15 research outputs found

    Development of a non-dairy probiotic fermented product based on almond milk and inulin

    Full text link
    A new fermented almond milk that combined the properties of both almonds and probiotics was considered to cover the current versatile health-promoting foods' demand. Almond milk fermentation with probiotic Lactobacillus reuteri and Streptococcus thermophilus was studied by using a Central Composite design with response surface methodology, and different factors (glucose, fructose, inulin and starters) were optimised to assure high probiotic survivals in the final product. The optimal formulation was physicochemically characterised throughout cold storage (28 days) and both probiotic survivals to invitro digestion and proteolysis were quantified. Results showed that a high probiotic population (>10(7) cfu/mL) was obtained in the previously optimised almond milk throughout storage time, which correspond to the addition of 0.75g of glucose/100mL, 0.75g of fructose/100mL, 2g/100mL inulin and 6mL/100mL inoculum. Glucose was used as the main nutrient and the production of mannitol by L. reuteri was detected. The fermentation process increased the viscosity values, forming a weak gel structure, whose physical properties hardly changed. Probiotic bacteria notably survived (51%) to the invitro digestion, surely related to the inulin presence, which would add value to the developed product by enhancing the potential health benefits of its consumption.This research has been carried out thanks to a funded project by the Universitat Politecnica de Valencia (PAID-05-11-2740). This work was also supported by the Conselleria de Educacion of Valencia government, which granted the author N. Bernat (ACIF/2011).Bernat Pérez, N.; Cháfer Nácher, MT.; Chiralt Boix, MA.; González Martínez, MC. (2015). Development of a non-dairy probiotic fermented product based on almond milk and inulin. International Journal of Food Science and Technology. 21(6):1-14. https://doi.org/10.1177/1082013214543705S114216Aguirre, L., Garro, M. S., & Savoy de Giori, G. (2008). Enzymatic hydrolysis of soybean protein using lactic acid bacteria. Food Chemistry, 111(4), 976-982. doi:10.1016/j.foodchem.2008.05.018Albillos, S. M., Menhart, N., & Fu, T.-J. (2009). Structural Stability of Amandin, a Major Allergen from Almond (Prunus dulcis), and Its Acidic and Basic Polypeptides. Journal of Agricultural and Food Chemistry, 57(11), 4698-4705. doi:10.1021/jf803977zAl-Dabbas. (2010). Acid-Base Buffering Properties of Five Legumes and Selected Food in vitro. American Journal of Agricultural and Biological Sciences, 5(2), 154-160. doi:10.3844/ajabssp.2010.154.160Angelov, A., Gotcheva, V., Kuncheva, R., & Hristozova, T. (2006). Development of a new oat-based probiotic drink. International Journal of Food Microbiology, 112(1), 75-80. doi:10.1016/j.ijfoodmicro.2006.05.015Arskold, E., Lohmeier-Vogel, E., Cao, R., Roos, S., Radstrom, P., & van Niel, E. W. J. (2007). Phosphoketolase Pathway Dominates in Lactobacillus reuteri ATCC 55730 Containing Dual Pathways for Glycolysis. Journal of Bacteriology, 190(1), 206-212. doi:10.1128/jb.01227-07Årsköld, E., Svensson, M., Grage, H., Roos, S., Rådström, P., & van Niel, E. W. J. (2007). Environmental influences on exopolysaccharide formation in Lactobacillus reuteri ATCC 55730. International Journal of Food Microbiology, 116(1), 159-167. doi:10.1016/j.ijfoodmicro.2006.12.010Bender FE, Douglas LW, Kramer DS (1989) Statistical methods for food and agriculture, Westport: Avi Publishing Co Inc, pp. 191–221.Bezkorovainy, A. (2001). Probiotics: determinants of survival and growth in the