Obesity Reviews最新文献

{"title":"Efficacy and Safety of Tirzepatide on Weight Loss in Patients Without Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Sharath Kommu, Param P Sharma, Rachel M Gabor","doi":"10.1111/obr.13961","DOIUrl":"https://doi.org/10.1111/obr.13961","url":null,"abstract":"<p><p>Tirzepatide has positive effects on weight loss in individuals with overweight or obesity. Considering its broad side-effect profile, its efficacy and safety in individuals without diabetes mellitus (DM) are yet to be fully understood. To address this, we conducted a comprehensive meta-analysis of six randomized trials on individuals with overweight or obesity, without DM, which showed that tirzepatide, when compared with placebo, resulted in a change in percentage body weight with a mean difference (MD) of -16.32% (95% CI: -18.35 to -14.29) and change in absolute body weight in kilograms (MD -13.95 kg; -18.83 to -9.07). There were significant reductions in body mass index and waist circumference when compared with placebo, with MDs of -5.89 kg/m² (-8.97 to -2.81) and -12.31 cm (-13.93 to -10.68), respectively. It was associated with gastrointestinal (GI) side effects: nausea (relative risk [RR] 3.11; 2.74-3.54), vomiting (RR 5.94; 4.50-7.85), diarrhea (RR 2.92; 2.53-3.37), and constipation (RR 2.85; 2.38-3.42). Serious adverse events were not statistically significant (RR 0.93; 0.76-1.13), but serious GI events and discontinuation due to adverse events were significant (RRs 3.07; 2.03-4.66, and 2.29; 1.74-3.01, respectively). In conclusion, this meta-analysis suggests that in patients with overweight or obesity without DM, tirzepatide is effective for significant weight loss. Though the overall risk of serious adverse events is not higher compared with placebo, it carries an elevated risk of GI side effects, serious GI events, and discontinuation due to adverse effects.</p>","PeriodicalId":216,"journal":{"name":"Obesity Reviews","volume":" ","pages":"e13961"},"PeriodicalIF":8.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Circulating Interleukin Concentrations in Type 2 Diabetes: A Systematic Review and Meta-Analysis.","authors":"Chang Cao, Jing Yuan, Elizabeth R Gilbert, Mark A Cline, Fan Lam, King C Li, Ryan N Dilger","doi":"10.1111/obr.13971","DOIUrl":"https://doi.org/10.1111/obr.13971","url":null,"abstract":"<p><strong>Objectives: </strong>This work aimed to quantitatively evaluate circulating interleukin concentration data available for patients with Type 2 diabetes.</p><p><strong>Methods: </strong>We performed a systematic review using PubMed, Web of Science, and the Cochrane Library. Original studies reporting data on circulating interleukin concentrations in at least one group of patients with Type 2 diabetes (obese Type 2 diabetes [OBD], overweight Type 2 diabetes [OWD], or lean Type 2 diabetes [LD]) and healthy weight controls (HWCs) were included. Data were extracted from 43 included studies uniquely encompassing 2646 patients with Type 2 diabetes and 6605 HWCs by independent investigators. We used a random-effects model to pool data in the Comprehensive Meta-Analysis Version 2 software. Effect sizes (ESs) were calculated as the standardized mean difference in interleukin concentrations between groups and then transformed into Hedge's g statistic.</p><p><strong>Results: </strong>Our results revealed higher circulating concentrations in patients with Type 2 diabetes compared with HWCs, including IL-4, IL-6, IL-17, and IL-18. When stratified by BMI subgroups, all patients with Type 2 diabetes displayed elevated IL-6 concentrations compared with HWCs, with OBD patients having the highest ES, followed by OWD and LD. Similar to the overall results, higher interleukin concentrations in different BMI subgroups of patients with Type 2 diabetes were observed compared with HWCs in IL-4 (OWD), IL-17 (LD), and IL-18 (OBD, but not OWD).</p><p><strong>Conclusion: </strong>Meta-analysis outcomes demonstrated higher circulating concentrations of IL-4, IL-6, IL-17, and IL-18 in patients with Type 2 diabetes, strengthening the clinical evidence that Type 2 diabetes is accompanied by a systemic inflammatory response.