Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2005.

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published_or_final_version / Community Medicine / Master / Master of Philosophy

Background Nutritional deterioration in patients with head and neck cancer (HNC) has a multifactorial etiology mainly associated with tumor and treatment related factors. The objective of the present thesis was to investigate the impact of the disease and treatment on body weight and eating in patients with HNC treated with radiation therapy (RT) as the single modality treatment or as preoperative RT by analyzing body weight and body mass index (BMI) over time, predictive factors for weight loss and BMI, weight loss and BMI as prognostic factors for survival, and by studying the patients’ own experience of food and eating. Methods ARTSCAN is a randomized prospective multicenter trial conducted between the years of 1998 - 2006. Data were collected during and after RT with a total follow-up time of five years. Nutritional data from the whole study cohort (n = 712), from patients with oropharyngeal cancer (n = 232) and from two of the participating treatment centers (n = 101) were retrospectively analyzed in the present thesis. In addition, interviews (n = 13) were conducted nine months after the termination of RT as part of a care development project. Results On a group level, the patients lost weight during and after RT with a nadir at five months after the termination of RT. Factors related to a higher weight loss were oropharyngeal cancer, a high BMI at the start of RT, post-treatment aspiration, no tube feeding at the start of RT, and larger treated volumes. Furthermore, a high BMI at the start of RT was shown to be significantly related to a better five-year overall survival in patients with oropharyngeal cancer, whereas weight loss was not. The patients’ own narratives showed that all aspects of food, eating and meals were affected by the remaining sequelae, and that the patients found ways to accept and cope with the changes that had to be done to facilitate eating. Conclusions and clinical implications The disease and treatment gave persistent effects on the HNC patients’ weight and BMI which calls for a prolonged nutritional follow-up. The predictive factors found for weight loss can be used during patient history to find patients at risk for nutritional deterioration. In oropharyngeal cancer, patients with a high BMI at the start of RT had the best survival. This finding indicates that patients with a low BMI should be encouraged to gain weight before RT start. All aspects of food, eating and meals were affected during and after RT, and therefore the nutritional treatment should be given with a holistic approach to meet the multifaceted need patients with HNC experience.

Background: The role of dietary calcium in weight management is gaining support in the nutrition research community. It has been hypothesized that high calcium diets protect against fat gain by creating a balance of lipolysis over lipogenesis in adipocytes (Zemel et al., 2000) and that a diet deficient in calcium is associated with higher body weight and that augmenting calcium intake may reduce weight and fat gain or enhance fat loss (Shapses et al., 2004). Objectives: A lack of baseline data on the physical, physiological and mental effects of obesity on urban African women was the motivation for the POWIRS (Profiles of Obese Women with Insulin Resistance Syndrome) study. The aim of the study was to assess the effects of obesity on health determinants of urban African and white women by comparing the lifestyle and risk factors for non-communicable diseases (NCDs) of lean, overweight and obese subjects. This led to a multi-disciplinary cross-sectional case-control study in which health determinants and health status, as well as the underlying mechanistic relationships between these factors were measured in a sample of African women volunteers. The study was repeated a year later, done in a sample of white women volunteers, POWIRS II. The effect of calcium intake on body composition was assessed during this study. Methods: One hundred and two apparently healthy urban African women, between the ages of 20 and 50 years participated in the first phase of this case-control cross-sectional survey. For a period of about three weeks, each afternoon ten subjects were to report at a Metabolic Unit Facility (consisting of 10 single bedrooms, 2 bathrooms, a living room and kitchen). Each subject received a "participant sheet" which guided them through the different research 'stations' where the various measurements were done. During the course of the evening demographic questionnaires were filled in and all anthropometric measurements were taken, except weight and height measurements. All participants received an identical light supper which excluded alcohol and caffeine at 20h00, went to sleep before 23h00 and fasted overnight. From 06h00 in the morning weight, height and blood pressure measurements were taken. After a fasting blood sample was taken, a two-hour glucose tolerance test commenced. Subjects received a breakfast and afterwards habitual dietary intake questionnaires were completed. Results: Mean total dietary calcium intake as significantly higher in white women (POWIRS II), with a mean intake 1053.8 mg per day, as opposed to a mean intake of 494.8 mg calcium per day in the blacks subjects (POWIRS I). Mean fat intake in the black subjects was 59.3 g per day, and in the white women 103.1 g per day. Thus the calcium:fat ratio in white women was higher than in black women (11.0 and 8.4 respectively). After adjustment for age and total dietary energy intake, significant negative correlations were found between dietary calcium intake and various variables, only in the white subjects. These were BMI (r=-0.255, p=0.01), percentage body fat (r=-0.252, p=0.01), fasting insulin (r=-0.205, p=0.05) and fasting glucose (r=-0.199, p=0.046). The calcium:fat ratio correlated negatively with BMI (r=-0.378, p<0.0001), percentage body fat (r=-0.401, p<0.0001), fasting glucose (r=-0.229, p=0.02), fasting insulin (r=-0.212, p=0.04) and plasma leptin (r=-0.284, p=0.004). Adjustment for smoking resulted in slightly different correlation coefficients, but similar significant correlations were still found. The only significant association that was found in the black population, was a negative correlation between dietary calcium intake and systolic blood pressure (p=0.03) as well as diastolic blood pressure (p=0.04). After adjustment for age, smoking and dietary energy intake no significant correlations were found in the black subjects. Conclusion: The results from the POWIRS study in white women are consistent with the hypothesis that there may be an inverse relationship between adiposity and calcium intake. In our study higher calcium intakes were associated with lower body fat, lower BMI, lower fasting glucose and insulin, as well as plasma leptin in white women. The association seems to be significant in subjects with high intakes of fat and calcium (as seen in the white women). / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2005.

