The Journal of Nutrition
Supplement: Filling America’s Fiber Gap—Probing Realistic Solutions
Filling America’s Fiber Intake Gap: Summary of
a Roundtable to Probe Realistic Solutions with a
Focus on Grain-Based Foods1,2
Roger Clemens,3* Sibylle Kranz,4Amy R. Mobley,5Theresa A. Nicklas,6Mary Pat Raimondi,7
Judith C. Rodriguez,8Joanne L. Slavin,9and Hope Warshaw10
3Department of Pharmacy, University of Southern California, Los Angeles, CA;4Department of Nutrition Science, Purdue University,
West Lafayette, IN;5Department of Nutritional Sciences, University of Connecticut, Storrs, CT;6Baylor College of Medicine, USDA/ARS
Children’s Nutrition Research Center, Houston, TX;7Academy of Nutrition and Dietetics (formerly American Dietetic Association),
Chicago, IL;8Department of Nutrition and Dietetics, University of North Florida, Jacksonville, FL;9Department of Food Science and
Nutrition, University of Minnesota, St. Paul, MN; and10Hope Warshaw Associates, LLC, Alexandria, VA
Current fiber intakes are alarmingly low, with long-term implications for public health related to risk of coronary heart
disease, stroke, hypertension, certain gastrointestinal disorders, obesity, and the continuum of metabolic dysfunctions
including prediabetes and type 2 diabetes. Eating patterns high in certain fibers are known to lower LDL cholesterol and
blood pressure, lower blood glucose, and decrease insulin resistance in people with prediabetes and type 2 diabetes; help
with both weight loss and maintenance; and improve bowel regularity and gastrointestinal health. With .90% of adults
and children who fall short of meeting their daily fiber recommendations, the 2010 Dietary Guidelines for Americans once
again classifiedfiber as a nutrientof concern.Despite efforts overthe pastdecadeto promote adequate fiber throughfruit,
vegetable, and whole-grain intakes, fiber consumption has remained flat at approximately half the daily recommended
amount. The public health implications of inadequate fiber intake prompted the roundtable session “Filling America’s Fiber
Gap: Probing Realistic Solutions,” which assembled nutrition researchers, educators, and communicators to identify
challenges, opportunities, and realistic solutions to help fill the current fiber gap. The roundtable discussions highlighted
the need for both consumer and professional education to improve acceptance for and inclusion of grain-based foods with
added fiber as one strategy for increasing fiber intakes within daily energy goals. J. Nutr. 142: 1390S–1401S, 2012.
meeting recommended intakes (1). It is recognized that the
development of many risk factors associated with highly
prevalent chronic diseases could be reduced by increasing
consumption of fiber (2). Evidence suggests that fiber plays a
critical role in reducing the risk of cardiovascular disease,
obesity, and prediabetes and type 2 diabetes and is essential for
optimal digestive health. Fiber was identified as an “under-
consumed nutrient of public health concern” by the 2010
Dietary Guidelines Advisory Committee (2). This statement was
based on mean intakes well below Adequate Intake (AI)11levels,
coupled with fiber’s established role in risk reduction of
coronary heart disease and its emerging role in contributing to
satiety and weight control (2).
With support from unrestricted educational funding from the
Kellogg Company, a group of leading nutrition researchers,
educators, and communicators, with expertise in fiber research,
food technology, and consumer and professional education,
convened on October 27, 2011, for a roundtable discussion
entitled “Filling America’s Fiber Gap: Probing Realistic Solu-
tions.” Objectives of the roundtable included identifying chal-
1Published in a supplement to The Journal of Nutrition. Published as a synopsis
of participants’ views and perspectives at the roundtable meeting “Filling
America’s Fiber Gap: Probing Realistic Solutions,” held in Chicago Illinois,
October 27, 2011.The meeting was sponsored by Kellogg Company. The
coordinator for this supplement is Betsy Hornick. Supplement Coordinator
disclosures: Betsy Hornick is supported by funds from the Kellogg Company, and
is a nutrition writer and consultant for FoodMinds, LLC, a food and nutrition
affairs company that represents the Kellogg Company. The supplement is the
responsibility of the Guest Editor to whom the Editor of The Journal of Nutrition
has delegated supervision of both technical conformity to the published
regulations of The Journal of Nutrition and general oversight of the scientific
merit of each article. The Guest Editor for this supplement is A. Catharine Ross.
Guest Editor disclosure: A. Catharine Ross has no conflicts to report. Publication
costs for this supplement were defrayed in part by the payment of page charges.
This publication must therefore be hereby marked “advertisement” in accordance
publication are those of the authors and are not attributable to the sponsors or the
publisher, Editor, or Editorial Board of The Journal of Nutrition.
2Authors disclosures: R. Clemens, S. Kranz, A. R. Mobley, T. A. Nicklas, M. P.
Raimondi, J. C. Rodriguez, J. L. Slavin, and H. Warshaw, no conflicts of interest.
All authors received an honorarium for their participation in the roundtable.
* To whom correspondence should be addressed. E-mail: email@example.com.
11Abbreviations used: AI, Adequate Intake; DGA, Dietary Guidelines for
Americans; IOM, Institute of Medicine; RD, registered dietitian.
ã 2012 American Society for Nutrition.
First published online May 30, 2012; doi:10.3945/jn.112.160176.
at PURDUE UNIVERSITY on February 24, 2014
lenges and realistic solutions for translating current fiber guidance
into practical advice for obtaining fiber from a variety of
sources, both whole and enriched, to help Americans better meet
their daily fiber recommendations within their energy needs. The
meeting included brief presentations by the participants, with a
focus on their areas of expertise related to the public health
concern about low fiber intakes, followed by discussions of the
challenges of adhering to current dietary guidance, and oppor-
tunities for filling the fiber intake gap. Consideration of the
effects on energy intake was also a focus because of the emphasis
on energy balance in the 2010 Dietary Guidelines for Americans
The roundtable experts agreed that all fiber-containing foods,
including fruit, vegetables, legumes, and whole grains, should
play a role in helping Americans meet their daily fiber needs.
