This one simple lifestyle change could help prevent diabetes and other diseases, study shows

From theprint.in

One in 11 people across the globe lives with diabetes, which causes 1.5 million deaths worldwide each year. Here's to taking a stand against it

• 1 in 11 people worldwide lives with diabetes, which causes 1.5 million deaths worldwide each year.
• A new study has discovered that standing up during long periods of sitting can reduce the chances of developing type 2 diabetes, even if someone is overweight.
• The UN’s Sustainable Development Goal number 3 targets a one-third reduction in deaths attributable to noncommunicable diseases, by 2030.

It’s time to take a stand against chronic lifestyle diseases… literally. Standing can help prevent serious health conditions like type 2 diabetes, new research suggests.

Scientists from Finland’s Turku PET Centre and UKK Institute have discovered a link between standing and better insulin sensitivity.

Insulin helps regulate body metabolism and blood sugar levels. But factors like being overweight can disturb how the body’s insulin hormone functions, leading to a reduction in insulin sensitivity and an increased risk of developing chronic conditions like type 2 diabetes.

People with diabetes are susceptible to complications like stroke, blindness, kidney failure and heart disease, and at increased risk of premature death. One in 11 people worldwide lives with the disease, which causes 1.5 million deaths worldwide each year.

                         A diabetic person tests blood sugar levels | Photo: Alex Flynn | Bloomberg File Photo

Standing improves insulin production

While it’s no secret that physical exercise can help with diabetes and other non-communicable diseases, the study in Finland was unusual in that it looked closely at how periods of inactivity impact insulin production.

The findings, published in the Journal of Science and Medicine in Sport, found that when study participants interrupted long periods of sitting by standing up, their insulin function improved, even for inactive adults at higher risk of developing type 2 diabetes. Standing improved insulin regardless of how long a participant sat, their activity and fitness levels, or whether they were overweight.

“This association has not been shown before,” Taru Garthwaite, one of the study’s authors, told Science Daily. “These findings further encourage replacing a part of daily sitting time with standing, especially if physical activity recommendations are not met.”

A worldwide problem

Noncommunicable diseases (NCDs) like diabetes, heart disease, cancer, stroke and chronic lung diseases are a growing problem worldwide. So much so that the United Nations' Sustainable Development Goal (SDG) number three targets a one-third reduction in premature deaths from noncommunicable diseases by 2030.

These lifestyle-related conditions kill 41 million people - more than 70% of deaths worldwide - each year, according to the World Health Organization (WHO). More than two-thirds of these deaths are in low- and middle-income countries, which emphasizes the link between poverty and lifestyle-linked diseases.

Lack of physical exercise is one of four long-term key risk factors, alongside unhealthy diet, exposure to tobacco smoke and excessive alcohol use. Inactivity or taking insufficient exercise causes an estimated 1.6 million deaths annually.

What’s the solution?

The WHO advises people to change the unhealthy lifestyle choices that lead to the development of NDCs.

Detection, screening and treatment programmes are a vital part of managing NDCs, yet access to healthcare is limited for many people in low- and middle-income countries.

While there is no single solution to ensure greater access to global healthcare systems, policy initiatives like the WHO's Global Co-ordination Mechanism on the prevention and control of NDCs, provide a building block for collaboration to help combat this growing problem.

https://theprint.in/health/this-one-simple-lifestyle-change-could-help-prevent-diabetes-and-other-diseases-study-shows/748439/

How to take care of your feet if you have diabetes

From economictimes.indiatimes.com

By Bhavya Arora

Neglecting your feet can result in some serious complications, and may cost your life too

There is a lot to manage if you have diabetes: checking your blood sugar, making healthy food, finding time to be active, taking medicines, going for doctor’s appointments. With all that, your feet might be the last thing on your mind. In diabetic patients, foot infections are very common, and hence foot care tips are important in diabetes management. Neglecting your feet can result in some serious complications, and may cost your life too. It’s important not to ignore foot pain. If your feet hurt, it’s time to see your doctor or schedule an appointment with a podiatrist. As a matter of fact, your feet should be checked regularly even before there is a problem.

The two main foot problems that occur in people with diabetes are:

* Diabetic neuropathy: Over time, diabetes can cause nerve damage that leads to numbness in the feet. This can make it hard for people with diabetes to feel sensation in their extremities.

