Research Article
Volume 3 Issue 5 - 2016
Consumption of Pomegranate Juice Attenuates Exercise - Induced Oxidative Stress, Blood Pressure and Urinary Cortisol/Cortisone Ratio in Human Adults
Emad A S Al-Dujaili1*, Gillian Good1 and Catherine Tsang2
1Department of Dietetics, Nutrition and Biological Sciences, Queen Margaret University, Queen Margaret Drive, Musselburgh, EH21 6UU, UK
2Division of Food and Drink, School of Science, Engineering and Technology, University of Abertay, Dundee, DD1 1HG
*Corresponding Author: Emad A S Al-Dujaili, Department of Nutrition, BHF Cardiovascular Centre Queens Medical Research Institute University of Edinburgh 47 Little France.
Received: August 16, 2016; Published: August 23, 2016
Citation: Emad A S Al-Dujaili., et al. “Consumption of Pomegranate Juice Attenuates Exercise - Induced Oxidative Stress, Blood Pressure and Urinary Cortisol/Cortisone Ratio in Human Adults”. EC Nutrition 4.6 (2016): 982-995.
Background: Oxidative stress is exacerbated in overweight and obese individuals after acute exercise compared with their non-obese counterparts. Antioxidants supplementation of the diet may be one intervention to reduce exercise-induced oxidative stress in this vulnerable population. The aim of this study was to investigate whether polyphenol-rich pomegranate juice attenuates post-exercise oxidative stress and contributors to oxidative stress (glucocorticoids) and blood pressure in healthy overweight subjects.
Methods: Males and females participated in a randomized placebo controlled parallel pilot-study (mean BMI: 26.7 ± 6.6 kg/m2). Two groups of (n = 12) participants received either pomegranate pure juice (500 mL/day containing total polyphenols of 1685 mg GAE/L) or placebo (water matched for total energy) and all participants completed two standardized 30 min treadmill tests (50% Wmax) at baseline and after one week of the intervention.
Results: Exercise induced lipid peroxidation (MDA) was lower following pomegranate juice consumption compared with placebo (31.2 ± 10.6 to 26.5 ± 9.8 MDA μmole/day) after 1 week (P = 0.035). Urinary free cortisol was reduced from 179.4 ± 53.2 to 125.6 ± 43.5 nmole/24h which was significant (p = 0.042). In addition, there was a statistically significant increase in urinary free cortisone: from 112.2 ± 40.4 to 187.6 ± 90.2 nmole/24 h (p = 0.045), and a significant decrease in the urinary free cortisol/cortisone ratio (p=0.009) from 1.6 ± 1.1 to 0.67 ± 0.55 following one week of pomegranate juice intake. Pomegranate juice consumption was also found to decrease systolic blood pressure pre-exercise (136.7 ± 11.7 to 131.8 ± 8.8 mmHg (p=0.007), and post-exercise from 158.8 ± 15.8 to 148.1 ± 12.3 mmHg (p < 0.01) and diastolic blood pressure (86.3 ± 10.6 to 82.5 ± 6.8 mmHg (p = 0.04) and 103.1 ± 12.5 to 93.9 ± 11.5 mmHg (p = 0.001), pre and post exercise, respectively. Correlation results between the change in Cortisol/cortisone ratio with the effect on blood pressure showed a negative significant association post pomegranate juice intake (p = 0.028 for systolic and p = 0,008 for diastolic BP). There were no changes in lipid peroxidation or blood pressure following placebo treatment.
Conclusions: These findings suggest that pomegranate juice consumption prior to an acute bout of moderate intensity exercise can alleviate Blood pressure and exercise-induced oxidative stress in the overweight and obese population.
Keywords: Pomegranate juice; Blood Pressure; Glucocorticoids; Exercise; Oxidative Stress
AOX: Antioxidant; BP: Blood Pressure; CVD: Cardiovascular disease; DBP: Diastolic Blood Pressure; ELISA: Enzyme-Linked Immune Sorbent Assay; GC: Glucocorticoids LDL: Low Density Lipoprotein; MDA: Malonaldehyde PJ: Pomegranate (pomegranate pure) Juice ROS: Reactive Oxygen Species SBP: Systolic Blood Pressure TBARS: Thio barbituric Reactive Substances
Oxidative stress is defined as an imbalance between the antioxidant and pro-oxidant processes that occur during metabolism resulting in an increase in the production of free radicals and reactive oxygen species (ROS) [1-3]. An accumulation of oxidative by-products over time may lead to oxidative damage of biological molecules including lipids, proteins and DNA [4]. It is well known that acute exercise particularly of a moderate to high intensity promotes oxidative stress which is exacerbated in overweight and obese individuals [5,6]. The prevalence of overweight is increasing globally and has become a serious public health concern. Overweight increases the risk of chronic metabolic diseases including hypertension, cardiovascular disease and type 2 diabetes [7-9]. Low-grade inflammatory status in overweight individuals has been proposed as one of the mediating processes in the development of metabolic disease and several studies have reported an association between oxidative stress and inflammation in these conditions [10-12]. It is thought that a compromised endogenous antioxidant defence system in this population enhances free radical production and may contribute to further oxidative damage during exercise [13-14]. Studies have found that blood levels of specific antioxidants including vitamins C and E, and total antioxidant status are lower in obese than non-obese individuals [15-18]. Thus, it was concluded that dietary factors represent a key component of the disease process and specific dietary constituents are considered to be important to health.
