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Fälth-Magnusson, Karin
Publikationer (10 of 65) Visa alla publikationer
Tapsas, D., Hollén, E., Stenhammar, L. & Fälth-Magnusson, K. (2016). The clinical presentation of celiac disease in 1030 Swedish children: changing features over the past 41 years: a long-term follow-up study. Digestive and Liver Disease, 48(1), 16-22
Öppna denna publikation i ny flik eller fönster >>The clinical presentation of celiac disease in 1030 Swedish children: changing features over the past 41 years: a long-term follow-up study
2016 (Engelska)Ingår i: Digestive and Liver Disease, ISSN 1590-8658, E-ISSN 1878-3562, Vol. 48, nr 1, s. 16-22Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background- Aims

The features of pediatric celiac disease have changed in recent decades. We hypothesized that the age at diagnosis continued to increase, whereas the severity of symptoms should decrease.

Methods

In the present study, filed data about 1030 pediatric patients diagnosed with celiac disease between 1973 and 2013 were analysed. Available information covered 99.8% of the small bowel biopsies, and included information on sex, age, and clinical symptoms.

Results

The age at diagnosis increased significantly, from a mean of 2.2 years during the first 10 years to 8.2 years the current years. The proportion of children with severe symptoms declined from 92.8% to 78%, as did the proportion of biopsies characterized by severe pathology. In recent years, the monosymptomatic form of celiac disease has been more common, and the number of patients detected at screening has increased. The frequency of patients with gastrointestinal symptoms, extra-intestinal symptoms, and failure to thrive and/or short stature at presentation decreased.

Conclusions

The mean age of newly diagnosed patients increased the last 15 years. Currently celiac disease shows a less severe picture in terms of symptoms and intestinal pathology. Younger children suffer primarily from gastrointestinal symptoms and growth failure, and adolescents from extra-intestinal manifestations.

Ort, förlag, år, upplaga, sidor
Elsevier, 2016
Nationell ämneskategori
Klinisk medicin Mikrobiologi inom det medicinska området
Identifikatorer
urn:nbn:se:liu:diva-122369 (URN)10.1016/j.dld.2015.09.018 (DOI)000368761300004 ()
Anmärkning

Funding agencies: Medical Research Council of Southeast Sweden; County Council of Ostergotland; Swedish Research Council

Tillgänglig från: 2015-10-30 Skapad: 2015-10-30 Senast uppdaterad: 2018-01-10Bibliografiskt granskad
Hultman, E., Cederborg, A.-C. & Fälth-Magnusson, K. (2015). Social workers’ assessments of children’s health when arguing for children’s needs. Child and Adolescent Social Work Journal, 32(4), 301-308
Öppna denna publikation i ny flik eller fönster >>Social workers’ assessments of children’s health when arguing for children’s needs
2015 (Engelska)Ingår i: Child and Adolescent Social Work Journal, ISSN 0738-0151, E-ISSN 1573-2797, Vol. 32, nr 4, s. 301-308Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

In Sweden, child-related social services constitute an institutional body that conducts both preventive and supportive work for children in need of health support. However, in the social services Act (2001:453) there are few concrete statements about how social workers should assess children’s health. In this study we therefore explore how social workers in Sweden adapt to the task of assessing children’s health. Specifically, we investigate the ways in which children’s health is explained in the context of reaching conclusions about the concrete needs of children. Inspired by a social constructionist and discursive analytical approach we analysed 60 written investigations where health concerns were expressed at the point of initiating an investigation. The findings are that social workers limited their assessments of children’s health, using only a few words when mentioning health aspects. There was a difference in how they described physical- and psychological health problems. When they did pay attention to children’s psychological health this was mostly carried out with the use of one single explanation for the cause of the health condition; parental misbehaviour. Besides, this explanation fitted the suggested support. Signs of children’s psychological problems were described by their own destructive behaviour. Physical health was only briefly mentioned and the recommendations for child support involved external assistance. This means that social workers could use a simplified explanatory model lacking descriptions of each child’s life situation. This way of limiting assessment may hinder a deeper understanding of causes and consequences and thereby impose limits on specifying the particular support the child needs.

