Enhance insulin sensitivity -
The excess glucose in the blood is shunted to the liver to be metabolized or stored. The liver is responsible for processing energy substrates.
It packages, recirculates, and creates fatty acids and processes, stores, and creates glucose. If the liver becomes insulin-resistant, these processes are severely affected, resulting in significant metabolic consequences. When skeletal muscle develops insulin resistance, excess glucose in the blood is shunted to the liver.
When the liver tissue senses an excess of energy substrate, particularly in the form of diacylglycerol, a process similar to that in skeletal muscle occurs.
In the liver, the diacylglycerol content activates protein kinase C epsilon PKC-epsilon , which decreases proximal insulin signaling. Excess glucose enters hepatocytes via insulin-independent pathways stimulating DNL via substrate push, creating more fatty acids from the glucose surplus.
The excess fatty acid is deposited in the liver or as ectopic lipid throughout the viscera. Additionally, immune-mediated inflammatory changes contribute to excess lipolysis from adipose tissue, which is re-esterified by the liver and further adds to circulating fatty acid and ectopic lipid deposition.
Finally, normal insulin-mediated suppression of gluconeogenesis is defective, and the liver continues to create more glucose, adding to the circulating glucose surplus. Using the hyperinsulinemic-euglycemic clamp technique, researchers determined that lipolysis is sensitive to insulin.
The failure of insulin to suppress lipolysis in insulin-resistant adipose tissue, especially visceral adipose tissue, increases circulating free fatty acids FFAs.
Higher levels of circulating FFAs directly affect both liver and muscle metabolism, further exacerbating insulin resistance in these tissues and contributing to lipotoxicity-induced beta-cell dysfunction.
The clinical presentation of insulin resistance is variable concerning both history and physical examination findings. Common presentations include:. The gold standard for measuring insulin resistance is the hyperinsulinemic-euglycemic glucose clamp technique. The amount of glucose required to reach a steady state reflects the exogenous glucose disposal needed to compensate for hyperinsulinemia.
Insulin resistance calculation is based on whole-body glucose disposal and body size. The associated risks and complexity of the glucose clamp method limit its clinical usefulness. As a result, multiple surrogate markers for insulin resistance have been developed and tested.
The homeostatic model assessment for insulin resistance HOMA-IR , based on fasting glucose and fasting insulin levels, is a widely utilized measure of insulin resistance in clinical research. Other measures based on fasting insulin include HOMA2, the Glucose to Insulin Ratio GIR , and the Quantitative Insulin Sensitivity Index QUICKI.
The McAuley Index utilizes fasting insulin and triglycerides. Post-glucose challenge tests, done after an overnight fast, measure insulin and glucose response to a gram glucose load. Methods include the Matsuda Index and Insulin Sensitivity Index ISI.
Other surrogate markers involve triglycerides alone or in relation to HDL cholesterol. In general, a ratio greater than 3. More specifically, a ratio greater than or equal to 3.
These correlations do not hold up in individuals who identify as Black. Measures of insulin resistance have not been integrated into clinical guidelines.
As a result, the presence of insulin resistance is generally inferred from the clinical presentation. Metabolic syndrome MetS and insulin resistance syndrome IRS are considered to be clinical indicators of insulin resistance. Multiple criteria for metabolic syndrome MetS exist. In , a joint scientific statement harmonizing criteria for MetS was released.
The American College of Endocrinology identifies specific physiologic abnormalities that increase IRS risk. Lifestyle intervention represents the cornerstone of treatment for insulin resistance.
Dietary intervention should include a combination of calorie restriction and high glycemic index carbohydrate reduction.
Physical activity improves both calorie expenditure and insulin sensitivity in muscle tissue. Individuals with insulin resistance are at high risk of developing T2D. While no medications are FDA approved for the treatment of insulin resistance, general approaches include the following:.
Surgical intervention in the form of gastric sleeves, banding, and bypass is available for qualified individuals with obesity. The excess fat loss associated with bariatric surgery improves insulin sensitivity. The results of the STAMPEDE trial provide good evidence of the benefit of bariatric surgery on T2D.
