Blog

Sugar Vs. Fat

January 12, 2016

For years, there has been heavy debate as to whether sugar or fat is the culprit in the obesity epidemic. In the 1970s, this debate reached its peak and fat was pinned as the cause of our general decline in metabolic health. However more recently, sugar has come back into the limelight, with links to obesity, type II diabetes incidence and fatty liver disease.

With a general failure in halting the obesity and diabetes epidemics under the current guidelines and the lack of evidence that low-fat diets improve obesity, cardiovascular risk and other general health problems^1-18, it is now more important than ever to take a good look at the research done on sugar and fat to understand how these wee molecules affect our health.

What’s the story with fats?

For years, fats have been the bad guy, with many products boasting fat free or low fat alternatives. But how did this all get started? What scientific evidence is there to really substantiate the anti-fat argument? In short it comes down to this – the type of fat matters. Let me elaborate a little.

The links between fat intake and metabolic disease are more to do with the “bad fats”, such as trans fats found in processed food, biscuits, salad dressings…and the list goes on. In particular, trans fats have been strongly linked to coronary heart disease^9,19-22. The jury isn’t quite out on saturated fats. Some studies suggest, that saturated fats significantly worsen insulin resistance^10,23-29 and increase blood pressure^10,30,31, while others indicate that some forms of saturated fat (in particular those derived from plants) are not as detrimental to our health^9,32.

“Good fats” (monunsaturated and polyunsaturated) are found in foods such as seafood, avocado, nuts and olive oil. These have been shown to reduce low density lipoprotein (LDL), sustain high density lipoprotein (HDL) and improve insulin sensitivity^{9,10,12,32-37}. Some research does suggest that there isn’t a link between these ‘good fats’ and cholesterol levels, however most of these studies only sampled a small number of people for a short period of time^10,38-42.

How about low fat diets? Overwhelmingly, the majority of research suggests that there is no benefit of a low fat diet vs. a high fat diet for weight loss^1-18. Furthermore, there is little evidence to suggest adverse affects of a general high fat diet^10,43-45. Interesting stuff!

What’s the story with sugars?

There is a lot of evidence to suggest that consuming too much sugar can have a negative effect on our metabolic health. Regular sugar consumption produces a constant release of the hormone insulin. If this continues, it can lead to serious problems, such as the synthesis of tryglycerides^46-50, insulin resistance^51,52, fatty liver disease^53,54, type II diabetes^55-59, an increase in very low density lipoprotein (the bad kind of cholesterol) and the accumulation of fat on all tissues^49,50,60-63. Studies have also shown that our brains respond differently to fructose containing sugars than to glucose containing sugars^49,64.

Some research however does cast sugar in a sweeter light. Several studies conclude that there is no clear evidence that added sugar is worse than any other source of calories for the development of diabetes or obesity^65-69. However, many of these studies were either industry funded or had a strong financial interest to maintain high levels of sugar consumption⁴⁹, so should be taken with a grain of salt!

So how about low sugar diets? Much of the research suggests that this way of eating is beneficial for reducing blood glucose levels^50,70-78, weight loss and serum triglyverides^50,62,79-81, often more so than low fat or low calorie diets^50,78,82-84.

The verdict

All in all, most of the current evidence suggests that unsaturated fats are good for our general health, but that those cheeky trans fats should be avoided! The jury isn’t quite out on saturated fats. High-sugar consumption can also have a negative impact on our health by increasing the risk of type II diabetes, fatty liver disease and obesity. However there is a lot more work required to tease out the differences between various fat and sugar content diets. Remember, the more we understand about the types of foods we’re eating, the better quipped we will be to make awesome food choices!*

(*Amended 19/01/2016)

