scholarly journals Sources of Energy, Empty Calories, Added Sugars, and Solid Fats Among Children and Adolescents 2–18 Years in the United States

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 296-296
Author(s):  
Edwina Wambogo ◽  
Jill Reedy ◽  
Marissa Shams-White ◽  
Kirsten Herrick ◽  
Jennifer Lerman ◽  
...  
Keyword(s):  
Total Energy ◽  
Children And Adolescents ◽  
Energy Intake ◽  
Age Groups ◽  
The United States ◽  
Soft Drinks ◽  
Added Sugars ◽  
Reduced Fat ◽  
Whole Milk ◽  
Over Time

Abstract Objectives To identify top dietary sources of energy, empty calories, added sugars, and solid fats among 2–18 year old children and adolescents in the U.S. and describe trends. Methods Day 1 24-hour dietary recalls from the NHANES Survey were categorized according to the What We Eat in America Food categories and used to examine food sources (percentage contribution and mean intake) of total energy and energy from added sugars and solid fats (collectively, empty calories). Trends over time between 2007–2016 were examined in 2–18-year-olds. Significance was set at P < 0.05. Results The top five sources of energy overall from 2007–2016 for 2–18-year-olds were pizza (5.8%), other sandwiches (3.9%), soft drinks (3.4%), cakes and brownies (3.1%), and flavored milk (2.6%). Energy intake decreased between 2007–08 to 2015–16, largest decrease between 2011–12 to 2015–16 for 2–3-year-olds (–8.7%, P = 0.02) and for 4–8-year-olds (–6.8%, P = 0.0005); and from 2009–10 to 2015–16 for 14–18-year-olds (–7.0%, P = 0.005). In all age groups, empty calories declined, regardless of energy intake. Nevertheless, in all age groups, >25% of total energy intake came from empty calories: 2–3-year-olds (26.1%–30.0%), 4–8-year-olds (30.0%–33.6%), 9–13-year-olds (30.2%–34.4%), and 14–18-year-olds (30.5%–35.5%). Over time the top sources of energy and empty calories did not vary greatly within each age group, but with increasing age, there was a shift from beverages to solid foods, and in types of beverages. For example, of the top five energy sources among 2–3 year-olds, four were beverages (flavored milk, 3.9–5.7%; whole milk, 3.4–5.4%; reduced fat milk, 4.2–5.3%, and fruit drinks, 2.9–3.1%), among 4–8 year-olds, two were beverages (flavored milk, 3.2–4.7% and fruit drinks, 3.1–3.3%), and among 9–13 year-olds and 14–18 year-olds, mainly soft drinks (3.4–4.7% and 4.1–6.3%, respectively), and in some years, fruit drinks (2.7% and 2.9%, respectively). Conclusions There is an overlap in top sources of energy and empty calories: flavored milk, fruit drinks, whole milk, reduced fat milk, soft drinks, pizza, cookies and brownies, and other sandwiches. Continued research on how the sources of empty calories transition from early childhood into adolescence can inform how to modify the food landscape to include fewer empty calorie foods and potentially address excess energy intake. Funding Sources N/A.

scholarly journals Dietary Sugar Intake and Its Association with Obesity in Children and Adolescents

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 676
Author(s):  
Emmanuella Magriplis ◽  
George Michas ◽  
Evgenia Petridi ◽  
George P. Chrousos ◽  
Eleftheria Roma ◽  
...  
Keyword(s):  
Total Energy ◽  
Children And Adolescents ◽  
Age Groups ◽  
Significant Proportion ◽  
Dietary Intakes ◽  
Food Groups ◽  
Added Sugar ◽  
Added Sugars ◽  
Sugar Intake ◽  
Sweetened Beverages

