OBJECTIVE: The main aim of this thesis was to investigate the role of nutrition during "early" HIV-infection in African women. METHODS: Data reported in this investigation formed part of two cross-sectional studies, the THUSA and Mangaung studies. The Mangaung study investigated women and, therefore, the sub-sample of the THUSA study was chosen accordingly. The data of the two studies were kept and analysed separately. The investigation consisted of 1040 women from the THUSA study, aged between 15 and 90 years of which 120 (11.5%) were HIV infected. The Mangaung study comprised of 488 women aged between 25 and 44 years of which 248 (51%) women were infected. Demographic data, anthropometric measurements, health outcome variables and habitual nutrient intakes by a quantified food frequency questionnaire were used. The SPSS statistical package (version 14.0; SPSS Inc., Chicago, Illinois, 2005) was used to analyse data. Descriptive statistics were done expressing variables as means, medians, standard deviations (SD), standard errors (SE) and confidence intervals (CI). An analysis of variance (ANOVA) was done to test for significance between the HIV-infected and non-infected groups in both studies. Partial correlations were done in the infected and non-infected groups to determine associations between dietary / nutrient intake, anthropometry and the biological health variables. In the THUSA study we controlled for age, education level, degree of urbanization and alcohol intake and in the Mangaung study for age, education level and alcohol intake. Nutrient intakes of both infected and non-infected women above and below median values as well as in the first and fourth quartile of total cholesterol (TC) and albumin distribution were compared to assess the role of nutrients in the observed decreases in TC and albumin of HIV-infected women. RESULTS AND DISCUSSION: The dietary intakes of the HIV-infected women in both the studies did not differ significantly from the non-infected women. Total serum cholesterol, albumin, fibrinogen and blood pressure were significantly lower in the HIV-infected women in both the THUSA and Mangaung studies. The non-infected THUSA women with lower serum cholesterol levels (than the median) had significantly lower intakes of percentage energy from fat (25.2 versus 26.4%, p ≤0.027), percentage energy from total protein (11.6 versus 12.1%, p≤0.000), animal protein (25.6 versus 27.7g, p≤0.005), and significantly higher intakes of plant protein (32.2 versus 29.4g, p≤0.002) and fibre (16.9 versus 15.89 p≤0.029). There were no significant differences observed in the nutrient intakes in the infected women with serum cholesterol levels above and below the median. In the Mangaung study no significant nutrient intake differences were observed in both of the HIV-infected and non-infected women with lower and higher than the median TC levels. In the THUSA study, higher intakes of fat (percentage energy) were close to significant (27.3 versus 24.5%, p≤0.053) in the infected women with higher (than the median) albumin levels. In the non-infected group with higher albumin levels, significant differences were observed in percentage energy from fat (26.6 versus 24.9%; p≤0.001) protein (12.2 versus 11.6%; p≤0.001) and carbohydrate (62.8 versus 65.2%; p≤0.000). Higher intakes of saturated fat (SATFAT) (17.7 versus 16.1g, p≤0.008), monounsaturated fats (MUFAT) (19.3 versus 17.4g, p≤0.004) as well as higher intakes of animal protein (28.5 versus 24.4g, p≤0.000) were observed in the group with higher than the median levels of serum albumin. In the Mangaung study the HIV-infected women (with higher than the median serum albumin levels), had significantly higher intakes of energy (13 275 versus 11 622 kJ, p≤0.022), polyunsaturated fatty acids (32.3 versus 17.3g, p≤0.036), dietary cholesterol (412.9 versus 344.5mg, p≤0.043) and plant protein (42.3 versus 35.3g, p≤0.008). No differences were observed in the non-infected women. The further analyses, comparing the dietary intakes in both studies of infected and non-infected women with TC and albumin levels in the first and fourth quartiles, showed that in the THUSA study, non-infected women with lower TC levels had significantly lower intakes of protein (% of total energy), total fat (% of total energy) and vitamin B12 and significantly higher intakes of total energy (TE), plant protein, total carbohydrate, % TE from carbohydrate, dietary fibre, added sugar and thiamine. In the infected women saturated fatty acids (SATFAT), calcium and the fat ratio (polyunsaturated/saturated ratio) differed significantly between women with TC levels in the first and the fourth quartile. A significant higher intake of riboflavin was seen in the non-infected women from Mangaung with TC levels in the fourth quartile, while significant higher intakes of energy, total protein, animal protein, total fat, SATFAT, MUFAT, total