Seaweed therapy: tackling LOAD.
Abstract.
This second running project entitled: “Seaweed Therapy: Tackling LOAD”, aims to evaluate the potential of seaweed therapy in mitigating the by “Lancet December 2022 projection study” (Lancet Public Health, 2022) around 2050 “Late Onset Alzheimer’s Disease” (LOAD) pandemics, focusing on its rich nutritional profile, including ω-3 ‘Very Long-Chain Polyunsaturated Fatty Acids’ (VLC-PUFAs) and essential vitamins. By promoting affordable, accessible nutritional supplementation in ‘low- and middle-income countries’ (LMICs), we seek to prevent and treat Alzheimer’s Disease, countering the limitations of the traditional “Amyloid-β protein cascade hypothesis” and focus on the “Nutritional deficiency hypothesis” of AD.
By dr. dr. ir. Vincent van Ginneken, June 2024, Alzheimer Solutions B.V.
1. Tackling Alzheimer's in LMICs: Insights from the Lancet December 2022 Study
Alzheimer's Disease (AD) stands as the leading cause of dementia among the elderly, characterized by progressive cognitive decline, memory loss, and impaired judgment. The disease manifests in two primary forms: Late-Onset (LOAD), affecting individuals over 65, and familial Early-Onset (EOAD), occurring before age 65 due to genetic mutations. The urgency for effective interventions in AD is palpable, particularly in Low- and Middle-Income Countries (LMICs), where cases are projected to escalate significantly. Historically perceived as a malady of High-Income Countries (HICs), the Lancet December 2022 projection study highlights an anticipated rise in LMICs, necessitating globally applicable treatments.
Alzheimer's disease and dementia present a substantial global economic challenge, impacting nations across all income levels. Using a willingness-to-pay methodology, the estimated global economic burden in 2019 was approximately $2 trillion USD, with projections indicating a sharp increase to $10–13.5 trillion USD by 2050, against a projected global GDP of $228 trillion USD (inflation-adjusted) (Chen et al., 2024).
The financial strain associated with dementia care was estimated at $321 billion in 2022 for individuals aged 65 and older in the USA alone, with projections of a global AD pandemic around 2050. A Nature projection study anticipates unprecedented medical costs, reaching approximately one trillion US dollars for an estimated 300 million AD patients in the USA by 2050
The second project of TTA B.V. aims to elucidate the nutritional factors influencing Alzheimer's Disease (AD) prevalence, with a focus on low- and middle-income countries (LMICs). Integrating insights from the Lancet's December 2022 projection study and nutritional research, this project explores how dietary supplementation can provide a cost-effective preventive strategy against AD.
Figure 1: Global Projections of Alzheimer's Disease Increase by 2050 aligning with the Lancet's December 2022 projection study. This figure illustrates the projected percentage change in dementia cases from 2019 to 2050 across various regions. All regions show growth, with the smallest increases in high-income Asia Pacific (53% [95% UI 41–67]) and Western Europe (74% [58–90]). The largest increases are expected in North Africa and the Middle East (367% [329–403]) and Eastern Sub-Saharan Africa (357% [323–395]) (Modified: Lancet Public Health, 2022).
The analysis examines the interplay between genetic predispositions and dietary factors, emphasizing the need to address nutritional deficiencies for optimal brain health.The project's primary goal is to identify affordable anti-LOAD therapies that align with the Lancet's emphasis on addressing the global burden of AD, especially in regions projected to experience the most significant increases in LOAD cases, such as North Africa, Central-Eastern and Sub-Saharan Africa, and the Middle East.
This project investigates global factors including age, insulin resistance (IR) & type-2 diabetes (T2DM), heterozygosity for the ApoE-ε4 allele, imbalanced [ω-6/ω-3] ratio, and zinc deficiency. These factors are significantly correlated with regions expected to see the largest increase in LOAD cases by 2050, particularly in LMICs. This analysis challenges prevailing perceptions and aligns with the Lancet's December 2022 projections. Refer to Figure 1 for visualization.
