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Nutrient intakes and adenocarcinoma of the esophagus and distal stomach.

We studied the relationship between nutrient intakes and adenocarcinoma of the esophagus and distal stomach among 124 esophageal adenocarcinoma cases, 124 distal stomach cancer cases, and 449 controls in a population-based case-control study in eastern Nebraska. The residual method was used to adjust nutrient intake quartiles or tertiles for energy intake. We observed significant inverse associations with risk of esophageal adenocarcinoma for dietary intakes of total vitamin A [highest vs. lowest quartile, multivariate odds ratio (OR) = 0.5, P for trend = 0.05], beta-cryptoxanthin (OR = 0.5, P = 0.05), riboflavin (OR = 0.5, P = 0.01), folate (OR = 0.5, P = 0.03), zinc (OR = 0.5, P = 0.05), dietary fiber (OR = 0.5, P = 0.05), protein (OR = 0.5, P = 0.02), and carbohydrate (OR = 0.4, P = 0.02). For distal stomach cancer, only vitamin C (OR = 0.6, P = 0.04), dietary fiber (OR = 0.4, P = 0.007), and carbohydrate (OR = 0.4, P = 0.004) were inversely associated with risk. Our analyses showed significant interaction between dietary fat intake, but not intakes of other nutrients, and respondent type for both cancer sites. Subgroup analyses among self-respondents revealed positive associations between saturated fat intake and risk of esophageal adenocarcinoma (OR = 1.0, 4.1, and 4.6 for intake tertiles, P for trend = 0.02) and risk of distal stomach cancer (OR = 1.0, 1.2, and 3.6, P = 0.03). However, no such associations were found among proxy respondents. Our data suggest that greater intake of dietary fiber, certain carotenoids, and vitamins may decrease the risk of esophageal adenocarcinoma, whereas greater intake of saturated fat may increase the risk of esophageal adenocarcinoma and distal stomach cancer.

Adenocarcinoma↗

Dietary carotenoid intake and colorectal cancer risk.

Several studies have found inverse associations between fruit and vegetable consumption and colorectal cancer risk, suggesting the potential etiological importance of carotenoids (and other phytochemicals) contained in these foods. However, only one study (a case-control study) has examined the association between dietary carotenoids other than beta-carotene and colorectal cancer risk. In the study reported here, we examined the relationships between dietary intakes of beta-carotene, alpha-carotene, lycopene, lutein, and beta-cryptoxanthin and colorectal cancer risk in a large cohort study of Canadian women. A case-cohort analysis was undertaken within the cohort of 56,837 women who were enrolled in the Canadian National Breast Screening Study and who completed a self-administered dietary questionnaire. During follow-up to the end of 1993, a total of 388 women were diagnosed with colorectal cancer. For comparative purposes, a subcohort of 5,681 women was randomly selected. After exclusions for various reasons, the analyses were based on 295 cases and 5,334 noncases. We did not find any clear association between intake of any of the studied carotenoids and colorectal cancer risk in the study population as a whole or in subgroups defined by smoking status, relative body weight (body mass index), intakes of total fat, energy, alcohol, and folic acid, or menopausal status. Our data do not support any association between dietary intakes of the studied carotenoids and colorectal cancer risk. However, given that this is the first prospective cohort study of carotenoids in relation to colorectal cancer, further studies are warranted.

Adult↗

Increased cellular carotenoid levels reduce the persistence of DNA single-strand breaks after oxidative challenge.

Dietary antioxidants, such as the carotenoids, may protect DNA from oxidative damage. This has been proposed to explain the epidemiological association between higher consumption of fruits and vegetables, which are rich in antioxidants, and lower incidence of cancer. However, this remains to be demonstrated conclusively. The effects of carotenoid supplementation on 1) baseline DNA damage, 2) susceptibility of cellular DNA to oxidative attack, and 3) DNA repair were measured in the human lymphocyte cell line Molt-17. Baseline DNA damage, susceptibility to oxidant attack (100 mumol/l H2O2 for 5 min at 4 degrees C), and disappearance of DNA single-strand breaks (SSB) after oxidative challenge were monitored by single-cell gel electrophoresis. DNA repair patch synthesis activity in cell extracts was determined using assays that measure nucleotide incorporation during repair of oxidative lesions in template DNA. Unlike single-cell gel electrophoresis, the parameters measured with these assays are not dependent on strand break religation. There was no evidence that beta-carotene, lutein, or beta-cryptoxanthin supplementation protected cellular DNA from oxidation under basal conditions or after oxidative challenge. However, only carotenoid-supplemented cells exhibited a significant decrease in numbers of SSB over a 2-h period after treatment with H2O2. Carotenoid supplementation did not provoke any detectable change in repair patch synthesis activity. We conclude that supplementation with carotenoids at 8 mumol/l does not provide significant antioxidant protection for DNA in Molt-17 lymphocytes but may enhance recovery of cells from oxidative challenge, as measured by loss of SSB. We argue that these data are most consistent with carotenoids acting to enhance DNA strand break repair.

