Skip to main content
Erschienen in: European Journal of Nutrition 2/2013

01.03.2013 | Original Contribution

Relationship between vitamin D deficiency, bone remodelling and iron status in iron-deficient young women consuming an iron-fortified food

verfasst von: Ruth Blanco-Rojo, Ana M. Pérez-Granados, Laura Toxqui, Pilar Zazo, Concepción de la Piedra, M. Pilar Vaquero

Erschienen in: European Journal of Nutrition | Ausgabe 2/2013

Einloggen, um Zugang zu erhalten

Abstract

Background

Iron and vitamin D deficiencies are two of the most widespread nutritional disorders in the world. Our aim was to know whether the consumption of an iron-fortified fruit juice modifies bone remodelling and the possible influence of baseline vitamin D status on the recovery of iron status in a group of iron-deficient women.

Methods

Iron biomarkers, 25-hydroxyvitamin D levels and dietary intake were measured in 123 iron-deficient menstruating women. A subgroup (n = 41) participated in a randomised double-blind placebo-controlled study of 16-weeks during winter. They consumed a placebo fruit juice (P) or iron-fortified fruit juice (F). Dietary intake, 25-hydroxyvitamin D, parathormone (PTH), bone alkaline phosphatase (ALP), aminoterminal telopeptide of collagen I (NTX) and iron biomarkers were determined.

Results

Ninety-two per cent of the iron-deficient women were vitamin D deficient or insufficient. Transferrin saturation and 25-hydroxyvitamin D were positively correlated. Iron status improved in F, 25-hydroxyvitamin D decreased in F and P, and PTH, ALP and NTX levels were within the normal range and did not vary. Women with 25-hydroxyvitamin D ≥ 50 nmol/L compared with 25-hydroxyvitamin D < 50 nmol/L showed a higher increase in transferrin saturation (a marker of iron supply to tissues) during iron recovery.

