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Barbara Piperata

    Barbara Piperata

    The goal of this study was to understand the relationship between economic change (wage labor, retirement, and the Bolsa Família program) and dietary patterns in the rural Amazon and to determine the extent to which these changes followed... more
    The goal of this study was to understand the relationship between economic change (wage labor, retirement, and the Bolsa Família program) and dietary patterns in the rural Amazon and to determine the extent to which these changes followed the pattern of the nutrition transition. The study was longitudinal. The weighed-inventory method and economic interviews were used to collect data on dietary intake and household economics in a sample of 30 and 52 women in 2002 and 2009, respectively. Twenty of the women participated in both years and make-up the longitudinal sub-sample. Comparative statistics were used to identify changes in dietary patterns over time and multiple linear regressions were used to explore the relationship between economics, subsistence strategies, and diet. There was a significant decline in kcal (P < 0.01) and carbohydrate (P < 0.01) but no change in protein intake over time in both the larger and smaller, longitudinal subsample. The percent of energy, carbohydrate, protein, and fat purchased increased in the larger and longitudinal samples (P ≤ 0.02) and there was an increase in refined carbohydrate and processed, fatty-meat consumption over time. The abandonment of manioc gardens was associated with increased dependence on purchased food (P = 0.03) while receipt of the Bolsa Família was associated with increased protein intake and adequacy (P = 0.02). The dietary changes observed are only in partial agreement with predictions of the nutrition transition literature. The relationship between the economic and diet changes was shaped by the local context which should be considered when implementing CCT programs, like the Bolsa Família.
    We extend the conceptualization of the social and health burdens of household water insecurity on children beyond the traditional narrow lens of microbiological pathogens and diarrhea. The global burden of disease associated with water... more
    We extend the conceptualization of the social and health burdens of household water insecurity on children beyond the traditional narrow lens of microbiological pathogens and diarrhea. The global burden of disease associated with water insecurity has traditionally focused on diarrheal disease as the most significant driver of infant and child mortality. However, there are many other pathways through which children experience adverse health and social consequences from inadequate or unsafe household water. We synthesize evidence of a broad range of health impacts, affecting children from infancy to late adolescence, across four domains: exposure to unsafe water; interruptions to growth and development through poor nutrition and hydration; negative social effects such as school absenteeism and interpersonal violence; and other non‐communicable health issues such as mental health, injuries, and reproductive health. The growing burden and urgency of these issues is implicated by forecasted increases in climate‐ and conflict‐induced water scarcity, human displacement, and environmental contamination in the decades ahead.This article is categorized under: Engineering Water > Water, Health, and Sanitation Human Water > Rights to Water
    Food insecurity, a significant contributor to nutritional inequality, disproportionately affects women and children in low- and middle-income countries. The magnitude of the problem has inspired research on its impacts on health,... more
    Food insecurity, a significant contributor to nutritional inequality, disproportionately affects women and children in low- and middle-income countries. The magnitude of the problem has inspired research on its impacts on health, especially on nutritional status and, more recently, mental well-being. Current research is dominated by surveillance-type studies that emphasize access, one of food security's four dimensions. Findings are inconclusive regarding the association between food insecurity and women and children's nutritional status, but some evidence indicates that it is a key contributor to mental distress in women. To understand these inconsistent findings, we emphasize the need for research on the strategies that people use to cope with inadequate access to food. We contend that biocultural approaches that recognize the importance of local contexts and the role of broader political-economic factors in shaping them are well suited for addressing current knowledge gaps.
    Compared to other mammals, human milk is dilute which lowers the relative daily cost of lactation allowing women greater flexibility in the strategies they use to meet the energy demands of lactation. These strategies include increasing... more
    Compared to other mammals, human milk is dilute which lowers the relative daily cost of lactation allowing women greater flexibility in the strategies they use to meet the energy demands of lactation. These strategies include increasing dietary intake, reducing energy expenditure, and drawing on energy stores. Women are affected by the biosocial context in which they live, including norms regarding the sexual division of labor and diet and activity patterns during lactation, as well as household-level factors such as economic strategy and the availability of social support. This paper combines longitudinal data on dietary intake, energy expenditure, and body weight of 23 lactating Amazonian women living in a subsistence-based economy with detailed ethnographic data and considers how adherence to the cultural norms and the availability of social support contributed to intra-population variation in maternal energetic strategies. Dietary intake was found to vary more than energy expenditure. Adherence to dietary restrictions during the postpartum period of resguardo significantly reduced intra-population variation in energy intake. Women with social support came closer to achieving energy balance during resguardo (t = 2.8; P = 0.01) and peak lactation (t = 2.7; P = 0.02) and lost less weight (t = 3.6; P = 0.002) than those without such support. Those with social support had higher energy (t = 2.1; P = 0.05) and carbohydrate (t = 2.1, P = 0.05) intakes during resguardo and spent significantly less time in subsistence work during peak (t = 2.6, P = 0.03) and late lactation(t = 2.4, P = 0.03). Case studies are used to place these finding in context.
