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Food Research International 116 (2019) 786–794

Contents lists available at ScienceDirect

Food Research International


journal homepage: www.elsevier.com/locate/foodres

Edible nuts deliver polyphenols and their transformation products to the T


large intestine: An in vitro fermentation model combining targeted/
untargeted metabolomics
Gabriele Rocchettia,b,c, , Sudarshana Reddy Bhumireddyc, Gianluca Giubertib, Rupasri Mandalc,

Luigi Lucinib, , David S. Wishartc,d


a
Department of Animal Science, Food and Nutrition, Università Cattolica del Sacro Cuore, Piacenza 29122, Italy
b
Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Piacenza 29122, Italy
c
Department of Biological Sciences, University of Alberta, Edmonton, AB T6G 2E9, Canada
d
Department of Computing Science, University of Alberta, Edmonton, AB T6G 2E8, Canada

ARTICLE INFO ABSTRACT

Keywords: The fate of polyphenols from edible tree nuts was investigated using a simulated in vitro intestinal fermentation
Nuts system. The digested food matrix was fermented for 48 h and the changes in the phenolic profiles were evaluated
Polyphenols by both untargeted UHPLC-QTOF and targeted UHPLC-Orbitrap mass spectrometry. The untargeted metabo-
In vitro fermentation lomics approach allowed us to monitor the comprehensive changes in phenolic profiles from 0 up to 48 h of in
Food metabolomics
vitro fermentation. Multivariate statistics (i.e., orthogonal projection to latent structures discriminant analysis)
UHPLC-QTOF
applied to this untargeted data allowed us to identify the most discriminating phenolic metabolites and to
UHPLC-Orbitrap
further understand the colonic transformation pathways involved. In particular, 13 putatively identified com-
pounds derived from flavonoids, lignans and phenolic acids were found to have the highest discrimination
potential. Six phenolic metabolites were then quantified by means of targeted metabolomics (using a UHPLC-
Orbitrap). These metabolites included 3,4-dihydroxyphenylacetic acid, 4-hydroxybenzoic acid, hippuric acid,
caffeic acid, protocatechuic acid and protocatechuic aldehyde. Using the targeted data, a clear matrix effect was
observed over time, with an increase of some phenolic metabolites moving from 8 to 48 h of in vitro fermen-
tation. Based on these data, catabolic pathways for colonic microbial degradation of flavonoids, hydro-
xycinnamic acids, tyrosols and lignans are proposed. Our findings show that edible tree nuts deliver polyphenols
to the colon, where several microbial transformations occur that lead to smaller phenolic metabolites being
observed. Furthermore, we found that the combined use of targeted and untargeted metabolomics can be par-
ticularly effective for investigating the fate of polyphenols in the large intestine.

1. Introduction polyphenols may also contribute (Lamuel-Raventos & Onge, 2017).


Polyphenols are a diverse family of bioactive compounds found in al-
The consumption of tree nuts, such as almonds, hazelnuts, pis- most all plant foods. Five main polyphenolic classes exist, namely fla-
tachios, walnuts, pecans, and cashews has been found to be inversely vonoids, phenolic acids, lignans, stilbenes, and phenolic alcohols
associated with the incidence and prevalence of several common, (Rothwell, Knaze & Zamora-Ros, 2017).
chronic diseases including type 2 diabetes and coronary heart disease After ingestion, polyphenols can undergo extensive metabolism
(Lamuel-Raventos & Onge, 2017). Nut consumption has also been within the human gastrointestinal tract. The bioactivity and bioavail-
shown to have favorable effects on the lipid profile and cardiovascular ability of a given polyphenol is often defined by the metabolic changes
disease risk factors, as demonstrated by several supplementation studies it experiences in the body (Bohn et al., 2015). In particular, some
involving almonds, hazelnuts, peanuts, pistachios and walnuts (Vinson polyphenols can be released from the food matrix and partially ab-
& Cai, 2012). The health benefits of tree nuts have been mainly at- sorbed, while others escape from the small intestine almost unchanged,
tributed to their fatty acid profile, although the high levels of dietary thereby reaching the large intestine where a series of microbial trans-
fiber, vitamins and secondary metabolites such as phytosterols and formations usually occur (Cardona et al., 2013; Ozdal et al., 2016). It


Corresponding authors at: Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Piacenza 29122, Italy.
E-mail addresses: gabriele.rocchetti@unicatt.it (G. Rocchetti), luigi.lucini@unicatt.it (L. Lucini).

https://doi.org/10.1016/j.foodres.2018.09.012
Received 11 July 2018; Received in revised form 28 August 2018; Accepted 8 September 2018
Available online 11 September 2018
0963-9969/ © 2018 Elsevier Ltd. All rights reserved.
G. Rocchetti et al. Food Research International 116 (2019) 786–794

