Nutrients

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12 pages, 311 KiB

Open AccessArticle

Barriers to and Facilitators of the Consumption of Animal-Based Protein-Rich Foods in Older Adults: Re-Analysis with a Focus on Sustainability

by Katherine M. Appleton

Nutrients 2023, 15(2), 470; https://doi.org/10.3390/nu15020470 - 16 Jan 2023

Cited by 3 | Viewed by 2286

Abstract

Older adults may gain health benefits from the consumption of animal-based protein-rich foods, but environmental pressures suggest advocating some meat and dairy foods over others, and understanding the barriers and facilitators for consuming these different foods would be of value. Existing data on [...] Read more.

Older adults may gain health benefits from the consumption of animal-based protein-rich foods, but environmental pressures suggest advocating some meat and dairy foods over others, and understanding the barriers and facilitators for consuming these different foods would be of value. Existing data on the barriers to and facilitators of the consumption of meat and dairy products were re-analysed for differing effects for white, red, and processed meat consumption and for yoghurt, soft cheese, and hard cheese consumption. White meat consumption was associated with fewer concerns over spoilage and waste and stronger perceptions that meat is convenient (smallest Beta = 0.135, p = 0.01), while red and processed meat consumption were positively associated with liking /taste, appearance, and convenience (smallest Beta = 0.117, p = 0.03). Yoghurt and soft cheese consumption were positively associated with liking/taste and medical concerns, and fewer concerns over ability and habit (smallest Beta = −0.111, p = 0.05), while hard cheese consumption was only associated with liking/taste (Beta = 0.153, p = 0.01). Taken together, these data suggest that enhancing or promoting the enjoyment, taste, visual appeal, and ease-of-consumption of the more sustainable meat and dairy options may be of value in encouraging the consumption of these foods in older adults. Full article

(This article belongs to the Special Issue Dietary and Lifestyle-Related Behaviours in Community-Dwelling Older Adults)

11 pages, 375 KiB

Open AccessArticle

Effects of Both Japanese-Style Dietary Patterns and Nutrition on Falling Incidents among Community-Dwelling Elderly Individuals: A Cross-Sectional Study

by Ji-Woo Park, Satoko Kakuta, Rie Sakai, Tomoko Hamasaki and Toshihiro Ansai

Nutrients 2022, 14(21), 4663; https://doi.org/10.3390/nu14214663 - 4 Nov 2022

Viewed by 2174

Abstract

Approximately 20% of the community-dwelling Japanese elderly (≥65 years) experience falling annually, with injury frequency rising with age. Increased nursing home admission/hospitalization risk influences healthy aging and QOL. Nutrition for musculoskeletal health is necessary, though the relationship of falling with nutritional status in [...] Read more.

Approximately 20% of the community-dwelling Japanese elderly (≥65 years) experience falling annually, with injury frequency rising with age. Increased nursing home admission/hospitalization risk influences healthy aging and QOL. Nutrition for musculoskeletal health is necessary, though the relationship of falling with nutritional status in the elderly is largely unknown. We investigated falling incidents and nutritional status, including a Japanese-style diet in a community-dwelling cohort. Using a cross-sectional design, 186 subjects (median age 83.0 years, males/females 67/119) were analyzed. Oral and systemic health conditions were assessed. A brief-type self-administered diet history questionnaire (BDHQ) was given for nutritional status. Analysis of covariance (adjusted for gender, age, BMI, articular disease/osteoporosis history, present tooth number, educational level) and the Japanese-Mediterranean diet (jMD) score adapted for Japan were used. The jMD score and falling incidents were significantly associated, with point increases related to a significantly decreased falling risk of 28% (OR: 0.72; 95%CI: 0.57–0.91). Of the 13 jMD food components, fish, eggs, and potatoes had a significant relationship with reduced falling, while significant associations of intake of animal protein, potassium, magnesium, zinc, and cholesterol (p < 0.05) were also observed. The results suggest that the jMD dietary pattern is an important factor for the prevention of falling incidents in elderly individuals. Full article

(This article belongs to the Special Issue Dietary and Lifestyle-Related Behaviours in Community-Dwelling Older Adults)

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15 pages, 986 KiB

Open AccessArticle

Factors Associated with Low Vitamin D Status among Older Adults in Kuwait

by Thurayya ALbuloshi, Ahmed M. Kamel and Jeremy P. E. Spencer

Nutrients 2022, 14(16), 3342; https://doi.org/10.3390/nu14163342 - 15 Aug 2022

Cited by 7 | Viewed by 2656

Abstract

Low vitamin D levels among older people represent a significant health problem worldwide. This study aimed to examine the factors associated with vitamin D deficiency in older people (aged ≥ 65) in the Kuwaiti population. A cross-sectional study was conducted in seven primary [...] Read more.