With evidence that fiber intake is closely linked to energy intake,
there was recognition of the challenges of increasing fiber while
attempting to reduce energy intake, as is the goal for many who
are overweight (4). This prompted the need to focus solutions on
immediate and realistic small-step changes that could be
implemented within current eating patterns. Considering that
nearly all Americans fall short of meeting their fiber needs, yet
meet or exceed their daily recommendations for grain foods (5),
the roundtable discussions centered on opportunities to improve
the fiber content of grain-based food choices as a strategy with
an immediate potential for increasing fiber intakes without
exceeding energy goals. This article summarizes the roundtable
proceedings and call-to-action, focusing on realistic and energy-
neutral (minimal or no effect on energy intake) solutions to help
increase fiber intakes among Americans.
Fiber is generally recognized as the carbohydrates and lignin
that escape digestion in the upper gastrointestinal tract, undergo
complete or partial fermentation in the colon, and exert varying
beneficial physiologic effects depending on the type of fiber (6).
The roundtable participants acknowledged the fact that a
universally accepted definition for fiber does not exist, wherein
lies the confusion in what can be designated as “fiber.” With this
understanding, the participants agreed to use the Institute of
Medicine’s (IOM’s) definition for total fiber in their discussions,
which differentiates between dietary (naturally occurring) and
functional (isolated) fibers, because the IOM is an authoritative
source for science-based dietary standards and recommenda-
tions in the United States (7). However, the participants also
recognized that the American Association of Cereal Chemists
and, most recently, the Codex Alimentarius Commission include
in their definitions of dietary fiber the naturally occurring plant
fibers in addition to analogous carbohydrates, such as fibers
obtained from food by physical, enzymatic, or chemical means,
and synthetic fibers (Table 1) (8,9). The roundtable participants
agreed on definitions of various nutrition- and fiber-related
terminology used in the discussions (Table 2).
Today’s Inadequate Fiber Intake: “A Public
Health Concern for All Americans”
Fiber was first identified as a “nutrient of concern” for
Americans in the 2005 DGA, and this categorization was
reaffirmed in 2010 (3,12). Mean intakes of fiber range from 10
to 18 g/d for individuals aged 2 y (Fig. 1), indicating that most
Americans need to double their consumption to meet the IOM
fiber recommendation of 19–38 g/d (7,13). This translates to
$90% of adults and children with fiber intakes below the daily
recommended amount (14).
The AI for fiber is 14 g/1000 kcal, an amount associated with
reducing the risk of cardiovascular disease (7). The AI is based
on total daily fiber intake and does not differentiate between the
IOM designations of “dietary” (intrinsic, or naturally occurring)
and “functional” (added, or isolated) fiber (7). Other beneficial
physiologic effects of sufficient intake of differing types of fiber
include healthy laxation, normalization of total and LDL
cholesterol, reduction in blood glucose and insulin levels, and
protection against weight gain through its effects on satiety
(6,15,16). In children, increased fiber intake has been found to
be associated with better diet quality, which in turn is associated
with lower risk for overweight or obesity (17,18).
At a time when two-thirds of American adults and 1 in 3
children are overweight or obese (19,20), and many are also
undernourished despite excess energy intake, energy balance is a
critical consideration (3). Current dietary guidance directs con-
sumers to increase intakes of nutrient-dense and fiber-containing
foods, yet emphasizes maintaining energy balance over time to
achieve and sustain a healthy weight (3). This poses a key
challenge in modifying current eating patterns to meet overall
nutrient needs without exceeding energy goals. To meet daily
fiber needs, the 2010 DGA recommend increased consumption
of cooked dry beans and peas, other vegetables, fruit, whole
grains, and other foods with naturally occurring fiber (3). On
the basis of USDA nutrient profiles for food groups (Table 3),
recommended intakes of vegetables and fruit will provide
;63% of the daily fiber goal for a 2000-kcal intake, whereas
recommended intakes of grains will provide ;36% of daily
fiber, with whole-grain choices accounting for the majority of
the grain group’s fiber at ;28% of the daily fiber goal (21).
Fruit and vegetable intakes. Current consumption of fruit and
vegetables is well below recommended intakes. According to the
CDC, 40% of people nationwide consume fruit and vegetables
#2 times/d (22). The typical American meets only 42% and
59% of his or her fruit and vegetable goals (3), respectively, and
the vast majority of Americans aged $2 y have usual intakes
below recommended amounts of fruit (80%) and vegetables
Whole-grain intakes. Among the plant-based foods recom-
mended to increase fiber intake, whole grains are recognized and
promoted in the 2010 DGA as a food to increase as part of a
dietary pattern that meets daily fiber goals. In addition to
contributing to fiber intake, whole-grain consumption is asso-
ciated with improved diet quality and nutrient intake in both
children and adults (24,25). The typical American eating pattern
meets only 15% of the whole-grain goal, or ,28 g (1 oz) of the
recommended 85 g (3-oz equivalents)/d (3). More than 99% of
Americans (aged 2 y) are not consuming recommended amounts
of whole grains, yet nearly two-thirds meet daily intake goals for
total amount of grains, including refined grains (23). In fact,
mean daily intakes of total grains of 181 g (6.4 oz) are slightly
above the recommended amount of 170 g (6 oz)/d for a 2000-
kcal diet, whereas whole-grain intakes are 17 g (0.6 oz)/d
compared with the recommended amount of $85 g (3 oz)/d, or
one-half of total grain intake (5).
A focus on grain-based foods. The amounts of fiber in grains,
fruit, and vegetables recommended by the 2010 DGA to close
the fiber intake gap vary considerably, and many choices within
these food groups are not considered a “good” source of fiber,
defined as equivalent to 10–19% of the Daily Value, or 2.5–4.9 g
per reference serving, nor an “excellent” source of fiber, defined
Filling America’s fiber intake gap1391S
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as equivalent to $20% of the Daily Value or $5 g per reference
serving, as defined by the FDA (26). Americans attempting to
achieve increased intakes of fruit and vegetables would require a
considerable change in behavior, because higher fiber fruits and
vegetables currently are not widely consumed and efforts to
change this have not resulted in measurable improvements (27).
Current definitions of fiber
Organization (reference) Definition
Institute of Medicine (7)Dietary fiber consists of nondigestible carbohydrates and lignin
that are intrinsic and intact in plants. Functional fiber consists
of isolated, nondigestible carbohydrates that have beneficial
physiologic effects in humans. Total fiber is the sum of dietary fiber
and functional fiber.