has been estimated that about 5–10% of total human polyphenol intake hazelnuts (Corylus avellana L.), pistachios (Pistacia vera L.), almonds
is absorbed in the small intestine, while the remaining 90–95% must be (Prunus dulcis Mill.) and natural walnuts (Juglans regia L.). Samples were
subject to enzymatic activity of the gut microbiota (Cardona et al., gratefully provided by Nicola Scala S.r.l. (Liveri, Italy) and freshly
2013). It has also been suggested that polyphenolic interactions with prepared prior to the further analyses.
gut microbes may lead to several biochemical transformations of the
native polyphenols into more bioavailable metabolites. These metabo- 2.2. Extraction and profiling of polyphenols from raw nuts
lites are typically lower molecular weight substances and many of them
may be responsible for the real health-promoting effects of polyphenol- Free and bound polyphenols were extracted from each raw nut
rich foods (Mosele et al., 2015; Espín et al., 2017). sample and then profiled and quantified, as described in a previous
The most important biotransformation reactions promoted by gut work (Rocchetti et al., 2018). For the quantification step, methanolic
microbiota can be grouped into three major catabolic processes: i) hy- standard solutions of ferulic acid (for phenolic acids), sesamin (lig-
drolysis (O-deglycosylations and ester hydrolysis), ii) cleavage (C-ring nans), cyanidin (anthocyanins), catechin (flavanols and flavonols), lu-
cleavage and demethylation), and iii) reductions (dehydroxylation and teolin (flavones), resveratrol (stilbenes), 5-pentadecylresorcinol (alkyl-
double bond reduction) (Mosele et al., 2015; Serra et al., 2012). In vivo, phenols) and tyrosol (tyrosols and others) were used. All standard
these phenolic metabolites are transported to the liver where they are compounds were purchased from Extrasynthese (Genay, France) each
subject to phase I (oxidation, reduction and hydrolysis) and phase II having a purity > 98%. These reference compounds were considered as
(conjugation) metabolism or secreted back into the gut, where they are representative of their respective phenolic class.
again absorbed or finally excreted (Tarko et al., 2013).
Nuts are among the richest food source of polymerized polyphenols 2.3. Simulated in vitro digestion and faecal fermentation process
(i.e., ellagitannins and proanthocyanins). These polymerized poly-
phenols can be further processed by colonic microbiota, yielding a wide To simulate digestion and the faecal fermentation process, nut
range of low molecular weight phenolic metabolites. These metabolites samples were milled and hydrolyzed with digestive enzymes simulating
appear to alter the microbial ecosystem as well as the microbiota pro- human gastric and pancreatic digestion phases, and then subjected to
file, often leading to beneficial prebiotic effects (Lamuel-Raventos & an in vitro faecal fermentation process, as detailed by Rocchetti et al.
Onge, 2017; Cardona et al., 2013). In this regard, Rocchetti, Giuberti, (2018). Briefly, pooled dried post-hydrolysis residues were incubated
and Lucini (2018) showed a temporal increase in the bioaccessibility of with a fresh faecal inoculum collected from five growing pigs (35–46 kg
nut phenolics during in vitro simulated gastrointestinal digestion and body weight; fed with a standard commercial diet devoid of anti-
fermentation. They found that lower-molecular-weight phenolic com- biotics). The faecal inoculum was obtained by pooling equal amounts
pounds such as phenolic acid, tyrosol and alkylphenol equivalents (by wet weight) of fresh faeces from each animal and then gently mixed
generally increased over time. In addition to facilitating the production with 200 mL of 39 °C CO2-saturated buffer solution and filtered through
of polyphenolic metabolites, colonic microbiota is also able to process a 250 μm mesh screen. An additional volume of buffer solution was
the undigested nut/food matrix (i.e., the fiber) reaching the colon. This added to reach the desired dilution of faeces in the buffer (0.05 g
typically leads to the biosynthesis of short-chain fatty acids (SCFA) and faeces/mL buffer) (Giuberti, Gallo, Moschini, & Masoero, 2013).
the release of the so-called bound phenolics, or non-extractable-poly- Thereafter, 400 mg of each dry pooled nut residue was weighted in
phenols (NEPP) (Lamuel-Raventos & Onge, 2017; Rocchetti et al., 2017; triplicate into a 125 mL glass serum bottle (Z114041, Sigma-Aldrich,
Acosta-Estrada et al., 2014). Once accessible, these NEPPs can be fur- Milan, Italy) and filled with 60 mL of the buffer solution containing the
ther processed by the microbial community of large intestine. faecal inoculum. Bottles were sealed with a rubber stopper and im-
Over the past few years, in vitro fermentation models mimicking the mediately placed in a 39 °C shaking water bath (50 rpm). Three bottles
physiological conditions of the large intestine have been applied to without substrate were used as blanks. All manipulations and sample
better explore the biotransformation of polyphenols (Rocchetti et al., handlings were done under continuous CO2 flushing (technical grade:
2017; Rocchetti, Chiodelli, et al., 2018; Juániz et al., 2016). These in 5.5; from SAPIO, Monza, Italy). Three incubation runs were conducted
vitro methods, which often use human or pig faecal inoculum, are over three different days, and bottles within runs were considered re-
widely used to predict phenolic bioavailability and have several cost petitions, whereas bottles between runs were considered replicates.
and reproducibility advantages compared to in vivo models (Minekus Finally, aliquots (3 mL) were aseptically removed from each bottle
et al., 2014). When combined with metabolomic approaches, these in using a 5 mL plastic injection syringe equipped with a catheter needle at
vitro models permit the study of several aspects of molecular nutrition, 0, 8, 24 and 48 h after incubation and stored at −4 °C for further
including the characterization of polyphenols during gastrointestinal analysis.
processes (Rocchetti, Giuberti, & Lucini, 2018) or the analysis of phy-
tochemicals for food quality and authenticity purposes (Castro-Puyana 2.4. Characterization of bacterial profile in faecal inoculum
et al., 2017).
However, to the best of our knowledge, no in vitro digestion/fer- The DNA extraction of the dominant bacterial communities in fresh
mentation models have been used to explore the possible catabolic faeces was carried out according to the method reported by Miragoli
pathways by which nut polyphenols are processed. Likewise, advanced et al. (2016). Afterwards, copy numbers of the 16S rRNA genes from
metabolomic techniques have not been applied to characterize these in Bacteroides/Prevotella, Clostridium coccoides, Bifidobacterium, Lactoba-
vitro derived catabolic end products. Therefore, the purpose of this cillus, Enterococcus, Enterobacteriaceae, and Ruminococcus groups were
work was to use both targeted metabolomics (i.e., UHPLC-Orbitrap MS) determined by means of previously reported DNA primers (Bruzzese
and untargeted metabolomics (i.e., UHPLC-QTOF MS) to robustly and et al., 2014), according to a real-time polymerase chain reaction (RT-
accurately characterize the metabolic fate of nut polyphenols in the PCR).
large intestine.
2.5. Untargeted UHPLC-ESI-QTOF screening of phenolic metabolites during
2. Materials and methods in vitro faecal fermentation

2.1. Samples Using samples collected from the simulated in vitro (large intestine)
fermentation, 1 mL aliquots were taken at 0, 8, 24 and 48 h and ex-
Five commercial edible nut categories (100 g plastic bags) were tracted into the same volume of a 3% formic acid in 70% methanol
analysed in this study, namely peanuts (Arachis hypogaea L.), peeled (LCMS grade, Sigma-Aldrich, Milan, Italy) solution. Each aliquot was

