Methodology for altering omega-3 EPA+DHA and omega-6 linoleic acid as controlled variables in a dietary trial
Increasing dietary intake of n-3 EPA+DHA and lowering dietary n-6 LA is under investigation as a therapeutic diet for improving chronic pain syndromes as well as other health outcomes. Herein we describe the diet methodology used to modulate intake of n-3 and n-6 PUFA in a free living migraine heada...
Gespeichert in:
| Veröffentlicht in: | Clinical nutrition (Edinburgh, Scotland) Scotland), 2021-06, Vol.40 (6), p.3859-3867 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 3867 |
|---|---|
| container_issue | 6 |
| container_start_page | 3859 |
| container_title | Clinical nutrition (Edinburgh, Scotland) |
| container_volume | 40 |
| creator | MacIntosh, Beth A. Ramsden, Christopher E. Honvoh, Gilson Faurot, Keturah R. Palsson, Olafur S. Johnston, Angela D. Lynch, Chanee Anderson, Paula Igudesman, Daria Zamora, Daisy Horowitz, Mark Gaylord, Susan Mann, John D. |
| description | Increasing dietary intake of n-3 EPA+DHA and lowering dietary n-6 LA is under investigation as a therapeutic diet for improving chronic pain syndromes as well as other health outcomes. Herein we describe the diet methodology used to modulate intake of n-3 and n-6 PUFA in a free living migraine headache population and report on nutrient intake, BMI and diet acceptability achieved at week 16 of the intensive diet intervention and week 22 follow-up time-point.
A total of 178 participants were randomized and began one of three diet interventions: 1) a high n-3 PUFA, average n-6 PUFA (H3) diet targeting 1500 mg EPA+DHA/day and 7% of energy (en%) from n-6 linoleic acid (LA), 2) a high-n-3 PUFA, low-n-6 PUFA (H3L6) targeting 1500 mg EPA+DHA/day and |
| doi_str_mv | 10.1016/j.clnu.2021.04.050 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8293619</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0261561421002454</els_id><sourcerecordid>2541782643</sourcerecordid><originalsourceid>FETCH-LOGICAL-c455t-64d8d0962e8622aba99001955dd91585e4c43479bbc89e47a0fb9bc38a55f2a43</originalsourceid><addsrcrecordid>eNp9kU9rGzEQxUVpady0X6CHomMh7FZ_1xKUgknTpJCSHNqz0EqzjoxWSqW1Id--a-yE5pLTwMybN4_5IfSRkpYS2n3ZtC6mbcsIoy0RLZHkFVpQyVlDteKv0YKwjjayo-IEvat1QwiRfKneohMuKCeE8wUaf8F0l32Oef2Ah1ywjROUkNY4j7C2DccXt6uz71crbJM_9jocQ8oRgsPWBY9txS6nqeQYweOdLcH2ESoOCVvsA0y2POBp7sb36M1gY4UPx3qK_vy4-H1-1VzfXP48X103Tkg5NZ3wyhPdMVAdY7a3WhNCtZTeayqVBOEEF0vd905pEEtLhl73jisr5cCs4Kfo28H3ftuP4B3M6Ww09yWMcxaTbTDPJyncmXXeGcU076ieDT4fDUr-u4U6mTFUBzHaBHlbDZOCLhXrBJ-l7CB1JddaYHg6Q4nZczIbs-dk9pwMEWbmNC99-j_g08ojmFnw9SCA-U27AMVUFyA58KGAm4zP4SX_f7KipIg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2541782643</pqid></control><display><type>article</type><title>Methodology for altering omega-3 EPA+DHA and omega-6 linoleic acid as controlled variables in a dietary trial</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>MacIntosh, Beth A. ; Ramsden, Christopher E. ; Honvoh, Gilson ; Faurot, Keturah R. ; Palsson, Olafur S. ; Johnston, Angela D. ; Lynch, Chanee ; Anderson, Paula ; Igudesman, Daria ; Zamora, Daisy ; Horowitz, Mark ; Gaylord, Susan ; Mann, John D.</creator><creatorcontrib>MacIntosh, Beth A. ; Ramsden, Christopher E. ; Honvoh, Gilson ; Faurot, Keturah R. ; Palsson, Olafur S. ; Johnston, Angela D. ; Lynch, Chanee ; Anderson, Paula ; Igudesman, Daria ; Zamora, Daisy ; Horowitz, Mark ; Gaylord, Susan ; Mann, John D.</creatorcontrib><description>Increasing dietary intake of n-3 EPA+DHA and lowering dietary n-6 LA is under investigation as a therapeutic diet for improving chronic pain syndromes as well as other health outcomes. Herein we describe the diet methodology used to modulate intake of n-3 and n-6 PUFA in a free living migraine headache population and report on nutrient intake, BMI and diet acceptability achieved at week 16 of the intensive diet intervention and week 22 follow-up time-point.
