By Melissa Kvidahl Reilly, Contributing Writer 05.01.20
Though better-for-you and wellness trends are transforming consumers’ eating habits, research from Mintel shows there’s still a long way to go. Overall, the market insights firm found just one in three survey respondents thinks their diet is healthy, and only one in five is actively seeking and buying products with added health claims. When it comes to fiber, only 30% of consumers say they make it a point to eat naturally fiber-rich foods, and 27% of respondents think food with added fiber doesn’t taste that great.
“Before processed foods, people routinely consumed 35-50 grams of resistant starch each and every day, which ferments slowly over a long period of time and is easily tolerated without producing a lot of gas or digestive complaints,” said Rhonda Witwer, executive director of Resistant Starch Research. She also pointed out that today’s processed diet yields just 5-6 grams of resistant starch daily on average.
“In other words, we have shifted our carbohydrate digestion from feeding the intestinal microbiome to high glycemic foods that rapidly break down in the small intestines and trigger high insulin levels, contributing to epidemic levels of obesity, diabetes, heart disease, and cancer,” Witwer said.
Indeed, the American consumer needs a wake up call when it comes to fiber. Mintel found that 22% of consumers don’t know enough about fiber to know if it’s important to their health, and 37% believe they can get enough of the nutrient from their daily diets, despite evidence to the contrary.
“Across categories of food and beverage, there is room for improvement when it comes to brand positioning and consumer education around the varied benefits of functional fiber,” said Greg Dodson, vice president of fiber at ADM, citing company research that 33% of consumers don’t know which products to turn to for fiber.
Plus, brands face an additional hurdle: many consumers think added fiber can actually cause digestive distress. ADM research showed that nearly 70% of consumers would not purchase a product again if they thought it caused them digestive upset. “Many consumers are aware that fiber plays a role in regularity and digestion, but few have a well-rounded understanding of the various ways it can be beneficial for holistic health and wellness,” said Dodson.
That said, fiber is slowly but surely getting back onto consumers’ radars, as overall trends toward holistic wellness nudge it along. “Rather than waiting until there is an issue to seek help, consumers become more aware of the value of proactive health and developing lifestyles that center around proper diets and exercise,” said Rob Brewster, president of Ingredients By Nature.
ADM research showed 62% of consumers seek out fiber in food and beverages, representing a 6% increase between 2013 and 2019; and 52% are motivated to do so in pursuit of better digestive health.
As a result, the fiber market is on the rise. According to SPINS, the market has grown 7.3% in sales in the 52 weeks ending Mar. 22, 2020, led by high-performing ingredients like psyllium, which grew 8.6% to reach a $228 million market, and acacia, which represents a nearly $2 million market.
Looking forward at years to come, fiber’s blood sugar benefits may launch the category’s popularity past that of today’s booming gluten-free market. “While a minority of consumers require gluten-free foods, half of American adults need to manage their blood sugar levels more closely,” Witwer said. “Removing high glycemic carbohydrates from the diet helps people to effectively manage their blood glucose levels and effectively lower insulin levels.”
Indeed, the need for glycemic management is reflected in the Centers for Disease Control and Prevention 2020 National Diabetes Statistics Report, which showed more than one in 10 Americans has diabetes and one in three has prediabetes.
“A large challenge is negative public perception of carbs,” said Brewster. “Fiber is a type of carbohydrate that the body can’t digest and, unfortunately, there are a lot of diets out there that push for an abstention of carbs whether they’re ‘good’ or ‘bad.’ When formulating and selling fiber products, developers need to provide a product with added value to show the overall benefit of including this necessary carb.” Increasingly, that solution takes the shape of natural ingredients with recognizable names and clean label attributes.
Natural Solutions
“During the past two years, we’ve seen new fibers appear on the market like monk fruit and citrus fiber,” noted Julie Imperato, marketing manager at Nexira. “This reflects the consumer need for natural and clean ingredients they can recognize easily on product labels.”
Fibersol dietary fiber from ADM is one solution for products where a clean label and optimal digestive comfort are necessary. “Unlike some fiber ingredients, Fibersol is well tolerated,” explained Dodson. “This is because Fibersol is fermented in the colon at a slower rate compared to other soluble fibers such as inulin or fructooligosaccharides, which helps minimize gastric distress.” It’s recognized as a low FODMAP ingredient by Monash University, he added, “a designation reserved for foods and ingredients that have been shown not to aggravate the gut or cause irritable bowel syndrome (IBS) symptoms like intestinal bloating and digestive discomfort.” For a cleaner label, the ingredient can be listed as soluble corn fiber.
