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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.

<p>Background: The objective of this thesis was to examine the role of psychosocial factors in weight loss success after bariatric surgery. It was proposed that a higher pre-operative body mass index (BMI), greater weight, depression, low self-esteem, and a childhood history of sexual abuse (CSA) would predict poor outcomes one year after Roux-en-y gastric bypass as evidenced by a BMI > 35 kg/m²and a lower percent total weight loss (%TWL). Methods: We administered a battery of psychological screening tools, including the Beck Depression Inventory-II, the Rosenberg Self-Esteem Scale and a self-report measure assessing CSA, to 262 patients seeking bariatric surgery at St. Joseph's Healthcare Hamilton. Patients completed the questionnaires prior to surgery and again one year post-surgery. Results: On average patients (n = 79) achieved good weight loss outcomes (BMI = 32.8 kg/m²) at one-year follow-up. Through multiple regression analysis we found that pre-operative BMI accounted for a significant proportion of variance in postoperative BMI [<em>R²</em> = .60, <em>F</em>(1, 77) = 114.4, <em>p</em> < .001]. Weight before surgery, however, did not predict %TWL after surgery. None of the psychosocial variables significantly predicted post-operative BMI or weight loss. These results are preliminary and are limited by the fact that participants did not present with clinically significant symptomatology and those with active psychopathology were excluded as suitable surgical candidates. Conclusion: These findings indicate that pre-operative BMI is a significant predictor of BMI one year after bariatric surgery, suggesting that more attention should be directed toward managing pre-operative BMI for heavier patients.</p> / Master of Science (MSc)

