dietary intervention synonyms

Prostaglandins, leukotrienes, and essential fatty acids. antonyms. This would help answer the question of whether outcomes are better when people consume red meat or chicken. What's the definition of Nutrition interventions in thesaurus? In most clinical trials of medications, the study drugs are provided to the participant without cost. The Proceedings of the Nutrition Society. official website and that any information you provide is encrypted Education is arguably one of the most important aspects of a clinical trial involving a diet. Check out the pronunciation, synonyms and grammar. In the latter cases additional regulations would apply to the conduct of clinical trials and marketing of the product. Randomized trial of four financial-incentive programs for smoking cessation. Ananthakrishnan AN, Khalili H, Konijeti GG, Higuchi LM, de Silva P, Korzenik JR, Fuchs CS, Willett WC, Richter JM, Chan AT. Enteral nutritional therapy, typically exclusive enteral nutrition (EEN) with elemental, semi-elemental and polymeric formula diets, is frequently used in the treatment of pediatric CD, particularly in Canada, Japan and Europe3739. However, adherence is difficult to measure in dietary trials and the level of adherence that is necessary to achieve the outcome is rarely known at the time the trial is designed. For example, investigations on the impact of the glycemic load on health outcomes typically necessitate comparing diets that differ in numerous, hard to standardize ways since the dietary glycemic load can be lowered by consuming more low-glycemic sugars such as fructose or lactose, by incorporating more high-fiber foods, or by lowering the overall carbohydrate content of the diet. a capsule or liquid containing the additional dietary components). For example, 4 to 12 weeks of a restriction diet is unlikely to lead to significant nutritional deficiencies whereas this could be a problem in longer maintenance trials. This has triggered interest in using dietary modification as a treatment. 2. In such cases, consumption of the study product would be expected to reduce intake of other food. Day AS, Lopez RN. In-school nutrition interventions, including school feeding programmes, should be integrated into national education plans. food. This is likely secondary to the unique challenges associated with conducting dietary clinical trials. Hedrick VE, Dietrich AM, Estabrooks PA, Savla J, Serrano E, Davy BM. Finally, one important distinction of dietary intervention trials from drug trials is whether to consider the baseline diet as part of the inclusion criteria. Supplementation can be in the form of a whole food, an ingredient, or a prepared dietary supplement (e.g. In these cases, the investigators need to be aware that they are not assessing the impact of the supplemented food per se, but actually comparing the supplemented to the replaced food. Anthocyanin-containing purple-fleshed potatoes suppress colon tumorigenesis via elimination of colon cancer stem cells. Recent advances in genomics, metabolomics, and gut microbiome technologies have offered opportunities as well as . The source of food and how it is prepared adds to the heterogeneity of dietary interventions. An important aspect of drug development is identifying the minimum effective dose. The most common protocol involves the administration of a defined formula at 100% of caloric needs for 412 weeks in order to induce remission44. Dr. Kratz has received honoraria and compensation for travel as well as a research grant from dairy-related organizations. Studies that house participants and provide and measure all dietary consumption allow for the greatest control of dietary exposures. Here, we highlight several key concepts that should be considered in the design and implementation of dietary intervention trials. Lang A, Salomon N, Wu JC, Kopylov U, Lahat A, Har-Noy O, Ching JY, Cheong PK, Avidan B, Gamus D, Kaimakliotis I, Eliakim R, Ng SC, Ben-Horin S. Curcumin in Combination With Mesalamine Induces Remission in Patients With Mild-to-Moderate Ulcerative Colitis in a Randomized Controlled Trial. For dietary interventions that provide additional amounts of a specific nutrient, it is intuitive to consider measuring the concentration of the nutrient in the plasma or urine. poultry) and fish, and use of olive oil as the principal fat for cooking20. How to use intervention in a sentence Van Den Bogaerde J, Cahill J, Emmanuel AV, Vaizey CJ, Talbot IC, Knight SC, Kamm MA. The duration of the trial may be an important consideration. Whether a clinical trial should include patients with active disease or those in remission depends on the question to be answered. Unfortunately, circulating concentrations of most micronutrients are not representative of even recent