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Background: This study investigated the association between handgrip strength (HGS) and physical activity (PA) at different levels in Korean adults for the purpose of providing direction for increasing HGS, which represents muscular strength, and increasing understanding of PA and HGS. Methods: This study targeted adults aged ≥30 years from the Korean National Health and Nutrition Examination Survey (2014–2019), including 31,888 participants for analysis. HGS was defined as the maximum value of the three measurements of the dominant hand. PA was defined as an activity that causes shortness of breath or a fast heartbeat. Data were weighted according to survey district and household data; p <.05 was considered statistically significant. Results: In men, HGS in those aged 30–64 years was significantly associated with high‐intensity PA and in those aged ≥65 years was associated with moderate‐intensity PA. In women, HGS in those aged 30–64 years was also significantly associated with high‐intensity PA, and in those aged ≥65 years, it was significantly associated with both moderate‐ and high‐intensity PA. Moreover, compared to participants who did not participate in weight training, those who participated showed higher HGS in both sexes. Conclusions: This study demonstrated age‐ and sex‐specific characteristics of the association between HGS and PA in Koreans. The findings suggest the importance of managing health by considering differences in age‐ and sex‐related PA. In particular, this study suggests that adequate PA is necessary despite its importance of PA for elderly individuals. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the association between multimorbidity, which refers to the presence of two or more chronic diseases, and periodontal disease in Korean adults using national survey data. Methods: A total of 12,440 Korean adults aged ≥19 years were selected from the seventh Korea National Health and Nutrition Examination Survey (KNHANES). We investigated periodontal disease status based on various variables, including the gender, age, educational level, income level, smoking and alcohol drinking status, frequency of daily toothbrushing, and unmet dental treatment needs. Furthermore, periodontal status according to diagnosed chronic diseases, including hypertension, dyslipidaemia, stroke, myocardial infarction, angina pectoris, and diabetes, was investigated, and the association between multimorbidity and periodontal disease was analysed through multiple logistic regression using SAS 9.4. Results: According to the general characteristics of the study participants, the prevalence of periodontal disease was higher in males, smokers, older age, and lower educational and income levels (p < 0.001). Moreover, as the frequency of daily toothbrushing increased, the distribution of periodontal disease decreased (p < 0.001). The prevalence of periodontal disease was higher in those with chronic diseases than in those without chronic diseases and was statistically significantly higher as the number of diagnosed chronic diseases increased (p < 0.001). Additionally, an increase in the number of chronic diseases was observed to increase the prevalence and risk of periodontal disease. Conclusion: These results suggest that multimorbidity significantly affects the prevalence of periodontal disease. [ABSTRACT FROM AUTHOR]

Aim: Adult women experience several changes in physiological status, such as pregnancy and childbirth, during their life cycle. This study analyses the association between birth‐related factors (the number of childbirths, abortions and miscarriages) and periodontitis using data from the Korea National Health and Nutrition Examination Survey, which represents Korean adults. Materials and Methods: The study used data from Korea National Health and Nutrition Examination Survey VI and VII (2013–2018) and included 10,072 women 19 years or older, with no missing data on the variables assessed. Periodontitis was defined according to the Community Periodontal Index (CPI) criteria. Multiple logistic regression analysis, adjusting for age, household income, education, alcohol consumption, smoking, stress, body mass index, waist circumference, hypertension, diabetes mellitus, an oral examination within 1 year, daily tooth brushing frequency, hygiene products and self‐perceived oral health as identified via logistic regression analyses, was performed to determine the association between birth‐related variables and periodontitis. Results: In the crude model, the odds ratio (OR) showed a significantly increased risk of periodontitis (CPI ≥ 3) and severe periodontitis (CPI = 4) based on the number of childbirths, abortions and miscarriages (p <.05). After covariate adjustment, periodontitis (CPI ≥ 3) was associated with the number of childbirths (1: OR = 1.92; 95% confidence interval [CI]: 1.47–2.50; 2: OR = 2.03; 95% CI: 1.57–2.61; ≥3: OR = 2.11; 95% CI: 1.60–2.78). Furthermore, severe periodontitis (CPI = 4) was also associated with the number of childbirths (1: OR = 2.33; 95% CI: 1.24–4.38; 2: OR = 2.99; 95% CI: 1.62–5.52; ≥3: OR = 3.34; 95% CI: 1.79–6.21). Conclusions: The findings of this large‐scale, nationally representative study suggest that the number of childbirths is associated with the severity of periodontitis. However, the relationship between the number of abortions and miscarriages and periodontitis (CPI ≥ 3) or severe periodontitis (CPI = 4) is not significant. [ABSTRACT FROM AUTHOR]

Background: Uric acid is known for its antioxidant capacity; however, whether uric acid is independently associated with depression in the older population remains controversial. The current study aimed to investigate the association between uric acid and depressive symptoms in older adults according to sex, using a large national sample population. Methods: Data from the 2016, 2018, and 2020 Korean National Health and Nutrition Examination Surveys were analyzed, and 5609 participants older than 60 years were included in this study. We defined a Patient Health Questionnaire‐9 score ≥5 as indicating the presence of depressive symptoms. Results: The prevalence of depressive symptoms was higher in women with lower uric acid levels than in those with higher uric acid levels. In women, the lower levels of uric acid were significantly associated with depressive symptoms in the multivariable logistic regression analysis (odds ratio, 1.36; 95% confidence interval, 1.10–1.68; p = 0.005). However, no significant association between uric acid levels and depressive symptoms was observed in men. Conclusion: The findings of this study suggest that uric acid is associated with depressive symptoms in older women, but not in men. Relatively lower serum uric acid levels in women compared to men and sex differences in oxidative stress may explain the significant association of uric acid levels and depressive symptoms in older women. Further research is needed on sex differences in the relationship between serum uric acid levels and depressive symptoms. Key points: Uric acid is known for its antioxidant capacity and may have neuroprotective effects.Low serum uric acid levels are associated with a higher prevalence of depressive symptoms in women aged over 60 years, but not in men.Women's lower total serum uric acid levels and greater susceptibility to oxidative stress compared to men may explain the sex differences. [ABSTRACT FROM AUTHOR]

Hypertriglyceridemia is a well‐known risk factor of various chronic diseases including diabetes mellitus, metabolic syndrome, obesity, and cardiovascular diseases. This study aimed to determine dietary patterns and explore the relationship between dietary patterns and hypertriglyceridemia in the Korean adult population. We utilized a cross‐sectional and nationally representative survey, the Korea National Health and Nutrition Examination Survey 2013–2018 database. From 47,217 subjects who participated in the survey between 2013 and 2018, only subjects over 40 years old were included. Subjects lacking 24‐h recall data and data on hypertriglyceridemia and body mass index, and who had implausible energy intake were excluded. A total of 19,806 participants' data were analyzed. Dietary data were based on 24‐h recall data, and dietary patterns were derived using factor analysis. Triglyceride levels greater than 200 mg/dl were considered hypertriglyceridemia, according to the Korean Society of Lipid and Atherosclerosis. Three dietary patterns— "oil and fats & seasoning", "soybean paste and vegetable", and "fruit and whole‐grain"— explained 7.9%, 6.3%, and 5.8% of variation in food intake, respectively. Comparing the lowest and highest dietary pattern score groups after adjusting for potential confounders revealed an inverse relationship between "fruit and whole‐grain" dietary pattern and hypertriglyceridemia in men (odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.45–0.82, p for trend <.0001); which was only marginal in women (OR: 0.78, 95% CI: 0.58–1.07, p for trend:.628). A diet containing high proportions of fruit and whole‐grain may have preventive effects on hypertriglyceridemia in middle and older aged Korean adults. [ABSTRACT FROM AUTHOR]

