Tesi sul tema "Nutritional aspects"

The nutritional support in orthopedic surgery is an unclear idea to date. In these years, the goal of this project has been to clarify what is meant by nutritional support in patients undergoing hip or knee replacement and spine surgery, demonstrating its value in relation to the perioperative path. This aim was pursued by applying a methodology of first studying the literature, then analyzing the setting, evidencing shortcomings, proposing management protocols, and verifying the effectiveness of nutritional strategies. The literature search highlighted the multiple phases that should be coordinated, including prehabilitation, perioperative, and postdischarge management. When applying optimization strategies, such as anemia correction, it may be necessary to examine the eating behavior and anticipate the metabolic responses according to the patient’s state of health. The predictive potential of hemoglobin on the clinical outcome in spine surgery has been investigated through retrospective analysis of existing data, suggesting the need to refine decision-making algorithms that identify the patients to be treated, underlining the importance of having high hemoglobin values in the preoperative period to have more chances of clinical success. Prospective observational studies confirmed that patients either after spine surgery or arthroplasty do not meet their needs for what concerns energy and proteins. It seems to be vital to redefine the tactics to promote early oral nutrition, counteract the depletion of body reserves, and acknowledge the impairment of the olfactory stimulus caused by anesthetic drugs. More transparent information on diet and nutrition should be conveyed to patients. The nutritional support program might include a healthy eating education that teaches the concepts of nutritional value, quantity, quality, and timing. Clear information on what to eat or not to eat before surgery must be accompanied by dietary advice also for postoperative recovery. New management proposals can integrate aspects of healthy eating education into a multimodal approach that includes advice on increasing physical activity and promoting night sleep. A risk management system inspired by the hazard analysis and critical control points system can be effectively applied before orthopedic surgery to manage malnutrition. The interventional trials proved that nutrient deficiencies, including those of vitamin D and iron, are common in the surgical population. Dietary supplements should be carefully selected for what concerns the pharmaceutical formula, as well as for the content of important cofactors that may be necessary to boost the metabolic response. Early cardiovascular effects can derive from correcting hypovitaminosis D with a liquid form of vitamin D, and promising data on enhancing preoperative hemoglobin values can derive from using a supplement containing iron and B vitamins. The future of perioperative medicine in orthopedic surgery should choose a pragmatic integration of dietary and nutritional aspects in orthopedics, thus possibly improving health performance and patient experience.

The present study was performed to determine whether ongoing oxidative stress in some BPD infants contributes to their increased energy expenditure leading to growth failure. The study consisted of two parts. The first is a descriptive census of BPD infants (n = 38) followed at the outpatient clinics at The Montreal Children's Hospital (MCH). The second is a cross-sectional study of fifteen patients wherein anthropometric parameters, energy intake, and oxidative stress measures (red cell glutathione (GSH) and plasma malondialdehyde (MDA)) were assessed. Nine infants with growth failure were compared to six thriving infants with respect to their nutritional and oxidative stress status. Growth failure was defined as weight for age and weight for height for age less than the tenth percentile (z score $ leq - 1).$ Results revealed that the prevalence of growth failure in the BPD infants followed at MCH ranged between 45% and 55%. The mean ($ pm$ SD) energy intakes for thriving and failing to thrive infants expressed as a percent of the recommended nutrient intake were 104 $ pm$ 46% and 133 $ pm$ 35% respectively. Six infants had reduced mean ($ pm$ SD) blood glutathione per hemoglobin (3.63 $ pm$ 0.37 umol/g) compared to adult controls (6.57 $ pm$ 1.04 umol/g). Four of the six infants had growth failure while two were thriving. Fourteen Infants including all failing to thrive infants had elevated mean ($ pm$ SD) plasma MDA levels compared to adult controls (129 $ pm$ 48 vs 55 $ pm$ 3 nmol/l). Differences in oxidative stress markers were not observed between the two groups. These results suggest that growth failure is associated with an increase in caloric consumption and not with a decrease in caloric intake. The preliminary findings on oxidative stress markers suggest a depletion of the GSH antioxidant in some infants and marked lipid peroxidation in the BPD population.

Il formaggio sta dimostrando possedere, oltre alle caratteristiche nutrizionali classiche, degli aspetti nutrizionali innovati derivanti dalle proprietà di peptidi bioattivi contenuti nella frazione proteica caseinica del formaggio e rilasciati in seguito a proteolisi, ed ancora dalle proprietà di acidi grassi insaturi, quale l’acido linoleico coniugato. L’obiettivo di tale studio di dottorato è stato indagare su questi aspetti nutrizionali innovativi in formaggi tipici italiani quali Grana Padano e TrentinGrana, che pur essendo due formaggi molto simili tra loro, differiscono per l’uso della molecola antibatterica lisozima solo per la produzione del Grana Padano. Simulazioni in vitro della digestione gastrointestinale, nei campioni dei due formaggi a diversi tempi di stagionatura, ha dimostrato che esiste una relazione positiva tra tempo di stagionatura e digeribilità del calcio nel Grana Padano ,quando vengono considerati nella correlazione i risultati dei campioni con stagionatura superiore ai 24 mesi. A tempi di stagionatura inferiori a 24 mesi, i risultati di digeribilità del calcio del Grana Padano sono dispersi come appare nei campioni di TrentinGrana analizzati. Inoltre l’analisi RP-HPLC della distribuzione molecolare degli oligopeptidi dei campioni dei due formaggi, dimostra che la frazione peptidica coinvolta nel legame del calcio e quindi nel suo assorbimento, è quella compresa tra 1000 e 1500 D, e che l’analisi Seldi ha rilevato essere quella dei peptidi attivi fosfocaseinici. Inoltre differenze tra i due formaggi con e senza lisozima, appaiono solo per campioni tra 15 e 20 mesi di stagionatura, in cui campioni di formaggio senza lisozima appaiono più idrolizzati di quelli che lo contengono. Quindi dai risultati ottenuti appare che le differenze del profilo peptidico apportate dal lisozima non modificano le proprietà dei fosfopeptidi di assorbimento del calcio, forse influenzate da altri fattori che intervengono nella produzione del formaggio. L’attività ACE-inibitoria di abbassamento della pressione arteriosa esercitata da peptidi bioattivi è stata testata nei due formaggi, dimostrando che né il tempo di stagionatura e il grado di proteolisi, né il lisozima sono correlati all’attività ACE-inibitoria. Ed infine per l’importante ruolo che ha il minerale calcio nella dieta, indici di digeribilità del minerale in diversi alimenti sono stati considerati, in modo da poter formulare in maniera corretta diete alimentari coprendo il fabbisogno giornaliero con l’adeguato apporto energetico. I formaggi hanno dimostrato possedere indici di digeribilità del calcio superiori ad altri alimenti vegetali o a base di soia. In particolare il valore di digeribilità del Calcio del Grana Padano calcolato in vitro ha confermato il valore ottenuto in vivo , pari a 80%.
This study aimed to investigate about the not common known nutritional aspects of cheeses, which derive from their chemical components. In fact, in addition to the supply of macronutrient, cheeses are gaining interest as a source of bioactive peptides, of conjugated linoleic acid or for the new insight in the metabolic role of calcium. In vitro simulation of human gastrointestinal digestion revealed that cheeses have an higher digestibility of calcium than other foods, because of their casein-derived bioactive phosphopetides (CPPs) content has the ability to carry calcium minerals and avoid calcium precipitation, making it available for intestinal absorption. The in vitro calcium digestibility was calculated for different foods- cheeses, soya based foods and vegetables- to correct cover calcium requirements with an equilibrate energy intake. Calcium digestibility was also assessed in different ripened time Italian locally produced, semi fat, hard cheeses, Grana Padano and TrentinGrana. The main difference between them is the use or not of lysozyme during manufacturing. In Grana Padano samples, produced using lysozyme, there is a positive relationship between aging and dCa (r2 = 0.27; P<0.05) when sample > 24 months aged are considered (Grana Padano dCa results of samples less 24 months aged are quite widespread) , while in TrentinGrana, produced without the use of lysozyme, no significant correlation has been detected. RP-HPLC distribution analysis of oligopeptides molecular weight of these cheese showed that the only difference between them is that cheeses without lyzozyme, aged between 15 and 20 months, are more hydrolyzed than the same ripened time Grana Padano samples. Moreover the fraction of oligopeptides involved in calcium binding ranges between 1000 and 1500 D. SELDI analysis confirmed CPPs presence in this range. Therefore changes in cheese peptidic profiles probably caused by the use of lysozyme do not influence calcium digestibility because according to this study there is not a connection between change in peptidic profile and calcium digestibility results. The difference in calcium digestibility in Grana Padano samples aged over 24 month results should be probably ascribed also to the influence of other factors occurring during cheese manufacturing. Moreover, ACE-inhibitory activity of bioactive peptides was tested on in vitro digested Grana Padano and TrentinGrana samples with different ripening times. Correlation was not found between ACE-inhibitory activity and proteolysis level in different ripened time samples nor the lysozyme influence in releasing ACE-inhibitory bioactive peptides.

Il formaggio sta dimostrando possedere, oltre alle caratteristiche nutrizionali classiche, degli aspetti nutrizionali innovati derivanti dalle proprietà di peptidi bioattivi contenuti nella frazione proteica caseinica del formaggio e rilasciati in seguito a proteolisi, ed ancora dalle proprietà di acidi grassi insaturi, quale l’acido linoleico coniugato. L’obiettivo di tale studio di dottorato è stato indagare su questi aspetti nutrizionali innovativi in formaggi tipici italiani quali Grana Padano e TrentinGrana, che pur essendo due formaggi molto simili tra loro, differiscono per l’uso della molecola antibatterica lisozima solo per la produzione del Grana Padano. Simulazioni in vitro della digestione gastrointestinale, nei campioni dei due formaggi a diversi tempi di stagionatura, ha dimostrato che esiste una relazione positiva tra tempo di stagionatura e digeribilità del calcio nel Grana Padano ,quando vengono considerati nella correlazione i risultati dei campioni con stagionatura superiore ai 24 mesi. A tempi di stagionatura inferiori a 24 mesi, i risultati di digeribilità del calcio del Grana Padano sono dispersi come appare nei campioni di TrentinGrana analizzati. Inoltre l’analisi RP-HPLC della distribuzione molecolare degli oligopeptidi dei campioni dei due formaggi, dimostra che la frazione peptidica coinvolta nel legame del calcio e quindi nel suo assorbimento, è quella compresa tra 1000 e 1500 D, e che l’analisi Seldi ha rilevato essere quella dei peptidi attivi fosfocaseinici. Inoltre differenze tra i due formaggi con e senza lisozima, appaiono solo per campioni tra 15 e 20 mesi di stagionatura, in cui campioni di formaggio senza lisozima appaiono più idrolizzati di quelli che lo contengono. Quindi dai risultati ottenuti appare che le differenze del profilo peptidico apportate dal lisozima non modificano le proprietà dei fosfopeptidi di assorbimento del calcio, forse influenzate da altri fattori che intervengono nella produzione del formaggio. L’attività ACE-inibitoria di abbassamento della pressione arteriosa esercitata da peptidi bioattivi è stata testata nei due formaggi, dimostrando che né il tempo di stagionatura e il grado di proteolisi, né il lisozima sono correlati all’attività ACE-inibitoria. Ed infine per l’importante ruolo che ha il minerale calcio nella dieta, indici di digeribilità del minerale in diversi alimenti sono stati considerati, in modo da poter formulare in maniera corretta diete alimentari coprendo il fabbisogno giornaliero con l’adeguato apporto energetico. I formaggi hanno dimostrato possedere indici di digeribilità del calcio superiori ad altri alimenti vegetali o a base di soia. In particolare il valore di digeribilità del Calcio del Grana Padano calcolato in vitro ha confermato il valore ottenuto in vivo , pari a 80%.
This study aimed to investigate about the not common known nutritional aspects of cheeses, which derive from their chemical components. In fact, in addition to the supply of macronutrient, cheeses are gaining interest as a source of bioactive peptides, of conjugated linoleic acid or for the new insight in the metabolic role of calcium. In vitro simulation of human gastrointestinal digestion revealed that cheeses have an higher digestibility of calcium than other foods, because of their casein-derived bioactive phosphopetides (CPPs) content has the ability to carry calcium minerals and avoid calcium precipitation, making it available for intestinal absorption. The in vitro calcium digestibility was calculated for different foods- cheeses, soya based foods and vegetables- to correct cover calcium requirements with an equilibrate energy intake. Calcium digestibility was also assessed in different ripened time Italian locally produced, semi fat, hard cheeses, Grana Padano and TrentinGrana. The main difference between them is the use or not of lysozyme during manufacturing. In Grana Padano samples, produced using lysozyme, there is a positive relationship between aging and dCa (r2 = 0.27; P<0.05) when sample > 24 months aged are considered (Grana Padano dCa results of samples less 24 months aged are quite widespread) , while in TrentinGrana, produced without the use of lysozyme, no significant correlation has been detected. RP-HPLC distribution analysis of oligopeptides molecular weight of these cheese showed that the only difference between them is that cheeses without lyzozyme, aged between 15 and 20 months, are more hydrolyzed than the same ripened time Grana Padano samples. Moreover the fraction of oligopeptides involved in calcium binding ranges between 1000 and 1500 D. SELDI analysis confirmed CPPs presence in this range. Therefore changes in cheese peptidic profiles probably caused by the use of lysozyme do not influence calcium digestibility because according to this study there is not a connection between change in peptidic profile and calcium digestibility results. The difference in calcium digestibility in Grana Padano samples aged over 24 month results should be probably ascribed also to the influence of other factors occurring during cheese manufacturing. Moreover, ACE-inhibitory activity of bioactive peptides was tested on in vitro digested Grana Padano and TrentinGrana samples with different ripening times. Correlation was not found between ACE-inhibitory activity and proteolysis level in different ripened time samples nor the lysozyme influence in releasing ACE-inhibitory bioactive peptides.

