Total vegetables and all-cause mortality/survival.
25 articles, providing information about 16 different cohorts were found, including a total of 18,554 cases. Survival was the end point in one article
(Nube M [2]), and mortality was the end point in all remaining articles.
Use of data from The EPIC Study: 7 publications were found about The EPIC Study (21). Publications included data about the same population with different length of
follow-up (Trichopoulou A. 2003 vs Trichopoulou A. 2009), or about a subgroup of- vs all diabetic subjects from the cohort (Trichopoulou A. 2006 vs Nöthlings U. 2008).
Obviously, the publications about longer length of follow-up, and about larger parts of the cohort were included.
The EPIC-Elderly study provided data about 74,607 elderly (aged ≥ 60) subjects - with or whithout diabetes - from 9 countries (including Greece & Spain), and
including 4,047 deaths (Trichopoulou A. 2005b). But 3 other publications provided information about subgroups of this cohort from which the data partly overlapped
with data from The EPIC-Elderly Study:
- Agudo A (2007) 41.358 subjects aged 30-69 from EPIC-Spain, including 562 deaths.
- Nöthlings U (2008) 10.449 subjects aged 35-70 with diabetes from 10 countries, and including 1,346 deaths.
- Trichopoulou A (2009) 23,349 subjects aged 20-86 from EPIC-Greece, including 1,075 deaths.
The latter 3 publications were included in the systematic review, excluding data from The EPIC-Elderly Study. These 3 subcohorts included less deaths than the
former subcohort (2,983 vs 4,047). But they all provided RR's as a categorized variable, allowing for analysis about effects at different levels of consumption, and for
more precise analysis of the effect size. Whereas The EPIC-Elderly Study provided RR's as a continuous variable.
Also, a 4th publication about this cohort was included: Trichopoulou A (2005a) provided data about subjects from EPIC-Greece with CHD only, whereas he provided data about
subjects from EPIC-Greece without CHD only in a later publication (Trichopoulou A. 2009).
Results: Significant protective effects were found in 3 cohorts (Sahyoun NR [7], Nöthlings U [21], and Seccareccia F [24]), and among men in a 4th cohort
(Nube M [2]). These 4 cohorts included 3,383 cases (18 % of all cases). No other associations were found of high vs low consumption.
The average RR = 0.96 for all cohorts (excluding Knekt P [9], because no amount of cases was specified, stratified by sex. And excluding Strandhagen E [16], and
Chang-Claude J [31] because of incomplete data).
Conclusion: Protective effects were found in 4 cohorts, including 18% of all cases. Inconclusive evidence was found for an association between vegetable
consumption and all-cause mortality.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 33) González S (2008) | No cohort name defined | 83 | RR = 1.20 (0.92-1.57; P = 0.18) |
| 32) Nagura J (2009) | The JACC Study | 7,606 | HR = 1.03 (0.96-1.10; P = 0.188). |
| 31) Chang-Claude J (2005) | The German Vegetarian Study | 456 | No association. |
| 29) Tucker KL (2005) | The Baltimore Longitudinal Study of Aging | 306 | RR = 0.94 (0.85-1.04) |
| 27) Darmadi-Blackberry I (2004) | The Food Habits In Later Life Study | 169 | RR = 1.00 (0.98-1.02; P = 0.70) |
| 24) Seccareccia F (2003) | The Seven Countries Study | 1,096 | HR = 0.82 (0.69-0.96) |
| 22) Ness AR (2005) | The Boyd Orr Cohort | 1,010 | RR = 0.95 (0.75-1.19; P = 0.4) |
| 21) Trichopoulou A (2009) | The EPIC-Greece Study (non-CHD cases) | 1,075 | MR = 0.90 (0.78-1.05; P = 0.18). |
| 21) Nöthlings U (2008) | The EPIC Study (diabetic subjects) | 1,346 | RR = 0.78 (0.63-0.98; P = 0.03). |
| 21) Agudo A (2007) | The EPIC-Spain Study | 562 | HR = 0.84 (0.66-1.06). |
| 21) Trichopoulou A (2005a) | The EPIC-Greece Study (CHD cases) | 131 | MR = 0.80 (0.62-1.02). |
| 16) Strandhagen E (2000) | The Study Of Men Born In 1913 | 390 | No significant association. |
| 15) Lasheras C (2000) | No cohort name defined | Age < 80: 38. Age ≥ 80: 58. | Age < 80: RR = 1.44 (0.53-3.80; P = 0.46) Age ≥ 80: RR = 1.03 (0.96-1.11; p = 0.37) |
| 14) Kouris-Blazos A (1999) | No cohort name defined | 38 | RR = 1.02 (0.99-1.07) |