Sugar intake has been associated with increased prevalence of childhood overweight/obesity; however, results remain controversial. The aim of this study was to examine the probability of overweight/obesity with higher sugar intakes, accounting for other dietary intakes. Data from 1165 children and adolescents aged ≥2–18 years (66.8% males) enrolled in the Hellenic National Nutrition and Health Survey (HNNHS) were used; specifically, 781 children aged 2–11 years and 384 adolescents 12–18 years. Total and added sugar intake were assessed using two 24 h recalls (24 hR). Foods were categorized into specific food groups to evaluate the main foods contributing to intakes. A significant proportion of children (18.7%) and adolescents (24.5%) exceeded the recommended cut-off of 10% of total energy intake from added sugars. Sweets (29.8%) and processed/refined grains and cereals (19.1%) were the main sources of added sugars in both age groups, while in adolescents, the third main contributor was sugar-sweetened beverages (20.6%). Being overweight or obese was 2.57 (p = 0.002) and 1.77 (p = 0.047) times more likely for intakes ≥10% of total energy from added sugars compared to less <10%, when accounting for food groups and macronutrient intakes, respectively. The predicted probability of becoming obese was also significant with higher total and added-sugar consumption. We conclude that high consumption of added sugars increased the probability for overweight/obesity among youth, irrespectively of other dietary or macronutrient intakes.

scholarly journals Comparison Between Total Energy Intake and Screen Time Among U.S Children Based on NHANES 2015–2016 Data

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 263-263
Author(s):  
Isabella Penso ◽  
Alejandra Luna ◽  
Adriana Campa ◽  
Cristina Palacios
Keyword(s):  
Energy Expenditure ◽  
Total Energy ◽  
Energy Intake ◽  
Screen Time ◽  
Age Groups ◽  
Caloric Intake ◽  
The United States ◽  
Overweight And Obesity ◽  
Total Energy Intake ◽  
Older Children

Abstract Objectives Childhood obesity is a multifactorial condition related to energy intake and decreased energy expenditure. Increased screen time as television, computers, tablets, and video games may be contributing to the rates of overweight and obesity in the United States. The American Academy of Pediatrics and the Centers of Disease Control and Prevention recommend that children aged 3–5 years should spend up to 1 hour as screen time and older children up to 2 hours per day. Exceeding screen time recommendations may be related to overweight and obesity due to an increased consumption of sugar, fats, and highly advertised food products and to a lower energy expenditure. Our objectives were to compare total energy intake between children that comply or not with recommendations for screen time. Methods This was an analysis of data from NHANES 2015–2016. Responses on the average of hours spent daily as screen time from television (TV), video watching, and computer use were analyzed and compared with the mean energy intake obtained from two 24-h dietary recalls. The sample was divided into two age groups following the recommendations for screen time: 3–5 y and 6–14 y. Data were analyzed by one-way analysis of variance (ANOVA), with Bonferroni post-hoc stratified by gender only for 6–14 y. Results A total of 1936 participants aged 3–14 y had complete data and were included in the analysis. Reported mean screen time was 5.48 ± 3.91 h in children 3–5 y and 4.98 ± 3.48 h in 6–14 y. Most did not meet the recommendations for screen time (87.6% in 3–5 y and 71.2% in 6–14 y). Girls aged 6–14 y who met the recommended screen time (≤2 h) had significantly lower mean energy intake (1733 ± 534.18 kcal/d) compared to those that spent between 4–8 h (1908 ± 809 kcal/d; P &lt; 0.041). No significant differences in caloric intake were found in energy intake among boys aged 6–14 y or among children aged 3–5 y. Conclusions Most of the children did not meet the recommendations for screen time. In girls aged 6–14 years, the length of screen time was associated with total calories consumed. This association might be explained by the high frequency of high calorie-dense foods advertised on television and the internet, which may influence food choices or by less energy expenditure with the long hours of sedentary viewing. This needs to be confirmed in future studies. Funding Sources Internal funds from Florida International University.

scholarly journals Dietary and Weight Loss Benefits of a National Sugar-sweetened Beverage Health Warning Policy: A Microsimulation Analysis (OR28-02-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Anna Grummon ◽  
Natalie Smith ◽  
Leah Frerichs ◽  
Lindsey Smith Taillie ◽  
Noel Brewer
Keyword(s):  
Total Energy ◽  
Energy Intake ◽  
The United States ◽  
Total Energy Intake ◽  
Dietary Behaviors ◽  
Model Parameters ◽  
Health Warnings ◽  
Health Warning ◽  
The Impact ◽  
Over Time

