Increased prevalence rates of overweight and obesity (OW/OB) have been reported among Aboriginal women and while the literature suggests that changes in lifestyle (i.e. physical activity and diet) account for this trend, few studies have explored how the physical and sociocultural environments and individual attitudes and beliefs regarding physical activity (PA) and healthy eating may contribute to the increase. The purposes of this project were to: 1) Determine the current prevalence of OW/OB in the community, 2) assess changes in OW/OB from 1991 to 2005, 3) assess current PA and dietary practices, and 4) explore the influence of the physical and sociocultural environments as well as individual attitudes and beliefs regarding PA and healthy eating among the females in the community.<p> The prevalence of OW/OB was 26% among youth and 68% among adults. Overall, no significant difference in rates of OW/OB among youth or adults occurred over time, however there was a significant decrease in rates of OW/OB for adult males and a tendency towards a greater increase in OW/OB among female youth. A pattern of abdominal obesity among all age groups of females was noted. There was a significant increase in body mass index (BMI) classification over time among individuals with serial data. Walking and housework were the most frequently reported activities. Although the PA data suggests levels associated with health benefits, these results must be interpreted cautiously given housework was performed at a low intensity. Personal, community-specific and environmental factors were highlighted as barriers to PA, whereas organized, age-specific, women-only programs were highlighted as potential enablers for PA. Low intakes of fruits and vegetables and milk products across all age groups, with high intakes of foods high in fat, oil, sugar, salt, particularly among those under 25 years were reported. Traditional food use increased with increasing age, however was low even among women aged 55+. While food preference was influenced primarily by taste, barriers to healthy eating were largely related to geographic location. Collectively, the results of this study emphasize the importance developing community-based health promotion programs that focus on reducing identified barriers to PA and healthy eating to promote healthy body weights in the community.

Graduation date: 1995

This paper deals with stable isotope analysis on the children of the early Christian cemetery in Varnhem, Västergötland. Human bone and tooth material from the cemetery has been analysed for stable carbon, nitrogen and sulphur isotopes. The analysis showed that the diet had been homogeneous and that the children had been breastfed, with a possible exception of the child from grave 100.

In 2004, Ontario’s Chief Medical Officer of Health Report, Healthy Weights, Healthy Lives (Ministry of Health and Long Term Care, 2004) identified the family (as well as the government, food industry, workplaces, schools, and individuals) for recommendations for action. As a means to promote, achieve, and maintain healthy body weights for both parents and children, Healthy Weights, Healthy Lives (2004) recommended enjoying family meals whenever possible. Very little evidence, however, exists to justify the promotion of family meals within Canada. Therefore, the purpose of this thesis was to describe family meal frequency and meal environments, and to examine the associations with diet quality (as assessed using a Canadian adaptation to the Health Eating Index (HEI-C; Glanville and McIntyre, 2006), and other commonly reported food behaviours and attitudes. The sample (males=1572 and females=1627) comprised students in grade six (n=1266), seven (n=1359), and eight (n=579) classrooms from Northern Ontario (Porcupine Region n=385), Southern Ontario (Peel Region n=1413, Region of Waterloo n=405, Toronto District n=216), and Nova Scotia (as part of the Physical Activity in Children and Youth (PACY) study n=804) participating in school surveillance-based studies. Data were collected using the web-based Food Behaviour Questionnaire, which included a 24 hour food recall, food frequency questionnaire, and specific questions relating to family meals. The majority of participants reported frequent family meals (70% on 6-7 days/week, 19% on 3-5 days/week, and 11% on 0-2 days/week). Family meal frequency decreased with increasing grade (X2=30.629 (df=4), p<0.001), and was significantly higher among participants from Porcupine, and lower among participants from Peel (X2=46.815 (df=8), p<0.001). The mean HEI-C score across all participants was 65.1 (SD 13.2) and the majority (73%) were rated in the needs improvement category. Family meal frequency, particularly between 0-2 and 6-7 days/week, was positively associated with diet quality scores (adjusted p=0.045) and ratings (p=0.049). When investigating the person(s) with whom meals were consumed, participants who ate breakfast with family members (versus alone, p=0.012) and/or lunch with friends (versus alone, p=0.007 or with family members, p<0.001) had a significantly greater likelihood of having a better diet quality. Participants who skipped breakfast (p<0.001) and/or lunch (p<0.001) had a greater likelihood of having a worse diet quality than those that consumed each meal. Cluster K-means procedures were used to classify observations about the four meal environment variables (where the meal was consumed, with whom the meal was consumed, who prepared the meal, and where the food was originally purchased) into groups. A total of 3, 8, and 6 clusters of meal environments were identified for breakfast, lunch, and dinner, respectively. Diet quality was negatively associated with consuming/purchasing meals outside of the home, and skipping breakfast and/or lunch. Meal skipping had a larger impact on overall diet quality than the environmental conditions under which the meal was consumed. Finally, associations among family meal frequency and other commonly reported food behaviours and attitudes were investigated. Higher family meal frequency was significantly associated with less pop consumption, consuming breakfast on the day of the survey, having higher self-efficacy for healthy eating when at home with family and during social times with friends. This research, in a large, geographically diverse sample of grade six, seven, and eight students from Ontario and Nova Scotia, found that family meal frequency and specific aspects of meal environments were positively associated with diet quality, and various healthy eating behaviours and attitudes. This research supports the growing body of literature in favour of family meals. Since the diet of most students in grade six, seven, and eight was suboptimal, strategies to promote healthy family meals should be widely encouraged.

