Effects of 12 weeks of aerobic exercise plus dietary restriction on body composition, resting energy expenditure and aerobic fitness in mildly obese middle-aged women

This study investigated the effects of 12 weeks of aerobic exercise plus voluntary food restriction on the body composition, resting metabolic rate (RMR) and aerobic fitness of mildly obese middle-aged women. The subjects were randomly assigned to exercise/diet (n = 17) or control (n = 15) groups. The exercise/diet group participated in an aerobic training programme, 45–60 min · day ^–1 at 50%–60% of maximal oxygen uptake (VO_2max), 3–4 days · week^–1, and also adopted a self-regulated energy deficit relative to predicted energy requirements (–1.05 MJ · day ^–1 to –1.14 MJ · day ^–1 ). After the regimen had been followed for 12 weeks, the body mass of the subjects had decreased by an average of 4.5 kg, due mainly to fat loss, with little change of fat free mass (m _ff). The absolute RMR did not change, but the experimental group showed significant increases in the RMR per unit of body mass (10%) and the RMR per unit of m _ff (4%). The increase in RMR/m _ff was not correlated with any increase in VO_2max/m _ff. The resting heat production per unit of essential body mass increased by an average of 21%, but the resting heat production rate per unit of fat tissue mass remained unchanged. We concluded that aerobic exercise enhances the effect of moderate dietary restriction by augmenting the metabolic activity of lean tissue.     

Relationship of androgens to body composition, energy and substrate metabolism and aerobic capacity in healthy, young women

Objective

To evaluate the role of physiologic levels of androgens and their precursors in the regulation of body composition, energy and substrate metabolism and aerobic capacity in healthy, cycling, premenopausal women.

Experimental

We evaluated 30 young (27 ± 1 year) premenopausal, non-obese (23 ± 0.5 kg/m²), normally-cycling women, without clinical or chemical evidence of hyperandrogenism or hyperinsulinemia, for parameters of total and regional body composition, glucose tolerance, aerobic capacity and resting energy expenditure and substrate oxidation. Serum was assayed for androgens and androgen precursors by techniques optimized to assess the low androgen levels in this population.

Results

Higher serum testosterone levels correlated with greater fat mass (r = 0.377; p = 0.04), but not abdominal adiposity or other metabolic/physiologic variables. Additionally, dehydroepiandrosterone (DHEA) was negatively related to visceral fat content (r = −0.569; p = 0.02). Other serum androgens did not correlate with total or regional adiposity, skeletal muscle mass, aerobic capacity, glucose tolerance, or resting energy and substrate metabolism.

Conclusion

In this group of non-obese, premenopausal women with no clinical or chemical evidence of hyperandrogenemia, serum testosterone levels were positively related with fat mass, but not with abdominal adiposity; whereas, DHEA was negatively related to visceral adiposity. Our data suggest that within the normal physiologic range, testosterone is a predictor of overall adiposity, but that this effect does not appear to be associated with concomitant alterations in resting energy or substrate metabolism that could predispose to weight gain.     

Peak power and body mass as predictors of tibial bone strength in healthy male and female adults

Objective:The purpose of this study was to examine whether a non-invasive, muscular fitness field test was a better predictor of bone strength compared to body mass in healthy adults.Methods:Hierarchical multiple regression analyses were used to determine the amount of variance that peak power explained for tibial bone strength compared to body mass. Peak power was estimated from maximal vertical jump height using the Sayer’s equation. Peripheral quantitative computed tomography scans were used to assess bone strength measures.Results:Peak power (β=0.541, p<0.001) contributed more to the unique variance in bone strength index for compression (trabecular bone) compared to body mass (β=-0.102, p=0.332). For polar strength strain index (cortical bone), the beta coefficient for body mass remained significant (β=0.257, p<0.006), however peak power’s contribution was similar (β=0.213, p=0.051).Conclusion:Compared to body mass, peak power was a better predictor for trabecular bone strength but similar to body mass for cortical bone strength. These data provide additional support for the development of a vertical jump test as an objective, valid and reliable measure to monitor bone strength among youth and adult populations.     

Influence of maturation on anthropometry and body composition in Japanese junior high school students

Background

The purpose of this study was to examine maturity-related differences in anthropometry and body composition in Japanese youth within a single year.

