食物热量与体重控制PPT课件

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1、1食物熱量與體重控制 台大醫院歐陽鍾美 營養師2如何確知是否肥胖？如何確知是否肥胖？體脂肪體脂肪 :一般而言，男人體脂肪超過一般而言，男人體脂肪超過25%25%，女人超過女人超過30%30%皆認為是肥胖皆認為是肥胖 測量方法測量方法l最準確的作法是將個體在水中稱重 l測量身體若干部位的皮下厚度l是利用脂肪不導電的原理，以傳入微弱無害的電流藉以測量體脂肪。3容易計算且不需儀器的方法體重身高對照表體重身高對照表(weight-for-height tables)體質指標(body mass index;BMI)4體重身高對照表體重身高對照表5肥胖的定義肥胖的定義 身體質量指數(Body Mass

2、Index;BMI)BMI=BMI=體重體重(kg)/(kg)/(身高身高;m);m)2 2 例如:身高160公分，體重50公斤，BMI:BMI:501.61.619.5 肥胖:BMI 276行政院衛生署91年4月公告國人成年人體重過重及肥胖的定義 分類BMI(kg/m2)體重過輕 18.5正常18.5 BMI 24體重過重體重過重24 BMI 27肥胖肥胖 277年年齡齡男生男生女生女生正常範圍正常範圍(BMI介於介於)過重過重(BMI)肥胖肥胖(BMI)正常範圍正常範圍(BMI介於介於)過重過重(BMI)肥胖肥胖(BMI)215.2-17.717.719.014.9-17.317.318.

3、3314.8-17.717.719.114.5-17.217.218.5414.4-17.717.719.314.2-17.117.118.6514.0-17.717.719.413.9-17.117.118.9613.9-17.917.919.713.6-17.217.219.1714.7-18.618.621.214.4-18.018.020.3815.0-19.319.322.014.6-18.818.821.0915.2-19.719.722.514.9-19.319.321.61015.4-20.320.322.915.2-20.120.122.31115.8-21.021.023.

4、515.8-20.920.923.11216.4-21.521.524.216.4-21.621.623.91317.0-22.222.224.817.0-22.222.224.61417.6-22.722.725.217.6-22.722.725.11518.2-23.123.125.518.0-22.722.725.31618.6-23.423.425.618.2-22.722.725.31719.0-23.623.625.618.3-22.722.725.31819.2-23.723.725.618.3-22.722.725.3兒童與青少年肥胖定義兒童與青少年肥胖定義8行政院衛生署91年

5、4月公告國人成年人肥胖的定義性別中圍(公分)男性90 公分女性80 公分9決定肥胖的因素 遺傳(Genetics)環境(Environment)生理因素(Physical factors)心理因素(Psychological factors)內分泌因素(Endocrine disorders)10Obesity Therapy11Obesity/Energy Balance Energy requirement=30kcal x Wt Net energy=Energy intake Energy expenditure 500 calories per day weight 0.51 kg

6、per week12體重控制的方法 飲食控制飲食控制 運動運動 生活型態改變生活型態改變 藥物藥物 外科手術外科手術 其他其他13飲食控制 減少熱量攝取 選擇低油的烹調方式 選擇低熱量食物 選擇高纖食物 避免含糖飲料14兒童熱量需求計算以理想體重計算100 x 10+50 x(20-10)+20 x(wt-20)例:理想體重為35公斤 100 x 10+50 x(20-10)+20 x(35-20)=1800(大卡)15成年人熱量需求計算以輕度工作者為例:30 卡 x 理想體重=熱量需求另可依目前體重狀況與活動量調整體重過輕理想範圍體重過重輕度工作353025中度工作403530重度工作454

7、03516現代人的文明病l肥胖l心臟血管疾病l腦血管疾病l糖尿病l高血壓l高脂血l痛風17體重控制減少減少熱量熱量攝取攝取(飲食控制飲食控制)增加增加熱量熱量消耗消耗(運動運動)18熱量計算u 1 公克 醣類醣類(碳水化合物碳水化合物)=4 大卡u 1 公克 蛋白質=4 大卡u 1 公克 油脂油脂=9 大卡u 1 公克 酒精酒精=7 大卡u 1 公克 水=0 大卡19含700卡熱量食物20含800卡熱量食物21運 動Sedentary=BMR X 1.2(little or no exercise,desk job)Lightly active=BMR X 1.375(light exerci