At Nexira, inavea pure acacia is another clean label solution. It’s an all-natural, non-GMO and organic non-digestible polysaccharide sourced from acacia trees, and is appropriate as a prebiotic to target gut health and improved immune function, Imperato said. Plus, it’s FODMAP-friendly, offering a high tolerance of up to 30 mg per day with no discomfort.
It also performs quite well in a variety of formulations, from daily dairy shots to powder mixes for sports nutrition, cereal bars, bakery items, supplements (stick packs, powders, capsules, and tablets) and fruit pouches, because it’s odorless, colorless, and flavorless, said Imperato.
VERSAFIBE 1490 and NOVELOSE 3490 dietary fibers from Ingredion Incorporated are also options for food formulators who want to add fiber with little to no impact on flavor, texture, or color. In fact, these resistant starches are appropriate for baked goods, pasta, snacks, nutrition bars, and even beverages. They, too, are low FODMAP.
Sometimes, though, fiber can be used to improve taste while also increasing nutritional value. At Ingredients By Nature, the company’s new MonkFiber, made using the pomace of luo han guo (monk fruit), offers a source of insoluble fiber while providing a sweet taste with zero calories.
Chicory root fibers also remain a popular choice for formulators, even as the reasons why have evolved over time. If you ask Pam Stauffer, global marketing programs manager at Cargill, chicory root fiber was primarily attractive to product developers years ago because it is soluble and easy to work with. It could be used in a wide range of applications without impacting texture and flavor, she said. “Then it became a big part of the fat-reduction movement as some grades of chicory root fiber act as a fat memetic, imparting creaminess back into low-fat and reduced-fat products,” she explained. “More recently, the highly soluble forms of chicory root fiber have played key roles in sugar reduction.” Plus, it fits with clean label trends like recognizable ingredients and keto-friendliness.
At Cargill, Oliggo-Fiber is a plant-based, label-friendly (appearing as chicory root fiber on labels) and non-GMO option to promote digestive health. “A big part of its appeal to formulators is its ease of use,” said Christine Addington, senior technical service specialist at Cargill. Not only is it a soluble fiber that can be used in a wide array of food and beverage applications, but Cargill offers grades of chicory root fiber that can add little to no viscosity for beverages.
“We also have SKUs that gel with heat and shear, helping to provide a creamy mouthfeel and acting as a fat memetic,” said Addington. Last year, the company launched Oliggo-Fiber XL Ultra, which is a new product grade of chicory root fiber designed to be compatible with probiotics in supplements like capsules, tablets, and powder blends.
“Being soluble and having a pleasant and mild natural taste, inulin and oligofructose are easily incorporated into an extensive range of food products from yogurt to breakfast cereals to savory items, while maintaining or even improving taste and texture,” said Kyle Krause, product manager, functional fiber and carbohydrates, North America at BENEO. “For example, in cereal bars, BENEO’s prebiotic chicory root fiber adds fiber and contributes to digestive health while helping to reduce sugar and calories.” As a bonus, he added, chicory root fiber also acts as a humectant, helping bars and other products remain soft over time.
Though chicory root fiber is generally very easy to work with, Addington warned that it is susceptible to hydrolysis in acidic conditions around pH 4.0 and lower. “The degree of hydrolysis will depend on the temperature and duration of exposure to the acidic environment,” she said. “When hydrolysis occurs, the long chain oligosaccharide is broken down into shorter chains and simple sugars such as fructose.”
The Future of Fiber
As Stauffer pointed out, product developers have used functional fibers to achieve health claims for many years, and consumers are generally able to identify fiber as beneficial to digestive health. “However, when product developers can combine fiber claims with even more impactful sugar-reducing messaging, we believe it creates an even more compelling story for consumers,” she said of opportunities going forward.
Another compelling story for consumers is one that leverages any sustainability initiatives. “Millennials are increasingly looking for products to be sustainable and eco-friendly, with twice as many indicating they are willing to pay a premium for them compared to 10 years ago,” Imperato noted. To that end, Nexira has been involved in sustainable development since the 1970s, and has partnered with the French non-profit SOS SAHEL to up its involvement in the sustainable development of acacia forests for future supply.
