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Clinical & Translational Metabolism
Published in: Clinical Reviews in Bone and Mineral Metabolism 1/2009

01-03-2009 | Original Paper

Vitamin D Deficiency in the Middle East and its Health Consequences for Children and Adults

Author: Ghada El-Hajj Fuleihan

Published in: Clinical & Translational Metabolism | Issue 1/2009

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Abstract

Despite its abundant sunshine the Middle East, a region spanning latitudes from 12°N to 42°N allowing vitamin D synthesis year round, registers some of the lowest levels of vitamin D and the highest rates of hypovitaminosis D worldwide. This major public health problem affects individuals across all life stages including pregnant women, neonates, infants, children and adolescents, adults, and the elderly. Furthermore, while rickets is almost eradicated from developed countries, it is still reported in several countries in the Middle East. These observations can be explained by limited sun exposure due to cultural practices, dark skin color, and very hot climate in several countries in the gulf area, along with prolonged breast feeding without vitamin D supplementation, decreased calcium content of diets and outdoor activity, obesity, and lack of government regulation for vitamin D fortification of food, in several if not in all countries. The lack of population based studies renders estimates for the prevalence and incidence of rickets in the Middle East difficult, but several series from the region illustrate its dire consequences on growth and development. Furthermore, it is reported that 20–80% of apparently healthy individuals from several countries in this region have suboptimal vitamin D levels, depending on the cut-off used for defining hypovitaminosis D, the country, season, age group, and gender studied. Suboptimal levels have been associated with compromised skeletal health across age groups, and with poor muscular function and increased fall risk and osteoporotic fractures in the elderly. Studies detailing associations between low vitamin D levels and musculoskeletal health in the Middle East, and the impact of various treatment regimens are reviewed. Current recommendations for vitamin D derived from data in western subjects may not be sufficient for subjects from the Middle East, therefore suggestions for vitamin D replacement doses based on evidence available to-date are provided. Hypovitaminosis D is a major public health problem across all life stages in the Middle East with deleterious immediate and latent manifestations. Long term strategies to address this often silent disease should include public education, national health policies for screening and prevention through food fortification, and treatment through vitamin D supplementation.
Literature
1.
Koppes CR. Captain Mahan, General Gordon and the origin of the term “Middle East”. Middle East Stud. 1976;12:95–8.CrossRef
2.
Beaumont P, Blake GH, Wagstaff JM. The Middle East: a geographical study. 2nd ed. London, England: David Fulton Publishers; 1998.
3.
Holick M. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. 2004;79:362–71.PubMed
4.
Pettifor JM. Nutritional rickets: deficiency of vitamin D, calcium, or both? Am J Clin Nutr. 2004;80(Suppl 6):1725S–9S.PubMed
5.
6.
Thacher T, Fischer P, Strand M, Pettifor J. Nutritional rickets around the world: causes and future directions. Ann Trop Paediatr. 2006;26:1–16.PubMedCrossRef
7.
Baroncelli G, Bereket A, El Kholy M, Audì L, Cesur Y, Ozkan B, et al. Rickets in the Middle East: role of environment and genetic predisposition. J Clin Endocrinol Metab. 2008;93:1743–50.PubMedCrossRef
8.
Lerch C, Meissner T. Interventions for the prevention of nutritional rickets in term born children. Cochrane Database Syst Rev 2007;(4): CD006164.
9.
Underwood P, Margetts B. High levels of childhood rickets in rural North Yemen. Soc Sci Med. 1987;24:37–41.PubMedCrossRef
10.
Awwaad S, Khalifa AS, Naga MA, Tolba KA, Fares R, Gaballa AS, et al. A field survey on child health in a rural community in Egypt. J Trop Med Hyg. 1975;78:20–5.PubMed
11.
Lubani MM, Al-Shab TS, Al-Saleh QA, Sharda DC, Quattawi SA, Ahmed SA, et al. Vitamin-D-deficiency rickets in Kuwait: the prevalence of a preventable problem. Ann Trop Paediatr. 1989;9:134–9.PubMed
12.
Fida NM. Assessment of nutritional rickets in Western Saudi Arabia. Saudi Med J. 2003;24:337–40.PubMed
13.
