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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Microbiology".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 66730

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Prof. Dr. Diana María Cardona Mena

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Guest Editor

Department of Nursing, Physiotherapy and Medicine, Health Research Center (CEINSA), University of Almeria, 04120 Almeria, Spain
Interests: microbiota; gut-brain-axis; neurotoxicity
Special Issues, Collections and Topics in MDPI journals

Dr. Pablo Roman

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Guest Editor

Department of Nursing, Physiotherapy and Medicine, Health Research Center (CEINSA), University of Almeria, 04120 Almeria, Spain
Interests: gut microbiota; gut-brain-axis; functional food; probiotic; clinical trials; systematic review
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Gut microbiota is an area recently targeted by modern biomedical research. In fact, during the last five years, there has been increasing evidence related to the role of gut microbiota as a remarkable symbiotic partner critical for the maintenance of good health. Several factors cause alteration in gut microbiota which are, indeed, accompanied by alterations to the quality of health. Accordingly, gut microbiota dysbiosis has been related to increased susceptibilities to intestinal, cardiovascular, and nervous pathologies. However, more research is required to elucidate the role of microbiota, its outcomes in health diseases, and the underlying pathways.
We invite you to submit a manuscript for publication in this Special Issue dedicated to evaluate the role of gut microbiota in health, which may be an original research article (preclinical or clinical) or review. Important topics include but are not limited to interactions between gut microbiota and several health conditions (digestive disorders, health mental disorders, cardiovascular disorders, etc.); factors that alter gut microbiota (exposure to toxic substance, stress, nutrition, habits, etc.); changes in the gut microbiota throughout lifetime; modulators of the microbiota as therapy for different health disorders (prebiotics, probiotics, fecal transplantation, etc.); and the gut–brain axis and its implication for health.

We thank you for considering this invitation and are available for any inquiries.

Prof. Dr. Diana María Cardona Mena
Dr. Pablo Roman
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

gut microbiota
gut–brain axis
dysbiosis
microbiome
modulatory effects of gut microbiota
probiotics
prebiotics
functional food

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2nd Edition of New Perspectives in Health: Gut Microbiota in International Journal of Environmental Research and Public Health (3 articles)

Published Papers (13 papers)

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Editorial

Jump to: Research, Review, Other

3 pages, 264 KiB

Open AccessEditorial

New Perspectives in Health: Gut Microbiota

by Diana Cardona and Pablo Roman

Int. J. Environ. Res. Public Health 2022, 19(10), 5828; https://doi.org/10.3390/ijerph19105828 - 10 May 2022

Cited by 4 | Viewed by 1826

Abstract

The gut microbiota has an important role in different physiological functions, exerting effects from energy metabolism to psychiatric well-being [...] Full article

(This article belongs to the Special Issue New Perspectives in Health: Gut Microbiota)

Research

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7 pages, 1373 KiB

Open AccessArticle

Feasibility of an At-Home Adult Stool Specimen Collection Method in Rural Cambodia

by Jordie A. J. Fischer and Crystal D. Karakochuk

Int. J. Environ. Res. Public Health 2021, 18(23), 12430; https://doi.org/10.3390/ijerph182312430 - 26 Nov 2021

Cited by 3 | Viewed by 8098

Abstract

The human microbiome has received significant attention over the past decade regarding its potential impact on health. Epidemiological and intervention studies often rely on at-home stool collection methods designed for high-resource settings, such as access to an improved toilet with a modern toilet seat. However, this is not always appropriate or applicable to low-resource settings. Therefore, the design of a user-friendly stool collection kit for low-resource rural settings is needed. We describe the development, assembly, and user experience of a simple and low-cost at-home stool collection kit for women living in rural Cambodia as part of a randomized controlled trial in 2020. Participants were provided with the stool collection kit and detailed verbal instruction. Enrolled women (n = 480) provided two stool specimens (at the start of the trial and after 12 weeks) at their home and brought them to the health centre that morning in a sterile collection container. User specimen collection compliance was high, with 90% (n = 434) of women providing a stool specimen at the end of the trial (after 12 weeks). This feasible and straightforward method has strong potential for similar or adapted use among adults residing in other rural or low-resource contexts. Full article