    Diets of subsistence-based Amazonian populations have been linked to local resources, but are changing with market penetration. To review the available data on traditional Amazonian foods and diets and evaluate their implications for... more
    Diets of subsistence-based Amazonian populations have been linked to local resources, but are changing with market penetration. To review the available data on traditional Amazonian foods and diets and evaluate their implications for human biology as a step toward understanding nutrition transitions in the region. This study used the Human Relations Area Files for information on the diets of Amerindian groups in the Amazon Basin from 1950 to the present, and used other published sources and the authors' own data. Data on food use was identified for only nine groups and dietary intake data for individuals in only three of the groups. A diet based on starchy staples (manioc and plantains) and fish, supplemented with a limited variety of other plant and animal foods, was found. Bitter manioc-based foods were associated with the consumption of cyanogens and fish with the consumption of mercury. Diets of adults appear to be adequate in energy and protein and low in fats. Children's diets were not well documented. Based on the limited available data, Amazonian diets are restricted in variety, but appear to be adequate in energy and protein for adults, but likely insufficiently nutrient-dense for children.
    BackgroundThe period from 6 to 24 months in an infant's life presents a critical window for understanding feeding practices and for designing culturally appropriate interventions. However, little is known about the complementary... more
    BackgroundThe period from 6 to 24 months in an infant's life presents a critical window for understanding feeding practices and for designing culturally appropriate interventions. However, little is known about the complementary feeding practices of Black mothers and how this period can be used to optimise the long‐term health of their children. The present study aimed to identify factors that influence the complementary feeding practices of low‐income Black mothers with children aged 6–24 months.MethodsParticipants were recruited through Research Match, Facebook advertising, flyers, and snowballing techniques. Low‐income, Black mothers, with a 6–24‐month‐old infant, and who lived in Franklin County, Ohio, USA, were eligible for the study. A cross‐sectional design using in‐depth interviews was used. Reflexive thematic analysis was utilised to analyse and interpret the feeding practices of Black mothers.ResultsMothers (n = 8) were aged between 18 and 30 years old and most completed college or had some college education (n = 6). Half (n = 4) were married, employed, and rated their diet quality and their children's as very good. Three themes emerged: (a) complementary feeding at ≥ 6 months of age; (b) involvement of health care providers and service organisations in feeding decisions; and (c) use of responsive feeding cues.ConclusionsAll mothers breastfed exclusively and most (n = 6) initiated complementary feeding at 6 months. Paediatricians, other health providers and service organisations were instrumental in helping Black mothers adopt complementary feeding practices. Mothers also engaged in responsive feeding practices. These findings point to the critical nature of access and education in helping Black mothers in the study achieve feeding recommendations for their infants.
    ObjectiveFood insecurity is a significant and growing concern undermining the wellbeing of 30% of the global population. Food in/security is a complex construct consisting of four dimensions: availability, access, utilization, and... more
    ObjectiveFood insecurity is a significant and growing concern undermining the wellbeing of 30% of the global population. Food in/security is a complex construct consisting of four dimensions: availability, access, utilization, and stability, making it challenging to measure. We provide a toolkit human biologists/ecologists can use to advance research on this topic.MethodsWe review the strengths and limitations of common tools used to measure food access and utilization, the two dimensions most proximate to people's lived experience, and emphasize tools that provide data needed to best link food security with human biological outcomes. We also discuss methods that provide contextual data human biologists/ecologists will find useful for study design, ensuring instrument validity, and improving data quality.ResultsFood access is principally measured using experience‐based instruments that emphasize economic access. Social access, such as food sharing, is under‐studied and we recommend using social network analysis to explore this dimension. In terms of utilization, emphasis has been on food choice measured as dietary diversity. Food preparation and intrahousehold distribution, also part of the utilization dimension, are less studied and standardized instruments for measuring both are lacking. The embodiment of food insecurity has focused on child growth, although a growing literature addresses adult mental wellbeing and chronic and infectious disease risk.ConclusionsWe see the potential to expand outcomes to include reproductive and immune function, physical activity, and the gut microbiome. Human biologists/ecologists are well‐positioned to advance understanding of the human health impacts of food insecurity and provide data to support intervention efforts.