</p>","PeriodicalId":216,"journal":{"name":"Obesity Reviews","volume":" ","pages":"e13971"},"PeriodicalIF":8.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Key Predictors of Mid-Childhood Obesity in a Population-Based Cohort Study: An Evidence Synthesis and Predictive Modeling Study.","authors":"Yuchan Mou, Susana Santos, Macarena Lara, Ivonne P M Derks, Vincent W V Jaddoe, Romy Gaillard, Janine F Felix, Eric Steegers, Trudy Voortman, Marinus H van IJzendoorn, Pauline W Jansen","doi":"10.1111/obr.13958","DOIUrl":"https://doi.org/10.1111/obr.13958","url":null,"abstract":"<p><p>A wide spectrum of predictors of childhood overweight and obesity has been identified over past decades, yet a quantitative overview of multidisciplinary predictors is missing, and the relative importance and their collective contribution to childhood obesity remains unclear. We synthesized evidence from 93 published studies from the Generation R Study, a population-based prospective cohort from early-pregnancy onwards in the Netherlands, to provide a quantitative overview of 210 predictors across preconception and childhood associated with body mass index (BMI) in mid-childhood and selected 59 candidate predictors. Then, we further identified 32 key predictors for either zBMI or weight status using model search algorithms and built prediction models with data from the same cohort. Associations of note were identified among predictors in preconception and prenatal parental health, early-life weight, and child behavior domains. An interquartile range increase in parental prepregnancy BMI (maternal β = 0.17, 95% CI: 0.14, 0.20; paternal β = 0.17, 95% CI: 0.14, 0.21), early-life weight (e.g., zBMI at age 2y β = 0.28, 95% CI: 0.23, 0.33), and food responsiveness (β = 0.25, 95% CI: 0.21, 0.28) were positively associated with mid-childhood BMI, and satiety responsiveness was negatively associated (β = -0.18, 95% CI: -0.21, -0.15). Together, identified key predictors accounted for 49.2% of the variance of BMI and 33.7% of the variance of the odds of overweight and obesity at the age of 10 years. Multimodal interventions targeting parental BMI before pregnancy, early adiposity rebound, and management of appetite in early childhood may be most effective in maintaining a healthy weight during childhood.</p>","PeriodicalId":216,"journal":{"name":"Obesity Reviews","volume":" ","pages":"e13958"},"PeriodicalIF":8.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exposure to and Impact of Unhealthy Food Marketing on Adolescents and Young Adults: A Narrative Review and Research Agenda.","authors":"Rositsa T Ilieva, Nava Gottlieb, Hailey Christian, Nicholas Freudenberg","doi":"10.1111/obr.13957","DOIUrl":"https://doi.org/10.1111/obr.13957","url":null,"abstract":"<p><p>Consumption of unhealthy food has become a leading cause of premature deaths and preventable illnesses around the world. Research shows that marketing by the companies that produce, distribute, and sell unhealthy foods and beverages is associated with increased consumption of these products. To date, however, limited research has focused on the cumulative exposure and impact of various modes of marketing employed to reach distinct populations. In this narrative review, we summarize 25 years of scientific evidence and findings from 108 empirical studies and 19 systematic and scoping reviews of various forms of unhealthy food marketing to adolescents (aged 13 to 17) and young adults (aged 18 to 25). These are populations often targeted by food advertising, globally. The review offers insights into young people's exposure to unhealthy food marketing, how this exposure and its impacts vary by age, socioeconomic status, and race/ethnicity, and what is known about the cumulative effects of multi-platform food marketing. Our findings reveal patterns of disproportionate exposure among lower-income and racial/ethnic minority youth, especially Black and Latinx adolescents in the U.S., across different media platforms. Additionally, more than 90% of impact studies in our sample found that exposure to unhealthy food marketing is associated with higher consumption of advertised products, with social media influencer marketing gaining an increasingly prominent role. Despite emerging evidence on multi-platform marketing, cumulative exposure remains insufficiently researched. Based on these findings, we suggest paths for future research to reduce the harmful impact of marketing unhealthy food and beverages to young people.