home Drugs Is it possible to lose weight if you have pancreatic disease? Reasons for losing weight and how can you gain normal weight with pancreatitis? What products are strictly prohibited?

Is it possible to lose weight if you have pancreatic disease? Reasons for losing weight and how can you gain normal weight with pancreatitis? What products are strictly prohibited?

Do people lose weight with pancreatitis? How are inflammation of the pancreas and the patient’s weight related? What leads to rapid loss and is diet always a guarantee of gaining lost kilograms? Is it possible to pause the process, and why is such weight loss dangerous?

Why do people lose weight with pancreatitis?

Experts name several probable causes losing kilograms with inflammatory process pancreas. First of all, we're talking about about organ dysfunction caused poor nutrition and lifestyle, since regulation digestive process– one of the leading roles of the organ.

As the disease progresses, digestive problems worsen. The absorption of vitamins, minerals and useful substances from incoming food, which promotes rapid weight loss.

The bolus of food, after passing through the gastrointestinal tract and pancreas, should enter the duodenum, where enzyme activation should occur. However, if you abuse fatty and spicy food, alcoholic drinks, smoking and other harmful addictions, their activity occurs directly in the gland, without waiting for it to reach its destination. Premature activation of enzymes is extremely dangerous. Their slow outflow into the duodenum becomes the culprit of inflammatory processes in the organ - pancreatitis.

In parallel with this, there is a lack of these same enzymes in the intestines, which does not allow digestion to proceed at the proper level. Poor absorption of food, deficiency of nutrients, dyspeptic disorders, etc. are noted.

Lack of proteins responsible for the construction of tissues and cells;

Deficiency of fats, which take part in the metabolism of cholesterol and vitamins, creating the fat layer and, logically, influencing the loss of kilograms;

Lack of sugar in the blood, since glucose is nothing more than a source of energy for the whole body.

The consequence of all of the above is rapid weight loss, since the body does not receive the substances in the required volume, and it has to take the missing ones from subcutaneous fat and substances from other organs.

What to do to stop weight loss with pancreatitis

Weakening of the functionality of the organ is inevitable with inflammation of the pancreas. To restore its functioning, Pancreatin, an enzyme replacement agent, is most often prescribed.

In this case, it is required full examination from a gastroenterologist. Diseases of the gastrointestinal tract associated with pancreatitis can either contribute to the development of the inflammatory process or become its consequence - dysbacteriosis, gastritis, cholecystitis, etc.

Principles of weight gain in pancreatitis include:

Contacting a qualified nutritionist to create an individual diet;

Compliance with the designated diet and lifestyle;

Taking vitamins and minerals;

Use protein shakes.

Diet for pancreatitis

Diet planning is the most important step on the path to recovery after an acute attack or exacerbation of chronic pancreatitis.

Rules to follow:

6 meals during the day;

The temperature of the food when serving is about 37 degrees;

Thorough chewing of even pre-chopped foods;

Do not drink after finishing your meal. It is recommended to drink no earlier than an hour later.

Particular attention is paid to strict dosage, and therefore it is advisable to have a kitchen scale on hand. You can eat it as one of your meals baby food, the rest - only home-cooked dishes. The ban includes semi-finished products and store-bought juices, spicy, fried, fatty, pickled, smoked and carbonated foods.

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Inflammatory processes in the pancreas are called pancreatitis. The occurrence of this disease is associated with poor nutrition and bad habits. Most people with chronic pancreatitis are underweight. The more progressive the disease, the more syndromes of disruption of the process of digestion and absorption of essential substances appear. nutrients(maldigestion and malabsorption). This situation certainly leads a person to exhaustion and frequent failures when trying to gain weight due to pancreatitis. The development of pancreatic insufficiency entails serious problems Gastrointestinal tract, and even with good nutrition It is very difficult to return to a stable state.

With pancreatitis, sudden weight loss is often observed

In this article you will learn:

Why weight loss

The pancreatic gland produces its own enzymes to digest food, and if they are not enough, the intestines begin to suffer. Undigested food particles settle on the intestinal walls and irritate the mucous membrane. Gastrointestinal tract subject to heavy load. Subsequently, diarrhea begins increased gas formation, gagging or even vomiting itself.

