There is no abstract available for this thesis. / Department of Family and Consumer Sciences

Patients with non-insulin-dependent diabetes mellitus (NIDDM) usually exhibit a marked disturbance of lipid metabolism which is reflected in high levels of plasma total cholesterol, low-density lipoproteins (LDL), and triglycerides, along with low levels of high-density lipoproteins (HDL). Elevated triglycerides are the major contributor to diabetic hyperlipidemia. These plasma lipid concentrations and the fatty acid composition of these lipids are clearly influenced by the type of diet consumed along with the proportion of dietary fatty acids. Therefore, it was the purpose of this investigation to examine the relationships between glycemic control, serum lipid levels of total cholesterol, HDL, LDL and triglycerides to the amounts and types of fats in the typical diets of NIDDM patients as compared to non-diabetic individuals. The dietary fats were also compared with the distribution of fatty acids found in their total lipids and free (in vivo) fatty acids. The relationship between dietary fat intake and serum total lipid levels along with total and free fatty acid distributions was the primary focus.This investigation found that NIDDM subjects have significantly greater triglyceride levels (200 ± 18.4 mg/dL) than non-diabetic controls (93 ± 13.2 mg/dL). Total and LDL cholesterol levels of the NIDDM group were elevated from the control group while HDL levels were depressed, but these differences were of nonsignificant proportions. The NIDDM group typically consumed significantly lowered amounts of teal, saturated, and monounsaturated dietary fatty acids (46.7 ± 7.1 grams, 114.0 ± 2.9 grams, and 16.8 ± 2.5 grams, respectively) compared to the control group (80.0 ± 10.9 grams, 26.7 ± 4.5 grams, and 30.2 ± 4.5 grams, respectively). Even so, the percentage of kilocalories from total fat in the NIDDM vs. the control group diets was not statistically different which may explain the lack of significance between groups with regard to distribution of serum fatty acids. On an individual basis, the types of fat that predominated in the diet were also found in a large percentage in the serum lipid distributions. Positive correlations between saturated fat intake and the blood serum stearic free fatty acid along with polyunsaturated fat intake and linoleic free fatty acid supported this observation. Other investigators (6,62) have reported that dietary intake does indeed contribute to the percentage of fatty acids distributed in the plasma lipids. To determine if a particular dietary fatty acid contributes more significantly to hyperlipidemia, the diet needs to be controlled.On an individualized basis, it was also noted that the diabetics with the lowest amount and percentage of fat in their diets, also had the lowest serum lipid levels. Besides diet, other influential factors which may have contributed to the lipid levels of these NIDDM patients are genetic predisposition, environmental influences, and the stage and progression of each individual's disease. Thus, due to the underlying metabolic impairments which are exacerbated by genetic and/or environmental influences, it is of vital importance to recognize how essential diet manipulation is with regards to lipid control in the treatment of NIDDM patients. / Department of Biology

We have studied the effect of S-adenosylmethionine (SAM) on tail flick latency in the rat. We also studied the effect of methionine the immediate precursor of SAM. Administration of methionine to the rat increases brain SAM, but little is known about its behavioral effects. Long-Evans rats were given SAM and methionine orally at different doses and tail-flick latency was measured at various times. Both methionine and SAM increased tail-flick latency, but methionine did so at a lower dose. A biochemical study showed that methionine was more effective than SAM in raising brain SAM probably because it is transported better into brain. The biochemical measurements were not consistent with the idea that the effects of SAM and methionine were mediated by an increase in brain 5-HT. / Folate deficiency can lower brain SAM levels and cause depression. Thus, methionine, which raises brain SAM, may overcome the effects of folate deficiency. Seven day food records were done by 26 psychiatric outpatients who were stable on lithium treatment. Eight patients had mean daily folate intakes below those recommended. Some of those with low folate intake had high methionine intake consistent with the idea that methionine could substitute metabolically for folate deficiency. Daily methionine intakes ranged from 13 to 304% of the recommended intake. As methionine had behavioral effects in the rat at doses much less than the daily dietary intake this raises the question of whether varying daily intakes of methionine in humans have behavioral implications. (Abstract shortened by UMI.)

