Background and Significance: MetS encompasses a cluster of cardiometabolic abnormalities that increase the risk for developing chronic diseases including cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Its prevalence among middle-aged and older adults has increased to 45% among adults aged 60 years and older. Epidemiological studies suggest that higher fruit and vegetable consumption is associated with improved overall health as well as a reduced incidence of CVD and T2DM. Animal research and limited human studies suggest that pears and their bioactive compounds may improve certain parameters associated with MetS including body weight and abdominal obesity, lipid profiles, insulin sensitivity, and glycemic control; however, there is a paucity of such studies in general and in humans in particular. The central hypothesis of this 12-week randomized, open-label, placebo-controlled crossover clinical trial was to examine the extent to which daily consumption of two medium-sized pears (green D' Anjou and/or green Bartlett, ~166 g each) would improve clinical signs of MetS and improve underlying factors contributing to its development and progression in middle-aged and older adults (men and women aged 45-60 years) with MetS. Methods: Fifty men and women (age: 59.0 ± 1 years; body mass index [BMI]: 33 ± 1 kg/m2; systolic blood pressure (SBP): 135 ± 2 mmHg, diastolic blood pressure (DBP): 82 ± 1 mmHg; fasting blood glucose: 97 ± 2 mg/dL; HDL-C: 44 ± 2 mg/dL; and TG: 182 ± 13 mg/dL) were randomly assigned to one of two treatment groups: 1) two medium-sized fresh pears (green Bartlett or green D' Anjou depending on the season)/day for 12 weeks, or 2) 50 g of calorie and carbohydrate matched control powder/day for 12 weeks. The initial treatment period was 12 weeks in duration followed by a 4-week washout period. After the 4-week washout period, participants crossed over into the other group for an additional 12-week period. Serum samples were directly analyzed enzymatically for TC, HDL-C, LDL-C, TG levels, Apo-B, fasting blood glucose levels, insulin levels, and high-sensitivity CRP at baseline, 6- and 12-week. Body composition including percent fat mass, fat free mass, as well as android/gynoid ratio were assessed at baseline, 6- and 12-week using dual energy x-ray absorptiometry. Waist and hip circumferences were measured to the nearest 0.5 cm during each visit. Questionnaires were used for monitoring dietary and physical activity patterns over the course of the study. Analyses were performed for the 43 subjects who completed the entire study. Results: Self-reported compliance with the treatments was 82% on average for each group. The retention of participants was excellent as only seven out of fifty participants dropped over the course of the study (14% attrition). A daily intake of two-medium-sized pear resulted in improvements of certain parameters associated with MetS including SBP tended to be reduced (130 ± 2 mmHg vs. 134 ± 2 mmHg at baseline, - 4 mmHg, P = 0.07) and pulse pressure was significantly reduced (50 ± 1 vs. 54 ± 1 at baseline, P < 0.05) at 12 weeks while no changes were observed in the control group. Waist circumference was significantly reduced (- 0.6 cm, P < 0.05) at 12 weeks in the pear group (107.5 ± 1.9 cm vs. 108.1 ± 2.0 cm at baseline) while waist circumference was significantly increased (108.4 ± 1.9 cm vs. 107.9 ± 2.0 cm at baseline, P < 0.05) at 6 weeks in the control group and was sustained at 12 weeks. Additionally, at 6 weeks, waist circumference tended to be lower (P = 0.0987) in the pear group (107.8 ± 1.9 cm) than the control group (108.4 ± 1.9 cm). Moreover, waist-to-hip ratio was significantly reduced (0.925 ± 0.011 vs. 0.930 ± 0.011 at baseline, P < 0.05) at 12 weeks in the pear group, and at 6- and 12- week values were significantly lower (P < 0.05) in the pear group (0.926 ± 0.011 and 0.925 ± 0.011, respectively) than the control group (0.933 ± 0.010 and 0.932 ± 0.010, respectively) at 6- and 12-week. Android-to-gynoid ratio (abdominal fat to hip fat) was significantly higher (P < 0.05) in the control group at 6 weeks (0.60 ± 0.01 vs. 0.57 ± 0.02 at baseline) and 12 weeks (0.61 ± 0.02 vs. 0.57 ± 0.02 at baseline) compared to baseline while no changes were noted in the pear group. Pear consumption for 12 weeks also tended to increase HDL-C by 7% (P = 0.07) and numerically lowered TG levels by 4%. The remaining parameters assessed in this study were not impacted by pear consumption. Discussion: The findings of this study suggest that daily consumption of fresh pears may improve certain features of MetS and therefore may improve cardiometabolic health in middle-aged and older adults. / A Dissertation submitted to the Department of Nutrition, Food, and Exercise Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester 2017. / March 20, 2017. / Includes bibliographical references. / Bahram H. Arjmandi, Professor Directing Dissertation; Cathy W. Levenson, University Representative; Maria T. Spicer, Committee Member; Jaminka Ilich-Ernst, Committee Member; Jeong-Su Kim, Committee Member.

