{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:19:08Z","timestamp":1790666348890,"version":"4.1.0"},"reference-count":88,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2020,8,6]],"date-time":"2020-08-06T00:00:00Z","timestamp":1596672000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,8,6]],"date-time":"2020-08-06T00:00:00Z","timestamp":1596672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012306","name":"Universit\u00e0 degli Studi di Trieste","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012306","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Rev Endocr Metab Disord"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>A paradoxical double challenge has emerged in the last decades with respect to nutrition and nutrition-related clinical conditions. Hunger-related undernutrition continues to represent an unacceptable burden, although its prevalence has been encouragingly reduced worldwide. On the other hand, the prevalence of overweight and obesity, defined as fat excess accumulation with negative impact on individual health, has dramatically increased due to increasingly pervasive obesogenic lifestyle changes. Undernutrition and obesity may coexist in world regions, Countries and even smaller communities and households, being referred to as double burden of malnutrition. It is however important to point out that fat accumulation and obesity may also induce additional nutritional derangements in affected individuals, both directly through metabolic and body composition changes and indirectly through acute and chronic diseases with negative impact on nutritional status. In the current narrative review, associations between fat accumulation in obesity and malnutrition features as well as their known causes will be reviewed and summarized. These include risk of loss of skeletal muscle mass and function (sarcopenia) that may allow for malnutrition diagnosis also in overweight and obese individuals, thereby introducing a new clinically relevant perspective to the obesity-related double burden of malnutrition concept.<\/jats:p>","DOI":"10.1007\/s11154-020-09578-1","type":"journal-article","created":{"date-parts":[[2020,8,6]],"date-time":"2020-08-06T15:02:45Z","timestamp":1596726165000},"page":"307-313","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":109,"title":["Double burden of malnutrition in persons with obesity"],"prefix":"10.1007","volume":"21","author":[{"given":"Rocco","family":"Barazzoni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Gortan Cappellari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,8,6]]},"reference":[{"key":"9578_CR1","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1146\/annurev-nutr-080508-141048","volume":"30","author":"F Luca","year":"2010","unstructured":"Luca F, Perry GH, Di Rienzo A. Evolutionary adaptations to dietary changes. Annu Rev Nutr. 2010;30:291\u2013314.","journal-title":"Annu Rev Nutr"},{"issue":"1708","key":"9578_CR2","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1098\/rspb.2010.2433","volume":"278","author":"CC Babbitt","year":"2011","unstructured":"Babbitt CC, Warner LR, Fedrigo O, Wall CE, Wray GA. Genomic signatures of diet-related shifts during human origins. Proc Biol Sci. 2011;278(1708):961\u20139.","journal-title":"Proc Biol Sci"},{"issue":"1","key":"9578_CR3","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s40519-017-0467-9","volume":"23","author":"V Guglielmi","year":"2018","unstructured":"Guglielmi V, Sbraccia P. Obesity phenotypes: depot-differences in adipose tissue and their clinical implications. Eat Weight Disord. 2018;23(1):3\u201314. https:\/\/doi.org\/10.1007\/s40519-017-0467-9.","journal-title":"Eat Weight Disord"},{"issue":"3","key":"9578_CR4","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1056\/NEJMra1514009","volume":"376","author":"SB Heymsfield","year":"2017","unstructured":"Heymsfield SB, Wadden TA. Mechanisms, Pathophysiology, and Management of Obesity. N Engl J Med. 2017;376(3):254\u201366. https:\/\/doi.org\/10.1056\/NEJMra1514009.","journal-title":"N Engl J Med"},{"key":"9578_CR5","unstructured":"WHO. Obesity and overweight - Fact sheet. https:\/\/wwww.hoint\/news-room\/fact-sheets\/detail\/obesity-and-overweight. Accessed 20 Jan 2020."},{"issue":"4","key":"9578_CR6","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1016\/j.clnu.2016.11.007","volume":"36","author":"SC Bischoff","year":"2017","unstructured":"Bischoff SC, Boirie Y, Cederholm T, Chourdakis M, Cuerda C, Delzenne NM, et al. Towards a multidisciplinary approach to understand and manage obesity and related diseases. Clin Nutr. 2017;36(4):917\u201338. https:\/\/doi.org\/10.1016\/j.clnu.2016.11.007.","journal-title":"Clin Nutr"},{"key":"9578_CR7","doi-asserted-by":"publisher","first-page":"17034","DOI":"10.1038\/nrdp.2017.34","volume":"3","author":"P Gonzalez-Muniesa","year":"2017","unstructured":"Gonzalez-Muniesa P, Martinez-Gonzalez MA, Hu FB, Despres JP, Matsuzawa Y, Loos RJF, et al. Obesity Nat Rev Dis Primers. 