Master of Science / Department of Agricultural Economics / Vincent Amanor-Boadu / Metabolic syndrome (MetS) continues to be a public health concern in the United States. The current prevalence rate is about 34% among American adults. One of the recommended line of treatment for the components of MetS is dietary behavior change. Although, many dietary recommendations guidelines are published to aid in better dietary choices, little is known about how effectively they alter dietary choices. Thus, the overall objective of this study was to examine the extent to which knowledge about the presence of metabolic syndrome components influenced macronutrient intake. Data from 2013-2014 National Health and Nutrition Examination Survey (NHANES) were used for the study. The variables used were taken from modules of the NHANES dataset: demographic, dietary (day 1 and 2 recall), questionnaire (blood Pressure & Cholesterol, medical condition, diabetes and weight history), examination (blood pressure and body measures) and laboratory (cholesterol – high density lipoprotein, and triglycerides and plasma fasting glucose). Daily macronutrients (calories, protein, carbohydrate, fat and total sugar) intake were regressed on knowledge of MetS components presence and demographic characteristics using Ordinary Least Square model. The results show that having information that one has diabetes was associated with a reduced intake of daily calories (160 kcal), carbohydrate (22.73 g) and total sugar (15.26 g). There was no significant association between protein and fat intakes and the knowledge of the presence of a metabolic syndrome component in the econometric model. Ageing was associated with increase in calorie (16 kcal/day), protein (0.502 g/day) and fat (0.66 g/day) intake. Males consumed higher amounts of all macronutrients than females. Higher education was associated with higher fat intake (5.09 g/day for High School and 4.54 g/day for college compared with those with less than high school education) but reduced sugar intake (8.86 g/day) for those with college education. It was found that 27.59% of individual’s who had diabetes did not know they had it, and about 41% of those who did know they were overweight had central obesity. The study concludes that compared to knowledge about high triglyceride levels, low high-density lipoprotein, diabetes, high blood pressure and overweight, knowledge about having diabetes seems to motivate people to change their dietary intake. This may be due to the immediate effect of diet on diabetic patients compared to the other MetS components. The result of this is that it may be appropriate to pursue drug therapy for addressing the other MetS components while diet change may be effective contributor to managing diabetes.

This investigation examined acute energy compensation and macronutrient intake in habitually active and sedentary, college-aged males, following an exercise session as compared to a resting (control) session, to see if habitually active males compensate intake better to an energy deficit incurred by exercise, than sedentary males. Participants were males, aged 18-30 years, of a normal percent body fat and body mass index, and exercised < 60 min per week (sedentary) or > 150 min per week (habitually active). Participants came in for two sessions: 1) 45 minutes of resting (control) and then eating an ad libitum meal; and 2) riding a cycle ergometer for 45 minutes (exercise) and then eating an ad libitum meal. Sessions were counterbalanced across participants. Energy and macronutrient intake were calculated for the meal and over the remaining part of the day. Sedentary individuals ate significantly less during the meal in the exercise session (which expended a mean of 453.5 kcals across both groups) as compared to the control session (934.8 + 222.0 kcals vs. 1073.9 + 470.3 kcals, p < 0.03), which demonstrated negative energy compensation (-30.6%). The habitually active group showed no significant difference in energy intake between sessions at the meal (1016.8 + 396.7 kcal [control] vs. 1105.6 + 389.2 kcal [exercise]). While the habitually active group showed no significant difference in intake at the meal, the slight increase in intake at the meal in the exercise session demonstrated some energy compensation (19.6%), which was significantly better (p < 0.03) than that in the sedentary group. No differences in macronutrient intake at the meal were found between the sessions. Over the day following the sessions, both groups reported a significant increase in energy intake after the exercise session as compared to the control session (1457.5 + 646.2 kcals vs. 1356.1 + 657.2 kcals, p < 0.04), with no difference in macronutrient intake between the sessions. These results indicate that, although complete acute compensation did not occur, the habitually active group acutely compensated intake significantly more so than the sedentary group, demonstrating better energy regulation ability.