Low vitamin D levels among older people represent a significant health problem worldwide. This study aimed to examine the factors associated with vitamin D deficiency in older people (aged ≥ 65) in the Kuwaiti population. A cross-sectional study was conducted in seven primary healthcare centers across Kuwait (November 2020 to June 2021). The participants (n = 237) had their serum vitamin D (25(OH)D) concentrations (analyzed using LC-MS) classified as sufficiency 75 nmol/L (30 ng/mL) or deficiency < 75 nmol/L (below 30 ng/mL). The data were collected using self-administered questionnaires and face-to-face interviews with participants in geriatric clinics. Binomial logistic regression analysis was applied to assess factors associated with vitamin D deficiency. Vitamin D deficiency was found to be present in two thirds of the participants (n = 150, 63%), with a higher prevalence of deficiency in participants who did not receive vitamin D supplements, compared to those who did (84% vs. 16%, p = 0.001). The results from the binary logistic regression showed that a low duration of sun exposure (OR = 0.24, 95% C.I. [0.08–0.7], p = 0.011), dark skin pigmentation (OR = 4.46, 95% [1.35–20.49], p = 0.026), and lower caloric intake (OR = 0.9, 95% C.I. [0.85–0.96], p = 0.001) were risk factors for vitamin D deficiency. Furthermore, a significant inverse relationship was found between vitamin D levels and parathyroid hormone (PTH) levels (OR = 1.16, 95% C.I. [1.04–1.31], p = 0.016). These findings support the recommendation that vitamin D supplementation and adequate sunlight exposure are necessary for raising low vitamin D levels in older people in Kuwait. Full article

(This article belongs to the Special Issue Dietary and Lifestyle-Related Behaviours in Community-Dwelling Older Adults)

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15 pages, 322 KiB

Open AccessArticle

Association between Lebanese Mediterranean Diet and Frailty in Community-Dwelling Lebanese Older Adults—A Preliminary Study

by Tracy Daou, Joelle Abi Kharma, Alexandra Daccache, Maya Bassil, Farah Naja and Berna Rahi

Nutrients 2022, 14(15), 3084; https://doi.org/10.3390/nu14153084 - 27 Jul 2022

Cited by 3 | Viewed by 2319

Abstract

Discrepancies in the characteristics of the food components of a Mediterranean diet exist based on the country of origin. In Lebanon, a traditional Mediterranean diet emphasizes the high intakes of fruits (including dried), vegetables, burghol, and dairy products. Therefore, this cross-sectional study aimed [...] Read more.

Discrepancies in the characteristics of the food components of a Mediterranean diet exist based on the country of origin. In Lebanon, a traditional Mediterranean diet emphasizes the high intakes of fruits (including dried), vegetables, burghol, and dairy products. Therefore, this cross-sectional study aimed to explore the association between adherence to the Lebanese Mediterranean diet (LMD) and frailty among older adults in Lebanon. A total of 112 community-dwelling older adults aged ≥65 years were recruited. Demographic and clinical characteristics were collected through face-to-face interviews. A 61-item food frequency questionnaire (FFQ) was used to collect dietary intake data, and adherence to LMD was calculated. Physical frailty was defined by the presence of three out of the five criterion: weight loss, weakness, exhaustion, slowness, and low activity. Binary logistic regression was used to examine the relationship between LMD adherence and frailty while adjusting for several confounders. The participants’ mean age was 73 ± 12.8 and 65% were females. Sixteen (14.3%) individuals were identified as frail. Frail individuals were significantly older (p = 0.001), depressed (p < 0.001), at risk of cognitive impairment (p = 0.006), and reported polypharmacy (p = 0.003). No significant association was found between LMD adherence and frailty in fully adjusted models (OR = 0.195; 95% CI: 0.033–1.154; p = 0.071 when categorical and OR = 0.856; 95% CI: 0.668–1.097; p = 0.218 when continuous). We also performed additional analyses with a modified frailty index where house chores were not considered as part of leisure activities of the physical activity criterion. The results showed that a higher LMD adherence was associated with a significantly decreased frailty prevalence (OR = 0.123, 95% CI: 0.022–0.676, p = 0.016 when categorical and OR = 0.773, 95% CI 0.608–0.983, p = 0.036). Larger, longitudinal studies are needed to clarify the relationship between the adherence to the Lebanese Mediterranean diet and frailty in Lebanese older adults. Full article

