Metabolic syndrome (MetS) represents a cluster of metabolic abnormalities, characterised by the presence of 3 or more of 1) abdominal obesity, 2) insulin resistance, 3) hypertension, 4) dyslipidaemia, and 5) emerging risk factors, such as pro-thrombotic and pro-inflammatory states, which are each independent cardiovascular disease (CVD) risk factors. This clustering of risk factors is reported to increase the odds ratio for cardiovascular and all-cause mortality above the risk associated with the individual components (Wilson, 2004). The precise aetiology of MetS is currently unknown, however an energy-dense diet, particularly high in carbohydrate, and an inactive lifestyle or low fitness may interact with a genetic susceptibility to contribute to the pathophysiology of MetS (Bouchard, 2007). Therefore the purpose of the studies included in this thesis were to determine whether accumulative brisk walking may improve risk factors associated with MetS and whether one single session of brisk walking at a moderate intensity may improve risk factors associated with MetS in middle-aged men at risk of MetS. Study one recruited 85 males aged 38-73 onto a 24-week randomised controlled trial with participants allocated to control (CON), single 30 minute daily brisk walking (SBW) or accumulative 30 minutes of daily brisk walking (ABW; 3×10 min or 2×15 min) groups. Measures included aerobic fitness (OO2max), body composition and selected blood variables. The main findings were that 24 weeks of accumulating 150 min·wk-1 of brisk walking at ~65% HRmax significantly improved insulin sensitivity, which was associated with decreased abdominal adiposity, assessed by waist circumference, and was at least as effective as a single daily session of equal volume in middle-aged men at risk of MetS. Study two investigated the 24-hour effect of walking for 30 minutes at 50% OO2max (30×50%), 30 minutes at 65% OO2max (30×65%) and 60 minutes at 50% OO2max (60×50%) compared to rest (CON) on cardiovascular control, resting metabolism and selected blood variables. The main findings were that a single 30 minute walking session at 50% OO2max favourably improved cardiovascular control, indicated by decreased heart rate and systolic blood pressure, thus decreasing the workload of the heart, whereas increasing the intensity of the walk to 65% OO2max attenuated this effect, while increasing the duration to 60 minutes had no additional effect compared to 30 minutes at 50% OO2max in men at risk of MetS.

Introduction: The global burden of non-communicable diseases (NCDs) has long been neglected, with the omission of NCDs from the Millennium Development Goals (MDGs) bearing testament to this. The growing prevalence of chronic cardio-metabolic diseases in South Africa places huge demands on the health system. This study sought to determine the community prevalence of these cardio-metabolic diseases and associated risk factors in Chiawelo, Soweto – a township undergoing rapid urbanization in the Johannesburg Health District. Methods: The study comprised 337 participants: 124 male and 213 female. This was a community based cross sectional survey using questionnaires, anthropometric and biochemical measurement of HbA1c. Cluster sampling techniques identified eligible adult participants. Regression models were performed to identify factors associated with disease. Ethical approval to conduct the study was obtained from the University of the Witwatersrand and written informed consent was obtained from the participants. Results: The study population was black with middle to higher socio-economic status and education levels below Grade 12 mostly. The prevalence of diabetes mellitus (DM) in this study population was 14%, with many undiagnosed and those with disease poorly controlled. More than half the study population had hypertension (HPT) (58%) and most were poorly controlled. This was a markedly obese population (39%) with 54% of women having a body mass index (BMI) categorised as obese (BMI ≥ 30 kg/m2). Conclusions: The burden of chronic cardio-metabolic diseases in the Johannesburg Health District has been grossly underestimated. The prevalence of HPT and DM was high and both diseases were poorly controlled with obesity reaching epidemic proportions. Countering the burden of disease involves targeting females as a high risk priority group, engaging the community in health promotion and developing a NCD surveillance system. Clinically, it is the findings of this study to support the screening of cardio-metabolic diseases from as early as 30 years of age in males and 40 years of age in females.