Il magnesio (Mg), nella sua forma biologicamente attiva di catione, è un micronutriente essenziale per la vita. Circa il 25% del Mg totale dell’organismo si trova nel muscolo scheletrico, dove è fondamentale per il rilassamento delle fibre. Una corretta assunzione di Mg con la dieta è associata a salute muscolare e a un ridotto rischio di sarcopenia. Nei paesi occidentali si registra un elevato rischio di ipomagnesemia cronica ma questo deficit nutrizionale è largamente sottostimato e il suo impatto a livello delle cellule muscolari non è ben caratterizzato. Inoltre, non è chiaro il suo contributo nella patogenesi della sarcopenia. A questo scopo, in questo lavoro sono stati utilizzati modelli di ipomagnesemia sia in vivo che in vitro. Topi nutriti per due settimane con una dieta povera di Mg hanno mostrato a livello muscolare una significativa rimodulazione dell’espressione di geni coinvolti nella rigenerazione delle fibre, nel catabolismo delle proteine, nelle dinamiche mitocondriali e nel metabolismo sia glucidico che lipidico. Questi aspetti sono stati confermati e approfonditi in vitro su mioblasti C2C12. Nel corso della miogenesi, è stata osservata una modulazione sia del livello intracellulare di Mg che dell’espressione proteica di suoi trasportatori di membrana, tra cui TRPM7, MagT1 e SLC41A1. Inoltre concentrazioni extracellulari non fisiologiche di Mg influiscono sulla capacità dei mioblasti di fondersi tra loro e, di conseguenza, provocano un difetto in miogenesi. In particolare questo danno è risultato essere connesso alla eccessiva produzione di specie reattive dell’ossigeno in condizioni di Mg non fisiologiche. Esponendo miotubi differenziati a basse concentrazioni di Mg, sono stati osservati cambiamenti morfologici, una compromissione dell’autofagia e alterazioni del metabolismo energetico. In particolare, una riduzione del livello di Mg intracellulare porta a una riduzione della glicolisi e un aumento dell’ossidazione degli acidi grassi, con conseguente diminuzione delle riserve di lipidi neutri. Questo adattamento metabolico è accompagnato anche da variazioni nell’espressione delle proteine contrattili. Tutte queste risposte metaboliche osservate in cellule esposte a basso Mg sono risultate connesse ad un significativo aumento della sintesi di ossido nitrico, una molecola segnale in grado di modulare l’attività di proteine target e di contribuire allo stress ossidativo. In conclusione, un deficit di Mg esercita un significativo impatto sulla fisiologia del muscolo scheletrico e gli effetti osservati sono sovrapponibili a caratteristiche tipiche della sarcopenia. Ciò suggerisce che alterazioni dell’omeostasi del Mg contribuiscano attivamente all’invecchiamento delle fibre muscolari.
Magnesium (Mg) is a micronutrient essential to all vital processes and a quarter of body Mg is located in skeletal muscles where it is essential for fibers relaxation. It is widely known that a correct dietary Mg intake is associated to healthy skeletal muscles and to a reduced risk to develop sarcopenia. In western countries a latent risk of Mg deficiency is evident but this electrolyte imbalance is largely underestimated. Moreover, very little is known about the impact of Mg deficiency on skeletal muscle at the cellular and molecular levels and about its contribution in developing a sarcopenic and aged phenotype. With this aim, both in vivo and in vitro models of Mg deficiency were used. Mice fed two weeks with low Mg diets show a reduction in magnesemia and intramyocellular Mg content, which influences the expression of genes involved in muscle regeneration, protein catabolism, mitochondria dynamics, carbohydrates and lipids metabolism. To deeper investigate these pathways modulated by a low Mg status, in vitro experiments were performed on C2C12 myoblasts, both during myogenesis and on differentiated myotubes. New insights into the role of Mg during the myogenic process emerged. An interesting modulation of intracellular Mg content was observed during myogenesis and a coherent fluctuation in the levels of the Mg transporters TRPM7, MagT1 and SLC41A1 was found. Moreover, variations in extracellular Mg concentration impact on myoblasts fusion capacity and hence of the myogenic process in a ROS-dependent manner. C2C12-derived myotubes exposed to low Mg concentrations showed a reduced thickness, a compromised autophagic process and alterations in energy metabolism. Mg deficiency induced alterations of glucose metabolism and an increased fatty acids oxidation rate, with a consequent reduction of intracellular neutral lipids stores. This metabolic adaptation is accompanied by changes in the expression of contractile proteins and to a fast-to-slow phenotypic shift of the fibers. All these metabolic responses were found connected to the low Mg-dependent overproduction of nitric oxide which is able to modulate the activity of several target proteins and contribute to oxidative stress. Overall, Mg deficiency significantly impacts on skeletal muscle physiology and its effects overlap with typical features of a sarcopenic phenotype, thus suggesting that alterations in intramyocellular Mg status contribute to skeletal muscle aging.

Thesis (MNutr)--Stellenbosch University, 2011.
ENGLISH ABSTRACT: Background: The role of antioxidants and adequate nutrition in the prevention and course of cancer treatment is globally recognised in nullifying the effects of free radicals and increasing the nutritional status of children during treatment. Objective: To investigate whether children with cancer meet their Dietary Reference Values and Safe Intakes for antioxidants, energy and protein. Design: Single centre prospective study. Setting: Children were recruited from the East of England Primary Treatment Centre using convenience sampling over 8 months. Forty-two children and adolescents diagnosed with a Solid tumour, Lymphoma or Leukaemia were eligible for data analysis (n=20 male; n=22 female). Method: Data was collected with an Estimated Food Record (EFR) in the 1st (EFR1) and 3rd month (EFR2) post-diagnosis. In the week following EFR completion, parents and/or children were contacted to complete four non-consecutive days of 24-hr food recalls. Data was categorised into diet alone, diet + food supplement (FS), tube feeding (tube) or diet + multi-vitamin-mineral supplementation (VMS). Malnutrition was determined by weight-for-age z-scores. Nutrient intake was compared to the Recommended Nutrient Intake (RNI), the Estimated Average Requirements (EAR) and the Lower Recommended Nutrient Intake (LRNI). Result: The sample consisted of 33% (n=14) diagnosed with Leukaemia, 24% (n=10) with Lymphoma and 43% (n=18) with Solid tumours. Sixty seven percent (n=28) underwent chemotherapy and 33% (n=14) a combination of therapies. Significant correlations were seen between the assessment tools in the diet alone category for both months for; vitamins A, C, E, selenium and protein and for EFR1 for zinc and energy. In both months greater numbers of children achieved ≥100% of requirements for diet + VMS (EFR 1; p<0.05; EFR2 p<0.05) than for other feeding modes. Vitamin C achieved the highest intakes compared to the RNI at 773% (EFR1) and 829% (EFR2). Intakes above 200% of the RNI were seen for vitamins A, C, E, selenium and zinc. No significant differences were seen between modes of feeding in either month for selenium or zinc. Vitamin A (EFR1≤ 100% diet alone p<0.05) and zinc (EFR1≤ 100% diet alone p=0.02) met the least of the LRNI in the 1st month compared to other antioxidants. No statistical significant difference was observed between the number of children attaining their EAR’s between the 3 modes of feeding in the 1st month and 3rd month. In the 1st month 27% (n=8) of participants consumed vitamin and/or mineral supplements, 18% in the 3rd month (n=4). In the 1st month 5% (n=2) of children were moderately malnourished and 10% (n=4) in 3rd month. Conversely in the 1st month 3% (n=1) were overweight and 3% (n=1) obese; the leukaemia group predominant. Conclusion: The research tools showed good correlation. Children using vitamin and/or mineral supplements mostly achieved their RNI’s compared to other feeding modes. Across feeding modes some children achieved antioxidant intakes above 200% RNI. LRNI’s on diet alone were not achieved for vitamin A and zinc. The study showed Leukaemics as having a higher prevalence of obesity. More research is required to determine the clinical implications of these findings.
AFRIKAANSE OPSOMMING: Agtergrond: Die rol van anti-oksidante en voldoende voeding in die voorkoming en verloop van kanker behandeling word wêreldwyd erken vir vernietiging van die effek van vry radikale en die verbetering van voedingstatus van kinders tydens behandeling. Doelwit: Om ondersoek in te stel of kinders met kanker hul Dieet Verwysingswaardes en Veilige Innames vir anti-oksidante, energie en proteïen bereik. Ontwerp: Enkel sentrum prospektiewe studie. Omgewing: Kinders was gewerf deur middel van gerieflikheidsteekproefneming oor 8 maande vanaf die “East of England Primary Treatment Centre”. Twee-en-veertig kinders en adolessente gediagnoseer met 'n Soliede tumor, Limfoom of Leukemie het in aanmerking gekom vir dataanalise (n=20 manlik, n=22 vroulik). Metode: Data was ingesamel met ‘n Geskatte Voedsel Rekord (GVR) in die eerste (GVR1) en derde maand (GVR2) na diagnose. In die week na voltooiing van die GVR is ouers en/of kinders gekontak om vier onopeenvolgende dae van 24-uur herroepe te voltooi. Data was verdeel in dieet alleen, dieet + voedsel supplement (VS), buisvoeding (buis) of dieet + multi-vitamien-mineraal supplementasie (VMS). Wanvoeding was bepaal deur middel van gewig-vir-ouderdom z-tellings. Nutriënt inname was vergelyk met die Aanbevole Nutriënt Inname (ANI), die Geskatte Gemiddelde Behoeftes (GGB) en die Laer Aanbevole Nutriënt Inname (LANI). Resultate: Die steekproef het bestaan uit 33% (n=14) gediagnoseer met Leukemie, 24% (n=10) Limfoom en 43% (n=18) Soliede tumore. Sewe-en-sestig persent (n=28) het chemoterapie ontvang en 33% (n=14) ‘n kombinasie van terapieë. Betekenisvolle korrelasies was waargeneem tussen die assesseringsinstrumente in die dieet alleen kategorie vir beide maande vir vitamiene A, C, E, selenium en proteïen en vir GVR1 ook vir sink en energie. In beide maande het ‘n groter aantal kinders ≥100% van hul behoeftes bereik vr dieet+VMS (GVR1; p<0.05; GVR2 p<0.05) as vir ander modi van voeding. Vitamien C het die hoogste innames bereik vergeleke met die ANI teen 773% (GVR1) en 829% (GVR2). Innames bo 200% van die ANI was waargeneem vir vitamiene A, C, E, selenium en sink. Geen betekenisvolle verskille was waargeneem tussen modi van voeding in enige maand vir selenium en sink nie. Vitamien A (GVR1≤100% dieet alleen p<0.05) en sink (GVR1≤100% dieet alleen p=0.02) het die minste van die LANI bereik in die eerste maand vergeleke met ander anti-oksidante. Geen statisties beduidende verskil was waargeneem tussen die aantal kinders wat hul GGB’s bereik het tussen die 3 voedingswyses in die eerste en derde maande nie. In die eerste maand het 27% (n=8) van deelnemers vitamien en/of mineraal supplemente ingeneem, en 18% (n=4) in die derde maand. In die eerste maand was 5% (n=2) van kinders matig wangevoed en 10% (n=4) in die derde maand. In die eerste maand was 3% (n=1) van kinders oorgewig en 3% (n=1) vetsugtig, die leukemie groep spesifiek. Gevolgtrekking: Die navorsingsinstrumente het goeie korrelasie getoon. Kinders wat vitamien en/of mineraal supplemente gebruik het het meestal hul ANI’s bereik vergeleke met ander modi van voeding. Oor voeding modi het sommige kinders anti-oksidant innames bo 200% ANI bereik. LANI’s op dieet alleen was nie bereik vir Vitamien A en sink nie. Hierdie studie het aangetoon dat dié met Leukemia ‘n hoër prevalensie van oorgewig/vetsug getoon het. Meer navorsing is nodig om die kliniese implikasies van die bevindinge te bepaal.

Thesis (MNutr)--Stellenbosch University, 2012.
ENGLISH ABSTRACT: Introduction and Objectives: Schools can serve as a supportive environment for the promotion of healthy eating in order to prevent childhood overweight and obesity and the development of noncommunicable diseases such as cardiovascular diseases, type 2 diabetes mellitus, fatty liver disease, muscoskeletal disorders and some cancers. Tuck shops at schools often offer unhealthy items that are energy dense and high in fat and/or sugar with a low content of vitamins, minerals and dietary fibre. The availability of unhealthy items in tuck shops prevents learners from making healthy food choices, since children tend to choose unhealthy foods when given a choice. In addition to unhealthy items offered by tuck shops, learners also bring unhealthy items to school in their lunchboxes. The aim of the study was to investigate the influence of a nutritionally-regulated tuck shop on primary school learners’ perceptions, attitudes and behaviour towards healthy eating in a Bloemfontein, Afrikaans medium, co-education primary school, and compare it to learners of a school with a conventional tuck shop. Methods: In a cross-sectional survey with an analytical component, grade 2 to 7 learners in a school with a nutritionally-regulated tuck shop (n=116) and a school with a conventional tuck shop (n=141) completed a questionnaire. Six learners per grade also took part in focus group discussions. Questions related to lunchbox contents and perceptions, attitudes and behaviour towards the tuck shop and healthy eating. Nutritional information of the items available for purchase at each of the school tuck shops was collected. Results: The lunchboxes of learners in the school with a nutritionally-regulated tuck shop contained significantly (p<0.05) more healthy items (fruit, water and muffins), as well as significantly more unhealthy items (sweets and chips). The items offered by the nutritionally-regulated tuck shop contained approximately half the kilojoules compared to items offered by the conventional tuck shop. Learners in the school with a nutritionally-regulated tuck shop liked certain fruits and vegetables significantly (p<0.05) more than learners in the school with a conventional tuck shop. Statistical significant differences (p<0.05) between different grades and gender showed that grade 2 learners in both schools had a less positive attitude towards certain fruit and vegetables compared to the older learners, while girls in both schools were more positive towards certain fruits and vegetables compared to boys. Younger learners had a more positive attitude towards their nutritionally-regulated tuck shop than older learners. In both schools learners had similar perceptions regarding the particular school’s tuck shop and healthy eating. Conclusion: The hypothesis that learners in a school with a nutritionally-regulated tuck shop have positive attitudes, perceptions and behaviour towards healthy eating was rejected. The availability of healthier items in a school tuck shop had a positive influence on certain behaviours and attitudes of learners, but the potential value of controlling the type of items available for purchase at schools might be counteracted by lunchbox contents, certain fixed eating patterns, perceptions of learners and previous exposure to a conventional tuck shop. Recommendations include a multi-pronged approach such as the Health Promoting Schools concept.
AFRIKAANSE OPSOMMING: Inleiding en doelwitte: Skole bied ‘n omgewing waar goeie eetgewoontes bevorder kan word ten einde oorgewig en vetsug in kinders te voorkom, asook die ontwikkeling van nie-oordraagbare siektes soos kardiovaskulêre siektes, tipe-2 diabetes mellitus, lewervervetting sindroom, ortopediese komplikasies en sekere soorte kanker. Snoepies in skole voorsien meestal ongesonde items met ‘n hoë energie, vet- en/of suikerinhoud en wat laag is in vitamiene, minerale en dieetvesel. Die beskikbaarheid van ongesonde items in snoepies verhoed dat leerders gesonde voelselkeuses uitoefen, omdat kinders geneig is om voorkeur aan ongesonde kos te gee as hulle 'n keuse gebied word. Benewens die ongesonde items wat snoepies aanbied, neem leerders boonop ongesonde kos in hul kosblikke skooltoe. Die doel van die studie was om by 'n Afrikaans dubbelmedium laerskool in Bloemfontein die invloed van ‘n voedingkundig-gereguleerde snoepie op leerders se persepsies, houdings en gedrag teenoor gesonde eetgewoontes te ondersoek en te vergelyk met leerders in 'n skool met 'n konvensionele snoepie. Metodes: In ‘n deursnit-opname met ‘n analitiese komponent, het graad 2 tot 7 leerders in ‘n skool met ‘n voedingkundig-gereguleerde snoepie (n=116) en ‘n skool met ‘n konvensionele snoepie (n=141), ‘n vraelys ingevul. Ses leerders in elke graad in elk van die skole het ook aan fokusgroepbesprekings deelgeneem. Vrae het oor die inhoud van kosblikke, asook persepsies, houding en gedrag teenoor die snoepie en gesonde eetgewoontes, gehandel. Voedingsinligting rakende die items wat in elk van die skole se snoepies verkoop word, is ook ingesamel. Resultate: Die kosblikke van leerders in ‘n skool met ‘n voedingkundig-gereguleerde snoepie het statisties beduidend (p<0.05) meer gesonde items bevat (vrugte, water en muffins), maar ook beduidend meer ongesonde items (lekkergoed en aartappelskyfies). Voedsel-items wat in die voedingkundig-gereguleerde snoepie beskikbaar was, het omtrent die helfte minder energie bevat as voedsel-items wat in die konvensionele snoepie beskikbaar was. Leerders in ‘n skool met ‘n voedingkundig-gereguleerde snoepie het beduidend (p<0.05) meer van sekere groente en vrugte gehou as leerders in ‘n skool met ‘n konvensionele snoepie. Statisties beduidende (p<0.05) verskille tussen verskillende grade en die houding van verskillende geslagte dui daarop dat graad 2 leerders in albei skole minder positief gevoel het oor sekere groente en vrugte as ouer leerders, terwyl meisies in albei skole ‘n meer positiewe houding teenoor sekere groente en vrugte getoon het as seuns. Jonger leerders het ‘n meer positiewe houding teenoor hulle voedingkundig-gereguleerde snoepie getoon as ouer leerders. In albei skole het leerders soortgelyke persepsies rondom hul onderskeie skole se snoepies en gesonde eetgewoontes openbaar. Gevolgtrekking: Die hipotese dat leerders in ‘n skool met ‘n voedingkundig-gereguleerde snoepie positiewe persepsies, houding en gedrag teenoor gesonde eetgewoontes toon is nie aanvaar nie. Die beskikbaarheid van gesonder items in ‘n skoolsnoepie het 'n positiewe invloed op sekere eetgewoontes en houdings van die leerders, maar die potensiële waarde daarvan om die tipes voedsel wat by skole te koop aangebied word te reguleer mag egter teengewerk word deur kosblikke se inhoud asook sekere vaste eetpatrone, persepsies van leerders en vorige blootstelling aan ‘n konvensionele snoepie. ‘n Veelvoudige benadering soos die konsep van ‘n Gesondheidbevorderingskool word aanbeveel.

