what do proteins build to repair and build muscles
Nutrients. 2019 May; 11(5): 1136.
Dietary Protein and Muscle Mass: Translating Science to Application and Health Benefit
John W. Carbone
1School of Health Sciences, Eastern Michigan Academy, Ypsilanti, MI 48197, USA
Stefan M. Pasiakos
2Military Diet Division, U.Due south. Army Inquiry Constitute of Environmental Medicine (USARIEM), Natick, MA 01760, USA; lim.liam@vic.sokaisap.k.nafets
Received 2019 April 16; Accepted 2019 May xx.
Abstract
Adequate consumption of dietary protein is critical for the maintenance of optimal wellness during normal growth and aging. The electric current Recommended Dietary Allowance (RDA) for poly peptide is divers as the minimum corporeality required to prevent lean body mass loss, but is often misrepresented and misinterpreted equally a recommended optimal intake. Over the by two decades, the potential muscle-related benefits achieved past consuming college-poly peptide diets have become increasingly articulate. Despite greater awareness of how higher-protein diets might be advantageous for muscle mass, bodily dietary patterns, peculiarly as they pertain to poly peptide, take remained relatively unchanged in American adults. This lack of change may, in part, result from defoliation over the purported detrimental furnishings of higher-protein diets. This manuscript will highlight common perceptions and benefits of dietary protein on musculus mass, accost misperceptions related to college-protein diets, and annotate on the translation of academic advances to existent-life awarding and health benefit. Given the vast enquiry prove supporting the positive effects of dietary protein intake on optimal health, we encourage critical evaluation of electric current protein intake recommendations and responsible representation and application of the RDA every bit a minimum protein requirement rather than 1 determined to optimally meet the needs of the population.
Keywords: hypertrophy, poly peptide balance, musculoskeletal, protein RDA
i. Introduction
Consuming adequate dietary protein is disquisitional for maintaining optimal health, growth, development, and part throughout life. Dietary protein requirements in healthy adults (≥nineteen years old) are dictated largely by trunk mass and lean trunk mass, also as net energy balance and physical action [1]. The Institute of Medicine (IOM) established the current Dietary Reference Intakes (DRIs) for poly peptide in 2005, including the Estimated Average Requirement (EAR), Recommended Dietary Allowance (RDA), and the Acceptable Macronutrient Distribution Range (AMDR) [2]. The EAR for protein is 0.66 g per kg body mass per day (g/kg/d) and is divers as the minimum amount of protein expected to meet the individual indispensable amino acid requirements of 50% of the U.S. adult population. The RDA, however, is 0.8 yard/kg/d, and reflects the minimum amount of dietary poly peptide required to meet indispensable amino acid requirements, establish nitrogen residual, and prevent musculus mass loss for about the entire (i.e., 97.v%) U.Southward. adult population [2,3]. The RDA for American adults is similar to international developed protein recommendations established by the World Wellness Organization (0.83 g/kg/d) [four]. The electric current protein RDA, nonetheless, is often incorrectly applied when used as the definition of recommended intake, rather than its truthful designation as the required minimum intake. This misapplication is problematic for healthy populations and aging adults, and disadvantageous for those with pathophysiological conditions that would necessitate higher-protein needs.
Over the past decade, the potential muscle-related benefits achieved by consuming higher-protein diets (i.eastward., > RDA but within the AMDR) take become increasingly clear. Increased protein intake contributes to greater strength and muscle mass gains when coupled with resistance exercise [5], allows for greater muscle mass preservation when consumed during periods of negative free energy balance [6], limits age-related muscle loss [7], and, to a lesser extent, provides a greater muscle poly peptide synthetic response when evenly distributed beyond meals [5,8]. A prospective, cantankerous-sectional assay of the National Health and Diet Examination Survey (NHANES) database demonstrates inverse associations betwixt animal and plant protein intake and waist circumference, body weight, and body mass index (BMI) [ix]. Advances in this field of nutritional science have translated to a greater emphasis on higher-poly peptide diets, protein quality, and supplemental protein in peer-reviewed literature, lay media, and the commercial food market. Despite greater sensation of how higher-protein diets might be advantageous for muscle mass, actual dietary patterns, particularly equally they pertain to poly peptide, have remained relatively unchanged in American adults equally a whole [x]. The disparity betwixt knowledge and action raises the question of whether this expanded agreement of dietary protein is truly meaningful if scientific information are not translated and ultimately reflected in nutrition guidance and, more importantly, in what people swallow. Equally such, the purpose of this brief advice is to highlight common perceptions and benefits of dietary protein on muscle mass, to accost misperceptions related to higher-poly peptide diets, and to annotate on the translation of academic advances to real-life application and wellness benefit.
2. Dietary Protein and Musculus Mass Perceptions
Skeletal muscle protein is dynamic and in abiding flux, alternating between states of negative (i.eastward., muscle protein synthesis < muscle protein breakdown) and positive (i.eastward., muscle protein synthesis > musculus protein breakdown) protein balance, largely in response to fasting (i.e., postabsorptive) and feeding (i.eastward., postprandial), respectively. In the postabsorptive state, muscle poly peptide serves as the primary repository of amino acids that is readily catabolized to release gratis amino acids that can exist reincorporated into muscle protein or used to support other disquisitional physiological needs, including serving every bit an energy substrate through carbon skeleton oxidation, as well as past providing gluconeogenic precursors to support euglycemia (Effigy 1). In improver, gratis amino acids derived from musculus protein breakdown are used in the synthesis of immune organisation components, plasma proteins, peptide hormones, and intra- and extracellular enzymes. Transient periods of negative protein balance in healthy adults are completely normal and reversed by feeding. The magnitude of the postprandial stimulation of muscle protein synthesis, suppression of musculus (and whole-body) protein breakup, and shift to a positive protein rest is mediated by dietary protein content, protein quality (i.e., based on an individual poly peptide's digestibility and absorption kinetics, and abundance of indispensable amino acids), and the format in which protein is consumed (e.g., mixed-macronutrient meal, isolated supplemental intact protein, or free-grade amino acids) [vi]. The collective optimization of these protein intake-related factors can potentiate the beneficial furnishings of other protein kinetic stimuli, such as the mechanical and metabolic effects of resistance and aerobic exercise, respectively, resulting in the enhanced remodeling and repair of existing muscle proteins and synthesis of new musculus protein, providing the conditions for muscle maintenance and growth [xi].
Free energy and/or dietary protein brake induce net muscle catabolism, releasing amino acids for energy production, gluconeogenesis, and synthesis of peptide hormones, plasma proteins, immune system components, and enzymes (representative examples, not an exhaustive list; not drawn to scale). AA, amino acids; ADH, antidiuretic hormone; hGH, human being growth hormone; T3, triiodothyronine; T4, thyroxine.
2.i. Current Dietary Poly peptide Recommendations
The current DRIs for poly peptide accept been in identify since 2005 but are not without limitations. The EAR and RDA were derived from meta-analyses of nitrogen balance studies [12]. The nitrogen residue method has many limitations and tends to overestimate nitrogen intake (via nutrition) and underestimate nitrogen excretion (via urine, feces, sweat, and integumental loss), thus falsely illustrating nitrogen residual [13]. Nitrogen remainder is also considered a crude measure that fails to provide any information as to what occurs inside the system to modulate the body nitrogen pool and subsequent balance [14,fifteen]. Too, the AMDR for protein (10–35% of total daily energy intake) was established by setting the lower stop of the AMDR at the relative corporeality of protein believed to meet the set RDA of 0.8 thousand/kg/d, while the upper end is the mathematical departure achieved if carbohydrate (45–65% of free energy) and fat (20–35% of energy) are consumed at the lower ends of their respective AMDR (i.due east., 100% − 45% − 20% = 35% as the upper cease of protein AMDR) [ii]. Saccharide and fat are important energy substrates and energy balance is critical to optimal health, just this derivation raises uncertainty almost the physiological relevance underlying a recommended upper limit for protein consumption at 35% of total free energy intake.
