Feline diet 5 contained salmon oil, but also contained salmon meat, and tested positive for salmon DNA as would be expected. If extrapolating from the finding that salmon DNA was not found in the diets containing salmon oil, it may be expected that the other diets containing fish sources of oil did not contain cod or sardine DNA as potential allergens. In general, plant- and animal-based oils are not considered allergenic when highly purified . Of additional note was the finding that no diet contained the DNA of kangaroo. The commercial RMBD tested were obtained in California due to the proximity to the testing facility . Since kangaroo meat is not used by any of the manufacturers in their RMBD, this finding serves as an additional negative control for this study to validate that no DNA of kangaroo origin was detected in the analysis, as would be expected. Analysis of the 2 extensively hydrolyzed poultry feather based diets revealed no detection of unlisted animal DNA. This is consistent with previous reports that contaminants are detected less commonly and in lower numbers in hydrolyzed diets . The extensive hydrolysis of poultry feather proteins into component amino acids or very short oligopeptides is intended to avoid inducing IgE-mediated mast cell activation that can occur with proteins 10 kDa in size or greater . Extensive hydrolysis to reduce poultry allergenicity has been validated in both serum IgE and feeding trials to show the clinical benefits for CAFR .

These negative control diets were selected because of the rigorous quality control methods undertaken by the manufacturer to ensure cross-contamination does not occur before market release . While the canine diet did test positive for chicken DNA, plastic grow pots the manufacturer does list the feathers of chicken, turkey, and duck as their sourced raw materials . The target gene of the analysis for chicken DNA, transforming growth factor beta 3, is a protein expressed in chicken feathers . Additionally, the manufacturer is aware that cross-contamination needs to be avoided in a therapeutic diet and has developed and clinically validated calibration curves to prevent contamination . These calibration curves correspond to a known DNA level that was clinically tolerated based on Global Skin Scores in feeding trials in order to set a tolerance level for ancillary proteins known as the NPPI , which is strictly monitored in each diet prior to allowing market release . Based on the manufacturer’s quality control data, 72.3% of these extensively hydrolyzed diets contain DNA below the limit of detection , and 25.7% may have DNA above the LOD but below a safety threshold of 1.2 g/g . However, no diet released to market will exceed the established cut-offs of the NPPI based on the pre-established calibration curves . Therefore, trace copies of chicken DNA may be expected on PCR in some of the diets released to market, as was found in our study. The DNA in the feline extensively hydrolyzed diet in this study was below the LOD, and no animal DNA was detected in the assay. Based on the sensitivity of qPCR, it can be argued that these assays, being sensitive enough to detect as few as 10 copies of the target gene, are of greater sensitivity than that required to detect clinically meaningful contamination that would trigger CAFR.

There is no established maximum tolerable level of a contaminating protein that may elicit a pruritic reaction in a food sensitized pet. In humans, soy protein concentration as low as 10 ppm may evoke a reaction in a soy-sensitized individual . Additionally, dose distribution has been demonstrated to vary between different food allergens in sensitized humans, showing that a tolerance range may exist for different food antigens themselves . The additional concern for CAFR pets is that, as opposed to most humans, pets are often fed a specific commercial diet with daily regularity, increasing their risk of chronic re-exposure to a food antigen contained therein. As a result, even small amounts of unknown allergens may lead to a cumulative reaction in a CAFR-affected pet and skew the clinical impression of their response to a particular ED. These reactions may even be sporadic if there is significant variation of the protein constituents of the diet between batches. The need to validate food allergic threshold distributions in canine and feline CAFR is an important area for future research. Until such time, rigorous quality control using protein analysis methods such as qPCR or enzyme linked immunosorbent assay remains a sensitive method to confirm such contaminants are not detected in therapeutic diets fed for the purpose of the clinical diagnosis of CAFR. This remains the industry standard for quality control of commercially produced diets, including extensively hydrolyzed diets. In conclusion, this study confirms that commercial RMBD should not be considered appropriate for selection as ED in the diagnosis of CAFR as a result of their tendency to include unlisted protein ingredients, which can differ from batch to batch.