The present project investigated the effect of epidural blockade with local anesthetic on the catabolic stress response during and immediately after abdominal surgery in fasting patients and during infusion of glucose at 2 mg·kg-1·min-1. The kinetics of glucose and protein metabolism were assessed by the stable isotope tracers [6,6-2H2]glucose and L-[1-13C]-leucine. / Epidural blockade was associated with a lower plasma glucose concentration and glucose production when compared to control subjects in the fasted state. Whole body protein breakdown, amino acid oxidation and protein synthesis were suppressed during surgery, and epidural blockade had no modifying effect on perioperative protein metabolism. The suppression of endogenous glucose production by exogenous glucose was more pronounced in the presence of epidural blockade. Perioperative protein metabolism, however, was not influenced by epidural blockade during glucose infusion. / Although epidural blockade suppressed glucose metabolism both in the fasted state and during glucose administration, it failed to exert a modifying effect on perioperative protein metabolism.

We questioned whether improved glycemic control achieved by oral agent (gliclazide) would correct the altered protein metabolism during an iso-energetic (ISO) and a low energetic (50% of ISO) diets. Seven diabetic (DM) and 7 matched obese control (OB) subjects were give ISO for 14 (DM) or 7 (OB) days, followed by 28 days of the low energetic diet with constant 1.5 g protein/kg BMI$ sb{25}$/d. Giclazide (+ metformin in 4 DM) was given during days 8-14 of ISO and the low energety diet to DM. With ISO and gliclazide, fasting plasma glucose decreased and plasma insulin and nitrogen retention increased while 3-methylhistidine excretion and resting metablic rate decreased to levels no longer different from OB. With moderate energy restriction, weight decreased in all subjects and glycemia normalized in DM. Nitrogen equilibrium was maintained and 3-methylhistidine excretion did not change. The altered protein metabolism observed during hyperglycemia can be improved with oral hypoglycemic agent therapy $ pm$ the low energy diet. Moderate energy restriction with oral hypoglycemic agent therapy achieves diabetes control, nitrogen equilibrium, and a modest decrease in resting metabolic rate.

Interactions among zinc deficiency, energy restriction, immunity and Heligmosomoides polygyrus (Nematoda) infection in mice were investigated. Mice were fed zinc-sufficient (Zn+: 60mg zinc/kg diet), zinc-deficient (Zn$-$: 0.75 mg/kg) or pair-fed (PF) diets. Liver and serum zinc concentrations were reduced in Zn$-$ mice, but zinc content of worms was unaffected by host diet. Both zinc deficiency and energy restriction accelerated worm maturation during a primary infection, but zinc deficiency caused stunting of female worms. Energy restriction led to a anteriorad distribution of worms along the intestine whereas zinc deficiency led to a posteriorad distribution. Enhanced parasite survival in Zn$-$ and PF mice was associated with a decreased immune response in both primary and challenge infections. In the primary infection, spleen cell production of interleukin-4 (IL-4) and interferon-gamma (IFN-$ gamma$), peripheral eosinophilia and serum levels of IgE and IgG1 were reduced by zinc deficiency, whereas the reduced delayed type hypersensitivity (DTH) response and impaired interleukin-5 (IL-5) production were attributed to energy restriction. In the challenge infection, reduced antibody levels (total IgE and IgG1, parasite-specific IgG1 and IgG3) and eosinophilia were attributed to zinc deficiency whereas the higher worm numbers were attributed to a combined effect of zinc deficiency and energy restriction. Although the absolute number of spleen cells was reduced in both Zn$-$ and PF mice, neither deficiency altered the proportion of the cell subpopulations. In vitro functional assays in response to parasite antigen (Ag) revealed that T cell proliferation was reduced by a direct effect of zinc deficiency on T cells, and by the effects of energy restriction on antigen presenting cells (APC). Impaired cytokine production in Zn$-$ mice was more complex. Zinc deficiency reduced T cell function (IL-4 production), energy restriction decreased T cell (IFN-$ gamma$ productio

