京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18130号 / 医博第3850号 / 新制||医||1001(附属図書館) / 30988 / 京都大学大学院医学研究科医学専攻 / (主査)教授 佐藤 俊哉, 教授 横出 正之, 教授 中山 健夫 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

BACKGROUND: Microvascular dysfunction (MD: impaired performance of blood flow, tissue perfusion, blood pressure, etc.) is one of the earliest stages in the progression of various chronic diseases. OBJECTIVE: The aim of this study was to determine if a difference in microvascular function existed between two metabolically healthy groups that differed in BMI and waist circumference. DESIGN: This study employed a causal comparative design, with two groups: I) normal weight (n =14, BMI 28 kg/m2). METHODS: Microvascular function was assessed by measuring skin blood flow (SkBF) using laser Doppler flowmetry during postocclusive reactive hyperemia (PORH). The area under the SkBF time curve during the 60-second PORH response was used to quantify the magnitude of the microvascular response. RESULTS: Group I (control) had a significantly higher average area under the SkBF time curve (3240 ± 879) than Group II (1948 ± 808) (Z= -3.0094, p = 0.0026). CONCLUSIONS: The overweight/obese subjects exhibited a diminished skin blood flow response to occlusion compared to their normal-weight counterparts. This supports the hypothesis that overweight/obese subjects who are otherwise metabolically healthy exhibit a biological change that is linked to chronic disease.

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Submitted by Alison Vanceto (alison-vanceto@hotmail.com) on 2017-08-24T12:16:41Z No. of bitstreams: 1 DissROM.pdf: 1802563 bytes, checksum: 8a20822e115118f79c74001c251e9156 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-09-05T19:51:30Z (GMT) No. of bitstreams: 1 DissROM.pdf: 1802563 bytes, checksum: 8a20822e115118f79c74001c251e9156 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-09-05T19:51:38Z (GMT) No. of bitstreams: 1 DissROM.pdf: 1802563 bytes, checksum: 8a20822e115118f79c74001c251e9156 (MD5) / Made available in DSpace on 2017-09-05T19:57:23Z (GMT). No. of bitstreams: 1 DissROM.pdf: 1802563 bytes, checksum: 8a20822e115118f79c74001c251e9156 (MD5) Previous issue date: 2017-02-15 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objective: The aim of the present study was to investigate associations between abdominal obesity/dynapenia/dynapenic abdominal obesity and a single fall/recurrent falls as well as determine the effect size of such associations using two cutoff points for dynapenia. Methods: A cross-sectional study was conducted with 1.063 older adults pertaining to the third wave of the Saúde, Bem Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. Abdominal obesity was defined as a waist circumference of >102 cm for men and > 88 cm for women. The following were the cutoff points for dynapenia: grip strength < 30 kg for men and < 20 kg for women or < 26 kg for men and < 16 kg for women. Dynapenic abdominal obesity was defined by the combination of abdominal obesity and dynapenia. Regarding the outcome, the individuals were classified as non-fallers, single fallers or recurrent fallers. Socioeconomic, neuropsychiatric and environmental factors as well as living habits, polypharmacy, health status and functionality were the control variables in the multinomial regression models. Results: Adopting a cutoff point of 30/20, only one association was found: dynapenic abdominal obesity and a single fall (RRR = 2.37; 95% CI: 1.48-3.80). However, adopting a cutoff point of 26/16, dynapenic abdominal obesity (RRR = 1.93; 95% CI: 1.09-3.44), abdominal obesity (RRR = 1.65; 95% CI: 1.08-2.52) and dynapenia (RRR = 1.77; 95% CI: 1.01-3.13) were associated with a single fall, with a larger effect size of the association with dynapenic abdominal obesity than the other two conditions. Moreover, dynapenia defined using the 26/16 cutoff point was associated with recurrent falls (RRR = 2.39; 95% CI: 1.19-4.82). Conclusions: The cutoff point used to define dynapenia affects associations between abdominal obesity/dynapenia/dynapenic abdominal obesity