A Mediterranean-Style Diet Improves the Parameters for the Management and Prevention of Type 2 Diabetes Mellitus.

Background and Objectives: Type 2 diabetes mellitus (T2DM) is a chronic condition recognized as the inability to maintain glucose homeostasis, typically presenting with insulin resistance and systemic inflammation. With the prevalence of T2DM and major risk factors, such as prediabetes and obesity, increasing each year, the need to address risk factor reduction strategies is crucial. Materials and Methods: Twenty-two men and women, overweight-to-obese adults (BMI mean: 26.1-31.6) (age range mean: 44.6-51.8) with T2DM, indicators of prediabetes, or who were metabolically healthy, participated in Cal Poly's Nutrition and Exercise in Type 2 Diabetes (CPNET) study. There were no significant differences in terms of age, BMI, or sex distribution among the groups at the baseline. This study's protocol included following a Mediterranean-style diet, the daily consumption of a high-quality whey protein supplement, and physical activity recommendations for 16 weeks. Body composition data, via dual-energy X-ray absorptiometry (DXA), and fasting blood samples were collected at the baseline and following the intervention. Due to restrictions associated with the outbreak of the COVID-19 pandemic, only 13 of the 22 participants who started this study were able to return for the second data collection to complete this study following the 16-week intervention. Results: The prediabetic and T2DM groups exhibited reductions in their fasting plasma glucose (12.0 mg/dL reduction in the prediabetic group; 19.6 mg/dL reduction in the T2DM group) to that of normal and prediabetic levels, respectively, while the T2DM group also demonstrated improvement in their hemoglobin A1c (reduced from 6.8% to 6.0%) to prediabetic levels. Additionally, the metabolically healthy, overweight group exhibited significant improvements in adiposity, while the obese prediabetic and T2DM groups showed non-significant improvements in all the measured metrics of body composition. No significant changes were observed in the inflammatory biomarkers (p-values ranged from 0.395 to 0.877). Conclusions: Collectively, our results suggest that adherence to a well-balanced, nutritious diet and activity may improve the parameters of glycemic control and provide benefits to body composition that help to manage and prevent the development of T2DM. Our study was able to yield significant findings signifying that the effects of a Mediterranean-style diet are observed even for a more conservative sample size.

Protein Intake in NCAA Division 1 Soccer Players: Assessment of Daily Amounts, Distribution Patterns, and Leucine Levels as a Quality Indicator.

Dietary protein is required to support recovery and adaptation following exercise training. While prior research demonstrates that many athletes meet total daily protein needs, intake seems to be predominantly skewed toward the evening meal. An even distribution of protein doses of ≥0.24 g/kg BW consumed throughout the course of a day is theorized to confer greater skeletal muscle anabolism outcomes compared to a skewed pattern of intake. Protein quality is also an important dietary consideration for athletes, with the amino acid leucine seemingly serving as the primary driver of the postprandial anabolic response. The present study investigates protein consumption characteristics among a cohort of NCAA D1 soccer players and evaluates differences between male and female athletes. Athletes were instructed to complete 3-day food diaries, which were subsequently analyzed and compared to UEFA expert group-issued nutrition guidelines for soccer players. Breakfast, lunch, and dinner accounted for 81.4% of the total daily dietary protein intake. Most athletes (77.8%) ingested optimum amounts of protein at dinner but not at breakfast (11.1%) or lunch (47.2%). In addition, statistically significant sex-based differences in daily dietary protein intake, meal-specific protein amounts, and protein quality measures were detected. Findings indicate suboptimal dietary protein intake practices among the collegiate soccer athletes.

Capacity Strengthening Undertaking-Farm Organized Response of Workers against Risk for Diabetes: (C.S.U.-F.O.R.W.A.R.D. with Cal Poly)-A Concept Approach to Tackling Diabetes in Vulnerable and Underserved Farmworkers in California.

