Hunger, thirst, and energy intakes following consumption of caloric beverages

Hunger, thirst, and energy intakes following consumption of caloric beverages

Physiology & Behavior 79 (2003) 767 – 773 Hunger, thirst, and energy intakes following consumption of caloric beverages Eva Almiron-Roig, Adam Drewno...

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Physiology & Behavior 79 (2003) 767 – 773

Hunger, thirst, and energy intakes following consumption of caloric beverages Eva Almiron-Roig, Adam Drewnowski* Nutritional Sciences Program, Department of Epidemiology, School of Public Health and Community Medicine, 305 Raitt Hall, Box 353410, University of Washington, Seattle, WA 98195, USA Received 6 January 2003; received in revised form 2 May 2003; accepted 28 May 2003

Abstract Whereas soft drinks are described as primarily thirst-quenching liquids, juices and milk are said to be liquid foods, with a greater satiating power. This study was conducted to compare the effects of orange juice, low-fat milk (1%), regular cola, and sparkling water on hunger, thirst, satiety, and energy intakes at the next meal. Thirty-two volunteers (14 men and 18 women), ages 18 – 35 years, consumed a breakfast preload composed of 590 ml (20 oz) of an energy-containing beverage (1036 kJ) or water (0 kJ) and a slice of toast (418 kJ) on four different occasions. Participants rated hunger, thirst, fullness, and desire to eat at baseline and at 20-min intervals for 2 h following preload ingestion. A tray lunch was presented at 2 h, 15 min and food consumption was measured. Compared to sparkling water, the three energy-containing beverages were associated with higher fullness and reduced hunger rating and desire to eat. However, energy intakes at lunch (4511 F 151 kJ for men and 3183 F 203 kJ for women) were the same across all four beverage conditions and no compensation for breakfast energy was observed. The three beverages of equal energy value were significantly different from sparkling water, but not from each other, in their effects on hunger and satiety ratings. All four beverages satisfied thirst equally well. Whether energy-containing cola, juice, and low-fat milk facilitate a positive energy balance remains a topic for further study. D 2003 Elsevier Inc. All rights reserved. Keywords: Energy-containing beverages; Soft drinks; Energy compensation; Hunger; Thirst; Satiety

1. Introduction Energy density of foods, measured in terms of kilojoules per unit weight, is said to influence daily energy intakes more than any other factor [1 –4]. Energy density depends almost entirely on the foods’ water content [5]. Lower energydensity foods are said to have greater satiating power so that participants are able to ‘‘feel full on fewer calories’’ [1]. Foods with a high water content have an impact on both satiation and satiety [1]. Reducing energy density of an entre´e through addition of vegetables to a pasta salad led to increased satiation, as measured by lower energy intakes during that meal [2 – 4]. Reducing energy density of a preload, such as a milk beverage, led to increased satiety, defined as lower food consumption at the next eating occasion [6]. Rolls and Barnett [1] found that soups, milk-

* Corresponding author. Tel.: +1-206-543-8016; fax: +1-206-6851696. E-mail address: [email protected] (A. Drewnowski). 0031-9384/$ – see front matter D 2003 Elsevier Inc. All rights reserved. doi:10.1016/S0031-9384(03)00212-9

based drinks, and vegetable and fruit juices helped people feel full and eat less at the next meal. Lowering energy density of the diet may be a promising strategy for weight control [1,5]. Energy-containing beverages, juices, and milk are mostly water and deliver relatively little dietary energy per gram [5]. One might expect beverages to be useful in lowering energy density of the total diet [5]. However, there is no agreement as to the impact of liquid calories on satiety [7– 9]. Whereas some researchers believe that liquid foods are good choices for promoting satiety [10,11], others believe that physiological compensation for liquid energy is imprecise and incomplete [9,12,13]. The latter view holds that low energy-density beverages have less impact on satiety than do energy-dense solid foods. To deal with this seeming paradox, researchers have proposed that some beverages had a lesser impact on satiety than others. Soft drinks were described as primarily thirstquenching liquids [1] that failed to trigger satiety mechanisms regulating food consumption. Rising rates of childhood and adolescent obesity were blamed on the failure of