Antioxidant supplementation may therefore minimise exercise-induced oxidative stress in the vulnerable overweight and obese populations. However, evidence for this has shown conflicting results especially following administration of single antioxidant supplements which in some cases have been shown to promote pro-oxidation processes [19-22]. As a consequence, the emphasis placed on the benefits of antioxidants derived from food products has been important. Dietary polyphenols have received much attention in this regard as they have the ability to neutralize free radicals and ROS. Consumption of Green tea has been shown to effectively inhibit LDL oxidation and increase serum antioxidant activity [23,24].
Furthermore, polyphenol-rich dark chocolate alleviated blood pressure and its complications in overweight and obese individuals [25,26]. Pomegranate (Punica granatum L) provides a rich and varied source of polyphenols. Several studies have demonstrated that consumption of pomegranate juice can exert positive effects on cardiovascular risk; hypertension, atherosclerosis, endothelial dysfunction and inflammation [27-33]. In addition, some researchers have shown that PJ consumption reduces carotid intima-media thickness and blood pressure [34]. As powerful antioxidants, phenolics may protect the body from damaging oxidation reactions [37-39] however other mechanisms may also operate which are currently under investigation. In a limited study of hypertensive patients, consumption of pomegranate juice for two weeks was shown to reduce systolic blood pressure by inhibiting serum angiotensin-converting enzyme [38]. Obesity and diabetes are other underlying factors linked to metabolic and cardiovascular risk [39,40], as well as abnormal cortisol levels and metabolism [41-43].
The importance of cortisol in regulating blood pressure has been highlighted in several conditions, and Chronic excessive activation of the glucocorticoid receptor (GR) is known to induce obesity, insulin resistance, glucose intolerance and hypertension [42, 44, 45] In Glucocorticoids exert a direct effect on the heart and blood vessels via 11β HSD enzymes type 1 and 2. Increased 11β HSD-1 activity is implicated in the development of the metabolic syndrome and identifying dietary constituents that influence 11β HSD-1 activity could lead to novel methods of preventing CVD and associated risk factors. The association between excess cortisol and various parameters of the metabolic syndrome, including hypertension and insulin resistance, is now increasingly recognised [45,46]. The purpose of this study was to determine whether consumption of polyphenol-rich pomegranate juice lowers oxidative stress in healthy overweight adults following a single acute bout of moderate intensity exercise. A secondary purpose was to determine whether blood pressure and urinary glucocorticoids are attenuated by pomegranate juice supplementation in this population.
Methods and protocols
Free-living male and female volunteers (n = 24) who were apparently healthy participated in this study. Subjects were recruited from the University following an advertisement through the internal moderator email system. All participants had to meet the following criteria before enrolment in the study: no participation in regular physical activity (vigorous exercise two times or more per week); no chronic health problems or current smoking; no history of cardiovascular, metabolic, or respiratory disease and no consumption of antioxidant supplements within the past 6 months. Written informed consent was provided by each participant consistent with the university policy on the protection of human subjects. The protocol of the study was approved by the Research Ethics Committee at Queen Margaret University (UK).

Figure 1: Outline of the study protocol.

Study design
The study was a randomised, single-blind, placebo-controlled parallel group trial. All participants visited the clinical facility on two occasions where they performed a 30 minutes moderate treadmill exercise session (50% Wmax) pre and post consumption of pure PJ (500 mL daily containing 1685 mg total phenolics L-1) or placebo. During each visit anthropometric measurements were taken. Height and weight were measured using a standard medical grade scale. Waist circumference was measured using a metal measuring tape at anatomical landmarks described by the American College of Sports Medicine [47]. BMI values were determined as overweight and obese (BMI ≥ 25 kg/m2) and participants were randomised into two groups: placebo and PJ. Groups assigned to receive PJ were provided with a 500 ml bottle per day (containing 1685 mg total phenolics/L). The placebo (water) was matched for volume and energy. All liquid samples were provided to participants in dark coloured opaque bottles. The dose of polyphenols in the PJ was chosen based on previous studies that showed reductions in SBP and DBP and urinary glucocorticoids, in healthy adults [33]. Treatment was administered for a period of one week. All 24 participants completed this study.
Twenty-four-hour urine samples were collected from volunteers into sterile plastic containers after each exercise session at baseline and after 1 week of the juice or placebo intake. The weight of each collected sample of urine was measured and a 20 mL aliquot was taken and stored at -80°C until analysis.
Cortisol and cortisone levels in urine samples were estimated by using highly specific and sensitive ELISA methods previously published [48,49]. All samples from the same subject were tested on the same day to prevent any inter-day variation. The data were then used to calculate cortisol-to-cortisone ratio which serves as an index of 11β-Hydroxy steroid dehydrogenase activity. Monitoring the activity of this enzyme helps detect changes in peripheral metabolism of cortisol [46].
Thio barbituric acid reactive substances (TBARS)
The TBARS assay was performed for the assessment of oxidative stress in urine as previously described [50]. This assay quantifies the amount of malonaldehyde (MDA) formed as a result of lipid peroxidation and involves reacting samples with 2-thiobarbituric acid (TBA) under high temperatures (90-100°C) and acidic conditions. TBA reacts with a MDA to produce a stable adduct that can be quantified spectrophotometrically.
Blood pressure
A validated automated A&D Medical UA-767 BP monitor (A&D medical, San Jose, CA, USA) was used to measure BP according to Grassi., et al. [51]. Three readings of blood pressure were taken before and after each session and the average was calculated.
