Made available in DSpace on 2016-08-10T10:55:32Z (GMT). No. of bitstreams: 1 Paulo Wharton Negri.pdf: 574968 bytes, checksum: 620c27695ef5cba0b308438c6ae013ea (MD5) Previous issue date: 2008-08-30 / The impact of non-transmissible chronic diseases in the population has been growing worldwide and creating serious problems of public health. The purpose of this study was to identify the prevalence of the risk factors to cardiac disease and to analyze the association between these risk factors to cardiac disease. Three hundred and five employees of the administrative area of Companhia de Saneamento do Estado de Goiás were examined. The data was undertaken between September and November 2007 through form and blood sample. Identification and measurable data like weight, height, body mass index, and blood pressure were obtained during the form application. After the form application, blood was collected to analyze glucose and total cholesterol. The majority of the 305 participants were male. Most of the males had between 50 and 60 year-old and most of the females had between 40 and 50 year-old. There was no significant statistic difference in the education level between gender. The total prevalence of hypertension was 30,8%. It increased according to the age and was more common in males. The total obesity prevalence was 18,7%. It was also more frequent in males. The bigger prevalence of obesity was between 20 and 40 years (23,4%) and older than 60 years (23,5%). The prevalence of high cholesterol was elevated (60,0%), and more common in males. There was no difference in the cholesterol medium rates in both sexes. The prevalence of high glicemia was prominent (20,3%) and more frequent in males. The glicemia was higher in older people, especially after 50 year-old. The estimated risk of an obese person to have hypertension was 4,675. The estimated risk of a hypertension individual to have high cholesterol and elevated glicemia was bigger than normal one. The prevalence of hypertension was high in obese male group. Analysis by multiple logistic regression demonstrated the correlation between hypertension, obesity and sex. It is recommended to include in the company health programs to the employees paying special attention to those with risk factors to well established cardiac disease. Moreover, programs of prevention should also be done to minimize the prevalence of risk factors to cardiac diseases. / O impacto das doenças crônicas não-transmissíveis na saúde das populações é crescente em todo o mundo gerando sério problema de saúde pública. Trata-se de um estudo transversal realizado no período de setembro a novembro de 2007. Teve como objetivo identificar a prevalência de fatores de risco para doença cardíaca e analisar associação entre os fatores de risco para doença cardíaca; fizeram parte do estudo 305 empregados da área administrativa da Companhia de Saneamento do Estado de Goiás. Os dados foram coletados por meio da aplicação de formulário e coleta da amostra de sangue. Dados de identificação e os mensuráveis como peso, altura, índice de massa corporal, pressão arterial, obtidos no momento da aplicação do formulário, após o que realizou-se a coleta de sangue para realização da glicemia de jejum e colesterol total . Entre os 305 participantes, a maioria era do sexo masculino. A maioria dos sujeitos do sexo masculino possuía idade entre 50 e 60 anos e os do sexo feminino entre 40 e 50 anos. A prevalência da hipertensão arterial, de 30,8%, foi crescente conforme a faixa etária e maior entre os homens do que entre as mulheres. A prevalência da obesidade, de 18,7%, sendo que entre os homens a taxa foi maior. Maior prevalência de obesos está entre as faixas etárias de 20 a 40 anos (23,4%) e naqueles com mais de 60 anos (23,5%). A prevalência de colesterol foi elevada (60,0%), sendo maior entre os homens. Não houve diferença na média do colesterol entre homens e mulheres. A prevalência de glicemia também foi elevada (20,3%), sendo maior entre os homens. A glicemia, maior entre aqueles de faixas etárias mais avançadas, significativamente na faixa etária superior a 50 anos. O risco estimado de um indivíduo obeso ter hipertensão arterial foi de 4,675; o risco estimado de um hipertenso apresentar colesterol elevado, de 1,702; e glicemia elevada, de 2,106. A prevalência da hipertensão arterial foi maior entre os indivíduos obesos e do sexo masculino. Análise por regressão logística múltipla demonstrou que a hipertensão arterial esteve correlacionada com a obesidade e com o sexo. Recomenda-se sejam instituidos na empresa programas de saúde do trabalhador para atenção imediata daqueles que possuem os fatores de risco para doença cardíaca já estabelecida, e programas de prevenção para minimizar a prevalência destes fatores de risco para doença cárdica.

