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Higher Habitual Flavonoid Intakes Are Associated With A Lower Risk Of Peripheral Artery Disease Hospitalizations, Nicola P. Bondonno, Kevin Murray, Aedin Cassidy, Catherine P. Bondonno, Joshua Lewis, Kevin D. Croft, Cecilie Kyro, Gunnar Gislason, Christian Torp-Pedersen, Augustin Scalbert, Anne Tjonneland, Jonathan M. Hodgson, Frederik Dalgaard Dec 2021

Higher Habitual Flavonoid Intakes Are Associated With A Lower Risk Of Peripheral Artery Disease Hospitalizations, Nicola P. Bondonno, Kevin Murray, Aedin Cassidy, Catherine P. Bondonno, Joshua Lewis, Kevin D. Croft, Cecilie Kyro, Gunnar Gislason, Christian Torp-Pedersen, Augustin Scalbert, Anne Tjonneland, Jonathan M. Hodgson, Frederik Dalgaard

Research outputs 2014 to 2021

Background

The role of nutrition in the primary prevention of peripheral artery disease (PAD), the third leading cause of atherosclerotic cardiovascular disease, is undetermined. Flavonoids may attenuate atherosclerosis and therefore persons who consume flavonoid-rich foods may have a lower risk of developing PAD.

Objectives

We aimed to examine the association between flavonoid intake and PAD hospitalizations and investigate if the association differs according to established risk factors for PAD.

Methods

Baseline data from 55,647 participants of the Danish Diet, Cancer, and Health Study without PAD, recruited from 1993 to 1997, were cross-linked with Danish nationwide registries. Flavonoid intake was calculated …


Musculoskeletal Responses To Exercise Plus Nutrition In Men With Prostate Cancer On Androgen Deprivation: A 12-Month Rct, Jack Dalla Via, Patrick J. Owen, Robin M. Daly, Niamh L. Mundell, Patricia M. Livingston, Timo Rantalainen, Stephen J. Foulkes, Jeremy L. Millar, Declan G. Murphy, Steve F. Fraser Oct 2021

Musculoskeletal Responses To Exercise Plus Nutrition In Men With Prostate Cancer On Androgen Deprivation: A 12-Month Rct, Jack Dalla Via, Patrick J. Owen, Robin M. Daly, Niamh L. Mundell, Patricia M. Livingston, Timo Rantalainen, Stephen J. Foulkes, Jeremy L. Millar, Declan G. Murphy, Steve F. Fraser

Research outputs 2014 to 2021

Purpose:

Androgen deprivation therapy (ADT) for prostate cancer has multiple adverse effects on musculoskeletal health. This 12-month randomized controlled trial aimed to assess the effects of multicomponent exercise training combined with whey protein, calcium and vitamin D supplementation on bone mineral density (BMD), structure and strength, body composition, muscle strength, and physical function in ADT-treated men.

Methods:

Seventy ADT-treated men were randomized to exercise plus supplementation (Ex + Suppl; n = 34) or usual care (control; n = 36). Ex + Suppl involved thrice weekly progressive resistance training plus weight-bearing impact exercise with daily multinutrient supplementation. Primary outcomes were DXA …


Life In A Time Of Covid: A Mixed Method Study Of The Changes In Lifestyle, Mental And Psychosocial Health During And After Lockdown In Western Australians, Ranila Bhoyroo, Paola Chivers, Lynne Millar, Caroline Bulsara, Ben Piggott, Michelle Lambert, Jim Codde Jan 2021

Life In A Time Of Covid: A Mixed Method Study Of The Changes In Lifestyle, Mental And Psychosocial Health During And After Lockdown In Western Australians, Ranila Bhoyroo, Paola Chivers, Lynne Millar, Caroline Bulsara, Ben Piggott, Michelle Lambert, Jim Codde

Research outputs 2014 to 2021

Background: Since the beginning of the COVID-19 pandemic, the Western Australian government imposed multiple restrictions that impacted daily life activities and the social life. The aim of this study was to examine the effects of COVID-19 lockdown on the community’s physical, mental and psychosocial health. Methods: Approximately 2 months after a three-month lockdown, a cross-sectional study was opened to Western Australian adults for an 8-week period (25th August – 21 October 2020). Participants competed a 25-min questionnaire adapted from the Western Australia Health and Wellbeing Surveillance system. Participants provided information on their socio-demographic status, lifestyle behaviours, mental health, and psychosocial …