(This article belongs to the Special Issue Dietary and Lifestyle-Related Behaviours in Community-Dwelling Older Adults)

11 pages, 539 KiB

Open AccessArticle

Relationship between Dietary Patterns and Subjectively Measured Physical Activity in Japanese Individuals 85 Years and Older: A Cross-Sectional Study

by Tao Yu, Yuko Oguma, Keiko Asakura, Michiyo Takayama, Yukiko Abe and Yasumichi Arai

Nutrients 2022, 14(14), 2924; https://doi.org/10.3390/nu14142924 - 17 Jul 2022

Cited by 3 | Viewed by 2579

Abstract

High-quality diets and regular physical activity (PA) are considered healthy behaviors (HBs). HBs are associated with many health outcomes and are expected to improve quality of life. Although implementing HBs is important, the relationship between dietary patterns (DPs) and PA has not been [...] Read more.

High-quality diets and regular physical activity (PA) are considered healthy behaviors (HBs). HBs are associated with many health outcomes and are expected to improve quality of life. Although implementing HBs is important, the relationship between dietary patterns (DPs) and PA has not been well investigated, especially among those aged ≥ 85. This study used data from the Tokyo Oldest Old survey on Total Health study to examine the relationship between DPs and PA in a cross-sectional study. The dietary survey used the brief self-administered diet history questionnaire to estimate the intake of 58 foods. After energy adjustment, principal component analysis was performed to identify major DPs. A validated questionnaire was used to evaluate PA, and linear regression analysis was used to investigate the association between DPs and PA, considering confounders. A total of 519 participants were included. Three major DPs (‘Various plant foods’, ‘Fish and mushrooms’, ‘Cooked rice and miso soup’) were identified. ‘Various plant foods’ was similar to DPs previously named ‘Healthy’ or ‘Prudent’, and its trend was positively associated with higher PA. This study observed the implementation of HBs even among those aged ≥ 85, suggesting that a trend toward a healthier diet is associated with higher PA. Full article

(This article belongs to the Special Issue Dietary and Lifestyle-Related Behaviours in Community-Dwelling Older Adults)

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11 pages, 272 KiB

Open AccessArticle

Meal Patterns of Older Adults: Results from the OUTDOOR ACTIVE Study

by Imke Stalling, Birte Marie Albrecht, Linda Foettinger, Carina Recke and Karin Bammann

Nutrients 2022, 14(14), 2784; https://doi.org/10.3390/nu14142784 - 6 Jul 2022

Cited by 4 | Viewed by 1764

Abstract

Eating habits have a substantial effect on health, not only because of consumed foods and nutrients, but also because of the regularity of meals. This study investigates meal patterns in older adults. Data from 1198 adults (52.8% female) aged between 65 and 75 [...] Read more.

Eating habits have a substantial effect on health, not only because of consumed foods and nutrients, but also because of the regularity of meals. This study investigates meal patterns in older adults. Data from 1198 adults (52.8% female) aged between 65 and 75 years, who resided in Bremen, Germany, were included in this cross-sectional study. Using a self-administered questionnaire, daily meals were assessed and categorised into three meal pattern types: ‘regular eaters’ (eating at least three meals a day), ‘meal skippers’ (skipping one meal a day), and ‘irregular eaters’ (skipping more than one meal a day). Descriptive analyses were carried out, stratified by sex and meal pattern types. Most women and men were regular eaters (51.5% and 51.7%, respectively), 33.8% of women and 33.3% of men were meal skippers, and 14.7% of women and 15.0% of men were irregular eaters. Differences between meal patterns were seen with regard to socioeconomic status; self-rated health; body-mass index; hypertension; consumption of self-prepared meals; and consumption of whole-grain products, green vegetables, meat, and alcohol. The results provide first insights into possible associations between meal patterns and sociodemographic and health factors, and can benefit disease prevention and health promotion in older adults. Full article

