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Palm Oil:Palm Oil:...Health and Nutritional Benefits...Health and Nutritional Benefits
Pramod Khosla, PhD
Associate Professor,
Dept. of Nutrition & Food Science,
Wayne State University,
Detroit, MI 48202
Chronic Disease
Cardiovasculardisease
Cancer
Diabetes
Osteoporosis
Hypertension
ExerciseFat Quality
Low calories: More fiber, grains, vegs. More fruits
Lower sodium
Increased calcium
Control CHO &energy intake
Cognitive dec ??????????????
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� No smoking
� Maintain a healthy body weight
� Low to moderate intensity exercise 30-45 mins/day
Diet and Lifestyle changesDiet and Lifestyle changes� Fat quality
� Protein quality
� Fiber
� Antioxidants
� Phytochemicals
� Carbohydrate type
� Alcohol
DIETARY DIETARY FAT
Per Capita Fat Consumption Per Capita Fat Consumption -- g/dayg/day
0
10
20
30
40
50
60
70
80
90
100
Afr
ica
Asia
CA
mer
ica
SAm
eric
a
REuro
pe
Oce
ania
NA
mer
ica
EU
15
Source : FAO websiteSource : FAO website
WHO recommendationWHO recommendation
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RISK FACTORS FOR CHD RISK FACTORS FOR CHD RISK FACTORS FOR CHD RISK FACTORS FOR CHD
� Gender
� Increasing age
� Genetics: Family history of CHD
� High TC, LDL-C
� Low HDL-C
� Smoking
� Diabetes
� Obesity
DIET
Fat quality
Protein quality
Fiber
Antioxidants
Phytochemicals
Carbohydrate type
Alcohol
Dietary fat composition: by fatty acid classesDietary fat composition: by fatty acid classes
0
10
20
30
40
50
60
70
80
90
100
Fatty Acid Classes ,%
SFA
AAD34%en15:12:7P/S 0.4
Coco PKO MilkF CoButt Tallow Pstear Palm POlein Lard Chick Olive hiOsun Canola Soyb Corn Saff
TFA
MUFA
PUFA
PUFA
MUFA
SFA
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What about trans fatty acids?What about trans fatty acids?
•Unsaturated fatty acids - at least one trans double bond
•Partial hydrogenation of polyunsaturated oils - isomerization and migration of double bonds - distribution of cis and transdouble bonds (margarines, shortenings, salad & cooking oils)
•Partial hydrogenation����tFA. Full hydrogenation ���� SFA
•Major tFA - elaidic acid (t9 - 18:1)
•Dairy and meats have t9 - 16:1 and t11 - 18:1 (vaccenic acid)
…what are the effects of fatty acid …what are the effects of fatty acid classes on lipoprotein cholesterol? classes on lipoprotein cholesterol?
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-0.02
0
0.02
0.04
LDL
S
cM
P
tM
0
0.02
0.04
HDL
S
cM
P
tM
-0.04-0.02
00.020.04
TC/HDL
S
cM
P
tM
Changes shown in mmol/L for LDL and HDL. Adapted from Mensink et al Am J Clin Nutr Changes shown in mmol/L for LDL and HDL. Adapted from Mensink et al Am J Clin Nutr (2003) 77: 1146(2003) 77: 1146--11551155
MUFA & PUFA best.MUFA & PUFA best.Trans worse than SFATrans worse than SFA
CHO CHO �������� FAFA
-0.06
-0.04
-0.02
0
S cM P
-0.04
-0.02
0
0.02
S S cMcM P P tFAtFA
tFA tFA �������� FAFA
Effects on the TC/HDLEffects on the TC/HDL--C ratioC ratio
Am J Clin Nutr (2003) 77: 1146Am J Clin Nutr (2003) 77: 1146--11551155 N Engl J Med (2006) 344: 1601N Engl J Med (2006) 344: 1601--16131613
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Ascherio et al, (1999 N Engl J Med 340: 1994-1998 55
TC/HDLTC/HDL--C adversely affected by the C adversely affected by the trans..trans..
