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- All Subjects: Nutrition
- Creators: Sweazea, Karen
- Member of: Theses and Dissertations
Description
With the rising prevalence of obesity and diabetes, novel treatments to help mitigate or prevent symptoms of these conditions are warranted. Prior studies have shown that fossilized plant materials found in soil lowers blood sugar in a mouse model of diabetes. The goal of this study is to determine whether a similar organometallic complex (OMC) could prevent insulin resistance in the skeletal muscle brought on by chronic high fat intake by examining the protein expression of key enzymes in the insulin signaling pathway and examining glucoregulatory measures. Six-week-old periadolescent male Sprague-Dawley rats (n=42) were randomly chosen to be fed either a high fat diet (HFD) (20% protein, 20% carbohydrates [6.8% sucrose], 60% fat) or a standard chow diet (18.9% protein, 57.33% carbohydrates, 5% fat) for 10 weeks. Rats from each diet group were then randomly assigned to one of three doses of OMC (0, 0.6, 3.0 mg/mL), which was added to their drinking water and fasting blood glucose was measured at baseline and again at 10 weeks. After 10 weeks, rats were euthanized, and soleus muscle samples were isolated, snap-frozen, and stored at -80°C until analyses. Fasting plasma glucose was measured using a commercially available glucose oxidase kit. Following 6 and 10 weeks, HFD rats developed significant hyperglycemia (p<0.001 and p=0.025) compared to chow controls which was prevented by high dose OMC (p=0.021). After 10 weeks, there were significant differences in fasting serum insulin between diets (p=0.009) where levels were higher in HFD rats. No significant difference was seen in p-PI3K expression between groups. These results suggest that OMC could prevent insulin resistance by reducing hyperglycemia. Further studies are needed to characterize the effects of diet and OMC on the insulin signaling pathway in skeletal muscle, the main site of postprandial glucose disposal. This study was supported by a grant from Isagenix International LLC as well as funds from Barrett, the Honors College at Arizona State University, Tempe Campus.
ContributorsStarr, Ashlee (Author) / Sweazea, Karen (Thesis director) / Johnston, Carol (Committee member) / Hyatt, JP (Committee member) / Sanford School of Social and Family Dynamics (Contributor) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2018-12
Description
In my creative project, I decided to shadow a naturopathic doctor to experience what the process of naturopathic treatment entails. I conducted interviews with patients and Dr. Raisanen to explore their backgrounds and motivations, and read studies he recommended that explained some of the science behind his methods of treatment, such as fasting, dietary adjustment (a plant based diet), sodium and saturated/trans fats reduction, caffeine reduction, exercise, stress modulation, supplements, and sleep adjustments. I wrote small expositional summaries on these studies. I also took measurements recorded by Dr. Raisanen through the course of treatments with different patients to produce visuals of changes in body composition. I finally produced a small handout with Dr. Raisanen's help that summarized on a page the basics of lifestyle changes that a naturopathic doctor would want a patient to undertake.
ContributorsSkoog, David Alexander (Author) / Alexon, Christy (Thesis director) / Raisanen, Peter (Committee member) / Department of Finance (Contributor) / Department of Management and Entrepreneurship (Contributor) / Department of Supply Chain Management (Contributor) / Barrett, The Honors College (Contributor)
Created2018-12
Description
Birds have shown promise as models of diabetes due to health and longevity despite naturally high plasma glucose concentrations, a condition which in diabetic humans leads to protein glycation and various complications. Research into mechanisms that protect birds from high plasma glucose have shown that some species of birds have naturally low levels of protein glycation. Some hypothesize a diet rich in carotenoids and other antioxidants protects birds from protein glycation and oxidative damage. There is little research, however, into the amount of protein glycation in birds of prey, which consume a high protein, high fat diet. No studies have examined the potential link between the diet of carnivorous birds and protein glycation. The overall purpose of this study was to evaluate whether birds of prey have higher protein glycation given their high protein, high fat diet in comparison to chickens, which consume a diet higher in carbohydrates. This was accomplished through analyses of serum samples from select birds of prey (bald eagle, red-tailed hawk, barred owl, great horned owl). Serum samples were obtained from The Raptor Center at the University of Minnesota where the birds of prey consumed high protein, high fat, non-supplemented diets that consisted of small animals and very little to no carbohydrate. Serum was also obtained from one chicken for a control, which consumed a higher carbohydrate and antioxidant-rich diet. Glucose, native albumin glycation and antioxidant concentrations (uric acid, vitamin E, retinol and several carotenoids) of each sample was measured. Statistical analyses showed significant between group differences in percent protein glycation amongst the birds of prey species. Glycation was significantly higher (p < 0.001) in bald eagles (23.67 ± 1.90%) and barred owls (24.28 ± 1.43%) compared to red-tailed hawks (14.31 ± 0.63%). Percent glycation was higher in all birds of prey compared to the chicken sample and literature values for chicken albumin glycation. Levels of the carotenoid lutein were significantly higher in bald eagles and barred owls compared to great horned owls and red-tailed hawks and the carotenoids beta-cryptoxanthin and beta-carotene were significantly greater in bald eagles compared to red-tailed hawks and great horned owls.
