Food

What Should I Eat to Live Longer?

Long studies link several eating patterns to lower mortality. They share legumes, whole grains, produce, nuts and less processed and red meat.

11 min read · Longevity365 Editorial

Nutrition advice for living longer arrives in bulk: one hero food, one villain, one diet with a founder and a book. Occasionally a podcast and a line of snack bars, too. At Humanic Blue, the question is what the research says about eating to live longer. The answer may be less exciting than a hero food, but more useful. Nobody is going to build a merch table around it.

Trials of whole dietary programs have found fewer deaths in adults at cardiovascular risk; they do not tell us how many years a particular diet adds. What long studies do show is that people whose meals most closely follow any of several healthy eating patterns tend to die later. Harvard researchers who tracked about 120,000 nurses and health professionals for decades found that four such patterns each went with roughly 14% to 20% lower risk of death. The patterns overlap heavily: vegetables, fruit, whole grains, legumes, nuts and unsaturated fats, with less red and processed meat, sugary drinks, sodium and highly processed food.

The rest of this page compares those four patterns, looks at a major heart trial, pooled survival findings and the “extra decade” headlines, then follows the question past 65, when eating enough becomes part of it.

Key Takeaways

  • Four different healthy eating patterns were each linked to about 14% to 20% lower risk of death over decades in Harvard’s long-running studies. These studies observed eating habits; they did not establish cause and effect.
  • The same patterns also track with reaching older age free of major disease and with thinking, movement and mood intact. This is an association, not proof that the eating patterns caused healthier aging.
  • One large randomized trial, PREDIMED, found a lower combined rate of heart attack, stroke or cardiovascular death with a Mediterranean diet plus olive oil or nuts. It did not establish a reduction in each component separately or added years of life.
  • Pooled dietary-program trials found fewer deaths in higher-risk adults; the programs could include support beyond diet.
  • For adults over 65, getting enough protein and energy to preserve muscle and function is part of the question, according to geriatric medicine guidance.
Cups of dried chickpeas, oats and grains on a dark surface.

Do four eating patterns point to the same result?

Researchers don’t usually study “the Mediterranean diet” as a menu. They score how closely people’s reported eating matches a pattern and follow them for decades. One of the most-cited recent comparisons, published in JAMA Internal Medicine in 2023, came from researchers at the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, with Frank Hu, who chairs Harvard’s nutrition department, as senior author. They scored about 75,000 women from the Nurses’ Health Study and 44,000 men from the Health Professionals Follow-up Study on four patterns and followed them for up to 36 years.

The four scores, in plain terms:

  • Healthy Eating Index 2015: how closely people followed the US Dietary Guidelines of the time.
  • Alternate Mediterranean: a Mediterranean-style pattern of plants, legumes, fish and olive oil.
  • Healthful Plant-based Diet Index: healthy plant foods, with less animal food and fewer refined plant foods.
  • Alternate Healthy Eating Index (AHEI): guideline foods, adjusted toward factors tied to chronic-disease risk.

People in the top fifth on each score were about 14% to 20% less likely to die during the study than people in the bottom fifth. The plant-based index sat at the low end of that range and the AHEI at the high end. Every score was also linked with fewer deaths from heart disease, cancer and respiratory disease. The authors wrote that the findings “support the recommendations of Dietary Guidelines for Americans that multiple healthy eating patterns can be adapted to individual food traditions and preferences.”

These are observational results from US health professionals, based on food questionnaires. People who eat this way may differ in other ways that the analysis can’t fully adjust for. The results cannot establish cause and effect. See the four scores side by side

Do these eating patterns also track with aging well?

A 2025 study in Nature Medicine, led by Anne-Julie Tessier of the Harvard T.H. Chan School of Public Health and the Université de Montréal, used the same cohorts to ask a harder question. It defined healthy aging as reaching 70 free of major chronic disease, with intact thinking, physical function and mental health. Of about 105,000 people followed for up to 30 years, fewer than one in ten got there.

For all eight eating patterns tested, the people who followed them most closely had roughly 1.5 to 1.9 times the odds of aging healthily compared with those who followed them least. Odds compare how often an outcome occurs with how often it does not; they are not the same as the probability of that outcome. Having 1.9 times the odds does not mean a 90-percentage-point increase in the chance of aging healthily. The plant-based index again sat at the low end and the AHEI at the high end.

