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Inflammation status has been associated with chronic diseases such as Type 2 Diabetes, cardiovascular disease and cancer. Previous studies suggested that healthful dietary patterns and dietary scores may have been associated with reduced concentrations of inflammatory biomarkers. However, studies have been usually conducted among middle- aged and older adults by examining commonly used biomarkers such as C-Reactive Protein (CRP) and Interleukin 6 (IL-6). For the current study, diet quality was measured by applying food frequency data to create the 2010 Dietary Guidelines for Americans Adherence Index (DGAI-2010). Concentrations of inflammatory biomarkers were obtained from fasting blood samples collected at the late-luteal phase of paticipants’ menstrual cycle. We used linear regression to analyze the association between each natural log-transformed inflammatory biomarker concentration and the continuous DGAI-2010 Score among 142 young, healthy women (aged 18-30 years) from the UMass Vitamin D Status Study. We found that as diet quality increased, concentrations of IL-7, IL-12p70, IL-13 and IFN- were significantly lower after adjustment for BMI, age, physical activity, smoking, race/ethnicity, multivitamin use, oral contraceptive use, and total energy intake per day. Following a diet that adheres to the Dietary Guidelines for Americans as a measure of dietary quality is associated with lower inflammation in healthy, normal weight and overweight young women.

Cambodian immigrants have become a large population group in the United States since late 1970s. Traditional heath practices and alcohol consumption during pregnancy and lactation have both been associated with risks of maternal and child health in previous research. However, these associations have never been investigated in the Cambodian immigrant population. The mechanism for the potential interaction is that the traditional health practice, the use of sraa t’nam, which is an alcohol concoction usually consumed during postpartum period, may increase risks for both mothers and children. Sraa t’nam is the traditional alcohol and drinking alcohol during pregnancy and while lactation is not recommended. This study examined the knowledge, attitudes and behaviors of traditional health practices among Cambodian women aged between 15-35 years old living in Massachusetts. Health insurance, acculturation and food security scores were not independently associated with the dependent variable. The odds of ‘ever used sraa t’nam’ were higher (OR 1.67, CI 1.10, 2.51, p<0.05) with every one unit or one person increase in household size, after adjusting for covariates. Similarly, women with at least one child had a 4.54 odds (CI 1.24, 16.5) of reporting that they 'ever used psraa t’nam’ compared to women with no children (p<0.05) U.S.-born women (OR 0.12, CI 0.02, 0.83, p<0.05) and those with more than a high school education (OR 0.13, CI 0.02, 0.71, p<0.05) had lower odds of having 'ever used (psraa t’nam’. Age was independently associated with having ‘ever used sraa t’nam’ (OR 1.32, CI 1.01, 1.74, p<0.05); for every year older, the odds of ever using sraa t’nam increased by 0.32 units. In summary, women who lived in larger households, had at least one child, were foreign-born, had less education, or were older in age had higher odds of reporting that they had ‘ever used sraa t’nam’. Univariate analyses tested for associations between intention to breastfeed, age, smoking status, and intention to use sraa t’nam. Age was positively associated with the intention to breastfeed (OR=1.26, p<0.05), and smoking was also positively associated with the intention to breastfeed (OR=4.81, p<0.05).

Food insecurity has long been a global challenge associated with negative health outcomes. The spectrum of food insecurity corresponds to a spectrum of negative health outcomes that range from kwashiorkor and marasmus to obesity and chronic disease. The burden of food insecurity is a stressor that additionally negatively effects mental health. In this study, the relationship between food insecurity and mental health was examined using data from the National Health and Nutrition Examination Survey (NHANES). Food insecurity was assessed with the 18-item United States Food Security Survey Module, and participants were classified into one of four categories based on their responses: (1) full food security (FFS), for households with no concerns related to obtaining adequate food, (2) marginal food security (MFS), for households that occasionally had problems obtaining adequate food, (3) low food security (LFS), for households that had to reduce the quality, variety, or desirability of the food they ate, and (4) very low food security (VLFS), for households where at least one member had their food intake reduced due to a lack of money for food. Food insecurity survey scores were classified as FFS if zero affirmative responses were reported, MFS for 1 or 2 affirmative responses, LFS for 3 to 5 affirmative responses, and VLFS for 6 to 10 affirmative responses. Depression was assessed with the Patient Health Questionnaire-9 with scores ≥ 10 indicating depression. Data were analyzed from 28,448 adults aged 20 and older who participated in NHANES from 2005 to 2016. Food insecurity was present in 19.2% of the sample population (n=5,452). Food security status was significantly associated with gender, race, education level, marital status, smoking status, and BMI (Rao-Scott chi-square, p < 0.05). Adults with FFS and VLFS experienced depression at rates of 5.1% and 25.8%, respectively. Participants with VLFS had a significantly greater odds of depression than FFS adults, OR=3.50 (95% CI: 2.98, 4.12). These findings suggest that food insecurity is a significant risk factor for depression among US adults. To address this issue in our citizenry, policy initiatives and public health interventions addressing both food access and mental health should be prioritized.

In this thesis the utility of a bivariate gamma distribution is explored. In the field of nutritional epidemiology a nutrition density transformation is used to reduce collinearity. This phenomenon will be shown to result due to the independent variables following a bivariate gamma model. In the field of radiation oncology paired comparison of variances is often performed. The bivariate gamma model is also appropriate for fitting correlated variances. A method for simulating bivariate gamma random variables is presented. This method is used to generate data from several bivariate gamma models and the asymptotic properties of a test statistic, suggested for the radiation oncology application, is studied.

The school food environment has the ability to increase the consumption of fruit and vegetables in rural adolescents. This study used a survey to allow adolescents in seven rural counties to self-report their fruit and vegetable intake as well as utilizing the USDA Mathematica tool and the School Nutrition and Meal Cost Study audits to evaluate what food and beverage products were actually available to adolescents. By using these two measures, associations between fruit and vegetable intake and availability of healthy and unhealthy foods were determined. The availability of healthy snacks and beverages was found to be associated with sugar-sweetened beverage intake in adolescents (p < 0.001); the availability of unhealthy snacks and beverages was associated with fruit and vegetable intake in adolescents (p < 0.001); the school marketing of water bottle stations and/or water dispenser availability was associated with sugar- sweetened beverage intake in adolescents (p < 0.001). Increasing the availability and school marketing of healthy foods and beverages in rural schools may be an effective way to improve fruit and vegetable consumption in adolescents.

Over the past four decades, obesity in the United States has risen to record levels. Co-morbid conditions such as heart disease, diabetes, and stroke will impose over twenty trillion dollars of economic burden over the next two decades. More than half that sum will be direct medical expenses. Under current entitlement programs, governments, and ultimately taxpayers, will be responsible for about 43 percent of that. Even with all this spending, millions of lives will be cut short. Dietary factors are largely to blame. This thesis explores how policy interventions to encourage healthy diet and discourage healthy diet can be projected to affect future healthcare spending. It assesses six dietary factors to determine whether there is sufficient research to determine how much economic disease burden they will impose. Among those for which such research exists, the thesis estimates the cost-effectiveness of interventions such as education, subsidies, taxes and legislative bans.

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-11-01T19:38:08Z No. of bitstreams: 1 camilaferreiracarrara.pdf: 3006536 bytes, checksum: 43c2b4a1a61cfde603de87b649a3f7ab (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-11-23T11:37:20Z (GMT) No. of bitstreams: 1 camilaferreiracarrara.pdf: 3006536 bytes, checksum: 43c2b4a1a61cfde603de87b649a3f7ab (MD5) / Made available in DSpace on 2018-11-23T11:37:20Z (GMT). No. of bitstreams: 1 camilaferreiracarrara.pdf: 3006536 bytes, checksum: 43c2b4a1a61cfde603de87b649a3f7ab (MD5) Previous issue date: 2018-08-29 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Uma das causas centrais da epidemia de obesidade e de doenças crônicas não transmissíveis (DCNT) é a substituição de alimentos in natura e minimamente processados por alimentos ultraprocessados de alta densidade energética e baixa qualidade nutricional. A tendência generalizada de aumento do consumo destes alimentos justifica a necessidade de estudar os fatores associados à sua aquisição. O objetivo do estudo foi avaliar os perfis de aquisição de alimentos e os fatores associados em famílias com adolescentes de Juiz de Fora, Minas Gerais. Trata-se de um estudo epidemiológico, de delineamento transversal, realizado nos anos de 2016 e 2017 com 660 adolescentes entre 10 e 16 anos de idade de ambos os sexos e seus responsáveis, matriculados no Ensino Fundamental de escolas públicas e privadas da região central da cidade. Foram coletados dados antropométricos, socioeconômicos e relativos à hábitos relacionados às refeições através de questionários. Para a coleta dos dados de aquisição de alimentos, foi montado um grande estande contendo alimentos cenográficos, expostos em gôndolas, sacos e prateleiras. Os adolescentes foram orientados a comprar os itens geralmente consumidos pela família. Estes itens foram contabilizados de acordo com o grau de processamento em in natura ou minimamente processados, processados e ultraprocessados. A partir desses dados, através da análise de cluster, as famílias foram agrupadas de acordo com características comuns de aquisição de alimentos e gerou-se quatro perfis, nomeados de “saudável”, “restrito”, “excesso” e “junk food”. Avaliou-se a associação entre esses perfis e outros dados coletados através do teste qui quadrado. Os resultados evidenciaram associação entre o perfil de aquisição “junk food” e famílias de adolescentes frequentadores da rede pública de ensino. Evidencia-se também a prevalência alarmante de famílias que encontram-se no perfil “junk food”. Faz-se necessário aprofundar as investigações relacionadas aos perfis de aquisição de alimentos, a fim de classificar os domicílios quanto à presença de fatores de risco e de proteção à saúde relacionados com a disponibilidade de alimentos ultraprocessados. / One of the central causes of the obesity epidemic and noncommunicable chronic diseases is the replacement of fresh and minimally processed foods with ultraprocessed foods of high energy density and low nutritional quality. The general tendency of increased consumption of these foods justifies the need to study the factors associated with their acquisition. The objective of the study was to group the sample into profiles according to the acquisition of in natura, processed and ultraprocessed foods and to investigate the association between these profiles and the anthropometric, socioeconomic and diet related habits of families with adolescents from Juiz de Fora. This is a cross-sectional epidemiological study conducted in 2016 and 2017 with 660 adolescents between 10 and 16 years of age, both male and female, enrolled in primary and secondary education in public and private institutions. Anthropometric, socioeconomic and diet related habits were collected through questionnaires. For the collection of food acquisition data, a large booth containing scenic food was set up, displayed on gondolas, bags and shelves. The adolescents were instructed to buy the items usually consumed by the family. These items were accounted for according to the degree of processing in fresh, processed and ultraprocessed foods. From these data, through cluster analysis, families were grouped according to common food acquisition characteristics and generated four profiles, named "healthy", "restricted", "excess" and "junk food". The association between these profiles and other data collected was evaluated through chi-square test. Results evidenced combined between the acquisition profile of junk food and the families of adolescents attending the public school system. It is also evidenced the alarmed of families that are in the profile "junk food". It is necessary to deepen the investigations related to the profiles of food acquisition in order to classify the households regarding the presence of risk factors and health protection related to the availability of ultraprocessed foods.

