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Typescript. / Thesis (Ph. D.)--University of Hawaii at Manoa, 1976. / Bibliography: leaves [121]-143. / Microfiche. / vii, 153 leaves ill

Abstract inserted as part of Final MPH Thesis: Non-Communicable Diseases like diabetes, cardiovascular diseases, cancers and others, have become the major cause of premature death, morbidity and disability in many Pacific countries including Samoa. These are linked by common preventable risk factors like obesity, hypertension, smoking, unhealthy diets and physical inactivity. OBJECTIVES: To determine the trends and development of Non-Communicable diseases and its risk factors in Samoa over the last 24 years using the recently developed diagnostic criteria. RESEARCH DESIGN AND METHODS: This research thesis combines 3 large surveys that were done in 1978, 1991, and 2002, looking at the trends in the prevalence of diabetes, and the prevalence of the NCD risk factors such as blood pressure, obesity, cholesterol and smoking. The 3 survey samples were selected randomly from around similar regions (Urban Upolu, Rural Upolu, and Rural Savaii) of Samoa in 1978, 1991 and 2002, with a total of 5973 individuals (1978 survey = 1467; 1991 survey = 1778; 2002 survey = 2728) available for the thesis analysis. The 1978 and 1991 data sets were secured from Professor P Zimmet, and the 2002 STEPs survey data set was secured from the Samoa Ministry of Health. The 3 surveys methodologies, survey procedures, questionnaires and anthropometric measurements were similar though the diagnostic criteria used to measure obesity slightly differ between the surveys. The blood pressure measurements were similar though the diastolic blood pressure measure in 1978 was higher. The 1978 and 1991 surveys used fasting venous blood sampling to measure fasting plasma glucose, and cholesterol levels at the laboratory. OGTT was also used in 1978 and 1991, but not 2002. The 2002 survey used capillary sampling to measure fasting glucose using a glucometer, and cholesterol level using a cholesterol meter. The combined data was then cleaned, standardized and matched with each survey, to make analysis easier. The recent diagnostic criteria were then applied to all the surveys to diagnose diabetes (1999 WHO Diabetes Criteria), hypertension (WHO 1999, JNC-VII 2003, NHF 1999 Hypertension Criteria), obesity (BMI ≥30 kg/m??), and hypercholesterolaemia. The prevalences using the recent diagnostic criteria were then mapped out. RESULTS: The overall age-standardized prevalence of type 2 diabetes (known or previously unknown) utilizing the current 1999 WHO diagnostic criteria for men and women ≥20 years of age has increased from 5.4% (males 4.8%, females 5.9%) in 1978, to 12.0% (males 10.9%, females 13.5%) in 1991, and to 20.1% (males 17.2%, females 22.2%) in 2002. Among the individuals with diabetes in the 3 surveys, more than 60% had previously undiagnosed diabetes. Compared with the 1978 survey, the diabetes prevalence in 2002 represents a 4-fold increase over the 24 year period. This has occurred along with increasing obesity, urbanization and modernization, aging, cultural changes, and changes in physical activity. There is a high prevalence of non-communicable disease risk factors. The age-standardized prevalence of hypertension defined by the WHO 1999 and JNC-VII 2003 criteria was 47.2% in 1978, 22.5% in 1991, and 24.0% in 2002. The high prevalence of hypertension in 1978 was due to the method used for recording diastolic blood pressure. Hypertension was more common in the urban regions than rural regions in 1978 and 1991 while in 2002, there was no statistical difference between the rates of hypertension between the different regions due to the rise in the prevalence rate of hypertension in rural regions. There is a high prevalence of overweight and obesity in Samoa. Using the WHO classification for BMI, there was an increase in obesity (BMI ≥ 30kg/m??) prevalence in Samoa in the last decade, increasing steeply from 34.9% in 1978 to 51.3% in 1991, and slowing down to an increase to 57.4% in 2002. The prevalence of obesity is significantly higher in females compared with their male counterparts. The overweight prevalence (BMI 25-29.9kg/m??) was 34% in 1978, 31% in 1991 and 29% in 2002. The prevalence of obesity has increased by 65% from 1978 to 2002 with an increase of 47% from 1978 to 1991, and 12% from 1991 to 2002. Prevalence