abstract: Background: Higher intake of carbohydrates in the evening and later eating times has been associated with higher total energy intake (TEI)1-3 and higher risk of being overweight or obese.1,4 Though existing evidence indicates a link between added sugars intake and increased body mass index (BMI), the effect of daily patterns of added sugars intake on TEI and BMI is unknown. Research on added sugars has relied on self-report dietary assessments with limited days of dietary data, resulting in unreliable estimates. The purpose of this thesis was to describe patterns of added sugars consumption, and to investigate the relationship between dietary sugars, eating patterns, TEI, and BMI using 15-days of dietary data from a feeding study. Methods: 40 participants age 18 to 70 years completed a 15-d highly controlled feeding study which imitated their normal diet, while recording meal times. Meals and snacks were coded based on participant identified, time-of-day, and meal content specific criteria. All consumed foods and beverages were carefully weighed and entered into the Nutrition Data System for Research (NDSR) for analysis. Pearson correlation, independent t-test, one-way repeated measures analysis of variance (ANOVA) with post hoc tests, and multiple linear regressions were used to investigate the association between patterns of added sugars and energy intake, as well as eating frequency (EF), with TEI and BMI. Results: 15-d median added sugars intake was 9.7% of total calories. The highest contribution to added sugars intake (% of g/d) came from snacks (44%) in women and from afternoon (39%) consumption in men. The highest contribution to TEI came from dinner (30%) and afternoon (34%) consumption in women, and from lunch (31%) or dinner (30%) and afternoon (35%) consumption in men. Total eating occasion (EO) frequency had a negative association with TEI (r = -0.31) and no association with % energy from added sugars. In multivariate regression models, besides sex, % energy from beverages only (Adjusted R2 = 0.41) and % added sugars from dinner (Adjusted R2 = 0.39) were significant predictors of TEI, while none of the variables were associated with BMI. Conclusion: Changing one’s pattern of eating, (EF and % energy from beverages only and % added sugars from dinner), may reduce TEI, potentially reducing BMI. / Dissertation/Thesis / Masters Thesis Nutrition 2019

The purpose of this investigation was to expand the evaluation of Normal Weight Obesity (NWO) and its association with insulin resistance using a nationally representative sample of U.S. adults. A cross-sectional study including 5,983 subjects was conducted. Body fat percentage was assessed using dual energy X-ray absorptiometry (DXA). Expanded Normal Weight Obesity (eNWO) categories (pairings of BMI and body fat percentage classifications) were determined by standard cut-points for BMI and the gender specific median for body fat percentage. Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) levels were used to index insulin resistance. Mean ± SE values were as follows: BMI: 27.9 ± 0.2 (women) and 27.8 ± 0.1 (men); body fat percentage: 40.5 ± 0.2 (women) and 27.8 ± 0.2 (men); HOMA-IR: 2.04 ± 0.05 (women) 2.47 ± 0.09 (men). HOMA-IR differed systematically and in a dose-response fashion across all levels of the eNWO categories (F = 291.3, P < 0.0001). As BMI levels increased, HOMA-IR increased significantly and within each BMI category, higher levels of body fat were associated significantly with higher levels of HOMA-IR. Both high BMI and high body fat percentage are strongly related to insulin resistance. In this study, insulin resistance increased incrementally according to BMI levels primarily and body fat levels secondarily. Consequently, due to the costs associated with precisely measuring body fat, and the accuracy of using BMI independently, we recommend that BMI be used in its standard form to predict insulin resistance and not be supplemented with an estimate of body fat.

