Resposta à restrição calórica por meio de uma intervenção dietética para redução de peso em mulheres obesas portadoras de polimorfismos dos genes ADRB2, ADRB3 e GHRL

Orientadora : Profª Drª Lupe Furtado AlleTese (doutorado) - Universidade Federal do Paraná, Setor de Ciências Biológicas, Programa de Pós-Graduação em Genética. Defesa: Curitiba, 09/05/2014Inclui referênciasÁrea de concentração :GenéticaResumo: Ainda que as formas de tratamento da obesidade estejam estabelecidas, existe uma variação interindividual na resposta aos tratamentos, assim, genes relacionados à obesidade, os chamados genes candidatos à obesidade e seus polimorfismos, tem sido investigados visando esta compreensão. O objetivo deste estudo foi investigar a resposta à restrição calórica por meio de uma intervenção dietética em mulheres portadoras e não-portadoras de polimorfismos dos genes ADRB2, ADRB3 e GHRL sobre parâmetros antropométricos e bioquímicos. Foi realizada restrição calórica por meio de uma intervenção dietética para perda de peso, com desenho quasi-experimental em adultas obesas (n=120). Foram coletados dados de peso e estatura, para cálculo de índice de massa corpórea (IMC), de circunferência da cintura, colesterol total, colesterol da LDL, colesterol da HDL e triglicérides. Foram analisados os polimorfismos Arg16Gly e Gln27Glu do gene ADRB2; Trp64Arg do gene ADRB3 e Leu72Met do gene GHRL por genotipagem TaqMan . Para testar o efeito dos polimorfismos sobre as variáveis de estudo, foi utilizado o análise de variância ANOVA 2 x 2 para medidas repetidas para o IMC, e regressão logística stepwise forward conditional para as demais variáveis. Para avaliar a diferença entre antes e após a intervenção dietética foi utilizado o teste de Wilcoxon. Para comparação das médias da circunferência da cintura e do perfil lipídico entre os grupos na pré e na pós-intervenção foi utilizado o teste U de Mann-Whitney. Valores <0,05 foram considerados significantes. Na análise longitudinal, verificando o efeito dos polimorfismos, não foi identificada resposta diferente à restrição calórica para as portadoras e não-portadoras dos polimorfismos Arg16Gly e Gln27Glu do gene ADRB2; Trp64Arg do gene ADRB3 e Leu72Met do gene GHRL sobre o IMC, circunferência da cintura, colesterol, HDL-C, LDL-C, e triglicérides plasmáticos. A intervenção dietética reduziu o IMC (p< 0.001), a circunferência da cintura (p<0,001), o colesterol (p=0,003) e o HDL-C (p<0,001), entretanto, uma média maior de redução para o colesterol foi encontrada para as portadoras do polimorfismo Arg16Gly (p=0.015) e Gln27Glu (p=0.046) e para as não-portadoras do Leu72Met (p=0.002). Analisando a variabilidade interindividual (ANOVA), a comparação das médias entre portadoras e não-portadoras, apontou que as portadoras do polimorfismo Gln27Glu apresentaram média do IMC menor (p=0.006). Na análise transversal, a média dos triglicérides para as portadoras do polimorfismo Arg16Gly foi maior tanto na pré (p=0,014) quanto na pós-intervenção (p=0,018). Concluindo, não foi identificado efeito dos polimorfismos Arg16Gly e Gln27Glu do gene ADRB2, Trp64Arg do gene ADBR3 e Leu72Met do gene GHRL sobre IMC, circunferência da cintura, colesterol, HDL-C, LDL-C e triglicérides. Entretanto, os dados encontrados sugerem que os polimorfismos Arg16Gly, Gln27Glu e Leu72Met tem algum efeito sobre o metabolismo lipídico e o controle de peso. A intervenção dietética reduziu o IMC, a circunferência da cintura, o colesterol e o HDL-C. Palavras-chave: Obesidade. Redução de peso. Polimorfismos. ADRB2. ADRB3. GHRL. Nutrigenética.Abstract: Although the obesity treatment is well established, there is an interindividual variation to the response, thus, genes and polymorphisms related to obesity have been studied. The aim of this study was to assess the answer to a caloric restriction in women carriers and non-carriers of the ADRB2, ADRB3 and GHRL gene polymorphisms over biochemical and anthropometrical parameters. This study was a caloric restriction through a dietary intervention for weight loss with 120 obese adult women. The study design was a quasi-experimental intervention. Height was measured at pre-intervention, and waist circumference and weight at pre-intervention and post-intervention. The body mass index (BMI) was calculated. Blood samples were collected from participants to analyze cholesterol, triacylglycerol, HDL-C, LDL-C and for DNA analyses. Genotyping of ADRB2 (Arg16Gly and Gln27Glu), ADRB3 (Trp64Arg) and GHRL (Leu72Met) polymorphisms were achieved using a TaqMan SNP Genotyping Assay. Two-way repeated-measures ANOVA (2 x 2) were used to analyze the intervention effect between polymorphisms and the BMI over the period - two groups (carrier and non-carrier subjects) for each polymorphism (Arg16Gly, Gln27Glu, Trp64Arg and Leu72Met) and two periods (pre-intervention and postintervention) - analyzing the effect of period, group, and the interaction between period and group. To asses the polymorphisms effect over waist circumference and lipid profile variables it was used stepwise forward conditional. The difference of the parameters between pre and post intervention was assessed by Wilcoxon test, and the difference between groups for waist circumference and lipid profiles, was assessed by Mann-Whitney U test. For all statistical analyses p <0.05 was considered significant. There was no difference between any polymorphisms carriers and non-carrieres for any parameter. The weight loss intervention reduced the BMI (p< 0.001), waist circumference (p<0,001), cholesterol (p=0,003) and HDL-C (p<0,001). However, the medium difference for cholesterol pre and post intervention for the Arg16Gly, Gln27Glu carriers and Leu72Met non-carriers was greater. Comparing the differences between groups (cross-sectional assessment), the Arg16Gly carriers have shown a greater mean for triacylglycerol. Although in this study the polymorphism Arg16Gly, Gln27Glu, Trp64Arg and Leu72Met carriers and non-carriers did not respond differently to the weight loss diet intervention, the results suggest that Arg16Gly, Gln27Glu and Leu72Met polymorphisms may have a role related to lipid metabolism and weight control. Key-words: Obesity. Weight loss. ADRB2. ADRB3. GHRL. Polymorphism. Nutrigenetics