(This article belongs to the Special Issue New Perspectives in Health: Gut Microbiota)

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11 pages, 1257 KiB

Open AccessArticle

Impact of Dietary Isoflavone Supplementation on the Fecal Microbiota and Its Metabolites in Postmenopausal Women

by Lucía Guadamuro, M. Andrea Azcárate-Peril, Rafael Tojo, Baltasar Mayo and Susana Delgado

Int. J. Environ. Res. Public Health 2021, 18(15), 7939; https://doi.org/10.3390/ijerph18157939 - 27 Jul 2021

Cited by 12 | Viewed by 2919

Abstract

Isoflavones are metabolized by components of the gut microbiota and can also modulate their composition and/or activity. This study aimed to analyze the modifications of the fecal microbial populations and their metabolites in menopausal women under dietary treatment with soy isoflavones for one month. Based on the level of urinary equol, the women had been stratified previously as equol-producers (n = 3) or as equol non-producers (n = 5). The composition of the fecal microbiota was assessed by high-throughput sequencing of 16S rRNA gene amplicons and the changes in fatty acid excretion in feces were analyzed by gas chromatography. A greater proportion of sequence reads of the genus Slackia was detected after isoflavone supplementation. Sequences of members of the family Lachnospiraceae and the genus Pseudoflavonifractor were significantly increased in samples from equol-producing women. Multivariable analysis showed that, after isoflavone treatment, the fecal microbial communities of equol producers were more like each other. Isoflavone supplementation increased the production of caproic acid, suggesting differential microbial activity, leading to a high fecal excretion of this compound. However, differences between equol producers and non-producers were not scored. These results may contribute to characterizing the modulating effect of isoflavones on the gut microbiota, which could lead to unravelling of their beneficial health effects. Full article

(This article belongs to the Special Issue New Perspectives in Health: Gut Microbiota)

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19 pages, 1601 KiB

Open AccessArticle

Casomorphins and Gliadorphins Have Diverse Systemic Effects Spanning Gut, Brain and Internal Organs

by Keith Bernard Woodford

Int. J. Environ. Res. Public Health 2021, 18(15), 7911; https://doi.org/10.3390/ijerph18157911 - 26 Jul 2021

Cited by 13 | Viewed by 7413

Abstract

Food-derived opioid peptides include digestive products derived from cereal and dairy diets. If these opioid peptides breach the intestinal barrier, typically linked to permeability and constrained biosynthesis of dipeptidyl peptidase-4 (DPP4), they can attach to opioid receptors. The widespread presence of opioid receptors spanning gut, brain, and internal organs is fundamental to the diverse and systemic effects of food-derived opioids, with effects being evidential across many health conditions. However, manifestation delays following low-intensity long-term exposure create major challenges for clinical trials. Accordingly, it has been easiest to demonstrate causal relationships in digestion-based research where some impacts occur rapidly. Within this environment, the role of the microbiome is evidential but challenging to further elucidate, with microbiome effects ranging across gut-condition indicators and modulators, and potentially as systemic causal factors. Elucidation requires a systemic framework that acknowledges that public-health effects of food-derived opioids are complex with varying genetic susceptibility and confounding factors, together with system-wide interactions and feedbacks. The specific role of the microbiome within this puzzle remains a medical frontier. The easiest albeit challenging nutritional strategy to modify risk is reduced intake of foods containing embedded opioids. In future, constituent modification within specific foods to reduce embedded opioids may become feasible. Full article

(This article belongs to the Special Issue New Perspectives in Health: Gut Microbiota)

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17 pages, 4982 KiB

Open AccessArticle

Detection of Dysbiosis and Increased Intestinal Permeability in Brazilian Patients with Relapsing–Remitting Multiple Sclerosis

by Felipe Papa Pellizoni, Aline Zazeri Leite, Nathália de Campos Rodrigues, Marcelo Jordão Ubaiz, Marina Ignácio Gonzaga, Nauyta Naomi Campos Takaoka, Vânia Sammartino Mariano, Wellington Pine Omori, Daniel Guariz Pinheiro, Euclides Matheucci Junior, Eleni Gomes and Gislane Lelis Vilela de Oliveira