RED-S is a syndrome that stems from low energy availability (LEA) in athletes. It can impact numerous physiological and psychological functions, as well as negatively affect performance. Because RED-S is a relatively new syndrome, there are few studies showing the impact of RED-S on performance and physiological factors. The aim of this systematic review was to examine the consequences of induced LEA in relation to RED-S in male athletes. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Five studies were deemed eligible based on inclusion and exclusion criteria. Studies measured risk of RED-S through body composition, bone mineral density, clinical biomarkers, and performance. Studies ranged in duration from 2- 8 weeks with a decrease in energy availability of 50% or 25%. Of the five studies investigated, data showed significant changes lactate metabolism and IGF-1,non-significant changes in body composition, and inconclusive changes in performance.

<p>Diet and physical activity (PA) are independent risk factors for obesity and chronic diseases including type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). The temporal sequence of these exposures could be used to create patterns with potential links to health status indicators.</p> <p>The objectives were (1) to create clusters of joint temporal dietary and PA patterns (TDPAPs) and to determine their association with health status indicators including body mass index (BMI), waist circumference (WC), fasting plasma glucose, glycated hemoglobin, triglycerides, high density lipoprotein cholesterol, total cholesterol, blood pressure, and disease status including obesity, T2DM, and MetS; (2) compare the number and strength of association between clusters of daily temporal dietary patterns (TDPs), temporal PA patterns (TPAPs), and TDPAPs and health status indicators above; (3) determine the association between TDPs on weekday and weekend days and health indicators (diet quality, waist circumference, BMI, and obesity) and their overlap of membership; (4) assess concurrent validity of energy and time cut-offs describing the data-driven TDPs by determining their relationships to BMI and WC.</p> <p>A 24-h dietary recall and random day of accelerometer data of U.S. adults aged 20-65 years from the cross-sectional National Health and Nutrition Examination Survey 2003-2018 data were used to create data-driven TDPAP, TDP, TPAP clusters by constrained or modified dynamic time warping, coupled with a kernel k-means clustering algorithm. Multivariate regression models determined associations between the temporal pattern clusters and health status indicators, controlling for potential confounders and adjusting for multiple comparisons. The number of significant differences among clusters and adjusted R2/the Akaike information criterion compared the strength of associations between clusters of patterns and continuous/categorical health status indicators. The percentages of overlap in cluster membership between temporal patterns were also calculated.</p> <p>A TDPAP/TDP cluster with proportionally equivalent energy consumed at evenly spaced eating occasions, or a TDPAP/TPAP cluster with the highest PA counts among 4 clusters, </p> <p>was associated with significantly better health indicators including lower BMI, WC, and</p> <p>odds of obesity than other temporal lifestyle pattern clusters. TDPAPs and TDPs had stronger and more numerous associations with health indicators compared with TPAPs. Both a weekday and weekend day TDP of proportionally equivalent energy consumed throughout the day were significantly associated with better health indicators compared with the other TDP clusters but the TDPs of most adults were not consistent on weekdays and weekend days. The data-driven TDP was validated using descriptive cut-off generated TDP and holds promise for obesity interventions and translation to dietary guidance. </p> <p>Temporal lifestyle patterns are significantly associated with health indicators, providing evidence that incorporating time with lifestyle style behaviors comprehensively may provide insight into health. Further evaluation of temporal patterns linked to health holds potential for application to interventions to prevent chronic disease.</p>