CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF STUDY

Green cabbage (Brassica oleracea var. Capitata L.) is a vegetable plant that is widely used in

the world at large. Is a group of vegetables that have many benefits for the body. Cabbage has

several variation including green cabbage, white cabbage and red cabbage. It is a herbaceous

biennial with leaves that form a compact head.

In the year 2008, Yuma Country in Arizona, southwestern U.S grew 1200 acres of cabbage.

Cabbage is derived from a leafy wild mustered plant native to the Mediterranean region. It

was known to be an ancient Greeks and Romans and was praised for its medicinal properties,

declaiming that it is first of all the vegetables.

Cabbages have proven to be beneficial for health by numerious epidemiological and clinical

studies (Podsedek 2007; Cartea & Velasco 2008). High intake of cabbages for consumers

could reduce the risk of degenerative diseases, age related chronic illnesses (Kris-Etherton et

al., 2002). And several types of cancer (Wang et al., 2004; Björkman et al., 2011). The

presence of vitamins and provitamins such as folic acids, and a wide variety of phenolic

substances as well as organosulfur compounds are considered to be contributory factors

(Khanam et al., 2012; Cartea & Velasco 2008). Phenolic substances are correlated with the

antioxidant activity in many studies (Leja et al., 2010). Cabbages have also proved to1have

higher antioxidant activity than many other vegetables such as capsicum, carrot, cucumber,

gourd and so on (Isabelle et al., 2010). There are many reports about the phenolic substances

and antioxidant activity of cabbage with many of them focusing on the Chinese cabbage or

the red cabbage (Ahmadiani et al., 2014; Seong et al., 2016).

1
Head cabbage (Brassica oleracea var. capitata) considered to have originated from China, has

been cultivated for a long period (King & Zhang, 1996). They play an important role in the

diet in Asian countries, especially in China. The production of cabbages and other brassicas

were more than 33.88 million tons in China in 2016. It is almost 20% of total vegetable

production according to the Food and Agriculture Organization of the United Nations. The

head cabbage commonly consumed in China can be classified into four groups based on the

shape and color:

i. red head cabbage (Brassica oleracea var. capitata f, rubra),

ii. conical head cabbage (Brassica oleracea var. capitata f, acuta),

iii. ball head (round head) cabbage (Brassica oleracea var. capitata f, alba), and

iv. flat head (drum head) cabbage (Brassica oleracea var. capitata f, linn).

Antioxidants are factors that can reduce radical oxidative superoxide (ROS), both topical and

systemic. Based on the source of the acquisition there are two kinds of antioxidants, namely

natural antioxidants and synthetic antioxidants (synthetic). Green cabbage will be

investigated on the antioxidant activity on blood glucose and cholesterol concentration in

albino Wistar rats. The burden of diabetes is growing all over the world. Cabbage is a diet

rich vegetable that is a powerful weapon against high blood sugar levels and Cabbage is

known one ọf the vaggies for tackling this condition which may lead to diabetes. Cabbage

has a lot of antihyperglycemic and antioxidant properties that make it a medicine for diabetes.

The findings of this research will improve the understanding of nutrition of head cabbages for

food nutritionists and consumers. The use of juice can increase anthocyanin levels in plasma

so that it will increase the effectiveness of antioxidants (Zeitschrift, 2014).2Indonesia is one

of the countries with largest natural wealth in the world. There are nutritious plants as a
2
source of abundant natural antioxidant cabbage was found to have antioxidant power 150

times stronger than flavonoids.

Cabbage is a good source of vitamin c which helps in fastening the healing of wounds. It also

contains significant amounts of glutamine which is an amino acid that has anti-inflammatory

properties. In conjunction with broccoli and other Brassica vegetables, cabbage is a source of

indole-3-carbinol, a chemical which boosts DNA repair cells and appears to block the growth

of cancer cells. Boiling reduces anticancer properties (Warwick, 2007). Cabbage is claimed

to be effective in relieving painfully engorged breasts in breast feeding. Fresh cabbage juice

has been shown to promote rapid healing of peptic ulcers (Cheney, 1949), thus restoring

homeostasis in the internal body environment.

1.2 STATEMENT OF THE PROBLEM

Taking control of diabetes to improve quality of life has put the spotlight on the need for

additional support and education for patients with type 2 diabetes. Although new treatments

and technology have aided in controlling the disease in many individuals, the challenges of

diabetes self-management are overwhelming for most. Diabetes is a chronic disease for

which control of the condition demands patient self-management (Langford et al., 2007).

Self-management behaviors include monitoring blood glucose levels, taking medication,

maintaining a healthy diet and regularly exercising. For most patients, it is important to

conduct daily foot exams. However, despite the technological and scientific advances made

toward the treatment of diabetes, the American Association of Clinical Endocrinologists

reports that only 1 in 3 patients with type 2 diabetes is well controlled (AACE, 2005). Only

about one-third of patients report adherence to monitoring blood glucose levels (vincze et al.,

2004). The American Association of Diabetes Educators suggests that only one-half of

patients adhere to medication (AADE, 2004). There are relatively high levels of
3
nonadherence in all areas of self-management behaviors. This non-adherence is perhaps due

to the fact that self-management behaviors usually require changes in the patient’s daily life.

In order to successfully make these changes, patients opt or are encouraged by others to set

goals to make the incremental changes necessary to create life-long habits that allow them to

manage their diabetes (Langford et al., 2007; Glasgow et al., 2002).

1.3 AIM AND OBJECTIVES

1.3.1 Aim

To create awareness to the entire world on the advantages of cabbage consumption this

decreases blood pressure, blood sugar and cholesterol concentration.

1.3.2 Objectives

i. The objective of my study is to carry out an evaluation on the antioxidant effect of

cabbage extract on blood sugar and cholesterol concentration in other to eradicate the

resulting issues of high sugar level in the body leading to diabetes on albino Wistar

rats.

ii. To evaluate the effect of green cabbage extract which may result to hyperglycemic or

hypoglyceminc effect on Wistar rats.

iii. To determine the effect of cabbage on lipid profile in Wistar rats.

1.4 HYPOTHESIS

Null: cabbage extract has no effect on blood sugar and cholesterol concentration in Wistar

rats.

Alternative: cabbage extract has effect on blood sugar and cholesterol concentration in Wistar

rats.

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1.5 SIGNIFICANCE OF STUDY

My experimental result of the project work will show an indication of the antioxidant effect

of cabbage (Brassica oleracea Var capitata L.) on blood sugar and cholesterol effect in the

case of hyperglycemia ( increase in blood sugar level) or hypoglycemia (decrease in blood

sugar level).

