Effects of Obesity and Weight Loss Following Bariatric Surgery on Brain Function, Structural Integrity and Metabolism

Obesity is one of the key challenges to health care system worldwide and its prevalence is estimated to rise to pandemic proportions. Numerous adverse health effects follow with increasing body weight, including increased risk of hypertension, diabetes, hypercholesterolemia, musculoskeletal pain and cancer. Current evidence suggests that obesity is associated with altered cerebral reward circuit functioning and decreased inhibitory control over appetitive food cues. Furthermore, obesity causes adverse shifts in metabolism and loss of structural integrity within the brain. Prior cross-sectional studies do not allow delineating which of these cerebral changes are recoverable after weight loss. We compared morbidly obese subjects with healthy controls to unravel brain changes associated with obesity. Bariatric surgery was used as an intervention to study which cerebral changes are recoverable after weight loss. In Study I we employed functional magnetic resonance imaging (fMRI) to detect the brain basis of volitional appetite control and its alterations in obesity. In Studies II-III we used diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) to quantify the effects of obesity and the effects of weight loss on structural integrity of the brain. In study IV we used positron emission tomography (PET) with [18F]-FDG in fasting state and during euglycemic hyperinsulinemia to quantify effects of obesity and weight loss on brain glucose uptake. The fMRI experiment revealed that a fronto-parietal network is involved in volitional appetite control. Obese subjects had lower medial frontal and dorsal striatal brain activity during cognitive appetite control and increased functional connectivity within the appetite control circuit. Obese subjects had initially lower grey matter and white matter densities than healthy controls in VBM analysis and loss of integrity in white matter tracts as measured by DTI. They also had initially elevated glucose metabolism under insulin stimulation but not in fasting state. After the weight loss following bariatric surgery, obese individuals’ brain volumes recovered and the insulin-induced increase in glucose metabolism was attenuated. In conclusion, obesity is associated with altered brain function, coupled with loss of structural integrity and elevated glucose metabolism, which are likely signs of adverse health effects to the brain. These changes are reversed by weight loss after bariatric surgery, implicating that weight loss has a causal role on these adverse cerebral changes. Altogether these findings suggest that weight loss also promotes brain health.Key words: brain, obesity, bariatric surgery, appetite control, structural magnetic resonance

Genetic, prenatal and postnatal determinants of weight gain and obesity in young children – The STEPS Study

Genetic, Prenatal and Postnatal Determinants of Weight Gain and Obesity in Young Children – The STEPS Study University of Turku, Faculty of Medicine, Department of Paediatrics, University of Turku Doctoral Program of Clinical Investigation (CLIPD), Turku Institute for Child and Youth Research. Conditions of being overweight and obese in childhood are common health problems with longlasting effects into adulthood. Currently 22% of Finnish boys and 12% of Finnish girls are overweight and 4% of Finnish boys and 2% of Finnish girls are obese. The foundation for later health is formed early, even before birth, and the importance of prenatal growth on later health outcomes is widely acknowledged. When the mother is overweight, had high gestational weight gain and disturbances in glucose metabolism during pregnancy, an increased risk of obesity in children is present. On the other hand, breastfeeding and later introduction of complementary foods are associated with a decreased obesity risk. In addition to these, many genetic and environmental factors have an effect on obesity risk, but the clustering of these factors is not extensively studied. The main objective of this thesis was to provide comprehensive information on prenatal and early postnatal factors associated with weight gain and obesity in infancy up to two years of age. The study was part of the STEPS Study (Steps to Healthy Development), which is a follow-up study consisting of 1797 families. This thesis focused on children up to 24 months of age. Altogether 26% of boys and 17% of girls were overweight and 5% of boys and 4% of girls were obese at 24 months of age according to New Finnish Growth references for Children BMI-for-age criteria. Compared to children who remained normal weight, the children who became overweight or obese showed different growth trajectories already at 13 months of age. The mother being overweight had an impact on children’s birth weight and early growth from birth to 24 months of age. The mean duration of breastfeeding was almost 2 months shorter in overweight women in comparison to normal weight women. A longer duration of breastfeeding was protective against excessive weight gain, high BMI, high body weight and high weight-for-length SDS during the first 24 months of life. Breast milk fatty acid composition differed between overweight and normal weight mothers, and overweight women had more saturated fatty acids and less n-3 fatty acids in breast milk. Overweight women also introduced complementary foods to their infants earlier than normal weight mothers. Genetic risk score calculated from 83 obesogenic- and adiposity-related single nucleotide polymorphisms (SNPs) showed that infants with a high genetic risk for being overweight and obese were heavier at 13 months and 24 months of age than infants with a low genetic risk, thus possibly predisposing to later obesity in obesogenic environment. Obesity Risk Score showed that children with highest number of risk factors had almost 6-fold risk of being overweight and obese at 24 months compared to children with lowest number of risk factors. The accuracy of the Obesity Risk Score in predicting overweight and obesity at 24 months was 82%. This study showed that many of the obesogenic risk factors tend to cluster within children and families and that children who later became overweight or obese show different growth trajectories already at a young age. These results highlight the importance of early detection of children with higher obesity risk as well as the importance of prevention measures focused on parents. Keywords: Breastfeeding, Child, Complementary Feeding, Genes, Glucose metabolism, Growth, Infant Nutrition Physiology, Nutrition, Obesity, Overweight, Programming

