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- Genre: Doctoral Dissertation
- Member of: Theses and Dissertations
Description
Background: Heart failure is the leading cause of hospitalization in older adults and has the highest 30-day readmission rate of all diagnoses. An estimated 30 to 60 percent of older adults lose some degree of physical function in the course of an acute hospital stay. Few studies have addressed the role of posture and mobility in contributing to, or improving, physical function in older hospitalized adults. No study to date that we are aware of has addressed this in the older heart failure population.
Purpose: To investigate the predictive value of mobility during a hospital stay and patterns of mobility during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients.
Methods: This was a prospective observational study of 21 older (ages 60+) patients admitted with a primary diagnosis of heart failure. Patients wore two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Patients wore all sensors continuously during hospitalization and the ankle accelerometer for 30 days after hospital discharge. Function was assessed in all patients the day after hospital discharge and again at 30 days post-discharge.
Results: Five patients (23.8%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower Timed Up and Go (TUG) time (b = .08, p = .01) and poorer hand grip strength (b = -13.94, p = .02) at 30 days post-discharge. Higher daily stepping activity during the 30 day post-discharge period was marginally associated with improvements in SPPB scores at 30 days (b = <.001, p = .06).
Conclusion: For older heart failure patients, increased time lying while hospitalized is associated with slower walking time and poor hand grip strength 30 days after discharge. Higher daily stepping after discharge may be associated with improvements in physical function at 30 days.
Purpose: To investigate the predictive value of mobility during a hospital stay and patterns of mobility during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients.
Methods: This was a prospective observational study of 21 older (ages 60+) patients admitted with a primary diagnosis of heart failure. Patients wore two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Patients wore all sensors continuously during hospitalization and the ankle accelerometer for 30 days after hospital discharge. Function was assessed in all patients the day after hospital discharge and again at 30 days post-discharge.
Results: Five patients (23.8%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower Timed Up and Go (TUG) time (b = .08, p = .01) and poorer hand grip strength (b = -13.94, p = .02) at 30 days post-discharge. Higher daily stepping activity during the 30 day post-discharge period was marginally associated with improvements in SPPB scores at 30 days (b = <.001, p = .06).
Conclusion: For older heart failure patients, increased time lying while hospitalized is associated with slower walking time and poor hand grip strength 30 days after discharge. Higher daily stepping after discharge may be associated with improvements in physical function at 30 days.
ContributorsFloegel, Theresa A (Author) / Buman, Matthew P (Thesis advisor) / Hooker, Steven (Committee member) / Dickinson, Jared (Committee member) / DerAnanian, Cheryl (Committee member) / McCarthy, Marianne (Committee member) / Arizona State University (Publisher)
Created2015
Description
Sustainability, as it relates to nutrition, affects all aspects of food from systems-level production to consumption. Viability of local food systems in the southwest of the United States has been largely understudied. In order to address this gap in the literature, semi-structured interviews were conducted with 20 farmers in Arizona and New Mexico to determine best practices, challenges and barriers to farming. Interviews were recorded, transcribed, and coded for themes. Many trends were consistent with those reported elsewhere in the US, but the importance of water emerged, a unique need not explicitly noted in other regional studies.
Vegetarian diets are typically more sustainable than omnivorous ones due to using less environmental resources in the production of food. An important consideration with plant protein and vegetarian diets, however, is whether this would affect athletic performance. To examine this, 70 male and female endurance athletes were compared for maximal oxygen uptake (VO2 max), peak torque when doing leg extensions, and body composition. Vegetarians had higher VO2 max, but peak torque was not significantly different by diet. Omnivores had higher total body mass, lean body mass, and there was a trend for peak torque to be higher.
To investigate whether plant-protein can comparably support development of lean body mass and strength development in conjunction with strength training, 61 healthy young males and females began a 12-week training and protein supplementation study. While previous training studies have shown no differences for lean body mass or strength development when consuming either soy (plant) or whey (animal) protein supplements in very large amounts (>48 grams), when consuming around 15-20 grams, whey has contributed to greater lean body mass accrual, although strength increases remain similar. The present study matched supplements by leucine content instead of by total protein amount since leucine has been shown to be a key stimulator of muscle protein synthesis and is more concentrated in animal protein. There were no significant differences between the whey or soy group for lean body mass or strength development, as assessed using isokinetic dynamometry doing leg extensions and flexions.