(This article belongs to the Special Issue Dietary and Lifestyle-Related Behaviours in Community-Dwelling Older Adults)

14 pages, 316 KiB

Open AccessArticle

Adherence to Lifestyle Recommendations for Bone Health in Older Adults with and without Osteoporosis: Cross-Sectional Results of the OUTDOOR ACTIVE Study

by Birte Marie Albrecht, Imke Stalling, Linda Foettinger, Carina Recke and Karin Bammann

Nutrients 2022, 14(12), 2463; https://doi.org/10.3390/nu14122463 - 14 Jun 2022

Cited by 9 | Viewed by 3009

Abstract

Sustaining good bone health into older age is key for preventing osteoporosis. Bone health is associated with several lifestyle factors. This study investigates older adults’ adherence to bone health-promoting lifestyle recommendations dependent on osteoporosis status. Cross-sectional data of 1610 community-dwelling older adults (65–75 [...] Read more.

Sustaining good bone health into older age is key for preventing osteoporosis. Bone health is associated with several lifestyle factors. This study investigates older adults’ adherence to bone health-promoting lifestyle recommendations dependent on osteoporosis status. Cross-sectional data of 1610 community-dwelling older adults (65–75 years) residing in Bremen, Germany (53.4% female) were included. The Osteoporosis Self-Assessment Tool and self-reported osteoporosis diagnosis were used to classify participants by osteoporosis status (low risk, high risk, diagnosis). Adherence to bone health recommendations regarding calcium and vitamin D intake, sun exposure, alcohol consumption, resistance/weight-bearing exercise, and physical activity were assessed. Descriptive statistics were applied, stratified by sex and osteoporosis status. A total of 91 women (10.6%) and 15 men (2.0%) reported an osteoporosis diagnosis, 457 women (43.2%) and 311 men (41.4%) were classified as having a high risk, and 311 women (36.2%) and 425 men (56.6%) as having a low risk. Adherence to bone health recommendations was high for calcium intake (93.3–100.0%), vitamin D intake (77.8–93.3%), and sun exposure (86.7–97.7%). Lower adherence was observed regarding resistance/weight-bearing exercise (36.3–54.4%), physical activity (14.3–57.7%), and alcohol consumption (40.0–72.4%). In conclusion, tailored prevention strategies are needed that focus on older adults with an osteoporosis diagnosis or who are at high risk. Full article

(This article belongs to the Special Issue Dietary and Lifestyle-Related Behaviours in Community-Dwelling Older Adults)

13 pages, 727 KiB

Open AccessArticle

Behavioral Health Risk Factors and Motivation to Change among Cardiovascular General Hospital Patients Aged 50 to 79 Years

by Ulrike Siewert-Markus, Sabina Ulbricht, Beate Gaertner, Birgit-Christiane Zyriax, Marcus Dörr, Stefanie Tobschall, Sophie Baumann, Ulrich John and Jennis Freyer-Adam

Nutrients 2022, 14(9), 1963; https://doi.org/10.3390/nu14091963 - 7 May 2022

Cited by 4 | Viewed by 2148

Abstract

Little is known about the (co-)occurrence of smoking, alcohol at-risk drinking, physical inactivity and overweight, and the motivation to change these behavioral health risk factors (HRFs) in older general hospital patients with cardiovascular disease. Between October and December 2016, all consecutively admitted patients [...] Read more.

Little is known about the (co-)occurrence of smoking, alcohol at-risk drinking, physical inactivity and overweight, and the motivation to change these behavioral health risk factors (HRFs) in older general hospital patients with cardiovascular disease. Between October and December 2016, all consecutively admitted patients aged 50 to 79 years were proactively recruited on 3 cardiology wards and asked to participate in a survey on HRFs and behavior change motivation. Of the eligible patients, 80.4% participated in the survey (n = 328). The mean age was 66.5 years (standard deviation 9.0), and 65.5% were male. At least 1 HRF was present in 91.8% (n = 280), at least 2 HRFs in 54.4% (n = 166), and 3 or 4 HRFs in 12.1% (n = 37) of participants. The proportion of older adults who contemplated or were changing or planning to change their behavior to meet health behavior recommendations ranged between 66.0% (smoking) and 93.2% (alcohol consumption). The results indicate a notable co-occurrence of behavioral HRFs in older patients with cardiovascular disease. The majority of older adults were at least considering changing the respective behavior. To prevent and treat diseases efficiently, hospitalization may be a suitable moment for systematic multiple HRF screening and intervention. Full article

