Skip to main content

Advertisement

SpringerLink
Log in

Dietary intake of fish, n-3 polyunsaturated fatty acids, and risk of inflammatory bowel disease: a systematic review and meta-analysis of observational studies

  • Review
  • Published:
European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Purpose

Fish consumption and dietary intake of n-3 polyunsaturated acids (PUFAs) may be associated with inflammatory bowel disease (IBD). We aimed to conduct a systematic review and summarize published articles on the association between fish consumption and dietary intake of n-3 PUFAs with the risk of IBD.

Methods

PubMed, Scopus, and Web of Science databases were used to conduct a comprehensive search and identify eligible literature published prior to January 2019. Fixed-effects model or random-effects models (DerSimonian–Laird method) were applied to pool the effect sizes. Cochrane Q test was used to trace the potential source of heterogeneity across studies.

Results

12 studies (5 prospective and 7 case–control) were included in the systematic review, which ten of them were eligible for inclusion in the meta-analysis. Studies were included a total sample size of 282610 participants which 2002 of them were cases of IBD [1061 Crohn’s disease (CD) and 937 ulcerative colitis (UC)]. A negative association was found between fish consumption and the incidence of CD (pooled effect size: 0.54, 95%CI: 0.31–0.96, P = 0.03). There was no relationship between total dietary n-3 PUFAs intake and IBD (pooled effect size: 1.17, 95%CI: 0.80–1.72, P = 0.41). A significant inverse association was observed between dietary long-chain n-3 PUFAs and the risk of UC (pooled effect size: 0.75, 95%CI: 0.57–0.98, P = 0.03). Moreover, no association was found between α-Linolenic acid (ALA) and IBD (pooled effect size: 1.17, 95%CI: 0.63–2.17, P = 0.62).

Conclusions

Findings showed a negative association between fish consumption and the risk of CD. Moreover, there was a significant inverse association between dietary long-chain n-3 PUFAs and the risk of UC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Molodecky NA, Soon S, Rabi DM, Ghali WA, Ferris M, Chernoff G, Benchimol EI, Panaccione R, Ghosh S, Barkema HW (2012) Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 142(1):46–54.e42

    Article  PubMed  Google Scholar 

  2. Cho JH (2008) The genetics and immunopathogenesis of inflammatory bowel disease. Nat Rev Immunol 8(6):458

    Article  CAS  PubMed  Google Scholar 

  3. Jantchou P, Monnet E, Carbonnel F (2006) Environmental risk factors in Crohn’s disease and ulcerative colitis (excluding tobacco and appendicectomy). Gastroenterol Clin Biol 30(6–7):859–867

    Article  PubMed  Google Scholar 

  4. Cho JH, Abraham C (2007) Inflammatory bowel disease genetics: Nod2. Annu Rev Med 58:401–416

    Article  CAS  PubMed  Google Scholar 

  5. Lee D, Albenberg L, Compher C, Baldassano R, Piccoli D, Lewis JD, Wu GD (2015) Diet in the pathogenesis and treatment of inflammatory Bowelá diseases. Gastroenterology 148(6):1087–1106

    Article  CAS  PubMed  Google Scholar 

  6. Cashman KD, Shanahan F (2003) Is nutrition an aetiological factor for inflammatory bowel disease? Eur J Gastroenterol Hepatol 15(6):607–613

    Article  CAS  PubMed  Google Scholar 

  7. Boeing H, Bechthold A, Bub A, Ellinger S, Haller D, Kroke A, Leschik-Bonnet E, Müller MJ, Oberritter H, Schulze M (2012) Critical review: vegetables and fruit in the prevention of chronic diseases. Eur J Nutr 51(6):637–663

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Mouli VP, Ananthakrishnan AN (2014) vitamin D and inflammatory bowel diseases. Aliment Pharmacol Ther 39(2):125–136

    Article  CAS  PubMed  Google Scholar 

  9. Oldenburg B, Koningsberger J, Van Berge Henegouwen G, Van Asbeck B, Marx J (2001) Iron and inflammatory bowel disease. Aliment Pharmacol Ther 15(4):429–438

    Article  CAS  PubMed  Google Scholar 

  10. Mori TA, Beilin LJ (2004) Omega-3 fatty acids and inflammation. Curr Atheroscler Rep 6(6):461–467

    Article  PubMed  Google Scholar 

  11. Abubakar I, Myhill DJ, Hart AR, Lake IR, Harvey I, Rhodes JM, Robinson R, Lobo AJ, Probert CS, Hunter PR (2007) A case-control study of drinking water and dairy products in Crohn’s disease—further investigation of the possible role of Mycobacterium avium paratuberculosis. Am J Epidemiol 165(7):776–783