Diet
a
1 2 3 4 5 6 7 8 9 10 11
TransPalmitate
0
20
40
60
80
100
120
140
-20
-10
0
10
20
% t
ran
sfer
(c.
f. c
on
trol)
16:0 Trans
p = 0.03
Khosla et al, (1997)
trans lowers HDLtrans lowers HDL--CC
trans increases TC/ HDLtrans increases TC/ HDL--C ratioC ratio
trans increases CETPtrans increases CETP
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…so what about effects on CVD? …so what about effects on CVD?
Dietary Fat intake and Risk of CHD and Type II Dietary Fat intake and Risk of CHD and Type II Diabetes (TIID) in WomenDiabetes (TIID) in Women
CHD data - Hu et al, (1997) N Engl J Med, 337: 1491-1499
Type II Diabetes data - Salmeron et al, (2001) Am J Clin Nutr 73: 1019-1026
Effects of replacing 5%en from carbohydrates with specific fatty acidsEffects of replacing 5%en from carbohydrates with specific fatty acids
Effects of replacing 2%en from carbohydrates with trans fatty acidsEffects of replacing 2%en from carbohydrates with trans fatty acids
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-30
-20
-10
0
10
20
30
40
50
60
SFA MUFA PUFA tFA
1
2
3
4
5
from Oh et al (2005) Am J Epidemiol, 161: 672-679
1.6 to 2.8% en4.1 to 7.4% en12 to 18% en
Relative risk of CHD based on quintiles of dietary fatty acid intake Relative risk of CHD based on quintiles of dietary fatty acid intake (Multivariate analyses) (Multivariate analyses)
20 year follow20 year follow--up data from the Nurses Health Studyup data from the Nurses Health Study
Beneficial effects with PUFABeneficial effects with PUFA
Adverse effects with tFAAdverse effects with tFA
• Pooled analysis of 11 studies. 4-10 year follow-up
• Pooled RR evaluated in 344, 696 subjects (5, 249 coronary events, 2155 coronary deaths)
• Effect of 5% lower energy intake from SFA with a simultaneous higher energy intake from PUFA, carbs or MUFA is shown for coronory events and coronory deaths
Jakobsen et al , (2009) Am J Clin Nutr 89: 1425 - 1432
0
0.2
0.4
0.6
0.8
1
1.2
1.4
PUFA Carbs MUFA
Replacing SFA with different fatty acids or carbohydratesReplacing SFA with different fatty acids or carbohydrates
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• Prospective cohort study. Median 12 year follow-up
• Hazard Ratio evaluated in 53, 644 subjects [1, 943 cases of incident myocardial infarction (MI)]
• For a 5% lower energy intake from SFA with a simultaneous higher energy intake from carbs with different GI values
• Singificant association with high GI carbs
Exchanging 5% calories from SFA with Exchanging 5% calories from SFA with carbscarbs of different GI valuesof different GI values
Jakobsen et al , (2009) Am J Clin Nutr 89: 1425 - 1432
MichaMicha and and MozaffarianMozaffarian, (2010) Lipids. 45: 893, (2010) Lipids. 45: 893--905905
Predicted effects are based on changes in the TC:HDL-C ratio
Evidence from a meta-analysis of eight randomized controlled trials
Evidence for observed relationships of usual dietary habits with CHD events comes from a
pooled analysis of 11 prospective cohort studies.