and a single fall/recurring falls. A cutoff point of 26/16 is better for identifying such associations. / Objetivo: Investigar a associação de obesidade abdominal (OA), dinapenia e obesidade abdominal dinapênica (OA/D) com queda única e quedas recorrentes, assim como o tamanho do efeito de tais associações, adotando duas notas de cortes para dinapenia. Método: Estudo transversal com 1.063 idosos provenientes da terceira onda do Estudo SABE. OA foi definida como circunferência de cintura > 102 cm para homens e > 88 cm para mulheres. As notas de corte para dinapenia foram: força de preensão manual < 30 kg para homens e < 20 kg para mulheres ou < 26 kg para homens e < 16 kg para mulheres. OA/D foi definida pela associação de OA e dinapenia. Quanto ao desfecho, os idosos foram classificados como não caidores, caidores únicos ou recorrentes. Fatores socioeconômicos, neuropsiquiátricos, ambientais, hábitos de vida, polifarmácia, estado de saúde e funcionalidade foram variáveis de controle nos modelos de regressão multinomial. Resultados: Adotando a nota de corte 30/20, encontramos somente a associação entre OA/D e queda única (RRR = 2,37 IC 95% 1,48–3,80). Em contrapartida, adotando a nota de corte 26/16 tanto a OA/D (RRR = 1,93 IC 95% 1,09–3,44), quanto a OA (RRR = 1,65 IC 95% 1,08–2,52) e a dinapenia (RRR = 1,77 IC 95% 1,01–3,13) associaram-se à queda única, sendo o tamanho do efeito da associação maior com OA/D do que com as duas condições isoladas. Além disso, a dinapenia definida com o corte 26/16 associou-se com quedas recorrentes (RRR = 2,39 IC 95% 1,19–4,82). Conclusões: A nota de corte adotada para definir dinapenia modifica as associações de OA, dinapenia, OA/D com queda única e recorrente, sendo o corte 26/16 melhor para identificá-las. / FAPESP: 2015/18291-7

Introdução: O excesso de tecido adiposo, tanto global quanto abdominal, tem se associado com o desenvolvimento de comorbidades, sendo a hipertensão arterial sistêmica (HAS) uma das mais importantes. Objetivos: O objetivo deste estudo foi determinar a influência de categorias de índice de massa corpórea (IMC) e de medida de cintura abdominal (CA) na ocorrência de HAS. Sujeitos e Métodos: Fizeram parte deste estudo transversal 1.584 indivíduos, com idades entre 18 e 64 anos (44,6% homens, idade média de 33,1 anos), funcionários de um hospital de grande porte de São Paulo, Brasil. Medida principal do desfecho: A HAS foi definida como sendo a medida da pressão arterial &#8805; 140/90 mmHg e/ou o uso de medicação anti-hipertensiva. O efeito do IMC e da CA sobre a pressão arterial foi estudado através de modelos de regressão logística, ajustados para potenciais variáveis de confusão. Foi calculado também aproximações do risco atribuível populacional (RAP) de HAS relacionado ao IMC e a CA. Resultados: A prevalência de HAS foi de 18,9%, sendo 26,9% no sexo masculino e 12,5% no sexo feminino. Foi observada uma tendência linear de associação entre as categorias de IMC e HAS, sendo que, tomando-se como base os indivíduos com IMC < 22,5, as razões de chance para a ocorrência de HAS foram de 2,1, 3,8 e 12 para homens com IMC de 22,5 a 25, de 25 a 30 e &#8805; 30, respectivamente. Para mulheres esses valores foram de 1,6, 2,3 e 8,7, respectivamente. As razões de chance de HAS associadas a valores elevados de IMC se mantiveram significativas mesmo após o controle para CA. Os modelos de regressão logística construídos para CA indicaram razões de chance para a ocorrência de HAS de 2,2 e 5,9 para homens com CA entre 94 e 102 e &#8805; 102 cm, respectivamente. Para mulheres com CA de 80 a 88 e &#8805; 88 cm esses valores foram de 1,1 e 4,2, respectivamente. As razões de chance se mantiveram significativas mesmo após a inclusão do IMC nesses modelos. Na divisão por quartis do IMC e da CA foi observada a mesma tendência linear de associação com a HAS. O cálculo do RAP indicou que valores elevados de IMC (&#8805; 22,5) determinavam 73% da ocorrência de HAS em homens, sendo 8%, 31% e 34% dessa ocorrência atribuível a IMC de 22,5 a 25, de 25 a 30 e &#8805; 30, respectivamente. Para mulheres esses valores foram de 55%, 