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1 July 2020
GI News - July 2020
Posted by GI Group at 5:08 am
FOOD FOR THOUGHT
MAPPING POSTPRANDIAL RESPONSES SETS THE SCENE FOR TARGETED DIETARY ADVICE
A
new study finds that machine learning can predict differences between
people in how they respond to meals
If you are managing to stay lean in today’s obesogenic environment
(lucky you!), you might suspect that it’s your good genes and/or
disciplined adherence to a healthy diet and lifestyle. On the other
hand, if you’ve struggled with body fat and dieting for most of your
life, you live in hope there’s a specific type of diet (or perhaps
better still, a drug) that’s perfect for you… if only you could identify
which one. Enter Personalised Nutrition.
In the June issue of the prestigious journal Nature Medicine,
Sarah Berry and her colleagues took a major step in that direction.
They presented the findings of PREDICT (1), a large-scale study
involving ~1000 people, including twins and other adults from the US and
UK. Using machine learning, the goal was to use the data to derive
‘algorithms’ (mathematical formulas) that predict a person’s
postprandial (after-meal) responses, that is, the rise in glucose,
insulin and triglycerides (fats) in the blood after meals of varying
composition.
The end-game of this kind of research is
the ability to give scientifically valid ‘personalised’ dietary advice
based on factors such as age, body mass index (BMI), specific genes,
large bowel microbial flora (the “micobiome”) and postprandial
responses.
But the findings were not what they
expected. They found much more person-to-person variation than was
expected, but differences in genes, the gut microbiome and insulin
levels explained only a minor proportion of the differences.
By
contrast, they were surprised to find a person’s response to the same
foods was fairly predictable and reproducible. Food composition and
macronutrient (carbohydrate, fat and protein) distribution explained
some of the variation in post-meal blood glucose levels, but not in
triglyceride levels. And interestingly, blood glucose responses did not
predict triglyceride levels; indeed, they warned that advice based just
on glucose responses (such as flash glucose monitoring) alone would be
misleading.
From our point of view, the associations
between the carbohydrate content of meals, post-meal blood glucose
levels and other factors were among the most interesting findings. High
blood glucose levels after meals are a well-established predictor of
type 2 diabetes, the metabolic syndrome, fatty liver, and cardiovascular
disease (2).
We have known for a long time that people
vary widely in their ‘glucose tolerance’, i.e. the absolute blood
glucose response to a carbohydrate challenge. In a lean, active person,
the area under the curve (AUC) after a 50 g glucose challenge can be as
low as 50 units, but in a sedentary person with a family history of
type 2 diabetes, it can be 400 units, an 8-fold difference. Higher AUC
means the beta-cells (insulin producing) in the pancreas are working
hard. If you have a family history, your pancreas may not have what it
takes to do this without becoming dysfunctional over time.
We
know that glucose tolerance worsens (measured as higher AUC) with age,
increased body weight and sedentary lifestyle. We also know that the
background diet is important – low carbohydrate consumption is
associated with a higher glycemic response to a glucose challenge.
However, it’s reversible - just a day or so of higher carbohydrate
intake will improve glucose tolerance.
Is there an
optimal diet composition for your body? Is one diet better than another
for you but not me? Does human evolution play a role here? Yes! Many
different diets can reduce blood glucose responses on a day-to-day
basis. Indeed, we have argued that this is one of key mechanisms behind
the success of the Mediterranean diet, low GI diets, vegetarian diets
based on legumes and lower carbohydrate diets.
Logically,
reductions in blood glucose can also be achieved with carefully
planned, very-low-carbohydrate diets (50-100 g/day), with parallel
improvements in body weight and HbA1c (glycated haemoglobin) in people
with type 2 diabetes (3). However, it would be very easy to choose a
poor quality very-low-carbohydrate diet and it may be hard to sustain in
the longer-term. It may not be as effective (or as easy) as changing
the kind (quality) of carbohydrate.
For a given amount
of carbohydrate, the glycemic index of a food predicts the degree of
glycaemia relative to a standard reference food. Choosing a diet based
on low GI foods such as pasta, legumes, most fruit, milk, yogurt and
specific types of rice and bread can halve the AUC and reduce HbA1c in
individuals with diabetes. Furthermore, meta-analyses of observational
studies confirm that diets based on low GI food choices are associated
with reduced risk of type 2 diabetes (4) and cardiovascular disease (5).
The relative risk reduction is biologically significant, similar to
increasing the amount of exercise or dietary fibre.
In
our view, the potential of personalised nutritional guidance versus
standard advice (national dietary guidelines) to improve weight control
is far from proven. In many ways, the findings of PREDICT are important
because they challenge so much of the prevailing hype.
REFERENCES:
- Berry S, and colleagues. Decoding human postprandial responses to food and their potential for precision nutrition: the PREDICT 1 study.
- The DECODE group. European Diabetes Epidemiology Group. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria.
- Wycherley TP, and colleagues. Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials.
- Livesey G, and colleagues. Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes: A Systematic Review and Updated Meta-Analyses of Prospective Cohort Studies.
- Livesey G, and colleagues. Coronary Heart Disease and Dietary Carbohydrate, Glycemic Index, and Glycemic Load: Dose-Response Meta-analyses of Prospective Cohort Studies.
Professor Jennie Brand-Miller holds a Personal Chair in Human Nutrition in the Charles Perkins Centre and the School of Life and Environmental Sciences, at the University of Sydney. She is recognised around the world for her work on carbohydrates and the glycemic index (or GI) of foods, with over 300 scientific publications. Her books about the glycemic index have been bestsellers and made the GI a household word.
Posted by GI Group at 5:07 am
WHAT’S NEW?
IS ONE WEIGHT LOSS DIET MORE EFFECTIVE THAN OTHERS?
If
you’re trying to lose weight, there’s no shortage of ‘diets’ and weight
loss programs promising impressive results. But is there really one
type of diet that is more effective than others?
A new study published in the April edition of the
British Medical Journal (BMJ) set out to answer this question. The
researchers conducted a systematic review and meta-analysis looking at
the effect of different dietary macronutrient patterns and popular diet
programs on weight loss and improvement of cardiovascular risk factors
in overweight adults. They included 121 randomised controlled trials
involving almost 22 000 subjects. The diets included low fat, low
carbohydrate and popular named diets such as Atkins, Zone, DASH (Dietary
Approaches for Stopping Hypertension) and Ornish.
When
they compared these diets to usual or control diets, low fat (such as
Ornish), low carbohydrate (such as Atkins and Zone) and moderate
macronutrient diets (such as DASH and Mediterranean) all resulted in
moderate weight loss at 6 months but not 12 months. The average weight
loss at 12 months was 2kgs and any differences between the diets are
described as being trivial to small.
At six months,
each of these diets also reduced blood pressure and the low fat and
moderate macronutrient diets reduced levels of ‘bad’ LDL cholesterol.
However, these improvements almost disappeared by 12 months.
The
authors conclude that people wanting to make dietary changes to lose
weight should choose the diet they prefer. This is an important point.
For example, an older study comparing four different diets with
different macronutrient ratios (Atkins, Ornish, Zone and Weight
Watchers) found that weight loss was similar on all four diets and what
predicted success was cutting kilojoules and being able to stick to the
diet.
This new study, and previous research comparing
different diets for weight loss, show us that there are different ways
to achieve the same result – it’s not one size fits all. The key is to
find an eating plan you can adopt for the long-term as this is the only
way to lose weight and keep it off.
Read more:
- Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials.
- Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial.
Kate Marsh is an is an Advanced Accredited Practising Dietitian, Credentialled Diabetes Educator and health and medical writer with a particular interest in plant-based eating and the dietary management of diabetes and polycystic ovary syndrome (PCOS).
Contact: Via her website www.drkatemarsh.com.au.
