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Fox News
17 hours ago
- Health
- Fox News
Just one hot dog a day could raise disease risk, study suggests, but some cite caveats
A new meta-analysis from the University of Washington suggests that no amount of processed food is safe to consume. Researchers analyzed 77 different studies to gauge the link between certain amounts of these foods and common chronic diseases. "Habitual consumption of even small amounts of processed meat, sugary drinks and trans fatty acids is linked to increased risk of developing type 2 diabetes, ischemic heart disease and colorectal cancer," lead study author Demewoz Haile, a research scientist at the Institute for Health Metrics and Evaluation at the University of Washington, told Fox News Digital. "There is no safe level of habitual consumption of these food groups, so they should not be included in our daily diet," he stated. For processed meats in particular, the researchers concluded that eating as little as 0.6 to 57 grams per day was linked to an 11% greater likelihood of developing type 2 diabetes. Consuming between 0.78 and 55 grams per day was associated with a 7% increase in colorectal cancer risk, the study found. (One hot dog, which is made up of almost entirely processed meat, is approximately 50 grams.) The researchers also analyzed the impact of sugar-sweetened beverages, finding that drinking between 1.5 and 390 grams per day could raise type 2 diabetes risk by 8%. Consuming between 0 and 365 grams of the beverages could increase the risk of ischemic heart disease — the most common type of heart disease and a leading cause of death — by 2%, the study found. Trans fatty acids were also analyzed in the study. When the unsaturated fats made up anywhere from 0.25% to 2.56% of daily energy intake, they were linked to a 3% greater risk of ischemic heart disease. "There is no safe level of habitual consumption of these food groups." (Some examples of trans fats include crackers, cookies, baked goods, frozen pizza, coffee creamer, refrigerated dough products, and vegetable shortenings and some stick margarines, according to WebMD. Some fast foods also contain it.) The findings were published in the journal Nature Medicine on June 30. Previous studies have established the link between processed foods and chronic disease, Haile acknowledged. "However, our study evaluated the shape of the relationship with the most recent studies, using a more advanced analytical method, and objectively assessed the strength of the evidence," he noted. "Our analysis showed that the strongest association is observed at lower exposure levels equivalent to a serving or less, which implies that consuming these food items on a regular basis at any amount increases the risk of adverse health outcomes." While the researchers recognized that diet is a "personal choice" and that some may be limited in food choices, they recommend limiting or eliminating consumption of processed foods. "Our findings support what is widely recommended, including by the WHO and CDC: Avoid or reduce to the minimum possible level the consumption of processed meats, sugary drinks and artificial trans fats," Haile told Fox News Digital. "Individuals who regularly consume these foods, even in small amounts, should be aware of the increased risk of chronic diseases." The major limitations of this study are associated with dietary intake assessment, Haile acknowledged. "Almost all of the included studies used food frequency questionnaires to assess intake, which can introduce measurement errors, primarily due to difficulties experienced by respondents in recalling long-term intake," he told Fox News Digital. Several studies included in the analysis only looked at consumption at the start of the study, Haile noted — "which might not accurately reflect the future dietary habits of the study participants." Also, the study only looked at a limited set of health outcomes for each dietary risk factor. "Consequently, our study may underestimate the total health loss associated with these foods," Haile said. "We also observed substantial variation across existing literature, which implies that high-quality research is still needed to strengthen the evidence and reduce uncertainty." Dr. Nick Norwitz, M.D., PhD, a Harvard-educated clinical researcher and metabolic health educator, acknowledged that the study shows a "relatively consistent association" between higher processed meat intake and worse health outcomes, but pointed out some caveats. "These are associations — not necessarily causal relationships," Norwitz, who was not involved in the study, told Fox News Digital. Additionally, as the researchers themselves acknowledged, the quality of the evidence was graded as "weak," Norwitz pointed out. "At the end of the day, the office donut or bottle of soda is almost certainly doing more metabolic damage than a slice of deli turkey." "While these large studies have certain strengths, one key weakness is that they lump together many different foods within a single category," the researcher went on. "There are various ways to process meats, and not all will have the same biological consequences." While it's "certainly feasible" that processed meat can contribute to poor health outcomes, Norwitz said that more research is needed to confirm the meta-analysis' claims. "At the end of the day, the office donut or bottle of soda is almost certainly doing more metabolic damage than a slice of deli turkey," he added. A spokesperson from the American Association of Meat Processors (AAMP) sent the below statement to Fox News Digital regarding the study. "We have not read the [full] report, but the abstract in the paper itself states that the assertions reflect 'weak relationships or inconsistent input evidence' and that more research is necessary. We would like to know how the paper defined 'processed meat,' or if the researchers weighed any supposed risks against the proven benefits of nutrients and protein found in meat." For more Health articles, visit In the study, the researchers defined processed meat as "any meat preserved by smoking, curing, salting or the addition of chemical preservatives." Fox News Digital also reached out to the Academy of Nutrition and Dietetics and the U.S. Department of Agriculture (USDA) for comment.
