Phytosterols (PSs), classified into plant sterols and stanols, are bioactive compounds found in foods of plant origin. PSs have been proposed to exert a wide number of pharmacological properties, including the potential to reduce total and low‐density lipoprotein (LDL) cholesterol levels and thereby decreasing the risk of cardiovascular diseases. Other health‐promoting effects of PSs include anti‐obesity, anti‐diabetic, anti‐microbial, anti‐inflammatory, and immunomodulatory effects. Also, anticancer effects have been strongly suggested, as phytosterol‐rich diets may reduce the risk of cancer by 20%. The aim of this review is to provide a general overview of the available evidence regarding the beneficial physiological and pharmacological activities of PSs, with special emphasis on their therapeutic potential for human health and safety. Also, we will explore the factors that influence the physiologic response to PSs.

Background Cystic fibrosis (CF) is a genetic disorder, which is caused by the CFTR protein defects. Along with CFTR dysfunction, inflammation plays a key role in the disease outcomes. Inflammation may develop due to the internal dysfunction of the CFTR protein or external factors. Curcumin affects the CFTR protein function primarily as a corrector and potentiator and secondary as an anti-inflammatory and antimicrobial agent. The present study aims to assess the impact of nano-curcumin on clinical and inflammatory markers in children with CF. Methods This prospective, double blind control trial will be conducted at the Akbar Children’s Hospital in Mashhad, Iran. Children with CF will be enrolled based on the eligibility criteria. Placebo and curcumin with the maximum dose of 80 mg considering the body surface of the patients will be administrated for 3 months. The primary outcome is to evaluate inflammation based on serum interleukin-6, interleukin-10, and hs-CRP, stool calprotectin, and neutrophil count of nasopharyngeal swab. The secondary outcome involved clinical assessment via spirometry, anthropometrics, and quality of life. They will be assessed before and after 3 months. Discussion Due to the multifarious effects of curcumin on CF disease, it could be proposed as a nutritional strategy in the treatment of cystic fibrosis. Trial registration Iranian Registry of Clinical Trials IRCT20200705048018N1. Registered on July 10, 2020.

Background: Enteral feeding (EF) is the delivery of liquid nutritional support through a tube for hospitalized patients with gastrointestinal dysfunction who are incapable of eating or unable to meet their nutritional requirements via the oral route. Hospitals’ reports indicate an increased interest and demand for blenderized tube feeding (BTF) as an alternative to commercial enteral formulas particularly in families of tube fed children. In particular, by increasing food sensitivity and more complex identification in children, BTF allows families to adjust their diet to their children's needs. This systematic review aimed to summarize the published evidence regarding BTF in pediatric patients. Methods: Literature search was conducted in four databases, including Scopus, PubMed, Science Direct, and Google Scholar, using multiple keywords, such as blenderized tube feeding, blended formula, homemade enteral nutrition, pediatric, and children. Out of 103 retrieved articles, 6 were selected and reviewed. Results: Six articles were eligible to be included in the current review. The results showed that calories were approximately 1kcal/g, protein 13 -22%, fat 30 - 34%, and carbohydrates intake 45-55% of total energy intake. Conclusions: The results indicated that BTF is acceptable and can be administered to children; however, due to concerns about calorie and macronutrients deficiency, it should be providing under the supervision of a nutritionist.  BTFs are a good choice among children; since they can improve gastrointestinal symptoms and are a good option for families who use EF for their children at home. Most pediatric patients use BTFs as a portion of their EF, making it necessary that nutritionists and physicians expand their knowledge about BTFs to appropriately care for these pediatric patients.

Inflammation plays an important role in the outcome of patients with cystic fibrosis (CF). It may develop due to cystic fibrosis transmembrane conductance regulator protein dysfunction, pancreatic insufficiency, or prolonged pulmonary infection. Fecal calprotectin (FC) has been used as a noninvasive method to detect inflammation. Therefore, the aim of the current meta-analysis was to investigate the relationship between FC and phenotype severity in patients with CF. In this study, searches were conducted in PubMed, Science Direct, Scopus, and Embase databases up to August 2021 using terms such as “cystic fibrosis,” “intestine,” “calprotectin,” and “inflammation.” Only articles published in English and human studies were selected. The primary outcome was the level of FC in patients with CF. The secondary outcome was the relationship between FC and clinical severity. Statistical analysis was performed using Comprehensive Meta-Analysis software. Of the initial 303 references, only six articles met the inclusion criteria. The mean (95% confidence interval [CI]) level of FC was 256.5 mg/dL (114.1-398.9). FC levels were significantly associated with pancreatic insufficiency (mean, 243.02; 95% CI, 74.3 to 411.6; p =0.005; I 2 =0), pulmonary function (r=–0.39; 95% CI, –0.58 to –0.15; p =0.002; I 2 =60%), body mass index (r=–0.514; 95% CI, 0.26 to 0.69; p <0.001; I 2 =0%), and Pseudomonas colonization (mean, 174.77; 95% CI, 12.5 to 337.02; p =0.035; I 2 =71%). While FC is a reliable noninvasive marker for detecting gastrointestinal inflammation, it is also correlated with the severity of the disease in patients with CF.

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Background Due to the benefits of blenderized tube feeding (BTF) diets, the interest in using them is increasing. This study aimed to design BTFs for children and investigate their physicochemical and microbial properties, as well as Dietary Inflammatory Index (DII). Methods Five BTF diets were formulated mainly with fresh foods; their DII, physical (viscosity), and chemical (moisture, ash, protein, fat, energy, and micronutrients) characteristics were assessed. Also, the Hazard Analysis and Critical Control Points (HACCP) system was implemented for quality assurance of preparation, storage, and delivery of BTFs to patients in hospital. The microbial contamination (total count, Salmonella, Escherichia coli, Bacillus cereus, Listeria monocytogenes, coliforms, Staphylococcus aureus coagulase positive, mold, and yeast) was analyzed. Results Energy and percentages of protein, fat, and carbohydrate in BTFs were in the range of 103–112 kcal/100 ml, 16%–22%, 28%–34%, and 48%–52%, respectively. The viscosity of the five developed BTFs was between 29 and 64 centipoises, which allows the formulas to flow without syringe pressure. The DII of all BTFs was between −0.73 and −2.24. Due to the implementation of HACCP, monitoring the production line of BTFs, and performance of corrective measures, no microbial contamination was observed by indicator pathogenic microorganisms. Conclusion A planned BTF diet can be an excellent selection for children using enteral nutrition with tube feeding especially when they are made from fresh and anti‐inflammatory foods such as recipes prepared in this study.

Inflammation may develop due to internal dysfunction of the cystic fibrosis transmembrane conductance regulator (CFTR) protein or external factors in patients with cystic fibrosis (CF). This prospective randomized clinical trial aimed to ascertain the effects of nano‐curcumin as an anti‐inflammatory agent and a CFTR modulator on clinical and inflammatory markers in children with CF. Children with CF were randomly assigned to receive daily curcumin or a placebo for 3 months. The primary outcome measure was to evaluate inflammatory indices, nasopharyngeal swab analysis, and clinical assessments via spirometry, anthropometric measurements, and quality of life (QOL) analysis. Sixty children were included. Intra‐group changes comparison showed that curcumin decreased the level of high‐sensitivity C‐reactive protein (hs‐CRP) (median: −0.31 mg/L, IQR: −1.53 to 0.81; p = .01) and fecal calprotectin level (−29 μg/g, −57.5 to 11.5; p = .03), also increased the level of interleukin (IL)‐10 (6.1 pg/mL, 4.5–9; p = .01). Moreover, curcumin improved the overall QOL and the subscales of the questionnaire. Inter‐group changes comparison depicted the number of Pseudomonas colonies reduced by about 52% in the curcumin group and gained weight by about 16% (p > .05). Nano‐curcumin seems to be considered as an effective nutritional supplement on hs‐CRP, IL‐10, fecal calprotectin levels, and improving QOL in patients with CF.

Background: Cystic fibrosis(CF) is a genetic disorder, which is caused by the CFTR protein defects. Along with CFTR dysfunction, inflammation plays a key role in the disease outcomes. Inflammation may develop due to the internal dysfunction of the CFTR protein or external factors. Curcumin affects the CFTR protein function primarily as a corrector and potentiator and secondary as an anti-inflammatory and antimicrobial agent. The present study aims to assess the impact of Nano-curcumin on clinical and inflammatory markers in children with CF.Methods: This prospective, double blind control trial will be conducted at Akbar Children's Hospital in Mashhad, Iran. children with CF will be enrolled based on the eligibility criteria. Placebo and curcumin with the maximum dose of 80 milligrams considering the body surface of the patients will be administrated for three months. The primary outcome is to evaluate inflammation based on serum interleukin-6, interleukin-10, and hs-CRP, stool calprotectin, and neutrophil count of nasopharyngeal swab. The secondary outcome involved clinical assessment via spirometry, anthropometrics, and quality of life. They will be assessed before and after three mounts.Discussion: Due to the multifarious effects of curcumin on CF disease, it can be used as a nutritional strategy in the treatment of cystic fibrosis.Trial registration: Iranian Registry of Clinical Trials, IRCT20200705048018N1, Registered on 2020-07-10, https://en.irct.ir/search/result?query=IRCT20200705048018N1