8%, 15% e 32%, respectivamente. Da mesma forma, valores elevados de CA em homens (&#8805; 94 cm) determinavam 50% da ocorrência de HAS, sendo 14% e 36% nos indivíduos com CA entre 94 e 102 cm e &#8805; 102 cm, respectivamente. Em mulheres esses valores foram de 44%, 2%, e 42% para medidas de CA &#8805; 80 cm, entre 80 e 88 cm e &#8805; 88 cm, respectivamente. Conclusão:Foi possível demonstrar relações, independentes de potenciais fatores de confusão, entre as categorias de IMC e de medida da cintura abdominal e a ocorrência de HAS. Essas relações se mantiveram significativas quando o IMC era ajustado para CA e quando a CA era ajustada para IMC, indicando que tanto o excesso de tecido adiposo abdominal quanto o excesso de tecido adiposo global representavam riscos para o desenvolvimento da HAS. Foi demonstrado também que o excesso de tecido adiposo, global e abdominal, responderam por grande parte da ocorrência de HAS em homens e mulheres e que valores de IMC comumente considerados como normais (22,5 a 24,9) já representam risco para o desenvolvimento de HAS. / Introduction: The excess of adipose tissue, global as much as abdominal, has been associated with development of comorbidities, which case systemic arterial hipertension (SAH) is one of the most important. Objectives: The aim of this study was to evaluate the relationship between categories of body mass index (BMI) and waist circumference (WC) on SAH. Subjects and Methods: A cross sectional analysis was conducted of 1,584 subjects aged 18 to 64 years (44,6% men, mean age 33,1 years) of a great hospital’s employees of Sao Paulo, Brazil. Principal outcome: The SAH was defined as blood pressure levels &#8805; 140/90 mmHg and/or use of anti-hypertensive medication. Logistic regression models, adjusted for potential’s confusion factors, studied the correlation between BMI and WC on SAH. The population attributable risk (PAR) of SAH related to BMI and WC was also calculated. Results: Prevalence of SAH was 18.9%, wich 26.9% in male and 12.5% in female. A linear trend relationship between categories of BMI and HAS was observed, and based in individuals with BMI < 22.5, odds ratio for HAS were 2.1, 3.8 and 12 for men with BMI from 22.5 to 25, 25 to 30 and &#8805; 30, respectively. For women these values were 1.6, 2.3 and 8.7, respectively. Odds ratio for HAS associated with high values of BMI remained significant, even after adjustement for WC. Logistic regression’s models for WC showed odds ratio for HAS of 2.2 and 5.9 for men with WC from 94 to 102 and &#8805; 102 cm, respectively. For women with WC from 80 to 88 and &#8805; 88 cm these values were 1.1 and 4.2, respectively. Odds ratios remained significant after inclusion of BMI in these models. A same linear trend relationship with SAH was observed in division for quartiles for BMI and WC. Calculation of RAP indicated that high values of BMI (&#8805; 22.5) determined 73% of occurrence of SAH in men and 8%, 31% and 34% of this occurrence were attributable to BMI from 22.5 to 25, 25 to 30 and &#8805; 30, respectively. For women these values were 55%, 8%, 15% and 32%, respectively. In the same way, high values of WC in men (&#8805; 94 cm) determined 50% of occurrence of SAH, which case 14% and 36% of this occurrence in individuals with WC from 94 to 102 cm and &#8805; 102 cm, respectively. In women these values were 44%, 2%, and 42% for WC &#8805; 80 cm, from 80 to 88 cm and &#8805; 88 cm, respectively. Conclusion: It was possible to demonstrate relationships, independent of potential’s confusion factors, between categories of BMI and waist circumference and occurrence of SAH. These relationships remained significant when BMI was adjusted for WC and when WC was adjusted for BMI, showing that excess of abdominal adipose tissue as much as excess of global adipose tissue represented a risk for development of SAH. It was also demonstrated that excess of adipose tissue, global and abdominal, was responsible for great part of occurrence of SAH in men and women and BMI from 22,5 to 24,9, commonly consider as normal, already represented a risk on development of SAH.