Purpose: National big data pertaining to the status of common respiratory diseases is essential to devising appropriate policies to promote proper treatment and prevention of respiratory diseases amid the prolonged coronavirus disease 2019 (COVID‐19) pandemic. The aim of this study is to investigate the prevalence of common respiratory diseases and their association with sociodemographic characteristics, comorbidities, and medical history using 11 years (2008–2018) of the Korea National Health and Nutrition Examination Survey (KNHANES) data, ultimately to present foundational data for policy decision making and disease prevention measures. Methods: Among the participants of the KNHANES survey (2008–2018), 93 028 adults aged ≥40 years who underwent a lung function test were included in this cross‐sectional study. The participants were divided into four groups: Asthma, chronic obstructive pulmonary disease (COPD), asthma + COPD, and no respiratory disease. Their data were analyzed for demographic factors, health behavior, and disease‐related factors. Multiple logistic regression was used to calculate the odds ratio (OR) adjusted for sex, age, household income, educational level, occupation, body mass index (BMI), smoking status, alcohol consumption, physical activity, and comorbidities. Results: Of all participants, 1.83%, 12.63%, and 1.27% had only asthma, only COPD, and asthma + COPD, respectively. With respect to the patients with asthma who also had asthma + COPD, the OR of asthma + COPD was 5.272 in underweight patients and 6.479 in patients aged ≥70 years. Meanwhile, a high association between COPD and asthma + COPD was found in female patients, whereas asthma was more highly associated with asthma + COPD in male patients. Conclusion: The study confirmed that old age, sex, smoking status, BMI, previous history of atopic dermatitis, and lung cancer were independent risk factors for asthma, COPD, and asthma + COPD. The present study demonstrated the need for a multidisciplinary integrative approach to respiratory diseases, and the findings could be used for developing policies for the treatment of COVID‐19 and respiratory diseases and the prevention of infectious diseases. [ABSTRACT FROM AUTHOR]

Background and Aim: The association between thyroid autoimmunity and nonalcoholic fatty liver disease (NAFLD) remains unclear. In this study, we aimed to investigate the relationship between thyroid autoimmunity and NAFLD in a large cohort of euthyroid subjects. Methods: We analyzed clinical and biochemical data from a nationwide, population‐based, cross‐sectional survey (KNHANES VI). A total of 1589 middle‐aged participants aged 45–65 years, with normal thyroid function, were included in this study. NAFLD was defined as a hepatic steatosis index of > 36. We estimated the odds ratios (ORs) for NAFLD according to anti‐thyroid peroxidase antibody (TPOAb) positivity by using logistic regression models, and adjusted for potential confounders. Results: Overall, 24% (n = 378) of the subjects had NAFLD. Subjects with NAFLD showed a higher positivity for TPOAb (11% vs 7%, P = 0.014) compared with those without NAFLD. TPOAb positivity was a significant risk factor for NAFLD [OR 1.668, 95% confidence interval (CI) 1.019–2.730, P = 0.042] even after adjusting for confounding variables, including age, sex, household income, education, smoking, alcohol consumption, walking activity, abdominal obesity, elevated blood pressure, dyslipidemia and hyperglycemia. In addition, TPOAb positivity predicted the risk of advanced liver fibrosis (OR 3.112, 95% CI 1.256–7.713, P = 0.014) in subjects with NAFLD, independent of the confounding variables. Conclusion: In euthyroid subjects, thyroid autoimmunity is associated with NAFLD and advanced liver fibrosis, independent of known metabolic risk factors. Large longitudinal studies in the future will help clarify the causality. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined the associations of temporomandibular disorders (TMDs) and tinnitus with health‐related quality of life on a national level. Objective: We aimed to investigate the associations of TMDs, tinnitus and quality of life among the Korean population, aged 19 years or older. Methods: Data were obtained from the fifth Korea National Health and Nutrition Examination Survey (2012; N = 5786). TMDs, tinnitus and health‐related quality of life were assessed using self‐report data from EuroQol‐5 Dimension. Participants were divided into four groups: no TMD and no tinnitus, TMD present but no tinnitus, no TMD but tinnitus present and both TMD and tinnitus present. Results: Among the participants, 21.88% had TMD, 24.93% had tinnitus, and 7.74% had both. The prevalence of most TMD and all types of tinnitus was higher among females than among males. The group with both TMD and tinnitus reported the highest percentage of problems in the usual activity, pain/discomfort and anxiety/depression dimensions. Moreover, the odds ratio (OR) for lower quality of life was significantly higher in the group with both TMD and tinnitus compared to the group without TMD and tinnitus: mobility (OR = 1.527, 95% confidence interval [CI]: 1.014–2.300), pain/discomfort (OR = 2.072, 95% CI: 1.570–2.735), anxiety/depression (OR = 1.692, 95% CI: 1.034–2.767), EQ‐5D score (OR = 1.651, 95% CI: 1.121–2.431) and EQ‐VAS (OR = 1.682, 95% CI: 1.246–2.269). Conclusion: The presence of both TMD and tinnitus has a considerable impact on HRQoL in the Korean population. In our study, the group with both TMD and tinnitus showed lower HRQoL than without TMD and tinnitus group. These results emphasise the need for a multilateral and comprehensive approach to address these disorders and provide baseline data for developing appropriate interventions. [ABSTRACT FROM AUTHOR]

