Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder that increases a woman’s risk of developing cardiovascular disease and diabetes. Women with PCOS have extremely high rates of obesity, insulin resistance, cardiovascular morbidity and mortality. Obese women with PCOS also tend to have elevated sympathetic nerve activity and systemic markers of inflammation, which likely contribute to cardiometabolic risk and PCOS pathogenesis. While few medication or lifestyle intervention options for women with PCOS target elevated sympathetic nerve activity, inflammation, and insulin resistance, passive heat exposure shows promise as a novel intervention for improving cardiovascular and metabolic health in this population. Therefore, the purpose of this study was to examine changes in inflammation, cardiovascular, autonomic, and metabolic health in obese women with PCOS following a 30-session, 8-10 week chronic passive heat intervention (termed ‘heat therapy’). Eighteen obese women with PCOS (Age: 27±1y, BMI 41.3±1.1 kg·m2) were matched for age and body mass index (BMI), then divided into heat therapy (HT) or time control (CON). At the beginning (Pre), middle (Mid), and end (Post) of 8-10 weeks, subjects participated in study days to assess vascular, autonomic, and metabolic function, and additionally underwent a subcutaneous fat biopsy in Pre and Post. HT subjects took part in 30 one-hour hot tub sessions over 8-10 weeks (3-4 per week) in 40.5˚C water, while CON subjects completed all other testing but were not exposed to heat. No change in BMI was observed over the study in HT or CON; however; HT subjects exhibited dramatically improved vascular and metabolic function, as well as reduced sympathetic nerve activity and circulating inflammatory markers. In fat biopsies, insulin signaling was improved in HT subjects, while CON subjects remained stable over time. These findings show promise for HT as a treatment option for obese women with PCOS to improve cardiovascular and metabolic risk profiles. This dissertation includes previously published co-authored material.

p. 1-101 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-05-02T19:07:04Z No. of bitstreams: 1 7777777777777aaa.pdf: 645591 bytes, checksum: d42bcd7410890d638848d6e5f366302c (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:42:39Z (GMT) No. of bitstreams: 1 7777777777777aaa.pdf: 645591 bytes, checksum: d42bcd7410890d638848d6e5f366302c (MD5) / Made available in DSpace on 2013-05-04T17:42:39Z (GMT). No. of bitstreams: 1 7777777777777aaa.pdf: 645591 bytes, checksum: d42bcd7410890d638848d6e5f366302c (MD5) Previous issue date: 2009 / Objetivo: identificar fatores associados ao baixo risco cardiometabólico (RCM) em mulheres obesas (MOb) atendidas em ambulatórios especializados do SUS, Salvador – BR. Métodos: estudo caso-controle, pareado pela idade com 306 MOb, IMC ≥30kg/m², sendo 66 (21,6%) casos – todos não hipertensos, normolipídicos e não diabéticos e 240 (78,4%) controles. Dados secundários foram obtidos dos prontuários médicos e primários através de inquérito domiciliar e de exames laboratoriais. Foram realizadas análises: descritiva, bivariada e regressão logística condicional. Resultados: associações positivas, estatisticamente significantes, foram detectadas entre baixo RCM e consumo de ≥3 porções de frutas/dia (ORaj = 20,1; IC95%: 5,6 – 71,9); PCR do 1º. quartil (ORaj = 4,1; IC95%: 2,0 – 8,3) e da adiponectina plasmática (AdipoQ) a partir do 3º. quartil (ORaj = 2,3; IC95%:1,1 – 4,8). Conclusão: este estudo sugere que dieta rica em fibras solúveis (≥3 porções de frutas/dia), valores da PCR ≤3,70mg/L e da AdipoQ >10,00µg/mL podem dificultar, retardar ou impedir o aparecimento de outros fatores de risco ou doenças metabólicas em MOb. / Salvador