The chemical structure of the intestinal contents is not physiological, for this reason the enzymes that are secreted to complete the digestion process cease to be produced in sufficient quantities. A huge number of microscopic hairs of the mucous membrane small intestine is a unique absorbent apparatus that is subject to negative impact from insufficiently digested chyme (food gruel).

These negative properties affect the body, which is subject to significant shortages important substances– nutrients:

protein – needed for the construction of cells and tissue;
glucose is the main primary source of energy for the whole body;

The gastrointestinal tract and enzymes work poorly, food is poorly absorbed

fats – participate in the absorption of vitamins and the process of cholesterol metabolism, form subcutaneous adipose tissue, responsible for the optimal process of thermoregulation, as well as protection against damage to internal organs.

The body seeks to obtain enzymes that sense a lack of substances in some other way. For example, it begins to take glycogen from subcutaneous fat reserves, liver and muscle tissue. Protein is an emergency reserve; its forced consumption leads to a zero level and a deep degenerative state.

People suffering from inflammation of the pancreas quickly lose weight, and after recovery they are unable to regain the lost kilograms to the desired initial levels.

How can you stop the weight loss process?

Gaining weight with this disease is possible and even necessary. But the process needs integrated approach, assistance from specialists and the course of treatment. At chronic degree pancreatitis, body weight loss can be slowed down if you achieve positive results or achieve sustained remission in the disease.

For recovery, you can take Pancreatin

If the disease is in an advanced state, the gland tissues are severely damaged and their function is on the verge, the lack of digestive enzymes is compensated for by an enzyme agent - pancreatin, having previously selected correct dosage. For this purpose, two-shell drugs are prescribed, the action of which is organized so that they assist in the digestion of food in a manner similar to the activities of natural physiology.

Initially, you need to radically change your diet, follow the instructions of your doctor, and strictly follow the prescribed diet. At chronic pancreatitis need to approach it correctly the following features diets:

you need to eat often, ideally six meals a day;
portions should be small so that the stomach is not overloaded and digestive problems are not provoked;

You need to follow a proper diet

You cannot eat foods that are prohibited for pancreatitis, as they are difficult to digest;
Do not eat hot or cold food, because it irritates the lining of the organ and increases inflammation;
food must be chewed thoroughly, soaking it with saliva, which breaks down carbohydrates and facilitates the digestion of foods;
When eating food, you should not drink it down, because the density of digestive enzymes is discharged and their activity is lost. Drinking after meals is allowed an hour later;
It is recommended to drink 100-150 milliliters half an hour before meals warm water or mineral, having previously released gases;
You should definitely reduce your salt intake.

What products are strictly prohibited?

In case of inflammation, exclusion from the diet is prescribed food products, which stimulate the activity of the organ. Reducing the production of enzymes helps relieve inflammation. The list of prohibited products includes:

fried foods;
raw smoked products;
broths fatty varieties meat and fish;
animal fats;

Alcohol is strictly prohibited

bakery products made from rye flour, baked goods;
alcoholic drinks;
carbonated sweet drinks;
coffee;
raw vegetables;
hot spices.

Principles of nutrition during weight gain

Patients face the problem of gaining weight with pancreatitis after completing acute period diseases. The weight loss has already stopped, now you have to regain the lost kilograms. For this purpose, it is important to follow the prescriptions of a nutritionist and follow a diet prepared by a specialist with suitable recipes. The amount of proteins, carbohydrates and fats intended for daily use for weight gain. Daily allowance food calorie content is considered individually for each patient, taking into account his initial weight, health status and age. Important to include in the menu more products with protein content. After all, protein is building material new cells.

It is recommended to eat lean meat

In order to gain weight during pancreatitis, the menu should include the following products:

dietary meat;
low-fat fish;
chicken or quail eggs;
dry cookies, natural crackers, dried day-old bread;
durum wheat pasta;
cereals;
baked, steamed or stewed vegetables;
fermented milk products, low-fat or low-fat;
herbal teas, jelly, dried fruit compote and clean water.

Some nutritionists recommend using baby food - purees (vegetables, fruits, meat) to gain weight. They contain necessary substances that promote growth and correct formation. And small portions of jars are convenient for one-time use, which is very important for pancreatitis.

Durum pasta is also allowed

It is very useful to use kitchen scales not only for people who are losing weight and controlling portions. They will help you accurately determine the dose of food during preparation. dietary dish, according to which the volume of enzymes consumed is calculated so that there are enough of them to digest the food eaten.

