It is well documented that behavioural and biological risk factors for Chronic Diseases of Lifestyle (CDL) such as overweight and high blood pressure persist from childhood into adulthood. CDL is considered to be a group of diseases that shares similar risk factors as a result of exposure over many decades to physical inactivity, unhealthy diets, smoking, lack of regular exercise, and possibly stress. This study assessed health-related physical fitness and risk factors associated with obesity among 1361 (boys: n=678; girls: n=683) primary school children aged 9-12 years in the Limpopo (LP) and Mpumalanga (MP) Provinces, South Africa. Anthropometric and physical fitness measurements were taken using the protocol of the International Society for the Advancement of Kinanthropometry (ISAK) (Marfell-Jones, et al., 2006) and EUROFIT (1988) test batteries. Body composition measures included body mass index (BMI) (weight/height2), percentage body fat (%BF) and waist-to-hip ratio, respectively. BMI for age and gender was used to classify the children as underweight, overweight or obese (Cole et al., 2007), whilst %BF calculated from the sum of two skinfolds (triceps and subscapular) using the equation of Slaughter et al. (1988) indicated adiposity. The International Physical Activity Questionnaire (IPAQ) was used to categorise the children’s physical activity (PA) level as follows: Low (METs scores of less than 500); Moderate (METs scores from 500 to 1499) or High (METs >1500). In general, 75% of the children were underweight/stunted and 1.6% overweight. Frequencies of underweight, normal weight and overweight were 77%, 22.4% and 0.2% in MP and 72%, 24% and 3% in LP province. Boys were generally taller and heavier than girls. At age 10 the MP boys performed significantly (p=0.05) better in sit-ups (SUP: 20.5 ±5.4) than the LP boys (18.6±6.56). However, the LP boys performed significantly better than the MP boys in sit-and-reach (SAR) at ages 10 and 11. The MP boys performed significantly (p=0.00) better in SBJ (121.6±9.1cm) compared to the Limpopo (118.4±11.00cm) boys at age 9. Generally, LP boys were significantly (p=0.00) better than the MP boys across all ages. The PA results showed that 27.7% (377), 58.5% (796) and 13.8% (188) of the children participate in low, moderate and high PA, respectively. Children in the MP province had higher PA (28.6%) in comparison to the low PA participation in LP children (26.7%). Furthermore, 59.7% of MP children compared to the LP children (57.3%) participate in moderate PA. A higher PA participation rate (15.8%) was found among the LP than MP children (11.6%). The girls had non-significantly higher BP values (systolic: 112.94±11.28mmHg; diastolic: (79.40±12.80mmHg) than boys (systolic: 110.71±14.95mmHg; diastolic: (75.53±12.53mmHg) who had higher PA levels (METs =1286.72±317.47) than girls (METs =397.28±30.14) (p<0.01). A total of 81% (n=1089) and 19% (n=253) of the combined samples had normal BP and prehypertension, respectively. When controlled for provinces, gender and age, results indicated that BMI was negatively associated with systolic BP (SBP) (-0.54) (p<0.01), but positively correlated with %BF (0.133) (p<0.01), whilst SBP related positively with %BF (0.125) (p<0.01). The children’s PA level correlated positively with BMI (0.86) (p<0.01) but negatively with %BF (-0.67); weight circumference (WC) (-0.41); SUP (sit-up) (-0.22); and predicted 2max • VO (-0.17) (p<0.05). The high percentage of underweight and pre-hypertensive children in the study warrants an urgent need to periodically evaluate PA levels among South African children and design appropriate intervention programmes to alleviate concerns over body weight disorders and low PA levels in children, thus optimising health outcomes. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2015

The Body Mass Index (BMI) is a tool used broadly by public health agencies to assess weight in populations. However, when differentiating between fat mass and fat free mass the formula (BMI = weight in kilograms/height in meters2) is not applicable. Research suggests that evaluating body fat percentage and adipose tissue deposition may provide a nuanced indication of overall health, making it more accurate on an individual basis. This study evaluated four methods (Body Mass Index, waist circumference, A Body Shape Index, and Waist to Stature Index) that assess body composition and their ability to predict body fat percentage in female collegiate athletes and overweight/obese females. The study also investigated if the CUN‐BAE formula could calculate body fat percentage accurately in comparison to air displacement plethysmography in both populations. The study found that the universality of these algorithms is uncertain in diverse populations and that the predictive power of anthropometric‐based formulas is inconsistent when considering body fat percentage.

ABSTRACT Title: Relative Energy Deficiency in Female Collegiate Track & Field Athletes. Background: Energy deficiency and its consequences have long been studied in female athletes because of it’s potential for increasing risks of illness and injury. Sustaining an energy deficient diet while training and during competition may result in muscle loss and reduction in performance. Studies suggest that athletes competing in sports focusing on appearance or a lean physique are at high risk for energy deficiency. In 2014, the IOC developed the concept of ‘Relative Energy Deficiency in Sport’ (RED-S) to include new components not previously included in the Female Athlete Triad. A study has not yet been completed applying the RED-S paradigm in collegiate track and field athletes. Objective: The purpose of this study was to examine the prevalence of RED-S in female collegiate track and field athletes. It was hypothesized that the majority of collegiate track and field athletes experience RED-S. It was also hypothesized that a greater percentage of distance runners experience RED-S than other track and field athletes, including throwers, jumpers, and sprinters. The components of RED-S assessed were menstrual function, bone health, and energy expenditure. Methods: This study was a descriptive cross-sectional study, obtaining data through the use of a questionnaire and a relative energy expenditure index on a population of 12 female collegiate track and field athletes. Data were obtained through the use of a LEAF-Q questionnaire, a three-day food and exercise recall, and body composition analysis. Results: The 12 athletes were a combination of distance runners (n=5), throwers (n=2), and sprinters (n=5). Average subject characteristics were: age (20.6 ±1. 44 years), height (165.6 ±7.5cm), weight (63.58 ± 16.97kg), and body fat percentage (20.9± 7.2). Average energy intake over three days was 2146 kcal (±627), and the average predicted energy expenditure was 2380 kcal (±458). Average hours spent in a catabolic (52.8 ± 24.0), highly catabolic (37.5 ± 25.0), anabolic (19.2 ± 24.0), and highly anabolic state (12.4 ± 21.0). Subjects were in a negative energy balance state the majority of the days analyzed, and 75% of the population had at least one day of dietary recall below 45 kcal/kg FFM/day. Spearman’s rho analysis found a significant inverse correlation between Day 1 hours spent in optimal energy balance (± 400 kcal) and body fat percent (p=0.024, rs= -0.643), and significant positive correlation between Day 1 hours spent in optimal energy balance (± 400 kcal) and fat free mass percentage (p=0.03, rs=0.625). Spearman’s rho analysis also found an inverse correlation between Day 1 hours spent in an energy deficit (s= -0.626), and a positive correlation between Day 1 hours spent in an energy deficit and body fat percentage (p=0.026, rs=0.636). Seven out of twelve participants scored ≥ 8 on the LEAF-Q putting them at risk for RED-S. Conclusion: The study highlights the misleading effect of averaging multiple days of dietary recall on energy balance. When participant’s dietary recalls were assessed day by day the majority of hours were spent in a catabolic state, however when the three days of the recall were averaged the severity of the hours spent in a catabolic state lessened. The associations in this study are consistent with previous studies evaluating the relationships between energy balance deficits and body composition, indicating that longer duration spent in an energy deficit is associated with lower lean and higher fat mass. The findings from the LEAF-Q show that 58% of participants were at risk for RED-S, and half of all participants had or were experiencing menstrual dysfunction.