Conclusion

The prevalence of vitamin D deficiency or insufficiency is very high in iron-deficient women. The recovery of iron status by consuming an iron-fortified food does not affect 25-hydroxyvitamin D levels; however, the increase in iron supply to tissues is lower if the women also present vitamin D deficiency. Although bone health does not seem to be affected in this group of women, correction of iron and vitamin D deficiencies should be promoted in young women to improve present and future health.
Literatur
1.
Zurück zum Zitat Holick MF, Chen TC (2008) Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 87(4):1080S–1086S Holick MF, Chen TC (2008) Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 87(4):1080S–1086S
2.
Zurück zum Zitat Bendich A (2010) Iron deficiency and overload. Humana Press, New York Bendich A (2010) Iron deficiency and overload. Humana Press, New York
3.
Zurück zum Zitat McGillivray G, Skull SA, Davie G, Kofoed SE, Frydenberg A, Rice J, Cooke R, Carapetis JR (2007) High prevalence of asymptomatic vitamin D and iron deficiency in East African immigrant children and adolescents living in a temperate climate. Arch Dis Child 92(12):1088–1093. doi:10.1136/adc.2006.112813 CrossRef McGillivray G, Skull SA, Davie G, Kofoed SE, Frydenberg A, Rice J, Cooke R, Carapetis JR (2007) High prevalence of asymptomatic vitamin D and iron deficiency in East African immigrant children and adolescents living in a temperate climate. Arch Dis Child 92(12):1088–1093. doi:10.​1136/​adc.​2006.​112813 CrossRef
4.
Zurück zum Zitat Grindulis H, Scott PH, Belton NR, Wharton BA (1986) Combined deficiency of iron and vitamin D in Asian toddlers. Arch Dis Child 61(9):843–848CrossRef Grindulis H, Scott PH, Belton NR, Wharton BA (1986) Combined deficiency of iron and vitamin D in Asian toddlers. Arch Dis Child 61(9):843–848CrossRef
5.
8.
Zurück zum Zitat Jones G, Strugnell SA, DeLuca HF (1998) Current understanding of the molecular actions of vitamin D. Physiol Rev 78(4):1193–1231 Jones G, Strugnell SA, DeLuca HF (1998) Current understanding of the molecular actions of vitamin D. Physiol Rev 78(4):1193–1231
9.
Zurück zum Zitat DeLuca HF (2004) Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 80(6 Suppl):1689S–1696S DeLuca HF (2004) Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 80(6 Suppl):1689S–1696S
10.
Zurück zum Zitat Knott L, Bailey AJ (1998) Collagen cross-links in mineralizing tissues: a review of their chemistry, function, and clinical relevance. Bone 22(3):181–187CrossRef Knott L, Bailey AJ (1998) Collagen cross-links in mineralizing tissues: a review of their chemistry, function, and clinical relevance. Bone 22(3):181–187CrossRef
11.
Zurück zum Zitat Katsumata S, Tsuboi R, Uehara M, Suzuki K (2006) Dietary iron deficiency decreases serum osteocalcin concentration and bone mineral density in rats. Biosci Biotechnol Biochem 70(10):2547–2550CrossRef Katsumata S, Tsuboi R, Uehara M, Suzuki K (2006) Dietary iron deficiency decreases serum osteocalcin concentration and bone mineral density in rats. Biosci Biotechnol Biochem 70(10):2547–2550CrossRef
12.
Zurück zum Zitat Parelman M, Stoecker B, Baker A, Medeiros D (2006) Iron restriction negatively affects bone in female rats and mineralization of hFOB osteoblast cells. Exp Biol Med (Maywood) 231(4):378–386 Parelman M, Stoecker B, Baker A, Medeiros D (2006) Iron restriction negatively affects bone in female rats and mineralization of hFOB osteoblast cells. Exp Biol Med (Maywood) 231(4):378–386
13.