Effects on CHD risk of consuming PUFA, carbs , or MUFA in place of SFA
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MetaMeta--analysis of 21 prospective epidemiologic studies showed no analysis of 21 prospective epidemiologic studies showed no significant evidence for concluding SFA are associated with increased significant evidence for concluding SFA are associated with increased CHD riskCHD risk
• 5-23 year follow-up
• Pooled RR evaluated in 347, 747 subjects (11, 006 developed CHD or stroke)
• SFA intake was not associated with
CHD (Pooled RR – 1.07; 95% CI 0.96 – 1.19, p=0.22)
Stroke (Pooled RR - 0.81; 95% CI 0.62 – 1.05, p=0.11)
CVD – (Pooled RR - 1.00; 95% CI 0.89 – 1.11, p=0.95)
Siri-Tarino et al , (2010 ) Am J Clin Nutr 91: 535 – 546
Association of Dietary, Circulating, and Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk:Supplement Fatty Acids With Coronary Risk:A Systematic Review and MetaA Systematic Review and Meta--analysisanalysis
Chowdhury et al, (2014) Ann Int Med 160: 398-406
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Date of download: 3/18/2014
Copyright © American College of Physicians. All rights reserved.
Figure Legend:
Dietary Fatty Acids and CHD: Summary of the EvidenceDietary Fatty Acids and CHD: Summary of the Evidence
C = Convincing evidence; P = Probable evidence; NR C = Convincing evidence; P = Probable evidence; NR –– no relation; no relation; RedRed denotes denotes increased risk while increased risk while GreenGreen denotes decreased riskdenotes decreased risk
Fatal CHD CHD events
Total Fat C-NR C-NR
TFA P C
SFA/CHO P-NR P-NR
MUFA/SFA
PUFA/SFA C C
Linoleic acid
Alpha Linolenic
n3 LCPUFA P C
Skeaff and Miller , (2009) Ann. Nutr. Metab. 55: 173Skeaff and Miller , (2009) Ann. Nutr. Metab. 55: 173--201201
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…what about individual saturated FA? …what about individual saturated FA?
Dietary fats comprised of individual fatty acids Dietary fats comprised of individual fatty acids –– especially important for SFAespecially important for SFA
0
10
20
30
40
50
60
70
80
90
100
Fatty Acid Classes
16:0
AAD34%en15:12:7P/S 0.4
Coco PKO MilkF CoaBut Tallow Pstear Palm pOle Lard Chick Olive hiOsun Canola Soyb Corn Saff
18:0
C18:1
18:2
18:3
t18:1
10:06:0+ 8:0
12:0
14:0
16:1
10/2510/25
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Effects of individual SFA on lipoprotein cholesterolEffects of individual SFA on lipoprotein cholesterol
-0.020
0.020.040.06
LDL
L
M
P
S
0
0.02
0.04
0.06
HDL
L
M
P
S
-0.04
-0.02
0
0.02
TC/HDL
L
M
P
S
Changes shown in mmol/L for LDL and HDL. Adapted from Mensink et al Am J Clin Nutr Changes shown in mmol/L for LDL and HDL. Adapted from Mensink et al Am J Clin Nutr (2003) 77: 1146(2003) 77: 1146--11551155
14:0, 16:0 no effect14:0, 16:0 no effect18:0, 12:0 beneficial18:0, 12:0 beneficial
• The global importance of palm oil
• Effects of palm oil on the ration of TC/HDL-C…
• Replacement for trans fatty acids
• Variety of carotenoids - pro Vitamin A
• Vitamin E (tocopherols and tocotrienols)
Nutritional attributes of Palm Oil and Nutritional attributes of Palm Oil and Palm Palm OleinOlein
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…the global importance of palm oil? …the global importance of palm oil?