abstract: Physical activity, sedentary behaviors, and sleep are often associated with cardiometabolic biomarkers commonly found in metabolic syndrome. These relationships are well studied, and yet there are still questions on how each activity may affect cardiometabolic biomarkers. The objective of this study was to examine data from the BeWell24 studies to evaluate the relationship between objectively measured physical activity and sedentary behaviors and cardiometabolic biomarkers in middle age adults, while also determining if sleep quality and duration mediates this relationship. A group of inactive participants (N = 29, age = 52.1 ± 8.1 years, 38% female) with increased risk for cardiometabolic disease were recruited to participate in BeWell24, a trial testing the impact of a lifestyle-based, multicomponent smartphone application targeting sleep, sedentary, and more active behaviors. During baseline, interim (4 weeks), and posttest visits (8 weeks), biomarker measurements were collected for weight (kg), waist circumference (cm), glucose (mg/dl), insulin (uU/ml), lipids (mg/dl), diastolic and systolic blood pressures (mm Hg), and C reactive protein (mg/L). Participants wore validated wrist and thigh sensors for one week intervals at each time point to measure sedentary behavior, physical activity, and sleep outcomes. Long bouts of sitting time (>30 min) significantly affected triglycerides (beta = .15 (±.07), p<.03); however, no significant mediation effects for sleep quality or duration were present. No other direct effects were observed between physical activity measurements and cardiometabolic biomarkers. The findings of this study suggest that reductions in long bouts of sitting time may support reductions in triglycerides, yet these effects were not mediated by sleep-related improvements. / Dissertation/Thesis / Masters Thesis Public Health 2017

Submitted by Maike Costa (maiksebas@gmail.com) on 2016-12-01T13:57:09Z No. of bitstreams: 1 arquivo total.pdf: 4379549 bytes, checksum: a07419a785a8ed5059059c6ad702947a (MD5) / Made available in DSpace on 2016-12-01T13:57:09Z (GMT). No. of bitstreams: 1 arquivo total.pdf: 4379549 bytes, checksum: a07419a785a8ed5059059c6ad702947a (MD5) Previous issue date: 2016-04-15 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Excessive sedentary behavior has been associated with poor health, and may increase the risk of an unfavorable profile in metabolic syndrome risk factors and score. Investigations with adolescents are scarce with respect to the relationship between total time and bouts of sedentary behavior and metabolic syndrome risk factors and score. OBJECTIVE: The objective of this study was to analyze the associations between total time and bouts of sedentary behavior and metabolic syndrome risk factors and score in adolescents from João Pessoa, Paraiba (PB) state, Brazil. METHODS: This is a school-based cross-sectional epidemiological study that analyzed data collected in the first year (2014) of the Longitudinal Study on Sedentary Behavior, Physical Activity, Food Habits and Health of Adolescents – LONCAAFS study. We analyzed data from a subsample of 572 adolescents (53.3% female) aged between 10 and 14 years, enrolled in Fundamental II (grades 6-9) of the public school system in João Pessoa (PB). Sedentary behavior was measured using an Actigraph GT3X accelerometer, mean time was estimated in hours and mean number of bouts per day of sedentary behavior was recorded. The metabolic syndrome risk factors analyzed were: glucose, HDL-c, triglycerides and systolic and diastolic pressure. The metabolic syndrome risk score was determined from the sum of z-scores of these factors. Crude and adjusted linear regression was used to analyze the relationship between total time and the mean number of bouts per day of sedentary behavior and metabolic syndrome risk factors and score. RESULTS: Adjusted analysis demonstrated that total time spent in sedentary behavior was not associated (p>0.05) with metabolic syndrome risk factors and score. In males, the mean number of 1 to-4-minute bouts was inversely associated with glucose (ß = -0.215; 95%CI: -0.376; - 0.054), systolic blood pressure (ß = -0.202; 95%CI: -0.341; - 0.063), diastolic blood pressure (ß = -0.131; 95%CI: -0.247; - 0.015) and metabolic syndrome risk score (ß = -0.074; 95%CI: -0.124; - 0.025). In females, the mean number of 15 to-30-minute bouts was positively associated with diastolic blood pressure (ß = 0.591; 95%CI: 0.018; 1.165) and the mean number of 5 to-9-minute bouts was inversely associated with the metabolic syndrome risk score (ß = -0.096; 95%CI: -0.180; -0.012). CONCLUSION: Total sedentary behavior time showed no relationship with metabolic syndrome factors and score. Short-duration bouts are inversely associated with metabolic syndrome factors and score, but long-duration bouts seem to