The aim of the present thesis was to study elderly self-managing and disabled women’s dietary intake and meals in relation to age, household structure (single-living or cohabitant), disability and cooking ability. The women were aged 64-88 years and living at home, in the mid-eastern part of Sweden. The self-managing women were randomly selected. The disabled women – suffering from Parkinson's disease, rheumatoid arthritis or stroke – were selected from patient records. A total of 139 self-managing and 63 disabled women participated. Two dietary assessment methods were used: a repeated 24-h recall and a three-day estimated food diary, providing dietary intake for five non-consecutive days. The results indicate that elderly women still living in their homes seem to manage a sufficient dietary intake despite disability and high age. The reported energy intakes in all groups of women were low, which might be explained by an actual low intake and/or under-reporting. The portion sizes seemed to be smaller in the highest age group, leading to lower intakes of some nutrients. Thus also the nutrient density of the food should be given greater consideration. The meal pattern was shown to be regular and the distribution of main meals and snacks was found to be satisfactory. Meals and snacks that were defined as such by the women themselves thus seem to be more significant from an energy and nutritional perspective. Perceived cooking ability co-varied with energy and nutrient intake as well as with meal pattern. Further, a qualitative dietary assessment method, FBCE, was analysed. It was concluded that it must be supplemented with a dietary assessment method providing energy intake figures to ensure a sufficient intake, especially when studying groups at risk for low energy intake. Furthermore, the aim was to perform a dropout analysis. When studying older women and food, a low participation rate might be expected since the most active, the very ill as well as the disabled tend to decline participation, but also since food is a gender issue. Food could, especially for women, be a sensitive area of discussion, even though older women seem to choose "healthy foods" and eat "proper meals".

Darbo tikslas – įvertinti Tauragės miesto darželio vaikų mitybą ir jos sąsajas su tėvų socialine-ekonomine padėtimi. Tyrimo metodika. Apytikslio registravimo metodu vaikų mitybos tyrimas atliktas 2012 m. liepos 9, 11 ir 14 dienomis lopšelyje-darželyje ,,Žvaigždutė“. Tyrime dalyvavo aštuonių grupių vaikai, iš viso 124 tiriamieji (44,4 proc. berniukų ir 55,6 proc. mergaičių), kurių amžius – 3 - 6 metai. Vaikų mityba darželyje stebėta dvi darbo dienas, o vieną dieną mityba tirta namuose neanoniminiu anketiniu būdu apklausiant vaikų tėvus apie suvartotus maisto produktus ir jų kiekius. Šiame darbe analizuojami tik tų vaikų duomenys, kurie dalyvavo tyrime visas tris dienas. Atsako dažnis – 67,4 proc. Statistinė duomenų analizė atlikta naudojantis SPSS 16.0 for Windows programa. Rezultatai. Išanalizavus trijų parų maisto davinio energinę vertę ir maisto medžiagų sudėtį, nustatyta, kad 1 - 3 metų amžiaus grupės vaikų vidutinė paros maisto davinio energinė vertė buvo 1587,4 kcal, o 4 - 6 metų – 1940,0 kcal. Abiejose amžiaus grupėse daugiausia energijos gauta iš angliavandenių (atitinkamai 50,1 ir 50,3 proc.). Tačiau tiriamųjų suvartota angliavandenių, skaidulinių maisto medžiagų dalis buvo nepakankama. Baltymų dalis ikimokyklinio amžiaus vaikų maisto davinyje – pakankama. Maisto davinyje buvo per daug riebalų, ypač sočiųjų riebalų rūgščių. 1 - 3 ir 4 - 6 metų amžiaus grupių vaikų maisto davinyje riebalai viršijo maksimalią rekomenduojamą normą atitinkamai 7,5 proc. ir 7 proc... [toliau žr. visą tekstą] / Aim of the study – to assess dietary intake of children in Taurage kindergarden and its links between parental socioeconomic status. Research methodology. An approximate recording method was used in July 9, 11, 14, 2012, to carry out dietary intake of children in a nursery-kindergarten “Žvaigždute”. Children from three groups, i. e. 124 respondents (44.4 percent of boys and 55.6 percent of girls), aged 3 - 6 years participated in the research. Dietary intake of children was observed for two days and one day it was observed at children’s homes – parents were provided with non-anonymous questionnaires which had to be filled with the data about food products and their quantities their children had that day. In this study it is analyzed the data of those children who participated in the research for all three days. Response rate – 67.4 percent. Statistical analysis of the data has been carried out using SPSS 16.0 Windows Programme. Results. Analysis of the three-day food intake energy value and nutrient composition determined that the energy value of the food ration of the group of 1 - 3 years old children was 1587,4 kcal and 1940,0 kcal of the group of 4 - 6 years old children. Both age groups got the most energy from carbohydrates (respectively 50.1 and 50.3 percent). However, part of investigated carbohydrates and fiber nutrients was insufficient. The part of proteins in pre-school children’s food ration was sufficient. Also, there was too much fat, especially saturated fatty... [to full text]