intake, as they are homeostatically regulated or because their storage in tissues or secretion are important additional determinants of plasma concentrations69. To ensure consistency, appropriate education of patients, family members, and the clinical or research team is critical. The reverse has also been shown, namely that eating a healthy diet rich in fruit, vegetables, fish and lean meat, is associated with reduced risk of depression. We distinguished four groups of dietary interventions: Calorie restriction and fasting, purine-low diets, Mediterranean-style diets, and supplements. Journal of the Academy of Nutrition and Dietetics. Although a full discussion is beyond the scope of this review, investigators should recognize that under certain circumstances a dietary intervention could be considered as a drug, a medical food, or a supplement. For example, gluten can be replaced with nearly anything and celiac disease will improve. Grover Z, Muir R, Lewindon P. Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohns disease. The order of treatment is determined by random assignment. Diet: for the purpose of this review, an intervention involving a "whole dietary pattern" such as the Mediterranean diet Dash diet MIND diet or foods analysed from 4 out of 5 of the food groups (protein, grains/carbohydrates, oil and fats, dairy, fruit/vegetable. FFQ are considered relatively poor instruments to assess compliance with a dietary intervention, as it would be relatively easy for participants to manipulate their responses to the standardized questions to appear more compliant than they were. Laursen L. Interdisciplinary research: Big science at the table. Nutrigenomics is an evolving discipline in which the expression of genes is measured in response to a dietary intervention, and may be helpful in IBD in order to understand on how an altered nutritional exposure could regulate gene expression and ultimately phenotype70,71. Children with IBD often require lifelong immunosuppressive therapy, and the concern for possible adverse events such as infection and cancer often plays a role for families to seek out alternative therapies, including diet. The chemical components that comprise foods include macronutrients, essential micronutrients, food additives, contaminants (agricultural chemical, microbial toxin, inorganic), chemicals formed during the cooking/processing of food, natural toxins, and other natural compounds15. Clinical trial: vitamin D3 treatment in Crohns disease - a randomized double-blind placebo-controlled study. Ideally, the same principles should apply as with drug development. Synonyms This is an important focus for future studies. Screening for such can be accomplished with food frequency questionnaires or other dietary measurement approaches. APA: Classic Thesaurus. Willett WC, Sampson L, Stampfer MJ, Rosner B, Bain C, Witschi J, Hennekens CH, Speizer FE. What Are Adults With Inflammatory Bowel Disease (IBD) Eating? Rosario M, Dirks NL, Gastonguay MR, Fasanmade AA, Wyant T, Parikh A, Sandborn WJ, Feagan BG, Reinisch W, Fox I. Conducting such research is challenging, but not beyond the reach of the IBD community. For instance, MeSH terms in PubMed and Thesaurus in PsycInfo and CINAHL were used to identify synonyms for . Zachos M, Tondeur M, Griffiths AM. The differential role of food chemical component exposures at different stages of growth and development requires further study, in particular the role of dietary exposures in the developing immune system. Reproducibility and validity of a semiquantitative food frequency questionnaire. The 24-hour dietary recall and food record methods capture food intake on one or more specified days. A recent randomized trial following infants through childhood demonstrated the protective effect of early exposure to peanut protein on the future development of peanut allergies86. Halpern SD, French B, Small DS, Saulsgiver K, Harhay MO, Audrain-McGovern J, Loewenstein G, Brennan TA, Asch DA, Volpp KG. examples. Similarly, registered dietitians can help assure that study diets meet patients nutritional requirements and also guide patients on the practical aspects of consuming specialized diets. Thus, many trials of dietary interventions are open label or at most single blind (i.e. The three principle models of dietary intervention are supplementation with selected dietary components, exclusion of selected dietary components, or use of dietary formulas in place of a normal diet. Measuring dietary intake and adherence can be accomplished with simple checklists that are kept by the participants to report their adherence to the specific intervention, ideally daily. Jorgensen SP, Agnholt J, Glerup H, Lyhne S, Villadsen GE, Hvas CL, Bartels LE, Kelsen J, Christensen LA, Dahlerup JF. The childs assent should be