Ozkan B, Doneray H, Karacan M, Vançelik S, Yildirim ZK, Ozkan A, et al. Prevalence of vitamin D deficiency rickets in the eastern part of Turkey. Eur J Pediatr. 2009;168(1):95–100.PubMedCrossRef
14.
Kimball S, El-Hajj Fuleihan G, Vieth R. Vitamin D: a growing perspective. Crit Rev Clin Lab Sci. 2008;45:339–415.PubMedCrossRef
15.
Abanamy A, Salman H, Cheriyan M, Shuja M, Siddrani S. Vitamin D deficiency in Riyadh. Ann Saudi Med. 1991;11:35–9.PubMed
16.
Elidrissy ATH. Vitamin D-deficiency rickets in Saudi Arabia. In: Glorieux EH, editor. Rickets. Nestle nutrition workshop series, vol. 21. New York: Raven press; 1991. p. 223–31.
17.
18.
Najada AS, Mabashneh MS, Khader M. The frequency of nutritional rickets among hospitalized infants and its relation to respiratory diseases. J Trop Pediatr. 2004;50:364–8.PubMedCrossRef
19.
Taha SA, Dost SM, Sedrani SH. 25-Hydroxyvitamin D and total calcium: extraordinarily low plasma concentrations in Saudi mothers and their neonates. Pediatr Res. 1984;18:739–41.PubMedCrossRef
20.
Dawodu A, Agarwal M, Sankarankutty M, Hardy D, Kochiyil J, Badrinath P. Higher prevalence of vitamin D deficiency in mothers of rachitic than nonrachitic children. J Pediatr. 2005;147:109–11.PubMedCrossRef
21.
Hatun S, Ozkan B, Orbak Z, Doneray H, Cizmecioglu F, Toprak D, et al. Vitamin D deficiency in early infancy. J Nutr. 2005;135:279–82.PubMed
22.
Amirhakimi GH. Rickets in a developing country: observations of general interest from Southern Iran. Clin Pediatr. 1973;12:88–92.CrossRef
23.
Nagi NA. Vitamin D deficiency rickets in malnourished children. J Trop Med Hyg. 1972;75:251–4.PubMed
24.
El Radhi AS, Majeed M, Mansor M, Ibrahim M. High incidence of rickets in children with wheezy bronchitis in a developing country. J R Soc Med. 1982;75:884–7.PubMed
25.
Erfan A, Nafie O, Neyaz AA, Hassanein MA. Vitamin D deficiency in maternity and children’s hospital, Makkah, Saudi Arabia. Ann Saudi Med. 1997;17:371–3.PubMed
26.
Al-Mustafa Z, Al-Madan M, Al-Majid Al-MuslemS, Al-Ateeq S, Al-Ali AK. Vitamin D deficiency and rickets in the eastern province of Saudi Arabia. Ann Trop Paediatr. 2007;27:63–7.PubMedCrossRef
27.
Abdullah MA, Salhi HS, Bakry LA, Okamoto E, Abomelha AM, Stevens B, et al. Adolescent rickets in Saudi Arabia: a rich and sunny country. J Pediatr Endocrinol Metab. 2002;15:1017–25.PubMed
28.
Al-Jurayyan NA, El-Desouki ME, Al-Herbish AS, Al-Mazyad AS, Al-Qhtani MM. Nutritional rickets and osteomalacia in school children and adolescents. Saudi Med J. 2002;23:182–5.PubMed
29.
Narchi H, El Jamil M, Kulaylat N. Symptomatic rickets in adolescents. Arch Dis Child. 2001;84:501–3.PubMedCrossRef
30.
Majid Molla A, Badawi MH, Al-Yaish S, Sharma P, el-Salam RS, Molla AM. Risk factors for nutritional rickets among children in Kuwait. Pediatr Int. 2000;42:280–4.PubMedCrossRef
31.
Rajah J, Jubeh J, Haq A, Shalash A, Parsons H. Nutritional rickets and Z scores for height in the United Arab Emirates: to D or not to D? Pediatr Int. 2008;50:424–8.PubMedCrossRef
32.
