Association of Fish Consumption and Mercury Exposure During Pregnancy With Metabolic Health and Inflammatory Biomarkers in Children
The balance of mercury risk and nutritional benefit from fish intake during pregnancy for the metabolic health of offspring to date is unknown. To assess the associations of fish intake and mercury exposure during pregnancy with metabolic syndrome in children and alterations in biomarkers of inflamm...
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| creator | Stratakis, Nikos Conti, David V Borras, Eva Sabido, Eduardo Roumeliotaki, Theano Papadopoulou, Eleni Agier, Lydiane Basagana, Xavier Bustamante, Mariona Casas, Maribel Farzan, Shohreh F Fossati, Serena Gonzalez, Juan R Grazuleviciene, Regina Heude, Barbara Maitre, Lea McEachan, Rosemary R C Theologidis, Ioannis Urquiza, Jose Vafeiadi, Marina West, Jane Wright, John McConnell, Rob Brantsaeter, Anne-Lise Meltzer, Helle-Margrete Vrijheid, Martine Chatzi, Leda |
| description | The balance of mercury risk and nutritional benefit from fish intake during pregnancy for the metabolic health of offspring to date is unknown.
To assess the associations of fish intake and mercury exposure during pregnancy with metabolic syndrome in children and alterations in biomarkers of inflammation in children.
This population-based prospective birth cohort study used data from studies performed in 5 European countries (France, Greece, Norway, Spain, and the UK) between April 1, 2003, and February 26, 2016, as part of the Human Early Life Exposome (HELIX) project. Mothers and their singleton offspring were followed up until the children were aged 6 to 12 years. Data were analyzed between March 1 and August 2, 2019.
Maternal fish intake during pregnancy (measured in times per week) was assessed using validated food frequency questionnaires, and maternal mercury concentration (measured in micrograms per liter) was assessed using maternal whole blood and cord blood samples.
An aggregate metabolic syndrome score for children was calculated using the z scores of waist circumference, systolic and diastolic blood pressures, and levels of triglyceride, high-density lipoprotein cholesterol, and insulin. A higher metabolic syndrome score (score range, -4.9 to 7.5) indicated a poorer metabolic profile. Three protein panels were used to measure several cytokines and adipokines in the plasma of children.
The study included 805 mothers and their singleton children. Among mothers, the mean (SD) age at cohort inclusion or delivery of their infant was 31.3 (4.6) years. A total of 400 women (49.7%) had a high educational level, and 432 women (53.7%) were multiparous. Among children, the mean (SD) age was 8.4 (1.5) years (age range, 6-12 years). A total of 453 children (56.3%) were boys, and 734 children (91.2%) were of white race/ethnicity. Fish intake consistent with health recommendations (1 to 3 times per week) during pregnancy was associated with a 1-U decrease in metabolic syndrome score in children (β = -0.96; 95% CI, -1.49 to -0.42) compared with low fish consumption ( |
| doi_str_mv | 10.1001/jamanetworkopen.2020.1007 |
| format | Article |
| fullrecord | <record><control><sourceid>hal_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7076335</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>oai_HAL_hal_04371055v1</sourcerecordid><originalsourceid>FETCH-LOGICAL-a476t-a2cbb05d87691450f1553fc4bdfec7c212b099912a4ddc5169cf66de0d24b2d53</originalsourceid><addsrcrecordid>eNpdUclOwzAQtRAIEPALyBw5FLzEMbkglbK0UhEcQBwtx3YaQ2JHdgL0zI-TtICA04zeptE8AI4wOsEI4dNnWUtn2jcfXnxj3AlBZMXwDbBLGE9G9AyxzV_7DjiI8RmhXodplrJtsEMJ5ilFyS74GMfolZWt9Q76Al7bWMKJd7GrmxUmnYa3JqguLOHVe-NjFwy87IJ1C3gfzMJJp5bwybZlL2tl7iur4NTIqgcG78wVlaxr2fo-4ML6WoYXEyK0Dk5KW-lg3D7YKmQVzcHX3AOP11cPk-lofnczm4znI5nwtB1JovIcMX3G0wwnDBWYMVqoJNeFUVwRTHKUZRkmMtFaMZxmqkhTbZAmSU40o3vgfJ3bdHlttDKuDbISTbD9UUvhpRV_GWdLsfCvgqP-W3QIOF4HlP9s0_FcDBhKKMeIsVfca7O1VgUfYzDFjwEjMRQp_hUphiIHhvfew9-H_ji_a6OfGPiiTw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Association of Fish Consumption and Mercury Exposure During Pregnancy With Metabolic Health and Inflammatory Biomarkers in