Effect of supplementation of Purslane (Portulacaoleracea) in hypertriglyceridemic subjects

INTRODUCTION

In recent years, there has been an adverse dietary changes seen in the consumption structure of the diet towards a high energy density diet with a greater saturated fat intake (mostly from animal sources) reduced intakes of complex carbohydrates and dietary fibre, and a reduced fruit and vegetable intake. Diets in developing countries like India has been changed with rise in family income. The share of staples, such as cereals, roots and tubers, is found to be reduced, while that of meat, dairy products and oil crops has increased. With an increase in economic prosperity, there has been an increase in the consumption of animal products, hence the associated excess dietary fats has led to the increase of the non-communicable diseases like wise hyperlipidemia, atherosclerosis, hypertension and Diabetes.¹ In fact, these diseases rank at the second position among the major factors causing death.² The link between intake of animal products and risk of developing CVD has largely been attributed to the intake of saturated fatty acids (SFA). The saturated fat intake increases heart disease risk factors, including LDL (bad) cholesterol and apolipoprotein B (apoB).¹ Purslane (Portulacaoleracea) is a kind of annual plant which belongs to Portulacaceae and is commonly called “pigweed” or “little hogweed’ in English, “Khursa/Naunia/Chotalunia” in Hindi, “Gangapaayala/Peddapaayala/Peddapaavilaaakukoora” in telugu, “Parippukeerai” in Tamil and “Bruhalloani” in Sanskrit. It can be frequently seen in such places as vegetable gardens and empty spaces as well as any roadside. In the Western style, it can be mainly used with lettuce for salads.³ Also, it can be dried and used as a material for various dishes as well as tea or soup.^4,5 In Korea, people used to blanch a tender shoot of the plant in summer to preserve them for eating throughout the winter.⁶

Purslane shows higher amounts than many other plants of certain biological components, including oleic acid, linoleic acid and γ-linolenic acid, and has been reported to suppress cancer or be effective in decreasing the occurrence rate of heart diseases.^7,8 Also, Purslane contains great amounts of nutrients such as tocopherol and ascorbic acid. ⁹ Moreover, purslane extract shows an antioxidant activity based on phenolic compounds, including flavonoids, which are known to lower cholesterol or triglyceride levels in hyperlipidemic rats.^5,10-13 However, there are few studies related to the prevention of hyperlipidemia by purslane.^14-16 To verify the biological effect of purslane on hyperlipidemia, this study focuses on the effect of supplementation of dehydrated Purslane spice powder on the change of the lipid components and diabetics in human subjects.

METHODS

An experimental study was conducted among 60 subjects aged between 40 and 60 years. They were selected from Hyderabad after obtaining a written consent of willingness to participate in the study. The study was conducted for a period of 3 months the subjects were identified from the population who underwent a recent triglyceride, cholesterol screening at, family practice clinics for diabetic screenings at biochemical labs in the BHEL general hospital, Ramachandrapuram, Hyderabad. Subjects were further evaluated using two additional complete fasting lipid profiles that included total cholesterol, LDL, HDL, and triglycerides (TGs). Those whose LDL values were interventions between the 50th and 95th percentile for age and sex (lipid research clinics 1980) and triglyceride values below 300 mg/dl based on the mean of the baseline measurements were invited to participate in the study. The resulting sample (n=60) was grouped for this analysis into experimental and control subgroups. Subjects were supplemented with 15 g a day spice powder of dehydrated Purslane for a period of three months. Biochemical parameters like lipid profile, i.e., total cholesterol, LDL-C triglycerides, HDL, VLDL were assessed.^17-20 The kidney functioning capacity was assessed by measuring the levels of serum creatinine, urea and uric acid.^21-23 Liver function test were assessed byserum bilirubin, alkaline phosphatase, alkaline amino transferase (SGPT/ALAT) using standard kits with help of Roche/Hitachi 904/911 automatic enzyme analyzer.^24-26 Baseline information, their medical history and 24 hr dietary recall was elicited from the subjects through a pretested schedule.

Selection criteria

The subjects who consented were included on the criteria that they were screened previously and were recorded with serum triglycerides160-300 mg/dl total cholesterol (total cholesterol) values between the 50th and 95th percentile for age and sex, as outlined by the lipid research clinics.

Period of study

During the study period of 9 months first 3 months from September 2008 to November 2008 a base line study was conducted, between December 2008 and February 2009 supplementation of the developed product was given and between march 2009to may 2009 a follow up study was taken up. The covariance of the variables and results of study were measured, statistical analyzed and compared.

