and herbs and spices that are either unprocessed or only slightly processed.
• processed items used in cooking, including butter, vinegar, sugar, honey, and cooking oils.
  
• processed foods created by mixing elements from Category 2 with those from Category 1 and preserving or altering them using comparatively easy techniques including baking, fermentation, canning, and bottling. This category include fish, beans, and vegetables in cans, most cheeses, and freshly baked bread. Preservatives that lengthen shelf life might be present in some foods.
  
• foods that have been ultraprocessed by the use of industrial techniques and non-grocery store products such as hydrogenated oils, concentrated proteins like soy isolate, and high-fructose corn syrup. They frequently have flavorings, colorings, or emulsifiers added to them to give them a more appealing and edible appearance. Consider energy drinks and sodas, candy, chips, flavored yogurts, margarine, lunch meats, hot dogs, sausages, chicken nuggets, boxed macaroni and cheese, most packaged breads, plant milks, meat alternatives, and cereal for breakfast.

  According to Virginia Tech nutrition professor Brenda Davy, “if you look at the ingredient list and you see things that you wouldn’t use in home cooking, then that’s probably an ultraprocessed food.”Notably, the Nova method does not group foods according to nutrients such as fat, fiber, vitamins, or minerals. Maya Vadiveloo, an associate professor of nutrition at the University of Rhode Island, described it as “agnostic to nutrition.”

This has sparked a discussion among nutrition professionals regarding the usefulness of UPFs in characterizing a food’s healthfulness, in part because many of them, such as newborn formulae, flavored yogurts, and whole grain breads, can offer important nutrients, according to Dr. Vadiveloo.

Are meals with a lot of processing bad?

The majority of studies that relate UPFs to bad health are observational in nature, meaning that participants’ diets are asked about and their health is monitored over an extended period of time. Scientists found that drinking UPFs was linked to 32 health problems in a comprehensive assessment of research published in 2024. The strongest evidence was found for heart disease-related fatalities, Type 2 diabetes, and common mental health conditions like worry and depression.

According to Josiemer Mattei, an associate professor of nutrition at the Harvard T.H. Chan School of Public Health, these kinds of studies are important because they can examine large populations over the many years that it can take for chronic health conditions to develop. Results from almost 10 million people were included in the 2024 review. She continued by saying that she was more convinced than ever that there was a serious issue with the foods because of the persistent connection between UPFs and health problems.

However, as noted by nutrition scientist and epidemiologist Lauren O’Connor, who previously held positions at the National Institutes of Health and the Department of Agriculture, the observational studies also have drawbacks. She acknowledged that there is a link between certain meals and chronic illnesses, but that doesn’t imply

Dr. O’Connor questioned the usefulness of combining such “starkly different” goods into a single category, such as breakfast cereals and Twinkies. There are some ultraprocessed food kinds that are obviously more dangerous than others, such as drinks and processed meats. On the other hand, UPFs such whole grain breads and flavored yogurts have been linked to a lower risk of Type 2 diabetes.

According to Dr. O’Connor, clinical trials are required to determine whether UPFs directly cause health issues. There has only been one small-scale research of this kind, with certain limitations, she noted.

Twenty persons with a variety of body types spent four weeks living in a research hospital at the National Institutes of Health as part of the 2019 study. They mostly consumed food for two weeks.

Why could UPFs be detrimental?

Dr. Hall stated that there are “strong opinions” on the health risks associated with ultraprocessed meals. He went on, “But there’s actually not a lot of rigorous science” regarding the nature of those systems.

UPFs are definitely replacing healthier foods in our diets because they are frequently affordable, easily accessible, and convenient, according to Dr. Hall.

Picture

On a drab backdrop, dried ramen noodles are piled on top of one another.

Give credit…For The New York Times, Casey Zhang

However, he and other scientists believe that the meals may be impacting health more directly. They are high in calories, simple to chew, and contain tempting mixtures of carbohydrates, sugars, fats, and salt, which may contribute to their tendency to be overindulged. Additionally, it’s likely that the ensuing surges in blood sugar may

However, the majority of researchers believe that the foods are harmful in a variety of ways. According to Dr. Vadiveloo, “there is rarely a single factor in nutrition that fully explains the relationship between foods and some health outcome.”

In regards to ultraprocessed foods, what should we do?

Dr. Monteiro was involved in the 2014 Brazilian Dietary Guidelines, which recommended avoiding highly processed foods.

Several nations, including Israel, Canada, and Mexico, have also made it clear that consuming too few or no UPFs, or “highly processed foods,” is advised. Such recommendations are not included in the U.S. dietary guidelines, but the 2025 standards may change as a result of an advisory committee’s investigation into the data about UPFs’ potential to influence weight gain.

According to Dr. Hall, there is a lack of knowledge regarding UPFs in the US, as a large portion of food is already ultraprocessed and those with lower incomes may be more reliant on them.

“Food is food at the end of the day, and they are a significant source of it,” Dr. Mattei continued. She remarked, “We really can’t demonize them.”

Though research on UPFs is ongoing, opinions among experts range on how individuals should use them. According to Dr. Monteiro, the best course of action is to stay away from them completely. For example, you can replace flavored yogurt with plain yogurt and fruit, or if you can afford it, you can get a fresh loaf of bread from a nearby bakery in place of packaged goods.

Dr. Vadiveloo recommended a more measured approach that concentrated on reducing UPFs that don’t offer beneficial nutrients, like as soda and cookies. Increased consumption of fruits, vegetables, whole grains—whether processed or not—legumes, nuts, and seeds were other suggestions made by her.

Dr. Davy advised cooking as much as possible at home with minimally processed foods. “Right now, we’re not really able to say much more than that.”

A Handbook for Enhancing Nutrition

• Ultraprocessed foods have a direct correlation to ill health. However, scientists are still learning the reasons behind this.
  

• According to aging specialists, animals that restrict their caloric intake and undergo intermittent fasting live longer. What that means to you is as follows.
  

• “Oatzempic,” a half-cup portion of rolled oats combined with a cup of water and the juice of half a lime, is promoted as a weight-loss trick on a popular TikTok video. If there was anything to it, we questioned the specialists.
  

• There is sodium in everything that we eat. How much salt, though, is too much?
  

• For years, doctors advised patients that calorie restriction might lessen polycystic ovarian syndrome symptoms. However, studies imply that dieting might not be very helpful.

16 Easy Dinner Ideas for a Mediterranean Diet Low in Inflammation

16 Easy Dinner Ideas for a Mediterranean Diet Low in Inflammation

MAY 11,2024

NR.BALOCH

16 Easy Dinner Ideas for a Mediterranean Diet Low in Inflammation

These 30-minute dinners are perfect for anyone wishing to eat meals that support general health. Seafood, dark leafy greens, legumes, and herbs—ingredients with anti-inflammatory qualities—are used in these meals. By include these recipes in your diet, you can help relieve some of the bothersome symptoms of chronic inflammation, such as headaches, migraines, and brain fog. These dishes also follow the Mediterranean diet’s tenets, which are well known for their health advantages. These recipes, which range from the flavorful and nutritious Chicken Piccata Casserole to the tantalizingly spicy Chicken Tinga Baked Pasta, are full of protein.