Antioxidants↗

Intakes of carotenoids, vitamin C, and vitamin E and MS risk among two large cohorts of women.

BACKGROUND: Antioxidant nutrients may reduce the risk of MS. In a recent case-control study, vitamin C intake was significantly inversely associated with MS risk among women. However, no prospective data are available. OBJECTIVE: To examine prospectively the associations of intakes of carotenoids, vitamin C, and vitamin E with the risk of MS among women. METHODS: The authors documented the occurrence of definite and probable MS within two large cohorts of women who completed detailed and validated semiquantitative food frequency questionnaires. One cohort (Nurses' Health Study) comprised 81,683 women aged 38 to 63 years in 1984, who were followed for 12 years; the other (Nurses' Health Study II) comprised 95,056 women aged 27 to 44 years in 1991, who were followed for 6 years. RESULTS: The authors documented a total of 214 cases of MS. After adjustments for age, latitude of birthplace, pack-years of smoking, and total energy intake, the pooled multivariate relative risks (95% CIs) comparing women in the highest quintile with those in the lowest quintile were 1.1 (0.7 to 1.7) for alpha-carotene, 1.1 (0.7 to 1.6) for beta-carotene, 1.4 (0.8 to 2.2) for beta-cryptoxanthin, 1.0 (0.6 to 1.5) for lycopene, 1.0 (0.7 to 1.6) for lutein/zeaxanthin, 1.4 (0.9 to 2.1) for total vitamin C, 1.3 (0.9 to 2.0) for dietary vitamin C, 0.8 (0.6 to 1.3) for total vitamin E, and 0.9 (0.6 to 1.4) for dietary vitamin E. The authors found no associations between intakes of fruits and vegetables and risk of MS. Use of vitamin C, vitamin E, and multivitamin supplements was also unrelated to risk of MS. CONCLUSIONS: These findings do not support hypotheses relating higher intakes of dietary carotenoids, vitamin C, and vitamin E to reduced risk of MS in women.

Adult↗

Inhibitory effect of natural carotenoids on Epstein-Barr virus activation activity of a tumor promoter in Raji cells. A screening study for anti-tumor promoters.

As a screening study for anti-tumor promoters, 51 carotenoids with diverse structures were examined for their inhibitory effects on the Epstein-Barr virus activation activity of 12-O-tetradecanoylphorbol-13-acetate (TPA) in Raji cells. The results showed that most of the carotenoids exhibited inhibitory activity, and in general, no cytotoxicity on Raji cells was observed in the assay. Among the carotenoids, beta-cryptoxanthin, lutein, and lactucaxanthin showed the strongest inhibitory activity, superior to the well known anti-tumor promoter, beta-carotene. Heteroxanthin, peridinin, and halocynthiaxanthin showed cytotoxicity at the high concentration (1000 molar ratio per TPA), but indicated a strong inhibitory effect at the lower concentrations, which were only weakly toxic (500 and 100 molar ratios). Based on these results, the essential moiety for the activity of carotenoids was considered to be the 3-hydroxy-epsilon-end group.

Antineoplastic Agents, Phytogenic↗

Antioxidant-micronutrients and HIV infection.