RESULTS

The 24 hour dietary recall records were used to determine the average daily intake of cereals, pulses, and certain other foods like green leafy vegetables, other vegetables, milk and milk products, oils and fats and meat and meat products. Daily nutrient intake of cereals, pulses, milk and milk products, oils and fats, and meat and meat products was greater in control than that of experimental for all nutrients studied except for other vegetables and leafy vegetables as seen in (Table 3). Cereals intake averaged 373.2 g/day, (control) and 366.4 g/day (in experimental) for all subjects, 41.6 g/day of pulses for control and 40.5 g/day of pulses for experimental was recorded as daily intake and oils and fats (66.6 g/day in control and 62.4g/day in experimental), meat and meat products (76.2 g/day in control and 68.2 g/day in experimental) were consumed more than the recommended daily allowances. Subgroup analyses revealed that green leafy vegetables, other vegetables, milk and milk products were consumed less than the RDA.

Pulses, oils and fats, and meat and meat products also were observed to be consumed on the higher side in comparison to the RDA as seen in (Table 3). In both the control and experimental group green leafy vegetables and other vegetables along with milk and milk products were seen to be consumed lesser than the RDA in both the groups.

The TGs were 308.47 mg/dl, 309.13 mg/dl, and 298.40 mg/dl in the consecutive 3 month period prior to supplementation for the study subjects and control had TG values of 217.0, 235.17, and 239.87 mg/dl in the same 3 months period (Table 4). The TG levels were all above the normal range (TG normal range 60-160 mg/dl) for both control and subjects on Purslane spice powder. The resultant effects of Purslane spice powder for 3 months, it was seen that the triglycerides decreased significantly to 211.9 mg/dl (first month), 147.17 mg/dl (second month), 118.17 (third month) in comparison to the control group where the mean TG was 248.8 mg/dl. The percentage reduction in triglyceride content at the end of three months was 60.4%. Post supplementation the TG value rose slightly from 119.37 mg/dl to 136.33 mg/dl in the subjects and in the control a high triglyceride value (TG >150 mg/dl).

The effects of Portulacaoleracea spice powder on lipid profile levels were examined at the end of every month during the entire 9 month period of study. The total lipid profile levels of the subjects who were on the spice powder supplementation substantially decreased compared to the levels in the control group during supplementation. In the experimental group on supplementation with spice powder of Portulacaoleracea total cholesterol decreased from 161.7 to 143.3 mg/dl, LDL from 115.4 to 94.6 mg/dl, VLDL from 59.7 to 23.77 mg/dl) and HDL increased and is reflected in table-5 from 36.17 to 48.3 mg/dl. Post supplementation the increases in total cholesterol, LDL-cholesterol (LDL-C), and VLDL-C concentrations, compared to the control group in respective values were substantial. Ratio of total cholesterol/HDL showed no significant differences in males and females. All the test group subjects are below risk level (<4.5 level in males and <4.0 in females during supplementation of spice powder and post supplementation periods slight increase was seen. Control group subjects are at mild to moderate risk level were regularly followed up and nutrition education was given tothem. LDL/HDL ratio also has shown similar effect.

The kidney functioning capacity was assessed in this study by measuring the levels of serum creatinine, urea and uric acid in the serum of the subjects and controls as depicted in (Table 6). Kidneys remove metabolic wastes such as urea, uric acid, creatinine and ions, so optimum chemical composition of body fluids is maintained. Administration of spice powder of Purslane showed announced significant decrease (p< 0.05) in the levels of serum urea, creatinine, and serum uric acid as compared with the hypertriglyceridemic control group. The reduced levels of creatinine in serum during supplementation may imply that, the spice powder had interfered with creatinine metabolism and its eventual excretion from the blood.

Liver functions in hypertriglyceridemia

The overall ALT alanine transaminase or alanine amino transferase or SGPT concentrations decreased significantly from 23.2 u/l to 20.7 u/l (Table 7). The serum bilirubin activity of the spice powder of purslane has been studied in 30 hyper triglyceredemic patients. The patients were studied at 3 month intervals during 3 months of pre supplementation and 3 months of supplementation and 3 months of post supplementation of the twice a day 7.5 g (total 15 g) spice powder daily.

At the end of administration, serum bilirubin which was high prior to the 3 direct months from 0.79 mg/dl significantly was suppressed from 0.76 mg/dl to 0.65 mg/dl and later a slight increase in the consequent 3 month period of post supplementation to 0.73 mg/dl was seen, in (Table 7). It evidently showed that the spice powder of Purslane administration significantly suppressed increases in serum bilirubin, serum alkphosphatase, and alanine aminotransferase when compared to the control group.