A total of 178 participants were randomized and began one of three diet interventions: 1) a high n-3 PUFA, average n-6 PUFA (H3) diet targeting 1500 mg EPA+DHA/day and 7% of energy (en%) from n-6 linoleic acid (LA), 2) a high-n-3 PUFA, low-n-6 PUFA (H3L6) targeting 1500 mg EPA+DHA/day and <1.8 en% n-6 LA or 3) a Control diet with typical American intakes of both EPA+DHA (<150 mg/day) and 7 en% from n-6 LA. Methods used to achieve diet change to week 16 include diet education, diet counseling, supply of specially prepared foods, self-monitoring and access to online diet materials. Only study oils and website materials were provided for the follow-up week 16 to week 22 periods. Diet adherence was assessed by multiple 24 h recalls administered throughout the trial. Diet acceptability was assessed in a subset of participants at 4 time points by questionnaire.
At week 16 H3 and H3L6 diet groups significantly increased median n-3 EPA+DHA intake from 48 mg/2000 kcals at baseline to 1484 mg/2000 kcals (p < 0.0001) and from 44 mg/2000 kcals to 1341 mg/2000 kcals (p < 0.0001), respectively. In the Control group, EPA+DHA intake remained below the typical American intake with baseline median at 60 mg/2000 kcals and 80 mg/2000 kcals (p = 0.6) at week 16. As desired, LA intake was maintained in the H3 and Control group with baseline median of 6.5 en% to 7.1 en% (p = 0.4) at week 16 and from 6.5 en% to 6.8 en% (p = 1.0) at week 16, respectively. In the H3L6 group, n-6 LA decreased from 6.3 en% at baseline to 3.2 en% (p < 0.0001) at week 16. There were no significant changes in BMI or diet acceptability throughout the trial or between diet groups.
We find this diet method to be acceptable to research participants and successful in altering dietary n-3 EPA+DHA with and without concurrent decreases in n-6 LA. If n-6 LA of less than 3 en% is desired, additional techniques to limit LA may need to be employed.</description><identifier>ISSN: 0261-5614</identifier><identifier>ISSN: 1532-1983</identifier><identifier>EISSN: 1532-1983</identifier><identifier>DOI: 10.1016/j.clnu.2021.04.050</identifier><identifier>PMID: 34130033</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adult ; Chronic Pain - diet therapy ; Diet ; Docosahexaenoic Acids - administration & dosage ; Double-Blind Method ; Fatty Acids, Omega-3 - administration & dosage ; Fatty Acids, Omega-6 - administration & dosage ; Female ; Fish ; Humans ; Linoleic acid ; Male ; Migraine headache ; n-3 ; n-6 ; Polyunsaturated fatty acids ; Research Design</subject><ispartof>Clinical nutrition (Edinburgh, Scotland), 2021-06, Vol.40 (6), p.3859-3867</ispartof><rights>2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism</rights><rights>Copyright © 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c455t-64d8d0962e8622aba99001955dd91585e4c43479bbc89e47a0fb9bc38a55f2a43</citedby><cites>FETCH-LOGICAL-c455t-64d8d0962e8622aba99001955dd91585e4c43479bbc89e47a0fb9bc38a55f2a43</cites><orcidid>0000-0002-0061-8586 ; 0000-0002-4532-1532 ; 0000-0001-5209-4625</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0261561421002454$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34130033$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MacIntosh, Beth A.</creatorcontrib><creatorcontrib>Ramsden, Christopher E.</creatorcontrib><creatorcontrib>Honvoh, Gilson</creatorcontrib><creatorcontrib>Faurot, Keturah R.</creatorcontrib><creatorcontrib>Palsson, Olafur S.</creatorcontrib><creatorcontrib>Johnston, Angela D.</creatorcontrib><creatorcontrib>Lynch, Chanee</creatorcontrib><creatorcontrib>Anderson, Paula</creatorcontrib><creatorcontrib>Igudesman, Daria</creatorcontrib><creatorcontrib>Zamora, Daisy</creatorcontrib><creatorcontrib>Horowitz, Mark</creatorcontrib><creatorcontrib>Gaylord, Susan</creatorcontrib><creatorcontrib>Mann, John D.</creatorcontrib><title>Methodology for altering omega-3 EPA+DHA and omega-6 linoleic acid as controlled variables in a dietary trial</title><title>Clinical nutrition (Edinburgh, Scotland)</title><addtitle>Clin Nutr</addtitle><description>Increasing dietary intake of n-3 EPA+DHA and lowering dietary n-6 LA is under investigation as a therapeutic diet for improving chronic pain syndromes as well as other health outcomes. Herein we describe the diet methodology used to modulate intake of n-3 and n-6 PUFA in a free living migraine headache population and report on nutrient intake, BMI and diet acceptability achieved at week 16 of the intensive diet intervention and week 22 follow-up time-point.
