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PENENTUAN KECUKUPAN KH

DAN SERAT
MUKHLIDAH HANUN SIREGAR, M.KM

Sub Bahasan
Konsep kecukupan KH dan serat
Metode kalkulasi kecukupan KH dan serat
Kalkulasi kecukupan KH dan serat

Dietary Carbohydrates

KARBOHIDRAT
Karbohidrat memegang
peranan penting karena
merupakan sumber energi
utama bagi kehidupan
manusia dan hewan.
Di negara sedang berkembang
kurang lebih 80 % energi
makanan berasal dari
karbohidrat.
Susunan kimia dari
karbohidrat terdiri atas unsurunsur karbon (C), hidrogen (H),
dan oksigen (O).
Formula umum karbohidrat
adalah CnHnOn.

KLASIFIKASI KARBOHIDRAT
KARBOHIDRAT

KH Sederhana

MONOSAKARIDA

DISAKARIDA

KH Kompleks

GULA ALKOHOL

OLIGOSAKARIDA

POLISAKARIDA

Almatsier, 2009

SERAT/
POLISAKARIDA
NON PATI

Classes of Carbohydrates
Class

DP

Example

Site of digestion

Monosaccharides

Glucose

Small bowel

Fructose

Small bowel

Sucrose

Small bowel

Lactose

Small bowel

Raffinose

Large bowel

3-9

Inulin

Large bowel

>9

Starches

Predominantly
Small bowel

>9

Nonstarch
polysaccharides

Large bowel

Oligosaccharides
Polysaccharides

Gibney, et.al, 2009

Classification of Dietary Carbohydrates


Class

Definition

Example

monosaccharide

consists of one sugar unit

glucose or fructose
(sugar alcohols, such
as sorbitol and
mannitol)

disaccharide

consists of two sugar units

sucrose, lactose, and


maltose

Oligosaccharides

containing 3 to 10 sugar units,


are often breakdown products of
polysaccharides

raffinose and
stachyose

Polysaccharides

contain more than


10 sugar units

starch
and glycogen
IOM, 2005

Sugar and Starch


The term sugars is traditionally used to describe monoand disaccharides (FAO/WHO, 1998). Sugars are used as
sweeteners to improve the palatability of foods and
beverages and for food preservation (FAO/WHO, 1998). In
addition, sugars are used to confer certain functional
attributes to foods such as viscosity, texture, body, and
browning capacity. The monosaccharides include glucose,
galactose, and fructose, while the disaccharides include
sucrose, lactose, maltose, and trehalose.
Extrinsic and Intrinsic Sugars
Starch consists of less than 1,000 to many thousands of linked glucose units.

Function of CH
The primary role of carbohydrates (sugars and
starches) is to provide energy to cells in the
body, particularly the brain, which is the only
carbohydrate-dependent organ in the body.

Metabolisme KH
Sumber dari Eksogen dan Endogen
1. GLIKOLISIS serangkaian reaksi biokimia di mana glukosa
dioksidasi menjadi molekul asam piruvat.
2. GLIKOGENESIS proses pembentukan glikogen
3. GLIKOGENOLISIS pemecahan glikogen menjadi bentuk
glukosa di dalam sel.
4. GLUKONEOGENESIS sintesis glukosa dari senyawa bukan
karbohidrat, misalnya asam laktat dan beberapa asam amino.

Evidence for EAR Carbohydrate (1)


Endogenous glucose production rate & utilization rate duration of
starvation.
Glucose production determined by isotopically labeled glucose
The minimal amount of KH required is determined by the brains
requirement for glucose. Because brain is only true carbohydratedependent organ in that it oxidizes glucose completely to carbon dioxide
and water.
The endogenous glucose production rate in a postabsorptive state
correlates very well with the estimated size of the brain from birth to
adult life.

Evidence... (2)
In overnight fasted adults, glucose production : 2 to 2.5 mg/kg/min, or
2.8 to 3.6 g/kg/d. In a 70-kg man, this represents approximately 210 to
270 g/d.
In overnight fasted adults, approximately 50 percent of glucose
production comes from glycogenolysis in liver and 50 percent from
gluconeogenesis in the liver.