2017;3:17034. https:\/\/doi.org\/10.1038\/nrdp.2017.34.","journal-title":"Obesity Nat Rev Dis Primers"},{"issue":"10026","key":"9578_CR8","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1016\/S0140-6736(16)30054-X","volume":"387","author":"Trends in adult","year":"2016","unstructured":"Trends in adult. body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377\u201396. https:\/\/doi.org\/10.1016\/S0140-6736(16)30054-X.","journal-title":"Lancet"},{"issue":"3","key":"9578_CR9","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1038\/oby.2006.49","volume":"14","author":"T Stecker","year":"2006","unstructured":"Stecker T, Sparks S. Prevalence of obese patients in a primary care setting. Obesity (Silver Spring). 2006;14(3):373\u20136. https:\/\/doi.org\/10.1038\/oby.2006.49.","journal-title":"Obesity (Silver Spring)"},{"key":"9578_CR10","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.exger.2016.01.008","volume":"76","author":"A Buch","year":"2016","unstructured":"Buch A, Carmeli E, Boker LK, Marcus Y, Shefer G, Kis O, et al. Muscle function and fat content in relation to sarcopenia, obesity and frailty of old age\u2013An overview. Exp Gerontol. 2016;76:25\u201332. https:\/\/doi.org\/10.1016\/j.exger.2016.01.008.","journal-title":"Exp Gerontol"},{"issue":"5","key":"9578_CR11","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1016\/j.clnu.2012.02.007","volume":"31","author":"F Landi","year":"2012","unstructured":"Landi F, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, et al. Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr. 2012;31(5):652\u20138.","journal-title":"Clin Nutr"},{"issue":"4","key":"9578_CR12","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1016\/j.maturitas.2013.07.013","volume":"76","author":"E Agarwal","year":"2013","unstructured":"Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: a narrative review. Maturitas. 2013;76(4):296\u2013302.","journal-title":"Maturitas"},{"key":"9578_CR13","doi-asserted-by":"crossref","unstructured":"Sanchez A, Rojas P, Basfi-Fer K, Carrasco F, Inostroza J, Codoceo J, et al. Micronutrient deficiencies in morbidly obese women prior to bariatric surgery. Obes Surg. 2016;26(2):361\u20138.","DOI":"10.1007\/s11695-015-1773-9"},{"issue":"5","key":"9578_CR14","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1016\/j.pcl.2009.07.002","volume":"56","author":"SA Xanthakos","year":"2009","unstructured":"Xanthakos SA. Nutritional deficiencies in obesity and after bariatric surgery. Pediatr Clin North Am. 2009;56(5):1105\u201321.","journal-title":"Pediatr Clin North Am"},{"issue":"9468","key":"9578_CR15","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1016\/S0140-6736(05)66378-7","volume":"365","author":"RH Eckel","year":"2005","unstructured":"Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet. 2005;365(9468):1415\u201328. https:\/\/doi.org\/10.1016\/S0140-6736(05)66378-7.","journal-title":"Lancet"},{"issue":"24","key":"9578_CR16","doi-asserted-by":"publisher","first-page":"2339","DOI":"10.1056\/NEJMra0906948","volume":"363","author":"MI McCarthy","year":"2010","unstructured":"McCarthy MI. Genomics. type 2 diabetes, and obesity. N Engl J Med. 2010;363(24):2339\u201350. https:\/\/doi.org\/10.1056\/NEJMra0906948.","journal-title":"N Engl J Med"},{"issue":"10","key":"9578_CR17","doi-asserted-by":"publisher","first-page":"1428","DOI":"10.1016\/j.amjcard.2015.02.024","volume":"115","author":"A Sharma","year":"2015","unstructured":"Sharma A, Lavie CJ, Borer JS, Vallakati A, Goel S, Lopez-Jimenez F, et al. Meta-analysis of the relation of body mass index to all-cause and cardiovascular mortality and hospitalization in patients with chronic heart failure. Am J Cardiol. 2015;115(10):1428\u201334. https:\/\/doi.org\/10.1016\/j.amjcard.2015.02.024.","journal-title":"Am J Cardiol"},{"issue":"9","key":"9578_CR18","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1016\/S2213-8587(16)00082-6","volume":"4","author":"N Stefan","year":"2016","unstructured":"Stefan N, Fritsche A, Schick F, Haring HU. Phenotypes of prediabetes and stratification of cardiometabolic risk. Lancet Diabetes Endocrinol. 