A total of 178 participants were randomized and began one of three diet interventions: 1) a high n-3 PUFA, average n-6 PUFA (H3) diet targeting 1500 mg EPA+DHA/day and 7% of energy (en%) from n-6 linoleic acid (LA), 2) a high-n-3 PUFA, low-n-6 PUFA (H3L6) targeting 1500 mg EPA+DHA/day and <1.8 en% n-6 LA or 3) a Control diet with typical American intakes of both EPA+DHA (<150 mg/day) and 7 en% from n-6 LA. Methods used to achieve diet change to week 16 include diet education, diet counseling, supply of specially prepared foods, self-monitoring and access to online diet materials. Only study oils and website materials were provided for the follow-up week 16 to week 22 periods. Diet adherence was assessed by multiple 24 h recalls administered throughout the trial. Diet acceptability was assessed in a subset of participants at 4 time points by questionnaire.
At week 16 H3 and H3L6 diet groups significantly increased median n-3 EPA+DHA intake from 48 mg/2000 kcals at baseline to 1484 mg/2000 kcals (p < 0.0001) and from 44 mg/2000 kcals to 1341 mg/2000 kcals (p < 0.0001), respectively. In the Control group, EPA+DHA intake remained below the typical American intake with baseline median at 60 mg/2000 kcals and 80 mg/2000 kcals (p = 0.6) at week 16. As desired, LA intake was maintained in the H3 and Control group with baseline median of 6.5 en% to 7.1 en% (p = 0.4) at week 16 and from 6.5 en% to 6.8 en% (p = 1.0) at week 16, respectively. In the H3L6 group, n-6 LA decreased from 6.3 en% at baseline to 3.2 en% (p < 0.0001) at week 16. There were no significant changes in BMI or diet acceptability throughout the trial or between diet groups.
We find this diet method to be acceptable to research participants and successful in altering dietary n-3 EPA+DHA with and without concurrent decreases in n-6 LA. If n-6 LA of less than 3 en% is desired, additional techniques to limit LA may need to be employed.</description><subject>Adult</subject><subject>Chronic Pain - diet therapy</subject><subject>Diet</subject><subject>Docosahexaenoic Acids - administration & dosage</subject><subject>Double-Blind Method</subject><subject>Fatty Acids, Omega-3 - administration & dosage</subject><subject>Fatty Acids, Omega-6 - administration & dosage</subject><subject>Female</subject><subject>Fish</subject><subject>Humans</subject><subject>Linoleic acid</subject><subject>Male</subject><subject>Migraine headache</subject><subject>n-3</subject><subject>n-6</subject><subject>Polyunsaturated fatty acids</subject><subject>Research Design</subject><issn>0261-5614</issn><issn>1532-1983</issn><issn>1532-1983</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9rGzEQxUVpady0X6CHomMh7FZ_1xKUgknTpJCSHNqz0EqzjoxWSqW1Id--a-yE5pLTwMybN4_5IfSRkpYS2n3ZtC6mbcsIoy0RLZHkFVpQyVlDteKv0YKwjjayo-IEvat1QwiRfKneohMuKCeE8wUaf8F0l32Oef2Ah1ywjROUkNY4j7C2DccXt6uz71crbJM_9jocQ8oRgsPWBY9txS6nqeQYweOdLcH2ESoOCVvsA0y2POBp7sb36M1gY4UPx3qK_vy4-H1-1VzfXP48X103Tkg5NZ3wyhPdMVAdY7a3WhNCtZTeayqVBOEEF0vd905pEEtLhl73jisr5cCs4Kfo28H3ftuP4B3M6Ww09yWMcxaTbTDPJyncmXXeGcU076ieDT4fDUr-u4U6mTFUBzHaBHlbDZOCLhXrBJ-l7CB1JddaYHg6Q4nZczIbs-dk9pwMEWbmNC99-j_g08ojmFnw9SCA-U27AMVUFyA58KGAm4zP4SX_f7KipIg</recordid><startdate>20210601</startdate><enddate>20210601</enddate><creator>MacIntosh, Beth A.</creator><creator>Ramsden, Christopher E.</creator><creator>Honvoh, Gilson</creator><creator>Faurot, Keturah R.</creator><creator>Palsson, Olafur S.</creator><creator>Johnston, Angela D.