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Childhood (ages 2-9 years) and adolescence (ages 10-19 years) make up important periods of human life. Food preferences and dietary behaviors are developing during this time, and health status can impact noncommunicable disease (NCD) risk in adulthood. Many of the behaviors associated with developing NCD are modifiable and include dietary behaviors. Globally, children and adolescents are impacted by NCD, and obesity prevalence is growing among this population. One of the recommendations for combating obesity is to promote the consumption of healthy foods and beverages and the reduction of sugar-sweetened beverage intake. In order to assess beverage patterns, the Healthy Beverage Index (HBI) was created for adults. This tool provides a score from 0-100, with higher scores indicating better adherence to evidence-based beverage recommendations. Because many beverage recommendations for children and adolescents differ from those for adults, the purpose of this thesis was to develop the HBI for U.S. Children and Adolescents (HBI-CA). National Health and Nutrition Examination Survey (NHANES) data was used to calculate HBI-CA scores among a sample of U.S. children and adolescents. The HBI-CA resulted in scores similar to the adult HBI and provides a reference of beverage pattern quality in this population. Significant differences in scores were found among males and females and certain races. Evaluation of the HBI-CA demonstrated its construct validity and reliability. The HBI-CA still needs to undergo predictive validity tests. Overall, the HBI-CA provides a method to assess beverage pattern quality in clinical, public health, and research settings for this important population. / Master of Science / Children (ages 2-9 years) and adolescents (ages 10-19 years) makeup an important population for the implementation of dietary interventions because they are still developing their food preferences and dietary behaviors. The rise of obesity among these age groups indicates that their dietary behaviors may not be aligned with recommendations. Beverages can easily be overlooked as a dietary component, but they currently constitute a large portion of daily energy intake. In order to assess beverage pattern quality in this population, the Healthy Beverage Index for U.S. Children and Adolescents (HBI-CA) was developed based on the HBI for adults. This tool provides a score from 0-100, with higher scores indicating better adherence to evidence-based beverage recommendations. The HBI-CA also provides a resource of comprehensive beverage recommendations for these age groups, which was previously limited in the literature. National Health and Nutrition Examination Survey (NHANES) data was used to calculate HBICA scores among a sample of U.S. children and adolescents. The HBI-CA resulted in scores similar to the adult HBI and provides a reference of beverage pattern quality in this population. Significant differences in scores were found among males and females and certain races. Evaluation of the HBI-CA demonstrated its ability to reliably and consistently measure beverage pattern quality. Future evaluation of the HBI-CA should include examination of the relationship between HBI-CA scores and dietary-related health outcomes. Overall, the HBI-CA provides a method to assess beverage pattern quality in clinical, public health, and research settings for this important population.

Submitted by Daniella Santos (daniella.santos@ufma.br) on 2017-08-11T14:58:42Z No. of bitstreams: 1 Bruna Pires.pdf: 4058602 bytes, checksum: 8405d2df0e834d76d15b26aaf9f64d85 (MD5) / Made available in DSpace on 2017-08-11T14:58:42Z (GMT). No. of bitstreams: 1 Bruna Pires.pdf: 4058602 bytes, checksum: 8405d2df0e834d76d15b26aaf9f64d85 (MD5) Previous issue date: 2017-04-24 / Studies developed in Brazil have shown that the lipid profile of adolescents is undergoing changes. Probably due to changes that the dietary patterns of this population have been suffering over the years. However, there are few studies on the relationship between dietary patterns and dyslipidemia in adolescents, especially in the Northeast of Brazil. Objective: To analyze the association between dietary patterns and dyslipidemia in adolescents. Material and methods: Cross-sectional study with 363 adolescents of both sexes, ages 17 to 18, from public schools of São Luís, Maranhão. Food consumption was evaluated by means of a Food Frequency Questionnaire (FFQ) and the dietary patterns were identified by Principal Component Analysis (PCA). Adolescents who had an alteration in at least one of the following conditions were considered dyslipidemia carriers: total cholesterol (TC), low density lipoprotein (LDL-c), high density lipoprotein (HDL-c), triglycerides (TG), Index of Castelli I and II and No HDL-c. For selection of the variables that were controlled in the analysis of the effect of dietary patterns on the dyslipidemias, we used the Directed Acyclic Graphs (DAG) and the final sample was weighted to the inverse of the probability of selection for these variables through doubly robust method. Results: Three dietary patterns were identified in this study: “Western” (stuffed cookie, cake, soft drinks, processed juices, coffee/ tea with sugar, red meat/ viscera, fast food, sugar/ sweets), “Healthy” (vegetables, fruits, natural juices, nonfat milk/ derivatives, coffee/ tea without sugar, legumes, light butter/ margarine and salad dressings), and “Traditional” (breads/ cookies without filling, butter/ margarine, whole milk/ milk products, beans, rice, cereals and eggs). Most of the adolescents showed dyslipidemia (59.23%), and the inadequacy of HDL-c levels was the primary dyslipidemia found (44.9%). There was no significant difference in the occurrence of dyslipidemia among the three identified dietary patterns (p>0.05). Conclusion: The study population had a high prevalence of dyslipidemia. However, the adolescents’ dietary pattern did not explain dyslipidemia. / Estudos desenvolvidos no Brasil têm demonstrado que o perfil lipídico de adolescentes está sofrendo alterações. Provavelmente, em decorrência de modificações nos padrões alimentares dessa população. No entanto, há poucos estudos sobre a relação entre os padrões alimentares e as dislipidemias em adolescentes, especialmente no nordeste brasileiro. Objetivo: Analisar associação entre padrões alimentares e dislipidemia em adolescentes. Material e métodos: Estudo transversal com 363 adolescentes de ambos os sexos, entre 17 e 18 anos de idade, de escolas públicas de São Luís, Maranhão. O consumo alimentar foi avaliado por meio de Questionário de Frequência Alimentar (QFA) e o padrão alimentar foi identificado por meio da Análise de Componentes Principais (ACP). Considerou-se portador de dislipidemia o adolescente que apresentasse alteração em pelo menos uma das seguintes condições: colesterol total (CT), lipoproteína de baixa densidade (LDL-c), lipoproteína de alta densidade (HDL-c), triglicerídeos (TG), Índice de Castelli I e II e Não HDL-c. Para seleção das variáveis que foram controladas na análise do efeito dos padrões alimentares sobre as dislipidemias foi elaborado o Directed Acyclic Graphs (DAG) e a amostra final do estudo foi ponderada pelo inverso da probabilidade de seleção para essas variáveis, através de método duplamente robusto. Resultados: Três padrões alimentares foram identificados: “Ocidental” (biscoito recheado, bolo, refrigerantes, sucos industrializados, café/chá com açúcar, carne vermelha/ vísceras, “fast food”, açúcar/doces), “Saudável” (hortaliças, frutas, sucos naturais, leite/derivados desnatados, café/chá sem açúcar, leguminosas, manteiga/margarina light e temperos para salada) e “Tradicional” (pães/biscoito sem recheio, manteiga/margarina comum, leite/derivados integrais, feijão, arroz, cereais e ovos). A maior parte dos adolescentes apresentou dislipidemia (59,2%), sendo a inadequação dos níveis de HDL-c a principal dislipidemia encontrada (44,9%). Não houve diferença significativa na ocorrência de dislipidemia entre os três padrões alimentares identificados (p>0,05). Conclusão: A população em estudo apresentou elevada prevalência de dislipidemia. No entanto, a dislipidemia não foi explicada pelo padrão alimentar dos adolescentes.

The Indian population is at high risk for obesity and its related diseases. Paradoxically, there is also a high prevalence of low birth weight in this population. Throughout life, factors associated with these abnormalities reflect genetic, environmental and lifestyle patterns.World-wide, the Indian population is largely non-meat-eating which could compromise the quantity and quality of the diet in macronutrients (proteins) and micronutrients (vitamin B12). Vitamin B12 has been suggested to increase the risk for the metabolic syndrome (dyslipidemia, insulin resistance, hypertension and central adiposity). Factors measured in this pilot study designed to examine the differences between meat-eating and non-meat-eating Indian preadolescent girls were body composition, dietary food and nutrient analysis, physical activity patterns and biomarkers of diet and metabolic syndrome.Six non-meat-eating (9.8±0.9 y) and six meat-eating (10.0±0.6 y) Indian preadolescent girls participated in the two weeks study. Mothers and their daughters in each group had followed the same dietary pattern from birth. Anthropometry, hand-to-foot bioelectrical impedance and resting energy expenditure were measured. Biomarkers associated with one carbon metabolism; serum B12, methylmalonic acid (MMA) and folate were measured. Inflammatory markers; high sensitivity C-reactive protein and ferritin were measured. Serum lipids, fasting glucose and haematological parameters were measured. Time spent in sedentary activities and dietary information was extracted from seven day physical activity and food diaries respectively.There was an overall trend towards higher values for the non-meat-eaters as compared to the meat-eaters in body fat percent (29.7±6.6 vs. 29.0±6.2%, p = 0.85), and waist to hip ratio (0.89±0.12 vs. 0.84±0.07, p = 0.37) but the meat-eaters weighed more (31.2±5.5 vs. 33.3±9.6kg, p = 0.65). Compared to British reference ranges, girls in both groups had a higher BF% of 29±6% which was 34 percentile points above the British median (McCarthy et al., 2006) adjusted for age.Both groups spent 21 hours each day in non-moving/sedentary activities. Dietary consumption of vitamin B12 was higher in meat-eaters compared to non-meat-eaters (2.5±0.8 vs 1.8±0.6μg.day-1, p = 0.11). Serum vitamin B12 was substantially higher in the meat-eaters (543±212 vs. 232±95 pmol/L, p = 0.01) with lower serum concentrations of MMA (0.2 ± 0.1 vs 0.3 ± 0.2 μmol/L, p=0.3). Serum folate was adequate in all girls ranging from 16.5-45.0 pmol/L, which was within the normal reference values. Two non-meat-eating girls were vitamin B12 deficient (<170pmol/L). These differences were associated with high fibre and less protein intake in the nonmeat-eaters (30±8 vs. 20±7 g day-1; 64±12 vs. 66±11 g.day-1).The initial findings in this pilot study provide early evidence that risk factors for metabolic disease associated with body composition, diet and activity are accumulating in preadolescent Indian girls. Imbalance in one carbon metabolism is clearly a factor to be considered. In those with a low consumption of meat and/or animal products, B12 monitoring, dietary recommendations and if necessary supplementation should be considered and where possible intervention before pregnancy (as for folate) be a priority. New Zealand Indian people would be a priority group.It is time for serious action in this area of health so that the risk accumulated through an imbalance in nutrition and physical activity is reduced and the health of those as yet unborn is improved.

The Indian population is at high risk for obesity and its related diseases. Paradoxically, there is also a high prevalence of low birth weight in this population. Throughout life, factors associated with these abnormalities reflect genetic, environmental and lifestyle patterns.World-wide, the Indian population is largely non-meat-eating which could compromise the quantity and quality of the diet in macronutrients (proteins) and micronutrients (vitamin B12). Vitamin B12 has been suggested to increase the risk for the metabolic syndrome (dyslipidemia, insulin resistance, hypertension and central adiposity). Factors measured in this pilot study designed to examine the differences between meat-eating and non-meat-eating Indian preadolescent girls were body composition, dietary food and nutrient analysis, physical activity patterns and biomarkers of diet and metabolic syndrome.Six non-meat-eating (9.8±0.9 y) and six meat-eating (10.0±0.6 y) Indian preadolescent girls participated in the two weeks study. Mothers and their daughters in each group had followed the same dietary pattern from birth. Anthropometry, hand-to-foot bioelectrical impedance and resting energy expenditure were measured. Biomarkers associated with one carbon metabolism; serum B12, methylmalonic acid (MMA) and folate were measured. Inflammatory markers; high sensitivity C-reactive protein and ferritin were measured. Serum lipids, fasting glucose and haematological parameters were measured. Time spent in sedentary activities and dietary information was extracted from seven day physical activity and food diaries respectively.There was an overall trend towards higher values for the non-meat-eaters as compared to the meat-eaters in body fat percent (29.7±6.6 vs. 29.0±6.2%, p = 0.85), and waist to hip ratio (0.89±0.12 vs. 0.84±0.07, p = 0.37) but the meat-eaters weighed more (31.2±5.5 vs. 33.3±9.6kg, p = 0.65). Compared to British reference ranges, girls in both groups had a higher BF% of 29±6% which was 34 percentile points above the British median (McCarthy et al., 2006) adjusted for age.Both groups spent 21 hours each day in non-moving/sedentary activities. Dietary consumption of vitamin B12 was higher in meat-eaters compared to non-meat-eaters (2.5±0.8 vs 1.8±0.6μg.day-1, p = 0.11). Serum vitamin B12 was substantially higher in the meat-eaters (543±212 vs. 232±95 pmol/L, p = 0.01) with lower serum concentrations of MMA (0.2 ± 0.1 vs 0.3 ± 0.2 μmol/L, p=0.3). Serum folate was adequate in all girls ranging from 16.5-45.0 pmol/L, which was within the normal reference values. Two non-meat-eating girls were vitamin B12 deficient (<170pmol/L). These differences were associated with high fibre and less protein intake in the nonmeat-eaters (30±8 vs. 20±7 g day-1; 64±12 vs. 66±11 g.day-1).The initial findings in this pilot study provide early evidence that risk factors for metabolic disease associated with body composition, diet and activity are accumulating in preadolescent Indian girls. Imbalance in one carbon metabolism is clearly a factor to be considered. In those with a low consumption of meat and/or animal products, B12 monitoring, dietary recommendations and if necessary supplementation should be considered and where possible intervention before pregnancy (as for folate) be a priority. New Zealand Indian people would be a priority group.It is time for serious action in this area of health so that the risk accumulated through an imbalance in nutrition and physical activity is reduced and the health of those as yet unborn is improved.

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Yes / Purpose: The purpose of this research has been to investigate whether burnout and eating behaviour traits were associated with food intake. Design/methodology/approach: Participants (n=109) 78 per cent female, mean age 39 years, were recruited from various occupations within a UK university to complete an on-line survey. Dietary habits were measured using Food Frequency Questionnaire (FFQ), burnout using the Maslach Burnout Inventory (MBI) and eating behaviour traits using the Three Factor Eating Questionnaire (TFEQ) R18. Findings: Principal component analyses of FFQ responses revealed four dietary patterns: fast/junk food (+chicken and low fruit/vegetables); meat/fish; dairy/grains; beans/nuts. Dietary patterns were examined using multiple regression analysis as outcome variables with age, gender, burnout and eating behaviour traits as explanatory variables. More frequent consumption of “junk/fast food” was associated with lower TFEQ-Cognitive Restraint, higher TFEQ-Uncontrolled Eating (UE), lower MBI-Emotional Exhaustion and higher MBI-Depersonalisation. More frequent consumption of beans/nuts was associated with higher TFEQ-UE and higher MBI-Emotional Exhaustion. Models for meat/fish and grains/dairy dietary patterns were not significant. Research limitations/implications: Burnout may need to be considered to reduce junk food consumption in higher education employees. Causality between burnout, eating behaviour traits and food consumption requires further investigation on larger samples. Originality/value: This appears to be the first study to have explored associations between burnout, eating behaviour traits and dietary patterns.

Controversy surrounds the use of artificial sweeteners (non-nutritive sweeteners [NNS]) as an effective weight-loss and/or maintenance strategy. This controversy is especially important as obesity is an epidemic in the United States. Excessive added sugar intake, primarily from sugar-sweetened beverages, has been linked to increased risk of overweight and obesity, as well as type 2 diabetes and cardiovascular disease. NNS provide minimal to no calories and thus, they have been suggested as a method to reduce added sugar intake, and consequently decrease energy intake, weight, and cardiometabolic risk. However, NNS intake has been associated with various health outcomes in observational studies and randomized controlled trials, including cancer, weight gain and loss, physiological and intestinal changes, cardiovascular disease, and diabetes. The uncertainties around the effect of NNS on health outcomes stem from a variety of limitations, one of which is inadequate dietary assessment methodology. Accuracy of dietary intake assessment methods is limited by the inability to distinguish between different types of NNS and lack of information about consumer use of NNS in a variety of beverages and foods. The purpose of this investigation is to explore NNS consumer characteristics and to characterize NNS intake in a sample of rural Southwest Virginian adults. This characterization is especially important for rural populations, as they are known to be high sugar-sweetened beverage consumers and are at an increased risk of obesity and chronic disease; thus, NNS could serve as a replacement method to facilitate cardiometabolic health. Cross-sectional data from a large randomized controlled trial, Talking Health (n=301), was utilized in this investigation to compare demographic characteristics, anthropometrics, biochemical markers, dietary quality, and dietary factors between NNS consumers and NNS non-consumers. This data was also used to characterize NNS intake (frequency, type, and source of sweetener). Of this rural sample, 33% consumed NNS, with sucralose being the most prevalent type of NNS and diet soda being the most frequently consumed source of NNS. NNS consumers had a higher BMI status than NNS non-consumers. However, NNS consumers had better overall dietary quality than NNS non-consumers. The characteristics of these NNS consumers and their intake patterns can be used to develop well-designed dietary intake assessment tools that accurately measure NNS intake, which can facilitate a better understanding of the associations of NNS with health outcomes. / Master of Science