Author Interviews, Environmental Risks, Pediatrics, Toxin Research, Weight Research / 08.03.2021

MedicalResearch.com Interview with: Alison P. Sanders, PhD Pronouns:  She/Her Assistant Professor Icahn School of Medicine at Mount Sinai Department of Environmental Medicine and Public Health Department of Pediatrics Director, Interdisciplinary Environmental Health Postdoctoral Fellowship MedicalResearch.com: What is the background for this study? Response: My research group is dedicated to understanding environmental and early life risk factors that contribute to kidney function declineWhile some of the pathobiology leading to chronic kidney disease remains unclear, we understand that the process is complex and, like many chronic diseases, begins long before clinical diagnosis. My research investigates how the environment and mixtures of environmental chemicals/toxicants interact with traditional risk factors such as obesity, preterm birth, and nutritional status to hasten or prevent chronic kidney disease. (more…)
Author Interviews, Diabetes, Sugar, Weight Research / 24.02.2021

MedicalResearch.com Interview with: Eric Crosbie, PhD, MA Assistant Professor School of Community Health Sciences Ozmen Institute for Global Studies University of Nevada Reno MedicalResearch.com: What is the background for this study? Response: My colleague Dr. Laura Schmidt and I established a framework for studying preemption (when a higher level of government limits the authority of lower levels to enact laws) by studying the history of state preemption of local tobacco control policies in the U.S., which we published last year (2020) in AJPH. We noticed the same strategies that the tobacco industry employed were now being used by the beverage industry to suppress local taxation policies on sugar sweetened beverages (e.g. soda, coffee drinks, energy drinks, etc). We used this preemption framework to publish a new study this year in AJPH that analyzed state preemption of local sugar sweetened beverage taxes in the U.S.  (more…)
Author Interviews, Race/Ethnic Diversity, Weight Research / 26.01.2021

MedicalResearch.com Interview with: Raveena Chara Loma Linda University Loma Linda, CA MedicalResearch.com: What is the background for this study? latin food fried food obesityResponse: In a country struggling with an epidemic of obesity, Hispanics are one of the fastest growing population groups in the U.S. and have the highest prevalence of obesity. They are also least likely to enroll in weight reduction programs, complete them, and successfully lose weight (though reasons for this remain elusive). Obesity- a leading predisposing factor for many chronic diseases - is a complex biophysical phenomenon shaped by many factors, including a person’s social environment, health and culture. Culture permeates many aspects of one’s life including how a person views weight and behaviors associated with eating and physical activity. Indeed, for many values and norms about what is culturally acceptable and views on “body weight” vary culturally and affect their decisions about weight and weight loss. This too is the case within the Hispanic population in the US. Given the rising human and financial impact of obesity, preventing and reducing obesity, diabetes and other weight related medical conditions is a growing priority, especially for low income Hispanics.  (more…)
Author Interviews, Diabetes, JAMA, Weight Research / 14.01.2021

MedicalResearch.com Interview with: Dr. Steven Heymsfield, MD Professor, Pennington Biomedical Research Center Baton Rouge, LA MedicalResearch.com: What is the background for this study? Response: Bimagurmab is a monoclonal antibody that blocks the activin type 2 receptor. This receptor is found mainly on skeletal muscles and when blocked acts to stimulate muscle growth. Bimagrumab was developed as a potential treatment for skeletal muscle disorders. However, the first-in-man studies revealed an unexpected response to the drug: not only did skeletal muscle mass increase, but marked lowering in body fat and improved insulin sensitivity were observed. The current study was launched to follow up on these initial observations.  (more…)
Author Interviews, Microbiome, Nature, Weight Research / 21.12.2020