Int. J. Environ. Res. Public Health 2021, 18(9), 4621; https://doi.org/10.3390/ijerph18094621 - 27 Apr 2021

Cited by 24 | Viewed by 4191

Abstract

Dysbiosis, associated with barrier disruption and altered gut–brain communications, has been associated with multiple sclerosis (MS). In this study, we evaluated the gut microbiota in relapsing–remitting patients (RRMS) receiving disease-modifying therapies (DMTs) and correlated these data with diet, cytokines levels, and zonulin concentrations. Stool samples were used for 16S sequencing and real-time PCR. Serum was used for cytokine determination by flow cytometry, and zonulin quantification by ELISA. Pearson’s chi-square, Mann–Whitney, and Spearman’s correlation were used for statistical analyses. We detected differences in dietary habits, as well as in the gut microbiota in RRMS patients, with predominance of Akkermansia muciniphila and Bacteroides vulgatus and decreased Bifidobacterium. Interleukin-6 concentrations were decreased in treated patients, and we detected an increased intestinal permeability in RRMS patients when compared with controls. We conclude that diet plays an important role in the composition of the gut microbiota, and intestinal dysbiosis, detected in RRMS patients could be involved in increased intestinal permeability and affect the clinical response to DTMs. The future goal is to predict therapeutic responses based on individual microbiome analyses (personalized medicine) and propose dietary interventions and the use of probiotics or other microbiota modulators as adjuvant therapy to enhance the therapeutic efficacy of DMTs. Full article

(This article belongs to the Special Issue New Perspectives in Health: Gut Microbiota)

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11 pages, 758 KiB

Open AccessArticle

The Effect of Multiprobiotics on Memory and Attention in Fibromyalgia: A Pilot Randomized Controlled Trial

by Diana Cardona, Pablo Roman, Fernando Cañadas and Nuria Sánchez-Labraca

Int. J. Environ. Res. Public Health 2021, 18(7), 3543; https://doi.org/10.3390/ijerph18073543 - 29 Mar 2021

Cited by 13 | Viewed by 3949

Abstract

Fibromyalgia syndrome (FMS) is a chronic, generalized and diffuse pain disorder accompanied by cognitive deficits such as forgetfulness, concentration difficulties, loss of vocabulary and mental slowness, among others. In recent years, FMS has been associated with altered intestinal microbiota, suggesting that modulating gut microbiota (for example, through probiotics) could be an effective therapeutic treatment. Thus, the aim of the present study was to continue exploring the role of probiotics in cognitive processes in patients with FMS. A pilot randomized controlled trial was conducted in 31 patients diagnosed with FMS to compare the effects of a multispecies probiotic versus a placebo on cognitive variables (memory and attention) after eight weeks. Results showed that treatment with a multispecies probiotic produced an improvement in attention by reducing errors on an attention task, but it had no effect on memory. More specifically, a tendency to reduce errors of omission (Go trials) during the Go/No-Go Task was observed after treatment. These findings, along with our previous results in impulsivity, underline the relevance of using probiotics as a therapeutic option in FMS, although more research with a larger sample size is required. Full article

(This article belongs to the Special Issue New Perspectives in Health: Gut Microbiota)

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17 pages, 1963 KiB

Open AccessArticle

Effect of Simulated Gastrointestinal Tract Conditions on Survivability of Probiotic Bacteria Present in Commercial Preparations

by Lidia Stasiak-Różańska, Anna Berthold-Pluta, Antoni Stanisław Pluta, Krzysztof Dasiewicz and Monika Garbowska

Int. J. Environ. Res. Public Health 2021, 18(3), 1108; https://doi.org/10.3390/ijerph18031108 - 27 Jan 2021

