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Nguyen TT, Nguyen MH, Nguyen YH, Nguyen TTP, Giap MH, Tran TDX, Pham TTM, Pham KM, Nguyen KT, Le VTT, Su CT, Duong TV. Body mass index, body fat percentage, and visceral fat as mediators in the association between health literacy and hypertension among residents living in rural and suburban areas. Front Med (Lausanne) 2022; 9:877013. [PMID: 36148456 PMCID: PMC9485490 DOI: 10.3389/fmed.2022.877013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Hypertension is a major cause of death and disability worldwide. Enhancing health literacy (HL) may help to alleviate the risk of hypertension and its burden. However, evidence on the association between HL and hypertension and potential mechanisms remain to be explored. Objectives This study examined the association between HL and hypertension; and explored whether body mass index (BMI), body fat percentage (PBF), and visceral fat (VF) were mediators of this association in people who resided in rural and suburban areas in Vietnam. Methods A cross-sectional survey was conducted from 1st July to 31st December 2019, involving 1655 residents and exploring participants' sociodemographic characteristics, HL, health-related behaviors, comorbidities, body composition, and blood pressure (BP). People with systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or using antihypertensive medication were classified as having hypertension. Multiple logistic regression and mediation analyses were used to explore associations. Results The hypertension prevalence was 41.9% (694/1,655). In adjusted models, a higher HL score was associated with a lower hypertension likelihood (OR = 0.96; 95%CI = 0.95–0.97; p < 0.001). Factors associated with a higher odd of hypertension were overweight/obese (OR = 1.69; 95%CI = 1.24–2.29; p = 0.001), high PBF (OR = 2.35; 95%CI = 1.85–2.99; p < 0.001), and high VF (OR = 2.27; 95%CI = 1.63–3.16; p < 0.001). Notably, PBF significantly mediated the association between HL and hypertension (indirect effect, OR = 0.99; 95%CI = 0.98–0.99; p = 0.009; percent mediated = 8.56%). The mediating roles of BMI and VF were not found. Conclusion The prevalence of hypertension was relatively high. People with better HL were less likely to have hypertension. The association between HL and hypertension was partially explained by PBF. Strategic approaches are required to improve people's HL and body fat which further help to manage hypertension in rural and suburban areas.
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Affiliation(s)
- Tham T. Nguyen
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Minh H. Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen H. Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Department of Pharmacy, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam
- Ph.D. Program in School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Thao T. P. Nguyen
- Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Manh H. Giap
- Emergency Department, Bai Chay Hospital, Hạ Long, Vietnam
| | - Tung D. X. Tran
- Stem Cell Unit, Van Hanh Hospital, Ho Chi Minh, Vietnam
- Hi-Tech Institute, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Thu T. M. Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Khue M. Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Kien T. Nguyen
- Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Vinh-Tuyen T. Le
- Department of Pharmacognosy - Traditional Pharmacy - Pharmaceutical Botanic, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Ph.D. Program in Clinical Drug Development of Herbal Medicine, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chien-Tien Su
- School of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tuyen Van Duong
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Tuyen Van Duong
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Nguyen TT, Nguyen MH, Pham TTM, Le VTT, Nguyen TT, Luong TC, Do BN, Dao HK, Nguyen HC, Ha TH, Pham LV, Nguyen PB, Nguyen HTT, Do TV, Nguyen HQ, Trinh MV, Le TT, Tra AL, Nguyen TTP, Nguyen KT, Phan DT, Pham KM, Bai CH, Duong TV. Negative Impacts of COVID-19 Induced Lockdown on Changes in Eating Behavior, Physical Activity, and Mental Health as Modified by Digital Healthy Diet Literacy and eHealth Literacy. Front Nutr 2021; 8:774328. [PMID: 34869540 PMCID: PMC8633895 DOI: 10.3389/fnut.2021.774328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The COVID-19-induced lockdown has been implemented in many countries, which may cause unfavorable changes in lifestyles and psychological health. People's health literacy, healthy diet, and lifestyles play important roles in mitigating the negative impacts of the pandemic. Therefore, we aimed to examine associations of COVID-19 lockdown with changes in eating behavior, physical activity, and mental health; and the modification effects by digital healthy diet literacy (DDL) and eHealth literacy (eHEALS) on the associations. Methods: We conducted an observational study on 4,348 outpatients from 7th April to 31st May 2020. Data from 11 hospitals in Vietnam included demographic characteristics, DDL, eHEALS, eating behavior, physical activity, and mental health changes. Multiple logistic regression and interaction models were performed to examine associations. Results: Patients under lockdown had a lower likelihood of having “unchanged or healthier” eating behavior (odds ratio, OR, 0.38; 95% confidence interval, 95%CI, 0.29 to 0.51; p < 0.001), “unchanged or more” physical activity (OR, 0.79; 95% CI, 0.69 to 0.90; p < 0.001), and “stable or better” mental health (OR, 0.77; 95% CI, 0.67 to 0.89; p < 0.001), as