Maternal folate intake and levels of folate in milk, serum and red cells were assessed in 57 healthy, lactating women, ages 22-38 years, throughout early (0-6 months) and later (7-23 months) lactation. Average maternal folate intake from diet alone was 212 µg/day or 78.5% RDA (1989) and mean total folate intake from diet and supplements was 314% RDA (878 µg/day) at 0-6 months and 238% RDA (620 µg/day) at >6 months. Human milk folate was sufficient to meet the RDA (1989) for infants. Milk folate was not related to maternal folate intake, maternal serum or red cell folate and was unaffected by extended lactation (7-23 months), perhaps at the expense of maternal folate stores. Compared with early lactation, serum folate decreased (p=0.0004) and red cell folate tended to decrease (p=0.08) in later lactation and were both increased by folate supplementation (p < 0.001).Level of folic acid supplementation appeared to predict red cell folate concentration. An average of 884 µg supplemental folate/day was associated with red cell folate levels >400 ng/mL, which have previously been reported as optimal for prevention of folateresponsive neural tube defects. The addition of an 880 µg/day folic acid supplement to the diet of lactating women may raise red cell folate concentrations of lactating women to protective levels.
Department of Family and Consumer Sciences

Thesis (Mnutr)--Stellenbosch University, 2003.
ENGLISH ABSTRACT: INTRODUCTION: The objective of this pilot study was to evaluate the effects of a new micronutrient, glutamine, pre- and probiotic enriched liquid nutritional supplement on the nutritional status and immunity of adults living with HIV/AIDS. The study was designed as a prospective randomised double-blind placebo-controlled trial. Subjects were HIV-infected male and female adult volunteers (n = 47) from a community-based hospice centre in a peri-urban area in a resource-poor setting and were included irrespective of duration or clinical stage of HIV/AIDS. None of the subjects received antiretroviral therapy. METHOD: The intervention involved the daily ingestion of 40g (200 ml reconstituted) of either the enriched test product or an lsocalorie carbohydrate placebo for a period of 12 weeks. Anthropometric assessment (weight, height and triceps skinfold thickness; mid-upper arm, waist and hip circumferences) was performed at baseline and thereafter every 4 weeks (4 times). Biochemical (serum total protein, serum albumin and C-reactive protein) and haematological (full blood count and immunophenotyping) assessment was performed at baseline and again after week 12. RESULTS: Statistical analysis of baseline values was performed with Wilcoxon two-sample tests for comparison between the supplemented and placebo groups. Outcomes were evaluated using analysis of variance with Shapiro-Wilk tests and thereafter either pair-wise t-tests or sign tests (for nonparametric data) were used. Thirty-two subjects completed the trial, 14 in the supplemented group and 18 in the placebo group. Weight increased significantly in the supplemented group (2.73 ± 3.53 kg, P = 0.013). Triceps skinfold thickness increased significantly in both the supplemented (p = 0.047) and placebo group (p = 0.001). No other significant anthropometric change was observed. Serum albumin increased significantly in the supplemented group (p = 0.003) and was associated with a significant decline in C-reactive protein (p = 0.028). Haemoglobin decreased significantly in both groups. A significant decline in CD4+ count was observed in the placebo group while the decline in the supplemented group did not reach significance. CONCLUSION: Oral nutritional supplementation in limited quantities was well tolerated for a period of 3 months. This study demonstrated that an enriched nutritional supplement was able to promote weight gain and ameliorate hypoalbuminaemia and possibly inflammation in adults living with HIV/AIDS in the short to medium term. The enriched nutritional supplement does not appear to have an effect on the immunity of people with HIV/AIDS. The small sample is a limitation of the study and the conclusions pertain to the test product as a whole and not to any of its respective ingredients. Although further studies are required to evaluate long-term feasibility, these findings suggest that the use of an enriched nutritional supplement has a role in the management of weight loss in persons with HIV/AIDS.
AFRIKAANSE OPSOMMING: INLEIDING: Die doel van hierdie loodsstudie was om die uitwerking van 'n nuwe mikronutriënt, glutamien, pre- en probiotika verrykte voedingsaanvulling in vloeistof vorm te ondersoek. Die studie is ontwerp as 'n prospektiewe ewekansige dubbelblinde plasebogekontroleerde toets. Proefpersone was MIV-geïnfekteerde manlike and vroulike vrywilligers (n = 47) van 'n gemeenskapsgebaseerde hospitium in a semi-stedelike gebied in 'n hulpbron-arme omgewing. Proefpersone is ingesluit ongeag die duur of kliniese graad van MIVNIGS. Geen proefpersoon het antiretrovirale behandeling ontvang nie. METODE: Die intervensie het die daaglikse inname van 40g (200 ml gerekonstitueer) van óf die toetsproduk óf 'n isokaloriese koolhidraatplasebo gedurende 'n 12 week periode behels. Antropometriese evaluering (gewig, lengte en trisepsvelvoudikte; midbo-arm-, middel- en heupomtrekke) is uitgevoer met aanvang en daarna weer elke 4 weke (4 keer). Biochemiese (serum totale protein, serumalbumien en C-reaktiewe protein) en hematologiese (volbloedtelling en immunofenotipering) evaluering is uitgevoer met aanvang en weer na 12 weke. RESULTATE: Statistiese verwerking van basislyndata is gedoen deur middel van Wilcoxon twee-steekproef toetse waarmee vergelyking tussen die aangevulde en plasebogroep uitgevoer is. Studiegevolge is geëvalueer deur verspeidingsanalise met behulp van Shapiro-Wilk toetse waarna óf paargewyse t-toetse óf tekentoetse (vir nie-parametriese data) gebruik is. Twee-en-dertig proefpersone het die studietydperk voltooi, 14 in die aangevulde groep en 18 in die plasebogroep. Gewig het betekenisvol toegeneem in die aangevulde groep (2.73 ± 3.53 kg, p = 0.013). Triseps velvoudikte het betekenisvol toegeneem in beide die aangevulde (p = 0.047) en die plasebogroep (p = 0.001). Geen ander betekenisvolle antropometriese veranderinge is waargeneem nie. Serumalbumien het betekenisvol gestyg in die aangevulde groep (p = 0.003) en het gepaard gegaan met 'n betekenisvolle daling in C-reaktiewe protein (p = 0.028). Hemoglobienwaardes het in beide groepe betekenisvol gedaal. 'n Betekenisvolle daling in CD4+ telling is waargeneem in die plasebogroep terwyl die daling in die aangevulde groep nie betekenisvol was nie. GEVOLGTREKKING: Mondelingse voedingsaanvulling van 'n beperkte hoeveelheid was goed aanvaar en verdra oor 'n 3-maande tydperk. Hierdie studie toon dat 'n verrykte voedingsaanvulling in staat is om gewigstoename te bevorder en om hipoalbumienemie en moontlik ook inflammasie te verlig in volwassenes met MIVNIGS oor 'n kort tot medium tydperk. Die verrykte voedingsaanvulling blyk nie 'n effek op die immuniteit van mense met MIVNIGS te hê nie. Die klein steekproef is 'n beperking van die studie en die gevolgtrekkinge is slegs van toepassing op die toetsproduk as 'n geheel en nie op enige van die onderskeie bestanddele daarvan nie. Hoewel verdere studies nodig geag word om langtermyn uitvoerbaarheid te ondersoek, dui hierdie bevindinge daarop dat die gebruik van 'n verrykte voedingsaanvulling 'n rol speel in die beheer van gewigverlies in persone met MIVNIGS.

This study was designed to measure the prevalence and nutritional impact of dairy product restriction in both pregnant and lactating women. Dairy product (DP) restriction was assessed in 2091 prenatal class attendees. Subsamples of 279 healthy pregnant and 175 exclusively breastfeeding women provided repeat 24-hour dietary recalls which were used to estimate nutrient intake and to assess dietary adequacy using adjusted nutrient distributions. Pregnancy outcome was recorded. Pregnancy. DP restriction was reported by 13.2% (95% CI: 12.7%,14.1%) of pregnant women. Significant differences were found in the proportion of restrictors (Rs, 20.8%) below the calculated EAR for adjusted protein intakes vs. nonrestrictors (NRs, 9.2%, chi 2 = 6.78, p = 0.009). Intake distributions of calcium and vitamin D were compared to their respective Als for descriptive purposes and were lower for Rs vs. NRs but dietary inadequacy could not be assessed. Infants of NRs weighed on average 120 g +/- 468.9 g more than those of Rs but this difference was not statistically significant (p = 0.06). However, in multiple regression analysis where maternal weight gain, age, education and pregravid weight were controlled for, restriction predicted a comparable loss in birthweight of 122.5 g's (p = 0.048) and vitamin D intakes were positively associated with fetal growth. Lactation. Restriction (≤250 ml milk/day) was reported by 23% (95% CI; 16%--29%) of exclusively lactating women. Protein was lower than the EAR for 60% of Rs and 37.8% of NRs (chi 2 = 6.22, p = 0.025). The proportion of Rs and NRs < EAR from diet differed for thiamin (15% vs. 0%, chi2 = 0.97, p < 0.001), riboflavin (15% vs. 1.5%, chi2 = 12.93, p < 0.001) and zinc (65.0% vs. 34.8%, chi2 = 11.6, p < 0.041). From diet and supplement intake vitamin D and calcium remained lower for Rs compared to NRs but inadequacy could not be assessed or compared. DP restriction was not associated with greater weight loss amo

