Tag: Hemoglobin

Study reveals key gut microbiome differences in prediabetic patients
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A recent Nutrients study compares the composition of the gut microbiome in prediabetic patients and healthy individuals.

Study: Gut Microbiota in Patients with Prediabetes. Image Credit: Sebastian Kaulitzki / Shutterstock.com

What is prediabetes?

Prediabetes is defined as glycated hemoglobin levels between 5.7-6.5% and fasting blood glucose levels between 100-126 mg/dL. Prediabetes significantly increases the mortality risks and burden on the healthcare system; therefore, several interventions have been designed to maintain healthy glucose levels.

For example, lifestyle changes, bariatric surgery, and medications are commonly used to prevent the progression of prediabetes to diabetes. Despite these interventions, a recent American Diabetes Association report indicated that most prediabetic patients eventually develop diabetes. Therefore, it is imperative to develop more effective interventions to prevent or reverse the prediabetic condition.

The gut microbiome and diabetes

The gut microbiome plays a vital role in regulating lipid and glucose metabolism, as gut microbial dysbiosis leads to the development of many diseases. For example, intestinal bacterial composition and abundance changes influence intestinal permeability, which induces insulin resistance and the introduction of bacterial lipopolysaccharides into the bloodstream.

Gut microbial dysbiosis is directly associated with increased gut permeability, which promotes low-grade systemic inflammation. This condition is a key contributor to metabolic syndrome and various chronic diseases, such as type 2 diabetes.

Considering these observations, it is important to understand the mechanism by which intestinal bacteria alterations influence the development of diabetes. This information could ultimately support the development of novel approaches to prevent the progression of prediabetes to diabetes.

Diet, drugs, and age play an important role in altering the gut microbiota. Although several studies have established differential intestinal bacteria between diabetic and healthy individuals, few studies have assessed intestinal bacteria composition in prediabetic patients and its impact on the physiological mechanisms of this health condition.

About the study

The current study compared gut microbial composition between prediabetic patients and healthy individuals. The impact of diet on the gut microbiome of prediabetic patients was also assessed in an effort to identify nutrition-based interventions that could potentially prevent the progression of prediabetes to diabetes.

A total of 57 study participants were recruited from Taipei Tzu-Chi Hospital in Taiwan. Gut microbiota data of 60 healthy individuals between 18 and 65 years were obtained from biobanks and used as the reference group.

Study participants were advised to keep a three-day food record and collect fecal samples on the third day. The nutrient composition of the participants’ diet was measured using Nutritionist Professional software 2.0.

Study findings

The composition, diversity, and abundance of the gut microbiota were significantly reduced in prediabetic patients compared to healthy individuals. This finding was in line with previous studies that indicated differential microbial composition in patients with diabetes. Prediabetic patients also exhibited a higher body mass index (BMI) than controls.

Gut microbiome profile of 117 fecal samples at the genus level. The remaining bacterial genera are summed as ‘Others’.

Consistent with previous studies on type 2 diabetes, the current study reported higher levels of Mediterraneibacter, Bifidobacterium, Blautia, Anaerostipes, Clostridium, and Butyricicoccus in the fecal samples of healthy individuals than prediabetic patients.

Previous studies have shown that butyrate maintains the integrity of the intestinal mucosa. This metabolite is synthesized by gut bacteria, namely, Anaerostipes and Faecalibacterium.

Maintaining the integrity of intestinal mucosa can prevent the invasion of pathogenic bacteria in the blood and the destruction of pancreatic β-cells. This finding indicates the indirect role of Anaerostipes and Faecalibacterium in regulating blood glucose levels.

In contrast to prediabetic samples, healthy fecal samples exhibited high levels of Eggerthella and Streptococcus. However, a higher abundance of Phascolarctobacterium, Bacteroides, Paraprevotella, and Parabacteroides was observed in prediabetic fecal samples.

Prediabetic patients exhibited multiple altered physiological metabolic pathways, which affect insulin transmembrane signaling and overexpression of retinoic acid-inducible gene I (RIG-I). This metabolic dysfunction triggers immune cells to attack β cells, affecting blood glucose levels. Previous studies have also indicated that abnormal sphingolipid metabolism leads to insulin resistance and neuronal apoptosis.