This investigation examined acute energy compensation and macronutrient intake in habitually active and sedentary, college-aged males, following an exercise session as compared to a resting (control) session, to see if habitually active males compensate intake better to an energy deficit incurred by exercise, than sedentary males. Participants were males, aged 18-30 years, of a normal percent body fat and body mass index, and exercised < 60 min per week (sedentary) or > 150 min per week (habitually active). Participants came in for two sessions: 1) 45 minutes of resting (control) and then eating an ad libitum meal; and 2) riding a cycle ergometer for 45 minutes (exercise) and then eating an ad libitum meal. Sessions were counterbalanced across participants. Energy and macronutrient intake were calculated for the meal and over the remaining part of the day. Sedentary individuals ate significantly less during the meal in the exercise session (which expended a mean of 453.5 kcals across both groups) as compared to the control session (934.8 + 222.0 kcals vs. 1073.9 + 470.3 kcals, p < 0.03), which demonstrated negative energy compensation (-30.6%). The habitually active group showed no significant difference in energy intake between sessions at the meal (1016.8 + 396.7 kcal [control] vs. 1105.6 + 389.2 kcal [exercise]). While the habitually active group showed no significant difference in intake at the meal, the slight increase in intake at the meal in the exercise session demonstrated some energy compensation (19.6%), which was significantly better (p < 0.03) than that in the sedentary group. No differences in macronutrient intake at the meal were found between the sessions. Over the day following the sessions, both groups reported a significant increase in energy intake after the exercise session as compared to the control session (1457.5 + 646.2 kcals vs. 1356.1 + 657.2 kcals, p < 0.04), with no difference in macronutrient intake between the sessions. These results indicate that, although complete acute compensation did not occur, the habitually active group acutely compensated intake significantly more so than the sedentary group, demonstrating better energy regulation ability.

To help mitigate the escalating prevalence of Type 2 Diabetes (T2D) and alleviate society of its associated morbidity and economic burden on health care, it is crucial to understand its aetiology. Both genetic and the environmental risk factors are known to be involved. Healthy diets have been proven to reduce the risk of T2D in primary prevention trials, however, which components and exact mechanisms are involved is not fully understood, in particular, the role of macronutrient intake. Body weight, glycaemic markers and T2D are all to some extent genetically regulated. There may also be genetic influences on how people digest, absorb or metabolise macronutrients. This poses the possibility that the interplay between genes and our diet may help us unravel T2D’s aetiology. The aim of this PhD was to investigate gene-diet interactions on the risk of incident T2D, focusing primarily on macronutrient intake as the dietary factor. First, I systematically evaluated the current evidence before taking a step-wise approach (hypothesis driven to hypothesis-free) to interrogate gene-macronutrient interactions. This identified 13 publications, with 8 unique interactions reported between macronutrients (carbohydrate, fat, saturated fat, dietary fibre, and glycaemic load derived from self-report of dietary intake and circulating n-3 polyunsaturated fatty acids) and genetic variants in or near TCF7L2, GIPR, CAV2 and PEPD (p < 0.05) on T2D. All studies were observational with moderate to serious risk of bias and limitations that included lack of adequate adjustment for confounders, lack of reported replication and insufficient correction for multiple testing. Second, these reported interactions did not replicate in a large European multi-centre prospective T2D case-cohort study called EPIC-InterAct. We concluded that the heterogeneity between our results and those published could be explained by methodological differences in dietary measurement, population under study, study design and analysis but also by the possibility of spurious interactions. Third, given the paucity of gene-macronutrient interaction research using genetic risk scores (GRS), we examined the interaction between three GRS (for BMI (97 SNPs), insulin resistance (53 SNPs) and T2D (48 SNPs)) and macronutrient intake (quantity and quality indicators) in EPIC-InterAct. We did not identify any statistically significant interactions that passed multiple testing corrections (p≥0.20, with a p value threshold for rejecting the null hypothesis of 0.0015 (based on 0.05/33 tests)). We also examined 15 foods and beverages identified as being associated with T2D, and no significant interactions were detected. Lastly, we applied a hypothesis-free method to examine gene-macronutrient interactions and T2D risk by using a genome-environment-wide-interaction-study. Preliminary findings showed no significant interactions for total carbohydrate, protein, saturated fat, polyunsaturated fat and cereal fibre intake on T2D. In conclusion, the consistently null findings in this thesis using a range of statistical approaches to examine interactions between genetic variants and macronutrient intake on the risk of developing T2D have two key implications. One, based on the specific interactions examined, this research does not confirm evidence for gene-diet interactions in the aetiology of T2D and two, this research suggests that the association between macronutrient intake and the risk of developing T2D does not differ by genotype.

Introdução. O consumo de açúcares aumentou consideravelmente nas últimas décadas, bem como a incidência e a prevalência da obesidade, gerando a elaboração de recomendações para moderá-lo. Os açúcares contribuem para a palatabilidade dos alimentos, podendo também aumentar sua densidade energética (DE), outro fator de risco para obesidade. Uma alternativa seria a substituição por adoçantes não calóricos, que também aumentam a palatabilidade dos alimentos, porém são isentos calorias. No entanto, ainda não existe consenso a respeito das implicações desta substituição principalmente na redução da ingestão energética e do peso corporal. Objetivo. Identificar a DE da dieta, a ingestão energética total e de macronutrientes, segundo consumo de adoçantes e/ou alimentos processados com adoçantes por adultos e idosos. Métodos. Estudo transversal, no qual foram coletados dados de sexo; idade; peso e estatura, para cálculo do IMC; consumo de adoçantes, por questionário adaptado e pelo recordatório de 24 horas, foram calculadas as médias de DE, de ingestão energética total e de macronutrientes. Para verificar associação entre variáveis independentes (idade, sexo, IMC, uso de adoçantes não calóricos) com a dependente \"classificação da DE foi realizada regressão logística, considerando dietas com alta DE aquelas com 1,5 Kcal/g ou mais. Para comparação das médias de ingestão energética e de macronutrientes, entre usuários de adoçantes e não usuários, foi utilizado o Teste t de Student (p 0,05) pelo Stata 10.0. Resultados. Participaram do estudo 168 indivíduos, com idade média de 54,8 anos (DP = 14,9 anos), sendo 84,5 por cento do sexo feminino, 67,9 por cento com sobrepeso ou obesidade e 44,1 por cento usuários de adoçantes. A média da DE das dietas de usuários de adoçantes foi 1,15 Kcal/g (IC 95 por cento [1,11; 1,19]), e de não usuários 1,28 Kcal/g (IC 95 por cento [1,23; 1,33]). Para regressão logística, as variáveis contínuas, idade e IMC, foram categorizadas, porém esta última não permaneceu no modelo final (p > 0,10). Apesar de não significativo, a variável sexo permaneceu no modelo como ajuste. A classificação da idade (p = 0,042) e o uso de adoçantes (p = 0,002) apresentaram associação com os menores valores de DE. Não foi encontrada diferença nas médias de ingestão energética e de macronutrientes entre os grupos. Conclusão. Uso de adoçantes se associou com menores valores de DE, mas não houve diferença no consumo energético total e de macronutrientes entre grupos / The consumption of sugar has increased considerably in recent decades, as well as the incidence and prevalence of obesity, leading the development of recommendations to moderate this consumption. Sugars contribute to the palatability of food, but may also increase their energy density (ED), which is an important obesitys risk factor. An alternative would be replacing sugar by non-caloric sweeteners, which increase the palatability of foods, but with free calories. However, the implications of this substitution in reducing energy intake and body weight are controversial. Objective. Identify the ED of diets, the total energy intake and macronutrient consumption according to the consumption of sweeteners and/or processed foods with sweeteners by adults and elderly. Methods. A cross sectional study, that collected data on gender, age, weight and height, to calculate BMI, consumption of non-caloric sweeteners, by questionnaire and with data from 24-hour recall, were calculated the average of ED, total energy intake and total macronutrient intake. Logistic regression was performed to assess the association between independent variables (age, gender, BMI, use of non-caloric sweeteners) and the dependent classification of ED, considering diets with high ED those with 1.5 kcal/g or more. To compare the means of total energy intake and total macronutrient intake, among noncaloric sweeteners users and nonusers, was used the Students t test (p 0.05) by Stata 10.0. Results. Were collected data form 168 individuals, with an average age of 54.8 years (SD = 14.9 years), 84.5 per cent female, 67.9 per cent overweight or obese and 44.1 per cent users of sweeteners. The mean of ED diets of non-caloric sweeteners users was 1.15 kcal/g (CI 95 per cent [1.11; 1.19]), and 1.28 Kcal/g (CI 95 per cent [1.23; 1.33]) for non-users. For logistic regression the continuous variables, BMI and age, were categorized, but the former did not remained in the final model. Although the variable gender was not significant it remained in the model for adjustment. The classification of age (p = 0.042) and the use of sweeteners (p = 0.002) were associated with lower values of ED. No difference was found in the means of total energy intake and total macronutrient intake between the groups. Conclusion. The use of sweeteners was associated with lower values of ED, but there was no difference in the means of total energy intake and total macronutrient intake between the groups