A cross-sectional study in older women was designed and conducted to identify prevalence, specific characteristics and diagnostic criteria for the newly identified condition named osteosarcopenic obesity syndrome. Osteosarcopenic obesity (OSO) is a condition where an older adult experiences bone loss, sarcopenia and increased fat mass, the latter either as a clinically diagnosed overweight/obesity, or infiltrated fat into bone and muscle. The study lasted 24 months and a total of N=59 Caucasian ambulatory women aged 76.0±7.3 years (mean ± SD) and BMI of 27.0±5.5 kg/m2 from the local area were assessed for body composition measurements (bone, muscle, fat tissue) using dual energy x-ray absorptiometry scans (DXA). Osteoporosis/osteopenia was identified based on femoral neck and lumbar spine (L1-L4) T-scores (≤-1). A linear regression model was created to identify sarcopenic obesity in the sample, based on the appendicular lean mass, controlling for height (m) and fat mass (kg). Obesity status was based on percent body fat with a cut-off at ≥32%. Muscle quality was measured via echo intensity obtained via ultrasound scans as well as knee extension scores divided by lower appendicular lean mass. Bioelectrical impedance analyses were used to calculate phase angle to assess for frailty in the population. The participants were also tested on physical performance measures including handgrip strength, one-leg stance, 4-m timed normal and brisk walking test, 2-minute walking test, sit-to-stand, knee extension and arm flexion. In the final analysis, the women were divided into four groups based on body composition: OSO (n=10), osteopenic obese (OO; n=35), obese-only (obese; n=10) and osteopenic/sarcopenic non-obese (non-obese; n=4). There was also one participant who had sarcopenic obesity (SO), however due to the small sample size (n=1), was not included in the calculations. All data analyses were performed in SAS 9.4.with p<0.05 deemed as statistically significant. As expected, the OSO women presented with lower bone mineral density (BMD) at most skeletal sites in comparison to other groups (although not always significantly different): right femoral neck BMD (OSO: 0.778±0.080; OO: 0.792±0.082; obese: 1.013±0.102; non-obese: 0.773±0.048 g/cm2, p<0.05), left femoral neck BMD (OSO: 0.759±0.066; OO: 0.801±0.074; obese: 0.957±0.048; non-obese: 0.747±0.018 g/cm2, p<0.05) and lumbar spine BMD (OSO: 1.133±0.139; OO: 1.182±0.184; obese: 1.394±0.212; non-obese: 1.064±0.136 g/cm2, p<0.05). The OSO women had significantly lower appendicular lean mass (OSO: 15.9±1.7; OO: 17±2.4; obese: 18.5±2.7; non-obese: 14±1.3 kg, p<0.05) and higher percent body fat (OSO: 45±4.9; OO 42.2±5.7; obese: 43.7±3.8; non-obese: 27.1±3.8%, p<0.05), on average than women in other groups. The OSO and OO women had the poorest scores on physical performance tests, with the OSO women scoring significantly lower on sit-to-stand (OSO: 10.3±1.6; OO: 11.9±4; obese: 10.9±3.3; non-obese: 14.3±2.6 times/30 sec, p<0.05) and the knee extension (OSO: 43±11; OO: 56±14.1; obese: 65.5±15.2; non-obese: 41.5±19.1 kg, p<0.05) than other groups. The OSO women also had lower muscle quality based on echo intensity (right quadriceps) from ultrasound measurements (OSO: 65.7±9.9; OO: 65.5±12; obese: 71±13.9; non-obese: 76.6±6.7 pixel intensity) and from the knee extension (OSO: 3.8±0.8; OO: 4.4±1.0; obese: 4.9±0.7; non-obese: 3.8±1.8 kg) calculation than other groups. Results from this study can be used to better recognize OSO syndrome in older women using body composition measures via DXA, physical performance tests and muscle quality measurements. These results also indicate that in situations when DXA is not available for body composition measurements for the OSO diagnosis, simple physical performance measures could be used for preliminary assessment and patient referrals for further evaluations. / A Dissertation submitted to the Department of Nutrition, Food and Exercise Sciences in partial fulfillment of the Doctor of Philosophy. / Spring Semester 2017. / February 28, 2017. / functionality, muscle quality, Osteopenia/osteoporosis, Osteoporosis, Osteosarcopenic Obesity, Sarcopenic obesity / Includes bibliographical references. / Jasminka Ilich-Ernst, Professor Directing Dissertation; Dan McGee, University Representative; Bahram H. Arjmandi, Committee Member; Lynn Panton, Committee Member.