Diet plays a vital role in maintaining gut bacterial diversity and abundance. Therefore, prediabetic patients are advised to consume a low carbohydrate (LC) diet with a higher dietary fiber intake. This combination could improve intestinal barrier integrity, thereby preventing the progression of prediabetes to diabetes.

Conclusions

Differential gut microbial composition and abundance were observed in prediabetic patients compared to healthy controls. This difference is also associated with altered metabolic and physiological responses. These findings suggest that improving the gut microbiome could prevent the onset of diabetes by maintaining normal physiological metabolism.
Journal reference:

Chang, W., Chen, Y., Tseng, H., et al. (2024). Gut Microbiota in Patients with Prediabetes. Nutrients 16(8); 1105. doi:10.3390/nu16081105
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April 12, 2024
Study shows daily glucose levels fluctuate more than we thought, challenging diabetes diagnosis

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In a recent study published in the journal Nature Medicine, researchers examined fasting glucose (FG) variability in nondiabetic adults using continuous glucose monitoring (CGM), assessing its impact on diabetes classification and its association with clinical measures.

Study: Continuous glucose monitoring and intrapersonal variability in fasting glucose. Image Credit: Suriyawut Suriya / Shutterstock

Background

The global increase in prediabetes and diabetes poses significant health risks and financial burdens. Diagnosis primarily relies on elevated plasma fasting glucose (PFG), glycated hemoglobin (HbA1c) levels, the oral glucose tolerance test (OGTT), or random plasma glucose in symptomatic individuals. However, the OGTT is often bypassed due to its cost and inconvenience, leaving PFG and HbA1c as key diagnostic tools, especially for asymptomatic cases. Despite its diagnostic importance, the day-to-day variability of PFG in nondiabetic individuals remains underexplored, potentially leading to misdiagnosis. CGM devices, which measure interstitial glucose levels, offer improved accuracy over time and are now used independently or in hybrid closed-loop systems for insulin dosing. Further research is needed to develop CGM-based diagnostic criteria that accurately reflect the intrapersonal variability of FG levels and their clinical implications.

About the study

The present study analyzed data from the 10K study, focusing on individuals aged 40 to 70 years. At baseline, various measures, including lifestyle, nutritional habits, vital signs, and medical history were collected alongside specific tests such as blood tests, electrocardiography, and CGM using the FreeStyle Libre Pro Flash system for two weeks. This study included participants without a self-reported diagnosis of type 2 diabetes or related conditions who also engaged in active meal logging alongside their CGM data. Exclusion criteria were rigorous, including abnormal CGM readings and inadequate meal logging.

The research particularly emphasized FG measurements during morning hours, utilizing CGM data to observe intrapersonal variability and its potential impact on diabetes diagnosis. The methodology ensured a realistic emulation of fasting conditions, relying on at least 8 hours of no caloric intake prior to the measurement windows and rigorous meal logging criteria. A total of 8,315 individuals with 59,565 fasting morning windows were analyzed for FG variability and its correlation with various clinical measures, including anthropometry, vital signs, and sleep monitoring, among others. Sleep monitoring employed the Food and Drug Association (FDA)-approved WatchPAT-300 device, while detailed retinal imaging and other health metrics were carefully analyzed for associations with FG variability. Furthermore, the study applied statistical analyses to explore the relationship between FG variability and clinical measures, considering age and gender.

Study results

In analyzing FG measurements from 8,315 individuals across 59,565 morning windows, researchers delved into the details of FG variability and its implications for diabetes classification. The study participants, averaging 51.3 years, had a mean body mass index (BMI) of 25.92 ± 4.07 kg m−2. Data collection was rigorous, with morning FG measurements taken between 06:00 and 09:00, following a predefined minimum of 8 hours of fasting, although the actual mean fasting duration was over 10 hours. Notably, fasting duration showed no significant correlation with FG values.

The study’s methodology was thorough in calculating FG for each individual, ensuring valid morning windows through strict criteria, including active meal logging. This large-scale examination revealed an average FG value of 96.2 mg dl−1, which was observed to increase slightly with age, indicating a gradual rise in glucose levels over time. The analysis also highlighted considerable day-to-day variability in FG measurements within individuals, a finding that underscores the complex nature of glucose metabolism and its sensitivity to various factors.

In assessing the potential for misclassification of diabetes and prediabetes based on FG levels, the research unearthed significant variability. A notable portion of participants experienced shifts in their glycemic status classification throughout the study, emphasizing the limitations of relying on a single FG measurement for diagnosing diabetes. This variability, coupled with the narrow range defining normal and diabetic FG levels, suggests a need for refined diagnostic criteria to better accommodate individual glucose reading fluctuations.

The study also examined the clinical correlations of FG variability to various health indicators such as body composition, blood pressure, and liver function. Interestingly, FG variability showed significant associations with several clinical measures, highlighting its potential as a marker for metabolic health. Particularly, correlations with body composition and daily caloric intake suggest that FG variability might reflect broader metabolic processes beyond glucose regulation alone.

Conclusions

To summarize, this research analyzed FG data from 8,315 nondiabetic individuals using CGM, uncovering significant FG variability that challenges the reliability of current diabetes diagnostic criteria based on PFG. Initial classifications indicated most participants had normal FG levels, but further measurements suggested a substantial shift towards prediabetes, highlighting the risk of misclassification. The study demonstrated that increasing the number of FG tests could significantly reduce misdiagnosis. Additionally, it found meaningful associations between FG levels and various clinical measures within normal glucose ranges, suggesting the need for a better approach to diabetes diagnosis that considers the variability and dynamic nature of FG levels.

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April 11, 2024
Unlocking clotting mechanisms in caterpillar hemolymph for medical use

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Blood is a remarkable material: it must remain fluid inside blood vessels, yet clot as quickly as possible outside them, to stop bleeding. The chemical cascade that makes this possible is well understood for vertebrate blood. But hemolymph, the equivalent of blood in insects, has a very different composition, being notably lacking in red blood cells, hemoglobin, and platelets, and having amoeba-like cells called hemocytes instead of white blood cells for immune defense.

The caterpillar of another species of moth, the yellow-striped oakworm (Anisota peigleri). Image Credit: Konstantin Kornev

Just like blood, hemolymph clots quickly outside the body. How it does so has long remained an enigma. Now, materials scientists have shown in Frontiers in Soft Matter how this feat is managed by caterpillars of the Carolina sphinx moth. This discovery has potential applications for human medicine, the authors said.

“Here we show that these caterpillars, called tobacco hornworms, can seal the wounds in a minute. They do that in two steps: first, in a few seconds, their thin, water-like hemolymph becomes ‘viscoelastic’ or slimy, and the dripping hemolymph retracts back to the wound,” said senior author Dr Konstantin Kornev, a professor at the Department of Materials Science and Engineering of Clemson University.

“Next, hemocytes aggregate, starting from the wound surface and moving up to embrace the coating hemolymph film that eventually becomes a crust sealing the wound.”

Challenging to study

Fully grown tobacco hornworms, ready to pupate, are between 7.5cm and 10cm long. They only contain a minute amount of hemolymph, which typically clots within seconds, which makes it hard to study with conventional methods.

For these reasons, Kornev and colleagues had to develop new techniques for the present study, and work fast. Even so, the failure rate for the trickiest manipulations was enormous (up to 95%), requiring many attempts.

They restrained individual hornworms in a plastic sleeve, and made a slight wound in one of each caterpillar’s pseudolegs through a window in the sleeve. They then touched the dripping hemolymph with a metal ball, which was pulled away, creating a hemolymph ‘bridge’ (about two millimeters long and hundreds of micrometers wide) that subsequently narrowed and broke, producing satellite droplets. Kornev et al. filmed these events with a high frame rate camera and macro lens, to study them in detail.

Instantaneous change in properties

These observations suggested that during the first approximately five seconds after starting to flow, hemolymph behaved similarly to water: in technical terms, like a Newtonian, low viscosity liquid. But within the next 10 seconds, the hemolymph underwent a marked change: it now did not break instantaneously but formed a long bridge behind the falling drop. Typically, bleeding stopped completely after 60 to 90 seconds, after a crust formed over the wound.

Kornev et al. studied the hemolymph’s flow properties further by placing a 10-micrometer-long nickel nanorod in a droplet of fresh hemolymph. When a rotating magnetic field caused the nanorod to spin, its lag relative to the magnetism gave an estimate of the hemolymph’s ability to hold the rod back through viscosity.

They concluded that within seconds after leaving the body, caterpillar hemolymph changes from a low-viscous into a viscoelastic fluid.

