O objetivo deste trabalho foi descrever a prevalência de diferentes estados nutricionais de crianças e adolescentes brasileiros, identificando a tendência do comportamento do baixo peso, do sobrepeso e da obesidade ao longo de um período de seis anos. Este estudo de tendência foi realizado com uma amostra voluntária de 37.801 escolares, provenientes do banco de dados do Projeto Esporte Brasil (PROESPBr). A amostra foi agrupada em três períodos de tempo (I= 2005-2006; II= 2007-2008; e, III= 2009 a 2011) e por idades (crianças: 7 a 10 anos, e adolescentes: 11 a 14 anos), além de, estratificada por sexo. A massa corporal e a estatura foram avaliadas pelos professores nas escolas, e o índice de massa corporal (IMC) foi calculado posteriormente. O IMC foi classificado em baixo peso, eutrófico, sobrepeso e obesidade, conforme os critérios propostos por Conde e Monteiro (2006). Para verificação da associação entre os períodos de tempo e as categorias do perfil nutricional foi utilizado o teste do qui-quadrado de Pearson e na identificação da tendência da prevalência do baixo peso, do sobrepeso e da obesidade, ao longo dos últimos seis anos, recorreu-se ao teste de Regressão Logística Multinomial (em ambos procedimentos o nível de significância foi de 5%). Os resultados apontaram, no baixo peso, uma probabilidade da ocorrência diminuir significativamente nos adolescentes do sexo masculino do ano de 2005-06 para 2007-08, e uma probabilidade da prevalência aumentar significativamente nas crianças do sexo feminino entre o ano de 2007-08 para 2009-11, embora em todas as categorias de idade e sexo, as ocorrências tenham sido menores que 5%. Observamos no sobrepeso, uma probabilidade da ocorrência aumentar do período I para o II (2005-2006 para 2007-2008), nas crianças do sexo masculino, e prevalências sempre próximas a 20% nas demais categorias de idade e sexo. Encontramos, além disso na obesidade, uma probabilidade da prevalência aumentar significativamente do período I para o II em todas as categorias de idade e nos dois sexos, sendo que não foi observado uma permanência do aumento. Entretanto as ocorrências, tanto no sobrepeso como na obesidade, permaneceram elevadas no último período avaliado (2009 a 2011), indicando possivelmente um platô das prevalências. No entanto, a população de crianças e adolescentes brasileiros é composta por aproximadamente 30% de casos com sobrepeso e obesidade. Esses resultados apontam a importância da continuidade de investigações sobre o perfil nutricional de crianças e adolescentes e demonstram a necessidade de um planejamento de ações que proporcionem uma reversão desses achados. / The aim of this study was to analyze the prevalence of different nutritional status among Brazilian children and adolescents (male and female), from the identification of underweight, overweight and obesity behavior trends in a period of six years. This trend study was performed with a voluntary sample of 37.801. Data was obtained from the PROESP-Br (Brazil Sport Project) database. Sample was clustered in three periods of time (I=2005-2006; II= 2007-2008; and III=2009 to 2011), in two age groups (children: 7 for 10 years old and adolescents: 11 to 14 years old), and stratified for sex. The weight and height was measured for teachers at school during physical education class and body mass index (BMI) was calculated. BMI was stratified in underweight, eutrophic, overweight and obesity, according with Conde and Monteiro (2006) criteria. To assess the association between time periods and nutritional profile categories, we used the Pearson chi-square test and to identify of trends in underweight, overweight and obesity prevalence were conducted using multiple logistic regression (overall α level of 5%).. Results showed, of underweight, a significant prevalence decrease probability in male adolescents in 2005-06 to 2007-08 and increase in female children in 2007-08 to 2009- 11, although in all categories of age and sex, the occurrences have been less than 5%. We observed in the overweight, an occurrence increase probability in period I to II (2005-2006 to 2007-2008) in male children, and prevalence close to 20% in the others age and gender categories. Also, we found an occurrence increase probability in obesity in the period I to II in all age categories and both sexes, but remained stable until the last period study (2009 -2011). This possibly indicates a plateau in prevalence. However, the population of Brazilian children and adolescents is composed of approximately 30% of cases of overweight and obesity. The results show the importance of continuing investigations about nutritional status of children and adolescents and demonstrate the need for action planning to provide a reversal of these findings.