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Urban sprawl often has a negative connotation, used as a derogatory label for certain forms and consequences of land development that are seen as environmentally and socially unpleasant. Although sprawl may be seen as offensive, there may be other, far greater and more harmful consequences of sprawl. The literature indicates that rates of negative health outcomes, such as obesity, tend to be higher in more developed areas. However, aside from a few studies, little empirical research looks specifically at the influence of sprawl when it comes to individual health. This research project focuses on sprawl and examines the relationships it has with health behaviors and health outcomes. By analyzing data from the CDC’s 2003 Behavioral Risk Factor Surveillance System (BRFSS), an annual telephone survey of adults that include more than two-hundred self- reported and calculated variables, I investigate the associations between sprawl, physical activity, body weight, and health outcomes using Structural Equation Modeling (SEM). By employing SEM, my research differs from previous research in this field by adding not only additional layers to the evaluation of sprawl and health outcomes, but also allows for the evaluation of associations through various “paths” instead of looking at variables within simpler hierarchical regression models. In addition to direct effects, it also allows for the determination of indirect, or mediated, effects between variables within a path model. Even though no direct relationship between sprawl and health outcomes was revealed, sprawl did show to have a statistically significant indirect effect on health outcomes mediated by physical activity and body weight. Physical activity is also shown to mediate the relationship between sprawl and body weight. Additionally, physical activity reveals both a direct and indirect effect on health outcomes, with its indirect effect being mediated by body weight. Finally, physical activity and body weight are both shown to have statistically significant direct effects on health outcomes. In the concluding chapter I propose a new path model in light of the results of the analyses of data in order to represent the associations between sprawl, physical activity, body weight, and health outcomes more accurately.

Cardiovascular disease (CVD) is responsible for 25% of the annual deaths in the United States and represents a major public health burden, as patients often require screening and lifestyle changes related to multiple risk factors such as high blood pressure and high cholesterol. The purpose of this quantitative correlational study was to determine if there was a statistically significant association between high blood pressure and high cholesterol awareness (prevention and management) and cardiovascular health outcomes (angina pectoris, coronary heart disease, and heart attack). The theoretical framework that guided this study was the health belief model. Data from adults over the age of 18 from the 2017 National Health and Nutrition Examination Survey dataset were used for this study. Logistic regression was used to analyze data. Results showed no statistically significant association between high blood pressure awareness (prevention and management) and cardiovascular health outcome (angina pectoris, coronary heart disease, and heart attack) based on race, age, level of education, and acculturation. There was also no statistically significant association between high cholesterol awareness (prevention and management) and cardiovascular health outcome (angina pectoris, coronary heart disease, and heart attack) based on race, age, level of education, and acculturation. This study may contribute to positive social change through an increase in individuals' level of awareness of their medical condition, which could lead to a reduction in the burden of cardiovascular disease.

<p>This dissertation takes the format of a "three paper model" (i.e. Sandwich Thesis), and all three articles have been submitted for publication.</p> <p>Article 1 (Chapter 4) - appears in <em>Food, Culture & Society (2014).</em></p> <p>Article 2 (Chapter 5) - appears in <em>Social Science & Medicine (2014).