5
 CHAPTER TWO

LITERATURE REVIEW

2.1 DIABETES MELLITUS

Diabetes Mellitus (DM) is a global health care menace that may reach pandemic levels by

2030 (Abougalambou et al., 2010). About 80% of the total adult diabetics are in developing

countries and the greatest concern is the growing incidence of Type 2 Diabetes at a younger

age including some obese children even before puberty affecting the productive years of their

lives (Tabish, 2007). Considerable evidence has seen diabetes changing into an epidemic in

many developing countries with an estimated prevalence of diabetes of 1% in rural areas of

Africa and prevalence in Nigeria ranging from 0.65% in rural Mangu in the North to 11% in

urban Lagos in the Southern part of the country (Chinenye & Young 2011; Mutlu, et al.,

2014). Diabetes mellitus is a disease that is waging war against the wellbeing of humans and

may probably be due to drastic lifestyle changes accompanying urbanization and

westernization in developing countries (Harande, 2011). Individuals with diabetes are more

likely to be hospitalized with cardiovascular disease, end stage renal disease and most

frequently, non traumatic lower limb amputation compared to the general population (Cheng,

2013).

Studies have shown the antioxidant capacities and polyphenolics of Chinese cabbage leaves,

(Watanabe et al., 2011). Investigated the polyphenol content and antioxidant activity of

orange colored Chinese cabbage. (Mizgier et al., 2016). Reported the characterization of

phenolic compounds and antioxidant properties of cabbage. (Leja et al., 2010). Found

phenolic compounds as the major antioxidant in red cabbage. Nonetheless, the systematic

analysis of phytochemicals in cabbages and the comparisons between the different cabbage

varieties were limited.

6
Oxidative stress is thought to play an important role in the pathogenesis of numerous

degenerative and chronic diseases. Oxidative stress is characterized by an imbalance between

antioxidant capacity and reactive oxygen species (ROS) generation. Over- production of ROS

increased during aging and contributed to many pathological events such as cancer and

cardiovascular disease (Marorrni et al., 2004). Reactive oxygen species (ROS), including free

radicals, are reported to cause damage of biological system, and to be involved in aging and

in the pathogenesis of some diseases such as arthritis, atherosclerosis, diabetes and cancer

(Ames, 1983; Feher et al., 1987; Aruoma, 1998). Almost all organisms possess antioxidants

and repair systems that evolved to protect them against oxidative damage. These systems are

insufficient to prevent them entirely. However, antioxidants may be used to help human body

to reduce oxidative damage (Yang et al., 2002). Plants contain different natural products,

which have a remarkable role in the traditional medicine in different countries. Nowadays the

prevention of many diseases has been associated with the ingestion of different plants rich in

natural antioxidants (Johnson, 2001; Virgilli et al., 2001; Adedapo et al., 2008). In recent

years, there has been a particular interest in the antioxidant and health benefit of

phytochemicals in food and vegetables. This was as a result of their potential effects on

human health (Wei & Shiow, 2001). Oxidative stress indicates the intracellular accumulation

of ROS and nitrogen compounds. The major ROS variants are hydrogen peroxide (H2O2),

hypochlorous acid ( HOCl ), superoxide (.O2+), hydroxyl (OH), peroxyl (RO2+) and

hydroperoxyl (HO2+) in mitochondrial respiration, ROS are generated in the electron chain,

as a byproduct in the ATP generating process. This occurs in situation of enhanced oxidation

of energy subtract such as glucose and FFA, unless uncoupling compensates and prevents

ROS formation (Susan, 2004). Oxidative stress refers to self-amplifying free radical chain

reactions that damage biomolecules. Free radicals contain unpaired electrons, usually in outer

orbitals, and have important functions in normal cellular physiology, including oxidative
7
phosphorylation and cellular signaling (Meda et al., 2019). One to two percent of the oxygen

consumed by mitochondria normally results in the formation of ROS mitochondrial

dysfunction results in an increase in reactive molecules within the mitochondria (Galley,

2011, Mantzerlis et al., 2017). Dietary plants, which have protective biochemical function of

natural antioxidants, are suitable for prevention or protection against oxidative damage

caused by free radical species (Lanzotti, 2006). Among the known biological antioxidants,

Cabbage has been used in herbal medicine for the treatment or prevention of a number of

diseases such as cardiovascular disease and diabetes (Lanzotti, 2006). It has been found to

provide alleviating effects on hyperglycemia and hyperlipidemia. According to World Health

Organization (WHO), more than 80% of the World population depends on the traditional

medicine for their primary health care. WHO however emphasizes the fact that safety should

be overriding criteria in the selection of herbal medicine for the use in health care programme

and protective actions of plants against chronic diseases (Udenigwe et al., 2012). However, it

is very hapless that the pharmaceutical drugs formulated for the inhibition of these key

enzymes always come with attendant side effects coupled with their expensive cost

(Adefegha & Oboh, 2012). Hence, a search for a cheap alternative management approach

with little or no side effect becomes pertinent. Meanwhile, recent studies on the beneficial

health effects of plants have raised the interest of researchers on the possible preventive

measure. Cabbage has numerous uses in the world today, including the flavoring of some

cuisine like salads, and sauces (Chadha, 2001).

Gluconeogenesis is the synthesis of glucose. It is basically glycolysis run backwards; three

new reactions (involving four new enzymes) make the standard free energy favorable. For

every molecule of glucose synthesized from two molecules of pyruvate, 4 ATP, 2 GTP, and 2

NADH are used.

8
Pyruvate, the first designated substrate of the gluconeogenic pathway, can then be used to

generate glucose. Transamination or deamination of amino acids facilitates entering of their

carbon skeleton into the cycle directly (as pyruvate or oxaloacetate), or indirectly via the

citric acid cycle.

Regulation of Glucose in most steps in gluconeogenesis are the reverse of those found in

glycolysis, three regulated and strongly endergonic reactions are replaced with more

kinetically favorable reactions. Hexokinase/glucokinase, phosphofructokinase, and pyruvate

kinase enzymes of glycolysis are replaced with glucose-6-phosphatase, fructose-1,6-

bisphosphatase, and PEP carboxykinase/pyruvate carboxylase. These enzymes are typically

regulated by similar molecules, but with opposite results. For example, acetyl CoA and citrate

activate gluconeogenesis enzymes (pyruvate carboxylase and fructose-1,6-bisphosphatase,

respectively), while at the same time inhibiting the glycolytic enzyme pyruvate kinase. This

system of reciprocal control allow glycolysis and gluconeogenesis to inhibit each other and

prevents a futile cycle of synthesizing glucose to only break it down. Pyruvate kinase can be

also bypassed by 86 pathways (Christos, c. 2020). Not related to gluconeogenesis, for the

purpose of forming pyruvate and subsequently lactate; some of these pathways use carbon

atoms originated from glucose.

The majority of the enzymes responsible for gluconeogenesis are found in the cytosol; the

exceptions are mitochondrial pyruvate carboxylase and, in animals, phosphoenolpyruvate

carboxykinase. The latter exists as an isozyme located in both the mitochondrion and the

cytosol (Chakravarty et al., 2005). The rate of gluconeogenesis is ultimately controlled by the

action of a key enzyme, fructose-1, 6-bisphosphatase, which is also regulated through signal

transduction by cAMP and its phosphorylation.

