Skip to main content
Top
Published in: The journal of nutrition, health & aging 7/2016

01-07-2016

Association of dietary variety with body composition and physical function in community-dwelling elderly Japanese

Authors: Yuri Yokoyama, M. Nishi, H. Murayama, H. Amano, Y. Taniguchi, Y. Nofuji, M. Narita, E. Matsuo, S. Seino, Y. Kawano, S. Shinkai

Published in: The journal of nutrition, health & aging | Issue 7/2016

Login to get access

Abstract

Objectives

To examine the associations of dietary variety with body composition and physical function in community-dwelling elderly Japanese

Design

Cross-sectional study.

Setting

Community-based.

Participants

A total of 1184 community-dwelling elderly adults aged 65 and over.

Measurements

Dietary variety was assessed with a food frequency questionnaire (maximum, 10 points) that encompassed the 10 main food components of Japanese meals (meat, fish/shellfish, eggs, milk, soybean products, green/yellow vegetables, potatoes, fruit, seaweed, and fats/oils). Body composition was determined by multifrequency bioelectrical impedance analysis. Physical function was assessed by measuring grip strength and usual walking speed. Multiple linear regression analysis was used to examine the associations of dietary variety with body composition and physical function.

Results

After adjusting for potential confounders, higher dietary variety scores were independently associated with higher lean mass (β (SE): 0.176 (0.049), p<0.001) and appendicular lean mass (β (SE): 0.114 (0.027), p<0.001) but not with body fat mass. Elders with a higher dietary variety score had greater grip strength and faster usual walking speed (β (SE): 0.204 (0.071), p=0.004, and β (SE): 0.008 (0.003), p=0.012, respectively).