Methods

Two hundred and ten Japanese youth aged from 13 to 13.99 years participated in this study. Their maturity status was assessed using a self-assessment of stage of pubic hair development. Bioelectrical impedance analysis was used to estimate percent body fat and lean body mass (LBM). Muscle thickness of the anterior thigh, posterior lower leg and rectus abdominis muscles were measured by ultrasound.

Results

For boys, height, body weight, and LBM in less mature groups were lower than that in more mature groups. The maturity-related differences were still significant after adjusting for chronological age. On the other hand, muscle thickness values in the lower extremity and abdomen differed among the groups at different stages of pubic hair development, whereas there was no maturity-related difference in the relative values corrected by LBM, except for those thickness values measured at the abdomen. For girls, only the muscle thickness at the anterior thigh and muscle thickness relative to LBM^1/3 at the posterior lower leg was significantly affected by maturity status, but significant maturity-related difference was not found after adjusting for chronological age.

Conclusions

At least for Japanese boys and girls aged 13 years, maturity status affected body size in boys, but not in girls, and the influence of maturation on the muscularity of the lower extremity and trunk muscles is less in both sexes.     

Orchiectomized Fischer 344 male rat models body composition in hypogonadal state

The hypogonadal state in men is accompanied by substantial decreases in muscle and bone mass and by an increase in adiposity. Most of the strains of orchiectomized (ORX) rat that have been used to model this state display substantial losses in bone, but only subtle changes in adiposity and muscle mass. In order to identify a rat model displaying a robust catabolic response to ORX, we studied three strains: Fischer 344 (F344), Brown Norway and Wistar. ORX caused a significant and sustained decrease in weight gained by F344, but only a trend toward reduced weight gain in Brown Norway rats and a modest reduction weight gain in Wistar rats that was significant only after 56days. ORX suppressed food intake in F344 rats, and to a lesser degree in Brown Norway and Wistar rats. ORX reduced muscle mass significantly in F344 rats, but not in Brown Norway or Wistar rats. ORX increased adiposity moderately in F344 rats and substantially in Wistar rats. ORX caused a marked reduction in prostate mass and increase in bone resorption in all three strains. Thus, F344 was the only strain in which ORX produced substantial decreases in food intake, body weight and muscle mass with increased adiposity and increased bone resorption. We conclude that the F344 rat displays a broad range of catabolic effects following ORX and is the best rat model for studying the androgenic pathway and strategies for reversing catabolic changes induced by hypogonadism.     

中国少数民族体成分的变化

本文对中国少数民族23352例（男10070例,女13282例）的体成分进行了分析,以了解中国少数民族脂肪率、肌肉量的现状,探讨体成分随年龄增长的变化规律。研究发现,男性和女性总体上属于超重水平,还没有达到肥胖水平。与南方族群男性相比,北方阿尔泰语系族群的男性四肢脂肪率高、内脏脂肪等级高、水分率低。南方族群中,藏缅语族群、苗瑶语族群、壮侗语族群的四肢脂肪率、内脏脂肪等级、水分率相对接近;南亚语系族群与这3个南方族群差距较大。与南方族群女性相比,北方阿尔泰语系族群的女性躯干、四肢肌肉量大,骨骼重;南方4个族群女性躯干、四肢肌肉量较小,骨骼较轻,骨量、肌肉量彼此接近。随年龄增长,男性骨量下降,水分率增大;上肢脂肪率减小,躯干脂肪率增大,内脏脂肪等级增大,即脂肪向躯干集中,全身总体脂率增大;下肢肌肉量减少,躯干肌肉量下降,最终导致全身总肌肉量下降。随年龄增长,女性上肢的脂肪率和肌肉量没有明显变化,下肢的脂肪率下降,躯干脂肪率和内脏脂肪等级增大,总体脂率增大;躯干肌肉量下降,总肌肉量下降。男性推定骨量下降的节点是50岁,女性是60岁。男性总肌肉量下降的节点是40岁,女性是50岁。男性、女性身体水分率增加的节点都是60岁,内脏脂肪等级增加的节点都是30岁,总脂肪率下降的节点都是60岁,躯干脂肪率增加的节点都是30岁,躯干肌肉量下降的节点都是40岁。研究还发现,体脂率、内脏脂肪等级与血糖呈显著正相关。研究结果反映了中国少数民族从青年到老年的体成分变化的基本规律。     

