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Automated Enteropathy: Discovering the Potential of Machine Learning in Environmental Enteropathy
Wallach, Thomas
doi : 10.1097/MPG.0000000000003115
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 785-786
High-volume Plasmapheresis in Children With Acute Liver Failure: Another Brick in the Wall in the Current Management?
Grazioli, Serge?; Deep, Akash
doi : 10.1097/MPG.0000000000003134
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 786-787
Current Evidence on the Clinical Relevance of Donor-specific Antibodies in Paediatric Liver Transplantation
G?tz, Juliane K.?; Kiene, Hella?; Goldschmidt, Imeke?; Junge, Norman?; Pfister, Eva-Doreen?; Leiskau, Christoph?; Brown, Rachel M.‡,§; Immenschuh, Stephan†; Baumann, Ulrich?,||
doi : 10.1097/MPG.0000000000003127
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 788-793
The clinical impact of donor-specific antibodies (DSA) occurring before or after liver transplantation (LT) against donor-human leucocyte antigen (HLA) on graft outcome is still unclear. We aim to present the current consensus based on recent paediatric LT case series. Compared to kidney transplantation, the liver seems to be less susceptible to antibody-mediated graft damage, which is likely due to protective Kupffer cell activity. The incidence of DSA after liver transplantation is higher in children than in adults. DSA directed against HLA class II molecules, mainly DQ, occur more often. The presence of such anti-class II DSA (DQ/DR), especially of the complement-binding IgG3 subclass, may be associated with endothelial injury, T-cell-mediated rejection (TCMR), inflammation, and fibrosis. Regular DSA-posttransplant monitoring cannot as yet be recommended in routine practice but may be useful in selected cases.
Functional Fecal Incontinence in Children: Epidemiology, Pathophysiology, Evaluation, and Management
Rajindrajith, Shaman?; Devanarayana, Niranga Manjuri†; Thapar, Nikhil‡; Benninga, Marc Alexander
doi : 10.1097/MPG.0000000000003056
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 794-801
Functional fecal incontinence (FI) is a worldwide problem in children and comprises constipation-associated FI and nonretentive FI. Irrespective of pathophysiology, both disorders impact negatively on the psychological well-being and quality of life of affected children. A thorough clinical history and physical examination using the Rome IV criteria are usually sufficient to diagnose these conditions in most children. Evolving investigations such as high-resolution anorectal and colonic manometry have shed new light on the pathophysiology of functional FI. Although conventional interventions such as toilet training and laxatives successfully treat most children with constipation-associated FI, children with nonretentive FI need more psychologically based therapeutic options. Intrasphincteric injection of botulinum toxin, transanal irrigation and, in select cases, surgical interventions have been used in more resistant children with constipation-associated FI.
Non-invasive Predictors of Esophageal Varices With a High Risk of Bleeding in Pediatric Cirrhotic Patients
Lopes, José Ricardo Borém?; Ferreira, Alexandre Rodrigues?; Liu, Priscila Menezes Ferri?; Queiroz, Tha?s Costa Nascentes?; Fagundes, Eleonora Druve Tavares?; Pimenta, J?lio Rocha?; Neto, José Andrade Franco?; Carvalho, Simone Diniz?; Borges, Maria Eduarda Marques†; Colin, Lucas Garcia de Figueiredo†
doi : 10.1097/MPG.0000000000003039
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 802-806
To evaluate non-invasive predictive factors of varices with a high risk of bleeding in pediatric cirrhotic patients.
Severe Acute Respiratory Syndrome Coronavirus-2 Infection in Children With Liver Transplant and Native Liver Disease: An International Observational Registry Study
Kehar, Mohit?,†,‡; Ebel, Noelle H.‡; Ng, Vicky L.§; Baquero, Jairo Eduardo Rivera||; Leung, Daniel H.¶; Slowik, Voytek#; Ovchinsky, Nadia??; Shah, Amit A.††; Arnon, Ronen‡‡; Miloh, Tamir§§; Gupta, Nitika||||; Mohammad, Saeed¶¶; Kogan-Liberman, Debora??; Squires, James E.##; Sanchez, Maria Camila???; Hildreth, Amber†††; Book, Linda‡‡‡; Chu, Christopher§§§; Alrabadi, Leina§; Azzam, Ruba||||||; Chepuri, Bhavika§; Elisofon, Scott¶¶¶; Falik, Rachel##; Gallagher, Lisa###; Kader, Howard????; Mogul, Douglas††††; Mujawar, Quais‡‡‡‡; Namjoshi, Shweta S.§; Valentino, Pamela L.§§§§; Vitola, Bernadette||||||||; Waheed, Nadia¶¶¶¶; Zheng, Ming-Hua####; Lobritto, Steven?????; Martinez, Mercedes?????
doi : 10.1097/MPG.0000000000003077
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 807-814
Increased mortality risk because of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection in adults with native liver disease (LD) and liver transplant (LT) is associated with advanced age and comorbid conditions. We aim to report outcomes for children with LD and LT enrolled in the NASPGHAN/SPLIT SARS-CoV2 registry.
