April 2017: Issue 123

Page 11 – FOLLOW-ON FORMULA: FRIEND OR FOE?

References

1. Department of Health (2013). Guidance Notes on the Infant Formula and Follow-on Formula Regulations 2007 (as amended). www.gov.uk/government/uploads/system/uploads/attachment_data/file/204314/Infant_formula_guidance_2013_-_final_6_March.pdf. Accessed 03/03/17

2. Crawley H and Westland S (2017) for First Steps Nutrition Trust. Infant Milks in the UK: A Practical Guide for Health Professionals. http://firststepsnutrition.org/newpages/Infants/infant_feeding_infant_milks_UK.html. Accessed 3/3/17

3. Crawley H and Westland S (2016). for First Steps Nutrition Trust. Infant Milk Composition. www.firststepsnutrition.org/pdfs/Infant_milk_composition_February2016.pdf Accessed 3/3/17

4. Koletzko B, Bhutta ZA, Cai W et al (2012). Compositional requirements of follow-up formula for use in infancy: recommendations of an International Expert Group coordinated by the Early Nutrition Academy. Annals of Nutrition and Metabolism, DOI: 10.1159/000345906

5. Koletzko B, Koletzko S, Ruemmele F (2009). Drivers of Innovation in Pediatric Nutrition. Nestlé Nutrition Institute

6. European Food Safety Authority (2014). Scientific opinion on the essential composition of infant and follow-on formulae. EFSA Journal, 12 (7), 3760. Available at www.efsa.europa.eu/en/efsajournal/doc/3760.pdf Accessed 03/03/17

7. European Food Safety Authority (2012). Scientific opinion on the suitability of goat milk protein as a source of protein in infant formulae and in follow-on formulae. Available at: www.efsa.europa.eu/en/efsajournal/pub/2603.htm Accessed 03/03/17

8. Stoltzfus RJ (2003). Iron deficiency: global prevalence and consequences. Food Nutr Bull. 24(4 Suppl):S99

9. SACN (2010). Iron and Health. Available at: www.gov.uk/government/uploads/system/uploads/attachment_data/file/339309/SACN_Iron_and_Health_Report.pdf Accessed 03/03/17

10. Thorisdottir AV, Ramel A, Palsson GI, Tomassson H and Thorsdottir I (2013). Iron status of one-year-olds and association with breast milk, cows’ milk or formula in late infancy. European Journal of Nutrition, 52(6 ) 1661-1668

11. Morley R, Abbott R, Fairweather-Tait S, MacFadyen U, Stephenson T and Lucas A (1999). Iron fortified follow-on formula from nine to 18 months improves iron status but not development or growth: a randomised trial. Archives of disease in childhood, 81(3), pp 247-252

12. Daly A, Macdonald A, Aukett A, Williams J, Wolf A, Davidson J, Booth IW (1996). Prevention on anaemia in inner city toddlers by an iron supplemented cows’ milk formula. Archives of Disease in Childhood 75(1): 9-16

13. World Health Organisation (WHO 2013). Information concerning the use and marketing of follow-up formula. www.who.int/nutrition/topics/WHO_brief_fufandcode_post_17July.pdf Accessed 03/03/17

14. Ballard O, Morrow AL (2013). Human milk composition: nutrients and bioactive factors. Pediatric Clinics of North America, 60, 49-74

15. McAndrew F, Thompson J, Fellows L, Large A, Speed M and Renfrew MJ for Health and Social Care Information Centre (2012). Infant Feeding Survey 2010. http://content.digital.nhs.uk/catalogue/PuB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf Accessed 3/3/17

16. McFadden A, Mason F, Baker J, Begin F, Dykes F, Grummer-Strawn L, Kenney-Muir N, Whitford H, Zehner E, Renfrew MJ (2016). Spotlight on infant formula: coordinated global action needed. Lancet 387(10017): 413-5

17. Odom E, Li R, Scanlon K, Perrine C and Grummer-Strawn L (2013). Reasons for earlier than desired cessation of breastfeeding. Pediatrics, 18, 2012-1295. Available at: http://pediatrics.aappublications.org. Accessed 4/3/17