In our project herein, we use the case of farmworkers, an underserved and understudied population at high risk for Type-2 Diabetes Mellitus (T2DM), as a paradigm of an integrated action-oriented research, education and extension approach involving the development of long-term equitable strategies providing empowerment and tailored-made solutions that support practical decision-making aiming to reduce risk of T2DM and ensuing cardiovascular disease (CVD). A Technology-based Empowerment Didactic module (TEDm) and an Informed Decision-Making enhancer (IDMe) coupled in a smart application (app) for farmworkers aiming to teach, set goals, monitor, and support in terms of nutrition, hydration, physical activity, sleep, and circadian rhythm towards lowering T2DM risk, is to be developed and implemented considering the particular characteristics of the population and setting. In parallel, anthropometric, biochemical, and clinical assessments will be utilized to monitor risk parameters for T2DM and compliance to dietary and wellness plans. The app incorporating anthropometric/clinical/biochemical parameters, dietary/lifestyle behavior, and extent of goal achievement can be continuously refined and improved through machine learning and re-programming. The app can function as a programmable tool constantly learning, adapting, and tailoring its services to user needs helping optimization of practical informed decision-making towards mitigating disease symptoms and associated risk factors. This work can benefit apart from the direct beneficiaries being farmworkers, the stakeholders who will be gaining a healthier, more vibrant workforce, and in turn the local communities.

The Risk of T2DM in College Women: The Predictive Power of Financial versus Residential Status in a Cross-Sectional Pilot Study in Turkey.

Aim: This study aimed to investigate the relationships between dietary habits, income levels and type 2 diabetes mellitus (T2DM) risk in Turkish female university students who are living with their family or in the dormitory. Materials and Methods: This work was a cross-sectional pilot study conducted during December 2016-January 2017 in Istanbul Yeni Yuzyil University. A survey was administered to 100 female students, 60 living with their family and 40 in dormitories. Income level was determined based on TURKSTAT 2015 percentiles. T2DM risk was determined using the Finnish Diabetes Association Type 2 Diabetes Risk Assessment Form (FINDRISC). Food frequency questionnaire and 24 h dietary recall results were analyzed by the diet analysis software Beslenme Bilgi Sistemi (BeBiS), specially developed for Turkey. Results: Results indicated inadequacies and imbalanced nutrition among female college students overall. Notably, there was a statistically significant higher diet quality for the students living with their families compared to those living in dormitories. Income level was consistently positively associated with better nutritional outcomes, while negatively associated with T2DM risk, but interestingly, only in the case of students living in the dormitory and not for those living with family. Conclusions: Our findings indicated that financial status, rather than living in the dormitory versus with family, is positively associated with increased T2DM risk as assessed via FINDRISC among Turkish female college students. This study's results indicate a potential need for educational programs and nutritional support for students, particularly those living away from family.

Assessing Dietary Nutrient Adequacy and the Effect of Season-Long Training on Body Composition and Metabolic Rate in Collegiate Male Basketball Players.

The success of performance in basketball relies on both optimal body composition and nutrient intake. The purpose of this study was to examine seasonal changes in body composition (BC), resting metabolic rate (RMR) and respiratory quotient (RQ), as well as dietary intake of National Collegiate Athletic Association (NCAA) Division I (DI) male basketball players. BC, RMR and RQ were assessed during pre-season, in-season, and post-season (September, December, and March) while dietary assessment data were collected in September and February. Results of this study indicated that players received inadequate energy (p < 0.0001), protein (p < 0.001) and carbohydrate (p < 0.0001) relative to the recommendations for exercising individuals during the September baseline period. However, following diet analysis and consultations and relative to recommendations, athletes received adequate amounts of energy and protein during follow-up, yet intakes of carbohydrate (p = 0.0025) were still significantly different than recommended. Results also indicated that there was a decrease in percent body fat (%BF) during season, an increase in lean body mass (LBM) from pre- to post-season, a peak in RMR during season and an increase in RQ post-season. These findings reveal that significant metabolic and body composition changes occur in players over the season and suggest that nutritional strategies employed concomitantly may be beneficial.

High-Fructose, High-Fat Diet Alters Muscle Composition and Fuel Utilization in a Juvenile Iberian Pig Model of Non-Alcoholic Fatty Liver Disease.