promote unfavorable alterations in metabolic syndrome risk factors. / O tempo excessivo em exposição à comportamento sedentário tem sido associado a níveis mais baixos de saúde, podendo aumentar o risco de perfil desfavorável nos fatores e escore de risco para síndrome metabólica. Investigações com adolescentes são escassas acerca da relação entre tempo total e bouts em comportamento sedentário e os fatores e escore de risco para síndrome metabólica. OBJETIVO: O objetivo deste estudo foi analisar as associações do tempo total e bouts em comportamento sedentário com fatores e escore de risco para síndrome metabólica em adolescentes de João Pessoa (PB), Brasil. MÉTODOS: Trata-se de estudo epidemiológico transversal, de base escolar, que consistiu na análise dos dados coletados no primeiro ano (2014) do Estudo Longitudinal sobre Comportamento Sedentário, Atividade Física, Hábitos Alimentares e Saúde de Adolescentes - Estudo LONCAAFS. Foram analisados dados em uma subamostra com 572 adolescentes (53,3% do sexo feminino) de 10 a 14 anos de idade do sexto ano do Ensino Fundamental II da rede pública de ensino do município de João Pessoa (PB). O comportamento sedentário foi mensurado por acelerômetros da marca Actigraph GT3X, sendo estimado o tempo médio em horas e número médio de bouts por dia em comportamento sedentário. Os fatores de risco para síndrome metabólica analisados foram: glicose, HDL-c, triglicerídeos e pressão arterial sistólica e diastólica. Determinou-se um escore de risco para síndrome metabólica a partir da soma dos escores z desses fatores. Para analisar a relação entre tempo total e o número médio de bouts por dia em comportamento sedentário e os fatores e escore de risco para síndrome metabólica foi utilizada a regressão linear bruta e ajustada. RESULTADOS: A análise ajustada demonstrou que o tempo total em comportamento sedentário não se associou (p>0,05) aos fatores e ao escore de risco para síndrome metabólica. No sexo masculino, número médio de bouts de 1 a 4 minutos foi inversamente associado à glicose (ß = -0,215; IC95%: -0,376; - 0,054), pressão arterial sistólica (ß = -0,202; IC95%: -0,341; - 0,063), pressão arterial diastólica (ß = -0,131; IC95%: -0,247; - 0,015) e ao escore de risco para síndrome metabólica (ß = -0,074; IC95%: -0,124; - 0,025). No sexo feminino, os bouts de 15 a 30 minutos foi positivamente associado à pressão arterial diastólica (ß = 0,591; IC95%: 0,018; 1,165), e o número bouts de 5 a 9 minutos foi inversamente associado ao escore de risco para síndrome metabólica (ß = -0.096; IC95%: -0,180; -0,012). CONCLUSÃO: Tempo total em comportamento sedentário não apresentou relação com os fatores e o escore de risco para síndrome metabólica. Bouts de curta duração está inversamente associado aos fatores e escore de risco para síndrome metabólica, porém bouts de longa duração parecem promover alterações desfavoráveis nos fatores de risco para síndrome metabólica.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The oxidative biomarkers play an important role in the genesis of cardiometabolic risk related processes. This study aimed to investigate in clinically healthy young non-obese subjects, the total antioxidant capacity of plasma and its possible associations with anthropometric, body composition, clinical, biochemical and dietary related to cardiometabolic risk. This study evaluated individuals between the ages of 18 and 25 y, of two college of the state of Sergipe. Anthropometric parameters and body composition were measured using standardized techniques and previously described in the literature. Mechanical sphygmomanometer mercury column was used for the measurement of systolic and diastolic pressure. After fasting for 12 hours, by venipuncture, blood samples were collected to make biochemical parameters analysis and plasma antioxidant capacity. The samples (serum and plasma) were conditioned at -80°C until assay. Serum glucose, total cholesterol, high density lipoprotein, triglycerides and total antioxidant capacity plasma was evaluated by colorimetric or turbidimetric assays. The daily dietary intake was assessed by food frequency questionnaire semi-quantitative. Comparisons between groups categorized by the 25th percentile of total antioxidant capacity plasma were performed using the Mann-Whitney- U test for