18. Stewart-Knox B, Gardiner K and Wright M (2003). What is the problem with breastfeeding? A qualitative analysis of infant feeding perceptions. Journal of Human Nutrition and Dietetics, 16: 265-273. doi:10.1046/j.1365-277X.2003.00446.x

19. Piwoz EG, Huffman SL (2015). The Impact of Marketing of Breast Milk Substitutes on WHO-Recommended Breastfeeding Practices. Food and Nutrition Bulletin 36 (4), pp 373-386

20. Schultz PW, Nolan JM, Cialdini RB, Goldstein NJ and Griskevicius V (2007). The constructive, destructive and reconstructive power of social norms. Psychological science, 18(5), pp 429-434

21. World Health Organisation (WHO 1981). International Code of Marketing of Breast Milk Substitutes. Geneva: Available from: www.who.int/nutrition/publications/infantfeeding/9241541601/en/. Accessed 3/3/17

22. Berry NJ, Jones S, Iverson D (2010). It’s all formula to me: women’s understanding of toddler milk ads. Breastfeeding Review, 18, 1, 21-30

23. Parry K, Taylor E, Hall-Dardess P, Walker M, Labbok M (2013). Understanding women’s interpretations of infant formula advertising. Birth 2013; 40: 115-24

24. Rollins N, Bhandari N, Hajeebhoy N, Horton S, Lutter C, Martines J et al (2016). Why invest and what it will take to improve breastfeeding practices? Lancet 387: 491-504

25. Save the Children. Breastfeeding: policy matters. Identifying strategies to effectively influence political commitment to breastfeeding: a review of six country case studies. London: Save the Children, 2015

26. World Health Organisation (WHO 2013). Country implementation of the International Code of Marketing of Breast Milk Substitutes: status report 2011. Geneva

27. Renfrew MJ et al, for UNICEF UK (2012). Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK. http://dspace.brunel.ac.uk/bitstream/2438/10266/1/Fulltext.pdf Accessed 3/3/17

28. http://services.parliament.uk/bills/2016-17/feedingproductsforbabiesandchildrenadvertisingandpromotion.html

29. Baby Milk Action Group. www.babymilkaction.org/archives/8042. Accessed 3/3/17

30. Balogun OO, O'Sullivan EJ, McFadden A, Ota E, Gavine A, Garner CD, Renfrew MJ, MacGillivray S. Interventions for promoting the initiation of breastfeeding. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD001688. DOI: 10.1002/14651858.CD001688.pub3, Issue 11. Art No: CD001688. DOI: 10.1002/14651858.CD001688.pub3

Page 16 - NASOGASTRIC FEEDING OF ADULT PATIENTS IN THE COMMUNITY SETTING

References

1 NICE (2006). CG32 Nutrition support for adults: oral nutrition support, enteral feeding and parenteral nutrition

2 Wang J, Liu M, Liu C, Ye Y and Huang G (2014). Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for patients with head and neck cancer: a systematic review. Journal of Radiation Research, 55(3), 559-67

3 British Artificial Nutrition Survey (2011). Artificial Nutrition Support in the UK 2000-2010. A Report by the British Artificial Nutrition Survey (BANS), a committee of BAPEN (The British Association for Parenteral and Enteral Nutrition)

4 Brotherton AM and Judd PA (2007). Quality of life in adult enteral tube feeding patients. Journal of Human Nutrition and Dietetics, 20(6), 513-22-5

5 National Patient Safety Agency (2011). Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants. NPSA. Patient Safety Alert NPSA/2011/PSA002

6 Reeve J (1851). An apparatus for administering nourishment to insane persons who refuse food. Lancet 1851; 1: 520-521

7 National Patient Safety Agency (2009). Misplaced naso or orogastric tube not detected prior to use. Available online at: www.nrls.npsa.nhs.uk/resources/collections/never-events/core-list/misplaced-naso-or-orogastric-tube-not-detected-prior-to-use/

8 NHS Improvement (2016). Resource set. Initial placement checks for nasogastric and orogastric tubes. Available at: https://improvement.nhs.uk/uploads/documents/Patient_Safety_Alert_Stage_2_-_NG_tube_resource_set.pdf