Introdução: Beribéri é uma doença causada pela deficiência de tiamina (vitamina B1) que, apesar de facilmente tratável, pode levar a óbito. Há pelo menos setenta anos não se tinha referência de surtos de beribéri no Brasil. Objetivo: Descrever o perfil epidemiológico dos casos de beribéri e óbitos notificados no Estado do Maranhão. Método: Estudo descritivo-retrospectivo que analisou 1.207 casos notificados de beribéri e 40 óbitos ocorridos no Maranhão no período de 2006 a 2008. As informações foram obtidas do banco de dados da Vigilância Epidemiológica e fichas de notificação. Resultados: Os casos distribuíram-se em 434 (36,0%) em 2006, 551 (45,6%) em 2007 e 222 (18,4%) em 2008. Afetou dois terços das Unidades Regionais de Saúde e 26,3% dos municípios localizados nas regiões centro-oeste, noroeste e sudoeste do Estado. As notificações foram maiores nos meses de março a agosto, com pico em junho. O coeficiente de incidência no período foi de 4,32/10.000 hab. Homens foram mais acometidos (81,9%), com concentração de casos na faixa etária de 20-40 anos (57,0%). Predominou a ocorrência do beribéri seco (84,6%) e o tempo decorrido entre os primeiros sintomas e a notificação foi inferior a três meses para dois terços dos casos. A hospitalização ocorreu para 50% dos casos em 2006, 30% em 2007 e 15% em 2008. O consumo de álcool foi referido por 53,2% dos acometidos em 2006, com proporção discretamente menor nos anos subseqüentes, e o hábito de fumar por cerca de um terço dos acometidos. Sintomas mais comuns foram: diminuição da força, dormência e edema das pernas, dificuldade para caminhar e dor na panturrilha. Em relação à escolaridade, constatou-se que mais da metade (57,2%) tinha quatro anos ou menos de estudo, dois terços (66,2%) desempenhava atividade laboral pesada e 72,9% tinham renda familiar inferior a um salário mínimo. Foram registrados 40 óbitos (3,3% do total de casos notificados) apenas em 2006, concentrados no mês de junho (61,9%) e distribuídos em 21 municípios (9,7%). A taxa de mortalidade para o Estado foi de 0,45/10.000 hab. Praticamente a totalidade dos óbitos ocorreu no sexo masculino (97,5%), sendo 72,5% na faixa etária de 20-30 anos. Para dois terços, o tempo decorrido entre os primeiros sintomas e a notificação foi inferior a três meses e a hospitalização ocorreu para 42,5%. Hábito de consumir álcool e fumar foi elevado entre aqueles que foram a óbito, 75,0% e 66,7%, respectivamente. Conclusão: O estudo se destaca por abranger análise de todas as notificações de beribéri do estado do Maranhão. Constatou-se que os casos e óbitos apresentaram distribuição espacial e temporal relacionado à realidade do estado. A ausência de óbitos em 2007 e 2008 e redução dos casos em 2008 sugerem efeitos positivos das ações de enfretamento governamentais implementadas. Esta avaliação descritiva é importante para nortear as atividades e áreas a serem priorizadas no planejamento das ações de combate, tanto no nível central (federal, estadual e municipal), como para os profissionais da atenção básica e especializada, no direcionamento de suas práticas. Os resultados contribuem também para o delineamento de outras pesquisas que possam auxiliar no estudo da determinação do beribéri no Brasil. / Introduction: Beriberi is a disease caused by a deficiency of thiamine (vitamin B1) which, although easily treatable, may lead to death. There had been no register of beriberi outbreaks in Brazil for at least seventy years. Objective: To describe the epidemiological profile of reported beriberi cases in the State of Maranhão. Method: A descriptive retrospective study of 1,207 reported beriberi cases and 40 deaths in the State of Maranhão from 2006 to 2008. The information was obtained from the database of Epidemiological Surveillance and the reporting forms. Results: The cases were distributed in 434 (36.0%) in 2006, 551 (45.6%) in 2007 and 222 (18.4%) in 2008. It affected two thirds of the Regional Health Units and 26.3% of the municipalities located in the Central-Western, Northwestern and Southwestern of the State. The notifications were higher in the months from March to August, peaking in June. The incidence rate in the period was 4.32 / 10,000 inhabitants. Men were more affected (81.9%), with more concentration of cases in the age group 20-40 years (57.0%). Dry beriberi was predominant (84.6%) and the elapsed time between first symptoms and reporting was less than three months in two thirds of cases. Hospitalization occurred for 50.0% of cases in 2006, 30.0% in 2007 and 15.0% in 2008. Alcohol consumption was reported by 53.2% of patients in 2006 and slightly lower proportion in subsequent years, and smoking was reported for about one-third of patients. Main symptoms were loss of strength, numbness and swelling of the legs, difficulty in walking and calf pain. Regarding education it was found that more than half (57.2%) had four or fewer years of study, two thirds (66.2%) performed heavy labor activity and 72.9% had a family income lower than minimum wage. Forty deaths were recorded (3.3% of all reported cases) only in 2006, concentrated in the month of June (61.9%) and distributed in 21 municipalities (9.7%). The mortality rate for the State was 0.45 per 10,000 inhabitants. Almost all the deaths occurred in males (97.5%), and 72.5% aged 20-30 years. For two-thirds of the patients who died, the elapsed time between first symptoms and reporting was less than three months and hospitalization occurred in 42.5%. Alcohol consumption and smoking were higher among those who died, 75.0% and 66.7% respectively. Conclusion: This study stands out for including analysis of all reported beriberi cases in the State of Maranhão. It was found that cases and deaths showed spatial and temporal distribution related to the social reality of the State. The absence of deaths in 2007 and 2008 and reduction of cases in 2008 suggest positive effects of the implemented governmental actions. This descriptive evaluation is important to guide the activities and areas to be prioritized in the planning of actions at the central level (federal, state and municipal), as well as for guiding the practice of primary and specialized healthcare professionals. The results also contribute to the design of other research that may support the study of beriberi in Brazil.