2. Understanding the Causes of Alzheimer's Disease: LOAD Variant.
2.1. Global Aging Trends and Alzheimer’s Disease.
The contemporary challenge of global population aging underscores a projected significant rise in the elderly population by 2050. This demographic shift increases vulnerability to various diseases, including Alzheimer’s Disease (AD). The connection between insulin dysregulation and AD highlights the significance of metabolic syndrome (MetS), insulin resistance (IR), and type-2 diabetes mellitus (T2DM). The aging population surge is expected to amplify the global disease burden, evidenced by increased demand for health services and elevated disability-adjusted life years (DALYs). The Global Burden of Disease Study (GBD) reveals that population aging has significantly contributed to elevated DALYs. These trends underscore the pivotal role of aging in the escalating prevalence of AD on a global scale. Figure 2 vividly illustrates the projected surge in total DALY rates and the significant increase in DALY rates attributable to age structure by 2050, particularly in Africa.
Figure 2: Expected Surge in Total DALY Rates and Increase in DALY Rates Attributable to Age Structure by 2050, Particularly Pronounced in Africa. NA = not available (Modified: Xi et al 2022).
2.2. Metabolic Disorders as Precursors to Alzheimer’s (LOAD-variant).
MetS, IR, and T2DM intricately contribute to LOAD pathogenesis through dysregulated insulin functioning and altered fatty acid metabolism. The global prevalence of T2DM is projected to surge to 783 million by 2045, particularly in LMICs. These metabolic conditions, prevalent in LMICs, are strongly correlated with the anticipated surge in AD cases, particularly in regions such as North, Central-Eastern, Sub-Saharan Africa, and the Middle East. This aligns with findings from a Lancet December 2022 projection study, where T2DM incidence is projected to escalate dramatically. This upward trend mirrors the increasing burden of MetS, IR, and T2DM, especially in LMICs. The Middle East and North Africa region, as depicted in Figure 3, demonstrates alarming rates of T2DM morbidity. Importantly, these findings directly link to AD, as LOAD shows a clear association with MetS, IR, and T2DM, all characterized by dysregulated insulin levels.
Figure 3. Projections of number of people with diabetes worldwide and per International Diabetes Foundation (IDF) Region in 2021-2045 (20-79 years) (Modified: IDF, 2021).
2.3. ApoE-ε4 and Alzheimer's Disease in LMICs.
Apolipoprotein E (ApoE), particularly the ε4 allele, is a primary genetic risk factor for Alzheimer’s Disease. Homozygosity for the ε4 allele predisposes individuals to Early-Onset AD (EOAD), while heterozygosity increases the risk for LOAD. The anticipated increase in LOAD cases in LMICs, particularly in Africa and the Middle East, aligns with the high prevalence of the ApoE ε4 allele in the§se regions. The Lancet December 2022 projection study highlights a significant rise in AD cases in North Africa, the Middle East, and eastern Sub-Saharan Africa by 2050. This emphasizes the urgent need for targeted research and therapeutic strategies focused on understanding and mitigating the impact of ApoE ε4 in AD with focus on LOAD within LMICs, where the burden of the disease is anticipated to be disproportionately high (Figure 4).
Figure 4. Provides a comprehensive illustration of the global distribution of the ApoE4 allele, emphasizing the extreme prevalence in sub-Sahara and central Africa, where the AD burden is expected to be particularly pronounced. Frequency of ε4 is low (light red regions) and high (dark red regions). The grey colour indicates that there are no data available for this country (Modified: Husain et al., 2021).
2.4. The Nutritional Approach to Combating Alzheimer’s (AD).
The next following comprehensive summary paragraph provides a clear, concise, and logical exploration of how imbalanced [ω-6/ω-3] ratios, genetic predispositions, and zinc deficiencies impact the development and prevention of Alzheimer's Disease (AD). Which is in principle based on the “Nutritional deficiency hypothesis” of Alzheimer’s disease (LOAD-variant), see Figure 5.
Figure 5. The Nutritional Approach to Combating Alzheimer’s (AD).
2.4.a. The Role of Omega-3s in Alzheimer’s Prevention.
The intricate nature of Alzheimer's Disease (AD) poses a formidable challenge due to its multifaceted characteristics. However, nutritional supplementation offers a potentially straightforward preventive measure against late-onset Alzheimer’s disease (LOAD). Various cohort and meta-analyses studies on fish consumption, along with clinical trials exploring the effects of highly enriched EPA [Eicosapentaenoic acid (C20:5, ω-3; EPA], DPA [Docosapentaenoic acid (C22:5, ω-3; DPA], or DHA [Docosahexaenoic acid (C22:6, ω-3; DHA] preparations, suggest that both dietary fish intake and fish oil supplementation have protective effects against LOAD. Notably, individuals with high fish intake exhibit a comparable risk of dementia to regular fatty fish consumers, supporting the protective role of fish consumption. Clinical trials have demonstrated significant improvements in memory functions and cognitive decline in individuals receiving DHA treatment. These findings underscore the importance of individual ω-3 VLC-PUFAs (EPA, DPA, and DHA) in combating LOAD, highlighting their unique mechanisms of action, particularly their anti-inflammatory properties.