Glycemic intake influences the rise in blood glucose concentration following consumption of a carbohydrate containing meal, known as the postprandial glycemic response. The glycemic response is a result of both the type and amount of carbohydrate foods consumed and is commonly measured as the glycemic index (GI) or glycemic load (GL), where the GI is a ranking in comparison to glucose and the GL is an absolute value encompassing both the GI and amount of carbohydrate consumed. Evidence from controlled trials in rat models suggests that glycemic intake has a role in development of insulin resistance, however trials and observational studies of humans have produced conflicting results. As insulin resistance is a precursor to type 2 diabetes mellitus, lifestyle factors that could prevent development of this condition have important public health implications. Previous observational studies have used food frequency questionnaires to assess usual diet, which could have resulted in a lack of precision in assessment of individual serve sizes, and have been limited to daily measures of glycemic intake. Daily measures do not take fluctuations in glycemic intake on a per meal basis into account, which may be a more relevant measure for investigation in relation to disease outcomes. This PhD research was conducted in a group of Brisbane women aged 42 to 81 years participating in the multidisciplinary Brisbane Longitudinal Assessment of Ageing in Women (LAW study). Older women may be at particular risk of insulin resistance due to age, hormonal changes, and increases in abdominal obesity associated with menopause, and the LAW study provided an ideal opportunity to study the relationship between diet and insulin resistance. Using the diet history tool, we aimed to assess the glycemic intake of the population and hypothesised that daily GI and daily GL would be significantly positively associated with increased odds of insulin resistant status. We also hypothesised that a new glycemic measure representing peaks in GL at different meals would be a stronger predictor of insulin resistant status than daily measures, and that a specially designed questionnaire would be an accurate and repeatable dietary tool for assessment of glycemic intake. To address these hypotheses, we conducted a series of studies. To assess glycemic intake, information on usual diet was obtained by detailed diet history interview and analysed using Foodworks and the Australian Food and Nutrient (AUSNUT) database, combined with a customised GI database. Mean ± SD intakes were 55.6 ± 4.4% for daily GI and 115 ± 25 for daily GL (n=470), with intake higher amoung younger participants. Bread was the largest contributor to intakes of daily GI and GL (17.1% and 20.8%, respectively), followed by fruit (15.5% and 14.2%, respectively). To determine whether daily GI and GL were significantly associated with insulin resistance, the homeostasis model assessment of insulin resistance (HOMA) was used to assess insulin resistant status. Daily GL was significantly higher in subjects who were insulin resistant compared to those who were not (134 ± 33 versus 114 ± 24 respectively, P<0.001) (n=329); the odds of subjects in the highest tertile of GL intake being insulin resistant were 12.7 times higher when compared with the lowest tertile of GL (95% CI 1.6-100.1, P=0.02). Daily GI was not significantly different in subjects who were insulin resistant compared to those who were not (56.0 ± 3.3% versus 55.7 ± 4.5%, P=0.69). To evaluate whether a new glycemic measure representing fluctuations in daily glycemic intake would be a stronger predictor of insulin resistant status than other glycemic intake measures, the GL peak score was developed to express in a single value the magnitude of GL peaks during an average day. Although a significant relationship was seen between insulin resistant status and GL peak score (Nagelkerke’s R2=0.568, P=0.039), other glycemic intake measures of daily GL (R2=0.671, P<0.001) and daily GL per megajoule (R2=0.674, P<0.001) were stronger predictors of insulin resistant status. To develop an accurate and repeatable self-administered tool for assessment of glycemic intake, two sub-samples of women (n=44 for the validation study and n=52 for the reproducibility study) completed a semi-quantitative questionnaire that contained 23 food groupings selected to include the top 100 carbohydrate foods consumed by the study population. While there were significant correlations between the glycemic intake questionnaire and the diet history for GL (r=0.54, P<0.01), carbohydrate (r=0.57, P<0.01) and GI (r=0.40, P<0.01), Bland-Altman plots showed an unacceptable difference between individual intakes in 34% of subjects for daily GL and carbohydrate, and 41% for daily GI. Reproducibility results showed significant correlations for daily GL (r=0.73, P<0.001), carbohydrate (r=0.76, P<0.001) and daily GI (r=0.64, P<0.001), but an unacceptable difference between individual intakes in 25% of subjects for daily GL and carbohydrate, and 27% for daily GI. In summary, our findings show that a significant association was observed between daily glycemic load and insulin resistant status in a group of older women, using a diet history interview to obtain precise estimation of individual carbohydrate intake. Both the type and quantity of carbohydrate are important to consider when investigating relationships between diet and insulin resistance, although our results suggest the association is more closely related to overall daily glycemic intake than individual meal intake variations. A dietary tool that permits precise estimation of carbohydrate intake is essential when evaluating possible associations between glycemic intake and individual risk of chronic diseases such as insulin resistance. Our results also suggest that studies using questionnaires to estimate glycemic intake should state degree of agreement as well as correlation coefficients when evaluating validity, as imprecise estimates of carbohydrate at an individual level may have contributed to the conflicting findings reported in previous studies.