Dietary Analysis
A record of all food and beverage intake was monitored over the study period to assess compliance with the dietary instructions given and also to determine whether nutritional intake was different between groups. Three-day dietary records were provided to each participant with standard instructions on how to complete the record. Participants were instructed to estimate servings of foods using household measurements as described in national dietary guidance documents as previously described [52]. Diet records were assessed using Windiets™ (2011) for windows (Robert Gordon University, Aberdeen) [53] and were analysed for macronutrient, micronutrient and caloric intake.
All data are expressed as mean standard deviation. Data were analysed using the SPSS statistical program (version 21.0 for Windows; SPSS, Inc., Chicago, IL). Data collected pre and one-week post-consumption of PJ or placebo were compared and analysed by a series of paired t-tests. Significance levels were determined by p-value of ≤ 0.05. In addition, Spearman’s correlations were used to assess the possibility of an association between the change in Cortisol/ cortisone ratio and the change in blood pressure for basal and post exercise values.
Participants were recruited by email moderator advertisement at Queen Margaret University, Edinburgh. Eligible participants were aged between 18-37 years with a body mass index between 20.1 and 29.5 kg/m2. In this randomised, placebo controlled, parallel study, all 24 volunteers (12 males and 12 females) have completed the study and each consumed either 500 mL/day of Pomegreat Pure® pomegranate juice or placebo for a period of 1 week. There were no statistically significant differences observed in mean age (years); height (m); weight (kg), body mass index (kg/m2) or waist circumference (cm).
  Placebo Group (n = 12) Placebo Group (n = 12)
  Mean ± SD Range Mean ± SD Range
Age (years)
22.1 ± 4.6 20 - 34 22.8 ± 5.1 18 - 37
Weight (kg)
79.7 ± 12.8 62.7 - 105.2 70.6 ± 10.5 55.8 - 90.3
Waist circumference (cm)
89.6 ± 13.1 71 - 117 82.7 ± 11.6
68 - 110
Body mass index (kg/m2)
26.9 ± 3.8 20.6 - 29.5 25.3 ± 3.7 20.1 - 29.4
Table 1: Anthropometric characteristics of treatment (n = 12) and placebo (n = 12) participants. Results are expressed as mean values ± standard deviation (SD) and range.
One week of PJ consumption was associated with a significant reduction in both systolic and diastolic blood pressure compared with the placebo group. SBP was reduced from 136.7 ± 11.7 to 131.8 ± 8.8 mmHg (p = 0.007) and 158.8 ± 15.8 to 148.1 ± 12.3 mmHg (p < 0.01), pre and post exercise, respectively. Diastolic blood pressure decreased from 86.3 ± 10.6 to 82.5 ± 6.8 mmHg (p = 0.04) and 103.1 ± 12.5 to 93.9 ± 11.5 mmHg (p = 0.001), pre and post exercise, respectively.
Figure 2: Effect pomegranate juice and placebo intake on SBP and DBP pre and post exercise in healthy volunteers.
Urinary levels of TBARS were significantly reduced, from 31.2 ± 10.6 to 26.5 ± 9.8 MDA µmole/day (p = 0.035) following 1 week of pomegranate juice consumption. There were no significant changes observed in markers of lipid peroxidation or blood pressure following the placebo arm of the study.
  Treatment Group (n = 12) Placebo Group (n = 12)
  Pre-exercise Post-exercise Pre-exercise Post-exercise
Post Intervention
Baseline 136.7 ± 11.5

131.8 ± 8.8 *
158.8 ± 15.8

148.1 ± 12.3**
130.1 ± 14.1

131.7 ± 13.2
144.5 ± 11.7

145.1 ± 19.9
Post Intervention
baseline 86.3 ± 8.1

82.5 ± 6.8+
103.1 ± 12.5

93.9 ± 11.5
85 ± 11.8

84.4 ± 9.4
92.1 ± 12.6

93.3 ± 10.5
Table 2: Systolic and Diastolic blood pressure (mmHg), pre and post exercise of participants consuming 500 ml/day PJ for 1-week (n = 12) and from a placebo group (n = 12).
Statistical significance within each group based on paired t-test: *P = 0.01, **P < 0.01, ‡P = 0.001, + P=0.04. Results are expressed as mean values ± SD, where n = 12.
Urinary free cortisol was reduced from 179.4 ± 53.2 to 125.6 ± 43.5 nmole/24h which was significant (p = 0.042). In addition, there was a statistically significant increase in urinary free cortisone: from 112.2 ± 40.4 to 187.6 ± 90.2 nmole/24 h (p = 0.045). Calculation of the cortisol/cortisone ratio in urine were found to be significantly decreased (p = 0.009) from 1.6 ± 1.1 to 0.67 ± 0.55 following one week of pomegranate juice intake (see Table 3 and figure 3). Spearman’s correlations were run between the Ratio of cortisol/cortisone and change in SBP (SBP Difference) and DBP (DBP Difference) in pre and post exercise of the pomegranate group.