Maintaining Weight Loss In Obese Men With Prostate Cancer Following A Supervised Exercise And Nutrition Program—A Pilot Study, Rebekah L. Wilson, Dennis R. Taaffe, Robert U. Newton, Nicolas H. Hart, Philippa Lyons-Wall, Daniel A. Galvão Jan 2021

Maintaining Weight Loss In Obese Men With Prostate Cancer Following A Supervised Exercise And Nutrition Program—A Pilot Study, Rebekah L. Wilson, Dennis R. Taaffe, Robert U. Newton, Nicolas H. Hart, Philippa Lyons-Wall, Daniel A. Galvão

Research outputs 2014 to 2021

Supervised exercise and nutrition programs can mitigate or reverse androgen deprivation therapy (ADT) induced fat mass (FM) gain, lean mass (LM) loss, and impaired physical function. It is unclear whether these benefits are retained following transition to self-management. This study examined the effect of a home-based weight maintenance program on body composition and physical function in obese men with prostate cancer (PCa) on ADT following a 12-week supervised weight loss intervention. Eleven obese PCa patients (74 ± 5 years, 40.0 ± 4.9% body fat) on ADT ( > 6 months) com-pleted a 12-week self-managed home-based weight maintenance program consisting of 150 …


Using Exercise And Nutrition To Alter Fat And Lean Mass In Men With Prostate Cancer Receiving Androgen Deprivation Therapy: A Narrative Review, Rebekah L. Wilson, Dennis R. Taaffe, Robert U. Newton, Nicolas H. Hart, Philippa Lyons-Wall, Daniel A. Galvao Jan 2021

Using Exercise And Nutrition To Alter Fat And Lean Mass In Men With Prostate Cancer Receiving Androgen Deprivation Therapy: A Narrative Review, Rebekah L. Wilson, Dennis R. Taaffe, Robert U. Newton, Nicolas H. Hart, Philippa Lyons-Wall, Daniel A. Galvao

Research outputs 2014 to 2021

Fat mass (FM) gain and lean mass (LM) loss are common side effects for patients with prostate cancer receiving androgen deprivation therapy (ADT). Excess FM has been associated with an increased risk of developing obesity-related comorbidities, exacerbating prostate cancer progression, and all-cause and cancer-specific mortality. LM is the predominant contributor to resting metabolic rate, with any loss impacting long-term weight management as well as physical function. Therefore, reducing FM and preserving LM may improve patient-reported outcomes, risk of disease progression, and ameliorate comorbidity development. In ADT-treated patients, exercise and nutrition programs can lead to improvements in quality of life and …


Habitual Flavonoid Intake And Ischemic Stroke Incidence In The Danish Diet, Cancer, And Health Cohort, Benjamin H. Parmenter, Frederik Dalgaard, Kevin Murray, Aedin Cassidy, Catherine P. Bondonno, Joshua R. Lewis, Kevin D. Croft, Cecilie Kyrø, Gunnar Gislason, Augustin Scalbert, Anne Tjønneland, Jonathan M. Hodgson, Nicola P. Bondonno Jan 2021

Habitual Flavonoid Intake And Ischemic Stroke Incidence In The Danish Diet, Cancer, And Health Cohort, Benjamin H. Parmenter, Frederik Dalgaard, Kevin Murray, Aedin Cassidy, Catherine P. Bondonno, Joshua R. Lewis, Kevin D. Croft, Cecilie Kyrø, Gunnar Gislason, Augustin Scalbert, Anne Tjønneland, Jonathan M. Hodgson, Nicola P. Bondonno

Research outputs 2014 to 2021

Background

Flavonoid-rich foods have antiinflammatory, antiatherogenic, and antithrombotic properties that may contribute to a lower risk of ischemic stroke.

Objectives

We aimed to investigate the relationship between habitual flavonoid consumption and incidence of ischemic stroke in participants from the Danish Diet, Cancer and Health Study.