As dificuldades associadas à coleta de urina de 24h e à baixa credibilidade do uso do biomarcador na prática clínica para estimar a ingestão de proteína de pacientes com doença renal crônica (DRC) na fase não-dialítica sinalizam para busca de alternativas acuradas e de ampla acessibilidade para a descrição do consumo de proteína nessa população. Avaliar a acurácia de métodos de inquérito dietético para estimar o consumo de proteína em pacientes de DRC na fase não dialítica e, a concordância desses com o biomarcador de ingestão protéica. Também foi avaliado a concordâncias entre o registro alimentar (RA) e recordatório alimentar de 24 horas (Rec24h). Cento e vinte e dois pacientes com DRC na fase não dialítica, que atenderam aos critérios de elegibilidade, foram submetidos à avaliação antropométrica, laboratorial e, tiveram a ingestão de proteína estimada por três métodos de avaliação do consumo alimentar, sendo estes dois métodos de inquérito dietético e um método de biomarcador. Os métodos de inquéritos alimentares compreenderam 4 dias de RA e 2 dias de Rec24h. Para o biomarcador foi avaliado a excreção de nitrogênio uréico em uma amostra de urina de 24 horas, o qual foi utilizado em equação do equivalente protéico do aparecimento do de nitrogênio uréico (PNA). Na análise estatística dos métodos de inquérito dietético, utilizou-se o PC-Side para estimar a variabilidade da ingestão de proteína, equações para estimar o número de dias necessários para estimativas acuradas da ingestão de proteína em avaliações no nível individual e coletivo. Para avaliar a concordância entre os três métodos de avaliação do consumo de proteína, utilizou-se o Concordance correlation coefficient (CCC) e o gráfico de Bland & Altman. Resultados: Os 4 dias de RA e 2 Rec24h descreveram com acurácia elevada a ingestão de proteína no nível coletivo, sendo respectivamente de 0,85 e 0,73. Para o nível individual, com erro tolerado intermediário de 20% (acurácia de 0,8), foram necessários 6 dias de RA e 5 de Rec24h para avaliação do consumo de proteína. Ao avaliar a concordância entre o PNA com o RA e Rec24h, observou-se CCC reduzido (< 0,3). Da mesma forma, ao avaliar a dispersão individual das diferenças obtidas entre o PNA e RA e Rec24h pelo gráfico de Bland & Altman, notou-se valores amplos de limite de concordância. Por outro lado, valores mais elevados de CCC (>0,4) foram encontrados entre o RA e o Rec24h. O gráfico de Bland & Altman desses dois métodos mostrou menor dispersão. Contudo, essa melhor concordância pode ser decorrente de superestimação da correspondência entre os métodos. Além disso, a concordância reduzida observada entre o PNA e o RA e Rec24h não permitiram afirmar que os métodos de inquéritos dietéticos ofereçam medidas irreais da ingestão de proteína, nem tampouco foi possível afirmar que a medida real é aquela sugerida pelo PNA. Em pacientes com DRC na fase não dialítica, orientada a seguir dieta hipoprotéica, o RA e Rec24h podem ser usados em substituição ao uso PNA como alternativas de baixo custo e de ampla acessibilidade à prática clínica para descrever a ingestão de proteína, desde que sejam definidos o nível da avaliação, o número ideal de dias e a acurácia desejada. / It has been well described in the literature the errors inherent to the 24 hours urine collection in free-living individuals. Therefore, the assessment of protein intake in nondialyzed chronic kidney disease (CKD) patients by the urinary urea excretion in the 24 hour urine sample, may lead to important errors related to the method itself. In this regard, assessing surrogate methods is of high relevance. To evaluate the accuracy of the dietary methods to estimate the protein consumption in nondialyzed CKD patients and also to assess the agreement between a biomarker of protein intake and dietary methods. In addition, it was also evaluated the agreement between two dietary methods. One hundred and twenty-two nondialyzed CKD patients, who met the eligibility criteria, were included. All participants underwent to antropometric and laboratory assessments, and had the protein intake estimated by three methods: two methods of dietary intake and one dietary biomarker. The dietary intake comprised 4 days of food records (FRec) and 2 days of 24-hour food recall (24hFRecall). For the biomarker, it was evaluated the urinary urea nitrogen excretion in a 24 hours urine sample, which was used in the equation of the protein equivalent of nitrogen appearance (PNA). The software PC-Side was used to estimate the variability of the protein intake in the FRec and 24hFRecall. In addition, specific equations were used to assess the number of days needed to estimate the protein intake with high accuracy in the individual and collective level. In order to evaluate the agreement between the 3 methods, it was used the concordance correlation coefficient (CCC) and the Bland & Altman plot analysis (1986). In the collective level, 4 days FRec and the 2 days of 24hFRecall described the protein intake with an accuracy close the highest acceptable level, being of respectively 0.85 and 0.73. For the individual level, by accepting an intermediate tolerated error of 20% (accuracy 0.8), 6 days of FR and 5 days of 24hFR were needed for the assessment of protein intake. When assessing the agreement between the PNA and the FRec and 24hFRecall, it was observed reduced CCC (< 0.3). Likewise, when evaluating the individual differences obtained between the PNA and the FRec and 24hFRecall by the Bland & Altman plot analysis, it was observed a wide concordance limit, which is consistent with the low concordance observed between the methods. Moreover, higher values of CCC (> 0.4) were found between the FRec and 24hFRecall. The Bland & Altman plot analysis of these two methods showed more narrows differences, which is consistent with the higher CCC observed. However, this best agreement may be due to an overestimation between the methods. Furthermore, the reduced concordance observed between the PNA and the FRec and 24hFRecall does not mean that the dietary intake methods give biased or unrepresentative measurements of protein intake, nor was that the PNA gave unbiased measurements of protein intake. FRec and 24hFRecall can be used as surrogate methods for the PNA, as an alternative low cost and high applicability method in the clinical routine practice to describe the protein intake.