CTV News
2 days ago
- Health
- CTV News
There is no safe amount of processed meat to eat, according to new research
The equivalent of one medium-size hot dog was associated with an increased risk of colorectal cancer and Type 2 diabetes in a new study. (RiverRockPhotos/iStockphoto/Getty Images via CNN Newsource) There is strong evidence that there is 'no safe amount' of processed meat to eat, nutrition experts say in response to a new study on the connection between diet and the risk of major diseases, including cancer, Type 2 diabetes and heart disease. The researchers also found elevated risks from the consumption of sugar-sweetened beverages and trans fatty acids. Researchers analyzed data from more than 60 previous studies on the relationship between processed meats, sugar-sweetened beverages and trans fatty acids in a person's diet and their risk of Type 2 diabetes, colorectal cancer and ischemic heart disease, which reduces blood supply to the heart and cuts off oxygen and nutrients, according to the study published Monday in the journal Nature Medicine. 'Habitual consumption of even small amounts of processed meat, sugary drinks, and trans fatty acids is linked to increased risk of developing Type 2 diabetes, ischemic heart disease and colorectal cancer,' said lead author of the study, Dr. Demewoz Haile, a research scientist at the Institute for Health Metrics and Evaluation in Seattle. The data showed that people who ate as little as one hot dog a day when it comes to processed meats had an 11% greater risk of Type 2 diabetes and a 7% increased risk of colorectal cancer than those who didn't eat any. And drinking the equivalent of about a 12-ounce soda per day was associated with an 8% increase in Type 2 diabetes risk and a 2% increased risk of ischemic heart disease. 'This current research has shown, yet again and consistent with prior research … that to achieve health gains it is best to avoid or minimize the habitual consumption of each of processed meat, sugar-sweetened beverages (SSBs) and industrially produced trans fatty acids (TFAs),' said Dr. Nita Forouhi, head of nutritional epidemiology at the University of Cambridge in the United Kingdom. She was not involved in the research. The risk increased as consumption increased; and for processed meat consumption, the data showed that there is no 'safe amount,' she added in an email. A stronger association than it may appear At first glance, the increase in risk seems modest and might look like the association is weak, said Dr. Mingyang Song, associate professor of clinical epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. He was not involved in the research. 'When we look at the actual data there, it's really remarkably consistent and remarkably strong, and even in the lower dose of consumption, we can still see an increased risk of disease,' he said. The researchers examined dozens of earlier findings on diet and disease using a burden-of-proof method: a newer form of meta-analysis that not only tries to quantify an association across multiple studies but also accounts for the quality of each, Song said. 'One caveat is it tends to give very conservative results,' he added. It's also important to note that the studies included in the analysis were observational, meaning that the data can only show an association between eating habits and disease –– not prove that what people ate caused the disease. They also relied on people recalling their dietary patterns, which can leave room for misremembering or misreporting, said Dr. Gunter Kuhnle, professor of nutrition and food science at the University of Reading in the United Kingdom. He was not involved in the study. Utilizing even 'the most sophisticated techniques does not really solve the problem that the information about diet is rather limited – which is obviously a big problem in nutritional epidemiology in general,' he said. Why meats, drinks and fats are linked to disease There are many reasons why such foods could be associated with health problems. Sugar-sweetened beverages and processed meat –– such as sausages, bacon, salami and burgers –– can increase inflammation, which plays a big part in a variety of chronic diseases, Song said. Processed meats are also often cured with nitrite, which is converted to carcinogenic nitrosamines in the stomach, Kuhnle said. The problem with sugary drinks is that they are a quick way to consume large amounts of sugar, he added. Not only can that cause weight gain, but it also influences metabolic pathways that affect heart disease and diabetes risk, Kuhnle said. Trans fatty acids reduce levels of good cholesterol and increase the bad, which is known to increase the risk of plaque buildup in arteries and heart disease, he added. Other potential connections to consider are that people who are more likely to eat processed meats, sugar-sweetened beverages and trans-fats are often also at a higher risk of diseases because of 'lifestyle factors (smoking, lack of exercise), but also social factors such as education and income, chronic stress and limited access to health care,' Kuhnle said. 