{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:02:15Z","timestamp":1770271335797,"version":"3.49.0"},"reference-count":52,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T00:00:00Z","timestamp":1623888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Vitaflo International Ltd","award":["001"],"award-info":[{"award-number":["001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>In patients with phenylketonuria (PKU), treated by diet therapy only, evidence suggests that areal bone mineral density (BMDa) is within the normal clinical reference range but is below the population norm. Aims: To study longitudinal bone density, mass, and geometry over 36 months in children with PKU taking either amino acid (L-AA) or casein glycomacropeptide substitutes (CGMP-AA) as their main protein source. Methodology: A total of 48 subjects completed the study, 19 subjects in the L-AA group (median age 11.1, range 5\u201316 years) and 29 subjects in the CGMP-AA group (median age 8.3, range 5\u201316 years). The CGMP-AA was further divided into two groups, CGMP100 (median age 9.2, range 5\u201316 years) (n = 13), children taking CGMP-AA only and CGMP50 (median age 7.3, range 5\u201315 years) (n = 16), children taking a combination of CGMP-AA and L-AA. Dual X-ray absorptiometry (DXA) was measured at enrolment and 36 months, peripheral quantitative computer tomography (pQCT) at 36 months only, and serum blood and urine bone turnover markers (BTM) and blood bone biochemistry at enrolment, 6, 12, and 36 months. Results: No statistically significant differences were found between the three groups for DXA outcome parameters, i.e., BMDa (L2\u2013L4 BMDa g\/cm2), bone mineral apparent density (L2\u2013L4 BMAD g\/cm3) and total body less head BMDa (TBLH g\/cm2). All blood biochemistry markers were within the reference ranges, and BTM showed active bone turnover with a trend for BTM to decrease with increasing age. Conclusions: Bone density was clinically normal, although the median z scores were below the population mean. BTM showed active bone turnover and blood biochemistry was within the reference ranges. There appeared to be no advantage to bone density, mass, or geometry from taking a macropeptide-based protein substitute as compared with L-AAs.<\/jats:p>","DOI":"10.3390\/nu13062075","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T11:20:26Z","timestamp":1623928826000},"page":"2075","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["A Three-Year Longitudinal Study Comparing Bone Mass, Density, and Geometry Measured by DXA, pQCT, and Bone Turnover Markers in Children with PKU Taking L-Amino Acid or Glycomacropeptide Protein Substitutes"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2579-8699","authenticated-orcid":false,"given":"Anne","family":"Daly","sequence":"first","affiliation":[{"name":"Birmingham Women\u2019s and Children\u2019s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4328-6304","authenticated-orcid":false,"given":"Wolfgang","family":"H\u00f6gler","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine, Johannes Kepler University, Kepler University Hospital, Krankenhausstra\u00dfe 26-30, 4020 Linz, Austria"}]},{"given":"Nicola","family":"Crabtree","sequence":"additional","affiliation":[{"name":"Birmingham Women\u2019s and Children\u2019s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK"}]},{"given":"Nick","family":"Shaw","sequence":"additional","affiliation":[{"name":"Birmingham Women\u2019s and Children\u2019s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7654-3621","authenticated-orcid":false,"given":"Sharon","family":"Evans","sequence":"additional","affiliation":[{"name":"Birmingham Women\u2019s and Children\u2019s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK"}]},{"given":"Alex","family":"Pinto","sequence":"additional","affiliation":[{"name":"Birmingham Women\u2019s and Children\u2019s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK"}]},{"given":"Richard","family":"Jackson","sequence":"additional","affiliation":[{"name":"Liverpool Clinical Trials Centre, University of Liverpool, Brownlow Hill, Liverpool L69 3GL, UK"}]},{"given":"Catherine","family":"Ashmore","sequence":"additional","affiliation":[{"name":"Birmingham Women\u2019s and Children\u2019s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4977-8345","authenticated-orcid":false,"given":"J\u00falio C.","family":"Rocha","sequence":"additional","affiliation":[{"name":"Nutrition and Metabolism, NOVA Medical School, Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal"},{"name":"Centre for Health and Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5391-9681","authenticated-orcid":false,"given":"Boyd J.","family":"Strauss","sequence":"additional","affiliation":[{"name":"School of Medical Sciences, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester M13 9PL, UK"},{"name":"School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3800, Australia"}]},{"given":"Gisela","family":"Wilcox","sequence":"additional","affiliation":[{"name":"School of Medical