In the summer of 2003, David Cutler, Edward Glaeser, and Jesse Shapiro published the paper, “Why Have Americans Become More Obese?”1 In the paper, the authors explore changing trends in American weight and caloric intake over time and hypothesize as to the potential causes of these changes. In performing our tests, we hope to both replicate their results and update any analysis for the present.

Background: While the provision of adequate nutrition support in critically ill patients has been shown to have an impact on short-term clinical outcomes, relatively little is known about subsequent long-term outcomes. We aimed to examine the association between nutritional adequacy and long-term outcomes including survival and health-related quality of life (HRQoL) in critically ill patients requiring prolonged mechanical ventilation. Methods: The study was conducted as a retrospective cohort study on data collected prospectively in the context of a multicenter randomized controlled trial (RCT) in critically ill patients. Randomized patients who stayed in the intensive care unit (ICU) and were mechanically ventilated for >8 days were eligible for the study, but only six-month survivors were considered for the assessment of HRQoL. Nutritional adequacy was obtained from the average proportion of prescribed calories received during the first eight days of mechanical ventilation in the ICU. Survival status and HRQoL as assessed using Short-Form 36 Health Survey (SF-36) were obtained prospectively as part of the RCT protocol at three-months and six-months post ICU admission. Results: Of the 1223 patients enrolled in the randomized controlled trial, 475 met the inclusion criteria for this study. At six-month follow-up, 302 of the 475 patients were alive. Among critically ill patients with >8 days of mechanical ventilation in the ICU, survival time in those who received low nutritional adequacy was significantly shorter than for those who received high nutritional adequacy after adjusting for important covariates. Among six-month survivors, clinically meaningful and statistical significant associations between increase in scores of Physical Functioning (PF) and Role Physical domains (RP) of the SF-36 and 25% increase in nutritional adequacy were observed at three-months follow-up. No significant associations were observed at six-months. Conclusions: Our findings suggest that nutritional adequacy received as early as the first week in the ICU seems beneficial to longer survival time and faster physical recovery post ICU discharge in critically ill patients requiring prolonged mechanical ventilation in the ICU. Well-designed randomized controlled trials are needed to provide stronger assessment of the causal impact of nutrition therapy on long-term outcomes. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-09-28 21:31:40.064

Human (h) growth hormone (GH) levels decline rapidly in response to excess caloric intake before there is any evidence of obesity. In this thesis, the mechanism underlying this response was examined by manipulating levels of caloric intake and physical activity at the levels of gene expression and chromosomal structure. Transgenic mice containing the intact hGH locus were used as a model system. Briefly, the findings are: (I) High caloric intake (high fat diet) for three days resulted in hyperinsulinemia and a decrease in both hGH synthesis and secretion. (II) Incorporation of physical activity (swim) muted the effects of excess caloric intake on insulin levels as well as hGH production. (III) Human GH RNA accumulation was shown for the first time to be negatively regulated by insulin in pituitary cultures, and (IV) an enhancer box (E-box) DNA element was implicated in this response. (V) Induction of the E-box associated transcription factor HIF-1α with insulin significantly decreased hGH RNA levels, and was accompanied by recruitment of HIF-1α to the hGH gene (hGH) promoter in situ. (VI) Both a reduction in HIF-1α synthesis and HIF-1 DNA binding blunted the negative effect of insulin on hGH RNA levels. (VII) The hGH response to insulin was associated with a decrease in histone H3/H4 hyperacetylation in the proximal hGH promoter region. The same pattern of chromatin remodelling was observed in pituitary cells in vivo in response to excess caloric intake. (IX) Increased recruitment of nuclear receptor co-repressor and decreased association of RNA polymerase II were also observed. Collectively, these effects are consistent with reduced hGH promoter function. (X) This reduction by excess caloric intake was also consistent with changes in the three dimensional-structure of the hGH locus including detected loss of physical interaction between hGH enhancer and promoter regions. (XI) By contrast, physical activity combined with the high caloric intake preserved the chromosomal structure of the hGH locus. These observations are discussed in relation to a physiological requirement for rapid control of hGH levels in response to energy homeostasis, as well as the molecular basis governing this process. / May 2015

Fear and stigmatization are often used to motivate overweight individuals to engage in healthy behaviors, but these strategies are often counterproductive and can lead to undesirable outcomes. In the present study, I examined the impact of weight-based stigma on cognitive ability (i.e., inhibitory control) and food selection (i.e., calories selected) in individuals who consider themselves to be overweight. I predicted that participants higher in perceived weight stigma would perform more poorly on an inhibitory control task and order more calories on a menu task when they read about discrimination against the overweight versus discrimination against a self-irrelevant out-group. Additionally, I expected that inhibitory control would mediate the relationship between perceived weight stigma and calories ordered for participants who read about discrimination against the overweight, but not for control participants. Participants completed online prescreen measures assessing whether or not they considered themselves to be overweight and their perceptions of weight stigma. Those individuals who considered themselves overweight were then invited into the laboratory to complete tasks to (1) manipulate weight-based discrimination, (2) measure inhibitory control, and (3) measure food selection. As predicted, participants higher in perceived weight stigma performed more poorly on the inhibitory control task and ordered more calories when they read about discrimination against the overweight, but not when they read about discrimination against an out-group. Conversely, inhibitory control did not mediate the relationship between perceived weight stigma and number of calories ordered by participants. Importantly, the present findings provide evidence that perceptions of weight stigma are critical in our understanding of the impact of weight discrimination. Additionally, these results have theoretical and practical implications for both understanding and addressing the psychological and physical consequences of weight-based stigma.

Made available in DSpace on 2014-06-11T19:23:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-03-03Bitstream added on 2014-06-13T20:11:38Z : No. of bitstreams: 1 brunetto_ma_me_jabo.pdf: 958952 bytes, checksum: 6724d0e6a3da1050f16ae04e406f6428 (MD5) / Funep / O objetivo deste trabalho foi investigar o efeito do suporte nutricional assistido sobre a taxa de alta de cães e gatos hospitalizados. Foram incluidos no estudo um grupo de 947 animais hospitalizados no período de março de 1998 a dezembro de 2000 que não receberam assistência nutricional (G1) e 522 animais, hospitalizados no período de março de 2003 a dezembro de 2005 que foram manejados nutricionalmente (G2). Para a comparação de G1 versus G2 empregou-se o teste t. Em G2 empregou-se o Qui-quadrado e a Correlação de Spearman para avaliar as associações entre ingestão calórica e alta, escore de condição corporal e alta, escore de condição corporal e ingestão calórica. Os pacientes de G2 apresentaram 83,16% de alta hospitalar e tempo médio de intemação de 9,42 dias, valores significantemente maiores (p<0.001) que os de G1, de 67,1% e 6,6 dias. Em G2, 63% dos animais apresentaram consumo voluntário com ou sem persuasão (92,93% de alta), 18,90% receberam terapia nutricional enteral (71,82% de alta), 6,19% alimentação forçada (75,0% de alta), 7,0% terapia nutricional parenteral (61,90 de alta) e 4,47% dos animais ficaram em jejum (38,46% de alta), demonstrando associação entre o tipo de suporte nutricional e alta hospitalar (p<O.01). Dentre os animais que receberam de 0% a 33% da necessidade energética de manutenção (NEM), 62,73% tiveram alta, dos que receberam entre 34% e 66% da NEM, 87,78% tiveram alta e para os que receberam mais de 67% da NEM, 93,28% tiveram alta, demonstrando menor mortalidade nas faixas de maior balanço calórico (p<0.001). Nas faixas de maior balanço calórico os animais permaneceram mais tempo internados (p<0.001). O escore de condição corporal não teve associação (p>0.05) com o consumo de calorias, porém apresentou dependência com as taxas de alta e óbito (p<0.01). / The objective of the present study was to investigate the effect of an assisted nutritional support on the outcome in dogs and cats.The study involved a group of 947 animals hospitalized in the Veterinary Hospital of FCAV - Unesp, before the Clinical Nutrition Service was implemented and therefore did not receive assisted nutritional support (G1), which was compared to a group of 522 animals that were nutritionally managed (G2). The statistical analysis of the results included the t test (G1 vs. G2) and Chi-Square and Spearman's correlation to evaluate G2 (CI and outcome, body condition score and outcome, body condition score e CI).The outcome in G2 was 83.16% and TH 9.42 days, values higher than G1 with 63% and 6.6 days (p<0.001). In G2, 63% showed voluntary feed consumption (92.93% outcome), 18.90% received enteral support (71.82% outcome), 6.19% were forced fed (75.0% outcome), 7.0% received parenteral support (61.90% outcome) and 4.47% did not eat (38.46% outcome), demonstrating an association between the type of nutritional support and outcome (p<0.01). In G2, animals that received 0% to 33% of their MER had 62.7% outcome and those receiving more than 67% of their MER had 93.28% outcome, showing a lower mortality in the higher CI range (p<0.001). TH was higher in the ranges with higher CI (p<0.001). The body condition score (BCS) was not associated with the calories consumption (p>O.05), but showed dependence on outcome (p<0.01), the discharged percentages were 73.0% for animals with low BCS, 86.32% for with ideal SCS, and 83.18% for overweight animals.