Abstract Objectives Overconsumption of sugar-sweetened beverages (SSBs) is a major contributor to obesity in the United States. To reduce SSB consumption, five U.S. states have proposed requiring front-of-package health warnings on SSBs. Randomized trials indicate that SSB health warnings reduce SSB purchases, but uncertainty remains regarding how these reductions translate into population-level dietary and health outcomes. We aimed to quantify the effects of a national SSB health warning policy on U.S. adults’ dietary behaviors and weight outcomes. Methods We developed and validated a Monte Carlo microsimulation model of dietary behaviors and bodyweight using dietary and anthropometric data from the National Health and Nutrition Examination Survey. Using estimates from existing literature, we simulated how an SSB health warning policy would affect SSB intake and, in turn, how changes in SSB intake would affect total energy intake. We then incorporated a validated model of weight change to translate changes in total energy intake into changes in weight over time. We used the model to simulate the impact of a national SSB health warning policy on SSB intake, total energy intake, body mass, and obesity among U.S. adults over a five-year period. Uncertainty analyses simulated scenarios when varying assumptions about three key model parameters: (1) the extent to which warnings would reduce SSB intake, (2) the degree of caloric compensation following a reduction in SSB intake, and (3) the extent to which warnings’ impact would increase or decrease over time. Results Implementing a national SSB health warning policy would reduce average SSB intake by 26.2 calories/day (95% uncertainty interval [UI] = −32.8, −19.4) and total energy intake by 32.4 calories/day (95% UI = −37.9, −26.7). These dietary changes would reduce average BMI by 0.6 kg/m2 (95% UI = −0.7, −0.5) and obesity prevalence by 2.1 percentage points (95% UI = −3.2pp, −0.9pp). BMI reductions would be largest among adults who are Black or Hispanic, have low educational attainment, or have low income. Obesity reductions persist when assuming warning efficacy decreases over time and when using conservative estimates of warning impact or caloric compensation. Conclusions Implementing a national SSB health warning policy could reduce SSB consumption, average BMI, and obesity among U.S. adults. Funding Sources National Institutes of Health. Supporting Tables, Images and/or Graphs

scholarly journals Free Sugars Consumption in Canada

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1471
Author(s):  
Huma Rana ◽  
Marie-Claude Mallet ◽  
Alejandro Gonzalez ◽  
Marie-France Verreault ◽  
Sylvie St-Pierre
Keyword(s):  
Type 2 Diabetes ◽  
Weight Gain ◽  
Total Energy ◽  
Children And Adolescents ◽  
Overweight And Obesity ◽  
Free Sugars ◽  
Added Sugars ◽  
Increased Risk ◽  
Baked Products

Free sugars (FS) are associated with a higher risk of dental decay in children and an increased risk of weight gain, overweight and obesity and type 2 diabetes. For this reason, Canada’s Food Guide recommends limiting foods and beverages that contribute to excess free sugars consumption. Estimating FS intakes is needed to inform policies and interventions aimed at reducing Canadians’ consumption of FS. The objective of this study was to estimate FS intake of Canadians using a new method that estimated the free sugars content of foods in the Canadian Nutrient File, the database used in national nutrition surveys. We define FS as sugars present in food products in which the structure has been broken down. We found that 12% of total energy (about 56 g) comes from FS in the diet of Canadians 1 year of age and older (≥1 year). The top four sources were: (1) sugars, syrups, preserves, confectionary, desserts; (2) soft drinks; (3) baked products and (4) juice (without added sugars), and accounted for 60% of total free sugars intake. The results show that efforts need to be sustained to help Canadians, particularly children and adolescents, to reduce their FS intake.

scholarly journals Sources of excessive saturated fat, trans fat and sugar consumption in Brazil: an analysis of the first Brazilian nationwide individual dietary survey

2012 ◽  
Vol 17 (1) ◽  
pp. 113-121 ◽  
Author(s):  
Rosangela A Pereira ◽  
Kiyah J Duffey ◽  
Rosely Sichieri ◽  
Barry M Popkin
Keyword(s):  
Total Energy ◽  
Energy Intake ◽  
Rural Areas ◽  
Family Income ◽  
Saturated Fat ◽  
Total Sugar ◽  
Total Energy Intake ◽  
Food Groups ◽  
Cross Sectional ◽  
Added Sugars