Pasta with Baked Chicken Tinga

With leftover chicken tinga, a Puebla-style classic Mexican meal, this zesty baked pasta shines. The meal is enhanced with the ideal balance of creaminess and spice from the rich tomato-chipotle sauce.

Salmon with Creamy Spinach-Artichoke

The vegetables and sauce for this quick and simple dinner for four may be combined in a single skillet in a matter of minutes, while the salmon broils. Salmon is also loaded with heart-healthy omega-3 fatty acids and packed full of vital nutrients like potassium and B vitamins.

16 Easy Dinner Ideas for a Mediterranean Diet Low in Inflammation

Consuming foods that promote optimal well-being simply get simpler with these 30-minute meals

DIETS SPECIAL 10/10/20225 minutes to read

16 Easy Dinner Ideas for a Mediterranean Diet Low in Inflammation

These 30-minute dinners are perfect for anyone wishing to eat meals that support general health. Seafood, dark leafy greens, legumes, and herbs—ingredients with anti-inflammatory qualities—are used in these meals. By include these recipes in your diet, you can help relieve some of the bothersome symptoms of chronic inflammation, such as headaches, migraines, and brain fog. These dishes also follow the Mediterranean diet’s tenets, which are well known for their health advantages. From the protein-rich Chicken Piccata Casserole to the mouthwateringly spicy Chicken Tinga Baked Pasta,

Cucumber-Cheese Feta Salad with Lemon

This zesty and cooling cucumber chickpea salad with feta and lemon may be enjoyed as a standalone dish or combined with greens for a quick lunch or dinner. Although dill adds a grassy taste, you may easily replace it with another fresh herb such as chives, parsley, or oregano.

A Protein-Packed Chicken Piccata Casserole with 31 Grams

All the ingredients of the traditional meal are combined in this delicious, protein-rich chicken piccata casserole. This casserole doesn’t need the sauce to be prepared or dredged like regular piccata does. The sharpness of the lemon slices is tempered and their tanginess amplifies the taste profile when they are cooked in butter.

Pasta with Green Goddess Ricotta

With the help of lemon, anchovies, and herbs, this spaghetti sauce perfectly captures the tastes of green goddess dressing while remaining vibrant and zesty. A blend of parsley, tarragon, chives, and basil is really effective, but you can use any mix of herbs that you have on hand. The creamy texture is expertly counterbalanced by the slight acidity from the lemon juice, and the inclusion of ricotta cheese adds a rich, velvety texture. To catch the sauce, we suggest shell-shaped pasta, but you may certainly use any kind of noodle in its place. Consider using peas or asparagus for an added boost of vegetables in the recipe.

Rice Bowls Inspired by Bibimbap

These brown rice bowls are influenced by Korean bibimbap, even though they are not entirely conventional. They have chopped vegetables, ground beef that is both sweet and spicy, and a fried egg on top. Gochujang is a fermented paste prepared with rice, soybeans, and chilies that lends layers of flavor and a light kick of heat. A small drizzle of toasted sesame oil adds a lovely nutty flavor to the meal, making it look and taste amazing.

Phyto-Inflammatory Beet and

Chicken Salad

Tart cherry juice concentrate provides flavor and anti-inflammatory properties, which are harnessed in this fast salad. When mixed with other ingredients like walnuts and beets, it makes a filling and healthy dish. Choosing precooked beets in a packet reduces mess and saves time. Find them with other prepared vegetables in the produce area.

Extra Verdant Pasta

You can add a lot of vegetables to your lunch with this simple and quick green spaghetti recipe. When cooked and combined with basil, pine nuts, and Parmesan cheese, kale and spinach become a vivid green sauce with a pesto-like taste. Savor this pasta dish without meat by adding grilled chicken or white beans for an additional protein boost.

Fish tacos with tilapia

Taking a cue from Korean bibimbap, indulge in these protein-packed brown rice bowls and stray from convention. They have sliced vegetables, a fried egg as a delectable garnish, and a mixture of sweet and spicy ground beef. Gochujang, a fermented paste produced from rice, soybeans, and chilies, gives the meal layers of complexity and a hint of heat. A thin drizzle of toasted sesame oil adds a lovely nuttiness to round out the tastes.

Please be aware that the output result’s language and tone of voice will resemble the original text that was provided.

Quick and Refreshing Fish Tacos with Tilapia

These tasty fish tacos made with tilapia are not only refreshing and easy to prepare, but they also have a flavor and texture that will take you to the beach. These tacos go well with flour or corn tortillas. Although we adore the mild flavor of tilapia, any white, flaky fish, such as cod or haddock, may be used in its place with equal ease and yield equally delicious results.

Quinoa, chicken, and fresh berries combined in a spinach salad

To make the dressing, just combine all the ingredients in a small container and take the grain bowl with you to work. When you’re ready to eat, combine the salad and dressing by shaking it well and tossing everything together. In case you lack time and don’t have any homemade dressing, a three-tsp store-bought olive oil vinaigrette can serve the same purpose. Use a microwaveable quinoa pouch and leftover or rotisserie chicken to cut down on prep time.

Bibim Naengmyeon

The sauce is the highlight of bibim naengmyeon; it’s a lovely blend of acidic, spicy, and sweet flavors that go well with the chewy noodles. Although eggs and meat are common toppings, this version eliminates them for a hassle-free vegan dinner. Add slices of grilled or fried tofu for a more filling dish. Since the noodles get rigid and hard to mix the longer they sit, it’s better to enjoy this meal right away.

Fried eggs paired with braised lentils and kale

Full in protein, these braised lentils are cooked with soft kale in a broth made from fire-roasted tomatoes and finished with a fried egg. It just takes a little time in the pan for microwaveable lentils to cook through. Feel free to substitute prepared or canned lentils if you have them on hand; just make sure to cook them for a little shorter amount of time so they don’t get overly soft. The dish is enhanced by the lovely touch of the egg’s runny, velvety yolk. Cover the pan and cook for a another 2 or 3 minutes if you like your yolks to be firmer.

20-Minute Limone Pasta

You can make this silky and zesty pasta al limone in 20 minutes. This dish highlights the tastes of these unusual lemons, which are native to Sorrento, Italy, which is well-known for their aromatic lemons with thick, rough rinds and a balanced sugar level that borders on sweet. But don’t worry if you don’t have Sorrento lemons—any big, firm, ripe lemon with a rough rind will work just fine. The greatest results are usually obtained from lemons with thicker skins since they yield more zest.

Farro Bowls with Grilled Vegetables and Black Beans

With the exception of the tortilla, these filling bowls have all the flavor of a black bean and veggie burrito. Rice is swapped out for chewy, nutty farro, and perfectly grilled veggies are dressed with a tart lime vinaigrette. Although these bowls taste great served cold, you may reheat the vegetables in a small skillet and warm the beans with a little vegetable broth if you’d like.

Pasta, Cashew, and Chickpea Salad with Mint-Cilant Vinaigrette

We think the dressing is the highlight of this salad. It adds a delicious crunch from the shallots and a tangy, citrus flavor. Cook the pasta and combine everything after chopping the vegetables and making the dressing. Prepare to savor this incredibly tasty salad!

FOOD SELECTIONS FOR TYPE 2 DIABETES

 Food Selections for Type 2 Dibetes

beabetesen someone is told they have type 2 diabetes is, “What should I (or a loved one) eat now?