numerical variables. The Spearman correlation were used to track the between total antioxidant capacity plasma and other variables. The results were presented as mean ± SD or absolute frequency and relative. The confidence interval was 95% and the level of statistical significance of 5%. The study included 139 subjects with a mean age of 21,4 ± 1,9 years, with 77% belonging to the female sex. There was no statistical difference between the groups established by percentile value 25th (2,635 mM) of the distribution of CAT using established groups. Regarding the components of cardiometabolic risk almost 25% of the sample had more than one component, 7.9% over two and 0.7% more than three, the most prevalent being reduced HDL cholesterol (15%). The value of CAT did not differ between the groups for the components of cardiometabolic risk. With regard to nutrient intake, individuals showed higher CAT less of trans fat consumption values, vitamin D, iodine and zinc. Inadequacies in energy intake, saturated fat, fiber, and vitamin D were substantial though not significant. There was no statistical difference to the daily dietary intake of any food groups according to the categorization of CAT. The CAT plasma was positively correlated with the PCSI variables (r =0,15, p =0,04) and glucose (r = 0,15, p = 0,03) and negatively with SBP (-0,18, p = 0,01). In the case of young people, non-obese and clinically healthy, unlike what occurs in people with diseases already installed the CAT was unable to predict the components of cardiometabolic risk, possibly because of the introduction of active compensatory mechanism in physiological conditions. / Os biomarcadores oxidativos desempenham importante papel na gênese de processos relacionados ao risco cardiometabólico. O presente estudo teve como objetivo investigar, em indivíduos jovens, não obesos e clinicamente saudáveis, a capacidade antioxidante total do plasma e suas associações com os parâmetros antropométricos, de composição corporal, clínicos, bioquímicos e dietéticos, relacionados ao risco cardiometabólico. Foram avaliados indivíduos com idade entre 18 e 25 anos, de duas instituições de ensino de nível superior do estado de Sergipe. Os parâmetros antropométricos e de composição corporal foram aferidos mediante técnicas, previamente padronizadas e descritas na literatura. Esfigmomanômetro mecânico de coluna de mercúrio foi utilizado para a aferição da pressão arterial sistólica e diastólica. Após jejum de 12 horas, mediante punção venosa, foram coletadas amostras de sangue, separadas em soro e plasma e acondicionadas a -80°C As concentrações séricas de glicose, colesterol total, lipoproteína de alta densidade, triacilgliceróis e capacidade antioxidante total do plasma foram analisadas por ensaios colorimétricos ou turbidimétricos. A ingestão dietética diária foi estimada mediante aplicação de questionário de frequência alimentar semi-quantitativo. As comparações entre grupos, categorizados pelo percentil 25 da capacidade antioxidante total do plasma, foram realizadas utilizando o teste de U-Mann-Whitney. Foi utilizado o teste de Spearman para rastrear as correlações existentes entre a capacidade antioxidante total do plasma e as demais variáveis estudadas. O intervalo de confiança foi de 95% e o nível de significância estatística de 5%. Participaram do estudo 139 indivíduos com idade média de 21,4 ± 1,9 anos, sendo 77% pertencente ao sexo feminino. Não houve diferença estatística entre os grupos estabelecidos pelo valor do percentil 25 (2,635 mM) da distribuição da CAT. Quanto aos componentes do risco cardiometabólico quase 25% da amostra apresentou mais de um componente, 7,9% mais de dois e 0,7% mais de três, sendo o mais prevalente o HDL-colesterol reduzido (15%). O valor de CAT não diferiu entre os grupos para os componentes do risco cardiometabólico. A CAT do plasma se correlacionou positivamente com as variáveis PCSI (r=0,15, p=0,04) e glicemia de jejum (r=0,15, p=0,03) e negativamente com a PAS (-0,18, p=0,01). Tratando-se de indivíduos jovens, não obesos e clinicamente saudáveis, diferente do que ocorre em populações com doenças já instaladas, a CAT não foi capaz de predizer os componentes do risco cardiometabólico, possivelmente, em razão da instauração do mecanismo compensatório atuante em condições fisiológicas.

