O objetivo deste estudo foi avaliar o efeito do suplemento de colostro (SC) associado ao colostro materno (CM) de alta ou média qualidade na saúde e desempenho de bezerros leiteiros. No primeiro experimento foram utilizados 44 machos da raça Holandesa, distribuídos nos tratamentos: 1) CM de alta qualidade fornecido em volume correspondente a 15% do peso ao nascer (PN); 2) CM de média qualidade (15%PN) e 3) CM de média qualidade (15% PN) + SC. O protocolo de colostragem afetou a concentração de proteína total nas primeiras 48 horas de vida e durante a fase de aleitamento (P<0,05). Em relação a saúde, o protocolo de colostragem não afetou o escore fecal, bem como o número de dias com diarreia, dias com febre e dias de hidratação (P>0,05); no entanto, os animais que receberam CM de alta qualidade foram medicados por um menor número de dias (P<0,05). O consumo e o desempenho não foram afetados pelos tratamentos (P>0,05), embora tenha ocorrido efeito de idade (P<0,0001). O fornecimento de suplemento de colostro associado ao CM de média qualidade não afetou a transferência de imunidade passiva, o desempenho ou o metabolismo dos animais durante o período de aleitamento. No segundo experimento foram utilizadas 80 fêmeas da raça Holandesa nos seguintes tratamentos: 1) CM de alta qualidade fornecido em volume correspondente a 15% PN; e 2) CM de alta qualidade (15% PN) + SC. Não houve diferença na qualidade do colostro ingerido pelos animais (P>0,05). Os parâmetros sanguíneos nas primeiras 24 horas não foram afetados pelos tratamentos (P>0,05). O consumo e o desempenho não foram afetados pela administração do suplemento de colostro (P>0,05), no entanto houve efeito de idade para ambos os parâmetros (P<0,0001). Em relação à saúde, o fornecimento adicional de Ig não afetou os dias com diarreia, dias com febre ou dias medicados (P>0,05). A taxa de mortalidade observada durante o experimento foi de 2,5%. O consumo adicional de Ig através do fornecimento de suplemento de colostro em associação ao colostro materno de alta qualidade não melhorou a imunidade, bem como não afetou o desempenho ou a saúde de bezerros leiteiros. No terceiro experimento, foram utilizadas 67 fêmeas da raça Holandesa ou mestiças Girolando nos seguintes tratamentos: 1) CM de alta qualidade fornecido em volume correspondente a 10% PN; e 2) CM de alta qualidade (10% PN) + SC. O consumo e o desempenho não foram afetados pelo SC (P>0,05). O escore fecal também não foi afetado (P>0,05), mas observou-se maior frequência de animais com escore de desidratação nas 2ª e 3ª semana de vida, quando os escores fecais foram mais altos para todos os tratamentos. Houve uma maior porcentagem de animais suplementados sendo medicados devido a diarreias na segunda semana de vida. Houve maior frequência dos animais do grupo não suplementado com escore 1 de descarga nasal nas semanas 3 a 7. O consumo adicional de imunoglobulinas através do fornecimento de suplemento de colostro em associação ao colostro materno de alta qualidade não afetou o desempenho ou a saúde dos animais. / The aim of this study was to evaluate the effect of colostrum supplement (CS) associated with maternal colostrum (MC) of high and medium quality on health and performance of calves. In the first experiment 44 Holstein males were used in the following treatments: 1) high quality MC provided in a volume corresponding to 15% of birth weight (BW); 2) medium quality MC (15% BW) and 3) medium quality MC (15% BW) + CS. Colostrum feeding protocol affected the total protein concentration in the first 48 hours of life (P<0.05). As regard to animal health, colostrum feeding protocol did not affect the fecal score, the number of days with diarrhea, days with fever and hydration days (P>0.05); however, animals that received high quality colostrum were treated for a shorter number of days (P<0.05). The concentrate intake and performance were not affected by the supply of CS (P>0.05) and were increased over the weeks (P<0.0001). Feeding the colostrum supplement associated with the medium quality MC did not affect the transfer of passive immunity, performance or metabolism of animals during the liquid-feeding phase. In the second trial, 80 Holstein females were assigned to two treatments: 1) high quality MC, supplied in a volume corresponding to 15% BW; and 2) high quality MC (15% BW) + CS. There was no difference in the quality of colostrum ingested by animals (P> 0.05). Blood parameters during the first 24h were not affected by treatments (P>0.05). The concentrate intake and performance were not affected by the administration of CS (P> 0.05), however there was an age effect (P <0.0001). With regard to health, the additional supply of Ig did not affect the number of days with diarrhea, days with fever or medicated days (P> 0.05). The mortality rate observed during the experiment was 2.5%. The additional intake of Ig via CS in combination with high quality MC have not improved immunity or affected the performance and health of dairy calves. In the third trial, 67 female Holstein or Holstein x Gir were assigned to two treatments: 1) high quality MC supplied in c volume corresponding to 10% BW; and 2) high quality MC (10% BW) + CS. Concentrate intake and performance were not affected by feeding a CS (P> 0.05). The fecal score was not affected by the CS (P> 0.05), but there was a higher frequency of animals with dehydration score during the 2nd and 3rd week of life, when the fecal scores were higher for both treatments. There was a higher percentage of supplemented animals being medicated because of diarrhea during the second week of life. There was a higher frequency of animals in the non-supplemented group with nasal discharge score 1 in weeks 3 to 7. The additional consumption of immunoglobulins through the colostrum supplement feeding in combination with high quality colostrum did not affect the performance or the health of animals.