</p>","PeriodicalId":216,"journal":{"name":"Obesity Reviews","volume":" ","pages":"e13957"},"PeriodicalIF":8.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144264959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut Microbiota-Derived Trimethylamine N-Oxide and the Risk of Diabetes: An Updated Systematic Review and Meta-Analysis.","authors":"Sammy Mohammadi, Maysa Eslami, Farzad Pourghazi, Hanieh-Sadat Ejtahed, Ehsan Shahrestanaki, Mostafa Qorbani, Shirin Hasani-Ranjbar, Bagher Larijani","doi":"10.1111/obr.13963","DOIUrl":"https://doi.org/10.1111/obr.13963","url":null,"abstract":"<p><p>Recent studies have discovered higher levels of circulating trimethylamine N-oxide, a metabolite produced by gastrointestinal microbiota, among patients diagnosed with diabetes. This study presents an updated systematic review and meta-analysis examining the association between trimethylamine N-oxide levels and the risk of developing diabetes. PubMed and Scopus databases were searched for the studies published up to April 2024. Observational (cross-sectional, case-control, and cohort) studies examining the relationship between TMAO levels and diabetes were included in our systematic review and meta-analysis, excluding non-original research, non-human studies, and non-English publications. Out of 1538 publications, 32 studies focusing on type 2 and gestational diabetes were included. We conducted two distinct meta-analyses investigating the association between TMAO levels and type 2 diabetes. First, we found significantly elevated TMAO levels in diabetic patients compared to non-diabetics (standardized mean difference [SMD]: 1.21, 95% confidence interval [CI]: 0.13-2.28). Second, we observed that elevated TMAO levels were associated with 49% increased odds of diabetes (odds ratio [OR]: 1.49, 95% CI: 1.06-2.10). However, the pooled hazard ratio (HR) analysis did not reveal a statistically significant association (HR: 1.00, 95% CI: 0.62, 1.61). Moreover, the included studies showed a higher type 2 diabetes prevalence in the elevated TMAO group. Regarding gestational diabetes, we also detected a positive correlation with TMAO levels. Our study indicates that individuals with type 2 diabetes have notably higher TMAO levels compared to non-diabetics. Furthermore, our systematic review suggests an elevated risk of developing both type 2 diabetes and gestational diabetes in individuals with higher TMAO levels.</p>","PeriodicalId":216,"journal":{"name":"Obesity Reviews","volume":" ","pages":"e13963"},"PeriodicalIF":8.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144264960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Significance and Therapeutic Approach Concerning Various Abdominal Adipose Tissue Irregularities in End-Stage Liver Disease.","authors":"Qing Liu, Junling Liu, Chao Sun","doi":"10.1111/obr.13955","DOIUrl":"https://doi.org/10.1111/obr.13955","url":null,"abstract":"<p><p>Accumulating evidence suggests that body mass index is an inaccurate measure of body composition mainly due to its limitation in differentiating distinct compartments in cirrhosis. Adipose tissue, as one of the most important body components, is likely to be misestimated. Cross-sectional imaging using CT or MRI can demonstrate the objective distribution of adipose tissue in patients with end-stage liver disease. CT allows a more precise assessment of adipose tissue and has been increasingly used as a non-invasive metric with substantially predictive and prognostic value. Based on CT, visceral adipose tissue index, subcutaneous adipose tissue index, and the ratio of visceral to subcutaneous adipose tissue area are indicators to measure various adipose tissues. In recent years, the relationship between adipose tissue and prognostication in those populations has been widely investigated, but conclusions remain