Preoperative micronutrient status in morbidly obese patients before undergoing bariatric surgery: results of a cross-sectional study
Abstract Background Reliable information on micronutrient status before bariatric surgery is needed to optimize preoperative nutritional status and postoperative nutritional therapy. Objective To investigate the pro-/vitamin and mineral status and its association with nutrient intake in morbidly obe...
Gespeichert in:
| Veröffentlicht in: | Surgery for obesity and related diseases 2015-09, Vol.11 (5), p.1157-1163 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1163 |
|---|---|
| container_issue | 5 |
| container_start_page | 1157 |
| container_title | Surgery for obesity and related diseases |
| container_volume | 11 |
| creator | Wolf, Eva, M.Sc Utech, Markus, M.D Stehle, Peter, Ph.D Büsing, Martin, M.D Stoffel-Wagner, Birgit, M.D Ellinger, Sabine, Ph.D |
| description | Abstract Background Reliable information on micronutrient status before bariatric surgery is needed to optimize preoperative nutritional status and postoperative nutritional therapy. Objective To investigate the pro-/vitamin and mineral status and its association with nutrient intake in morbidly obese patients seeking bariatric surgery Setting Klinikum Vest, Recklinghausen, Germany. Methods The cross-sectional study investigated retinol, ascorbic acid, tocopherol, and β-carotene (high-pressure liquid chromatography), 25-hydroxycholecalciferol (enzyme-linked immunosorbent assay), and calcium, phosphate, and magnesium (photometry) in serum/plasma in 43 patients (body mass index: 52.6±10.5 kg/m2 ) before sleeve gastrectomy. Albumin, parathyroid hormone, and alkaline phosphatase were analyzed. Data were compared with accepted cutoff values. Dietary intake was estimated by 3-day food records, and nutrient intake was compared with recommended values. Results One third of participants had ascorbic acid concentrations6.5 pmol/L). Calcium, magnesium, and alkaline phosphatase were always, and phosphate was mostly (98%) above cutoff values. Intake of retinol (23%), ascorbic acid (55.8%), vitamin D (90.7%), tocopherol (48.8%), and β-carotene ( |
| doi_str_mv | 10.1016/j.soard.2015.03.018 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1747313969</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1550728915000921</els_id><sourcerecordid>1747313969</sourcerecordid><originalsourceid>FETCH-LOGICAL-c414t-fa236770b627d00a233e958d1ee9ad29c4e56b277b6bcca7230fcfa0094fb0ce3</originalsourceid><addsrcrecordid>eNqFkk2L1TAUhosozof-AkGydNN6kjRNKygMg47CgIK6Dvk4veTaNtekGejeH27u3NGFG1dJ4HnPyXk4VfWCQkOBdq_3TQo6uoYBFQ3wBmj_qDqnvexrKTh_XO5CQC1ZP5xVFyntAXgnJHtanTEx9MA5Pa9-fYkYDhj16u-QzN7GsOQ1elxWkla95kT8QuYQjXfTRoLBhORQ6AIkYnAMEUleHMZd8MuOGB29LnlLUo47jNsbEjHlqcBhJJqU-inVCe3qw6Kn0iO77Vn1ZNRTwucP52X1_cP7b9cf69vPN5-ur25r29J2rUfNeCclmI5JB1BeHAfRO4o4aMcG26LoDJPSdMZaLRmH0Y4aYGhHAxb5ZfXqVPcQw8-MaVWzTxanSS8YclJUtpJTPnRDQfkJvf9wxFEdop913BQFddSv9upevzrqV8BV0V9SLx8aZDOj-5v547sAb08AljHvPEaVbFFp0flYnCgX_H8avPsnbye_eKunH7hh2occi9UyiUpMgfp63IDjAlABRQOj_DfAE7Bt</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1747313969</pqid></control><display><type>article</type><title>Preoperative micronutrient status in morbidly obese patients before undergoing bariatric surgery: results of a cross-sectional study</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Wolf, Eva, M.Sc ; Utech, Markus, M.D ; Stehle, Peter, Ph.D ; Büsing, Martin, M.D ; Stoffel-Wagner, Birgit, M.D ; Ellinger, Sabine, Ph.D</creator><creatorcontrib>Wolf, Eva, M.Sc ; Utech, Markus, M.D ; Stehle, Peter, Ph.D ; Büsing, Martin, M.D ; Stoffel-Wagner, Birgit, M.D ; Ellinger, Sabine, Ph.D</creatorcontrib><description>Abstract Background Reliable information on micronutrient status before bariatric surgery is needed to optimize preoperative nutritional status and postoperative nutritional