Zurück zum Zitat Diaz-Castro J, Lopez-Frias MR, Campos MS, Lopez-Frias M, Alferez MJ, Nestares T, Ojeda ML, Lopez-Aliaga I (2011) Severe nutritional iron-deficiency anaemia has a negative effect on some bone turnover biomarkers in rats. Eur J Nutr. doi:10.1007/s00394-011-0212-5 Diaz-Castro J, Lopez-Frias MR, Campos MS, Lopez-Frias M, Alferez MJ, Nestares T, Ojeda ML, Lopez-Aliaga I (2011) Severe nutritional iron-deficiency anaemia has a negative effect on some bone turnover biomarkers in rats. Eur J Nutr. doi:10.​1007/​s00394-011-0212-5
14.
Zurück zum Zitat Ilich-Ernst JZ, McKenna AA, Badenhop NE, Clairmont AC, Andon MB, Nahhas RW, Goel P, Matkovic V (1998) Iron status, menarche, and calcium supplementation in adolescent girls. Am J Clin Nutr 68(4):880–887 Ilich-Ernst JZ, McKenna AA, Badenhop NE, Clairmont AC, Andon MB, Nahhas RW, Goel P, Matkovic V (1998) Iron status, menarche, and calcium supplementation in adolescent girls. Am J Clin Nutr 68(4):880–887
15.
Zurück zum Zitat D’Amelio P, Cristofaro MA, Tamone C, Morra E, Di Bella S, Isaia G, Grimaldi A, Gennero L, Gariboldi A, Ponzetto A, Pescarmona GP, Isaia GC (2008) Role of iron metabolism and oxidative damage in postmenopausal bone loss. Bone 43(6):1010–1015. doi:10.1016/j.bone.2008.08.107 CrossRef D’Amelio P, Cristofaro MA, Tamone C, Morra E, Di Bella S, Isaia G, Grimaldi A, Gennero L, Gariboldi A, Ponzetto A, Pescarmona GP, Isaia GC (2008) Role of iron metabolism and oxidative damage in postmenopausal bone loss. Bone 43(6):1010–1015. doi:10.​1016/​j.​bone.​2008.​08.​107 CrossRef
16.
Zurück zum Zitat Blanco-Rojo R, Perez-Granados AM, Toxqui L, Gonzalez-Vizcayno C, Delgado MA, Vaquero MP (2011) Efficacy of a microencapsulated iron pyrophosphate-fortified fruit juice: a randomised, double-blind, placebo-controlled study in Spanish iron-deficient women. Br J Nutr 105(11):1652–1659. doi:10.1017/S0007114510005490 CrossRef Blanco-Rojo R, Perez-Granados AM, Toxqui L, Gonzalez-Vizcayno C, Delgado MA, Vaquero MP (2011) Efficacy of a microencapsulated iron pyrophosphate-fortified fruit juice: a randomised, double-blind, placebo-controlled study in Spanish iron-deficient women. Br J Nutr 105(11):1652–1659. doi:10.​1017/​S000711451000549​0 CrossRef
17.
Zurück zum Zitat Institute of Medicine (2001) Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Food and Nutrition Board, Washington DC Institute of Medicine (2001) Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Food and Nutrition Board, Washington DC
18.
Zurück zum Zitat de Groot CP, van Staveren WA, Dirren H, Hautvast JG (1996) Summary and conclusions of the report on the second data collection period and longitudinal analyses of the SENECA study. Eur J Clin Nutr 50(Suppl 2):S123–S124 de Groot CP, van Staveren WA, Dirren H, Hautvast JG (1996) Summary and conclusions of the report on the second data collection period and longitudinal analyses of the SENECA study. Eur J Clin Nutr 50(Suppl 2):S123–S124
19.
Zurück zum Zitat Navas-Carretero S, Perez-Granados AM, Schoppen S, Vaquero MP (2009) An oily fish diet increases insulin sensitivity compared to a red meat diet in young iron-deficient women. Br J Nutr 102(4):546–553. doi:10.1017/S0007114509220794 CrossRef Navas-Carretero S, Perez-Granados AM, Schoppen S, Vaquero MP (2009) An oily fish diet increases insulin sensitivity compared to a red meat diet in young iron-deficient women. Br J Nutr 102(4):546–553. doi:10.​1017/​S000711450922079​4 CrossRef
20.
21.