    Article  PubMed  Google Scholar 

  12. Ananthakrishnan AN, Khalili H, Konijeti GG, Higuchi LM, de Silva P, Fuchs CS, Willett WC, Richter JM, Chan AT (2014) Long-term intake of dietary fat and risk of ulcerative colitis and Crohn’s disease. Gut 63(5):776–784

    Article  CAS  PubMed  Google Scholar 

  13. Ananthakrishnan AN, Khalili H, Song M, Higuchi LM, Richter JM, Nimptsch K, Wu K, Chan AT (2015) High school diet and risk of Crohn’s disease and ulcerative colitis. Inflamm Bowel Dis 21(10):2311–2319

    PubMed  Google Scholar 

  14. Chan S, Luben R, Olsen A, Tjonneland A, Kaaks R, Lindgren S, Grip O, Bergmann M, Boeing H, Hallmans G (2014) Association between high dietary intake of the n – 3 polyunsaturated fatty acid docosahexaenoic acid and reduced risk of Crohn’s disease. Aliment Pharmacol Ther 39(8):834–842

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Investigators IiES (2009) Linoleic acid, a dietary n-6 polyunsaturated fatty acid, and the aetiology of ulcerative colitis: a nested case–control study within a European prospective cohort study. Gut 58(12):1606–1611

    Article  CAS  Google Scholar 

  16. Jantchou P, Morois S, Clavel-Chapelon F, Boutron-Ruault M-C, Carbonnel F (2010) Animal protein intake and risk of inflammatory bowel disease: the E3N prospective study. Am J Gastroenterol 105(10):2195

    Article  CAS  PubMed  Google Scholar 

  17. Maconi G, Ardizzone S, Cucino C, Bezzio C, Russo AG, Porro GB (2010) Pre-illness changes in dietary habits and diet as a risk factor for inflammatory bowel disease: a case-control study. World J Gastroenterol WJG 16(34):4297

    Article  PubMed  Google Scholar 

  18. Pugazhendhi S, Sahu MK, Subramanian V, Pulimood A, Ramakrishna BS (2011) Environmental factors associated with Crohn’s disease in India. Indian J Gastroenterol 30(6):264–269

    Article  PubMed  Google Scholar 

  19. Rashvand S, Somi MH, Rashidkhani B, Hekmatdoost A (2015) Dietary protein intakes and risk of ulcerative colitis. Med J Islam Repub Iran 29:253

    PubMed  PubMed Central  Google Scholar 

  20. Rashvand S, Somi MH, Rashidkhani B, Hekmatdoost A (2015) Dietary fatty acid intakes are related to the risk of ulcerative colitis: a case–control study. Int J Colorectal Dis 30(9):1255–1260

    Article  PubMed  Google Scholar 

  21. Reif S, Klein I, Lubin F, Farbstein M, Hallak A, Gilat T (1997) Pre-illness dietary factors in inflammatory bowel disease. Gut 40(6):754–760

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Sakamoto N, Kono S, Wakai K, Fukuda Y, Satomi M, Shimoyama T, Inaba Y, Miyake Y, Sasaki S, Okamoto K (2005) Dietary risk factors for inflammatory bowel disease A multicenter case–control Study in Japan. Inflamm Bowel Dis 11(2):154–163

    Article  PubMed  Google Scholar 

  23. Turner D, Shah PS, Steinhart AH, Zlotkin S, Griffiths AM (2011) Maintenance of remission in inflammatory bowel disease using omega-3 fatty acids (fish oil): a systematic review and meta-analyses. Inflamm Bowel Dis 17(1):336–345

    Article  PubMed  Google Scholar 

  24. Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341

    Article  PubMed  Google Scholar 

  25. Wells G, Shea B, O’connell D, Peterson J, Welch V, Losos M, Tugwell P (2016) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa (ON): Ottawa Hospital Research Institute, 2009. (Available in March)

  26. Mozaffari H, Djafarian K, Mofrad M, Shab-Bidar S (2018) Dietary fat, saturated fatty acid, and monounsaturated fatty acid intakes and risk of bone fracture: a systematic review and meta-analysis of observational studies. Osteoporos Int 2018:1–13

    Google Scholar 

  27. Higgins JP, Green S (2011) Cochrane handbook for systematic reviews of interventions, vol 4. Wiley, Hoboken

    Google Scholar 

  28. Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Marlow G, Ellett S, Ferguson IR, Zhu S, Karunasinghe N, Jesuthasan AC, Han DY, Fraser AG, Ferguson LR (2013) Transcriptomics to study the effect of a Mediterranean-inspired diet on inflammation in Crohn’s disease patients. Hum Genomics 7(1):24

