Food intolerance and the few-foods (or oligoantigenic) diet in children with attention-deficit hyperactivity disorder
Abstract
The hypothesis that some children with attention-deficit hyperactivity disorder (ADHD) may show sensitivity or allergic reactions to various food items has led to the development of the the few-foods (or oligoantigenic)diet. The rationale of the diet is to eliminate certain foods from the diet in order to exclude potential allergens contained either naturally in food or in artificial ingredients with allergenic properties. The oligoantigenic diet attempts to identify individual foods to which a person might be sensitive. First, ADHD symptoms are monitored while multiple foods are excluded from the diet. Subsequently, if symptoms remit, foods are re-introduced, while observing the individual for the return of symptoms. An advantage of the oligoantigenic diet is that it can be tailored to the individual. A growing body of evidence suggests that behavioral symptoms of subgroups of children with ADHD may benefit from the elimination of certain foods. The effect sizes of an oligoantigenic diet regarding improvement of ADHD symptoms have been found to be medium to large. Available evidence suggests that the investigation of the role of food hypersensitivities in ADHD is a promising avenue worthy of further exploration. Further large-scale, randomized controlled studies including assessment of long-term outcome are therefore warranted.
References
A. Thapar, M. Cooper, Attention deficit hyperactivity disorder, Lancet 387 (2016) 1240-1250. https://doi.org/10.1016/S0140-6736(15)00238-X.
C.M. Jensen, H.C. Steinhausen, Comorbid mental disorders in children and adolescents with attention-deficit/hyperactivity disorder in a large nationwide study, Atten. Defic. Hyperact. Disord. 7 (2015) 27-38. https://doi.org/10.1007/s12402-014-0142-1.
B. Wankerl, J. Hauser, E. Makulska-Gertruda, et al., Neurobiologische Grundlagen der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung, Fortschr. Neurol. Psychiatr. 82 (2014) 9-29. https://doi.org/10.1055/s-0033-1355710.
J. Thome, A.C. Ehlis, A.J. Fallgatter, et al., Biomarkers for attention-deficit/hyperactivity disorder (ADHD). A consensus report of the WFSBP task force on biological markers and the World Federation of ADHD, World J. Biol. Psychiatry 13 (2012) 379-400. https://doi.org/10.3109/15622975.2012.690535.
K.W. Lange, The treatment of attention deficit hyperactivity disorder has no proven long-term benefits but possible adverse effects, Mov. Nutr. Health Dis. 1 (2017) 11-25. https://doi.org/10.5283/mnhd.4.
A.F. Kortekaas-Rijlaarsdam, M. Luman, E. Sonuga-Barke, et al., Does methylphenidate improve academic performance? A systematic review and meta-analysis, Eur. Child Adolesc. Psychiatry 28 (2019) 155-164. https://doi.org/10.1007/s00787-018-1106-3.
G.J. Wang, N.D. Volkow, T. Wigal, et al., Long-term stimulant treatment affects brain dopamine transporter level in patients with attention deficit hyperactive disorder, PLoS ONE 8 (2013) e63023. https://doi.org/10.1371/journal.pone.0063023.
Z. Chang, P. Lichtenstein, L. Halldner, et al., Stimulant ADHD medication and risk for substance abuse, J. Child Psychol. Psychiatry 55 (2014) 878-885. https://doi.org/10.1111/jcpp.12164.
Z. Chang, P. Lichtenstein, B.M. D'Onofrio, et al., Serious transport accidents in adults with attention-deficit/hyperactivity disorder and the effect of medication: a population-based study, JAMA Psychiatry 71 (2014) 319-325. https://doi.org/10.1001/jamapsychiatry.2013.4174.
P. Lichtenstein, L. Halldner, J. Zetterqvist, et al., Medication for attention deficit-hyperactivity disorder and criminality, N. Engl. J. Med. 367 (2012) 2006-2014. https://doi.org/10.1056/NEJMoa1203241.
Q. Chen, A. Sjölander, B. Runeson, et al., Drug treatment for attentiondeficit/hyperactivity disorder and suicidal behaviour: register based study, BMJ 348 (2014) g3769. https://doi.org/10.1136/bmj.g3769.
