Journal of Nutrition LabDiet, Your World of Nutritional Answers

Home Help [Feedback] [For Subscribers] [Archive] [Search] [Contents]
 QUICK SEARCH:   [advanced]


     


This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Miller, K. B.
Right arrow Articles by Finley, J. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Miller, K. B.
Right arrow Articles by Finley, J. W.
(Journal of Nutrition. 2000;130:2032-2035.)
© 2000 The American Society for Nutritional Sciences


Research Communication

High Dietary Manganese Lowers Heart Magnesium in Pigs Fed a Low-Magnesium Diet1

Kevin B. Miller*, Joel S. Caton*, Denice M. Schafer**, David J. Smith{dagger} and John W. Finley**2

* Department of Animal and Range Science, North Dakota State University (NDSU), Fargo, ND 58105 {dagger} United States Department of Agriculture,1 Agricultural Research Service, Biosciences Research Laboratory, Fargo, ND 58105, and ** United States Department of Agriculture, Agricultural Research Service, Grand Forks Human Nutrition Research Center (GFHNRC), Grand Forks, ND 58202

2To whom correspondence should be addressed.


    ABSTRACT
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Young pigs were fed a diet moderately high or low in manganese (Mn) (0.95 ± 0.10 mmol Mn/kg, n = 8 or 0.040 ± 0.003 mmol Mn/kg, n = 6) and deficient in magnesium (Mg) (4.1 mmol Mg/kg) for 5 wk. All eight pigs consuming the high Mn diet died following convulsive seizures, whereas only two of six died in the group fed low Mn. In an attempt to determine the cause of death, a subsequent study examined the interactive effect of deficient dietary Mg and Mn on the tissue distribution of Mg and Mn. Pigs were individually fed, for 5 wk, diets that contained: 4.1 mmol Mg/kg and 36.0 µmol Mn/kg, 4.1 mmol Mg/kg and 0.91 mmol Mn/kg, 4.1 mmol Mg/kg and 0.91 mmol Mn/kg with added ultratrace minerals, or 41.1 mmol Mg/kg and 0.91 mmol Mn/kg, and ultratrace minerals. Liver and skeletal muscle Mn concentrations were significantly elevated by increased dietary Mn. Increased dietary Mn did not affect heart Mn, but heart Mg concentrations were significantly depressed by high, as compared to low, dietary Mn (38.7 ± 3.3 vs. 32.7 ± 2.6 mmol Mg/kg). These data suggest high dietary Mn may exacerbate Mg deficiency in heart muscle and thus may be a complicating factor in the deaths observed in Mg-deficient pigs.


KEY WORDS: • manganese • magnesium • toxicity • heart • swine


    INTRODUCTION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Although manganese (Mn) is an essential component of several enzymes involved in carbohydrate, lipid and protein metabolism, it also is a toxic element (Khan et al. 1997Citation ). Acute Mn toxicity in humans is characterized by a crippling neurological disorder resembling Parkinson’s disease in humans (Chandra et al. 1974Citation , Cotzias 1958Citation ). Although Mn toxicity also has been reported in animals (Grummer et al. 1950Citation , Khan et al. 1997Citation ), Leibholz et al. (1962)Citation fed growing swine 72.8 mmol Mn/kg diet without mortality or severe morbidity. Grummer et al. (1950)Citation fed growing swine up to 9.1 mmol Mn/kg diet and observed "retarded appetite and growth especially during the latter part of the trial," but no deaths. However, Grummer et al. (1950)Citation did speculate that Mn may cause some symptoms of toxicity at concentrations between 0.91 and 1.82 mmol Mn/kg diet.