* Peripheral vascular disease: Diabetes leads to changes in blood vessels, including the arteries. In peripheral vascular disease, fatty deposits block these vessels and reduce the blood circulation to and from hands and feet.

How to identify signs of diabetic foot problems
If you have diabetes, contact your doctor if you have any of these problems:

* Changes in skin color

* Changes in skin temperature

* Numbness or tingling sensation

* Swelling in the foot or ankle

* Pain in the legs

* Open sores on the feet that are slow to heal or are draining

* Ingrown toenails or toenails infected with fungus

* Corns or calluses

* Dry cracks on the skin, especially around the heel

* Foot odour that is unusual or won't go away

Tips for Foot Care:
1. Keep your blood sugar levels within a good range.

2. Check your feet everyday with a mirror for cuts, blisters, red spots, swelling, colour changes, open sores, cuts, and ingrown toe nails.

3. Wash your feet everyday with lukewarm water and soap.

4. Dry your feet in between the toes. Use powder if needed

5. Keep the skin soft and smooth. Apply skin lotion over top and bottom of feet but not between your toes.

6. Trim your toenails straight across and file the edges with nail file.

7. Never walk barefoot

8. Wear shoes that are comfortable and protect your feet. Shoes should have enough air passage and soft lining inside. Always buy shoes in the evening .Wear new footwear only for around half an hour daily for 1 week to avoid bites.

9. Change your socks daily. Prefer cotton seamless socks with no holes.

10. Protect your feet from hot and cold. Don’t use hot water bottles or heating pads. Wear socks at night in winters if you feel cold.

11. Put your feet up when sitting. Move your ankles 2-3 times a day.

12. Don’t cross your legs for long periods of time.

13. Plan your physical activity with your doctor.

14. Get your feet checked by your doctor periodically.

15. Don’t use chemical agents or blades to remove corns and calluses, go and see a foot specialist.

16. Don’t wear tight socks or knee-highs.

(The writer is Nutritionist/CDE(Certified Diabetes Educator)/CPT (Certified Pump Trainer)

https://economictimes.indiatimes.com/news/how-to/how-to-take-care-of-your-feet-if-you-have-diabetes/articleshow/86884961.cms

Weight loss of 15% should be primary goal for most people with type 2 diabetes

From healio.com

Losing 15% of body weight should be a primary treatment goal for most people with type 2 diabetes and could help lead to diabetes remission, according to two speakers.

Ildiko Lingvay, MD, MPH, MSCS, a professor of medicine at the University of Texas Southwestern Medical Centre in Dallas, and Priya Sumithran, MBBS (Hons), FRACP, PhD, a senior research fellow in the department of medicine at the University of Melbourne in Australia, said health care professionals treating people with diabetes should be trained in obesity management to prepare for a future of diabetes treatment where weight loss is a major focus. 

“The treatment of obesity should be the future of diabetes treatment,” Lingvay said during a press conference at the European Association for the Study of Diabetes virtual meeting. “It is now our responsibility to work at making it the present of diabetes treatment.”

According to estimates included in a review article published in The Lancet, 40% to 70% of people with type 2 diabetes have obesity, and about 20% to 40% have cardiovascular disease. This leads to three subgroups of people with type 2 diabetes: adiposity-related diabetes, diabetes with CVD and isolated hyperglycaemia. Lingvay said treatment should be tailored specifically toward those subtypes.

“We propose a gluco-centric approach for those with beta-cell dysfunction and isolated hyperglycaemia, a cardio-centric approach in those with CVD, and a weight-centric approach in everybody else,” Lingvay said.

Weight loss of 15% as primary goal

In the review article, researchers detailed specific targets for each of the three diabetes subtypes. For isolated hypoglycaemia, the primary target should be an HbA1c of less than 7%. For diabetes with CVD, treatment should centre on the use of proven cardio-protective agents. For adiposity-related diabetes, adults should aim for 15% or more weight loss. Adiposity-related diabetes should center around weight-loss interventions and anti-obesity agents.

Researchers selected a 15% weight-loss goal due to evidence showing weight loss at that level can induce diabetes remission. For adults with type 2 diabetes participating in the Diabetes Remission Clinical Trial (DiRECT), each 1 kg of weight lost was associated with 32% greater odds for diabetes remission at 1 year (95% CI, 1.23-1.41; P < .0001). Of participants who lost 15 kg or more body weight, 86.1% had diabetes remission after 1 year.