O objetivo deste estudo foi avaliar a prevalência de cárie dentária e sua associação com índice de massa corpórea (IMC), bem como seus fatores de risco demográficos (sexo e idade), socioeconômicos, familiares (escolaridade dos pais, número de filhos) e comportamentais (dieta e práticas de higiene bucal) de crianças e adolescentes. Duzentos e trinta e sete crianças e adolescentes foram inseridos neste estudo. Após a autorização de participação, aplicou-se um questionário, realizou-se exame clínico intrabucal das crianças e a coleta dos dados antropométricos. Os parâmetros analisados neste estudo foram peso, altura, IMC-para-idade e número de dentes cariados, extraídos e obturados para posterior cálculo do ceo-d ou CPO-D para dentes decíduos e permanentes, respectivamente. Teste do Qui-quadrado e o teste T foram usados para analisar a associação entre as variáveis (idade, etnia, gênero, hábitos de higiene bucal e alimentar) e alterações do IMC. A média e desvio padrão do índice ceo-d nos grupos de baixo peso, peso normal, grupos de sobrepeso e obesidade, foram de 9.5 (± 0.70), 5.06 (± 4.54), 7.66 (± 4.41), e 6 (± 5.19), respectivamente (p>0,05). A porcentagem de indivíduos que estavam com a dentição hígida foi de 13,5%. Houve uma associação entre prevalência de cárie e etnia (p<0,05), indivíduos de cor branca e parda apresentaram maiores índices de cárie do que os indivíduos pretos. Características sociodemográficas como escolaridade materna e paterna não influenciaram na experiência de cárie das crianças e adolescentes (p>0,05). Em relação aos hábitos alimentares na primeira infância, o tempo de aleitamento materno não influenciou na experiência de cárie (p>0,05), por outro lado, o açúcar acrescido na mamadeira esteve associado à doença cáries (p<0,05). A escovação diária realizada somente pela criança, sem supervisão dos pais ou responsáveis, foi significativamente associada com a cárie. Não houve associação entre cárie dentária e IMC. / The aim of this study was to evaluate the prevalence of dental caries and its association with body mass index (BMI), as well as their demographic risk factors (gender and age), socioeconomic, family (parents\' education, number of children) and behavioral (diet and oral hygiene practices) of children and adolescents. Two hundred and thirty-seven children and adolescents 3-15 years treated were entered into this study at the Ribeirão Preto Dental School - USP. After the authorization of participation, we applied a questionnaire and an intraoral clinical examination of children was held and the collection of anthropometric data. The parameters analyzed in this study were weight, height, BMI-for-age and number of decayed teeth extracted and sealed for subsequent calculation of the dmft and DMFT for deciduous and permanent teeth, respectively. It was used the Chi-square test and T test to analyze the association between variables (age, ethnicity, gender, oral hygiene and dietary habits) and changes in BMI. The mean and standard deviation of the DMFT in groups of underweight, normal weight, overweight and obese groups were 9.5 (± 0.70), 5:06 (± 4:54), 7.66 (± 4:41), and six (± 5.19), respectively (p> 0.05). The percentage of subjects who were healthy female with the teeth was 13.5%. There was an association between caries prevalence and ethnicity (p <0.05), white and brown colored individuals had higher caries rates than black individuals. Sociodemographic characteristics such as maternal and paternal schooling did not influence the caries experience of children and adolescents (p> 0.05). With regard to eating habits in early childhood, the duration of breastfeeding did not affect the caries experience (p> 0.05), on the other hand, sugar plus the bottle was associated with caries disease (p <0.05). Daily brushing performed only by the child without supervision of parents or guardians, was significantly associated with caries. There was no association between dental caries and BMI.

Class of 2013 Abstract / Specific Aims: To assess the impact that exercise-type has on diabetes control through improvement in monitoring parameters such as hemoglobin A1c and fasting blood glucose. Methods: Studies were selected using a study inclusion tool and then data was extracted using the data extraction tool. The primary outcomes assessed were BMI and HbA1c. The standardized mean difference (SMD) was the main summary measure and the I2 statistic ¬¬¬¬¬¬was used to assess variability among the studies. Main Results: Ten studies met inclusion criteria (Total N = 1,787). The age range of patients was 40-66 years old with equal amounts of male and female participants. Aerobic and resistance exercise were effective (p < 0.01) in reducing A1c; Tai Chi was not (p = 0.50). Aerobic exercise did not have a significant effect on BMI (p = 0.07), however Tai Chi and Resistance exercise did (p<0.04). Conclusion: Aerobic and resistance exercise produced a significant reduction in HbA1c, whereas Tai Chi did not. The non-significant impact aerobic exercise had on BMI was probably due to large variation between the studies. No significant differences were found between the different forms of exercise and their overall impact on diabetes control. Based upon the data incorporated in this meta-analysis, it is reasonable for patients with diabetes mellitus type 2 to use aerobic or resistance exercise to improve their HbA1C. However, it remains to be seen whether recommending specific exercise types over others will provide increased benefit.