We aimed to determine the short- and long-term effects on growth, body composition, metabolic and inflammatory markers following supplementation with the probiotic Lactobacillus paracasei ssp. paracasei F19 (LF19) during weaning. Methods: One-hundred and seventy-nine healthy, infants in Umeå city, Västerbotten County were randomised to daily intake of cereals with (n=89) or without (n=90) LF19 108 colony-forming units from 4 to 13 months of age. Weight, length, head circumference and body composition, assessed by skinfold thickness, were examined at 4, 5.5, 6.5, 9, 12 and 13 months of age. Venous blood was drawn at 5.5 and 13 months. In all, 171 infants completed the intervention and were invited to a follow-up at 8-9 years of age between 2009 and 2011, 120 children participated. Weight, height, sagittal abdominal diameter and body composition (using Dual Energy X-ray Absorptiometry-scan) were measured. Data on weight and height at 4 years were collected from medical records. The families filled out a 4-day food record and a food frequency questionnaire, physical activity was assessed using a pedometer for 7 days. At 5.5, 13 months and 8-9 years of age we analysed the serum blood lipid profile. At 8-9 years fasting glucose, insulin, aspartate and alanine transaminases were analysed in serum. Homeostatic Model Assessment index was calculated. At follow-up serum adiponectin, high-sensitivity C-reactive protein and plasma C-peptide, ghrelin, gastric inhibitory polypeptide, glucagon-like peptide 1, glucagon, insulin, leptin, plasminogen activator inhibitor-1, resistin and visfatin were analysed. For characterisation of the plasma metabolome, a subgroup (n=40) was analysed at 5.5 and 13 months of age by gas chromatography time-of-flight mass spectrometry (GC-TOF/MS) analysis and in all (n=112) children at the follow-up using untargeted GC-GC/MS. Results: There were no differences between the LF19 and placebo group regarding body weight, length/height at any assessment from 4 months to 8-9 years of age; nor were there any differences between the groups in body composition. In the LF19 group 19 % were overweight/obese, the corresponding number was 21 % in the placebo group (p=0.78). Analysed metabolic and inflammatory markers, both during the intervention and the follow-up did not differ between the two groups. At 13 months of age lower levels of palmitic acid and palmitoleic acid (both p&lt;0.04) and higher levels of putrescine (p&lt;0.01) were seen in the LF19 compared to the placebo group. These differences did not persist at 8-9 years of age. At that age, we found statistically stronger models when comparing overweight/obese and normal weight children as well as in relation to sex. Conclusion: Early intervention with the probiotic LF19 at the time of weaning exerted transient effects on the metabolome. In a long-term perspective, we found neither benefit nor harm on growth, body composition, metabolic or inflammatory markers following supplementation with LF19 during weaning.

The aim of this thesis was to investigate the effects of dietary fatty acids on body composition and ectopic fat in humans, with emphasis on the role of the omega-6 polyunsaturated fatty acid (PUFA) linoleic acid (18:2n-6) and the saturated fatty acid (SFA) palmitic acid (16:0). The overall hypothesis was that linoleic acid would be beneficial compared with palmitic acid during overfeeding, as previously indicated in animals. Papers I, II and IV were double-blinded, randomized interventions in which different dietary fats were provided to participants and Paper III was a cross-sectional study in a community-based cohort (PIVUS) in which serum fatty acid composition was assessed as a biomarker of dietary fat intake. In Paper I, overfeeding with sunflower oil (n-6 PUFA) for 7 weeks caused less accumulation of liver fat, visceral fat and total body fat (as assessed by MRI) compared with palm oil (SFA) in young and lean subjects despite similar weight gain among groups. Instead, sunflower oil caused a larger accumulation of lean tissue. In Paper II, plasma from Paper I was analyzed with NMR-based metabolomics, aiming to identify metabolites differentially affected by the two dietary treatments. Acetate decreased by PUFA and increased by SFA whereas lactate increased by PUFA and decreased by SFA. In Paper III, the proportion of linoleic acid in serum was inversely associated with contents of visceral-, subcutaneous- and total body adipose tissue whereas the proportion of palmitic acid was directly associated with visceral- and total body adipose tissue in 70-year old men and women. In Paper IV, overfeeding with sunflower oil for 8 weeks caused less accumulation of liver fat compared with palm oil also in overweight and obese subjects. SFA increased visceral fat in men only. Accumulation of lean tissue was similar between groups. In conclusion, SFA (palmitic acid) from palm oil promotes marked liver fat accumulation in both normal-weight and overweight/obese subjects during overeating, whereas n-6 PUFA (linoleic acid) from sunflower oil prevents such liver fat accumulation. Diverging effects of SFA and PUFA on visceral adipose tissue and lean tissue may only be applicable in some groups and/or circumstances. These results imply that negative effects associated with weight gain (e.g. fatty liver) may be partly counteracted by the type fat in the diet, overall supporting a beneficial role of diets higher in unsaturated fat compared with saturated fat for preventing liver fat accumulation.

