Dietetics and Clinical Nutrition Commons^™

Nutritional Strategies To Optimise Musculoskeletal Health For Fall And Fracture Prevention: Looking Beyond Calcium, Vitamin D And Protein, James Webster, Jack Dalla Via, Christina Langley, Cassandra Smith, Craig Sale, Marc Sim

Research outputs 2022 to 2026

Falls and osteoporotic fractures are a major public health problem, particularly among older adults. A third of individuals aged 65 years and over fall at least once each year, with up to 20 % of these resulting in serious injury, including fracture. In conjunction with regular exercise, the importance of diet for musculoskeletal health has largely focused upon calcium, vitamin D, and protein, particularly in the context of preventing falls and fractures. Whilst there is evidence for the benefits of these nutrients for musculoskeletal health, other aspects of the diet remain largely underexplored. For example, vegetables are rich sources of …

Culinary Medicine And The Promotion Of Plant-Based Diets: Is Caution Needed For Older Adults?, Wendy J. Dahl, Sayaka Nagao-Sato, Christina Riccardo

Nutrition Faculty Publications

Culinary Medicine (CM), which combines food, cooking, and the science of medicine1 for the management of chronic disease conditions, is an emerging practice area for health professionals, particularly physicians.2 Culinary skills and food-disease-related knowledge are enhanced by CM training3 ; however, there is much to learn regarding optimal program outcome measures.4 What cannot be gained from a CM program is the comprehensive nutrition knowledge that may be needed to ensure CM prescriptions result in benefits and minimize harm. This may be particularly important for older adults.

Plasma Metabolomic Profiles Of Plant-Based Dietary Indices Reveal Potential Pathways For Metabolic Syndrome Associations, Fabian Lanuza, Tomas Meroño, Raul Zamora-Ros, Nicola P. Bondonno, Agnetha L. Rostgaard-Hansen, Alex Sánchez-Pla, Berta Miro, Francesc Carmona-Pontaque, Gabriele Riccardi, Anne Tjønneland, Rikard Landberg, Jytte Halkjær, Cristina Andres-Lacueva

Research outputs 2022 to 2026

Background and aims: Plant-based dietary patterns have been associated with improved health outcomes. This study aims to describe the metabolomic fingerprints of plant-based diet indices (PDI) and examine their association with metabolic syndrome (MetS) and its components in a Danish population. Methods: The MAX study comprised 676 participants (55% women, aged 18-67 y) from Copenhagen. Sociodemographic and dietary data were collected using questionnaires and three 24-h dietary recalls over one year (at baseline, and at 6 and 12 months). Mean dietary intakes were computed, as well as overall PDI, healthful (hPDI) and unhealthful (uPDI) scores, according to food groups for …

Antibiotic-Induced Gut Dysbiosis And Cognitive, Emotional, And Behavioral Changes In Rodents: A Systematic Review And Meta-Analysis, Shivdeep S. Hayer, Soonjo Hwang, Jonathan B. Clayton

Food for Health: Publications

There are previous epidemiological studies reporting associations between antibiotic use and psychiatric symptoms. Antibiotic-induced gut dysbiosis and alteration of microbiota-gut-brain axis communication has been proposed to play a role in this association. In this systematic review and meta-analysis, we reviewed published articles that have presented results on changes in cognition, emotion, and behavior in rodents (rats and mice) after antibiotic-induced gut dysbiosis. We searched three databases—PubMed, Web of Science, and SCOPUS to identify such articles using dedicated search strings and extracted data from 48 articles. Increase in anxiety and depression-like behavior was reported in 32.7 and 40.7 percent of the …

Antibiotic-Induced Gut Dysbiosis And Cognitive, Emotional, And Behavioral Changes In Rodents: A Systematic Review And Meta-Analysis, Shivdeep S. Hayer, Soonjo Hwang, Jonathan B. Clayton

Food for Health: Publications

There are previous epidemiological studies reporting associations between antibiotic use and psychiatric symptoms. Antibiotic-induced gut dysbiosis and alteration of microbiota-gut-brain axis communication has been proposed to play a role in this association. In this systematic review and meta-analysis, we reviewed published articles that have presented results on changes in cognition, emotion, and behavior in rodents (rats and mice) after antibiotic-induced gut dysbiosis. We searched three databases—PubMed, Web of Science, and SCOPUS to identify such articles using dedicated search strings and extracted data from 48 articles. Increase in anxiety and depression-like behavior was reported in 32.7 and 40.7 percent of the …

Partner Discussion Using An Ehr And Chatgpt, Anne Bodensteiner

AI Assignment Library

This assignment requires students to complete a worksheet using a simulated EHR (which is a subscription software purchase) and meet with a partner to discuss AI in nutrition care and compare their results to the worksheet with answers they get from ChatGPT.

