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Wednesday 31 October 2007

Be thin to cut cancer - World Cancer Research Fund report

reposted from: http://news.bbc.co.uk/1/hi/health/7069914.stm

Be thin to cut cancer, study says
Bacon on shelves
A no no: people should try to avoid bacon, the study urges
Even those who are not overweight should slim down if they want to cut their risk of cancer,
a major international study - Food, Nutrition,
Physical Activity, and the Prevention of Cancer: a global Perspective, has claimed.

The World Cancer Research Fund WCRF carried out the largest ever inquiry into lifestyle and cancer, and issued several stark recommendations.

They include

not gaining weight as an adult, avoiding sugary drinks and alcohol, and not eating bacon or ham.

Everyone must also aim to be as thin as possible without becoming underweight.

People with a Body Mass Index (BMI), a calculation which takes into account height and weight, of between 18.5 and 25, are deemed to be within a "healthy" weight range.

Cancer is not a fate, it is a matter of risk, and you can adjust those risks by how you behave. It is very important that people feel that they are in control of what they do
Professor Martin Wiseman
Report author

But the study says t

heir risk increases as they head towards the 25 mark, and that everyone should try to be as close to the lower end as possible.

There is no new research involved in this document: the panel examined 7,000 existing studies over five years.

The result, they say, is the most comprehensive investigation ever into the risks of certain lifestyle choices.

RECOMMENDATIONS INCLUDE:
Limit red meat
Limit alcohol
Avoid bacon, ham, and other processed meats
No sugary drinks
No weight gain after 21
Exercise every day
Breastfeed children
Do not take dietary supplements to cut cancer

They see body fat as a key factor in the development of cancer, estimating its significance to be much higher than previously thought.

The report's authors say they have produced a list of recommendations, not "commandments".

"But if people are interested in reducing their cancer risk, then following the recommendations is the way to do it," said Professor Martin Wiseman.

"Cancer is not a fate, it is a matter of risk, and you can adjust those risks by how you behave. It is very important that people feel that they are in control of what they do."

Making cuts

However, two-thirds of cancer cases are not thought to be related to lifestyle, and there is little people can do to prevent the disease in these circumstances.

READ THE FINDINGS

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Nevertheless,

more than three million of the 10 million cases of cancer which are diagnosed across the world each year could be prevented if the recommendations were followed,
Professor Wiseman indicated.

In the UK alone, there are 200,000 new cases of cancer each year.

Cancers of the colon and breast are some of the most common forms of the disease, and the report says the evidence is "convincing" that body fat plays a key role in the development of these tumours.

The report also links the kind of food consumed to cancers, especially colorectal ones.

In particular, researchers say people should stop eating processed meats, such as ham, bacon and salami, and limit the consumption of red meat to 500g a week - although this still means you could eat, for instance, five hamburgers each week.

Alcohol, red meat and bacon in moderation will do us no harm, and to suggest it will is wrong
Karol Sikora
Cancer specialist

From a cancer perspective, all alcohol should be avoided, although researchers accepted drinking small amounts could have protective benefits for other diseases.

The recommendation is therefore

no more than two drinks a day for a man, and no more than one for a woman, slightly less than current UK government guidelines.

Sugary drinks meanwhile should be avoided, as these make you fat, and fruit juice consumption should also be reduced.

The report is also the first to urge breastfeeding as a means to protect against cancer, arguing that it may reduce breast cancer in the mother and prevent obesity in the child - although this has not been proven.

Cancer specialist Professor Karol Sikora said: "The educational message for the public should be that there are healthy diets and unhealthy diets but we should keep everything in perspective and not suggest rigid avoidance.

"Alcohol, red meat and bacon in moderation will do us no harm, and to suggest it will is wrong."

Antonia Dean, a specialist at Breast Cancer Care, said: "it is notoriously difficult to examine the potential role of diets or other lifestyle factors on breast cancer, as it is hard to isolate specific influences or establish how they might interact with each other.

"It is important that women keep the report findings in perspective - after gender, the highest known risk factor in relation to breast cancer is age, with 80 per cent of cases occurring in women over the age of 50."