Zurück zum Zitat Rodriguez Sangrador M, Beltran de Miguel B, Cuadrado Vives C, Moreiras Tuny O (2010) Influence of sun exposure and diet to the nutritional status of vitamin D in adolescent Spanish women: the five countries study (OPTIFORD Project)]. Nutr Hosp 25(5):755–762 Rodriguez Sangrador M, Beltran de Miguel B, Cuadrado Vives C, Moreiras Tuny O (2010) Influence of sun exposure and diet to the nutritional status of vitamin D in adolescent Spanish women: the five countries study (OPTIFORD Project)]. Nutr Hosp 25(5):755–762
22.
Zurück zum Zitat Groba MV, Miravalle A, Gonzalez Rodriguez E, García Santana S, Gonzalez Padilla E, Saavedra P, Soria A, Sosa M (2010) Factors related to vitamin D deficiency in medical students in Gran Canaria. Revista de Osteoporosis y Metabolismo Mineral 2:11–18 Groba MV, Miravalle A, Gonzalez Rodriguez E, García Santana S, Gonzalez Padilla E, Saavedra P, Soria A, Sosa M (2010) Factors related to vitamin D deficiency in medical students in Gran Canaria. Revista de Osteoporosis y Metabolismo Mineral 2:11–18
23.
Zurück zum Zitat Moreiras O, Carbajal A, Cabrera L, Cuadrado C (2011) Tablas de composición de alimentos. 15 ampliada y revisada edn Moreiras O, Carbajal A, Cabrera L, Cuadrado C (2011) Tablas de composición de alimentos. 15 ampliada y revisada edn
24.
Zurück zum Zitat Cuervo M, Corbalan M, Baladia E, Cabrerizo L, Formiguera X, Iglesias C, Lorenzo H, Polanco I, Quiles J, Romero de Avila MD, Russolillo G, Villarino A, Alfredo Martinez J (2009) Comparison of dietary reference intakes (DRI) between different countries of the European Union, The United States and the World Health Organization. Nutr Hosp 24(4):384–414 Cuervo M, Corbalan M, Baladia E, Cabrerizo L, Formiguera X, Iglesias C, Lorenzo H, Polanco I, Quiles J, Romero de Avila MD, Russolillo G, Villarino A, Alfredo Martinez J (2009) Comparison of dietary reference intakes (DRI) between different countries of the European Union, The United States and the World Health Organization. Nutr Hosp 24(4):384–414
25.
Zurück zum Zitat Navas-Carretero S, Perez-Granados AM, Schoppen S, Sarria B, Carbajal A, Vaquero MP (2009) Iron status biomarkers in iron deficient women consuming oily fish versus red meat diet. J Physiol Biochem 65(2):165–174CrossRef Navas-Carretero S, Perez-Granados AM, Schoppen S, Sarria B, Carbajal A, Vaquero MP (2009) Iron status biomarkers in iron deficient women consuming oily fish versus red meat diet. J Physiol Biochem 65(2):165–174CrossRef
26.
Zurück zum Zitat Blanco-Rojo R, Baeza-Richer C, Lopez-Parra AM, Perez-Granados AM, Brichs A, Bertoncini S, Buil A, Arroyo-Pardo E, Soria JM, Vaquero MP (2011) Four variants in transferrin and HFE genes as potential markers of iron deficiency anaemia risk: an association study in menstruating women. Nutr Metab (Lond) 8:69. doi:10.1186/1743-7075-8-69 CrossRef Blanco-Rojo R, Baeza-Richer C, Lopez-Parra AM, Perez-Granados AM, Brichs A, Bertoncini S, Buil A, Arroyo-Pardo E, Soria JM, Vaquero MP (2011) Four variants in transferrin and HFE genes as potential markers of iron deficiency anaemia risk: an association study in menstruating women. Nutr Metab (Lond) 8:69. doi:10.​1186/​1743-7075-8-69 CrossRef
27.
Zurück zum Zitat Toxqui L, De Piero A, Courtois V, Bastida S, Sanchez-Muniz FJ, Vaquero MP (2010) Iron deficiency and overload. Implications in oxidative stress and cardiovascular health. Nutr Hosp 25(3):350–365 Toxqui L, De Piero A, Courtois V, Bastida S, Sanchez-Muniz FJ, Vaquero MP (2010) Iron deficiency and overload. Implications in oxidative stress and cardiovascular health. Nutr Hosp 25(3):350–365
28.