Atrial fibrillation (AF) is a common and serious arrhythmia. Current treatments are of limited efficacy, and most do not treat the atrial structural remodeling (hypertrophy and fibrosis) that underlies most clinical AF. Our group has created an experimental dog model of atrial mechanical stretch called the simultaneous atrial and ventricular pacing (SAVP) model (which results in atrial fibrosis and susceptibility to AF) in order to study novel treatments for structural remodeling induced AF. Omega-3 polyunsaturated fatty acids (n3 PUFAs), particularly the marine derived forms eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been shown to be effective in treating arrhythmias (including AF) in some animal studies and clinical trials. The mechanism for this effect of n3 PUFAs is not well understood. In this study we sought to characterize the n3 PUFA effect on AF vulnerability, atrial electrophysiology, histology, and gene expression, and determine relevant mechanisms. Dogs were paced for 0, 2, 7 or 14 days and given n3 PUFAs, olive oil or nothing. Prophylactic n3 PUFAs significantly reduced both AF vulnerability and conduction slowing in SAVP dogs (%AF inducibility: 9.2±8.8 vs. 4.7±6.3; global atrial conduction time: 75±11ms vs. 65±6ms [SAVP 14 days vs. SAVP 14 days with n3 PUFAs, P<0.05 for both comparisons]). Prophylactic n3 PUFAs also reduced inflammation (mean CD18 grade: 2.1±0.8 vs. 1.3±0.6 [SAVP 2 days vs. SAVP 2 days with n3 PUFAs, P=0.055]), hypertrophy (myocyte cross-sectional area: 498±64µm2 vs. 322±111µm2 [SAVP 14 days vs. SAVP 14 days with n3 PUFAs, P<0.05]), and fibrosis (%collagen area vs. unpaced dogs: 178±58 vs. 127±37 [SAVP 14 days vs. SAVP 14 days with n3 PUFAs, P<0.05]). N3 PUFAs were also found to reduce the expression of structural remodeling related molecules such as TGF-β, EGF, ERK and Akt. N3 PUFAs given after some pacing had already occurred were found to be less effective at reducing AF vulnerability and structural remodeling. The results of this study suggest that, in the SAVP model, n3 PUFAs reduce vulnerability to AF by attenuation of adverse structural remodeling at the genetic level.

