The Effect of Herbal Extracts Containing Punica granatum, Mentha spicata, and Honey on Weight and Cachexia Indices in Peritoneal Dialysis Patients

Document Type : Original Article (s)

Authors

1 Pharmacy Students, Pharmacy Students’, Research Committee, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Department of Internal Medicine, School of Medicine, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

4 Associate Professor, Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

5 Medicinal Plant Research Center of Barij, Kashan, Iran

Abstract

Background: Chronic kidney disease (CKD) is defined as a gradual decline in kidney function. CKD could be manifested by nausea, vomiting, and loss of appetite. Cachexia results from systemic inflammation and oxidative stress in CKD patients. Some drugs used for cachexia have adverse effects like increased risk of death due to edema, thromboembolism, and sarcopenia with long-term uses. Nowadays, Appetizer Barij Essence Syrup®, which contains the extract of Punica granatum, Mentha spicata, and honey, has been used to enhance appetite. In this paper, we studied the effect of this syrup on weight, anthropometric markers, and cachexia in peritoneal dialysis patients.
Methods: Fifty-four patients were enrolled in this randomized clinical trial. The 5ml syrup was administered
3 times a day before meals to the patients in the intervention group for two months. Biomarkers like serum triglycerides and albumin levels, as well as muscle mass, appetite score, and actual weight were recorded at the beginning and the end of the intervention.
Findings: The appetite score, serum albumin, and average muscle mass increased significantly in the intervention group after two months. Also, serum triglyceride levels decreased significantly in this group.
Conclusion: Using Appetizer Barij Essence Syrup® in peritoneal dialysis patients with cachexia improved the appetite, as well as cachexia indices, like serum albumin and muscle mass. However, the impact of these interventions on these indices must be evaluated over a longer period so, long-term studies may yield more reliable results.

Keywords


  1. Senanayake S, Gunawardena N, Palihawadana P, Bandara P, Haniffa R, Karunarathna R, et al. Symptom burden in chronic kidney disease; a population based cross sectional study. BMC Nephrol 2017; 18(1): 228.
  2. Koppe L, Fouque D, Kalantar‐Zadeh K. Kidney cachexia or protein‐energy wasting in chronic kidney disease: facts and numbers. J Cachexia Sarcopenia Muscle 2019; 10(3):479-84.
  3. Ruiz-García V, López-Briz E, Carbonell-Sanchis R, Bort-Martí S, Gonzálvez-Perales JL. Megestrol acetate for cachexia-anorexia syndrome. A systematic review. J Cachexia Sarcopenia Muscle 2018; 9(3): 444-52.
  4. Devipriya N, Srinivasan M, Sudheer AR, Menon VP. Effect of ellagic acid, a natural polyphenol, on alcohol-induced prooxidant and antioxidant imbalance: a drug dose dependent study. Singapore Med J 2007; 48(4): 311-8.
  5. Bardaweel SK, Bakchiche B, ALSalamat HA, Rezzoug M, Gherib A, Flamini G. Chemical composition, antioxidant, antimicrobial and Antiproliferative activities of essential oil of Mentha spicata L. (Lamiaceae) from Algerian Saharan atlas. BMC Complement Altern Med 2018; 18(1): 201.
  6. Ajibola A, Chamunorwa JP, Erlwanger KH. Nutraceutical values of natural honey and its contribution to human health and wealth. Nutr Metab (Lond). 2012; 9: 61.
  7. Argilés JM, López-Soriano FJ, Toledo M, Betancourt A, Serpe R, Busquets S. The cachexia score (CASCO): a new tool for staging cachectic cancer patients. J Cachexia Sarcopenia Muscle 2011; 2(2): 87-93.
  8. Preston CL. Stockley’s Drug Interactions: A source book of interactions, their mechanisms, clinical importance and management. 12th London, UK: Pharmaceutical Press; 2019.
  9. Wilson MMG, Thomas DR, Rubenstein LZ, Chibnall JT, Anderson S, Baxi A, et al. Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr 2005; 82(5): 1074-81.
  10. Rahmani Ghobadi M, Rahmaninia F, Mirzaie B, Hedayati M, Agha Alinejad H. Effect of 8 weeks aerobic training on appetite, calories intake and nutrition behavior in overweight sedentary women [In Persian]. Sport Physiol 2017; 9(33): 201-14.
  11. Lustgarten MS, Fielding RA. Assessment of analytical methods used to measure changes in body composition in the elderly and recommendations for their use in phase II clinical trials. J Nutr Health Aging 2011; 15(5): 368-75.
  12. Mahon AK, Flynn MG, Iglay HB, Stewart LK, Johnson CA, McFarlin BK, et al. Measurement of body composition changes with weight loss in
    postmenopausal women: comparison of methods.
    J Nutr Health Aging 2007; 11(3): 203-13.
  13. Verdich C, Barbe P, Petersen M, Grau K, Ward L, Macdonald I, et al. Changes in body composition during weight loss in obese subjects in the NUGENOB study: comparison of bioelectrical impedance vs. dual-energy X-ray absorptiometry. Diabetes Metab 2011; 37(3): 222-9.
  14. Hanna RM, Ghobry L, Wassef O, Rhee CM, Kalantar-Zadeh K. A Practical Approach to Nutrition, Protein-Energy Wasting, Sarcopenia, and Cachexia in Patients with Chronic Kidney Disease. Blood Purif 2020; 49(1-2): 202-11.
  15. Lu JL, Kalantar-Zadeh K, Ma JZ, Quarles LD, Kovesdy CP. Association of body mass index with outcomes in patients with CKD. J Am Soc Nephrol 2014; 25(9): 2088-96.
  16. Windahl K, Faxén Irving G, Almquist T, Korkeila Lidén M, van de Luijtgaarden M, Chesnaye NC, et al. Prevalence and risk of protein-energy wasting assessed by subjective global assessment in older adults with advanced chronic kidney disease: results from the EQUAL study. J Ren Nutr 2018; 28(3): 165-74.
  17. Wilkinson TJ, Miksza J, Yates T, Lightfoot CJ, Baker LA, Watson EL, et al. Association of sarcopenia with mortality and end‐stage renal disease in those with chronic kidney disease: a UK Biobank study.
    J Cachexia Sarcopenia Muscle 2021; 12(3): 586-98.
  18. Honda H, Qureshi AR, Axelsson J, Heimburger O, Suliman ME, Barany P, et al. Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality. Am J Clin Nutr 2007; 86(3): 633-8.