Links:

Cancer Research UK

Have your Say at the BBC


Sunday 28 October 2007

Georgina Street BMI

BMI Calculator for Child and Teen: Results on a Growth Chart



Information Entered for Georgina Street

Age: 13 years 0 months Sex: Girl
Birth Date: October 10, 1994 Height: 4 feet 11 inch(es)
Date of Measurement: October 28, 2007 Weight: 88 pounds




Results




Based on the height and weight entered, the BMI is 17.8, placing the BMI-for-age at the 36th percentile for girls aged 13 years 0 months. This teen has a healthy weight.



Body mass index-for-age percentiles: Girls, 2 to 20 years

Growth chart of BMI-for-age percentile for girls, 2 to 20 years



BMI Range: Healthy weight


orange underweight, less than the 5th percentile
green healthy weight, 5th percentile up to the 85thpercentile
yellow at risk of overweight, 85th to less than the 95th percentile
red overweight, equal to or greater than the 95th percentile




What does this mean?

BMI is calculated using your child’s weight and height and is then used to find the corresponding BMI-for-age percentile for your child’s age and sex.

BMI-for-age percentile shows how your child’s weight compares to that of other children of the same age and sex. For example, a BMI-for-age percentile of 65% means that the child’s weight is greater than that of 65% of other children of the same age and sex.

Based on the height and weight entered, the BMI is 17.8, placing the BMI-for-age at the 36th percentile for girls aged 13 years 0 months. This teen has a healthy weight.

Maintaining a healthy weight throughout childhood and adolescence may reduce the risk of becoming overweight or obese as an adult.




What should you do?

Regardless of the current BMI-for-age category, help your child or teen develop healthy weight habits and keep track of BMI-for-age.

Practice healthy weight habits
Encourage children and teens to practice healthy weight habits by:
  • Eating healthy foods
  • Participating in physical activity on most (preferably all) days of the week
  • Limiting television viewing

For more information, see
Tips to Promote Healthy Eating and Physical Activity for Children and Teens
(http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/tips_for_parents.htm.)


Keep track of BMI-for-age
Check BMI-for-age annually, or more often if recommended by the child’s healthcare provider. Tracking growth patterns over time can help you make sure your child is achieving or maintaining a healthy weight. A single BMI-for-age calculation is not enough to evaluate long-term weight status because height and weight change with growth.





About Growth Charts

See the following example of how some sample BMI numbers would be interpreted for a 10-year-old boy.



Example of BMI-for-age percentile growth chart

Dominic Street BMI

reposted from: http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx?CalculatorType=English

Calculator for Childrens BMI

BMI—Body Mass Index

BMI Calculator for Child and Teen: Results on a Growth Chart



Information Entered for Dominic Street

Age: 16 years 11 months Sex: Boy
Birth Date: November 12, 1990 Height: 5 feet 4 inch(es)
Date of Measurement: October 28, 2007 Weight: 126 pounds




Results




Based on the height and weight entered, the BMI is 21.6, placing the BMI-for-age at the 56th percentile for boys aged 16 years 11 months. This teen has a healthy weight.



Body mass index-for-age percentiles: Boys, 2 to 20 years

Growth chart of BMI-for-age percentile for boys, 2 to 20 years



BMI Range: Healthy weight


orange underweight, less than the 5th percentile
green healthy weight, 5th percentile up to the 85thpercentile
yellow at risk of overweight, 85th to less than the 95th percentile
red overweight, equal to or greater than the 95th percentile




What does this mean?

BMI is calculated using your child’s weight and height and is then used to find the corresponding BMI-for-age percentile for your child’s age and sex.

BMI-for-age percentile shows how your child’s weight compares to that of other children of the same age and sex. For example, a BMI-for-age percentile of 65% means that the child’s weight is greater than that of 65% of other children of the same age and sex.

Based on the height and weight entered, the BMI is 21.6, placing the BMI-for-age at the 56th percentile for boys aged 16 years 11 months. This teen has a healthy weight.

Maintaining a healthy weight throughout childhood and adolescence may reduce the risk of becoming overweight or obese as an adult.




What should you do?

Regardless of the current BMI-for-age category, help your child or teen develop healthy weight habits and keep track of BMI-for-age.

Practice healthy weight habits
Encourage children and teens to practice healthy weight habits by:
  • Eating healthy foods
  • Participating in physical activity on most (preferably all) days of the week
  • Limiting television viewing

For more information, see
Tips to Promote Healthy Eating and Physical Activity for Children and Teens
(http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/tips_for_parents.htm.)


Keep track of BMI-for-age
Check BMI-for-age annually, or more often if recommended by the child’s healthcare provider. Tracking growth patterns over time can help you make sure your child is achieving or maintaining a healthy weight. A single BMI-for-age calculation is not enough to evaluate long-term weight status because height and weight change with growth.





About Growth Charts

See the following example of how some sample BMI numbers would be interpreted for a 10-year-old boy.



Example of BMI-for-age percentile growth chart


This information was printed from CDC's Division of Nutrition, Physical Activity and Obesity (DNPAO) website http://apps.nccd.cdc.gov/dnpabmi/Result.aspx?&dob=11/12/1990&dom=10/28/2007&age=203&ht=64&wt=126&gender=1&method=0&inchtext=0&wttext=0

Obesity 'as bad as climate risk'




reposted from: http://news.bbc.co.uk/1/hi/health/7043639.stm

Obesity 'as bad as climate risk'
Two obese people
Alan Johnson said a "cultural and societal shift" was needed
The public health threat posed by obesity in the UK is a "potential crisis on the scale of climate change", the health secretary has warned.

Alan Johnson said the magnitude of the problem was becoming clear for the first time and "it is in everybody's interest to turn things round".

Details have emerged of a government study which says half the population could be obese within 25 years.

Ministers are drawing up a long-term action plan to tackle obesity.

Greater efforts

The government-commissioned Foresight report is expected to report on Wednesday.

It suggests the cost of the epidemic, in terms of health care provision and lost work hours, could reach £45bn a year by 2050, according to the Observer.

Professor Klim McPherson, of Oxford University, and Tim Marsh, of the National Heart Foundation, predict that

within 15 years 86% of men will be overweight - but not necessarily obese -
(currently 73% - see figure 1 at top)
and within 20 years, 70% of women.

The study showed there had to be "further and faster" efforts beyond existing anti-obesity measures to encourage exercise and healthy eating, Mr Johnson said.

We will only succeed if the problem is recognised, owned and addressed at every level and every part of society
Alan Johnson, health secretary

Prime Minister Gordon Brown has backed a long-term action plan to fight obesity, funded by money earmarked in Tuesday's Comprehensive Spending Review.

The government is also due to ask the Food Standards Agency to probe the use of unhealthy "trans-fats", which have been linked to coronary heart disease, in fast food.

But Mr Johnson said individuals also had to take responsibility for their own health as part of a "cultural and societal shift".

He said: "There is no single solution to tackle obesity and it cannot be tackled by government action alone.

"We will only succeed if the problem is recognised, owned and addressed at every level and every part of society."

Life expectancy

Graph
Public Health Minister Dawn Primarolo told the BBC that a longer term view needed to be taken of the obesity issue.

She said: "The government has been doing a lot already in terms of healthy foods in schools, sports activity in schools, labelling of food, working with young people.

"This report was part of the development of our strategies.

"But... if we don't act, what will happen in health terms for individuals and for our communities in 10, 20 years' time is really something we that we need to face up to, and that means looking at everything."

Dr Colin Waine - who chairs the National Obesity Forum - said that

in terms of its impact on society, the health threat posed by obesity "will hit us much earlier than climate change".

He added:

"We are now in a situation where levels of childhood obesity will lead to the first cut in life expectancy for 200 years. These children are likely to die before their parents."

Report Warns UK of Burgeoning Obesity

reposted from: http://ap.google.com/article/ALeqM5gn5vhYdfDa9UWNdAxIGAh80YFp6QD8SB6G800

An overweight person eats in London, Wednesday, Oct. 17, 2007. Britain's health secretary called Wednesday for a fundamental shift in the way the nation tackles obesity after a study said dramatic action was required to stop the majority of the population from becoming obese by 2050. (AP Photo/Kirsty Wigglesworth)

Report Warns UK of Burgeoning Obesity

LONDON (AP) — Most British citizens could be obese by 2050, a new government report warns, http://www.foresight.gov.uk/Obesity/Obesity_final/14.pdf

and the nation's health secretary called Wednesday for a fundamental shift in the way the nation tackles obesity.

Health Secretary Alan Johnson didn't blame British eating habits, calling obesity "a consequence of abundance, convenience and underlying biology."