Seroprevalence of Hepatitis C in Children Without Identifiable Risk-Factors: A Systematic Review and Meta-Analysis
Melikoki, Vasiliki?; Kourlaba, Georgia†; Kanavaki, Ino‡; Fessatou, Smaragdi‡; Papaevangelou, Vassiliki‡
doi : 10.1097/MPG.0000000000003099
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p e140-e148
Hepatitis C virus (HCV) remains a major public health burden for >30 years since its discovery. It is estimated that >80 million people have been already infected. Direct-acting antiviral (DAA) treatment is now approved for young children over the age of 3 years. Treating children before the development of high-risk behaviors is optimal. Thus, assessing the current epidemiology of HCV in children becomes important and may promote awareness.
Safety of High-Volume Plasmapheresis in Children With Acute Liver Failure
J?rgensen, Marianne H?rby?; Rasmussen, Allan†; Christensen, Vibeke Brix?; Jensen, Anne-mette B?k‡; Fonsmark, Lise§; Andreassen, Bente Utoft?; Damholt, Mette Brimnes||; Larsen, Fin Stolze¶
doi : 10.1097/MPG.0000000000003108
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 815-819
Paediatric acute liver failure (P-ALF) is a rare condition and is associated with a high mortality rate. Management of P-ALF aims to stabilise vital organ functions and to remove circulating toxins and provide vital plasma factors that are lacking. High-volume plasmapheresis (HVP) removes protein-bound substances and improves survival in adult ALF. It is unknown if this effect can be extrapolated to P-ALF. The aim of this study is to report the safety and feasibility of HVP in P-ALF.
Long-term Morbidity of Choledochal Malformations in Children
Hyv?rinen, Ilona?; Hukkinen, Maria?; Kivisaari, Reetta†; Parviainen, Helka‡; M?kisalo, Heikki§; Koivusalo, Antti?; Pakarinen, Mikko?
doi : 10.1097/MPG.0000000000003054
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 820-825
The aim of the study was to assess long-term morbidity in children operated for choledochal malformation (CM) by relating clinical complications to liver histopathology, follow-up imaging, liver stiffness, and biochemistry.
Genetic Enteropathies Linked to Epithelial Structural Abnormalities and Enteroendocrine Deficiency: A Systematic Review
Caralli, Morgane?; Roman, Celine?; Coste, Marie-Edith?; Roquelaure, Bertrand?; Buffat, Christophe†,§; Bourgeois, Patrice‡,§; Badens, Catherine‡,§; Fabre, Alexandre?,‡
doi : 10.1097/MPG.0000000000003049
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 826-832
Congenital diarrhea and enteropathies linked to epithelial structural abnormalities constitute 3 different rare diseases: the tufting enteropathies (TE; EPCAM and SPINT2 mutations), microvillous inclusion disease (MVID; MYO5B and STX3 mutations), and tricho-hepato-enteric syndrome (THE; TTC37 and SKIV2L mutations). Moreover, enteroendocrine deficiencies (ED; PCSK1 and NEUROG3 mutations) share common clinical characteristics with TE, THE, and MVID in that the treatment requires, in most cases, long-term parenteral nutrition. Although numerous cases have been reported in the literature, aggregated data on morbidity and mortality are missing owing to the rarity of the diseases.