9 National Patient Safety Agency (2005). Reducing harm caused by misplaced nasogastric feeding tubes. NPSA. Patient Safety Alert NPSA/2011/PSA002

10 Sevilla W, McElhanon B (2016). Optimising Transition to Home Enteral Nutrition for Pediatric Patients. Nutrition in Clinical Practice. 2016. 31(6): 762-768

11 Gomez Lopez L G et al (2014). Home Enteral Nutrition. Diet and Nutrition in Critical Care. 22 November 2014: 1-14

12 NICE (2012). Nutrition Support in adults. Quality Standard QS24. Available at www.nice.org.uk/guidance/qs24

13 Chang S, Huang C, Lin C, Tu S, Chao M, Chen M (2015). The effects of systematic educational interventions about nasogastric tube feeding on caregivers' knowledge and skills and the incidence of feeding complications. Journal of Clinical Nursing, 2015. Vol: 24 (11-12); pp 1567-1575

14 Fogg L (2007). Home enteral feeding: Part 2: Current issues in community practice. British Journal of Community Nursing. 2007.12(7): 296-300

15 Greene H, Helinek G, Folk C, Courtney M,Thompson S, MacDonell R, Lukens J (1981). Nasogastric tube feeding at home: a method for adjunctive nutritional support of malnourished patients. The American journal of clinical nutrition. 1981. 34(6): 1131-8

16 Quilliot D, Zallot C, Malgras A, Germain A, Bresler L, Ayav A, Bigard M, Peyrin-Biroulet L, Ziegler O (2013). Self-Insertion of a Nasogastric Tube for Home Enteral Nutrition A Pilot Study. Journal of Parenteral and Enteral Nutrition. 2013. 38(7): 895-900

17 NHS Five-year forward view (2014). Available at: www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

18 Williams T (2016). Nasogastric tube feeding: a safe option for patients? British Journal of Community Nursing. 2016. 21 (Sup7): S28-S31

19 1Dinenage S, Gower M, Van Wyk J, Blamey A, Ashbolt K, Sutcliffe M, Green S (2015). Development and evaluation of a home enteral nutrition team. Nutrients 7(3): 1607-17

20 Elia M (on behalf of the Malnutrition Action Group of BAPEN and the NIHR Biomedical Research Centre (Nutrition) Southampton). The cost of malnutrition in England and the potential cost savings from nutritional interventions: BAPEN 2015

Page 21 – ORAL NUTRITIONAL SUPPLEMENTS IN NUTRITION SUPPORT

References

1 NICE Quality Standard [QS24]: Nutrition support in adults. www.nice.org.uk/guidance/qs24

2 The ‘Malnutrition Universal Screening Tool’ (‘MUST’) developed by the Malnutrition Advisory Group, a standing committee of BAPEN. www.bapen.org.uk/screening-and-must/must/introducing-must

3 The British Association for Parenteral and Enteral Nutrition (BAPEN). Oral Nutritional Supplements (ONS). www.bapen.org.uk/nutrition-support/nutrition-by-mouth/oral-nutritional-supplements

4 NHS England Guidance: Commissioning Excellent Nutrition and Hydration (2015-2018). www.england.nhs.uk/wp-content/uploads/2015/10/nut-hyd-guid.pdf

5 NICE Clinical Guidance CG32: Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition www.nice.org.uk/guidance/cg32/

6 NICE Clinical Guidance CG174: Intravenous fluid therapy in adults in hospital https://www.nice.org.uk/guidance/cg174

7 Based on Elia et al, Stratton et al (various publications). www.nutriciacongresses.com/congresses/presentation/62/new-evidence-on-the-costs-of-malnutrition-and-the-benefits-of-nutritional-support/

8 HM Stationery Office (1991). Dietary Reference Values for Food Energy and Nutrients for the United Kingdom: Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy

Page 28 - JUICES AND SMOOTHIES: WHAT ARE THE CURRENT TRENDS?