Lawson DE, Cole TJ, Salem SI, Galal OM, el-Meligy R, Abdel-Azim S, et al. Etiology of rickets in Egyptian children. Hum Nutr Clin Nutr. 1987;41:199–208.PubMed
33.
34.
Mathew PM, Imseeh GW. Convulsions as a possible manifestation of vitamin D deficiency rickets in infants 1–6 months of age. Ann Saudi Med. 1992;12:34–7.PubMed
35.
Ahmed I, Atiq M, Iqbal J, Khurshid M, Whittaker P. Vitamin D deficiency rickets in breast-fed infants presenting with hypocalcaemic seizures. Acta Paediatr. 1995;84:941–2.PubMedCrossRef
36.
Erdeve O, Atasay B, Arsan S, Siklar Z, Ocal G, Berberoğlu M. Hypocalcemic seizure due to congenital rickets in the first day of life. Turk J Pediatr. 2007;49:301–3.PubMed
37.
Karatekin G, Kaya A, Salihoglu O, Balci H, Nuhoğlu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr. 2007 [Epub ahead of print].
38.
Cesur Y, Caksen H, Gundem A, Kirimi E, Odabaş D. Comparison of low and high dose of vitamin D treatment in nutritional vitamin D deficiency rickets. J Pediatr Endocrinol Metab. 2003;16:1105–9.PubMed
39.
Maiya S, Sullivan I, AllgroveJ YatesR, Malone M, Brain C, Archer N, et al. Hypocalcaemia and vitamin D deficiency: an important, but preventable, cause of life-threatening infant heart failure. Heart. 2008;94:581–4.PubMedCrossRef
40.
Kosecik M, Ertas T. Dilated cardiomyopathy due to nutritional vitamin D deficiency rickets. Pediatr Int. 2007;49:397–9.PubMedCrossRef
41.
Amirlak I, Al Dhaheri W, Narchi H. Dilated cardiomyopathy secondary to nutritional rickets. Ann Trop Paediatr. 2008;28:227–30.PubMedCrossRef
42.
Robinson PD, Hogler W, Craid ME, Verge CF, Walker JL, Piper AC, et al. The re-emerging burden of rickets: a decade of experience from Sydney. Arch Dis Child. 2006;91:564–8.PubMedCrossRef
43.
Mallet E, Gaudelus J, Reinert P, Le Luyer B, Lecointre C, Léger J, et al. Symptomatic rickets in adolescents. Arch Pediatr. 2004;11:871–8.PubMedCrossRef
44.
45.
Lips P. Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem Mol Biol. 2007;103:620–5.PubMedCrossRef
46.
El-Hajj Fuleihan G, Vieth R. Vitamin D insufficiency and musculoskeletal health in children and adolescents. Int Congr Ser. 2007;1297:91–108. (Elsevier).CrossRef
47.
Biale Y, Shany S, Levi M, Shainkin-Kestenbaum R, Berlyne GM. 25 Hydroxy-cholecalciferol levels in Beduin women in labor and in cord blood of their infants. Am J Clin Nutr. 1979;32:2380–2.PubMed
48.
Dawodu A, Agarwal M, Hossain M, Kochiyil J, Zayed R. Hypovitaminosis D and vitamin D deficiency in exclusively breast-feeding infants and their mothers in summer; a justification for vitamin D supplementation of breast-feeding infants. J Pediatr. 2003;142:169–73.PubMedCrossRef
49.
Dawodu A, Dawson KP, Amirlak I, Kochiyil J, Agarwal M, Badrinath P. Diet, clothing, sunshine exposure and micronutrient status of Arab infants and young children. Ann Trop Paediatr. 2001;21:39–44.PubMedCrossRef
50.
Serenius F, Elidrissy AT, Dandona P. Vitamin D nutrition in pregnant women at term and in newly born babies in Saudi Arabia. J Clin Pathol. 1984;37:444–7.PubMedCrossRef
51.
Ainy E, Ghazi AA, Azizi F. Changes in calcium, 25(OH) vitamin D3 and other biochemical factors during pregnancy. J Endocrinol Invest. 2006;29:303–7.PubMed
52.