Non-alcoholic fatty liver disease (NAFLD) is a serious metabolic condition affecting millions of people worldwide. A "Western-style diet" has been shown to induce pediatric NAFLD with the potential disruption of skeletal muscle composition and metabolism. To determine the in vivo effect of a "Western-style diet" on pediatric skeletal muscle fiber type and fuel utilization, 28 juvenile Iberian pigs were fed either a control diet (CON) or a high-fructose, high-fat diet (HFF), with or without probiotic supplementation, for 10 weeks. The HFF diets increased the total triacylglycerol content of muscle tissue but decreased intramyocellular lipid (IMCL) content and the number of type I (slow oxidative) muscle fibers. HFF diets induced autophagy as assessed by LC3I and LC3II, and inflammation, as assessed by IL-1α. No differences in body composition were observed, and there was no change in insulin sensitivity, but HFF diets increased several plasma acylcarnitines and decreased expression of lipid oxidation regulators PGC1α and CPT1, suggesting disruption of skeletal muscle metabolism. Our results show that an HFF diet fed to juvenile Iberian pigs produces a less oxidative skeletal muscle phenotype, similar to a detraining effect, and reduces the capacity to use lipid as fuel, even in the absence of insulin resistance and obesity.

Comparison of Whey Versus Almond Protein Powder on Nitrogen Balance in Female College Students; The California Almond Protein Powder Project (CAlmond-P3).

Plant-based diets have become increasingly popular in the past decade, with approximately 11% of Americans self-identifying as vegan or vegetarian and many others trying to reduce meat consumption. Due to increasing interest, the plant-based food market has significantly expanded, with several innovative products serving as alternatives to animal-based products. One such example is almond protein powder, a new protein supplement created as an alternative to whey protein. Due to the novelty of almond protein products, little is known regarding how well the protein supplement supports nitrogen metabolism. The effects of both an almond-based protein beverage and a whey-based protein beverage on nitrogen balance are investigated in the work presented herein. Twenty female college students aged 20-25 years were randomly assigned to consume either an almond- or whey-based protein drink twice daily for one week; 24-h urine collection was performed at the baseline and endpoint of the 7-day treatment period and nitrogen balance was assessed. Body composition and hydration status were also assessed. Both protein sources (almond and whey) were able to notably improve nitrogen balance, thus indicating that almond protein powder may be a functional plant-based alternative to whey protein powder and may be of interest in future research regarding muscle mass and body composition improvement.

Technological Devices and Their Effect on Preschool Children's Eating Habits in Communities of Mixed Socioeconomic Status in Istanbul; a Pilot Cross-Sectional Study.

The use of technological devices is increasing in all age groups, especially in preschool-aged children. However, there is a limiting number of studies investigating the relationship between the use of technological devices, eating behavior, and weight status in preschool children. The aim of this study was (1) to describe total usage of technological devices, (2) to evaluate level of exclusive use of such devices by children, (3) to investigate children's eating behaviors and diet in relation to screen time and type. A cross-sectional study was conducted with 104 children aged 2-5 years in Küçükçekmece and Bakirköy, Istanbul. Data collection consisted of a validated parental questionnaire on demographics and the child's use of technology and eating behavior, while associations in children were examined using logistic regression analysis. The analysis of the obtained data uncovered a strong association between children's TV and tablet/smart phone use and the foods consumed by children when using these devices (p = 0.0001; p = 0.012). Also, there was a significant association between children's eating habits and TV, and tablet/smart phone durations of use (p = 0.015; p = 0.025), but not with computer duration of use (p > 0.05). Obesity and associated health problems can arise as results of suboptimal eating behavior, such as the ones observed in our study, which are also intensified with an increased duration of use of technological devices. The attitude of families towards prudent use of technological equipment is of great importance in impacting present and future health.

Effects of Dietary Red Raspberry Consumption on Pre-Diabetes and Type 2 Diabetes Mellitus Parameters.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition characterized by glucose clearance abnormalities and insufficient insulin response. Left uncontrolled, T2DM can result in serious complications and death. With no cure available currently and the prevalence of major risk factors such as pre-diabetes and the metabolic syndrome continuously increasing, there is an urgent need for effective treatments with limited or no side effects. Red raspberries (RR) contain various phytonutrients with potential for modulating insulin function, glucose, and lipid metabolism. The objective of this literature review was to investigate the potential metabolic benefits of dietary RR in individuals with T2DM and pre-diabetes. A search of major scientific databases was employed to identify peer-reviewed, in vivo, or human studies that utilized whole RR or its functional constituents as treatment. The studies examined provide evidence that RR may offer clinically beneficial effects for the prevention and management of chronic diseases through improvements in glucose handling and insulin sensitivity, adiposity, lipid profiles, ectopic lipid accumulation, inflammation, oxidative stress, and cardiac health. More human trials and in vivo studies are needed to confirm the benefits of dietary RR in T2DM and pre-diabetes and to explore the dose-dependent relationships, optimal duration, and treatment modality.

Traditional Societal Practices Can Avert Poor Dietary Habits and Reduce Obesity Risk in Preschool Children of Mothers with Low Socioeconomic Status and Unemployment.

Healthy nutritional habits are of vital importance for good health and quality of life for all individuals in all life stages. Nutritional habits shaped in early childhood set the foundation for future dietary practices applied through lifespan, hence informing risk towards chronic diseases. A key contributor to child health is maternal impact. A healthy childhood status translates into increased lifespan, health, and life-quality, as well as better family and social interactions and improved academic performance. These conditions can contribute to a healthier and more vibrant workforce, and thus extend positive impact on the economic and overall development of a country. Evidence related to maternal impact on childhood dietary habits is limited in Turkey, an emerging economy with notable disparities and a significant segment (approximately one third) of its 83 million population under the age of 30. Hence, the aim of this study was to investigate the relationship between the socioeconomic status (SES) of mothers on the dietary habits of their preschool children. A pilot cross-sectional observational study was conducted involving the mothers of 109 preschool children aged 4-6 years. Data on the nutritional status of children were collected through a food frequency questionnaire and a 24-h recall interview, while sociodemographic information was also collected, and statistical analyses conducted. An unexpected finding regarding the lack of association between the socioeconomic and employment status of mothers and the nutritional intakes of their children was observed. Interestingly, it appears that more traditional societal and nutritional practices typically undertaken in the case of lower SES, especially in more traditional settings like the case of Turkey, appear to extend a protective effect as per the nutritional habits and ensuing obesity risk in the case of children of women with lower SES. Another way to interpret our finding is that the difference in education and SES is not adequate to produce a significant effect in terms of children dietary intake. This is an interesting finding that warrants further study. Additionally, such studies serve to increase awareness about the importance of healthy nutritional practices in preschool children and the critical role of the mother on their nutritional status, particularly in the Turkish idiosyncratic setting.

Organic Winemaking and Its Subsets; Biodynamic, Natural, and Clean Wine in California.

From the ancient times, when wine/oenos was described as "Wine, the benevolent demon" by ancient Greek gastronomist and philosopher Athinaios in "Dipnosofistes", to modern days, the craft has seen significant fruition. The wine industry has evolved over time, and more so recently, to encompass many different subsets, one of which is the organic wine market. The organic wine industry has grown in recent years, especially in California. This rapid gain in interest has resulted in the evolution of several subsets, including biodynamic, natural, and clean wine. While biodynamic and natural wine, function more as a fulfillment of niche markets, clean wine may provide benefits for consumers that otherwise suffer from side effects of wine consumption. Low sulfite levels and lack of histamines in clean wine plausibly decrease headaches and adverse effects some consumers experience when drinking wine. An overview of the organic wine industry and its evolution with potential contributions to consumers, with an emphasis on clean wine, is discussed herein.

Non-Alcoholic Beverages, Old and Novel, and Their Potential Effects on Human Health, with a Focus on Hydration and Cardiometabolic Health.

The Beverage Guidance System has established dietary recommendations for daily intake of commonly consumed beverages including water, tea, coffee, milk, non-calorically sweetened beverages, and calorically sweetened beverages. As obesity in America continues to be a growing problem, this guidance becomes of increasing importance due to many beverages' potential links to Type 2 Diabetes Mellitus (T2DM), Cardiovascular disease (CVD), and numerous other harmful health effects. However, the growing popularity of "better for you" beverages is causing a shift in the market, with consumers pushing for healthier beverage alternatives. Beverages simultaneously present advantages while posing concerns that need to be evaluated and considered. In this review, health effects of nonalcoholic beverages are discussed including various aspects of consumption and current trends of the beverage market such as the novel Soft Seltzer category as an alternative to Hard Seltzer and various mashups. A variety of advisory boards and agencies responsible for dietary guidelines in various countries suggest drinking water as the preferred practice for hydration.

Utilization of Hydroxyl-Methyl Butyrate, Leucine, Glutamine and Arginine Supplementation in Nutritional Management of Sarcopenia-Implications and Clinical Considerations for Type 2 Diabetes Mellitus Risk Modulation.