9
Global control of gluconeogenesis is mediated by glucagon (released when blood glucose is

low); it triggers phosphorylation of enzymes and regulatory proteins by Protein Kinase A (a

cyclic AMP regulated kinase) resulting in inhibition of glycolysis and stimulation of

gluconeogenesis. Insulin counteracts glucagon by inhibiting gluconeogenesis. Type 2

diabetes is marked by excess glucagon and insulin resistance from the body (He et al., 2009).

Insulin can no longer inhibit the gene expression of enzymes such as PEPCK which leads to

increased levels of hyperglycemia in the body (Hatting et al., 2018). The anti-diabetic drug

metformin reduces blood glucose primarily through inhibition of gluconeogenesis,

overcoming the failure of insulin to inhibit gluconeogenesis due to insulin resistance (Wang

et al., 20018). Studies have shown that the absence of hepatic glucose production has no

major effect on the control of fasting plasma glucose concentration. Compensatory induction

of gluconeogenesis occurs in the kidneys and intestine, driven by glucagon, glucocorticoids,

and acidosis (Mutel et al., 2011).

2.2 CLASSIFICATION OF DIABETE MELLITUS

There are several forms of diabetes mellitus, which occur due to different causes. Diabetes

may be primary or secondary. Primary diabetes is unrelated to another disease. Secondary

diabetes occurs due to damage or disease of pancreas by another disease or factor. Recent

classification divides primary diabetes mellitus into two types, Type I and Type II.

2.2.1 Type 1 Diabetes Mellitus

Type 1 diabetes mellitus (T1DM) is present in about 5–10% of people having diabetes with a

strong genetic linkage inherited mainly through the HLA complex (Daneman, 2006). An

autoimmune disease mediated by T lymphocytes which cause a progressive destruction of the

pancreatic beta cells (Dip & Gomez, 2009). A large number people with T1DM are youths,

10
amounting to ≥85% of all diabetes cases in youth < 20 years of age and individuals diagnosed

with T1DM when they are adults have been referred to as having latent autoimmune diabetes

of adults (Maahs et al., 2011). Those with T1DM have increased risk of other autoimmune

disorders like autoimmune thyroid and celiac diseases while complications like nephropathy

may result into hypercalciuria which can alter vitamin D metabolism leading to vitamin D

deficiency and consequently osteoporosis (Dhaon & Shah, 2014). The genetic basis of T1DM

is not yet fully understood. However, genetic determinants such as alleles of the major

histocompatibility locus (HLA) at the HLA-DRB1 and DQB1 loci and it has been discovered

that HLA-B*39 locus account for some 40–50% of the familial clustering of T1DM (Forbes

& Cooper, 2013). 11

2.2.2 Type 2 Diabetes Mellitus11

Type 2 Diabetes Mellitus is a chronic metabolic disease caused by impaired glucose tolerance

due to insulin resistance and consequential islet β-cell exhaustion, resulting to insulin

deficiency (Badawi et al., 2010). It is the most common type of diabetes affecting about 85-

90% of all people with older adults usually affected. Younger populations are also now

increasingly being diagnosed with Type 2 diabetes, having about 45% of new cases of Type 2

diabetes mellitus in the paediatric population (Jordan & Jordan, 2012). Genetic and

environmental factors play a role in the aetiology of Type 2 diabetes and the risk is greatly

increased with change in lifestyle factors such as high blood pressure, obesity, lack of

exercise and poor diet (Hu et al., 2001). It is still not established whether genetic factors or

aging can explain the rapid increase in the prevalence of Type 2 Diabetes (Forbes & Cooper,

2013).

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2.2.3 Maturity Onset of Diabetes of the Young (MODY)12

Maturity onset of diabetes of the young (MODY) is a form of diabetes that is caused by

mutations in a number of different genes. It has now been discovered that there are at least six

forms of MODY (MODY 1- 6), each with mutation in a different gene that is directly

involved with beta cell function (Winter, 2003). Those who carry MODY2 mutations have a

very mild form of the disease, while those who carry MODY1 and MODY3 variants have a

much more severe expression that is associated with long-term complications (Pearson et al.,

2004). MODY, is inherited as an autosomal dominant trait resulting from mutations in

glucokinase gene on chromosome 7p.This condition is diagnosed as hyperglycemia before

the age of twenty-five years and treatable for over five years without insulin in cases where

islet cell antibodies are negative and HLA-DR3 and DR4 are heterozygous. MODY is more

common in blacks and 12Indians seen in more than 10% of diabetics but rare in Caucasians

having a prevalence of less than 1% (Ozougwu et al., 2013).

2.2.4 Gestational Diabetes

Gestational diabetes mellitus (GDM) is defined by glucose intolerance diagnosed first at any

time during pregnancy. This condition is found to be associated with various prenatal and

maternal complications ranging from neonatal hypoglycemia, macrosomia, jaundice,

hypocalcaemia and polycythemia with an increased frequency of maternal hypertensive

disorders leading to an increased rate of caesarean delivery (Linsay, 2009).

2.2.5 Neonatal Diabetes

Neonatal diabetes mellitus (NDM) is defined as hyperglycaemia requiring insulin treatment

occurring in the first 6 months of life (Kataria, 2014). Neonatal diabetes mellitus is
12
considered a rare disease affecting one in 300,000 to 400,000 newborns (Polak & Cavé ,

2007; Grulich Henn et al., 2010). It is classified as transient NDM (TNDM) and permanent

NDM (PNDM) with TNDM, accounting for 50% to 60% of all NDM cases, requires initial

insulin treatment but appears to resolve spontaneously by a median of 12 weeks of age, only

to relapse years later (Kataria, 2014). Permanent NDM is less common and is also

characterized by early hyperglycaemia. However, unlike TNDM, PNDM has no period of

remission and must be treated lifelong. Unlike autoimmune diabetes, which is extremely rare

before 6 months of age, NDM is a monogenic form of diabetes, with insulinopenia resulting

from abnormal pancreatic islet development, decreased β -cell mass, or -cell β dysfunction

(Aguilar-Bryan & Bryan, 2008.)