Vegetarian diets are typically more sustainable than omnivorous ones due to using less environmental resources in the production of food. An important consideration with plant protein and vegetarian diets, however, is whether this would affect athletic performance. To examine this, 70 male and female endurance athletes were compared for maximal oxygen uptake (VO2 max), peak torque when doing leg extensions, and body composition. Vegetarians had higher VO2 max, but peak torque was not significantly different by diet. Omnivores had higher total body mass, lean body mass, and there was a trend for peak torque to be higher.
To investigate whether plant-protein can comparably support development of lean body mass and strength development in conjunction with strength training, 61 healthy young males and females began a 12-week training and protein supplementation study. While previous training studies have shown no differences for lean body mass or strength development when consuming either soy (plant) or whey (animal) protein supplements in very large amounts (>48 grams), when consuming around 15-20 grams, whey has contributed to greater lean body mass accrual, although strength increases remain similar. The present study matched supplements by leucine content instead of by total protein amount since leucine has been shown to be a key stimulator of muscle protein synthesis and is more concentrated in animal protein. There were no significant differences between the whey or soy group for lean body mass or strength development, as assessed using isokinetic dynamometry doing leg extensions and flexions.
ContributorsLynch, Heidi (Author) / Wharton, Christopher M (Thesis advisor) / Johnston, Carol (Committee member) / Dickinson, Jared (Committee member) / Buman, Matthew (Committee member) / Swan, Pamela (Committee member) / Ransdell, Lynda (Committee member) / Arizona State University (Publisher)
Created2017
Description
High fiber diets have been associated with improved cardiometabolic health with specific efforts to lower circulating levels of low-density lipoprotein (LDL cholesterol). Whole grain and grain-based foods are major contributors of dietary fiber in the American diet, of which wheat has been extensively studied. Corn, however, has not been well studied for its cholesterol-lowering properties. Further, the mechanisms by which grains improve cardiometabolic health require further exploration with regard to the human microbiome. The objective of this single-blind randomized controlled, crossover trial was to assess the impact of three different corn flours (whole grain, refined, and bran-enhanced refined flour mixture) on serum LDL cholesterol and the gut microbiota diversity and composition. Twenty-three participants were recruited, between the ages of 18-70 with hypercholesterolemia (Male = 10, Female = 13, LDL >120 mg/dL) who were not taking any cholesterol-lowering medications. Participants consumed each flour mixture for 4 weeks prepared as muffins and pita breads. At the beginning and end of each 4-week period serum for cholesterol assessment, anthropometrics, and stool samples were obtained. Serum cholesterol was assessed using a clinical analyzer. Stool samples were processed, and microbial DNA extracted and sequenced based on the 16S rRNA gene. A generalized linear model demonstrated a significant treatment effect (p=0.016) on LDL cholesterol and explained a majority of the variance (R-squared= 0.89). Post hoc tests revealed bran-enhanced refined flour had a significant effect on cholesterol in comparison to whole grain flour (p=0.001). No statistically significant differences were observed for gut microbial community composition (Jaccard and weighted Unifrac) after corn consumption. However, relative abundance analysis (LEfSE) identified Mycobacterium celatum (p=0.048 FDR=0.975) as a potential marker of post-corn consumption with this microbe being differentially less abundant following bran-enhanced flour treatment. These data suggest that corn flour consumption may be beneficial for individuals with hypercholesterolemia but the role of gut microbiota in this relationship requires further exploration, especially given the small sample size. Further research and analysis of a fully powered cohort is needed to more accurately describe the associations and potential mechanisms of corn-derived dietary fiber on circulating LDL cholesterol and the gut microbiota.
ContributorsWilson, Shannon L (Author) / Whisner, Corrie M (Thesis advisor) / Sears, Dorothy (Committee member) / Buman, Matthew (Committee member) / Dickinson, Jared (Committee member) / Zhu, Qiyun (Committee member) / Arizona State University (Publisher)
Created2022