Herbal Appetizer for Children with Failure to Thrive (FTT)

18 Pages·2017·0.61 MB·English

http:// ijp.mums.ac.ir
Review Article (Pages: 6203-6220)

Herbal Appetizer for Children with Failure to Thrive (FTT) in
View of Traditional Persian Medicine: A Review
Roghayeh Javan1, Akram Kooshki2, Monavvar Afzalaghaee3, Mitra Aldaghi4, Sadegh
Shokri5, Hamideh Naghedi Baghdar1, Elaheh Delshad1, *Mahdi Yousefi61
1Student Research Committee, Faculty of Persian and Complementary Medicine, Mashhad University of
Medical Sciences, Mashhad, Iran. 2Ph.D of Nutrition, Associate Professor, Department of Nutrition and
Biochemistry, Faculty Member of Medicine School, Sabzevar University of Medical Sciences, Sabzevar, Iran.
3Assistant Professor, Department of Community Medicine, Mashhad University of Medical Sciences, Mashhad,
Iran. 4Assistant Professor, Department of Pediatrics, Sabzevar University of Medical Sciences, Sabzevar, Iran.
5Ph.D of Persian Medicine, Faculty of Persian and Complementary Medicine, Mashhad University of Medical
Sciences, Mashhad, Iran. 6Assistant Professor, Depatrment of Persian Medicine, Faculty of Persian and
Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract
Background
Failure to thrive (FTT) is a condition of poor weight gain in early childhood. Low appetite
which is associated with FTT interacts with increasing caloric intake as the main treatment
for FTT. Phytochemicals in herbal remedies could alter appetite more than the expected
effects of other nutrients. This review aimed to assess the effective and safe herbal appetizer
for children with FTT according to Traditional Persian Medicine (TPM).

Materials and Methods
By searching through major pharmaceutical books of Persian medicine during 8th -18th centuries
(A.D.), herbal remedies as appetizer were determined. We searched the phytochemical and
pharmacological activities of these herbs in PubMed, Scopus, Web of Sciences and Google scholar
databases, from 1950 to 15 December 2016.
Results
Overall, 42 herbs were found. Among these herbs, only 11 herbs were prescription for
children. Improvement of feed intake, growth performance, weight gain and gastro-
esophageal protection were the most reported activities.

Conclusion
Natural remedies prepared from these herbs may be useful for enhancing appetite especially for FTT
in children. Additional well-designed studies are required to investigate the safety and efficacy of
these herbs.
Key Words: Appetite, Children, Herbal Medicine, Failure to Thrive, Persian Medicine, Traditional.

*Please cite this article as: Javan R, kooshki A, Afzalaghaee M, Aldaghi M, Shokri S, Naghedi Baghdar H, et al.
Herbal Appetizer for Children with Failure to Thrive in View of Traditional Persian Medicine: A Review. Int J
Pediatr 2017; 5(12): 6203-20. DOI: 10.22038/ijp.2017.23777.2012

Corresponding Author:
Dr. Mahdi Yousefi, Address: Department of Persian Medicine, Faculty of Persian and Complementary
Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Email: [email protected]
Received date: Jul.29, 2017; Accepted date: Aug. 22, 2017
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Herbal Appetizer for FTT in Children
1- INTRODUCTION medicine literatures on the basis of new
researches.
Failure to thrive (FTT) is a condition
of poor weight gain and growth of any age,
2- MATERIALS AND METHODS
especially in infancy and early childhood
(1). FTT exists in all socioeconomic The main books of TPM and herbs
groups with the relative priority incidence advised for increasing appetite were
in lower income communities (2). As a selected according to the following
result of negative effects of FTT on criteria:
children in terms of a long-term sequel of
 Author’s reputation,
developmental delay, micronutrient
 Historical coverage (a thousand year
deficiencies, and suboptimal linear growth,
ranging from about 800 to 1800 A.D),
it is noticeably important to treat these
deficiencies (3-6). Majority of cases  R e p e t i t i o n o f h e r b a l a d m i n i s t ration (at
secondary to inadequate nutrition whether least in two textbooks).
