Polyphenols are naturally-occurring phytochemicals, which form an integral part of the human diet. Results from epidemiological studies have associated polyphenol intake with reduced risk of cardiovascular diseases. Previous human intervention studies suggested that dietary polyphenols exert their cardioprotective effects through their antioxidant and anti-inflammatory effects. While most in vitro experiments have not accounted for the bioavailability and metabolism of these polyphenols, our work has provided direct evidence, using quercetin, that metabolic transformation, together with bioavailability, exert profound effects on bioactivity. We examined the effect of quercetin and its major metabolites on the production of pro-inflammatory eicosanoids by human leukocytes. Studies comparing free radical scavenging, antioxidant activity and eicosanoid production demonstrate that there are different structural requirements for antioxidant and anti-inflammatory activity. We also investigated the effect of metabolic transformation on flavonoid bioactivity by comparing the activity of quercetin and its major metabolites to inhibit inflammatory eicosanoid production from human leukocytes. Quercetin was a potent inhibitor of leukotriene B4 formation in leukocytes (IC50 ~ 2µM), and its activity was dependent on specific structural features, particularly the 2,3 double bond of the C ring. Functionalisation of the 3'-OH group with either methyl or sulfate reduced inhibitory activity up to 50% while a glucuronide substituent at the 3-OH effectively removed the leukotriene B4 inhibitory activity. The major quercetin metabolite quercetin-3'-O-sulfate retained considerable lipoxygenase inhibitory activity (IC50 ~ 7 µM) while quercetin-3-O-glucuronide maintained antioxidant activity but had no lipoxygenase inhibitory activity at physiologically relevant concentrations. We conclude that structural modification of quercetin due to metabolic transformation had a profound effect on bioactivity, and that the structural features required for antioxidant activity of 8 quercetin and related flavonoids were unrelated to those required for inhibition of inflammatory eicosanoids.

This study evaluated a mandatory fitness assessment and counseling program designed to reduce coronary risk factors related to diet and exercise. The study was conducted at a southwestern graduate level theological institution. There were 19 mandatory and 22 voluntary participants. Each subject initially had either high blood pressure, high percentage body fat, or high total cholesterol. Significant changes were made within both groups regarding body fat percentage and diastolic blood pressure. Total cholesterol levels decreased for the voluntary group only. The mandatory group significantly improved their exercise level, yet still showed a significantly less positive attitude towards exercise. Overall, the fitness assessment and counseling was somewhat beneficial for both the mandatory and voluntary groups.

The present study sought to determine whether a dietary and multi-element psychological treatment (DMPT) approach in combination with standard medical treatment would offer a more efficacious therapeutic package to irritable bowel syndrome (IBS) patients than would standard medical treatment (SMT) employed alone. The DMPT group (N = 19) received a stress management training package for a 2 week period consisting of relaxation training, imagery, and bowel sound biofeedback training via a stethoscope, in addition to instructions to increase their daily consumption of dietary fiber. They also were to continue the implementation of whatever standard medical treatment they were currently receiving, be it a bulking agent, or anti-anxiety, anti-cholinergic, or anti-depressant medications, etc. The SMT group (N = 19) simply received whatever conventional medical treatment they had been prescribed.

Trata-se de pesquisa realizada em hospital da rede pública estadual de São Paulo, especializado em cardiologia com pacientes obesos em acompanhamento ambulatorial pelo Serviço de Nutrição e Dietética (SND) dessa instituição. As formas de intervenção nutricional investigadas foram: atendimento individual, em grupo (controle) e grupo multiprofissional (com nutricionista e psicóloga). Na fase preliminar do estudo, realizou-se pesquisa de opinião que possibilitou o embasamento das variáveis analisadas. Na fase principal, os participantes foram divididos em grupos, sendo realizadas duas entrevistas individuais no intervalo de seis meses. Foram investigados apenas os pacientes de alta. Compararam-se os resultados obtidos quanto ao peso corporal, índice de massa corpórea, circunferência do abdome; o acompanhamento dos fatores de risco cardiovascular (hipertensão arterial, diabetes melito, dislipidemias) foi feito através da variação das medidas de pressão arterial e níveis sanguíneos de glicose, triglicérides, colesterol total e frações. Analisaram-se as opiniões sobre as facilidades e dificuldades para seguir as orientações recebidas por meio de instrumento próprio, não validado. No atendimento em grupo, foram obtidos resultados satisfatórios, porém não ideais, e verificou-se que os participantes passaram a valorizar o apoio familiar. No atendimento individual, os participantes conseguiram maior redução da glicemia e triglicérides, porém isso não pode ser atribuído exclusivamente à dieta. No atendimento em grupo multiprofissional, houve mudança de comportamento com valorização desse tipo de atendimento. / The study was performed in a cardiology specialty hospital of Sao Paulo state public system with obese outpatients followed up by the Sector of Nutrition and Dietetics of the institution. Nutritional intervention actions that were assessed include: individual visit, group approach (control) and multiprofessional group (including dietitian and psychologist). In the preliminary phase of the study, an opinion survey was performed, which supported many of the studied variables. In the main phase of the study, the participants were divided into groups, and 2 individual interviews were conducted within a 6-month interval. Only patients who had been discharged were assessed. The results concerning body weight, body mass index, abdominal circumference, and follow up of cardiovascular risks (arterial hypertension, diabetes mellitus, dyslipidemia) were compared using variation of blood pressure measures and blood levels of glucose, triglycerides and total and fractioned cholesterol. We also checked whether patients found it easy or difficult to follow the received instructions, using our own non-validated instrument. In the group activities, results were satisfactory but not optimal and participants started to value family support. In the individual approach, participants reached higher reduction of glucose and triglyceride levels, but they could not be explained exclusively by the diet. In the multiprofessional group, there was change in behavior and recognition of multiprofessional approach.

Trata-se de pesquisa realizada em hospital da rede pública estadual de São Paulo, especializado em cardiologia com pacientes obesos em acompanhamento ambulatorial pelo Serviço de Nutrição e Dietética (SND) dessa instituição. As formas de intervenção nutricional investigadas foram: atendimento individual, em grupo (controle) e grupo multiprofissional (com nutricionista e psicóloga). Na fase preliminar do estudo, realizou-se pesquisa de opinião que possibilitou o embasamento das variáveis analisadas. Na fase principal, os participantes foram divididos em grupos, sendo realizadas duas entrevistas individuais no intervalo de seis meses. Foram investigados apenas os pacientes de alta. Compararam-se os resultados obtidos quanto ao peso corporal, índice de massa corpórea, circunferência do abdome; o acompanhamento dos fatores de risco cardiovascular (hipertensão arterial, diabetes melito, dislipidemias) foi feito através da variação das medidas de pressão arterial e níveis sanguíneos de glicose, triglicérides, colesterol total e frações. Analisaram-se as opiniões sobre as facilidades e dificuldades para seguir as orientações recebidas por meio de instrumento próprio, não validado. No atendimento em grupo, foram obtidos resultados satisfatórios, porém não ideais, e verificou-se que os participantes passaram a valorizar o apoio familiar. No atendimento individual, os participantes conseguiram maior redução da glicemia e triglicérides, porém isso não pode ser atribuído exclusivamente à dieta. No atendimento em grupo multiprofissional, houve mudança de comportamento com valorização desse tipo de atendimento. / The study was performed in a cardiology specialty hospital of Sao Paulo state public system with obese outpatients followed up by the Sector of Nutrition and Dietetics of the institution. Nutritional intervention actions that were assessed include: individual visit, group approach (control) and multiprofessional group (including dietitian and psychologist). In the preliminary phase of the study, an opinion survey was performed, which supported many of the studied variables. In the main phase of the study, the participants were divided into groups, and 2 individual interviews were conducted within a 6-month interval. Only patients who had been discharged were assessed. The results concerning body weight, body mass index, abdominal circumference, and follow up of cardiovascular risks (arterial hypertension, diabetes mellitus, dyslipidemia) were compared using variation of blood pressure measures and blood levels of glucose, triglycerides and total and fractioned cholesterol. We also checked whether patients found it easy or difficult to follow the received instructions, using our own non-validated instrument. In the group activities, results were satisfactory but not optimal and participants started to value family support. In the individual approach, participants reached higher reduction of glucose and triglyceride levels, but they could not be explained exclusively by the diet. In the multiprofessional group, there was change in behavior and recognition of multiprofessional approach.

Indiana University-Purdue University Indianapolis (IUPUI) / Given the numerous benefits of a healthy diet and exercise for cancer survivors, there has been an increase in the number of lifestyle intervention trials for this population in recent years. However, the extent to which adherence to a diet and exercise intervention predicts health-related outcomes among cancer survivors is currently unknown. To address this question, data from the Reach out to ENhancE Wellness in Older Cancer Survivors (RENEW) diet and exercise intervention trial were analyzed. RENEW was a yearlong telephone and mailed print intervention for 641 older (>65 years of age), overweight (body mass index: 25.0-39.9), long-term (>5 years post-diagnosis) survivors of colorectal, breast, and prostate cancer. Participants were randomized to the diet and exercise intervention or a delayed-intervention control condition. The RENEW telephone counseling sessions were based on determinants of behavior derived from Social Cognitive Theory (SCT) (e.g., building social support, enhancing self-efficacy). These factors have been hypothesized to improve health behaviors, which in turn should improve health outcomes. Thus, drawing on SCT and prior diet and exercise research with cancer survivors, I hypothesized that telephone counseling session attendance would be indirectly related to health-related outcomes (i.e., physical function, basic and advanced lower extremity function, mental health, and body mass index) through intervention-period strength and endurance exercise and dietary behavior (i.e., fruit and vegetable intake, saturated fat intake). The proposed model showed good fit to the data; however, not all of the hypothesized relationships were supported. Specifically, increased telephone counseling session attendance was related to engagement in all of the health behaviors over the intervention period. In turn, (a) increased endurance exercise was related to improvement in all of the health-related outcomes with the exception of mental health; (b) increased strength exercise was solely related to improved mental health; (c) increased fruit and vegetable intake was only related to improved basic lower extremity function; and (d) saturated fat intake was not related to any of the health-related outcomes. Taken together, these findings suggest that SCT determinants of behavior and the importance of session attendance should continue to be emphasized in diet and exercise interventions. Continued exploration of the relationship between adherence to a diet and exercise intervention and health-related outcomes will inform the development of more cost-effective and efficacious interventions for cancer and other medical populations.

Text in English with abstracts in English and isiZulu / Poor adherence to their prescribed diet, medications and treatment contributes to increased mortality and morbidity in patients with end-stage renal disease. These patients must change their diet when receiving dialysis treatment, but cultural beliefs and practices can affect their adherence to the prescribed diet. The purpose of this qualitative, descriptive, exploratory study was to improve health education on prescribed diet adherence to patients living on haemodialysis at a haemodialysis unit in eThekwini Municipality. Data from a sample of 20 patients was collected using semi-structured interviews and analysed using qualitative content analysis. The findings revealed that haemodialysis patients’ prescribed diet adherence was influenced by cultural and religious views, and by family support. Food availability, patients’ geographical location and patients’ financial means hindered their adherence to their prescribed diet. A multi-disciplinary health care team including nurses, should be sensitive to patients’ different cultural beliefs and practices when providing health education. / Ukungabambeleli endleleni emisiwe yokudla, amakhambi nasekwelashweni kunomthelela ekwandiseni izimpawu zesifo sezinso esingapheli (ESRD) futhi kwandisa isibalo sabantu ababulawa yilesisifo. Iziguli ezinalesisifo zidinga ukushitsha indlela yokuphila, iziphuzo kanye nokulandela indlela emisiwe yokudla kakhulukazi mabe ngaphansi kokwelashwa ngokuhlanzwa kwegazi ngomshini (dialysis). Izinkolelo zamasiko nendlela zokuphila ezihambisana namasiko kwenze imfundiso nge ezempilo maqondana nendlela emisiwe yokudla yaba lukhuni. Inhloso yalolucwaningo bekuwukwandisa ulwazi nemfundiso ngezempilo mayelana nokulandela indlela emisiwe yokudla kwiziguli izithola ukulashwa ngokuhlanzwa kwegazi ngomshini (haemodialysis) esikhungweni esikuMasipala weTheku. Kusetshenziwe indlela yokwenza ucwaningo esezingeni elifanele, Imininingwano eqoqiwe eqembini (sample) leziguli ezingamashumi amabili (20) ezithola ukwelashwange haemodialyisis. Imininigwane iqoqwe kusetshenziswa izingxoxo ezihleliwe. Imigomo elawula ukuhlaziya ilandeliwe yonke ngenkathi kwenziwe lolucwaningo. Lolucwaningo luveze ukuthi indlela yokudla emisiwe yeziguli ezikwi dialysis iphazanyiswa imobono yamasiko, inkolo kanye nokusekelwa nokuzimbandakanya kwamalungu omndeni. Izinselelo ezinjengokutholakala, indawo isiguli esihlala kuyo nezinkinga zemali zivimbela ukubambelela endleleni emisiwe yokudla. Abasebenzi bezempilo kumele banakekele indima edlalwa izinkolelo namasiko uma befundisa ngezempilo ezigulini eziphethwe izinso. / Nursing Science / M.A. (Nursing Science)