ContributorsIngram, Tana (Author) / Sweazea, Karen (Thesis advisor) / Johnston, Carol (Committee member) / Lespron, Christy (Committee member) / Arizona State University (Publisher)
Created2017
Description
Background. Despite research aimed at understanding the mechanisms of essential hypertension, instances of this condition continue to rise. Recent findings indicate that the administration of dietary nitrates, in the form of beetroot juice and other nitrate-rich vegetables, may offer anti-hypertensive effects in various study populations.
Objective. This randomized, placebo-controlled, crossover trial sought to compare the effects of high-nitrate vegetable salads to the effects of low-nitrate canned vegetables on plasma nitrate
itrite concentration, peripheral and central-aortic systolic and diastolic blood pressures, pulse wave velocity, and flow-mediated dilation.
Methods. Healthy, post-menopausal women (n=5; 80% Caucasian; 52.6 ± 5.7 years) with mildly elevated blood pressure (mean blood pressure ≥ 115/70 mm Hg and < 140/80 mm Hg) were randomly assigned to ingest a fresh, high-nitrate vegetable salad or a low-nitrate vegetable medley, twice per day, for a total of 10 consecutive days. Given the crossover design of the trial, participants observed a two to three week washout period followed by reassignment to the opposite condition. Findings were considered significant at a p-value < 0.05, and Wilcoxon Signed-Rank tests compared mean differences between conditions.
Results. Plasma nitrate
itrite concentration was significantly higher following consumption of the high-nitrate versus the low-nitrate condition (p = 0.043). Conversely, the differences in peripheral systolic and diastolic blood pressures were not statistically significant (p = 0.345 and p = 0.684 for systolic and diastolic pressures, respectively) nor were the differences in central-aortic systolic and diastolic blood pressures statistically significant (p = 0.225 and p = 0.465 for systolic and diastolic pressures, respectively). Similarly, when comparing the effects of the high-nitrate condition to the low-nitrate condition, the difference in pulse wave velocity was not statistically significant (p = 0.465). Finally, flow-mediated dilation tended to improve following consumption of the high nitrate condition (p = 0.080).
Conclusion. Twice daily consumption of a fresh, high-nitrate vegetable salad significantly increased plasma nitrate
itrite concentration. Although the trial was underpowered, there was a trend for improved flow-mediated dilation. Finally, twice daily consumption of a fresh, high-nitrate vegetable salad did not significantly lower peripheral or central-aortic systolic or diastolic blood pressures or pulse wave velocity.
Objective. This randomized, placebo-controlled, crossover trial sought to compare the effects of high-nitrate vegetable salads to the effects of low-nitrate canned vegetables on plasma nitrate
itrite concentration, peripheral and central-aortic systolic and diastolic blood pressures, pulse wave velocity, and flow-mediated dilation.
Methods. Healthy, post-menopausal women (n=5; 80% Caucasian; 52.6 ± 5.7 years) with mildly elevated blood pressure (mean blood pressure ≥ 115/70 mm Hg and < 140/80 mm Hg) were randomly assigned to ingest a fresh, high-nitrate vegetable salad or a low-nitrate vegetable medley, twice per day, for a total of 10 consecutive days. Given the crossover design of the trial, participants observed a two to three week washout period followed by reassignment to the opposite condition. Findings were considered significant at a p-value < 0.05, and Wilcoxon Signed-Rank tests compared mean differences between conditions.