obtained if they are able to comprehend the relevant issues around their participation in a trial90. Exclusion of those whose usual diet is similar to the intervention may serve to increase statistical power. There is strong epidemiological evidence that poor diet is associated with depression. Yelland LN, Makrides M, McPhee AJ, Quinlivan J, Gibson RA. A 2011 systematic review identified only 108 N-of-1 trials published over a 25 year period, none of which were dietary interventions57. synonyms. Diet in the pathogenesis and treatment of inflammatory bowel diseases. Dietary patterns can also be defined by the exclusion of specific foods, such as vegan or gluten-free diets. Stratified randomization can help assure balance on important covariates and may be particularly helpful when sample sizes are relatively small. It may be difficult to find specialized food products or adequate variety in smaller, rural markets. Dietary interventions considered potentially beneficial for patients with inflammatory bowel disease. Lochs H, Dejong C, Hammarqvist F, Hebuterne X, Leon-Sanz M, Schutz T, van Gemert W, van Gossum A, Valentini L, Lubke H, Bischoff S, Engelmann N, Thul P. ESPEN Guidelines on Enteral Nutrition: Gastroenterology. Copyright HarperCollins Publishers Definition of 'intervention' intervention (ntvenn ) variable noun Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. However, to sustain adequate caloric intake the excluded nutrients must be replaced with another nutrient source. EEN is an exclusion diet of sorts where the typical, whole foods diet is replaced by defined formulas. N-of-1 trials in the medical literature: a systematic review. UN-2. sentences. Mobile phone food records using photograph-based assessments and the usage of sensor technology to estimate portion sizes are in active development and hold promise for the future of dietary assessment65. antonyms. Day AS, Whitten KE, Lemberg DA, Clarkson C, Vitug-Sales M, Jackson R, Bohane TD. To date, the study of dietary interventions in patients with IBD has primarily concentrated on three approaches which can be used independently or in combination supplementation with anti-inflammatory components, the exclusion/restriction of pro-inflammatory components, or replacement of the usual diet with nutritional formulas, the mechanism of which is not fully understood (Figure 2). Though it has been suggested that single-center studies may lack the rigor of multi-center studies, single-center studies often observe larger treatment effects. Other diets, such as the Paleolithic diet, are popular in the lay press, but have yet to be scientifically studied (Table 1). the evaluator is blinded but the patient is aware of the treatment) and the comparator group consumes a control diet or their usual diet. An example for an established biomarker commonly used in research is the plasma phospholipid concentration of the fatty acids C15:0, C17:0, and C16:1 n-7 trans, all of which are biomarkers for dairy fat consumption63. nutritional. CD and UC are chronic debilitating diseases for which there is no medical cure. Each of these methods is subject to bias from errors in the assessment of diet62. Furthermore, the mechanism of action of these diets is unclear. In the simplest form, a dietary component can be encapsulated and provided in a pill form or within a solution52. dietary fiber,21 and probiotics22 in both CD and UC, omega-3 fatty acid supplementation in CD23, vitamin D supplementation in CD24, polyphenols found in green tea (()-epigallocatechin-3-gallate) for UC25, and curcumin for CD26 and UC27,28. For example, an ongoing trial of the specific carbohydrate diet has employed this strategy (https://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT02610101","term_id":"NCT02610101"}}NCT02610101?term=suskind&rank=8). Comparative Transcriptome Analysis of White and Purple Potato to Identify Genes Involved in Anthocyanin Biosynthesis. The main advantage of the design is increased statistical power as each participant serves as their own control. Current evidence suggests that environmental factors, including diet, may be important in the development and progression of IBD1. Both are open-ended, i.e. A Closer Look at the Dietary Habits of a Population-Based Canadian IBD Cohort. Wyant T, Estevam J, Yang L, Rosario M. Development and validation of receptor occupancy pharmacodynamic assays used in the clinical development of the monoclonal antibody vedolizumab. Copyright HarperCollins Publishers Definition of 'intervention' intervention (ntvenn ) variable noun Why we should be wary of single-center trials. To define dietary needs, the Institute of Medicine has put forth Dietary Reference Intakes for macronutrients, fluids and electrolytes, vitamins, and minerals17. Creation of a placebo or control is more complicated if the study product has substantial caloric content. dietary intervention translation in English - English Reverso dictionary, see also 'dietary fibre, diary, diet, deary', examples, definition, conjugation Despite this, high-quality evidence for a direct effect of dietary modifications on reduction in symptoms and inflammation is limited. Feagan BG, Sandborn WJ, Mittmann U, Bar-Meir S, DHaens G, Bradette M, Cohen A, Dallaire C, Ponich TP, McDonald JW, Hebuterne X, Pare P, Klvana P, Niv Y, Ardizzone S, Alexeeva O, Rostom A, Kiudelis G, Spleiss J, Gilgen D, Vandervoort MK, Wong CJ, Zou GY, Donner A, Rutgeerts P. Omega-3 free fatty acids for the maintenance of remission in Crohn disease: the EPIC Randomized Controlled Trials. Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE): Determining Therapeutic Goals for Treat-to-Target. Given the high prevalence of nutritional deficiencies among patients with IBD in general34, some trials may need to assess for nutritional deficiencies and replete those identified as part of the study protocol. Soltoft J, Krag B, Gudmand-Hoyer E, Kristensen E, Wulff HR. Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center. Partial enteral nutrition with a Crohns disease exclusion diet is effective for induction of remission in children and young adults with Crohns disease. Inclusion in an NLM database does not imply endorsement of, or agreement with, Best (but oft-forgotten) practices: designing, analyzing, and reporting cluster randomized controlled trials. 2017 Feb; 23(2): 181191. Just as adherence to medications can influence the effectiveness, adherence to therapeutic diets may be just as important. Exclusion diets focus on exclusion of selected components of the usual diet. Blinding is more difficult in exclusion diets since the relevant dietary component may be acquired from a number of different foods. The study, "Effects of 24-week prebiotic intervention on self-reported upper . Such designs may be used for early phase studies to assess tolerability of the dietary intervention and the impact of short term exposures on biomarkers. A new study has further revealed the potential for prebiotics to support athletic health and sports nutrition. Drawing upon the importance of randomization to balance confounders between the treatment groups, the primary analysis for most trials should employ the principle of intention to treat, whereby all participants are analyzed according to their assigned diet. This is time consuming and generally requires additional personnel. Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, OKeefe JH, Brand-Miller J. Lionetti P, Callegari ML, Ferrari S, Cavicchi MC, Pozzi E, de Martino M, Morelli L. Enteral nutrition and microflora in pediatric Crohns disease. (Most of the time.). Bellomo R, Warrillow SJ, Reade MC. Journal of pediatric gastroenterology and nutrition. By manipulating the participants usual diet in any way, it is possible that any observed difference in outcomes in the clinical trial could be due to the effects of the study diet, the control diet, or both. Similarly, some have proposed that isolated colonic Crohns disease responds less well to EEN than ileal disease50. Streiner DL. See full entry for 'dietary' Collins COBUILD Advanced Learner's Dictionary. Alternatively, it is possible that dietary interventions may be more effective in new onset disease. Evaluating the subjects usual diet allows one to more closely understand the impact the introduction of the study diet may have on the course of the disease. Wall CL, Day AS, Gearry RB. C. nutrition interventions > synonyms. Caprilli R, Gassull MA, Escher JC, Moser G, Munkholm P, Forbes A, Hommes DW, Lochs H, Angelucci E, Cocco A, Vucelic B, Hildebrand H, Kolacek S, Riis L, Lukas M, de Franchis R, Hamilton M, Jantschek G, Michetti P, OMorain C, Anwar MM, Freitas JL, Mouzas IA, Baert F, Mitchell R, Hawkey CJ. Johnson RK. Dr. Reinisch has served as a consultant for Nestle Health Science. However, to avoid having a clinically important effect on the disease course, such run in periods need to be short. One speaker suggested that nutrition interventions be mainstreamed in health, . At present, food product labeling largely does not distinguish between different plant varieties, or cultivars, despite substantial differences in nutrient profiles. However, the effectiveness is greatest when used as the exclusive source of nutrition41,43. Other possibilities include 24-hour dietary recalls, food diaries, food frequency questionnaires (FFQs), evaluation by a registered dietitian, or directly measuring the food not consumed in controlled studies that provide some, most, or all of the food (analogous to pill counts for drug studies). Dryden GW, Lam A, Beatty K, Qazzaz HH, McClain CJ. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. For a recent discussion of these and other issues see Yelland et al76. and transmitted securely. Title: eCopy, Inc. Keywords: None Created Date: 9/5/2012 12:47:15 PM [.] A literature search was conducted using PubMed Central. The following key words were used (including synonyms and closely related words) as index . Careers, Unable to load your collection due to an error. Before Understanding the impact and role of processing foods is important in dietary trials and collaboration with food scientists may be a valuable opportunity for clinicians. Enteral nutritional therapy has been the most extensively studied dietary intervention and has repeatedly been demonstrated to produce improvements in clinical, biochemical, and mucosal healing outcomes in patients with CD. Greenley RN, Stephens KA, Nguyen EU, Kunz JH, Janas L, Goday P, Schurman JV. The difference in outcomes between children and adults may in part be due to stricter adherence enforced by parents in pediatric studies. If the goal is to assess the impact of increasing consumption of a specific nutrient, providing a placebo with comparable calories will minimize the risk of contamination of the intervention by greater consumption of other foods that contain the same ingredient in the control group. In 2018, Ayres' lab looked at how dietary interventions can create an asymptomatic infection, which Ayres calls a cooperative relationship between bacteria and host (the person or animal that the . Liu Y, Lin-Wang K, Deng C, Warran B, Wang L, Yu B, Yang H, Wang J, Espley RV, Zhang J, Wang D, Allan AC. Browse the use examples 'Nutritional intervention' in the great English corpus. The choice between a well-defined control diet and using the subjects usual diet as the control should be driven by the underlying study question. Gabler NB, Duan N, Vohra S, Kravitz RL. For dietary interventions, particularly exclusion diets, the question may be how much of a substance is too much or too little. Such designs have been used to assess the impact of fiber supplementation in a number of health conditions5355. Implementation is easier when the dietary intervention is limited, such as addition of a special beverage, bread, etc. Examples of dietary supplementation trials include randomized control trials of supplementation with prebiotics, i.e. One should recognize that supplementation may result in reduction of consumption of another component of the diet, particularly if the supplementation has appreciable caloric content. Careful consideration must be given to inclusion criteria, the choice of a comparator group, mode of treatment assignment, blinding, measuring adherence and statistical methods. When 'thingamajig' and 'thingamabob' just won't do, A simple way to keep them apart. For example, one may wish to exclude patients with a prior partial colonic resection if it is anticipated that the diet would be poorly tolerated in those with prior surgery. Chiba M, Abe T, Tsuda H, Sugawara T, Tsuda S, Tozawa H, Fujiwara K, Imai H. Lifestyle-related disease in Crohns disease: relapse prevention by a semi-vegetarian diet. Hanai H, Iida T, Takeuchi K, Watanabe F, Maruyama Y, Andoh A, Tsujikawa T, Fujiyama Y, Mitsuyama K, Sata M, Yamada M, Iwaoka Y, Kanke K, Hiraishi H, Hirayama K, Arai H, Yoshii S, Uchijima M, Nagata T, Koide Y. Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial. Best synonyms for 'nutrition interventions' are 'nutrition-related', 'dietary' and 'food'. Consideration should be given to the amount of oversight and attention given to the respective study arms, as differential guidance may bias study results. Brown AW, Li P, Bohan Brown MM, Kaiser KA, Keith SW, Oakes JM, Allison DB. Afzal NA, Davies S, Paintin M, Arnaud-Battandier F, Walker-Smith JA, Murch S, Heuschkel R, Fell J. Colonic Crohns disease in children does not respond well to treatment with enteral nutrition if the ileum is not involved. Contexts Adjective Of, or relating to diet Able to be eaten Noun more Adjective Of, or relating to diet nutritive nutritional alimentary alimental dietetic eating nutritious nourishing nutrient beneficial wholesome salutary food sustaining digestible sustentative comestible peptic nutrimental strengthening sharing sensitive information, make sure youre on a federal Takagi S, Utsunomiya K, Kuriyama S, Yokoyama H, Takahashi S, Iwabuchi M, Takahashi H, Kinouchi Y, Hiwatashi N, Funayama Y, Sasaki I, Tsuji I, Shimosegawa T. Effectiveness of an half elemental diet as maintenance therapy for Crohns disease: A randomized-controlled trial. With regard to blood lipids, regional diet interventions either failed to induce significant differences or improved selective blood lipid markers of the participants adhering to the experimental regional diet arms. Exclusion diets do not meet any of these definitions. Food scientists study the physical, chemical, and biochemical properties of food and the principles of food processing84. Most related words/phrases with sentence examples define Intervention meaning and usage. Preparing food primarily or exclusively at home can be expensive and time consuming and may limit the generalizability of the dietary interventions. Browse the use examples 'dietary interventions' in the great English corpus. Dietary Interventions: A Promising Treatment for Polycystic Ovary Syndrome A range of dietary patterns have been shown to impact weight loss and insulin resistance (IR) and improve reproductive function, including the Mediterranean diet, the ketogenic diet, Dietary Approaches to Stop Hypertension, and other dietary patterns. Indeed, for many years, even the smallest intake of fat was "demonized" and a high-fat diet was a synonym to a higher CVD . Lists. Of these, dietary fiber, vitamin D, probiotics, green tea polyphenols and curcumin have some evidence of efficacy but have not been subject to large scale state of the art clinical trials, while omega-3 fatty acids showed no benefit in two large, well-designed placebo-controlled trials to prevent relapse of Crohns disease. antonyms. When possible, early phase trials should assess the impact of differing amounts of the dietary component on tolerability and biomarkers relevant to the study question. nutrition-related. Yan D, Ren J, Wang G, Liu S, Li J. Predictors of response to enteral nutrition in abdominal enterocutaneous fistula patients with Crohns disease. The majority of the exclusion diets that have been proposed for the treatment of IBD require significant restrictions and preparing food at home becomes essential. These values provide guidance on norms of intake and the physiological needs of individuals. dietary. The principles of pharmacokinetics and pharmacodynamics can be used to predict the minimum effective dose of a drug. This may happen with therapies such as EEN that have high osmotic load. Specifically, if a dietary intervention is efficacious when the key components are provided to participants at no cost, the effectiveness when implemented outside of a clinical trial may be substantially less, particularly if the diet is difficult to follow. However, dietary interventions that supplement or replace the usual diet could potentially meet the definition of a supplement, medical food or a drug. Alternatively, investigators may provide the same food with and without a particular nutrient in a blinded fashion to demonstrate the efficacy of adding or removing the nutrient. In particular, there is the risk that participants assigned to one diet will also implement all or some aspects of the other diet on their own. Clinical and experimental gastroenterology. . Of all dietary interventions, EEN is supported by the strongest clinical evidence. Words dietary adjective of or relating to the diet intervention noun the act of intervening (as to mediate a dispute, etc.) Inflammatory bowel disease is believed to be caused by a combination of genetic and environmental stimuli such as our diet. . thesaurus. Federal government websites often end in .gov or .mil. participants list their actual foods consumed, rather than respond to questions about consumption in broad food categories as in the FFQ. thesaurus. European evidence based consensus on the diagnosis and management of Crohns disease: special situations. A variant of crossover trials is the N-of-1 trial design where an individual participant is randomly assigned to treatment periods with the different therapies. nutrition related. How to use dietary in a sentence The first is that cornstarch is gluten free, making it the obvious choice for anyone with such dietary restrictions. verbs. Subar AF, Kirkpatrick SI, Mittl B, Zimmerman TP, Thompson FE, Bingley C, Willis G, Islam NG, Baranowski T, McNutt S, Potischman N. The Automated Self-Administered 24-hour dietary recall (ASA24): a resource for researchers, clinicians, and educators from the National Cancer Institute. New technology in dietary assessment: a review of digital methods in improving food record accuracy. If a study diet is anticipated to result in weight loss, one may exclude underweight or undernourished patients. Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. nutritional . Dietary patterns and self-reported associations of diet with symptoms of inflammatory bowel disease. Review article: the role of nutrition in the treatment of inflammatory bowel disease. Drs. Because of the complexity of most natural foods and the large quantity of different combinations in which these foods can be consumed, dietary factors and their health effects may be difficult to isolate and specify.

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