A similar association was found in a study analysing 5,928 adults with type 2 diabetes who underwent bariatric surgery. In the study, weight loss of 10% to 15% was associated with a greater likelihood for diabetes remission compared with those who lost 5% of weight or less (HR = 1.97; 95% CI, 1.47-2.64).

Sumithran noted losing 15% or more weight is challenging. Lifestyle change plus pharmacotherapy is typically associated with weight loss of 5% to 8%. Bariatric surgery, which is invasive and not scalable for a larger population, typically results in weight loss greater than 15%. This leaves a gap in obesity treatment, but Sumithran said, new and combination pharmacotherapy, such as semaglutide (Wegovy, Novo Nordisk) and tirzepatide (Eli Lilly) could fill the gap, can induce weight loss of 15%.

“Type 2 diabetes remission is achievable for many people, particularly if they can achieve weight loss of 10% or more, and particularly if they can sustain that weight loss,” Sumithran said. “New medications are demonstrating that these targets are increasingly achievable in large numbers of participants. This presents an opportunity for how we think about treating diabetes.”

Implementing an obesity-centred approach

With weight management and type 2 diabetes closely entwined, changes will be required in clinical care, according to Lingvay. Health care professionals who treat people with diabetes will need to be trained on obesity management if they are not already, and practices may need specialized staff to assist with weight-related elements of the new diabetes treatment strategy.

“Right now, a relatively small group of physicians or providers actually address obesity or know how to treat obesity,” Lingvay said. “That will have to change. Every provider that treats diabetes would need to know how to address obesity, how to treat obesity, what available options are there, how to implement them, the benefits, how to coach the patient. Then it takes that office environment to be successful.

“All of that has to change, and it’s not going to be a quick change, it’s going to take time to get there,” Lingvay said. “But I’m optimistic that if we spread the message and people understand the benefits of this approach and the greater benefit over just focusing on blood sugar, then this will come naturally.”

https://www.healio.com/news/endocrinology/20211005/weight-loss-of-15-should-be-primary-goal-for-most-people-with-type-2-diabetes

5 Myths About Diabetes, and What You Need to Know to Stay Healthy

From prevention.com

What to eat, what to skip, who's at risk—misconceptions are as common as the condition itself

Even if you're one of the more than 34 million people with diabetes, according to the Centres for Disease Control and Prevention, there's so much confusing information out there that what's fact and what's gotten oversimplified or distorted isn't quite clear. But knowing how to prevent and treat this condition, the rate of which has doubled in the last 20 years, is key to keeping it under control. And because diabetes dramatically increases your risk of cardiovascular problems such as heart disease and stroke, taking it seriously could save your life.

Check out these diabetes myths and set yourself straight.

Myth #1 Too much sugar causes diabetes.

Sugar does not cause diabetes. Being overweight, however, is one of the major risk factors, and foods that are high in added sugar tend to be high in calories. “But keep in mind that fat has twice as many calories as sugar,” says Matt Petersen, managing director of medical information at the American Diabetes Association. Another potential culprit: eating red meat. If you’re at risk, your best bet is to lower your total calorie intake and get those calories from nutrient-rich foods like non-starchy vegetables, whole grains, and low-fat protein and dairy, says Christine Lee, M.D., of the National Institute of Diabetes and Digestive and Kidney Diseases. And when you have a hankering for a sweet, focus on foods with naturally occurring sugar.

Myth #2 You can only get type 1 diabetes as a kid.

There’s a reason type 1 diabetes isn’t called juvenile diabetes anymore—you can get it at any age, says Petersen. Five percent of U.S. adults have been diagnosed with type 1, but sometimes grown-ups are misdiagnosed with the more common type 2, says Sara Pinney, M.D., a paediatric endocrinologist at Children’s Hospital of Philadelphia. The two types of diabetes have different causes: In type 1 diabetes, “the body attacks the pancreatic beta cells by mistake, causing them to stop making insulin,” the hormone that lowers glucose in the blood, says Dr. Pinney. With type 2, the pancreas makes insulin, but the body doesn’t respond well to it. Patients with type 1 need to take insulin to normalize their blood sugar, or they will become very ill. To tell the difference, your doctor may test for certain antibodies in your blood.