8、se/sports 1-3 days/wk)Mod.active=BMR X 1.55(moderate exercise/sports 3-5 days/wk)Very active=BMR X 1.725(hard exercise/sports 6-7 days/wk)Extr.active=BMR X 1.9(hard daily exercise/sports&physical job or 2X day training,i.e marathon,contest etc.)Men:BMR=66+(13.7 X wt in kg)+(5 X ht in cm)-(6.8 X age

9、in years)Women:BMR=655+(9.6 X wt in kg)+(1.8 X ht in cm)-(4.7 X age in years)22Light Activity(50 to 200 KCals per hour)Lying or Sleeping(80 kcals/hour)Desk Work(110 kcals/hour)Driving(120 kcals/hour)Fishing(130 kcals/hour)Sitting(100 kcals/hour)Standing(140 kcals/hour)Housework(180 kcals/hour)23Mode

10、rate Activity(200 to 350 KCals per hour)Bicycling-Pace:5.5 mph(220 kcals/hour)-Pace:11 mph(440 kcals/hour)-Pace:16.5 mph(660 kcals/hour)Bowling(270 kcals/hour)Golf-Golf cart:150 kcals/hour -Walking:300 kcalks/hour Swimming at 0.25 mph(300 kcals/hour)Walking(approximately 100 calories per mile)Pace:2

11、 mph(150 kcals/hour)Pace:4 mph(330 kcals/hour)24Strenuous Activity(over 350 kcals/hour)Dance-Slow Step:300 kcals/hour -Square Dancing:350 kcals/hour -Fast Step(Aerobic):490 kcals/hour Racquet Sports -Badminton(350 kcals/hour)-Racquetball Singles(775 kcals/hour)-Squash or Handball(600 kcals/hour)-Ten

12、nis Singles(420 kcals/hour)Running(approximately 100 calories per mile)-Jogging:5 mph(640 kcals/hour)-Moderate:6 mph(750 kcals/hour)-Fast:10 mph(1200 kcals/hour)Shoveling(400 kcals/hour)Skating at 10 MPH(400 kcals/hour)25適當運動建議的決定與實行美國公共衛生局建議：在1週中多數的日子，甚至每天累積30分鐘或更長時間的中度運動中度運動 A每小時快走3-4英哩被認為是中度運動，而散

13、步則不是 A中度運動中度運動包括：步行、游泳、騎腳踏車、割草、打掃房子和修理房子。A日常生活中累積中度運動的策略包括：爬樓梯、步行取代短程的交通工具、看電視時踩固定式腳踏車及清掃庭院的落葉。運動的建議應強調頻率的重要性 26診斷(評估)治療(介入)體重控制流程效果效果(評價評價)27肥胖肥胖行為行為環境環境教育教育流行病診斷流行病診斷行為與環境診斷行為與環境診斷教育診斷教育診斷診斷(評估)28行為與環境之診斷行為與環境之診斷晚上一定吃完宵夜才睡覺(B)找不到適當的餐廳吃低熱量食物(E)常吃油炸食物如炸雞腿等(B)家裡的伙食太油膩(E)教育程度(E)不覺得肥胖會對健康影響很大(B)覺得自己有點胖

14、但不是太胖(B)想減肥但不知道那裡有辦減肥班?(E)29教育的診斷教育的診斷nPredisposing factors(內在內在,傾向傾向)knowledge,attitudes,beliefs,values,motivation,self-efficacy,psychological domain,socio-demographic factors.nEnabling factors(能力能力)n Availability,accessibility and affordabilitynReinforcing factors(增強增強)Social support,peer influenc

15、e,advice and feedback by health care providers,physical consequences of behavior.30 教育的診斷教育的診斷不知道那些食物含熱量高(Knowledge)無法改變家裡的伙食(Enabling)應酬太多(Enabling)不知道如何製作低熱量食物(Skills)缺乏醫療人員支持與建議(Reinforcing)不覺得減重可改善健康狀況(Predisposing)沒有錢付減重班的學費(Enabling)31治療治療(介入介入)Educational Setting High risk population in commu

16、nity/institution High risk population at hospital General population for obesity preventionEducational Programs(duration,F/U)Individual/group teaching Individual nutrition counseling/assessment Individual behavioral/psychosocial counseling Support groupEducational materials(教材教材)Types of materials F