</creator><creator>Lynch, Chanee</creator><creator>Anderson, Paula</creator><creator>Igudesman, Daria</creator><creator>Zamora, Daisy</creator><creator>Horowitz, Mark</creator><creator>Gaylord, Susan</creator><creator>Mann, John D.</creator><general>Elsevier Ltd</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>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-0061-8586</orcidid><orcidid>https://orcid.org/0000-0002-4532-1532</orcidid><orcidid>https://orcid.org/0000-0001-5209-4625</orcidid></search><sort><creationdate>20210601</creationdate><title>Methodology for altering omega-3 EPA+DHA and omega-6 linoleic acid as controlled variables in a dietary trial</title><author>MacIntosh, Beth A. ; Ramsden, Christopher E. ; Honvoh, Gilson ; Faurot, Keturah R. ; Palsson, Olafur S. ; Johnston, Angela D. ; Lynch, Chanee ; Anderson, Paula ; Igudesman, Daria ; Zamora, Daisy ; Horowitz, Mark ; Gaylord, Susan ; Mann, John D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c455t-64d8d0962e8622aba99001955dd91585e4c43479bbc89e47a0fb9bc38a55f2a43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Chronic Pain - diet therapy</topic><topic>Diet</topic><topic>Docosahexaenoic Acids - administration & dosage</topic><topic>Double-Blind Method</topic><topic>Fatty Acids, Omega-3 - administration & dosage</topic><topic>Fatty Acids, Omega-6 - administration & dosage</topic><topic>Female</topic><topic>Fish</topic><topic>Humans</topic><topic>Linoleic acid</topic><topic>Male</topic><topic>Migraine headache</topic><topic>n-3</topic><topic>n-6</topic><topic>Polyunsaturated fatty acids</topic><topic>Research Design</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MacIntosh, Beth A.</creatorcontrib><creatorcontrib>Ramsden, Christopher E.</creatorcontrib><creatorcontrib>Honvoh, Gilson</creatorcontrib><creatorcontrib>Faurot, Keturah R.</creatorcontrib><creatorcontrib>Palsson, Olafur S.</creatorcontrib><creatorcontrib>Johnston, Angela D.</creatorcontrib><creatorcontrib>Lynch, Chanee</creatorcontrib><creatorcontrib>Anderson, Paula</creatorcontrib><creatorcontrib>Igudesman, Daria</creatorcontrib><creatorcontrib>Zamora, Daisy</creatorcontrib><creatorcontrib>Horowitz, Mark</creatorcontrib><creatorcontrib>Gaylord, Susan</creatorcontrib><creatorcontrib>Mann, John D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MacIntosh, Beth A.</au><au>Ramsden, Christopher E.</au><au>Honvoh, Gilson</au><au>Faurot, Keturah R.</au><au>Palsson, Olafur S.</au><au>Johnston, Angela D.</au><au>Lynch, Chanee</au><au>Anderson, Paula</au><au>Igudesman, Daria</au><au>Zamora, Daisy</au><au>Horowitz, Mark</au><au>Gaylord, Susan</au><au>Mann, John D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Methodology for altering omega-3 EPA+DHA and omega-6 linoleic acid as controlled variables in a dietary trial</atitle><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle><addtitle>Clin Nutr</addtitle><date>2021-06-01</date><risdate>2021</risdate><volume>40</volume><issue>6</issue><spage>3859</spage><epage>3867</epage><pages>3859-3867</pages><issn>0261-5614</issn><issn>1532-1983</issn><eissn>1532-1983</eissn><abstract>Increasing dietary intake of n-3 EPA+DHA and lowering dietary n-6 LA is under investigation as a therapeutic diet for improving chronic pain syndromes as well as other health outcomes. Herein we describe the diet methodology used to modulate intake of n-3 and n-6 PUFA in a free living migraine headache population and report on nutrient intake, BMI and diet acceptability achieved at week 16 of the intensive diet intervention and week 22 follow-up time-point.