'It is very difficult to take these apart.' What to avoid and what to add Although the data can't say reducing your consumption of these foods and drinks will cause a lower risk of the diseases, it does suggest that a reduction is a good idea, Song said. A sensible approach is to follow a varied and balanced diet that avoids excess, Kuhnle said. That means people who drink a lot of sugary drinks should cut back, he said. It can also be helpful to avoid excess amounts of processed meats and avoid hydrogenated fats where possible –– although they are no longer as common as they used to be, he said. 'The goal shouldn't be perfection but rather a healthy and sensible dietary pattern that allows room for enjoyment,' Kuhnle said. A good diet isn't just about what to avoid. It's also important to get good nutrients, Forouhi said. 'Wider research has shown us that overall dietary patterns that include higher consumption of fruit and vegetables, whole grains, legumes, nuts and fermented dairy products like yogurt are good for health and longevity,' she said. 'My general advice: don't panic,' Kuhnle said in an email. 'Food is not just (a) source of nutrients –– it plays a central role in culture, pleasure, family life, and social connection. Reducing it solely to a list of health risks misses the bigger picture.' By Madeline Holcombe, CNN
RNZ News
2 days ago
- Health
- RNZ News
There is no safe amount of processed meat to eat, according to new research
The equivalent of one medium-size hot dog was associated with an increased risk of colorectal cancer and type 2 diabetes in a new study. Photo: SCIENCE PHOTO LIBRARY By Madeline Holcombe, CNN There is strong evidence that there is "no safe amount" of processed meat to eat, nutrition experts say in response to a new study on the connection between diet and the risk of major diseases, including cancer, type 2 diabetes and heart disease. The researchers also found elevated risks from the consumption of sugar-sweetened beverages and trans fatty acids. Researchers analysed data from more than 60 previous studies on the relationship between processed meats, sugar-sweetened beverages and trans fatty acids in a person's diet and their risk of type 2 diabetes, colorectal cancer and ischemic heart disease, which reduces blood supply to the heart and cuts off oxygen and nutrients, according to the study published on Monday in the journal Nature Medicine. "Habitual consumption of even small amounts of processed meat, sugary drinks, and trans fatty acids is linked to increased risk of developing type 2 diabetes, ischemic heart disease and colorectal cancer," said lead author of the study, Dr Demewoz Haile, a research scientist at the Institute for Health Metrics and Evaluation in Seattle. The data showed that people who ate as little as one hot dog a day when it comes to processed meats had an 11 percent greater risk of type 2 diabetes and a seven percent increased risk of colorectal cancer than those who didn't eat any. And drinking the equivalent of about a 12-ounce (350 millilitres) soda per day was associated with an eight percent increase in type 2 diabetes risk and a two percent increased risk of ischemic heart disease. "This current research has shown, yet again and consistent with prior research - that to achieve health gains it is best to avoid or minimise the habitual consumption of each of processed meat, sugar-sweetened beverages (SSBs) and industrially produced trans fatty acids (TFAs)," said Dr Nita Forouhi, head of nutritional epidemiology at the University of Cambridge in the United Kingdom. She was not involved in the research. The risk increased as consumption increased; and for processed meat consumption, the data showed that there was no "safe amount", she added in an email. At first glance, the increase in risk seems modest and might look like the association is weak, said Dr Mingyang Song, associate professor of clinical epidemiology and nutrition at the Harvard TH Chan School of Public Health. He was not involved in the research. "When we look at the actual data there, it's really remarkably consistent and remarkably strong, and even in the lower dose of consumption, we can still see an increased risk of disease," he said. The researchers examined dozens of earlier findings on diet and disease using a burden-of-proof method: a newer form of meta-analysis that not only tries to quantify an association across multiple studies but also accounts