2.4.b. Genetic Factors in Alzheimer’s: The African Predisposition.
The role of ω-6 VLC-PUFAs, particularly Arachidonic acid [Arachidonic acid (C20:4, ω-6; ARA], emerges as a significant factor in LOAD based on meta-analyses and cohort studies. The interplay between ARA and DGLA [Dihomo-γ-Linolenic acid (C20:3, ω-6; DGLA], regulated by delta-5 desaturase (∆5D; FADS1-gene), is crucial in LOAD pathogenesis and is influenced by common ‘Fatty Acid Desaturase’ (FAD) polymorphisms. African American populations, characterized by higher frequencies of genotypes associated with increased ARA levels, exhibit heightened susceptibility to inflammatory reactions, potentially exacerbating the risk of LOAD compared to Caucasian populations. This genetic predisposition underscores the importance of understanding population-specific genetic profiles in LOAD susceptibility. An imbalanced [ω-6/ω-3] ratio in the modern Western diet might be driving the escalating global incidence of LOAD, as evidenced by low levels of ω-3 VLC-PUFAs in various regions.
Figure 6 illustrates alarmingly low levels of ω-3 VLC-PUFAs in Sub-Saharan Africa, South America (excluding Chile), and Asian mainland nations, underscoring the global deficiency of these essential fatty acids and necessitating focused public health initiatives and policies, including dietary ω-3 supplementation through seaweed consumption.
Figure 6. Global and regional mean seafood consumption levels of dietary ω-3 polyunsaturated fat intake (mg/day) for adults aged ≥20 years in 2010 (Modified: Micha et al 2014).
2.3. Zinc Deficiency: A Hidden Risk for Alzheimer’s.
The enzymatic conversion of ‘essential fatty acids’ (EFAs) like ALA [α-Linolenic acid (C18:3, ω-3; ALA] and LA [Linoleic acid (C18:2, ω-6; LA], towards anti-inflammatory ω-3 VLC-PUFAs like EPA, DPA, and DHA, crucial in LOAD pathogenesis, is regulated by delta-6 desaturase (∆6D; FADS2-gene) and reliant on adequate zinc (Zn2+) concentrations. Zinc deficiency, exacerbated by factors such as insulin and protein deficiencies, correlates with reduced ∆6 desaturase activity and subsequently diminished concentrations of ω-3 VLC-PUFAs, potentially heightening LOAD susceptibility. Geographical distribution patterns highlight the urgency for targeted interventions, particularly in regions with high zinc deficiency rates, to mitigate LOAD risk associated with impaired ∆6D activity. A deficiency in zinc reduces concentrations of crucial ω-3 VLC-PUFAs, increasing susceptibility to LOAD (Figure 7).
Figure 7: Global Zinc (Zn2+) Availability and Implications for LOAD Risk (Modified: Myers et al., 2015).
3. Nutritional Strategies to Prevent Alzheimer's: Micronutrients and Dietrary Patterns.
3.1. Understanding Ntritional Deficiencies in Alzheimer's.
To understand the surge in Alzheimer's Disease (AD) cases, particularly in regions facing nutritional deficiencies, it is critical to examine the role of nutrients. Essential omega-3 Very Long Chain Polyunsaturated Fatty Acids (VLC-PUFAs) like EPA, DPA, and DHA, as well as vitamins, minerals, and dietary patterns, are vital for brain health. The imbalance of omega-6/omega-3 ratios in modern diets is hypothesized to contribute to AD pathogenesis. This section aims to explore these nutritional factors and their implications for cognitive health, especially in Low and Middle-Income Countries (LMICs), which are projected to bear 65% of the global economic burden of AD by 2050 (Lancet Public Health, 2022).
