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Trend and challenges in food and nutrition development in Thailand

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Title: Trend and challenges in food and nutrition development in Thailand


1
Trend and challenges in food and nutrition
development in Thailand
  • Kraisid Tontisirin
  • Professor Emeritus, Mahidol University
  • Presentation at the 2nd National Health Promotion
    Meeting, Ministry of Health Thailand
  • 15 June 2007

2
Overview of presentation
  • Introduction
  • Nutrition and nutrition related chronic diseases
    (NRCDs) in Thailand
  • Past achievement of nutrition improvement in
    Thailand
  • Major global issues on food and nutrition
  • Life course approaches in nutrition promotion
  • Conclusion

3
Fundamentals for human, animal and plant health
  • Genetics
  • Nutrition
  • Prevention and control of diseases
  • Environment

4
Factors influencing health and quality of life
  • Genetics
  • Nutrition
  • Mental well being
  • Physical activity and exercise
  • Avoidance of toxicants i.e. smoking, excessive
    alcoholic consumption

5
Nutrition - a link between food and health
enabling
  • Availability, access, consumption and utilization
    of food of adequate quality, quantity safety
  • Meeting human nutrient and non-nutritient
    requirements during the life cycle

Kraisid Tontisirin 2007, Mahidol University
6
Overview of presentation
  • Introduction
  • Nutrition and nutrition related chronic diseases
    (NRCDs) in Thailand
  • Past achievement of nutrition improvement in
    Thailand
  • Major global issues on food and nutrition
  • Life course approaches in nutrition promotion
  • Conclusion

7
Major food and nutrition problem in Thailand
  • Undernutrition PEM ( underweight, stunting,
    wasting), hunger, micronutrient deficiencies (
    iron, iodine, vitamin A)
  • Overnutrition and nutrition related chronic
    diseases (NRCDs) overweight, obesity,
    hyperlipidemia, diabetes mellitus, high blood
    pressure, CVD
  • Food safety (unsafe from hazards in food) and
    food high in fat (sat. FA and trans FA) sugar and
    sodium)

Kraisid Tontisirin 2007, Mahidol University
8
i
Mapping the Situation of Children and Women Findings from the Thailand Multiple Indicator Cluster Survey 2006 May 2007 Mapping the Situation of Children and Women Findings from the Thailand Multiple Indicator Cluster Survey 2006 May 2007

PLACE NAME AND LOGO OF IMPLEMENTING AGENCY HERE
PLACE NAME AND LOGO OF IMPLEMENTING AGENCY HERE
  • ,

9
Thailand Multiple Indicator Cluster Survey (MICS
2006)
  • National samples of over 40,000 households (HH)
    plus over-sampling of an additional 30,000 HH
  • In 26 focus provinces

10
Thailand Multiple Indicator Cluster Survey 2006
Unicef May 2007
In 26 focus provinces in 4 regions
11
Prevalence of Low Birth Weight (LBW)
  • 9 of infants born weighing less than 2500 grams
  • Top province () Weakest Province
    ()
  • Phuket (4.89) Mukdahan
    (16.32)
  • Phangnga (5.510) Yala (17.83)
  • Mae Hong Son (5.911) Ubon (20.4)
  • Satun (7.812) Chiang
    Rai (27.15)
  • Pattani (7.913) Chiang
    Mai (27.2)

From Thailand Multiple Indicator Cluster Survey
2006 Unicef May 2007
12
Millennium Development Goal 4. (Reduce child
mortality)
  • Reduce by two thirds, between 1990 and 2015 the
    under-five mortality rate.
  • National Goal No more than 6 of newborns
    weighing less than 2,500 grams (NPA, 2005-2014)
    from 18
  • Indicators available in Thailand MICS3 -Birth
    weight

From Thailand Multiple Indicator Cluster Survey
2006 Unicef May 2007
13
From Thailand Multiple Indicator Cluster Survey
2006 Unicef May 2007
14
From Thailand Multiple Indicator Cluster Survey
2006 Unicef May 2007
15
Prevalence of undernutrition of children under
five years
  • Underweight (wt/age) 9.3
  • Stunted (ht/age) 11.9
  • Wasting (wt/ht) 4.1

