https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/65 Tue, 02 Aug 2016 11:56:07 +0000 The prevalence of non-communicable diseases (NCD) like diabetes, hypertension, dyslipidemia and atherosclerotic cardiovascular diseases (CVD) are on the increase globally and predominantly in the South East Asian Region (SEAR). The increasing NCD and its complications burdened the health cost of Bangladesh. The available literatures suggest that edible mushrooms are effective in controlling metabolic risks like hyperglycemia and hypercholesterolemia. A total of 5000 newly registered diabetic women were screened for eligible participants (urban housewives, age 30 – 50y, BMI 22 – 27, FBG 8 – 12 mmol/l; free from complications or systemic illnesses and agreed to adhere to the study for 360 days). The investigations included weight and height for BMI, waist- and hip-girth for WHR, BP, FBG, 2ABF, T-chol, TG, HDL, LDL, ALT and Creatinine starting from the day 0 (baseline) and each subsequent follow-up days: 60, 120, 180, 240, 300 and 360 for comparison between placebo and mushroom groups and also within group (baseline vs. follow up days), individually for placebo and mushroom. The daily intake of mushroom was 200g for the mushroom group and an equivalent calorie of vegetables for the placebo group. Mushroom was found to have significant effect in reducing blood glucose, T-chol, TG and LDL. No impaired function was observed for liver, kidney and hemopoeitic tissue in taking mushroom for 360 days of the study period.   Introduction Bangladesh is one of the least developing countries with the highest population density of the world. And the brunt of NCD is overwhelming considering its poor economy, which is already overburdened with population explosion and communicable diseases. Very few of the NCD population can afford the cost of lifelong treatment. Only 1.4% of GDP is allocated to health and 43.3% of its population are below international poverty line (£US$1.25 per day).7 The NCD patients need lifelong follow up treatment. A diabetic patient needs medication either oral hypoglycemic agent (OHA) or insulin for life. Likewise, lifelong antihypertensive medications are essential for a hypertensive subject. The dyslipidemic patients need lipid lowering agent(s) to prevent atherosclerosis. For lifelong maintenance of these medication is expensive and hardly feasible or affordable for most of the NCD patients. Considering the increasing NCD population at the face of poor affordability of treatment one has to explore alternative approach. And we have edible mushroom, popularly known and consumed as “Beneficial for Health” though exactly not known what the true benefit is. There are cumulative evidences that some edible mushroom, particularly, oyster mushroom (OM) rich in digestible proteins and bioactive compounds like vitamins, minerals, β-glucans (or immuno-modulants) that have effects in combating NCDs.8 The metabolic effects have been reported by many investigators, but these were observed in animal models.9-11 Very few studies have been carried out in human subjects.12,13 Based on some important considerations this study was undertaken: a) an increasing trend of NCDs in Bangladesh; b) the suffering individuals can not afford lifelong treatment and frequently develop disabling complications; c) the oyster mushroom is popularly accepted and taken as beneficial vegetables for health; d) if this proved to be effective in reducing hypertension, hyperglycemia and hyperlipidemia without adverse outcomes then it would create immense economic possibilities – reducing import of medicine that required for millions of NCD patients in the country and saving hard earn foreign currency, increasing mushroom production by generating employment to such an extent that result in cultivating and exporting it to the increasing global need of rising NCD population. Thus, the aims of this study were to determine the metabolic effects of edible (Pleurotus ostreatus) mushroom in diabetic subjects and to assess any undesirable effect among subjects who were familiar with mushroom. Study Population and Methods From the BIRDEM Registry, a total of 5000 newly registered female diabetic subjects were screened for the selection of eligible participants. Of them, 300 women satisfied the eligible criteria as mentioned above. They were enrolled for the study. The protocol was discussed and they were informed about the procedural details. Of the 300 eligible participants, 173 agreed to volunteer the study. These subjects were reinvestigated for baseline data and to assess whether there was any complication. Microproteinuria was found in 15, background retinopathy in 19, proliferative retinopathy 2 and maculopathy in 1. Neurological assessment revealed peripheral neuropathy in 17, and autonomic neuropathy in 21. Oral hypoglycemic agent failed to control in 25, who were prescribed insulin and were excluded from the study. So, the remaining 73 were finally selected as eligible participants. Of these 73, 43 women were familiar with the mushroom as they used to take the mushroom occasionally, and 30 women never tasted the mushroom. So, the former group was assigned to mushroom (n=43) and the later assigned to placebo group (n=30). The stepwise selection of the study participants based on eligibility criteria is depicted in