| 10) Knoops KT (2006) | The HALE | 1,384 | HR = 0.99 (0.90-1.09) |
| 9) Knekt P (1996) | The Finnish Mobile Clinic Health EXamination Cohort | 1364 | Men: RR = 0.88 (0.73-1.06) Women: RR = 0.97 (0.76-1.24) |
| 7) Sahyoun NR (1996) | No cohort name defined | 199 | RR = 0.49 (0.31-0.77; P = 0.01) |
| 6) Trichopoulou A (1995) | No cohort name defined | 53 | RR = 0.97 (0.93-1.02; P = 0.20) |
| 2) Nube M (1987) | No cohort name defined | 742 men. 448 women. | Men: A protective effect. Women: No association. |
| Total number of cases: 18,554 | Average RR = 0.96 |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 33) González S (2008) | Not defined. | 288 elderly people aged 60-85 from nursing homes in Asturias (Northern Spain) | 6 (1999-2002 to 2007) | 83 | All-cause mortality | Vegetables and roots (not defined) | RR = 1.201 (0.918-1.572; P = 0.180) per 1 SD increase. | Age, gender, BMI, energy intake, hyperglycemia, hypercholesterolemia, chewing ability, physical activity, smoking, self perceived health, education level and institution. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 32) Nagura J (2009) | The JACC Study | 25,206 men and 34,279 women aged 40-79, and without a history of CHD, stroke, or cancer. (Japan) | 12.7 (1989-2003) | 7,606 | Mortality from all causes | Vegetables (spinach or garland chrysanthemum; carrot or pumpkin; tomatoes; cabbage or head lettuce; and Chinese cabbage) |
HR = 1.03 (0.96-1.10; P = 0.188) for the highest vs lowest quartile of consumption. Amount specific data (servings per week): 1.2: HR = 1. 2.3: HR = 0.95 (0.89-1.02). 3.4: HR = 0.99 (0.93-1.06). 5.2: HR = 1.03 (0.96-1.10). The association did not vary by sex (no data shown). | Sex, age, BMI, smoking status, alcohol intake, hours of walking, hours of sleep, education years, perceived mental stress, cholesterol intake, SFA intake, n-3 fatty acids intake, sodium intake, fruit intake, bean intake and histories of hypertension and diabetes. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 31) Chang-Claude J (2005) | The German Vegetarian Study | 1,724 vegetarians and health conscious persons. | 21 (1978-1999) | 456? | All-cause mortality | Vegetables (not defined) | Frequency of consumption did not show an appreciable effect on mortality (no data shown). | Age, gender, smoking, level of activity, alcohol consumption, vegetarianism, BMI, and education. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 29) Tucker KL (2005) | The Baltimore Longitudinal Study of Aging. | 501 men age 34-80. | 18 | 306? | Total mortality | Vegetables (not defined) | RR = 0.94 (0.85-1.04) for an increment of 1 serving/d. | Age, total energy, BMI, smoking, alcohol, physical activity, supplement use, saturated fat, and secular trend. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 27) Darmadi-Blackberry I (2004) | The Food Habits in Later Life (FHILL) Study. | 785 people aged ≥ 70 from 5 cohorts in Japan (n = 89), Sweden (n = 184), Greece (n = 182) and Australia (n = 141 Anglo-Celts, and 189 Greeks). | Up to 7 (1988-91 to ?) | 169? | All-cause mortality | Vegetables (not defined) | RR = 1.00 (0.98-1.02; P = 0.70) for an increase of 20 gram. | Adjusted to 2500 kcal for men and 2000 kcal for women, including terms of age, sex, smoking status, and ethnicity/locality. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 24) Seccareccia F. (2003) | Two Italian Cohorts of "The Seven Countries Study". | 1,536 men aged 45-65. | 30 (1965-1995) | 1,096? (308 CHD, 325 cancer, 158 cerebrovascular disease, and 305 other causes) | Total mortality | Vegetables (raw vegetables, cooked vegetables, tomatoes, peppers, and eggplant. But excluding legumes) | HR = 0.82 (0.69-0.96) for the highest vs lowest quartile of consumption (≥ 60 vs 0-20 g/day). HR = 0.97 (0.94-0.99; P = ≤ 0.05) for an increase of 20 g/day. Men who consumed 60 g or more vegetables/day lived 1.8 years longer than those consuming 0-20 g/day. This increase in survival was more striking in smokers than nonsmokers (2.1 vs. a 1 year gain, respectively). | age, energy, smoking, physical activity, systolic blood pressure, total cholesterol, BMI, and fruit consumption. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 22) Ness AR (2005) | The Boyd Orr Cohort. | 4,028 people (1,995 men, and 2,033 women) from England and Scotland. | average 37 (1948 to 2000) | 1,010 | All-cause mortality | Vegetables (not defined, but excluding potatoes) |
