The Bolsa Atleta program is the biggest athletes sponsorship program, however no study evaluated the dietary intake these athletes. This study was divided into two stages. The first aimed to compare the eating habits and the dietary intake of male and female athletes, while the second evaluated the effect of a nutrition intervention on body composition, nutritional intake, nutrition knowledge and dietary habits of athletes. Eighty athletes participated in the first stage of the study, being 47 male and 33 female. A 24-hour recall was applied to evaluate athletes dietary intake. Both groups showed a high inadequacy in caloric intake. Men were more inadequate in protein and saturated fat intake, while women showed a higher percentage of inadequacy in monounsaturated fat. Both groups showed a high inadequacy in vitamin A, E, D and calcium intake. Men were more inadequate in vitamin C and sodium, while women had a higher inadequacy in vitamin B12, B3, magnesium, folate, phosphorus, and five times more probability of inadequate iron intake. Women had a more inadequate intake of fruit, meat, and Low adequacy of pre and post workout meals. Athletes of both sexes present inadequacies on dietary intake, however, these were higher among women.In the second stage of the study, 32 athletes, 21 adults and 11 adolescents received nutritional counseling and were analyzed separately. After follow-up, both groups had increased body mass and lean mass and adolescents increased arm muscle area. There was an increase in the number of meals and reduction in the range and the omission of the them in adolescents. Both groups increased the adequacy of pre and post workout meals and nutrition knowledge. Teenagers increased their water intake after the intervention. Both groups showed a high prevalence of positive effects on energy intake, nutrients and food portions. The nutritional counselling has been effective in promoting beneficial changes on the athlete´s nutritional knowledge, their body composition, and their dietary intake, however, the overall effect was greater in the adolescents than in the adults. / O programa bolsa atleta é o maior programa de patrocínio de atletas do mundo, no entanto nenhum trabalho avaliou a alimentação desses atletas.O presente trabalho foi dividido em duas etapas. A primeira teve o objetivo de comparar os hábitos alimentares e o perfil nutricional entre atletas do sexo masculino e feminino, enquanto a segunda avaliou o efeito de uma intervenção nutricional sobre a composição corporal, a ingestão dietética e o conhecimento em nutrição dos atletas. Oitenta atletas participaram da primeira etapa do trabalho, sendo 47 homens e 33 mulheres. Para avaliação da alimentação foi aplicado um recordatório de 24 horas. As atletas do sexo feminino estavam mais inadequadas quanto à ingestão hídrica no treino e refeições pré e pós-treino. Ambos os grupos apresentaram uma elevada prevalência de inadequações nos grupos de hortaliças, leite e derivados, açúcares e doces e óleos e gorduras, no entanto, as mulheres estavam mais inadequadas quanto à ingestão de frutas e carnes e ovos. Os homens apresentaram maior ingestão nutricional e alimentar do que as mulheres. Ambos os grupos apresentaram uma elevada inadequação em micronutrientes, estando as mulheres mais inadequadas em vitaminas do complexo B e ferro. Os atletas de ambos os gêneros apresentaram inadequações nutricionais, no entanto, essas foram maiores entre as mulheres. Na segunda etapa do estudo, 32 atletas, sendo 21 adultos e 11 adolescentes receberam acompanhamento nutricional e foram analisados separadamente. Após o acompanhamento, ambos os grupos tiveram aumento da massa corporal e da massa magra e os adolescentes aumentaram a área muscular do braço. Foi observado um aumento do número de refeições e redução no intervalo e na omissão das mesmas nos adolescentes. Os adolescentes aumentaram a ingestão hídrica diária e no treino após a intervenção. Ambos os grupos apresentaram uma elevada prevalência de efeitos positivos na ingestão de energia, nutrientes e porções alimentares, além de terem aumentado o nível de conhecimento em nutrição. O acompanhamento nutricional proporcionou uma melhora na alimentação, na composição corporal e no nível de conhecimento em nutrição dos atletas, no entanto, esses efeitos foram maiores nos adolescentes.