A good example of a viscoelastic fluid is saliva. When you smear a drop between your fingers, it behaves like water: materials scientists will say it is purely viscous. But thanks to very large molecules called mucins in it, saliva forms a bridge when you move your fingers apart. Therefore, it’s properly called viscoelastic: viscous when you shear it and elastic when you stretch it.”

Dr Konstantin Kornev, Professor at Department of Materials Science and Engineering, Clemson University

The scientists further used optical phase-contrast and polarized microscopy, X-ray imaging, and materials science modeling to study the cellular processes by which hemocytes aggregate to form a crust over a wound. They did this not only in Carolina sphinx moths and their caterpillars, but also in 18 other insect species.

Hemocytes are key

The results showed that hemolymph of all species studied reacted similarly to shear. But its reaction to stretching differed drastically between the hemocyte-rich hemolymph of caterpillars and cockroaches on the one hand, and the hemocyte-poor hemolymph of adult butterflies and moths on the other: droplets stretched out to form bridges for the first two, but immediately broke for the latter.

“Turning hemolymph into a viscoelastic fluid appears to help caterpillars and cockroaches to stop any bleeding, by retracting dripping droplets back to the wound in a few seconds,” said Kornev. “We conclude that their hemolymph has an extraordinary ability to instantaneously change its material properties. Unlike silk-producing insects and spiders, which have a special organ for making fibers, these insects can make hemolymph filaments at any location upon wounding.”

The scientists concluded that hemocytes play a key role in all these processes. But why caterpillars and cockroaches need more hemocytes than adult butterflies and moths is still unknown.

“Our discoveries open the door for designing fast-working thickeners of human blood. We needn’t necessarily copy the exact biochemistry, but should focus on designing drugs that could turn blood into a viscoelastic material that stops bleeding. We hope that our findings will help to accomplish this task in the near future,” said Kornev.

Source:

Journal reference:

Aprelev, P., et al. (2024) To seal a wound, caterpillars transform blood from a viscous to a viscoelastic fluid in a few seconds. Frontiers in Soft Matter. doi.org/10.3389/frsfm.2024.1341129.

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March 30, 2024
Mediterranean diet’s aromatic herbs lower blood sugar
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In a recent study published in the journal Nutrients, researchers from Spain investigated the influence of aromatic herbs and spices in the Mediterranean diet (MedDiet) on the glycemic profiles of patients with type 2 diabetes mellitus (T2DM). They found that black cumin, cinnamon, ginger, curcumin, and saffron significantly lowered fasting blood glucose levels. Further, they found that black cumin and ginger significantly improved glycated hemoglobin (HbA1c) levels in T2DM patients, while cinnamon and ginger significantly lowered insulin concentration.

Review: Changes in food preferences and ingestive behaviors after glucagon-like peptide-1 analog treatment: techniques and opportunities. Image Credit: aboikis / Shutterstock

Background

T2DM is a critical healthcare concern, affecting 460 million people globally. Its prevalence has surged in the past four decades, contributing to three or more comorbidities in 60% of patients ten years after diagnosis and causing 6.7 million annual deaths. Various risk factors, including genetics, metabolism, and the environment, influence the disease. While non-modifiable factors like ethnicity and family history play a role, addressing the modifiable risk factors such as lack of physical activity, obesity, and an unhealthy diet can potentially prevent T2DM. Dietary guidance is essential for improving patients’ lifespan and quality of life.

MedDiet emphasizes high consumption of extra-virgin olive oil, low-glycemic-index carbohydrates, and moderate fish, poultry, and dairy intake. Additionally, it limits the intake of red meat and alcohol. Evidence suggests that MedDiet can positively impact metabolic syndrome and T2DM, as demonstrated by lowered diabetes risk and improved glycemic profiles. The diet incorporates various aromatic herbs and spices, such as black cumin, clove, parsley, saffron, thyme, ginger, black pepper, rosemary, turmeric, basil, oregano, and cinnamon, known for potential health benefits, including antitumor, antioxidative, anti-inflammatory, and cholesterol-lowering properties. Therefore, researchers in the present study aimed to examine the effect of all these aromatic spices and herbs on the glycemic profiles of T2DM subjects.

About the study

For the present systematic review and meta-analysis, databases including Web of Science, PubMed, and Scopus to identify peer-reviewed articles and interventional studies. Case studies, commentaries, letters, conference papers, narrative reviews, and studies not conducted in humans or those involving children were excluded. The systematic review included 77 studies, while the meta-analysis included 45 studies (3050 participants).