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physiological satiety and the lack of accurate compensation for sugar energy consumed in the form of caloric soft drinks [14]. In contrast, sugar energy consumed in the form of fruit and vegetable juices was said to satisfy hunger [1,11]. Rolls et al. [1,10,11,15] noted that soup and vegetable juices effectively suppressed food consumption at lunch and that milk-based beverages also tended to be satiating. Milk and juices were characterized as ‘‘foods that you drink’’ [1]. There are no published data to support, or disprove, this point of view. Energy densities of low-fat (1%) milk (1.8 kJ/ g), orange juice (1.8 kJ/g), and regular cola (1.8 kJ/g) are almost exactly the same [1,5]. If milk, fruit juice, and soft drinks have a differential impact on hunger and satiety, then, factors other than energy density must be involved. Most studies on the short-term regulation of food intake made use of the preload paradigm [16 – 18]. Energy density was manipulated by varying preload volume at constant energy or varying preload energy at constant volume [3,19 – 21]. Preload energy was often manipulated using sugar or fat replacements [20 – 22], whereas preload volume was increased by the addition of water [6]. In this study, preload energy and preload volume were both held constant. Instead, beverage type changed across conditions. This was the first study to directly compare the impact of milk (1% fat), orange juice, and regular cola on hunger, thirst, and satiety, and on energy intakes during a subsequent meal. A carbonated water preload served as a no-energy control condition. The question was whether the three energycontaining beverages would have differential effects on hunger and thirst and on subsequent food consumption or would their effects be substantially the same.

2. Materials and methods 2.1. Participants Thirty-two participants (14 men and 18 women), ages 18 –35 years, were recruited at the University of Washington by means of advertisements and flyers. Enrolled were normal-weight (BMI = 20 –27) adults who identified themselves as nondieters, nonsmokers, and regular consumers of breakfast. Potential participants with food allergies or food restrictions, those who disliked two or more foods or beverages in the study; those on prescription medications likely to affect taste, smell, or appetite; athletes in training; and persons reporting recent weight loss or weight cycling were excluded. After a telephone-administered screen to verify eligibility, potential participants reported to the lab for a brief session, during which, their weight and height were measured and recorded. A card stating the dates and times for the study sessions was provided as a reminder. The participants selected for the study attended four sessions, once a week from 9:30 a.m. to 1:00 p.m. To minimize variability within subjects, all participants were asked to report to the lab on the same day of the week if possible, to

keep evening meals and activity levels on the day before the test as similar as possible; to refrain from drinking alcohol the day before the test; and to refrain from eating after midnight the day before the test. The study protocol was approved by the Institutional Review Board (IRB) of the University of Washington and all participants provided informed consent. All 32 participants completed the study and were compensated for their time. 2.2. Study design A within-subjects design was used with each participant returning for four separate test sessions, generally spaced a week apart. The order of presentation of the four beverages was counterbalanced across sessions. The same lunch foods were offered on all four testing occasions. A time interval of 2 h and 15 min between preload and lunch was selected, based on studies showing that a significant change in motivational ratings following a 1500 – 1600 kJ (375 – 400 kcal) preload was observed within that time window [17,22]. Power analysis indicated that a sample of 12 subjects, was sufficient to detect a minimum difference of 250 kcal in compensation, with a power of 80% and alpha .05 [23]. 2.3. Preload stimuli The four beverages were orange juice (Minute Maid Original; Coca-Cola, GA); 1% milk (Lucerne; Safeway, CA); cola beverage (Coca-Cola, GA); and carbonated water (Safeway Select Club, Safeway, CA). The beverages were presented chilled but without ice in 591-ml (20-oz) portions in opaque plastic containers with a lid and a straw. Orange juice was prepared by thawing the contents of a can and diluting it with tap water to 1.76 kJ/g (0.42 kcal/g). Energy and nutrient composition of each preload beverage are shown in Table 1. The caloric beverages had the same energy density (1.76 kJ/g or 0.42 kcal/g) and supplied 1036 kJ (248 kcal) each. Participants liked orange juice, cola, and Table 1 Energy and macronutrient composition of the four beverages

Volume (oz) Energy (kJ) Carbohydrate (g) Total sugars (g) Glucose (g) Fructose (g) Lactose (g) Fiber (g) Protein (g) Fat (g) Energy density (kJ/g)

Orange juice (frozen canned)

1% milk

Cola

Carbonated water

20 1036 61.8 55.0 27.4 24.0 0 0 0 0 1.76

20 1036 29.1 28.0 0 0 28.0 0 20 6.5 1.76

20 1036 67.6 67.6 25.6 28.2 0 0 0 0 1.76

20 0 0 0 0 0 0 0 0 0 0

Data from the food label, manufacturer’s specifications and from Food Processor software (ESHA, Salem, OR).