Background A well-balanced nutritious diet is important for the pregnant woman and the growing fetus, as well as for their future health. Poor nutrition results from both over-consumption of energy-rich foods which can lead to a higher weight gain than is healthy and under-nutrition of essential nutrients. Food intake is regulated in complex biological systems by many factors, where steroid hormone is one factor involved. The overall aim of this thesis is to describe dietary intake, vitamin D levels, dietary information and dietary changes, and to study the relation between allopregnanolone and weight gain during pregnancy and postpartum. Methods Study I was a qualitative study with focus group interviews with 23 pregnant women. The text was analysed with content analysis. Study II was a quantitative cross-sectional study conducted in early pregnancy (n=209) with a reference group (n=206). Self-reported dietary data from a questionnaire was analysed using descriptive comparative statistics and a cluster analysis model (Partial Least Squares modelling). Study III had a quantitative longitudinal design. Vitamin D concentrations were analysed in 184 women, collected on five occasions during pregnancy and postpartum. Descriptive comparative statistics and a linear mixed model were used. Study IV was a quantitative longitudinal study with 60 women. Concentrations of allopregnanolone were analysed in gestational week 12 and 35. Descriptive and comparative statistics as well as Spearman’s correlation (rho) were used to describe the relationship between weight gain and allopregnanolone concentrations.   Results The focus group interviews showed that women wanted to know more about different foods to reduce any risk for their child but the information about foods was partly up to themselves to find out. They expressedfeelingsof insecurityand guiltif they accidentallyate something“forbidden”. The recommendationswere followedas best as possiblealong withcommon sense todeal with dietchanges. The main themes were “Finding out by oneself”, “Getting professional advice when health problems occur”, “Being uncertain” and “Being responsible with a pinch of salt”. Some differences in the dietary patterns were found among the pregnant women compared to references, with less, vegetables (47 g/day), potatoes/rice/pasta (31 g/day), meat/fish (24 g/day) and intake of alcohol and tobacco/snuff but a higher intake of supplements. Bothpregnant women and referenceshad intakes offolatethrough diet45% (pregnant) and 22% (references) lower than current recommendations(500vs400g/day). Vitamin Dintake was34% lower than the recommendationsof 10mg/day. At least a third of the participants had insufficient plasma levels below 50 nmol/L of vitamin D. Season was a strong factor influencing the longitudinal pattern. Gestational week, season, total energy intake, dietary intake of vitamin D, and multivitamin supplementation over the previous 14 days were factors related to vitamin D levels. A correlation betweenallopregnanoloneconcentrations ingestationalweek 35and weight gainin weeks12–35was seen (p = 0.016). Therewas alsoa correlation betweenthe increase inallopregnanolone(weeks12–35) andweight gain(see above) (p = 0.028).   Conclusions Dietary recommendations were described as contradictory and confusing and the dietary advice felt inadequate. The women faced their diet changes and sought information on their own but would have wished for more extensive advice from the midwife. The intake of vitamins essential for pregnancy was lower than recommended, which is also confirmed by low plasma levels of vitamin D in at least one third of the pregnant women. Vitamin D levels peaked in late pregnancy. Aside from gestational week and season which were related to plasma levels, intake from foods and supplements also affected the levels. Reasons for weight gain are complex and depend on many factors. Allopregnanolone is a factor that was seen to relate to the weight gain of the studied pregnant women.
Bakgrund En välbalanserad näringsrik kost är viktig för den gravida kvinnan och det växande fostret, så även för deras framtida hälsa. En bristfällig kost kan utgöras av både överförbrukning av energirika livsmedel vilket kan leda till högre viktuppgång än vad som är hälsosamt och bristande intag av viktiga näringsämnen. Kostintag regleras av komplexa biologiska system där flera faktorer är inblandade däribland steroidhormonet allopregnanolon. Det övergripande syftet med denna avhandling är att under och efter graviditet beskriva kostintag, vitamin D-nivåer, kostinformation och kostförändringar och att studera allopregnanolons relation till viktökning. Metod Studie I var en kvalitativ studie med fokusgruppsintervjuer med 23 gravida kvinnor. Texten analyserades med innehållsanalys. Studie II var en kvantitativ tvärsnittsstudie som genomfördes i tidig graviditet (n = 209) och med en grupp icke-gravida kvinnor (kontrollgrupp) (n=206). Självrapporterade kostdata från ett frågeformulär analyserades med beskrivande, jämförande statistik och en klusteranalysmodell (Partial Least Squares modellering). Studie III hade en kvantitativ longitudinell design. Vitamin D-koncentrationer analyserades hos 184 kvinnor, vid fem tillfällen under graviditeten och efter förlossningen. Beskrivande, jämförande statistik och en linjär mixad regressionsmodell användes. Studie IV var en kvantitativ longitudinell studie med 60 kvinnor. Koncentrationerna av allopregnanolon analyserades vid graviditetsvecka 12 och 35. Beskrivande och jämförande statistik samt Spearman’s korrelation användes för att beskriva samband mellan viktökning och koncentrationer av allopregnanolon. Resultat Intervjuerna i studie I visade att kvinnor ville veta mer om olika typer av mat för att minska en eventuell risk för sina barn men kostinformation var delvis upp till dem själva att ta reda på. De VIII uttryckte känslor av osäkerhet och skuld om de råkat äta något ”förbjudet”. Rekommendationerna följdes så väl som möjligt, tillsammans med sunt förnuft för att hantera kostförändringar. Huvudteman var ”Söka information på egen hand”, ”Få professionell rådgivning när problem uppstår”, ”Känna sig osäker” och ”Ta ansvar med en nypa salt”. I studie II kunde man se vissa skillnader i kostmönster bland de gravida kvinnorna jämfört med kontrollgruppen: mindre intag av grönsaker (47 g/dag), potatis/ris/pasta (31 g/dag), kött/fisk (24 g/dag) och alkohol och tobak/snus och ett högre intag av kosttillskott. Både gravida kvinnor och kontrollgruppen hade lägre intag av folsyra via kosten med 45 % (gravida) och 22 % (kontrollgruppen) än de gällande rekommendationer som är (500 resp 400 g/dag). I studie III såg man att inta et av vitamin D var 34 % lägre än rekommendationen på 10 µg/dag. Minst en tredjedel av deltagarna hade otillräckliga plasma nivåer av vitamin D, under 50 nmol/L. Årstid var en stark faktor som påverkar det longitudinella mönstret. Graviditetsvecka, säsong, totala energiintaget, intaget av vitamin D och multivitamintillskott under de senaste 14 dagarna var faktorer som relaterade till Dvitaminnivåer. I studie IV sågs ett samband mellan allopregnanolon-koncentrationer vid graviditetsvecka 35 och viktökning från vecka 12 till 35 (p = 0,016). Det sågs också ett samband mellan ökningen av allopregnanolon (vecka 12–35) och viktökningen (se ovan) (p = 0,028). Slutsatser Kostrekommendationer beskrevs som motsägelsefulla och förvirrande och kostråden de fick uppfattades som otillräckliga. Kvinnorna tog itu med sina kostförändringar och sökte information på egen hand men hade önskat mer omfattande råd från barnmorskan. Intaget av vitaminer viktiga för graviditeten var lägre än rekommendationerna, vilket också bekräftas av låga plasmanivåer av D-vitamin hos cirka en tredjedel av de gravida kvinnorna. D-vitaminnivåerna nådde en topp i slutet av graviditeten. Graviditetsvecka och säsong på året påverkade D vitaminnivåer, så även intag via mat och kosttillskott. Orsakertill viktökning är komplexa och beror på många faktorer. Allopregnanolon är en faktor som sågs relatera till viktökningen hos de undersökta gravida kvinnorna.

[EN] In recent years, persimmon crop has become very relevant in Mediterranean Spain, where the production of this fruit centres on only one variety, persimmon cv. Rojo Brillante, majorly located in the Valencian Community. The main postharvest disorders manifested by 'Rojo Brillante' persimmons are flesh browning, which is associated with mechanical damage and chilling injury displayed after low-temperature storage. Previous research has determined the postharvest conditions that lead fruit to develop such alterations. However, the biochemical process behind flesh browning and chilling injury disorders is still unknown. Currently, there is special interest in introducing cultivars from other countries to broaden the varietal range. Besides, prolonging the fruit storage period to supply the markets according to the demand is one of the main challenges. In this context, the present Thesis approached three main objectives: 1) Studying the biochemical process implied in the main physiological postharvest disorders manifested in persimmon fruits by focusing on changes in the fruit redox state; 2) Evaluating postharvest treatments to preserve fruit quality during cold storage; 3) Assessing the physico-chemical and nutritional quality of persimmon cultivars introduced from other countries to increase the varietal range. Biochemical, chromatographic and microstructural studies have revealed that flesh browning manifested by fruits submitted to mechanical damage after removing astringency is associated with a tannins oxidation process caused by a stress oxidative situation. A new flesh disorder, "pinkish bruising", has been described on fruits submitted to mechanical impacts while showing high astringency levels. Sensitiveness to the flesh browning disorder has also been evaluated on different cultivars introduced from other countries. The implication of the redox system in the chilling injury manifestation on 'Rojo Brillante' persimmon has been determined. Moreover, we described the changes in this system associated with chilling injury alleviation by 1-MCP treatment. The effect of a controlled atmosphere based on 4-5% O2 + N2 to prolong the storage of cultivars 'Rojo Brillante' and 'Triumph' has been seen to strongly depend on variety. The results were highly positive on cultivar 'Triumph', in which the evaluated atmosphere extended the storage period up to 3 months. The use of short-term high CO2 treatments was another technology assayed to alleviate chilling injury in non-astringent cultivar 'Fuyu'. This treatment significantly reduced the main chilling injury symptom manifested by this cultivar, which is flesh gelling. This effect was related to cell structure preservation. Recent studies have shown that ethyl formate treatment is highly effective for pest control of persimmon 'Fuyu'. However, this treatment induces fruit softening, which causes quality loss. This Thesis revealed that ethyl formate treatment induces the activity of ethylene synthesis-related genes and that flesh softening is mediated by this hormone. It also demonstrated that by applying 1-MPC pretreatment, fruit softening associated with ethyl formate can be controlled. Therefore, the combined used of both treatments is seen as a potential treatment to disinfect persimmon fruits while preserving quality. Finally, the study of ten cultivars introduced from other countries helped select the most interesting cultivars to broaden the varietal range according to their maturation date and their response to deastringency treatment. The main nutritional compounds of persimmon and how they are affected by CO2 deastringency treatment are described.
[ES] El caqui es un cultivo de gran relevancia en el área mediterránea de España, estando la producción centrada en una única variedad, el cv. Rojo Brillante, y localizada principalmente en la Comunidad Valenciana. Las principales alteraciones presentadas por el caqui 'Rojo Brillante' durante el periodo postcosecha son el pardeamiento de la pulpa asociado a los daños mecánicos y los daños por frío manifestados tras la conservación a bajas temperaturas. Las investigaciones previas han determinado las condiciones de manejo bajo las cuales se desarrollan dichas alteraciones, sin embargo los procesos bioquímicos involucrados en la manifestación de estos desórdenes no se conocen en profundidad. Actualmente uno de los principales retos es la introducción de nuevas variedades que permitan ampliar la gama varietal, así como prolongar los periodos de conservación del caqui con el fin de poder escalonar la puesta en el mercado en función de la demanda. En la presente Tesis se han abordado tres objetivos principales: 1) Estudiar los procesos bioquímicos implicados en los principales desórdenes postcosecha del caqui, prestando especial atención a los cambios en el sistema redox del fruto; 2) Evaluar diferentes tratamientos postcosecha para preservar la calidad del fruto durante la conservación frigorífica; 3) Evaluar la calidad físico-química y nutricional de diferentes variedades de caqui introducidas desde otros países para ampliar la gama varietal. Estudios bioquímicos, cromatográficos y microestructurales, han revelado que el pardeamiento de la pulpa o "browning", manifestado por la fruta que ha sufrido daños mecánicos tras la eliminación de la astringencia está asociado a un proceso de oxidación de taninos motivado por una situación de estrés oxidativo. Además se ha descrito una nueva alteración de la pulpa, "pinkish bruising", manifestada por los frutos sometidos a daño mecánico con alto nivel de astringencia. También se ha evaluado la sensibilidad al pardeamiento de diferentes variedades introducidas desde otros países. Con el objetivo de prolongar la conservación del fruto se ha ensayado el uso de la atmósfera controlada basada en 4-5% O2 + N2 sobre las variedades 'Rojo Brillante' y 'Triumph', observándose que la respuesta a esta tecnología depende de manera muy importante de la variedad. Los resultados fueron especialmente positivos en el caso del cultivar 'Triumph', en el que la atmósfera ensayada permitió prolongar la conservación frigorífica hasta tres meses. Otra tecnología ensayada para el control de los daños por frío fue la aplicación de choques con altas concentraciones de CO2 en el cultivar no astringente 'Fuyu'. Este tratamiento alivió el principal síntoma de daño por frío manifestado por esta variedad, la gelificación de la pulpa. Este efecto se ha relacionado con la preservación de la estructura celular de la pulpa del fruto. Estudios recientes han mostrado que el tratamiento con etil formato es altamente efectivo en el control de insectos durante la conservación y comercialización del caqui 'Fuyu', sin embargo este tratamiento provoca un ablandamiento del fruto mermando su calidad. En esta Tesis se ha demostrado que las aplicaciones de etil formato activan los genes de síntesis de etileno, siendo está hormona mediadora del ablandamiento. Los estudios también revelaron que la aplicación de un tratamiento previo con 1-MCP reduce el ablandamiento del fruto asociado al etil formato, por lo que el uso combinado de ambos tratamientos puede ser considerado una alternativa para la desinfección de los frutos sin detrimento de su calidad. Por último, el estudio de diez variedades introducidas desde otros países permitió seleccionar en base a su momento de maduración y respuesta al tratamiento de desastringencia aquellas variedades de mayor interés para ampliar la gama varietal. Además, se identificaron los principales compuestos nutricionales del caqui y
[CAT] El caqui s'ha convertit en els últims anys en un cultiu de gran rellevància en l'àrea mediterrània d'Espanya, estant la producció centrada en una única varietat, el cv. Rojo Brillante, i localitzada principalment a la Comunitat Valenciana. Les principals alteracions presentades pel caqui 'Rojo Brillante' durant el període postcollita són l'enfosquiment de la polpa associat als danys mecànics i els danys per fred manifestats després de la conservació a baixes temperatures. Les investigacions prèvies han determinat les condicions de maneig sota les quals es desenvolupen estes alteracions, però els processos bioquímics involucrats en la manifestació d'estos desordres no es coneixen en profunditat. D'altra banda, actualment un dels principals reptes és la introducció de noves varietats que permetin ampliar la gamma varietal, així com prolongar els períodes de conservació del caqui per tal de poder escalonar la posada en el mercat en funció de la demanda. En este context, en la present Tesi s'han abordat tres objectius principals: 1) Estudiar els processos bioquímics implicats en els principals desordres postcollita del caqui, posant especial atenció als canvis en el sistema redox del fruit; 2) Avaluar diferents tractaments postcollita per preservar la qualitat del fruit durant la conservació frigorífica; 3) Avaluar la qualitat fisicoquímica i nutricional de diferents varietats de caqui introduïdes des d'altres països per ampliar la gamma varietal. Estudis bioquímics, cromatogràfics i microestructurals, han revelat que l'enfosquiment de la polpa o "Browning", manifestat per fruita que ha patit danys mecànics després de l'eliminació de l'astringència està associat a un procés d'oxidació de tanins motivat per una situació d'estrès oxidatiu. A més s'ha descrit una nova alteració de la polpa, "pinkish bruising", manifestada pels fruits sotmesos a dany mecànic amb alt nivell d'astringència. També s'ha avaluat la sensibilitat a l'enfosquiment de diferents varietats introduïdes des d'altres països. Amb l'objectiu de perllongar la conservació del fruit s'ha assajat l'ús de l'atmosfera controlada basada en 4-5% O2 + N2 sobre les varietats 'Rojo Brillante' i 'Triumph', observant-se que la resposta a esta tecnologia depèn de manera molt important de la varietat. Els resultats van ser especialment positius en el cas del cultivar 'Triumph', en què l'atmosfera assajada va permetre prolongar la conservació frigorífica fins a tres mesos. Una altra tecnologia assajada per al control dels danys per fred va ser l'aplicació de xocs amb altes concentracions de CO2 en el cultivar no astringent 'Fuyu'. Este tractament va alleujar el principal símptoma de dany per fred manifestat per esta varietat, la gelificació de la polpa. Este efecte s'ha relacionat amb la preservació de l'estructura cel¿lular de la polpa del fruit. Estudis recents han mostrat que el tractament amb etil format és altament efectiu en el control d'insectes durant la conservació i comercialització del caqui 'Fuyu', però este tractament provoca un estovament del fruit minvant la seua qualitat. En esta Tesi s'ha demostrat que les aplicacions d'etil format activen els gens de síntesi d'etilè, sent esta hormona mediadora de l'estovament. Els estudis també van revelar que l'aplicació d'un tractament previ amb 1-MCP redueix l'estovament del fruit associat a l'etil format, per la qual cosa l'ús combinat de tots dos tractaments pot ser considerat una alternativa per a la desinfecció dels fruits sense detriment de la seua qualitat. Finalment, l'estudi de deu varietats introduïdes des d'altres països va permetre seleccionar en base al seu moment de maduració i resposta al tractament de desastringència aquelles varietats de més interès per ampliar la gamma varietal. A més, es van identificar els principals compostos nutricionals del caqui i es va avaluar l'efecte del tractament de desastringència amb CO2 sobre els mat
Novillo Borrás, P. (2015). HARVEST AND POSTHARVEST QUALITY OF PERSIMMON FRUIT:PHYSICOCHEMICAL AND NUTRITIONAL ASPECTS [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/58270
TESIS

Thesis (Ph.D.) - University of Glasgow, 2009.
Ph.D. thesis submitted to the Division of Developmental Medicine, Faculty of Medicine, University of Glasgow, 2009. Includes bibliographical references. Print version also available.