carbohydrate, phosphorus, chromium and iodine was seen in the infected women with TC levels in the fourth quartile. These results suggest that a more "westernized" diet with higher intakes of energy, and animal derived foods (SATFAT and calcium) could have protected against the detrimental decreases in TC observed in HIV infection. Significant differences were observed in the intakes in the non-infected THUSA women who had serum albumin in the first and fourth quartiles. lntakes in percentage energy from protein and fat, animal protein, total fat, SATFAT, MUFAT, calcium, zinc, vitamin C and fat ratio, were significantly lower in the women with albumin levels in the first quartile. Significantly higher carbohydrate intakes were observed in the women who had serum albumin levels in the first quartile. In the Mangaung study, significant differences were seen in the intakes between infected women who had serum albumin levels in the first and fourth quartiles. lntakes of total energy, protein, fat, MUFAT, SATFAT, carbohydrate, magnesium, zinc, chromium, biotin, pantothenic acid and iodine were significantly lower in the infected women with serum albumin levels in the first quartile. In the non-infected women significantly lower intakes of calcium were observed in the group who had serum albumin levels in the first quartile compared to those who had serum albumin levels in the fourth quartile. These results also suggest that a more "westernized” diet was associated with higher albumin levels in HIV-infected women. CONCLUSION: It is well known that nutrition has an integral part to play in the care of people living with HIV/AIDS (PLWHA). Maintaining proper nutrition, weight and immune function is thought to delay disease progression, prolong the asymptomatic phase and improve survival. These analyses suggest that the "prudent" diet generally regarded as an optimal diet for prevention of non-communicable diseases, may not be the optimal diet for PLWHA. The overall analyses therefore suggest that a more "westernized" diet, higher in fat and protein could be more beneficial to asymptomatic HIV-infected women compared to that of a more "prudent" diet. As these studies were not primarily designed to investigate HIV and nutrition, the role of a higher energy, fat and animal protein intake ("western" diet) in asymptomatic HIV warrants urgent investigation. / Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007.

Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007.

OBJECTIVE: The main aim of this thesis was to investigate the role of nutrition during "early" HIV-infection in African women. METHODS: Data reported in this investigation formed part of two cross-sectional studies, the THUSA and Mangaung studies. The Mangaung study investigated women and, therefore, the sub-sample of the THUSA study was chosen accordingly. The data of the two studies were kept and analysed separately. The investigation consisted of 1040 women from the THUSA study, aged between 15 and 90 years of which 120 (11.5%) were HIV infected. The Mangaung study comprised of 488 women aged between 25 and 44 years of which 248 (51%) women were infected. Demographic data, anthropometric measurements, health outcome variables and habitual nutrient intakes by a quantified food frequency questionnaire were used. The SPSS statistical package (version 14.0; SPSS Inc., Chicago, Illinois, 2005) was used to analyse data. Descriptive statistics were done expressing variables as means, medians, standard deviations (SD), standard errors (SE) and confidence intervals (CI). An analysis of variance (ANOVA) was done to test for significance between the HIV-infected and non-infected groups in both studies. Partial correlations were done in the infected and non-infected groups to determine associations between dietary / nutrient intake, anthropometry and the biological health variables. In the THUSA study we controlled for age, education level, degree of urbanization and alcohol intake and in the Mangaung study for age, education level and alcohol intake. Nutrient intakes of both infected and non-infected women above and below median values as well as in the first and fourth quartile of total cholesterol (TC) and albumin distribution were compared to assess the role of nutrients in the observed decreases in TC and albumin of HIV-infected women. RESULTS AND DISCUSSION: The dietary intakes of the HIV-infected women in both the studies did not differ significantly from the non-infected women. Total serum cholesterol, albumin, fibrinogen and blood pressure were significantly lower in the HIV-infected women in both the THUSA and Mangaung studies. The non-infected THUSA women with lower serum cholesterol levels (than the median) had significantly lower intakes of percentage energy from fat (25.2 versus 26.4%, p ≤0.027), percentage energy from total protein (11.6 versus 12.1%, p≤0.000), animal protein (25.6 versus 