Hypertension is a major chronic health problem that can lead to heart attack, stroke, and kidney failure. African Americans disproportionately suffer from the morbidity and mortality of hypertension-related illnesses. The purpose of this comparative project was to determine the impact of peer support educational workshops as an avenue for lifestyle modification, using changes in blood pressure (BP) before and after participation. The target population consisted of 64 African Americans with hypertension in Brooklyn NY, aged 20 to 65 years old. BP measurements were taken within 1 month before and after participating in a weekly peer support educational workshop facilitated by designated healthcare providers. The health belief model, using the tenets of lifestyle modification, societal support and health education, was used to guide the study. Demographic data were collated and categorized, considering numeric values used to represent age, income level, and education. Normality testing of the study variables was performed to ensure that the data followed a normal distribution. The study variables included the pre- and post-test systolic and diastolic BP. A t test was used in order to compare the 2 groups, revealing a statistically lower significant score from African Americans who participated than those who did not. African Americans who adhered to peer support educational regimens in the workshops revealed a statistically significant lower diastolic BP than those who did not participate. This research contributes to social change by providing evidence-based recommendations that government and health care professionals may use to create strategic plans to promote the well-being of individuals and communities.

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

Thesis submitted in fulfilment of the requirement for the degree Doctor of Technologiae (Biomedical Technology) in the Faculty of Health and Wellness Sciences at the Cape Peninsula University of Technology Supervisor: Prof J van Rooyen Co-supervisor: Prof JL Marnewick Bellville October 2013 / Cardiovascular disease (CVD) is without a doubt one of the most challenging health issues of our time and accounts for the highest number of deaths in both developed and developing countries. Despite the huge strides that have been achieved in the diagnosis and therapeutic intervention of CVD, the disease burden still remains enormous. Therefore, this calls for novel and innovative interventions to curb the surge of CVD. The use of plant based food with bioactive phytochemicals,has a great potential to reduce the incidence of CVD, specifically in resource-strained countries. Red palm oil (RPO) and the indigenous herbal tea, rooibos have previously been shown to exhibit potential cardioprotective effects. Their health promoting properties have largely been attributed to their antioxidant and anti-inflammatory activities and emerging evidence also showed that they have the potential to modulate cell signalling events. Substancial scientific evidence proposes oxidative stress and inflammation to play an important role in the pathogenesis of cardiovascular disease. Hence, natural plant extracts such as RPO and rooibos could be recommended as adjuvants to clinical therapy to reduce the morbidity and mortality associated with CVD. This thesis reports on three studies investigating the cardiovascular protective effects that chronic feeding of either RPO, rooibos or their combination have on 1) antioxidant enzymes and the NO-cGMP pathway in myocardial tissue of spontaneous hypertensive rats, 2) the modulation of systemic and myocardial inflammation and 3) the myocardial ischaemic/reperfusion tolerance in a rat model of lypopolysaccharide induced inflammation. The aim of the first study was to investigate the effect of RPO on cardiac function in sponteneously hypertensive rats. The role of the nitric oxide cyclic-guanosine monophosphate(NO-cGMP) pathway, (as determined by the nitric oxide (NOS) activity) and the antioxidant defence system (selected antioxidant enzymes) were also investigated. Cardiac function was monitored at stabilization and reperfusion using the Langendorff perfusion system. Antioxidant enzymes were determined from left ventricular tissue, while total NOS activity was determined in the aorta and left ventricular tissue. The results show that RPO offered cardiac protection as evidenced by improved left ventricular developed pressure (LVDevP), maximum velocity of pressure rise (+dp/dt) max and fall (-dp/dt) max during reperfusion in sponteneously hypertensive rats (SHR) compared to their control counterparts. Improved function in SHR was associated with