Ort, förlag, år, upplaga, sidor
Springer US, 2015
Nyckelord
Social services written assessment; children’s ill-health; limited information; simplified explanatory model
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-102182 (URN)10.1007/s10560-014-0371-3 (DOI)
Tillgänglig från: 2013-12-02 Skapad: 2013-12-02 Senast uppdaterad: 2017-12-06Bibliografiskt granskad
Tapsas, D., Hollén, E., Stenhammar, L. & Fälth-Magnusson, K. (2015). Unusually High Incidence of Paediatric Coeliac Disease in Sweden during the Period 1973 – 2013: a long-term follow-up study. PLoS ONE, 10(12)
Öppna denna publikation i ny flik eller fönster >>Unusually High Incidence of Paediatric Coeliac Disease in Sweden during the Period 1973 – 2013: a long-term follow-up study
2015 (Engelska)Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 12Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective

The prevalence of coeliac disease in Sweden during the “epidemic period” (1984−1996) was one of the highest in the world. The aim of this study was to assess the coeliac disease incidence in our region over the 41-year period, and how diagnostic activity and diagnostic accuracy were affected by the introduction of antibody testing. We also looked into how patients with mild enteropathy were evaluated.

Methods

In the county of Östergötland in Sweden, 2790 paediatric patients were investigated for suspected coeliac disease between 1973 and 2013. Notes were scrutinised for data on sex, age, histopathological reports and final diagnosis. For comparative purposes this period was divided into three sub-periods (1973−1983, 1984−1996 and 1997−2013) named pre-epidemic, epidemic and post-epidemic.

Results

Coeliac disease diagnosis was received by 1,030 patients. The peak incidence rate, 301 cases/100,000 in 1994 for the age group 0−1.9 years is the highest figure ever reported. The other age groups, 2−4.9, 5−14.9, and 15−17.9 years, also had high incidence rates. After the 1984−1996 “epidemic period” the incidence decreased for the youngest group but continued to increase for the other groups. The cumulative incidence at 18 years-of-age for children born 1994 reached 14 cases/1000 births, the highest figure hitherto reported. Diagnostic activity differed significantly between the three sub-periods (p<0.001) increasing gradually from 1984 and reaching a peak value of 0.87 in 2012. Cases of mild enteropathy were more frequently regarded as non-coeliac disease cases, decreasing significantly in the “postepidemic” period (p<0.001).

Conclusions

The incidence rate and cumulative incidence of coeliac disease among children were possibly the highest ever reported. Changes in diagnostic activity and accuracy could not be attributed to the introduction of new antibody tests, possibly because of other changes e.g. variations in the symptoms at presentation and improved knowledge of the disease among parents and health professionals.

Ort, förlag, år, upplaga, sidor
PUBLIC LIBRARY SCIENCE, 2015
Nationell ämneskategori
Klinisk medicin Mikrobiologi inom det medicinska området
Identifikatorer
urn:nbn:se:liu:diva-122370 (URN)10.1371/journal.pone.0144346 (DOI)000366903600037 ()
Anmärkning

Funding agencies: Medical Research Council of Southeast Sweden; County Council of Ostergotland; Swedish Research Council