3.2. Crucial Nutrients for Cognitive Resilience.
Nutritional deficiencies in vitamins B1, B2, B6, B9, B12, D, A, E, omega-3 VLC-PUFAs, and albumin, as well as elevated homocysteine levels, are significantly correlated with mild cognitive impairment. These nutrients play crucial roles in brain function, influencing short-term memory, problem-solving, mental health, cognition, vision, and neurotransmitter synthesis. For instance, deficiencies in vitamin D, albumin, and antioxidants like lutein and zeaxanthin are linked to frailty and cognitive decline in the elderly. Targeted nutritional interventions can help mitigate these risks and support cognitive resilience in aging populations. In the cognitive landscape, AD primarily damages memory-related regions like the entorhinal cortex and hippocampus, particularly affecting episodic memory, which is crucial for AD diagnosis. Understanding the intricate relationship between nutrition and cognitive function is paramount in developing strategies to support cognitive resilience in the face of LOAD.
In Table 1 is illuminated the vital role of various vitamins, micronutrients, and minerals in fostering proper brain functioning. These nutrients intertwine with different domains of cognitive functioning, including short-term memory, problem-solving abilities, mental health, cognition, vision, and neurotransmitter synthesis (Rolfes et al., 2019).
Table 1. A comprehensive summary of Nutrient-Brain relationships (Rolfes et al., 2019).
As we embark on this exploration of the nuanced interplay between nutrition and cognitive resilience, we next will unravel the intricate tapestry that underscores the importance of targeted nutrients in preserving brain health.
3.3. Critical Trace Elements for Brain Function.
Trace metals such as Copper, Iron, Zinc, and Manganese are crucial for the enzymatic conversion of essential fatty acids (EFAs) into neuroprotective ω-3 VLC-PUFAs like EPA, DPA, and DHA. Enzymes Δ6D and Δ5D facilitate this conversion, with co-factors including vitamins B1, B6, B12, B9, C, and trace elements Zinc, Manganese, and Calcium. Imbalances in these elements can impair enzymatic activity and are linked to cognitive decline. Studies using ICP-MS analysis have shown that individuals with cognitive decline exhibit significant deficiencies in these trace metals, highlighting their role in LOAD pathogenesis and the importance of maintaining their balance for cognitive health.
In Figure 8 is a brief overview given of some vitamins, minerals, macro- micro- & trace- elements required for proper healthy cognitive brain functioning.
Figure 8. Overview of some Vitamins, Minerals, Macro- Micro- & Trace- elements required for proper healthy cognitive brain functioning.
3.4. Water-Soluble Vitamins and Brain Health.
Water-soluble vitamins, especially B vitamins and vitamin C, play essential roles in maintaining brain health and mitigating LOAD. Vitamin B12, for instance, has antioxidative properties and is vital for nervous system integrity, cellular energy processes, myelin maintenance, and neurotransmitter synthesis. Deficiencies in B12, B6, and folate can elevate homocysteine levels, leading to oxidative damage and increasing the risk of AD. Adequate intake of these vitamins is crucial for preventing age-related neurodegenerative diseases and supporting cognitive function.
3.5. Impact of Fat-Solube Vitamins of Alzheimer's.
Fat-soluble vitamins A, D, E, and K significantly influence LOAD pathogenesis. Vitamin A regulates neuroinflammation and neurotransmission. Vitamin D deficiency is linked to LOAD risk factors such as impaired neurite growth and calcium signalling. Vitamin E's antioxidant properties are critical for reducing oxidative stress and inflammation. Vitamin K impacts cerebral homeostasis and sphingolipid synthesis. Addressing deficiencies in these vitamins, prevalent in regions like Africa, is essential for preventing neurodegenerative diseases and promoting cognitive health. Figure 9 illustrates global deficiencies in vitamins crucial for neurodegenerative disease prevention, emphasizing the importance of addressing nutritional gaps in regions like Africa, where deficiencies in essential vitamins are prevalent and may persist in the foreseeable future.
Figure 9. Global map depicting deficiencies of vitamin A (blue), vitamin B (orange), vitamin D (grey), and vitamin E (yellow) across continents or regions (Modified: Chaudhary et al 2020).
3.6. Dietary Patterns to Prevent Alzheimer's.
Dietary patterns like the Mediterranean Diet (MD) (Figure 10), DASH diet, and their variants (MDASHIND, MIND) are rich in anti-inflammatory ω-3 VLC-PUFAs, antioxidants, and polyphenols, offering neuroprotective benefits. These diets emphasize nutrient-rich foods such as fish oils, carotenoids, vitamin D, B vitamins, and polyphenols, which collectively combat cognitive aging. Innovative strategies, such as the Modified Mediterranean-Ketogenic (MMK) diet, are also showing promise in addressing brain energetics defects and preventing neurodegenerative diseases. These dietary patterns provide a holistic approach to sustaining cognitive health and preventing LOAD.