The authors named the foods that tracked with healthy aging: “fruits, vegetables, whole grains, unsaturated fats, nuts, legumes and low-fat dairy products.” Trans fats, sodium, sugary drinks and red or processed meat went the other way. The study’s senior author, Marta Guasch-Ferré, leads a grant funded by the International Nut Council, according to the paper’s competing-interests statement. This is healthspan evidence, meaning years lived in good health, and it’s still observational. Inside the healthy-aging study

A major heart trial: PREDIMED

Food trials long enough to measure death are rare. The one most often cited is PREDIMED, run by a network of Spanish research groups, with Ramón Estruch of Barcelona’s Hospital Clínic as first author. It randomly assigned about 7,400 Spanish adults aged 55 to 80 at high heart risk to a Mediterranean diet with extra olive oil, a Mediterranean diet with extra nuts, or advice to cut down on dietary fat.

After about five years, both Mediterranean groups had a roughly 30% lower combined rate of heart attack, stroke or cardiovascular death than the low-fat-advice group. Those events were counted together; the result does not mean each type fell by 30%. Olive oil and nut producers, including the California Walnut Commission, donated the extra foods; the paper says the sponsors had no role in the design, analysis or reporting.

The trial’s first report, from 2013, was withdrawn and reissued in 2018 after the investigators found problems with how some people were assigned to groups. Leaving those people out gave similar results. PREDIMED measured heart events in high-risk adults. It wasn’t designed to measure years of life added. The trial’s numbers and history

There is also narrower trial evidence about survival. Giorgio Karam and colleagues’ 2023 analysis in The BMJ found moderately certain evidence of fewer deaths with Mediterranean and low-fat programs versus minimal intervention in adults at increased cardiovascular risk. Programs could include exercise, behavioral support or medication. That is evidence about whole programs and deaths during follow-up, not extra years from one food or a fixed menu.

What does PREDIMED establish about heart events, and what remains open about lifespan?

Where the “extra decade” headlines come from

If you’ve seen a headline about adding a decade to your life with food, it likely traces to a 2022 modelling study in PLOS Medicine by Lars Fadnes and colleagues at the University of Bergen in Norway. They combined earlier research summaries with Global Burden of Disease data. Their estimate: a lasting switch from a typical Western diet to their “optimal” diet at age 20 would add more than a decade of life expectancy for US women and men, and about eight to nine years if started at 60. In their model, the largest gains came from eating more legumes, whole grains and nuts, and less red and processed meat.

These are estimates, not observations. The authors rated their overall evidence as moderate quality and described the results as “population estimates.” No one has been followed to show those years actually appear. The model’s numbers

What separates a modeled gain in life expectancy from years observed in a trial?

Cooked fish, rice, broccoli and carrots in a plate and a food container.

What changes after 65? Eating enough counts too

Much longevity nutrition talk is about restraint. For many older adults, the risk runs the other way. That’s an unexpected turn for a field that mostly talks about eating less of things.

The PROT-AGE Study Group, an international panel convened by the European Union Geriatric Medicine Society, recommends that people over 65 average at least 1.0 to 1.2 grams of protein per kilogram of body weight a day to maintain muscle and function. It recommends 1.2 to 1.5 g/kg for most older adults with acute or chronic disease. People with severe kidney disease who aren’t on dialysis are the exception and may need to limit protein. The group noted that losing physical function is a warning sign for losing independence, for falls and even for death.

The 2025–2030 Dietary Guidelines for Americans make a related point: “Some older adults need fewer calories but still require equal or greater amounts of key nutrients such as protein, vitamin B12, vitamin D, and calcium.” When food intake or absorption falls short, the guidelines add, fortified foods or supplements may be needed under medical supervision. The protein guidance in full

That’s also why weight loss after 60 needs a different conversation. Losing weight without losing muscle is its own topic in this series.

The new US guidelines and a Harvard critic

The newest US guidelines, released January 7, 2026, changed the emphasis in ways that researchers are still arguing about. They set protein goals of “1.2–1.6 grams of protein per kilogram of body weight per day” for adults, encourage full-fat dairy, and list butter or beef tallow as cooking options. They keep the limit of saturated fat at no more than 10% of daily calories and call for “a dramatic reduction in highly processed foods.”