Cancer of the esophagus has a high mortality rate of greater than 82% within five years of diagnosis. There is little difference in mortality rate between the two main subtypes of esophageal cancer (EC), esophageal squamous cell cancer (ESCC) and esophageal adenocarcinoma (EAC). When symptoms develop and a diagnosis made, EC is often in the late stages of the disease and weight loss leading to malnutrition is common. The treatment of EC, which includes radiation therapy, chemotherapy, and the esophagectomy, can further contribute to gastrointestinal side effects, weight loss, and inflammation contributing to high rates of malnutrition. Malnutrition in EC is associated with longer hospital stays and higher mortality rates after esophagectomy. Due to the high incidence and consequence of malnutrition, nutrition assessment and intervention should be an essential component of EC treatment and outcomes. Nutritional risk assessment throughout treatment can be determined using nutritional screen tools such as the Subjective Global Assessment (SGA), Patient-Generated Subjective Global Assessment, and the Nutrition Risk Screening tool (NRS). Indirect calorimetry should be used to determine basal energy requirements but, if unavailable, the Harris Benedict equation can be used to estimate energy requirements with the use of disease and physical activity factors to prevent weight loss and promote lean mass accretion. Dietitian driven nutritional assessment and implementation of nutrition support protocols; including the provision adequate nutrition prior to as well as soon after surgery, can improve nutritional status and post-surgery outcomes. Three to five days prior to the esophagectomy, supplemental immune enhanced nutrition (IEN) containing eicosapentaenoic acid (EPA) should be given orally or enterally and should commence 24 to 48 hours postoperatively. If parenteral nutrition (PN) is needed it should be administered concurrently with EN if possible. Lipid emulsions containing Ω-3 fatty acids for PN administration should be used. Dietitian driven nutrition therapy should continue postoperatively, and follow up should continue after discharge until dietary intake is adequate to meet nutritional goals. / A Thesis submitted to the Department of Food, Nutrition, and Exercise Science in partial fulfillment of the Master of Science. / Spring Semester 2017. / March 22, 2017. / Dietitian, Enteral nutrition, Esophageal cancer, Esophagectomy, Immune enhanced nutrition, Nutrition / Includes bibliographical references. / Maria T. Spicer, Professor Directing Thesis; Jasminka Ilich-Ernst, Committee Member; Cathy Levenson, Committee Member.

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No description available.

