Dissertations / Theses: 'Obesity – Diagnosis'

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Groll, Emily D. "Comparison of anthropometric and DXA measurements of regional body fat." Virtual Press, 2008. http://liblink.bsu.edu/uhtbin/catkey/1398712.

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Purpose: The primary purpose of this research study was to assess the degree of agreement between simple anthropometric measurements (i.e. body mass index, waist circumference, hip circumference, and waist-to-hip ratio) and the measures of regional adiposity, with a primary focus on the androidlgynoid ratio, assessed using dual energy x-ray absorptiometry (DXA). This secondary purpose of the study was to identify any significant correlations between the measures of regional adiposity, physical activity, and cardiovascular risk factors. Methods: Forty-eight subjects, 19 males (48.7 ± 16.9 years) and 29 females (43.6 ± 16.2 years), volunteered to participate in this study. Subjects underwent laboratory testing compromised of resting blood pressure, blood lipid analysis, waist & hip circumference, total body DXA scan, and a one week physical activity assessment. Results: Significant correlations were observed between body mass index and region body fat % (r = 0.84, 0.79), waist circumference and android fat % (r = 0.79, 0.75), and waist-to-hip ratio and androidlgynoid ratio (r = 0.72, 0.61) for men and women, respectively. Fasting insulin was correlated with region body fat %, android body fat %, trunk body fat %, and the android/gynoid ratio. The android/gynoid ratio was correlated with high density lipoproteins, very low density lipoproteins, triglycerides, and fasting glucose. There was a statistically significant negative relationship observed between average steps per day and body mass index, waist circumference, hip circumference, region body fat %, android body fat %, and trunk body fat %. Conclusions: This study found that there are strong relationships between simple anthropometric measures and regional body fat measures from the DXA. According to the data in the present study, body mass index, waist circumference, and waist-to-hip ratio provide simple yet sensitive methods for the estimation of regional body fat in Caucasian males and females. In addition, this study found significant correlations between measures of the blood lipid profile, physical activity, and both simple anthropometric and DXA measures of regional body fat. Key words: android fat, body mass index, dual-energy x-ray absorptiometry, gynoid fat, obesity, waist circumference.
School of Physical Education, Sport, and Exercise Science

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Wenzel, Virginia. "Use of electronic health records to aid in pediatric obesity diagnosis." Thesis, Weill Medical College of Cornell University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=1601009.

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Background: Obesity has recently been classified by the American Medical Association (AMA) as a disease which, if unrecognized and unaddressed in childhood, causes multiple medical and psychological complications that can impact both personal and population health. Unprecedented funding is being invested in electronic health records to improve quality, safety, and delivery of healthcare and reduce healthcare costs. Scant literature has evaluated the use of aids in the electronic health record (EHR) to identify obesity.

Objectives: The purpose of this study was to determine to what extent the tools available in an EHR for automatic Body Mass Index (BMI) calculation based on height and weight documentation are used by pediatricians to correctly identify obesity in children. Secondary objectives were to evaluate quality of data input (discrete vs. free text) and see if there is any variation in rates of identification among patients of different socio-demographic characteristics and trainees of different levels.

Methods: We conducted a retrospective chart review for patients aged 2–18 years seen for a well-child visit at New York Presbyterian Hospital between January 2011 and January 2014, where it is standard practice at these visits to take height and weight measurements. The EHR automatically populates these values onto growth curves, converting them into BMI with percentiles. Standardized definitions from the Centers for Disease Control and Prevention (CDC) 2010 were used to qualify overweight and obese based on BMI. We determined the percentage of patients who were overweight or obese (based on CDC percentiles) that had the diagnosis identified by the pediatrician, and then assessed the quality of data input. We assessed laboratory follow up and referrals for all patients, and assessed for demographic differences among patients properly and not properly documented by providers as obese or overweight.

Results: We reviewed 700 charts in total. Inclusion criteria were all of the patients who had a BMI between 85–95% (these were grouped as overweight) and a BMI over 95% (obese). 209 patients were overweight or obese and therefore eligible for inclusion. Of the 209 clinically overweight/obese children, 72.2% had some form of documentation of this diagnosis, although the diagnosis was documented more often in the obese vs. overweight child. The diagnosis was most often captured electronically in the free text progress note. Over half of clinically overweight/obese children aged ≥8 years did not receive follow-up standard laboratory testing, and only about one-quarter of clinically overweight/obese children had documented in-office nutrition guidance. Diagnosis of overweight was higher in females, but it was almost twice as likely that an obese male would be documented as such. Results showed no identification variation based on age or race/ethnicity. There was no difference in recognition of obesity/overweight based on postgraduate year (PGY) or nurse practitioner (NP) status.

Conclusion: Despite its importance as a public health priority for children, automatic calculation of BMI by use of an EHR led to documentation by a provider as a child being overweight/obese only three quarters of the time. This study suggests that despite increasing focus on using EHRs to improve individual and population health, including for obesity, clinical decision support remains underutilized.

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Hall, Gerald William. "Identification, Diagnosis, Counseling, and Referral of Overweight Military Dependent Children to Reverse Early Childhood Obesity." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3685.

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Since 1980, the obesity rate in children 5 to 11 years of age has increased from 7% to 18%. The lack of structured physical activity and poor dietary habits childhood are primary risk factors for obesity related comorbidities in adulthood. Guided by primary care providers, families can reverse childhood obesity by implementing healthy dietary habits and engaging in structured physical activity. The purpose of this quality improvement project was to develop an evidenced-based policy with procedures to standardize the timely and consistent identification of overweight children at a primary care clinic serving military families. With an emphasis on obesity prevention within families through primary care interventions, the revised health belief model guided the project design. A literature review was conducted in a systematic manner to identify effective strategies and interventions to inform the policy development. Then, the Delphi technique guided a 12-member expert panel to evaluate the policy and procedures in terms of the level of evidence and the implementation plan with the goal of achieving consensus with recommendations for revisions. Consensus was achieved with multiple revisions following the completion of two Delphi rounds. The first panel session (n=12) concluded with a 70% consensus, including recommended revisions to improve the policy implementation. The second panel session (n=12) concluded with 100% consensus for the revised policy. The final policy and procedures addressed the clinical practice gap with a robust process to identify, counsel, and refer overweight children to external specialty programs for obesity management. By intervening to reverse the progression of childhood obesity, this project achieved positive social change at an organization level.

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Badger, S. J. "A genetic diagnosis for obesity : social and moral experiences of the body and responsibility in childhood." Thesis, University of Cambridge, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.596242.

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This thesis is an ethnographic exploration of the impact of genetic research on how obesity is understood, explained and experienced across scientific, political, personal and familial terrains. This thesis draws on three main areas of data: the historical, biomedical and scientific literature concerning obesity and causation; ethnographic work with Genetics of Obesity Study (GOOS) across the laboratory and clinical research facility conducted between November 2003 and August 2006; and ethnographic work and qualitative interviews conducted with up to three generations from 21 families recruited to GOOS. In short, the data suggested that a genetic diagnosis for obesity raises several different issues to those associated with other genetic conditions. In western societies, obesity is often equated with negative body image and health risks resulting in stigmatisation and blame being directed toward the individual and in the case of childhood obesity, also toward parents. While a genetic diagnosis may offer alternative explanations and relief from guilt, there is also a degree of ambivalence toward the result. The data suggest that assumed commentaries about the transformative impact of a genetic diagnosis are overstated. Participation in GOOS is prompted by a broad range of motivations: from hopes for cures to the belief in a mutual exchange of data and relationship between the GOOS team and family members. Yet the transfer of that information to other disciplines and services that families encounter in their everyday negotiations has been limited. This suggests that factors such as the historical and political context, lay and professional beliefs about the norms of human development, the context of care and the ambiguity between clinical care and research participation, are important for the construction of a particular field and of disease status.

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Moreira, Rosa Aparecida Nogueira. "DiagnÃsticos de enfermagem da classe: respostas cardiovasculares/pulmonares em clientes submetidos Ã cirurgia bariÃtrica." Universidade Federal do CearÃ, 2011. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=7988.

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nÃo hÃ
Na complexidade do tratamento da obesidade, inclui-se a cirurgia bariÃtrica. EntÃo, conhecer os fatores relacionados e caracterÃsticas definidoras dos diagnÃsticos da classe cardiopulmonar associados no perÃodo pÃs-operatÃrio imediato de cirurgia bariÃtrica torna-se essencial para o desenvolvimento da assistÃncia de enfermagem, jÃ que, a partir dos diagnÃsticos de enfermagem mais prevalentes, intervenÃÃes serÃo instituÃdas. Assim, o estudo teve por objetivo avaliar o perfil de diagnÃstico de enfermagem da classe respostas cardiovasculares/pulmonares de acordo com a taxonomia II da NANDA dos pacientes no pÃs-operatÃrio de cirurgia bariÃtrica. Um estudo transversal foi desenvolvido com 59 pacientes internados em um hospital de referÃncia de cirurgia bariÃtrica no MunicÃpio de Fortaleza/CE, cuja coleta de dados ocorreu no perÃodo de junho de 2010 a junho de 2011. As informaÃÃes foram coletadas por meio de entrevista e exame fÃsico; posteriormente trÃs juÃzes realizaram a inferÃncia dos diagnÃsticos de enfermagem na classe respostas cardiovasculares/pulmonares segundo a Taxonomia da NANDA versÃo 2009-2011. Os dados foram compilados em planilha Excel e a anÃlise estatÃstica realizou-se no STATA versÃo 8.0. O nÃvel de significÃncia adotado no estudo foi 5%. Observou-se o predomÃnio do sexo feminino, com mÃdia de idade 35,3 anos. A maior parte dos pacientes apresentou diagnÃstico de obesidade mÃrbida com IMC > 40 Kg/m2. Os diagnÃsticos reais de maior concordÃncia entre os juÃzes foram PerfusÃo Tissular PerifÃrica Ineficaz (78%), DÃbito CardÃaco DiminuÃdo (76,3%), IntolerÃncia Ã Atividade e PadrÃo RespiratÃrio Ineficaz (47,5%). Pulsos perifÃricos diminuÃdos, edema, fadiga pÃs-carga alterada e prÃ-carga alterada foram proporcionalmente associados ao diagnÃstico DÃbito CardÃaco DiminuÃdo. AlteraÃÃes na profundidade respiratÃria, dispneia, ortopneia, uso da musculatura acessÃria para respirar, ansiedade, dor, fadiga, fadiga da musculatura respiratÃria foram proporcionalmente associados a PadrÃo RespiratÃrio Ineficaz. Desconforto aos esforÃos, relato verbal de fadiga, relato verbal de fraqueza, resposta anormal da pressÃo sanguÃnea Ã atividade, estilo de vida sedentÃrio, imobilidade e repouso no leito foram proporcionalmente associados a IntolerÃncia Ã Atividade. Edema, parestesia, pulsos diminuÃdos, hipertensÃo e tabagismo foram proporcionalmente associados Ã PerfusÃo Tissular PerifÃrica Ineficaz. Este estudo contribuirÃ para a construÃÃo da SistematizaÃÃo da AssistÃncia de Enfermagem frente aos diagnÃsticos de enfermagem da classe respostas cardiovasculares/pulmonares, como descrito nos resultados apresentados, e na fundamentaÃÃo cientÃfica para cada diagnÃstico. AlÃm da importante contribuiÃÃo para identificar as reais necessidades e facilitar a utilizaÃÃo de intervenÃÃes adequadas nessa populaÃÃo, estÃ a capacidade de o profissional usufruir dessas informaÃÃes, vista a escassez de pesquisas realizadas com diagnÃsticos de enfermagem em pacientes submetidos Ã cirurgia bariÃtrica.
The bariatric surgery is included in the complexity of the treatment of obesity. Then, knowing the related factors and defining characteristics of cardiopulmonary diagnostic associated with the immediate postoperative period of bariatric surgery becomes essential for the development of nursing care, since, from the most prevalent nursing diagnoses, interventions will be instituted. Thus, the study aimed to evaluate the profile of nursing diagnosis of the class cardiovascular/pulmonary answers according to NANDA Taxonomy II of the patients after bariatric surgery. A cross-sectional study was conducted with 59 patients hospitalized in a referral hospital for bariatric surgery in the city of Fortaleza, state of CearÃ, which data collection occurred from June 2010 to June 2011. Information was collected through interviews and physical examinations; then three judges made the inference of nursing diagnoses in the class cardiovascular/pulmonary answers according to the NANDA-I Taxonomy 2009-2011. The data were compiled in an Excel spreadsheet and the statistical analysis was carried out in the STATA version 8.0. The significance level in this study was 5%. There was a predominance of females, mean age of 35.3 years. Most patients had a diagnosis of morbid obesity with BMI>40kg/m2. The actual diagnoses of greater agreement among the judges were Ineffective Peripheral Tissue Perfusion (78%), Decreased Cardiac Output (76.3%), and Activity Intolerance and Ineffective Breathing Pattern (47.5%). Decreased peripheral pulses, edema, altered preload and afterload fatigue were proportionally associated with the diagnosis Decreased Cardiac Output. Changes in respiratory depth, dyspnoea, orthopnoea, use of accessory muscles for breathing, anxiety, pain, fatigue, respiratory muscle fatigue were proportionally associated with Ineffective Breathing Patterns. Discomfort in efforts, verbal report of fatigue, verbal report of weakness, abnormal blood pressure response to activity, sedentary lifestyle, immobility and bed rest were proportionally associated with Activity Intolerance. Edema, paresthesia, decreased pulses, hypertension and smoking were proportionally associated with Ineffective Peripheral Tissue Perfusion. This study will contribute to the construction of the Systematization of Nursing Care regarding nursing diagnoses of the class cardiovascular/pulmonary answers, as described in the results presented, and in the scientific basis for each diagnosis. Besides the important contribution to identifying the real needs and facilitating the use of appropriate interventions in this population, it is the ability of the professionals in taking advantage of this information, in view of the scarcity of researches related to nursing diagnoses in patients undergoing bariatric surgery.