Dietary intake data of 15 treated patients with phenylketonuria (PKU) (7-17 years) and six control siblings (6-14 years) were used to evaluate the effectiveness of medical foods to balance energy, protein, vitamin B-6, and individual amino acids from natural foods and to evaluate vitamin B-6 status. Four-day diet records were computer-analyzed and the contribution of medical foods and natural foods to the total diets of the patients was determined. A fasting blood sample and two 24-hour urine collections were obtained from each subject. In eight patients consuming a strict diet, natural foods provided 0.9 g protein and 39 mg phenylalanine (phe)/100 calories, a significant reduction from control intakes of 3.3 g protein and 153 mg phe/100 calories. However, plasma phe levels were above the acceptable treatment range. Medical foods were consumed in less than the recommended quantities to meet approximately 120% of the Recommended Dietary Allowances (RDAs) for protein. These foods contributed 73% of the total protein RDAs but only met 22% of the energy RDAs of patients consuming the strict diet. Taste qualities of certain L-amino acids (L-AAs; Lmethionine, L-glutamic and L-aspartic acids), which constitute the protein in elemental medical foods (EMFs) for school-aged patients, make acceptance of these products difficult. Intakes of each of these L-AAs were above nutritional standards and suggested that their levels could be safely lowered in EMFs. Natural foods and medical foods provided 0.057 and 0.046 mg vitamin B-6/g protein, respectively, above the 0.020 RDA standard and the mean control intake of 0.018 mg vitamin B-6/g protein. The mean plasma pyridoxal 5'- phosphate (PLP) concentration for the patients with PKU was over twice that of the mean control concentration and above literature values. However, more than half of the patients excreted less than 30% of their vitamin B-6 as 4-pyridoxic acid; values below the criterion suggested for inadequate status. This work provides data for a better understanding of vitamin B-6 metabolism and status in PKU and supports the design and testing of a new EMF to balance energy, protein, and amino acids from natural foods and which may improve dietary adherence. / Graduation date: 1991

Bibliography: leaves 194-219 / xxi, 219 leaves, [2] leaves of plates : ill. (some col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Animal Sciences, 1986

Thesis (MNutr)--Stellenbosch University, 2011 / ENGLISH ABSTRACT: Introduction Rheumatoid Arthritis (RA) is a chronic, inflammatory, autoimmune disorder characterized by inflammation of the joints and surrounding tissue causing pain, swelling and stiffness. Studies suggest that aspects of the diet may alleviate symptoms and decrease the risk of complications. The scientific basis for a role of dietary therapy in RA has grown although there is still no consensus on the optimum diet. It has been shown that persons with RA tend to have a poor nutritional status; and rheumatoid cachexia, the loss of body cell mass, occurs in nearly two-thirds of all patients with RA. The study aimed to establish what RA patients are practicing and their perceptions regarding the effect of diet, nutritional supplements, medication and complementary and alternative medicines (CAM) and therapies on their symptoms as well as determining their body composition and the possible presence of rheumatoid cachexia. Methodology The study design was a cross-sectional study with an analytical component. The study population consisted of adult (18 years or older) RA patients in the Cape Metropole from the private and public sector. An interviewer-administered questionnaire was used followed by the measurement of weight, height, waist circumference and skinfold thickness. Information was also gathered from the medical records. Results The sample size comprised of 251 RA patients (n=201 public sector; n=50 private sector). The mean body mass index (BMI) was 30.3 