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Rahman MM, de Silva A, Sassa M, Islam MR, Aktar S, Akter S. A systematic analysis and future projections of the nutritional status and interpretation of its drivers among school-aged children in South-East Asian countries. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 16:100244. [PMID: 37456534 PMCID: PMC10344936 DOI: 10.1016/j.lansea.2023.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/29/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
Background Nutrition inadequacy during childhood and adolescence can cause suboptimal growth, intergenerational effects on offspring and an increased risk of chronic diseases in adulthood. There is little information on the prevalence and drivers of malnutrition in children aged 5-19 years, in the South-East Asian setting, since most existing interventions have to date targeted undernutrition. We assessed the national prevalence of nutritional indicators, their trends, and associated risk factors among children aged 5-19 years from 11 countries of WHO South-East Asia Region (SEA Region) in order to provide evidence to guide future policy direction. Methods We included 5,210,646 children for analysis from 345 studies and 25 survey datasets. A Newcastle-Ottawa Scale was used to assess the quality of the study. Bayesian regression models were used to estimate the prevalence of malnutrition between 2000 and 2030, and a series of subgroup analyses were performed to assess variation in pooled estimates by different socio-demographic and lifestyle factors. The protocol was registered with PROSPERO database (CRD42023400104). Findings Overall, pooled analysis demonstrated that indicators of undernutrition in SEA is predicted to decrease between 2000 and 2030 including stunting (36.6%-27.2%), thinness (29.5%-6.2%), and underweight (29.2%-15.9%). However, a substantial increase in prevalence of overweight (6.0% in 2000-16.9% in 2030), and obesity (2.6%-9.5%) are predicted. The prevalence of micronutrient deficiencies between 2000 and 2030 is predicted to decrease-vitamin A by 84% and vitamin D by 53%. Parents' education levels and household wealth were inversely associated with malnutrition. Children's health-related behaviours, such as unhealthy dietary habits and spending more time watching TV, playing games, or using the computer, were associated with increased chance of overweight and obesity. There were no clear signs of publication bias in our study. Interpretation Our analysis highlights the pattern of a double burden of malnutrition, with clear differences between different socio-demographic groups. Despite a substantial reduction in the prevalence of stunting, underweight, and anaemia since 2000, an emerging increase in overweight/obesity and micronutrient deficiencies warrants urgent attention. Funding World Health Organization Regional Office for South-East Asia New Delhi, India.
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Affiliation(s)
- Md. Mizanur Rahman
- Research Center for Health Policy and Economics, Hitotsubashi University, Tokyo, Japan
| | - Angela de Silva
- Nutrition and Health for Development Unit, Department of Healthier Populations and Noncommunicable Disease, World Health Organization (WHO), Regional Office for South-East Asia, India
| | - Miho Sassa
- Department of Global Health Policy, School of International Health, The University of Tokyo, Japan
| | - Md. Rashedul Islam
- Research Center for Health Policy and Economics, Hitotsubashi University, Tokyo, Japan
| | - Sarmin Aktar
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Shamima Akter
- Research Center for Health Policy and Economics, Hitotsubashi University, Tokyo, Japan
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Olatona FA, Ogide PI, Abikoye ET, Ilesanmi OT, Nnoaham KE. Dietary diversity and nutritional status of adolescents in Lagos, Nigeria. J Family Med Prim Care 2023; 12:1547-1554. [PMID: 37767409 PMCID: PMC10521850 DOI: 10.4103/jfmpc.jfmpc_1783_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/21/2022] [Accepted: 03/22/2023] [Indexed: 09/29/2023] Open
Abstract
Background/Objectives Adolescents in low- and middle-income countries, such as Nigeria, are at increased risk of malnutrition, especially obesity, but there is limited data describing the risk. We assessed this risk by examining the nutritional status and associated factors such as dietary habits, dietary diversity, nutritional knowledge and sociodemographic characteristics among adolescents in Lagos, Nigeria. Methods A descriptive cross-sectional study in which 682 adolescents were selected from their communities using a multistage sampling technique. Dietary habits were assessed using a food frequency questionnaire, and dietary diversity was assessed through nonquantifiable 24-h diet recall. Anthropometric measurements were taken to determine nutritional status. Data were analyzed using Epi-Info software version 7.2.3.1. Nutritional status was evaluated using WHO AnthroPlus software. Chi-square was used to test for an association between categorical variables, and P values ≤0.05 were considered statistically significant. Results The mean age of the adolescents was 13.6 ± 2.3 years, and only 47.4% of them had good nutritional knowledge. Dietary habits were poor and dietary diversity was low. The prevalence of overweight and obesity was 13.4% and 7.0%. Eating dinner, dieting to control weight and daily consumption of foods outside the home were associated with overweight and obesity (P < 0.05). Conclusions Dietary habits and diversity of the adolescents were poor, while overweight and obesity were high. Eating dinner and daily consumption of foods outside the home were factors associated with being overweight and obesity. Our findings emphasize the critical need for adolescent nutrition programs that address weight control, especially among those who eat outside their homes.