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G. Rocchetti et al. Food Research International 116 (2019) 786–794

stored overnight at −18 °C, centrifuged at 10,000 ×g for 10 min at 4 °C, 2.7. Multivariate statistics
and then filtered in amber vials using 0.22 μm cellulose syringe filters.
In order to monitor the change in the phenolic metabolite profile Untargeted MS data on the phenolic metabolite profiles observed
during the in vitro fermentation process, the methanolic extracts were during in vitro large intestine fermentation were analysed using Agilent
analysed by ultra-high-pressure liquid chromatography and then de- Mass Profiler Professional B.12.06. In particular, compounds were fil-
tected by a hybrid quadrupole-time-of-flight mass spectrometer tered by abundance and by frequency (only those compounds with an
(UHPLC-ESI/QTOF-MS), according to previously optimized analytical area > 5000 counts and appearing in 100% of samples in at least one
conditions (Rocchetti et al., 2017; Rocchetti, Chiodelli, et al., 2018). In condition were considered), normalized at the 75th percentile, base-
conducting these assays an Agilent 1290 liquid chromatograph coupled lined to the median of each compound in all samples and corrected for
with an Agilent G6550 mass spectrometer equipped with a dual elec- the control (only faeces) in order to eliminate matrix effects.
trospray jet stream ionization system (all from Agilent technologies, The raw and processed metabolomic dataset obtained after the in
Santa Clara, CA, USA) was used. The mass spectrometer was set to the vitro large intestine fermentation was exported to SIMCA 13 (Umetrics,
“Scan mode” to acquire positive ions in the range of 50–1100 m/z. Raw Malmo, Sweden), scaled and elaborated for orthogonal partial-least-
data were processed using the Agilent Profinder B.06 software, ac- squares discriminant analysis (OPLS-DA). Variations between the
cording to the targeted ‘find-by-formula’ algorithm. Accurate mass in- groups were separated into predictive and orthogonal components (i.e.,
formation was used together with the spectral isotope pattern (isotopic those components ascribable to technical and biological variation). The
spacing and isotopic ratio) to achieve a higher confidence in metabolite presence of outliers was investigated according to Hotelling's T2
identification. Features that were not present in 100% of replications method (i.e., the distance from the origin in the model) using 95% and
within at least one treatment were discarded. Data from Phenol-Ex- 99% confidence limits for “suspect” and “strong” outliers, respectively.
plorer 3.6 (Rothwell et al., 2013) listed under “polyphenol metabolites” Cross validation of the OPLS-DA model was performed to exclude over
was used as a reference for compound identification, adopting a 5 ppm fitting using CV-ANOVA (p < .001) and through permutation testing
tolerance for mass accuracy. Based on the strategy adopted, identifi- after recording model parameters (goodness-of-fit R2Y and goodness-of-
cation was carried out according to Level 2 (i.e., putatively annotated prediction Q2Y). For the Q2Y prediction ability, a value > 0.5 was
compounds) as set out by the COSMOS Metabolomics Standards In- adopted as a threshold to identify acceptable models, according to
itiative (http://cosmos-fp7.eu/msi). Phenolic metabolites that passed software recommendations and as described in the literature
the mass accuracy and frequency of detection thresholds, that had (Rombouts et al., 2017). Finally, variable importance in projection (VIP
plausible chromatogram peak features, and that showed significantly analysis) was used to evaluate the importance of phenolic metabolites
different trends from the control (faeces only), were considered as po- during the in vitro fermentation process and to select those with the
tential polyphenol fermentation markers. highest discrimination potentials (VIP score > 1).

2.6. Targeted determination of phenolic metabolites during in vitro faecal 3. Results and discussion
fermentation
3.1. Evaluation of microbial groups characterizing faecal inoculum
Targeted LC-MS analyses were performed on Q Exactive HF Hybrid
Quadrupole-Orbitrap Mass Spectrometer (Thermo Scientific, Waltham, Colonic bioconversion of phenolic compounds is strictly related to
MA, USA) coupled to a Vanquish ultra-high-pressure liquid chromato- the microbiota activity and composition found in the colon (van
graphy (UHPLC) pump and equipped with a HESI-II probe (Thermo Duynhoven et al., 2011). Therefore, to fully investigate the microbial
Scientific, USA). The chromatographic separation was achieved on re- catabolism of polyphenols, one should include a combination of in vitro
versed-phase Agilent Eclipse XDB C18 column (3.5 μm particle size; and in vivo colonic models. However, in vivo models are not always
3.0 × 100 mm; Agilent, Santa Clara, CA, USA) connected to an available due to ethical concerns and in vitro large intestine fermenta-
ACQUITY UPLC CSH C18 VanGuard Pre-column, (1.7 μm, tion methods are considered a valuable alternative for performing in
2.1 mm × 5 mm). Mobile phases were water (solvent A) and methanol vivo studies (Payne et al., 2012). For many kinds of in vitro large in-
(solvent B), both LC-MS grade. Ammonium formate (5 mM) and formic testine models, faecal inoculum from humans (Parkar et al., 2013) or
acid 0.1% (v/v) were added to both phases. The binary gradient elution pigs (Rocchetti et al., 2017; Rocchetti, Chiodelli, et al., 2018) has been
program was as follows: t = 0 min, 0% B; t = 0.2 min 5% B; t = 9 min, used. Indeed, pig faecal inocula are considered to be among the most
75% B; t = 10 min 0% B; t = 13 min, 0% B. The sample injection vo- suitable alternatives to human faecal inocula. This is because pig faecal
lume and flow rates were 5 μL and 0.5 mL/min, respectively, while the inocula reflect the environmental conditions of the distal region of the
column temperature was maintained at 50 °C. For MS analysis, the LC human large intestine owing to the similarities they share in the di-
eluents were allowed to enter the heated electrospray ionization (HESI- gestive anatomy, gastrointestinal fermentation profiles (the colon being
II) probe with typical operational conditions corresponding to a probe the main site of bacterial fermentation in pigs and humans), physiology,
heater temperature of 425 °C, a capillary temperature of 275 °C, a nutrition as well as gut microbiota (Roura et al., 2016). Real-time PCR
2.40 μA spray current, and a 2.5 kV spray voltage. Nitrogen was used as analysis seems to corroborate this, since both Firmicutes and Bacter-
both auxiliary and sheath gas, at a flow rate of 50 mL/min and 12 mL/ oidetes have been identified as the two dominant bacteria phyla in the
min, respectively. A mass range of m/z 70 to 1000 and a resolution of human, mouse and pig gut. Interestingly, two other enterotype-like
60,000 (FWHM) was employed. Each faecal fermented nut sample was clusters (Ruminococcus and Prevotella) have been recently identified in
analysed in triplicate. pig faeces and these are very similar to those described in humans
Finally, data acquisition (both chromatograms and spectral in- (Roura et al., 2016). Our results clearly indicate that Bacteroides/Pre-
formation) and processing was done using XCalibur 4.1.31.9 (Thermo votella (belonging to the Bacteroidetes phylum) and Clostridium coc-
Fisher Scientific Inc.). Quantification was performed against calibration coides (part of the Firmicutes phylum) were the most represented mi-
curves built with pure reference standard compounds for 3,4-dihy- crobial groups in the pig faecal inoculum, accounting for 55.5% and
droxyphenylacetic acid, 4-hydroxybenzoic acid, hippuric acid, caffeic 38.5% of the bacterial taxa respectively. These ratios are similar to
acid, protocatechuic acid and protocatechuic aldehyde (all from Sigma- those reported in human stool samples (Stearns et al. 2011). Other
Aldrich; purity > 98%). Accurate mass information, spectra compar- microbial groups were also identified by our PCR studies including
ison and retention time data were used for compound annotation Lactobacillus (4%), Ruminococcus (1%), Enterococcus (0.5%), Bifido-
(supplementary material). Quantitative results were expressed as nmol/ bacterium (0.3%) and Enterobacteriaceae (0.2%). Gut microbiota en-
g dry matter (DM). zymes have an essential role in the transformation of native

