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Hannan FM, Leow MKS, Lee JKW, Kovats S, Elajnaf T, Kennedy SH, Thakker RV. Endocrine effects of heat exposure and relevance to climate change. Nat Rev Endocrinol 2024; 20:673-684. [PMID: 39080505 DOI: 10.1038/s41574-024-01017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 10/09/2024]
Abstract
Climate change is increasing both seasonal temperatures and the frequency and severity of heat extremes. As the endocrine system facilitates physiological adaptations to temperature changes, diseases with an endocrinological basis have the potential to affect thermoregulation and increase the risk of heat injury. The effect of climate change and associated high temperature exposure on endocrine axis development and function, and on the prevalence and severity of diseases associated with hormone deficiency or excess, is unclear. This Perspective summarizes current knowledge relating to the hormonal effects of heat exposure in species ranging from rodents to humans. We also describe the potential effect of high temperature exposures on patients with endocrine diseases. Finally, we highlight the need for more basic science, clinical and epidemiological research into the effects of heat on endocrine function and health; this research could enable the development of interventions for people most at risk, in the context of rising environmental temperatures.
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Affiliation(s)
- Fadil M Hannan
- Larsson-Rosenquist Foundation Oxford Centre for the Endocrinology of Human Lactation, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
| | - Melvin K S Leow
- Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jason K W Lee
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Heat Resilience and Performance Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sari Kovats
- NIHR Health Protection Research Unit in Environmental Change and Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Taha Elajnaf
- Larsson-Rosenquist Foundation Oxford Centre for the Endocrinology of Human Lactation, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Stephen H Kennedy
- Larsson-Rosenquist Foundation Oxford Centre for the Endocrinology of Human Lactation, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Rajesh V Thakker
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
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2
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McCarthy SF, Tucker JAL, Hazell TJ. Exercise-induced appetite suppression: An update on potential mechanisms. Physiol Rep 2024; 12:e70022. [PMID: 39187396 PMCID: PMC11347021 DOI: 10.14814/phy2.70022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/16/2024] [Accepted: 08/16/2024] [Indexed: 08/28/2024] Open
Abstract
The first systematic reviews of the effects of exercise on appetite-regulation and energy intake demonstrated changes in appetite-regulating hormones consistent with appetite suppression and decreases in subsequent relative energy intake over a decade ago. More recently, an intensity-dependent effect and several potential mechanisms were proposed, and this review aims to highlight advances in this field. While exercise-induced appetite suppression clearly involves acylated ghrelin, glucagon-like peptide-1 may also be involved, though recent evidence suggests peptide tyrosine tyrosine may not be relevant. Changes in subjective appetite perceptions and energy intake continue to be equivocal, though these results are likely due to small sample sizes and methodological inconsistencies. Of the proposed mechanisms responsible for exercise-induced appetite suppression, lactate has garnered the most support through in vitro and in vivo rodent studies as well as a growing amount of work in humans. Other potential modulators of exercise-induced appetite suppression may include sex hormones, growth-differentiation factor 15, Lac-Phe, brain-derived neurotrophic factor, and asprosin. Research should focus on the mechanisms responsible for the changes and consider these other modulators (i.e., myokines/exerkines) of appetite to improve our understanding of the role of exercise on appetite regulation.
