Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-12-11T11:13:28Z No. of bitstreams: 1 Maria Arlene de Almeida Moreira.pdf: 1847654 bytes, checksum: b0e0f9fe39fd0b6e59e0ad74347b915c (MD5) / Made available in DSpace on 2017-12-11T11:13:28Z (GMT). No. of bitstreams: 1 Maria Arlene de Almeida Moreira.pdf: 1847654 bytes, checksum: b0e0f9fe39fd0b6e59e0ad74347b915c (MD5) Previous issue date: 2017-11-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Longevity is a global phenomenum. The Active Aging is advised by World Health Organization (WHO), as optimizing opportunities for health participation and security in order to enhance quality of life as people age. The word active refers the continuing participation in social, economic, cultural, spiritual and civic affairs, not just the ability to be physically active or to participate in the labour force. In the understanding of health, it refers to physical, mental and social well being as expressed in the WHO definition of health. Maintaining autonomy and independence for the older people is a key goal in the policy framework for active ageing. Brazil is a continental country, and the elderly is far away to be homogeneous. Brazil has some particuliarities about ageing: in it, the velocity of ageing is higher, because the effects of the influence of the tecnology of information (TI) and the globalization. Besides, as an emergent country, it has some differences from the developing countries, who met the elderly last century, who got richess before got old. As a results, in Brazil there are some infeccious diseases, that are not under control, and they occur concurrently with chronic- degeneratives ones in the elderly. The matter of this study is not explore the theme on the looses of the elderly, but in the years to live, and the opportunities that could be open to realise new dreams. The authors use the lens of the Theory of Complexity to understand the elderly as multifaceted matter. The method used is the qualitative, with the design of Narratives Analyse. The title of the study is: Longevity- New Conquers, New Mirrors, and New Visions. The general objective is to perceive the meening of how is to live the elderly. As specific subjectives one intends: to understand the motivation on life in this fase; if there are still dreams to be lived; to understand the importance of the memories in the elderly; to perceive how the elders feel the belonging on elderly; and how they live their sexuality / A longevidade é um fenômeno global. O envelhecimento ativo é aconselhado pela Organização Mundial de Saúde (WHO), para um envelhecer com qualidade de vida. Nesse entendimento, ele é pensado como decorrente de vida, que se desenvolve num contexto de acesso à educação, de serviços de assistência e de saúde, de ambiente e hábitos saudáveis, com oportunidades de participação, para que as pessoas possam desenvolver suas potencialidades. A manutenção de autonomia e independência no envelhecimento é uma meta no quadro de políticas públicas. Nem sempre é isso que se tem e o envelhecimento não é homogêneo. No Brasil, país continental, há duas características: a velocidade do envelhecimento está sendo maior por conta da globalização e importação de tecnologias, em relação aos países, que envelheceram no século passado. Em segundo lugar, sendo um país emergente, diferentemente dos países desenvolvidos, não somou qualidade ao envelhecer, por não ter enriquecido antes de envelhecer. Com isso, as moléstias infecto-contagiosas, próprias de países em desenvolvimento, concorrem com as doenças crônico-degenerativas da velhice. Diferentemente do foco em perdas, este estudo procurou explorar o tema Envelhecimento, no ganho do viver, nas lentes da Teoria da Complexidade, pelo fato de o envelhecimento ser multifacetado. O viver a velhice tem apresentado mudanças e fugido ao estereótipo redutor. É esse novo espelho que queremos explorar. A abordagem qualitativa com delineamento da análise de narrativas foi o suporte metodológico escolhido para abordar o tema: Longevidade- Novas Conquistas, Novos Espelhos, Novos Olhares. O objetivo geral do estudo é percebero significado de ser velho e viver a velhice. Como objetivos específicos, pretende-se: entender a motivação da vida; perceber que sonhos se encaixam nesse viver; entender a importância do rememorar; perceber como se mantém o pertencimento; e a vivência da sexualidade