Children</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Stratakis, Nikos ; Conti, David V ; Borras, Eva ; Sabido, Eduardo ; Roumeliotaki, Theano ; Papadopoulou, Eleni ; Agier, Lydiane ; Basagana, Xavier ; Bustamante, Mariona ; Casas, Maribel ; Farzan, Shohreh F ; Fossati, Serena ; Gonzalez, Juan R ; Grazuleviciene, Regina ; Heude, Barbara ; Maitre, Lea ; McEachan, Rosemary R C ; Theologidis, Ioannis ; Urquiza, Jose ; Vafeiadi, Marina ; West, Jane ; Wright, John ; McConnell, Rob ; Brantsaeter, Anne-Lise ; Meltzer, Helle-Margrete ; Vrijheid, Martine ; Chatzi, Leda</creator><creatorcontrib>Stratakis, Nikos ; Conti, David V ; Borras, Eva ; Sabido, Eduardo ; Roumeliotaki, Theano ; Papadopoulou, Eleni ; Agier, Lydiane ; Basagana, Xavier ; Bustamante, Mariona ; Casas, Maribel ; Farzan, Shohreh F ; Fossati, Serena ; Gonzalez, Juan R ; Grazuleviciene, Regina ; Heude, Barbara ; Maitre, Lea ; McEachan, Rosemary R C ; Theologidis, Ioannis ; Urquiza, Jose ; Vafeiadi, Marina ; West, Jane ; Wright, John ; McConnell, Rob ; Brantsaeter, Anne-Lise ; Meltzer, Helle-Margrete ; Vrijheid, Martine ; Chatzi, Leda</creatorcontrib><description>The balance of mercury risk and nutritional benefit from fish intake during pregnancy for the metabolic health of offspring to date is unknown.
To assess the associations of fish intake and mercury exposure during pregnancy with metabolic syndrome in children and alterations in biomarkers of inflammation in children.
This population-based prospective birth cohort study used data from studies performed in 5 European countries (France, Greece, Norway, Spain, and the UK) between April 1, 2003, and February 26, 2016, as part of the Human Early Life Exposome (HELIX) project. Mothers and their singleton offspring were followed up until the children were aged 6 to 12 years. Data were analyzed between March 1 and August 2, 2019.
Maternal fish intake during pregnancy (measured in times per week) was assessed using validated food frequency questionnaires, and maternal mercury concentration (measured in micrograms per liter) was assessed using maternal whole blood and cord blood samples.
An aggregate metabolic syndrome score for children was calculated using the z scores of waist circumference, systolic and diastolic blood pressures, and levels of triglyceride, high-density lipoprotein cholesterol, and insulin. A higher metabolic syndrome score (score range, -4.9 to 7.5) indicated a poorer metabolic profile. Three protein panels were used to measure several cytokines and adipokines in the plasma of children.
The study included 805 mothers and their singleton children. Among mothers, the mean (SD) age at cohort inclusion or delivery of their infant was 31.3 (4.6) years. A total of 400 women (49.7%) had a high educational level, and 432 women (53.7%) were multiparous. Among children, the mean (SD) age was 8.4 (1.5) years (age range, 6-12 years). A total of 453 children (56.3%) were boys, and 734 children (91.2%) were of white race/ethnicity. Fish intake consistent with health recommendations (1 to 3 times per week) during pregnancy was associated with a 1-U decrease in metabolic syndrome score in children (β = -0.96; 95% CI, -1.49 to -0.42) compared with low fish consumption (<1 time per week) after adjusting for maternal mercury levels and other covariates. No further benefit was observed with fish intake of more than 3 times per week. A higher maternal mercury concentration was independently associated with an increase in the metabolic syndrome score of their offspring (β per 2-fold increase in mercury concentration = 0.18; 95% CI, 0.01-0.34). Compared with low fish intake, moderate and high fish intake during pregnancy were associated with reduced levels of proinflammatory cytokines and adipokines in children. An integrated analysis identified a cluster of children with increased susceptibility to metabolic disease, which was characterized by low fish consumption during pregnancy, high maternal mercury levels, decreased levels of adiponectin in children, and increased levels of leptin, tumor necrosis factor α, and the cytokines interleukin 6 and interleukin 1β in children.