Objective To determine the relationship between increased body hair growth in women and serum sex hormone level, body mass index, and clinical signs. Sample and methods The sample group consisted of 186 women, 18–35 year old residents of Lithuania who were referred to the Clinic of Endocrinology, Kaunas University of Medicine Hospital in 2002–2004 and complained for increased body hair growth. Exclusion criteria: 1) taking systemic medications within the period shorter than three months before the beginning of the study; 2) specific reasons of excessive body hair growth, such as androgen secreting adrenal or ovarian tumors, hyperprolactinemia, Cushing syndrome; 3) thyroid dysfunction. A total number of 37 women were excluded from further study. Statistical analysis was performed on 149 women. Increased body hair growth was assessed using Ferriman-Gallwey (F-G) method. Blood samples were drawn in the morning (08:00–10:00 h), in the early follicular phase, with an exclusion of 7 women with amenorrhea, while the blood sample of 12 women with oligomenorrhea was drawn following at least 2 months after the last menstruation. Serum hormones (total testosterone (T), sex hormone binding globulin (SHBG), free androgen index (FAI), dehydroepiandrosterone sulphate (DHEAS) level were measured using the commercial kits. FAI was calculated as follows: T (nmol/l) × 100/ SHBG (nmol/l). Results The significance of correlations between the F-G score and the tested variables decreased in the... [to full text]