gut. The American Journal of Clinical Nutrition, 73(2), 399s-405s. doi:10.1093/ajcn/73.2.399sBuddington, R. (2009). Using Probiotics and Prebiotics to Manage the Gastrointestinal Tract Ecosystem. Prebiotics and Probiotics Science and Technology, 1-31. doi:10.1007/978-0-387-79058-9_1Capela, P., Hay, T. K. C., & Shah, N. P. (2006). Effect of cryoprotectants, prebiotics and microencapsulation on survival of probiotic organisms in yoghurt and freeze-dried yoghurt. Food Research International, 39(2), 203-211. doi:10.1016/j.foodres.2005.07.007Champagne, C. P., Green-Johnson, J., Raymond, Y., Barrette, J., & Buckley, N. (2009). Selection of probiotic bacteria for the fermentation of a soy beverage in combination with Streptococcus thermophilus. Food Research International, 42(5-6), 612-621. doi:10.1016/j.foodres.2008.12.018CHANG, C.-Y., & STONE, M. B. (1990). Effect of Total Soymilk Solids on Acid Production by Selected Lactobacilli. Journal of Food Science, 55(6), 1643-1646. doi:10.1111/j.1365-2621.1990.tb03590.xChurch, F. C., Swaisgood, H. E., Porter, D. H., & Catignani, G. L. (1983). Spectrophotometric Assay Using o-Phthaldialdehyde for Determination of Proteolysis in Milk and Isolated Milk Proteins. Journal of Dairy Science, 66(6), 1219-1227. doi:10.3168/jds.s0022-0302(83)81926-2Coccorullo, P., Strisciuglio, C., Martinelli, M., Miele, E., Greco, L., & Staiano, A. (2010). Lactobacillus reuteri (DSM 17938) in Infants with Functional Chronic Constipation: A Double-Blind, Randomized, Placebo-Controlled Study. The Journal of Pediatrics, 157(4), 598-602. doi:10.1016/j.jpeds.2010.04.066Cruz, A. G., Faria, J. A. F., Walter, E. H. M., Andrade, R. R., Cavalcanti, R. N., Oliveira, C. A. F., & Granato, D. (2010). Processing optimization of probiotic yogurt containing glucose oxidase using response surface methodology. Journal of Dairy Science, 93(11), 5059-5068. doi:10.3168/jds.2010-3336Cruz, N. S., Capellas, M., Jaramillo, D. P., Trujillo, A. J., Guamis, B., & Ferragut, V. (2009). Soymilk treated by ultra high-pressure homogenization: Acid coagulation properties and characteristics of a soy-yogurt product. Food Hydrocolloids, 23(2), 490-496. doi:10.1016/j.foodhyd.2008.03.010DE SOUZA OLIVEIRA, R. P., PEREGO, P., CONVERTI, A., & DE OLIVEIRA, M. N. (2009). The effect of inulin as a prebiotic on the production of probiotic fibre-enriched fermented milk. International Journal of Dairy Technology, 62(2), 195-203. doi:10.1111/j.1471-0307.2009.00471.xDonkor, O. N., Henriksson, A., Vasiljevic, T., & Shah, N. P. (2005). Probiotic Strains as Starter Cultures Improve Angiotensin-converting Enzyme Inhibitory Activity in Soy Yogurt. Journal of Food Science, 70(8), m375-m381. doi:10.1111/j.1365-2621.2005.tb11522.xFranck A.*. (2002). Technological functionality of inulin and oligofructose. British Journal of Nutrition, 87(6), 287-291. doi:10.1079/bjnbjn/2002550Glahn, R. P., Lee, O. A., Yeung, A., Goldman, M. I., & Miller, D. D. (1998). Caco-2 Cell Ferritin Formation Predicts Nonradiolabeled Food Iron Availability in an In Vitro Digestion/Caco-2 Cell Culture Model. The Journal of Nutrition, 128(9), 1555-1561. doi:10.1093/jn/128.9.1555Grobben, G. J., Peters, S. W. P. G., Wisselink, H. W., Weusthuis, R. A., Hoefnagel, M. H. N., Hugenholtz, J., & Eggink, G. (2001). Spontaneous Formation of a Mannitol-Producing Variant of Leuconostoc pseudomesenteroides Grown in the Presence of Fructose. Applied and Environmental Microbiology, 67(6), 2867-2870. doi:10.1128/aem.67.6.2867-2870.2001Hutchings, J. B. (1999). Colour Measurement of Foods. Food Colour and Appearance, 238-326. doi:10.1007/978-1-4615-2373-4_8Indrio, F., Riezzo, G., Raimondi, F., Bisceglia, M., Cavallo, L., & Francavilla, R. (2008). The