for the quality of each, Song said. "One caveat is it tends to give very conservative results," he added. It's also important to note that the studies included in the analysis were observational, meaning that the data can only show an association between eating habits and disease - not prove that what people ate caused the disease. They also relied on people recalling their dietary patterns, which can leave room for misremembering or misreporting, said Dr Gunter Kuhnle, professor of nutrition and food science at the University of Reading in the United Kingdom. He was not involved in the study. Utilising even "the most sophisticated techniques does not really solve the problem that the information about diet is rather limited - which is obviously a big problem in nutritional epidemiology in general", he said. There are many reasons why such foods could be associated with health problems. Sugar-sweetened beverages and processed meat - such as sausages, bacon, salami and burgers - can increase inflammation, which plays a big part in a variety of chronic diseases, Song said. Processed meats are also often cured with nitrite, which is converted to carcinogenic nitrosamines in the stomach, Kuhnle said. The problem with sugary drinks is that they are a quick way to consume large amounts of sugar, he added. Not only can that cause weight gain, but it also influences metabolic pathways that affect heart disease and diabetes risk, Kuhnle said. Trans fatty acids reduce levels of good cholesterol and increase the bad, which is known to increase the risk of plaque build-up in arteries and heart disease, he added. Other potential connections to consider are that people who are more likely to eat processed meats, sugar-sweetened beverages and trans-fats are often also at a higher risk of diseases because of "lifestyle factors (smoking, lack of exercise), but also social factors such as education and income, chronic stress and limited access to health care", Kuhnle said. "It is very difficult to take these apart." Although the data can't say reducing your consumption of these foods and drinks will cause a lower risk of the diseases, it does suggest that a reduction is a good idea, Song said. A sensible approach is to follow a varied and balanced diet that avoids excess, Kuhnle said. That means people who drink a lot of sugary drinks should cut back, he said. It can also be helpful to avoid excess amounts of processed meats and avoid hydrogenated fats where possible - although they are no longer as common as they used to be, he said. "The goal shouldn't be perfection but rather a healthy and sensible dietary pattern that allows room for enjoyment," Kuhnle said. A good diet isn't just about what to avoid. It's also important to get good nutrients, Forouhi said. "Wider research has shown us that overall dietary patterns that include higher consumption of fruit and vegetables, whole grains, legumes, nuts and fermented dairy products like yogurt are good for health and longevity," she said. "My general advice: don't panic," Kuhnle said in an email. "Food is not just (a) source of nutrients - it plays a central role in culture, pleasure, family life, and social connection. Reducing it solely to a list of health risks misses the bigger picture." - CNN
CNN
2 days ago
- Health
- CNN
There is no safe amount of processed meat to eat, according to new research
There is strong evidence that there is 'no safe amount' of processed meat to eat, nutrition experts say in response to a new study on the connection between diet and the risk of major diseases, including cancer, type 2 diabetes and heart disease. The researchers also found elevated risks from the consumption of sugar-sweetened beverages and trans fatty acids. Researchers analyzed data from more than 60 previous studies on the relationship between processed meats, sugar-sweetened beverages and trans fatty acids in a person's diet and their risk of type 2 diabetes, colorectal cancer and ischemic heart disease, which reduces blood supply to the heart and cuts off oxygen and nutrients, according to the study published Monday in the journal Nature Medicine. 'Habitual consumption of even small amounts of processed meat, sugary drinks, and trans fatty acids is linked to increased risk of developing type 2 diabetes, ischemic heart disease and colorectal cancer,' said lead author of the study, Dr. Demewoz Haile, a research scientist at the Institute for Health Metrics and Evaluation in Seattle. The data showed that people who ate as little as one hot dog a day when it comes to processed meats had an 11% greater risk of type 2 diabetes and a 7% increased risk of colorectal cancer than those who didn't eat any. And drinking the equivalent of about a 12-ounce soda per day was associated with an 8% increase in type 2 diabetes risk and a 2% increased risk of ischemic heart disease. 