Magnesium (Mg) is present in soft tissues and bone, and functions as a component or activator of enzymes involved in cellular respiration (Wacker and Parisi 1968aCitation , Wacker and Parisi 1968bCitation , Wacker and Parisi 1968cCitation ). Mg deficiency, as a consequence of various factors such as low dietary intake and inhibition of absorption by fats, has been linked to an increased risk of ischemic heart disease (IHD),3 irreversible cardiac failure (Altura et al. 1981Citation , Wu et al. 1992Citation ) and reduced coronary blood flow as a result of coronary vasospasm (Altura and Altura 1990Citation , Altura and Altura 1996Citation , Chipperfield and Chipperfield 1978Citation , Johnson et al. 1979Citation , Karppanen et al. 1978Citation , Raab 1969Citation ). IHD is a pathophysiologic state caused by blood vessel constriction or blockage that results in inadequate blood flow to the myocardium. Epidemiological research suggests Mg deficiency as a risk factor for several cardiovascular disorders, such as myocardial infarction and congestive heart failure in addition to IHD (Altura and Altura 1985Citation , Eisenberg 1992Citation , Rasmussen 1993Citation , Seelig 1989Citation ).

There are several possible points of interaction between Mn and Mg. The body can replace Mn with Mg with similar efficiency in Mn-activated proteins (Wapnir 1990Citation ). Similarly, Mn can occupy Mg allosteric sites in Mg-activated proteins, such as the sarcoplasmic reticulum calcium ATPase (Chiesi and Inesi 1981Citation ). Mn-supplemented diets increased Mg excretion through the urine in rats (Gaillard et al. 1996Citation ), and Mg deficiency increased the Mn absorption and retention in rats (Sanchez-Morito et al. 1999Citation ). Scheuhammer and Cherian (1983)Citation reported that Mn decreases Mg concentrations in both heart and bone by an undefined mechanism. Sanchez-Morito et al. (1999)Citation found that feeding rats a diet deficient in Mg decreased urinary and fecal Mn excretion. They also observed greater Mn retention in skeletal muscle, heart and kidney in Mg-deficient rats as compared to control.

In the present communication we report that Mg-deficient pigs had greater mortality when fed moderately high, as compared to low dietary Mn; however, Mn concentrations were well below previously reported toxic levels. A follow-up investigation was performed to more carefully examine the cause of death of pigs fed high Mn.


    MATERIALS AND METHODS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Animals and diets

All studies were approved by the Animal Care and Use Committee of the Grand Forks Human Nutrition Research Center, and pigs were maintained in accordance with the National Research Council guidelines for the care and use of laboratory animals.

    Study 1. Crossbred barrow pigs (n = 14, initial weight 22 kg; North Dakota State University Swine Research Unit, Fargo, ND) were randomly assigned to diets with either high (0.95 ± 0.10 mmol Mn/kg, n = 8) or low (0.040 ± 0.003 mmol Mn/kg, n = 6) Mn (Table 1Citation ). Pigs were placed into individual pens with free access to diet and water. Pigs that died prior to the study completion were examined by a veterinary diagnostic laboratory for gross pathology.


View this table:
[in this window]
[in a new window]
 
Table 1. Composition of diets

 
    Study 2. Crossbred barrow pigs (n = 20, initial weight 22 kg) were randomly assigned for 5 wk to one of four dietary treatments (Table 1)Citation . Diets were: (i) basal diet (4.1 mmol Mg/kg and 36.0 µmol Mn/kg); (ii) basal diet + high Mn (4.1 mmol Mg/kg and 0.91 mmol Mn/kg); (iii) basal diet + high Mn + ultratrace element premix (4.1 mmol Mg/kg and 0.91 mmol Mn/kg); (iv) basal diet + high Mn + ultratrace + adequate Mg (41.1 mmol Mg/kg and 0.91 mmol Mn/kg). Pigs were placed into individual pens with free access to diet and water. After 5 wk on diets, pigs were killed by electrical stun and exsanguination. Organs (heart, liver, brain, lung and skeletal muscle) and fluids (bile and serum) were collected and immediately frozen. Two pigs (one fed diet 1 and the other diet 3) died prior to the 5-wk completion; organ samples were collected at the time of death.