(This article belongs to the Special Issue Dietary and Lifestyle-Related Behaviours in Community-Dwelling Older Adults)

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12 pages, 289 KiB

Open AccessArticle

Nutrition Risk, Resilience and Effects of a Brief Education Intervention among Community-Dwelling Older Adults during the COVID-19 Pandemic in Alberta, Canada

by Michelle Capicio, Simran Panesar, Heather Keller, Leah Gramlich, Naomi Popeski, Carlota Basualdo-Hammond, Marlis Atkins and Catherine B. Chan

Nutrients 2022, 14(5), 1110; https://doi.org/10.3390/nu14051110 - 6 Mar 2022

Cited by 5 | Viewed by 5185

Abstract

Up to two-thirds of older Canadian adults have high nutrition risk, which predisposes them to frailty, hospitalization and death. The aim of this study was to examine the effect of a brief education intervention on nutrition risk and use of adaptive strategies to [...] Read more.

Up to two-thirds of older Canadian adults have high nutrition risk, which predisposes them to frailty, hospitalization and death. The aim of this study was to examine the effect of a brief education intervention on nutrition risk and use of adaptive strategies to promote dietary resilience among community-dwelling older adults living in Alberta, Canada, during the COVID-19 pandemic. The study design was a single-arm intervention trial with pre–post evaluation. Participants (N = 28, age 65+ years) in the study completed a survey online or via telephone. Questions included the Brief Resilience Scale (BRS), SCREEN-14, a brief poverty screen, and a World Health Organization-guided questionnaire regarding awareness and use of nutrition-related services and resources (S and R). A brief educational intervention involved raising participant awareness of available nutrition S and R. Education was offered via email or postal mail with follow-up surveys administered 3 months later. Baseline and follow-up nutrition risk scores, S and R awareness and use were compared using paired t-test. Three-quarters of participants had a high nutrition risk, but very few reported experiencing financial strain or food insecurity. Those at high nutrition risk were more likely to report eating alone, compared to those who scored as low risk. There was a significant increase in awareness of 20 S and R as a result of the educational intervention, but no change in use. The study shows increasing individual knowledge about services and resources in the community is not sufficient to change use of these services or improve nutrition risk. Full article

(This article belongs to the Special Issue Dietary and Lifestyle-Related Behaviours in Community-Dwelling Older Adults)

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10 pages, 708 KiB

Open AccessArticle

Eating Speed Is Associated with the Presence of Sarcopenia in Older Patients with Type 2 Diabetes: A Cross-Sectional Study of the KAMOGAWA-DM Cohort

by Yoshitaka Hashimoto, Fuyuko Takahashi, Ayumi Kaji, Ryosuke Sakai, Takuro Okamura, Noriyuki Kitagawa, Hiroshi Okada, Naoko Nakanishi, Saori Majima, Takafumi Senmaru, Emi Ushigome, Mai Asano, Masahide Hamaguchi, Masahiro Yamazaki and Michiaki Fukui

Nutrients 2022, 14(4), 759; https://doi.org/10.3390/nu14040759 - 11 Feb 2022

Cited by 5 | Viewed by 2827

Abstract

To determine the relationship between eating speed and the presence of sarcopenia in older patients with type 2 diabetes (T2D), in this cross-sectional study, patient eating speeds were classified as “fast-”, “normal-” and “slow-speed eating.” A multifrequency impedance analyzer was used to evaluate [...] Read more.