Effects of Probiotics on Feeding Tolerance, Bowel Habits, and Gastrointestinal Motility in Preterm Newborns. The Journal of Pediatrics, 152(6), 801-806. doi:10.1016/j.jpeds.2007.11.005Jones, J. L., Fernandez, M. L., McIntosh, M. S., Najm, W., Calle, M. C., Kalynych, C., … Lerman, R. H. (2011). A Mediterranean-style low-glycemic-load diet improves variables of metabolic syndrome in women, and addition of a phytochemical-rich medical food enhances benefits on lipoprotein metabolism. Journal of Clinical Lipidology, 5(3), 188-196. doi:10.1016/j.jacl.2011.03.002Kamil, A., & Chen, C.-Y. O. (2012). Health Benefits of Almonds beyond Cholesterol Reduction. Journal of Agricultural and Food Chemistry, 60(27), 6694-6702. doi:10.1021/jf2044795Kolida, S., Tuohy, K., & Gibson, G. R. (2002). Prebiotic effects of inulin and oligofructose. British Journal of Nutrition, 87(S2), S193-S197. doi:10.1079/bjn/2002537Kopp-Hoolihan, L. (2001). Prophylactic and Therapeutic Uses of Probiotics. Journal of the American Dietetic Association, 101(2), 229-241. doi:10.1016/s0002-8223(01)00060-8Kroh, L. W. (1994). Caramelisation in food and beverages. Food Chemistry, 51(4), 373-379. doi:10.1016/0308-8146(94)90188-0Li, T. Y., Brennan, A. M., Wedick, N. M., Mantzoros, C., Rifai, N., & Hu, F. B. (2009). Regular Consumption of Nuts Is Associated with a Lower Risk of Cardiovascular Disease in Women with Type 2 Diabetes. The Journal of Nutrition, 139(7), 1333-1338. doi:10.3945/jn.108.103622Liu, R. H. (2012). Health Benefits of Phytochemicals in Whole Foods. Nutritional Health, 293-310. doi:10.1007/978-1-61779-894-8_13Julian McClements, D. (2004). Food Emulsions. Contemporary Food Science. doi:10.1201/9781420039436Matissek R, Schnepel FM, Steiner G (1998) Análisis de los Alimentos: Fundamentos, Métodos y Aplicaciones, Zaragoza: Acribia S.A. publishings, pp. 123–132.Ortiz, M. E., Fornaguera, M. J., Raya, R. R., & Mozzi, F. (2012). Lactobacillus reuteri CRL 1101 highly produces mannitol from sugarcane molasses as carbon source. Applied Microbiology and Biotechnology, 95(4), 991-999. doi:10.1007/s00253-012-3945-zPatrignani, F., Iucci, L., Lanciotti, R., Vallicelli, M., Maina Mathara, J., Holzapfel, W. H., & Guerzoni, M. E. (2007). Effect of High-Pressure Homogenization, Nonfat Milk Solids, and Milkfat on the Technological Performance of a Functional Strain for the Production of Probiotic Fermented Milks. Journal of Dairy Science, 90(10), 4513-4523. doi:10.3168/jds.2007-0373Pereda, J., Ferragut, V., Quevedo, J. M., Guamis, B., & Trujillo, A. J. (2007). Effects of Ultra-High Pressure Homogenization on Microbial and Physicochemical Shelf Life of Milk. Journal of Dairy Science, 90(3), 1081-1093. doi:10.3168/jds.s0022-0302(07)71595-3Rivera-Espinoza, Y., & Gallardo-Navarro, Y. (2010). Non-dairy probiotic products. Food Microbiology, 27(1), 1-11. doi:10.1016/j.fm.2008.06.008Roberfroid, M. B. (2005). Introducing inulin-type fructans. British Journal of Nutrition, 93(S1), S13-S25. doi:10.1079/bjn20041350Roland, I. (2003). Systematic characterization of oil-in-water emulsions for formulation design. International Journal of Pharmaceutics, 263(1-2), 85-94. doi:10.1016/s0378-5173(03)00364-8Rajasekaran, A., & Kalaivani, M. (2012). Designer foods and their benefits: A review. Journal of Food Science and Technology, 50(1), 1-16. doi:10.1007/s13197-012-0726-8Savijoki, K., Ingmer, H., & Varmanen, P. (2006). Proteolytic systems of lactic acid bacteria. Applied Microbiology and Biotechnology, 71(4), 394-406. doi:10.1007/s00253-006-0427-1Savino, F., Pelle, E., Palumeri, E., Oggero, R., & Miniero, R. (2007). Lactobacillus