References

Tobias, D. K. et al. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 3, 968–979 (2015).
Howard, B. V. et al. Low-Fat Dietary Pattern and Risk of Cardiovascular Disease: The Women’s Health Initiative Randomized Controlled Dietary Modification Trial. Jama-J Am Med Assoc 295, 655–666 (2006).
Anderson, K. M., Castelli, W. P. & Levy, D. Cholesterol and Mortality: 30 Years of Follow-up From the Framingham Study. Jama-J Am Med Assoc 257, 2176–2180 (1987).
Siri-Tarino, P. W., Sun, Q., Hu, F. B. & Krauss, R. M. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am. J. Clin. Nutr. 91, ajcn.27725–546 (2010).
Siri-Tarino, P. W., Sun, Q., Hu, F. B. & Krauss, R. M. Saturated fat, carbohydrate, and cardiovascular disease. Am. J. Clin. Nutr. 91, 502–509 (2010).
Weinberg, S. L. The diet–heart hypothesis: a critique. J Am Coll Cardiol 43, 731–733 (2004).
Ravnskov, U., Rosch, P. J., Sutter, M. C. & Houston, M. C. Controversy: Should we lower cholesterol as much as possible? BMJ : British Medical Journal 332, 1330–1332 (2006).
Yancy, W. S., Westman, E. C., French, P. A. & Califf, R. M. Diets and clinical coronary events: the truth is out there. Circulation 107, 10–16 (2003).
Willett, W. C. Dietary fats and coronary heart disease. J. Intern. Med. 272, 13–24 (2012).
Riccardi, G., Giacco, R. & Rivellese, A. A. Dietary fat, insulin sensitivity and the metabolic syndrome. Clin Nutr 23, 447–456 (2004).
Kratz, M., Baars, T. & Guyenet, S. The relationship between high-fat dairy consumption and obesity, cardiovascular, and metabolic disease. Eur J Nutr 52, 1–24 (2013).
Swinburn, B. A., Boyce, V. L., Bergman, R. N., Howard, B. V. & Bogardus, C. Deterioration in Carbohydrate Metabolism and Lipoprotein Changes Induced by Modern, High Fat Diet in Pima Indians and Caucasians. The Journal of Clinical Endocrinology & Metabolism 73, 156–165 (2013).
Bisschop, P. H. et al. Dietary fat content alters insulin-mediated glucose metabolism in healthy men. Am. J. Clin. Nutr. 73, 554–559 (2001).
Garg, A., Grundy, S. M. & Unger, R. H. Comparison of Effects of High and Low Carbohydrate Diets on Plasma Lipoproteins and Insulin Sensitivity in Patients With Mild NIDDM. Diabetes 41, 1278–1285 (1992).
Hughes, V. A. et al. Long-term effects of a high-carbohydrate diet and exercise on insulin action in older subjects with impaired glucose tolerance. Am. J. Clin. Nutr. 62, 426–433 (1995).
Sarkkinen, E., Schwab, U., Niskanen, L. & Hannuksela, M. The effects of monounsaturated-fat enriched diet on lipid and glucose metabolism in subjects with impaired glucose tolerance. (Eur J Clin Nutr, 1996).
Thomsen, C. & Rasmussen, O. Comparison of the effects of a monounsaturated fat diet and a high carbohydrate diet on cardiovascular risk factors in first degree relatives to type-2 diabetic subjects. European journal of Clinical Nutrition (1999).
Campbell, L. V., Brokman, M., Chisholm, D. J. & Storlien, L. H. Comparison of the Effects on Insulin Sensitivity of High Carbohydrate and High Fat Diets in Normal Subjects*. The Journal of Clinical Endocrinology & Metabolism 72, 432–437 (2013).
Keys, A. Serum cholesterol response to dietary cholesterol. Am. J. Clin. Nutr. 40, 351–359 (1984).
Hegsted, D. M. Serum-cholesterol response to dietary cholesterol: a re-evaluation. Am. J. Clin. Nutr. 44, 299–305 (1986).