kg/m2 for females and 26.6 kg/m2 for males. BMI was used to classify obesity (n=133; 45.9%), overweight (n=66; 26.8%), normal weight (n=63; 25.6%) and underweight (n=4; 1.6%). Waist circumference measurement classifications showed a substantially increased risk for metabolic complications in 51.8% of participants (n=127) and an increased risk in 21.2% of participants (n=52). Just over half of the participants (n=65; 55.6%) had an unhealthy high body fat percentage classification. Rheumatoid cachexia was seen in 10.3% participants (n=12). Low fat-free mass (Fat-free mass index <10th percentile) was seen in 21% participants (n=24) and obesity (Fat mass index >90th percentile) was seen in 27% of participants (n=31). Twenty nine percent of participants (n=73) believed that certain types of food could improve their symptoms of RA and 60% of participants (n=151) believed that certain foods worsened their symptoms. Sixty four percent of participants (n=161) thought that nutritional supplements or complementary and alternative medicines and therapies could improve their symptoms of RA and 98% (n=246) of participants used nutritional supplements. The most frequently used supplements included folic acid (n=218; 91.6%), calcium (n=182; 76.5%), vitamin D (n=185; 77.7%), omega-3 fatty acids (n=48; 64.9%) and multivitamin and mineral preparations (n=22; 29.7%). Conclusion The obesity and waist circumference figures were unacceptably elevated in this population and the body composition of these RA patients should be highlighted as a concern. The high prevalence of risk factors for cardiovascular disease (CVD) need to be urgently addressed since CVD is the leading cause of mortality in RA patients. This study highlights the important role of the intra-professional team, including the dietitian, in the management of RA patients. / AFRIKAANSE OPSOMMING: Inleiding Rumatoïede artritis (RA) is 'n chroniese, inflammatoriese, outo-immuun siekte wat gekenmerk word deur inflammasie van die gewrigte en omliggende weefsel en veroorsaak pyn, swelling en styfheid. Studies dui daarop dat aspekte van die dieet simptome kan verlig en die risiko van komplikasies kan verminder. Die wetenskaplike basis vir die rol van dieetterapie in RA het gegroei, hoewel daar nog geen konsensus aangaande die optimale dieet is nie. Dit is al bewys dat persone met RA geneig is om 'n swak voedingstatus te hê; en rumatoïede cachexia, die verlies van liggaam selmassa in byna twee-derdes van alle pasiënte met RA voorkom. Die doel van die studie was om te bepaal wat RA-pasiënte se praktyke en persepsies ten opsigte van die uitwerking van dieet, voedselaanvullings, medikasie en aanvullende of alternatiewe medisyne (CAM) en terapieë op hul simptome het, sowel as om hul liggaamsamestelling en die moontlike teenwoordigheid van rumatoïede cachexia te bepaal. Metodiek Die studie ontwerp was 'n dwarssnitstudie met 'n analitiese komponent. Die studiepopulasie het bestaan uit volwassene (18 jaar of ouer) RA pasiënte uit die privaat en openbare sektore in die Kaapse Metropool. Onderhoude was gevoer met behulp van vraelyste. Gewig, lengte, middelomtrek en velvoudikte was ook gemeet. Inligting was ook versamel uit mediese rekords. Resultate Die steekproefgrootte het uit 251 RA pasiënte (n=201 openbare sektor, n=50 privaat sektor) bestaan. Die gemiddelde liggaamsmassa-indeks (LMI) was 30.3 kg/m2 vir vroue en 26.6 kg/m2 vir mans. LMI was gebruik om vetsug te klassifiseer (n=133; 45.9%), asook oorgewig (n=66; 26.8%), normale gewig (n=63; 25.6%) en ondergewig (n=4; 1.6%). Klassifikasie van middelomtrek metings het 'n aansienlike verhoogde risiko vir metaboliese komplikasies in 51.8% van die deelnemers (n=127) en 'n verhoogde risiko in 21.2% van die deelnemers (n=52) getoon. Net meer as die helfte van die deelnemers (n=65; 55.6%) het 'n ongesonde hoë liggaamsvet persentasie klassifikasie getoon. Rumatoïede cachexia was by 10.3% van die deelnemers (n=12) gevind. Lae vetvrye massa (vetvrye massa indeks <10de persentiel) was by 21% deelnemers (n=24) en vetsug (vet massa indeks >90ste persentiel) in 27% van die deelnemers (n=31) teenwoordig. Nege-entwintig persent