  Treatment Group (n = 12) Placebo Group (n = 12)
Parameter Baseline After 1-week Baseline After 1-week
TBARS (µmole/day) 31.2 ± 10.6 26.5 ± 9.8* 27.1 ± 8.4 28.7 ± 10.7
Free Cortisol (nmole/day) 179.4 ± 53.2 125.6 ± 43.5* 166.6 ± 71.5 191.2 ± 93.7
Free Cortisone (nmole/day) 112.2 ± 40.4 187.6 ± 90.2* 125.5 ± 49.5 136.4 ± 53.8
Ratio: Cortisol/cortisone 1.598 ± 1.1 0.669 ± 0.55** 1.33 ± 0.44 1.41 ± 0.48
Table 3: Glucocorticoids; free cortisol and cortisone (nmoles/24 h) and thiobarbituric acid-reactive substances (TBARS) (µmole/day) in urine of participants consuming 500 mL PJ daily for 1-week (n = 12) and from a placebo group (n = 12).
Statistical significance within each group based on paired t-test: * P < 0.05 and **P < 0-01. Results are expressed as mean values ± standard deviation (SD), where n = 12.
Urinary free cortisol was reduced from 179.4 ± 53.2 to 125.6 ± 43.5 nmole/24h which was significant (p = 0.042). In addition, there was a statistically significant increase in urinary free cortisone: from 112.2 ± 40.4 to 187.6 ± 90.2 nmole/24 h (p = 0.045). Calculation of the cortisol/cortisone ratio in urine were found to be significantly decreased (p = 0.009) from 1.6 ± 1.1 to 0.67 ± 0.55 following one week of pomegranate juice intake (see Table 3 and figure 3). Spearman’s correlations were run between the Ratio of cortisol/cortisone and change in SBP (SBP Difference) and DBP (DBP Difference) in pre and post exercise of the pomegranate group.
The data showed that the following pomegranate juice intake, there was a negative correlation between the ratio of free cortisol/cortisone and the drop in blood pressure.
    ∆ SBP- Basal ∆ DBP- Basal ∆ SBP Post ∆ DBP Post    
Ratio Cortisol/cortisone Correlation Coefficient -0.347 -0.231 -0.490* -0.573**    
  Sig. (2-tailed) 0.133 0.326 0.028 0.008    
  N 12 12 12 12    
Table 4: pearman’s correlations between the cortisol/cortisone ratio versus the drop in SBP and DBP(∆ change) at basal and post intervention group. N = 12.
** Correlation is significant at the 0.01 level (2-tailed). * Correlation is significant at the 0.05 level (2-tailed).
Body Mass Index and Waist Circumference
There was no significant change in either BMI or WC in both study groups after the 7 days’ intervention period. (BMI- Intervention: 26.72kg/m2 - 26.85 kg/m2 p = 0.278, Control: 25.67kg/m² - 25.61 kg/m² p = 0.509.) (WC- Intervention: 89.8 cm - 89.5 cm p = 0.810, Control: 82.6 cm - 82.7 cm). The analysis of the food diary during the phases of our study showed that there was a comparable intake of total energy and macronutrients in both the PJ and placebo groups suggesting that their food intake did not influence the physiological and biochemical parameters studied.
Figure 3: Effect pomegranate juice and placebo intake on the 24hour urinary cortisol/cortisone ratio in healthy volunteers.
The present study was conducted to investigate the effect of polyphenol-rich pomegranate juice on the cardio-metabolic and oxidative stress effects in healthy male and female overweight participants following an acute bout of moderate intensity exercise. Daily consumption of PJ for 1 week significantly reduced lipid peroxidation (measured as MDA) post-exercise. The substrate used, MDA, is known as a marker of oxidative stress as it is a product of the oxidative degradation of polyunsaturated lipids. In contrast to this, those individuals drinking placebo showed no significant change in their levels of lipid Peroxidation. This therefore highlights that pomegranate juice did produce a reduction in oxidative damage of lipids which in turn shows a reduction in levels of oxidative stress. Oxidative stress has been linked to a growing list of conditions in which a more preventative approach is desirable [54].
Two previous studies have shown a reduction in lipid peroxidation. Research into polyphenols in red fruit juice concluded similar results relating to oxidative stress. For example, patients undergoing haemodialysis and due to their conditions were deemed to be at higher risk of many conditions related to oxidative stress. Following the consumption of 200 ml/day of red fruit juice containing a high level of polyphenols for 4 weeks, researchers found concentrations of the lipid Peroxidation marker MDA were significantly lowered (p = 0.001) [35]. A similar study also looked at a heavy smokers group over the age of 50 years who also had increased risk of oxidative stress and involved a randomized double blind cross over trial. They were given a polyphenol rich grape seed extract (in tablet form) for 4 weeks and the results showed that the supplements significantly improved low density lipoprotein cholesterol resistance to oxidation by using TBARS assays [55]. Another study used green tea extracts showed similar results in rats after being treated with green tea extracts for 30 days and were found to have a significantly reduced level of MDA post the intervention period [56].
The results of participant’s blood pressure and heart rate measures show promising links between pomegranate juice supplementation and an improvement in general exercise performance. Those in the intervention group had a significant decrease in systolic blood pressure prior to undertaking exercise after one week of drinking the juice whereas the control group showed no such significant decrease. In addition, the pomegranate juice appeared to significantly lower the heart rate of individuals after the 30 minutes of exercise (data not shown), whereas the control group did not show a significant reduction. Similar studies using green tea polyphenols have concluded comparable results with overall reduction in blood pressure (both systolic and diastolic) after consumption of green tea [57,58] and polyphenols found in red wine caused a reduction in overall blood pressure in normotensive subjects [59].