Severe maternal morbidity generally refers to the most severe complications of pregnancy and includes: hemorrhage, embolism, acute renal failure, stroke, acute myocardial infarction, and other complications. These complications affect more than 50,000 women in the United States every year, with rates significantly increasing from 1998 to 2011. In an effort to reduce these increasing complication rates, clinicians and researchers have emphasized the need to identify potential modifiable risk factors for severe maternal morbidity, and the need to study the relationships between these risk factors and severe maternal morbidity. The overall goal of this study is to improve the understanding of the increasing rates of severe maternal morbidity. The objective of the first study is to examine the association between prepregnancy BMI and severe maternal morbidity in women residing in Florida who had a live birth during 2007-2014. Additionally, the specific association between prepregnancy BMI and the most common individual conditions that comprise the composite measure of severe maternal morbidity will also be examined. We conducted a population-based retrospective cohort study using Florida’s linked birth certificate and maternal hospital discharge data for the years 2007-2014. The risk of severe maternal morbidity associated with BMI was then estimated by odds ratios (OR) and 95% confidence intervals (CI) derived using generalized estimating equations (GEE) for logistic regression. This final model was rerun separately for the most common conditions that comprise severe maternal morbidity as the outcome measure to assess differences by type of condition. Unadjusted rates of severe maternal morbidity increased with increasing BMI; however, after risk adjustment overweight and obese women had slightly protective odds of severe maternal morbidity when compared with normal weight women. The association between prepregnancy BMI and severe maternal morbidity differs by types of severe maternal morbidity. A protective dose-response relationship was seen for blood transfusion and disseminated intravascular coagulation, with the odds of morbidity decreasing with increasing BMI. The odds of heart failure, adult respiratory distress syndrome, and ventilation all increased with increasing BMI. This study shows that severe maternal morbidity is a complex measure and not just a single condition. In future studies, it will be imperative to analyze severe maternal morbidity as a composite measure and as individual conditions to identify modifiable risk factors to focus on for interventions. The objective of the second study is to identify potential determinants of the increase in the rate of severe maternal morbidity among women residing in Florida who had a live birth during 2005-2014. We examined severe maternal morbidity rates and related risk factors in live births to Florida women between 2005 and 2014, using Florida’s linked birth certificate and hospital discharge data. We initially conducted a Kitagawa analysis to evaluate the components of the increased rate of severe maternal morbidity between 2005 and 2014. Additionally, we performed a multivariable regression analysis to estimate the contribution of the multiple factors to differences in the rate of severe maternal morbidity in 2005 and 2014. The rate of severe maternal morbidity in 2014 was 19.3 per 1,000 live births, which was 1.65 times higher than the rate in 2005. Nearly all of the excess severe maternal morbidity and blood transfusions in 2014 can be explained by differences in the rate of severe maternal morbidity and blood transfusion between the two time periods. In total, sociodemographic factors, medical factors, and individual and hospital health service factors explained 9.1% of the overall severe maternal morbidity increase in 2014 compared with 2005, and only explained 2.5% of the increase in blood transfusions during this time period. Our study findings indicate that the increase in the rate of severe maternal morbidity is comprised almost entirely by an increase in the rate of blood transfusions. Further research will need to be conducted to explain the increase in the rate of severe maternal morbidity and blood transfusions. Consistent with national trends, the rates of severe maternal morbidity have been increasing in Florida. This increase is driven almost entirely by blood transfusions and cannot be explained by traditional factors that are readily available in current datasets. In addition to the differences between the trends of blood transfusions and the 20 severe maternal morbidity conditions, there are also differences in risk factors associated with these different conditions. Prepregnancy overweight and obesity is associated with a protective effect with blood transfusions and disseminated intravascular coagulation that is not seen in the other conditions. Therefore, initiatives to decrease the rates of severe maternal morbidity will need to take these differences into account.

Incidence and prevalence of obesity is increasing worldwide. According to current trends, there is a high risk of pandemy of obesity in 21. century. WHO announced 1 bilion of obese people worldwide. In the majority of countries in Europe the prevalence of obesity is about 10-25%. Obesity has very negative impact on the public health, quality of life but also very high economic burden. The economic cost on obesity achieve 5% of teh whole healthcare cost in EU and 12% in the USA. Assumption of the direct and indirect cost was 32,8 bilion Euros in EU. It comes up to 0,3% of HDP. The aim of my analysis is to estimate direct cost on the healthcare in the direct connection with obesity in Czech Republic.

