Effects of spirulina and wakame consumption on intestinal cholesterol absorption and serum lipid concentrations in non-hypercholesterolemic adult men and women
Purpose Consumption of the algae spirulina ( Arthrospira platensis or maxima) and wakame ( Undaria pinnatifida ) has been shown to lower LDL cholesterol concentrations in animals and humans, possibly due to the inhibition of intestinal cholesterol absorption. This mechanism, however, has never been...
Gespeichert in:
| Veröffentlicht in: | European journal of nutrition 2020-08, Vol.59 (5), p.2229-2236 |
|---|---|
| Hauptverfasser: | , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 2236 |
|---|---|
| container_issue | 5 |
| container_start_page | 2229 |
| container_title | European journal of nutrition |
| container_volume | 59 |
| creator | van den Driessche, José J. Plat, Jogchum Konings, Maurice C. J. M. Mensink, Ronald P. |
| description | Purpose
Consumption of the algae spirulina (
Arthrospira platensis or maxima)
and wakame (
Undaria pinnatifida
) has been shown to lower LDL cholesterol concentrations in animals and humans, possibly due to the inhibition of intestinal cholesterol absorption. This mechanism, however, has never been investigated in humans. Therefore, we examined in non-hypercholesterolemic men and women the effects of spirulina and wakame consumption on serum markers for intestinal cholesterol absorption.
Methods
Thirty-five healthy men and women without hypercholesterolemia consumed in a random order daily 4.8 g spirulina, wakame or placebo for 17 days, separated by 14-day washouts. After 17 days, serum cholesterol-standardized campesterol, sitosterol and cholestanol, and lathosterol concentrations were measured as markers for intestinal cholesterol absorption and cholesterol synthesis, respectively. Concentrations of serum total cholesterol, LDL and HDL cholesterol, triacylglycerol, and plasma glucose, and blood pressure were measured as well.
Results
Compared with placebo, spirulina or wakame did not affect serum cholesterol-standardized campesterol (CI − 0.23 to 0.10 μmol/mmol,
P
= 0.435 and CI − 0.14 to 0.19 μmol/mmol,
P
= 0.729, respectively), sitosterol (
P
= 0.314 and
P
= 0.112), cholestanol (
P
= 0.610 and
P
= 0.809), or lathosterol (
P
= 0.388 and
P
= 0.102) concentrations. In addition, serum lipid and plasma glucose concentrations, and blood pressure were not changed.
Conclusions
Daily consumption of 4.8 g spirulina or wakame for 17 days did not affect plasma markers for intestinal cholesterol absorption or cholesterol synthesis in non-hypercholesterolemic men and women. Serum lipid and glucose concentrations, and blood pressure were also not altered. |
| doi_str_mv | 10.1007/s00394-019-02073-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7351869</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2268837302</sourcerecordid><originalsourceid>FETCH-LOGICAL-c540t-ea2360a6f9d820e3247e3d0383b5d6644c85579d1b1058ceac54e40dd2b29d63</originalsourceid><addsrcrecordid>eNp9kc1u1TAQRi0EouXCC7BAltiwCYztJE42SKgqP1IlNt1bvvak18Wxg51Q9Wl4VZymXAoLJEseac6cePIR8pLBWwYg32UA0dcVsL4CDlJU8hE5ZbVoq5az5vGxBnlCnuV8DQBctOwpORFMdJ0U_Sn5eT4MaOZM40Dz5NLiXdBUB0tv9Dc9IjUx5GWcZhcDLceFGfNcGE_NIfpSY4qe6n2OaYPW2YxpGal3k7OrwGCYk167uQhoiKE63E6YHhhwdIZqu_iZjrhJbmKpnpMng_YZX9zfO3L58fzy7HN18fXTl7MPF5Vpapgr1GUz0O3Q244DCl5LFBZEJ_aNbdu6Nl3TyN6yPYOmM6jLGNZgLd_z3rZiR95v2mnZj2i3B3s1JTfqdKuidurvTnAHdRV_KCka1rV9Eby5F6T4fSlLqdFlg97rgHHJivMC9aKtZUFf_4NexyWVP3pHdZ2QouS0I3yjTIo5JxyOj2Gg1vjVFr8q8au7-NWqfvVwjePI77wLIDYgl1a4wvTn2__R_gKYrMA8</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2268837302</pqid></control><display><type>article</type><title>Effects of spirulina and wakame consumption on intestinal cholesterol absorption and serum lipid concentrations in non-hypercholesterolemic adult men and women</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>van den Driessche, José J. ; Plat, Jogchum ; Konings, Maurice C. J. M. ; Mensink, Ronald P.</creator><creatorcontrib>van den Driessche, José J. ; Plat, Jogchum ; Konings, Maurice C. J. M. ; Mensink, Ronald P.</creatorcontrib><description>Purpose
Consumption of the algae spirulina (
Arthrospira platensis or maxima)
and wakame (
Undaria pinnatifida
) has been shown to lower LDL cholesterol concentrations in animals and humans, possibly due to the inhibition of intestinal cholesterol absorption. This mechanism, however, has never been investigated in humans. Therefore, we examined in non-hypercholesterolemic men and women the effects of spirulina and wakame consumption on serum markers for intestinal cholesterol absorption.