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Fig. 1. Cumulative phenolic composition (as mg/kg Equivalents) in different raw edible nuts, either in free [A] or bound [B] phenolic fractions.

polyphenols into the large intestine, however relatively few bacterial et al., 2018). In regard to tree nuts, polyphenol content can vary ex-
species are able to catalyse the metabolic transformations of poly- tensively between different genotypes (pre-harvest factors) and some
phenols (i.e., Escherichia coli, Bifidobacterium spp., Lactobacillus spp., phenolic classes can be deeply influenced by processing (i.e., roasting,
Bacteroidetes spp., and Firmicutes spp.) (Parkar et al., 2013). irradiation, and pasteurization) and storage (i.e., temperature and
duration) in the post-harvest period (Bolling et al., 2011; Grundy et al.,
2016).
3.2. Changes of the phenolic profile during in vitro faecal fermentation After our initial characterization of the raw materials, the same
untargeted approach (UHPLC-ESI-QTOF mass spectrometry) was used
A comprehensive untargeted metabolomic profile of both free and to investigate the changes in the phenolic profile of edible nuts during
bound phenolics from raw nut samples was investigated by means of simulated in vitro gastrointestinal digestion and fermentation. In this
UHPLC-ESI-QTOF mass spectrometry. This was done in order to broadly regard, Phenol-Explorer” (Rothwell et al., 2013), the comprehensive
characterize the native phenolic composition of these food matrices in database on polyphenols and polyphenol metabolites, was used to help
an unbiased manner. Overall, 339 compounds were putatively anno- identify the compounds from the QTOF-MS data. Overall, 75 phenolic
tated in the free phenolic fraction, while the bound fraction was char- metabolites were putatively annotated in the faecal fermented samples,
acterized by a somewhat lower number of compounds (i.e., 114 puta- with 31 compounds having an identification score > 75% (supple-
tive annotations). A detailed list of all phenolic compounds annotated mentary material). Therefore, in order to better characterize the
in each nut sample is provided in the supplementary material, together changes and the catabolic processes occurring during colonic fermen-
with composite mass data. Semi-quantitative values for each phenolic tation, a multivariate statistical approach (OPLS-DA) was employed.
class are reported in Fig. 1. Peanuts were characterized by the highest The OPLS-DA score plot illustrating the modification of the phenolic
total phenolic content (as sum of free and bound phenolics), with profile during fermentation is provided as Fig. 2. This OPLS-DA plot
8903.9 mg kg−1 equivalents and 65% of these being free phenolic clearly shows the modification of the phenolic profile moving from
compounds (i.e., phenolic acid, tyrosol, alkylphenol and flavanol/fla- digested to faecal fermented samples. This result confirms the well-
vonol equivalents). Regarding the other samples, peeled hazelnuts were known fact that polyphenols are subject to extensive microbial meta-
the second most abundant source of total phenolics (6895.8 mg kg−1 bolism as previously reviewed by Mosele et al. (2015). The parameters
equivalents), followed by almonds, pistachios and walnuts (on average of this OPLS-DA regression were more than acceptable, with relatively
5505.1 mg kg−1 equivalents). Interestingly, the bound phenolic fraction high values of R2Y and Q2Y (i.e., 0.89 and 0.75, respectively) and an
of all nut samples was characterized by very high levels of tyrosol adequate CV-ANOVA coefficient (p < 0.001). The Hotelling's T2 and
equivalents, with an average content of 1544.6 mg kg−1 equivalents. In permutation test respectively were also found to be adequate and are
particular, the most abundant compounds detected were tyrosol p- provided as supplementary material. Indeed, OPLS is able to process
HPEA-AC, followed by hydroxycoumarin/4-hydroxycoumarin (supple- very large dataset even when the number of the variables is much larger
mentary material). The polyphenol content of tree nuts has been re- than the number of samples (Farrés et al., 2015; Worley and Powers,
viewed recently (Alasalvar and Bolling, 2015), and it is characterized 2013). However, most of these variables are of little or no relevance for
by a wide distribution of phenolic acids, flavonoids (i.e., flavonols, investigating the biological problem, as they are not directly related to
anthocyanins, flavanols, isoflavones), condensed and hydrolysable the dependent variable (Y). Therefore, variable selection methods are
tannins, lignans and stilbenes. Most of the studies available on tree nuts often employed to help reduce the number of predictors, thereby pro-
that compare the total phenolic content of these nutrient-dense foods, viding only the most relevant ones. One of the most important variable
have used colorimetric assays such as Folin-Ciocalteu. However, as selection methods is the VIP (variable importance in projection)
recently reported by Granato et al. (2018), colorimetric methods pre- method. Specifically, this approach identifies those X variables that
sent many pitfalls and they are generally more useful as screening tools contribute the most to explaining the Y-variance (Farrés et al., 2015). In
rather than quantitative tools. Indeed, it is widely acknowledged that this work, the VIP method was used to identify the most important
the use of high-resolution mass spectrometry is the best method to metabolites contributing to the changes in the phenolic profile over
profile and quantify polyphenols in different food matrices (Granato

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Fig. 2. Orthogonal Projections to Latent Structures Discriminant Analysis (OPLS-DA) score plot on edible nuts phenolic metabolites' profile at 0 (immediately after in
vitro digestion), 8, 24 and 48 h of in vitro faecal fermentation.

time. Table 1 displays the phenolic metabolites having the highest VIP 3.3. Targeted identification and quantification of phenolic metabolites
scores (> 1), together with their chemical structure and the colonic
pathways in which they are involved. Overall, 13 compounds were In order to both validate and determine the absolute quantitative
found to have sufficiently high VIP scores, with the 4-hydro- values of the phenolic metabolites putatively identified in the faecal
xyphenylacetic acid possessing the highest VIP score (1.33), followed fermented nut samples, a targeted, high-resolution metabolomic
by a methylequol with a VIP score of 1.31. The phenolic metabolites method was used. Table 2 displays the phenolic metabolites identified
identified by the VIP approach are representative of the main catabolic and quantified via targeted UHPLC-Orbitrap mass spectrometry in the
pathways that are believed to play key roles in the large intestinal different nut samples during the in vitro fermentation process. The
fermentation of polyphenols. In fact, several catabolic pathways have phenolic metabolites detected and quantified include 3,4-dihydrox-
been proposed for each specific phenolic class and subclass (Mosele yphenylacetic acid, 4-hydroxybenzoic acid, hippuric acid, caffeic acid,
et al., 2015). For instance, the undigested polyphenols that are able to protocatechuic acid and protocatechuic aldehyde. These were selected
pass into the large intestine are often subject to further degradation into as being representative of those polyphenolic metabolites arising from
small phenolic acids by colonic microflora. In this regard, phenolic the degradation of the native, higher-molecular-weight compounds
glycosides are first hydrolysed by bacteria to aglycones, which are then followed by the further processing by the colonic microbiota. Interest-
transformed into different organic acids through the action of microbial ingly, hazelnuts, pistachios, almonds and walnuts showed an increase
enzymes such as β-glucosidase, β-rhamnosidase and esterases. Fur- in 3,4-dihydroxyphenylacetic acid over time, especially from 8 to 24 h
thermore, microbial enzymes are able to catalyse the degradation of the of in vitro faecal fermentation. The maximum concentration was re-
common flavonoid ring into simple chemical subunits, after which corded in pistachios (i.e., 6.60 nmol/g DM), followed by almonds (i.e.,
several reactions such as hydrolysis, dihydroxylation, demethylation 6.16 nmol/g DM). Another phenolic metabolite detected in all nut-fer-
and decarboxylation occur (Mosele et al., 2015; Ozdal et al., 2016). mented samples was protocatechuic acid, which belongs to the phenolic
These catabolic routes play a key role in the synthesis of lower-mole- class of hydroxybenzoic acids. The highest content of the proto-
cular-weight phenolics (i.e., phenyl-valerolactones, hydro- catechuic acid (i.e., 11.86 nmol/g DM) was found in peanuts after 8 h of
xyphenylacetics and hydroxyphenylpropionics) (Tarko et al., 2013); in vitro faecal fermentation, with somewhat lower values and different
(van Duynhoven et al., 2011). Overall, the multivariate OPLS-DA model trends over time recorded for hazelnuts, almonds and walnuts
we used, coupled with a VIP approach, allowed us to confirm that the (Table 2). Interestingly, both 4-hydroxybenzoic acid and hippuric acid
native polyphenols found in edible tree nuts are processed during in were measurable in faecal fermented samples. Hippuric acid was
vitro gastrointestinal digestion and fermentation through microbial ac- quantified only in peanuts, hazelnuts and walnuts after both 8 and 24 h
tivity, independently from the type of nut considered. of fermentation. This compound is a glycine conjugate of benzoic acid
The extensive bioconversion of phenolic compounds due to colonic and is commonly found in plasma and urine as marker of the con-
microbiota catabolism produces a wide range of phenolic metabolites. sumption of polyphenol-rich foods (Mosele et al., 2015). Hippuric acid
Some of these can also be exported into the systemic circulation. These is also produced from the metabolism of many dietary components
metabolites are part of the so-called “food metabolome” and over the including phenylalanine, quinic acid, shikimic acid, chlorogenic acid
past several years various metabolomic techniques (including NMR and catechin (Lees et al., 2013). Therefore, the detection and quanti-
and/or LC-MS methods) have been applied to characterize these com- fication of hippuric acid in faecal fermented nut aliquots could be due
pounds (Scalbert et al., 2014). While considerable effort has been de- to the microbial transformation of phenolic acids such as 4-hydro-
voted to putatively identifying the constituents of the food metabolome xybenzoic acid or quinic acid (Mosele et al., 2015). Relative to the other
(through untargeted metabolomic studies), relatively little effort has metabolites, caffeic acid and protocatechuic aldehyde, gave notably
been devoted to validating and fully quantifying these compounds. lower values, with caffeic acid being found only in peanuts, hazelnuts
Indeed, an intrinsic limitation of untargeted metabolomic approaches is and walnuts (Table 2). Interestingly, the results obtained by untargeted
that they are mostly qualitative or at best, semi-quantitative. Therefore, metabolomics (UHPLC-QTOF) were in general agreement with those
to obtain accurate quantification and fully validated metabolite anno- obtained by our targeted approach (UHPLC-Orbitrap). According to our
tation, targeted metabolomic approaches must be employed. untargeted data, 4-hydroxybenzoic acid and protocatechuic aldehyde

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Table 1
Phenolic compounds identified by VIP (Variable Importance in Projection) analysis following OPLS-DA model, during the in vitro faecal fermentation of edible nuts.
Compounds are provided together with VIP scores (measure of variable's importance in the OPLS-DA model), chemical structure and colonic pathways in which are
involved.