Diana Nieto, senior manager, business development, starch-based texturizers U.S./Canada at Ingredion, said brands have only started to scratch the surface of the potential to market foods as low FODMAP.
“The low FODMAP diet is quickly gaining momentum in the food industry and consumers are beginning to take notice,” she said. In fact, Ingredion’s August 2019 quantitative study of more than 750 U.S. participants revealed that consumers have a great interest in foods that help support digestive health. When introduced to low FODMAP product lines, 68% of participants felt they were good for digestive health and 53% said they would be very likely to purchase low FODMAP foods.
Finally, Krause expected food manufacturers to up their game, either by making food categories known for their fiber more appealing, or enriching new food categories altogether like pasta, ready-to-drink coffee, and confectionery, which have not traditionally been associated with added fiber in the past. As long as the product is tasty, he said, it should find favor.
“Digestive health has morphed from a medically driven issue to a health and wellness topic,” he added. “With consumers looking for ways to increase their consumption of fiber-containing food and drink, producers are faced with both a challenge and an opportunity: how to create products that provide sufficient amounts of fiber while tasting good.”
The Science Says ...
Bloating? Fiber may not be to blame. Though many consumers may think added fiber can cause digestive upset, a new study from the Johns Hopkins Bloomberg School of Public Health found that participants who ate versions of a heart-healthy high-fiber diet rich in proteins were about 40% more likely to report bloating symptoms than those eating a carb-rich version of the same high-fiber diet. This suggests that, when it comes to eating more fiber, high-protein sources may actually be to blame for digestive upset.1
Fiber consumption linked to lower breast cancer risk. With studies generating inconsistent results regarding the relationship between fiber intake and breast cancer, researchers at the Harvard TH Chan School of Public Health searched for all relevant prospective studies published through July 2019. What they found, from the 20 observational studies they identified, was that individuals with the highest consumption of fiber had an 8% lower risk of breast cancer. Soluble fiber was associated with lower risks overall, and high total fiber intake was associated with a lower risk in both premenopausal and postmenopausal women.2
This comes on the heels of a study published in October 2019 by researchers at Vanderbilt University Medical Center, which found that a diet high in fiber and yogurt was associated with a reduced risk of lung cancer.3 In fact, subjects with the highest yogurt and fiber consumption had a 33% reduction in lung cancer risk as opposed to the group that did not consume yogurt and consumed the least amount of fiber. One senior author explained that the health benefits of this diet may be rooted in its prebiotic and probiotic properties, which may modulate gut microbiota in a beneficial way.
Chicory root fiber supports kids’ gut microbiome during antibiotic treatment. It’s common for children to be prescribed antibiotics, which are known to significantly alter the gut microbiome. What if functional fiber could mitigate the damage? A new study demonstrated that daily consumption of 6 grams chicory root fiber in children ages 3 to 6 can keep levels of Bifidobacteria higher and more stable, even during antibiotic treatment.4
Low fiber intake linked to hypertension and its complications. When fed a diet lacking in prebiotic fiber, mouse subjects experienced hypertension in the presence of a mild stimulus. Once the fibers were reintroduced, researchers observed protective effects on the development of hypertension, cardiac hypertrophy, and fibrosis. Ultimately, they determined that maintaining a healthy microbiome capable of producing short-chain fatty acids is important for cardiovascular
health overall.5
Preeclampsia risk may be reduced by a high-fiber diet. Can gut bacteria have an impact on pregnancy outcomes? Researchers from the University of Sydney and four partner institutions linked reduced levels of acetate, which is mainly produced by fiber fermentation in the gut, with the common and serious pregnancy-related condition preeclampsia.6 And since preeclampsia was found in this study to affect fetal immune system development, it may explain the rapid increases in allergies and autoimmune conditions in the West, where diets are increasingly dominated by highly processed foods and are very low in fiber.
References
“Before processed foods, people routinely consumed 35-50 grams of resistant starch each and every day, which ferments slowly over a long period of time and is easily tolerated without producing a lot of gas or digestive complaints,” said Rhonda Witwer, executive director of Resistant Starch Research. She also pointed out that today’s processed diet yields just 5-6 grams of resistant starch daily on average.
“In other words, we have shifted our carbohydrate digestion from feeding the intestinal microbiome to high glycemic foods that rapidly break down in the small intestines and trigger high insulin levels, contributing to epidemic levels of obesity, diabetes, heart disease, and cancer,” Witwer said.
Indeed, the American consumer needs a wake up call when it comes to fiber. Mintel found that 22% of consumers don’t know enough about fiber to know if it’s important to their health, and 37% believe they can get enough of the nutrient from their daily diets, despite evidence to the contrary.
“Across categories of food and beverage, there is room for improvement when it comes to brand positioning and consumer education around the varied benefits of functional fiber,” said Greg Dodson, vice president of fiber at ADM, citing company research that 33% of consumers don’t know which products to turn to for fiber.
Plus, brands face an additional hurdle: many consumers think added fiber can actually cause digestive distress. ADM research showed that nearly 70% of consumers would not purchase a product again if they thought it caused them digestive upset. “Many consumers are aware that fiber plays a role in regularity and digestion, but few have a well-rounded understanding of the various ways it can be beneficial for holistic health and wellness,” said Dodson.
That said, fiber is slowly but surely getting back onto consumers’ radars, as overall trends toward holistic wellness nudge it along. “Rather than waiting until there is an issue to seek help, consumers become more aware of the value of proactive health and developing lifestyles that center around proper diets and exercise,” said Rob Brewster, president of Ingredients By Nature.
ADM research showed 62% of consumers seek out fiber in food and beverages, representing a 6% increase between 2013 and 2019; and 52% are motivated to do so in pursuit of better digestive health.
As a result, the fiber market is on the rise. According to SPINS, the market has grown 7.3% in sales in the 52 weeks ending Mar. 22, 2020, led by high-performing ingredients like psyllium, which grew 8.6% to reach a $228 million market, and acacia, which represents a nearly $2 million market.
Looking forward at years to come, fiber’s blood sugar benefits may launch the category’s popularity past that of today’s booming gluten-free market. “While a minority of consumers require gluten-free foods, half of American adults need to manage their blood sugar levels more closely,” Witwer said. “Removing high glycemic carbohydrates from the diet helps people to effectively manage their blood glucose levels and effectively lower insulin levels.”
Indeed, the need for glycemic management is reflected in the Centers for Disease Control and Prevention 2020 National Diabetes Statistics Report, which showed more than one in 10 Americans has diabetes and one in three has prediabetes.
“A large challenge is negative public perception of carbs,” said Brewster. “Fiber is a type of carbohydrate that the body can’t digest and, unfortunately, there are a lot of diets out there that push for an abstention of carbs whether they’re ‘good’ or ‘bad.’ When formulating and selling fiber products, developers need to provide a product with added value to show the overall benefit of including this necessary carb.” Increasingly, that solution takes the shape of natural ingredients with recognizable names and clean label attributes.
Natural Solutions
“During the past two years, we’ve seen new fibers appear on the market like monk fruit and citrus fiber,” noted Julie Imperato, marketing manager at Nexira. “This reflects the consumer need for natural and clean ingredients they can recognize easily on product labels.”
Fibersol dietary fiber from ADM is one solution for products where a clean label and optimal digestive comfort are necessary. “Unlike some fiber ingredients, Fibersol is well tolerated,” explained Dodson. “This is because Fibersol is fermented in the colon at a slower rate compared to other soluble fibers such as inulin or fructooligosaccharides, which helps minimize gastric distress.” It’s recognized as a low FODMAP ingredient by Monash University, he added, “a designation reserved for foods and ingredients that have been shown not to aggravate the gut or cause irritable bowel syndrome (IBS) symptoms like intestinal bloating and digestive discomfort.” For a cleaner label, the ingredient can be listed as soluble corn fiber.
At Nexira, inavea pure acacia is another clean label solution. It’s an all-natural, non-GMO and organic non-digestible polysaccharide sourced from acacia trees, and is appropriate as a prebiotic to target gut health and improved immune function, Imperato said. Plus, it’s FODMAP-friendly, offering a high tolerance of up to 30 mg per day with no discomfort.
It also performs quite well in a variety of formulations, from daily dairy shots to powder mixes for sports nutrition, cereal bars, bakery items, supplements (stick packs, powders, capsules, and tablets) and fruit pouches, because it’s odorless, colorless, and flavorless, said Imperato.
VERSAFIBE 1490 and NOVELOSE 3490 dietary fibers from Ingredion Incorporated are also options for food formulators who want to add fiber with little to no impact on flavor, texture, or color. In fact, these resistant starches are appropriate for baked goods, pasta, snacks, nutrition bars, and even beverages. They, too, are low FODMAP.
Sometimes, though, fiber can be used to improve taste while also increasing nutritional value. At Ingredients By Nature, the company’s new MonkFiber, made using the pomace of luo han guo (monk fruit), offers a source of insoluble fiber while providing a sweet taste with zero calories.
Chicory root fibers also remain a popular choice for formulators, even as the reasons why have evolved over time. If you ask Pam Stauffer, global marketing programs manager at Cargill, chicory root fiber was primarily attractive to product developers years ago because it is soluble and easy to work with. It could be used in a wide range of applications without impacting texture and flavor, she said. “Then it became a big part of the fat-reduction movement as some grades of chicory root fiber act as a fat memetic, imparting creaminess back into low-fat and reduced-fat products,” she explained. “More recently, the highly soluble forms of chicory root fiber have played key roles in sugar reduction.” Plus, it fits with clean label trends like recognizable ingredients and keto-friendliness.
At Cargill, Oliggo-Fiber is a plant-based, label-friendly (appearing as chicory root fiber on labels) and non-GMO option to promote digestive health. “A big part of its appeal to formulators is its ease of use,” said Christine Addington, senior technical service specialist at Cargill. Not only is it a soluble fiber that can be used in a wide array of food and beverage applications, but Cargill offers grades of chicory root fiber that can add little to no viscosity for beverages.
“We also have SKUs that gel with heat and shear, helping to provide a creamy mouthfeel and acting as a fat memetic,” said Addington. Last year, the company launched Oliggo-Fiber XL Ultra, which is a new product grade of chicory root fiber designed to be compatible with probiotics in supplements like capsules, tablets, and powder blends.
“Being soluble and having a pleasant and mild natural taste, inulin and oligofructose are easily incorporated into an extensive range of food products from yogurt to breakfast cereals to savory items, while maintaining or even improving taste and texture,” said Kyle Krause, product manager, functional fiber and carbohydrates, North America at BENEO. “For example, in cereal bars, BENEO’s prebiotic chicory root fiber adds fiber and contributes to digestive health while helping to reduce sugar and calories.” As a bonus, he added, chicory root fiber also acts as a humectant, helping bars and other products remain soft over time.
Though chicory root fiber is generally very easy to work with, Addington warned that it is susceptible to hydrolysis in acidic conditions around pH 4.0 and lower. “The degree of hydrolysis will depend on the temperature and duration of exposure to the acidic environment,” she said. “When hydrolysis occurs, the long chain oligosaccharide is broken down into shorter chains and simple sugars such as fructose.”
The Future of Fiber
As Stauffer pointed out, product developers have used functional fibers to achieve health claims for many years, and consumers are generally able to identify fiber as beneficial to digestive health. “However, when product developers can combine fiber claims with even more impactful sugar-reducing messaging, we believe it creates an even more compelling story for consumers,” she said of opportunities going forward.
Another compelling story for consumers is one that leverages any sustainability initiatives. “Millennials are increasingly looking for products to be sustainable and eco-friendly, with twice as many indicating they are willing to pay a premium for them compared to 10 years ago,” Imperato noted. To that end, Nexira has been involved in sustainable development since the 1970s, and has partnered with the French non-profit SOS SAHEL to up its involvement in the sustainable development of acacia forests for future supply.
Diana Nieto, senior manager, business development, starch-based texturizers U.S./Canada at Ingredion, said brands have only started to scratch the surface of the potential to market foods as low FODMAP.
“The low FODMAP diet is quickly gaining momentum in the food industry and consumers are beginning to take notice,” she said. In fact, Ingredion’s August 2019 quantitative study of more than 750 U.S. participants revealed that consumers have a great interest in foods that help support digestive health. When introduced to low FODMAP product lines, 68% of participants felt they were good for digestive health and 53% said they would be very likely to purchase low FODMAP foods.
Finally, Krause expected food manufacturers to up their game, either by making food categories known for their fiber more appealing, or enriching new food categories altogether like pasta, ready-to-drink coffee, and confectionery, which have not traditionally been associated with added fiber in the past. As long as the product is tasty, he said, it should find favor.