The Brazilian consumer's understanding and perceptions of organic vegetables: a Focus Group approach

Focus Group is a tool which generates, through interview sessions with a small number of participants, preliminary data to be used in subsequent quantitative stages. Many consumer studies use qualitative research with the aim of obtaining information and opinions on a specific product or situation. The objective of the present study was to obtain knowledge on the opinion, understanding and perception of the Brazilian consumer with respect to vegetables, focusing on organic products, using Focus Group Sessions. Four Focus Group Sessions were held with men and women in different environments, following a previously elaborated interview guide. In this study, it was observed that the consumers demonstrated being interested in having a healthy diet, based on fruit, vegetables and natural products. However, only a few declared consuming organic foods. Some participants did not know what the term organic meant, and most of them think that organic products are still very expensive, are not easily available in the supermarkets, do not have a good appearance, mainly in terms of size and packaging, and their certification is not always trustworthy. Almost all participants stated that they read package labels and among the items most observed were best-before date, nutritional information, production system and price. This study has identified important vegetable attributes perceived by the consumer, favouring the planning of a subsequent quantitative research. The results suggest that more information on the benefits of organic agriculture has to be passed on to consumers in order to contribute to a higher consumption of such products.

The effect of a diet education with six iso-caloric meals on the body weight and blood glucose of diabetes type 2 patients

The treatment of Diabetes should not only be sought through drug administration; diet is also a part of its treatment. The aim of this study was to determine the effect of a diet with six meals having equal calories on the body weight and blood glucose on diabetes type 2 patients. This research is an Experimental study conducted in 2009 on 181 patients with diabetes. The patients visited the IDSF (Iranian Diabetes Society of Fars) weekly and the patients to be studied were randomly divided into two groups of 85 and 96 patients, respectively. The participants were repeatedly requested to consume their calculated calorie in six equal parts. The average age in the Experimental and Control groups were 51.2 ± 13.3 and 53.1 ± 9.4, respectively. The mean body weight and fasting blood glucose at the beginning of the study in Experimental and Control groups were 66.3 ± 9.4 and 69.1 ± 11.1 kg, 198.9 ± 35.1, and 199.8 ± 39.1 mg.dL-1, respectively. At the end of the study, however, the values were 63.5 ± 7.5 and 66.98 ± 9 kg, 139.5 ± 34.6 and 164.2 ± 22.1 mg.dL-1, respectively. Only the mean fasting blood glucose at the end of the study revealed a significant difference (p-value = 0.001). The results show that educating those afflicted with Diabetes Type 2 aiming at changing their diet can greatly help them manage their blood glucose.

Reduction of carcass weight loss in swines

The carcass fast freezing is one of the aspects of great prominence to the final quality of pork. In order to reduce weight loss, two experiments were performed, in which the carcasses were monitored during 20 hours to evaluate the main variables involved during two different freezing processes (standard and proposed) as follows: microbiological quality, storage temperature, relative humidity (RH) and air velocity. In experiment I, the carcasses were submitted to a system using heat shock (2 hours in static tunnel at - 25 °C) and subsequently sent to the equalization chamber. In experiment II, the carcasses were submitted to the heat shock and stored in a chamber with RH between 80-85%. The chambers used in both experiments showed no change in the variables studied (internal temperature of 5 °C and air velocity of approximately 0.3 m/s). However, the relative humidity in the three chambers was evaluated and significant differences were found; as a consequence, high levels of weight loss were observed in both chambers In experiment II there was an increase of RH, which reduced the weight loss of the carcasses.