reuteri (American Type Culture Collection Strain 55730) Versus Simethicone in the Treatment of Infantile Colic: A Prospective Randomized Study. PEDIATRICS, 119(1), e124-e130. doi:10.1542/peds.2006-1222Sze, A., Erickson, D., Ren, L., & Li, D. (2003). Zeta-potential measurement using the Smoluchowski equation and the slope of the current–time relationship in electroosmotic flow. Journal of Colloid and Interface Science, 261(2), 402-410. doi:10.1016/s0021-9797(03)00142-5Tamime AY, Robinson RK (2000) Yoghurt. Science and Technology, Boca Raton: CRC Press, pp. 535–588.Vasiljevic, T., Kealy, T., & Mishra, V. K. (2007). Effects of ?-Glucan Addition to a Probiotic Containing Yogurt. Journal of Food Science, 72(7), C405-C411. doi:10.1111/j.1750-3841.2007.00454.xWilson, S., Blaschek, K., & Mejia, E. G. (2005). Allergenic Proteins in Soybean: Processing and Reduction of P34 Allergenicity. Nutrition Reviews, 63(2), 47-58. doi:10.1111/j.1753-4887.2005.tb00121.xWisselink, H. ., Weusthuis, R. ., Eggink, G., Hugenholtz, J., & Grobben, G. . (2002). Mannitol production by lactic acid bacteria: a review. International Dairy Journal, 12(2-3), 151-161. doi:10.1016/s0958-6946(01)00153-4Yaakob, H., Ahmed, N. R., Daud, S. K., Malek, R. A., & Rahman, R. A. (2012). Optimization of ingredient and processing levels for the production of coconut yogurt using response surface methodology. Food Science and Biotechnology, 21(4), 933-940. doi:10.1007/s10068-012-0123-0Yada, S., Lapsley, K., & Huang, G. (2011). A review of composition studies of cultivated almonds: Macronutrients and micronutrients. Journal of Food Composition and Analysis, 24(4-5), 469-480. doi:10.1016/j.jfca.2011.01.00

    Hazelnut milk fermentation using probiotic Lactobacillus rhamnosus GG and inulin

    Full text link
    Following the consumer demand of healthy vegetable products due to their interesting nutritional profiles and potential functionalities, the fermentation process of hazelnut milk with Lactobacillus rhamnosus GG and S.thermophilus was studied. The effect of different factors (glucose, inulin and inoculum contents) was analysed to ensure sufficient probiotic survivals in a minimum time. The shelf life of the optimised product was characterised in terms of its main physicochemical and quality parameters (probiotic survivals and sensory analysis). Results showed that the defined formulation allowed high probiotic survivals (approximate to 10(8)cfumL(-1)) throughout cold storage and >60% survived to the in vitro digestion process (approximate to 10(5)cfumL(-1)). Lactobacillus rhamnosus GG was no able to degrade inulin, which remained to exert health benefits in the host. The product was highly appreciated by the sensory panel during its shelf life despite the formation of a weak gel, which presented syneresis at the last storage time.This research has been carried out thanks to a funded project by the Universitat Politecnica de Valencia (PAID-05-11-2740). This study was also supported by the Conselleria de Educacion of Valencian government, which granted the author N. Bernat (ACIF/2011).Bernat Pérez, N.; Cháfer Nácher, MT.; Chiralt Boix, MA.; González Martínez, MC. (2014). Hazelnut milk fermentation using probiotic Lactobacillus rhamnosus GG and inulin. International Journal of Food Science and Technology. 49(12):2553-2562. https://doi.org/10.1111/ijfs.12585S255325624912Allgeyer, L. C., Miller, M. J., & Lee, S.