O.J. Storebø, E. Faltinsen, M. Zwi, et al., The jury is still out on the benefits and harms of methylphenidate for children and adolescents with AttentionDeficit/Hyperactivity Disorder, Clin. Pharmacol. Ther. 104 (2018) 606-609. https://doi.org/10.1002/cpt.1149.
MTA Cooperative Group, A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder, Arch. Gen. Psychiatry 56 (1999) 1073-1086. https://doi.org/10.1001/archpsyc.56.12.1073.
P.S. Jensen, L.E. Arnold, J.M. Swanson, et al., 3-Year follow-up of the NIMH MTA study, J. Am. Acad. Child Adolesc. Psychiatry 46 (2007) 989-1002. https://doi.org/10.1097/CHI.0b013e3180686d48.
B.S.G. Molina, S.P. Hinshaw, J.M. Swanson, et al., The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study, J. Am. Acad. Child Adolesc. Psychiatry 48 (2009) 484-500. https://doi.org/10.1097/CHI.0b013e31819c23d0.
Y.S. Huang, M.H. Tsai, Long-term outcomes with medications for attention-deficit hyperactivity disorder: current status of knowledge, CNS Drugs 25 (2011) 539-554. https://doi.org/10.2165/11589380-000000000-00000.
N.D. Volkow, T.R. Insel, What are the long-term effects of methylphenidate treatment?, Biol. Psychiatry 54 (2003) 1307-1309. https://doi.org/10.1016/j.biopsych.2003.10.019.
J.M. Swanson, L.E. Arnold, B.S.G. Molina, et al., Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression, J. Child Psychol. Psychiatry 58 (2017) 663-678. https://doi.org/10.1111/jcpp.12684.
J. Sieluk, B. Palasik, S. dosReis, et al., ADHD medications and cardiovascular adverse events in children and adolescents: cross-national comparison of risk communication in drug labeling, Pharmacoepidemiol. Drug Saf. 26 (2017) 274-284. https://doi.org/10.1002/pds.4164.
L. Hennissen, M.J. Bakker, T. Banaschewski, et al., Cardiovascular effects of stimulant and non-stimulant medication for children and adolescents with ADHD: a systematic review and meta-analysis of trials of methylphenidate, amphetamines and atomoxetine, CNS Drugs 31 (2017) 199-215. https://doi.org/10.1007/s40263-017-0410-7.
J.W. Jackson, The cardiovascular safety of methylphenidate, BMJ 353 (2016) i2874. https://doi.org/10.1136/bmj.i2874.
I. Singh, Beyond polemics: science and ethics of ADHD, Nat. Rev. Neurosci. 9 (2008) 957-964. https://doi.org/10.1038/nrn2514.
J. Graham, D. Coghill, Adverse effects of pharmacotherapies for attentiondeficit hyperactivity disorder: epidemiology, prevention and management, CNS Drugs 22 (2008) 213-237. https://doi.org/10.2165/00023210-200822030-00003.
T.M. Winhusen, D.F. Lewis, P.D. Riggs, et al., Subjective effects, misuse, and adverse effects of osmotic-release methylphenidate treatment in adolescent substance abusers with attention-deficit/hyperactivity disorder, J. Child Adolesc. Psychopharmacol. 21 (2011) 455-463. https://doi.org/10.1089/cap.2011.0014.
K.W. Lange, The evidence of the benefits and harms of methylphenidate in the treatment of attention deficit/hyperactivity disorder is inconclusive, J. Pharmacol. Clin. Toxicol. 6 (2018) 1118.
K.W. Lange, Lifestyle and attention deficit/hyperactivity disorder, Mov. Nutr. Health Dis. 2 (2018) 22-30. https://doi.org/10.5283/mnhd.10.
K.W. Lange, Diet, exercise, and mental disorders - public health challenges of the future, Mov. Nutr. Health Dis. 2 (2018) 39-59. https://doi.org/10.5283/MNHD.12.
W. Marx, G. Moseley, M. Berk, et al., Nutritional psychiatry: the present state of the evidence, Proc. Nutr. Soc. 76 (2017) 427-436. https://doi.org/10.1017/S0029665117002026.
