✪✪✪ Dietary Intake Assessments

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Dietary Intake Assessments

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Ch 16 Nutritional Assessment process

According to the recommendation of the American Dietetic Association ADA , vegetarians should increase their consumption of rice milk, soy milk, yeast extracts and breakfast cereals to ensure a sufficient intake of vitamin B In contrast, a vegan diet is a total vegetarian diet that excludes any and all animal products i. Therefore, vegans generally have a lower calcium intake than non-vegetarians, but they may have lower calcium requirements as well.

Vegans are advised to increase their intake of Omega-3 fatty acids found in flax seed, walnuts, soybeans and dark green vegetables. The ADA is just one example of a major health organization that recognizes that a well-planned vegetarian or vegan diet can reduce the risk of many chronic conditions, such as heart disease, obesity, diabetes, asthma, high blood pressure and cancer. Because vegetarians are less susceptible to major diseases, they can live healthier, longer and more productive lives, with fewer visits to doctors, fewer dental problems and lower medical bills.

Showing care for what you eat can save your body and mind. Eat moderately and consume simple, pure, healthy foods a Sattvic diet even when not fasting. Do you need advice on how to provide culturally sensitive care to patients from a particular ethnic or religious background? Are you looking for ways to increase understanding and acceptance of cultural differences in your work environment? Our expert can help! Author Recent Posts. Latest posts by see all. The following guidance is based on the best available evidence. The full guideline gives details of the methods and the evidence used to develop the guidance. Ensure hospitals have access to specialist equipment — such as larger scanners and beds — when providing general care for people who are severely obese.

The choice of intervention should be agreed with the person. Comply with the approaches outlined in the Department of Health's A call to action on obesity in England. See also NICE's guideline on weight management: lifestyle services for overweight or obese children and young people. The GDG noted that 'environment' could include settings other than the home, for example, schools. Tailor interventions to the needs and preferences of the child and the family.

Take into account the age and maturity of the child, and the preferences of the child and the parents. Ensure continuity of care in the multidisciplinary team through good record keeping. Opportunities include registration with a general practice, consultation for related conditions such as type 2 diabetes and cardiovascular disease and other routine health checks. Interpret BMI with caution because it is not a direct measure of adiposity. Use it to give additional information on the risk of developing other long-term health problems. Some other population groups, such as people of Asian family origin and older people, have comorbidity risk factors that are of concern at different BMIs lower for adults of an Asian family origin and higher for older people. Use clinical judgement when considering risk factors in these groups, even in people not classified as overweight or obese, using the classification in recommendation 1.

For men, waist circumference of less than 94 cm is low, 94 cm to cm is high and more than cm is very high. For women, waist circumference of less than 80 cm is low, 80 cm to 88 cm is high and more than 88 cm is very high. Levels of intervention 1. The level of intervention should be higher for patients with comorbidities see section 1. Adjust the approach as needed, depending on the person's clinical need and potential to benefit from losing weight. Give them information on the benefits of losing weight, healthy eating and increased physical activity.

Stress that obesity is a clinical term with specific health implications, rather than a question of how people look; this may reduce any negative feelings. During the consultation:. Assess the person's view of their weight and the diagnosis, and possible reasons for weight gain. Explore any beliefs about eating, physical activity and weight gain that are unhelpful if the person wants to lose weight. Be aware that people from certain ethnic and socioeconomic backgrounds may be at greater risk of obesity, and may have different beliefs about what is a healthy weight and different attitudes towards weight management. Find out what the person has already tried and how successful this has been, and what they learned from the experience.

If necessary, offer another consultation to fully explore the options for treatment or discuss test results. Then, assess:. For more information on tier 3 services, see NHS England's report on joined up clinical pathways for obesity. Use investigations such as:. Interpret the results of any tests used in the context of how overweight or obese the child is, the child's age, history of comorbidities, possible genetic causes and any family history of metabolic disease related to being overweight or obese.

An appropriate balance of essential fatty acids— omega-3 and omega-6 fatty acids —seems also important for health, although definitive experimental demonstration has been elusive. Both of these "omega" long-chain polyunsaturated fatty acids are substrates for a class of eicosanoids known as prostaglandins , which have roles throughout the human body. The omega-3 eicosapentaenoic acid EPA , which can be made in the human body from the omega-3 essential fatty acid alpha-linolenic acid ALA , or taken in through marine food sources, serves as a building block for series 3 prostaglandins e. The omega-6 dihomo-gamma-linolenic acid DGLA serves as a building block for series 1 prostaglandins e.