Cited by 28 | Viewed by 4649

Abstract

Probiotics are recommended, among others, in the diet of children who are under antibiotic therapy, or that suffer from food allergies or travel diarrhea, etc. In the case of toddlers taking probiotic preparations, it is highly recommended to first remove the special capsule, which normally protects probiotic strains against hard conditions in the gastrointestinal tract. Otherwise, the toddler may choke. This removal can impair probiotic survival and reduce its efficacy in a toddler’s organism. The aim of this study was to evaluate the survivability of five strains of lactic acid bacteria from the commercial probiotics available on the Polish market under simulated conditions of the gastrointestinal tract. Five probiotics (each including one of these strains: Bifidobacterium BB-12, Lactobacillus (Lb.) rhamnosus GG, Lb. casei, Lb. acidophilus, Lb. plantarum) were protective capsule deprived, added in a food matrix (chicken–vegetable soup) and subjected under simulated conditions of the gastric and gastrointestinal passage. Strain survivability and possibility to growth were evaluated. Obtained results showed that, among all analyzed commercial probiotic strains, the Lb. plantarum was the most resistant to the applied conditions of the culture medium. They showed a noticeable growth under both in vitro gastric conditions at pH 4.0 and 5.0, as well as in vitro intestinal conditions at all tested concentrations of bile salts. Full article

(This article belongs to the Special Issue New Perspectives in Health: Gut Microbiota)

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14 pages, 696 KiB

Open AccessArticle

Addition of Probiotics to Anti-Obesity Therapy by Percutaneous Electrical Stimulation of Dermatome T6. A Pilot Study

by Oscar Lorenzo, Marta Crespo-Yanguas, Tianyu Hang, Jairo Lumpuy-Castillo, Artur M. Hernández, Carolina Llavero, MLuisa García-Alonso and Jaime Ruiz-Tovar

Int. J. Environ. Res. Public Health 2020, 17(19), 7239; https://doi.org/10.3390/ijerph17197239 - 3 Oct 2020

Cited by 10 | Viewed by 5271

Abstract

Obesity is becoming a pandemic and percutaneous electrical stimulation (PENS) of dermatome T6 has been demonstrated to reduce stomach motility and appetite, allowing greater weight loss than isolated hypocaloric diets. However, modulation of intestinal microbiota could improve this effect and control cardiovascular risk factors. Our objective was to test whether addition of probiotics could improve weight loss and cardiovascular risk factors in obese subjects after PENS and a hypocaloric diet. A pilot prospective study was performed in patients (n = 20) with a body mass index (BMI) > 30 kg/m². Half of them underwent ten weeks of PENS in conjunction with a hypocaloric diet (PENS-Diet), and the other half was treated with a PENS-Diet plus multistrain probiotics (L. plantarum LP115, B. brevis B3, and L. acidophilus LA14) administration. Fecal samples were obtained before and after interventions. The weight loss and changes in blood pressure, glycemic and lipid profile, and in gut microbiota were investigated. Weight loss was significantly higher (16.2 vs. 11.1 kg, p = 0.022), whereas glycated hemoglobin and triglycerides were lower (−0.46 vs. −0.05%, p = 0.032, and −47.0 vs. −8.5 mg/dL, p = 0.002, respectively) in patients receiving PENS-Diet + probiotics compared with those with a PENS-Diet. Moreover, an enrichment of anti-obesogenic bacteria, including Bifidobacterium spp, Akkermansia spp, Prevotella spp, and the attenuation of the Firmicutes/Bacteroidetes ratio were noted in fecal samples after probiotics administration. In obese patients, the addition of probiotics to a PENS intervention under a hypocaloric diet could further improve weight loss and glycemic and lipid profile in parallel to the amelioration of gut dysbiosis. Full article

(This article belongs to the Special Issue New Perspectives in Health: Gut Microbiota)

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Review

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14 pages, 1478 KiB

Open AccessReview

The Microbiota-Bone-Allergy Interplay

by Maria Maddalena Sirufo, Francesca De Pietro, Alessandra Catalogna, Lia Ginaldi and Massimo De Martinis

Int. J. Environ. Res. Public Health 2022, 19(1), 282; https://doi.org/10.3390/ijerph19010282 - 28 Dec 2021

Cited by 7 | Viewed by 3534

Abstract

Emerging knowledge suggests an increasing importance of gut microbiota in health and disease. Allergy and bone metabolism are closely interconnected, and the possible negative effects of common therapies are not the only aspects of this relationship. The immune system is influenced by the microbiota-host interactions, and several pieces of evidence suggest the existence of an interplay between microbiota, bone metabolism, and allergies. Understanding these inter-relationships is essential for the development of new potential strategies of treatment and prevention targeting microbiota. A wide range of substances and germs, prebiotics and probiotics, are capable of influencing and modifying the microbiota. Prebiotics and probiotics have been shown in several studies to have different actions based on various factors such as sex, hormonal status, and age. In this review, we summarize the latest knowledge on the topic, and we discuss practical implications and the need for further studies. Full article

