Os Sistemas Produtivos Agroalimentares têm um papel preponderante na formação de modelos alimentares, desde a produção primária, nos sistemas de cultivo e pecuária até o desenvolvimento e oferta no mercado, de alimentos que atendam as expectativas dos consumidores, sob pena de terem seu consumo reduzido. O Modelo Alimentar predominante no mundo ocidental é caracterizado pelo consumo de alimentos práticos e de preparo rápido, mas que contêm alta densidade energética, muito sódio e pouca fibra, o que leva às chamadas Doenças Crônicas Não Transmissíveis (DCNT). Na busca pelo enfrentamento desse problema, emerge um novo modelo alimentar que tenta conjugar praticidade com benefícios para a saúde. O objetivo deste trabalho foi verificar a interação entre sistemas produtivos de alimentos, modelo alimentar ocidental e saúde da população, num estudo aplicado ao Sistema Agroindustrial do Arroz, visando proporcionar elementos para orientar políticas de Nutrição e Saúde e de estímulo ao consumo. A metodologia incluiu um estudo binacional Brasil-Espanha, que verificou a configuração do Sistema Agroindustrial doa arroz, a oferta e o consumo de derivados de arroz na Espanha e um estudo da viabilidade de produção de derivados de arroz que conjuguem características de praticidade, versatilidade e benefícios para a saúde. Os resultados mostraram que o arroz possui potencial para servir de matéria-prima a alimentos processados, semi-elaborados e prontos para o consumo, com propriedades nutricionais que permitem sua indicação tanto na prevenção quanto na dietoterapia das DCNT. A indústria espanhola desenvolveu e colocou no mercado produtos com praticidade e versatilidade e os consumidores vêm incluindo esses produtos na alimentação. No Brasil se observa um movimento da indústria no sentido de alinhar sua produção para esse conceito, no entanto o Sistema Produtivo do Arroz tanto espanhol, quanto brasileiro, não explora os aspectos de saúde associados a seus produtos. / The Western dietary pattern is characterized by the consumption of practical food and fast preparation, but that contains a high energy density, much sodium and little food fiber, which takes to non-transmissible chronic diseases. In the search for the confrontation of this problem, a new food model which tries to conjugate practical with health benefits comes up. The agribusiness have an important role in this process, since the primary production, on the breeding and cultivation systems, until the development and offer of practical and healthy food in the market, taking the risk of having their consumption reduced. The objective of this work is to check the interaction among productive food systems, western food model and the population‘s health, in a study applied to the agribusiness Rice, driving to provide elements to guide health and consumption motivation politics. The methodology includes a binational study Brazil-Spain, which verified the configuration of the agribusiness and the offer of the products derived from rice in Brazil and in Spain, the analysis of the consumption of the products derived from rice in Spain and a study about the availability of these products which brings together practicality, versatility an health benefits. The results showed that the rice has potential to be used as base for processed food, semi manufactured and ready for consumption, with nutrition facts that allow it to be used both on prevention and non-transmissible chronic diseases diet therapy. The Spanish industry developed and put on the market practical and versatile products and the consumers have been including these products on their diet. In Brazil there has been a gradual change in the industry to line up its production to this concept, however the rice production system in both Spanish and Brazilian does not explore the health aspects associated with their products. / La dieta occidental se caracteriza por el consumo de alimentos prácticos, pero que contienen por un lado una alta densidad energética y elevados contenidos de sodio y por otro lado poca cantidad de fibra, lo que conduce a las Enfermedades Crónicas no Transmisibles (ENT). En la búsqueda de la confrontación de este problema, surge un nuevo modelo alimentario que trata de combinar lo práctico con beneficios para la salud. El sector agroalimentario tiene un papel clave en este proceso, desde la producción primaria en los sistemas de cultivo y el desarrollo ganadero hasta la industria, desarrollando y promoviendo productos más saludables, que contribuyan a una alimentación sana y equilibrada. El objetivo de este estudio ha sido investigar la interacción entre la producción de alimentos, el patrón de consumo occidental y la salud de la población en busca de información para orientar las políticas de salud y estimular el consumo de alimentos saludables. La metodología consistió en un estudio binacional Brasil-España, aplicado al sistema de producción de arroz, que confirmó la configuración de la agroindustria y el suministro derivados del arroz en Brasil y en España, examinando el consumo. Un estudio de viabilidad de productos derivados del arroz que combinen las características de practicidad, versatilidad y beneficios para la salud. Los resultados han mostrado que el arroz tiene el potencial para servir como materia prima para alimentos elaborados, semi-terminados y listos para el consumo. La industria española ha desarrollado y puesto en el mercado productos cómodos, versátiles y con propiedades nutricionales que permiten indicaciones en dietas que puedan ayudar en la prevención de las ENT. Los consumidores están incluyendo estos productos en la alimentación. Sin embargo, el sistema de producción de arroz no expone estos aspectos de sus productos.