The prognosis of insulin resistance depends on the subset of the disease, the severity of the disease, underlying pancreatic beta-cell function, the heritable susceptibility of the patient to the secondary complications from insulin resistance, and individual response to appropriate therapy.
The outcomes range from mildly insulin-resistant, asymptomatic individuals to those with catastrophic cardiovascular or cerebrovascular events and their resulting morbidity and mortality.
Statistically, coronary artery disease is the leading cause of mortality in the US, with diabetes as seventh. The common basis for diabetes and much of the resultant vascular disease is insulin resistance.
Additional mortality from insulin resistance occurs in the less common manifestations of the disease, including genetic syndromes and fatty deposition diseases.
Finally, substantial morbidity manifests with the loss of reproductive function and associated features of PCOS. Mitigation for the disease exists.
Increased clinical awareness enables early diagnosis and treatment. Improved understanding of the disease process has resulted in more targeted, multi-faceted therapies. Efforts to attain and maintain a healthy weight through improved dietary intake and increased physical activity can reduce insulin resistance and prevent associated complications.
More generalized lay recognition can increase the efficacy of preventative care, with the hope of an eventual downturn in epidemic obesity and resultant insulin resistance.
Most of the complications from insulin resistance are related to the development of vascular complications. The microvascular disease manifests as retinopathy, nephropathy, and peripheral neuropathy. In the central nervous system, dementia, stroke, mood disturbance, and gait instability may occur.
Cardiac microvascular disease can manifest as angina, coronary artery spasm, and cardiomyopathy. Renal microvascular disease is a significant cause of chronic kidney disease, renal failure, and dialysis.
Ophthalmological small vessel disease is a leading cause of retinopathy and visual impairment. Macrovascular disease, secondary to insulin resistance, causes PAD, CAD, and CVA.
Non-alcoholic fatty liver disease NAFLD is intricately related to insulin resistance and T2D. Patients with T2D have a 2-fold increased risk for NAFLD. With an increasing worldwide prevalence and incidence in children, NAFLD should be of great concern to clinicians treating patients with insulin resistance.
Primary prevention promotes public education regarding the importance of regular health monitoring. A healthy diet and increased activity level can prevent or delay the onset of insulin resistance, metabolic syndrome, and diabetes, along with the associated complications.
The emphasis on behavior modification and a sustainable lifestyle is critical for long-term weight management. Secondary prevention includes laboratory screening for insulin resistance, diabetes, and further subspecialist referral to manage the early intervention for insulin resistance.
Public acceptance of tertiary prevention, such as intensive medical intervention and bariatric surgery for weight reduction, can lead to decreased morbidity and mortality associated with the consequent complications of insulin resistance.
Intensive lifestyle intervention should be the first line of therapy for patients with metabolic syndrome or insulin resistance syndrome. The benefits of exercise cannot be understated in treating patients with insulin resistance. Barriers to exercise should be discussed, and a well-formulated plan, including moderate-intensity cardiovascular exercise like walking, should be provided in accordance with the physical activity guidelines.
Discussion of dietary modification following the dietary guidelines should also be provided with individualization to the patient's preferences, with particular attention to reducing sugar, refined grain products, and high glycemic index carbohydrates.
Over the past few decades, the incidence of insulin resistance has skyrocketed primarily due to our lifestyle and the rising incidence of obesity. Without treatment, the condition is associated with numerous complications, including fatal cardiac events.
Therefore, the management of insulin resistance is best done with an interprofessional team. The consultations and coordination of care most indicated for the treatment of insulin resistance include:.
There is limited evidence in favor of continuous glucose monitoring CGM. Remote monitoring for healthcare teams shows benefits in the management of T2D. More research is needed to show the effects of CGM on those with prediabetes or insulin resistance without T2D.
The key to the management of insulin resistance is encouraging lifestyle changes. Dietary intervention should include a combination of calorie restriction and reduction of high glycemic index carbohydrates. The outcomes of well-managed insulin resistance are good for those who remain adherent to therapy.
Unfortunately, many patients struggle with adherence to therapy, with consequential progression to T2D and subsequent risk of adverse cardiac or CNS events.
Early identification and intervention with an interprofessional team approach are essential in managing these patients.