A total of 178 participants were randomized and began one of three diet interventions: 1) a high n-3 PUFA, average n-6 PUFA (H3) diet targeting 1500 mg EPA+DHA/day and 7% of energy (en%) from n-6 linoleic acid (LA), 2) a high-n-3 PUFA, low-n-6 PUFA (H3L6) targeting 1500 mg EPA+DHA/day and <1.8 en% n-6 LA or 3) a Control diet with typical American intakes of both EPA+DHA (<150 mg/day) and 7 en% from n-6 LA. Methods used to achieve diet change to week 16 include diet education, diet counseling, supply of specially prepared foods, self-monitoring and access to online diet materials. Only study oils and website materials were provided for the follow-up week 16 to week 22 periods. Diet adherence was assessed by multiple 24 h recalls administered throughout the trial. Diet acceptability was assessed in a subset of participants at 4 time points by questionnaire.
At week 16 H3 and H3L6 diet groups significantly increased median n-3 EPA+DHA intake from 48 mg/2000 kcals at baseline to 1484 mg/2000 kcals (p < 0.0001) and from 44 mg/2000 kcals to 1341 mg/2000 kcals (p < 0.0001), respectively. In the Control group, EPA+DHA intake remained below the typical American intake with baseline median at 60 mg/2000 kcals and 80 mg/2000 kcals (p = 0.6) at week 16. As desired, LA intake was maintained in the H3 and Control group with baseline median of 6.5 en% to 7.1 en% (p = 0.4) at week 16 and from 6.5 en% to 6.8 en% (p = 1.0) at week 16, respectively. In the H3L6 group, n-6 LA decreased from 6.3 en% at baseline to 3.2 en% (p < 0.0001) at week 16. There were no significant changes in BMI or diet acceptability throughout the trial or between diet groups.
We find this diet method to be acceptable to research participants and successful in altering dietary n-3 EPA+DHA with and without concurrent decreases in n-6 LA. If n-6 LA of less than 3 en% is desired, additional techniques to limit LA may need to be employed.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>34130033</pmid><doi>10.1016/j.clnu.2021.04.050</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-0061-8586</orcidid><orcidid>https://orcid.org/0000-0002-4532-1532</orcidid><orcidid>https://orcid.org/0000-0001-5209-4625</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0261-5614 |
| ispartof | Clinical nutrition (Edinburgh, Scotland), 2021-06, Vol.40 (6), p.3859-3867 |
| issn | 0261-5614 1532-1983 1532-1983 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8293619 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Chronic Pain - diet therapy Diet Docosahexaenoic Acids - administration & dosage Double-Blind Method Fatty Acids, Omega-3 - administration & dosage Fatty Acids, Omega-6 - administration & dosage Female Fish Humans Linoleic acid Male Migraine headache n-3 n-6 Polyunsaturated fatty acids Research Design |
| title | Methodology for altering omega-3 EPA+DHA and omega-6 linoleic acid as controlled variables in a dietary trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-23T15%3A33%3A21IST&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=Methodology%20for%20altering%20omega-3%20EPA+DHA%20and%20omega-6%20linoleic%20acid%20as%20controlled%20variables%20in%20a%20dietary%20trial&rft.jtitle=Clinical%20nutrition%20(Edinburgh,%20Scotland)&rft.au=MacIntosh,%20Beth%20A.&rft.date=2021-06-01&rft.volume=40&rft.issue=6&rft.spage=3859&rft.epage=3867&rft.pages=3859-3867&rft.issn=0261-5614&rft.eissn=1532-1983&rft_id=info:doi/10.1016/j.clnu.2021.04.050&rft_dat=%3Cproquest_pubme%3E2541782643%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=2541782643&rft_id=info:pmid/34130033&rft_els_id=S0261561421002454&rfr_iscdi=true |