Considering current levels of overweight and obesity in the population and the associated adverse health consequences, engaging people with chronic exercise programmes is of heightened importance. During chronic structured exercise programmes, some adults experience adaptive compensatory behavioural responses through increased dietary intake and/or decreased free-living physical activity. These responses can negate the benefits of an exercise-induced energy deficit. However, it is unclear whether young people experience similar responses during chronic structured exercise. Therefore, the experimental research presented in this thesis examined the existence and extent of exercise-induced energy compensation in adolescent girls. To achieve this, a total of 92, 12 to 15 year old girls and 26 adults were recruited into six experimental studies. The Medical Research Council guidance for designing complex interventions was used to structure the experimental chapters into development (Chapters 4 to 7), piloting (Chapter 8) and evaluation (Chapter 9). The first experimental study (Chapter 4) demonstrated that typical daily variation of total energy expenditure (TEE) in adolescent girls is ~3% when estimated by the Actiheart. Physical activity energy expenditure (AEE) variation was found to be ~10%. In the second experimental study (Chapter 5) the agreement and variability of laboratory buffet meals test days was investigated. The results demonstrated typical daily variation of 8.7% in laboratory-based energy intake (EI) in adolescent girls aged 12 to 15 years. Furthermore, a buffet meals familiarisation day is recommended to reduce the variability in EI. Estimation of EI was further explored in Chapter 6 using a digital photography method. This study demonstrated potential for EI assessment using digital photography, but highlighted that, at present, a supplementary written record of EI is required to overcome the limitations associated with missing photographs. Chapter 7 explored themes related to recruitment and retention of adolescent girls to chronic exercise intervention studies. The seven recommendations identified were used to recruit and retain participants in a twelve week pilot exercise intervention study with adolescent girls (Chapter 8). There was no evidence of energy compensation behaviours on a group level; however, high individual variability in both EI and EE behaviours was apparent. The final experimental chapter (Chapter 9) evaluated the fidelity of the exercise intervention and compliance with the measurement of primary outcome variables. Intervention fidelity was largely upheld. On average, participants attended 94% of exercise sessions and 73% of the participants met their individual target heart rate zone. Focus groups with the participants and parents highlighted preference for school-based exercise sessions due to increased variety and convenience, and recommendations for future estimation of free-living EI and EE. Collectively, these studies suggest there is value in pursuing the investigation of energy compensation behaviours in adolescent girls using a mixed methods approach. These studies demonstrate the factors requiring attention when designing and delivering complex interventions to investigate exercise-induced energy compensation in adolescent girls. In particular, methods for estimating free-living EI and EE require further attention before attempting to conduct such research in a larger sample.

Introdução: Há evidências de que o uso de adoçantes não-calóricos (ANC) pode interferir na regulação do apetite, promovendo maior ingestão alimentar, maior ganho de peso (GP) e maior adiposidade. Um estudo prévio, realizado pelo nosso grupo de pesquisa, demonstrou que o uso de sacarina (p=0,005) e aspartame (p=0,048) promoveu maior GP quando comparados ao uso sacarose. Entretanto, devido às limitações metodológicas, não foi possível afirmar se os adoçantes poderiam causar maior GP quando comparados a uma condição inerte; ou ainda, se os sub-componentes da sacarose (glicose e frutose), quando avaliados isoladamente, poderiam contribuir para o menor GP. Além disso, foi verificado que os grupos dos adoçantes compensaram o déficit calórico, ingerindo proporcionalmente mais ração, de modo que, a fração entre a ingestão calórica total e peso corporal não diferiu entre os grupos. Portanto, adicionamos no presente estudo, um terceiro macronutriente com baixo poder de saciedade e potencial indutor de maior GP, o lipídio. Deste modo, o presente estudo contempla analisar o efeito da sacarina comparando-a a condição controle, glicose, frutose e lipídio, além de avaliar o efeito entre cada um dos grupos. Métodos: Foi realizado um experimento controlado envolvendo 40 ratos machos Wistar com peso médio inicial de 300g. Os animais foram randomizados em 5 grupos e receberam água e ração ad libitum, além das seguintes dietas: Controle (20ml de iogurte,75 kcal/semana), Sacarina (0,3%, 75 kcal/semana), Glicose (20%, 139 kcal/semana), Frutose (20%, 139 kcal/semana) ou Lipídio (9%, 139 kcal/semana). As dietas foram administradas 5 dias semanais, por 14 semanas. Realizou-se diariamente o controle da ingestão alimentar e hídrica, e semanalmente o controle do peso corporal. A composição corporal foi determinada pela