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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 1  |  Page : 105-108

Antioxidant-rich peridialytic granola bar for hemodialytic subjects


Department of Clinical Nutrition, Sri Ramachandra Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to be university), Chennai, India

Date of Submission17-Sep-2021
Date of Acceptance16-Oct-2021
Date of Web Publication11-Mar-2022

Correspondence Address:
Supriya Velraja
Assistant Professor, Department of Clinical Nutrition, Sri Ramachandra Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamilnadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_235_21

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  Abstract 


Background: Chronic kidney disease is an emerging major noncommunicable health problem globally. The hemodialysis procedure results with increase in lipid peroxidation and decrease in antioxidant enzymes such as superoxide dismutase with change in serum antioxidant activity. The aim of the study is to formulate an antioxidant-rich peridialytic granola bar to supplement hemodialysis patients. Methods: The recipe was formulated using oats, ground nuts, dehydrated papaya, flax seeds, almonds, honey, and vegetable oil. To make the supplement antioxidant-rich, dehydrated papaya, honey, and vegetable oil have been selected. Results: The amount of antioxidant in the analyzed peridialytic granola bar has been compared with the recommended dietary allowance (RDA) for the hemodialysis patients and the quantity for supplementation has been finalized. The 80 g of peridialytic granola bar provides around 3369.6 μg of antioxidant, 15 g of protein, and 346.4 kcal of energy to meet the two-third of the recommended antioxidants and one-fourth of the protein and energy. Conclusion: The composition of the developed bar was standardized through organoleptic evaluation. The antioxidant content of the developed product was analyzed and compared with RDA. Eighty grams, i.e., 2 numbers of peridialytic granola bar, will provide roughly around 3369.6 μg of antioxidant, 15 g of protein, and 346.4 kcal of energy. This nutritional value is equivalent to approximately 1 serving of standard commercial formulas of 50 g. The formulated antioxidant-rich peridialytic granola bar can be considered for supplementation for 4 weeks to the subjects undergoing hemodialysis to reduce their oxidative stress.

Keywords: Antioxidant, oxidative stress, peridialytic, peridialytic granola bar


How to cite this article:
Kumar S, Velraja S, Arambakkam HJ. Antioxidant-rich peridialytic granola bar for hemodialytic subjects. Biomed Biotechnol Res J 2022;6:105-8

How to cite this URL:
Kumar S, Velraja S, Arambakkam HJ. Antioxidant-rich peridialytic granola bar for hemodialytic subjects. Biomed Biotechnol Res J [serial online] 2022 [cited 2022 May 20];6:105-8. Available from: https://www.bmbtrj.org/text.asp?2022/6/1/105/339372




  Introduction Top


Chronic kidney disease is an emerging major noncommunicable health problem globally. Oxidative stress and protein–calorie malnutrition are highly prevalent in maintenance hemodialysis (MHD) patients. The antioxidant systems of chronic renal failure patients were significantly lower than a normal person. The effect is noticeable with antioxidant enzyme activities and concentrations of nonenzymatic components of the system.

The prevalence of increased lipid peroxidation has been widely reported among hemodialysis patients. It leads to certain changes in antioxidant levels by decreasing the serum superoxide dismutase activity and change in serum antioxidants. This increase in lipid peroxidation and decrease in antioxidant activity will lead to development and progression of atherosclerosis in hemodialysis patients.[1]

Hemodialysis results in the production of reactive oxygen species such as peroxides which are harmful by increasing the free radicals. The main cause is due to the increase in exchange of microbial products during the interaction between the dialysate membrane and blood. The intake of dietary antioxidants will be lower in malnourished hemodialysis patients with increase in antioxidants loss.[2]

Certain diet therapies such as antioxidant-rich diet can be used to decreasing the oxidative stress by preventing the free radicals production in hemodialysis patients. Antioxidant diet therapy is essential to improve heart health by minimizing the risk for cardiovascular disease (CVD) development. Since hemodialysis patients are highly prone to CVD due to the higher rate of cholesterol level.[2] Dietary management strategies will help decrease oxidative stress; these can be attained by encouraging hemodialysis patients to take antioxidant-rich foods. The antioxidant-rich foods will reduce lipid peroxidation and prevents the activity of free radicals. High protein intake is essential to prevent or to overcome malnutrition in the patients undergoing hemodialysis.

In MHD patients, the most commonly recognized nutritional problem was protein–calorie malnutrition which increases the mortality rate. The three main causes for this malnutrition are due to more loss of nutrients especially protein, during dialysis procedure, loss of appetite with more dietary restrictions, and recurrent health problems. The rate of malnutrition reported to be of 33% in mild–moderate category and 6%–8% in severe category.[3] Further, the higher mortality rate was due to low intake of anabolic nutrients such as proteins and others. The antioxidant intake has been proven to reduce lipid peroxidation, thereby reducing the production of free radicals and oxidative stress; this study aimed at formulating an antioxidant-rich peridialytic granola bar for supplementation to the subjects undergoing hemodialysis.