DISCUSSION

Along-standing association exists between elevated triglyceride levels and cardio vascular disease (CVD).^27,28 Special attention has been paid recently to natural products and alternatives by specialists to minimize problems and complications of diseases.²⁹ Portulacaoleracea which was rich in omega- 3 fatty acids as seen earlier and studied by several investigators, is known to regulate lipid and sugar metabolism in the body hence it was further chosen for this study to see the changes of effect of supplementation of the 15 g a day spice powder of Portulacaoleracea in hypertriglyceridemic subjects in pre supplementation, during supplementation and post supplementation.

It was seen that there was 31 to 60% reduction in serum triglycrerides levels of hypertriglyceredemic subjects after supplementation of Portulacaoleracea spice powder in the test group. Post supplementation the TG value rose slightly from 119.37±11.49 mg/dl to 136.33±10.86 mg/dl in the subjects and in the control group a high triglyceride value (TG >150 mg/dl) 248.76±10.47 was seen which correlated with Gao et al who studied the effect of supplementation of polysaccharide from Portulacaoleracea for 28 days in aloxan induced diabetic rats and which resulted in a significant decrease in triglycerides.³⁰ All the test group subjects were below risk level (<4.5 level in males and <4.0 in females during supplementation of spice powder and post supplementation period slight increase was seen. Control group subjects were at mild to moderate risk level and were given nutrition education. Results also are agreed with Ford et al who stated that the increase in HDL-C is one of the most important criteria of anti-hypercholesterolemicagent.³¹

One of the metabolic waste uric acid has been shown to have a mechanistic role in atherosclerosis both by scavenging nitric oxide and, from studies reducing concentrations of uric acid with allopurinol, by improving endothelial dysfunction.³²Administration of spice powder of Portulacaoleracea showed significant decrease (p< 0.05) in the levels of serumurea, creatinine, and serum uric acid as compared with the hypertriglyceridemic control group. A study by Dkhill et al showed that Portulacaoleracea administration at 1.5 mg/kg Portulacaoleracea aqueous juice for 12 days caused significant decrease in urea and creatinine respectively. Hypertriglyceridemia often leads to liver damage and progress to liver cirrhosis and failure with severe morbidity, ultimately leading to mortality abnormalities and is frequently observed in patients receiving parentral nutrition.^34,35

*Significant at 0.05% level (p<0.05)

*Significant at 0.05% level (p<0.05)

*Significant at 0.05% level (p<0.05); ns: non significant.

*Significant at 0.05% level (p<0.05).

Test group evidence suggests that steatotic livers more readily develop hepatitis and function abnormalities when exposed to endotoxin.³⁶ Conversely, reduced liver function as a result of lipid infusionis thought to disturb immune function.³⁷ Visschers et al assessed the influence of patient characteristics such as the occurrence of sepsis on changes in triglyceride concentration. The secondary end point included changes in as part ateaminotransaminase (ASAT, u/l), alanine aminotrans-aminase (ALAT, U/l), alkaline phosphatase (ALP,u/l), γ-glutamyltranspeptidase (γ-GT, u/l), bilirubin (µmol/l), glucose (mmol/l), albumin (g/l) and leukocyte count and has seen that increases in triglyceride concentration aggravates or induces hepatocellular and systemic inflammatory effects. So with all the above factors when spice powder made with Portulacaoleracea (Purslane) was administered for three straight months in hyper-tryglyceridemic subjects the liver function tests were checked to see the impact of the same. SGPT concentrations decreased significantly from 21.53 u/l to 20.7 u/l. The reduction in SGPT concentration was significantly associated with the control group who had a mean of 22.9±1.6 u/l ALT or SGPT. Determined whether hypertriglyceridemia in healthy Miniature Schnauzers (dogs) is associated with high serum liver enzyme activities and suggested that moderate to severe hyper triglyceridemia was associated with high serum liver enzyme activities. At the end of administration, serum bilirubin which was high prior to the 3 direct months from 0.79 mg/dl significantly was suppressed from 0.69 mg/dl to 0.65 mg/dl and later a slight increase in the consequent 3 month period of post supplementation to 0.73±0.084 mg/dl. Here it evidently shows that the spice powder of Portulacaoleracea (Purslane) administration significantly suppressed increases in serum bilirubin, serum alkphosphatase, and alanine aminotransferase when compared to the apparently normal group which was echoed by Dkhil et al who studied that Portulacaoleracea (purslane) aqueous extract administration caused a significant reduction in AST, γ-GT, ALP and bilirubin (-7.4,-10.1,-31.0 and 13.3%) respectively while ALT was non significantly changed indicating that Portulacaoleracea administration support the function of liver and he further stated that this could probably be due to the presence of antioxidants present in Portulacaoleracea in abundance which act against oxidative stress.³³

Limitations

The study subjects who were screened for hyper triglyceridemia also suffered other co morbidities and were consuming oral medications. The impact and interference of the oral medications on the supplementation of the spice powder was not taken into consideration.