    Conditional cash transfer (CCT) programs have become an increasingly popular component of poverty-alleviation policies worldwide. The highly publicized success of Brazil’s Bolsa Família program (BFP), the largest such program in the... more
    Conditional cash transfer (CCT) programs have become an increasingly popular component of poverty-alleviation policies worldwide. The highly publicized success of Brazil’s Bolsa Família program (BFP), the largest such program in the world, has become a model for CCT programs elsewhere, including in highly rural African nations. This is despite the dearth of information on the impact of the program in rural contexts. Drawing on a unique natural experiment and using detailed anthropometric and dietary data collected in rural Amazonian subsistence-based communities, we analyze the impact of this critical policy on programmatic goals among the rural poor. Our data demonstrate the urgent need for more fine-grained biocultural research on this and similar policies. We show that despite close adherence to programmatic conditionalities, recipient households’ food security was measurably worse off and children’s poor nutritional status was virtually unchanged 4 years into the program. Using detailed ethnographic insights, we discuss the mechanisms that may explain these disappointing results in this rural zone and raise broader questions about the role of CCT programs for breaking the cycle of poverty in subsistence-based communities worldwide, especially without concomitant investment in public health and sanitation infrastructure.
    ABSTRACT Resumo: Historicamente, duas abordagens distintas vêm sendo empregadas para estudar o estado nutricional e a saúde das populações tradicionais amazônicas: uma de viés médico-sanitarista e outra, mais recente, de caráter... more
    ABSTRACT Resumo: Historicamente, duas abordagens distintas vêm sendo empregadas para estudar o estado nutricional e a saúde das populações tradicionais amazônicas: uma de viés médico-sanitarista e outra, mais recente, de caráter interdisciplinar, que combina teorias e métodos das ciências sociais e da nutrição. Este último enfoque, chamado ecologia nutricional, vem sendo utilizado tanto para avaliar aspectos da saúde e segurança alimentar dessas populações no tocante às suas dinâmicas ambientais, históricas, políticas e socioeconômicas, quanto para validar os modelos de ocupação humana da região. Um levantamento da literatura em língua portuguesa e inglesa sobre o estado nutricional, a saúde e a dieta de populações tradicionais indígenas e não indígenas da Amazônia brasileira, publicada em periódicos científicos entre 1970 e 2012, revela paralelos com os diferentes paradigmas dominantes na avaliação da questão alimentar e nutricional do Brasil, com a alternância na busca de fatores ambientais e sociais como explicação para déficits calóricos ou proteicos. Em tempos recentes, alterações nos padrões de vida resultantes da urbanização, do aumento de renda e acesso e incentivo ao mercado de consumo têm afetado esses grupos humanos, com mudanças perceptíveis em índices de sobrepeso e obesidade, além da degradação geral das condições físicas, que podem ser associados à transição nutricional de hábitos alimentares tradicionais para a adoção de produtos industrializados. De qualquer maneira, nota-se uma grande carência de informações sobre a maioria das populações amazônicas, cujo suprimento será indispensável para quaisquer intervenções que visem a melhoria de sua saúde e qualidade de vida.
    Background: Early life plays a vital role in the development of the gut microbiome and subsequent health. While many factors that shape the gut microbiome have been described, including delivery mode, breastfeeding, and antibiotic use,... more
    Background: Early life plays a vital role in the development of the gut microbiome and subsequent health. While many factors that shape the gut microbiome have been described, including delivery mode, breastfeeding, and antibiotic use, the role of household environments is still unclear. Furthermore, the development of the gut antimicrobial resistome and its role in health and disease is not well characterized, particularly in settings with water insecurity and less sanitation infrastructure. Results: This study investigated the gut microbiomes and resistomes of infants and young children (ages 4 days-6 years) in rural Nicaragua using Oxford Nanopore Technology’s MinION long read sequencing. Differences in gut microbiome and resistome diversity and antibiotic resistance gene (ARG) abundance were examined for associations with host factors (age, sex, height for age z-score, weight for height z-score, delivery mode, breastfeeding habits) and household environmental factors (animals in...