Posted by GI Group at 5:06 am
PERSPECTIVES: Dr ALAN BARCLAY
PUBLIC HEALTH NUTRITION COMPARED TO PERSONALISED DIETARY ADVICE
Diet-related
health conditions like obesity, type 2 diabetes, heart disease and
certain cancers (e.g., bowel) are increasing all around the globe and
governments are struggling to cope with their economic costs as are
individuals with their social, psychological and financial costs.
Strategies
for reducing their burden range from public health nutrition at one end
of the intervention spectrum, using a systems approach to sustainably
re-shape the food and nutrition supply, and at the other, there is
personalized dietary advice ideally provided by suitably qualified
health professionals like dietitians and nutritionists. While the two
are not mutually exclusive, they often do play complimentary roles.
Public Health Nutrition
The
epitome of public health nutrition is the federal government’s Dietary
Guidelines that provide advisory statements for the general population
(i.e., healthy children, adolescents and adults). They are very similar
around the globe. Australia’s most recent version published in 2013
advises people to:
- Be physically active and choose amounts of nutritious food and drinks to meet energy needs.
- Drink plenty of water and enjoy a wide variety of nutritious foods from the five food groups every day:
- plenty of vegetables, including different types and colours, and legumes/beans
- fruit
- grain (cereal) foods, mostly wholegrain and/or high fibre varieties, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley
- lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans
- milk, yoghurt, cheese and/or their alternatives, mostly reduced fat (reduced fat milks are not suitable for children under the age of 2 years). - Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.
- Encourage, support and promote breastfeeding.
- Care for your food; prepare and store it safely.
The Guidelines stated aims are to:
- promote health and wellbeing;
- reduce the risk of diet-related conditions, such as high cholesterol, high blood pressure and obesity; and
- reduce the risk of chronic diseases such as type 2 diabetes, cardiovascular disease and some types of cancers.
In theory, Dietary Guidelines apply to all healthy people, as well as those with common health conditions such as being overweight. However, they do not apply to people who need special dietary advice for a medical condition like diabetes or heart disease, or to the frail elderly.
In some countries like the USA, they are updated every 5 years and as such they are based on the most recent and best available scientific evidence. Unfortunately, in others, like Australia, they are not updated on a regular basis and may be scientifically outdated.
Personalised dietary advice
Ideally, people with specific diet-related health conditions like obesity, type 2 diabetes, heart disease, cancer, etc… will see a registered/accredited dietitian or nutritionist for personalised dietary advice.
A dietitian/nutritionist assesses your:
- vital statistics (height, weight, waist circumference, etc…),
- biochemistry (blood glucose, insulin, blood proteins, iron status, etc..) and
- eating and drinking habits (diet recall, food frequency, etc…),
Based on this, they will then work out what area of your diet needs improvement, if any, and what changes can be made based on your own:
- personal goals (weight loss, weight gain, blood glucose, pressure, cholesterol, etc…),
- food preferences,
- family situation,
- cultural background, and
- finances.
Shopping lists, information sheets and other written materials (e.g., booklets) may also be provided, depending on your own personal needs.
Follow-up appointments cover how well you are feeling and how you are managing with your dietary changes, assessment of your vital statistics and biochemistry, and general progress towards your goals, trouble‑shooting and further refinement of your personalised eating plan.
It is easy to see that public health nutrition epitomised by Dietary Guidelines is by necessity very different from personalised nutrition advise provided by a qualified health professional. Unfortunately, sometimes debates about what constitutes a healthy diet get heated and the two are conflated, with some fad diet advocates erroneously believing that dietitians/nutritionists simply advise everyone regardless of their personal circumstances to follow the latest version of the Dietary Guidelines. The reality is that both public health nutrition and personalised dietary advice can help people purchase healthy, affordable foods to ensure they enjoy a sustainable diet that will help them achieve optimal health, whatever their circumstances.
Read more:
Alan Barclay, PhD is a consultant dietitian and chef (Cert III). He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).
Contact: You can follow him on Twitter, LinkedIn or check out his website.
Posted by GI Group at 5:05 am
DIABETES CARE
INDIVIDUALS FASTING BLOOD GLUCOSE AND INSULIN ARE STRONG PREDICTORS
OF THE WEIGHT LOSS RESPONSE TO DIETS WITH DIFFERENT MACRONUTRIENT
COMPOSITION IN A LONG-TERM STUDY
Efforts to identify a single optimal diet for the treatment of overweight and obesity have so far failed.
Overall, the body of scientific evidence from
randomised controlled trials (RCTs) indicate that in order to lose
weight, individuals need to consume less energy (kilojoules/calories)
than they are expending through their physical activities and basal
metabolic rate. Dietary energy can come from a range of different diets
with varying macronutrient contents. The macronutrients are
carbohydrate, fat, protein and arguably alcohol (although not officially
a macronutrient, for some people it is a significant source of energy).
One size does not fit all, and the best diet for most people is the one
that they can stick to (the one that suits their cultural, religious,
familial and personal food preferences, and budget) in the long run.
Due
to the high cost of conducting RCTs, most are short-term (conducted
over a period of 3-6 months) and few are long-term studies (at least 2
years). Short-term studies often do suggest that one dietary pattern is
superior to another, but these results rarely hold true after 12 months
in the rare instances that they last that long, and differences usually
completely disappear by 2 years as people develop diet fatigue and are
no longer able to maintain the disruptions to their family, religious
and social lives.
Because they are rare, when a
well-designed long-term RCT is conducted, we should pay attention to the
results. Back in 2010, a group of American scientists randomised around
300 people to one of two diets and followed them up for 2 years:
- One of the diets was low-carbohydrate, which consisted of limited carbohydrate intake (20 g per day for 3 months) in the form of low–glycemic index vegetables with unrestricted consumption of fat and protein. After 3 months, people in the low-carbohydrate diet group increased their carbohydrate intake (5 g per day per week) until a stable and desired weight was achieved.
- The other was a reduced energy (1200 to 1800 calories (5000 to 7500 kJ) per day) low-fat diet that provided no more than 30% of calories from fat.
However, a group of Danish scientists worked with the original American scientists last year, re-analysing the study data according to whether the people in the study had prediabetes (blood glucose between 5.6-6.9 mmol/L) or high fasting blood insulin. After 2 years, participants with prediabetes and high fasting insulin lost 7.2 kg more with the low-fat compared to the low-carbohydrate diet, whereas those with prediabetes and low fasting insulin tended to lose 6.2 kg more on the low-carbohydrate diet than low-fat diet.
This new analysis of a well-designed long-term randomised controlled trial helps explain why there is not one single optimal diet for the treatment of overweight and obesity. Tailor-making dietary advice to suit the specific needs of individuals is the direction we need to be heading in.
Read more:
- Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet: A Randomized Trial.
- Personalized nutrition: pre-treatment glucose metabolism determines individual long-term weight loss responsiveness in individuals with obesity on low-carbohydrate versus low-fat diet.
Alan Barclay, PhD is a consultant dietitian and chef (Cert III). He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).
Contact: You can follow him on Twitter, LinkedIn or check out his website.
Posted by GI Group at 5:04 am 3 comments
YOUR GI SHOPPING GUIDE
WHICH STARCHY SNACK FOODS?
Spending more time
at home means easier access to food, especially unplanned extras, like
snacks. Ideally snacks are chosen from core foods - things like a piece
of fruit, a handful of nuts, a hard-boiled egg or a slice of wholegrain
bread - and make a valuable nutrient contribution to our diet. More
popular options like crispy, crunchy crisps and cookies don’t give us
much except starchy carbohydrate that add to the glycemic load of the
diet. Here we’ve taken a look at how the GI and GL of starchy snack
foods compares.