Laboratory analyses

Mn and Mg concentrations in organs and fluids were determined by atomic absorption spectrometry (Perkin-Elmer 3030B, Norwalk, CT). Samples were prepared for analysis by digesting lyophilized material with concentrated nitric acid and hydrogen peroxide as previously described (Bock 1979Citation ). Lanthanum oxide was added to samples for determination of Mg concentration to prevent phosphorus interference during spectrometry (AOAC 1990Citation ).

Quality control

Duplicate samples of National Institute of Standards and Technology (NIST) standards (Bovine Liver 1577b, NIST) were analyzed with each run to maintain quality control. Runs were acceptable if the NIST analyzed values fell within the stated range. The run-to-run CV averaged 3–6%, and the detection limits for Mn and Mg were 1.8 and 41.0 nmol/g, respectively.

Statistical analyses

Mortality data from study 1 were analyzed by a chi-square test. Data from study 2 were analyzed by one-way ANOVA for effect of diet on tissue Mn and Mg concentrations (SAS; SAS Institute, Cary, NC). Data were considered different if P < 0.05. Contrasts between treatments were determined by Tukeys Studentized Range Test.


    RESULTS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Study 1.

All pigs fed the high-Mn diet died before the end of the study (2 moribund pigs were euthanized), but only 2 fed the low-Mn diet died (P = 0.003). The pigs that died were observed paddling with their feet while lying on their sides, convulsing and hemorrhaging from the nose and mouth prior to death; pathology included severe, necrotizing myocarditis. An initial veterinary pathologist diagnosis was death from Mulberry Heart Disease (MHD) as a result of Se deficiency. Livers from the pigs contained 50.3 ± 1.4 nmol {alpha}-tocopherol/g and 21.5 ± 1.2 nmol selenium (Se)/g; normal ranges are between 42–63.4 and 12.5–31.5 nmol/g for {alpha}-tocopherol and Se, respectively. Subsequently pigs were injected with Se (BoSe; Shering-Plough, Union, NJ). The deaths continued after the pigs were given supplemental vitamin E and Se injections.

Study 2.

After 5 wk, pigs fed diet 4 were significantly heavier (Table 2Citation ) than those given other treatments (P < 0.05). Mn concentrations in the liver and skeletal muscle were greater (P < 0.01) in pigs fed high-, as compared to low-, dietary Mn (Table 2)Citation . Increased dietary Mn did not affect heart Mn, but high Mn depressed heart Mg concentrations in pigs without ultratrace mineral supplementation (P < 0.01) (Table 2)Citation . Brain Mg concentrations were not significantly (P > 0.05) affected by dietary Mn, but were numerically lower in the pigs fed high-Mn without ultratrace minerals. Dietary Mn did not affect the Mg concentrations of any other tissues or fluids measured. Plasma Mg was increased (P < 0.001) by increased dietary Mg (Table 2)Citation .


View this table:
[in this window]
[in a new window]
 
Table 2. Initial and final weights, tissue manganese and magnesium concentrations in swine fed diets high or low in manganese and moderately deficient in magnesium (study 2)12

 

    DISCUSSION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Although Mn toxicity in animals is well-established, we are unaware of any work that has reported deaths at the concentrations fed in this study. Mn requirements in young swine were formerly set as high as 0.36 mmol Mn/kg (NRC 1973Citation ). Leibholz et al. (1962)Citation reported that "no toxicity symptoms were observed in pigs fed 72.8 mmol Mn/kg"; however, there was evidence of growth depression and stiffness. Leibholz et al. (1962)Citation summarized that pigs have a high tolerance to Mn and that there exists a "considerable margin of safety between levels of Mn likely to be ingested in the diet and detrimental levels." Likewise, Grummer et al. (1950)Citation fed growing swine for 16 wk a corn-soybean-based diet and reported only moderate growth inhibition at Mn concentrations of up to 2.4 mmol Mn/kg. In the present study, pigs fed diets with 0.91 mmol Mn/kg and moderately deficient in Mg were dying after only 3 wk.