van die deelnemers (n=73) het geglo dat sekere voedselsoorte hul simptome van RA kon verbeter en 60% van die deelnemers (n=151) was van mening dat sekere kosse die simptome kon vererger. Vier-en-sestig persent van die deelnemers (n=161) het gedink dat voedingsaanvullings of aanvullende en alternatiewe medisyne en terapieë hulle simptome van RA kon verbeter en 98% (n=246) van die deelnemers het voedingsaanvullings gebruik. Die mees algemene gebruikte aanvullings was foliensuur (n=218; 91.6%), kalsium (n=182; 76.5%), vitamien D (n=185; 77.7%), omega-3 vetsure (n=48, 64,9%) en multi-vitamien en mineraal preparate (n=22; 29.7%). Gevolgtrekking Die vetsug en middelomtrek syfers was onaanvaarbaar verhoog in die studiepopulasie en die liggaamsamestelling van hierdie RA pasiënte is 'n bekommernis. Die hoë voorkoms van risikofaktore vir kardiovaskulêre siekte (KVS) moet dringend aangespreek word, aangesien die KVS die grootste oorsaak van sterfte in RA pasiënte is. Hierdie studie beklemtoon die belangrike rol van die intra-professionele span, met inbegrip van die dieetkundige, in die bestuur van RA pasiënte.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: Postmenopausal osteoporosis is associated with significant morbidity, mortality, reduction in quality of life, and increasing health care costs OBJECTIVE: The study objective was to identify the risk factors associated with the occurrence of osteoporosis, in Kenyan Asian women seen at the Aga Khan University Hospital, Nairobi, Kenya since there is no literature on the prevalence of all these risk factors for osteoporosis in a similar middle aged population sample of Kenyan Asian women. METHOD: The study was of a retrospective design and used recall as a basis of data collection. A socio-demographic questionnaire was completed and anthropometric measurements, of height, weight, waist and hip circumference taken. Bone mineral density (BMD) had been measured previously using Quantitative Computed Tomography (QCT) at the lumbar spine, T11 to L4. Nutrient intake was assessed using a validated food frequency questionnaire (FFQ) and physical activity was determined using the Epic Physical Activity Questionnaire 2 (EPAQ2). BMD scans had been done on all study participants from January 2004 to December 2004 and the subjects were aware of their bone status. RESULTS: Risk factors that were identified by being associated with the development of osteoporosis in Asian women were age (p<0.001), waist size (p<0.001), hip size (p<0.001) and BMI (p<0.001), low physical activity (p=0.001) and use of prescription drugs. Seventy two percent of the study sample was using prescription drugs and the effect on bone mass was most likely detrimental. Anti-hypertensive (p=0.002), non steroidal anti inflammatory drugs (p=0.003) and anti-diabetic drugs (p=0.033) had a significant negative association with bone health. Energy, protein, fat and carbohydrate intake in all the groups was above the EAR and comparatively similar. The intake of all the micronutrients in the study group was above the DRI. There were no statistical significant differences in most of the trace element intake between the two groups, apart from iodine, biotin and manganese. No dietary risk factors were identified which impacted adversely on bone health in this group. The impact of gynaecologic history (parity, oral contraceptive use, age of menarche) on BMD was uncertain. The educational level of the study sample was high as 50% of the subjects were graduates and had a relatively better diet. CONCLUSION: As Kenyan Asian women age they experience the menopausal transition and the risk of developing osteoporosis increases. No nutritional factors were identified that were adversely associated with BMD. Low level of physical activity, prescription drugs for chronic diseases like hypertension, asthma, diabetes and arthritis, age, weight and body mass index were identified and found to be adversely associated with bone mineral density. Early detection, and implementation of patient education, physical activity, and a diet rich in all nutrients, will help to slow down the progression of osteoporosis.