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Amre DK, D’souza S, Morgan K, Seidman G, Lambrette P, Grimard G, Israel D, Mack D, Ghadirian P, Deslandres C (2007) Imbalances in dietary consumption of fatty acids, vegetables, and fruits are associated with risk for Crohn’s disease in children. Am J Gastroenterol 102(9):2016

    Article  CAS  PubMed  Google Scholar 

  31. D’souza S, Levy E, Mack D, Israel D, Lambrette P, Ghadirian P, Deslandres C, Morgan K, Seidman EG, Amre DK (2007) Dietary patterns and risk for Crohn’s disease in children. Inflamm Bowel Dis 14(3):367–373

    Article  Google Scholar 

  32. Tasson L, Canova C, Vettorato MG, Savarino E, Zanotti R (2017) Influence of diet on the course of inflammatory bowel disease. Dig Dis Sci 62(8):2087–2094

    Article  CAS  PubMed  Google Scholar 

  33. Andersen V, Olsen A, Carbonnel F, Tjønneland A, Vogel U (2012) Diet and risk of inflammatory bowel disease. Dig Dis Sci 44(3):185–194

    CAS  Google Scholar 

  34. Gentschew L, Ferguson LR (2012) Role of nutrition and microbiota in susceptibility to inflammatory bowel diseases. Mol Nutr Food Res 56(4):524–535

    Article  CAS  PubMed  Google Scholar 

  35. Benno Y, Suzuki K, Suzuki K, Narisawa K, Bruce WR, Mitsuoka T (1986) Comparison of the fecal microflora in rural Japanese and urban Canadians. Microbiol Immunol 30(6):521–532

    Article  CAS  PubMed  Google Scholar 

  36. Benno Y, Endo K, Miyoshi H, Okuda T, Koishi H, Mitsuoka T (1989) Effect of rice fiber on human fecal microflora. Microbiol Immunol 33(5):435–440

    Article  CAS  PubMed  Google Scholar 

  37. Ogura Y, Bonen DK, Inohara N, Nicolae DL, Chen FF, Ramos R, Britton H, Moran T, Karaliuskas R, Duerr RH (2001) A frameshift mutation in NOD2 associated with susceptibility to Crohn’s disease. Nature 411(6837):603

    Article  CAS  PubMed  Google Scholar 

  38. Hisamatsu T, Suzuki M, Reinecker H-C, Nadeau WJ, McCormick BA, Podolsky DK (2003) CARD15/NOD2 functions as an antibacterial factor in human intestinal epithelial cells. Gastroenterology 124(4):993–1000

    Article  CAS  PubMed  Google Scholar 

  39. Flores A, Burstein E, Cipher DJ, Feagins LA (2015) Obesity in inflammatory bowel disease: a marker of less severe disease. Dig Dis Sci 60(8):2436–2445

    Article  CAS  PubMed  Google Scholar 

  40. Aljada A, Mohanty P, Ghanim H, Abdo T, Tripathy D, Chaudhuri A, Dandona P (2004) Increase in intranuclear nuclear factor κB and decrease in inhibitor κB in mononuclear cells after a mixed meal: evidence for a proinflammatory effect. Am J Clin Nutr 79(4):682–690

    Article  CAS  PubMed  Google Scholar 

  41. Chapman-Kiddell CA, Davies PS, Gillen L, Radford-Smith GL (2010) Role of diet in the development of inflammatory bowel disease. Inflamm Bowel Dis 16(1):137–151

    Article  PubMed  Google Scholar 

  42. Dandona P, Aljada A, Bandyopadhyay A (2004) Inflammation: the link between insulin resistance, obesity and diabetes. Trends Immunol 25(1):4–7

    Article  CAS  PubMed  Google Scholar 

  43. Walters WA, Xu Z, Knight R (2014) Meta-analyses of human gut microbes associated with obesity and IBD. FEBS Lett 588(22):4223–4233

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Miller LG, Goldstein G, Murphy M, Ginns LC (1982) Reversible alterations in immunoregulatory T cells in smoking: analysis by monoclonal antibodies and flow cytometry. Chest 82(5):526–529

    Article  CAS  PubMed  Google Scholar 

  45. Srivastava E, Russell M, Feyerabend C, Rhodes J (1990) Effect of ulcerative colitis and smoking on rectal blood flow. Gut 31(9):1021–1024