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Soybean
oil
Palm oil Rapeseed
oil
Sunflower
oil
Animal
Fats
Laurics Others
33.3 33.5
16.0
9.7
23.3
7.0
16.6
million
to
nne
s
Soybean40%
Palm
4%
Rapeseed
12%Sunflower10%
Coconut
4%
Others
30%
Total Area
Soybean29%
Palm 29%
Rapeseed14%
Sunflower8%
Laurics6%
Others14%
Total Vegetable Oil Output
0
0.5
1
1.5
2
2.5
3
3.5
4
SBOSunflO
RapSO
Tonnes/hectare/year
Soybean oil18%
Palm oil52%
Rapeseed oil3%
Sunflower oil8%
Animal Fats7%
Laurics8%
Others4%
Global ExportsGlobal Exports
Others
Taiwan
Nigeria
Russia
South Korea
South Africa
Turkey
Japan
Mexico
Bangladesh
Iran
Pakistan
N Africa
India
EU-27
China PR
(x
100
0
ton
Net Importers
Net Exporters
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…effects of palm oil on the ratio of TC/HDL…effects of palm oil on the ratio of TC/HDL--C? C?
Palm Olein and MUFAPalm Olein and MUFA--rich Oils exert similar effects on the ratio of rich Oils exert similar effects on the ratio of Total cholesterol to HDL cholesterol (TC/HDLTotal cholesterol to HDL cholesterol (TC/HDL--C) in human subjectsC) in human subjects
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Palm oil and blood lipid related markers Palm oil and blood lipid related markers of cardiovascular disease: a systematic of cardiovascular disease: a systematic
review and metareview and meta--analysis of dietary analysis of dietary intervention trialsintervention trials
FattoreFattore et al, , (2014) Am J. et al, , (2014) Am J. ClinClin NutrNutr. . doidoi: 10.3945/ajcn.113.081190: 10.3945/ajcn.113.081190
• 51 studies; 1526 volunteers (2/3 men); ages 16-70 y
• Studies from Australia, Canada, China, Denmark, Finland, France, India, Malaysia, Netherlands, Norway, Scotland, South Africa, Spain, Thailand, USA
• Feeding times 2 to 16 wks
• Studies in healthy volunteers who were normocholesterol-emic, hypercholesterolemic as well as n/h subjects
• Dietary fat content 28% to 53% of total calories (test fat 4% to 43% of total calories)
Synopsis of metaSynopsis of meta--analysisanalysis
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TC LDL VLDL apoB HDL ApoAI TG Lp(a) LDL / HDL
TC / HDL
Stearic I I N I I I N N I N
Lauric + Myristic
D N N N D D N N N
MUFA I I N I I N N N N N
PUFA I N N I I I N N N N
transFA N N N D I I D N N D
Effects on plasma lipoproteins of substituting various fatty acids with palm oil
I- increase, D – decrease and N – no significant change
Adpated from Fattore et al, (2014). Am J Clin Nutr 99: 1331-1350
…palm oil as a replacement for trans fat? …palm oil as a replacement for trans fat?
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……. ……. practical aspectspractical aspects
SFA vs tFA– not a realistic comparison
Look at specific fats/oils replacing
PHVO containing tFA
CHD risk based not just on changes
in plasma lipoproteins.
Report of Mozaffarian and Clarke (2009)
is of interest
Also risk assessment papers
(Barraj et al 2008, Mente et al 2009)
…so how much palm oil …so how much palm oil in the diet? in the diet?
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conservative conservative ---- based on current recommendations for based on current recommendations for restricting SFArestricting SFA----can calculate the amount of palm oil in a can calculate the amount of palm oil in a prudentprudent diet that satisfies various dietary guidelinesdiet that satisfies various dietary guidelines
Khosla (2006) J Agro Food Ind. 17: 21-23 Hayes and Khosla, Eur J Lipid Sci Tech (2007) 109: 453-464
…can readily replace trans by blending …can readily replace trans by blending palm with local vegetable oils? palm with local vegetable oils?