Shepherd, J. et al. Prevention of Coronary Heart Disease with Pravastatin in Men with Hypercholesterolemia. New Engl J Med 333, 1301–1308 (1995).
Sacks, F. M. et al. The Effect of Pravastatin on Coronary Events after Myocardial Infarction in Patients with Average Cholesterol Levels. New Engl J Med 335, 1001–1009 (1996).
Maron, D. J., Fair, J. M. & Haskell, W. L. Saturated fat intake and insulin resistance in men with coronary artery disease. The Stanford Coronary Risk Intervention Project Investigators and Staff. Circulation 84, 2020–2027 (1991).
Parker, D. R. et al. Relationship of dietary saturated fatty acids and body habitus to serum insulin concentrations: the Normative Aging Study. Am. J. Clin. Nutr. 58, 129–136 (1993).
Mayer, E. J., Newman, B., JR, C. P. Q. & Selby, J. V. Usual Dietary Fat Intake and Insulin Concentrations in Healthy Women Twins. Diabetes Care 16, 1459–1469 (1993).
Feskens, E. J., Loeber, J. G. & Kromhout, D. Diet and physical activity as determinants of hyperinsulinemia: the Zutphen Elderly Study. Am. J. Epidemiol. 140, 350–360 (1994).
Marshall, J. A., Bessesen, D. H. & Hamman, R. F. High saturated fat and low starch and fibre are associated with hyperinsulinaemia in a non-diabetic population: The San Luis Valley Diabetes Study. Diabetologia 40, 430–438 (1997).
Mooy, J. M., Grootenhuis, P. A. & De Vries, H. Determinants of specific serum insulin concentrations in a general Caucasian population aged 50 to 74 years (the Hoorn Study). Diabetic Medicine (1998).
Mayer-Davis, E. J. et al. Dietary fat and insulin sensitivity in a triethnic population: the role of obesity. The Insulin Resistance Atherosclerosis Study (IRAS). Am. J. Clin. Nutr. 65, 79–87 (1997).
Stamler, J., Caggiula, A. W. & Grandits, G. A. Relation of body mass and alcohol, nutrient, fiber, and caffeine intakes to blood pressure in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial. Am. J. Clin. Nutr. 65, 338S–365S (1997).
Trevisan, M. et al. Consumption of Olive Oil, Butter, and Vegetable Oils and Coronary Heart Disease Risk Factors. Jama-J Am Med Assoc 263, 688–692 (1990).
Hu, F. B. et al. Dietary Fat Intake and the Risk of Coronary Heart Disease in Women. New Engl J Med 337, 1491–1499 (1997).
Storlien, L. H. et al. Influence of Dietary Fat Composition on Development of Insulin Resistance in Rats: Relationship to Muscle Triglyceride and ω-3 Fatty Acids in Muscle Phospholipid. Diabetes 40, 280–289 (1991).
Pelikánová, T., Kohout, M., Válek, J., Bas̆e, J. & Kazdová, L. Insulin secretion and insulin action related to the serum phospholipid fatty acid pattern in healthy men. Metabolism 38, 188–192 (1989).
Borkman, M., Storlien, L. H. & Pan, D. A. The relation between insulin sensitivity and the fatty-acid composition of skeletal-muscle phospholipids. The New England Journal of Medicine (1993).
Vessby, B., Tengblad, S. & Lithell, H. Insulin sensitivity is related to the fatty acid composition of serum lipids and skeletal muscle phospholipids in 70-year-old men. Diabetologia 37, 1044–1050 (1994).
Pan, D. A. et al. Skeletal muscle membrane lipid composition is related to adiposity and insulin action. Journal of Clinical Investigation 96, 2802–2808 (1995).
Heine, R. J., Mulder, C., Popp-Snijders, C., van der Meer, J. & van der Veen, E. A. Linoleic-acid-enriched diet: long-term effects on serum lipoprotein and apolipoprotein concentrations and insulin sensitivity in noninsulin-dependent diabetic patients. Am. J. Clin. Nutr. 49, 448–456 (1989).