2016;4(9):789\u201398. https:\/\/doi.org\/10.1016\/S2213-8587(16)00082-6.","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"1","key":"9578_CR19","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1097\/01.CCM.0000297885.60037.6E","volume":"36","author":"ME Akinnusi","year":"2008","unstructured":"Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med. 2008;36(1):151\u20138. https:\/\/doi.org\/10.1097\/01.CCM.0000297885.60037.6E.","journal-title":"Crit Care Med"},{"issue":"4","key":"9578_CR20","doi-asserted-by":"publisher","first-page":"866","DOI":"10.1097\/TA.0000000000000597","volume":"78","author":"M Gharib","year":"2015","unstructured":"Gharib M, Kaul S, LoCurto J, Perez M, Hajri T. The obesity factor in critical illness: Between consensus and controversy. J Trauma Acute Care Surg. 2015;78(4):866\u201373. https:\/\/doi.org\/10.1097\/TA.0000000000000597.","journal-title":"J Trauma Acute Care Surg"},{"issue":"1","key":"9578_CR21","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.clnu.2016.09.004","volume":"36","author":"T Cederholm","year":"2017","unstructured":"Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36(1):49\u201364. https:\/\/doi.org\/10.1016\/j.clnu.2016.09.004.","journal-title":"Clin Nutr"},{"issue":"10","key":"9578_CR22","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/S2213-8587(14)70034-8","volume":"2","author":"RR Kalyani","year":"2014","unstructured":"Kalyani RR, Corriere M, Ferrucci L. Age-related and disease-related muscle loss: the effect of diabetes, obesity, and other diseases. Lancet Diabetes Endocrinol. 2014;2(10):819\u201329. https:\/\/doi.org\/10.1016\/S2213-8587(14)70034-8.","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"6","key":"9578_CR23","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1007\/s40520-019-01170-1","volume":"31","author":"CC Sieber","year":"2019","unstructured":"Sieber CC. Malnutrition and sarcopenia. Aging Clin Exp Res. 2019;31(6):793\u20138. https:\/\/doi.org\/10.1007\/s40520-019-01170-1.","journal-title":"Aging Clin Exp Res."},{"issue":"2","key":"9578_CR24","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/s0899-9007(96)90702-9","volume":"12","author":"CR Plata-Salaman","year":"1996","unstructured":"Plata-Salaman CR. Anorexia during acute and chronic disease. Nutrition. 1996;12(2):69\u201378. https:\/\/doi.org\/10.1016\/s0899-9007(96)90702-9.","journal-title":"Nutrition"},{"key":"9578_CR25","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2019.11.024","author":"LM Donini","year":"2019","unstructured":"Donini LM, Busetto L, Bauer JM, Bischoff S, Boirie Y, Cederholm T, et al. Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review. Clin Nutr. 2019. https:\/\/doi.org\/10.1016\/j.clnu.2019.11.024.","journal-title":"Clin Nutr"},{"issue":"3","key":"9578_CR26","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1007\/s12020-014-0315-x","volume":"47","author":"E Poggiogalle","year":"2014","unstructured":"Poggiogalle E, Migliaccio S, Lenzi A, Donini LM. Treatment of body composition changes in obese and overweight older adults: insight into the phenotype of sarcopenic obesity. Endocrine. 2014;47(3):699\u2013716. https:\/\/doi.org\/10.1007\/s12020-014-0315-x.","journal-title":"Endocrine"},{"issue":"5","key":"9578_CR27","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/j.clnu.2012.06.010","volume":"31","author":"CM Prado","year":"2012","unstructured":"Prado CM, Wells JC, Smith SR, Stephan BC, Siervo M. Sarcopenic obesity: A Critical appraisal of the current evidence. Clin Nutr. 2012;31(5):583\u2013601. https:\/\/doi.org\/10.1016\/j.clnu.2012.06.010.","journal-title":"Clin Nutr"},{"issue":"4","key":"9578_CR28","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1017\/S002966511500169X","volume":"74","author":"SG Wannamethee","year":"2015","unstructured":"Wannamethee SG, Atkins JL. Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity. Proc Nutr Soc. 2015;74(4):405\u201312. https:\/\/doi.org\/10.1017\/S002966511500169X.","journal-title":"Proc Nutr Soc"},{"issue":"Suppl 2","key":"9578_CR29","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1038\/ijo.2010.235","volume":"34","author":"Z Pataky","year":"2010","unstructured":"Pataky Z, Bobbioni-Harsch E, Golay A. Open questions about metabolically normal obesity. Int J Obes (Lond). 2010;34(Suppl 2):18\u201323. https:\/\/doi.org\/10.1038\/ijo.2010.235.","journal-title":"Int J Obes (Lond)"},{"issue":"1","key":"9578_CR30","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/j.1753-4887.2011.00456.x","volume":"70","author":"BM Popkin","year":"2012","unstructured":"Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70(1):3\u201321. https:\/\/doi.org\/10.1111\/j.1753-4887.2011.00456.x.","journal-title":"Nutr Rev"},{"issue":"2","key":"9578_CR31","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s40519-018-0481-6","volume":"23","author":"R Barazzoni","year":"2018","unstructured":"Barazzoni R, Gortan Cappellari G, Ragni M, Nisoli E. Insulin resistance in obesity: an overview of fundamental alterations. Eat Weight Disord. 