K.W. Lange, Omega-3 fatty acids and mental health, Glob. Health J. 4 (2020) 18-30. https://doi.org/10.1016/j.glohj.2020.01.004.
K.W. Lange, Dietary factors in the etiology and therapy of attention deficit/hyperactivity disorder, Curr. Opin. Clin. Nutr. Metab. Care 20 (2017) 464-469. https://doi.org/10.1097/MCO.0000000000000415.
K.W. Lange, Micronutrients and diets in the treatment of attention-deficit/hyperactivity disorder: chances and pitfalls, Front. Psychiatry 11 (2020) 102. https://doi.org/10.3389/fpsyt.2020.00102.
J. Sarris, A.C. Logan, T.N. Akbaraly, et al., Nutritional medicine as mainstream in psychiatry, Lancet Psychiatry 2 (2015) 271-274. https://doi.org/10.1016/S2215-0366(14)00051-0.
K.W. Lange, Do food bioactives play a role in attention-deficit/hyperactivity disorder? J. Food Bioact. 4 (2018) 1-7. https://doi.org/10.31665/JFB.2018.4160.
N.M. Uldall Torp, P.H. Thomsen, The use of diet interventions to treat symptoms of ADHD in children and adolescents - a systematic review of randomized controlled trials, Nord. J. Psychiatry 74 (2020) 558-568. https://doi.org/10.1080/08039488.2020.1769187.
K.W. Lange, Y. Nakamura, A. Reissmann, Diet and food in attentiondeficit hyperactivity disorder, J. Future Foods 2 (2022) 112-118. https://doi.org/10.1016/j.jfutfo.2022.03.008.
K.W. Lange, J. Hauser, K.M. Lange, et al., The role of nutritional supplements in the treatment of ADHD: what the evidence says? Curr. Psychiatry Rep. 19 (2017) 8. https://doi.org/10.1007/s11920-017-0762-1.
K.W. Lange, K.M. Lange, Y. Nakamura, et al., Nutrition in the management of ADHD: a review of recent research. Curr. Nutr. Rep. 12 (2023).
A. Farsad-Naeimi, F. Asjodi, M. Omidian, et al., Sugar consumption, sugar sweetened beverages and attention deficit hyperactivity disorder: a systematic review and meta-analysis, Complement. Ther. Med. 53 (2020) 102512. https://doi.org/10.1016/j.ctim.2020.102512.
B. Del-Ponte, G.C. Quinte, S. Cruz, et al., Dietary patterns and attention deficit/hyperactivity disorder (ADHD): a systematic review and metaanalysis, J. Affect. Disord. 252 (2019) 160-173. https://doi.org/10.1016/j.jad.2019.04.061.
V. Breda, R.O. Cerqueira, G. Ceolin, et al., Is there a place for dietetic interventions in adult ADHD?, Prog. Neuropsychopharmacol. Biol. Psychiatry 119 (2022) 110613. https://doi.org/10.1016/j.pnpbp.2022.110613.
L.M. Pelsser, K. Frankena, J. Toorman, et al., Diet and ADHD, reviewing the evidence: a systematic review of meta-analyses of double-blind placebocontrolled trials evaluating the efficacy of diet interventions on the behavior of children with ADHD, PLoS ONE 12 (2017) e0169277. https://doi.org/10.1371/journal.pone.0169277.
C. Cornu, C. Mercier, T. Ginhoux, et al., A double-blind placebo-controlled randomised trial of omega-3 supplementation in children with moderate ADHD symptoms, Eur. Child Adolesc. Psychiatry 27 (2018) 377-384. https://doi.org/10.1007/s00787-017-1058-z.
K.W. Lange, Y. Nakamura, A.M. Gosslau, et al., Are there serious adverse effects of omega-3 polyunsaturated fatty acid supplements?, J. Food Bioact. 7 (2019) 1-6. https://doi.org/10.31665/JFB.2019.7192.
A. Rios-Hernandez, J.A. Alda, A. Farran-Codina, et al., The mediterranean diet and ADHD in children and adolescents, Pediatrics 139 (2017) e20162027. https://doi.org/10.1542/peds.2016-2027.