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Affiliation(s)
- Foluke A. Olatona
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Precious I. Ogide
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ebunoluwa T. Abikoye
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Oluwafemi T. Ilesanmi
- Department of Medical Rehabilitation, Obafemi Awolowo University Teaching Hospitals Complex, Ile- Ife, Nigeria
| | - Kelechi E. Nnoaham
- Faculty of Health and Human Sciences, Plymouth University, England, United Kingdom
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Overweight/Obesity Prevalence among Under-Five Children and Risk Factors in India: A Cross-Sectional Study Using the National Family Health Survey (2015–2016). Nutrients 2022; 14:nu14173621. [PMID: 36079879 PMCID: PMC9460849 DOI: 10.3390/nu14173621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
The occurrence of overweight and obesity has increased in recent years in India. In this study, we investigate the prevalence and associated risk factors of overweight/obesity among children aged 0–59 months in India. Using data from the 2015–2016 National Family Health Survey-4 (NFHS-4), the research sample included 176,255 children aged 0 to 59 months. Bivariate and multivariate techniques were used to analyze children’s risk factors for overweight/obesity. We identified that the prevalence of overweight/obesity among children aged 0–59 was 2.6% in India. The study findings reveal that factors such as child sex, age, birth weight, birth rank, maternal education, number of children, age at marriage, mother’s BMI, media exposure, social group, and dietary diversity score were most significantly correlated with childhood overweight and obesity in India. Furthermore, we found that male children (ARR: 1.08) aged between 0 and 11 months (ARR: 3.77) with low birth rank (ARR: 1.24), obese (ARR: 1.81) children whose mothers married after the age of 18 (ARR: 1.15), children who belong to a scheduled tribe family (ARR: 1.46), and children who consumed 7–9 food items (ARR: 1.22) were at highest risk of being overweight and obese. However, breastfeeding (ARR: 0.85) and Muslim families (ARR: 0.87) appeared to be protective factors with respect to childhood overweight and obesity in India. Pertinent public health programs, clinical follow-up, and awareness about sedentary lifestyles can help to reduce overweight/obesity risks in children.
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Bhargava M, Bhargava A, Ghate SD, Rao RSP. Nutritional status of Indian adolescents (15-19 years) from National Family Health Surveys 3 and 4: Revised estimates using WHO 2007 Growth reference. PLoS One 2020; 15:e0234570. [PMID: 32569312 PMCID: PMC7307767 DOI: 10.1371/journal.pone.0234570] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/27/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The National Family Health Surveys (NFHS) in India apply adult cutoffs of nutritional status for the estimation of undernutrition/overweight in the 15-19 age group. The prevalence of thinness in boys and girls thus estimated is 58.1% and 46.8% in NFHS-3, and 45% and 42% in NFHS-4 respectively. But the WHO recommends using age and sex-specific reference for adolescents. We reanalyzed the nutritional status of the adolescents using the WHO 2007 Growth Reference to obtain revised estimates of thinness, overweight and stunting across states, rural-urban residence, and wealth quintiles. METHODS AND FINDINGS Demographic information, anthropometric data, and wealth index were accessed from the Demographic and Health Survey (DHS) database. We re-analyzed the anthropometric data using WHO AnthroPlus software which uses the WHO 2007 Growth reference. The revised estimates of thinness assessed by BMI-for-age z-scores in boys and girls was 22.3% (95%CI: 21.6, 23.0) and 9.9% (95%CI: 9.5, 10.3) in NFHS-3 and 16.5% (95%CI: 16.0,17.0) and 9% (95%CI: 8.9, 9.2) in NFHS-4 respectively. Stunting was found to be 32.2% (95% CI: 31.6, 32.9) in boys and 34.4% (95% CI: 34.2, 34.7) in girls in NFHS-4. This was higher than that in NFHS-3; 25.2% (95% CI: 24.4, 26) in boys and 31.2 (95% CI: 30.6, 31.8) in girls. There was a clear socioeconomic gradient as there were higher thinness and stunting in rural areas. There was wide variation among the states with pockets of a double burden of malnutrition. CONCLUSION Using the adult cutoffs significantly overestimates thinness in adolescents in the age group of 15-19 years old in India. Stunting, which is an indicator of long term nutrition is also widely prevalent in them. Future editions of DHS and NFHS should consider adolescents as a separate age group for nutritional assessment for a better understanding of nutritional transition in the population.