medical, or psychosocial problems lead to
FTT (7). According to parent’s reports, According to these criteria, the following
20% of children showed eating disorders books were selected: Al-Hawi fi al-tibb
during childhood (8). Although increasing (The Liber Continents) by Rhazes (865-
caloric intake is the main treatment for 925 A.D.), Al-Qanun fi'l-Tibb (The Canon
FTT, low appetite associated with FTT of Medicine) by Avicenna (980-1037
interacts with this treatment (9, 10). A.D.), al-Abniah 'an Haqaeq al Adwia by
Majority of studies demonstrate the Abu Mansur Movafaq ibn Ali al-Heravi
effectiveness of the intervention in terms (10th century)', Tuhfeh-ye Hakim Mu’min
of applied behavior analysis in treatment by Mir Muhammad Mu’min Husaini
of feeding disorders (11, 12). Tonekaboni (1669 AD), known as Hakim
Mu’min and Makhzan-Al-Advie by Aghili
Cyproheptadine has been used for
Khorasani (1772 AD). Shahvat (which
improving feeding behaviors and weight
means appetite) and Moshahhee (which
gain. This drug has its own side effects
means appetizer) were the specific main
(13). It is believed that herbal medicines
key words used for searching herbs in
are relatively safer and have fewer side
traditional textbooks (19-23).
effects than other medicines (14). In recent
years, there has been an increasing The next step was designed for evaluating
tendency through using herbal the safety of these herbs in children
supplements in diseases all over the world according to new herbal books and
(15). The use of herbal medicines is also electronic databases. The other search was
common in children (16, 17). performed using electronic databases
Phytochemicals that are found in herbal including PubMed, Scopus, from 1900 to
remedies could alter appetite beyond the 15 December 2016 to find any in vitro,
expected effects of other nutrients (18). animal or clinical evidence for the efficacy
Many herbs have been introduced in of each of these herbs and the relevant
Traditional Persian Medicine (TPM) for pharmacological activities supporting their
enhancing appetite and maybe useful for effectiveness in appetite enhancing. The
children with FTT. Mechanisms of action search keywords used included scientific
for some of these plants are known. This or common name of each plant with
study was conducted to extract the "appetite", "ghrelin", " neuropeptide Y",
traditional herbal appetizers from Persian "growth", "weight", "leptin", "serotonin",
"gut hormones", "nesfatin-1", "Vaspin",
Int J Pediatr, Vol.5, N.12, Serial No.48, Dec. 2017 6204
Javan et al.
"apelin", "visfatin", and "cholecystokinin". hypothalamus regulates food intake and
Language restriction was performed, and energy expenditure with two populations
only studies in Persian or English of neurons that show an opposite effect
languages were considered in this study. (stimulant or inhibitor) to one another. The
medial parts contain orexigenic neurons
3- RESULTS that act as orexigenic neurons that express
neuropeptide Y (NPY), and agouti-related
3-1. Appetite mechanism in
protein (AgRP). The lateral side of ARC
conventional medicine
act as anorexigenic neurons that express
Appetite regulation includes two alpha-melanocyte-stimulating hormone (α-
components: homeostatic which shows MSH) derived from Pro-opiomelanocortin
daily energy requirement for sustaining (POMC), and cocaine and amphetamine-
bodily functions and hedonic which means regulated transcript (CART) (Figure.1)
pleasures and desires for food (24). The (25, 26).
arcuate nucleus (ARC) in the

Fig.1: Changes in appetite and food intake by stimulant or inhibitor signals.

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Herbal Appetizer for FTT in Children
Moreover, neuronal circuits, circulating the most dominant element existing in its
gastrointestinal and adipocyte hormones structure (43, 44). The temperament has an
are involved in this regulation (27). important role in maintaining the ideal
Information signals from peripheral organs healthy state of an individual.
are sent to the hypothalamus by vagal Dystemperament in humans result from
afferent pathway and circulation (28). imbalances in healthy temperament, and
Ghrelin is a stimulating appetite hormone, may lead to organ dysfunction and disease.
predominantly found in the stomach (29, Humor is a biochemical composition
30). Ghrelin also carries out other func- originating from disposition of foodstuffs
tions such as regulation of growth in stomach towards liver and blood vessels
hormone (GH), gastric acid secretion, and (45). Four natural humors in the body are
gut motility (31-33). Increase in food related by pairs of qualities: Sanguine is
intake has been shown in obese and lean hot and wet, bile is hot and dry, phlegm is
subjects after intravenous administration of cold and wet and melancholy is cold and
ghrelin (34), while other gut peptides such dry (46). In TPM, having an appropriate
as peptide YY, cholecystokinin, appetite is considered as a sign of health.