As dificuldades associadas à coleta de urina de 24h e à baixa credibilidade do uso do biomarcador na prática clínica para estimar a ingestão de proteína de pacientes com doença renal crônica (DRC) na fase não-dialítica sinalizam para busca de alternativas acuradas e de ampla acessibilidade para a descrição do consumo de proteína nessa população. Avaliar a acurácia de métodos de inquérito dietético para estimar o consumo de proteína em pacientes de DRC na fase não dialítica e, a concordância desses com o biomarcador de ingestão protéica. Também foi avaliado a concordâncias entre o registro alimentar (RA) e recordatório alimentar de 24 horas (Rec24h). Cento e vinte e dois pacientes com DRC na fase não dialítica, que atenderam aos critérios de elegibilidade, foram submetidos à avaliação antropométrica, laboratorial e, tiveram a ingestão de proteína estimada por três métodos de avaliação do consumo alimentar, sendo estes dois métodos de inquérito dietético e um método de biomarcador. Os métodos de inquéritos alimentares compreenderam 4 dias de RA e 2 dias de Rec24h. Para o biomarcador foi avaliado a excreção de nitrogênio uréico em uma amostra de urina de 24 horas, o qual foi utilizado em equação do equivalente protéico do aparecimento do de nitrogênio uréico (PNA). Na análise estatística dos métodos de inquérito dietético, utilizou-se o PC-Side para estimar a variabilidade da ingestão de proteína, equações para estimar o número de dias necessários para estimativas acuradas da ingestão de proteína em avaliações no nível individual e coletivo. Para avaliar a concordância entre os três métodos de avaliação do consumo de proteína, utilizou-se o Concordance correlation coefficient (CCC) e o gráfico de Bland & Altman. Resultados: Os 4 dias de RA e 2 Rec24h descreveram com acurácia elevada a ingestão de proteína no nível coletivo, sendo respectivamente de 0,85 e 0,73. Para o nível individual, com erro tolerado intermediário de 20% (acurácia de 0,8), foram necessários 6 dias de RA e 5 de Rec24h para avaliação do consumo de proteína. Ao avaliar a concordância entre o PNA com o RA e Rec24h, observou-se CCC reduzido (< 0,3). Da mesma forma, ao avaliar a dispersão individual das diferenças obtidas entre o PNA e RA e Rec24h pelo gráfico de Bland & Altman, notou-se valores amplos de limite de concordância. Por outro lado, valores mais elevados de CCC (>0,4) foram encontrados entre o RA e o Rec24h. O gráfico de Bland & Altman desses dois métodos mostrou menor dispersão. Contudo, essa melhor concordância pode ser decorrente de superestimação da correspondência entre os métodos. Além disso, a concordância reduzida observada entre o PNA e o RA e Rec24h não permitiram afirmar que os métodos de inquéritos dietéticos ofereçam medidas irreais da ingestão de proteína, nem tampouco foi possível afirmar que a medida real é aquela sugerida pelo PNA. Em pacientes com DRC na fase não dialítica, orientada a seguir dieta hipoprotéica, o RA e Rec24h podem ser usados em substituição ao uso PNA como alternativas de baixo custo e de ampla acessibilidade à prática clínica para descrever a ingestão de proteína, desde que sejam definidos o nível da avaliação, o número ideal de dias e a acurácia desejada. / It has been well described in the literature the errors inherent to the 24 hours urine collection in free-living individuals. Therefore, the assessment of protein intake in nondialyzed chronic kidney disease (CKD) patients by the urinary urea excretion in the 24 hour urine sample, may lead to important errors related to the method itself. In this regard, assessing surrogate methods is of high relevance. To evaluate the accuracy of the dietary methods to estimate the protein consumption in nondialyzed CKD patients and also to assess the agreement between a biomarker of protein intake and dietary methods. In addition, it was also evaluated the agreement between two dietary methods. One hundred and twenty-two nondialyzed CKD patients, who met the eligibility criteria, were included. All participants underwent to antropometric and laboratory assessments, and had the protein intake estimated by three methods: two methods of dietary intake and one dietary biomarker. The dietary intake comprised 4 days of food records (FRec) and 2 days of 24-hour food recall (24hFRecall). For the biomarker, it was evaluated the urinary urea nitrogen excretion in a 24 hours urine sample, which was used in the equation of the protein equivalent of nitrogen appearance (PNA). The software PC-Side was used to estimate the variability of the protein intake in the FRec and 24hFRecall. In addition, specific equations were used to assess the number of days needed to estimate the protein intake with high accuracy in the individual and collective level. In order to evaluate the agreement between the 3 methods, it was used the concordance correlation coefficient (CCC) and the Bland & Altman plot analysis (1986). In the collective level, 4 days FRec and the 2 days of 24hFRecall described the protein intake with an accuracy close the highest acceptable level, being of respectively 0.85 and 0.73. For the individual level, by accepting an intermediate tolerated error of 20% (accuracy 0.8), 6 days of FR and 5 days of 24hFR were needed for the assessment of protein intake. When assessing the agreement between the PNA and the FRec and 24hFRecall, it was observed reduced CCC (< 0.3). Likewise, when evaluating the individual differences obtained between the PNA and the FRec and 24hFRecall by the Bland & Altman plot analysis, it was observed a wide concordance limit, which is consistent with the low concordance observed between the methods. Moreover, higher values of CCC (> 0.4) were found between the FRec and 24hFRecall. The Bland & Altman plot analysis of these two methods showed more narrows differences, which is consistent with the higher CCC observed. However, this best agreement may be due to an overestimation between the methods. Furthermore, the reduced concordance observed between the PNA and the FRec and 24hFRecall does not mean that the dietary intake methods give biased or unrepresentative measurements of protein intake, nor was that the PNA gave unbiased measurements of protein intake. FRec and 24hFRecall can be used as surrogate methods for the PNA, as an alternative low cost and high applicability method in the clinical routine practice to describe the protein intake.