Dietary fiber is the edible parts of plants or analogous carbohydrates
that are resistant to digestion and absorption in the human small
intestine, with complete or partial fermentation in the large
intestine. Dietary fiber includes polysaccharides, oligosaccharides,
lignin, and associated plant substances. Dietary fibers promote
beneficial physiologic effects including laxation, and/or blood
cholesterol attenuation, and/or blood glucose attenuation.
Dietary fiber means carbohydrate polymers1with $10 monomeric
units2, which are not hydrolyzed by the endogenous enzymes in the
small intestine of humans and belong to the following categories:
American Association of Cereal Chemists (8)
Codex Alimentarius Commission (9)
dEdible carbohydrate polymers naturally occurring in the food
dCarbohydrate polymers that have been obtained from food raw
material by physical, enzymatic, or chemical means and which
have been shown to have a physiologic effect of benefit to health
as demonstrated by generally accepted scientific evidence to
dSynthetic carbohydrate polymers that have been shown to have
a physiologic effect of benefit to health as demonstrated by
generally accepted scientific evidence to competent authorities
1When derived from a plant origin, dietary fiber may include fractions of lignin and/or other compounds associated with polysaccharides in
the plant cell walls. These compounds also may be measured by certain analytic method(s) for dietary fiber. However, such compounds are
not included in the definition of dietary fiber if extracted and reintroduced into a food.
2The decision on whether to include carbohydrates of 3 to 9 monomeric units should be left up to national authorities.
Glossary of terms
Term Definition (reference)
Energy balanceThe balance between energy (kcal) consumed through eating and
drinking and energy expended through physical activity and
metabolic processes (3).
Isolated or synthesized nondigestible carbohydrates that have
beneficial physiologic effects in humans. May be extracted from the
original food source that it is being added back to, such as bran
added to grain-based foods, or from fruit, vegetables, legumes,
nuts, and seeds; modified forms of traditional fibers (e.g.,
fructooligosaccharides, or FOS, from inulin); or manufactured from
other ingredients such as corn or wheat (7).
Whole foods and fortified, enriched, or enhanced foods that have a
potentially beneficial effect on health when consumed as part of a
varied diet on a regular basis at effective levels (10).
A way to describe foods or beverages that provide vitamins, minerals,
and other substances that may have positive health effects, with
relatively low energy contribution. Nutrient-dense foods and
beverages are low in solid fats and minimize or exclude added solid
fats, sugars, starches, and sodium (3).
The intact, ground, cracked, or flaked fruit of the grain whose principal
components—the starchy endosperm, germ, and bran—are
present in the same relative proportions as they exist in the intact
Added fiber (also known as functional, isolated, or novel fiber)
at PURDUE UNIVERSITY on February 24, 2014
However, modifying grain-based food choices may be a more
reasonable small step toward higher fiber consumption without
increased energy intakes (4). Most Americans are already meeting
(or exceeding) daily total grain recommendations (5); thus, a shift
from low-fiber to higher fiber grain-based foods may be an
achievable public health goal. This recognition was the focus of
the remaining roundtable discussions and recommendations
around grain-based foods.
Barriers to Meeting Fiber
Limited understanding and recognition of fiber’s role in
The roundtable experts recognized that the fiber deficit has long-
term health implications for Americans, potentially contributing
to increased risk of chronic diseases and obesity (15,16,28,29),
yet agreed that understanding and recognition of this fiber deficit
as a public health concern and priority are often overlooked.
Whereas science continues to point to fiber’s role in promoting
health and reducing the risk of developing some noncommuni-
cable diseases, these benefits are primarily longer term, making
fiber intake less of an immediate concern to consumers and
health professionals. Unlike many other nutrient inadequacies,
the clinical signs or symptoms of low fiber intakes are not directly
evident. However, there are some immediate benefits of adequate
intakes of fiber, such as promoting healthy laxation in addition
to contributing to satiety, which have short- and long-term
implications related to weight management and reducing the
risk of obesity, prediabetes, and type 2 diabetes (30). Data on the
effect of fiber intake on children’s health are limited (31).
The lack of new clinical research on fiber benefits combined
with poor understanding of the effects of low fiber intake have
given fiber less prominence as a nutrient of concern by health
professionals. Recommendations for fiber intake in the 2010
DGA are based primarily on achieving nutrient density, rather
than physiologic benefits. Although much of what we know
about fiber’s effects on health is based on observational data,
most of the clinical studies of fiber’s physiologic benefits have
been conducted using isolated forms of fiber rather than whole,
fiber-containing foods (7,15). Current dietary guidance, which
emphasizes foods that contain naturally occurring fiber, disre-
gards clinical research outcomes that use isolated fibers to
demonstrate health benefits, which are the same fibers used
when adding fiber back to grain foods. Yet, intact fiber in foods
is typically perceived as healthier and accepted as providing
health benefits without undergoing the same clinical scrutiny to
demonstrate these effects. The 2010 DGA call attention to
dietary fiber that occurs naturally in foods as helping to reduce
the risk of heart disease, obesity, and type 2 diabetes and as
essential for optimal digestive health. In its advice to consume
foods naturally high in dietary fiber, however, the DGA
overestimate the ability of these foods to meet fiber needs in
typical diets, and undervalue the potential role and contribution
of foods that contain added fiber.
Whole grains, fiber, and health. The health-protective
mechanisms of whole grains are complex and are likely due to
the interaction between fiber, minerals, antioxidants, and
bioactive compounds (32). Epidemiologic studies have sug-
gested an association between higher intakes of whole grain and
reduced risk of heart disease, certain types of cancer, type 2
diabetes, and obesity (33). However, recent research suggests
that not all whole grains exert the same effects (34,35). A review
examining the association between whole grains, based on the
FDA definition, and reduction in risk for cardiovascular disease
found an association, but only when the definition of whole
grains was broadened to include studies using fiber-rich bran and
germ (36), which suggests that the fiber components of whole
grains deliver the key benefits. Although whole grains are
believed to play an important role in the diet beyond fiber (33),
vidual, compared with recommended in-
takes. Values are means 6 SEM, n =
8529, estimated from Day 1 dietary recall
interviews conducted in What We Eat in
America, NHANES 2007–2008. The 24-h
recalls were conducted in person, by
trained interviewers, using the USDA 5-
step Automated Multiple-Pass Method.