While onset characteristics may vary, sarcopenia gradually develops over time as a result of the aging process, leading to muscle loss, disturbance of the muscle to fat ratio, and a variety of negative symptoms undermining the wellbeing, quality of life, and lifespan in the aging population globally. There is evidence that sarcopenia may be a cause and consequence of type 2 diabetes mellitus (T2DM) in the aging population. The importance of nutritional management in the prevention and/or deceleration of sarcopenia is critical, with the main focus placed on the amount and quality of protein intake. Significant efforts are being made towards the development of medical nutrition therapies involving certain amino acids and amino compounds, as well as their combinations, for the improvement in muscle strength, muscle function and protein synthesis. This may reduce hospitalization times and hasten the recovery of patients with sarcopenia. The administration of protocols with varying dose and frequencies, as well as their efficacy, is being investigated. In the work herein, we present and evaluate data derived from human trials regarding the utilization of hydroxyl-methyl butyrate (HMB), L-leucine (Leu), L-glutamine (Gln) and L-arginine (Arg) supplementation for optimal management of sarcopenia in geriatric patients, a topic of significant clinical nutrition interest which may have important implications in T2DM status.

The Gut Microbiome and Type 2 Diabetes Mellitus: Discussing a Complex Relationship.

Type 2 diabetes mellitus (T2DM) is a disease that affects over 9% of the United States population and is closely linked to obesity. While obesity was once thought to stem from a sedentary lifestyle and diets high in fat, recent evidence supports the idea that there is more complexity pertinent to the issue. The human gut microbiome has recently been the focus in terms of influencing disease onset. Evidence has shown that the microbiome may be more closely related to T2DM than what was originally thought. High fat diets typically result in poor microbiome heath, which then shifts the gut into a state of dysbiosis. Dysbiosis can then lead to metabolic deregulation, including increased insulin resistance and inflammation, two key factors in the development of T2DM. The purpose of this review is to discuss how microbiome relates to T2DM onset, especially considering obesity, insulin resistance, and inflammation.

The Effect of Eating Habits' Quality on Scholastic Performance in Turkish Adolescents.

Evidence associates scholastic performance to quality of eating habits. However, there is limited information on this topic in Turkey, an emerging economy with notable disparities. Our work aimed to evaluate the effect of eating habits quality of high-school students in Turkey, on the Scholastic Aptitude Standardized Examination (TEOG) scores. The study was conducted in 29 different cities in Turkey during the academic year 2016-2017, involving students of ages 14-17 years (up to senior-high school). A dietary habits survey developed and validated for this population was distributed over the internet in February 2017. Apart from students' TEOG scores, Family Affluence Score (FAS) was used to categorize the students into low, medium, and high financial standing. Eating Habits Score (EHS) was calculated by using a validated scoring system. A working sample of 298 participants was used. Based on our results, we observed that there is a significant positive correlation between EHS, FAS and success rate of students as assessed by TEOG scores. Further research on this subject should be conducted in combination with intervention studies to reveal potential strategies and policies that would enhance positive behavior change as it relates to nutritional habits, aiming at improved scholastic performance and overall health throughout lifespan.

From Food for Survival to Food for Personalized Optimal Health: A Historical Perspective of How Food and Nutrition Gave Rise to Nutrigenomics.

Human nutrition has progressed impressively from the hunter-gatherer mode to that of promising personalized nutrition for health optimization through advanced and sophisticated omics technologies. The contemporary major diseases, while having strong genetic components, do not conform to Mendelian genetics; hence, their expression/manifestation is not controlled by a single gene. Noncommunicable diseases such as obesity, cancer, type 2 diabetes mellitus, and cardiovascular disease are attributed to a series of chronic anomalies closely related to dietary, among other, environmental factors, and consistent deregulation of one or more groups of genes (polygenic). Collectively, these diseases constitute the main cause of death globally and pose tremendous financial burden on healthcare systems. Dietary interventions offer significant possibilities for cost-effective strategies to reduce risk of a series of metabolic diseases and/or improve the outcome of prognosis. In recent decades, the ability of particular nutrients to influence certain cellular functions as well as the regulation of several metabolic pathways via genomic interplay has been demonstrated. Nutrients can influence cellular responses and hence exert an effect on health parameters and outcomes. Several nutrients have been documented to extend their regulatory capacity at various levels including gene expression profile signatures' modulation. In addition, specific nutrients can modulate expression/activation of genes that encode regulatory hormones, which in turn are signaling agents strongly affecting metabolism and subsequently risk levels for certain metabolic diseases. The field of nutrigenomics attempts to revolutionize modern thinking on diet, food, and health; whether it will deliver is still an open matter of debate Key teaching points: A brief, yet comprehensive account on how food and nutrition evolved to give rise to nutrigenomics. Discusses potential of nutrigenomics for public health contribution in noncommunicable diseases. Debates credibility of nutrigenomics' commercial products versus the bio-hype in the field. Presents experts' and stakeholders' opinions for future directions of nutrigenomics.