Results. Plasma nitrate
itrite concentration was significantly higher following consumption of the high-nitrate versus the low-nitrate condition (p = 0.043). Conversely, the differences in peripheral systolic and diastolic blood pressures were not statistically significant (p = 0.345 and p = 0.684 for systolic and diastolic pressures, respectively) nor were the differences in central-aortic systolic and diastolic blood pressures statistically significant (p = 0.225 and p = 0.465 for systolic and diastolic pressures, respectively). Similarly, when comparing the effects of the high-nitrate condition to the low-nitrate condition, the difference in pulse wave velocity was not statistically significant (p = 0.465). Finally, flow-mediated dilation tended to improve following consumption of the high nitrate condition (p = 0.080).
Conclusion. Twice daily consumption of a fresh, high-nitrate vegetable salad significantly increased plasma nitrate
itrite concentration. Although the trial was underpowered, there was a trend for improved flow-mediated dilation. Finally, twice daily consumption of a fresh, high-nitrate vegetable salad did not significantly lower peripheral or central-aortic systolic or diastolic blood pressures or pulse wave velocity.
ContributorsMayra, Selicia (Author) / Sweazea, Karen (Thesis advisor) / Johnston, Carol (Committee member) / Mayol-Kreiser, Sandra (Committee member) / Arizona State University (Publisher)
Created2017
Description
Cardiovascular disease is the leading cause of death in the world, responsible for 17.3 million deaths annually. Aerobic activity and almond ingestion have a cardio-protective effect against cardiovascular disease, however, the synergistic effect of both interventions is not known. This 8-week randomized, parallel, two-arm study examined the combined effect of daily almond ingestion (2.5 ounces) and brisk walking (10,000 steps per day) compared to ingestion of an isocaloric placebo (4 Tbsp cookie butter) and brisk walking (10,000 steps per day) in sedentary adults on various markers of cardiovascular health. The additive effect of the daily walking intervention with almond consumption resulted in significant differences in total cholesterol with a -11.0 ± 10.5 and +3.3 ± 15.8 mg/dL (p=0.043) change in the ALM and CON group respectively and LDL with a -11.5 ± 7.5 and +0.5 ± 13.7 mg/dL (p=0.025) change in the ALM and CON group respectively. There was a trend for TBARS to decrease in the ALM group versus the CON group (-0.2 ± 0.8 and +0.3 ± 0.6 nmol MDA/mL (p=0.099) respectively) with a large effect size of 0.304 but this did not reach statistical significance. There were no significant differences seen in markers of other plasma lipid profile measures, plasma inflammatory cytokines, or blood pressure regulation. Results suggest that the simple, cost-effective, and accessible intervention of daily brisk walking and almond consumption is an effective strategy to reduce cardiovascular disease risk in sedentary adults through improvements in cholesterol. This represents a pilot study due to the small sample size, therefore, additional studies are needed to determine the impact and mechanisms of this synergistic effect.
ContributorsSchwab, Emily (Author) / Sweazea, Karen (Thesis advisor) / Johnston, Carol (Committee member) / Lespron, Christy (Committee member) / Arizona State University (Publisher)
Created2017
Description
The transition to college has been identified as a vulnerable period for weight gain and the onset of obesity. Research has shown that the gut microbiota is different in obese compared to lean individuals, but a period of weight gain has never been studied in free-living individuals. The objective of this longitudinal, observational study was to assess the association between changes in the intestinal microbiota and weight-related outcomes in healthy college students living in on-campus dormitories at Arizona State University (n=39). Anthropometric measures and fecal samples were collected at the beginning and end of the school year, and microbial relative abundance for A. muciniphila, F. prausnitzii, R. gnavus, and L. acidophilus was measured through qPCR analyses. In this population, body mass index (BMI) and waist circumference (WC) increased by 0.97 ± 1.28 kg/m2 and 2.64 ± 4.90 cm, respectively. Wilcoxon-Rank tests revealed that R. gnavus fold change was significantly different between groups of weight loss/maintenance and weight gain ≥ 5% body weight (0.14 [-0.21, 0.64], n=24 vs. -0.14 [-0.92, 0.05], n=15, respectively; p=0.028). Correlation analyses suggested a significant negative association between A. muciniphila fold change and both % WC change and % BMI change (r= -0.66; p<0.01 and r= -0.33; p=0.04, respectively). However, multivariate regression analysis controlling for sex and race/ethnicity showed a significant association between A. muciniphila and % WC change, but not % BMI change (R2= 0.53; p<0.01 and R2= 0.24; p=0.15). F. prausnitzii was not associated with weight-related outcomes in this sample. L. acidophilus was excluded from study analyses after subsequent qPCR trials revealed no amplification in participant samples. Overall, this was the first study to show a relationship between A. muciniphila fold change and weight-related outcomes over a period of weight gain. Specifically, A. muciniphila was strongly negatively associated with WC in this sample. Further research is needed to more accurately describe these associations and potential mechanisms associated with the shift in gut microbiota observed with weight gain. Findings from future research may be used to develop interventions for college students aiming to shift the gut microbiota to prevent weight gain.