Deux approches ont été mises au point et utilisées afin de mieux comprendre les facteurs nutritionnels, physiopathologiques et génétiques intervenant dans la grande variabilité d'absorption du cholestérol chez l'homme (30-80%) :- le dosage de marqueurs plasmatiques d'absorption et de synthèse du cholestérol (METHODE INDIRECTE), qui s'applique aux grandes cohortes.- le dosage simultané de deux isotopes stables du cholestérol utilisés comme traceurs (METHODE DIRECTE), qui est la méthode de référence pour déterminer le taux d'absorption du cholestérol alimentaire.Nous avons déterminé, par la méthode indirecte, des interactions gène-régime-sexe, dans une population mixte présentant un risque cardiovasculaire modéré.On a montré qu'en modifiant les habitudes alimentaires, le statut d'absorption du cholestérol d'un sujet n'était pas modifié après 3 mois de régime méditerranéen, quel que soit le sexe. De plus la diminution du cholestérol circulant (LDL-C) induite par le régime de type méditerranéen était plus marquées chez les faibles absorbeurs de cholestérol. Le statut d'absorbeur est donc stable dans le temps et sous différents régimes, mais il module la réponse au régime, illustrant l'importance de ce statut dans la prise en charge nutritionnelle personnalisée des sujets. Nous avons aussi établi une interaction gène-régime sur le polymorphisme génétique du gène de la microsomal triglyceride transfer protein (-493G/T). Ce polymorphisme module le niveau d'absorption du cholestérol chez les femmes sous un régime occidental et cet effet est aboli sous un régime méditerranéen.La méthode indirecte présente cependant des limites. Aussi avons-nous mis au point une méthode de dosage directe originale, basée sur l'abondance relative des isotopomères du cholestérol, le but étant de mesurer simultanément les marqueurs directs et indirects et de comparer les deux méthodes en vue de l'application systématique de la méthode indirecte dans différentes études chez l'homme. / Two approaches were used to better understand nutritional, physio-pathological and genetic factors intervening in the great inter-individual variability of cholesterol absorption in humans (30-80%) : - INDIRECT METHOD consisting in the determination of both absorption and synthesis plasmatic markers of cholesterol, which is used in large scale studies; - a DIRECT METHOD by measuring simultaneaously two cholesterol stable isotopes, used as tracers. It is the "gold" method to determine the absorption percentage of dietary cholesterol. By using indirect method, we have shown gene-diet interactions according to sex in a population of men and women with moderate cardiovascular risks. Changing in dietary habits didn't alter cholesterol absorption statuts after 3 months of mediterranean type diet, whatever the sex. Moreover, the lowering of plasma LDL-cholesterol induced by mediterranean type diet was more marked in low-cholesterol absorbers. Thus, the cholesterol absorption status is stable over time and under differents regimes, but it modulates responsiveness to a dietary challenge. These findings illustrate the importance of cholesterol absorption status in personalized nutrition recommendations. Another finding is a gene-diet interaction in the -493G/T gene polymorphism of the microsomal triglyceride transfer protein. This polymorphism modulates the level of cholesterol absorption in women under a western diet, an effect abolished under a prudent mediterranean type diet. As indirect method shows limits, we established an original direct method, based on relative abundance of cholesterol isotopomers. Our goal is to measure simultaneously both direct and indirect plasmatic markers. Then, we could compare the two methods with the objective of applying systematically indirect method in different studies in humans.

Need of nutritional intervention in patients after stroke Summary Aims: To identify how many patients after acute stroke have accurate oral intake of energy and proteins and how is this condition changed after one month of hospitalization. To evaluate the association between dysphagia and food intake. Methods: The evaluation was conducted by observations of food intake, eaten food records, calculating of energy and nutrients intake and comparing to needed energy (by Harris-Benedicts equation) and proteins. GUSS screening tool was used to evaluation of swallowing, ADL test for self-sufficiency assessment. Data included antropometrical indicators (weight, height, arm circumference) and nutritional screenings in Thomayer hospital in Prague. Results: Of the 35 patients, 54 % had adequate oral intake of energy and 23 % adequate intake of proteins in the first week after stroke. Adequate oral intake of energy was indicated in 66 % of patients and adequate intake of proteins in 11 % after one month of hospitalization. There were no significant improvements of oral energy intake (p=0,2891, α=0,05) or protein intake (p=0,1336, α=0,05) after one month of hospitalization. 84,4 % of patients suffered from dysphagia in first week after stroke and 60,6 % after one month of hospitalization. Correlation between inadequate...