Sciences, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester M13 9PL, UK"},{"name":"The Mark Holland Metabolic Unit, Salford Royal Foundation NHS Trust, Ladywell NW2, Salford, Manchester M6 8HD, UK"}]},{"given":"William D.","family":"Fraser","sequence":"additional","affiliation":[{"name":"BioAnalytical Facility, BCRE Builiding University or East Anglia, Norwich NR4 7TJ, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6305-6333","authenticated-orcid":false,"given":"Jonathan C. Y.","family":"Tang","sequence":"additional","affiliation":[{"name":"BioAnalytical Facility, BCRE Builiding University or East Anglia, Norwich NR4 7TJ, UK"},{"name":"Departments of Clinical Biochemistry and Endocrinology, Norfolk and Norwich University Hospitals Trust, Norwich NR4 7UY, UK"}]},{"given":"Anita","family":"MacDonald","sequence":"additional","affiliation":[{"name":"Birmingham Women\u2019s and Children\u2019s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1186\/s13023-020-01391-y","article-title":"PKU dietary handbook to accompany PKU guidelines","volume":"15","author":"MacDonald","year":"2020","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1007\/s00198-007-0422-0","article-title":"Dietary protein intake and bone mineral content in adolescents\u2014The Copenhagen Cohort Study","volume":"18","author":"Budek","year":"2007","journal-title":"Osteoporos. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1359\/jbmr.051215","article-title":"Childhood fractures are associated with decreased bone mass gain during puberty: An early marker of persistent bone fragility?","volume":"21","author":"Ferrari","year":"2006","journal-title":"J. Bone Miner. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1159\/000342256","article-title":"Adherence Issues in Inherited Metabolic Disorders Treated by Low Natural Protein Diets","volume":"61","author":"Macdonald","year":"2012","journal-title":"Ann. Nutr. Metab."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/S0140-6736(02)09334-0","article-title":"How practical are recommendations for dietary control in phenylketonuria?","volume":"360","author":"Walter","year":"2002","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1007\/s00198-018-4534-5","article-title":"Benefits and safety of dietary protein for bone health\u2014An expert consensus paper endorsed by the European Society for Clinical and Economical Aspects of Osteopororosis, Osteoarthritis, and Musculoskeletal Diseases and by the International Osteoporosis Foundation","volume":"29","author":"Rizzoli","year":"2018","journal-title":"Osteoporos. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/j.1753-4887.2011.00379.x","article-title":"Dietary protein and bone health: Harmonizing conflicting theories","volume":"69","author":"Thorpe","year":"2011","journal-title":"Nutr. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1146\/annurev.nutr.28.061807.155328","article-title":"Dietary Protein and Bone Health: Roles of Amino Acid\u2013Sensing Receptors in the Control of Calcium Metabolism and Bone Homeostasis","volume":"28","author":"Conigrave","year":"2008","journal-title":"Annu. Rev. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.bone.2009.10.005","article-title":"Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly","volume":"46","author":"Rizzoli","year":"2010","journal-title":"Bone"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1093\/ajcn\/82.5.1107","article-title":"Long-term protein intake and dietary potential renal acid load are associated with bone modeling and remodeling at the proximal radius in healthy children","volume":"82","author":"Alexy","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S153","DOI":"10.1139\/h2001-050","article-title":"Protein Intake and Bone Growth","volume":"26","author":"Bonjour","year":"2001","journal-title":"Can. J. Appl. Physiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"398","DOI":"10.2527\/1990.682398x","article-title":"A review of the role of acid-base balance in amino acid nutrition","volume":"68","author":"Patience","year":"1990","journal-title":"J. Anim. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1210\/jc.2004-0179","article-title":"The Impact of Dietary Protein on Calcium Absorption and Kinetic Measures of Bone Turnover in Women","volume":"90","author":"Kerstetter","year":"2005","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1079\/PNS2002159","article-title":"Nutrition Society Medal Lecture: The role of the skeleton in acid\u2014Base homeostasis","volume":"61","author":"New","year":"2002","journal-title":"Proc. Nutr. Soc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/S0002-8223(95)00219-7","article-title":"Potential Renal Acid Load of Foods and its Influence on Urine pH","volume":"95","author":"Remer","year":"1995","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1093\/ajcn\/76.6.1308","article-title":"Estimation of the net acid load of the diet of ancestral preagricultural Homo sapiens and their hominid ancestors","volume":"76","author":"Sebastian","year":"2002","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1359\/jbmr.090515","article-title":"Meta-Analysis of the Effect of the Acid-Ash Hypothesis of Osteoporosis on Calcium Balance","volume":"24","author":"Fenton","year":"2009","journal-title":"J. Bone Miner. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/1475-2891-8-41","article-title":"Phosphate decreases urine calcium and increases calcium balance: A meta-analysis of the osteoporosis acid-ash diet hypothesis","volume":"8","author":"Fenton","year":"2009","journal-title":"Nutr. J."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Solverson, P., Murali, S.G., Litscher, S.J., Blank, R.D., and Ney, D.M. (2012). Low bone strength is a manifestation of phenylketonuria in mice and is attenuated by a glycomacropeptide diet. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0045165"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1186\/s13023-017-0685-2","article-title":"The complete European guidelines on phenylketonuria: Diagnosis and treatment","volume":"12","author":"Wegberg","year":"2017","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1111\/jhn.12438","article-title":"Glycomacropeptide in children with phenylketonuria: Does its phenylalanine content affect blood phenylalanine control?","volume":"30","author":"Daly","year":"2017","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.clinms.2016.08.001","article-title":"LC-MS\/MS application for urine free pyridinoline and free deoxypyridionine: Urine markers of collagen and bone degradation","volume":"1","author":"Tang","year":"2016","journal-title":"Clin. Mass Spectrom."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Daly, A., Evans, S., Pinto, A., Jackson, R., Ashmore, C., Rocha, J.C., and Macdonald, A. (2020). The Impact of the Use of Glycomacropeptide on Satiety and Dietary Intake in Phenylketonuria. Nutrients, 12.","DOI":"10.3390\/nu12092704"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"de Castro, M.J., de Lamas, C., Sanchez-Pintos, P., Gonzalez-Lamuno, D., and Couce, M.L. (2020). Bone Status in Patients with Phenylketonuria: A Systematic Review. Nutrients, 12.","DOI":"10.3390\/nu12072154"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s13023-015-0232-y","article-title":"Bone health in phenylketonuria: A systematic review and meta-analysis","volume":"10","author":"Demirdas","year":"2015","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.jocd.2013.08.004","article-title":"Executive Summary of the 2013 International Society for Clinical Densitometry Position Development Conference on Bone Densitometry","volume":"16","author":"Schousboe","year":"2013","journal-title":"J. Clin. Densitom."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1359\/jbmr.1999.14.10.1664","article-title":"Biochemical Markers of Bone Turnover and the Volume and the Density of Bone in Children at Different Stages of Sexual Development","volume":"14","author":"Mora","year":"1999","journal-title":"J. Bone Miner. Res."},{"key":"ref_28","first-page":"224","article-title":"Bone mineral turnover and bone densitometry in patients with a high-risk diet: Hyperphenylalaninemia and galactosemia","volume":"63","year":"2005","journal-title":"An. Pediatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1093\/ajcn\/55.5.997","article-title":"Bone mineral status in children with phenylketonuria\u2014Relationship to nutritional intake and phenylalanine control","volume":"55","author":"McMurry","year":"1992","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1651-2227.1998.tb01387.x","article-title":"Decreased trabecular bone mineral density in patients with phenylketonuria measured by peripheral quantitative computed tomography","volume":"87","author":"Schwahn","year":"1998","journal-title":"Acta Paediatr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"62","DOI":"10.6065\/apem.2018.23.2.62","article-title":"Fat and bone in children\u2014Where are we now?","volume":"23","author":"Dimitri","year":"2018","journal-title":"Ann. Pediatr. Endocrinol. Metab."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1359\/jbmr.060601","article-title":"Association Between Bone Mass and Fractures in Children: A Prospective Cohort Study","volume":"21","author":"Clark","year":"2006","journal-title":"J. Bone Miner. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.bone.2004.01.022","article-title":"The \u2018muscle-bone unit\u2019 during the pubertal growth spurt","volume":"3","author":"Rauch","year":"2004","journal-title":"Bone"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1210\/jc.2009-1475","article-title":"Visceral Fat Is a Negative Predictor of Bone Density Measures in Obese Adolescent Girls","volume":"95","author":"Russell","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Carbone, J.W., and Pasiakos, S.M. (2019). Dietary Protein and Muscle Mass: Translating Science to Application and Health Benefit. Nutrients, 11.","DOI":"10.3390\/nu11051136"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.bone.2004.06.009","article-title":"The relationship between lean body mass and bone mineral content in paediatric health and disease","volume":"35","author":"Crabtree","year":"2004","journal-title":"Bone"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Daly, A., H\u00f6gler, W., Crabtree, N., Shaw, N., Evans, S., Pinto, A., Jackson, R., Strauss, B., Wilcox, G., and Rocha, J. (2021). Growth and Body Composition in PKU Children\u2014A Three-Year Prospective Study Comparing the Effects of L-Amino Acid to Glycomacropeptide Protein Substitutes. Nutrients, 13.","DOI":"10.3390\/nu13041323"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1007\/s00774-010-0216-x","article-title":"Bone metabolism and the muscle\u2013bone relationship in children, adolescents and young adults with phenylketonuria","volume":"29","author":"Adamczyk","year":"2010","journal-title":"J. Bone Miner. Metab."