Ariana Grande Reveals Her Natural Hair And It’s Gorgeous

Photo: Getty Images

In a beauty move so unprecedented that it’s rocked the very fabric of our nation, Ariana Grande has released her hair from its ponytail shackles — and guess what? It’s absolutely, completely, and totally gorgeous.

 

Ariana’s hair has always been pretty (if somewhat predictable), but who knew she was hiding a cascade of healthy curls in that ponytail, AMIRIGHT? Did we mention that row of braids complimenting what Grande calls “peekaboo healthy curls” alongside her perfect pink pout, all captured in optimal selfie lighting?

No word yet if this edgier and more grown-up style will become a staple for Grande, but this is definitely a “don’t mind if we do” moment.

This article originally appeared on MIMIchatter.com.

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Obesity Rates Remain High in the U.S.

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Every state in the U.S. has an obesity rate that’s over 20%—and many are well over that, a new report found.

The “State of Obesity” report, published by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation, found that the U.S. adult obesity rate remained high in 2014, and 23 out of the 25 states with the highest rates are in the South or Midwest.

In Arkansas, West Virginia and Mississippi, the adult obesity rate exceeds 35%, the report shows. In addition, 22 states have an obesity rate that’s above 30% and 45 states are above 25%. The state with the highest percentage of obese adults was Arkansas at 35.9% and Colorado had the lowest rate at 21.3%. That’s still a major increase from the 6.9% adult obesity rate in Colorado in 1990.

The report also underlines racial differences among obese adults nationwide. Overall, adult obesity rates in the U.S. are 38% higher among black people compared to white people and 26% higher among Latinos compared to white people. The report shows that in 14 states the obesity rate among black men and women is at or above 40%.

The rates also increase with age, with a rate of 30% among 20-to-39-year-olds and close to 40% among 40-to-59-year-old adults.

“Efforts to prevent and reduce obesity over the past decade have made a difference. Stabilizing rates is an accomplishment. However, given the continued high rates, it isn’t time to celebrate,” said Jeffrey Levi, executive director of TFAH, in a statement. “We’ve learned that if we invest in effective programs, we can see signs of progress. But, we still haven’t invested enough to really tip the scales yet.”

The report defines obesity as an “excessively high amount of body fat or adipose tissue in relation to lean body mass.” The report uses body mass index (BMI) as a measurement, which is the ratio of person’s height to weight. Adults with a BMI of 30 or more are considered obese.

Obesity puts 78 million Americans at a higher risk for other health complications like diabetes and heart disease, the authors say. They argue that creating healthy communities, by implementing strategies like improved school nutrition and physical activity interventions, can help people live better lifestyles. Preventing obesity among children is also easier and key to reversing trends.

This article originally appeared on Time.com.

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Treating Older Patients for Pneumonia in ICU May Boost Survival, But Not Costs

TUESDAY, Sept. 22, 2015 (HealthDay News) — Admitting older, low-risk patients with pneumonia to the intensive-care unit — compared with admission to regular wards — is linked with higher survival rates but not higher medical expenses, new research suggests.

Researchers led by Dr. Thomas Valley of the University of Michigan analyzed the link between intensive care admissions and outcomes among older people hospitalized for pneumonia as well as 30-day death rates and overall medical costs. The study included more than 1 million Medicare beneficiaries older than age 64 who were admitted to nearly 3,000 U.S. hospitals for pneumonia from 2010 to 2012.

Of those, 30 percent were admitted to the ICU. Meanwhile, 36 percent of those living within roughly 3 miles of the hospital were admitted to the ICU compared to 23 percent of those who lived farther away.

Of the 13 percent of patients whose admission appeared to be dependent only on distance, survival rates were higher among those treated in the ICU than in general wards. Researchers pointed out that Medicare spending and hospital costs were comparable. The study was published Sept. 22 in the journal JAMA.

“A randomized trial may be warranted to assess whether more liberal ICU admission policies improve mortality for patients with pneumonia,” the study authors wrote. The research only found an association, rather than a cause-and-effect relationship, between ICU admission rates and survival.

The findings argue against efforts to reduce ICU admissions, at least for older patients with pneumonia, Dr. Ian Barbash and Dr. Jeremy Kahn of the University of Pittsburgh School of Medicine wrote in an accompanying editorial.