4. Revolutionizing Brain Health with Seaweeds by 2050.
4.1. Seaweeds: A Nutrient-Rich Solution for AD Prevention.
The rise in Alzheimer’s Disease (AD) cases, especially in regions with nutritional deficiencies, is linked to an imbalanced [ω-6/ω-3] ratio and deficiencies in essential vitamins and minerals. In this context, seaweeds emerge as the most viable and sustainable solution to produce the required ω-3 VLC-PUFAs. With a global seaweed industry experiencing exponential growth (FAO, 2021), seaweeds offer a promising avenue. Contrary to misconceptions about their low-fat content, seaweeds boast an exceptionally high ω-3 VLC-PUFA content (EPA, DPA & DHA) ranging from 2-14 mg/g dry matter (van Ginneken et al., 2011). Two selected seaweed species, Ulva lactuca and Sargassum natans, not only exhibit favourable ω-3 profiles (van Ginneken et al., 2011) but also contain essential vitamins and minerals. The globally abundant green seaweed Ulva lactuca (Chlorophyta), known for its extensive blooms (Figure 11a) and high biomass production (Dominguez & Loret, 2019), and the brown seaweed Sargassum natans (Phaeophyceae), considered a pest due to its rampant growth (Figure 11b), particularly in the Caribbean (Resiere et al., 2018), present an opportunity as they not only showcase a favourable ω-3 VLC-PUFAs "fish-oil" profile but also encompass crucial vitamins and minerals protective against LOAD. We propose a solution using two seaweed species, Ulva lactuca and Sargassum natans, to address these deficiencies and provide an affordable means to combat AD. These seaweeds, rich in essential nutrients and ω-3 VLC-PUFAs (EPA, DPA, and DHA), offer neuroprotective properties. With the expected increase in AD cases in Low- and Middle-Income Countries (LMICs) by 2050, incorporating these seaweeds into diets could significantly mitigate the disease's impact (Lancet Public Health, 2022).
Figure 11. An image of the removal of a nuisance algal bloom of Ulva prolifera from the coastal region of Qiandao, China, between May-July 2008, which threatened the preparation of sailing events in the Olympic Games. Approximately 1 million fresh weight (FW) tonnes of seaweed were removed (Courtesy: Michael Ross (PhD)).
4.2. Seaweeds: Meeting Global ω-3 Demands.
The growing prevalence of AD necessitates alternative sources of ω-3 VLC-PUFAs to meet the recommended intake of 500 mg/day. Current sources, like fish, are inadequate to meet the global demand. Seaweeds, particularly Ulva lactuca(Figure 12) and Sargassum natans (Figure 13), provide a viable solution due to their high ω-3 VLC-PUFA content. In this context, seaweeds emerge as the most viable and sustainable solution to produce the required ω-3 VLC-PUFAs. With a global seaweed industry experiencing exponential growth (FAO, 2021), seaweeds offer a promising avenue. Contrary to misconceptions about their low-fat content, seaweeds boast an exceptionally high ω-3 VLC-PUFA content (EPA, DPA & DHA) ranging from 2-14 mg/g dry matter (van Ginneken et al., 2011). Ulva lactuca provides significant EPA and DPA content, while Sargassum natans offers substantial EPA and DHA quantities, crucial for optimal brain function (see: Table 3). In addition, these two seaweed species also offer essential vitamins and minerals (see: Table 4), making them a sustainable and nutritionally rich alternative to traditional fish oils, capable of preventing early AD and combating “Mild cognitive impairment” (MCI).
Figure 12: The seaweed Ulva lactuca (Chlorophyta) origin the Netherlands (Source: van Ginneken & de Vries 2018).
Figure 13: The brown seaweed Sargassum natans (Phaeophyceae), considered a pest due to its rampant growth (Figure 10b), particularly in the Caribbean (Resiere et al., 2018).
4.3: Clinical Benefits of Seaweed-Derived ω-3 for AD.