Submitted by William Justo Figueiro (williamjf) on 2015-07-06T23:00:32Z No. of bitstreams: 1 06a.pdf: 1506093 bytes, checksum: 4f15fdde7bba98d9df70cc71d508411e (MD5) / Made available in DSpace on 2015-07-06T23:00:32Z (GMT). No. of bitstreams: 1 06a.pdf: 1506093 bytes, checksum: 4f15fdde7bba98d9df70cc71d508411e (MD5) Previous issue date: 2012-07-30 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / UNISINOS - Universidade do Vale do Rio dos Sinos / Introdução: A prática regular de atividades físicas, principalmente no período da adolescência, pode resultar em um estilo de vida fisicamente ativo na idade adulta, assim como diminuir a ocorrência de problemas cardiometabólicos. Objetivo: Verificar a associação entre atividades físicas realizadas em diferentes períodos da vida, da adolescência à idade adulta, e obesidade abdominal em mulheres trabalhadoras de turnos. Métodos: Estudo de caso-controle não pareado realizado em 2011 com 541 mulheres trabalhadoras de turnos (215 casos; 326 controles), de 18 a 53 anos de idade, de uma empresa no sul do Brasil. Mulheres com circunferência da cintura ≥88 centímetros foram consideradas casos. Exposição à atividade física foi avaliada por um questionário com informações de atividades de lazer, deslocamento, doméstico e trabalho no campo em quatro períodos da vida. Para a análise foi utilizada a regressão logística não condicional. Resultados: A média da circunferência da cintura foi 97,5cm (desvio padrão [DP]:±8,5cm) nos casos e 78,7 (DP:±5,7cm) nos controles, e para a idade, a média foi 35,2 anos (DP:±8,6 anos) e 32,6 anos (DP:±8,4 anos), respectivamente. As atividades de lazer foram mais predominantes no período da adolescência com significativa redução na idade adulta tanto para os casos como controles. Após ajuste para fatores demográficos, socioeconômicos e ocupacionais, verificou-se que as mulheres com obesidade abdominal apresentaram uma chance 50% menor (Razão de Odds [OR]=0,50; Intervalo de Confiança de 95% [IC95%]:0,27 - 0,93;p=0,029) de terem praticado cinco ou mais atividades físicas quando comparadas às que praticaram uma ou nenhuma atividade física. Não foi identificada diferença nas atividades físicas de deslocamento, doméstico e de trabalho no campo entre casos e controles. Conclusões: Exposição a um maior número de atividades físicas de lazer na adolescência pode oferecer proteção para obesidade abdominal na vida adulta, mesmo que haja redução das atividades ao longo da vida. / Introduction: The practice of regular physical activity, especially during adolescence, may result in a physically active lifestyle in adulthood, as well as reduce the occurrence of cardiometabolic problems. Objective: To investigate the association between physical activities performed in different periods of life, from adolescence to adulthood, and abdominal obesity in women working shifts. Methods: A non-matched case-control study carried out in 2011 with 541 women (215 cases, 326 controls) from 18 to 53 years of age, of an industry in southern Brazil. Women with waist circumference ≥88cm were considered cases. Exposure to physical activity was assessed by a questionnaire with information on leisure-time, transport, housework and rural work in four periods of life. The non-conditional logistic regression was used for analysis. Results: The mean of the waist circumference was 97.5cm (standard deviation [SD]: ±8.5cm) in cases and 78.7 (SD: ±5.7cm) in controls, and for age, the average was 35.2 years (SD: ±8.6 years) and 32.6 years (SD: ±8.4 years), respectively. Leisure-time physical activities were most prevalent during adolescence with a significant reduction in adulthood for both cases and controls. After adjustment for demographic, socioeconomic and occupational factors, it was found that women with abdominal obesity had a 50% lower chance (Odds Ratio [OR]=0.50; 95% Confidential Interval [95% CI]: 0.27 to 0.93; p-value=0.029) of having practiced five or more physical activities than those who practiced of one or no physical activity. No difference was observed in the physical activities of transport, housework and rural work between cases and controls. Conclusions: Exposure to a greater number of leisure-time physical activities in adolescence may provide protection for abdominal obesity in adulthood, even with reduced of physical activity throughout life.

Made available in DSpace on 2014-07-29T15:25:17Z (GMT). No. of bitstreams: 1 TESE ANA TEREZA.pdf: 2294961 bytes, checksum: ffd0798a9fedc7ba17064d061bcc48d7 (MD5) Previous issue date: 2011-11-24 / Introduction: parallel to the malnutrition, overweight, and especially abdominal fat, contribute to worse clinical outcomes in hemodialysis patients. Objective: To assess the prevalence and factors associated with malnutrition and abdominal obesity in hemodialysis (HD) patients. Methodology: cross sectional study with 344 patients over 18 years old. The dependent variables, malnutrition and abdominal obesity were obtained by the subjective global assessment (SGA) and waist circumference, respectively. The independent variables involved socioeconomic, demographic, lifestyle, medical history factors, energy and macronutrients intake. It was calculated the body mass index (BMI) and midarm muscle circumference (MAMC), body fat by the sum of four skinfolds (triceps, biceps, subscapular and suprailiac), serum albumin and creatinine. A statistical package Stata 8.0 was used. Student t test, Mann Whitney, chi-square and multiple Poisson regression, with a hierarchical model were used. The considered the level of significance was < 0.05. Results: the group was composed mostly by males (59,30%), with average age of 49.33 ± 13.76 years old and prevalence of moderate malnutrition in 22.4%, with no statistically significant difference between sexes (p=0,929). Malnourished patients had lower BMI, MAMC, % body fat, serum creatinine, p <0.001 and nPNA (p = 0.001). The following variables remained associated with malnutrition: age of 19 to 29 years (PR = 1.23, CI = 1.06 to 1.43), family income <2 minimum wages (PR = 1.13, CI = 1.01 -1.27), duration on HD &#8805; 60 months (PR = 1.08, CI = 1.01 to 1.16), Kt / V &#8805; 1.2 (RP = 1.12, CI = 1.03 1.22), caloric intake below 35 kcal / kg / day (PR = 1.22, CI = 1.10 - 1.34) and nPNA<1 (PR = 1.13, CI = 1.05 to 1.21). The prevalence of obesity was 44.77% (n=154). It was more prevalent in women (55.71%) than men (37.25%), p = 0.001. The end result of the multivariate analysis identified four factors independently associated with abdominal obesity in men: age over 40 years (PR = 1.22; 95%CI: 1.09 -1.37), economic class D/E (PR = 0.78, 95%CI: 0.68 - 0.90), duration on hemodialysis between 24 to 59 months (PR = 1.12; 95%CI: 1.001-1.26) and BMI &#8805; 25kg/m² (PR = 1.52; 95%CI 1.40 -1.65) and three factors in women: age over 40 years (PR = 1.43; 95%CI:1.27-1.60), protein intake below 1,2 g/kg/day (PR= 1.21; 95%CI= 1.05 - 1.39) and BMI &#8805; 25kg/m² (PR=1.37; 95%CI:1.26 1.49). Conclusion: There was a high prevalence of malnutrition and abdominal obesity in the population studied. The age below 29 years, low family income, longer hemodialysis period and inadequate protein and caloric intake were the factors associated with malnutrition. In the abdominal obesity, age over 40 years and overweight were associated in both men and women. In men belonging to lower socioeconomic classes and duration on hemodialysis between 2 and 5 years and women with protein intake below the recommended were also associated with abdominal obesity, emphasizing the importance of nutritional intervention because the inadequate food intake, a modifiable risk factor, was crucial in both