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Affiliation(s)
- Seth F. McCarthy
- Department of Kinesiology and Physical EducationWilfrid Laurier UniversityWaterlooOntarioCanada
| | - Jessica A. L. Tucker
- Department of Kinesiology and Physical EducationWilfrid Laurier UniversityWaterlooOntarioCanada
| | - Tom J. Hazell
- Department of Kinesiology and Physical EducationWilfrid Laurier UniversityWaterlooOntarioCanada
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3
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Coca M, Besançon L, Erblang M, Bourdon S, Gruel A, Lepetit B, Beauchamps V, Tavard B, Oustric P, Finlayson GS, Thivel D, Malgoyre A, Tardo-Dino PE, Bourrilhon C, Charlot K. Twenty four-hour passive heat and cold exposures did not modify energy intake and appetite but strongly modify food reward. Br J Nutr 2024; 132:209-226. [PMID: 38634266 DOI: 10.1017/s0007114524000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Effects of acute thermal exposures on appetite appear hypothetical in reason of very heterogeneous methodologies. The aim of this study was therefore to clearly define the effects of passive 24-h cold (16°C) and heat (32°C) exposures on appetitive responses compared with a thermoneutral condition (24°C). Twenty-three healthy, young and active male participants realised three sessions (from 13.00) in a laboratory conceived like an apartment dressed with the same outfit (Clo = 1). Three meals composed of three or four cold or warm dishes were served ad libitum to assess energy intake (EI). Leeds Food Preference Questionnaires were used before each meal to assess food reward. Subjective appetite was regularly assessed, and levels of appetitive hormones (acylated ghrelin, glucagon-like peptite-1, leptin and peptide YY) were assessed before and after the last meal (lunch). Contrary to the literature, total EI was not modified by cold or heat exposure (P = 0·120). Accordingly, hunger scores (P = 0·554) were not altered. Levels of acylated ghrelin and leptin were marginally higher during the 16 (P = 0·032) and 32°C (P < 0·023) sessions, respectively. Interestingly, implicit wanting for cold and low-fat foods at 32°C and for warm and high-fat foods at 16°C were increased during the whole exposure (P < 0·024). Moreover, cold entrées were more consumed at 32°C (P < 0·062) and warm main dishes more consumed at 16°C (P < 0·025). Thus, passive cold and hot exposures had limited effects on appetite, and it seems that offering some choice based on food temperature may help individuals to express their specific food preferences and maintain EI.
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Affiliation(s)
- Maxime Coca
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 Place Général Valérie André, 91223 Brétigny Cedex, France
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
| | - Louis Besançon
- Hôpital d'instruction des armées Percy, 92140 Clamart, France
| | - Mégane Erblang
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
| | - Stéphanie Bourdon
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 Place Général Valérie André, 91223 Brétigny Cedex, France
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
| | - Arnaud Gruel
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 Place Général Valérie André, 91223 Brétigny Cedex, France
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
| | - Benoît Lepetit
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 Place Général Valérie André, 91223 Brétigny Cedex, France
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
| | - Vincent Beauchamps
- Unité Fatigue et Vigilance, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 Place Général Valérie André, 91223 Brétigny Cedex, France
- EA 7330 VIFASOM, Université de Paris, 75004 Paris, France
| | - Blandine Tavard
- Centre Interarmées du Soutien « Equipements Commissariats », Service du commissariat des armées, 78120 Rambouillet, France
| | - Pauline Oustric
- Inserm, U1296 Unit, "Radiation: Defense, Health and Environment", Centre Léon Bérard, 28 rue Laënnec, 69008 Lyon, France
| | - Graham S Finlayson
- Appetite Control Energy Balance Research Group, School of Psychology, Faculty of Medicine and Health, University of Leeds, LeedsLS2 9JT, UK
| | - David Thivel
- Laboratoire des adaptations Métaboliques à l'Exercice en conditions Physiologiques et Pathologiques (EA 3533), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Alexandra Malgoyre
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 Place Général Valérie André, 91223 Brétigny Cedex, France
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
| | - Pierre-Emmanuel Tardo-Dino
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 Place Général Valérie André, 91223 Brétigny Cedex, France
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
| | - Cyprien Bourrilhon
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 Place Général Valérie André, 91223 Brétigny Cedex, France
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
| | - Keyne Charlot
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 Place Général Valérie André, 91223 Brétigny Cedex, France
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
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4
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Fujihira K, Takahashi M, Wang C, Hayashi N. Factors explaining seasonal variation in energy intake: a review. Front Nutr 2023; 10:1192223. [PMID: 37545581 PMCID: PMC10400769 DOI: 10.3389/fnut.2023.1192223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
Maintaining a balance between energy intake and expenditure is crucial for overall health. There are seasonal variations in energy intake, with an increase during spring and winter as well as a decrease during summer. These variations are related to a combination of environmental factors, including changes in temperature and daylight hours; social factors, including events and holidays; and physiological factors, including changes in physical activity and emotions. Accordingly, this review aimed to summarize the environmental, social, and physiological factors that contribute to seasonal variations in energy intake. A review of the current literature revealed that changes in temperature and daylight hours may affect eating behavior by altering homeostatic responses and appetite-related hormones. Additionally, increased participation in events and frequency of eating out, especially during winter vacations, may contribute to increased energy intake. Notably, these findings may not be generalisable to all populations since environmental and social factors can vary significantly depending on the local climatic zones and cultural backgrounds. The findings of the present review indicate that seasonal climate, events, and associated hormonal changes should be taken into account in order to maintain adequate energy intake throughout the year.