AbstractObjectiveTo examine the patterns of consumption of foods high in solid fats and added sugars (SoFAS) in Brazil.DesignCross-sectional study; individual dietary intake survey. Food intake was assessed by means of two non-consecutive food records. Foods providing >9·1 % of energy from saturated fat, or >1·3 % of energy from trans fat, or >13 % of energy from added sugars per 100 g were classified as high in SoFAS.SettingBrazilian nationwide survey, 2008–2009.SubjectsIndividuals aged ≥10 years old.ResultsMean daily energy intake was 8037 kJ (1921 kcal), 52 % of energy came from SoFAS foods. Contribution of SoFAS foods to total energy intake was higher among women (52 %) and adolescents (54 %). Participants in rural areas (43 %) and in the lowest quartile of per capita family income (43 %) reported the smallest contribution of SoFAS foods to total energy intake. SoFAS foods were large contributors to total saturated fat (87 %), trans fat (89 %), added sugar (98 %) and total sugar (96 %) consumption. The SoFAS food groups that contributed most to total energy intake were meats and beverages. Top SoFAS foods contributing to saturated fat and trans fat intakes were meats and fats and oils. Most of the added and total sugar in the diet was supplied by SoFAS beverages and sweets and desserts.ConclusionsSoFAS foods play an important role in the Brazilian diet. The study identifies options for improving the Brazilian diet and reducing nutrition-related non-communicable chronic diseases, but also points out some limitations of the nutrient-based criteria.

Abstract 88: Increasing False Positive Diagnoses May Lead to Overestimation of Stroke Incidence, Particularly in the Young

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Abhinav J Appukutty ◽  
Lesli E Skolarus ◽  
Mellanie V Springer ◽  
William J Meurer ◽  
James F Burke
Keyword(s):  
Older Adults ◽  
False Positive ◽  
Age Groups ◽  
Vascular Risk Factor ◽  
The United States ◽  
Cross Sectional ◽  
Stroke Incidence ◽  
Ed Visits ◽  
Over Time

Introduction: Stroke incidence is reportedly increasing in younger adults. While increasing vascular risk factor prevalence has been suggested as a cause, the reasons for rising stroke incidence in the young are not clear. We explored several alternate explanations: trends in neurologically-focused emergency department (ED) visits, differential diagnostic classification of stroke and TIA over time, and changes in the use of advanced imaging in young and older adults. Methods: We performed a retrospective, serial, cross-sectional study on a nationally representative sample of all ED visits in the United States to quantify changes in patterns of neurologically-focused ED visits, stroke and TIA diagnoses, and rates of MRI utilization for young (18 – 44 years) and older (65+ years) adults over a 17-year period (1995 – 2000; 2005 – 2015) using National Hospital Ambulatory Medical Care Survey (NHAMCS) data. Results: In young adults, 0.4% (95% CI 0.3% – 0.5%) of neurologically-focused ED visits resulted in a primary diagnosis of stroke vs. 6.8% (95% CI 6.2% – 7.5%) for older adults. In both populations, the incidence of neurologically-focused ED visits has increased over time (+111/100,000 population/year, 95% CI +94 – +130 in the young vs. +70/100,000 population/year, 95% CI +34 – +108 in older adults). There was no evidence of differential classification of TIA to stroke over time (OR 1.001 per year, 95% CI 0.926 – 1.083 in the young; OR 1.003 per year, 95% CI 0.982 – 1.026 in older adults) and no evidence of disproportionate rise in MRI utilization for neurologically-focused ED visits in the young (OR 1.057 per year, 95% CI 1.028 – 1.086 in the young; OR 1.095 per year, 95% CI 1.066 – 1.125 in older adults). Conclusions: If the specificity of stroke diagnosis amongst ED visits is similar amongst young and older populations, then the combination of data observed here, including (1) a lower prior probability of stroke diagnoses in the young and (2) an increasing trend in neurologically-focused ED visits in both age groups, suggests that false positive diagnoses will increase over time, with a faster rise in the young compared to older adults. These data suggest a potential explanation that may contribute to higher stroke incidence in the young and merits further scrutiny.