“Digestive health has morphed from a medically driven issue to a health and wellness topic,” he added. “With consumers looking for ways to increase their consumption of fiber-containing food and drink, producers are faced with both a challenge and an opportunity: how to create products that provide sufficient amounts of fiber while tasting good.”
The Science Says ...
Bloating? Fiber may not be to blame. Though many consumers may think added fiber can cause digestive upset, a new study from the Johns Hopkins Bloomberg School of Public Health found that participants who ate versions of a heart-healthy high-fiber diet rich in proteins were about 40% more likely to report bloating symptoms than those eating a carb-rich version of the same high-fiber diet. This suggests that, when it comes to eating more fiber, high-protein sources may actually be to blame for digestive upset.1
Fiber consumption linked to lower breast cancer risk. With studies generating inconsistent results regarding the relationship between fiber intake and breast cancer, researchers at the Harvard TH Chan School of Public Health searched for all relevant prospective studies published through July 2019. What they found, from the 20 observational studies they identified, was that individuals with the highest consumption of fiber had an 8% lower risk of breast cancer. Soluble fiber was associated with lower risks overall, and high total fiber intake was associated with a lower risk in both premenopausal and postmenopausal women.2
This comes on the heels of a study published in October 2019 by researchers at Vanderbilt University Medical Center, which found that a diet high in fiber and yogurt was associated with a reduced risk of lung cancer.3 In fact, subjects with the highest yogurt and fiber consumption had a 33% reduction in lung cancer risk as opposed to the group that did not consume yogurt and consumed the least amount of fiber. One senior author explained that the health benefits of this diet may be rooted in its prebiotic and probiotic properties, which may modulate gut microbiota in a beneficial way.
Chicory root fiber supports kids’ gut microbiome during antibiotic treatment. It’s common for children to be prescribed antibiotics, which are known to significantly alter the gut microbiome. What if functional fiber could mitigate the damage? A new study demonstrated that daily consumption of 6 grams chicory root fiber in children ages 3 to 6 can keep levels of Bifidobacteria higher and more stable, even during antibiotic treatment.4
Low fiber intake linked to hypertension and its complications. When fed a diet lacking in prebiotic fiber, mouse subjects experienced hypertension in the presence of a mild stimulus. Once the fibers were reintroduced, researchers observed protective effects on the development of hypertension, cardiac hypertrophy, and fibrosis. Ultimately, they determined that maintaining a healthy microbiome capable of producing short-chain fatty acids is important for cardiovascular
health overall.5
Preeclampsia risk may be reduced by a high-fiber diet. Can gut bacteria have an impact on pregnancy outcomes? Researchers from the University of Sydney and four partner institutions linked reduced levels of acetate, which is mainly produced by fiber fermentation in the gut, with the common and serious pregnancy-related condition preeclampsia.6 And since preeclampsia was found in this study to affect fetal immune system development, it may explain the rapid increases in allergies and autoimmune conditions in the West, where diets are increasingly dominated by highly processed foods and are very low in fiber.
References
- Zhang M et al. “Effects of High-Fiber Diets and Macronutrient Substitution on Bloating.” Clinical and Translational Gastroenterology. 2020; 1 DOI: 10.14309/ctg.0000000000000122
- Farvid MS et al. “Fiber consumption and breast cancer incidence: A systematic review and meta-analysis of prospective studies.” CANCER. Published online 4/6/2020.
- Yang JJ et al. “Association of Dietary Fiber and Yogurt Consumption With Lung Cancer Risk.” JAMA Oncology. 2019; DOI: 10.1001/jamaoncol.2019.4107
- Soldi et al. “Prebiotic supplementation over a cold season and during antibiotic treatment specifically modulates the gut microbiota composition of 3-6 year-old children.” Benef Microbes. 2019; 19:1-12.
- Kaye et al. “Deficiency of Prebiotic Fibre and Insufficient Signalling Through Gut Metabolite Sensing Receptors Leads to Cardiovascular Disease.” Circulation. 2020. https://doi.org/10.1161/CIRCULATIONAHA.119.043081
- 6Hu M et al. “Decreased maternalserum acetate and impaired fetal thymic and regulatory T cell development in preeclampsia.” Nature Communications. 2019; 10 (1) DOI: 10.1038/s41467-019-10703-1
