Formulation and Quality Characterization of Gluten Free Malted Multigrain Beverage Premix

V
Verma Anisha1,*
S
Savita Parul2
N
Neeru Bala2
V
Verma Chhavi3
1Department of Food and Nutrition, College of Community Science, Acharya Narendra Deva University of Agriculture and Technology, Kumarganj, Ayodhya-224 229, Uttar Pradesh, India.
2Department of Food Nutrition and Public Health, Sam Higginbottom University of Agriculture Technology and Sciences, Prayagraj-211 007, Uttar Pradesh, India.
3Department of Food and Nutrition, Acharya Narendra Deva University of Agriculture and Technology, Kumarganj-224 229, Uttar Pradesh, India.

Background: Celiac disease is a chronic immune-mediated enteropathy triggered by the ingestion of gluten proteins present in wheat, barley and rye. It is characterized by villous atrophy and persistent inflammation of the small intestine, leading to impaired nutrient absorption. A recent study indicates that celiac disease affects approximately 1% of the global population, with increasing diagnosis rates worldwide. The only effective treatment remains lifelong adherence to a strict gluten-free diet.  In the present study gluten free malted multigrain beverage premix formulation was optimized by using multi objectives to prepare the malted multigrain flour using the selected ingredients and to evaluate the sensory acceptability, physicochemical, nutritional and storage quality of prepared beverage premix.

Methods: Multigrain beverage premix was prepared from malted buckwheat, malted green gram, malted soybean and dehydrated vegetables like carrot, beetroot and mint leaves. Malted multigrain powder was prepared using soaking, germinating, drying, roasting and grinding process. Formulation of malted multigrain powder was done by incorporation of different ingredient in various proportion on trial basis. Formulated premix was analyzed for their sensory acceptability, physico-chemical, nutritional and storage quality using standard procedure.

Result: The results showed that the prepared product received high sensory scores for colour and appearance, consistency, taste and flavour, as well as overall acceptability, demonstrating good consumer acceptance. The observed values of physicochemical properties indicate that the different processing methods could not change the final quality of prepared malted beverage premix. Nutrient content of prepared Malted Multigrain Beverage Premix was rich in protein, iron and β carotene. TPC, Yeast and Mold count and sensory scores of the developed food product were found at desirable level till the 90 days of storage.

Celiac disease is an autoimmune enteropathy characterized by chronic inflammation and villous atrophy of the small intestine triggered by ingestion of gluten, a complex of storage proteins found in wheat, rye and barley. A strict gluten free diet is the only effective treatment, yet the disease often leads to malabsorption of essential nutrients including iron, calcium, folic acid and fat soluble vitamins, contributing to micronutrient deficiencies in a significant proportion of patients. Between 20 per cent and 38 per cent of individuals with celiac disease exhibit iron deficiency and substantial proportions show deficiencies in vitamin B12, calcium and vitamin D due to intestinal damage and dietary limitations (Seyede et al., 2018). Despite the expanding gluten-free market driven by medical necessity and consumer perception of health benefits, commercially available gluten-free products often remain nutritionally imbalanced. Contemporary analyses (2020-2024) demonstrate that many gluten-free formulations contain lower protein and dietary fiber but higher fat and sodium compared to their gluten-containing counterparts (Mehtab et al., 2024). Furthermore, these products frequently rely on refined starches and flours with limited micronutrient density and reduced bioactive compounds, thereby failing to address the long-term nutritional vulnerabilities of individuals with celiac disease (Letizia et al., 2010).
       
Rapid urbanization and changing life styles have increased the demand for convenient, shelf stable  and nutrients enriched ready to reconstitute (RTR) foods. Powdered RTR beverage premixes provide an effective way to deliver nutrient-dense formulations that are easy to prepare and store while overcoming the stability challenges of liquid beverages. Traditional processing methods such as malting, germination and roasting enhance the nutritional quality of plant-based ingredients by reducing anti-nutritional factors and improving digestibility through activation of endogenous enzymes. Malting is an effective pre-treatment technique that enhances the nutritional quality of flours by increasing both the concentration and bioavailability of essential minerals, thereby making them more suitable for use in functional food formulations (Bangar et al., 2026).
        
Despite of growing interest in functional and gluten- free convenience foods, researches on nutrient enriched Ready to Reconstitute premixes remains limited. Gluten-free multigrain formulations offer the added benefit of catering to individuals with gluten intolerance while delivering essential micronutrients and bioactive compounds for long-term health.
       
Therefore, the present study aims to develop and evaluate a novel gluten-free multigrain RTR beverage premix formulated from malted buckwheat, green gram and soybean flours enriched with dehydrated carrot, beetroot and mint powders. This formulation is designed not merely as a convenience product, but as a functional beverage with enhanced protein content, improved iron availability, elevated β-carotene levels and increased antioxidant potential. The study comprehensively assesses its physicochemical characteristics, nutritional composition, sensory acceptability and storage stability, thereby addressing a significant research gap and contributing to the advancement of nutritionally enriched gluten-free functional foods.
Procurement of raw materials
 
• The raw materials were procured from the local market of  Naini area, Prayagraj. The samples (buckwheat, green gram, soybean) were cleaned by hand to remove  extraneous matter such as dirt, grit and broken seeds from it. Samples were sealed and placed in plastic bags and stored at 21- 23°C until used.
• Carrots, Beetroot and Mint leaves are purchased from the local vegetable market of Prayagraj.
 
Processing of ingredients
 
Raw ingredients were processed using the following procedure-
 
Preparation of malted grains powder
 
The selected grains buckwheat, green gram and soybean were manually cleaned, washed and soaked in potable water for 10-12 hours. After draining, they were spread on trays, covered with a moist cloth and germinated at 25-30°C for 24-48 hours until sprouts appeared. Malting was then carried out following the standard procedure (Fig 1).

Fig 1: Flowchart for preparation malted grains flour.



Dehydration of vegetables
 
Fresh carrots (Daucus carota) and beetroot (Beta vulgaris) were selected based on uniform size, color and freedom from mechanical damage and microbial spoilage. The vegetables were washed thoroughly under running tap water to remove adhering soil and extraneous matter. Carrots and beetroot were peeled manually using a stainless steel peeler and sliced into uniform thickness (0.3 cm) using a stainless steel knife. The prepared slices were blanched in hot water containing 0.2% potassium metabisulphit for 2-3 minutes to inactivate enzymes, followed by immediate cooling in cold water. The prepared vegetables were evenly spread in trays for dehydration followed the procedure given in Fig 2.