Effect of high and low molecular weight glutenin subunits, and subunits of gliadin on physicochemical parameters of different wheat genotypes

Identification of functional properties of wheat flour by specific tests allows genotypes with appropriate characteristics to be selected for specific industrial uses. The objective of wheat breeding programs is to improve the quality of germplasm bank in order to be able to develop wheat with suitable gluten strength and extensibility for bread making. The aim of this study was to evaluate 16 wheat genotypes by correlating both glutenin subunits of high and low molecular weight and gliadin subunits with the physicochemical characteristics of the grain. Protein content, sedimentation volume, sedimentation index, and falling number values were analyzed after the grains were milled. Hectoliter weight and mass of 1000 seeds were also determined. The glutenin and gliadin subunits were separated using polyacrylamide gel in the presence of sodium dodecyl sulfate. The data were evaluated using variance analysis, Pearson's correlation, principal component analysis, and cluster analysis. The IPR 85, IPR Catuara TM, T 091015, and T 091069 genotypes stood out from the others, which indicate their possibly superior grain quality with higher sedimentation volume, higher sedimentation index, and higher mass of 1000 seeds; these genotypes possessed the subunits 1 (Glu-A1), 5 + 10 (Glu-D1), c (Glu-A3), and b (Glu-B3), with exception of T 091069 genotype that possessed the g allele instead of b in the Glu-B3.

Natural born weight gainers: The mechanisms of obesity in transgenic mice overexpressing neuropeptide Y

Neuropeptide Y (NPY) is a neurotransmitter promoting energy storage by activating Y-receptors and thus affecting food intake, thermogenesis and adipose tissue metabolism. NPY is expressed both in the central and sympathetic nervous system. Hypothalamic NPY is known to stimulate feeding, but the effects of noradrenergic neuron NPY are more ambiguous. Chronic stress stimulates fat accumulation via NPY release from noradrenergic neurons. Furthermore, polymorphism in the human Npy gene has been associated with metabolic disturbances and increased NPY secretion after sympathetic stimulation. The main objective of this study was to clarify the mechanisms of noradrenergic neuron NPY in the development of obesity. The metabolic phenotype of a homozygous mouse overexpressing NPY in the brain noradrenergic neurons and sympathetic nervous system (OE-NPYDβH mouse) was characterized. OE-NPYDβH mice had an increased fat mass and body weight, which caused impairments of glucose metabolism and hyperinsulinaemia with age. There were no differences in energy intake or expenditure, but the sympathetic tone was down-regulated and the endocannabinoid system activated. Furthermore, peripheral Y2-receptors in energy-rich conditions played an important role in mediating the fat-accumulating effect of NPY. These results indicate that noradrenergic neuron NPY promotes obesity via direct effects in the periphery and by modulating the sympatho-adrenal and endocannabinoid systems. Additionally, NPY in the central noradrenergic neurons is believed to possess many important roles. The phenotype of the OE-NPYDβH mouse resembles the situations of chronic stress and Npy gene polymorphism and thus these mice may be exploited in testing novel drug candidates for the treatment of obesity.

Finnish perceptions on management accounting systems: towards an upgraded sophistication model

This study is based on a large survey study of over 1500 Finnish companies’ usage, needs and implementation difficulties of management accounting systems. The study uses quantitative, qualitative and mixed methods to answer the research questions. The empirical data used in the study was gathered through structured interviews with randomly selected companies of varying sizes and industries. The study answers the three research questions by analyzing the characteristics and behaviors of companies working in Finland. The study found five distinctive groups of companies according to the characteristics of their cost information and management accounting system use. The study also showed that the state of cost information and management accounting systems depends on the industry and size of the companies. It was found that over 50% of the companies either did not know how their systems could be updated or saw systems as inadequate. The qualitative side also highlighted the needs for tailored and integrated management accounting systems for creating more value to the managers of companies. The major inhibitors of new system implementation were the lack of both monetary and human resources. Through the use of mixed methods and design science a new and improved sophistication model is created based on previous research results combined with the information gathered from previous literature. The sophistication model shows the different stages of management accounting systems in use and what companies can achieve with the implementation and upgrading of their systems.

Weight loss improves renal hemodynamics in patients with metabolic syndrome

OBJECTIVE: We investigated the impact of weight loss on urinary albumin excretion (UAE) and creatinine clearance in obese patients with metabolic syndrome. METHODS: Thirty-five obese patients undertook a 12-week calorie-restricted diet. The patients underwent a metabolic (oral glucose tolerance test, plasma lipids, and uric acid) and renal hemodynamic evaluations (creatinine clearance and urinary albumin excretion) before (phase 1), and after the 12-week diet (phase 2). RESULTS: After the dietary intervention, the subjects were divided into two groups: patients who achieved the target weight reduction (R: responders, n = 14), and patients who did not (NR: non-responders, n = 21). The patients in Group R showed an improvement in lipid profile, a decrease in UAE (median = 162.5 mg/24 hours, range: 0.8 to 292 mg/24 hours, at phase 1 versus 10.4 mg/24 hours, range: 1.6 to 22.4 mg/24 hours, at phase 2), and a significant reduction in creatinine clearance (121.4 ± 66.5 mL/min. in phase 1 to 92.9 ± 35.6 mL/min. at the end of phase 2, p = 0.001). In Group NR, no statistically significant differences were observed between phases 1 and 2. CONCLUSION: Body weight reduction has a positive impact on renal hemodynamics, decreasing urinary albumin excretion as well as glomerular hyperfiltration in obese patients with metabolic syndrome.

Perceptions of corporate social responsibility: A case study of the perceived contents and outcomes

CSR has been subject of broad debate and research over the decades and has gained attention recently. The purpose of this thesis is to find out how companies perceive CSR. In addition this thesis is researching what is CSR in Finnish companies, how do companies measure CSR, what are the effects of CSR and how companies perceive those effects and what actors and factors support CSR. This research is a case study where altogether nine informants from seven companies were interviewed. This research is qualitative case study implemented with theme interviews. The analysis method is content analysis. Several interesting issues emerged from the empirical findings. CSR is playing pivotal role in companies values, vision and mission. CSR was perceived differently in companies but also mutual points emerged. The role of stakeholders is essential in CSR. In addition the communication with stakeholders was seen very important. Companies perceived that they can gain many benefits when acting responsibly for instance in issues related to cost reduction, reputation and personnel. However measuring these effects from CSR point of view was seen challenging. Other CSR related challenges are for example change and lack of resources. When considering empirical findings from a theoretical point of view, three interesting issues emerged. CSR reports play an important role in measuring and developing of CSR. However, this is not the case with all companies and some of them argued that reporting has too much attention nowadays when talking about CSR. The benefits of CSR are mostly related to responsive CSR. However maybe in a long-term follow-up strategic CSR related competitive advantage benefits could be more easily noticed. Many different issues supported CSR. Some issues are driven by outside of companies like NGO`s and media and some inside like the motivation of personnel and management. Vastuullista liiketoimintaa on tutkittu vuosien saatossa laajalti ja se on saanut viime vuosina erityisen paljon huomiota. Tämän pro gradu –tutkielman tavoitteena on selvittää, miten yritykset kokevat vastuullisen liiketoiminnan. Tämän lisäksi tutkimuksessa selvitetään, mitä vastuullinen liiketoiminta suomalaisissa yrityksissä tarkoittaa, miten yritykset mittaavat omaa vastuullisuuttaan, mitkä ovat vastuullisuuden vaikutukset, miten yritykset kokevat vastuullisuuden vaikutukset ja mitkä tekijät tukevat vastuullisen liiketoiminnan syntyä. Tutkimus toteutettiin haastattelemalla yhdeksää suomalaisen yrityksen yritysvastuusta vastaavaa tai sen kanssa työskentelevää henkilöä seitsemästä eri organisaatiosta loppuvuodesta 2014 ja alkuvuodesta 2015. Tutkimus on laadullinen, teemahaastatteluilla toteutettu haastattelututkimus. Aineisto on analysoitu teemoittain. Tutkimusaineiston perusteella vaikuttaa siltä, että vastuullinen liiketoiminta on tärkeässä roolissa yritysten arvoissa, visiossa ja missiossa. Yritysvastuu koettiin yrityksissä erilailla, mutta myös yhtäläisyyksiä on nähtävissä. Sidosryhmien rooli on erittäin tärkeä yritysvastuusta puhuttaessa ja myös kommunikointi sidosryhmien kanssa nousi tärkeäksi aiheeksi. Yritykset kokivat saavuttavansa monia hyötyjä vastuullisesta toiminnasta kuten kustannussäästöihin, maineeseen ja työntekijöihin liittyvissä asioissa. Näiden hyötyjen mittaaminen yritysvastuun näkökulmasta koettiin kuitenkin haasteelliseksi. Muita vastuullisuuteen liittyviä haasteita olivat esimerkiksi siihen liittyvä muutos sekä niukat resurssit. Tutkimuksen johtopäätöksistä nousi esille kolme merkittävää seikkaa. Vastuullisuusraportoinnin koettiin olevan hyödyllinen yritysvastuun mittaamisessa ja kehittämisessä. Kaikki yritykset eivät kuitenkaan olleet tätä mieltä ja osa koki raportoinnin saavan liian paljon huomiota nykypäivänä. Yritysten kokemat hyödyt vastuullisuuteen liittyen syntyivät pääosin reaktiivisesta vastuullisuudesta. Tässä kohdin on kuitenkin huomionarvoista mainita, että strategisen vastuullisuuden hyödyt olisivat saattaneet nousta paremmin esille pidemmän aikavälin tutkimuksessa. Yritysvastuun syntyä tukevia tekijöitä löytyi monia. Osa tekijöistä oli yrityksen ulkopuolisia kuten kansalaisjärjestöt ja media ja jotkut taas kumpusivat yrityksen sisältä esimerkiksi työntekijöiden ja johdon motivaatio.