Food intakes were coded, and nutrient
values were determined using the USDA
Food and Nutrient Database for Dietary
Studies 4.0, which is based on nutrient
values in the USDA National Nutrient
Database for Standard Reference, Re-
lease 22. Intakes of nutrients are based
on the consumption of food and bever-
ages and do not include intake from
Daily fiber intakes per indi-
supplements or medications. Mean fiber intakes for individuals aged $2 y do not include breast-fed children. Data are from (7,13).
Expected fiber in USDA food groups/subgroups1
Food group ServingMean fiber
Cooked dry beans (legumes)
28 g (1 oz)
28 g (1 oz)
28 g (1 oz)
1From (21). Mean fiber reflects fiber amounts of the food group or subgroup
composite, a representation of the foods contained in the group in amounts that
correspond to relative consumption. Fiber data derived from USDA National Nutrient
Database for Standard Reference, Release 17.
Filling America’s fiber intake gap1393S
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this point is often overlooked in dietary guidance that emphasizes
consumption of whole grains as a primary way to increase fiber
intake. To help differentiate and reduce confusion, there is a need
in future research and education to clearly delineate between
“whole grains” and “fiber” to avoid the interchange of the food
(whole grains) with the nutrient (fiber) and to provide clearer
direction for choosing grain foods that provide at least a good
source of fiber, an idea yet to be embraced by policymakers. For
example, the recently released Nutrition Standards in the
National School Lunch and School Breakfast Programs include
new directives that all grains must be “whole-grain rich” within
2y after implementation (37), yet do not address a fiber re-
quirement for defining a food that is “whole-grain rich.” By not
using fiber as a marker of whole-grain quality, the roundtable
experts considered this to be a missed opportunity for clarifying
the role of fiber in providing key health benefits in whole grains.
Confusion about “good sources” of fiber
The roundtable experts discussed how current fiber and whole-
grain recommendations may have unintended consequences of
making it more challenging to achieve adequate fiber intakes.
For example, dietary guidance emphasizes eating more of
specific foods to achieve fiber recommendations, including fruit,
vegetables, legumes, and whole grains, yet many of the foods in
these categories are not considered a “good” or “excellent”
source of fiber based on FDA labeling definitions. Some naturally
occurring fiber-containing foods are also higher in moisture,
including many fruit and vegetables, and contain only 1–3 g of
fiber per serving. This is illustrated in the mean fiber content per
serving for food groups/subgroups on the basis of typical
consumption, which is used to assess adequacy of the USDA’s
food intake patterns (Table 3).
Results from an analysis of consumers’ fiber sources found
that adults’ mean intake of 13.8 g fiber/d comes from ;25
different food items in a single day, including a variety of foods
such as vegetables, sandwiches, fruit, ready-to-eat cereals, and
potatoes (38). Although white flour and white potatoes provide
the most fiber in the U.S. food supply, these are not concentrated
fiber sources but instead are widely consumed foods (16,39).
Foods that provide at least a “good” or “excellent” source of
fiber include most legumes, foods that contain additional bran,
or foods that include other added-fiber ingredients. By empha-
sizing whole, plant-based foods in dietary guidance, consumers
have the perception that they can achieve recommended fiber
In reality, meeting recommended fiber intakes requires a careful
of first meeting recommended daily servings and then choosing
foods that provide fiber in the upper range for that food group.
Moreover, any increase or addition of fiber-containing foods
must be paired with other dietary trade-offs to avoid exceeding
energy needs, a critical consideration in today’s nutrition en-
vironment. A modeling study examined the effects on fiber
intake and calories when currently consumed fiber-containing
foods (grains, vegetables, fruit) increased by 10, 25, 50, or
100% (4). Although fiber intakes increased from 16.9 to 29.5
g/d, there was a concurrent energy increase ranging from 104–
1042 kcal/d. This illustrates the concern with simply advising
consumers to increase their intakes of fiber-containing foods
without consideration of energy needs.
Fiber amounts in different whole grains vary widely, yet there
is a perception among consumers and health professionals that
whole grains deliver substantial amounts of fiber. A study that
surveyed food and nutrition professionals and groups of
consumers found that most believed the major benefit of eating
whole grains was for the fiber (40). Consumer research indicates
that Americans are indeed seeking out whole-grain food choices
for the purpose of getting more fiber and for the health benefits
associated with adequate whole-grain and fiber intakes. The
2010 Food and Health Survey conducted by the International
Food Information Council found that ;7 out of 10 Americans
are trying to consume more fiber (72%) and whole grains (73%)
(41). Similar findings were reported by the Academy of Nutrition
and Dietetics (formerly the American Dietetic Association) 2011
Trends Survey, with nearly half of American adults reporting they
have increased their consumption of whole grains compared with
other foods over the past 5 y (42).
Whole-grain labeling and content do not guarantee fiber
The roundtable experts agreed that whole-grain labeling of
foods may be a source of consumer confusion regarding fiber
content. There has been a proliferation of packaged foods that
boast their “whole grain” content, estimated by the Whole
Grain Council as a 20-fold increase in the number of new whole-
grain product launches from 2000 (164 new products) to 2010
(3272 new products) (43). However, this has not translated to
increased whole-grain and fiber intakes, despite a recommenda-
tion, beginning with the 2005 DGA, that all age groups should
consume at least half of their grain servings as whole grains to
help increase fiber intakes. At the same time, it has become
increasingly clear that labeling claims for “fiber” and “whole
grain” may be synonymous in the minds of consumers (38). Yet,
all whole-grain foods do not qualify as a “good” source of fiber.
A web-based study in 1000 adults was conducted to measure
perceptions and understanding of the relationship between
whole grains, fiber, and potential health benefits. This research
found that 85% of respondents believed that if a product in-
dicates it is made with whole grains, then it also contains at least
a good source of fiber (38).
There is also contradiction in consumers’ perceptions of
whole-grain products and the actual amounts of fiber delivered
by products that contain whole grains. A marketplace audit was
conducted of nationally distributed ready-to-eat cereals with
whole-grain claims, such as “made with whole grains,” “rich in
whole grains,” and “whole grain guaranteed” during a 3-y
period from 2005 to 2008 (38). The fiber content in the 72
cereals analyzed ranged from 0 to 11 g/serving, with nearly half
of the cereals containing less than the minimum amount of fiber
to be labeled as a “good” source of fiber. Approximately 60% of
these cereals with whole-grain claims that provided less than a
“good” source of fiber contained #1 g of fiber. With evidence
that consumers are seeking out more whole-grain products with
an expectation of obtaining fiber, this scenario has the potential
to create the unintended consequence of increased energy intake
without a substantial increase in fiber intake.