We measured plasma levels of all the antioxidant-micronutrients in subjects with HIV infection and controls. Plasma levels of all the carotenoids, including lutein, cryptoxanthin, lycopene, alpha-carotene and beta-carotene as well as vitamins A, C and E and cholesterol were assayed in 35 subjects with HIV infection and 38 controls. We found a significant depletion of all the carotenoids (P < 0.001) and vitamin C (P < 0.01) and cholesterol (P < 0.001) but not vitamins A or E in HIV-infected subjects. Further analysis of the HIV-infected subjects revealed that plasma levels of 4 of the groups of carotenoids and cholesterol were correlated with CD4 count but that beta-carotene and vitamins A, C and E were not. These results are reviewed in the light of the published literature and we conclude that these abnormalities of antioxidant-micronutrients are likely to reflect a metabolic phenomenon associated with HIV infection. However, an additional contribution to these deficiencies from malabsorption later in HIV disease cannot be ruled out.

Adult↗

Effects of the consumption of cigarettes, alcohol and foods on serum concentrations of carotenoids, retinol and tocopherols in healthy inhabitants living in a rural area of Hokkaido.

The relationship between serum concentrations of carotenoids, tocopherols and retinol and the consumption of cigarettes, alcohol and foods was investigated in 835 healthy inhabitants (aged 35-79 years) of a rural area of Hokkaido. Serum concentrations of beta-carotene (BC), alpha-carotene (AC), lycopene (LY), beta-cryptoxanthin (BX), zeaxanthin (including lutein, ZX), canthaxanthin (CX) and beta-tocopherol (including gamma-tocopherol, BT) were higher in females than in males, while serum retinol (RE) concentrations were lower. Serum alpha-tocopherol (AT) concentrations were the same for both sexes. The serum values of BC, BX, AC, LY and ZX for males were inversely associated with the consumption of cigarettes in multiple-regression analysis. The serum values of BC, AC and BX for males were inversely associated with alcohol consumption, while serum RE values were positively related to alcohol consumption for both sexes. There were significant relations between serum values of BC, AC, and ZX and the intake frequencies of carrots, tomatoes, milk and/or green-leaf vegetables, especially for females, and between serum BX values and the intake of oranges, juices and fruits. Serum RE and AT concentrations were not associated with any food intake, and BT concentrations were associated with the intake of tomatoes and juices for males.

Adult↗

[A study on serum carotenoid levels of people with hyperglycemia who were screened among residents living in a rural area of Hokkaido, Japan].

Serum carotenoid levels among residents with hyperglycemia who were screened in a health check-up program for the inhabitants living in a rural area of Hokkaido were compared with those with normal levels. Serum levels of alpha, beta-carotenes and cryptoxanthin were lower among those with high HbA1c newly detected than among those with a normal level, whereas the serum lipid peroxide (TBARS) level was higher in the former than in the latter for both sexes. Among males who currently smoked and drank alcohol, the intake frequency of carrot or pumpkin was significantly lower for those with high HbA1c than for the others, although no significant differences of serum carotenoid levels were observed. For the diabetes mellitus patients who were consulted in this study, and who have already been under control in the clinic, no significant differences of serum levels of carotenoids, or lipids such as total cholesterol and TBARS were shown compared with other groups. In conclusion, serum carotenoid levels might be a useful indicator of food intake and oxidative stress for the prediabetic condition since newly detected hyperglycemia tends to show lower serum antioxidant levels such as beta-carotene, and higher serum lipid peroxide levels.

Adult↗

Carotenoid pigments in GAC fruit (Momordica cochinchinensis SPRENG).

The carotenoids in Gac fruit (Momordica Cochinchinensis spreng) were analysed by high-performance liquid chromatography (HPLC), and the concentrations of beta-carotene, lycopene, zeaxanthin and beta-cryptoxanthin were measured. Lycopene was found to be predominantly present in the Gac seed membrane at a concentration of up to 380 microg/g of seed membrane. The concentration of lycopene in the Gac seed membrane was about ten-fold higher than that in known lycopene-rich fruit and vegetables, indicating that Gac fruit could be a new and potentially valuable source of lycopene.

Carotenoids↗

Simultaneous determination of tocotrienols, tocopherols, retinol, and major carotenoids in human plasma.