    Ethnography is a core methodology in anthropology and other disciplines. Yet, there is currently no scholarly consensus on how to teach ethnographic methods—or even what methods belong in the ethnographic toolkit. We report on a... more
    Ethnography is a core methodology in anthropology and other disciplines. Yet, there is currently no scholarly consensus on how to teach ethnographic methods—or even what methods belong in the ethnographic toolkit. We report on a systematic analysis of syllabi to gauge how ethnographic methods are taught in the United States. We analyze 107 methods syllabi from a nationally elicited sample of university faculty who teach ethnography. Systematic coding shows that ethics, research design, participant observation, interviewing, and analysis are central to ethnographic instruction. But many key components of ethical, quality ethnographic practice (like preparing an IRB application, reflexivity, positionality, taking field notes, accurate transcription, theme identification, and coding) are only taught rarely. We suggest that, without inclusion of such elements in its basic training, the fields that prioritize this methodology are at risk of inadvertently perpetuating uneven, erratic, and...
    ObjectiveThis study describes secular trends in physical stature, Cormic Index (CI), and body mass index (BMI) of adult Makushi Amerindians born between 1910 and 1980, compares the stature of these Makushi adults to Makushi adults... more
    ObjectiveThis study describes secular trends in physical stature, Cormic Index (CI), and body mass index (BMI) of adult Makushi Amerindians born between 1910 and 1980, compares the stature of these Makushi adults to Makushi adults measured in 1921, and provides contextual data to inform the findings.MethodsPearson's correlation was used to assess the relationship between year of birth and physical stature, BMI, and CI for 231 females and 113 males, 20 to 90 years of age measured in 2000 to 2001. Wilcoxon's test was used to compare physical stature of Makushi adults measured in 2000 to 2001 with that of 40 Makushi adults measured in 1921.ResultsAmong Makushi measured in 2000 to 2001, females and males born more recently were taller and had a lower CI but did not differ in BMI relative to their elders. Makushi measured in 2000 to 2001 are significantly taller than those Maksuhi measured in 1921.ConclusionThe increased physical stature of and decreased CI in more recently born ...
    American Anthropology is engaged in significant self-reckonings that call for big changes to how anthropology is practiced. These include (1) recognizing and taking seriously the demands to decolonize the ways research is done; (2)... more
    American Anthropology is engaged in significant self-reckonings that call for big changes to how anthropology is practiced. These include (1) recognizing and taking seriously the demands to decolonize the ways research is done; (2) addressing precarious employment in academic anthropology; and (3) creating a discipline better positioned to respond to urgent societal needs. A central role for ethnographic methods training is a thread that runs through each of these four reckonings. This paper, written by a team of cultural, biocultural, and linguistic anthropologists, outlines key connections between ethnographic methods training and the challenges facing anthropology. We draw on insights from a large-scale survey of American Anthropological Association members to examine current ethnographic methods capabilities and training practices. Study findings suggest that there is a strong desire among anthropologists for deeper training in foundational methods such as participant observatio...
    Every year, during one the planet’s greatest seasonal flooding events, Central Amazonian rivers inundate farmland and expand aquatic habitats, making fish harder to catch. Understudied is whether this hydrological regime impacts human... more
    Every year, during one the planet’s greatest seasonal flooding events, Central Amazonian rivers inundate farmland and expand aquatic habitats, making fish harder to catch. Understudied is whether this hydrological regime impacts human dietary intakes/sufficiency, and, if so, whether it varies between communities in seasonally flooded (várzea) and non-flooded (terra firme) zones. To address this gap, we collected dietary data on 8,100 meals over the course of the hydrological cycle in six várzea and three terra firme communities, and calculated energy, carbohydrate, protein, and fat intake. Diets were dominated by fish (44%), the main source of protein and fat, and manioc flour (26%), the main source of energy and carbohydrate. Fish consumption fell as water levels rose, resulting in reduced energy and macronutrient intake in várzea communities. Terra firme communities showed greater seasonal resilience, maintaining protein and fat levels largely by increasing the consumption of wild...