oxyntomodulin (OXM), and glucagon-like The main organs which are involved in
peptide-1 (GLP-1) have a reducing role on this regulation are stomach, liver and
appetite pathway (35-37). Visceral adipose brain. Every dystemperament in whole
tissue has an endocrine function, with the body or in these organs may lead to loss of
secretion of many adipokines such as appetite. In most cases, hot
leptin, and adiponectin (38). dystemperament in the heart or excess cold
dystemperament in whole stomach is the
Leptin has an ability to reduce appetite and
main responsibility in the loss of appetite.
body weight in lean as well as obese rats
Cold weather can enhance the appetite in
(39). Leptin serum levels increased in a
contrast to hot weather. Melancholy is
BMI-dependent manner in patients with
increased in the stomach when an
anorexia nervosa (AN) after refeeding
individual is in a state of hunger. Fundus is
(40). Vaspin, a new adipokine, have shown
sensitive to melancholy, so this humor can
higher levels in serum of girls with
stimulate the appetite. This sensation may
restrictive anorexia nervosa compared to
be lost because of brain disorders or neural
the control group (41). Other adipokines
involvement. Melancholy is considered as
such as visfatin and apelin had lower
a sour taste. Sleep and mood affect the
levels in underweight children compared
appetite (22, 47).
to normal group and should be considered
in the etiology of anorexia (42). 3-3. Herbal appetizers in TPM
3-2. Appetite mechanism in TPM The most common plants which have been
recommended by TPM to enhance appetite
According to Traditional Persian
are shown in Table.1. Forty two herbs
Medicine, existence is formed by four
were known as appetite enhancing herbs
groups of elements, which are
with majority of were from Lamiaceae
symbolically named fire, air, water, and
followed by Rosaceae and Apiaceae. Only
earth. Every element has its specific
sumac and citron were mentioned as
quality for example, fire is hot and dry, air
appetite enhancers in all 5 main TPM
is hot and moist, water is cold and moist,
texts. Other herbs such as peach, apple,
and soil is cold and dry. The combination
quince, olive, lettuce, radish, mastic, onion
of these elements with different ratios
were followed as more cited herbs in these
makes the temperament. So every being
texts and most of these plants were not
has its own quality which is dependent on
considered as healthy in children. There is
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Javan et al.
no available data on the safety of many divided into four groups and experimental
herbs in children. However, a search on diets (non-medicated diets containing 0.3
pediatrics herbal books, herbal or 0.5% onion extract), or fed control diets
monographs, resources and databases (non-medicated commercial diet or
showed that 11 herbs including apple, medicated antibiotics) for 5 weeks. Weight
quince, olive, peppermint, mint, chickpea, gain of the group fed by non-medicated
lettuce, radish, coriander, flixweed and control diet was lower than those fed by
onion were identified as safe for children medicated control group. Weight gain of
(Table.1). Although wormwood is advised broiler chicks fed with 0.3 or 0.5% onion
for enhancing appetite in children through extract was as similar as medicated control
phytotherapy in paediatric books and group (68).
widely used in many countries; the
3-3-2. Coriandrum sativum L.
European Medicines Agency (EMA) does
not recommend the use for children due to Coriander has been widely used for the
lack of sufficient data (59). There are few treatment of different disorders such as
studies on the therapeutic effects of these loss of appetite, insomnia, vertigo, airways
herbs on appetite enhancing. We could not and digestive disorders. In TPM, it is
find randomized clinical trials about considered as a tonic for stomach, heart
orexigenic pathway for them. Hence, other and brain (19, 23). Coriander is prescribed
positive effects on gastrointestinal organs for enhancing appetite in children in recent
and weight gain were considered. These books (50). Various cases have reported
findings are presented in Table.2 (please the allergenicity of coriander (80, 81).
see the tables 1 and 2 in the end of paper). Sensitivity to the Apiaceae family
(coriander, caraway, fennel, celery) of
3-3-1. Allium cepa L.
spices was reported to be high following
Onion, a species of the genus Allium, is
skin prick tests in children (< 15 years
probably native of south west Asia (76).
old), and adults (82). According to
According to TPM, onion is a herbal
European Food Safety Authority (EFSA),
appetizer which has tonic effect on
"coriander seed oil" as a novel food
digestive system (19). Onion possesses
ingredient (NFI) is not aimed towards
noticeable health beneficial substances
children (83). The main bioactive
such as the flavonoid (mainly quercetin).