estimativa da massa gorda, representada pelo peso (g) do tecido adiposo marrom interescapular somado ao tecido adiposo branco (epididimal e retroperitoneal); a massa magra foi representada pela soma do músculo esquelético gastrocnêmio e músculo cardíaco, todos foram removidos imediatamente após o sacrifício dos animais e pesados em balança de precisão milesimal. A análise dos dados foi realizada no SPSS versão 17, utilizou-se Modelo Linear Misto para as medidas longitudinais e ANOVA com teste complementar de Tukey para medidas únicas. Resultados: Houve compensação calórica entre consumo de iogurte e de ração, de modo que a ingestão calórica total (kcal/g) não diferiu entre os grupos (p=0,42). Os grupos também apresentaram similaridade quanto à ingestão hídrica (ml/g) (p=0,27) e composição corporal (p=0,13). Entretanto, o uso de sacarina promoveu maior GP que o controle (p=0,035), sendo similar ao uso de glicose (p=0,06), lipídio (p=0,76) e frutose (p=0,38). Os grupos Lipídio (p=0,016) e Glicose (p<0,001) também ganharam mais peso que o controle, todavia, o grupo Frutose não diferiu deste, mas apresentou GP menor que o grupo Glicose (p=0,006). Conclusão: Independentemente do tipo de suplementação, a regulação do apetite parece ser dependente do aporte calórico, sendo proporcional ao peso corporal, assim como a ingestão hídrica. O uso crônico de sacarina demonstrou promover maior GP, sendo similar ao uso de lipídio, glicose ou frutose. Já, o grupo Frutose apresentou ganho de peso intermediário, diferindo apenas do grupo Glicose. Apesar de haver diferenças quanto ao ganho de peso, a estimativa de massa magra e gorda foi semelhante entre os grupos. Estudos adicionais são necessários para elucidar outros mecanismos, que, independentemente da ingestão calórica estariam envolvidos no maior ganho de peso. / Introduction: There are evidences that the use of nonnutritive sweeteners (NNS) can interfere in the appetite regulation, promoting higher food intake, more weight gain (WG) and the increaseof adiposity. A previous study, performed by our research group, demonstrated that the use of saccharin (p=.005) and aspartame (p=.048) promoted more WG when compared with the use of sucrose. However, due to the methodological limitations, it was not possible to say whether sweeteners could promote more WG compared to an inert condition, or if the sub-components of sucrose (glucose and fructose), when evaluated in isolation, might contribute to less WG. Moreover, it was found that the groups of sweeteners compensated the caloric deficit, ingesting proportionally more chow, so that the ratio between the total caloric intake and body weight did not differ between the groups.Thus, it was added a third macronutrient with low power of satiety and potential inducer of greater WG, as the lipid. Therefore, this study contemplates to analyze the effect of the saccharin, comparing it to the control condition, glucose, fructose and lipid, besides evaluating the effect between each group. Methods: It was conducted a controlled experiment involving 40 male Wistar rats with initial average weight of 300g. The animals were randomized into 5 groups and given water and chow ad libitum, and the following diets: Control (20ml of yogurt, 75 kcal/wk), Saccharin (.3%, 75 kcal/wk), Glucose (20%, 139 kcal/wk), Fructose (20%, 139 kcal/wk) or Lipid (9%, 139 kcal/wk). The diets were administered 5 days weekly for 14 weeks. It was performed daily control of food and water intake, and weekly body weight control. Body composition was determined by estimating fat mass represented by the weight (g) of interscapular brown adipose tissue added to the white adipose tissue (epididymal and retroperitoneal); the lean mass was represented by the sum of the gastrocnemius skeletal muscle and cardiac muscle.Everything was removed immediately after sacrificing the animals and weighed in millesimal precision. The data analysis was performed with SPSS version 17, and it was used Linear Mixed Model for longitudinal measures and ANOVA with Tukey's pot hoc test for single measures. Results: There was caloric compensation between intake of the yogurt and chow, so that the total cumulative caloric intake (kcal/g) did not differ between groups. The groups also had similar regarding the water intake (ml/g) and body composition. However, the use of saccharin promoted greater WG than the control (p=.035), being similar to the use of glucose (p=.06), lipid (p=.76) and fructose (p=.38). Lipid (p=.016) and Glucose groups (p<.001) also gained more weight than the control, though, the Fructose group did not differ from this, but had weight gain less than the Glucose group (p=.006). Conclusion:Whatever type of diet, the appetite regulation appears to be dependent on calorie intake, being proportional to body weight, as well as water intake. The chronic use of saccharin demonstrated to promote greater WG, being similar to the use of lipids, glucose or fructose. Already, the Fructose group showed intermediate weight gain, differing only of Glucose group. Although there are differences in weight gain, the estimate of lean and fat mass was similar between groups. Additional studies are needed to elucidate other mechanisms that, independently of caloric intake, would be involved in more weight gain.