Evidence... (3)
The requirement for glucose has been reported to be approximately 110
to 140 g/d in adults (Cahill et al., 1968). Nevertheless, even the brain
can adapt to a carbohydrate-free, energy-sufficient diet, or to
starvation, by utilizing ketoacids for part of its fuel requirements.
In individuals fully adapted to starvation, ketoacid oxidation can
account for approximately 80 percent of the brains energy
requirements (Cahill et al., 1973). Thus, only 22 to 28 g/d of glucose
are required to fuel the brain.

Evidence... (4)
Glucose utilization by the brain has been determined either by measuring
arteriovenous gradients of glucose, oxygen, lactate, and ketones across the brain and
the respiratory quotient (Kety, 1957; Sokoloff, 1973), or with estimates of brain
blood flow determined by different methods. But, the problem is the limited
accuracy of the blood flow methods used (Settergren et al., 1976, 1980). indirect
method and has limitations.
Brain O2 consumption in association with the brain respiratory quotient also has been
used as an indirect estimate of glucose utilization (Kalhan and Kili, 1999).
Setting EAR Only data determined by direct measurement of glucose
arteriovenous difference across the brain in association with determination of brain
blood flow can be considered, indirect methods yield similar results.
The glucose consumption by the brain can be used along with information from
Dobbing and Sands (1973) and Dekaban and Sadowsky (1978), which correlated
weight of the brain with body weight to calculate glucose utilization.

Infants Ages 0 Through 12 Months


Evidence
Carbohydrate Utilization by the Brain
Growth
Human Milk

The method used to set the AI for older


infants is carbohydrate intake from human
milk and complementary foods.
According to Third National Health and
Nutrition Examination Survey

AI for Infants
1. 06 months 60 g/d of carbohydrate
Average volume of ASI intake 0.78 L/d as reported from studies of fullterm
infants by test weighing (Butte et al., 1984; Chandra, 1984; Hofvander et al.,
1982; Neville et al., 1988) 0,78 L/d x 74 g/L

2. 712 months 95 g/d of carbohydrate


median carbohydrate intake from weaning food for ages 7 through 12 months
was 50.7 5 g/d
Based on an average volume of 0.6 L/d of human milk that is secreted, the
carbohydrate intake from human milk is 44 g/d (0.6 L/d 74 g/L).
Total intake of carbohydrate from human milk and complementary foods is
95 g/d (44 + 51).

Special Considerations for Infant


The carbohydrate content of milk protein-based formulas for
term infants is similar to that of human milk (70 to 74 g/L).
Whole cow milk contains lower concentrations of
carbohydrate than human milk (48 g/L) (Newburg and
Neubauer, 1995).
In addition to lactose, conventional infant formulas can also
contain sucrose or glucose polymers.

Children & Adolescents Ages 1 18 Years


Evidence
In the newborn, the brain weight (380 g), by age 1 year
this has increased (1,000 g) in boys and (980 g) in girls,
1-5 years increase (1,300 g in boys and 1,150 g in girls)
The consumption of glucose by the brain after age 1
year also remains rather constant or increases
modestly and is in the range reported for adults.
EAR for carbohydrate is set based on information used
for adults. As for adults, the EAR is the same for both
genders since differences in brain glucose utilization
are small.

Carbohydrate EAR Summary


EAR for Children
13 years 100 g/d of carbohydrate
48 years 100 g/d of carbohydrate

EAR for Boys


913 years 100 g/d of carbohydrate
1418 years 100 g/d of carbohydrate

EAR for Girls


913 years 100 g/d of carbohydrate
1418 years 100 g/d of carbohydrate

Carbohydrate RDA Summary


RDA for Children
13 years 130 g/d of carbohydrate
48 years 130 g/d of carbohydrate

RDA for Boys


913 years 130 g/d of carbohydrate
1418 years 130 g/d of carbohydrate

RDA for Girls


913 years 130 g/d of carbohydrate
1418 years 130 g/d of carbohydrate

Adults Ages 19 Years and Older

Evidence : Glucose Utilization by the Brain


Estimated by Indirect and Direct of Glucose Utilization.
Indirect by measuring brain O2 Comsumption
Direct by measuring brain glucose comsumption

Evidence (1)
EAR for total carbohydrate is set at 100 g/d. RDA calculate with CV
15%.
This amount should be sufficient to fuel central nervous system cells
without having to rely on a partial replacement of glucose by ketoacids.
Although the latter are used by the brain in a concentration-dependent
fashion (Sokoloff, 1973), their utilization only becomes quantitatively
significant when the supply of glucose is considerably reduced and
their circulating concentration has increased several-fold over that
present after an overnight fast.