Estado nutricional relativo a ferro e zinco de atletas profissionais de uma equipe feminina brasileira de voleibol

Dissertação (mestrado) - Universidade Federal de Santa Catarina. Centro de Ciências da Saúde. Prograrma de Pós-Graduação em NutriçãoOs atletas estão sob risco de desenvolverem carências de micronutrientes, em especial as atletas do sexo feminino. Dentre os minerais importantes para o metabolismo do exercício e desempenho do atleta, estão o ferro e o zinco, pouco estudados em atletas profissionais, notadamente de voleibol. O objetivo deste trabalho foi avaliar o estado nutricional relativo ao zinco (no plasma e no eritrócito) e ao ferro (ferritina sérica, hemoglobina e hematócrito) de 12 atletas profissionais do voleibol feminino. O consumo alimentar de zinco, ferro, calorias, proteína, carboidrato e lipídeo, foi analisado utilizando-se o registro alimentar de 3 dias e posterior análise em software de avaliação de dieta. Em relação a concentração de zinco no plasma, 100% das atletas não apresentaram deficiência. Quanto ao zinco no eritrócito, 100 % das atletas apresentaram valores abaixo da faixa de normalidade. A avaliação quanto ao estado nutricional de ferro não mostrou nenhuma atleta com depleção dos estoques de ferro, porém apresentou 4 atletas com anemia esportiva, caracterizada por baixos níveis de hemoglobina e hematócrito. Em relação à ingestão alimentar de zinco, 1 atleta não atingiu a recomendação, e quanto ao ferro, 4 atletas apresentaram consumo insuficiente deste mineral. A análise da ingestão de macronutrientes apresentou consumo de carboidratos abaixo recomendação mínima para 10 atletas e quanto a proteína, 6 atletas excederam a recomendação. Quanto aos lipídeos, 7 atletas apresentaram ingestão abaixo da recomendação diária. A escassez de pesquisas avaliando zinco no eritrócito, principalmente em atletas, dificulta a compreensão dos dados encontrados. Os resultados encontrados da análise das dietas, podem refletir a preocupação com o controle e prevenção de aumento de massa gorda ou a própria falta de hábitos alimentares adequados