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Affiliation(s)
- Madhavi Bhargava
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
- Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
- * E-mail:
| | - Anurag Bhargava
- Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
- Department of General Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Sudeep D. Ghate
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - R. Shyama Prasad Rao
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
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Jansen EC, Dunietz GL, Tsimpanouli ME, Guyer HM, Shannon C, Hershner SD, O'Brien LM, Baylin A. Sleep, Diet, and Cardiometabolic Health Investigations: a Systematic Review of Analytic Strategies. Curr Nutr Rep 2019; 7:235-258. [PMID: 30187293 DOI: 10.1007/s13668-018-0240-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Poor sleep is a risk factor for cardiometabolic morbidity. The relationship of sleep and cardiometabolic health could be confounded, mediated, or modified by diet, yet the incorporation of diet in sleep-cardiometabolic health studies is inconsistent. This rapid systematic literature review evaluates the conceptualization of diet as a confounder, mediator, or effect modifier within sleep-cardiometabolic health investigations, and the statistical approaches utilized. RECENT FINDINGS Of 4692 studies identified, 60 were retained (28 adult, 32 pediatric). Most studies included diet patterns, quality, or energy intake as confounders, while a few examined these dietary variables as mediators or effect modifiers. There was some evidence, mostly in pediatric studies, that inclusion of diet altered sleep-cardiometabolic health associations. Diet plays a diverse role within sleep-cardiometabolic health associations. Investigators should carefully consider the conceptualization of diet variables in these relationships and utilize contemporary statistical approaches when applicable.
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Affiliation(s)
- Erica C Jansen
- Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, C728 Med Inn Building, Ann Arbor, MI, 48109, USA.
| | - Galit Levi Dunietz
- Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, C728 Med Inn Building, Ann Arbor, MI, 48109, USA
| | - Maria-Efstratia Tsimpanouli
- Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, C728 Med Inn Building, Ann Arbor, MI, 48109, USA
| | - Heidi M Guyer
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Carol Shannon
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Shelley D Hershner
- Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, C728 Med Inn Building, Ann Arbor, MI, 48109, USA
| | - Louise M O'Brien
- Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, C728 Med Inn Building, Ann Arbor, MI, 48109, USA.,Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA.,Department of Oral & Maxillofacial Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Ana Baylin
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Nonboonyawat T, Pusanasuwannasri W, Chanrat N, Wongthanavimok N, Tubngern D, Panutrakul P, Mungthin M, Nivesvivat T, Hatthachote P, Rangsin R, Piyaraj P. Prevalence and associates of obesity and overweight among school-age children in a rural community of Thailand. KOREAN JOURNAL OF PEDIATRICS 2019; 62:179-186. [PMID: 30744316 PMCID: PMC6528063 DOI: 10.3345/kjp.2018.06499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 02/08/2019] [Indexed: 11/27/2022]
Abstract
Purpose Information about overweight and obesity among students in rural areas of Thailand is limited. Therefore, we aimed to determine overweight and obesity prevalences and associated factors among school-aged children in a rural community of Thailand. Methods We selected 9 public schools through cluster sampling in 2 provinces located in central Thailand in 2016. Anthropometric measurements were measured using standard techniques, classified as overweight (>1 standard deviation [SD]) and obese (>2 SD) with respect to their age and sex using 2007 World Health Organization reference charts. Standardized questionnaires on risk factors were sent to parents to be completed together with their child. Results Among 1,749 students, 8.98% had overweight and 7.26% had obesity. Mean age (range) was 11.5 years (5–18 years). Independent factors associated with overweight and obesity included primary school student (reference as secondary school) (adjusted odds ratio [aOR], 2.25; 95% confidence interval [CI], 1.24–4.08; P=0.07), mother’s body mass index (aOR, 1.07; 95% CI, 1.02–1.12; P=0.001), self-employed father (aOR, 1.99; 95% CI, 1.12–3.55; P=0.018), number of siblings (aOR, 0.61; 95% CI, 0.47–0.81; P=0.001), having sibling(s) with obesity (aOR, 1.82; 95% CI, 1.20–2.77; P=0.005), more than one (aOR, 7.16; 95% CI, 2.40–21.32; P<0.001), consuming 2–3 ladles of rice/meal (aOR, 2.14; 95% CI, 1.38–3.32; P=0.001), consuming >3 ladles of rice/meal (aOR, 2.69; 95% CI, 1.11–6.46; P= 0.27), watching <2 hours of television/day (aOR, 2.18; 95% CI, 1.19–4.01; P=0.012), and watching >2 hours of television/day (aOR, 2.60; 95% CI, 1.36–4.96; P=0.004). Conclusion Many sociodemographic, dietary, and behavioral factors were related to overweight and obesity among school-aged children not only in urban but also rural communities of Thailand.