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Table 2
Quantitative values of phenolic metabolites detected during in vitro faecal fermentation of edible nuts. Data are presented as mean value (nmol phenolic compounds/
g dry matter incubated) ± standard deviation (n = 3).
Matrix Timepoint (h) 3,4-DHPA 4-HBA HA CA PA PAL

(nmol/g DM) (nmol/g DM) (nmol/g DM) (nmol/g DM) (nmol/g DM) (nmol/g DM)

Peanuts 8 6.59 ± 0.06 0.79 ± 0.01 2.42 ± 0.02 1.75 ± 0.02 11.86 ± 0.12 0.11 ± 0.00
24 5.65 ± 0.05 nd 2.72 ± 0.03 0.27 ± 0.00 4.35 ± 0.04 0.35 ± 0.00
48 nd nd nd nd nd 0.81 ± 0.00
Hazelnuts 8 4.31 ± 0.04 0.21 ± 0.00 2.29 ± 0.02 1.73 ± 0.02 3.17 ± 0.03 0.15 ± 0.00
24 5.89 ± 0.06 nd 3.25 ± 0.03 0.52 ± 0.00 2.64 ± 0.03 0.26 ± 0.00
48 3.11 ± 0.03 nd nd nd 4.70 ± 0.05 0.53 ± 0.01
Pistachios 8 4.00 ± 0.04 0.71 ± 0.01 nd nd 2.51 ± 0.02 0.37 ± 0.00
24 6.60 ± 0.06 nd nd nd 3.23 ± 0.03 0.49 ± 0.00
48 nd nd nd nd nd 1.08 ± 0.01
Almonds 8 6.05 ± 0.06 0.31 ± 0.00 nd nd 5.89 ± 0.06 0.38 ± 0.00
24 6.14 ± 0.06 nd nd nd 4.06 ± 0.04 0.53 ± 0.01
48 4.91 ± 0.05 nd nd nd 4.53 ± 0.04 0.35 ± 0.00
Walnuts 8 4.11 ± 0.04 0.31 ± 0.00 1.98 ± 0.02 1.66 ± 0.02 4.95 ± 0.05 0.30 ± 0.00
24 4.97 ± 0.05 nd 3.48 ± 0.03 0.59 ± 0.00 3.32 ± 0.03 0.20 ± 0.00
48 nd nd nd nd 4.51 ± 0.04 0.34 ± 0.00

Abbreviations: 3,4-DHPA (3,4-Dihydroxyphenylacetic acid); 4-HBA (4-Hydroxybenzoic acid); HA (Hippuric acid); CA (Caffeic acid); PA (Protocatechuic acid); PAL
(Protocatechuic aldehyde); DM (dry matter incubated); nd (not detected).

were among the most discriminating compounds (i.e., VIP markers) regard, Aura et al. (2002) detected the highest concentration of 3,4-
characterizing the changes of the phenolic profile observed during dihydroxyphenylacetic acid within 2 h of in vitro anaerobic faecal in-
fermentation. Additionally, 4-hydroxyphenylacetic and benzoic acid cubation (a time point not included in the present study) using pure
(outlined by VIP) are the final products of the dehydroxylation of 3,4- flavonoids (i.e., rutin, isoquercitrin and quercetin), while Kay et al.
dihydroxyphenylacetic and 4-hydroxybenzoic acids, respectively. (2017) suggested the direct formation of protocatechuic acid from di-
Overall, these findings corroborate previous results (Rocchetti, hydrocaffeic acid via β-oxidation reactions. Other minor colonic cata-
Chiodelli, et al., 2018) where an increase in bioaccessibility for some bolites, such as hippuric acid, p-coumaric acid, vanillic acid, 4-hydro-
phenolic classes (i.e., phenolic acids, tyrosols and alkylphenols) was xybenzoic and other benzoic acids have been associated with the in vivo
observed using the same edible nuts subjected to an in vitro gastro- colonic metabolism of flavan-3-ols (Mosele et al., 2015). With regard to
intestinal process. While the results reported here are specific to tree the equol and enterodiol derivatives reported by our VIP approach, they
nuts, our data appears to align with colonic fermentation studies re- appear to be derived by isoflavone and lignan colonic pathways, re-
ported for other kinds of fruit. For instance, Low et al. (2016) reported spectively (Mosele et al., 2015). Finally, the high levels of bound tyrosol
an increase in 4-hydroxyphenylacetic acid within 4–8 h of in vitro co- equivalents that characterize all raw nuts, appear to be associated with
lonic fermentation of masticated mango and banana, while Juániz et al. the formation of 4-hydroxyphenylacetic acid, after different dehy-
(2016) analysed the catabolism of polyphenols found in raw and droxylation and oxidation reactions (Mosele et al., 2015).
cooked green pepper, showing the formation of 3 catabolites during
24 h of in vitro fermentation, namely 3,4-dihydroxybenzoic acid (i.e.,
4. Conclusions
protocatechuic acid), dihydrocaffeic acid and 3-(3′-hydroxyphenyl)
propionic acid.
In this work, two different high-resolution metabolomic approaches
The data from both the untargeted and targeted metabolomic stu-
were applied to investigate the catabolic fate of phenolic compounds
dies allowed us to propose specific catabolic pathways for microbial
during in vitro digestion and faecal fermentation processes of edible
colonic degradation of polyphenols, as shown in Fig. 3. The first cata-
nuts. The nuts we used in this study were found to be very rich in
bolic step outlined involves the C-ring fission of the flavan-3-ol-ske-
phenolic compounds, with the highest content recorded in peanuts and
leton, leading to the formation of 5-(3′,4′-dihydroxyphenyl)-λ-valer-
hazelnuts. Overall, multivariate statistics using data from untargeted
olactone (i.e., one of the compounds possessing the highest
metabolic profiling showed a clear modification of the phenolic meta-
discrimination potential in our OPLS-DA model) (Mosele et al., 2015).
bolites over time (from 0 up to 48 h of in vitro fermentation). This work
Indeed, nuts are a rich source of proanthocyanidins (i.e., flavan-3-ol
highlighted the most discriminating compounds and the colonic path-
oligomers linked through carbon‑carbon bonds) and in particular, nut
ways involved. To complement the untargeted approach, which was
proanthocyanidins mainly consist of (+)-catechin together with
aimed at putatively identifying possible phenolic metabolites, a tar-
(−)-epicatechin and epigallocatechin derivatives. These are the pre-
geted metabolomic approach was used to positively identify and
dominant flavan-3-ols in almonds, hazelnuts, peanuts, pecans and pis-
quantify some of the most common phenolic metabolites including 3,4-
tachios (Bolling et al., 2011). Therefore, looking at the raw phenolic
dihydroxyphenylacetic acid, protocatechuic acid and hippuric acid. An
profile in edible nuts provided by untargeted metabolomics (UHPLC-
initial increase followed by a slow decline was observed for some
QTOF), allowed us to postulate the mechanisms of degradation of these
phenolic metabolites over time, during faecal fermentation. The results
compounds. Subsequently, as described in literature (Mosele et al.,
obtained by targeted and untargeted metabolomics were in good
2015; Serra et al., 2012), several oxidation reactions must occur to
agreement, suggesting that these high-resolution approaches are very
produce lower-molecular-weight phenolic acids such as 3,4-dihydrox-
powerful for investigating the fate of polyphenols in the large intestine.
yphenylacetic acid. Interestingly, 3,4-dihydroxyphenylacetic acid is one
The complementarity of these approaches, together with the sensitivity
of the most important phenolic intermediates involved in the genera-
and specificity provided by high-resolution MS, allowed us to achieve a
tion of other metabolites. In particular, a dehydroxylation reaction of
comprehensive picture of the transformation processes originating from
3,4-dihydroxyphenylacetic acid is hypothesized to lead to 4-hydro-
in vitro digestion and fermentation. However, the positive health effects
xyphenylacetic acid, while an α-oxidation is proposed for the formation
that these phenolic metabolites may have are still not clearly defined.
of protocatechuic acid (Mosele et al., 2015; Juániz et al., 2016). In this
Therefore, further studies are necessary in order to better understand

