The present study showed no signifcant diference in hand grip strength in this observational study with lifestyle intervention. Overall, a decline in anthropometric measurements and cardiometabolic risk factors, including weight gain and high stress levels was observed, to a degree that would be expected with an energy-restricted diet intervention . The total weight and waist circumference decreased to a signifcantly greater extent in the RDP group than in the control group. Nevertheless, future long-term trials are required to present evidence-based recommendation regarding the beneficial effects of RDP on further body profles. Finally, regarding the effects of RDP on hand-grip strength, despite similar changes in HGS in both groups, the study group presented slightly greater improvements in strength when compared with the control group over 10 wk. However, further comprehensive RCTs are necessary in order to institute a quantifable implication of RDP consumption on carbohydrate absorption because statistical diferences have been seen. There were some draw-backs to this study. Although the sample size of eight was enough to verify the statistically signifcant effects on the fundamental outcomes, this number was not representative of the general population as a whole, particularly because it did not include individuals from dissimilar demographic and dietary backgrounds. Furthermore, the study was of a relatively short duration . Longer-term studies are required to establish whether the effects can be sustained over a longer period. This would require continued consumption of the rainbow diet for a longer duration.
Listeria monocytogenes is a bacterial foodborne pathogen implicated in sporadic cases, outbreaks,best grow pots and food recalls worldwide. Infection can be asymptomatic or cause a range of diseases from mild gastroenteritis in immunocompetent individuals to invasive disease in high-risk groups including the elderly, children, immunocompromised individuals, and pregnant women . Pregnancy-associated listeriosis can result in preterm birth, miscarriage, or stillbirth . Recent large-scale events such as the outbreak that occurred in South Africa from 2017 to 2018 have garnered renewed interest inthe potential for widespread disease. This may be facilitated by changes in food production and distribution processes . The outbreak in South Africa was the largest Listeria outbreak to date, with more than 1000 laboratory-confirmed cases and more than 200 fatalities . A ready-to-eat, processed meat product called polony was identified as the source using whole-genome sequencing . The outbreak strain was also identified in the manufacturer processing environment of the implicated product. Recalls were subsequently issued in South Africa and 15 other African countries to which the product was distributed , 2019. In the USA, whole cantaloupe melons from a single farm were associated with a large, multistate outbreak in 2011 . This event caused the most deaths from an outbreak of foodborne illness in the USA in more than 80 years . Modern day food systems are diverse and complex. The global movement of foods, processing supplies, and ingredients, coupled with the ability of Listeria to persist and multiply, facilitate the spread of contaminated products across borders, often resulting in mass recalls. Food recalls are not only a public health issue, but can also cause significant economic losses.
In the past, foods most commonly identified as vehicles of L. monocytogenes transmission included unpasteurized milk and dairy products, soft cheese varieties , cooked ready-to-eat sausages and sliced meats , refrigerated smoked seafood, and refrigerated pâtés or meat spreads. Over the last decade, several novel food vehicles have been implicated in listeriosis outbreaks and recalls, such as raw sprouts and the previously mentioned whole cantaloupe melons . Although L. monocytogenes infection is a mandated notifiable disease in some countries, this is not the case in many others. As of 2016, data from European countries that collect information on L. monocytogenes infections reported 2555 confirmed listeriosis cases in the European Union /European Economic Area , with the highest rates detected in infants below 1 year of age and among elderly people over 64 years of age . In France, which has a robust national surveillance system, 375 cases were reported in 2016 . Similarly, the USA reported 675 confirmed cases in 2014 . Listeriosis is more often a sporadic illness, as was illustrated in a report from the Foodborne Diseases Active Surveillance Network in the USA . When national surveillance data are lacking, informal disease surveillance systems provide an opportunity to understand epidemiological trends, particularly in cross-border settings. ProMED, the Program for Monitoring Emerging Diseases, is based on informal disease surveillance, which allows it to gather information on a variety of emerging and re-emerging diseases and disseminate this information more rapidly than traditional surveillance systems .
Using publicly available data to document trends in Listeria epidemiology may translate into valuable information for food safety enhancement, particularly in settings where foodborne disease surveillance is weak or non-existent. The purpose of this study was to better characterize global L. monocytogenes events through an analysis of ProMED reports over time.ProMED, the Program for Monitoring Emerging Diseases, is an infectiousdisease surveillancenetwork establishedin1994.ProMED currently hosts50 subjectmatterexpertslocated in 35countrieswho actively monitor media, professional networks, and other informal data sources to detect the earliest warning signs of an emerging infectious disease or toxic exposure event. ProMED followers often submit reports of cases or findings as well.The subjectmatterexperts provide expert commentary, supply references to previous reports and scientific literature, and put reports in perspective for a diverse audience. ProMED focuses primarily on the reporting of emerging and re-emerging outbreak events that are of global concern, unusual, or in excess of what would normally be expected in a particular region or country. It is used daily by public health leaders, government officials, physicians, veterinarians, researchers, private companies, journalists, and the general public. ProMED is independent, transparent, and committed to the open sharing of data. Meta-tagged information and full-text ProMED reports are stored in a central database with more than 55 000 individual records at present.For the purpose of this study, an outbreak of listeriosis was defined as an event associated with two or more cases. Given the limitations of informal disease surveillance data, definitive linkage of isolates through molecular subtyping was not reported on ProMED for some outbreak events. A single case, even if demonstrably related to a particular Listeria-contaminated food, was classified as sporadic if no other cases were identified. Either of these categories may have been associated with food recalls. The term ‘implicated food vehicles’ refers to food vehicles potentially linked to clinical cases.