'This current research has shown, yet again and consistent with prior research … that to achieve health gains it is best to avoid or minimize the habitual consumption of each of processed meat, sugar-sweetened beverages (SSBs) and industrially produced trans fatty acids (TFAs),' said Dr. Nita Forouhi, head of nutritional epidemiology at the University of Cambridge in the United Kingdom. She was not involved in the research. The risk increased as consumption increased; and for processed meat consumption, the data showed that there is no 'safe amount,' she added in an email. At first glance, the increase in risk seems modest and might look like the association is weak, said Dr. Mingyang Song, associate professor of clinical epidemiology and nutrition at the Harvard T.H. Chan Schoo of Public Healthl. He was not involved in the research. 'When we look at the actual data there, it's really remarkably consistent and remarkably strong, and even in the lower dose of consumption, we can still see an increased risk of disease,' he said. The researchers examined dozens of earlier findings on diet and disease using a burden-of-proof method: a newer form of meta-analysis that not only tries to quantify an association across multiple studies but also accounts for the quality of each, Song said. 'One caveat is it tends to give very conservative results,' he added. It's also important to note that the studies included in the analysis were observational, meaning that the data can only show an association between eating habits and disease –– not prove that what people ate caused the disease. They also relied on people recalling their dietary patterns, which can leave room for misremembering or misreporting, said Dr. Gunter Kuhnle, professor of nutrition and food science at the University of Reading in the United Kingdom. He was not involved in the study. Utilizing even 'the most sophisticated techniques does not really solve the problem that the information about diet is rather limited – which is obviously a big problem in nutritional epidemiology in general,' he said. There are many reasons why such foods could be associated with health problems. Sugar-sweetened beverages and processed meat –– such as sausages, bacon, salami and burgers –– can increase inflammation, which plays a big part in a variety of chronic diseases, Song said. Processed meats are also often cured with nitrite, which is converted to carcinogenic nitrosamines in the stomach, Kuhnle said. The problem with sugary drinks is that they are a quick way to consume large amounts of sugar, he added. Not only can that cause weight gain, but it also influences metabolic pathways that affect heart disease and diabetes risk, Kuhnle said. Trans fatty acids reduce levels of good cholesterol and increase the bad, which is known to increase the risk of plaque buildup in arteries and heart disease, he added. Other potential connections to consider are that people who are more likely to eat processed meats, sugar-sweetened beverages and trans-fats are often also at a higher risk of diseases because of 'lifestyle factors (smoking, lack of exercise), but also social factors such as education and income, chronic stress and limited access to health care,' Kuhnle said. 'It is very difficult to take these apart.' Although the data can't say reducing your consumption of these foods and drinks will cause a lower risk of the diseases, it does suggest that a reduction is a good idea, Song said. A sensible approach is to follow a varied and balanced diet that avoids excess, Kuhnle said. That means people who drink a lot of sugary drinks should cut back, he said. It can also be helpful to avoid excess amounts of processed meats and avoid hydrogenated fats where possible –– although they are no longer as common as they used to be, he said. 'The goal shouldn't be perfection but rather a healthy and sensible dietary pattern that allows room for enjoyment,' Kuhnle said. A good diet isn't just about what to avoid. It's also important to get good nutrients, Forouhi said. 'Wider research has shown us that overall dietary patterns that include higher consumption of fruit and vegetables, whole grains, legumes, nuts and fermented dairy products like yogurt are good for health and longevity,' she said. 'My general advice: don't panic,' Kuhnle said in an email. 'Food is not just (a) source of nutrients –– it plays a central role in culture, pleasure, family life, and social connection. Reducing it solely to a list of health risks misses the bigger picture.' Sign up for CNN's Eat, But Better: Mediterranean Style. Our eight-part guide shows you a delicious expert-backed eating lifestyle that will boost your health for life.