of obesity is increasing with age and is more of a problem in women than men. It is higher in the urban regions but there has been a faster rise in obesity prevalence in rural regions from 1978 to 2002 as the rural regions become urbanized. The prevalence of hypercholesterolaemia (total cholesterol ≥ 5.2 mmol/l) was 30.5% in 1978, and this increased to 51.1% in 1991. There was a marked decline of hypercholesterolaemia in 2002 (14.4%), which may be due to differences in the method of measurement. Although smoking prevalence remains high in Samoa it declined significantly from 42.4% 1978 to 35.3% 1991 but remained essentially steady at 38% in 2002. There was a significant gender difference in smoking with about 60% of men and 20% of women smoking regularly. CONCLUSION: Samoa is experiencing an increasing problem with Non-Communicable diseases like diabetes and some of its risk factors. Diabetes prevalence has dramatically increased by 4-fold in the last 24 years. The prevalence of hypertension has stabilized around 23% though there was a decrease from 1978. The prevalence of obesity has also increased. Smoking prevalence has slightly increased from 1991 to 2002 with a significant number of the population smoking. Hypercholesterolaemia is more common in 1991 with an apparent decrease in 2002. These findings have important implications for public health efforts and policy developments to contain the epidemic of Non-Communicable diseases in Samoa.

Context: Young women are at high risk of weight gain but there has been limited knowledge on weight management in this group. Hyperandrogenemia and menstrual abnormalities are common co-morbidities of obesity in young women but their associations with food cravings are not known. Metformin has been shown to reduce body weight and improve metabolic outcomes in older adults but its effects on healthy overweight and obese young women have not been investigated. Quantitative lifestyle advice has been shown to be effective in inducing weight loss but its psychological effects on young women have not been extensively studied. The overall objective of this study was to investigate the effectiveness of metformin, quantitative lifestyle advice and internet-based intervention on weight management in young. Methods: In the first 12-weeks, 203 overweight and obese young women (BMI 33.3±0.3 kg/m² , age 28±0.3 years; age range:17-37) were randomized to one of three treatment arms to receive metformin (Diabex XR 1500mg a day) plus qualitative lifestyle advice (M-QL), placebo plus qualitative lifestyle advice (P-QL) or a structured lifestyle program (L-QT). L-QT consisted of an energy restricted diet with quantitative lifestyle advice (6000KJ; 40% protein, 40% carbohydrate, 30% fat), structured exercise program, and behavioural therapy. From weeks 13 to 48, all participants were placed on the structured lifestyle program conducted through a website. Outcome measures include body weight, fasting lipids, insulin, glucose, psychological distress, self-esteem, food cravings, energy intake and physical activity. Primary analyses were conducted using linear mixed models. Results: At baseline, psychological distress and hyperandrogenemia were associated with increased food cravings (P<0.01). At 12-weeks, L-QT group had greater weight loss (-4.2±0.4 kg) compared to M-QL (-1.0±0.4 kg) and P-QL groups (-0.2±0.3 kg) (P<0.001). Attrition at week 12 was high particularly in L-QT group, ie 48% (28/59) for L-QT group, 34% (22/65) for M-QL group and 29% (23/79) for P-QL group (P=0.08). Baseline psychological distress and food cravings predicted attrition at week 12. At week 12, L-QT group had significantly greater improvements in psychological distress (-3.0+0.9 vs -0.84+0.52, P=0.013) and self-esteem (3.2±0.8 vs -0.04±0.4, P<0.001) compared to the M-QL and P-QL groups. At 48 weeks, both QT and QL groups maintained significant weight loss (-4.8±0.1 kg vs -1.3±0.4 kg respectively, P=0.0005). Weight changes from week 13 to 48 were similar between the groups (P>0.05). Attrition was similarly high in both groups by week 48 (78%; 159/203) (P=0.003). Being married or having children predicted attrition at week 48. Conclusions: A structured lifestyle intervention program was more effective than metformin in achieving weight loss in young women. Quantitative lifestyle advice produced greater improvements in psychological outcomes compared to qualitative lifestyle advice. Internet-based weight loss program was effective in maintaining weight loss in young women independent of initial weight loss. High attrition rates were seen throughout the study, particularly among those who had greater psychological distress or food cravings, and those who were married or had children. Strategies on managing issues relating to psychological distress, food cravings and family responsibilities may allow better tailoring of weight management programs for this group. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1523605 / Thesis (Ph.D.) -- University of Adelaide, School of Molecular and Biomedical Science, 2009