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Affiliation(s)
- Kyoko Fujihira
- Institute for Liberal Arts, Tokyo Institute of Technology, Tokyo, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Masaki Takahashi
- Institute for Liberal Arts, Tokyo Institute of Technology, Tokyo, Japan
- Department of Social and Human Sciences, Tokyo Institute of Technology, Tokyo, Japan
| | - Chunyi Wang
- Department of Social and Human Sciences, Tokyo Institute of Technology, Tokyo, Japan
| | - Naoyuki Hayashi
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Charlot K, Millet J, Pasquier F, Oustric P, Finlayson G, Van Beers P, Monin J, Sauvet F, Tardo-Dino PE, Malgoyre A. The impact of 16-h heat exposure on appetite and food reward in adults. Appetite 2022; 177:106144. [PMID: 35753442 DOI: 10.1016/j.appet.2022.106144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/02/2022]
Abstract
Heat exposure is thought to reduce energy intake (EI) but studies are sparse and results not always concordant. The aim of this study was to examine whether a 16-h exposure to 32 °C leads to reduced EI compared to a control session (22 °C) and whether modifications in appetite sensations or food reward are implied. Sixteen healthy, lean, and active participants (9 women and 7 men, 25 ± 5 yo, body mass index: 22.0 ± 2.4 kg.m-2) were passively exposed to two different thermal temperatures from 4:00 pm to 8:00 am under controlled conditions. Hunger and thirst scores were regularly assessed using visual analogue scales. A fixed dinner meal (3670 ± 255 kJ) was consumed at 7:30 pm and an ad libitum breakfast buffet (20 foods/drinks varying in temperature, fat, and carbohydrate content) at 7:30 am. Components of reward (explicit liking [EL] and implicit wanting [EI]) for fat and sweet properties of food were assessed before each meal using the Leeds Food Preference Questionnaire (LFPQ). Ad libitum EI at breakfast did not differ between sessions (2319 ± 1108 vs 2329 ± 1141 kJ, in 22 and 32 °C sessions, respectively; p = 0.955). While thirst scores were higher in the 32 than the 22 °C session (p < 0.001), hunger scores did not differ (p = 0.580). EL and IW for high fat foods relative to low fat foods were decreased in 32 compared to 22 °C before dinner and breakfast (p < 0.001 for all). Although EI and hunger were not affected by a 16-h exposure to heat, modifications in food reward suggested a reduction in the preference of high-fat foods. Future research should investigate whether reduced EI in response to heat exposure is due to spontaneous selection of low-fat foods rather than altered appetite sensations.
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Affiliation(s)
- Keyne Charlot
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 place Général Valérie André, 91223, Brétigny Cedex, France; LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025, Evry, France.