-Y. (2010). Sensory and microbiological quality of yogurt drinks with prebiotics and probiotics. Journal of Dairy Science, 93(10), 4471-4479. doi:10.3168/jds.2009-2582Angelov, A., Gotcheva, V., Kuncheva, R., & Hristozova, T. (2006). Development of a new oat-based probiotic drink. International Journal of Food Microbiology, 112(1), 75-80. doi:10.1016/j.ijfoodmicro.2006.05.015Arcia, P. L., Costell, E., & Tárrega, A. (2010). Thickness suitability of prebiotic dairy desserts: Relationship with rheological properties. Food Research International, 43(10), 2409-2416. doi:10.1016/j.foodres.2010.09.013Bezkorovainy, A. (2001). Probiotics: determinants of survival and growth in the gut. The American Journal of Clinical Nutrition, 73(2), 399s-405s. doi:10.1093/ajcn/73.2.399sBöhm, A., Kaiser, I., Trebstein, A., & Henle, T. (2004). Heat-induced degradation of inulin. European Food Research and Technology, 220(5-6), 466-471. doi:10.1007/s00217-004-1098-8Bolling, B. W., Chen, C.-Y. O., McKay, D. L., & Blumberg, J. B. (2011). Tree nut phytochemicals: composition, antioxidant capacity, bioactivity, impact factors. A systematic review of almonds, Brazils, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts. Nutrition Research Reviews, 24(2), 244-275. doi:10.1017/s095442241100014xBrennan, C. S., & Tudorica, C. M. (2008). Carbohydrate-based fat replacers in the modification of the rheological, textural and sensory quality of yoghurt: comparative study of the utilisation of barley beta-glucan, guar gum and inulin. International Journal of Food Science & Technology, 43(5), 824-833. doi:10.1111/j.1365-2621.2007.01522.xBuddington, R. (2009). Using Probiotics and Prebiotics to Manage the Gastrointestinal Tract Ecosystem. Prebiotics and Probiotics Science and Technology, 1-31. doi:10.1007/978-0-387-79058-9_1Corcoran, B. M., Stanton, C., Fitzgerald, G. F., & Ross, R. P. (2005). Survival of Probiotic Lactobacilli in Acidic Environments Is Enhanced in the Presence of Metabolizable Sugars. Applied and Environmental Microbiology, 71(6), 3060-3067. doi:10.1128/aem.71.6.3060-3067.2005Cruz, A. G., Faria, J. A. F., Walter, E. H. M., Andrade, R. R., Cavalcanti, R. N., Oliveira, C. A. F., & Granato, D. (2010). Processing optimization of probiotic yogurt containing glucose oxidase using response surface methodology. Journal of Dairy Science, 93(11), 5059-5068. doi:10.3168/jds.2010-3336DE SOUZA OLIVEIRA, R. P., PEREGO, P., CONVERTI, A., & DE OLIVEIRA, M. N. (2009). The effect of inulin as a prebiotic on the production of probiotic fibre-enriched fermented milk. International Journal of Dairy Technology, 62(2), 195-203. doi:10.1111/j.1471-0307.2009.00471.xDel Campo, R., Bravo, D., Canton, R., Ruiz-Garbajosa, P., Garcia-Albiach, R., Montesi-Libois, A., … Baquero, F. (2005). Scarce Evidence of Yogurt Lactic Acid Bacteria in Human Feces after Daily Yogurt Consumption by Healthy Volunteers. Applied and Environmental Microbiology, 71(1), 547-549. doi:10.1128/aem.71.1.547-549.2005Donkor, O. N., Nilmini, S. L. I., Stolic, P., Vasiljevic, T., & Shah, N. P. (2007). Survival and activity of selected probiotic organisms in set-type yoghurt during cold storage. International Dairy Journal, 17(6), 657-665. doi:10.1016/j.idairyj.2006.08.006Doron, S., Snydman, D. R., & Gorbach, S. L. (2005). Lactobacillus GG: Bacteriology and Clinical Applications. Gastroenterology Clinics of North America, 34(3), 483-498. doi:10.1016/j.gtc.2005.05.011Franck, A. (2002). Technological functionality of inulin and oligofructose. British Journal of Nutrition, 87(S2), S287-S291. doi:10.1079/bjn/2002550Garcı́a-Ochoa, F., Santos, V. ., Casas, J. ., & Gómez, E. (2000). Xanthan gum: production, recovery, and properties. Biotechnology Advances, 18(7), 549-579. doi:10.1016/s0734-9750(00)00050-1Glahn, R. P., Lee, O. A., Yeung, A., Goldman, M. I., & Miller, D. D. (1998). Caco-2 Cell Ferritin Formation