Few studies about elevated blood pressure in the U.S. military exist in which researchers examined exposure to combat and its association with elevated blood pressure. The purpose of this quantitative research was to describe the extent of association between those who were exposed to combat deployment, were 40 or older, and were overweight or obese and had elevated blood pressure for U.S. military personnel who deployed to an area of declared combat between 2012 and 2017. The conceptual basis of this research was best represented by the determinants of health model. Chi-square correlation revealed that being older (equal to or greater than 40 years; p = .018) and being overweight/obese (body mass index [BMI] equal to or greater than 25; p = .000) both have statistically significant relationships with elevated blood pressure (either systolic blood pressure equal to or greater than 120 mm/hg or diastolic blood pressure equal to or greater than 80 mm/hg) among military personnel, while combat deployment does not (deployment > 30 days; p =. 487). However, only being overweight/obese remained significant even when controlling for exposure to combat deployment and being older. Binary logistic regression revealed that elevated blood pressure/hypertension is greater than three times more likely to occur in the presence of the overweight/obese predictor (BMI equal to or greater than 25; p =. 000) variable. The findings of this research could be used to proactively enforce medically derived appropriate medical fitness standards such as maintenance of normal BMI during deployments. Social adaptations could be instrumental in improving wellness among deployed military personnel.

The World Health Organization noted that 2 global health problems have reached epidemic proportions: obesity and type 2 diabetes. These conditions affect nearly 170 million people worldwide. The clinical practice problem addressed by this project was the prevalence of adults ages 50 and older in an ambulatory care setting who suffer from obesity and diabetes and may benefit from a tailored weight management and nutrition education intervention. The purpose of this project was to design a program that would decrease body mass index and hemoglobin A1c in older patients through adaption of the Chronic Disease Self-Management Program. The evidence supporting this project was obtained through a systematic literature review. The self-efficacy theory guided the project, and the evidence-based practice model used to plan the translation of the evidence into practice was the plan-do-check/study-act cycle, a continuous process improvement model used in many health care settings. The product of the project was an education intervention implementation plan that will be agreed upon by the project team and tracked using a Gantt chart. The program's effectiveness will be evaluated by analyzing the themes of qualitative feedback from patients who complete the program and through comparisons using t test statistics of body mass index and A1c that will be collected at 12 weeks and 12 months after the program start. The social change expected of this program, when implemented, is an increase in patients' engagement in and self-management of their care and a more trusting relationship among patients and the health care team. The recommendations from this project also may be useful in addressing health disparities often experienced by patients suffering from obesity and diabetes.

Body fat, regional body fat and bone mineral mass, are linked to health conditions such as obesity and osteoporosis. The ethnic comparison of body composition may help to explain and understand the difference of health outcomes and health status in different ethnic groups. NZ Chinese is the largest Asian group in New Zealand, however, knowledge about health risks and body composition for NZ Chinese is very limited. Therefore, the aims of this thesis were: 1) To compare the relationships between body mass index (BMI) and percentage body fat (%BF) of European (M29, F37), Maori (M23, F23), Pacific people (M15, F23), and Asian Indian (M29, F25) (existing data) with NZ Chinese aged 30-39 years; 2) To compare fat distribution, appendicular skeletal muscle mass (ApSM), bone mineral density (BMD) and limb bone lengths across these five ethnic groups. A convenience sample of healthy NZ Chinese (M20, F23) was selected by BMI to cover a wide range of body fatness. Total and regional body fat, fat free mass (FFM) and bone mineral content were measured by whole-body Dual-energy X-ray absorptiometry (DEXA). The main study findings were: • For a fixed BMI, NZ Chinese had a higher %BF than European and less %BF than Asian Indian. At a %BF equivalent to a BMI of 30 kg.m-2 in Europeans (WHO threshold for obesity), BMI values for Asian Indian and NZ Chinese women were 5.8 and 2.2 BMI units lower than European, respectively, and for Asian Indian and NZ Chinese men, 8.2 and 3.0 BMI units lower. • Abdominal-to-thigh fat ratio of NZ Chinese was significantly higher than that of European (P<0.001) and similar to that of Asian Indian. NZ Chinese had a significantly higher central-to-appendicular fat ratio than both Asian Indian and European (P<0.001). NZ Chinese was centrally fatter than European and Asian Indian. • For the same height and weight, NZ Chinese had significantly less FFM (-2.1 kg, P=0.039) and ApSM (-1.4kg, P=0.007) than European. NZ Chinese had significantly more FFM (+3.2 kg, P=0.001) than Asian Indian and similar ApSM to Asian Indian. • For the same weight, NZ Chinese had a similar BMD as European for female and male. NZ Chinese male had a higher BMD (+0.07 g.cm-2, P= 0.001) than Asian Indian male. • Among the five ethnic groups, NZ Chinese had the shortest leg (-1.5cm, P=0.016) and arm bone lengths (-2.3cm, P=0.001) (measured by DEXA) for the same DEXA height. Therefore, the relationship between percent body fat and BMI for Asian Indian and NZ Chinese differs from Europeans and from each other, which indicates that different BMI thresholds for obesity may be required for these Asian ethnic groups. Given the relatively high percentage body fat, low appendicular skeletal muscle mass and high central fat to appendicular fat ratio of NZ Chinese aged 30-39 years demonstrated in this study, promotion of healthy eating and physical activity is needed to be tailored for NZ Chinese. The NZ Chinese community should be advised to keep fit, prevent limited movements in older age, and to prevent obesity and obesity-related diseases.