(This article belongs to the Special Issue New Perspectives in Health: Gut Microbiota)

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16 pages, 1021 KiB

Open AccessReview

Probiotic Supplements on Oncology Patients’ Treatment-Related Side Effects: A Systematic Review of Randomized Controlled Trials

by Miguel Rodriguez-Arrastia, Adrian Martinez-Ortigosa, Lola Rueda-Ruzafa, Ana Folch Ayora and Carmen Ropero-Padilla

Int. J. Environ. Res. Public Health 2021, 18(8), 4265; https://doi.org/10.3390/ijerph18084265 - 17 Apr 2021

Cited by 37 | Viewed by 5449

Abstract

Cancer affects more than 19.3 million people and has become the second leading cause of death worldwide. Chemo- and radiotherapy, the most common procedures in these patients, often produce unpleasant treatment-related side effects that have a direct impact on the quality of life of these patients. However, innovative therapeutic strategies such as probiotics are being implemented to manage these complications. Thus, this study aimed to evaluate the efficacy of probiotics supplements as a therapeutic strategy in adult oncology treatment-related side effects. A systematic review of randomized controlled trials was conducted in PubMed, Scielo, ProQuest and OVID databases up to and including January 2021, following the PRISMA guidelines. The quality of the included studies was assessed by the Jadad Scale. Twenty clinical trials published between 1988 and 2020 were included in this review. Seventeen studies (85%) revealed predominantly positive results when using probiotics to reduce the incidence of treatment-related side effects in oncology patients, while three studies (15%) reported no impact in their findings. This study sheds some light on the significance of chemotherapy and radiotherapy in altering the composition of gut microbiota, where probiotic strains may play an important role in preventing or mitigating treatment-related side effects. Full article

(This article belongs to the Special Issue New Perspectives in Health: Gut Microbiota)

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16 pages, 721 KiB

Open AccessReview

Impact of Food Additive Titanium Dioxide on Gut Microbiota Composition, Microbiota-Associated Functions, and Gut Barrier: A Systematic Review of In Vivo Animal Studies

by Emanuele Rinninella, Marco Cintoni, Pauline Raoul, Vincenzina Mora, Antonio Gasbarrini and Maria Cristina Mele

Int. J. Environ. Res. Public Health 2021, 18(4), 2008; https://doi.org/10.3390/ijerph18042008 - 19 Feb 2021

Cited by 18 | Viewed by 4427

Abstract

Background: Titanium dioxide (TiO₂) is used as a food additive in pastries, sweets, and sauces. It is recognized as safe by food safety authorities, but in recent years, governments and scientists have raised concerns about its genotoxicity. This systematic review aims to assess the potential associations between food TiO₂ exposure and microbiota composition and functions. Methods: A systematic literature search was performed up to December 2020 in PubMed, Web of Science, and Scopus databases. The PRISMA guidelines followed. The risk of bias was assessed from ARRIVE and SYRCLE tools. Results: A total of 18 animal studies were included (n = 10 mice, n = 5 rats, n = 2 fruit flies, n = 1 silkworm). Studies varied significantly in protocols and outcomes assessment. TiO₂ exposure might cause variations in abundance in specific bacterial species and lead to gut dysfunctions such as a reduction in SCFAs levels, goblet cells and crypts, mucus production, and increased biomarkers of intestinal inflammation. Conclusions: Although the extrapolation of these results from animals to humans remains difficult, this review highlights the key role of gut microbiota in gut nanotoxicology and stimulates discussions on the safe TiO₂ use in food and dietary supplements. This systematic review was registered at PROSPERO as CRD42020223968. Full article

(This article belongs to the Special Issue New Perspectives in Health: Gut Microbiota)

