Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Diet-induced alterations to postprandial metabolism and the gut microbiota(Montana State University - Bozeman, The Graduate School, 2022) Wilson, Stephanie Michelle-Gandia; Chairperson, Graduate Committee: Mary P. Miles; This is a manuscript style paper that includes co-authored chapters.Obesity is a key component of a cluster of metabolic risk factors for chronic disease which include dyslipidemia, hyperglycemia, and hypertension. Stark changes in diet and lifestyle contribute to growing metabolic disorder prevalence. Many Americans regularly consume foods low in fiber and rich in fat and sugar, which can negatively influence glucose and lipid metabolism over time. A nutritionally poor diet exerts deleterious effects on the gastrointestinal microbial community which has larger host health implications. As a modifiable risk factor, diet can be part of the solution to counter the rise of chronic disease. However, dietary responses as it pertains to glucose and lipid metabolism display high interindividual variability. This interindividual variability with diet can also be observed at the microbial level in our gastrointestinal system. In metabolically at-risk adults, we examined postprandial responses and the efficacy of a long-term lentil dietary intervention in improving postprandial glycemic responses. We further assessed the effect of an antioxidant-rich juice from the Aronia melanocarpa berry and its anti-inflammatory potential against a high fat diet in a gnotobiotic mouse model to evaluate how specific gut microbial communities transferred from metabolically at-risk adults with different inflammatory profiles may impact dietary responses. Postprandial triglyceride responses in adults with overweight and obesity can be partially explained by central adiposity, insulin resistance, and the ability to switch between glucose and fat metabolism to a metabolic stress. A long-term dietary intervention with lentils, a fiber-rich pulse crop, worked in a dose-dependent manner to reduce insulin resistance in adults with increased central adiposity without an increase in gastrointestinal symptoms, a common deterrent to incorporating fiber-foods in the diet. Our gnotobiotic mouse experiments revealed donor- dependent changes in dietary responses. We observed protective effects of Aronia juice in mice, particularly in mice from the low inflammation stool donor. Metabolomic changes in phospholipids such as phosphatidylcholine and sphingomyelin were further detected, with changes respectively unique to Aronia juice and high-fat diet. Taken together, this dissertation provides an improved understanding of our metabolic responses and microbial alterations to the foods we consume, and how these responses influence the progression of metabolic diseases.Item A registered nurse care manager's role in implementing a veteran obesity program(Montana State University - Bozeman, College of Nursing, 2022) Fleming-Weiler, Denise Dawn; Chairperson, Graduate Committee: Denise RiveraAim: A link exists between obesity, hypertension, cardiovascular disease, diabetes, and numerous other comorbid conditions. Studies have shown that weight reduction has a positive effect on comorbid conditions. The aim is to develop an obesity management program that combats obesity in the veteran population by focusing on self-efficacy and the registered nurse (RN) care manager role. Design: Quality improvement project Methods: The databases searched include Montana State University: CatSearch, Google Scholar, ProQuest, CINAHL, MEDLINE, and EBSCO Web of Science. The study participants include adults who met the Center for Disease Control and Prevention's (CDC) definition of obesity, with a Body Max Index (BMI) greater than 30 kg/m 2. Results: Further research could yield better practices for successfully implementing weight management treatment and intervention plans if programs focus on self-efficacy and collaboration with established programs. Additionally, more research would help identify an obesity registered nurse care manager's impact in combating obesity in the veteran populationItem A quality improvement project to address veteran obesity(Montana State University - Bozeman, College of Nursing, 2022) Anderson, Mary Rebecca; Chairperson, Graduate Committee: Susan LuparellObesity is rising, and veterans have more risk factors than the general public. The health implications and financial burden are enormous. Established guidelines recommend weekly in-person intensive lifestyle counseling focused on diet, exercise, goal-setting, and self-monitoring. Despite referrals to free obesity management classes, few veterans choose to engage. Alternatives to these referrals include provider engagement and nurse follow-up. Research shows promising evidence that self-monitoring with the use of smart phone