</em></p> <p>Article 3 (Chapter 6) - Revise & Resubmit from <em>Sociology of Health & Illness</em></p> / <p>Food and the various aspects surrounding what we eat, what we <em>should</em> eat, and concerns about how to remain healthy and ward off disease and illness is escalating while our choices are endless. In this competitive food market a new type has emerged: the functional food. Functional foods are those that have an added health benefit beyond the basic nutritional content and display physiological benefits in reducing chronic diseases. A popular category of functional foods are those that purport to lower one's cholesterol. In particular, high cholesterol is marketed as a "disease" rather than a risk factor for various cardiovascular diseases, such as heart disease. Little is known about the sociological diagnosis of high cholesterol and the marketing of functional foods, in particular with women. This dissertation address this gap by asking: (1) How is high cholesterol (HC) identified and marketed as a disease rather than a risk factor for cardiovascular diseases in functional food advertising - specifically addressing the Becel® pro.activ® margarine campaign? (2) How do women understand the issue and <em>causes </em>of high cholesterol; and (3) What do women understand the <em>solution </em>to high cholesterol to be and how do they view Becel's^® high cholesterol solution? --The findings center on 4 key issues: <ol> <li>The construction and marketing of high cholesterol <em>as a disease</em> (i.e. via the sociology of diagnosis), rather than a risk factor for heart disease;</li> <li>The causes of high cholesterol and attribution of blame are placed on women's poor lifestyle choices and seen as an individual responsibility;</li> <li>There are class differences regarding women's knowledge and awareness of the social determinants of health (SDOH); and</li> <li>The solution to high cholesterol is individualized via the 'proactive myopia' repertoire.</li> </ol></p> / Doctor of Philosophy (PhD)

Il existe un nombre grandissant de preuves au cours des dernières années que la diminution de la sécrétion des œstrogènes chez les animaux ovariectomisés (Ovx) et chez les femmes ménopausées conduit à une accumulation importante de triglycérides (TG) dans le foie. Cependant, les évidences de perturbations dans le métabolisme du cholestérol, en lien avec la diminution des œstrogènes, sont limitées à des observations de niveaux élevés de cholestérol total dans le plasma trouvés chez la femme ainsi que chez les animaux. En fait, l'impact de la suppression des œstrogènes sur le métabolisme du cholestérol dans le foie a reçu peu d'attention et montre quelques controverses. Par conséquent, les trois études présentées dans cette thèse ont été réalisées chez des rats Ovx, comme modèle animal de femmes post-ménopausées, afin de documenter les effets du retrait des œstrogènes sur les marqueurs moléculaires clés du métabolisme du cholestérol et des acides biliaires dans le foie et dans l'intestin et des effets potentiels de l’entraînement physique. Il a été en effet démontré que l'entraînement physique peut réduire le niveau plasmatique de cholestérol. Une amélioration du transport du cholestérol en périphérie vers le foie pour sa sécrétion subséquente dans la bile et pour son l'excrétion de l'organisme a été suggérée, bien que les mécanismes sous-jacents ne soient pas entièrement compris. Dans la première étude, nous avons démontré que les rattes Ovx nourris avec une diète standard et une diète standard + cholestérol avait un taux de cholestérol total dans le foie plus élevé (P <0,05) que les rattes avec une ovariectomie simulée (Sham) nourris avec ces deux derniers types de diète, tandis que la teneur en triglycérides du foie était plus élevée chez les rattes Ovx que chez les rattes Sham nourris avec une diète standard, une diète standard + cholestérol et aussi une diète riche en grasses + cholestérol. Étonnement, la diète standard + cholestérol a été associée à un niveau plasmatique plus faible (P <0,001) de cholestérol total et de triglycérides chez les rats Ovx que les rats Sham, ce qui suggère une diminution de la sécrétion de lipoprotéines à très basses densités (VLDL). Par conséquent, la transcription de plusieurs marqueurs clés de la synthèse des VLDL, y compris la microsomal triglyceride transfer Protein (MTP) et apoB-100, ont été réduites (P <0,05) chez les rattes Ovx par rapport aux rattes Sham nourris avec tous les trois types diètes et cette diminution de MTP et apoB-100 était plus prononcée chez les rats nourris avec la diète standard + cholestérol. Pour aller un peu plus loin, dans la deuxième étude, nous avons déterminé les effets de l'entraînement physique sur les marqueurs clés hépatiques de la voie farnesoid X receptor (FXR) - small heterodimer partner (SHP) - de cholestérol 7 alpha-hydroxylase (CYP7A1) (FXR-SHP-CYP7A1) impliquée dans la conversion de cholestérol en acides biliaires et de leur excrétion chez les rat Ovx nourris avec une diète standard + cholestérol. Notre groupe expérimental principal comprenait des rats Ovx nourris avec une diète riche en cholestérol (Ovx-Chol). Ce groupe a été comparé à un groupe de rats Ovx nourris avec une diète standard (Ovx-SD) et un