From Thailand Multiple Indicator Cluster Survey
2006 Unicef May 2007
16
Millennium Development Goal 1.(Eradication
extreme poverty and hunger)
  • Eradicate extreme poverty and hunger. Reduce by
    half between 1990 and 2015 the proportion of
    people who suffer from hunger.
  • National Goal No more than 5 of children under
    five years underweight for age (10 in WFFC)
  • National Status Thailand MICS 2006
  • 9.3 of children aged 0-59 months underweight
    for age

17
Prevalence of under weight of under five
Underweight prevalence MICS 3, Indicator 6, Thailand MICS 2006 Underweight prevalence MICS 3, Indicator 6, Thailand MICS 2006 Underweight prevalence MICS 3, Indicator 6, Thailand MICS 2006 Underweight prevalence MICS 3, Indicator 6, Thailand MICS 2006 Underweight prevalence MICS 3, Indicator 6, Thailand MICS 2006 Underweight prevalence MICS 3, Indicator 6, Thailand MICS 2006
Rank Province Rank Province
1 TRANG 4.6 14 NAKORN PHANOM 10.7
2 CHIANG RAI 4.9 15 KANCHANABURI 11.5
3 PHAYAO 5.1 16 MUKDAHAN 12.6
4 BANGKOK 5.3 17 NAN 13.1
5 RAYONG 6.8 18 UBON 13.1
6 RATCHABURI 6.9 19 TAK 13.4
7 PHUKET 8.3 20 PHANGNGA 14.6
8 KHON KAEN 8.7 21 MAE HONG SON 14.8
9 SA KAEO 9.3 22 SATUN 16.6
10 KRABI 9.8 23 NARATHIWAT 20.3
11 RANONG 9.8 24 YALA 21.9
12 SONGKHLA 10.3 25 PATTANI 25.4
13 CHIANG MAI 10.7 26 SRI SAKET 26.3
From Thailand Multiple Indicator Cluster Survey
2006 Unicef May 2007
18
From Thailand Multiple Indicator Cluster Survey
2006 Unicef May 2007
19
Map Low Weight for Age of under five
From Thailand Multiple Indicator Cluster Survey
2006 Unicef May 2007
20
Malnutrition contributes about 50 of this
mortality
21
Underweight Children in Thailand
  • 8-12 in preschool children (ruralgt urban)
  • 7-9 in 6-14 years old children (ruralgturban)
  • 6-9 in 15- 18 years old children (ruralgturban)
  • --------------------------------------------------
    ---------
  • Div of Nutrition, MOPH, 2003

Kraisid Tontisirin 2007, Mahidol University
22
Stunted children in Thailand
  • 5-9 in preschool children (ruralgt urban)
  • 7-8 in 6-14 years old children (ruralgturban)
  • 11-16 in 15- 18 years old children
    (urbangtrural)
  • --------------------------------------------------
    ---------
  • Div of Nutrition, MOPH, 2003

Kraisid Tontisirin 2007, Mahidol University
23
Overweight and obesity (Thailand)
  • National Goal No more than 10 overweight in
    every group of 0-5 year old children (NPA 2006,
    p. 90)
  • National Status 6.9 of all children and 10.4
    of municipal children under the age of 5 are
    overweight

From Thailand Multiple Indicator Cluster Survey
2006 Unicef May 2007
24
From Thailand Multiple Indicator Cluster Survey
2006 Unicef May 2007
25
Childhood overweight and obesity in Thailand
  • 10-15 in primary school children
  • Over 50 of obese children with hyperlipidemia (
    high cholesterol and TG)
  • Over 25 of normal weight children with
    hyperlipidemia
  • various sources of data from Dr Ladda, INMU (Dr.
    Uruwan) and Faculty of Public Health, Mahidol U.
    (Dr. Chutima) more data in various setting are
    still needed.

