該前瞻性研究對香港中國裔孕婦的25羥基維生素D（25（OH）D）的水平及其影響因素進行調查，并對25（OH）D與甲狀旁腺激素（PTH）、孕期肌肉酸痛、不良妊娠結局、孕期及産後骨質流失，以及嬰兒的骨骼發育等關係進行探索，力求建立適用于香港的中國孕婦的25（OH）D正常值。 / 共有237名單胎妊娠婦女以及62名多胎妊娠的婦女在2010年8月至2011年11月間參加本研究中的隊列研究，分別在參加研究時（<20 孕周）、24-28孕周、31-36孕周以及産後6-11周進行抽血測量血清25（OH）D以及PTH水平，同時填寫一份包括對每月攝取含維生素D的食物以及營養補充劑頻度、接受日照情況及喜好、以及肌肉不適等情況的問卷，并在24-28孕周進行75克口服葡萄糖耐量試驗。參與隊列研究的單胎孕婦在20周前、31-36孕周以及産後隨訪時接受用定量超聲測量非優勢手的橈骨遠端以及中指近掌指骨的骨質超聲速率（SoS）。在産後複查時，對其嬰兒左側腓骨中部的骨質SoS進行測量。記錄婦女各次檢查時的體重、抽血月份紫外線輻射強度的歷史記錄、以及妊娠結局。另外募集一批孕婦參加病例對照研究，比較患早產（PTB）、子癇前期（PET）、妊娠糖尿病 （GDM）以及胎兒生長受限（FGR）併發癥的婦女與對照組 （體重指數以及抽血時紫外線強度配對）的血清25（OH）D水平。 / 孕婦在孕期的平均25（OH）D水平在44.7 ± 12.6 至48.9 ± 17.1 nmol/l範圍，25（OH）D水平與體重指數、維生素D營養補充劑、抽血時紫外線強度以及個人對陽光的喜好情況有關，而與胎兒數量、孕次、孕周以及終止妊娠無關。 / 單胎妊娠的孕婦三個孕期的血清25（OH）D與PTH水平均負相關，但在多胎妊娠中，二者無明顯相關性。PTH在孕期以及産後的變化相對不受25（OH）D影響。孕婦25（OH）D的水平與孕婦肌肉酸痛癥狀、産後恢復、孕期及產褥期骨質流失以及嬰兒骨質無關。患早期PTB（< 34孕周）、PET或FGR的孕婦的血清25（OH）D比對照組低，但GDM患者的25（OH）D水平與對照組無差別。血清25（OH）D低於34.3 nmol/l者的早期早產以及子癇前期的風險增高，低於50 nmol/l者發生胎兒生長受限的風險增高。服用維生素D補充劑情況可能影響25（OH）D與FGR的關係。 / 總而言之，血清25（OH）D水平不足以全面完全反映孕期維生素D的情況，對預測不良妊娠結局的作用有限。 / This prospective study explored the maternal serum level of 25(OH)D in Chinese pregnant women in Hong Kong and the factors affecting 25(OH)D level. It also explored the correlation between maternal 25(OH)D with PTH level, maternal musculoskeletal complaints, adverse pregnancy outcome, maternal bone turnover during pregnancy and postpartum, and the bone development of the offspring, aiming to explore and establish a normal range of 25(OH)D level in pregnancy for the Hong Kong Chinese women. / A total of 237 women with singleton pregnancy and 62 women with multiple pregnancies were recruited for the cohort study from August, 2010 to November, 2011. Maternal blood samplings for 25(OH)D and PTH measurements were performed at recruitment, 24-28 weeks, 31-36 weeks of gestation, and 6-11 weeks postpartum respectively. A questionnaire which included the monthly dietary and supplement intake of vitamin D, questions about sunlight exposure, and musculoskeletal complaints was administered on each visit. A 75g oral glucose tolerance test (OGTT) was performed on cohort cases at 24-28 weeks of gestation. Measurements of the speed of sound (SoS) at the distal one third of the maternal radius and the proximal phalanx of the third finger of the non-dominant side were performed with quantitative ultrasonography (QUS) measurement during the visits at the first and third trimesters, and postnatal period. The SoS at the left mid-shaft tibia of the offspring was determined during the postnatal visit. Maternal characteristics, ultraviolet radiation (UVR) intensity at blood sampling, and pregnancy outcome, were also recorded. Cases with pregnancy complications were recruited for case-control studies, and maternal 25(OH)D level was examined with respect to preterm birth (PTB), preeclampsia (PET), gestational diabetes (GDM), and fetal growth restriction (FGR, birthweight below the 10th percentile of the customized estimated birthweight). The controls were matched for booking body mass index (BMI) and UVR intensity at blood sampling. / The mean 25(OH)D level in ranged from 44.7 ± 12.6 to 48.9 ± 17.1 nmol/l in the three trimesters, and was related to BMI, vitamin D supplementation, UVR intensity at blood sampling, and the acceptance of sunlight exposure, but not the number of fetus, parity, gestational age, or the completion of pregnancy. / Inverse correlation between PTH and 25(OH)D were observed in singleton, but not in multiple, pregnancy. The change in maternal PTH level is found to be relatively independent from that of 25(OH)D. There was no correlation between maternal 25(OH)D level with musculoskeletal complaints, postnatal recovery, bone turnover during and after pregnancy, or the bone density of the offspring. Maternal 25(OH)D level was lower in women with early PTB ( < 34 weeks), PET, and FGR, but not for GDM. A maternal 25(OH)D level of lower than 34.3nmol/l and 50 nmol/l was associated with increased risk of early PTB, PET, and FGR respectively. But the correlation between maternal 25(OH)D level with FGR might be affected by supplementation. / In conclusion, serum level of 25(OH)D is insufficient in reflecting maternal vitamin D status and metabolism in pregnancy, and is of limited use in predicting adverse pregnancy outcome. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Hu, Zhiyang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 201-223). / Abstracts and appendixes also in Chinese. / Thesis dedication --- p.i / Acknowledgments --- p.ii / Abstract --- p.v / Abstract (Chinese) --- p.viii / List of Abbreviation --- p.x / Table of contents --- p.xiii / List of Figures --- p.xxii / List of Tables --- p.xxiv / Chapter Chapter 1: --- Literature Review --- p.1 / Chapter 1.1 --- The synthesis and metabolism of vitamin D --- p.3 / Chapter 1.1.1 --- The synthesis of vitamin D --- p.3 / Chapter 1.1.2 --- The metabolism of vitamin D --- p.4 / Chapter 1.1.3 --- Vitamin D binding protein --- p.10 / Chapter 1.1.4 --- Factors related to 25(OH)D level --- p.11 / Chapter 1.2 --- Function of vitamin D --- p.13 / Chapter 1.2.1 --- Mechanism of vitamin D function --- p.13 / Chapter 1.2.2 --- Classic function --- p.14 / Chapter 