Background and Significance: The postmenopausal period is characterized by ovarian hormone deficiency which increases the production of pro-inflammatory molecules with a concomitant rise in oxidative stress levels. This cascade of events negatively affect bone metabolism with a subsequent development of osteoporosis and increased risk of fractures. Ovarian hormone deficiency is also linked to greater incidence of cardiovascular disease (CVD), in part, due to compromised endothelial function which may result in elevated blood pressure (BP), a major modifiable risk for CVD. Although osteoporosis and hypertension are commonly regarded as two separate chronic diseases, their pathophysiology appear to be linked as prospective studies have demonstrated a correlation between decreased bone mineral density (BMD) and hypertension. Even though a number of medications are available to treat these conditions, they are not free of side effects. Thus, a considerable number of people prefer alternative and/or complementary therapies such as functional foods and dietary supplements over conventional treatment options. Epidemiological studies have demonstrated that consumption of fruits and vegetables is associated with decreased incidence of chronic diseases which is mainly attributed to the polyphenol content of these foods. Strawberries are widely consumed in the United States and are reported to have a high phenolic content which confers to them strong antioxidant, anti-inflammatory, and vasodilator properties. Objective: The main objective of this eight-week randomized, double-blind, placebo-controlled clinical trial was to investigate the extent to which daily consumption of strawberries would favorably alter blood biomarkers of bone metabolism and reduce BP by improving endothelial function in pre- and stage 1-hypertensive postmenopausal women. Furthermore, we aimed to determine whether increases in antioxidant capacity and decreases in inflammatory markers were, in part, responsible for strawberries' protective effects on bone and endothelium. Methods: Sixty women (age: 59.63 ± 5.31 years; body mass index [BMI]: 31.9 ± 4.8 kg/m2; BMD: 1.15 ± 0.13 g/cm2, systolic BP: 139 ± 13 mmHg, diastolic BP: 79 ± 7 mmHg [means ± SDs]) were randomly assigned to one of three groups (n=20 per group): (1) placebo-control, (2) 25g of freeze-dried strawberry powder (FDSP; equivalent to 1½ cups of sliced fresh strawberries), and (3) 50g of FDSP (equivalent to 3 cups of sliced fresh strawberries). Body composition and BMD of whole body, lumbar spine, hip, and forearm as well as body composition were measured by dual energy x-ray absorptiometry. BP was assessed using an automatic device. Blood biomarkers of bone metabolism, endothelial function, oxidative stress, and inflammation were assessed using immunoassay and colorimetric kits. Dietary and physical activity patterns were also monitored over the course of the study using validated questionnaires. Data were analyzed using Repeated Measures analysis of variance. Results: As anticipated, there were no significant differences in baseline characteristics among groups. No changes were noted for body composition and BMD in any of the intervention groups, as expected. Serum bone alkaline phosphatase levels, a marker of bone formation, were unaltered whereas a negative time effect (p =. 002) for serum levels of tartrate-resistant acid phosphatase-5b, a marker of bone resorption, was detected in the placebo-control and 25g FDSP groups. A negative time effect was noted for systolic BP in all three groups while diastolic BP was unaltered after eight weeks of treatment. Plasma levels of nitric oxide (NO), a vasodilator molecule, increased by 23% and 56% in the 25g and 50g FDSP groups, respectively, and decreased in the placebo-control group by 3% compared to baseline levels (p =. 04). Furthermore, levels of angiotensin II, a vasoconstrictor molecule, decreased in all three intervention groups (p =. 03). Lastly, a time-by-treatment interaction (p = .034) was detected for plasma levels of adiponectin, an anti-inflammatory molecule, which increased in the 25g and 50g FDSP groups by 5 and 6%, respectively, and decreased in the placebo-control group by 30% after eight weeks of supplementation. Conclusion: Daily consumption of strawberries for eight weeks did not alter BP, but improved plasma NO levels, though not statistically significant, as well as plasma levels of adiponectin which can be beneficial for bone and endothelial health. Further studies are warranted to examine the efficacy of long-term incorporation of strawberries into the diet on a number of health outcomes including bone and vascular health. / A Dissertation submitted to the Department of Nutrition, Food & Exercise Sciences in partial fulfillment of the Doctor of Philosophy. / Spring Semester, 2015. / March 2, 2015. / Includes bibliographical references. / Bahram H. Arjmandi, Professor Directing Dissertation; Kenneth Brummel-Smith, University Representative; Arturo Figueroa, Committee Member; Gershon Tenenbaum, Committee Member.

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No description available.

Includes bibliographical references. / Septic shock is associated with oxidative stress, reduced levels of plasma vitamin C and stress hyperglycaemia – all factors that may influence endothelial, and therefore, organ function. Vitamin C is an important antioxidant in human plasma; and it has been implicated in maintaining normal endothelial function during oxidative stress. The vitamin C status of critically ill patients in South African ICUs has not been well investigated; neither has the relationship between vitamin C status, oxidative stress, hyperglycaemia and endothelial function been studied in this patient group. In a prospective, cross-sectional study investigating these factors in critically ill patients with septic shock on inotropic support, serial blood samples from 25 patients were taken at days zero and one, following inotrope initiation, and on day seven after inotrope cessation. These samples were analysed for plasma vitamin C, thiobarbituric acid-reactive substances (TBARS) - as a biomarker of oxidative stress - and soluble vascular cell adhesion molecule-1 (sVCAM-1), and E-selectin, as markers of endothelial dysfunction. The plasma glucose to vitamin C ratios were also calculated. Daily clinical measures in the patients included Sequential Organ Failure Assessment (SOFA) score, mean arterial blood pressure, blood glucose, fluid balance and inotropic support. The clinical outcomes were recorded.

Osteoporosis has significant public health importance for both women and men, where 54% of the U.S. population age 50 and older have low bone mineral density (BMD). Chronic inflammation alters bone remodeling, which is one contributor to bone loss; therefore, foods rich in antioxidants, such as dried plums (Prunus domestica L.), are of great interest for preventing chronic inflammation. Previously, dietary intervention with dried plums has been shown to prevent orichidectomy-induced decreases in BMD, microstructure, and biomechanics in male rats; however, this has yet to be studied in a clinical setting in adult males. The purpose of this study was to document the effects of two doses of dried plums on biomarkers of inflammation and bone metabolism in men after three months of consumption. Thirty-five men between the ages of 55 and 80 with moderate bone loss (T-score between -0.1 and -2.5 SD below the mean) were included. The men were randomized into one of three groups: 100g dried plums, 50g dried plums, or control group. All three groups also consumed a multivitamin containing 450mg calcium and 800 IU vitamin D (Shaklee Corporation) to provide baseline protection against bone loss. Serum samples from the baseline and three-month time points were analyzed for C-reactive protein (CRP), glutathione peroxidase (GPx), bone-specific alkaline phosphatase (BALP), osteoprotegerin (OPG), osteocalcin, sclerostin, receptor activator of nuclear factor beta ligand (RANKL), and tartrate-resistant acid phosphatase type 5b (TRAP-5b). DXA scans were used to assess BMD and BMC of the whole body, lumbar vertebrae, total hip, and forearm. DXA scans of the lumbar vertebrae alongside TBS iNnsight® software were used to generate trabecular bone score (TBS). After three months, consumption of 100g dried plums was associated with a significant decrease in BMD of the radius (P=0.013), and serum concentrations of osteocalcin (P<0.001). Consumption of 50g of dried plum was associated with significant decreases in systolic blood pressure, serum OPG (P=0.003), and serum osteocalcin concentrations (P=0.040), and an increase in the OPG:RANKL ratio (P=0.041). The control group also saw significant decreases in systolic blood pressure, OPG (P=0.004), RANKL (P=0.010), and osteocalcin (P=0.049). There was a significant group*time effect for changes in OPG (P=0.019) and the OPG:RANKL ratio (P=0.039). There were no significant differences in any other measures assessed. TBS was significantly negatively correlated with age (r= -0.23, P=0.013), and positively correlated with body weight (r=0.25, P=0.007). Decreases in osteocalcin indicate a decrease in bone turnover, and a higher OPG:RANKL ratio indicates a greater number of RANKL is bound to OPG, and not to osteoclasts, thus down-regulated osteoclast activity. Therefore, regular consumption of either 100g or 50g dried plum for three months may make some contributions to bone formation and bone turnover activity, and minimal contribution to decreasing inflammation and improving bone density and quality. Furthermore, TBS correlation results indicate that bone quality may be associated with both age and body weight. Three months of consumption may not be long enough to manifest changes in bone; therefore, future analysis of data after six months and one year of dried plum consumption in a larger number of men is warranted. / A Dissertation submitted to the Department of Nutrition, Food and Exercise Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / 2019 / September 20, 2019. / Includes bibliographical references. / Bahram H. Arjmandi, Professor Directing Dissertation; Cathy W. Levenson, University Representative; Robert C. Hickner, Committee Member; Jeong-Su Kim, Committee Member.