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Dietary fat composition: by fatty acid classesDietary fat composition: by fatty acid classes
0
10
20
30
40
50
60
70
80
90
100
SFA
AAD34%en15:12:7P/S 0.4
Coco PKO CoButt Pstear Palm Polein Olive Sun Canola Soy Corn Saff
TFA
MUFA
PUFA
““““RD””””30%en
10:10:10P/S 1.0
Dietary fat composition: by fatty acid classesDietary fat composition: by fatty acid classes
0
10
20
30
40
50
60
70
80
90
100
SFA
TFA
MUFA
PUFA
Coco PKO CoButt Pstear Palm Polein Olive PO/SBO Canola Soy Corn SaffAAD
34%en15:12:7P/S 0.4
““““RD””””30%en
10:10:10P/S 1.0
Palm/Soy 1:1 mixPalm/Soy 1:1 mix
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• The global importance of palm oil
• Effects of palm oil on the ration of TC/HDL-C…
• Replacement for trans fatty acids
• Variety of carotenoids - pro Vitamin A
• Vitamin E (tocopherols and tocotrienols)
Nutritional attributes of Palm Oil and Nutritional attributes of Palm Oil and Palm OleinPalm Olein
““““““““Vitamin AVitamin A”””””””” activity of red palm oilactivity of red palm oilRE
Per 100 g
Relative quality
(Times <red palm oil
Red Palm Oil
30,000 -
Carrots 2,000 15
Leafy Vegetables
685 44
Apricots 250 120
Tomatoes 100 300
Bananas 30 1000
Orange Juice
8 3,750
Phytoene 2.0%
Phytofluene 1.2%
Cis-β- Carotene 0.8%
β – Carotene 47.4%
α- Carotene 37.0%
Cis- α- Carotene 6.9%
ζ- Carotene 1.3%
δ - Carotene 0.6%
γ - Carotene 0.5%
Neurosporene Tr
β - Zeacarotene 0.5%
α - Zeacarotene 0.3%
Lycopene 1.5%
Numerous human studies showing efficacy Numerous human studies showing efficacy of red palm oilof red palm oil in fighting Vitamin A deficiencyin fighting Vitamin A deficiency
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…studies have adopted different methods to provide Vitamin A naturally…studies have adopted different methods to provide Vitamin A naturally
� Children fed traditional Indian sweets made with redPO
� School children fed biscuits baked with redPO
� School children given 5 – 10 mL redPO daily
� Cooking green leafy vegetables in redPO
� Also Vitamin A status improved by feeding redPO to pregnant mothers at various stages of pregnancy.
� Also lactating mothers
Numerous human studies showing efficacy of Numerous human studies showing efficacy of red palm oil red palm oil in fighting Vitamin A deficiencyin fighting Vitamin A deficiency
• The global importance of palm oil
• Effects of palm oil on the ration of TC/HDL-C…
• Replacement for trans fatty acids
• Variety of carotenoids - pro Vitamin A
• Vitamin E (tocopherols and tocotrienols)
Nutritional attributes of Palm Oil and Nutritional attributes of Palm Oil and Palm OleinPalm Olein
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• Variety of carotenoids (Vitamin A)
• Vitamin E (tocopherols and tocotrienols)
Nutritional attributes of PNutritional attributes of Palm Oil & Palm alm Oil & Palm OleinOlein
Oil Tocopherols(ppm)
αT βT γT δT
Tocotrienols(ppm)
αT3 βT3 γT3 δT3
Ppm
T+T3
Red Palm Oil 152 - - - 205 - 439 94 890
Soyabean 101 - 593 264 985
Cornoil 112 50 602 18 782
Groundnut 130 - 216 21 367
Safflower 387 - 174 240 801
Sunflower 487 - 51 8 546
Numerous in vitro studies showing efficacy of Numerous in vitro studies showing efficacy of tocotrienolstocotrienols in inhibiting in inhibiting cancer cellcancer cell proliferation proliferation and decreasingand decreasing neurodegenerationneurodegeneration. .