An appropriately balanced intake of omega-3 and omega-6 partly determines the relative production of different prostaglandins. In industrialized societies, people typically consume large amounts of processed vegetable oils, which have reduced amounts of the essential fatty acids along with too much of omega-6 fatty acids relative to omega-3 fatty acids. The conversion desaturation of DGLA to AA is controlled by the enzyme deltadesaturase , which in turn is controlled by hormones such as insulin up-regulation and glucagon down-regulation. Dietary fiber is a carbohydrate , specifically a polysaccharide, which is incompletely absorbed in humans and in some animals. Like all carbohydrates, when it is metabolized, it can produce four Calories kilocalories of energy per gram, but in most circumstances, it accounts for less than that because of its limited absorption and digestibility.

Whole grains, beans, and other legumes , fruits especially plums , prunes , and figs , and vegetables are good sources of dietary fiber. Fiber has three primary mechanisms, which in general determine their health impact: bulking, viscosity and fermentation. Some soluble and insoluble fibers produce a solution of high viscosity ; this is essentially a gel, which slows the movement of food through the intestines. Fermentable fibers are used as food by the microbiome , mildly increasing bulk, and producing short-chain fatty acids and other metabolites, including vitamins, hormones, and glucose.

One of these metabolites, butyrate , is important as an energy source for colon cells, and may improve metabolic syndrome. In , the U. FDA approved a qualified health claim stating that resistant starch might reduce the risk of type 2 diabetes , but with qualifying language for product labels that only limited scientific evidence exists to support this claim. The FDA requires specific labeling language, such as the guideline concerning resistant starch: "High-amylose maize resistant starch may reduce the risk of type 2 diabetes.

FDA has concluded that there is limited scientific evidence for this claim. Proteins are the basis of many animal body structures e. Each protein molecule is composed of amino acids which contain nitrogen and sometimes sulphur these components are responsible for the distinctive smell of burning protein, such as the keratin in hair. The body requires amino acids to produce new proteins protein retention and to replace damaged proteins maintenance. Amino acids are soluble in the digestive juices within the small intestine, where they are absorbed into the blood. Once absorbed, they cannot be stored in the body, so they are either metabolized as required or excreted in the urine. The most important aspect and defining characteristic of protein from a nutritional standpoint is its amino acid composition.

For all animals, some amino acids are essential an animal cannot produce them internally so they must be eaten and some are non-essential the animal can produce them from other nitrogen-containing compounds. About twenty amino acids are found in the human body, and about ten of these are essential. The synthesis of some amino acids can be limited under special pathophysiological conditions, such as prematurity in the infant or individuals in severe catabolic distress, and those are called conditionally essential.

A diet that contains adequate amounts of amino acids especially those that are essential is particularly important in some situations: during early development and maturation, pregnancy, lactation, or injury a burn, for instance. A complete protein source contains all the essential amino acids; an incomplete protein source lacks one or more of the essential amino acids. It is possible with protein combinations of two incomplete protein sources e. However, complementary sources of protein do not need to be eaten at the same meal to be used together by the body. There is an ongoing debate about the differences in nutritional quality and adequacy of protein from vegan , vegetarian and animal sources, though many studies and institutions have found that a well-planned vegan or vegetarian diet contains enough high-quality protein to support the protein requirements of both sedentary and active people at all stages of life.

Water is excreted from the body in multiple forms; including urine and feces , sweating , and by water vapour in the exhaled breath. Therefore, it is necessary to adequately rehydrate to replace lost fluids. Early recommendations for the quantity of water required for maintenance of good health suggested that six to eight glasses of water daily is the minimum to maintain proper hydration. Most of this quantity is contained in prepared foods. For healthful hydration, the current EFSA guidelines recommend total water intakes of 2. These reference values include water from drinking water, other beverages, and from food. The EFSA panel also determined intakes for different populations. Recommended intake volumes in the elderly are the same as for adults as despite lower energy consumption, the water requirement of this group is increased due to a reduction in renal concentrating capacity.