| | - Juliette Millet
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 place Général Valérie André, 91223, Brétigny Cedex, France; LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025, Evry, France
| | - Florane Pasquier
- French Institute of Sport (INSEP), Laboratory Sport, Expertise and Performance, EA, 7370, Paris, France
| | - Pauline Oustric
- Appetite Control Energy Balance Research Group, School of Psychology, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Graham Finlayson
- Appetite Control Energy Balance Research Group, School of Psychology, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Pascal Van Beers
- Unité Fatigue et Vigilance, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 place Général Valérie André, 91223, Brétigny Cedex, France; EA 7330 VIFASOM, Université de Paris, 75004, Paris, France
| | - Jonathan Monin
- Centre d'expertise principal du personnel naviguant, Hôpital d'instruction des armées Percy, 94140, Clamart, France
| | - Fabien Sauvet
- Unité Fatigue et Vigilance, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 place Général Valérie André, 91223, Brétigny Cedex, France; EA 7330 VIFASOM, Université de Paris, 75004, Paris, France
| | - Pierre-Emmanuel Tardo-Dino
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 place Général Valérie André, 91223, Brétigny Cedex, France; LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025, Evry, France
| | - Alexandra Malgoyre
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, 1 place Général Valérie André, 91223, Brétigny Cedex, France; LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025, Evry, France
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6
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What Is the Impact of Energy Expenditure on Energy Intake? Nutrients 2021; 13:nu13103508. [PMID: 34684509 PMCID: PMC8539813 DOI: 10.3390/nu13103508] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 02/07/2023] Open
Abstract
Coupling energy intake (EI) to increases in energy expenditure (EE) may be adaptively, compensatorily, or maladaptively leading to weight gain. This narrative review examines if functioning of the homeostatic responses depends on the type of physiological perturbations in EE (e.g., due to exercise, sleep, temperature, or growth), or if it is influenced by protein intake, or the extent, duration, timing, and frequency of EE. As different measures to increase EE could convey discrepant neuronal or humoral signals that help to control food intake, the coupling of EI to EE could be tight or loose, which implies that some ways to increase EE may have advantages for body weight regulation. Exercise, physical activity, heat exposure, and a high protein intake favor weight loss, whereas an increase in EE due to cold exposure or sleep loss likely contributes to an overcompensation of EI, especially in vulnerable thrifty phenotypes, as well as under obesogenic environmental conditions, such as energy dense high fat—high carbohydrate diets. Irrespective of the type of EE, transient elevations in the metabolic rate seem to be general risk factors for weight gain, because a subsequent decrease in energy requirement is not compensated by an adequate adaptation of appetite and EI.
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Millet J, Siracusa J, Tardo-Dino PE, Thivel D, Koulmann N, Malgoyre A, Charlot K. Effects of Acute Heat and Cold Exposures at Rest or during Exercise on Subsequent Energy Intake: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13103424. [PMID: 34684424 PMCID: PMC8538265 DOI: 10.3390/nu13103424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 02/06/2023] Open
Abstract
The objective of this meta-analysis was to assess the effect of acute heat/cold exposure on subsequent energy intake (EI) in adults. We searched the following sources for publications on this topic: PubMed, Ovid Medline, Science Direct and SPORTDiscus. The eligibility criteria for study selection were: randomized controlled trials performed in adults (169 men and 30 women; 20–52 years old) comparing EI at one or more meals taken ad libitum, during and/or after exposure to heat/cold and thermoneutral conditions. One of several exercise sessions could be realized before or during thermal exposures. Two of the thirteen studies included examined the effect of heat (one during exercise and one during exercise and at rest), eight investigated the effect of cold (six during exercise and two at rest), and three the effect of both heat and cold (two during exercise and one at rest). The meta-analysis revealed a small increase in EI in cold conditions (g = 0.44; p = 0.019) and a small decrease in hot conditions (g = −0.39, p = 0.022) for exposure during both rest and exercise. Exposures to heat and cold altered EI in opposite ways, with heat decreasing EI and cold increasing it. The effect of exercise remains unclear.
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Affiliation(s)
- Juliette Millet
- Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, 91223 Bretigny-Sur-Orge, France; (J.M.); (J.S.); (P.-E.T.-D.); (N.K.); (A.M.)
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
| | - Julien Siracusa
- Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, 91223 Bretigny-Sur-Orge, France; (J.M.); (J.S.); (P.-E.T.-D.); (N.K.); (A.M.)
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
| | - Pierre-Emmanuel Tardo-Dino
- Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, 91223 Bretigny-Sur-Orge, France; (J.M.); (J.S.); (P.-E.T.-D.); (N.K.); (A.M.)
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
| | - David Thivel
- Laboratory AME2P, University of Clermont Auvergne, 63170 Aubière, France;
| | - Nathalie Koulmann
- Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, 91223 Bretigny-Sur-Orge, France; (J.M.); (J.S.); (P.-E.T.-D.); (N.K.); (A.M.)
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
- Ecole du Val-de-Grâce, 1, Place Alphonse Laveran, 75230 Paris, France
| | - Alexandra Malgoyre
- Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, 91223 Bretigny-Sur-Orge, France; (J.M.); (J.S.); (P.-E.T.-D.); (N.K.); (A.M.)
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
| | - Keyne Charlot
- Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, 91223 Bretigny-Sur-Orge, France; (J.M.); (J.S.); (P.-E.T.-D.); (N.K.); (A.M.)
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
- Correspondence: ; Tel.: +33-(1)78-65-13-03
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