compared to those after lockdown. In interaction models, as compared to patients after lockdown and with the lowest DDL score, those under lockdown and with a one-score increment of DDL had a higher likelihood of having “unchanged or healthier” eating behavior (OR, 1.05; 95% CI, 1.02 to 1.07; p < 0.001), and “stable or better” mental health (OR, 1.02; 95% CI, 1.01 to 1.04; p < 0.001). Similarly, as compared to patients after lockdown and with the lowest eHEALS score, those under lockdown and with a one-score increment of eHEALS had a higher likelihood of having an “unchanged or more” physical activity (OR, 1.03; 95% CI, 1.01 to 1.05; p < 0.001). Conclusion: The COVID-19 lockdown measure could negatively affect eating behavior, physical activity, and mental health among outpatients. Better DDL and eHEALS were found to mitigate the negative impacts of the lockdown, which may empower outpatients to maintain healthy lifestyles and protect mental health. However, this study holds several limitations that may undermine the certainty of reported findings.
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Affiliation(s)
- Tham T Nguyen
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Minh H Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Thu T M Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Vinh-Tuyen T Le
- Department of Pharmacognosy-Traditional Pharmacy-Pharmaceutical Botanic, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.,Ph.D. Program in Clinical Drug Development of Herbal Medicine, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Tan T Nguyen
- Department of Orthopedics, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.,Director Office, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam
| | - Thuc C Luong
- Director Office, Military Hospital 103, Hanoi, Vietnam.,Department of Cardiology, Cardiovascular Center, Military Hospital 103, Hanoi, Vietnam
| | - Binh N Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam.,Division of Military Science, Military Hospital 103, Hanoi, Vietnam
| | - Hung K Dao
- Director Office, Bac Ninh Obstetrics and Pediatrics Hospital, Bac Ninh, Vietnam
| | - Huu C Nguyen
- Director Office, E Hospital, Hanoi, Vietnam.,Department of Thoracic and Cardiovascular Surgery, E Hospital, Hanoi, Vietnam
| | - Tung H Ha
- Director Office, General Hospital of Agricultural, Hanoi, Vietnam
| | - Linh V Pham
- Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam.,Director Office, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam
| | | | - Hoai T T Nguyen
- Training and Direction of Healthcare Activity Center, Kien An Hospital, Hai Phong, Vietnam
| | - Thinh V Do
- Director Office, Bai Chay Hospital, Quang Ninh, Vietnam
| | - Hung Q Nguyen
- Director Office, Quang Ninh Obstetrics and Pediatrics Hospital, Quang Ninh, Vietnam
| | - Manh V Trinh
- Director Office, Quang Ninh General Hospital, Quang Ninh, Vietnam
| | - Thuy T Le
- Faculty of Medical Laboratory Science, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam.,President Office, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Anh L Tra
- Department of Physiotherapy and Rehabilitation, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Thao T P Nguyen
- Health Management Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Kien T Nguyen
- Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Dung T Phan
- Faculty of Nursing, Hanoi University of Business and Technology, Hanoi, Vietnam.,Nursing Office, Thien An Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Khue M Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam.,President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Chyi-Huey Bai
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
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Vu DN, Phan DT, Nguyen HC, Le LTH, Nguyen HC, Ha TH, Dao HK, Trinh MV, Do TV, Nguyen HQ, Nguyen TTP, Le TT, Tran CQ, Tran KV, Duong TT, Pham HX, Le VTT, Van Duong T. Impacts of Digital Healthy Diet Literacy and Healthy Eating Behavior on Fear of COVID-19, Changes in Mental Health, and Health-Related Quality of Life among Front-Line Health Care Workers. Nutrients 2021; 13:nu13082656. [PMID: 34444814 PMCID: PMC8398620 DOI: 10.3390/nu13082656] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/23/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We aimed to examine the impacts of digital healthy diet literacy (DDL) and healthy eating behaviors (HES) on fear of COVID-19, changes in mental health, and health-related quality of life (HRQoL) among front-line healthcare workers (HCWs). METHODS An online survey was conducted at 15 hospitals and health centers from 6-19 April 2020. Data of 2299 front-line HCWs were analyzed-including socio-demographics, symptoms like COVID-19, health literacy, eHealth literacy, DDL, HES, fear of COVID-19, changes in mental health, and HRQoL. Regression models were used to examine the associations. RESULTS HCWs with higher scores of DDL and HES had lower scores of FCoV-19S (regression coefficient, B, -0.04; 95% confidence interval, 95% CI, -0.07, -0.02; p = 0.001; and B, -0.10; 95% CI, -0.15, -0.06; p < 0.001); had a higher likelihood of stable or better mental health status (odds ratio, OR, 1.02; 95% CI, 1.00, 1.05; p = 0.029; and OR, 1.04; 95% CI, 1.00, 1.07; p = 0.043); and HRQoL (OR, 1.02; 95% CI, 1.01, 1.03; p = 0.006; and OR, 1.04; 95% CI, 1.02, 1.06; p = 0.001), respectively. CONCLUSIONS DDL and HES were found as independent predictors of fear of COVID-19, changes in mental health status, and HRQoL in front-line HCWs. Improving DDL and HES should be considered as a strategic approach for hospitals and healthcare systems.