Methods
Thirty-five healthy men and women without hypercholesterolemia consumed in a random order daily 4.8 g spirulina, wakame or placebo for 17 days, separated by 14-day washouts. After 17 days, serum cholesterol-standardized campesterol, sitosterol and cholestanol, and lathosterol concentrations were measured as markers for intestinal cholesterol absorption and cholesterol synthesis, respectively. Concentrations of serum total cholesterol, LDL and HDL cholesterol, triacylglycerol, and plasma glucose, and blood pressure were measured as well.
Results
Compared with placebo, spirulina or wakame did not affect serum cholesterol-standardized campesterol (CI − 0.23 to 0.10 μmol/mmol,
P
= 0.435 and CI − 0.14 to 0.19 μmol/mmol,
P
= 0.729, respectively), sitosterol (
P
= 0.314 and
P
= 0.112), cholestanol (
P
= 0.610 and
P
= 0.809), or lathosterol (
P
= 0.388 and
P
= 0.102) concentrations. In addition, serum lipid and plasma glucose concentrations, and blood pressure were not changed.
Conclusions
Daily consumption of 4.8 g spirulina or wakame for 17 days did not affect plasma markers for intestinal cholesterol absorption or cholesterol synthesis in non-hypercholesterolemic men and women. Serum lipid and glucose concentrations, and blood pressure were also not altered.</description><identifier>ISSN: 1436-6207</identifier><identifier>EISSN: 1436-6215</identifier><identifier>DOI: 10.1007/s00394-019-02073-7</identifier><identifier>PMID: 31388739</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Algae ; Animals ; Bile ; Blood pressure ; Chemistry ; Chemistry and Materials Science ; Cholesterol ; Cholesterol, LDL ; Female ; Glucose ; High density lipoprotein ; Humans ; Hypercholesterolemia ; Intestinal Absorption ; Intestine ; Lipids ; Low density lipoprotein ; Male ; Mens health ; Nutrition ; Original Contribution ; Phytosterols ; Spirulina ; Undaria ; Women ; Womens health</subject><ispartof>European journal of nutrition, 2020-08, Vol.59 (5), p.2229-2236</ispartof><rights>The Author(s) 2019</rights><rights>The Author(s) 2019. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c540t-ea2360a6f9d820e3247e3d0383b5d6644c85579d1b1058ceac54e40dd2b29d63</citedby><cites>FETCH-LOGICAL-c540t-ea2360a6f9d820e3247e3d0383b5d6644c85579d1b1058ceac54e40dd2b29d63</cites><orcidid>0000-0002-8908-3580 ; 0000-0003-2893-0595 ; 0000-0002-1570-9608</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00394-019-02073-7$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00394-019-02073-7$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31388739$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van den Driessche, José J.</creatorcontrib><creatorcontrib>Plat, Jogchum</creatorcontrib><creatorcontrib>Konings, Maurice C. J. M.</creatorcontrib><creatorcontrib>Mensink, Ronald P.</creatorcontrib><title>Effects of spirulina and wakame consumption on intestinal cholesterol absorption and serum lipid concentrations in non-hypercholesterolemic adult men and women</title><title>European journal of nutrition</title><addtitle>Eur J Nutr</addtitle><addtitle>Eur J Nutr</addtitle><description>Purpose
Consumption of the algae spirulina (
Arthrospira platensis or maxima)
and wakame (
Undaria pinnatifida
) has been shown to lower LDL cholesterol concentrations in animals and humans, possibly due to the inhibition of intestinal cholesterol absorption. This mechanism, however, has never been investigated in humans. Therefore, we examined in non-hypercholesterolemic men and women the effects of spirulina and wakame consumption on serum markers for intestinal cholesterol absorption.
Methods
Thirty-five healthy men and women without hypercholesterolemia consumed in a random order daily 4.8 g spirulina, wakame or placebo for 17 days, separated by 14-day washouts. After 17 days, serum cholesterol-standardized campesterol, sitosterol and cholestanol, and lathosterol concentrations were measured as markers for intestinal cholesterol absorption and cholesterol synthesis, respectively. Concentrations of serum total cholesterol, LDL and HDL cholesterol, triacylglycerol, and plasma glucose, and blood pressure were measured as well.