The Effect Of Oral Nutrition Supplements And Appetite Stimulants On Weight Status Among Pediatric Cancer Patients: A Systematic Review, Corey Hawes, Alison Gomes, Laura Byham-Gray, Stephanie Henderson

Health & Biomedical Sciences Faculty Publications and Presentations

The objective of this study was to identify the use and impact of oral nutrition supplements (ONSs) and appetite stimulants on weight status among pediatric patients diagnosed with malignancy. We performed a literature search of trials using Medline PubMed, CINAHL, Web of Science Core Collection, Scopus, and Cochrane Database of Systematic Reviews and included all prospective studies except review articles and case-reports/series that assessed ONSs or appetite stimulants among patients (0-20 years old) diagnosed with a pediatric malignancy. Databases were searched through May 17, 2022. There were six trials included with three studies related to ONS and the remaining on …

Homeobox Transcription Factor Hbxa Influences Expression Of Over One Thousand Genes In The Model Fungus Aspergillus Nidulans, Sandesh S. Pandit, Jinfang Zheng, Yanbin Yan, Sophie Lorber, Olivier Puel, Sourabh Dhingra, Eduardo A. Espeso, Ana M. Calvo

Food for Health: Publications

In fungi, conserved homeobox-domain proteins are transcriptional regulators governing development. In Aspergillus species, several homeobox-domain transcription factor genes have been identified, among them, hbxA/hbx1. For instance, in the opportunistic human pathogen Aspergillus fumigatus, hbxA is involved in conidial production and germination, as well as virulence and secondary metabolism, including production of fumigaclavines, fumiquinazolines, and chaetominine. In the agriculturally important fungus Aspergillus flavus, disruption of hbx1 results in fluffy aconidial colonies unable to produce sclerotia. hbx1 also regulates production of aflatoxins, cyclopiazonic acid and aflatrem. Furthermore, transcriptome studies revealed that hbx1 has a broad effect on …

Revisional Bariatric Surgery For Weight Recurrence Or Surgical Nonresponse, Erin Briggs, Sunjay Kumar, Francesco Palazzo, Talar Tatarian

Department of Surgery Faculty Papers

No abstract provided.

Distinct Gene Expression Profiles Between Human Preterm-Derived And Adult-Derived Intestinal Organoids Exposed To Enterococcus Faecalis: A Pilot Study, Andrea C. Masi, Tatiana Y. Fofanova, Christopher A. Lamb, Jennifer Auchtung, Robert A. Britton, Mary K. Estes, Sasirekha Ramani, Simon J. Cockell, Jonathan Coxhead, Nicholas D. Embleton, Janet E. Berrington, Joseph F. Petrosino, Christopher J. Stewart

Food for Health: Publications

We read with interest the study by Kayisoglu et al¹ comparing the gene expression between embryo-derived and adult-derived intestinal organoids. Some innate immune system genes were differentially expressed between the two organoid types, suggesting a potential role of exposure to the environment, including gut microbiota, in shaping the intestinal gene expression. In extremely preterm infants (<32 weeks gestation), microbial–host interaction at the epithelial surface has been associated with various morbidities including late onset sepsis and necrotising enterocolitis.² Thus, preterm intestinal organoids may provide a specific and robust model for this population.

