PURPOSE: The impact of academic lessons taught using twice daily 25 minutes of physical activity on the early literacy skills in Head Start preschools serving Black children. METHODS: Ninety-one Black children (mean ± SD, age 3.7 ± 0.4y) from a low socioeconomic urban Head Start program (225 min/wk, n = 6 classrooms, F, n = 57, M, n = 38) performed physical activity academic lessons for 6 months. The PA program was designed to promote 225 min/wk of moderate to vigorous PA academic lessons (3.0-6.0 METS, ~25 min each, 2 lessons/day). The Get It, Got It, Go Individual Growth and Development Indicators for children ages 3-5y was administered to assess academic achievement related to early literacy and phonological awareness in the areas of picture naming, rhyming, and alliteration. Intensity of classroom PA was measured by SOFIT observation. All measures were assessed at baseline, 3 and 6 months. RESULTS: The physical activity academic lessons resulted in significantly (p < 0.05) greater levels of PA in the classroom during free play at 3 (10.1 ± 2.6%) and 6 (23.1 ± 2.5%) months compared to baseline. Picture naming (number of pictures named correctly/min) significantly (p < 0.01) improved from baseline (15.2 ± 5.3) to 3 (22.5 ± 5.1) and 6 (25.5 ± 4.5) months. Rhyming (number of rhymes correctly identified/two min) significantly (p < 0.01) improved from baseline (1.3 ± 1.5) to 3 (2.4 ± 2.1) and 6 (5.2 ± 3.9) months. Alliteration (number of letters sounds correctly identified/two min) significantly (p < 0.01) improved from baseline (1.2 ± 1.6) to 3 months (2.1 ± 1.5) and at 6 months (2.8 ± 1.4). Higher scores for picture naming, rhyming, and alliteration indicate greater early literacy skills and phonological awareness. CONCLUSION: Physical activity incorporated into preschool academic lessons improves earlier literacy skills in Black preschool children.

Finding effective ways to treat obese individuals with NAFLD is important in reducing health risks. Intrahepatic triglyceride (IHTG) and intramyocellular triglyceride (IMTG) are common metabolic complications NAFLD. The effects of aerobic exercise in reducing IHTG and IMTG is unknown. PURPOSE: Determine the effect of a single bout of the aerobic exercise on IHTG and IMTG content obese individuals with NAFLD. METHODS: Twelve obese people (Means ± SD, Age 46.3 ± 4.2 years, BMI = 39.1 ± 4.1 kg/m2) with NAFLD performed a single bout of aerobic exercise (60 minutes at 50% of V02max) on a motor driven treadmill. Magnetic resonance spectroscopy was used to evaluate IHTG and IMTG content before and immediately after the exercise bout. IMTG was evaluated from the soleus muscle. Duel Energy X-ray Absorptiometry (DXA) was used to measure body weight and percent body fat. RESULTS: A single bout of aerobic exercise resulted in a significant (p < 0.05) decrease in IHTG from before (16.1 ± 1.6%) to after (12.5 ± 1.0%) the exercise bout. IMTG significantly (p < 0.05) decreased from before (3.9 ± 0.6%) to after (1.7 ± 0.7%) the single exercise bout. As expected there was no significant change in body weight (104.0 ± 3.0 kg and 103.8 ± 3.2 kg) or percent body fat (31.0 ± 2.2% and 30.8 ± 2.1%) before and after the exercise bout. CONCLUSION: Performing even a single bout of aerobic exercise reduces IHTG and IMTG obese persons with NAFLD.

Most preschool lunches must meet dietary standards that ensure a balanced diet. However, what is served and consumed by children is not restricted, potentially affecting consumption of a balanced diet. PURPOSE: To evaluate lunch menus that meet dietary standards to what is served and consumed. METHODS: Preschool children (n = 52, mean ± SD, age 3y and 10 m ± 8 m) were enrolled in a 10-week university based preschool dietary study. During lunch, 15 children were randomly selected for nutritional analysis. A picture of the child’s tray was taken using digital photography just prior to and immediately after consumption. In the event of a child having more food (second’s), a second set of pictures were taken in the same manner as described above. Using Food Processor Nutrition Analysis by ESHA energy and nutrient content for menus, food served, and food consumed was completed. Food color (white, brown, orange, yellow, red, green, other) was determined by observation during analysis. A food preference survey was administered orally to children immediately after each meal. RESULTS: The majority of food served was white (38.1%), brown (20.4%), or yellow (14.2%) with minimal from orange (10.2%), red (6.1%) or green (10.7) foods. Children described food as yummy (75.2%), okay (7.6%), and yucky (17.2%). There was a significant (p < 0.05) difference for total kilocalories (kcals) between menu (448 ± 130), served (523 ± 148) and consumed (361 ± 178). There was a significant (p < 0.05) difference for grams of fat between menu (15.9 ± 8.7 g), served (21.2 ± 9.7 g) and consumed (14.5 ± 10.0 g). There was a significant (p < 0.05) difference for protein between menu (21.7 ± 5.7 g), served (27.9 ± 10.6 g) and consumed (19.5 ± 11.8 g). There was a significant (p > 0.05) difference for grams of carbohydrate between menu (55.3 ± 18.9 g) and served (56.5 ± 20.5 g) compared to what was consumed (38.5 ± 21.7 g). Consumption of vegetables (46.9%) was significantly (p < 0.05) lower than dairy (88.9%), fruits (82.0%), grains (81.8%), and meats (72.8%). Children consumed a high percentage (77.9%) of fats/sweets. CONCLUSION: The amount of food consumed at lunch was significantly less than the menu and served amounts for breakfast, indicating that children were not meeting the dietary recommendations as intended, potentially contributing to long-term health consequences.

Evolutionarily, the body tends to store fat and resist its loss. Any weight gain most often leads to obesity, a chronic disease characterized by an excess of adipose tissue in the body. It is the cause of a mismatch in energy balance, where calories taken in from food exceed those that are used, thus, resulting in an excess amount of fat in the bloodstream, referred to as hyperlipidemia. The chapter starts by defining body mass index, and explains how it can be calculated. It compares the body mass index of a normal person to that of an overweight and an obese individual. It then lists the four pathways by which daily expenditure of energy takes place and the amount of energy that each one of these consumes. The chapter discusses in detail the causes of obesity, and explains how genetics is linked to obesity. It lists the different types of obesity and identifies the type that leads to chronic diseases. It is established where leptin and ghrelin are made and their roles in the body are summarized. Leptin's regulation of release and its mechanism of action are both described, and the causes for leptin resistance are identified. Obesity is related to insulin resistance. The chapter summarizes the strategies that are used in reversing obesity. It defines metabolic syndrome, and lists the clusters of diseases that contribute to metabolic syndrome. The underlying mechanism in the development of this syndrome is also explained. Finally, the chapter summarizes the treatment choices for obesity and metabolic syndrome.

Blood vessels serve as the transport medium within the body. They move blood from the heart to the entire body and back to the heart. They also provide a physical site for gases, nutrients, and other substances to be exchanged between the blood and the tissues. Any disturbance associated with blood flow would result in tissue injury and subsequent loss of bodily functions. This chapter compares the blood vessel wall of an artery with that of a vein and a capillary, and lists the different types of capillaries, providing examples. It describes the characteristics of each type of blood vessel: artery, arteriole, capillary, venule, and vein, and then summarizes the mechanisms involved in allowing the blood to flow. This chapter covers the role of peripheral resistance and blood pressure in the regulation of blood flow, the various factors associated with blood flow, and the capillary exchange system, including the forces involved in this process. It also captures the role of the lymphatic system in capillary exchange, and the role played by the skeletal muscle pump and respiratory pump in relation to venous return. Finally, the chapter identifies the role of exercise in maintaining vascular homeostasis.

The pancreas is a soft, slender organ located in the upper abdomen directly behind the stomach and next to the small intestine. It is primarily an exocrine gland secreting a variety of digestive enzymes and pancreatic juice. It is also a very important endocrine gland secreting hormones, insulin and glucagon, which are essential in regulating blood glucose concentrations. The pancreatic exocrine function is carried out by acinar cells. Pancreatic juice rich in digestive enzymes is transported into the small intestine by the pancreatic duct. This chapter describes the location and the structure of the pancreas, and the histology and function of the pancreatic islets (islets of Langerhans). It differentiates the cells that synthesize insulin from other cells in the islets of Langerhans. Name the peptide that is released along with insulin. The steps involved in the synthesis of insulin are described, and the mechanism is explained by which insulin is released, including the stimuli for its release. The mechanism of action of insulin at its target cell is also explained. The cells that synthesize and release glucagon are named, and the trigger for the release of glucagon is explained. The chapter compares and contrasts the functions of insulin and glucagon in maintaining normal blood glucose concentration. Finally, it defines absorptive and postabsorptive (fasting) states, and explains the roles of glucagon and insulin in these states.