Artificial Intelligence-based Analytics for Diagnosis of Small Bowel Enteropathies and Black Box Feature Detection
Syed, Sana?,†; Ehsan, Lubaina?; Shrivastava, Aman?,‡; Sengupta, Saurav?,‡; Khan, Marium?; Kowsari, Kamran§,||; Guleria, Shan¶; Sali, Rasoul§; Kant, Karan‡; Kang, Sung-Jun‡; Sadiq, Kamran†; Iqbal, Najeeha T.†; Cheng, Lin#; Moskaluk, Christopher A.??; Kelly, Paul††,‡‡; Amadi, Beatrice C.††; Asad Ali, Syed†; Moore, Sean R.?; Brown, Donald E.§
doi : 10.1097/MPG.0000000000003057
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 833-841
Striking histopathological overlap between distinct but related conditions poses a disease diagnostic challenge. There is a major clinical need to develop computational methods enabling clinicians to translate heterogeneous biomedical images into accurate and quantitative diagnostics. This need is particularly salient with small bowel enteropathies; environmental enteropathy (EE) and celiac disease (CD). We built upon our preliminary analysis by developing an artificial intelligence (AI)-based image analysis platform utilizing deep learning convolutional neural networks (CNNs) for these enteropathies.
Measuring Gastric pH in Tube-fed Children With Neurologic Impairments and Gastroesophageal Disease
Tjon, James?,††; Cooper, Mitchell†; Pe, Michael‡; Boodhan, Sabrina?,††; Mahant, Sanjay§,||,‡‡,§§; Avitzur, Yaron¶,‡‡; Atenafu, Eshetu G.#; Moradipour, Tassnim??; Sepiashvili, Lusia||||,¶¶; Cohen, Eyal§,||,‡‡,§§
doi : 10.1097/MPG.0000000000003087
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 842-847
The aim of the study was to determine the extent of agreement between pH paper and handheld pH meter with a laboratory pH meter for gastric pH measurement in children with neurologic impairments and gastrostomy tubes who have gastroesophageal reflux disease (GERD).
Clinical Characterization of Pediatric Gastroparesis Using a Four-hour Gastric Emptying Scintigraphy Standard
Wolfson, Sharon?; Wilhelm, Zoe†; Opekun, Antone R.†,‡; Orth, Robert§; Shulman, Robert J.‡,||; Chumpitazi, Bruno P.‡,||
doi : 10.1097/MPG.0000000000003089
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 848-853
Four-hour gastric emptying scintigraphy (GES) is the recommended method to identify both adult and childhood gastroparesis (GP). Previous pediatric studies have, however, not used this standard. We sought to determine the characteristics and outcomes of children versus adolescents with GP using the 4-hour GES evaluation.
Clinical and Esophagogastroduodenoscopy Findings in Pediatric Patients With Severe Obesity Evaluated Before Bariatric Surgery
Sivan, Rachel Frenklak?,†; Bar Lev, Michal Rozenfeld?; Silbermintz, Ari?; Mozer-Glassberg, Yael?,†; Seguier-Lipzyc, Emmanuelle‡; Shalitin, Shlomit†,§; Stafler, Patrick†,||; Tiroler, Simona‡; Shamir, Raanan?,†; Waisbourd-Zinman, Orith?,†
doi : 10.1097/MPG.0000000000003109
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 854-858
Severe obesity in the pediatric population has lifelong consequences. Bariatric surgery has been suggested for selected adolescents with severe obesity after careful evaluation. The indications for preoperative esophagogastroduodenoscopy (EGD) in this age group are not clear, despite its established usefulness in adults. We aimed to assess the usefulness of EGD before bariatric surgery in pediatric patients with severe obesity and metabolic comorbidities.
Markers of Bile Acid Metabolism in Pediatric Diarrhea Predominant Irritable Bowel Syndrome and Healthy Controls
Beinvogl, Beate C.?; Manini, Mhd Louai†; Camilleri, Michael‡; Donato, Leslie J.§; Harmsen, William Scott||; Absah, Imad†; Burch, Elizabeth?; Schechter, Neil L.¶; Nurko, Samuel?
doi : 10.1097/MPG.0000000000003067
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 859-865
Excessive fecal bile acids in adults have been associated with diarrhea-predominant irritable bowel syndrome (IBS-D), but their role in pediatric IBS-D is unknown. Serum markers including 7?-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor-19 (FGF-19) were validated in adults to detect bile acid diarrhea (BAD) compared to 48-hour fecal bile acid collection (48FBA). Our aims were to assess fasting serum C4 and FGF–19 and 48FBA in a pediatric population, to compare measurements in IBS-D patients and healthy controls (HC), and to determine the prevalence of BAD among children with IBS-D.
Therapeutic Drug Monitoring of Adalimumab During Long-term Follow-up in Paediatric Patients With Crohn Disease
Kim, Mi Jin?; Kim, Eunsil?; Kang, Ben†; Choe, Yon Ho?
doi : 10.1097/MPG.0000000000003070
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 870-876
We investigated the therapeutic drug monitoring of adalimumab (ADL) on clinical remission (CR) and mucosal healing (MH) rates in paediatric patients with Crohn disease (CD). Furthermore, long-term treatment efficacy of ADL in paediatric CD was evaluated through 3-year follow-up.