Myth #3 If you have type 2 diabetes, you need insulin.

Most people don’t—many are able to control their diabetes through diet and exercise, oral medication, or a combination of both. Of those with type 2 diabetes, only 40% use insulin, according to the Centres for Disease Control and Prevention. Your need for insulin may change with age, though. “Eventually, to keep your blood glucose levels in a healthy range, you might need to use it,” Petersen says. “And that’s OK. It’s just that your disease has progressed and now you’re taking the best step to manage it.” (And if you have type 1 diabetes, you will need to take insulin right from the start.)

Myth #4 You’d know if you had diabetes.

It can take months—or even years—for symptoms to get extreme enough for people to figure out on their own that they have type 2 diabetes, says Dr. Pinney. That’s because the most common signs, increased urination and thirst, are easy to overlook or to write off as part of getting older. By the time more noticeable symptoms like blurry vision or tingling hands and feet prompt someone to make a doctor’s appointment, he or she may have had elevated blood sugars for a long time. An estimated 24% of people with diabetes are undiagnosed, which is why doctors recommend that those with major risk factors—such as being 45 or older, being overweight, or having a family history of diabetes—have their A1C tested periodically. This simple blood draw will give your doc a snapshot of your blood glucose levels over the past three months and is one way to diagnose diabetes.

Myth #5 The only reason diabetes docs tell patients to exercise is so they’ll lose weight.

Nope! While it may help people lose weight, exercise (even if you don’t drop pounds) also increases your insulin sensitivity, which naturally lowers your blood glucose. Studies have shown that a single bout of exercise can improve insulin sensitivity by up to 50% for as long as 72 hours after the sweat session. And even if your weight stays exactly the same, exercise can lower your A1C (long-term glucose levels) and your odds of developing diabetes. That’s because when muscle cells are active, they’re able to take up glucose and use it for energy without needing any insulin, says Petersen. “Exercise is kind of a miracle treatment in its own way.”

https://www.prevention.com/health/health-conditions/a32404289/diabetes-myths/

Type-2 diabetes: Study blames THIS one action most, suggests the right time to eat

From timesnownews.com

Type-2 diabetes, although a condition that increases risk of mortality and other chronic diseases, is in truth triggered by our everyday habits like diet and lifestyle

New Delhi: The year 2020 was debilitating – ironically, not only because of the COVID-19 pandemic. While COVID-19 did claim hundreds and thousands of lives, turns out that type-2 diabetes was another killer in hiding that caused three times as many deaths as coronavirus.

Type-2 diabetes, although a condition that increases risk of mortality and other chronic diseases, is in truth triggered by our everyday habits like diet and lifestyle. While some simple choices can easily ward off the risk, there are others that unknowingly spike blood sugar levels and disturb insulin sensitivity. Wondering what it is? Keep reading to find out.

Diabetes: How it affects health

Diabetes refers to a state wherein the body fails to process sugar (glucose) properly. When a non-diabetic person consumes sugar, the pancreas releases insulin which converts the same component into energy by breaking it down into glucose. When affected with diabetes, the pancreas either does not produce enough insulin or the body becomes resistant to it, thereby disturbing the balance and spiking blood sugar levels.

Over time, high blood sugar levels can affect the arteries and may trigger heart disease, stroke, and eye problems and might even increase risk of limb amputation in extreme cases.

Which dietary habit is a major risk factor of type-2 diabetes?

One of the major risk factors of type-2 diabetes is sugar intake – be it in the form of desserts or through carbonated drinks. When sugar intake increases drastically over time, it can disturb the insulin and blood sugar balance thereby resulting in diabetes. Therefore, the easiest way to not stress the pancreas or task the insulin supply is cutting down or managing sugar consumption.

While fruits contain natural sugars in the form of fructose which in limited quantities is healthy; sugar-sweetened drinks, carbonated sodas, refined carbs like cookies, chips, breads and other processed foods  contain high quantities of refined sugars which in no way can benefit your health. To banish them from your diet, replace these foods with complex carbs like whole grains, vegetables and oats so that they take time to break down and don’t spike blood sugar levels drastically.

One of the major risk factors of type-2 diabetes is sugar intake – be it in the form of desserts or through carbonated drinks  |            Photo Credit: iStock Images

The beverage diabetics must avoid

When it comes to managing sugar intake, sweetened beverages like sodas must be eliminated first. Turns out, one glass of sweetened soda contains 39 grams of sugar which is way more than what a person needs in a day. And to further improve the outcome, a 2017 study published in the Cleveland Clinic Journal of Medicine recommends combining a healthy diet with an exercise regimen. This can help improve insulin sensitivity, maintain a healthy body mass index and builds muscle mass.

Is there a right time to eat your meals for type-2 diabetes management?

While diet and exercise play a key role in type-2 diabetes management, what matters more is eating at the right time, and the most important meal of the day – your breakfast – can leave a lasting impact.  According to a new study, eating breakfast on the early side of the day can help lower risk of type-2 diabetes and other metabolic disorders. Presented in the Endocrine Society’s annual meeting, the study’s results revealed that people who had an early breakfast – before 8.30 am – had lower blood sugar levels and insulin resistance.

Disclaimer: Tips and suggestions mentioned in the article are for general information purposes only and should not be construed as professional medical advice. Always consult your doctor or a professional healthcare provider if you have any specific questions about any medical matter.

https://www.timesnownews.com/health/article/type-2-diabetes-eat-at-the-right-time-breakfast-blood-sugar-levels-diabetes-metabolic-disorders-high-blood-sugar/819703

Drs. Oz and Roizen: Your three goals for diabetes control

From mainstreet-nashville.com

When Allen Iverson retired from the NBA in 2010, he headed for the Hall of Fame because of his astounding control of the ball. His dribbling magic allowed him to repeatedly provide his teams (the 76ers, Nuggets, Pistons and Grizzlies) with a healthy lead.

That’s the same kind of artful control you want to execute so you can get a healthy lead on your Type 2 diabetes — and stay in the game of life! Unfortunately, when it comes to reaching the big three goals that will make you the master of your diabetes, most of you are benching yourselves!

A new study in JAMA Network reveals that only about 21% of adults with diagnosed diabetes hit their healthy targets, which are essential for reducing the risk of serious complications such as heart attack, nerve, kidney and eye damage, and gastro-distress.

The targets include: 1. an individualized target for your A1c — a measure of your blood sugar levels over several months; 2. blood pressure of less than 130/80; and 3. a lousy LDL cholesterol level below 100 mg/dL. And those targets are more generous than what we recommend — an A1c of below 7%, blood pressure of 120/75 or less, and an LDL of 70 mg/dL.

So arrange for a doc visit to evaluate your A1c, blood pressure and LDL cholesterol level. Then set up a team strategy, working with your doctor, a nutritionist and exercise coach. Together you can get your numbers in a game-winning range. Diabetes can be controlled — even reversed. Slam dunk!

©2021 Michael Roizen, M.D. and Mehmet Oz, M.D.

https://www.mainstreet-nashville.com/life/drs-oz-and-roizen-your-three-goals-for-diabetes-control/article_8ed0820d-6320-5676-943e-ab48cf2cc742.html

Reversing type 2 diabetes: Visceral fat more important than overall weight

From medicalnewstoday.com

• Researchers have shown that for people with overweight or obesity, losing weight can reverse type 2 diabetes.
• In a small study, the team found that weight loss reversed type 2 diabetes in participants, even though their body mass index (BMI) was in a moderate range.
• The study authors believe that lowering levels of fat around the organs may be more important than lowering BMI.

In a small, preliminary study, researchers have found that people with type 2 diabetes who also have a BMI that falls within a moderate range can reverse their diabetes by losing weight.

The researchers reported their findings at the Annual Meeting of the European Association for the Study of Diabetes. 

Type 2 diabetes

Type 2 diabetes is the most common form of diabetes, accounting for around 91.2%Trusted Source of diabetes cases in the United States.

The condition occurs when a person’s body does not produce enough insulin or if the insulin no longer works effectively. Insulin normally helps glucose enter the cells of the body. In the absence of insulin, glucose stays in the blood, where it can damage organs and tissues.

This means that a person with type 2 diabetes has an increased risk of several health issues, including stroke, heart disease, issues with their feet, kidney disease, dental issues, and bladder problems.

According to researchers writing in the journal Nutrients, scientists for a long time believed that type 2 diabetes was incurable, so they primarily focused on how people should manage symptoms of the condition.

However, evidence now suggests that if individuals who are overweight or have obesity achieve and maintain weight loss, they can reverse type 2 diabetes.

Weight loss without overweight?

In the present small, preliminary study, researchers have gone one step further and examined whether weight loss might reverse type 2 diabetes even in those whose weight falls within the moderate BMI range.

Medical News Today spoke with the study’s first author, Dr. Ahmad Al-Mrabeh, a Transitional Research Fellow at the Centre for Cardiovascular Science at Queen’s Medical Research Institute at the University of Edinburgh in the United Kingdom.

He explained that they decided to explore whether weight loss could be effective at reversing type 2 diabetes for people with moderate BMI after looking at the results of their previous research.

“We observed that the metabolic profile changed markedly after following a low calorie diet even when the change in body weight was […] minor. We, therefore, wanted to test whether inducing modest weight loss could achieve remission in those who are non-obese,” said Dr. Al-Mrabeh.

According to the principal investigator of the study, Prof. Roy Taylor, Director of the Newcastle Magnetic Resonance Centre at Newcastle University, U.K., “[o]ur previous research has shown that weight loss of 10–15% can achieve remission in people with type 2 diabetes who are overweight or obese.”

“Doctors tend to assume, however, that type 2 diabetes has a different cause in those who aren’t overweight. This means that, unlike those who are overweight, those who are of [moderate] weight aren’t usually advised to lose weight before being given diabetes drugs and insulin.”

“Instead, there’s a tendency to start them on insulin and other medication at a much earlier stage.”

“What we’ve shown is that if those of [moderate] weight lose 10-15% of their weight, they have a very good chance of getting rid of their diabetes.”

Preliminary study

The study involved just 23 people. Of these, 12 individuals had a type 2 diabetes diagnosis with an average age of 58.3 years and an average BMI of 24.5. The remaining 11 did not have diabetes and were of similar age and BMI. This group acted as the control.

The Centres for Disease Control and Prevention (CDC) classify BMI scores of 18.5-24.9Trusted Source as “healthy.”

All participants followed a low calorie diet for 2 weeks, consuming no more than 800 calories each day. The researchers then supported them to maintain their new weight for 4–6 weeks.

They completed this cycle two or three times until all participants had reduced their body weight by 10–15%.

The researchers measured each participants’ visceral fat and insulin sensitivity before, during, and after the study.

Remission in two-thirds

At the end of the study, the researchers matched the people with diabetes with control participants of the same age, sex, and BMI. The scientists found that the individuals with diabetes lost more than twice as much fat in their liver compared with the controls.

In the diabetes group, fat in the pancreas reduced from 5.1% to 4.5%. Also, their average triglyceride levels fell from 1.6 millimoles per litre to 1.0 millimoles per litre — a significant reduction similar to the control group.

Most significantly, two-thirds of the participants found that their type 2 diabetes went into remission and could stop taking their medication.

Prof. Taylor says that “[t]hese results, while preliminary, demonstrate very clearly that diabetes is not caused by obesity but by [carrying too much weight] for your own body. It’s due to having too much fat in your liver and pancreas, whatever your BMI.”

“In the liver, this excess fat prevents insulin from working normally. In the pancreas, it causes the beta cells to stop producing insulin.”

Dr. Al-Mrabeh said to MNT that the results may be reproducible in larger studies, “however, it is important to understand the mechanisms of excess fat build-up within these vital metabolic organs (liver and pancreas) in non-obese people.”

Speaking with MNT, Prof. Pål R. Njølstad, Leader of the Centre for Diabetes Research at the University of Bergen, Norway, said that “[t]he findings are interesting and indicate that weight loss is also important in non-obese individuals with type 2 diabetes.”

Prof. Njølstad added that “[m]ore studies are needed with an increased number of study participants and increased time of follow up, in addition to investigating the effect of other factors, such as age, sex, and ethnicity.”

Dr. Al-Mrabeh said to MNT that he will continue developing the initial findings.

“I have recently moved to the University of Edinburgh to establish an independent research program looking into the mechanisms of how excess fat causes damage to the pancreas in type 2 diabetes. My aim is to dissect these mechanisms using both human and animal studies.”

https://www.medicalnewstoday.com/articles/reversing-diabetes-visceral-fat-more-important-than-overall-weight#Remission-in-two-thirds