The power of partnerships: State public health department multisector collaborations in major chronic disease programme areas in the United States

BACKGROUND: Multisector collaboration between state public health departments (SHDs) and diverse community partners is increasingly recognized as important for promoting positive public health outcomes, addressing social determinants of health, and reducing health inequalities. This study investigates collaborations between SHDs in the United States and different types of organizations addressing chronic disease in and outside of the health sector. METHODS: SHD employees were randomly selected from the National Association of Chronic Disease Directors membership list for participation in an online survey. Participants were asked about their primary chronic disease work unit (cancer, obesity, tobacco, diabetes, cardiovascular disease, and others), as well as their work unit collaborations (exchange of information/cooperation in activities) with organizations in health and non-health sectors. As a measure of the different organizations SHDs collaborated with in health and non-health sectors, a collaboration heterogeneity score for each programme area was calculated. One-way analysis of variance (ANOVA) with Tukey\u27s post hoc tests were used to assess differences in collaborator heterogeneity between programme areas. RESULTS: A total of 574 participants were surveyed. Results indicated that the cancer programme area, along with diabetes and cardiovascular disease, had significantly less collaboration heterogeneity with organizations outside of the health sector compared to the obesity and tobacco programme areas. CONCLUSIONS: While collaborations with health sector organizations are commonly reported, public health departments can increase collaboration with sectors outside of health to more fully address chronic disease prevention

Leading the way: Competencies of leadership to prevent mis-implementation of public health programs

Public health agencies are increasingly concerned with ensuring that they are maximizing limited resources by delivering effective programs to enhance population-level health outcomes. Preventing mis-implementation (ending effective activities prematurely or continuing ineffective ones) is necessary to sustain public health efforts and resources needed to improve health and well-being. The purpose of this paper is to identify the important qualities of leadership in preventing mis-implementation of public health programs. In 2019, 45 state health department chronic disease employees were interviewed via phone and audio-recorded, and the conversations were transcribed verbatim. Thematic analysis focused on items related to mis-implementation and the manners in which leadership were involved in continuing ineffective programs. Final themes were based on a Public Health Leadership Competency Framework. The following themes emerged from their interviews regarding the important leadership competencies to prevent mis-implementation: \u27(1) leadership and communication; (2) collaborative leadership (3) leadership to adapt programs; (4) leadership and organizational learning and development; and (5) political leadership\u27. This first of its kind study showed the close interrelationship between mis-implementation and leadership. Increased attention to public health leader competencies might help to reduce mis-implementation in public health practice and lead to more effective and efficient use of limited resources

It\u27s good to feel like you\u27re doing something : A qualitative study examining state health department employees\u27 views on why ineffective programs continue to be implemented in the USA

BACKGROUND: Mis-implementation, the inappropriate continuation of programs or policies that are not evidence-based or the inappropriate termination of evidence-based programs and policies, can lead to the inefficient use of scarce resources in public health agencies and decrease the ability of these agencies to deliver effective programs and improve population health. Little is known about why mis-implementation occurs, which is needed to understand how to address it. This study sought to understand the state health department practitioners\u27 perspectives about what makes programs ineffective and the reasons why ineffective programs continue. METHODS: Eight state health departments (SHDs) were selected to participate in telephone-administered qualitative interviews about decision-making around ending or continuing programs. States were selected based on geographic representation and on their level of mis-implementation (low and high) categorized from our previous national survey. Forty-four SHD chronic disease staff participated in interviews, which were audio-recorded and transcribed verbatim. Transcripts were consensus coded, and themes were identified and summarized. This paper presents two sets of themes, related to (1) what makes a program ineffective and (2) why ineffective programs continue to be implemented according to SHD staff. RESULTS: Participants considered programs ineffective if they were not evidence-based or if they did not fit well within the population; could not be implemented well due to program restraints or a lack of staff time and resources; did not reach those who could most benefit from the program; or did not show the expected program outcomes through evaluation. Practitioners described several reasons why ineffective programs continued to be implemented, including concerns about damaging the relationships with partner organizations, the presence of program champions, agency capacity, and funding restrictions. CONCLUSIONS: The continued implementation of ineffective programs occurs due to a number of interrelated organizational, relational, human resources, and economic factors. Efforts should focus on preventing mis-implementation since it limits public health agencies\u27 ability to conduct evidence-based public health, implement evidence-based programs effectively, and reduce the high burden of chronic diseases. The use of evidence-based decision-making in public health agencies and supporting adaptation of programs to improve their fit may prevent mis-implementation. Future work should identify effective strategies to reduce mis-implementation, which can optimize public health practice and improve population health