“The greatest lesson from this study may be that low-value health care is difficult to find,” they wrote. “Reducing health care spending by preventing ICU readmissions will require addressing the difficult questions about rationing ICU care and the degree to which the nation can afford to make intensive care available to anyone at any time.”

Barbash and Kahn wrote that the task now is to determine why intensive care saves lives, and then to use that information to make care as safe and effective for all patients, no matter where in the hospital they are treated.

More information

The Kaiser Family Foundation provides more information on health care costs.

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Could a Texting App Help Your Heart?

By Dennis Thompson
HealthDay Reporter

TUESDAY, Sept. 22, 2015 (HealthDay News) — Regular text message reminders can help people with heart disease stick to a healthier lifestyle, Australian researchers report.

Patients who received automated text messages throughout their week saw improvements in their “bad” LDL cholesterol levels, blood pressure and weight, the study found.

The text messages even helped many quit smoking, the researchers added.

The clinical trial provides some of the first evidence that simple, low-cost mobile communications programs and apps can help people adopt healthier habits, said study author Clara Chow, an associate professor at the University of Sydney Medical School and acting director of the cardiovascular division at the George Institute for Global Health.

“In our fast-paced society, patients are leaving hospitals so quickly now after suffering a heart attack. They are given so much information in hospital, and it’s easy to become confused,” Chow said.

The text messages “provide advice, support and encouragement in personalized bite-size chunks about making those behavior changes that are so difficult to make after a heart attack,” she explained.

In the study, published in the Sept. 22/29 issue of the Journal of the American Medical Association, half of a group of 700 heart disease patients were assigned to receive four text messages each week for six months. Both groups started with similar heart risk factors, on average.

The messages were selected from a bank of messages by an automated computer messaging system that took each patient’s individual health risks into account, the study authors said. For example, a smoker might receive messages that encourage quitting, or those struggling with their weight might get tips on eating right or exercising.

“Messages were often personalized with [a] name,” Chow said. “For example, ‘Hi Mike, don’t forget physical activity is good for you! It reduces your risk of diabetes, heart attack, stroke and their complications.'”

After six months, levels of “bad” cholesterol were lower in participants who received text messages compared with those who didn’t (the “control” group), the researchers found. Those on the text message system also had lower blood pressure levels and lower body mass index (a measurement of body fat based on height and weight).

Both groups started with about 53 percent smokers. By the end of the six months, there were 26 percent smokers in the text message group, compared with 43 percent in the control group, the findings showed.

People receiving text messages also were better able to achieve multiple lifestyle changes. The proportion of patients achieving three of five guideline target levels of risk factors were substantially higher in the text message group (63 percent) versus the control group (34 percent), the investigators found.

The study shows that technology can help doctors better guide patients in making what can be very difficult changes to their everyday life, said Dr. Zubin Eapin, an assistant professor at Duke Medical Center, in Durham, N.C.

“Creating and sustaining long-term behavior change is difficult in all aspects of life, and doing what it takes to be healthy is no exception,” said Eapin, who co-wrote an editorial that accompanied the study. “The decisions we make today for our own health — eating and exercising well, quitting smoking, taking medications as prescribed — are often far removed from the rewards or consequences.”

Dr. Elliott Antman, past president of the American Heart Association, called the study “an excellent start in the right direction.”

“This is what we need to see to understand how to use mobile technologies to effectively modify behavior so individuals lead a more healthy lifestyle,” said Antman, who is a professor at Harvard Medical School in Boston. “There are many health-related apps, and only a few have undergone any kind of rigorous evaluation. This program has been proven effective using gold-standard methodology.”

However, Antman added that the study only lasted for six months, and it remains to be seen if patients will be able to stick with their heart-healthy lifestyles.

“The question, of course, will be, is this sustainable?” he said. “Repeating the same text messages again and again may not be enough. You may have to change up the messages, to remain effective.”

More information

For more on preventing heart disease, visit the U.S. Centers for Disease Control and Prevention.

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Relaxed Guidelines on PSA Testing Might Miss Aggressive Tumors: Study

By Steven Reinberg
HealthDay Reporter

TUESDAY, Sept. 22, 2015 (HealthDay News) — Relaxed guidelines on prostate cancer screening may delay diagnosis and treatment of aggressive tumors, a new study suggests.