2018;23(2):149\u201357. https:\/\/doi.org\/10.1007\/s40519-018-0481-6.","journal-title":"Eat Weight Disord"},{"issue":"4","key":"9578_CR32","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1210\/er.2012-1041","volume":"34","author":"S Hocking","year":"2013","unstructured":"Hocking S, Samocha-Bonet D, Milner KL, Greenfield JR, Chisholm DJ. Adiposity and insulin resistance in humans: the role of the different tissue and cellular lipid depots. Endocr Rev. 2013;34(4):463\u2013500. https:\/\/doi.org\/10.1210\/er.2012-1041.","journal-title":"Endocr Rev"},{"issue":"3","key":"9578_CR33","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1172\/JCI37048","volume":"119","author":"EJ Anderson","year":"2009","unstructured":"Anderson EJ, Lustig ME, Boyle KE, Woodlief TL, Kane DA, Lin CT, et al. Mitochondrial H2O2 emission and cellular redox state link excess fat intake to insulin resistance in both rodents and humans. J Clin Invest. 2009;119(3):573\u201381. https:\/\/doi.org\/10.1172\/JCI37048.","journal-title":"J Clin Invest"},{"issue":"5","key":"9578_CR34","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1172\/JCI13714","volume":"108","author":"MJ Birnbaum","year":"2001","unstructured":"Birnbaum MJ. Turning down insulin signaling. J Clin Invest. 2001;108(5):655\u20139. https:\/\/doi.org\/10.1172\/JCI13714.","journal-title":"J Clin Invest"},{"issue":"2","key":"9578_CR35","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1016\/j.clnu.2016.09.010","volume":"36","author":"R Barazzoni","year":"2017","unstructured":"Barazzoni R, Deutz NEP, Biolo G, Bischoff S, Boirie Y, Cederholm T, et al. Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group. Clin Nutr. 2017;36(2):355\u201363. https:\/\/doi.org\/10.1016\/j.clnu.2016.09.010.","journal-title":"Clin Nutr"},{"issue":"6","key":"9578_CR36","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1002\/jcsm.12254","volume":"8","author":"R Barazzoni","year":"2017","unstructured":"Barazzoni R, Gortan Cappellari G, Palus S, Vinci P, Ruozi G, Zanetti M, et al. Acylated ghrelin treatment normalizes skeletal muscle mitochondrial oxidative capacity and AKT phosphorylation in rat chronic heart failure. J Cachex Sarcopenia Muscle. 2017;8(6):991\u20138. https:\/\/doi.org\/10.1002\/jcsm.12254.","journal-title":"J Cachex Sarcopenia Muscle"},{"issue":"5","key":"9578_CR37","doi-asserted-by":"publisher","first-page":"1168","DOI":"10.1016\/j.clnu.2015.10.002","volume":"35","author":"R Barazzoni","year":"2016","unstructured":"Barazzoni R, Gortan Cappellari G, Semolic A, Ius M, Mamolo L, Dore F, et al. Plasma total and unacylated ghrelin predict 5-year changes in insulin resistance. Clin Nutr. 2016;35(5):1168\u201373. https:\/\/doi.org\/10.1016\/j.clnu.2015.10.002.","journal-title":"Clin Nutr"},{"issue":"1","key":"9578_CR38","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1002\/oby.20454","volume":"22","author":"R Barazzoni","year":"2014","unstructured":"Barazzoni R, Semolic A, Cattin MR, Zanetti M, Guarnieri G. Acylated ghrelin limits fat accumulation and improves redox state and inflammation markers in the liver of high-fat-fed rats. Obesity (Silver Spring). 2014;22(1):170\u20137. https:\/\/doi.org\/10.1002\/oby.20454.","journal-title":"Obesity (Silver Spring)"},{"issue":"11","key":"9578_CR39","doi-asserted-by":"publisher","first-page":"2614","DOI":"10.1038\/oby.2007.313","volume":"15","author":"R Barazzoni","year":"2007","unstructured":"Barazzoni R, Zanetti M, Cattin MR, Visintin L, Vinci P, Cattin L, et al. Ghrelin enhances in vivo skeletal muscle but not liver AKT signaling in rats. Obesity (Silver Spring). 2007;15(11):2614\u201323. https:\/\/doi.org\/10.1038\/oby.2007.313.","journal-title":"Obesity (Silver Spring)"},{"issue":"10","key":"9578_CR40","doi-asserted-by":"publisher","first-page":"e26224","DOI":"10.1371\/journal.pone.0026224","volume":"6","author":"R Barazzoni","year":"2011","unstructured":"Barazzoni R, Zanetti M, Semolic A, Cattin MR, Pirulli A, Cattin L, et al. High-fat diet with acyl-ghrelin treatment leads to weight gain with low inflammation, high oxidative capacity and normal triglycerides in rat muscle. PLoS One. 2011;6(10):e26224. https:\/\/doi.org\/10.1371\/journal.pone.0026224.","journal-title":"PLoS One"},{"issue":"1","key":"9578_CR41","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.clnu.2007.06.013","volume":"27","author":"R Barazzoni","year":"2008","unstructured":"Barazzoni R, Zanetti M, Stulle M, Mucci MP, Pirulli A, Dore F, et al. Higher total ghrelin levels are associated with higher insulin-mediated glucose disposal in non-diabetic maintenance hemodialysis patients. Clin Nutr. 2008;27(1):142\u20139. https:\/\/doi.org\/10.1016\/j.clnu.2007.06.013.","journal-title":"Clin Nutr"},{"issue":"1","key":"9578_CR42","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1038\/ki.2009.411","volume":"77","author":"R Barazzoni","year":"2010","unstructured":"Barazzoni R, Zhu X, Deboer M, Datta R, Culler MD, Zanetti M, et al. Combined effects of