Cortisol is regarded to be one of the important factors in regulating blood pressure, and this has been highlighted in several cases of hypothalamic pituitary adrenal axis conditions, and chronic excessive activation of the glucocorticoid receptor (GR) is known to induce obesity, insulin resistance, glucose intolerance and hypertension [41]. Glucocorticoids exert a direct effect on the heart and blood vessels via 11β-HSD enzymes type 1 and 2. Increased 11β HSD-1 activity is implicated in the development of the metabolic syndrome, type 2 diabetes and obesity, and identifying dietary constituents that can modulate 11β HSD-1 activity could lead to novel methods of preventing CVD and associated risk factors. The association between excess cortisol and various parameters of the metabolic syndrome, including hypertension and insulin resistance, has now been increasingly recognised [42,43]. One of the main objectives of this study was to investigate whether the drop in blood pressure might be caused by inactivation of 11ß-HSD1 enzyme which converts cortisone to the active steroid, cortisol. Plasma cortisol is an important factor in blood pressure regulation and it can also exert negative effects on the cardiovascular system at an autocrine level. There are 2 isozymes of 11ß-HSD that catalyse the interconversion of active cortisol and inactive cortisone. We have shown that PJ intake has the potential of inhibiting 11β-HSD type1 enzyme activity as evident by the reduction in the cortisol/cortisone ratio in both urine and saliva [60] dark grape paper. The role of this enzyme in hypertension has been previously reported, for example in the syndrome of apparent mineralocorticoid excess [61]. Our results showed that there was a negative correlation between the ratio of cortisol/cortisone (indicative of 11ß-HSD1 enzyme activity) and the difference in SBP and DBP pre and post exercise only for those who consumed the pomegranate juice.
Previous research has suggested that antioxidants can protect human cells within the body against damage that can cause diseases such as CVD, diabetes, cancer and other illness and in healthy young and older people [33,62-64] and in mice [65]. This study was carried out as a pilot crossover placebo controlled design to investigate the effects of increasing antioxidant consumption on exercise-induced oxidative stress in healthy volunteers. Participants consuming the pomegranate juice high in antioxidants for a week increased the urinary total antioxidant content levels and significantly decreased lipid peroxidation as measured by the TBARS assay following the juice intake. Zern and colleagues [66] have also reported a cardio protective effect for grape juice in Pre- and Postmenopausal women by lowering plasma lipids and ROS. The body generally has sufficient stores of antioxidant defense to deal with the free radicals and allow the cells to function normally. However, when it is exposed to many factors that cause oxidative stress such as tobacco smoke and other air pollutants (motor vehicles), combined with exercise that is known to induce oxidative stress, the production of these free radical’s increases.
This may lead to the defense system working ineffectively causing cell damage, especially if there is a deficiency of antioxidants [67]. As suggested by previous evidence, it is believed that people that partake in regular exercise have a higher antioxidant capacity [68-70]. In our study, the marker of oxidative stress, TBARS was significantly reduced in the group consuming the pomegranate juice following the exercise bout. However, the group who drank the placebo did not show an improvement in TBARS levels.
There is still a lack of evidence that exercise-induced oxidative stress and antioxidant supplementation can affect sporting performance [67]. In 1978, Dillard., et al. [71] were the first to discover a link between exercise and oxidative stress. They found that there was an increase in exhaled pentane levels after cycling for one hour. Pentane is a possible by-product of oxidative damage. This evidence has been supported by several studies carried out since then. A study by Bejma and Ji [72] involving both young and old rats found that there was an increase in reactive oxygen species (ROS) production due to exercise in both groups. However, it was discovered that heart ROS production was increased in the older rats only. This suggests that the effect on heart oxidative stress may be age related. As we get older it is believed that the body defence system works less efficiently against the production of ROS. The rate of lipid peroxidation in the muscle increases as we age and evidence has shown that as the antioxidants are not sufficient enough to cope with this increase. This suggests that the elderly is more prone to cell damage due to oxidative stress and therefore may benefit from an increase in antioxidants in the diet [70]. Indeed, Jackson and McArdle [73] reported age-related changes in skeletal muscle reactive oxygen species generation and adaptive responses to reactive oxygen species. By performing regular exercise training, it is thought that oxidative stress capacity can be increased, along with enzymatic antioxidant defence against free radicals. Although, training does stimulate the release of antioxidant enzymes, it is thought that vitamin E is needed by the muscle during intense exercise [70]. However, a study was carried out investigating antioxidant response during exhaustive exercise. This study suggested that intense exercise over a prolonged period of time can cause such a rapid increase in the production of free radicals that can be too intense for the antioxidant defence system and thus result in tissue damage [2]. Garcia- Alonso., et al. [74] supported this hypothesis when they looked into the short term effect of consuming a juice high in polyphenols and also discovered that lipid peroxidation was reduced. Another study carried out by Morillas-Ruiz and colleagues [75] looked into the effect of polyphenolic antioxidants on exercise- induced oxidative stress and reported that consuming high levels of polyphenols whilst exercising had a positive effect on markers of oxidative stress.
Our study had some limitations for example, the small sample size. A larger sample size would be essential. Due to the small sample and the method of recruitment, the age range of participants was low, with only one volunteer being over the age of 25. However, a good range of other attributes of the participants including BMI, WC, and blood pressure. The design of the study was planned to last foe only one week which is a very short timescale due to time restrictions of the study. The lack of time also affected the amount of samples that could be collected and analysed which meant no urine samples were collected prior to the initiation phase to provide a basal measurement of antioxidant capacity and total Phenolic levels. The protocol was constructed for participants to drink 500 mL of pomegranate juice daily, which showed significant benefits. However, this might be impractical, and future studies could perhaps involve the same process but with the pomegranate juice in a smaller quantity, or a different form (tablet or capsule) to enable this to become promoted as a realistic health supplement. Some potential participants were embarrassed by the concept of collecting 24hour urine samples and thought it would be too time consuming, restrict their movement and social life. Several volunteers had social events due to the festive period which meant that they were unable to exercise or consume the required amount of juice for that day. Although participants were given a list of foods rich in polyphenols to restrict their intake during the study, this may not have been precisely followed.