Abstract inserted as part of Final MPH Thesis: Non-Communicable Diseases like diabetes, cardiovascular diseases, cancers and others, have become the major cause of premature death, morbidity and disability in many Pacific countries including Samoa. These are linked by common preventable risk factors like obesity, hypertension, smoking, unhealthy diets and physical inactivity. OBJECTIVES: To determine the trends and development of Non-Communicable diseases and its risk factors in Samoa over the last 24 years using the recently developed diagnostic criteria. RESEARCH DESIGN AND METHODS: This research thesis combines 3 large surveys that were done in 1978, 1991, and 2002, looking at the trends in the prevalence of diabetes, and the prevalence of the NCD risk factors such as blood pressure, obesity, cholesterol and smoking. The 3 survey samples were selected randomly from around similar regions (Urban Upolu, Rural Upolu, and Rural Savaii) of Samoa in 1978, 1991 and 2002, with a total of 5973 individuals (1978 survey = 1467; 1991 survey = 1778; 2002 survey = 2728) available for the thesis analysis. The 1978 and 1991 data sets were secured from Professor P Zimmet, and the 2002 STEPs survey data set was secured from the Samoa Ministry of Health. The 3 surveys methodologies, survey procedures, questionnaires and anthropometric measurements were similar though the diagnostic criteria used to measure obesity slightly differ between the surveys. The blood pressure measurements were similar though the diastolic blood pressure measure in 1978 was higher. The 1978 and 1991 surveys used fasting venous blood sampling to measure fasting plasma glucose, and cholesterol levels at the laboratory. OGTT was also used in 1978 and 1991, but not 2002. The 2002 survey used capillary sampling to measure fasting glucose using a glucometer, and cholesterol level using a cholesterol meter. The combined data was then cleaned, standardized and matched with each survey, to make analysis easier. The recent diagnostic criteria were then applied to all the surveys to diagnose diabetes (1999 WHO Diabetes Criteria), hypertension (WHO 1999, JNC-VII 2003, NHF 1999 Hypertension Criteria), obesity (BMI ≥30 kg/m??), and hypercholesterolaemia. The prevalences using the recent diagnostic criteria were then mapped out. RESULTS: The overall age-standardized prevalence of type 2 diabetes (known or previously unknown) utilizing the current 1999 WHO diagnostic criteria for men and women ≥20 years of age has increased from 5.4% (males 4.8%, females 5.9%) in 1978, to 12.0% (males 10.9%, females 13.5%) in 1991, and to 20.1% (males 17.2%, females 22.2%) in 2002. Among the individuals with diabetes in the 3 surveys, more than 60% had previously undiagnosed diabetes. Compared with the 1978 survey, the diabetes prevalence in 2002 represents a 4-fold increase over the 24 year period. This has occurred along with increasing obesity, urbanization and modernization, aging, cultural changes, and changes in physical activity. There is a high prevalence of non-communicable disease risk factors. The age-standardized prevalence of hypertension defined by the WHO 1999 and JNC-VII 2003 criteria was 47.2% in 1978, 22.5% in 1991, and 24.0% in 2002. The high prevalence of hypertension in 1978 was due to the method used for recording diastolic blood pressure. Hypertension was more common in the urban regions than rural regions in 1978 and 1991 while in 2002, there was no statistical difference between the rates of hypertension between the different regions due to the rise in the prevalence rate of hypertension in rural regions. There is a high prevalence of overweight and obesity in Samoa. Using the WHO classification for BMI, there was an increase in obesity (BMI ≥ 30kg/m??) prevalence in Samoa in the last decade, increasing steeply from 34.9% in 1978 to 51.3% in 1991, and slowing down to an increase to 57.4% in 2002. The prevalence of obesity is significantly higher in females compared with their male counterparts. The overweight prevalence (BMI 25-29.9kg/m??) was 34% in 1978, 31% in 1991 and 29% in 2002. The prevalence of obesity has increased by 65% from 1978 to 2002 with an increase of 47% from 1978 to 1991, and 12% from 1991 to 2002. Prevalence of obesity is increasing with age and is more of a problem in women than men. It is higher in the urban regions but there has been a faster rise in obesity prevalence in rural regions from 1978 to 2002 as the rural regions become urbanized. The prevalence of hypercholesterolaemia (total cholesterol ≥ 5.2 mmol/l) was 30.5% in 1978, and this increased to 51.1% in 1991. There was a marked decline of hypercholesterolaemia in 2002 (14.4%), which may be due to differences in the method of measurement. Although smoking prevalence remains high in Samoa it declined significantly from 42.4% 1978 to 35.3% 1991 but remained essentially steady at 38% in 2002. There was a significant gender difference in smoking with about 60% of men and 20% of women smoking regularly. CONCLUSION: Samoa is experiencing an increasing problem with Non-Communicable diseases like diabetes and some of its risk factors. Diabetes prevalence has dramatically increased by 4-fold in the last 24 years. The prevalence of hypertension has stabilized around 23% though there was a decrease from 1978. The prevalence of obesity has also increased. Smoking prevalence has slightly increased from 1991 to 2002 with a significant number of the population smoking. Hypercholesterolaemia is more common in 1991 with an apparent decrease in 2002. These findings have important implications for public health efforts and policy developments to contain the epidemic of Non-Communicable diseases in Samoa.

Research Doctorate - Doctor of Philosophy (PhD) / The prevalence of overweight and obesity in Australian children continues to rise. Without receiving treatment, many of these children will become overweight or obese adults and will develop a range of associated health problems and incur higher direct and indirect health costs compared to those who remain healthy weight. There is marked disparity between the scale of the public health issue and the evidence on how to best treat childhood obesity and which elements of dietary interventions are effective. Reviews of previous treatment studies have acknowledged methodological weaknesses which need to be addressed. Descriptions of dietary interventions, dietary intake and changes in dietary intake of children are rarely reported. This may be partly due to the lack of validated assessment tools available for use with paediatric populations. There is no question of the importance of diet in helping to reduce child obesity levels; the role of dietary treatment alone is difficult to elucidate. Consequently it is unknown what comprises an effective dietary treatment as studies to date have produced modest results and there is an ongoing need to identify which factors could improve weight related outcomes. The first aim of the studies in this thesis was to validate parental reports of young children’s fruit and vegetable intake using a child specific Australian food frequency questionnaire (FFQ) and comparing reported intakes with nutritional biomarkers. The second aim was to comprehensively describe a dietary intervention treatment program for use in a methodologically high quality obesity treatment randomised controlled trial (RCT). Thirdly, this thesis aimed to describe the parental reports of the child participants’ dietary intakes and food behaviours using the FFQ and report the parent child feeding practices. These outcome measures are reported both in the short-term (post-intervention) and the long-term (12 months post-intervention). The underlying hypothesis was that the group receiving the dietary intervention would achieve better dietary outcomes compared with a group given a physical activity treatment program only. An additional aim of the thesis was to investigate the feasibility of developing a brief dietary intake assessment tool for use in clinical and community settings by undertakinga feasibility study on the development of a diet variety score for use in assessing children’s dietary intakes. Results from the validation