1.2.3 --- Non-classic function --- p.16 / Chapter 1.2.3.1 --- Immune system --- p.17 / Chapter 1.2.3.2 --- Cardiovascular system --- p.18 / Chapter 1.2.3.3 --- Cell proliferation and differentiation --- p.18 / Chapter 1.2.3.4 --- Neurological system --- p.19 / Chapter 1.2.3.5 --- Reproductive system --- p.20 / Chapter 1.2.3.6 --- Fetal development --- p.21 / Chapter 1.3 --- The definition of vitamin D deficiency --- p.21 / Chapter 1.4 --- Vitamin D status and pregnancy --- p.24 / Chapter 1.4.1 --- Alteration in vitamin D metabolism during pregnancy --- p.24 / Chapter 1.4.2 --- Factors affecting maternal serum level of 25(OH)D --- p.25 / Chapter 1.4.3 --- Vitamin D and bone resorption during pregnancy and lactation --- p.27 / Chapter 1.4.3.1 --- Alteration of calcium metabolism, bone absorption and the role of vitamin D --- p.27 / Chapter 1.4.3.2 --- Measurement of bone density in pregnant women and babies --- p.33 / Chapter 1.4.4 --- Current studies on maternal vitamin D status and pregnancy outcome --- p.35 / Chapter 1.4.4.1 --- Birthweight --- p.35 / Chapter 1.4.4.2 --- Infection --- p.37 / Chapter 1.4.4.3 --- Preterm delivery --- p.39 / Chapter 1.4.4.4 --- Diabetes (DM) and gestational diabetes (GDM) --- p.39 / Chapter 1.4.4.5 --- Hypertension and preeclampsia --- p.41 / Chapter 1.4.4.6 --- Multiple pregnancy, muscular symptoms --- p.42 / Chapter 1.4.4.7 --- Vitamin D supplementation and pregnancy outcome --- p.44 / Chapter 1.5 --- Defining vitamin D deficiency in pregnancy --- p.45 / Chapter 1.6 --- Objective of the study --- p.46 / Chapter Chapter 2: --- Study design and methods --- p.48 / Chapter 2.1 --- Case recruitment and study design --- p.48 / Chapter 2.1.1 --- Longitudinal singleton study --- p.49 / Chapter 2.1.2 --- Cross-sectional study --- p.50 / Chapter 2.1.2.1 --- Preterm birth (PTB) --- p.51 / Chapter 2.1.2.2 --- Preeclampsia (PET) --- p.51 / Chapter 2.1.2.3 --- Gestational diabetes (GDM) --- p.52 / Chapter 2.1.3 --- Multiple pregnancy study --- p.52 / Chapter 2.2 --- Measurements --- p.53 / Chapter 2.2.1 --- Hormonal analysis of serum levels of 25(OH)D and PTH --- p.53 / Chapter 2.2.2 --- Calculation of monthly intake of vitamin D from diet --- p.55 / Chapter 2.2.3 --- SoS measurements --- p.56 / Chapter 2.2.4 --- Ultraviolet radiation strength assessment --- p.59 / Chapter 2.3 --- Statistical analysis --- p.60 / Chapter Chapter 3 --- Longitudinal Study on the Level of and Factors Affecting Vitamin D in Singleton Pregnancy --- p.62 / Chapter 3.1 --- Introduction --- p.62 / Chapter 3.2 --- Material and method --- p.63 / Chapter 3.3 --- Statistics --- p.64 / Chapter 3.4 --- Results --- p.65 / Chapter 3.4.1 --- Demographic data of the subjects --- p.65 / Chapter 3.4.2 --- Maternal levels of 25(OH)D and PTH, and the factors affecting their levels --- p.66 / Chapter 3.4.2.1 --- Distribution of 25(OH)D level and PTH level in the four visits --- p.66 / Chapter 3.4.2.2 --- Dietary intake of vitamin D and supplementation --- p.69 / Chapter 3.4.2.3 --- Seasonality and sunlight exposure --- p.73 / Chapter 3.4.2.4 --- Parity --- p.76 / Chapter 3.4.3 --- Changes of maternal levels of 25(OH)D and PTH in pregnancy --- p.78 / Chapter 3.4.4 --- Independent factors related to maternal 25(OH)D level in pregnancy --- p.79 / Chapter 3.4.5 --- Maternal and fetal 25(OH)D level at delivery --- p.80 / Chapter 3.4.6 --- Muscular symptoms and other complaints in pregnancy, pregnancy outcome, and their relationships with maternal 25(OH)D level --- p.81 / Chapter 3.4.7 --- Postnatal recovery and factors related to postnatal level of 25(OH)D and PTH --- p.86 / Chapter 3.4.7.1 --- Postnatal symptoms and relationship with 25(OH)D and PTH --- p.86 / Chapter 3.4.7.2 --- The postnatal level of 25(OH)D and PTH in women with different feeding mode --- p.88 / Chapter 3.4.7.3 --- Independent factors related to postnatal 25(OH)D and PTH level --- p.89 / Chapter 3.4.7.4 --- Factors related to the change of 25(OH)D and PTH after delivery --- p.90 / Chapter 3.4.8 --- Correlation between 25(OH)D with PTH in pregnancy and postnatal period --- p.91 / Chapter 3.5 --- Discussion --- p.92 / Chapter 3.5.1 --- 25(OH)D level in Chinese pregnant women --- p.92 / Chapter 3.5.2 --- Factors related to maternal 25(OH)D level --- p.93 / Chapter 3.5.2.1 --- Dietary and supplementation --- p.93 / Chapter 3.5.2.2 --- Seasonality and outdoor activity --- p.96 / Chapter 3.5.2.3 --- Gestational age --- p.98 / Chapter 3.5.2.4 --- Age and parity --- p.98 / Chapter 3.5.3 --- Relationship of 25(OH)D level in the cord blood with maternal 25(OH)D level --- p.99 / Chapter 3.5.4 --- 25(OH)D level and muscular complains in pregnancy --- p.100 / Chapter 3.5.5. --- Postnatal recovery and 25(OH)D level --- p.101 / Chapter 3.5.6 --- PTH level in pregnancy and postnatal period --- p.101 / Chapter 3.6 --- Conclusion --- p.102 / Chapter Chapter 4 --- Longitudinal Study on the Relationship between Maternal 25(OH)D level with Changes of Maternal Bone Density in Pregnancy and Lactation, and Factors Affecting Bone Density of newborn Infants --- p.105 / Chapter 4.1 --- Introduction --- p.105 / Chapter 4.2 --- Material and method --- p.106 / Chapter 4.3 --- Statistics --- p.108 / Chapter 4.4 --- Results --- p.108 / Chapter 4.4.1 --- Demographic data --- p.108 / Chapter 4.4.2 --- Maternal bone density and the changes in pregnancy and postnatal recovery --- p.109 / Chapter 4.4.2.1 --- Maternal bone density in the first trimester and related factors --- p.109 / Chapter 4.4.2.2 --- Maternal bone density in the three visits --- p.109 / Chapter 4.4.2.3 --- The change in maternal bone density in the three visits --- p.110 / Chapter 4.4.2.4 --- Diversity in the change of bone density in pregnant women --- p.112 / Chapter 4.4.3 --- Factors related to the changes in bone density --- p.114 / Chapter 4.4.3.1 --- Changes between the first and the third trimesters --- p.114 / Chapter 4.4.3.2 --- Change between the third trimester and postnatal visits --- p.116 / Chapter 4.4.4 --- The bone density in infants and related factors --- p.120 / Chapter 4.5 --- Discussion --- p.122 / Chapter 4.5.1 --- Maternal bone density changes in pregnancy and postnatal period --- p.122 / Chapter 4.5.2 --- Factors related to the maternal bone density changes in pregnancy and postnatal period --- p.124 / Chapter 4.5.2.1 --- Initial bone density, parity, and BMI --- p.125 / Chapter 4.5.2.2 --- 25(OH)D and PTH level --- p.126 / Chapter 4.5.2.3 --- Supplement --- p.127 / Chapter 4.5.2.4 --- Lactation --- p.128 / Chapter 4.5.2.5 --- Height --- p.129 / Chapter 4.5.3 --- Factors related to bone density of the infant. --- p.130 / Chapter 4.5.3.1 --- Maternal 25(OH)D level --- p.130 / Chapter 4.5.3.2 --- Gestational age and birthweight --- p.131 / Chapter 4.5.3.3 --- Maternal bone density change --- p.131 / Chapter 4.5.3.4 --- The gender of the offspring and feeding method --- p.132 / Chapter 4.6 --- Conclusion --- p.133 / Chapter Chapter 5 --- Maternal 25(OH)D Level in Multiple Pregnancy --- p.134 / Chapter 5.1 --- Introduction --- p.134 / Chapter 5.2 --- Material and method --- p.135 / Chapter 5.3 --- Statistics --- p.136 / Chapter 5.4 --- Results --- p.137 / Chapter 5.4.1 --- Demographic data of the subjects --- p.137 / Chapter 5.4.2 --- The level of 25(OH)D in multiple pregnancy and singleton pregnancy --- p.137 / Chapter 5.4.3 --- Supplementation in multiple pregnancy --- p.140 / Chapter 5.4.4 --- The change of maternal 25(OH)D and PTH levels in the three trimesters --- p.141 / Chapter 5.4.5 --- 25(OH)D level in cord blood and its correlation with 25(OH)D level of the sibling --- p.143 / Chapter 5.4.6 --- Correlation between 25(OH) with PTH in pregnancy --- p.143 / Chapter 5.5 --- Discussion --- p.144 / Chapter 5.5.1 --- 25(OH)D level in multiple pregnancy and singleton pregnancy --- p.144 / Chapter 5.5.2 --- Supplementation in multiple pregnancy --- p.146 / Chapter 5.5.3 --- Changes of maternal levels of 25(OH)D and PTH in the three trimesters in multiple pregnancy --- p.146 / Chapter 5.5.4 --- The PTH/25(OH) correlation --- p.147 / Chapter 5.6 --- Conclusion --- p.148 / Chapter Chapter 6 --- Maternal level of 25(OH)D in complicated pregnancy --- p.150 / Chapter 6.1 --- Introduction --- p.150 / Chapter 6.2 --- Method --- p.153 / Chapter 6.2.1 --- Preterm birth --- p.155 / Chapter 6.2.2 --- Preeclampsia --- p.155 / Chapter 6.2.3 --- Gestational diabetes --- p.156 / Chapter 6.2.4 --- Fetal growth restriction --- p.157 / Chapter 6.2.5 --- The association between 25(OH)D level with pregnancy complication --- p.158 / Chapter 6.3 --- Statistics --- p.159 / Chapter 6.4 --- Results --- p.160 / Chapter 6.4.1 --- Setting of the cutoff values of hypovitaminosis D --- p.160 / Chapter 6.4.2 --- Preterm birth --- p.160 / Chapter 6.4.3 --- Preeclampsia --- p.164 / Chapter 6.4.4 --- Gestational diabetes --- p.168 / Chapter 6.4.4.1 --- Case-control study --- p.168 / Chapter 6.4.4.2 --- Factors affecting OGTT results --- p.170 / Chapter 6.4.5 --- Fetal growth restriction --- p.173 / Chapter 6.5 --- Discussion --- p.179 / Chapter 6.5.1 --- Adjustment for confounders for case-control study --- p.179 / Chapter 6.5.2 --- PTB and 25(OH)D level --- p.181 / Chapter 6.5.3 --- PET and 25(OH)D level --- p.182 / Chapter 6.5.4 --- GDM and 25(OH)D level --- p.186 / Chapter 6.5.5 --- FGR and 25(OH)D level --- p.189 / Chapter 6.5.6 --- Defining vitamin D deficiency in pregnancy --- p.192 / Chapter 6.6 --- Conclusion --- p.195 / Chapter Chapter 7 --- Summary --- p.196 / References --- p.201 / Chapter Appendix 1 --- Antenatal questionnaire (English/Chinese) --- p.224 / Chapter Appendix 2 --- Postnatal questionnaire (English/Chinese) --- p.238

by Au-Yeung Kit Mei. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 219-232). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / Abstract (Chinese Version) --- p.v / Table of Contents --- p.vii / List of Figures --- p.xiii / List of Tables --- p.xv / List of Abbreviations --- p.xxviii / Chapter CHAPTER ONE: --- INTRODUCTION / Chapter 1.1 --- Health-related Transition in Hong Kong and Their Implications --- p.1 / Chapter 1.2 --- "Eating Habits, Lifestyle and Health of Hong Kong Children" --- p.1 / Chapter 1.2.1 --- Affluent Diet --- p.1 / Chapter 1.2.2 --- Poor Diet Habits --- p.2 / Chapter 1.2.2.1 --- Low Breastfeeding Rate --- p.2 / Chapter 1.2.2.2 --- Breakfast Skipping --- p.4 / Chapter 1.2.2.3 --- Increased Eating Out --- p.5 / Chapter 1.2.2.4 --- Quality of School Lunch --- p.6 / Chapter 1.2.2.5 --- Snacking Habits --- p.7 / Chapter 1.2.3 --- Physical Inactivity --- p.8 / Chapter 1.2.4 --- Childhood Obesity Prevalence and Trend --- p.9 / Chapter 1.2.5 --- Health Implications and Consequences --- p.10 / Chapter 1.2.6 --- Children's Eating and Physical Activity Habit Formation --- p.13 / Chapter 1.2.6.1 --- Parental Influences --- p.13 / Chapter 1.2.6.2 --- Influence of School Environment and Healthy Food Availability --- p.14 / Chapter 1.2.6.3 --- Media Influences --- p.15 / Chapter 1.3 --- Prevention Rather than Management --- p.15 / Chapter 1.3.1 --- Good Habit Establishment is Essential When Young --- p.16 / Chapter 1.3.2 --- Need for Comprehensive Health or Nutrition Education --- p.17 / Chapter 1.3.3 --- Brief Review of Nutrition Education Research in Other Nations --- p.17 / Chapter 1.3.4 --- Nutrition / Health Education in Hong Kong --- p.21 / Chapter 1.3.4.1 --- Government and Community Promotion --- p.21 / Chapter 1.3.4.2 --- Nutrition and Physical Activity in Primary School Syllabus --- p.22 / Chapter 1.3.4.3 --- Barriers --- p.23 / Chapter 1.4 --- Rationale of This Study --- p.24 / Chapter 1.4.1 --- Project Background: Multidisciplinary Advisory Committee Composition --- p.24 / Chapter 1.4.2 --- Objectives of this Project --- p.24 / Chapter 1.4.3 --- Theoretical Framework --- p.25 / Chapter 1.4.4 --- Research Design and Hypothesis --- p.26 / Chapter CHAPTER TWO: --- METHODOLOGY / Chapter 2.1 --- Target Subjects --- p.27 / Chapter 2.2 --- Sample --- p.27 / Chapter 2.2.1 --- Gaining Access To Subjects --- p.27 / Chapter 2.2.2 --- Sample Selection --- p.29 / Chapter 2.3 --- Questionnaires Development and Data Collection --- p.30 / Chapter 2.3.1 --- Questionnaire Design --- p.30 / Chapter 2.3.1.1 --- Students' Questionnaire --- p.31 / Chapter 2.3.1.2 --- Parents' Questionnaire --- p.32 / Chapter 2.3.1.3 --- Pre-testing --- p.32 / Chapter 2.3.1.4 --- Student Helper Training --- p.33 / Chapter 2.3.1.5 --- Reliability and validity of measures --- p.33 / Chapter 2.4 --- Intervention --- p.34 / Chapter 2.4.1 --- Intervention Activities and Curriculum Design --- p.34 / Chapter 2.4.2 --- Intervention Materials Development and Pre-testing --- p.39 / Chapter 2.5 --- Evaluation --- p.39 / Chapter 2.5.1 --- Outcome Evaluation --- p.39 / Chapter 2.5.1.1 --- Data Management --- p.39 / Chapter 2.5.1.2 --- Statistics --- p.40 / Chapter 2.5.1.3 --- "Knowledge,Attitude and Behavior Scores of Students" --- p.40 / Chapter 2.5.2 --- Process Evaluation of Program Materials and Activities During the Intervention --- p.41 / Chapter 2.6 --- Ethics --- p.44 / Chapter CHAPTER THREE: --- RESULTS / Chapter 3.1 --- Response Rate --- p.45 / Chapter 3.2 --- Baseline Characteristics of Students and Parents in Pre-intervention Survey --- p.46 / Chapter 3.2.1 --- General Sociodemographic Characteristics --- p.46 / Chapter 3.2.2 --- Breastfeeding --- p.58 / Chapter 3.2.3 --- Healthy Diet Pyramid and General Healthy Eating Awareness --- p.63 / Chapter 3.2.4 --- Healthy Breakfast --- p.67 / Chapter 3.2.5 --- Healthy Eating Out --- p.73 / Chapter 3.2.6 --- Healthy School Lunch --- p.79 / Chapter 3.2.7 --- Healthy Snacking --- p.82 / Chapter 3.2.8 --- Family Dietary Habits --- p.88 / Chapter 3.2.9 --- Physical Activity --- p.97 / Chapter 3.2.10 --- Summary Profile of the Subjects at Pre-intervention Survey --- p.109 / Chapter 3.3 --- Outcome Evaluation --- p.114 / Chapter 3.3.1 --- General Sociodemographic Characteristics of Students and Parents in Post-intervention survey --- p.114 / Chapter 3.3.2 --- Breastfeeding --- p.117 / Chapter 3.3.3 --- Healthy Diet Pyramid and General Healthy Eating Awareness --- p.122 / Chapter 3.3.4 --- Healthy Breakfast --- p.125 / Chapter 3.3.5 --- Healthy Eating Out --- p.130 / Chapter 3.3.6 --- Healthy School Lunch --- p.134 / Chapter 3.3.7 --- Healthy Snacking --- p.138 / Chapter 3.3.8 --- Family Dietary Habits --- p.144 / Chapter 3.3.9 --- Physical Activity --- p.150 / Chapter 3.3.10 --- "Changes in Students' Knowledge, Attitudes and Behavior With Respect to Healthy Eating and Physical Activity" --- p.157 / Chapter 3.3.11 --- Summary Profile of the Subjects at Post-intervention Survey --- p.162 / Chapter 3.4 --- Parents' Evaluation of Program Materials and Activities --- p.166 / Chapter 3.5 --- Teachers' Evaluation of Program Materials and Activities --- p.174 / Chapter 3.5.1 --- Breastfeeding Evaluation --- p.175 / Chapter 3.5.2 --- Program Evaluation: Other FUN-IN-SEVEN Themes --- p.181 / Chapter CHAPTER FOUR: --- DISCUSSION / Chapter 4.1 --- Implication of Findings --- p.193 / Chapter 4.2 --- Strengths and Limitations of the Study --- p.210 / Chapter 4.3 --- Major Difficulties Encountered in Launching Nutrition Promotion in Schools --- p.213 / Chapter 4.4 --- Implications and Recommendations for Meeting the Challenges to Improving Hong Kong Primary Students Nutrition and Physical Activity Habits --- p.214 / Chapter CHAPTER FIVE: --- CONCLUSION --- p.218 / References --- p.219 / Appendices / Chapter AI --- Students' questionnaire (Chinese version) --- p.233 / Chapter AII --- Students' questionnaire (English version) --- p.238 / Chapter BI --- Visual aids (Chinese version) --- p.251 / Chapter BII --- Visual aids (English version) --- p.258 / Chapter CI --- Parents' questionnaire (Chinese version) --- p.265 / Chapter CII --- Parents' questionnaire (English version) --- p.273 / Chapter DI --- Introductory letter (Chinese version) --- p.281 / Chapter DII --- Introductory letter (English version) --- p.283 / Chapter EI --- Consent form (Chinese version) --- p.285 / Chapter EII --- Consent form (English version) --- p.286 / Chapter F --- Principal/teacher questionnaire --- p.287 / Chapter G --- Background information of the partner schools --- p.289 / Chapter H --- Summary of materials and activities of FUN-IN-SEVEN Programme (Chinese version) --- p.291 / Chapter KI --- "Programme materials, pamphlets/brochures and photographs of some activities" --- p.292 / Chapter LI --- Parents' evaluation (Chinese version) --- p.370 / Chapter LII --- Parents' evaluation (English version) --- p.372 / Chapter MI --- Teachers' breastfeeding evaluation (Chinese version) --- p.373 / Chapter MII --- Teachers' breastfeeding evaluation (English version) --- p.375 / Chapter NI --- Teachers' programme evaluation (Chinese version) --- p.377 / Chapter NII --- Teachers' programme evaluation (English version) --- p.381 / Chapter P --- Socioeconomic background information of partner schools --- p.385

Introdução: Diversos estudos indicaram consequências de alterações na nutrição materna durante a gestação sobre a saúde da prole adulta, tais como: hipertensão, doenças cardiovasculares, resistência à insulina, diabete melito e doença renal. No entanto, a literatura é pobre em avaliações decorrentes de modificações nutricionais maternas sobre a prole logo após o nascimento. Métodos: Ratas Wistar durante o período gestacional foram alimentadas com dieta hipossódica (HO - 0,15% de NaCl), normossódica (NR - 1,3% de NaCl) ou hipersódica (HR - 8% de Na Cl). Após o nascimento, nas primeiras vinte e quatro horas foram coletados rins e coração dos neonatos machos e fêmeas (n=6- 8/grupo) para verificar as possíveis alterações na estrutura cardíaca e renal pelo método de estereologia. Também foi avaliada a expressão proteica e gênica dos componentes do sistema renina angiotensina (SRA) no coração e rins através do método ELISA indireto e RT-qPCR. Resultados: O peso ao nascimento foi menor em machos e fêmeas da prole de mães alimentadas com dieta hipossódica durante a gestação quando comparado NR e HR. Não houve diferença no volume renal, volume de seus compartimentos (córtex, medula e pelve) e número de glomérulos entre os grupos experimentais (HO, NR e HR). No entanto, o número de glomérulos foi maior em fêmeas comparado aos machos nos três grupos experimentais. O diâmetro transverso do núcleo dos cardiomiócitos no ventrículo esquerdo e no ventrículo direito de machos da prole HR foi maior do que na prole NR. A expressão proteica do receptor AT1 no rim de machos da prole foi menor no grupo HO do que no grupo NR e HR. A expressão proteica do receptor AT2 também foi menor em machos do grupo HO do que no grupo NR. Não houve diferença entre os grupos na expressão proteica dos receptores AT1 e AT2 no rim das fêmeas. Conclusão: O presente estudo detectou alterações na estrutura cardíaca de neonatos machos, mas não em neonatos fêmeas decorrentes de sobrecarga de sal durante a gravidez. As alterações observadas na expressão dos receptores AT1 e AT2 no rim de neonatos machos podem ser responsáveis por alterações na função renal / Introduction: Several studies have shown several consequences on adult offspring due to alterations in maternal nutrition during pregnancy, such as: hypertension, heart diseases, insulin resistance, diabetes mellitus and kidney diseases. Nevertheless, few studies evaluated maternal nutritional alterations in neonates. Methods: Female Wistar rats where fed from day one of pregnancy until delivery with low- (LS - 0.15% NaCl), normal- (NS - 1.3% NaCl) or high- (HS - 8%NaCl) salt diet. During the first twenty-four hours after birth, newborn\'s (n=6- 8/group) kidneys and heart were collected to evaluate possible changes of their structure by stereology. The protein and the gene expression of the renin angiotensin system components were evaluated by indirect ELISA and by RTqPCR, respectively. Results: Birth weight was lower in male and female offspring of dams fed LS during pregnancy. No differences between groups (LS, NS and HS) were observed in total renal volume and its compartments (cortex, medulla and pelvis) and number of glomeruli. The number of glomeruli was higher in female when compared to male newborns in the three experimental groups. The transverse diameter of the nuclei of the cardiomyocytes was higher in HS in both left and right ventricle vs. NS. The AT1 receptor protein expression was lower in kidneys of LS than in NS and HS male newborns. AT2 receptor protein expression was also lower in male LS than in NS. No differences in AT1 and AT2 receptors protein expression in female newborn\'s kidneys were found. Conclusion: The present study shows changes in cardiac structure male but not of female neonates induced salt overload during pregnancy. The alterations observed in AT1 and AT2 expression in kidneys of neonates may be responsible for alteration in renal function

Pau King-man. / Thesis submitted in: October 2001. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 173-181). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / Abstract (Chinese version) --- p.iii / Table of Contents --- p.iv / List of Figures --- p.xii / List of Tables --- p.xiii / List of Abbreviations --- p.xxiv / Chapter CHAPTER ONE: --- INTRODUCTION / Chapter 1.1 --- Women's Overweight and Obesity Prevalence and Trends --- p.1 / Chapter 1.2 --- Etiology of Overweight and Obesity --- p.2 / Chapter 1.3 --- Health Consequences of Obesity in Women --- p.4 / Chapter 1.4 --- Dietary and Physical Activity Recommendations for Good Health for Adults --- p.6 / Chapter 1.5 --- Health Behavior Change Theories --- p.8 / Chapter 1.6 --- Weight Control/Loss Interventions for Women --- p.10 / Chapter 1.7 --- Weight Loss Risks --- p.11 / Chapter 1.8 --- Health Promotion Programs for Women --- p.12 / Chapter 1.9 --- General Situation and Population Trends Among Hong Kong Middle- aged Women --- p.15 / Chapter 1.10 --- Nutrition-related Morbidity and Mortality Among Hong Kong Women --- p.16 / Chapter 1.11 --- Diet Composition of Hong Kong Middle-aged Women --- p.20 / Chapter 1.12 --- Physical Activity Patterns of Hong Kong Middle-aged Women --- p.21 / Chapter 1.13 --- Education and Health in Hong Kong Middle-aged Women --- p.23 / Chapter 1.14 --- Attitudes Toward and Beliefs About Diet and Health of Hong Kong Middle-aged Women --- p.24 / Chapter 1.15 --- Common Weight Loss Methods Among Hong Kong Middle-aged Women --- p.25 / Chapter 1.16 --- Sources of Health Information Among Hong Kong Middle-aged Women --- p.25 / Chapter 1.17 --- Summary --- p.26 / Chapter 1.18 --- Study Purpose and Objectives --- p.26 / Chapter CHAPTER TWO: --- METHODOLOGY / Chapter 2.1 --- Recruitment of Participants --- p.29 / Chapter 2.2 --- Focus Groups --- p.29 / Chapter 2.3 --- Survey Instrument --- p.30 / Chapter 2.3.1 --- Questionnaire --- p.30 / Chapter 2.3.2 --- Three-day Dietary Record --- p.35 / Chapter 2.3.3 --- Anthropometric and Cholesterol Measurements --- p.35 / Chapter 2.4 --- Intervention --- p.37 / Chapter 2.5 --- Evaluation --- p.39 / Chapter 2.5.1 --- Process Evaluation --- p.39 / Chapter 2.5.2 --- Outcome Evaluation --- p.40 / Chapter 2.6 --- Data Management --- p.40 / Chapter 2.7 --- Statistics --- p.40 / Chapter 2.8 --- Data Analysis --- p.41 / Chapter 2.8.1 --- Physical Activity Patterns --- p.41 / Chapter 2.8.2 --- Dietary Patterns --- p.44 / Chapter 2.8.3 --- Nutrition Knowledge Score --- p.45 / Chapter 2.8.4 --- Physical Activity Knowledge Score --- p.46 / Chapter 2.8.5 --- Blood Total Cholesterol --- p.46 / Chapter 2.8.6 --- Body Mass Index --- p.47 / Chapter 2.8.7 --- Percent Body Fat --- p.47 / Chapter 2.9 --- Ethics --- p.47 / Chapter CHAPTER THREE: --- RESULTS / Chapter 3.1 --- Focus Group Results --- p.43 / Chapter 3.1.1 --- General Description of Participants --- p.48 / Chapter 3.1.2 --- Perceived Values and Views on 'Health' --- p.50 / Chapter 3.1.3 --- Perceived Values and Views on 'Healthy Lifestyle' --- p.51 / Chapter 3.1.4 --- Perceived Values and Views on 'Healthy Eating' --- p.52 / Chapter 3.1.5 --- Perceived Values and Views on 'Physical Activity' --- p.53 / Chapter 3.1.6 --- The Factors Motivating the Women to Adopt a Healthy Lifestyle --- p.53 / Chapter 3.1.7 --- Sources of Information About Healthy Eating and Physical Activity --- p.55 / Chapter 3.1.8 --- Suggestions for the Type and Content of Activities in a Health Promotion Program --- p.55 / Chapter 3.2 --- Participation Rate in the Study --- p.56 / Chapter 3.3 --- Pretest --- p.57 / Chapter 3.3.1 --- General Participant Sociodemographic Description --- p.57 / Chapter 3.3.2 --- Anthropometry --- p.59 / Chapter 3.3.3 --- Health Conditions Reported --- p.60 / Chapter 3.3.4 --- Meal Patterns --- p.61 / Chapter 3.3.5 --- Nutrient Supplements Practices --- p.62 / Chapter 3.3.6 --- Cooking Practices --- p.63 / Chapter 3.3.7 --- Food Removal Behavior --- p.65 / Chapter 3.3.8 --- Food Label Reading --- p.65 / Chapter 3.3.9 --- Dietary Intake --- p.66 / Chapter a. --- From the Three-day Dietary Records --- p.66 / Chapter b. --- From the Food Frequency Questionnaire --- p.68 / Chapter 3.3.10 --- Nutrition Knowledge --- p.69 / Chapter 3.3.11 --- Physical Activity Habits --- p.72 / Chapter 3.3.12 --- Physical Activity Knowledge --- p.73 / Chapter 3.3.13 --- Intention and Confidence in Changing Behavior --- p.76 / Chapter 3.3.14 --- Perceived Difficulties in Changing Behavior --- p.77 / Chapter 3.3.15 --- Perceived Methods Facilitating Behavior Change --- p.79 / Chapter 3.3.16 --- Health Information Desired --- p.80 / Chapter 3.3.17 --- Areas of Health the Women Would Like to Improve --- p.81 / Chapter 3.3.18 --- Summary Profile of the Women at Pretest --- p.82 / Chapter 3.4 --- Outcome Evaluation --- p.85 / Chapter 3.5 --- Posttest --- p.85 / Chapter 3.5.1 --- General Participant Sociodemographic Description --- p.85 / Chapter 3.5.2 --- Anthropometry --- p.86 / Chapter 3.5.3 --- Health Conditions Reported --- p.87 / Chapter 3.5.4 --- Meal Patterns --- p.88 / Chapter 3.5.5 --- Nutrient Supplements Practices --- p.89 / Chapter 3.5.6 --- Cooking Practices --- p.90 / Chapter 3.5.7 --- Food Removal Behavior --- p.91 / Chapter 3.5.8 --- Food Label Reading --- p.91 / Chapter 3.5.9 --- Dietary Intake --- p.93 / Chapter a. --- From the Three-day Dietary Records --- p.93 / Chapter b. --- From the Food Frequency Questionnaire --- p.94 / Chapter 3.5.10 --- Nutrition Knowledge --- p.95 / Chapter 3.5.11 --- Physical Activity Habits --- p.98 / Chapter 3.5.12 --- Physical Activity Knowledge --- p.99 / Chapter 3.5.13 --- Analysis the Changes by Education Level --- p.102 / Chapter 3.5.14 --- Analysis the Changes by Age Group --- p.104 / Chapter 3.5.15 --- Intention and Confidence in Changing Behavior --- p.105 / Chapter 3.5.16 --- Perceived Difficulties in Changing Behavior --- p.107 / Chapter 3.5.17 --- Perceived Methods Facilitating Behavior Change --- p.109 / Chapter 3.5.18 --- Health Information Desired --- p.110 / Chapter 3.5.19 --- Areas of Health the Women Would Like to Improve --- p.111 / Chapter 3.5.20 --- Summary Profile of the Women at Posttest --- p.112 / Chapter 3.6 --- Participants' Evaluation of the Intervention Program --- p.113 / Chapter 3.7 --- Follow-up --- p.118 / Chapter 3.7.1 --- General Participant Sociodemographic Description --- p.118 / Chapter 3.7.2 --- Anthropometry --- p.118 / Chapter 3.7.3 --- Health Conditions Reported --- p.121 / Chapter 3.7.4 --- Meal Patterns --- p.121 / Chapter 3.7.5 --- Nutrient Supplements Practices --- p.122 / Chapter 3.7.6 --- Cooking Practices --- p.123 / Chapter 3.7.7 --- Food Removal Behavior --- p.125 / Chapter 3.7.8 --- Food Label Reading --- p.126 / Chapter 3.7.9 --- Dietary Intake --- p.127 / Chapter a. --- From the Three-day Dietary Records --- p.127 / Chapter b. --- From the Food Frequency Questionnaire --- p.129 / Chapter 3.7.10 --- Nutrition Knowledge --- p.131 / Chapter 3.7.11 --- Physical Activity Habits --- p.135 / Chapter 3.7.12 --- Physical Activity Knowledge --- p.136 / Chapter 3.7.13 --- Intention and Confidence in Changing Behavior --- p.140 / Chapter 3.7.14 --- Analysis the Changes by Education Level --- p.142 / Chapter 3.7.15 --- Analysis the Changes by Age Group --- p.143 / Chapter 3.7.16 --- Perceived Difficulties in Changing Behavior --- p.144 / Chapter 3.7.17 --- Perceived Methods Facilitating Behavior Change --- p.145 / Chapter 3.7.18 --- Health Information Desired --- p.148 / Chapter 3.7.19 --- Areas of Health the Women Would Like to Improve --- p.149 / Chapter 3.7.20 --- Summary Profile of the Women at Follow-up --- p.150 / Chapter CHAPTER FOUR: --- DISCUSSION / Chapter 4.1 --- Implications of Findings --- p.154 / Chapter 4.1.1 --- Current Situations in Diet and Physical Activity of Hong Kong Middle-aged Women --- p.154 / Chapter 4.1.2 --- Overall Effects of the Program --- p.161 / Chapter a. --- Changes in Knowledge --- p.161 / Chapter b. --- Changes in Awareness and Intention --- p.163 / Chapter c. --- Changes in Behavior --- p.164 / Chapter d. --- Changes in Anthropometery --- p.166 / Chapter 4.2 --- Strengths and Limitations of the Study --- p.167 / Chapter 4.3 --- Implications and Recommendations for Meeting the Challenges of Improving Hong Kong Middle-aged Women's Nutrition and Physical Activity Habits --- p.169 / Chapter 4.4 --- Suggestions for Future Research --- p.170 / Chapter CHAPTER FIVE: --- CONCLUSIONS --- p.172 / References --- p.173 / Appendices / Chapter A --- Consent form (Chinese version) --- p.182 / Chapter B --- Consent form (English version) --- p.183 / Chapter C --- Questionnaire (Chinese version) --- p.184 / Chapter D --- Questionnaire (English version) --- p.196 / Chapter E --- Photos for food amount quantities and household measures (Chinese version) --- p.210 / Chapter F --- Photos for food amount quantities and household measures (English version) --- p.213 / Chapter G --- Sample of dietary record (Chinese version) --- p.216 / Chapter H --- Sample of dietary record (English version) --- p.217 / Chapter I --- Three-day dietary record (Chinese version) --- p.218 / Chapter J --- Three-day dietary record (English version) --- p.221 / Chapter K --- Pamphlets for health talks (Chinese version) --- p.224 / Chapter L --- Pamphlets for health talks (English version) --- p.236 / Chapter M --- Pamphlets for physical activity demonstration (Chinese version) --- p.248 / Chapter N --- Pamphlets for physical activity demonstration (English version) --- p.253 / Chapter O --- Process evaluation questionnaire (Chinese version) --- p.258 / Chapter P --- Process evaluation questionnaire (English version) --- p.260 / Chapter Q --- Overall evaluation questionnaire (Chinese version) --- p.262 / Chapter R --- Overall evaluation questionnaire (English version) --- p.263 / Chapter S --- Focus group questionnaire (Chinese version) --- p.264 / Chapter T --- Focus group questionnaire (English version) --- p.265 / Chapter U --- Focus group question guides (Chinese version) --- p.266 / Chapter V --- Focus group question guides (English version) --- p.268 / Chapter W --- The food consumption patterns of women in the Education and Control Groups --- p.270

Introdução: Diversos estudos indicaram consequências de alterações na nutrição materna durante a gestação sobre a saúde da prole adulta, tais como: hipertensão, doenças cardiovasculares, resistência à insulina, diabete melito e doença renal. No entanto, a literatura é pobre em avaliações decorrentes de modificações nutricionais maternas sobre a prole logo após o nascimento. Métodos: Ratas Wistar durante o período gestacional foram alimentadas com dieta hipossódica (HO - 0,15% de NaCl), normossódica (NR - 1,3% de NaCl) ou hipersódica (HR - 8% de Na Cl). Após o nascimento, nas primeiras vinte e quatro horas foram coletados rins e coração dos neonatos machos e fêmeas (n=6- 8/grupo) para verificar as possíveis alterações na estrutura cardíaca e renal pelo método de estereologia. Também foi avaliada a expressão proteica e gênica dos componentes do sistema renina angiotensina (SRA) no coração e rins através do método ELISA indireto e RT-qPCR. Resultados: O peso ao nascimento foi menor em machos e fêmeas da prole de mães alimentadas com dieta hipossódica durante a gestação quando comparado NR e HR. Não houve diferença no volume renal, volume de seus compartimentos (córtex, medula e pelve) e número de glomérulos entre os grupos experimentais (HO, NR e HR). No entanto, o número de glomérulos foi maior em fêmeas comparado aos machos nos três grupos experimentais. O diâmetro transverso do núcleo dos cardiomiócitos no ventrículo esquerdo e no ventrículo direito de machos da prole HR foi maior do que na prole NR. A expressão proteica do receptor AT1 no rim de machos da prole foi menor no grupo HO do que no grupo NR e HR. A expressão proteica do receptor AT2 também foi menor em machos do grupo HO do que no grupo NR. Não houve diferença entre os grupos na expressão proteica dos receptores AT1 e AT2 no rim das fêmeas. Conclusão: O presente estudo detectou alterações na estrutura cardíaca de neonatos machos, mas não em neonatos fêmeas decorrentes de sobrecarga de sal durante a gravidez. As alterações observadas na expressão dos receptores AT1 e AT2 no rim de neonatos machos podem ser responsáveis por alterações na função renal / Introduction: Several studies have shown several consequences on adult offspring due to alterations in maternal nutrition during pregnancy, such as: hypertension, heart diseases, insulin resistance, diabetes mellitus and kidney diseases. Nevertheless, few studies evaluated maternal nutritional alterations in neonates. Methods: Female Wistar rats where fed from day one of pregnancy until delivery with low- (LS - 0.15% NaCl), normal- (NS - 1.3% NaCl) or high- (HS - 8%NaCl) salt diet. During the first twenty-four hours after birth, newborn\'s (n=6- 8/group) kidneys and heart were collected to evaluate possible changes of their structure by stereology. The protein and the gene expression of the renin angiotensin system components were evaluated by indirect ELISA and by RTqPCR, respectively. Results: Birth weight was lower in male and female offspring of dams fed LS during pregnancy. No differences between groups (LS, NS and HS) were observed in total renal volume and its compartments (cortex, medulla and pelvis) and number of glomeruli. The number of glomeruli was higher in female when compared to male newborns in the three experimental groups. The transverse diameter of the nuclei of the cardiomyocytes was higher in HS in both left and right ventricle vs. NS. The AT1 receptor protein expression was lower in kidneys of LS than in NS and HS male newborns. AT2 receptor protein expression was also lower in male LS than in NS. No differences in AT1 and AT2 receptors protein expression in female newborn\'s kidneys were found. Conclusion: The present study shows changes in cardiac structure male but not of female neonates induced salt overload during pregnancy. The alterations observed in AT1 and AT2 expression in kidneys of neonates may be responsible for alteration in renal function

The aim of this research was to explore consumer perceptions of personalised nutrition and to compare these across three different levels of "medicalization": lifestyle assessment (no blood sampling); phenotypic assessment (blood sampling); genomic assessment (blood and buccal sampling). The protocol was developed from two pilot focus groups conducted in the UK. Two focus groups (one comprising only "older" individuals between 30 and 60 years old, the other of adults 18-65 yrs of age) were run in the UK, Spain, the Netherlands, Poland, Portugal, Ireland, Greece and Germany (N=16). The analysis (guided using grounded theory) suggested that personalised nutrition was perceived in terms of benefit to health and fitness and that convenience was an important driver of uptake. Negative attitudes were associated with internet delivery but not with personalised nutrition per se. Barriers to uptake were linked to broader technological issues associated with data protection, trust in regulator and service providers. Services that required a fee were expected to be of better quality and more secure. An efficacious, transparent and trustworthy regulatory framework for personalised nutrition is required to alleviate consumer concern. In addition, developing trust in service providers is important if such services to be successful.