References

1 Wootton-Bear PC and Ryan L. A beetroot juice shot is a significant and convenient source of bio-accessible antioxidants. Journal of Functional Foods Volume 3, Issue 4. October 2011, Pages 329-334. www.sciencedirect.com/science/journal/17564646

2 Wootton-Bear PC, Moran A and Ryan L. Stability of the total antioxidant capacity and total polyphenol content of 23 commercially available vegetable juices before and after in vitro digestion measured by FRAP, DPPH, ABTS and Folin–Ciocalteu methods. Food Research International Volume 44, Issue 1 January 2011, Pages 217-224. www.sciencedirect.com/science/journal/09639969

3 Siervo M, Lara J, Ogbonmwan I, Mathers JC. Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: a systematic review and meta-analysis. J Nutr. 2013. Jun; 143(6): 818-26. doi: 10.3945/jn.112.170233. Epub 2013 Apr 17. www.ncbi.nlm.nih.gov/pubmed/23596162

4 Hoon MW, Johnson NA, Chapman PG, Burke LM. The effect of nitrate supplementation on exercise performance in healthy individuals: a systematic review and meta-analysis. Int J Sport Nutr Exerc Metab. 2013 Oct; 23 (5): 522-32. Epub 2013 Apr 9

5 Li L, Seeram NP. Further investigation into maple syrup yields three new lignans, a new phenylpropanoid and 26 other phytochemicals. J Agric Food Chem. 2011 Jul 27; 59(14): 7708-16. doi: 10.1021/jf2011613. Epub 2011 Jun 22

6 Wiese J, McPherson S, Odden MC, Shlipak MG. Effect of Opuntia ficus indica on symptoms of the alcohol hangover. Arch Intern Med. 2004; 164:1334-1340.

7 Tesoriere L, Allegra M, Butera D, Livrea MA. Absorption, excretion and distribution of dietary antioxidant betalains in LDLs: potential health effects of betalains in humans. Am J Clin Nutr. 2004 Oct; 80(4): 941-5

8 McMahon NF, Leveritt MD. The effect of dietary nitrate supplementation on endurance exercise performance in healthy adults: A systematic review and meta-analysis. Sports Med. 2016 Sep 6. [Epub ahead of print]

9 Figueroa A, Sanchez-Gonzalez MA, Perkins-Veazie PM, Arjmandi BH. Effects of watermelon supplementation on aortic blood pressure and wave reflection in individuals with prehypertension: a pilot study. Am J Hypertens. 2011 Jan; 24(1): 40-4. doi: 10.1038/ajh.2010.142. Epub 2010 Jul 8

10 Figueroa A, Wong A, Hooshmand S, Sanchez-Gonzalez MA. Effects of watermelon supplementation on arterial stiffness and wave reflection amplitude in postmenopausal women. Menopause. 2013 May; 20(5): 573-7. doi: 10.1097/GME.0b013e3182733794

Page 33 - PKU: EUROPEAN GUIDELINES - WHAT DO THEY MEAN FOR ADULTS?

Information sources

1 Van Spronsen et al (2017). Key European guidelines for the diagnosis and management of patients with phenylketonuria; Lancet Diabetes & Endocrinology Available online 10 January 2017

2 NSPKU (2014). Management of PKU: A consensus document for the diagnosis and management of children, adolescents and adults with phenylketonuria, 4th Edn Pub: NSPKU London ISBN 0953 5550 03

3 Medical Research Council Working Party on Phenylketonuria. Recommendations on the dietary management of phenylketonuria. Arch Dis Child, 1993, 68 426-7

www.nspku.org

Page 37 – THE USE OF GLYCOMACROPEPTIDE AS AN ALTERNATIVE PROTEIN SOURCE FOR PKU

References

1 Van Calcar et al. Improved nutritional management of phenylketonuria by using a diet containing glycomacropeptide compared with amino acids. Am J Clin Nutr 2009: 89; 1068-77

2 Ney DM et al. Advances in the nutritional and pharmacological management of phenylketonuria. Curr Opin Clin Nutr Metab 2014: 17(1); 61-8

3 LaClair et al. Purification and use of glycomacropeptide for nutritional management of phenylketonuria. J Food Sci 2009: 74 (4); E199-E206

4 Aguiar et al. Practices in prescribing protein substitutes for PKU in Europe: No uniformity of approach. Mol Genet Metab. 2015 May; 115(1): 17-22