Fig 2: Dehydration of carrot and beetroot.


 
Dehydration of mint leaves
 
Fresh mint (Mentha spicata) leaves were manually sorted to remove damaged, diseased and discolored leaves. The selected leaves were washed thoroughly under running tap water to remove surface contaminants. Excess water was removed by blotting paper. The prepared mint leaves were evenly spread in trays and dehydration was carried out using steps in (Fig 3).

Fig 3: Flow chart for dehydration of mint.


 
Product formulation
 
Malted multigrain and dehydrated vegetables were blended in different ratios, milled and sieved to produce dry premix powders, served as treatments T1, T2 and T3 (Table 1). Buckwheat served as the primary base for its high carbohydrate content, gluten-free nature and mineral profile, while soybean and green gram were increased to enhance protein and amino acid balance. Carrot, beetroot and mint were added to boost micronutrients, improve color and impart mild sweetness and flavor. All the treatments were replicated four times to get accurate and reliable results.

Table 1: Details of treatment and replications of malted multigrain beverages premix.


 
Reconstitution of beverage premix
 
The malted multigrain beverage was prepared by reconstituting 20 g of the premix powder in 200 ml of water (either at room temperature or cold). The mixture was stirred thoroughly until the powder was fully dissolved. Seasoning ingredients-including one tablespoon of mixed spices (such as black salt and roasted cumin powder, or adjusted to taste) and two tablespoons of lemon juice were then added. The beverage was mixed well and served to the panel members for evaluation (Budnimath et al., 2023).
 
Analysis of prepared product        
 
Sensory evaluation of malted beverage premix
 
Sensory evaluation of the malted multigrain beverage for their acceptability was done on the day of production by a panel of ten trained judges selected among the faculty members of Ethelind College of Community Science, Sam Higginbottom University of Agriculture Technology and Sciences, Prayagraj and twenty untrained panel members (Ph.D. and M.Sc. Students). The judges were requested to evaluate the re-constituted products with the help of a score card based on the 9-point Hedonic Scale (Color and Appearance, Consistency, Taste and Flavor and Overall Acceptability) (Srilakshami, 2018).
 
Determination of the physico-chemical properties
 
Based on the sensory analysis, treatment T1 obtained the highest score among the three treatments and was consequently chosen for further analysis. pH, total soluble solids of water activity, bulk and tapped density and  foaming capacity properties were analyzed using the standard procedure.
 
Determination of water activity
 
The water activity (aw) of malted multigrain beverage premix samples was determined as per the described method (Goudar et al., 2023). A small quantity of malted multigrain beverage premix sample was placed in the sample holder up to the indicated mark and then placed inside the water activity meter sensing groove and analyzed by the biosensor on the lid of the analyzer. The endpoint was indicated by three beep sounds displaying the water activity reading digitally which was recorded in water activity meter.
 
Determination of bulk and tapped density
 
A measured amount of malted multigrain beverage premix was placed into a 10 mL measuring cylinder and the volume occupied by the powder was measured and subsequently used to determine the bulk density (weight per unit volume).
       
The tapped density was calculated by tapping the measuring cylinder for 5 min until no visible decrease in volume was noticed. The final volume was then read and used to calculate the tapped density (Jangam et al., 2010).
                   
 
 
Determination of foaming capacity
 
The foaming capacity of the malted multigrain beverage premix was determined using a laboratory electric blender for whipping the sample and a graduated measuring cylinder for measuring foam volume. An analytical weighing balance was used to accurately weigh the sample. During the analysis, 2 g of sample was weighed using the analytical balance and mixed with 100 mL of distilled water. The mixture was whipped for 5 minutes using an electric blender to incorporate air and form foam. The whipped mixture was then transferred into a 10 mL graduated measuring cylinder to measure the foam volume and the foaming capacity was calculated according to the method reported by Budnimath, et al., (2023). The foaming capacity was calculated according to following equation:
Calculation:
 
 
  
Determination of the nutritional composition
 
Moisture, ash, protein, fat, fiber, beta carotene and iron of best treatment were analyzed as pre procedure given by AOAC (2023). Total carbohydrate was analyzed as per procedure given by (Tollen’s test) AOAC (2023).
 
Determination of shelf life
 
Organoleptically best treatment (T1) of malted   multigrain beverage premix was  packed and stored in low density polyethylene (LDPE) pouches  at the day of manufactured for the study of storage. Samples were drawn periodically after 15-15 days intervals and analyzed for microbial load (Total plate count and yeast/ mold count) and sensory analysis. The change in sensory acceptability and microbial load were noted down at intervals 0,15,30,45,60,75,90 days till the unacceptable limit for over a period of time using the following procedures:
• Total plate count (FSSAI, 2016).
• Yeast and mold count analysis by Enumeration method (FSSAI, 2016).
• Sensory analysis (Srilaxshmi, 2018).
 
Statistical analysis
 
The data obtained during the study was statistically analyzed by using statistical analysis of variance (ANOVA) and critical difference technique. Effect of incorporation of different ratio of ingredients was determined by using CD (Critical difference) test t (Gupta and Kapoor, 2002).
The data of the present studies “Formulation and characterization of gluten free malted multigrain beverage premix” are discussed in this chapter.
 
Sensory attributes of the malted multigrain beverage premix
 
Colour and appearance
 
It can be observed from the Table 2 that mean sensory scores of malted beverage premix in relation to colour and appearance indicates that T1 had the highest score (9.0) followed by T2 (8.5) and T3 (7.5) respectively. The results of analysis of variance shows that the calculated F value (92.2) for treatments is higher than the tabulated F value (4.75) at the 5% level of significance. This indicates that the treatments had a significant effect on the colour and appearance of the malted beverage premix. Hence, it can be concluded that the incorporation of different proportions of buckwheat, green gram, soybean, carrot, beetroot and mint leaves significantly improved the colour and appearance of the product. It was observed that all three experimental treatments of malted beverage premix showed increased intensity of colour because of the addition of increasing proportion of buckwheat, green gram, soybean, carrot, beetroot and mint leaves which gave the treatment a pinkish red colour in T1 comparison to T2 and T3 which included has more intense deep brown colour as compared to other treatments little lighter colour.
       
Khwairakpam and Murugkar (2023) reported that in the development of millet-based beverages, the addition of  ingredients (e.g., carrot and cocoa powder) significantly affected colour attributes, with increased redness and yellowness correlating with higher sensory colour scores among panelists.
 