Design

In this prospective cohort study, 55,169 Danish residents without a prior ischemic stroke [median (IQR) age at enrolment of 56 y (52–60)], were followed for 21 y (20–22). We used Phenol-Explorer to estimate flavonoid intake from food frequency questionnaires obtained at study entry. Incident cases of ischemic stroke were identified from Danish nationwide registries …


Childcare Food Provision Recommendations Vary Across Australia: Jurisdictional Comparison And Nutrition Expert Perspectives, Alison Spence, Penelope Love, Rebecca Byrne, Amy Wakem, Louisa Matwiejczyk, Amanda Devine, Rebecca Golley, Ros Sambell Sep 2020

Childcare Food Provision Recommendations Vary Across Australia: Jurisdictional Comparison And Nutrition Expert Perspectives, Alison Spence, Penelope Love, Rebecca Byrne, Amy Wakem, Louisa Matwiejczyk, Amanda Devine, Rebecca Golley, Ros Sambell

Research outputs 2014 to 2021

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Early childhood is a critical stage for nutrition promotion, and childcare settings have the potential for wide-reaching impact on food intake. There are currently no Australian national guidelines for childcare food provision, and the comparability of existing guidelines across jurisdictions is unknown. This project aimed to map and compare childcare food provision guidelines and to explore perspectives amongst early childhood nutrition experts for alignment of jurisdictional childcare food provision guidelines with the Australian Dietary Guidelines (ADG). A desktop review was conducted and formed the basis of an online survey. A national …


The Effects Of Vitamin K-Rich Green Leafy Vegetables On Bone Metabolism: A 4-Week Randomised Controlled Trial In Middle-Aged And Older Individuals, Marc Sim, Joshua R. Lewis, Richard L. Prince, Itamar Levinger, Tara C. Brennan-Speranza, Claire Palmer, Catherine P. Bondonno, Nicola P. Bondonno, Amanda Devine, Natalie C. Ward, Elizabeth Byrnes, Carl J. Schultz, Richard Woodman, Kevin Croft, Jonathan M. Hodgson, Lauren C. Blekkenhorst Jan 2020

The Effects Of Vitamin K-Rich Green Leafy Vegetables On Bone Metabolism: A 4-Week Randomised Controlled Trial In Middle-Aged And Older Individuals, Marc Sim, Joshua R. Lewis, Richard L. Prince, Itamar Levinger, Tara C. Brennan-Speranza, Claire Palmer, Catherine P. Bondonno, Nicola P. Bondonno, Amanda Devine, Natalie C. Ward, Elizabeth Byrnes, Carl J. Schultz, Richard Woodman, Kevin Croft, Jonathan M. Hodgson, Lauren C. Blekkenhorst

Research outputs 2014 to 2021

Background: High vegetable intake is associated with beneficial effects on bone. However, the mechanisms remain uncertain. Green leafy vegetables are a rich source of vitamin K1, which is known to have large effects on osteoblasts and osteocalcin (OC) metabolism. Objective: To examine the effects of consumption of two to three extra serves of green leafy vegetables daily on bone metabolism. Methods: Thirty individuals (mean age 61.8 ± 9.9 years, 67% male) completed three experimental phases in a randomised controlled crossover design, each lasting four weeks, with a washout period of four weeks between phases (clinical trial registration: ACTRN12615000194561). The three …


Clinical Oncology Society Of Australia: Position Statement On Cancer-Related Malnutrition And Sarcopenia, Nicole Kiss, Jenelle Loeliger, Merran Findlay, Elizabeth Isenring, Brenton J. Baguley, Anna Boltong, Alexis Butler, Irene Deftereos, Michelle Eisenhuth, Steve F. Fraser, Rebecca Fichera, Hayley Griffin, Sandi Hayes, Emily Jeffery, Catherine Johnson, Chris Lomma, Barbara Van Der Meij, Carolyn Mcintyre, Tracey Nicholls, Lina Pugliano, Tina Skinner, Jane Stewart, Judy Bauer Jan 2020

Clinical Oncology Society Of Australia: Position Statement On Cancer-Related Malnutrition And Sarcopenia, Nicole Kiss, Jenelle Loeliger, Merran Findlay, Elizabeth Isenring, Brenton J. Baguley, Anna Boltong, Alexis Butler, Irene Deftereos, Michelle Eisenhuth, Steve F. Fraser, Rebecca Fichera, Hayley Griffin, Sandi Hayes, Emily Jeffery, Catherine Johnson, Chris Lomma, Barbara Van Der Meij, Carolyn Mcintyre, Tracey Nicholls, Lina Pugliano, Tina Skinner, Jane Stewart, Judy Bauer