MedicalResearch.com Interview with: Harriët Schellekens MSc PhD Lecturer Department of Anatomy & Neuroscience, and APC Microbiome Ireland SFI Research Centre University College Cork, Cork, IRELAND.  MedicalResearch.com: What is the background for this study? Response: There has been an increased emphasis on gut microbiota-targeted therapeutics for the amelioration of obesity. Recent studies have identified several probiotic strains with different anti-obesity effects, including members of the genus Bifidobacterium, but the exact mechanisms of action are still lacking. Moreover, positive effects in animal studies often do not translate in human studies. The APC Microbiome Ireland has set up a “culture-to-product” platform, a well catalogued and quality controlled collection of bacteria with potential biofunctional activities. In my laboratory, I have developed a state-of the art “bug-to-drug” screening approach, using high-throughput biochemical and cellular assays, to fully characterize bacteria and identify the most promising bacterial strains with specific desirable probiotic and functional properties. This careful in vitro screening of APC’s strains (or customer strains) is designed to identify the most potent candidates that can impact on host physiology and overall gut-brain axis function, e.g. by producing microbial metabolites or neuroactives, altering gut-barrier function, reducing inflammation, or modifying G-protein coupled receptors. This comprehensive screening approach facilitates the precise selection and prediction of the best strains that are likely to yield a specific positive health effects in subsequent animal and human studies, based on their in vitro probiotic and functional properties.  (more…)
Author Interviews, Weight Research / 18.12.2020

MedicalResearch.com Interview with: Dr. Louis Aronne, MD, FACP Chief Medical Officer, Intellihealth Medical Director, Comprehensive Weight Control Center Weill Cornell Medicine MedicalResearch.com: What is the background for the study Effect of an Online Weight Management Program Integrated With Population Health Management on Weight Change: A Randomized Clinical Trial”? Response: More than 70% of U.S. adults have overweight or obesity. Online programs promoting lifestyle change have had some success in helping people achieve and maintain weight loss, but study results have been variable, and these programs have not been widely implemented in primary care. We studied the effectiveness of an online program we have developed (Intellihealth, formerly known as BMIQ) in routine primary care practices, both alone and integrated with population health management (with participants receiving additional support and outreach from nonclinical staff). The study’s objective was to determine whether a combined intervention integrating online weight management with population health management would increase weight loss at 12 months among primary care patients compared with the online program only and usual care. (more…)
Author Interviews, Weight Research / 03.12.2020

MedicalResearch.com Interview with: Gurmukh Singh, MD, PhD, MBA Department of Pathology, Section of Clinical Pathology Walter Shepeard Professor of Pathology Section Chief, Clinical Pathology. Associate Medical Director, Clinical Laboratory GRMC and Children's Hospital of Georgia MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by the obesity paradox? Response: Obese people tend to get more diseases, such as hypertension, diabetes, cancer etc. However, when they get seriously ill, e.g., sick enough to require admission to intensive care treatment unit (ICU), obese people tend to have better outcomes than normal weight people. (more…)
Author Interviews, Columbia, JAMA, OBGYNE, Weight Research / 05.11.2020

MedicalResearch.com Interview with: Marisa N. Spann, PhD, MPH Columbia University Irving Medical Center New York, New York MedicalResearch.com: What is the background for this study? Response: Prior research has demonstrated that higher maternal pre-pregnancy body mass index is associated with adverse long-term outcomes for offspring including obesity, poorer cognitive and social abilities, and increased risk of psychiatric disorders.  MedicalResearch.com: What are the main findings? Response: In this study, we investigated the association of maternal pre-pregnancy body mass index with fetal growth and neonatal functional connectivity and found that maternal pre-pregnancy BMI has a significant positive correlation with fetal weight and with greater thalamic connectivity of the brain.  (more…)
Author Interviews, Pediatrics, PNAS, Weight Research, Wistar / 15.10.2020

MedicalResearch.com Interview with: Kristina M. Rapuano PhD, Postdoctoral Research Fellow BJ Casey, PhD, Professor of Psychology at Yale University Richard Watts PhD Technical Consultant Department of Psychology Yale University, New Haven, CT MedicalResearch.com: What is the background for this study? Response: Around 35% of children and adolescents in the US are overweight or obese, dramatically increasing their likelihood of obesity as adults and the associated health risks. In our paper we use a novel MRI technique to investigate links between obesity and neurobiology in a large group of typically developing 9-10 year-olds. The data were acquired as part of the NIH-funded Adolescent Brain Cognitive DevelopmentSM (ABCD) study, which enrolled more than 11,000 children from across the US. We looked specifically at a reward-related region of the brain called the nucleus accumbens. Previous human studies have shown that healthy weight and obese children display different responses to food cues, for example adverts for unhealthy foods, in this region. Animal studies have also found that a high saturated fat (unhealthy) diet induces inflammation in the nucleus accumbens, and changes in behavior including sucrose-seeking. We wanted to investigate if we could use advanced MRI techniques to provide evidence of a similar effect in humans. (more…)
Author Interviews, COVID -19 Coronavirus, Weight Research / 24.08.2020