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Affiliation(s)
- Dinh N. Vu
- Director Office, Military Hospital 103, Hanoi 121-08, Vietnam;
- Department of Trauma and Orthopedic Surgery, Vietnam Military Medical University, Hanoi 121-08, Vietnam
| | - Dung T. Phan
- Nursing Office, Thien An Obstetrics and Gynecology Hospital, Hanoi 112-06, Vietnam;
- Faculty of Nursing, Hanoi University of Business and Technology, Hanoi 116-22, Vietnam
| | - Hoang C. Nguyen
- Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam; (H.C.N.); (L.T.H.L.)
- President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City 241-17, Vietnam
| | - Lan T. H. Le
- Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam; (H.C.N.); (L.T.H.L.)
- Training and Direction of Healthcare Activity Center, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
- Biochemistry Department, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
| | - Huu C. Nguyen
- Director Office, E Hospital, Hanoi 113-08, Vietnam;
- Department of Thoracic and Cardiovascular Surgery, E Hospital, Hanoi 113-08, Vietnam
| | - Tung H. Ha
- Director Office, General Hospital of Agricultural, Hanoi 125-16, Vietnam;
| | - Hung K. Dao
- Director Office, Bac Ninh Obstetrics and Pediatrics Hospital, Bac Ninh 161-23, Vietnam;
| | - Manh V. Trinh
- Director Office, Quang Ninh General Hospital, Quang Ninh 011-08, Vietnam;
| | - Thinh V. Do
- Director Office, Bai Chay Hospital, Quang Ninh 011-21, Vietnam;
| | - Hung Q. Nguyen
- Director Office, Quang Ninh Obstetrics and Pediatrics Hospital, Quang Ninh 011-24, Vietnam;
| | - Thao T. P. Nguyen
- Health Management Training Institute, University of Medicine and Pharmacy, Hue University, Thua Thien Hue 491-20, Vietnam;
- Department of Health Economics, Corvinus University of Budapest, 1093 Budapest, Hungary
| | - Thuy T. Le
- Faculty of Medical Laboratory Science, Da Nang University of Medical Technology and Pharmacy, Da Nang 502-06, Vietnam;
- President Office, Da Nang University of Medical Technology and Pharmacy, Da Nang 502-06, Vietnam
| | - Cuong Q. Tran
- Director Office, Thu Duc City Health Center, Ho Chi Minh City 713-10, Vietnam; (C.Q.T.); (H.X.P.)
- Faculty of Health, Mekong University, Vinh Long 852-16, Vietnam
| | - Khanh V. Tran
- Director Office, Le Van Thinh Hospital (Previously Hospital District 2), Ho Chi Minh City 711-13, Vietnam;
| | - Trang T. Duong
- Nursing Office, Tan Phu District Hospital, Ho Chi Minh City 720-16, Vietnam;
| | - Hai X. Pham
- Director Office, Thu Duc City Health Center, Ho Chi Minh City 713-10, Vietnam; (C.Q.T.); (H.X.P.)