Research outputs 2014 to 2021

© 2020 The Authors. Nutrition & Dietetics published by John Wiley & Sons Australia, Ltd on behalf of Dietitians Australia. This position statement describes the recommendations of the Clinical Oncology Society of Australia (COSA) regarding management of cancer-related malnutrition and sarcopenia. A multidisciplinary working group completed a review of the literature, focused on evidence-based guidelines, systematic reviews and meta-analyses, to develop recommendations for the position statement. National consultation of the position statement content was undertaken through COSA members. All people with cancer should be screened for malnutrition and sarcopenia in all health settings at diagnosis and as the clinical situation …


Flavonoid Intake And Its Association With Atrial Fibrillation, Nicola P. Bondonno, Kevin Murray, Catherine P. Bondonno, Joshua R. Lewis, Kevin D. Croft, Cecilie Kyro, Gunnar Gislason, Anne Tjonneland, Augustin Scalbert, Aedin Cassidy, Jonathan P. Piccini, Kim Overad, Johnathan M. Hodgson, Frederik Dalgaard Jan 2020

Flavonoid Intake And Its Association With Atrial Fibrillation, Nicola P. Bondonno, Kevin Murray, Catherine P. Bondonno, Joshua R. Lewis, Kevin D. Croft, Cecilie Kyro, Gunnar Gislason, Anne Tjonneland, Augustin Scalbert, Aedin Cassidy, Jonathan P. Piccini, Kim Overad, Johnathan M. Hodgson, Frederik Dalgaard

Research outputs 2014 to 2021

Background & aims: Primary prevention of atrial fibrillation (AF) through behavioural and dietary modification is a critically important and unmet need. Flavonoids are bioactive dietary compounds with promising cardiovascular health benefits. Our aim was to investigate the association between flavonoid intake and clinically apparent AF. Methods: Baseline data from 55 613 participants of the Danish Diet, Cancer and Health Study, without AF, recruited between 1993 and 1997, were cross-linked with Danish nationwide registries. Total flavonoid and flavonoid subclass intakes were calculated from validated food frequency questionnaires using the Phenol-Explorer database. Associations between flavonoid intake and incident AF (first-time hospitalization or …


Summary Of Nutrition Among Aboriginal And Torres Strait Islander People, Australian Indigenous Healthinfonet Jan 2020

Summary Of Nutrition Among Aboriginal And Torres Strait Islander People, Australian Indigenous Healthinfonet

Research outputs 2014 to 2021

No abstract provided.


Dietary Nitrate Intake Is Associated With Muscle Function In Older Women, Marc Sim, Joshua R. Lewis, Lauren C. Blekkenhorst, Catherine P. Bondonno, Amanda Devine, Kun Zhu, Peter Peeling, Richard L. Prince, Jonathan M. Hodgson Jun 2019

Dietary Nitrate Intake Is Associated With Muscle Function In Older Women, Marc Sim, Joshua R. Lewis, Lauren C. Blekkenhorst, Catherine P. Bondonno, Amanda Devine, Kun Zhu, Peter Peeling, Richard L. Prince, Jonathan M. Hodgson

Research outputs 2014 to 2021

Background

In younger individuals, dietary nitrate supplementation has been shown to improve short‐term vascular and muscle function. The role of higher habitual nitrate intake as part of a typical diet on muscle function in ageing has not been investigated. A cross‐sectional study of relationships between dietary nitrate and measures of muscle function in older community‐dwelling Australian women (n = 1420, ≥70 years) was undertaken.

Methods

Participants completed a semi‐quantitative food frequency questionnaire assessing dietary intake over the previous year. Total nitrate from vegetables and non‐vegetable sources was calculated from a validated instrument that quantified the nitrate content of food …


Nutrition And Vulnerable Groups, Amanda Devine, Tanya Lawlis May 2019

Nutrition And Vulnerable Groups, Amanda Devine, Tanya Lawlis

Research outputs 2014 to 2021

Food insecurity is a complex 'wicked' problem that results from a range of unstable and uncertain physical, social, cultural, and economic factors that limit access to nutritious food...