BACKGROUND: Epidemiologic evidence suggests that the concentrations of antioxidant vitamins in human plasma may play an important role in numerous chronic diseases, such as cancer and cardiovascular disease. However, methods for simultaneous measurement of these antioxidants are scarce. We developed and validated a new HPLC method for simultaneous determination of these vitamers in human plasma that uses a novel column-switching approach. METHODS: The new method uses liquid-liquid extraction and isocratic separation with two monomeric C(18) columns maintained at 35 and 4 degrees C coupled with ultraviolet-visible and fluorometric detection. This method could separate 14 vitamers and 3 internal standards within 27 min. No additional modifier was required; the mobile phase was acetonitrile-methanol (65:35 by volume), and the flow rate was 1 mL/min. RESULTS: For photodiode array detection, the detection limits (signal-to-noise ratio >3) were 0.02 mg/L for beta-carotene, lutein, zeaxanthin, and canthaxanthin; 0.01 mg/L for all-trans-retinol, beta-cryptoxanthin, alpha-carotene, and lycopene; and 0.1 mg/L for all tocopherols and tocotrienols. The detection limit was at least 25-fold lower (0.004 mg/L) when fluorometry was used for measurement of delta-, gamma-, and alpha-tocotrienol and delta-tocopherol compared with ultraviolet detection. The recovery and imprecision of the assay were generally >90% and <10%, respectively. CONCLUSIONS: This new method separates a wide range of fat-soluble antioxidant vitamins in human plasma, including six carotenoids, three isoforms of tocotrienols and tocopherols (delta-, gamma-, and alpha-), and all-trans-retinol. The overall findings suggest that our method is faster, more sensitive, and more comprehensive than existing methods.

Antioxidants↗

Relation between lung function and RBC distribution width in a population-based study.

STUDY OBJECTIVES: Pulmonary function is dependent not only on smoking, but also on nutritional status. Since an increased RBC distribution width (RDW) has been associated with nutritional deficiencies, we postulated that RDW has an inverse relation to pulmonary function. The purpose of this study was to test this hypothesis. DESIGN AND SETTING: A cross-sectional study was conducted of a random sample of the general population in western New York. PARTICIPANTS: A total of 1,616 subjects of both genders who were aged 35 to 79 years and were free of respiratory disease. INTERVENTIONS: None. MEASUREMENTS: Pulmonary function was assessed from FEV(1), FVC, height, body weight, total pack-years of smoking, smoking status, hemoglobin concentration, and hematologic indexes, eosinophil count, education, and blood levels of retinol, beta-cryptoxanthin, and vitamin E. RESULTS: We found a direct relation between RDW and the number of pack-years of smoking and smoking status, and an inverse relation between FEV(1) and FVC with RDW, even when potentially confounding variables such as smoking were taken into account. When the variability of FEV(1) due to smoking was used for comparison, an additional 27% of that variability in FEV(1) was explained by variations in antioxidant vitamin levels, and another 24% by RDW. CONCLUSIONS: The results confirmed our hypothesis that there is an inverse relation between RDW and pulmonary function, and raise the possibility that RDW may be a biomarker for as-yet unidentified nutrients that affect pulmonary function.

Adult↗

Biofactors in the Mediterranean diet.

This Review covers the sources and the main effects on human health of well-known micronutrients such as minerals and vitamins and also of microconstituents contained in the Mediterranean diet. Vitamins were first identified because of deficiency diseases still present in certain parts of the world. Hydrosoluble vitamins, among them folic acid and vitamin C, also play a role in chronic degenerative diseases, not only the main cause of mortality in the Western world but also increasingly common in developing countries. Hydrosoluble vitamins are well represented in the Mediterranean diet, more so than vitamin A, a liposoluble vitamin obtained primarily from animal foods. Vitamin E is important for antioxidant and cellular functions. The Mediterranean diet is also rich in provitamins A, such as alpha- and beta-carotene and beta-cryptoxanthine. Microconstituents are non-nutritional compounds known to protect plants and more recently suspected to have a protective effect in humans. They play a role in the antioxidant defense of the organism, but their effect on various enzyme activities appears even more promising and is still under investigation. It is nevertheless difficult to isolate the effect of the numerous biofactors present in the Mediterranean diet from the foods themselves, especially because of the possible synergy between the various biofactors.

Allyl Compounds↗

Relationship of retinoid and carotenoid metabolism with caecotrophy in rabbits.

