Obesity is affecting an increasingly larger proportion of adolescents in the world, and this can be attributed to low resting metabolic rate (RMR) as well as reduced physical activity (PA) levels. Little is known about objectively determined habitual PA and RMR in 16 year old African adolescents. The purpose of this study is twofold. Firstly, to determine the objectively measured PA status of adolescents and secondly, to determine the relationship that exists between RMR and PA in 16 year old adolescents. Two hundred and twenty six (226) adolescents aged sixteen (16) wore the Actiheart® monitor, combined accelerometry and heart rate for seven (7) consecutive days. Six high schools were recruited to take part in the study: two from town (high socio-economic status) and four from the township (low socio-economic status) of the Potchefstroom area of the North West Province of South Africa. Times spent in moderate to vigorous physical activity, physical activity counts per minute (CPM), total energy expenditure (TEE), active energy expenditure (AEE) and physical activity levels (PAL) were assessed using the Actiheart®. The participants’ RMR was measured by indirect calorimetry using the Fitmate Pro (Cosmed, Italy). All data analyses were performed with the SPSS Version 20 software (IBM SPSS, II). The descriptive statistics (mean and standard deviations) as well as independent t-tests and Mann-Whitney U test were performed to determine differences between ethnicity and genders and to calculate practical significance. A Type I error rate of p ≤ 0.05 was used for statistical significance. To investigate the relationship between RMR and physical activity regression analysis was performed with adjustment for gender, race and fat free mass. Results: Significantly higher PAL (1.57 ± 0.15) were determined in girls compared to boys (PAL = 1.41 ± 0.10). Black adolescents indicated significant higher PAL (1.53 ± 0.14) compared to white adolescents (1.45 ± 0.16). On average, regardless of race or gender, the participants were more active on weekdays than weekends. The current study shows that girls spent more minutes/day in moderate to vigorous physical activity (MVPA) than the boys. The results show that 16.4% of the study sample was either overweight or obese. After adjustment for gender, ethnicity and FFM, linear regression between RMR and moderate-to-vigorous PA yielded an r2 = 0.46 (p ˂ 0.05.) Conclusion: Objectively determined PA of adolescents in South Africa indicates that only one third of adolescents are meeting the recommended 60 minutes of daily MVPA. Gender and race specific interventions are needed to increase habitual physical activity levels in adolescents. Given the fact that the studied sample did not meet recommended daily physical activity and the adverse effect of inactivity and chronic diseases of life style, urgent strategies to inculcate the culture of regular physical activity as a preventative measure of chronic diseases of life style are needed. Behaviour that is carried on into adulthood is established during adolescence. Civic health efforts should focus on encouraging adolescent involvement in regular moderate-to-vigorous PA, which will subsequently increase RMR and lower the risk of the development of non-communicable chronic diseases such as obesity. Further local research is needed to confirm the association between RMR and PA in the local population. / Thesis (MSc (Biokinetics))--North-West University, Potchefstroom Campus, 2013.