Uusitupa, M. et al. Effects of two high-fat diets with different fatty acid compositions on glucose and lipid metabolism in healthy young women. Am. J. Clin. Nutr. 59, 1310–1316 (1994).
Schwab, U. S., Niskanen, L. K. & Maliranta, H. M. Lauric and palmitic acid-enriched diets have minimal impact on serum lipid and lipoprotein concentrations and glucose metabolism in healthy young women. Journal of Nutrition (1995).
Fasching, P. et al. No Effect of Short-Term Dietary Supplementation of Saturated and Poly- and Monounsaturated Fatty Acids on Insulin Secretion and Sensitivity in Healthy Men. Ann Nutr Metab 40, 116–122 (1996).
Lovejoy, J. C. et al. Effects of diets enriched in saturated (palmitic), monounsaturated (oleic), or trans (elaidic) fatty acids on insulin sensitivity and substrate oxidation in healthy adults. Diabetes Care 25, 1283–1288 (2002).
Ludwig, D. S., Peterson, K. E. & Gortmaker, S. L. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 357, 505–508 (2001).
Chen, L. B. Mitochondrial-Membrane Potential in Living Cells. Annu Rev Cell Biol 4, 155–181 (1988).
Lovejoy, J. C., Windhauser, M. M., Rood, J. C. & la Bretonne, de, J. A. Effect of a controlled high-fat versus low-fat diet on insulin sensitivity and leptin levels in African-American and Caucasian women. Metabolism 47, 1520–1524 (1998).
Duffey, K. J., Gordon-Larsen, P., Steffen, L. M., Jacobs, D. R. & Popkin, B. M. Drinking caloric beverages increases the risk of adverse cardiometabolic outcomes in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am. J. Clin. Nutr. 92, 954–959 (2010).
Welsh, J. A. et al. Caloric Sweetener Consumption and Dyslipidemia Among US Adults. Jama-J Am Med Assoc 303, 1490–1497 (2010).
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Assy, N. et al. Soft drink consumption linked with fatty liver in the absence of traditional risk factors. Can. J. Gastroenterol. 22, 811–816 (2008).
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Bhupathiraju, S. N. et al. Caffeinated and caffeine-free beverages and risk of type 2 diabetes. Am. J. Clin. Nutr. 97, 155–166 (2013).
de Koning, L., Malik, V. S., Rimm, E. B., Willett, W. C. & Hu, F. B. Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men. Am. J. Clin. Nutr. 93, 1321–1327 (2011).
Montonen, J., Järvinen, R., Knekt, P., Heliövaara, M. & Reunanen, A. Consumption of sweetened beverages and intakes of fructose and glucose predict type 2 diabetes occurrence. J. Nutr. 137, 1447–1454 (2007).
Palmer, J. R. et al. Sugar-Sweetened Beverages and Incidence of Type 2 Diabetes Mellitus in African American Women. Arch Intern Med 168, 1487–1492 (2008).
Schulze, M. B. et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. Jama-J Am Med Assoc 292, 927–934 (2004).
Odegaard, A. O., Choh, A. C., Czerwinski, S. A., Towne, B. & Demerath, E. W. Sugar‐Sweetened and Diet Beverages in Relation to Visceral Adipose Tissue. Obesity (Silver Spring) 20, 689–691 (2012).
Pollock, N. K. et al. Greater fructose consumption is associated with cardiometabolic risk markers and visceral adiposity in adolescents. J. Nutr. 142, 251–257 (2012).
Volek, J. S., Fernandez, M. L., Feinman, R. D. & Phinney, S. D. Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Progress in Lipid Research 47, 307–318 (2008).
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Blog