Kraisid Tontisirin 2007, Mahidol University
26
Exclusive breastfeeding
  • Infants who received only breast milk and
    vitamins, mineral supplements or medicine in the
    24 hours prior to the interview are classed as
    exclusively breastfed.
  • Only 5 of Thai infants benefit from ex.BF (vs.
    46 of global figures)
  • 8/26 focus provinces, no ex.BF was reported

27
From Thailand Multiple Indicator Cluster Survey
2006 Unicef May 2007
28
Salt iodization( 15-29.9 ppm for adequately
iodized salt))
  • Only 10.4 of samples of HH found adequate level
    of iodine
  • Lowest rate (22.6 ) was found in the Northeast
    with adequate level
  • 53.7 in the Northern, 59.7 in the Central,
    and 60.3 in the Southern region

From Thailand Multiple Indicator Cluster Survey
2006 Unicef May 2007
29
From Thailand Multiple Indicator Cluster Survey
2006 Unicef May 2007
30
Ten leading causes of health burden in Thailand
(MOPH 1999)
  • Male Female
  • HIV/AID HIV/AIDS
  • Traffic accident Stroke
  • Stroke Diabetes
    mellitus
  • CA liver
    Depression
  • Murder/violence Traffic accident
  • Suicide Low birth
    weight
  • Diabetes mellitus CA liver
  • COPD
    Osteoarthritis
  • Ischemic HD COPD
  • Low birth weight Ischemic HD

31
13 leading causes of DALY in Thailand(Disability
adjusted life years MOPH 1999)
  • Male
    Female
  • Unsafe sex Unsafe
    sex
  • Cigarette Smoking Overweight
    and obesity
  • Alcoholic consumption High blood
    pressure
  • No helmet protection Cigarette
    Smoking
  • High blood pressure High blood
    cholesterol
  • Drug addicts
    Occupational accident
  • Overweight and obesity No helmet
    protection
  • Inadequate intake of FV Physical
    inactivity
  • High blood cholesterol Poor hygiene
  • Occupational accident Inadequate
    intake of FV
  • Poor hygiene
    Alcoholic consumption
  • Air pollution Drug
    addicts
  • Physical inactivity Air
    pollution

32
Nutrition situation and NRCDs in Thai
adults(MOPH 3rd Physical examination surveys
2004)
  • Male
    Female
  • BMI (kg/m2) 22.6
    23.8
  • Waist circ. (cm) 78.6
    76.6
  • Waist circ.gt90 and 80 cm () 15.4
    36.1
  • Thinness () 11.6
    9.6
  • Overweight () 17.8
    25.4
  • Obesity () 4.8
    9.0

33
Nutrition situation and NRCDs in Thai
adults(MOPH 5th Food and Nutrition Survey 2003)
  • Male
    Female
  • High LDL-C gt130 () 13-33
    13-44
  • LOW HDL-C lt40 () 6-13
    18-32
  • High TG gt150 () 6-46
    8-37
  • Prevalence of DM () 6.4
    7.3
  • Prevalence of high BP () 23.3
    20.9
  • Fruit veg intake (g/d) 268
    283

MOPH 3rd Physical examination surveys 2004)
34
Food, nutrition and life style factors (Dada
from various sources 2003-2005)
  • Sugar consumption in 2004 was 30.3 (kg/person/y)
    or 83 g/d or 16.6 of energy intake from sugar.
  • Soft drink beverage intake was 102
    bottles/person/y ( 816 in the US)
  • Increased consumption of sugary drink i.e. fruit
    juices, sweet tea and coffee
  • Increasing snack consumption particularly in
    children, 2 packs/person/day
  • Expansion of fast food services

35
Food, nutrition and life style factors (Dada
from various sources 2002-2005)
  • Increasing snack consumption particularly in
    children, 2 packs/person/day
  • Expansion of fast food services
  • Increased alcoholic beverage intake, 81.7
    liter/person/y in 2003
  • Only 35.7 of male and 23.7 female from 6 year
    onward exercised regularly (2002..Office of
    National Statistics)

36
Overview of presentation
  • Introduction
  • Nutrition and nutrition related chronic diseases
    (NRCDs) in Thailand
  • Past achievement of nutrition improvement in
    Thailand
  • Major global issues on food and nutrition
  • Life course approaches in nutrition promotion
  • Conclusion

37
Nutrition interventions
  • Supplementation with micronutrients/food
  • Food fortification
  • Nutrition education/communication
  • Food based approach ensuring food
    security/consumption of safe and nutritious food
  • Public health measures basic services,
    immunization, sanitation, deworming
  • Community based (integrated) approaches