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Tillgänglig från: 2015-10-30 Skapad: 2015-10-30 Senast uppdaterad: 2018-01-10Bibliografiskt granskad
Lahdenperä, A., Fälth-Magnusson, K., Hogberg, L., Ludvigsson, J. & Vaarala, O. (2014). Expression pattern of T-helper 17 cell signaling pathway and mucosal inflammation in celiac disease. Scandinavian Journal of Gastroenterology, 49(2), 145-156
Öppna denna publikation i ny flik eller fönster >>Expression pattern of T-helper 17 cell signaling pathway and mucosal inflammation in celiac disease
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2014 (Engelska)Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 49, nr 2, s. 145-156Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective. The aim was to investigate the mucosal activation of a broad range of genes associated with the T-helper 17 cell (Th17) signaling pathway in children at different stages of celiac disease (CD), including children with increased risk for CD and children with untreated and gluten-free diet (GFD)-treated CD. Material and methods. Small intestinal biopsies were taken from children with untreated and GFD-treated CD, transglutaminase antibody (TGA)-positive children with potential CD, and reference children. Real-time polymerase chain reaction (PCR) arrays were used to study the gene expression pattern of Th17-related genes, and quantitative PCR was used to study the interleukin (IL)-17A expression. Results. The mucosal expression of CD8A was elevated at all stages of CD. Children with untreated CD had diminished levels of IL-17RE, IL-23R, RORc, STAT6, CCL22, NFATC2, IL-18, CD4, CD247, and matrix metalloproteinase (MMP)9 but had elevated levels of MMP3, IL-17, interferon-gamma (IFN-gamma) and CD8A, compared to references. The majority of the aforementioned genes, being differentially expressed in untreated CD, displayed similar expression in GFD-treated children and references. Children with untreated and GFD-treated CD had elevated expression of IFN-gamma but had reduced expression of CD247. Interestingly, children with potential CD displayed reduced FOXP3, IL-21, and IL-17A levels. Conclusion. Mucosal upregulation of Th17 immunity occurs at the late stage of disease and is downregulated with dietary treatment, thus indicating that IL-17 immunity is not a fundamental feature of CD as Th1 immunity, which is not fully downregulated by GFD.

Ort, förlag, år, upplaga, sidor
Informa Healthcare, 2014
Nyckelord
arrays; celiac disease; children; gene expression; gluten-free diet; IL-17; mucosa; Th17
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-104288 (URN)10.3109/00365521.2013.863966 (DOI)000329874800003 ()
Tillgänglig från: 2014-02-17 Skapad: 2014-02-14 Senast uppdaterad: 2017-12-06
Stenhammar, L., Högberg, L., Ivarsson, A., Laurin, P., Myléus, A. & Fälth-Magnusson, K. (2014). Letter: Coeliac disease and socio-economic status [Letter to the editor]. Acta Paediatrica, 103(8), e328
Öppna denna publikation i ny flik eller fönster >>Letter: Coeliac disease and socio-economic status
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2014 (Engelska)Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, nr 8, s. e328-Artikel i tidskrift, Letter (Refereegranskat) Published
Nationell ämneskategori
Klinisk medicin
Identifikatorer
urn:nbn:se:liu:diva-116359 (URN)10.1111/apa.12665 (DOI)24766430 (PubMedID)
Tillgänglig från: 2015-03-26 Skapad: 2015-03-26 Senast uppdaterad: 2017-12-04
Sjöberg, V., Hollén, E., Pietz, G., Magnusson, K.-E., Fälth-Magnusson, K., Sundström, M., . . . Hammarström, M.-L. (2014). Noncontaminated dietary oats may hamper normalization of the intestinal immune status in childhood celiac disease.. Clinical and Translational Gastroenterology, 5(e58)
Öppna denna publikation i ny flik eller fönster >>Noncontaminated dietary oats may hamper normalization of the intestinal immune status in childhood celiac disease.
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2014 (Engelska)Ingår i: Clinical and Translational Gastroenterology, ISSN 2155-384X, E-ISSN 2155-384X, Vol. 5, nr e58Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVES: Life-long, strict gluten-free diet (GFD) is the only treatment for celiac disease (CD). Because there is still uncertainty regarding the safety of oats for CD patients, the aim was to investigate whether dietary oats influence the immune status of their intestinal mucosa.

METHODS: Paired small intestinal biopsies, before and after >11 months on a GFD, were collected from children with CD who were enrolled in a randomized, double-blind intervention trial to either of two diets: standard GFD (GFD-std; n=13) and noncontaminated oat-containing GFD (GFD-oats; n=15). Expression levels of mRNAs for 22 different immune effector molecules and tight junction proteins were determined by quantitative reverse transcriptase (RT)-PCR.

