Master of Public Health / Human Nutrition / Richard R. Rosenkranz / Background: Type 2 diabetes mellitus (T2DM) is a costly and burdensome lifelong disease, and without proper glycemic control, severe life-threatening complications result. In Southeast Asia, the prevalence of T2DM is forecast to increase markedly from 2000 to 2030. Although literature reviews on lifestyle modification for glycemic control are available, these are mainly for the Western context, and there is a dearth of evidence for Southeast Asians who are at greater risk of T2DM and have differing patterns of diet, physical activity and body composition than Western populations. Objective: To systematically review literature on the effectiveness of lifestyle modification interventions for glycemic control in T2DM patients from Southeast Asia. Methods: Randomized controlled trials (RCT) with interventions ≥ 8 weeks that compared HbA1c or blood glucose for intervention (lifestyle modification) versus control groups were identified from searches in Cochrane Library, CINAHL, PubMed, ProQuest, Science Direct, SPORTDiscus, Scopus and Web of Science. Results: Seven RCTs (679 participants) meeting inclusion and exclusion criteria were identified. There was a significant reduction in HbA1c% (MD = -0.56%; 95% CI = -0.95,-0.16%; p = 0.006; n = 5 studies) and in blood glucose mg/dl (MD = -16.76 mg/dl; 95% CI = -31.36, -2.17 mg/dl; p = 0.02; n = 4 studies) over 3 months for lifestyle modification intervention groups. Lifestyle interventions included diet (n = 2), exercise (n = 2), and general lifestyle interventions (n = 3). Duration of interventions ranged from 12 weeks to 6 months. Studies included populations from Thailand (n = 5) and Malaysia (n = 2). Conclusion: Overall, lifestyle modification interventions are effective for the glycemic control of T2DM patients in countries of Southeast Asia.

Master of Science / Department of Human Nutrition / Denis M. Medeiros / Copper deficiency has been linked with many health problems, among them cardiac hypertrophy. Because of its potential for causing oxidative damage, copper within the cell must be bound to chaperone proteins. In this thesis, we examined the role of dietary copper deficiency in the regulation of select copper chaperone proteins in cardiac tissue of rats. Sixteen weanling male Long-Evans rats were randomized into treatment groups, one group receiving a copper deficient diet (< 1 mg Cu/kg diet) and one group receiving a diet containing adequate copper (6 mg Cu/kg diet) for 5 weeks. Rats were sacrificed and a small blood sample was removed to determine hematocrit. Also, heart and liver tissues were removed for subsequent analysis. Rats fed the copper deficient diet had lower body weights but greater heart weights and heart:body weight. Hematocrit levels and liver copper concentrations were markedly decreased in copper deficient rats. These variables indicated that the copper deficient diet did in fact induce a copper deficiency in these animals. Non-myofibrillar proteins from the hearts were removed and separated by SDS-PAGE. Western Blotting was used to determine the concentrations of CTR1, CCS, Cox17, SCO1, Cox1 and Cox4. No changes were observed in the concentrations of CTR1 and Cox17. CCS and SCO1 were up-regulated as a result of copper deficiency, while Cox1 and Cox4 were both down-regulated. However, use of another antibody against Cox subunits suggested that only the nuclear encoded subunits including subunit IV were decreased, but not subunits I and II. These data provide new insight into the cardiac hypertrophy observed in copper deficiency, which suggests that select chaperone proteins may be up-regulated by a dietary copper deficiency.

Master of Science / Department of Animal Sciences and Industry / Evan C. Titgemeyer / Two experiments analyzed effects of zilpaterol-HCl and nitrogen supplementation in the form of either dried distiller’s grains with solubles (DDGS) or urea fed to steers. In Experiment 1, steers were fed corn-based diets: control (CON; 10.2% CP), urea (UREA; 13.3% CP), or DDGS (14.9% CP). Nitrogen intake differed among treatments (99, 151, and 123 g/d for CON, DDGS, and UREA). Urea-N synthesis tended to be greater for DDGS (118 g/d) than for UREA (86 g/d), which tended to be greater than CON (52 g/d). Urinary urea-N excretion was greater ([italics]P[italics]<0.03) for DDGS (35.1 g/d) and UREA (28.6 g/d) than for CON (12.7 g/d). Gut entry of urea-N (GER) was numerically greatest for DDGS (83 g/d), intermediate for UREA (57 g/d), and least for CON (39 g/d). Urea-N returned to the ornithine cycle tended to be greater for DDGS (47 g/d) than for UREA (27 g/d) or CON (16 g/d). The percent of microbial N flow derived from recycled urea-N tended ([italics]P[italics]=0.10) to be greater for DDGS (35%) than for UREA (22%) or CON (17%). The percent of urea production captured by ruminal bacteria was greater ([italics]P[italics]<0.03) for CON (42%) than for DDGS (25%) or UREA (22%). Experiment 2 diets were identical to those used in Experiment 1. In addition, steers were also fed either 0 or 60 mg/d zilpaterol-HCl. Dietary CP was 9.6, 12.4, and 13.7% for CON, UREA, and DDGS, respectively. Zilpaterol increased ([italics]P[italics]<0.01) total DMI and N intake; however, zilpaterol did not affect urea entry rate ([italics]P[italics]=0.80) or GER ([italics]P[italics]=0.94). Urea entry rate and GER were numerically greater for DDGS than CON and UREA. In conclusion, zilpaterol did not influence urea entry rate or GER. This lack of response in the face of greater N intake was interpreted to suggest that zilpaterol may reduce urea production and GER at constant N intake.