Introdução: Há evidências de que o uso de adoçantes não-calóricos (ANC) pode interferir na regulação do apetite, promovendo maior ingestão alimentar, maior ganho de peso (GP) e maior adiposidade. Um estudo prévio, realizado pelo nosso grupo de pesquisa, demonstrou que o uso de sacarina (p=0,005) e aspartame (p=0,048) promoveu maior GP quando comparados ao uso sacarose. Entretanto, devido às limitações metodológicas, não foi possível afirmar se os adoçantes poderiam causar maior GP quando comparados a uma condição inerte; ou ainda, se os sub-componentes da sacarose (glicose e frutose), quando avaliados isoladamente, poderiam contribuir para o menor GP. Além disso, foi verificado que os grupos dos adoçantes compensaram o déficit calórico, ingerindo proporcionalmente mais ração, de modo que, a fração entre a ingestão calórica total e peso corporal não diferiu entre os grupos. Portanto, adicionamos no presente estudo, um terceiro macronutriente com baixo poder de saciedade e potencial indutor de maior GP, o lipídio. Deste modo, o presente estudo contempla analisar o efeito da sacarina comparando-a a condição controle, glicose, frutose e lipídio, além de avaliar o efeito entre cada um dos grupos. Métodos: Foi realizado um experimento controlado envolvendo 40 ratos machos Wistar com peso médio inicial de 300g. Os animais foram randomizados em 5 grupos e receberam água e ração ad libitum, além das seguintes dietas: Controle (20ml de iogurte,75 kcal/semana), Sacarina (0,3%, 75 kcal/semana), Glicose (20%, 139 kcal/semana), Frutose (20%, 139 kcal/semana) ou Lipídio (9%, 139 kcal/semana). As dietas foram administradas 5 dias semanais, por 14 semanas. Realizou-se diariamente o controle da ingestão alimentar e hídrica, e semanalmente o controle do peso corporal. A composição corporal foi determinada pela estimativa da massa gorda, representada pelo peso (g) do tecido adiposo marrom interescapular somado ao tecido adiposo branco (epididimal e retroperitoneal); a massa magra foi representada pela soma do músculo esquelético gastrocnêmio e músculo cardíaco, todos foram removidos imediatamente após o sacrifício dos animais e pesados em balança de precisão milesimal. A análise dos dados foi realizada no SPSS versão 17, utilizou-se Modelo Linear Misto para as medidas longitudinais e ANOVA com teste complementar de Tukey para medidas únicas. Resultados: Houve compensação calórica entre consumo de iogurte e de ração, de modo que a ingestão calórica total (kcal/g) não diferiu entre os grupos (p=0,42). Os grupos também apresentaram similaridade quanto à ingestão hídrica (ml/g) (p=0,27) e composição corporal (p=0,13). Entretanto, o uso de sacarina promoveu maior GP que o controle (p=0,035), sendo similar ao uso de glicose (p=0,06), lipídio (p=0,76) e frutose (p=0,38). Os grupos Lipídio (p=0,016) e Glicose (p<0,001) também ganharam mais peso que o controle, todavia, o grupo Frutose não diferiu deste, mas apresentou GP menor que o grupo Glicose (p=0,006). Conclusão: Independentemente do tipo de suplementação, a regulação do apetite parece ser dependente do aporte calórico, sendo proporcional ao peso corporal, assim como a ingestão hídrica. O uso crônico de sacarina demonstrou promover maior GP, sendo similar ao uso de lipídio, glicose ou frutose. Já, o grupo Frutose apresentou ganho de peso intermediário, diferindo apenas do grupo Glicose. Apesar de haver diferenças quanto ao ganho de peso, a estimativa de massa magra e gorda foi semelhante entre os grupos. Estudos adicionais são necessários para elucidar outros mecanismos, que, independentemente da ingestão calórica estariam envolvidos no maior ganho de peso. / Introduction: There are evidences that the use of nonnutritive sweeteners (NNS) can interfere in the appetite regulation, promoting higher food intake, more weight gain (WG) and the increaseof adiposity. A previous study, performed by our research group, demonstrated that the use of saccharin (p=.005) and aspartame (p=.048) promoted more WG when compared with the use of sucrose. However, due to the methodological limitations, it was not possible to say whether sweeteners could promote more WG compared to an inert condition, or if the sub-components of sucrose (glucose and fructose), when evaluated in isolation, might contribute to less WG. Moreover, it was found that the groups of sweeteners compensated the caloric deficit, ingesting proportionally more chow, so that the ratio between the total caloric intake and body weight did not differ between the groups.Thus, it was added a third macronutrient with low power of satiety and potential inducer of greater WG, as the lipid. Therefore, this study contemplates to analyze the effect of the saccharin, comparing it to the control condition, glucose, fructose and lipid, besides evaluating the effect between each group. Methods: It was conducted a controlled experiment involving 40 male Wistar rats with initial average weight of 300g. The animals were randomized into 5 groups and given water and chow ad libitum, and the following diets: Control (20ml of yogurt, 75 kcal/wk), Saccharin (.3%, 75 kcal/wk), Glucose (20%, 139 kcal/wk), Fructose (20%, 139 kcal/wk) or Lipid (9%, 139 kcal/wk). The diets were administered 5 days weekly for 14 weeks. It was performed daily control of food and water intake, and weekly body weight control. Body composition was determined by estimating fat mass represented by the weight (g) of interscapular brown adipose tissue added to the white adipose tissue (epididymal and retroperitoneal); the lean mass was represented by the sum of the gastrocnemius skeletal muscle and cardiac muscle.Everything was removed immediately after sacrificing the animals and weighed in millesimal precision. The data analysis was performed with SPSS version 17, and it was used Linear Mixed Model for longitudinal measures and ANOVA with Tukey's pot hoc test for single measures. Results: There was caloric compensation between intake of the yogurt and chow, so that the total cumulative caloric intake (kcal/g) did not differ between groups. The groups also had similar regarding the water intake (ml/g) and body composition. However, the use of saccharin promoted greater WG than the control (p=.035), being similar to the use of glucose (p=.06), lipid (p=.76) and fructose (p=.38). Lipid (p=.016) and Glucose groups (p<.001) also gained more weight than the control, though, the Fructose group did not differ from this, but had weight gain less than the Glucose group (p=.006). Conclusion:Whatever type of diet, the appetite regulation appears to be dependent on calorie intake, being proportional to body weight, as well as water intake. The chronic use of saccharin demonstrated to promote greater WG, being similar to the use of lipids, glucose or fructose. Already, the Fructose group showed intermediate weight gain, differing only of Glucose group. Although there are differences in weight gain, the estimate of lean and fat mass was similar between groups. Additional studies are needed to elucidate other mechanisms that, independently of caloric intake, would be involved in more weight gain.

O consumo de alimentos é frequentemente avaliado em estudos sobre a etiologia de doenças crônicas não-transmissíveis. A maioria desses estudos nutricionais utiliza métodos que dependem de auto-relato e são susceptíveis a potenciais erros. Um desses principais vieses é o sub-relato da ingestão energética, o qual consiste no relato de energia implausivelmente inferior às quantidades mínimas necessárias à manutenção do peso corporal do indivíduo. Objetivos: Identificar a prevalência e os fatores associados ao sub-relato e analisar os padrões dietéticos de indivíduos sub-relatores e não sub-relatores da ingestão energética. Métodos: Foram utilizados dados do estudo transversal de base populacional ISA - Capital 2008, de indivíduos com 20 anos ou mais, de ambos os sexos. A ingestão energética foi avaliada pela média de dois recordatórios de 24 horas coletados em dias não consecutivos. O gasto energético total foi calculado por equação preditiva, considerando sub-relatores indivíduos com ingestão energética inferior a 1 ou 2 desvios-padrão (DP) da razão ingestão energética/gasto energético total predito. A análise de regressão múltipla foi utilizada para identificar os fatores associados à subnotificação e a análise fatorial por componentes principais foi utilizada para identificar os padrões alimentares. Resultados: A prevalência de sub-relatores da ingestão energética utilizando o ponto de corte de 2 DP foi de 15,1 por cento e com 1 DP, 60, 9 8 por cento. Indivíduos com excesso de peso e insatisfeitos com o peso corporal apresentaram maior chance de serem sub-relatores quando comparados aos indivíduos sem excesso de peso e aos satisfeitos com peso corporal, respectivamente. A média de IMC entre indivíduos sub-relatores mostrou-se significativamente superior à de não sub-relatores, contraditoriamente, a média da ingestão energética foi estatisticamente inferior. Em cada grupo, foram identificados três padrões principais não semelhantes. Não houve diferença entre os grupos no consumo de carboidratos, mas a proporção de gorduras e proteínas foi maior no grupo de sub- relatores. Conclusão: É necessário o estudo de métodos que sejam viáveis de serem aplicados em estudos de base populacional e isso se torna mais relevante quando a população tem elevada prevalência excesso de peso, pois o mesmo associa-se tanto à maior ocorrência de doenças crônicas não-transmissíveis quanto à maior chance de sub-relato / The consumption of food is often evaluated in studies on the etiology of chronic diseases. Most of these nutritional studies use methods that rely on self- report and are subject to potential errors. One such bias is the major underreporting of energy intake, which consists of the report implausibly energy less than the minimum necessary to maintain the individual\'s body weight. Objectives: To identify the prevalence and factors associated with underreporting and analyze dietary patterns of underreporters and non- underreporters of energy intake. Methods: We used data from a cross-sectional population-based ISA - Capital 2008, individuals aged 20 or more, of both sexes. Energy intake was assessed by averaging two 24-hour recalls collected on nonconsecutive days. Total energy expenditure was calculated by the predictive equation, considering underreporters if energy intake less than 1 or 2 standard deviations (SD) of the ratio energy intake / predict energy expenditure. A multiple regression analysis was used to identify factors associated with underreporting and principal components factor analysis was used to identify dietary patterns. Results: The prevalence of underreporters of energy intake using the cutoff of 2 SD was 15.1 per cent and using 2 SD was 60.8 per cent. Individuals who are overweight and dissatisfied with body weight were more likely to be underreport when compared to individuals without overweight and satisfied with body weight, respectively. The mean BMI among individuals underreporters was significantly 11 higher than that of non-sub-rapporteurs, contradictorily, the average energy intake was significantly lower. In each group, identified three main patterns are not similar. There was no difference between groups in carbohydrate intake, but the proportion of fat and protein was higher in the group of underreporters. Conclusion: It is necessary to study methods that are feasible to be applied in population-based studies and this becomes more relevant when the population has a high prevalence of overweight, because it is associated with both a higher incidence of chronic non- transmitted as a higher likelihood of underreporting