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Messa, Camilla, and Alma-mia Ugarte. "Omvårdnadsåtgärder för patienter med fetma : En litteraturöversikt." Thesis, Röda Korsets Högskola, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-3996.

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Background:Obesity is a condition in which the individual accumulates fat to an abnormal or excessive extent, which can be harmful to health. Every year, almost 4 million people diefrom the obesity epidemic, which is seen to increase in all age groups and burden individuals as well as society. It is a complex disease state caused by various factors such as biological, behavioural, social and environmental conditions and increases the risk of developing secondary diseases and premature death. Aim: The aim of the study was to identify nursing measures in the diagnosis of obesity. Method: The study is a general literature study based on eleven scientific articles with a qualitativeapproach and was analysedwith a thematic analysis method. Results: A recurring topic in the scientific articles was screened for a latent theme: person-centered patient education. The theme is based on developed sub-themes: physical activity, autonomy,and nutrition. Conclusions: The conclusion of the study is that the nurse works based onperson-centered patient education and offers patients with obesity nursing measures that include increased physical activity, strengthen the patient's autonomy and nutritional science. The obesity epidemic is a problem that is increasing in society on a national and global level, thus the authors of this study believe that there is an increased need for supplementary research in the field.
Bakgrund: Fetma är ett tillstånd där individen ansamlar fett i en onormal eller överdriven omfattning vilket kan vara skadligt för hälsan. Årligen dör närmare 4 miljoner människor av fetmaepidemin som ses öka i alla åldersgrupper och belastar individer som samhället. Det är ett komplext sjukdomstillstånd som orsakas av olika faktorer som biologiska-, beteendemässiga-, sociala- och miljömässiga förhållanden samt ökar risken att utveckla sekundära sjukdomar och förtidig död. Syfte: Syftet med studien var att identifiera omvårdnadsåtgärder vid diagnosen fetma. Metod: Studien är en allmän litteraturstudie baserad på elva vetenskapliga artiklar med kvalitativ ansats och analyserades med tematisk analysmetod. Resultat: Ett återkommande ämne i de vetenskapliga artiklarna avskärmades till ett latent tema: personcentrerad patientutbildning. Temat utgår från framtagna subteman: fysisk aktivitet, autonomi och nutrition. Slutsatser: Slutsatsen till studien är att sjuksköterskan arbetar utifrån personcentrerad patientutbildning samt erbjuder patienter med fetma omvårdnadsåtgärder som inkluderar ökad fysisk aktivitet, förstärka patientens autonomi samt nutritionslära. Fetmaepidemin är ett problem som ökas i samhället på en nationell och global nivå, därmed anser författarna till denna studie att det finns ett utökat behov med kompletterande forskning inom området.

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Kim, Grace Eunhae. "The impact of obesity and age at diagnosis on the chronic quality of life and long-term outcomes of psoriasis patients." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17295917.

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Background: Psoriasis is a chronic inflammatory skin disorder that detracts from quality of life, including elements of physical, psychological, and social functioning. Objective: The purpose of this study was to (1) investigate whether retrospective questions about chronic quality of life (CQoL) were better predictors of poor socioeconomic and medical outcomes than the current Dermatology Life Quality Index (DLQI) and (2) to evaluate the relative impact of body mass index (BMI) and (3) age at diagnosis on the long-term outcomes and CQoL of psoriasis patients. Methods: 114 subjects were examined and asked to complete a self-administered questionnaire regarding disabilities, relationships, education, as well as medical and economic outcomes. Participants also answered the ten questions used in the Dermatology Life Quality Index (DLQI) modified to ask “over the last week,” “over the last year,” and “over your lifetime with psoriasis.” Survey responses were compared amongst BMI groups (normal, overweight, obese) and age-at-diagnosis quartiles. Results: Greater lifetime DLQI (LT DLQI) correlated with lower satisfaction with treatment (P=0.007), greater concern that psoriasis will worsen (P=0.012), worse perceived general health (P=0.003), younger age at which weight became problematic (P=0.002), greater likelihood of believing psoriasis had caused weight gain (P<0.001), shorter retention of current job (P=0.001), more experiences of discrimination at work (P=0.002) and in social settings (P<0.001) over one’s lifetime, and more severe discrimination in social settings over one’s lifetime (P=0.002). Greater LT DLQI predicted more packs smoked per day (P=0.005), greater likelihood of believing psoriasis caused smoking (P=0.012), greater likelihood of recreational drug use (P=0.004), greater likelihood of a depression diagnosis (P<0.001), greater likelihood of having felt depressed (P=0.011), and greater likelihood of believing psoriasis caused depression (P<0.001). Patients with elevated BMI were more likely to rate their general health lower (P<0.001), believe that psoriasis caused their weight gain (P=0.014), experience sleep problems over their lifetime (P=0.016), hide their psoriasis over their lifetime (P=0.010), have their self-confidence affected by their psoriasis over their lifetime (P=0.011), and avoid common activities over their lifetime (P=0.012). Those diagnosed at a younger age were more likely to have a greater LT DLQI (P<0.001), have felt depressed (P=0.003), believe that their psoriasis had caused their depression (P<0.001), experience sleep problems over their lifetime (P=0.004), use recreational drugs (P<0.001), hide their psoriasis over their lifetime (P<0.001), and experience more severe discrimination in social settings over their lifetime (P=0.002). Conclusion: Compared to the standard LW DLQI, LT DLQI was a better predictor of patient outcomes related to weight, discrimination, and depression. While obesity is linked to impaired self-confidence, early-onset psoriasis is associated with depression, social discrimination, and greater LT DLQI. Both BMI and age at diagnosis independently cause a negative effect on sleep quality and recreational drug use.

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Foster, Clare. "Experiences of physical activity by children with a diagnosis of obesity from the Bangladeshi community living in East London : an interpretative phenomenological analysis." Thesis, University of East London, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.532684.

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This study explored the experiences of physical activity of Bangladeshi adolescents diagnosed with obesity. It adopted a qualitative methodology using Interpretative Phenomenological Analysis and semi-structured interviews to explore this un-researched area. Physical activity generally declines In adolescence, and is especially low in Bangladeshi young people. It is an integral part of treatments for childhood obesity and therefore, it is important to maximise uptake and engagement. The study findings are reported as four main themes. Physical activity was understood to offer protection from health problems and facilitate weight loss. However, young people did physical activity for fun, weight loss and because it was a social experience, rather than for health reasons. The motivation of being with others, inclusion and friendships were high in the face of associated costs. Young people had to negotiate their dependency on adults for information about their health and for opportunities to do physical activity. Uptake of physical activity was limited by competing demands on time, proximity to home, ability to travel safely, and for females, by the presence of men and concerns over 'mixing'. However, when young people did access physical activity they enjoyed feeling energised, improved thinking, feeling lighter and the social approval physical changes offered. They disliked the physiological experiences associated with exertion and some young people were anxious about experiencing these. These findings are sample-specific; they cannot be extrapolated onto other groups in other areas. However, they highlight that many experiences were similar to the general population whilst some were culturally mediated. Young people accepted some personal responsibility for physical activity, which was problematic given the external barriers faced. Family norms, cultural norms, bullying and poverty are factors requiring attention in interventions. The findings are discussed in terms of the existing research base. Clinical and research implications are highlighted.

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Bramlage, Peter, David Pittrow, Hans-Ulrich Wittchen, Wilhelm Kirch, Steffen Boehler, Hendrik Lehnert, Michael Hoefler, Thomas Unger, and Arya M. Sharma. "Hypertension in Overweight and Obese Primary Care Patients Is Highly Prevalent and Poorly Controlled." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-110125.

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Background: Although the relationship between body weight and blood pressure (BP) is well established, there is a lack of data regarding the impact of obesity on the prevalence of hypertension in primary care practice. The objective of this study was to assess the prevalence of hypertension and the diagnosis, treatment status, and control rates of hypertension in obese patients as compared to patients with normal weight. Methods: A cross-sectional point prevalence study of 45,125 unselected consecutive primary care attendees was conducted in a representative nationwide sample of 1912 primary care physicians in Germany (HYDRA). Results: Blood pressure levels were consistently higher in obese patients. Overall prevalence of hypertension (blood pressure ≥140/90 mm Hg or on antihypertensive medication) in normal weight patients was 34.3%, in overweight participants 60.6%, in grade 1 obesity 72.9%, in grade 2 obesity 77.1%, and in grade 3 obesity 74.1%. The odds ratio (OR) for good BP control (<140/90 mm Hg) in diagnosed and treated patients was 0.8 (95% confidence interval [CI] 0.7– 0.9) in overweight patients, 0.6 (95% CI 0.6–0.7) in grade 1, 0.5 (95% CI 0.4–0.6) in grade 2, and 0.7 (95% CI 0.5– 0.9) in grade 3 obese patients. Conclusions: The increasing prevalence of hypertension in obese patients and the low control rates in overweight and obese patients document the challenge that hypertension control in obese patients imposes on the primary care physician. These results highlight the need for specific evidence-based guidelines for the pharmacologic management of obesity-related hypertension in primary practice.

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Bramlage, Peter, David Pittrow, Hans-Ulrich Wittchen, Wilhelm Kirch, Steffen Boehler, Hendrik Lehnert, Michael Hoefler, Thomas Unger, and Arya M. Sharma. "Hypertension in Overweight and Obese Primary Care Patients Is Highly Prevalent and Poorly Controlled." Technische Universität Dresden, 2004. https://tud.qucosa.de/id/qucosa%3A26813.

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Background: Although the relationship between body weight and blood pressure (BP) is well established, there is a lack of data regarding the impact of obesity on the prevalence of hypertension in primary care practice. The objective of this study was to assess the prevalence of hypertension and the diagnosis, treatment status, and control rates of hypertension in obese patients as compared to patients with normal weight. Methods: A cross-sectional point prevalence study of 45,125 unselected consecutive primary care attendees was conducted in a representative nationwide sample of 1912 primary care physicians in Germany (HYDRA). Results: Blood pressure levels were consistently higher in obese patients. Overall prevalence of hypertension (blood pressure ≥140/90 mm Hg or on antihypertensive medication) in normal weight patients was 34.3%, in overweight participants 60.6%, in grade 1 obesity 72.9%, in grade 2 obesity 77.1%, and in grade 3 obesity 74.1%. The odds ratio (OR) for good BP control (<140/90 mm Hg) in diagnosed and treated patients was 0.8 (95% confidence interval [CI] 0.7– 0.9) in overweight patients, 0.6 (95% CI 0.6–0.7) in grade 1, 0.5 (95% CI 0.4–0.6) in grade 2, and 0.7 (95% CI 0.5– 0.9) in grade 3 obese patients. Conclusions: The increasing prevalence of hypertension in obese patients and the low control rates in overweight and obese patients document the challenge that hypertension control in obese patients imposes on the primary care physician. These results highlight the need for specific evidence-based guidelines for the pharmacologic management of obesity-related hypertension in primary practice.

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Hilbert, Anja. "Binge-Eating Disorder." Elsevier, 2019. https://ul.qucosa.de/id/qucosa%3A75711.

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Binge-eating disorder (BED) was first included as its own diagnostic entity in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) within the Feeding and Eating Disorders section.1 BED’s hallmark feature is recurrent binge eating, involving the consumption of an amount of food that is definitively larger than what others would eat under comparable circumstances within a certain time, associated with a feeling of loss of control over eating. Diagnosis of BED according to DSM-5 (307.59) requires this objective binge eating to occur at least once per week over 3 months. In contrast to binge eating in bulimia nervosa, binge eating in BED occurs without regular inappropriate compensatory behaviors aimed at preventing weight gain, such as self-induced vomiting, fasting, or laxative misuse. Binge eating in BED is further characterized by behavioral abnormalities, such as eating rapidly or until feeling uncomfortably full, and results in marked distress.

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John, Angela Beatriz. "Determinação de padrões ventilatórios e avaliação de estratégias de rastreamento de transtornos respiratórios durante o sono em pacientes candidatos à cirurgia bariátrica." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/139775.