situations. / Introdução: ao lado da desnutrição, o excesso de peso e, especialmente, a gordura abdominal, contribuem para piores desfechos clínicos em pacientes em hemodiálise. Objetivo: avaliar a prevalência e os fatores associados à desnutrição e à obesidade abdominal em pacientes em hemodiálise (HD). Metodologia: estudo transversal com 344 pacientes maiores de 18 anos. As variáveis dependentes, desnutrição e obesidade abdominal foram obtidas, respectivamente, pela avaliação subjetiva global (ASG) e pela circunferência da cintura. As independentes envolveram fatores socioeconômicos, demográficos, estilo de vida, história clínica, ingestão energética e macronutrientes. Foram calculados o índice de massa corporal (IMC), a circunferência muscular do braço (CMB) e a gordura corporal pelo somatório das quatro dobras cutâneas (triciptal, biciptal, subescapular e suprailíaca); Analisou-se os níveis séricos de albumina, creatinina, ureia pré e pós hemodiálise. Realizou-se teste t de Student, Mann Whitney, qui-quadrado e regressão de Poisson múltipla, a partir de modelo hierárquico, com nível de significância 5% pelo pacote estatístico Stata/SE, 8,0. Resultados: grupo composto por maioria do sexo masculino (59,30%), idade média de 49,33 ± 13,76 anos e prevalência de desnutrição moderada em 22,4%, sem diferença estatisticamente significativa entre os sexos (p=0,929). Pacientes considerados desnutridos apresentaram menor IMC, CMB, gordura corporal, creatinina sérica (p<0,001) e nPNA (p=0,001). As seguintes variáveis permaneceram associadas à desnutrição: idade de 19 a 29 anos (RP=1,23; IC=1,06-1,43), renda familiar < 2 salários mínimos (RP=1,13; IC=1,01-1,27), tempo em HD &#8805; 60 meses (PR=1,08; IC=1,01-1,16), Kt/V &#8805; 1,2 (RP=1,12; IC=1,03-1,22), ingestão calórica inferior a 35 kcal/kg/dia (RP=1,22; IC=1,10-1,34) e nPNA < 1 (RP=1,13; IC=1,05-1,21). Já a prevalência de obesidade abdominal foi de 44,77% (n=154) sendo mais prevalente nas mulheres (55,71%) em relação aos homens (37,25%), p= 0,001. O resultado final da análise multivariada identificou quatro fatores independentemente associados à obesidade abdominal em homens: idade superior a 40 anos (RP= 1,22; IC= 1,09 1,37), classe social D/E (RP= 0,78; IC= 0,68 0,90), tempo em hemodiálise entre 24 59 meses (RP=1,12; IC= 1,001 1,26) e IMC &#8805; 25 kg/m² (RP= 1,52; IC 1,40 1,65) e três fatores nas mulheres: idade nas faixas superiores a 40 anos (RP= 1,43; IC=1,27 1,60), ingestão proteica inferior a 1,2 g/kg/dia (RP= 1,21; IC= 1,05 1,39) e IMC &#8805; 25 kg/m² (RP= 1,37; IC= 1,26 1,49).Conclusão: observou-se alta prevalência de desnutrição e de obesidade abdominal na população estudada. Idade inferior a 29 anos, renda familiar baixa, maior tempo em tratamento de hemodiálise e ingestão calórica e proteica inadequadas foram os fatores associados à desnutrição. Na obesidade abdominal, a idade superior a 40 anos e o excesso de peso avaliado pelo IMC foram associados em homens e mulheres. Nos homens pertencer a classes econômicas mais baixas e tempo em tratamento de hemodiálise entre 2 e 5 anos e nas mulheres ingestão proteica inferior ao recomendado também associaram à obesidade abdominal, ressaltando a importância da intervenção nutricional, já que a ingestão alimentar inadequada, um fator de risco modificável, foi determinante nas duas situações.