5 Al Hafid N, Christodoulou J. Phenylketonuria: a review of current and future treatments. Transl Pediatr. 2015 Oct; 4(4): 304-17. 2224-4336

6 Brown CS, Lichter-Konecki U. Phenylketonuria (PKU): A problem solved? Mol Genet Metab Rep. 2015 Dec 29; 6:8-12

7 Clinical Paediatric Dietetics, 4th Edition. Edited by Vanessa Shaw. 2015. John Wiley and Sons Ltd

8 Mitchell JJ. Phenylalanine Hydroxylase Deficiency. 2000 Jan 10 [Updated 2013 Jan 31]. In: Pagon RA, Adam MP, Ardinger HH et al. Editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2016

9 O’Flynn ME, Holtzman NA, Blaskovics M et al. The diagnosis of phenylketonuria: a report from the Collaborative Study of Children Treated for Phenylketonuria. Am J Dis Child. 1980 Aug; 134(8): 769-74

10 Koch R, Burton B, Hoganson G et al. Phenylketonuria in adulthood: a collaborative study. J Inherit Metab Dis. 2002 Sep; 25(5): 333-46

11 Nardecchia F et al. Neurocognitive and neuroimaging outcome of early treated young adult PKU patients: A longitudinal study. Mol Genet Metab. 2015 Jun-Jul; 115(2-3): 84-90

12 MacDonald A, Godmen-Ozel H, Daly A. Changing dietary practices in phenylketonuria Turkish J of Ped 2009; 51: 409-15

13 MacDonald A. Diet and compliance in phenylketonuria. Eur J Ped 2000, 159 (suppl) S136-141

14 Macdonald A, Daly A, Davies P et al. Protein substitutes for PKU: what's new? J Inherit Metab Dis. 2004; 27(3): 363-71

15 MacDonald A et al. Abnormal feeding behaviours in phenylketonuria. J Hum Nutr Diet 1997; 10: 163-170

16 Schulz B and Bremer HJ. Nutrient intake and food consumption of adolescents and young adults with phenylketonuria. Acta Paediatrica 1995; 84: 743-8

17 Zaki et al. The use of glycomacropeptide in dietary management of phenylketonuria. J Nutr Metab; Epub 2016 May 30

18 Hennermann JB et al. Chronic kidney disease in adolescent and adult patients with phenylketonuria. J Inherit Metab Dis. 2013 Sep; 36(5): 747-56

19 Jehle S et al. Effect of potassium citrate on bone density, microarchitecture and fracture risk in healthy older adults without osteoporosis: a randomised controlled trial. J Clin Endocrinol Metab. 2013 Jan; 98(1): 207-17

20 De Groot MJ et al. Relationships between lumbar bone mineral density and biochemical parameters in phenylketonuria patients. Mol Genet Metab. 2012 Apr; 105(4): 566-70

21 Hansen KE and Ney D. A systematic review of bone mineral density and fractures in phenylketonuria. J Inherit Metab Dis 2014; 37(6): 875-80

22 Demirdas S et al. Bone health in phenylketonuria: a systematic review and meta-analysis. Orphanet Journal of Rare Diseases 2015; 10: 17

23 Solverson et al. Low bone strength is a manifestation of phenylketonuria in mice and is attenuated by a glycomacropeptide diet. PLoS ONE 7(9): e45165

24 Hermes et al. Casein glycomacropeptide in the diet may reduce Escherichia coli attachment to the intestinal mucosa and increase the intestinal lactobacilli of early weaned piglets after an enterotoxigenic E. coli K88 challenge. British Journal of Nutrition (2013), 109, 1001-1012

25 Sawin et al. Glycomacropeptide is a prebiotic that reduces Desulfovibrio bacteria, increases cecal short-chain fatty acids and is anti-inflammatory in mice. Am J Physiol Gastrointest Liver Physiol. 2015 Oct 1; 309(7): G590-601

26 Daly et al. Glycomacropeptide: can we safely advocate its use in children with PKU? J Inherit Metab Dis 2015; 38 (suppl 1): S39-40

27 Burrage et al. High prevalence of overweight and obesity in females with phenylketonuria. Mol Genet Metab. 2012 Sep; 107(1-2): 43-8