ContributorsJourney, Elizabeth (Author) / Whisner, Corrie M (Thesis advisor) / Bruening, Meredith (Committee member) / Sweazea, Karen (Committee member) / Arizona State University (Publisher)
Created2017
Description
Background Hemodialysis (HD) patients elicit an oxidant-antioxidant imbalance in addition to a selenium deficiency, possibly contributing to cardiovascular disease (CVD) mortality. Objective To evaluate the effect of selenium supplementation on CVD outcomes and antioxidant status in HD patients. Design A randomized controlled intervention trial conducted from October 2012 to January 2013. Participants/setting The study included 27 maintenance HD patients (61.1+17.5y, 14M, 13F) receiving HD in the greater Phoenix, AZ area. Intervention Patients received one of three treatments daily: 2 Brazil nuts, (5g, 181µg/day of selenium as selenomethionine [predicted]), 1 tablet of selenium (200µg/day of selenium as selenomethionine), or control (3 gummy bears). Main outcome measures Antioxidant status outcome measures included total antioxidant capacity, vitamin C, and RBC and plasma glutathione peroxidase (GSH-Px). CVD outcomes measures included brain natriuretic peptide; plasma cholesterol, high density lipoprotein, low density lipoprotein, triglycerides; blood pressure, and thoracic cavity fluid accumulation. Statistical analyses performed Repeated measures ANOVA analyzed changes over time and between groups at months 0 and 2 and months 0 and 3. Results Independent analysis showed the Brazil nuts provided 11µg of selenium/day and the pill provided 266µg of selenium/day. Consequently, the Brazil nut group was combined with the placebo group. 21 patients completed 2 months of the study and 17 patients completed the study in its entirety. Data was analyzed for months 0, 1 and 2. No significant differences were noted for antioxidant status outcome measures with the exception of plasma GSH-Px. Patients receiving the selenium pill had a significant increase in plasma GSH-Px compared to the placebo group (6.0+11 and -4.0+7.6, respectively, p=0.023 for change between month 0 and month 2). No significant differences were seen in total antioxidant capacity or for CVD outcome measures over time or between groups. Conclusions These data indicate that selenium supplementation increased plasma GSH-Px concentration in HD patients; however, oxidative stress was not altered by selenium supplementation. The low vitamin C status of HD patients warrants further research, specifically in conjunction with selenium supplementation.