BACKGROUND: The prevalence and burden of cardiovascular disease (CVD) is a concern. While CVD events will occur later in a woman’s life, modifiable risk factors for CVD occur earlier during adult years. While, there is strong evidence linking modifiable risk factors to CVD, the influence of the work environment on CVD risk is poorly understood. OBJECTIVES: The study objectives were to: 1) determine the prevalence of cardiovascular risk indicators; 2) determine the relationships between work patterns and lifestyle behaviours in female hospital workers; 3) determine the relationships between work patterns and cardiovascular risk indicators; and 4) determine the relationships between work patterns, lifestyle behaviours and cardiovascular risk while controlling for covariates. METHODS: Participants were female hospital workers (N= 466) from 2 hospital sites in Southeastern Ontario. Cardiovascular risk data were obtained through anthropometric measurements, blood sampling and self-report. Work pattern data were collected through self-report and linked with hospital administrative work data. Lifestyle behaviour data were obtained through self-report using validated questionnaires. Metabolic syndrome was classified in accordance with the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) (III) guidelines. RESULTS: Approximately 1 in 4 female participants had the metabolic syndrome, with elevated waist circumference being the most common CVD risk factor. After adjustments, the multivariate analysis found a few key significant associations between irregular work patterns, specifically extended shifts and CVD risk, specifically elevated systolic and diastolic blood pressure. However, consistent with the literature, the bivariate analyses revealed that after 6 or more years of shift work, female workers were more likely to develop the metabolic syndrome (OR 1.9, 95% CI 1.12, 3.17) and abdominally obesity (OR = 2.0, 95% CI, 1.31, 3.11). CONCLUSIONS: The findings from this study suggest that generally work patterns do not influence the development of unhealthy behaviours and cardiovascular risk factors, although a few key exceptions exist. Further research is needed to elucidate the mechanisms linking harmful and protective work pattern characteristics to CVD risk. Given the prevalence of abdominal obesity and overall CVD risk, hospital decision makers need to consider cardiovascular health within healthy workplace initiatives as the healthcare workforce is aging. / Thesis (Master, Nursing) -- Queen's University, 2009-09-24 18:39:03.718

Studies in both children and adults indicate that waist circumference (WC), a measure of abdominal obesity is closely related to cardiovascular risk factors. The accurate identification of abdominally obese children in health screening programmes for early intervention is of importance. There are, however, concerns about using international definitions for screening purposes because in most instances these have been derived from Western populations and, therefore, may have limited usefulness to children in other parts of the world. When these cut–off points are used in developing countries, they ignore the fact that the growth patterns of children and burdens of disease vary between countries. Due to lack of population specific cut–off points for children in the developing world it may be tempting and convenient to use the same cut–off points as for children in developed countries, but such a practice runs the risk of exporting failure. Ideally, a screening tool should have both high sensitivity and specificity, and these are important considerations in choosing the definition for the detection of childhood abdominal obesity. High sensitivity is necessary to avoid failure of identifying obese children and high specificity of the screening tool ensures that non–obese children are not misclassified as obese, which may otherwise lead to unnecessary treatment and psychosocial implications of stigmatisation. Failure to identify the abdominally obese child may have more serious consequences than misclassification, since it results in an increase in adult morbidity and mortality. Therefore, the main aim of this thesis was to examine fat distribution patterns of black South African (SA) children in relation to health risk. The specific objectives were to: compare the body composition of black stunted and non–stunted children from two rural communities in South Africa; to describe and compare the age and sex specific WC percentile distribution for black SA children from different study populations and compare the WC percentile distribution with those for African–American (A–A) children and to assess the diagnostic accuracy of waist–to–height ratio (WHtR) as a marker for high blood pressure, a cardiovascular risk factor in SA children. Findings of this study demonstrated increased total adiposity in non–stunted children, but trends of increased central adiposity, measured as WHtR in stunted children. This warrants further investigation on this relationship among children older than 13 years in the African context where many children are stunted. The differences observed between the different data sets and between SA and A–A children suggest that nationally representative data should be used to develop age, sex and ethnic specific WC percentiles for this population. The results indicate clearly that the median WC of children from SA studies is smaller than those of A–A children, with a medium to large effect size for the difference. Results also suggest concern with respect to high WC values (> 80 cm) among some children. The recommended universal WHtR cut–off value of 0.5 for assessment of cardiovascular risk is not suitable for black SA children because it had low sensitivity in predicting high blood pressure. The absence of locally developed cut–off values for WC and WHtR for children warrants research due to the associations between being overweight and obese and disease outcomes. It is fundamental to detect risk at an early stage so that appropriate intervention can be initiated timeously. / Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2011.