E. Shareghfarid, Z.S. Sangsefidi, A. Salehi-Abargouei, et al., Empirically derived dietary patterns and food groups intake in relation with Attention Deficit/Hyperactivity Disorder (ADHD): a systematic review and metaanalysis, Clin. Nutr. ESPEN 36 (2020) 28-35. https://doi.org/10.1016/j.clnesp.2019.10.013.
L.M.J. Pelsser, J.K. Buitelaar, H.F.J. Savelkoul, ADHD as a (non) allergic hypersensitivity disorder: a hypothesis, Pediatr. Allergy Immunol. 20 (2009) 107-112. https://doi.org/10.1111/j.1399-3038.2008.00749.x.
B.R. Hoobler, Some early symptoms suggesting protein sensitization in infancy, Am. J. Dis. Child. 12 (1916) 129-135. https://doi.org/10.1001/ARCHPEDI.1916.04110140022003.
W.R. Shannon, Neuropathic manifestations in infants and children as a result of anaphylactic reaction to foods contained in their dietary, Am. J. Dis. Child. 24 (1922) 89-94. https://doi.org/10.1001/ARCHPEDI.1922.04120070092008.
G. Piness, H. Miller, Allergic manifestations in infancy and childhood, Arch. Pediatr. 42 (1925) 557-562.
W.F. Schneider, Psychiatric evaluation of the hyperkinetic child, J. Pediatr. 26 (1945) 559-570. https://doi.org/10.1016/S0022-3476(45)80083-5.
T.G. Randolph, Allergy as a causative factor of fatigue, irritability, and behavior problems of children, J. Pediatr. 31 (1947) 560–572. https://doi.org/10.1016/s0022-3476(47)80145-3.
F. Speer, The allergic tension-fatigue syndrome, Pediatr. Clin. North Am. (1954) 1029-1037. https://doi.org/10.1016/s0031-3955(16)30167-5.
T.W. Clarke, Neuro-allergy in childhood, N. Y. State J. Med. 48 (1948) 393-397.
T.W. Clarke, The relation of allergy to character problems in children, Ann. Allergy 8 (1950) 175-187.
W.G. Crook, W.W. Harrison, S.E. Crawford, et al., Systemic manifestations due to allergy. Report of fifty patients and a review of the literature on the subject (sometimes referred to as allergic toxemia and the allergic tensionfatigue syndrome), Pediatrics 27 (1961) 790-799.
B.F. Feingold, Hyperkinesis and learning disabilities linked to artificial food flavors and colors, Am. J. Nurs. 75 (1975) 797-803.
C.K. Conners, C.M. Goyette, D.A. Southwick, et al., Food additives and hyperkinesis: A controlled double-blind study, Pediatrics 58 (1976) 154-166.
J.I. Williams, D.M. Cram, F.T. Tausig, et al., Relative effects of drugs and diet on hyperactive behaviors: an experimental study, Pediatrics (1978) 811-817.
D. McCann, A. Barrett, A. Cooper, et al., Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial, Lancet 370 (2007) 1560-1567. https://doi.org/10.1016/S0140-6736(07)61306-3.
L.J. Stevens, T. Kuczek, J.R. Burgess, et al., Dietary sensitivities and ADHD symptoms: thirty-five years of research, Clin. Pediatr. 50 (2011) 279-293. https://doi.org/10.1177/0009922810384728.
C.M. Carter, M. Urbanowicz, R. Hemsley, et al., Effects of a few food diet in attention deficit disorder, Arch. Dis. Child. 69 (1993) 564-568. https://doi.org/10.1136/adc.69.5.564.
K.E.C. Grimshaw, Dietary management of food allergy in children, Proc. Nutr. Soc. 65 (2006) 412-417. https://doi.org/10.1017/s0029665106005167.
J.T. Nigg, K. Holton, Restriction and elimination diets in ADHD treatment, Child Adolesc. Psychiatr. Clin. N. Am. 23 (2014) 937-953. https://doi.org/10.1016/j.chc.2014.05.010.
J. Egger, C.M. Carter, P.J. Graham, et al., Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome, Lancet 1 (1985) 540-545. https://doi.org/10.1016/s0140-6736(85)91206-1.
M.H. Schmidt, P. Möcks, B. Lay, et al., Does oligoantigenic diet influence hyperactive/conduct-disordered children-a controlled trial, Eur. Child Adolesc. Psychiatry 6 (1997) 88-95. https://doi.org/10.1007/BF00566671.
R. Schnoll, D. Burshteyn, J. Cea-Aravena, Nutrition in the treatment of attention-deficit hyperactivity disorder: a neglected but important aspect, Appl. Psychophysiol. Biofeedback 28 (2003) 63-75. https://doi.org/10.1023/a:1022321017467.
L.M.J. Pelsser, J.K. Buitelaar, Gunstige invloed van een standaardeliminatiedieet op het gedrag van jonge kinderen met aandachtstekort-hyperactiviteitstoornis (ADHD), Ned. Tijdschr. Geneeskd. 146 (2002) 2543-2547.
L.M. Pelsser, K. Frankena, J. Toorman, et al., Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial, Lancet 377 (2011) 494-503. https://doi.org/10.1016/S0140-6736(10)62227-1.
E.J.S. Sonuga-Barke, D. Brandeis, S. Cortese, et al., Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments, Am. J. Psychiatry 170 (2013) 275-289. https://doi.org/10.1176/appi.ajp.2012.12070991.
B.J. Kaplan, J. McNicol, R.A. Conte, et al., Dietary replacement in preschool-aged hyperactive boys, Pediatrics 83 (1989) 7-17.
M. Boris, F.S. Mandel, Foods and additives are common causes of the attention deficit hyperactive disorder in children, Ann. Allergy 72 (1994) 462-468.
J. Stevenson, J. Buitelaar, S. Cortese, et al., Research review: the role of diet in the treatment of attention-deficit/hyperactivity disorder--an appraisal of the evidence on efficacy and recommendations on the design of future studies, J. Child Psychol. Psychiatry 55 (2014) 416-427. https://doi.org/10.1111/jcpp.12215.
M.J. Heilskov Rytter, L.B.B. Andersen, T. Houmann, et al., Diet in the treatment of ADHD in children - a systematic review of the literature, Nord. J. Psychiatry 69 (2015) 1-18. https://doi.org/10.3109/08039488.2014.921933.
C.J. Dunst, D.W. Hamby, Guide for calculating and interpreting effect sizes and confidence intervals in intellectual and developmental disability research studies, J. Intellect. Dev. Disabil. 37 (2012) 89-99. https://doi.org/10.3109/13668250.2012.673575.
R. Hubbard, R.M. Lindsay, Why P values are not a useful measure of evidence in statistical significance testing, Theory Psychol. 18 (2008) 69-88. https://doi.org/10.1177/0959354307086923.
S. Goodman, A dirty dozen: twelve P-value misconceptions, Semin. Hematol. 45 (2008) 135-140. https://doi.org/10.1053/j.seminhematol.2008.04.003.
J.A. Durlak, How to select, calculate, and interpret effect sizes, J. Pediatr. Psychol. 34 (2009) 917-928. https://doi.org/10.1093/jpepsy/jsp004.
C.O. Fritz, P.E. Morris, J.J. Richler, Effect size estimates: current use, calculations, and interpretation, J. Exp. Psychol. Gen. 141 (2012) 2-18. https://doi.org/10.1037/a0024338.
D. Benton, The impact of diet on anti-social, violent and criminal behaviour, Neurosci. Biobehav. Rev. 31 (2007) 752-774. https://doi.org/10.1016/j.neubiorev.2007.02.002.
K.A. Kavale, S.R. Forness, Hyperactivity and diet treatment: a meta-analysis of the Feingold hypothesis, J. Learn. Disabil. 16 (1983) 324-330. https://doi.org/10.1177/002221948301600604.
D.W. Schab, N.H.T. Trinh, Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials, J. Dev. Behav. Pediatr. 25 (2004) 423-434. https://doi.org/10.1097/00004703-200412000-00007.
