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Maternal and fetal factors affecting cord plasma leptin and adiponectin levels and their ratio in preterm and term newborns: New insight on fetal origins of metabolic dysfunction. 影响早产儿和足月新生儿脐带血浆瘦素和脂联素水平及其比值的母胎因素:胎儿代谢功能障碍起源的新见解
Pub Date : 2022-11-01 Epub Date: 2022-08-18
Kartikeya Makker, Mingyu Zhang, Guoying Wang, Xiumei Hong, Khyzer B Aziz, Xiaobin Wang

Background: Understanding of maternal and fetal factors affecting leptin, adiponectin and adiponectin: leptin ratio at birth, may provide valuable insights into potential future risk of metabolic alterations and inform primordial prevention and precision nutrition strategies.

Objective: To identify maternal and fetal risk factors that affect leptin and adiponectin levels (markers of adiposity) and adiponectin/leptin ratio (a marker of dysfunctional adipose tissue) at birth.

Methods: We studied mother-infant pairs in the Boston Birth Cohort. Cord blood was collected at birth. We used student t-tests to compare log normalized cord leptin and adiponectin levels. Regression analysis were performed to examine the association of maternal and fetal factors with leptin and adiponectin levels and adiponectin: leptin ratio at birth in both term and preterm infants.

Results: We analyzed 1012 infants (245 preterm). Both cord leptin and adiponectin were higher in term infants than preterm infants (10.2 ± 0.9 vs. 9.2 ± 1.3, p < 0.0001 and 9.5 ± 0.7 vs. 8.9 ± 0.8, p < 0.0001 respectively). Cord leptin was higher for Black infants (10.1 ± 1.1 vs. 9.9 ± 1.2; p < 0.001) although Black (ref: non Black) infants had lower cord adiponectin levels (9.3 ± 0.8 vs. 9.5 ± 0.7; p = 0.01). Ratio of adiponectin to leptin (log normalized) was higher in preterm infants (-0.24) vs. term infants (-0.69). On regression analysis cord leptin was positively associated with longer gestational age, birth weight z score, Black race, maternal overweight and obesity, gestational diabetes and pregestational diabetes mellitus and negatively associated with male sex. Cord adiponectin was positively associated with gestational age, birth weight z score and negatively with Black race and male sex. Adiponectin: leptin ratio was positively with male sex and negatively with GA, birth wt. z score, Black race, gestational DM, pregestational DM and maternal overweight and obesity.

Conclusion: We identified several factors that affect leptin and adiponectin levels along with adiponectin-leptin ratio at birth beyond GA and birth weight which could also play an important role in influencing the trajectory of these hormones and future cardio metabolic outcomes. This knowledge can help tailor precision nutrition interventions.

背景:了解影响出生时瘦素、脂联素和脂联素:瘦素比率的母体和胎儿因素,可能为潜在的未来代谢改变风险提供有价值的见解,并为原始预防和精确营养策略提供信息。目的:确定出生时影响瘦素和脂联素水平(肥胖的标志)和脂联素/瘦素比值(脂肪组织功能失调的标志)的母胎危险因素。方法:我们研究了波士顿出生队列中的母婴对。脐带血是在出生时采集的。我们使用学生t检验比较对数标准化脐带瘦素和脂联素水平。采用回归分析来检验母胎因素与足月和早产儿出生时瘦素和脂联素水平以及脂联素:瘦素比值的关系。结果:我们分析了1012名婴儿(245名早产儿)。足月儿脐带瘦素和脂联素均高于早产儿(分别为10.2±0.9比9.2±1.3,p < 0.0001和9.5±0.7比8.9±0.8,p < 0.0001)。黑人婴儿脐带瘦素较高(10.1±1.1 vs. 9.9±1.2;p < 0.001),尽管黑人(非黑人)婴儿脐带脂联素水平较低(9.3±0.8比9.5±0.7;P = 0.01)。脂联素与瘦素的比值(对数归一化)在早产儿中(-0.24)高于足月婴儿(-0.69)。经回归分析,脐带瘦素与较长胎龄、出生体重z分、黑人种族、母亲超重和肥胖、妊娠期糖尿病和妊娠期糖尿病呈正相关,与男性呈负相关。脐带脂联素与胎龄、出生体重z分呈正相关,与黑人、男性呈负相关。脂联素:瘦素比值与男性呈正相关,与GA、出生wt. z评分、黑人、妊娠期糖尿病、妊娠期糖尿病、母亲超重和肥胖呈负相关。结论:我们发现了几个影响瘦素和脂联素水平以及出生时脂联素-瘦素比值的因素,这些因素在影响这些激素的轨迹和未来的心脏代谢结果方面也起着重要作用。这些知识可以帮助量身定制精确的营养干预措施。
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引用次数: 0
Boston Birth Cohort Profile: Rationale and Study Design. 波士顿出生队列简介:基本原理和研究设计。
Pub Date : 2022-11-01 Epub Date: 2022-08-18
Colleen Pearson, Tami Bartell, Guoying Wang, Xiumei Hong, Serena A Rusk, LingLing Fu, Sandra Cerda, Blandine Bustamante-Helfrich, Wendy Kuohung, Christina Yarrington, William G Adams, Xiaobin Wang