Frank Hu, MD, PhD, chair of the Department of Nutrition at the Harvard T.H. Chan School of Public Health, gave a mixed response in the school’s Nutrition Source. Hu is also the senior author of the 2023 mortality analysis and a co-author of the 2025 healthy-aging study above.

He credited the guidelines with reinforcing cuts to added sugars, refined grains and other highly processed foods. He also warned: “Substantially raising overall protein intake without distinguishing between different protein sources may have unintended long-term health implications.”

His concern is less about protein itself than about where it comes from. Hu pointed to evidence that plant proteins and fish are associated with better health outcomes than diets high in red meat, and to the guidelines’ “mixed messages” about red meat, butter and beef tallow. The guidelines and Hu disagree on these points. The full exchange

The guidelines and their critics agree on one thing: far less highly processed food. That’s covered in detail in Do Ultra-Processed Foods Shorten Your Life?

What’s Interesting

The four patterns in the Harvard comparison came from different traditions: a US government guideline, a Mediterranean regional diet, a plant-based index and a chronic-disease-focused score. Their reported relative reductions in mortality ranged from 14% to 20%, each comparing high with low adherence to that score. That range is not an absolute death-risk gap between the diets or a head-to-head ranking.

Four scorecards, built by different people for different reasons, and they ended up with nearly the same grocery list. Nutrition doesn’t often produce a result that calm. That convergence is the more useful finding for most readers. It’s also the point the study’s authors made about adapting patterns to food traditions. The details that differ among them, like dairy fat or exact protein targets, are where the live arguments are.

It’s also worth remembering who those averages describe: US nurses and health professionals filling in food questionnaires, and, in PREDIMED, older Spanish adults at high heart risk. Someone from a different food tradition, or with severe kidney disease where the protein advice changes, may not track those group results closely.

What This Means in Practice

  • The studies concern habitual eating. Their mortality associations came from decades of eating habits, rather than a short-term plan.
  • The patterns share several foods. Legumes, whole grains and nuts appear in every pattern above and had the largest modelled effects in the Bergen study. The model does not establish what an individual should eat.
  • After 65, enough food matters alongside food choices. Unplanned weight loss, a shrinking appetite or new weakness are worth raising with a clinician, and protein targets depend on kidney function.
  • Treat big life-expectancy numbers as models. They describe populations under assumptions, not a personal forecast.

A registered dietitian can translate these patterns into your food traditions, budget and medical needs. A primary care clinician or nephrologist should weigh in before a large protein increase if you have kidney disease. For the related questions of meal timing and fasting, see Does Intermittent Fasting Help You Live Longer?, and for how diet fits alongside sleep, movement and prevention, see What Are the Best Habits for Longevity?

Bottom Line

The answer the research keeps pointing to, for what to eat to live longer, is a pattern rather than a product: mostly plants, legumes, whole grains, nuts and unsaturated fats, with less red and processed meat, sugary drinks and highly processed food. Several versions of that pattern track with lower mortality and healthier aging in decades-long studies, and a Mediterranean version reduced cardiovascular events in a trial. Whole-program trials also found fewer deaths in higher-risk groups, without establishing a personal gain in years or a higher maximum lifespan. Protein targets remain under active debate. After 65, PROT-AGE guidance also emphasizes adequate protein to maintain muscle and function. A dietitian can help clarify how that guidance relates to food preferences and medical needs.

A NOTE FROM LONGEVITY365

We read research, consult expert perspectives and work to make complicated health information easier to understand. What you’re reading here reflects how we’ve interpreted and organized that information. It is educational content—not personal medical advice, diagnosis or treatment guidance.

We’re not perfect, and neither is the available research. Evidence changes, new studies emerge and what’s appropriate for one person may not be appropriate for another.

Use this article as a starting point for your own research and conversations with qualified professionals. Always talk with your doctor or another trusted healthcare professional before making decisions that could affect your health, particularly if you take medications, are receiving treatment, have existing health conditions, are pregnant or have other circumstances that could affect what’s appropriate for you.

Reader Questions

A few questions to carry into the comments or your next conversation. Please leave out identifying or personal medical details.