MAY 9,2024

BY NR.BALOCH

DIABETES 

Making Food Decisions When Living with Type 2 Diabetes

One of the first questions that come up when someone is told they have type 2 diabetes is, “What should I (or a loved one) eat now?” This doesn’t have to be a hard question to answer. Here’s a helpful, condensed guide.

1. Adhere to the “ideal plate” concept. Try to divide your dinner plate in half for non-starchy veggies and quarters for each of protein and carbohydrates.

2. Special meals are not required. People who have type 2 diabetes are not required to buy certain foods or have meals apart from their family. There are lots of tasty and nutritious meals that the whole family will love.

3. Effortlessly encourage better choices. Decide as a family not to keep unhealthy food on hand at home. Although this initially appears difficult, it ultimately benefits

Rules Regarding Pantry Items


Throw away
Foods heavy in calories and low in nutrients, like ice cream, high-fat cereals with little fiber, cakes, biscuits, chocolates, sweets, thick sauces, cheeses, white bread, croissants, brioche, and white rice (basmati may be an exception), should be thrown out of your cupboard.

Keep in mind that foods high in fiber (those that don’t need to be toasted and have more than 7g of fiber per 100g, such as bran-based cereals, rolled oats, or untoasted muesli) are good for your health. Other possibilities include heart-healthy oils like olive or sunflower oil, nuts, and seeds; dried legumes; brown or basmati rice; high-fiber breads and crackers; canned veggies (such sweet corn, tomato, and beetroot); and canned legumes (like chickpeas, lentils, and chili beans). Keep fish, poultry, lean meat, and frozen veggies in your freezer. Use smaller amounts of different Asian sauces (such as mirin, oyster sauce, sweet chilli sauce, low-soy sauce, and fish sauce) to give your food some flavor.

Guidelines for Purchasing

The Top 10 Items Every Pantry Needs

1. Legumes in cans, such as lentils, cannellini beans, and chickpeas

These low-cost, satisfying legumes are high in fiber. Pureed chickpeas or cannellini beans, garlic, and lemon juice combine to make a simple hummus. To add more texture and protein to soups or curries, you may also add drained chickpeas.

2. Fish in cans, such as sardines, salmon, and tuna

These fish, which are high in protein and omega-3 fats, go well in a lunchbox with salad and bread. Choose the ones that are canned in spring water or eat the ones that have been drained of oil.

3. Tomato cans

 

You may utilize these lycopene-rich tomatoes in a variety of recipes. The flavored ones make great marinades for meats or beans.

4. Sunflower or pumpkin seeds

These crispy, salty dry-fried seeds add a delightful touch to a variety of recipes.

5. Balsamic

6. Nut butter and nuts

They enhance your food with taste, crunch, and a creamy texture while providing heart-healthy fats.

7. Fish sauce

This enhances the flavor of Asian salads and stir-fry sauces well. But because it contains a lot of sodium, dilute it with water or use less than the recipe calls for.

8. Mustard seeds

This is excellent as a side dish with practically any cuisine, as a rub for lean meat, as a spread on toast, and in salad dressings.

9. Chilled red pepper flakes

Your casseroles, sauces, and soups will taste better with these heat-packed flakes.

10. Soy sauce with less sodium

This sauce does a good job of flavoring without adding extra calories. 

Top 10 New Essentials

The most important ingredients in a nutritious pantry are fresh fruits and vegetables. Non-starchy ones are a terrific way to give your meals more flavor and volume. They are also brimming with nutrients to maintain your health. On the other hand, keep in mind that starchy veggies like potatoes, kumara, yams, and taro should only make up 25% of a well-balanced dish.

1. Green salad

Take mesclun salad mix or baby spinach, for example. These nutrient-dense greens are perfect to complement your meals. Make it a daily ritual to eat at least one handful of greens!

2.NEWLY HARVESTED HERBS

They work wonders for boosting flavor without increasing calorie intake. For instance, coriander tastes well with practically any Asian food, while fresh basil pairs wonderfully with tomatoes.

3. Cucumber on Telegraph

It is a great choice for adding to salads, sandwiches, or platters because it is low in calories. Grate some cucumber and add a little salt and garlic to thick, low-fat plain yogurt to make a simple, low-calorie dip.

4. Tomatillos

In terms of flavor and nutrition, tomatoes are an invaluable ingredient. They work well in a variety of recipes and make an outstanding

5. Fruits

Add some banana slices to your cereal in the morning to make it even more sweet. They make a convenient snack to have on hand at your desk or in your car for those moments when hunger strikes. Think of them as one of nature’s best quick meals!

6. Kiwi

After supper, a kiwi, which is high in fibre and vitamin C, might be a delightful sweet break. For a tasty nightcap, try slicing up a kiwi and topping it with some yogurt and cereal.

7. Berries of blueberries

Antioxidants are abundant in blueberries, surpassing those found in almost all vegetables and fruits. The deep blue color of the berries is caused by antioxidants called anthocyanins, which have been shown to support brain function.

8. Breasts of chicken

Skinless, lean chicken breasts are one of the lower-fat meat options. Although they are expensive, a small amount goes a long way—especially in a filling stir-fry.

9. Tofu

Even though tofu doesn’t have a very strong flavor, it melds well with the flavors of the other ingredients it cooks with to produce a delicious dish. Tofu is a soy product high in protein that works well as a protein replacement in stir-fry dishes.

10. The Falafel

Here’s your fix for fast food, health enthusiasts! Made from ground legumes like fava beans or chickpeas, falafels are a convenient and healthful option found in most supermarket deli areas.

Favorites from the Fridge and Freezer: 1. Frozen Baby Beans

When fresh vegetables become scarce, they make an excellent substitute. Add a handful to stir-fries, casseroles, or curries as a last-minute, enlivening touch.

2. Milk, Trim or Calci-Trim

Choosing trim or Calci-Trim milk, which has a green or yellow top instead of full-cream milk’s dark blue top, encourages a lower consumption of calories and saturated fat.

3. Greek Yogurt with Less Fat

Have a cup of this yogurt when you’re craving smoothness but still want to keep your calorie intake in check.

4. Paste Made with Tomatoes

Tomato paste tubes, which have a brief shelf life, are great as a low-calorie pizza sauce or as an addition to tomato-based dishes.

5. Cheddar Cheese

It requires concentrated energy, yet all you need is a sprinkle of Parmesan cheese. Use it to boost the flavor of low-fat cheese or sprinkle it gently over Italian recipes.

6. Jars with curry paste

Stir a tablespoon or two of curry paste into cooked fish or poultry for a flavorful explosion that offers little in the way of calories. Simply stir in a small amount of low-fat coconut milk, but take note of the sodium level.

7. Jars with Minced Garlic and Ginger

When time is of the essence, these jars offer convenience even if fresh ingredients are best. They provide flavor to your food while providing very few kilojoules.

8. Bread Made Whole Grain

Put a loaf of bread high in fiber in the freezer. By removing only the necessary number of slices, you may effortlessly regulate serving sizes in this manner.

9. Jar of Caper

Rich in taste and low in calories, capers are a delicious garnish for salads, pizzas, and pasta sauces.

The Top 8 Foods to Gain Muscle

 The Top 8 Foods to Gain Muscle

Because amino acids make up a large amount of our muscle and organ tissues, protein is an essential nutrition for promoting muscle growth.

HEALTHY FOODS 

bare-chested dude with an orange bar in his black shorts

In addition to being crucial for bodybuilders, muscle growth also helps us stay healthy and happy as we age. Our food is a key factor in both gaining and maintaining muscle mass, in addition to a well-rounded exercise program and strength training.

Because amino acids make up a large amount of our muscle and organ tissues, protein is an essential nutrition for promoting muscle growth. Shakes and other protein supplements have their uses, but they are not required. Including whole foods in your diet is another good strategy to make sure you’re getting enough protein.

Thankfully, adding a range of high-protein foods and other nutrients that help build muscle to your

 meals is simple. These eight

How Nutrition Aids in Building Muscle

While protein is important for muscle building, it is not the only essential component for this process. The National Academy of Sports Medicine suggests that a muscle-building diet should also provide sufficient carbohydrates, vitamins, and minerals. A well-balanced diet containing these nutrients provides the necessary building blocks for muscle repair and growth.

According to the NASM, most individuals should consume around 0.7 to 0.8 grams of protein and 1.8 to 3.2 grams of carbohydrates per pound of body weight each day. Calorie intake is also crucial when it comes to muscle building, as a calorie deficit can impede muscle growth.

However, diet alone is not sufficient to stimulate muscle growth. Regular exercise, especially resistance training, is necessary to kick-start the muscle-building process. When you engage in activities that cause micro-tears in your muscles, your body utilizes the nutrients from food to repair and strengthen the muscle tissue. Other factors such as meal timing, rest periods between workouts, and individual genetic and hormonal factors can also influence the effectiveness of this process.

Eight Ideal Foods to Gain Muscle

1. Eggs

For good reason, eggs have been known for a long time as a strength meal. These are very nutrient-dense, full of protein, fat, and important vitamins like thiamin, B12, and B6. Because eggs contain a high amount of leucine, which is known to have muscle-building qualities, they are unique when it comes to muscle building.

2. Fish

If you want to up your protein consumption without going overboard with fat in your diet, fish is a great option. It is rich in vitamins, minerals, and omega-3 fatty acids and is a lean source of protein. In addition to their many health advantages, omega-3s increase muscular function and stop the loss of muscle mass. Fish that are particularly good for growing muscle are salmon and tuna.

3. Almonds

When ingested in moderation, nuts are a wonderful option for muscle building. They offer a healthy supply of fiber, lipids, and protein. But keep in mind that they contain a lot of calories. Walnuts and almonds are two of the nut varieties highest in nutrients.

4. Vegetables

For muscle building, soybeans should be your go-to food if you eat a plant-based diet. They are very healthy legumes that include all nine of the essential amino acids as well as a wealth of protein. One of the best sources of plant-based protein available is said to be soybeans.

5. Yogurt

Dairy products, like Greek yogurt, provide a special blend of casein protein, which digests slowly, and whey protein, which digests quickly. Combining these proteins improves and extends the process of muscle protein synthesis, contributing to the growth of lean body mass. Greek yogurt offers extra probiotic advantages and has double the protein level of normal yogurt.

6. Cheddar

Cottage cheese is a great substitute for dairy-based protein even though it doesn’t have the same probiotic benefits as yogurt. It has both slow- and fast-digesting proteins, including casein, and provides more protein than Greek yogurt. If necessary, cottage cheese also offers a substantial calorie boost.

7. Extra Virgin Olive Oil

Extra virgin olive oil isn’t usually connected to bodybuilding, although it’s become more well-known for its benefits to muscle. Olive oil is good for muscle-building programs since it not only contains healthy monounsaturated fats but also lowers inflammation and slows down the breakdown of muscle.

8. Quinoa

There’s a reason quinoa is frequently referred to as a superfood. This adaptable seed is rich in protein, fiber, carbs, vitamins, and minerals and is categorized as a whole grain. It is the ideal diet for increasing muscle growth and optimizing the advantages of your exercise regimen.

It goes without saying that incorporating these nutrients into your diet will help you gain more muscle mass and general strength. Recall that nutrition is only one aspect of the puzzle; developing muscle takes time. A balanced diet heavy in foods high in protein, together with consistent exercise and enough sleep, will help you make progress more quickly and improve your general health as you go.

IS ALMOND MILK BAD FOR ENVIORNMENT?

IS ALMOND MILK BAD FOR ENVIRONMENT?

Over the past ten or so years, almond milk has grown in popularity. An increasing number of Americans are enjoying it straight from the carton or in recipes.

However, a lot of customers are curious if almond milk is harmful to the environment. It originates from thirsty trees, some of which were grown during California’s protracted drought. Here, we compare the amount of water used in the production of almond milk to that of dairy and other plant-based alternatives.

Describe Almond Milk.

Almond milk is a beverage prepared by blending and straining almonds along with water and, depending on the type of milk, a few other possible flavoring additives like sugar or vanilla.

Although the dairy industry opposes the sale of plant-based products labeled as “milk,” the term “milk” has always been associated with the resulting beverage. Not only has almond milk been mentioned in recipes going back at least to the 13th century, but plant-based milks are also included in the definition of the Oxford English Dictionary. Almond milk is, according to a recent FDA ruling, a milk. 

Is Environmental Damage Caused by Almond Milk?

In general, almond milk poses less of a threat to the environment than cow’s milk. However, there are a few things that buyers need to be aware of. 

What Are Almond Milk’s Environmental Drawbacks?

1. Use of Water

The amount of water used in almond production is among its worst features. Almonds require approximately 371 liters of fresh water per liter of milk, making them thirstier than other plants. That is still far less than dairy milk, but it is more than soy milk, oat milk, and even rice milk.

Unfortunately, California, which is particularly prone to drought, produces around 80% of the almonds planted worldwide. Although almond farming uses less water than dairy, it nevertheless contributes to the state’s droughts. Farmers in California are also switching to more water-efficient irrigation methods, which conserve water in comparison to methods from ten or twenty years ago.

2. Use of Pesticides

With more than 34 million pounds of active chemicals sprayed on almond trees in the United States in 2017—more than most other crops—almonds have a significant pesticide problem. An increase in pesticide use may be detrimental to local wildlife populations, particularly insects, as well as

 3. Effect on Honeybees

In particular, bees may be negatively impacted by all of these chemicals. Because of the potential harm that pesticides can cause to their bee colonies, some honeybee farmers think twice before planting almond trees.

Still, there’s space for development. In an effort to support nearby bees and pollinators, many almond tree groves are attempting to increase biodiversity by incorporating other types of plants.

Which Kind of Milk Is Worse for the Environment, Almond or Dairy?

Almond milk is less harmful to the environment than cow’s milk in practically every way. Actually, all plant-based milk varieties are more environmentally friendly than cow’s milk. 

How Come Almond Milk Is Superior to Dairy Milk?

Use of Land

Almond milk uses half a square meter of land per liter, compared to 8.95 square meters for dairy milk. Because animals require a lot of feed, animal agriculture is intrinsically inefficient in its use of land; just the cattle industry accounts for 41% of global deforestation. The dairy industry is not an exception to this pattern. 