ABSTRACT Objective: The objective of this review was to describe the effects of low carbohydrate diets in people with diabetes type 2. Methods: Review. An article search was made in the databases PubMed and Medline. The search resulted in 17 studies. After review and analysis of the studies main results five categories were highlighted; bloodsugar levels, HbA1c, weight, lipid levels and antidiabetic medications. Results: The results revealed that diets low in carbohydrates may reduce blood sugar levels, fasting blood glucose and HbA1c-levels in people with type 2 diabetes. A low carbohydrate diet may reduce body weight for people with type 2 diabetes, this was shown in 12 of 17 studies. Total cholesterol was reduced in six of 17 studies. A reduction of triglycerides was found in eight of 17 studies. LDL-cholesterol was reduced in four of the studies. HDL- cholesterol was increased in eight of 17 studies. Conclusion: Some of the studies showed positive effects of a low carbohydrate diet for people with type 2 diabetes, for instance improvements in blood sugar levels, bodyweight, total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. The study implies that a low carbohydrate diet may be an alternative for people with type 2 diabetes in short terms.Keywords: Diabetes type 2, diet, low-carbohydrate, ketogenic, HbA1c

In 2004, Ontario’s Chief Medical Officer of Health Report, Healthy Weights, Healthy Lives (Ministry of Health and Long Term Care, 2004) identified the family (as well as the government, food industry, workplaces, schools, and individuals) for recommendations for action. As a means to promote, achieve, and maintain healthy body weights for both parents and children, Healthy Weights, Healthy Lives (2004) recommended enjoying family meals whenever possible. Very little evidence, however, exists to justify the promotion of family meals within Canada. Therefore, the purpose of this thesis was to describe family meal frequency and meal environments, and to examine the associations with diet quality (as assessed using a Canadian adaptation to the Health Eating Index (HEI-C; Glanville and McIntyre, 2006), and other commonly reported food behaviours and attitudes. The sample (males=1572 and females=1627) comprised students in grade six (n=1266), seven (n=1359), and eight (n=579) classrooms from Northern Ontario (Porcupine Region n=385), Southern Ontario (Peel Region n=1413, Region of Waterloo n=405, Toronto District n=216), and Nova Scotia (as part of the Physical Activity in Children and Youth (PACY) study n=804) participating in school surveillance-based studies. Data were collected using the web-based Food Behaviour Questionnaire, which included a 24 hour food recall, food frequency questionnaire, and specific questions relating to family meals. The majority of participants reported frequent family meals (70% on 6-7 days/week, 19% on 3-5 days/week, and 11% on 0-2 days/week). Family meal frequency decreased with increasing grade (X2=30.629 (df=4), p<0.001), and was significantly higher among participants from Porcupine, and lower among participants from Peel (X2=46.815 (df=8), p<0.001). The mean HEI-C score across all participants was 65.1 (SD 13.2) and the majority (73%) were rated in the needs improvement category. Family meal frequency, particularly between 0-2 and 6-7 days/week, was positively associated with diet quality scores (adjusted p=0.045) and ratings (p=0.049). When investigating the person(s) with whom meals were consumed, participants who ate breakfast with family members (versus alone, p=0.012) and/or lunch with friends (versus alone, p=0.007 or with family members, p<0.001) had a significantly greater likelihood of having a better diet quality. Participants who skipped breakfast (p<0.001) and/or lunch (p<0.001) had a greater likelihood of having a worse diet quality than those that consumed each meal. Cluster K-means procedures were used to classify observations about the four meal environment variables (where the meal was consumed, with whom the meal was consumed, who prepared the meal, and where the food was originally purchased) into groups. A total of 3, 8, and 6 clusters of meal environments were identified for breakfast, lunch, and dinner, respectively. Diet quality was negatively associated with consuming/purchasing meals outside of the home, and skipping breakfast and/or lunch. Meal skipping had a larger impact on overall diet quality than the environmental conditions under which the meal was consumed. Finally, associations among family meal frequency and other commonly reported food behaviours and attitudes were investigated. Higher family meal frequency was significantly associated with less pop consumption, consuming breakfast on the day of the survey, having higher self-efficacy for healthy eating when at home with family and during social times with friends. This research, in a large, geographically diverse sample of grade six, seven, and eight students from Ontario and Nova Scotia, found that family meal frequency and specific aspects of meal environments were positively associated with diet quality, and various healthy eating behaviours and attitudes. This research supports the growing body of literature in favour of family meals. Since the diet of most students in grade six, seven, and eight was suboptimal, strategies to promote healthy family meals should be widely encouraged.