The studies involved varying dosages of the spices and herbs and assessed their effect on glycemic profiles. The primary outcomes included fasting glucose, insulin, and HbA1c alterations, while secondary outcomes included variations in body weight and body mass index (BMI). Statistical analysis involved the determination of changes in means and standard deviation and the use of Cochrane Q and Higgins I² tests. The risk of publication bias was assessed using Egger plots. The quality of the included trials was assessed using the methodology described by Kmet et al.

Results and discussion

Cinnamon supplementation significantly reduced fasting glucose in six out of eleven studies. The meta-analysis indicated a reduction of 18.67 mg/dL compared to placebo, but the difference was not statistically significant in considering predictive value. Curcumin supplementation in seven studies showed a significant reduction in fasting glucose (p < 0.001) compared to placebo, with a significant difference including predictive value. Ginger supplementation in ten studies demonstrated a reduction in fasting glucose (17.12 mg/dL, p = 0.0004) compared to placebo, with no significant difference, including predictive value. Black cumin supplementation in eight studies resulted in a significant reduction in fasting glucose (p = 0.0001) compared to placebo, with no significant difference in considering predictive value. Using saffron supplementation resulted in substantially lowering glucose, an effect more pronounced when combined with physical activity. Overall, black cumin demonstrated the most substantial reduction in fasting glucose, followed by cinnamon and ginger.

Further, only ginger and black cumin exhibited a significant improvement in HbA1c, and cinnamon and ginger significantly decreased insulin levels. Among the analyzed aromatic herbs and spices in the MedDiet, ginger stood out as the sole contributor to significant decreases in all three examined outcomes: HbA1c, fasting glucose, and insulin level.

The quality of studies selected for the review (mean score 0.54) was lower than the quality of studies selected for the meta-analysis (mean score 0.68). Despite the large scale of the study, the findings are limited by the lack of consideration of body weight and lifestyle changes affecting fasting glucose levels, alongside challenges posed by varying study quality, inadequate statistical analyses, and the absence of standardized herb dosage information.

Conclusion

In conclusion, the present study could identify the potential therapeutic benefits of various aromatic herbs and spices in MedDiet for diabetes management. Further research is needed to determine optimal dosages and assess the impact of active components of the herbs and spices, facilitating their application in targeted interventions for glycemic control in T2DM patients.
Journal reference:

Effect of Aromatic Herbs and Spices Present in the Mediterranean Diet on the Glycemic Profile in Type 2 Diabetes Subjects: A Systematic Review and Meta-Analysis. Garza MC et al., Nutrients, 16(6):756 (2024), DOI: 10.3390/nu16060756, https://www.mdpi.com/2072-6643/16/6/756
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March 11, 2024
Nutrition’s crucial role in Alzheimer’s progression revealed
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In a recent cross-sectional study published in the journal Frontiers in Nutrition, researchers used data from 266 participants along the cognitive impairment spectrum to investigate the association between nutrition and cognitive decline. Their study reveals that nutrition-related variables such as body composition and dietary patterns are significantly associated with the onset and progression of Alzheimer’s disease (AD), with malnutrition substantially increasing AD risk. Since malnutrition presents an easily adjustable, safe, and non-invasive health behavior, the early identification of at-risk populations and dietary interventions therein may substantially reduce the future global burden of AD and similar cognitive disabilities.

Study: An investigation into the potential association between nutrition and Alzheimer’s disease. Image Credit: Adisak Riwkratok / Shutterstock

Diet and cognitive health

One of humanity’s crowning achievements is longevity – modern medicine’s lengthening of natural human lifespans. An unfortunate side-effect of this achievement, however, is a slowly aging world, with more senior citizens alive today than ever before and a corresponding explosion in the incidence and prevalence of chronic, age-associated conditions such as cardiovascular diseases, cognitive declines, and some cancers. While initially presenting a ‘safer’ (lower mortality) pathology than cancers and cardiovascular diseases, cognitive declines are alarmingly debilitating conditions, resulting in substantial economic and mental trauma for patients and their families, even before accounting for their potentially lethal comorbidities.

Alzheimer’s disease (AD) is the most common cognitive disorder associated with old age. It is a chronic, progressive disease characterized by initial mild memory loss, which eventually declines into severely debilitating dementia. It is caused by the deposition of specific proteins, which results in the loss of neural connections. Despite substantial research in the field, a cure for the condition remains elusive, with clinical interventions focused on symptom management and progression delay.

Recently, studies have suggested a link between malnutrition and dementia. The European Society for Clinical Nutrition and Metabolism (ESPEN) has further classified malnutrition as the most common AD-associated comorbidity. Unfortunately, research has failed to establish an association between specific nutritional components and their impacts on the different stages of AD progression. Understanding the holistic relationship between multiple nutritional indices and their implications on various stages of AD would allow clinicians and dieticians the information needed to curb the prevalence of these cognitive disorders.

About the study

The present study aimed to investigate the relationship between various commonly used nutritional indices and their respective contributions to AD risk and progression. The sample cohort was recruited from the Center for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.

Between April 2019 and April 202, 946 participants with mild cognitive impairment (MCI due to AD – ‘AD-MCI’) or dementia due to AD (‘AD-D’) without other neurological conditions relating to cognition (e.g., Parkinson’s disease) and non-diet-based malnutrition (prevalence of hematological tumors, liver cirrhosis) were enrolled. Of these, 266 participants presented completed demographic and medical information and were included in the final analyses. These comprised 73 controls (normal cognition – ‘NC’), 72 AD-MCI, and 121 AD-D samples.

Subject body composition metrics were measured using the Global Leadership Initiative on Malnutrition (GLIM) criteria. These included ‘reduced food intake,’ ‘non-volatile weight loss,’ ‘muscle mass,’ and ‘body mass index (BMI).’ Additionally, subjects’ dietary patterns (e.g., Mediterranean diet and Mediterranean-DASH diet intervention for neurodegenerative delay [MIND]) were recorded, and the nutritional composition of these diets was separately investigated.

Venous blood samples were used for the estimations of fasting blood glucose (FBG), hemoglobin A1c (HbA1c), blood urea nitrogen (BUN), hemoglobin, creatinine, total calcium, albumin, globulin, albumin/globulin (A/G), and other nutritional status determinants.

Study findings

The present study comprised 266 participants, 57.14% of whom were female, with a mean age of 64.89 years. Medical data revealed that 36.84% of participants carried the APOE ε4 allele, a common culprit in AD pathology. Body composition metrics showed that AD-D patients had, on average, substantially lower arm, waist, calf, and hip circumferences and lower BMIs compared to AD-MCI and NC cohorts. Surprisingly, all participants were found to follow some interpretation of either Mediterranean or MIND dietary patterns, which did not differ in their nutritional scores.

“…a smaller waist circumference was linked to lower level of β amyloid protein (Aβ) and higher levels of phosphorylated tau (P-tau) and total tau (T-tau) in the cerebrospinal fluid of AD patients. This phenomenon may be attributed to the utilization of skeletal muscle mass as a nutritional reservoir in response to a prolonged state of negative energy balance during disease. Consequently, the muscle mass of AD patients gradually decreases as the disease progresses in AD.”

Nutritional assessment scales present that the AD-D cohort fared worse than the NC and AD-MCI groups. Study data analyses show that BMI and AD occurrence are independently associated, validating previous research.

Investigations into specific nutritional variables revealed that body composition, nutritional assessment scales, and blood-based nutritional laboratory variables were significantly associated with the occurrence and progression of AD. Malnutrition was found to be most prevalent in the AD-D cohort, but prevalence in even the AD-MCI was shown to be substantially higher than in the NC group.

“Since malnutrition is a risk factor that can be intervened, early identification and intervention of individuals with nutritional risk or malnutrition are significantly beneficial for reducing the risk, development, and progression of AD.”
Journal reference:

He, M., Lian, T., Liu, Z., Li, J., Qi, J., Li, J., Guo, P., Zhang, Y., Luo, D., Guan, H., Zhang, W., Zheng, Z., Yue, H., Zhang, W., Wang, R., Zhang, F., & Zhang, W. (2024). An investigation into the potential association between nutrition and Alzheimer’s disease. In Frontiers in Nutrition (Vol. 11). Frontiers Media SA, DOI – 10.3389/fnut.2024.1306226, https://www.frontiersin.org/articles/10.3389/fnut.2024.1306226/full
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March 11, 2024