To gain weight with pancreatitis, it is necessary to normalize the metabolism that was disrupted during the period acute course diseases. The result is achieved by taking a balanced vitamin and mineral complex. This technique regulates the metabolism of the digestive system, and food is better absorbed.

In case of illness, the vitamin complex should be prescribed by the attending physician.

Amino acids and protein shakes

For full recovery the patient after illness is recommended to use biological additives and foods high in amino acids, which help restore digestion and systematically gain weight. Amino acid supplements are prescribed after detailed analysis position of the patient by the attending physician. Chicken eggs are natural origin amino acids. It is better to eat them boiled.

If you want to know how to gain weight with pancreatitis, then watch this video:

With pancreatitis in complete remission, protein shakes are allowed to gain weight, but under the supervision of a doctor. Protein is an easily digestible protein. Before taking protein drinks, you need to confirm that there are no contraindications, such as protein intolerance, kidney and liver dysfunction.

You can buy ready-made drinks or make your own at home. For preparation, low-fat dairy products and fruits, eggs or protein powder are used. The products are whipped with a blender and consumed in small sips slowly in the morning or evening, shortly before bedtime.

The table shows the most simple ways making protein shakes at home.

Name of the cocktail	Content kcal (per 100 gr.)	Ingredients	Preparation
Protein	226 kcal, whites 50.5 g., fats 2.8 gr., carbohydrates 10.53 gr.	500 ml milk, 50 gr. dry protein, 100 gr. fat-free cottage cheese, 1 egg, natural fruit syrup for taste.	Mix milk with two tablespoons of protein powder in a blender; add cottage cheese and beat again for 20 seconds; add the remaining protein and fruit syrup; beat everything until smooth.
Protein-carbohydrate	399 kcal, whites 25 gr., fats 2 gr., carbohydrates 74 gr.	200 ml natural apple juice, 120 ml applesauce sugarless, 50 gr. frozen vanilla yogurt 2 tbsp. l. toasted wheat germ, 40 gr. skimmed milk powder, 10 gr. whey protein.	Mix juice, puree and yogurt in a blender for 20 seconds; add remaining ingredients and beat until smooth.
Protein free "Classic"	306 kcal, whites 16 gr., fats 11 gr., carbohydrates 38 gr.	1 PC. banana, 4 things. boiled egg white, 350 gr. milk, 100 gr. cottage cheese, 2 tbsp. honey, 1 tbsp. l. butter.	Place all the ingredients into a blender at once and mix until smooth so that there are no lumps.
Protein-free Cocoa Vanilla	135 kcal, whites 60 gr., fats 9 gr., carbohydrates 50 gr.	300 gr. cottage cheese, 2 cups kefir or yogurt 1 tbsp. spoon of sugar, 1 packet of vanillin, 100 ml boiled water.	Add sugar and cocoa to the water, and put on the fire, stirring, let it boil for one minute; Cool the resulting chocolate mass slightly, pour it into a blender and add the remaining ingredients; beat in a blender and cool.

You can gain weight during pancreatitis without causing harm to the body if you eat right and do not overeat. Rely on quick result not worth it. You should have patience, perseverance, and with daily work, success will be ensured over the disease and the lost kilograms will be returned to the body.

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Pancreatitis is inflammatory disease pancreas, which causes serious disturbances in its functioning. Pancreas, with normal functioning, produces a number of enzymes involved in the digestion of food, and also produces important hormones (insulin), which are part hormonal levels the whole body.

Unstable and inadequate work on the production of enzymes leads to the disruption of the entire digestion process. Enzymes are retained in the pancreas and partially enter the stomach, causing gastritis. Into the intestines the required volume Enzymes are not supplied, and its functioning begins to malfunction. Consequently malfunction intestines and pancreas, there is a decrease in appetite and body weight in the patient.

In addition, the body, especially with chronic pancreatitis, constantly lacks important nutrients, since the food consumed, without being properly digested, leaves the body. Very often, with pancreatitis, there is a violation of the absorption of water and nutrients by the intestinal walls. This results in diarrhea, which contributes to sudden weight loss.