MedicalResearch.com Interview with: Lisa Pawloski PhD Associate Dean for International Programs Professor of Anthropology College of Arts and Sciences The University of Alabama Tuscaloosa, AL 35487 MedicalResearch.com: What is the background for this study? What are the main findings? Response: This exploratory research uses the currently available data on COVID-19 cases and mortality, along with estimates of the morbidly obese populations in the United States by county to examine the association between morbid obesity and deaths from COVID-19 and to identify potential coincident spatial clusters of morbid obesity and COVID-19 deaths. Results indicate statistically significant positive correlation between population adjusted COVID-19 deaths and cases and the estimated population with a BMI>=40. Clustering analyses show there is a predominant similarity in the distribution of COVID-19 deaths and obesity. Our findings suggest it is critical to include an awareness of obesity when developing infectious disease control measures and point to a greater need to focus resources towards obesity education and policy initiatives.  (more…)
Author Interviews, Diabetes, Surgical Research, Weight Research / 03.07.2020

MedicalResearch.com Interview with: Carlos KH Wong, PhD, MPhil, BSc Department of Family Medicine and Primary Care LKS Faculty of Medicine The University of Hong Kong MedicalResearch.com: What is the background for this study? Response: The background is that bariatric surgery has been widely indicated for the management of obesity and related comorbidities. However, there are uncertainties pertaining to the risks of post-bariatric severe hypoglycaemia (SH), cardiovascular diseases (CVDs), end-stage kidney diseases (ESKDs) and all-cause mortality in obese patients with Type 2 diabetes mellitus (T2DM), especially among Asian populations.  (more…)
Author Interviews, COVID -19 Coronavirus, Weight Research / 11.06.2020

MedicalResearch.com Interview with: Sarah Messiah, PhD, MPH Professor of epidemiology, human genetics, and environmental sciences UTHealth School of Public Health Dallas MedicalResearch.com: What is the background for this study? Response: Given that obesity is a prevalent, serious, complex, chronic, and relapsing disease, and severe obesity is a deepening crisis, it is important to pay special attention to these challenges during the COVID-19 pandemic. This will avoid placing an even greater burden on individuals, health systems, and society in the post-COVID-19 recovery phase. Thus, it is critically important to document, in real time, how socioecological determinants of health are impacting behaviors among those with obesity. Before our study, how the COVID-19 pandemic is impacting weight management, health behaviors, and psychosocial health in particular among people with obesity was unknown. (more…)
Author Interviews, Nutrition, Weight Research / 01.06.2020

MedicalResearch.com Interview with: Zachary Zeigler PhD College of Science, Engineering, and Technology Grand Canyon University. Phoenix, AZ  MedicalResearch.com: What is the background for this study? Response: We already know that during the COVID-19 pandemic, children alter eating, sleep, and activity behaviors in a manner that promotes weight gain.  Additionally, the unprecedented self-quarantine mandate during the COVID-19 pandemic has led to widespread concern that adults may gain weight during the current pandemic. (more…)
Author Interviews, COVID -19 Coronavirus, Weight Research / 24.04.2020

MedicalResearch.com Interview with: Univ.-Prof. Norbert Stefan, MD -Heisenberg Professorship for Clinical and Experimental Diabetology Internal Medicine IV, University of Tübingen -Head of the Department of Pathophysiology of Prediabetes at the Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich -Visiting Professor Harvard Medical School, Boston, USA  MedicalResearch.com: What is the background for this study? Response: Working in the field of obesity and cardiometabolic diseases my colleagues and I were very surprised that most of the articles reporting data about comorbid conditions, which may be associated with increased risk of severe COVID-19, did not provide data about body fat mass. Because increased fat mass, and more so higher upper-body fat mass, are known to strongly predict an increased risk of cardiometabolic disease, pneumonia and mortality, we hypothesized that they may also predict a more severe course of COVID-19. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Weight Research / 08.04.2020