In 2011, the U.S. Preventive Services Task Force recommended against routine prostate specific antigen (PSA) testing, to curb over-diagnosis and overtreatment of prostate cancer. Since then, PSA screening has dropped by 28 percent, the researchers report.

“On the positive side, there is a lot of prostate cancer that we don’t need to know about,” said lead researcher Dr. Daniel Barocas, an assistant professor of urologic surgery at Vanderbilt University, in Nashville, Tenn.

These are low-risk cancers that most men will not die of, and the treatment can be more harmful than the cancer, he explained. “To that extent, the guideline had a beneficial effect,” Barocas said.

“On the negative side, we seem to be missing intermediate and high-risk cancers in men who would be eligible for treatment,” he said. “Those are missed opportunities to identify disease and treat it.”

The report will be published in the December issue of the Journal of Urology.

Dr. Kirsten Bibbins-Domingo, vice chair of the U.S. Preventive Services Task Force, said, “When the task force reviewed the evidence on PSA screening for prostate cancer in 2011, what we found is that there is a very small potential benefit and significant potential harms.”

Most prostate cancers found by PSA screening are slow-growing and not life-threatening, she explained. “However, there is currently no way to determine which cancers are likely to threaten a man’s health and which will not,” she said.

Barocas disagreed.

“The policy of screening no one is throwing the baby out with the bathwater,” he said.

Some men are at high risk for prostate cancer and should be screened, he said. These include men with a family history of prostate cancer, and black men.

In addition, screening should be combined with treatment. Low-risk cancer need not be treated but watched, while high-risk cancer should be treated, Barocas said. “That’s the solution,” he said.

Another expert made another point.

Since 2011, when the guideline was published, new techniques, including MRI and ultrasound, have been developed that can diagnose prostate cancer more accurately and distinguish between low- and high-risk cancers. These techniques may need to be taken into account in modifying the guideline, said Dr. Anthony D’Amico, chief of genitourinary radiation oncology at Brigham and Women’s Hospital and Dana-Farber Cancer Institute in Boston.

Using the U.S. National Cancer Database, Barocas and colleagues looked at the effect of the new guidelines on the number of new prostate cancer diagnoses between January 2010 and December 2012.

The researchers found that the number of prostate cancer diagnoses dropped more than 12 percent (1,363 cases) in the month after the draft guideline was issued. It continued to drop to an overall decline of 28 percent in the year after the draft guideline was issued.

The diagnoses of low, intermediate and high-risk prostate cancers all decreased significantly, but diagnoses of prostate cancer that had spread beyond the prostate did not change, they found. The decreases were similar for all ages, races, income and insurance.

In the year after the guidelines were published, diagnoses of new low-risk cancers dropped nearly 38 percent and continued to fall more rapidly than diagnoses of more aggressive cancer. This suggests that for low-risk cancer, the guideline had its intended effect, Barocas said.

In addition, prostate cancer diagnoses fell by 23 percent to 29 percent among men over 70 and by 26 percent among men who were not likely to live long enough to benefit from early diagnosis and treatment, the researchers found.

However, researchers also found a drop of 28 percent in diagnoses of intermediate-risk cancer and a 23 percent drop in diagnoses of high-risk cancer one year after the guideline was published.

“These findings are consistent with what we hoped would not happen,” D’Amico said.

It is likely that men will develop more advanced prostate cancer before it is diagnosed and be less likely to be cured, he added. “This is a warning that we are not picking up patients who are curable,” D’Amico said.

More information

Visit the American Cancer Society for more on prostate cancer.

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Most Americans Will Experience At Least 1 Diagnostic Error: Report

By E.J. Mundell
HealthDay Reporter

TUESDAY, Sept. 22, 2015 (HealthDay News) — A new report commissioned by the U.S. government contends that most Americans will encounter at least one diagnostic error in their lifetime, sometimes with severe consequences for their physical and mental health.

The report, released Tuesday by an independent panel at the Institute of Medicine (IOM), urges changes to an increasingly complex health care system that may be adding to the problem.

“This latest report is a serious wake-up call that we still have a long way to go,” Victor Dzau, president of the National Academy of Medicine, which oversees the IOM, said in an IOM news release.

“Diagnostic errors are a significant contributor to patient harm that has received far too little attention until now,” he said.