27.7g, p≤0.005), and significantly higher intakes of plant protein (32.2 versus 29.4g, p≤0.002) and fibre (16.9 versus 15.89 p≤0.029). There were no significant differences observed in the nutrient intakes in the infected women with serum cholesterol levels above and below the median. In the Mangaung study no significant nutrient intake differences were observed in both of the HIV-infected and non-infected women with lower and higher than the median TC levels. In the THUSA study, higher intakes of fat (percentage energy) were close to significant (27.3 versus 24.5%, p≤0.053) in the infected women with higher (than the median) albumin levels. In the non-infected group with higher albumin levels, significant differences were observed in percentage energy from fat (26.6 versus 24.9%; p≤0.001) protein (12.2 versus 11.6%; p≤0.001) and carbohydrate (62.8 versus 65.2%; p≤0.000). Higher intakes of saturated fat (SATFAT) (17.7 versus 16.1g, p≤0.008), monounsaturated fats (MUFAT) (19.3 versus 17.4g, p≤0.004) as well as higher intakes of animal protein (28.5 versus 24.4g, p≤0.000) were observed in the group with higher than the median levels of serum albumin. In the Mangaung study the HIV-infected women (with higher than the median serum albumin levels), had significantly higher intakes of energy (13 275 versus 11 622 kJ, p≤0.022), polyunsaturated fatty acids (32.3 versus 17.3g, p≤0.036), dietary cholesterol (412.9 versus 344.5mg, p≤0.043) and plant protein (42.3 versus 35.3g, p≤0.008). No differences were observed in the non-infected women. The further analyses, comparing the dietary intakes in both studies of infected and non-infected women with TC and albumin levels in the first and fourth quartiles, showed that in the THUSA study, non-infected women with lower TC levels had significantly lower intakes of protein (% of total energy), total fat (% of total energy) and vitamin B12 and significantly higher intakes of total energy (TE), plant protein, total carbohydrate, % TE from carbohydrate, dietary fibre, added sugar and thiamine. In the infected women saturated fatty acids (SATFAT), calcium and the fat ratio (polyunsaturated/saturated ratio) differed significantly between women with TC levels in the first and the fourth quartile. A significant higher intake of riboflavin was seen in the non-infected women from Mangaung with TC levels in the fourth quartile, while significant higher intakes of energy, total protein, animal protein, total fat, SATFAT, MUFAT, total carbohydrate, phosphorus, chromium and iodine was seen in the infected women with TC levels in the fourth quartile. These results suggest that a more "westernized" diet with higher intakes of energy, and animal derived foods (SATFAT and calcium) could have protected against the detrimental decreases in TC observed in HIV infection. Significant differences were observed in the intakes in the non-infected THUSA women who had serum albumin in the first and fourth quartiles. lntakes in percentage energy from protein and fat, animal protein, total fat, SATFAT, MUFAT, calcium, zinc, vitamin C and fat ratio, were significantly lower in the women with albumin levels in the first quartile. Significantly higher carbohydrate intakes were observed in the women who had serum albumin levels in the first quartile. In the Mangaung study, significant differences were seen in the intakes between infected women who had serum albumin levels in the first and fourth quartiles. lntakes of total energy, protein, fat, MUFAT, SATFAT, carbohydrate, magnesium, zinc, chromium, biotin, pantothenic acid and iodine were significantly lower in the infected women with serum albumin levels in the first quartile. In the non-infected women significantly lower intakes of calcium were observed in the group who had serum albumin levels in the first quartile compared to those who had serum albumin levels in the fourth quartile. These results also suggest that a more "westernized” diet was associated with higher albumin levels in HIV-infected women. CONCLUSION: It is well known that nutrition has an integral part to play in the care of people living with HIV/AIDS (PLWHA). Maintaining proper nutrition, weight and immune function is thought to delay disease progression, prolong the asymptomatic phase and improve survival. These analyses suggest that the "prudent" diet generally regarded as an optimal diet for prevention of non-communicable diseases, may not be the optimal diet for PLWHA. The overall analyses therefore suggest that a more "westernized" diet, higher in fat and protein could be more beneficial to asymptomatic HIV-infected women compared to that of a more "prudent" diet. As these studies were not primarily designed to investigate HIV and nutrition, the role of a higher energy, fat and animal protein intake ("western" diet) in asymptomatic HIV warrants urgent investigation. / Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007.