Tobias, D. K. et al. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 3, 968–979 (2015).

Howard, B. V. et al. Low-Fat Dietary Pattern and Risk of Cardiovascular Disease: The Women’s Health Initiative Randomized Controlled Dietary Modification Trial. Jama-J Am Med Assoc 295, 655–666 (2006).

Anderson, K. M., Castelli, W. P. & Levy, D. Cholesterol and Mortality: 30 Years of Follow-up From the Framingham Study. Jama-J Am Med Assoc 257, 2176–2180 (1987).

Siri-Tarino, P. W., Sun, Q., Hu, F. B. & Krauss, R. M. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am. J. Clin. Nutr. 91, ajcn.27725–546 (2010).

Siri-Tarino, P. W., Sun, Q., Hu, F. B. & Krauss, R. M. Saturated fat, carbohydrate, and cardiovascular disease. Am. J. Clin. Nutr. 91, 502–509 (2010).

Weinberg, S. L. The diet–heart hypothesis: a critique. J Am Coll Cardiol 43, 731–733 (2004).

Ravnskov, U., Rosch, P. J., Sutter, M. C. & Houston, M. C. Controversy: Should we lower cholesterol as much as possible? BMJ : British Medical Journal 332, 1330–1332 (2006).

Yancy, W. S., Westman, E. C., French, P. A. & Califf, R. M. Diets and clinical coronary events: the truth is out there. Circulation 107, 10–16 (2003).

Willett, W. C. Dietary fats and coronary heart disease. J. Intern. Med. 272, 13–24 (2012).

Riccardi, G., Giacco, R. & Rivellese, A. A. Dietary fat, insulin sensitivity and the metabolic syndrome. Clin Nutr 23, 447–456 (2004).

Kratz, M., Baars, T. & Guyenet, S. The relationship between high-fat dairy consumption and obesity, cardiovascular, and metabolic disease. Eur J Nutr 52, 1–24 (2013).

Swinburn, B. A., Boyce, V. L., Bergman, R. N., Howard, B. V. & Bogardus, C. Deterioration in Carbohydrate Metabolism and Lipoprotein Changes Induced by Modern, High Fat Diet in Pima Indians and Caucasians. The Journal of Clinical Endocrinology & Metabolism 73, 156–165 (2013).

Bisschop, P. H. et al. Dietary fat content alters insulin-mediated glucose metabolism in healthy men. Am. J. Clin. Nutr. 73, 554–559 (2001).

Garg, A., Grundy, S. M. & Unger, R. H. Comparison of Effects of High and Low Carbohydrate Diets on Plasma Lipoproteins and Insulin Sensitivity in Patients With Mild NIDDM. Diabetes 41, 1278–1285 (1992).

Hughes, V. A. et al. Long-term effects of a high-carbohydrate diet and exercise on insulin action in older subjects with impaired glucose tolerance. Am. J. Clin. Nutr. 62, 426–433 (1995).

Sarkkinen, E., Schwab, U., Niskanen, L. & Hannuksela, M. The effects of monounsaturated-fat enriched diet on lipid and glucose metabolism in subjects with impaired glucose tolerance. (Eur J Clin Nutr, 1996).

Thomsen, C. & Rasmussen, O. Comparison of the effects of a monounsaturated fat diet and a high carbohydrate diet on cardiovascular risk factors in first degree relatives to type-2 diabetic subjects. European journal of Clinical Nutrition (1999).

Campbell, L. V., Brokman, M., Chisholm, D. J. & Storlien, L. H. Comparison of the Effects on Insulin Sensitivity of High Carbohydrate and High Fat Diets in Normal Subjects*. The Journal of Clinical Endocrinology & Metabolism 72, 432–437 (2013).

Keys, A. Serum cholesterol response to dietary cholesterol. Am. J. Clin. Nutr. 40, 351–359 (1984).

Hegsted, D. M. Serum-cholesterol response to dietary cholesterol: a re-evaluation. Am. J. Clin. Nutr. 44, 299–305 (1986).

Shepherd, J. et al. Prevention of Coronary Heart Disease with Pravastatin in Men with Hypercholesterolemia. New Engl J Med 333, 1301–1308 (1995).

Sacks, F. M. et al. The Effect of Pravastatin on Coronary Events after Myocardial Infarction in Patients with Average Cholesterol Levels. New Engl J Med 335, 1001–1009 (1996).

Maron, D. J., Fair, J. M. & Haskell, W. L. Saturated fat intake and insulin resistance in men with coronary artery disease. The Stanford Coronary Risk Intervention Project Investigators and Staff. Circulation 84, 2020–2027 (1991).

Parker, D. R. et al. Relationship of dietary saturated fatty acids and body habitus to serum insulin concentrations: the Normative Aging Study. Am. J. Clin. Nutr. 58, 129–136 (1993).

Mayer, E. J., Newman, B., JR, C. P. Q. & Selby, J. V. Usual Dietary Fat Intake and Insulin Concentrations in Healthy Women Twins. Diabetes Care 16, 1459–1469 (1993).