Figure-1. The daily mushroom intake was prescribed 200g and the placebo group was prescribed equivalent calorie of locally available vegetables exchange. The mushroom packets, each containing 200g, were supplied twice a week from the “Govt. Mushroom Farm” at Savar near Dhaka city. The field workers maintained home-visit twice a week, distributing mushroom and checking whether the participants were consuming it daily, and reporting to the physician if there was any irregularities in continuing mushroom intake. Home visit was also maintained to the placebo participants twice weekly. The follow up was strictly maintained for each participant as long as she was residing in the Dhaka City Corporation (DCC) area and was lost to follow up only if she left DCC area or withdrew from the study. The mushroom and the placebo groups were followed up from the day 0 (baseline) through the day 360 (Figure 2). The investigations in each visit on day 0, 60, 120, 180, 240, 300 and 360 included BMI, SBP, DBP, FBG, 2ABF, T-chol, HDL, TG, Hb, creatinine and ALT for both mushroom and placebo group. The study protocol was duly approved by the Ethical Review Committee of Diabetes Association of Bangladesh (DAB). Results i.    Comparison between mushroom and placebo group: The mean (with SEM) values of BMI, SBP, DBP, FBG, 2ABF, T-chol, HDL, TG, Hb, creatinine and ALT of the placebo group were compared with that of the mushroom group on day 0 (baseline) and then on each subsequent follow-up visits. Compared to the placebo, the mushroom group showed significantly lower values for FBG (p<0.001), 2ABF (p<0.001) [Fig (2a), (2b)], T-chol (p<0.001), TG (p=0.03) and LDL (p<0.001) [Fig-(3a), (3b), (3c)]; whereas, the differences were not significant for BMI, SBP, DBP, HDL, Hb, creatinine and ALT (data not shown).               Figure-2: Comparison of mushroom and placebo groups for fasting blood glucose (2a) and glucose 2ABF  (2b) at   day 0, 60, 120, 180, 240, 300 and 360. Compared to placebo the mushroom group showed significant reduction (p<00.1) in FBG levels at day 120 to 360 and for 2ABF level from day 60 to 360 except at day 300. FBG: Fasting blood glucose, 2ABF: 2hrs after breakfast     Figure-3:  Comparison of serum total cholesterol (3a), triglycerides (3b) and, LDL (3c) levels of mushroom and placebo groups at day 0, 60, 120, 180, 240, 300 and 360. For total cholesterol p< 0.01 at day 120, 300 and 360; For  triglyceride p< 0.03 at day 120, 240, 300 and 360; For LDL p< 0.001 at day 360.     iv.  The mushroom showed no significant effect on hemoglobin, creatinine and alanine amino transferase (ALT). Discussion This study clearly demonstrated that Oyster mushroom (OM) had anti-hyperglycemic and anti-lipids effects which are consistent with other studies.8-10 In India, Bajaj et al made similar conclusions that mushroom had hypocholesterolemic effect.13 These evidences are consistent with other studies.14,15 Though some other studies claimed that mushroom had anti-obesity effect16 this study showed no such effect. Again this study found that edible mushroom did not reduce blood pressure significantly as claimed by other though in rat model.17 Conclusions   We are very much grateful to the authorities of “Strengthening Mushroom Development Project, Department of Agricultural Extension under M/O Agriculture” for funding the project. We are indebted to BIRDEM Authority and Ibrahim Medical College for providing space, access to the patients and facilities for laboratory investigations. References 2.    McKeigue PM, Marmot MG, Syndercombe Court YD, Cottier DE, Rahman S, Riemersma RA. Diabetes hyperinsulinemia and coronary risk factors in Bangladeshis in East London. Br Heart J 1988; 60: 390-396. 4.    Sayeed MA, Mahtab H, Sayeed S. Begum T, Khanam PA and Banu A. Prevalence and risk factors of coronary heart disease in a rural population of Bangladesh. Ibrahim Med Coll J 2010; 4(2): 37-43. 6.    Rahim MA, Hussain A, Azad Khan AK, Sayeed MA, Keramat Ali SM, Vaaler S. Rising prevalence of type 2 diabetes in rural Bangladesh: a population based study. Diabetes Res Clin Pract 2007; 77(2): 300-5. 8.    Lo HC, Wasser SP. Medicinal mushrooms for glycemic control in diabetes mellitus: history, current status, future perspectives, and unsolved problems (review). Int J Med Mushrooms 2011; 13(5): 401-26. 10.  Kanagasabapathy G, Kuppusamy UR,  Malek SNA,Abdulla MA, Chua KH and Sabaratnam V. Glucan-rich polysaccharides from Pleurotus sajor-caju (Fr.) Singer prevents glucose intolerance, insulin resistance and inflammation in C57BL/6J mice fed a high-fat diet. BMC Complement: Altern Med 2012; 12: 261. 12.  Khatun K, Mahtab H, Khanam PA, Sayeed MA and Azad Khan AK. Oyster Mushroom reduced blood glucose and cholesterol in diabetic subjects. Mymensingh Med J 2007; 16(1): 94-99. 13.  Hossain S, Hashimoto M, Choudhury EK, Alam N, Hussain S, Hasan M, Choudhury SK,Mahmud I. Dietary mushroom (Pleurotus ostreatus) ameliorates atherogenic lipid in hypercholesterolaemic rats. Clin Exp Pharmacol Physiol 2003; 30(7): 470-5. 16.  Jeon BS, Park JW, Kim BK, Kim HK, Jung TS, Hahm JR, Kim DR, Cho YS, Cha JY.Fermented mushroom milk-supplemented dietary fibre prevents the onset of obesity and hypertriglyceridaemia in Otsuka Long-Evans Tokushima fatty rats. Diabetes Obes Metab 2005; 7(6): 709-15. 2026 Ibrahim Medical College. All rights reserved.