Protective Role of Dietary Berries in Cancer.

Dietary patterns, including regular consumption of particular foods such as berries as well as bioactive compounds, may confer specific molecular and cellular protection in addition to the overall epidemiologically observed benefits of plant food consumption (lower rates of obesity and chronic disease risk), further enhancing health. Mounting evidence reports a variety of health benefits of berry fruits that are usually attributed to their non-nutritive bioactive compounds, mainly phenolic substances such as flavonoids or anthocyanins. Although it is still unclear which particular constituents are responsible for the extended health benefits, it appears that whole berry consumption generally confers some anti-oxidant and anti-inflammatory protection to humans and animals. With regards to cancer, studies have reported beneficial effects of berries or their constituents including attenuation of inflammation, inhibition of angiogenesis, protection from DNA damage, as well as effects on apoptosis or proliferation rates of malignant cells. Berries extend effects on the proliferation rates of both premalignant and malignant cells. Their effect on premalignant cells is important for their ability to cause premalignant lesions to regress both in animals and in humans. The present review focuses primarily on in vivo and human dietary studies of various berry fruits and discusses whether regular dietary intake of berries can prevent cancer initiation and delay progression in humans or ameliorate patients' cancer status.

Bile sequestration potential of an edible mineral (clinoptilolite) under simulated digestion of a high-fat meal: an in vitro investigation.

Bile, important for cholesterol homeostasis, is a potential target of hypercholesterolemia management. Bile sequestration by orally administered resins, while mostly effective in reducing blood cholesterol, presents several side effects and disadvantages. Thus, widely available natural edible minerals such as clinoptilolite with adsorptive properties offer an alternative for bile sequestration. In an experimental setting mimicking the physiological conditions of digestion/absorption (pH, temperature, and retention times) with a series of assessment methods, scanning electron microscopy-energy dispersion X-ray analysis (SEM-EDX), X-ray diffraction (XRD), Fourier transform infrared analysis (FT-IR), thermogravimetric differential thermal analysis (TG-DTA), and molecular docking modeling, the ability of natural unmodified clinoptilolite to retain bile, while mixed with a simulated high-fat meal, was investigated. Our results demonstrate that clinoptilolite sequesters bile via adsorption of macromicelles at 75.4% efficiency, when the former is administered at a reasonable dose of 4% (w/w) of a meal's weight. This work provides the possibility of clinoptilolite utilization as a bile-sequestering/cholesterol-reducing agent.

Amino acids and immune response: a role for cysteine, glutamine, phenylalanine, tryptophan and arginine in T-cell function and cancer?

While proteins are critical for immunity, T-cells constitute a critical component of adaptive immunity by clearing cancerous cells among other abnormal cells. However, cancer cells exhibit a potential to escape T-cell control by employing mechanisms not completely delineated. Interesting work has investigated how certain amino acids affect the proliferation rate of T-cells as well as their effectiveness in clearing tumors. The role of amino acids cysteine, glutamine, phenylalanine, tryptophan and arginine in immunomodulation and particularly regarding T-cell proliferation and activation is discussed. The redox balance is reported to affect T-cell proliferation via modulation of cysteine availability. In addition antigen presenting cells (APCs), similar to myeloid cells determine the availability of amino acids in the extracellular microenvironment affecting T-cell proliferation and activation. A better mechanistic understanding of T-cell function modulation via amino acid signaling or metabolic properties may be helpful towards optimization of adaptive immunity with implications for cancer prognosis and treatment.