Políticas de governo, nos seus vários níveis, abordam o tema da alimentação e nutrição ressaltando sua importância para a melhora da qualidade da saúde da população. Nas últimas décadas as Doenças Crônicas Não Transmissíveis (DCNT) passaram a liderar as causas de óbito no Brasil, ultrapassando as taxas de mortalidade por doenças infecciosas e parasitárias da década de 80. As DCNTs se caracterizam por ter uma etiologia incerta, múltiplos fatores de risco, longos períodos de latência, curso prolongado, origem não infecciosa e por estar associadas a deficiências e incapacidades funcionais. A experiência de diversos países mostra que o sucesso das intervenções de saúde pública, no que se refere aos fatores de risco e à redução da prevalência das DCNTs, tem sido atribuído ao enfoque na vigilância de fatores comuns de risco e na promoção de modos de viver favoráveis à saúde e à qualidade de vida, tendo um custo menor do que as abordagens para as doenças específicas. Em 2005, o Ministério da Saúde apresentou como uma de suas prioridades, implementar políticas promotoras de modos de viver saudáveis, enfatizando as diretrizes da Estratégia Global de Alimentação Saudável, Atividade Física e Saúde (EG) proposta pela Organização Mundial da Saúde (OMS) e a prevenção do tabagismo. Essas prioridades foram abordadas na Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 que objetiva especificamente contribuir para a mudança do modelo de atenção do sistema de maneira a ampliar e qualificar as ações de promoção da saúde. O presente trabalho apresenta uma proposta de intervenção nutricional para uma amostra de funcionários não docentes da USP, que foram previamente avaliados e apresentaram alta incidência de sobrepeso e obesidade. Esse modelo baseia-se nas diretrizes propostas pela PNPS e usa a educação nutricional como principal instrumento de intervenção. / Government policies, in its levels, addressing the topic of food and nutrition emphasizing its importance to improving the quality of health. In recent decades the Chronic Noncommunicable Diseases (NCDs) are now leading causes of death in Brazil, surpassing the rates of mortality from infectious and parasitic diseases of the 80s. The NCDs are characterized by an uncertain etiology, multiple risk factors, long latency periods, a prolonged, non-infectious origin and be associated with functional impairment and disability. Experience in several countries shows that the success of public health interventions, with regard to risk factors and reduce the prevalence of NCCD, has been assigned to focus on surveillance of common risk factors and promote ways of living favorable to health and quality of life, having a lower cost than the approaches to specific diseases. In 2005, the Ministry of Health (MS) presented as one of their priorities, implementing policies that promote healthy ways of living, emphasizing the guidelines of the Global Strategy on Diet, Physical Activity and Health (GS) proposed by the World Health Organization (WHO) and smoking prevention. These priorities have been addressed in the National Policy for Health Promotion (PNPS), published in 2006 that aims specifically to bring about change in the attention system in order to widen and improve the actions of health promotion. This paper presents a proposal for nutritional intervention for a sample of non-teaching staff of the University of São Paulo (USP), which were previously evaluated and showed a high incidence of overweight and obesity. This model is based on the guidelines proposed by PNPS and use nutrition education as the main instrument of intervention.