ContributorsSussman, Elizabeth Jessica (Author) / Johnston, Carol S (Thesis advisor) / Boren, Kenneth (Committee member) / Mayol-Kreiser, Sandra (Committee member) / Sweazea, Karen (Committee member) / Vaughan, Linda (Committee member) / Arizona State University (Publisher)
Created2013
Description
Cardiovascular disease (CVD) is characterized by impaired vasodilation and the development of atherosclerosis.78 A diet high in saturated fat, such as palmitate, contributes to this by promoting inflammation and oxidative stress in human vascular smooth muscle cells (VSMC). 11,12,84,88 The inflammation cascade that occurs increases pro-inflammatory cytokines, like tumor necrosis factor alpha (TNF-alpha) and increases proinflammatory enzymes like cyclooxygenase 2 (COX-2) contributing to inflammation, oxidative stress, blood pressure shifts, and atherosclerosis.11,12,69,84 Palmitate has been found to upregulate TNF-alpha,85 and COX-2. 11,12, 84
In various studies, sumac, a Mediterranean spice and known antioxidant,39,7,66,67 has been shown to have antioxidant properties through its ability to inhibit reactive oxygen species (ROS) such as superoxide.39,7,66,67 Sumac has also been found to reduce TNF-alpha.100 Results from a study of hypertensive human subjects fed a sumac supplement showed a decrease in blood pressure.59
In the current study, COX-2 levels were determined to evaluate the level of inflammation in response to palmitate when primary aortic human vascular smooth muscle cells (HAoVSM) were treated with sumac. The treatments included: vehicle (bovine serum albumin), 100 µM palmitate, and 10, 20, 40, 60, and 80 µg/mL sumac. Sumac did not alter COX-2 protein levels between vehicle and sumac groups. Additional studies were designed to examine whether 80 µg/mL sumac could reverse impaired vasodilation caused by 10 weeks of high fat intake, consisting of 60% of total calories from fat, in Sprague-Dawley rats. Mesenteric arteries were isolated and exposed to sumac. High fat diet (HFD) arteries had impaired vasodilation compared to arteries from chow-fed fats. HFD arteries exposed to sumac had similar endothelium-dependent vasodilation responses as those not exposed to sumac, however, there were trends for improved vasodilation. I suggest that sumac likely exhibits antioxidant capabilities that prevent superoxide from decreasing the bioavailability of nitric oxide in the vasculature, thus promoting endothelium-dependent vasodilation and preventing the creation of more harmful reactive oxygen species. Isolated arteries from chow fed rats developed irreversible vasodilation when exposed to sumac and were therefore not responsive to pre-constriction with phenylephrine (PE) likely related to nitrates and gallic acid naturally present in sumac whereby inhibiting PE.
In various studies, sumac, a Mediterranean spice and known antioxidant,39,7,66,67 has been shown to have antioxidant properties through its ability to inhibit reactive oxygen species (ROS) such as superoxide.39,7,66,67 Sumac has also been found to reduce TNF-alpha.100 Results from a study of hypertensive human subjects fed a sumac supplement showed a decrease in blood pressure.59
In the current study, COX-2 levels were determined to evaluate the level of inflammation in response to palmitate when primary aortic human vascular smooth muscle cells (HAoVSM) were treated with sumac. The treatments included: vehicle (bovine serum albumin), 100 µM palmitate, and 10, 20, 40, 60, and 80 µg/mL sumac. Sumac did not alter COX-2 protein levels between vehicle and sumac groups. Additional studies were designed to examine whether 80 µg/mL sumac could reverse impaired vasodilation caused by 10 weeks of high fat intake, consisting of 60% of total calories from fat, in Sprague-Dawley rats. Mesenteric arteries were isolated and exposed to sumac. High fat diet (HFD) arteries had impaired vasodilation compared to arteries from chow-fed fats. HFD arteries exposed to sumac had similar endothelium-dependent vasodilation responses as those not exposed to sumac, however, there were trends for improved vasodilation. I suggest that sumac likely exhibits antioxidant capabilities that prevent superoxide from decreasing the bioavailability of nitric oxide in the vasculature, thus promoting endothelium-dependent vasodilation and preventing the creation of more harmful reactive oxygen species. Isolated arteries from chow fed rats developed irreversible vasodilation when exposed to sumac and were therefore not responsive to pre-constriction with phenylephrine (PE) likely related to nitrates and gallic acid naturally present in sumac whereby inhibiting PE.
ContributorsBarberes, Julia (Author) / Sweazea, Karen (Thesis advisor) / Gonzales, Rayna (Committee member) / Alexon, Christy (Committee member) / Arizona State University (Publisher)
Created2018
Description
This feasibility study explored the use of an evolutionary mismatch narrative in nutritional education intervention aiming to reduce ultra-processed foods in the diets of veterans with type 2 diabetes and improve diabetic outcomes. Ultra-processed foods are foods that are primarily manufactured through industrial processes. These foods are high in calories but low in nutritional content. Diets high in these foods have been linked to increased health risks. One of the major health risks is type 2 diabetes. Type 2 diabetes is a chronic disease that is developed when cells become unable to properly utilize insulin. Over time this may lead to additional health conditions such as nerve damage, cardiovascular disease, and renal disease. Evolutionary mismatch narrative nutritional intervention offers a different approach to nutritional education to help reduce ultra-processed foods in diets. This study was a randomized controlled feasibility study at the Phoenix VA. Eleven participants were enrolled and randomly selected to be given either an evolutionary mismatch narrative education intervention or general nutritional education about ultra-processed foods. 24-hour diet recalls and blood chemistry were collected and analyzed. Blood chemistry provided diabetes related measurements which included glucose, HbA1c, insulin, HOMA-IR, and C-reactive protein. Statistically significant findings in this study included percentage of ultra-processed foods decreasing for both control and experimental groups from week 0 to week 4 (p=0.014), and C-reactive protein levels between the control and experimental groups (p=0.042). However, baseline C-reactive protein concentrations were lower in the experimental group such that normalizing for group differences at baseline revealed no significant difference in C-reactive protein change between interventions (p = 1.000). There were no other statistically significant values regarding diabetes related measurements. The results from this study suggest that nutritional education in general may help decrease ultra-processed food consumption.