D.Med.. Faculty of Medicine, University of the Witwatersrand, 1973

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management OCTOBER 2014 / BACKGROUND: Gelukspan District Hospital is situated in the Ngaka Modiri Molema District in the North West Province. The majority of patients admitted in the adult medical wards of this Hospital are due to two conditions namely (a) HIV/ AIDS and (b) Cardio-metabolic diseases. The Hospital regularly analyse data related to the HIV/ AIDS patients for HIV/ AIDS conditional grant. The information related to cardio-metabolic diseases are seldom analysed by the Hospital management, although there is a belief within the Hospital that more than one thirds of the patients admitted in these two wards are due to cardio–metabolic diseases. This study was planned against this background to systematically analyse the routinely collected data from the Hospital information system. The results of the study would hopefully provide the estimation of the prevalence of these diseases at a health facility level and the cost for managing these conditions. AIM: To describe the profiles of patients admitted of cardio–metabolic diseases in the Gelukspan District Hospital in the North West Province during one year study period (from 01 April 2010 to 31 March 2011). METHODOLOGY: This was a cross-sectional study based on retrospective review of routinely collected data from the Adult Medical Wards of the Gelukspan District Hospital during the one year study period (1 April 2010 to 31 March 2011). No primary data was collected for this study. The study variables included: the number of subjects with cardio-metabolic diseases among the subjects who were admitted in the Medical wards of the Hospital during one year study period; their profiles and the type and cost of laboratory tests performed for these patients at the time of admission. Permission to conduct the research at the Hospital was obtained from the North West Department of the Health and the University of the Witwatersrand ‘Human Research Ethics Committee (Medical) before commencement of the study. RESULTS: Number of admissions in male and female medical wards for noncommunicable diseases was 558. There were almost same number of female (n= 287) and male (271) admissions. The result showed that both males and females suffer equally from cardio-metabolic diseases. The age – group 8805634J DM Moalosi vi analysis showed almost a third of the subjects were below 50 years age and another third was above 65 years of age. More than 20% of the population were pensioners representing the age distribution of the study cohort. The majority of the subjects were black (97.8%) and unemployed (98%) representing the demographics of the catchment population. The majority of the women were single (55.4%). There was no significant difference between male and female patients in terms of primary clinical diagnoses. Thirty-nine percent of the males (n=108) and 56% (163) females stayed more than 3 days (the norms of average length of stay for District hospitals. The case fatality rate was 19.5% probably high in a district hospital setting, this implies that probably these patients were not managed properly at the PHC level and or at this The laboratory tests done at the time of admission included random and fasting blood glucose, and creatinine. No HbA1C, lipogram and other renal function tests were done at the time of admission contrary to the norms and guidelines for management of cardio-metabolic diseases. The laboratory test result showed the possibility of significant comorbidity among the patients. Fourteen percent of the subject probably had nephropathy. CONCLUSION: This was the first study conducted in this Hospital to systematically evaluate management of a particular group of patients. Hopefully, this study would assist the Hospital management to improve the management of patients admitted in this Hospital.

The current epidemic of obesity is driven, at least in part, by excessive caloric intake and fat intake has been implicated as a major contributing factor. The mammalian taste system displays marked plasticity, and it has been shown that the detection of fatty acids, the prototypical fat taste stimulus, leads to reduced sensitivity upon prolonged exposure to a high-fat diet. Increased obesity and metabolic disorders in postmenopausal females indicate that the female steroid hormone, estrogen, may contribute to metabolic homeostasis. Sex differences in the taste system were explored using a multidisciplinary approach to examine the ways in which estrogen influences the detection and recognition of fatty acids in the taste system. The findings suggest that estrogen in females is an essential factor in mediating sex differences in fat taste. Moreover, the stimulatory effect of fatty acid taste cell activation is further enhanced by estradiol (E2), suggesting a specific role of E2 in modulating peripheral fat detection. Genes and protein function important for the transduction pathway of fatty acids vary between males and females and these differences exist across the various taste papillae. In vivo support for the effect of estrogens in taste cells was provided by comparing the fatty acid responsiveness in males, intact females, and ovariectomized (OVX) female mice with and without hormone replacement. In general, females detected fatty acids at lower concentrations and the presence of circulating estrogens increased this apparent fat taste sensitivity. To study the long-term effects of fat intake in males and females, a diet-induced obesity model was used. Estrogen loss in females lead to increases in food intake, body weight, adiposity, and fat mass, and ultimately reduced taste cell activity. These metabolic effects were reversed by estrogen replacement in females. Taken together, these data indicate that increased circulating estrogens in the taste system may play a significant role in physiology and chemosensory cellular activation and, in turn, may alter taste driven behavior and overall nutrient intake.