  • 01Which part of this food question feels most practical in real life: what to eat, how much, timing, cost, or consistency?
  • 02Where do you still see a gap between population evidence and the way one person actually eats?
  • 03What would make "What Should I Eat to Live Longer" easier to discuss without turning food into another thing to optimize perfectly?

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Extra Insights & Sources

For readers who want the details behind each claim above.

What We Know

  • Four distinct healthy eating patterns were each associated with 14% to 20% lower total mortality over up to 36 years. Supported (observational).
  • The patterns share more vegetables, fruit, whole grains, legumes, nuts and unsaturated fats, and less red and processed meat, sugary drinks, sodium and trans fat. Supported.
  • A Mediterranean diet with olive oil or nuts reduced major cardiovascular events in high-risk Spanish adults in a randomized trial. Supported.
  • Geriatric guidance calls for at least 1.0 to 1.2 g/kg of protein a day after 65, with exceptions for severe kidney disease. Supported.

What We Don’t Know

  • How many years a specific eating pattern adds to an individual’s life, or whether it changes maximum human lifespan. Unknown. Fewer deaths during dietary-program trials are a narrower survival finding.
  • How much of the cohort benefit comes from diet itself and how much from the people who choose it. Uncertain.
  • The right protein level for adults under 65 who aren’t frail. The new US guidelines and nutrition researchers currently disagree. Contested.
  • Whether modelled life-expectancy gains of a decade or more hold up in real populations. Unknown.

The four patterns in detail

Shan et al., JAMA Internal Medicine, 2023. The prospective cohort study included 75,230 initially healthy women from the Nurses’ Health Study (1984–2020; mean baseline age 50.2) and 44,085 men from the Health Professionals Follow-up Study (1986–2020; mean baseline age 53.3), 119,315 adults in all. Over 3,559,056 person-years of follow-up—the participants’ combined observation time, with one person followed for one year contributing one person-year— 31,263 women and 22,900 men died (54,163 deaths). First author Zhilei Shan; senior author Frank B. Hu.

Comparing the highest with the lowest fifth (quintile) of each score, the pooled multivariable-adjusted hazard ratios for total mortality were as follows. A hazard ratio (HR) below 1 indicates a lower rate of death during follow-up; the 95% confidence interval (CI) shows the statistical uncertainty around that estimate. These estimates account for measured differences between groups, but cannot remove all possible confounding:

PatternWhat the score rewardsLower risk of death, top vs. bottom fifthThe catch
Healthy Eating Index 2015 (HEI-2015)Following the US Dietary Guidelines of the time19% (HR 0.81; 95% CI 0.79–0.84)Tracks the 2015–2020 guidelines; US guidance has been rewritten twice since
Alternate Mediterranean (AMED)A Mediterranean-style pattern: plants, legumes, fish, olive oil18% (HR 0.82; 95% CI 0.79–0.84)A US scoring of a regional diet; the one large trial of a Mediterranean diet measured heart events, not lifespan
Healthful Plant-based Diet Index (HPDI)Healthy plant foods, with less animal food and fewer refined plant foods14% (HR 0.86; 95% CI 0.83–0.89)The smallest association of the four, here and in the 2025 healthy-aging study
Alternate Healthy Eating Index (AHEI)Guideline foods, modified toward factors tied to chronic-disease risk20% (HR 0.80; 95% CI 0.77–0.82)Top scorers drank more alcohol than bottom scorers in the 2025 healthy-aging study, which complicates the comparison

The trend in total mortality across quintiles was significant for all four scores (P < .001). All four scores were significantly inversely associated with death from cardiovascular disease, cancer and respiratory disease. The AMED score and AHEI were also inversely associated with mortality from neurodegenerative disease. The associations were consistent across Hispanic, non-Hispanic Black and non-Hispanic White participants. The authors concluded that “greater adherence to various healthy eating patterns was consistently associated with lower risk of total and cause-specific mortality,” and that the findings “support the recommendations of Dietary Guidelines for Americans that multiple healthy eating patterns can be adapted to individual food traditions and preferences.”