Os Sistemas Produtivos Agroalimentares têm um papel preponderante na formação de modelos alimentares, desde a produção primária, nos sistemas de cultivo e pecuária até o desenvolvimento e oferta no mercado, de alimentos que atendam as expectativas dos consumidores, sob pena de terem seu consumo reduzido. O Modelo Alimentar predominante no mundo ocidental é caracterizado pelo consumo de alimentos práticos e de preparo rápido, mas que contêm alta densidade energética, muito sódio e pouca fibra, o que leva às chamadas Doenças Crônicas Não Transmissíveis (DCNT). Na busca pelo enfrentamento desse problema, emerge um novo modelo alimentar que tenta conjugar praticidade com benefícios para a saúde. O objetivo deste trabalho foi verificar a interação entre sistemas produtivos de alimentos, modelo alimentar ocidental e saúde da população, num estudo aplicado ao Sistema Agroindustrial do Arroz, visando proporcionar elementos para orientar políticas de Nutrição e Saúde e de estímulo ao consumo. A metodologia incluiu um estudo binacional Brasil-Espanha, que verificou a configuração do Sistema Agroindustrial doa arroz, a oferta e o consumo de derivados de arroz na Espanha e um estudo da viabilidade de produção de derivados de arroz que conjuguem características de praticidade, versatilidade e benefícios para a saúde. Os resultados mostraram que o arroz possui potencial para servir de matéria-prima a alimentos processados, semi-elaborados e prontos para o consumo, com propriedades nutricionais que permitem sua indicação tanto na prevenção quanto na dietoterapia das DCNT. A indústria espanhola desenvolveu e colocou no mercado produtos com praticidade e versatilidade e os consumidores vêm incluindo esses produtos na alimentação. No Brasil se observa um movimento da indústria no sentido de alinhar sua produção para esse conceito, no entanto o Sistema Produtivo do Arroz tanto espanhol, quanto brasileiro, não explora os aspectos de saúde associados a seus produtos. / The Western dietary pattern is characterized by the consumption of practical food and fast preparation, but that contains a high energy density, much sodium and little food fiber, which takes to non-transmissible chronic diseases. In the search for the confrontation of this problem, a new food model which tries to conjugate practical with health benefits comes up. The agribusiness have an important role in this process, since the primary production, on the breeding and cultivation systems, until the development and offer of practical and healthy food in the market, taking the risk of having their consumption reduced. The objective of this work is to check the interaction among productive food systems, western food model and the population‘s health, in a study applied to the agribusiness Rice, driving to provide elements to guide health and consumption motivation politics. The methodology includes a binational study Brazil-Spain, which verified the configuration of the agribusiness and the offer of the products derived from rice in Brazil and in Spain, the analysis of the consumption of the products derived from rice in Spain and a study about the availability of these products which brings together practicality, versatility an health benefits. The results showed that the rice has potential to be used as base for processed food, semi manufactured and ready for consumption, with nutrition facts that allow it to be used both on prevention and non-transmissible chronic diseases diet therapy. The Spanish industry developed and put on the market practical and versatile products and the consumers have been including these products on their diet. In Brazil there has been a gradual change in the industry to line up its production to this concept, however the rice production system in both Spanish and Brazilian does not explore the health aspects associated with their products. / La dieta occidental se caracteriza por el consumo de alimentos prácticos, pero que contienen por un lado una alta densidad energética y elevados contenidos de sodio y por otro lado poca cantidad de fibra, lo que conduce a las Enfermedades Crónicas no Transmisibles (ENT). En la búsqueda de la confrontación de este problema, surge un nuevo modelo alimentario que trata de combinar lo práctico con beneficios para la salud. El sector agroalimentario tiene un papel clave en este proceso, desde la producción primaria en los sistemas de cultivo y el desarrollo ganadero hasta la industria, desarrollando y promoviendo productos más saludables, que contribuyan a una alimentación sana y equilibrada. El objetivo de este estudio ha sido investigar la interacción entre la producción de