  Methods Top


Recipe formulation

The recipe was formulated using oats, ground nuts, dehydrated papaya, flax seeds, almonds, honey, and vegetable oil. To make the supplement calorie, protein and antioxidant dense oats, dehydrated papaya, groundnuts, vegetable oil, and honey have been selected. Oats have been selected for its soluble fiber content and for its antioxidant property – avenanthramides. Antioxidant content was enhanced using dehydrated papaya, honey, and vegetable oil. Groundnuts and almonds have high-quality protein and are low in sodium and potassium which are essential for a renal patient and thus were selected. Since it is given during dialysis, a dry snack would be preferred; therefore, the bar has been formulated and named as “peridialytic granola bar.”

To remove the moisture content of the selected ingredients, especially oats, flax seeds, almonds, and groundnuts, were roasted separately. After roasting, cool it and coarsely grind the ingredients separately for making bar-like texture. Heat honey in a pan on medium flame until texture is runny. Mix honey and vegetable oil with coarsely grinded ingredients. Stir until all ingredients are well coated. Grease a pan and press in ingredients evenly [Plate No. 1]. Cool in fridge for at least 30 min. Slice and wrap individual bars in foil or plastic wrap.



Due to fluids restrictions and minerals such as sodium, potassium, and phosphorus, finding the right quality of protein-rich supplements was found to be difficult in dialysis patient. The tailor-made protein supplements such as protein bars that contain a low amount of sodium, potassium, and phosphorus can be given to dialysis patients; further, it does not require any fluids. Hence, in the present study also, peridialytic granola bar has been formulated with the nutrient recommendations for hemodialysis patients.


  Results Top


Standardization of the ingredients

[Table 1] presents the composition of selected ingredients for the development of peridialytic granola bar, with respect to its antioxidant, sodium, potassium, phosphorus, and protein content: These ingredients in the peridialytic granola bar have been selected based on its sodium, potassium, and phosphorus content. Supplementation of this antioxidant-enriched peridialytic granola bar may help in reducing oxidative stress in the patients undergoing hemodialysis. Since antioxidant intake has been proven through the reduction in lipid peroxidation, thereby reducing the production of free radicals and oxidative stress [Table 1].
Table 1: Composition of selected ingredients for the formulation of peridialytic granola bar

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The oxidative stress was seen to be higher in patients undergoing maintenance dialysis due to the lower essential trace minerals such as selenium and higher nonessential metals.[3] The antioxidant-rich minerals – zinc – have been supplemented, which showed decrease in oxidative stress and improved antioxidants level.[4] In the present study, antioxidant-rich vitamins such as Vitamin C and E, β-carotene, and minerals such as zinc, selenium, and manganese has been selected for preparing the peridialytic granola bar from the natural food sources [Table 2].[5]
Table 2: Antioxidant composition of the selected ingredient for formulated peridialytic bar[5]

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There is evidence that shows the antioxidant supplements will alter the serum antioxidants to decrease the oxidative stress in hemodialysis patients, thereby minimizing the occurrence of atherogenetic events.

Organoleptic evaluation

[Table 3] depicts that the organoleptic evaluation of the two variations in the peridialytic granola bar, i.e., A and B (A – incorporated with pumpkin seeds and B – incorporated with dehydrated papaya). The results of the organoleptic evaluation revealed that sample B scored high with a total of 25.8/30 [Figure 1]. Thus, dehydrated papaya-incorporated peridialytic granola bar has been finalized for supplementation.
Figure 1: Comparison of organoleptic evaluation score card of two variation samples (A and B)

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Table 3: Scorecard of 5-point Hedonic scale for organoleptic evaluation of the formulated granola bar

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Nutrient analysis

The finalized product has been sent for analysis for its energy, protein, carbohydrates, fat, and antioxidant content. [Table 4] reveals the nutrient analysis.
Table 4: Results of nutrient analysis for the formulated peridialytic granola bar

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The effects of antioxidants (Vitamin C) on patients undergoing long-term hemodialysis were investigated. After the oral supplementation of Vitamin C 200 mg/day, there was improvement in inflammatory markers.[6] Hence, the formulated peridialytic granola bar contains Vitamin C for decreasing inflammatory markers such as C-reactive protein.

According to Kidney Disease Outcomes Quality Initiative 2014, the recommended sodium intake should be <1500 mg, potassium <2500 mg, and phosphorus should be 800–1200 mg/day. The developed peridialytic granola bar contains low sodium, potassium, and phosphorus within the normal range.