Doctor of Philosophy / Department of Hospitality Management and Dietetics / Deborah D. Canter / The culture-change movement in skilled nursing facilities is challenging foodservices to consider their role in supporting the paradigm shift to person-centered care. Optimal nutrition for residents supports physical and emotional health of institutionalized older adults. The purpose of this study was to explore factors associated with resident dining in skilled nursing facilities that have transitioned from a traditional foodservice system to restaurant-style dining. The study investigated foodservice employee perceptions of resident satisfaction with foodservices, foodservice employee job satisfaction, and effect of the delivery system transition on employee intent to leave. The study was conducted in two phases. Phase I was a case study of one skilled nursing facility’s transition from the traditional foodservice to restaurant-style dining. Phase II consisted of a survey of residents and employees in seven skilled nursing facilities utilizing restaurant-style dining. Two questionnaires, addressing the constructs of food quality, service quality, and customization relating to resident satisfaction with foodservices, were developed and administered to residents and foodservice employees. The Phase 1 case study revealed differences in financial and unintended weight loss data from pre- to post-menu transitioning. Focus groups provided insight into resident satisfaction with food and foodservices. In both phases, residents were satisfied with restaurant-style dining. Statements regarding the ability to choose foods at meals times scored highly. Service statements such as “Being treated respectfully by employees” were rated high by the residents. Portion sizes and food quality consistency were rated lower by residents. Employee perceptions of resident satisfaction were consistent with the resident ratings of satisfaction. Foodservice employee job satisfaction was high and intent to leave was low. Job satisfaction mediated the relationship between the employee perception of resident service and their intent to leave. Overall, restaurant-style dining appears to be a positive alternative to the traditional foodservice system in skilled nursing facilities. Implications and future research are discussed.

Doctor of Philosophy / Department of Human Nutrition / Tonatiuh Melgarejo / Background and Objective: Crohn’s disease (CD) patients express low levels of host defense peptides (HDPs) especially β-defensins, which may compromise intestinal barrier function. Antibiotic treatment for bacterial infections in CD is limited and rarely curative, making it necessary to find alternative therapeutic approaches. We therefore investigated to what extent an essential amino acid; L-isoleucine (L-ILE) might induce the expression of human β-defensins (HBDs) in colonic epithelial cells as an alternative approach to help patients with CD. Antimicrobial activity of HBD2 was also assessed against four bacterial isolates which can cause secondary infections in CD. Methods: HTB-37 Caco-2 cells were stimulated with L-ILE at a concentration of 0 - 500µg/ml for 6 hours. Total RNA was extracted using RNeasy Micro Kit (QIAGEN). Reverse transcription was carried out with Superscript ®III First-Strand Synthesis System. The cDNA was amplified using specific primers for HBD1-3. Antimicrobial activity of HBD2 was determined using the broth dilution assay. Results: HBD1 was constitutively expressed under all conditions. HBD2 was expressed in HTB-37 cells after stimulation with L-ILE. Below 25µg/ml L- ILE stimulation, no expression of HBD2 was observed. HBD2 exhibited antimicrobial activity against bacterial isolates tested, with a MIC of 32, 64 and 128 µg/ml for both strains of E. coli, S. aureus and P. aeruginosa respectively. Conclusions: Our results indicate that L-ILE stimulation of HTB-37 Caco-2 cells can induce HBD2 expression. Data collected from our in vitro studies might have major implications for modifying the intestinal microbiota towards a healthier state in CD patients. Promoting the expression of HBD2 by colonic cells may lead to a lower rate of infection in these patients. Future in vivo studies are warranted to determine the potential clinical use of intra colonic administration of L-ILE in CD patients. The observed antimicrobial activity of HBD2 against bacterial isolates provides evidence that it is a crucial component of mucosal epithelial defense against infections which can complicate disease symptoms in CD.