Made available in DSpace on 2016-03-15T19:40:21Z (GMT). No. of bitstreams: 1 Larissa Aguiar Silva.pdf: 2060546 bytes, checksum: 509f4a007093ede4075a937cd69bde08 (MD5) Previous issue date: 2015-08-17 / Prader-willi syndrome (pws) presents a complex clinical condition characterized by several alterations and endocrine, hypothalamic, metabolic, cognitive and behavioral disorders. One of the main symptoms of this disease is hyperphagia, being responsible for the increased risk for the development of obesity, cardiovascular diseases, endocrine and respiratory dysfunctions. Many behavior problems of people with pws are associated to hypothalamic dysfunctions related to inhibitory control that lead to development of behavior patterns of aggressiveness and manipulation for obtaining food. Caregivers of people with pws must establish environments with rigorous controls of food stimulation to avoid overstated caloric intakes. The objective of this study was to verify behavior problems and information of dietary intake of a group of people with prader-willi syndrome. The specific objectives were: a) verify the dietary intake of macronutrients and micronutrients, as well as the nutritional status of the group according to age groups. B) identify associations among dietary intake and nutritional monitoring of the group according to age groups. C) verify and compare behavior problems and associations with dietary intake among age groups. The study adopted a cross-sectional design and was composed by a sample of 22 people of both genders with pws (children, adolescents and adults aged at least 1 year old and maximum of 22) and their caregivers (project approved by ethics committee in research with human beings as the protocol - process cep/upm caae n. 34649314.2.0000.0084). The instruments of data collection were: a) instruments of nutritional, behavioral and physical assessment belonging to the protocol of evaluation of people with pws of department of kinesiology of college ofhealth and human development of california state university, fullerton; b) nutrition screen and intake form; c) 24-hour recall (24hr); d) verification of body mass index (bmi); e) brief problem monitor - parent form for ages 6-18 (bpm-p). The main results indicate the prevalence of several behavior problems assessed by instruments that evaluate this variable, with predominance of this problems in the group above 11 years old. Similar data were obtained regarding the dietary intake. More than 80% of total sample performed nutritional monitoring, however were verified indicative correlation that the greater the age, greater the dietary intake, especially of macronutrients. Also the higher age group makes a greater number of meals out home. In adolescence and adult age Externalizing behavior problems as challenge, aggressiveness and perserverative answers characterized more consistently the behavioral phenotype of pws. These are problems that when associated with the main symptom of disease, hyperphagia, complicate the management of people with pws, especially in relation to food access. It s likely that increased intake of macronutrients, especially energy and lipids, are associated with these behavior problems in people with pws over 11 years old. It's concluded from data that in the sample there are indicators of behavior problems and dietary intake that require multiprofessional interventions on people with pws and their family members focusing on dietary/nutritional, psychological, endocrinological and family social aspects. / A síndrome de prader-willi (spw) apresenta um quadro clínico complexo caracterizado por diversas alterações e disfunções endócrinas, hipotalâmicas, metabólicas, cognitivas e comportamentais. Um dos sintomas cardinais da doença é a hiperfagia, sendo responsável pelo aumento do risco para o desenvolvimento de obesidade, doenças cardiovasculares, endocrinológicas e disfunções respiratórias. Muitos dos problemas de comportamento de pessoas com spw se associam a disfunções hipotalâmicas relacionadas ao controle inibitório que oportunizam o desenvolvimento de padrões comportamentais de agressividade e comportamentos de manipulação para a obtenção de alimentos. Cuidadores de pessoas com spw precisam estabelecer ambientes com controles rigorosos dos estímulos alimentares para evitar ingestões calóricas exageradas destes. O objetivo geral do estudo foi verificar problemas de comportamento e informações sobre consumo alimentar de um grupo de pessoas com spw. Os objetivos específicos foram: a) verificar o consumo alimentar de macronutrientes e micronutrientes, assim como do estado nutricional do grupo em função de faixas etárias. B) identificar associações entre o consumo alimentar e o uso de serviços de acompanhamento nutricional do grupo em função de faixas etárias. C) verificar e comparar entre faixas etárias problemas de comportamento e associações com o consumo alimentar. O estudo adotou um delineamento do tipo transversal e foi composto por uma amostra de 22 participantes ambos os sexos com spw (entre crianças, adolescentes e adultos, com idade mínima de 1 ano e máxima de 22) e seus respectivos cuidadores (projeto aprovado pelo comitê de ética em pesquisa com seres humanos conforme o protocolo - processo cep/upm caae n° 34649314.2.0000.0084). Os instrumentos de coleta de dados foram: a) instrumentos do protocolo de avaliação nutricional, comportamental e física pertencentes ao protocolo de avaliação de pessoas com spw do departamento de cinesiologia da escola de saúde e desenvolvimento humano da universidade estadual da califórnia, fullerton; b) formulário de ingestão e rastreio nutricional (firn)/ nutrition screen and intake form; c) recordatório de 24 horas (r24h); d) verificação de índice de massa corporal (imc); e) monitor abreviado de problemas para pais de crianças e adolescentes entre 6 e 18 anos/brief problem monitor parent Form for ages 6-18 (bpm-p). Os principais resultados apontam para a prevalência de diversos problemas de comportamento verificados nos instrumentos que avaliam essa variável com predomínio destes no grupo de participantes acima de 11 anos. Dados semelhantes foram obtidos em relação ao consumo alimentar. Mais de 80% do total da amostra realizava acompanhamento nutricional, entretanto verificaram-se correlações indicativas de que quanto maior a idade, mais elevados foram os indicadores de consumo alimentar, especialmente os macronutrientes. Também o grupo de maior idade realiza um número maior de refeições fora de casa do tipo fast food . Na adolescência e idade adulta problemas de comportamento de tipo externalizantes como desafio, agressividade e respostas perserverativas caracterizam de maneira mais consistente o fenótipo comportamental da spw. Trata-se de problemas que, quando associados ao sintoma cardinal da doença, a hiperfagia, dificultam o manejo de pessoas com spw, especialmente em relação ao acesso a alimentos. É provável que o aumento da ingesta de macronutrientes, especialmente energia e lipídeos, esteja associado a esses problemas de comportamento dos participantes acima de 11 anos. Conclui-se a partir dos dados que no grupo há indicadores de problemas de comportamento e consumo alimentar que demandam intervenções multiprofissionais nos participantes com spw e seus familiares com foco em aspectos dietéticos/nutricionais, psicológicos, endocrinológicos e sócio familiares.

