What is eaten and how it bears on mind and body.
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151 to 175 of 1,410Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: a qualitative systematic review of the literature.
Background: Consuming a balanced diet and regular activity have health benefits. However, many adults have a difficult time adhering to diet and activity recommendations, especially in lifestyle interventions. Adherence to recommendations could be improved if common facilitators and barriers are accounted for in intervention design. The aim of this systematic review was to understand perceived barriers and facilitators to lifestyle (diet and/or activity) intervention guidelines.
Methods: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies included relied on qualitative methods to explore the barriers and facilitators healthy adults ([Formula: see text] 18 years) experienced in lifestyle interventions. Google Scholar, Cochrane Reviews, Medline, PubMed, and Web of Science were searched from January 2005 to October 2021. Main themes…
matched on Diet (mesh), nutrition (text)
Sex as a biological determinant in anthropometric, biochemical, and dietary changes during Ramadan intermittent fasting in healthy people: A systematic review.
Aims: Observing Ramadan intermittent fasting (RIF) is associated with different behavioral, dietary, and health-related outcomes among healthy and unwell people. Sex is a major biological determinant that affects various health outcomes and impacts the effectiveness of dietary and lifestyle modifications. This systematic review aimed to identify differences in health-related outcomes following the practice of RIF by the sex of study participants.
Methods: A systematic search was conducted across several databases to qualitatively identify studies focused on dietary, anthropometric, and biochemical outcomes associated with RIF in females and males.
Results: Of 3870 retrieved studies, sex-based differences were reported in 29 studies that included 3167 healthy people (females n = 1558, 49.2%). Most differences between males and females were reported both before and during RIF. Sex differen…
matched on Diet (mesh), nutrition (text)
The effect of social media interventions on physical activity and dietary behaviours in young people and adults: a systematic review.
Background: The objectives of this systematic review were to update the evidence base on social media interventions for physical activity and diet since 2014, analyse the characteristics of interventions that resulted in changes to physical activity and diet-related behaviours, and assess differences in outcomes across different population groups.
Methods: A systematic search of the literature was conducted across 5 databases (Medline, Embase, EBSCO Education, Wiley and Scopus) using key words related to social media, physical activity, diet, and age. The inclusion criteria were: participants age 13+ years in the general population; an intervention that used commercial social media platform(s); outcomes related to changes to diet/eating or physical activity behaviours; and quantitative, qualitative and mixed methods studies. Quality appraisal tools that aligned with the study designs wer…
matched on Diet (mesh), nutrition (text)
A systematic review of the use of dietary self-monitoring in behavioural weight loss interventions: delivery, intensity and effectiveness.
Objective: To identify dietary self-monitoring implementation strategies in behavioural weight loss interventions.
Design: We conducted a systematic review of eight databases and examined fifty-nine weight loss intervention studies targeting adults with overweight/obesity that used dietary self-monitoring.
Setting: NA.
Participants: NA.
Results: We identified self-monitoring implementation characteristics, effectiveness of interventions in supporting weight loss and examined weight loss outcomes among higher and lower intensity dietary self-monitoring protocols. Included studies utilised diverse self-monitoring formats (paper, website, mobile app, phone) and intensity levels (recording all intake or only certain aspects of diet). We found the majority of studies using high- and low-intensity self-monitoring strategies demonstrated statistically significant weight loss in intervention gro…
matched on Diet (mesh), nutrition (text)
Recruiting and retaining young adults: what can we learn from behavioural interventions targeting nutrition, physical activity and/or obesity? A systematic review of the literature.
Objective: To describe strategies used to recruit and retain young adults in nutrition, physical activity and/or obesity intervention studies, and quantify the success and efficiency of these strategies.
Design: A systematic review was conducted. The search included six electronic databases to identify randomised controlled trials (RCT) published up to 6 December 2019 that evaluated nutrition, physical activity and/or obesity interventions in young adults (17-35 years). Recruitment was considered successful if the pre-determined sample size goal was met. Retention was considered acceptable if ≥80 % retained for ≤6-month follow-up or ≥70 % for >6-month follow-up.
Results: From 21 582 manuscripts identified, 107 RCT were included. Universities were the most common recruitment setting used in eighty-four studies (79 %). Less than half (46 %) of the studies provided sufficient information to…
matched on Nutritional Status (mesh), nutrition (text)
Maternal-focused interventions to improve infant growth and nutritional status in low-middle income countries: A systematic review of reviews.
Background: Small and nutritionally at-risk infants under 6 months (<6m) are a vulnerable group at increased risk of mortality, morbidity, poor growth and sub-optimal development. Current national and international (World Health Organization) management guidelines focus mainly on infants' needs, yet growing evidence suggests that maternal factors also influence infant outcomes. We aimed to inform future guidelines by exploring the impacts of maternal-focused interventions on infant feeding and growth.
Methods: We conducted a systematic review of reviews published since 2008 (PROSPERO, register number CRD 42019141724). We explored five databases and a wide variety of maternal-focused interventions based in low- and middle-income countries. Infant outcomes of interest included anthropometric status, birthweight, infant mortality, breastfeeding and complementary feeding practices. Given het…
matched on Nutritional Status (mesh), nutrition (text)
The Impact of Nutrition and Intestinal Microbiome on Elderly Depression-A Systematic Review.
The aim of this review is to systematically review the evidence whether proper nutrition has a positive impact on the prevention or decline of depressive symptoms among elderly people. In addition, possible connections between nutrition, microbiome, and serotonin molecules and its tryptophan precursor are discussed. The methodology follows the PRISMA guidelines, including the PRISMA flow chart. The authors systematically reviewed peer-review, English-written articles published in Web of Science and PubMed between 2013 and 2018. The findings of six original articles, detected on the set inclusion and exclusion criteria, indicate that there is an association between nutrition and depressive symptoms in the target group, i.e., that proper nutrition has a positive impact on the prevention or reduction of depressive symptoms among elderly people. The findings also reveal that there is a consi…
matched on Nutritional Status (mesh), nutrition (text)
Consumption of ultra-processed foods and health outcomes: a systematic review of epidemiological studies.
Background: Consumption of ultra-processed foods (UPFs) plays a potential role in the development of obesity and other diet-related noncommunicable diseases (NCDs), but no studies have systematically focused on this. This study aimed to summarize the evidence for the association between UPFs consumption and health outcomes.
Methods: A comprehensive search was conducted in PubMed, Embase, and Web of Science to identify all relevant studies. Epidemiological studies were included, and identified studies were evaluated for risk of bias.A narrative review of the synthesized findings was provided to assess the association between UPFs consumption and health outcomes.
Results: 20 studies (12 cohort and 8 cross-sectional studies) were included in the analysis, with a total of 334,114 participants and 10 health outcomes. In a narrative review, high UPFs consumption was obviously associated with a…
matched on Diet (mesh), nutrition (text)
Evaluation of Dietary Approaches for the Treatment of Non-Alcoholic Fatty Liver Disease: A Systematic Review.
Lifestyle interventions, namely optimizing nutrition and increasing physical activity, remain the cornerstone of therapy for non-alcoholic fatty liver disease (NAFLD), as this can lead to the significant improvement or resolution of disease. The optimal nutritional approach to treat NAFLD remains unclear. The aim of this systematic review is to evaluate the effectiveness of different nutritional patterns on hepatic, metabolic, and weight-loss endpoints. MEDLINE via PubMed, Embase, Scopus, and Google Scholar were searched. Randomized trials of dietary interventions alone for adults with NAFLD were selected. Two authors independently reviewed articles, to select eligible studies, and performed data abstraction. Six studies, representing 317 patients, were included. The participants had a median age of 46, mean body mass index (BMI) 31.5 and were 64.3% male. The mean study duration was 16.3…
matched on Diet, Mediterranean (mesh), nutrition (text)
Unhealthy diets, obesity and time discounting: a systematic literature review and network analysis.