The misunderstanding of whole grains and fiber is likely due
in part to a lack of clear and consistent labeling of whole-grain
containing products. The FDA issued “draft guidance” for
whole-grain label statements in 2006, but these are yet to be
finalized (44). Although this guidance allows manufacturers to
make factual statements about the amount of whole grain,
content claims (e.g., good or excellent source of whole grains)
are not approved, with the rationale that source claims for
whole-grain content are considered to be implied claims about
fiber content and may be misleading. Despite the lack of labeling
guidelines for whole grains, the FDA approved a health claim
linking diets rich in whole-grain foods and other plant foods
with reduced risk of heart disease and certain cancers (45).
at PURDUE UNIVERSITY on February 24, 2014
Foods that bear the whole-grain health claim are required to
contain $51% whole-grain ingredients by weight per reference
amount and to meet criteria for fat and cholesterol, but there is
not a minimum requirement for fiber content. Likewise, the
“Whole Grain Stamp,” a popular icon developed by the Whole
Grains Council, allows a food that contains $8 g (0.5 serving) of
whole grains to qualify for using the basic stamp or that contains
a minimum of 16 g of whole grain per serving to qualify for the
almost identical stamp, “100% Whole Grain” (46). However,
the product’s fiber content is not part of these requirements.
Sensory, attitudinal, and economic factors
In the roundtable discussions, it became clear that multiple levels
of influence affect behaviors that determine fiber intake. The
International Food Information Council’s 2011 Food and
Health Survey indicated that taste and price are the primary
factors influencing purchasing decisions for foods and beverages
overall (47). Healthfulness was the third most important factor,
with convenience following closely behind. When asked about
barriers to consuming functional foods, consumers identified ex-
pense, taste, and availability/convenience as the top 3 barriers
(47). Sensory barriers to increasing fiber intake, particularly from
whole-grain foods, include taste, texture, color, and moisture
content in addition to the perception that cost is greater (48).
Consumers and marketers tend to have a negative perception of
the taste and textureof fiber, with marketing that often focuses on
how specific fiber-containing foods do not taste like “cardboard”
and actually taste good.
For consumers who may choose to reduce or control their
intake of carbohydrates, such as individuals with diabetes or
those attempting to manage their weight, fiber intake may be
compromised based on the false assumption that carbohydrate-
containing foods are unhealthy and should be limited. In fact,
research supports the use of lower energy/fat diets with $25 g
fiber/d over low-carbohydrate diets for people with diabetes and
for weight loss (49). With regard to blood glucose control in
people with diabetes, it is generally believed that an increased
fiber intake helps to modulate blood glucose (2), but this effect is
generally not seen with typical fiber intakes of ,24 g/d (50).
In an effort to change attitudes and behaviors, educators and
communicators often take a binary approach, suggesting the
same solutions to ongoing problems, such as the general advice
to “choose more fruit, vegetables, and whole grains to improve
fiber intakes.” Although this not only limits innovation, it also
narrows the scope of the problem and prevents new solutions
from being considered, such as the use and acceptance of added
fiber in foods that Americans already consume. In the case of fiber,
improving outcomes must go beyond approaches that simply focus
on increasing knowledge. Consumers need to value fiber and have
reasons to care about eating more fiber. They also need skills for
how to select and prepare good-tasting foods with more fiber.
Agricultural and economic challenges are important consid-
erations in meeting recommendations for increasing intakes of
fruit, vegetables, and whole grains. To support the production of
crops needed to supply adequate amounts of produce and grains,
millions of additional acres of cropland would be required (51),
making it unlikely that current production of whole grains could
supply the quantities needed to meet recommended intakes.
Opportunities to Fill the Fiber Intake Gap
After discussing the obstacles consumers encounter in meeting
current fiber recommendations, the roundtable experts focused
on identifying opportunities to improve intakes of fiber to help
close the gap between current and recommended fiber con-
sumption. The discussions centered around understanding and
addressing consumer attitudes and behaviors, whole-grain
labeling reform, focusing on all types of fiber, optimizing eating
occasions, and education and resources for health professionals.
Meet consumers where they are to overcome barriers
The roundtable experts emphasized the importance of taking
consumers’ current understanding and dietary behaviors into
account to help them overcome the barriers they face in
increasing their fiber intake. This requires segmenting the target
audience and providing small-step guidance that is realistic and
addresses their unique concerns. Recognizing that consumers
already meet recommendations for total grains makes this an
important area of focus. Simple swaps from low-fiber grain
choices to whole grain or fiber-added enriched grains with at
least a “good” source of fiber offer a way to boost fiber intake
without affecting energy intake and do not require a consider-
able behavior change. Breaking down the barriers of taste,
texture, cost, and convenience may prove that fiber-containing
foods can be accessible, tasty, and affordable. Sampling, demon-
strations to show how to increase fiber in food preparation, and
use of coupons are ways to expose consumers to less familiar
fiber-containing foods. Incentives for increasing fiber were
discussed, with agreement that fiber for weight management
and health benefits for children and families were strategies that
would be most likely to motivate consumers.
Fiber for weight management. The 2010 DGAwere released
at a time of rising concern about the health of Americans, with
recognition that nutrient-poor intakes and physical inactivity
have contributed to the obesity epidemic in American adults and
children. The DGA clearly point out the need to focus on main-
and beverages. This dichotomy of getting more nutrients for fewer
kilocalories is a concept that consumers need to understand and
implement. Unlike several other nutrients of concern—calcium,
fiber are associated with varying health benefits, and adequate
intakes of this nutrient also play a role in weight management
A recent study evaluating the effect of consumption of total
fiber and types of fiber on the prevalence of overweight and
obesity found that total fiber intake is inversely related to BMI,
waist circumference, and percentage of obesity (29). The inverse
relationship between fiber intake and body weight was more
pronounced for cereal fiber compared with fruit and vegetable
fiber, which may be a factor in the low consumption of fruit and
vegetables and the inconsistent association between fruit and
vegetable intake and adiposity (27,52). Fiber is believed to play a
role in weight management by slowing digestion, contributing to
satiety, and subsequent reduced energy intake (30). In addition,
higher fiber intakes may delay digestion of other macronutrients
in the small intestine, and reduce postprandial blood glucose,
which improves insulin sensitivity and favors fat oxidation
In children, a lower risk of overweight and obesity with
increased fiber intake has been observed (54). This investigation
using national intake data found that children who consume
high amounts of fiber consume large amounts of lower-fiber
foods, such as French fries and pizza. Thus, establishing the
evidence for a beneficial effect of fiber intake on children’s health
is confounded by the fact that children who meet the intake
recommendations are likely overconsumers and are therefore
Filling America’s fiber intake gap1395S
at PURDUE UNIVERSITY on February 24, 2014
overweight or obese. In communications to improve fiber
intakes, a focus on the benefit of managing weight is a strategy
for getting the attention of consumers, including parents of
overweight children, who have concerns about weight.