ContributorsLiang, Nathan Adam (Author) / Sweazea, Karen (Thesis advisor) / Basile, Anthony J (Committee member) / Johnston, Carol (Committee member) / Arizona State University (Publisher)
Created2023
Description
Background. Despite extensive research in the literature aimed at understanding the role of hypertension as a major risk factor for numerous leading causes of death in the United
States, rates of this disease continue to rise. Recent findings suggest that antiseptic mouthwash use may increase blood pressure through elimination of oral bacteria that facilitate the enterosalivary nitrate-nitrite-nitric oxide pathway.
Objective. The purpose of this randomized, controlled, crossover trial was to examine the effects of antiseptic mouthwash use and sodium intake on blood pressure and salivary nitrate levels in prehypertensive adults.
Methods. Healthy adults (n=10; 47.3±12.5) with mildly elevated blood pressure (average baseline blood pressure of 114.9/75.2 mmHg) were recruited and were randomly assigned to a control condition, antiseptic mouthwash use, or antiseptic mouthwash use + consumption of three pickles per day (~6000 mg/day of sodium) for a total of 7 days. Given the crossover design of this study, participants adhered to a 1-week washout period between each condition and all participants received all three treatments. Findings were considered significant at a p-value of <0.05 and a repeated measures ANOVA test was used to compare change data of each condition.
Results. Changes in systolic and diastolic blood pressure were not statistically significant (p=0.469 and p=0.859, respectively). Changes in salivary nitrite levels were not statistically significant (p=0.493). Although there appeared to be fluctuations in sodium intake between interventions, differences in sodium intake were not statistically significant when pickles were not accounted for (p=0.057).
Conclusion. Antiseptic mouthwash use did not appear to induce significant changes in systolic or diastolic blood pressure in this population.
States, rates of this disease continue to rise. Recent findings suggest that antiseptic mouthwash use may increase blood pressure through elimination of oral bacteria that facilitate the enterosalivary nitrate-nitrite-nitric oxide pathway.
Objective. The purpose of this randomized, controlled, crossover trial was to examine the effects of antiseptic mouthwash use and sodium intake on blood pressure and salivary nitrate levels in prehypertensive adults.
Methods. Healthy adults (n=10; 47.3±12.5) with mildly elevated blood pressure (average baseline blood pressure of 114.9/75.2 mmHg) were recruited and were randomly assigned to a control condition, antiseptic mouthwash use, or antiseptic mouthwash use + consumption of three pickles per day (~6000 mg/day of sodium) for a total of 7 days. Given the crossover design of this study, participants adhered to a 1-week washout period between each condition and all participants received all three treatments. Findings were considered significant at a p-value of <0.05 and a repeated measures ANOVA test was used to compare change data of each condition.
Results. Changes in systolic and diastolic blood pressure were not statistically significant (p=0.469 and p=0.859, respectively). Changes in salivary nitrite levels were not statistically significant (p=0.493). Although there appeared to be fluctuations in sodium intake between interventions, differences in sodium intake were not statistically significant when pickles were not accounted for (p=0.057).
Conclusion. Antiseptic mouthwash use did not appear to induce significant changes in systolic or diastolic blood pressure in this population.
ContributorsShaw, Karrol (Author) / Johnston, Carol (Thesis advisor) / Alexon, Christy (Committee member) / Sweazea, Karen (Committee member) / Arizona State University (Publisher)
Created2019