Psychological well-being of the parents and child development, behavior, and quality of life in very low birth weight infants

The parents of premature infants, especially the mothers, are at increased risk for distress. Infants born prematurely are at risk for developmental problems. The aim of this study was to investigate whether the psychological well-being of both parents is associated with child development in very low birth weight (VLBW, ≤1500g) children. The burden of prematurity-related morbidity to the children and to the family was also assessed. A cohort of 201 VLBW infants born during 2001–2006 in the Turku University Hospital, Finland, and their parents were studied (I–IV). One study included a control group (n=166) of full-term infants (IV). The psychological well-being of the parents was evaluated by assessments of depressive symptoms, parenting stress, the sense of coherence and general family functioning. Cognitive, behavioral, and socio-emotional development, and the health-related quality of life (HRQoL) of the children were determined when the children were 2 to 8 years old. The psychological well-being of the parents was associated with the cognitive, behavioral and social development of the VLBW children. The VLBW infants with prematurity-related morbidities had a poorer HRQoL and the general functioning of the family was inferior compared to the control children and their families. 64.5% of the VLBW children survived without morbidities. Most of the VLBW children did not have significant behavior problems (93%), had normal social skills (63%), had no emotional problems (64%), and had no problems in executive functioning (62%). Only 3% of the surviving VLBW infants had significant cognitive delay. In conclusion, the depressive symptoms and stress of the parents can be risk factors for disadvantageous child development, while a strong sense of coherence can be protective. Parents of the premature children with developmental delays might also experience more depressive symptoms and stress than other parents. Prematurity-related morbidities were a burden to the VLBW child as well as to the family.

Accelerating food safety and quality control: The use of antibody engineering techniques in the detec-tion of low-molecular weight food contaminants

The increased awareness and evolved consumer habits have set more demanding standards for the quality and safety control of food products. The production of foodstuffs which fulfill these standards can be hampered by different low-molecular weight contaminants. Such compounds can consist of, for example residues of antibiotics in animal use or mycotoxins. The extremely small size of the compounds has hindered the development of analytical methods suitable for routine use, and the methods currently in use require expensive instrumentation and qualified personnel to operate them. There is a need for new, cost-efficient and simple assay concepts which can be used for field testing and are capable of processing large sample quantities rapidly. Immunoassays have been considered as the golden standard for such rapid on-site screening methods. The introduction of directed antibody engineering and in vitro display technologies has facilitated the development of novel antibody based methods for the detection of low-molecular weight food contaminants. The primary aim of this study was to generate and engineer antibodies against low-molecular weight compounds found in various foodstuffs. The three antigen groups selected as targets of antibody development cause food safety and quality defects in wide range of products: 1) fluoroquinolones: a family of synthetic broad-spectrum antibacterial drugs used to treat wide range of human and animal infections, 2) deoxynivalenol: type B trichothecene mycotoxin, a widely recognized problem for crops and animal feeds globally, and 3) skatole, or 3-methyindole is one of the two compounds responsible for boar taint, found in the meat of monogastric animals. This study describes the generation and engineering of antibodies with versatile binding properties against low-molecular weight food contaminants, and the consecutive development of immunoassays for the detection of the respective compounds.