Greenhouse Gases

Almond milk generates 0.7 kg of greenhouse emissions per liter, more than four times less than dairy milk’s 3.15 kg. As ruminant animals, cows release a significant amount of methane when housed in the large quantities needed for the dairy and beef sectors.

Use of Water

Dairy milk uses less water than almond milk, even though almond milk gets a lot of flak for it. Almond milk uses 371 liters of fresh water per liter, which is still high but not quite as much as 628 liters for dairy milk.

The largest water-guzzlers in the American West are feed crops, such as alfalfa and corn, which are fed to livestock like dairy cows. During a drought, the demands of animal husbandry on the water supply are enormous. Even if they exacerbate the issue, almonds still pose less of a threat than dairy, but more so than other plant-based milk alternatives.  

Other Issues

Additionally, the surplus nutrients that dairy milk washes into streams with the potential to harm aquatic life contributes to pollution. A large amount of pesticides are used in animal agriculture in order to develop feed crops.

What Are Some Almond Milk Substitutes?

Aisles full of milk options, ranging from different plant-based milks to cow’s milk, can be found in most supermarkets in the United States. Every one has a varied need for the use of water and land, and produces a different amount of emissions. 

Milk of Oats

• The manufacturing of oat milk uses, per liter

• 48.24 liters of water on 0.76 square meters of land
  
• 0.9 kg of emissions of greenhouse gases
  

The bottom line is that oat milk is far less bad for the environment than almond or dairy milk. 

Is the Environment Affected by Soy Milk?

The manufacturing of soy milk uses, per liter:

• 0.66 square meters of terrain
• 27.8 water liters
  
• 0.98 kg of emissions of greenhouse gases
  

Conclusion: Fortified soy milk provides the same nutrients as dairy milk, which is also fortified, and is among the best milks in terms of environmental effect. 

Is There Environmental Danger with Cashew Milk?

Because cashew milk is not as popular as other plant-based milks, experts have not yet thoroughly examined its life cycle assessments. Nonetheless, cashew production itself employs:

6,450 water gallons for every pound

7.6 grams per kilogram of greenhouse gas emissions

Assuming the amount of cashews used in many recipes found online, 130 grams per liter of milk comes to approximately:

131.9 water liters

A quantity of 0.988 kg of carbon dioxide

Sometimes, subpar labor techniques are used to make cashew milk. Furthermore, since cashews are a climate-specific crop, their overall carbon emissions are increased by transportation (though the production of food always contributes more to emissions than transportation). 

Is Environmental Damage Caused by Coconut Milk?

The manufacturing of coconut milk uses, per kilogram:

6.81 water liters

Emissions of greenhouse gases of 0.1 kg

There are occasions when the manufacturing of coconut milk is connected to deforestation in Southeast Asian nations. Additionally, because picking coconuts is a physically demanding task, workers’ rights are occasionally violated. It’s crucial to purchase fair trade or locally grown coconuts because of this.

Conclusion: Read origin labels carefully because coconut milk has been connected to deforestation.

Which Milk Is Best for the Environment?

It’s challenging to choose a single milk that is the greenest, but soy and oat milks are almost completely free of emissions, water pollution, and land use. It is also evident that dairy milk is the worst option; it is more harmful than plant-based milks in almost every manner.

Actions You Can Take

Fortunately, choosing a sustainable option can also mean choosing health, especially if you choose for something like soy that is fortified and unsweetened. If you decide to consume almond milk, be sure it was made with as little pesticide as possible by looking for the Bee Better seal. The main conclusion is that plant-based milks are obviously healthier for the environment and can also be a component of a balanced diet. 

 

 

 

Fifty years of vaccines that save lives: 154 million lives are saved by WHO's EPI

 Fifty years of vaccines that save lives: 154 million lives are saved by WHO’s EPI

MAY 7,2024

NR.BALOCH

Researchers have looked at the effects of the World Health Organization’s Expanded Program on Immunization (EPI) on public health, with findings published in The Lancet.

In 1974, the World Health Assembly committed itself to ensuring that everyone may benefit from vaccinations by establishing the Expanded Protection Index (EPI). By 1990, children were to be vaccinated against measles, poliomyelitis, smallpox, pertussis, tetanus, diphtheria, and tuberculosis, according to a WHO plan. As of right now, the EPI offers protection for all ages against other pathogens. The breadth of protection has significantly increased as a result of vaccination programs expanding to include more diseases.

Researchers modeled the effect of EPI on public health in the current study. They calculated the number of years of life gained, years of complete health acquired (i.e., disability-adjusted life-years averted), and years of life gained in WHO member states from June 1974 to May 2024 as a result of vaccination against 14 diseases.

The following diseases/pathogens were made vaccines against: rotavirus, poliomyelitis, rubella, invasive pneumococcal disease, tetanus, meningitis A, hepatitis B, yellow fever, diphtheria, Japanese encephalitis, pertussis, measles, poliomyelitis, and rubella. A uniform structure was created to evaluate the effect for each fully immunized person.

The group combined vaccination coverage estimates from the Vaccine Impact Modeling Consortium (VIMC), Immunization Dashboard, Supplementary Immunization Activities Database, and WHO’s Polio Information System. A total of 24 vaccination initiatives were assessed, divided into disease categories,

Firstly, impact estimates were obtained using the simulation of established measles and poliomyelitis transmission models for a 50-year timeframe. Second, from 2000 to 2024, VIMC transmission models for Japanese encephalitis, rotavirus, rubella, H. influenzae type B, and hepatitis B were expanded. Third, updated static disease burden models were created for diphtheria, tetanus, pertussis, and tuberculosis.

The three modeling approaches made it possible to capture vaccine effects at the individual and population levels. Estimating the effect of EPI on lives prevented, years of life gained, years of full health gained, and the percentage of infant mortality reduction related to vaccinations was the main goal of the study. These indicators were also assessed by the World Bank income stratum and region as secondary outcomes.

Results

According to the researchers, vaccination campaigns against the 14 infections prevented an estimated 154 million fatalities between June 1974 and May 2024, of which 146 million were prevented in children under the age of five. Nine billion life-years and 10.2 billion years of perfect health were also gained during this time. Gained were 58 years of life and 66 years of complete health on average.

Thanks to vaccinations, there have been fewer deaths, years of life preserved, and years of perfect health. The data spans the years 1974–2024. Measles: 93·7 million fatalities prevented, 5·7 billion years of life preserved, and 5·8 billion years of full health gained. Tetanus: 27·9 million fatalities prevented, 1·4 billion years of life preserved, and 1·4 billion years of good health gained. With pertussis, 1 billion years of complete health were acquired, 0.8 billion years of life were spared, and 13.2 million fatalities were prevented. 10·9 million deaths from tuberculosis are prevented; 0.6 billion years of life are preserved; and 0.9 billion years of good health are acquired. For Haemophilus influenzae type B, there were 2.78 million fewer fatalities, 0.2 billion more years of life saved, and 0.2 billion more years of good health gained. Poliomyelitis: 1·6 million fatalities prevented, 0·1 billion years of life saved, and years of

Notably, the prevention of poliomyelitis cases resulted in 0.8 billion years of increased health. The measles vaccination was the single most important factor in the 93.7 million lives that were saved over the course of 50 years in both World Bank income stratum and WHO areas. Additionally, since 1974, there has been a significant drop in infant mortality worldwide, with immunization directly contributing to 40% of this development.