Disclosure: Andrew Freeman declares no relevant financial relationships with ineligible companies. Disclosure: Luis Acevedo declares no relevant financial relationships with ineligible companies. Disclosure: Nicholas Pennings declares no relevant financial relationships with ineligible companies.
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StatPearls [Internet]. Treasure Island FL : StatPearls Publishing; Jan-. Show details Treasure Island FL : StatPearls Publishing ; Jan-. Search term. Insulin Resistance Andrew M. Author Information and Affiliations Authors Andrew M.
Affiliations 1 Southeastern Regional Medical Center. Continuing Education Activity Insulin resistance, identified as an impaired biologic response to insulin stimulation of target tissues, primarily involves liver, muscle, and adipose tissue.
Introduction Insulin resistance is identified as the impaired biologic response of target tissues to insulin stimulation. Etiology The etiologies of insulin resistance may be acquired, hereditary, or mixed. Medications glucocorticoids, anti-adrenergic, protease inhibitors, selective serotonin reuptake inhibitors, atypical antipsychotics, and some exogenous insulins.
Type-A insulin resistance: Characterized by severe insulin resistance abnormal glucose homeostasis, ovarian virialization, and acanthosis nigricans caused by abnormalities of the insulin receptor gene. Type-B insulin resistance: Characterized severe impairment of insulin action triggered by the presence of insulin receptor autoantibodies with resultant abnormal glucose homeostasis, ovarian hyperandrogenism, and acanthosis nigricans.
Epidemiology Epidemiologic assessment of insulin resistance is typically measured in relation to the prevalence of metabolic syndrome or insulin resistance syndrome. Pathophysiology The 3 primary sites of insulin resistance are the skeletal muscle, liver, and adipose tissue.
History and Physical The clinical presentation of insulin resistance is variable concerning both history and physical examination findings.
Common presentations include: Associated Diseases Non-alcoholic fatty liver disease NAFLD. Evaluation The gold standard for measuring insulin resistance is the hyperinsulinemic-euglycemic glucose clamp technique.
Elevated blood pressure greater than or equal to mm Hg systolic or greater than or equal to 85 mm Hg diastolic or on antihypertensive medication.
Metformin is a common first-line therapy for medication treatment of T2D and is approved for use in PCOS. Despite the concerns about using metformin in mild to moderate renal dysfunction, several organizations, including the American Geriatric Society and the Kidney Disease Improving Global Outcomes guidelines, endorse use as long as the GFR exceeds Glucagon-like peptide one GLP-1 receptor agonists stimulate the GLP-1 receptors in the pancreas, thereby increasing insulin release and inhibiting glucagon secretion.
The use of GLP-1 agonists is associated with weight loss, which may reduce insulin resistance. Liraglutide and semaglutide are FDA-approved for the treatment of T2D and obesity. Another agent, tirzepitide, is a dual GLP-1 and gastric inhibitory polypeptide GIP agonist, has effects similar to semaglutide, and is also FDA-approved for treating T2D.
Sodium-glucose cotransporter 2 SGLT2 inhibitors increase urinary glucose excretion, thereby reducing plasma glucose levels and exogenous insulin requirements.
The use of SGLT2 inhibitors has also been associated with weight loss, which may reduce insulin resistance. Thiazolidinediones improve insulin sensitivity and glucose control by increasing insulin-dependent glucose disposal in skeletal muscle and adipose tissue and decreasing hepatic glucose output.
Though effective, associated secondary weight gain and fluid retention, with associated cardiovascular concerns, limit their use.
Dipeptidyl peptidase-4 DPP-4 inhibitors prolong the activity of endogenous GLP-1 and GIP by preventing their breakdown. Differential Diagnosis Lipodystrophy acquired, localized or generalized : Loss of adipose tissue that results from either genetic or acquired causation and can result in the ectopic deposition of fat in either hepatic or muscular tissue [56].
Obesity: Excess body weight is categorized as overweight BMI of 25 to Other forms of glucose intolerance impaired fasting glucose, impaired glucose tolerance, and gestational diabetes.