Program adaptation by health departments

INTRODUCTION: The dissemination of evidence-based interventions (i.e., programs, practices, and policies) is a core function of US state health departments (SHDs). However, interventions are originally designed and tested with a specific population and context. Hence, adapting the intervention to meet the real-world circumstances and population\u27s needs can increase the likelihood of achieving the expected health outcomes for the target population from the implemented intervention. This study identified how SHD employees decide to adapt public health programs and what influences decisions on how to adapt them. MATERIALS AND METHODS: SHD employees ( RESULTS: Data, outcomes, and health department evaluations influenced decisions to adapt a program (pre-adaptation), and reasons to adapt a program included organizational and sociopolitical contextual factors. SHD middle-level managers, program managers and staff, and local agencies were involved in the decisions to adapt the programs. Finally, the goals for adapting a program included enhancing effectiveness/outcomes, reach and satisfaction with the program; funding; and partner engagement. After SHD employees decided to adapt a program, data and evidence guided the changes. Program staff and evaluators were engaged in the adaptation process. Program managers consulted partners to gather ideas on how best to adapt a program based on partners\u27 experiences implementing the program and obtaining community input. Lastly, program managers also received input on adapting content and context from coalition meetings and periodic technical assistance calls. DISCUSSION: The findings related to decisions to adapt public health programs provide practitioners with considerations for adapting them. Findings reaffirm the importance of promoting public health competencies in program evaluation and adaptation, as well as systematically documenting and evaluating the adaptation processes. In addition, the themes could be studied in future research as mechanisms, mediators, and moderators to implementation outcomes

Approaches for ending ineffective programs: Strategies from state public health practitioners

Background: Public health agencies are increasingly concerned with ensuring they are maximizing limited resources by delivering evidence-based programs to enhance population-level chronic disease outcomes. Yet, there is little guidance on how to end ineffective programs that continue in communities. The purpose of this analysis is to identify what strategies public health practitioners perceive to be effective in de-implementing, or reducing the use of, ineffective programs.Methods: From March to July 2019, eight states were selected to participate in qualitative interviews from our previous national survey of US state health department (SHD) chronic disease practitioners on program decision making. This analysis examined responses to a question about “…advice for others who want to end an ineffective program.” Forty-five SHD employees were interviewed via phone. Interviews were audio-recorded, and the conversations were transcribed verbatim. All transcripts were consensus coded, and themes were identified and summarized.Results: Participants were program managers or section directors who had on average worked 11 years at their agency and 15 years in public health. SHD employees provided several strategies they perceived as effective for de-implementation. The major themes were: (1) collect and rely on evaluation data; (2) consider if any of the programs can be saved; (3) transparently communicate and discuss program adjustments; (4) be tactful and respectful of partner relationships; (5) communicate in a way that is meaningful to your audience.Conclusions: This analysis provides insight into how experienced SHD practitioners recommend ending ineffective programs which may be useful for others working at public health agencies. As de-implementation research is limited in public health settings, this work provides a guiding point for future researchers to systematically assess these strategies and their effects on public health programming

Understanding misimplementation in U.S. state health departments: An agent-based model