Consistency
 
It can be observed from the above Table 2 that mean sensory scores of malted beverage premix in relation to consistency indicates that T1 treatments had the highest score 8 followed by T2 (7.5) and T3 (7.0) respectively. Statistical analysis revealed that the calculated F value (83.7) for treatments was higher than the tabulated F value (3.23) at (3,6) degrees of freedom at the 5% probability level. This indicates that the treatments had a significant effect on the consistency of the malted beverage premix. Hence, the incorporation of different proportions of buckwheat, green gram, soybean, carrot, beetroot and mint leaves significantly improved the consistency of the product. It can be concluded that addition of different proportions of buckwheat, green gram, soybean carrot, beetroot and mint leaves improves the consistency of the product. Dipak  et al. ( 2017) reported that increasing levels of soy protein isolate and pectin led to higher viscosity and improved consistency scores in sensory evaluation of developed high protein, high fiber smoothie as a grab-and-go breakfast option using response surface methodology.
 
Taste and flavour
 
It can be observed from the Table 2 that mean sensory scores of malted beverage premix in relation to taste and flavor indicates that T1 had the highest score 9 followed by T2 (8), T3 (7.5), respectively. Statistically, the calculated F value (155.9) for treatments exceeded the tabulated F value (4.75) at the 5% probability level, indicating a significant effect of treatments on the taste and flavour of the malted beverage premix. The improved taste and flavor of the malted beverage premix is due to the combined effects of its ingredients as carrot and beetroot add natural sweetness, mint leaves provide a refreshing aroma, buckwheat gives a mild nutty flavor, green gram adds a subtle pulse taste and soybean enriches smoothness and richness. Together, their balanced proportions enhance the beverage’s overall palatability. The taste and flavour of the malted beverage premix were influenced not only by the ingredients but also by processing techniques such as soaking, germination and roasting. Germination enhances free amino acids and sugars, which during roasting participate in Maillard reactions, producing desirable nutty and roasted flavours. Soaking reduces bitter compounds, while roasting develops aroma and colour, improving sensory appeal. Combined with the natural flavours of buckwheat, carrot, beetroot, mint, green gram and soybean, these processes significantly enhanced the overall taste and flavour of the product (Dong-Hwa  et al., 2025).
 
Overall acceptability
 
It can be observed from the Table 2 that mean sensory scores of malted beverage premix in relation to overall acceptability indicates that T1 had the highest score 8.6 followed by T2 (7.8) T3 (7.3) respectively. It can be concluded that the addition of buckwheat, green gram, soybean, carrots, beetroot and mint leaves improve the overall acceptability of malted beverage premix.

Table 2: Average sensory score of different parameters in treated sample of “malted beverage premix”.


 
Physicochemical properties of malted beverage premix
 
Table 3 showed the  malted multigrain beverage premix prepared from buckwheat, green gram, soybean and the addition of carrots, beetroot and mint leaves are responsible to increases the pH which is around 6.35 and on the other hand, a higher pH (low acidity) can make a beverage taste fuller or rounder (Jena  et al., 2013).  

Table 3: Physicochemical properties of organoleptically best treatment of malted beverage premix.


       
The change in pH has the more hydrogen ions in a solution, the more acidic it is. pH is indirectly proportional to the total acidity of the sample. The pH and acidity of a beverage can impact its taste, safety and shelf life. The high acidity (7.0) can make a beverage taste tart and it may help to increase the shelf life of the malted multigrain beverage premix. While low acidity can make it taste flat or bland and may be the reason for affecting it’s shelf life. High acidity can brighten a flavor and may be the reason for decreasing the growth of micro-organsim and low acidity can increase the growth of micro-organism (Pulligundla et al., 2010). The malting duration significantly affects the Total Soluble Solids (TSS) of a buckwheat, green gram, soybean and carrots, beetroot and mint leaves primarily indicating changes in sugar content. In prepared malted beverage premix TSS was observed relatively high, typically around 6.46 (Table 3)  Brix reflecting the natural sugars in the carrots and beetroot.
       
The water activity (aw) of powdered beverages plays a crucial role in determining their stability and quality over their shelf life. A decrease in the amount of free water present in the product leads to a reduction in water activity. Water activity was monitored to determine the potential for growth of micro-organisms (Pragati et al., 2014). The water activity of the best treatment was  observed 0.65 (Table 3) that near about the standard value. The increased value of water activity in best treatment may be due to the hygroscopic nature of the MBP which is rich in protein. The proteins are known to have high affinity for water molecule and other hydrophilic constituents that may be the reason for the water activity.
       
Green gram incorporation at 15% proved strategically important for protein enhancement. Pulse addition exceeding 20% in cereal-based products increases batter viscosity and prolongs cooking time due to modified starch-protein interactions and altered water absorption properties (Gaikwad et al., 2026).
       
Bulk density is a measure of the weightiness of a materials and a lower bulk density is nutritionally beneficial as it promotes the digestibility of the product if the bulk density is lower than small particles of flour can bind together to highest range. Then the result is increased energy content (Dong-Hwa  et al., 2025). This can be influenced by the shape and size of the particles, surface characteristics material and the density of the solid. If the bulk density is higher than the denser packaging material was required, which indicates the porosity of the Malted Multigrain Beverage Premix. In the best treatment of the  prepared Malted Multigrain Beverage premix the bulk density (0.69 g/cm3) (Table 3) was observed and it is compared with the value given by standard value (0.35 g/cm3 to 0.79 g/cm3) (Iwe et al., 2016). The highest incorporation of Malted Multigrain Beverage Premix showed higher bulk density and tapped density, this might be due to the coarse texture of malted multigrain beverage premix which provide bulkiness (Bian et al., 2015). Several studies have reported that the tapped density of cereal based flour ranged from 0.76 to 0.84 g/cm3 (Budnimath et al., 2023). When a product has higher bulk and tapped density, its particles become closer to each other, effectively filling the empty spaces between them. In prepared malted multigrain beverage premix tapped density was observed 0.64 g/cm3 (Table 3).
       