Our results suggest that pomegranate juice consumption moderates exercise-induced oxidative stress and reduces systolic and diastolic blood pressure. This may be due to the inhibition of 11 βHSD type 1 activity as evidenced by the reduction in the cortisol/cortisone ratio or other mechanisms yet to be investigated. The results as well as those of similar research in this area provide a definitive need for these benefits to be explored further. With cardiovascular disease and various cancers being the leading cause of death in the U.K, preventative measures with diet intervention showing signs to be the key to reduce CVD risk.
Conflict of interest statement
The authors have declared no conflict of interest and nothing to disclose. EASAD was responsible for designing, conducting the research and statistical analysis and preparing the manuscript. CT provided essential reagents and assisted with antioxidant analyses. GG has recruited the volunteers and performed the anthropometrical measurements.
We would like to thank all the participants who took part in this study. The authors are grateful for Pomegreat, UK for supplying the pomegranate pure juice.
  1. Clarkson P and Thompson H. “Antioxidants-what role do they play in physical activity and health?” American Journal of clinical nutrition 72.2 (2000): 637S-646S.
  2. Aguilo A., et al. “Antioxidant response to oxidative stress induced by exhaustive exercise”. Physiology & Behaviour 84.1 (2005): 1-7.
  3. Ji LL. “Antioxidants and oxidative stress in exercise”. Proceedings of the Society for Experimental Biology and Medicine”. 222.3 (1999): 283-292.
  4. Sies., et al. “Oxidative stress: damage to intact cells and organs”. Biological sciences 311.1152 (1985): 617-631.
  5. Vincent HK.,et al. “Obesity exacerbates oxidative stress levels after acute exercise”. Medicine & Science in Sports & Exercise 36.5 (2004): 772-779.
  6. Vincent HK., et al. “Obesity and post-exercise oxidative stress in older women”. Medicine & Science in Sports & Exercise 37.2 (2005): 213-219.
  7. Rahmouni K., et al. “Obesity-Associated Hypertension, new insights into mechanisms”. Hypertension 45.1 (2005): 9-14.
  8. Fontana S and Klein S. “Aging, adiposity and calorie restriction”. JAMA 297.9 (2007): 986-994.
  9. Ginsberg HN and Maccallum P. “The obesity, metabolic syndrome and type 2 diabetes mellitus pandemic: Part 1. Increased cardiovascular disease risk and the importance of atherogenic dyslipidemia in persons with the metabolic syndrome and type 2 diabetes metllitus”. Journal of Cardiometabolic Syndrome 4.2 (2009): 113-119.
  10. Koskal H, Kurban S. “Total oxidant status, total antioxidant status and Paraoxonase and Arylesterase activities during laparoscopic cholecystectomy”. Clinics (Sao Paulo) 65.3 (2010): 285-290.
  11. Folsom AR., et al. “C-reactive protein and incident of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) study”. American Heart Journal 144.2 (2002): 233-238.
  12. Saadeddin SM., et al. “Markers of inflammation and coronary artery disease”. Medical Science Monitor 8.1 (2002): RA5-RA12.
  13. Kuno T., et al. “Antioxidant vitamin levels in plasma and low density lipoprotein of obese girls”. Free Radical Biology & Medicine 28.1 (1998): 81-86.
  14. Ohrvall M., et al. “Lower tocopherol serum levels in subjects with abdominal adiposity”. Journal of Internal Medicine 234.1 (1993): 53-60.
  15. McAnulty SR., et al. “Effect of alpha-tocopherol supplementation on plasma homocysteine and oxidative stress in highly trained athletes before and after exhaustive exercise”. Journal of Nutritional Biochemistry 16.9 (2005): 530-537.
  16. Brigelius-Flohe and Traber. “Vitamin E: function and metabolism”. FASEB Journal 13.10 (1999): 1145-1155.
  17. Sies and Stahl. “Vitamin C and E, Beta-carotene and other carotenoids as antioxidants”. American Journal of Clinical Nutrition 62 (6 Suppl) (1995): 1315-1321.
  18. Meydani M., et al. “Protective effect of vitamin E on exercise-induced oxidative damage in young and older adults”. American Journal of Clinical Nutrition 60.5 pt 2 (1993): 704-709.
  19. Halliwell B and Gutteridge JMC. “Lipid peroxidation, oxygen radicals, cell damage and antioxidant therapy”. Lancet 1.8391 (1984): 1396-1397.
  20. Van Gaal LF., et al. “The in vitro oxidizability of lipoprotein particles in obese and non-obese subjects”. Atherosclerosis 137 Suppl (1998): S39-S44.
  21. Hollman PCH., et al. “The Biological Relevance of Direct Antioxidant Effects of Polyphenols for Cardiovascular Health in Humans is not established”. Journal of Nutrition 141.5 (2011): 989S-1009S.
  22. Barbosa KB., et al. “Influence of Dietary intake on plasma biomarkers of oxidative stress in humans”. Anales del Sistema Sanitario de Navarra 31.3 (2008): 259-280.
  23. Yokozaw T., et al “Antioxidant activity of green tea polyphenol in cholesterol-fed rats”. Journal of Agriculture and Food Chemistry 50.12 (2000): 3549-3552.
  24. Srividhya R., et al. “Attenuation of senescence induced oxidative exacerbations in aged rat brain by EGCG”. International Journal of Dev Neuroscience 26.2 (2008): 217-223.
  25. Almoosawi C Tsang., et al. “Differential effect of polyphenol-rich dark chocolate on biomarkers of glucose metabolism and cardiovascular risk factors in healthy, overweight and obese subjects: a randomized clinical trial”. Food and Function 3.10 (2012): 1035-1043.
  26. Almoosawi S., et al. “The effect of polyphenol-rich dark chocolate on fasting capillary whole blood glucose, total cholesterol, blood pressure and glucocorticoids in healthy overweight and obese subjects”. British Journal of Nutrition 103.6 (2010): 842-850.
  27. Aviram M., et al. “Pomegranate juice consumption reduces oxidative stress, atherogenic modifications to LDL, and platelet aggregation: studies in humans and in atherosclerotic apolipoprotein E-deficient mice”. The American Journal of Clinical Nutrition 71.5 (2000): 1062-1076.
  28. Arun N and Singh D. 2012. “Punica granatum: a review on pharmacological and therapeutic properties”. IJPSR 3.5 (2012): 1240-1245.
  29. Asgary S., et al. “Clinical investigation of the acute effects of pomegranate juice on blood pressure and endothelial function in hypertensive individuals”. ARYA Atherosclerosis 9.6 (2013): 326.
  30. Asgary S., et al. “Clinical Evaluation of Blood Pressure Lowering, Endothelial Function Improving, Hypolipidemic and Anti‐Inflammatory Effects of Pomegranate Juice in Hypertensive Subjects”. Phytotherapy Research 28.2 (2014): 193-199.
  31. Basu A and Penugonda K. “Pomegranate juice: a heart-healthy fruit juice”. Nutrition Reviews 67.1 (2009): 49-56.
  32. De Nigris F., et al “Pomegranate juice reduces oxidized low-density lipoprotein downregulation of endothelial nitric oxide synthase in human coronary endothelial cells”. Nitric Oxide 15.3 (2006): 259-263.
  33. Tsang C., et al. “Polyphenol rich pomegranate pure juice intake influences blood pressure, glucocorticoids, arterial compliance and HOMA-IR in healthy volunteers”. Journal of Nutritional Science 1 (2012): e9.
  34. Davidson MH., et al. “Effects of consumption of pomegranate juice on carotid intima–media thickness in men and women at moderate risk for coronary heart disease”. The American Journal of Cardiology 104.7 (2009): 936-942.
  35. Spoorman TM., et al. “Anthocyanin/polyphenolic-rich fruit juice reduced oxidative cell damage in an intervention study in patients on haemodialysis”. Cancer epidemiology and Biomarkers and prevention 17.12 (2008): 3372-3380.
  36. Elsayed NM. “Antioxidant mobilization in response to oxidative stress: a dynamic environmental-nutritional interaction”. Nutrition 17.10 (2001): 828-834.
  37. Ananga A., et al. “Manipulation of engineering of metabolic and biosynthetic pathway of plant polyphenols”. Current Pharmaceutical Design 19.34 (2013): 6186-6206.
  38. Avriam M and Dornfield L. Pomegranate juice consumption inhibits serum angiotensin converting enzyme activity and reduces systolic blood pressure”. Atherosclerosis”. 158.1 (2001): 195-198.
  39. Bastien M., et al. “Overview of epidemiology and contribution of obesity to cardiovascular disease”. Progress in Cardiovascular Diseases 56.4 (2014): 369-381.
  40. Decorde K., et al. “Chardonnay grape seed procyanidin extract supplementation prevents high-fat diet-induced obesity in hamsters by improving adipokine imbalance and oxidative stress markers”. Molecular Nutrition & Food Research 53.5 (2009): 659-666.
  41. Walker BR., et al. “Glucocorticoids and blood pressure: a role for the cortisol/cortisone shuttle in the control of vascular tone in man”. Clinical Science 83.2 (1992): 171-178.
  42. Duclos M., et al. “Increased cortisol bioavailability, abdominal obesity and the metabolic syndrome in obese women”. Obesity Research 13.7 (2005): 1157-1166.
  43. Kidambi S., et al. “Association of adrenal steroids with hypertension and the metabolic syndrome in blacks”. Hypertension 49.3 (2007): 704-711.
  44. Vicennati V and Pasquali R. “Abnormalities of the hypothalamic-Pituitary-Adrenal Axis in non-depressed women with abdominal obesity and relations with insulin resistance: evidence for a central and a peripheral alteration”. Journal of Clinical Endocrinology & Metabolism 85.11 (2000): 4093-4098.
  45. Tomlinson JW., et al. “Impaired glucose tolerance and insulin resistance are associated with increased adipose 11beta-hydroxysteroid dehydrogenase type 1 expression and elevated hepatic 5alpha-reductase activity”. Diabetes 57.10 (2008): 2652-2660.
  46. Palermo M., et al. “Urinary free cortisone and the assessment of 11B-hydroxysteroid dehydrogenase activity in man”. Clinical Endocrinology (Oxford) 45.5 (1996): 605-611.
  47. American College of Sports Medicine. ACSM’s Guidelines for exercise testing and prescription. 6th Ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2000.