Conclusion

Greater dietary variety was significantly associated with greater lean mass and better physical function in Japanese elders. The causal relationship warrants investigation in a prospective study.
Literature
1.
go back to reference Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel J-P, Rolland Y, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39:412–423.CrossRefPubMedPubMedCentral Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel J-P, Rolland Y, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39:412–423.CrossRefPubMedPubMedCentral
2.
go back to reference Houston DK, Nicklas BJ, Ding J, Harris TB, Tylavsky FA, Newman AB, Lee JS, Sahyoun NR, Visser M, Kritchevsky SB. Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr 87:150–155. Houston DK, Nicklas BJ, Ding J, Harris TB, Tylavsky FA, Newman AB, Lee JS, Sahyoun NR, Visser M, Kritchevsky SB. Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr 87:150–155.
3.
go back to reference Beasley JM, Wertheim BC, La Croix AZ, Prentice RL, Neuhouser ML, Tinker LF, Kritchevsky S, Shikany JM, Eaton C, et al. Biomarker-calibrated protein intake and physical function in the Women’s Health Initiative. J Am Geriatr Soc 2013;61:1863–1871.CrossRefPubMedPubMedCentral Beasley JM, Wertheim BC, La Croix AZ, Prentice RL, Neuhouser ML, Tinker LF, Kritchevsky S, Shikany JM, Eaton C, et al. Biomarker-calibrated protein intake and physical function in the Women’s Health Initiative. J Am Geriatr Soc 2013;61:1863–1871.CrossRefPubMedPubMedCentral
4.
go back to reference Cesari M, Pahor M, Bartali B, Cherubini A, Penninx BWJH, Williams GR, Atkinson H, Martin A, Guralnik JM, Ferrucci L. Antioxidants and physical performance in elderly persons: the Invecchiare in Chianti (InCHIANTI) study. Am J Clin Nutr, 2004;79:289–294.PubMed Cesari M, Pahor M, Bartali B, Cherubini A, Penninx BWJH, Williams GR, Atkinson H, Martin A, Guralnik JM, Ferrucci L. Antioxidants and physical performance in elderly persons: the Invecchiare in Chianti (InCHIANTI) study. Am J Clin Nutr, 2004;79:289–294.PubMed
5.
go back to reference Kim J, Lee Y, Kye S, Chung Y-S, Kim K-M. Association of vegetables and fruits consumption with sarcopenia in older adults: the Fourth Korea National Health and Nutrition Examination Survey. Age Ageing 2015;44:96–102.CrossRefPubMed Kim J, Lee Y, Kye S, Chung Y-S, Kim K-M. Association of vegetables and fruits consumption with sarcopenia in older adults: the Fourth Korea National Health and Nutrition Examination Survey. Age Ageing 2015;44:96–102.CrossRefPubMed
6.
go back to reference Radavelli-Bagatini S, Zhu K, Lewis JR, Dhaliwal SS, Prince RL. Association of dairy intake with body composition and physical function in older communitydwelling women. J Acad Nutr Diet 2013;113:1669–1674.CrossRefPubMed Radavelli-Bagatini S, Zhu K, Lewis JR, Dhaliwal SS, Prince RL. Association of dairy intake with body composition and physical function in older communitydwelling women. J Acad Nutr Diet 2013;113:1669–1674.CrossRefPubMed
7.
go back to reference Robinson SM, Jameson KA, Batelaan SF, Martin HJ, Syddall HE, Dennison EM, Cooper C, Sayer AA. Diet and its relationship with grip strength in communitydwelling older men and women: the Hertfordshire cohort study. J Am Geriatr Soc 2008;56:84–90.CrossRefPubMed Robinson SM, Jameson KA, Batelaan SF, Martin HJ, Syddall HE, Dennison EM, Cooper C, Sayer AA. Diet and its relationship with grip strength in communitydwelling older men and women: the Hertfordshire cohort study. J Am Geriatr Soc 2008;56:84–90.CrossRefPubMed
8.
go back to reference Milaneschi Y, Bandinelli S, Corsi AM, Lauretani F, Paolisso G, Dominguez LJ, Semba RD, Tanaka T, Abbatecola AM, et al. Mediterranean diet and mobility decline in older persons. Exp Gerontol 2011;46:303–308.CrossRefPubMed Milaneschi Y, Bandinelli S, Corsi AM, Lauretani F, Paolisso G, Dominguez LJ, Semba RD, Tanaka T, Abbatecola AM, et al. Mediterranean diet and mobility decline in older persons. Exp Gerontol 2011;46:303–308.CrossRefPubMed
9.
go back to reference Shahar DR, Houston DK, Hue TF, Lee J-S, Sahyoun NR, Tylavsky FA, Geva D, Vardi H, Harris TB. Adherence to mediterranean diet and decline in walking speed over 8 years in community-dwelling older adults. J Am Geriatr Soc 2012;60:1881–1888.CrossRefPubMedPubMedCentral Shahar DR, Houston DK, Hue TF, Lee J-S, Sahyoun NR, Tylavsky FA, Geva D, Vardi H, Harris TB. Adherence to mediterranean diet and decline in walking speed over 8 years in community-dwelling older adults. J Am Geriatr Soc 2012;60:1881–1888.CrossRefPubMedPubMedCentral
