Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2008. / Source: Dissertation Abstracts International, Volume: 69-11, Section: B, page: 6704. Adviser: Nicki Engeseth. Includes bibliographical references. Available on microfilm from Pro Quest Information and Learning.

Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2009. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3234. Adviser: Kelly A. Tappenden. Includes bibliographical references (leaves 115-120) Available on microfilm from Pro Quest Information and Learning.

Thesis (M.A.)--Fairleigh Dickinson University, 2005. / Source: Masters Abstracts International, Volume: 43-05, page: 1809. Chair: Cynthia L. Radnitz.

Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2006. / Source: Dissertation Abstracts International, Volume: 67-11, Section: B, page: 6315. Adviser: John W. Erdman, Jr. Includes bibliographical references (leaves 126-152) Available on microfilm from Pro Quest Information and Learning.

<p> While adolescent endurance runners are at risk for energy deficiency, limited studies have evaluated the effect of a nutrition education intervention. We evaluated the effect of a 4-week nutrition curriculum on adolescent cross-country runners&rsquo; nutrition knowledge, dietary behaviors, and self-efficacy to optimize intake of nutrient-dense carbohydrate foods, using a quasi-experimental, pretest-posttest design. Runners (<i>n</i> = 45; <i>n</i> = 26 F, <i>n</i> = 19 M; age 15.7 &plusmn; 0.2y) attended 4 weekly 30 to 60-minute lessons. Baseline body weight and composition were measured using bioelectrical impedance analysis. Paired samples t-tests measured difference in nutrition knowledge and self-efficacy scores, before and after each lesson. Mean nutrition knowledge scores significantly increased from pre- to post-test for lessons 1 and 2 (<i>p</i> &lt; .001). Mean self-efficacy scores significantly improved pre- to post-test for all lessons (<i>p</i> &lt; .001). Findings suggest a benefit of the curriculum to increase nutrition knowledge, self-efficacy, and support dietary behaviors promoting increase in nutrient-dense carbohydrate intake among adolescent runners.</p><p>

Breast cancer is a leading cause of cancer and the second leading cause of cancer death among women in the US. Although many risk factors for breast cancer are known, few are modifiable and little is known about ways to prevent its incidence. Early-life body size is inversely associated with both premenopausal and postmenopausal breast cancer risk, suggesting an excess risk in lean girls. In a prospective analysis within the Nurses’ Health Study (NHS) II, Chapter 1 examines whether adolescent physical activity mitigates the excess risk of breast cancer associated with early-life body leanness. Lean girls were at higher risk of breast cancer, regardless of the level of adolescent physical activity; however, the association was slightly, though not significantly, attenuated among the most active girls. Breast cancer is hormone-related cancer; estrogen metabolites (EM) are both estrogenic and genotoxic, suggesting factors that alter the pattern of estrogen metabolism may contribute to breast carcinogenesis. With the application of advanced technology that measures 15 different individual estrogens and EM in urine, Chapter 2 examines the associations of dietary fiber and macronutrients intake with detailed estrogen metabolism in a cross-sectional analysis within the NHSII. Few significant associations were identified: a positive association between total fiber intake and 4-methoxyestradiol, an inverse association between total fiber intake and 17-epiestriol, and inverse associations for polyunsaturated and trans-fat intakes with 17-epiestriol. The tissue-specific responsiveness to potentially carcinogenic hormones, estrogen and progesterone, is partially regulated by the tissue expression of receptors that bind these hormones. Using benign breast biopsy samples collected in a nested case-control study within the NHS and NHSII, Chapter 3 assesses estrogen receptor (ER), progesterone receptor (PR), and proliferative marker Ki67 expression in normal breast tissue in relation to subsequent breast cancer risk. In this case-control analysis, PR expression in normal breast tissue was significantly positively associated with breast cancer risk in premenopausal women. ER and Ki67 expression was not significantly associated with breast cancer risk; however, our power was limited. Results of this dissertation help elucidate the underlying biologic mechanisms of breast cancer and enhance our understanding of the link between risk factors and breast cancer risk.

Type 2 diabetes has reached epidemic proportions globally, and accumulating evidence suggests extremes of sleep duration increase risk. Diet may be an important mechanism, yet few studies examine prospective relationships of sleep duration and diet quality or whether diet explains associations of sleep duration with childhood obesity or diabetes in adults. In Chapter One, we report a moderate correlation between self-reported sleep duration and actigraphy in Sueño, the sleep ancillary study to the Hispanic Community Health Study/Study of Latinos. Chapter Two identifies associations of chronic insufficient sleep duration since infancy with lower diet quality in mid-childhood in Project Viva: children with the least favorable diet and sleep have the highest body mass index z-scores in mid-childhood, but diet does not explain associations with adiposity. In Chapter Three, adherence to healthful dietary patterns reduces risk of diabetes in the Women’s Health Initiative; high quality diets are protective in all groups, but race/ethnicity modifies associations. In Chapter Four, we find that changes in sleep duration, increases in particular , are associated with diabetes and concomitant changes in diet quality, physical activity and weight in the Nurses’ Health Study. Each of these studies contributes new knowledge: Sueño represents the largest sleep validation to date, the only validation among Hispanic/Latinos and allows researchers to better understand the information contained in (and the limitations of) self-reported measures of sleep duration within subgroups. In the Women’s Health Initiative, we address limitations of the current literature on dietary patterns by calculating four dietary indices within the same cohort, standardizing the scores for comparison and examining associations across racial/ethnic groups. Project Viva is the first study to examine the influence of chronic insufficient sleep on diet quality in childhood when health behaviors and dietary preferences are being formed. Finally, examining changes in sleep duration and changes in diet quality, physical activity and weight in the Nurses’ Health Study represents a novel way to leverage repeated assessments. Results of this dissertation may help build the case for policy and intervention efforts to prevent and treat obesity and diabetes, particularly those that seek to improve both sleep and diet. / Nutrition

Children’s diet is a key driver of childhood obesity, and thus understanding the role of caregivers in mediating the frequency and content of foods offered to children is critical to developing population-based interventions to support healthy behaviors. The main objective of this thesis is to describe multi-ethnic caregiver feeding practices in the context of childhood feeding recommendations through three studies. The first study presents cross-sectional survey data on the feeding practices of n=166 infant/toddler child care providers serving minority children in Boston, examining their adherence to current feeding guidelines. In multivariable analysis, center Child and Adult Care Food Program (CACFP) participation was associated with providers sitting with children at meals (OR=5.2; 95% CI 1.2-21.7), offering fruits and vegetables (OR=3.3; 95% CI 1.7-6.2), and limiting fast food (OR=3.5; 95% CI 1.8-6.7). These findings suggest that CACFP participation may encourage positive feeding behaviors among child care providers. Next, using qualitative in-depth interview data (n=47) low-income multi-ethnic caregivers’ conceptualizations of preschoolers’ snacking in the context of television (TV) viewing are described. Using schema theory to frame data analysis, interview transcripts were coded using the constant comparative method and emergent themes identified. TV viewing was an important component of caregivers’ schemas around child snacking, as they were aware of and accommodated preschoolers’ snacking and TV viewing which was described as routine, positive, and useful for non-nutritive purposes such as family bonding and managing children’s behavior. Finally, cross-sectional survey data from n=271 low-income parents of multi-ethnic children (2-12 years) is presented to identify both reasons and frequency that children receive snacks and the association between these reasons and children’s diet. Using multivariate logistic regression, children were significantly less likely to adhere to dietary recommendations (e.g. soda, fruit/vegetable consumption) when parents offered snacks for non-nutritive reasons like rewarding behavior (OR=0.83; 95% CI 0.70-0.99), celebrating events/holidays (OR=0.72; 95% CI 0.52-0.99), or achievements (OR=0.82; 95% CI 0.68-0.98). For caregivers/parents, public health messages should encourage “screen free” snacking, healthy snack options, and guidance for managing children’s behavior without using snacks or TV. Future research should explore ways to promote child-centered feeding practices both in child care and at home. / Nutrition