Regulary performed exercise may protect against coronary artery disease (atherosclerosis). Fatty meal may influence progression of coronary artery didease, because humans spend too many hours in posprandial state each day. The purpose of this study was to examine the changes in concentration of the blood total cholesterol and body composition after training of wellness aerobics. The study was performed on 21 healthy female subjects aged from 29 to 46 years. The subjects were free from clinical history of bleeding or coagulation disorders, they were healthy. 29 % of subjects were smokers. All subjects were not physically active, they did not do sports for five years. The research was based on antropometrical measures, questionnaires, registration of food allowance, total cholesterol determination in the blood and analysis. Twenty one healthy females followed the wellness aerobics training for 1,5 month and performed 3 training sessions per week. The duration of each session was 45 minutes. Concentration of total cholesterol in the blood and body composition was evaluated before the session of training and after 1,5 month of the wellness aerobics training. The energetical nutritives disbalance was established which manifested in fat and protein overrun and in too scarce amount of carbohydrates. Mathematical statistics method was used to analyse the research data. The significant criterion was p = 0,05. After the wellness aerobics training program was conducted for 1,5... [to full text]

Darbo tikslas: nustatyti, vaistinėse besilankančių pacientų, lipidų apykaitos sutrikimo profilaktikai ir gydymui rekomenduojamų vaistinių preparatų ir maisto papildų suvartojimo tendencijas. Uždaviniai: 1) išanalizuoti statinų grupės preparatų suvartojimą Lietuvoje 2005-2012 metais, naudojant tarptautinę, PSO patvirtintą, vaistų suvartojimo ATC/DDD metodiką ir gautus rezultatus palyginti su kitomis ES šalimis, 2) įvertinti, vaistinėse besilankančių pacientų, lipidogramos rodiklius ir jų dinamiką, vartojant antilipideminius vaistus ir maisto papildus, 3) įvertinti lipidų apykaitos sutrikimo profilaktikai ir gydymui rekomenduojamų vaistų ir maisto papildų atitikimą tarptautinėms rekomendacijoms (NCEP ATP III). Metodika: vaistų, kurie priklauso C10AA (HMG KoA reduktazės inhibitorių) ir C10BX (HMG KoA reduktazės inhibitorių, kitų derinių) pogrupiams, suvartojimas buvo analizuojamas ATC/DDD metodika, išreiškiant duomenis DDD/1000 gyventojų per dieną (DDD/1000 gyv/d). Vaistinėje besilankančių pacientų lipidogramos rodikliai ir vartojami vaistai/maisto papildai buvo vertinami atliekant anketinę apklausą. Surinktų duomenų statistinė analizė atlikta naudojant SPSS programinį paketą, 17,0 versiją. Rezultatai: statinų suvartojimas Lietuvoje padidėjo nuo 3,873 DDD/1000 gyv/d 2005 m. iki 12,787 DDD/1000 gyv/d 2012 m., o išlaidos išaugo nuo 6,19 mln Lt 2005 m. iki 9,12 mln Lt 2012 m. Anketinėje apklausoje dalyvavo 358 pacientai, kurie vaistinėje įsigijo vaistus ir/ar maisto papildus lipidų... [toliau žr. visą tekstą] / Objective of the work: to determine the usage tendencies of the medicinal products and food supplements recommended for prevention and treatment of the disorder of lipid metabolism to the patients coming to the pharmacies. Tasks: 1) to analyze the usage of the products of statin group in Lithuania in 2005-2012 using the international, WHO approved methodology of the medicine usage ATC/DDD, and to compare the results with other EU States, 2) to assess the indexes of lipidogram and their dynamics of the patients coming to the pharmacies, who use antilipidemic medicine and food supplements, 3) to assess the conformity of the medicinal products and food supplements recommended for prevention and treatment of the disorder of lipid metabolism to the international guidelines (NCEP ATP III). Methodology: the usage of the medicine that belongs to the sub-groups of C10AA (HMG CoA reductase inhibitors) and C10BX (Other combinations) was analyzed by the ATC/DDD methodology expressing the data as DDD/1000 inhabitants per day (DDD/1000 inhabitants/d). The indexes of lipidogram and the medicine/food supplements used by the patients coming to the pharmacies were assessed using the survey by questionnaires. The statistical analysis of the collected data was done using the SPSS program package, version 17.0. Results: the usage of statins in Lithuania increased from 3,873 DDD/1000 inhabitants/d in 2005 until 12,787 DDD/1000 inhabitants/d in 2012, while the expenses for statins increased from 6... [to full text]

abstract: There are limited studies exploring the direct relationship between coconut oil and cholesterol concentrations. Research in animals and a few intervention trials suggest that coconut oil increases the good cholesterol (high density lipoprotein, HDL) and thus reduces the risk of cardiovascular disease. Preliminary research at Arizona State University (ASU) has found similar results using coconut oil as a placebo, positive changes in HDL cholesterol concentrations were observed. The goal of this randomized, double blind, parallel two arm study, was to further examine the beneficial effects of a 2g supplement of coconut oil taken each day for 8 weeks on cholesterol concentrations, specifically the total cholesterol to HDL cholesterol ratio, compared to placebo. Forty-two healthy adults between 18-40 years of age, exercising less than 150 minutes each week, non smoking, BMI between 22-35 and not taking any medications that could effect blood lipids were recruited from the ListServs at ASU. Participants were randomized to receive either a placebo capsule of flour or a coconut oil capsule (Puritan’s Pride brand, coconut oil softgels, 2g each) and instructed to take the capsules for 8 weeks. Results indicated no significant change in total cholesterol to HDL ratio between baseline and 8 weeks in the coconut oil and placebo groups (p=0.369), no significant change in HDL (p=0.648), no change in LDL (p=0.247), no change in total cholesterol (p=0.216), and no change in triglycerides (p=0.369). Blood lipid concentrations were not significantly altered by a 2g/day dosage of coconut oil over the course of 8 weeks in healthy adults, and specifically the total cholesterol to HDL ratio did not change or improve. / Dissertation/Thesis / Masters Thesis Nutrition 2017