therapy. Objective To investigate the pro-/vitamin and mineral status and its association with nutrient intake in morbidly obese patients seeking bariatric surgery Setting Klinikum Vest, Recklinghausen, Germany. Methods The cross-sectional study investigated retinol, ascorbic acid, tocopherol, and β-carotene (high-pressure liquid chromatography), 25-hydroxycholecalciferol (enzyme-linked immunosorbent assay), and calcium, phosphate, and magnesium (photometry) in serum/plasma in 43 patients (body mass index: 52.6±10.5 kg/m2 ) before sleeve gastrectomy. Albumin, parathyroid hormone, and alkaline phosphatase were analyzed. Data were compared with accepted cutoff values. Dietary intake was estimated by 3-day food records, and nutrient intake was compared with recommended values. Results One third of participants had ascorbic acid concentrations<28 nmol/L. All patients had β-carotene levels≤.9 µmol/L, although retinol was below the cutoff value (<.7 µmol/L) in only 5%. Tocopherol/cholesterol-ratio was always>2.8 µmol/mmol. Of the patients, 84% had 25-hydroxycholecalciferol levels below 50 nmol/L. Parathyroid hormone was elevated in 23% (>6.5 pmol/L). Calcium, magnesium, and alkaline phosphatase were always, and phosphate was mostly (98%) above cutoff values. Intake of retinol (23%), ascorbic acid (55.8%), vitamin D (90.7%), tocopherol (48.8%), and β-carotene (<2.0 mg/d; 37.2%) were often below recommendations. Correlations between serum/plasma concentrations and nutritional intake and associations between low concentrations and inadequate intake were not observed. Conclusions Many morbidly obese patients in Germany suffer from deficiencies in multiple micronutrients, particularly vitamin D, ascorbic acid, and β-carotene before sleeve gastrectomy. Measurement of preoperative micronutrient status will help supplement patients before, and optimize nutritional therapy after, surgery.</description><identifier>ISSN: 1550-7289</identifier><identifier>EISSN: 1878-7533</identifier><identifier>DOI: 10.1016/j.soard.2015.03.018</identifier><identifier>PMID: 25980331</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Bariatric surgery ; Bariatric Surgery - adverse effects ; Bariatric Surgery - methods ; Body Mass Index ; Chromatography, High Pressure Liquid ; Cross-Sectional Studies ; Deficiency Diseases - diagnosis ; Deficiency Diseases - epidemiology ; Dietary intake ; Enzyme-Linked Immunosorbent Assay ; Female ; Follow-Up Studies ; Gastroenterology and Hepatology ; Germany ; Humans ; Male ; Micronutrients ; Micronutrients - blood ; Micronutrients - deficiency ; Middle Aged ; Nutrition Assessment ; Nutritional deficiencies ; Nutritional recommendations ; Nutritional Status ; Obesity ; Obesity, Morbid - blood ; Obesity, Morbid - epidemiology ; Obesity, Morbid - surgery ; Postoperative Care - methods ; Preoperative Care - methods ; Preoperative nutritional assessment ; Risk Assessment ; Surgery ; Treatment Outcome</subject><ispartof>Surgery for obesity and related diseases, 2015-09, Vol.11 (5), p.1157-1163</ispartof><rights>American Society for Metabolic and Bariatric Surgery</rights><rights>2015 American Society for Metabolic and Bariatric Surgery</rights><rights>Copyright © 2015 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-fa236770b627d00a233e958d1ee9ad29c4e56b277b6bcca7230fcfa0094fb0ce3</citedby><cites>FETCH-LOGICAL-c414t-fa236770b627d00a233e958d1ee9ad29c4e56b277b6bcca7230fcfa0094fb0ce3</cites><orcidid>0000-0002-9988-9406</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1550728915000921$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25980331$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wolf, Eva, M.Sc</creatorcontrib><creatorcontrib>Utech, Markus, M.D</creatorcontrib><creatorcontrib>Stehle, Peter, Ph.D</creatorcontrib><creatorcontrib>Büsing, Martin, M.D</creatorcontrib><creatorcontrib>Stoffel-Wagner, Birgit, M.D</creatorcontrib><creatorcontrib>Ellinger, Sabine, Ph.D</creatorcontrib><title>Preoperative