Bassir M, Laborie S, Lapillonne A, Claris O, Chappuis MC, Salle BL. Vitamin D deficiency in Iranian mothers and their neonates: a pilot study. Acta Paediatr. 2001;90:577–9.PubMedCrossRef
53.
Sabour H, Hossein-Nezhad A, Maghbooli Z, Madani F, Mir E, Larijani B. Relationship between pregnancy outcomes and maternal vitamin D and calcium intake: a cross-sectional study. Gynecol Endocrinol. 2006;22:585–9.PubMedCrossRef
54.
55.
Molla AM, Al Badawi M, Hammoud MS, Molla AM, Shukkur M, Thalib L, et al. Vitamin D status of mothers and their neonates in Kuwait. Pediatr Int. 2005;47:649–52.PubMedCrossRef
56.
Moussavi M, Heidarpour R, Aminorroaya A, Pournaghshband Z, Amini M. Prevalence of vitamin D deficiency in Isfahani high school students in 2004. Horm Res. 2005;64:144–8.PubMedCrossRef
57.
Siddiqui AM, Kamfar HZ. Prevalence of vitamin D deficiency rickets in adolescent school girls in western region, Saudi Arabia. Saudi Med J. 2007;28:441–4.PubMed
58.
El-Hajj Fuleihan G, Nabulsi M, Choucair M, Salamoun M, Hajj Shahine C, Kizirian A, et al. Hypovitaminosis D in healthy school children. Pediatrics. 2001;107:E53.PubMedCrossRef
59.
El-Hajj Fuleihan G, Nabulsi M, Tamim H, Maalouf J, Salamoun M, Khalife H, et al. Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab. 2006;91:405–12.PubMedCrossRef
60.
Rabbani A, Alavian SM, Motlagh ME, Ashtiani MT, Ardalan G, Salavati A, Rabbani B, Rabbani A, Shams S, Parvaneh N. Vitamin D insufficiency among children and adolescents living in Tehran, Iran. J Trop Pediatr. 2008 [Epub ahead of print].
61.
Dahifar H, Fraji A, Ghorbani A, Yassobi S. Impact of dietary and lifestyle on vitamin D in healthy student girls aged 11–15 years. J Med Invest. 2006;53:204–8.PubMedCrossRef
62.
Bener A, Al-Ali M, Hoffmann GF. Vitamin D deficiency in healthy children in a sunny country: associated factors. Int J Food Sci Nutr. 2008;22:1–11.CrossRef
63.
Looker AC, Dawson-Hughes B, Calvo MS, Gunter EW, Sahyoun NR. Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone. 2002;30:771–7.PubMedCrossRef
64.
Bahijri SM. Serum 25-hydroxy cholecalciferol in infants and preschool children in the western region of Saudi Arabia: etiological factors. Saudi Med J. 2001;22:973–9.PubMed
65.
Salamoun MM, Kizirian AS, Tannous RI, Nabulsi MM, Choucair MK, Deeb ME, et al. Low calcium and vitamin D intake in healthy children and adolescents and their correlates. Eur J Clin Nutr. 2005;59:177–84.PubMedCrossRef
66.
Sedrani SH, Elidrissy AW, El Arabi KM. Sunlight and vitamin D status in normal Saudi subjects. Am J Clin Nutr. 1983;38:129–32.PubMed
67.
Gannage-Yared MH, Chemali R, Yaacoub N, Halaby G. Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J Bone Miner Res. 2000;15:1856–62.PubMedCrossRef
68.
El-Hajj Fuleihan G, Deeb M. Letter to the Editor. Hypovitaminosis in a sunny country. N Engl J Med. 1999;340:1840–1.CrossRef
69.
Ghannam NN, Hammami MM, Bakheet SM, Khan BA. Bone mineral density of the spine and femur in healthy Saudi females: relation to vitamin D status, pregnancy, and lactation. Calcif Tissue Int. 1999;65:23–8.PubMedCrossRef
70.
71.
Mishal AA. Effects of different dress styles on vitamin D levels in healthy young Jordanian women. Osteoporos Int. 2001;12:931–5.PubMedCrossRef
72.