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Introdução: A obesidade é um problema de saúde pública em crescimento, sendo o principal fator de risco para os transtornos respiratórios durante o sono (TRS), como a apneia obstrutiva do sono (AOS) e a hipoventilação noturna. A cirurgia bariátrica se consolidou como possibilidade terapêutica para a obesidade significativa. A identificação precoce dos TRS na fase pré-operatória é essencial, pois acarretam um risco aumentado de complicações perioperatórias. Diversas propostas de triagem dos TRS com abordagens mais simplificadas em relação à polissonografia (PSG) têm surgido na literatura nos últimos anos, nem todas avaliadas em uma população de pacientes obesos. Objetivo: Determinar os padrões ventilatórios em obesos candidatos à cirurgia bariátrica e avaliar três estratégias de rastreamento de TRS nessa população. Métodos: Os critérios de inclusão foram pacientes com idade ≥18 anos com obesidade graus III [índice de massa corporal (IMC) ≥40 kg/m2] ou II (IMC ≥35 kg/m2) com comorbidades relacionadas à obesidade encaminhados para avaliação para cirurgia bariátrica. Foram excluídos pacientes com cardiopatia e/ou pneumopatia graves ou descompensadas. Foram avaliados 91 pacientes através de três estratégias: (1) Clínica [Escala de Sonolência de Epworth e questionários STOP-Bang, Berlim e Sleep Apnea Clinical Score (SACS), acrescidos de gasometria arterial (GA)]; (2) Oximetria (holter de oximetria durante o sono e GA) e (3) Portátil [monitorização portátil (MP) durante o sono e capnografia)]. Todos os testes realizados foram comparados com o teste padrão, a PSG, para o diagnóstico de AOS. Resultados: A amostra estudada foi composta por 77 mulheres (84,6%) com média de idade de 44,7 ± 11,5 anos e de IMC de 50,1 ± 8,2 kg/m2. Os padrões ventilatórios identificados foram ronco, hipoxemia isolada durante o sono, AOS e hipoventilação noturna em associação com AOS. Os dados polissonográficos evidenciaram AOS em 67 de 87 pacientes (77%), sendo 26 com transtorno leve, 19 moderado e 22 grave. Vinte pacientes (23%) tiveram diagnóstico de ronco e dois deles também apresentaram hipoxemia isolada durante o sono sem AOS ou hipoventilação concomitantes. Hipoventilação noturna associada com AOS foi identificada por capnografia em um paciente. Na Estratégia Clínica, o melhor resultado alcançado foi com o escore STOP-Bang ≥6 em pacientes com índice de apneia hipopneia (IAH) ≥30 (acurácia total de 82,8%). Na Estratégia Oximetria, os pontos de corte com maior sensibilidade e especificidade para IAH ≥5, ≥10, ≥15 e ≥30 foram tempo total de registro com saturação periférica de oxigênio (SpO2) <90% por, pelo menos, 5 minutos; índice de dessaturação (ID)3% ≥22 dessaturações/hora de registro e ID4% ≥10 e ≥15 dessaturações/hora de registro. Todas as áreas sobre a curva (ASC) situaram-se acima de 0,850. Para um IAH ≥5, o ID4% ≥10 apresentou sensibilidade de 97%, especificidade de 73,7%, valor preditivo positivo de 92,8% e negativo de 87,5% e acurácia total de 91,8%. Na Estratégia Portátil, o índice de distúrbios respiratórios (IDR) foi um bom preditor de AOS nos variados pontos de corte de IAH (ASC de 0,952 a 0,995). As melhores sensibilidades e especificidades foram alcançadas em pontos de corte semelhantes de IDR e IAH, especialmente nos extratos de IAH ≥10 e ≥30. A acurácia total máxima foi de 93,9% para IDR ≥5, ≥10 e ≥30 nos seus correspondentes IAH. Baseados nesses resultados, foram testadas estratégias combinadas compostas pelo questionário STOP-Bang ≥6 com ID4% ≥10 ou ≥15. O melhor equilíbrio entre sensibilidade e especificidade e a maior acurácia foram obtidos com a estratégia STOP-Bang ≥6 com ID4% ≥15 em AOS grave. Conclusões: A frequência de ocorrência de TRS nos obesos em avaliação para cirurgia bariátrica foi alta, sendo a AOS o transtorno mais encontrado. Os questionários disponíveis até o momento, isoladamente, parecem ser insuficientes para o rastreamento de AOS nessa população, à exceção do STOP-Bang ≥6 em pacientes com AOS grave. O uso de uma medida fisiológica objetiva expressa pelo holter de oximetria foi útil para rastrear AOS em pacientes obesos. A MP apresentou acurácia aumentada, especialmente nos extremos de valores de IAH, com resultados comparáveis aos da PSG. A PSG poderia ser reservada apenas para confirmação diagnóstica em casos selecionados.
Introduction: Obesity is a growing public health problem and the main risk factor for sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) and nocturnal hypoventilation. Bariatric surgery has become an option for the treatment of significant obesity. Early detection of SDB preoperatively is essential, since these disorders are associated with an increased risk of perioperative complications. Several screening tools for SDB, with a more simplified approach than polysomnography (PSG), have been proposed in recent years, but not all of them have been evaluated in a population of obese patients. Objective: To determine ventilatory patterns in obese candidates for bariatric surgery and evaluate three SDB screening strategies in this population. Methods: Eligible participants were all patients aged ≥18 years with grade III (body mass index [BMI] ≥ 40kg/m2) or grade II (BMI ≥35 kg/m2) obesity and obesity-related comorbidities who were referred for evaluation for bariatric surgery. Exclusion criteria were heart disease and/or severe or decompensated pulmonary disease. Ninety-one patients were evaluated by three strategies: (1) Clinical (Epworth Sleepiness Scale and STOP-Bang questionnaire, Berlin questionnaire and Sleep Apnea Clinical Score [SACS] plus blood gas analysis [BGA]); (2) Oximetry (overnight Holter-oximeter monitoring and BGA); and (3) Portable (overnight portable monitoring and capnography). All tests were compared with the gold standard, PSG, for the diagnosis of OSA. Results: The sample consisted of 77 women (84.6%) with a mean (SD) age of 44.7 (11.5) years and BMI of 50.1 (8.2) kg/m2. The ventilatory patterns identified were snoring, isolated nocturnal hypoxemia, OSA, and nocturnal hypoventilation associated with OSA. Polysomnographic data showed OSA in 67 of 87 patients (77%), 26 with mild, 19 with moderate and 22 with severe disorder. Twenty patients (23%) had a diagnosis of snoring, and two of them also had isolated nocturnal hypoxemia without concomitant OSA or hypoventilation. Nocturnal hypoventilation associated with OSA was detected by capnography in one patient. In the Clinical Strategy, the best result was obtained with the STOP-Bang score ≥6 in patients with an apnea-hypopnea index (AHI) ≥30 (overall accuracy of 82.8%). In the Oximetry Strategy, the cutoff values with the highest sensitivity and specificity for AHI ≥5, ≥10, ≥15, and ≥30 were total recording time with peripheral oxygen saturation (SpO2)< 90% for at least 5 minutes, 3% oxygen desaturation index (ODI) ≥22 desaturations/hour of recording, and 4%ODI ≥10 and ≥15 desaturations/hour of recording. All areas under the curve (AUC) were above 0.850. For AHI ≥5, 4%ODI ≥10 had a sensitivity of 97%, specificity of 73.7%, positive predictive value of 92.8%, negative predictive value of 87.5%, and overall accuracy of 91.8%. In the Portable Strategy, the respiratory disturbance index (RDI) was a good predictor of OSA in various cutoff values of AHI (AUC of 0.952 to 0.995). The highest sensitivity and specificity were obtained at similar cutoff values for RDI and AHI, especially for AHI ≥10 and ≥30. The maximum overall accuracy was 93.9% for RDI ≥5, ≥10, and ≥30 in their corresponding AHI. Based on these results, combined strategies were tested consisting of the STOP-Bang score ≥6 combined with 4%ODI ≥10 or ≥15. The best balance between sensibility and specificity and the maximum accuracy were achieved with the strategy composed by STOP-Bang ≥6 and 4%ODI ≥15 in patients with severe OSA. Conclusions: The frequency of occurrence of SDB in obese individuals undergoing evaluation for bariatric surgery was high, and OSA was the most frequent occurrence. Currently available questionnaires were insufficient to screen for OSA in this population, with the exception for the STOP-Bang score ≥6 in patients with severe OSA. The use of an objective physiological measure, such as Holter-oximetry monitoring, was useful as a screening tool for OSA in obese patients. Portable monitoring showed increased accuracy, especially in extreme AHI values, with results comparable to those obtained with PSG. The PSG could be reserved only for certain cases where diagnostic confirmation is necessary.

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Cabré, Casares Noemí. "Assessing Diagnostic and Therapeutic Targets in Obesity-Associated Liver Diseases." Doctoral thesis, Universitat Rovira i Virgili, 2019. http://hdl.handle.net/10803/667718.

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Les alteracions hepàtiques, com la malaltia del fetge gras no alcohòlic (NAFLD) i l'esteatohepatitis no alcohòlica, o NASH, s'associen freqüentment amb l'obesitat. L'absència de marcadors no invasius per al diagnòstic de NASH dificulta la pràctica clínica i el desenvolupament de tractaments farmacològics. Per investigar els mecanismes moleculars d'aquestes alteracions i identificar les molècules que podrien usar-se com a possibles dianes terapèutiques, busquem marcadors biològics no invasius d'alteracions hepàtiques en pacients amb obesitat tipus III sotmesos a cirurgia bariàtrica (CB). En el nostre primer estudi, vam demostrar que la funció hepàtica millora significativament després de la CB a través de mecanismes que impliquen la reducció de l'estrès oxidatiu i els processos inflamatoris. En el segon estudi, mitjançant metabolòmica dirigida vam observar que els perfils plasmàtics van identificar connexions entre el metabolisme hepàtic i l'obesitat mòrbida. Els models combinats de mesuraments en plasma simples o aparellades de alpha-cetoglutarat, beta-hidroxibutirat, piruvat i oxalacetat van reduir la incertesa en el diagnòstic clínic de NASH i van predir la seva remissió. En el tercer estudi, es demostra que alpha-cetoglutarat és un metabòlit clau en l'homeòstasi energètica modulant el procés d’apoptosis en pacients amb NASH a través de l'activació de mTORC1. Després de la CB, la desregulació metabòlica i l'autofàgia compromesa en pacients amb NASH va ser restaurada per complet. L'activació d'AMPK en els hepatòcits va anul·lar l'efecte de l'activació de la glutaminolisis i promou l'ús d'inhibidors de mTORC1. Finalment, confirmem que els metabòlits poden promoure canvis epigenètics que afecten la metilació de l'ADN i les possibles modificacions post-traduccionals en els enzims que regulen el metabolisme energètic del fetge. L'estrès oxidatiu, la disfunció mitocondrial i la mort cel·lular estan implicats en la malaltia de la NAFLD mitjançant la reprogramació metabòlica. En conclusió, alpha-cetoglutarat podria ser un nou marcador biològic potencial i una estratègia terapèutica de NASH.
Las alteraciones hepáticas, como la enfermedad del hígado graso no alcohólico (NAFLD) y la esteatohepatitis no alcohólica, o NASH, se asocian frecuentemente con la obesidad. La ausencia de marcadores no invasivos para el diagnóstico de NASH dificulta la práctica clínica y el desarrollo de tratamientos farmacológicos. Para investigar los mecanismos moleculares de estas alteraciones e identificar las moléculas que podrían usarse como posibles dianas terapéuticas, buscamos marcadores biológicos no invasivos de alteraciones hepáticas en pacientes con obesidad tipo III sometidos a cirugía bariátrica (CB). En nuestro primer estudio, demostramos que la función hepática mejora significativamente después de la CB a través de mecanismos que implican la reducción del estrés oxidativo y los procesos inflamatorios. En el segundo estudio, mediante metabolómica dirigida observamos que los perfiles plasmáticos identificaron conexiones entre el metabolismo hepático humano y la obesidad mórbida. Los modelos combinados de mediciones en plasma simples o pareadas de alpha-cetoglutarato, beta-hidroxibutirato, piruvato y oxaloacetato redujeron la incertidumbre en el diagnóstico clínico de NASH y predijeron su remisión. En el tercer estudio, demostramos que alpha-cetoglutarato es un metabolito clave en la homeostasis energética modulando el proceso de apoptosis en pacientes con NASH a través de la activación de mTORC1. Después de la CB, la desregulación metabólica y la autofagia comprometida en pacientes con NASH fue restaurada por completo. La activación de AMPK en los hepatocitos anuló el efecto de la activación de la glutaminolisis y apoya el uso de inhibidores de mTORC1. Finalmente, confirmamos que los metabolitos pueden promover cambios epigenéticos que afectan la metilación del ADN y las posibles modificaciones postraduccionales en las enzimas que regulan el metabolismo energético del hígado. El estrés oxidativo, la disfunción mitocondrial y la muerte celular están implicados en la enfermedad de la NAFLD mediante la reprogramación metabólica. En conclusión, alpha-cetoglutarato podría ser un nuevo marcador biológico potencial y una estrategia terapéutica de NASH.
Hepatic alterations, such as non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are frequently associated with obesity. The absence of non-invasive markers for NASH diagnosis hampers clinical practice and the development of pharmacological treatments. In order to investigate the molecular mechanisms of these alterations and to identify molecules that could be used as potential therapeutic targets we search for noninvasive biomarkers of liver alterations in patients type III obesity undergoing bariatric surgery (BS). In our first study we showed that the liver function of patients with obesity are significantly improved after BS through mechanisms that involve the reduction of oxidative stress and inflammatory processes. In the second study we performed measurements in obese patients undergoing BS to identify specific metabolic patterns and to test the diagnostic ability to distinguish between patients with and without NASH. Targeted plasma metabolic profiles identified connections between liver metabolism and morbid obesity. Combined models of single or paired plasma measurements of alpha-ketoglutarate, beta-hydroxybutyrate, pyruvate and oxaloacetate reduced the uncertainty in clinical diagnosis of NASH and predicted NASH remission. In the third study we demonstrated that alpha-ketoglutarate is a key metabolite of energy homeostasis that modulates hepatocyte death in NASH patients through mammalian TORC1 (mTORC1). After BS, the mitochondrial oxidative metabolism and the autophagy-lysosomal function compromised in NASH patients, were also completely restored. AMPK activation in hepatocytes abrogated the effects of glutaminolysis supports the potential use of mTORC1 inhibitors. Finally, we confirm that metabolites may promote epigenetic changes affecting DNA methylation and likely post-translational modifications on enzymes regulating liver energy metabolism. Oxidative stress, mitochondrial dysfunction and cell death responses are implicated in NAFLD diseases via metabolic reprogramming. In conclusion, alpha-ketoglutarate could be a new potential biomarker and therapeutic strategy of NASH.

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Schäfer, Lisa, Anne Brauhardt, and Anja Hilbert. "Psychologische Diagnostik bei Kindern und Jugendlichen mit Adipositas." Universitätsbibliothek Leipzig, 2016. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-205811.