In 1998, the Boston Birth Cohort (BBC) was initiated at Boston Medical Center (BMC) in response to persistently high rates of preterm birth (PTB, defined as birth before 37 weeks of gestation) in the US population and the longstanding profound PTB disparity among Black, Indigenous, and people of color (BIPOC). The BBC encompasses two linked study protocols: The Preterm Birth Study serves as the baseline recruitment in the BBC. It aims to address fundamental questions about the causes and consequences of PTB. The study oversamples preterm babies using a case/control study design, in which cases are defined as mothers who deliver a preterm and/or low birthweight baby (<2500 grams regardless of gestational age). Controls are enrolled at a 2:1 control/case ratio and matched by maternal age (±5 years), self-reported race and ethnicity, and date of delivery (± 7 days for case delivery). From inception, it was designed as a comprehensive gene-environmental study of PTB. As a natural extension, the Children's Health Study, under a separate but linked IRB protocol, is a longitudinal follow-up study of the participants who were recruited at birth in the Preterm Birth Study and who continue pediatric care at BMC. This linked model allows for investigation of early life origins of pediatric and chronic disease in a prospective cohort design. The BBC is one of the largest and longest NIH-funded prospective birth cohort studies in the US, consisting of 8733 mother-child dyads enrolled in the Preterm Birth Study at birth, and of those, 3,592 children have been enrolled in the Children's Health Study, with a median follow-up of 14.5 years. The BBC mirrors the urban, under-resourced and underrepresented BIPOC population served by BMC. A high proportion of BBC children were born prematurely and had chronic health conditions (e.g., asthma, obesity and elevated blood pressure) in childhood. The BBC's long-term goal has been to build a large, comprehensive database (epidemiological, clinical, multi-omics) and biospecimen repository to elucidate early life origins of pediatric and chronic diseases and identify modifiable upstream factors (e.g., psychosocial, environmental, nutritional) to improve health across the life course for BIPOC mothers and children.

1998年,波士顿医学中心(BMC)启动了波士顿出生队列(BBC),以应对美国人口中持续高的早产率(PTB,定义为妊娠37周前出生)以及黑人,土著和有色人种(BIPOC)中长期存在的深刻PTB差异。英国广播公司包括两个相关的研究方案:早产研究是英国广播公司招募的基线。它的目的是解决关于肺结核病因和后果的基本问题。该研究采用病例/对照研究设计,对早产婴儿进行了抽样调查,其中病例定义为分娩早产和/或低出生体重婴儿的母亲(儿童健康研究,在一个独立但相关的IRB协议下,是一项纵向随访研究,参与者在早产研究中出生时被招募,并继续在BMC进行儿科护理。这种关联模型允许在前瞻性队列设计中调查儿童和慢性疾病的早期生命起源。BBC是美国国家卫生研究院资助的规模最大、时间最长的前瞻性出生队列研究之一,包括8733对在出生时参加早产研究的母婴,其中3592名儿童参加了儿童健康研究,中位随访时间为14.5年。BBC反映了BMC服务的城市、资源不足和代表性不足的BIPOC人口。在英国广播公司的儿童中,有很大一部分是早产儿,儿童时期患有慢性健康问题(如哮喘、肥胖和高血压)。英国广播公司的长期目标是建立一个大型综合数据库(流行病学、临床、多组学)和生物标本库,以阐明儿科和慢性疾病的早期生命起源,并确定可改变的上游因素(如社会心理、环境、营养),以改善BIPOC母亲和儿童整个生命过程中的健康。
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引用次数: 0
Boston Birth Cohort profile: rationale and study design. 波士顿出生队列概况:基本原理和研究设计。
Pub Date : 2022-08-18 eCollection Date: 2022-09-01 DOI: 10.1097/PN9.0000000000000011
Colleen Pearson, Tami Bartell, Guoying Wang, Xiumei Hong, Serena A Rusk, LingLing Fu, Sandra Cerda, Blandine Bustamante-Helfrich, Wendy Kuohung, Christina Yarrington, William G Adams, Xiaobin Wang

