Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Consumer Science: Food and Nutrition in the Faculty of Applied Sciences at the Cape Peninsula University of Technology 2014 / The prevalence of nutrition-related chronic diseases of lifestyle (CDL) is escalating in South Africa (SA). Studies suggest that poor nutrition plays a major role in the aetiology of these diseases. Phytochemicals present in plant foods, namely fruit, vegetables, whole grains and tea, may prevent the onset of CDL. Most South African diets appear to be deficient of these plant foods. Achieving enhanced phytochemical intake amongst South Africans may therefore have to be supported in other ways. The objectives of this research were to determine whether consumers in the professional sector in the City of Cape Town would be (i) likely to consume proficient home-cooked category prepared dishes and (ii) purchase and consume commercially manufactured category prepared dishes for enhanced phytochemical intake and, if so, (iii) which dietary source adjustment category/categories and (iv) food vehicle category/categories they would be likely to consume, and (v) who would be likely to consume them. After obtaining ethical approval, a survey was conducted amongst 184 white collar workers (87% response rate) representing the professional sector (professional, technician and associate professional) occupational groups. The respondents were approached for voluntary participation based on their occupation and age, representing adulthood to the elderly life stage as a risk factor for the development of lifestyle diseases. A pilot-tested questionnaire was used to obtain information regarding the respondents awareness of phytochemicals, whether or not they were involved in the preparation of food at home, their degree of ‘likelihood’ to consume proficient home-cooked and commercially manufactured category prepared dishes for enhanced phytochemical intake, their current daily intake of fruit, vegetables, whole grains and tea, and demographic, health and lifestyle information. The frequencies of the respondents’ consumption of phytochemical-rich dietary sources pertaining to the stages of change model were assessed using Pearson’s chi-squared analysis to determine significant associations/differences (p < 0.05) between the data sets. The repeated measure analysis of variance (ANOVA) on Bonferroni correction was used to assess the ‘likeliness’ scale (from ‘extremely unlikely’ as ‘1’ to ‘extremely likely’ as ‘5’) for the household and commercial dietary source adjustment and food vehicle categories. The respondents were mostly female (58.7%), 31 to 44 years of age (67.9%) and of White ethnicity (72.3%). The majority (61.5%) had obtained grade 12 and a diploma (29.4%) or a degree (32.1%). Almost half were married or living together with children (48.9%) and were English (48.9%) or Afrikaans (47.3%) speaking. The majority of respondents were non-smokers (69%), and approximately half (54.4%) consumed alcohol less than three times per week (54.4%). About fifty percent used dietary supplements (50.5%) and exercised (59.2%) regularly. A small percentage of the respondents were obese (7.6%), had diabetes mellitus (4.4%) or cardiovascular disease (CVD) and cancer (2.2% or four respondents each). Cancer was most prevalent (36.4%) within the respondents’ family, followed by diabetes mellitus (29.9%), CVD (26.6%) and obesity (7.6%). The majority (77.7%) were not aware of phytochemicals and about half (55.4%) could not indicate the role these compounds play in the human diet. Half of the respondents consumed the recommended two to four servings of fruit daily, very few (10.9%) consumed the recommended three to five servings of vegetables daily, only about 10% (9.2% or 17 respondents) consumed the recommended three servings of whole grains daily, and about a third (36.4%) consumed two to three cups of tea daily. The respondents who considered phytochemicals to be very necessary to support health were more likely to consume rooibos herbal tea added to category prepared dishes than those who considered phytochemicals to be necessary to support health (p < 0.05) and those who did not know the role phytochemicals played in the diet (p < 0.05). The likelihood to consume category prepared dishes with added vegetables and added fruit respectively was lower (p < 0.05) amongst those respondents who consumed none to one serving of vegetables daily than amongst those who consumed two to four servings of vegetables daily. The respondents who did not consume tea were less likely to consume category prepared dishes with added rooibos herbal tea than those who consumed one cup (p < 0.05) or two to three cups (p < 0.001) daily. Furthermore, the respondents who did not consume tea were also less likely to consume category prepared dishes with added herbs than those who consumed one cup (p < 0.05), two to three cups (p < 0.001) or four to six cups (p < 0.05) daily. The likelihood to consume category prepared dishes with fruit additions was lower amongst those respondents who did not consume tea than amongst those who consumed two to three cups (p < 0.05) or four to six cups (p < 0.05) daily. The respondents were more likely (p < 0.05) to consume herb, vegetable and fruit additions respectively than rooibos herbal tea addition, and more likely to consume vegetable additions than herb (p < 0.05) or fruit (p < 0.001) additions as dietary source adjustment options. Furthermore, vegetable additions to category prepared dishes were more likely to be consumed by the respondents than fruit additions (p < 0.001), and starch-based dishes more likely to be consumed than vegetable-based dishes (p < 0.001) or fruit-based dishes (p < 0.05) for the addition of rooibos herbal tea. The respondents were likely to consume the food vehicle categories egg and chicken for added herbs in comparison to other starch (p < 0.05) and vegetables (p < 0.001) respectively. Chicken was a likely option over pasta for added broccoli (p < 0.05). Crêpe was a likely option over compote for added mixed berries (p < 0.001). Potato was a likely option over vegetables (p < 0.05) as well as other starch over vegetables (p < 0.05) for added herbs. Carrot salad with raisins was a likely option above carrot salad with raisins and parsley (p < 0.05). Poached pear in red grape juice was a likely option over poached pear in rooibos herbal tea (p < 0.001). Tomato (p < 0.001) and broccoli (p < 0.05) were more likely to be consumed than spinach, while spinach (p < 0.05) and roasted butternut (p < 0.05) respectively were likely options over onion as vegetables added to a quiche. Onion was a less likely option over broccoli (p < 0.001), tomato (p < 0.001) and roasted butternut (p < 0.001) as respective vegetables in a soup. Tomato soup was a likely option over tomato soup with rooibos herbal tea (p < 0.001). Roasted butternut soup was a likely option over butternut and orange soup (p < 0.001) and butternut and rosemary soup (p < 0.001). Berries as fruit addition were a likely option over pome fruit as pear (p < 0.05) and citrus fruit (p < 0.001), and furthermore citrus fruit over pome fruit as pear (p < 0.05). Raw apple with its skin on was a more likely option over chicken breast salad with apple pieces (p < 0.001), and chicken breast salad with apple a likely option over chicken and apple casserole (p < 0.001). Parsley was a likely option over basil (p < 0.001), and mixed herbs (p < 0.001) and rosemary (p < 0.001) respectively were likely options over basil as herb addition. Commercially manufactured category prepared dishes likely to be purchased and consumed by the respondents included category prepared dishes with added fibre more than added herbs (p < 0.05), fruit (p < 0.001), vegetables (p < 0.001) or tea (p < 0.001), and added herbs than added vegetables (p < 0.05) or tea (p < 0.05). Pizza/pasta was a likely option over beverages (p < 0.05), grains/bake (p < 0.001) and dairy (p < 0.001) respectively, and baked goods than grains/bake (p < 0.001), dairy (p < 0.001) and beverages (p < 0.05) respectively as food vehicles. A baked dish with added fibre was more likely to be consumed than with added fruit (p < 0.001), tea (p < 0.001) or vegetables (p < 0.001), and added fruit more likely to be consumed than added vegetables (p < 0.05). Pasta incorporating vegetables was a more likely option than pasta incorporating fruit (p < 0.001). Shortbread with added fruit was a likely option over added herbs (p < 0.05), and a muffin with bran (p < 0.001) or blueberries (p < 0.001) a likely option over a muffin with spinach. Fruit juice incorporating rooibos herbal tea (p < 0.001) or herbs (p < 0.001) were likely options over fibre incorporation. The female respondents were more likely to consume category prepared dishes with added fruit than the male respondents (p < 0.05), while the older respondents (55 to 64 years) were more likely to consume category prepared dishes with added herbs than the younger respondents (31 to 44 years) (p < 0.05). The older respondents were also more likely to consume category prepared dishes with fruit additions than the younger respondents aged 31 to 44 (p < 0.05) and 45 to 54 (p < 0.05) respectively. The respondents involved in the preparation of food at home were more likely to consume category prepared dishes with the addition of rooibos herbal tea (p < 0.05), herbs (p < 0.05) and fruit (p < 0.05) respectively than those who were not involved in preparing food at home.

The purpose of this dissertation series was to describe sedentary behavior and its associations with cardiovascular disease (CVD) biomarkers and outcomes, and to explore the potential that reducing sedentary behavior may be a secondary prevention target for Acute Coronary Syndrome (ACS) survivors. As such, the following series of research studies evaluate the mechanisms, patterns, and correlates of sedentary behavior in relation to CVD risk and examine whether sedentary behavior might be a risk factor for CVD outcomes among ACS survivors. In Chapter II, a cross-sectional study of young, healthy adults examined a set of biomarkers representing several aspects of endothelial cell health to elucidate the relationship between free-living, habitual sedentary time and endothelial dysfunction. Results showed that there were no differences in measures of endothelial cell injury, endothelial cell reparative capacity, or upper extremity endothelium-dependent vasodilatation in participants with high compared with low volumes of device-measured sedentary behavior in a sample of young, healthy adults. These findings suggest that physiological mechanisms other than endothelial dysfunction may need to be explored as a potential link between habitual prolonged sedentary time and CVD in young adults. Chapter III employed group-based trajectory modeling to identify distinct patterns of sedentary behavior, as measured by accelerometry, in ACS survivors over the 28 consecutive days following hospital discharge, and, secondly, to explore potential correlates of these patterns. Results demonstrated that ACS patients as a group engaged in high volumes of accelerometer-measured sedentary time. Three patterns of sedentary behavior over the first month post-discharge were identified; these involved either gradual or rapid reductions in sedentary behavior. Several measures of disease severity and physical health (e.g., GRACE CVD risk score, physical health-related quality of life), and partner status (i.e., married or partnered or without partner), were associated with the worst patterns of sedentary behavior (i.e., high volume of sedentary time with only a slight decline over time). These findings provide insight on the different patterns of sedentary behavior that emerge as patients resume their daily life over the first month post hospital discharge. Chapter IV, building upon the study presented in Chapter III, examined whether accelerometer-measured sedentary behavior of ACS survivors over the first month post hospital discharge was associated with 1-year health outcomes. The purpose of this study was to understand whether sedentary behavior in the early post hospital discharge period may be an important risk factor in ACS survivors, that might be targeted in secondary prevention strategies. Results demonstrated that the average sedentary behavior over the first month post hospital discharge was not significantly associated with increased risk of 1-year recurrent major adverse cardiovascular events or hospitalizations. These findings do not support sedentary behavior in the early post hospital discharge period as a prognostic risk factor that should be modified in ACS survivors as part of secondary heart disease prevention strategy. However, studies with larger sample sizes, and that evaluate sedentary behavior patterns beyond the first month are needed. Collectively, these studies show that high volumes of sedentary behavior are prevalent in ACS survivors over the first month immediately following hospital discharge. Future work is needed to further study the underlying mechanisms through which sedentary behavior may confer CVD risk and to determine whether sedentary behavior is an important modifiable risk factor in ACS survivors.

Master of Dental Surgery / This work was digitised and made available on open access by the University of Sydney, Faculty of Dentistry and Sydney eScholarship . It may only be used for the purposes of research and study. Where possible, the Faculty will try to notify the author of this work. If you have any inquiries or issues regarding this work being made available please contact the Sydney eScholarship Repository Coordinator - ses@library.usyd.edu.au

Includes bibliographical references (leaves 349-421) Addresses some of the mechanisms which may potentially contribute to the physiological anorexia of ageing, as suggested by previous animal and human studies.

published_or_final_version / Nursing Studies / Master / Master of Nursing

Background Cardiovascular disease (CVD) is the worldwide leading cause of death among non-communicable diseases and results in a huge burden of mortality and morbidity. China, a rapidly growing East Asian country, has the world largest population and is facing an increasing burden. Incidence of CVD is lower in China than in Western countries. There are more strokes, especially hemorrhagic strokes, but less coronary heart disease (CHD) in China than in Western countries. Statin, a first-choice drug for lowering low-density lipoprotein cholesterol (LDL-C), has been shown to be effective in preventing CVD and is widely used in Western countries. However, it is not known whether the same can be applied to Asian countries, where the incidence of CVD is lower and ischemic events are rarer. The aim of this systematic review is to evaluate the effectiveness of statin for prevention of CVD in East Asian populations. Methods A systematic review was conducted by searching for randomized controlled trials from 3 databases (PubMed, MEDLINE and Cochrane Trial) for prevention of CVD comparing statin with usual care or placebo in East Asian population. Data on CVD events (deaths, CHD and cerebrovascular events, rehospitalization and revascularization) and serum lipid levels (total cholesterol (TC), LDL-C, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG)) were extracted. Risk ratios of CVD events and change in serum lipid level were tabulated. The relationship between change in serum lipid level and mortality and incidence of CVD events were also explored. Results Fourteen studies were included, with most of them (9 studies) done in Japan. Overall, statins did not significantly reduce risk of mortality, CHD events, cerebrovascular events, revascularization and rehospitalization due to CHD. However, statins consistently lowered the risk of angina-related rehospitalization by 53% (95% confidence interval (CI) 23% to 71%) and 64% (95% CI 11% to 86%) respectively in 2 studies. There was a consistent reduced risk of composite CVD events by 34% (95% CI 5% to 55%) to 54% (95% CI 6% to 41%) in 4 studies for secondary prevention. In terms of change in lipid levels, TC and LDL-C were significantly reduced by 8% to 31% and 14% to 41% respectively with statin treatment. Change in HDL-C and TG were not consistent across studies. Lowering of TC and LDL-C level was correlated with the reduction in composite CVD and CHD events. Conclusion The use of statins in East Asian populations to prevent CVD may not be as effective as in Western countries, because of the lower baseline risk and different patterns of CVD. As the prevalence of CVD risk factors increases, the incidence of CVD will increase and the pattern of CVD may change, so careful monitoring is needed. More importantly, most of the studies included had small sample sizes, short follow-up periods and/or low methodological quality, which might contribute to the inconsistent findings. A further large-scale randomized controlled trial should be done to confirm the benefits of statins among Chinese. / published_or_final_version / Public Health / Master / Master of Public Health

Non-native parasites pose a significant threat to aquatic bio-diversity and fishery development. Many factors have facilitated the introduction of non-native parasites into England and Wales. Identifying the effects of these parasites and the importance of any changes to wild fish populations represents a considerable challenge. However, in order for the Environment Agency to identify future disease threats, effectively manage resources and implement practical and sustainable control measures, the risks posed by these parasites to fisheries must be better understood. A structured, risk-assessment process for non-native freshwater parasites is proposed. This approach includes procedures for hazard identification, impact assessment, risk management and communication. A quantitative approach to hazard identification provides an initial prediction of impact at the time of introduction to inform decisionmaking and guide preliminary control measures. This is followed by a more comprehensive framework for impact assessment that promotes understanding of changes at host, population and fishery levels. These are placed into context with the economic and ecological value of native resources. An independent 'non-native parasite review group' has been convened to ensure consistency of policy decisions and clear communication of disease risks to interested bodies. It is hoped that this wil assist the management of future invasions and provide a scientifically robust foundation on which to base proportionate control measures. The Category 2 parasites are defined as &quot;species having a significant disease potential when introduced into waters where they do not already exist, or are non-indigenous species with unknown pathogenicity and distribution&quot;. Understanding of the dangers posed by these parasites varies considerably. Ergasilus sieboldi, Anguilicola crassus, Bothriocephalus acheilognathi and Lernaea cyprinacea, are well recognised non-native fish pathogens that pose a considerable threat to fisheries. Conversely, the effects of other introduced parasites remain poorly understood. In many cases, a paucity of published literature at the time of introduction has limited a reliable assessment of impact. Four non-native parasites were considered a priority for further study. These were Paraergasilus longidigitus (Copepoda: Poecilostomatoida), Ergasilus briani (Copepoda: Caryophylldae) Poecilostomatoida ), Atractolytocestus huronensis (Cestoda: and Philometroides sanguinea (Nematoda: Philometridae). Pathological, epidemiological and experimental investigations were undertaken to assess the effects of these parasites at host and population levels. P. longidigitus can cause pronounced pathological changes to the olfactory epithelium of infected fish. Although this damage provides the potential for disruption to spawning through reduced sensitivity to reproductive chemical cues, experimental observations combined with seasonality studies suggest that the parasite is unlikely to disrupt reproduction within infected cyprinid fisheries. Similarly, studies conducted on the caryophylidean cestode A. huronensis provide little evidence to suggest that the parasites poses a threat to car fisheries. Damage within the intesinal tract was characterised by relatively mild mechanical and inflammatory changes. Infections of up 213 parasites had no adverse affect upon the conditon of common carp. Based on these findings and the application of the aformentioned risk model, P. longidigitus and A. huronensis are considered to be of low disease risk to fisheries. The pathology of E. briani and P. sanguinea are described for the first time. Literature suggests that both parasites are pathogenic to juvenile fIsh. E. briani causes a number of pathological changes within the gils of juvenile cyprinids, although these remain localised due to the very strict site specificity of the parasite. Migrations of the nematode P. sanguinea causes damage to the fins and caudal musculature of juvenile crucian car. For both parasites, the extent and severity of pathological changes are inversely proprtional to host size. Further studies at the population level are needed before an assessment of impact to fisheries can be made. The difficulties associated with studying the effects of introduced parasites to juvenile fish populations in the wild are recognised. Recommendations for further study are given.

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