Similarly, the RDA may exist sufficient to come across the dietary protein needs of good for you, relatively sedentary immature adults, though investigators have argued that this recommendation should exist reconsidered based on data from studies demonstrating the inadequacy of the RDA within certain populations when compared to greater requirements derived from the indicator amino acid oxidation method [sixteen]. Accordingly, internationally recognized professional organizations recommend poly peptide intakes on the order of double the current RDA for physically active individuals, including the joint recommendation to consume protein betwixt 1.2–ii.0 k/kg/d established by the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine [17]. The International Society for Sports Nutrition also recommends protein intake at levels higher than the RDA for physically active individuals (1.4–2.0 g/kg/d) [1]. The definition of the protein RDA itself draws criticism given that information technology reflects the minimal corporeality of protein required to foreclose deficiency, rather than an amount which may allow for optimal health. The AMDR does provide for more than flexibility in dietary protein intake recommendations in the context of the complete nutrition, yet most American adults habitually consume poly peptide on the lower end of this range (i.e., 14–xvi% of full energy intake) [10].
ii.2. Dietary Protein and Physical Action
The benefits of consuming protein post-obit resistance exercise training have been well-documented, peculiarly as they chronicle to muscle hypertrophy and office [18]. A contempo meta-analysis showed significant positive associations betwixt coupling resistance exercise with post-exercise poly peptide ingestion and total fat-complimentary mass, strength, equally measured past one-repetition maximum, and musculus size, as measured past myofiber cantankerous-sectional surface area [eighteen]. The type and book of do plays a determining office in muscle poly peptide constructed responses to post-practice protein ingestion [19,20], as does age [21] and the training experience [18] of the individual. The blazon of protein consumed also factors into the net anabolic response, given that postprandial muscle poly peptide and whole-body protein kinetic responses to free-form amino acids, isolated intact proteins, and mixed-macronutrient meals all differ [22,23,24]. Equally reflected in sports nutrition recommendations [one,17], holistic evaluation of varied experimental designs suggests that coupling post-resistance do poly peptide ingestion (~20–xxx yard or 0.25–0.30 thousand/kg) with habitual protein intakes at ~1.6 thousand/kg/d promotes favorable muscle adaptations to exercise training [18].
2.3. Dietary Protein during Energy Deficit
Consuming college amounts of poly peptide during typical moderate energy-deficient weight loss diets (i.e., 500–750 kcal/d deficit [25]) preserves muscle mass in an otherwise catabolic physiological environment [six]. However, the protective consequence of higher-protein diets on muscle and whole-trunk protein homeostasis is compromised as the severity of energy deficit increases beyond 40% of daily energy needs, equally a greater proportion of dietary amino acids are oxidized for free energy production, thereby minimizing amino acrid availability to support protein balance [26] (Figure 1). Even so, nearly adults rarely feel astute or sustained periods of astringent energy deficit, except for perhaps acute fasting for religious reasons, poorly-constructed drastic weight loss plans, preparation and/or recovery from bariatric surgery, or scenarios where food availability is severely limited (e.1000., victims of natural disasters, emergency responders, etc.). Regardless of the cause, these periods of astringent energy deficit usually manifest only for brusque durations (e.g., 1–3 days) and, therefore, are likely physiologically tolerable. Yet, if energy expenditures are high and dietary free energy and poly peptide intake are express for extended periods of time, for instance during sustained, multi-stressor military operations [27,28], the consequences of severe free energy deficit are much more problematic, especially if torso mass and fat-free mass loss are and then astringent that immune organisation and muscle function and performance are compromised [29,xxx,31]. During those conditions, prioritizing energy intake, more and then than focusing solely on protein per se, is vitally important to help prevent excessive musculus catabolism and conserve musculus function and performance. With moderate energy deficit, however, poly peptide intakes on the order of double the current RDA (i.e., 1.6 g/kg/d) take proved efficacious in preserving muscle mass during weight loss [6].
two.4. Pathophysiological Weather
Inadequate dietary protein intake challenges muscle and whole-body poly peptide residue (i.e., poly peptide synthesis = protein breakup), negatively impacting musculus mass, role, adaptations to practise, os and calcium homeostasis, allowed arrangement response, fluid and electrolyte residuum, enzyme product and activity, and hormone synthesis. In the absenteeism of sufficient dietary protein intake, muscle is catabolized to provide amino acids to allow for continued endogenous protein synthesis in critical physiological tissues and organs [32] (Figure ane). Certain pathophysiological weather condition, such every bit burns [33], chronic obstructive pulmonary illness (COPD) [34], human being immunodeficiency virus/caused immunodeficiency syndrome (HIV/AIDS) [35], cancer [36], and sepsis [37], as well challenge poly peptide homeostasis, albeit the etiology and mechanisms for disrupted protein balance are generally much dissimilar from those in healthy adults [38]. Nevertheless, these atmospheric condition often induce muscle wasting, suggesting that greater dietary protein intakes may be warranted, with specific recommendations based on the individual patient and clinical scenario.
While much focus has been placed on adult poly peptide needs in the context of these illness states, the potential benefits of higher-protein intakes extend beyond the lifespan. Muscle loss and failure-to-thrive are particularly worrisome in the pediatric population, a time typically characterized by rapid growth and development. Recent meta-analysis shows that college poly peptide intakes in critically sick pediatric patients are associated with positive protein balance, improved clinical outcomes, and lower bloodshed [39]. These effects manifest at intakes above 1.1 g/kg/d and go more than prominent when protein intakes exceed 1.five g/kg/d. Similarly, unintentional weight loss and decrements in muscle mass in the elderly are predictive of morbidity and bloodshed, particularly in institutionalized populations [40,41,42]. Provision of dietary protein at or in a higher place ane.2 g/kg/d is associated with reductions in unintentional weight loss [43]. Dietary poly peptide supplementation, bringing daily protein intake to 1.5 g/kg, may also be benign in mitigating the detrimental body composition changes and muscle mass and function losses associated with sarcopenia [44]. Similarly, consideration should be made for the timing and method of delivery, with isolated, intact proteins providing for a greater anabolic response than mixed meals [45]. While advanced historic period does limit the postprandial anabolic response typically observed subsequent to poly peptide feeding [46,47], regular intakes in a higher place the current protein RDA and consumption of at least 0.4 thou/kg (i.e., 0.6 g/kg lean torso mass) high quality protein at each meal appear to be critical contributors to preservation of muscle mass and strength that may limit frailty in older populations [42,46,48]. In that location is likewise some bear witness to support the notion that even higher protein intakes (due east.yard., 70 g per repast) may be of do good, in terms of suppressing whole-body proteolysis and enhancing net protein balance [49,50].
iii. Poly peptide Misconceptions and Reality
While the popularity of dietary protein has increased over the past decade or longer, largely because of its role in muscle health, in that location are still some in the media, clinical practice, and within academia [51] that perpetuate certain risks associated with the protein content of balanced mixed-diets for salubrious adults. Mutual criticisms of greater protein intakes, or with the types of foods dietary protein is derived from, include the potential for detrimental effects of protein on os, renal function, low-grade inflammation, cardiometabolic illness, and cancer hazard. These concerns are mostly unfounded with regard to the poly peptide content of the diet and are antithetical to contemporary published information [52,53,54,55,56,57,58,59]. Their persistence, however, and the mislabeling of wellness detriments to poly peptide itself, as opposed to the whole foods which contribute protein to the overall diet, may underlie lower dietary intakes and thereby contribute to suboptimal muscle integrity. While these associations take been corrected in the scientific literature, other concerns exercise warrant thoughtful consideration and should be debated in the context of whole foods rather than just ascribing poly peptide foods to labels of "non-dairy beast," "dairy," and "establish," without consideration of the other nutrients these foods provide and their possible links to wellness and illness [lx].
Observations of hypercalciuria from almost a century ago in those consuming greater amounts of meat raised concerns that higher protein intakes resulted in increased bone resorption and, therefore, diminished os mineral density [61]. It was later hypothesized that greater intakes of sulfur-containing amino acids induce an acidemia that leads to increased os resorption and calcium release from bone as a compensatory mechanism to buffer reductions in pH secondary to college protein intake [ii]. More than recent information suggest that this determination is faux, every bit well-controlled studies using stable isotope tracer techniques to appraise calcium assimilation have shown that the observed hypercalciuria secondary to higher poly peptide intake results from increased calcium bioavailability and greater intestinal calcium absorption potentiated by protein [62,63]. Information from NHANES show that dietary acid load and bone mineral density are not related in adults who consume adequate calcium [64]. In fact, higher protein diets may actually protect against osteoporosis, in office, as a consequence of the increased hepatic release of insulin-like growth cistron one (IGF-1) [65]. A recent meta-analysis demonstrated that those with the highest protein intakes had significantly lower hip fracture incidence relative to those with the lowest protein intakes, supporting the assertion that increased dietary poly peptide intake may be protective and serve a disquisitional role in accruing and maintaining os mineral density [66]. The National Osteoporosis Foundation recognizes the potential benefit of dietary protein on bone, while advocating for continued inquiry, particularly the execution of randomized controlled trials that account for dietary calcium intake [67].
Higher-poly peptide diets have also been labeled as damaging to the kidneys. Increased amino acid intake tin potentiate renal workload and should be reduced in the presence of established renal disease. However, otherwise healthy kidneys are well-capable of adapting to protein intakes above the RDA and within the AMDR. The kidneys are faced with increased nitrogenous waste product as more amino acids are oxidized for energy and/or directed towards gluconeogenesis equally the relative pct of energy intake derived from protein increases. In a recent evaluation of NHANES data, protein intake was directly associated with blood urea nitrogen (BUN) concentrations, but those in the highest decile for protein intake (~1.four g/kg/d) still exhibited normal BUN (xiv.viii ± 0.3; reference range, 7–20 mg/dL) [ix]. This finding held true across non-dairy brute, animate being, and establish protein sources and neither glomerular filtration rate (GFR) nor blood creatinine concentrations were related to dietary protein content. Similarly, a recent meta-assay of randomized controlled trials with dietary protein interventions showed a pocket-size only positive relationship between higher protein intakes (i.east., ≥ i.5 1000/kg/d or ≥ xx% energy intake) and GFR [52]. Overall, current bachelor data suggest college-protein diets exercise increase renal workload, but they do non negatively impact kidney health nor increase the run a risk of developing chronic kidney disease in healthy adults.
Contempo studies have raised concerns about the potential for higher-poly peptide intakes to increase systemic inflammation. One large-scale investigation showed that those in the greatest high-sensitivity C-reactive protein (hs-CRP) serum concentration quartile also had college relative protein intakes than the lowest hs-CRP quartile [68]. Withal, the mean differences in accented and energy-adapted protein intakes betwixt the highest and everyman hs-CRP quartiles were but 1.0 and 1.2 g/d, respectively. Similarly, a big controlled dietary intervention study showed greater reductions in hs-CRP with lower-protein intakes (i.eastward., x–fifteen% vs. 23–28% full energy intake), although this protein-based departure was observed only in conjunction with a high-glycemic index diet and non with a low-glycemic index background [69]. In contrast, an analysis of the Framingham Heart Study Offspring Accomplice shows an inverse association betwixt dietary protein intake and inflammation and oxidative stress scores, derived from measures of 9 inflammatory biomarkers [59]. This potential beneficial effect was observed for higher total and animal poly peptide intakes simply was fifty-fifty more pronounced with higher plant poly peptide intakes.
Concern has too been raised regarding potential connections between dietary protein intake and chance of cardiometabolic disease and cancer. These associations are typically confounded past misrepresentation of foods labeled as "protein-rich" which may, by their nature, be overall less-healthful nutrient-sparse food options, providing high amounts of total and saturated fats and processing additives (e.1000., nitrates, nitrites, sodium) [60]. To the all-time of our knowledge, there are no information demonstrating a well-defined association between dietary protein itself and cardiovascular disease [70,71] or type 2 diabetes mellitus [56]. Similarly, methionine restriction (e.g., vegan dietary pattern) may exist a feasible approach to limit carcinogenic processes and tumor growth [72,73], even so meta-analyses show no link between overall dietary protein intake and incidence of colorectal [57] or breast [58] cancers. Higher poly peptide intakes may, nevertheless, exert a protective effect on post-diagnosis survival [74]. A greater emphasis must be placed on dietary protein consumption in the context of overall nutrient-dumbo, healthy food choices when considering relations to wellness and disease, as the aforementioned potential connections are influenced heavily by food item quality more and so than macronutrient profile [55,75].
four. Translation and Application
An assessment of national dietary patterns shows that poly peptide food intakes have remained relatively unchanged over the by decade (i.due east., five.79 ounce equivalents (2005–2006), 5.58 (2007–2008), 5.74 (2009–2010), 5.70 (2011–2012), 5.83 (2013–2014), 5.eighty (2015–2016)), as intake data for the latest ii-year wheel are nearly identical to those from ten years earlier [76,77,78,79,80,81]. This static intake pattern may relate to the regular presentation of recommended protein intakes in a g/d format [82,83], calculated from anthropometrics causeless when the RDA was crafted in 2005 (i.e., 70 kg male, 57 kg female [2]), despite the fact that contemporary measures are significantly unlike (i.e., xc kg boilerplate male, 77 kg boilerplate female person [84]). A present-day, moderately physically active, average adult male, consuming poly peptide at the RDA, would have an intake below the low end of the AMDR while maintaining energy balance. In reality, most American adults eat ~14–16% of total free energy as poly peptide (i.0–1.5 g/kg/d, depending on age and sex) [10]; an amount greater than the electric current RDA, but supported as beneficial to muscle and overall health by contemporary enquiry. In fact, the Healthy Vegetarian, Healthy Mediterranean-Manner, and Salubrious U.S.-Style eating patterns promoted in the 2015 Dietary Guidelines for Americans equate to protein intakes 1.55-, 1.94-, and 1.98-fold greater than the current RDA, respectively (theoretical 19–l year old female person consuming 2000 kcal/d) [85]. If the American adult population, every bit a whole, consumed poly peptide at approximately 1.half-dozen g/kg/d, every bit advocated in a recent review from one of the more prominent laboratory groups in this field [5], this would still represent an approximate 17–19% of full energy intake, certainly reasonable based on the current AMDR for protein. Indeed, even increasing to two.five–3.0 yard/kg/d would nevertheless fall inside the 10–35% of full energy from protein suggested by the AMDR and would provide ample opportunity to optimize muscle health.
In addition to the dietary protein and skeletal muscle considerations, the protein leverage hypothesis suggests that protein under-consumption increases appetite drive in an try to ensure sufficient amino acrid intake [86]. The unfortunate effect of this response in the absence of increased protein intake is backlog free energy consumption and resultant positive energy balance. The fact that over 120 million Americans have some type of cardiovascular disease [87], over 29 million are believed to have type 2 diabetes mellitus [88], and approximately 5–7% of the young developed population meets the diagnostic criteria for metabolic syndrome [89] illustrates the need to change how we structure feeding recommendations and encourage compliance with dietary guidance. Improper application of the protein RDA in federal policy, which informs institutional feeding practices, can result in dietary protein intakes that may be sub-optimal for muscle growth and preservation and overall health. As an example, the National School Tiffin Act (Section 17(o)(1)) requires that participating programs provide "approximately one-third of the daily recommended dietary assart" [ninety]. In practise, this means that American school children are required to be provided with i-third of the minimum corporeality of dietary protein needed to prevent dysfunction, rather than one-third of the corporeality which may best back up muscle mass, growth, and wellness. Given the relative toll of protein-rich foods and concerns for toll-efficiency amongst school breakfast and lunch programme administrators [91], it is reasonable to expect that protein offerings are reflective of the minimum requirement, rather than robust provision for optimal health.
Certainly, food choices within macronutrient recommendations are critical, with a needed emphasis on nutrient-dumbo selections [92]. Similarly, we recognize the traditional clan between higher-protein diets and college meat consumption and the much-needed focus on sustainability and the potential environmental impact of our food sources. With these in mind, nosotros strongly encourage the reevaluation of macronutrient recommendations to best reverberate high quality science, basing them on experimental studies over observational data [93]. Implementing reliable macronutrient recommendations for both good for you and diseased populations at all stages of the lifecycle, which engender consumer confidence, can then be followed by greater emphasis on quality nutrient choices within those guidelines. Such action would allow for dietary protein recommendations, and resultant public health policy, all-time designed to provide for muscle accretion, quality, and preservation throughout the lifespan. A realignment of macronutrient intake recommendations with contemporary research findings would create the foundation for advances in public health.
Acknowledgments
The authors similar to thank Jillian Allen for her assistance with manuscript development.
Author Contributions
J.W.C. and South.M.P. conceptualized, wrote, reviewed, and approved this manuscript.
Funding
This enquiry received no external funding.
Conflicts of Interest
The authors declare no conflict of interest. The opinions or assertions contained herein are the private views of the authors and are not to be construed equally official or as reflecting the views of the Army or the Department of Defense. Whatsoever citations of commercial organizations and trade names in this report exercise not plant an official Department of the Army endorsement of approval of the products or services of these organizations.
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