Orientador: Antonio de Azevedo Barros Filho / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T22:36:43Z (GMT). No. of bitstreams: 1 Pereira_HelenRoseCamargo_M.pdf: 2514186 bytes, checksum: 816408a812c2437749c004d35b296357 (MD5) Previous issue date: 2011 / Resumo: Introdução: Mudanças no padrão alimentar e de atividades físicas durante os últimos 30 anos foram propulsoras para o excedente de peso em crianças e adolescentes, pois estimularam o consumo excessivo de energia combinado ao reduzido gasto energético em atividades. Ações preventivas devem ser baseadas em evidências e neste contexto, quantificar as alterações na ingestão e no gasto energético pode servir de base para o desenvolvimento de formas eficazes de prevenção. Objetivos: (1) Realizar uma revisão dos artigos que investigam a magnitude do desequilíbrio energético associado ao aumento do peso em crianças e adolescentes, (2) estimar o grau de desequilíbrio energético de adolescentes eutróficos, com sobrepeso e obesos, e o viés causado pela subnotificação do consumo alimentar. Métodos: Estudo transversal com adolescentes entre 11 e 17 anos. Foram utilizadas as médias de três registros alimentares e três registros de atividade física, preenchidos simultaneamente. A avaliação nutricional foi composta por medida do peso e estatura, cálculo do índice de massa corporal, avaliação do total de tecido adiposo e da sua distribuição. A ingestão energética relatada foi confrontada com as necessidades estimadas pelas Dietary Reference Intakes (2002) e avaliada a subnotificação do consumo. Foi calculado o balanço energético a partir da ingestão energética relatada e estimada. Para a análise dos resultados, os adolescentes foram divididos de acordo com o estado nutricional segundo critérios da World Health Organization (2007). Resultados: Foram avaliados 39 indivíduos eutróficos, 33 com sobrepeso e 32 obesos. Todos os grupos apresentaram baixo gasto energético em atividades físicas, alto tempo despendido em atividades sedentárias, alto consumo de açúcares e alta proporção de gorduras na dieta, independente do estado nutricional. A frequência da subnotificação do consumo alimentar foi significativa entre os adolescentes (58%), principalmente entre os obesos (76%). O balanço energético calculado a partir do consumo alimentar relatado foi positivo nos eutróficos (+240kcal) e nos sobrepesos (+60kcal) e negativo nos obesos (-700kcal). Calculado a partir da ingestão energética estimada, eutróficos, sobrepesos e obesos apresentaram respectivamente consumo de 180kcal, 240kcal e 150kcal acima do gasto energético. Conclusão: Adolescentes ingerem mais calorias do que gastam independente do estado nutricional. Quando se analisa o grau de desequilíbrio energético a partir da ingestão relatada e pelas estimativas teóricas, observa-se que os adolescentes subnotificam o consumo, levando ao paradoxo de que os obesos encontram-se em balanço energético negativo, enquanto os eutróficos encontram-se em balanço energético positivo / Abstract: Introduction: Changes in dietary intake and physical activity patterns during the last 30 years have been drivers for overweight, once estimulated excessive energy intake with reduced energy expenditure on activities. Preventive actions must be based on evidence and in this context, quantify the changes in energy intake and energy expenditure, responsible for changes in body weight, serve as a basis for developing effective ways of prevention. Objective: (1) review the main articles related to energy imbalance and obesity in order to measure the energy excess associated with weight gain in children, (2) estimate the degree of energy imbalance in eutrophic adolescents, overweight and obesity and underreporting of food intake. Methods: Cross sectional study of adolescents between 11 and 17 years. It has been used the average of three food records and three records of physical activity, fulfilled simultaneously. The nutritional assessment has been prepared by measuring the height and weight, calculating the Body Mass Index (BMI) and evaluation of the total and the distribution of adipose tissue. The reported energy intake was confronted with the requirements estimated by the Dietary Reference Intakes (2002) and assessed the underreporting of intake. It has been calculated the energy balance from the reported energy intake also estimated. In order to analyze the results, adolescents were divided according to the nutritional criteria of WHO (2007). Results: It has been studied 39 eutrophic, 33 overweight and 32 obese. All groups had low energy expenditure in physical activity, high time spent in sedentary activities, high consumption of sugars and high proportion of dietary fat, regardless of nutritional status. The frequency of underreporting of dietary intake among adolescents was significant (58%), especially among obese patients (76%). The energy balance calculated from the reported food intake was positive in the eutrophic (+240kcal) and overweight (+60kcal) and negative in obeses (-700kcal). Calculated from the estimated energy intake, normal weight, overweight and obese subjects showed, respectively, consumption of 180kcal, 240 kcal and 150kcal above energy expenditure. Conclusion: When analyzing the degree of energy imbalance from the reported energy intake and the theoretical estimates, it is observed that adolescents underreport their intake, leading to the paradox that the obese are in negative energy balance while eutrophics are in positive energy balance / Mestrado / Saude da Criança e do Adolescente / Mestre em Ciências

There is a high prevalence in malnutrition among traumatic brain injury (TBI) due to the hypermetabolism and hypercatabolism which develop post injury. Traumatic brain injury patients are different, even among themselves, in their energy requirements and response to nutritional therapy. This implies that there are other factors that affect the energy intake of these patients and enhance the incidence of malnutrition. This dissertation study examines the nutritional status of TBI patients upon admission to the intensive care unit (ICU) and during their hospital stay to describe baseline status, detect changes in nutritional status over 7 days, and identify the factors affecting the adequacy of energy intake and the change in nutritional status as a consequence. Anthropometric measurements, biomedical measurements, measures of severity of illness, daily health status, level of brain injury severity, and other data were collected from the medical records of 50 patients, who were ≥ 18 years old, mechanically ventilated in the first 24 hours of ICU admission, and had a Glasgow Coma Scale score between 3-12. These data were used to examine the previous relationships. Although there was no statistically significant change found in body mass index and weight, there was a significant change detected in other nutritional markers, including hemoglobin, albumin, and total lymphocyte levels over the 7 days of ICU and hospital stay. No significant relationship was found between the adequacy of energy intake and total prescribed energy, severity of illness, level of brain injury severity, daily health status, patient age, intracranial pressure, or time of feeding initiation. Findings may be used to develop and test interventions to improve nutritional status during the acute phase of TBI. This will lay a foundation for health care providers, including nurses, to establish standards for practice and nutrition protocols to assure optimal nutrition assessment and intervention in a timely manner.

Obezita představuje ve vyspělých zemích závažný zdravotní problém a hlavní rizikový faktor rozvoje kardiovaskulárních onemocnění, cukrovky 2. typu, nemocí pohybového aparátu a některých nádorových onemocnění. Je také provázena řadou komplikací a výrazně zhoršuje kvalitu života. 27 pacientů, kteří byli hospitalizováni za účelem redukce hmotnosti na oddělení D3 III. interní kliniky Všeobecné fakultní nemocnice v Praze v období ledna až počátku dubna roku 2017 byli sledováni z hlediska výskytu komorbidit a příjmu a výdeje energie za použití aplikace kaloricketabulky.cz, portálu casprozdravi.cz a krokoměrů Garmin Vivofit. Byla hodnocena vhodnost bioimpedanční metody pro sledování změn složení těla pacientů během redukčních pobytů za použití přístroje InBody S10. V souladu s teorií se ve sledované skupině pacientů vyskytovala v důsledku extrémní obezity celá řada komplikací. Diagnostická kritéria pro metabolický syndrom splňovalo 23 (85%) pacientů. Rozdílné hodnoty obsahu energie a jednotlivých živin v aplikacích kaloricketabulky.cz a Nutriservis jsou příčinou průměrného denního rozdílu 717 kJ mezi záznamy pacientů a nemocničním rozpisem. Průměrně pacienti ušli denně 4713 kroků. Pacienti průměrně zredukovali hmotnost o 7,6 kg (SD ±3,54). Bioimpedanční metoda vykazuje příliš vysokou variabilitu a není...

The main objective of this thesis was to examine the independent effects of sleep duration and timing on appetite, food reward and energy balance. Study 1 investigated the associations between satiety quotient (SQ) with habitual, self-reported sleep duration, quality and timing. No significant associations were noted between SQ and sleep parameters. Short-duration sleepers had a lower mean SQ vs. those with ≥7h sleep/night (P=0.04). Study 2 evaluated associations between changes in sleep duration, efficiency and timing with changes in next day food reward. Greater sleep duration and earlier wake-times were associated with greater food reward (P=0.001). However, these associations were no longer significant after controlling for elapsed time between awakening and completion of the food reward task. Study 3 examined the effects of 50% sleep restriction (SR) anchored during the first (delayed bedtime) or second (advanced wake-time) half of the night on appetite, SQ, food reward, energy intake (EI) and energy expenditure (EE). Greater appetite ratings and explicit high-fat food reward were noted following SR with an advanced wake-time vs. control and SR with a delayed bedtime (P=0.03-0.01). No difference in SQ was noted between sessions. Energy and carbohydrate intakes were greater on day 2 and over 36h in the delayed bedtime vs. control session (P=0.03). Activity EE and moderate-intensity physical activity (PA) time were greater following delayed bedtime vs. control and advanced wake-time on day 1, whereas vigorous-intensity PA time was greater following advanced wake-time vs. delayed bedtime on day 1 (P=0.01-0.04). Greater sleep quality and slow-wave sleep duration between SR sessions were associated with lower EI and increased vigorous-intensity PA time, respectively (P=0.01-0.04). Collectively, these findings suggest that appetite, SQ and food reward are influenced by sleep parameters, but these changes may not alter EI. These findings also suggest that individuals with greater sleep quality in response to SR had greater vigorous-intensity activity time and lower EI.