Orientador: Aulus Cavalieri Carciofi / Banca: Aparecido Antonio Camacho / Banca: Ingrid Dick de Paula / Resumo: O objetivo deste trabalho foi investigar o efeito do suporte nutricional assistido sobre a taxa de alta de cães e gatos hospitalizados. Foram incluidos no estudo um grupo de 947 animais hospitalizados no período de março de 1998 a dezembro de 2000 que não receberam assistência nutricional (G1) e 522 animais, hospitalizados no período de março de 2003 a dezembro de 2005 que foram manejados nutricionalmente (G2). Para a comparação de G1 versus G2 empregou-se o teste t. Em G2 empregou-se o Qui-quadrado e a Correlação de Spearman para avaliar as associações entre ingestão calórica e alta, escore de condição corporal e alta, escore de condição corporal e ingestão calórica. Os pacientes de G2 apresentaram 83,16% de alta hospitalar e tempo médio de intemação de 9,42 dias, valores significantemente maiores (p<0.001) que os de G1, de 67,1% e 6,6 dias. Em G2, 63% dos animais apresentaram consumo voluntário com ou sem persuasão (92,93% de alta), 18,90% receberam terapia nutricional enteral (71,82% de alta), 6,19% alimentação forçada (75,0% de alta), 7,0% terapia nutricional parenteral (61,90 de alta) e 4,47% dos animais ficaram em jejum (38,46% de alta), demonstrando associação entre o tipo de suporte nutricional e alta hospitalar (p<O.01). Dentre os animais que receberam de 0% a 33% da necessidade energética de manutenção (NEM), 62,73% tiveram alta, dos que receberam entre 34% e 66% da NEM, 87,78% tiveram alta e para os que receberam mais de 67% da NEM, 93,28% tiveram alta, demonstrando menor mortalidade nas faixas de maior balanço calórico (p<0.001). Nas faixas de maior balanço calórico os animais permaneceram mais tempo internados (p<0.001). O escore de condição corporal não teve associação (p>0.05) com o consumo de calorias, porém apresentou dependência com as taxas de alta e óbito (p<0.01). / Abstract: The objective of the present study was to investigate the effect of an assisted nutritional support on the outcome in dogs and cats.The study involved a group of 947 animals hospitalized in the Veterinary Hospital of FCAV - Unesp, before the Clinical Nutrition Service was implemented and therefore did not receive assisted nutritional support (G1), which was compared to a group of 522 animals that were nutritionally managed (G2). The statistical analysis of the results included the t test (G1 vs. G2) and Chi-Square and Spearman's correlation to evaluate G2 (CI and outcome, body condition score and outcome, body condition score e CI).The outcome in G2 was 83.16% and TH 9.42 days, values higher than G1 with 63% and 6.6 days (p<0.001). In G2, 63% showed voluntary feed consumption (92.93% outcome), 18.90% received enteral support (71.82% outcome), 6.19% were forced fed (75.0% outcome), 7.0% received parenteral support (61.90% outcome) and 4.47% did not eat (38.46% outcome), demonstrating an association between the type of nutritional support and outcome (p<0.01). In G2, animals that received 0% to 33% of their MER had 62.7% outcome and those receiving more than 67% of their MER had 93.28% outcome, showing a lower mortality in the higher CI range (p<0.001). TH was higher in the ranges with higher CI (p<0.001). The body condition score (BCS) was not associated with the calories consumption (p>O.05), but showed dependence on outcome (p<0.01), the discharged percentages were 73.0% for animals with low BCS, 86.32% for with ideal SCS, and 83.18% for overweight animals. / Mestre

Overweight and obesity are prevalent public health problems that impact physical, mental, and social health. Many studies have evaluated weight loss treatments, but most individuals are unsuccessful at maintaining weight loss long-term. Behavioral and cognitive interventions may be effective in promoting weight loss and weight loss maintenance. One cognitive intervention that has shown potential success in reducing weight and caloric intake is inhibitory control training (ICT). ICT involves trainings where individuals are asked to repeatedly withhold dominant responses to unhealthy or high-calorie food images in an effort to increase food-related inhibitory control abilities. Reductions in caloric intake or weight may occur after as little as one week of ICT; however, it is unclear how more frequent ICT sessions promote weight loss and reduce caloric intake. Further, studies on food-specific ICT are generally poorly powered and it is unclear how ICT affects underlying cognitive and neural mechanisms. One way to measure inhibitory control processes is through the N2 component of the scalp-recorded event-related potential (ERP). The amplitude of the N2 ERP component tends to be larger (i.e., more negative) when an individual inhibits a dominant response during go/no-go tasks compared to non-inhibition go trials. I conducted a quasi-randomized controlled trial where 100 individuals with overweight or obesity were assigned to either a generic (active control; n = 48) or food-specific ICT (experimental group; n = 52). ICTs were completed four times per week for four weeks. Weight and caloric intake were obtained at baseline, immediately after four-weeks of ICT, and at a 12-week follow-up. Participants also completed a high-calorie and a neutral go/no-go task while electroencephalogram (EEG) was recorded at each visit. Results from mixed model analyses suggest that neither weight, caloric intake, nor N2 ERP component amplitude towards high-calorie foods changed at post-testing or at the 12-week follow up for either group. Regression analyses suggest that individuals with lower baseline levels of inhibition may show greater weight loss and reductions in caloric intake after a generic ICT, while individuals with higher baseline levels of inhibition may show greater weight loss and reductions in caloric intake after a food-specific ICT. Self-report ratings indicated the appetitive drive towards food decreased over the course of the study, particularly for individuals with higher levels of baseline inhibition. Overall, generic- or food-specific ICT did not affect weight, caloric intake, or food-specific N2 ERP amplitude. Food-specific ICT may be more effective in reducing caloric intake and weight for individuals with larger inhibition responses to food stimuli, while generic ICT may be more effective in reducing caloric intake and weight for individuals with smaller inhibition responses to food stimuli. ICT may also be targeting other mediating processes, such as the appetitive value of food, as opposed to improving food-specific inhibitory control.

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