A pilot human breast cancer clinical trial was A pilot human breast cancer clinical trial was not definitivenot definitive
A series of studies show efficacy A series of studies show efficacy against lung cancer against lung cancer and Phase I and Phase I human studies are the next logical stephuman studies are the next logical step
Ongoing human Ongoing human stroke prevention stroke prevention trial is recruiting subjects. An earlier trial is recruiting subjects. An earlier study from our lab helped establish the dosestudy from our lab helped establish the dose
Evidence that Evidence that tooctrienolstooctrienols may lower blood lipids may lower blood lipids –– and possible and possible synergy with synergy with statinstatin drugs has been suggested??drugs has been suggested??
Recent Recent Phase I study Phase I study in dialysis patients from in dialysis patients from our laboratoryour laboratory. .
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TocotrienolTocotrienol effects on white matter lesionseffects on white matter lesions
Mean white matter lesion volume -change from baseline of tocotrienol and placebo treated groups (1 and 2 yrs)
Gopalan et al. Stroke, 2014
⬇Renal Function Dialytic Factors Co-morbidities
↓Clearance of cytokine↑of uremic toxins
BioincompatibilityVascular access
Protein catabolizers
Chronic infectionsDiabetes mellitus
Congestive heart failure
Inflammation
PEW
Anorexia
CVD
OxidativeStress
↓protein & energy↓antioxidant intake
Adapted from: Ikizler et al 2004; Libetta et al 2011
⬆ Energy expenditure
Pathophysiology of Pathophysiology of CVD in CKD/ESRDCVD in CKD/ESRD
Dyslipidemia
Delayed catabolism of TG-rich lipoprotein
↓ HDL
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Screened for eligibility(n=118)
Screened for eligibility(n=118)
Randomization(n=81)
Randomization(n=81)
Excluded (n=37)Did not met inclusion criteria
(n=30)Declined to participate (n=7)
Allocated to TRF(n=41)
Allocated to TRF(n=41)
Allocated to Placebo(n=40)
Allocated to Placebo(n=40)
Analyzed(n=37)
Analyzed(n=37)
Analyzed(n=40)
Analyzed(n=40)
Died (n=1) (Cardiac arrest)Underwent transplantation (n=1)
Excluded (catheter dysfunction) (n=1) Week 1
Week 3
1 pt c/o diarrhea – but willing to continue the study
Baseline
Week 12
Week 8
Week 12 Died (n=1) (Cardiac arrest)
Week 16
Daud et al. Vasc. Health Risk Manag, 2013
Exclusion criteria:< 3 months on HD treatment
< 18 years old
Vit. E supplement
Stay in nursing home
On interdialytic PN
Lipid changes during the course of the study
*P<0.05(P=0.07)-60
-50
-40
-30
-20
-10
0
10
20
30
Placebo TRF
Daud et al. Vasc. Health Risk Manag, 2013
*
p<0.001
*p<0.05
0
5
10
15
20
25
30
Week-8 Week-12 Week-16
Triglyceride HDL-cholesterol
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Oil Palm Oil Palm PhenolicsPhenolics –– the exciting future the exciting future
Oil palm fruit Oil palm fruit –– water soluble water soluble phenolicsphenolics -- scaled production scaled production
First First nutritionnutrition studies reported starting in 2011studies reported starting in 2011
NeuroprotectiveNeuroprotective, anti, anti--atherogenicatherogenic, anti, anti--diabetic and antidiabetic and anti--cancer cancer effectseffects
SummarySummary
Diet and Lifestyle changes – first line of defense – can have profound effect on chronic disease (prevention)
Alcohol, smoking and lack of physical activity – major drivers
Numerous dietary changes shown to be effective
Palm Oil – serves a multitude of nutritional needs
Supply of palm oil makes it the important player globally and is an important factor in global food security
Fatty acid profile of palm eliminates need for hydrogenation
Minor components (antioxidant/phytochemicals) help alleviate micronutrient deficiencies using food-based approach AND show promise for preventative route in certain chronic disease
Additional details: J. Am. Coll. Nutr. (2010), 29 (3S) 237-340