apps with nurse phone support results in reductions of BMI for some patients. By establishing a clinic workflow, this QI project sought to show that primary care teams can manage obesity alongside other chronic health conditions. The healthcare teams screened, assessed, and began treatment for obesity over an 8-week implementation period. Data from the pilot implementation show greater than 90% staff compliance with process measures. Provider referral rates increased 20% suggesting increased comfort with discussions about weight over time. The project demonstrated that the clinic process is feasible for staff to deliver. Future implementations can focus on patient-level outcomes, such as reduction in BMI and acceptability of the intervention to patients.Item Childhood obesity: screening and interventions(Montana State University - Bozeman, College of Nursing, 2022) Upham, Meghan Karen; Chairperson, Graduate Committee: Tracy HellemChildhood obesity has been a growing concern in the United States for the last three decades. With the COVID19 pandemic, a substantial increase in weight gain has been noted in the pediatric population, leading to a more alarming obesity trend. The American Association of Pediatrics, Centers for Disease and Control and Prevention and the World Health Organization, have established a standard of care for measuring obesity in children using BMI percentiles for age and sex specific growth charts. However, at a pediatric clinic in Northwest Montana providers were not using BMI percentiles to assess for pediatric overweight/obesity. Therefore, the aim of this project was to standardize practice that included screening for childhood obesity using age and sex specific growth charts, document BMIs in provider charting, add overweight or obese to a child's problem list and refer overweight/obese children to a behavioral therapist or nutritionist. During a six-week data collection a total of 90 well child visits were documented, 92% of the children were screened for overweight/obesity using BMI, documented in the medical record, and added to the problem lists. The referral rate to a behavioral therapist or nutritionist was 41%. The conclusion of this project showed improvement with screening using BMI and documenting in the electronic medical record. However there were limitations for referring children to a behavioral therapist or nutritionist that included, finances, time, bias, and lack of conversations.Item Impact of weight classifications on weight loss behavior: a regression discontinuity design(Montana State University - Bozeman, College of Agriculture, 2020) Worley, Ronald Wayne, III (Trey); Co-Chairs, Graduate Committee: Andrew Hill and Mariana CarreraAround 70% of US adults are overweight or obese, conditions strongly associated with medical issues and lower worker productivity. Efforts to address this issue have largely failed to instill long-term healthy living habits in individuals, and a better understanding of how individuals respond to these weight classifications may aid in creating effective interventions. Using the National Longitudinal Survey of Youth 1979, I exploit the quasi-random assignment of weight classifications through the body mass index in a regression discontinuity design (RD) to analyze the impacts of overweight and obese assignments on weight change behavior and attempts to lose weight. My results suggest that individuals do not respond to these classifications by altering their weight change behavior or their efforts to lose weight. Limitations to my study make it uncertain whether this is the true relationship between weight classifications and weight-related behaviors. However, these findings align with previous research utilizing similar natural experiments. Future studies could exploit additional sources of variation in weight information, utilize different techniques, and explore alternative samples to contribute to the small, yet growing, literature on this topic.Item Developing a family based program to reduce the incidence of obesity in American Indian children(Montana State University - Bozeman, College of Nursing, 2021) Crowley, Jacy Kate; Chairperson, Graduate Committee: Angela JukkalaChildhood obesity is a significant health problem resulting in decreased lifespan related to chronic health problems. Prevalence of childhood obesity is experienced in American Indian (AI) children at greater rates than their non-native peers. Social determinants of health significantly impact AIs; socioeconomic status, geographic location of reservations, and family and community dynamics uniquely impact health outcomes and risk factors of AI families and communities. This scholarly project investigates the disparity of childhood obesity within the AI community and the potential of a culturally relevant and acceptable family-based program to reduce the prevalence. A community advisory board (CAB) and components of successful AI-specific programs will guide the development of a culturally relevant family-based program. This project aims to reduce the prevalence of childhood obesity in AI children by supporting nutritional knowledge and sovereignty, family engagement, and positive behavior support and coping mechanisms. A culturally relevant family-based program has the potential to reduce the prevalence of childhood obesity in AI children and improve health equity.Item Childcare as a protective factor for childhood obesity(Montana State University - Bozeman, College of Nursing, 2020) Carnahan, Brittany Anne; Chairperson, Graduate Committee: Susan RaphChildhood obesity is a major public health crisis. Obese children are at risk for developing chronic diseases and are more likely to become obese adults. Despite efforts to decrease the number of obese children, the rate has more than tripled since the 1980s. Since childhood obesity is multifactorial, any person involved in caring for a child outside of the home can have an impact on the child's life helping to minimize risk factors, such as poor nutrition, which is known to contribute to obesity. Purpose: The purpose of the project was to 1) assess ECE providers' understanding of national childhood nutrition guidelines in relation to whether or not they participate in the STARS to Quality program or the CACFP; 2) create and provide childhood nutrition education to ECE providers with the objective to reinforce or increase knowledge on childhood nutrition and the important role of the ECE provider to deliver sound nutrition; and 3) to evaluate the effectiveness and sustainability of the education tool in increasing ECE provider knowledge of national childhood nutrition guidelines. Methods: Licensed ECE programs in the State of Montana completed a demographic survey, pre-test, educational video viewing, and posttest regarding childhood nutrition recommendation guidelines. The project was developed using the National Dietary Guidelines for all Americans and the Child and Adult Care Food Program recommendations for reimbursable meals. Pre and posttest scores were compared and analyzed. Evaluation: Overall, there was an 11.5% improvement in correct answers from the pretest to the posttest indicating that viewing of the educational tool was successful in increasing knowledge. Discussion: The use of a guideline based educational tool for ECE programs has the potential to increase caregiver knowledge regarding childhood nutrition recommendations and contribute to prevention efforts concerning childhood obesity.Item Post-prandial serum concentrations of Trimethylamine-N-oxide in overweight and obese adults with low and high systemic inflammation(Montana State University - Bozeman, College of Education, Health & Human Development, 2018) Wilson, Stephanie Michelle; Chairperson, Graduate Committee: Mary P. MilesPurpose: Elevated trimethylamine-N-oxide (TMAO) levels have been implicated in the development of atherosclerosis. The impact of a high-fat meal on the post-prandial TMAO response in healthy overweight and obese adults was explored, accounting for additional variables that may affect the rate of TMAO conversion. Methods: Forty overweight and obese men and women participated in a high-fat meal challenge containing 50 g fat. Blood samples were collected at fasting and hourly in the 4 hours after meal ingestion and tested for concentrations of TMAO, liver enzymes, lipids, creatinine, insulin, and inflammatory markers. An initial mixed-effects model was constructed to analyze TMAO changes in participants who classified as having low or high levels of systemic inflammation accounting for factors that may influence TMAO concentrations. Backward refinement of the initial model was performed based off p-values. Results: Model refinement found that the log TMAO response was best explained by inclusion of estimated glomerular filtration rate (eGFR), insulin over time, a linear interaction between time and inflammation phenotype, and random effects on subject. Log TMAO after the meal was not different between inflammation phenotypes (p = 0.33). Estimated GFR was the most important determinant in the log TMAO response (p = 0.03), with lower log TMAO observed with higher eGFR values. In conclusion, serum TMAO concentrations during a high fat-meal challenge were strongly determined by eGFR, but not by fasting inflammation status.Item Adolescent, parent, and nurse practitioner contract for behavioral change : a booklet to guide the process(Montana State University - Bozeman, College of Nursing, 1999) Babb, Deanna Lynn; Chairperson, Graduate Committee: Daryl T. RiesItem Acanthosis nigricans and risks for type 2 diabetes in children(Montana State University - Bozeman, 2002) Mullenberg, Erin; Chairperson, Graduate Committee: Vonna Branam