ABSTRACT Assessment of the Effects of Malaria and Anemia in Pregnant Malawian Women Before and After Treatment of Moderate Malnutrition William Shipley Background: Moderate acute malnutrition (MAM) can lead to adverse maternal and infant outcomes and possibly further complications. Supplementary foods or treatments with high quality nutrients should be administered to those with MAM in hopes to increase the chance of healthy maternal and infant outcomes. Sometimes supplementary food is not enough to overcome MAM and disease may play a role, particularly in pregnant malnourished women. Objective: To determine if the effects of malaria and anemia moderated the effect of nutritional treatments (one of the three given nutritional interventions) used to improve malnutrition and achieve a MUAC ≥ 23 cm during study participation. Additionally, this research serves to assess whether the relationship between malaria and anemia is associated with malnutrition status. Methods: Women were given a dose of IPTp at each antenatal visit between zero and four total IPTp doses. Infant anthropometrics – length, weight, head circumference, and MUAC were taken at birth, 6 weeks, and 3 months. Maternal hemoglobin levels were assessed at enrollment and after 10 weeks of enrollment as well as infant hemoglobin at 3 months. Anemia was defined by a hemoglobin less than 11.0 g/dL. Mild anemia was defined as hemoglobin greater than 7.0 but less than 9.9 g/dL and moderate anemia was defined by hemoglobin values 9.9 or greater but less than 11.0 g/dL. Analysis was completed using ANOVA, and if any significant differences were observed, they were compared via Tukey HSD (continuous) or Chi-squared test (categorical). Results: Total number of IPTp doses was found to be a more statistically significant predictor of maternal weight gain during treatment than timing of the doses. It stands to reason that women receiving three or more IPTp doses was the most beneficial for women during treatment as it saw the highest increases in maternal weight gain. At baseline, women that achieved a MUAC > 23 cm during the study was 32.0% (n = 1805). The greatest proportion of women, after adjustment, that achieved a MUAC ≥ 23 cm was seen in women receiving four (47.3 %) and three (37.8 %) total IPTp doses during pregnancy. Maternal weight gain correlated closely with hemoglobin at enrollment (p-value = 0.0111). Total number of IPTp doses received during pregnancy was not found to have a statistical effect on infant hemoglobin or anemia at three months. Infant length at six weeks was higher in infants from mothers that received two or three IPTp doses compared to mothers that received one IPTp dose (p-value = 0.0218). A p-value below 0.05 by total number of IPTp doses was observed for infant weight, head circumference, and MUAC at birth, six weeks, and three months. Conclusion: At least three IPTp was effective in improving maternal weight gain and achievement of MUAC > 23 cm as well as improved many infant outcomes. Hemoglobin at enrollment was a predictor of maternal weight gain during tx but was not associated with any other outcomes.

Sarcopenia and diabetes are two conditions that reflect ongoing changes in global health trends: aging and obesity. Sarcopenia affects approximately 10-40% of the global population and type II diabetes affects around 415 million individuals (6.28% globally), with obesity contributing to a majority of the cases. Currently, approximately 9.3% of the population (727 million individuals) is aged 65 years or older; this number is predicted to reach 16% of the global population (around 1.5 billion individuals) in 2050. Many developed countries are undergoing demographic population pyramid rearrangements whereby an increasingly aging population must be supported by a shrinking youth cohort. Sarcopenia involves progressive loss of muscle mass as a natural, physiological result of the aging process and is proving a pressing concern for the modern-day, aging population, as it may contribute to increased risk of falls, accidents, hospitalization, decreased range of motion and mobility, increased comorbidities, and overall decreased quality of life, particularly in elderly populations. Type II diabetes occurs when normal insulin function and regulation is impaired. It often features symptoms of hyperglycemia, insulin resistance, polydipsia, polyuria, and fatigue and is among one of the most alarming metabolic conditions for the modern world. Both sarcopenia and diabetes involve complex metabolic disturbances. Several studies have established a reciprocal relationship between sarcopenia and diabetes, where the presence of one condition influences or exacerbates the other. However, to the best of our knowledge, no studies have analyzed if a difference in the strength of the relationship exists among different ethnic groups. The main objective of this project is to conduct a review and meta-analysis to further explore the relationship between sarcopenia and diabetes, to determine whether a statistically significant difference in the strength of the relationship exists among different ethnic groups, and to suggest future research directions and perspectives based on given results.

by Patricia Jane Anderson. / "June 1999." / Thesis (Ph.D.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (p. 300-328). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

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