Evidence (2)
Aging decreases with aging overall rate of energy
metabolism, total body glucose oxidation rate (10% less than 19-29
years)
Changes out of proportion to brain mass remains a controversial
issue.
There is no evidence to indicate that a certain amount of carbohydrate
should be provided as starch or sugars. sugar + 30% from total
energy

Carbohydrate EAR Summary


EAR for Men
1930 years 100 g/d of carbohydrate
3150 years 100 g/d of carbohydrate
5170 years 100 g/d of carbohydrate
> 70 years 100 g/d of carbohydrate

EAR for Women


1930 years 100 g/d of carbohydrate
3150 years 100 g/d of carbohydrate
5170 years 100 g/d of carbohydrate
> 70 years 100 g/d of carbohydrate

Carbohydrate RDA Summary


RDA for Men
1930 years 130 g/d of carbohydrate
3150 years 130 g/d of carbohydrate
5170 years 130 g/d of carbohydrate
> 70 years 130 g/d of carbohydrate

RDA for Women


1930 years 130 g/d of carbohydrate
3150 years 130 g/d of carbohydrate
5170 years 130 g/d of carbohydrate
> 70 years 130 g/d of carbohydrate

Pregnancy
EVIDENCE
Pregnancy increased metabolic rate and fuel
requirement Establishment of the placental
fetal unit and an increased energy supply for
growth and development of the fetus.
Adaptation to pregnancy, there is a decrease in
maternal blood glucose concentration, a
development of insulin resistance, and a
tendency to develop ketosis.
Some data indicate an increase in glucose
ulitization.

Evidence (1)
Fetus 56 kkal/kg/d, so if 3 kg 168 kkal/d.
Transfer form mother 17 26 g/d in late
gestation.
Assuming the glucose consumption rate is the
same for infants and adults (32.5 g/d) greater
than transfer from mother
Glucose oxidation can only account for 70% of
the brains estimated fuel requirement fetus. So
70% from 32,5 = 23 g/d it adequate from
mother.

Evidence (2)
In order to assure provision of glucose to the fetal brain additional
+ 35 g/d
EAR Non pregnant 100 g/d + 35 g/d = 135 g/d RDA calculating
by CV 15%
EAR for Pregnancy
1418 years 135 g/d of KH
1930 years 135 g/d of KH
3150 years 135 g/d of KH

RDA for Pregnancy


1418 years 175 g/d of KH
1930 years 175 g/d of KH
3150 years 175 g/d of KH

Lactation
EVIDENCE
The requirement for carbohydrate is increased during lactation. The
lactose content of human milk is approximately 74 g/L.
Lactose is synthesized from glucose, and increased supply of glucose
must be obtained from ingested carbohydrate or from an increased
supply of amino acids.
Intake necessary to replace the carbohydrate secreted in human milk
(60 g/d)

EAR and RDA Summary


EAR for Lactation
1418 years 160 g/d of KH
1930 years 160 g/d of KH
3150 years 160 g/d of KH

RDA for Lactation


1418 years 210 g/d of KH
1930 years 210 g/d of KH
3150 years 210 g/d of KH

Adverse Effects Of Overconsumption


Hazard Identification
Behavior hyperactivity (allergic reaction & hypoglycemic
response)
Dental Caries fermentable sugars
Triacylglycerol, LDL, and HDL Cholesterol Concentration
Fructose, high GI, coronary heart disease (CHD)
Insulin Sensitivity and Type 2 Diabetes sugar, high GI
Obesity sugar, high GI
Physical Activity consumption of high GI

Dietary Fiber

FIBER
Dietary Fiber consists of nondigestible
carbohydrates and lignin that are intrinsic and
intact in plants.
Functional Fiber consists of isolated,
nondigestible carbohydrates that have
beneficial physiological effects in humans.
Total Fiber is the sum of Dietary Fiber and
Functional Fiber.