To investigate the possibility that malnutrition is an important factor that prolongs respiratory failure (PRF), I studied the effects of pharmacologic injections of recombinant human growth hormone (rhGH), an important anabolic stimulus, on nutritional and respiratory parameters in patients requiring mechanical ventilation for more than three days. Patients were excluded from consideration if dominating factors known to prolong ventilatory failure had not been stabilized. Over ten months, 106 patients in PRF were evaluated, but only six met the selection criteria. Three patients were randomized to receive standard nutritional support, and three into a group that received the equivalent nutrition plus 5 mg/day of rhGH for 14 days or until withdrawal of mechanical ventilation. Baseline characteristics of the selected patients were divergent as demonstrated by body mass indexes ranging from 14 to 42 (kg/m$ sp2),$ baseline maximal inspiratory pressures (PI$ sb{ max}$ from $-$15 to $-$70 cm H$ sb2$O, and Day 1 N balances from $-$13.5 to 1.2 g N/day. Despite increased plasma insulin-like growth factor-1 concentrations, the mean daily N balances of the rhGH-treated group were no better than the controls (1.3 $ pm$ 5.0 vs. 0.4 $ pm$ 2.6 g N/day; Mean $ pm$ SD), nor were there differences in PI$ sb{ max},$ level of ventilatory assistance required, and days to weaning. The persistence of respiratory failure in the overwhelming majority of patients in PRF appears to be due to factors already known to prevent weaning from mechanical ventilation. Even the carefully selected patients enrolled in the present study were insufficiently homogeneous or stable enough to allow proper testing of the experimental hypothesis.

Motivation and study design: Iron deficiency is a common condition in infancy, particularly in lower socio-economic groups. In Cape Town it remains a problem in spite of public health measures taken against it: a recent survey found a prevalence of iron deficiency anaemia of 34% in healthy 1-year old term infants who had ready access to a municipal health clinic where iron fortified milk formula is sold at subsidized prices. The consequences of iron deficiency extend beyond anaemia- to involve all organ systems including the immune system. Since Helen Mackay's report in 1928 of a striking decrease in incidents of infection in infants treated with iron, clinicians have assumed that iron deficiency predisposes to infection. Despite a sound theoretical basis for this belief, the clinical evidence for the assumption is poor as studies to date have displayed methodological deficiencies. On the other hand, iron is also essential for the growth of micro-organisms. As such, supplemental iron may predispose to infection. Indeed, there is much laboratory and clinical evidence to show that excess iron can result in the recrudescence of quiescent infections and increase the virulence of newly acquired infections. Thus, the competition between host and parasite may sometimes hinge on the relative availability of iron and it has been speculated that excess iron in infant milk formula may increase susceptibility to infectious diarrhoeal disease. The problem addressed by this thesis was to determine the utility of increasing the level of iron fortification of infant milk formula. Three questions were posed: Does increasing the level of iron fortification of conventional infant milk formula improve the iron nutrition of normal infants fed on the formula? Does increased iron fortification of infant milk formula alter immunity as reflected by incidence of infection and laboratory tests of immune function? Are there any handful effects of increasing the quantity of iron in conventional infant milk formula? A double blind randomized trial was carried out in 1983 and 1984 to answer these questions. A group of 149 healthy, well-nourished infants from a lower socio-economic community of so called Cape Coloureds were followed from the age of 3 months to 1 year. Half of the infants, the Control group, were given a commercially available infant milk formula (Lactogen Full Protein) which has 8.3 mg Fe/ 100 g formula and 37 mg ascorbic acid/ 100 g. The other half of subjects, the Test group, were given the same milk formula but fortified with iron to a concentration of 40 mg Fe/ 100 g. The children were examined every 3 or 4 weeks and any infection or history of infection was noted. Laboratory tests were done at the start of the trial and again on completion. During the trial, laboratory tests were performed only if clinically indicated. The tests included full blood count and differential analysis, red cell zinc protoporphyrin, plasma ferritin, plasma and hair zinc and lymphocyte subtyping with monoclonal antibodies. Within each group, half of the infants were randomly selected for assay of neutrophil bactericidal activity. The other half were assayed for lymphocyte blastogenic response to stimulation with phytohaemagglutinin. Tests of delayed cutaneous hypersensitivity to Candida antigen and PPD were done and all children and their mothers had antibodies to tetanus and polio determined. Results: 74 infants in the Control group started the trial and 62 completed it. In the Test group, 75 infants began and 70 completed the study. Intake of milk and solid foods was not quantified, but the ages of weaning and of introduction of new foods were determined. The Control and Test groups did not differ significantly on any test item. The mean age of completion of weaning was 3.60 months for the Control group and 4.04 months for the Test group. The Control group was first given meat or fish at a mean age of 5.19 months; the Test. group had meat or fish introduced to their diets at a mean age of 4.36 months. These differences were not statistically significant. The children in the Control group were lighter and shorter than the Test group at the end of the year. Mean standard deviation scores for weight were 0.23 and 0.48 respectively (P = 20%), while for length the SD scores were -0.13 and 0.06 (P = 20%).

We developed a methodology to measure plasma hepatic glutathione (GSH) turnover and we tested it in rats treated with an inhibitor of GSH synthesis. Our goal was to determine whether protein intakes above NRC recommendations maximize hepatic GSH stores and turnover in vivo. We also wished to learn if plasma GSH, cysteine, or methionine concentrations or plasma GSH turnover could be used as noninvasive predictors of liver GSH status. Rats were fed purified diets containing 0, 5, 10, 20 or 40% casein for one week. The 0 and 5% casein diets were considered inadequate in protein, 10% marginal, 20% adequate and 40% excessive. Liver GSH content (mmol/liver) of rats fed 0 and 5% casein diets was 12.29 $ pm$ 1.11 and 16.43 $ pm$ 0.95, respectively, and increased to 23.62 $ pm$ 1.82 in the 10% group. Liver GSH content did not differ between the 20 and 40% groups. As dietary casein increased from 0-20%, free plasma GSH and cysteine concentrations and plasma GSH turnover increased, but did not increase further with the 40% diet. A sigmoidal relationship between plasma GSH turnover and hepatic GSH content was demonstrated. The best predictor of liver GSH content was not free plasma GSH concentration nor plasma GSH turnover, but the free plasma cysteine concentration.

Cocoyam [Colocasia esculenta (L.) Schott] is widely cultivated as a staple food in the tropical and subtropical regions of the world. The crop, however, remains unpopular and not well known outside KwaZulu-Natal Province of South Africa where it is cultivated mainly for subsistence. The aims of the study were to collect local landraces (accessions) of the crop from where it is found growing within the country for various studies and also to document its nutritional values as well as the safety/toxicity of the crop. The study was carried out using various methods. These included a comparative assessment of the proximate, mineral and antinutrient compositions of cooked and uncooked tubers of a typical commercially available cocoyam and potato found in South African markets. These investigations were repeated for the tubers and leaves of available landraces (seven accessions) of C. esculenta found growing in the farmers’ fields in KwaZulu-Natal Province. Also, an in vivo toxicological study on cooked accessions of the local landraces was conducted to determine possible toxicity effects after consumption using albino rats as a model. The results revealed that commercially available cocoyam and potato tubers have very close nutritional components. Analysis of the proximate composition of seven accessions (UFCe1- UFCe7) of cooked and uncooked tubers of cocoyam indicated that UFCe7 was better in ash, crude protein, crude fibre and crude lipid contents but with higher moisture which could make it more vulnerable to microbial attack. No tubers of the seven accessions appeared to be ii outstandingly better than the others based on their mineral compositions. However, in terms of antinutritional factors, UFCe1, UFCe3 and UFCe7 had the least amounts of oxalate, tannins and phytate in their cooked states. It was discovered however, that the leaves of the accessions of this vegetable contain substantial amount of minerals, and therefore, can contribute significantly to the nutrient requirements of humans and could be recommended as a cheap source of nutrients in South Africa. None of the accessions was outstandingly better than the others in terms of their mineral contents and anti-nutritional factors. Moreover, the current study has shown that boiling the leaves of cocoyam prior to consumption is an effective way of reducing the antinutrient contents of the leaves of the plant thereby making it safe for consumption. The findings also revealed that cooking C. esculenta leaves may increase the levels of protein, fibre and lipid contents while cooking may also decrease the mineral, carbohydrate and caloric contents of the leaves of the accessions. The leafy vegetable may, therefore, be recommended as a cheap source of plant protein. Cooking improved the nutritive value as a result of the reduction in antinutrient levels, thereby improving the food quality in all the tuber and leaf samples used for this study. At the same time, cooked samples also suffered loss of some nutrients with respect to the proximate and mineral compositions. However, supplementation from other food sources that are rich in these nutrients is necessary when these crops are cooked for consumption. Any of the cocoyam accessions may be recommended for consumption for improved protein and mineral nutrients while tubers of accession UFCe7 have also shown good promise in terms of protein and fibre content availability. The results of the in vivo study, using the liver and kidney functional endpoints of weanling albino rats (Rattus norvegicus) maintained on different accessions of cooked cocoyam-based iii diets (UFCe1-UFCe7) for 28 days, revealed that all the accessions produced selective alterations on the hepatorenal indices of weanling rats. The highest alterations were produced by UFCe4 while the least was from UFCe2. These alterations may have consequential effects on the normal functioning of the liver and kidney of the animals. The UFCe2 exhibited the least toxicity risk among the accessions of C. esculenta growing in KwaZulu-Natal Province of South Africa.

Malnutrition, as evidenced by low weight for height, low triceps skinfold thickness and low midarm muscle circumference, is prevalent among COPD patients. A stepped decline in nutritional status has been postulated as a mechanism for malnutrition wherein patients progressively suffer weight loss with each COPD exacerbation. A randomized clinical trial of continuous enteral nutrition could not successfully address whether or not the stepped decline in weight can be prevented. Despite this, sixteen patients admitted for a COPD exacerbation, participated in an observational prospective study wherein anthropometric, biochemical, dynamometric, respiratory, general well-being and energy consumption measures were obtained. Twelve patients had body weights below 90% of ideal weight. The mean energy intake was 107% $ pm$ 30 of estimated resting energy expenditure. Measures were repeated to assess changes during hospitalization. Weight change was a poor indicator of nutritional status. Midarm muscle circumference and handgrip strength appear to be useful as nutritional status indicators among unstable hospitalized COPD patients. Changes in handgrip strength and midarm muscle circumference were closely linked (r =.78, p $<$ 0.0005) and tended to decrease over the course of hospitalization despite clinical improvement. In the absence of adequate nutrition, COPD patients have at least as much risk of developing iatrogenic malnutrition as are other hospitalized medical patients.

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A gravidez é uma fase do ciclo de vida em que a nutrição desempenha um papel muito importante, uma vez que esta influência o produto da concepção. O objetivo deste estudo foi descrever o estado nutricional de gestantes do município de Botucatu que se localiza na região centro sul do estado de São Paulo, distando aproximadamente 230km da Capital. A população é predominantemente urbana. Foram estudadas 496 gestantes com idade de 13-43 anos submetidas a entrevista para obtenção de dados socioeconômicos, demográficos e dietéticos, e coleta de sangue. Dentre as mulheres 83% eram brancas. 30,5% de adolescente, a renda mostrou que 69% estava abaixo da linha de pobreza, a escolaridade mostrou 63% era baixa, 79% casada, 25% eram fumantes, 41% eram primigestas e 12% apresentaram positividade para o exame parasitológico. As medianas para as variáveis antropométricas (percentagem de gestantes abaixo do ponto de corte) foram para: peso pré gestacional-56,0 kg;(20), peso gestacional-58,1 kg (15); estatura -158 cm(9), índice de massa corpórea pré gestacional-22,0 kg/m2 (18,7), circunferência do braço-270 mm (8,0), prega tricipital-8,6 mm (4,0).O IMC, ainda detectou 17,5% acima da normalidade. O ganho de peso semanal foi 180 g, mostrando valores maiores nas gestantes com IMC abaixo da normalidade. As medianas da ingestão de nutrientes (percentagem de gestantes que ingerem menos que 100% do RDA) foram para : energia 2186 Kcal (73), proteína 64,5 g (42), vitamina A 647,6 mg (56), a tocoferol 4,3 mg (100), vitamina C 106,0 mg (30) e ferro 11,0 mg (99). Os exames bioquímicos mostraram as medianas (percentagem abaixo do ponto de corte): hemoglobina 13,0 g/dL (3),ferro 92mg/dL (13), saturação da transferrina...
Pregnancy is a life cycle where nutrition plays an important role once it influences the product of conception. This study aimed to describe nutritional status of pregnant women in Botucatu located in the southern part of the State of São Paulo, 230 km far from the capital (São Paulo City). Population is predominantly an urban one. Pregnant women (496) between 13 and 43 years old were studied and subjected to interviews to obtain social, economic, demographic, dietetic data a well as blood sampling. Within the women 83% were white, 30.5% adolescents and the income showed that 69% were down poverty line, education was low 63%; 79% were married, 25% were smokers, 41% were pregnant for the first time, and 12% were positive for parasitological exam. Medians and anthropometric variables (percentage of pregnant women below cut point) were: pre-gestational weight – 56.0 kg (20) gestational weight - 58.1 kg (15) height 158 cm (9) ; pre-gestational body mass index 22.0 kg/m2 (15.o); arm circumference 270 mm (8.0); tricipital fold 18.6 mm (4.0) . BMI also detected 15.5% above normality. Weekly weight gain was 180g, with higher values on below normal BMI pregnant women. Nutrients intake medians (percentage of pregnant women who intake less than 100 % of RDA) was: energy 2186 Kcal (73), protein 64.5g (42) , vitamin A 647.mg (56), a- tocopherol 4.3 mg (100), vitamin C 106.0 mg (30) and iron 11.0 mg (99). Biochemical examinations showed medians (percentage below cut point) : hemoglobin 13.0 g/dL (3), iron 92 μ/dL (13), transferrin saturation 30.0% (8), ferritine... (Complete abstract click electronic access below)

Undernutrition and dysphagia in the institutionalized elderly are well documented in the literature. However, the clinical efficacy of diets to treat dysphagia have not been established. To offer a better understanding of the textural characteristics of the new Sainte-Anne's Hospital (SAH) modified texture reformed foods, rheological evaluations were performed. Apparent viscosity, consistency coefficient, flow behavior index and yield stress values were calculated for the thickened beverages. Texture profile analyses were performed on the reformed foods. Secondly, to evaluate the impact of SAH's reformed foods on nutritional intake and weight, a 12-week clinical trial was undertaken. Dysphagic frail elderly subjects (n = 17) of a long-term care facility of Montreal were randomly assigned to receive SAH reformed foods or traditional care. The experimental group demonstrated a significant increase in nutritional intake resulting in significant weight gain. These findings suggest that dysphagic frail elderly could reach healthy weight when adequately fed.