It is important to note that the main therapy for pancreatitis is a strict diet; in the first few days it is recommended to abstain from eating food altogether, and in subsequent days only pureed porridges and vegetable broths are allowed. You can’t suddenly gain momentum and return to your usual diet. In view of this, weight loss with pancreatitis is a completely natural phenomenon.

When is it time to sound the alarm?

However, a decrease in body weight of no more than 2.5 - 3 kg per month is considered normal. Experts say that this particular approach to losing weight does not entail pathological disorders in organism. But very often, weight loss with pancreatitis is pathological, when the patient can lose up to 8 kg per week. This entails disruption of the cardiovascular and nervous systems, exhaustion of the body and a host of other dangerous changes in the internal organs.

Therefore, with such an illness, it is important to monitor not only the quality and structure of the diet, but also body weight, the indices of which are calculated based on a person’s height: current weight in kilograms is divided by the square of height in meters. For age group from 25 to 35 years, the body mass index should fluctuate between 20-25. If it is less than 20, it’s time to sound the alarm and seriously think about how to gain weight with pancreatitis without harm to health.

Nutritional Features

It is important to understand that normalizing weight with pancreatitis is a long process aimed at improving the condition of the gland. The longer the period of remission, the better the quality of life will be and the weight will return to normal.

Unfortunately, weight loss with this disease does not always depend on the amount of food consumed, but almost always on the quality and rules of intake.

You should always remember these rules:

fractional meals: the number of meals per day should not be less than 5 times;
you should not feel hungry;
last meal – no later than 19.00;
food temperature should be equal to body temperature;
You cannot drink food or eat immediately after drinking a glass of water;
protein foods are the basis of the diet;
It is prohibited to swallow unchewed pieces (it is necessary to grind the food before eating);
You can use baby food to diversify your diet (mashed potatoes, porridge).

If any product is subject to a ban, then the ban is final and irrevocable. You should not eat fried, sour, salty, smoked and fatty foods, canned food and preserves, flour, chocolate, spices, mustard, ketchup, mayonnaise and sauces based on it, coffee or strong tea. Once departing from this rule, a patient with chronic pancreatitis receives acute attack and, as a consequence, pathological sudden loss weight.

It should be remembered that the recommended diet for illness does not exclude, but only minimizes the presence of other components in the diet. Fats, half of which must be of animal origin, are allowed for consumption at the lower limit daily allowance. It is also necessary to do the same with carbohydrates, given the fact that bread, cereals and vegetables are carbohydrate foods. That is, from the general diet to percentage you need to consume proteins - 40%, fats - 25%, carbohydrates - 35%.

In addition, you can support the body and stop weight loss during pancreatitis by taking, in addition to enzymes, medications such as multivitamins, calcium, magnesium, omega 3 fatty acid, alpha lipoic acid, coenzyme Q 10 and other additives. During the period of remission, protein shakes are allowed. Any of these drugs must be prescribed by a doctor.

Physiotherapy

You can support an excessively losing weight with a system of certain exercises.

Movement is life. In the case of patients with pancreatitis, this motto comes in handy. You should not put excessive stress on the body. You can limit yourself to one and a half hour walks. While walking, sugar is processed without the participation of insulin, which significantly reduces the load on the pancreas.

Walks can be combined with breathing exercises: for three steps you need to take one slow breath, then also smoothly and completely exhale. And so 3-4 times every 30 minutes of walking.

Simple gymnastics will improve the functioning of the gland, but you should avoid squats and other exercises that increase intra-abdominal pressure due to breath holding. For the same purpose, gravity cannot be understood. You should avoid tight clothing and belts that put pressure on your stomach.

For calmer exercises, you can use the following. Sit on the floor, keeping your legs together. Then bend over with your whole body, touch your feet with your hands, lower your head to your knees, count to 15 and slowly return to the starting position. All you need is 3 approaches per charge.

And do not forget that the most harmful thing for the pancreas is alcohol. It should not be taken under any circumstances.

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One of the first signs of pancreatitis (inflammation of the pancreas) is a person’s sudden weight loss. This is normal; this is the specificity of inflammation of the pancreas. But if this process is not stopped, then rapid development is possible muscular dystrophy(protein). To prevent this from happening, doctors prescribe specific medications– they will solve the problem only if you follow a diet.