INTRODUCTION: The research goal of this study is to explore why misimplementation occurs in public health agencies and how it can be reduced. Misimplementation is ending effective activities prematurely or continuing ineffective ones, which contributes to wasted resources and suboptimal health outcomes. METHODS: The study team created an agent-based model that represents how information flow, filtered through organizational structure, capacity, culture, and leadership priorities, shapes continuation decisions. This agent-based model used survey data and interviews with state health department personnel across the U.S. between 2014 and 2020; model design and analyses were conducted with substantial input from stakeholders between 2019 and 2021. The model was used experimentally to identify potential approaches for reducing misimplementation. RESULTS: Simulations showed that increasing either organizational evidence-based decision-making capacity or information sharing could reduce misimplementation. Shifting leadership priorities to emphasize effectiveness resulted in the largest reduction, whereas organizational restructuring did not reduce misimplementation. CONCLUSIONS: The model identifies for the first time a specific set of factors and dynamic pathways most likely driving misimplementation and suggests a number of actionable strategies for reducing it. Priorities for training the public health workforce include evidence-based decision making and effective communication. Organizations will also benefit from an intentional shift in leadership decision-making processes. On the basis of this initial, successful application of agent-based model to misimplementation, this work provides a framework for further analyses

Implementation of Flexibilities to the National School Lunch and Breakfast Programs and Their Impact on Schools in Missouri

Background: In 2018, the United States Department of Agriculture (USDA) issued flexibilities to the National School Lunch and Breakfast Programs, relaxing the nutrition standards for milk, whole grains, and sodium. This study examines the implementation decision-making among Missouri school food services and the impact of implementing these flexibilities on the meals served. Methods: We developed a survey using the Consolidated Framework of Implementation to determine schools&rsquo; implementation of the flexibilities and factors related to implementation. To determine how the implementation of flexibilities affected participation, we merged the survey results with school-level meal county data from the Missouri Department of Elementary and Secondary Education. We used ordinary least squares regression to examine how flexibility adoption related to the number of meals served. Results: Most schools implemented the wheat, milk, and sodium flexibilities. Common reasons for implementation were increasing participation, meeting students&rsquo; preferences, expanding menu variety, and saving money. The implementation of flexibilities was associated with more lunches and breakfasts being served per month, particularly among free and reduced-price meals. Conclusions: Continued research is needed to determine how the increased uptake of school meals that do not fully meet dietary guidelines by low-income students results in inequities in health outcomes. The findings can inform the design and implementation of future policies, especially as new rules related to flexibility design are determined

Effects of energetic restriction diet on butyrylcholinesterase in obese women from southern Brazil – A longitudinal study

Objective Butyrylcholinesterase (BChE) activity has been associated with obesity, lipid concentrations, and CHE2 locus phenotypes. This, the aim of this study was to evaluate the effects of an energetic restriction diet intervention on anthropometrical and biochemical variables and on absolute and relative BChE activity in CHE2 C5+ and CHE2 C5- individuals. Subjects and methods One hundred eleven premenopausal obese women from Southern Brazil participated in an energetic restriction diet intervention (deficit of 2500 kJ/day) for 8 weeks. Their anthropometric and biochemical parameters were evaluated before and after the intervention. Plasma BChE activity was measured, and BChE bands in plasma and CHE2 locus phenotypes were detected by electrophoresis. Results The dietetic intervention decreased anthropometric and biochemical parameters as well as absolute BChE activity and relative activity of the G4 band. The CHE2 C5+ phenotype presented a different effect when compared with the CHE2 C5- phenotype. The CHE2 C5+ phenotype showed an effect in absolute BChE activity and in the relative activity of the G4 form, maintaining higher BChE activity regardless of the metabolic changes. Conclusion In our study, 8 weeks was not sufficient time to lower the body mass index to normal, but it was enough to significantly reduce the absolute BChE activity, which became similar to the levels in nonobese individuals. CHE2 C5+ individuals were resistant to the decrease in BChE activity compared to CHE2 C5- individuals. This shows that the diet did not affect the CHE2 and G4 fraction complex and that the products of the CHE2 locus in association with BChE have a role in energy metabolism, maintaining high levels of enzymatic activity even after dietary intervention