Políticas de governo, nos seus vários níveis, abordam o tema da alimentação e nutrição ressaltando sua importância para a melhora da qualidade da saúde da população. Nas últimas décadas as Doenças Crônicas Não Transmissíveis (DCNT) passaram a liderar as causas de óbito no Brasil, ultrapassando as taxas de mortalidade por doenças infecciosas e parasitárias da década de 80. As DCNTs se caracterizam por ter uma etiologia incerta, múltiplos fatores de risco, longos períodos de latência, curso prolongado, origem não infecciosa e por estar associadas a deficiências e incapacidades funcionais. A experiência de diversos países mostra que o sucesso das intervenções de saúde pública, no que se refere aos fatores de risco e à redução da prevalência das DCNTs, tem sido atribuído ao enfoque na vigilância de fatores comuns de risco e na promoção de modos de viver favoráveis à saúde e à qualidade de vida, tendo um custo menor do que as abordagens para as doenças específicas. Em 2005, o Ministério da Saúde apresentou como uma de suas prioridades, implementar políticas promotoras de modos de viver saudáveis, enfatizando as diretrizes da Estratégia Global de Alimentação Saudável, Atividade Física e Saúde (EG) proposta pela Organização Mundial da Saúde (OMS) e a prevenção do tabagismo. Essas prioridades foram abordadas na Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 que objetiva especificamente contribuir para a mudança do modelo de atenção do sistema de maneira a ampliar e qualificar as ações de promoção da saúde. O presente trabalho apresenta uma proposta de intervenção nutricional para uma amostra de funcionários não docentes da USP, que foram previamente avaliados e apresentaram alta incidência de sobrepeso e obesidade. Esse modelo baseia-se nas diretrizes propostas pela PNPS e usa a educação nutricional como principal instrumento de intervenção. / Government policies, in its levels, addressing the topic of food and nutrition emphasizing its importance to improving the quality of health. In recent decades the Chronic Noncommunicable Diseases (NCDs) are now leading causes of death in Brazil, surpassing the rates of mortality from infectious and parasitic diseases of the 80s. The NCDs are characterized by an uncertain etiology, multiple risk factors, long latency periods, a prolonged, non-infectious origin and be associated with functional impairment and disability. Experience in several countries shows that the success of public health interventions, with regard to risk factors and reduce the prevalence of NCCD, has been assigned to focus on surveillance of common risk factors and promote ways of living favorable to health and quality of life, having a lower cost than the approaches to specific diseases. In 2005, the Ministry of Health (MS) presented as one of their priorities, implementing policies that promote healthy ways of living, emphasizing the guidelines of the Global Strategy on Diet, Physical Activity and Health (GS) proposed by the World Health Organization (WHO) and smoking prevention. These priorities have been addressed in the National Policy for Health Promotion (PNPS), published in 2006 that aims specifically to bring about change in the attention system in order to widen and improve the actions of health promotion. This paper presents a proposal for nutritional intervention for a sample of non-teaching staff of the University of São Paulo (USP), which were previously evaluated and showed a high incidence of overweight and obesity. This model is based on the guidelines proposed by PNPS and use nutrition education as the main instrument of intervention.

Si l’obésité a longtemps été considérée comme protectrice pour le squelette, sa prise en charge nutritionnelle s’accompagne d’une perte osseuse. Dans le but d’étudier les mécanismes liant le tissu adipeux et le tissu osseux, des rats ont été nourris avec un régime riche en graisse et en sucre afin d’induire une obésité et ses complications métaboliques. Puis, ces rats ont suivi un programme de prise en charge de l’obésité associant un rééquilibrage nutritionnel à de l’activité physique. Des investigations de la densité, de la micro architecture trabéculaire, de la qualité corticale, des propriétés biomécaniques et des paramètres cellulaires du tissu osseux ont été réalisées sur le squelette des rats. L’obésité induite a amélioré les paramètres densitométriques et corticaux des rats. La prise en charge de l’obésité a entraîné des effets contrastés. Le rééquilibrage de l’alimentation n’a pas altéré la densité ni les paramètres biomécaniques et corticaux du tissu osseux des rats en dépit d’altérations de la micro architecture et des perturbations l’activité cellulaire osseuse. L’exercice a augmenté la densité minérale osseuse du tibia des rats. Nos résultats montrent que l’inclusion de l’exercice dans un programme de prise en charge de l’obésité permet de potentialiser la perte de masse grasse et de maintenir l’intégrité du squelette. En étudiant l’impact d’un régime obésogène et de la prise en charge de l’obésité sur le tissu osseux chez le rat, ce travail de thèse apporte sa contribution dans la compréhension des mécanismes liant le tissu adipeux et le tissu osseux. / While obesity has long been considered protective of bone tissue, its nutritional management is linked to a concomitant bone loss. In order to access these mechanisms, male rats were given a high fat / high sucrose diet to induce obesity and its resulting metabolic disorders. Then, these rats participated in a well balanced nutritional program combined, or not, with physical activity in order to treat their obesity. Investigations on density, trabecular micro-architecture, cortical quality, biomechanical properties and cellular parameters of bone tissue were performed on rat’s skeleton. Obesity had improved the bone density and cortical parameters of rats. Obesity management had induced mixed effects. The well balanced diet did alter neither the bone density nor biomechanical and cortical parameters despite the presence of alterations in the trabecular micro architecture and some disturbances of bone cellular activity. Exercise by itself had increased the tibia bone mineral density. Our results show that including exercise in obesity management allows increasing the fat mass loss and maintaining the skeleton integrity. By studying the impact of an obesogenic diet and obesity treatment on bone tissue in rats, this study brings its contribution to the understanding of the mechanisms linking adipose tissue and bone tissue.

Grâce aux progrès médicaux, le taux de survie à 5 ans des enfants et des adolescents diagnostiqués d’un cancer est maintenant d’environ 85%. Malgré ces chiffres encourageants, à l’âge adulte, les survivants d’un cancer pédiatrique sont à risque de développer plusieurs problèmes de santé dont des maladies cardiovasculaires et des complications cardiométaboliques (CM) comme de l'hypertension, une résistance à l'insuline, de la dyslipidémie et de l'obésité abdominale. Devant cette réalité, il importe d’enrichir les connaissances quant à l’évolution et l’étiologie de ces séquelles tôt dans la trajectoire du cancer et de la survivance afin d’améliorer la prise en charge précoce des patients. Pourtant, à ce jour, seulement quelques études ont décrit la santé CM de patients à court terme après la fin des traitements et les facteurs associés au développement hâtif de ces complications demeurent méconnus. Le cancer et ses traitements causent un état pro-inflammatoire & pro-oxydant susceptible d’entraîner le développement de complications CM. En parallèle, la période de traitement est caractérisée par des changements dans les habitudes alimentaires, un comportement sédentaire et une augmentation de l’indice de masse corporelle (IMC), qui peuvent persister après la fin des traitements. À long terme chez les survivants de cancers pédiatriques, le statut d’obésité à la fin des traitements ainsi que certains biomarqueurs inflammatoires ont été associés à la présence de complications CM. De plus, la composition des HDL est différente à long terme chez les survivants de la leucémie lymphoblastique aiguë comparativement à celle de contrôles sains. Étant donné l’importance de tous ces facteurs, il est primordial de les décrire à court terme, après la fin des traitements. Par ailleurs, l’obésité au moment du diagnostic et l’augmentation de l’IMC pendant le traitement influencent négativement le pronostic et l’occurrence d’effets secondaires graves durant les traitements. Toutefois, la plupart des interventions nutritionnelles en oncologie pédiatrique ne tiennent pas en compte la problématique du gain de poids significatif durant les traitements. Ainsi, il semble important d’évaluer la possibilité d’implanter des stratégies misant sur la promotion d'habitudes de vie saines tôt après le diagnostic d’un cancer pédiatrique afin d’améliorer l'état nutritionnel, la qualité de vie et possiblement la santé CM des patients à court et à long terme. Les travaux de cette thèse ont pour but de : i) décrire la santé CM de patients en oncologie pédiatrique peu de temps après les traitements, ii) élaborer, par une revue de littérature, sur le rôle de l’état inflammatoire et oxydant relié au cancer de l’enfant et ses traitements dans le développement des complications CM, iii) évaluer les associations entre l’évolution de l’IMC durant la trajectoire de soins d’un cancer pédiatrique et les complications CM ainsi que le statut inflammatoire; vi) détailler la composition lipidique et protéique des HDL des patients peu de temps après la fin des traitements du cancer pédiatrique et; v) déterminer la faisabilité d’une intervention nutritionnelle précoce chez des enfants et des adolescents nouvellement diagnostiqués d’un cancer. Pour ce faire, deux cohortes de patients ont été recrutées dans le cadre de l’étude VIE (Valorisation, Implication, Éducation) au CHU Sainte-Justine. D’abord, 80 patients suivis en hémato-oncologie ont été rencontrés en moyenne 1,4 ± 0,8 an après la fin de leur traitement contre un cancer pédiatrique. De ce groupe, 56,3 % étaient des filles, 43,8% avaient été traités pour une leucémie. L'âge moyen lors de la rencontre était de 11,8 ans (min - max: 4,5 - 21,0). La proportion de complications CM observée était de 26,3 % pour la pression artérielle (PA) élevée, 8,1 % pour le prédiabète, 35,0 % pour la dyslipidémie et 11,5 % pour l’obésité. Les adolescents (≥ 10 ans au diagnostic) étaient plus susceptibles d'avoir une PA élevée, une dyslipidémie et de cumuler ≥ 2 complications CM que les enfants. Être en surpoids ou obèse après le traitement était associé à des niveaux plus élevés d'insuline, d’HOMA-IR, de leptine et du ratio leptine/adiponectine du plasma. Chez les patients en surpoids ou obèses à la fin du traitement, le changement de l’IMC a été relié au niveau d’adipokines (leptine et ratio leptine/adiponectine) après les traitements. De plus, les fractions de HDL3 étaient enrichies en triglycérides chez les patients présentant une dyslipidémie à l’évaluation par rapport aux normolipidiques et chez ceux ayant été traités avec des doses de doxorubicine ≥ 90 mg/m2 par rapport à des doses inférieures. Parallèlement, une intervention nutritionnelle d'un an, comprenant une évaluation initiale et six visites de suivi tous les deux mois, a été effectuée auprès de 61 participants. De ceux-ci, 51,6% étaient des garçons, l’âge moyen était de 8,5 ans et le temps moyen entre le début de l’intervention et le diagnostic était de 13,2 semaines. Après 1 an d’intervention, le taux de rétention étaient de 72,6 %, 258 rencontres ont été menées sur 362 planifiées (taux de présence 71,6%) et la moitié des participants (50,8 %) avaient participé à au moins 4 rencontres de suivi. En conclusion, peu après le traitement d’un cancer pédiatrique, la santé CM est influencée par l’âge au diagnostic et l’évolution de l’IMC pendant les traitements, et le métabolisme des HDL tant par l’âge que les doses de doxorubicine reçues. Les biomarqueurs du statut inflammatoire peuvent servir d’indicateur de la santé CM chez ces patients. Par ailleurs, l’implantation d’une intervention nutritionnelle impliquant les patients et leurs parents tôt après le diagnostic d’un cancer pédiatrique est faisable et constitue une stratégie à prioriser afin d’optimiser la santé CM de cette population à court et à long terme. Dans leur ensemble, nos travaux contribuent à améliorer la prise en charge et les méthodes d’interventions auprès des enfants et des adolescents diagnostiqués d’un cancer. / Due to medical advances, the 5-year survival rate for children and adolescents diagnosed with cancer is now approximately 85%. Despite these encouraging statistics, in adulthood, survivors of pediatric cancer are at risk of developing several health problems including cardiovascular disease and cardiometabolic complications (CM) such as hypertension, insulin resistance, dyslipidemia and abdominal obesity. In this context, it is important to increase the knowledge of the evolution and etiology of these sequelae to improve early management. However, to date, only a few studies have described the CM health of patients in the short term after the end of treatment and the factors associated with the early development of these complications remain unknown. Cancer and its treatment cause a pro-inflammatory & pro-oxidative state that can lead to the development of CM complications. In parallel, the treatment period is characterized by changes in dietary habits, sedentary behavior, and increased body mass index (BMI), which may persist after treatment ends. In the long term in pediatric cancer survivors, obesity status at the end of treatment and some inflammatory biomarkers have been associated with the presence of CM complications. In addition, HDL composition is different in long-term survivors of acute lymphoblastic leukemia compared with healthy controls. Given the importance of these factors, it is critical to describe them in the short term, after the end of treatment. In addition, obesity at diagnosis and increasing BMI during treatment negatively influence prognosis and the occurrence of serious side effects during treatment. However, most nutritional interventions in pediatric oncology do not address the issue of significant weight gain during treatment. Thus, it seems important to evaluate the possibility of implementing strategies focusing on the promotion of healthy lifestyle habits early after the diagnosis of pediatric cancer in order to improve the nutritional status, quality of life and possibly the CM health of patients in the short and long term. The work in this thesis aims to: i) describe the CM health of pediatric oncology patients shortly after treatment, ii) elaborate, through a literature review, on the role of inflammatory and oxidative status related to pediatric cancer and its treatments in the development of CM complications, iii) evaluate the associations between changes in BMI during the pediatric cancer care trajectory and CM complications as well as inflammatory status; vi) detail the lipid and protein composition of patients' HDL shortly after completion of pediatric cancer treatments and; v) determine the feasibility of early nutritional intervention in children and adolescents newly diagnosed with cancer. Two cohorts of patients were recruited as part of the VIE (Valorisation, Implication, Education) study at CHU Sainte-Justine. First, 80 patients followed in hemato-oncology were met on average 1.4 ± 0.8 year after the end of their treatment for pediatric cancer. Of this group, 56.3% were girls, 43.8% had been treated for leukemia. The mean age at encounter was 11.8 years (min - max: 4.5 - 21.0). The proportion of CM complications observed was 26.3% for high blood pressure (BP), 8.1% for prediabetes, 35.0% for dyslipidemia, and 11.5% for obesity. Adolescents (≥ 10 years of age at diagnosis) were more likely to have elevated BP, dyslipidemia, and ≥ 2 CM complications than children. Being overweight or obese after treatment was associated with higher levels of insulin, HOMA-IR, leptin, and plasma leptin/adiponectin ratio. In patients who were overweight or obese at the end of treatment, the change in BMI was related to the level of adipokines (leptin and leptin/adiponectin ratio) after treatments. In addition, HDL3 fractions were enriched in triglycerides in patients who were dyslipidemic at assessment compared with the normolipidics, and in those who had been treated with doxorubicin doses ≥90 mg/m2 compared to lower doses. In parallel, a one-year nutrition intervention, including an initial assessment and six follow-up visits every two months, was conducted with 61 participants. Of these, 51.6% were boys, the mean age was 8.5 years, and the mean time from intervention initiation to diagnosis was 13.2 weeks. After 1 year of intervention, the retention rate was 72.6%, 258 visits were held out of the 362 planned (71.6% attendance rate) and half of the participants (50.8%) had attended at least 4 follow-up visits. In conclusion, shortly after treatment of pediatric cancer, CM health is influenced by age at diagnosis and BMI changes during treatment, and HDL metabolism by both age and doses of doxorubicin received. Biomarkers of inflammatory status may serve as an indicator of CM health in these patients. Furthermore, implementation of a nutritional intervention involving patients and parents early after diagnosis of pediatric cancer is feasible and is a strategy to prioritize to optimize CM health in this population in the short and long term. Taken together, our work contributes to improve the management and intervention methods for children and adolescents diagnosed with cancer.

Problématique : Les enfants ayant survécu à un cancer présentent un risque accru de développer des complications cardiométaboliques à long terme par rapport à leurs pairs. Cette étude vise à évaluer la faisabilité et l’impact du volet nutritionnel de l’intervention multidisciplinaire VIE (Valorisation, Implication, Éducation) pendant le traitement du cancer pédiatrique sur les apports alimentaires et la santé cardiométabolique des enfants après la fin de leur traitement. L’aspect multidisciplinaire de cette intervention impliquait également l’activité physique et la psychologie. Méthodologie : La faisabilité de l’étude, évaluée un an après le début de l’intervention, a inclus le taux de rétention, de participation, d’assiduité, d’achèvement des mesures de l’étude et d’engagement des participants. Suite à l’intervention, les participants qui ont été exposés à VIE ont fait l’objet d’une évaluation de fin d’étude, tandis que les participants d’un groupe contrôle ont fait l’objet d’une évaluation unique. Les données ont été recueillies 1,3 ± 0,8 an après la fin du traitement dans le groupe d’intervention et 1,4 ± 0,8 an dans le groupe de contrôle. Des mesures nutritionnelles (journal alimentaire de 3 jours et rappel de 24 heures), anthropométriques (poids, taille, tour de taille, tour brachial, pli cutané), biochimiques (profil lipidique, HbA1c, vitamine D) et de pression artérielle ont été recueillies. Résultats : Après un an d’intervention, le taux de rétention était de 72,6 %, 258 rencontres ont été menées sur 362 planifiées (taux de présence 71,6 %) et la moitié des participants (50,8 %) avaient participé à au moins 4 rencontres de suivi. À l’évaluation de fin d’étude, 45 participants de l’étude VIE (10,2 ± 4,5 ans) ont été comparés à 77 contrôles (12,0 ± 5,6 ans). Par rapport aux contrôles, les participants à l’étude VIE consommaient moins de calories (1997 ± 669 vs. 1759 ± 513, p=0,042) et avaient des apports en calcium ajustés à l’énergie plus élevés (548 ± 240 mg/1000 kcal vs. 432 ± 197 mg/1000 kcal, p=0,005). Les participants à l’étude VIE avaient également tendance à consommer davantage de fibres totales (9,2 ± 3,4 g/1000 kcal contre 8,4 ± 2,8 g/1000 kcal, p=0,188) et de vitamine D (2,6 ± 2,0 g/1000 kcal contre 2,2 ± 2,0 g/1000 kcal, p=0,311) que les contrôles. Aucune différence entre les groupes n’a été constatée en ce qui concerne les résultats anthropométriques ou cardiométaboliques. Conclusion : Cette étude montre que le