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-18T22:38:27Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Ediana_Neitzke_Karnopp.pdf: 588486 bytes, checksum: 37d8863a410e5ecbfc776d5502f42d4a (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-18T22:44:37Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Ediana_Neitzke_Karnopp.pdf: 588486 bytes, checksum: 37d8863a410e5ecbfc776d5502f42d4a (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-18T22:44:43Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Ediana_Neitzke_Karnopp.pdf: 588486 bytes, checksum: 37d8863a410e5ecbfc776d5502f42d4a (MD5) / Made available in DSpace on 2018-05-18T22:44:43Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Ediana_Neitzke_Karnopp.pdf: 588486 bytes, checksum: 37d8863a410e5ecbfc776d5502f42d4a (MD5) Previous issue date: 2016-04-01 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Introdução: Evidencia-se um consumo alarmante de alimentos com elevada densidade energética e baixa qualidade nutricional - denominados ultraprocessados - em todas as faixas etárias da população brasileira. Entretanto, os adolescentes são considerados um grupo de risco nutricional, por serem vulneráveis a escolhas de alimentos não saudáveis. O presente estudo teve como objetivo avaliar o consumo de alimentos ultraprocessados e sua relação com o perfil lipídico sérico de adolescentes com 18 anos de idade. Métodos: Estudo transversal aninhado a uma coorte de nascimentos de base populacional. A amostra do estudo foi composta pelos participantes da coorte de nascimentos de 1993 da cidade de Pelotas, RS acompanhados aos 18 anos de idade. A informação de consumo alimentar foi obtida por questionário de frequência alimentar semi-quantitativo, autoplicado em versão eletrônica, com período recordatório de um ano. O grau de processamento dos alimentos foi avaliado conforme a classificação proposta pelo Guia Alimentar para População Brasileira de 2014. O consumo de ultraprocessados foi analisado como percentual de contribuição energética da ingestão diária, categorizado em quintis. Foram obtidas informações sobre o sexo, cor da pele, renda familiar, escolaridade materna ao nascimento, fumo atual, atividade física no lazer, peso e altura. Resultados: 3.846 indivíduos foram incluídos no estudo. Quanto à contribuição no total energético, os alimentos in natura ou minimamente processados contribuíram com 54%, seguido pelos alimentos ultraprocessados (41,4%), ingredientes culinários processados (3,3%) e alimentos processados (2%). As proteínas e as fibras dietéticas apresentaram uma tendência ao declínio conforme o aumento nos quintis de contribuição energética dos alimentos ultraprocessados. O contrário foi observado para a ingestão total de energia, carboidratos e gorduras totais. Em relação aos níveis médios de CT, LDL e HDL foram mais elevados em adolescentes do sexo feminino. Tanto o CT, HDL, LDL e TG associaram-se aos maiores quintis de contribuição energética dos alimentos ultraprocessados. Conclusão: Os resultados deste estudo revelam um impacto negativo do consumo de alimentos ultraprocessados, sobretudo nos níveis de CT e TG e na qualidade nutricional da dieta dos adolescentes aos 18 anos idade. Entende-se que a redução no consumo de alimentos ultraprocessados é um dos caminhos para a promoção da alimentação saudável e da saúde. / Introduction: This study highlights an alarming consumption of foods with high energy density and low nutritional quality - called ultraprocessados - in all age groups of the population. However, teenagers are considered a nutritional risk group because they are vulnerable to unhealthy food choices. This study aimed to evaluate the consumption of ultraprocessados food and its relationship with serum lipid profile in adolescents 18 years of age. Methods: Cross-sectional study nested in a cohort of births. The study sample was composed by participants of the 1993 Birth Cohort in Pelotas, RS followed up to 18 years old. The information of food consumption was obtained by questionnaire semi-quantitative food frequency autoplicado in electronic version, with recall period of one year. The degree of food processing was evaluated according to the classification proposed by the Food Guide for the Brazilian Population 2014. The consumption of ultraprocessados was analyzed as energy contribution percentage of the daily intake, categorized into quintiles. They obtained information about sex, skin color, family income, maternal education at birth, current smoking, physical activity during leisure time, weight and height. Results: 3846 subjects were included in the study. As the contribution to the total energetic, foods fresh or minimally processed contributed 54%, followed by ultraprocessados food (41.4%), processed cooking ingredients (3.3%) and processed foods (2%). Protein and dietary fiber showed a tendency to decline as the increase in energy contribution quintiles of ultraprocessados food. The opposite was observed for total energy intake, carbohydrates and total fat. In relation to average levels of TC, LDL and HDL were higher in female adolescents. Both TC, HDL, LDL and TG were associated to higher quintiles of energy contribution of ultraprocessados food. Conclusion: The results of this study show a negative impact of consumption ultraprocessados food, particularly the levels of TC and TG and nutritional quality of the diet of adolescents to 18 years old. It is understood that the reduction in the consumption of ultraprocessados food is one of the ways to promote healthy eating and health.