Disclosures listed in the paper: Megu Baden reported financial support to her institution from Kubara Honke Co. during the study; Shilpa Bhupathiraju reported personal fees from and consulting for LayerIV; Eric Rimm reported grants from and scientific advisory board service for the US Department of Agriculture/US Highbush Blueberry Growers; JoAnn Manson reported grants from the NIH during the study and from the NIH and Mars Edge outside the submitted work.

The healthy-aging study in detail

Tessier et al., Nature Medicine, 2025. Using Nurses’ Health Study and Health Professionals Follow-up Study questionnaires from 1986 to 2016, the researchers examined eight dietary patterns and ultraprocessed food intake among 105,015 participants (66% women; mean age 53). After up to 30 years, 9,771 (9.3%) achieved healthy aging, defined as living to 70 free of major chronic diseases with intact cognitive, physical and mental health.

For each pattern, higher adherence was associated with greater odds of healthy aging and its domains. Odds are the probability of the outcome divided by the probability of not having it; an odds ratio compares those odds between groups. It is neither a ratio of the probabilities themselves nor a percentage-point difference in probability. Odds ratios for the highest versus lowest quintile ranged from 1.45 (95% CI 1.35–1.57) for the healthful plant-based diet to 1.86 (95% CI 1.71–2.01) for the AHEI. With the healthy-aging threshold moved to age 75, the AHEI association rose to an odds ratio of 2.24 (95% CI 2.01–2.50).

In the authors’ words: “Higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes and low-fat dairy products were linked to greater odds of healthy aging, whereas higher intakes of trans fats, sodium, sugary beverages and red or processed meats (or both) were inversely associated.”

According to the full text (PMC12092270), participants in the highest quintile of the AHEI, MIND, healthful plant-based and several other scores consumed more alcohol than those in the lowest, while top scorers on DASH and the Mediterranean score consumed less.

Competing interests, as stated in the paper: “M.G.-F. is the principal investigator of a grant funded by the International Nut Council. The other authors declare no competing interests.” Marta Guasch-Ferré is the last-listed (senior) author; Frank B. Hu is a co-author (12th of 13).

PREDIMED in detail

Estruch et al., New England Journal of Medicine, 2018 (republished). The multicenter Spanish trial assigned 7,447 participants aged 55 to 80 (57% women), at high cardiovascular risk but without cardiovascular disease at enrollment, to a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly educational sessions and, depending on group, free extra-virgin olive oil, mixed nuts or small nonfood gifts. The primary end point was a major cardiovascular event: heart attack, stroke or death from cardiovascular causes.

After a median follow-up of 4.8 years, the trial was stopped on the basis of a prespecified interim analysis. Events occurred in 288 participants: 96 in the olive-oil group (3.8%), 83 in the nut group (3.4%) and 109 in the control group (4.4%). In the intention-to-treat analysis, participants were analyzed in their originally assigned groups. The researchers also adjusted for starting characteristics and propensity scores, statistical estimates of how likely a participant was to have received a particular assignment. In that analysis, the hazard ratios were 0.69 (95% CI 0.53–0.91) for olive oil and 0.72 (95% CI 0.54–0.95) for nuts, compared with the control diet.

The original 2013 report was retracted and republished in 2018. The investigators had identified protocol deviations, including enrollment of household members without randomization, assignment of some participants without randomization at 1 of 11 sites, and apparently inconsistent use of randomization tables at another site. Results were similar after leaving out the 1,588 participants whose assignments were known or suspected to have departed from protocol.

Funding came from grants from Spain’s Instituto de Salud Carlos III, Spanish Ministry of Health. According to the paper, the supplemental foods were donated: extra-virgin olive oil by Hojiblanca and Patrimonio Comunal Olivarero, walnuts by the California Walnut Commission, almonds by Borges and hazelnuts by Morella Nuts. The paper states that none of the sponsors had a role in designing the study, analysing the data or reporting the results.

The Bergen modelling study

Fadnes et al., PLOS Medicine, 2022. Using meta-analyses and Global Burden of Disease (2019) data with life-table methods, the University of Bergen team estimated life-expectancy changes from sustained changes in intake of 12 food groups. For US adults, a sustained switch from a typical Western diet to the optimal diet from age 20 was estimated to add 10.7 years for women (95% uncertainty interval 8.4–12.3) and 13.0 years for men (9.4–14.3). Starting at 60, the estimates were 8.0 years for women and 8.8 for men; 80-year-olds would gain 3.4 years. A “feasibility approach” diet, midway between typical and optimal, would add 6.2 years for 20-year-old US women and 7.3 for men.