To determine the relationship between eating speed and the presence of sarcopenia in older patients with type 2 diabetes (T2D), in this cross-sectional study, patient eating speeds were classified as “fast-”, “normal-” and “slow-speed eating.” A multifrequency impedance analyzer was used to evaluate patient body compositions. Sarcopenia was defined as having both low muscle strength, a handgrip strength <28 kg for men and <18 kg for women, and low skeletal muscle mass as a skeletal muscle mass index <7.0 kg/m² for men and <5.7 kg/m² for women. Among 239 individuals, the frequencies of fast-, normal-, and slow-speed eating were 47.3%, 32.2%, and 20.5%, respectively; and the prevalence of sarcopenia was 15.9%. Patients with a slow eating speed had greater prevalence of low skeletal muscle mass, low muscle strength, and sarcopenia than those with a fast or normal eating speed. After adjusting for covariates, compared to slow eaters, the odds ratio of having sarcopenia among fast- and normal-speed eaters was 0.31 [95% CI: 0.12–0.80] and 0.18 [95% CI: 0.06–0.53], respectively. Having a slow eating speed is associated with a heightened risk of sarcopenia in older patients with T2D. Full article

(This article belongs to the Special Issue Dietary and Lifestyle-Related Behaviours in Community-Dwelling Older Adults)

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14 pages, 584 KiB

Open AccessArticle

Eating Slowly Is Associated with Undernutrition among Community-Dwelling Adult Men and Older Adult Women

by Tomiyo Nakamura, Yasuyuki Nakamura, Naoyuki Takashima, Aya Kadota, Katsuyuki Miura, Hirotsugu Ueshima and Yosikuni Kita

Nutrients 2022, 14(1), 54; https://doi.org/10.3390/nu14010054 - 23 Dec 2021

Cited by 6 | Viewed by 4897

Abstract

The double burden of malnutrition refers to the co-occurrence of overweight and obesity and undernutrition. Eating quickly has been linked to overweight and obesity. However, no study has examined the association between eating speed and undernutrition. This retrospective, cross-sectional study analyzed data from [...] Read more.

The double burden of malnutrition refers to the co-occurrence of overweight and obesity and undernutrition. Eating quickly has been linked to overweight and obesity. However, no study has examined the association between eating speed and undernutrition. This retrospective, cross-sectional study analyzed data from 3529 community-dwelling residents. Eating speed was divided into three categories: fast, medium, and slow. Undernutrition was defined as body mass index (BMI) of <18.5 kg/m² in adults aged < 70 years (adults) and as <20 kg/m² in adults aged ≥ 70 years (older adults), in accordance with the Global Leadership Initiative on Malnutrition criteria for Asians. Multivariable logistic regression analysis was used to examine the association between eating speed and undernutrition. Among adult men, compared with eating quickly, eating slowly was associated with elevated prevalence of undernutrition (odds ratio (OR) 9.68, 95% confidence interval (CI) 2.32–40.51, p = 0.001). Among older adult women, the prevalence of undernutrition in the slow-eating group was higher than that in the fast-eating group (OR 3.82, 95% Cl 1.51–9.69, p = 0.005). Eating slowly is independently associated with the prevalence of undernutrition among community-dwelling adult men and older adult women in Japan. Full article

(This article belongs to the Special Issue Dietary and Lifestyle-Related Behaviours in Community-Dwelling Older Adults)

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Review

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19 pages, 553 KiB

Open AccessReview

Protein Intake and Oral Health in Older Adults—A Narrative Review

by Thilini N. Jayasinghe, Sanaa Harrass, Sharon Erdrich, Shalinie King and Joerg Eberhard

Nutrients 2022, 14(21), 4478; https://doi.org/10.3390/nu14214478 - 25 Oct 2022

Cited by 11 | Viewed by 7193

Abstract

Oral health is vital to general health and well-being for all ages, and as with other chronic conditions, oral health problems increase with age. There is a bi-directional link between nutrition and oral health, in that nutrition affects the health of oral tissues [...] Read more.

Oral health is vital to general health and well-being for all ages, and as with other chronic conditions, oral health problems increase with age. There is a bi-directional link between nutrition and oral health, in that nutrition affects the health of oral tissues and saliva, and the health of the mouth may affect the foods consumed. Evidence suggests that a healthy diet generally has a positive impact on oral health in older adults. Although studies examining the direct link between oral health and protein intake in older adults are limited, some have explored the relationship via malnutrition, which is also prevalent among older adults. Protein–energy malnutrition (PEM) may be associated with poor oral health, dental caries, enamel hypoplasia, and salivary gland atrophy. This narrative review presents the theoretical evidence on the impact of dietary protein and amino acid composition on oral health, and their combined impact on overall health in older adults. Full article

(This article belongs to the Special Issue Dietary and Lifestyle-Related Behaviours in Community-Dwelling Older Adults)

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