Darbe atlikta teorinė paauglių požiūrio į savo kūną ir mitybos įpročių analizė. Iškeltos dvi hipotezės: 1. Dauguma paauglių, norėdamos tapti lieknesnėmis, keičia savo mitybos įpročius, stengiasi sveikai maitintis, didina fizinį aktyvumą. 2. Daugumai normalaus svorio ir kūno sudėjimo merginoms atrodo, kad jų svoris yra per didelis, jos save vertina storesnėmis nei iš tiesų yra, tampa nepatenkintos savo kūno vaizdu.Empirinėje dalyje tiriami paauglių mitybos įpročiai, kūno vaizdas ir fizinis aktyvumas. Taip pat pasitenkinimas savo kūno vaizdu, bei paauglės nurodomas, jos norimas, tobulas kūno vaizdas.Anketinės apklausos metodu buvo atliktas tyrimas, kurio tikslas atskleisti paauglių (mergaičių) požiūrį į savo kūną ir mitybos įpročius. Atlikta statistinė duomenų analizė. Pusiau struktūruotu interviu buvo siekiama išsiaiškinti kaip paauglės vertina ir koks turėtų būti jų tobulas kūno vaizdas. Mergaičių supratimas apie kūno vaizdo estetiką nustatytas paveikslais, naudojant Ališauskaitės (2011) metodika, kur didesnis skirtumas tarp nurodomo kūno vaizdo ir norimo reiškia didesnį nepasitenkinimą savo kūno vaizdu. / The paper displays theoretical analysis of teenage girls’ attitude towards their body and eating habits. There are two hypotheses: 1. Most of the teenage girls change their eating habits, try to eat healthy and do physical activities in order to become fit. 2. Most of the regular weight and body type girls think they weigh too much and asses their self as thicker than they are and become not satisfied with their body. The empirical part studies eating habits, body image and physical activities. Moreover, the satisfaction of one’s body image, given and wanted image of the perfect body is explored.The questionnaire survey was made which aimed to reveal the attitude of teenage girls towards their bodies and eating habits. The statistic data analysis was made. Due to semi-structural interview, the self-assessment of how should a perfect body look like was made. Satisfaction / dissatisfaction of one’s body image (Ališauskaitė, 2011), where the difference between the given body image and the wanted body image shows the greater dissatisfaction of one’s body image.The quantitative part of the research consisted of 403 and the qualitative part of the research consisted of 14 teenage girl participants from various Lithuanian cities and regions.

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Background Type 2 diabetes is a common disease and the prevalence has increased in large parts of the world. In treatment of diabetes the type of diet is of great importance considering metabolic factors such as glucose level and blood lipids. Which diet that is most beneficial to avoid diabetic complications has been heavily debated in recent decades. This thesis is based on two clinical studies designed to compare the effects of different macronutrients. Methods A clinical trial was designed to compare a low-carbohydrate diet (LCD) to a low-fat diet (LFD) in treatment of patients with type 2 diabetes. Sixty-one patients at two health care centres were included and randomized to get advice to eat a LCD or a LFD. The LCD had an energy content where 50 energy percent (E%) where from fat, 20 E% from carbohydrates and 30 E% from protein. For the LFD the nutrient composition was similar to what is traditionally recommended for treatment of type 2 diabetes in Sweden. Metabolic factors, anthropometrics and questionnaires were analysed. To study postprandial effects a trial was designed to compare three different diets. Twentyone patients with type 2 diabetes were included to in randomized order test the three types of diets on separate test days. On each test day the patients were served breakfast and lunch and blood samples were taken at six times these days. Glucose, lipids and hormones were analysed. Results There were equal weight reduction in the two groups in the first trial during the two-year study period. At six month when compliance was good according to diet-records, the glucose level (HbA1c) was lowered and the HDL-cholesterol was increased in the LCD group. The inflammatory markers IL-6 and IL-1Ra were significantly lower in the LCD group than in the LFD group. At 12 months the physical function, bodily pain and general health  scores improved within the LCD group only. In the second trial the postprandial glucose and insulin levels were lower on the LCD compared to the LFD. However, the LCD resulted in a tendency to higher postprandial triglyceride levels. The Mediterranean type of diet with all energy intake at lunch resulted in a more pronounced insulin response and a glucose level at lunch similar to that of the low-fat diet. The increase-ratio of insulin correlated to the elevation of the incretin glucose-dependent insulinotropic peptide (GIP). Conclusions In the two-year study we found benefits for the LCD group regarding glucose control and insulin doses. Furthermore, only the LCD was found to improve the subclinical inflammatory state and there were some aspects of improved well-being in this group. Aiming for 20% of energy intake from carbohydrates is safe with respect to cardiovascular risk factors  compared with the traditional LFD and this approach could constitute a treatment alternative. In the postprandial state, the LCD induced lower insulin and glucose excursions than the LFD but at the same time a tendency of higher triglycerides. The long-term significance needs to be further examined. The accumulation of caloric intake from breakfast to lunch to a single large Mediterranean-style lunch-meal in type 2 diabetes might be advantageous from a metabolic perspective.

Background: The role of dietary calcium in weight management is gaining support in the nutrition research community. It has been hypothesized that high calcium diets protect against fat gain by creating a balance of lipolysis over lipogenesis in adipocytes (Zemel et al., 2000) and that a diet deficient in calcium is associated with higher body weight and that augmenting calcium intake may reduce weight and fat gain or enhance fat loss (Shapses et al., 2004). Objectives: A lack of baseline data on the physical, physiological and mental effects of obesity on urban African women was the motivation for the POWIRS (Profiles of Obese Women with Insulin Resistance Syndrome) study. The aim of the study was to assess the effects of obesity on health determinants of urban African and white women by comparing the lifestyle and risk factors for non-communicable diseases (NCDs) of lean, overweight and obese subjects. This led to a multi-disciplinary cross-sectional case-control study in which health determinants and health status, as well as the underlying mechanistic relationships between these factors were measured in a sample of African women volunteers. The study was repeated a year later, done in a sample of white women volunteers, POWIRS II. The effect of calcium intake on body composition was assessed during this study. Methods: One hundred and two apparently healthy urban African women, between the ages of 20 and 50 years participated in the first phase of this case-control cross-sectional survey. For a period of about three weeks, each afternoon ten subjects were to report at a Metabolic Unit Facility (consisting of 10 single bedrooms, 2 bathrooms, a living room and kitchen). Each subject received a "participant sheet" which guided them through the different research 'stations' where the various measurements were done. During the course of the evening demographic questionnaires were filled in and all anthropometric measurements were taken, except weight and height measurements. All participants received an identical light supper which excluded alcohol and caffeine at 20h00, went to sleep before 23h00 and fasted overnight. From 06h00 in the morning weight, height and blood pressure measurements were taken. After a fasting blood sample was taken, a two-hour glucose tolerance test commenced. Subjects received a breakfast and afterwards habitual dietary intake questionnaires were completed. Results: Mean total dietary calcium intake as significantly higher in white women (POWIRS II), with a mean intake 1053.8 mg per day, as opposed to a mean intake of 494.8 mg calcium per day in the blacks subjects (POWIRS I). Mean fat intake in the black subjects was 59.3 g per day, and in the white women 103.1 g per day. Thus the calcium:fat ratio in white women was higher than in black women (11.0 and 8.4 respectively). After adjustment for age and total dietary energy intake, significant negative correlations were found between dietary calcium intake and various variables, only in the white subjects. These were BMI (r=-0.255, p=0.01), percentage body fat (r=-0.252, p=0.01), fasting insulin (r=-0.205, p=0.05) and fasting glucose (r=-0.199, p=0.046). The calcium:fat ratio correlated negatively with BMI (r=-0.378, p<0.0001), percentage body fat (r=-0.401, p<0.0001), fasting glucose (r=-0.229, p=0.02), fasting insulin (r=-0.212, p=0.04) and plasma leptin (r=-0.284, p=0.004). Adjustment for smoking resulted in slightly different correlation coefficients, but similar significant correlations were still found. The only significant association that was found in the black population, was a negative correlation between dietary calcium intake and systolic blood pressure (p=0.03) as well as diastolic blood pressure (p=0.04). After adjustment for age, smoking and dietary energy intake no significant correlations were found in the black subjects. Conclusion: The results from the POWIRS study in white women are consistent with the hypothesis that there may be an inverse relationship between adiposity and calcium intake. In our study higher calcium intakes were associated with lower body fat, lower BMI, lower fasting glucose and insulin, as well as plasma leptin in white women. The association seems to be significant in subjects with high intakes of fat and calcium (as seen in the white women). / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2005.