ghrelin and higher food intake enhance skeletal muscle mitochondrial oxidative capacity and AKT phosphorylation in rats with chronic kidney disease. Kidney Int. 2010;77(1):23\u20138. https:\/\/doi.org\/10.1038\/ki.2009.411.","journal-title":"Kidney Int"},{"issue":"12","key":"9578_CR43","doi-asserted-by":"publisher","first-page":"5159","DOI":"10.1096\/fj.201700126R","volume":"31","author":"G Gortan Cappellari","year":"2017","unstructured":"Gortan Cappellari G, Semolic A, Ruozi G, Vinci P, Guarnieri G, Bortolotti F, et al. Unacylated ghrelin normalizes skeletal muscle oxidative stress and prevents muscle catabolism by enhancing tissue mitophagy in experimental chronic kidney disease. Faseb J. 2017;31(12):5159\u201371. https:\/\/doi.org\/10.1096\/fj.201700126R.","journal-title":"Faseb J"},{"issue":"4","key":"9578_CR44","doi-asserted-by":"publisher","first-page":"874","DOI":"10.2337\/db15-1019","volume":"65","author":"G Gortan Cappellari","year":"2016","unstructured":"Gortan Cappellari G, Zanetti M, Semolic A, Vinci P, Ruozi G, Falcione A, et al. Unacylated Ghrelin Reduces Skeletal Muscle Reactive Oxygen Species Generation and Inflammation and Prevents High-Fat Diet-Induced Hyperglycemia and Whole-Body Insulin Resistance in Rodents. Diabetes. 2016;65(4):874\u201386. https:\/\/doi.org\/10.2337\/db15-1019.","journal-title":"Diabetes"},{"key":"9578_CR45","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s12263-017-0582-2","volume":"12","author":"F Bifari","year":"2017","unstructured":"Bifari F, Ruocco C, Decimo I, Fumagalli G, Valerio A, Nisoli E. Amino acid supplements and metabolic health: a potential interplay between intestinal microbiota and systems control. Genes Nutr. 2017;12:27. https:\/\/doi.org\/10.1186\/s12263-017-0582-2.","journal-title":"Genes Nutr"},{"issue":"6086","key":"9578_CR46","doi-asserted-by":"publisher","first-page":"1262","DOI":"10.1126\/science.1223813","volume":"336","author":"JK Nicholson","year":"2012","unstructured":"Nicholson JK, Holmes E, Kinross J, Burcelin R, Gibson G, Jia W, et al. Host-gut microbiota metabolic interactions. Science. 2012;336(6086):1262\u20137. https:\/\/doi.org\/10.1126\/science.1223813.","journal-title":"Science"},{"issue":"Suppl 2","key":"9578_CR47","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1038\/ijo.2010.234","volume":"34","author":"AG Dulloo","year":"2010","unstructured":"Dulloo AG, Jacquet J, Solinas G, Montani JP, Schutz Y. Body composition phenotypes in pathways to obesity and the metabolic syndrome. Int J Obes (Lond). 2010;34(Suppl 2):4\u201317. https:\/\/doi.org\/10.1038\/ijo.2010.234.","journal-title":"Int J Obes (Lond)"},{"key":"9578_CR48","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.arr.2016.09.008","volume":"35","author":"A Kalinkovich","year":"2017","unstructured":"Kalinkovich A, Livshits G. Sarcopenic obesity or obese sarcopenia: A cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis. Ageing Res Rev. 2017;35:200\u201321. https:\/\/doi.org\/10.1016\/j.arr.2016.09.008.","journal-title":"Ageing Res Rev"},{"issue":"4","key":"9578_CR49","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.3945\/ajcn.116.130385","volume":"104","author":"JW Beals","year":"2016","unstructured":"Beals JW, Sukiennik RA, Nallabelli J, Emmons RS, van Vliet S, Young JR, et al. Anabolic sensitivity of postprandial muscle protein synthesis to the ingestion of a protein-dense food is reduced in overweight and obese young adults. Am J Clin Nutr. 2016;104(4):1014\u201322.","journal-title":"Am J Clin Nutr"},{"issue":"8","key":"9578_CR50","doi-asserted-by":"publisher","first-page":"3044","DOI":"10.1210\/jc.2008-2216","volume":"94","author":"C Guillet","year":"2009","unstructured":"Guillet C, Delcourt I, Rance M, Giraudet C, Walrand S, Bedu M, et al. Changes in basal and insulin and amino acid response of whole body and skeletal muscle proteins in obese men. J Clin Endocrinol Metab. 2009;94(8):3044\u201350.","journal-title":"J Clin Endocrinol Metab"},{"key":"9578_CR51","doi-asserted-by":"crossref","unstructured":"Murton AJ, Marimuthu K, Mallinson JE, Selby AL, Smith K, Rennie MJ, et al. Obesity appears to be associated with altered muscle protein synthetic and breakdown responses to increased nutrient delivery in older men, but not reduced muscle mass or contractile function. Diabetes. 2015;64(9):3160\u201371.","DOI":"10.2337\/db15-0021"},{"key":"9578_CR52","doi-asserted-by":"crossref","unstructured":"Smeuninx B, McKendry J, Wilson D, Martin U, Breen L. Age-related anabolic resistance of myofibrillar protein synthesis is exacerbated in obese inactive individuals. J Clin Endocrinol Metab. 