38
Kraisid Tontisirin 2007, Mahidol University
39
Multisectoral-community based strategies since
1981
  • Under the umbrella of the Poverty Alleviation
    Plan (PAP) targeting to the poor areas to
    achieving BMN
  • Primary Health Care (PHC) and Food and Nutrition
    Plan (FNP) have been incorporated in the PAP
  • Nutrition has been used as goals and indicators

40
Forging the link between government and community
41
Components of a successful community based
program
Minimum Basic Services (Health, Education, Agr.
Extension)
  • Supportive System
  • Training
  • Funding
  • Problem Solving
  • Supervision

Facilitators
  • Menus (Activities)
  • Food production
  • Nutrition education
  • Food sanitation safety
  • ANC
  • GMP
  • BF/CF
  • Other activities
  • Interface
  • (service providers and
  • community leaders)
  • Plan/goals
  • Implementation
  • Monitoring/evaluation

Mobilizers (110 households)
Community Leaders Family Individual
Basic Minimum Needs Goals/Indicators
42
Food and nutrition security
Food-based dietary guidelines
  • Health service
  • Caring practices
  • Food Nutrition Programmes
  • Prevent control malnutrition
  • School meals, etc.

Nutrition labelling
Consumption
Consumer protection
Individual/Family Community as Core
Utilization
Food processing
Food production
Monitoring and Surveillance
Food combination Fortification
Rice/cereals Legumes Fish Chicken Eggs Vegetabl
es Fruits Dairy
43
Dramatic improvements are possible
  • Between 1960 and 2004, Chile cut its underweight
    rate from 37 to 2.4
  • Thailand reduced malnutrition rates from 36 to
    13 in the 15 years to 1990
  • Brazil decreased its child undernutrition by 67
    between 1970 and 2000
  • Malnutrition in India has declined by about 30
    since 1960
  • Between 1980 and 1990, Tanzania reduced reduce
    child malnutrition from 50 to 30
  • Common factor national leadership, focus on
    nutrition

From Ending child hunger and undernutrition
initiatives (ECHUI, WFP 2007
44
Overview of presentation
  • Introduction
  • Nutrition and nutrition related chronic diseases
    (NRCDs) in Thailand
  • Past achievement of nutrition improvement in
    Thailand
  • Major global issues on food and nutrition
  • Life course approaches in nutrition promotion
  • Conclusion

45
Global problem
  • 852 m undernourished people worldwide
  • 400 m undernourished children lt 18
  • 149 m underweight children lt 5
  • 5-6 m preventable U5 deaths per year,
    (where undernutrition is a key factor)
  • 85 m families in need
  • (countries where U5 underweight 10)
  • Approximations and estimates, sources FAO,
    WFP, WHO/UNICEF, WFP/UNICEF

46
Prevalence of undernourishment, 2000-2002
Region No. (millions) undernourished undernourished
World 852 13
Developing countries 815 17
Asia 519 16
South Asia 301 22
Source FAO, SOFI, 2004
47
FAOs Hunger map (2002-2004)
48
We are not on track to meet the World Food Summit
Goal
49
What will it cost if we do nothing?
  • Economic and social consequences of approx 45
    million preventable child deaths by 2015 (at
    todays rate of attrition)
  • approx. 2 to 3 percent of GDP lost annually to
    undernutrition in high prevalence countries
  • 500 billion to 1 trillion in lost productivity
    and income over the lifetime of todays
    undernourished children
  • Prospect of achieving other MDGs reduced.
  • Sources UN Standing Committee on Nutrition,
    World Bank, FAO

50
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51
Importance of nutrition in achieving the MDGs
  • Good nutritional status is essential to reduce
    poverty, improve human capital and enhance
    productivity
  • Well nourished children will be better able to
    concentrate and learn in school
  • Well nourished girls will be more likely to stay
    in school and gain maximum benefit from their
    education
  • Well nourished children and mothers are much less
    likely to suffer premature death from illness and
    childbirth

52
Childhood overweight and obesity
  • Affecting 10 the world children
  • 10-15 of Thai children
  • 20 Chinese children
  • 26 of Canadian children and youth (8 obese)
  • 33 in the US, 6-19 yr of age (13 obese)
  • 30 in EC with 8 obese