Zurück zum Zitat Roman Vinas B, Ribas Barba L, Ngo J, Gurinovic M, Novakovic R, Cavelaars A, de Groot LC, Van’t Veer P, Matthys C, Serra Majem L (2011) Projected prevalence of inadequate nutrient intakes in Europe. Ann Nutr Metab 59(2–4):84–95. doi:10.1159/000332762 CrossRef Roman Vinas B, Ribas Barba L, Ngo J, Gurinovic M, Novakovic R, Cavelaars A, de Groot LC, Van’t Veer P, Matthys C, Serra Majem L (2011) Projected prevalence of inadequate nutrient intakes in Europe. Ann Nutr Metab 59(2–4):84–95. doi:10.​1159/​000332762 CrossRef
32.
Zurück zum Zitat Durham BH, Joseph F, Bailey LM, Fraser WD (2007) The association of circulating ferritin with serum concentrations of fibroblast growth factor-23 measured by three commercial assays. Ann Clin Biochem 44(Pt 5):463–466. doi:10.1258/000456307781646102 CrossRef Durham BH, Joseph F, Bailey LM, Fraser WD (2007) The association of circulating ferritin with serum concentrations of fibroblast growth factor-23 measured by three commercial assays. Ann Clin Biochem 44(Pt 5):463–466. doi:10.​1258/​0004563077816461​02 CrossRef
33.
Zurück zum Zitat Prie D, Friedlander G (2010) Reciprocal control of 1,25-dihydroxyvitamin D and FGF23 formation involving the FGF23/Klotho system. Clin J Am Soc Nephrol 5(9):1717–1722. doi:10.2215/CJN.02680310 CrossRef Prie D, Friedlander G (2010) Reciprocal control of 1,25-dihydroxyvitamin D and FGF23 formation involving the FGF23/Klotho system. Clin J Am Soc Nephrol 5(9):1717–1722. doi:10.​2215/​CJN.​02680310 CrossRef
34.
Zurück zum Zitat Imel EA, Peacock M, Gray AK, Padgett LR, Hui SL, Econs MJ (2011) Iron modifies plasma FGF23 differently in autosomal dominant hypophosphatemic rickets and healthy humans. J Clin Endocrinol Metab 96(11):3541–3549. doi:10.1210/jc.2011-1239 CrossRef Imel EA, Peacock M, Gray AK, Padgett LR, Hui SL, Econs MJ (2011) Iron modifies plasma FGF23 differently in autosomal dominant hypophosphatemic rickets and healthy humans. J Clin Endocrinol Metab 96(11):3541–3549. doi:10.​1210/​jc.​2011-1239 CrossRef
35.
Zurück zum Zitat Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22(4):477–501CrossRef Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22(4):477–501CrossRef
36.
Zurück zum Zitat Alcoba LM, Cabeza B, Castaño-Milla C, Castaño de la Mota MJ, Matías MJ, Sanchez-Pernaute O, de la Piedra C (2006) Patrón clínico y bioquímico de los pacientes con elevación de la hormona paratiroidea (PTH) en una cohorte de 103 casos de osteoporosis. Revista española de enfermedades metabolicas oseas 15:115 Alcoba LM, Cabeza B, Castaño-Milla C, Castaño de la Mota MJ, Matías MJ, Sanchez-Pernaute O, de la Piedra C (2006) Patrón clínico y bioquímico de los pacientes con elevación de la hormona paratiroidea (PTH) en una cohorte de 103 casos de osteoporosis. Revista española de enfermedades metabolicas oseas 15:115
37.
Zurück zum Zitat Hollis BW (2005) Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D. J Nutr 135(2):317–322 Hollis BW (2005) Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D. J Nutr 135(2):317–322
38.
Zurück zum Zitat Ahijado P, Rubert M, Zazo P, Mahillo I, de la Piedra C (2010) Hiperparatiroidismo secundario asociado a un déficit de vitamina D. Revista de Osteoporosis y Metabolismo Mineral 2:16 Ahijado P, Rubert M, Zazo P, Mahillo I, de la Piedra C (2010) Hiperparatiroidismo secundario asociado a un déficit de vitamina D. Revista de Osteoporosis y Metabolismo Mineral 2:16
39.
Zurück zum Zitat Gonzalez-Padilla E, Soria Lopez A, Gonzalez-Rodriguez E, Garcia-Santana S, Mirallave-Pescador A, Groba Marco Mdel V, Saavedra P, Quesada Gomez JM, Sosa Henriquez M (2011) High prevalence of hypovitaminosis D in medical students in Gran Canaria, Canary Islands (Spain). Endocrinol Nutr 58(6):267–273. doi:10.1016/j.endonu.2011.03.002 CrossRef Gonzalez-Padilla E, Soria Lopez A, Gonzalez-Rodriguez E, Garcia-Santana S, Mirallave-Pescador A, Groba Marco Mdel V, Saavedra P, Quesada Gomez JM, Sosa Henriquez M (2011) High prevalence of hypovitaminosis D in medical students in Gran Canaria, Canary Islands (Spain). Endocrinol Nutr 58(6):267–273. doi:10.​1016/​j.​endonu.​2011.​03.​002 CrossRef