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1111\/j.1651-2227.1998.tb00924.x","article-title":"Bone mineral status in children with phenylketonuria under treatment","volume":"87","author":"Schulpis","year":"1998","journal-title":"Acta Paediatr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S148","DOI":"10.1007\/PL00014234","article-title":"Decreased bone mineralization in children with phenylketonuria under treatment","volume":"155","author":"Hillman","year":"1996","journal-title":"Eur. J. Pediatr."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Roato, I., Porta, F., Mussa, A., D\u2019Amico, L., Fiore, L., Garelli, D., Spada, M., and Ferracini, R. (2010). Bone Impairment in Phenylketonuria Is Characterized by Circulating Osteoclast Precursors and Activated T Cell Increase. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0014167"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.ymgme.2018.08.010","article-title":"A bone mineralization defect in the Pah(enu2) model of classical phenylketonuria involves compromised mesenchymal stem cell differentiation","volume":"125","author":"Dobrowolski","year":"2018","journal-title":"Mol. Genet. Metab."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1111\/j.1365-2265.1994.tb03019.x","article-title":"Biochemical markers of bone turnover in girls during puberty","volume":"40","author":"Blumsohn","year":"1994","journal-title":"Clin. Endocrinol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/j.clinbiochem.2005.09.002","article-title":"Is deoxypyridinoline a good resorption marker to detect osteopenia in phenylketonuria?","volume":"38","author":"Millet","year":"2005","journal-title":"Clin. Biochem."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/8756-3282(94)90888-5","article-title":"Bone resorption rates in children monitored by the urinary assay of collagen type I cross-linked peptides","volume":"15","author":"Bollen","year":"1994","journal-title":"Bone"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1136\/adc.72.2.177","article-title":"Mineral accretion in growing bones\u2014A framework for the future?","volume":"72","author":"Shaw","year":"1995","journal-title":"Arch. Dis. Child."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.clinbiochem.2016.04.005","article-title":"Age- and sex-matched reference curves for serum collagen type I C-telopeptides and bone alkaline phosphatase in children and adolescents: An alternative multivariate statistical analysis approach","volume":"49","author":"Gennai","year":"2016","journal-title":"Clin. Biochem."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.clinbiochem.2011.04.008","article-title":"Establishment of reference intervals for bone markers in children and adolescents","volume":"44","author":"Huang","year":"2011","journal-title":"Clin. Biochem."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1210\/jc.2006-1706","article-title":"Sex- and Age-Specific Reference Curves for Serum Markers of Bone Turnover in Healthy Children from 2 Months to 18 Years","volume":"92","author":"Rauchenzauner","year":"2006","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s001980070116","article-title":"Biochemical Measurements of Bone Turnover in Children and Adolescents","volume":"11","author":"Szulc","year":"2000","journal-title":"Osteoporos. Int."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1007\/s00414-016-1382-8","article-title":"A biochemical approach for assessing cutoffs at the age thresholds of 14 and 18 years: A pilot study on the applicability of bone specific alkaline phosphatase on an Italian sample","volume":"130","author":"Ferrante","year":"2016","journal-title":"Int. J. Leg. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"176","DOI":"10.3109\/17453679509157687","article-title":"Biochemical markers of bone turnover","volume":"266","author":"Delmas","year":"1995","journal-title":"Acta Orthop. Scand. Suppl."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/6\/2075\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:17:36Z","timestamp":1760163456000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/6\/2075"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,17]]},"references-count":52,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["nu13062075"],"URL":"https:\/\/doi.org\/10.3390\/nu13062075","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,17]]}}}