28 Robertson et al Body mass index in adult patients with diet-treated phenylketonuria. J Hum Nutr Diet. 2013 Jul; 26 Suppl 1: 1-6

29 Albersen et al. Whole body composition analysis by the BodPod air-displacement plethysmography method in children with phenylketonuria shows a higher body fat percentage. J Inherit Metab Dis (2010) 33 (Suppl 3): S283-S288

30 Rocha et al Dietary treatment in phenylketonuria does not lead to increased risk of obesity or metabolic syndrome. Mol Genet Metab. 2012 Dec; 107(4): 659-63

31 MacLeod et al. Breakfast with glycomacropeptide compared with amino acids suppresses plasma ghrelin levels in individuals with phenylketonuria. Met Genet Metab 2010; 100 (4): 303-8

32 Schulpis et al. Morning preprandial plasma ghrelin and catecholamine concentrations in patients with phenylketonuria and normal controls: evidence for catecholamine-mediated ghrelin regulation. J Clin Endo Metab 89(8); 3983-7

33 Strisciuglio P and Concolino D. New Strategies for the Treatment of Phenylketonuria (PKU) Metabolites 2014, 4, 1007-1017

34 Schindeler et al. The effects of large neutral amino acid supplements in PKU: an MRS and neuropsychological study. Mol Gen Metab 2007: 91; 48-54

35 Ney et al. Dietary glycomacropeptide supports growth and reduces the concentrations of phenylalanine in plasma and brain in a murine model of phenylketonuria. 2008. J Nutrition 138: 316-22

36 Sanjurjo P, Aldamiz L, Georgi G, et al. Dietary threonine reduces plasma phenylalanine levels in patients with hyperphenylalaninemia. J Pediatr Gastroenterol Nutr. 2003; 36:23-26.

37 MacDonald A, Daly A, Chahal S, Evans S. Impact of residual phenylalanine and large neutral amino acid profile of casein glycomacropeptide on metabolic control in children with PKU. Abstract at BIMDG 30 June - 1 July 2016

38 Daly A, Evans S, Chahal S, Santra S and MacDonald A (2017). Glycomacropeptide in children with phenylketonuria: does its phenylalanine content affect blood phenylalanine control? J Hum Nutr Diet. doi:10.1111/jhn.12438

Page 43 - ATHLETES AND ORAL HEALTH

References

1. Accessed online www.ucl.ac.uk/news/news-articles/1014/141014-athletes-oral-health. (8/3/2017)

2. Needleman I et al (2015). Oral health and impact of athletes participating in the London 2012 Olympic Games: a cross sectional study. British Journal of Sports Medicine; 49 (1): 3-6

3. Wolvius E et al (2017). Optimising oral health among Dutch elite athletes for Rio 2016. British Journal of Sports Medicine. Accessed online http://bjsm.bmj.com/content/51/4/410.2.short?rss=1 (8/3/2017)

4. British Dietetic Association. Thomas B, Manual of Dietetic Practice, 3rd edition. 2001. Blackwell Science, Oxford

5. Young E, Macias R and Stephens L (2015). Common dental injury management in athletes. Sports Health; 7 (3) pg 250-255

6. A Sheilham et al (2015). Diet and dental caries the pivotal role of the free sugars reemphasised. Journal of dental research; 94 (10) pg 1-7

7. A Sheilham et al (2015). The shape of the dose-response relationship between sugars and caries in adults. British Dental Journal; 219 (570) pg 167-72

8. Public Health England (2015). Accessed online at www.gov.uk/government/publications/sacn-carbohydrates-and-health-report (8/3/2017)

9. Government statistics: National Diet and Nutrition Survey: Headline Results from Years 1, 2 and 3 (combined) of the Rolling Programme 2008/09-2010/11. Accessed online at www.gov.uk/government/uploads/system/uploads/attachment_data/file/207707/ndns-y3-executive-summary_final.pdf (10/3/2017)

10. American Dental Association (2006). Using mouth guards to reduce the incidence and severity of sports-related oral injuries. Journal of American Dental Association; 137 (12) pg 1712-20

11. TAGB: Tae Kwon Do Association of Great Britain accessed online Safety equipment. www.tagb.biz/page.php?81 (10/3/2017)