Pain has caused innumerable suffering to countless individuals and has impacted their lives in profound ways. There are many detrimental effects of pain including decreased ability to work, depression, isolation, increased pharmaceutical use, and addiction. Pain, on a worldwide scale, remains ineffectively treated and alternative solutions for managing pain are needed. Pain is conventionally treated with pharmaceuticals, primarily narcotics. Continuation of medications for these painful conditions often causes dependence and addiction. The pain and narcotics cycle contributes to the opioid epidemic. The cost in human lives is immense. Pulsed Electromagnetic Field (PEMF) is a holistic modality used for various ailments. This exploratory descriptive research study focused on the experience of individuals using the Micro-Pulse, PEMF, for pain relief. The mind/body connection was a foundation of the holistic theoretical framework for this study. The theoretical grounding for this study was Watson’s (2018) theory of human caring, which is based on a foundation of holistic healing incorporating mind, emotional body, physical body, and spirit for treatment of pain. Understanding an individual’s experience of pain relief will potentially raise awareness and promote the exploration of holistic therapeutic approaches for patients in pain. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

Background: Chronic arsenic (As) exposure in a global public health concern. Arsenic exposure through drinking water affects over 140 million people in at least 70 countries, including 40 million people in Bangladesh. In the United States (US), 2.4 million people rely on private wells or public water systems with As levels above the US maximum contaminant level. Ingested inorganic arsenic (InAs) is methylated to monomethyl (MMAs)- and dimethyl (DMAs)-arsenical species using the methyl donor S-adenosylmethionine (SAM). Full methylation of InAs to DMAs decreases As toxicity and facilitates urinary As excretion. Arsenic methylation capacity is influenced by nutrients involved in one-carbon metabolism (OCM), the biochemical pathway that synthesizes SAM. Folate recruits one-carbon units for the remethylation of homocysteine and the synthesis of SAM. The availability of one-carbon units is also impacted by nutrients including the alternative methyl donor betaine, its precursor choline, and possibly the cofactor vitamin B12. In addition, As methylation capacity may also be influenced by creatine; an estimated 50% of SAM is consumed by the final step of endogenous creatine synthesis. The adverse health outcomes associated with chronic As exposure include impaired intellectual function, cardiovascular disease, diabetes, inflammation, and cancers of the bladder, lung, kidney, liver, and skin. In utero As exposure is associated with adverse birth outcomes include decreased birth weight and gestational age. Elevated health risks persist after exposure has been reduced or ended, leading to the hypothesis that epigenetic dysregulation, including changes in DNA methylation, may be a biological mechanism linking As exposure to health outcomes. Objectives: This research has three main objectives: (1) to investigate the influence of OCM nutritional factors on As methylation by evaluating effects of folic acid (FA) and creatine supplementation on As methylation capacity, and effect modification by baseline status of OCM-related nutrients; (2) to examine associations between As exposure and loci-specific DNA methylation in an epigenome-wide association study (EWAS); and (3) to assess mediation of the association between in utero As exposure and birth outcomes (i.e., gestational age and birth weight) by DNA methylation of target genes identified in an EWAS, as well as the candidate gene DNA methyltransferase 3 alpha (DNMT3A), a protein-coding gene involved in de novo DNA methylation. Methods: This research used data from three studies of As-exposed individuals. To address the first objective, we used data from the Folic Acid and Creatine Trial (FACT), a 24-week randomized clinical trial of FA (400 or 800 μg/day) and/or creatine supplementation (3 g/day or 3 g creatine and 400 μg FA/day) among As-exposed adults in Bangladesh recruited independent of folate status (N = 622). We investigated overall FA and creatine treatment effects on mean within-person changes in As metabolite proportions in urine compared to the placebo group (weeks 0 to 12). Rebound of As methylation capacity following the cessation of FA supplementation was assessed from weeks 12 to 24. We also assessed effect modification by baseline choline, betaine, vitamin B12, and plasma folate of treatment effects on changes in homocysteine, guanidinoacetate (GAA) (biomarkers of OCM and endogenous creatine synthesis, respectively), total blood As, and urinary As metabolite proportions and indices. To address the second objective, we used data from the Strong Heart Study (SHS), a population-based prospective cohort of American Indians with low-moderate levels of As exposure. DNA methylation was measured in 2,325 participants using the Illumina MethylationEPIC array, which interrogates > 850,000 loci. We tested for differentially methylated positions (DMPs) and regions (DMRs), and conducted gene ontology (GO) enrichment analysis to understand functions of genes containing differential methylation. To address the third objective, we used data from a prospective birth cohort in Bangladesh. In a discovery phase, an EWAS was conducted to identify CpGs with methylation measured in cord blood that are associated with maternal water As levels and birth outcomes (N = 44). In a validation phase, DNA methylation in cord blood was measured using bisulfite pyrosequencing at three target CpGs annotated to miR124-3, MCC, and GNAL (N = 569). We applied structural equation models (SEMs) to assess mediation of the association between in utero As exposure and gestational age by DNA methylation. In addition, mediation of the association between in utero As exposure and birth outcomes by DNA methylation of the candidate gene DNA methyltransferase alpha (DNMT3A) was assessed. Results: In FACT, the mean within-person decreases %InAs and %MMAs and increase in %DMAs were greater among all groups receiving FA supplementation at weeks 6 and 12 compared to placebo (P < 0.05) (Chapter 3). Stratified by median choline and betaine concentrations at baseline, we observed a trend towards greater FA treatment effects among participants with levels below the median of both nutrients compared to participants above the median (Chapter 4). Among participants who discontinued FA supplementation, at week 24, %InAs and %DMAs were not significantly different than baseline levels, suggesting a rebound in As methylation capacity with cessation of FA supplementation. We observed a significantly greater mean within-person decreases in %MMAs with creatine supplementation compared to placebo at weeks 1, 6, and 12; mean within-person changes in %InAs and %DMAs did not differ significantly between the creatine and placebo groups (Chapter 3). The mean within-person decrease in urinary %MMAs at week 12 with creatine treatment was significantly greater than placebo among participants with baseline choline concentrations below the median, but did not differ from placebo among participants with choline concentrations above the median (Chapter 4). In an EWAS conducted in SHS, we identified 20 DMPs associated with urinary As levels at FDR < 0.05; five DMPs were significant at PBonferroni < 0.05 (Chapter 5). The top significant CpG, cg06690548, was located in solute carrier family 7 member 11 (SLC7A11 ), part of the amino-acid transporter cystine:glutamate antiporter system xc-, which is involved in biosynthesis of the endogenous antioxidant glutathione (GSH). Additional Bonferroni-significant CpGs were located in ANKS3, LINGO3, CSNK1D, and ADAMTSL4. We identified one FDR-significant DMR (chr11:2,322,050-2,323,247) including the open reading frame C11orf21 and tetraspanin 32 (TSPAN32 ). Mediation of the association between in utero As exposure and birth outcomes by cord blood DNA methylation was assessed in a Bangladeshi birth cohort. In the discovery phase (N = 44), the association between maternal water As levels and gestational age was fully mediated by DNA methylation of the top 10 CpGs associated with both variables. In a discovery phase (N = 569), there were significant indirect effects of maternal water As levels on gestational age through DNA methylation of miR124-3 and MCC ; the indirect effect through DNA methylation of GNAL was not significant (Chapter 6). In an adjusted SEM including miR124-3 and MCC, mediation of the association between in utero As exposure and gestational age by DNA methylation of miR124-3 was borderline significant (P = 0.06); DNA methylation of MCC did not act as a mediator. We also assessed mediation by DNA methylation of DNMT3A (Chapter 7). In an adjusted SEM including birth weight and gestational age, there was a significant indirect effect of maternal toenail As levels on gestational age through DNMT3A methylation, the indirect effect on birth weight was borderline significant (P = 0.082). However, the indirect effects of maternal toenail As levels on birth weight through all pathways including gestational age were statistically significant. A doubling in maternal toenail As concentrations had a total effect of a decrease in gestational age of 2.1 days and a decrease in birth weight of 28.9 g. Conclusions: Results from FACT (Chapters 3 and 4) provide evidence of the associations between OCM-related nutrients and As methylation capacity. Specifically, FA and creatine supplementation may increase As methylation capacity by increasing the availability of SAM, and treatment effects may be greater among individuals with low betaine and choline status, respectively. In addition, results reported in Chapters 5-7 support the hypotheses that chronic As exposure is associated with epigenetic dysregulation, and that changes in the epigenome may mediate the association between As exposure and adverse health effects. Findings from the research presented here may help inform public health interventions to reduce the adverse health effects of chronic As exposure. However, further research is needed to fully understand the biological mechanism that influence As methylation and that underlie the associations between chronic As exposure and adverse health outcomes.

Background: Three billion individuals worldwide rely on biomass fuel (crops, dung, wood) for cooking and heating, mostly in the developing world. Incomplete combustion of these biomass fuels in inefficient cookstoves leads to high levels of household air pollution (HAP). Health conditions resulting from HAP are responsible for approximately 1.6 million premature deaths each year. Of the diseases associated with HAP exposure, lower respiratory infections (LRIs) are the leading cause of death for children under five worldwide. There is a great need to understand the etiology of HAP-associated LRIs to inform health interventions and to improve treatments. Ultimately, however, the only way to prevent the disease burden from HAP is to stop exposure. Policies and programs to promote the use of clean fuels for cooking are a pivotal prevention strategy. Methods: All three studies draw from an established cohort in Ghana. The Ghana Randomized Air Pollution and Health Study (GRAPHS), was a cookstove intervention trial in Kintampo, Ghana. Participants were randomized to a more efficient biomass cookstove arm, a liquefied petroleum gas (LPG) stove arm, or the traditional cookstove arm (baseline). The principal outcome of GRAPHS was childhood pneumonia. The first chapter utilizes banked nasal swabs from GRAPHS to assess the relationship between HAP exposures and a panel of known respiratory pathogens. In the second chapter we leverage data on stove use during GRAPHS, and then follow a sub cohort 6 months prior to and 6 months after the GRAPHS termination date. We employ a novel construct, suspended use, to understand the factors associated with people stopping LPG use. The third chapter tests a new randomized intervention on a subset of the GRAPHS participants. We provide free cookstoves, and allocate participants to one of four arms: a behavior change intervention, an intervention where LPG fuel is directly delivered to their home, a dual intervention of behavior change and fuel delivery, or a control arm. We track their stove use to identify the most effective intervention on sustained use. Results: In Chapter 1, we find that the traditional cookstove users had a higher mean number of microbial species than the LPG (LPG: 2.71, 3-stone: 3.34, p<0.0001, n = 260). This difference was driven by increased bacterial (p<0.0001) rather than viral species presence (non-significant). Adjusted exposure-response analyses, however, produced null results. Chapter 2 identifies several factors associated with reduced or suspended LPG use of intervention cookstoves, including: experience of burns, types of food made, and access to biomass fuels. Finally, in Chapter 3 results show increased use for all three intervention arms, the largest for the direct delivery arm with an increased weekly use of 4.7 minutes per week (p<0.001). Conclusions: Transition away from traditional biomass stoves is projected to curb the health effects of HAP by mitigating exposure, but the full benefits of newer clean cookstove technologies can only be realized if use of these new stoves is absolute and sustained. This work enhances our understanding of the etiology of HAP-associated pneumonia, the drivers of clean cookstove suspension, and informs policies designed to promote clean cookstove sustained use, thus reducing the burden of disease associated with exposure. We recommend future use of the suspended use paradigm in research to inform future household energy interventions. Additionally, we encourage policymakers to incorporate health behavior change theory and approaches in cookstove intervention and promotion efforts.

[Truncated abstract] This thesis examines the health outcomes of women exposed to blue asbestos at Wittenoom, Western Australia. Blue asbestos was mined and milled from 1943 to 1966 by the Australian Blue Asbestos Company (ABA) at Wittenoom, 1,600km from Perth in the remote Pilbara region of Western Australia. The original work for this thesis is presented in six manuscripts, some of which have been published in peer-reviewed Journals. The following aims have been investigated. 1. (a) To compare the all-cause mortality rates of women who lived at Wittenoom compared with all-cause mortality rates of the Western Australian female population (b) To assess the exposure-response relationship between asbestos and mortality in women. 2. (a) To compare the incidence rates of common cancers in women who lived at Wittenoom, compared with the incidence rates of these cancers in the Western Australian female population. (b) To assess the exposure-response relationship between asbestos and cancer incidence at various sites in women. 3. (a) To determine if reproductive cancers (ovarian, uterine cervical and corpus and breast) and gestational trophoblastic diseases are associated with asbestos exposure. v (b) To determine if ovarian cancer has been misclassified as malignant peritoneal mesothelioma or vice versa. (c) To determine if colon cancer has been misclassified as malignant peritoneal mesothelioma or vice versa. (d) To assess the exposure-response relationship between asbestos and reproductive cancer incidence. 4. To assess the susceptibility of women to asbestos exposure in comparison with men with similar exposure histories. 5. To predict the future mortality from malignant mesothelioma among women who lived at Wittenoom. '...' The Wittenoom crocidolite industry has had a damaging impact upon the health of the women workers and residents who lived there. Wittenoom women are more likely to die from malignant mesothelioma and lung cancer, all cancers and all causes than women in the Western Australian population. This brief period of crocidolite mining in Western Australia's history will continue to exert a detrimental impact upon the future of the women who lived there, with another 66 to 87 mesotheliomas predicted to occur to the end of 2030.

Drug Consumption Rooms (DCRs), where injecting drug users (IDUs) can use pre-obtained drugs in a hygienic and professionally supervised low threshold setting, aim to engage high risk IDUs, reduce public drug use, injecting-related morbidity and mortality, and improve access to drug treatment. This thesis evaluates the service demand, accessibility, utilisation, and coverage of Australia???s first DCR, the Sydney Medically Supervised Injecting Centre (MSIC), located in an area with a history of illegal shooting gallery operation. MSIC impact on injecting practices and injecting related health, and referral to drug treatment were also examined. Methods included cross-sectional IDU surveys, key informant interviews, staff focus groups, analysis of client registration and surveillance data and routinely collected data on needles and syringes - including multiple indirect prevalence estimation, and prospective follow-up of MSIC referrals. Shooting gallery users expressed demand for and willingness to use the MSIC. Injecting episodes previously occurring in shooting galleries appear to have been transferred to the MSIC, although shooting galleries continued to operate at a reduced level. The MSIC service model was accessible, with few refusals of entry, high levels of client satisfaction and limited non-use for reasons relating to the model. MSIC engaged high risk IDUs - regular injectors, sex workers, and those injecting in public places and shooting galleries - who were also more likely to be frequent attendees. MSIC clients were more likely than other IDUs to inject in public places and shooting galleries, be HCV seropositive, have riskier injecting practices and more severe injecting related health problems. MSIC achieved good coverage of the local IDU population (70.7%, range 59.1%-86.7%) and modest coverage of their estimated total injecting episodes during its operating hours (8.8%, range 7.3%-10.8%). MSIC use was associated with improvements in injecting practices and health. Frequent MSIC use was also associated with higher rates of referral to drug treatment than less frequent use. Drug treatment referral uptake was positively associated with a recent history of daily injection and sex work and negatively associated with a lifetime history of psychiatric treatment and/or self harm. This research was confounded by substantial changes in heroin availability during the study period but provides new evidence on DCR coverage, impact on injecting practices and health, and referral to drug treatment. Implications for future research are discussed.

The air found in a shearing shed environment is normally contaminated with many different airborne substances. These contaminants include dust (predominantly organic), bioaerosols (fungi and bacteria), and gases (ammonia and carbon monoxide). Respiratory disorders have been associated with exposure to the types of contaminants found in a normal sheep shearing environment. Twenty nine shearing sheds in the state of New South Wales in Eastern Australia were sampled for concentrations of airborne contaminants. Based on the results of this study the following recommendations are made for the shearing industry: under the current dust and bioaerosol exposure standards there are no requirements to investigate mechanical ventilation to reduce airborne contaminants and there is no need for respiratory protection in any of the monitored sheds. However, it is recommended that if a person has a known predisposition to respiratory illness/stress they should be closely monitored while working in a shearing shed. There are issues raised in this thesis that require further research including the need for an epidemiological study on the health of people working in shearing sheds in relation to their respiratory health. The monitoring of shearing sheds in other regions of Australia needs to be undertaken and based on available literature similar studies are also needed in other livestock industries in Australia. / Doctor of Philosophy (PhD)

Lifestyle diseases such as cardiovascular diseases, hypertension, cancer, type 2 diabetes are the major causes of mortality and morbidity worldwide. The prevalence of these diseases is high in New Zealand as well. It is believed that promoting a healthy diet and increased physical activity can make beneficial changes and extend the healthy life expectancy. This twelve week study with follow-up at 52 weeks was designed to demonstrate if a diet and physical activity group intervention in the workplace would result in changes in risk factors for antioxidant damage and therefore reduce the risk for lifestyle diseases. The effect of the addition of kiwifruit to the diet on markers of oxidative stress was also measured in a crossover sub study within this study. Fifty two healthy subjects (male 24, female 28, mean age 46), completed the 12 week study with measurements points being at 0, 3, 6, 9 and 12 weeks. Thirty eight subjects presented for another set of measurements at 52 weeks. The intervention started at week 3 and the kiwifruit crossover treatment was launched between weeks 6 and 12.Ferric reducing ability of plasma (FRAP) assay was utilized to measure the changes in plasma antioxidant activity(AOA) and thiobarbituric acid reactive substances (TBARS) assay to measure the changes in plasma malondialdehyde (MDA), as a marker of lipid peroxidation (LP) at each measurement point. Since almost all participants had a normal range of baseline measurements of plasma AOA and LP (plasma MDA), they were categorized as relatively low and high AOA (1200micromol/L cut off point) and LP groups (1.70mmol/L cut off point), as well as divided into male and female groups. The effect of changed diet and increased physical activity during the 12 week study period resulted in a significant increase (P<0.05) in plasma AOA. The changes were much higher in low AOA group (P=0.005) and in male subjects (P<0.005), while no changes were observed in subjects with already high AOA at baseline. The increased plasma AOA level was maintained and increased even more over the year. No changes were observed in LP (plasma MDA). The effect of kiwifruit on the markers of oxidative stress was modest, the 3-week daily kiwifruit consumption (2-3 kiwifruit per day) resulted in significant increase (P=0.01) in plasma AOA only in female subjects within the low AOA group. However, the precision and validity of the measurements were limited by a possible loss of vitamin C due to storage of the plasma samples rather than analysis when fresh. Given that kiwifruit is particularly high in vitamin C the effect of the addition of kiwifruit to the diet might not have been detected. In this study it was shown that a group diet and physical activity intervention within the workplace can increase the level of plasma antioxidant activity and thereby reduce the risk for oxidative stress and related lifestyle diseases.