Measuring Food Provision In Western Australian Long Day Care (Ldc) Services: A Weighed Food Record Method/Protocol At A Service Level, Ros Sambell, Ruth Wallace, Leesa Costello, Amanda Devine Jan 2019

Measuring Food Provision In Western Australian Long Day Care (Ldc) Services: A Weighed Food Record Method/Protocol At A Service Level, Ros Sambell, Ruth Wallace, Leesa Costello, Amanda Devine

Research outputs 2014 to 2021

Background

There are currently 1.3 million children utilising Early Childhood Education and Care (ECEC) services in Australia. Long day care (LDC), family day care and out of school hours care currently provide this service in different environments. This research reports findings from a LDC perspective. Children can consume 40–67% of their food intake whilst at LDC services, this highlights the importance of monitoring food provision at a service level. There are several methods to measure food provision which typically focus on intake at an individual level. There is limited evidence of measuring food provision accurately at a service level and …


Utilising A Multi‐Item Questionnaire To Assess Household Food Security In Australia, Lucy M. Butcher, Therese A. O'Sullivan, Maria M. Ryan, Johnny Lo, Amanda Devine Jan 2019

Utilising A Multi‐Item Questionnaire To Assess Household Food Security In Australia, Lucy M. Butcher, Therese A. O'Sullivan, Maria M. Ryan, Johnny Lo, Amanda Devine

Research outputs 2014 to 2021

Issue addressed: Currently, two food sufficiency questions are utilised as a proxy measure of national food security status in Australia. These questions do not capture all dimensions of food security and have been attributed to underreporting of the problem. The purpose of this study was to investigate food security using the short form of the US Household Food Security Survey Module (HFSSM) within an Australian context; and explore the relationship between food security status and multiple socio-demographic variables.

Methods: Two online surveys were completed by 2334 Australian participants from November 2014 to February 2015. Surveys contained the short form of …


Vegetable Diversity, Injurious Falls, And Fracture Risk In Older Women: A Prospective Cohort Study, Marc Sim, Lauren C. Blekkenhorst, Joshua Lewis, Catherine P. Bondonno, Amanda Devine, Kun Zhu, Richard J. Woodman, Richard L. Price, Jonathan M. Hodgson Jan 2018

Vegetable Diversity, Injurious Falls, And Fracture Risk In Older Women: A Prospective Cohort Study, Marc Sim, Lauren C. Blekkenhorst, Joshua Lewis, Catherine P. Bondonno, Amanda Devine, Kun Zhu, Richard J. Woodman, Richard L. Price, Jonathan M. Hodgson

Research outputs 2014 to 2021

The importance of vegetable diversity for the risk of falling and fractures is unclear. Our objective was to examine the relationship between vegetable diversity with injurious falling and fractures leading to hospitalization in a prospective cohort of older Australian women (n = 1429, ≥70 years). Vegetable diversity was quantified by assessing the number of different vegetables consumed daily. Vegetable intake (75 g servings/day) was estimated using a validated food frequency questionnaire at baseline (1998). Over 14.5 years, injurious falls (events = 568, 39.7%), and fractures (events = 404, 28.3%) were captured using linked health records. In multivariable-adjusted Cox regression models, …


Over-Provision Of Discretionary Foods At Childcare Dilutes The Nutritional Quality Of Diets For Children, Ruth M. Wallace, Leesa N. Costello, Amanda Devine Jan 2017

Over-Provision Of Discretionary Foods At Childcare Dilutes The Nutritional Quality Of Diets For Children, Ruth M. Wallace, Leesa N. Costello, Amanda Devine

Research outputs 2014 to 2021

The childcare setting can significantly influence the lifelong eating habits and health outcomes of children.It is ideal for health-promoting interventions that optimise the provision of nutritious food and nutrition education. Unfortunately, these interventions are neither offered nor promoted in many childcare settings. Recent studies have indicated an increased risk of overweight/obesity with childcare attendance, which if present in early life is associated with increased risk of chronic disease and reduced psychological wellbeing.