41.
Zurück zum Zitat Gonzalez-Molero I, Morcillo S, Valdes S, Perez-Valero V, Botas P, Delgado E, Hernandez D, Olveira G, Rojo G, Gutierrez-Repiso C, Rubio-Martin E, Menendez E, Soriguer F (2011) Vitamin D deficiency in Spain: a population-based cohort study. Eur J Clin Nutr 65(3):321–328. doi:10.1038/ejcn.2010.265 CrossRef Gonzalez-Molero I, Morcillo S, Valdes S, Perez-Valero V, Botas P, Delgado E, Hernandez D, Olveira G, Rojo G, Gutierrez-Repiso C, Rubio-Martin E, Menendez E, Soriguer F (2011) Vitamin D deficiency in Spain: a population-based cohort study. Eur J Clin Nutr 65(3):321–328. doi:10.​1038/​ejcn.​2010.​265 CrossRef
43.
44.
Zurück zum Zitat Del Campo MT, Gonzalez-Casaus ML, Aguado P, Bernad M, Carrera F, Martinez ME (1999) Effects of age, menopause and osteoporosis on free, peptide-bound and total pyridinium crosslink excretion. Osteoporos Int 9(5):449–454CrossRef Del Campo MT, Gonzalez-Casaus ML, Aguado P, Bernad M, Carrera F, Martinez ME (1999) Effects of age, menopause and osteoporosis on free, peptide-bound and total pyridinium crosslink excretion. Osteoporos Int 9(5):449–454CrossRef
45.
Zurück zum Zitat Rojas-Rivera J, De La Piedra C, Ramos A, Ortiz A, Egido J (2010) The expanding spectrum of biological actions of vitamin D. Nephrol Dial Transplant 25(9):2850–2865. doi:10.1093/ndt/gfq313 CrossRef Rojas-Rivera J, De La Piedra C, Ramos A, Ortiz A, Egido J (2010) The expanding spectrum of biological actions of vitamin D. Nephrol Dial Transplant 25(9):2850–2865. doi:10.​1093/​ndt/​gfq313 CrossRef
46.
Zurück zum Zitat Hewison M, Burke F, Evans KN, Lammas DA, Sansom DM, Liu P, Modlin RL, Adams JS (2007) Extra-renal 25-hydroxyvitamin D3-1alpha-hydroxylase in human health and disease. J Steroid Biochem Mol Biol 103(3–5):316–321. doi:10.1016/j.jsbmb.2006.12.078 CrossRef Hewison M, Burke F, Evans KN, Lammas DA, Sansom DM, Liu P, Modlin RL, Adams JS (2007) Extra-renal 25-hydroxyvitamin D3-1alpha-hydroxylase in human health and disease. J Steroid Biochem Mol Biol 103(3–5):316–321. doi:10.​1016/​j.​jsbmb.​2006.​12.​078 CrossRef
47.
Zurück zum Zitat Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, Ochoa MT, Schauber J, Wu K, Meinken C, Kamen DL, Wagner M, Bals R, Steinmeyer A, Zugel U, Gallo RL, Eisenberg D, Hewison M, Hollis BW, Adams JS, Bloom BR, Modlin RL (2006) Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 311(5768):1770–1773. doi:10.1126/science.1123933 CrossRef Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, Ochoa MT, Schauber J, Wu K, Meinken C, Kamen DL, Wagner M, Bals R, Steinmeyer A, Zugel U, Gallo RL, Eisenberg D, Hewison M, Hollis BW, Adams JS, Bloom BR, Modlin RL (2006) Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 311(5768):1770–1773. doi:10.​1126/​science.​1123933 CrossRef
Metadaten
Titel
Relationship between vitamin D deficiency, bone remodelling and iron status in iron-deficient young women consuming an iron-fortified food
verfasst von
Ruth Blanco-Rojo
Ana M. Pérez-Granados
Laura Toxqui
Pilar Zazo
Concepción de la Piedra
M. Pilar Vaquero
Publikationsdatum
01.03.2013
Verlag
Springer-Verlag
Erschienen in
European Journal of Nutrition / Ausgabe 2/2013
Print ISSN: 1436-6207
Elektronische ISSN: 1436-6215
DOI
https://doi.org/10.1007/s00394-012-0375-8

Weitere Artikel der Ausgabe 2/2013

European Journal of Nutrition 2/2013 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.