Hosseinpanah F, Rambod M, Hossein-Nejad A, Larijani B, Azizi F. Association between vitamin D and bone mineral density in Iranian postmenopausal women. J Bone Miner Metab. 2008;26:86–92.PubMedCrossRef
73.
Hashemipour S, Larijani B, Adibi H, Sedaghat M, Pajouhi M, Bastan-Hagh MH, et al. The status of biochemical parameters in varying degrees of vitamin D deficiency. J Bone Miner Metab. 2006;24:213–8.PubMedCrossRef
74.
Saadi HF, Nagelkerke N, Benedict S, Qazaq HS, Zilahi E, Mohamadiyeh MK, et al. Predictors and relationships of serum 25 hydroxyvitamin D concentration with bone turnover markers, bone mineral density, and vitamin D receptor genotype in Emirati women. Bone. 2006;39:1136–43.PubMedCrossRef
75.
Arabi A, Baddoura R, Awada H, Salamoun M, Ayoub G, El-Hajj Fuleihan G. Hypovitaminosis D osteopathy: is it mediated through PTH, lean mass, or is it a direct effect? Bone. 2006;39:268–75.PubMedCrossRef
76.
Atli T, Gullu S, Uysal AR, Erdogan G. The prevalence of vitamin D deficiency and effects of ultraviolet light on vitamin D levels in elderly Turkish population. Arch Gerontol Geriatr. 2005;40:53–60.PubMedCrossRef
77.
Weisman Y. Vitamin D deficiency rickets and osteomalacia in Israel. Isr Med Assoc J. 2003;5:289–90.PubMed
78.
Snijder MB, van Dam RM, Visser M, Deeg DJ, Dekker JM, Bouter LM, et al. Adiposity in relation to vitamin D status and parathyroid hormone levels. A population-based study in older men and women. J Clin Endocrinol Metab. 2005;90:4119–23.PubMedCrossRef
79.
El-Sonbaty MR, Abdul-Ghaffar NU. Vitamin D deficiency in veiled Kuwaiti women. Eur J Clin Nutr. 1996;50:315–8.PubMed
80.
Mirsaeid Ghazi AA, Rais Zadeh F, Pezeshk P, Azizi F. Seasonal variation of serum 25 hydroxy D3 in residents of Tehran. J Endocrinol Invest. 2004;27:676–9.PubMed
81.
Alagol F, Shihadeh Y, Boztepe H, Tanakol R, Yarman S, Azizlerli H, et al. Sunlight exposure and vitamin D deficiency in Turkish women. J Endocrinol Invest. 2000;7:783–9.
82.
Lips P, Hosking D, Lippuner K, Norquist JM, Wehren L, Maalouf G, et al. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Int Med. 2006;260:245–54.CrossRef
83.
Siam A/R, Hammoudeh M, Khanjer I, Bener A, Sarakbi H, Mehdi S. Vitamin D deficiency in Rheumatology clinic practice in Qatar. Qatar Med J. 2006;15:49–51.
84.
Goldray D, Mizrahi-Sasson E, Merdler C, Edelstein-Singer M, Algoetti A, Eisenberg Z, et al. Vitamin D deficiency in elderly patients in a general hospital. J Am Geriatr Soc. 1989;37:589–92.PubMed
85.
Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, et al. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998;338:777–83.PubMedCrossRef
86.
Preece MA, McIntosh WB, Tomlinson S, Ford JA, Dunnigan MG, O’Riordan JL. Vitamin D deficiency among Asian immigrants to Britain. Lancet. 1973;1:907–10.PubMedCrossRef
87.
Torrente de la Jara G, Pecoud A, Farrat B. Musculoskeletal pain in female asylum seekers and hypovitaminosis D3. BMJ. 2004;329:56–7.CrossRef
88.
Van der Meer IM, Boeke AJ, Lips P, Grootjans-Geerts I, Wuister JD, Devillé WL, et al. Fatty fish and supplements are the greatest modifiable contributors to hydroxyvitamin D concentration in multi-ethnic population. Clin Endocrinol. 2008;68:466–72.
89.