Dehydration and over-hydration — too little and too much water, respectively — can have harmful consequences. Drinking too much water is one of the possible causes of hyponatremia , i. Dietary minerals are inorganic chemical elements required by living organisms, [55] other than the four elements carbon , hydrogen , nitrogen , and oxygen that are present in nearly all organic molecules. Some have roles as cofactors , while others are electrolytes. Some are heavier than the four just mentioned — including several metals , which often occur as ions in the body. Some dietitians recommend that these be supplied from foods in which they occur naturally, or at least as complex compounds, or sometimes even from natural inorganic sources such as calcium carbonate from ground oyster shells.

Some are absorbed much more readily in the ionic forms found in such sources. On the other hand, minerals are often artificially added to the diet as supplements; the most well-known is likely iodine in iodized salt which prevents goiter. Many elements are required in smaller amounts microgram quantities , usually because they play a catalytic role in enzymes. Many ultratrace elements have been suggested as essential, but such claims have usually not been confirmed. Definitive evidence for efficacy comes from the characterization of a biomolecule containing the element with an identifiable and testable function. These include: [69] [70]. Except for vitamin D , vitamins are essential nutrients, [55] necessary in the diet for good health.

Vitamin D can be synthesized in the skin in the presence of UVB radiation. Many animal species can synthesize vitamin C , but humans cannot. Certain vitamin-like compounds that are recommended in the diet, such as carnitine , are thought useful for survival and health, but these are not "essential" dietary nutrients because the human body has some capacity to produce them from other compounds. Moreover, thousands of different phytochemicals have recently been discovered in food particularly in fresh vegetables , which may have desirable properties including antioxidant activity see below ; experimental demonstration has been suggestive but inconclusive. Other essential nutrients not classed as vitamins include essential amino acids see above , essential fatty acids see above , and the minerals discussed in the preceding section.

Vitamin deficiencies may result in disease conditions: goiter , scurvy , osteoporosis , impaired immune system , disorders of cell metabolism , certain forms of cancer, symptoms of premature aging , and poor psychological health including eating disorders , among many others. Excess levels of some vitamins are also dangerous to health. In developed countries, the diseases of malnutrition are most often associated with nutritional imbalances or excessive consumption; there are more people in the world who are malnourished due to excessive consumption. According to the United Nations World Health Organization , the greatest challenge in developing nations today is not starvation, but insufficient nutrition — the lack of nutrients necessary for the growth and maintenance of vital functions.

The causes of malnutrition are directly linked to inadequate macronutrient consumption and disease, and are indirectly linked to factors like "household food security, maternal and child care, health services, and the environment. The U. ULs are set a safe fraction below amounts shown to cause health problems. ULs are part of Dietary Reference Intakes. When too much of one or more nutrients is present in the diet to the exclusion of the proper amount of other nutrients, the diet is said to be unbalanced.

High calorie food ingredients such as vegetable oils, sugar and alcohol are referred to as "empty calories" because they displace from the diet foods that also contain protein, vitamins, minerals and fiber. Pure ethanol provides 7 calories per gram. For distilled spirits , a standard serving in the United States is 1. A 5-ounce serving of wine contains to calories. A ounce serving of beer contains 95 to calories. Alcoholic beverages are considered empty calorie foods because other than calories, these contribute no essential nutrients. Phytochemicals such as polyphenols are compounds produced naturally in plants phyto means "plant" in Greek. In general, the term identifies compounds that are prevalent in plant foods, but are not proven to be essential for human nutrition, as of There is no conclusive evidence in humans that polyphenols or other non-nutrient compounds from plants confer health benefits, mainly because these compounds have poor bioavailability , i.

While initial studies sought to reveal if dietary supplements might promote health, one meta-analysis concluded that supplementation with antioxidant vitamins A and E and beta-carotene did not convey any benefits, and may increase risk of death. Health effect of non-nutrient phytochemicals such as polyphenols were not assessed in this review. The intestines contain a large population of gut flora. In humans, the four dominant phyla are Firmicutes , Bacteroidetes , Actinobacteria , and Proteobacteria. Bacteria are essential for metabolizing food substrates and thereby increasing energy output, and produce a great variety of metabolites, including vitamins and short-chain fatty acids that contribute to the metabolism in a wide variety of ways.