The new IOM report is the latest in a series that have examined the ongoing issue of medical errors. Focusing this time on missed or mistaken diagnoses, the panel noted that diagnosis has always been “a collaborative and inherently inexact process.”

“Diagnosis is a collective effort that often involves a team of health care professionals — from primary care physicians, to nurses, to pathologists and radiologists,” said Dr. John Ball, chairman of the IOM committee behind the report and executive vice president emeritus of the American College of Physicians.

“The stereotype of a single physician contemplating a patient case and discerning a diagnosis is not always accurate,” Ball said in the IOM news release.

A misleading diagnosis can be costly in terms of trauma to the patient and their loved ones, missed opportunities for treatment, unnecessary treatments and other issues, the report said.

Litigation costs stemming from faulty diagnoses can also be huge. According to a study of 350,000 U.S. malpractice cases published in 2013 in the journal BMJ Quality & Safety, lawsuits involving missed or wrong diagnoses were the leading cause of payouts between 1986 and 2010.

Researchers led by Dr. David Newman-Toker, of Johns Hopkins University School of Medicine in Baltimore, estimated that the number of misdiagnosis-related claims that cause preventable, permanent damage or death may be as high as 160,000 each year.

The new IOM report stressed that there are many players involved in diagnosing a sick patient, and more must be done to help coordinate care. These partners include:

• Patients and their families. The IOM panel urges that health care organizations offer more help to patients and their loved ones in terms of understanding a diagnosis, and widen access to electronic health records, including clinical notes and test results. Patients and families should also be made to feel comfortable about offering their own opinions and feedback, the IOM said.
• Health care organizations. These key players need to learn from past mistakes and use that knowledge to improve systems so diagnostic errors decrease. A more “open” corporate culture, where people aren’t punished for pointing out errors, is key to this, the IOM panel said.
• The legal system. States should work with entities in the health care sector to “promote a legal environment that facilitates the timely identification, disclosure, and learning from diagnostic errors,” the IOM said.
• Health care professionals. Doctors and other staff may need training that focuses on “clinical reasoning, teamwork, communication, and diagnostic testing,” the panel said.

All of this must be a coordinated, team effort involving patients, health care workers and organizations, Ball stressed.

“To make the changes necessary to reduce diagnostic errors in our health care system, we have to look more broadly at improving the entire process of how a diagnosis is made,” he said.

An expert in patient safety agreed.

Jennifer Lenoci-Edwards is a registered nurse and director of the Institute for Healthcare Improvement. She said she wasn’t surprised by the prediction that most Americans will eventually encounter at least one diagnostic error.

“Health care continues to get more complex,” Lenoci-Edwards said. She said her group “agrees with the stated goals [of the IOM report], especially those that relate to increasing the role of team-based care in making diagnoses and engaging the patient in these conversations.”

Her advice to patients? Don’t be silent.

“When you have that nagging feeling that you have not gotten your questions answered by your physician or provider, stop and raise it again,” Lenoci-Edwards said. “Trust your intuition that you know your body best,” she advised.

“In addition, patients and family members should be sure that they understand the purpose of a test, and how and when the results will be communicated,” she added.

More information

There’s more on how you can help avoid a medical error at the U.S. Agency for Healthcare Research and Quality.

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Watch Lady Gaga’s Chilling New Video About Sexual Assault

Lady Gaga’s first single and music video of the year “Til it Happens to You” isn’t just another song to add to Gaga’s list of chart-toppers. Instead, it’s a powerful and important PSA about campus sexual violence, released just ahead of a large new report underscoring the widespread nature of the problem.

On Monday, the Association of American Universities announced the results of the largest ever survey on campus sexual assault, which polled more than 150,000 students from 27 universities and found that 26.1 percent of senior female undergraduates were victims of sexual assault.

This is startling given that sexual assault can have serious affects on victims’ mental health, with survivors facing an increased risk for post-traumatic stress disorder, substance abuse, depression, self-harm, and even suicide, according the Rape, Abuse and Incest National Network (RAINN).

RELATED: 10 Signs You Should See a Doctor for Depression

Originally featured in the documentary The Hunting Ground earlier this year, the video for “Til it Happens to You” continues the film’s goal to raise awareness about sexual assault on college campuses. It depicts the attacks of four women (and opens with a trigger warning due to disturbing content) with very different stories, reminding viewers there isn’t just one face of this epidemic.