Obesity is affecting an increasingly larger proportion of adolescents in the world, and this can be attributed to low resting metabolic rate (RMR) as well as reduced physical activity (PA) levels. Little is known about objectively determined habitual PA and RMR in 16 year old African adolescents. The purpose of this study is twofold. Firstly, to determine the objectively measured PA status of adolescents and secondly, to determine the relationship that exists between RMR and PA in 16 year old adolescents. Two hundred and twenty six (226) adolescents aged sixteen (16) wore the Actiheart® monitor, combined accelerometry and heart rate for seven (7) consecutive days. Six high schools were recruited to take part in the study: two from town (high socio-economic status) and four from the township (low socio-economic status) of the Potchefstroom area of the North West Province of South Africa. Times spent in moderate to vigorous physical activity, physical activity counts per minute (CPM), total energy expenditure (TEE), active energy expenditure (AEE) and physical activity levels (PAL) were assessed using the Actiheart®. The participants’ RMR was measured by indirect calorimetry using the Fitmate Pro (Cosmed, Italy). All data analyses were performed with the SPSS Version 20 software (IBM SPSS, II). The descriptive statistics (mean and standard deviations) as well as independent t-tests and Mann-Whitney U test were performed to determine differences between ethnicity and genders and to calculate practical significance. A Type I error rate of p ≤ 0.05 was used for statistical significance. To investigate the relationship between RMR and physical activity regression analysis was performed with adjustment for gender, race and fat free mass. Results: Significantly higher PAL (1.57 ± 0.15) were determined in girls compared to boys (PAL = 1.41 ± 0.10). Black adolescents indicated significant higher PAL (1.53 ± 0.14) compared to white adolescents (1.45 ± 0.16). On average, regardless of race or gender, the participants were more active on weekdays than weekends. The current study shows that girls spent more minutes/day in moderate to vigorous physical activity (MVPA) than the boys. The results show that 16.4% of the study sample was either overweight or obese. After adjustment for gender, ethnicity and FFM, linear regression between RMR and moderate-to-vigorous PA yielded an r2 = 0.46 (p ˂ 0.05.) Conclusion: Objectively determined PA of adolescents in South Africa indicates that only one third of adolescents are meeting the recommended 60 minutes of daily MVPA. Gender and race specific interventions are needed to increase habitual physical activity levels in adolescents. Given the fact that the studied sample did not meet recommended daily physical activity and the adverse effect of inactivity and chronic diseases of life style, urgent strategies to inculcate the culture of regular physical activity as a preventative measure of chronic diseases of life style are needed. Behaviour that is carried on into adulthood is established during adolescence. Civic health efforts should focus on encouraging adolescent involvement in regular moderate-to-vigorous PA, which will subsequently increase RMR and lower the risk of the development of non-communicable chronic diseases such as obesity. Further local research is needed to confirm the association between RMR and PA in the local population. / Thesis (MSc (Biokinetics))--North-West University, Potchefstroom Campus, 2013.

Energy intake (EI) and energy expenditure (EE) across the menstrual cycle (MC), while considering body adiposity, have not been previously evaluated in the same individuals. This study mainly examined the variations in energy balance (EB) across MC. Seventeen women (Body fat-DXA:28.5%) participated in three identical sessions during distinct phases of the MC: Early-follicular, Late-follicular/ovulation and Mid-luteal (confirmed by basal temperature and sex-steroid hormones). EI, resting metabolic rate (RMR), physical-activity EE (PAEE), severity of PMS, leptin and relative-reinforcing value (RRV) of preferred foods were measured during each phase. No differences in body fat, EI, RMR, PAEE, leptin and RRV of food were noted across MC. Trends were noted in preferred snack (p=0.06) and combined snack/fruit (p=0.06) intakes, while differences were noted in severity of PMS (p<0.05) across phases. Changes in EB across the MC were not noted. PMS was more severe, and preferred snack and combined snack/fruit intakes were slightly higher during mid-luteal phase.

Made available in DSpace on 2014-06-11T19:23:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-06-19Bitstream added on 2014-06-13T19:09:27Z : No. of bitstreams: 1 souza_cl_me_arafcf.pdf: 612007 bytes, checksum: 205b15eafb3b20ed92b7460fb74d2b3c (MD5) / Universidade Estadual Paulista (UNESP) / Unimep / A obesidade é uma doença estreitamente relacionada ao desenvolvimento da síndrome metabólica (SM) e é fundamentalmente um problema de balanço energético que se desenvolve quando a ingestão de energia proveniente dos alimentos é maior que o gasto energético total. O gasto energético total compreende a taxa metabólica de repouso, o efeito térmico dos alimentos e os gastos com atividade física e pode ser medido pela calorimetria indireta. O objetivo deste trabalho foi estudar a relação da taxa metabólica de repouso (TMR) em mulheres obesas com os componentes da SM e fatores relacionados. O grupo de estudo foi constituído por 35 mulheres com idade entre 18 e 40 anos, que apresentavam um índice de massa corporal (IMC) maior ou igual a 30 kg/m². Foram excluídas as mulheres portadoras de diabetes mellitus, hipotireoidismo, gestantes, lactantes e aquelas em tratamento (medicamentoso ou não) para obesidade e dislipidemias, além das portadoras de doenças graves. Foram aplicados um questionário para obtenção de dados sócio-demográficos, três recordatórios de 24 horas em dias não consecutivos sendo um final de semana e três diários de atividade física, aplicados no mesmo dia dos recordatórios. O comportamento alimentar foi avaliado pela escala de compulsão alimentar periódica (ECAP). Dentre as variáveis antropométricas foram avaliadas peso, estatura, circunferência de cintura, quadril e braço. A composição corporal (percentual de gordura e massa magra) foi avaliada pela bioimpedância elétrica e a TMR foi avaliada por meio do analisador de gases VO2000 MedGraphicsÒ. Foram ainda dosados em sangue o colesterol total e frações, glicose, insulina, proteína C reativa e triglicérides. As mulheres foram agrupadas quanto à presença ou não de SM e em tercil de TMR ajustada para a massa corporal (TMR/MC)... / It is known that obesity, a disease closely related to the development of the metabolic syndrome (MS), is basically a problem of energy balance and develops when energy intake exceeds total energy expenditure. Total energetic expenditure includes basal metabolic rate, the thermogenic effect of food and expenditures with physical activity and can be determined by indirect calorimetry. The objective of this study was to relate the basal metabolic rate (BMR) of obese women with MS components and related factors. The studied group included 35 women aged 18 to 40 years with a body mass index equal to or above 30 kg/m². Women with diabetes mellitus, hypothyroidism, severe diseases, women being treated for obesity and dyslipidemias and pregnant and lactating women were excluded from this study. A questionnaire to obtain sociodemographic data, three 24-hour dietary recalls in non-consecutive days one being during the weekend and three physical activity diaries administered on the same day as the 24-hour recalls were administered. Eating behavior was assessed by the binge eating scale (BES). The following anthropometric variables were assessed: weight, height and waist, hip and arm circumferences. Body composition (percentage of fat and lean mass) was determined by electrical bioimpedance and the basal metabolic rate was assessed by the gas exchange testing system MedGraphics VO2000®. The women were divided into groups with and without the MS and in BMR terciles adjusted for body mass (BMR/BM). The results showed that there was no significantly statistical difference between the groups with and without the MS regarding income, physical activity, presence of binge eating disorder, dietary macronutrient and micronutrient composition, energy intake, BMR, respiratory quotient (RQ), BMR/BM or MBR/LM. When the women were divided into BMR/BM terciles, BMR/BM was not associated with MS components... (Complete abstract click electronic access below)

A contribuição genética para o desenvolvimento da obesidade precisa ser esclarecida em intervenções para perda de peso, como é o caso da cirurgia bariátrica. Portanto, a análise da expressão gênica relacionada ao gasto energético e posterior associação com a taxa metabólica de repouso pode elucidar o entendimento de fatores genéticos que contribuem para a obesidade. Além disso, as informações genéticas expressas em determinados indivíduos, podem ajudar a esclarecer mecanismos relacionados à regulação energética e oxidação de substratos. Assim, o objetivo do presente trabalho foi verificar a expressão dos genes ADRB3, UCPs, PLIN1, PPARG2, em tecido adiposo subcutâneo abdominal e associar com medidas da taxa metabólica de repouso em indivíduos obesos grau III antes e após cirurgia bariátrica. A amostra foi composta por 13 mulheres com obesidade antes e após 6 meses de cirurgia bariátrica pela técnica de derivação gástrica em Y de Roux e 10 mulheres eutróficas. Tratou-se de um estudo longitudinal, no qual foram coletadas medidas antropométricas de peso, estatura, índice de massa corporaI, circunferência abdominal, composição corporal (massa corporal magra e massa gorda) pela bioimpedância elétrica, calorimetria indireta para mensurar a taxa metabólica de repouso e análise de expressão gênica pela técnica de PCR em tempo real. Foram observadas diferenças nas variáveis de peso, índice de massa corporal, circunferência abdominal, massa corporal magra, massa gorda e taxa metabólica de repouso entre os grupos do estudo. Houve diminuição dos valores absolutos da taxa metabólica de repouso (2.094±275 vs 1.863±210kcal, p=0,01), porém quando ajustada pelo peso observou-se aumento (17,7±2,1 vs 20,4±2,1kcal/kg p=0,01). A massa corporal magra no momento pós operatório exerceu influência de 29% na taxa metabólica de repouso por quilograma de peso, sendo que houve correlação positiva entre as duas variáveis (r=0,63, p=0,02). A expressão do gene UCP2 apresentou diferença entre os dois momentos do estudo (p=0,01). Houve influência dos genes UCP2 e PLIN1 na taxa metabólica de repouso por quilograma de peso no período pré operatório. O percentual de perda de peso foi influenciado pela expressão dos genes UCP2 e PLIN1 no período pré operatório. Conclui-se que as modificações proporcionadas pela cirurgia bariátrica aumentam a expressão dos genes e gasto energético de mulheres com obesidade grau III. / The contribution of genetic to the development of obesity need to be established accurately interventions for weight loss, as in the case of bariatric surgery. Therefore, the analysis of gene expression related to energy expenditure and subsequent association with the resting metabolic rate can elucidate the understanding of genetic factors that contribute to obesity. Furthermore, the genetic information expressed in certain individuals may help clarify regulatory mechanisms related to energy and substrate oxidation. The objective was to investigate the expression of genes ADRB3, UCPs, PLIN1 and PPARG2 in abdominal subcutaneous adipose tissue and associate it with measures of resting metabolic rate in grade III obese patients before and after bariatric surgery. The sample consisted of 13 obese women before and 6 months after bariatric surgery (gastric bypass Roux-Y technique) and 10 healthy women. This was a longitudinal study in which anthropometric measurements of weight were collected, height, body mass index, waist circumference, body composition (lean body mass and fat mass) by bioelectrical impedance, indirect calorimetry to measure the resting metabolic rate and gene expression was analysed by PCR real time. Differences in body weight, body mass index, waist circumference, lean body mass, fat mass and resting metabolic rate between the study groups. There was a decrease of the absolute values of the resting metabolic rate (2.094±275 vs 1863±210kcal, p=0,01), but when adjusted for body weight an increase was observed (17,7±2,1 vs 20,4±2,1kcal/kg p=0,01). Lean body mass in the post operative period influenced 29% in resting metabolic rate per kilogram of weight, and there was a positive correlation between resting metabolic rate and lean body mass (r=0,63, p=0,02). The expression of UCP2 gene was different between the two sample points (p=0,01). There was influence of UCP2 and PLIN1 genes in resting metabolic rate per kilogram of weight in the preoperative period. The percentage of weight loss was influenced by the UCP2 gene and PLIN1 preoperative period. We conclude that the modifications provided by bariatric surgery increase the gene expression and energy expenditure women with morbid obesity.