| | - Vinh-Tuyen T. Le
- Department of Pharmacognosy-Traditional Pharmacy-Pharmaceutical Botanic, Can Tho University of Medicine and Pharmacy, Can Tho 941-17, Vietnam;
- Ph.D. Program in Clinical Drug Development of Herbal Medicine, College of Pharmacy, Taipei Medical University, Taipei 110-31, Taiwan
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan
- Correspondence: ; Tel.: +886-2-2736-1661 (ext. 6545)
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Duong TV, Pham KM, Do BN, Kim GB, Dam HTB, Le VTT, Nguyen TTP, Nguyen HT, Nguyen TT, Le TT, Do HTT, Yang SH. Digital Healthy Diet Literacy and Self-Perceived Eating Behavior Change during COVID-19 Pandemic among Undergraduate Nursing and Medical Students: A Rapid Online Survey. Int J Environ Res Public Health 2020; 17:E7185. [PMID: 33008102 PMCID: PMC7579441 DOI: 10.3390/ijerph17197185] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 12/25/2022]
Abstract
Assessing healthy diet literacy and eating behaviors is critical for identifying appropriate public health responses to the COVID-19 pandemic. We examined the psychometric properties of digital healthy diet literacy (DDL) and its association with eating behavior changes during the COVID-19 pandemic among nursing and medical students. We conducted a cross-sectional study from 7 April to 31 May 2020 at 10 public universities in Vietnam, in which 7616 undergraduate students aged 19-27 completed an online survey to assess socio-demographics, clinical parameters, health literacy (HL), DDL, and health-related behaviors. Four items of the DDL scale loaded on one component explained 71.32%, 67.12%, and 72.47% of the scale variances for the overall sample, nursing, and medical students, respectively. The DDL scale was found to have satisfactory item-scale convergent validity and criterion validity, high internal consistency reliability, and no floor or ceiling effect. Of all, 42.8% of students reported healthier eating behavior during the pandemic. A 10-index score increment of DDL was associated with 18%, 23%, and 17% increased likelihood of healthier eating behavior during the pandemic for the overall sample (OR, 1.18; 95%CI, 1.13, 1.24; p < 0.001), nursing students (OR, 1.23; 95%CI, 1.10, 1.35; p < 0.001), and medical students (OR, 1.17; 95%CI, 1.11, 1.24; p < 0.001), respectively. The DDL scale is a valid and reliable tool for the quick assessment of digital healthy diet literacy. Students with higher DDL scores had a higher likelihood of healthier eating behavior during the pandemic.
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Affiliation(s)
- Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110–31, Taiwan;
| | - Khue M. Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 042–12, Vietnam;
- President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong 042–12, Vietnam
| | - Binh N. Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi 121–08, Vietnam;
- Division of Military Science, Military Hospital 103, Hanoi 121–08, Vietnam
| | - Giang B. Kim
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 115–20, Vietnam;
- Center for Assessment and Quality Assurance, Hanoi Medical University, Hanoi 115–20, Vietnam
| | - Hoa T. B. Dam
- Department of Psychiatry, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 241–17, Vietnam;
| | - Vinh-Tuyen T. Le
- Department of Pharmacognosy—Traditional Pharmacy—Pharmaceutical Botanic, Can Tho University of Medicine and Pharmacy, Can Tho 941–17, Vietnam;
- Ph.D. Program in Clinical Drug Development of Herbal Medicine, College of Pharmacy, Taipei Medical University, Taipei 110–31, Taiwan
| | - Thao T. P. Nguyen
- Health Management Training Institute, Hue University of Medicine and Pharmacy, Thua Thien Hue 491–20, Vietnam;
- Department of Health Economics, Corvinus University of Budapest, Budapest 1093, Hungary
| | - Hiep T. Nguyen
- Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh 725–10, Vietnam;
- Pham Ngoc Thach Clinic, Pham Ngoc Thach University of Medicine, Ho Chi Minh 725–10, Vietnam
- President Office, Pham Ngoc Thach University of Medicine, Ho Chi Minh 725–10, Vietnam
| | - Trung T. Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi 113–09, Vietnam;
| | - Thuy T. Le
- Faculty of Medical Laboratory Science, Da Nang University of Medical Technology and Pharmacy, Da Nang 502–06, Vietnam;
- President Office, Da Nang University of Medical Technology and Pharmacy, Da Nang 502–06, Vietnam
| | - Hien T. T. Do
- Faculty of Nursing, Hai Duong Medical Technical University, Hai Duong 031–17, Vietnam;
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110–31, Taiwan;
- Research Center of Geriatric Nutrition, Taipei Medical University, Taipei 110–31, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 110–31, Taiwan
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