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Thomas GA, Rhodes J, Green JT, Richardson C (2000) Role of smoking in inflammatory bowel disease: implications for therapy. Postgrad Med J 76(895):273–279

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Prytz H, Benoni C, Tagesson C (1989) Does smoking tighten the gut? Scand J Gastroenterol 24(9):1084–1088

    Article  CAS  PubMed  Google Scholar 

  48. John S, Luben R, Shrestha SS, Welch A, Khaw K-T, Hart AR (2010) Dietary n-3 polyunsaturated fatty acids and the aetiology of ulcerative colitis: a UK prospective cohort study. Eur J Gastroenterol Hepatol 22(5):602–606

    Article  CAS  PubMed  Google Scholar 

  49. Hekmatdoost A, Wu X, Morampudi V, Innis SM, Jacobson K (2013) Dietary oils modify the host immune response and colonic tissue damage following Citrobacter rodentium infection in mice. Am J Physiol Gastrointest Liver Physiol 304(10):G917–G928

    Article  CAS  PubMed  Google Scholar 

  50. Hekmatdoost A, Mirshafiey A, Feizabadi MM, Djazayeri A (2009) Polyunsaturated fatty acids, microflora and colitis. Ann Nutr Metabol 55(4):325–325

    Article  CAS  Google Scholar 

  51. Hekmatdoost A, Feizabadi MM, Djazayery A, Mirshafiey A, Eshraghian MR, Yeganeh SM, Sedaghat R, Jacobson K (2008) The effect of dietary oils on cecal microflora in experimental colitis in mice. Indian J Gastroenterol 27(5):186–189

    PubMed  Google Scholar 

  52. Nieto N, Torres MI, Ríos A, Gil A (2002) Dietary polyunsaturated fatty acids improve histological and biochemical alterations in rats with experimental ulcerative colitis. J Nutr 132(1):11–19

    Article  CAS  PubMed  Google Scholar 

  53. Uchiyama K, Nakamura M, Odahara S, Koido S, Katahira K, Shiraishi H, Ohkusa T, Fujise K, Tajiri H (2010) N-3 polyunsaturated fatty acid diet therapy for patients with inflammatory bowel disease. Inflamm Bowel Dis 16(10):1696–1707

    Article  PubMed  Google Scholar 

  54. Collie-Duguid E, Wahle K (1996) Inhibitory effect of fish oil N-3 polyunsaturated fatty acids on the expression of endothelial cell adhesion molecules. Biochem Biophys Res Commun 220(3):969–974

    Article  CAS  PubMed  Google Scholar 

  55. Shores DR, Binion DG, Freeman BA, Baker PR (2010) New insights into the role of fatty acids in the pathogenesis and resolution of inflammatory bowel disease. Inflamm Bowel Dis 17(10):2192–2204

    Article  PubMed  Google Scholar 

  56. Esteve-Comas M, Nunez M, Fernández-Bañares F, Abad-Lacruz A, Gil A, Cabre E, Gonzalez-Huix F, Bertran X, Gassull M (1993) Abnormal plasma polyunsaturated fatty acid pattern in non-active inflammatory bowel disease. Gut 34(10):1370–1373

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Kawakami Y, Okada H, Murakami Y, Kawakami T, Ueda Y, Kunii D, Sakamoto Y, Shiratori Y, Okita M (2007) Dietary intake, neutrophil fatty acid profile, serum antioxidant vitamins and oxygen radical absorbance capacity in patients with ulcerative colitis. J Nutr Sci Vitaminol 53(2):153–159

    Article  CAS  PubMed  Google Scholar 

  58. Nishida T, Miwa H, Shigematsu A, Yamamoto M, Iida M, Fujishima M (1987) Increased arachidonic acid composition of phospholipids in colonic mucosa from patients with active ulcerative colitis. Gut 28(8):1002–1007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Marion-Letellier R, Savoye G, Beck PL, Panaccione R, Ghosh S (2013) Polyunsaturated fatty acids in inflammatory bowel diseases: a reappraisal of effects and therapeutic approaches. Inflamm Bowel Dis 19(3):650–661

    Article  PubMed  Google Scholar 

  60. Weatherill AR, Lee JY, Zhao L, Lemay DG, Youn HS, Hwang DH (2005) Saturated and polyunsaturated fatty acids reciprocally modulate dendritic cell functions mediated through TLR4. J Immunol 174(9):5390–5397

    Article  CAS  PubMed  Google Scholar 

  61. Novak TE, Babcock TA, Jho DH, Helton WS, Espat NJ (2003) NF-κB inhibition by ω-3 fatty acids modulates LPS-stimulated macrophage TNF-α transcription. Am J Physiol Lung Cell Mol Physiol 284(1):L84–L89