The challenges facing global nutrition are disease, child malnutrition, obesity, and vitamin deficiency. The most common non-infectious diseases worldwide, that contribute most to the global mortality rate, are cardiovascular diseases, various cancers, diabetes, and chronic respiratory problems, all of which are linked to poor nutrition. Nutrition and diet are closely associated with the leading causes of death, including cardiovascular disease and cancer. Obesity and high sodium intake can contribute to ischemic heart disease, while consumption of fruits and vegetables can decrease the risk of developing cancer. Food-borne and infectious diseases can result in malnutrition, and malnutrition exacerbates infectious disease.

Poor nutrition leaves children and adults more susceptible to contracting life-threatening diseases such as diarrheal infections and respiratory infections. According to UNICEF, in , million children across the globe were underweight and one in four children, million, were stunted in growth. Childhood malnutrition is common and contributes to the global burden of disease. UNICEF defines undernutrition "as the outcome of insufficient food intake hunger and repeated infectious diseases.

When humans are undernourished, they no longer maintain normal bodily functions, such as growth, resistance to infection, or have satisfactory performance in school or work. Many children are born with the inherent disadvantage of low birth weight, often caused by intrauterine growth restriction and poor maternal nutrition, which results in worse growth, development, and health throughout the course of their lifetime.

Stunting and other forms of undernutrition reduces a child's chance of survival and hinders their optimal growth and health. Data on global and regional food supply shows that consumption rose from to in all regions. Diets became more diverse, with a decrease in consumption of cereals and roots and an increase in fruits, vegetables, and meat products. Undernourishment, or hunger, according to the FAO, is dietary intake below the minimum daily energy requirement. The spike in food prices prevented many people from escaping poverty, because the poor spend a larger proportion of their income on food and farmers are net consumers of food.

Malnutrition in industrialized nations is primarily due to excess calories and non-nutritious carbohydrates, which has contributed to the obesity epidemic affecting both developed and some developing nations. Obesity is more prevalent amongst high income and higher middle income groups than lower divisions of income. Vitamins and minerals are essential to the proper functioning and maintenance of the human body. Iron deficiency is the most common inadequate nutrient worldwide, affecting approximately 2 billion people. Vitamin A plays an essential role in developing the immune system in children, therefore, it is considered an essential micronutrient that can greatly affect health. The WHO estimates that 5.

Estimates say that Moderate deficiencies are common in Europe and Africa, and over consumption is common in the Americas. This ultimately leads to poor school performance and impaired intellectual capabilities. Improvement of breast feeding practices, like early initiation and exclusive breast feeding for the first two years of life, could save the lives of 1. This leaves children less likely to contract diarrheal diseases and respiratory infections. Besides the quality and frequency of breastfeeding, the nutritional status of mothers affects infant health. When mothers do not receive proper nutrition, it threatens the wellness and potential of their children.

The lifetime prevalence of anorexia nervosa in women is 0. NAAL introduced the first-ever measure of "the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions" — an objective of Healthy People [] and of which nutrition literacy might be considered an important subset. The study found that health literacy increases with education and people living below the level of poverty have lower health literacy than those above it.

Another study examining the health and nutrition literacy status of residents of the lower Mississippi Delta found that 52 percent of participants had a high likelihood of limited literacy skills. For example, only 12 percent of study participants identified the My Pyramid graphic two years after it had been launched by the USDA. The study also found significant relationships between nutrition literacy and income level and nutrition literacy and educational attainment [] further delineating priorities for the region. Among these problems are the lack of information about food choices, a lack of understanding of nutritional information and its application to individual circumstances, limited or difficult access to healthful foods, and a range of cultural influences and socioeconomic constraints such as low levels of education and high levels of poverty that decrease opportunities for healthful eating and living.

The links between low health literacy and poor health outcomes has been widely documented [] and there is evidence that some interventions to improve health literacy have produced successful results in the primary care setting. More must be done to further our understanding of nutrition literacy specific interventions in non-primary care settings [] in order to achieve better health outcomes. In the US, dietitians are registered RD or licensed LD with the Commission for Dietetic Registration and the American Dietetic Association, and are only able to use the title "dietitian", as described by the business and professions codes of each respective state, when they have met specific educational and experiential prerequisites and passed a national registration or licensure examination, respectively.