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1% milk more than sparkling water, as measured by ninepoint category scales (described under Motivational ratings section). Preference for orange juice (7.3 F 0.2), cola (6.4 F 0.3), and 1% milk (6.2 F 0.3) were higher than for water (3.9 F 0.4) [ F(3,28) = 25.26, P < .001]. There were no differences in preference ratings by gender. Participants also consumed a standard slice (43 g) of toasted bread (Northwest Eight Grain; Northwest bakeries, WA) for a total of 418 kJ (100 kcal). The bread provided 20 g of carbohydrate, 3 g of protein, and < 1 g of fat. 2.4. Motivational ratings Participants rated their hunger, thirst, nausea, fullness, and desire to eat, using nine-point category scales. These motivational scales were provided in the form of a booklet, one scale per page. The unipolar adjective scales were anchored at each end with labels ‘‘1 = not at all’’ and ‘‘9 = extremely’’ [24]. Participants rated each beverage on a number of sensory attributes, using nine-point category scales. They also rated their liking for each beverage along nine-point hedonic preference scales, where ‘‘1 = dislike extremely’’ and ‘‘9 = like extremely.’’ 2.5. Test meal A lunch meal was provided at noon. The meal, presented on a tray, included a variety of foods, both savory and sweet. Energy content was 7248 kJ (1734 kcal). Food energy and nutrient values were calculated with the Food Processor software 6.11 (ESHA Research, Salem, OR) and from the manufacturer’s food label. Nutrient composition of the bread roll was calculated from the recipe provided by the manufacturer. Nutrient composition of the test meal is shown in Table 2. Identical meals were provided on each testing occasion. Additional preweighed food portions were available from a self-service buffet and participants were told that they could have as much or as little of any food as they wished. They were asked to record any foods consumed from the side buffet. No caloric beverages were provided as part of the test meal, only still water. All foods were preweighed at the time of serving and plate waste was collected and weighed by the experimenters. 2.6. Procedures On arrival (9:30 a.m.), participants were seated in separate cubicles in the sensory-evaluation laboratory. They remained there for the duration of the session and were allowed to read, listen to music with earphones, stretch, and use the bathroom. The first set of motivational ratings was obtained on arrival (Time 0). The breakfast preload was served at 9:35 a.m. Participants were asked to consume the breakfast within 25 min and rate the sensory attributes of each beverage. Following ingestion, participants rated the

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Table 2 Energy and nutrient composition of foods provided at lunch Food

CHO Protein Fat (g) (g) (g)

White-flour roll 48 6.7 French mustard 0 0 Reduced fat 2 18 provolone cheese Oven-roasted 1.2 6.8 turkey (sliced) Honey ham 1.2 6.8 (sliced) Salad 2.8 2 (spinach leaves with sunflower seeds) Fresh large tomato 9.3 1.7 Fresh fruit (banana, 30.2 0.9 apple or pear) Plain-potato chips 32 4 Balsamic vinaigrette 4 0 Light-ranch salad 3 1 dressing Chocolate-chip 31 2.9 cookies Ice cream-sandwich 26 3 bar Fat-free fruit yogurt 38 7 Total grams and 228.7 60.8 energy (kJ)

0.7 0 10

Sugar Fiber Portion (g) (g)

kJ

1 0 0

1.8 0 0

1 roll 1 pack 2 slices

957 21 585

0.4

0.8

0

4 slices

167

1.2

1.2

0

4 slices

167

0.8

0

1.9

1.5 cups

377

0.7 0.7

5.8 25

2.4 4.3

1 piece 1 piece

176 489 1170 293 334

16 6 7

0 3 1

2 0 0

26 chips 2 tbsp. 2 tbsp.