  48. EA Al-Dujaili., et al “Validation and application of a highly specific and sensitive ELISA for the estimation of cortisone in saliva, urine and in vitro cell-culture media by using a novel antibody”. Steroids 77.6 (2012) 703-709.
  49. Al-Dujaili., et al. “Liquorice and glycyrrhetinic acid increase DHEA and deoxycorticosterone levels in vivo and in vitro by inhibiting adrenal SULT2A1 activity”. Molecular and Cellular Endocrinology 336.1-2 (2011): 102-109.
  50. uege JA and Aust SD. “Microsomal lipid peroxidation”. Methods in Enzymology 52 (1978): 302-310.
  51. Grassi D., et al. “Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons”. American Journal of Clinical Nutrition 81.3 (2005): 611-614.
  52. FSA nutrient and food based guidelines for UK institutions 2007.
  53. WinDiets software, 2011. Robert Gordon University, Aberdeen, UK.
  54. Aruoma OL., et al. “Low Molecular Procinthocyanidin dietary biofactor Oligonol: Its modulation of Oxidative stress, bioefficacy, neuroprotection, food application and chemoprevention”. Bio factors 24.1-4 (2006): 245-265.
  55. Constantini VGB and Aldini G. “Effect of a standardised grape seed extract on low density lipoprotein susceptibility to oxidation in heavy smokers”. Metabolism 52.10 (2003): 1250-1257.
  56. Srividhya R., et al. “Attenuation of senescence-induced oxidative exacerbations in aged rat brain by (−)-epigallocatechin-3-gallate”. International Journal of Developmental Neuroscience 26.2 (2008): 217-223.
  57. Potenza MA., et al. “EGCG, a green tea polyphenol, improves endothelial function and insulin sensitivity, reduces blood pressure, and protects against myocardial I/R injury in SHR”. American Journal of Physiology - Endocrinology and Metabolism 292.5 (2007): E1378-E1387.
  58. Peng X., et al. “Effect of green tea consumption on blood pressure: A meta-analysis of 13 randomized controlled trials”. Scientific Reports 4 (2014): 6251.
  59. Penchanova O., et al. “Red wine polyphenols prevent cardiovascular alterations in L-NAME induced hypertension”. Journal of Hypertension 22.8 (2004): 1551-1559.
  60. Al-Dujaili EAS., et al. "The Effect of Dark Grape Juice Consumption on Exercise-Induced Oxidative Stress in Healthy Adults Aged 41 to 60 Years”. EC Nutrition 1.4 (2015): 217-228.
  61. Edwards CR., et al. “Localisation of 11beta- 19 hydroxysteroid dehydrogenase tissue specific protector of the mineralocorticoid receptor”. Lancet 2.8618 (1988): 986-989.
  62. Hyson DA. “A Review and Critical Analysis of the Scientific Literature Related to 100% Fruit Juice and Human Health”. Advances in Nutrition 6 (2015): 37-51.
  63. Bjelakovic G., et al. “Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases”. Cochrane Database of Systematic Reviews 14.3 (2012): CD007176.
  64. Krikorian R., et al. “Blueberry Supplementation Improves Memory in Older Adults”. Journal of Agricultural and Food Chemistry 58.7 (2010): 3996-4000.
  65. Gordillo G., et al. “Oral Administration of Blueberry Inhibits Angiogenic Tumor Growth and Enhances Survival of Mice with Endothelial Cell Neoplasm”. Antioxidants & Redox Signalling 11.1 (2009): 47-58.
  66. Zern TL., et al. “Grape Polyphenols Exert a Cardioprotective Effect in Pre- and Postmenopausal Women by Lowering Plasma Lipids and Reducing Oxidative Stress”. Journal of Nutrition 135.8 (2005): 1911-1917.
  67. Powers SK., et al. “Reactive oxygen species are signalling molecules for skeletal muscle adaptation”. Experimental Physiology 95.1 (2010): 1-9.
  68. Powers SK., et al. “Reactive oxygen and nitrogen species as intracellular signals in skeletal muscle”. Journal of Physiology 589.9 (2011): 2129-2138.
  69. Jacob RA and Burri BJ. “Oxidative damage and defence”. Clinical Nutrition 63.6 (1996): 985-990.
  70. Dillard CJ., et al. “Effects of exercise, vitamin E, and ozone on pulmonary function and lipid peroxidation”. Journal of Applied Physiology 87 (1978): 2032-2036.
  71. Dillard CJ., et al. “Effects of exercise, vitamin E, and ozone on pulmonary function and lipid peroxidation”. Journal of Applied Physiology 87 (1978): 2032-2036.
  72. Bejma J and Ji LL. “Aging and acute exercise enhance free radical generation in rat skeletal muscle”. The American Physiological society 87.1 (1999): 465-470.
  73. Jackson MJ and McArdle A. “Age-related changes in skeletal muscle reactive oxygen species generation and adaptive responses to reactive oxygen species”. Journal of Physiology 589.9 (2011): 2139-2145.
  74. Garcia-Alonso J., et al. “Acute intake of phenolic-rich juices improves antioxidant status in healthy subjects”. Nutrition Research 26.7 (2006): 330-339.
  75. Morillas-Ruiz JM., et al. “Effects of polyphenolic antioxidants on exercise-induced oxidative stress”. Clinical Nutrition 25.3 (2006): 444-453.
Copyright: © 2016 Emad A S Al-Dujaili., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

January Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before February 14, 2023.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.