Popcorn (commercial microwave popcorn)
GI 51-67
Serving: 1 small bag (25g/1oz)
Potato chips/crisps
GI 51-60
Serving: 1 single serve bag (50g/1 ¾oz)
Flavoured extruded crispy packaged snack
GI 74-90
Serving: 1 single serve bag (50g/1 ¾oz)
Wholegrain rye crackers
GI 59-74
Serving: 2 large crackers (20g/ ¾oz)
Plain crackers - white flour based, e.g., Soda cracker or Sao
GI 63-78
Serving: 3 large, or 6 small crackers (20g/ ¾oz)
Puffed Rice cake
GI 82-91
Serving: 3 thick or 5 thin rice cakes (30g/1oz)
Oatmeal biscuit or cookie
GI 45-55
Serving: 2 cookies (20g/3/4 oz)
Read more:
Kaye Foster-Powell is an Accredited Practising Dietitian who has worked with people with diabetes for 30 years. She was co-author of the original series of international, best-selling books on the glycemic index. She conducts a specialized private practice for people with diabetes in the Blue Mountains, west of Sydney, Australia.
Contact: Via her website.
Posted by GI Group at 5:03 am
GOOD CARBS FOOD FACTS
CITRUS
I know its winter because the citrus trees in my
neighbourhood are laden with fruit. The citrus fruit family has
something for everyone, whether it be the sweet and juicy orange, the
cute and easy to peel mandarin, the gorgeously fragrant lime, the cook’s
favourite lemon or bittersweet grapefruit. Then there are the more
exotic citrus fruits such as the gigantic pomello (aptly named citrus
maxima), the oh-so-hip Japanese yuzu or the gorgeous pot plant and
preserve favourite, cumquat. There really is a citrus fruit for
everybody but the whole citrus family shares the qualities of intensely
exhilarating refreshment and beautifully bright colours.
Citrus is famous for its fresh zing, both in your mouth and in
the air around you when you peel them. For cooks, their sour astringency
makes them ideal to partner with creamy or fatty foods as they ‘slice
through’ the richness for an altogether more satisfying taste sensation.
This is used to great effect in Asian savoury dishes, in the famous
French dish duck a l’orange and my grandma’s specialty lemon butter (or
lemon curd). Citrus zest packs amazing flavour. Use a microplane or
zester and add zest to baking, sauces and anything with a citrus
ingredient to turn up the citrus flavour volume to the max. The sourer
the citrus, the better they balance with sweetness, so lemon and lime
cakes taste divine and lemon curd is sunshine and happiness on a spoon.
Citrus
are also perfect for juicing but limit to small amounts and eat mostly
whole fruit to preserve all their nutritional goodness and fibre. If you
only drink citrus you juice yourself this puts a natural brake on your
intake. And once you’ve experienced the joy of freshly squeezed, it’s
hard to go back.
Citrus fruits are a powerhouse of
nutrition. They are perhaps best known for their vitamin C content,
however this is only part of their good news story. They are packed with
natural phytochemicals with a laundry list of health benefits including
antioxidant, anti-inflammatory and anti-cancer properties. All this and
they are also low GI.
Source: AusFoods, 2019
Nicole Senior is an Accredited Practising
Dietitian, author, consultant, cook and food enthusiast who strives to
make sense of nutrition science and delights in making healthy food
delicious.
Contact: You can follow her on Twitter, Facebook, Pinterest, Instagram or check out her website.
Posted by GI Group at 5:02 am
THE GOOD CARBS KITCHEN
QUICK CHICKEN and VEGETABLE SOUP WITH GREMOLATA
0:20 Prep • 4 Serves • Main • Every day
INGREDIENTS
1 tablespoon olive oil
1 leek, chopped
2 x 400g packets fresh pre-chopped soup vegetables
5 cups reduced-salt chicken stock
2 cups shredded or chopped BBQ chicken
4 small slices rye bread, toasted, to serve
Gremolata
¼ cup chopped flat-leaf parsley
2 tablespoons lemon thyme leaves
1 garlic clove, crushed
3 tablespoons fresh grated Parmesan
METHOD
Place
the olive oil in a large, heavy-based pan on medium-high heat. Add the
chopped leek; sauté for 2–3 minutes, or until just softening. Add
vegetables; cook, stirring for 1–2 minutes.
Add stock
to pan and bring the mixture to the boil. Cover, reduce the heat and
simmer for10 minutes. Add chicken, stir to heat through. Add an
additional ½–1 cup of water, if the soup needs more liquid. Season with
cracked black pepper.
Meanwhile, make gremolata: Combine all the ingredients in a small bowl. Season and mix well.
Divide soup between serving bowls. Top with gremolata and serve with rye toast.
NUTRITION
Per serve
1691kJ/405 calories; 34g protein; 14.6g fat (includes 4.8g saturated
fat; saturated : unsaturated fat ratio 0.5); 28g available carbs
(includes 9g sugars and 19g starch); 11.5g fibre; 414mg sodium
RECIPE AND IMAGE
Courtesy of Australian Healthy Food Guide magazine.
For more healthy recipe inspiration and expert advice, visit healthyfoodguide.com.au
WOOD EAR MUSHROOM and ENOKI MUSHROOMS SALAD
0:15 Prep • 0:08 Cook • 4 Servings • Entrée • Vegetarian
INGREDIENTS
½ cup dried wood ear mushrooms
1 cup celery
1 cup enoki mushroom
4 cups water
1 tablespoon soy sauce (salt-reduced or dark soy sauce is preferred)
2 tablespoons Chinese black vinegar
1 teaspoon sesame oil
1 teaspoon ginger
2 teaspoons white sesame seeds (optional)
Oil for cooking (2-3 tablespoons)
METHOD
Preparation
Gently
rinse the wood ear mushrooms with tap water. Soak with 2 cups of warm
water in a big bowl. Rehydrate for 30 minutes or until tender. Prepare
the celery by chopping it into small pieces. Remove tough ends of wood
ear mushrooms, then chop into bite-sized pieces. Grate the ginger.
Cooking
Add
the water to a pot, and then add the wood ear mushrooms and enoki
mushrooms to it. Brining the water to a simmer. Transfer the mushrooms
to the dish, and combine with the celery, soy sauce, Chinese black
vinegar, ginger, and sesame oil.
Top with white sesame seeds (optional) and serve.
TIPS
• For a nut-free and gluten-free dish, use gluten-free soy sauce.
DO YOU KNOW?
Dark soy sauce is less salty than the regular soy sauce. Dark soy sauce
is darker, thicker and sweeter due to added molasses. It is often used
for seasoning and dipping. You can use dark soy sauce to replace regular
soy sauce in stir-fries, stews and casseroles.
NUTRITION
Per serve
Energy: 152kJ/36 Calories; 1.8g protein; 2.1g fat (includes 0.3g
saturated fat; saturated : unsaturated fat ratio 0.2); 1g available
carbs (includes 0.5g sugars and 0.5g starches); 1.2g fibre; 227mg
sodium; 252mg potassium; sodium : potassium ratio 0.9.
RECIPE
Shannon Shanshan Lin is an is an Accredited Practising
Dietitian and Credentialled Diabetes Educator with a particular research
interest in culturally and linguistically and indigenous populations.
She has been actively involved in the various committees both national
and internationally, including the Australian Diabetes Educators
Association, Global Chinese Diabetes Association and Beijing Key
Laboratory of Nutrition Intervention for Chronic Disease.
Contact: You can follow her on.
Posted by GI Group at 5:01 am
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Nutritional analysis To analyse Australian foods, beverages, processed products and recipes, we use FoodWorks which contains the AusNut and Nuttab databases. If necessary, this is supplemented with data from www.calorieking.com.au or http://ndb.nal.usda.gov/ndb/search.
Disclaimer GI News endeavours to check the veracity of news stories cited in this free e-newsletter by referring to the primary source, but cannot be held responsible for inaccuracies in the articles so published. GI News provides links to other World Wide Web sites as a convenience to users, but cannot be held responsible for the content or availability of these sites. All recipes that are included within GI News have been analysed however they have not been tested for their glycemic index properties by an accredited laboratory according to the ISO standards.
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Posted by GI Group at 5:00 am