Cardiovascular disease is a major cause of death in most Westernised countries. The prevalence of obesity, type 2 diabetes mellitus and cancers is rapidly increasing. Older people with elevated blood lipids, obesity and DNA damage are at high risk of developing these diseases. There is a plethora of research to support the claim that a healthy diet and increased physical activity can reduce the risk of increased body fatness, diabetes and generally improve health. However, most interventions require intensive one to one advice. The aim of this study was to measure the effect of a group approach to advising on changes in lifestyle with particular attention to foods high in fibre. The study spanned a period of 12 weeks with a follow up session at 52 weeks to ascertain sustainability. The study: This study was a 12 week longitudinal intervention study with a follow up after 52 weeks. Measurements of anthropometry (skin folds, girths, weight and height), blood pressure, body fat by bio impedance and fasting blood (lipids, glucose and insulin) were made at weeks 0, 3, 6, 9,1 2 and 52. The participants were asked to complete a food frequency questionnaire and a physical activity questionnaire at each of the 6 measuring sessions and to provide an indication of what the goals that they had set and if they had accomplished them after 9,12 and 52 weeks. Between measurements at weeks 0 and 3 the volunteers were left to follow their usual food and activity pattern. Then as a group they were given a diet and exercise talk and provided with written material and pedometers to increase motivation. After measurement at week 6 they were randomly divided into two groups. The first group (A) were prescribed and provided with kiwifruit at a dose of 100g/30 kg body weight for three weeks while the second group (B) continued with the changes in diet and physical activity. Following measurement at week 9 group A abstained from kiwifruit while Group B added the kiwifruit to their diet and the measurements repeated. After 52 weeks, with only emails as ongoing communication, they were remeasured. Results For this multicultural, relatively middle aged group of 53 staff (28 women, 25 men) of mean age 46 years, measurable and statistically significant metabolic gains were made in the lipid profile over 12 weeks. Total cholesterol, LDL cholesterol, triglycerides and the ratio of total cholesterol to HDL all decreased and HDL increased significantly. Total cholesterol decreased from 5.6(±1.1) mean (±SD) mmol/L at baseline to 5.3(±1.1) mmol/L at week 12 (p<0.001); LDL cholesterol decreased from 3.5(±0.97) mmol/L at baseline to 3.3(±0.94) mmol/L at week 12 (p<0.001); and total cholesterol to HDL ratio decreased from 4.0(±1.1) to 3.7(±0.9) (p<0.001). In the 36 who were measured at 52- week follow- up these changes persisted. With the other outcome measures glucose showed a statistically but not biologically significant decrease over the 12 week period and body composition, blood pressure and insulin showed no significant change. The kiwifruit crossover had no apparent affect on the measures of any of the measurements reported. The participants reported that they increased fruit and vegetable and oily fish consumption and increased physical activity. These increases took place over the initial 12 week period and were maintained over 52 weeks. Conclusion: This study has shown that changes in diet and physical activity can favourably influence blood biochemistry even without accompanying changes in percentage body fat and weight. Furthermore, small, manageable lifestyle changes can result in biochemical changes persisting over 52 weeks.

Typescript (photocopy) Includes bibliographical references (leaves: 260-304)