"As this report starkly demonstrates, people in the U.K. are not more gluttonous than previous generations and individual action alone will not be sufficient," he said in a speech to Parliament.

The obesity analysis by the Foresight program, run by the Office for Science, concludes that excess weight has become the norm and described Britain as an "obesogenic" society.

Obesity costs Britain the equivalent of $90 million a year already. Obese people have a greater risk for life-threatening conditions, including diabetes, heart disease, and cancer.

The number of overweight and obese people has tripled in the last 25 years. One in four adults are now obese, according to the most recent Health Study for England.

By comparison, about one-third of adults in the United States are obese; two-thirds are overweight.

The Foresight report projects that by 2050, 60 percent of British men, 50 percent of women and a quarter of children and young people will be obese unless drastic action is taken.

The study's authors, who based their findings on research from 250 experts over two years, said there was scant proof that current anti-obesity policies worked. The government pledged to draw up new plans to combat bulging waistlines.

Solutions to the problem will not be found "in exhortations to greater individual responsibility or in the futility of isolated initiatives," the health secretary said.

The report made a series of proposals:

_Earlier action when young children start gaining too much weight.

_Targeting people who are at increased risk.

_Controlling high-calorie foods.

_Changing the design of towns to make them more physically demanding.

_Increasing employer responsibility.

"There is a danger that the moment to act radically and dramatically will be missed," said Sir David King, the government's chief scientific adviser and head of the Foresight report. "It is a problem that is getting worse every year."

King and his fellow authors said obesity was inevitable in developed societies like Britain, where convenience foods, labor-saving devices, cars and sedentary work are part of daily life.

"We are facing a far worse scenario than even our gloomiest predictions," said Philip James, chairman of the International Obesity TaskForce, in a statement. "We need to respond rapidly and decisively."

Thursday 25 October 2007

Micro-robot that can clear arteries

clipped from www.telegraph.co.uk

A microscopic robot small enough to travel through blood vessels has been built by scientists.

Less than a millimetre in size, the robot walks like a crab on six legs and has been designed to clear blocked arteries.

A microscopic robot small enough to travel through blood vessels has been built by scientists.

Less than a millimetre in size, the robot walks like a crab on six legs and has been designed to clear blocked arteries.

It was produced by researchers at Chonnam National University in Korea, who found the robot was able to travel 55 yards in a week.

Once inside a blocked artery, it is able to release drugs to dissolve blood clots, which are often the cause of heart attacks.

By attaching grafted heart muscle to the legs, the scientists found the legs would bend as the muscle cells contracted. The cells get their energy from sugar in the patient's blood.

That means the robot does not need an external power supply, which are often heavy and cumbersome, if not impractical.

 blog it

Tuesday 23 October 2007

Obesity 'epidemic' turns global

reposted from: http://news.bbc.co.uk/1/hi/health/7057951.stm

Obesity 'epidemic' turns global
obesity
Obesity increases heart disease risk
People are getting fatter in all parts of the world, with the possible exception of south and east Asia, a one-day global snapshot shows.

Between half and two-thirds of men and women in 63 countries across five continents - not including the US - were overweight or obese in 2006.

The Circulation journal study included over 168,000 people evaluated by a primary care doctor.

Experts said the findings were deeply worrying.

Excess body weight is pandemic
Lead researcher Beverley Balkau

People who are overweight have a higher risk of heart disease, Type II diabetes and other diseases including some cancers.

The International Day for the Evaluation of Obesity (IDEA) study looked at two measures of fatness - waist circumference and a calculation called body mass index or BMI.

A BMI (weight in kg divided by square of height in meters) of 18.5 to 25 is considered healthy.

A BMI over 25 is deemed overweight and greater than 30 is obese.

Pandemic

Just 7% of people in eastern Asia were obese, compared to 36% of people seeing their doctors in Canada, 38% of women in Middle Eastern countries and 40% in South Africa.

Canada and South Africa led in the percentage of overweight people, with an average BMI of 29 among both men and women in Canada and 29 among South African women.

Graph: global obesity, men
168,000 people were evaluated by a doctor on a single day. The US was not included in the report.
A BMI over 25 is deemed overweight and greater than 30 is obese.