<p>Syftet med uppsatsen är att undersöka matvanorna hos Lilla Edets åttonde klassare och den påverkan de har på deras vardag. Finns det ett samband mellan frukostvanor och BMI? Tidigare forskning har visat att sunda frukostvanor motverkar övervikt. Min avsikt är att se om jag kan finna liknande samband bland Lilla Edets åttondeklassare. Jag avser även att söka efter samband mellan sunda matvanor och prestationsförmåga i skolan samt vilken kunskap respondenterna har om kost. Slutligen avser jag att studera vilka skillnader som finns mellan de båda könen. För att få en uppfattning om i vilken riktning utvecklingen är på väg har jag valt GÖTE-ÄLV studien som referensobjekt. Det är en enkätundersökning som utfördes 1996 bland regionens alla åttondeklassare. Av den anledningen har jag valt att utgå ifrån samma enkät med vissa omarbetningar. De mest intressanta resultaten av undersökningen var att medelvärdet på BMI hos respondenterna låg kvar på samma nivå som i GÖTE-ÄLV studien för elva år sedan. Att det inte fanns något samband mellan frukostvanor och BMI. Att skillnaderna mellan könen fortfarande är stora. Och slutligen att andelen som äter frukost varje dag har minskat.</p>

This thesis explores race and gender differences in perceptions and behaviors regarding weight and obesity, along with the relative influence of individual and structural factors on the personal weight status of black and white adults. In addition, this study examines the extent to which black and white adults differ in their perceptions of discrimination attributed to their personal weight. Based on an analysis of data from a national poll conducted by ABC News and TIME magazine, results indicate that weight status perceptions of overweight black females were consistent, while incongruity was found in perceived and actual weight status among obese black women. On the other hand, a greater proportion of obese white women under-assessed their weight status compared to obese black women. However, regardless of race, men were more likely to under-assess their weight than women. There were no differences by race and gender in reports of having felt discriminated against because of personal weight status. Findings also revealed that black females and males face greater constraints than their white counterparts related to controlling weight and fighting obesity, including such factors as a lack of information on how to establish good eating habits, the need to monitor food content, and being able to afford the cost of purchasing healthy food. A discussion of these findings in relation to previous research is provided along with recommendations for further study.