MedicalResearch.com Interview with: Zhen Yang MD PhD Department of Endocrinology, Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai, China   MedicalResearch.com: What is the background for this study? Response: Hypertension is a major public health problem affecting more than 1 billion people worldwide. And it is the leading cause of mortality and disability globally. Startlingly, more than half of people with elevated blood pressure were unaware of their hypertensive status in numerous surveys, partly owing to hypertension rarely shows symptoms in the early stages. Hence, hypertension is a silent killer. (more…)
Author Interviews, JAMA, Pediatrics, Weight Research / 16.03.2020

MedicalResearch.com Interview with: Ashlesha Datar, PhD Senior Economist Director of Program on Children & Families USC Dornsife Center for Economic and Social Research (CESR) University of Southern California  MedicalResearch.com: What is the background for this study? Response: Prior research, including our own work, has suggested that there might be some kind of social contagion or social transmission in obesity. So we wanted to explore that avenue further. In the present study, we showed teens in military families a set of human body figures with varying body sizes and asked them to choose the figure that best captured their ideal body size. (more…)
Author Interviews, Colon Cancer, JAMA, Weight Research / 13.03.2020

MedicalResearch.com Interview with: Dr Laurent Bailly MD, PhD Département de Santé Publique, CHU Nice, Hôpital Archet 1. Niveau1 NICE France  MedicalResearch.com: What is the background for this study? Response: Obesity is known to increase cancer incidence and notably colorectal cancer incidence. Bariatric surgery is an effective treatment of obesity however the association of this surgery with the colorectal cancer remained controversial. We used the French National Health Insurance Information System to conduct a nationwide retrospective cohort study, between 2009 and 2018, of patients hospitalized in France with a diagnosis of obesity. We followed more than 1 million obese individuals aged 50 to 75 years and free of colorectal cancer at baseline, some of them did undergo bariatric surgery and others did not. (more…)
Author Interviews, BMC, Breast Cancer, Cancer Research, Weight Research / 27.02.2020

MedicalResearch.com Interview with: Carolyn Ee PhD NICM Health Research Institute Western Sydney University Australia MedicalResearch.com: What is the background for this study? Response: Worldwide and in Australia, breast cancer is the most common cancer in women. Weight gain is common after diagnosis of breast cancer and may increase tumour recurrence risk, mortality rate, and worsen quality of life. As there was no national data on the prevalence of weight gain after breast cancer in Australia, we undertook a national survey which was open to any woman living in Australia who had breast cancer. (more…)
Author Interviews, OBGYNE, Pediatrics / 04.02.2020

MedicalResearch.com Interview with: Andrea M. Tilstra Doctoral Candidate, Department of Sociology Population Program, Institute of Behavioral Science University of Colorado Boulder MedicalResearch.com: What is the background for this study? Response: Average U.S. birth weight declined across the 1990s and 2000s, and this has puzzled most researchers. We investigate this and find that the increases in cesarean deliveries and induction of labor between 1990 and 2013 resulted in a shift in the gestational age distribution of U.S. births. We find that births are less likely to occur at gestational weeks 40+ and much more likely to occur between weeks 37-39. Additionally, results from our simulations show that if U.S. rates of cesarean deliveries and labor induction had not increased over time, then average birth weight would have increased.   (more…)
Author Interviews, JAMA, Pediatrics, Weight Research / 29.01.2020

MedicalResearch.com Interview with: Dr. Carol Chelimo PhD Research Fellow Dept. of Paediatrics, School of Medicine University of Auckland MedicalResearch.com: What is the background for this study? Response: New Zealand has the third highest prevalence of obesity among Organisation for Economic Co-operation and Development countries. Pediatric obesity is associated with development of cardiovascular risk factors in later life, such as type 2 diabetes, hypertension, dyslipidemia, and metabolic syndrome. Antibiotic exposures in early life may affect weight by altering the gut microbiota, potentially increasing the risk of childhood obesity. The overall aim of this research was to examine whether repeated antibiotic exposure by age 48 months is associated with higher body mass index (BMI) at age 54 months. Specifically, it evaluates whether the number, timing (age), and type of antibiotic exposures are associated with a higher body mass and an increased likelihood of overweight and obesity. This work incorporates antibiotic exposure during pregnancy (more…)
Author Interviews, JAMA, Surgical Research, Weight Research / 15.01.2020

MedicalResearch.com Interview with: Anita P. Courcoulas MD, MPH, FACS Anthony M. Harrison MD Chair and Professor of Surgery Chief, MIS Bariatric & General Surgery University of Pittsburgh Medical Center  MedicalResearch.com: What is the background for this study? Response: Fewer published studies in bariatric surgery address long term adverse outcomes or problems that can occur after different operations.  In addition, a lack of standardized reporting of potential adverse events limits the understanding of these issues. This paper results from one of the largest studies of bariatric surgery ever undertaken and includes both gastric bypass and gastric sleeve, the 2 most common operations performed in the U.S. and worldwide at the current time.  This study leverages large data sets from the electronic health record linked to insurance claims and death indices.  This is real-world data coming from a population-based cohort of 33,560 adults at 10 sites in 4 clinical data research networks throughout the U.S., so it may be different from data that accrues from a longitudinal observational study or randomized trial.  Patients and other important stakeholders in bariatric surgery were critical to the design, conduct, and dissemination of results from this study. (more…)
Author Interviews, Nutrition, Weight Research / 15.01.2020

MedicalResearch.com Interview with: Leigh Frame, PhD, MHS Director for the Integrative Medicine Program School of Medicine and Health Sciences George Washington University MedicalResearch.com: What is the background for this study? Response: As food consumed in the U.S. becomes more and more processed, obesity may become more prevalent. Through reviewing overall trends in food, we concluded that detailed recommendations to improve diet quality and overall nutrition are needed for consumers, who are prioritizing food that is cheaper and more convenient, but also highly processed. When comparing the U.S. diet to the diet of those who live in "blue zones" - areas with populations living to age 100 without chronic disease - the differences are stark. Many of the food trends we reviewed are tied directly to a fast-paced U.S. lifestyle that contributes to the obesity epidemic we are now facing. (more…)
Author Interviews, Johns Hopkins, NEJM, Weight Research / 02.01.2020

MedicalResearch.com Interview with: Mark P. Mattson, Ph.D. Adjunct Professor of Neuroscience Johns Hopkins University School of Medicine  MedicalResearch.com: What is the background for this study? Response: The usual eating pattern of most people in modern societies is breakfast, lunch, dinner plus a snack(s) every day.   Animals used for most biomedical research – rats and mice – are usually fed ‘ad libitum’ (food is always available for them to eat).    During the past 25 years, myself and the many scientists who trained in my laboratory discovered that when rats or mice are fed intermittently such that they have no food every other day or eat only during a 4-6 hour time period each day, their overall health improves in many ways.  Animals on such intermittent fasting (IF) regimens exhibit signs of slowed aging and they live much longer than those fed ad libitum. The editors of the New England Journal of Medicine invited me and Rafa de Cabo (a former postdoc in my laboratory at the National Institute on Aging) to write this review article for two main reasons.   First, there have been a sufficient number of studies demonstrating the health benefits of IF in humans and knowledge of the underlying mechanisms to justify a review article.  Second, many physicians are being asked about IF by their patients and the physicians are not privy as to if they should recommend IF and how to prescribe specific IF eating patterns and follow-up to increase the likelihood that the patient will be successful in changing their eating pattern.  (more…)
Author Interviews, Breast Cancer, Weight Research / 19.12.2019

MedicalResearch.com Interview with: Lauren Teras, PHD Scientific Director, Epidemiology Research American Cancer Society MedicalResearch.com: What is the background for this study? Response: Excess body weight is a known cause of postmenopausal breast cancer, but an important question is: can you reverse it? Believe it or not, this not something we knew for certain. We had hoped it was true, but the scientific evidence was not there. This research question is, of course, particularly important for the more than two-thirds of U.S. women who are overweight or obese, and therefore at higher risk for breast cancer. To try to answer this question, we used a very large pooled study of 180,000 women aged ≥50 years from 10 different prospective studies.  (more…)
Author Interviews, Pediatrics, Weight Research / 07.11.2019

MedicalResearch.com Interview with: Kai Ling Kong, PhD, MS Assistant Professor Division of Behavioral Medicine Department of Pediatrics School of Medicine and Biomedical Sciences State University of New York at Buffalo MedicalResearch.com: What is the background for this study? Response: The deleterious effects that obesity has on an individual’s health and the difficulty of reversing it in adults are well-known, ranging from diabetes and heart disease to cancer. For these reasons, obesity prevention in babies and children in populations at high risk is increasingly seen as a critical way to address the obesity epidemic. However, most studies on factors that contribute to obesity in very young children haven’t focused on the populations most at risk. Now an ongoing longitudinal University at Buffalo study being presented Nov. 5 in Las Vegas at ObesityWeek is among the first to explore how mother-infant behaviors during feeding and active play (non-feeding situations) affect infants and children in families with low socioeconomic status. Infants of mothers exhibiting less warmth during free play interactions when infants were 7 months old were associated with steeper body mass index trajectories while the infants of mothers exhibiting more warmth during these interactions were not. (more…)
Author Interviews, Circadian Rhythm, Gastrointestinal Disease, Genetic Research, Weight Research / 13.10.2019

MedicalResearch.com Interview with: Marco Colonna, MD Robert Rock Belliveau MD Professor Pathology & Immunology Washington University School of Medicine Qianli Wang MD-PhD Student MSTP student Washington University School of Medicine MedicalResearch.com: What is the background for this study? Response: Many aspects of the mammalian digestive system including gut motility, nutrient absorption, and microbiota follow a daily rhythm. This circadian rhythm is generated by the cyclic expressions of molecular clock genes thought to be present in most cells. Group 3 innate lymphoid cells (ILC3) are lymphocytes residing in the intestinal mucosa that respond rapidly to activation in both homeostatic and inflammatory settings. Namely, ILC3s help maintain the mucosal barrier, regulate epithelial lipid transport, and protect against bacterial enteric infections. As tissue resident cells within the highly dynamic and rhythmic environment of the intestine, it may be advantageous for ILC3s to also be synchronized with the circadian rhythm.  (more…)
Author Interviews, Nutrition, Pediatrics, Sugar, Weight Research / 26.09.2019

MedicalResearch.com Interview with: Professor Alex Bentley Head of Anthropology University of Tennessee Knoxville TN  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In recent years, considerable evidence has accumulated suggesting that excess sugar consumption, e.g. in sugar-sweetened beverages, has been a major driver of the U.S. obesity crisis. Critics of this idea, however, have asked: why did the rise in sugar consumption precede the U.S. obesity crises by a decade or more, and why did obesity continue to rise even after sugar consumption began declining the early 2000s? We modeled the delayed onset of obesity by assuming that diet is a cumulative process that begins in childhood. On average, each age cohort (birth year) has its own specific cumulative exposure to excess sugar in their diets.  The inherent delay in our model links childhood consumption of excess sugar with propensity for adult obesity as an adult. Our model explains a simple process by which excess sugar in diets of children of the 1970s and 1980s could explain the sharp increase of adult obesity that began in the 1990s. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Nutrition, Weight Research / 24.09.2019

MedicalResearch.com Interview with: Deirdre K Tobias, ScD Associate Epidemiologist, Brigham and Women’s Hospital Assistant Professor, Harvard Medical School nuts-nutrition-weight-obesityMedicalResearch.com: What is the background for this study? What types of nuts are helpful? Peanuts included?  Response: We did not have the granularity in our study to evaluate too many individual nut types, and did not perform head-to-head comparisons between types of nuts. All seemed to be better for long-term weight control compared with the snacks like potato chips that we know are not great for us on a regular basis. (more…)
Author Interviews, Gastrointestinal Disease, Weight Research / 21.09.2019

MedicalResearch.com Interview with: Sarah Ballou, PhD Health Psychologist Division of Gastroenterology, Hepatology, and Nutrition Beth Israel Deaconess Medical Center Boston, MA MedicalResearch.com: What is the background for this study? What are the main findings? Response: Obesity is known to be associated with an increased risk of gastrointestinal and liver diseases, but less is known about the relationship between obesity and constipation or diarrhea. We used a nationally representative sample of the US population to evaluate whether obesity was associated with abnormal bowel habits. We found that obese individuals were 60% more likely to have diarrhea, even after controlling for possible confounding factors such as dietary, lifestyle, psychological, and medical conditions. (more…)