En av de största utmaningarna, inom folkhälsan, under 2000-talet beskrivs vara, övervikt och fetma hos barn. Sen år 1990 är ökningen alarmerande och detta främst i låg- och medelinkomstländerna. I Sverige har det främst varit en ökning av övervikt och fetma bland barn i en mer utsatt socioekonomisk bakgrund. Familjen och de levnadsvanor som följer barnet i uppväxten beskrivs vara avgörande, för om barnet utvecklar övervikt eller fetma. Sjuksköterskor har goda möjligheter, att komma i kontakt med hela familjen för att rådgöra samt stötta. Syftet med studien är att beskriva sjuksköterskors erfarenheter av att möta barn med övervikt samt deras familjer. En litteraturstudie genomfördes. Elva vetenskapliga artiklar, varav 9 med kvalitativ forskningsansats och 2 med kvantitativ forskningsansats, granskades och analyserades. Fyra teman och nio subteman identifierades. Resultatet visar att yrkesverksamma sjuksköterskor möter svårigheter, till dessa hör att övervikt tolereras och accepteras på ett annat sätt än tidigare, liksom livsstilsförändringar som innebär att vi idag är mer stillasittande. De ansåg sig väl positionerade för att ta hand om barnen med övervikt och fetma, men upplevde en osäkerhet för samtalet kring och med barnet, samt dess familj. Bristande riktlinjer på arbetsplatsen bidrog till färre antal samtal, med berörda föräldrar. Sjuksköterskorna upplevde en osäkerhet i den egna professionen, där mer utbildning önskades, dels i hur kommunikationen med barn och deras föräldrar kunde förbättras men även i ämnet övervikt. För att öka tryggheten hos sjuksköterskorna behövs tydlig arbetsbeskrivning och riktlinjer, mer utbildning, främst i kommunikation med barn och familj, men även ett förbättrat samarbete med andra yrkeskategorier.

Sphingolipids are important signaling molecules regulating cell growth, cell death and differentiation, thus making them important molecules in determining the fate of a cell and in the pathogenesis of chronic illnesses. The sphingolipid signaling pathway can be initiated by reactive oxygen species (ROS) and inflammatory molecules, both of which are believed to be upregulated in a state of obesity. The hypothesis tested in this dissertation is that due to the inflammatory state of obese animals, the sphingolipid pathway is altered, shifting the balance of pro- and anti-apoptotic proteins and contributing to the pathogenesis of diseases associated with an obese state. The specific aims were to compare, 1) key sphingolipid signaling enzymes; 2) levels of sphingolipid signaling molecules and 3) pro and anti-apoptotic protein levels, in hepatic and colonic tissues procured from lean and obese animals. Obese animals are susceptible to various diseases, including colon cancer and hepatic steatosis. To assess the effect of obesity on sphingolipid signaling, and to provide insight as to the pathogenesis of diseases in a state of obesity, liver and colon tissues from Zucker obese female rats (fa/fa) were compared to tissues from their lean counterparts (Fa/fa or Fa/Fa Zucker rats). Enzyme analyses included an assay of sphingomyelinase (SMase) activity and quantification of ceramidase and sphingosine kinase-1 (SK1) protein expression by western blot. Also, sphingomyelin (SM), ceramide, ceramide-1 phosphate (C1P), sphingosine and sphingosine-1-phosphate (S1P) levels were determined by high-performance liquid chromatography (HPLC) -tandem mass spectroscopy (MS). Representative apoptotic proteins, Bax and Bcl-2 were quantified by western blot. Obese liver demonstrates hepatic steatosis in the Zucker animal model. Among the major differences noted between obese and lean liver were significantly upregulated ceramidase, and downregulated SK1 and C1P levels (P<0.05), as well as a difference in ceramide and SM species composition. Bax was overexpressed while Bcl-2 level was lower in obese compared to lean liver (P<0.05). Taken together, the results indicate a shift toward higher apoptotic signaling in obese liver tissue and correspond with the diseased state of the steatotic liver. Analysis of the sphingolipid pathway in colon revealed upregulation of ceramidase and downregulation of SK1 (P<0.05), similar to liver tissue. C1P levels were lower (P<0.05) but no changes were observed for ceramide, SM or sphingosine levels. A trend toward higher SMase activity in obese colon was observed. Bax was overexpressed in obese colon tissue (P< 0.05), while Bcl-2 results were inconclusive. The liver expressed lower level of molecules associated with sphingolipid signaling than the colons. This study is first to demonstrate tissue-specific differences in the sphingolipid signaling pathway, regardless of genotype. Nevertheless, overall the genotype of Zucker model was found to be a factor altering the expression levels of various sphingolipid enzymes and metabolites in both colon and liver. The findings of the present research provide incentive to further understand the role and modulation of sphingolipid signaling pathway in causation and prevention of chronic diseases prevalent in obese state.

ABSTRACT SANDRA C. METCALF Associations of Youth Weight Status Categories and Cholesterol Levels: Analysis of Data from the National Health and Nutrition Examination Survey (NHANES) (Under the direction of RODNEY LYN, PhD, Assistant Professor) Obesity is recognized as a risk factor for dyslipidemia, however studies specific to overweight youth and dyslipidemia are scarce. Nonetheless, expert bodies have established BMI at the 85th percentile or greater as the threshold for “at risk” in youth and advocate for lipid screening. This study analyzed associations of weight categories and occurrence of dyslipidemia among a multi-racial sample of youth 6 to 18 years of age. In this NHANES cohort, overweight youth were at significant increased risk of dyslipidemias of total cholesterol, high-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. Obese children and adolescents demonstrated even higher risk. This study supports the hypothesis that overweight youth are at increased risk for dyslipidemia. Despite the increased risk, test agreement for overweight and dyslipidemia was poor. BMI at the 85th percentile did not provide good discrimination in detecting children with dyslipidemia and use of this threshold warrants further review.

Sphingolipids are important signaling molecules regulating cell growth, cell death and differentiation, thus making them important molecules in determining the fate of a cell and in the pathogenesis of chronic illnesses. The sphingolipid signaling pathway can be initiated by reactive oxygen species (ROS) and inflammatory molecules, both of which are believed to be upregulated in a state of obesity. The hypothesis tested in this dissertation is that due to the inflammatory state of obese animals, the sphingolipid pathway is altered, shifting the balance of pro- and anti-apoptotic proteins and contributing to the pathogenesis of diseases associated with an obese state. The specific aims were to compare, 1) key sphingolipid signaling enzymes; 2) levels of sphingolipid signaling molecules and 3) pro and anti-apoptotic protein levels, in hepatic and colonic tissues procured from lean and obese animals. Obese animals are susceptible to various diseases, including colon cancer and hepatic steatosis. To assess the effect of obesity on sphingolipid signaling, and to provide insight as to the pathogenesis of diseases in a state of obesity, liver and colon tissues from Zucker obese female rats (fa/fa) were compared to tissues from their lean counterparts (Fa/fa or Fa/Fa Zucker rats). Enzyme analyses included an assay of sphingomyelinase (SMase) activity and quantification of ceramidase and sphingosine kinase-1 (SK1) protein expression by western blot. Also, sphingomyelin (SM), ceramide, ceramide-1 phosphate (C1P), sphingosine and sphingosine-1-phosphate (S1P) levels were determined by high-performance liquid chromatography (HPLC) -tandem mass spectroscopy (MS). Representative apoptotic proteins, Bax and Bcl-2 were quantified by western blot. Obese liver demonstrates hepatic steatosis in the Zucker animal model. Among the major differences noted between obese and lean liver were significantly upregulated ceramidase, and downregulated SK1 and C1P levels (P<0.05), as well as a difference in ceramide and SM species composition. Bax was overexpressed while Bcl-2 level was lower in obese compared to lean liver (P<0.05). Taken together, the results indicate a shift toward higher apoptotic signaling in obese liver tissue and correspond with the diseased state of the steatotic liver. Analysis of the sphingolipid pathway in colon revealed upregulation of ceramidase and downregulation of SK1 (P<0.05), similar to liver tissue. C1P levels were lower (P<0.05) but no changes were observed for ceramide, SM or sphingosine levels. A trend toward higher SMase activity in obese colon was observed. Bax was overexpressed in obese colon tissue (P< 0.05), while Bcl-2 results were inconclusive. The liver expressed lower level of molecules associated with sphingolipid signaling than the colons. This study is first to demonstrate tissue-specific differences in the sphingolipid signaling pathway, regardless of genotype. Nevertheless, overall the genotype of Zucker model was found to be a factor altering the expression levels of various sphingolipid enzymes and metabolites in both colon and liver. The findings of the present research provide incentive to further understand the role and modulation of sphingolipid signaling pathway in causation and prevention of chronic diseases prevalent in obese state.

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Orientador: Ismael Forte Freitas Júnior / Banca: Rômulo Araújo fernandes / Banca: Dorotéia Rossi Silva Souza / Resumo: Objetivo: Avaliar o efeito do treinamento concorrente sobre fatores de risco para a doença gordurosa não alcoólica do fígado (DGNAF) em adolescentes obesos. Metodologia: A amostra foi formada por 38 indivíduos com idade entre 12 e 15 anos. Inicialmente, classificados como obesos pelo Índice de Massa Corporal (IMC) e, posteriormente submetidos à exames bioquímicos de sangue, ultrassonografia e avaliação da composição corporal. Todas as avaliações foram realizadas antes e ao final do estudo. Os sujeitos do estudo sofreram intervenção durante 20 semanas. A Intervenção consistiu de treinamento concorrente com frequência semanal de três vezes, uma hora/dia. A análise estatística foi realizada por meio do software SPSS, versão 17.0, com significância estatística fixada em 5%. Resultados: Após a intervenção, foram observadas melhoras significantes no IMC, percentual de gordura corporal (%GC), massa gorda (MG)(kg), massa livre de gordura (MLG), Percentual de gordura de tronco (%GTronco), triglicérides (TG), colesterol total (COL), LDL-colesterol (LDL), lobo direito e esquerdo do fígado, insulinêmia... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Nonalcoholic Fatty Liver Disease (NAFLD), in obese adolescents. Methodology: The sample was composed by 38 individuals aged 12 to 15 years. Initially the obesity was classified according Body Mass index and, subsequently, blood biochemical tests, ultrasonography and measurement of body composition were assessed. All evaluations were performed before and at in the final of the intervention. They were submitted to an intervention during 20 weeks, that consisted of concurrent training, three times per week, one hour/day. Statistical analysis was performed using the SPSS software, version 17.0, with statistical significance set at 5%. Results: The BMI,% BF, MG (kg), FFM, BFtrunk%, triglycerides, total cholesterol... (Complete abstract click electronic access below) / Mestre

To date, only a small number of studies have examined the results of physical literacy (PL) assessments using the Canadian Assessment of Physical Literacy (CAPL). Among these studies, none have evaluated the correlations between the four domains of PL assessed within the CAPL, nor have they evaluated whether these correlations differ depending on weight status. The current study aimed to determine the strength of associations between the four domains of PL, and compare the correlation coefficients between healthy weight and overweight/obese children. Children aged 8-12 years (n=456) were assessed using the CAPL protocol and partial correlations (controlling for age, sex, and other domain scores) were calculated between domains, for healthy weight (n=275) and overweight/obese children (n=181) separately. The results of this study show that the domains of physical competence, daily behaviour, and motivation and confidence correlate significantly with one another at similar low-to-moderate levels in both body weight groups examined (r = 0.15 to 0.38). The domain of knowledge and understanding did not correlate significantly with other domains in healthy weight participants, and only correlated significantly with physical competence in overweight/obese children (r = 0.22). Overall, the low level of correlations seen between domains in this study lends support to the psychometric architecture of the CAPL and suggests that the four domains of CAPL measure different constructs. Furthermore, the results of this study suggest that interventions aimed at improving PL in children should assess multiple domains, and do not necessarily need to be tailored based on a child’s weight status.

Class of 2008 Abstract / Objectives: To assess the effect of treatment with placebo on weight loss in obese patients. Methods: The placebo groups from nine orlistat and three sibutramine weight loss studies, as identified from the Padwal meta-analysis, were analyzed for: weight loss in kilograms; change in BMI; type of nutrition and exercise interventions; and bias. The means and standard deviations for weight loss were entered into the Stata meta-analysis program to obtain a forest plot to determine an overall estimate of weight loss. The Potential for Methodological Bias Assessment Tool (PMBAT) was used to create a bias score for each study. Results: Overall, subjects in the placebo group lost 3.8 kg (p<0.001). Placebo subjects in the orlistat trials lost significantly more weight (4.3 kg) than did subjects in the sibutramine trials (1.1 kg, p=0.014). The subjects in the sibutramine studies did not lose a significant amount of weight (p=0.397). There were distinct differences between the sibutramine and orlistat studies with regard to nutrition and exercise interventions. The mean score on the PMBAT was 16.7 ± 3.6; and no study scored higher than 25 out of 45 total points. Conclusions: Overall subjects in the placebo group in the combined orlistat and sibutramine studies lost a significant amount of weight. Differences in study design, bias, and the Hawthorne effect may have contributed to this weight loss.

Obesity is a public health issue linked to high morbidity and mortality among critically ill patients. There are approximately 15.5 million morbidly obese adults in the United States. The purpose of the project was to develop and implement an educational program using evidence-based protocols for bariatric care to educate nurses and caregivers regarding best practices when attending to obese patients. The practice-focused question examined whether learning about evidence-based bariatric care would improve the knowledge of nurses and caregivers caring for morbidly obese patients in an acute care setting. The theoretical foundation was Bandura'€™s self-efficacy theory. A questionnaire using a Likert scale was used to collect data from the 100 participants before and after the learning intervention. The selection criteria involved the inclusion of all nurses and caregivers working at the adult in-patient unit. A paired-samples t-test was used to evaluate levels of improvement in knowledge of the causes, treatment, management, and care of patients with obesity and the challenges in caring for morbidly obese patients. The findings indicated a statistically significant increase in participants'€™ knowledge of the causes (p < 0.000), treatment, management, and care of patients with obesity (p < 0.000) and the challenges involved in caring for morbidly obese patients after the learning intervention (p < 0.004). Thus, the implementation of an educational intervention may be effective in improving nurses'€™ knowledge of bariatric care. The implications of the project for social change involve the improvement in nurse'€™s knowledge of clinical guidelines, which can lead to increase in patient satisfaction, and improved overall health outcomes.

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