J.T. Nigg, K. Lewis, T. Edinger, et al., Meta-analysis of attentiondeficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives, J. Am. Acad. Child Adolesc. Psychiatry 51 (2012) 86-97. https://doi.org/10.1016/j.jaac.2011.10.015.
A. Dölp, K. Schneider-Momm, P. Heiser, et al., Oligoantigenic diet improves children's ADHD rating scale scores reliably in added video-rating, Front. Psychiatry 11 (2020) 730. https://doi.org/10.3389/fpsyt.2020.00730.
E. Yorgidis, L. Beiner, N. Blazynski, et al., Individual behavioral reactions in the context of food sensitivities in children with attention-deficit/hyperactivity disorder before and after an oligoantigenic diet, Nutrients 13 (2021) 2598. https://doi.org/10.3390/nu13082598.
L. Pelsser, T. Stobernack, K. Frankena, Physical complaints decrease after following a few-foods diet in children with ADHD, Nutrients 14 (2022) 3036. https://doi.org/10.3390/nu14153036.
L. Pelsser, K. Frankena, J. Toorman, et al., Retrospective outcome monitoring of ADHD and nutrition (ROMAN): The effectiveness of the fewfoods diet in general practice, Front. Psychiatry 11 (2020) 96. https://doi.org/10.3389/fpsyt.2020.00096.
G. Walz, N. Blazynski, L. Frey, et al., Long-term effects of an oligoantigenic diet in children with attention-deficit/hyperactivity disorder (ADHD) on core symptomatology, Nutrients 14 (2022) 5111. https://doi.org/10.3390/nu14235111.
S. Hontelez, T. Stobernack, L.M. Pelsser, et al., Correlation between brain function and ADHD symptom changes in children with ADHD following a few-foods diet: an open-label intervention trial, Sci. Rep. 11 (2021) 22205. https://doi.org/10.1038/s41598-021-01684-7.
L.M. Pelsser, D.J. van Steijn, K. Frankena, et al., A randomized controlled pilot study into the effects of a restricted elimination diet on family structure in families with ADHD and ODD, Child Adolesc. Ment. Health 18 (2013) 39-45. https://doi.org/10.1111/j.1475-3588.2012.00652.x.
C.L. Huang-Pollock, S.L. Karalunas, H. Tam, et al., Evaluating vigilance deficits in ADHD: a meta-analysis of CPT performance, J. Abnorm. Psychol. 121 (2012) 360-371. https://doi.org/10.1037/a0027205.
R. Lambek, R. Tannock, S. Dalsgaard, et al., Executive dysfunction in school-age children with ADHD, J. Atten. Disord. 15 (2011) 646-655. https://doi.org/10.1177/1087054710370935.
K.W. Lange, J. Hauser, K.M. Lange, et al., Utility of cognitive neuropsychological assessment in attention-deficit/hyperactivity disorder, Atten. Defic. Hyperact. Disord. 6 (2014) 241-248. https://doi.org/10.1007/s12402-014-0132-3.
H.B. Abikoff, P.S. Jensen, L.L.E. Arnold, et al., Observed classroom behavior of children with ADHD: relationship to gender and comorbidity, J. Abnorm. Child Psychol. 30 (2002) 349-359. https://doi.org/10.1023/a:1015713807297.
A.W. Chan, D.G. Altman, Identifying outcome reporting bias in randomised trials on PubMed: review of publications and survey of authors, BMJ 330 (2005) 753. https://doi.org/10.1136/bmj.38356.424606.8F.
T. Shamliyan, R.L. Kane, Clinical research involving children: registration, completeness, and publication, Pediatrics 129 (2012) e1291-1300. https://doi.org/10.1542/peds.2010-2847.
L.A. David, C.F. Maurice, R.N. Carmody, et al., Diet rapidly and reproducibly alters the human gut microbiome, Nature 505 (2014) 559-563. https://doi.org/10.1038/nature12820.
S.M. Collins, M. Surette, P. Bercik, The interplay between the intestinal microbiota and the brain, Nat. Rev. Microbiol. 10 (2012) 735-742. https://doi.org/10.1038/nrmicro2876.
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