10.
go back to reference Xu B, Houston DK, Locher JL, Ellison KJ, Gropper S, Buys DR, Zizza CA. Higher Healthy Eating Index-2005 scores are associated with better physical performance. J Gerontol A Biol Sci Med Sci 2012;67:93–99.CrossRefPubMed Xu B, Houston DK, Locher JL, Ellison KJ, Gropper S, Buys DR, Zizza CA. Higher Healthy Eating Index-2005 scores are associated with better physical performance. J Gerontol A Biol Sci Med Sci 2012;67:93–99.CrossRefPubMed
11.
go back to reference Xu B, Houston D, Locher JL, Zizza C. The association between Healthy Eating Index-2005 scores and disability among older Americans. Age Ageing 2012;41:365–371.CrossRefPubMed Xu B, Houston D, Locher JL, Zizza C. The association between Healthy Eating Index-2005 scores and disability among older Americans. Age Ageing 2012;41:365–371.CrossRefPubMed
12.
go back to reference Kant AK, Schatzkin A, Harris TB, Ziegler RG, Block G. Dietary diversity and subsequent mortality in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Am J Clin Nutr 1993;57:434–440.PubMed Kant AK, Schatzkin A, Harris TB, Ziegler RG, Block G. Dietary diversity and subsequent mortality in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Am J Clin Nutr 1993;57:434–440.PubMed
13.
go back to reference Kant AK, Schatzkin A, Graubard BI, Schairer C. A prospective study of diet quality and mortality in women. JAMA 2000;283:2109–2115.CrossRefPubMed Kant AK, Schatzkin A, Graubard BI, Schairer C. A prospective study of diet quality and mortality in women. JAMA 2000;283:2109–2115.CrossRefPubMed
14.
go back to reference Bernstein MA, Tucker KL, Ryan ND, O’Neill EF, Clements KM, Nelson ME, Evans WJ, Fiatarone Singh MA. Higher dietary variety is associated with better nutritional status in frail elderly people. J Am Diet Assoc 2002;102:1096–1104.CrossRefPubMed Bernstein MA, Tucker KL, Ryan ND, O’Neill EF, Clements KM, Nelson ME, Evans WJ, Fiatarone Singh MA. Higher dietary variety is associated with better nutritional status in frail elderly people. J Am Diet Assoc 2002;102:1096–1104.CrossRefPubMed
15.
go back to reference Michels KB, Wolk A. A prospective study of variety of healthy foods and mortality in women. Int J Epidemiol 2002;31:847–854.CrossRefPubMed Michels KB, Wolk A. A prospective study of variety of healthy foods and mortality in women. Int J Epidemiol 2002;31:847–854.CrossRefPubMed
16.
go back to reference Kaluza J, Håkansson N, Brzozowska A, Wolk A. Diet quality and mortality: a population-based prospective study of men. Eur J Clin Nutr 2009;63:451–457.CrossRefPubMed Kaluza J, Håkansson N, Brzozowska A, Wolk A. Diet quality and mortality: a population-based prospective study of men. Eur J Clin Nutr 2009;63:451–457.CrossRefPubMed
17.
go back to reference Wengreen HJ, Neilson C, Munger R, Corcoran C. Diet quality is associated with better cognitive test performance among aging men and women. J Nutr 2009;139:1944–1949.CrossRefPubMedPubMedCentral Wengreen HJ, Neilson C, Munger R, Corcoran C. Diet quality is associated with better cognitive test performance among aging men and women. J Nutr 2009;139:1944–1949.CrossRefPubMedPubMedCentral
18.
go back to reference Kumagai S, Watanabe S, Shibata H, Amano H, Fujiwara Y, Shinkai S, Yoshida H, Suzuki T, Yukawa H, et al. Effects of dietary variety on declines in high-level functional capacity in elderly people living in a community. Nihon Koshu Eisei Zasshi 2003;50:1117–1124.PubMed Kumagai S, Watanabe S, Shibata H, Amano H, Fujiwara Y, Shinkai S, Yoshida H, Suzuki T, Yukawa H, et al. Effects of dietary variety on declines in high-level functional capacity in elderly people living in a community. Nihon Koshu Eisei Zasshi 2003;50:1117–1124.PubMed
19.
go back to reference Kwon J, Suzuki T, Kumagai S, Shinkai S, Yukawa H. Risk factors for dietary variety decline among Japanese elderly in a rural community: a 8-year follow-up study from TMIG-LISA. Eur J Clin Nutr 2006;60:305–311.CrossRefPubMed Kwon J, Suzuki T, Kumagai S, Shinkai S, Yukawa H. Risk factors for dietary variety decline among Japanese elderly in a rural community: a 8-year follow-up study from TMIG-LISA. Eur J Clin Nutr 2006;60:305–311.CrossRefPubMed
20.
go back to reference Kimura M, Moriyasu A, Kumagai S, Furuna T, Akita S, Kimura S, Suzuki T. Community-based intervention to improve dietary habits and promote physical activity among older adults: a cluster randomized trial. BMC Geriatr 2013;13:8. doi: 10.1186/1471-2318-13-8. Kimura M, Moriyasu A, Kumagai S, Furuna T, Akita S, Kimura S, Suzuki T. Community-based intervention to improve dietary habits and promote physical activity among older adults: a cluster randomized trial. BMC Geriatr 2013;13:8. doi: 10.1186/1471-2318-13-8.