increased myocardial superoxide dismutase 2 (SOD2) protein expression compared to the normotensive rats. There was differential modulation of the NOS activity by RPO, an increase in NOS activity was observed in the aorta while a reduction in the activity of NOS was observed in the left ventricular tissue of both RPO supplemented normotensive and hypertensive rats compared to their respective control groups. These results argue a role for elevated NO production in the aorta for endothelial function maintenance. Increased SOD2 protein might lead to reduced oxidative stress. Thus, NO-cGMP pathway and antioxidant defense systems synergistically acted to restore cardiovascular function in SHR. The aim of the second study was to investigate the effect of RPO and rooibos supplementation on the modulation of systemic and myocardial inflammation in a rat model. As RPO and rooibos contain different types of antioxidants which reside and exert their biological effects in different cellular compartments, the combination of these two natural food compounds has the potential to enhance the spectrum of available dietary antioxidants in different cellular compartments, which could result in a better protection against certain pathological conditions such as inflammation. The Langendorff system and the lypopolysaccharide (LPS)-induced inflammatory model were used to determine if RPO and rooibos could protect against the negative effect of LPS-induced inflammation on baseline cardiac function. Both inflammation and dietary supplementation did not have any effect on baseline cardiac functional parameters. Our results show that administration of LPS resulted in elevated plasma levels of IL-1β in supplemented and non-supplemented rats indicating that an inflammatory response was triggered in the LPS-treated rats. However, this increase in IL-1β was counteracted by concurrent elevation of plasma IL-10 in LPS-induced rats consuming either rooibos or RPO alone. Furthermore the combination of RPO and rooibos enhanced myocardial IL-10 levels in LPS-induced rats. This data shows a difference in response to LPS injection between the myocardium and the systemic circulation. The results indicate that the combination of these two natural food substances exhibit potential anti-inflammatory properties which could be beneficial in clinically relevant conditions where inflammation plays a role. Having shown that dietary intervention with RPO and rooibos had the potential to modulate the inflammatory response in the model of inflammation at basal conditions, we then proceeded to the third study to specifically establish if dietary RPO when supplemented alone will improve functional recovery and reduce infarct size in LPS-treated hearts. The Langendorff perfusion system was employed for determination of cardiac function and infarct size. The roles of NFkB, p38 MAPK and the myocardial antioxidant defence systems were investigated as potential mechanisms of protection. LPS-treatment caused significant increases in myocardial IL-1 β indicating that inflammation was induced. However, the levels of myocardial IL-10 was reduced in LPS-treated hearts compared to the non-treated hearts. Intervention with dietary RPO resulted in improved functional recovery and reduced infarct size, in both healthy hearts and in the LPS-treatment group. The RPO-induced cardio-protection was associated with increases in myocardial protein expression of the antioxidant enzymes, SOD1, SOD2, GPX1 as well as increased p38 phosphorylation during reperfusion. LPS treatment increased myocardial protein expression of NFkB p65 which was reversed by RPO supplementation. Reduction of myocardial NFkB protein expression, increased p38 phosphorylation and elevated mitochondrial antioxidant (SOD2 and GPX1) as well as cytosolic enzymes (SOD 1) are proposed as potential mechanisms underlying the RPO-induced cardio-protection in this model. Based on these study results, for the first time, having included vasculature aspects in the cardio-protective effects of RPO we have shown that the NO-cGMP pathway and antioxidant defense systems may act synergistically to restore cardiovascular function in spontaneously hypertensive rats. Results from the second study also provide the first scientific evidence that RPO in combination with rooibos (a flavonoid rich endemic herbal tea) could have potential anti-inflammatory activities at systemic as well as myocardial level, which may be beneficial in clinically relevant conditions where inflammation plays a role. From the third study it can be concluded that dietary RPO improved myocardial tolerance to ischaemia-reperfusion injury in a model of inflammation.