Firearm Injuries Affecting the Pediatric Population

PEDIATRICS ◽  
1992 ◽  
Vol 89 (4) ◽  
pp. 788-790
Author(s):  
Keyword(s):  
United States ◽  
Children And Adolescents ◽  
Pediatric Population ◽  
Age Groups ◽  
Unintentional Injury ◽  
The United States ◽  
Male Adolescents ◽  
Firearm Injuries ◽  
Group 2 ◽  
Developed Nations

In the United States approximately 30 000 people die from firearm injuries each year. Many more are wounded. In the mid 1980s, more than 3000 of the dead were children and adolescents aged 1 to 19 years.1 In 1989 nearly 4000 firearm deaths were among children 1 to 19 years of age, accounting for 12% of all deaths in that age group.2 All of these deaths or injuries affect other children because the victims who are killed or wounded are frequently relatives, neighbors, or friends. Comparison data for childhood age groups demonstrate that in 1987, 203 children aged 1 to 9 years, 484 children aged 10 to 14 years, and 2705 adolescents aged 15 to 19 years died as a result of firearm injuries.1 Firearm deaths include unintentional injuries, homicides, and suicides. Among the 1- to 9-year-olds, half of the deaths were homicides and half were unintentional. Among the 10- to 14-year-olds, one third of the deaths were homicides, one third were suicides, and one third were unintentional. Among the 15- to 19-year-olds, 48% were homicides, 42% were suicides, and 8% were unintentional.1 Firearm homicides are the leading cause of death for some US subpopulations, such as urban black male adolescents and young adults.3 Table 1 indicates how firearms contributed to the deaths of children and adolescents (homicides, suicides, and all causes) in 1987. Table 2 illustrates the unusual scale of firearm violence affecting young people in the United States compared with other developed nations.4 Firearm injuries are the fourth leading cause of unintentional injury deaths to children younger than 15 years of age in the US.5

scholarly journals Food consumption of sugarcane workers' families in the Brazilian Northeast

2015 ◽  
Vol 28 (2) ◽  
pp. 175-184
Author(s):  
Vanessa Messias Muniz ◽  
Débora Silva Cavalcanti ◽  
Nayalla Morais de Lima ◽  
Mônica Maria Osório
Keyword(s):  
Food Intake ◽  
Total Energy ◽  
Energy Intake ◽  
Family Members ◽  
Age Groups ◽  
Total Energy Intake ◽  
Dietary Intakes ◽  
Food Groups ◽  
Micronutrient Intake ◽  
Brazilian Northeast

OBJECTIVE: To analyze the food intake of sugarcane workers' family members. METHODS: The food intake of 159 family members of sugarcane workers from Gameleira, Pernambuco, Brazilian Northeast, was investigated by directly weighing the foods on three non-consecutive days. The percent risk of inadequate macro- and micronutrient intakes was analyzed according to the Reference Dietary Intakes. The macronutrients were analyzed in relation to acceptable distribution intervals. The energy consumed from the various food groups was expressed as a ratio of the total energy intake. RESULTS: The median intake of carbohydrates and proteins remained above the Estimated Average Requirement, and all age groups presented a low risk of inadequate carbohydrate and protein intakes. The median intakes of riboflavin, niacin, thiamin, and iron remained above the Estimated Average Requirement for all age groups, but children aged 1-3 years presented a high percent risk of inadequate iron intake. All age groups presented high percent risk of inadequate zinc, calcium, vitamin A, and vitamin C intakes. Grains and derivatives had a greater participation in the total energy intake, especially in men aged 19-30 years. The group "milk and dairy products" had a greater participation in the diet of children aged 1-3 years. CONCLUSION: The low percent risk of inadequate carbohydrate and protein intakes in all age groups was opposed to the high risk of inadequate mineral and vitamin intakes, making the population vulnerable to nutritional disorders caused by excess macronutrient intake and inadequate micronutrient intake.

scholarly journals Validation of energy intake by 24-hour multiple pass recall: comparison with total energy expenditure in children aged 5–7 years

2005 ◽  
Vol 93 (5) ◽  
pp. 671-676 ◽  
Author(s):  
Colette Montgomery ◽  
John J. Reilly ◽  
Diane M. Jackson ◽  
Louise A. Kelly ◽  
Christine Slater ◽  
...  
Keyword(s):  
Energy Expenditure ◽  
Total Energy ◽  
Energy Intake ◽  
School Children ◽  
Age Groups ◽  
Total Energy Expenditure ◽  
Doubly Labelled Water ◽  
Individual Level ◽  
Multiple Pass ◽  
The Individual