Mg is essential for energy metabolism and bone structure. Growing pigs require ~16.4 mmol Mg/kg per day to maintain maximal growth (NRC 1988Citation ). The dietary Mg intake at which acute deficiency results in death is conflicting. Mayo et al. (1959)Citation reported fatal deficiency (intake at which half the animals on test died) within 21 d when pigs were fed 2.8 mmol Mg/kg diet. However, they also reported that other pigs fed 2.6 mmol Mg/kg diet for 42 d survived, although they developed severe deficiency symptoms (Mayo et al. 1959Citation ). In the present study, both the high- and low-Mn diets were formulated to contain 4.1 mmol Mg/kg diet. Because of the above reports, and because only two of six pigs died in the low-Mn group, as compared to all eight fed the high-Mn diet, we concluded that dietary Mg deficiency was not solely responsible for their deaths.

Symptoms of acute hypomagnesemia, or grass tetany in ruminants, include grinding of teeth, paddling of limbs and convulsions prior to death (Church 1988Citation , Merck Veterinary Manual 1990Citation ). Church (1988)Citation reported that despite the lack of characteristic postmortem lesions, subendocardial lesions may be caused by severe tetanic convulsions associated with Mg deficiency. Signs of Mg deficiency in pigs also include muscular twitching, reluctance to stand, loss of equilibrium and tetany followed by death (Mayo et al. 1959Citation , Miller et al. 1965Citation ). Similar symptoms were observed in the present study.

A veterinary pathologists diagnosis of MHD was deduced from both the sudden death and cardiac muscle degeneration observed in necropsy; however, subsequent treatment of all remaining pigs with supplemental vitamin E and Se prophylaxis failed to prevent mortality. Moreover, the liver {alpha}-tocopherol and Se concentrations were not deficient providing further evidence that MHD as a result of inadequate {alpha}-tocopherol and Se was not the cause of death. The veterinary pathology summary of pigs fed the high-Mn diets included "myodegeneration, necrosis and mineralization of heart," "moderate myocardiocyte necrosis" and "severe, multifocal, myocardial necrosis." In contrast, pigs fed the low-Mn diet were reported to have "mild, nonsupportive myocarditis" and "mild myocardial fibrosis." The heart tissue pathology of MHD includes "severe, necrotizing myocarditis" and "myocardial lesions," symptoms that are also associated with Mg deficiency (Wutzen and Rozycka 1975Citation ).

In the second study, brain Mg was numerically lower in the pigs fed high-Mn and low-Mg. We recognize the link between Mn toxicity and neurological disorders. Electroencephalograms were recorded for each pig, and the data will be presented elsewhere, although initial visual analysis revealed no major differences.

The reduction of Mg in the hearts of pigs fed high-Mn implicates Mn as a potential Mg antagonist in that organ. Heart Mg concentrations were increased by supplementation with ultratrace minerals. Ultratrace minerals included in the supplemental mix were chromium (Cr), fluorine (F), silicon (Si), nickel (Ni), lithium (Li), molybdenum (Mo), vanadium (V) and selenium (Se) and copper (Cu). Copper was supplied in both the ultratrace and mineral premix at 0.09 mmol/kg diet. The mechanism through which supplementation of these minerals increased the heart Mg concentration is unknown.

In humans, the link between hypomagnesemia in the heart and the increased risk of IHD as well as coronary vasospasm, cardiac dysrhythmia and altered cellular respiration has been well-documented (Altura and Altura 1985Citation , Eisenberg 1992Citation , Rasmussen 1993Citation , Seelig 1989Citation ). If high dietary Mn displaces Mg from the heart, then people suffering from depressed Mg status could be at greater risk for Mn toxicity.

In conclusion, these data suggest that Mn exacerbates Mg deficiency and is responsible for a decrease in heart muscle Mg concentrations. This reduction of Mg concentrations in the heart may therefore be a contributing factor in the deaths observed in pigs fed high Mn.