To stop weight loss, doctors most often prescribe Pancreatin. It is mandatory to follow a diet and correct the diet: meals should be frequent, but in small portions. For chronic pancreatitis It’s better to sit down at the table 5-6 times a day than just 3 times and eat an excessively large portion and chew the food thoroughly. Products must be at room temperature. It is strictly forbidden to drink food with water, drink 30 - 40 minutes after the end of the meal.

Menu for 1 day could be like this:

evening – steamed meat or fish + baked vegetables + compote or fruit jelly.

Recipes for pancreatitis for weight loss:

Soufflé from chicken fillet. Boil ½ breast in salted water, cut into pieces and place in a blender, add 1 chicken protein, 3 tbsp. l. milk, all whipped into puree. Place the mixture in a mold and bake in the oven for 10-15 minutes on medium heat.
Fish with vegetables. Cut into large pieces of fish, zucchini, carrots. Place fish and vegetables in a thick-walled pan, adding a little salt and finely chopped dill and parsley. Pour in water, cook at a low boil for 30 minutes. 5 minutes before the end of cooking, add 1 tbsp. vegetable oil.

Read more about losing weight with pancreatitis, diet and recipes in our article.

Read in this article

Is weight loss with pancreatitis normal?

One of the first signs of pancreatitis (inflammation of the pancreas) is considered to be sudden, without any prerequisites, weight loss in a person. Explain this process with scientific point easy enough to see:

chronic pancreatitis provokes insufficient production of pancreatic enzymes - this leads to problems with digestion of food;
large and dense fragments of food entering the intestines irritate its walls;
the ability to absorb proteins, fats and carbohydrates decreases;
Insufficient intake of these microelements from food forces the body to obtain them from fat reserves.

In principle, weight loss with pancreatitis is the norm - this is the specificity of inflammation of the pancreas. But if this process is not stopped, then the rapid development of muscular dystrophy (protein) is possible. To prevent this from happening, doctors prescribe specific medications - they will solve the problem only if you follow a diet.

How to stop patients losing weight

Most often, doctors prescribe Pancreatin, a drug that is the main active substance which is a pancreatic enzyme. In addition, it will be necessary to conduct a full examination of the patient to identify hidden current concomitant diseases– pancreatitis often progresses simultaneously with cholecystitis (inflammation of the gallbladder), diabetes mellitus or gastritis (inflammation of the stomach lining).

In this case, it is important to undergo complex therapy.

It is mandatory to follow a diet and correct the diet:

Meals should be frequent, but in small portions. With chronic pancreatitis, it is better to sit down at the table 5-6 times a day than just 3 times and eat an excessively large portion.
Immediately after food enters oral cavity you need to chew it thoroughly, which will speed up the process of processing starch and facilitate the further functioning of the digestive system. This is due to the fact that human saliva contains amylose, which contributes to the rapid and almost complete breakdown of starch.
Products should be at room temperature - cold and hot foods disrupt the production of enzymes by the pancreas.
It is strictly forbidden to drink food with water, because it worsens the quality characteristics of enzymes. But it will be absolutely safe to use clean water 30 - 40 minutes after finishing the meal.

In addition, the doctor will select a diet for such patients according to individually, although there are general principles:

exclude alcoholic and sweet, carbonated drinks, fatty foods;
in addition to the main food, it is worth including pureed vegetables and fruits in the menu (mashed potatoes for baby food are an excellent choice);
the maximum break between meals is 3 hours.

Additionally you can take vitamin complexes And nutritional supplements, which directly solve the problem of weight loss.

For information on what you can eat if you have chronic pancreatitis, watch this video:

Chronic diet for weight gain

To stop the process of destruction of pancreatic cells, accelerate their recovery and gain weight after a sharp weight loss, you need to follow the following recommendations from nutritionists:

You can use any cereals and even pasta, but they should not be "enriched" butter or rich meat gravy. The best option will be a combination of these products with vegetables - raw, stewed or baked.
Within 1 week you are allowed to eat a maximum of 4 chicken eggs. And the yolk should remain on the plate, but you can cook omelettes or light casseroles from proteins.
Every day you need to eat soups that are prepared on the basis of dietary meat or vegetable broth. You can add spices and seasonings to them, but white cabbage will need to be abandoned - it contains just a huge amount of fiber, which digestive system It will be very difficult, almost impossible, to recycle.
You can include milk and fermented milk products in the menu, but with low level fat content. There is no need to get carried away with these products; 300-400 g of one thing per day is enough.
Fruits are consumed only according to the list - pears, apples and peaches, and only after heat treatment. For example, you can make pastille, jam, jelly or compote.
Vegetables are allowed, but again only after preliminary heat treatment. Soups, stews, casseroles and "complex" dishes with cereals will prevent diarrhea, increased gas formation.