Background Patterns of dyslipidemia and incidence of hypertension have been rarely reported in Asian populations with inconsistent findings. To accumulate further evidence in Asian populations, the study aimed to investigate the relationship between lipid profiles and hypertension in Chinese adult males. Methods We conducted a cross-sectional study based on the data from the DATADRYAD database. The overall population was divided into hypertensive and non-hypertensive groups based on baseline blood pressure levels. For continuous variables, Mann-Whitney test was performed between two groups, while Kruskal-Wallis and Dunn tests were used among multiple groups. The chi-square test was carried out for dichotomous variables. Spearman's correlation coefficient was employed to assess the association between systolic blood pressure (SBP), diastolic blood pressure (DBP) and lipid profiles, whereas the relationship between lipid profiles and the incidence of hypertension was evaluated using multivariate logistic regression. The Bayesian network (BN) model was adopted to investigate the relationship between clinical characteristics and hypertension, and the importance of related predictor to the incidence of hypertension was obtained to make conditional probability analysis. Results Finally, totally 62,957 participants were included in this study. In the lipid profiles, total cholesterol (TC), low-density cholesterol (LDL-c), and non- high-density lipoprotein cholesterol (non-HDL-c) were higher in the hypertensive population (p <0.001). In the fully multivariate model, for every 1 mg/dl increase in TC, LDL-c and non-HDL, the risk of hypertension increased by 0.2% [1.002 (1.001–1.003)], 0.1% [1.001 (1.000–1.002)], and 0.1% [1.001 (1.000–1.002)]. Meanwhile, HDL-c became positively associated with the incidence of hypertension (p for trend < 0.001) after adjusting for the body mass index (BMI), and 1 mg/dl increment in HDL-c increased the risk of hypertension by 0.2% [1.002 (1.000–1.002)] after fully adjusting for multiple variables. Furthermore, the BN showed that the importance of age, BMI, fasting plasma glucose (FPG), and TC to the effect of hypertension is 43.3, 27.2, 11.8, and 5.1%, respectively. Conclusion Elevated TC, LDL-c, and non-HDL-c were related to incidence of hypertension in Chinese adult males, whereas triglycerides (TG) was not significantly associated. The relationship between HDL-c and hypertension incidence shifted from no association to a positive correlation after adjusting for the BMI. Moreover, the BN model displayed that age, the BMI, FPG, and TC were strongly associated with hypertension incidence.

Background: Dyslipidemia is strongly associated with the development of hypertension. In our previous study, it was shown that elevated TC, LDL-c, and non-HDL-c were associated with the prevalence of hypertension in Chinese men, whereas the relationship between HDL-c and hypertension shifted from no association to a positive association after adjusting for the BMI. To further accumulate epidemiological evidence in Asian women, this study aimed to investigate the relationship between lipid profile and prevalence of hypertension in Chinese adult women. Methods: This is a cross-sectional study including 54,099 Chinese women aged>20 years at 32 health screening centers in 11 cities from 2010-2016. The original data were obtained from DATADRYAD database (www.datadryad.org). Besides, the overall women were classified into non-hypertensive and hypertensive groups based on baseline blood pressure levels. Differences between the two groups were examined by Man-Whitney test or Chi-square test. Spearman’s correlation coefficient was employed to evaluate the correlation between systolic blood pressure (SBP), diastolic blood pressure (DBP) and lipid profiles. Multivariate logistic regression was performed to estimate the relationship between different lipid levels and the prevalence of hypertension. Odds ratios (ORs) and 95% confidence intervals (CIs) indicated the risk of lipid and hypertension. Bayesian model (BN) model was constructed to further assess the relationship between baseline characteristics and the prevalence of hypertension, as well as the importance of each variable for the prevalence of hypertension. Results: Compared to the non-hypertensive population, the hypertensive population was older, and had the higher body mass index (BMI), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), serum creatinine (Scr), fasting blood glucose (FPG), blood urea nitrogen (BUN), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and non-high-density lipoprotein cholesterol (non-HDL-c), but HDL-c and the presence concerning the family history of diabetes were lower. Multivariate logistic regression analysis revealed that TC, LDL-c, and non-HDL-c showed a positive trend with hypertension risk (p for trend < 0.05) whereas TC and HDL-c were not significantly associated with hypertension prevalence. Moreover, each 1 mg/dl increase in TC, LDL, and non-HDL hypertension prevalence increased by 0.2% [1.002 (1.000-1.003)], 0.2% [1.002 (1.000- 1.004)], and 0.2% [1.002(1.001-1.004)], respectively. BN suggested that the importance of age, BMI, FPG, non-HDL-c on the prevalence of hypertension was 52.73%, 24.98%, 11.22%, and 2.34%, respectively. Conclusion: Overall, in Chinese adult women, TC, LDL-c and non-HDL-c levels were higher and HDL-c level was lower in the hypertensive population, whereas TG did not differ significantly from the non-hypertensive population. Meanwhile, TC, LDL-c, and non-HDL-c were positively associated with prevalence of hypertension, and HDL-c was negatively associated with prevalence of hypertension but became nonsignificant after full adjustment for variables. Moreover, BN model suggested that age, BMI, FPG, and non-HDL-c had a greater effect on the development of hypertension.