Foam is a colloidal of many gas or solids. These are the results of the behavior of proteins at air- water interfaces. Protein contributes to foam film formation by lowering interfacial tension. Foaming capacity of whey protein can be improved by lowering the fat content. Hence WPC is highly suitable as foaming agent as it is bland in taste and stable at different pH (Kumar et al., 2018). The foaming capacity of different combination of mixed powder was observed 47.65% and compared from the researcher’s observed value which is 23.83 to 51.17%. This might be due to higher concentration of Malted Multigrain Beverage Premix having higher protein and crude fiber which hinders the formation of gas bubbles which turns into less value of foaming capacity. To explain this it’s needed to be considered that both protein adsorption at the air water interface and its capacity to decrease surface tension influence the liquid phase’s ability to capture air (Zhang et al., 2004).
 
Nutritional composition of the malted multigrain beverage premix   
 
The results shown in Table 4 demonstrated the nutritional profile of developed malted multigrain beverage premix best treatment (T1).The premix contained 6.3 per cent moisture, 3.42 per cent ash, 0.8 g crude fiber, 69.99 g carbohydrates and 14.27 g protein per 100 g. Among micronutrients, the iron content (8.98 mg) is relatively high, making the food a good contributor to iron intake and helpful in preventing anemia. The β-carotene content (9840 µg) is exceptionally high, highlighting its potential as a rich source of vitamin A precursor, which is essential for vision, immune function and skin health. The low moisture content ensures good storage stability and reduced microbial spoilage. Ash and protein levels indicate significant mineral and nutritional value, enhanced by malting, which improves protein digestibility and mineral bioavailability. High carbohydrate content provides energy, while β-carotene contributes antioxidant and nutritional benefits (Tong Zhao  et al., 2024). Iron content in the formulated premix further enhances its value, particularly for the treatment of iron deficiency. Similar finding were reported by Verma and Mishra (2025) addition of defatted soya flour increased the protein value of gluten-free pasta. Pasta was formulated using varying proportions of rice flour, corn flour, defatted soy flour and guar gum flour. Nutritional analysis revealed significantly higher levels of protein, fiber, energy, vitamins and minerals in the gluten-free pasta.  Singh et al., (2017) also reported that addition of  soyabean in value added multigrain porridge  enhanced the protein value.
 
Storage quality of malted multigrain beverage premix
 
Microbial properties of the malted multigrain beverage premix
 
Data presented in Table 5 shows that the shelf-life of optimized (T1) gluten free malted beverage includes TPC, Yeast and Mold count. According to the Food Safety and Standards Authority of India (FSSAI), the microbiological standards for malted beverage premixes, specifically malt-based foods, are outlined in the Food Safety and Standards Authority of India (Food Products Standards and Food Additives) Regulations, 2011. These standards are applicable to products obtained by mixing malt (wort, flour, or malt extract) with other ingredients such as cereal and legume flours, milk or milk powder, flavoring agents, spices, emulsifying agents and various nutrients. The observed values presented in Table 4 indicate that both the Total Plate Count and Yeast and Mould Count in the gluten-free malted beverage remain within acceptable limits, suggesting that the prepared product can be safely stored at room temperature for up to 90 days.

Table 4: Nutritional composition of best treatment of malted multigrain beverage premix.



Table 5: Value of total plate count and yeast and mold count of the best treatment of malted multigrain beverage premix during storage.


 
Sensory evaluation of best treatment during storage of malted multigrain beverage premix
 
Sensory evaluation data presented in Fig 4 indicates that the during storage time period from 0 day to 90 days no change was observed in colour and appearance, consistency, taste and flavour and overall acceptability of the malted beverage premix.

Fig 4: Sensory attributes of malted multigrain beverage premix.


 
Limitations of the study
 
The study has certain limitations as it was conducted within the six-month duration of an M.Sc. thesis, which restricted the scope of investigation. Storage stability was evaluated only at room temperature and microbial analysis was limited to two key tests. Additionally, the sensory evaluation was carried out with a relatively small panel consisting of 10 trained and 20 untrained panelists (M.Sc. and Ph.D. students).
       
Further studies are recommended to evaluate the shelf-life stability, antioxidant retention and nutritional bioavailability, expand sensory evaluation, assess consumer acceptance and market feasibility and explore fortification with probiotics or other functional ingredients.
It is concluded that the malted buckwheat flour, green gram flour, soybean flour, dehydrated carrot, dehydrated Beetroot and dried Mint leaves can be utilized for the preparation of malted beverage premix. Sensory evaluation of prepared products indicated that T1 (60 g buckwheat flour + 10 g green gram flour + 10 g soybean flour + 8 g carrots + 6 g beetroot + 6 g mint leaves) was highly acceptable with regards to colour and appearance, consistency, taste and flavour and overall acceptability. The observed values of physico-chemical properties (pH, TSS, water activity, bulk and tapped density and foaming capacity) indicates that the different processing methods (soaking, germination, roasting and milling) could not change the final quality of prepared malted beverage premix. Nutrient content of prepared malted multigrain beverage premix was found (T1) per 100 g fiber (0.80 g), Fat (5.22 g), carbohydrate (69.99 g), protein (14.27 g), energy (388 kcal) iron (8.986 mg) and â carotene (9840 mg) in per 100 g . TPC, yeast and mold count and sensory scores of the developed food product were found at desirable level till the 90 days of storage.
       
Commercial multigrain beverage premixes commonly available in the market are generally prepared using cereals such as wheat along with added sugar and preservatives. These products may contain gluten and higher sugar levels. In contrast, the developed gluten-free malted multigrain beverage premix is formulated using gluten-free grains such as malted buckwheat flour, green gram flour, soybean flour, dehydrated carrot, dehydrated beetroot and dried Mint leaves, providing natural nutrients, higher dietary fiber and improved digestibility through the malting process. Therefore, the developed gluten-free malted multigrain beverage premix offers a healthier alternative and has good potential to compete in the market, especially for health-conscious and gluten-intolerant consumers.
The present study was supported by Department of Food and Nutrition, SHUATS Prayagraj.
 
Disclaimers
 
The finding and results reported in this article  are solely those of the authors and do   not necessarily represent the views of their affiliated institutions. The authors are responsible for the accuracy and completeness of the information provided, but do not accept any liability for any direct or indirect losses resulting from the use of this content.
 
Informed consent
       
All animal procedures for experiments were approved by the Committee of Experimental Animal care and handling techniques were approved by the University of Animal Care Committee.
       
I declare that this study did not involve any direct human intervention; therefore, ethical clearance was not required.
 
The authors declare that there are no conflicts of interest regarding the publication of this article. No 2386 funding or sponsorship influenced the design of the study, data collection,  analysis, decision to publish, or preparation of the manuscript.