The relationship of retinoid and carotenoid metabolism with caecotrophy was studied in adult female New Zealand White rabbits kept in individual metabolic cages. Caecotrophy was prevented by the use of plastic collars. The dry matter, crude protein, fibre, fat and ash contents of hard and soft faecal samples were determined. The retinoid (retinol and retinyl palmitate) and carotenoid (canthaxanthin, beta-carotene, beta-cryptoxanthin, lutein and zeaxanthin) levels of the blood, liver, kidney, caecal content and faeces were also measured by high-performance liquid chromatography (HPLC). The prevention of caecotrophy resulted in a significant decrease of blood retinol (P < 0.001) and retinyl palmitate (P < 0.01) concentration but it did not cause any significant change in the retinol and retinyl palmitate contents of the liver and kidney. The caecal content (25.78 +/- 6.87 microg/g) and the soft faeces (34.52 +/- 10.48 microg/g) contained the retinoids in similar amounts. Various carotenoids were found in considerable amounts in different types of faeces, while in the tissues (blood, liver and kidney) these pigments did not occur in substantial amounts. Total carotenoid concentration was similar in the caecal content (11.23 microg/g) and in the caecotroph (13.85 microg/g). On the basis of the results it can be assumed that the retinoid content of rabbit feed could be lowered in the presence of adequate caecal function and caecotrophy.

Animals↗

Carotenoids extraction from Japanese persimmon (Hachiya-kaki) peels by supercritical CO(2) with ethanol.

The extraction of carotenoids from Japanese persimmon peels by supercritical fluid extraction (SFE), of which the solvent was CO(2), was performed. In order to enhance the yield and selectivity of the extraction, some portion of ethanol (5 - 20 mol%) was added as an entrainer. The extraction temperature ranged from 313 to 353 K and the pressure was 30 MPa. The effect of temperature on the extraction yield of carotenoids was investigated at 10 mol% of the ethanol concentration in the extraction solvent, and a suitable temperature was found to be 333 K among the temperatures studied with respect to the carotenoid yield. With increasing the entrainer amount from 0 to 10 mol% at a constant temperature (333 K), the carotenoid yield in the extraction was improved, whereas the selectivity of the extracted carotenoids was drastically depressed. We also conducted qualitative and quantitative analyses for the carotenoid components in the extract by HPLC, and analyzed the extraction behavior of each individual carotenoid (alpha-carotene, beta-carotene, beta-cryptoxanthin, lycopene, lutein, and zeaxanthin). The selectivity of each carotenoid changed with the elapsed time and its time evolution was dependent on the carotenoid component, indicating that the location profile and the content can be important factors to understand the SFE behavior of each carotenoid in persimmon peels.

Carbon Dioxide↗

Relationship between serum carotenoids and hyperglycemia: a population-based cross-sectional study.

The present study investigated the relationship between hyperglycemia and both serum carotenoids and intake of vegetables and fruits. Subjects with a history of diabetes mellitus (DM group, n = 133) or with hyperglycemia diagnosed using a 5.6% cutoff value for hemoglobin A1c (High HbA1c group, n = 151) were recruited from among inhabitants of a rural area in Hokkaido, Japan. Intake frequencies of vegetables and fruits were assessed using a questionnaire administered by public health nurses. Serum levels of carotenoids and retinol were measured using high-performance liquid chromatography. The relationships between high HbA1c or DM and both serum carotenoids and intake frequencies of vegetables and fruits were analyzed using logistic regression modeling for a case-control study; each case (High HbA1c or DM) was matched to two controls (healthy subjects without any history of disease) matched for sex and age (within 3 years). The odds ratio (OR) for high HbA1c was 0.49 (95% confidence interval: 0.29-0.85) on high intake frequency of carrot and pumpkin and the OR for DM was 1.21 (95% Cl: 0.79-1.84). No significant relationships were observed between high HbA1c and intake frequencies of other vegetables and fruits. The ORs on high serum levels of alpha- and beta-carotenes, lycopene, beta-cryptoxanthin and zeaxanthin and lutein were 0.38 (0.22-0.65), 0.35 (0.21-0.59), 0.57 (0.35-0.93), 0.35 (0.20-0.59), and 0.88 (0.54-1.46) for high HbA1c, respectively. In conclusion, intake of vegetables and fruits rich in carotenoids might be a protective factor against hyperglycemia.

Adult↗

High serum carotenoids are inversely associated with serum gamma-glutamyltransferase in alcohol drinkers within normal liver function.