Predicts Nonradiolabeled Food Iron Availability in an In Vitro Digestion/Caco-2 Cell Culture Model. The Journal of Nutrition, 128(9), 1555-1561. doi:10.1093/jn/128.9.1555Granato, D., de Araújo Calado, V. M., & Jarvis, B. (2014). Observations on the use of statistical methods in Food Science and Technology. Food Research International, 55, 137-149. doi:10.1016/j.foodres.2013.10.024Hekmat, S., Soltani, H., & Reid, G. (2009). Growth and survival of Lactobacillus reuteri RC-14 and Lactobacillus rhamnosus GR-1 in yogurt for use as a functional food. Innovative Food Science & Emerging Technologies, 10(2), 293-296. doi:10.1016/j.ifset.2008.10.007Kedia, G., Wang, R., Patel, H., & Pandiella, S. S. (2007). Use of mixed cultures for the fermentation of cereal-based substrates with potential probiotic properties. Process Biochemistry, 42(1), 65-70. doi:10.1016/j.procbio.2006.07.011Köksal, A. İ., Artik, N., Şimşek, A., & Güneş, N. (2006). Nutrient composition of hazelnut (Corylus avellana L.) varieties cultivated in Turkey. Food Chemistry, 99(3), 509-515. doi:10.1016/j.foodchem.2005.08.013Kolida, S., Tuohy, K., & Gibson, G. R. (2002). Prebiotic effects of inulin and oligofructose. British Journal of Nutrition, 87(S2), S193-S197. doi:10.1079/bjn/2002537Lovejoy, J. C. (2005). The impact of nuts on diabetes and diabetes risk. Current Diabetes Reports, 5(5), 379-384. doi:10.1007/s11892-005-0097-xMarcotte, M., Taherian Hoshahili, A. R., & Ramaswamy, H. S. (2001). Rheological properties of selected hydrocolloids as a function of concentration and temperature. Food Research International, 34(8), 695-703. doi:10.1016/s0963-9969(01)00091-6Mårtensson, O., Andersson, C., Andersson, K., Öste, R., & Holst, O. (2001). Formulation of an oat-based fermented product and its comparison with yoghurt. Journal of the Science of Food and Agriculture, 81(14), 1314-1321. doi:10.1002/jsfa.947Julian McClements, D. (2004). Food Emulsions. Contemporary Food Science. doi:10.1201/9781420039436Ott, A., Hugi, A., Baumgartner, M., & Chaintreau, A. (2000). Sensory Investigation of Yogurt Flavor Perception:  Mutual Influence of Volatiles and Acidity. Journal of Agricultural and Food Chemistry, 48(2), 441-450. doi:10.1021/jf990432xRanadheera, R. D. C. S., Baines, S. K., & Adams, M. C. (2010). Importance of food in probiotic efficacy. Food Research International, 43(1), 1-7. doi:10.1016/j.foodres.2009.09.009Roberfroid, M. B. (2005). Introducing inulin-type fructans. British Journal of Nutrition, 93(S1), S13-S25. doi:10.1079/bjn20041350Saad, N., Delattre, C., Urdaci, M., Schmitter, J. M., & Bressollier, P. (2013). An overview of the last advances in probiotic and prebiotic field. LWT - Food Science and Technology, 50(1), 1-16. doi:10.1016/j.lwt.2012.05.014Shah, N. P. (2007). Functional cultures and health benefits. International Dairy Journal, 17(11), 1262-1277. doi:10.1016/j.idairyj.2007.01.014Song, K.-W., Kim, Y.-S., & Chang, G.-S. (2006). Rheology of concentrated xanthan gum solutions: Steady shear flow behavior. Fibers and Polymers, 7(2), 129-138. doi:10.1007/bf02908257Tey, S. L., Brown, R., Chisholm, A., Gray, A., Williams, S., & Delahunty, C. (2011). Current guidelines for nut consumption are achievable and sustainable: a hazelnut intervention. British Journal of Nutrition, 105(10), 1503-1511. doi:10.1017/s0007114510005283Tey, S. L., Brown, R. C., Chisholm, A. W., Delahunty, C. M., Gray, A. R., & Williams, S. M. (2010). Effects of different forms of hazelnuts on blood lipids and α-tocopherol concentrations in mildly hypercholesterolemic individuals. European Journal of Clinical Nutrition, 65(1), 117-124. doi:10.1038/ejcn.2010.20
    corecore