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Formulation and Quality Characterization of Gluten Free Malted Multigrain Beverage Premix

V
Verma Anisha1,*
S
Savita Parul2
N
Neeru Bala2
V
Verma Chhavi3
1Department of Food and Nutrition, College of Community Science, Acharya Narendra Deva University of Agriculture and Technology, Kumarganj, Ayodhya-224 229, Uttar Pradesh, India.
2Department of Food Nutrition and Public Health, Sam Higginbottom University of Agriculture Technology and Sciences, Prayagraj-211 007, Uttar Pradesh, India.
3Department of Food and Nutrition, Acharya Narendra Deva University of Agriculture and Technology, Kumarganj-224 229, Uttar Pradesh, India.

Background: Celiac disease is a chronic immune-mediated enteropathy triggered by the ingestion of gluten proteins present in wheat, barley and rye. It is characterized by villous atrophy and persistent inflammation of the small intestine, leading to impaired nutrient absorption. A recent study indicates that celiac disease affects approximately 1% of the global population, with increasing diagnosis rates worldwide. The only effective treatment remains lifelong adherence to a strict gluten-free diet.  In the present study gluten free malted multigrain beverage premix formulation was optimized by using multi objectives to prepare the malted multigrain flour using the selected ingredients and to evaluate the sensory acceptability, physicochemical, nutritional and storage quality of prepared beverage premix.

Methods: Multigrain beverage premix was prepared from malted buckwheat, malted green gram, malted soybean and dehydrated vegetables like carrot, beetroot and mint leaves. Malted multigrain powder was prepared using soaking, germinating, drying, roasting and grinding process. Formulation of malted multigrain powder was done by incorporation of different ingredient in various proportion on trial basis. Formulated premix was analyzed for their sensory acceptability, physico-chemical, nutritional and storage quality using standard procedure.

Result: The results showed that the prepared product received high sensory scores for colour and appearance, consistency, taste and flavour, as well as overall acceptability, demonstrating good consumer acceptance. The observed values of physicochemical properties indicate that the different processing methods could not change the final quality of prepared malted beverage premix. Nutrient content of prepared Malted Multigrain Beverage Premix was rich in protein, iron and β carotene. TPC, Yeast and Mold count and sensory scores of the developed food product were found at desirable level till the 90 days of storage.

Celiac disease is an autoimmune enteropathy characterized by chronic inflammation and villous atrophy of the small intestine triggered by ingestion of gluten, a complex of storage proteins found in wheat, rye and barley. A strict gluten free diet is the only effective treatment, yet the disease often leads to malabsorption of essential nutrients including iron, calcium, folic acid and fat soluble vitamins, contributing to micronutrient deficiencies in a significant proportion of patients. Between 20 per cent and 38 per cent of individuals with celiac disease exhibit iron deficiency and substantial proportions show deficiencies in vitamin B12, calcium and vitamin D due to intestinal damage and dietary limitations (Seyede et al., 2018). Despite the expanding gluten-free market driven by medical necessity and consumer perception of health benefits, commercially available gluten-free products often remain nutritionally imbalanced. Contemporary analyses (2020-2024) demonstrate that many gluten-free formulations contain lower protein and dietary fiber but higher fat and sodium compared to their gluten-containing counterparts (Mehtab et al., 2024). Furthermore, these products frequently rely on refined starches and flours with limited micronutrient density and reduced bioactive compounds, thereby failing to address the long-term nutritional vulnerabilities of individuals with celiac disease (Letizia et al., 2010).
       
Rapid urbanization and changing life styles have increased the demand for convenient, shelf stable  and nutrients enriched ready to reconstitute (RTR) foods. Powdered RTR beverage premixes provide an effective way to deliver nutrient-dense formulations that are easy to prepare and store while overcoming the stability challenges of liquid beverages. Traditional processing methods such as malting, germination and roasting enhance the nutritional quality of plant-based ingredients by reducing anti-nutritional factors and improving digestibility through activation of endogenous enzymes. Malting is an effective pre-treatment technique that enhances the nutritional quality of flours by increasing both the concentration and bioavailability of essential minerals, thereby making them more suitable for use in functional food formulations (Bangar et al., 2026).
        
Despite of growing interest in functional and gluten- free convenience foods, researches on nutrient enriched Ready to Reconstitute premixes remains limited. Gluten-free multigrain formulations offer the added benefit of catering to individuals with gluten intolerance while delivering essential micronutrients and bioactive compounds for long-term health.
       
Therefore, the present study aims to develop and evaluate a novel gluten-free multigrain RTR beverage premix formulated from malted buckwheat, green gram and soybean flours enriched with dehydrated carrot, beetroot and mint powders. This formulation is designed not merely as a convenience product, but as a functional beverage with enhanced protein content, improved iron availability, elevated β-carotene levels and increased antioxidant potential. The study comprehensively assesses its physicochemical characteristics, nutritional composition, sensory acceptability and storage stability, thereby addressing a significant research gap and contributing to the advancement of nutritionally enriched gluten-free functional foods.
Procurement of raw materials
 
• The raw materials were procured from the local market of  Naini area, Prayagraj. The samples (buckwheat, green gram, soybean) were cleaned by hand to remove  extraneous matter such as dirt, grit and broken seeds from it. Samples were sealed and placed in plastic bags and stored at 21- 23°C until used.
• Carrots, Beetroot and Mint leaves are purchased from the local vegetable market of Prayagraj.
 
Processing of ingredients
 
Raw ingredients were processed using the following procedure-
 
Preparation of malted grains powder
 
The selected grains buckwheat, green gram and soybean were manually cleaned, washed and soaked in potable water for 10-12 hours. After draining, they were spread on trays, covered with a moist cloth and germinated at 25-30°C for 24-48 hours until sprouts appeared. Malting was then carried out following the standard procedure (Fig 1).

Fig 1: Flowchart for preparation malted grains flour.



Dehydration of vegetables
 
Fresh carrots (Daucus carota) and beetroot (Beta vulgaris) were selected based on uniform size, color and freedom from mechanical damage and microbial spoilage. The vegetables were washed thoroughly under running tap water to remove adhering soil and extraneous matter. Carrots and beetroot were peeled manually using a stainless steel peeler and sliced into uniform thickness (0.3 cm) using a stainless steel knife. The prepared slices were blanched in hot water containing 0.2% potassium metabisulphit for 2-3 minutes to inactivate enzymes, followed by immediate cooling in cold water. The prepared vegetables were evenly spread in trays for dehydration followed the procedure given in Fig 2.