Magister Artium (Social Work) - MA(SW) / Globally childhood obesity is becoming an epidemic, which is resulting in a generation of children who will live a shorter life expectancy than their parents. Researchers claim that overweight and obesity in school going children is on the rise with very few publications that have examined its significance and prevalence in South Africa. Recent research indicates that parenting styles are a contributing factor towards children’s weight status and obesegenic behaviours (such as eating patterns). Recent studies have identified a gap in this area where more informed research needs to be conducted on this topic. The aim of this study was to investigate the relationship between parenting styles and BMI scores of school children in low and high socio economic areas. A quantitative cross sectional study, with correlational, comparative research design was conducted. This study used a multi stage sampling procedure which included convenient sampling and cluster sampling to identify the areas as well as the schools relevant to the study. The sample size consisted of all the grade 2 learners in the 4 randomly selected schools (200 male and 166 female learners) with a primary care giver (366). The final sample consisted of 366 learners and 366 primary caregivers from the 4 different schools which provided a final sample of 732 participants. The parents completed the Parenting Style and Dimensions Questionnaire (PSDQ) and the BMI of the children was manually taken. Findings of the study show that authoritative parenting styles are higher in high socio economic areas but this style of parenting has a higher prevalence in both socio economic areas when compared to the other parenting style typologies. Furthermore the BMI scores in low socio economic areas were documented as being more in line with the WHO growth curves assigned to that age group as compared to the high socio economic areas that did not meet those growth curve markers. There was no clear correlation identified between the parenting style and increased BMI scores.

Indiana University-Purdue University Indianapolis (IUPUI) / Obesity is a medical condition whose rates have seen a rise in both the United States and worldwide in recent decades. Numerous studies have been done to understand obesity, and through the use of GWAS researchers have been able to find multiple genetic factors that can contribute to obesity in mammals. One proposed cause of obesity are genetic impacts on cilia formation in the CNS, which causes downstream effects on food intake and energy expenditure, causing obesity via overeating and decreased activity. In the first half of this thesis, I describe a study, in collaboration with the Berbari Lab at IUPUI, that explored the human chromosome 16:53801550-53808600 (GRCh37/hg19), an intron of the FTO alpha-ketoglutarate Dependent Dioxygenase (FTO) gene for transcriptional regulators that impact BMI and obesity. First, using control DNA, PCR, and gel-electrophoresis, we created an assay for 44 primer sets (forward and reverse) covering the genomic region. After optimizing the assay, we then selected 111 human DNA samples across three weight groups (underweight, normal weight, and obese) to sequence using the assay. The samples were selected from subjects enrolled in the Walsh Lab FDP study. Sequencing was completed using the Illumina MiSeq System, and sequenced results were viewed using the Integrative Genomics Viewer (IGV) program. Variants that showed in the results were analyzed across and within the weight groups, and their locations were researched for previously known BMI or enhancer activity using online genome browsers Ensembl and UCSC Genome Browser. The results of this study revealed two SNPs, rs8055197 and rs11642015, that provided the best correlation with the weight categories among the samples. These results were consistent with literature that previously linked these single-nucleotide polymorphisms (SNPs) to obesity, particularly in relation to genes that are regulated by FTO (CUX1, POMC, and IRX3/5). Both SNPs lie within areas that show high enhancer activity in neural crest cells, important cells for cilia formation. Although there were SNPs in high LD within both regions, these two SNPs were chosen due to their homologous variant locations within the mouse genome (rs8055197 - GRCm38/mm10 8:91376305; rs11642015 - GRCm38/mm10 8:91375651), which provides a means of testing this obesity correlation, with a proposed enhancer relationship through FTO, in mouse models. In the second half of this thesis, I explored new methods for quantitatively defining natural hair color categories, and attempted to find novel SNPs impacting hair color in a GWAS using the quantitative values as phenotypes. In previous publications, the development and validation of the HIrisPlex-S Prediction Tool for hair prediction was made using categorical hair colors, which were defined and classified by individual researchers or lab personnel. Using spectrophotometer measurements and HSV color values, we used a machine-learning tool to objectively classify sample hair photos into natural hair color classes. We then used this quantitative data as the input phenotype for a GWAS, using both linear regression and linear mixed model regression, to search for new genetic associations with these objectively defined hair color classes. Lastly, we also measured correlations between these hair color phenotypes and a SNP array consisting of all currently known pigment SNPs cited in recent literature. The results of this study showed that quantitative values can be used as a means of classifying human hair colors. Both models used in the GWAS highlighted previously known SNPs that contributed to quantitative hair color. By utilizing the linear mixed model approach which has the ability to generate more power due to the normalization of hidden population structure, there was one near genome-wide significant SNP found that is currently not linked with hair color, rs2037697 (IQUB), which showed strong associations with light brown hair (p-value = 1.83192E-07), however this would need to be confirmed with increased numbers to validate its association. The results of the correlation analysis showed that SNPs cited as having impacts on pigmentation (eye, skin, and hair) also show strong associations with these objectively defined quantitative hair color classes and these rankings may prove very useful as the field moves towards quantitative hair color prediction.

Powerlifting is the sport of maximal effort of back squat, bench press and deadlift. The purpose of this study was to identify the ideal body composition of female powerlifters. Body composition measurements were taken on the day of competition on women who competed in a raw powerlifting meet in United States Powerlifting Federation using bioelectrical impedance analysis. Participants’ powerlifting experience ranged from novice to world-class lifters. One hundred ninetyive women completed the study and ages ranged from 18 to 75 years old. Mean body fat percentage (BF%) of all powerlifters was 31.21% and body mass index was 26.68. Results showed an increase in BF% as weight classes increased from 47 kg to 84+ kg weight class. Novice lifters had 34 BF% and elite lifters had 31.1 BF% Women who had a high BF% could lift more based on their powerlifting total. Body composition varied among the women powerlifters.

Anovulation accounts for approximately 12 percent of all female infertility in the United States. Prior studies suggest women with high body mass index (BMI) have an increased risk of infertility, particularly obese women with abnormal cycle lengths. To date no studies have examined the relationship between measures of adiposity, including BMI and percent body fat measured by DXA scan (%BF), and anovulation among women with regular menstrual cycles assessed with biomarkers. We evaluated this association using data from the BioCycle study, a prospective cohort of 259 women with regular menstrual cycles. All measures of adiposity and covariates were collected at baseline. Anovulation was assessed via luteinizing hormone and progesterone levels in urine samples collected 16 times throughout two menstrual cycles. A total of 34 women had at least one anovulatory cycle during the study. Unadjusted models for BMI show a significant decrease in risk comparing highest BMI quartile to the lowest, (OR: 0.29; 95% CI .090-.968). Once multivariable logistic regression was used to adjust for age no significant associations were found in any BMI quartile, but point estimates did not change significantly. Similar trends were found using other measures of adiposity. Results show that there is a non-significant inverse trend between adiposity and anovulation in healthy women with regular menstrual cycles. This relationship can possibly be explained by age due to the influence of time since menarche (TSM). Further research is needed to examine this relationship.

BACKGROUND: Since 2010, nurses in Massachusetts public schools have conducted state-mandated Body Mass Index (BMI) screening of first, fourth, seventh, and tenth graders and communicated results in a letter to parents/caregivers. The objective of this study was to explore parents’ responses to the BMI letter and their experiences with weight-related language used by health professionals. These two areas were examined in the context of parents’ health literacy skills and readability of the letter. METHODS: Readability of the letter was calculated using five common formulas. One-hour focus groups were conducted using a semi-structured interview guide with a convenience sample of parents/caregivers of 8- to 14-year-old obese children participating in a weight management program. Parents were asked to share reactions to 10 weight terms in random order. Parents also completed a written version of the Newest Vital Sign (NVS) health literacy assessment. Focus group data were transcribed verbatim, and content analyses conducted to identify emergent themes. Descriptive statistics were calculated for NVS scores. RESULTS: Reading-level estimates of the BMI letter ranged from fifth to seventh grade. Twenty-nine individuals participated in eight focus groups (83% female, mean age 41 yrs+9 yrs, 59% self-identified as Hispanic/Latino). NVS scores for 12 participants (41%) indicated a possibility (n=7) or high likelihood (n=5) of limited health literacy. “Emotions” emerged as a major theme. Parents expressed concern, guilt, fear, anger, rationalization, skepticism, and acceptance regarding the letter and weight-related terms. Parents had mixed reactions to the letter: finding the information helpful, voicing concern about privacy and self-esteem, and displaying confusion when interpreting the weight status. A majority (67%) of parents who expressed confusion about the letter or weight terminology received an NVS score indicating a possibility or high likelihood of limited health literacy. Among the weight terms, parents preferred weight, weight problem, and unhealthy weight more than obese or extremely obese. CONCLUSIONS: This is the first known study to evaluate how parents respond to and comprehend the Massachusetts BMI letter. Emergent themes could be used to inform quantitative assessment of communication challenges associated with the letter. This study has implications for respectfully and effectively communicating BMI results nationwide.