Introdução. O consumo de açúcares aumentou consideravelmente nas últimas décadas, bem como a incidência e a prevalência da obesidade, gerando a elaboração de recomendações para moderá-lo. Os açúcares contribuem para a palatabilidade dos alimentos, podendo também aumentar sua densidade energética (DE), outro fator de risco para obesidade. Uma alternativa seria a substituição por adoçantes não calóricos, que também aumentam a palatabilidade dos alimentos, porém são isentos calorias. No entanto, ainda não existe consenso a respeito das implicações desta substituição principalmente na redução da ingestão energética e do peso corporal. Objetivo. Identificar a DE da dieta, a ingestão energética total e de macronutrientes, segundo consumo de adoçantes e/ou alimentos processados com adoçantes por adultos e idosos. Métodos. Estudo transversal, no qual foram coletados dados de sexo; idade; peso e estatura, para cálculo do IMC; consumo de adoçantes, por questionário adaptado e pelo recordatório de 24 horas, foram calculadas as médias de DE, de ingestão energética total e de macronutrientes. Para verificar associação entre variáveis independentes (idade, sexo, IMC, uso de adoçantes não calóricos) com a dependente \"classificação da DE foi realizada regressão logística, considerando dietas com alta DE aquelas com 1,5 Kcal/g ou mais. Para comparação das médias de ingestão energética e de macronutrientes, entre usuários de adoçantes e não usuários, foi utilizado o Teste t de Student (p 0,05) pelo Stata 10.0. Resultados. Participaram do estudo 168 indivíduos, com idade média de 54,8 anos (DP = 14,9 anos), sendo 84,5 por cento do sexo feminino, 67,9 por cento com sobrepeso ou obesidade e 44,1 por cento usuários de adoçantes. A média da DE das dietas de usuários de adoçantes foi 1,15 Kcal/g (IC 95 por cento [1,11; 1,19]), e de não usuários 1,28 Kcal/g (IC 95 por cento [1,23; 1,33]). Para regressão logística, as variáveis contínuas, idade e IMC, foram categorizadas, porém esta última não permaneceu no modelo final (p > 0,10). Apesar de não significativo, a variável sexo permaneceu no modelo como ajuste. A classificação da idade (p = 0,042) e o uso de adoçantes (p = 0,002) apresentaram associação com os menores valores de DE. Não foi encontrada diferença nas médias de ingestão energética e de macronutrientes entre os grupos. Conclusão. Uso de adoçantes se associou com menores valores de DE, mas não houve diferença no consumo energético total e de macronutrientes entre grupos / The consumption of sugar has increased considerably in recent decades, as well as the incidence and prevalence of obesity, leading the development of recommendations to moderate this consumption. Sugars contribute to the palatability of food, but may also increase their energy density (ED), which is an important obesitys risk factor. An alternative would be replacing sugar by non-caloric sweeteners, which increase the palatability of foods, but with free calories. However, the implications of this substitution in reducing energy intake and body weight are controversial. Objective. Identify the ED of diets, the total energy intake and macronutrient consumption according to the consumption of sweeteners and/or processed foods with sweeteners by adults and elderly. Methods. A cross sectional study, that collected data on gender, age, weight and height, to calculate BMI, consumption of non-caloric sweeteners, by questionnaire and with data from 24-hour recall, were calculated the average of ED, total energy intake and total macronutrient intake. Logistic regression was performed to assess the association between independent variables (age, gender, BMI, use of non-caloric sweeteners) and the dependent classification of ED, considering diets with high ED those with 1.5 kcal/g or more. To compare the means of total energy intake and total macronutrient intake, among noncaloric sweeteners users and nonusers, was used the Students t test (p 0.05) by Stata 10.0. Results. Were collected data form 168 individuals, with an average age of 54.8 years (SD = 14.9 years), 84.5 per cent female, 67.9 per cent overweight or obese and 44.1 per cent users of sweeteners. The mean of ED diets of non-caloric sweeteners users was 1.15 kcal/g (CI 95 per cent [1.11; 1.19]), and 1.28 Kcal/g (CI 95 per cent [1.23; 1.33]) for non-users. For logistic regression the continuous variables, BMI and age, were categorized, but the former did not remained in the final model. Although the variable gender was not significant it remained in the model for adjustment. The classification of age (p = 0.042) and the use of sweeteners (p = 0.002) were associated with lower values of ED. No difference was found in the means of total energy intake and total macronutrient intake between the groups. Conclusion. The use of sweeteners was associated with lower values of ED, but there was no difference in the means of total energy intake and total macronutrient intake between the groups