Precautionary food recalls were defined as recalls of food contaminated with Listeria with no reported human cases. Collectively, outbreaks, sporadic cases, and precautionary recalls were labeled ‘events’.Foods most commonly identified as vehicles of L. monocytogenes transmission include unpasteurized milk and dairy products, soft cheese varieties ,plants in pots ideas cooked ready-to-eat sausages and sliced meats , refrigerated smoked seafood, and refrigerated pâtés or meat spreads. For the purpose of this analysis, any additional food vehicles were defined as ‘novel’ items linked to Listeria transmission. International events were defined as involving two or more countries. In the case of precautionary recalls,contaminated food sources not traditionally associated with Listeria recalls were labeled ‘novel food sources’.Rates of multinational events per total number of Listeria events and rates of events linked to non-traditional food vehicles per total Listeria events reported in ProMED each year were calculated to ensure that trends were not due to changes in the total number of ProMED Listeria reports over time. The rates of Listeria events during different time periods were compared using a normal approximation to the Poisson distribution. Microsoft Excel and Stata were used for the statistical analysis. An α level of 0.05 was used and a p-value of <0.05 was considered to be statistically significant.One hundred and twenty-six Listeria events from 30 countries were identified in the ProMED database. Three reports described events involving domestic animals or pets and were excluded from further analysis. Study characteristics are summarized in Table 1. Of the remaining 123 events, 94 were associated with human cases, while 29 were categorized as a precautionary food recall due to the presence of bacterial contamination without associated human case. Of the 94 cases associated with human cases, 81 were associated with two or more human cases and 13 events were associated with one human case . Figure 1 demonstrates the number of Listeria-associated events reported in ProMED per year. Casefatality rates associated with Listeria infection from ProMED reports were 20%. Although this is similar to the 20–30% worldwide CFR for listeriosis estimated by the US Centers for Disease Control and Prevention, it is likely an underestimate, as the last ProMED post for some outbreaks may not have reported final outcome data .Food vehicles were identified in 69 Listeria outbreak events and in 10 sporadic case events reported in ProMED. Of note, 28 events implicated novel food vehicles or identified contaminated foods not traditionally recognized in precautionary recalls . Table 2 demonstrates a list of novel food vehicles and contaminated foods linked to Listeria events identified in the ProMED database. For example, listeriosis outbreaks involving fruits such as cantaloupe melons, stone fruits , and caramel apples were reported, as were outbreaks related to desserts such as ice cream and profiteroles. The number of Listeria events associated with novel food vehicles or contaminated foods increased over time .
Rates of Listeria events linked to novel food vehicles per total number of Listeria events reported in ProMED each year were calculated and compared over three time periods, starting in 1998. Rates increased from 0.06 to 0.28 , an overall increase of 366% .Twenty-one of all events were noted to involve two or more countries. Of these, 17 events occurred over the last decade as compared to only four reports occurring between 1996 and 2007 . Rates of Listeria events involving two or more countries per total number of Listeria events reported in ProMED each year were calculated to ensure that any trends observed were not secondary to changes in the number of Listeria events reported. Figure 3 demonstrates the increasing rates of multi-country events from 1998 to 2018… No multi-country events were reported in 1996 and 1997. Rates increased from 0.07 to 0.19 , an overall increase of 171% . Several of these events involved neighboring countries suchas Canada and the USA, Austria and Germany, and Spain and Portugal. Other events involved countries in more than one continent. In 2018, Listeria was linked to cantaloupe melons from Australia that were distributed to eight countries including China , Japan, Kuwait, Malaysia, Oman, Singapore, and the USA. In 2009, an outbreak with seven confirmed deaths was linked to chicken wraps distributed to airlines affecting approximately 5000 national and international flights.Ten events were attributed to foods prepared and served in hospitals. Nine of these events were outbreaks with two or more associated human cases. One event was categorized as sporadic with only one reported human case. An outbreak that involved 13 public hospitals in Australia in 2013 was linked to profiteroles while one in the USA in 2015 was linked to ice cream. Additional hospital-acquired cases were reported from Norway, the UK, and New Zealand.Identification of the implicated food vehicle in Listeria outbreaks and sporadic cases resulted in numerous product recalls, some of which included products sold under different brands and distributed to multiple countries. During one outbreak in 2014, more than 358 consumer products sold under 42 different brands were recalled, including broccoli, cauliflower, peas, onions, peppers, sweet potatoes, blueberries, cranberries, peaches, raspberries, strawberries and others. The recent outbreak in South Africa related to contaminated polony resulted in recalls from 15 countries. Twenty-four percent of Listeria events reported in ProMED were precautionary food product recalls due to the presence of bacterial contamination without associated cases. For example, one early report in 1998 described a large recall of more than 35 million pounds of hot dogs and deli meats in the USA. Similarly in 2002, a recall in the USAinvolved 27.4 million pounds of deli meats, turkey, and poultry.Listeria monocytogenes remains a potent source of foodborne infection worldwide. This study aimed to identifyepidemiological trends in Listeria events and recalls since 1996. Relevant data were extracted from ProMED in order to elucidate global trends given the increasingly interconnected nature of food distribution practices worldwide. The past 20 years have witnessed an increase in L. monocytogenes events reported to ProMED.