Grip strength, muscle fatigue, and body composition in nomadic Turkana pastoralists

Tests of hand grip strength and hand grip muscle fatigue were conducted on Ngisonyoka Turkana pastoralists of northwest Kenya to explore some of the functional relationships between activity and body composition. The test of maximal voluntary contraction (MVC) of hand grip flexors was conducted on 151 Turkana and 38 U.S. men and women. The fatigue test was conducted on the same number of subjects who were instructed to attempt to maintain 80% of the MVC for 90 seconds. The results of these tests, combined with arm measurements of size and body composition, were used to evaluate muscle size and strength relationships and to estimate muscle fiber type distribution in the forearm. MVC values of Turkana men were low by U.S. and European standards. The low values resulted from smaller Turkana muscle areas. MVC values of Turkana women were comparable to those of U.S. and European women, reflecting comparable muscle areas. The fatigue curves of Turkana and U.S. men and women suggest that slow-twitch aerobic muscle fibers predominate for the hand grip flexors of the Turkana pastoralists.     

Morphological and functional differences in the elbow extensor muscle between highly trained male and female athletes

The purpose of this study was to investigate the difference in the morphological and functional aspects of the triceps brachii muscle between highly trained male and female athletes who were members of the 1996 Japanese Olympic teams in each of three different events: soccer, gymnastics and judo. The thickness (TB_mt) and fibre pennation angle (TB_pen) of the triceps brachii muscle and force output during elbow extensions were determined using a B-mode ultrasound apparatus and an isokinetic dynamometer, respectively. The TB_mt and its value relative to upper arm length (TB_mt/l _ua) were significantly larger in the men than in the women in all the events except judo. In all the subjects, a significant correlation was found between TB_mt/l _ua) and TB_pen (r= 0.721, P < 0.05). The existence of the sex difference in TB_pen within the same event was in agreement with that observed in TB_mt/l _ua except for the soccer players. The TB_pen of the soccer players were similar in both sexes although a significant sex differences was found in TB_mt/l _ua. The isokinetic forces measured using the two velocities 60°· s⁻¹ (F ₆₀) and 180°· s⁻¹ (F ₁₈₀) were significantly correlated to the cross-sectional area (CSA) of the triceps brachii muscle estimated from TB_mt (r= 0.702, P < 0.05 for F ₆₀, and r= 0.776, P < 0.05 for F ₁₈₀). No significant sex differences were found in either F ₆₀/CSA or F ₁₈₀/CSA in any of the events. From these results, it could be assumed, at least in the Olympic athletes tested in this study, that the fibre angulation of the triceps brachii muscle was almost the same in the two sexes if allowance was made for the difference in the muscle size, and the sex difference in force generation capability of the triceps brachii muscle could in the main be attributed to the difference in CSA rather than in the architectural characteristics. Accepted: 7 January 1998     

Phenotypic flexibility of body composition associated with seasonal acclimatization in passerine birds

Improved winter cold tolerance is widespread among small birds overwintering in cold climates and is associated with improved shivering endurance and elevated summit metabolic rate (M_sum). Phenotypic flexibility resulting in elevated M_sum could result from either increased skeletal muscle mass (perhaps with support from similar adjustments in “nutritional organs”) and/or cellular metabolic intensity. We investigated seasonal changes in body composition of three species of passerine birds resident in cold winter climates, all of which show large seasonal variations in M_sum (>25%); white-breasted nuthatch (Sitta carolinensis), black-capped chickadee (Poecile atricapillus), and house sparrow (Passer domesticus). All three species displayed significant winter increases in pectoralis and heart masses, and supracoracoideus mass also increased in winter chickadees. Gizzard mass increased in winter for all three species, but masses of other nutritional organs did not vary consistently with season. These data suggest that winter increases in pectoralis and heart masses are important contributors to elevated thermogenic capacity and cold tolerance, but seasonal variation in nutritional organ masses, other than gizzard, which is likely associated with dietary changes, are not universally associated with seasonal phenotypes. The winter increases in pectoralis and heart masses are consistent with data from other small passerines showing marked seasonal changes in cold tolerance and support the Variable Maximum Model of seasonal phenotypic flexibility, where physiological adjustments that promote improved cold tolerance, also result in elevated M_sum.     