alimentos, el patrón de consumo occidental y la salud de la población en busca de información para orientar las políticas de salud y estimular el consumo de alimentos saludables. La metodología consistió en un estudio binacional Brasil-España, aplicado al sistema de producción de arroz, que confirmó la configuración de la agroindustria y el suministro derivados del arroz en Brasil y en España, examinando el consumo. Un estudio de viabilidad de productos derivados del arroz que combinen las características de practicidad, versatilidad y beneficios para la salud. Los resultados han mostrado que el arroz tiene el potencial para servir como materia prima para alimentos elaborados, semi-terminados y listos para el consumo. La industria española ha desarrollado y puesto en el mercado productos cómodos, versátiles y con propiedades nutricionales que permiten indicaciones en dietas que puedan ayudar en la prevención de las ENT. Los consumidores están incluyendo estos productos en la alimentación. Sin embargo, el sistema de producción de arroz no expone estos aspectos de sus productos.

Cardiovascular disease is the leading cause of death in the world, in Brazil it is main manifestation is coronary artery disease. The lifestyle and dietary pattern seem to be the main determinants of the manifestation of cardiometabolic risk factors for cardiovascular disease and diabetes. Given this situation, the aim of this study was to evaluate the effect of the Programa Alimentar Brasileiro Cardioprotetor (Brazilian Cardioprotective Nutritional Program) in food intake and cardiometabolic risk components, abdominal obesity, hyperglycemia, hypertension, hypertriglyceridemia and reduced serum high-density lipoprotein. This was a randomized, dietary intervention trial, based on reducing nutrient density favorable to cardiovascular diseases: calories, saturated fat, sodium and cholesterol. Control group (n=31) and intervention group (n=27) were homogeneous in relation to sociodemographic, clinical, anthropometric and biochemical characteristics. Intervention group with a nutritionist follow up reduced consumption of calories, total fat, saturated fat, trans fat and sodium. The control group with food guidance to nurses and pharmacists no change in food intake. The effect of the nutritional program on cardiometabolic risk after the intervention was observed in reducing fasting glucose levels by comparing the intervention and control groups. The other parameters of cardiometabolic risk were not statistically significant. Hyperglycemia reduction in the intervention group using a multivariate analysis adjusted for use of hypoglycemic drug, gender and age was 40% by decreasing abdominal obesity in 3,90cm (r² = 0.474, β = 0.654, p = 0.007), weight and BMI also explained the reduction in serum glucose by 17% and 0.07%, respectively. The Brazilian Nutritional Programme effect was in reducing the consumption of lipids and sodium, with metabolic consequences in the reduction of hyperglycemia and evolution of anthropometric parameters. Indicating that improving the diet in chronic patients is a slow process because it involves changes in lifestyle. / As doenças cardiovasculares constituem a principal causa de morte no mundo, no Brasil a sua principal manifestação é a doença arterial coronariana. O estilo de vida e o padrão dietético parecem ser os principais determinantes da manifestação de fatores de risco cardiometabólico para as doenças cardiovasculares e diabetes. Diante dessa situação o objetivo do presente estudo foi avaliar o efeito do Programa Alimentar Brasileiro Cardioprotetor em pacientes cardiovasculares sobre o consumo alimentar e os componentes do risco cardiometabólico: obesidade abdominal, hiperglicemia, hipertensão arterial sistêmica, hipertrigliceridemia e redução da lipoproteína de alta densidade sérica. Realizou-se um ensaio clínico randomizado de intervenção dietética, baseada na redução da densidade de nutrientes que predispõem às doenças cardiovasculares: calorias, gorduras saturadas, colesterol e sódio. Os grupos controle (n=31) e intervenção (n=27) eram homogêneos, na admissão, em relação às características sociodemográficas, clínicas, antropométricas e bioquímicas. No grupo intervenção com acompanhamento de nutricionista, foram reduzidos o consumo de calorias totais, gordura total, saturada, ácido graxos trans, e sódio. O grupo controle com orientação alimentar de enfermeiro e farmacêutico não apresentou alterações no consumo alimentar. O efeito do programa alimentar no risco cardiometabólico após a intervenção foi observado na redução da glicemia de jejum, comparando os grupos intervenção e controle. Os demais parâmetros do risco cardiometabólico não foram estatisticamente significativos. Em análise de regressão multivariada, ajustada por uso de hipoglicemiante, sexo e idade, a redução de 3,90 cm de CC, obtida após 12 meses de seguimento, determinou a diminuição de 2,535 mg/dL na glicemia, 44% da redução alcançada após 12 meses de intervenção dietética (r²=0,474, β=0,654, p=0,007), peso e IMC também explicaram a redução da glicemia sérica em 17% e 0,07%, respectivamente. Os fatores de risco cardiometabólico do grupo controle mantiveram-se iguais ao momento basal. O Programa Alimentar Brasileiro apresentou efeito significativo na redução do consumo de lipídeos e sódio, com consequência metabólica na diminuição da hiperglicemia e evolução dos parâmetros antropométricos. Indicando que melhorar a dieta em pacientes crônicos é um processo lento por envolver mudanças no estilo de vida.

Diversos estudos apontam uma forte influência do ambiente terrestre sobre os corpos dágua nele inseridos. No caso de riachos de cabeceira esta relação não se resume a variáveis químicas e físicas, mas também está ligada diretamente ao que chamamos de metabolismo do riacho, regulando o aporte direto de nutrientes em forma de folhiço e material particulado e a produtividade interna, através de incidência de luz. Estes são fatores que estão intrinsecamente ligados a manutenção deste metabolismo e por conseqüência da biodiversidade que existe nestes riachos. Este estudo, através da técnica isotópica do \'dela\'13C e \'delta\'15N e índices ecológicos (riqueza, abundância, diversidade, EPT e EPTC) comparou riachos de Mata Atlântica inseridos em ambientes com diferentes características. Primeiramente com relação à altitude, foram comparados riachos inseridos em matriz de Floresta Ombrófila Densa de Terras Baixas (5 a 50 m), sopé da Serra do Mar e de Floresta Ombrófila Densa Montana (500 a 1.200 m), topo da serra. E em um segundo momento, riachos em diferentes usos do solo, inseridos em matriz de floresta, eucalipto e pastagem. Foram encontradas diferenças não só relacionadas aos índices ecológicos, mas principalmente com relação as variáveis isotópicas, que apontaram mudanças nos padrões alimentares. Os riachos de terras baixas apresentaram um alto consumo de perifiton que foi substituído pelo consumo de material particulado nos riachos de altitude. O consumo de folhiço foi importante em ambas as altitudes e se manteve estável temporalmente. No caso de uso do solo, os riachos inseridos em plantações de eucalipto, seguiram um padrão muito próximo aos riachos florestados. Os padrões encontrados nos riachos de pastagem diferiram de ambas as fisionomias florestais apresentando um baixo consumo de folhiço e influência de plantas C4 na dieta de alguns invertebrados, além de uma grande variação interna explicada pela composição do folhiço e material particulado encontrados nestes riachos. / Several studies show a strong influence of terrestrial environment on streams contained therein. On headwater streams that influence is not just related to chemical and physical variables, but also is directly linked to what the stream metabolism, regulating the direct input of nutrients in the form of litter and particulate matter and internal productivity through light incidence. Factors that are inextricably linked to maintenance of these metabolism and consequently to the biodiversity that exists in these streams. This study, using the isotopic technique of \'delta\'13C and \'delta\'15N and ecological indexes (richness, abundance, diversity, EPT and EPTC) compared Atlantic Forest streams inserted in environments with different characteristics. We compared streams inserted in Tropical Rain Forest of lowlands (50-50 m), foothills of the Serra do Mar and Mountain Tropical Rain Forest (500-1200 m) upland. Also compared streams in different land uses, inserted into a matrix of forest, grassland and eucalyptus. Differences found on isotopic variables showed changes in dietary patterns. The lowland streams showed a high consumption of periphyton that was replaced by the consumption of particulate matter in the upland streams. Consumption of leaf litter was important in both altitudes and remained stable on both seasons. For land use comparison, streams inserted in eucalyptus plantations, followed a pattern similar to forested streams. The patterns found in pasture streams differed from both forest formations, showing a low consumption of leaf litter and influence of C4 plants in the diet of some invertebrates, as well as a large internal variation explained by the composition of litter and particulate matter collected in these streams.

<p>  To improve cardiometabolic health, omnivores are often recommended to simultaneously adopt a healthy dietary pattern with an emphasis on increasing intakes of plant-based proteins and decreasing intakes of red and processed meats. However, the totality of observational and experimental results inconsistently supports relations between red meat intake and risks of cardiometabolic diseases such as cardiovascular disease and type 2 diabetes mellitus. Red meat is often not clearly or consistently defined within nutrition and health research and is consumed within healthy and unhealthy dietary patterns. These issues contribute to the conflicting findings. Observational data, which assess red meat (both unprocessed and processed) within an unrestricted Western-style dietary pattern, typically support positive associations with cardiometabolic disease incidence and mortality outcomes. Whereas experimental randomized controlled trial data consistently show that consuming healthy dietary patterns with or without the inclusion of lean unprocessed red meat, improve cardiometabolic disease risk factors. These discordant findings have left laymen, researchers,and policymakers alike to question whether a high intake of red meat is causally related to cardiometabolic disease outcomes. The results of the single blinded crossover randomized controlled feeding trial (Study 1, Chapter 3) support that consuming a U.S.-style healthy dietary pattern that included two 3oz servings/day of lean unprocessed beef did not adversely affect cardiometabolic disease risk factors. Based on observational and experimental research, the umbrella systematic review described in Chapter4, led to the inference that red and processed meats are not causally related with cardiovascular disease. However, relations between processed meat and mixed unprocessed and processed meat and type 2 diabetes were inferred to be potentially causal. Overall, the results described in this dissertation support that lean and unprocessed red meats consumed within healthy dietary patterns do not adversely affect cardiometabolic health</p>

La Polynésie française et la Nouvelle-Calédonie, îles du Pacifique, ont l’un des taux de cancer de la thyroïde les plus élevés au monde. A l’exception des rayonnements ionisants, aucun autre facteur de risque n’est clairement établi pour ce cancer. Deux études cas-témoins sur le cancer de la thyroïde ont été réalisées en Polynésie française et Nouvelle-Calédonie afin d’étudier les facteurs de risque qui sont encore peu connus. L'objectif de ce travail de thèse est d’étudier le rôle des facteurs anthropométriques et de l’alimentation sur le risque de cancer de la thyroïde dans les îles du Pacifique.En Polynésie française, 229 cas de cancer de la thyroïde diagnostiqués entre 1979 et 2004 et 371 témoins appariés sur l’âge et le sexe ont été inclus. En Nouvelle-Calédonie, 331 cas de cancer de la thyroïde diagnostiqués entre 1993 et 1999 et 412 témoins appariés également sur l’âge et le sexe ont été inclus.Dans l’analyse poolée des deux études cas-témoins, un peu plus de la moitié des Polynésiens et Néo-calédoniens étaient en surpoids ou obèses. Une augmentation du risque de cancer thyroïdien a été mise en évidence avec une taille, un poids, un indice de masse corporelle, et une surface corporelle élevés. Parmi ces facteurs anthropométriques, la surface corporelle joue un rôle dominant dans le risque de cancer de la thyroïde, en particulier à l’âge de 18 ans.Ensuite, nous nous sommes intéressés à l’alimentation des Polynésiens uniquement. Nous avons identifié deux régimes (ou patterns) alimentaires : l’un occidental et l’autre polynésien traditionnel. Le régime « occidental » n’était pas associé à un risque de cancer thyroïdien, alors que le régime « polynésien traditionnel » était faiblement associé à une diminution du risque. Par ailleurs, les résultats ont montré que les Polynésiens avaient une alimentation carencée en iode. Une consommation élevée de poissons et fruits de mer, ainsi qu’un apport alimentaire en iode élevé étaient associés à une diminution du risque de cancer de la thyroïde. Enfin, une consommation élevée de manioc, aliment goitrigène, diminuait le risque de cancer thyroïdien. / French Polynesia and New Caledonia, Pacific Islands, have one of the world’s highest thyroid cancer incidence rates. Except ionizing radiation, no other risk factor is clearly established for this cancer. Two case-control studies on thyroid cancer were conducted in French Polynesia and New Caledonia to investigate the risk factors not still understood. The objective of this thesis is to study the role of anthropometric and dietary factors in the risk of thyroid cancer in the Pacific Islands.In French Polynesia, 229 cases of thyroid cancer diagnosed between 1979 and 2004 and 371 controls matched on age and sex were included. In New Caledonia, 331 cases of thyroid cancer diagnosed between 1993 and 1999 and 412 controls matched also on age and sex were included.In the pooled analysis of the two case-control studies, half of Polynesians and Melanesians were overweighed or obese. An increased risk of thyroid cancer was shown with a high height, weight, body mass index, and body surface area. Among anthropometric factors, BSA plays a dominant role in thyroid cancer risk, in particular at 18 years old.Then, we are interested in the diet only of Polynesians. We have identified two dietary patterns: Western and traditional Polynesian. The pattern “Western" was not associated with a risk of thyroid cancer, while the pattern "traditional Polynesian" was weakly associated with a decreased risk. Moreover, results showed that Polynesians had a diet deficient in iodine. A higher consumption of fish and shellfish, and a higher dietary iodine intake are significantly associated with a decreased risk of thyroid cancer. Lastly, high cassava consumption decreased the thyroid cancer risk.

By the year 2025, it is anticipated that over 300 million individuals world wide will have type 2 diabetes, with a projected increase from 84 to 288 million (170%) in developing countries and from 51 to 72 million (42%) in developed countries. Diabetes leads to a markedly increased risk of heart disease and renal failure and to expensive and debilitating retinopathy and neuropathy. Cognitive decline is also increased. As there is accumulating evidence of the beneficial effects of moderate carbohydrate, low fat dietary patterns compared to high carbohydrate diets, this thesis will focus on the effects of moderate carbohydrate high protein dietary patterns (total carbohydrate: protein: fat ratio of 40%:34%:26%) on glycemic control, risk factors for macrovascular disease and cognitive function. Information on two key areas in type 2 diabetes will be presented, 1. Acute effects of dietary patterns, moderately carbohydrate restricted and high in protein on glucose levels assessed using continuous glucose monitoring systems (CGMS) with verification of these results through a small repeat study. 2. Chronic effects of energy restricted dietary patterns, moderately carbohydrate restricted and high in protein on glucose levels, HbA1c, cognitive function, cardiovascular disease (CVD) risk markers and renal function. In the acute study, we recruited 23 subjects with type 2 diabetes. The participants were randomized to each of 4, 3-day interventions in a cross over design with a 4 day wash out period in which the carbohydrates were distributed differently at each meal; carbohydrates evenly distributed across the day, or carbohydrates loaded at breakfast, lunch or dinner. Glucose levels were continuously measured using CGMS. Outcomes were assessed by postprandial peak glucose (Gmax), time spent above 12 mmol/L (T>12) and total area under the glucose curve (AUC20). The intervention showed that an even distribution of carbohydrates did not optimise blood glucose control, whereas carbohydrates loaded at the lunch time meal provided the most favourable postprandial profile. To verify these results we conducted a repeat study. Six of the previous participants accepted the invitation to return and complete the even distribution arm of the study after a 20 week time lag. The intervention showed that although HbA1c, fasting blood glucose (FBG), AUC, exercise and ambient temperature remained constant there was a significant effect of change in sunlight hours on Gmax, suggesting an effect of sunlight. To assess the chronic effects of energy restricted dietary patterns on the determinants of HbA1c, cognitive function, CVD risk markers and renal function under conditions of weight loss, we recruited 82 participants with type 2 diabetes. These participants were randomised to one of two high protein energy restricted dietary patterns that differed in cholesterol content, for a 12 week period, in a parallel design. A sub group of these participants completed cognitive function testing with (n=34) or without (n=17) CGMS at baseline and at 8 weeks. After 8 weeks of the intervention the determinants of HbA1c under conditions of energy restriction were evaluated. The intervention showed the change in FBG accounted for most of the variance in change in HbA1c, but % energy reduction also contributed independently of FBG. Both energy restricted high protein diets equally improved glycemic control, particularly T>12, AUC, HbA1c and FBG. Fifty one participants completed cognitive testing to evaluate the effect of weight loss and blood glucose control on cognition. Cognitive function was not altered by time, diet, baseline lipid levels. Working memory was predicted by FBG. Short term memory was predicted by FBG, Gmax and AUC24. Sixty five participants completed 12 weeks of the intervention to assess CVD risk markers and renal function. Renal function was maintained and CV markers improved on both dietary patterns, with greatest improvement in HDL-C observed in the group consuming a high protein, energy restricted dietary pattern, high in dietary cholesterol. In conclusion, in the context of a high protein, carbohydrate restricted dietary pattern, cognitive function and renal function did not change, while glycemia and CV risk profiles improved with weight loss over the short term. Under conditions of energy balance diurnal glucose profiles were optimal when the carbohydrates were loaded in the lunch meal. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1342253 / Thesis (Ph.D.) - University of Adelaide, School of Molecular and Biomedical Science, 2008

By the year 2025, it is anticipated that over 300 million individuals world wide will have type 2 diabetes, with a projected increase from 84 to 288 million (170%) in developing countries and from 51 to 72 million (42%) in developed countries. Diabetes leads to a markedly increased risk of heart disease and renal failure and to expensive and debilitating retinopathy and neuropathy. Cognitive decline is also increased. As there is accumulating evidence of the beneficial effects of moderate carbohydrate, low fat dietary patterns compared to high carbohydrate diets, this thesis will focus on the effects of moderate carbohydrate high protein dietary patterns (total carbohydrate: protein: fat ratio of 40%:34%:26%) on glycemic control, risk factors for macrovascular disease and cognitive function. Information on two key areas in type 2 diabetes will be presented, 1. Acute effects of dietary patterns, moderately carbohydrate restricted and high in protein on glucose levels assessed using continuous glucose monitoring systems (CGMS) with verification of these results through a small repeat study. 2. Chronic effects of energy restricted dietary patterns, moderately carbohydrate restricted and high in protein on glucose levels, HbA1c, cognitive function, cardiovascular disease (CVD) risk markers and renal function. In the acute study, we recruited 23 subjects with type 2 diabetes. The participants were randomized to each of 4, 3-day interventions in a cross over design with a 4 day wash out period in which the carbohydrates were distributed differently at each meal; carbohydrates evenly distributed across the day, or carbohydrates loaded at breakfast, lunch or dinner. Glucose levels were continuously measured using CGMS. Outcomes were assessed by postprandial peak glucose (Gmax), time spent above 12 mmol/L (T>12) and total area under the glucose curve (AUC20). The intervention showed that an even distribution of carbohydrates did not optimise blood glucose control, whereas carbohydrates loaded at the lunch time meal provided the most favourable postprandial profile. To verify these results we conducted a repeat study. Six of the previous participants accepted the invitation to return and complete the even distribution arm of the study after a 20 week time lag. The intervention showed that although HbA1c, fasting blood glucose (FBG), AUC, exercise and ambient temperature remained constant there was a significant effect of change in sunlight hours on Gmax, suggesting an effect of sunlight. To assess the chronic effects of energy restricted dietary patterns on the determinants of HbA1c, cognitive function, CVD risk markers and renal function under conditions of weight loss, we recruited 82 participants with type 2 diabetes. These participants were randomised to one of two high protein energy restricted dietary patterns that differed in cholesterol content, for a 12 week period, in a parallel design. A sub group of these participants completed cognitive function testing with (n=34) or without (n=17) CGMS at baseline and at 8 weeks. After 8 weeks of the intervention the determinants of HbA1c under conditions of energy restriction were evaluated. The intervention showed the change in FBG accounted for most of the variance in change in HbA1c, but % energy reduction also contributed independently of FBG. Both energy restricted high protein diets equally improved glycemic control, particularly T>12, AUC, HbA1c and FBG. Fifty one participants completed cognitive testing to evaluate the effect of weight loss and blood glucose control on cognition. Cognitive function was not altered by time, diet, baseline lipid levels. Working memory was predicted by FBG. Short term memory was predicted by FBG, Gmax and AUC24. Sixty five participants completed 12 weeks of the intervention to assess CVD risk markers and renal function. Renal function was maintained and CV markers improved on both dietary patterns, with greatest improvement in HDL-C observed in the group consuming a high protein, energy restricted dietary pattern, high in dietary cholesterol. In conclusion, in the context of a high protein, carbohydrate restricted dietary pattern, cognitive function and renal function did not change, while glycemia and CV risk profiles improved with weight loss over the short term. Under conditions of energy balance diurnal glucose profiles were optimal when the carbohydrates were loaded in the lunch meal. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1342253 / Thesis (Ph.D.) - University of Adelaide, School of Molecular and Biomedical Science, 2008

Prendre part à un jardin communautaire ou collectif (JCC) est associé entre autres à une consommation accrue de fruits et légumes (FL) dans la littérature. Avec la popularité croissante des JCC dans les pays développés, l’impact des JCC sur les iniquités de santé demeure méconnu. Cette étude analyse 1) la répartition des JCC à Montréal en fonction de certaines caractéristiques sociodémographiques des voisinages et 2) l’association entre la proximité résidentielle d’un JCC et la consommation quotidienne de FL chez les adultes. Le nombre moyen de JCC dans les voisinages de Montréal a été comparé selon la densité populationnelle, la proportion de ménages locataires, la proportion d’immigrants et les proportions de personnes à faible revenu ou sans diplôme d’études secondaires. Une régression logistique multivariée a été effectuée pour évaluer l’association entre la proximité résidentielle d’un JCC (présente si jardin à ≤ 500 m de la résidence) et la consommation quotidienne de FL (suffisante étant ≥5 fois/jour). Les analyses ont été répétées avec une proximité à 300 m et à 1 000 m. Les analyses comparatives ont révélé un nombre significativement plus élevé de JCC dans les voisinages plus denses, avec plus de locataires et avec plus de personnes à faible revenu ou sans diplôme d'études secondaires. La proximité résidentielle à un JCC s’avère non associée à la fréquence de consommation de FL chez les adultes. La répartition actuelle des JCC à Montréal favorise un accès accru dans les quartiers plus défavorisés et présente un potentiel pour réduire les iniquités de santé. Dans notre étude, vivre près d’un jardin ne serait pas associé à une consommation plus importante de FL. Des études supplémentaires sont nécessaires pour évaluer d'autres dimensions de l'accès et de l’impact sur les iniquités de santé. / Taking part in community/collective gardening has been linked to greater fruit and vegetable (FV) consumption. However, little is known regarding their impact on social health inequalities. This study aims to examine 1) the distribution of community/collective gardens in Montreal and 2) the association between residential proximity to a community garden and daily FV consumption among adults. First, the mean number of gardens within a neighbourhood was compared as a function of neighbourhood-level socio-demographic indicators. Second, a multivariable logistic regression was performed to evaluate the relationship between FV consumption and the presence of a community/collective garden. FV consumption of individuals was classified as sufficient (≥ 5 times/day) or insufficient (< 5). Presence of a community/collective garden was dichotomized as being present (≤ 500 m from residence) or absent (> 500 m). Sensitivity analyses were conducted to assess the impact of modifying the cut-point using 300 m and 1000 m. Comparative analyses revealed significantly more gardens in neighbourhoods with higher population densities, higher tenancy rates, and higher proportions of people living under the low-income threshold or without a high-school diploma. There was no trend according to immigrant proportions. Our regression results showed no association between residential proximity and the frequency of FV consumption among adults. The current distribution of community/collective gardens in Montreal favours increased access in more disadvantaged neighbourhoods and shows potential to reduce health inequities. Living close to a garden doesn’t seem to be associated with the FV consumption pattern. Additional studies are needed to assess other important dimensions of access and the impact on health inequities.