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Full-Text Articles in Dietetics and Clinical Nutrition

Malnutrition And Frailty Risk Among Community Dwelling Older Adults In Northeast Tennessee, Shreeyesha Pradhan May 2026

Malnutrition And Frailty Risk Among Community Dwelling Older Adults In Northeast Tennessee, Shreeyesha Pradhan

Electronic Theses and Dissertations

Frailty and malnutrition are prevalent conditions among community-dwelling older adults, affecting approximately 10% and 25% of this population, respectively. Despite overlapping symptoms such as functional decline, their relationship remains underexplored in community dwelling older adults. This cross-sectional feasibility study examined the association between frailty and nutritional status among 47 older adults in the East Tennessee Tri-Cities area using the Fried’s Frailty Phenotype (FFP) and the Mini Nutritional Assessment-Long Form (MNA-LF®). Results indicated 13% were pre-frail, 24% were frail, 21% were at risk for malnutrition, and 2% were malnourished. Regression analyses revealed that self-perceived nutritional status (37.6%), daily meal frequency (29.0%), …


Feasibility Of Assessing Dietary Patterns And Anxiety In College Students: A Pilot Study Using Nutrition Questionnaires, Gad-7, And Asq, Kylie Ford May 2026

Feasibility Of Assessing Dietary Patterns And Anxiety In College Students: A Pilot Study Using Nutrition Questionnaires, Gad-7, And Asq, Kylie Ford

Electronic Theses and Dissertations

Anxiety is highly prevalent among college students representing a significant public health concern. Research indicates that dietary patterns may influence mental health outcomes; however, the practicality of collecting comprehensive dietary and psychological data in college populations remains unclear. This pilot study assessed the feasibility of evaluating dietary patterns and anxiety using self-report instruments. Participants completed the Nutrition and Eating Habit questionnaire, the Generalized Anxiety Disorder-7 (GAD-7), and the Anxiety Sensitivity Questionnaire (ASQ). Although twenty-one students were recruited, survey completion rates were low, with only seven participants completing the nutrition questionnaire necessary to calculate the Dietary Inflammatory Index (DII). Descriptive analyses …


Analyzing The Association Of Competitive Food Policy On Competitive Food Content In U.S. Schools., Mary E. Curnutte May 2025

Analyzing The Association Of Competitive Food Policy On Competitive Food Content In U.S. Schools., Mary E. Curnutte

Electronic Theses and Dissertations

OBJECTIVES: School food can have a profound effect on the population’s health. Thirty million children receive food at school and consume half their daily calorie intake at school. Competitive foods are foods sold outside of school breakfast and lunch, such as those sold in vending machines. A new ruling for Smart Snacks Standards, a set of competitive food guidelines, started in the school year 2014-2015. It is known that competitive foods undermine school lunch participation, and a decrease in school lunch consumption is associated with poorer student health. Additionally, an increase in competitive foods tends to be of nutrient-poor …


Enriching The Pcos Lifestyle, Callie Coleman Aug 2024

Enriching The Pcos Lifestyle, Callie Coleman

Electronic Theses and Dissertations

Polycystic Ovary Syndrome (PCOS) is an endocrine disorder affecting approximately 4 – 20% of women worldwide. It is associated with insulin resistance, fertility problems, and an increased susceptibility to chronic conditions through multiple inflammatory pathways. Women with PCOS are also at increased risk for disordered eating. The Mediterranean diet is associated with decreased inflammation and risk of chronic conditions, and intuitive eating principles are associated with decreased disordered eating patterns. The purpose of this study was to determine if a six-week nutrition education workshop incorporating information and skills related to both the Mediterranean lifestyle and intuitive eating principles can improve …


Food Insecurity And Self-Rated Health Of Older Adults In Appalachia, Sarah Kelley Aug 2024

Food Insecurity And Self-Rated Health Of Older Adults In Appalachia, Sarah Kelley

Electronic Theses and Dissertations

Food insecurity is prevalent in the United States. Although older adults experience food insecurity at lower-than-average rates, this population is vulnerable to the nutrition and health related implications. Food insecurity is tied to both a diminishment of diet quantity and quality, and is associated with incidence of chronic disease, loss of functional status, and quality of life. This survey seeks to fill a gap in research by looking into the prevalence of food insecurity among older adults in Northeast Tennessee, associations between food insecurity and self-rated health, and associations between food insecurity and geographical limitations.