21.
go back to reference Murayama H, Nishi M, Shimizu Y, Kim M-J, Yoshida H, Amano H, Fujiwara Y, Shinkai S. The Hatoyama Cohort Study: design and profile of participants at baseline. J Epidemiol 2012;22:551–558.CrossRefPubMed Murayama H, Nishi M, Shimizu Y, Kim M-J, Yoshida H, Amano H, Fujiwara Y, Shinkai S. The Hatoyama Cohort Study: design and profile of participants at baseline. J Epidemiol 2012;22:551–558.CrossRefPubMed
22.
go back to reference Shinkai S, Yoshida H, Fujiwara Y, Amano H, Fukaya T, Ri S, Watanabe N, Watanabe S, Kumagai O, et al. A 10-year community intervention for disability prevention and its effect on healthy aging in Kusatsu town. Nihon Koshu Eisei Zasshi 2013;60:596–605.PubMed Shinkai S, Yoshida H, Fujiwara Y, Amano H, Fukaya T, Ri S, Watanabe N, Watanabe S, Kumagai O, et al. A 10-year community intervention for disability prevention and its effect on healthy aging in Kusatsu town. Nihon Koshu Eisei Zasshi 2013;60:596–605.PubMed
23.
go back to reference Kim M, Kim H. Accuracy of segmental multi-frequency bioelectrical impedance analysis for assessing whole-body and appendicular fat mass and lean soft tissue mass in frail women aged 75 years and older. Eur J Clin Nutr 2013;67:395–400.CrossRefPubMed Kim M, Kim H. Accuracy of segmental multi-frequency bioelectrical impedance analysis for assessing whole-body and appendicular fat mass and lean soft tissue mass in frail women aged 75 years and older. Eur J Clin Nutr 2013;67:395–400.CrossRefPubMed
24.
go back to reference Kim M, Shinkai S, Murayama H, Mori S. Comparison of segmental multifrequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for the assessment of body composition in a community-dwelling older population. Geriatr Gerontol Int. 2015;15:1013–1022.CrossRefPubMed Kim M, Shinkai S, Murayama H, Mori S. Comparison of segmental multifrequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for the assessment of body composition in a community-dwelling older population. Geriatr Gerontol Int. 2015;15:1013–1022.CrossRefPubMed
25.
go back to reference Chen L-K, Liu L-K, Woo J, Assantachai P, Auyeung T-W, Bahyah KS, Chou M-Y, Chen L-Y, Hsu P-S, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2014;15:95–101.CrossRefPubMed Chen L-K, Liu L-K, Woo J, Assantachai P, Auyeung T-W, Bahyah KS, Chou M-Y, Chen L-Y, Hsu P-S, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2014;15:95–101.CrossRefPubMed
26.
go back to reference Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir G V, Studenski S, Berkman LF, Wallace RB. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 2000;55: 221–231.CrossRef Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir G V, Studenski S, Berkman LF, Wallace RB. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 2000;55: 221–231.CrossRef
27.
go back to reference Shinkai S, Watanabe S, Kumagai S, Fujiwara Y, Amano H, Yoshida H, Ishizaki T, Yukawa H, Suzuki T, Shibata H. Walking speed as a good predictor for the onset of functional dependence in a Japanese rural community population. Age Ageing 2000;29:441–446.CrossRefPubMed Shinkai S, Watanabe S, Kumagai S, Fujiwara Y, Amano H, Yoshida H, Ishizaki T, Yukawa H, Suzuki T, Shibata H. Walking speed as a good predictor for the onset of functional dependence in a Japanese rural community population. Age Ageing 2000;29:441–446.CrossRefPubMed
28.
go back to reference Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, et al. Gait speed and survival in older adults. JAMA 2011;305:50–58.CrossRefPubMedPubMedCentral Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, et al. Gait speed and survival in older adults. JAMA 2011;305:50–58.CrossRefPubMedPubMedCentral
29.
go back to reference Bohannon RW (2008) Hand-grip dynamometry predicts future outcomes in aging adults. J Geriatr Phys Ther, 2008;31:3–10.CrossRefPubMed Bohannon RW (2008) Hand-grip dynamometry predicts future outcomes in aging adults. J Geriatr Phys Ther, 2008;31:3–10.CrossRefPubMed
30.