2.3 PATHOGENESIS OF TYPE 2 DIABETES MELLITUS

Under normal physiological conditions, plasma glucose concentrations are maintained within

a narrow range, despite wide fluctuations in supply and demand, through a tightly regulated

and dynamic interaction between tissue sensitivity to insulin (especially in the liver) and

insulin secretion (DeFronzo, 1988). In type 2 diabetes these mechanisms break down, with

the consequence that the two main pathophysiological defects in type 2 diabetes are impaired

insulin secretion through a dysfunction of the pancreatic β-cell, and impaired insulin action

through insulin resistance. Insulin resistance is now regarded as being synonymous with a

reduced rate of whole-body insulin-mediated glucose disposal in insulin-sensitive tissues

(DeFronzo and Ferrannini, 1991; Moller and Flier, 1991). This definition is too narrow, and

insulin resistance may be better defined as existing when normal insulin concentrations fail to

produce a normal biological response (Kahn, 1978). The main advantage of the latter

definition is that it does not restrict consideration of insulin action to a solitary aspect of

intermediary metabolism. The importance of insulin actions on other aspects of intermediary

13
metabolism, including lipid and protein metabolism, has now been appreciated. In 1988,

Reaven described syndrome X (now commonly known as the metabolic syndrome or insulin

resistance syndrome) as the association between several cardiovascular risk factors, including

hypertension, dyslipidaemia and glucose intolerance, and he proposed that insulin resistance

was the underlying cause (Reaven, 1988). Since his original description, it has been

recognized that a significant proportion of patients with the metabolic syndrome do not have

insulin resistance (Ford et al, 2002). The definition of the metabolic syndrome has therefore

been modified: most notably, central obesity has been added as a core feature. This is

important, as it is increasingly recognized that central obesity is fundamental to the origin of

this disorder (Maison et al, 2001). Abnormalities in β-cell function are found early in the

natural history of type 2 diabetes and in first-degree relatives of people with type 2 diabetes

(Pratley and Weyer, 2001). Suggested that they are an integral component of the pathogenesis

of type 2 diabetes.

2.4 COMPLICATIONS OF DIABETES MELLITUS

Diabetes is associated with a number of complications. These complications are wide ranging

and are due at least in part to chronic elevation of blood glucose levels, which leads to

damage of blood vessels (angiopathy). In diabetes, the resulting complications are grouped

under microvascular disease and macrovascular disease. Microvascular complications include

retinopathy, nephropathy, and neural damage or neuropathy. The major macrovascular

complications include accelerated cardiovascular disease resulting in myocardial infarction

and cerebrovascular disease manifesting as strokes. Other chronic complications of diabetes

include depression, (Nouwen et al., 2011). Dementia (Cukierman et al., 2005). And sexual

dysfunction (Adeniyi et al., 2011; Thorve et al., 2011).

14
2.4.1 Diabetic Retinopathy

Diabetic retinopathy develops over many years, and almost all patients with type 1 diabetes

(Roy et al., 2004; Hirai et al., 2011). And most having type 2 diabetes (Kempen et al., 2004).

Exhibit some retinal lesions after 20 years of disease. Furthermore, whereas in type 1 diabetes

the major vision threatening retinal disorder appears to be proliferative retinopathy ( Klein et

al., 2008). In type 2 diabetes there is a higher incidence of macula oedema. Nevertheless,

only a minority of such patients will have progression resulting in impaired vision. In

addition to maintenance of blood pressure and glycaemia control, there are a number of

treatments for diabetic retinopathy that have efficacy in reducing vision loss. These three

treatments include laser photocoagulation, injection of the steroid triamcinolone, and more

recently vascular endothelial growth factor (VEGF) antagonists into the eye, and vitrectomy,

to remove the vitreous. However, there is no agreed medical approach to slow disease

progression before the use of these rather invasive treatments.

2.4.2 Diabetic Nephropathy

Diabetes is one of the leading causes of end-stage renal failure. The pathophysiologic event

that takes place in diabetic nephropathy is damage to the basement membrane with associated

renal damage. There is a progressive thickening of the basement membrane and damage to

mesangial and vascular cells leading to the passage of macromolecules which may activate

inflammatory pathways that contribute to secondary damage (Evans & Capell, 2000).

Activation of the transforming growth factor-β (TGF-β) system is also said to be linked in the

pathogenesis of diabetic nephropathy, based on the properties of TGF-β, as well as the

observation that levels of TGF-β mRNA and protein are significantly increased in the

15
glomeruli and tubulointerstitium in human diabetes and in animal models (Wendt et al.,

2013). Some of the risk factors for the development of diabetic nephropathy include

hypertension, hyperglycaemia smoking and high protein diet. Treatment intervention may

include screening for the earliest stages of renal damage and aggressively controlling blood

glucose and blood pressure which can help prevent further renal damage (Evans & Capell,

2000; Ayodele et al., 2004).

2.4.3 Erectile Dysfunction

Erectile dysfunction (ED) affects approximately 34 % to 45 % of men with diabetes and has a

negative impact on quality of life (Eardley et al., 2007). Studies have shown that alteration of

the cyclic guanosinemonophosphate (cGMP /nitric acid (NO) pathway among men with

diabetes with impaired vascular relaxation is related to endothelial dysfunction (Angulo et al.,

2006 ; Angulo et al., 2009 ; Angulo et.al., 2010). Among individuals with diabetes, the risk

factors that may lead to ED include increasing age, poor glycaemic control, hypertension,

cigarette smoking dyslipidemia, androgen deficiency states and cardiovascular disease (CVD)

(Brock, & Harper, 2013).

2.4.4 Diabetic Neuropathy

The most common complication forms of diabetic neuropathy are autonomic neuropathy and

distal symmetrical polyneuropathy (DSPN) with DSPN being the most common

manifestation, but many patterns of nerve injury can also occur (Callaghan et al., 2012;

Jimenez-Cohl et al., 2012). The risk factor is hyperglycaemia. Sensorimotor neuropathy is

associated with pain, sensory loss and paresthesia. Gastroparesis and Genitourinary

dysfunctions are the main complications of diabetic neuropathy. The pathology involves

oxidative stress, advanced glycation end products, polyol pathway flux and protein kinase C

16
activation which contribute to nerve dysfunction and microvascular disease (Duby et al.,

2004). In addition to motor neuron dysfunction, the autonomic nervous system is also

influenced by diabetes. One common abnormality in autonomic function seen in individuals

with diabetes is orthostatic hypotension, due to an inability to adjust heart rate and vascular

tone to maintain blood flow to the brain. The autonomic nerves innervating the

gastrointestinal tract are also affected leading to gastroparesis, nausea, bloating, and

diarrhoea, which can also alter the efficacy of oral medications. In particular, delayed gastric

emptying can dramatically affect glycaemia control by delaying the absorption of key

nutrients, as well as antidiabetic agents leading to imbalances in glucose homeostasis. The

wide variety of clinical manifestations seen with neuropathy, in addition to impaired wound

healing, erectile dysfunction, and cardiovascular disease, can severely impede quality of life.

Indeed, autonomic markers can predict which diabetic individuals have the poorest prognosis

following myocardial infarction (Barthel et al., 2011). Consistent with other complications,

the duration of diabetes and lack of glycaemia control are the major risk factors for

neuropathy in both major forms of diabetes (Forbes & Cooper, 2013). Other than

optimization of glycaemia control and management of neuropathic pain, there are no major

therapies approved in either Europe or the United States for the treatment of diabetic

neuropathy. In addition, as is seen with other complications, the mechanisms leading to

diabetic neuropathy are poorly understood. At present, treatment generally focuses on

alleviation of pain, but the process is generally _progressive.