Fig 2: Dehydration of carrot and beetroot.


 
Dehydration of mint leaves
 
Fresh mint (Mentha spicata) leaves were manually sorted to remove damaged, diseased and discolored leaves. The selected leaves were washed thoroughly under running tap water to remove surface contaminants. Excess water was removed by blotting paper. The prepared mint leaves were evenly spread in trays and dehydration was carried out using steps in (Fig 3).

Fig 3: Flow chart for dehydration of mint.


 
Product formulation
 
Malted multigrain and dehydrated vegetables were blended in different ratios, milled and sieved to produce dry premix powders, served as treatments T1, T2 and T3 (Table 1). Buckwheat served as the primary base for its high carbohydrate content, gluten-free nature and mineral profile, while soybean and green gram were increased to enhance protein and amino acid balance. Carrot, beetroot and mint were added to boost micronutrients, improve color and impart mild sweetness and flavor. All the treatments were replicated four times to get accurate and reliable results.

Table 1: Details of treatment and replications of malted multigrain beverages premix.


 
Reconstitution of beverage premix
 
The malted multigrain beverage was prepared by reconstituting 20 g of the premix powder in 200 ml of water (either at room temperature or cold). The mixture was stirred thoroughly until the powder was fully dissolved. Seasoning ingredients-including one tablespoon of mixed spices (such as black salt and roasted cumin powder, or adjusted to taste) and two tablespoons of lemon juice were then added. The beverage was mixed well and served to the panel members for evaluation (Budnimath et al., 2023).
 
Analysis of prepared product        
 
Sensory evaluation of malted beverage premix
 
Sensory evaluation of the malted multigrain beverage for their acceptability was done on the day of production by a panel of ten trained judges selected among the faculty members of Ethelind College of Community Science, Sam Higginbottom University of Agriculture Technology and Sciences, Prayagraj and twenty untrained panel members (Ph.D. and M.Sc. Students). The judges were requested to evaluate the re-constituted products with the help of a score card based on the 9-point Hedonic Scale (Color and Appearance, Consistency, Taste and Flavor and Overall Acceptability) (Srilakshami, 2018).
 
Determination of the physico-chemical properties
 
Based on the sensory analysis, treatment T1 obtained the highest score among the three treatments and was consequently chosen for further analysis. pH, total soluble solids of water activity, bulk and tapped density and  foaming capacity properties were analyzed using the standard procedure.
 
Determination of water activity
 
The water activity (aw) of malted multigrain beverage premix samples was determined as per the described method (Goudar et al., 2023). A small quantity of malted multigrain beverage premix sample was placed in the sample holder up to the indicated mark and then placed inside the water activity meter sensing groove and analyzed by the biosensor on the lid of the analyzer. The endpoint was indicated by three beep sounds displaying the water activity reading digitally which was recorded in water activity meter.
 
Determination of bulk and tapped density
 
A measured amount of malted multigrain beverage premix was placed into a 10 mL measuring cylinder and the volume occupied by the powder was measured and subsequently used to determine the bulk density (weight per unit volume).
       
The tapped density was calculated by tapping the measuring cylinder for 5 min until no visible decrease in volume was noticed. The final volume was then read and used to calculate the tapped density (Jangam et al., 2010).
                   
 
 
Determination of foaming capacity
 
The foaming capacity of the malted multigrain beverage premix was determined using a laboratory electric blender for whipping the sample and a graduated measuring cylinder for measuring foam volume. An analytical weighing balance was used to accurately weigh the sample. During the analysis, 2 g of sample was weighed using the analytical balance and mixed with 100 mL of distilled water. The mixture was whipped for 5 minutes using an electric blender to incorporate air and form foam. The whipped mixture was then transferred into a 10 mL graduated measuring cylinder to measure the foam volume and the foaming capacity was calculated according to the method reported by Budnimath, et al., (2023). The foaming capacity was calculated according to following equation:
Calculation:
 
 
  
Determination of the nutritional composition
 
Moisture, ash, protein, fat, fiber, beta carotene and iron of best treatment were analyzed as pre procedure given by AOAC (2023). Total carbohydrate was analyzed as per procedure given by (Tollen’s test) AOAC (2023).
 
Determination of shelf life
 
Organoleptically best treatment (T1) of malted   multigrain beverage premix was  packed and stored in low density polyethylene (LDPE) pouches  at the day of manufactured for the study of storage. Samples were drawn periodically after 15-15 days intervals and analyzed for microbial load (Total plate count and yeast/ mold count) and sensory analysis. The change in sensory acceptability and microbial load were noted down at intervals 0,15,30,45,60,75,90 days till the unacceptable limit for over a period of time using the following procedures:
• Total plate count (FSSAI, 2016).
• Yeast and mold count analysis by Enumeration method (FSSAI, 2016).
• Sensory analysis (Srilaxshmi, 2018).
 
Statistical analysis
 
The data obtained during the study was statistically analyzed by using statistical analysis of variance (ANOVA) and critical difference technique. Effect of incorporation of different ratio of ingredients was determined by using CD (Critical difference) test t (Gupta and Kapoor, 2002).
The data of the present studies “Formulation and characterization of gluten free malted multigrain beverage premix” are discussed in this chapter.
 
Sensory attributes of the malted multigrain beverage premix
 
Colour and appearance
 
It can be observed from the Table 2 that mean sensory scores of malted beverage premix in relation to colour and appearance indicates that T1 had the highest score (9.0) followed by T2 (8.5) and T3 (7.5) respectively. The results of analysis of variance shows that the calculated F value (92.2) for treatments is higher than the tabulated F value (4.75) at the 5% level of significance. This indicates that the treatments had a significant effect on the colour and appearance of the malted beverage premix. Hence, it can be concluded that the incorporation of different proportions of buckwheat, green gram, soybean, carrot, beetroot and mint leaves significantly improved the colour and appearance of the product. It was observed that all three experimental treatments of malted beverage premix showed increased intensity of colour because of the addition of increasing proportion of buckwheat, green gram, soybean, carrot, beetroot and mint leaves which gave the treatment a pinkish red colour in T1 comparison to T2 and T3 which included has more intense deep brown colour as compared to other treatments little lighter colour.
       
Khwairakpam and Murugkar (2023) reported that in the development of millet-based beverages, the addition of  ingredients (e.g., carrot and cocoa powder) significantly affected colour attributes, with increased redness and yellowness correlating with higher sensory colour scores among panelists.
 