[Truncated abstract] This thesis examines the potential role of dietary intake in the development of two common conditions affecting the prostate gland; prostate cancer and benign prostatic hyperplasia (BPH). Diet is of interest as a potential risk factor for prostate cancer because of geographical variations in prostate cancer incidence and increased prostate cancer risks associated with migration from Asian to western countries. Some geographical variation has been suggested for BPH, but this is less certain. However, both prostate cancer and BPH have potential links with diet through their positive associations with sex hormone levels, metabolic syndrome, increased insulin levels and chronic inflammation. In addition, zinc is an essential dietary micronutrient required for semen production in the prostate gland. The original work for this thesis is presented in six manuscripts of which, four have been published in peer-reviewed journals (at the time of thesis completion). BPH investigated in this thesis is defined as surgically-treated BPH. The following hypotheses were investigated. Regarding foods, nutrients and the risk of prostate cancer and BPH: 1. Increasing intakes of fruits, vegetables and zinc are inversely associated with the risk of prostate cancer and BPH 2. Increasing intakes of total fat and calcium are positively associated with the risk of prostate cancer and BPH. 3. Dietary patterns characterised by high meat, processed meat, calcium and fat content are positively associated with the risk of prostate cancer and BPH. 4. Dietary patterns characterised by high fruit and vegetable and low meat content are inversely associated with the risk of prostate cancer and BPH. v Regarding methodological issues related to the study of diet-disease relationships: 5. Dietary patterns (overall diet) elicited from principal components analysis yield stronger diet-disease associations than when studying isolated nutrients. 6. Remotely recalled dietary intake is reliable enough to be used in studies of chronic disease with long latency periods, such as prostate cancer and BPH. Methods: Data from two studies was used to address the hypotheses above. ... Based on the literature reviewed and the original work for this thesis, the most important dietary risk factors for prostate cancer and BPH appear to be those common to western style diets, i.e. diets high in red meat, processed meat, refined grains, dairy products, and low in fruit and vegetables. This type of diet is likely to result in marginal intakes of antioxidants and fibre, excess intakes of fat and possibly, moderate intakes of carcinogens associated with processed meat and meat cooked at high temperatures. These dietary factors have been linked with biomarkers of inflammation, and they support the hypotheses that chronic inflammation is involved in the development of both prostate cancer and BPH. In addition, this work builds on evidence that zinc is an important factor in prostate health. There is scope for more investigation into the reliability of dietary patterns and the use of nutrient patterns as an alternative to focussing on single food components. Further studies on the reliability of remote dietary intake would also be useful. Because of the latency of chronic disease, it can be theorised that remote dietary recall may uncover more robust diet-disease relationships.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2006.
Background At least 40 - 80% of all cancer patients develop some degree of clinical malnutrition and cachexia. The complex and multi-factorial nature of cancer cachexia and the inability of conventional nutrition intervention to reverse or attenuate the effects of this syndrome have driven investigators to consider new therapies and approaches to manage the syndrome of cancer cachexia including eicosapentaenoic acid (EPA), an n-3 fatty acid of fish oil origin. Objectives The aim of this study was to review Phase I, Phase II and Phase III (RCT) trials investigating the safety and efficacy of n-3 supplementation in the treatment of cancer cachexia in adult patients with unresectable solid tumours, with special reference to weight loss, body composition, appetite, dietary intake, energy expenditure, functional status, acute phase response and quality of life. Adverse effects associated with EPA supplementation were also reviewed. Methodology and data collection The major databases were systematically searched for studies that met the inclusion criteria using a structured keyword search strategy or various combinations of these keywords. Relevancy of studies was assessed by two independent reviewers according to pre-determined inclusion and exclusion criteria. Quality was assessed by two independent reviewers using the Jadad scale. Data extraction was performed by the principal reviewer and one of the independent reviewers, and investigators of the included studies were contacted where further information was required. Meta-analysis was not appropriate due to heterogeneity of the data. However, where possible, the paired t-test was used for analysis of the data. Descriptive or non-quantitative analysis of the tabulated data provided a summary of the characteristics of the included studies enabling comparisons to be made between interventions and outcomes within the specified population. Results The search resulted in a total of 1408 citations, of which only 16 studies met the inclusion and exclusion criteria. Of these, only 4 studies were of a good quality. Although the reported data was incomplete and variable, the combined analyses suggested that the effect of EPA supplementation on weight, fat mass, dietary intake, energy expenditure, and acute phase response was not significant. Interestingly there appeared to be a significant increase increased or decreased? in lean body mass (p<0.05). There was little or no data to draw any conclusions regarding the effect of supplementation on appetite and quality of life. Conclusion Despite several limitations in this review, the data collected and analysed are suggestive of the beneficial effects of EPA supplementation, but there remains a significant lack of substantial evidence and conclusive statistical analysis to confirm that EPA supplementation is a safe and effective method of intervention in the management of patients with cancer cachexia.

Thesis (MNutr)--Stellenbosch University, 2011
ENGLISH ABSTRACT: Introduction Rheumatoid Arthritis (RA) is a chronic, inflammatory, autoimmune disorder characterized by inflammation of the joints and surrounding tissue causing pain, swelling and stiffness. Studies suggest that aspects of the diet may alleviate symptoms and decrease the risk of complications. The scientific basis for a role of dietary therapy in RA has grown although there is still no consensus on the optimum diet. It has been shown that persons with RA tend to have a poor nutritional status; and rheumatoid cachexia, the loss of body cell mass, occurs in nearly two-thirds of all patients with RA. The study aimed to establish what RA patients are practicing and their perceptions regarding the effect of diet, nutritional supplements, medication and complementary and alternative medicines (CAM) and therapies on their symptoms as well as determining their body composition and the possible presence of rheumatoid cachexia. Methodology The study design was a cross-sectional study with an analytical component. The study population consisted of adult (18 years or older) RA patients in the Cape Metropole from the private and public sector. An interviewer-administered questionnaire was used followed by the measurement of weight, height, waist circumference and skinfold thickness. Information was also gathered from the medical records. Results The sample size comprised of 251 RA patients (n=201 public sector; n=50 private sector). The mean body mass index (BMI) was 30.3 kg/m2 for females and 26.6 kg/m2 for males. BMI was used to classify obesity (n=133; 45.9%), overweight (n=66; 26.8%), normal weight (n=63; 25.6%) and underweight (n=4; 1.6%). Waist circumference measurement classifications showed a substantially increased risk for metabolic complications in 51.8% of participants (n=127) and an increased risk in 21.2% of participants (n=52). Just over half of the participants (n=65; 55.6%) had an unhealthy high body fat percentage classification. Rheumatoid cachexia was seen in 10.3% participants (n=12). Low fat-free mass (Fat-free mass index <10th percentile) was seen in 21% participants (n=24) and obesity (Fat mass index >90th percentile) was seen in 27% of participants (n=31). Twenty nine percent of participants (n=73) believed that certain types of food could improve their symptoms of RA and 60% of participants (n=151) believed that certain foods worsened their symptoms. Sixty four percent of participants (n=161) thought that nutritional supplements or complementary and alternative medicines and therapies could improve their symptoms of RA and 98% (n=246) of participants used nutritional supplements. The most frequently used supplements included folic acid (n=218; 91.6%), calcium (n=182; 76.5%), vitamin D (n=185; 77.7%), omega-3 fatty acids (n=48; 64.9%) and multivitamin and mineral preparations (n=22; 29.7%). Conclusion The obesity and waist circumference figures were unacceptably elevated in this population and the body composition of these RA patients should be highlighted as a concern. The high prevalence of risk factors for cardiovascular disease (CVD) need to be urgently addressed since CVD is the leading cause of mortality in RA patients. This study highlights the important role of the intra-professional team, including the dietitian, in the management of RA patients.
AFRIKAANSE OPSOMMING: Inleiding Rumatoïede artritis (RA) is 'n chroniese, inflammatoriese, outo-immuun siekte wat gekenmerk word deur inflammasie van die gewrigte en omliggende weefsel en veroorsaak pyn, swelling en styfheid. Studies dui daarop dat aspekte van die dieet simptome kan verlig en die risiko van komplikasies kan verminder. Die wetenskaplike basis vir die rol van dieetterapie in RA het gegroei, hoewel daar nog geen konsensus aangaande die optimale dieet is nie. Dit is al bewys dat persone met RA geneig is om 'n swak voedingstatus te hê; en rumatoïede cachexia, die verlies van liggaam selmassa in byna twee-derdes van alle pasiënte met RA voorkom. Die doel van die studie was om te bepaal wat RA-pasiënte se praktyke en persepsies ten opsigte van die uitwerking van dieet, voedselaanvullings, medikasie en aanvullende of alternatiewe medisyne (CAM) en terapieë op hul simptome het, sowel as om hul liggaamsamestelling en die moontlike teenwoordigheid van rumatoïede cachexia te bepaal. Metodiek Die studie ontwerp was 'n dwarssnitstudie met 'n analitiese komponent. Die studiepopulasie het bestaan uit volwassene (18 jaar of ouer) RA pasiënte uit die privaat en openbare sektore in die Kaapse Metropool. Onderhoude was gevoer met behulp van vraelyste. Gewig, lengte, middelomtrek en velvoudikte was ook gemeet. Inligting was ook versamel uit mediese rekords. Resultate Die steekproefgrootte het uit 251 RA pasiënte (n=201 openbare sektor, n=50 privaat sektor) bestaan. Die gemiddelde liggaamsmassa-indeks (LMI) was 30.3 kg/m2 vir vroue en 26.6 kg/m2 vir mans. LMI was gebruik om vetsug te klassifiseer (n=133; 45.9%), asook oorgewig (n=66; 26.8%), normale gewig (n=63; 25.6%) en ondergewig (n=4; 1.6%). Klassifikasie van middelomtrek metings het 'n aansienlike verhoogde risiko vir metaboliese komplikasies in 51.8% van die deelnemers (n=127) en 'n verhoogde risiko in 21.2% van die deelnemers (n=52) getoon. Net meer as die helfte van die deelnemers (n=65; 55.6%) het 'n ongesonde hoë liggaamsvet persentasie klassifikasie getoon. Rumatoïede cachexia was by 10.3% van die deelnemers (n=12) gevind. Lae vetvrye massa (vetvrye massa indeks <10de persentiel) was by 21% deelnemers (n=24) en vetsug (vet massa indeks >90ste persentiel) in 27% van die deelnemers (n=31) teenwoordig. Nege-entwintig persent van die deelnemers (n=73) het geglo dat sekere voedselsoorte hul simptome van RA kon verbeter en 60% van die deelnemers (n=151) was van mening dat sekere kosse die simptome kon vererger. Vier-en-sestig persent van die deelnemers (n=161) het gedink dat voedingsaanvullings of aanvullende en alternatiewe medisyne en terapieë hulle simptome van RA kon verbeter en 98% (n=246) van die deelnemers het voedingsaanvullings gebruik. Die mees algemene gebruikte aanvullings was foliensuur (n=218; 91.6%), kalsium (n=182; 76.5%), vitamien D (n=185; 77.7%), omega-3 vetsure (n=48, 64,9%) en multi-vitamien en mineraal preparate (n=22; 29.7%). Gevolgtrekking Die vetsug en middelomtrek syfers was onaanvaarbaar verhoog in die studiepopulasie en die liggaamsamestelling van hierdie RA pasiënte is 'n bekommernis. Die hoë voorkoms van risikofaktore vir kardiovaskulêre siekte (KVS) moet dringend aangespreek word, aangesien die KVS die grootste oorsaak van sterfte in RA pasiënte is. Hierdie studie beklemtoon die belangrike rol van die intra-professionele span, met inbegrip van die dieetkundige, in die bestuur van RA pasiënte.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010.
ENGLISH ABSTRACT: See full text for abstract
AFRIKAANSE OPSOMMING: Sien volteks vir opsomming

Thesis (M. Tech. (Environmental Health)) -- Central University of technology, Free State, 2013
Malnutrition and concomitant infections are major contributing factors to child morbidity and mortality in developing countries such as South Africa. Globally, children benefiting from school feeding programmes are generally from communities with low socio-economic statuses. The meals provided through feeding schemes, such as the National School Nutrition Programme (NSNP) in South Africa, are aimed at significantly supplementing the beneficiaries’ daily energy and nutrient requirements. The possible nutrient deficiency of meals provided through such programmes compromises the nutritional well-being of children, promotes malnutrition and renders children more susceptible to infectious diseases. Furthermore, illness, particularly caused by diarrhoeal and infectious diseases, is a major factor contributing to child malnutrition as the human body is unable to efficiently digest foods and absorb nutrients during illness. Therefore, the microbiological safety of the foods served to children via feeding schemes is essential. In an effort to contribute towards the safety and wholesomeness of foodstuffs served through the NSNP, the present study was conducted with a view to assess the nutritional quality and safety of the foodstuffs. The knowledge, attitudes and practises (KAP) of food handlers and NSNP representatives/committee members at the schools were also investigated in order to assess origins of potential food contamination. Data collected via nutritional analyses of meals served to school children were compared to the nutrient-based standards set by the United Kingdom as guidelines for an average school lunch. The carbohydrate, energy, calcium and zinc contents of the school meals were below the standards, the majority of the meals met the protein and iron standards and all meals complied with the standards for lipid and vitamin C contents. During the microbiological analysis study, preparation surfaces yielded higher counts of all detected organisms (total coliforms, Escherichia coli, Staphylococcus aureus and yeasts and moulds) compared to the hands of food handlers. Therefore possible sources of contamination may be foodstuffs, animal pests and environmental elements such as dust. However, significant differences of surface microbial counts could not be established (P > 0.05) and thus cross-contamination may have resulted among surfaces, possibly augmented by shortfalls in cleaning regimes. The majority of the participants of the questionnaire survey reportedly washed their hands and cleaned all surfaces several times during the day with water and detergent. In addition, a disinfectant was used by some of the food preparers during cleaning. Furthermore, participants stated that their aprons were washed daily. These claims were in agreement with the findings of the surface microbial study with regards to the hands, however, they did not match the findings of the preparation surfaces which contained the highest counts of total coliforms, E. coli and S. aureus of the three surfaces analysed, and aprons responsible for the highest yeast and mould counts. Improper storage and food preparation methods, such as the application of high temperatures, excessive exposure to UV light and oxygen, and high moisture conditions, may result in the deterioration of nutrients. Storage conditions which may permit pest infestation may also increase the risk of food-related illnesses and risk could be further elevated by application of improper cleaning and sanitation practices. In order for the NSNP to operate effectively, it is essential that the national and provincial Departments of Basic Education, which are responsible for the overall administration of the NSNP, and schools’ personnel function in an integrated manner through support structures and effective communication. Infrastructural limitations (lack of proper kitchen facilities and ventilation) and shortage of resources while administering the NSNP were the main challenges observed during the present study. Due to these hurdles, adhering to food safety practices and maintaining nutritional quality of foods may be a challenge. Continuous training in personal and general hygiene is also a necessity in preserving food safety. Furthermore, nutritional quality of foodstuffs may be preserved through proper storage practices and application of preparation methods which minimize loss of nutrients.