2.5 METABOLIC SYNDROME

Metabolic syndrome (MetS) is defined by a group of interconnected physiological,

biochemical, clinical, and metabolic factors that directly increases the risk of atherosclerotic

cardiovascular disease (Grundy et al., 2005; Kaur, 2014). Worldwide prevalence of MetS

17
ranges from <10% to as much as 84%, depending on the region, urban or rural environment,

composition of the population studied, and the definition of the syndrome used (Kaur, 2014).

MetS is a state of chronic low grade inflammation as a consequence of complex interplay

between genetic and environmental factors. Insulin resistance, visceral adiposity, atherogenic

dyslipidemia, endothelial dysfunction, genetic susceptibility, elevated blood pressure,

hypercoagulable state, and chronic stress are the several factors which constitute the

syndrome.

2.5.1 Tumour Necrosis Factor

It is a paracrine mediator in adipocytes and appears to act locally to reduce the insulin

sensitivity of adipocytes (Lau et al., 2005). Evidence suggests that Tumour Necrosis Factor

(TNF- ) induces adipocytes apoptosis and promotes insulin resistance by the inhibition of the

insulin receptor substrate 1 signalling pathway (Hotamisligil et al., 1996 ; Xydakis et al.,

2004). The paracrine action would further tend to increase the FFA release, inducing an

atherogenic dyslipidaemia. Plasma TNF is positively associated with the body weight, and

triglycerides (TGs), while, a negative association exists between the plasma TNF and High

density lipoprotein (HDL) (Krauss, 2004).

2.5.2 Adiponectin

It regulates the lipid and glucose metabolism, increases insulin sensitivity, regulates food

intake and body weight, and protects against a chronic inflammation. It inhibits hepatic

gluconeogenic enzymes and the rate of an endogenous glucose production in the liver. It

increases glucose transport in muscles and enhances fatty acid oxidation (Eckel et al., 2005).

It has a multifactorial antiatherogenic action which includes an inhibition of endothelial

activation, a reduced conversion of macrophages to foam cells, and inhibition of the smooth

18
muscle proliferation and arterial remodelling that characterizes the development of the

mature atherosclerotic plaque (Eckel et al., 2005). Adiponectin is inversely associated with

CVD risk factors such as blood pressure, low density lipoprotein cholesterol (LDL), and

Triglycerides (Krauss, 2004). It has been reported that hypoadiponectinemia is associated

with insulin resistance, hyperinsulinemia, and the possibility of developing T2DM,

independent of fat mass (Fumeron et al., 2004). Adiponectin is seen to be “protective,” not

only in its inverse relationship with the features of MetS but also through its antagonism of

TNF action.

2.5.3 Dyslipidemia

This dyslipidemia is characterized by a spectrum of qualitative lipid abnormalities reflecting

perturbations in the structure, metabolism, and biological activities of both atherogenic

lipoproteins and antiatherogenic high density lipoprotein (HDL) which includes an elevation

of lipoproteins containing apolipoprotein B (apoB), elevated TGs, increased levels of small

particles of LDL, and low levels of HDL. Insulin resistance leads to an atherogenic

dyslipidemia in several ways. First, insulin normally suppresses lipolysis in adipocytes, so an

impaired insulin signalling increases lipolysis, resulting in increased FFA levels. In the liver,

FFAs serve as a substrate for the synthesis of TGs. FFAs also stabilize the production of

apoB, the major lipoprotein of very low density lipoprotein (VLDL) particles, resulting in a

more VLDL production. Second, insulin normally degrades apoB through PI3K-dependent

pathways, so an insulin resistance directly increases VLDL production. Third, insulin

regulates the activity of lipoprotein lipase, the rate-limiting and major mediator of VLDL

clearance. Thus, hypertriglyceridemia in insulin resistance is the result of both an increase in

VLDL production and a decrease in VLDL clearance. VLDL is metabolized to remnant

lipoproteins and small dense LDL, both of which can promote an atheroma formation. The

19
TGs in VLDL are transferred to HDL by the cholesterol ester transport protein (CETP) in

exchange for cholesteryl esters, resulting in the TG-enriched HDL and cholesteryl ester

enriched VLDL particles. Further, 20the TG-enriched HDL is a better substrate for hepatic

lipase, so it is cleared rapidly from the circulation, leaving a fewer HDL particles to

participate in a reverse cholesterol transport from the vasculature. Thus, in the liver of

insulin-resistant patients, FFA flux is high, TGs synthesis and storage are increased, and

excess TG is secreted as VLDL (Hu et al., 2001). For the most part, it is believed that the

dyslipidaemia associated with insulin resistance is a direct consequence of increased VLDL

secretion by the liver .These anomalies are closely associated with an increased oxidative

stress and an endothelial dysfunction, thereby reinforcing the proinflammatory nature of

macrovascular atherosclerotic disease (Bastaki, et al., 2005).

2.5.4 Hypertension

Hypertension is frequently common among patients with diabetes (Matheus et al., 2013).The

coexistence of these two conditions increase the risk of developing macrovascular

complications and also microvascular complications and close monitoring and treatment of

hypertension may reduce the progression of these complications (Matheus et al., 2013).

Hypertension affects majority of individuals with diabetes mellitus especially those with type

2 diabetes mellitus and its pathogenesis is complex, involving interactions between genetic

predisposition and a range of environmental factors (Gilbert et al., 2013). Hypertension

commonly occurs without abnormal renal function and insulin resistance precipitate

hypertension by stimulating the sympathetic nervous system and the rennin – angiotensin

system, promoting sodium retention (Lago et al., 2007).

20
2.6 MANAGEMENT OF DIABETES MELLITUS

2.6.1 Insulin

Insulin is lifesaving pharmacological therapy for people with type 1 diabetes. This hormone

is primarily produced by recombinant DNA technology and is formulated either as

structurally identical to human insulin or as insulin analogues (McGibbon et al., 2013).

Insulin regimens should be tailored to the individual‟s treatment goals, lifestyle, diet, age,

general health, motivation, hypoglycaemia awareness status and ability for self-management.

Social and financial aspects also should be considered. While fixed-dose regimens once were

common and still may be used in some circumstances, they are not encouraged. The intensive

insulin treatment of type 1 diabetes significantly delays the onset and slows the progression

of microvascular and macrovascular complications (Nathan et al., 2005; McGibbon et al.,

2013).The most successful protocols for type 1 diabetes rely on basal-bolus regimens that are

used as a component of intensive diabetes therapy. Basal insulin is provided by intermediate-

acting insulin or a long-acting insulin analogue once or twice daily. Bolus insulin is provided

by short-acting insulin or a rapid-acting insulin analogue given at each meal. Such protocols

attempt to duplicate normal pancreatic insulin secretion. Prandial insulin dose must take into

account the carbohydrate content and glycaemia index of the carbohydrate consumed,

exercise around meal time. Regular insulin should ideally be administered 30 to 45 minutes

prior to a meal. However, it has been known that pre-prandial injections achieve better

postprandial control and, possibly, better overall glycaemia control (Jovanovic et al., 2004;

Schernthaner et al., 2004; Garg et al., 2005). Complications of insulin therapy include weight

21
gain and hypoglycaemia. Hypoglycaemia may result from an inappropriately large dose, from

mismatch between the peak delivery of insulin and food intake.