Motivation: The prevalence of non-communicable diseases such as diabetes mellitus (DM) and cardiovascular disease (CVD) is rapidly increasing in industrialized societies. Experts believe that lifestyle, and in particular its nutritional aspects, plays a decisive role in increasing the burden of these chronic conditions. Dietary habits would, therefore, be modified to exert a positive impact on the prevention and treatment of chronic diseases of lifestyle. It is believed that the state of hyperglycaemia that is observed following food intake under certain dietary regimes contributes to the development of various metabolic conditions. This is not only true for individuals with poor glycaemic control such as some diabetics, but could also be true for healthy individuals. It would, therefore, be helpful to be able to reduce the amplitude and duration of postprandial hyperglycaemia. Selecting the correct type of carbohydrate (CHO) foods may produce less postprandial hyperglycaemia, representing a possible strategy in the prevention and treatment of chronic metabolic diseases. At the same time, a key focus of sport nutrition is the optimal amount of CHO that an athlete should consume and the optimal timing of consumption. The most important nutritional goals of the athlete are to prepare body CHO stores pre-exercise, provide energy during prolonged exercise and restore glycogen stores during the recovery period. The ultimate aim of these strategies is to maintain CHO availability to the muscle and central nervous system during prolonged moderate to high intensity exercise, since these are important factors in exercise capacity and performance. However, the type of CHO has been studied less often and with less attention to practical concerns than the amount of CHO. The glycaemic index (GI) refers to the blood glucose raising potential of CHO foods and, therefore, influences secretion of insulin. In several metabolic disorders, secretion of insulin is inadequate or impossible, leading to poor glycaemic control. It has been suggested that low GI diets could potentially contribute to a significant improvement of the conditions associated with poor glycaemic control. Insulin secretion is also important to athletes since the rate of glycogen synthesis depends on insulin due to it stimulatory effect on the activity of glycogen synthase. Objectives: Three main objectives were identified for this study. The first was to conduct a meta-analysis of the effects of the GI on markers for CHO and lipid metabolism with the emphasis on randomised controlled trials (RCT's). Secondly, a systematic review was performed to determine the strength of the body of scientific evidence from epidemiological studies combined with RCT's to encourage dieticians to incorporate the GI concept in meal planning. Finally, a systematic review of the effect of the GI in sport performance was conducted on all available literature up to date to investigate whether the application of the GI in an athlete's diet can enhance physical performance. Methodology: For the meta-analysis, the search was for randomised controlled trials with a cross-over or parallel design published in English between 1981 and 2003, investigating the effect of low GI vs high GI diets on markers of carbohydrate and lipid metabolism. The main outcomes were serum fructosamine, glycosylated haemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), total cholesterol (TC) and triacylglycerols (TG). For the systematic review, epidemiological studies as well as RCT's investigating the effect of LGI vs HGI diets on markers for carbohydrate and lipid metabolism were used. For the systematic review on the effect of the GI on sport performance, RCT's with either a cross-over or parallel design that were published in English between January 1981 and September 2004 were used. All relevant manuscripts for the systematic reviews as well as meta-analysis were obtained through a literature search on relevant databases such as the Cochrane Central Register of Controlled Trials, MEDLINE (1981 to present), EMBASE, LILACS, SPORTDiscus, ScienceDirect and PubMed. This thesis is presented in the article format. Results and conclusions of the individual manuscripts: For the meta-analysis, literature searches identified 16 studies that met the strict inclusion criteria. Low GI diets significantly reduced fructosamine (p<0.05), HbA1c, (p<0.03), TC(p<0.0001) and tended to