Thesis (Ph.D (Nutrition)) --University of Limpopo, 2009
AIM: This study aimed to assess the nutritional status of non-pregnant women of childbearing age residing in a rural area of Limpopo Province, South Africa, and the effect of fortification of staple foods on their folate and iron status. The following objectives were carried out:  To assess the socio-demographic status and maternity history of non-pregnant rural women of childbearing age.  To determine the following anthropometric measurements; body weight, height, body mass index, waist and hip circumference, and waist hip ratio of women of childbearing age.  To assess dietary intake of non-pregnant rural women of childbearing age using 24-hour recall and quantitative food frequency questionnaires prior to fortification of foods.  To determine folate status of non-pregnant rural women of childbearing age by levels of serum and red blood cell folate, and assessing vitamin B12 and homocysteine levels before and after fortification of foods.  To determine iron status of non-pregnant rural women of childbearing age by full blood count, serum ferritin, iron, total iron binding capacity, transferrin saturation and C–reactive protein before and after fortification of foods.  To determine albumin and liver enzymes (ALP, ALT, AST and GGT) of women of childbearing age before and after fortification.  To assess mycotoxins (i.e. fumonisins) in morogo samples collected randomly among participants from the study area.
the University of Limpopo Research Department,and the National Research Foundation

Interactions between manganese (Mn) deficiency and streptozotocin (STZ)-diabetes with respect to tissue antioxidant status were investigated in male, Sprague-Dawley rats. All rats were fed either a Mn-deficient (1 ppm) or a Mn-sufficient (45 ppm) diet for 8 weeks. Diabetes was then induced by tail-vein injection of STZ (60 mg/kg body weight), after which the rats were kept for an additional 4 to 8 weeks. The control groups comprised rats not injected with STZ, which were either Mn-deficient or Mn-sufficient. The Mn-deficient diet decreased the activities of manganese superoxide dismutase (MnSOD) in kidney and heart, and of copper-zinc superoxide dismutase (CuZnSOD) in kidney, in non-diabetic animals. In the diabetic rats, the Mn-deficient diet induced more pronounced decreases in activities of these same enzymes, and also increased liver MnSOD activity. Pancreas weights were significantly lower in Mn-deficient, compared to Mn-sufficient rats. Also, Mn-deficient, diabetic rats were significantly more hyperglycemic in response to a glucose load than Mn-sufficient, suggesting that they may have been more severely diabetic. Surprisingly, plasma and hepatic vitamin E levels increased progressively with the duration of diabetes. Lipid peroxidation, as measured by H₂O₂ -induced production of thiobarbituric acid reactive substances in erythrocytes, plasma lipoperoxides, and renal adipose tissue fluorescence, also increased concomitant with decreased liver and kidney glutathione levels. The effect of vitamin E-deficiency on Mn-deficient, diabetic rats was also investigated. Predictably, vitamin E-deficient rats were almost entirely depleted of plasma and liver vitamin E after 12 weeks on the deficient diets (4 weeks after STZ treatment). Consistent with this, tissue lipid peroxides were elevated compared to vitamin E-sufficient rats. Superimposing vitamin E-deficiency on manganese deficiency failed to add any further deficits in tissue antioxidant status. Higher glycosylated hemoglobin levels were observed in vitamin E-deficient, compared to vitamin E-sufficient, diabetic rats. These findings demonstrate for the first time an interactive effect between manganese deficiency and STZ-diabetes resulting in amplification of tissue antioxidant changes seen with either manganese deficiency or STZ-diabetes alone. This effect of cofactor deprivation in experimental diabetes raises the question of adequacy of the nominally Mn-sufficient diet in insulin-dependent diabetes mellitus.
Land and Food Systems, Faculty of
Graduate

Despite the acknowledged importance of nutritional support for COPD patients, it is difficult to accomplish in acutely stressed individuals. A randomized trial of nutritional supplementation during an acute exacerbation was carried out in 16 hospitalized patients for a 2 week period. Six control patients consumed a standard diet supplying 1,951 $ pm$ 130 (mean $ pm$ SEM) kcal and 80 $ pm$ 6 g protein/d, while ten treatment patients, in addition to the usual diet received oral supplements (Ensure) or snacks, resulting in an intake of 2,516 $ pm$ 129 kcal (p = 0.012) and 99 $ pm$ 6 g protein/d (p = 0.059). Although the treatment subjects improved their intake over the control group, no significant improvement in nutritional status occurred in either group.
Forced vital capacity (FVC % predicted) improved significantly over the study period in treated vs control subjects (+11.10 $ pm$ 4.63 vs $-$4.50 $ pm$ 2.14; p = 0.026). Nitrogen balances were calculated for 9 subjects, and all were in negative balance ($-$8.42 $ pm$ 1.74 g nitrogen/d) with no difference between groups.
Because of the high doses of methylprednisolone administered (69.6 $ pm$ 8.3 mg/d), and their known catabolic effects, we examined whether the dose affected nitrogen balance and muscle strength. Both nitrogen balance (r = $-$0.73; p = 0.025) and grip strength (r = $-$0.76; p $<$ 0.001) worsened with higher doses of steroids. The catabolic process may have resulted from elevated energy requirements, inadequate intake of protein and energy or been induced by high doses of steroids.
Hospitalized COPD patients are highly stressed and catabolic, and the means to preventing protein wasting during an acute exacerbation of their disease remains to be established. (Abstract shortened by UMI.)

Thesis (MNutr)--University of Stellenbosch, 2011.
ENGLISH ABSTRACT: Introduction: Nutritional genomics is a new and emerging field aimed at investigating the complex interactions between genetics and diet and the joint influence this has on disease prevention and health promotion. Research is accelerating at a rapid pace and although still in its infancy, it is important for registered dietitians (RDs) to be knowledgeable and keep abreast of these developments as it promises to revolutionize dietetic practice. International studies have demonstrated low confidence and involvement as well as poor knowledge of both genetics and nutritional genomics amongst RDs. To date no similar studies have been conducted amongst South African (SA) RDs. Methods: A cross-sectional descriptive study was conducted using a national survey of 1881 dietitians registered with the Health Professions Council of South Africa (HPCSA). Data was collected using an existing and validated questionnaire as developed for use in a similar study amongst RDs in the United Kingdom (UK). The self-administered questionnaire consisted of 4 sections to assess the following aspects: i) involvement and confidence in activities relating to genetics and nutritional genomics ii) knowledge of genetics and nutritional genomics iii) factors associated with knowledge and iv) demographic information. The main method of questionnaire distribution was via email (70%) using the Association of Dietetics in South Africa (ADSA) distribution service and questionnaires were posted to those RDs not registered with ADSA (30%). Results: The response rate was 15.2% (n = 279). Results showed low involvement in activities relating to genetics (n = 47, 17%) and nutritional genomics (n = 72, 25.8%). The majority of respondents indicated low confidence in performing activities relating to genetics (n = 161, 58.7%) and nutritional genomics (n = 148, 53.8%). However, a significant positive association was found between involvement and confidence for all activities (p < 0.001). The mean total knowledge score was 48.5 (±19%) and considered as low, with the mean genetics score of 58.5 (± 24%) being significantly higher than the nutritional genomics score of 31.9 (±23%), p < 0.001. Those respondents who reported involvement in discussing the genetic basis of a disease (p = 0.02); providing guidance to patients with genetic disorders (p = 0.01); providing training or education on human genetics (p = 0.01) and discussing with patients how diet may interact with genes to influence risk (p = 0.03) also had higher total knowledge scores. Factors associated with knowledge were greater genetics content in university studies (p < 0.001); higher qualification (p = 0.01); participating in related continuous professional development (CPD) activities (p <0.001) and considering genetics of greater importance to dietetic practice (p = 0.03). Conclusions: The results of this study indicate that there is overall low involvement, confidence and knowledge of genetics and nutritional genomics amongst SA RDs and this compares well with international studies. Recommendations therefore include the development of a competency framework for genetics and nutritional genomics for undergraduate dietetic education as well as CPD activities in order to provide the driving force for the development of this field in SA.
AFRIKAANSE OPSOMMING: Inleiding: Voeding genomika is 'n nuwe en ontwikkelende veld wat die komplekse interaksies tussen dieet en genetika bestudeer, asook die gesamentlike invloed wat dit op gesondheids- bevordering en siekte voorkoming het. Navorsing is vinnig besig om uit te brei en alhoewel dit nog in die begin fase is, is dit belangrik vir geregistreerde dieetkundiges (GDs) om op hoogte te bly van die nuutste ontwikkelinge, aangesien dit die potensiaal het om 'n merkwaardige invloed op die dieetkunde praktyk te hê. Internasionale studies het lae selfvertroue en betrokkenheid, asook lae kennis van genetika en voeding genomika onder GDs bevind. Daar is tans geen studies beskikbaar onder Suid Afrikaanse (SA) GDs nie. Methodes: 'n Dwarssit studie is onderneem deur gebruik te maak van 'n nasionale opname van al 1881 dieetkundiges wat by die Health Professions Council of South Africa (HPCSA) geregistreer is. Data is ingesamel deur 'n gevalideerde self-geadministreerde vraelys wat ook begruik is vir 'n eenderse studie onder dieetkundiges in die Vereenigde Koninkryk (VK). Dit het bestaan uit vier afdelings om die volgende aspekte te evalueer: i) betrokkenheid en selfvertroue in aktiwiteite te make met genetika en voeding genomika ii) kennis van genetika en voeding genomika iii) faktore wat met kennis geassosieer word asook iv) demografiese inligting. Die hoof metode van data insameling was deur middel van epos (70%) met behulp van die Association for Dietetics in South Africa (ADSA) se epos databasis. Vraelyste is aan diegene gepos wat nie geregistreer was by ADSA nie (30%). Resultate: Vyftien persent (n = 279, 15.2%) van GDs het op die vraellys gereaggeer. Resultate het lae betrokkenheid in aktiwitiete met betrekking tot genetika (n = 47, 17%) en voeding genomika (n = 72, 25.8%) gewys. Die meerderheid van die deelnemers het lae selfvertroue gerapporteer in die uitvoering van aktiwiteite wat genetika (n = 161, 58.7%), asook voeding genomika (n = 148, 53.8%) behels. Daar was 'n statistiese beduidende positiewe assosiasie tussen betrokkenheid en selfvertroue vir alle aktiwiteite (p < 0.001). Die gemiddelde kennis telling was 48.5 (±19%) wat as laag beskou kan word. Die gemiddelde kennis vir genetika van 58.5 (± 24%) was statisties beduidend meer as die vir voeding genomika 31.9 (±23%), p < 0.001. Deelnemers wat betrokkenheid aangedui het in die bespreking van die genetiese basis van 'n siekte (p = 0.02); raadgewing aan pasiënte met genetiese siektes (p = 0.01); lewering van opleiding met betrekking tot genetika (p = 0.01) asook die bespreking van die interaksie van dieet en genetika met pasiënte en die invloed hiervan op risiko (p = 0.03), het ook beduidende hoër totale kennis gehad. Faktore wat met kennis geassosieer word is die genetika inhoud in voorgraadse studies (p < 0.001), hoër kwalifikasies (p = 0.01), voorgesette professionele onderrig (VPO) (p <0.001) asook diegene wat genetika as belangrik beskou vir dieetkunde praktyk (p = 0.03). Gevolgtrekking: Die resultate van hierdie studie wys dat daar oor die algemeen lae betrokkenheid, selfvertroue en kennis is van genetika en voeding genomika onder SA GDs. Dit vergelyk goed met international bevindinge. Aanbevelings is dat 'n raamwerk vir die kennis van genetika asook voeding genomika ontwikkel word vir voorgraadse dieetkunde studies, asook die ontwikkeling van VPO aktiwiteite wat die dryfkrag sal voorsien vir die ontwikkeling van hierdie veld in SA.

Orientador: Sergio Alberto Rupp de Paiva
Resumo: A gravidez é uma fase do ciclo de vida em que a nutrição desempenha um papel muito importante, uma vez que esta influência o produto da concepção. O objetivo deste estudo foi descrever o estado nutricional de gestantes do município de Botucatu que se localiza na região centro sul do estado de São Paulo, distando aproximadamente 230km da Capital. A população é predominantemente urbana. Foram estudadas 496 gestantes com idade de 13-43 anos submetidas a entrevista para obtenção de dados socioeconômicos, demográficos e dietéticos, e coleta de sangue. Dentre as mulheres 83% eram brancas. 30,5% de adolescente, a renda mostrou que 69% estava abaixo da linha de pobreza, a escolaridade mostrou 63% era baixa, 79% casada, 25% eram fumantes, 41% eram primigestas e 12% apresentaram positividade para o exame parasitológico. As medianas para as variáveis antropométricas (percentagem de gestantes abaixo do ponto de corte) foram para: peso pré gestacional-56,0 kg;(20), peso gestacional-58,1 kg (15); estatura -158 cm(9), índice de massa corpórea pré gestacional-22,0 kg/m2 (18,7), circunferência do braço-270 mm (8,0), prega tricipital-8,6 mm (4,0).O IMC, ainda detectou 17,5% acima da normalidade. O ganho de peso semanal foi 180 g, mostrando valores maiores nas gestantes com IMC abaixo da normalidade. As medianas da ingestão de nutrientes (percentagem de gestantes que ingerem menos que 100% do RDA) foram para : energia 2186 Kcal (73), proteína 64,5 g (42), vitamina A 647,6 mg (56), a tocoferol 4,3 mg (100), vitamina C 106,0 mg (30) e ferro 11,0 mg (99). Os exames bioquímicos mostraram as medianas (percentagem abaixo do ponto de corte): hemoglobina 13,0 g/dL (3),ferro 92mg/dL (13), saturação da transferrina... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Pregnancy is a life cycle where nutrition plays an important role once it influences the product of conception. This study aimed to describe nutritional status of pregnant women in Botucatu located in the southern part of the State of São Paulo, 230 km far from the capital (São Paulo City). Population is predominantly an urban one. Pregnant women (496) between 13 and 43 years old were studied and subjected to interviews to obtain social, economic, demographic, dietetic data a well as blood sampling. Within the women 83% were white, 30.5% adolescents and the income showed that 69% were down poverty line, education was low 63%; 79% were married, 25% were smokers, 41% were pregnant for the first time, and 12% were positive for parasitological exam. Medians and anthropometric variables (percentage of pregnant women below cut point) were: pre-gestational weight - 56.0 kg (20) gestational weight - 58.1 kg (15) height 158 cm (9) ; pre-gestational body mass index 22.0 kg/m2 (15.o); arm circumference 270 mm (8.0); tricipital fold 18.6 mm (4.0) . BMI also detected 15.5% above normality. Weekly weight gain was 180g, with higher values on below normal BMI pregnant women. Nutrients intake medians (percentage of pregnant women who intake less than 100 % of RDA) was: energy 2186 Kcal (73), protein 64.5g (42) , vitamin A 647.mg (56), a- tocopherol 4.3 mg (100), vitamin C 106.0 mg (30) and iron 11.0 mg (99). Biochemical examinations showed medians (percentage below cut point) : hemoglobin 13.0 g/dL (3), iron 92 μ/dL (13), transferrin saturation 30.0% (8), ferritine... (Complete abstract click electronic access below)
Mestre

Nutritional aspects of size-related sex differences in the diets of free-living mink were investigated in laboratory-based feeding trials with adult farm-bred mink maintained on 'natural' diets. As preliminary studies had shown that carcase utility was virtually complete, the rations presented comprised the minced whole carcasses of wild rabbit Oryctolagus cunniculus, eel Anquilla anguilla, laboratory rats and mice, and domestic fowl. Determinations of gross composition revealed significant differences between these diets; the smaller prey types, including rodents, birds and fish, were found to have a higher ratio of Apparent Digestible Energy to Nitrogen than larger items such as rabbits, although comparisons with data presented by other workers demonstrated that the variations between species within these prey groups are as great as, or greater than, those between the diets themselves. From the results of the feeding trials, it was also apparent that such diets do not differ significantly, either in digestibility or biological value and attempts to classify particular prey items in terms of their nutritional value are, therefore, of limited application in analyses of the feeding ecology of a generalist predator. Nutrient intake was related to diet composition and varied widely between trials, although the mass-specific requirements of females were higher than those of males. Comparisons of gut morphology indicated that, in females, hypertrophy of the alimentary tract may develop in response to increased energy demands. A similar adaptation was evident in both males and females from wild populations, suggesting that the natural diets of free-living mink are generally of a lower quality than the rations fed to commercially raised animals. Feeding trials were also carried out on growing kits from 56 to 105 days post partum. Sex differences in nutrient metabolism were not significant but the growth rates of males were higher than those of females. In both sexes the growth rates of kits feeding on 'natural' diets were lower than those of animals raised on commercial rations. This effect was most pronounced in males, a finding which supports the hypothesis that the degree of sexual dimorphism in this species is dependent on the extent to which the growth potential of males is constrained by dietary regime during the early phases of development.