There is an increasing policy commitment to address the avoidable burdens of unhealthy diet, overweight and obesity. However, to design effective policies, it is important to understand why people make unhealthy dietary choices. Research from behavioural economics suggests a critical role for time discounting, which describes how people's value of a reward, such as better health, decreases with delay to its receipt. We systematically reviewed the literature on the relationship of time discounting with unhealthy diets, overweight and obesity in Web of Science and PubMed. We identified 41 studies that met our inclusion criteria as they examined the association between time discount rates and (i) unhealthy food consumption; (ii) overweight and (iii) response to dietary and weight loss interventions. Nineteen out of 25 cross-sectional studies found time discount rates positively associated w…
matched on Diet (mesh), nutrition (text)
Clark A, Mach N (2016)systematic reviewMEDLINE-indexed journal, not yet read by usJournal of the International Society of Sports Nutrition351 citations Exercise-induced stress behavior, gut-microbiota-brain axis and diet: a systematic review for athletes.
Fatigue, mood disturbances, under performance and gastrointestinal distress are common among athletes during training and competition. The psychosocial and physical demands during intense exercise can initiate a stress response activating the sympathetic-adrenomedullary and hypothalamus-pituitary-adrenal (HPA) axes, resulting in the release of stress and catabolic hormones, inflammatory cytokines and microbial molecules. The gut is home to trillions of microorganisms that have fundamental roles in many aspects of human biology, including metabolism, endocrine, neuronal and immune function. The gut microbiome and its influence on host behavior, intestinal barrier and immune function are believed to be a critical aspect of the brain-gut axis. Recent evidence in murine models shows that there is a high correlation between physical and emotional stress during exercise and changes in gastroin…
matched on Diet (mesh), nutrition (text)
Malnutrition and quality of life in older people: a systematic review and meta-analysis.
Although the effects of malnutrition on morbidity and mortality of older people is well established, there has been little work done to investigate the relationship between malnutrition and quality of life (QoL) in this population. In order to facilitate further research and to aggregate existing evidence into a clear overview, a systematic review was conducted. The objective was to identify the literature on the topic, review the findings systematically, and assess the association between nutritional status and QoL. MEDLINE, EMBASE, CINAHL and Web of Science were searched for relevant studies published up to April 2011. References within identified studies also searched. The primary author extracted all data using a purpose-built form, and evaluated the quality of the studies using a published checklist. A second reviewer checked a random sample of articles independently. Evidence in th…
matched on Nutritional Status (mesh), nutrition (text)
Moving beyond hunger and nutrition: a systematic review of the evidence linking food insecurity and mental health in developing countries.
Food insecurity is a significant problem in the developing world, and one that is likely to increase given the current global food crisis spurred by rising oil prices, conversion of food to biofuels, and reduced harvests in the wake of natural disasters. The impacts of food insecurity on nutrition status, growth, and development are well substantiated; less is known about the non-nutritional impacts of food insecurity, such as its effects on mental health. This systematic review assesses current findings regarding the impacts of food insecurity on mental health in developing countries. Both qualitative and quantitative studies are considered. The results of the search reveal that little work has examined these issues directly, and serious methodological flaws are present in many of the existing studies. Gaps in the literature, implications, and research priorities are discussed.
matched on Nutritional Status (mesh), nutrition (text)
A randomised controlled intervention trial evaluating the efficacy of a Mediterranean dietary pattern on cognitive function and psychological wellbeing in healthy older adults: the MedLey study.
Background: The incidence of age-related cognitive decline is rising considerably around the world. There is evidence from a number of recent cross-sectional and prospective studies indicating positive associations between the Mediterranean dietary pattern (MedDiet) and improved cognitive outcomes among the elderly including, reduced age-related cognitive decline and enhanced age-related cognitive performance. However, to date no study has validated these associations in healthy older adult populations (≥65 years and above) with randomised evidence. The main aim of the present study is to provide justified evidence regarding the efficacy of a MedDiet approach to safely reduce the onset of cognitive decline, and promote optimal cognitive performance among healthy older adults using rigorous, randomised intervention methodology.
Methods/design: MedLey is a 6-month, randomised controlled 2-…
matched on Diet, Mediterranean (mesh), dietary pattern (text)
Is There an Optimal Diet for Weight Management and Metabolic Health?