Consistency
 
It can be observed from the above Table 2 that mean sensory scores of malted beverage premix in relation to consistency indicates that T1 treatments had the highest score 8 followed by T2 (7.5) and T3 (7.0) respectively. Statistical analysis revealed that the calculated F value (83.7) for treatments was higher than the tabulated F value (3.23) at (3,6) degrees of freedom at the 5% probability level. This indicates that the treatments had a significant effect on the consistency of the malted beverage premix. Hence, the incorporation of different proportions of buckwheat, green gram, soybean, carrot, beetroot and mint leaves significantly improved the consistency of the product. It can be concluded that addition of different proportions of buckwheat, green gram, soybean carrot, beetroot and mint leaves improves the consistency of the product. Dipak  et al. ( 2017) reported that increasing levels of soy protein isolate and pectin led to higher viscosity and improved consistency scores in sensory evaluation of developed high protein, high fiber smoothie as a grab-and-go breakfast option using response surface methodology.
 
Taste and flavour
 
It can be observed from the Table 2 that mean sensory scores of malted beverage premix in relation to taste and flavor indicates that T1 had the highest score 9 followed by T2 (8), T3 (7.5), respectively. Statistically, the calculated F value (155.9) for treatments exceeded the tabulated F value (4.75) at the 5% probability level, indicating a significant effect of treatments on the taste and flavour of the malted beverage premix. The improved taste and flavor of the malted beverage premix is due to the combined effects of its ingredients as carrot and beetroot add natural sweetness, mint leaves provide a refreshing aroma, buckwheat gives a mild nutty flavor, green gram adds a subtle pulse taste and soybean enriches smoothness and richness. Together, their balanced proportions enhance the beverage’s overall palatability. The taste and flavour of the malted beverage premix were influenced not only by the ingredients but also by processing techniques such as soaking, germination and roasting. Germination enhances free amino acids and sugars, which during roasting participate in Maillard reactions, producing desirable nutty and roasted flavours. Soaking reduces bitter compounds, while roasting develops aroma and colour, improving sensory appeal. Combined with the natural flavours of buckwheat, carrot, beetroot, mint, green gram and soybean, these processes significantly enhanced the overall taste and flavour of the product (Dong-Hwa  et al., 2025).
 
Overall acceptability
 
It can be observed from the Table 2 that mean sensory scores of malted beverage premix in relation to overall acceptability indicates that T1 had the highest score 8.6 followed by T2 (7.8) T3 (7.3) respectively. It can be concluded that the addition of buckwheat, green gram, soybean, carrots, beetroot and mint leaves improve the overall acceptability of malted beverage premix.

Table 2: Average sensory score of different parameters in treated sample of “malted beverage premix”.


 
Physicochemical properties of malted beverage premix
 
Table 3 showed the  malted multigrain beverage premix prepared from buckwheat, green gram, soybean and the addition of carrots, beetroot and mint leaves are responsible to increases the pH which is around 6.35 and on the other hand, a higher pH (low acidity) can make a beverage taste fuller or rounder (Jena  et al., 2013).  

Table 3: Physicochemical properties of organoleptically best treatment of malted beverage premix.


       
The change in pH has the more hydrogen ions in a solution, the more acidic it is. pH is indirectly proportional to the total acidity of the sample. The pH and acidity of a beverage can impact its taste, safety and shelf life. The high acidity (7.0) can make a beverage taste tart and it may help to increase the shelf life of the malted multigrain beverage premix. While low acidity can make it taste flat or bland and may be the reason for affecting it’s shelf life. High acidity can brighten a flavor and may be the reason for decreasing the growth of micro-organsim and low acidity can increase the growth of micro-organism (Pulligundla et al., 2010). The malting duration significantly affects the Total Soluble Solids (TSS) of a buckwheat, green gram, soybean and carrots, beetroot and mint leaves primarily indicating changes in sugar content. In prepared malted beverage premix TSS was observed relatively high, typically around 6.46 (Table 3)  Brix reflecting the natural sugars in the carrots and beetroot.
       
The water activity (aw) of powdered beverages plays a crucial role in determining their stability and quality over their shelf life. A decrease in the amount of free water present in the product leads to a reduction in water activity. Water activity was monitored to determine the potential for growth of micro-organisms (Pragati et al., 2014). The water activity of the best treatment was  observed 0.65 (Table 3) that near about the standard value. The increased value of water activity in best treatment may be due to the hygroscopic nature of the MBP which is rich in protein. The proteins are known to have high affinity for water molecule and other hydrophilic constituents that may be the reason for the water activity.
       
Green gram incorporation at 15% proved strategically important for protein enhancement. Pulse addition exceeding 20% in cereal-based products increases batter viscosity and prolongs cooking time due to modified starch-protein interactions and altered water absorption properties (Gaikwad et al., 2026).
       
Bulk density is a measure of the weightiness of a materials and a lower bulk density is nutritionally beneficial as it promotes the digestibility of the product if the bulk density is lower than small particles of flour can bind together to highest range. Then the result is increased energy content (Dong-Hwa  et al., 2025). This can be influenced by the shape and size of the particles, surface characteristics material and the density of the solid. If the bulk density is higher than the denser packaging material was required, which indicates the porosity of the Malted Multigrain Beverage Premix. In the best treatment of the  prepared Malted Multigrain Beverage premix the bulk density (0.69 g/cm3) (Table 3) was observed and it is compared with the value given by standard value (0.35 g/cm3 to 0.79 g/cm3) (Iwe et al., 2016). The highest incorporation of Malted Multigrain Beverage Premix showed higher bulk density and tapped density, this might be due to the coarse texture of malted multigrain beverage premix which provide bulkiness (Bian et al., 2015). Several studies have reported that the tapped density of cereal based flour ranged from 0.76 to 0.84 g/cm3 (Budnimath et al., 2023). When a product has higher bulk and tapped density, its particles become closer to each other, effectively filling the empty spaces between them. In prepared malted multigrain beverage premix tapped density was observed 0.64 g/cm3 (Table 3).
       