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Die Adipositas im Kindes- und Jugendalter geht mit einem erhöhten Risiko für psychische Komorbiditäten sowie psychosoziale Folgeprobleme einher, die den Verlauf und Erfolg einer Gewichtsreduktionsbehandlung beeinflussen können. Untersuchungen zeigen, dass vor allem Essprobleme und Essstörungen sowie affektive, Angst- und Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen mit der Adipositas assoziiert sind. Hinzu kommen psychosoziale Folgen wie gewichtsbezogene Stigmatisierung, negativer Selbstwert, erhöhte Körperunzufriedenheit und verringerte Lebensqualität. Darüber hinaus wurde ein Einfluss restriktiver Ernährungspraktiken auf die Adipositas beschrieben. Deshalb erscheint es ratsam, im Rahmen der Adipositastherapie eine umfassende psychologische Diagnostik durchzuführen. Um diese zu gewährleisten, wurden in einem Überblick wichtige und bewährte deutsche psychodiagnostische Instrumente dargestellt. Untersuchungen belegen dabei deren psychometrische Güte und legen Vergleichswerte vor. Eine Anwendung dieser Verfahren kann einer optimalen Therapieplanung sowie der Verlaufskontrolle dienen
Obesity in childhood and adolescence is accompanied by a greater risk of psychiatric co-morbidities and psychosocial consequences, which influence the course and outcome of weight reduction treatments. Investigations show that especially eating problems and eating disorders, as well as affective, anxiety, and attention-deficit/hyperactivity disorders are associated with obesity. In addition, psychosocial consequences, including weight-related teasing, lower self-esteem, increased body dissatisfaction, and lower quality of life have been reported. Furthermore, an influence of restrictive feeding practices on obesity has been described. Therefore, it appears advisable to conduct comprehensive psychological diagnostics within the scope of obesity treatment. To make this possible, the most important and well-established German psychological diagnostic instruments have been presented in an overview. Investigations have verified their psychometric quality and provided reference values. The use of these procedures will enable an optimal therapy planning, as well as the evaluation of obesity treatments

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Kulendran, Myutan. "Neurocognitive measures of impulsivity : explanatory, diagnostic and a prognostic role in obesity." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/24656.

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Obesity is a growing public health problem with multiple aetiological factors. Behavioural determinants are likely to be key contributors to obesity, with a need for applied research in this field. Recently the obesity has been compared to food addiction with the connotation that obese individuals are impulsive in their behaviour. Impulsivity is a trait that is closely linked to addiction and has been studied in personality, psychiatry and more recently in the neurocognitive arena. A conceptual review of the construct of impulsivity identified inhibitory control (SST) and temporal discounting (TD) as two key behavioural constructs universal to all the key fields of impulsivity research. A systematic review of the literature supported their use to profile participants based on their Body Mass Index. The validity of the tools were proven by endophenotyping participants (N=202) of both normal weight and those seeking weight loss intervention. Both measures could successfully differentiate between obese and normal weight adolescents (N=85). The SST was also prognostic for short-term weight reduction in adolescents attending a lifestyle intervention, with the TD being able to predict weight loss maintenance at 6 months. The tasks could not differentiate significantly between adults of different weights but the TD was able to predict weight reduction after surgery (N=90). The modifiability of obesity through neuronal dopamine pathways was supported by a randomised controlled trial testing neurocognitive enhancement agents (N=40) against a placebo (N=40) in normal weight adults. Weight was also controlled by a commitment intervention targeting automatic impulsive behaviours (N=27). These findings support an association between impulsivity, obesity and weight reduction. The experimental inferences have been described in terms of a novel interconnected neuronal network, which leaves itself open to testing using functional brain imaging.

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Delport, Darnielle. "The development and application of a polymerase chain reaction (PCR) based assay to determine the impact of genetic variation in South African patients diagnosed with depression." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86564.

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Thesis (MPath)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Major Depressive Disorder (MDD) is a severe debilitating medical condition that may lead to suicide. Due to a poor understanding of the biological mechanisms underlying the disease process therapeutic decisions are usually taken using a ‘trial and error’ approach. This is not ideal since many treatments do not work as expected for all individuals. Studies have shown that only half of MDD patients receive the appropriate treatment, whereas many patients have adverse response to anti-depressants. These may include weight gain and raised homocysteine levels that may further compromise the health status of MDD patients and may partly explain the link with cardiovascular disease. The objective of the study was to identify genetic risk factors interacting with environmental factors implicated in MDD that may be of relevance to the South African population. Polymorphisms in the MTHFR (677 C>T, rs1801133 and 1298 A>C, rs1801131), COMT (472G>A, rs4680), CYP2D6 (6937G>A, rs3892097), ASMT (24436 G>A, rs4446909) and SLC6A4 (43 bp ins/del, rs4795541) genes were genotyped in 86 MDD patients and 97 population-matched controls. The specific aims were 1) to analytically validate high throughput real-time polymerase chain reaction (RT-PCR) genotyping assays for the selected SNPs against direct sequencing as the gold standard for 2) possible integration into a pathology-supported genetic testing strategy aimed at improved clinical management of MDD. A total of 183 unrelated Caucasians participated in the study, including 69 females and 17 males with MDD and 57 female and 40 male controls without a personal and family medical history of overlapping stress/anxiety and depressive disorders. All study participants were genotyped for the six selected SNPs considered clinically useful based on international data. The allelic distribution of the SNPs, single or combined into a genotype risk score after counting their minor alleles, did not differ between MDD patients and controls. Homocysteine levels were determined and correlated with body mass index (BMI) and other variables known to influence these phenotypes. The folate score assessed with use of the study questionnaire was significantly lower in the patient group compared with controls (p=0.003) and correlated significantly with BMI, particularly in females (p=0.009). BMI was on average 8% higher in the MDD patients compared with controls (p=0.015) after adjustment for age and sex. The MTHFR rs1801133 677 T-allele was associated with a 14% increase in BMI in MDD patients but not controls (p=0.032), which in turn was associated with significantly increased homocysteine levels (p<0.05). The aims of the study were successfully achieved. Identification of the MTHFR rs1801133 677 T-allele reinforces the importance of adequate folate intake in the diet due to increased risk of obesity and depression found to be associated with low dietary intake. Evidence of shared genetic vulnerability for many chronic diseases and drug response mediated by the MTHFR 677 T-allele support the clinical relevance of this low-penetrance mutation.
AFRIKAANSE OPSOMMING: Major depressie (MD) is ‘n aftakelende siektetoestand wat tot selfdood kan lei. Onkunde oor die siekte se onderliggende biologiese meganismes lei dikwels tot ‘n lukrake terapeutiese benadering. Dit is ‘n onbevredigende situasie aangesien indiwidue verskillend reageer op die middels wat voorgeskryf word. Navorsing toon dat slegs ongeveer die helfte van MD pasiënte toepaslike behandeling kry, terwyl anti-depressante ‘n nadelige uitwerking het op baie pasiënte. Dit sluit massatoename en verhoogde homosisteïenvlakke in wat MD pasiënte se gesondheid bykomend nadelig kan beïnvloed en die verband met kardiovaskulêre siekte gedeeltelik kan verklaar. Hierdie studie poog om MD verwante genetiese risikofaktore en omgewingsfaktore wat mekaar beïnvloed en moontlik op die Suid Afrikaanse bevolking betrekking het, te identifiseer. Polimorfismes in die MTHFR (677 C>T, rs1801133 en 1298 A>C, rs1801131), COMT (472G>A, rs4680), CYP2D6 (6937G>A, rs3892097), ASMT (24436 G>A, rs4446909) en SLC6A4 (43 bp ins/del, rs4795541) gene is geanaliseer in 86 MD pasiënte en 97 kontroles geselekteer van dieselfde populasie. Die spesifieke doelwitte was om 1) hoë deurset direkte polimerase kettingreaksie (RT-PCR) genotiperingstoetse vir die 6 gekose polimorfismes met direkte volgordebepaling as maatstaf analities te valideer vir 2) moontlike insluiting in ‘n patologie-ondersteunde genetiese toetsstrategie met die oog op beter kliniese hantering van MD. Altesaam 183 Kaukasiërs het aan die studie deelgeneem. Die MD pasiënte het uit 69 vroue en 17 mans bestaan. Die kontroles (57 vroue en 40 mans) het geen mediese geskiedenis (persoonlik of familie) van oorvleuelende stress/angstigheid of depressie gehad nie. Gebaseer op internasionale data, is al die deelnemers vir die 6 gekose, potensieel klinies-bruikbare polimorfismes getoets. Die alleliese verspreiding van die polimorfismes enkel of gekombineer (uitgedruk as ‘n genotipe-risiko-syfer nadat minor allele getel is), was dieselfde in MD-pasiënte en kontroles. Homosisteïenvlakke is bepaal en gekorreleer met die liggaamsmassa-indeks (BMI) en ander veranderlikes wat bekend is vir hulle invloed op hierdie fenotipes. In teenstelling met die kontroles, was die folaat telling, soos bepaal met die studievraelys, betekenisvol laer in die pasiënte (p=0.003). Die korrelasie met die liggaamsmassa-indeks, spesifiek by vroue, was ook betekenisvol (p=0.009). Na aanpassings vir ouderdom en geslag, is gevind dat die liggaamsmassa-indeks gemiddeld 8% hoër was in die die MD pasiënte teenoor die kontroles. By MD-pasiënte, maar nie by die kontroles nie, is die MTHFR rs1801133 677 T-alleel geassosieer met ‘n 14% toename in liggaamsmassa-indeks (p=0.032), wat ook geassosieer was met betekenisvolle verhoogde homosisteïenvlakke (p<0.05). Die doelwitte van die studie is bereik. Identifisering van die MTHFR rs1801133 677 T-alleel beklemtoon hoe belangrik dit is om voldoende folaat in te neem, veral omdat ‘n verhoogde risiko vir vetsug en depressie met ‘n lae folaatinname in die diet geassosieer word. Die kliniese belang van die MTHFR 677 T-alleel word beklemtoon deur toenemende bewyse wat daarop dui dat gedeelde genetiese vatbaarheid vir ‘n verskeidenheid van kroniese siektes asook middelrespons aan bemiddeling deur hierdie lae penetrasie mutasie toegeskryf kan word.
Winetech
Technology for Human Resources and Industry Program (THRIP).

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17

Oudanonh, Thiphavone. "Progesterone receptor, obesity and prognosis in women diagnosed with estrogen receptor positive breast cancer." Master's thesis, Université Laval, 2020. http://hdl.handle.net/20.500.11794/67944.

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INTRODUCTION: Le pronostic du cancer du sein (CS) est délétère pour les femmes obèses comparé à celles de poids normal et pourrait dépendre du statut du récepteur de la progestérone (PR). L’objectif était d’examiner si l’association entre l’obésité et la mortalité varie selon le statut de PR chez les femmes avec un CS positif pour le récepteur d’estrogène (ER+). MÉTHODOLOGIE: Les 3747 femmes diagnostiquées au Centre des Maladies du Sein d’un CS ER+ non métastatique entre 1995 et 2010 étaient catégorisées selon l’indice de masse corporelle (IMC) (<18,5; 18,5-24,9; 25,0-29,9; ≥30,0 kg/m²) et le statut de PR (PR–; PR+). Les risques instantanés (HR) de mortalité globale et spécifique au CS et leur 95% intervalle de confiance (IC) étaient estimés par des modèles de Cox multivariés. L’effet modifiant de PR était évalué sur les échelles additive et multiplicative. RÉSULTATS: Après un suivi médian de 5,9 années, le risque de mortalité globale pour les femmes avec une tumeur PR– augmentait en moyenne par 2,76 (95%IC:1,40-4,91) pour celles de faible poids, 2,02 (95%IC:1,43-2,81) pour celles en surpoids et 2,51 (95%IC:1,67-3,65) pour celles obèses, comparé aux femmes de poids normal avec une tumeur PR+. Des augmentations similaires étaient observées pour la mortalité spécifique au CS. Les risques de mortalité étaient similaires pour les femmes avec une tumeur PR+, peu importe leur IMC. Le risque de mortalité globale était modifié positivement par le statut de PR sur l’échelle additive chez les femmes en surpoids et obèses, tandis que la mortalité spécifique au CS était modifiée positivement chez les femmes de faible poids. Des observations similaires ont été trouvées sur l’échelle multiplicative. CONCLUSION: Notre étude suggère que le risque de décès plus élevé chez les femmes de faible poids, en surpoids et obèses avec un CS ER+ pourrait être lié au statut de PR.
INTRODUCTION: Studies have shown that prognosis for breast cancer (BC) was worse for obese than normal weight women. This differential survival might depend on the progesterone receptor (PR) status of the tumor. Our objective was to examine whether the association between obesity and mortality varies by PR status among women with estrogen receptor positive (ER+) BC. METHODS: The 3747 women diagnosed at the Center of Breast Diseases with non metastatic invasive ER+ BC between 1995 and 2010 were included in the analyses, and classified according to the body mass index (BMI) (<18.5, 18.5-24.9, 25.0-29.9, ≥30.0 kg/m²) and tumor PR status (PR–, PR+). Hazard ratios (HR) for all-cause and BC-specific mortalities, and 95% confidence interval (95%CI) were estimated from multivariable Cox proportional hazards models. Effect modification was evaluated on the additive and multiplicative scales using relative excess risk due to interaction (RERI) and ratio of HR, respectively. RESULTS: After a median follow-up of 5.9 years, the risk of all-cause mortality was increased on average by 2.76 (95%CI: 1.40-4.91) for underweight women with PR– tumors, by 2.02 (95%CI: 1.43-2.81) for overweight women with PR– tumors and by 2.51 (95%CI:1.67-3.65) for obese women with PR– tumors compared to women with normal weight and PR+ tumors. Similar increased risks were observed for BC-specific mortality. Conversely, risks of mortality were similar for women with PR+ tumors, regardless of BMI. All-cause mortality was modified by PR status on the additive scale for overweight (RERI=0.85,95%CI: 0.18-1.52) and obese women (RERI=1.28, 95%CI: 0.31-2.25), whereas BC-specific mortality was modified for underweight women (RERI=3.57, 95%CI: 0.25-6.88). Similar observations were found on the multiplicative scale. CONCLUSION: Our study suggests that the higher risk of dying observed among underweight, overweight and obese women with ER+ BC could be related to the PR status of the tumor.

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Schäfer, Lisa, Anne Brauhardt, and Anja Hilbert. "Psychologische Diagnostik bei Kindern und Jugendlichen mit Adipositas: ein Überblick." Kinder- und Jugendmedizin (2015) 15, 4, S. 243-249, 2015. https://ul.qucosa.de/id/qucosa%3A14792.