Importantly, the video also captures the aftermath for each woman. Throughout the video, survivors display written words on their bodies like “believe me” and “I am worthless,” showcasing both the emotional toll of the incident itself as well as the lack of support after the fact that many survivors experience.

In a statement about the video, director Catherine Hardwicke told The Huffington Post: “I hope that this PSA, with its raw and truthful portrayals, will send a clear message that we need to support these courageous survivors and end this epidemic plaguing our college campuses.”

On Twitter, Gaga announced that a portion of the proceeds from the sale of the song will be donated to advocacy organizations.

WATCH #TilItHappensToYou PSA: http://t.co/q9KWKRw14z A portion of proceeds from sales of the song will be donated to orgs helping survivors.

— Lady Gaga (@ladygaga) September 18, 2015

RELATED: Anti-Rape Program Halved Number of Campus Assaults: Study

She also shared this message about the meaning of the song.

.@diane_warren & I made "Til It Happens To You" for people all over the world who suffer from painful life experiences. #TheHuntingGround

— Lady Gaga (@ladygaga) September 18, 2015

We hope u feel our love&solidarity through the song & perhaps find some peace in knowing u r not alone through this film #TilItHappensToYou

— Lady Gaga (@ladygaga) September 18, 2015

RELATED: Meet Brooke Axtell, the Domestic Violence Survivor Who Performed With Katy Perry at the Grammys

 

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You Carry Your ‘Microbial Cloud’ With You

TUESDAY, Sept. 22, 2015 (HealthDay News) — In a finding that’s sure to alarm germophobes everywhere, scientists say people emit a “microbial cloud” of bacteria wherever they may be.

The study found that air samples could even pinpoint which individual had just left a sealed chamber, based on the makeup of their particular cloud of bacteria.

“We expected that we would be able to detect the human microbiome in the air around a person, but we were surprised to find that we could identify most of the occupants just by sampling their microbial cloud,” study author James Meadow, of the University of Oregon, said in a news release from the journal PeerJ.

The findings were published in the journal on Sept. 22.

It’s long been known that humans are host to a myriad of mostly helpful microbes, both in the gastrointestinal tract and on the skin. This colony of organisms is what scientists have dubbed the “microbiome.”

Now, the Oregon study finds that people also emit some of their microbiome in a kind of haze around themselves.

In the study, Meadow’s team tested the air around 11 different people while they were each placed alone in a sealed, sanitized chamber.

The researchers found that the presence of most of the people could be sequenced and identified within four hours of leaving the chamber — just by the cloud of bacteria in the air they had left behind.

Different combinations of several groups of bacteria commonly found on and in humans are the key to distinguishing individuals, the research team said. Key species were Streptococcus, usually found in the mouth, and skin germs such as Propionibacterium and Corynebacterium.

“Our results confirm that an occupied space is microbially distinct from an unoccupied one,” Meadow said, and “demonstrate for the first time that individuals release their own personalized microbial cloud.”

The findings may help improve understanding of how infectious diseases are spread in buildings, or even offer new ways to identify crime suspects, the researchers said.

More information

The Society for General Microbiology has more about bacteria.

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Girls Who Are Impulsive, Poor Planners May Be Prone to Weight Gain

By Maureen Salamon
HealthDay Reporter

TUESDAY, Sept. 22, 2015 (HealthDay News) — Girls who are impulsive and have difficulties planning at age 10 may tend to gain more weight as they enter puberty, and binge eating may be a common path to that result, new research suggests.

Girls at age 10 with poorer “executive function” — characterized in part by problems with self-regulating or planning ahead — were significantly more likely to have episodes of binge eating by 12 and gain excess weight by 16, the study found.

“The novel finding here is that binge eating partially explains the relationship between impulsivity and later weight gain,” said study author Andrea Goldschmidt, an assistant professor of psychiatry and behavioral neuroscience at the University of Chicago.

The study findings were published online Sept. 21 in the journal Pediatrics.

About 17 percent of children in the United States ages 2 to 19 are obese, according to the U.S. Centers for Disease Control and Prevention. Obesity in a child means that child has a body mass index (BMI) at or above the 95th percentile compared to other children of the same age and sex, the CDC says. BMI is a rough measure of a person’s body fat based on height and weight measurements.