Results of this study suggest that moderate fish intake consistent with current health recommendations during pregnancy was associated with improvements in the metabolic health of children, while high maternal mercury exposure was associated with an unfavorable metabolic profile in children.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2020.1007</identifier><identifier>PMID: 32176304</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adult ; Animals ; Biomarkers - metabolism ; Child ; Female ; Fishes ; Humans ; Incidence ; Inflammation - metabolism ; Life Sciences ; Maternal Exposure - adverse effects ; Mercury - adverse effects ; Mercury Poisoning - epidemiology ; Mercury Poisoning - metabolism ; Nutrition, Obesity, and Exercise ; Online Only ; Original Investigation ; Pregnancy ; Prenatal Exposure Delayed Effects - epidemiology ; Prenatal Exposure Delayed Effects - metabolism ; Prospective Studies ; Risk Factors ; United States - epidemiology</subject><ispartof>JAMA network open, 2020-03, Vol.3 (3), p.e201007</ispartof><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><rights>Copyright 2020 Stratakis N et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a476t-a2cbb05d87691450f1553fc4bdfec7c212b099912a4ddc5169cf66de0d24b2d53</citedby><cites>FETCH-LOGICAL-a476t-a2cbb05d87691450f1553fc4bdfec7c212b099912a4ddc5169cf66de0d24b2d53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,864,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32176304$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://univ-eiffel.hal.science/hal-04371055$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Stratakis, Nikos</creatorcontrib><creatorcontrib>Conti, David V</creatorcontrib><creatorcontrib>Borras, Eva</creatorcontrib><creatorcontrib>Sabido, Eduardo</creatorcontrib><creatorcontrib>Roumeliotaki, Theano</creatorcontrib><creatorcontrib>Papadopoulou, Eleni</creatorcontrib><creatorcontrib>Agier, Lydiane</creatorcontrib><creatorcontrib>Basagana, Xavier</creatorcontrib><creatorcontrib>Bustamante, Mariona</creatorcontrib><creatorcontrib>Casas, Maribel</creatorcontrib><creatorcontrib>Farzan, Shohreh F</creatorcontrib><creatorcontrib>Fossati, Serena</creatorcontrib><creatorcontrib>Gonzalez, Juan R</creatorcontrib><creatorcontrib>Grazuleviciene, Regina</creatorcontrib><creatorcontrib>Heude, Barbara</creatorcontrib><creatorcontrib>Maitre, Lea</creatorcontrib><creatorcontrib>McEachan, Rosemary R C</creatorcontrib><creatorcontrib>Theologidis, Ioannis</creatorcontrib><creatorcontrib>Urquiza, Jose</creatorcontrib><creatorcontrib>Vafeiadi, Marina</creatorcontrib><creatorcontrib>West, Jane</creatorcontrib><creatorcontrib>Wright, John</creatorcontrib><creatorcontrib>McConnell, Rob</creatorcontrib><creatorcontrib>Brantsaeter, Anne-Lise</creatorcontrib><creatorcontrib>Meltzer, Helle-Margrete</creatorcontrib><creatorcontrib>Vrijheid, Martine</creatorcontrib><creatorcontrib>Chatzi, Leda</creatorcontrib><title>Association of Fish Consumption and Mercury Exposure During Pregnancy With Metabolic Health and Inflammatory Biomarkers in Children</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>The balance of mercury risk and nutritional benefit from fish intake during pregnancy for the metabolic health of offspring to date is unknown.
To assess the associations of fish intake and mercury exposure during pregnancy with metabolic syndrome in children and alterations in biomarkers of inflammation in children.
This population-based prospective birth cohort study used data from studies performed in 5 European countries (France, Greece, Norway, Spain, and the UK) between April 1, 2003, and February 26, 2016, as part of the Human Early Life Exposome (HELIX) project. Mothers and their singleton offspring were followed up until the children were aged 6 to 12 years. Data were analyzed between March 1 and August 2, 2019.
Maternal fish intake during pregnancy (measured in times per week) was assessed using validated food frequency questionnaires, and maternal mercury concentration (measured in micrograms per liter) was assessed using maternal whole blood and cord blood samples.
An aggregate metabolic syndrome score for children was calculated using the z scores of waist circumference, systolic and diastolic blood pressures, and levels of triglyceride, high-density lipoprotein cholesterol, and insulin. A higher metabolic syndrome score (score range, -4.9 to 7.5) indicated a poorer metabolic profile. Three protein panels were used to measure several cytokines and adipokines in the plasma of children.