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Die Adipositas im Kindes- und Jugendalter geht mit einem erhöhten Risiko für psychische Komorbiditäten sowie psychosoziale Folgeprobleme einher, die den Verlauf und Erfolg einer Gewichtsreduktionsbehandlung beeinflussen können. Untersuchungen zeigen, dass vor allem Essprobleme und Essstörungen sowie affektive, Angst- und Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen mit der Adipositas assoziiert sind. Hinzu kommen psychosoziale Folgen wie gewichtsbezogene Stigmatisierung, negativer Selbstwert, erhöhte Körperunzufriedenheit und verringerte Lebensqualität. Darüber hinaus wurde ein Einfluss restriktiver Ernährungspraktiken auf die Adipositas beschrieben. Deshalb erscheint es ratsam, im Rahmen der Adipositastherapie eine umfassende psychologische Diagnostik durchzuführen. Um diese zu gewährleisten, wurden in einem Überblick wichtige und bewährte deutsche psychodiagnostische Instrumente dargestellt. Untersuchungen belegen dabei deren psychometrische Güte und legen Vergleichswerte vor. Eine Anwendung dieser Verfahren kann einer optimalen Therapieplanung sowie der Verlaufskontrolle dienen.
Obesity in childhood and adolescence is accompanied by a greater risk of psychiatric co-morbidities and psychosocial consequences, which influence the course and outcome of weight reduction treatments. Investigations show that especially eating problems and eating disorders, as well as affective, anxiety, and attention-deficit/hyperactivity disorders are associated with obesity. In addition, psychosocial consequences, including weight-related teasing, lower self-esteem, increased body dissatisfaction, and lower quality of life have been reported. Furthermore, an influence of restrictive feeding practices on obesity has been described. Therefore, it appears advisable to conduct comprehensive psychological diagnostics within the scope of obesity treatment. To make this possible, the most important and well-established German psychological diagnostic instruments have been presented in an overview. Investigations have verified their psychometric quality and provided reference values. The use of these procedures will enable an optimal therapy planning, as well as the evaluation of obesity treatments.

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Lopes, Hugo Miguel de Sousa. "Diagnostic accuracy of CDC, IOTF and WHO criteria for obesity classification, in a Portuguese school-aged children population." Dissertação, Faculdade de Medicina da Universidade do Porto, 2011. http://hdl.handle.net/10216/62314.

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Lopes, Hugo Miguel de Sousa. "Diagnostic accuracy of CDC, IOTF and WHO criteria for obesity classification, in a Portuguese school-aged children population." Master's thesis, Faculdade de Medicina da Universidade do Porto, 2011. http://hdl.handle.net/10216/62314.

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Lima, Clelia. "Identifying patients at risk for obstructive sleep apnea in primary health care : can obesity in combination with other high-risk diagnoses be used for screening purposes?" Doctoral diss., University of Central Florida, 2011. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/4698.

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Obstructive sleep apnea (OSA) affects about 15 million adults in the United States, and is an independent risk factor for all-cause mortality. The under-diagnosing of OSA has been linked to the inadequate screening by primary care practitioners (PCPs). Existing screening tools are not widely used by PCPs possibly due to time constraints they experience as providers. This study demonstrates how common high-risk diagnoses (obesity, hypertension, diabetes mellitus type 2, dyslipidemia, arrhythmia, and coronary artery disease) can be used to help PCPs identify adult patients at risk for OSA. Unlike other screening tools, these diagnoses are easy to identify in a routine visit. This study was a retrospective chart review that used a random sample of 220 electronic health records. Seventy percent of the sample was positive for OSA, 69% had obesity, and 33% had two or more high-risk diagnoses. The setting of this study was six sleep centers located in five cities in Central Florida. Logistic regression was used to analyze the data to determine interaction among variables and odds ratios. The variables "obesity" and "two or more high-risk diagnoses" had significant effects on the likelihood of being diagnosed with OSA independently of each other (odds ratio of 4.2 and 4.3 respectively; p<.001). However, there was no significant interaction between these two variables (p=.56). The predictive value for an OSA diagnosis using "obesity" was 83%, and it was 88% using "two or more high-risk diagnoses." These findings argue for the use of high-risk diagnoses to identify patients at risk for OSA. PCPs are in an ideal position to increase the number of patients screened and treated for OSA because they routinely see patients with these diagnoses in their practices. Proper diagnosis and treatment of OSA has the potential to improve patients* outcomes and their quality of life.
D.N.P.
Doctorate
Nursing
College of Nursing
Nursing Practice DNP

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22

Davis, Lisa. "The effects of a high walnut and unsalted cashew nut diet on the antioxidant status of subjects with diagnosed metabolic syndrome / Lisa Davis." Thesis, North-West University, 2005. http://hdl.handle.net/10394/987.

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Motivation: Metabolic syndrome is a constellation of risk factors predisposing to coronary heart disease (CHD) and is classified as a "disease of modern civilization". Characteristics of the metabolic syndrome include abdominal obesity, increased triacylglycerol (TG) concentrations, increased small dense low-density lipoprotein(LDL) particles, decreased high-density lipoprotein cholesterol (HDL-C), hypertension, insulin resistance, inflammation, glucose intolerance and/or type 2 diabetes mellitus. Subjects with metabolic syndrome may be susceptible to oxidative stress due to their prolonged exposure to elevated glucose levels. A variety of natural antioxidants exists (e.g. glutathione, l3-carotene, vitamin C, polyphenols) that may prevent oxidative damage to biological structures. Nuts are rich sources of unsaturated fatty acids, protein, fibre, .micronutrients, phytochemicals and antioxidants. Duet o their high antioxidant content, it can, therefore, be speculated that nuts may play a role in the prevention of oxidative stress in subjects with the metabolic syndrome. Objective: - To investigate the effect of a high walnut and a high unsalted cashew nut diet on the antioxidant status of subjects with metabolic syndrome. Methods: Sixty eight subjects with diagnosed metabolic syndrome (according to the ATP III criteria) were recruited to take part in this parallel, randomized, controlled feeding trial. Subjects were mainly recruited from the North-West University, Potchefstroom Campus and surrounding areas. After a run-in period of three weeks during which the participants followed a prudent diet, subjects were randomly divided into three groups receiving either walnuts or cashew nuts (63- 108g/day)as part of a prudent diet, or continued with the prudent control diet. The intervention was followed for eight weeks. Fasting blood samples were taken at the beginning(after the three week run-in period) and at the end of the intervention. Antioxidant variables including oxygen radical absorbance capacity (ORAC), reduced glutathione (GSH)/oxidized glutathione (GSSG), diacron reactive oxygen metabolites (dRom) were measured at the beginning and the end of the intervention. C-reactive protein (CRP), fibrinogen and plasminogen activator-inhibitor activity (PAI-1a) were also measured as markers of inflammation. The antioxidant capacity and the polyphenol content of the diets and the walnuts and cashew nuts were determined at the end of the intervention. Results: A significant decrease in dRom and significant increases in GSSG, the redox status of glutathione (GSH/GSSG) and ORAC were observed in all three groups from baseline to end. GSH remained unchanged from baseline to end in all three groups. No significant differences in changes in dRom (p = 0.92), GSSG (p = 0.99), GSH/GSSG (p = 0.86), antioxidant capacity (p = 0.10) and GSH (p = 0.34) were observed from baseline to end between groups. The total polyphenol content of the walnut and control diets were similar and significantly higher than the cashew nut diet. The antioxidant capacity of the walnut and cashew nut diets showed a tendency to be higher than the control diet (p = 0.07 and p = 0.06 respectively). CRP, fibrinogen and PAI-1a concentrations did not differ significantly between groups. Conclusion No significant differences between the groups receiving walnuts, cashew nuts or no nuts were observed in GSH, GSSG, GSH/GSSG, dRom or ORAC. Therefore, there seems to be no beneficial effect of the inclusion of walnuts and cashew nuts in the diet on the antioxidant status of the participants.
Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2006.

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Tjaronda, Timothy Ngatangwe. "Effect of smoking and waist circumference on biochemical markers of oxidative stress in subjects with IGT and newly diagnosed diabetics from Bellville South, Western Cape, South Africa." Thesis, Cape Peninsula University of Technology, 2011. http://hdl.handle.net/20.500.11838/2241.

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Thesis (MTech (Biomedical Technology))--Cape Peninsula University of Technology, 2011.
Studies have shown that oxidative stress (OS) is a major pathological risk factor in various diseases, including type 2 diabetes mellitus (T2DM). Hyperglycemia independently is a generator of free radicals, hence increases the level of OS in T2DM subjects. The oxidation of LDL is suggested to play a significant role in the pathogenesis of macrovascular complications observed in diabetic patients. In subjects with hyperglycemia or normoglycemia we investigated the relationship between MDA-protein adducts, HNE-protein adducts and auto-antibodies against oxLDL, and cardiovascular profile as measured by hs- CRP. From an epidemiological study that screened a high risk urban population for diabetes using oral glucose tolerance test, 98 hyperglycaemie and 79 normoglycaemic individuals were selected for this study. Enzyme linked immuno-sorbent-assay methods were used to determine the levels of serum MDA-protein adducts, HNE-protein adducts or auto-antibodies against oxLDL. High sensitive CRP was measured by nephelometry.

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Neovius, Martin. "Diagnostic tests for adiposity and metabolic risk factors in adolescence : results from the Stockholm weight development study (Swedes) /." Stockholm : Karolinska institutet, 2005. http://diss.kib.ki.se/2005/91-7140-320-5/.

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Ottino, González Jonatan. "Overweight, Allostatic Load and Neuroimaging." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/666987.

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Overweight and stress interact in complex ways. Excess weight promotes chronic low-grade inflammatory states that can mobilise the hypothalamic-pituitary-adrenal (HPA) axis. HPA axis activation resulting from frequent stress situations can modify energy uptake and expenditure. Separately, both conditions have been linked to changes in brain integrity and executive performance. The organism adapts to situations of caloric surplus through boosting immune, neuroendocrine and cardiometabolic systems to restore energy homeostasis. The allostatic load model establishes that the cumulative effects of adapting to challenging scenarios may result in adverse health situations in the future. There is sufficient evidence to consider that a state of overweight is inherently linked to a higher chronic physiological stress, or allostatic load. Our hypothesis was that, independently of the effects of visceral adiposity, the aggregated effects of the biological alterations related to overweight would be enough detrimental to brain structure and executive functioning. Lean-to-obese volunteers aged 21 to 40 years were recruited from primary health care centres belonging to the Consorci Sanitari de Terrassa. Subjects underwent a medical and neuropsychological examination, as well as a magnetic resonance imaging acquisition at the Hospital Clínic de Barcelona. The allostatic load index consisted of the sum of several biomarkers representing physiological stress. Overweight subjects had a greater allostatic load than healthy weight participants. The allostatic load escalation was negatively correlated with the morphology of cortical areas and tracts known to be ascribed to circuits involved in cognitive control, reward-processing and the integration of visceral-sensory signalling. Finally, the intensification in this index correlated with worse cognitive flexibility.
El sobrepès i l'estrès interactuen de formes complexes. L'excés de pes promou estats inflamatoris crònics de baix grau que poden mobilitzar l'eix hipotalàmic-pituitari-adrenal (HPA). L'activació de l'eix HPA resultant de situacions d'estrès freqüents pot modificar la captació i la despesa d'energia. Les dues condicions s'han vinculat per separat a canvis en la integritat cerebral i l'acompliment executiu. L'organisme s'adapta a situacions de superàvit calòric a través de impulsar sistemes immunes, neuroendocrins i cardiometabòlics per restaurar l'homeòstasi energètica. El model de càrrega alostàtica estableix que els efectes acumulatius de l'adaptació a escenaris desafiadors poden resultar en situacions adverses per a la salut en el futur. Hi ha evidència suficient per a considerar que un estat de sobrepès està inherentment vinculat a un major estrès fisiològic crònic, o càrrega alostàtica. La nostra hipòtesi va ser que, independentment dels efectes de l'adipositat visceral, els efectes agregats de les alteracions biològiques relacionades amb l'excés de pes resultarien suficientment perjudicials per a la estructura cerebral i el funcionament executiu. Es van reclutar voluntaris amb normopès i sobrepès amb edats compreses entre els 21 i els 40 anys de centres d'atenció primària de salut pertanyents al Consorci Sanitari de Terrassa. Els subjectes es van sotmetre a un examen mèdic i neuropsicològic, així com a l'adquisició d'imatges per ressonància magnètica a l'Hospital Clínic de Barcelona. L'índex de càrrega alostàtica va consistir en la suma de diversos biomarcadors representant estrès fisiològic. Els subjectes amb sobrepès van presentar major càrrega alostàtica que els participants de pes saludable. L'escalada de càrrega alostàtica es va correlacionar negativament amb la morfologia d'àrees corticals i tractes coneguts per estar adscrits a circuits implicats en el control cognitiu, el processament de recompenses i la integració de la senyalització visceral-sensorial. Finalment, la intensificació en l'esmentat índex va correlacionar amb una pitjor flexibilitat cognitiva.
El sobrepeso y el estrés interactúan de formas complejas. El exceso de peso promueve estados inflamatorios crónicos de bajo grado que pueden movilizar el eje hipotalámico- pituitario-adrenal (HPA). La activación del eje HPA resultante de situaciones de estrés frecuentes puede modificar la captación y el gasto de energía. Ambas condiciones se han vinculado por separado a cambios en la integridad cerebral y el desempeño ejecutivo. El organismo se adapta a situaciones de superávit calórico a través de varias modificaciones fisiológicas. Esto incluye impulsar sistemas inmunes, neuroendocrinos y cardiometabólicos para restaurar la homeostasis energética. El modelo de carga alostática establece que los efectos acumulativos de la adaptación a escenarios desafiantes pueden resultar en situaciones adversas para la salud en el futuro. Existe evidencia suficiente para considerar que un estado de sobrepeso está inherentemente vinculado a un mayor estrés fisiológico crónico, o carga alostática. Nuestra hipótesis fue que, independientemente de los efectos de la adiposidad visceral, los efectos agregados de las alteraciones biológicas relacionadas con el sobrepeso resultarían suficientemente perjudiciales para la estructura cerebral y el funcionamiento ejecutivo. Se reclutaron voluntarios con normopeso y sobrepeso con edades comprendidas entre los 21 y los 40 años de centros de atención primaria de salud pertenecientes al Consorci Sanitari de Terrassa. Los sujetos se sometieron a un examen médico y neuropsicológico, así como a la adquisición de imágenes por resonancia magnética en el Hospital Clínic de Barcelona. El índice de carga alostática consistió en la suma de varios biomarcadores que representan estrés fisiológico. Los sujetos con sobrepeso presentaron mayor carga alostática que los participantes de peso saludable. La escalada de carga alostática se correlacionó negativamente con la morfología de áreas corticales y tractos conocidos por estar adscritos a circuitos implicados en el control cognitivo, el procesamiento de recompensas y la integración de la señalización visceral-sensorial. Finalmente, la intensificación en dicho índice correlacionó con una peor flexibilidad cognitiva.