compounds present in coriander are lipids
Quercetin may protect against
(containing fatty acids, sterols, and tocols),
cardiovascular disease, and cancer (77).
polyphenols and essential oils (84). Many
Organosulfur compounds have been
studies have shown the medicinal effects
associated with anthelmintic, antiseptic
of coriander as a sedative-hypnotic,
and hypoglycemic effects of onion (76).
antioxidant, anxiolytic, analgesic, and
These compounds have been linked to
anticonvulsant, gut modulatory, and
lowering of cholesterol levels and blood
diuretic herb (85-88).
pressure (78). High levels of antioxidant
Nematy et al. investigated the effect of
compounds (polyphenolics) in onion have
Coriandrum sativum (coriander)
protective effects against different
hydroalcoholic extract on rat appetite.
degenerative agents (79).
They divided thirty male wistar rats
Onion has been used in animal feed as
randomly into five groups. One of the two
digestion stimulants and growth
control groups received 0.5 ml of water per
promoters. An et al. investigated the
day (vehicle group), the other one did not
effects of onion extract on growth
receive anything (control group). The other
performance of broilers. Chicks were
3 groups were treated daily with 50, 100 or
Int J Pediatr, Vol.5, N.12, Serial No.48, Dec. 2017 6207
Herbal Appetizer for FTT in Children
150 mg/kg of coriander for 7 days. There Mint is a well-known herb in TPM. Tonic
was a significant change in energy intake effect of spearmint on stomach and
after treatment by 100 and 150 mg/kg of reducing stomach bloating has been
the extract in comparison to other groups. mentioned in TPM in terms of useful
This study indicated that coriander had consequences on nausea, vomiting, hiccup
positive effects on appetite of rats (69). and belch. Spearmint, especially with
pomegranate, considerably enhances
3-3-3. Artemisia absinthium L.
appetite (22, 23). The aromatic herbs of
Wormwood is considered as a tonic for the "mint" group include taxa of the
stomach, liver and whole body and used as Lamiaceae family. All of them have rich
an anti-helminthic in TPM. It is essential oils in p-menthane compounds
administrated for enhancing appetite and (95). Mint is mostly taken after a meal due
stomach ache (22, 23). Several trials to its ability to reduce indigestion and
demonstrated the advantageous effects of intestinal spasms by reducing the
wormwood for the treatment of many gastrocholic reflux (96). M. spicata
diseases condition such as lead exposure, possesses several biological activities such
inflammatory periodontal disease, Crohn’s as antimicrobial and antioxidant activities
disease (89-91). Wormwood has as well as being quite rich in phenolic
phytochemicals such as phenolic and components (97, 98). In an animal study,
flavonoids compounds. These compounds impact of different levels of spearmint was
may contribute to its anti-oxidative activity investigated on performance in broiler
(92). Thujone, a bicyclic ketone terpene, is diets. Birds were fed with four levels of
a major active ingredient of wormwood spearmint of 0, 1, 1.5, and 2%. Average
which was blamed for his side effects such feed intakes obtained from the experiment
as seizures. Risk assessment of Thujone in were 2680.20, 2679.11, and 2708.55,
foods and medicines showed that there is respectively. Nevertheless, the body
no risk associated with the occasional weight gains for the treatments were
medicinal use of wormwood or sage (93, 1481.63, 1512.81, 1519.57, and 1519.63,
94). Although wormwood is indicated for 0, 1, 1.5 and 2, respectively. As a result of
appetite in Pediatric Phytotherapy hand feed intake, there is body weight gain of
book, the European Medicines Agency broiler which is enhanced by the
(EMA) did not recommend the use for supplementation of different levels of
children under 18 years of age (50, 59). spearmint to the diets (71). Khurshid et al.