If someone were to live to be 10, 25, or 50 years old in 2024, their chances of surviving the next year would be 44%, 35%, or 16% higher, respectively, than if they had not had any immunizations since 1974. The probability of surviving a life course increased most significantly in the African and Eastern Mediterranean regions, while it decreased most in the European zone. Upon

In conclusion

According to the research, vaccinations have prevented the deaths of an estimated 154 million people since 1974, the most of them (95%) were young children. This indicates that vaccinations have resulted in 10.2 billion extra years of healthy living and nine billion life-years saved. Interestingly, the measles vaccination was the single biggest factor.

Moreover, vaccinations accounted for about half of the decrease in infant mortality worldwide. As a result, the annual survival rate of a child born in 2024 will climb by 40%. Furthermore, the advantages of baby vaccination for survival last for more than 50 years. Areas with higher beginning mortality rates saw larger absolute advances at the expense of smaller relative gains. 

Journal citation: Sim SY, Johnson HC, Shattock AJ, et al. Improving health and survival via immunization: a 50-year retrospective of the Expanded Program on Immunization. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00850-X/fulltext The Lancet, 2024, DOI: 10.1016/S0140-6736(24)00850-X

In Patients With Chronic Liver Disease, Platelet Count to Prothrombin Time: A Noninvasive Predictor of Esophageal Varices

MAY 4,2024

NRBALOCH

Summary of Introduction

One potentially fatal side effect of portal hypertension in cirrhosis patients is esophageal variceal hemorrhage. The current study measured the platelet count to prothrombin time (PLT/PT) ratio for the assessment of portal hypertension and subsequent diagnosis of esophageal varices (EVs) in patients with chronic liver disease (CLD), even though upper gastrointestinal endoscopy is still the preferred method for EV identification.

Techniques

Using a non-probability consecutive sampling technique, this observational comparison study was carried out at the outpatient department of Patel Hospital in Karachi, Pakistan. The Patel Hospital Ethical Review Committee (PH/IRB/2022/028) granted ethical approval. For parametric data, an independent sample t-test was employed; for non-parametric data, the Mann-Whitney U test was utilized. The category data were compared using the chi-square test.

Outcomes

105 participants with and without EV participated in the trial. Thirty (66.7%) males and fifteen (33.3%) females did not have EV, while 38 (63.3%) males and 22 (36.7%) females did. Additionally, patients with EV had a substantially lower platelet (PLT) count (87.6 ± 59.8) than patients without EV (176.6 ± 87.7) (p < 0.001). those with EV had a PLT/PT ratio that was considerably lower (median: 5.04, IQR: 3.12-9.21) than those without EV (median: 14.57, IQR: 8.08-20.58) (p < 0.001). The PLT/PT ratio’s EV identification sensitivity and specificity were 97.80% and 83.30%, respectively.

In summary

In comparison to cases without EV, we observed a considerably decreased PLT/PT ratio in EV patients. PLT/PT demonstrated a good sensitivity in detecting cases with EVs in CLD after establishing an ideal threshold. Thus, we conclude that the PLT/PT ratio is a noninvasive predictor of the occurrence of EV in individuals with CLD.

Overview

Cirrhosis is the primary cause of morbidity and death worldwide. In 2016, it accounted for 2.2% of deaths and 1.5% of years of life with a disability adjusted for disability, making it the 11th most common cause of death and the 15th most prevalent cause of morbidity globally [1]. Chronic liver disease (CLD) claimed the lives of 1.32 million persons in 2017; nearly two-thirds of these deaths were in males and one-third in females [2]. Portal hypertension and related consequences, such as tissue scarring, mixed regenerating nodules, and liver cell degeneration, are caused by liver cirrhosis. Among Asian countries, Pakistan has the greatest incidence of CLD [3].

Clinically speaking, portal hypertension is defined as a pathological rise in portal vein pressure brought on by a number of factors, the most frequent of which being

Supplies & Techniques

Patient Choice
This non-probability consecutive sampling strategy was used in an observational comparison study conducted in the outpatient department of Patel Hospital in Karachi, Pakistan. The Patel Hospital Ethical Review Committee (PH/IRB/2022/028) granted ethical approval. Six months were dedicated to the study. Every patient has provided written consent. 105 male and female patients with liver cirrhosis between the ages of 30 and 55 were included in the study. The study excluded patients with hepatocellular carcinoma, gastrectomy, lower portal hypertension patients on medication, patients undergoing sclerotherapy, critically ill patients with liver cirrhosis, patients with past portosystemic anastomosis, and other variables associated with ascites.

Biochemical and clinical characteristics

Each patient received a comprehensive evaluation that included a clinical history, laboratory testing to assess liver and renal function, total blood count, PLT, PT, and the international normalized ratio (INR). Our completely automated chemical analyzer was utilized to quantify creatinine and urea. Every laboratory test was done at Patel Hospital’s clinical pathology department. After being calculated, the PLT/PT ratios were statistically examined. After being screened for EGD, the patients were divided into two groups according to whether or not they had EV.

Gastroscopy and abdominal ultrasonography

Every patient had upper gastroesophageal endoscopy for EVs screening in the endoscopy suite and abdominal ultrasonography in the radiology department. The treatments were carried out by skilled gastroenterologists and radiologists. The laboratory and clinical parameters were unknown to the sonologists or the endoscopists. The grading system used to categorize EV was based on size; varices in the mucosa were included in grade I; large varices that did not flatten with insufflation and occupied more than a third of the esophageal lumen were included in grade III; and varices covering more than two-thirds of the esophageal lumen were included in grade IV [16].

Data interpretation

IBM SPSS Statistics, version 26.0, was used to enter and analyze the data (IBM Corp., Armonk, NY). For quantitative variables, descriptive statistics are presented as means and standard deviations; for qualitative variables, the same is true for frequencies and percentages. The data’s normality was examined using the Shapiro-Wilk test. Patients with and without EV were compared for numerical variables; for parametric data, an independent sample t-test was employed, and for nonparametric data, a Mann-Whitney U test. To compare the categorical data of patients with and without EV, the chi-square test was employed. The PLT/PT ratio, sensitivity, specificity, and area under the curve (AUC) cutoff points were assessed using a receiver operating characteristic (ROC) analysis. An

Outcomes

Clinical, biochemical, and endoscopic characteristics of EV-positive and -negative individuals
105 participants with and without EV participated in the trial. There was no discernible variation in the gender distribution among them; 38 (63.3%) men and 22 (36.7%) females had EV, while 30 (66.7%) males and 15 (33.3%) females did not (p = 0.723). There was no significant difference (p = 0.899) in the mean age of patients with and without EV, which was 40.33 ± 15.98 years and 41.93 ± 12.72 years, respectively. Likewise, a negligible correlation was observed in the body mass index (BMI) between the two cohorts (p = 0.131). However, there was a notable difference in the etiology of cirrhosis across the groups (p = 0.029), with the hepatitis C virus being the predominant cause in 31 (51.7%) of the patients with EV. Individuals with EV show notably