Feskens, E. J., Loeber, J. G. & Kromhout, D. Diet and physical activity as determinants of hyperinsulinemia: the Zutphen Elderly Study. Am. J. Epidemiol. 140, 350–360 (1994).

Marshall, J. A., Bessesen, D. H. & Hamman, R. F. High saturated fat and low starch and fibre are associated with hyperinsulinaemia in a non-diabetic population: The San Luis Valley Diabetes Study. Diabetologia 40, 430–438 (1997).

Mooy, J. M., Grootenhuis, P. A. & De Vries, H. Determinants of specific serum insulin concentrations in a general Caucasian population aged 50 to 74 years (the Hoorn Study). Diabetic Medicine (1998).

Mayer-Davis, E. J. et al. Dietary fat and insulin sensitivity in a triethnic population: the role of obesity. The Insulin Resistance Atherosclerosis Study (IRAS). Am. J. Clin. Nutr. 65, 79–87 (1997).

Stamler, J., Caggiula, A. W. & Grandits, G. A. Relation of body mass and alcohol, nutrient, fiber, and caffeine intakes to blood pressure in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial. Am. J. Clin. Nutr. 65, 338S–365S (1997).

Trevisan, M. et al. Consumption of Olive Oil, Butter, and Vegetable Oils and Coronary Heart Disease Risk Factors. Jama-J Am Med Assoc 263, 688–692 (1990).

Hu, F. B. et al. Dietary Fat Intake and the Risk of Coronary Heart Disease in Women. New Engl J Med 337, 1491–1499 (1997).

Storlien, L. H. et al. Influence of Dietary Fat Composition on Development of Insulin Resistance in Rats: Relationship to Muscle Triglyceride and ω-3 Fatty Acids in Muscle Phospholipid. Diabetes 40, 280–289 (1991).

Pelikánová, T., Kohout, M., Válek, J., Bas̆e, J. & Kazdová, L. Insulin secretion and insulin action related to the serum phospholipid fatty acid pattern in healthy men. Metabolism 38, 188–192 (1989).

Borkman, M., Storlien, L. H. & Pan, D. A. The relation between insulin sensitivity and the fatty-acid composition of skeletal-muscle phospholipids. The New England Journal of Medicine (1993).

Vessby, B., Tengblad, S. & Lithell, H. Insulin sensitivity is related to the fatty acid composition of serum lipids and skeletal muscle phospholipids in 70-year-old men. Diabetologia 37, 1044–1050 (1994).

Pan, D. A. et al. Skeletal muscle membrane lipid composition is related to adiposity and insulin action. Journal of Clinical Investigation 96, 2802–2808 (1995).

Heine, R. J., Mulder, C., Popp-Snijders, C., van der Meer, J. & van der Veen, E. A. Linoleic-acid-enriched diet: long-term effects on serum lipoprotein and apolipoprotein concentrations and insulin sensitivity in noninsulin-dependent diabetic patients. Am. J. Clin. Nutr. 49, 448–456 (1989).

Uusitupa, M. et al. Effects of two high-fat diets with different fatty acid compositions on glucose and lipid metabolism in healthy young women. Am. J. Clin. Nutr. 59, 1310–1316 (1994).

Schwab, U. S., Niskanen, L. K. & Maliranta, H. M. Lauric and palmitic acid-enriched diets have minimal impact on serum lipid and lipoprotein concentrations and glucose metabolism in healthy young women. Journal of Nutrition (1995).

Fasching, P. et al. No Effect of Short-Term Dietary Supplementation of Saturated and Poly- and Monounsaturated Fatty Acids on Insulin Secretion and Sensitivity in Healthy Men. Ann Nutr Metab 40, 116–122 (1996).

Lovejoy, J. C. et al. Effects of diets enriched in saturated (palmitic), monounsaturated (oleic), or trans (elaidic) fatty acids on insulin sensitivity and substrate oxidation in healthy adults. Diabetes Care 25, 1283–1288 (2002).

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