Thesis (MScSportSc)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: There is a universal concern about the rapid decline in the physical activity levels of children, particularly adolescent girls. There is evidence of an increase in juvenile obesity that is associated with numerous health risks. During adolescence the majority of psychological problems associated with obesity stem from a disturbance in the self-concept. The purpose of this study was to determine the relationship between fitness, body composition and physical selfperception of a sample of 167 adolescent girls (14-17 years), and to compare these results with the results of similar studies from around the world. The results show a significant positive relationship (r = 0.47; P < 0.01) between levels of cardiorespiratory fitness and physical self-perception and significant negative relationships between percentage body fat and physical self-perception (r = -0.35; p < 0.01), as well as body composition and cardiorespiratory fitness (r = -0.47; P < 0.01). The results clearly illustrate the current prevalence of obesity associated with low cardiorespiratory fitness (due to inactivity) and low selfperception. The importance of being physically active for the physical and psychological well-being of adolescents is a valuably preventive and treatment measure. / AFRIKAANSE OPSOMMING: Die bekommernis oor die toenemende afname in die fisieke aktiwiteitsvlakke van kinders, veral adolessente meisies, blyk 'n universele verskynsel te wees. Bewyse is gevind van 'n toename in obesiteit by kinders wat verband hou met verskeie gesondheidsrisikos. Tydens adolessensie word die meeste sielkundige probleme wat verband hou met obesiteit deur 'n versteuring in die selfkonsep veroorsaak. Die doel van hierdie studie was om vas te stel wat die verband tussen fiksheid, liggaamsamestelling en fisieke selfpersepsie is. Die steekproef het bestaan uit 167 adolessente meisies (14 - 17 jaar oud) en hierdie resultate is vergelyk met die resultate van soortgelyke studies van regoor die wêreld. Die resultate toon 'n beduidend positiewe verband (r = 0.47; P < 0.01) tussen kardiorespiratoriese fiksheidsvlakke en fisieke selfpersepsie vlakke en beduidend negatiewe verbande tussen liggaamsvetpersentasie en selfpersepsie (r = -0.35; P < 0.01) sowel as liggaamsamestelling en kardiorespiratoriese fiksheid (r = -0.47; P < 0.01). Die resultate toon dat die voorkoms van obesiteit met lae kardiorespiratoriese fiksheid (as gevolg van 'n gebrek aan fisieke aktiwiteit) en lae selfpersepsie verband hou. Die belangrikheid van fisieke aktiwiteit vir die fisieke en sielkundige welstand van adolessente is 'n waardevolle voorkomende en behandelingsmetode.

Obesity increases the risk for the development of cardiovascular disease, type 2 diabetes and other co-morbid conditions. Type 2 diabetes also is often associated with excessive visceral abdominal fat. Weight loss in obese individuals decreases the risk for developing the co-morbid conditions. Individuals with type 2 diabetes often have a greater difficulty in controlling these complications compared to individuals without type 2 diabetes. The purpose of this study was to evaluate adherence to a medically-supervised low-energy diet (LED) weight loss program and changes in body composition and metabolic parameters after weight loss in women with and without type 2 diabetes. Subjects consisted of Caucasian women, between the ages of 40 to 65 years, with BMIs between 30 and 45 kg/m2. There was no significant difference in BMI between the groups at study initiation (38.1 kg/m2, diabetics (DM) and 36.0 kg/m2, non-diabetics (NDM), p=0.2314). All subjects participated in the HMR Program for 16 weeks. Twenty-nine subjects completed the weight loss phase (18 diabetics, 11 non-diabetics) and were evaluated for change in weight, body composition, and blood parameters. Data were analyzed by repeated-measures ANCOVA and students t-tests using SAS version 8.02. DM and NDM lost 11.7% and 16% of body weight, respectively (p=0.6474). Results indicate DM has more total lean tissue (p=0.004), more total body fat (p=0.04), more total abdominal tissue (p=0.001), more visceral adipose tissue (p=0.001) and lost less percent body fat (p=0.04) than NDM after 16 weeks of weight loss. After weight loss there was no significant difference in leptin, ghrelin or adiponectin levels. DM had greater insulin (p=0.05), HOMA-IR (pandlt;0.0001), glucose (pandlt;0.0001), HbA1c (pandlt;0.0001), resistin (p=0.04) and PAI-1 (p=0.02). There were no differences after weight loss in lipid levels, blood pressure, diet compliance or exercise. The data show that medically-supervised LEDs are safe and effective for treating obesity in individuals with type 2 diabetes. Cardiovascular risk factors improved in both NDM and DM subjects with weight loss. The findings also suggest that insulin and metabolically dysfunctional lean tissue may play a critical role in the complex axes affecting changes in body composition and inflammation in individuals with type 2 diabetes.

Objective. This study was designed to test the hypotheses that a 16-week, individualized, intensive strength training program in rheumatoid arthritis (RA) patients taking Remicade™ (Infliximab) would improve strength, body composition, disease activity, physical function, pain and quality of life outcomes , as compared to RA patients on Remicade™ with no strength training program. Methods. Twenty-four patients with RA taking Remicade™, participated in a randomized, controlled trial. The exercise group carried out a three time a week strength training program, with the control group continuing standard of care. Assessments were completed at baseline, 8-week, and 16-week time points . Maximal strength, physical function, disease activity, body composition, quality of life, and pain were measured with active tests and via questionnaires. Patients also completed exit evaluations on their satisfaction with the study. Results. Highly significant strength gains were seen in the exercise group according to 3 repetition maximums (3RMs) (p<.01), as well as in all 8 exercises performed in the gym (p<.01). The mean exercise attendance for the 16 weeks was 82.0±10.6%. Compared to the control group, there was a significant increase in right hand grip strength (p<.1), and lean tissue in the trunk (p<.01). Significant improvements were also seen in physical function according to 50-foot walk time (p<.01), the Arthritis Impact Measurement Scale 2 (AIMS2) hand and arm function subscales (p<.05), and the Medical Outcomes Study Short Form 36 (MOS SF-36) (p<.1), as compared to controls. The exercise group showed clinically important differences via the Health Assessment Questionnaire Disability Index (HAQ DI), with a mean change of -0.41±0.42. Significant reductions in pain, as measured by the Pain Visual Analogue Scale (VAS), also occurred (p<.1). The individualization of the strength training program and personal attention received by the patients was critical to the success of the study. Patient satisfaction with the study was high, with limitations due primarily to funding constraints. Conclusion. This 16-week high intensity strength training program led to statistically significant improvements in strength, lean soft tissue, disease activity, function, pain and quality of life in this RA population. No detrimental effects on the disease were seen in this study.

The prevalence of obesity is a growing problem for children and adolescents worldwide (Schwellnus & Derman, 2003:12; Verster, 2001:15; Cameron, 1999:75). Obesity contributes to primary and secondary health risks such as coronary heart disease and diabetes (Kalk, 2001:576). Obesity is inheritable as well as the health disorders associated with the type of obesity (Kalk, 2001:576; Dietz, 1995:157; Garfinkel & Cosina, 1990:511; Bouchard et a/., 1985:64). A possible cause for the increase of obesity is inactivity, and this generates numerous health problems for children and adolescents (Du Toit & Van der Merwe, 2003:49; Verster, 2001:15; Kalk,2001:576; Steinbeck, 2000:28; Cameron, 1999:75; Reilley et a/., 1999:217). Research has shown that regular exercise can lower the risk of obesity and have many health benefits in general (Deheeger et a/., 1997:375).Consequently the participation of physical activity is important for everyone not only for the obese individual (Van Mil et a/., 1999:842). Physical activity has physical as well as psychological benefits such as positive development in self-concept (Walters & Martin, 2000:51). A positive self-concept during adolescence can have an influence on mental and physical health, and the development of a positive self-concept is critical during the adolescent period (Park, 2003:42). Research also indicates that a strong self-concept can lead to an increase in participation physical activity (Park, 2003:47). Physical activity can also be a social opportunity during which self-concept and self-worth can develop (Marsh, 1997:28). The objective of this study firstly was to determine the influence of a 16-week physical activity intervention program on body composition and self-concept of black South African adolescents. The second objective was to determine the incidence of obesity among these adolescents. The third objective was to determine the influence of body composition on self-concept after participation in a 16-week physical activity intervention program. A total of 95 black adolescents (ages 13 to 18) were recruited to participate in the PLAY study (Physical Activity for the Youth). A control group of 24 adolescents did not participate in any exercise, where an experimental group of 71 adolescents did indeed participate in a 16-week physical activity intervention program. Anthropometric measurements and a comprehensive body composition were taken, using skin folds, BMl and the Bod Pod. The subjects completed a self-concept questionnaire (PASWIN2004 computer program). The findings in this study seems to indicate that there was a positive relationship, between physical activity and BMI as well as Bod Pod changes, after a 16-week activity intervention program in the experimental boys group. No further correlations were traced in the other groups. Among all the adolescents (experimental and control groups), were 80.85% overweight, of which 40.42% were classified as obese. This shows that the majority of this group of adolescents were overweight. No significant changes were found in body composition. The girls showed a slight increase in BMI as well as body fat percentage and a decrease in self-concept. This indicates that an increase in body fat can lead to a lower self-concept. / Thesis (M.Sc. (Human Movement Science))--North-West University, Potchefstroom Campus, 2006.

Obesity is currently the most common and costly nutritional problem in developed countries and ten percent of the world's school-aged children are estimated to be overweight to some extent. Low-grade systemic inflammation is increasingly emerging as a significant component of the metabolic syndrome. Youth in lower income families are particularly vulnerable because of poor diet and limited opportunities for physical activity. In developing countries obesity among youth is rising among the urban poor, possibly due to their exposure to Westernised diets coinciding with a history of under-nutrition. The aim of this study was to assess the association between serum CRP and physical activity and to assess the association between serum CRP and body composition in black high-school children from a township in the North West Province (NWP), South Africa. Methods and results: The study group consisted of 193 school children between the ages 13 to 18 years (78 boys and 115 girls) residing in lkageng, the township outside of Potchefstroom in the North West Province, South Africa. Children were from a black ethnic group, living in a poor socioeconomic setting. Demographic and body composition measurements were taken and fasting blood samples were drawn for serum C-reactive protein (CRP) measurements. The difference between serum CRP of overfat versus girls with a normal fat percentage was non-significant (p = 0.46). Boys with body fat percentage >20% (n=16) had .a mean serum CRP of 1.42 2.16 mg/L and for boys with a normal fat percentage (n=53) mean serum CRP was 0.89 k 1.62 mg/L. The Mann-Whitney U-test for the difference between mean CRP of the two groups of boys was Z=1.39, p=0.16 (no significant difference), but with a trend of higher serum CRP concentration in the boys with higher % body fat. For the boys, the only positive partial correlation was between serum CRP and triceps skinfold (r=0.327, p=0.045). In the girls' group no statistically significant partial correlations were found between CRP and body composition variables. There was no significant difference between serum CRP concentrations of the three physical activity categories of girls. Interestingly, there was an inverse correlation between percentage body fat and fitness in the boys' group (r=-0.509 and p= 0.008). The difference in log CRP between activity groups showed a trend of lower serum CRP with higher physical activity in the girls. Conclusion: This study showed no statistically significant associations between serum CRP and body composition, except for the positive correlation between triceps skin fold and serum CRP in boys, or CRP and physical activity, but clear trends were noted of an inverse association between CRP and physical activity in the girls. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2007