In Northern Europe men had an average BMI of 27 and women 26 - just into the overweight category. In southern Europe, the average BMI was 28. In Australia BMI was 28 for men and 27.5 for women while in Latin America the average BMI was just under 28.

Waist circumference was also high - 56% of men and 71% of women carried too much weight around their middle.

"The study results show that excess body weight is pandemic, with one-half to two-thirds of the overall study population being overweight or obese," said Beverley Balkau, director of research at the French National health research institute INSERM in Villejuif, who led the study.

That puts the rest of the world close to par with the US, long considered the country with the worst weight problem.

Graph: global obesity, women
168,000 people were evaluated by a doctor on a single day. The US was not included in the report.
A BMI over 25 is deemed overweight and greater than 30 is obese.

An estimated two-thirds of Americans are overweight and a third of these are obese. In the US, the lifetime risk of developing diabetes, is also high - 33% for men and 38% for women.

In the study, the overall frequency of heart disease was 16% in men and 13% in women. There was a high frequency of heart disease in Eastern European men, 27%, and women, 24%, in contrast to Canada where the frequency in women was 8%, and in men 16%.

The frequency of diabetes varied across regions. Overall, 13% of men and 11% of women were diagnosed with diabetes.

Ellen Mason of the British Heart Foundation said: "It is tragic irony that whilst much of the world is starving, many developed countries across the world are in the grips of an obesity crisis.

"Whilst it is vital not to stigmatise people in our society for being overweight, it is important we all know the health risks from being obese. The worrying increase of diabetes in the UK is clearly linked to rising obesity levels and plummeting physical activity levels. Being obese or diabetic, or worse, both, increases your chance of getting heart disease.

"Whilst the UK may not be the worst offender in this global study, we are aware that it's a major health issue in our country. After seeing the heart attack death rate reduce in the UK in the last few years, there is a real risk that this figure could go back up if diabetes and obesity continue to rise as they currently are."

  • A BMI over 25 is deemed overweight and greater than 30 is obese.
  • Monday 22 October 2007

    Child obesity alert plan pondered

    reposted from: http://news.bbc.co.uk/1/hi/uk/7055735.stm

    Child obesity alert plan pondered
    An obese child
    Obesity is linked to a number of health problems
    Parents may be warned if their children are found to be overweight, under Department of Health (DoH) proposals.

    Children in England and Wales are currently measured at the ages of five and 10 but parents are informed of the results only if they request them.

    But the figures may be given to parents automatically under the new plans.

    The DoH said ministers were prepared to go further and faster in the fight against childhood obesity, although no firm decisions had been made.

    Between a quarter and a third of children are thought to be overweight and doctors fear there will be an epidemic of poor health related to obesity in coming decades.

    An obese person dies on average nine years earlier than somebody of normal weight, while a very obese person's life is cut short by an average of 13 years.

    Under the proposals being considered, information obtained under the national measurement programme could be given to parents automatically.

    And involvement in the measurement scheme may become compulsory unless people choose to opt out of the scheme.

    Early education

    Tam Fry, from the National Obesity Forum, said child obesity was a "huge problem to overcome".

    He said: "It's a good thing in the sense that if the government expects parents to [have] prime responsibility for the raising of their children, it is absolutely essential that they should know what the healthy range of weight is.

    "We would think, in fact, this whole thing has got to start earlier.

    "If you start earlier, around the age of two and three from nursery, then you've got the time to start to implant the healthy eating, healthy exercise education, which will then carry them through school."

    Mr Fry added that the Forum would even like to start to promote this mode of lifestyle "from conception".

    A recent report by the Foresight Programme argued that dramatic and comprehensive action was required to stop the majority of us becoming obese by 2050.

    Its authors predicted that if current trends continue, in that year, 60% of men and half of women will be obese and cases of type 2 diabetes will rise by 70%.

    The report also suggested that cases of stroke will rise by 30% by the middle of the century and cases of coronary heart disease will rise by 20%.

    Sunday 21 October 2007

    Statin Heart drugs 'have longer effect'

    reposted from: http://news.bbc.co.uk/1/hi/scotland/glasgow_and_west/7039256.stm

    Heart drugs 'have longer effect'

    Image of pills
    Researchers found statins had long term benefits
    The cholesterol-lowering drugs statins can provide protection against heart disease years after patients stop taking them, a study has found.
    The drugs can reduce the risk of heart attacks by a quarter in men, according to the report's lead author.
    The University of Glasgow study found long-term benefits in taking statins.
    People taking the drug for five years were still experiencing the benefits 10 years after they stopped taking them, with a reduced risk of heart disease.
    Professor Stuart Cobbe, the leading cardiologist on the study, said: "We were very surprised to find patients who had been treated for five years with a statin continued to have significantly fewer heart attacks and other coronary events compared to those treated with a placebo treatment.
    "This benefit appeared to extend at least 10 years after the original trial.
    "These results are very reassuring for patients who might be concerned about safety when taking a drug for a very long period of time."
    Slowing development
    The 15 year-West of Scotland Coronary Prevention study involved 6,595 men from the region, with an average age of 55, who had high cholesterol.
    They were recruited between 1989 and 1991 and split in half, with one group given a placebo and the other half given pravastatin.
    Their health was followed for five years, until 1995, with the results showing that the statin users had a lower risk of strokes and heart disease.
    The latest research, published in the New England Journal of Medicine, examined the group 10 and 15 years later.
    It found that there was a "significant" reduction in coronary problems for people who had taken statins for five years.
    Professor Ian Ford, lead author of the study, said: "In fact, remarkably, five years of treatment with a statin resulted in 27% fewer non-fatal heart attacks or deaths due to heart disease over the period of 15 years.
    "There was a significant 12% reduction in deaths over the entire period, with deaths due to heart disease reduced by 22%.

    "This suggests that statin treatment has a long-term beneficial effect in slowing the development of coronary artery disease."
    Professor Peter Weissberg of the British Heart Foundation said: "This research provides yet more evidence that statins help prevent heart attacks, and therefore save lives."
    Statins are taken by an estimated three million people in the UK.

    Friday 19 October 2007

    Public 'misled' on exercise needs

    reposted from: http://news.bbc.co.uk/1/hi/health/7035557.stm

    Public 'misled' on exercise needs
    Gardening
    People shouldn't believe that this will do, the report chides
    "Misleading" government guidelines have led to many Britons wrongly believing that moderate exercise is as beneficial as a vigorous workout, a study alleges.

    In a survey of nearly 1,200 people, around half of men and three quarters of women thought moderate exercise conferred the greatest health benefits.

    Guidelines urge 30 minutes of moderate exercise each day five days per week.

    But the authors of the study, published in Preventive Medicine, said vigorous exercise was best for averting disease.

    The NHS guidelines say "taking a brisk walk, spending some time doing the gardening or doing a few laps of the local swimming pool on the way home from work" can all improve health.

    But the researchers from Exeter and Brunel Universities said these activities were unlikely to do much for them.

    "It's extremely worrying that British adults now believe that a brief stroll and a bit of gardening is enough to make them fit and healthy," said Dr Gary O'Donovan, lead author.

    "Brisk walking offers some health benefits, but jogging, running and other vigorous activities offer maximal protection from disease."

    Academic debate

    Other specialists said the survey results were not surprising, and that few people in any event met the guidelines for moderate exercise.

    But Paul Gately, professor of exercise and obesity at Leeds Metropolitan, said

    it was very difficult to formulate a "one size fits all" policy to exercise, as moderate exercise for one would be intense for another.

    DEFINING EXERCISE
    Light: You can talk at the same time
    Moderate: Makes you slightly breathless
    Vigorous: Makes you breathe rapidly

    He also stressed that public misunderstandings about exercise could not be blamed solely on the government, as academics themselves were continually formulating new theories.

    In August alone two separate and apparently contradictory reports emerged.

    One found walking less than the current guidelines stipulated had significant health benefits; another suggested a minimum of 20 minutes of vigorous exercise three times a week was needed for good health.

    In addition, no-one is clear what part exercise really plays in preventing disease.

    While some studies have shown that those who workout may have a reduced cancer risk, it can be difficult to separate this from other lifestyle factors like diet, alcohol and tobacco consumption, and socio-economic group.

    A Department of Health spokesperson said its guidelines were "based on a comprehensive review of the evidence, carried out by a team of academics and expert advisers.

    "We take a keen interest in new developments in this area, but there are no plans at present to change the existing recommendations for adults."