Depot medroxyprogesterone acetate (DMPA) is a long acting progesterone only contraceptive agent. Side effects such as irregular bleeding patterns and weight gain are attributed to discontinuation. The purpose of this study was to describe depot medroxyprogesterone acetate discontinuation after weight gain in 17 to 19 year-old adolescent girls.

Dans cette thèse, nous avons étudié la relation entre le traitement par antidépresseurs, la prise du poids et le syndrome métabolique sur un échantillon de patients atteints de TDM. Les résultats cliniques ont suggéré que la prise du poids précoce due au traitement par antidépresseurs augmenterait le risque de prise du poids ultérieure et d’incidence ultérieure du syndrome métabolique. Ainsi que la relation entre l'utilisation des antidépresseurs, la réponse au traitement et la prise du poids reste complexe. Malgré l'augmentation simultanée de la consommation d'antidépresseurs et la tendance à l'obésité dans les sociétés occidentales, des cohortes prospectives supplémentaires sont nécessaires pour tester pleinement l'hypothèse traitant que la prise du poids chez les utilisateurs des antidépresseurs est un effet iatrogène. Bien que l'impact des antidépresseurs sur la morbidité cardiovasculaire ne puisse toujours pas être déterminé, les résultats du premier chapitre ont montré que l'utilisation des antidépresseurs, indépendamment de leurs classes, avait un impact sur les dérèglements métaboliques, nécessitant une attention clinique spécifique. Une étude de cohorte à long terme est nécessaire pour confirmer si l'interruption et la réinstauration du traitement par des antidépresseurs seraient liées à la fluctuation des dysrégulations du syndrome métabolique. / In this dissertation we have studied the relationship between AD treatment, weight gain and MetS on a sample of MDD patients. Clinical findings have suggested that early weight gain due to AD treatment would increase the risk of both later weight gain and later MetS incidence. The relationship between AD use, response to treatment and weight gain remain complex. Despite the simultaneous increase in AD use and obesity trends in Western societies, additional prospective cohorts are needed to fully test the hypothesis that weight gain among AD users is indeed an iatrogenic effect. Although impact of AD on cardiovascular morbidity still cannot be ascertained, the results from the first chapter showed that AD use – irrespective of the class - does impact and worsen metabolic dysregulations, which would require specific clinical attention. A long term cohort study is required to confirm whether discontinuation and re-initiation of AD treatment would be linked to fluctuation in MetS dysregulations.

In the US, 8.4% of children are diagnosed with asthma by age 18, making asthma one of the most common chronic conditions among children. Additionally, 25% of children experience persistent wheezing by age 6, an indicator of childhood asthma. Both childhood asthma and persistent wheezing may be linked to inflammatory and immune mechanisms, which are associated with inadequate and excessive gestational weight gain. Studies investigating the relationship between gestational weight gain and offspring asthma and wheeze phenotypes are limited by self-reported gestational weight gain, early age at asthma and wheeze assessments, limited adjustment for potential confounders and no trimester-specific evaluations. Therefore, we investigated the association between total and trimester-specific gestational weight gain, offspring asthma and wheeze phenotypes among 2128 mother-child pairs in Project Viva, a prospective cohort study in eastern Massachusetts. Gestational weight gain was abstracted from medical records and self-reported prepregnancy weight, and defined both continuously and using Institute of Medicine guidelines. Offspring asthma was obtained via maternal report at approximately 7 years, while wheeze trajectories were derived via latent class mixed models based on presence of wheeze between 1 and 9 years, inclusively, via maternal report. We investigated the relationship between gestational weight gain, offspring asthma and wheeze phenotypes using multivariable regressions and predicted probabilities, adjusting for important covariates. Most women had excessive gestational weight gain (56%), while 31% had adequate gestational weight gain and 13% had inadequate gestational weight gain. Approximately 18% of children had current mid-childhood asthma, 13% had early transient wheeze and 13% had persistent wheeze. We found a non-linear association between total gestational weight gain and offspring current mid-childhood asthma. Additionally, there was a 36% decreased odds of early transient wheeze among children of mothers with excessive third trimester gestational weight gain (aOR= 0.64; 95% CI: 0.42-0.98). This study adds to the body of literature by incorporating adequate inclusion of confounders and risk factors for adjustment, as well as being the first study to evaluate the association between trimester-specific gestational weight gain, offspring asthma and wheeze phenotypes.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23377号 / 医博第4746号 / 新制||医||1051(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 近藤 尚己, 教授 万代 昌紀 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Body weight in mammals is defended so that small changes in weight evoke neuroendocrine and metabolic responses that encourage a return to one’s previous weight. While these homeostatic responses have been more commonly studied in the case of weight loss, our lab has developed a mouse model of overfeeding to study the physiology of defense against weight gain. In response to overfeeding-induced weight gain, the return to previous body weight is mediated primarily by a striking reduction in food intake, which persists until pre-overfeeding body weight is restored. However, preliminary data do not suggest activation of anorectic POMC neurons which reduce food intake or inhibition of the appetite stimulating AgRP or NPY neurons in the arcuate nucleus of the hypothalamus. Furthermore, we found that adipose tissue from overfed mice does not show the same inflammatory response as mice that have become obese slowly due to ad libitum high-fat diet (HFD) consumption. Paradoxically, despite the existence of mammalian systems that defend against weight gain, average body weight in humans has been on the rise over the last half century. Concomitant with the rise in obesity rates, has been increasing availability and consumption of processed and fast foods which are generally high in sugar, salt, and fat making them extremely palatable and calorically dense. Both the caloric density and enticing taste of the foods have been implicated in causing overconsumption and contributing to a rise in average body weight and prevalence of obesity. Thus, while controlling for caloric density we have investigated whether diet palatability can increase body weight and suppress defense against weight gain in mice. We designed our studies so that all diets were of the same caloric density and therefore varied only proportion of calories derived from fats, carbohydrates, and protein. Palatability is the relative subjective preference of one food over another; in our mouse studies we equated preference, when given, a choice with palatability. We confirmed that liquid diets sweetened with sucrose or the non-nutritive sweeteners sucralose and saccharin were preferred over non-sweetened diets. In 12 day feeding studies, although we found that sweetened diets were more palatable than unsweetened diets, they did not increase caloric intake or body weight. Next, we tested whether increasing percent calories from fat leads to increases in palatability or caloric intake. In a similar 12 day feeding preference study, we found diets higher in percent calories from fat (high-fat diet = HFD) were preferred to diets with lower percent calories from fat (low-fat diet = LFD) and that the access to a HFD increased caloric intake and body weight. Employing a four-week single diet feeding study, we also found a linear relationship between percent calories from fat and caloric intake consistent with our hypothesis that percent calories from fat is sensed and modulates caloric intake. To test whether HFD can suppress defense of body weight, we used an overfeeding paradigm which I help develop, to test whether ad libitum access to a HFD prevented a return to the original body weight following overfeeding. HFD did attenuate the hypophagic response to overfeeding and prevented a return to each mouse’s initial weight with the mice having access to the HFD mice stabilizing at a higher body weight. Palatability has traditionally been ascribed to sensing of smell and taste, however, macronutrients can also be sensed within intestinal tract. To determine whether the effects of percent calories from fat require naso-oral sensing to modulate feeding behavior, we used an intragastric feeding system to bypass taste and smell and deliver HFD directly into the stomach of mice. Even in the absence of oropharyngeal sensing, HFD in the gut was sufficient to increase ad libitum caloric intake of a low-fat diet and increase body weight. Finally, based on our findings of post-oral fat sensing driving caloric intake, we tested whether post-oral sensing of percent calories from fat was sufficient to condition a flavor preference. However, we found that when caloric density was controlled, a high percent calories from fat was not sufficient to condition a flavor preference.

Orientador: Cristina Maria Garcia de Lima Parada / Resumo: Introdução: As alterações do sono durante a gestação são frequentes, em decorrência das modificações anatômicas e fisiológicas típicas dessa fase da vida e associam-se a diversos problemas de saúde para o binômio materno-fetal, especialmente déficit de desenvolvimento placentário, ocasionando pré-eclâmpsia e restrição de crescimento intrauterino; parto prematuro e alterações no sono do lactente. A presença de sobrepeso e/ou obesidade tem sido associada a distúrbios do sono em adultos e existe base para a hipótese de que o padrão nutricional pré- gestacional possa influir na qualidade do sono da mulher na gestação e que a má qualidade do sono, independente do estado nutricional pré-gestacional, é fator de risco para ganho de peso inadequado na gestação. Objetivo: estudar as associações entre estado nutricional pré-gestacional, ganho de peso na gravidez e qualidade do sono; construir tecnologia para autocontrole do ganho de peso na gravidez. Método: Trata-se de estudo transversal aninhado a um estudo de coorte que analisou aspectos da saúde mental de gestantes, sono e desfechos nutricionais. A coleta de dados foi realizada no período de maio de 2018 a junho de 2019 mediante entrevistas presenciais, telefônicas e consulta aos prontuários das gestantes. Utilizou-se a escala de sono Mini-sleep Questionnaire, adotando-se como ponto de corte o escore 30 para definição de distúrbio severo do sono. Calculou-se o Índice de Massa Corpórea pré-gestacional, classificando as participantes ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Sleep changes during pregnancy are frequent, due to anatomical and physiological typical changes of this stage of life and are associated with several health problems for the maternal-fetal binomial, especially deficit in placental development, causing preeclampsia and fetal growth restriction; prematurity and changes in the infant's sleep. The presence of overweight and/or obesity has been associated with sleep disorders in adults and there is a basis for the hypothesis that the pre-gestational nutritional pattern may influence the quality of sleep during pregnancy and that poor sleep quality, regardless of the pre-gestational nutritional status, is a risk factor for inadequate weight gain during pregnancy. Methods: This is a nested cohort cross-sectional study. The collection was carried out from May to December 2018 and included 210 pregnant women who participated in face-to-face and telephone interviews. The Mini-sleep Questionnaire sleep scale was used, adopting a score of 30 as the cutoff point for the definition of severe sleep disorder. The pre-gestational Body Mass Index was also calculated, classifying participants as eutrophic, underweight, overweight and obese. Bivariate analysis of the data was performed and variables associated with the level of p <0.20 were included in multivariate analysis, with a 95% confidence interval and adopting a critical p <0.05. Results: Regarding the investigated associations, there was no relationship between pre-gestat... (Complete abstract click electronic access below) / Mestre

Traditional dogma is that men have a higher metabolism compared to women. Because of an increased obesity rate in women, the purpose of this study was to test the hypothesis that compared to males, females will gain more body weight per gram of food consumed. Methods: To test our hypothesis male and female mice were fed either a high or low-fat diet for 20-weeks, while monitoring food intake and body weight. At the end of the 20 week feeding plan, a final weight on the mice was taken, as well as a measurement from the nose to rump of the mouse in order to calculate a BMI. Results: Male mice consistently consumed more food than female mice, regardless of the diet. As expected mice on the high-fat diet gained more weight than mice on the low-fat diet. Further, on the low-fat diet male mice gained more weight than the female mice. Interestingly, there was no difference between the amount of weight gain between male and female mice on the high fat. However, within the same diet, male mice gained more weight per gram of food consumed. On average, male mice gained approximately double the body weight per gram of food consumed compared with female mice (51 vs. 27 mg of body weight per gram of food consumed). Conclusions: We had hypothesized that increased food intake in male mice would primarily account for the differences in body weight between male and female mice. However, contrary to our hypothesis, the data shows that male mice gained more body weight per gram of food consumed. This finding provides a novel hypothesis to explain the mechanism by which, at least in rodents, females are more resistant to obesity. Future studies comparing metabolic rate and physical activity levels will need to be performed to explore this finding further.

Nonadherence to fluid restrictions is a common problem with serious health consequences for patients with end-stage renal disease (ESRD). For the present study, the authors evaluated psychological variables of stress, as measured by major and minor life events, and depression. They sought to determine the role of these events in patients’failure to adhere to fluid restrictions as measured by increased interdialytic weight gain. Forty-two hemodialysis patients completed inventories assessing major life events, daily stressful events, and depression on three consecutive dialysis sessions. Fluid adherence was measured by interdialytic weight gain. A path analysis model found daily minor stress to have a direct effect on nonadherence, whereas there was a direct inverse effect of depression on nonadherence. Possible mechanisms and implications for future studies arediscussed.

Diabetes mellitus, whether type 1 or type 2, offers special challenges to home health care providers. Treatment of diabetes can become increasing complex. While insulin remains the cornerstone of treatment in patients with type 1 diabetes (T1DM), the utilization of insulin to safely control blood glucose is also necessary for many patients with type 2 diabetes (T2DM). Many different insulin products are available, with each product possessing different characteristics and adverse effect potential. Balancing glycemic control with patient safety is paramount. The individualization of insulin therapy can be challenging for both patients and health care professionals. Regular evaluation of blood glucose monitoring is vital for patient assessment. This article provides a review of insulin for providers caring for patients in the home health care setting.