International Journal of Obesity (1997) 21, 1085±1092
ß 1997 Stockton Press All rights reserved 0307±0565/97 $12.00
Are there ethnic differences in the association
between body weight and resistance, measured
by bioelectrical impedance?
BL Heitmann1,2, BA Swinburn3, H Carmichael3, K Rowley4, L Plank5, R McDermott6, D Leonard6 and K O'Dea4
1
Danish Epidemiology Science Center, Institute of Preventive Medicine, Copenhagen Hospital Corporation, Municipal Hospital of
Copenhagen, Denmark; 2 The Glostrup Population Studies, Medical Dept. C, Glostrup Hospital, Copenhagen, Denmark; 3 Department of
Community Health, University of Auckland, Auckland, New Zealand; 4 Deakin Institute of Human Nutrition, Deakin University,
336 Glenferrie Road, Malvern, Australia; 5 Department of Surgery, University of Auckland, Auckland, New Zealand and 6 Tropical Public
Health Unit, Queensland Health, Cairns, Queensland, Australia.
OBJECTIVE: To describe ethnic differences in the relationship between body size and body composition. Knowledge
about such differences is important when studying obesity-related complications, such as hypertension and noninsulin dependent diabetes, because it may not be possible to generalize results from one study population to other
populations.
DESIGN: Cross-sectional study.
SUBJECTS: Four groups of different ethnic identity (2987 Caucasians (Danes), 243 predominantly Melanesian (Torres
Strait Islanders from northern Australia), 206 Australian Aborigines and 146 Polynesians (New Zealand Samoans)),
aged 30±70 y, were studied.
MEASUREMENTS: We examined associations between body weight and bioelectrical impedance, as a measure of
body composition.
RESULTS: Except for Australian Aborigines, associations (slopes) between body weight and resistance were generally
constant in the different ethnic groups, once height and age differences had been considered, indicating that this
relationship may involve a certain universality, that is independent of the population speci®city for impedance
measurement. Systematic differences in instrument readings or electrodes did not seem to be responsible for the
differences found.
CONCLUSION: With the exception of Australian Aborigines, there may be a constant relation between body size and
body composition (total body water or fat free mass) of different ethnic groups, that depends on gender and age
category only.
Keywords: body composition; bioelectrical impedance; ethnic differences
Introduction
The relationship between body weight and body fatness is important in both populations and individuals.
There is recognition that this relationship may differ
between ethnic groups.1±3 However, few studies have
examined the effects of ethnicity on the relationship
between body size and body composition. Although
the prevalence of obesity-related complications, such
as hypertension and non-insulin dependent diabetes
varies widely among ethnic groups,4 data on body fatdisease vs overweight-disease relationships, is not
available. Bioelectrical impedance analysis is an
attractive tool in epidemiology for the assessment of
body composition, due to its portability, low cost and
ease of use for a large number of subjects. However,
one of the problems with the method is the apparent
population speci®city of the equations applied to
Correspondence: Dr BL Heitmann.
Received 11 October 1996; revised 13 May 1997; accepted
19 May 1997
estimate body composition.5 In this context, we have
examined the associations between bioelectrical impedance, as a measure of body composition, and body
weight, in different ethnic groups.
While the nature of the relationship between body
size and body composition may contain some fundamental characteristics, the aim of this study was to
describe the ethnic differences in the relationship.
Subjects and methods
Subjects
Four groups, of different ethnic identity, were studied:
a Caucasian group (Danes), a predominantly Melanesian group (Torres Strait Islanders from northern
Australia), a group of Australian Aborigines and a
Polynesian group (New Zealand Samoans). In all
instances, representative samples of the populations
were studied. In this present study, only subjects aged
30±70 y were included. All analyses were done separately for subjects above or below 50 y of age.
Ethnic differences in bioelectrical impedance
BL Heitmann et al
1086
The Danes
The study population included 3608 Danish citizens,
all full Caucasian, aged 35, 45, 55 and 65 y. This
group was a gender and age strati®ed random sample
of the population in the western part of the Copenhagen County.6 The group was selected from the Central
Person Register, ®ve years prior to the study, to
represent the general population. The study was part
of the Danish MONICA project.7±8 The present
examination (GEN-MONICA) was carried out from
December 1987 to November 1988. All subjects were
invited to a general health examination including
measurements of height, weight and bioelectrical
impedance. A total of 2987 subjects (83%) attended
the examination. These subjects were considered the
participating Danes. Non-participation has been
described in an earlier study.9,10.