A clinician should use caution when interpreting the results of an owner-directed ED trial using RMBD to exclude CAFR as a cause of their pet’s pruritic dermatopathy, and veterinarian-guided elimination diet oversight is still recommended. Until further evidence is presented, an elimination diet and provocation trial with a patient-appropriate prescription-based diet subjected to applicable quality control or a home-prepared novel protein diet remain the current diagnostic standard for CAFR.Lifestyle choices such as diet and physical activity can create risk factors for several chronic diseases including cardiovascular disease , diabetes, and certain cancers. Worldwide, chronic diseases are projected to cause USD 17.3 trillion of cumulative economic loss between 2011 and 2030 due to increased healthcare expenditures, reduced productivity, and lost capital. Prevention and risk-reduction strategies, including dietary recommendations, are crucial to stem this burden. In addition to guidelines on items to avoid, emphasis on health-promoting foods that complement current dietary strategies is key to the prevention and treatment of numerous chronic diseases. Current dietary guidelines advocate beneficial patterns that share several key characteristics, including abundant intakes of fruits, vegetables, nuts and seeds, legumes, and whole grains, as well as seafood, yogurt, and vegetable oils, while minimizing the intake of red and processed meats, refined grains, starches, and added sugars. Fruits and vegetables are rich in many essential nutrients and other bioactive compounds that can provide protection against many chronic diseases. Dietary recommendations promote the consumption of at least five to nine servings of a variety of fruits and vegetables per day in a 2000 kcal diet, which provide abundant amounts of vitamins , minerals ,fibers, and a diversity of bioactive phytochemicals such as polyphenols and carotenoids. An increased intake of polyphenols, particularly flavonoids, has been associated with a decreased risk for CVD through improved endothelial function, and a reduction in platelet reactivity, low-density lipoprotein, and blood pressure. Date palm fruit , a species of the family Arecaceae that is rich in many essential nutrients and polyphenols, is one of the most commonly consumed fruits in the Middle East and North Africa. Date palm fruit, which is termed simply as dates in this review, is cultivated throughout the Middle East and to an increasing degree in other regions of the world including parts of Central and South America, Europe, India, and the United States. Consumer demand for dates continues to increase. The top countries produced about 3.5 million metric tons in 1990, around 6.5 million metric tons by 2000, and in excess of 7.5 million metric tons by 2014. Several biological activities, proposed mainly based on in vitro and animal models, have been described with respect to potential health effects of dates. These include support of oxidant defense, anti-inflammatory and gastroprotective effects, big plastic pots and anticancer activity. With the high incidence of CVD and diabetes worldwide, a comprehensive review of dates and their potential value in promoting vascular health is timely. Here, we focus on the roles of dates to affect markers of cardiovascular function, with particular attention to their beneficial actions in humans.

Future research directions concerning dates are also suggested.Date trees are among the oldest in the world, and are an important fruit crop in Middle Eastern countries. Dates have significant religious importance for Muslims, where the fruit is mentioned in many sections of the Holy Quran for its nutritional and medicinal values. This fruit has been used traditionally to break the fast during the holy month of Ramadan in Arabic and Islamic countries. The earliest examples of the use of dates in the Middle East come from two sites, Sabiyah in Kuwait and the island of Dalma in the United Arab Emirates, as evidenced by carbonized date seeds and stones. Dates have a special social status among Middle Eastern countries and with Arabs in general, as dates and date-based foods are served during most auspicious occasions and events, such as weddings, births, family gatherings, and religious holidays. Although dates are admired for their nutritional and health-promoting properties by the natives of the Middle East and northern Africa, the fruit is less recognized in other regions of the world due in part to limited scientific documentation derived from Islamic prophetic traditions.Many date cultivars are grown around the world that differ in size, taste, color and degree of ripeness when consumed. The chemical and functional composition of dates is significantly altered during the ripening process, with levels of sugars increasing and vitamin, mineral, and fiber levels gradually decreasing on a weight basis. Ripening reduces the content of phenolic acids and flavonoids , as evidenced with Ajwa dates. Polyphenol concentrations also vary by cultivar. For example, the khalal stage of the Ajwa cultivar contained significantly higher levels of the anthocyanidin petunidin compared to Barni and Khalas cultivars at a similar stage of ripeness. The phenolic content of Amari dates /g; flavonols: 1.37 µmol GAE/g was also reported to be greater than the fraction isolated from Hallawi dates at the same stage of ripeness. The total phenolic content of different Iraqi dates also varied, ranging from 331 to 475 mg GAE/100 g, which are concentrations higher than other fruits such as apple, blueberry, orange, pomegranate, papaya, banana, and red grape. In contrast, others have reported that the polyphenol content in the earlier stages of date ripening to be similar to that in apples, but lower than that in an extract of various citrus fruits. Delineating the composition, variety, and ripening stage of dates and their bioactive fractions is important when designing and interpreting research studies. For consistent compositional reporting, standardization of extraction and analytical methods is needed. Dates are relatively rich in kilocalories and contain a substantial percentage of carbohydrates , which are predominately glucose , fructose, and sucrose. The fruit also contains a significant amount of dietary fibers including pectin, hemicellulose, lignin, resistant starch, and soluble fiber. Around 100 g of dates, equivalent to seven to nine fruits, provide 25–30 g of dietary fiber, which is 100% of the current US recommendations. Date fruits contain protein and 23 different amino acids that are not commonly found in other fruits. A variety of micronutrients are found in dates, including vitamins A, B-complex and C, and minerals such as calcium, magnesium, copper, sodium, phosphorus, zinc, selenium, fluorine, potassium, and iron. Variability in the polyphenol content of dates exists, as well as in the macro- and micronutrient levels, depending on the cultivar and degree of ripeness, along with geographic location and environmental conditions.Worldwide, CVD is the leading cause of death, taking an estimated 17.8 million lives in 2017, and is expected to account for more than 22.2 million deaths in 2030. An estimated 54% of deaths from noncommunicable disease in the eastern Mediterranean region are due to CVD and by 2030, an estimated 44% of the US population is projected to suffer from some form of CVD. Age-standardized prevalence rates of CVD per 100,000 for both sexes are particularly high in North Africa and the Middle East, Central Asia and North America, ranging between about 7066 to greater than 9266. A number of risk factors are associated with the development and progression of CVD. While constitutional risk factors such as family history, age and sex cannot be controlled, lifestyle factors related to hypercholesterolemia, hypertension, hyperglycemia, obesity, physical inactivity, and smoking can be modified and can significantly impact cardiovascular health.