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Medeville, Sophie. "Contribution à l'étude analytique et à l'utilisation pratique de quatre paramètres biochimiques d'actualité : HbA1c, fructosamine, microalbuminurie, uricémie." Bordeaux 2, 1991. http://www.theses.fr/1991BOR2P114.

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Eendebak, Robert. "The potential relationships between hormone biomarkers and functional and health outcomes of ageing." Thesis, University of Manchester, 2017. https://www.research.manchester.ac.uk/portal/en/theses/the-potential-relationships-between-hormone-biomarkers-and-functional-and-health-outcomes-of-ageing(e28321cc-703c-44df-99b4-fb0d76f7f429).html.

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Although the female menopause has been extensively characterized as a well-defined symptomatic state of oestrogen deficiency, which responds relatively well to oestrogen replacement therapy, the symptomatic state of androgen deficiency in men is poorly defined and uncertainty exists whether it responds to testosterone replacement. It has been proposed that hypothalamic-pituitary-testicular (HPT)-axis function (responsible for the production of androgens) and regulation could be viewed as a âbarometerâ of health status in older men and that potential alterations in HPT-axis function and regulation reflect subclinical and clinical deficits in function and health, which may result in an aged phenotype of human health and disease in older men. The HPT-axis constitutes a well-defined, tractable, clinically-relevant, biological system, which may permit insight into the mechanisms underlying the expression of ageing-related phenotypes of human health and disease. By using a different lens â such as the genetic background; the compensatory responses within the HPT-axis; the syndromes of androgen deficiency; the ethnic background of an individual or the life course trajectory of function and health from conception into older age â to magnify potential dysregulation in the HPT-axis will it be possible to visualize and understand the phenotypic expression of human male ageing as a gradient of functional and health outcomes. This will allow for a better understanding of the physiological mechanics underlying symptomatic expression of dysregulation in the HPT-axis.

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Lara-Castor, Laura. "Diagnosis of non-alcoholic fatty liver disease in obese adolescents using non-invasive methods." Thesis, 2017. https://hdl.handle.net/2144/20802.

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OBJECTIVE. To identify clinical, socio-demographic, dietary and biological markers to be used in a non-invasive and cost-effective clinical tool for screening for non-alcoholic fatty liver disease (NAFLD) in obese adolescents. METHODS. We conducted a cross-sectional analysis using baseline data from 77 obese adolescents enrolled in a drug trial for the Glaser Pediatric Research Network, between October 2003 and August 2007. NAFLD was defined as the presence of fatty liver infiltration assessed by computed tomography. Receiver operation characteristic (ROC) analyses were performed to identify variables with the highest area under the curve (AUC) for NAFLD. Serum biomarkers were dichotomized using sensitivity analyses to identify the best cutoff point for NAFLD. Multiple logistic regression models were created to predict prevalent NAFLD. RESULTS. Serum triglycerides was identified as the best biomarker for NAFLD (AUC 0.790; pseudo R2 0.235). Additional adjustment for sex, age and Tanner stage improved the AUC to 0.846 and the pseudo R2 to 0.290. We then explored adding a simple biochemical marker for predicting NAFLD (HOMA-B, ALT or glutamate) and found that HOMA-B led to greater improvement in AUC, ALT to a greater improvement in sensitivity and glutamate to a greater improvement in the pseudo R2. Thus, all three factors individually improved overall model performance to some degree and inclusion of all three led to an AUC=0.907 and pseudo R2=0.433. Our second objective was to develop a more complex exploratory model starting with the inclusion of important clinical predictors (triglycerides, sex, age, Tanner stage, SBP, BMI, waist circumference); this yielded an AUC of 0.871 and pseudo R2 of 0.342. Further adjustment for HOMA-B, ALT and glutamate gave an AUC=0.913 and pseudo R2=0.497. CONCLUSION. Simple clinical and biochemical factors may be used to screen for prevalent NAFLD. Our simplest clinically relevant model using triglycerides, age, sex and Tanner stage provided a reasonable screening tool for NAFLD in obese adolescents. A second more complex model that warrants further testing includes triglycerides, sex, age, Tanner stage, SPB, BMI, waist circumference, HOMA-B, ALT and glutamate. In this study, this model was more accurate for detecting undiagnosed cases of NAFLD in this pediatric population.

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Caligiuri, Stephanie. "Glomerulomegaly as an early marker of obesity-related glomerulopathy in the diet-induced obese experimental model and use of alpha-linolenic acid rich dietary oils for the treatment of disease and alteration of oxylipin profiles." 2012. http://hdl.handle.net/1993/8857.

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Obesity-related glomerulopathy (ORG) is an emerging epidemic for which an established model, diagnostic guidelines, and dietary treatments are absent. Oxylipins influence inflammation and hemodynamics, yet the renal oxylipin profile or the influence of dietary linoleic acid (LA) and alpha-linolenic acid (ALA) on their formation has yet to be examined. Therefore, obese-prone rats were provided high fat lard/soy diets to induce obesity and subsequently divided among 7 diets with varying LA and ALA levels. The diet-induced obese experimental model developed characteristics of ORG; morphology and histology revealed glomerulomegaly as an early diagnostic marker as it was the first pathological change and indicated further renal damage. Liquid chromatography-tandem mass spectrometry detected 30 oxylipins. Higher dietary ALA resulted in greater n-3 oxylipin levels and resulted in reduced progression of glomerulomegaly and glomerular damage. To conclude, ORG may be diagnosed earlier with glomerulomegaly and treated with dietary oils rich in ALA which alter the oxylipin profile.

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Chameroy, Kelly Ann. "Diagnosis and Management of Horses with Equine Metabolic Syndrome (EMS)." 2010. http://trace.tennessee.edu/utk_graddiss/871.

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In horses, a painful and often debilitating disease known as laminitis can result in impaired function and, in severe cases, euthanasia. Equine Metabolic Syndrome (EMS) is a syndrome in horses that results in development of laminitis and is characterized by the presence of general and/or regional adiposity (“cresty neck”), aberrations in blood lipid concentrations, insulin resistance (IR) and/ or hyperinsulinemia. Therapies have focused on improving the state of obesity and insulin resistance with the goal of diminishing the likelihood of laminitis development. A definitive cause for laminitis has not been established, but hyperinsulinemia and IR are likely candidates as experimental states of hyperinsulinemia have been shown to induce laminitis and improvements in insulin sensitivity and obesity have been associated with a decreased risk of laminitis development. This dissertation discusses associations between obesity and IR, as well as potential therapies for alleviating insulin resistance with the ultimate goal of decreasing the risk of developing laminitis. Therapies evaluated included chromium and magnesium, levothyroxine sodium, and metformin hydrochloride. Horses were treated with each supplement for 10 to 36 weeks, depending on the supplement tested, and physical measurements such as body weight, neck circumference, and body condition score were obtained. Throughout each study, blood concentrations of glucose, insulin, and plasma lipids were analyzed. Chromium and magnesium currently do not appear to have any effect on insulin sensitivity, whereas results of levothyroxine administration indicate therapeutic responses, as does metformin, though results indicate further work are required. Research contained in this dissertation focuses on the potential of identifying animals at risk of developing IR and laminitis through measurement of blood biomarkers such as adiponectin and glucagon-like peptide 1. Assays to measure markers included enzyme-linked immunosorbent assays, western blots, and radioimmunoassays. Glucagon-like peptide 1 currently does not appear to differ between healthy and IR animals, but protein band density of high-molecular weight adiponectin does appear to be lower in horses with IR when compared to healthy animals. There is still much to learn about IR in horses, and therapy appears to be dependent on a case by case basis.

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Blumenfeld, Nicole Rose. "Engineering technology for accessible precision therapeutics and diagnostics." Thesis, 2020. https://doi.org/10.7916/d8-jyep-z187.

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Over the last two decades, the concept of precision medicine has remained more of a promise than a reality. While there has been significant advancement in the field in terms of scientific discovery, precision medicine has yet to truly permeate standard clinical practice. There are a few individual examples, such as the treatment of breast cancer, in which the precision medicine approach has been ubiquitously adopted, but for most applications it remains exploratory. This barrier can arguably be attributed to the lack of accessible technology. That is, highly laborious, costly, and time-consuming methods that inhibit the integration of precision medicine techniques into the current clinical paradigm. In this dissertation, we aim to develop new technology, for both therapeutics and diagnostics, that would enable access to precision medicine by considering factors such as scalability, manufacturability, cost, turnaround time and integration. In Aim 1, we developed a direct tissue engineering approach to increase endogenous brown fat for the treatment of obesity. This method capitalized on the use of brown adipose tissue (BAT), a highly metabolic tissue that expends energy via uncoupled respiration and has been shown to correlate with a lean phenotype and decreased risk of metabolic disease. Existing methods that seek to increase BAT mass include either the use of pharmacologic agents, which often exhibit detrimental off-target effects, or cold exposure, which is obviously unsustainable in practice. Cell therapies that involve the isolation of adipocyte progenitor cells have also been explored but are not easily scaled and are difficult to implement. Here, we developed a method to convert a patient’s own white adipose tissue (WAT) en masse to thermogenic BAT in a single ex vivo step, followed by reimplantation back into the patient. We demonstrated that this method, called exBAT, was able to convert full fragments of WAT to a BAT-like tissue, which sustained its phenotype up to 8-weeks after reimplantation in a mouse model. Further, allogeneic transplantation of exBAT in a diet-induced obesity mouse model exhibited a trend toward weight loss which should further be explored with additional dosing experiments. This method is highly scalable, patient-specific, and easily implemented with current clinical practice and has the potential to provide a precise method to combat the growing challenge of obesity. In Aim 2, we shifted our focus to the development of a point-of-care (POC) diagnostic device for precision oncology. Here, we developed a device capable of performing a POC liquid biopsy for the detection of resistance mutations in non-small cell lung cancer (NSCLC). While liquid biopsies, which seek to identify tumor fragments in a patient’s blood, hold significant promise and advantages over traditional tissue biopsies, there are still several challenges including long turnaround time, high cost, and challenges with sensitivity. We sought to build a fully integrated device that can reduce the turnaround time for liquid biopsies from 2 weeks to one hour, enabling much higher throughput for important genotyping tests in NSCLC patients, and thereby enabling faster access to treatment. We demonstrated the ability to isolate plasma from undiluted whole blood at the POC, purify and concentrate circulating nucleic acids, and perform detection of low variant allelic frequency (VAF) mutations down to 1% in a microfluidic chip using a low-cost thermocycler. The device was initially designed to identify the presence or absence of T790M mutations, an important gatekeeper mutation with a clear clinical use case that confers sensitivity toward specific tyrosine kinase inhibitors (TKIs) in advanced NSCLC patients. However, the device can be easily extrapolated toward any type of molecular profiling and has the potential to significantly increase access to precision oncology diagnostics and therapeutics. Finally, in Aim 3, we sought to develop a molecular diagnostic for detection of SARS-CoV-2 that would provide a qualitative result in less than 15 minutes at the POC. As the COVID-19 pandemic has continued to spread rapidly throughout the world, there is still an unmet need for high-throughput, ultrafast diagnostics that are sensitive, specific and accessible to all. To meet this challenge, we developed a molecular diagnostic that performs RT-PCR off of crude lysate from patient specimens in 15 minutes or less. To achieve this, we built upon previously demonstrated photothermal amplification techniques and extended its capabilities to perform ultrafast RT-PCR using a low-power infrared LED. We also sought to integrate sample preparation methods for both nasopharyngeal (NP) swabs and saliva samples to eliminate the need for labor-intensive RNA extraction and enable full automation for POC testing. Testing of our device using purified SARS-CoV-2 RNA showed high sensitivity and a limit of detection down to 500 copies/mL. We also demonstrated preliminary results showing the ability to detect SARS-CoV-2 RNA in unpurified saliva and further testing of clinical specimens in the POC device is ongoing. With a significantly faster and low-cost test that maintains gold-standard sensitivity and specificity, this device has the potential to drastically increase testing throughput and help contain the spread of COVID-19. Underlying this work is the development of accessible technology for precision medicine. Aim 1 focuses on a simple, patient-specific tissue engineering approach to treating obesity, which is significantly more scalable than other cell and tissue engineering methods. Aim 2 demonstrates the ability to perform a highly sensitive liquid biopsy at the POC down to 1% VAF. Aim 3 demonstrates a new POC diagnostic for SARS-CoV-2 that provides a result in less than 15 minutes. Both Aims 2 and 3 focus on the development of POC diagnostics and were designed to be user-friendly, scalable, and easily integrated into current clinical paradigms. In Appendix I, we expand the discussion of POC diagnostics and present a design framework based on cost and budget constraints that was used for the development of these POC devices. Overall, the sum of this work illustrates examples of thoughtful engineering for the development of impactful new technologies for precision therapeutics and diagnostics.

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Sousa, Beatriz Ribeiro de. "Diagnóstico de insulinorresistência em crianças e adolescentes obesos." Master's thesis, 2018. http://hdl.handle.net/10316/82282.

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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
A prevalência da obesidade infantil e das suas comorbilidades tem aumentado significativamente nas últimas décadas. A insulinorresistência (IR) é uma comorbilidade comum e predispõe ao desenvolvimento de outras complicações metabólicas e cardiovasculares. Porém, a sua determinação na vigilância das crianças com obesidade não é consensual. Pretende-se com este trabalho descrever os diferentes métodos de diagnóstico da insulinorresistência identificando os mais adequados para uso na prática clínica em crianças e adolescentes com obesidade. Efetuou-se uma pesquisa bibliográfica entre 2007 e 2017, na base de dados da MedLine / Pubmed, e B-on com as seguintes palavras chave: insulin resistance, type 2 diabetes mellitus, childhood obesity, children, adolescents, diagnosis. Foram selecionados os artigos em português e inglês, com informação relevante para este estudo. Até ao momento, não existe uma definição universalmente aceite para insulinorresistência em crianças e adolescentes, pela inexistência de um método com características de rastreio ideal. O clamp euglicémico hiperinsulinémico (CEH) e o teste endovenoso de tolerância à glicose com amostras frequentes utilizando o modelo mínimo são os métodos mais aceites e validados para a população pediátrica; porém a sua complexidade e custo limitam a aplicação na prática clínica. O Homeostatic model assessment for insulin resistance (HOMA-IR) por apresentar melhor correlação com o CEH e pela facilidade de execução, é o método mais largamente utilizado no âmbito da investigação e da clínica. Contudo, não é consensual, já que não estão claramente definidos os seus valores de referência. Estão descritas ainda outras formas de avaliação de insulinorresistência, mas as suas desvantagens limitam a sua aplicabilidade.Face à inexistência atual de um método ideal e à falta de um tratamento específico, o rastreio da insulinorresistência em idade pediátrica não é recomendado. Porém, a identificação destacomorbilidade poderá ter interesse no reforço da adoção de medidas de estilo de vida como prevenção de futuras complicações cardiometabólicas.
The prevalence of childhood obesity and its complications has significantly increased over the last decades. Insulin resistance is a common comorbidity and predisposes to other metabolic and cardiovascular complications. The aim of this review is to describe the different methods to assess insulin resistance and to identify the most practical ones to clinical use in obese children and adolescents. A bibliographic research between 2007 and 2017 in MedLine/PUBMed and B-on data bases was performed, with the following key-words: insulin resistance, type 2 diabetes mellitus, childhood obesity, children, adolescents, diagnosis. All Portuguese and English articles with relevant information for this study were selected. To date, there is no universally accepted definition of insulin resistance, due to the absence of an ideal screening method. The hyperinsulinemic euglycemic clamp and the minimal model analysis of frequently sampled intravenous glucose tolerance test are considered the most validated methods for the pediatric population; however, their complexity and cost limit their use in clinical practice. The homeostatic model assessment for insulin resistance (HOMA-IR), having the highest correlation with the hyperinsulinemic euglycemic clamp and for his simple execution, is the most widely used method in investigation and clinical practice, although it’s not consensual, due to the lack of its reference values. Other methods of measurement for insulin resistance are described but their disadvantages limit their applicability.Based on the current absence of an ideal method and the lack of a specific treatment, screening for insulin resistance in the pediatric population is not recommended. However, the identification of this comorbidity can be used to increase the need for life-style interventions that prevent future cardiometabolic complications.

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Wagner, Nathan V. "DXA reference standards for percent body fat and lean body mass in adults." 2013. http://liblink.bsu.edu/uhtbin/catkey/1713809.

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Dual energy x-ray absorptiometry (DXA) provides accurate measurements of percent body fat (%BF) and lean body mass (LBM), however no reference standards currently exist using DXA-derived data. This study’s purpose was to develop reference data sets for DXA-derived %BF and LBM, and to characterize the agreement of obesity classifications between BMI (≥30 kg/m2) and %BF (≥25% for men and ≥30% for women). 2,761 subjects were scanned from 2003-2013 using either the GE Medical Systems Lunar Prodigy or Lunar iDXA. Normative reference tables displaying mean values and select percentiles were created for %BF and LBM across defined age groups for both genders. Mean %BF and LBM closely reflected data from the National Health and Nutrition Examination Survey across age groups in both genders. Agreements between BMI and %BF were 97% when identified as obese and 33% when identified as non-obese. Future research should consider creating a national registry for DXA-derived measurements.
School of Physical Education, Sport, and Exercise Science

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Neto, Dina Fernandes. "Fígado Gordo Não Alcoólico e Obesidade em idade pediátrica: Rastreio, Diagnóstico e Monitorização." Master's thesis, 2018. http://hdl.handle.net/10316/82138.

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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
Introdução: A frequência do fígado gordo não alcoólico (FGNA) tem evoluído paralelamente ao aumento da prevalência da obesidade em idade pediátrica, sendo atualmente a hepatopatia mais comum. Na maioria dos casos verifica-se apenas a presença de esteatose, podendo reverter, porém em alguns casos pode evoluir para esteatohepatite, fibrose e culminar com doença hepática em estadio terminal levando à necessidade de transplante hepático. A prevalência da obesidade infantil justifica a necessidade de identificação desta comorbilidade, e a sua monitorização.Objetivo: Analisar qual a melhor abordagem em termos de rastreio, diagnóstico e monitorização do FGNA em crianças e adolescentes com obesidade através de uma revisão da literatura.Materiais e métodos: Recolha de artigos nos motores de pesquisa Pubmed / Embase, Index – revistas médicas portuguesas, Clinical Evidence e Uptodate dos últimos 10 anos. Os critérios de inclusão adicionais foram estudos aplicados a humanos entre os 0 e os18 anos, nos idiomas português, inglês, espanhol e francês.Resultados: O mecanismo fisiopatológico e a história natural do FGNA nas crianças e nos adolescentes com obesidade não são ainda bem conhecidos. As formas mais utilizadas para o seu rastreio são o doseamento da alanina aminotransferase (ALT) e a ecografia abdominal convencional. Para o diagnóstico e sua monitorização, as diferentes técnicas de ressonância magnética (RM) são as que apresentam maior acuidade, no entanto a biópsia hepática continua a ser o gold-standard para o diagnóstico. Outros marcadores laboratoriais e genéticos, bem como as técnicas de ecografia quantitativa (avaliação do coeficiente de retrodispersão), elastografia transitória, elastografia por impulso de força de radiação acústica (acoustic radiation force impulse (ARFI) elastography), a RM com o cálculo da fração de gordura baseada na densidade de protões (proton density fat fraction (PDFF)), elastografia por RM e espectroscopia por RM, são apresentados como potencialmente úteis no auxílio ao diagnóstico e sua monitorização. As diferentes guidelines internacionais não são consensuais relativamente à vigilância do FGNA nas crianças e nos adolescentes com obesidade. Conclusão: A ALT e a ecografia abdominal convencional deverão constituir a abordagem inicial no estudo do FGNA, seguindo-se a confirmação do diagnóstico por RM ou biópsia hepática para estudo histológico. A monitorização poderá ser feita através da combinação de marcadores laboratoriais e diferentes técnicas ecográficas ou de RM. É unânime a necessidade de conseguir chegar a um consenso em relação à abordagem do FGNA, sendo necessários mais estudos que permitam não só um melhor conhecimento da sua história natural, como da aplicabilidade dos atuais e promissores meios complementares para rastreio, diagnóstico e monitorização.
Background: The frequency of nonalcoholic fatty liver disease (NAFLD) is evolving in a parallel with the increased prevalence of obesity in the pediatric age group and is currently the most common liver disease. In most cases, the presence of steatosis can be reversed, but in others can progress to steatohepatitis, fibrosis and culminate with terminal liver disease, leading to the need for liver transplantation. The prevalence of childhood obesity justifies the need to identify this comorbidity and its monitoring.Aim: To analyze the best approach on screening, diagnosis and monitoring of NAFLD in obese children and adolescents, through a literature review. Materials and methods: Collection of articles in databases Pubmed / Embase, Index – revistas médicas portuguesas, Clinical Evidence and Uptodate of the last 10 years. The additional inclusion criteria were studies applied to humans between 0 and 18 years old, written in Portuguese, English, Spanish and French.Results: The pathophysiological mechanism and the natural history of NAFLD in obese children and adolescents are not yet well understood. The most widely used methods for screening are alanine aminotransferase (ALT) assay and conventional abdominal ultrasound. For the diagnosis and monitoring, the different techniques of magnetic resonance (MR) have got greater acuity, however the liver biopsy remains the gold standard for the diagnosis. Other laboratory and genetic markers, as well as the quantitative ultrasound techniques (backscatter coefficient evaluation), transient elastography, acoustic radiation force impulse (ARFI) elastography, the MR Imaging with proton density fat fraction (PDFF), MR elastography and the MR spectroscopy, are presented as potentially useful to help on diagnosis and monitoring. The different international guidelines are not consensual regarding the surveillance of NAFLD in obese children and adolescents.Conclusion: ALT and conventional abdominal ultrasound should be an initial approach to NAFLD, that must be confirmed by MR techniques or biopsy for histological study. Monitoring can be done by combining laboratory markers and different ultrasound or MR techniques. It is unanimous the need of a consensus to NAFLD approach, and further studies are needed to allow a better understanding of its natural history, as well as the applicability of current and promising complementary methods for screening, diagnosis and monitoring.

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"The associations between obesity, dietary intake, lifestyle factors and immune status in newly diagnosed female breast cancer patients in Hong Kong." 2004. http://library.cuhk.edu.hk/record=b5896191.

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Tse Man.
Accompanying booklet titled: Dietary assessment food portion booklet.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2004.
Includes bibliographical references (leaves 101-122).
Abstracts in English and Chinese.
Acknowledgements --- p.i
Abstract --- p.ii
Abstract (Chinese version) --- p.iv
Table of contents --- p.vi
List of figures --- p.x
List of tables --- p.xi
List of abbreviations --- p.xiv
Chapter Chapter one: --- Introduction --- p.1
Breast cancer trends in Hong Kong --- p.1
Risk factors for breast cancer occurrence --- p.4
"Body weight, obesity, hormones and breast cancer" --- p.4
Evidence for postmenopausal women --- p.4
Evidence for premenopausal women --- p.6
Hormones and breast cancer --- p.7
Dietary factors: Foods and nutrients --- p.11
Animal foods and fats --- p.11
Dietary fats --- p.13
Other animal foods --- p.14
Fruit and vegetable intakes --- p.14
Positive family history --- p.15
Alcohol consumption and cigarette smoking --- p.15
Physical Activity --- p.17
"Cancer, obesity and immunity" --- p.17
Aims and scope of the study --- p.19
Chapter Chapter two: --- Methodology --- p.22
Questionnaires and their derivation --- p.22
Literature derivation of the questionnaires --- p.22
Pretest of the questionnaires --- p.25
Research ethics --- p.26
Subject recruitment --- p.26
Anthropometric measurements --- p.27
Interviews --- p.28
First interview --- p.28
Second and third telephone interviews --- p.29
Immunoassays --- p.30
Materials for immunoassays --- p.30
Immunophenotyping of cells --- p.30
MultiTEST´ёØ four-color direct immunofluorescence reagent kit --- p.32
Human tumor neurosis factor-alpha (TNF-α) Quantikine® high sensitivity enzyme-linked immunosorbent assay (ELISA) kit --- p.33
Methods for immunoassays --- p.33
Flow cytometric analysis --- p.34
TNF-α Quantikine® high sensitivity ELISA assay --- p.35
Data management --- p.35
Statistical methods --- p.35
Data analysis --- p.36
Dietary analysis --- p.36
Definition of weight status --- p.37
Measurements of immune cell levels --- p.37
Chapter Chapter three: --- Results --- p.39
Participation rate --- p.39
Characteristics of the patients --- p.40
Demographics --- p.40
Pregnancy and breast-feeding experiences --- p.42
Medical history --- p.43
Body weight and obesity status --- p.45
Dietary patterns --- p.46
Fat and oil removal habit when eating meat and poultry --- p.46
Perceived fat consumption --- p.46
Eating out habits --- p.47
Vegetarian diet adoption and food allergy or intolerance --- p.48
Cooking methods --- p.48
Alcohol consumption and supplementation habits --- p.50
Preferences and perceived amounts of consumption on food groups --- p.51
Cooking oils used at home --- p.52
Nutrient intake patterns from dietary recalls --- p.53
Soy intakes --- p.55
Meal locations --- p.55
Energy intakes by weight status --- p.56
Food group intakes by FFQ --- p.57
Food items not covered by FFQ --- p.62
Top ten fat and fiber contributors by FFQ --- p.63
Daily fruit and vegetable intakes by FFQ and 3 days' dietary recalls --- p.64
Correlation of FFQ and 3 days' dietary recalls by food group intakes --- p.64
Correlation of FFQ and 3 days' dietary recalls by fat and fiber intakes --- p.65
Fat and fiber intakes by weight status --- p.66
Other lifestyle patterns --- p.68
Exercise participation and smoking habits --- p.68
Daily activities' participation by weight status --- p.69
Immune status
Overview of general immune cell levels --- p.71
Immune status and BMI weight grouping --- p.72
Immune status and overweight --- p.74
Immune status and percent body fat --- p.76
Immune status and waist-hip ratio --- p.77
"Weight status, adiposity and immune status: summary" --- p.78
Immune status and protein intakes --- p.82
Immune status and fat intakes --- p.83
Immune status and fiber intake --- p.84
Immune status and vitamin C intake --- p.85
Immune status and menopausal status --- p.86
Chapter Chapter four: --- Discussion
Implications of findings --- p.88
Interpreting the Immune status of the subjects --- p.88
Lymphocyte and NK cell levels --- p.89
Regulatory T cell (Treg) levels --- p.89
TNF-α levels --- p.90
Immune status and nutrient intakes --- p.90
Typical dietary patterns of the subjects --- p.91
Physical activity patterns --- p.94
Weight status --- p.95
"Subjects' fat, fiber intakes and anthropometric measurements compared to previous research" --- p.96
Limitations of the study --- p.96
Future directions of research --- p.98
Chapter Chapter five: --- Conclusion --- p.99
References --- p.101
Appendices --- p.123
Chapter A1 --- Questionnaire (Chinese version) --- p.123
Chapter A2 --- Questionnaire (English version) --- p.138
Chapter B1 --- Food frequency questionnaire (Chinese version) --- p.153
Chapter B2 --- Food frequency questionnaire (English version) --- p.156
Chapter C --- Dietary assessment food portion booklet --- p.160
Chapter D1 --- 3 days dietary recall questionnaire (Chinese version) --- p.161
Chapter D2 --- 3 days dietary recall questionnaire (English version) --- p.174
Chapter El --- Consent form (Chinese version) --- p.187
Chapter E2 --- Consent form (English version) --- p.189
Chapter F --- Results of patient invitation to participate during recruitment period --- p.191

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Manyanga, Taruwona. "Is the change in Body Mass Index among youth newly diagnosed with type 1 diabetes mellitus associated with obesity at age 18?" 2014. http://hdl.handle.net/1993/24073.