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Affiliation(s)
| | | | - Nattanon Chanrat
- 5th Year Medical Cadet, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Danutanut Tubngern
- 5th Year Medical Cadet, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Mathirut Mungthin
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Panadda Hatthachote
- Department of Physiology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Phunlerd Piyaraj
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, Thailand
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Ford ND, Patel SA, Narayan KV. Obesity in Low- and Middle-Income Countries: Burden, Drivers, and Emerging Challenges. Annu Rev Public Health 2017; 38:145-164. [DOI: 10.1146/annurev-publhealth-031816-044604] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We have reviewed the distinctive features of excess weight, its causes, and related prevention and management efforts, as well as data gaps and recommendations for future research in low- and middle-income countries (LMICs). Obesity is rising in every region of the world, and no country has been successful at reversing the epidemic once it has begun. In LMICs, overweight is higher in women compared with men, in urban compared with rural settings, and in older compared with younger individuals; however, the urban–rural overweight differential is shrinking in many countries. Overweight occurs alongside persistent burdens of underweight in LMICs, especially in young women. Changes in the global diet and physical activity are among the hypothesized leading contributors to obesity. Emerging risk factors include environmental contaminants, chronic psychosocial stress, neuroendocrine dysregulation, and genetic/epigenetic mechanisms. Data on effective strategies to prevent the onset of obesity in LMICs or elsewhere are limited. Expanding the research in this area is a key priority and has important possibilities for reverse innovation that may also inform interventions in high-income countries.
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Affiliation(s)
- Nicole D. Ford
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia 30322
| | - Shivani A. Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322;,
| | - K.M. Venkat Narayan
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia 30322
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322;,
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Tarun S, Arora M, Rawal T, Benjamin Neelon SE. An evaluation of outdoor school environments to promote physical activity in Delhi, India. BMC Public Health 2017; 17:11. [PMID: 28056908 PMCID: PMC5217605 DOI: 10.1186/s12889-016-3987-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 12/22/2016] [Indexed: 12/04/2022] Open
Abstract
Background Increasing physical activity in children is an important public health goal in India. Schools may be a target for physical activity promotion, but little is known about outdoor school environments. The purpose of this study was to describe characteristics of the surrounding outdoor school environments that may promote children’s physical activity in Delhi, India. Methods For this cross-sectional study, we conducted a structured observation of outdoor school environments in a random sample of 16 private schools in Delhi, India using the Sport, Physical activity and Eating behavior: Environmental Determinants in Young people (SPEEDY) audit tool. The SPEEDY school audit measured six categories, including (1) access to the school; (2) surrounding area; (3) school grounds; (4) aesthetics; (5) usage; and (6) overall environment. Six trained data collectors conducted the audit independently in the summer of 2012 while schools were in session. Results Of the 16 schools, one had cycle lanes separated from the road while two schools had cycle lanes on the road. Two schools had pavement on both sides of the road for pedestrians. One school had marked pedestrian crossings. No schools had school warning signs, road safety signs, or route signs for cyclists that would help calm vehicular traffic. Fifteen schools had playground equipment and nine had courts, an assault course (a sequence of equipment designed to be used together), and a quadrangle (an enclosed or semi-enclosed courtyard) for outdoor physical activity. The majority of schools were shielded from the surrounding area by hedges, trees, or fences (n = 13) and were well maintained (n = 10). One school had evidence of vandalism. Two schools had graffiti, seven had litter, and 15 had murals or art. Conclusions The majority of schools did not have infrastructure to support physical activity, such as cycle lanes, marked pedestrian crossings, or traffic calming mechanisms such as school warning signs. However, most had playground equipment, courts, and outdoor play areas. Nearly all were free from vandalism and many had murals or art. These results provide preliminary data for future work examining outdoor school environments, active transport to school, and children’s physical activity in India. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3987-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samiksha Tarun
- Saint Louis University School of Medicine, 1402 South Grand Boulevard, St Louis, MO, 63104, USA
| | - Monika Arora
- Health Promotion and Tobacco Control, Public Health Foundation of India, Plot No. 47, Sector-44, Gurgaon, 122002, India
| | - Tina Rawal
- Public Health Foundation of India, Plot No. 47, Sector-44, Gurgaon, 122002, India
| | - Sara E Benjamin Neelon
- Department of Health, Behavior and Society, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, USA.
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