17、actors in choosing materialsEducational methods(方法方法)32Educational Materials(教材)Types of material Videotapes Slide/tapes Booklets/Books Programmed instruction Audiotapes,Computer-assisted instruction TV/Radio,Newspaper,Newsletters,Posters Brochures/FlyersFactors in choosing material Applicability Ea

18、se of use Reading level Ease of obtaining Cost33Educational Methods(方法)Individual skill sessionsIndividual counseling sessionsIndividual content sessionSmall-group content sessionsSmall-group skill sessionsSupport groupsLarge-group discussionlectures34治療治療(介入介入)健康飲食觀念(knowledge)熱量計算(knowledge)低熱量食物烹

19、調(skills)記錄飲食(self-monitoring)行為修正(behavior modification)設定目標(set realistic goal)回饋(reward)35行為改變的治療行為改變的治療ComponentExamplesSelf-Monitoring記錄食物記錄食物,與造成多吃的情緒與環境與造成多吃的情緒與環境Stimulus control遠離高油脂的食物遠離高油脂的食物,在固定的食間在固定的食間與地點進餐與地點進餐Contingency Management若達到目標若達到目標,則給予獎勵則給予獎勵Changing behavior parameters減慢吃飯

20、速度減慢吃飯速度Cognitive-behavior modification利用社會認知與壓力改變行為利用社會認知與壓力改變行為36評價評價(Evaluation)效果如何?(體重減輕或減少肥胖發生)短期效果?(Wt,Bp,Lipid profile)長期效果?(Relapse or Maintenance)經濟效益?(Cost-effectiveness)37#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaJ7F4C0z)w&s!pYmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUi

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32、jSgOdLaI6F3B0y)v%s#pXlUiQfNcK8H5E2A+x*u$rZnWkThPeMaJ7G4C1z-w&t!pYmVjRgOdL9I6E3B0y(v%s#oXlUiQfNbK8H5D2A+x*u$qZnWkShPeMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pYmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeNbJ8G4

33、D1A-w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeMbJ7G4D1z-w*t!qYmVjSgOdLaI6F3B0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZnWkThPeMbJ7G4C1z-w&t!qYmVjRgOdL9I6F3B0y(v%s#oXlUiQfNbK8H5D2A+x*u$qZnWkShPeMaJ7G4C1z)w&t!pYmVjRgOcL9I6E3B0y(v%r#oXlTiQfNbK8G5D2A-x*u$qZnVkShPdMaJ7F4C0z)w&s!pYmUjRfOcL9H6E3B+y(v%r#o

34、WlTiQeNbK8G5D1A-x*t$qZnVnVkSgPdMaI7F4C0z)v&s!pXmUjRfOcK9H6E2B+y(u%rZoWlThQeNbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfOcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZnWkThPeMbJ7G4C1z-w&t!qYmVjSgOdL9I6F3B0y)v%s#oXlUiQfNcK8H5D2A+x*u$rZnWkShPeMaJ7G4C1z)w&t!pYmVjRgOcL

35、9I6E3B0y(v%r#oXlTiQfNbK8H5D2A-x*u$qZnWkShPdMaJ7F4C1z)w&s!pYmUjRgOcL9H6E3B+y(v%r#oWlTiQeNbK8G5D1A-x*t$qZnVkSgPdMaI7F4C0z)w&s!pXmUjRfOcL9H6E2B+y(u%r#oWlThQeNbJ8G5D1A-w*t$qYnVkSgPdLaI7F3C0z)v&s#pXmUiRfOcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1A-w*t!qYnVjSgPdLaI6F3C0y)v&s#pXlUiRfNcK9H5E2A+x(u$rZoWkThPeMbJ7G4D1z-w&

36、t!qYmVjSgOdL9I6F3B0y)v%s#pXlUiQfNcK8H5E2A+x*u$rZnWkThPeMaJ7G4C1z-w&t!pYmVjRgOdL9I6E3B0y(v%s#oXlTiQfNbK8H5D2A-x*u$qZnWkShPeMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pXmUjRfOcL9H6E2B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQe

37、MbJ8G4D1A-w*t!qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeMbJ7G4D1z-w*t!qYmVjSgOdLaI6F3B0y)v%s#pXlUiQfNcK8K8H5E2A+x*u$rZnWkThPeMaJ7G4C1z-w&t!qYmVjRgOdL9I6F3B0y(v%s#oXlUiQfNbK8H5D2A+x*u$qZnWkShPeMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQfNbK8G5D2A-x*u$qZnVkShPdMaJ7F4C0z)w&s!pYmUjRfOcL9H6E3B

38、+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUjRfOcK9H6E2B+y(u%rZoWlThQeNbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZnWkThPeMbJ7G4C1z-w&t!qYmVjRgOdL9I6F3B0y)v%s#oXlUiQfNcK8H5D2A+x*u$rZnWkShPeMaJ7G4C1z)w&t!pYmV

39、jRgOcL9I6E3B0y(v%r#oXlTiQfNbK8G5D2A-x*u$qZnVkShPdMaJ7F4C1z)w&s!pYmUjRgOcL9H6E3B+y(v%r#oWlTiQeNbK8G5D1A-x*t$qZnVkSgPdMaI7F4C0z)v&s!pXmUjRfOcK9H6E2B+y(u%r#oWlThQeNbJ8G5D1A-w*t$qYnVkSgPdLaI7F3C0z)v&s#pXmUiRfOcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v&s#pXlUiRfNcK9H5E2A+x(u$rZoWkThPeMbJ7G4

40、D1z-w&t!qYmVjSgOdL9I6F3B0y)v%s#oXlUiQfNcK8H5D2A+x*u$rZnWkThPeMaJ7G4C1z-w&t!pYmVjRgOdL9I6E3B0y(v%s#oXlTiQfNbK8H5D2A-x*u$qZnWkShPdMaJ7F4C4C1z)w&s!pYmUjRgOcL9H6E3B+y(v%r#oWlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pXmUjRfOcL9H6E2B+y(u%r#oWlThQeNbJ8G5D1A-w*t$qYnVkSgPdLaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%r

41、ZoWlThQeMbJ8G4D1A-w*t!qYnVjSgPdLaI6F3C0y)v&s#pXlUiRfNcK9H5E2A+x(u$rZoWkThPeMbJ7G4D1z-w*t!qYmVjSgOdLaI6F3B0y)v%s#pXlUiQfNcK8H5E2A+x*u$rZnWkThPeMaJ7G4C1z-w&t!pYmVjRgOdL9I6E3B0y(v%s#oXlUiQfNbK8H5D2A+x*u$qZnWkShPeMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaJ7F4C0z)w&s!pYmUjRfOcL

42、9H6E3B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeNbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeMbJ7G4D1z-w*t!qYmVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZnWkThPeMbJ7G4C1z-w&t!qYmVjRgOdL9I6F3B0y(v%s#oXlUiQfNbK8H5D2A+x*u$rZnWkShPeMaJ7G4C1z)w&

43、t!pYmVjRgOcL9I6E3B0y(v%r#oXlTiQfNbK8G5D2A-x*u$qZnVkShPdMaJ7F4C0C0z)w&s!pYmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbK8G5D1A-x*t$qZnVkSgPdMaI7F4C0z)v&s!pXmUjRfOcK9H6E2B+y(u%rZoWlThQeNbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfOcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZnWkTh

44、PeMbJ7G4D1z-w&t!qYmVjSgOdL9I6F3B0y)v%s#oXlUiQfNcK8H5D2A+x*u$rZnWkShPeMaJ7G4C1z)w&t!pYmVjRgOcL9I6E3B0y(v%s#oXlTiQfNbK8H5D2D2A-x*u$qZnWkShPdMaJ7F4C1z)w&s!pYmUjRgOcL9H6E3B+y(v%r#oWlTiQeNbK8G5D1A-x*t$qZnVkSgPdMaI7F4C0z)v&s!pXmUjRfOcL9H6E2B+y(u%r#oWlThQeNbJ8G5D1A-w*t$qYnVkSgPdLaI7F3C0z)v&s#pXmUiRfOcK9H5E

45、2B+x(u%rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgPdLaI6F3C0y)v&s#pXlUiRfNcK9H5E2A+x(u$rZoWkThPeMbJ7G4D1z-w&t!qYmVjSgOdL9I6F3B0y)v%s#oXlUiQfNcK8H5E2A+x*u$rZnWkThPeMaJ7G4C1z-w&t!pYmVjRgOdL9I6E3B0y(v%s#oXlTiQfNbK8H5D2A-x*u$qZnWkShPdMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pX

46、mUjRfOcL9H6E2B+y(u%r#oWlThQeNbJ8G5D1A-x*t-w*t$qYnVkSgPdLaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeMbJ8G4D1A-w*t!qYnVjSgPdLaI6F3C0y)v&s#pXlUiRfNcK9H5E2A+x(u$rZoWkThPeMbJ7G4D1z-w*t!qYmVjSgOdLaI6F3B0y)v%s#pXlUiQfNcK8H5E2A+x*u$rZnWkThPeMaJ7G4C1z-w&t!pYpYmVjRgOdL9I6E3B0y(v%s#oXlTiQfNbK8H5D2A-x*u$qZnWkSh

47、PeMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pXmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeMbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeMbJ7G4D1z-w*t!qYmVjSgOdLaI6F3B0y)v%s#pXlUiQfNcK8H5E2A

48、+x(u$rZnWkThPeMbJ7G4C1z-w&t!qYmVjRgOdL9I6F3B0y(v%s#oXlUiQfNbK8H5D2A+x*u$qZnWkShPeMaJ7F4C1z)w&t!pYmVjRgOcL9I6E3B0y(v%r#oXlTiQfNbK8G5D2A-x*u$qZnVkShPdMaJ7F4C0z)w&s!pYmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qZnVkSgPdMaI7F4C0z)v&s!pXmUjRfOcK9H6E2B+y(u%rZoWlThQeNbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmU

49、iRfOcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v%s#pXlUiRfNfNcK8H5E2A+x(u$rZnWkThPeMbJ7G4C1z-w&t!qYmVjRgOdL9I6F3B0y)v%s#oXlUiQfNcK8H5D2A+x*u$rZnWkShPeMaJ7G4C1z)w&t!pYmVjRgOcL9I6E3B0y(v%r#oXlTiQfNbK8G5D2A-x*u$qZnWkShPdMaJ7F4C1z)w&s!pYmUjRgOcL9H6E3B+y(v%r#oWlTiQeNbK8G5D1A-x*t$qZnVkSgPdMaI7

50、F4C0z)v&s!pXmUjRfOcL9H6E2B+y(u%r#oWlThQeNbJ8G5D1A-w*t$qYnVkSgPdLaI7F3C0z)v&s#pXmUiRfOcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgPdLaI6F3C0y)v&s#pXlUiRfNcK9H5E2A+x(u$rZoWkThPeMbJ7G4D1z-w&t!qYmVjSgOdL9I6F3B0y)v%s#oXlUiQfNcK8H5E2A+x*u$rZnWkThPeMaJ7G4C1z-w&t!pYmVjRgOdL9I6E3B0y(v%s#oXlTiQfNbK8H5D2A-x*u$q

51、ZnWkShPdMaJ7F4C1z)w&s!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pXmUjRfOcL9H6E2B+y(u%r#oWlThQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZo(u%rZoWlThQeMbJ8G4D1A-w*t!qYnVjSgPdLaI6F3C0y)v&s#pXlUiRfNcK9H5E2A+x(u$rZoWkThPeMbJ7G4D1z-w&t!qYmVjSgOdL9I6F3B0y)v%s#pXlU

52、iQfNcK8H5E2A+x*u$rZnWkThPeMaJ7G4C1z-w&t!pYmVjRgOdL9I6E3B0y(v%s#oXlTiQfNbK8H5D2A-x*u$qZnWkShPeMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pXmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeMbJ8G4D1A-w*t!qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeMbJ7G4D1z-w*t!qYmVjSgOdLaI6F3B0y)v%s#pXlUiQfNcK8H5E2A+x(u$rZnWkThPeMbJ7G4C1z-w&t!qYmVjRgOdL9I6F3B0y(v%s#oXlUiQfNbK8H5D2A+x*u$qZnWkShPeMaJ7F4C1z)w&t!pYmVjRgOcL9I6E3B0y(v%r#oXlTiQfNbK8G5D2A-x*u$qZnVkShPdMaJ7F4F4C0z)w&s!pYmUjRfOcL9H6E3B+y(u%r#oWlTi