Examples Of Fiber
Dietary Fiber includes plant nonstarch polysaccharides
(e.g., cellulose, pectin, gums, hemicellulose, -glucans,
and fibers contained in oat and wheat bran), plant
carbohydrates that are not recovered by alcohol
precipitation (e.g., inulin, oligosaccharides, and
fructans), lignin, and some resistant starch.
Potential Functional Fibers for food labeling include
isolated, nondigestible plant (e.g., resistant starch,
pectin, and gums), animal (e.g., chitin and chitosan), or
commercially produced (e.g., resistant starch,
polydextrose, inulin, and indigestible dextrins)
carbohydrates.

Contribution of Fiber to Energy


When a metabolizable carbohydrate is absorbed in the small intestine, its
energy value is 16.7 kJ/g (4 kcal/g); when fiber is anaerobically fermented
by colonic microflora in the large intestine, short-chain fatty acids (e.g.,
butyrate, acetate, and propionate) are produced and absorbed as an
energy source.
A small proportion of energy from fermented fiber is used for bacterial
growth and maintenance, and bacteria are excreted in feces, which also
contain short-chain fatty acids (Cummings and Branch, 1986). Differences
in food composition, patterns of food consumption, the administered dose
of fiber, the metabolic status of the individual (e.g., obese, lean,
malnourished), and the digestive capability of the individual influence the
digestible energy consumed and the metabolizable energy available from
various dietary fibers.
Because the process of fermentation is anaerobic, less energy is recovered
from fiber than the 4 kcal/g that is recovered from carbohydrate. While it
is still unclear as to the energy yield of fibers in humans, current data
indicate that the yield is in the range of 1.5 to 2.5 kcal/g.

Evidence For Estimating (1)


There is no biochemical assay that reflects
Dietary Fiber or Functional Fiber nutritional
status. Clearly one cannot measure blood fiber
concentration since, by definition, fiber is not
absorbed.
It should be kept in mind that although high
Dietary Fiber intake is associated with
decreased risk or improvements in several
chronic diseases.

Evidence For Estimating (2)


number of epidemiological studies have been
conducted to evaluate the relationship
between fiber intake and risk of chronic
disease. While Functional Fibers, such as
pectins and gums, are added to foods as
ingredients, these levels are minimal and
therefore fiber intakes that are estimated
from food composition tables generally
represent Dietary Fiber.

Dietary Fiber, Functional Fiber, and


the Prevention of Hyperlipidemia,
Hypertension, and Coronary Heart
Disease
have found reduced CHD rates in individuals
consuming high amounts of Dietary Fiber and
fiber-rich foods

A meta-analysis of 20 trials that used high doses


of oat bran, which is rich in viscous Dietary Fiber,
showed that the reductions in serum cholesterol
concentrations ranged from 0.1 to 2.5 percent/g
of intake (Ripsin et al., 1992).
prevention of CHD and recognizing that the
greatest benefit comes from the ingestion of
cereal fibers and viscous Functional Fibers,
including gums and pectins

Fiber Intake and Duodenal Ulcer


In a prospective cohort of 47,806 men with 138 newly
diagnosed cases of duodenal ulcer, Dietary Fibers, and
particularly the viscous fibers, were strongly associated
with a decreased risk of duodenal ulcer (relative risk of
0.40 for the highest quintile of viscous fiber intake)
(Aldoori et al., 1997).
In this study, fiber from fruit, vegetable, and
leguminous sources, but not cereal fiber, was
associated with a reduced risk of duodenal ulcer.
Although the mechanism behind this proposed positive
effect of viscous fibers on duodenal ulcer is not known.

Dietary Fiber, Functional Fiber, and


Colon Health
Constipation, Laxation, and the Contribution of Fiber
to Fecal Weight. Consumption of certain Dietary
and Functional Fibers is known to improve laxation and
ameliorate constipation. In most reports there is a
strong positive correlation between intake of Dietary
Fiber and daily fecal weight.
For example, in a weight-loss study, obese individuals
were put on a very low energy diet with or without 30
g/d of isolated plant fiber (Astrup et al., 1990). Those
receiving the fiber supplement had a higher number of
bowel movements per day (1.0) compared to those not
receiving the fiber supplement (0.7/d).