go back to reference Al-Delaimy WK, Ferrari P, Slimani N, Pala V, Johansson I, Nilsson S, Mattisson I, Wirfalt E, Galasso R, et al. Plasma carotenoids as biomarkers of intake of fruits and vegetables: individual-level correlations in the European Prospective Investigation into Cancer and Nutrition (EPIC). Eur J Clin Nutr 2005;59:1387–1396.CrossRefPubMed Al-Delaimy WK, Ferrari P, Slimani N, Pala V, Johansson I, Nilsson S, Mattisson I, Wirfalt E, Galasso R, et al. Plasma carotenoids as biomarkers of intake of fruits and vegetables: individual-level correlations in the European Prospective Investigation into Cancer and Nutrition (EPIC). Eur J Clin Nutr 2005;59:1387–1396.CrossRefPubMed
31.
go back to reference Lauretani F, Semba RD, Bandinelli S, Dayhoff-Brannigan M, Giacomini V, Corsi AM, Guralnik JM, Ferrucci L. Low plasma carotenoids and skeletal muscle strength decline over 6 years. J Gerontol A Biol Sci Med Sci 2008;63:376–383.CrossRefPubMedPubMedCentral Lauretani F, Semba RD, Bandinelli S, Dayhoff-Brannigan M, Giacomini V, Corsi AM, Guralnik JM, Ferrucci L. Low plasma carotenoids and skeletal muscle strength decline over 6 years. J Gerontol A Biol Sci Med Sci 2008;63:376–383.CrossRefPubMedPubMedCentral
32.
go back to reference Lauretani F, Semba RD, Bandinelli S, Dayhoff-Brannigan M, Lauretani F, Corsi AM, Guralnik JM, Ferrucci L. Carotenoids as protection against disability in older persons. Rejuvenation Res 2008;11:557–563.CrossRefPubMedPubMedCentral Lauretani F, Semba RD, Bandinelli S, Dayhoff-Brannigan M, Lauretani F, Corsi AM, Guralnik JM, Ferrucci L. Carotenoids as protection against disability in older persons. Rejuvenation Res 2008;11:557–563.CrossRefPubMedPubMedCentral
33.
go back to reference Volpi E, Kobayashi H, Sheffield-Moore M, Mittendorfer B, Wolfe RR. Essential amino acids are primarily responsible for the amino acid stimulation of muscle protein anabolism in healthy elderly adults. Am J Clin Nutr 2003;78:250–258.PubMedPubMedCentral Volpi E, Kobayashi H, Sheffield-Moore M, Mittendorfer B, Wolfe RR. Essential amino acids are primarily responsible for the amino acid stimulation of muscle protein anabolism in healthy elderly adults. Am J Clin Nutr 2003;78:250–258.PubMedPubMedCentral
34.
go back to reference Mecocci P, Fanó G, Fulle S, Mac Garvey U, Shinobu L, Polidori MC, Cherubini A, Vecchiet J, Senin U, Beal MF. Age-dependent increases in oxidative damage to DNA, lipids, and proteins in human skeletal muscle. Free Radic Biol Med 1999;26:303–308.CrossRefPubMed Mecocci P, Fanó G, Fulle S, Mac Garvey U, Shinobu L, Polidori MC, Cherubini A, Vecchiet J, Senin U, Beal MF. Age-dependent increases in oxidative damage to DNA, lipids, and proteins in human skeletal muscle. Free Radic Biol Med 1999;26:303–308.CrossRefPubMed
35.
go back to reference Kim J-S, Wilson JM, Lee S-R. Dietary implications on mechanisms of sarcopenia: roles of protein, amino acids and antioxidants. J Nutr Biochem 2010;21:1–13.CrossRefPubMed Kim J-S, Wilson JM, Lee S-R. Dietary implications on mechanisms of sarcopenia: roles of protein, amino acids and antioxidants. J Nutr Biochem 2010;21:1–13.CrossRefPubMed
36.
go back to reference Hayashida I, Tanimoto Y, Takahashi Y, Kusabiraki T, Tamaki J. Correlation between muscle strength and muscle mass, and their association with walking speed, in community-dwelling elderly Japanese individuals. PLoS One 2014;9:e111810. doi: 10.1371/journal.pone.0111810. eCollection 2014.CrossRefPubMedPubMedCentral Hayashida I, Tanimoto Y, Takahashi Y, Kusabiraki T, Tamaki J. Correlation between muscle strength and muscle mass, and their association with walking speed, in community-dwelling elderly Japanese individuals. PLoS One 2014;9:e111810. doi: 10.1371/journal.pone.0111810. eCollection 2014.CrossRefPubMedPubMedCentral
37.
go back to reference Ferrucci L, Bandinelli S, Benvenuti E, Di Iorio A, Macchi C, Harris TB, Guralnik JM. Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. J Am Geriatr Soc 2000;48:1618–1625.CrossRefPubMed Ferrucci L, Bandinelli S, Benvenuti E, Di Iorio A, Macchi C, Harris TB, Guralnik JM. Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. J Am Geriatr Soc 2000;48:1618–1625.CrossRefPubMed
Metadata
Title
Association of dietary variety with body composition and physical function in community-dwelling elderly Japanese
Authors
Yuri Yokoyama
M. Nishi
H. Murayama
H. Amano
Y. Taniguchi
Y. Nofuji
M. Narita
E. Matsuo
S. Seino
Y. Kawano
S. Shinkai
Publication date
01-07-2016
Publisher
Springer Paris
Published in
The journal of nutrition, health & aging / Issue 7/2016
Print ISSN: 1279-7707
Electronic ISSN: 1760-4788
DOI
https://doi.org/10.1007/s12603-015-0632-7

Other articles of this Issue 7/2016

The journal of nutrition, health & aging 7/2016 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.