The Greater Implications Of Self-Perceptions Of Aging Among Younger Adults: Results From The Socially Nutritious Volunteer Training Program, Ashlyn Cobble May 2024

The Greater Implications Of Self-Perceptions Of Aging Among Younger Adults: Results From The Socially Nutritious Volunteer Training Program, Ashlyn Cobble

Electronic Theses and Dissertations

The rapidly growing rate of the older adult population has created a need to better understand younger adults’ self-perceptions of aging and current trends of ageism. The purpose of this secondary data analysis research project was to determine changes, if any, in participants’ self-perception of aging after the Socially Nutritious facilitator or nutrition ambassador volunteer training, which aims to develop knowledge and skills related to aging trends, older adult nutrition, preventing ageism, and communication and educational considerations when working with older adults. Findings indicate that participants with more frequent interactions with older adults had a more positive perception of their …


Changes In Young Adults’ Perspective On Ageism After Participating In A Virtual Nutrition Education Program With Older Adults, Julianne Hensley May 2024

Changes In Young Adults’ Perspective On Ageism After Participating In A Virtual Nutrition Education Program With Older Adults, Julianne Hensley

Electronic Theses and Dissertations

The growing older adult population has led to increased ageist tendencies among younger generations. Previous research suggests that ageism is associated with cognitive and physical decline among older adults. This mixed-methods research project examined changes in ageist perceptions among graduate student facilitators and undergraduate nutrition ambassadors after participating in a training that included information about healthy aging, addressing ageism, and communicating with older adults. Results from a secondary data analysis of pre-test/post-test data and thematic analysis of semi-structured interviews with facilitators of Socially Nutritious, a virtual nutrition education program for older adults, indicate that ageist perceptions decreased after the …


Intestinal Microbiome, Fecal Fermentation Profile, And Health Indices In Hiv Infected Men Versus Non-Infected Controls, Mary Andreae, Mary C. Andreae Mrs Dec 2023

Intestinal Microbiome, Fecal Fermentation Profile, And Health Indices In Hiv Infected Men Versus Non-Infected Controls, Mary Andreae, Mary C. Andreae Mrs

Electronic Theses and Dissertations

Many HIV-positive (HIV+) males on Highly Active Anti-Retroviral Therapy (HAART) experience metabolic abnormalities, including Non-Alcoholic Fatty Liver Disease (NAFLD) and lipodystrophy. The intestinal microbiota and short chain fatty acids (SCFA), participate in bidirectional communication with their host. Dysbiosis in HIV+ males on HAART demonstrate a Prevotella-rich enterotype shaped by multiple factors including, medications, adiposity, diet, intestinal permeability, and lifestyle; our objective was to investigate these factors. 19 HIV+ and 21 HIV- males were enrolled. BMI and hip-to-waist ratio (H:W) were obtained, and FibroScan for liver health. Intestinal permeability markers Claudin-21, flagellin, and intestinal fatty acid binding protein (IFABP) in …


How Nutrition Knowledge Of Coaches, Athletic Trainers, And Strength And Conditioning Specialists Translates To Their Athletes, Alexa Carbone May 2021

How Nutrition Knowledge Of Coaches, Athletic Trainers, And Strength And Conditioning Specialists Translates To Their Athletes, Alexa Carbone

Electronic Theses and Dissertations

The basis of dietary habits is linked to an individuals’ nutrition knowledge; for collegiate athletes this is the difference between optimal performance and falling short. To understand how nutrition information is disseminated to student-athletes, this research surveyed the athletes themselves and their sports staff (coaches, athletic trainers, and strength and conditioning specialists) on their current knowledge. Sport staff and student-athletes at East Tennessee State University were given the opportunity to participate in a 52-question online survey that tested both their general and sports-related nutrition knowledge. While the study sample size did not allow for statistical analyses required to address all …


Sarcopenia Screening By Registered Dietitian Nutritionists (Rdns) In The United States (U.S.), Madison Marcom May 2021

Sarcopenia Screening By Registered Dietitian Nutritionists (Rdns) In The United States (U.S.), Madison Marcom