In addition, patients with chronic pancreatitis are allowed to consume:

chicken, veal, turkey and other varieties of dietary, non-fatty meat - in any form, but not in or stewed with big amount fat;
cod, pike, silver carp, pike perch and others lean fish, from which steamed meatballs/cutlets and casseroles with vegetables are prepared;
crackers without raisins and other additives, white bread (no more than 200 g per day), dry (biscuit type).

Menu and recipes

morning – omelet from whites of 2 eggs + 2 pieces of stale white bread+ 200 ml dried fruit compote;
snack – chicken fillet soufflé + 100 ml low-fat whole milk + chicory drink;
day – 150 ml of soup with vegetable broth + stew of meat and vegetables + weak tea;
afternoon snack – natural yogurt without flavoring and low fat;
evening - steam cutlets from meat or fish + baked vegetables + compote or fruit jelly.

Having studied the list of permitted products, you can create a varied menu for a patient with chronic pancreatitis. for a long time. Dishes are prepared in the most different ways, here are just a few recipes:

Chicken fillet soufflé. Boil ½ breast in salted water, cut the meat into pieces and place in a blender. Add 1 chicken protein, 3 tablespoons of milk and beat everything until pureed. The finished mass is placed in a mold and baked in the oven for 10 - 15 minutes over medium heat.
Fish with vegetables. Cut any permitted fish into large pieces, additionally prepare zucchini and carrots in the same way. Place fish and vegetables in a thick-walled pan or stewpan in layers, salting each of them and adding finely chopped dill and parsley.
Pour water over everything so that it barely covers the mass, cook at low boil (“on the boil”) for half an hour. 5 minutes before the end of cooking, add 1 tablespoon of vegetable oil to the dish.
Cottage cheese and apple casserole. Mix 2 tablespoons of semolina thoroughly with 200 g of grainy (low-fat) semolina, add whipped egg white to the mixture chicken egg and a thinly sliced apple. Then the mixture is transferred into a mold and baked in the oven for 20 - 30 minutes. After the dish has cooled, you can decorate it with powdered sugar.
Vegetable puree soup. Carrots, zucchini cauliflower or – clean everything, cut into large pieces. Boil them until fully cooked in a small amount of water (it should just cover them), cool slightly. Then beat everything in a blender, add salt to taste. Add a little dill or parsley to the plate, 1 teaspoon of low-fat sour cream and a handful of homemade wheat crackers.

In addition, it is worth excluding spices– oregano, cilantro (coriander), because they irritate the pancreas and can cause an exacerbation of the disease.

Diet for weight loss for chronic pancreatitis

The disease does not always manifest itself as weight loss; in many cases, the patient gains weight - this also negatively affects the condition and functioning of the pancreas. In any case, nutritional correction will be required and the doctor will definitely give recommendations regarding safe weight loss with already diagnosed chronic pancreatitis.

The menu proposed above and the list of permitted/prohibited foods normalizes metabolism and the production of enzymes by the inflamed organ. And this will definitely correct the weight in the right side– some will gain the missing kilograms, others will get rid of them. But there are some nuances regarding the fight against excess body weight:

you will need to give up bread altogether - black is contraindicated due to illness, white only increases obesity;
You should not include pasta in the menu, or limit their quantity as much as possible;
potatoes are excluded from the list of vegetables;
cooking fruit jellies, casseroles with cottage cheese should be made without the use of sugar.

Diet for pancreatitis for 4 days

Weight loss in chronic pancreatitis should be accompanied physical activity. Moderate or even gentle exercise will speed up the process of losing weight, and therefore the restoration of the pancreas. But you will need to consult with your doctor and physiotherapist about drawing up individual program training.

Losing weight or gaining weight due to the disease in question should be under the supervision of doctors. Self-restriction in food leads to a deterioration in the functionality of the pancreas, to a decrease in the amount of enzymes produced - the prognosis may become unfavorable.

Useful video

For treatment and diet for pancreatitis, watch this video: