Ph.D. - Nutrition

Permanent URI for this collectionhttps://hdl.handle.net/10125/40207

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Pre-hatch thermal manipulation of chicks’ embryo and post-hatch baicalein supplementations: A sustainable strategy to mitigate heat stress in broiler chickens
(University of Hawai'i at Manoa, 2025) Amaz, Sadid Al; Mishra, Birendra; Nutrition
Elevated environmental temperatures can cause heat stress in broiler chickens, impacting their health and production efficacy. Various dietary, managerial, and genetic strategies have been evaluated with some efficacy in alleviating heat stress (HS) in broilers. Therefore, it is essential to develop innovative strategies to mitigate HS for sustainable broiler production. This dissertation explores the effects of embryonic thermal manipulation and post-hatch baicalein supplementation on hatching performance, embryonic growth, metabolism, overall growth performance, gut health, muscle functional capacity, and immunity in broiler chickens. Six hundred fertile Cobb 500 eggs were incubated for 21 d. After candling on embryonic day (ED) 10, 238 eggs were thermally manipulated at 38.5 °C with 55% relative humidity (RH) from ED 12 to 18, then transferred to the hatcher (ED 19 to 21, standard temperature) and 236 eggs were incubated at a controlled temperature (37.5 °C) till hatch. After hatch, 180-day-old chicks from both groups were raised in 36 pens (n = 10 birds/pen, 6 replicates per treatment). The treatments were: 1) Control, 2) thermal manipulation (TM), 3) control heat stress (CHS), 4) thermal manipulation heat stress (TMHS), 5) control heat stress supplement (CHSS), and 6) thermal manipulation heat stress supplement (TMHSS). All birds were raised under the standard environment for 21 d, followed by chronic heat stress from d 22 to 35 (32–33 °C for 8 h) in the CHS, TMHS, CHSS, and TMHSS groups. A thermoneutral (22–24 °C) environment was maintained in the Control and TM groups. RH was constant (50% ± 5%) throughout the trial. All the data were analyzed using one-way and two-way ANOVA in R and GraphPad software at P < 0.05 and are presented as mean ± SEM. CLC Genomics Workbench 25.0.1 and the CLC Microbial Genomics module were utilized for bioinformatics analysis of microorganisms. In conclusion, Pre-hatch TM and post-hatch baicalein supplementation in heat-stressed birds mitigated the detrimental effects of heat stress on chickens' growth performance, increased hatchability, embryonic growth, and metabolism, as well as post-hatch VFA production, muscle cell proliferation capacity, and immunity. Additionally, it promoted gut health by increasing beneficial microbial communities. TM is essential for sustainability as it enhances feed conversion efficiency, reduces feed intake to reach comparable sizes at lower costs. Additionally, TM contributes to improved animal welfare, enhancing heat tolerance and promoting better health. It also reduces incubation time by 6 hours, which lowers energy consumption and production costs, making poultry products more economically viable. TM is crucial in establishing a more sustainable food production system while ensuring animal welfare. This research is crucial for addressing food insecurity in the era of global warming. TM has significant potential in alleviating heat stress and protecting the poultry industry in the United States and beyond. Ultimately, it aims to have a significant impact on the poultry industry.
Understanding dietary intake among young American Samoan children
(University of Hawai'i at Manoa, 2025) McFall, Pauline May; Novotny, Rachel; Nutrition
Overweight, obesity, diabetes and other non-communicable chronic diseases (NCDs) are among the greatest contributors to morbidity and mortality worldwide. Research that tracks and describes global and regional trends in obesity and diabetes has indicated that the Pacific Islands are disproportionately affected by NCDs. The Pacific territory of American Samoa has also been plagued with the obesity epidemic. The high prevalence of childhood overweight and obesity in American Samoa prompts a need to examine causes and consequences of obesity and highlights the need for nutrition and health monitoring as well as nutrition education programs and policies. There is little research to understand the environmental and socio-cultural determinants of child obesity in the US Affiliated Pacific (USAP) jurisdictions, including American Samoa. Poor diet quality and unhealthy dietary behavior are major risk factors for NCDs among children and adolescents. Ameliorating obesity early in life will help avert lifelong obesity and related disease (NCDs). There is a lack of published studies on dietary intake, dietary behavior and their association with diet quality of young children in American Samoa. Thus, the main objective of this research was to understand dietary intake of young American Samoan children, specifically the context and patterns of child eating, and influences on child diet quality. This dissertation used data collected from the Children’s Healthy Living (CHL) program and new data collected through qualitative interviews. This dissertation has three aims or studies. The first aim was to identify characteristics of children who have higher diet quality. This was a quantitative study using cross- sectional, data from the CHL Time 1 (2011-2013) study. This descriptive study examined energy intake and diet quality of children’s meals (N=586 participants). The dependent variables were drawn from the CHL Food Activity Logs (FALs, or food records) from children. Child diet quality was assessed using the Healthy Eating Index 2020 (HEI-2020). The independent variables were derived from child and household demographics. The main finding was that children who live in urban communities had higher diet quality and were likely to be consuming healthier foods than those living in rural communities. The second aim was to test differences in diet quality by diet context (specifically by food having been prepared and food having been consumed at home, at school, and other locations away from home). This quantitative study used data from CHL Time 1 (2011-2013). Higher consumption of foods prepared away from the home has been associated with lower diet quality among adolescents and adults. Aim 2 evaluated the association between location of food preparation and consumption and diet quality (using energy intake and HEI) among children ages 2-8 years, (N=581 participants). The main findings were that children who had meals prepared and consumed in the school had higher diet quality (especially for dairy) than those that had meals prepared and consumed at home and children who had meals prepared and consumed in the school had higher diet quality than those at other locations away from home (i.e. home of relative, restaurants, fast food, church). However, home food preparation and consumption was associated with higher (more adequate) seafood intake, compared to food prepared and consumed in other locations. The third aim was to identify caregiver attitudes and perceptions towards child diet quality and related dietary behaviors, utilizing key informant interviews. Participants for this study were drawn from households that participated in the CHL Time 3 study (2019). Twenty (20) mothers representing both rural (n=9) and urban (n=11) American Samoa participated in qualitative interviews. The study examined a healthy child and diet in American Samoa. Samoan themes and topics were derived including barriers and supports to healthy eating, and family influences. These themes showed influences of the Samoan culture and community, such as the positive role and influence of church and village programs on promoting health and nutrition. In addition, widespread availability and consumption of traditional foods is viewed as both a positive and strong influence towards health and nutrition. Meats cooked in the traditional oven were viewed as healthy while taro and other starchy vegetables were viewed as less healthy, especially when cooked with lots of coconut milk. This dissertation revealed an association between urban community living and higher diet quality and an association between consuming school meals and higher diet quality. Caregiver attitudes and perceptions (i.e. what defines a healthy child in American Samoa, barriers & supports) about child diet were influenced by family, churches, and villages, unique to the Samoan culture and community. Findings suggest that the cultural influence of church and village programs are a support and thus promote healthy eating within villages/communities. Findings from this dissertation highlight the importance of future multilevel interventions working with caregivers, schools and rural communities to improve diet and health among children and families in American Samoa. These include studies on the differences between urban and rural eating patterns of American Samoan children, and the need to further understand the differences in diet quality of food prepared and consumed in the home compared to other locations away from the home. In addition, further examination is needed to understand the differences of caregiver perceptions and understanding of child diet and health, based on additional characteristics (i.e. citizenship status, village, WIC/SNAP benefit recipient or not).
In Ovo And Post-hatch Nutritional Programming To Improve Broiler Performance And Gut Health
(University of Hawaii at Manoa, 2019) Singh, Amit Kumar; Jha, Rajesh; Nutrition
Feed and gut health management expenses of the flock account for over 70% in poultry production. To reduce the cost of production, nutritionists formulate broiler chickens feed with relatively cheaper alternative feedstuffs. Most of these alternative feedstuffs have high fiber content and low digestibility of nutrients. Thus, it is essential to test different exogenous enzymes to maximize nutrient utilization and enhance feed efficiency of fibrous feedstuffs for profitable broilers production. Better feed utilization also depends on improved gut health and microbial balance in the GIT of the birds. To reduce the load of pathogenic bacteria and maintain gut health for improved productivity, several antibiotic growth promoters (AGP) are used at a subtherapeutic level in poultry feed. However, due to the public health concern and risk of growing antibiotic resistance, the use of AGP has been restricted or regulated in several jurisdictions around the world. This further necessitates the finding of alternatives to AGPs and explore other effective nutritional strategies to modulate the gut health of broilers. Investigation and validation of several additives and functional foods for improving gut health and nutrient utilization are crucial to conveying the mechanistic understanding of these agents for nutritional programming in broilers. The principal objective of this dissertation research was to evaluate the effects of xylanase enzyme in feed and that of prebiotics application in ovo and post-hatch on broiler performance and gut health. To explore the effect of xylanase enzyme on broiler performance, two separate studies were conducted where xylanase was added to a corn-soybean meal (corn-SBM) based diet containing wheat bran in the first study and xylooligosaccharides (XOS) in the second study. Likewise, to examine the effect of prebiotics on gut health and production of broilers, two more studies were performed where oligosaccharides were applied in ovo in the third study, and resistant starch was fed during early post-hatch in the fourth study. The first study focused on the effect of xylanase supplementation on growth performance and cecal short chain fatty acid (SCFA) production in broilers fed corn-SBM diet containing different levels of fiber incorporated through wheat bran addition. The results from this study indicated that high fiber diets containing more wheat bran are more responsive to xylanase enzyme for improvement in feed efficiency while xylanase can equally improve SCFA production in both corn-based and wheat bran containing diet. The second study determined the effects of supplemental xylanase and XOS (as prebiotics) on growth performance, cecal SCFA production, and intestinal morphology of broilers fed corn-SBM diet. The results for this study demonstrate that xylanase can improve body weight gain without improving the feed efficiency of corn-SBM diets while both xylanase and XOS can lead to increased cecal fermentation in broilers. Thus, xylanase enzyme could be used in different basal formulations to improve growth performance of broilers, and it can potentially be used along with XOS prebiotics for better cecal fermentation capacity of broilers that might be more useful in a challenged environment. The third study was conducted to investigate the beneficial role of four different oligosaccharides (differing in chain length) as prebiotics when fed in ovo to the embryo of broilers through their amniotic fluid. The gene expression and histomorphometric study demonstrated the potency of xylotriose in stimulating T-cell based adaptive immunity and cecal SCFA compared with controls. The fourth study concentrated on evaluating the effect of resistant starch type 2 and type 4 feeding as prebiotics during early post-hatch in broilers. The results of this study revealed that resistant starch type 4 can be a candidate for immunomodulation in early post-hatch feeding but may not provide persistent benefit if used for a short duration. The in ovo oligosaccharides and early post-hatch resistant starch feeding can support the build-up of immunity in premature birds, but further studies are warranted to ascertain their effects to be used in combination with regular vaccine programs. Collectively, this dissertation elaborates on the application of xylanase enzyme, oligosaccharides, and resistant starch as alternative resources to improve gut health in broilers, but in the present form, they do not exhibit a greater potency to completely replace the AGPs in feed. However, further research is required to unravel the mechanistic role of existing additives to be used as an alternative to AGP and additional improvement in their potency and efficacy is required to promote their use to obtain the specific health benefits.
Considering Childhood Obesity through an Investigation of Maternal/Infant Factors and the Acceptability of a Text Message-Based Intervention
(University of Hawaii at Manoa, 2018-05) Gibby, Cheryl L. K.; Nutrition
Addressing childhood obesity in low-income groups in Hawai‘i and Puerto Rico requires examination of maternal and infant risk factors and evaluation of related interventions to advance preventive measures. This dissertation, entitled “Considering childhood obesity: an investigation of maternal/infant factors and the acceptability of a text message-based intervention,” includes a general overview of the dissertation, a literature review describing previous studies on factors contributing to childhood obesity and text message-based interventions, three stand-alone manuscripts, a concluding chapter that includes additional comments and future considerations, and appendices containing documents pertinent to the intervention and other information. The three stand-alone manuscripts present studies on a text message-based intervention aimed at promoting breastfeeding and preventing excessive weight gain in infants enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Hawai‘i and Puerto Rico. The studies 1) assess the acceptability of the intervention; 2) examine the association between maternal pregravid body mass index (BMI) and breastfeeding discontinuation; and 3) examine the association between gestational weight gain and rate of infancy weight gain. Main findings include the following: 1) the text message-based intervention was acceptable to participants based upon qualitative and quantitative measures; 2) breastfeeding discontinuation was not associated with pregravid BMI, but Native Hawaiian or Other Pacific Islanders (adjusted odds ratio [AOR]=7.12; 95% confidence interval [CI]=1.34, 37.97; p=0.02) and older women (AOR=4.21; 95% CI=1.13, 15.72; p=0.03) showed significantly higher odds of discontinuing breastfeeding before four to six months postpartum; and 3) excessive and inadequate gestational weight gain was associated with decreased proportional odds of rapid infancy weight gain versus on-track (AOR=0.23; 95% CI=0.08, 0.70; p=0.01) or slow (AOR=0.29; 95% CI=0.09, 0.94; p=0.04) infant weight gain. These findings may inform childhood obesity prevention strategies and programs.
Improving Physical Activity and Fruit and Vegetable Social Cognitive and Behavior Variables in Filipino Adolescents in Hawaiʻi: The Waipahu Hart Project
(University of Hawaii at Manoa, 2017-05) Thompson, Michelle A.; Nutrition
Filipino adolescents are one of the most overweight ethnic groups in Hawai‘i. With limited research on health behaviors of Filipino adolescents (age 10-19), it is important to have research that focuses on decreasing health disparities in this adolescent population. This study aims to fill the gap on Filipino adolescent physical activity (PA) and fruit and vegetable (FV) social cognitive and behaviors using the Social Cognitive Theory through peer influence to create positive health behaviors, examine Multiple Health Behavior Change (MHBC) and if peer educators (PEs) change their health behaviors through teaching a health curriculum. The Waipahu Health Action Research and Training (HART) project is a quasi-experimental design peer-influence study based at Waipahu High School (WHS). It includes three manuscripts: 1) use peer influence to increase PA and FV social cognitive and behavior variables in Filipino adolescents, 2) examine transfer and compensation effects of PA, FV consumption, and sedentary behavior (SB) in Filipino adolescents and 3) examine if PEs increase their PA and FV social cognitive and behavior variables through teaching a health curriculum. Participants were all Filipino students from nine WHS health classes (5 intervention, 4 control). PEs were Filipino senior health capstone class at WHS. Findings suggest a peer-led PA and nutrition curriculum can benefit participants and PEs in terms of PA social cognitive and behavior variables. Multiple regression analysis showed for the intervention group follow-up PA knowledge is 0.62 units (SE=0.15, p<0.01) higher and follow-up Moderate-Vigorous PA (MPVA) is 20.04 min/week (SE=6.13, p<0.01) higher than the control group. A trend towards follow-up PA enjoyment for the intervention group being 0.41units (SE=0.23, p=0.09) higher than the control group was seen. PA knowledge had a significant interaction for AT RISK (Stage of Change pre-contemplation, contemplation and preparation) (F(1, 65)=6.69, p<0.01). A trend towards a transfer effect of PA for Low vs. High SB (F(1, 76)=3.76, p=0.06) was seen. PEs increased their PA stage of change (F(1, 18) =5.51, p=0.03) and MVPA (F(1, 18)=7.44, p<0.01) through teaching the HART curriculum. Given currently limited research on Filipino adolescents’ health behaviors, this dissertation adds to the literature and gives guidance for future research.
Feasibility Study Using A One-way And Two-way Text Messaging Self-management Program In A Sample Of Afro-Caribbeans With Type 2 Diabetes Mellitus Living In The U.S. Virgin Islands
(University of Hawaii at Manoa, 2018-12) Storer, Andrew; Yen-Wang, Chen; Nursing
Type 2 diabetes is a global problem that has reached pandemic proportions. T2DM leads to significant premature morbidity and mortality. The risk for death among individuals with diabetes is almost twice that of individuals without diabetes. With the increasing onus of diabetes, an innovative and multifaceted approach to detection, self-management, screening, and delivery of care are needed. Non-white individuals suffer significant disparity in both the prevalence and treatment of T2DM. Among U.S. Virgin Islanders, there is an increased burden on Blacks, Hispanics, the poor, and those lacking education. There has been a rapid increase in the adoption of mobile technology and use of mobile technology for the promotion of health management behaviors in recent years. Mobile technology has allowed researchers to investigate the use of smartphones in health care support and interventions. However, the role and effectiveness of mobile technology remains unclear. The lack of evidence is particularly prevalent in underserved health care regions, such as the U.S. Virgin Islands. The purpose of the study was to explore the feasibility of using a SMS-based diabetes self-management program among Afro-Caribbean individuals with T2DM residing in the U.S. Virgin Islands. Participants in the feasibility study received a text message intervention related to diet and exercise over a two-week time frame. The mixed methods research indicated that a clinical research study able to achieve statistical significance is warranted on the topic. All participants viewed the one- and two-way text messaging intervention favorably with few drawbacks. Participants reported making better dietary decisions and becoming more active because of the text message intervention. Participants shared their desire for a long-term one- and two-way text messaging diabetes self-management program. However, as a feasibility study generalizability is limited due to the small non-representative sample size.
Factors influencing fire safety and evacuation preparedness among residential high-rise building occupants
(University of Hawaii at Manoa, 2018-12) Glauberman, Gary; Qureshi, Kristine; Nursing
Purpose. As urban populations grow, the number of people living in high-rise buildings will increase, resulting in higher occupant densities and an amplified risk in the event of a fire. Most of what is known regarding high-rise fire safety is from research involving commercial high-rise building occupants. Less is known about residential high-rise occupants’ fire preparedness. This report shares findings from a study that sought to better understand factors influencing fire safety and evacuation preparedness among residential high-rise occupants. Methods. A qualitative research study was done using semi-structured interviews. Thematic analysis was conducted on interview data and themes on preparedness for fires and building evacuation were extracted. Analysis was guided by Ajzen’s theory of planned behavior (TPB). Results. Twelve (N = 12) residents from 8 buildings participated, 25% male, 75% female, ages ranged from 31-71. Years living in their current high-rise building ranged from 1-35 years. Most (67%) had experienced a high-rise fire in their building, and most (67%) had experience evacuating a high-rise. One half had some form of exposure to fire safety or emergency preparedness (EP) training. Five primary themes emerged from qualitative interview data: attitudes towards fire safety, building fire safety culture, perceived ability to prepare for fires, intentions to prepare, and occupant fire preparedness behaviors. Discussion. Having at least one household member with prior training in fire safety/EP, and building fire safety culture, were found to be important factors influencing occupant fire safety behaviors. The TPB was found to be useful for describing fire preparedness among residential high-rise occupants. Factors influencing evacuation decision-making differed somewhat from commercial high-rise occupants due to the presence of children, pets, and older residents. These factors may prolong total evacuation time in residential high-rises. Implications for nursing and policy, and future research on this topic were also discussed.
Food, Culture, and Health in Mixed Raced and Multicultural Populations
(University of Hawaii at Manoa, 2015-08) Mosley, Michelle
The origins and history of race in the United States imposed an everlasting impact on the health and behaviors of various population groups. In particular, Mixed Race individuals faced oppression in various forms over time, including current exclusion from federal health analyses and reports despite legal inclusion requirements. Additionally, because of the melding of traditions and habits from diverse groups, it is important to determine how cultural influences impact daily food and activity practices today. This dissertation examined the health, dietary intake, and cultural beliefs and practices of Mixed Race and multicultural individuals. The first study of this dissertation was a secondary data analysis of Behavioral Risk Factor Surveillance System data on adults that aimed to examine the prevalence and odds of select diet-related chronic conditions in Mixed Race adults and highlight the failure of federal agencies to provide vital diet-related chronic condition statistics on Mixed Race individuals. Mixed Race individuals had greater prevalence and odds of the selected diet-related chronic conditions compared to White individuals, thus demonstrating the need for federal agencies to adhere to the existing legal guidelines when reporting on health and nutrition. The second study identified dietary patterns at two time points in a multicultural group of female adolescents living on Oʻahu, Hawaiʻi. Results of factor analyses indicated that dietary patterns were present in this population and changed over a two-year time period, but these patterns were not related to body mass index percentile. The final study of this dissertation identified the cultural beliefs and practices that influence the diet and physical activity habits of a multicultural group of female adolescents living on Oʻahu, Hawaiʻi. Interviews with adolescents and their mothers revealed cultural beliefs and practices regarding food purchasing practices, feeding practices, portion size practices, eating outside the home, body size perceptions, and exercise and activity practices. This dissertation provides information on health, dietary intake, and culture in Mixed Race and multicultural populations. Researchers can use this information to inform future work that can be used to develop successful programs and policies and equally distribute funding allocations among population groups of the United States.
Head Start Wellness Policy Intervention in Hawaii: A Project of the Children's Healthy Living Program (CHL)
(University of Hawaii at Manoa, 2015-05) Esquivel, Monica
Head Start (HS) preschools present an opportunity for obesity prevention efforts, and their presence throughout the Pacific makes them a potential source of data for monitoring body mass index (BMI) in the region. This dissertation is embedded within the Children’s Healthy Living (CHL) Program for Remote Underserved Minority Populations in the Pacific Region, which worked with HS preschools. It includes four manuscripts; 1) identifying HS teacher recommendations for policies to prevent childhood obesity in HS; 2) testing the effect of a HS teacher-informed wellness policy intervention on the HS classroom environment and childhood diet intake and obesity; 3) quantifying the relative validity of HS teachers’ anthropometric measurements for potential child BMI monitoring in the Pacific; and 4) quantifying the differences between child BMI assessment with World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) BMI reference data. Findings suggest that HS teachers (n=17) value being role models of healthy eating and nutrition to children and families, but voiced discomfort in sharing BMI information with parents. The intervention had positive effects on the classroom physical activity environment, as measured by the Environment and Policy Assessment and Observation (EPAO) tool (n= 23 classrooms, p=0.002). HS teachers’ priorities related to child nutrition mediated the intervention effect on the environment, and improvements in teachers’ personal health behaviors and status moderated the intervention effect on the classroom environment. In comparing height and weight assessments, HS measures were not significantly different from the researcher collected data (n=195, difference in height= 0.66cm, p =0.3458, difference in weight 0.09kg, p=0.8522). Kappa statistics showed good agreement; however, percent agreement varied by weight category (weight kappa=0.50, percent agreement= 94%, 87%, 75% and 50% for healthy weight, overweight, obese and underweight). In a sample of 941 Native Hawaiian and Pacific Islander children, CDC growth reference data significantly underestimated BMI z-scores compared to WHO reference data (zBMI difference=-0.31, p<0.001) with age and sex affecting the relationship, and significant differences in BMI classification were observed (chi square=8.95, p=0.03). Findings confirmed that HS teachers can be champions for childhood obesity prevention in Head Start, from policy planning to evaluation of intervention efforts.
Addressing Childhood Obesity through Novel Assessments, Enhancement of Summer Enrichment Programs and Surveillance in Guam
(University of Hawaii at Manoa, 2015-05) Aflague, Tanisha
Childhood obesity is increasing in all ethnic groups especially in nonwhite populations. Inadequate intake of fruits and vegetables (FV) has been associated with childhood obesity. FV were a prominent part of traditional diets of Pacific Islanders as in Guam. Intake of FV, among children, is lower than recommendations by national guidelines. Culture provides the context of meaning for individual behaviors and is, therefore, a critical element to influential behavioral interventions, such as FV intake, mediated by FV preference. A natural experiment was conducted where children were recruited from preexisting summer camp programs in Guam: a cultural immersion camp (CIC), university day camp (UDC), and a recreational sport camp (RSC). The objectives were to examine the influence of cultural immersion on willingness to try FV and FV intake among children, ages 3-12 y, in Guam. Outcomes were assessed before and after camp using previously validated assessment tools completed by children: the Adapted WillTry tool and the 2-day mobile food record (mFR), respectively. The Adapted WillTry and mFR were tested in advance for validity and feasibility among children in Guam and are described in this dissertation. Multiple linear regression analyses were performed to examine if differences in the Adapted WillTry local novel FV score and local common FV score after experiences at each summer camp were present. These analyses were adjusted for pre- assessment, sex, age, ethnicity, body mass index, lesson and camp dose, and parent’s cultural affiliation. Data (e.g., heights, weights) from the Guam Head Start Program were analyzed to determine early childhood overweight and obesity prevalence in Guam. This dissertation informs approaches to promoting FV intake among children in the Pacific that can easily be integrated into existing childhood programs. Improving children’s diets holds promise for reducing obesity rates. The ability to assess these outcomes will come closer to reality with the initiation of publicly available systems to monitor obesity rates.
Fish and long-chain omega-3 fatty acids in pediatric liver disease
(University of Hawaii at Manoa, 2013-08) St-Jules, David E.
Pediatric nonalcoholic fatty liver disease (NAFLD) and parenteral nutrition-associated liver disease (PNALD) are difficult to manage conditions that have been rising with increasing rates of childhood obesity and survival of infants with intestinal failure, respectively. This dissertation is comprised of five research studies, which examine: a) the burden of pediatric NAFLD in Hawaiʻi, b) the effect of dietary fish and long-chain omega-3 fatty acid intake (LCω3) on pediatric NAFLD, and c) the use of fish oil-based lipid emulsions (FOLEs) in infants with PNALD. In a cross-sectional analysis of 195 patients referred to a pediatric endocrinologist at Kapi'olani Medical Center for Women and Children (KMCWC) with metabolic syndrome, approximately two-thirds had elevated serum alanine aminotransferase (ALT) concentrations indicative of NAFLD, which makes it one of the most common obesity-related comorbidities in this population. Examination of 81 pediatric NAFLD patients referred to two pediatric gastroenterologists at KMCWC showed that these children were typically overweight (98%) and suffered from obesity-related comorbidities, particularly dyslipidemia, and often exhibited histological features of steatohepatitis. There was a significant reduction in serum ALT concentration in these patients over time; however, body weight tended to increase and was not associated with changes in serum ALT concentrations. In a prospective cohort of 200 Asian and White female adolescents recruited among members of Kaiser Permanente Oahu, greater fish consumption appeared to reduce two-year changes in waist circumference (n=103), a risk factor for NAFLD, although relatively few girls, mostly of Asian ethnicity, consumed the recommended eight ounces of fish per week (12.4%). Children who were attending one of the eight clinical centers of the Nonalcoholic Steatohepatitis Clinical Research Network (n=223) reported similarly low rates of eating eight or more ounces of fish per week (9.9%). In this study, greater fish and long-chain omega-3 fatty acid intake were associated with less severe of portal and lobular inflammation on liver biopsy. Among ten infants diagnosed with PNALD at KMCWC who were treated with FOLE, earlier initiation of FOLE treatment was associated with reduced length of hospital stay. In summary, the findings of this dissertation demonstrated that a) pediatric NAFLD is a common consequence of obesity in Hawaiʻi that is associated with serious disease sequelae, b) fish and Lcω3s consumption is low in adolescents, which may increase risk for and severity of hepatic inflammation in NAFLD, and c) early initiation of FOLE treatment in infants with PNALD may reduce length of hospital stay. Strategies to improve fish and LCω3 intake in children and infants at risk of NAFLD and PNALD, respectively, are needed to reduce the burden of pediatric liver disease.

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