2.6.2 α- Glucosidase inhibitors22

α-Glucosidase inhibitors have been developed specifically to delay the digestion of complex

carbohydrates and decrease the postprandial rise in plasma glucose. α-Glucosidase inhibitors

competitively block small intestine brush border enzymes that are necessary to hydrolyze

oligosaccharides and polysaccharides to monosaccharides (Bischoff, 1995). Inhibition of this

enzyme slows the absorption of carbohydrates; the postprandial rise in plasma glucose is

blunted in both normal and diabetic subjects (Rabasa-Lhoret & Chiasson 1998). Examples of

α-glucosidase inhibitors include acarbose, miglitol, and voglibose and all have similar

pharmacological profiles.

2.7 ANTI DIABETIC MEDICINAL PLANTS

2.7.1 Cabbage

Cabbage is one of the most important crop plants of the species (Brassica oleracea). It is a

herbaceous, biennial, dicotyledonous flowering plant with leaves forming a characteristic

compact head. The cabbage is differentiated into white head cabbage (Brassica oleraceavar

capitatasub.varalba) and red head cabbage (Brassica oleraceavar. capitata sub.var. rubra).

It is widely consumed probably due to the its acceptable price, consumer preferences and

availability at local markets The influence of cabbage consumption on human health is

evident and is, in addition to being a source of vitamins and fibre, connected with secondary

metabolites called glucosinolates, which are known to possess anticarcinogenic properties

( Sarikamiş et al., 2009). Cabbage is rich in phytochemicals such as polyphenolics,

22
glucosinolates, carotenoids and vitamin C that have showed antioxidant, anticancer

(Podsędek, 2007). And potential anti-obesity properties (Williams et al., 2013). Raw cabbage

juice can potentially heal an ulcer within 14 days of treatment. It is believed that the high

level of glutamine is responsible for this healing effect. The ulcer healing properties of

cabbage juice was verified in the 1950s in clinical trials both in United States and Europe

(Priya, 2012). It has also been known that taking the combination of cabbage and Broccoli

juice daily for 12 weeks significantly reduce the blood levels of low – density lipoproteins

(Takai et al., 2003). Epidemiological studies have shown cabbage to reduce the risk of lung,

stomach, colorectal, breast, bladder and prostate cancer. It is postulated that this ability comes

from glucosinolate proficiency for inhibiting cell division and inducing apoptosis (Priya,

2012). Cabbage has high level of anti – oxidants, such as vitamin C which has an immune

boosting effect (Singh et al., 2006). Cabbage extract intake reduce serum cholesterol level

and enhance faecal bile acid excretion and cholesterol 7 alpha hydroxylase activity, the rate

limiting enzyme for bile acid biosynthesis in the microsomal fraction liver (Priya, 2012).

2.7.2 Toxicity of Cabbage (ld50):

The LD50 of the extract in albino rats was determined using Lorke’s method (1981). The

procedure of determining the lethal dose is by increasing the concentration of the extracts

administered into rats (after weighing them) in each group consisting five (5 rats) per group

for two weeks.

Antioxidant activities

Consumption of food or nutritional supplements rich in antioxidants improves the pathways

of defences against free radicals and reactive oxygen species (ROS) and thereby helps to

protect against chronic diseases. The presence of biological activities with confirmed

23
antioxidant capacity, like vitamin C, carotenoids, polyphenolics, flavonoids, glucosinolates,

hydrolysis products, etc., has been predominantly associated with the health benefits of

Brassica vegetable (Podsędek, 2007; Singh et al., 2007; Cartea et al., 2011).

The antioxidant potential of green cabbage has been calculated using various methods in

multiple tests. Scientists have recommended the ORAC (Oxygen Radical Absorbance

Capacity) method for measuring antioxidant capacity. The total ORAC for fresh weight of

cabbage is between 498 and 1784 μmol TE/100 g, which grades B. oleracea var. capitata as a

vegetable with medium antioxidant activity, according to the USDA ORAC Database

(Haytowitz & Bhagwat, 2010).

According to (Jacob et al., 2011). The extract of green cabbage could be O2-, OH radicals

function as free radical scavengers and fix free-radical damage caused by radical guanosine.

In aerobic species, cellular biomembranes are the primary tasks of ROS, resulting in lipid

peroxide formation. Green cabbage water extract has been shown to be capable of preventing

lipid peroxidation and reducing lipid peroxide production (Podsędek, 2007).

Glucosinolates under the complete hydrolysis through fermentation of the green cabbage

create a variety of health-promoting compounds that have a high antioxidant activity, and

indeed fermentation boosts the cabbage antioxidant property. Due to global accessibility and

daily use, the green cabbage will contribute substantially to the total utilization of antioxidant

phytonutrients in human dietary (Singh et al., 2006).

2.7.3 Azadirachta indica (Neem)

Hydroalcoholic extracts of this plant showed antihyperglycaemic activity in streptozotocin

treated rats and this effect is because of increase in glucose uptake and glycogen deposition in

isolated rat hemidiaphragm. Apart from having anti-diabetic activity, this plant also has

24
antibacterial, antimalarial antifertility, hepatoprotective and antioxidant effects (Dheer &

Bhatnagar, 2010).

The use of acetaminophen that not following doctor's recommendations can cause liver

toxicity and induce the production of various enzymes such as Serum Glutamic Pyruvic

Transaminase (SGPT), Serum Glutamic Oxaloacetic Transaminase (SGOT), Alkali

Phosphatase (ALP), and gamma-glutamyl transferase (ƔGT). The increase in these enzymes

indicates cellular leakage and cellular damage to the liver function due to the increase in

Reactive Oxygen Species (ROS) induced by N-acetyl-benzo-quinoneimine (NAPQI). NAPQI

is a toxic metabolite of acetaminophen. An increase in NAPQI can occur due to an imbalance

in the amount of NAPQI and glutathione. This condition can be prevented by giving

antioxidants, one of which is anthocyanins. Anthocyanins have properties as hepatoprotector

by reducing oxidants and increasing glutathione, which can deplete NAPQI thereby reducing

inflammatory reactions in the liver. Previous research has shown that the anthocyanin content

in roselle flowers can act as a hepatoprotector (Suganda, G., 2010).