Minimally processed fruit (MPF) are products that have to maintain their quality similar to those of fresh ones. Being metabolic active tissues, they show physical and physiological response to minimal processing (wounding), that negatively influence their shelf-life. In the last decades, novel non-thermal processing methods have attracted the interest of food scientists, industries and consumers as technologies useful for shelf-life extension or increasing product functionality, with a minimal impact on the nutritional and sensory properties of foods. The main aim of this PhD thesis was to investigate qualitative, metabolic and nutritional aspects of different MPF, submitted to traditional and innovative non-thermal processes. This issue was addressed considering the product as a dynamic system, both in terms of endogenous physiological activity and porous matrix interacting with the surrounding ambient (during processing and storage), through the application of multi-analytical approach. The most consistent results related to the applied non-thermal techniques confirmed their different potentiality in the optic of processing and product innovation, but the need of their modulation in relation to the different raw material susceptibility to degradation and final product target. Cold plasma treatment effects on fresh-cut fruit, characterized by different kind of stability criticisms, resulted mainly bound to the inactivation of degradative enzymes and microbial cells, without evidencing functional modifications in the final products. The study of osmotic dehydration and vacuum impregnation highlighted as these techniques can be successfully applied for cold formulation/enrichment of MPF, but also the necessity to carefully account for the metabolic and structural modifications induced by the processing on the vegetable tissues. An induction of metabolic stress response was also evidenced as a consequence of pulsed electric fields treatment related to electric field strength. Below the threshold limit of irreversible damages to cell membranes, the treatment promoted only slight and reversible modifications of the metabolic profiles.

Minimally processed fruit (MPF) are products that have to maintain their quality similar to those of fresh ones. Being metabolic active tissues, they show physical and physiological response to minimal processing (wounding), that negatively influence their shelf-life. In the last decades, novel non-thermal processing methods have attracted the interest of food scientists, industries and consumers as technologies useful for shelf-life extension or increasing product functionality, with a minimal impact on the nutritional and sensory properties of foods. The main aim of this PhD thesis was to investigate qualitative, metabolic and nutritional aspects of different MPF, submitted to traditional and innovative non-thermal processes. This issue was addressed considering the product as a dynamic system, both in terms of endogenous physiological activity and porous matrix interacting with the surrounding ambient (during processing and storage), through the application of multi-analytical approach. The most consistent results related to the applied non-thermal techniques confirmed their different potentiality in the optic of processing and product innovation, but the need of their modulation in relation to the different raw material susceptibility to degradation and final product target. Cold plasma treatment effects on fresh-cut fruit, characterized by different kind of stability criticisms, resulted mainly bound to the inactivation of degradative enzymes and microbial cells, without evidencing functional modifications in the final products. The study of osmotic dehydration and vacuum impregnation highlighted as these techniques can be successfully applied for cold formulation/enrichment of MPF, but also the necessity to carefully account for the metabolic and structural modifications induced by the processing on the vegetable tissues. An induction of metabolic stress response was also evidenced as a consequence of pulsed electric fields treatment related to electric field strength. Below the threshold limit of irreversible damages to cell membranes, the treatment promoted only slight and reversible modifications of the metabolic profiles.

Women with exercise associated amenorrhea display a disturbance in basal and exercise levels of reproductive, anti-reproductive and stress hormones. Co-incident with chronic exercise are other factors, which alone, also affect the menstrual cycle. Therefore, amenorrheic runners (AR), regularly menstruating runners (RMR) and regularly menstruating sedentary controls (RMSC) were compared for plasma progesterone levels, plasma lipid levels, menstrual cycle characteristics, physical characteristics and nutritional adequacy to determine if the difference in menstrual status could be explained, and to determine whether exercise alone could be attributed as the cause of menstrual cycle disturbances.Plasma progesterone levels were significantly lower in the AR group (. 28 + .02 ng/ml) than in the RMR group (.41 + .06 ng/ml) and the RMSC group (.49 + .06 ng/ml) in the follicular phase. Regularly menstruating runners demonstrated lower plasma progesterone levels in the luteal phase (9.76 + 1.05 ng/ml) than RMSC subjects (10.24 + 2.21 ng/ml). Regularly menstruating runners had a significantly shorter luteal phase length relative to their cycle length (.35 + .01) than RMSC subjects (.46 + .01). Mean age, incidence of parity, age of menarche, height, weight, body composition, max V02 and number of miles run per week did not differ between the RMR and AR subjects. Amenorrheic runners took in significantly less fat, red meat, phosphorous and total calories than the RMR subjects. Serum LDL-C was significantly higher in the AR subjects (89.2 + 9.7 mg/dl) than in the RMR subjects in both the luteal (67.8+ 3.4 mg/dl) and follicular (66.8+ 5.6 mg/dl) phases. Serum HDL-C was significantly higher in the RMR subjects in both the luteal (62.9+ 4.1 mg/dl) and follicular (59.2+ 2.9 mg/dl) phase, and in the AR subjects (63.9+ 4.2 mg/dl), than in the RMSC subjects in the luteal (49.2+ 5.9 mg/dl) and follicular (47.2+ 2.4 mg/dl) phase. Serum VLDL-C did not differ between any groups.This investigation demonstrates that hormonal and lipid level alterations with exercise are significantly different in the amenorrheic runner. However, regularly menstruating runners display alterations which may represent and intermediate or potential phase of menstrual cycle disturbances. The nutritional inadequacy or energy imbalance separates amenorrheic runners from regularly menstruating runners. Thus, it appears that exercise alone is not enough to cause the hormonal disturbances that trigger amenorrhea, and, that exercise associated amenorrhea is not unlike other amenorrheas of hypothalamic origin.

The purpose of this investigation was to examine the seasonal change in the nutritional protein status of adolescent wrestlers who lost weight for competition. Additionally, this study determined if changes in plasma proteins and amino acids could be prevented through nutritional education and dietary supplementation. Twenty-seven adolescent wrestlers (14.8-18.1 yr) were divided into two groups for study during a three month period. One group received a nutritional education and supplement program, the other group served as a control. Height, weight, percent body fat, and free fat weight were measured during wrestling season. Venous blood samples were drawn and analyzed for essential (E) and nonessential (NE) plasma amino acids, hemoglobin (Hb), hematocrit (Hct), retinol-binding protein (RBP), prealbumin (PA), albumin (AL), and blood urea nitrogen (BUN). Four, 4-day dietary records taken during the season were analyzed for protein, carbohydrate, fat, and total calories. The results demonstrated that weight, percent body fat, and fat free weight decreased significantly during the experimental period (p<0.001), with no significant differences between treatment and control groups. The blood RBP and PA decreased significantly during the experimental period (p<0.01), whereas AL didNot change. Most of the amino acids did not show significant decreases during the experimental period whereas the total essential amino acids showed a decreasing trend (p<0.05), the total nonessential amino acids did not change. The subjects' average caloric intake showed significant decreases during the experimental period (p<0.001). The wrestlers failed to meet the RDA for energy and protein intake. It was concluded that nutritional status of adolescent wrestlers appears to be diminished as a result of weight loss during the season.
Human Performance Laboratory

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2006.
INTRODUCTION: Postmenopausal osteoporosis is associated with significant morbidity, mortality, reduction in quality of life, and increasing health care costs OBJECTIVE: The study objective was to identify the risk factors associated with the occurrence of osteoporosis, in Kenyan Asian women seen at the Aga Khan University Hospital, Nairobi, Kenya since there is no literature on the prevalence of all these risk factors for osteoporosis in a similar middle aged population sample of Kenyan Asian women. METHOD: The study was of a retrospective design and used recall as a basis of data collection. A socio-demographic questionnaire was completed and anthropometric measurements, of height, weight, waist and hip circumference taken. Bone mineral density (BMD) had been measured previously using Quantitative Computed Tomography (QCT) at the lumbar spine, T11 to L4. Nutrient intake was assessed using a validated food frequency questionnaire (FFQ) and physical activity was determined using the Epic Physical Activity Questionnaire 2 (EPAQ2). BMD scans had been done on all study participants from January 2004 to December 2004 and the subjects were aware of their bone status. RESULTS: Risk factors that were identified by being associated with the development of osteoporosis in Asian women were age (p<0.001), waist size (p<0.001), hip size (p<0.001) and BMI (p<0.001), low physical activity (p=0.001) and use of prescription drugs. Seventy two percent of the study sample was using prescription drugs and the effect on bone mass was most likely detrimental. Anti-hypertensive (p=0.002), non steroidal anti inflammatory drugs (p=0.003) and anti-diabetic drugs (p=0.033) had a significant negative association with bone health. Energy, protein, fat and carbohydrate intake in all the groups was above the EAR and comparatively similar. The intake of all the micronutrients in the study group was above the DRI. There were no statistical significant differences in most of the trace element intake between the two groups, apart from iodine, biotin and manganese. No dietary risk factors were identified which impacted adversely on bone health in this group. The impact of gynaecologic history (parity, oral contraceptive use, age of menarche) on BMD was uncertain. The educational level of the study sample was high as 50% of the subjects were graduates and had a relatively better diet. CONCLUSION: As Kenyan Asian women age they experience the menopausal transition and the risk of developing osteoporosis increases. No nutritional factors were identified that were adversely associated with BMD. Low level of physical activity, prescription drugs for chronic diseases like hypertension, asthma, diabetes and arthritis, age, weight and body mass index were identified and found to be adversely associated with bone mineral density. Early detection, and implementation of patient education, physical activity, and a diet rich in all nutrients, will help to slow down the progression of osteoporosis.

Bone marrow transplantation (BMT) involves the use of maximal doses of chemotherapy and total body irradiation. As a result, even well-nourished patients exhibit negative nitrogen balance and hypoproteinemia in the post-transplant period, despite a high energy and protein intake from Total Parenteral Nutrition (TPN). The purpose of this research was to investigate the impact of cytotoxic therapy, with a view toward explaining and improving the response to nutritional support. Stool, urine and serum biochemistry were studied prospectively in 10 BMT patients. Analysis of stool revealed increased sodium and decreased potassium. Examination of serum electrolytes indicated hyponatremia and hyperkalemia. A significant decrease in nitrogen balance, serum albumin and net protein utilization immediately followed the disturbances in serum electrolytes; improvement began as serum sodium and potassium returned to normal. Thus, electrolyte imbalance may have reduced the capacity of cells to utilize nitrogen. Lowering the volume of TPN dramatically decreased serum electrolyte aberrations and improved nitrogen utilization.

Acquired Immune Deficiency Syndrome (AIDS) and impaired or threatened nutritional status seem to be closely related. It is now known that AIDS results in many nutritional disorders including anorexia, vomiting, protein-energy malnutrition (PEM), nutrient deficiencies, and gastrointestinal, renal, and hepatic dysfunction (1-7, 8). Reversibly, nutritional status may also have an impact on the development of AIDS among HIV-infected people. Not all individuals who have tested antibody positive for the Human Immunodeficiency Virus (HIV) have developed AIDS or have even shown clinical symptoms (9, 10). A poor nutritional status, especially PEM, has a depressing effect on immunity which may predispose an individual to infection (11). It has been proposed that a qualitatively or quantitatively deficient diet could be among the factors precipitating the transition from HIV-positive to AIDS (12, 13). The interrelationship between nutrition and AIDS reveals the importance of having a multidisciplinary health care team approach to treatment (11), including having a registered dietitian on the medical team. With regards to alimentation, the main responsibility of a dietitian is to inform the public concerning sound nutritional practices and encourage healthy food habits (14). In individuals with inadequate nutritional behavior, a positive, long-term change has been seen when nutrition education tailored to specific physiological and emotional needs was provided along with psychological support through counseling (14). This has been the case for patients with various illnesses and may also be true in AIDS patients as well. Nutritional education specifically tailored for each AIDS patient could benefit the patient by improving the quality of life and preventing or minimizing weight loss and malnutrition (15-17). Also, it may influence the progression of the disease by delaying the onset of the most severe symptoms and increasing the efficacy of medical treatment (18, 19). Several studies have contributed to a dietary rationale for nutritional intervention in HIV-infected and AIDS patients (2, 4, 20-25). Prospective, randomized clinical research in AIDS patients have not yet been published to support this dietary rationale; however, isolated case reports show its suitability (3). Furthermore, only nutrition intervention as applied by a medical team in an institution or hospital has been evaluated. Research is lacking concerning the evaluation of nutritional education of either non-institutionalized or hospitalized groups of persons who are managing their own food choice and intake. This study compares nutrition knowledge and food intakes in HIV-infected individuals prior to and following nutrition education. It was anticipated that education would increase the knowledge of nutritional care of AIDS patients and lead to better implementation of nutrition education programs.

There is accumulating evidence on differences in the link between types of dairy products and cardio-metabolic health, but inconsistent findings limit the field. In my PhD project, I undertook an epidemiological investigation comprising inter-related but distinct themes evaluating aspects of nutritional, molecular and genetic epidemiology to advance scientific understanding. I undertook research to describe dairy consumption patterns over time by evaluating nationally-representative data of the United Kingdom National Diet and Nutrition Survey. I observed significant time trends for specific dairy types and groups, which were different among different groups of people e.g. adults younger than 65 years or elderly people. Using data from the large Fenland (n~12,000) and EPIC Norfolk (n~25,000) studies, I investigated associations of total and types of dairy consumption with markers of metabolic risk and adiposity as potential pathways to cardio-metabolic disease. The analyses showed differential associations of dairy types and groups mainly with markers of adiposity and lipidaemia. I explored the potential of objective markers to assess dairy consumption, by examining metabolomics profiles and blood fatty acids to identify a set of biomarkers predicting dairy consumption and prospective associations of the identified biomarkers with type 2 diabetes risk. I was able to develop and validate metabolite scores reflecting consumption of some dairy products and observed inverse associations between some of these scores and type 2 diabetes incidence. I analysed genetic determinants of dairy consumption, using a genome-wide association study in the UK Biobank (n~500,000) and identified single nucleotide polymorphisms predicting milk, cheese and total dairy consumption. Overall, this PhD work contributed towards (1) a more precise description of dairy consumption patterns in the UK, (2) hypothesis formulation for potential biological pathways linking to cardio-metabolic disease, (3) discovery of metabolite scores as potential dairy biomarkers and (4) hypothesis formulation for potential genetic predictors of dairy consumption.