Prognosis The prognosis of insulin resistance depends on the subset of the disease, the severity of the disease, underlying pancreatic beta-cell function, the heritable susceptibility of the patient to the secondary complications from insulin resistance, and individual response to appropriate therapy.
Complications Most of the complications from insulin resistance are related to the development of vascular complications.
Deterrence and Patient Education Primary, secondary, and tertiary prevention have distinct roles in managing insulin resistance.
Pearls and Other Issues Intensive lifestyle intervention should be the first line of therapy for patients with metabolic syndrome or insulin resistance syndrome. Enhancing Healthcare Team Outcomes Over the past few decades, the incidence of insulin resistance has skyrocketed primarily due to our lifestyle and the rising incidence of obesity.
The consultations and coordination of care most indicated for the treatment of insulin resistance include: Obesity medicine specialist: medical management for obesity treatment. Bariatric surgeon: bariatric surgery is effective for obesity treatment in individuals who satisfy the criteria for surgery.
Cardiology and cardiac surgery: management of the cardiovascular complications of insulin resistance. Neurology: management of the cerebrovascular and peripheral neurologic complications of insulin resistance. Pharmacist: educates the patient on the importance of medication adherence, instructing the patient on the proper use of medications, potential drug-drug interactions, and side effects.
Review Questions Access free multiple choice questions on this topic. Comment on this article. Figure Acanthosis Nigricans Contributed by Scott Dulebohn, MD.
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Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab. Kim-Dorner SJ, Deuster PA, Zeno SA, Remaley AT, Poth M.
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Losing weight is an effective way to lose belly fat, increase insulin sensitivity, and reduce your chance of developing type 2 diabetes if you have prediabetes Even if it is, they may want to supervise your weight loss journey. There are certain changes you can make to your diet that can help you increase your insulin sensitivity.
This includes both adding and limiting various foods and supplements to your diet. Fiber can be divided into two broad categories — soluble and insoluble. Soluble fiber helps feed the friendly bacteria in your gut, which have been linked to increased insulin sensitivity 14 , Discover the top 20 foods high in soluble fiber.
Many studies have found that eating a diet rich in plant compounds is linked to higher insulin sensitivity. This is because colorful fruits and vegetables are rich in antioxidants. Antioxidants bind to and neutralize molecules called free radicals that can cause harmful inflammation throughout the body 16 , 17 , Learn how much fruit you should eat per day and what to know about fruit as part of a diabetes eating plan.
Reducing your carb intake could help increase insulin sensitivity because high carb eating patterns tend to lead to spikes in blood sugar Eating regularly benefits insulin sensitivity, and eating low glycemic index GI carbs, in particular, is better because they slow the release of sugar into the blood, giving insulin more time to work efficiently 20 , Learn more about the types of carbs.
Added sugars , which are found mostly in highly processed foods, include primarily high fructose corn syrup and table sugar sucrose. Many studies have found that higher intakes of fructose can increase insulin resistance among people with diabetes 22 , The effects of fructose on insulin resistance also appear to affect people who do not have diabetes, as reported in a review of literature showing that consuming a lot of fructose over less than 60 days increased liver insulin resistance, independent of total calorie intake Learn which foods contain lots of added sugar.
Herbs and spices, including fenugreek , turmeric , ginger , cinnamon , and garlic , have shown promising results in increasing insulin sensitivity 25 , Other herbs that may have this effect include basil, dill, fennel, parsley, cumin, nutmeg, oregano, and rosemary.
Research has identified at least compounds contained in a variety of herbs and spices that may contribute to reducing insulin resistance Several studies have found that drinking green tea can help increase insulin sensitivity and reduce blood sugar 27 , These beneficial effects of green tea could be due to its powerful antioxidant epigallocatechin gallate EGCG , which helps increase insulin sensitivity Vinegar could help increase insulin sensitivity by reducing blood sugar and improving the effectiveness of insulin It also appears to delay the stomach from releasing food into the intestines, giving the body more time to absorb sugar into the bloodstream Unlike other fats, trans fats provide no health benefits and increase the risk of many diseases Evidence on the effects of high trans-fat intake on insulin resistance appears to be mixed.