controversial. Therefore, in this review, we focus on the distribution and function of adipose tissue and seek to define parameters commonly used to measure adipose tissue. We also discuss the association between various indices above mentioned and the development, complications, and mortality of end-stage liver disease in terms of recent data and emerging evidence. Finally, we shed light on potential management against adipose tissue irregularities through nutritional, physical, and pharmacological methods. It is concluded that comprehensive evaluation of fat distribution may help to predict and improve the prognosis of patients with end-stage liver disease.</p>","PeriodicalId":216,"journal":{"name":"Obesity Reviews","volume":" ","pages":"e13955"},"PeriodicalIF":8.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Combined Movement Behavior Interventions in Children and Adolescents: A Scoping Review.","authors":"Ciaran M C Maloney, Andrew J Atkin, Lee C Beaumont, Emily Budzynski-Seymour, Victoria E Warburton","doi":"10.1111/obr.13943","DOIUrl":"https://doi.org/10.1111/obr.13943","url":null,"abstract":"<p><p>Evidence suggests that targeting physical activity, sedentary behavior, and sleep in combination can benefit health and academic outcomes in young people. This scoping review aimed to describe the extent, range, and nature of combined movement behavior interventions and examine recruitment and effectiveness patterns in equity-denied populations. The following electronic databases were searched: Web of Science, CINAHL, MEDLINE, and PsycINFO. Gray literature was identified through ProQuest Dissertations and Theses Global, Google Scholar, and the British Library EThOS. Included studies were randomized or quasi-experimental interventions that modified two or more movement behaviors with the goal of affecting health-, behavioral-, or academic-related outcomes in children or adolescents. Peer-reviewed publications from scientific databases, master's level dissertations, and doctoral theses from gray literature searches in the English language were included. The behavior change technique taxonomy and PROGRESS-Plus framework were used to map intervention characteristics. Thirty studies met the inclusion criteria. Most studies were individual-level randomized controlled trials (40%), conducted in Europe (43%), and delivered in a school setting (77%). Physical activity and sedentary behavior were the predominant behaviors that were modified (83%). The most commonly used behavior change techniques included information about health consequences (67%) and social support [unspecified] (70%). All included studies focused on health-related outcome measures. Ten studies (33%) examined differential effects by PROGRESS-Plus subgroups. Future research should explore the value of movement behavior interventions across the breadth of non-health-related outcomes and include a stronger focus on differential effectiveness across population subgroups.</p>","PeriodicalId":216,"journal":{"name":"Obesity Reviews","volume":" ","pages":"e13943"},"PeriodicalIF":8.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Efficacy of Different Exercise Modes on Inflammatory Markers in Patients With Type 2 Diabetes Mellitus: A Systematic Review With Pairwise and Network Meta-Analyses.","authors":"Mousa Khalafi, Aref Habibi Maleki, Michael E Symonds, Karim Azali Alamdari, Mahsa Ehsanifar, Sara K Rosenkranz","doi":"10.1111/obr.13954","DOIUrl":"https://doi.org/10.1111/obr.13954","url":null,"abstract":"<p><p>Exercise training can reduce chronic low-grade inflammation; however, the most effective mode of exercise for lowering inflammation in patients with type 2 diabetes mellitus (T2D) is unknown. Therefore, we performed a systematic review with pairwise and network meta-analyses to determine the efficacy of different modes of exercise training for improving inflammation in patients with T2D. A systematic literature search was conducted in the PubMed, Web of Science, and Scopus from inception to May 2024 using four main key words including \"exercise,\" \"cytokines,\" \"type 2 diabetes,\" and \"randomization.