12

14.8

0

4 cookies 1006

13

0.9

1 bar

7

0 35 0 62.5 100.6 13.3

1 yogurt

752 752 7248

perceived sweetness, aftertaste, and overall liking for the beverage and completed the second set of motivational ratings (Time 1). Additional sets of ratings were completed every 20 min till noon (Times 2– 7). After lunch, participants completed the last set of ratings (Time 8) and were given a form to record the foods and beverages they consumed during the rest of the day. The food-record data were not used in the present analyses. 2.7. Data processing and statistics The Statistical Package for the Social Sciences (SPSS) version 8.0 for Windows [25] was used for data analyses. Analyses of motivational ratings used repeated-measures ANOVA with beverage and time postingestion (Times 1– 7) as the within-subjects factors and gender as the betweensubjects factor. Analyses of energy and nutrient intakes used repeated-measures ANOVA with beverage as the withinsubjects factor and gender as the between-subjects factor. Only when there was a gender interaction, the data were analyzed separately for each group. When appropriate, multiple pairwise comparisons were made adjusting the alpha value with the Bonferroni correction [23]. The strength of the association between cumulative motivational ratings and energy intakes at lunch was tested using Pearson’s correlation coefficients. Cumulative ratings were obtained by calculating the area under the curve (AUC) between Time 1 (post-preload) and Time 7 (prelunch).

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3. Results Mean ( F S.E.M.) age was 23.1 F 3.7 years for men and 25.4 F 4.2 years for women. Mean BMI (kg/m2) was 23.3 F 2.0 for men and 22.1 F 2.1 for women. Participants were Caucasian (75%), Asian (12.5%), and others (12.5%). 3.1. Motivational ratings As indicated in Fig. 1, hunger ratings were high following an overnight fast, were reduced following preload ingestion (9:45 a.m.), and gradually increased with time. Hunger ratings dropped sharply after lunch. All four breakfasts, regardless of energy content (418 kJ or 1454 kJ), led to a reduction in hunger ratings during the initial 20-min postingestion. Analysis of variance of hunger ratings showed a significant main effect of time [ F(6,540) = 74.72, P < .001] and of the beverage condition [ F(3,540) = 3.84, P < .05], confirming that energy-containing beverages suppressed hunger more effectively than did sparkling water. Multiple pairwise comparisons using Bonferroni correction showed significant differences between water and orange juice ( P < .05) and marginally, between water and milk ( P=.052). The three energy-containing beverages were not significantly different from each other ( P>.05 each). No interaction of the beverage condition with gender was observed [ F(3,540) = 0.55, P>.05]. The temporal profile of fullness ratings is shown in Fig. 2. As expected, these data were a mirror image of hunger ratings. Analysis of variance showed main effects of time [ F(6,540) = 63.32, P < .01] and beverage condition ( F(3,540) = 3.78, P < .025). Multiple pairwise comparisons showed that orange juice and milk were associated with marginally significant higher fullness ratings relative to sparkling water ( P=.05). There was no significant difference in fullness ratings between cola and other beverages ( P>.05). There was no interaction of the beverage condition with gender [ F(3,540) = 0.98, P>.05].

Fig. 1. Temporal profile of hunger ratings as a function of beverage condition (n = 32).

Fig. 2. Temporal profile of fullness ratings as a function of beverage condition (n = 32).

The temporal profile of thirst ratings is shown in Fig. 3. Although the main effect of time was highly significant [ F(6,540) = 47.69, P < .001], the effect of beverage type failed to reach significance [ F(3,540) = 2.69, P=.05]. Because thirst ratings showed a small but significant beverage by gender interaction [ F(3,540) = 2.97, P < .05], the data were analyzed separately for men and for women. The effect of beverage was significant among women [ F(3,306) = 5.05, P < .01] but not among men [ F(3,234) = 0.28, P>.05]. Among women, water and orange juice satisfied thirst better than did the cola beverage. Fig. 4 shows the temporal profile of the desire to eat. Main effects of time [ F(6,540) = 66.41, P < .001] and beverage condition [ F(3,540) = 4.29, P < .01] were both significant, indicating that the three energy-containing beverages differed from the sparkling-water condition. No differential effect on desire to eat was observed between orange juice and cola, orange juice and milk, or cola and milk ( P>.05 each). No interaction between beverage type and gender was

Fig. 3. Temporal profile of thirst ratings as a function of beverage condition (n = 32).

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Fig. 5. Total energy intake across conditions including breakfast preload (data are means F S.E.M.). Within each group, means with different superscript letters are significantly different ( P < .01).

Cumulative hunger ratings and the desire to eat were related to subsequent energy intakes, but only among women. Analyses of AUC for motivational ratings between Time 1 (post-preload) and Time 7 (prelunch) pooled the data across the four beverage conditions. For women, correlations between hunger and energy intake (r=.52; P < .001) and desire to eat and energy intake (r = .59; P < .001) were highly significant. No significant relation between cumulative (AUC) hunger ratings and food consumption at lunch was obtained for men.

Fig. 4. Temporal profile of the desire to eat as a function beverage condition (n = 32).

observed [ F(3,540) = 0.94, P>.05]. Ratings of nausea showed no significant main effect of time [ F(6,25) = 2.19, P>.05] or of beverage condition [ F(3,25) = 0.04, P>.05]. 3.2. Energy and nutrient intakes Energy and nutrient intakes at lunch for each beverage condition are summarized in Table 3, separately for men and women. Mean energy intakes at lunch, exclusive of preload and averaged across conditions, were 4511 F 151 kJ (1079 F 36 kcal) for men and 3183 F 203 kJ (762 F 48 kcal) for women. Analysis of variance of energy consumed at lunch (exclusive of preload) failed to show a main effect of beverage type [ F(3,90) = 2.47, P>.05]. Total energy intakes, including breakfast preload and lunch, are summarized in Fig. 5. The main effect of beverage type was significant for both men [ F(3,39) = 11.58, P < .001] and women [ F(3,51) = 4.45, P < .01], showing that total energy intakes in the three caloric-beverage conditions were higher than observed for sparkling water. Nutrient composition of the four lunch meals was analyzed separately for men and women. Beverage type had no impact of food selection and did not affect nutrient composition of the meal ( P>.05). Percent energy from carbohydrate, fat, protein, or sugar was not affected by beverage type ( P>.05 for all variables).

4. Discussion The three energy-containing beverages had comparable effects on satiety, contrary to past suggestions [1]. Using a preload design [10,11,17,20– 22], we were able to show that orange juice, low-fat milk (1%), and regular cola had identical temporal profiles for hunger and satiety. The three energy-containing beverages differed from sparkling water, but not from each other, in their effects on hunger, fullness, and desire to eat. The temporal profile of hunger ratings was paralleled by the desire to eat and was the inverse of fullness ratings, consistent with past studies [17,22]. There were no time-related interactions. The four beverages, including sparkling water, were equally effective in suppressing thirst. No differences in thirst ratings by beverage condition were found among men.

Table 3 Energy and macronutrient consumption after each preload type Men (n = 14)

Energy (kJ) Carbohydrate (g) Protein (g) Fat (g) Sugar (g) Total energy (kJ)

Women (n = 18)

Juice

1% milk

Cola

Water

Juice

1% milk

Cola

Water

4698 F 288 150.3 F 10.1 47.9 F 1.9 37.5 F 3.3 60.7 F 5.5 6162 F 303

4277 F 299 135.7 F 9.6 42.2 F 2.5 35.0 F 3.7 51.1 F 6.0 5746 F 322

4515 F 299 145.2 F 10.2 43.1 F 2.9 35.9 F 3.8 57.2 F 5.9 5956 F 318

4554 F 311 143.7 F 11.2 44.5 F 2.9 37.7 F 4.1 53.7 F 7.0 4972 F 354

3080 F 254 97.2 F 8.5 31.0 F 2.0 24.8 F 2.9 38.2 F 4.0 4537 F 244

2963 F 264 96.3 F 8.4 30.4 F 2.4 22.3 F 2.7 44.8 F 4.6 4402 F 246

3182 F 264 102.4 F 8.3 31.5 F 2.2 24.7 F 2.8 45.2 F 4.8 4634 F 247

3509 F 275 115.6 F 7.7 33.7 F 2.1 27.4 F 3.2 48.1 F 4.4 3927 F 241

Energy corresponds to that consumed at lunch only (top row) or that from breakfast and lunch (bottom row). Units are mean kJ F S.E.M.

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Among women, water was associated with lower thirst ratings than cola or orange juice. Rolls et al. [20] had reported that water suppressed thirst more effectively than sucrose-sweetened lemonade but in men, however, that effect was not robust and was observed for only one, out of two, volume conditions [20]. The present data provide no evidence for the notion of a differential impact of energycontaining beverages on thirst. The three energy-containing beverages had the same energy density (1.8 kJ/g) but differed in their nutrient composition, palatability, and sensory profiles. Cola had the highest sugar content and was judged as sweeter than either orange juice or milk. Orange juice and cola had a higher glycemic index ( f 76/100) than did low-fat milk ( f 46/100) [26]. Orange juice, low-fat milk, and cola were all preferred to sparkling water. However, sensory qualities of the energy-containing beverages as well as palatability had no measurable impact on hunger and satiety postingestion. The literature on this topic is inconclusive. Sensory factors such as taste, flavor, and texture have been shown to influence satiety in some cases [27 – 30] but not in others [31]. The lag between the breakfast preload and the test meal was 2.25 h. Differences in motivational ratings between energy-containing beverages and water reached a maximum at approximately 1 h and then converged, consistent with other data [17,22,32]. Beverage type had no impact on subsequent energy intakes or food choices [9,20,32]. Energy intakes at lunch were the same across all four preload conditions and within the range observed for college students in satiety studies [9,12,20,32]. The amount of food provided at lunch was copious (7248 kJ) and all participants had the option to request extra food from a side buffet. As expected, men consumed more energy than did women. However, no significant downward adjustment in energy intake at lunch was observed. Based on these data, we cannot reject the possibility that the provision of preload energy in liquid form leads to the absence of energy compensation at the next meal. Several researchers have raised the important issue that liquid energy could actually facilitate a positive energy balance and perhaps affect the control of body weight [9,13,14]. However, the focus has always been on energy-containing soft drinks. The present data show that cola beverage was not substantially different in that respect from orange juice or low-fat (1%) milk. Another possibility is that the 2-h, 15-min time lag between preload ingestion and the test meal was too long for any compensation effect to be observed. Based on what is known about gastric emptying, meals that are largely composed of liquids are rapidly absorbed. A review of the literature suggests that most consistent instances of energy compensation, whether with solid or liquid preloads, were observed in studies with a high preload volume and a very short interval (0 –20 min) between the preload and the test meal [7,18 – 20,27,32 –35]. Rolls et al. [6] observed energy

compensation in young male subjects following the ingestion of 600 ml of milk-based beverage (2088 kJ and 2.8% fat) given 30 min before lunch. Energy adjustment can also be obscured by high palatability of the test meal [30], so that factor, too, needs to be considered. In summary, three different energy-containing beverages matched on volume and energy were distinct from sparkling water, but not from each other, in their effects on hunger and satiety. Our data provide no support for the hypothesis that sweetened soft drinks are fundamentally different from orange juice or low-fat milk in their impact on hunger, satiety, and thirst. The present study represents a first direct comparison of common beverages that are regularly used by the consumer. The data presented here are directly relevant to the current controversy surrounding the role of sweetened beverages in the American diet and their contribution to the rising consumption of high-fructose corn syrup (HFCS) [36 –38]. Studies have linked energy-containing beverages with a purported failure of satiety, pointing to little- or noenergy compensation at the subsequent meal, increased energy intake at the long term, and in some cases, weight gain [14]. The present data show that sensory properties and the palatability of the three beverages had little impact on postingestive satiety [39]. As far as satiety was concerned, energy was the important variable. Beverages of the same energy density had comparable effects, and no differential effects on hunger and thirst were observed. Whether liquid and solid foods have the same satiating capacity remains a topic for further study.

Acknowledgements The authors are grateful to Brendan McKinnon-Patterson and to Emily Pan for technical support. A. Drewnowski was supported by a grant from the National Soft Drink Association. EA-R was supported by the ‘‘La Caixa’’ Fellowship.

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