The dietary intake of polybrominated diphenyl ethers (PBDEs) and hexabromocyclododecane (HBCD) have been estimated for Swedish children. A dietary survey performed in 2003, including 4, 8-9 and 11-12 year olds, and concentrations in individual food items were combined. The food included in the study was mainly of animal origin, consisting of fish and shellfish, dairy products, meat products, eggs, animal and vegetable fats and fats from miscellaneous food products. The medium-bound intake of PBDEs (9 congeners) were estimated to 23.0 ng/day, 30.9 ng/day and 27.7 ng/day for 4, 8-9 and 11-12 years olds respectively. The corresponding estimations for HBCD were 7.94 ng/day 10.7 ng/day and 9.46 ng/day for 4, 8-9 and 11-12 years olds respectively. These results show a higher daily intake for 8-9 year olds compared with the other age groups. However, when estimating the daily intake per kg bw, the intake decreases with age. BDE-47 contributed the most to the total intake of PBDEs, with approximately 40%. The food group contributing the most to the intake of PBDEs and HBCD was fish and shellfish, of which non-Baltic fatty fish was the largest contributor. There were no considerable differences between boys and girls in any of the aspects examined. The result from this study show a lower intake of PBDEs and HBCD in Swedish children compared with children in other studies made in Europe and the United States. / Bromerade flamskyddsmedel används för att skydda brännbara material från att fatta eld, till exempel skyddas textilier och plaster i bland annat elektronik, fordon och möbler. Två typer av bromerade flamskyddsmedel är polybromerade difenyletrar (PBDE) och hexabromocyklododekan (HBCD). Dessa är additiva flamskyddsmedel och blandas i materialet som ska skyddas men binder inte in i produkten och kan därför lätt läcka ut i miljön, vilket också har skett. Halter har påträffats i miljön och i biota långt från plaster där ämnena produceras eller används. PBDE och HBCD har visats ha hormonstörande och neurotoxiska effekter i studier på råtta och mus. Thyroxinnivåerna sjunker vid exponering av PBDE och HBCD, vilket skulle kunna leda till sköldkörtelproblem och störd utveckling av bland annat hjärnan om exponering sker perinatalt. De neurotoxiska effekterna inkluderar inlärnings- och minnessvårigheter och ett förändrat beteende med hyper- och hypoaktivitet som följd. Human exponering för PBDE och HBCD sker främst via födan och speciellt via animaliska produkter då dessa ämnen är lipofila, bioackumulerande och ofta biomagnifierande vilket gör att de påträffas i högre koncentrationer högre upp i trofinivåerna. Studier från bland annat Sverige och Finland visar att fisk och skaldjur är den största källan till intag av PBDE. De flesta intagsberäkningar av PBDE och HBCD baseras på livsmedelskonsumtionen hos vuxna och visar följaktligen endast hur intaget ser ut för den delen av populationen. För barn, som är en av de känsligaste grupperna i populationen, finns inte många studier att tillgå, varken från Sverige eller andra delar av världen. I den här studien har därför intaget av PBDE (summan av 9 kongener) och HBCD beräknats för barn i Sverige. I en rikstäckande kostundersökning utförd 2003 deltog barn i åldrarna 4, 8-9 och 11-12 år. De fick i en matdagbok ange sin konsumtion under fyra på varandra följande dagar. Data från denna undersökning kombinerades sedan med haltdata från olika livsmedel för att räkna ut intaget av PBDE och HBCD på individbasis. Undersökningen innefattade främst animaliska livsmedel och innehöll därför fisk och skaldjur, mejeriprodukter, köttprodukter, ägg, animaliskt och vegetabiliskt fett och fett från övriga livsmedel. Resultaten visar att födointaget av PBDE var 23,0 ng/dag, 30,9 ng/dag och 27,7 ng/dag för 4, 8-9 respektive 11-12 åringar. Intaget av HBCD beräknades till 7,94 ng/dag, 10,7 ng/dag och 9,46 ng/dag för 4, 8-9 respektive 11-12 åringar. Detta visar att 8-9 åringar har det högsta dagliga intaget av PBDE och HBCD. När intaget beräknas på kroppsvikt däremot, har de yngsta barnen det högsta intaget som sedan sjunker med åldern. Fisk och skaldjur var den största källan till intaget av PBDE och HBCD, trots att konsumtionen av dessa livsmedel var relativt lågt. Det fanns ingen större skillnad mellan pojkar och flickor, varken i intag av PBDE eller av HBCD. Jämfört med de få studier som gjorts i andra länder, är det tydligt att svenska barn har ett lägre intag av PBDE och HBCD. Undersökningen tyder också på att intaget av PBDE och HBCD hos svenska barn, utifrån de kunskaper vi har idag, inte utgör någon risk med avseende på de effekter av PBDE och HBCD som påträffats i toxikologiska studier. Däremot är barn i ett känsligt skede i livet och upprepad exponering samt exponering för flera miljögifter samtidigt skulle kunna påverka deras utveckling negativt.