Anyone may call themselves a nutritionist, including unqualified dietitians, as this term is unregulated. Dietary and physical activity guidelines from the USDA are presented in the concept of a plate of food which in superseded the MyPyramid food pyramid that had replaced the Four Food Groups. Department of Health and Human Services provides a sample week-long menu which fulfills the nutritional recommendations of the government. These disparities are a direct product of social inequalities and social inequalities are rising throughout the industrialized world, particularly in Europe.

South Asia has the highest percentage and number of underweight children under five in the world, at approximately 78 million children. The Eastern and Southern African nations have shown no improvement since in the rate of underweight children under five. West and Central Africa has the highest rate of children under five underweight in the world. The aim was to boost nutrition and livelihoods by producing a product that women could make and sell, and which would be accepted by the local community because of its local heritage. The East Asia and Pacific region has reached its goals on nutrition, in part due to the improvements contributed by China , the region's most populous country.

Further nutrient indicators show that only 12 per cent of Cambodian babies are exclusively breastfed and only 14 per cent of households consume iodized salt. This region has undergone the fastest progress in decreasing poor nutrition status of children in the world. Occurring throughout the world, lack of proper nutrition is both a consequence and cause of poverty. That likelihood doubles to four times in Peru. In the United States, the incidence of low birthweight is on the rise among all populations, but particularly among minorities.

Nutrition directly influences progress towards meeting the Millennium Goals of eradicating hunger and poverty through health and education. Policy and programming must target both individual behavioral changes and policy approaches to public health. While most nutrition interventions focus on delivery through the health-sector, non-health sector interventions targeting agriculture, water and sanitation, and education are important as well. For example, in , iodine deficiency was particularly prevalent, with one in five households, or 1. Emergencies and crises often exacerbate undernutrition, due to the aftermath of crises that include food insecurity, poor health resources, unhealthy environments, and poor healthcare practices. UNICEF's programming targeting nutrition services amongst disaster settings include nutrition assessments, measles immunization, vitamin A supplementation, provision of fortified foods and micronutrient supplements, support for breastfeeding and complementary feeding for infants and young children, and therapeutic and supplementary feeding.

Interventions aimed at pregnant women, infants, and children take a behavioral and program-based approach. Behavioral intervention objectives include promoting proper breast-feeding, the immediate initiation of breastfeeding, and its continuation through 2 years and beyond. However, because supplementation often occurs too late, these programs have had little effect. One example is the "Formula for Oil" relief program in Iraq, which resulted in the replacement of breastfeeding for formula, which has negatively affected infant nutrition. In April , the World Bank and the IMF released a policy briefing entitled "Scaling up Nutrition SUN : A Framework for action" that represented a partnered effort to address the Lancet's Series on under nutrition, and the goals it set out for improving under nutrition.

For instance, several East Asian nations have enacted legislation to increase iodization of salt to increase household consumption. For example, in the Philippines , improved production and market availability of iodized salt increased household consumption. Canada's Food Guide is an example of a government-run nutrition program. Produced by Health Canada , the guide advises food quantities, provides education on balanced nutrition, and promotes physical activity in accordance with government-mandated nutrient needs. Like other nutrition programs around the world, Canada's Food Guide divides nutrition into four main food groups: vegetables and fruit, grain products, milk and alternatives, and meat and alternatives. Dietary and physical activity guidelines from the USDA are presented in the concept of MyPlate , which superseded the food pyramid , which replaced the Four Food Groups.

HHS provides a sample week-long menu that fulfills the nutritional recommendations of the government. Governmental organisations have been working on nutrition literacy interventions in non-primary health care settings to address the nutrition information problem in the U. Some programs include:. The FNP has developed a series of tools to help families participating in the Food Stamp Program stretch their food dollar and form healthful eating habits including nutrition education.

It is designed to assist limited-resource audiences in acquiring the knowledge, skills, attitudes, and changed behavior necessary for nutritionally sound diets, and to contribute to their personal development and the improvement of the total family diet and nutritional well-being. An example of a state initiative to promote nutrition literacy is Smart Bodies , a public-private partnership between the state's largest university system and largest health insurer, Louisiana State Agricultural Center and Blue Cross and Blue Shield of Louisiana Foundation.