    IMPACT. 1: This effort will involve local researchers and community members in a much-needed food security and health study in León, Nicaragua, and in outreach efforts that provide evidencebased feedback to the local communities about... more
    IMPACT. 1: This effort will involve local researchers and community members in a much-needed food security and health study in León, Nicaragua, and in outreach efforts that provide evidencebased feedback to the local communities about these health issues. -- 2. The immediate outcome of the project will be the identification of barriers to food security and child health in poor communities in León, Nicaragua. In the long-term, this project will yield invaluable future opportunities for Ohio State students and faculty to engage with local communities in research, learning and service in an international setting, where food insecurity and child malnutrition present serious threats to individuals' well-being.OSU PARTNERS: Department of Anthropology; Department of Sociology; College of Arts and SciencesCOMMUNITY PARTNERS: Center for Demographic; and Health Research (León, Nicaragua)PRIMARY CONTACT: Barbara Piperata (Piperata.1@osu.edu); Kammi Schmeer (Schemer.1@osu.edu)With approxima...
    Abstract: In urban Maroua, Cameroon, improved drinking water sources are available to a large majority of the population, yet this water is frequently distributed through informal distribution systems and stored in home containers... more
    Abstract: In urban Maroua, Cameroon, improved drinking water sources are available to a large majority of the population, yet this water is frequently distributed through informal distribution systems and stored in home containers (canaries), leaving it vulnerable to contamination. We assessed where contamination occurs within the distribution system, determined potential sources of environmental contamination, and investigated potential pathogens. Gastrointestinal health status (785 individuals) was collected via health surveys. OPEN ACCESS Int. J. Environ. Res. Public Health 2014, 11 12455 Drinking water samples were collected from drinking water sources and canaries. Escherichia coli and total coliform levels were evaluated and molecular detection was performed to measure human-associated faecal marker, HF183; tetracycline-resistance
    Conditional cash transfer (CCT) programs have become an increasingly popular component of poverty-alleviation policies worldwide. The highly publicized success of Brazil’s Bolsa Família program (BFP), the largest such program in the... more
    Conditional cash transfer (CCT) programs have become an increasingly popular component of poverty-alleviation policies worldwide. The highly publicized success of Brazil’s Bolsa Família program (BFP), the largest such program in the world, has become a model for CCT programs elsewhere, including in highly rural African nations. This is despite the dearth of information on the impact of the program in rural contexts. Drawing on a unique natural experiment and using detailed anthropometric and dietary data collected in rural Amazonian subsistence-based communities, we analyze the impact of this critical policy on programmatic goals among the rural poor. Our data demonstrate the urgent need for more fine-grained biocultural research on this and similar policies. We show that despite close adherence to programmatic conditionalities, recipient households’ food security was measurably worse off and children’s poor nutritional status was virtually unchanged 4 years into the program. Using detailed ethnographic insights, we discuss the mechanisms that may explain these disappointing results in this rural zone and raise broader questions about the role of CCT programs for breaking the cycle of poverty in subsistence-based communities worldwide, especially without concomitant investment in public health and sanitation infrastructure.
    This study examined the spatial variation of potential gastrointestinal pathogens within drinking water sources and home storage containers in four neighborhoods in Maroua, Cameroon. Samples were collected from source (n= 28) and home... more
    This study examined the spatial variation of potential gastrointestinal pathogens within drinking water sources and home storage containers in four neighborhoods in Maroua, Cameroon. Samples were collected from source (n= 28) and home containers (n= 60) in each study neighborhood. Pathogen contamination was assessed using quantitative polymerase chain reaction, targeting Campylobacter spp., Shiga toxin producing Escherichia coli (virulence genes, stx1 and stx2), and Salmonella spp. Microbial source tracking (MST) targeted three different host-specific markers: HF183 (human), Rum2Bac (ruminant) and GFD (poultry) to identify contamination sources. Staphylococcus aureus and the tetracycline-resistance gene (tetQ) were assessed to measure human hand contact and presence of antibiotic-resistant bacteria. Pathogen/MST levels were compared statistically and spatially, and neighborhood variation was compared with previously collected demographic information. All the test fecal markers and p...