In1998, the Boston Birth Cohort (BBC) was initiated at Boston Medical Center (BMC) in response to persistently high rates of preterm birth (PTB, defined as birth before 37 weeks of gestation) in the US population and the longstanding profound PTB disparity among Black, Indigenous, and people of color (BIPOC). The BBC encompasses two linked study protocols: The PTB Study serves as the baseline recruitment in the BBC. It aims to address fundamental questions about the causes and consequences of PTB. The study oversamples preterm babies using a case/control study design, in which cases are defined as mothers who deliver a preterm and/or low birthweight baby (<2500 grams regardless of gestational age). Controls are enrolled at a 2:1 control/case ratio and matched by maternal age (±5 years), self-reported race and ethnicity, and date of delivery (± 7 days for case delivery). From inception, it was designed as a comprehensive gene-environmental study of PTB. As a natural extension, the Children's Health Study, under a separate but linked Institutional Review Board protocol, is a longitudinal follow-up study of the participants who were recruited at birth in the PTB Study and who continue pediatric care at BMC. This linked model allows for investigation of early life origins of pediatric and chronic disease in a prospective cohort design. The BBC is one of the largest and longest National Institutes of Health-funded prospective birth cohort studies in the United States, consisting of 8733 mother-child dyads enrolled in the PTB Study at birth, and of those, 3592 children have been enrolled in the Children's Health Study, with a median follow-up of 14.5 years. The BBC mirrors the urban, underresourced, and underrepresented BIPOC population served by BMC. A high proportion of BBC children were born prematurely and had chronic health conditions (e.g., asthma, obesity, and elevated blood pressure) in childhood. The BBC's long-term goal has been to build a large, comprehensive database (epidemiological, clinical, and multiomics) and biospecimen repository to elucidate early life origins of pediatric and chronic diseases and identify modifiable upstream factors (e.g., psychosocial, environmental, and nutritional) to improve health across the life course for BIPOC mothers and children.

1998年,波士顿医疗中心(BMC)发起了波士顿出生队列(BBC),以应对美国人口中持续高的早产率(PTB,定义为妊娠37周前出生)以及黑人、原住民和有色人种之间长期存在的严重PTB差异(BIPOC)。英国广播公司包括两个相关的研究方案:PTB研究作为英国广播公司的基线招募。它旨在解决关于PTB的原因和后果的基本问题。该研究使用病例/对照研究设计对早产儿进行了过度抽样,其中病例被定义为早产和/或低出生体重婴儿的母亲(
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引用次数: 19
Maternal and fetal factors affecting cord plasma leptin and adiponectin levels and their ratio in preterm and term newborns: New insight on fetal origins of metabolic dysfunction. 影响早产儿和足月儿脐血瘦素和脂联素水平及其比率的母体和胎儿因素:代谢功能障碍胎儿起源的新见解。
Pub Date : 2022-08-18 eCollection Date: 2022-09-01 DOI: 10.1097/PN9.0000000000000013
Kartikeya Makker, Mingyu Zhang, Guoying Wang, Xiumei Hong, Khyzer B Aziz, Xiaobin Wang

Background: Understanding of maternal and fetal factors affecting leptin, adiponectin, and adiponectin:leptin ratio at birth may provide valuable insights into potential future risk of metabolic alterations and inform primordial prevention and precision nutrition strategies. The objective of this study is to identify maternal and fetal risk factors that affect leptin and adiponectin levels (markers of adiposity) and adiponectin/leptin ratio (a marker of dysfunctional adipose tissue) at birth.

Methods: We studied mother-infant pairs in the Boston Birth Cohort. Cord blood was collected at birth. We used student t- tests to compare log normalized cord leptin and adiponectin levels. Regression analysis was performed to examine the association of maternal and fetal factors with leptin and adiponectin levels and adiponectin:leptin ratio at birth in both term and preterm infants.

Results: We analyzed 1012 infants (245 preterm). Both cord leptin and adiponectin were higher in term infants than preterm infants (10.2 ± 0.9 vs. 9.2 ± 1.3, P < 0.0001 and 9.5 ± 0.7 vs. 8.9 ± 0.8, P < 0.0001, respectively). Cord leptin was higher for Black infants (10.1 ± 1.1 vs. 9.9 ± 1.2; P < 0.001) although Black (ref: non-Black) infants had lower cord adiponectin levels (9.3 ± 0.8 vs. 9.5 ± 0.7; P = 0.01). Ratio of adiponectin to leptin (log normalized) was higher in preterm infants (-0.24) vs. term infants (-0.69). On regression analysis, cord leptin was positively associated with longer gestational age (GA), birth weight z score, Black race, maternal overweight and obesity, gestational diabetes and pregestational diabetes mellitus and negatively associated with male sex. Cord adiponectin was positively associated with GA, birth weight z score and negatively with Black race and male sex. Adiponectin:leptin ratio was positively with male sex and negatively with GA, birth weight z score, Black race, gestational DM, pregestational DM and maternal overweight and obesity.

Conclusions: We identified several factors that affect leptin and adiponectin levels along with adiponectin-leptin ratio at birth beyond GA and birth weight which could also play an important role in influencing the trajectory of these hormones and future cardiometabolic outcomes. This knowledge can help tailor precision nutrition interventions.

背景:了解影响出生时瘦素、脂联素和脂联素与瘦素比率的母体和胎儿因素,可以为未来代谢变化的潜在风险提供有价值的见解,并为早期预防和精确营养策略提供信息。本研究的目的是确定影响出生时瘦素和脂联素水平(肥胖标志物)以及脂联素/瘦素比率(功能失调脂肪组织的标志物)的母体和胎儿风险因素。方法:我们研究了波士顿出生队列中的母婴对。脐带血是在出生时采集的。我们使用学生t检验来比较对数归一化的脐带瘦素和脂联素水平。进行回归分析,以检查母亲和胎儿因素与足月儿和早产儿出生时的瘦素和脂联素水平以及脂联素:瘦素比率的关系。结果:我们分析了1012名婴儿(245名早产儿)。足月儿的脐带瘦素和脂联素均高于早产儿(10.2 ± 0.9对9.2 ± 1.3、P<0.0001和9.5 ± 0.7对8.9 ± 0.8,P<0.0001)。黑人婴儿的脐带瘦素水平较高(10.1 ± 1.1对9.9 ± 1.2;P<0.001),尽管黑人(参考:非黑人)婴儿的脐带脂联素水平较低(9.3 ± 0.8对9.5 ± 0.7;P=0.01)。早产儿的脂联素与瘦素的比值(对数归一化)(-0.24)高于足月儿(-0.69)。回归分析显示,脐带瘦素与孕龄(GA)、出生体重z评分、黑人、母亲超重和肥胖、妊娠期糖尿病和孕前糖尿病呈正相关,与男性呈负相关。脐带脂联素与GA、出生体重z评分呈正相关,与黑人和男性呈负相关。脂联素:瘦素比值与男性呈正相关,与GA、出生体重z评分、黑人、妊娠期糖尿病、妊娠期DM、母亲超重和肥胖呈负相关。结论:我们确定了影响瘦素和脂联素水平的几个因素,以及出生时超过GA的脂联素-瘦素比率和出生体重,这些因素也可能在影响这些激素的轨迹和未来的心脏代谢结果中发挥重要作用。这些知识可以帮助制定精确的营养干预措施。
{"title":"Maternal and fetal factors affecting cord plasma leptin and adiponectin levels and their ratio in preterm and term newborns: New insight on fetal origins of metabolic dysfunction.","authors":"Kartikeya Makker,&nbsp;Mingyu Zhang,&nbsp;Guoying Wang,&nbsp;Xiumei Hong,&nbsp;Khyzer B Aziz,&nbsp;Xiaobin Wang","doi":"10.1097/PN9.0000000000000013","DOIUrl":"10.1097/PN9.0000000000000013","url":null,"abstract":"<p><strong>Background: </strong>Understanding of maternal and fetal factors affecting leptin, adiponectin, and adiponectin:leptin ratio at birth may provide valuable insights into potential future risk of metabolic alterations and inform primordial prevention and precision nutrition strategies. The objective of this study is to identify maternal and fetal risk factors that affect leptin and adiponectin levels (markers of adiposity) and adiponectin/leptin ratio (a marker of dysfunctional adipose tissue) at birth.</p><p><strong>Methods: </strong>We studied mother-infant pairs in the Boston Birth Cohort. Cord blood was collected at birth. We used student <i>t</i>- tests to compare log normalized cord leptin and adiponectin levels. Regression analysis was performed to examine the association of maternal and fetal factors with leptin and adiponectin levels and adiponectin:leptin ratio at birth in both term and preterm infants.</p><p><strong>Results: </strong>We analyzed 1012 infants (245 preterm). Both cord leptin and adiponectin were higher in term infants than preterm infants (10.2 ± 0.9 <i>vs.</i> 9.2 ± 1.3, <i>P</i> < 0.0001 and 9.5 ± 0.7 <i>vs.</i> 8.9 ± 0.8, <i>P</i> < 0.0001, respectively). Cord leptin was higher for Black infants (10.1 ± 1.1 <i>vs.</i> 9.9 ± 1.2; <i>P</i> < 0.001) although Black (ref: non-Black) infants had lower cord adiponectin levels (9.3 ± 0.8 <i>vs.</i> 9.5 ± 0.7; <i>P</i> = 0.01). Ratio of adiponectin to leptin (log normalized) was higher in preterm infants (-0.24) <i>vs.</i> term infants (-0.69). On regression analysis, cord leptin was positively associated with longer gestational age (GA), birth weight <i>z</i> score, Black race, maternal overweight and obesity, gestational diabetes and pregestational diabetes mellitus and negatively associated with male sex. Cord adiponectin was positively associated with GA, birth weight <i>z</i> score and negatively with Black race and male sex. Adiponectin:leptin ratio was positively with male sex and negatively with GA, birth weight <i>z</i> score, Black race, gestational DM, pregestational DM and maternal overweight and obesity.</p><p><strong>Conclusions: </strong>We identified several factors that affect leptin and adiponectin levels along with adiponectin-leptin ratio at birth beyond GA and birth weight which could also play an important role in influencing the trajectory of these hormones and future cardiometabolic outcomes. This knowledge can help tailor precision nutrition interventions.</p>","PeriodicalId":74488,"journal":{"name":"Precision nutrition","volume":"1 2","pages":"e00013"},"PeriodicalIF":0.0,"publicationDate":"2022-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/da/b4/pn9-1-e00013.PMC10035290.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41164545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Longitudinal trajectories and determinants of plasma per- and polyfluoroalkyl substance (PFAS) levels from birth to early childhood and metabolomic associations: A pilot study in the Boston Birth Cohort. 从出生到幼儿期血浆全氟和多氟烷基物质 (PFAS) 水平的纵向轨迹和决定因素以及代谢组学关联:波士顿出生队列试点研究。
Pub Date : 2022-06-01 Epub Date: 2022-06-13
Mingyu Zhang, Chang Ho Yu, Guoying Wang, Jessie P Buckley, Xiumei Hong, Colleen Pearson, William G Adams, Zhihua Tina Fan, Xiaobin Wang

Background: Per- and polyfluoroalkyl substances (PFAS) are a major public health concern worldwide due to their ubiquitous exposures, environmental persistence, maternal-to-fetal transfer, and multi-organ toxicity. This pilot study aimed to generate preliminary data to inform future studies to address data gaps in the field, including early life PFAS exposure levels, longitudinal changes, determinants, and associated metabolomic alterations in understudied Black and Hispanic children in the United States (U.S.).

Methods: This study leveraged existing biosamples and data in the Boston Birth Cohort and measured 12 legacy and emerging PFAS, including Me-PFOSA-AcOH, PFDA, PFDoA, PFHxS, PFNA, PFOA, PFOS, PFUnA, GenX, ADONA, 9Cl-PF3ONS, and PFHpS, in paired cord and early childhood plasma samples. Summary statistics and graphic plots were used to depict PFAS levels at the two time points and their longitudinal changes. Linear regression models were used to identify the early-life factors associated with cord and early childhood PFAS levels. Associations of cord PFAS with cord metabolites were explored using a metabolome-wide association approach and a targeted approach.

Results: This study included 39 children, of whom 25 (64%) were Black, 14 (36%) were Hispanic, and 15 (38%) were female. PFOA, PFOS, PFNA, and PFHpS were detectable in all cord and early childhood plasma samples, while GenX and ADONA were not detectable in any sample. Cord PFAS levels were weakly-to-moderately correlated with early childhood PFAS levels (r = -0.03 to 0.40). Several maternal and child factors, including gestational age, year at blood collection, and race/ethnicity, were associated with cord and early childhood PFAS levels. The metabolome-wide association study and the targeted study identified several cord metabolites that may have been affected by in utero PFAS exposure.

Conclusions: This pilot study found ubiquitous exposure to multiple PFAS in cord plasma (reflects in utero exposure) and in early childhood plasma (reflects both prenatal and postnatal exposure) among U.S. Black and Hispanic children. Metabolomic analysis suggests that in utero PFAS exposures may alter fetal metabolism. Future large-scale studies are needed to replicate the findings and further examine the associations of fetal PFAS exposure with long-term health outcomes and underlying metabolic pathways.

背景:全氟和多氟烷基物质(PFAS)因其无处不在的暴露、环境持久性、母体向胎儿的转移以及多器官毒性而成为全球关注的主要公共卫生问题。这项试验性研究旨在生成初步数据,为今后的研究提供依据,以填补该领域的数据空白,包括美国(U.S.)黑人和西班牙裔儿童在生命早期的 PFAS 暴露水平、纵向变化、决定因素以及相关的代谢组学改变:本研究利用波士顿出生队列中现有的生物样本和数据,在配对的脐带和幼儿血浆样本中测量了 12 种传统和新兴的 PFAS,包括 Me-PFOSA-AcOH、PFDA、PFDoA、PFHxS、PFNA、PFOA、PFOS、PFUnA、GenX、ADONA、9Cl-PF3ONS 和 PFHpS。采用汇总统计和图形图描述了两个时间点的 PFAS 水平及其纵向变化。线性回归模型用于确定与脐带和幼儿期 PFAS 含量相关的早期生活因素。采用全代谢组关联方法和目标方法探讨了脐带PFAS与脐带代谢物的关联:这项研究包括 39 名儿童,其中 25 名(64%)为黑人,14 名(36%)为西班牙裔,15 名(38%)为女性。在所有脐带和幼儿血浆样本中都检测到了 PFOA、PFOS、PFNA 和 PFHpS,而在任何样本中都检测不到 GenX 和 ADONA。脐带中的 PFAS 含量与幼儿期的 PFAS 含量呈弱到中等程度的相关性(r = -0.03 到 0.40)。一些母婴因素,包括妊娠年龄、采血年份和种族/民族,与脐带和幼儿期的 PFAS 水平相关。全代谢组关联研究和目标研究确定了几种可能受子宫内PFAS暴露影响的脐带代谢物:这项试点研究发现,在美国黑人和西班牙裔儿童中,脐带血浆(反映子宫内暴露)和儿童早期血浆(反映产前和产后暴露)中普遍暴露于多种全氟辛烷磺酸。代谢组学分析表明,子宫内暴露于 PFAS 可能会改变胎儿的新陈代谢。未来需要进行大规模研究,以复制研究结果,并进一步研究胎儿接触全氟辛烷磺酸与长期健康结果和潜在代谢途径之间的关联。
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引用次数: 0
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Precision nutrition
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