Is it mandatory to use a database for keeping and accessing small items in node.js?

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No, it is not mandatory to use a database for keeping and accessing small items in node.js. There are other data structures and storage options available such as array, local storage, text files, or JSON files that can be used depending on the nature and size of the data. However, using a database has its own advantages like scalability, performance, and data consistency, which may be required for larger and complex datasets.