53
WHOs Latest projection globally 2005
  • 1.6 billion adults (age 15) were overweight, 70
    in low and middle income HH
  • 400 million adults were obese
  • 20 million Under 5 children were obese
  • 60 of all deaths were due to Diet RCD and 80 of
    those deaths occurred in low and middle income
    countries (DC)
  • By 2015, 2.3 billion adults will be over wt. and
    more than 700 million will be obese

Kraisid Tontisirin 2007, Mahidol University
54





Risks Associated to Global Deaths 2000


Significantly determined by diet and PA
(x 000)
Kraisid Tontisirin 2007, Mahidol University
55
Main contributors to the worlds health burden as
regards to the NCDs (WHO Report 2002 2004)
  • High blood pressure
  • Increased blood cholesterol levels
  • Low intakes of vegetables and fruit
  • Physical inactivity
  • Excessive weight gain
  • Tobacco consumption

Kraisid Tontisirin 2007, Mahidol University
56
Double burden of malnutrition
  • Refers to the dual burden of under- and
    over-nutrition occurring simultaneously within a
    population or even in the same community or in
    the same household

Kraisid Tontisirin 2007, Mahidol University
57
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58
Population nutrient intake goals
59
Overview of presentation
  • Introduction
  • Nutrition and nutrition related chronic diseases
    (NRCDs) in Thailand
  • Past achievement of nutrition improvement in
    Thailand
  • Major global issues on food and nutrition
  • Life course approaches in nutrition promotion
  • Conclusion

60
From Ricardo Uauy
61
From Ricardo Uauy
62
International Congress Foetal Origins of
Adult Disease Barker hypothesis programming
of function During early life nutrient exposure
sets metabolic behaviour and thereby determines
the risk of chronic disease during adult life.
63
Possible life course approaches in nutrition
promotion in Thailand
  • Aim of the plan/actions should lead toNutrition
    Security for all as to p/c of double burden of
    malnutrition (under and over nutrition)
  • Working principles
  • -people centered development
  • -life cycle approach from intra uterine
    period
  • -holistic and integrated approach
  • -partnership, esp. between service
    providers and
  • community participation
  • -decentralization of responsibilities and
    actions
  • -best practices for actions
  • -learning by doing
  • Develop (societal) plan with goals, targets and
    indicators

64
Life course approaches in nutrition promotion
  • Antenatal care for pregnant mothers with proper
    nutrition support and education to reduced low
    birth weight (LBW)
  • Infant and young child feeding
  • -Promotion, protection and support for breast
    feeding
  • -Adequate and appropriate complementary
    feeding
  • -Growth and development monitoring and
    promotion

65
Life course approaches in nutrition promotion
Life course approaches in nutrition promotion
  • Promotion of desirable eating habits
  • -Food based dietary guidelines (FBDGs)
  • -Nutrition program in school
  • -nutritional assessment/surveillance
  • -food services--school lunch/meals
  • -basic food, personal and environmental
    hygiene
  • -school gardens
  • -nutrition education
  • -promotion of physical activity and
    exercise
  • -positive school environment for healthy
    diets

Life course approaches in nutrition promotion
66
The 9 Thai FBDGs Recommendations
1. Eat a variety of foods from each of the
five food groups and maintain proper
weight 2. Eat adequate rice, or alternate
carbohydrate rich food groups 3. Eat
plenty of vegetables and fruits regularly 4.
Eat fish, lean meats, eggs, legumes and
pulses regularly 5. Drink sufficient amount of
milk every day 6. Take moderate amounts of fat
7. Avoid excessive intake of sweet and salty
foods 8. Eat clean and uncontaminated foods
9. Avoid or reduce consumption of alcoholic
beverages
67
HEALTHY EATING
  • Eat five food groups
  • Eat a wide variety of foods
  • Eat proper amount of food
  • Eat balanced food

Energy distribution of food
ProteinFatCHO 10-15 15-30 55-75
68
Life course approaches in nutrition promotion
  • Nutrition orientation to food production and
    supply as to response to the increased demands
    for healthy foods (promotion of healthier food
    supply)