Some human studies have found it harmful, while others have not 33 , Many different supplements can help increase insulin sensitivity, including vitamin C , probiotics , and magnesium. That said, many other supplements, such as zinc, folate, and vitamin D, do not appear to have this effect, according to research As with all supplements, there is a risk they may interact with any current medication you may be taking.
Insulin is an important hormone that has many roles in the body. When your insulin sensitivity is low, it puts pressure on your pancreas to increase insulin production to clear sugar from your blood.
Low insulin sensitivity is also called insulin resistance. Insulin sensitivity describes how your cells respond to insulin.
Symptoms develop when your cells are resistant to insulin. Insulin resistance can result in chronically high blood sugar levels, which are thought to increase your risk of many diseases, including diabetes and heart disease. Insulin resistance is bad for your health, but having increased insulin sensitivity is good.
It means your cells are responding to insulin in a healthier way, which reduces your chance of developing diabetes. Consider trying some of the suggestions in this article to help increase your insulin sensitivity and lower your risk of disease but be sure to talk with a healthcare professional first before making changes, especially adding supplements to your treatment regimen.
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VIEW ALL HISTORY. Insulin is a very important hormone in the body. A resistance to its effects, called insulin resistance, is a leading driver of many health conditions. If not treated, high insulin levels can lead to serious health problems.
Here are 14 diet and lifestyle changes you can make to reduce your levels. Eating certain foods can help you lose weight and reverse insulin resistance. Discover helpful and healthy diet tips for managing insulin resistance. Having high blood sugar levels is a common issue for people with diabetes and prediabetes.
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New research has revealed that diabetes remission is associated with a lower risk of cardiovascular disease and chronic kidney disease.
sensitivith means it's official. Federal Enhance insulin sensitivity websites often end in. gov or. Before sharing sensitive information, make sure you're on a federal government site. The site is secure.Enhance insulin sensitivity -
Albeit marketed as a healthy alternative to sugar, fructose and artificial sweeteners are directly related to metabolic syndrome, obesity, and insulin resistance. They disrupt our healthy gut microbiome, lead to decreased satiety feeling full , cause us to eat more, and alter how sugar is metabolized.
Animal studies showed that feeding rodents a high-fat sucrose diet resulted in insulin resistance, high triglycerides, enhanced blood clotting, high blood pressure, and metabolic syndrome after just a few weeks!
Completely remove things like aspartame and high fructose corn syrup commonly added to diet sodas, gum, and candy. Reach for bubbly water flavored with a real lime or lemon instead. Extensive studies show that both light continuous and high-intensity interval training improve insulin sensitivity, decrease fat tissue, and naturally treat metabolic syndrome.
This can be as simple as going for a 1 mile walk every evening. For those who struggle with chronic pain or mobility issues, swimming and recumbent cycling can be excellent, low-impact forms of exercise. Reducing chronic inflammation and stress is important for optimal health outcomes.
Learn how inflammation and stress affect your body long term and how to combat this. Studies show that those with shift work sleep disorder and circadian misalignment have worse signs of glucose control. This only perpetuates eating disorders and unhelpful, temporary diets.
Changing your diet is a lifestyle change. Fruit is a healthy source of sugar, vitamins, flavinoids, and nutrients when consumed in moderation. According to the American Academy of Family Physicians, poor insulin sensitivity and resistance are linked to higher rates of diabetes, hypertension, dyslipidemia high levels of bad cholesterol and triglycerides , heart disease, and many other diseases.
Decreased insulin sensitivity develops over many years, which is why having annual physicals and getting your labs checked every few years are so important. Those with a personal or family history of diabetes, obesity, polycystic ovarian syndrome PCOS , gestational diabetes, or heart disease would be well served to take preventative measures.
Some medications can exacerbate insulin and sugar problems, such as Quetiapine Seroquel and Olanzapine Zyprexa , to name a few. If you take several medications and suffer from poor insulin sensitivity, ask for a consult with your pharmacist.
adults have prediabetes or diabetes, based on their fasting glucose or A1c levels. Many genetic links have been identified, and the rates of insulin resistance are only increasing. Practicing the helpful tips in this article will help you avoid developing diabetes and re-establish a healthy relationship with food, sugar, and insulin.