Dietary Polyphenols, Metabolic Syndrome And Cardiometabolic Risk Factors: An Observational Study Based On The Dch-Ng Subcohort, Fabian Lanuza, Raul Zamora-Ros, Nicola P. Bondonno, Tomas Meroño, Agnetha Linn Rostgaard-Hansen, Gabriele Riccardi, Anne Tjønneland, Rikard Landberg, Jytte Halkjær, Cristina Andres-Lacueva

Research outputs 2022 to 2026

Background and aims: Polyphenol-rich foods have beneficial properties that may lower cardiometabolic risk. We aimed to prospectively investigate the relationship between intakes of dietary polyphenols, and metabolic syndrome (MetS) and its components, in 676 Danish residents from the MAX study, a subcohort of the Danish Diet, Cancer and Health–Next Generations (DCH-NG) cohort. Methods and results: Dietary data were collected using web-based 24-h dietary recalls over one year (at baseline, and at 6 and 12 months). The Phenol-Explorer database was used to estimate dietary polyphenol intake. Clinical variables were also collected at the same time point. Generalized linear mixed models were …

Higher Overall Intakes Are The Defining Feature Of Dietary Intakes In Nafld And Compared To The General Population, Catherine Properzi, Leon A. Adams, Johnny Lo, Jill L. Sherriff, Gary P. Jeffrey, Therese A. O’Sullivan

Research outputs 2022 to 2026

We aimed to compare the dietary intakes of Australian patients with non-alcoholic fatty liver disease (NAFLD) to general Australian population intake data and determine whether the intake of any nutrient or food group was able to predict the degree of steatosis. Dietary data from fifty adult patients with NAFLD were compared to intake data from the Australian Health Survey for energy, macronutrients, fat sub-types, alcohol, iron, folate, sugar, fibre, sodium and caffeine. Linear regression models adjusting for potential confounders (age, sex, physical activity and body mass index) were used to examine predictive relationships between hepatic steatosis (quantified via magnetic resonance …

Implementation Of A Biometric Screening Program And Wellness Coaching Program In A Hospital Employee Wellness Center, Carl Gastanes

Doctor of Nursing Practice Scholarly Projects

Background: Wellness programs are an emerging priority among organizations concerned about employee wellness and productivity. Data from Long Island Jewish Medical Center (LIJMC) revealed that in 2019 there were 1,690 employee visits to the ER due to chronic diseases; 30% were classified as ER sick visit and 40% of employees who visited the ER had no primary care provider. Many companies use biometric screening and health risk assessment to measure the health of their employees. The purpose of this improvement project was to implement a biometric screening program (BSP) that included wellness coaching to improve the health outcomes of LIJMC …

Neurodevelopment, Vision And Auditory Outcomes At Age 2 Years In Offspring Of Participants In The ‘Women First’ Maternal Preconception Nutrition Randomised Controlled Trial, Michelle Fernandes, Nancy F. Krebs, Jamie Westcott, Antoinette Tshefu, Adrien Lokangaka, Melissa Bauserman, Ana L. Garcés, Lester Figueroa, Sarah Saleem, Sumera A. Aziz, Robert L. Goldenberg, Shivaprasad S. Goudar, Sangappa M. Dhaded, Richard J. Derman, Jennifer F. Kemp, Marion Koso-Thomas, Amaanti Sridhar, Elizabeth M. Mcclure, K. Michael Hambidge

Global Health Articles

BACKGROUND: Maternal nutrition in preconception and early pregnancy influences fetal growth. Evidence for effects of prenatal maternal nutrition on early child development (ECD) in low-income and middle-income countries is limited.

OBJECTIVES: To examine impact of maternal nutrition supplementation initiated prior to or during pregnancy on ECD, and to examine potential association of postnatal growth with ECD domains.

DESIGN: Secondary analysis regarding the offspring of participants of a maternal multicountry, individually randomised trial.

SETTING: Rural Democratic Republic of the Congo, Guatemala, India and Pakistan.

PARTICIPANTS: 667 offspring of Women First trial participants, aged 24 months.

INTERVENTION: Maternal lipid-based nutrient supplement initiated …

The Effects Of Creatine Supplementation On Muscle Synthesis And Fitness Levels In Drosophila Melanogaster Using A Model Of Muscle Atrophy, Kevin Williams

Honors Program Projects

This study examines whether an inhibited electron transport chain can be aided with supplemented creatine to make up for the challenged adenosine triphosphate (ATP) production mechanism. The electron transport chain is a series of protein complexes in the mitochondrial membrane that transfer electrons and couples this reaction with the transfer of protons across the membrane to produce ATP. The differences between male and female flies and the supplementation of creatine at a 0.15% concentration was studied. The relationship between these components was studied over the course of two 3-week trials using a fly treadmill and Drosophila. The effects of creatine …

Nitrate: The Dr. Jekyll And Mr. Hyde Of Human Health?, Catherine P. Bondonno, Liezhou Zhong, Nicola P. Bondonno, Marc Sim, Lauren C. Blekkenhorst, Alex Liu, Anjana Rajendra, Pratik Pokharel, Dorit W. Erichsen, Oliver Neubauer, Kevin D. Croft, Jonathan M. Hodgson

Research outputs 2022 to 2026

Background: Dietary nitrate has a controversial role in human health. For over half a century, the nitrate content of the three major dietary sources – vegetables, meat, and water – has been legislated, regulated, and monitored due to public health concerns over cancer risk. In contrast, a growing and compelling body of evidence indicates that dietary nitrate, particularly from vegetables, protects against cardiovascular disease and other chronic diseases. This evidence for the protective effect of nitrate is overshadowed by the potential for nitrate to form carcinogenic N-nitrosamines. Scope and approach: The nitrate content, regulations and estimated intake from vegetables, meat …

How Can Consuming A Plant-Based Diet Reduce The Risk Of Cardiovascular Disease In Postmenopausal Women?, Rebecca Stack

Honors Program Theses and Projects

Despite the fact that women suffer higher rates of cardiovascular events after menopause, there exists a significant underrepresentation of women—especially postmenopausal women—in cardiovascular clinical trials to date. Fortunately, current evidence reveals that cardiovascular events in the general population are largely preventable through modifiable lifestyle factors, with dietary intervention being one of the most important (Amiri et al., 2022). As the impact of whole-diet interventions on cardiovascular risk factors is further explored, it has been determined that a plant-based dietary pattern may favorably influence the prevention of cardiovascular events in postmenopausal women (Barańska et al., 2021). Evidence also reveals that certain …

The Spice Is Right: Evaluating The Spice And Herb Content Of Congregate Meals, Tessa Vander Kamp, Tracy Noerper

Undergraduate and Master's Projects

Congregate meals offer social and nutritional benefits to Americans over the age of sixty. A nutritious diet is essential to support health and manage chronic health conditions, specifically for an aging population. Congregate meals must meet minimum nutritional requirements and typically include a variety of fruits, vegetables, grains, dairy products and protein.

Knowledge, Beliefs, And Practicies Of Ncaa Coaches And Sports Dietitians On Low Energy Availability, Laurel Card, Amy Banaszek

Undergraduate and Master's Projects

Low energy availability in athletes, or Relative Energy Deficiency in Sport (RED-S), is chronic under-fueling while consistently overtraining. RED-S is not an eating disorder, but can impact training performance and reproductive health, compromise bone health, impact cognitive health and mental illness, and decrease cardiac health. Body weight alone is not an indication of RED-S, and both men and women are susceptible.

The Inherited Intestinal Microbiota From Myeloid-Specific Zip8ko Mice Impairs Pulmonary Host Defense Against Pneumococcal Pneumonia, Derrick R. Samuelson, Deandra R. Smith, Kelly C. Cunningham, Sabah Haq, Daniel N. Villageliú, Christi Christi Ellis, Niaz Bahar Chowdhury, Amanda E. Ramer-Tait, Jeff Price, Daren L. Knoell

Food for Health: Publications

Intestinal dysbiosis increases susceptibility to infection through the alteration of metabolic profiles, which increases morbidity. Zinc (Zn) homeostasis in mammals is tightly regulated by 24 Zn transporters. ZIP8 is unique in that it is required by myeloid cells to maintain proper host defense against bacterial pneumonia. In addition, a frequently occurring ZIP8 defective variant (SLC39A8 rs13107325) is strongly associated with inflammation-based disorders and bacterial infection. In this study, we developed a novel model to study the effects of ZIP8-mediated intestinal dysbiosis on pulmonary host defense independent of the genetic effects. Cecal microbial communities from a myeloid-specific Zip8 knockout mouse …

Impact Of Community-Driven Interventions On Dietary And Physical Activity Outcomes Among A Cohort Of Adults In A Rural Appalachian County In Eastern Kentucky, 2019–2022, Heather Norman-Burgdolf, Emily M. Dewitt, Rachel Gillespie, Kathryn Cardarelli, Stacey Slone, Alison Gustafson

Dietetics and Human Nutrition Faculty Publications

Several environmental level factors exacerbate poor health outcomes in rural populations in the United States, such as lack of access to healthy food and locations to be physically active, which support healthy choices at the individual level. Thus, utilizing innovative place-based approaches in rural locations is essential to improve health outcomes. Leveraging community assets, like Cooperative Extension, is a novel strategy for implementing community-driven interventions. This prospective cohort study (n = 152), recruited in 2019 and surveyed again in 2020 and 2021, examined individual level changes in diet and physical activity in one rural Appalachian county. During this time, multiple …

Fruit And Vegetable Intake And Home Nutrition Environment Among Low-Income Minority Households With Elementary-Aged Children, Brittni Naylor Metoyer, Ru-Jye Chuang, Minjae Lee, Christine Markham, Eric L Brown, Maha Almohamad, Jayna M Dave, Shreela V Sharma

Journal Articles

Racial/ethnic and socioeconomic differences were shown to have an influence on child fruit and vegetable intake. This study examined the associations between parent and child fruit and vegetable intake and the home nutrition environment among Hispanic/Latino and African American families. Through a cross-sectional study design, self-reported surveys (

A Cross-Sectional Evaluation Of The Food Environment At An Australian University Campus, Daisy H. Coyle, Laura Sanavio, Eden Barrett, Liping Huang, Kristy K. Law, Pabasha Nanayakkara, Jonathan M. Hodgson, Merita O’Connell, Belinda Meggitt, Carrie Tsai, Simone Pettigrew, Jason H. Y. Wu

Research outputs 2022 to 2026

University food environments have a strong influence on the dietary choices of students and staff. The aim of this study was to assess the food environment at a large university in Sydney, Australia. Data were collected between March and July 2022 from 27 fixed food outlets and 24 vending machines. The healthiness of the food environment was evaluated using the Healthy Food and Drink in NSW Health Facilities for Staff and Visitors Framework (‘Framework’), which assesses food environment parameters including the availability, placement, and promotion of ‘Everyday’ (healthy) and ‘Occasional’ (less healthy) products. Each parameter was evaluated overall and across …

Health Consequences Of Low Energy Availability In Females And Their Underlying Physiological Mechanisms, Grace Parry

Senior Honors Theses

Low energy availability (LEA) is a state in which energy intake is insufficient to support energy expenditure while maintaining energy balance, which has been shown to result in gastrointestinal distress, immunosuppression, reduced metabolic rate, menstrual dysfunction, diminished bone health, and impaired cardiovascular function in females. Alterations to the microbiome and mucosal lining may propagate gastrointestinal complaints and compromised immune function associated with LEA. The pathophysiology of LEA is otherwise largely driven by hormonal adaptations. Diminished production of thyroid hormones is known to contribute to reduced metabolic rate. Decreases in leptin and insulin and increases in ghrelin disrupt reproductive function through …

Association Between Classes And Subclasses Of Polyphenol Intake And 5-Year Body Weight Changes In The Epic-Panacea Study, Jazmin Castañeda, Mercedes Gil-Lespinard, Enrique Almanza-Aguilera, Fjorida Llaha, Jesús-Humberto Gómez, Nicola Bondonno, Anne Tjønneland, Kim Overvad, Verena Katzke, Matthias B. Schulze, Giovanna Masala, Claudia Agnoli, Maria Santucci De Magistris, Rosario Tumino, Carlotta Sacerdote, Guri Skeie, Magritt Brustad, Cristina Lasheras, Esther Molina-Montes, María-Dolores Chirlaque, Aurelio Barricarte, Emily Sonestedt, Marisa Da Silva, Ingegerd Johansson, Johan Hultdin, Anne M. May

Research outputs 2022 to 2026

Objective: The aim of this study was to evaluate the associations among the intake of total polyphenols, polyphenol classes, and polyphenol subclasses and body weight change over 5 years. Methods: A total of 349,165 men and women aged 25 to 70 years were recruited in the Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home and Obesity (PANACEA) project of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort from nine European countries. Body weight was measured at baseline and at follow-up after a median time of 5 years. Polyphenol intake, including four main polyphenol classes and …

Longitudinal Associations Between Dietary Fructose And Sodium And Systolic And Diastolic Blood Pressure Among Us Black And White Adults In The Cardia Study, Rana Elhamzawy, Dragana Komnenov, Daniel Domin

Medical Student Research Symposium

Longitudinal associations between dietary fructose and sodium and systolic and diastolic blood pressure among US Black and White adults in the CARDIA study

Authors: Rana Elhamzawy, Daniel Domin, Dragana Komnenov

Hypertension is one of the leading risk factors for major adverse cardiovascular events (MACE). Likewise, suboptimal dietary habits, including high fructose and sodium intake, are major contributors to mortality. High dietary fructose alone predisposes to salt-sensitivity of blood pressure, which is an independent, significant cardiovascular risk factor. We previously showed in our rat model of fructose-salt-sensitive hypertension that even a short term (4 weeks) feeding with 20% fructose and 4% …

Advertising Sports Nutrition Practices To Adolescent Athletes: A Poster Series, Emma Hansen

Honors Theses

Sports nutrition is an important aspect of an athlete’s training and improvement, yet it is often overlooked when it comes to younger competitors. Four posters were created with the intent of providing adolescent athletes, their parents, and their coaches with information about important topics in sports nutrition including a general overview of nutrition goals, hydration strategies, recovery nutrition, and nutritional considerations for vegetarian and vegan youth athletes. The posters were designed to appeal to adolescents from the ages of 13 to 18, and each poster covers its designated topic in detail appropriate for middle and high school-aged athletes. The accompanying …

Calcium Supplements And Risk Of Cvd: A Meta-Analysis Of Randomized Trials, Xiqian Huo, Robert Clarke, Jim Halsey, Rebecca Jackson, Amy Lehman, Richard Prince, Joshua Lewis, John A. Baron, Heikki Kroger, Reijo Sund, Jane Armitage

Research outputs 2022 to 2026

Background: Vitamin D supplements may only be beneficial for the prevention of osteoporotic fractures when administered with calcium and in individuals with low blood levels of 25(OH)D, but possible hazards of calcium supplements on CVD cannot be excluded. Objectives: We conducted a meta-analysis of all placebo-controlled randomized trials assessing the effects of calcium supplements alone or with vitamin D on CHD, stroke, and all-cause mortality. Methods: A meta-analysis of 11 trials included 7 comparisons of calcium alone compared with control (n = 8634) and 6 comparisons of calcium plus vitamin D compared with control (n = 46,804). Aggregated study-level data …

Development Of The Menu Assessment Scoring Tool (Mast) To Assess The Nutritional Quality Of Food Service Menus, Claire Elizabeth Pulker, Leisha Michelle Aberle, Lucy Meredith Butcher, Clare Whitton, Kristy Karying Law, Amy Louise Large, Christina Mary Pollard, Georgina S. A. Trapp

Research outputs 2022 to 2026

Preventing the rise in obesity is a global public health priority. Neighbourhood environments can help or undermine people’s efforts to manage their weight, depending on availability of nutritious and nutrient-poor ‘discretionary’ foods. The proportion of household food budgets spent on eating outside the home is increasing. To inform nutrition policy at a local level, an objective assessment of the nutritional quality of foods and beverages on food service menus that is context-specific is needed. This study describes the development and piloting of the Menu Assessment Scoring Tool (MAST), used to assess the nutritional quality of food service menus in Australia. …

Association Of Healthful Plant-Based Diet Adherence With Risk Of Mortality And Major Chronic Diseases Among Adults In The Uk, Alysha S. Thompson, Anna Tresserra-Rimbau, Nena Karavasiloglou, Amy Jennings, Marie Cantwell, Claire Hill, Aurora Perez-Cornago, Nicola P. Bondonno, Neil Murphy, Sabine Rohrmann, Aedín Cassidy, Tilman Kühn

Research outputs 2022 to 2026

Importance: Plant-based diets have gained popularity for both environmental and health reasons, but a comprehensive assessment of their quality in relation to risk of mortality and major chronic diseases is lacking. Objective: To examine whether healthful vs unhealthful plant-based dietary patterns are associated with mortality and major chronic diseases among UK adults. Design, Setting, and Participants: This prospective cohort study used data from adults in the UK Biobank, a large-scale population-based study. Participants were recruited between 2006 and 2010 and followed up using record linkage data until 2021; follow-up for different outcomes ranged between 10.6 and 12.2 years. Data analysis …