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Motil KJ, Beisang A, Smith-Hicks C, Lembo A, Standridge SM, Liu E. Recommendations for the management of gastrointestinal comorbidities with or without trofinetide use in Rett syndrome. Expert Rev Gastroenterol Hepatol 2024; 18:227-237. [PMID: 38869952 DOI: 10.1080/17474124.2024.2368014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Although gastrointestinal (GI) comorbidities are experienced by over 90% of individuals with Rett syndrome (RTT), a neurodevelopmental disorder associated with mutations in the MECP2 gene, many neurologists and pediatricians do not rank the management of these comorbidities among the most important treatment goals for RTT. Trofinetide, the first approved pharmacologic treatment for RTT, confers improvements in RTT symptoms but is associated with adverse GI events, primarily diarrhea and vomiting. Treatment strategies for GI comorbidities and drug-associated symptoms in RTT represent an unmet clinical need. AREAS COVERED This perspective covers GI comorbidities experienced by those with RTT, either with or without trofinetide treatment. PubMed literature searches were undertaken on treatment recommendations for the following conditions: constipation, diarrhea, vomiting, aspiration, dysphagia, gastroesophageal reflux, nausea, gastroparesis, gastritis, and abdominal bloating. EXPERT OPINION The authors recommend a proactive approach to management of symptomatic GI comorbidities and drug-associated symptoms in RTT to enhance drug tolerance and improve the quality of life of affected individuals. Management strategies for common GI comorbidities associated with RTT are reviewed based on authors' clinical experience and augmented by recommendations from the literature.
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Affiliation(s)
- Kathleen J Motil
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Arthur Beisang
- Department of Pediatrics, Gillette Children's Hospital, Saint Paul, MN, USA
| | - Constance Smith-Hicks
- Center for Synaptic Disorders, Rett and Related Disorders Clinic, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Anthony Lembo
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shannon M Standridge
- Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Edwin Liu
- Digestive Health Institute, Children's Hospital Colorado, Denver, CO, USA
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Lionetti P, Wine E, Ran Ressler R, Minor GJ, Major G, Zemrani B, Gottrand F, Romano C. Use of fiber-containing enteral formula in pediatric clinical practice: an expert opinion review. Expert Rev Gastroenterol Hepatol 2023; 17:665-675. [PMID: 37278084 DOI: 10.1080/17474124.2023.2217355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Children who require enteral nutrition often report gastrointestinal symptoms. There is a growing interest in nutrition formulas that meet nutritional requirements and also maintain gut ecology and function. Fiber-containing enteral formulas can improve bowel function, promote the growth of healthy gut microbiota, and improve immune homeostasis. Nonetheless, guidance in clinical practice is lacking. AREAS COVERED This expert opinion article summarizes the available literature and collects the opinion of eight experts on the importance and use of fiber-containing enteral formulas in pediatrics. The present review was supported by a bibliographical literature search on Medline via PubMed to collect the most relevant articles. EXPERT OPINION The current evidence supports using fibers in enteral formulas as first-line nutrition therapy. Dietary fibers should be considered for all patients receiving enteral nutrition and can be slowly introduced from six months of age. Fiber properties that define the functional/physiological properties of the fiber must be considered. Clinicians should balance the dose of fiber with tolerability and feasibility. Introducing fiber-containing enteral formulas should be considered when initiating tube feeding. Dietary fiber should be introduced gradually, especially in fiber-naïve children, with an individualized symptom-based approach. Patients should continue with the fiber-containing enteral formulas they tolerate best.
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Affiliation(s)
- Paolo Lionetti
- Department Neurofarba, University of Florence - Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Firenze, Italy
| | - Eytan Wine
- Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Rinat Ran Ressler
- Nestle Product Technology Center, Nestlé Health Sciences, Bridgewater, NJ, US
| | - Gerard J Minor
- Pediatric Gastroenterology Hepatology and Nutrition, Kidz Medical Services, Florida, USA
| | - Giles Major
- Department Gastrointestinal Health, Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | - Boutaina Zemrani
- Clinical Research and Development, Pediatric Medical Nutrition, Nestlé Health Science, Lausanne, Switzerland
| | - Frédéric Gottrand
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Institute for Translational Research in Inflammation, University Lille, Lille, France
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Italy
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Nakamura S, Tanabe K, Yamate M, Osada S, Oku T. Trial of Available Energy Evaluation of Highly Cross-linked Starch and Modified Cellulose Based on Breath H2 Excretion. CURRENT NUTRITION & FOOD SCIENCE 2020. [DOI: 10.2174/1573401315666190723145558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
The energy value of a substance is essential in nutritional labeling. However,
the available energy of newly developed highly cross-linked phosphate starch (HCPS-N) and
modified cellulose (MC) are unknown.