ChangeablesEsophageal varices patients, n (%)/mean ± SDIndividuals free of gastric varices, n (%)/mean ± SDp-value
sex

38 males (63.3%)Thirty (66.7%)0.723

22 (36.7%) female; 15 (33.3%)

Years of age 40.33 ± 15.98(kg/m2) 41.93 ± 12.72~0.899 BMI22.26 ± 5.3422.01 ± 4.25<0.131

The cause of cirrhosis

HBV~5 (8.3%)Thirteen (28.1%)0.029* HCV~21 (46.7%)~31 (51.7%)

HBV+HDV~7 (11.7%)Six (13.3%)

Immune 5 (8.3%)2 (4.4%)

The remaining 5 (8.3%)Alcoholics: 3 (6.7%) 7 (11.7%) 0 (0.0%)

1.29 ± 0.20 < 1.13 ± 0.20 INR<0.001* Albumin 3.03 ± 0.687 mg/dL3.64 ± 0.640PLT/PT; median (IQR) 5.04 (3.12-9.21) 14.57 (8.08-20.58) <0.001* Portal vein diameter (cm) 1.12 ± 0.17 1.04 ± 0.18 0.038* Child-Pugh class A 24 (40.0%) 36 (80.0%)B~26 (43.3%) <0.001*Nine (20.0%)

0 (0.0%) C 10 (16.7%)

esophageal

Table 1 lists the etiology, grading, and demographic details of esophageal varices (n = 105).

*p-value at least 0.05 is significant. The information is shown as mean ± SD/median (IQR), n, and percentage.

Standard deviation (SD) and body mass index (BMI) Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are INR is the ratio that is internationalized. Interquartile range is known as IQR and platelet count to prothrombin time ratio as PLT/PT. 

Variations between individuals with and without EV in terms of hematological markers and renal and liver function tests

There was a significant correlation (p = 0.001) between the mean hemoglobin levels of patients with EV (10.28 ± 2.08 g/dL) and those without EV (11.66 ± 2.04 g/dL). Moreover, patients with EV had a significantly lower total leukocyte count (TLC) (4.47 ± 2.33) compared to those without (6.52 ± 2.16), with a highly significant difference (p < 0.001). Patients with EV had a substantially lower PLT (87.6 ± 59.8) than those without EV (176.6 ± 87.7) (p < 0.001). Furthermore, PT, urea, creatinine, and gamma-glutamyl transferase (GGT) levels between the two groups showed significant differences (p < 0.001). However, there were negligible variations in sodium levels, aspartate aminotransferase, alkaline phosphatase (ALP), and mean corpuscular volume (MCV).

ChangeablesEsophageal varices patients, n (%)/mean ± SDIndividuals without gastroesophageal reflux disease, n (%)/mean ± SDHb (g/dL) 10.28 ± 2.08 11.66 ± 2.04 0.001* Complete blood count

(×103/m3) total leukocyte count 4.47 ± 2.33 6.52 ± 2.16<<0.00187.6 ± 59.8~176.6 ± 87.7~<0.001 Platelet count (×103/mm3)* The mean corpuscular volume was 81.2 ± 7.95 against 81.6 ± 7.53 0.789.

Prothrombin time (sec) <0.001; 14.31 ± 2.62 <12.64 ± 2.97*

Test of renal function

(mg/dL) Urea<25.5 ± 18.16~51.22 ± 53.19~<0.001* Creatinine (milligrams/deciliter)~0.80 ± 0.64~2.26 ± 3.56~0.003* Sodium 133.6 ± 20.6 137.5 ± 4.91 0.738 (mEq/L)

Test of liver function

IU/L of alkaline phosphatase: 213.5 ± 180.7 ± 201.8 ± 193.7 0.534

(IU/L) aspartate aminotransferase 86.03 ± 65.7 59.6 ± 41.1 0.134

Alanine transaminase (IU/L) 48.9 ± 43.4~0.271 54.5 ± 33.7

(IU/L) Gamma-glutamyl transferase 72.5 ± 70.9~120.0 ± 155.7~<0.001*

Table 1: *P-value significant at <0.05, the etiology, grading, and demographics of esophageal varices (n = 105). The information is shown as mean ± SD/median (IQR), n, and percentage.

INR is for international normalized ratio; SD stands for standard deviation; BMI for body mass index; HBV for hepatitis B virus; HCV for hepatitis C virus; and HDV for hepatitis D virus. Platelet count to PLT/PT:Table 1: *P-value significant at <0.05, the etiology, grading, and demographics of esophageal varices (n = 105). The information is shown as mean ± SD/median (IQR), n, and percentage.

Standard deviation (SD) and body mass index (BMI) Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are INR is the ratio that is internationalized. Platelet count to prothrombin time ratio (PLT/PT); prothrombin time ratio (IQR): interquartile range; interquartile range

Variations between individuals with and without EV in terms of hematological markers and renal and liver function tests

There was a significant correlation (p = 0.001) between the mean hemoglobin levels of patients with EV (10.28 ± 2.08 g/dL) and those without EV (11.66 ± 2.04 g/dL). Moreover, patients with EV had a significantly lower total leukocyte count (TLC) (4.47 ± 2.33) compared to those without (6.52 ± 2.16), with a highly significant difference (p < 0.001). Patients with EV had a substantially lower PLT (87.6 ± 59.8) than those without EV (176.6 ± 87.7) (p < 0.001). Furthermore, PT, urea, creatinine, and gamma-glutamyl transferase (GGT) levels between the two groups showed significant differences (p < 0.001). However, there were negligible variations in sodium levels, aspartate aminotransferase, alkaline phosphatase (ALP), and mean corpuscular volume (MCV).

ChangeablesEsophageal varices patients, n (%)/mean ± SDIndividuals without gastroesophageal reflux disease, n (%)/mean ± SDHb (g/dL) 10.28 ± 2.08 11.66 ± 2.04 0.001* Complete blood count

(×103/m3) total leukocyte count 4.47 ± 2.33 6.52 ± 2.16<<0.00187.6 ± 59.8~176.6 ± 87.7~<0.001 Platelet count (×103/mm3)* The mean corpuscular volume was 81.2 ± 7.95 against 81.6 ± 7.53 0.789.

Prothrombin time (sec) <0.001; 14.31 ± 2.62 <12.64 ± 2.97* Test of renal function

(mg/dL) Urea<25.5 ± 18.16~51.22 ± 53.19~<0.001* Creatinine (milligrams/deciliter)~0.80 ± 0.64~2.26 ± 3.56~0.003* Sodium 133.6 ± 20.6 137.5 ± 4.91 0.738 (mEq/L)

Test of liver function

IU/L of alkaline phosphatase: 213.5 ± 180.7 ± 201.8 ± 193.7 0.534

(IU/L) aspartate aminotransferase 86.03 ± 65.7 59.6 ± 41.1 0.134

Alanine transaminase (IU/L) 48.9 ± 43.4~0.271 54.5 ± 33.7

(IU/L) Gamma-glutamyl transferase 72.5 ± 70.9~120.0 ± 155.7~<0.001

Table 2 shows the differences in complete blood counts, liver and renal function tests, and esophageal varices comparing patients with and without the condition. *p-value significant at <0.05. The information is displayed as n, %/mean ± SD.