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19 pages, 1604 KiB

Open AccessReview

Nicotinic Acetylcholine Receptor Involvement in Inflammatory Bowel Disease and Interactions with Gut Microbiota

by Lola Rueda Ruzafa, José Luis Cedillo and Arik J. Hone

Int. J. Environ. Res. Public Health 2021, 18(3), 1189; https://doi.org/10.3390/ijerph18031189 - 29 Jan 2021

Cited by 22 | Viewed by 10165

Abstract

The gut-brain axis describes a complex interplay between the central nervous system and organs of the gastrointestinal tract. Sensory neurons of dorsal root and nodose ganglia, neurons of the autonomic nervous system, and immune cells collect and relay information about the status of the gut to the brain. A critical component in this bi-directional communication system is the vagus nerve which is essential for coordinating the immune system’s response to the activities of commensal bacteria in the gut and to pathogenic strains and their toxins. Local control of gut function is provided by networks of neurons in the enteric nervous system also called the ‘gut-brain’. One element common to all of these gut-brain systems is the expression of nicotinic acetylcholine receptors. These ligand-gated ion channels serve myriad roles in the gut-brain axis including mediating fast synaptic transmission between autonomic pre- and postganglionic neurons, modulation of neurotransmitter release from peripheral sensory and enteric neurons, and modulation of cytokine release from immune cells. Here we review the role of nicotinic receptors in the gut-brain axis with a focus on the interplay of these receptors with the gut microbiome and their involvement in dysregulation of gut function and inflammatory bowel diseases. Full article

(This article belongs to the Special Issue New Perspectives in Health: Gut Microbiota)

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Other

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14 pages, 783 KiB

Open AccessProject Report

Evaluation of Changes in Gut Microbiota in Patients with Crohn’s Disease after Anti-Tnfα Treatment: Prospective Multicenter Observational Study

by Laura Sanchis-Artero, Juan Francisco Martínez-Blanch, Sergio Manresa-Vera, Ernesto Cortés-Castell, Josefa Rodriguez-Morales and Xavier Cortés-Rizo

Int. J. Environ. Res. Public Health 2020, 17(14), 5120; https://doi.org/10.3390/ijerph17145120 - 15 Jul 2020

Cited by 9 | Viewed by 3079

Abstract

Background: Crohn’s disease is believed to result from the interaction between genetic susceptibility, environmental factors and gut microbiota, leading to an aberrant immune response. The objectives of this study are to evaluate the qualitative and quantitative changes in the microbiota of patients with Crohn’s disease after six months of anti-tumor-necrosis factor (anti-TNFα) (infliximab or adalimumab) treatment and to determine whether these changes lead to the recovery of normal microbiota when compared to a control group of healthy subjects. In addition, we will evaluate the potential role of the Faecalibacterium prausnitzii/Escherichia coli and Faecalibacterium prausnitzii/Clostridium coccoides ratios as indicators of therapeutic response to anti-TNFα drugs. Methods/Design: This prospective multicenter observational study will comprise a total of 88 subjects: 44 patients with Crohn’s disease scheduled to start anti-TNFα treatment as described in the drug specifications to control the disease and 44 healthy individuals who share the same lifestyle and eating habits. The presence of inflammatory activity will be determined by the Harvey-Bradshaw index, analytical parameters in blood, including C-reactive protein, and fecal calprotectin levels at commencement of the study, at three months and at six months, allowing the classification of patients into responders and non-responders. Microbiota composition and the quantitative relationship between Faecalibacterium prausnitzii and Escherichia coli and between Faecalibacterium prausnitzii and Clostridium coccoides group as indicators of dysbiosis will be studied at inclusion and six months after initiation of treatment using ultra sequencing with Illumina technology and comparative bioinformatics analysis for the former relationship, and digital droplet PCR using stool samples for the latter. Upon inclusion, patients will complete a survey of dietary intake for the three days prior to stool collection, which will be repeated six months later in a second collection to minimize dietary bias. Discussion: In this study, massive sequencing, a reliable new tool, will be applied to identify early biomarkers of response to anti-TNF treatment in patients with Crohn’s disease to improve clinical management of these patients, reduce morbidity rates and improve efficiency. Full article

(This article belongs to the Special Issue New Perspectives in Health: Gut Microbiota)

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