Menopause transition is a natural process in a woman’s life associated with altered body fat distribution, increased cardiometabolic risk, and the presentation of vasomotor symptoms including hot flashes and night sweats. A 5-year observational, longitudinal study (MONET: Montreal Ottawa New Emerging Team), was performed to document the effect of menopause transition on body composition and cardiometabolic risk factors. Initially, the study included 102 healthy non-obese premenopausal women between the age of 47 and 55 years. By the end of year 5, 91 women completed the study, 4% were still premenopausal, 29% were perimenopausal and 67% became postmenopausal. The major finding of the first study was that the increases in body fat mass and visceral fat in our cohort of non-obese women followed through the menopause transition were independent of the increase in body weight. Furthermore, these changes in body composition and body fat distribution were not associated with cardiometabolic deteriorations. We further examined whether specific factors such as reporting vasomotor symptoms (hot flashes and/or night sweats), exaggerated exercise systolic blood pressure, physical activity levels and cardiorespiratory fitness, may be associated with adiposity, body fat distribution and cardiometabolic profile. Overall, women that experienced vasomotor symptoms (paper 2) or presented an exaggerated exercise systolic blood pressure (paper 3), did not present any alterations in their body composition, body fat distribution and cardiometabolic profile compared to asymptomatic women and participants with normal blood pressure response to exercise, respectively. Furthermore, exaggerated exercise systolic blood pressure was not predictive of future hypertension after a 5-year follow-up throughout menopause transition. On the other hand, total volume of physical activity was not linked with measures of a cardiometabolic profile, cardiorespiratory fitness appeared to have the greatest cardioprotective effect (paper 4). Therefore, in generally healthy physically active non-obese premenopausal women, the menopause transition does not generally alter cardiometabolic risk factors, and suggests that cardiorespiratory fitness may have greater cardiometabolic protective effects in this cohort.

Introduction: Metabolic syndrome (MetS) is a risk condition describing a clustering of traditional cardiovascular risk factors. A number of risk and protective factors have been associated with MetS, and individuals with MetS are at a higher risk for developing chronic diseases such as diabetes, cancer, and cardiovascular disease. Objective: To contribute to the understanding of MetS in Canada, and to describe how it is a risk state through which material, psychosocial, and behavioural factors associate with chronic diseases. This was examined through three objectives: (i) to describe the prevalence and distribution of MetS; (ii) to examine potential pathways linking income and education with MetS; and (iii) to examine the interplay between non-movement behaviours (NMBs, namely sleep, screen time, and sedentary behaviour) and MetS. Methods: The Canadian Health Measures Survey (2007-2009, 2009-2011, ages 18 and older) was used for all analyses, which include logistic regression, multinomial regression, and calculation of standardized logit coefficients. Results: MetS was prevalent among approximately 20% of Canadian adults. It was significantly associated with chronic diseases, such as diabetes (11.2% vs. 3.4% among those with MetS vs. the general population). A social gradient in MetS was identified, and the behavioural risk factors of alcohol use, smoking, physical inactivity, and screen time were suggested to be partial mediators of this pathway. Findings demonstrated that not adhering to physical activity guidelines (150 minutes or more of moderate-to-vigorous physical activity per week) was associated with increased odds of MetS. A stepwise moderating effect of guideline adherence on screen time and sleep behaviours was demonstrated. Conclusion: MetS is prevalent in Canadian adults, and a high proportion of individuals with MetS have chronic conditions. Addressing the modifiable determinants of physical inactivity, excess screen time, alcohol consumption, and smoking may reduce the social gradient in MetS. Furthermore, adhering to physical activity guidelines may mitigate the associations of NMBs with MetS. The current thesis suggests that healthy behaviours are associated with lower risk for MetS, and therefore, possibly for future chronic disease.