The majority of the studies cited above show a


relationship between Dietary Fiber and gastrointestinal
health. There are data that show the benefits of certain
Dietary and Functional Fibers on gastrointestinal
health, including the effect of fiber on duodenal ulcers,
constipation, laxation, fecal weight, energy source for
the colon, and prevention of diverticular disease.
A recommended intake level for Total Fiber based on
prevention of CHD should be sufficient to reduce
constipation in most normal people given adequacy of
hydration of the large bowel.
Lanza (1990) reviewed 48 epidemiological studies on
the relationship between diets containing Total Fiber
and colon cancer and found that 38 reported an
inverse relationship, 7 reported no association, and 3
reported a direct association.

Limitedness
All but one of the studies (Bonithon-Kopp et al., 2000)
cited in this section examined the relationship of
Dietary Fiber to colon cancer. Information is lacking on
the role of Functional Fibers in the incidence of colon
cancer because of the lack of intake data on specific
Functional Fibers collected in epidemiological studies.
Most animal studies on fiber and colon cancer,
however, have used what could be termed Functional
Fibers (Jacobs, 1986). Because evidence available is
either too conflicting or inadequately understood, a
recommended intake level based on the prevention of
colon cancer cannot be set.

Dietary Fiber and Functional Fiber and Glucose


Tolerance, Insulin Response, and Amelioration of
Diabetes

In some clinical intervention trials ranging from 2


to 17 weeks, consumption of Dietary Fiber was
shown to decrease insulin requirements in type 2
diabetics (Anderson et al., 1987; Rivellese et al.,
1980; HCR Simpson et al., 1981)
There is evidence that Total Fiber reduces the risk
of diabetes; this can be used as a secondary
endpoint to support a recommended intake level
for Total Fiber that is primarily based on
prevention of CHD

Fiber Intake, Satiety, and Weight


Maintenance
The strongest data supporting a relationship between fiber and
weight maintenance come from the few epidemiological studies
showing that Dietary Fiber intake is lower for obese men and
women than for lean men and women and that BMI is lower with
higher fiber consumption for both men and women.
Efforts to show that eating specific fibers increases satiety and thus
results in a decreased food intake have been inconclusive. However,
this hypothesis has not been validated in clinical trials.
Although the finding that the overall data on Dietary Fiber intake
are negatively correlated with BMI is suggestive of a role for fiber in
weight control, the studies designed to determine how fiber intake
might impact overall energy intake have not shown a major effect.
In fact, it appears that very high amounts of fiber (e.g., 30 g/meal)
are required to diminish subsequent energy intake after that meal.
For humans, there is no overwhelming evidence that Dietary Fiber
has an effect on satiety or weight maintenance, therefore this
endpoint is not used to set a recommended intake level.

Estimating AI
Total Fiber requirements (the sum of Dietary Fiber and
Functional Fiber) may be expressed in a variety of different
ways, including age plus number of grams per day (Williams
et al., 1995), grams per kilogram of body weight (AAP,
1993), grams per day (Health and Welfare Canada, 1985;
LSRO, 1987), and grams per 1,000 kcal (LSRO, 1987).
Each of these methods has its advantages and
disadvantages. Because the available evidence suggests
that the beneficial effects of fiber in humans are most likely
related to the amount of food consumednot to the
individuals age or body weight the best approach is to
set an Adequate Intake (AI) based on grams per 1,000 kcal.
However, since many people do not know how many
kilocalories they consume in a day, the AI is based on the
usual daily intake of energy.

Infants Ages 0 Through 12 Months


There are no functional criteria for fiber status that reflect
response to dietary intake in infants. Since human milk is
recognized as the optimal source of nourishment for infants
throughout at least the first year of life and as a sole
nutritional source for infants during the first 4 to 6 months
of life (IOM, 1991), and because human milk contains no
Dietary Fiber, there is no AI for infants 0 through 6 months
of age.
During the 7- through 12-month age period, the intake of
solid foods becomes more significant, and Dietary Fiber
intake may increase. However, there are no data on Dietary
Fiber intake in this age group and no theoretical reason to
establish an AI for infants 7 through 12 months of age.

Children and Adolescents Ages 1


Through 18 Years
Method to set AI none of these guidelines
recommend a specific level of fiber intake during
childhood.
Data suggest that North American children, like adults,
consume inadequate amounts of fiber for optimal
health, and that consumption of fiber should be
increased to promote normal laxation, to help prevent
diet-related cancer, to help reduce serum cholesterol
concentrations and therefore the risk of coronary heart
disease (CHD), and to help prevent obesity and the risk
of adult-onset diabetes.