The hepatic and renal function tests as well as the total blood count were compared between individuals with and without esophageal varices in SDTable 2. *p-value significant at <0.05. The information is displayed as n, %/mean ± SD.


Standard deviation (SD) and hemoglobin (Hb) are two different concepts.

PLT/PT ratio’s sensitivity and specificity in detecting EV

According to the receiver operator characteristic curve, the PLT/PT ratio is a significant predictor of EV, with an AUC of 0.823 indicating good discriminative ability and an extremely substantial correlation (p < 0.001). 2.5487 was the ideal cutoff value for the PLT/PT ratio. Table 3 and Figure 1 demonstrate the sensitivity and specificity of the PLT/PT ratio for EV identification, which were 97.80% and 83.30%, respectively.

Talk

To diagnose portal hypertension, a number of diagnostic procedures are available. Directly measuring portal pressure is an intrusive procedure. Therefore, a minimally invasive approach like an upper gastrointestinal tract endoscopy is preferred [17]. The gold standard for diagnosing gastroesophageal varices is still upper gastrointestinal endoscopy (UGIE), but in patients with CLD, the ratio of PLT/PT may be important for evaluating portal hypertension and EV.

A prospective study evaluating the impact of PT on EV initiation was carried out in Bangladesh. A total of sixty liver cirrhosis patients were split into two groups at random: group I consisted of thirty patients with EV, and group II consisted of thirty patients without EV. The mean age of the 60 patients was 37.11 ± 14.81 years, with 11 females and 49 men. The hepatitis B virus was primarily detected in cirrhosis in 43 (71.7%) instances. One patient (1.6%) was afflicted by Wilson’s sickness; twelve patients (20%) were neither B or C; and four instances (6.6%) had the hepatitis C virus (HCV). It was discovered that there was a positive correlation between EV and the longer plasma PT (four seconds) with a sensitivity of 56.67% and a specificity of 73.33% [17]. This research

The frequency and features of EV in patients with liver cirrhosis who received UGIE were further examined in a different retrospective analysis carried out in Pakistan. 92.6% of the 2089 patients had EV, whereas 7.45% did not. 766 (39.5%) instances had grade I EV, 465 (24%) had grade II EV, and 703 (36.4%) had grade III EV. UGIE was performed on a total of 1331 (63.7%) male and 758 (36.3%) female liver cirrhosis patients. 89.1% of the patients who were female had EV overall, compared to 94.6% of the patients who were male. The likelihood of experiencing EV was significantly higher in males (p < 0.01). The mean age of patients diagnosed with EV (51.25 ± 10.03 years) was found to be significantly different from that of patients diagnosed with no EV (49.26 ± 11.11 years).

In a similar vein, 110 patients participated in this cross-sectional descriptive study that was carried out in Pakistan; 49 (44.5%) of the patients were female, and 61 (55.5%) were male. The average age of the patients was 59.89 +/- 9.01 years. The PLT was less than 50,000/uL in 39 (35.5%) of the patients, with the range being between 50,000-99,000/uL in 29 (26.4%), 100,000-150000/uL in 14 (12.7%), and >150,000/uL in 28 (25.5%) patients. Overall, grade I EV was present in 26 (23.6%) of the patients, whereas grades II–IV EV were seen in 27 (24.5%), 37 (33.6%), and 20 (18.2%) of the patients [21]. These results aligned with those of a Taiwanese study that demonstrated male dominance in cirrhotic patients, with 71% of patients being male [22]. The current investigation supported these conclusions and showed that the majority of

Several prior studies used PLT in combination with other noninvasive indicators such as the AST to platelet ratio index (APRI) and the platelet count/spleen diameter ratio (PC/SD ratio) to predict the grading of EV and the necessity for endoscopy in patients with cirrhosis [23]. The PLT/PT ratio was utilized in this investigation because it is easily accessible, noninvasive, reasonably priced, and resource-efficient. Furthermore, no specific knowledge is needed.

It’s interesting to note that a different study evaluated the noninvasive EV markers’ diagnosis accuracy in cirrhosis patients. That investigation found that the PC/SD ratio’s optimal cutoff value was ≤818 and that its sensitivity and specificity were, respectively, 92.05% and 60% (AUC: 0.835) [24]. A different Chinese study with a 73% positive response rate likewise used PSDR <909 as a cutoff number.

In a similar vein, one study evaluated the PLT/PT ratio’s and the PC/SD ratio’s capacity to assess the incidence of EV in Egyptian patients with cirrhosis associated with ≤HCV. 99 patients had liver cirrhosis associated with HCV, of which 41 did not have EV and 58 did not have bleeding EV. The PLT/PT ratio at cutoff ≤9419.3 (AUC: 0.936) was shown to be a more effective test for EV detection than the PLT/SD ratio at cutoff ≤993.75 (AUC: 0.888), according to analyses of receiver operator characteristics. Comparing the PLT/PT ratio to the PLT/SD ratio, the PLT/PT ratio showed superior sensitivity, specificity, PPV, and NPV (95.31, 88.57, 93.8, and 91.2% vs. 89.06, 85.71, 91.9, and 81.1%, respectively) [27]. The current investigation revealed a highly significant p-value and an AUC of 0.823.

Restrictions

This research has certain restrictions. Only cirrhotic patients were included in this short, single-centered investigation. Despite the fact that numerous studies have shown that the PC/SD ratio is a more accurate way to estimate the size and grading of varices, we only employed PLT to evaluate the grading of varices. Cherry red patches, or other indicators of recent or impending bleeding, were not seen in this investigation. It is advised that future multicenter research employ the spleen size ratio, early bleeding symptoms, and a particular cirrhosis cause. To validate the findings, more prospective studies with a larger sample size are required.

In conclusion

PLT/PT was observed to be considerably lower in patients with EVs who had underlying CLD in this study. We discovered that the PLT/PT value had a high sensitivity and specificity in recognizing EVs after establishing an ideal cutoff. Therefore, the results suggest that the PLT/PT ratio is a noninvasive marker of EV occurrence in CLD patients. To create a prediction score and look at other markers and predictors of esophagogastric variceal bleeding, more research is required.

Citations

Cheemerla S, Balakrishnan M: Chronic liver disease: worldwide epidemiology. 10.1002/cld.1061 in Clin Liver Dis (Hoboken), 2021, 17:365–70.

Sepanlou SG, Safiri S, Bisignano C, et al.: A comprehensive analysis for the Global Burden of Disease Study 2017 of the national, regional, and worldwide burden of cirrhosis by cause in 195 countries and territories, 1990-2017. 2020; 5:245–26; 10.1016/S2468-1253(19)30349-8; Lancet Gastroenterol Hepatol.

Genetic predisposition to chronic liver disease in Pakistani individuals Raja AM, Ciociola E, Ahmad IN, et al. 2020, 21:3558 in Int J Mol Sci. 10.3390/ijms21103558

Yoshida H, Mamada Y, Taniai N, et al.: Esophagogastric varices bleeding risk factors. Journal of Japan Medical School, 2013; 80:252–259. 10.1272/jnms.80.252

Kibrit J, Khan R, Jung BH, Koppe S: Portal hypertension: Clinical assessment and therapy. (2018) Semin Intervent Radiol. 35:153–159.