Affectant près d'un milliard de personnes dans le monde, l'hypertension artérielle représente un facteur de risque majeur de pathologies cardiovasculaires et d'insuffisance rénale et constitue l'une des principales causes de mortalité. L'identification de traitements anti-hypertenseurs efficaces et tenant compte des particularités des différentes populations du globe présente ainsi un intérêt capital en termes de santé publique. Notre travail a été consacré à l'étude de plantes anti-hypertensives de la Pharmacopée ouïghoure, principale ethnie de la Région autonome du Xinjiang, vaste territoire montagneux et désertique situé au Nord-Ouest de la Chine. L'objectif de la thèse a été d'apporter des arguments scientifiques, phytochimiques et pharmacologiques, permettant de valider et valoriser l'utilisation traditionnelle de ces plantes. La première partie du travail a démontré sur le modèle d'aortes isolées de rat l'effet vasodilatateur de Ziziphora clinopodioides Lam. (Lamiaceae). L'étude des mécanismes impliqués a permis d'identifier une action indépendante de l'endothélium vasculaire et secondaire à une modification des conductances calciques et potassiques. La réalisation d'un fractionnement bioguidé a permis l'identification de 7 métabolites vasoactifs d'origine phénolique. Dans une deuxième partie, les propriétés vasodilatatrices et hypotensives des fruits Nitraria sibirica Pall. (Nitrariaceae) ont été démontrées. L'endothélium vasculaire et la voie du monoxyde d'azote ont été identifiés comme les éléments fondamentaux de cette action vasodilatatrice. Dans une troisième partie, nos travaux ont étudié pour la première fois les effets vasorelaxants et la composition chimique d'Echinops integrifolius Kar. & Kir. (Asteraceae) et ont permis de caractériser 11 métabolites incluant des triterpènes, des flavonoïdes ainsi qu'une coumarine. En conclusion, notre travail de thèse a permis d'apporter, pour la première fois, des arguments expérimentaux soutenant l'usage anti-hypertensif des espèces Ziziphora clinopodioides et Nitraria sibirica. L'étude phytochimique d'Echinops integrifo/ius a également offert des informations chimiotaxonomiques utiles concernant cette espèce et le genre Echinops / Affecting nearly one billion people worldwide, hypertension is the most important risk factor for cardiovascular disease and kidney failure and it is also one of the leading causes of death. The identification of efficient antihypertensive treatments taking into account the specificities of different populations of the world is an important public-health challenge. Our work has been dedicated to the study of anti-hypertensive plants from the Uighur Pharmacopoeia, one of the major ethnie groups in the Xinjiang Autonomous Region, a large desert and mountainous area from the northwestern China. The aim of this work was to provide phytochemical and pharmacological evidences to validate and to enhance the traditional use of these plants. First, the vasodilating properties of Ziziphora clinopodioides Lam. (Lamiaceae) have been shown by using the in vitro model of isolated rat aortic rings. Our data reported an endothelium-independent effect related to changes in calcium and potassium conductances. ln addition, a bioguided fractionation has been carried out and led to the identification of seven vasorelaxant phenolic compounds. Second, the vasodilating and the hypotensive effects of the fruits of Nitraria sibirica Pail. (Nitrariaceae) have been demonstrated and the contribution of vascular endothelium and nitric oxide pathway has been pointed out. Finally, the vasorelaxant properties and the chemical composition of Echinops integrifolius Kar. & Kir. have been investigated for the first time. Eleven secondary metabolites have been isolated including triterpenes, flavonoids and coumarins. ln conclusion, our results provide scientific evidences supporting the traditional use of Ziziphora clinopodioides and Nitraria sibirica as antihypertensive therapy. Additionaly, the phytochemical study of Echinops integrifolius gives chemotaxonomical data about that species and Echinops genus

<p>Research examining the relationships between religious indicators and the cardiovascular health of individuals and populations has been relatively understudied in the Canadian context. This thesis contains three main studies, developed from a sequential explanatory mixed method research design.</p> <p>The first study examined the association between the frequency of religious service attendance (RSA) and prevalence of coronary heart disease (CHD), diabetes and high blood pressure in Canada. The Saskatchewan sample of the Canadian Community Health Survey (CCHS-4.1) was used to build multivariable logistic regression models. The analysis revealed participants who attended religious services more than once a week had lower prevalent odds of CHD (OR= 0.82, 95% CI 0.61-1.11, p>0.05), diabetes (OR=0.60, 95% CI 0.45-0.80, p</p> <p>The second study was qualitative and undertaken to help interpret and explain the quantitative results from the CCHS. Twelve semi-structured interviews with ordained pastors and three focus groups with parishioners in Catholic, Anglican and United churches were conducted in Canada. The findings suggest that attending religious services: (1) promotes mental health; (2) provides social support and activities; and (3) promotes health and lifestyle behaviours to lower CHD risk.</p> <p>Qualitative data from the second study was used for the third study, which identified relevant factors associated with the implementation of heart health promotion programs in churches. Among the various factors identified, pastor leadership, funding for a parish nurse, community-focused interventions, secured infrastructure and social support were important to facilitate health promotion programs in churches.</p> / Doctor of Philosophy (PhD)

A hipertensão arterial sistêmica (HAS) é uma doença crônica altamente prevalente, que pode ser controlada com tratamento farmacológico. Para tal, recomenda-se aplicar as melhores evidências clínicas por meio da utilização de guias de prática clínica (GPC) de alta qualidade. No entanto, o processo de desenvolvimento de GPC requer recursos humanos e tempo, sendo a adaptação uma opção para reduzir a duplicação de esforços e adequar o GPC para uso local. O objetivo deste trabalho foi sintetizar as recomendações de GPC para o tratamento farmacológico da HAS. Aplicou-se o método de adaptação ADAPTE, realizando as duas primeiras fases: Configuração e Adaptação. Na fase de Configuração, o Grupo CHRONIDE realizou o planejamento e registrou a pesquisa no Próspero. Na fase de Adaptação, realizou-se uma revisão sistemática. Os critérios de eligibilidade foram: GPC que continham recomendações para o tratamento farmacológico da HAS em atenção primária, publicados em inglês, português ou espanhol, no período de 01/01/2011 a 31/12/2016. Em 31/11/2017 atualizou-se GPC incluídos. Para a determinação da qualidade destes GPC, três avaliadores, de forma independente, aplicaram o Appraisal of Guidelines for Research & Evaluation II (AGREE II). Dos 37 GPC avaliados, 6 foram considerados de alta qualidade (escore 60% ou mais no domínio Rigor de desenvolvimento do AGREE II). As recomendações destes foram extraídas e incluídas nas matrizes. Os GPC apresentaram divergências em suas recomendações. As divergências mais relevantes foram as recomendações mais rigorosas do GPC de 2017 da American College of Cardiology e American Heart Association (ACC/AHA), que trouxe metas terapêuticas e níveis pressóricos para indicação de farmacoterapia mais baixos que os demais. A maioria dos GPC recomendou o uso de diuréticos tiazídicos como farmacoterapia de primeira linha para tratamento da HAS e contraindicou o uso combinado de inibidores da enzima conversora de angiotensina e bloqueadores dos receptores de angiotensina II. Portanto, em uma discussão para adaptação local de recomendações, um dos pontos principais, além da questão do acesso aos medicamentos, seria adotar ou não os paramêtros mais rigorosos do GPC 2017 ACC/AHA. / Arterial hypertension is a high prevalent chronic disease that can be controlled with pharmacologic treatment. For such, is recommended the use of the high clinical evidences presented in high quality clinical practice guidelines (CPG). However, the guideline development process requires time and capable human resources, which transform the adaptation to an option to reduce a duplication of efforts and to adapt the CPG to local use. The objective of this work was to synthesize the recommendations of CPG for the pharmacological treatment of arterial hypertension. The ADAPTE method was applied, using 2 steps: Configuration and Adaptation. In the Configuration step, the CHRONIDE group carried out the planning and the method was registered in Prospero. In the Adaptation step a systematic review was performed. The eligibility criteria were: CPG containing recommendations for the pharmacological treatment of arterial hypertension in primary care, published in English, Portuguese or Spanish, from 01/01/2011 to 12/31/2016. On 11/31/2017 it was updated the GPC included. To determine the CPG quality, 3 independent reviewers, assessed the CPG using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. Of the 37 evaluated CPG, 6 were considered to being as high quality (score 60% or higher in the domain \" Rigour of Development \"). The recommendations were extracted and included in the matrix of recommendations. The CPG has presentes differences in their recommendations. The most relevant divergences were the further rigorous recommendations described on CPG 2017 of the American College of Cardiology and American Heart Association (ACC/AHA), which brought therapeutic goals and blood pressure levels lower for pharmacotherapy than the others recommendations. The majority of CPG has recommended the use of thiazide diuretics as first-line pharmacotherapy for the treatment of arterial hypertension and has contraindicated the combined use of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. Therefore, in a discussion for local adaptation of recommendations, one of the main points, apart from the issue of access to medicines, would be to adopt or would not be adopt the futher rigorous parameters of GPC 2017 ACC/AHA.