Objectives: This thesis examines the risks among Canadian children and adolescents for developing cardio-metabolic diseases, extending evidence that is well-established for adults to pediatric populations. As well, novel indicators and cut-offs for the measurements of disease risks are proposed and associations between physical activity, weight status, socio-economic status and cardio-metabolic health are examined. Methodology: Secondary data analysis was conducted using data from three cycles of the Canadian Health Measures Survey (CHMS), a nationally representative data set which includes measured anthropometric characteristics. A population health approach was applied throughout, underpinned by the World Health Organization’s Conceptual Framework for Action on the Social Determinants of Health. The thesis was designed such that a series of four manuscripts successively built on the key findings from each previous research paper: 1. Establishing the prevalence of Metabolic Syndrome and its risk factors for 10-18 year olds using the International Diabetes Federation child, adolescent and adult definitions. 2. Estimating pre-obesity epidemic waist circumference reference values for Canadian children 6-10 years using reference data from the 1981 Canada Fitness Survey, the Third National Health and Nutrition Examination Survey (1988-1994), and the CHMS through regression of linear, logarithmic and quadratic functions. This work facilitated an expanded age range for the subsequent projects as age- and sex-specific cut-offs based on a Canadian population prior to the obesity epidemic had not been available. 3. Cardio-metabolic risk by body mass index (BMI), waist circumference (WC), and a combined BMI-WC indicator quantified the associations between a dichotomous cardio-metabolic risk variable, and obesity, using three indicators of obesity including a novel indicator, for ages 6-18 years. 4. Association between cardio-metabolic risk and inflammation quantified the associations between inflammation, using high-sensitivity c-reactive protein (CRP) as a marker, and cardio-metabolic risk to determine if high CRP was a significant predictor of cardiometabolic risk among 6-18 year olds. Results: For Paper 1 (n=1228), only 2.1% were classified as having the Mets though 38% had at least 1 MetS risk factor. For Paper 2, logarithmic regression predicted WC cut-offs with the lowest degree of error. For Paper 3 (n=2678), 35% were classified as having cardio-metabolic risk with significantly higher levels among those classified as obese and/or having a low level of physical activity. All indicators of obesity had significant associations with cardio-metabolic risk. For Paper 4 (n=1831), 43.6% of children and 62.0% of adolescents with high CRP levels were classified as having cardio-metabolic risk, a significant relationship. Participants from households with moderate to high income and/or education had the lowest prevalence of MetS risk factors and abdominal obesity. Conclusions: High CRP is a useful indicator of cardio-metabolic risk for pediatric populations. With further research, novel combinations of BMI and WC may be shown to be more predictive for cardio-metabolic risk than these indicators individually. The substantial prevalence of multiple risk factors which predict premature onset of chronic disease foreshadows potential years of morbidity in adulthood for Canada’s youth population.

Introduction: Cardiometabolic syndrome is considered a chronic low-grade inflammatory condition that affects various organs and tissues. Individuals with type 2 diabetes mellitus (T2DM) and obesity are at an increased risk for developing the cardiometabolic syndrome and have greater rates of cardiovascular disease (CVD). These conditions are also associated with increased systemic and local inflammation and greater expression of pro-inflammatory markers such as monocyte chemoattractant protein 1 (MCP-1), tumor necrosis factor-α (TNF-α), and interleukin 1β (IL-1β) in many tissues. The heart is adversely affected by the inflammation and metabolic changes induced by diabetes and obesity. Nuclear transcription factor kappa B (NF-κB) activity is known to be related to inflammation and cytokine production. However, there is limited information on whether NF-κB signaling and inflammation play a role in early cardiac pathogenesis related to obesity and diabetes and whether lifestyle changes known to prevent or treat these diseases are effective in the heart. Purpose: Therefore, the purpose of this study was to compare the effect of exercise (EX) and caloric restriction (CR) to alter NF-κB signaling, inflammation, and markers of cardiac dysfunction in the heart of 20-week old Otsuka Long Evans Tokushima (OLETF) rats. Methods: Hearts of male 20 week old OLETF rats from a previous study (Crissey et al., 2014) were collected for gene expression (RT-PCR), NF-κB activity, and markers of inflammation and immune cell infiltration. Results: There were no significant differences detected in markers of cardiac dysfunction including, α-MHC, β-MHC, ANP, BNP, COL1, COL3 (all p>0.05). Second, 1-way ANOVA showed that there was trend for an overall effect of group (p=0.07) on NF-κB activation where CR tended to be greater compared to SED and WR (p=0.06). Finally, there were no significant differences between groups in inflammatory and immune cell markers; CD4, F4/80, CD68, IL-1β, MCP-1, TGFB1, and TNF-α (all p>0.05). Conclusion: This study shows that at 20 weeks, a time when OLETF animals exhibit characteristics of the metabolic syndrome such as hypertension, mild obesity, and increased insulin resistance, EX and CR do not reduce markers of cardiac dysfunction and inflammation, potentially because inflammation does not influence the heart at this early time period in the development of the disease. Further, the trend of greater NF-κB activity in CR compared to EX and SED, needs further exploration.

No description available.