Introduction: Ferritin regulates iron homeostasis, and is involved in the inflammation in the lung, especially in smokers; however, its associations on pulmonary function in nonsmokers remain unclear. Objectives: The present study aimed to evaluate the association between serum ferritin and lung function in a tobacco‐naïve postmenopausal women. Methods: In this study, 25 534 individuals were enrolled, among who 5338 tobacco‐naïve individuals were identified; of those, 342 men and 2879 women (742 pre‐ and 2137 postmenopausal) with data of serum ferritin, lung function and covariates were included. To evaluate the association of ferritin and lung function, multivariable‐adjusted linear regression analyses was used including the factors of predicted value of forced expiratory volume in 1 second (FEV1%) and forced vital capacity (FVC%). Logistic regression analyses were used to measure the relationship between ferritin and restrictive and obstructive lung disease. Results: In premenopausal women, FEV1%/FVC was weakly but positively associated with serum ferritin, and after adjusting for covariates, the association was without statistical significance. No significant association between ferritin and obstructive lung disease was observed. In postmenopausal women, predicted FVC% was negatively associated with serum ferritin, and ferritin was dose‐dependently related with risk for restrictive lung disease. The odds ratio for restrictive lung disease in postmenopausal women was 2.285 at T3 and 1.560 at T2 relative to that at T1. Conclusions: High serum ferritin level was significantly associated with lower FVC% and increased risk of restrictive lung disease in tobacco‐naïve postmenopausal women. Further study is needed to determine the mechanism underlying the current findings. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to investigate the association between periodontal status and non-alcoholic fatty liver disease (NAFLD) indicators in a representative Korean population.Methods: A cross-sectional study was conducted on 4061 participants >19 years of age using the 2010 Korea National Health and Nutrition Examination Survey data. Periodontal status was assessed by trained dentists using the community periodontal index. To identify the presence of NAFLD, biochemical data were defined using two validated indicators: the fatty liver index (FLI) and the hepatic steatosis index (HSI). The associations of the presence of periodontal pockets with FLI and HSI were evaluated by multivariable logistic regression analysis after adjusting for age, income, education level, smoking status, alcohol consumption, physical activity, diabetes mellitus, obesity, hypertension, and hypercholesterolemia.Results: The adjusted means in the FLI indicator increased in the presence of periodontal pockets, whereas there was no significant difference in the HSI (P = 0.005 for FLI; P = 0.142 for HSI). Periodontal pockets were consistently associated with the two NAFLD indicators in the sequential logistic models for women throughout the adjustment process. (OR = 1.77, 95% CI = 1.05 to 2.98 for FLI, OR = 1.64, 95% CI = 1.08 to 2.51 for HSI).Conclusions: Our findings showed that the presence of periodontal pockets may be independently associated with NAFLD indicators. Further study will be clarified by well-designed longitudinal studies. [ABSTRACT FROM AUTHOR]