Taraghdari et al. investigated orexigenic investigated the effect of peppermint on
effect of Artemisia absinthium in rats. Rats performance in broiler diets in five groups.
were randomly divided into five groups. Group (T1) is considered as control,
Control group did not receive anything and without additives in diets whereas T2 and
Vehicle group received0.5 ml of water per T3 were fed with raw mint leaves 1% (T2),
day. All 3 remaining groups received 50, and 2% (T3). In T4 and T5, enzyme
100 and 150 ml of wormwood. The results treated mint leaves, 1 and 2% were added
showed that in comparison to the control to the basal diet. In comparison to control
group, there were no significant (p>0.05) group, birds that received diet
differences in energy intake (receive) supplemented with either raw and enzyme
before and during intervention between treated mint leaves gained significantly
three case groups. In this study, data (p<0.05) higher live body weight. There
showed ineffective and dose-related result was a significant (p<0.05) improvement in
of wormwood on appetite of rats (70). cumulative feed conversion ratio in all the
treatment groups when compared with the
3-3-4. Mentha spicata L.
control (99).
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Javan et al.
3-3-5. Olea europeae damage (72). Gastroprotective activity of
Hypericum perforatum L. maceration in
The Olive tree is a native of the
three: oils sunflower (E1), olive (E2), and
Mediterranean basin and parts of Asia and
palm oil (E3), was evaluated by using
now it is widely cultivated in many other
cold-restraint stress (CRS) induced rat
parts of the world (10). According to TPM,
gastric mucosa lesions test. Contrary to the
olive is considered as a tonic for stomach
lowest quercetin content, HPE prepared
and enhancing appetite when used during
with olive oil (E2) showed the highest
meals (23). The presence of high content
protection against gastric damaging action
of monounsaturated fatty acid (MUFAs),
of CRS (73).
and functional bioactives including
carotenoids, phospholipids, tocopherols,
3-3-6. Cydonia oblonga Mill
and phenolics, with multiple biological
Quince as a fruit has been used in TPM to
activities in olive oil are the main reasons
increase appetite. According to TPM, it
ascribed to the health benefits of olive oil
has tonic effects on stomach, brain and
(101, 102). Olive fruit contains hydrophilic
heart, and may be useful in liver weakness
(phenolic acids, phenolic alcohols,
(23). The quince is a native of Iran, and
flavonoids and secoiridoids), and
Turkey, but it is now found in other places
lipophilic (cresols) phenolic compounds
(104). Quince has significant health
that are known to possess multiple
promoting values and activities, including
biological activities such as
phenolic composition, antioxidant
anticarcinogenic, antioxidant,
capacity, anti-inflammatory, anti-allergic,
antimicrobial, anti-inflammatory, anti-
anti-microbial, anti-carcinogenic, anti-
dyslipidemia, anti-hypertensive,
ulcerative, and it might also act as a tonic
cardiotonic, laxative, and antiplatelet.
for brain and heart (106). It is an
Pectin, organic acids, and pigments are
appropriate source of vitamin C and
other important compounds present in
minerals especially calcium, magnesium,
olive fruit (103).
potassium, and phosphorus. Moreover,
Olive leaf extract shows gastro-protective
quince contains organic acids, sugars, and
activities against experimentally induced
fatty acids. Quince is considered as a
gastric lesions by absolute ethanol in mice.
suitable source of polyphenols due to the
Administration of 40, 80, and 120 mg/kg
high intensity of astringency and bitterness
olive leaf had similar protective effect to
of this fruit even at ripening stage (106).
reference drug ranitidine given to the
Aqueous ethanol extracts of quince fruit
positive control at a dose of 50 mg/kg,
have been shown to exhibit anti-
intragastrically (104). Odabasoglu et al.
Helicobacter pylori activity (108, 109).
evaluated the effects of vegetable oils
Tansaz et al. evaluated the anti-gastro-
(corn, olive and sunflower oils), and alpha-
esophageal reflux effect of Cydonial
tocopherol on anti-inflammatory, and
oblonga Mill fruit extract in a pilot study.
gastrointestinal profiles of indomethacin in
After one month administration of quince
rats. Indomethacin given with sunflower,
extract to 5 infants with reflux and without
corn, and olive oils reduced paw edema
any response to routine management, four
induced by carrageenan by 79.5, 74.0, and
of them had significant changes in the
60.5%, whereas individual indomethacin
symptoms of reflux including vomiting,
and diclofenac reduced paw edema by
cough, agitation and low appetite. They
56.2, and 50.7%, respectively. These oils
concluded that because of the astringent
and alpha-tocopherol effectively improved
property of quince, it can reinforce the
the levels of antioxidant defense systems
sphincter and inhibit the reflux (74).