Standardization of peridialytic granola bar with the analysis

The standardization of the peridialytic granola bar was done based on correlating the recommended dietary allowance of the antioxidant for hemodialysis with the antioxidant in the peridialytic granola bar [Table 5].
Table 5: Comparison of antioxidant in peridialytic granola bar with the recommended dietary allowance for hemodialysis patients

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From [Table 5] and [Figure 2], standardization of the peridialytic granola bar has been finalized. Peridialytic nutritional supplement has been finalized with standardization of two numbers of nutria bar which weighs around 80 g (1 bar = 40 g); this will provide around 3369.6 μg of antioxidant, 15 g of protein, and 346.4 kcal of energy.
Figure 2: Graphical representation for comparison of antioxidant in peridialytic granola bar with the recommended dietary allowance for hemodialysis patients

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  Discussion Top


In many studies, the preferred supplementary form for hemodialysis patients has been in the form of bars. Protein bars have more advantages in dialysis patients, especially during fluid restrictions. Sports protein bars are always recommended for dialysis patients without any denture problems.[7] Thus, in this study, the bar form has been chosen to supplement the antioxidants to hemodialysis subjects to reduce oxidative stress and increase protein intake. Some of the antioxidant compounds present in the selected ingredients are phenolic compounds such as avenanthramides (26 mg/100 g) and ferulic acid (36 mg/100 g) is present in oats which have powerful antioxidant capacity. Flax seeds contain phenolic compound lutein-zeaxanthin (651 μg/100 g). These phenolic compounds have anti-inflammatory, antioxidant, anticancerous, and antiallergic properties.[8],[9] As it was planned for supplementation for hemodialysis patients, the ingredients were chosen according to their nutrient's requirements. The quantities of the ingredients were standardized according to the binding nature and its palatability. Vitamin C and E can be useful in minimizing the kidney injury following lithotripsy for renal stone disease.[10],[11]


  Conclusion Top


Peridialytic nutritional supplement has been finalized with standardization of two numbers of peridialytic granola bar which weighs around 80 g (1 bar = 40 g); this will provide around 3369.6 μg of antioxidant, 15 g of protein, and 346.4 kcal of energy. This formulated peridialytic granola bar has been planned for supplementation for 4 weeks to patients undergoing hemodialysis to reduce their oxidative stress through antioxidant enriched bar. To prevent oxidative stress and malnutrition, peridialytic antioxidant-rich peridialytic granola bars are well preferred than liquid supplements because of the fluid restriction suggested for renal patients. Diet of a hemodialysis patient should be tailor-made to decrease the oxidative stress induced during hemodialysis and to improve the nutritional intake.

Limitation of study

Sample size need to be increased in future studies.

Ethical clearance

The present study has been approved by the Institutional Ethical Committee(IEC) and the reference number is CSP/14/AUG/36/172.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Toborek M, Wasik T, Drózdz M, Klin M, Magner-Wróbel K, Kopieczna-Grzebieniak E. Effect of hemodialysis on lipid peroxidation and antioxidant system in patients with chronic renal failure. Metabolism 1992;41:1229-32.  Back to cited text no. 1
    
2.
Coombes JS, Fassett RG. Antioxidant therapy in hemodialysis patients: A systematic review. Kidney Int 2012;81:233-46.  Back to cited text no. 2
    
3.
Kopple JD. Effect of nutrition on morbidity and mortality in maintenance dialysis patients. Am J Kidney Dis 1994;24:1002-9.  Back to cited text no. 3
    
4.
Guo CH, Wang CL. Effects of zinc supplementation on plasma copper/zinc ratios, oxidative stress, and immunological status in hemodialysis patients. Int J Med Sci 2013;10:79-89.  Back to cited text no. 4
    
5.
Gopalan C. Nutritive Value of Indian Foods and USDA – National Nutrient Database. Hyderabad: National Institute of Nutrition, Indian Council of Medical Research; 2011.  Back to cited text no. 5
    
6.
Zhang K, Li Y, Cheng X, Liu L, Bai W, Guo W, et al. Cross-over study of influence of oral Vitamin C supplementation on inflammatory status in maintenance hemodialysis patients. BMC Nephrol 2013;14:252.  Back to cited text no. 6
    
7.
Meade A. Protein supplementation with sports protein bars in renal patients. J Ren Nutr 2007;17:214-7.  Back to cited text no. 7
    
8.
Al-Taie A, Victoria AO. Supplementary medicines and antioxidants in viral infections: A review of proposed effects for COVID-19. Biomed Biotechnol Res 2020;4:19.  Back to cited text no. 8
    
9.
Mollaei S, Ghanavi J, Farnia P, Abedi-Ghobadloo P, Velayati AA. Antioxidant, antibacterial, and cytotoxic activities of different parts of Salsola vermiculata. Biomed Biotechnol Res 2021;5:307.  Back to cited text no. 9
    
10.
Biwas C, Bala J, Kharb S. Vitamin E supplementation and renal functions in acute celphos poisoning. Biomed Biotechnol Res 2018;2:142.  Back to cited text no. 10
    
11.
Adikwu E, Ebinyo NC, Benalayefa O. Protective effect of lycopene against tamoxifen-induced hepatotoxicity in albino rats. Biomed Biotechnol Res 2020;4:69.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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