Association between body mass index and muscularity in healthy older Japanese women and men

Background

Body mass index (BMI), expressed as the ratio of body mass to height squared (kg/m²), involves not only fat but also lean mass. The present study aimed to clarify how BMI is associated with total muscle mass (TMM) in older Japanese women and men.

Findings

Using a B-mode ultrasound apparatus, muscle thickness was measured at nine sites (forearm, upper arm anterior and posterior, thigh anterior and posterior, lower leg anterior and posterior, abdomen, and subscapular) for 346 women (BMI 16.40 to 33.11 kg/m²) and 286 men (BMI 16.86 to 31.18 kg/m²) aged 60.0 to 79.5 yrs. TMM was estimated using the product of the sum of the muscle thicknesses at the nine sites with height as an independent variable. For both sexes, the estimated TMM relative to height squared was significantly correlated with BMI (r = 0.688, P<0.0001 for women; r = 0.696, P<0.0001 for men), but the percentage of the estimated TMM in body mass was not.

Conclusion

These results indicate that, for older Japanese women and men, BMI is a simple and convenient index for assessing total muscularity.     

Relationship between maximal oxygen uptake on different ergometers, lean arm volume and strength in paraplegic subjects

The present experiment was designed to study the importance of strength and muscle mass as factors limiting maximal oxygen uptake (V˙O_{2 max} ) in wheelchair subjects. Thirteen paraplegic subjects [mean age 29.8 (8.7) years] were studied during continuous incremental exercises until exhaustion on an arm-cranking ergometer (AC), a wheelchair ergometer (WE) and motor-driven treadmill (TM). Lean arm volume (LAV) was estimated using an anthropometric method based upon the measurement of various circumferences of the arm and forearm. Maximal strength (MVF) was measured while pushing on the rim of the wheelchair for three positions of the hand on the rim (−30°, 0° and +30°). The results indicate that paraplegic subjects reached a similar V˙O_{2 max} [1.23 (0.34) l · min⁻¹, 1.25 (0.38) l · min⁻¹, 1.22 (0.18) l · min⁻¹ for AC, TM and WE, respectively] and V˙O_{2 max} /body mass [19.7 (5.2) ml · min⁻¹ · kg⁻¹, 19.5 (6.14) ml · min⁻¹ · kg⁻¹, 19.18 (4.27) ml · min⁻¹ · kg⁻¹ for AC, TM and WE, respectively on the three ergometers. Maximal heart rate f _{c max} during the last minute of AC (173 (17) beats · min⁻¹], TM [168 (14) beats · min⁻¹], and WE [165 (16) beats · min⁻¹], were correlated, but f _{c max} was significantly higher for AC than for TM (P<0.03). There were significant correlations between MVF and LAV (P<0.001) and between the MVF data obtained at different angles of the hand on the rim [311.9 (90.1) N, 313.2 (81.2) N, 257.1 (71) N, at −30°, 0° and +30°, respectively]. There was no correlation between V˙O_{2 max} and LAV or MVF. The relatively low values of f _{c max} suggest that V˙O_{2 max} was, at least in part, limited by local aerobic factors instead of central cardiovascular factors. On the other hand, the lack of a significant correlation between V˙O_{2 max} and MVF or muscle mass was not in favour of muscle strength being the main factor limiting V˙O_{2 max} in our subjects. Accepted: 31 January 1997     

Comparison of body composition in middle-aged and elderly males using computed tomography

Computed tomography (CT) scans were taken of 21 middle-aged men (mean age 46.3 years) and 20 older men (mean age 69.4 years) to measure differences in body composition with age. Overall, the older men weighed 8.2 kg less than the middle-aged men, and this difference was primarily the result of their having less lean tissue. Although fat mass (by whole body potassium counting) was only slightly less in older men, there were distributional differences in fat between the age groups. Total abdomen adipose tissue area (from CT) was similar in both groups, although the subcutaneous portion of the abdomen adipose tissue was less in the older men, and they had correspondingly more adipose tissue within the abdominal cavity. Muscle areas of the leg and arm were significantly less in the older men, as were all lean tissues of the abdomen and chest. When these data were corrected for differences in body weight with age, the results were still significant, suggesting a centripetalization and internalization of fat with age. Causes of this apparent fat redistribution and decrease of lean tissue with age were not revealed by this study and are presently unknown.     