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Abstract Background: Patients diagnosed with Type 1 diabetes mellitus (T1DM) require insulin therapy. Although necessary, insulin therapy is associated with an immediate increase in Body Mass Index (BMI). Excessive increase in BMI may lead to obesity, which is associated with both short and long-term negative health outcomes. The objective of this study was to determine whether weight change in the six months after diagnosis in children and adolescents with T1DM is related to obesity status at age 18. Methods: Data from the Diabetes Education Resource for Children and Adolescents database was used for this study. This unique database combines extensive clinical information on each patient with virtually universal coverage. The study population comprised all children 2-18 years old diagnosed with T1DM by DER-CA endocrinologists in Manitoba between 1997 and 2012 (N=377). BMI z- scores calculated from measured height and weight were used to classify BMI group membership using the 2000 Centers for Disease Control growth charts. Regression models were used to assess the association between change in BMI z-score six months after diagnosis, and BMI z-score at last visit prior to transfer to adult care. The models controlled for BMI z-score at diagnosis, sex, pubertal status and length of follow up. Additional stratified analyses examined sub-groups within the sample, to determine whether the effects were different for children with different characteristics (e.g. sex and pubertal status at diagnosis). Results: At diagnosis, 9% of the study cohort was underweight, 68% normal weight, 15% overweight and 8% obese. Most, (91%) but not all patients gained weight in the six months after T1DM diagnosis and initiation of insulin therapy. The pattern of weight change differed by BMI group at diagnosis, sex, and pubertal status. At last visit, average BMI z-scores for all groups of patients were above zero, and varied less than BMI z-scores at diagnosis. Results of the multivariate analytic model (adjusted R2= 0.56) show that BMI z-score at diagnosis was most important, followed by female sex, change in BMI z-score in the six months after diagnosis, the interaction between BMI z-score at diagnosis and change in BMI z-score in the six months after diagnosis, and duration of follow up. Conclusion: Results of this study demonstrate that patients’ BMI group, sex, and pubertal status at diagnosis influenced the pattern of their BMI z-score change in the six months after diagnosis, and thereafter. Diabetic care teams may need to monitor not only the amount of weight change in the period after T1DM diagnosis, but also consider BMI at diagnosis.

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Leisegang, Kristian. "The effect of insulin, leptin and inflammatory cytokines on reproductive health and hypogonadism in males diagnosed with the metabolic syndrome." 2013. http://hdl.handle.net/11394/3602.

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Philosophiae Doctor - PhD
The metabolic syndrome (MetS) is a collection of various metabolic, hormonal and immunological risk factors that cluster together, closely related to poorly understood phenomena such a hyperinsulinaemia (insulin resistance), hyperleptinaemia (leptin resistance), a low grade, systemic and chronic inflammation and, in males, hypogonadism. Infertility is increasing globally, and male factor infertility accounts for a large percentage of couples who are not able to conceive. The relationship between components of MetS and male reproductive health is not clear, and requires further investigation, as does the impact of MetS on male reproductive health in a case controlled study. The impact of hyperinsulinaemia, hyperleptinaemia and inflammatory cytokines on the male reproductive tract also requires investigation. Furthermore, it is hypothesised that these phenomena negatively impact steroidogenesis cascades. In order to investigate this, a case controlled study and TM3 Leydig cell culture experiments were designed.Participants were recruited from public advertisements, and screened for strict exclusion criteria, including acute or chronic inflammation, hormonal treatments, vasectomy and leukocytospermia (> 106/ml). Following clinical diagnostics, 78 males were either placed into a control group (CG) or the MetS group, with numerous parameters compared between them. Serum was assayed for routine risk markers including HDL cholesterol, triglycerides, glucose and C-reactive protein (CRP). Saliva was assayed for free testosterone and progesterone. Semen samples underwent semen analysis for ejaculation volume, sperm concentration and motility, vitality, morphology and leukocyte concentration, in addition to mitochondrial membrane potential (MMP) and DNA fragmentation (DF). Both serum and seminal fluid were further assayed for insulin, leptin, tumour necrosis factor-alpha (TNF ) and interleukins 1-beta (IL1 ), 6 (IL6) and 8 (IL8). Glucose was also assayed in seminal fluid. Separately, hCG stimulated TM3 Leydig cells were exposed to varying concentrations of insulin (0.01, 0.1, 1 & 10 pg/ml), TNF , IL1 , IL6 and IL8 (0.1, 1, 10 & 100 pg/ml) for 48 hours at optimal cell culture conditions. TM3 cell viability, protein concentration and testosterone and progesterone concentrations were assessed.XXII Results indicated that males in the MetS group (n=34) had significantly increased body mass index, waist circumference, blood pressure, triglycerides, glucose, and Creactive protein (CRP) with decreased HDL cholesterol, as compared to the CG. Furthermore, ejaculation volume, sperm concentration, total sperm count, progressive and total motility were significantly decreased in the MetS group, and sperm with abnormal MMP and DF were increased in this group. No difference was found for morphology. Serum and seminal insulin, leptin, TNF , IL1 , IL6 and IL8 were all significantly increased in the MetS group. Both testosterone and progesterone were also significantly decreased in the MetS group. Insulin increased testosterone and decreased progesterone in the TM3 cells. TNF , IL1 and IL6 all decreased testosterone and progesterone concentrations and TM3 cell viability. IL8 increased TM3 cell viability and decreased progesterone, will no effect on testosterone. These results suggest MetS is associated with decreased fertility potential in males. Furthermore, a significant increase in seminal insulin, leptin, TNF , IL1 , IL6 and IL8 suggests local reproductive tract inflammation in the absence of leukocytospermia. Strong correlations between serum and seminal insulin, leptin, TNF , IL1 , IL6 and IL8, as well as serum CRP, imply that these systemic phenomenons are related to the reproductive tract changes observed. Therefore, the underlying pathophysiology of MetS negatively affects male reproduction, in addition to general health and wellbeing. A decrease in progesterone and testosterone suggests a collapse in steroidogenesis cascades. Additionally, inflammation, increased leptin and insulin resistance likely contribute to this collapse in steroidogenesis based on TM3 cell culture experiments. These results provide novel avenues for further investigations.

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Monteiro, Ana Raquel dos Santos. "Effect of nonsurgical weight loss interventions in overweight or obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis." Master's thesis, 2019. http://hdl.handle.net/10316/89952.

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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
Introdução: A gonartrose é uma das causas mais comuns de incapacidade após a quarta década de vida, com a prevalência aumentando com a idade. O sobrepeso e a obesidade são fatores-chave para o desenvolvimento e progressão da gonartrose, o que justifica fortemente a recomendação de perda de peso nesses casos. No entanto, apenas alguns dos doentes que apresentam concomitantemente excesso de peso e gonartrose têm apoio na implementação de medidas para perder peso. É, pois, necessário clarificar o impacto de estratégias não-cirúrgicas de perda de peso nestes doentes.Objetivo: Avaliar os efeitos de medidas não-cirúrgicas para perda de peso ao nível da dor, incapacidade funcional e qualidade de vida em doentes com sobrepeso ou obesos diagnosticados com gonartrose.Métodos: Foram pesquisados ensaios clínicos randomizados (ECR) publicados até 21 de Novembro de 2018 nas bases de dados Cochrane, Pubmed, EMBASE e PEDro comparando intervenções conservadoras para perda de peso com intervenções de controle ativo ou inativo (cuidado usual, somente exercício, nenhuma intervenção). Dois revisores extraíram os dados de forma independente. Diferenças médias padronizadas (DMP) de estudos individuais foram agrupadas através de meta-análise para expressar o tamanho do efeito (TE) do tratamento. Foi avaliado o risco de viés para cada estudo e a qualidade dos resultados foi classificada seguindo a abordagem Grading of Recommendations, Assessment, Development and Evaluation (GRADE).Resultados: Foram identificados 11 ECR elegíveis para inclusão. Todos os ensaios incluídos apresentaram risco de viés pouco claro. A qualidade dos resultados foi de alta a muito baixa. Dados agrupados apoiaram o uso de medidas não-cirúrgicas para perda de peso para melhorar a incapacidade auto- referida (TE = 0,33, IC 95% 0,17 a 0,49; p < 0,001; evidência de alta qualidade), o desempenho no teste funcional de caminhada (TE = 0,16; IC 95% 0,01 a 0,31; p = 0,031; evidência de alta qualidade), a qualidade de vida física (TE = 0,33, IC 95% 0,18 a 0,48, p < 0,001, evidência de alta qualidade) e a gonalgia (TE = 0,52, 95% IC 0,25 a 0,80; p < 0,001; evidência de qualidade moderada). Não houve fortes evidências de que intervenções conservadoras para perder peso tenham efeito benéfico na qualidade de vida mental (p = 0,58; evidência de baixa qualidade) nem no teste de subir escadas (p = 0,19; evidência de qualidade muito baixa).Discussão/Conclusão: Evidência de alta qualidade sugere que as intervenções conservadoras para a perda de peso fornecem benefícios (embora modestos) quanto à incapacidade funcional (auto-referida e teste funcional da caminhada) e qualidade de vida física. Evidência de qualidade moderada suporta um efeito positivo notório na melhoria da gonalgia. São necessários mais ensaios clínicos bem estruturados que testem os efeitos de intervenções não-cirúrgicas de perda de peso, particularmente no teste funcional de subir escadas e na qualidade de vida mental, onde a evidência de melhoria não é clara.
Introduction: Knee osteoarthritis (OA) is found mostly in people over 45 years old and is one of the common causes of disability after the fourth decade of life, with prevalence increasing with age. Being overweight is a key ingredient for knee OA and obesity is an established risk factor for development and progression of knee OA. Therefore, clinical guidelines strongly recommend conservative weight loss as primary management of concomitant weight excess and knee osteoarthritis (OA). Despite those recommendations, only few overweight patients with knee OA have support for weight loss management and there is still a need to understand the most recent evidence of the impact of nonsurgical weight loss strategies in obese or overweight patients with knee OA.Objective: To assess the effects of nonsurgical weight loss interventions on pain, physical function and quality of life in overweight or obese patients diagnosed with knee OA.Methods: Cochrane Library, Pubmed, EMBASE and PEDro were searched for randomized controlled trials (RCTs) published prior to November 21, 2018. RCTs comparing nonsurgical (conservative) weight loss interventions with an active or inactive control intervention (usual care, only exercise, no intervention) were selected. Two review authors independently extracted data. Standardized mean differences (SMDs) of individual studies were pooled using both random and fixed-effects meta-analysis (depending on the existence or not of heterogeneity, respectively) to express treatment effect sizes (ES) from the end of the treatment. The Cochrane tool was used to assess risk of bias for each study and the quality of evidence across studies was evaluated following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.Results: We identified eleven RCTs eligible for inclusion. All included trials had unclear risk of bias as no strategies were reported to address the issue of incomplete blinding. The quality of evidence for outcomes, using GRADE approach, ranged from high to very low. Pooled data supported the use of nonsurgical weight loss intervention compared with control for improving knee pain (Effect Size (ES) = 0.52, 95% Confidence Intervals (CI) 0.25 to 0.80; p < 0.001; moderate quality evidence), self-reported disability (ES = 0.33, 95% CI 0.17 to 0.49; p < 0.001; high quality evidence), 6MWT (ES = 0.16; 95% CI 0.01 to 0.31; p = 0.031; high quality evidence) and physical quality of life (ES = 0.33, 95% CI 0.18 to 0.48; p < 0.001; high quality evidence). There was no strong evidence that the intervention has an effect in timed stair climb test performance (ES = 0.27, 95% CI -0.13 to 0.67; p = 0.19; very low quality evidence) neither in mental quality of life (ES = 0.05, 95% CI -0.12 to 0.21; p = 0.58; low quality evidence).Discussion/Conclusion: High-quality evidence suggests that nonsurgical weight loss interventions provide benefit, even though small, in terms of self-reported disability, performance on 6MWT and physical quality of life. Also, moderate quality evidence supports a moderate positive effect of weight reduction interventions in the improvement of knee pain. Further powered well-designed clinical trials testing the effects of nonsurgical weight loss interventions are required, particularly on timed stair climb test and mental quality of life, where evidence of improvement is unclear.

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Senecký, Petr. "Monitoring obezity u mužů středního věku v Hradci Králové." Master's thesis, 2015. http://www.nusl.cz/ntk/nusl-335835.

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Title: Obesity monitoring in middle aged men in Hradec Kralove Targets: The targets of thesis is to determine prevalence of the obesity in men at age 30 - 50 years in Hradec Kralove. The necessary data for this empirical research will be obtained on the basis of the questionnaires distributed among 30 active athletes and 30 pacients of prof. Martinik's diabetology office, who suffer from obesity and undergo treatment in his office. Subsequently, I will perform a deep analysis of all the data obtained from the questionnaries, in order to identify hazard factors for obesity, stress management, physical aktivity, fixed daily routine and life management or the prevalence of the genetic load in the group of surveyed athletes and surveyed obese patients of prof. Martiník's diabetology office. These data will be then compared in order to identifily the main differences between active athletes and obese patients. Methods: The empirical research was conducted at 30 randomly selected active athletes (at age 30 - 50 years), who live in Hradec Kralove and at 30 random patients (also at age 30 - 50 years) of prof. Martiník, who also live in Hradec Kralove and undergo medical treatment on the basis of the questionnaire, which I created myself and filled personally with the patients and athletes in order to...

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Dissertations / Theses on the topic 'Obesity – Diagnosis'

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