study of a child specific FFQ against objective nutritional biomarkers in study 1 (Chapter 3) showed that there was a moderately strong relationship between parent reported intakes of fruit and vegetables using the Australian Schools Eating Survey (ASES) FFQ with fasting plasma carotenoids. This was after adjustment for child body weight. The ASES FFQ was a useful tool for estimating the dietary intakes of fruit and vegetables in younger children via parental report. A comparative study (Chapter 4) between overweight and obese children recruited to an obesity treatment intervention and a community sample illustrated that all parents’ over-report children’s dietary intakes of foods consumed when using the ASES FFQ. Relative dietary differences were detected between the groups for the percentage energy derived from the non-core extras food group of The Australian Guide to Healthy Eating. Parents of overweight children reported more controlling methods of child feeding The detailed description of the dietary intervention used in the RCT will allow for the possibility of replication of the key elements of this approach in child obesity treatment programs. The detailed reported changes in dietary intakes resulting from the obesity treatment intervention (Chapter 5), both in the short and long-term, demonstrated that all treatment groups were effective in improving children’s dietary intakes and in reducing total energy intakes, up to one year. The comprehensive reports have facilitated the identification of effective components of dietary interventions and identified foods, lifestyle behaviours that are able to be modified and sustained by families of overweight children. In addition, it was shown that a parent’s child feeding practices can be changed and sustained secondary to an obesity treatment program. While parent child feeding practices require further investigation, this could contribute to improving the outcomes of future studies. The dietary score feasibility study (Chapter 6), found that a dietary variety score, based on the ASES FFQ was a feasible option for reporting on children’s dietary intake more universally as an indicator of whole food consumption, rather than nutrient intake. However, the score was not directly useful in the current study and the diet variety scorehas methodological weaknesses that need to be addressed before it can be used as intended. In conclusion, the findings reported in this thesis have shown the ASES FFQ is a useful tool for estimating younger children’s fruit and vegetable intake via parental report. All treatment arms of the HIKCUPS RCT were equally efficacious in improving children’s dietary intakes. This study gives unique insights to the effectiveness of a specific dietary intervention and adds to the evidence base for targeting decreases in total energy, fat, sugar, sweetened drinks and take-away foods, increasing the consumption of low fat dairy products and vegetables. It also supports using parents as the agent of lifestyle change. Furthermore, it was shown that specific child feeding domains are modifiable in the context of a targeted obesity intervention which highlights the importance of addressing broader parenting issues in the management of childhood overweight and obesity. This thesis has several novel aspects: it reports a comparative validation study of a contemporary Australian FFQ; it provides a detailed description of a dietary intervention used in the treatment of childhood obesity and the resultant dietary changes after an obesity intervention and changes to the child feeding practices of parents of obese children.

Thesis (M. Nurs.)--University of Hong Kong, 2007.

Thesis (M.S.)--University of Kentucky, 2007. / Title from document title page (viewed on March 26, 2008). Document formatted into pages; contains: v, 36 p. : ill. Includes abstract and vita. Includes bibliographical references (p. 33-35).

Thesis (M.S. in Molecular Physiology and Biophysics)--Vanderbilt University, Dec. 2007. / Title from title screen. Includes bibliographical references.

Thesis (M.A.)--York University, 2006. Graduate Programme in Kinesiology and Health Science. / Typescript. Includes bibliographical references (leaves 66-88). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://proquest.umi.com/pqdweb?index=1&did=1299815381&SrchMode=1&sid=12&Fmt=2&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1194987702&clientId=5220