Variation in body composition of female big brown bats (Eptesicus fuscus) during lactation

Most small mammals support the nutritional requirements of milk production by increasing food intake. However, when nutrient intake is low, maternal body reserves may be mobilized to maintain adequate milk output. We examined patterns of body composition, including dry matter, fat, protein, and mineral content in big brown bats, Eptesicus fuscus, during lactation. Concentrations of fat and phosphorus were markedly lower in lactating mothers during week three of lactation than during the first two weeks, but these constituents rebounded to previous levels in the fourth and fifth week. Rapid recovery from fat depletion suggests that females are able to adjust to changes in demands for energy. The decrease in phosphorus during mid-lactation suggests bone demineralization, but an interspecific comparison of adult concentrations of minerals prevalent in bone suggests that mineral concentrations may never reach critically low levels in reproductively active females.     

Maximal aerobic power and leg muscle mass and strength related to age in non-athletic males and females

To investigate the relationships between the age-associated decline in peak oxygen uptake (peak VO2), leg muscle mass (LMM) and leg strength (LS) under the modulating effect of gender and level of physical activity (LPA, as assessed by questionnaire), we evaluated 71 sedentary subjects [males(M):females(F), 34:37], aged 20-80 years. Peak VO2 at maximum cycle ergometry was related to LMM (dual energy X-ray absorptiometry) and LS (isokinetic dynamometry) using both standard (y x x(-1)) and power function ratios (allometry). Absolute values of all variables were higher in males and declined with age (P < 0.01). Differences between the genders disappeared after peak VO2 x LS(-1.46(M)or -1.62(F)) adjustment but remained significant between peak VO2 LMM-(-0.51 (M)or -0.45(F)) and LS LMM- (-091(M) or -1.10(F)) corrected values. Allometric correction of peak VO2 and LS by LMM slowed their age-related declines; the flattening effect however, was more evident in the females. Interestingly, while no age-related decrement in peak VO2 LS(-1) was found, power function ratio values also declined with age, and at a slower rate in females. These findings are consistent with those obtained following a multiple regression analysis using LPA as an independent covariate (P < 0.01). We conclude that using adequate scaling methods and controlling by LPA: (1) no gender differences are observed in peak VO2 adjusted for LS, (2) loss of LS and LMM are important determinants of the age-associated reduction in physical fitness in both genders but (3) age per se has an LS- and LMM-independent influence on the functional decline, although this intrinsic effect of senescence is less pronounced in females.     

Behavioral responses to physical vs. social novelty in male and female laboratory rats

Most behavioral tests used with laboratory rodents involve measuring behavioral responses to physical novelty. However, laboratory rodents are often derived from highly social species for which novel social stimuli may induce different levels of fear or curiosity compared to novel physical objects. We hypothesized that behavioral responses will differ in response to novel physical vs. social cues, and that females may show more exploration of social novelty, based on prior studies indicating that females more actively seek social support during duress compared to males. We compared young (55-day-old) Sprague-Dawley rats’ responses to an arena filled with novel objects (“physical”) or a novel same-sex caged conspecific (“social”). Rats were more active and spent twice as much time in contact with the novel social stimulus compared to novel physical stimuli. Although females were more active than males, females were not particularly more exploratory in the social arena compared to males. The results indicate that a novel social partner (even a caged one with limited ability to interact) elicits more exploration than novel objects for both male and female rats.     

Maximal oxygen uptake, anaerobic threshold and running economy in women and men with similar performances level in marathons