RR = 0.95 (0.75-1.19; P = 0.4) for the highest vs lowest quartile of consumption. Amount specific data (g): 0-38.8: RR = 1. 38.8-58.1: RR = 1.01 (0.83-1.24). 58.3-83.1: RR = 0.86 (0.70-1.07). 83.2-481.2: RR = 0.95 (0.75-1.19). | Age, energy, sex, childhood family food expenditure, father's social class, district of residence as a child, period of birth, season when studied as a child, and Townsend score for current address or place of death. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 22) Maynard M. (2003) | The Boyd Orr Cohort. | 3.878 children -mean age 8 years- (1.959 women/1.919 men). (England/Scotland) | > 60 years (1937-39 to 2000) | 1,000 | all cause mortality | Vegetables (Not defined. Excluding potatoes) |
OR = 0.92 (0.69-1.22; P = 0.28) for the highest vs lowest quartile of consumption. Amount specific data (mean intake in g/day): 23.1: OR = 1. 47.3: OR = 1.06 (0.82-1.36). 68.5: OR = 0.86 (0.66-1.12). 115.2: OR = 0.92 (0.69-1.22). | Intra-family clustering. Age, sex, energy, food expenditure, Townsend score, season, and district. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 21) Trichopoulou A (2009) | The Greek segment of the EPIC Study | 23,349 men and women aged 20-86, and without cancer, CHD, or diabetes. | 8.5 (1994-97 to 2008) | 1,075? | All-cause mortality | Vegetables (not defined) | Mortality Ratio = 0.901 (0.775-1.048; P = 0.177) for ≥ vs < median consumption (548.60 g/day for men, and 499.33 g/day for women). | Sex, age, education, smoking status, waist:hip ratio, BMI, MET score, total energy, and consumption of legumes, fruits and nuts, cereals, fish and seafood, monounsaturated/saturated lipids ratio, dairy products, meat and meat products, ethanol. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 21) Nöthlings U (2008) | The EPIC Study. | 10,449 participants - aged 35 to 70- with self-reported diabetes mellitus. (10 European Countries) | 9 (1992-2000 to 2007) | 1346 | All-cause mortality | Vegetables (not defined) |
RR = 0.78 (0.63-0.98; P = 0.03) for the highest vs lowest quartile of consumption. Amount specific data (median intake, g/d): 127: RR = 1. 164: RR = 0.91 (0.77-1.07). 198: RR = 0.76 (0.62-0.92). 259: RR = 0.78 (0.63-0.98). RR for an increase of 80 g/d: 0.87 (0.77-0.97). Sex, smoking status, age at diagnosis, and waist-to-hip ratio did not modify the associations between intake of fruits and vegetables and mortality risk (data not shown). Associations among participants ≥ 60 y of age (n = 4591) were similar to results for the overall group. | Stratified on age. Adusted for sex, smoking status, self-reported heart attack at baseline, self-reported hypertension at baseline, self-reported cancer at baseline, waist-to-hip ratio, insulin treatment, age at diabetes diagnosis, energy intake, alcohol intake. |
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| 21) Agudo A. (2007) | The EPIC Study. | 41,358 subjects (15,610 men, and 25,748 women) aged 30-69. (Spain) | 6.5 (1992-96 to 2002) | 562? (295 cancer, and 123 CVD) | All cause mortality | Total vegetables (not defined) |
HR = 0.84 (0.66-1.06; P = 0.23) for the highest vs lowest quartile of consumption. Amount specific data (median intake in g/day): 92.9: HR = 1. 183.2: HR = 0.75 (0.59-0.96). 272.0: HR = 0.81 (0.64-1.03). 453.3: HR = 0.84 (0.66-1.06). HR as a continuous variable: A significantly decreased risk: HR = 0.91 (0.83-0.99). There was no effect modification by sex. | Stratified by center. Adjusted for age, sex, total energy, education, BMI, physical activity, cigarette smoking, and alcohol. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 21) Trichopoulou A. (2006) | The EPIC Study. | 1,013 subjects taking drugs for diabetes mellitus at enrolment. (Greece) | 4.5 | 80? (46 cardiovascular, 19 cancer, 15 other) | Mortality | Vegetables (not defined) | HR = 1.10 (0.80-1.52; P = 0.56) per increment of 210 g/day. | Gender, age, education, smoking, waist-to-height, hip circumference, MET score, treatment with insulin, treatment for hypertension, treatment for hypercholesterolaemia, legumes/potatoes, fruits/nuts, dairy, cereals, meat products, fish/seafood, eggs, sugar/confectionery, soft drinks/juices, tea/coffee, ethanol, and olive oil. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 21) Trichopoulou A (2005b) | The EPIC-elderly Study | 74,607 men and women aged ≥ 60 without a history of CHD, stroke, or cancer, and from 9 European countries. (Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, UK) | Median 89 months. (1992-2000 to 1999-2003) | 4,047? | Overall mortality | Vegetables (not defined) | Mortality ratio: 0.94 (0.90-0.98; No P-value) for an increment of 145 g/day. | Stratified by country and adjusted for sex, age, diabetes mellitus at baseline, BMI, educational achievement, smoking status, physical activity at occupation, physical activity at leisure, alcohol intake, and total energy intake. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 21) Trichopoulou A (2005a) | The Greek part of the EPIC Study | 1,302 men and women aged 20-86 with CHD (MI and/or angina pectoris), and with or without diabetes mellitus. (Greece) | 3.78 (1994-97 to 2003) | 131? | All-cause mortality | Vegetables (not defined) | MR = 0.80 (0.62-1.02) for an increment of 200 g/d. | Sex, age, previous treatment for hypercholesterolemia, diabetes mellitus at enrollment, years of schooling, smoking status, waist-to-hip ratio, metabolic equivalent score, BMI, and total energy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 21) Trichopoulou A. (2003) | The Greek component of The EPIC Study. | 22,043 adults aged 20-86. (Greece) | 3.7 (1994-99 to 2002) | 275? | All-cause mortality | Vegetables (not defined) | HR = 0.88 (0.74-1.04; No P-value) for an increment of 230 g/day. | Sex, age, waist-to-hip ratio, energy-expenditure score, education, smoking status and 5 categories of current smoker, BMI, and total energy. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 18) Hung HC. (2004) | The Nurses' Health Study & The Health Professionals' Follow-up Study. | 71,910 women (aged 30-55) and 37,725 men (aged 40-75). (USA) | 14 (1984-1998) (women), and 12 (1986-1998) (men) | 9329? events (1964 cardiovascular, 6584 cancer, and 781 other deaths) in women, and 4957? events (1670 cardiovascular diseases, 2500 cancers, and 787 other deaths) in men | Risk of major chronic disease (cardiovascular disease, cancer, or nontraumatic death) | All vegetables (tomatoes, tomato sauce, string beans, broccoli, cabbage or coleslaw, cauliflower, Brussels sprouts, carrots, corn, peas or lima beans, mixed vegetables, yellow [winter] squash, eggplant, zucchini, or other summer squash, yams or sweet potatoes, spinach, kale, mustard, or chard greens, iceberg or head lettuce, romaine or leaf lettuce, celery, mushrooms, beets, alfalfa sprouts, garlic, green or chili peppers, potatoes, artichokes, asparagus, avocado, bean sprouts, chicory, chili peppers, daikon radish, endive, escarole, jerusalem artichokes, turnips, kohlrabi, leeks, okra, oriental vegetables, parsley, parsnips, peapods, radishes, rhubarb, rutabagas, scallions, and water chestnuts) |
Total calorie intake, age, smoking status, alcohol use, body mass index, multivitamin and vitamin E supplement use, physical activity, family history of myocardial infarction, family history of colon cancer, personal history of hypertension, personal history of hypercholesterolemia, personal history of diabetes, and (for women only) family history of breast cancer, menopausal status, and use of hormone replacement therapy. |
18) McCullough ML. (2000) | The Health Professionals Follow-up Study. | 38,622 men aged 40-75. | (USA) 8 | (1986-1994) 3,119? | Risk of major chronic disease (defined as CVD, cancer, or death not resulting from trauma) | Vegetables (Not defined, including potatoes) | RR for a 5-point increase (representing more servings) = 0.91 (0.83-1.01). | Highest (10 points) vs lowest tertile (0 points) = 4.2-5 vs 0 servings/d respectively. Each component of the healthy food index was added individually into the multivariate model, adjusting for age, smoking, body mass index, alcohol intake, physical activity, diagnosis of hypertension or hypercholesterolemia at baseline, total energy intake, and time period. |