BACKGROUND: Many studies have reported that the consumption of alcohol induces the generation of free radicals. Moreover, recent studies suggest that serum gamma-glutamyltransferase (gamma-GTP) within its normal range might be an early marker of oxidative stress. In this study, we tested the hypothesis that serum antioxidant carotenoids would be inversely associated with serum gamma-GTP in alcohol drinkers within normal liver function. METHODS: A total of 266 Japanese men who had received health examination in 2003 participated in the study. The associations of serum gamma-GTP and serum-carotenoid concentrations stratified by alcohol intake levels were evaluated cross-sectionally. The participants were divided into three groups according to their ethanol intake level (non-drinker, less than 1 g/day; light drinker, 1-25 g/day; and moderate and heavy drinkers, 25+ g/day). The multivariate-adjusted geometric means of the serum gamma-GTP concentrations in each tertile of the serum-carotenoid concentrations were calculated after adjustment for ethanol intake, age, body mass index, total cholesterol, triacylglycerols, current tobacco use, and habitual exercise. RESULTS: The serum gamma-GTP concentrations were significantly high in accordance with the ethanol intake level. In moderate and heavy drinkers, the multivariate-adjusted geometric means of serum gamma-GTP concentrations were significantly low in accordance with the tertiles of the serum lycopene, alpha-carotene, beta-carotene, and beta-cryptoxanthin concentrations. CONCLUSIONS: The serum antioxidant carotenoids were inversely associated with alcohol-induced increases of serum gamma-GTP in moderate and heavy drinkers within normal liver function.

Adult↗

Updated information on risk factors for lung cancer: findings from the JACC Study.

BACKGROUND: In Japan, lung cancer is the top cause of cancer death in men and the third leading cause in women. Updated information on risk factors for lung cancer, therefore, is of great importance. The Japan Collaborative Cohort Study, a large prospective study started in 1988, has provided such information. METHODS: We reviewed published findings for lung cancer from the study. The endpoint was death from this cancer. RESULTS: The major findings were as follows. (1) The relative risks in current smokers versus nonsmokers were 4.46 in men and 3.58 in women. (2) Cigarette smoking accounted for 67.0% of lung cancer deaths in men and only 14.6% in women. (3) More than 15 years of smoking cessation may be required to decrease the risk of lung cancer to the level of never smokers. (4) A reduced risk was associated with frequent intake of green-leafy vegetables and fruit in men but not in women. These foods seemed to decrease the risk in male current or former smokers more than in female nonsmokers. (5) Serum levels of alpha- and beta-carotenes,beta-cryptoxanthin, and lycopene were inversely correlated with the risk in men. (6) In a preliminary study, serum 8-hydroxy-deoxyguanosine was higher in current smokers than in nonsmokers. CONCLUSIONS: The relative and attributable risks of smoking were smaller in Japan than in Western countries. In addition to smoking habits, therefore, we must pay attention to other risk factors for lung cancer or factors that modify the adverse effects of smoking including dietary factors.

Adult↗

Association of serum carotenoid concentration and dietary habits among the JACC Study subjects.

BACKGROUND: We wished to determine the validity of the association between serum carotenoid concentrations and dietary habits obtained from a food frequency questionnaire in the Japan Collaborative Cohort Study (JACC Study) for Evaluation of Cancer Risk sponsored by the Ministry of Education, Science, Sports and Culture of Japan (Monbusho). METHODS: The subjects were 866 male and 569 female controls in nested case-control studies for evaluating the risk of lung, colorectal, and urothelial cancers as parts of the JACC Study. Dietary habits were assessed using a food frequency questionnaire, and serum samples were obtained at baseline. Serum carotenoid concentrations of frozen-stored sera were measured and compared with the results of the survey. RESULTS: In males, consumption of dairy products, some oily foods, vegetables, fruits, and boiled beans correlated positively with serum carotenoid concentrations, whereas ingestion of boiled rice and sansai (edible wild plants) was negatively correlated with serum carotenoids. In females, only fruit consumption was positively correlated with serum carotenoid concentration, whereas ingestion of butter, sansai, and potatoes were negatively correlated. Some specific associations, between serum lycopene and tomato consumption and between serum beta-cryptoxanthin and ingestion of oranges, were observed in both sexes. CONCLUSIONS: In males, serum carotenoid concentrations were slightly associated with intake of foods rich in carotenoids. The lack of associations in females suggests that the food frequency questionnaire did not validly evaluate females' dietary habits concerning carotenoids in the JACC Study.

Adult↗