volet nutritionnel d’une intervention multidisciplinaire, mise en œuvre rapidement après le diagnostic de cancer, est faisable et peut avoir un impact positif sur le régime alimentaire des enfants et des adolescents. Une implantation multicentrique avec le projet VIE-Québec permettra d’augmenter l’étendue des retombées positives. / Background : Children who have survived cancer have an increased risk of developing long-term cardiometabolic complications compared to their peers. The aim of this study is to assess the feasibility and impact of the nutritional component of the multidisciplinary VIE (Valorisation, Implication, Éducation) intervention during pediatric cancer treatment on children's dietary intake and cardiometabolic health after the end of their treatment. The multidisciplinary aspect of this intervention involved also physical activity and psychology. Methods: Study feasibility, assessed one year after the start of the intervention, included retention, participation, attendance, completion of study measures and participant engagement. Following the intervention, participants who had been exposed to VIE underwent an end-of-study assessment, while participants in a control group underwent a one-off assessment. Data were collected 1.3 ± 0.8 years after the end of treatment in the intervention group and 1.4 ± 0.8 years in the control group. Nutritional (3-day food diary and 24-hour recall), anthropometric (weight, height, waist circumference, brachial circumference, skin fold), biochemical (lipid profile, HbA1c, vitamin D) and blood pressure measurements were collected. Results: After one year of intervention, the retention rate was 72.6%, 258 appointments were conducted out of 362 planned (71.6% attendance rate) and half of the participants (50.8%) had attended at least 4 follow-up appointment. At the end-of-study assessment, 45 VIE participants (10.2 ± 4.5 years) were compared with 77 controls (12.0 ± 5.6 years). Compared to controls, VIE participants consumed fewer calories (1997 ± 669 vs. 1759 ± 513, p=0.042) and had higher energy-adjusted calcium intakes (548 ± 240 mg/1000 kcal vs. 432 ± 197 mg/1000 kcal, p=0.005). VIE participants also tended to consume more total fiber (9,2 ± 3,4 g/1000 kcal vs. 8,4 ± 2,8 g/1000 kcal, p=0.188) and vitamin D (2,6 ± 2,0 g/1000 kcal vs. 2,2 ± 2,0 g/1000 kcal, p=0.311) than controls. There were no differences between the groups in terms of anthropometric or cardiometabolic outcomes. Conclusions : This study shows that the nutritional component of a multidisciplinary intervention, implemented rapidly after cancer diagnosis, is feasible and can have a positive impact on the diet of children and adolescents. A multicenter implementation via the VIE-Québec project will increase the extent of the positive impact.

This study explores the possible efficacy of a low carbohydrate and high fat nutritional intervention (LCHF) as a treatment possibility aiming to improve the ability of self-control and regulation in the context of carbohydrate-addiction. The study first outlines why increased simple carbohydrate consumption has been implicated as a risk-factor in numerous chronic conditions, and then explores the possibility that a reduction of such consumption could lower general medical expenditure in the healthcare sector of already overburdened institutions, especially in developing countries like South Africa. Since the neurobiological evidence for food addiction is compelling, this study investigates the impact of a low carbohydrate and high fat eating (LCHF) regimen by measuring the change in the severity of addictive behaviour in relation to a reduced carbohydrate consumption. Results indicate that a LCHF nutritional intervention lessened addictive behaviour after just 30 days, resulting in a statistically significant decrease in addiction symptoms from day 1 to day 30. The weight and BMI values of the participants recorded at the end of the study showed a reduction from those obtained during the pre- treatment stage, and the self-perceived ‘feeling in control’ also improved in all participants after the intervention. The introduction of a LCHF nutritional intervention presents a relatively cost-effective treatment and preventative measure to combat carbohydrate over-consumption and its numerous health complications, and it is therefore hoped that the positive findings of this study will foster further research, using larger samples, into this type of nutritional intervention against addictive eating behaviour. / Psychology / M.A. (Psychology)