Electronic Theses and Dissertations

Sarcopenia is a disease of muscle wasting primarily seen in older adults. Although this term was first coined over three decades ago, there is a lack of consensus on a definition, screening criteria, and treatment protocol for sarcopenia. The primary purpose of this study is to determine whether registered dietitian nutritionists (RDNs) in the United States (U.S.) screen for sarcopenia. Study participants were recruited through a randomized email list and included RDNs throughout the U.S. Respondents completed a survey questioning knowledge of sarcopenia, screening tools and company protocols in place, and the need and desire for sarcopenia education. Data revealed …


Exploring The Relationship Between Dietary Self-Monitoring With A Mobile App And Weight Change, Jason Payne May 2020

Exploring The Relationship Between Dietary Self-Monitoring With A Mobile App And Weight Change, Jason Payne

Electronic Theses and Dissertations

Background: Approximately 70% of the adult population in the United States has overweight or obesity and increased risk for developing chronic diseases. Dietary self-monitoring adherence using a paper diary is associated with weight loss; however, few studies have examined this association with dietary self-monitoring apps. Objectives: 1) explore if an association exists between app-based dietary self-monitoring and weight change among adults with overweight or obesity and 2) explore the relationships between the frequency, consistency, and completeness of self-monitoring and weight change. Methods: Participants self-monitored dietary intake for 8 weeks using the app Calorie Counter by FatSecret. Participants were assigned …


The Experiences Of Ncaa Student-Athletes With An Eating Disorder Or Disordered Eating, Rachel E. Taylor Jan 2020

The Experiences Of Ncaa Student-Athletes With An Eating Disorder Or Disordered Eating, Rachel E. Taylor

Electronic Theses and Dissertations

The purpose of this study was to explore the experiences of student-athletes who had an eating disorder or disordered eating (ED/DE) while competing for the National Collegiate Athletic Association (NCAA). Integrating criticism and connoisseurship and critical evocative portraiture, four post-collegiate women who participated in cross country and track, who were either clinically diagnosed with an ED/DE or who self-diagnosed, participated in two interviews to describe their experiences with and the impact of ED/DE on their athletic pursuits, academic pursuits, as well as their relationships with coaches, teammates, and family. The analysis of these interviews showed the complexity of this topic. …


Parenting Styles, Parenting Practices, And Dietary Intakes Of Preschoolers And Their Parents, Biyi Chen Jan 2020

Parenting Styles, Parenting Practices, And Dietary Intakes Of Preschoolers And Their Parents, Biyi Chen

Electronic Theses and Dissertations

Emerging research efforts have focused on the role of parents in the development of dietary behaviors of their children. Parental influences play a particularly important role in determining the children’s weight and shaping children’s dietary behaviors, especially during early childhood. Parent-related determinants can be classified as two types—general parenting (parenting style) and specific parenting practices (e.g, food parenting practices). Examining the interactions between parental influences and preschoolers’ and their parental dietary behaviors and may reveal important insights into how parents influence children’s dietary behaviors. Therefore, the goal of this research is to examine the associations between parenting styles, food parenting …


Effect Of Prebiotic, Probiotic, And Enzyme Supplementation On Gut Fermentation, Markers Of Inflammation And Immune Response In Individuals With Gi Symptoms, Kaitlyn Webb May 2019

Effect Of Prebiotic, Probiotic, And Enzyme Supplementation On Gut Fermentation, Markers Of Inflammation And Immune Response In Individuals With Gi Symptoms, Kaitlyn Webb

Electronic Theses and Dissertations

Current practices support the use of probiotic and prebiotic supplementation to improve chronic gastrointestinal distress (GID). The aim of this study was to determine the tolerance and benefits of GlutenShield (GS), a prebiotic, probiotic, and enzyme supplement, on adults with GID. Subjects (n=20) took either GS or the placebo for 30 days and completed a pre-treatment FFQ as well as a pre- and post-treatment GID questionnaire, blood draw, and stool sample. Participants consumed more total and saturated fat, and less fiber and whole grains compared to the recommended intake. A significant reduction in IgG2 was observed in the GS group …


Entry-Level Physical Therapy Students' Knowledge And Attitudes Of Nutrition, Jordan D. Day Apr 2018

Entry-Level Physical Therapy Students' Knowledge And Attitudes Of Nutrition, Jordan D. Day