    Poor mental health among those living in poverty is a serious global public health concern. Food insecurity (FI) is recognized as an important, yet critically understudied social determinant of mental health. The relationship between FI... more
    Poor mental health among those living in poverty is a serious global public health concern. Food insecurity (FI) is recognized as an important, yet critically understudied social determinant of mental health. The relationship between FI and mothers' mental health in low- and middle-income countries (LMIC) is especially important to understand considering the high rates of poverty and associated FI in these settings. For these mothers, social support may serve as a buffer in ameliorating the impact of FI on mental distress. However, data required to understand these relationships in LMIC remain sparse. To address this gap we used quantitative and qualitative data and convergence parallel analysis to assess: the association between FI and maternal mental distress; and, whether three forms of social support - mother's general social network support and family support (spouse/partner living in the home, parents/in-laws living in the home) - moderated the association. A survey that included data on FI (ELCSA) and mental distress (SRQ-20) was administered to a population-based sample of mothers in León, Nicaragua (n = 434) in 2012. The survey was complemented by data from 6 focus groups. Regression models identified a strong positive relationship between household-level FI and maternal distress. Evidence of social support moderation was mixed: while maternal social network and spousal/partner support did not moderate this relationship, parental support did. Our ethnographic data revealed three themes that help explain these findings: FI is embarrassing/shameful, close family is the most appropriate source of social support and, fear of gossip and ridicule limit the buffering capacity of the social support network. Our findings contribute to a growing literature demonstrating that FI is an important social determinant of maternal mental distress in LMIC; and that some forms of social support may reduce (but not eliminate) the impact of FI on mental distress.
    The goal of assessing psychosocial stress as a process and outcome in naturalistic (i.e., field) settings is applicable across the social, biological, and health sciences. Meaningful measurement of biology-in-context is, however, far from... more
    The goal of assessing psychosocial stress as a process and outcome in naturalistic (i.e., field) settings is applicable across the social, biological, and health sciences. Meaningful measurement of biology-in-context is, however, far from simple or straightforward. In this brief methods review, we introduce theoretical framings, methodological conventions, and ethical concerns around field-collection of markers of psychosocial stress that have emerged from 50 years of research at the intersection of anthropology and human biology. Highlighting measures of psychosocial stress outcomes most often used in biocultural studies, we identify the circumstances under which varied measures are most appropriately applied and provide examples of the types of cutting-edge research questions these measures can address. We explain that field-based psychosocial stress measures embedded in different body systems are neither equivalent nor interchangeable, but this recognition strengthens the study o...
    Diets of subsistence-based Amazonian populations have been linked to local resources, but are changing with market penetration. To review the available data on traditional Amazonian foods and diets and evaluate their implications for... more
    Diets of subsistence-based Amazonian populations have been linked to local resources, but are changing with market penetration. To review the available data on traditional Amazonian foods and diets and evaluate their implications for human biology as a step toward understanding nutrition transitions in the region. This study used the Human Relations Area Files for information on the diets of Amerindian groups in the Amazon Basin from 1950 to the present, and used other published sources and the authors' own data. Data on food use was identified for only nine groups and dietary intake data for individuals in only three of the groups. A diet based on starchy staples (manioc and plantains) and fish, supplemented with a limited variety of other plant and animal foods, was found. Bitter manioc-based foods were associated with the consumption of cyanogens and fish with the consumption of mercury. Diets of adults appear to be adequate in energy and protein and low in fats. Children&#39...
    Diets of subsistence-based Amazonian populations have been linked to local resources, but are changing with market penetration. To review the available data on traditional Amazonian foods and diets and evaluate their implications for... more
    Diets of subsistence-based Amazonian populations have been linked to local resources, but are changing with market penetration. To review the available data on traditional Amazonian foods and diets and evaluate their implications for human biology as a step toward understanding nutrition transitions in the region. This study used the Human Relations Area Files for information on the diets of Amerindian groups in the Amazon Basin from 1950 to the present, and used other published sources and the authors' own data. Data on food use was identified for only nine groups and dietary intake data for individuals in only three of the groups. A diet based on starchy staples (manioc and plantains) and fish, supplemented with a limited variety of other plant and animal foods, was found. Bitter manioc-based foods were associated with the consumption of cyanogens and fish with the consumption of mercury. Diets of adults appear to be adequate in energy and protein and low in fats. Children&#39...

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