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G. Rocchetti et al. Food Research International 116 (2019) 786–794

Fig. 3. Proposed catabolic pathways for polyphenols microbial degradation in the colon after gastrointestinal digestion of edible nuts. DeOH = dehydroxylation;
DeH = dehydrogenation; DeMet = demethylation.

the real mechanisms of action that these metabolites may have within Cardona, F., Andrés-Lacueva, C., Tulipani, S., Tinahones, F. J., & Queipo-Ortuno, M. I.
the colon or within other parts of the body. (2013). Benefits of polyphenols on gut microbiota and implications on human health.
Journal of Nutritional Biochemistry, 24, 1415–1422.
Supplementary data to this article can be found online at https:// Castro-Puyana, M., Pérez-Míguez, R., Montero, L., & Herrero, M. (2017). Application of
doi.org/10.1016/j.foodres.2018.09.012. mass spectrometry-based metabolomics approaches for food safety, quality and tra-
ceability. Trends in Analytical Chemistry, 93, 102–118.
van Duynhoven, J., Vaughan, E. E., Jacobs, D. M., Kemperman, R. A., van Velzen, E. J. J.,
Conflict of interest Gross, G., ... Van de Wiele, T. (2011). Metabolic fate of polyphenols in the human
superorganism. PNAS, 108, 4531–4538.
The authors declare no conflict of interest. Espín, J. C., González-Sarrías, A., & Tomás-Barberán, F. A. (2017). The gut microbiota: A
key factor in the therapeutic effect of (poly)phenols. Biochemical Pharmacology, 139,
82–93.
Acknowledgements Farrés, M., Platikanov, S., Tsakovski, S., & Tauler, R. (2015). Comparison of the variable
importance in projection (VIP) and of the selectivity ratio (SR) methods for variable
selection and interpretation. Journal of Chemometrics, 29, 528–536.
GR was the recipient of a Ph.D. fellowship from the Università
Giuberti, G., Gallo, A., Moschini, M., & Masoero, F. (2013). In vitro production of short-
Cattolica del Sacro Cuore (UCSC, Piacenza, Italy). The authors thank chain fatty acids from resistant starch by pig faecal inoculum. Animal, 7(9),
the “Romeo ed Enrica Invernizzi foundation” for its kind support to the 1446–1453.
metabolomic platform at Università Cattolica del Sacro Cuore. Granato, D., Shahidi, F., Wrolstad, R., Kilmartin, P., Melton, L. D., Hidalgo, F. J., ...
Finglas, P. (2018). Antioxidant activity, total phenolics and flavonoids contents:
Should we ban in vitro screening methods? Food Chemistry, 264, 471–475.
References Grundy, M. M.-L., Lapsley, K., & Ellis, P. R. (2016). A review of the impact of processing
on nutrient bioaccessibility and digestion of almonds. International Journal of Food
Science and Technology, 51(9), 1937–1946.
Acosta-Estrada, B. A., Gutiérrez-Uribe, J. A., & Serna-Saldívar, S. O. (2014). Bound Juániz, I., Ludwig, I. A., Bresciani, L., Dall'Asta, M., Mena, P., Del Rio, D., ... de Pena, M. P.
phenolics in foods, a review. Food Chemistry, 152, 46–55. (2016). Catabolism of raw and cooked green pepper (Capsicum annuum) (poly)phe-
Alasalvar, C., & Bolling, B. W. (2015). Review of nut phytochemicals, fat-soluble bioac- nolic compounds after simulated gastrointestinal digestion and faecal fermentation.
tives, antioxidant components and health effects. British Journal of Nutrition, 113, Journal of Functional Foods, 27, 201–213.
S68–S78. Kay, C. D., Pereira-Caro, G., Ludwig, I. A., Clifford, M. N., & Crozier, A. (2017).
Aura, A. M., O'Leary, K. A., Williamson, G., Ojala, M., Bailey, M., Puupponen-Pimia, R., ... Anthocyanins and flavonones are more bioavailable than previously perceived: A
Poutanen, K. (2002). Quercetin derivatives are deconjugated and converted to hy- review of recent evidence. Annual Review of Food Science and Technology, 8, 155–180.
droxyphenylacetic acids but not methylated by human fecal flora in vitro. Journal of Lamuel-Raventos, R. M., & Onge, M.-P., St. (2017). Prebiotic nut compounds and human
Agricultural and Food Chemistry, 50(6), 1725–1730. microbiota. Critical Reviews in Food Science and Nutrition, 57(14), 3154–3163.
Bohn, T., McDougal, G. J., Alegría, A., Alminger, M., Arrigoni, E., Aura, A.-M., ... Santos, Lees, H. J., Swann, J. R., Wilson, I. D., Nicholson, J. K., & Holmes, E. (2013). Hippurate:
C. N. (2015). Mind the gap – Deficits in our knowledge of aspects impacting the The natural history of a mammalian−microbial cometabolite. Journal of Proteome
bioavailability of phytochemicals and their metabolites – A position paper focusing Research, 12, 1527–1546.
on carotenoids and polyphenols. Molecular Nutrition & Food Research, 59, 1307–1323. Low, D. Y., Hodson, M. P., Williams, B. A., D'Arcy, B. R., & Gidley, M. J. (2016). Microbial
Bolling, B. W., Chen, C.-Y. O., McKay, D. L., & Blumberg, J. B. (2011). Tree nut phyto- biotransformation of polyphenols during in vitro colonic fermentation of masticated
chemicals: composition, antioxidant capacity, bioactivity, impact factors. A sys- mango and banana. Food Chemistry, 207, 214–222.
tematic review of almonds, Brazils, cashews, hazelnuts, macadamias, pecans, pine Minekus, M., Alminger, M., Alvito, P., Balance, S., Bohn, T., Bourlieu, C., ... Brodkorb, A.
nuts, pistachios and walnuts. Nutrition Research Reviews, 24, 244–275. (2014). A standardized static in vitro digestion method suitable for food – An inter-
Bruzzese, E., Callegari, M. L., Raia, V., Viscovo, S., Scotto, R., et al. (2014). Disrupted national consensus. Food & Function, 5(6), 1113–1124.
intestinal microbiota and intestinal inflammation in children with cystic fibrosis and Miragoli, F., Federici, S., Ferrari, S., Minuti, A., Rebecchi, A., Bruzzese, E., & Callegari, M.
its restoration with lactobacillus GG: A randomized clinical trial. PLoS One, 9(2), L. (2016). Impact of cystic fibrosis disease on archaea and bacteria composition of gut
e87796. https://doi.org/10.1371/journal.pone.0087796. microbiota. FEMS Microbiology Ecology, 93(2), fiw230. https://doi.org/10.1093/