The AI for Total Fiber for children and adolescents is


based on the data cited for adults, which showed that
14 g/1,000 kcal reduced the risk of CHD.
The median energy intake for 1- to 3-year-old children
is 1,372 kcal/d 19 g/d (14 1.37) of total fiber
would be recommended for this age group.
The median energy intake for 4- to 8-year-old children
is 1,759 kcal/d. 25 g/d (14 1.76) of Total Fiber
would be recommended for these children.

Total Fiber AI Summary


AI for Children
13 years 19 g/d of Total Fiber
48 years 25 g/d of Total Fiber

AI for Boys
913 years 31 g/d of Total Fiber
1418 years 38 g/d of Total Fiber

AI for Girls
913 years 26 g/d of Total Fiber
1418 years 26 g/d of Total Fiber

Adults Ages 19 Years and Older


Method to set AI
Fiber Intake and Risk of CHD
Data from 21,930 Finnish men showed that at the highest
quintile of Dietary Fiber intake (34.8 g/d), median energy intake
was 2,705 kcal/d, which equates to 12.9 g of Dietary Fiber/1,000
kcal (Pietinen et al., 1996).
The Health Professionals Follow-up Study of men reported a
Dietary Fiber intake of 28.9 g/d in the highest quintile, with a
normalized energy intake of 2,000 kcal/d, which equates to
14.45 g of Dietary Fiber/1,000 kcal (Rimm et al., 1996).
In the Nurses Health Study of women, the median Dietary Fiber
intake at the highest quintile was 22.9 g/d, with a normalized
energy intake of 1,600 kcal/d (Wolk et al., 1999), which equates
to 14.3 g of Dietary Fiber/1,000 kcal.

Fiber Intake and Risk of Type 2 Diabetes


The literature on Dietary Fiber intake and glucose
tolerance, insulin response, and amelioration of diabetes
alone is insufficient at this time to use as a basis for a
recommendation. However, it should be noted that the
positive effects seen in two large prospective studies
(Salmern et al., 1997a, 1997b) were achieved with the
same levels of fiber that have previously been reported as
being protective against CHD (Pietinen et al., 1996; Rimm
et al., 1996; Wolk et al., 1999). Therefore, the
recommendations made using the effect of Dietary Fiber
intake on CHD are supported by the data on Dietary Fiber
intake and type 2 diabetes.

Based on the average intake of Dietary Fiber


and its effect on CHD, as well as the beneficial
role of Functional Fibers (such as gums, pectin
and psyllium), an AI for Total Fiber is set for
each age and gender group by multiplying 14
g/1,000 kcal median energy intake
(kcal/1,000 kcal/d).

Total Fiber AI Summary


AI for Men
1930 years 38 g/d of
Total Fiber
3150 years 38 g/d of
Total Fiber
5170 years 30 g/d of
Total Fiber
> 70 years 30 g/d of
Total Fiber

AI for Women
1930 years 25 g/d of
Total Fiber
3150 years 25 g/d of
Total Fiber
5170 years 21 g/d of
Total Fiber
> 70 years 21 g/d of
Total Fiber

Pregnancy & Lactation


AI for Total Fiber (14
g/1,000 kcal 1,978
kcal/1,000 kcal/d)
AI for Pregnant Women

AI for Total (14 g/1,000


kcal 2,066 kcal/1,000
kcal/d)
AI for Lactating Women

1418 years 28 g/d of


Total Fiber
1930 years 28 g/d of
Total Fiber
3150 years 28 g/d of
Total Fiber

1418 years 29 g/d of


Total Fiber
1930 years 29 g/d of
Total Fiber
3150 years 29 g/d of
Total Fiber

Adverse Effects Of Overconsumption


Mineral Bioavailability Fibers may reduce the
bioavailability of minerals such as iron, calcium,
and zinc.
While occasional adverse gastrointestinal
symptoms are observed when consuming some
of the isolated or synthetic fibers, serious chronic
adverse effects have not been observed.
Furthermore, due to the bulky nature of fibers,
excess consumption is likely to be self-limiting.
Therefore, a UL was not set for these individual
fibers.

TERIMA KASIH

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