    Article  CAS  PubMed  Google Scholar 

  62. Hughes R, Magee E, Bingham S (2000) Protein degradation in the large intestine: relevance to colorectal cancer. Curr Issues Intestinal Microbiol 1(2):51–58

    CAS  Google Scholar 

  63. Roediger W (2008) Nitric oxide from dysbiotic bacterial respiration of nitrate in the pathogenesis and as a target for therapy of ulcerative colitis. Aliment Pharmacol Ther 27(7):531–541

    Article  CAS  PubMed  Google Scholar 

  64. Weylandt KH, Chiu C-Y, Gomolka B, Waechter SF, Wiedenmann B (2012) Omega-3 fatty acids and their lipid mediators: towards an understanding of resolvin and protectin formation. Prostaglandins Other Lipid Mediat 97(3–4):73–82

    Article  CAS  PubMed  Google Scholar 

  65. Depner CM, Philbrick KA, Jump DB (2013) Docosahexaenoic acid attenuates hepatic inflammation, oxidative stress, and fibrosis without decreasing hepatosteatosis in a Ldlr–/– mouse model of western diet-induced nonalcoholic steatohepatitis1–3. J Nutr 143(3):315–323

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Goldman D, Pickett W, Goetzl E (1983) Human neutrophil chemotactic and degranulating activities of leukotriene B5 (LTB5) derived from eicosapentaenoic acid. Biochem Biophys Res Commun 117(1):282–288

    Article  CAS  PubMed  Google Scholar 

  67. Rodríguez-Lagunas MJ, Ferrer R, Moreno JJ (2013) Effect of eicosapentaenoic acid-derived prostaglandin E3 on intestinal epithelial barrier function. Prostaglandins Leukot Essent Fatty Acids 88(5):339–345

    Article  PubMed  CAS  Google Scholar 

  68. Patterson E, Wall R, Fitzgerald G, Ross R, Stanton C (2012) Health implications of high dietary omega-6 polyunsaturated fatty acids. J Nutr Metabol 2012:539426

    Article  CAS  Google Scholar 

  69. Turner D, Steinhart AH, Griffiths AM (2007) Omega 3 fatty acids (fish oil) for maintenance of remission in ulcerative colitis. Cochrane Database of Syst Rev 18(3):CD006443

    Google Scholar 

  70. Scaioli E, Liverani E, Belluzzi A (2017) The imbalance between n-6/n-3 polyunsaturated fatty acids and inflammatory bowel disease: a comprehensive review and future therapeutic perspectives. Int J Mol Sci 18(12):2619

    Article  PubMed Central  CAS  Google Scholar 

  71. Blasbalg TL, Hibbeln JR, Ramsden CE, Majchrzak SF, Rawlings RR (2011) Changes in consumption of omega-3 and omega-6 fatty acids in the United States during the 20th century. Am J Clin Nutr 93(5):950–962

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Meyer BJ, Mann NJ, Lewis JL, Milligan GC, Sinclair AJ, Howe PR (2003) Dietary intakes and food sources of omega-6 and omega-3 polyunsaturated fatty acids. Lipids 38(4):391–398

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by National Institute for Medical Research Development (Grant and Ethics Number: 977288).

Author information

Authors and Affiliations

  1. Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, P. O. Box: 1416643931, Tehran, Iran

    Hadis Mozaffari, Elnaz Daneshzad & Leila Azadbakht

  2. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Bagher Larijani

  3. School of Nutrition, Ryerson University, Toronto, Canada

    Nick Bellissimo

  4. Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Leila Azadbakht

Authors
  1. Hadis Mozaffari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elnaz Daneshzad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bagher Larijani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nick Bellissimo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leila Azadbakht
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LA and HM designed the study. Searching processes, data extraction, statistical analysis, and manuscript drafting performed by HM and reviewed by ED, BL, NB, and LA. LA supervised all the study processes and checked the search strategy processing and statistical analysis. The final version of the manuscript was approved by all authors.

Corresponding author

Correspondence to Leila Azadbakht.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 645 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mozaffari, H., Daneshzad, E., Larijani, B. et al. Dietary intake of fish, n-3 polyunsaturated fatty acids, and risk of inflammatory bowel disease: a systematic review and meta-analysis of observational studies. Eur J Nutr 59, 1–17 (2020). https://doi.org/10.1007/s00394-019-01901-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00394-019-01901-0

Keywords

Search

Navigation