Objective: To investigate the extent to which changes in physical activity predict changes in abdominal fat in women over an 18-month period, while statistically controlling the effects of possible confounders, such as age, total body fat percent, and energy intake. Design: A prospective cohort design over 18 months. There was no intervention or treatment. Changes in objectively-measured physical activity were used to predict changes in abdominal fat over the study period. Subjects: 110 healthy, middle-aged women (mean: 41.3±3.3 yrs), primarily Caucasian, educated, and married. Measurements: An objective measure of physical activity (ACT) using CSA accelerometers, worn continuously for 7 consecutive days at baseline and again at follow-up. Total body fat and abdominal fat percent were assessed by dual energy x-ray absorptiometry (DEXA). Energy intake was estimated using 7-day, weighed food records for the days in which subjects wore accelerometers. Results: No significant change between baseline and follow-up means for abdominal fat, physical activity, or energy intake over the study period. Moreover, change in physical activity was not a significant predictor of change in abdominal fat, with or without statistical control of confounders. Change in energy intake was a predictor of abdominal fat (P=0.0688), and this association was strengthened after adjusting for age, baseline total body fat, and changes in physical activity. Conclusions: Apparently, when measured using accelerometers, changes in physical activity are not predictive of changes in abdominal fat over an 18-month period. However, changes in energy intake seem to predict changes in abdominal fat. Evidently, increases and decreases in abdominal fat are more a function of energy intake than physical activity in middle-aged women.

Objective: Sleep deprivation has been proposed as a potential correlate of obesity, particularly influencing energy intake. Therefore, the purpose of this study was to compare neural indices of attention related to food motivation and energy intake in normal-weight and obese women under two separate sleep conditions: 1) sleep-restricted (<5 hours) and 2) recommended sleep (~8 hours). This study used a combined cross-over and ex post facto design with condition order counter-balanced. Methods: Twenty-two normal-weight (age=30.9±9.5y, BMI=22.0±1.6 kg/m2) and 18 obese (age=29.7±10.7 y, BMI=36.4±5.3 kg/m2) women completed both sleep conditions. To confirm sleep levels, participants recorded sleep quality and quantity via sleep logs and wore a wrist actigraph. Following each condition, participants reported to the laboratory under the same fed state (energy shake ~10% of total daily needs) to verify they followed the sleep protocol. Subsequently, motivation for food was tested using electroencephalogram (EEG); participants completed a computerized passive-viewing task of food and flowers, while event-related brain potentials (ERPs) were recorded. After EEG testing, participants continued their normal routine but recorded all energy intake using weighed food scales. There were no instructions or limitations on dietary intake. Analyses included P300 and LPP amplitudes in response to picture type, total next day energy intake, and energy intake by several periods of the day. Results: Participants averaged 4.7±0.4 hours of sleep during the sleep-restricted condition and 7.7±0.3 hours during the recommended sleep condition (F=1057.02; P<0.0001). There was no group*condition interaction for next day food motivation (P300: F<2.896, P>0.09; LPP: F<2.967, P>0.093). Next day total energy intake also did not differ by group*condition (F=1.81; P=0.187). When participants were pooled, there was no difference in energy intake by sleep condition (F=0.00; P=0.953). However, when participants’ energy intake was analyzed during the lunch period (following testing to 1:30pm) there was a significant group*condition interaction (F=6.12; P=0.018). The obese women ate significantly more (~300 kcal) during the sleep-deprived condition compared to the recommended condition, whereas the normal-weight women did not. Conclusion: Compared to suggested levels of sleep, sleep restriction and obesity do not influence next day food motivation or total next day energy intake. However, sleep restriction and obesity may influence feeding during certain portions of the day.