\" Randomized control or clinical trials investigating the effects of any exercise training mode, including aerobic training (AT), resistance training (RT), AT + RT, high-intensity interval training (HIIT), and HIIT + RT on inflammatory markers including interleukin-6 (IL-6), TNF-α, C-reactive protein (CRP), leptin, or adiponectin in patients with T2D were included. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated using random effects models. Overall, 60 studies involving 3339 patients with T2D were included. Compared to control, exercise training effectively reduced IL-6 [SMD: -0.58], TNF-α [SMD: -0.62], CRP [SMD: -0.78], and leptin [SMD: -0.27], and increased adiponectin [SMD: 0.35]. Based on network meta-analysis, AT reduced IL-6, TNF-α, and leptin and increased adiponectin; and AT + RT reduced IL-6, TNF-α, and CRP, and increased adiponectin. However, RT, HIIT, and HIIT + RT did not change any inflammatory markers as compared with controls. Exercise training is an effective approach for lowering chronic low-grade inflammation in patients with T2D; specifically, AT and AT + RT appear to be more effective than RT, HIIT, or HIIT + RT.</p>","PeriodicalId":216,"journal":{"name":"Obesity Reviews","volume":" ","pages":"e13954"},"PeriodicalIF":8.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missing the Target: A Scoping Review of the Use of Percent Weight Loss for Obesity Management.","authors":"Diana Sherifali, Megan Racey, Donna Fitzpatrick-Lewis, Michelle Greenway, Sanjeev Sockalingam, Jun Wada, Soo Huat Teoh, Ian Patton, David Macklin, Elizabeth F C van Rossum, Luca Busetto, Deborah Bade Horn, J D Patricia Nece, Morgan Emile Gabriel Salmon Leguede, Nicole Pearce, Carel Le Roux, Jamy Ard, Angela S Alberga, Lee Kaplan, Arya M Sharma, Sean Wharton","doi":"10.1111/obr.13960","DOIUrl":"https://doi.org/10.1111/obr.13960","url":null,"abstract":"<p><strong>Introduction: </strong>To co-create comprehensive targets for obesity management, we need to understand the genesis and current use of percent weight loss targets in research. The goals of our scoping review are to (1) synthesize the literature on percent weight loss targets for adults with obesity and (2) discuss the percent weight loss targets in context with their health benefits.</p><p><strong>Methods: </strong>We searched Cochrane, MEDLINE, and EMBASE for English language, pharmaceutical, and/or behavioral intervention studies in adults with obesity where the explicit aim of the study was weight reduction defined as a percent of body weight. Reviewers screened citations and extracted data including study characteristics.</p><p><strong>Results: </strong>From 16,164 abstracts, we included 30 citations which were mostly randomized controlled trials (RCTs) (n = 17) or quasi-experimental studies (n = 12) published between 1992 and 2024. Most of the studies had target weight loss goals between 3% and 10% of body weight (n = 28), while n = 2 had body weight loss goals of 15% or 30%. The proportion of participants who met the percent weight loss target ranged from 5.9% (nutrition only study) to 85% (pharmaceutical study). The studies reported different reasons for targeting a percentage of weight loss such as disease-specific outcomes, reduced risk of disease, or patient-reported outcomes.</p><p><strong>Conclusion: </strong>Percent weight loss targets were based on similar research and were often not feasible nor sustainable for most participants. The design of these interventions and evaluation of obesity management would benefit from more patient-focused parameters which could help to co-design comprehensive targets for research and practice.</p>","PeriodicalId":216,"journal":{"name":"Obesity Reviews","volume":" ","pages":"e13960"},"PeriodicalIF":8.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"A Meta-Analysis of eHealth Interventions to Promote Physical Activity in Young, Middle-Aged, and Late Middle-Aged Adults With Obesity or Overweight\".","authors":"","doi":"10.1111/obr.13959","DOIUrl":"https://doi.org/10.1111/obr.13959","url":null,"abstract":"","PeriodicalId":216,"journal":{"name":"Obesity Reviews","volume":" ","pages":"e13959"},"PeriodicalIF":8.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}