Syfte: Att beskriva orsaker till brister i uppföljning, dess effekter och den motivation som sjuksköterskor kan möta hos patienter som är gastric bypass opererade i samband med fortsatta livsstilsförändringar och ökad livskvalitet, samt att som kvalitetsgranskning redogöra för undersökningsgrupper, deltagare och bortfall i artiklarna. Metod: Litteraturstudie med deskriptiv design. Sökning av kvantitativa och kvalitativa vetenskapliga artiklar i databaserna CINAHL och Pubmed. Artiklarnas resultat har sedan utifrån syfte och frågeställningar analyserats. Resultat: Det är betydelsefullt att få patienterna att komma på uppföljande återbesök för att hjälpa de till fortsatt livsstilsförändring. Högt BMI innan operationen kunde vara orsak till brister i att komma till uppföljning och återbesök vilket medförde förlust av stöd och hjälp till att följa dieten, samt att komplikationer upptäcktes sent och att information gick förlorad. Även om livskvaliteten ofta förbättrades markant så upplevde många en mer bristande grad av livskvalitet än förväntat och depression förekom. Hinder till motivation till förändrad livsstil och förbättrad livskvalitet kunde vara att pressas för hårt vilket kunde innebära att patienterna ofta ledsnade helt på att röra på sig. Slutsats: För att uppnå viktminskningsresultat och en förbättrad livskvalitet genom motiverande samtal behövs kunskap om hinder till motivation. Uppföljning och återbesök behöver prioriteras både av patienter och av sjuksköterskor.