Mudanças no hábito alimentar têm sido descritas como prováveis causas da obesidade. Estudos mostram que o peso depende do balanço energético definido pela relação entre a energia ingerida e o gasto energético. Sugere-se que o padrão alimentar, levando em consideração a freqüência de refeições e sua distribuição durante o dia, possa estar relacionado com a obesidade. Um efetivo programa de perda de peso tem como objetivo a perda do excesso da gordura corporal e a manutenção da massa livre de gordura apropriada para manutenção da saúde. O cortisol é um dos principais hormônios secretados pelo córtex supra-renal com ação predominante no metabolismo intermediário, incluindo a regulação das proteínas, carboidratos, lipídeos e ácidos nucléicos.O presente estudo teve como objetivos determinar se a ingestão alimentar hipocalórica em pacientes obesas grau III, feita exclusivamente no período das 9:00 às 11:00 h em contraposição à mesma dieta oferecida das 18:00 às 20:00 h, é capaz de alterar a perda de peso, a composição corporal, o ritmo de cortisol, o gasto energético e o balanço nitrogenado. As pacientes foram internadas na Unidade Metabólica da Divisão de Nutrologia do Departamento de Clínica Médica do Hospital das Clínicas de Ribeirão Preto USP durante um período de 64 dias, sendo divididos em 3 internações de 18 dias. Na 1ª fase receberam dieta fracionada em 5 refeições /dia, considerada controle. Na 2ª fase, receberam a mesma dieta, no período das 9:00 às 11:00 h. E na 3ª fase receberam, também, a mesma dieta no período das 18:00 às 20:00 h. Entre uma internação e outra, as pacientes tiveram alta hospitalar por 5 dias, recebendo dieta domiciliar usual. Durante cada fase realizou-se dosagem de nitrogênio urinário e de cortisol salivar. Além disto, as pacientes foram submetidas à avaliação nutricional incluindo: antropometria, bioimpedância e calorimetria indireta. O cortisol salivar obedeceu ao mesmo ritmo nas 3 fases, tanto no 1º quanto no 18º dias de internação, apresentando o pico máximo às 8:00 h, diminuindo progressivamente até atingir o nadir às 21:00 h. Não houve alteração no ritmo do cortisol quando se alterou o horário da alimentação. Houve uma diminuição significativa (p< 0,05) para todos os parâmetros antropométricos, exceto para o índice cintura/quadril durante as três fases, não havendo diferença entre as 3 fases. Houve, nas 3 internações, uma diminuição significativa tanto na quantidade de nitrogênio ingerido quanto na quantidade de nitrogênio excretado a partir do 4º dia de internação. No 10º dia de internação, o balanço nitrogenado estava negativo nas 3 fases da dieta. Não houve diferença entre as fases para ingestão, excreção ou balanço nitrogenado. Mudanças no padrão do horário da ingestão alimentar por períodos de 18 dias não foram estímulo suficiente para provocar diferentes alterações de peso, da composição corporal, da ritmicidade e níveis de produção de cortisol, da taxa metabólica de repouso e balanço nitrogenado em mulheres grau III. / Changes in dietary habits have been implicated as potential causes of obesity. Studies have suggested that weight depends on the energetic balance, which is the relation between energy intake and energy expenditure. Dietary behavior, specially eating frequency and temporal distribution of eating events during the day, may be related to obesity. An effective weight loss program should reduce body fat and preserve lean body mass. Cortisol is an important corticosteroid produced by the adrenal. It exerts metabolic effects on intermediary metabolism, regulating protein, carbohydrates, lipids and nucleic acids metabolism. The present studys goals were: compare differences in weight loss, body composition, energy expenditure and nitrogen balance using hypo caloric diet offered in two different time intervals, first from 9:00 to 11:00, second from 18:00 to 20:00; determinate if there is difference on urinary nitrogen when food is offered on different time intervals, comparing with salivary cortisol levels, and show salivary cortisol secretion rhythm of obese females undergoing hypo caloric diet in different day times. The patients were under hospital regimen in the Metabolic Unit of the Nutrology Division of the Internal Medicine Department of the HCFMRP USP for a 64 days period, divided in 3 periods of 18 days each. On phase 1, the patients received food five times a day. On phase 2, they received the same diet, but the meals were between 09:00 and 11:00. On phase 3, the same diet was offered between 18:00 and 20:00. After each 18 day period, patients went home for a 5 day wash-out period, eating their regular home food and respecting their usual dietary behavior. On each phase urinary nitrogen and salivary cortisol were measured. Also a nutritional evaluation, including anthropometry, bioimpedance and indirect calorimetry were done. There were a reduction (p< 0,05) in all parameters, except the Waist/ Hip Ratio during all phases, but there were no difference between the phases. On the 3 phases there were a reduction on both, nitrogen intake and excretion. After the 10th in hospital day, nitrogen balance was negative on the 3 phases. There are no differences on nitrogen intake, excretion or balance between the 3 phases of food intake. Salivary cortisol followed the same rhythm on all 3 phases, both on the 1st and on the 18th in hospital days, having the peak salivary level at 08:00 h and the nadir level at 21:00 h. Changing meal times for 18 days did not change salivary cortisol circadian rhythm and did not promote changes in weight loss, body composition and rest energy expenditure in grade III obese females.

Energy intake (EI) and energy expenditure (EE) across the menstrual cycle (MC), while considering body adiposity, have not been previously evaluated in the same individuals. This study mainly examined the variations in energy balance (EB) across MC. Seventeen women (Body fat-DXA:28.5%) participated in three identical sessions during distinct phases of the MC: Early-follicular, Late-follicular/ovulation and Mid-luteal (confirmed by basal temperature and sex-steroid hormones). EI, resting metabolic rate (RMR), physical-activity EE (PAEE), severity of PMS, leptin and relative-reinforcing value (RRV) of preferred foods were measured during each phase. No differences in body fat, EI, RMR, PAEE, leptin and RRV of food were noted across MC. Trends were noted in preferred snack (p=0.06) and combined snack/fruit (p=0.06) intakes, while differences were noted in severity of PMS (p<0.05) across phases. Changes in EB across the MC were not noted. PMS was more severe, and preferred snack and combined snack/fruit intakes were slightly higher during mid-luteal phase.

Introduction: Indirect calorimetry (IC) is a very accurate and non-invasive method which is used in clinical practice to measure the resting metabolic rate. This method is based on the assumption that oxygen consumption, carbon dioxide production and nitrogen metabolite waste are in definite relation to energy consumption. Based on the measurement of resting metabolic rate, a nutritional therapist can individually determine daily energy intake of a respective individual, the optimal amount of specific nutrients and thus prevents excessive or inadequate intake of energy and nutrients. Objective: The main aim of this thesis is to compare for group of overweight patients the results of the measurement of the resting metabolic rate (RMR), values of the resting metabolic rate calculated according to the Harris-Benedict (HB) equation and the actual energy intake calculated from the diet report obtained from the patients. In addition, the body composition of the examined group with a focus on the amount of muscle tissue is also marginally evaluated. Methods: The research sample includes in total 50 persons-36 women and 14 men. These persons are patients of the General Faculty Hospital in Prague. The average age is 46 years for women and 51 years for men. The average BMI for women is 38,2 kg/m2 and for men...

Use of induced hypothermia for the purpose of lowering intracranial pressure and preserving neuronal function has increased as research data reveals a trend of positive outcomes in patients treated with this therapy. Recently induced hypothermia following cardiac arrest due to ventricular fibrillation has been deemed successful. Current research has expanded to evaluate the effectiveness of induced hypothermia as a treatment modality for severe stroke and head trauma. In spite of its efficacy, complications exist with this treatment modality. The purpose of this literature review is to examine potential complications secondary to induced hypothermia and highlight the nurse's role in managing patient care. At the present, patient protocols for induced hypothermia are lacking. The success of treatment is largely dependent on the skill of the healthcare team to prevent further harm and enhance therapeutic outcomes by providing astute assessment and management of complications in patients undergoing induced hypothermia. The desired outcome of this review is to promote integration of research in the development of evidence-based protocols for induced hypothermia.

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