Doctor of Philosophy / Department of Human Nutrition / Valentina M. Remig / Preventing foodborne illness and promoting safe food practices among all age groups is a high priority, particularly for college students because little about their food safety awareness and food handling practices has been reported. The research aim was to evaluate food safety attitudes, beliefs, knowledge, and self-reported practices of current upper-division college students, and to determine whether a three-module interactive educational intervention, developed for this study, positively influenced these variables. Comparisons between health and non-health majors were made. Two methods of data collection were used with volunteer health and non-health majors: focused food safety discussion groups during academic year 2004-05, and a pre-experimental design. Prior to engaging in either method, students completed an on-line food safety questionnaire (FSQ), adapted from a telephone survey used at K-State with older adults. The FSQ was administered again to those in the pre-experimental design group one week after exposure to the food safety educational intervention. Five weeks later, the FSQ was administered to determine whether changes in attitudes, beliefs, knowledge, and self-reported practices persisted over time. Focused food safety discussion group responses were qualitatively evaluated. Pre-experimental statistical analyses included Wilcoxin Signed Rank, Friedman, Mann-Whitney U, Chi Square tests, and Spearman rho. Focused discussion group findings indicated that students perceived themselves at low risk for foodborne illness; few used food thermometers; students without health backgrounds mimicked undesirable home practices; and students stated being open to changing non-recommended behaviors. Pre-experimental findings showed the effects of intervention were improved food safety attitudes, beliefs, and knowledge, with the strongest effects seen in health majors. Students' FSQ attitude scores increased from 114 to 122 (P<0.001), FSQ belief scores increased from 86 to 98 (P<0.001), and FSQ knowledge scores increased from 11 to 13 (P<0.001). Intervention resulted in some improved food safety self-reported practices for health majors but not non-health majors. Intervention module post-test scores improved significantly for all students; health majors had greater increases. Conclusions. Focused food safety discussion groups were useful for obtaining food safety information from college students; educational intervention improved college students’ food safety attitudes, beliefs, and knowledge and for health majors, some self-reported practices improved.

Doctor of Philosophy / Department of Human Nutrition / Weiqun Wang / Wheat lignans are phenylpropane dimers linked by β-β bonds with a 1, 4-diarylbutane structure. They are biosynthesized in the cell cytoplasm through action of enzymes of the phenylpropanoid pathway. Pinoresinol lariciresinol reductase (PLR) catalyzes the final steps of biosynthesis of wheat lignans. In epidemiological and clinical investigations, studies show that high plasma lignan amounts correlate with reduced risks of breast, colon, and prostate cancers. However, in some of the studies, the results are not consistent. More consistent results are observed when animal and cell culture models are used. Our previous studies in the Wang lab demonstrated that treatment of human colon cancer cells, SW480 with lignans results in a dose and time dependent inhibition of cancer cell growth. In the first paper, we investigated direct experimental cancer preventative characteristics of a wheat lignan, secoisolariciresinol diglucoside (SDG) vs. its metabolite enterolactone in human colon cancer SW480 cells. Treatment of cancer cells with 0-40 µM SDG or enterolactone resulted into inhibition of cancer cell growth as observed by reduction of cell numbers. The reduction appeared related to induction of S-phase cell cycle arrest rather than cytotoxic effect. Further analysis revealed that SDG was more stable in cell culture medium than enterolactone. HPLC-MS/ESI showed that enterolactone is the principle metabolite in cancer cells but undetectable SDG or its metabolites were in the cells treated with SDG. In the second paper, we investigated over expression of the PLR gene and enhancement of lignan levels in transgenic wheat. We transformed wheat cultivars (‘Bobwhite’, ‘Madison’, and ‘Fielder’ respectively) with the Forsythia intermedia PLR gene under the regulatory control of the maize ubiquitin promoter. Of the total 217 transgenic wheat lines, we successfully obtained 7 transformants with the inserted ubiquitin PLR gene as screened by PCR. Real-time PCR further indicated 109-117% PLR over expression over the transgenic control in 3 transformants of the 7 at T0 generation. In addition, the levels of SDG, as determined by HPLC was found to be significantly elevated in one of the 3 positive transgenic plants. To the best of our knowledge, this is the first study reported that genetically engineered wheat with over expressed PLR enzyme enhancing phytochemical lignan has been successfully achieved.