16) Strandhagen E. (2000) | The Study Of Men Born In 1913. | 730 men aged 54. | (Sweden) 26 | (1967-1993) 390 | All death | Vegetables (not defined) | No significant association was found for men in the highest vs lowest quartile of consumption (6-7 vs 0-1 times/wk) (No data shown). | No data shown. |
15) Lascheras C. (2000) | No cohort name. | 161 nonsmoking elderly subjects aged 65-95 (74 aged < 80 y, and 87 aged > or = 80) living in Asturias, Spain. | 9.5 | (1989-1998) 96? | (38 < 80 y, and 58 > or = 80 y) All-cause mortality | Vegetables (not defined) |
|
RRs are for a 20 g change. Adjusted to 2500 kcal for men and 2000 kcal for women. Age, sex, BMI, albumin concentration, physical activity, self-assessment of health, and dieting for chronic conditions, monounsaturated fat, saturated fat. |
14) Kouris-Blazos A (1999) | Not defined. | 330 Anglo-Celts and Greek-Australians of both sexes aged ≥ 70 from Melbourne. | (Australia) 1990-92 to 1996 | 38? | All-cause mortality | Vegetables (not defined) | RR = 1.02 (0.99-1.07) for a daily consumption of 20 g (adjusted to 2500 kcal for men and 2000 kcal for women). | Age, sex, smoking status and ethnic origin. |
10) Knoops KT (2006) | The HALE (Healthy Ageing: a Longitudinal study in Europe). | (Including subjects of the SENECA and FINE study) 2,044 men and, 1,049 women aged 70-90 from 10 European countries. | (The FINE Study included the survivors of 5 cohorts [from Finland, Italy, and The Netherlands] of The Seven Countries Study) 10 | (1988-2000) See variables | All-cause mortality | Vegetables and potatoes (not defined) |
|
Age, gender, physical activity, smoking, alcohol use, education, BMI, chronic disease at baseline and study centre. |
10) Iestra J (2006) | The HALE | (Including the SENECA study, and the FINE study. The FINE study is an extension of "The Seven Countries Study" beyond the 25 years follow-up) 462 men and women age ≥ 70 with a history of MI | 10 | Not defined (53% died) | All-cause mortality | Vegetables (not defined, but including potatoes) |
HR = 1.06 (0.82-1.38) for above vs below median consumption. |
Study, gender, age, years of education, BMI, history of diabetes or stroke, smoking, physical activity, alcohol |
10) Osler M (1997) | Part of the Euronut SENECA Study. | 202 elderly subjects (101 men and 101 women) from the Danish Municipality Roskilde. | 6 | (1988-89 to 1995) 52? | Total mortality | Vegetables and legumes (not defined) | No significant association: RR = 0.99 (0.95-1.04; No P-value) for a 20 g change. | Adjusted for energy (to 10.5 MJ for men, and 8.4 MJ in women). Age, sex, and smoking status. |
9) Knekt P (1996) | The Finnish Mobile Clinic Health Examination Cohort. | 5133 subjects (2748 men and 2385 women) aged 30-69. | 26 | (1967-72 to 1992) 1364? | Total mortality | Vegetables (not defined) |
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Age, smoking, serum cholesterol, hypertension, and BMI. |
7) Sahyoun NR. (1996) | No cohort name. | 725 subjects (254 men, and 471 women) aged 60-101 from Massachusetts. | (USA) 9-12 | (1981-84 to 1993) 199? | Overall mortality | All vegetables (not defined) | RR = 0.49 (0.31-0.77; P = 0.01) for the highest vs lowest tertile of consumption. | Amount specific data (tertiles. No amounts defined): T1: RR = 1. T2: RR = 0.64 (0.46-0.88). T3: RR = 0.49 (0.31-0.77). Age, sex, disease status, disabilities affecting shopping, and citrus fruit/juices. |
6) Trichopoulou A (1995) | No cohort name. | 182 elderly residents (91 men, and 91 women) aged > 70 from 3 Greek villages. | 1988-90 to 1993-94 | 53? | All-cause mortality | Vegetables (not defined) | RR = 0.97 (0.93-1.02; P = 0.20) for an increment of 20 g. | Adjusted to 2500 kcal for men, and 2000 kcal for women. Age, sex, and smoking status. |
2) Nube M. (1987) | No cohort name. | 2,820 Dutch civil servants of Amsterdam and their spouses aged 40-64 (1,394 men, and 1,426). | 25 | (1953-54 to ?) 742? men, and | 448? women Survival | Vegetables (not defined) |
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Age. |
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