793
G. Rocchetti et al. Food Research International 116 (2019) 786–794

femsec/fiw230. vol. 20. Current opinion in clinical nutrition metabolic care (pp. 512–521).
Mosele, J. I., Macià, A., & Motilva, M.-J. (2015). Metabolic and microbial modulation of Rothwell, J. A., Perez-Jimenez, J., Neveu, V., Medina-Remón, A., M'Hiri, N., García-
the large intestine ecosystem by non-absorbed diet phenolic compounds: A review. Lobato, P., ... Scalbert, A. (2013). Phenol-Explorer 3.0: A major update of the Phenol-
Molecules, 20, 17429–17468. Explorer database to incorporate data on the effects of food processing on polyphenol
Ozdal, T., Sela, D. A., Xiao, J., Boyacioglu, D., Chen, F., & Capanoglu, E. (2016). The content. Database. https://doi.org/10.1093/database/bat070 2013: article ID
reciprocal interactions between polyphenols and gut microbiota and effects on bat070.
bioaccessibility. Nutrients, 8, 78. https://doi.org/10.3390/nu8020078. Roura, E., Koopmans, S.-J., Lallès, J.-P., Le Huerou-Luron, I., de Jager, N., Schuurman, T.,
Parkar, S. G., Trower, T. M., & Stevenson, D. E. (2013). Fecal microbial metabolism of & Val-Laillet, D. (2016). Critical review evaluating the pig as a model for human
polyphenols and its effects on human gut microbiota. Anaerobe, 23, 12–19. nutritional physiology. Nutrition Research Reviews. https://doi.org/10.1017/
Payne, A. N., Zihler, A., Chassard, C., & Lacroix, C. (2012). Advances and perspectives in S0954422416000020.
in vitro human gut fermentation modeling. Trends in Biotechnology, 30(1), 17–25. Scalbert, A., Brennan, L., Manach, C., Andres-Lacueva, C., Dragsted, L. O., Draper, J., ...
Rocchetti, G., Chiodelli, G., Giuberti, G., & Lucini, L. (2018). Bioaccessibility of phenolic Wishart, D. S. (2014). The food metabolome: A window over dietary exposure. The
compounds following in vitro large intestine fermentation of nuts for human con- American Journal of Clinical Nutrition, 99(6), 1286–1308.
sumption. Food Chemistry, 245, 633–640. Serra, A., Macià, A., Romero, M.-P., Reguant, J., Ortega, N., & Motilva, M.-J. (2012).
Rocchetti, G., Giuberti, G., & Lucini, L. (2018). Gluten-free cereal-based food products: Metabolic pathways of the colonic metabolism of flavonoids (flavonols, flavones and
The potential of metabolomics to investigate changes in phenolics profile and their in flavanones) and phenolic acids. Food Chemistry, 130, 383–393.
vitro bioaccessibility. Current Opinion in Food Science, 22, 1–8. Stearns, J. C., Lynch, M. D. J., Senadheera, D. B., Tenenbaum, H. C., Goldberg, M. B.,
Rocchetti, G., Lucini, L., Chiodelli, G., Giuberti, G., Gallo, A., Masoero, F., & Trevisan, M. Cvitkovitch, D. G., Croitoru, K., Moreno-Hagelsieb, G., & Neufeld, J. D. (2011).
(2017). Phenolic profile and fermentation patterns of different commercial gluten- Bacterial biogeography of the human digestive tract. Scientific Reports, 1, 170.
free pasta during in vitro large intestine fermentation. Food Research International, 97, Tarko, T., Duda-Chodak, A., & Zajac, N. (2013). Digestion and absorption of phenolic
78–86. compounds assessed by in vitro simulation methods. A review. Roczniki Panstwowego
Rombouts, C., Hemeryck, L. Y., Van Hecke, T., De Smet, S., De Vos, W. H., & Vanhaecke, Zakladu Higieny, 64(2), 79–84.
L. (2017). Untargeted metabolomics of colonic digests reveals kynurenine pathway Vinson, J. A., & Cai, Y. (2012). Nuts, especially walnuts, have both antioxidant quantity
metabolites, dityrosine and 3-dehydroxycarnitine as red versus white meat dis- and efficacy and exhibit significant potential health benefits. Food & Function, 3(2),
criminating metabolites. Scientific Reports, 7, 42514. 134–140.
Rothwell, J. A., Knaze, V., & Zamora-Ros, R. (2017). Polyphenols: Dietary assessment and Worley, B., & Powers, R. (2013). Multivariate analysis in metabolomics. Current
role in the prevention of cancers. Current opinion in clinical nutrition & metabolic care. Metabolomics, 1(1), 92–107.

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