The Effect of Nutritional Therapy on Bone Mineral Density and Bone Metabolism in Pediatric Crohn Disease
Lev-Tzion, Raffi?; Ben-Moshe, Tehila?; Abitbol, Guila?; Ledder, Oren?,†; Peleg, Sarit‡,§; Millman, Peri||; Shaoul, Ron§,¶; Kori, Michal#; Assa, Amit??,††; Cohen, Shlomi††,‡‡; Strich, David?,†; Revel-Vilk, Shoshana?,†; Tiomkin, Maayan?; Levine, Arie††,§§; Sigall Boneh, Rotem††,§§; Turner, Dan?,†
doi : 10.1097/MPG.0000000000003073
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 877-882
Both the inflammatory burden of Crohn disease (CD) and corticosteroids have a negative effect on bone density. Exclusive enteral nutrition (EEN) avoids corticosteroids and promotes endoscopic healing. We aimed to explore the effect of nutritional therapy on bone health in pediatric CD.
Sarcopenia is a Predictor for Adverse Clinical Outcome in Pediatric Inflammatory Bowel Disease
Atlan, Lilian?; Cohen, Shlomi†; Shiran, Shelly?; Sira, Liat Ben?; Pratt, Li-Tal?; Yerushalmy-Feler, Anat†
doi : 10.1097/MPG.0000000000003091
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 883-888
Inflammatory bowel disease (IBD) has a high impact on nutritional status. Sarcopenia is related to higher risk of surgery and rescue therapy in adults with IBD; however, comparable data in pediatric populations are scarce. We evaluated muscle mass as a predictor of disease outcome in pediatric IBD.
Celiac Disease Management in the United Kingdom Specialist Pediatric Gastroenterology Centers—A Service Survey
Paul, Siba Prosad?; Balakumar, Varathagini†; Gillett, Peter Michael‡
doi : 10.1097/MPG.0000000000003126
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p e149-e153
The 2012 European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines on celiac disease (CD) recommended a no-biopsy pathway (NBP) for symptomatic children with high immunoglobin A (IgA)-based anti-tissue transglutaminase (TGA-IgA) titers, positive anti-endomysial antibody and human leukocyte antigen (HLA)-DQ2/DQ8 status. We aimed to understand variations in practice amongst specialist pediatric gastroenterology centers (SPGIC) in the United Kingdom (UK).
Low-Risk Human Leukocyte Antigen Genes and Mild Villous Atrophy Typify Celiac Disease With Immunoglobulin A Deficiency
Schirru, Enrico?; Jores, Rita Désirée‡; Rossino, Rossano§; Corpino, Mara†; Cucca, Francesco||,¶; Congia, Mauro†,¶
doi : 10.1097/MPG.0000000000003129
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 889-893
We aimed to establish if in celiac disease (CD) with immunoglobulin A deficiency (IgAD) duodenal histopathology is influenced by human leukocyte antigen (HLA)-DQB1?02 alleles dosage. Clinical differences between patients with CD and patients with CD and IgAD (CD-IgAD) were also evaluated.
Age-Dependent Trends in the Celiac Disease: A Tertiary Center Experience
Krauthammer, Alexander?,†; Guz-Mark, Anat?,†; Zevit, Noam?,†; Marderfeld, Luba?,‡; Waisbourd-Zinman, Orith?,†; Silbermintz, Ari?; Mozer-Glassberg, Yael?; Nachmias Friedler, Vered?; Rozenfeld Bar Lev, Michal?; Matar, Manar?; Assa, Amit?,§; Shamir, Raanan?,†
doi : 10.1097/MPG.0000000000003130
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 894-899
Celiac disease (CD) is a common intestinal autoimmune disorder with diverse presenting features. We aimed to determine age-dependent patterns in CD presentation, diagnosis and management at a large tertiary referral center.
Nutritional Therapy in Children With Spinal Muscular Atrophy in the Era of Nusinersen
Yerushalmy-Feler, Anat?; Levy, Dina?,†; Sagi, Liora‡; Fattal-Valevski, Aviva‡; Shiff, Yaffa Elbaum?,†; Brener, Avivit§; Cohen, Shlomi?
doi : 10.1097/MPG.0000000000003055
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p e154-e160
Spinal muscular atrophy (SMA) is a genetic motor neuron disorder characterized by progressive muscle atrophy. Our aims were to evaluate the impact of nutritional intervention and nusinersen therapy on the nutritional status of SMA patients.