2.7.4 Zea mays (Corn Silk, Indian corn)

Cornsilk is a proven anti diuretic. It is plentiful, cheap, and commonly used to treat cystitis,

pyelitis, oliguria, and edema. It possesses hypoglycemic, antimicrobial, cholinergic and

hypotensive properties. Cornsilk has more or less confirmed oral hypoglycemic activity. In

one study the herb produced a constant hypoglycemic effect in starving rabbits. The active

principle is not known (Amreen et al., 2012).

25
 CHAPTER THREE

MATERIALS AND METHODS

3.1 MATERIALS

3.1.1 Plant Material26

 Green Cabbage Extract

Fresh cabbage were purchased in the local fruit market in Makurdi local government of

Benue state, Nigeria. Authentication and identification was done by the Department of

Biological Sciences, Benue State University, Makurdi. The leaves were washed properly,

crushed to semi aqueous form using a mechanical blender and seaved. It was stored in a glass

bottle with a plastic screw cap and kept in a refrigerator (4 o C) for subsequent use in the

study.

3.1.2 Equipment

Materials used were digital glucometer for blood glucose determination (Erba mannheim)

chem5v3 Germany by Suresh Vazirani (1979). Erba mannheim incubator, wondfo digital

timer, automated pasture pipet with pipet tip, testube Weighing balance (GF 2000), dissecting

set, syringes and needle, centrifuge for spining, spectrophotometer, animal feed and animal

cage.

3.1.3 Animals

Rat

A total of twenty male albino Wistar rats weighing 150-200 g were used for this study. The

animals were obtained from the Animal house of Department of Human Physiology, Benue

State University, Makurdi. They were grouped into 3 experimental and a control groups and

were kept in polypropylene cages. Standard animal feed made of pellets from growers mash
26
were provided to the animals. The rats were allowed access to drinking water and libitum

throughout the period of the study. Animals were acclimatized for one week before treatment.

3.2 METHOD

3.2.1 Experimental Treatment

10mg/kg, 20mg/kg and 40mg/kg of extract was administered to the rats with a blunt sterile

needle while giving them their normal rat pellets and drinking water.

Treatment procedure is as shown below

Group 1 (control): Received normal distilled water and rat feed orally.

Group 2 (10mg/kg): Received 1ml of Cabbage orally per kg body weight.

Group 3 (20mg/kg): Received 1 ml of Cabbage orally per kg body weight.

Group 4 (40mg/kg): Received 1ml of Cabbage orally per kg body weight.

Treatment was through oral route for 14 days, on day 15 and after an overnight, blood

samples was collected via cardiac puncture for analysis. Fasting blood glucose levels was

determined by using glucose oxidase method (Beach & Turner, 1958) using a digital

glucometer (Erba Mannheim Diagnostic, Germany). The results were expressed in mg/dl

(Rheney & Kirk, 2000).

3.2.2 Collection and Preparation of sera Samples for Lipid Profile Analysis

The blood samples were collected in Eppendorf tubes, allowed to clot and the serum

separated by centrifugation using Denley BS400 centrifuge (England) at 3000 g for 10

minutes. The supernatant (serum) collected was then used for lipid profile analysis.

Estimation of serum lipid profile Serum lipid profile was determined spectrophotometrically,

using enzymatic colometric assay kits (Randox, Northern Ireland) as follows:

i. Determination of Serum Total Cholesterol

27
The serum level of total cholesterol (TC) was quantified after enzymatic hydrolysis and

oxidation of the sample as described by method of Stein, (1987). 1ml of the reagent was

added to each of the sample and standard. It was then incubated for 10 minutes at 37 0C after

mixing and the absorbance of the sample (A sample) and standard (A standard) were

measured against the reagent blank within 30 minutes at 546 nm. The value of TC present in

serum was expressed in mg/dl.

TC concentration = A sample /A standard x 196.86 mg/dl.

ii. Determination of Serum Triglyceride

The serum triglyceride level was determined after enzymatic hydrolysis of the sample with

lipases as described by method of Tietz, (1990). 1ml of the reagent was added to each of the

sample and standard. This was incubated for 10 minutes at 37 0C after mixing and the

absorbance of the sample (A sample) and standard (A standard) was measured using

spectrophotometer against the reagent blank within 30 minutes at 546 nm. The value of

triglyceride present in the serum was expressed mg/dl.

TGL concentration = A sample/A standard x 194.0 mg/dl

iii. Determination of Serum High Density Lipoprotein (HDL)

The serum level of HDL was measured by the method of Wacnic and Albers, 1978. Low-

density lipoproteins (LDL and VLDL) and chylomicron fractions in the sample were

precipitated quantitatively by addition of phosphaturic acid in the presence of magnesium

ions. The mixture was allowed to stand for 10 minutes at room temperature and centrifuged

for 10 minutes at 4000

iv. Determination of Serum Low Density Lipoprotein (LDL)

28
The serum level of (LDL) was measured according to the protocol of Friedewald et al., 1972,

using the equation below:

LDL-C = TC - (TGL/5 + HDL)

The value was expressed in mg/dl29

3.3 STATISTICAL ANALYSIS

All data were expressed as mean ± SEM. The data obtained were statistically analyzed using

analysis of variance (ANOVA) with Tukey’s multiple comparison post hoc tests to compare

the level of significance between control and experimental groups. All statistical analysis

were evaluated using statistical package ọf social science (SPSS) software version 25.0

(2019). The values of P < 0.05 were considered as significant.

29
 CHAPTER FOUR

RESULTS

4.0 INTRODUCTION

Following the appropriate administration of cabbage at low dose (10mg/kg), medium dose

(20mg/kg) and high dose (40mg/kg), it effects were observed on lipid profile (Triglycerides,

low-density lipoprotein, high-density lipoprotein, total cholesterol and very low-density

lipoprotein) and the blood glucose level.

30
4.1 CHOLESTEROL CONCENTRATION

Table 1: Effect of cabbage doses (10mg/kg, 20mg/kg and 40mg/ kg) on cholesterol

concentration in Wistar rats.

TG TOTAL HDL LDL VLDL

CH

Group 1 (CONTROL) 0.46±0.02a 2.18±0.20 a 1.02±0.80b 0.86±0.12b 0.2±0.00a

Group 2 (10mg/kg) received 0.58±0.06a 2.28±0.21 a 0.98±0.05b 1.03±0.18b 0.28±0.03a

1mL of cabbage

Group 3 (20mg/kg) received 0.55±0.03a 2.20±0.14 a 1.05±0.06b 0.90±0.16b 0.25±0.03a

1mL of cabbage

Group 40 (10mg/kg) 0.58±0.06a 2.36±0.24 a 1.02±0.09b 1.08±0.17b 0.26±0.02a

received 1mL of cabbage

Data presented as Mean ± SEM. Values in same column with the same alphabets in

superscript are not significantly different (P < 0.05). Low dose; low dose (10mg/kg of

cabbage), M- dose; medium dose (20mg/kg of cabbage); H-dose; high dose (40mg/kg of

cabbage). TG; Triglycerides, LDL; low-density lipoprotein, HDL; high-density lipoprotein,

TOTAL CH; total cholesterol and VLDL; very low-density lipoprotein.

31
Table 2: Blood glucose levels in control and experimental groups.

Rat

Number Control group Experimental group

Group 2 (10mg/kg) Group 3(20mg/kg) Group 4 (40mg/kg)

received 1mL of received 1mL of received 1mL of

Control cabbage cabbage cabbage

1 3.5 3.0 5.6 3.3

2 4.3 3.3 3.9 2.2

3 3.9 2.9 4.9 2.6

4 2.9 2.5 2.8 2.8

5 3.8 2.9 4.3 2.9

32
 GLUCOSE LEVEL
6

4
mmol/L

0
L
O SE SE SE
TR O O O
N D - D - D
O W M H
C LO

FIGURE 1: Effect of 10mg/kg, 20mg/kg and 40mg/kg of cabbage on blood glucose level of

male Wistar rats.

No significant difference was observed in the blood glucose level of low dose (10mg/kg),

medium dose (20mg/kg), high dose (40mg/kg) administered rats when compared to the blood

glucose level of the control rats. The blood glucose level of high dose (40mg/kg) cabbage

administered rat was significantly lower than the blood glucose level of the medium dose

cabbage administered rat.

33
 CHAPTER FIVE

DISCUSSION, CONCLUSION AND RECOMMENDATION

5.1 DISCUSSION

In this chapter, the researcher attempts to discuss his findings in the order of the

predetermined study objectives/ hypotheses and to show how the current study fit into the

existing body of knowledge.

5.1.1 Effect of cabbage on cholesterol.

However, the study showed that cabbage has significant effect on lipids, specifically a

negative correlation was found between cabbage dosage and VLDL which implies that

increasing cabbage dose could decrease VLDL. This finding corroborate the findings from

earlier studies by (Takai et al., 2003), which showed that daily consumption of cabbage and

broccoli juice for 12 weeks significantly reduced LDL in a study population. Having a study

like the current study which exclude the broccoli component could provide a different

perspective, as it describes only the effect of cabbage. Similarly, the findings of this study is

supported by Priva (2012), who posited that cabbage extract consumption reduced serum

cholesterol level and enhance faecal bile acid excretion and cholesterol 7 alpha hydroxylase

activity, the rate limiting enzyme for bile acid biosynthesis in the microsomal fraction liver.

VLDL and LDL are lipoproteins that transport fats around the body. They are considered bad

cholesterols because when they are elevated above normal range, there is a corresponding

increase in the risk or likelihood of developing heart diseases and stroke, hence the need to

keep check on them.

5.1.2 Effect of Cabbage on blood glucose

In the present study from the result, it shows that administration of cabbage either at different

dose doesn't cause significant change across all group which might be that the high rise in
34
blood sugar commonly observed in pre-diabetics could only be achieved with longer period

of feeding the rats with the high sucrose feed. My study was not in agreement with (Amnah,

2013). Which stated to a reduction in the blood sugar of all the animals in the different group

from second week. The positive control group which was also in proximity was also

influenced. However, it was found that the blood glucose of the rats in a group increased at

sixth compared with that of the other and test groups which was an indication of the efficacy

of the extracts given.

An insufficient release of insulin, leads to high blood glucose level or hyperglycemia (Grover

et al., 2002). Insulin deficiency leads to various metabolic alterations in the animals, viz.

increased blood glucose, increased cholesterol and transaminases (Shanmugasundaram et al.,

1983). The fundamental mechanism underlying hyperglycemia in diabetes mellitus involves

overproduction (excessive hepatic glycogenolysis and gluconeogenesis) and decreased

utilization of glucose by the tissues (Jayasriet al., 2008).

In the present study the antihyperglycaemic activity of effects of methanolic effect of

cabbage was evaluated in normal. Notable antihyperglycaemic activity was observed with

cabbage extracts both in the normal (OGTT) and in high dose.

5.2 CONCLUSION

Cabbage has no significant effect on blood glucose but significantly affect lipid profile,

increasing cabbage dose reduces VLDL.

5.3 RECOMMENDATION

A prospective longitudinal randomized controlled study with strict eligibility or selection

criteria at baseline, and increased sample size may better evaluate the effect of cabbage dose

on glucose and cholesterol.

35
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 APPENDIX

Table 3: Blood glucose levels in control and experimental groups

Linear regression

Blood Coef. St.Err. t- p- [95% Interval] Sig

Glucose value value Conf

Dosage -.015 .013 -1.19 .249 -.043 .012

Constant 3.684 .296 12.45 0 3.062 4.306 ***

Mean dependent var 3.415 SD dependent var 0.863

R-squared 0.073 Number of obs 20

F-test 1.417 Prob > F 0.249

Akaike crit. (AIC) 52.344 Bayesian crit. (BIC) 54.335

*** p<.01, ** p<.05, * p<.1

48
Table 4: Regression Analysis of Cabbage Dosage and Blood Glucose

Test Statistics: F=1.417 (p value = 0.249)

At α = 0.05, we fail to reject H0 because the p-value (0.249) is greater than 0.05

Number of obs = 20 R-squared = 0.9964

Root MSE = .053479 Adj R-squared = 0.9943

Source | Partial SS df MS F Prob>F

-----------+-------------------------------------------------------------------

Model | 9.4895 7 1.3556429 474.00 0.0000

Dosage | .03238 3 .01079333 3.77 0.0406

Lipid Profile | 9.45712 4 2.36428 826.67 0.0000

Residual | .03432 12 .00286

-----------+---------------------------------------------------------------------

Total | 9.52382 19 .50125368

49
Table 5: Analysis of variance, Cabbage dose versus lipid profile

Test Statistics: F=474.00 (p value = 0.000)

At α = 0.05, we reject H0 because the p-value (0.000) is far less than 0.05

LipidProfile Coef. St.Err. t- p- [95% Interval] Sig

value value Conf
Dosage : base 0 . . . . .
Cont~l
Low .056 .034 1.66 .124 -.018 .13
Moderate .096 .034 2.84 .015 .022 .17 **
High .1 .034 2.96 .012 .026 .174 **
Profile : base 0 . . . . .
TG
Total CH 1.717 .038 45.42 0 1.635 1.8 ***
HDL .475 .038 12.56 0 .393 .557 ***
VLDL -.295 .038 -7.80 0 -.377 -.213 ***
LDL .425 .038 11.24 0 .343 .507 ***
Constant .48 .034 14.18 0 .406 .553 ***

Mean dependent var 1.007 SD dependent var 0.708

R-squared 0.996 Number of obs 20

F-test 474.001 Prob > F 0.000

Akaike crit. (AIC) -54.598 Bayesian crit. (BIC) -46.632

*** p<.01, ** p<.05, * p<.1

Table 5 shows that; Cabbage dose have no correlation with triglyceride (TG), but is
negatively correlated with VLDL (-0.295)

50