Aim: An elevated serum uric acid level is associated with various diseases, such as gout, hypertension, renal impairment, and diabetes. Heavy metals, including lead and cadmium, are suspected to increase serum uric acid levels, but evidence regarding this is not sufficient, particularly in the Asian population. Therefore, this study aimed to evaluate the association between lead, cadmium and mercury exposure and hyperuricemia in the Korean general population. Methods: We enrolled 2682 participants (1124 men and 1528 women) aged ≥19 years from The Korean National Health and Nutrition Examination Survey. Sex‐ and hyperuricemic state‐stratified general characteristics of study participants were compared using the Chi‐square test, Student's t test, and Mann–Whitney U test for categorical, continuous, and non‐normally distributed continuous variables, respectively. Multivariate logistic regression analysis was performed to evaluate the association between blood lead and cadmium levels and hyperuricemia. Results: Subjects with hyperuricemia had higher blood lead and cadmium levels than those without hyperuricemia. Lead and cadmium exposure had a positive association with serum uric acid levels in a dose–response manner in the nationally representative Korean population. In logistic analysis, blood cadmium levels had a positive association with increasing risk for hyperuricemia only in men, and this association was more evident in cotinine‐verified non‐smokers. Although an incremental trend of hyperuricemia in relation to lead exposure was observed, it was not statistically significant. Conclusion: Further studies are necessary to clarify the observed association, and public health strategies to reduce heavy metal exposure may be necessary for decreasing the potential harmful effects of hyperuricemia. [ABSTRACT FROM AUTHOR]

Background: Handgrip strength is easily assessed by muscle strength and is an important factor for health and physical performance. Empirical evidence for the association between the number of teeth and handgrip strength remains controversial. The objective of this study was to investigate the association between the number of teeth and handgrip strength.Methods: Data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2014 to 2015 were used (N = 7,741). The number of teeth was categorized into three groups: 0 to 9 teeth, 10 to 19 teeth, and 20 to 28 teeth. Handgrip strength of the participants was measured using a digital hand dynamometer. Multivariate linear regression and logistic regression models were fitted to assess the association between the number of teeth and hand grip strength after adjusting for sociodemographic factors, general health behaviors, and oral and general health factors.Results: Reduced handgrip strength was much more frequent in male and female participants with a lower number of teeth. Each tooth increased handgrip strength by 0.12 kg and 0.07 kg in males and females, respectively (P < 0.001 for both males and females). The association between the number of teeth and handgrip strength disappeared in females in the fully adjusted models, but the odds ratio of participants with 0 to 9 teeth was 1.73 (95% confidence interval: 1.02 to 2.95), which was higher than the reference group in males.Conclusion: Our results showed a significant association between the number of teeth and handgrip strength in Korean adults. [ABSTRACT FROM AUTHOR]

Abstract: Background: Dietary carbohydrate quality may play an important role in disease development. We evaluated the association between carbohydrate quality index (CQI) and the prevalence of obesity and metabolic disorders among adults in South Korea. Methods: We analysed 12 027 adults aged 19–64 years from the fifth Korea National Health and Nutrition Examination Survey (KNHANES). CQI was based on four criteria: crude fibre intake, dietary glycaemic index (DGI), whole grains/total grains ratio and solid carbohydrates/total carbohydrates ratio. Results: Participants with a lower CQI were younger, had a lower income and were more likely to be smokers and to drink alcohol. The highest quintile CQI group showed the lowest DGI and the lowest consumption of liquid carbohydrates and refined grains, as well as the highest consumption of solid carbohydrates, crude fibre and whole grains (P < 0.05). A higher CQI was negatively associated with the prevalence of obesity (odds ratio = 0.83; 95% confidence interval = 0.69–0.99) and hypertension (odds ratio = 0.78; 95% confidence interval = 0.61–0.99) but was not associated with other metabolic disorders. Conclusions: These results suggest that the quality of carbohydrates consumed is associated with the risk of obesity and hypertension. However, the cross‐sectional design does not preclude reverse causality. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to examine the association between early menarche (<12 years) and non-alcoholic fatty liver disease (NAFLD) in premenopausal women and to explore whether it is mediated by adult obesity and insulin resistance. Methods We analyzed data of premenopausal women, aged ≥15 years, from the Korea National Health and Nutrition Examination Survey (2007-2009). We divided the women into three groups: early menarche, reference (12.00-15.99 years), and late menarche. The presence of NAFLD was determined using hepatic steatosis index >36.0. Results Of the 4,387 women evaluated, 673 (15.4%) met the criteria for NAFLD. The prevalence of NAFLD was higher in both women with early and late menarche compared with the reference (early, 23.4%; reference, 14.0%; late, 19.9%, P < 0.001). After adjustment of confounders including age, the OR for NAFLD in early menarche compared with the reference was 3.04 (95%CI: 1.99-4.65). Further adjustment of mediators, such as central obesity or insulin resistance, attenuated the association to 1.91-2.17. There was no association, however, between late menarche and NAFLD after adjustment of confounders. Conclusions Early menarche was associated with an increased risk of NAFLD in young and middle-aged premenopausal Korean women. [ABSTRACT FROM AUTHOR]