M. Tech. (Department of Hospitality, Tourism and PR Management, Faculty of Human Sciences), Vaal University of Technology / The purpose of this study was to determine the contribution of the National School Nutrition Programme (NSNP) has made on the total nutrient intake of Kagiso learners. This was done by investigating the nutrient intake of school children participating in the NSNP (experimental group) and comparing this to the nutrient intake of learners participating in the tuck-shop or lunch box (control group) from one school. The research methodology was undertaken in two phases, namely phase one; planning and phase two; data collection and analysis. The following measuring methods were applied; socio-demographics, household food insecurity assessment scale, anthropometry measurements, food frequency questionnaires (FFQ), 24-hour recall and the observation of the NSNP during the school lunch breaks. Anthropometry measurements were analysed according to the World Health Organization standards (WHO 2008), socio-demographics, and household food insecurity assessment scale and FFQ were captured on an Excel spreadsheet by the researcher and analysed using the Statistical Package for Social Sciences (SPSS) version 22.0 for descriptive statistics such as frequencies, standard deviations and confidence intervals. An expediency sample of 160 primary school children aged 6-13 years, including girls (n=84) and boys (n=76) and 106 caregivers were recruited into the study. The results showed that majority of caregivers (59%) completed secondary level education, followed by 39% with primary level or college completion (2%). The employment rate in the Kagiso households of the sampled group was low with 20% of caregivers being unemployed. Out of the 76% of the employed caregivers, 26% were permanently employed and 51% were temporarily employed with contract work and piece jobs. The highest monthly income (42%) was between R1000-R3000 and the lowest (38%) was less than R1000 with only R101-R200 to spend on food per week. The food insecurity status of Kagiso learners showed that 44% of school children were food secure, and 56% were food insecure – of these, 29% experienced hunger. Heightfor-age, weight-for-age and BMI-for-age were measured for all of the 160 children. The group was categorized as follows; school children participating in the NSNP (n=59) and children using the tuck-shop foods (n=35) and lunch box (n=66). The nutritional status of Kagiso learners from the sampled group showed that more boys were stunted (13%) and wasted (12%) while of the girls, 30% were at risk of being overweight, with only 2% reported to be overweight. The majority of boys reported to be stunted and wasted were from the NSNP group and the girls reported to be overweight or at risk of being overweight were from the tuck-shop group. Thus, the learners from the lunchbox had optimum growth status when compared to the other two groups. The respondents consumed a mainly high carbohydrate diet with a low consumption of vegetable and fruits. The results from the Food Variety Score (FVS) revealed a low individual mean (2.25±1.57) in the legume and nuts group, followed by a medium individual mean (7.9±2.81) in the fruits and other juices group, 7.16±2.68 in the vegetable group, and lastly, the highest individual mean (9.26±3.04) in the cereal, roots and tubers diversity. The results from the top 20 popular food items ranked as follows; maize meal stiff (1st), maize meal porridge (5th), white rice (6th), white bread (7th) brown bread (9th), potato fries (12th), breakfast cereal (13th) and samp and beans (14th). Cabbage (15th) and pumpkin (20th) were the most popular vegetables and there were no fruits within the top 20 popular list of food items. The Nutrient Adequacy Ratio (NAR) of the NSNP (n=59) meals was below the 1/3 (33.3%) and 30% dietary requirements for lunch meals. This was very evident regarding vitamin A (16.85%), energy kilojoules (23.78%), calcium (18%), folate (26.72%), zinc (15.71%), dietary fiber (25.71%) and iodine (4.65%). Iron (38.98%) was slightly above the 1/3 and 30% dietary intake, but there were a high percentage (61%) of respondents who did not meet the EARs of 5.9mg for iron. The results revealed an inadequate contribution by the NSNP to the nutrient intake of Kagiso learners. The poor intake of folate, vitamin A and dietary fiber in this sampled group is linked to the low consumption of vegetable and fruits. Results from this observational study showed that a majority of respondents do not participate in the NSNP when they do not have their own eating utensils. Respondents also revealed that the NSNP meals caused allergies such as skin rash while some mentioned diarrhea as the cause of not eating meals from the NSNP. Hence, a larger percentage (41%) of school children preferred to participate in the lunch box rather than in the NSNP (37%). The high prevalence of inadequate nutrient intake and the poor nutritional status of Kagiso learners in the sampled group, is an indication that strict monitoring of dietary measures needs to be implemented and continuously evaluated to ensure that positive nutritional results are obtained by the NSNP across South Africa

Thesis (M. Sc. (Physiology)) --University of Limpopo, 2019 / Introduction: There is an increased trend in the prevalence of hypertension in children and adolescents in African countries. There are complications in diagnosing hypertension in children and adolescents due to the variation of blood pressure (BP) values with age, gender and height. The progression of the health transition with non-communicable diseases (NCDs) adds significantly to the disease burden, despite infectious diseases and undernutrition remaining persistent in both low and middle-income countries. Metabolic syndrome (MetS) is a global problem associated with the clustering of several cardiovascular risk factors. South African evidence suggests an upsurge of NCDs amidst the existence of communicable diseases (CDs) such as HIV/AIDS and tuberculosis. Moreover, NCDs and CDs in the country are influenced by socio-demographic factors; and thus tend to be more prominent in certain segments of the population. Aim and Objectives: The aim of this study was to perform blood pressure to height ratio and to determine lifestyle risk factors associated with metabolic syndrome among the Ellisras rural population aged 6-30 years, who are part of the ELS. Methods and materials: The current study is based on secondary data analysis of the Ellisras Longitudinal Study (ELS) and was conducted in two phases. Phase 1 included data analysis of all the participants in the ELS. This sample included a total number of 9002 children and adolescents (4678 boys and 4324 girls), aged 6-17 years. Parents or guardians provided written informed consent. Phase 2 consisted of biochemical analysis from a subsample of participants in the ELS. The subsample included 624 participants (306 males and 318 females) aged 18-30 years at the time the study was conducted. All participants underwent a series of anthropometric measurements (waist circumference and height) according to the standard of the International Society for the Advancement of Kinanthropometry (ISAK). The waist circumference (WC) measurements were taken to the nearest 0.1 cm, using a soft measuring tape. Metabolic syndrome was defined according to the International Diabetes Federation (IDF) criteria. Metabolic syndrome risk factors included total cholesterol (TCHOL), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), elevated fasting blood glucose (FBG), elevated blood pressure (BP) and high waist circumference (WC). A dietary intake questionnaire was also administered to each participant and self‑administered questionnaire was used to collect data on lifestyle factors, including smoking and alcohol intake. Dietary intake variables used in the linear regression method were log transformed prior to analysis because of their skewed distribution. Receiver-operating characteristic (ROC) curve was used to assess the accuracy of BPHR to screen children with prehypertension and hypertension. The optimal systolic BPHR (SBPHR) and diastolic BPHR (DBPHR) cut-off points for hypertension were determined. Sensitivity/specificity, positive predictive values and negative predictive values were calculated. Results: The optimal thresholds for defining prehypertension was 0.77 in children aged 6-10 years and 0.73 in adolescents aged between 11 and 17 years for systolic BPHR and 0.55 in children and 0.53 in adolescents for diastolic BPHR, respectively. The corresponding values for hypertension stage 1 were 0.76 and 0.73 for SBPHR and 0.50 and 0.58 for DBPHR, respectively. The BPHR is an accurate tool for screening elevated BP in Ellisras children aged 6-17 years. This can help to prevent the misclassification of children and adolescent hypertension. Furthermore, this tool can be used to screen children before the development of prehypertension and hypertension. Moreover, it can be used to manage hypertension in Ellisras children, ultimately reducing the risks of developing hypertension and associated cardiovascular disease in adulthood. Overall, the prevalence of metS was 23.1% (8.6% males and 36.8% females). Females appeared to have higher mean values for WC, FBG, TCHOL and LDL-C than males (82.14, 5.62, 4.62 and 2.97, respectively). The only significant gender difference observed was on WC (p<0.001). Males on the other hand had higher mean values for HDL-C, TG, SBP and DBP than females (1.20, 1.06, 125.91 and 71.44, respectively). The only significant difference observed in this case was on SBP (p<0.001). No significant age group differences were observed in all the metabolic risk factors with the exception of DBP where the older (25-30 years) participants presented with high SBP than the younger age group (18-24 years) (70.96 mmHg vs 68.78 mmHg, p<0.05). While, majority of females had significantly high WC, elevated total cholesterol and LDL-C, and reduced HDL-C; majority of males had elevated BP, SBP and DBP. No significant age and gender differences were observed on dietary intake. However, according to the linear regression analysis, no association between log total energy, log added sugar, log SFA and log MUFA with metabolic risk factors. There was a low and negative significant association between log fibre with SBP and DBP (β:-0.004, p=0.003 and β:-0.004, p=0.046), respectively, crude. After adjusting for the potential confounding factors, log fibre was also associated with FBG (β:-0.028, p=0.046). Log PUFAs was inversely associated with FBG, HDL-C and SBP crude. Log trans fatty acids was inversely associated with WC, HDL-C and SBP crude. Both log PUFAs and log trans fatty acids were not associated with any metabolic risk factors after adjusting for potential cofounding factors. Log protein was inversely associated with SBP both crude and adjusted for potential cofounding factors. On predicting the actual risk using the logistic regression analysis, participants who had high dietary energy intake were significantly less likely to present with larger WC, low HDL-C and high LDL-C (OR: 0.250 95%CI [0.161;0.389], OR: 0.306 95%CI [0.220;0.425] and OR: 0.583 95%CI [0.418;0.812], respectively), but more likely to presents with elevated FBG, high TCHOL, high TG and hypertension (OR: 1.01 95%CI [0.735;1.386], OR: 1.039 95%CI [0.575;1.337], OR: 1.186 95%CI [0.695;2.023], OR: 5.205 95%CI [3.156;8.585], respectively) crude. After adjusting for age, gender, smoking and alcohol status, high energy intake was more likely to increase two times high the large WC and elevated FBG among study participants (OR: 2.766 95%CI [0.863;3.477] and OR: 2.227 95%CI [1.051;3.328], respectively). Furthermore, low dietary fibre intake was nearly four times more likely to increase the low HDL-C, crude (OR: 3.864 95%CI [1.067;13.988]) crude. Those participants who consumed high trans fats were more likely to present with high FBG (OR:1.424 95%CI [0.985;2.060]), but less likely to present with LDL-C (OR: 0.540 95%CI [0.321;0.906]) crude. However, after adding potential cofounding factors, participants with high fatty acid were less likely to present with high FBG (OR: 0.672 95%CI [0.441;1.023]). Conclusions: MetS is prevalent in young adults in Ellisras and is differentiated by age and gender with more females at an increased rate by virtue of their body size status, reduced HDL-C, elevated FBG and high LDL-C and the diet they consume that is in most cases high energy, more carbohydrates, high added sugar and SFA. Therefore, identifying groups that are at an increased risk and those that are in their early stages of MetS will help improve and prevent the increase of the metS in the future. These results have high policy implications. KEY CONCEPTS Metabolic syndrome; risk factors; blood pressure; blood pressure to height ratio; cardiovascular disease; dietary intake; rural South African.

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