Health benefits for children and families. Fiber recommen-
dations for children vary, whether based on energy needs, age, or
weight, due to the fact that effects of fiber on child health have
not been studied closely. However, evidence suggests that
reducing constipation, obesity, and type 2 diabetes could be
achieved in children with increased intakes of fiber (31). Because
children’s dietary intake patterns are likely to track into adult-
hood, increasing fiber intakes during the earlier years of life
presents an opportunity to improve children’s health and
potentially influence their health as adults in a positive way.
Fiber is consistently consumed at inadequate levels by most
preschool-aged children, yet in a study in which children were
provided with higher-fiber snacks and lunch items in a day care
setting, they were found to try and like these foods, with the
resultofhigherdaily intakesof fiber(55,56).Interestingly,parents
and child care providers may make the assumption that their
children will not like certain fiber-containing foods, with the
unintended consequence of limiting their fiber intakes along with
other nutrients of concern. Although it has been shown that
children prefer familiarity and consistency in their diets, and may
be reluctant to try new foods, exposing children to a variety of
fiber sources beginning in the first years of life makes them more
acceptingofnovel foods(31,57,58). Other options for parentsare
to add fiber to foods that children like, such as using whole-wheat
flour in baked goods or substituting whole-grain versions of
crackers, chips, and pizza crust in place of lower-fiber products.
An added outcome associated with consuming higher fiber
foods is greater intake of other nutrients and the improvement of
diet quality (17), which in turn may potentially affect weight and
health. Furthermore, if children accept and like a new food, it
often leads to children requesting the new foods at home; thus,
parents may change their dietary habits to match their children’s
likes. Home availability and accessibility of foods such as fruit,
vegetables, and whole grains can be an important factor in
improving consumption (59). This underscores the importance
of helping parents learn how to select whole-grain foods that
provide a good source of fiber (60).
Call for clear and consistent labeling of fiber in
A critical need identified by the roundtable experts to help
improve fiber intakes from grain foods is to develop clearer,
universal messaging that also focuses on the fiber content in
whole-grain products. This could help address the confusion
around fiber and whole grains and may help promote greater
fiber intakes from all grain products, including whole grains and
enriched grains with added fiber. The 2010 Dietary Guidelines
Advisory Committee acknowledged that there is no consistent
way that whole-grain foods are defined and determined, and
identified developing a universally accepted definition and
criteria for “whole-grain foods” as an area for future research
(2). Defining what constitutes a whole-grain food would allow
consumers to better identify foods that can help them meet
recommendations for whole grain and fiber, and it would allow
comparison of research studies examining the effectiveness of
whole grains, independent of fiber content, on biomarkers and
health conditions, such as cardiovascular disease, diabetes, and
Currently, the FDA’s draft guidance allows food manufac-
turers to include factual statements about whole grains on
package labels, such as “8 grams of whole grains” or “100%
whole grains” (44), which consumers tend to equate with claims
about fiber content. This lack of clarity in whole-grain labeling
may be feeding the confusion around fiber and whole grains,
with the unintended consequence of exacerbating the fiber
deficit. Eligibility criteria for whole-grain claims based on the
amount of fiber per serving is a logical approach that would help
to inform and reinforce the expectation that whole-grain
products can deliver a good source of fiber.
Label statements on whole-grain products that include a
qualifying statement to highlight total fiber could bring greater
prominence to the fiber content while reinforcing whole grains
as a source of varying amounts of fiber. The use of food labels to
make purchasing decisions is linked to healthier eating, with
higher fiber intakes among food label users (61). In recognition
that every gram of fiber counts toward reaching daily fiber goals,
teaching consumers to check for fiber on a product’s Nutrition
Facts label is a simple action to help determine fiber content,
especially for products that note their whole-grain content. This
encourages consumers to pay closer attention to fiber amounts in
their typical food choices and promotes selection of whole-
grain-containing foods with greater amounts of fiber per serving.
Focus on all forms and sources of fiber
The roundtable experts agreed that more emphasis needs to be
placed on consuming adequate fiber, whether intrinsic or added.
Regardless of whether fiber occurs naturally in food or is added,
both forms become part of the total fiber content of the food,
referred to as Total Fiber by the IOM, and the amount reflected
on the Nutrition Facts label (7). Similarly, DRI recommenda-
tions and fiber definitions from the American Association of
Cereal Chemists and Codex address dietary fiber without dif-
ferentiation of amounts of naturally occurring and added fibers.
Thus, it is logical that recommendations for obtaining fiber from
food should be inclusive of all types of fibers (intrinsic and
Adding nutrients to foods to promote positive health benefits
is a practice that is well accepted and has been successful in
reducing nutrient deficits. With folic acid, for example, fortifi-
cation of widely consumed grains has raised intake of this
nutrient to more desirable levels, with subsequent reduction in
rates of neural tube birth defects (62). A recent analysis of usual
intakes of micronutrients in individuals aged 2 y found that
many Americans would not achieve the recommended micro-
nutrient intake levels set forth in the DRI recommendations
without enrichment, fortification, or supplementation (63).
Compared with intakes from naturally occurring nutrients,
enrichment and/or fortification dramatically improved intakes
of several key nutrients, including folate, thiamine, iron, and
vitamins A and D. The 2010 DGA acknowledge that “fortified
foods and supplements may be useful in providing one or more
nutrients that otherwise might be consumed in less than
recommended amounts” (3). Although extensive fiber fortifica-
tion of food was not considered a solution, roundtable partic-
ipants agreed that adding fiber lost in processing back to
enriched grains or adding to the fiber that is naturally present in
whole-grain foods are realistic and potentially impactful solu-
tions. As a nutrient of concern, total fiber content could be used
to establish the quality of a grain food.
The IOM acknowledges that consuming fiber from a variety
of sources with the objective of increasing total fiber intake
offers varying health benefits specific to the fiber source (Table
at PURDUE UNIVERSITY on February 24, 2014
4). Certain sources of fiber deliver more than physiologic
benefits and also offer functional and/or nutritional properties.
Growing recognition of the positive benefits of different types of
fibers, both intrinsic and added, has contributed to a greater use
of isolated fibers as food ingredients, particularly in grain foods.
Achieve energy balance with added fiber in grain-based
foods. In its recommendations for grain foods, the 2010 DGA
advise that at least half of total grain intake should be from
whole grains, with the remaining from enriched grains. Whole
grains are recognized in the DGA as a source of nutrients such
as iron, magnesium, selenium, B vitamins, and fiber, with the
caveat that whole grains vary in their fiber content. The DGA
acknowledge that whole grains higher in fiber have additional
health benefits but offer little advice on strategies to consume
foods with added fiber despite mounting evidence and recogni-
tion that isolated fibers also exert important physiologic health
benefits (6). This signifies the need for additional research and
education to create greater awareness of the benefits and
importance of added fiber as a strategy for filling the fiber intake
Current recommendations to increase fiber intake pose a
challenge to consumers who also need to manage energy intake
while maximizing nutrient intake. All grain-based foods, in-
cluding whole- and enriched-grain products, are logical vehicles
for added fibers because intakes of grain-based foods already
meet daily recommendations. A modeling study using intake
data obtained from NHANES 2003–2006 simulated various
approaches to increasing fiber in Americans’ diets and measured
the effect on total energy intake when whole-grain intake
increased and when fiber was added to grain foods already being
consumed (4). The addition of 2.5 or 5.0 g of fiber per serving to
Types, effects, and sources of fiber ingredients
Isolated, modified, or synthesized
fibers added to foods Main physiologic effects
Usually isolated or
b-Glucan and oat bran Blood lipid lowering
Attenuates blood glucose response
Oats and barley
CelluloseLaxation Plant foods
Chitin/chitosan Blood lipid lowering (as seen in animal studies)Fungi or shellfish
Guar gum Blood lipid lowering
Attenuates blood glucose response
Guar bean (legume)
Short-chain fructooligosaccharide, including inulin,
Microbiota modulation toward a more healthful community
Blood lipid lowering
Synthesized from sucrose
Galactooligosaccharide (64,65)Gut health
Microbiota modulation toward a more healthful community
Immune system modulation
Pectin Blood lipid lowering
Attenuates blood glucose response
PolydextroseLaxation Synthesized from dextrose
Psyllium husk (plant)PsylliumLaxation
Blood lipid lowering
Attenuates blood glucose response
Resistant dextrinsBlood lipid lowering
Attenuates blood glucose response
Corn and wheat
Attenuates blood glucose response when substituted for
Soluble corn fiber (66) Attenuates blood glucose response
Wheat branLaxation Wheat
Filling America’s fiber intake gap1397S
at PURDUE UNIVERSITY on February 24, 2014
grain foods low in fiber resulted in fiber intakes of 24.7 and 39.1
g/d, respectively, without an increase in energy intake. Increasing
consumption of currently available whole-grain foods to the
recommended levels increased fiber intake in all adults to 25.3 g/
d, but with an additional increase in energy of 1266 kcal/d (4).
Optimize eating occasions with the greatest potential
National eating-occasion data (NHANES 2007–2008) shows
that breakfast and snacks contribute 18% and 21%, respec-
tively, to the total daily fiber intake of Americans, compared
with lunch (25%) and dinner (36%) (67). These findings
illustrate the potential for focusing on breakfast and snacking
as eating occasions to help consumers increase fiber intake.
Eating breakfast has been associated with managing body
weight, higher -quality diets, and cognitive performance, espe-
cially in children (68–72). It also offers an opportunity to
consume fiber and whole grains, which have the potential to
enhance overall diet quality and offer satiety (24,30). These
important benefits combined with the wide variety of breakfast
foods available that provide fiber, such as whole-grain and fiber-
added cereals and breads, give breakfast the potential for
making a substantial impact on increasing fiber intakes in both
children and adults. Additional choices for higher-fiber breakfast
items “on the go” and tips for easy substitutions can help to
increase the fiber contribution of the breakfast meal.
Snacks offer another opportunity for increasing fiber con-
sumption, especially for children, with an array of snack-food
choices, whole-grain and/or fiber-added crackers, chips, baked
goods, and granola bars. As with any unfamiliar food, children
are more likely to enjoy higher-fiber snack foods when they are
exposed at an earlier age, and when influential adults such as
parents, caregivers, teachers, and coaches model healthy higher-
fiber snacking habits. Cultural food practices should also be
considered in fiber education. For example, some Latinos use
cereals as a snack food and add grains to beverages (e.g., batido
de trigo and atole).
Health professional education and resources
The roundtable discussions underscored the importance of
reaching consumers with accurate and practical information
about fiber. To do this, health professionals must understand the
significance and potential long-term consequences of the fiber
deficit, and their pivotal role in helping consumers make
necessary changes to increase fiber intakes through both naturally
occurring and added fiber sources. As research continues to
explore the mechanisms and benefits of fiber and whole grains,
including sources of isolated/added fibers, health professionals
will need resources to stay current in their knowledge of fiber as
well as practical tools for working with consumers. An online
survey (unpublished results, Kellogg Company, August 2010) of
150 registered dietitians (RD) in general or medical practice
specialty groups revealed that fiber from natural, whole-food
sources was preferred byRD participants for addressing the fiber
deficit. There was general consensus among the RD participants
that adding fiber to foods is also an acceptable option,
particularly when fiber is added to traditional sources of fiber,
including breads, ready-to-eat cereals, and cereal bars. Yet, RD
participants expressed concern that some fiber-added foods may
not offer the same benefits as natural fiber sources. With regard
to whole grains, .90% of the RD participants surveyed
expected that “whole-grain labeled products” will provide at
least a good source of fiber (3 g/serving).
To help RD and other health professionals overcome these
knowledge gaps and improve their communications with con-
? Develop continuing education modules to address the latest
research on fiber, with emphasis on the importance of fiber variety
and the physiologic value of all types of fiber, whether intact or
added, in providing beneficial effects. Additional learning on the
regulatory aspects of nutrient claims related to fiber, and how to
use language consistent with approved regulatory guidance,
particularly for whole grains, was also recommended.
? Debunk common myths about fiber, including the belief that
whole grain is equivalent to fiber, and concerns about added-fiber
sources, such as isolated and synthesized fibers. Help consumers
understand that all types of fiber deliver important physiologic
benefits, and become familiar with the types of ingredients that
may be used to add fiber to grain-based foods.
? Acquire and use cultural competency skills to better understand
how to address fiber in typical food choices, practices, and
behaviors of ethnic groups and develop culturally appropriate
programs and messages to optimize fiber intakes.
? Offer practical, “how to” guidance to show consumers how to
select and serve foods that provide fiber. For example, sample
menus can illustrate how small changes in food choices, including
use of foods with added fiber, can add up to dramatic changes in
daily fiber intakes while controlling energy intake (73).
? Address consumer concerns with taste, time, and cost, which may
include showing how to prepare foods with more fiber through
recipes and food demonstrations, food budgeting and shopping to
address cost concerns of fiber sources, and meal planning using
MyPlate resources (e.g., ChooseMyPlate.gov) to show how to
incorporate a variety of fiber sources into daily meals. Recognize
the importance of meeting consumers where they are with their
dietary and lifestyle behaviors, and encourage them to make
incremental small changes that can have a dramatic impact on
improving diet quality, including increasing fiber intake, without
consuming additional calories (74).
? Emphasize label reading as an essential skill for selecting grain
foods, with fiber content recommended as a marker for comparing
and choosing grain foods, including whole grains. A simple
criterion such as “choose grain foods with at least 3 g of fiber (or
with $10% of the Daily Value) per serving” offers a straightfor-
ward strategy for consumers to make an informed decision about
both whole-grain products and added-fiber foods.
Closing the fiber intake gap will require involvement by
various sectors of influence, including educators, health and
culinary professionals, policymakers, and the food industry.
Continued discussion and exploration of the potential benefits of
all fiber sources will help support development of clear and
consistent messages to reinforce the importance of adequate
fiber intakes. Additional resources, including review papers and
position statements, can provide support for the variety of fiber
sources and address needs for research and educational tools on
all types of fiber, including naturally occurring and fibers added
to foods. Industry can be leveraged as a resource to help support
needs for research and education with objective, applicable, and
practical information for students and practitioners. Industry
can also play a role in increasing fiber intakes through product
innovation with development of good-tasting and affordable
foods that provide fiber, including adding fiber to lower-fiber,
nutrient-dense grain-based foods.
Fiber’s essential role in optimal health creates an urgency to help
Americans overcome the barriers that hinder adequate fiber
at PURDUE UNIVERSITY on February 24, 2014
intakes. There was consensus among roundtable participants
that grain foods offer a unique opportunity to help Americans
increase their fiber intakes. With current grain intakes at or
slightly above recommended amounts, making simple changes
to choose grain foods with a good or excellent source of fiber
may be the most realistic and impactful way to help Americans
make immediate progress toward filling the fiber intake gap
while staying within energy needs. The roundtable experts
agreed that an energy-neutral strategy to increase fiber intakes is
adding fiber back to selected enriched grain foods when it was
lost in processing or adding more fiber to whole-grain products.
Roundtable participants acknowledged the importance of
meeting daily recommendations for other fiber-containing foods
such as fruit, vegetables, and legumes, yet recognized that in-
creasing intakes of these foods to recommended amounts
requires more complex behavior changes, including how to
increase servings of these foods while reducing intakes of other
foods to stay within daily energy goals.
The roundtable concluded with several key statements that
frame the current fiber intake situation and that provide realistic
solutions to close the fiber intake gap:
? Americans’ fiber intake is a public health concern for both adults
and children, with potential consequences that may increase the
risk of several chronic diseases and obesity. Although fiber is
recognized by the 2010 DGA as a nutrient of concern, recom-
mendations to improve fiber intakes focus on increased consump-
tion of fruit, vegetables, and whole grains, with little recognition
of the effect on total energy intake and the positive role of adding
fibers to foods to help close the fiber intake gap. With increased
emphasis on energy balance, added fiber in select grain-based
foods is a practical and energy-neutral solution.
? All forms and sources of fiber, including intrinsic and added fiber,
can play a role in closing the fiber intake gap. The 2009 Codex
definition of fiber acknowledges dietary fiber as naturally occur-
ring, isolated from food, or synthetically derived (9). This
recognizes the contributions of both intrinsic and added fiber,
thus giving value to all sources of fiber.
? Small changes in eating patterns—and to foods people already
enjoy—canhelpto increasefiber intakeswithout increasingenergy
intake. Meal occasions with the most potential for increasing fiber
intake are breakfast and snacks.
? Use of fiber as a marker for grain-based food quality offers a
practical way to identify grain-based foods that provide a good
source of fiber (3 g/serving), including whole grains and enriched
grains with added fiber. Using “whole grain” to characterize only
grain-based food quality does not tell the complete nutritional
story because many whole-grain products are not good sources of
? Eligibility criteria for whole-grain labeling claims based on the
amount of fiber per serving would help to inform and reinforce the
expectation that whole-grain products vary in their fiber content
and, with careful selection, they can deliver a good source of fiber.
? There are opportunities to educate health professionals and other
advocates with proof that illustrates how all fiber sources have
important health benefits and can contribute to filling Americans’
fiber intake gap.
All authors contributed to the meeting presentations and fully
participated in roundtable discussions, which was the basis for
the article. The authors thank Betsy Hornick, Supplement Coor-
dinator, for developing a manuscript based on the authors’
contributions and their discussions at the Fiber Roundtable. All
authors contributed content to the article based on their individual
expertise as follows: R.C. contributed content related to food
science, agricultural implications, and Dietary Guidelines for
Americans insights; J.L.S. contributed content related to fiber
benefits and its physiologic role and Dietary Guidelines for
Americans insights; T.A.N. contributed content related to food
modeling with added fibers; S.K. contributed content related to
children’s nutrient needs and increasing fiber intakes among
children; A.R.M. contributed content related to behavior
change needs and modeling; H.W. contributed content related
to diabetes; J.C.R. contributed content related to education and
health professional outreach; and M.P.R. contributed content
related to nutrition policy and health professional education.
All authors had responsibility for final content. All authors read
and approved the final manuscript.
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