Objectives To assess the association between chewing difficulty and symptoms of depression in a representative sample of the Korean population. Design Cross-sectional. Setting Korea National Health and Nutrition Examination Survey ( KNHANES). Participants KNHANES participants (N = 5,158). Measurements Chewing difficulty was assessed according to the self-reported presence of chewing problems using a structured questionnaire. Symptoms of depression were defined as having feelings of sadness or depression consecutively over 2 weeks during the last 12 months. Multivariable logistic regression analysis was used to determine the adjusted odds ratios ( AORs) and 95% confidence intervals ( CIs) of the associations between chewing difficulty and symptoms of depression, adjusted for age; sex; monthly household income; education; number of teeth; number of decayed, missing, or filled permanent teeth; periodontitis; state of dentition; tooth brushing frequency; regular dental visits; smoking status; alcohol consumption; hypertension; diabetes mellitus; and obesity. The interaction effects between chewing difficulty and confounders were evaluated, and age- and sex-stratified analyses were performed. Results There was a significant positive association between chewing difficulty and symptoms of depression in the fully adjusted model ( AOR = 1.86, 95% CI = 1.48-2.33). The strength of the association was highest in men aged 60 and older ( AOR = 3.28, 95% CI = 1.54-7.00). Conclusion Chewing difficulty was independently associated with symptoms of depression in a representative sample of Korean adults. [ABSTRACT FROM AUTHOR]

Aim: It is important to identify differences in nutrient patterns by region so that local governments can be better equipped to design effective public health plans in their administrative areas. The aim of this study was to identify the nutrient patterns of Korean adults living in various regions with different dietary cultures. We explored if there are regional associations with nutritional patterns along with other socio‐demographic characteristics. Methods: We utilised data for 17 415 adults who participated in the 2010–2012 Korean National Health and Nutrition Examination Survey (KNHANES V). First, we reduced 18 nutrient intake variables to nutrient patterns via exploratory factor analysis. Next, we used multiple linear regression analysis to identify the associations between nutrient patterns and geodemographic characteristics. Results: Five nutrient patterns were identified: ‘Meat‐Related Nutrients', ‘Minerals', ‘Fibre/Vitamin C', ‘Vitamin A' and ‘Retinol'. Nutrient patterns in the Honam and Jeju region were significantly different from those in the Capital region. Age, gender, household income, education level and number of family members were significantly associated with the identified nutrient patterns. Conclusions: We confirmed that there are differences in nutrient patterns by region. Our results suggest that the Honam and Jeju region should implement different regional public health plans from those in the Capital region. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association of hypertension and high systolic and diastolic blood pressure (SBP and DBP) with periodontitis in a nationally representative Korean adult population. Materials and Methods: Total of 14,625 participants of Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) aged over 19 years were cross-sectionally surveyed. Periodontitis was defined as CPI score of 3 or 4. Hypertension was categorized as: normotensive (SBP < 120 mmHg and DBP < 80 mmHg), pre-hypertensive (120 < SBP < 140 mmHg or 80 < DBP < 90 mmHg) and hypertensive (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or taking antihypertensive medication). Multivariate Poisson regression analyses were performed controlling for age, sex, household income, drinking, smoking, physical activity, obesity, hypercholesterolaemia and diabetes mellitus. Stratified analyses were performed to identify specific risk groups. Results: Hypertension showed a significant positive association with periodontitis in the fully adjusted model in female adults with a dose-response relationship. This association was highlighted in females aged 30-59 years (prevalence ratio = 1.25; 95% confidence interval: 1.11-1.40). The strength of the association was highest in females aged 30-39 years and decreased with increasing age. Among females aged 30-59 years, high-risk groups of this link were lower middle income quartile, never drinker and non-diabetes groups for both pre-hypertension and hypertension. Conclusion: Our data showed that hypertension was associated with periodontitis in Korean female adults independent of known confounders. [ABSTRACT FROM AUTHOR]