micronutrient status in morbidly obese patients before undergoing bariatric surgery: results of a cross-sectional study</title><title>Surgery for obesity and related diseases</title><addtitle>Surg Obes Relat Dis</addtitle><description>Abstract Background Reliable information on micronutrient status before bariatric surgery is needed to optimize preoperative nutritional status and postoperative nutritional therapy. Objective To investigate the pro-/vitamin and mineral status and its association with nutrient intake in morbidly obese patients seeking bariatric surgery Setting Klinikum Vest, Recklinghausen, Germany. Methods The cross-sectional study investigated retinol, ascorbic acid, tocopherol, and β-carotene (high-pressure liquid chromatography), 25-hydroxycholecalciferol (enzyme-linked immunosorbent assay), and calcium, phosphate, and magnesium (photometry) in serum/plasma in 43 patients (body mass index: 52.6±10.5 kg/m2 ) before sleeve gastrectomy. Albumin, parathyroid hormone, and alkaline phosphatase were analyzed. Data were compared with accepted cutoff values. Dietary intake was estimated by 3-day food records, and nutrient intake was compared with recommended values. Results One third of participants had ascorbic acid concentrations<28 nmol/L. All patients had β-carotene levels≤.9 µmol/L, although retinol was below the cutoff value (<.7 µmol/L) in only 5%. Tocopherol/cholesterol-ratio was always>2.8 µmol/mmol. Of the patients, 84% had 25-hydroxycholecalciferol levels below 50 nmol/L. Parathyroid hormone was elevated in 23% (>6.5 pmol/L). Calcium, magnesium, and alkaline phosphatase were always, and phosphate was mostly (98%) above cutoff values. Intake of retinol (23%), ascorbic acid (55.8%), vitamin D (90.7%), tocopherol (48.8%), and β-carotene (<2.0 mg/d; 37.2%) were often below recommendations. Correlations between serum/plasma concentrations and nutritional intake and associations between low concentrations and inadequate intake were not observed. Conclusions Many morbidly obese patients in Germany suffer from deficiencies in multiple micronutrients, particularly vitamin D, ascorbic acid, and β-carotene before sleeve gastrectomy. Measurement of preoperative micronutrient status will help supplement patients before, and optimize nutritional therapy after, surgery.</description><subject>Adult</subject><subject>Bariatric surgery</subject><subject>Bariatric Surgery - adverse effects</subject><subject>Bariatric Surgery - methods</subject><subject>Body Mass Index</subject><subject>Chromatography, High Pressure Liquid</subject><subject>Cross-Sectional Studies</subject><subject>Deficiency Diseases - diagnosis</subject><subject>Deficiency Diseases - epidemiology</subject><subject>Dietary intake</subject><subject>Enzyme-Linked Immunosorbent Assay</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology and Hepatology</subject><subject>Germany</subject><subject>Humans</subject><subject>Male</subject><subject>Micronutrients</subject><subject>Micronutrients - blood</subject><subject>Micronutrients - deficiency</subject><subject>Middle Aged</subject><subject>Nutrition Assessment</subject><subject>Nutritional deficiencies</subject><subject>Nutritional recommendations</subject><subject>Nutritional Status</subject><subject>Obesity</subject><subject>Obesity, Morbid - blood</subject><subject>Obesity, Morbid - epidemiology</subject><subject>Obesity, Morbid - surgery</subject><subject>Postoperative Care - methods</subject><subject>Preoperative Care - methods</subject><subject>Preoperative nutritional assessment</subject><subject>Risk