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The study investigated whether dietary flavonoid intake and dietary patterns were associated with bone mineral density (BMD) and bone turnover in postmenopausal Scottish women. The subjects were recruited in 1990-3, and the majority of them returned 6.3 ± 0.6 y later (mean age (SD) at baseline 54.7 (2.2) y). At the both visits they had bone density scans of the lumbar spine (LS) and hip (FN) and at the second visit they provided urine samples for analysis of bone resorption markers. Flavonoid intakes were calculated using food frequency questionnaires, “validated” for flavonoid intakes using 4-day food diaries. (R=0.76, p≤0.001 for energy adjusted total flavonoids). FN BMD was associated with flavonoid intakes at baseline and follow up (p=0.012, p=0.001 respectively after adjusting for confounders) and LS BMD at follow up only (p=0.038). Dietary flavanones had a negative correlation with bone resorption markers; catechins and procyanidins were associated with annual change in FN and LS BMD. Principal components analysis was used to identify five important patterns in the diets. The “healthy” diet, rich in fruit and vegetables, was negatively associated with bone resorption markers and the nutrient diets were both negatively associated with FN and LS BMD. Partial least squares analysis identified that tinned fruit and root vegetables were associated with greater bone resorption, and berries, tomatoes and juice with decreasing bone resorption. Tomato intakes were the most important when predicting bone resorption marker excretion. Tomatoes, salad, berries, and green vegetables were associated with increased BMD. Berries, applies, root vegetables and salad were the most important fruit and vegetables for predicting BMD. Results from this work confirm that fruit and vegetables are important in bone health.

Bakgrund Cancer är en vanlig sjukdom i Sverige och för de som genomgår behandling är det viktigt att tillgodose energi- och proteinbehovet. Olika budskap kring vad som är bra och dåligt att äta relaterat till cancer är vanlig förekommande på internet. Det kan öka risken för att flertalet livsmedel utesluts, och att behovet blir svårare att uppnå. Kunskap om hur olika livsmedel uppfattas är därför av värde för sjukvårdspersonal. Syfte Att undersöka vilken information om kost och cancer som individer med en relation till cancer tagit del av samt vilka informationskällor som använts. Metod En pappersenkät samt en webbenkät användes och deltagarna, individer med en cancerrelation, rekryterades via två onkologiska mottagningar samt via Facebook-grupper med koppling till cancer. Totalt samlades 154 svar in och av dessa användes 133 i den statistiska analysen. Insamlad data analyserades med Chi 2-test, One way-ANOVA samt Spearman Correlation Resultat Internet var den absolut vanligaste informationskällan bland deltagarna (n=114, 86%). Enbart hälften så många hade fått information via sjukvården (n=55, 41%). Deltagarna gjorde ingen skillnad på vad som var bra eller dåligt preventivt respektive under sjukdom. Drygt hälften av deltagarna upplevde att den information de fått påverkade matvanorna. De som använt böcker (p=0,001), slutna Facebook-grupper (p=0,001), bloggar (p=0,011) samt hemsidan ”Läkare för framtiden” (p=0,028) upplevde i större utsträckning av matvanorna påverkats. Slutsats Då internet var en stor informationskälla vad gäller kost och cancer behöver sjukvården kunna hänvisa patienter till pålitliga hemsidor. Att livsmedel minskas eller utesluts under sjukdom och behandling kan innebära svårigheter att uppnå energi- och proteinbehovet vilket i sin tur kan leda till minskad livskvalitet och avbrott i behandlingen. / Background Cancer is a common disease in Sweden and for those undergoing treatment, meeting the energy and protein requirements is important. Different statements about what’s good or bad to eat related to cancer are a frequent phenomenon on the Internet. It can increase the risk of a reduced diet and make it more difficult to achieve the requirements. For health care professionals, knowledge about how different kind of food is perceived is important. Objective To examine the information on diet and cancer that individuals with a relationship to cancer have received and what kind of information sources that has been used. Method(s) A paper questionnaire and a web-based questionnaire were used and the participants, individuals with a relation to cancer, were recruited by two oncology clinics and through groups, with a connection to cancer, on Facebook. A total of 154 replies were gathered and of these 133 were used in the statistical analysis. Collected data were analyzed by using Chi-2 test, One Samle-ANOVA and Spearman Correlation. Results The most common source of information among the participants was the Internet (n=114, 86%). Only half as many had received information through the healthcare system (n=55, 41%). The participants made no divergence between what was good or bad preventively and during cancer. More than half of the participants felt that the information they received affected their eating habits. A higher proportion of the participant who had used books (p=0,001), private Facebook-grups (p=0,001), blogs (p=0,011) or the website ”Läkare för framtiden” (p=0,028) said their eating habits had been affected. Conclusion Since the Internet was a major source of information about diet and cancer, health care professionals need to refer patients to reliable websites. A reduced diet can make it difficult in achieving energy and proteins needs, which may lead to lower quality of life and interruptions of treatment.

Rising obesity rates have generated serious policy concern and public interest. Along with biological and genetic factors contributing to weight gain, dietary and physical activity behaviours are considered the main determinants of individual body weight. In order to tackle the increasing obesity problem and change individual behaviour, effective policy interventions need to be developed which target specific groups within the population. Economic frameworks that have been designed to model individual choices can be applied to improve the understanding of how individual characteristics and socio-economic factors affect weight-related behaviours and body weight. This thesis uses data from the Scottish Health Survey and the HILDA (Household, Income, and Labour Dynamics in Australia) survey to empirically analyse (1) if average BMI and socio-economic characteristics differ across combinations of weight-related behaviours, (2) how diet and physical activity behaviours, as well as their determinants, can be adapted to explain BMI on average, (3) how determinants of BMI impact differently across a conditional BMI distribution, and (4) to what degree a change in BMI over time can be explained by changing influences. While previous economic research did not consider the combined effect of dietary and physical activity behaviours on body weight, this work will investigate the relationship between the weight-related behaviours and individual BMI on average and across the conditional BMI distribution to identify areas for policy interventions. Results indicate that an increase in individual physical activity is an effective measure to target individual weight. Although the energy balance framework suggests a promotion of both weight-related behaviours and traditional weight management measures promote a reduction in caloric intake, the analyses have shown that physical activity is the predominant behaviour regarding the influence on individual BMI (compared to individual diet measured by quality proxies rather than the overall caloric intake).

Millions of children throughout the world suffer from some form of nutritional insufficiency resulting- in a retardation of their physical and mental development. Recently results of behavioural studies have suggested that inclusion of a programme of psycho-social stimulation in the management and treatment of such children might cause enhancements in their mental development. However, the morphological effects of a period of sensory stimulation on neural development in previously undernourished subjects have largely remained uninvestigated. Experiments described in this Thesis were designed to attempt such an investigation using the laboratory rat as the animal model. Rats were undernourished during their brain growth spurt period and then raised either in enriched or isolated environmental conditions. The enriched environmental condition consisted of a group of twelve male rats living together in a large cage containing a set of stimulus objects called "toys". The isolated environmental condition consisted of a single rat living in a small opaque cage which did not contain any toys. A parallel set of well-fed rats was raised in identical environmental conditions. The experiments were carried out on four separate occasions. At the end of the period of environmental modification various gross and microscopic characteristics of the brain were analyzed. These analyses included measurements of brain weights, forebrain dimensions and cortical depths. Stereo- logical procedures at the light microscopic level were used to estimate nuclear diameters and numerical densities of neurons and glial cells as well as neuronal perikarya.1 volumes in the visual cortex. At the electron microscopic level synaptic disc diameters, synaptic numerical densities and synapse-to- neuron ratios were estimated in visual cortical layers II and III. Results of these analyses suggested that environmental enrichment caused significant increases in forebrain weights and lengths as well as deficits in neuronal numerical densities particularly in the upper third of the visual cortex. It also produced significant increases in synaptic disc diameters and synapse-to-neuron ratios in cortical layers II and III. These changes were seen both in well-fed and previously undernourished rats Measurements of cortical depths and estimates of neuronal nuclear diameters, perikaryal volumes and glial cell numerical densities did not show consistent effects of environmental treatment. This latter finding is in contrast to several previously published results. Possible reasons for this are discussed. Results of the two-way analysis of variance tests on data combined from both nutritional groups indicated that the interaction between nutrition and environment was not significant for any of the measurements carried out. This suggested that the cerebral changes seen in both nutritional groups were similar in magnitude as well as direction. These results provide experimental evidence for the morphological basis of the rehabilitative potentials of sensory stimulation for previously undernourished subjects. This may have implications for designing a programme of therapy for children who have suffered an episode of earlylife malnutrition.

A THESIS Submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa in fulfillment of the requirements for the degree of Doctor of Philosophy, 2014 / Introduction: An increase in the prevalence of eating disorders, body image dissatisfaction, low self-esteem and unhealthy weight control behaviors have been reported among adolescents worldwide, and are a public health concern with physical and psychological consequences. Although underweight and stunting still persists in South Africa, overweight and obesity is increasing in all ages, gender, and ethnic groups. Obesity is a biological risk factor for body dissatisfaction, low self-esteem and eating disorders among adolescents, all of which have been found to be associated with various weight change behaviors and strategies. South Africa being a culturally diverse country is undergoing rapid political, socioeconomic, nutrition and epidemiological transitions, and therefore offers a unique opportunity to investigate this area of research. Study design: There are two study components: (1) A cross-sectional study to determine gender and ethnic (black and white) differences in eating attitudes, self-esteem and body satisfaction in 13, 15 and 17 year-old boys (n=391) and girls (n=340) living in urban Johannesburg; (2) A longitudinal survey of the Birth-to-Twenty (Bt20) cohort at ages 13 and 17 years (n=1435) to compare eating attitudes, body-esteem and weight control behaviors between black and mixed ancestry adolescents, to examine the changes over time in these variables, and to investigate ethnic differences in the male and female perceptions of female body silhouettes at age 17 years. These ages were selected to provide a diverse sample of adolescents (early, mid and late adolescence). Methods: Anthropometric measurements were performed on all participants. Overweight and obesity were determined using age-gender specific cut-offs for BMI for children aged up to 17 years. Eating attitudes test-26 (EAT-26) scores were used to determine an increased risk of developing an eating disorder. The total EAT-26 score is the sum of the 26 items and scores range from 0 to 78. Participants who score more than 20 are considered to be at greater risk of developing an eating disorder, and represent more unhealthy attitudes towards food, body weight and eating. Body-esteem was measured using a body esteem scale. It consists of a set of 21 questions which measure 1) global feelings about one’s body e.g. “I like what I see when I look in the mirror”, 2) satisfaction with one’s weight e.g. “I really like what I weigh” and 3) positive evaluations about one’s body and appearance e.g. “People my own age like my looks”. The body-esteem assessment uses a 5-point scale ranging from “never” (1) to “always” (5) and the higher the score the more satisfied the participant is with their body. Total scores are divided into three categories; low body esteem (score 1 to 21), average body-esteem (score 22 to 42), and high body esteem (score > 43). The Rosenberg self-esteem tool was used to measure general self-esteem of the participants. Body image satisfaction tool was used to rate participants satisfaction with different parts of their body whereas, the body esteem scale was used to assess participant’s attitudes and feelings about their body and appearance. A series of randomly placed female silhouettes were used to assess participants association with different attributes. They were also asked to associate a series of randomly placed female silhouettes, with specific words or phrases including clumsy, happy, worst, strong, happiest, best, less respect, more respect, unhappy. All participants were asked a number of questions about their attempts to change their weight. Girls and boys were asked the following questions: “During the past year have you done anything to try to lose weight?”, “During the past year have you done anything to try to gain muscle?” If participants answered positively they were asked to give reasons, which included; health and cosmetic reasons e.g. to look better, clothes too tight, too fat, unhappy with self, and want to be a model. They were further asked about the methods they used to lose weight, and their responses were categorized into three groups: (i) healthy weight control behaviors (e.g. to exercise, eat more fruits and vegetables, and to eat less high fat foods and less sweets) [20] unhealthy weight control behaviors (e.g. fasting, eating very little food, skipping meals, cigarette smoking and use of food substitutes (iii) extreme weight control behaviors (e.g. use of diet pills, self-induced vomiting, use of laxatives and diuretics). Descriptive analyses were completed and stratified according to gender and ethnicity. For normally distributed data we used t-tests and ANOVAs, and for data that was not normally distributed Wilcoxon rank test was done to determine significant difference. Chi-square tests were used to determine differences between categorical data. Pearson correlation test was done to determine linear associations. A p-value of <0.05 was considered statistically significant. Results: In the non-cohort sample, the prevalence of overweight and obesity was higher in the white girls and boys compared to their black peers, significantly more black than white adolescents of both genders reported an EAT-26 score ≥20 (predisposition to an eating disorder). Although the prevalence of low self-esteem was greater in the white compared to black girls, in the study of the male adolescents, the low self-esteem was more prevalent in the black compared to the white boys. Significantly more black than white girls had high body image dissatisfaction (38.8 vs. 16.7%). There were significant differences between the male and female ethnic groups in their perception of female silhouettes, and the majority of the white girls (65.4%) wanted to be thinner compared to only 38.8% of the black girls. BMI was positively associated with self- esteem and negatively with dieting behavior in white boys , and with lower EAT-26 bulimic and oral control scores in black boys. In the Birth to Twenty cohort, black African females had a higher BMI (p<0.001) and an increased risk of developing eating disorders as well as significant increase in the prevalence of weight loss practices between the ages 13 and 17 years. At age 17 years both mixed ancestry adolescents had lower body-esteem compared to black adolescents. The prevalence of possible eating disorders was 11% and 13.1% in early and late adolescents respectively. Males and females shared similar opinions on normal silhouettes being the 'best', 'getting respect' and being the 'happiest', while the obese silhouette was associated with the 'worst' and the 'unhappiest', and the underweight silhouette with the "weakest". Conclusions: Black African urban teenagers seem to be embracing Western norms to fit in with the demands of Western culture, however there is still evidence of traditional influences in both boys and girls with regard to perceptions of female silhouettes. Our findings suggest ethnicity and gender play a major role in psychosocial disorders. Ethnicity and gender were found to be associated with an increased risk of future eating disorders, as well as weight loss and muscle gain practices. These findings are highly relevant for all African countries undergoing transition, and are important in planning the development of interventions to optimize adolescent health prior to adulthood.

Thesis advisor: Thanh V. Tran / Research has established that dietary quality among Asian immigrants declined after immigrating to the United States, indicated by decreasing intake of healthy food and increasing intake of unhealthy food. There is a need for a broader investigation for the interactive influence of acculturation, sociodemographic and environmental factors on dietary intake among this population. Guided by the Operant Theory of Acculturation, and the Dietary Acculturation Theory, the present study examined the following research questions to address the gaps in the literature: (1) Are acculturation factors associated with dietary intake among Asian immigrants? (2) What sociodemographic factors are associated with dietary intake among Asian immigrants? (3) What environmental factors are associated with dietary intake among Asian immigrants? (4) What sociodemographic factors moderate the effect of acculturation on dietary intake among Asian immigrants? (5) What environmental factors moderate the effect of acculturation on dietary intake among Asian immigrants? The data in use come from the 2011 – 2012 Adult California Health Interview survey. The sample includes 2,122 non-Hispanic Asian adults born out of the United States. Results from negative binomial regression indicate that intake of fruits, vegetables, soda, fries and fast food was all negatively associated with living in the United States for at least 10 years, compared to living in the Unites States for less than 10 years. The present study also found sociodemographic (including ethnicity, age, gender, education, employment status, and income) and environmental factors (including family type, household size, household tenure, housing type, perceived availability of fresh fruits and vegetables, residential area category, and participation in food stamp and WIC) statistically significantly confounded and moderated the association between length of time lived in the United States and dietary intake. Findings from this study extend the understanding of the protective and risk factors for Asian immigrants to develop and maintain healthy diet, and demonstrated the complexity of dietary changes among Asian immigrants. Based on the findings, the importance that social work research and practice in addressing nutrition inequality among Asian immigrants was highlighted. The study also discovered potential issues and challenges of developing measurement for dietary intake among Asian immigrants, and provided empirical evidence of longitudinal research designs to further explain dietary changes, and guidelines for community-based interventions to address strategies of nutrition promotion among Asian immigrants. / Thesis (PhD) — Boston College, 2017. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

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OBJECTIVE: To determine the effect of total dietary fat intake on the prevalence of hand osteoarthritis (HOA) utilizing data collected in the Osteoarthritis Initiative (OAI) study cohort. METHODS: This is an observational cross-sectional study. Subjects from the OAI cohort with hand radiographs were analyzed for HOA, defined as a Kellgren-Lawrence score of ≥2 in two or more joints on different fingers. Dietary data and socioeconomic factors were collected from the baseline study visit. Logistic regression analysis assessed the association of total fat intake and disease prevalence. Odds ratios were calculated from the coefficients and confidence intervals were calculated with log-likelihood. RESULTS: HOA was prevalent in 1,106 out of the 2,993 participants (37%). Total fat intake did not show a significant relationship to disease prevalence when adjusted for age, education, income, race, smoking, BMI, prescription NSAID use, calcium intake, protein intake, total calories, saturated/monounsaturated fats, and alcohol consumption. There was a significant association of HOA with age, sex, education, race, total calories, and alcohol intake. Sex was analyzed independently to assess for effect modification, showing an association with age (P<0.01) OR (95%CI) 1.03 (1.02,1.03), race (P<0.01) 1.16 (1.09,1.23), and alcohol consumption (P<0.01) 1.06 (1.02,1.09) among only female subjects. Male subjects showed a strong association with age (P<0.01) 1.02 (1.01,1.02). CONCLUSION: Total fat intake does not show a significant association with HOA prevalence with the study sample from the OAI cohort. Age, race, and alcohol consumption showed significant associations depending on sex. More research is needed to further investigation these associations among different groups.