Background: Weight gain, fat gain and loss of lean tissue are common among a growing population of breast cancer survivors. These unfavourable changes in body composition are distressing for many women and may lead to metabolic disturbance, increased risk of obesity-related disorders and poorer prognosis. Although data are accumulating on the adverse health effects of obesity and weight gain in this population, relationships between acute and chronic effects of treatment, dietary change and weight gain after diagnosis are poorly understood. Objectives: The purpose of this thesis was to gain an appreciation of the experience of food intake and body weight over the treatment trajectory, from the perspective of women who have received chemotherapy for breast cancer. Study 1 was designed to explore the unique challenges associated with chemotherapy in relation to diet and weight management and to investigate possible relationships among psychosocial and treatment-related factors, dietary intake and weight gain during treatment. Study 2 was a follow-up to study 1, within the same study population. The purpose of study 2 was to investigate relationships among persistent side effects of treatment, diet and weight gain since the completion of chemotherapy treatment. Methods: Twenty-eight early stage breast cancer survivors, who were within 12 months of completing chemotherapy, were recruited from four regions in southwestern Ontario, to participate in comprehensive qualitative interviews, identify changes in diet since diagnosis, provide 3-day food records and complete validated surveys to assess current (past week) symptoms of physical and psychological distress. Demographic, medical, treatment and weight history were collected via questionnaire. Current weight was measured at the time of interview. Results: The mean weight change during treatment (mean = 15±4 weeks) was +0.8± 4.6 kg (range = -12.3 - +9.1). Among women who gained (n=11) or lost (n=6) >2.0 kg during treatment, the mean weight change was + 5.1 and -5.2 kg, respectively. Based on the recalled experiences of women, who were on average 6.4±4.4 months from completing chemotherapy treatment, food intake during treatment appears to be highly responsive to treatment day, with most women reporting lower food intake and irregular eating patterns for the first few days after treatment. Women who lost weight during treatment tended to report more severe and persistent side effects of treatment, leading to a more prolonged reduction of food intake after each cycle. Increased appetite, food cravings and intake of energy dense comfort foods seemed to be more common among women who gained weight during treatment. In these women, changes in taste, nausea and emotional distress were central in promoting these dietary responses. Most women reported a reduction in physical activity during treatment. The mean weight change from the completion of chemotherapy treatment to the time of interview was -0.4± 3.2 kg (range = - 6.0 - +5.2), with six women gaining (mean=3.5 kg) and seven women losing (mean=5.1 kg) > 2.0 kg during this time frame. Most women (84%) reported changes in diet after diagnosis. Dietary changes were largely consistent with current recommendations for cancer prevention, however some women were still above the guidelines for total and saturated fat and many were below recommendations for vegetables/fruit and milk/alternatives. Based on the EAR cut-point method, the prevalence of inadequate calcium and vitamin D intakes from foods was high (47-96%). Although symptoms were highly variable, the mean levels of physical and psychological distress in this sample were similar to previous reports among early stage breast cancer patients in active treatment and appear to be markedly higher than previous reports of distress among cancer-free adults. Fatigue duration (proportion of daytime) was negatively correlated with weight change after treatment (r = -0.46, p<0.05). Conclusions: While the etiology of weight change in this population is complex, findings from this study suggest that food intake and dietary patterns may play an important role for some women. A theoretical model based on qualitative analysis supports several pathways by which psychosocial factors and treatment-related side effects might influence diet and eating patterns in ways that promote weight change during treatment. Relatively high levels of physical and psychological distress after treatment suggest that these symptoms may persist for many breast cancer survivors in the first year after completing chemotherapy, and may associate with weight change during this time frame. Data on dietary change and current dietary habits highlight several possible targets for intervention in this population. Understanding the unique challenges related to diet and weight management after diagnosis, in the context of psychosocial and treatment-related factors, may serve to inform future research and to guide the development of effective diet and weight management interventions after diagnosis.

Increased prevalence rates of overweight and obesity (OW/OB) have been reported among Aboriginal women and while the literature suggests that changes in lifestyle (i.e. physical activity and diet) account for this trend, few studies have explored how the physical and sociocultural environments and individual attitudes and beliefs regarding physical activity (PA) and healthy eating may contribute to the increase. The purposes of this project were to: 1) Determine the current prevalence of OW/OB in the community, 2) assess changes in OW/OB from 1991 to 2005, 3) assess current PA and dietary practices, and 4) explore the influence of the physical and sociocultural environments as well as individual attitudes and beliefs regarding PA and healthy eating among the females in the community.<p> The prevalence of OW/OB was 26% among youth and 68% among adults. Overall, no significant difference in rates of OW/OB among youth or adults occurred over time, however there was a significant decrease in rates of OW/OB for adult males and a tendency towards a greater increase in OW/OB among female youth. A pattern of abdominal obesity among all age groups of females was noted. There was a significant increase in body mass index (BMI) classification over time among individuals with serial data. Walking and housework were the most frequently reported activities. Although the PA data suggests levels associated with health benefits, these results must be interpreted cautiously given housework was performed at a low intensity. Personal, community-specific and environmental factors were highlighted as barriers to PA, whereas organized, age-specific, women-only programs were highlighted as potential enablers for PA. Low intakes of fruits and vegetables and milk products across all age groups, with high intakes of foods high in fat, oil, sugar, salt, particularly among those under 25 years were reported. Traditional food use increased with increasing age, however was low even among women aged 55+. While food preference was influenced primarily by taste, barriers to healthy eating were largely related to geographic location. Collectively, the results of this study emphasize the importance developing community-based health promotion programs that focus on reducing identified barriers to PA and healthy eating to promote healthy body weights in the community.