Assessment</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>1550-7289</issn><issn>1878-7533</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk2L1TAUhosozof-AkGydNN6kjRNKygMg47CgIK6Dvk4veTaNtekGejeH27u3NGFG1dJ4HnPyXk4VfWCQkOBdq_3TQo6uoYBFQ3wBmj_qDqnvexrKTh_XO5CQC1ZP5xVFyntAXgnJHtanTEx9MA5Pa9-fYkYDhj16u-QzN7GsOQ1elxWkla95kT8QuYQjXfTRoLBhORQ6AIkYnAMEUleHMZd8MuOGB29LnlLUo47jNsbEjHlqcBhJJqU-inVCe3qw6Kn0iO77Vn1ZNRTwucP52X1_cP7b9cf69vPN5-ur25r29J2rUfNeCclmI5JB1BeHAfRO4o4aMcG26LoDJPSdMZaLRmH0Y4aYGhHAxb5ZfXqVPcQw8-MaVWzTxanSS8YclJUtpJTPnRDQfkJvf9wxFEdop913BQFddSv9upevzrqV8BV0V9SLx8aZDOj-5v547sAb08AljHvPEaVbFFp0flYnCgX_H8avPsnbye_eKunH7hh2occi9UyiUpMgfp63IDjAlABRQOj_DfAE7Bt</recordid><startdate>20150901</startdate><enddate>20150901</enddate><creator>Wolf, Eva, M.Sc</creator><creator>Utech, Markus, M.D</creator><creator>Stehle, Peter, Ph.D</creator><creator>Büsing, Martin, M.D</creator><creator>Stoffel-Wagner, Birgit, M.D</creator><creator>Ellinger, Sabine, Ph.D</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9988-9406</orcidid></search><sort><creationdate>20150901</creationdate><title>Preoperative micronutrient status in morbidly obese patients before undergoing bariatric surgery: results of a cross-sectional study</title><author>Wolf, Eva, M.Sc ; Utech, Markus, M.D ; Stehle, Peter, Ph.D ; Büsing, Martin, M.D ; Stoffel-Wagner, Birgit, M.D ; Ellinger, Sabine, Ph.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-fa236770b627d00a233e958d1ee9ad29c4e56b277b6bcca7230fcfa0094fb0ce3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Bariatric surgery</topic><topic>Bariatric Surgery - adverse effects</topic><topic>Bariatric Surgery - methods</topic><topic>Body Mass Index</topic><topic>Chromatography, High Pressure Liquid</topic><topic>Cross-Sectional Studies</topic><topic>Deficiency Diseases - diagnosis</topic><topic>Deficiency Diseases - epidemiology</topic><topic>Dietary intake</topic><topic>Enzyme-Linked Immunosorbent Assay</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology and Hepatology</topic><topic>Germany</topic><topic>Humans</topic><topic>Male</topic><topic>Micronutrients</topic><topic>Micronutrients - blood</topic><topic>Micronutrients - deficiency</topic><topic>Middle Aged</topic><topic>Nutrition Assessment</topic><topic>Nutritional deficiencies</topic><topic>Nutritional recommendations</topic><topic>Nutritional Status</topic><topic>Obesity</topic><topic>Obesity, Morbid - blood</topic><topic>Obesity, Morbid - epidemiology</topic><topic>Obesity, Morbid - surgery</topic><topic>Postoperative Care - methods</topic><topic>Preoperative Care - methods</topic><topic>Preoperative nutritional assessment</topic><topic>Risk Assessment</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wolf, Eva, M.Sc</creatorcontrib><creatorcontrib>Utech, Markus, M.D</creatorcontrib><creatorcontrib>Stehle, Peter, Ph.D</creatorcontrib><creatorcontrib>Büsing, Martin, M.D</creatorcontrib><creatorcontrib>Stoffel-Wagner, Birgit, M.D</creatorcontrib><creatorcontrib>Ellinger, Sabine, Ph.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery for obesity and related diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wolf, Eva, M.Sc</au><au>Utech, Markus, M.D</au><au>Stehle, Peter, Ph.D</au><au>Büsing, Martin, M.D</au><au>Stoffel-Wagner, Birgit, M.D</au><au>Ellinger, Sabine, Ph.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative micronutrient status in morbidly obese patients before undergoing bariatric surgery: results of a cross-sectional study</atitle><jtitle>Surgery for obesity and related diseases</jtitle><addtitle>Surg Obes Relat Dis</addtitle><date>2015-09-01</date><risdate>2015</risdate><volume>11</volume><issue>5</issue><spage>1157</spage><epage>1163</epage><pages>1157-1163</pages><issn>1550-7289</issn><eissn>1878-7533</eissn><abstract>Abstract Background Reliable information on micronutrient status before bariatric surgery is needed to optimize preoperative nutritional status and postoperative nutritional therapy. Objective To investigate the pro-/vitamin and mineral status and its association with nutrient