Signos uses an AI-driven app to provide real-time notifications about your glucose levels. As you eat and log meals in the app, it will notify you if your glucose levels spike in response to certain foods.
Combined with a CGM, the app helps tailor personalized suggestions, including which foods trigger sugar spikes , when to eat them or not , and when to exercise. This keeps you within your optimal weight loss range and helps you make micro changes.
Danielle Kelvas, MD, earned her medical degree from Quillen College of Medicine at East Tennessee State University in Johnson City, TN. Please note: The Signos team is committed to sharing insightful and actionable health articles that are backed by scientific research, supported by expert reviews, and vetted by experienced health editors.
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How It Works. View Plans. Home How It Works FAQs Blog View Plans. How to Improve Insulin Sensitivity Increasing insulin sensitivity means your cells are able to use blood sugar more effectively, which helps your efforts to lose weight and burn fat.
Reviewed by Danielle Kelvas, MD. Updated by. Science-based and reviewed. Foods to Avoid. Foods to Eat. Metabolic Health. Glucose Table of contents Example H2. Example H3. While this article itself is not directly about diabetes, we will cover some of the key principles of diabetes, such as sugar, insulin, insulin sensitivity, and how to increase insulin sensitivity What Is Insulin?
This means the cell takes sugar and turns it into glycogen, so it can be stored and used later. In fat cells, insulin promotes storing sugar as fat.
In muscle cells, insulin promotes protein synthesis and glycogenesis. In pancreas cells, insulin regulates the secretion of glucagon, which is a hormone that facilitates cells releasing stored sugar into the bloodstream.
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Metabolism 75, 36— Citation: Lin Y, Fan R, Hao Z, Li J, Yang X, Zhang Y and Xia Y The Association Between Physical Activity and Insulin Level Under Different Levels of Lipid Indices and Serum Uric Acid. Received: 08 November ; Accepted: 06 January ; Published: 02 February Copyright © Lin, Fan, Hao, Li, Yang, Zhang and Xia.
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Introduction Insulin resistance IR is defined as an impaired biologic response to glucose disposal and insulin stimulation of target tissues mainly the liver, muscle, and adipose tissue , leading to a compensatory increase in beta-cell insulin production and hyperinsulinemia.
Materials and Methods Study Population The National Health and Nutrition Examination Study NHANES , which is a representative survey of the national population in the United States, was conducted by the Centers for Disease Control and Prevention CDC.
Exposure Variables and Outcomes The physical activity the exposure variable of participants between and was based on the Global Physical Activity Questionnaire GPAQ; Hallal et al.
Statistical Analysis All statistical analyses were performed using Empower Stats 2. Table 1. Basic characters. Table 2. The association between physical activity and insulin. com 3. x PubMed Abstract CrossRef Full Text Google Scholar.
The ability of the pancreas to increase insulin production means that insulin resistance alone won't have any symptoms at first.
Over time, though, insulin resistance tends to get worse, and the pancreatic beta cells that make insulin can wear out. Eventually, the pancreas no longer produces enough insulin to overcome the cells' resistance. The result is higher blood glucose levels, and ultimately prediabetes or type 2 diabetes.
Insulin has other roles in the body besides regulating blood glucose levels, and the effects of insulin resistance are thought to go beyond diabetes. For example, some research has shown that insulin resistance, independent of diabetes, is associated with heart disease.
Scientists are beginning to get a better understanding of how insulin resistance develops. For starters, several genes have been identified that make a person more or less likely to develop the condition. It's also known that older people are more prone to insulin resistance.
Lifestyle can play a role, too. Being sedentary, overweight or obese increases the risk for insulin resistance. It's not clear, but some researchers theorize that extra fat tissue may cause inflammation, physiological stress or other changes in the cells that contribute to insulin resistance.
There may even be some undiscovered factor produced by fat tissue, perhaps a hormone, that signals the body to become insulin resistant. Doctors don't usually test for insulin resistance as a part of standard diabetes care.
In clinical research, however, scientists may look specifically at measures of insulin resistance, often to study potential treatments for insulin resistance or type 2 diabetes.
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