Objective:
To evaluate the available energy of HCPS-N and MC, an indirect and simple method
which was applied as an indicator of the fermentability based on the breath hydrogen excretion, was
used.
Methods:
HCPS-N was made from tapioca starch by polymerization in the presence of 0.5% phosphoric
acid. MC was made from microcrystalline cellulose, maltodextrin, and karaya gum to attain a
highly stable suspension. The present study was carried out using a within-subject, repeatedmeasures
design. Blood was collected at 30 min intervals for 3 h after the ingestion of 30 g of a test
substance. The end-respiratory gas was collected for 14 h after ingestion of 5 g of a test substance to
evaluate the available energy.
Results and Discussion:
Plasma glucose and insulin levels did not elevate after the ingestion of
HCPS-N, although they increased significantly after glucose ingestion. In the experiments to evaluate
the available energy, breath hydrogen excretion after ingesting HCPS-N did not increase distinctly
during the experiment. Breath hydrogen excretion after preceding HCPS-P (0 kcal) ingestion was also
markedly smaller compared with the peak value at 4 h after FOS ingestion. For the ingestion of
MC, breath hydrogen excretion increased scarcely, and the basal level remained until the end of the
experiment.
Conclusion:
The available energies were evaluated to be 0 kcal/g for HCPS-N and 1 kcal/g for MC
in healthy humans.
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Affiliation(s)
- Sadako Nakamura
- Institute of Food, Nutrition and Health, Jumonji University, 2-1-28 Sugasawa, Niiza, Saitama 352-8510, Japan
| | - Kenichi Tanabe
- Department of Food Science and Nutrition, Nagoya Women's University, 3-40, Shioji, Mizuho, Nagoya 467-8610, Japan
| | - Misa Yamate
- Graduate School of Human Life Science, Jumonji University, 2-1-28 Sugasawa, Niiza, Saitama 352-8510, Japan
| | - Sanae Osada
- Junior College, Department of Food and Nutrition, Kagawa Education Institute of Nutrition, 3-24-3, Komagome, Toshima, Tokyo 170-0003, Japan
| | - Tsuneyuki Oku
- Institute of Food, Nutrition and Health, Jumonji University, 2-1-28 Sugasawa, Niiza, Saitama 352-8510, Japan
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Nakamura S, Yamate M, Tanabe K, Osada S, Oku T. Highly Cross-linked Starch and Modified Cellulose as Dietary Fibers, and their Acclimation Effect on Hydrogen Excretion in Rats. CURRENT NUTRITION & FOOD SCIENCE 2020. [DOI: 10.2174/1573401314666181112143530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Highly cross-linked phosphate starch (HCPS) and modified cellulose (MC)
were newly developed and modified dietary fiber materials to prevent lifestyle-related diseases.
Objective:
We investigated the physiological property of HCPS and MC to be a dietary fiber.
Methods:
HCPS was made from tapioca starch by polymerization in the presence of 0.5% phosphoric
acid, and MC was made from cellulose, maltodextrin and karaya gum by high-speed mixing. In the
present study, rats were raised on a diet containing 10% or 15% HCPS, or 10% MC for four weeks,
and physical effects such as growth, organ weights, blood biomedical parameters, fecal weight, and
hydrogen excretion were recorded.
Results:
Growth was normal among all groups, and there was no significant difference in total body
weight gain. Some organ weights including the adipose tissues differed slightly among groups, but
no difference based on diet composition was observed. Blood biomedical parameters were normal
and not significantly different among groups. Cecum tissue and content weights were significantly
greater in the 15% HCPS, 10% MC, and 10% fructooligosaccharide (FOS) groups than in the control
group, and fecal weight was significantly increased in the 10% and 15% HCPS, and 10% MC groups
compared with the control group. Hydrogen excretion over 24 h was negligible when HCPS was administered
orally to rats non-acclimatized to HCPS but increased significantly in rats acclimatized to
10% HCPS diet for one week.
Conclusion:
We conclude that both HCPS and MC could be suitable for use as low energy bulking
materials.
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Affiliation(s)
- Sadako Nakamura
- Institute of Food, Nutrition and Health, Jumonji University, 2-1-28 Sugasawa, Niiza, Saitama 352-8510, Japan
| | - Misa Yamate
- Graduate School of Human Life Science, Jumonji University, 2-1-28 Sugasawa, Niiza, Saitama 352-8510, Japan
| | - Kenichi Tanabe
- Department of Food Science and Nutrition, Nagoya Women's University, 3-40, Shioji, Mizuho, Nagoya, 467-8610, Japan
| | - Sanae Osada
- Junior College, Department of Food and Nutrition, Kagawa Education Institute of Nutrition, 3-24-3, Komagome, Toshima, Tokyo 170-8481, Japan
| | - Tsuneyuki Oku
- Institute of Food, Nutrition and Health, Jumonji University, 2-1-28 Sugasawa, Niiza, Saitama 352-8510, Japan
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Canto-Mangana J, Jofré-Peralta A, Martínez-Plata JE, Acosta-Robles PJ, Morales-Molina JA. Polyols: Is their use safe in enteral nutrition? ENDOCRINOL DIAB NUTR 2019; 66:393-395. [DOI: 10.1016/j.endinu.2019.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 12/19/2022]
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Utilisation of dietary fibre (non-starch polysaccharide and resistant starch) molecules for diarrhoea therapy: A mini-review. Int J Biol Macromol 2019; 122:572-577. [DOI: 10.1016/j.ijbiomac.2018.10.195] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/26/2018] [Accepted: 10/27/2018] [Indexed: 02/06/2023]
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Dostal AM, Samavat H, Bedell S, Torkelson C, Wang R, Swenson K, Le C, Wu AH, Ursin G, Yuan JM, Kurzer MS. The safety of green tea extract supplementation in postmenopausal women at risk for breast cancer: results of the Minnesota Green Tea Trial. Food Chem Toxicol 2015; 83:26-35. [PMID: 26051348 DOI: 10.1016/j.fct.2015.05.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/29/2015] [Accepted: 05/26/2015] [Indexed: 02/07/2023]
Abstract
Green tea is thought to provide health benefits, though adverse reactions to green tea extract (GTE) have been reported. We conducted a randomized, double-blind, placebo-controlled study of GTE on breast cancer biomarkers, including mammographic density, in which 1075 postmenopausal women were randomly assigned to consume GTE containing 843 mg (-)-epigallocatechin-3-gallate (EGCG) or placebo daily for one year. There were no significant differences in % of women with adverse events (AEs, 75.6% and 72.8% of the GTE group and placebo group, respectively) or serious AEs (2.2 % and 1.5% of GTE and placebo groups, respectively). Women on GTE reported significantly higher incidence of nausea (P < 0.001) and dermatologic AEs (P = 0.05) and significantly lower diarrhea incidence (P = 0.02). More women in the GTE group experienced an alanine aminotransferase (ALT) elevation compared with placebo group (n = 36, (6.7%) vs. n = 4, (0.7%); P < 0.001). There were no statistically significant differences between groups in frequencies of other AEs. Overall, AEs were mainly mild and transient, indicating that daily consumption of GTE containing 843 mg EGCG is generally well tolerated by a group of predominantly Caucasian postmenopausal women. However, 6.7% of GTE consumers experienced ALT elevations, with 1.3% experiencing ALT-related serious AEs.
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Affiliation(s)
- Allison M Dostal
- Department of Food Science and Nutrition, University of Minnesota, 1334 Eckles Ave., St. Paul, MN 55108, USA.
| | - Hamed Samavat
- Department of Food Science and Nutrition, University of Minnesota, 1334 Eckles Ave., St. Paul, MN 55108, USA.
| | - Sarah Bedell
- Department of Food Science and Nutrition, University of Minnesota, 1334 Eckles Ave., St. Paul, MN 55108, USA.
| | - Carolyn Torkelson
- Department of Family Medicine, University of Minnesota Medical Center, 420 Delaware St. SE, Minneapolis, MN 55455, USA.
| | - Renwei Wang
- University of Pittsburgh Cancer Institute, Division of Cancer Control and Population Sciences, University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, 5150 Centre Ave., Pittsburgh, PA 15232, USA.
| | - Karen Swenson
- Virginia Piper Cancer Institute, Allina Health System, 800 East 28th St., Suite 602, Minneapolis, MN 55407, USA.
| | - Chap Le
- Biostatistics and Informatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Anna H Wu
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, 1975 Zonal Ave., Los Angeles, CA 90033, USA.
| | - Giske Ursin
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, 1975 Zonal Ave., Los Angeles, CA 90033, USA; Cancer Registry of Norway, Oslo, Norway; Department of Nutrition, University of Oslo, Oslo, Norway.
| | - Jian-Min Yuan
- University of Pittsburgh Cancer Institute, Division of Cancer Control and Population Sciences, University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, 5150 Centre Ave., Pittsburgh, PA 15232, USA.
| | - Mindy S Kurzer
- Department of Food Science and Nutrition, University of Minnesota, 1334 Eckles Ave., St. Paul, MN 55108, USA.
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Barbieri G, Barone C, Bhagat A, Caruso G, Conley ZR, Parisi S. Sweet Compounds in Foods: Sugar Alcohols. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/978-3-319-11358-6_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Respondek F, Hilpipre C, Chauveau P, Cazaubiel M, Gendre D, Maudet C, Wagner A. Digestive tolerance and postprandial glycaemic and insulinaemic responses after consumption of dairy desserts containing maltitol and fructo-oligosaccharides in adults. Eur J Clin Nutr 2014; 68:575-80. [PMID: 24642779 PMCID: PMC4013556 DOI: 10.1038/ejcn.2014.30] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 01/28/2014] [Accepted: 01/29/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES To evaluate the short-term digestive tolerance and glycaemic response of several associations of maltitol and short-chain fructo-oligosaccharides (scFOS) used to replace sugars (for example, dextrose) in foods. SUBJECTS/METHODS Thirty-six healthy subjects aged 18-60 years were recruited for the study and 32 completed it. The subjects consumed six different mixtures of dextrose, maltitol and scFOS added in a chocolate dairy dessert at a dosage of 35 g. The test days were separated by 2-week washout periods. The subjects reported the intensity of four individual gastrointestinal (GI) symptoms, number of bowel movements and stool frequency for the 48 h following consumption of the dessert. A subgroup of 18 subjects also provided blood samples 2 h after intake to evaluate the postprandial glycaemic and insulinaemic responses. RESULTS The composite score calculated from the intensity of flatulence, borborygmi, bloating and discomfort was significantly higher (P<0.0001) for all the desserts containing maltitol and/or scFOS than for the control dessert containing dextrose, but remains at the level of mild effects. The number of bowel movements was also slightly increased (P=0.0006) and the stools were softer (P=0.0045) for the first 24 h but not after (P=0.1373 and 0.5420, respectively). Blood glycaemic and insulinaemic responses were lower for all the sugar-free recipes containing maltitol and scFOS in comparison to the control one (P<0.0001). CONCLUSIONS This study has shown that maltitol and scFOS can be used jointly when formulating sugar-free foods with the benefit to lower postprandial glycaemic response with only a small and transient increase in non-serious GI symptoms.
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Affiliation(s)
- F Respondek
- Innovation Department, Tereos Syral, Marckolsheim, France
| | - C Hilpipre
- Innovation Department, Tereos Syral, Marckolsheim, France
| | | | | | - D Gendre
- Biofortis SAS, Saint-Herblain, France
| | - C Maudet
- Biofortis SAS, Saint-Herblain, France
| | - A Wagner
- Innovation Department, Tereos Syral, Marckolsheim, France
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Insoluble fiber in young barley leaf suppresses the increment of postprandial blood glucose level by increasing the digesta viscosity. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:137871. [PMID: 24348688 PMCID: PMC3857754 DOI: 10.1155/2013/137871] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 09/27/2013] [Accepted: 10/07/2013] [Indexed: 11/18/2022]
Abstract
Barley (Hordeum vulgare L.) is a well-known cereal plant. Young barley leaf is consumed as a popular green-colored drink, which is named “Aojiru” in Japan. We examined the effects of barley leaf powder (BLP) and insoluble fibers derived from BLP on postprandial blood glucose in rats and healthy Japanese volunteers. BLP and insoluble fibers derived from BLP suppressed the increment of postprandial blood glucose levels in rats (P < 0.01), and increased the viscosity of their digesta. The insoluble fibers present in BLP might play a role in controlling blood glucose level by increasing digesta viscosity. In human, BLP suppressed the increment of postprandial blood glucose level only in those which exhibited higher blood glucose levels after meals (P < 0.01). BLP might suppress the increment of postprandial blood glucose level by increasing digesta viscosity in both of rats and humans who require blood glucose monitoring.
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Laflamme DP, Xu H, Cupp CJ, Kerr WW, Ramadan Z, Long GM. Evaluation of canned therapeutic diets for the management of cats with naturally occurring chronic diarrhea. J Feline Med Surg 2012; 14:669-77. [PMID: 22577048 PMCID: PMC11104099 DOI: 10.1177/1098612x12446906] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dietary therapy plays an important role in the management of most gastrointestinal disorders. This study was designed to test the efficacy of a new therapeutic diet for cats with diarrhea, compared to the top selling brand. Sixteen adult cats with chronic diarrhea were grouped and assigned to diet X (Hill's Prescription Diet i/d Feline) or diet Y (Purina Veterinary Diets EN Gastroenteric Feline Formula). Following baseline evaluations, cats were fed their assigned test diet for 4 weeks. Fecal scores (FS; 7=very watery; 1=extremely dry and firm) were recorded daily during the last week on each diet. Each cat was then switched to the alternate test diet and the procedure was repeated. Fifteen cats completed the study. Both therapeutic diets resulted in a significant improvement in average FS and diet Y also resulted in significantly better results compared with diet X. Average FS improved at least one unit in 40% of the cats while fed diet X and in 67% of the cats while fed diet Y, resulting in normal stools (average FS≤3) in 13.3% of cats fed diet X and 46.7% of cats fed diet Y. This study confirms the value of dietary change in the management of chronic diarrhea in cats.
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Klosterbuer A, Roughead ZF, Slavin J. Benefits of Dietary Fiber in Clinical Nutrition. Nutr Clin Pract 2011; 26:625-35. [DOI: 10.1177/0884533611416126] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Thabuis C, Cazaubiel M, Pichelin M, Wils D, Guerin-Deremaux L. Short-term digestive tolerance of chocolate formulated with maltitol in children. Int J Food Sci Nutr 2011; 61:728-38. [PMID: 20465435 DOI: 10.3109/09637481003766812] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Polyols are molecules of interest for food industries because of their technological and nutritional properties. Maltitol is known for its non-acidogenic and low-energetic properties. Our primary objective was to evaluate the digestive tolerance of maltitol in children. The secondary objective was to compare the organoleptic properties of maltitol and sucrose in chocolate. METHOD Healthy children were included in a double-blind, randomized parallel study versus placebo. The subjects received one dose of either maltitol or sucrose chocolate per week. Increasing doses were tested from 5 to 15 g maltitol in chocolate. Abdominal pain, rumbling, bloating and flatulence scores were evaluated using visual analog scales. RESULTS Some statistical differences on intestinal parameters were observed in the maltitol group compared with placebo, mainly concerning flatulence scores. Nevertheless, these scores remained low and could be considered minor. CONCLUSION Our results suggest that maltitol was well tolerated in children at 15 g in one intake.
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TAKAHASHI T. Flow Behavior of Digesta and the Absorption of Nutrients in the Gastrointestine. J Nutr Sci Vitaminol (Tokyo) 2011; 57:265-73. [DOI: 10.3177/jnsv.57.265] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Toru TAKAHASHI
- Department of Nutrition and Health Science, Faculty of Human Environmental Sciences, Fukuoka Women's University
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