The study included 805 mothers and their singleton children. Among mothers, the mean (SD) age at cohort inclusion or delivery of their infant was 31.3 (4.6) years. A total of 400 women (49.7%) had a high educational level, and 432 women (53.7%) were multiparous. Among children, the mean (SD) age was 8.4 (1.5) years (age range, 6-12 years). A total of 453 children (56.3%) were boys, and 734 children (91.2%) were of white race/ethnicity. Fish intake consistent with health recommendations (1 to 3 times per week) during pregnancy was associated with a 1-U decrease in metabolic syndrome score in children (β = -0.96; 95% CI, -1.49 to -0.42) compared with low fish consumption (<1 time per week) after adjusting for maternal mercury levels and other covariates. No further benefit was observed with fish intake of more than 3 times per week. A higher maternal mercury concentration was independently associated with an increase in the metabolic syndrome score of their offspring (β per 2-fold increase in mercury concentration = 0.18; 95% CI, 0.01-0.34). Compared with low fish intake, moderate and high fish intake during pregnancy were associated with reduced levels of proinflammatory cytokines and adipokines in children. An integrated analysis identified a cluster of children with increased susceptibility to metabolic disease, which was characterized by low fish consumption during pregnancy, high maternal mercury levels, decreased levels of adiponectin in children, and increased levels of leptin, tumor necrosis factor α, and the cytokines interleukin 6 and interleukin 1β in children.
Results of this study suggest that moderate fish intake consistent with current health recommendations during pregnancy was associated with improvements in the metabolic health of children, while high maternal mercury exposure was associated with an unfavorable metabolic profile in children.</description><subject>Adult</subject><subject>Animals</subject><subject>Biomarkers - metabolism</subject><subject>Child</subject><subject>Female</subject><subject>Fishes</subject><subject>Humans</subject><subject>Incidence</subject><subject>Inflammation - metabolism</subject><subject>Life Sciences</subject><subject>Maternal Exposure - adverse effects</subject><subject>Mercury - adverse effects</subject><subject>Mercury Poisoning - epidemiology</subject><subject>Mercury Poisoning - metabolism</subject><subject>Nutrition, Obesity, and Exercise</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Pregnancy</subject><subject>Prenatal Exposure Delayed Effects - epidemiology</subject><subject>Prenatal Exposure Delayed Effects - metabolism</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>United States - epidemiology</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUclOwzAQtRAIEPALyBw5FLzEMbkglbK0UhEcQBwtx3YaQ2JHdgL0zI-TtICA04zeptE8AI4wOsEI4dNnWUtn2jcfXnxj3AlBZMXwDbBLGE9G9AyxzV_7DjiI8RmhXodplrJtsEMJ5ilFyS74GMfolZWt9Q76Al7bWMKJd7GrmxUmnYa3JqguLOHVe-NjFwy87IJ1C3gfzMJJp5bwybZlL2tl7iur4NTIqgcG78wVlaxr2fo-4ML6WoYXEyK0Dk5KW-lg3D7YKmQVzcHX3AOP11cPk-lofnczm4znI5nwtB1JovIcMX3G0wwnDBWYMVqoJNeFUVwRTHKUZRkmMtFaMZxmqkhTbZAmSU40o3vgfJ3bdHlttDKuDbISTbD9UUvhpRV_GWdLsfCvgqP-W3QIOF4HlP9s0_FcDBhKKMeIsVfca7O1VgUfYzDFjwEjMRQp_hUphiIHhvfew9-H_ji_a6OfGPiiTw</recordid><startdate>20200316</startdate><enddate>20200316</enddate><creator>Stratakis, Nikos</creator><creator>Conti, David V</creator><creator>Borras, Eva</creator><creator>Sabido, Eduardo</creator><creator>Roumeliotaki, Theano</creator><creator>Papadopoulou, Eleni</creator><creator>Agier, Lydiane</creator><creator>Basagana, Xavier</creator><creator>Bustamante, Mariona</creator><creator>Casas, Maribel</creator><creator>Farzan, Shohreh F</creator><creator>Fossati, Serena</creator><creator>Gonzalez, Juan R</creator><creator>Grazuleviciene, Regina</creator><creator>Heude, Barbara</creator><creator>Maitre, Lea</creator><creator>McEachan, Rosemary R C</creator><creator>Theologidis, Ioannis</creator><creator>Urquiza, Jose</creator><creator>Vafeiadi, Marina</creator><creator>West, Jane</creator><creator>Wright, John</creator><creator>McConnell, Rob</creator><creator>Brantsaeter, Anne-Lise</creator><creator>Meltzer, Helle-Margrete</creator><creator>Vrijheid, Martine</creator><creator>Chatzi, Leda</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>1XC</scope><scope>VOOES</scope><scope>5PM</scope></search><sort><creationdate>20200316</creationdate><title>Association of Fish Consumption and Mercury Exposure During Pregnancy With Metabolic Health and Inflammatory Biomarkers in Children</title><author>Stratakis, Nikos ; 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To assess the associations of fish intake and mercury exposure during pregnancy with metabolic syndrome in children and alterations in biomarkers of inflammation in children.