The largest modelled gains came from more legumes, whole grains and nuts and less red and processed meat. Using NutriGrade, the authors rated the overall quality of evidence as moderate. They wrote that “the methodology provides population estimates under given assumptions and is not meant as individualized forecasting.” The authors declared no competing interests.

Protein after 65 in detail

PROT-AGE Study Group, Journal of the American Medical Directors Association, 2013. Appointed by the European Union Geriatric Medicine Society with other scientific organizations, the group (first author Jürgen Bauer) recommends an average daily intake of at least 1.0 to 1.2 g of protein per kg of body weight for people over 65, at least 1.2 g/kg for those who are exercising and otherwise active, and 1.2 to 1.5 g/kg for most older adults with acute or chronic disease. Older people with severe kidney disease (estimated glomerular filtration rate, or GFR, below 30 mL/min/1.73 m²—a measure of how much blood the kidneys filter each minute, standardized to body size) who are not on dialysis are an exception and may need to limit protein. The group wrote that older people are vulnerable to losing physical function, and that those losses foreshadow loss of independence, falls and even death.

Dietary Guidelines for Americans, 2025–2030 (older adults). “Some older adults need fewer calories but still require equal or greater amounts of key nutrients such as protein, vitamin B12, vitamin D, and calcium.” And: “When dietary intake or absorption is insufficient, fortified foods or supplements may be needed under medical supervision.”

The guidelines debate in detail

What the 2025–2030 guidelines say. Released January 7, 2026, by the US Department of Agriculture and the Department of Health and Human Services. Protein: “1.2–1.6 grams of protein per kilogram of body weight per day, adjusting as needed based on your individual caloric requirements.” Dairy: “When consuming dairy, include full-fat dairy with no added sugars.” Fats: “prioritize oils with essential fatty acids, such as olive oil. Other options can include butter or beef tallow.” Saturated fat: “In general, saturated fat consumption should not exceed 10% of total daily calories.” Processed food: the guidelines call for “a dramatic reduction in highly processed foods.”

Frank Hu’s response (Harvard T.H. Chan School of Public Health, The Nutrition Source, January 9, 2026). “I think the new Guidelines move in the right direction by reinforcing the importance of reducing added sugars and cutting back on refined grains and other highly processed foods.” And: “The mixed messages surrounding saturated-fat-rich foods such as red meat, butter, and beef tallow may lead to confusion and potentially higher intake of saturated fat and increased LDL cholesterol and cardiovascular risk.” On protein: “Substantially raising overall protein intake without distinguishing between different protein sources may have unintended long-term health implications.” He continued: “Evidence continues to suggest that plant-based proteins and fish are associated with more favorable health outcomes than diets high in red meat.”

Hu is the senior (last-listed, 16th of 16) author of Shan et al. 2023 and a co-author of Tessier et al. 2025.

Sources

  • Shan Z, et al. Healthy eating patterns and mortality, JAMA Internal Medicine, 2023: PubMed 36622660
  • Tessier AJ, et al. Optimal dietary patterns for healthy aging, Nature Medicine, 2025: PubMed 40128348
  • Estruch R, et al. PREDIMED (republished), New England Journal of Medicine, 2018: PubMed 29897866
  • Karam G, et al. Structured dietary programs and mortality, The BMJ, 2023. Pooled trial evidence for fewer deaths concerns adults at cardiovascular risk and whole programs, sometimes including medication, exercise or behavioral support; it does not isolate a fixed menu or establish individual years gained: PubMed 36990505
  • Fadnes LT, et al. Food choices and life expectancy, PLOS Medicine, 2022: PubMed 35134067
  • Bauer J, et al. PROT-AGE Study Group position paper, Journal of the American Medical Directors Association, 2013: PubMed 23867520
  • US Department of Agriculture and Department of Health and Human Services: Dietary Guidelines for Americans, 2025–2030
  • Harvard T.H. Chan School of Public Health, The Nutrition Source: Dietary Guidelines for Americans 2025–2030

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