CONCLUSION

The present study concludes that the product developed using Portulacaoleracea (Purslane) is a helpful plant in prevention of development of hyperlipidemia, fatty liver, etc. through preventing oxidative stress and chronic inflammation, improvement of fat metabolism, decreasing triglycerides, LDL, and total cholesterol, regulating the levels of liver enzymes (transaminases), etc. The study results indicated that the spice powder was rich in polyunsaturated fatty acids had a strong hypolipidemic, hypotriglyceridemic and hypocholesterolemic effects with a reduction of plasma LDL-C levels and an increase in HDL-C levels in hyper lipidemic subjects.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Global and regional food consumption patterns and trends. Available at: http://www.fao.org/3/ac911e/ac911e05.html. Accessed on 20 November 2020.
2. 2. Annual report on the cause of death statistics, Korea National statistical office. Available at: http://kostat.go.kr.2007. Accessed on 20 November 2020.
3. 3. Rashed AN, Afifi FU, Disi AM. Simple evaluationof the wound healing activity of a crude extract of Portulacaoleracea. J Ethnopharmacol. 2003;88:131-6.
4. 4. Yazici I, Turkan I, Sekmen AH, Demiral T. Salinity tolerance of purslane (PortulacaoleraceaL.) is achievedby enhanced antioxidative system, lower level of lipid peroxidationand proline accumulation. Env Exp Bot. 2007;61:49-57.
5. 5. Lim YY, Uddin MK, Juraimi AS, Ali ME, Ismail MR. Evaluation of antioxidant properties and mineral composition of Purslane at different growth stages. Int J Mol Sci. 2012;13(8):10257-67.
6. 6. Lee SJ, Shin JH, Kang MJ, Kim MJ, Kim SH, SungNJ. Effects of Portulacaolerecea powder on lipid levels of rats fed a hypercholesterolemia inducing diet. Prev Nutr Food Sci. 2011;16:202-9.
7. 7. Xu X, Yu L, Chen G. Determination of flavonoids in Portulacaoleracea L. by capillary electrophoresis with electrochemical detection. J Pharm Biomed Anal. 2006;41:493-9.
8. 8. Simopoulos AP Kifer RR, Martin RE. Health effects of polyunsaturated fatty acids in seafoods. Orlando: Academic Press;1986.
9. 9. Simopoulos AP, Norman HA, Gillaspy JE. Purslane in human nutrition and its potential for world agriculture. World Rev Nutr Diet. 1995;77:47-74.
10. 10. Oliveira I, Valentão P, Lopes R, Andrade PB, Bento A, Pereira JA. Phytochemical characterization and radicalscavenging activity of Portulacaoleracea L. Leaves and stems. Microchem J. 2009;92:129-34.
11. 11. Kim AR, Lee JJ, Lee YM, Jung HO, Lee MY. Cholesterol-lowering and anti-obesity effects of Polymniasonchifolia & Endl. powder in rats fed a high fat-high cholesterol diet. J Korean Soc Food Sci Nutr. 2010;39:210-8.
12. 12. Harnafi H, Aziz M, Amrani S. Sweet basil (Ocimumbasilicum L.) improves lipid metabolism in hypercholesterolemicrats. Eur J Clin Nutr Metab. 2009;e181-6.
13. 13. Shin MK, Kim DH, Han SH. Effects of dried tea leaf powder of serum on lipid concentrations in ratsfedhigh fat. Korean J Food Culture. 2003;18:226-34.
14. 14. Won HR, Kim SH. Antihyperlipidemic effect of dietcontainingPortulacaoleraceaL. ethanol extract in highfat diet-induced obese mice. J Korean Soc Food Sci Nutr. 2011;40:538-43.
15. 15. Kim SH, Won HR. Effect of Portulacaoleracea Linne ethanol extract on lipid metabolism in rats fed high fat diet. J Life Natr Sci. 2010;17:51-60.
16. 16. Kwon DK, Song YJ. Effect of swimming exercise and Portulucaoleraceae supplementation on metabolic parameters and immune function in fed a high-fat diet. Korean J Exerc Nutr. 2010;14:23-9.
17. 17. Allian C, Poon L, Richmond W, Fu P. Enzymatic determination of total serum cholesterol. Clin Chem. 1974;20:470-5.