    FOOTNOTES
 
1 The U.S. Department of Agriculture, Agricultural Research Service, Northern Plains Area, is an equal opportunity/affirmative action employer and all agency services are available without discrimination. Back

3 Abbreviations used: IHD, ischemic heart disease; Mg, magnesium; Mn, manganese; MHD, Mulberry Heart Disease; MHD, mulberry heart disease; NIST, National Institute of Standards and Technology; Se, selenium; UT, ultra-trace minerals. Back

Manuscript received October 20, 1999. Revision accepted March 22, 2000.


    REFERENCES
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 

1. Abraham A. S., Rosenmann D., Kramer M., Balkin J., Zion M. M., Farbstein H., Eylath U. Magnesium in the prevention of lethal arrhythmias in acute myocardial infarction. Arch. Intern. Med. 1987;147:753-755[Abstract/Free Full Text]

2. Altura B. M., Altura B. T. Magnesium ions and contraction of vascular smooth muscles: relationship to some vascular diseases. Fed. Proc. 1981;40:2672-2679[Medline]

3. Altura B. M., Altura B. T. New perspectives on the role of magnesium in the pathophysiology of the cardiovascular system. Magnesium 1985;4:226-244[Medline]

4. Altura B. M., Altura B. T. Magnesium and its role in biology, nutrition and physiology. Siegel H. Siegel A. eds. Metal Ions in Biological Systems 1990;Vol. 26:359-416 Marcel Dekker, Inc. New York, NY.

5. Altura B. M., Altura B. T. Role of magnesium in pathophysiological processes and the clinical utility of magnesium ion selective electrodes. Scand. J. Clin. Lab. Invest. Suppl. 1996;224:211-234[Medline]

6. AOAC Helrich K. eds. Official Methods of Analysis 15th Ed. Volume 1 1990 AOAC Arlington, VA.

7. Bock R. A Handbook of Decomposition Methods in Analytical Chemistry 1979 John Wiley & Sons New York, NY.

8. Ceremuzynski L., Jurgiel R., Kulakowski P., Grebalska J. Threatening arrhythmias in acute myocardial infarction are prevented by intravenous magnesium sulfate. Am. Heart. J. 1989;118:1333-1334[Medline]

9. Chandra S. V., Seth P. K., Mankeshwar J. K. Manganese poisoning: Clinical and biochemical observations. Environ. Res. 1974;7:374-380

10. Chiesi M., Inesi G. Mg and Mn modulation of Ca transport and ATPase activity in sarcoplasmic reticulum vesicles. Arch. Biochem. Biophys. 1981;208:586-592[Medline]

11. Chipperfield B., Chipperfield J. R. Relation of myocardial metal concentrations to water hardness and deathrates from ischemic heart disease. Lancet 1978;2:709-712[Medline]

12. Church D. C. The Ruminant Animal: Digestive Physiology and Nutrition 1988 Prentice Hall, Inc., Division of Simon & Schuster Englewood Cliffs, NJ.

13. Cotzias G. C. Manganese in health and disease. Physiol. Rev. 1958;38:503-532[Free Full Text]

14. Eisenberg M. J. Magnesium deficiency and sudden death. Editorial. Am. Heart J. 1992;124:544-549[Medline]

15. Gaillard E., Laurant P., Robin S., Berthelot A. Effects of long-term high manganese intake on magnesium metabolism in rats. Magnes-Res 1996;9:119-123

16. Grummer R. H., Bentley O. G., Phillips P. H., Bohstedt G. The role of manganese in growth, reproduction, and lactation of swine. J. Anim. Sci. 1950;9:170

17. Johnson C. J., Peterson D. R., Smith E. K. Myocardial tissue concentrations of magnesium and potassium in men dying suddenly from ischemic heart disease. Am. J. Clin. Nutr. 1979;32:967-970[Abstract/Free Full Text]

18. Karppanen H., Pennanen R., Passinen L. Minerals, coronary heart disease and sudden coronary death. Adv. Cardiol. 1978;25:924

19. Khan K. N., Andress J. M., Smith P. F. Toxicity of subacute intravenous MnCl2 administration in beagle dogs. Toxicol. Pathol. 1997;25:344-350[Abstract/Free Full Text]

20. Leibholz J. M., Speer V. C., Hays V. W. Effect of dietary manganese on baby pigs performance and tissue manganese levels. J. Anim. Sci. 1962;21:772[Abstract/Free Full Text]

21. Mayo R. H., Plumlee M. P., Beeson W. M. Magnesium requirement of the pig. J. Anim. Sci. 1959;18:264[Abstract/Free Full Text]

22. Merck Veterinary Manual A Handbook of Diagnosis, Therapy, and Disease Prevention and Control for the Veterinarian 6th Ed. 1990 Merck & Co., Inc. Rahway, NJ.