Blending Ulva lactuca and Sargassum natans optimizes the intake of EPA, DPA, and DHA, crucial for brain health, and is essential to harness the complementary effects of these fatty acids, as highlighted in Table 2. Ulva lactuca provides significant EPA and DPA content, while Sargassum natans offers substantial EPA and DHA quantities, crucial for optimal brain function. Clinical studies highlight the need for dietary supplementation with seaweed-derived ω-3 VLC-PUFAs, given the global scarcity of fish oils. Seaweeds can convert inflammatory ω-6 fatty acids into anti-inflammatory ω-3 fatty acids, addressing the imbalance in modern diets that contributes to AD. Public health initiatives should focus on integrating seaweed-based supplements to prevent neurodegenerative diseases like AD.
Table 2. Fatty acid lipid composition of the green seaweed Ulva lactuca (Chlorophyta) and Sargassum natans(Phaeophyceae) measured by GCMS-measurements. Mean ± Std (n=4). Abbreviation: n.d. = not detected with @: detection limit 0.022 μg FA per g dry matter (≈0.001%). Abbreviations: “SFA”: (Saturated Fatty Acids); “MUFA”: (Monounsaturated Fatty Acid); “PUFA”: (Polyunsaturated Fatty Acids) (Source: van Ginneken et al 2011).
4.4: Optimal Brain Health: The Nutritional Power of Seaweeds.
Moreover, Ulva lactuca and Sargassum natans provide not only ω-3 VLC-PUFAs but also a spectrum of vitamins and essential minerals, further supporting cognitive health as outlined in table 3. Ulva lactuca and Sargassum natans are rich in vitamins and minerals essential for brain function, including vitamins A, B1, B2, B3, B6, B9, B12, C, D, E, and K, and micro-elements like calcium, manganese, iron, copper, zinc, and selenium. These nutrients support cognitive health and prevent AD.
Table 3: Comparative Overview of Vitamins, Micro-, and Trace-Elements in Ulva lactuca (Chlorophyta), other Ulva Species, and Sargassum natans (Phaeophyceae).
5. Addressing the Impending Pandemic of Alzheimer's Disease: A Call for Immediate Action.
The impending Alzheimer’s Disease (LOAD) pandemic demands immediate intervention to mitigate its catastrophic impact. This study has identified crucial factors in AD pathogenesis, such as aging, genetic predispositions, inflammation, and nutritional deficiencies, emphasizing the need for early intervention. Understanding the economic ramifications and genetic factors underscores the urgency of preventive measures.
A holistic approach, combining nutritional supplementation and lifestyle modifications, is essential to disrupt AD progression. Seaweeds, as a "crop of the future," offer a sustainable, nutrient-rich and affordable solution for AD prevention (Figure 14), especially for Low- and Middle-Income Countries (LMICs) where a 65% increase in AD is projected by 2050. The rapid growth of the seaweed industry and the nutritional richness of selected seaweed species position them as viable solutions to combat the LOAD pandemic, contributing to a healthier global population by 2050.
Epigenetic insights highlight the transgenerational inheritance of AD susceptibility, stressing the importance of environmental factors and dietary interventions. Collaborative efforts from global health organizations are crucial in effectively addressing this crisis. Failure to act decisively now could have irreversible consequences for future generations.
Figure 14. Seaweeds: A Nutrient-Rich Solution for AD Prevention.
References
Lancet Public Health, 2022. GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022;7(2):e105-e125. https://doi.org/10.1016/s2468-2667(21)00249-8
Xi JY, Lin X, Hao YT 2022. Measurement and projection of the burden of disease attributable to population aging in 188 countries, 1990-2050: A population-based study. J Glob Health. 2022 Oct 30;12:04093. https://doi.org/10.7189/jogh.12.04093.
IDF 2021. International Diabetes Federation (IDF) Diabetes Atlas – 10th edition; www.diabetesatlas.org; 135 pages.
Husain MA, Laurent B, Plourde M 2021. APOE and Alzheimer’s Disease: From Lipid Transport to Physiopathology and Therapeutics. Front Neurosci. 2021;15:630502. https://doi.org/10.3389/fnins.2021.630502.
Micha R, Khatibzadeh S, Shi P, Fahimi S, Lim S, Andrews KG, et al. 2014. Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys. BMJ. 2014;348:g2272. https://doi.org/10.1136/bmj.g2272.