Results
Compared with placebo, spirulina or wakame did not affect serum cholesterol-standardized campesterol (CI − 0.23 to 0.10 μmol/mmol,
P
= 0.435 and CI − 0.14 to 0.19 μmol/mmol,
P
= 0.729, respectively), sitosterol (
P
= 0.314 and
P
= 0.112), cholestanol (
P
= 0.610 and
P
= 0.809), or lathosterol (
P
= 0.388 and
P
= 0.102) concentrations. In addition, serum lipid and plasma glucose concentrations, and blood pressure were not changed.
Conclusions
Daily consumption of 4.8 g spirulina or wakame for 17 days did not affect plasma markers for intestinal cholesterol absorption or cholesterol synthesis in non-hypercholesterolemic men and women. Serum lipid and glucose concentrations, and blood pressure were also not altered.</description><subject>Adult</subject><subject>Algae</subject><subject>Animals</subject><subject>Bile</subject><subject>Blood pressure</subject><subject>Chemistry</subject><subject>Chemistry and Materials Science</subject><subject>Cholesterol</subject><subject>Cholesterol, LDL</subject><subject>Female</subject><subject>Glucose</subject><subject>High density lipoprotein</subject><subject>Humans</subject><subject>Hypercholesterolemia</subject><subject>Intestinal Absorption</subject><subject>Intestine</subject><subject>Lipids</subject><subject>Low density lipoprotein</subject><subject>Male</subject><subject>Mens health</subject><subject>Nutrition</subject><subject>Original Contribution</subject><subject>Phytosterols</subject><subject>Spirulina</subject><subject>Undaria</subject><subject>Women</subject><subject>Womens health</subject><issn>1436-6207</issn><issn>1436-6215</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kc1u1TAQRi0EouXCC7BAltiwCYztJE42SKgqP1IlNt1bvvak18Wxg51Q9Wl4VZymXAoLJEseac6cePIR8pLBWwYg32UA0dcVsL4CDlJU8hE5ZbVoq5az5vGxBnlCnuV8DQBctOwpORFMdJ0U_Sn5eT4MaOZM40Dz5NLiXdBUB0tv9Dc9IjUx5GWcZhcDLceFGfNcGE_NIfpSY4qe6n2OaYPW2YxpGal3k7OrwGCYk167uQhoiKE63E6YHhhwdIZqu_iZjrhJbmKpnpMng_YZX9zfO3L58fzy7HN18fXTl7MPF5Vpapgr1GUz0O3Q244DCl5LFBZEJ_aNbdu6Nl3TyN6yPYOmM6jLGNZgLd_z3rZiR95v2mnZj2i3B3s1JTfqdKuidurvTnAHdRV_KCka1rV9Eby5F6T4fSlLqdFlg97rgHHJivMC9aKtZUFf_4NexyWVP3pHdZ2QouS0I3yjTIo5JxyOj2Gg1vjVFr8q8au7-NWqfvVwjePI77wLIDYgl1a4wvTn2__R_gKYrMA8</recordid><startdate>20200801</startdate><enddate>20200801</enddate><creator>van den Driessche, José J.</creator><creator>Plat, Jogchum</creator><creator>Konings, Maurice C. J. M.</creator><creator>Mensink, Ronald P.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><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>3V.</scope><scope>7QP</scope><scope>7RQ</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8908-3580</orcidid><orcidid>https://orcid.org/0000-0003-2893-0595</orcidid><orcidid>https://orcid.org/0000-0002-1570-9608</orcidid></search><sort><creationdate>20200801</creationdate><title>Effects of spirulina and wakame consumption on intestinal cholesterol absorption and serum lipid concentrations in non-hypercholesterolemic adult men and women</title><author>van den Driessche, José J. ; Plat, Jogchum ; Konings, Maurice C. J. M. ; Mensink, Ronald P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c540t-ea2360a6f9d820e3247e3d0383b5d6644c85579d1b1058ceac54e40dd2b29d63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Algae</topic><topic>Animals</topic><topic>Bile</topic><topic>Blood pressure</topic><topic>Chemistry</topic><topic>Chemistry and Materials Science</topic><topic>Cholesterol</topic><topic>Cholesterol, LDL</topic><topic>Female</topic><topic>Glucose</topic><topic>High density lipoprotein</topic><topic>Humans</topic><topic>Hypercholesterolemia</topic><topic>Intestinal Absorption</topic><topic>Intestine</topic><topic>Lipids</topic><topic>Low density lipoprotein</topic><topic>Male</topic><topic>Mens health</topic><topic>Nutrition</topic><topic>Original Contribution</topic><topic>Phytosterols</topic><topic>Spirulina</topic><topic>Undaria</topic><topic>Women</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van den Driessche, José J.</creatorcontrib><creatorcontrib>Plat, Jogchum</creatorcontrib><creatorcontrib>Konings, Maurice C. J. M.</creatorcontrib><creatorcontrib>Mensink, Ronald P.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Career & Technical Education Database</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European journal of nutrition</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van den Driessche, José J.</au><au>Plat, Jogchum</au><au>Konings, Maurice C. J. M.</au><au>Mensink, Ronald P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of spirulina and wakame consumption on intestinal cholesterol absorption and serum lipid concentrations in non-hypercholesterolemic adult men and women</atitle><jtitle>European journal of nutrition</jtitle><stitle>Eur J Nutr</stitle><addtitle>Eur J Nutr</addtitle><date>2020-08-01</date><risdate>2020</risdate><volume>59</volume><issue>5</issue><spage>2229</spage><epage>2236</epage><pages>2229-2236</pages><issn>1436-6207</issn><eissn>1436-6215</eissn><abstract>Purpose
Consumption of the algae spirulina (
Arthrospira platensis or maxima)
and wakame (
Undaria pinnatifida
) has been shown to lower LDL cholesterol concentrations in animals and humans, possibly due to the inhibition of intestinal cholesterol absorption. This mechanism, however, has never been investigated in humans. Therefore, we examined in non-hypercholesterolemic men and women the effects of spirulina and wakame consumption on serum markers for intestinal cholesterol absorption.
Methods
Thirty-five healthy men and women without hypercholesterolemia consumed in a random order daily 4.8 g spirulina, wakame or placebo for 17 days, separated by 14-day washouts. After 17 days, serum cholesterol-standardized campesterol, sitosterol and cholestanol, and lathosterol concentrations were measured as markers for intestinal cholesterol absorption and cholesterol synthesis, respectively. Concentrations of serum total cholesterol, LDL and HDL cholesterol, triacylglycerol, and plasma glucose, and blood pressure were measured as well.
Results
Compared with placebo, spirulina or wakame did not affect serum cholesterol-standardized campesterol (CI − 0.23 to 0.10 μmol/mmol,
P
= 0.435 and CI − 0.14 to 0.19 μmol/mmol,
P
= 0.729, respectively), sitosterol (
P
= 0.314 and
P
= 0.112), cholestanol (
P
= 0.610 and
P
= 0.809), or lathosterol (
P
= 0.388 and
P
= 0.102) concentrations. In addition, serum lipid and plasma glucose concentrations, and blood pressure were not changed.
Conclusions
Daily consumption of 4.8 g spirulina or wakame for 17 days did not affect plasma markers for intestinal cholesterol absorption or cholesterol synthesis in non-hypercholesterolemic men and women. Serum lipid and glucose concentrations, and blood pressure were also not altered.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31388739</pmid><doi>10.1007/s00394-019-02073-7</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-8908-3580</orcidid><orcidid>https://orcid.org/0000-0003-2893-0595</orcidid><orcidid>https://orcid.org/0000-0002-1570-9608</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1436-6207 |
| ispartof | European journal of nutrition, 2020-08, Vol.59 (5), p.2229-2236 |
| issn | 1436-6207 1436-6215 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7351869 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Adult Algae Animals Bile Blood pressure Chemistry Chemistry and Materials Science Cholesterol Cholesterol, LDL Female Glucose High density lipoprotein Humans Hypercholesterolemia Intestinal Absorption Intestine Lipids Low density lipoprotein Male Mens health Nutrition Original Contribution Phytosterols Spirulina Undaria Women Womens health |
| title | Effects of spirulina and wakame consumption on intestinal cholesterol absorption and serum lipid concentrations in non-hypercholesterolemic adult men and women |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-04T06%3A30%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effects%20of%20spirulina%20and%20wakame%20consumption%20on%20intestinal%20cholesterol%20absorption%20and%20serum%20lipid%20concentrations%20in%20non-hypercholesterolemic%20adult%20men%20and%20women&rft.jtitle=European%20journal%20of%20nutrition&rft.au=van%20den%20Driessche,%20Jos%C3%A9%20J.&rft.date=2020-08-01&rft.volume=59&rft.issue=5&rft.spage=2229&rft.epage=2236&rft.pages=2229-2236&rft.issn=1436-6207&rft.eissn=1436-6215&rft_id=info:doi/10.1007/s00394-019-02073-7&rft_dat=%3Cproquest_pubme%3E2268837302%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2268837302&rft_id=info:pmid/31388739&rfr_iscdi=true |