18. 18. Pisani T, Gebski CP, Leary ET. Accurate direct determination of low density lipoprotein cholesterol using an immune seperation agent and enzymatic cholesterol assays. Arch Pathol Lab Med. 1995;1119-27.
19. 19. Shepherd J, Packard CJ, Grundy SM. Effects of saturated and polyunsaturated fat diets on the chemical composition and metabolism of low density lipoproteins in man. J Lipid Res. 1990; 21(1):91-9.
20. 20. Sugiuchi H, Uji Y, Okabe H, Irie T. Direct measurement of high density lipoprotein cholesterol in serum with polyethylene Glycol-modified enzymes and sulphated alpha cyclo dextrin. Clin Chem. 1995; 41(5):717-23.
21. 21. Fabiny D. Ertingshahsen G. Automated reaction rate method for determination of serum creatinine with centrifichem. Clini Chem. 1971;17:696-700.
22. 22. Fauwett JK, Scott JE. A rapid and precise method for the determination of urea. J Clin Pathol. 1960;13:156-9.
23. 23. Kageyama N. A direct calorimetric determination of uric acd in serum and urine with uricase catalase system. Clin Chim Acta.1971;31:421-6.
24. 24. Malloy HT, Evelyn KA. The determination of bilirubin with the photoelectric colorimeter; J Biol Chem. 1973;119:481-90.
25. 25. Empfehlungen der deutschenGesselsChaft fur KlinischeChemie(Recommendations f the German Society of clinical Chemistry-Standard MethodeZurBEsstimmugderAktivitatderalkalischen Phosphatase. A KlinChem u Klin Biochemi;1972; 10:191
26. 26. Berg Meyer HU, Horder M, Rej R. Approved recommendation (1985) on IFCC methods for measurement of catalytic concentration of enzymes. IFCC method for the alanine amino transferase. J Clin Chem Clin Biochem. 1985;24;481-9.
27. 27. Austin MA, Hokanson JE, Edwards KL. Hypertriglyceridemia as a cardiovascular risk factor. Am J Cardiol. 1998;81:7-12.
28. 28. Sarwar N, Danesh J, Eiriksdottir G, Sigurdsson G, Wareham N, Bingham S, et al. Triglycerides and the risk of coronary heart disease: 10,158 incident cases among 262,525 participants in 29 Western prospective studies. Circulation. 2007;115:450-8.
29. 29. Kim YH, Lee JH, Koo BK, Lee HS. Isoflavone-rich bean sprouts improves hyperlipidemia. J Korean Soc Food Sci Nutr. 2007;36:1248-56.
30. 30. Gao S, Chen J, Zhang X. The synthetical and intelligent database of the active principles extracted and isolated from the medicinal plants. J Anhui Univ 2003;15(5):25-32.
31. 31. Ford ES, Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates. J Am Coll Cardiol. 2007;50(22):2128-32.
32. 32. Nakagawa T, Zharikov S. Uric acid as a casual factor for fructose indiced metabolic syndrome, Am J Renal Physiol. 2006;290:625-31.
33. 33. Dkhil MA, Ahmed E, Abdel M, Saleh AQ, Reda A. Antioxidant effect of purslane (Portulacaoleracea) and its mechanism of action. J Med Plants Res. 2011; 5(9):1589-93.
34. 34. GrauT, Bonet A, Rubio M. Liver dysfunction associated with artificial nutrition in critically ill patients. Crit Care. 2007:11;10.
35. 35. Llop J, Sabin P, Garau M. The importance of clinical factors in parenteral nutrition associated hypertriglyceridemia. Clin Nutr. 2003;22:577-83.
36. 36. Yang, S.Q.; Lin, H.Z.; Lane, M.D.; Clemens, M.; and Diehl, A.M. Obesity sensitivity to endotoxin liver injury: Implications for the pathogenesis of steatohepatitis. Proc Natl AcadSciUSA, 1997;94 (6):2557-62.
37. 37. Alwayn IP, Gura K, Nose V, Zausche B, Javed P, Garza J. Omega-3 fatty acid supplementation prevents hepatic steatosis in a murine model of non alcoholic fatty liver disease. Pediatr Res. 2005;57 (3);445-52.
38. 38. Visschers RG, Oldedamink SW, Gehlen JM, Winkens B, Soeters PB, van Germert WG. Treatment of hypertriglyceridemia in patients receiving parenteral nutrition. J Parenter Enteral Nutr. 2011;35(5);610-5.