CBC
26-06-2025
- Health
- CBC
Vaccination rates are slipping around the world. Canada isn't immune, says new study
Social Sharing After decades of progress, childhood vaccination rates have started stalling or falling around the world in recent years, and Canada is not immune to the trend, suggests a new study from The Lancet. The study estimated the coverage of 11 childhood vaccines in 204 countries and territories between 1980 and 2023, analyzing over 1,000 data sources from around the world. It found that although globally there were huge strides made in vaccine coverage for children during that period (vaccine coverage against diseases like measles, polio and pertussis more than doubled), progress started stalling, even before the COVID-19 pandemic. "Particularly in the Americas and high-income countries, between 2010 and 2019, measles vaccine coverage declined in about half the countries," said Dr. Jonathan Mosser, an assistant professor of health metric sciences at the Institute for Health Metrics and Evaluation at the University of Washington and one of the co-authors of the study. The pandemic dealt a heavy blow to vaccination rates, with more than 15 million children globally missing routine shots between 2020 and 2023, Mosser said. The world never fully rebounded to pre-pandemic childhood vaccination levels, he said. "The pandemic reversed decades of progress that we had in reducing the number of zero-dose children, those children that have never received one of these key childhood vaccines." Worsening vaccine inequalities The pandemic had an outsized impact on regions that already had low vaccine coverage before COVID-19, Mosser said. Countries in sub-Saharan Africa saw the greatest disruption to vaccine coverage: five to seven million children in the region are estimated to have missed vaccines protecting them against diseases like polio, pneumococcal disease and rotavirus. "We have challenges related to really long-standing global inequalities and vaccination coverage with many low- and middle-income countries having significantly lower coverage than high-income countries," Mosser said. Why vaccination rates have started stalling varies from country to country, he added. WATCH | Misinformation largely driving vaccination decline: study: Decline in childhood vaccination fuelled by global conflicts, misinformation: Lancet 1 day ago Duration 2:01 A new study published in the Lancet medical journal suggests childhood vaccinations have stagnated or declined since 2010. The authors say geopolitical instability is fuelling the drop in some countries, but misinformation is largely driving the decline in high-income countries. "In some places around the world, they're related to geopolitical instability, they're related to supply chain issues. In many high-income countries, they're related to vaccine misinformation and hesitancy," he said. Convincing those who won't get vaccinated In Canada, Mosser said, vaccine coverage for most shots has dropped compared to the early 2000s. Uptake for some vaccines have fallen over time, like the shot that protects against diphtheria, tetanus and pertussis. Recently there's been some increases in uptake for other jabs – like the first dose of the measles, mumps and rubella (MMR) vaccine — but the modest increase isn't enough to prevent outbreaks. For instance, Mosser said, vaccination rates for measles in 2023 — 92 per cent for one dose of the MMR and 79 per cent for two doses of the MMR — are well below the threshold needed for herd immunity, which is 95 per cent. In high-income countries like Canada, vaccine misinformation and hesitancy have seriously undermined confidence in vaccines and contributed to lower vaccination coverage, said Mosser. Another contributing factor could be disparities in coverage, along divides like socioeconomic status, location, race or religion, he added. "New strategies are needed to encourage people to listen to trusted and reliable voices, including their health-care providers, about vaccination." WATCH | Why ending the measles outbreak will be challenging: Why it's going to be hard to end Ontario's measles outbreak 12 days ago Duration 6:22 Ontario currently has more measles cases than in all of the U.S. combined, and infections are climbing in Alberta and Manitoba. CBC's Jennifer Yoon breaks down what's behind the resurgence of a disease eliminated decades ago, and why those on the front line say it's going to be really difficult to get this outbreak under control. In a statement, the Public Health Agency of Canada said it is researching the various and often complex reasons driving vaccine hesitancy across Canada. The agency says it also is developing evidence-based awareness campaigns and resources to support health-care providers encountering vaccine hesitancy. 'A travelling world' As public health authorities try to convince those in Canada who won't get vaccinated, it's also important to support and fund vaccination campaigns around the world, say experts in Canada. "The world is a travelling world," said Dr. Mahli Brindamour, a pediatrician at Jim Pattison Children's Hospital in Saskatoon. "If we don't have good vaccine coverage in sub-Saharan Africa, that touches Canada as well," said Brindamour, who also practices at REACH clinic, a multidisciplinary refugee clinic. She says she's seen patients, often from regions facing conflict, where it's difficult to access vaccines. But they're almost always eager to get the shot, if one is needed and offered. "We don't see a lot of vaccine hesitancy," she said, in reference to refugee populations. Dr. Gabriel Fabreau, a general internal medicine specialist in Calgary, who also works with newcomer populations, has also observed that his patients don't hesitate to get childhood vaccinations. He says Canada should make it easier for these populations to catch up on any childhood vaccines they've missed. "Health systems work best if we make routine and easy things that we know are important," he said. Ramping up pre-departure vaccination programs, facilitating medical and vaccine record-sharing across borders and offering vaccines upon arrival are easy ways to address this complex problem, he added.