Accurate measurement of energy intake (EI) is essential in studies of energy balance in all age groups. Reported values for EI can be validated against total energy expenditure (TEE) measured using doubly labelled water (DLW). Our previous work has indicated that the use of the standardized 24 h multiple pass recall (24 h MPR) method produces slight overestimates of EI in pre-school children which are inaccurate at individual level but acceptable at group level. To extend this work, the current study validated EI by 24 h MPR against TEE by DLW in sixty-three (thirty-two boys) school-aged children (median age 6 years). In both boys and girls, reported EI was higher than TEE, although this difference was only significant in the girls (median difference 420 kJ/d, P=0·05). On analysis of agreement between TEE and EI, the group bias was an overestimation of EI by 250 kJ/d with wide limits of agreement (−2880, 2380 kJ/d). EI was over-reported relative to TEE by 7 % and 0·9 % in girls and boys, respectively. The bias in the current study was lower than in our previous study of pre-school children, suggesting that estimates of EI become less inaccurate as children age. However, the current study suggests that the 24 h MPR is inaccurate at the individual level.

scholarly journals 2765. Pediatric Mumps during the 2015–2017 Mumps Resurgence in the United States

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S975-S975
Author(s):  
Mariel Marlow ◽  
John Zhang ◽  
Nakia S Clemmons ◽  
Mona Marin ◽  
Manisha Patel ◽  
...  
Keyword(s):  
United States ◽  
Children And Adolescents ◽  
Surveillance System ◽  
Pediatric Patients ◽  
Age Groups ◽  
Exposure Period ◽  
The United States ◽  
College Campuses ◽  
Control And Prevention ◽  
Low Rate

Abstract Background Numerous mumps outbreaks occurred in the United States over the last decade, with outbreaks affecting young adults on college campuses being among the largest and most widely publicized. However, at least half of mumps cases and outbreaks occurred in other age-groups and settings. We describe reported mumps cases among children and adolescents during 2015 through 2017. Methods The Centers for Disease Control and Prevention (CDC) analyzed reports of confirmed and probable mumps cases in persons aged ≤18 years (defined here as pediatric mumps) transmitted electronically through the Nationally Notifiable Diseases Surveillance System (NNDSS) by the 52 reporting jurisdictions. Results Between January 1, 2015 and December 31, 2017, 49 jurisdictions reported 4,886 pediatric mumps cases (35% of all US reported cases, 13,807); 8 jurisdictions reported >100 cases each, representing 82% of all pediatric cases. Overall, 29 (1%) cases were in infants <1 yr, 406 (8%) were in children aged 1–4 years, 1,408 (29%) in children aged 5–10 years, 1,365 (28%) in adolescents aged 11–14 years, and 1,678 (34%) in adolescents aged 15–18 years. Most (3,548, 73%) cases did not travel outside the state during their exposure period; only 37 (1%) traveled outside the country. Cases in patients aged 1–4 years were more frequently non-outbreak associated (38%) than those in patients <1 years and 5–18 years (24% and 9%, respectively). Among 3,309 (68%) patients with known number of MMR doses received, 81% of those 5–18 years had ≥2 MMR doses, while 67% of those 1–4 years had ≥1 dose. Median time since last MMR dose for patients with 2 doses was 8 years (IQR: 4, 11 years). Four patients had meningitis and 1 had encephalitis; all were ≥10 years old and previously received 2 MMR doses. Of male mumps patients older than 10 years of age (2,113), 46 (2%) reported having orchitis; of these, 33 (72%) had 2 MMR doses. Sixty-four patients were hospitalized and there were no deaths. Conclusion About one-third of cases reported during the recent US mumps resurgence were in children and adolescents. The low rate of mumps complications compared with previous studies suggests mumps complications may not be adequately captured in national surveillance or identified by providers. Providers should remain vigilant that mumps can still occur among fully vaccinated pediatric patients, even those recently vaccinated. Disclosures All authors: No reported disclosures.

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