Background: The association of asthma and obesity in youth is well studied. However, much of this research has been observational and the temporal relationship between the two factors remains the subject of debate. Moreover, there are mixed findings regarding the role of physical activity in the association between asthma and obesity in youth. Methods: A systematic review of existing literature of the relationship between asthma and obesity in youth, while examining the role of physical activity as a mediator, was conducted using PubMed and Medline databases. Studies conducted on children and adolescents aged 0 to 18 years, published in English during the period of 2000 to 2014 were included. A comprehensive search yielded 143 studies in PubMed and 133 studies in Medline databases. Of these, 76 studies met the review’s eligibility criteria. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were consulted to evaluate quality of selected citations. Results: The association between asthma and obesity in youth is well explored. However, there are varying hypotheses and conclusions regarding this relationship, of which temporality remains to be elucidated. Existing evidence was identified to support the mediation of this association by physical activity. Negative self- or parental- perception of exercise ability due to asthma symptoms secondary to physical exertion was identified as a determinant of physical activity in asthmatic youth. Also, control of asthma symptoms was found to directly impact daily physical activity levels. Greater odds of increased weight were observed among asthmatic children compared to non-asthmatic peers. However, annual weight gain was found to be similar among asthmatic children with well controlled symptoms to that of their healthy peers. Lastly, the review found that adverse respiratory symptoms secondary to exercise are experienced by 90% of asthmatic youth, resulting in activity limitation. According to this finding, it is reasonable that the incidence of obesity frequently observed to be greater in asthmatic youth than healthy peers is mediated by decreased expenditure of energy in asthmatic children due to reduced physical activity. Conclusions: It is likely that physical activity mediates the relation between asthma and obesity, though further research is required to determine the temporal relation and degree of this association.

PURPOSE: The association of asthma and overweight in youth is well studied. However, the temporal relationship between asthma and overweight, the strength of their association, and mediating factors involved in this relationship remain unclear. This review investigates the relationship between asthma and overweight in youth, while examining the role of physical activity as a mediator. METHODS: A systematic review of literature was conducted using PubMed and Medline databases. Studies conducted among youth aged 0-18 years, published in English between 2000-2014 were included. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were consulted to evaluate quality of selected citations. RESULTS: A comprehensive search yielded 143 studies in PubMed and 133 studies in Medline databases. Of these, 75 studies met the eligibility criteria. The review found varying hypotheses regarding the temporal relationship between asthma and overweight in youth; existing evidence supports the mediation of this association by decreased expenditure of energy due to reduced physical activity. Negative self-perception or parental perception of exercise ability due to asthma symptoms secondary to physical exertion was identified as a determinant of physical activity in asthmatic youth. CONCLUSIONS: Physical activity likely mediates the relationship between asthma and overweight in youth. Temporality of this relationship remains unclear.

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Background C1q TNF related protein 3 (CTRP3) is a relatively novel hormonal factor primarily derived from adipose tissue and has anti-diabetic properties. To determine if CTRP3 could play a role in early childhood development, the purpose of this study was to establish the presence of CTRP3 in breast milk (BM) and to determine whether CTRP3 levels were correlated with pregravid obesity status of the mother. Methods Breast milk was collected from breast-feeding mothers who had a pregravid body mass index (BMI) classification of normal weight (BMI 18–25 kg/m2, n = 23) or obese (BMI > 30 kg/m2, n = 14). Immunoprecipitation followed by immunoblot analysis confirmed the presence of CTRP3 in BM. The concentration of CTRP3 in BM samples was determined by ELISA. Additional bioactive components were also measured by commercially available assays: ghrelin, insulin, leptin, adiponectin, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and glucose. Bioactive components in normal weight and obese mothers were compared using unpaired t-test (parametric) and Mann–Whitney U-test (non-parametric), as appropriate. Results The primary findings of this study are that the adipokine CTRP3 is present in BM and CTRP3 levels are increased with pregravid obesity. Additionally, this study independently confirmed previous work that BM from obese mothers has a higher concentration of insulin and leptin. Further, no differences were observed in BM between obese and normal weight mothers in ghrelin, adiponectin, IL-6, TNF-α, or glucose levels. Conclusion This study identified a novel factor in BM, CTRP3, and showed that BM CTRP3 levels higher in obese mothers. Because of the purported insulin sensitizing effect of CTRP3, it is possible that the elevated levels of CTRP3 in the BM of obese mothers may offset negative effects of elevated leptin and insulin levels in the BM of obese mothers. Future studies will need to be conducted to determine the relevance of CTRP3 in BM and to examine the presence of other adipose tissue-derived hormonal factors.