Individuals can lose body weight and improve health status on a wide range of energy (calorie)-restricted dietary interventions. In this paper, we have reviewed the effectiveness of the most commonly utilized diets, including low-fat, low-carbohydrate, and Mediterranean approaches, in addition to commercial slimming programs, meal replacements, and newly popularized intermittent fasting diets. We also consider the role of artificial sweeteners in weight management. Low-fat diets tend to improve low-density lipoprotein cholesterol the most, while lower-carbohydrate diets may preferentially improve triglycerides and high-density lipoprotein cholesterol. However, differences between diets are marginal. Weight loss improves almost all obesity-related co-morbidities and metabolic markers, regardless of the macronutrient composition of the diet, but individuals do vary in preferences and abili…
matched on Diet (mesh), Diet, Mediterranean (mesh), Dietary Carbohydrates (mesh), Dietary Fats (mesh)
The accelerator, the brake, and the terrain: associations of reward-related eating, self-regulation, and the home food environment with diet quality during pregnancy and postpartum in the pregnancy eating attributes study (PEAS) cohort.
Background: Neurobehavioral factors, including reward-related eating and self-regulation, in conjunction with the food environment, may influence dietary behaviors. However, these constructs have not been examined in pregnancy and postpartum, a time of changing appetite and eating behaviors, and when dietary intake has implications for maternal and child health. This study examined associations of reward-related eating, self-regulation, and the home food environment with pregnancy and postpartum diet quality.
Methods: Participants in the Pregnancy Eating Attributes Study observational cohort were enrolled at ≤12 weeks gestation and followed through one-year postpartum. Pregnancy and postpartum Healthy Eating Index-2015 (HEI-total), and adequacy and moderation scores, respectively, were calculated by pooling 24-h diet recalls administered each trimester and during 2, 6, and 12 months post…
matched on Diet (mesh), Feeding Behavior (mesh), nutrition (text)
Amatori S, Donati Zeppa S, Preti A, Gervasi M, Gobbi E, Ferrini F, Rocchi MBL, Baldari C, Perroni F, Piccoli G, Stocchi V, Sestili P, Sisti D (2020)cohort or longitudinalMEDLINE-indexed journal, not yet read by usNutrients71 citations Dietary Habits and Psychological States during COVID-19 Home Isolation in Italian College Students: The Role of Physical Exercise.
Social isolation has adverse effects on mental health, physical exercise, and dietary habits. This longitudinal observational study aimed to investigate the effects of mood states and exercise on nutritional choices, on 176 college students (92 males, 84 females; 23 ± 4 years old) during the COVID-19 lockdown. During 21 days, nutrition and exercise were daily monitored, and the mood states assessed. A factor analysis was used to reduce the number of nutritional variables collected. The relationships between exercise, mood and nutrition were investigated using a multivariate general linear model and a mediation model. Seven factors were found, reflecting different nutritional choices. Exercise was positively associated with fruit, vegetables and fish consumption (p = 0.004). Depression and quality of life were, directly and inversely, associated with cereals, legumes (p = 0.005; p = 0.004…
matched on Diet (mesh), Feeding Behavior (mesh), nutrition (text)
An R (2017)cohort or longitudinalMEDLINE-indexed journal, not yet read by usInternational journal of adolescent medicine and health45 citations Diet quality and physical activity in relation to childhood obesity.
Objective: Healthy lifestyles such as being physically active and eating a healthy diet help reduce the childhood obesity risk. However, population-level studies on the relationship between lifestyles and childhood obesity typically focus on either physical activity or diet but seldom both. This study examined physical activity and diet quality in relation to obesity in a nationally representative sample of U.S. children and adolescents.
Methods: The study sample of 2818 children 6-17 years old came from the National Health and Nutrition Examination Survey 2003-2006 waves. A healthy eating index (HEI)-2010 was constructed based on two nonconsecutive 24-h dietary recalls. Participants at or above the 60th percentile of the HEI-2010 score were classified as consuming a healthy diet. Participants engaging in at least 60 min of moderate-vigorous physical activity daily measured by accelerome…
matched on Diet (mesh), Feeding Behavior (mesh), nutrition (text)
Orthorexia nervosa: A review of psychosocial risk factors.
Orthorexia nervosa (ON) is a condition described as a pathological obsession with healthy eating. This paper will review the prevalence of ON and how ON is measured. The primary objective is to critically analyze findings on the psychosocial risk factors associated with ON, to consider its relation to other mental disorders, and to offer directions for future research. The key words "orthorexia" and "orthorexia nervosa" were searched in the databases PsycINFO and MEDLINE/PubMed. This paper reviewed peer-reviewed articles published up until December 31st, 2018. Quality assessment was conducted on each study reviewed. Results identified psychometric problems with the most common measure of ON. Gender and self-esteem were generally found to be unrelated to ON. Perfectionism, obsessive-compulsive traits, psychopathology, disordered eating, history of an eating disorder, dieting, poor body im…
matched on Feeding Behavior (mesh), Diet, Healthy (mesh)
Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, Fiol M, Gómez-Gracia E, Arós F, Lapetra J, Serra-Majem L, Pintó X, Buil-Cosiales P, Sorlí JV, Muñoz MA, Basora-Gallisá J, Lamuela-Raventós RM, Serra-Mir M, Ros E, PREDIMED Study Investigators (2019)randomised controlled trialMEDLINE-indexed journal, not yet read by usThe lancet. Diabetes & endocrinology101 citations Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial.
Background: Because of the high density of fat, high-fat diets are perceived as likely to lead to increased bodyweight, hence health-care providers are reluctant to recommend them to overweight or obese individuals. We assessed the long-term effects of ad libitum, high-fat, high-vegetable-fat Mediterranean diets on bodyweight and waist circumference in older people at risk of cardiovascular disease, most of whom were overweight or obese.
Methods: PREDIMED was a 5 year parallel-group, multicentre, randomised, controlled clinical trial done in primary care centres affiliated to 11 hospitals in Spain. 7447 asymptomatic men (aged 55-80 years) and women (aged 60-80 years) who had type 2 diabetes or three or more cardiovascular risk factors were randomly assigned (1:1:1) with a computer-generated number sequence to one of three interventions: Mediterranean diet supplemented with extra-virgin o…
matched on Diet, Mediterranean (mesh), Dietary Fats (mesh)
Delgado-Lista J, Perez-Martinez P, Garcia-Rios A, Alcala-Diaz JF, Perez-Caballero AI, Gomez-Delgado F, Fuentes F, Quintana-Navarro G, Lopez-Segura F, Ortiz-Morales AM, Delgado-Casado N, Yubero-Serrano EM, Camargo A, Marin C, Rodriguez-Cantalejo F, Gomez-Luna P, Ordovas JM, Lopez-Miranda J, Perez-Jimenez F (2016)randomised controlled trialMEDLINE-indexed journal, not yet read by usAmerican heart journal137 citations CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (the CORDIOPREV study): Rationale, methods, and baseline characteristics: A clinical trial comparing the efficacy of a Mediterranean diet rich in olive oil versus a low-fat diet on cardiovascular disease in coronary patients.
Coronary heart disease (CHD) represents a major global health burden. However, despite the well-known influence that dietary habits exert over the progression of this disease, there are no well-established and scientifically sound dietary approaches to prevent the onset of clinical outcomes in secondary prevention. The objective of the CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (CORDIOPREV study, clinical trials number NCT00924937) is to compare the ability of a Mediterranean diet rich in virgin olive oil versus a low-fat diet to influence the composite incidence of cardiovascular events after 7 years in subjects with documented CHD at baseline. For this purpose, we enrolled 1,002 coronary patients from Spain. Baseline assessment (2009-2012) included detailed interviews and measurements to assess dietary, social, and biological variables. Results of bas…
matched on Diet, Mediterranean (mesh), Olive Oil (mesh)
Serra-Paya N, Ensenyat A, Castro-Viñuales I, Real J, Sinfreu-Bergués X, Zapata A, Mur JM, Galindo-Ortego G, Solé-Mir E, Teixido C (2015)randomised controlled trialMEDLINE-indexed journal, not yet read by usPloS one30 citations Effectiveness of a Multi-Component Intervention for Overweight and Obese Children (Nereu Program): A Randomized Controlled Trial.
Introduction: Treatment of childhood obesity is a complex challenge for primary health care professionals.
Objectives: To evaluate the effectiveness of the Nereu Program in improving anthropometric parameters, physical activity and sedentary behaviours, and dietary intake.
Methods: Randomized, controlled, multicentre clinical trial comparing Nereu Program and usual counselling group interventions in primary care settings. The 8-month study recruited 113 children aged 6 to 12 years with overweight/obesity. Before recruitment, eligible participants were randomly allocated to an intensive, family-based multi-component behavioural intervention (Nereu Program group) or usual advice from their paediatrician on healthy eating and physical activity. Anthropometric parameters, objectively measured sedentary and physical activity behaviours, and dietary intake were evaluated pre- and post-interven…
matched on Diet (mesh), Fruit (mesh)
Marin C, Delgado-Lista J, Ramirez R, Carracedo J, Caballero J, Perez-Martinez P, Gutierrez-Mariscal FM, Garcia-Rios A, Delgado-Casado N, Cruz-Teno C, Yubero-Serrano EM, Tinahones F, Malagon Mdel M, Perez-Jimenez F, Perez-Jimenez F, Lopez-Miranda J (2012)randomised controlled trialMEDLINE-indexed journal, not yet read by usAge (Dordrecht, Netherlands)64 citations Mediterranean diet reduces senescence-associated stress in endothelial cells.
This paper aims to study the effects of the oxidative stress induced by quality and quantity of dietary fat on cellular senescence. Twenty elderly subjects consumed three diets, each for 4 weeks: a saturated fatty acid diet (SFA), a low-fat and high-carbohydrate diet (CHO-ALA), and a Mediterranean diet (MedDiet) enriched in monounsaturated fatty acid following a randomized crossover design. For each diet, we investigated intracellular reactive oxidative species (ROS), cellular apoptosis and telomere length in human umbilical endothelial cells incubated with serum from each patient. MedDiet induced lower intracellular ROS production, cellular apoptosis, and percentage of cell with telomere shortening, compared with the baseline and with SFA and CHO-ALA diets. Dietary fat modulates the oxidative stress in human endothelial cells. MedDiet protects these cells from oxidative stress, prevents…
matched on Diet, Mediterranean (mesh), Dietary Carbohydrates (mesh)
Association of breakfast intake with obesity, dietary and physical activity behavior among urban school-aged adolescents in Delhi, India: results of a cross-sectional study.
Background: In developed countries, regular breakfast consumption is inversely associated with excess weight and directly associated with better dietary and improved physical activity behaviors. Our objective was to describe the frequency of breakfast consumption among school-going adolescents in Delhi and evaluate its association with overweight and obesity as well as other dietary, physical activity, and sedentary behaviors.
Methods:
Design: Cross-sectional study.
Setting: Eight schools (Private and Government) of Delhi in the year 2006.
Participants: 1814 students from 8th and 10th grades; response rate was 87.2%; 55% were 8th graders, 60% were boys and 52% attended Private schools.
Main outcome measures: Body mass index, self-reported breakfast consumption, diet and physical activity related behaviors, and psychosocial factors.
Data analysis: Mixed effects regression models were empl…
matched on Diet (mesh), Energy Intake (mesh)
Pagliai G, Sofi F, Vannetti F, Caiani S, Pasquini G, Molino Lova R, Cecchi F, Sorbi S, Macchi C (2018)MEDLINE-indexed journal, not yet read by usThe journal of nutrition, health & aging24 citations Mediterranean Diet, Food Consumption and Risk of Late-Life Depression: The Mugello Study.
Objectives: To investigate eating habits and adherence to Mediterranean Diet (MD) in relation to the risk of depression in a cohort of nonagenarians enrolled within the Mugello Study, an epidemiological study aimed at investigating both clinically relevant geriatric items and various health issues, including those related to nutritional status.
Design: Cross-sectional study.
Setting: Homes and nursing homes in the Mugello area, Florence, Italy.
Participants: Subjects aged 90-99 years [N=388 (271F; 117M) mean age: 92.7±3.1].
Measurements: All subjects were evaluated through questionnaires and instrumental examinations. Adherence to MD was assessed through the Mediterranean Diet Score. A shorter version of the Geriatric Depression Scale (GDS) was used to detect the possible presence of depressive symptoms. In addition, cognitive and functional status was assessed using the Mini-Mental Stat…
matched on Diet, Mediterranean (mesh), Nutritional Status (mesh), Feeding Behavior (mesh), Fruit (mesh), Olive Oil (mesh), nutrition (text), Olive Oil (keyword)