Foam is a colloidal of many gas or solids. These are the results of the behavior of proteins at air- water interfaces. Protein contributes to foam film formation by lowering interfacial tension. Foaming capacity of whey protein can be improved by lowering the fat content. Hence WPC is highly suitable as foaming agent as it is bland in taste and stable at different pH (Kumar et al., 2018). The foaming capacity of different combination of mixed powder was observed 47.65% and compared from the researcher’s observed value which is 23.83 to 51.17%. This might be due to higher concentration of Malted Multigrain Beverage Premix having higher protein and crude fiber which hinders the formation of gas bubbles which turns into less value of foaming capacity. To explain this it’s needed to be considered that both protein adsorption at the air water interface and its capacity to decrease surface tension influence the liquid phase’s ability to capture air (Zhang et al., 2004).
 
Nutritional composition of the malted multigrain beverage premix   
 
The results shown in Table 4 demonstrated the nutritional profile of developed malted multigrain beverage premix best treatment (T1).The premix contained 6.3 per cent moisture, 3.42 per cent ash, 0.8 g crude fiber, 69.99 g carbohydrates and 14.27 g protein per 100 g. Among micronutrients, the iron content (8.98 mg) is relatively high, making the food a good contributor to iron intake and helpful in preventing anemia. The β-carotene content (9840 µg) is exceptionally high, highlighting its potential as a rich source of vitamin A precursor, which is essential for vision, immune function and skin health. The low moisture content ensures good storage stability and reduced microbial spoilage. Ash and protein levels indicate significant mineral and nutritional value, enhanced by malting, which improves protein digestibility and mineral bioavailability. High carbohydrate content provides energy, while β-carotene contributes antioxidant and nutritional benefits (Tong Zhao  et al., 2024). Iron content in the formulated premix further enhances its value, particularly for the treatment of iron deficiency. Similar finding were reported by Verma and Mishra (2025) addition of defatted soya flour increased the protein value of gluten-free pasta. Pasta was formulated using varying proportions of rice flour, corn flour, defatted soy flour and guar gum flour. Nutritional analysis revealed significantly higher levels of protein, fiber, energy, vitamins and minerals in the gluten-free pasta.  Singh et al., (2017) also reported that addition of  soyabean in value added multigrain porridge  enhanced the protein value.
 
Storage quality of malted multigrain beverage premix
 
Microbial properties of the malted multigrain beverage premix
 
Data presented in Table 5 shows that the shelf-life of optimized (T1) gluten free malted beverage includes TPC, Yeast and Mold count. According to the Food Safety and Standards Authority of India (FSSAI), the microbiological standards for malted beverage premixes, specifically malt-based foods, are outlined in the Food Safety and Standards Authority of India (Food Products Standards and Food Additives) Regulations, 2011. These standards are applicable to products obtained by mixing malt (wort, flour, or malt extract) with other ingredients such as cereal and legume flours, milk or milk powder, flavoring agents, spices, emulsifying agents and various nutrients. The observed values presented in Table 4 indicate that both the Total Plate Count and Yeast and Mould Count in the gluten-free malted beverage remain within acceptable limits, suggesting that the prepared product can be safely stored at room temperature for up to 90 days.

Table 4: Nutritional composition of best treatment of malted multigrain beverage premix.



Table 5: Value of total plate count and yeast and mold count of the best treatment of malted multigrain beverage premix during storage.


 
Sensory evaluation of best treatment during storage of malted multigrain beverage premix
 
Sensory evaluation data presented in Fig 4 indicates that the during storage time period from 0 day to 90 days no change was observed in colour and appearance, consistency, taste and flavour and overall acceptability of the malted beverage premix.

Fig 4: Sensory attributes of malted multigrain beverage premix.


 
Limitations of the study
 
The study has certain limitations as it was conducted within the six-month duration of an M.Sc. thesis, which restricted the scope of investigation. Storage stability was evaluated only at room temperature and microbial analysis was limited to two key tests. Additionally, the sensory evaluation was carried out with a relatively small panel consisting of 10 trained and 20 untrained panelists (M.Sc. and Ph.D. students).
       
Further studies are recommended to evaluate the shelf-life stability, antioxidant retention and nutritional bioavailability, expand sensory evaluation, assess consumer acceptance and market feasibility and explore fortification with probiotics or other functional ingredients.
It is concluded that the malted buckwheat flour, green gram flour, soybean flour, dehydrated carrot, dehydrated Beetroot and dried Mint leaves can be utilized for the preparation of malted beverage premix. Sensory evaluation of prepared products indicated that T1 (60 g buckwheat flour + 10 g green gram flour + 10 g soybean flour + 8 g carrots + 6 g beetroot + 6 g mint leaves) was highly acceptable with regards to colour and appearance, consistency, taste and flavour and overall acceptability. The observed values of physico-chemical properties (pH, TSS, water activity, bulk and tapped density and foaming capacity) indicates that the different processing methods (soaking, germination, roasting and milling) could not change the final quality of prepared malted beverage premix. Nutrient content of prepared malted multigrain beverage premix was found (T1) per 100 g fiber (0.80 g), Fat (5.22 g), carbohydrate (69.99 g), protein (14.27 g), energy (388 kcal) iron (8.986 mg) and â carotene (9840 mg) in per 100 g . TPC, yeast and mold count and sensory scores of the developed food product were found at desirable level till the 90 days of storage.
       
Commercial multigrain beverage premixes commonly available in the market are generally prepared using cereals such as wheat along with added sugar and preservatives. These products may contain gluten and higher sugar levels. In contrast, the developed gluten-free malted multigrain beverage premix is formulated using gluten-free grains such as malted buckwheat flour, green gram flour, soybean flour, dehydrated carrot, dehydrated beetroot and dried Mint leaves, providing natural nutrients, higher dietary fiber and improved digestibility through the malting process. Therefore, the developed gluten-free malted multigrain beverage premix offers a healthier alternative and has good potential to compete in the market, especially for health-conscious and gluten-intolerant consumers.
The present study was supported by Department of Food and Nutrition, SHUATS Prayagraj.
 
Disclaimers
 
The finding and results reported in this article  are solely those of the authors and do   not necessarily represent the views of their affiliated institutions. The authors are responsible for the accuracy and completeness of the information provided, but do not accept any liability for any direct or indirect losses resulting from the use of this content.
 
Informed consent
       
All animal procedures for experiments were approved by the Committee of Experimental Animal care and handling techniques were approved by the University of Animal Care Committee.
       
I declare that this study did not involve any direct human intervention; therefore, ethical clearance was not required.
 
The authors declare that there are no conflicts of interest regarding the publication of this article. No 2386 funding or sponsorship influenced the design of the study, data collection,  analysis, decision to publish, or preparation of the manuscript.

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