69
Life course approaches in nutrition promotion
  • Regulatory approaches Promotion and enforcement
    of Codex and national food standards, guidelines,
    recommendations and codes
  • Nutrition labeling of foods in market shelves,
    canteens and restaurant menus, particularly
    snacks
  • Marketing including advertising to protect
    children from all forms of marketing
  • Quality control of food for children in
    nurseries, schools and other government
    facilities
  • Pricing falling cost for nutrient rich foods and
    increased cost for fatty/sugary drink and foods
  • Availability restriction the availability of
    fast food /soft drink outlets in urban
    environment and near schools

70
Life course approaches in nutrition promotion
  • Example of Nordic Plan of Actions on better
    health and QL to stop pan obesity by 2011
    healthy diet, one hr/day for PA and stop all
    advertising food directed at children, no vending
    machines in school
  • Promotion of physical environments that
    facilitate active lifestyle (PA), exercise and
    sport at home, schools and public places
  • Urban and rural planning to induce PA

71
Life course approaches in nutrition promotion
  • Community based program (CBP) at district level
    and below, and in school linking with national
    policy and strategy
  • Effective micronutient deficiencies control
    programs by nutrition IEC (FBDGs for example),
    food fortification, targeted supplementation to
    PL mothers
  • Special attention to IDD control through
    universal salt iodization need business plan for
    high quality of iodized salt used by all HH

72
Components of a successful community based
program
Minimum Basic Services (Health, Education, Agr.
Extension)
  • Supportive System
  • Training
  • Funding
  • Problem Solving
  • Supervision

Facilitators
  • Menus (Activities)
  • Food production
  • Nutrition education
  • Food sanitation safety
  • ANC
  • GMP
  • BF/CF
  • Other activities
  • Interface
  • (service providers and
  • community leaders)
  • Plan/goals
  • Implementation
  • Monitoring/evaluation

Mobilizers (110 households)
Community Leaders Family Individual
Basic Minimum Needs Goals/Indicators
73
Food and nutrition security
Food-based dietary guidelines
  • Health service
  • Caring practices
  • Food Nutrition Programmes
  • Prevent control malnutrition
  • School meals, etc.

Nutrition labelling
Consumption
Consumer protection
Individual/Family Community as Core
Utilization
Food processing
Food production
Monitoring and Surveillance
Food combination Fortification
Rice/cereals Legumes Fish Chicken Eggs Vegetabl
es Fruits Dairy
74
Forging the link between government and community
75
Life course approaches in nutrition promotion
  • Monitoring and evaluation wt, ht, eating
    behaviors and social capitals, particularly in
    schools
  • RD and capacity building to support national
    plan of actions

76
Overview of presentation
  • Introduction
  • Nutrition and nutrition related chronic diseases
    (NRCDs) in Thailand
  • Past achievement of nutrition improvement in
    Thailand
  • Major global issues on food and nutrition
  • Life course approaches in nutrition promotion
  • Conclusion

77
Conclusion
  • Prevention and control of undernutrion was a
    success experience in Thailand during the last 30
    years
  • Thailand is still facing with double burden of
    malnutrition (DBM) but more on overnutrition and
    NRCDs which are heavily burden to society and are
    the main causes of death.
  • Need collective effort and actions now to prevent
    DBM particularly childhood obesity which are
    beyond health sector.

78
Conclusion
  • Thailand past successful experience in p/c of
    childhood undernutrition sould be revitalized and
    adapted to p/c of overnutition and NRCDs
  • Urgent need for effective actions in schools
    (Food and nutrition friendly school program) to
    p/c of childhood obesity ( nutritional assesment
    and surveillance, promotion of healthy diets,
    nutrition education for desirable eating
    behavior, physical activity and sports with a
    strong participation by parents and community

79
Conclusion
  • Special attention to p/c of micronutrient
    deficiencies, particularly to IDD
  • Need more positive environment to facilitate PA
  • Periodic food and nutrition surveillances
    followed by actions are essential.
  • Need research and capacity development to back up
    strategic development and actions

80
Conclusion
  • With strong commitment, proper resource
    mobilization, dedication, decentralization,
    community participation and best practices,
    Thailand could set up again an excellent example
    for prevention and control of DBM especially
    overnutrition and NRCDs to the global community.

81
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82
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