Growth failure is a major problem in children with chronic renal failure (CRF). A number of factors have been suggested as explanations for this impaired growth including renal osteodystrophy, age of onset of chronic renal failure, degree of azotemia and nutritional status. As children with CRF are frequently unable to maintain sufficient nutrient intakes for optimal growth, the nutritional status of these individuals must obviously have a major, if as yet poorly understood, role in the observed growth failure. Therefore, a nutritional, physical and biochemical study was conducted to assess the nutritional status of seven children undergoing maintenance hemodialysis. To evaluate the adequacy of dietary intake, fourteen day food records were obtained from each of the participants and average nutrient intakes were compared to the recommended daily nutrient intake of the Canadian Dietary Standard (CDS) (1975). To assess the physical status of the children, height, height velocity, weight, per cent body fat, and bone age were determined. As abnormalities of taste sensitivity are known to influence dietary patterns, salivary flow rates, salivary urea concentrations, and taste detection and recognition thresholds for sweet, sour, salt and bitter were determined pre and post dialysis. Biochemical investigations included the determination of pre and post dialysis plasma amino acid concentrations following a standardized fast of five hours, and the quantification of the amounts of amino acids lost into dialysate during a complete hemodialysis treatment. The mean caloric intake of 54% ±11 of the CDS is inadequate for optimal growth. The mean protein intake was 1.09 ±.16 grams of protein per kilogram of body weight. The first and second limiting amino acids were histidine and threonine, respectively. Nutritional deficiencies of certain water soluble vitamins (riboflavin, niacin and pyridoxine) existed for some of the children. The mean zinc, magnesium and copper intakes were 45% ±8, 51% ±19 and 54% ±32 of the CDS, respectively. Growth (as measured by body height and weight) was found to be retarded one to two standard deviations from normal in the children studied. Per cent body fat estimations were within normal limits, but bone age was frequently below chronological age. Taste sensitivity was impaired as shown by elevated pre dialysis sweet and bitter recognition thresholds (p<.01). This reduced taste acuity was improved post dialysis (p<.005), but did not reach normal values. Pre and post dialysis, salivary flow rates were reduced (p<.0005) and salivary urea concentrations elevated (p<.0005) when compared to normal. Pre dialysis, plasma concentrations of taurine, a-amino-butyric acid, valine, cystine, leucine, tyrosine and tryptophan were decreased from normal levels (p<.025), and aspartic acid, proline, glycine, citrulline, ornithine, histidine, arginine, asparagine, 3-methylhistidine and hydroxyproline were elevated above normal (p<.005). The presence of subclinical protein calorie malnutrition (PCM) was indicated by a depressed plasma essential to nonessential amino acid ratio, a depressed plasma valine to glycine ratio, and an elevated plasma phenylalanine to tyrosine ratio as compared to normal. The detection of 3-methylhistidine and hydroxyproline in plasma provides additional indications of PCM. The mean amount of total amino acid lost into dialysate was 4.7 ±.9 grams. Histidine, threonine, lysine and valine were the essential amino acids lost in the largest amounts. In conclusion, growth is retarded in children with CRF and may be due to the accumulation of metabolic end products which depress appetite and/or delay the natural rate of growth events Suboptimal nutriture, as evidenced by the presence of PCM, is a major factor in the growth retardation of these individuals. / Land and Food Systems, Faculty of / Graduate

The purpose of this project was to explore parent perceptions about their children's weight and the perceived barriers to implementing healthy eating habits and patterns of physical activity for their children.

The purpose of this project was to explore parent perceptions about their children's weight and the perceived barriers to implementing healthy eating habits and patterns of physical activity for their children.

MSCPNT / Department of Nutrition

Post-natal care is a care given to the mother and the newborn during post-natal period. This period is crucial to save the lives of the mother and the newborn. Despite its importance, the utilisation of this service is very low in Ethiopia. This study was conducted to establish the views and experiences of women and health care workers on post-natal care services and determine the factors influencing its utilisation with the ultimate purpose of developing guidelines to improve uptake and quality of the services in South West Shoa Zone of Oromia Region, Ethiopia. The objectives of the study were to explore and describe the women’s views and experiences on utilisation of post-natal care service. Furthermore, the study sought to explore and describe health care workers views and experiences on provision of the services and to assess the factors facilitating or hindering to the utilisation of it. Ultimately, the study had intended to develop guidelines that would contribute towards improving the uptake and quality of the post-natal care services. The study used a qualitative descriptive and explorative research design to address the research questions. Qualitative data were collected from 19 women who gave birth in the past six months and from 24 health care workers providing post-natal care services (health care workers and health extension workers) and coordinating the overall maternal, neonatal and child health services in the study area (Zone and district health officials; primary health care units heads). The study used in-depth interview guides to collect data from the aforementioned study participants. Inductive thematic analysis was performed on the verbatim transcriptions using the Atlas ti version 8 qualitative data analysis software. Overall, the emerged themes from the analysis are categorised into women’s views and experiences on utilisation of PNC services, views and experiences of health care workers on PNC and factors facilitating and hindering the utilisation of PNC services. The study identified wide range of socio-cultural, knowledge and attitude related, physical, health facility related and health care workers related factors affecting the utilisation of post-natal care services. Consequently, after a systemic review of literature and stakeholders consultation the researcher used the findings of the study to develop guidelines to improve the uptake and quality of post-natal care services. The developed guidelines were also validated by maternal, neonatal and child health service providers and program leaders and the researcher strongly recommend the use of the developed guidelines that would improve the uptake and quality of post-natal care services. / Health Studies / Ph. D. (Public Health)

Indiana University-Purdue University Indianapolis (IUPUI) / Purpose: Obesity is a growing public health problem and the second most preventable cause of death in the US. Obesity has been linked as a risk factor for several cancers. However, there are limited studies that have examined the roles of metabolic syndrome (MetS) and C-reactive protein (CRP), as well as change in body composition from early adulthood to late adulthood on the risk of cancer. The overall objective of this dissertation was to determine the association of obesity and obesity-related markers with breast and colorectal cancer occurrence and mortality. Methods: Three datasets were used. The first study used 4,500 asymptomatic adults who were surveyed during a colorectal cancer screening study. The second study was based on the National Health and Nutrition Examination Survey (NHANES) 2005-2010. The dataset had 172 breast cancer survivors and 2,000 women without breast cancer. The last manuscript resulted from the NHANES follow-up study (NHANES III). A total of 120 cancer deaths from breast and colorectal deaths were identified from 10,103 women aged 18 years or older. Results: Overall, obesity and obesity related markers were associated with breast and colorectal cancer occurrence and mortality. BMI change and WC change were positively associated with increased risk of advanced colorectal neoplasia (AN). WC measures (both static and dynamic) were generally a better predictor of AN compared to BMI. In the second study involving breast cancer survivors, neither MetS nor CRP were associated with having a breast cancer diagnosis. Also, none of the individual components of MetS (WC, Triglycerides, HDL, fasting blood glucose and blood pressure) were associated with a breast cancer diagnosis. In the last study, MetS was associated with increased risk of mortality from obesity-related cancers. In addition, all components of MetS, except dyslipidemia, were associated with increased risk of mortality for the obesity-related cancers. Conclusion: Obesity expressed in terms of BMI and WC, or their change, MetS and CRP are important factors in regard to the occurrence, survivorship and mortality of breast and colorectal cancer. The results of this research underscore the importance of maintaining a healthy weight.

Indiana University-Purdue University Indianapolis (IUPUI) / A recent review of randomized controlled trials found that trivalent chromium (Cr3+) supplementation significantly improved glycemia among patients with diabetes, consistent with a long-standing appreciation that this micronutrient optimizes carbohydrate metabolism. Nevertheless, a clear limitation in the current evidence is a lack of understanding of Cr3+ action. We tested if increased AMP-activated protein kinase (AMPK) activity, previously observed in Cr3+-treated cells or tissues from Cr3+-supplemented animals, mediates improved glucose transport regulation under insulin-resistant hyperinsulinemic conditions. In L6 myotubes stably expressing the glucose transporter GLUT4 carrying an exofacial myc-epitope tag, acute insulin stimulation increased GLUT4myc translocation by 69% and glucose uptake by 97%. In contrast, the hyperinsulinemic state impaired insulin stimulation of these processes. Consistent with Cr3+’s beneficial effect on glycemic status, chromium picolinate (CrPic) restored insulin’s ability to fully regulate GLUT4myc translocation and glucose transport. Insulin-resistant myotubes did not display impaired insulin signaling, nor did CrPic amplify insulin signaling. However, CrPic normalized elevated membrane cholesterol that impaired cortical filamentous actin (F-actin) structure. Mechanistically, data support that CrPic lowered membrane cholesterol via AMPK. Consistent with this data, siRNA-mediated AMPK silencing blocked CrPic’s beneficial effects on GLUT4 and glucose transport regulation. Furthermore, the AMPK agonist 5-aminoimidazole-4-carboxamide-1-ß-D-ribonucleoside (AICAR) protected against hyperinsulinemia-induced membrane/cytoskeletal defects and GLUT4 dysregulation. To next test Cr3+ action in vivo, we utilized obesity-prone C57Bl/6J mice fed a low fat (LF) or high fat (HF) diet for eight weeks without or with CrPic supplementation administered in the drinking water (8 µg/kg/day). HF feeding increased body weight beginning four weeks after diet intervention regardless of CrPic supplementation and was independent of changes in food consumption. Early CrPic supplementation during a five week acclimation period protected against glucose intolerance induced by the subsequent eight weeks of HF feeding. As observed in other insulin-resistant animal models, skeletal muscle from HF-fed mice displayed membrane cholesterol accrual and loss of F-actin. Skeletal muscle from CrPic-supplemented HF-fed mice showed increased AMPK activity and protection against membrane cholesterol accrual and F-actin loss. Together these data suggest a mechanism by which Cr3+ may positively impact glycemic status, thereby stressing a plausible beneficial action of Cr3+ in glucose homeostasis.

Indiana University-Purdue University Indianapolis (IUPUI) / Seven human alcohol dehydrogenase genes (which encode the primary enzymes involved in alcohol metabolism) are grouped into classes based on function and sequence identity. While the Class I ADH isoenzymes contribute significantly to ethanol metabolism in the liver, Class IV ADH isoenzymes are involved in the first-pass metabolism of ethanol. It has been suggested that the ability to efficiently oxidize ethanol occurred late in primate evolution. Kinetic data obtained from the Class I ADH isoenzymes of marmoset and brown lemur, in addition to data from resurrected ancestral human Class IV ADH isoenzymes, supports this proposal--suggesting that two major events which occurred during primate evolution resulted in major adaptations toward ethanol metabolism. First, while human Class IV ADH first appeared 520 million years ago, a major adaptation to ethanol occurred very recently (approximately 15 million years ago); which was caused by a single amino acid change (A294V). This change increases the catalytic efficiency of the human Class IV enzymes toward ethanol by over 79-fold. Secondly, the Class I ADH form developed 80 million years ago--when angiosperms first began to produce fleshy fruits whose sugars are fermented to ethanol by yeasts. This was followed by the duplication and divergence of distinct Class I ADH isoforms--which occurred during mammalian radiation. This duplication event was followed by a second duplication/divergence event which occurred around or just before the emergence of prosimians (some 40 million years ago). We examined the multiple Class I isoforms from species with distinct dietary preferences (lemur and marmoset) in an effort to correlate diets rich in fermentable fruits with increased catalytic capacity toward ethanol oxidation. Our kinetic data support this hypothesis in that the species with a high content of fermentable fruit in its diet possess greater catalytic capacity toward ethanol.

In 2011, African Americans in Tarrant County, Texas experienced an infant mortality rate of 14.3 per 1,000 live births. The leading cause of infant mortality in Tarrant County is prematurity and maternal nutritional status. Both maternal under-nutrition and over-nutrition are known risk factors for premature birth. Improving maternal nutrition, by reducing rates of gestational diabetes and preeclampsia, and by increasing consumption of essential prenatal vitamins and nutrients, is a road to decreasing preterm birth in African Americans. This qualitative study, based on both anthropology and public health theory, of the nutrition behavior of a group of African American expectant mothers and the experience of their health care providers and co-facilitators had a goal to provide a foundation for future development of nutrition behavior research and education for this specific population. The main finding of this study was the substantial gap of lived experience and education between the patients and their providers and co-facilitators, which hinders delivery of care and the patients’ acquiescence to nutrition recommendations. The discrepancies between the authoritative knowledge of the providers and the bodily knowledge of expectant mothers were responsible for the ineffectiveness of nutrition recommendations.

The purpose of this study was to investigate the role of food gardens in influencing the vulnerability of women in rural communities to HIV-infections. The study was conducted at the Makotse Women's Club in rural Limpopo. Qualitative field research was used and five participants were purposefully selected for participation in face-to-face interviews. The study found that the women's involvement in the food gardens enabled them to take responsibility for their own lives. Participation in food gardens gave these women an opportunity for income generation, the chance to access healthy food sources to improve their and their families' diets and a sense of meaning and purpose in their lives. Financial independence from husbands and male partners freed them from poverty and male domination. Through exposure to HIV and AIDS education programmes offered at the food gardens the women were empowered with knowledge about sexual health, hence reducing their vulnerability to HIV-AIDS. / Sociology / M. A. ((Social Behaviour Studies in HIV/AIDS))