2017;102(9):3535\u201345.","DOI":"10.1210\/jc.2017-00869"},{"issue":"2\u20133","key":"9578_CR53","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/S1388-1981(02)00342-6","volume":"1585","author":"RH Unger","year":"2002","unstructured":"Unger RH, Orci L. Lipoapoptosis: its mechanism and its diseases. Biochim Biophys Acta. 2002;1585(2\u20133):202\u201312.","journal-title":"Biochim Biophys Acta"},{"issue":"5","key":"9578_CR54","doi-asserted-by":"publisher","first-page":"E987-98","DOI":"10.1152\/ajpendo.00229.2009","volume":"297","author":"R Vettor","year":"2009","unstructured":"Vettor R, Milan G, Franzin C, Sanna M, De Coppi P, Rizzuto R, et al. The origin of intermuscular adipose tissue and its pathophysiological implications. Am J Physiol Endocrinol Metab. 2009;297(5):E987-98. https:\/\/doi.org\/10.1152\/ajpendo.00229.2009.","journal-title":"Am J Physiol Endocrinol Metab"},{"issue":"4","key":"9578_CR55","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1002\/mus.20743","volume":"35","author":"JS Moylan","year":"2007","unstructured":"Moylan JS, Reid MB. Oxidative stress, chronic disease, and muscle wasting. Muscle Nerve. 2007;35(4):411\u201329. https:\/\/doi.org\/10.1002\/mus.20743.","journal-title":"Muscle Nerve"},{"key":"9578_CR56","doi-asserted-by":"publisher","unstructured":"Neeland IJ, Poirier P, Despres JP. Cardiovascular and metabolic heterogeneity of obesity: clinical challenges and implications for management. Circulation. 2018;137(13):1391\u2013406. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.117.029617.","DOI":"10.1161\/CIRCULATIONAHA.117.029617"},{"issue":"5","key":"9578_CR57","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1038\/sj.ijo.0803483","volume":"31","author":"TB Chaston","year":"2007","unstructured":"Chaston TB, Dixon JB, O\u2019Brien PE. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes (Lond). 2007;31(5):743\u201350. https:\/\/doi.org\/10.1038\/sj.ijo.0803483.","journal-title":"Int J Obes (Lond)"},{"issue":"5","key":"9578_CR58","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1016\/j.diabet.2015.04.003","volume":"41","author":"C Vaurs","year":"2015","unstructured":"Vaurs C, Dimeglio C, Charras L, Anduze Y, Chalret du Rieu M, Ritz P. Determinants of changes in muscle mass after bariatric surgery. Diabetes Metab. 2015;41(5):416\u201321. https:\/\/doi.org\/10.1016\/j.diabet.2015.04.003.","journal-title":"Diabetes Metab"},{"key":"9578_CR59","doi-asserted-by":"publisher","unstructured":"Cava E, Yeat NC, Mittendorfer B. Preserving healthy muscle during weight loss. Adv Nutr. 2017;8(3):511\u20139. https:\/\/doi.org\/10.3945\/an.116.014506.","DOI":"10.3945\/an.116.014506"},{"key":"9578_CR60","doi-asserted-by":"publisher","unstructured":"Strasser B, Schobersberger W. Evidence for resistance training as a treatment therapy in obesity. J Obes. 2011;2011. https:\/\/doi.org\/10.1155\/2011\/482564.","DOI":"10.1155\/2011\/482564"},{"issue":"5","key":"9578_CR61","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1093\/gerona\/gls213","volume":"68","author":"KM Beavers","year":"2013","unstructured":"Beavers KM, Hsu F-C, Houston DK, Beavers DP, Harris TB, Hue TF, et al. The role of metabolic syndrome, adiposity, and inflammation in physical performance in the Health ABC Study. J Gerontol A Biol Sci Med Sci. 2013;68(5):617\u201323.","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"9578_CR62","doi-asserted-by":"crossref","unstructured":"Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European working group on sarcopenia in older people. Age Ageing. 2010;39(4):412\u201323.","DOI":"10.1093\/ageing\/afq034"},{"issue":"8","key":"9578_CR63","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1093\/gerona\/glr070","volume":"66","author":"A Koster","year":"2011","unstructured":"Koster A, Ding J, Stenholm S, Caserotti P, Houston DK, Nicklas BJ, et al. Does the amount of fat mass predict age-related loss of lean mass, muscle strength, and muscle quality in older adults? J Gerontol A Biol Sci Med Sci. 2011;66(8):888\u201395.","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"9578_CR64","doi-asserted-by":"crossref","unstructured":"Rolland Y, Lauwers-Cances V, Cristini C, Abellan van Kan G, Janssen I, Morley JE, et al. Difficulties with physical function associated with obesity, sarcopenia, and sarcopenic-obesity in community-dwelling elderly women: the EPIDOS (EPIDemiologie de l\u2019OSteoporose) Study. Am J Clin Nutr. 2009;89(6):1895\u2013900.","DOI":"10.3945\/ajcn.2008.26950"},{"issue":"3","key":"9578_CR65","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1093\/ageing\/afq022","volume":"39","author":"DG Taekema","year":"2010","unstructured":"Taekema DG, Gussekloo J, Maier AB, Westendorp RGJ, de Craen AJM. Handgrip strength as a predictor of functional, psychological and social health. A prospective population-based study among the oldest old. Age Ageing. 2010;39(3):331\u20137.","journal-title":"Age Ageing"},{"issue":"12","key":"9578_CR66","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1038\/oby.2004.250","volume":"12","author":"RN Baumgartner","year":"2004","unstructured":"Baumgartner RN, Wayne SJ, Waters DL, Janssen I, Gallagher D, Morley JE. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res. 2004;12(12):1995\u20132004.","journal-title":"Obes Res"},{"issue":"3","key":"9578_CR67","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1002\/jcsm.12076","volume":"7","author":"S Tyrovolas","year":"2016","unstructured":"Tyrovolas S, Koyanagi A, Olaya B, Ayuso-Mateos JL, Miret M, Chatterji S, et al. Factors associated with skeletal muscle mass, sarcopenia, and sarcopenic obesity in older adults: a multi-continent study. J Cachexia Sarcopenia Muscle. 2016;7(3):312\u201321.","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"3","key":"9578_CR68","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1093\/ajcn\/86.3.633","volume":"86","author":"H Honda","year":"2007","unstructured":"Honda H, Qureshi AR, Axelsson J, Heimburger O, Suliman ME, Barany P, et al. Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality. Am J Clin Nutr. 2007;86(3):633\u20138.","journal-title":"Am J Clin Nutr"},{"issue":"2","key":"9578_CR69","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1002\/jcsm.12039","volume":"7","author":"AJ Montano-Loza","year":"2016","unstructured":"Montano-Loza AJ, Angulo P, Meza-Junco J, Prado CMM, Sawyer MB, Beaumont C, et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. J Cachexia Sarcopenia Muscle. 2016;7(2):126\u201335.","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"9578_CR70","doi-asserted-by":"crossref","unstructured":"Fogelholm M, Malmberg J, Suni J, Santtila M, Kyrolainen H, Mantysaari M. Waist circumference and BMI are independently associated with the variation of cardio-respiratory and neuromuscular fitness in young adult men. International journal of obesity (2005). 2006;30(6):962-9.","DOI":"10.1038\/sj.ijo.0803243"},{"issue":"3","key":"9578_CR71","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1053\/j.ajkd.2005.05.020","volume":"46","author":"K Kalantar-Zadeh","year":"2005","unstructured":"Kalantar-Zadeh K, Kopple JD, Kilpatrick RD, McAllister CJ, Shinaberger CS, Gjertson DW, et al. Association of morbid obesity and weight change over time with cardiovascular survival in hemodialysis population. Am J Kidney Dis. 2005;46(3):489\u2013500.","journal-title":"Am J Kidney Dis"},{"issue":"6","key":"9578_CR72","doi-asserted-by":"publisher","first-page":"1557","DOI":"10.1016\/j.clnu.2016.02.002","volume":"35","author":"G Bahat","year":"2016","unstructured":"Bahat G, Tufan A, Tufan F, Kilic C, Akpinar TS, Kose M, et al. Cut-off points to identify sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP) definition. Clin Nutr. 2016;35(6):1557\u201363.","journal-title":"Clin Nutr"},{"key":"9578_CR73","unstructured":"Donini LM, Busetto L, Bauer JM, Bischoff S, Boirie Y, Cederholm T, et al. Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review. Clin Nutr. 2019."},{"issue":"4","key":"9578_CR74","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1159\/000490361","volume":"11","author":"R Barazzoni","year":"2018","unstructured":"Barazzoni R, Bischoff S, Boirie Y, Busetto L, Cederholm T, Dicker D, et al. Sarcopenic Obesity: Time to Meet the Challenge. Obes Facts. 2018;11(4):294\u2013305.","journal-title":"Obes Facts"},{"issue":"6 Pt A","key":"9578_CR75","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1016\/j.clnu.2018.04.018","volume":"37","author":"R Barazzoni","year":"2018","unstructured":"Barazzoni R, Bischoff SC, Boirie Y, Busetto L, Cederholm T, Dicker D, et al. Sarcopenic obesity: Time to meet the challenge. Clin Nutr. 2018;37(6 Pt A):1787\u201393.","journal-title":"Clin Nutr"},{"issue":"5 Suppl","key":"9578_CR76","doi-asserted-by":"publisher","first-page":"21S-8S","DOI":"10.1177\/0148607111413773","volume":"35","author":"D Gallagher","year":"2011","unstructured":"Gallagher D, DeLegge M. Body composition (sarcopenia) in obese patients: implications for care in the intensive care unit. JPEN J Parenter Enteral Nutr. 2011;35(5 Suppl):21S-8S. https:\/\/doi.org\/10.1177\/0148607111413773.","journal-title":"JPEN J Parenter Enteral Nutr"},{"issue":"5","key":"9578_CR77","doi-asserted-by":"publisher","first-page":"2202","DOI":"10.1016\/j.clnu.2018.09.019","volume":"38","author":"N Kamo","year":"2019","unstructured":"Kamo N, Kaido T, Hamaguchi Y, Okumura S, Kobayashi A, Shirai H, et al. Impact of sarcopenic obesity on outcomes in patients undergoing living donor liver transplantation. Clin Nutr. 2019;38(5):2202\u20139. https:\/\/doi.org\/10.1016\/j.clnu.2018.09.019.","journal-title":"Clin Nutr"},{"issue":"1","key":"9578_CR78","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1186\/s12877-019-1195-y","volume":"19","author":"X Zhang","year":"2019","unstructured":"Zhang X, Xie X, Dou Q, Liu C, Zhang W, Yang Y, et al. Association of sarcopenic obesity with the risk of all-cause mortality among adults over a broad range of different settings: a updated meta-analysis. BMC Geriatr. 2019;19(1):183. https:\/\/doi.org\/10.1186\/s12877-019-1195-y.","journal-title":"BMC Geriatr"},{"issue":"3","key":"9578_CR79","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/S0261-5614(02)00214-5","volume":"22","author":"J Kondrup","year":"2003","unstructured":"Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc EWG. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321\u201336.","journal-title":"Clin Nutr"},{"issue":"4","key":"9578_CR80","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/s0261-5614(03)00098-0","volume":"22","author":"J Kondrup","year":"2003","unstructured":"Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415\u201321. https:\/\/doi.org\/10.1016\/s0261-5614(03)00098-0.","journal-title":"Clin Nutr"},{"issue":"6","key":"9578_CR81","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1038\/ejcn.2013.45","volume":"67","author":"E Leibovitz","year":"2013","unstructured":"Leibovitz E, Giryes S, Makhline R, Zikri Ditch M, Berlovitz Y, Boaz M. Malnutrition risk in newly hospitalized overweight and obese individuals: Mr NOI. Eur J Clin Nutr. 2013;67(6):620\u20134. https:\/\/doi.org\/10.1038\/ejcn.2013.45.","journal-title":"Eur J Clin Nutr"},{"issue":"1","key":"9578_CR82","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.clnu.2018.08.002","volume":"38","author":"T Cederholm","year":"2019","unstructured":"Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clin Nutr. 2019;38(1):1\u20139.","journal-title":"Clin Nutr"},{"issue":"1","key":"9578_CR83","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1002\/jpen.1440","volume":"43","author":"GL Jensen","year":"2019","unstructured":"Jensen GL, Cederholm T, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM Criteria for the diagnosis of malnutrition: A consensus report from the global clinical nutrition community. JPEN J Parenter Enter Nutr. 2019;43(1):32\u201340.","journal-title":"JPEN J Parenter Enter Nutr"},{"key":"9578_CR84","doi-asserted-by":"crossref","unstructured":"Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes (2005). 2009;33(3):289 \u2013 95.","DOI":"10.1038\/ijo.2009.2"},{"issue":"1","key":"9578_CR85","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.clnu.2018.08.037","volume":"38","author":"P Singer","year":"2019","unstructured":"Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48\u201379.","journal-title":"Clin Nutr"},{"issue":"6","key":"9578_CR86","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1177\/0148607113499374","volume":"37","author":"P Choban","year":"2013","unstructured":"Choban P, Dickerson R, Malone A, Worthington P, Compher C. A.S.P.E.N. Clinical guidelines: nutrition support of hospitalized adult patients with obesity. JPEN J Parenter Enteral Nutr. 2013;37(6):714\u201344. https:\/\/doi.org\/10.1177\/0148607113499374.","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"9578_CR87","doi-asserted-by":"publisher","unstructured":"Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, et al. European guidelines for obesity management in adults. Obes Facts. 2015;8(6):402\u201324. https:\/\/doi.org\/10.1159\/000442721.","DOI":"10.1159\/000442721"},{"issue":"2","key":"9578_CR88","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1038\/ijo.2015.182","volume":"40","author":"EM Backx","year":"2016","unstructured":"Backx EM, Tieland M, Borgonjen-van den Berg KJ, Claessen PR, van Loon LJ, de Groot LC. Protein intake and lean body mass preservation during energy intake restriction in overweight older adults. Int J Obes (Lond). 2016;40(2):299\u2013304. https:\/\/doi.org\/10.1038\/ijo.2015.182.","journal-title":"Int J Obes (Lond)"}],"container-title":["Reviews in Endocrine and Metabolic Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11154-020-09578-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11154-020-09578-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11154-020-09578-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T19:16:12Z","timestamp":1628190972000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11154-020-09578-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,6]]},"references-count":88,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,9]]}},"alternative-id":["9578"],"URL":"https:\/\/doi.org\/10.1007\/s11154-020-09578-1","relation":{},"ISSN":["1389-9155","1573-2606"],"issn-type":[{"value":"1389-9155","type":"print"},{"value":"1573-2606","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,6]]},"assertion":[{"value":"6 August 2020","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}