Goldschmidt and her team analyzed 2,450 girls using a variety of tools, including a parental report of impulsivity at age 10, self-reports of binge eating at 10, 12 and 14, and annual body mass index (BMI) measurements between ages 10 and 16.

Most of the girls were white or black. About 30 percent of families were receiving some kind of public assistance, such as food stamps or welfare, the study said.

The researchers found that impulsivity and planning problems at age 10 independently predicted BMI changes between ages 10 and 16. Binge eating at age 12 was also linked to impulsivity at age 10 and weight gain between 10 and 16, the study reported.

However, the study only found an association, rather than a cause-and-effect link.

Similar results have been found in adults, but Goldschmidt said her study marks the first of its type in this age group.

“Food in our society is so ubiquitous,” Goldschmidt said. “You can’t even go to [a hardware store] without seeing colorful candy bars in the checkout line. When kids have [problems] controlling their behaviors it makes sense they would disinhibit themselves around food.”

Dr. Jennifer LeComte is medical director of the transitions and pediatric practice at Christiana Care Health System in Wilmington, Del. She said the study results mirror what she’s observed among her own patients, many of whom face both executive function difficulties and obesity.

However, LeComte said she was “frustrated” because the study only included girls, noting that these same issues are prevalent among similar-aged boys. She also said the research was limited by its reliance on children’s self-reports on their binge eating.

“They were looking at the binge eating recall for kids over a year,” she said. “I don’t know that anyone can recall their eating habits over a year.”

LeComte agreed with Goldschmidt that more studies are needed. Also, identifying children predisposed to obesity because of behavioral risks could prevent more kids from gaining excess weight by the end of adolescence, they said.

“It’s a really exciting area,” Goldschmidt said. “I definitely think more research should be done, especially since obesity is such a huge issue in our society. The earlier we intervene, the better.”

More information

Harvard University’s Center on the Developing Child offers more information on executive function skills.

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Beet Juice Boosts Muscle Power in Heart Patients

MONDAY, Sept. 21, 2015 (HealthDay News) — Beet juice, with its high concentration of nitrates, may help boost muscle strength among heart patients, a small study has found.

Nitrates are processed into nitric oxide by the body, which helps relax blood vessels and improve metabolism. Dietary nitrate, found in beets and leafy greens like spinach, has been shown to boost muscle performance in elite athletes.

Based on studies of elite athletes, especially cyclists who use beet juice to boost performance, researchers at the Washington University School of Medicine in St. Louis tested the benefits of dietary nitrate among nine people with heart failure, a condition that causes the heart to gradually lose its pumping power.

The patients were given concentrated beet juice. Two hours later, they showed a 13 percent power increase in muscles that extend the knee. The researchers also found the greatest benefit when the muscles performed fast, powerful actions. Longer tests measuring muscle fatigue however, showed no performance improvement, according to the study published recently in Circulation: Heart Failure.

One to two weeks either before or after the nitrate supplement, the same nine patients were given a control drink of beet juice that had the nitrate removed, to serve as a baseline for muscle strength in each individual.

“It’s a small study, but we see robust changes in muscle power about two hours after patients drink the beet juice,” senior study author Dr. Linda R. Peterson, an associate professor of medicine at Washington University School of Medicine, said in a university news release. “A lot of the activities of daily living are power-based: getting out of a chair, lifting groceries, climbing stairs. And they have a major impact on quality of life. We want to help make people more powerful because power is such an important predictor of how well people do, whether they have heart failure, cancer or other conditions. In general, physically more powerful people live longer.”

The researchers estimated the benefits of the beet juice supplement by comparing its effects to the results of an exercise regimen.

“I have compared the beet-juice effect to Popeye eating his spinach,” said the study’s corresponding author, Andrew R. Coggan, assistant professor of radiology, in the university news release. “The magnitude of this improvement is comparable to that seen in heart failure patients who have done two to three months of resistance training.”

The researchers said they plan to also examine the beneficial effects nitrates could have on older people struggling with weakness.

“One problem in aging is the muscles get weaker, slower and less powerful,” Coggan said. “Beyond a certain age, people lose about 1 percent per year of their muscle function. If we can boost muscle power like we did in this study, that could provide a significant benefit to older individuals.”

More information

The American Heart Association has more on heart-healthy nutrition.

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