This population-based prospective birth cohort study used data from studies performed in 5 European countries (France, Greece, Norway, Spain, and the UK) between April 1, 2003, and February 26, 2016, as part of the Human Early Life Exposome (HELIX) project. Mothers and their singleton offspring were followed up until the children were aged 6 to 12 years. Data were analyzed between March 1 and August 2, 2019.
Maternal fish intake during pregnancy (measured in times per week) was assessed using validated food frequency questionnaires, and maternal mercury concentration (measured in micrograms per liter) was assessed using maternal whole blood and cord blood samples.
An aggregate metabolic syndrome score for children was calculated using the z scores of waist circumference, systolic and diastolic blood pressures, and levels of triglyceride, high-density lipoprotein cholesterol, and insulin. A higher metabolic syndrome score (score range, -4.9 to 7.5) indicated a poorer metabolic profile. Three protein panels were used to measure several cytokines and adipokines in the plasma of children.
The study included 805 mothers and their singleton children. Among mothers, the mean (SD) age at cohort inclusion or delivery of their infant was 31.3 (4.6) years. A total of 400 women (49.7%) had a high educational level, and 432 women (53.7%) were multiparous. Among children, the mean (SD) age was 8.4 (1.5) years (age range, 6-12 years). A total of 453 children (56.3%) were boys, and 734 children (91.2%) were of white race/ethnicity. Fish intake consistent with health recommendations (1 to 3 times per week) during pregnancy was associated with a 1-U decrease in metabolic syndrome score in children (β = -0.96; 95% CI, -1.49 to -0.42) compared with low fish consumption (<1 time per week) after adjusting for maternal mercury levels and other covariates. No further benefit was observed with fish intake of more than 3 times per week. A higher maternal mercury concentration was independently associated with an increase in the metabolic syndrome score of their offspring (β per 2-fold increase in mercury concentration = 0.18; 95% CI, 0.01-0.34). Compared with low fish intake, moderate and high fish intake during pregnancy were associated with reduced levels of proinflammatory cytokines and adipokines in children. An integrated analysis identified a cluster of children with increased susceptibility to metabolic disease, which was characterized by low fish consumption during pregnancy, high maternal mercury levels, decreased levels of adiponectin in children, and increased levels of leptin, tumor necrosis factor α, and the cytokines interleukin 6 and interleukin 1β in children.
Results of this study suggest that moderate fish intake consistent with current health recommendations during pregnancy was associated with improvements in the metabolic health of children, while high maternal mercury exposure was associated with an unfavorable metabolic profile in children.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>32176304</pmid><doi>10.1001/jamanetworkopen.2020.1007</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2574-3805 |
| ispartof | JAMA network open, 2020-03, Vol.3 (3), p.e201007 |
| issn | 2574-3805 2574-3805 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7076335 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Animals Biomarkers - metabolism Child Female Fishes Humans Incidence Inflammation - metabolism Life Sciences Maternal Exposure - adverse effects Mercury - adverse effects Mercury Poisoning - epidemiology Mercury Poisoning - metabolism Nutrition, Obesity, and Exercise Online Only Original Investigation Pregnancy Prenatal Exposure Delayed Effects - epidemiology Prenatal Exposure Delayed Effects - metabolism Prospective Studies Risk Factors United States - epidemiology |
| title | Association of Fish Consumption and Mercury Exposure During Pregnancy With Metabolic Health and Inflammatory Biomarkers in Children |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-22T11%3A57%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-hal_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Association%20of%20Fish%20Consumption%20and%20Mercury%20Exposure%20During%20Pregnancy%20With%20Metabolic%20Health%20and%20Inflammatory%20Biomarkers%20in%20Children&rft.jtitle=JAMA%20network%20open&rft.au=Stratakis,%20Nikos&rft.date=2020-03-16&rft.volume=3&rft.issue=3&rft.spage=e201007&rft.pages=e201007-&rft.issn=2574-3805&rft.eissn=2574-3805&rft_id=info:doi/10.1001/jamanetworkopen.2020.1007&rft_dat=%3Chal_pubme%3Eoai_HAL_hal_04371055v1%3C/hal_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_id=info:pmid/32176304&rfr_iscdi=true |