in rat stomach tissues against oxidative
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Herbal Appetizer for FTT in Children
Zohalinezhad et al. evaluated the efficacy However, there are few studies that have
of quince syrup in pediatrics with evaluated the effects of herbal extracts on
symptomatic gastro-esophageal reflux appetite (112). The current study
disease. In this study, symptoms were conducted a scientific evaluation to find
reduced in quince compared to control the relevant pharmacological activities
group (receiving omeprazole), but no supporting the effectiveness of TPM-
significant differences were found between recommended plants on appetite
two groups (65). enhancing. In TPM, having appropriate
feeding behaviors are considered as
3-3-7. Malus domestica Borkh.
nutritional orders for everyone. Central
Apple is a well-known fruit in TPM with Nervous System (CNS) has a main role in
many beneficial effects on main organs appetite and any disturbance.
such as heart, brain, liver, and stomach.
Hence, behavioral therapy and emotional
Apple with astringent effect on the heart
control are the first step in the treatment of
helps the stomach and enhances appetite
appetite disease according to TPM
(18). Polyphenols which are found in apple
scholars. Recent researches mentioned the
have a wide range of biological activities
role of many G protein coupled receptors
with a role in prevention of chronic
(GPCRs) in the oral cavity and
diseases (75). Flavonoids, a major class of
gastrointestinal tract acting as taste
phytochemicals found commonly in apple,
receptors. The gastrointestinal tract can
have an inverse relationship with coronary
sense basic tastes in the same manner with
mortality in women (110).
the tongue in most cases. In health, these
Current data suggest that apple might be receptors control the secretion of gut
linked to reduced risk of many diseases hormones and the expression of nutrient
such as lung cancer, asthma and transporters to maintain energy and
cardiovascular disease. Apple may also glucose homeostasis and gastrointestinal
influence outcomes related to diabetes, function through sense nutrients from a
bone health, Alzheimer’s disease, luminal and then transmit them as well;
cognitive decline of normal aging, weight any disturbances or adaptations in the
management, and gastrointestinal expression or sensitivity of these taste
protection from drug injury (111). receptors and their signaling pathways in
Carrasco-Pozo et al. evaluated the disease may affect digestive behavior and
protective effect of apple peel polyphenol metabolism. Evidences suggest that bitter
extract (APPE) against gastrointestinal agonists could be considered as suitable
damage in rats treated with indomethacin. targets to reduce hunger and motility
An increase in malondialdehyde (113). The identity of the sour taste sensor
concentrations and decrease in the ratio of is still unknown (114).
reduced glutathione (GSH) to oxidized
According to TPM, sour taste helps to
glutathione (GSSG) following
create a good appetite. Studies for
administration of APPE protected the
evaluating relationship between sour taste
gastric, intestinal, and colonic mucosa
receptors and ghrelin or other signaling
from oxidative stress. APPE also showed
hormones, in future are advisable. This
anti-inflammatory effects as evidenced by
study had a clear limitation which was not
the lower myeloperoxidase activity (75).
considering all of the related literature in
other foreign languages and unpublished
4- DISCUSSION
data. Despite the widespread use of
Medical help is often favorable for medicinal herbs, their administration is
children with poor appetite and growth. doubtful because of insufficient studies
Int J Pediatr, Vol.5, N.12, Serial No.48, Dec. 2017 6210
Javan et al.
about safety and drug interactions 5. ud Din Z, Emmett P, Steer C, Emond A.
especially in children. Further studies are Growth outcomes of weight faltering in
required to make a decision about the infancy in ALSPAC. Pediatrics.
2013;131(3):e843-e9.
helpfulness and safety of these herbs.
6. Saeidi M, Vakili R, Khakshour A,
5- CONCLUSIONS Taghizade Moghaddam H, Kiani MA, Zarif B,
et al. Iron and multivitamin supplements in
Appetite enhancing natural medicines
children and its association with growth rate.
with repeated traditional reports may be
International Journal of Pediatrics. 2013;
appropriate sources of new drug discovery.
1(1):13-17.
These natural medicines may introduce
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Ferri's Netter Patient Advisor: With Online
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2016;37(4):314-21.
The authors have no conflict of interest to
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declare. faltering and failure to thrive in infancy and
early childhood. B M J. 2012;345:e5931.
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This study is a part of the Ph.D. Faltering Pediatric gastrointestinal and liver
dissertation and is supported and funded disease. Elsevier Health Sciences; 2016. pp.
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