Launched in , this program promotes lifelong healthful eating patterns and physically active lifestyles for children and their families. It is an interactive educational program designed to help prevent childhood obesity through classroom activities that teach children healthful eating habits and physical exercise. Nutrition is taught in schools in many countries. In England and Wales , the Personal and Social Education and Food Technology curricula include nutrition, stressing the importance of a balanced diet and teaching how to read nutrition labels on packaging.

In some American schools, students are required to take a certain number of FCS or Health related classes. In many Nutrition classes, students learn about the food groups, the food pyramid, Daily Recommended Allowances, calories, vitamins, minerals, malnutrition, physical activity, healthful food choices, portion sizes, and how to live a healthy life.

In the US, Registered dietitian nutritionists RDs or RDNs [] are health professionals qualified to provide safe, evidence-based dietary advice which includes a review of what is eaten , a thorough review of nutritional health, and a personalized nutritional treatment plan through dieting. They also provide preventive and therapeutic programs at work places, schools and similar institutions.

Certified Clinical Nutritionists or CCNs, are trained health professionals who also offer dietary advice on the role of nutrition in chronic disease, including possible prevention or remediation by addressing nutritional deficiencies before resorting to drugs. These Board Certified Nutritionists typically specialize in obesity and chronic disease. In order to become board certified, potential CNS candidate must pass an examination, much like Registered Dieticians. This exam covers specific domains within the health sphere including; Clinical Intervention and Human Health.

The protein requirement for each individual differs, as do opinions about whether and to what extent physically active people require more protein. The Recommended Dietary Allowances RDA , aimed at the general healthy adult population, provide for an intake of 0. The main fuel used by the body during exercise is carbohydrates, which is stored in muscle as glycogen — a form of sugar.

During exercise, muscle glycogen reserves can be used up, especially when activities last longer than 90 min. Adequate nutrition is essential for the growth of children from infancy right through until adolescence. Some nutrients are specifically required for growth on top of nutrients required for normal body maintenance, in particular calcium and iron. Malnutrition in general is higher among the elderly, but has different aspects in developed and undeveloped countries.

Early human nutrition was largely determined by the availability and palatability of foods. The diet in the tropics tended [ when? Analyses of postcranial and cranial remains of humans and animals from the Neolithic, along with detailed bone-modification studies, have shown that cannibalism also occurred among prehistoric humans. Agriculture developed at different times in different places, starting about 11, years ago, providing some cultures with a more abundant supply of grains such as wheat , rice and maize and potatoes ; and originating staples such as bread , pasta dough , [] and tortillas. The domestication of animals provided some cultures with milk and dairy products. In , archeological research discovered a frescoed thermopolium a fast-food counter in an exceptional state of preservation from 79 in Pompeii, including 2,year-old foods available in some of the deep terra cotta jars.

During classical antiquity , diets consisted of simple fresh or preserved whole foods that were either locally grown or transported from neighboring areas during times of crisis. Since the Industrial Revolution in the 18th and 19th century, the food processing industry has invented many technologies that both help keep foods fresh longer and alter the fresh state of food as they appear in nature. Cooling and freezing are primary technologies used to maintain freshness, whereas many more technologies have been invented to allow foods to last longer without becoming spoiled.

These latter technologies include pasteurisation , autoclavation , drying , salting , and separation of various components, all of which appearing to alter the original nutritional contents of food. Pasteurisation and autoclavation heating techniques have no doubt improved the safety of many common foods, preventing epidemics of bacterial infection. Modern separation techniques such as milling , centrifugation , and pressing have enabled concentration of particular components of food, yielding flour, oils, juices, and so on, and even separate fatty acids, amino acids, vitamins, and minerals.

Inevitably, such large-scale concentration changes the nutritional content of food, saving certain nutrients while removing others. Heating techniques may also reduce the content of many heat-labile nutrients such as certain vitamins and phytochemicals, and possibly other yet-to-be-discovered substances. Because of reduced nutritional value, processed foods are often enriched or fortified with some of the most critical nutrients usually certain vitamins that were lost during processing. In addition, processed foods often contain potentially harmful substances such as oxidized fats and trans fatty acids.

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