Neurotrophic Factors in Human Milk in Early Lactation and the Effect of Holder and Microwave Pasteurization on Their Concentrations
Martysiak-?urowska, Dorota?; Puta, Ma?gorzata?; Kie?bratowska, Bogumi?a†; Weso?owska, Aleksandra‡
doi : 10.1097/MPG.0000000000003071
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 900-905
The objective of this study was to determine the level of brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) in human milk in the first 2 weeks of breast-feeding and compare the effects of Holder pasteurization (HoP, 62.5 °C, 30 minutes) and microwave pasteurization (MP) at constant temperature (62.5 °C) on the concentraion of both neurotrophic factors (NFs).
Long-Term Results of Laparoscopic Adjustable Gastric Banding in French adolescents: The Utmost Importance of Follow-Up
Yska, Hemmo A.F.?; Khen-Dunlop, Naziha†; Lacaille, Florence?; Dabbas, Myriam?
doi : 10.1097/MPG.0000000000003092
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 906-911
To investigate the long-term follow-up (FU) and effectivity of laparoscopic adjustable gastric banding (LAGB) in a French adolescent cohort.
Influence of Family History on Children With Irritable Bowel Syndrome
Fu, Yinan?; Thomas, Ron†; Cares, Kristen‡
doi : 10.1097/MPG.0000000000003059
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 866-869
The influence of family history on children with irritable bowel syndrome (IBS) is unknown. We conducted a retrospective study to compare the clinical profile and management differences between children with a family history of IBS (FH-IBS) versus without. A total of 251 children were included in the study, 75 (30%) had FH-IBS and 176 (70%) did not. No significant differences were observed between the 2 groups in sex composition, age at initial visit, age of IBS diagnosis, dietary modifications, supplements, laxatives, antispasmodics, antidiarrheals, and cyproheptadine use. Children with FH-IBS were, however, more like to have psychological comorbidities (41% vs 23%, P = 0.003), and were more likely to receive psychological counseling (49% vs 23%, P < 0.001) and antidepressant treatment (36% vs 15%, P < 0.001) versus children without. We concluded that children with FH-IBS are more likely to have underlying psychological disorders and receive psychological interventions.
Reference Values Matter: Fewer Patients With Malnutrition Using American Compared to More Recent German Growth Charts
Ellemunter, Helmut?; Dumke, Markus†; Steinkamp, Gratiana?,‡
doi : 10.1097/MPG.0000000000003095
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p 912-915
Reference values are important for patient care as well as for comparisons between different centers or countries. We investigated two anthropometric reference datasets, the US Centers for Disease Control (CDC) growth charts and the German Health Interview and Examination Survey for Children and Adolescents Study (KiGGS) percentiles, which were established in Germany between 2003 and 2006. A smaller proportion of children with cystic fibrosis had decreased z scores <?2 with CDC (5.0% for weight and 3.0% for height) compared to KiGGS (7.4% for weight and 6.3% for height) values (P < 0.0001). Median z scores were higher using the CDC reference data. Thus, the choice of growth reference is important, may influence clinical management and must be considered when comparing the outcomes of different institutions.
Glycogenic Acanthosis in a Child Diagnosed With Eosinophilic Esophagitis
Gonzalez Alvarez, Pablo?; Lozano-Ruf, Ana?; Martos, Raquel Lopez†; Querol, Montserrat Montraveta?
doi : 10.1097/MPG.0000000000003080
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p e161
Double Superior Vena Cava in Alagille Syndrome: Left is Not The Right Choice
Menon, Jagadeesh?; Shanmugam, Naresh?; Patel, Kinisha?; Kalyanasundaram, Srinivasan†; Kumar, Narendra‡; Rela, Mohamed§
doi : 10.1097/MPG.0000000000003081
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p e161
Prokinetics in Childhood Gastroesophageal Reflux Disease: Are They Indicated?
Bolia, Rishi?; Shrivastava, Yash†
doi : 10.1097/MPG.0000000000003083
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p e162
Prokinetics in Childhood Gastroesophageal Reflux Disease: Are They Indicated?
O’Donnell, Jonathan?,†; Krishnan, Usha?,†
doi : 10.1097/MPG.0000000000003084
Journal of Pediatric Gastroenterology and Nutrition: June 2021 - Volume 72 - Issue 6 - p e162-e163