The Samoans
The Samoans recruited for this study were matched
for body mass index (BMI) by gender and 10 y age
groups to Samoans surveyed in three communities in
different Auckland suburbs. There are no nationally
representative data for Paci®c Islands populations
living in New Zealand and these Presbyterian
church-based communities were considered to be
representative of New Zealand Samoans in general.
Mean age-adjusted BMI of the study group was
32.6 kg/m2 for males and 34.8 kg/m2 for females
compared to the community population of 33.4 kg/
m2 and 36.6 kg/m2, respectively. This difference was
signi®cant for the women (P < 0.05) but not the men.
Subjects were of at least 75% Samoan origin, did not
suffer from any serious illnesses and were not participating in weight lifting or body building. They
underwent height, weight and bioelectrical impedance
assessment in 1995. The group aged 30±70 y included
146 subjects.
The Australian Aborigines11,12
Anthropometric data, including body weight, height
and bioelectrical impedance, was collected as part of a
population-based health survey in 1995 in a group of
remote Australian Aboriginal communities in central
Australia. The communities constituted two related
population groups de®ned by language and cultural
factors. The survey included 90% of the resident adult
( 15 y) population. For the purpose of the present
analysis, where exclusion criteria were age below 30 y
or above 70 y, a total of 206 subjects were included.
The Torres Strait Islanders13
This group of indigenous Australians from The Torres
Strait region of far north Queensland is of primarily
Melanesian origin and is ethnically distinct from
mainland Australian Aboriginal people. As part of a
community health screening program (similar to that
carried out in the central Australian communities
described above), body weight, height and bioelectrical impedance data was collected in 1993±1995 in
®ve Torres Strait Island communities. The surveys
covered from 50±73% of the resident adult population
of the ®ve communities surveyed. Ethnic origin was
determined by questionnaire and subjects were
excluded from present analysis if, in addition to the
age criteria de®ned above, they reported their origins
to be wholly or partly Australian Aboriginal, or other
ethnic group. A total of 243 Torres Strait Islanders
were thus included in this analysis.
Anthropometric data
Anthropometric measurements were made in accordance with the WHO standards.14 Height (Ht) was
measured to the nearest 0.5 cm in Danes and Samoans,
and to the nearest 0.1 cm in about half the Australian
Aborigines and the Torres Strait Islanders. In the
remaining Australian Aborigines, heights were
recorded to the nearest 1 cm. All subjects were standing without shoes, heels together and head in the
horizontal Frankfurt plane. Body weight (BW) was
measured to the nearest 0.1 kg, using either a calibrated SECA scale or an UC300 digital electronic
scale. Subjects wore hospital underwear or light
clothing during measurements.
Measurements of electrical impedance
Different single frequency impedance instruments
were used for measuring impedance in the four
ethnic groups, but within ethnic group, the same
instrument was used. All Danes were measured
using a BIA-103 RJL-system-analyser, whereas
Samoans were measured with a BIA-101 RJLsystem-analyser (both from RJL-systems, Detroit,
USA). The connecting electrodes were of the brand
Accu Sensor, (Carbo Cone M45, Lynn Medical Michigan, USA) in the Danes, whereas the Samoans were
measured using halved disposable ECG electrodes,
supplied by RJL-systems. Australian Aborigines
impedance data was collected using an RJL-systems
model BIA-101Q (RJL-systems, Detroit, USA)
whereas Torres Strait Islanders impedance data came
from a SEAC model BIM-3.2 impedance analyser
(Inderlec, Sydney, Australia). In both groups, Nikota
electrodes (Nikotabs-E, Niko surgical, UK) were
used. All measurements were taken following instructions given by the manufacturer (tetra polar electrode
placement: electrodes on dorsal surfaces of right hand
and right foot, at the distal metacarpals and metatarsals, respectively, and between distal prominences of
the radius and the ulna at wrist, and the medial and
lateral malleoli at ankle. Subjects were supine with
arms and legs not touching the body, or each other).
Danes, Aborigines and Torres Strait Islanders had
measurements taken after a 12 h overnight fast,
whereas measurements in the Samoans were performed without prior fasting.