Integrating Diet And Exercise Into Care Of Prostate Cancer Patients On Androgen Deprivation Therapy, Mark A. Moyad, Robert Newton, Ulf W. Tunn, Damian Gruca Aug 2016

Integrating Diet And Exercise Into Care Of Prostate Cancer Patients On Androgen Deprivation Therapy, Mark A. Moyad, Robert Newton, Ulf W. Tunn, Damian Gruca

Research outputs 2014 to 2021

Improved diagnosis and treatment regimens have resulted in greater longevity for men with prostate cancer. This has led to an increase in both androgen deprivation therapy (ADT) use and duration of exposure, and therefore to its associated adverse effects, such as sexual dysfunction, osteoporosis, reduced muscle mass, increased fat mass, and increased incidence of cardiovascular disease and type 2 diabetes. Given that the adverse effects of ADT are systemic, often debilitating, and difficult to treat, efforts continue in the development of new strategies for long-term management of prostate cancer. The PubMed database was searched to select trials, reviews, and meta-analyses …


Anti-Aging Genes Improve Appetite Regulation And Reverse Cell Senescence And Apoptosis In Global Populations, Ian James Martins Jan 2016

Anti-Aging Genes Improve Appetite Regulation And Reverse Cell Senescence And Apoptosis In Global Populations, Ian James Martins

Research outputs 2014 to 2021

Appetite regulation by nutritional intervention is required early in life that involves the anti-aging gene Sirtuin 1 (Sirt 1) with Sirt 1 maintenance of other cellular anti-aging genes involved in cell circadian rhythm, senescence and apoptosis. Interests in anti-aging therapy with appetite regulation improve an individual’s survival to metabolic disease induced by gene-environment interactions by maintenance of the anti-aging genes connected to the metabolism of bacterial lipopolysaccharides, drugs and xenobiotics. Interventions to the aging process involve early calorie restriction with appetite regulation connected to appropriate genetic mechanisms that involve mitochondrial biogenesis and DNA repair in neurons. In the aging process …


Links Between Insulin Resistance, Lipoprotein Metabolism And Amyloidosis In Alzheimer's Disease, Ian J. Martins, Rhona Creegan Jan 2014

Links Between Insulin Resistance, Lipoprotein Metabolism And Amyloidosis In Alzheimer's Disease, Ian J. Martins, Rhona Creegan

Research outputs 2014 to 2021

The origins of premature brain aging and chronic disease progression are associated with atherogenic diets and sedentary lifestyles in Western communities. Interests in brain aging that involves non alcoholic fatty liver disease (NAFLD), the global stroke epidemic and neurodegeneration have become the focus of nutritional research. Atherogenic diets have been linked to plasma ceramide dysregulation and insulin resistance actively promoting chronic diseases and neurodegeneration in developed countries. Abnormal lipid signaling as observed in chronic diseases such as hypothyroidism, obesity and diabetes is connected to stroke and neurodegenerative diseases in man. Lipids that are involved in calcium and amyloid betahomeostasis are …


Metals In Commonly Eaten Groceries In Western Australia: A Market Basket Survey And Dietary Assessment, Anna Callan, Andrea Hinwood, Amanda Devine Jan 2014

Metals In Commonly Eaten Groceries In Western Australia: A Market Basket Survey And Dietary Assessment, Anna Callan, Andrea Hinwood, Amanda Devine

Research outputs 2014 to 2021

Children’s dietary exposure to metals has received limited attention in Australia. This study undertook a market basket survey and analysed 253 food and beverages for metals. These data were used in conjunction with recent average diet data for children in Western Australia to model dietary metals exposure, with mean metals intakes calculated for boys and girls aged 8, 12, 13 and 16 years. Results show that for some metals, including cadmium, nickel and manganese, dietary intake guidelines have been exceeded in younger children. The mean modelled cadmium intake in children aged 8 years was almost 60% of the World Health …


Induction Of Nafld With Increased Risk Of Obesity And Chronic Diseases In Developed Countries, Ian J. Martins Jan 2014

Induction Of Nafld With Increased Risk Of Obesity And Chronic Diseases In Developed Countries, Ian J. Martins

Research outputs 2014 to 2021

The susceptibility of individuals to obesity has been reported in many developed countries with predisposition of humans to obesity associated with high calorie diets and unhealthy lifestyles. Obesity may closely be involved in cell suicide in various organ diseases with the importance of accelerated aging that requires early intervention with drug therapy to prevent diseases such as non alcoholic fatty liver disease (NAFLD) that has increased in children and reached to approx. 40% of the global population. Obesity is induced by various diets and lifestyle factors such as stress, anxiety and depression which are important to consider with the global …