reduce LDL-c (p=0.06) compared to high GI diets. No changes were observed in HDL-c and TG concentrations. Results from this meta analysis, therefore, support the use of the GI concept in choosing CHO-containing foods to reduce TC and improve blood glucose control in diabetics. The systematic review combined the results of the preceding meta-analysis and results from epidemiological studies. Prospective epidemiological studies showed improvements in HDL-c concentrations over longer time periods with low GI diets vs. high GI diets, while the RCT's failed to show an improvement in HDL-c over the short-term. This could be attributed to the short intervention period during which the RCT's were conducted. Furthermore, epidemiological studies failed to show positive relationships between LDL-c and TC and low GI diets, while RCT's reported positive results on both these lipids with low GI diets. However, the epidemiological studies, as well as the RCT's showed positive results with low GI diets on markers of CHO metabolism. Taken together, convincing evidence from RCT's as well as epidemiological studies exists to recommend the use of low GI diets to improve markers of CHO as well as of lipid metabolism. 3 From the systematic review regarding the GI and sport performance it does not seem that low GI pre-exercise meals provide any advantages over high GI pre-exercise meals. Although low GI pre-exercise meals may better maintain CHO availability during exercise, low GI pre-exercise meals offer no added advantage over high GI meals regarding performance. Furthermore, the exaggerated metabolic responses from high GI compared to low GI CHO seems not be detrimental to exercise performance. However, athletes who experience hypoglycaemia when consuming CHO-rich feedings in the hour prior to exercise are advised to rather consume low GI pre-exercise meals. No studies have been reported on the GI during exercise. Current evidence suggests a combination of CHO with differing Gl's such as glucose (high GI), sucrose (moderate GI) and fructose (low GI) will deliver the best results in terms of exogenous CHO oxidation due to different transport mechanisms. Although no studies are conducted on the effect of the GI on short-term recovery it is speculated that high GI CHO is most effective when the recovery period is between 0-8 hours, however, evidence suggests that when the recovery period is longer (20-24 hours), the total amount of CHO is more important than the type of CHO. Conclusion: There is an important body of evidence in support of a therapeutic and preventative potential of low GI diets to improve markers for CHO and lipid metabolism. By substituting high GI CHO-rich with low GI CHO-rich foods improved overall metabolic control. In addition, these diets reduced TC, tended to improve LDL-c and might have a positive effect over the long term on HDL-c. This confirms the place for low GI diets in disease prevention and management, particularly in populations characterised by already high incidences of insulin resistance, glucose intolerance and abnormal lipid levels. For athletes it seems that low GI pre-exercise meals do not provide any advantage regarding performance over high GI pre-exercise meals. However, low GI meals can be recommended to athletes who are prone to develop hypoglycaemia after a CHO-rich meal in the hour prior to exercise. No studies have been reported on the effect of the GI during exercise. However, it has been speculated that a combination of CHO with varying Gl's deliver the best results in terms of exogenous CHO oxidation. No studies exist investigating the effect of the GI on short-term recovery, however, it is speculated that high GI CHO-rich foods are suitable when the recovery period is short (0-8 h), while the total amount rather than the type of CHO is important when the recovery period is longer (20-24 h). Therefore, the GI is a scientifically based tool to enable the selection of CHO-containing foods to improve markers for CHO and lipid metabolism as well as to help athletes to prepare optimally for competitions. Recommendations: Although a step nearer has been taken to confirm a place for the GI in human health, additional randomised, controlled, medium and long-term studies as well as more epidemiological studies are needed to investigate further the effect of low GI diets on LDL-c. HDL-c and TG. These studies are essential to investigate the effect of low GI diets on endpoints such as CVD and DM. This will also show whether low GI diets can reduce the risk of diabetic complications such as neuropathy and nephropathy. Furthermore, the public at large must be educated about the usefulness and application of the GI in meal planning. For sport nutrition, randomised controlled trials should be performed to investigate the role of the GI during exercise as well as in sports of longer duration such as cricket and tennis. More studies are needed to elucidate the short-term effect of the GI post-exercise as well as to determine the mechanism of lower glycogen storage with LGI meals post-exercise. / Thesis (Ph.D. (Dietetics))--North-West University, Potchefstroom Campus, 2005.