Ethnic differences in bioelectrical impedance
BL Heitmann et al
Systematic differences in impedance readings between
instruments used
We assessed differences in impedance readings
between three of the instruments used to measure
bioelectrical impedance in the ethnic groups
(machines used for Danes, New Zealand Samoans
and Australian Aborigines). Furthermore, we studied
differences in readings from the electrodes used in the
different populations. A sample of 20 men and 21
women, of different ethnicity (23 Caucasians, 2
Samoans, 2 Chinese, 5 Tongans, 2 Cook Islanders
and 7 Maori) and age (range 21±71 y) from Auckland
New Zealand, participated in the study.
The project was approved by the Ethical Committees for Copenhagen County, for University of Auckland, for Deakin University, for Alice Springs
Hospital and for Cairns Base Hospital, and is in
accordance with the Helsinki II Declaration.
Statistical methods
co-variates in the regression models. Resistance is a
function of the length (height) of the conductor (the
body) and residual age variation may confound the
relations, hence, all multiple regression analyses were
adjusted for differences in height and residual age.
Analyses of variance were used to describe differences between mean values between groups of different gender, age and ethnicity. A standard F-test was
applied to examine differences between regression
coef®cients and intercepts between ethnic groups.
This procedure has been previously described.15 To
assure linearity, probability and residual plots were
drawn for resistance, log of resistance, weight and log
weight, to test for normality and for normal distribution with constant variance of the residuals. Log
transformation did not improve linearity and all
groups had normally distributed data. All analyses
were performed using the SPSS PC‡ or the SAS PC
programmes.
Results
Two-way analysis of variance was used to describe
group differences between readings of different instruments and electrodes. Agreement between instruments
was displayed visually as differences between resistance readings as a function of the mean of the two
methods.
Multiple regression analyses were carried out for
separate stratas of gender, ethnic groups and age
(young: 30±50 y; old: 50±70 y). Impedance was
included as the dependent and weight as the independent variable. In order to account for interactions on
the associations between measures of size (body
weight) and measures of body composition (resistance), the regression models included ethnicitydependent intercepts and slopes for all stratas of
men and women in the two age-groups (30±50 y and
50±70 y). Height and residual age were included as
The characteristics (mean and s.d.) of subjects by
gender, age and ethnicity are shown in Table 1.
Within age group, mean ages were similar in all
four ethnic groups except that within the 30±50 y
age group the Danish men tended to be older, and
men from the Torres Strait Island were younger, than
other men in this group. In general average values of
weight, height and resistance were signi®cantly different between all groups of age, gender and ethnicity,
with the highest weights and lowest heights and
resistances in the Samoans. Figure 1 displays the
distribution of BMI in the four populations by
gender and age. The Samoans had the greatest prevalence of high BMI, whereas Danish women and
Australian Aboriginal men had the lowest prevalences.
Table 1 Mean and standard deviation (s.d.) of age, weight, height and resistance of the subjects by gender, age and ethnicity
Age (y) mean (s.d.)
Women (30±50 y)
Samoans (n ˆ 40)
Danes (n ˆ 772)
Torres St. (n ˆ 96)
Aborigines (n ˆ 76)
Women (50±70 y)
Samoans (n ˆ 36)
Danes (n ˆ 691)
Torres St. (n ˆ 36)
Aborigines (n ˆ 39)
Men (30±50 y)
Samoans (n ˆ 34)
Danes (n ˆ 786)
Torres St. (n ˆ 74)
Aborigines (n ˆ 63)
Men (50±70 y)
Samoans (n ˆ 36)
Danes (n ˆ 737)
Torres St. (n ˆ 37)
Aborigines (n ˆ 28)
Weight (kg) mean (s.d.)
Height (m) mean (s.d.)
Resistance (O) mean (s.d.)
39.4
40.0
39.0
38.8
(6.4)
(5.0)
(6.0)
(5.5)
92.0
64.4
87.6
67.7
(17.0)
(10.9)
(20.6)
(13.5)
1.624
1.654
1.623
1.617
(0.061)
(0.059)
(0.050)
(0.052)
459 (72)
569 (60)
511 (86)
624 (108)
58.5
59.6
59.5
58.4
(5.6)
(5.0)
(5.4)
(4.7)
86.5
66.0
76.8
66.7
(16.2)
(12.2)
(13.1)
(13.0)
1.568
1.612
1.592
1.617
(0.045)
(0.056)
(0.053)
(0.065)
480
567
541
652
(61)
(65)
(75)
(95)
39.9
40.3
38.1
39.2
(5.6)
(5.0)
(5.1)
(6.1)
95.9
80.3
94.1
74.3
(10.4)
(11.7)
(20.2)
(14.6)
1.715
1.778
1.730
1.731
(0.056)
(0.065)
(0.072)
(0.055)
386
464
418
539
(32)
(47)
(57)
(84)
59.3
59.8
58.5
59.0
(5.6)
(5.0)
(5.7)
(5.7)
96.0
79.6
84.1
74.4
(16.7)
(12.3)
(15.5)
(10.4)
1.701
1.735
1.699
1.740
(0.051)
(0.066)
(0.052)
(0.052)
391
468
442
543
(50)
(54)
(72)
(62)
1087
Ethnic differences in bioelectrical impedance
BL Heitmann et al
1088
Figure 1 Cumulative distribution curves of body mass index in the four ethnic groups by gender and age.
With the same electrodes (Accu Sensor) for all
measurements, virtually identical mean values were
obtained with the three instruments (Mean resistance
was, using the Danish instrument: 483 O, using the
New Zealand instrument: 485 O, and using the Australian instrument: 484 O). Readings were similar for
all groups of age, gender and ethnicity. Figure 2
shows the agreement between individual measurements with the three machines. Individual differences
were all less than 5% of the mean values and most
were within 2%. Different electrodes gave different
readings in the 35 subjects where comparison was
performed. In general, these differences were quite
small (1±2%), however, and did not vary systematically across the weight range (all P for trend
> 0.2). The average impedance readings, taken with
the type of electrodes used with the Danish instrument
(Accu Sensor) were, on average, 7 O lower than the
average value of the New Zealand instrument
(492 67 O compared to 498 71 O, P ˆ 0.01) and
9 O lower than the average impedance readings with
electrodes of the Australian instrument (Nikota)
(501 74 O, P ˆ 0.05).
Table 2 and Figure 3 show relationships for resistance measured by impedance regressed on body
weight, after adjustment for height and age. Weight
was negatively associated with resistance in all subgroups of gender, age and ethnicity. A standard F-test
showed that slopes were different (all P < 0.02) for
men and women aged 30±50 y in all ethnic groups,
except for Australian Aborigines. Among subjects
aged 50±70 y, slopes differed between Danish men
and Danish women only (P ˆ 0.02, all other P > 0.48).
In all men, except the Australian Aborigines, slopes
were different between those aged 30±50 y and 50±
70 y (all P < 0.01). Women displayed no signi®cant
age differences (all P > 0.17). Within the groups of
men and women aged 30±50 y, and in the women aged
Ethnic differences in bioelectrical impedance
BL Heitmann et al
aged 30±50 y was: b ˆ 72.49; s.e. ˆ 0.12, while the
slope common to Danes and Samoans aged 50±70 y
was: b ˆ 72.90; s.e. ˆ 0.13 and, Torres Strait Islanders
and Australian Aborigines aged 50±70 y: b ˆ 74.67;
s.e. ˆ 0.37). The same F-test showed that intercepts
were different for all groups by gender, age and
ethnicity, Samoans displaying the lowest intercepts,
and Australian Aborigines the highest (all P < 0.05).
Figure 3 illustrates the relations between body weight
and resistance in men and women of different agegroups, after adjusting for height and residual age
differences.
Discussion
Figure 2 Resistance measurements taken with three different
instruments used in the present study.
50±70 y there were no differences between the slopes
for the Danes, the Samoans and the Torres Strait
Islanders (all P > 0.06), whereas slopes for Australian
Aborigines were signi®cantly steeper (all P < 0.004).
In the men aged 50±70 y, the slopes for the Danes and
the Samoans were similar (P ˆ 0.31), but both were
¯atter than the slopes of Torres Strait Islanders and the
Australian Aborigines (P ˆ 0.002) of the same age.
No difference was found between the slopes of the
Torres Strait Islanders and the Australian Aborigines
(P ˆ 0.89).
The common slopes for women aged 30±50 y and
50±70 y of Danish, Torres Strait Island and Samoan
origin were: b ˆ 73.18; s.e. ˆ 0.14 and b ˆ 73.42;
s.e. ˆ 0.16 respectively, the slope common to the men
The present study was aimed at identifying differences in associations between body weight and resistance measured by bioelectrical impedance in four
different ethnic groups, living in Denmark, New
Zealand and Australia, after taking into account differences in height and age. The study showed that
associations (slopes) between body weight and resistance were generally constant in the different ethnic
groups, except for Australian Aborigines, and only
differences in the levels (intercepts) of the regression
relationships were apparent. The results indicate that
this relationship may involve a certain universality,
that is independent of the population speci®city for
impedance measurement, as proposed in other
literature.5
The results of the similar associations between
body weight and resistance in Danes, Samoans and
Torres Strait Islanders seem to be in general agreement with studies on gene pools suggesting that
differences between individuals within one ethnic
group are larger than differences between individuals
from different ethnic groups.16 The gene pool of
Australian Aborigines has been reported to bear the
least resemblance to other ethnic groups,16 a fact that
may be re¯ected in the present study.
Also, differences in relative sitting height, which are
probably also an expression of the genes, between the
Table 2 Multiple regression coef®cients (reg. coef.), standard errors (s.e.) and intercepts for the relationship between resistance and
weight in four different ethnic groups of men and women aged more than 50 y or less than 50 y
Age 30^50 y
Women
Samoans
Danes
Torres St.
Aborigines
Men
Samoans
Danes
Torres St.
Aborigines
Age 50^70 y
Reg. coef.
s.e.
Intercept
Reg. coef.
s.e.
72.94
73.23
73.13
77.28
0.50
0.17
0.28
0.67
635.3
438.9
940.1
203.9
72.30
73.45
74.72
75.47
0.41
0.17
0.73
0.90
218.7
360.7
61.0
548.9
71.23
72.45
73.11
74.85
0.47
0.13
0.33
0.52
1.7
276.9
137.4
365.4
72.77
72.94
74.32
74.83
0.40
0.14
0.52
0.56
437.5
369.1
478.0
7121.2
All multiple regressional analyses performed with statistical adjustment for differences in height and age.
All coef®cients (b) signi®cant (P < 0.01).
Intercept
1089
Ethnic differences in bioelectrical impedance
BL Heitmann et al
1090
Figure 3 Relationships between body weight and resistance in men and women of different ages and ethnicity. All multiple
regression analyses were performed with adjustment for height and residual age differences.
Australian Aborigines and the other groups may
explain the present ®ndings. Australian Aborigines
have been found to have the lowest mean relative
sitting height of any population in which this
parameter has been measured (ranges: 46.9±48.3)
followed by groups of African ancestry (ranges:
48.0±54.0).17±20 Subjects of European origin, together
with Paci®c Islanders, tend to have intermediate
values for relative sitting height, whereas Asian subjects have been reported to have the highest values,
although recent reports suggest that this is now changing, at least in the Japanese.21 We did not measure
relative sitting height in the present study. However,
the noted differences in relative sitting height have
general implications for the impedance measurements,
as resistance measurements vary as a function of
resistor length and cross sectional area.5 The relatively
longer limbs of Australian Aborigines, relative to their
trunks, would therefore, lead to higher impedance
readings in this ethnic group. Hence the different
body proportions may, in part, be responsible for the
different slopes seen between weight and resistance in
this group. In addition, Australian Aborigines tend to
have slender limbs compared to other ethnic groups, a
circumstance that also leads to higher impedance
readings.19
The present data suggest that, once differences in
gender, age and height have been taken into account, a
given difference in weight seems to correspond to the
same difference in electrical conductance, regardless
of a person's ethnic identity. It may be hypothesized
that, when differences in height have been considered,
with the exception of Australian Aborigines, there
may be a constant relation between body weight and
body composition (total body water or fat free mass)
of different ethnic groups, that depends on gender and
Ethnic differences in bioelectrical impedance
BL Heitmann et al
age category only. Although a more in-depth body
composition analysis is needed to actually establish
the validity of this hypothesis, ®ndings from Norgan22
who compared body fat to BMI relationships of
several population samples of different ethnic origin,
supports this hypothesis. On the other hand, the
signi®cantly different intercepts found between the
different groups, indicate that resistance, and thereby
possibly fat free mass, at a given level of weight, is
highly dependent on ethnicity. In this regard, the fact
that the Samoans had a lower resistance for given
body weight than, for instance the Danes, suggests
that Polynesians are leaner (more fat free mass), for
given weight than the other groups studied. This has
also been reported by others.1 However, the greater
leanness in the Samoans to a given weight does not
imply that Samoans, as a population, are leaner. The
very high prevalence of BMI > 30 kg/m2,23 suggests
that there is considerable overweight in the Samoans,
and not all of this overweight may be accounted for by
high lean/fat ratios. Australian Aborigines, on the
other hand, would be assumed to have more body
fat, at lower levels of body weight. However, because
of the steeper relationship between weight and resistance in the Australian Aborigines, lower levels of
body fat would be assumed at higher weights, as is
particularly evident in the women aged 30±50 y.
Systematic differences in instrument readings or
electrodes do not seem to be responsible for the
differences found, since differences were small and
did not vary consistently across the range of body
weight. However, the slightly lower values obtained
with the Accu sensor electrodes, may have resulted in
slightly lower intercepts in the relationships for the
Danes. Also, differences in measurement conditions
(Samoans had not fasted), exercise and/or room temperature at measurement may have played a role.
However, although a number of authors report that
both fasting, exercise and cold room temperatures
tend to lower impedance measurements, others have
reported that these conditions are of no importance, or
®nd even reversed effects.5,6
The present study indicates that in subjects of
similar age and height, a given weight difference
would be expected to result in a similar difference
in body composition in Caucasians, Melanesians and
Polynesians. At this point, it needs to be noted that the
present study is cross-sectional in design, and hence,
can not determine causal relationships. Only differences in resistance between groups of subjects, and
not individual changes in resistance with weight gain,
or age, can be predicted. This has to be considered
when interpreting the data. However, some trends are
evident. For instance, the statistically different slopes
in women and men, and in younger and older subjects
could imply that changes in weight in general, give
rise to large changes in resistance. This is likely to
re¯ect a greater proportional increase in fat mass in
women than in men, or in older than in younger
people. These ®ndings are consistent with the ®ndings
by Norgan.22 However, the data would also imply that
a given increase in body weight is accompanied by the
same change in body composition in different ethnic
groups, and hence, does not lead to a smaller increase
in obesity in, for instance, the Samoans than in the
other ethnic groups.24,25
Similarities in the relationship between resistance
and body weight (except in Australian Aborigines),
may also indicate that there is less of a need for
population speci®c equations in epidemiological
studies, because only the level (intercept) seems
speci®c to the given ethnic group after age and
gender have been taken into account. This is supported by other research, for instance the ®nding of a
common coef®cient for predicting total body water
from Ht2/R in individuals ranging from infants to
obese adults,26 or by the large number of studies
®nding that equations, developed from a suf®ciently
large population sample, seem to predict body composition with similar precision.5
Conclusions
We found large differences in the level of body weight
corresponding to a given level of resistance, measured
by electrical impedance, between the different ethnic
groups. These results suggest that large differences
exist in body composition. However, in all ethnic
groups studied, except for the Australian Aborigines,
a similar relationship was found between body weight,
as a measure of body size, and resistance, which may
be considered a measure of body composition. These
®ndings suggest that the nature of this relationship
contains some fundamental characteristics, and imply,
that weight gain may be accompanied by similar
changes in body composition, independent of ethnic
identity. The present ®ndings therefore may have
implications for our understanding of variations in
body fat-disease relationships among different ethnic
groups.
Acknowledgements
Dr Leigh Ward, University of Queensland, Australia
is warmly thanked for constructive comments to the
manuscript. The present study was kindly supported
by The Ciba Foundation, by providing Berit Lilienthal
Heitmann with a travel award to New Zealand. The
research with the Danes was supported by grants from
The Danish Health Insurance Foundation, The Danish
Research Councils and Wedell Wedellsborgs Foundation. Research with Australian Aborigines and Torres
Strait Islanders was supported by grants from the
National Health and Medical Research Council of
Australia. Research with Samoans was supported by
a grant from the New Zealand Ministry of Health.
1091
Ethnic differences in bioelectrical impedance
BL Heitmann et al
1092
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