Myers S, Wessells KR, Kloog I, Zanobetti A 2015. Effect of increased concentrations of atmospheric carbon dioxide on the global threat of zinc deficiency: a modelling study. Lancet Glob Health. 2015;3:e639-e645. https://doi.org/10.1016/S2214-109X(15)00093-5
Rolfes SR, Pinna K, Whitney E 2019. Understanding Normal and Clinical Nutrition. 8th ed. Wadsworth, Cengage Learning; 2009. ISBN-13: 978-0-495-55646-6.
Chaudhary R, Chaturvedi S, Sharma R, Tiwari S 2020. Global Scenario of Vitamin Deficiency and Human Health [Book Chapter]. In: Sharma TR, Deshmukh R, Sonah H, editors. Advances in Agri-Food Biotechnology. Singapore: Springer; 2020. p. 22. https://doi.org/10.1007/978-981-15-2874-3_9.
FAO (2021). Food and Agriculture Organization. Global status of seaweed production, trade and utilization, May 2021. World Aquaculture Performance Indicators (WAPI). http://www.fao.org/fishery/statistics/software/wapi/en.
van Ginneken V, Helsper J, de Visser W, van Keulen H, Brandenburg W (2011). Polyunsaturated fatty acids in various macroalgae species from North Atlantic and Tropical Seas. Lipids in Health and Disease. 2011 Jun 22;10:104. https://doi.org/10.1186/1476-511X-10-104.
Dominguez H & Loret EP (2019). Ulva lactuca, A Source of Troubles and Potential Riches. Mar Drugs. 2019 Jun;17(6):357. https://doi.org/10.3390/md17060357.
Resiere D, Valentino R, Nevière R, Banydeen R, Gueye P, Florentin J, et al (2018). Sargassum seaweed on Caribbean islands: an international public health concern. The Lancet. 2018 Dec;392(10165):2691. https://doi.org/10.1016/s0140-6736(18)32777-6.
van Ginneken V & de Vries E (2018). Seaweeds as Biomonitoring System for Heavy Metal (HM) Accumulation and Contamination of Our Oceans. American Journal of Plant Sciences, 9, 1514-1530. https://doi.org/10.4236/ajps.2018.97111.
Pereira L (2011). A Review of the Nutrient Composition of Selected Edible Seaweeds. In: Pomin VH, editor. Seaweed. New York: Nova Science Publishers, Inc.; 2011. https://doi.org/10.1080/09670262.2011.632029.
Rasyid A (2017). Evaluation of the Nutritional Composition of The Dried Seaweed Ulva lactuca from Pameungpeuk waters Indonesia. Trop Life Sci Res. 2017;28(2):119–125. https://doi.org/10.21315/tlsr2017.28.2.9.
Réka P, Banu AT, Seethalakshmi M (2017). Nutrient Content, Phytonutrient Composition and Functional Properties of Selected Seaweeds Collected from Gulf of Mannar, Tamil Nadu, India. Int J Nutr Diet. 2017;4:145–159. https://doi.org/10.17654/ND004020145.
El-Beltagi HS, Mohamed AA, Mohamed HI, Ramadan KMA, Barqawi AA, Mansour AT (2022). Phytochemical and Potential Properties of Seaweeds and Their Recent Applications: A Review. Mar Drugs. 2022;20:342. https://doi.org/10.3390/md20060342.
Debbarma J, Rao M, Murthy N, Mathew S, Venkatesh-Warlu G, Ravishankar N (2016). Nutritional profiling of the edible seaweeds Gracilaria edulis, Ulva lactuca and Sargassum sp. Indian J Fish. 2016;63(3):81–87. https://doi.org/10.1077/ijf.2016.63.3.60073-11.
Farzanah R, Clausen MP, Arnspang EC, Schmidt JE, Bastidas-Oyanedel J-R (2022). Feasibility of United Arab Emirates Native Seaweed Ulva intestinalis as a Food Source: Study of Nutritional and Mineral Compositions. Phycology. 2022;2(1):120–131. https://doi.org/10.3390/phycology2010008.
Chen S, Cao Z, Nandi A, Counts N, Jiao L, Prettner K, Kuhn M, Seligman B, Tortorice D, Vigo D, Wang C, Bloom DE. (2024). The global macroeconomic burden of Alzheimer's disease and other dementias: estimates and projections for 152 countries or territories. The Lancet Global Health Volume 12, Issue 9, e1534; https://doi.org/10.1016/S2214-109X(24)00264-X.
After reading this article