Sex differences in running economy (gross oxygen cost of running, C_R), maximal oxygen uptake (VO_2max), anaerobic threshold (Th_an), percentage utilization of aerobic power (% VO_2max), and Th_an during running were investigated. There were six men and six women aged 20–30 years with a performance time of 2 h 40 min over the marathon distance. The VO_2max, Th_an, and CR were measured during controlled running on a treadmill at 1° and 3° gradient. From each subject's recorded time of running in the marathon, the average speed (v _M) was calculated and maintained during the treadmill running for 11 min. The VO_{2 max} was inversely related to body mass (m _b), there were no sex differences, and the mean values of the reduced exponent were 0.65 for women and 0.81 for men. These results indicate that for running the unit ml·kg^–0.75·min^–1 is convenient when comparing individuals with different m _b. The VO_2max was about 10% (23 ml·kg^–0.75·min^–1) higher in the men than in the women. The women had on the average 10–12 ml·kg^–0.75·min^–1 lower VO₂ than the men when running at comparable velocities. Disregarding sex, the mean value of C_R was 0.211 (SEM 0.005) ml·kg^–1·m^–1 (resting included), and was independent of treadmill speed. No sex differences in Th_an expressed as % VO_2max or percentage maximal heart rate were found, but Than expressed as VO₂ in ml·kg^–0.75·min^–1 was significantly higher in the men compared to the women. The percentage utilization of f _emax and concentration of blood lactate at v _M was higher for the female runners. The women ran 2 days more each week than the men over the first 4 months during the half year preceding the marathon race. It was concluded that the higher VO_2max and Th_an in the men was compensated for by more running, superior C_R, and a higher exercise intensity during the race in the performance-matched female marathon runners.     

Cinnamon improves insulin sensitivity and alters the body composition in an animal model of the metabolic syndrome

Polyphenols from cinnamon (CN) have been described recently as insulin sensitizers and antioxidants but their effects on the glucose/insulin system in vivo have not been totally investigated. The aim of this study was to determine the effects of CN on insulin resistance and body composition, using an animal model of the metabolic syndrome, the high fat/high fructose (HF/HF) fed rat. Four groups of 22 male Wistar rats were fed for 12 weeks with:

(i)

(HF/HF) diet to induce insulin resistance,

(ii)

HF/HF diet containing 20 g cinnamon/kg of diet (HF/HF + CN),

(iii)

Control diet (C) and

(iv)

Control diet containing 20 g cinnamon/kg of diet (C + CN).

Data from hyperinsulinemic euglycemic clamps showed a significant decrease of the glucose infusion rates in rats fed the HF/HF diet. Addition of cinnamon to the HF/HF diet increased the glucose infusion rates to those of the control rats. The HF/HF diet induced a reduction in pancreas weight which was prevented in HF/HF + CN group (p < 0.01). Mesenteric white fat accumulation was observed in HF/HF rats vs. control rats (p < 0.01). This deleterious effect was alleviated when cinnamon was added to the diet. In summary, these results suggest that in animals fed a high fat/high fructose diet to induce insulin resistance, CN alters body composition in association with improved insulin sensitivity.     

Doxorubicin treatment in vivo activates caspase-12 mediated cardiac apoptosis in both male and female rats

We investigated in vivo the chemotherapeutic anthracycline agents doxorubicin and its ability to activate mitochondrial-mediated, receptor-mediated and endoplasmic/sarcoplasmic reticulum-mediated apoptosis transduction pathways in cardiac tissue from male and female rats. We administered a single low dose of doxorubicin (10 mg/kg of body weight, i.p.) and then isolated mitochondrial and cytosolic proteins one and four days later from the heart. Caspase-3 protein content and caspase-3 activity were significantly increased after day four of doxorubicin treatment in both male and female rats. However, while males had DNA fragmentation at day one but not day four following doxorubicin administration, females showed no significant increase in DNA fragmentation at either time. Caspase-12, localized in the SR, is considered a central caspase, and its activation by cleavage via calpain indicates activation of the SR-mediated pathway of apoptosis. Cleaved caspase-12 content and calpain activity significantly increased after day four of doxorubicin treatment in both sexes. In the mitochondrial-mediated pathway, there were no significant treatment effects observed in cytosolic cytochrome c and cleaved (active) caspase-9 in either sex. In control rats (saline injection), glutathione peroxidase (GPX) activity and hydrogen peroxide (H2O2) production were lower in females compared to males. Doxorubicin treatment did not significantly affect H2O2, GPX activity or ATP production in isolated mitochondria in either sex. Female rats produced significantly lower levels of H2O2 production one day after doxorubicin treatment, whereas male rats produced significantly less mitochondrial H2O2 four days after doxorubicin treatment. The receptor-mediated pathway (caspase-8 and c-FLIP) showed no evidence of being significantly activated by doxorubicin treatment. Hence, doxorubicin-induced apoptosis in vivo is mediated by the SR to a greater extent than other apoptotic pathways and should therefore be considered for targeted therapeutic interventions. Moreover, no major sex differences exist in apoptosis signaling transduction cascade due to doxorubicin treatment.