Introduktion: Buller definieras som oönskat ljud. Uppfattningen av ett oönskat ljud är mycket individuellt. Det som anses vara oljud för en person, kan upplevas som icke-oljud för en annan person. Buller anses dock generellt som störande ljud och är vanligtvis något som varje individ stöter på under sin vardag som exempelvis på arbetsplatsen, skolan, eller i hemmet. Buller anses vara den miljöstörning som berör flest människor i Sverige. Det är ett växande problem och flygtrafik anses vara en av de mest genomgripande utomhusljudkällorna. Bullerproblem som är förknippade med flygtrafik är koncentrerade i områden nära flygplatser, vilket kan påverka flera tusentals boendes hälsa. Flygtrafikbuller har länge varit ett folkhälsoproblem och många människor som är bosatta i närheten av en flygplats har utvecklat ett antal negativa hälsoeffekter av flygtrafikbuller Syfte: Att undersöka hur boende som är bosatta nära flygplatsen Linköping City Airport upplever och påverkas av flygtrafikbuller.  Metod: Studien har utförts som en enkätundersökning med en kvantitativ tvärsnittsdesign. Webbenkäten som har använts som mätinstrument har konstruerats för att besvara syftet. 292 vuxna individer (&gt;18år), varav 158 män och 133 kvinnor, deltog i studien. Insamlad statistiska data har bearbetats och analyserats i SPSS. För att kunna besvara syftet har följande statistiska tester använts: chi2-test, spearmans-korrelationsanalys och logistisk regressionsanalys.   Resultat och konklusion: Boende som är bosatta i Tannefors visade överlag positiva upplevelser till flygtrafiken och var positivt inställda till flygplatsen. De boende som upplevde störningar minst varje vecka vissa delar av året upplevde att flygtrafikbuller medför svårigheter att utföra olika aktiviteter. Kvinnor i den yngsta åldersgruppen upplevde flygtrafikbuller som mer störande jämfört med män. Män hade en mer negativ inställning till flygplatsen jämfört med kvinnor. Boende som rapporterade sämre hälsotillstånd, sömnproblem och användande av öronproppar eller något annat hörselskydd för att kunna sova bättre, sämre sömnkvalitet, trötthet, obehagskänslor, ledsenhet och nedstämdhet, osällskaplighet och att man föredrar att vara ifred, irritation och vresighet, stress, lock eller tinnitus i öronen meddelade också ett större besvär för flygtrafikbuller. / Introduction: Aircraft noise is an example of unwanted sound. The perception of unwanted sound is very individual. What is considered noise by one person may be perceived as non-noise by someone else. However, noise is generally regarded as disturbing noise and is usually something that each individual encounters in their daily life, such as in the workplace, at school, or at home. Noise is considered to be the form of environmental disruption that affects the most people in Sweden. It is a growing problem, and air traffic is considered to be one of the most pervasive outdoor sound sources. Noise problems associated with air traffic are concentrated in areas close to airports, which can affect the health of thousands of residents. Air traffic noise has long been a public health problem, and many people living near an airport have developed a number of negative health effects due to air traffic noise. Purpose: To study how residents living near Linköping City Airport experience and are affected by air traffic noise.   Method: The study has been conducted as a questionnaire survey with a quantitative crosssectional design. The online survey that has been used as a measuring instrument has been designed to answer the purpose. 292 adult subjects (&gt; 18 years), including 158 men and 133 women, participated in the study. Collected statistical data has been processed and analysed in SPSS. In order to answer the purpose, the following statistical tests have been used: chi2 test, Spearman’s correlation analysis and logistic regression analysis. Results and conclusion: Residents living in Tannefors generally had positive experiences from air traffic and were positive towards the airport. The residents who experienced disturbances at least every week during certain parts of the year felt that air traffic noise caused difficulties performing various activities. Women in the youngest age group experienced air traffic noise as more disturbing compared to men. Men had fewer negative attitudes towards the airport compared to women. Residents who reported poorer health conditions, sleep problems and the use of earplugs or other hearing protectors to be able to sleep better, poorer sleep quality, fatigue, discomfort, sadness and depressed mood, low morale, a desire to be left alone, irritation and grief, stress, clogged ear or tinnitus also started that air traffic noise was a major inconvenience.

The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood.

The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood.

The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood.