Objetivo: Verificar o efeito em longo prazo do tratamento da apneia do sono com CPAP na circunferência da cintura em pacientes com apneia do sono. Métodos: Foram incluídos indivíduos com apneia do sono de ambos os sexos, idade superior a 18 anos, com indicação de uso de CPAP que aderiram ou não ao tratamento. Todos foram submetidos à polissonografia de noite inteira pelo método convencional em laboratório do sono afiliado a universidade entre 01/01/2007 e 01/06/2012. O grupo com CPAP realizou pelo menos três polissonografias. O grupo controle foi composto por pacientes que repetiram a polissonografia após pelo menos seis meses, que relataram não receber qualquer tipo de tratamento e que mantinham o IAH na segunda polissonografia. Resultados: No grupo CPAP foram incluídos 77 pacientes e no grupo controle, 43 pacientes. O tempo de acompanhamento foi respectivamente de 2,5 e 2,3 anos. Foi observada uma redução significativa na circunferência abdominal no grupo CPAP, comparando com controles através do teste t de Student (P= 0,024). O modelo logístico binário para prever redução da circunferência abdominal após o período de acompanhamento foi significativo (P <0,001), utilizando-se como regressores: uso do CPAP, sexo, idade> 45 anos, IMC≥ 30 kg/m2 e IAH≥ 30. O R2 de Nagelkerke foi de 0,36, indicando que essas variáveis explicam 36% da variação da redução da circunferência abdominal. Conclusão: O uso de CPAP se associa à redução da circunferência abdominal, independentemente de sexo, idade e índice de apneia-hipopneia basais, bem como da diferença de índice de massa corporal. Este achado justifica pesquisas futura sobre o papel da apneia do sono no volume de gordura visceral. / Objective: Verify the long term effect of sleep apnea treatment with CPAP on waist circumference in patients with sleep apnea. Methods: Individuals of both genders, older than 18 years that adhered to CPAP use or not were included. All underwent a full-night polysomnography by the conventional method in a university-affiliated sleep laboratory between 01/01/2007 to 01/06/2012. The group using CPAP underwent at least three polysomnographies. The control group consisted of patients with moderate to severe OSA who repeated a polysomnography after at least six months. Only individuals who reported not receiving any treatment and in which the AHI continued in the same OSA categories at the second polysomnography were included. Results: The CPAP group included 77 and the control group, 43 patients. Follow up time was, respectively, 2.5 and 2.3 years. A significant reduction in waist circumference was observed in the CPAP group, comparing with controls by Student’s t test (P= 0.024). The binary logistic model to predict decreased waist circumference after follow up period was significant (P<0.001), using as regressors: CPAP use, gender, age>45 years, BMI≥30 Kg/m2, and AHI≥30. The Nagelkerke R Square was 0.36, indicating that these variable explain 36% of the variance of waist circumference reduction. Conclusion: Long-term CPAP therapy is associated with a reduction in waist circumference, regardless of sex, age and basal apnea-hypopnea as well as the difference in body mass index.

Made available in DSpace on 2014-07-29T15:29:17Z (GMT). No. of bitstreams: 1 dissertacao mestrado Denise Macedo.pdf: 1343530 bytes, checksum: cb925207654f5ac7bd284cd975185480 (MD5) Previous issue date: 2009-05-07 / Physical exercise seems to reduce abdominal fat, however new researches comparing different kind of exercises are needed to define efficient training programs. The purpose of the study was to compare the effects of the aerobic training and the resistance training on abdominal fat loss. Participants were 31 overweight women (mean age 44,5 ± 8,6 years) with high level of abdominal fat that do not practice regular physical exercise. The training program of the aerobic group (AG), 19 women, consisted of walking and running while the resistance group (RG), 12 participants, consisted of weight lifting exercises. During 10 weeks, participants of both groups (AG and RG) were required to attend three sessions of physical exercise per week. Body weight, height, waist circumference (WC), seven skinfold thickness were assessed and body max index (BMI) and body composition were calculated at baseline and after the exercise intervention. Reduces in WC, total body fat (%BF) and abdominal skinfold thickness (AbST) were statistically significant (p < 0.01) in both groups, despite no significant changes in body weight and BMI. RG showed a higher reduction in %BF (AG = 2.3%; RG = 3.1%), WC (AG= 1.9%; RG = 2.5%) and AbST (AG = 6.6%; RG = 6.8%), however there were no significantly differences between the values of the two training groups. In conclusion, the results of the study demonstrate that 150 to 210 minutes of moderate aerobic exercise or progressive resistance training produces abdominal fat and total body fat losses among overweight and obese women / O exercício físico parece promover diminuição da obesidade abdominal, entretanto, pesquisas comparativas com diferentes tipos e intensidades de treinamento são necessárias para se definir as prescrições mais eficientes. O presente estudo objetivou avaliar o efeito dos exercícios aeróbico e resistido sobre a gordura abdominal. A amostra incluiu 31 indivíduos do sexo feminino (44,5 ± 8,6 anos de idade) com excesso de peso, alto índice de gordura abdominal e não praticantes de exercício físico regular. O treinamento do grupo aeróbico (GA), 19 mulheres, incluiu caminhada e corrida e do grupo resistido (GR), 12 sujeitos, exercícios com pesos. Os grupos realizaram de 50 a 70 minutos de exercícios, três vezes por semana, durante 10 semanas. Mediuse peso, estatura, circunferência da cintura (CC), dobras cutâneas e calculouse o índice de massa corporal (IMC) e a composição corporal no pré e pós treinamento. Em ambos os grupos ocorreram diminuições significativas (p<0,01) na CC, no percentual total de gordura corporal (%GC) e dobra cutânea do abdome (DOCabd), entretanto o peso corporal e o IMC não alteraram significativamente. Apesar do GR apresentar maiores reduções no %GC (2,3% GA e 3,1% GR) e na gordura abdominal avaliada por meio da CC (1,9% GA e 2,5% GR) e da DOCabd (6,6% GA e 6,8% GR), não houve diferença estatística entre os valores. Concluiuse que tanto o exercício aeróbico como o resistido, realizados com intensidade moderada por 150 a 210 minutos semanais promovem ajustes positivos na composição corporal e diminuição da obesidade abdominal de mulheres com excesso de peso

Objectives: This thesis examines the risks among Canadian children and adolescents for developing cardio-metabolic diseases, extending evidence that is well-established for adults to pediatric populations. As well, novel indicators and cut-offs for the measurements of disease risks are proposed and associations between physical activity, weight status, socio-economic status and cardio-metabolic health are examined. Methodology: Secondary data analysis was conducted using data from three cycles of the Canadian Health Measures Survey (CHMS), a nationally representative data set which includes measured anthropometric characteristics. A population health approach was applied throughout, underpinned by the World Health Organization’s Conceptual Framework for Action on the Social Determinants of Health. The thesis was designed such that a series of four manuscripts successively built on the key findings from each previous research paper: 1. Establishing the prevalence of Metabolic Syndrome and its risk factors for 10-18 year olds using the International Diabetes Federation child, adolescent and adult definitions. 2. Estimating pre-obesity epidemic waist circumference reference values for Canadian children 6-10 years using reference data from the 1981 Canada Fitness Survey, the Third National Health and Nutrition Examination Survey (1988-1994), and the CHMS through regression of linear, logarithmic and quadratic functions. This work facilitated an expanded age range for the subsequent projects as age- and sex-specific cut-offs based on a Canadian population prior to the obesity epidemic had not been available. 3. Cardio-metabolic risk by body mass index (BMI), waist circumference (WC), and a combined BMI-WC indicator quantified the associations between a dichotomous cardio-metabolic risk variable, and obesity, using three indicators of obesity including a novel indicator, for ages 6-18 years. 4. Association between cardio-metabolic risk and inflammation quantified the associations between inflammation, using high-sensitivity c-reactive protein (CRP) as a marker, and cardio-metabolic risk to determine if high CRP was a significant predictor of cardiometabolic risk among 6-18 year olds. Results: For Paper 1 (n=1228), only 2.1% were classified as having the Mets though 38% had at least 1 MetS risk factor. For Paper 2, logarithmic regression predicted WC cut-offs with the lowest degree of error. For Paper 3 (n=2678), 35% were classified as having cardio-metabolic risk with significantly higher levels among those classified as obese and/or having a low level of physical activity. All indicators of obesity had significant associations with cardio-metabolic risk. For Paper 4 (n=1831), 43.6% of children and 62.0% of adolescents with high CRP levels were classified as having cardio-metabolic risk, a significant relationship. Participants from households with moderate to high income and/or education had the lowest prevalence of MetS risk factors and abdominal obesity. Conclusions: High CRP is a useful indicator of cardio-metabolic risk for pediatric populations. With further research, novel combinations of BMI and WC may be shown to be more predictive for cardio-metabolic risk than these indicators individually. The substantial prevalence of multiple risk factors which predict premature onset of chronic disease foreshadows potential years of morbidity in adulthood for Canada’s youth population.

60 % of Canadians have suboptimal vitamin D (<75 nmol/L) and 25% are obese. Obesity has been reported to be a risk factor for low vitamin D, but there is uncertainty about the magnitude of the association. Linear regression was performed using data from the nationally representative cross-sectional Canadian Health Measures Survey (2007-2009). Height, weight, waist circumference (WC), and vitamin D levels were directly measured. There were 5298 participants aged 6 to 79 years. Using a conservative p value of 0.001, body mass index (BMI) category obese / obese I was positively associated and WC was inversely associated with vitamin D level in crude analysis. WC was inversely associated with vitamin D level in multivariate analysis. The pattern of relationship is not the same as other studies, yet this was a large study with direct measurements. There may be issues with linearity of relationships or subgroups disturbing the relationship.

Twenty-two young men and women of the 49thMilitary Police Brigade of the California National Guard were participants of our nutrition education and health assessment program. The California National Guard has expressed concern of unsatisfactory physical and nutritional status of their personnel related to a nutrition knowledge deficit as evidenced by preliminary data of insufficient dietary intake and poor nutrition knowledge assessment scores. Our program was designed to implement a nutrition intervention including education and evaluate its effectiveness in reducing Metabolic Syndrome (MetS) risk factors, improving body composition, and providing educational lessons intended to alter lifestyle. Baseline data was quantified and analyzed for statistical significance. Participants reported consuming less than average daily recommended calories and variable macronutrient % of recommended values (%Recommended). DXA analysis revealed high %Body Fat (BF), positively correlated with high values of Visceral Adipose Tissue (VAT) in both sexes. Statistical analyses identify HDL cholesterol (HDL-C) and waist circumference as significant predictive variables of VAT, after adjusting for age and sex. Follow-up data from two participants was collected but excluded from statistical analysis due to small sample size. Exploratory (stepwise regression) analysis considering several predictive variables reveals HDL-C is the most significant predictor of VAT (p=0.0011), when waist circumference is excluded from the model, after correcting for age and sex. Waist circumference was excluded with the consideration that waist may be a surrogate measure for VAT. HDL-C seems to be the variable most strongly associated with VAT and HDL-C explains 67% of the variability of VAT (RSquared=0.6741) in the fit model after correcting for age and sex. While the impact of high HDL-C on improved body composition and reduction of cardiometabolic risk factors is well supported by literature, the significance of HDL-C on VAT deposition presented in our findings provokes continued research.

<p>Obesity is a major public health problem globally and in the United States (U.S.). Amongst adults in the U.S., prevalence estimates of obesity reached 42.4% in 2017-2018 [1]. Obesity is both a contributor and outcome of chronic disease development including type 2 diabetes and metabolic syndrome [2,3]. Underlying modifiable risk factors for these chronic conditions include lifestyle habits such as dietary intake and physical activity. </p><p>Much of nutrition research investigating the relationship of dietary intake to health outcomes has taken a reductionist approach with a focus on single nutrients and food groups; however, the complexity of the overall diet with all its constituents is being increasingly recognized. Dietary patterns examine the quantities, frequencies, and combinations of food and beverages consumed allowing a more comprehensive investigation of the diet-health relationship [4], yet, the concept and creation of patterns have not considered elements beyond nutrients and food, such as time of eating, which could be an important aspect of dietary patterns. Moreover, most physical activity research has focused on the effect of intensity or counts of activity on health [5–8], while studies investigating daily physical activity patterns have focused on distinct time periods i.e., type of day (weekday vs. weekend) or seasonality [9,10]. Nevertheless, connecting these patterns to health outcomes through the integration of time across an entire day has received little attention.</p><p>Studies that have incorporated time to the concept of dietary patterns focus on behaviors such as breakfast skipping and late meal consumption and show associations with health [11–14]. For instance, compared to early lunch eaters, late lunch eaters lost less weight and had reduced glucose tolerance [15,16]. In contrast, studies that have investigated timing of exercise focused on early vs. evening exercise [17–19]. For example, exercise performed in the morning vs. evening has been associated with a greater reduction in weight and odds of obesity [17,18]. Furthermore, several studies have investigated links between timing of exercise relative to a single meal or over a single day with health [20–24] and revealed a potential benefit to modulating time of these behaviors on postprandial metabolic response. Together, these studies establish the importance of timing of these behaviors in terms of links to health; however, studies are limited by a focus on single time spans or blocks of time in a day. Consideration of the patterns of dietary intake and activity throughout a day, or “temporal dietary and physical activity patterns”, are a novel concept that may provide insight to the behavioral patterns related to health outcomes. Notably, one of the challenges in this work is utilizing methods that will characterize dietary and physical activity patterns as an exposure by integrating timing and other characteristics of these patterns in relation to health. </p> To our knowledge, there are no published reviews that have emphasized joint consideration of the time of eating and exercise, with a focus on the time of day of these events and association with health outcomes. Therefore, Chapter 1 focuses on summarizing current literature that has integrated both of these concepts by answering the question, how does the timing of exercise relative to eating throughout the day effect postprandial response in adults? Moreover, Chapters 2 and 3, include primary research in which a novel distance measure, based on dynamic time warping, is used to develop independent temporal dietary and physical activity patterns over a 24-hour period using data from the National Health and Nutrition Examination Survey and examine their association with short- and long-term health outcomes.

Background: Skinfold thickness (ST), waist circumference (WC) and hip circumference (HC) measurements are simple methods for assessing fat tissue at defined body parts. We examined these parameters in a cohort of healthy children and adolescents in Leipzig. Our study provides current percentile curves for biceps, triceps, subscapular and iliac crest ST, plus WC, HC, Waist-to-Hip Ratio and Waist-to-Height Ratio. Materials and methods: 6,344 visits were recorded involving 2,363 individuals from 3 to 16 years in age. Continuous age- and gender-related percentiles (3rd, 10th, median, 90th, 97th percentiles) were estimated using Cole's LMS method. Results: For biceps and triceps ST, boys show a peak at the beginning of adolescence with a subsequent decrease, while percentile values among girls rise across the age range. Subscapular and iliac crest percentiles also show increasing curves with disproportionately high values for P90 and P97. Boys show higher values of WC, girls have higher levels of HC. WC and HC median percentiles constantly increase in both sexes with a plateau at the age of 16 for girls. Conclusion: Trends for all parameters of body fat are in line with other national and international studies. Unlike the KiGGS study, our study provides circumference data across the whole of our age range, i.e. from 3-16 years.:I. Abkürzungsverzeichnis 1. Vorbemerkung 2. Wissenschaftlicher Hintergrund 2.1. Übergewicht und Adipositas im Kindes- und Jugendalter 2.2. Bestimmung des Körperfettanteils bei Kindern und Jugendlichen 2.3. Die Bedeutung kindlichen Übergewichts und dessen Folgeschäden 2.4. Assoziation von Körperfettparametern und kardiovaskulären Risikofaktoren im Fokus 2.5. Anthropometrische Referenzwerte für Kinder und Jugendliche in Deutschland 3. Fragestellung 4. Publikation 5. Zusammenfassung der Arbeit 6. Literaturverzeichnis II. Anlagen 1. Abbildungen 2. Tabellen 3. Formeln nach Slaughter zur Abschätzung des Körperfettanteils III. Darstellung des eigenen Beitrags IV. Erklärung über die eigenständige Abfassung der Arbeit VI. Danksagung

OBJECTIVE: The main objective of the present study was to assess the association between varying amounts of strength training and insulin resistance. Another goal was to assess the influence of several potential confounding variables on the strength training and insulin resistance relationship. Lastly, the role of waist circumference, fat free mass, and body fat percentage on the association between strength training and insulin resistance was assessed. METHODS: This cross-sectional study included 6561 randomly selected men and women in the US. Data were collected using the precise protocol established by NHANES. HOMA-IR was used as the outcome variable. Both time spent strength training and frequency of strength training bouts were used as exposure variables. RESULTS: There was not a statistically significant relationship between strength training and insulin resistance in women. However, after controlling for 10 potential confounding variables, men who reported no strength training had significantly higher levels of HOMA-IR compared to men who reported moderate or high levels of strength training (F = 9.87, P < 0.0001). Odds ratios were also assessed, and 10 potential confounding variables were controlled. Men reporting no strength training had 2.42 times the odds of having insulin resistance compared to men reporting moderate levels of strength training (95% CI: 1.19 to 4.93). Similarly, men reporting no strength training had 2.50 times the odds of having insulin resistance compared to men reporting high levels of strength training (95% CI: 1.25 to 5.00). CONCLUSION: There was a strong relationship between strength training and insulin resistance in US men, but not in US women. Differences in waist circumference, fat free mass, and body fat percentage, as well as demographic and lifestyle measures, do not appear to mediate the relationship.

Adiposity has been linked to impaired respiratory function in adults but whether the distribution of adipose tissue has a differential effect on pulmonary function is still uncertain. Moreover, in children, the relationship between adiposity and lung dysfunction is not clearly understood. A two-stage multivariate analysis was conducted using data from 5604 Canadians aged 6 to 79 years who participated in the Canadian Health Measures Survey (CHMS). The associations of various anthropometric and skinfold measures with lung function were examined separately in adults and children. After adjustment of covariates, waist circumference and subscapular skinfold thickness showed the strongest inverse associations with FVC and FEV1 in men. In women, BMI and sum of five skinfolds had the largest impact on pulmonary function. FVC and FEV1 in boys were most affected by waist-to-hip ratio and triceps skinfold. In girls, adiposity was not linked to the lung function testing variables. Adiposity measures have differing effects on respiratory function depending on age and sex group.

Background: According to the South African National Health and Nutrition Examination Survey, approximately 69% of South African women and 29% of men are considered overweight/obese. In South Africa, overweight and obesity rates are on the rise and have reached epidemic proportions. Several conventional weight loss strategies have been employed and have been unsuccessful in addressing this issue. It is for this reason that this study strives to uncover if any improvement in weight and fitness status are associated with an improvement in health status. Methods: One of our main aims were to determine the success in weight loss and reduction in health risk factors in members who have completed 18-weeks of the Healthy weight programme. Therefore, this study is a retrospective, observational study of adults with a mean body mass index (BMI) of 32.63 ± 7.39 who completed an 18-week supervised exercise program. An online health questionnaire was completed followed by pre- intervention assessments which included: Anthropometric measures (height, weight, waist circumference, body fat percentage) followed by blood pressure, finger-prick random glucose and cholesterol measurements. A 12-min motion test to assess functional capacity were completed. All anthropometric, resting health measures and fitness tests were repeated at 12-weeks (post-beginner programme) and 18 weeks (post-intervention) after the start of the intervention. The intervention included 2 weekly classes with an optional gym class. The type of exercise intervention that was included in this study largely focused resistance training and cardiorespiratory fitness which targeted multiple large muscle groups. Each exercise session included 80 to 90 % exercise intensity as well as lumbopelvic core exercises. The data set was analysed as an intention to treat (ITT) protocol as some of the testing time points were missing. Results: Out of a possible 50 participants, 34 met the inclusion criteria of at least all 3 health measures taken on the 3 different occasions (baseline, post-beginner, postintervention). The 34 participants had a mean age of 47.26 ± 10.44 ranging between 24 years and 76 years old. 65 % of the participants were female. Anthropometric results showed significant changes in weight and waist circumference at 12- and at 18-weeks compared to baseline measures (p < 0.005). Additionally, body fat % significantly reduced at 12-weeks but increased slightly at 18 weeks diminishing the significant reduction compared to the baseline measure. In terms of fitness, participants succeeded in improving their average distance to complete a 12-min motion test by 14.5% (p < 0.001) at 12-weeks and 20% (p < 0.001) at 18-weeks compared to starting measures, respectively. After adjusting for multiple comparisons during post-hoc analysis, none of the health status outcomes (blood pressure, random glucose, random cholesterol) showed a significant improvement at any of the time points. In terms of associations, a change in body fat % could significantly explain some of the variance in the change (from baseline to 18-weeks) in cholesterol; and a change in weight could significantly explain some of the variance in the change in glucose over the same intervention time. Conclusion: The results of this study revealed the 18-week supervised exercise intervention led to a modest reduction (approximately 5%) in weight and a substantial improvement in fitness. However, no changes in health status were observed, suggesting that greater improvements in weight and fitness may be required to have a profound influence on health status.