Electronic Theses and Dissertations

Like other allied health fields, physical therapy has incorporated health promotion as a part of their practice. A large and important component of health promotion is nutrition. Little research has been conducted on the knowledge and attitudes of nutrition in physical therapists and has only included small sample sizes. Therefore, the purpose of the present study was to expand upon the knowledge and attitudes of nutrition in physical therapy students. Subjects included doctoral physical therapy students from across the United States, ranging from first year to senior level. The present research was conducted online via a Qualtrics survey. Surveys, included …


Effects Of Parent Role Modeling Behaviors In Correlation To Child Overweight And Obesity In Preschool-Aged Children, Nicole Van Heek Jan 2018

Effects Of Parent Role Modeling Behaviors In Correlation To Child Overweight And Obesity In Preschool-Aged Children, Nicole Van Heek

Electronic Theses and Dissertations

OBJECTIVE: Parents have been proven to shape their children’s health through their growing years.1-6 Extensive research has been done on the correlation between adolescent’s health status and parent’s role modeling behaviors. However, little research has been done in preschool-aged children. Therefore, the purpose of this study was to determine if parenting style with food and meal behaviors was associated with body mass index (BMI) and weight status in preschool-aged children (3-5 years).
METHODS: This study is a part of South Dakota State University’s iGrow Readers study. For this study, a total of 229 child/parent dyads participated from 14 recruited daycare …


Weight Management Related Factors And Healthy Behaviors In Adults, Sumadhuri Pamarthi Jan 2018

Weight Management Related Factors And Healthy Behaviors In Adults, Sumadhuri Pamarthi

Electronic Theses and Dissertations

Obesity is an ongoing global pandemic that affects more than one in three adults in the United States. Being overweight or obese also increases the risk of chronic health conditions. Weight management does not only center on immediate weight loss but also on the proper maintenance of an appropriate body weight over the years. Methods of weight management include eating a healthy diet and meeting physical activity guidelines. Such weight management practices are important to ensure that the people suffering from obesity can decrease risks of morbidity or even mortality. Nevertheless, unhealthy weight management strategies might lead to unintended health …


Daily Pork Consumption As A Part Of The Dietary Approaches To Stop Hypertension Diet Influences Body Composition And Preserves Muscle Mass In Older Adults Consuming Controlled Intakes, Alyssa Anne Kauffman Jan 2018

Daily Pork Consumption As A Part Of The Dietary Approaches To Stop Hypertension Diet Influences Body Composition And Preserves Muscle Mass In Older Adults Consuming Controlled Intakes, Alyssa Anne Kauffman

Electronic Theses and Dissertations

The purpose of this study was to test the hypothesis that muscular fitness is preserved in older adults who consumed pork daily as a part of the DASH dietary pattern. A controlled feeding pilot study was used to test this. Eight healthy older men and women were randomly assigned to consume either 3 ounces or 6 ounces of pork daily as a part of the DASH diet for a total of 12 weeks. Indicators of muscle mass, strength, and function were assessed at five time points (weeks 0, 3, 6, 9, 12) throughout the 12 weeks. A seven day cyclical …


Design And Validation Of A Scale For Preschoolers: Measuring Nutrition Knowledge, Beliefs, And Behaviors, Michelle E. Johnson Dec 2017

Design And Validation Of A Scale For Preschoolers: Measuring Nutrition Knowledge, Beliefs, And Behaviors, Michelle E. Johnson

Electronic Theses and Dissertations

The literature indicates a lack of validated scales to measure nutrition knowledge, attitudes and behaviors in preschool-aged children. Reliable and valid assessment tools are critical in the development of nutritional interventions for young children; careful design, including psychometric evaluation of reliability and validity, is the best approach to scale development. Best practice points to an efficient, yet comprehensive look at the constructs of knowledge, attitudes, and behaviors. This multi-phase study included 298 preschool children ages 2-6 years (151 girls, 147 boys; mean age 3.936). A 45-item scale was created, with 4 subscales to measure the nutrition knowledge, attitudes, and behaviors …


The Effects Of A Supermarket Tour On Improvement Of Nutrition Knowledge And Eating Behavior, Elizabeth Hall Dec 2017

The Effects Of A Supermarket Tour On Improvement Of Nutrition Knowledge And Eating Behavior, Elizabeth Hall

Electronic Theses and Dissertations

The purpose of this study was to determine if participation in a supermarket tour improves nutrition knowledge and eating behavior in adult participants. Participants were recruited in communities surrounding Food City stores, a local supermarket. Prior to completing a standardized tour, participants completed a survey to assess nutrition knowledge and eating behavior. This survey was given to participants again three months later. A program evaluation was given one time at the end of the tour. Data analysis revealed no significant findings, other than the behavior-based question: “How many meals or snacks on most days included vegetables”. Vegetable consumption appeared to …


Nutrient Content Of Human Breast Milk From Overweight And Normal Weight Caucasian Women Of Northeast Tennessee, Megan R. Kwon May 2017

Nutrient Content Of Human Breast Milk From Overweight And Normal Weight Caucasian Women Of Northeast Tennessee, Megan R. Kwon

Electronic Theses and Dissertations

Many factors influence the nutrient composition of breast milk (BRM) particularly within the fatty acids composition. In this study BRM between 2-14 weeks of lactation was collected from 44 Caucasian women (24 normal weight (NW, BMI 18.5-24.9kg/m2) and 20 overweight (OW, BMI >25.0kg/m2). BRM was subjected to proximate analysis and participants completed food frequency questionnaires (FFQ) to estimate fruit, vegetable, and fat intake. BMI differed between NW and OW groups, 22.03 vs 33.86kg/m2 (p0.10) were identified for total calories (5,581.8 vs 5562.9cal/g), %fat (39.6 vs 43.9), or %protein (9.8 vs 8.9) for BRM in NW …


Let Them Eat Beef: Effects Of Beef Consumption On Markers Of Metabolic Syndrome, Kristin L. Olson Jan 2017

Let Them Eat Beef: Effects Of Beef Consumption On Markers Of Metabolic Syndrome, Kristin L. Olson

Electronic Theses and Dissertations

To determine the effects of a diet that provides 30% energy from protein with ½ as lean, red meat on risk factors of metabolic syndrome in humans. This pilot study was a 3- month, randomized, control, intervention trial with 33 participants (Beef-Intervention n=18; DASH-Control n=15) who displayed markers of metabolic syndrome. Registered Dietitians Nutritionists recruited and educated participants on Beef-Intervention Lean Beef Pattern, (30% of energy from protein with ½ as lean red meat, 40% carbohydrate, 30% fat) or DASH-Control dietary pattern, (15% of energy from protein, 55% carbohydrate and 30 % fat). Of the 33 participants who completed the …


Awareness, Perception, And Self-Reported Purchasing Behaviors Of College Students Regarding Front-Of-Package Nutrition Labeling Systems And Symbols, Audrey L. Kessler Aug 2016

Awareness, Perception, And Self-Reported Purchasing Behaviors Of College Students Regarding Front-Of-Package Nutrition Labeling Systems And Symbols, Audrey L. Kessler

Electronic Theses and Dissertations

Traditional students enroll in post-secondary institutions during emerging adulthood. College enrollment is increasing and adult weight gain occurs most rapidly during the college-age years, with poor food decisions as a potential contributing factor. The present study examined the awareness, perception, and self-reported purchasing behaviors of college students regarding four front-of-package (FOP) nutrition labeling systems and symbols. Students were sent a 24-question web-based survey, with 908 completed surveys that met the research criteria. There were 888 (98.3%) respondents who recognized at least one of the four presented FOP nutrition labels. There were no significant differences between the groups that recognized one …


The Combined Effects Of Leptin And Coenzyme Q10 In Ameliorating Obesity- Induced Infertility In Female Rats, Adekunle Adedeji Aug 2016

The Combined Effects Of Leptin And Coenzyme Q10 In Ameliorating Obesity- Induced Infertility In Female Rats, Adekunle Adedeji

Electronic Theses and Dissertations

Infertility is one of the major problems of obesity. Studies have shown that administration of leptin reversed obesity-induced infertility in rats and mice. Coenzyme Q10 (CoQ10) is an antioxidant and also supplies the energy needed for ovulation and embryo development. We hypothesized that leptin when combined with CoQ10 could greatly improve obesity-induced infertility. The results showed a significant decrease in food intake, body weight, and the regular estrous cycle was restored after treatment with leptin+CoQ10. There was a significant increase (p10 significantly (p10 can improve fertility in obese infertile female rats. This study could …


Health At Every Size Program Intervention Versus Traditional Weight Loss Intervention: Impact On Diet And Physical Activity, Brooke Noble Jan 2015

Health At Every Size Program Intervention Versus Traditional Weight Loss Intervention: Impact On Diet And Physical Activity, Brooke Noble

Electronic Theses and Dissertations

Backround. A shift from a weight-focus to a health focus -Health At Every Size (HAES)-has been suggested. Yet, little research has compared the impact of this approach to a traditional weight loss program on diet, while physical activity, anthropometric and health indicators have been mixed. Objective. This study evaluated diet, physical activity, anthropometric measurements, blood pressure, blood sugar and cholesterol in participants in these two interventions. It was hypothesized that the HAES group would consume a more nutrient dense diet, more whole foods, higher fiber and lower sodium, while the traditional group would consume lower calories, fat and fiber …


Assessment Of Red Blood Cell Membrane Fatty Acid Composition In Relation To Dietary Intake In Patients Undergoing Cardiac Catheterization, Nicole S. Litwin May 2014

Assessment Of Red Blood Cell Membrane Fatty Acid Composition In Relation To Dietary Intake In Patients Undergoing Cardiac Catheterization, Nicole S. Litwin

Electronic Theses and Dissertations

Red blood cells (RBC) have been shown to mediate plaque development seen in coronary artery disease (CAD). This study determined whether differences in RBC fatty acid (FA) composition were related to CAD risk. FAs were extracted from RBCs of 38 individuals who have undergone cardiac catheterization, 9 of whom had obstructive CAD, and analyzed via gas chromatography. Ferric reducing ability of plasma (FRAP) assay was used to determine oxidative stress. Food frequency questionnaires were used to correlate RBC omega-3 FA to daily intake of omega-3 FA. No correlation was found between RBC content and intake of omega-3 FA. FRAP values …


Dietary Counseling Practices And Perceived Barriers Among Utah Dental Hygienists, Natalie F. Carlson May 2014

Dietary Counseling Practices And Perceived Barriers Among Utah Dental Hygienists, Natalie F. Carlson

Electronic Theses and Dissertations

Diet related factors are associated with the 2 most prevalent oral diseases- caries and periodontal disease. Furthermore, there is growing evidence of a synergistic link between nutrition, systemic health, and oral health. Regardless of this evidence and in spite of recommendations by dental associations, researchers have shown the majority of dental professionals are consistently excluding nutritional screenings and dietary counseling in their dental services. The purpose of this study was to examine the nutritional screening and dietary counseling practices of Utah dental hygienists and to evaluate possible associations between various factors influencing the implementation of nutritional services. Surveys were collected …


Comparison Of Obesity Bias, Attitudes, And Beliefs Among Undergraduate Dietetic Students, Dietetic Interns, And Practicing Registered Dietitians, Sarah E. Welborn May 2013

Comparison Of Obesity Bias, Attitudes, And Beliefs Among Undergraduate Dietetic Students, Dietetic Interns, And Practicing Registered Dietitians, Sarah E. Welborn

Electronic Theses and Dissertations

The obesity epidemic in the United States is increasing, and health concerns are also on the rise as they are directly related to obesity. Even though the majority of Americans are overweight or obese, prejudice and weight bias continue to be prevalent and socially accepted in a culture that tolerates discrimination towards these individuals. Health care providers, including registered dietitians, are not exempt from instigating bias towards obese patients causing a decrease in the level of care that they receive. The main purpose of this study was to compare attitudes, beliefs, and bias concerning obesity among undergraduate dietetic students, dietetic …


Autobiography Of Proteins In Nutrients, Marguerite Jones Jan 1933

Autobiography Of Proteins In Nutrients, Marguerite Jones

Electronic Theses and Dissertations

This thesis, submitted to Xavier University in 1933, surveys the chemical classification of proteins and their role in human nutrition, with the stated aim of preparing home economics students to understand protein's function in the diet. Jones organizes proteins into three major classes: simple proteins, including albumins, globulins, glutelins, protamins, and histones; conjugated proteins, including nucleo-proteins, glyco-proteins, phospho-proteins, and hemoglobins; and derived proteins, including albumoses, peptones, and peptids, describing the chemical composition, solubility properties, and sources of each.

The thesis then examines amino acids as the end products of protein digestion, identifying those essential for growth and maintenance, including tryptophane, …