groupe de rats Sham nourris avec une diète riche en cholestérol (Sham-Chol) pour observer, respectivement, l'effet de l'alimentation et l’effet du retrait de l'œstrogène. Les résultats de cette étude ont démontré que les niveaux de cholestérol total dans le plasma et dans le foie ne sont pas affectés par l'entraînement physique dans aucune des conditions expérimentales. L'alimentation en cholestérol a induit une accumulation plus importante chez les rats Sham et Ovx a mené à une accumulation du cholestérol dans le foie significativement plus élevée (P <0,001) que chez les rats Ovx-SD. Un effet principal d'entraînement physique (P <0,05) a été trouvée dans l’expression génique du SHP et de CYP7A1. Ce dernier gène est reconnu pour son implication majeure sur le contrôle de la biosynthèse des acides biliaires à partir du cholestérol. De plus, cette étude a montré que le récepteurs des LDL (LDL-R) et proprotein convertase subtilisin/kexin type 9 (PSCK9) au foie, qui sont impliqués dans l'absorption du cholestérol de la circulation, ne sont pas influencés par l’entraînement physique. Ces résultats suggèrent que l'entraînement physique module le métabolisme du cholestérol chez les animaux Ovx par un réglage positif de la formation des acides biliaires. Un nombre croissant de preuves récentes suggèrent que le transport inverse du cholestérol (RCT) peut également passer par une voie non-biliaire connue sous le nom « transintestinal cholesterol excretion » (TICE). En effet, le foie et l'intestin sont impliqués dans l'excrétion du cholestérol excédentaire du corps. Dans cette optique, dans la troisième étude, nous avons élargi nos recherches afin de déterminer si l'entraînement physique module l’expression des récepteurs de cholestérol de la membrane intestinale qui sont impliqués dans TICE chez les rats intacts et Ovx nourris avec une diète standard et une diète riche en cholestérol. Les résultats de cette étude ont montré que l'entraînement physique a augmenté (P <0,01) l’expression génique intestinale de LDL-R et de PCSK9 impliquées dans la captation du cholestérol intestinal de la circulation et de leur récepteur nucléaire, « sterol regulatory element-binding protein 2 » (SREBP2) (P <0,05) chez les rats Sham et Ovx par rapport aux rats sédentaires (Sed). D'autre part, l’expression des gènes hépatiques de LDL-R et de PCSK9 ont été supprimées (P <0,01) par l’alimentation riche en cholestérol, mais pas affectée par l'entraînement physique. L'expression du gène « flavin monooxygénase 3 » (FMO3), en tant que régulateur de l'équilibre du cholestérol dans le foie, a été diminuée de façon significative (P <0,01) par le cholestérol alimentaire chez les rats Sham et Ovx par rapport aux rats nourris avec la diète standard, mais demeure inchangée suite à l'entraînement physique et le retrait des œstrogènes. Un réglage positif de l'expression de gènes du LDL-R et PCSK9 intestinale par l'entraînement physique chez les rats intacts et Ovx suggère que l'entraînement physique peut contribuer à l’accroissement de l'élimination de cholestérol par la voie TICE. Dans l'ensemble, nos résultats indiquent qu'une combinaison d’une diète riche en cholestérol et un retrait des œstrogènes a mené à une diminution de l'expression des gènes des marqueurs essentiels de la synthèse de VLDL, ce qui implique une réduction de l'excrétion du cholestérol du foie. Il semble que la réduction de LDL-R hépatique pourrait être due à l'accumulation du cholestérol dans le foie. De plus, nos résultats ont présenté l’entraînement physique comme une intervention non pharmacologique appropriée pour stimuler l'excrétion du cholestérol excédentaire de l'organisme par le réglage positif des gènes impliqués dans la biosynthèse des acides biliaires dans le foie et les récepteurs intestinaux de cholestérol dans la voie TICE. / There has been accumulating evidence in recent years that the estrogen deficient state in ovariectomized (Ovx) animals and in postmenopausal women results in substantial liver triglyceride (TG) accumulation. However, evidence of disturbances in cholesterol metabolism in link with estrogen deficiency is limited to observations of higher plasma total cholesterol levels found in human as well as in animals. In fact, the impact of estrogen withdrawal on liver cholesterol metabolism has received little attention and shows some controversies. Therefore, the three studies presented in this thesis have been conducted in Ovx rats, as an animal model of post-menopausal women, to investigate the effects of estrogen withdrawal on key molecular markers of cholesterol and bile acid metabolism in liver and in transintestinal cholesterol excretion (TICE), and also to determine the potential role of exercise training as a positive alternative intervention. It has been shown that exercise training can improve plasma cholesterol levels. An enhanced transport of peripheral cholesterol toward the liver for subsequent secretion into bile and excretion from the body has been suggested; however, the underlying mechanism for this action is not fully understood. In the first study, we showed that estrogen withdrawal was associated with higher (P < 0.05) liver total cholesterol under the standard diet and the standard diet + cholesterol diet, while liver triglyceride (TG) content was higher in Ovx than in Sham rats in all three dietary conditions which are the standard diet, the standard diet + cholesterol and the high fat diet + cholesterol. Surprisingly, the standard diet + cholesterol was associated with lower (P < 0.001) plasma total cholesterol and TG levels in Ovx than in Sham rats, suggesting a decrease in very low-density lipoprotein (VLDL) secretion. Accordingly, several transcripts of key markers of VLDL synthesis including microsomal triglyceride transfer protein (MTP) and apoB-100 were decreased (P < 0.05) in Ovx compared to Sham rats under the three dietary conditions and even more so for MTP and apoB-100 when rats were fed the standard diet + cholesterol. To go one step further, in the second study we determined the effects of exercise training on hepatic key markers of farnesoid X receptor (FXR)-small heterodimer partner (SHP)-cholesterol 7 alpha-hydroxylase (CYP7A1) (FXR-SHP-CYP7A1) pathway, involved in cholesterol conversion into bile acid and excretion from the body, in Ovx cholesterol fed rats. Our main experimental group was Ovx rats fed a high cholesterol diet (Ovx-Chol) that was compared, on one hand, to a group of Ovx rats fed a standard diet (Ovx-SD) to observe the effects of the diet and, on the other hand, compared to a group of Sham operated rats fed the cholesterol diet (Sham-Chol) to observe the effect of estrogen withdrawal. Results of this study showed that plasma and liver total cholesterol levels were not affected by exercise training in any of the experimental conditions. Cholesterol feeding in both Sham and Ovx rats resulted in significantly (P<0.001) higher hepatic cholesterol accumulation than in Ovx-SD rats. A main effect of training (P< 0.05) was, however, found for transcripts of SHP and CYP7A1. The SHP and CYP7A1 transcripts were increased by training. These results suggest that exercise training through up-regulation of genes involved in bile acid formation may modulate cholesterol metabolism in Ovx animals. Finally, a recent growing body of evidence suggests that reverse cholesterol transport (RCT) can also proceed through a non-biliary pathway known as transintestinal cholesterol excretion (TICE). Indeed, both liver and intestine are involved in excretion of the excess cholesterol from the body. Based on this concept, we expanded our research to determine whether exercise training has an effect on intestinal membrane cholesterol receptors involved in TICE pathway in intact and Ovx rats fed a normal and a high cholesterol diet. Results of the third study showed that exercise training increased (P< 0.01) transcripts of intestinal LDL-R and PCSK9, which are involved in intestinal cholesterol uptake from circulation, and their nuclear transcription factor, intestinal sterol regulatory element-binding protein 2 (SREBP2) (P< 0.05) in both Sham and Ovx rats compared to rats remaining sedentary (Sed). On the other hand, hepatic LDL-R and PCSK9 gene expression was suppressed (P< 0.01) by cholesterol feeding but not affected by exercise training. Flavin monooxygenase 3 (FMO3) gene expression, as a cholesterol balance regulator in liver, was significantly decreased (P<0.01) by cholesterol feeding in both Sham and Ovx rats compared to rats were fed the SD diet but unchanged following exercise training and estrogen withdrawal. An up-regulation of intestinal gene expression of LDL-R and PCSK9 following voluntary wheel running in intact and Ovx rats suggests that exercise training may contribute to increased cholesterol elimination through the TICE pathway. Overall, our results indicate that a high cholesterol diet and ovariectomy combine to decrease the gene expression of key markers of VLDL synthesis suggesting a reduction in cholesterol excretion from the liver. Alternatively, it seems that reduced hepatic LDL-R transcript found in Ovx animals might be due to hepatic cholesterol accumulation. Moreover, our findings introduced exercise training as an appropriate non-pharmacological intervention to stimulate the excretion of the excess cholesterol from the body through upregulation of genes involved in bile acid biosynthesis in liver and intestinal basolateral cholesterol transporters in TICE.