Doctor of Philosophy / Department of Human Nutrition / David A. Dzewaltowski / The environment can be broadly defined as all things external to an individual. One of the most important environments for children is the home in which they live, particularly with regard to the role that parents play to provide opportunities for healthful development, including adequate physical activity and healthful eating habits. Parents are the gatekeepers of children's healthful opportunities, and are influential in numerous aspects related to obesity. The present paper consists of four chapters related to impacting the home environment for prevention of obesity in children. Although obesity is a complex issue, its cause is energy imbalance, wherein less energy is expended than is consumed. Consideration of both sides of the equation is essential for obesity prevention. In this dissertation, chapter 1 serves as a literature review for the home food environment. A conceptual model is presented as an attempt to place relevant literature in the greater context of environmental variables related to childhood obesity. Frequent family meals have been shown to be protective for child and adolescent obesity, and to promote fruit and vegetable consumption. However, time pressures and lack of cooking skills are potential barriers to this healthful practice. Decreases in television viewing and sugar-sweetened beverage consumption are other home environmental aspects showing promise in the obesity prevention literature. Chapters two and three address the influence of parents on children's obesity-preventive behaviors and relative weight status. These chapters help to inform the planning of interventions to prevent obesity in children. Parent-child shared physical activity may hold promise as a strategy to decrease the likelihood of children becoming obese, and bonding may be an important consideration in programs aimed at obesity treatment or prevention. Chapter four describes the evaluation of an intervention developed to impact the home environment of young girl scouts. This intervention was implemented by troop leaders altering troop-meeting environments toward more healthful opportunities for physical activity and nutrition, and through the delivery of a scouts-tailored curriculum. Results of the intervention showed marked changes to troop meeting environments, but apparently little impact on parents or the home environment.

Doctor of Philosophy / Department of Human Nutrition / Denis M. Medeiros / Laman Mamedova / The internalization of aggregated low-­density lipoprotein (agLDL) may involve the actin cytoskeleton in ways that differ from the endocytosis of soluble LDL. Based on previous findings the P2Y[subscript]2 receptor (P2Y[subscript]2R) mediates these effects through interaction with filamin‐A (FLN‐A), an actin binding protein. Our findings also showed that uridine 5’‐ triphosphate (UTP), a preferential agonist of the P2Y[subscript]2R, stimulates the uptake of agLDL, and increases expression of low‐density lipoprotein receptor related protein 1 (LRP 1) in cultured mouse vascular smooth muscle cells (SMCs). The strategy of this research was to define novel mechanisms of LDL uptake through the modulation of the actin cytoskeleton in order to identify molecular targets involved in foam cell formation in vascular SMCs. For this project, we isolated aortic SMCs from wild type (WT) and P2Y[subscript]2R‐/‐ mice to investigate whether UTP and the P2Y[subscript]2R modulate expression of LRP 1 and low‐density lipoprotein receptor (LDLR). We also investigated the effects of UTP on uptake of DiI‐labeled agLDL in WT and P2Y[subscript]2R‐/‐ vascular SMCs. For LRP1 expression, cells were stimulated in the presence or absence of 10 [mu]M UTP. To determine LDLR mRNA expression, and for agLDL uptake, cells were transiently transfected for 24 h with cDNA encoding hemagglutinin-­tagged (HA-­tagged) WT P2Y[subscript]2R or a mutant P2Y[subscript]2R that does not bind FLN‐A, and afterwards treated with 10 [mu]M UTP. Total RNA was isolated, reversed transcribed to cDNA, and mRNA relative abundance determined by RT-­PCR using the delta-­delta Ct method with GAPDH as control gene. Results show SMCs expressing the mutant P2Y[subscript]2R that lacks the FLN‐A binding domain exhibit 3‐fold lower LDLR expression than SMCs expressing the WT P2Y[subscript]2R. There was also decrease in LRP1 mRNA expression in response to UTP in P2Y[subscript]2R‐/‐ SMCs compared to WT. Actinomycin‐D (20 [mu]g/ml) significantly reduced UTP-­induced LRP1 mRNA expression in P2Y[subscript]2R‐/‐ SMCs (P < 0.05). Compared to cells transfected with mutant P2Y[subscript]2R, cells transfected with WT P2Y[subscript]2R showed greater agLDL uptake in both WT VSMC and P2Y[subscript]2R-­/-­ cells. Together these results show that both LRP 1 and LDLR expressions are dependent on an intact P2Y[subscript]2R, and P2Y[subscript]2R/ FLN‐ A interaction is necessary for agLDL uptake.