intake in morbidly obese patients seeking bariatric surgery Setting Klinikum Vest, Recklinghausen, Germany. Methods The cross-sectional study investigated retinol, ascorbic acid, tocopherol, and β-carotene (high-pressure liquid chromatography), 25-hydroxycholecalciferol (enzyme-linked immunosorbent assay), and calcium, phosphate, and magnesium (photometry) in serum/plasma in 43 patients (body mass index: 52.6±10.5 kg/m2 ) before sleeve gastrectomy. Albumin, parathyroid hormone, and alkaline phosphatase were analyzed. Data were compared with accepted cutoff values. Dietary intake was estimated by 3-day food records, and nutrient intake was compared with recommended values. Results One third of participants had ascorbic acid concentrations<28 nmol/L. All patients had β-carotene levels≤.9 µmol/L, although retinol was below the cutoff value (<.7 µmol/L) in only 5%. Tocopherol/cholesterol-ratio was always>2.8 µmol/mmol. Of the patients, 84% had 25-hydroxycholecalciferol levels below 50 nmol/L. Parathyroid hormone was elevated in 23% (>6.5 pmol/L). Calcium, magnesium, and alkaline phosphatase were always, and phosphate was mostly (98%) above cutoff values. Intake of retinol (23%), ascorbic acid (55.8%), vitamin D (90.7%), tocopherol (48.8%), and β-carotene (<2.0 mg/d; 37.2%) were often below recommendations. Correlations between serum/plasma concentrations and nutritional intake and associations between low concentrations and inadequate intake were not observed. Conclusions Many morbidly obese patients in Germany suffer from deficiencies in multiple micronutrients, particularly vitamin D, ascorbic acid, and β-carotene before sleeve gastrectomy. Measurement of preoperative micronutrient status will help supplement patients before, and optimize nutritional therapy after, surgery.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25980331</pmid><doi>10.1016/j.soard.2015.03.018</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-9988-9406</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1550-7289 |
| ispartof | Surgery for obesity and related diseases, 2015-09, Vol.11 (5), p.1157-1163 |
| issn | 1550-7289 1878-7533 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1747313969 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Adult Bariatric surgery Bariatric Surgery - adverse effects Bariatric Surgery - methods Body Mass Index Chromatography, High Pressure Liquid Cross-Sectional Studies Deficiency Diseases - diagnosis Deficiency Diseases - epidemiology Dietary intake Enzyme-Linked Immunosorbent Assay Female Follow-Up Studies Gastroenterology and Hepatology Germany Humans Male Micronutrients Micronutrients - blood Micronutrients - deficiency Middle Aged Nutrition Assessment Nutritional deficiencies Nutritional recommendations Nutritional Status Obesity Obesity, Morbid - blood Obesity, Morbid - epidemiology Obesity, Morbid - surgery Postoperative Care - methods Preoperative Care - methods Preoperative nutritional assessment Risk Assessment Surgery Treatment Outcome |
| title | Preoperative micronutrient status in morbidly obese patients before undergoing bariatric surgery: results of a cross-sectional study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T21%3A35%3A27IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Preoperative%20micronutrient%20status%20in%20morbidly%20obese%20patients%20before%20undergoing%20bariatric%20surgery:%20results%20of%20a%20cross-sectional%20study&rft.jtitle=Surgery%20for%20obesity%20and%20related%20diseases&rft.au=Wolf,%20Eva,%20M.Sc&rft.date=2015-09-01&rft.volume=11&rft.issue=5&rft.spage=1157&rft.epage=1163&rft.pages=1157-1163&rft.issn=1550-7289&rft.eissn=1878-7533&rft_id=info:doi/10.1016/j.soard.2015.03.018&rft_dat=%3Cproquest_cross%3E1747313969%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1747313969&rft_id=info:pmid/25980331&rft_els_id=S1550728915000921&rfr_iscdi=true |