Nutritional factors have been intensively studied as important determinants of many diseases. Food frequency questionnaires (FFQ), dietary records, 24-hour dietary recalls, nutrient biomarkers are important dietary assessment methods, and are subject to various sources of measurement error. Given the limitations of these methods, much effort has been devoted to refining them and evaluating their ability to measure diet. This dissertation focused on evaluating the performance of a semi-quantitative FFQ (SFFQ), multiple web-based automated-self-administered 24-hour recalls (ASA24), 7-day dietary records (7DDR) and biochemical indicators in assessing nutrient intakes among women. Intraclass correlation coefficient, Spearman correlation coefficient, and validity coefficient calculated by method of triads were used to evaluate the reproducibility and validity of each dietary method. The first paper evaluated the performance of a 152-item SFFQ comparing intakes of nutrients estimated by SFFQ with those measured by the average of two 7DDR, and of four ASA24s kept over a one-year period. The study SFFQ performed consistently well when compared with multiple diet records, and that modifications to the questionnaire over time have adequately taken into account the changes in the food supply and eating patterns that have occurred since 1980. Multiple ASA24s can provide similar estimates of validity as dietary records if day-to-day variation is taken into account. The second paper explored the validity of long-term intakes of energy, protein, sodium and potassium assessed by SFFQ and ASA24s using recovery biomarkers and 7DDR as standards. The study SFFQ and averaged ASA24’s are reasonably valid measurements for energy-adjusted protein, sodium and potassium compared to multiple recovery biomarkers or dietary records. Recovery biomarkers should not be considered to be without error, including systematic within-person error. Finally, the third paper further evaluated the validity of nutrient assessed by SFFQ and ASA24 compared with intakes by the 7DDR and plasma levels of fatty acids, carotenoids, retinol, tocopherols and folate. Again, the study SFFQ provides reasonably valid measurements for specific fatty acid, most carotenoids, alpha-tocopherol and folate compared to concentration biomarkers or dietary records. Compared to SFFQ, almost all nutrients estimated by averaged ASA24s had relatively low correlations with biomarkers, 7DDRs and estimated ‘true’ underlying intakes. / Nutrition

The following dissertation addresses of two themes: the role of vitamin D and neurodegenerative diseases and methodologic concepts related to correlated missing outcome data. In the first chapter, the relation between vitamin D (characterized by circulating levels of 25Zhydroxyvitamin D 25[OH]D) and multiple sclerosis (MS) activity and progression is assessed in a secondary analysis of a population of over 1400 relapsing remitting MS patients with multiple asynchronous assessments of 25(OH)D. Overall, using a combination of clinical and magnetic resonance imaging endpoints, higher levels of vitamin D were associated with lesser MS activity. Results were more equivocal for clinical and brain volume measures. In the second chapter, the relation between dietary vitamin D and risk of amyotrophic lateral sclerosis (ALS) is assessed in pooled analysis of five prospective cohort studies. The study included nearly 1500 cases of ALS that occurred in a population of over 1 million individuals. Using dietary intake derived from food-frequency questionnaires, no association between dietary intake of vitamin D and risk of ALS was observed in any model. Similarly null results were observed for vitamin D intake from food and supplemental vitamin D. The third chapter addresses a methodologic concern when disease outcomes can be classified into multiple subtypes. It was not well understood of how to properly address marker-specific effects of a particular risk when markers are correlated and some are missing. This was addressed using an analysis of breast cancer in the Nurses’ Health Study (NHS) considering 5 markers with varying levels of correlation and missingness. Correlation among outcome measures was addressed through the calculation of an adjusted hazard ratio and four approaches for missing data were evaluated: the complete case, inverse probability weighting, missing indicator and multiple imputation. In the NHS, 4380 cases (with pathology reports) of breast cancer occurred; however, only 1551 cases had information on all five markers. We considered a list of established breast cancer risk factors and calculate adjusted marker-specific effects addressing missing using each of the 4 approaches. Effect estimates were generally similar for each method but corresponding standard errors were smaller using the multiple imputations and missing indicator approaches. Subsequent simulation studies suggest the missing indicator approach to produce the least bias and increases in standard error compared with datasets with complete information on all markers.