RESULTS: The number of mRNAs that remained elevated was higher in the GFD-oats group (P=0.05). In particular, mRNAs for the regulatory T cell (Treg) signature molecules interleukin-10 (IL-10) and transforming growth factor-β1 (TGF-β1), the cytotoxicity-activating natural killer (NK) receptors KLRC2/NKG2C and KLRC3/NKG2E, and the tight junction protein claudin-4 remained elevated. Between the two groups, most significant differences were seen for claudin-4 (P=0.003) and KLRC3/NKG2E (P=0.04).

CONCLUSIONS: A substantial fraction of pediatric CD patients seem to not tolerate oats. In these patients, dietary oats influence the immune status of the intestinal mucosa with an mRNA profile suggesting presence of activated cytotoxic lymphocytes and Tregs and a stressed epithelium with affected tight junctions. Assessment of changes in levels of mRNA for claudin-4 and KLC3/NKG2E from onset to after a year on oats containing GFD shows promise to identify these CD patients.

Ort, förlag, år, upplaga, sidor
Nature Publishing Group, 2014
Nationell ämneskategori
Pediatrik
Identifikatorer
urn:nbn:se:liu:diva-115888 (URN)10.1038/ctg.2014.9 (DOI)000355530800002 ()24964993 (PubMedID)2-s2.0-84903278030 (Scopus ID)
Tillgänglig från: 2015-03-23 Skapad: 2015-03-23 Senast uppdaterad: 2017-12-04Bibliografiskt granskad
Ekbäck, M., Tedner, M., Devenney, I., Oldaeus, G., Norrman, G., Strömberg, L. & Fälth-Magnusson, K. (2014). Severe Eczema in Infancy Can Predict Asthma Development. A Prospective Study to the Age of 10 Years. PLoS ONE, 9(6), e99609
Öppna denna publikation i ny flik eller fönster >>Severe Eczema in Infancy Can Predict Asthma Development. A Prospective Study to the Age of 10 Years
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2014 (Engelska)Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, nr 6, s. e99609-Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Children with atopic eczema in infancy often develop allergic rhinoconjunctivitis and asthma, but the term "atopic march has been questioned as the relations between atopic disorders seem more complicated than one condition progressing into another. Objective: In this prospective multicenter study we followed children with eczema from infancy to the age of 10 years focusing on sensitization to allergens, severity of eczema and development of allergic airway symptoms at 4.5 and 10 years of age. Methods: On inclusion, 123 children were examined. Hanifin-Rajka criteria and SCORAD index were used to describe the eczema. Episodes of wheezing were registered, skin prick tests and IgE tests were conducted and questionnaires were filled out. Procedures were repeated at 4.5 and 10 years of age with additional examinations for ARC and asthma. Results: 94 out of 123 completed the entire study. High SCORAD points on inclusion were correlated with the risk of developing ARC, (B = 9.86, P = 0.01) and asthma, (B = 10.17, P = 0.01). For infants with eczema and wheezing at the first visit, the OR for developing asthma was 4.05(P = 0.01). ARC at 4.5 years of age resulted in an OR of 11.28(P = 0.00) for asthma development at 10 years. Conclusion: This study indicates that infant eczema with high SCORAD points is associated with an increased risk of asthma at 10 years of age. Children with eczema and wheezing episodes during infancy are more likely to develop asthma than are infants with eczema alone. Eczema in infancy combined with early onset of ARC seems to indicate a more severe allergic disease, which often leads to asthma development. The progression from eczema in infancy to ARC at an early age and asthma later in childhood shown in this study supports the relevance of the term "atopic march, at least in more severe allergic disease.

Ort, förlag, år, upplaga, sidor
Public Library of Science, 2014
Nationell ämneskategori
Klinisk medicin
Identifikatorer
urn:nbn:se:liu:diva-110983 (URN)10.1371/journal.pone.0099609 (DOI)000340947700119 ()24914552 (PubMedID)
Anmärkning

Funding Agencies|Health Research Council in the South-East of Sweden (FORSS); Swedish Asthma and Allergy Associations Research Foundation; Lions Club in the South-East of Sweden; GlaxoSmithKline; Konsul Th C Berghs Foundation for Scientific Research

Tillgänglig från: 2014-10-01 Skapad: 2014-10-01 Senast uppdaterad: 2017-12-05
Tapsas, D., Fälth-Magnusson, K., Högberg, L., Hammersjö, J.-Å. & Hollén, E. (2014). Swedish children with celiac disease comply well with a gluten-free diet, and most include oats without reporting any adverse effects: a long-term follow-up study. Nutrition Research, 34(5), 436-441
Öppna denna publikation i ny flik eller fönster >>Swedish children with celiac disease comply well with a gluten-free diet, and most include oats without reporting any adverse effects: a long-term follow-up study
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2014 (Engelska)Ingår i: Nutrition Research, ISSN 0271-5317, E-ISSN 1879-0739, Vol. 34, nr 5, s. 436-441Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The only known treatment for celiac disease is a gluten-free diet (GFD), which initially meant abstention from wheat, rye, barley, and oats. Recently, oats free from contamination with wheat have been accepted in the GFD. Yet, reports indicate that all celiac disease patients may not tolerate oats. We hypothesized that celiac children comply well with a GFD and that most have included oats in their diet. A food questionnaire was used to check our patients; 316 questionnaires were returned. Mean time on the GFD was 6.9 years, and 96.8% of the children reported that they were trying to keep a strict GFD. However, accidental transgressions occurred in 263 children (83.2%). In 2 of 3 cases, mistakes took place when the patients were not at home. Symptoms after incidental gluten intake were experienced by 162(61.6%) patients, mostly (87.5%) from the gastrointestinal tract. Small amounts of gluten (less than4 g) caused symptoms in 38% of the cases, and 68% reported symptoms during the first 3 hours after gluten consumption. Oats were included in the diet of 89.4% of the children for a mean of 3.4 years. Most (81.9%) ate purified oats, and 45.3% consumed oats less than once a week. Among those who did not consume oats, only 5.9% refrained because of symptoms. General compliance with the GFD was good. Only the duration of the GFD appeared to influence adherence to the diet. Most patients did not report adverse effects after long-term consumption of oats.

Ort, förlag, år, upplaga, sidor
Elsevier, 2014
Nyckelord
Celiac disease; GFD compliance; Oats; Children; Food questionnaire
Nationell ämneskategori
Klinisk medicin
Identifikatorer
urn:nbn:se:liu:diva-109147 (URN)10.1016/j.nutres.2014.04.006 (DOI)000337715700008 ()24916557 (PubMedID)
Tillgänglig från: 2014-08-13 Skapad: 2014-08-11 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
Tjellstrom, B., Stenhammar, L., Sundqvist, T., Fälth-Magnusson, K., Hollén, E., Magnusson, K.-E., . . . Högberg, L. (2014). The effects of oats on the function of gut microflora in children with coeliac disease. Alimentary Pharmacology and Therapeutics, 39(10), 1156-1160
Öppna denna publikation i ny flik eller fönster >>The effects of oats on the function of gut microflora in children with coeliac disease
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2014 (Engelska)Ingår i: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 39, nr 10, s. 1156-1160Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background Faecal short chain fatty acids (SCFAs) are produced by the gut microflora. We have previously reported high faecal SCFA levels in children with coeliac disease (CD), indicating alteration in gut microfloral metabolism. Data accumulated over recent decades by us and others suggest that wheat-free oats can safely be included in a gluten-free diet (GFD). However, concerns have been raised with respect to the safety of oats in a subset of coeliacs. Aim To describe faecal SCFA patterns in children with newly diagnosed CD treated for 1year with a GFD with or without oats. Methods This report is part of a randomised, double-blind study on the effect of a GFD containing oats (GFD-oats) vs. a standard GFD (GFD-std). Faecal samples were received from 34 children in the GFD-oats group and 37 in the GFD-std group at initial diagnosis and/or after 1year on a GFD. Faecal SCFAs were analysed. Results The GFD-std group had a significantly lower total faecal SCFA concentration at 12months compared with 0months (Pless than0.05). In contrast, total SCFA in the GFD-oats group remained high after 1year on the GFD. The children in the GFD-oats group had significantly higher acetic acid (Pless than0.05), n-butyric acid (Pless than0.05) and total SCFA concentration (Pless than0.01) after 1-year diet treatment compared to the GFD-std group. Conclusions Our results indicate that oats do affect the gut microflora function, and that some coeliac children receiving oats may develop gut mucosal inflammation, that may present a risk for future complications.

Ort, förlag, år, upplaga, sidor
Wiley, 2014
Nationell ämneskategori
Klinisk medicin
Identifikatorer
urn:nbn:se:liu:diva-106829 (URN)10.1111/apt.12707 (DOI)000334304200013 ()
Tillgänglig från: 2014-05-28 Skapad: 2014-05-23 Senast uppdaterad: 2017-12-05
Tapsas, D., Fälth-Magnusson, K., Högberg, L., Forslund, T., Sundqvist, T. & Hollén, E. (2014). Urinary nitric oxide metabolites in children with celiac disease after long-term consumption of oats-containing gluten-free diet. Scandinavian Journal of Gastroenterology, 49(11), 1311-1317
Öppna denna publikation i ny flik eller fönster >>Urinary nitric oxide metabolites in children with celiac disease after long-term consumption of oats-containing gluten-free diet
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2014 (Engelska)Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 49, nr 11, s. 1311-1317Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective. Oats are accepted in the gluten-free diet (GFD) for children with celiac disease (CD). Some reports have indicated, however, that not all celiac patients tolerate oats. We have previously shown that some children still have high levels of urinary nitric oxide (NO) metabolites as markers of intestinal inflammation after 1 year on GFD with oats. In this study, we measured urinary NO metabolites in CD children who had been consuming oats-containing GFD for an extended, 2-6-year period, also taking into consideration ordinary consumption of nitrite/nitrate-rich foods close to the urine sampling. Materials and Methods. Morning urinary nitrite/nitrate concentrations were measured in 188 pediatric CD patients. A questionnaire was used to elucidate factors possibly affecting the urinary levels, for example, dietary factors, asthma, or urinary tract infection. Results. Oats were consumed by 89.4% of the patients for a median time of 3 years. The median nitrite/nitrate level was 980 mu M. The majority (70.2%) who consumed oats had low levels of urinary nitrite/nitrate, that is, less than 1400 mu M, while 29.8% demonstrated high levels, that is, greater than 1400 mu M. Nitrite/nitrate-rich foods did not significantly influence the urinary concentrations. Conclusion. The urinary levels of NO metabolites revealed two subpopulations, one with high and one with low levels. The high levels could be possibly due to poor adherence to the GFD, sensitivity to oats, or some unknown factor(s). Nitrate-rich foods, asthma, or urinary tract infection did not affect the result. The elevated levels of NO metabolites could indicate mucosal inflammation and pinpoint the need of careful follow-up of children on oats-containing GFD.

Ort, förlag, år, upplaga, sidor
Informa Healthcare, 2014
Nyckelord
celiac disease; gluten-free diet; oats; urinary nitrite/nitrate
Nationell ämneskategori
Klinisk medicin
Identifikatorer
urn:nbn:se:liu:diva-113064 (URN)10.3109/00365521.2014.946081 (DOI)000345603400006 ()25263796 (PubMedID)
Anmärkning

Funding Agencies|Medical Research Council of Southeast Sweden; County Council of Ostergotland; Swedish Research Council

Tillgänglig från: 2015-01-09 Skapad: 2015-01-08 Senast uppdaterad: 2017-12-05
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