23. Miller E. R., Ullrey D. E., Zutaut C. L., Hoefer J. A., Luecke R. W. Mineral balance studies with the baby pig; Effects of dietary magnesium level upon calcium, phosphorus, and magnesium balance. J. Nutr. 1965;86:209[Medline]

24. National Research Council Nutrient Requirements of Swine 7th Ed 1973 National Academy Press Washington, D.C.

25. National Research Council Nutrient Requirements of Swine 9th Ed. 1988 National Academy Press Washington, D.C.

26. Raab W. Myocardial electrolyte derangement: crucial feature of pluricausal, so-called coronary, heart disease. Ann. NY Acad. Sci. 1969;147:629-686

27. Rasmussen H. S. Justification for magnesium therapy in acute ischemic heart disease. Clinical and experimental studies. Danish Med. Bull. 1993;40:84-99

28. Rasmussen H. S., McNair P., Norregard P., Backer V., Lindeneg O., Balslev S. Intravenous magnesium in acute myocardial infarction. Lancet 1986;1:234-236[Medline]

29. Sanchez-Morito N., Planells E., Aranda P., Llopis J. Magnesium-manganese interactions caused by magnesium deficiency in rats. J. Am. Coll. Nutr. 1999;18:475-480[Abstract/Free Full Text]

30. Scheuhammer A. M., Cherian M. G. The influence of manganese on the distribution of essential trace elements. II. The tissue distribution of manganese, magnesium, zinc, iron, and copper in rats after chronic manganese exposure. J. Toxicol. Environ. Health. 1983;12:361-370[Medline]

31. Seelig M. S. Cardiovascular consequences of magnesium deficiency and loss: pathogenesis, prevalence and manifestations—magnesium and chloride loss in refractory potassium repletion. Am. J. Cardiol. 1989;63:4G-21G[Medline]

32. Wacker W.E.C., Parisi A. F. Magnesium metabolism. New Engl. J. Med. 1968a;278:658-663

33. Wacker W.E.C., Parisi A. F. Magnesium metabolism. New Engl. J. Med. 1968b;278:712-717

34. Wacker W.E.C., Parisi A. F. Magnesium metabolism. New Engl. J. Med. 1968c;278:772-776

35. Wapnir R. A. Protein nutrition and mineral absorption, Chapter 10 1990 CRC Press Boca Raton, FL.

36. Wu F., Zou L., Altura B. T., Barbour R. L., Altura B. M. Ferrylmyoglobin formation induced by acute magnesium deficiency in perfused rat heart causes cardiac failure. Magnesium & Trace Elem 1992;10:364-373

37. Wutzen J., and Rozycka Z. Electron microscopic lesions of the myocardium of rats fed a low-magnesium diet. Polish Med. Sci. Hist. Bull. 1975;4:407-414




This article has been cited by other articles:


Home page
JPEN J Parenter Enteral NutrHome page
C. J. Klein, F. H. Nielsen, and P. B. Moser-Veillon
Trace Element Loss in Urine and Effluent Following Traumatic Injury
JPEN J Parenter Enteral Nutr, March 1, 2008; 32(2): 129 - 139.
[Abstract] [Full Text] [PDF]


This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Miller, K. B.
Right arrow Articles by Finley, J. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Miller, K. B.
Right arrow Articles by Finley, J. W.


Home Help [Feedback] [For Subscribers] [Archive] [Search] [Contents]
Copyright © 2000 by American Society for Nutrition