Van der Meer IM, Karamali NS, Boeke AJ, Lips P, Middelkoop BJ, Verhoeven I, et al. High prevalence of vitamin D deficiency in pregnant non-Western women in The Hague, Netherlands. Am J Clin Nutr. 2006;84:350–3.PubMed
90.
Holvik K, Meyer HE, Haug E, Brunvand L. Prevalence and predictors of vitamin D deficiency in five immigrant groups living in Oslo, Norway, the Oslo Immigrant Health Study. Eur J Clin Nutr. 2005;59:57–63.PubMedCrossRef
91.
Kovacs C, El-Hajj Fuleihan G. Calcium and bone disorders during pregnancy and lactation. Endocrinol Metab Clin North Am. 2006;35:21–51.PubMedCrossRef
92.
Dawson-Hughes B. Serum 25-hydroxyvitamin D and functional outcomes in the elderly. Am J Clin Nutr. 2008;88(2):537S–40S.PubMed
93.
Veith R, El-Hajj Fuleihan G. There is no lower threshold for parathyroid hormone as 25-hydroxy vitamin D concentration increases. J Endocrinol Invest. 2005;28:183–6.
94.
Rassouli A, Milanian I, Moslemi-Zadeh M. Determination of serum 25-hydroxyvitamin D (3) levels in early postmenopausal Iranian women: relationship with bone mineral density. Bone. 2001;29:428–30.PubMedCrossRef
95.
Akcam M, Yildiz M, Yilmaz A, Artan R. Bone mineral density in response to two different regimes in rickets. Indian Pediatr. 2006;43:423–7.PubMed
96.
Soliman A, Al Khalaf F, AlHemaidi N, Al Ali M, Al Zyoud M, Yakoot K. Linear growth in relation to the circulating concentrations of insulin-like growth factor I, parathyroid hormone, and 25-hydroxy vitamin D in children with nutritional rickets before and after treatment: endocrine adaptation to vitamin D deficiency. Metabolism. 2008;57:95–102.PubMedCrossRef
97.
Kutluk G, Cetinkaya F, Basak M. Comparisons of oral calcium, high dose vitamin D and a combination of these in the treatment of nutritional rickets in children. J Trop Pediatr. 2002;48:351–3.PubMedCrossRef
98.
Saadi HF, Dawodu A, Afandi BO, Zayed R, Benedict S, Nagelkerke N. Efficacy of daily and monthly high-dose calciferol in vitamin D-deficient nulliparous and lactating women. Am J Clin Nutr. 2007;85:1565–71.PubMed
99.
Wagner CL, Greer F, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122:1142–52.PubMedCrossRef
100.
Maalouf J, Nabulsi M, Vieth R, Kimball S, El-Rassi R, Mahfoud Z, et al. Short- and long-term safety of weekly high-dose vitamin D3 supplementation in school children. J Clin Endocrinol Metab. 2008;93:2693–701.PubMedCrossRef
101.
Ish Shalom S, Segal E, Salganik T, Raz B, Bromberg IL, Vieth R. Comparison of daily, weekly, and monthly vitamin D3 in ethanol dosing protocols for 2 months in elderly hip fracture patients. J Clin Endocrinol Metab. 2008;93:3430–5.PubMedCrossRef
102.
Shany S, Chaimovitz C, Yagev R, Bercovich M, Lowenthal MN. Vitamin D-deficiency in the elderly: treatment with ergocalciferol and hydroxylated analogues of vitamin D3. Isr J Med Sci. 1988;24:160–3.PubMed
103.
Arabi A, Baddoura R, El-Hajj Fuleihan G. PTH and not vitamin D predicts age related bone loss in the elderly: a prospective population-based study. J Bone Miner Res. 2008;23:S417.CrossRef
Metadata
Title
Vitamin D Deficiency in the Middle East and its Health Consequences for Children and Adults
Author
Ghada El-Hajj Fuleihan
Publication date
01-03-2009
Publisher
Humana Press Inc
Published in
Clinical & Translational Metabolism / Issue 1/2009
Print ISSN: 1534-8644
Electronic ISSN: 2948-2445
DOI
https://doi.org/10.1007/s12018-009-9027-9

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