Regular aerobic exercise may reduce cardiovascular disease (CVD) risk in part by lowering the concentration of inflammatory markers such as C-reactive protein (CRP). While studies in diseased populations have shown significant decreases in CRP concentrations with regular aerobic training, little has been conclusively determined regarding the effects of aerobic training on CRP concentrations in apparently healthy, untrained populations who may not be adequately screened for CVD risk by traditional methods. PURPOSE: To examine the effects of a 17-wk half marathon training program (TP) on CRP concentrations, aerobic fitness, and body composition in apparently healthy, untrained men. METHODS: Twenty men (29.3 ± 1.0 yr, 37.0 ± 1.6 mL•kg-1•min-1 VO2max, 29.1 ± 1.8% body fat) registered as training subjects (TRN) in a 17-wk half marathon TP. An additional 22 men (27.8 ± 1.4 yr, 38.8 ± 1.0 mL•kg-1•min-1 VO2max, 26.8 ± 1.4% BF) served as controls (CON). Fasting blood samples were taken at four time points over the TP and were analyzed for CRP and interleukin-6 (IL-6) concentrations. Aerobic capacity (VO2max) and body fat (BF%) were measured before and after the TP. RESULTS: No significant changes in CRP (P=0.69) or IL-6 concentrations (P=0.73) were seen in TRN as a result of the TP despite significant improvements in VO2max (42.2 ± 1.9 ml•kg-1•min-1, P<0.0001), resting heart rate (P =0.004), BF% (P =0.03) and BMI (P =0.05). No significant changes in CRP, aerobic fitness, BMI or BF% were detected in CON over time. CONCLUSION: Moderate, long-term aerobic training does not appear to affect CRP concentrations in apparently healthy, untrained men despite significant improvements in BW, BF%, BMI, and VO2max.

This dissertation was designed to determine the effects of body mass index (BMI) and walking speed on activity monitor outputs. A secondary purpose was to compare the activity monitors’ performance in a free-living environment. In the first experiment, 71 participants wore three waist-mounted activity monitors (Actical, ActiGraph, and NL-2000) and an ankle-mounted device (StepWatch 3) while walking on a treadmill (40, 67 and 94 m/min). The tilt angle of each device was measured. The Actical recorded 26% higher activity counts (P < 0.01) in obese persons with a tilt <10 degrees, compared to normal weight persons. The ActiGraph was unaffected by BMI or tilt angle. In the second experiment, the steps recorded by the devices were compared to actual steps. Speed had the greatest influence on the accuracy these devices. At 40 m/min, the ActiGraph was the least accurate device for normal weight (38%), overweight (46%) and obese (48%) individuals. The Actical, NL-2000 and StepWatch averaged 65%, 73% and 99% of steps taken, respectively. Lastly, several generations of the ActiGraph (7164, GT1M, and GT3X), and other research grade activity monitors (Actical; ActivPAL; and Digi-Walker) were compared to a criterion measure of steps. Fifty-six participants performed treadmill walking (40, 54, 67, 80 and 94 m/min) and wore the devices for 24-hours under free-living conditions. BMI did not affect step count accuracy during treadmill walking. The StepWatch, PAL, and the AG7164 were the most accurate across all speeds; the other devices were only accurate at the faster speeds. In the free-living environment, all devices recorded about 75% of StepWatch-determined steps, except the AG7164 (99%). Based on these findings, we conclude that BMI does not affect the output of these activity monitors. However, waist-borne activity monitors are highly susceptible to under-counting steps at walking speeds below 67 m/min, or stepping rates below 100 steps/min. An activity monitor worn on the ankle is less susceptible to these speed effects and provides the greatest accuracy for step counting.

To date there are no studies focusing on the relationship between subjective social status (SSS) and weight perceptions among young people. This study aims to fill this gap in current available literature by examining associations between youth’s family SSS and individual SSS with their gender, race, body mass index (BMI), and weight perceptions. Questionnaires and BMI data were collected from 1,171 youth participating in the 2008 Global Finals of Destination ImagiNation (DI) hosted by the University of Tennessee. Participants ranged in ages 11 to 18 years. Regression analyses indicated that gender, race and individual SSS were significant predictors of BMI. Gender was the only significant predictor of underweight perceptions, while gender, race, and individual SSS were predictors of overweight perceptions. Results for outcomes based on two grade levels, middle school and high school, are also discussed. Findings have implications of gender and racial differences for BMI and weight perception status. Lastly, individual SSS within the school community was a significant predictor of both BMI and overweight perception.