The chapter starts by defining arterial blood pressure and how it is generated. The values of the blood pressure measurements can be used to calculate mean arterial blood pressure. Arterial systolic, diastolic, mean, and pulse pressure are affected by changes in the cardiac output and total peripheral resistance. The chapter explains the causes of essential (primary) hypertension, and the mechanisms involved in the development of hypertension. The factors that regulate arterial blood pressure are described, and how the baroreceptor reflex helps to compensate for a fall in blood pressure. The aortic and carotid artery baroreceptor reflexes are mapped, and the significance of this baroreceptor in the regulation of blood pressure is explained. The chapter describes how sympathetic and parasympathetic activation affects blood pressure, and explains the chemoreceptor reflex in the regulation of blood pressure. The hormones that help regulate blood pressure are named, along with the mechanisms used to accomplish this. Finally, the mechanisms associated with exercise in lowering blood pressure are identified, and the recommended types of exercise for hypertensive patients are listed.

PURPOSE: We determined the effects of weight regain in individuals with NAFLD following a low carbohydrate diet (LC). METHODS: Participants (n-12, body-mass index, 36.5 ± 1.0 kg/m2) with NAFLD (10.3 ± 2.8% liver triglyceride) followed a LC (<60 g/d) energy-deficit diet (1,200kcals/day) for 12 weeks with a follow up at 9 months after the end of the weight loss (WL) phase. DXA, Magnetic resonance spectroscopy, muscle biopsies, and a euglycemic-hyperinsulinemic clamp were used to determine body composition, intrahepatic triglyceride content (IHTG), and insulin action before, after ~12 weeks of caloric restriction using a LC diet, and 9 months follow-up (post weight loss). RESULTS: Participants lost a significant (p < 0.05) amount of body weight from baseline (101.9 ± 4.0 kg) to 12 weeks WL (93.4 ± 4.0 kg) but regained most of the body weight body at 9 months follow-up (97.5 ± 5.5 kg, p > 0.05 compared to baseline). Basal glucose rate of appearance significantly decreased from baseline (14.2 ± 0.4 μmol/kgFFM/min, p < 0.001) to WL (11.7 ± 0.3 μmol/kgFFM/min) but returned to baseline values at 9 months follow up (13.2 ± 1.5 μmol/kgFFM/min, p > 0.05 compared to baseline). IHTG significantly (p < 0.05) decreased from baseline (12.4 ± 2.9%) to 12-weeks WL (8.9 ± 7.3%) but returned to baseline values at 9 months follow-up (11.5 ± 8.9%, p > 0.05 compared to baseline). Homeostasis model assessment (HOMA-IR) significantly (p < 0.01) decreased from baseline (4.9 ± 0.7) to WL (2.7 ± 0.5) but returned to baseline values at 9 months follow up (4.6 ± 1.6, p > 0.05 compared to baseline). CONCLUSIONS: Weight regain following a LC diet resulted in a return of IHTG and insulin resistance suggesting the importance of weight loss and maintenance.

Diabetes mellitus (DM), commonly referred to as diabetes, is a metabolic disorder characterized by high blood glucose levels over a prolonged period. While 70–110 mg/dL fasting blood glucose is considered normal, blood glucose levels between 100 and 125 mg/dL is considered prediabetes, and 126 mg/dL or higher is defined as diabetes. There are two major forms of diabetes mellitus: type 1 and type 2. This chapter describes the causes of both types of diabetes mellitus. It links the role of genetics in the development of type 1 and type 2 diabetes mellitus, and explains the development of insulin resistance in the adipose tissue, liver, and muscle. The chapter describes how obesity is tied to the pathogenesis of type 2 diabetes mellitus. Advanced glycation end products are defined, and their effects in the body are set out. A summary of the signs and symptoms of diabetes mellitus is provided. The chapter defines diabetic ketoacidosis and explains its manifestation in a patient. It then lists acute signs and symptoms of diabetes mellitus, and the major chronic complications of diabetes mellitus. The oral glucose tolerance test is explained, and the role of exercise in the management of diabetes is discussed.

A human heart pumps approximately 108,000 times per day, more than 39 million times in 1 year, and nearly 3 billion times during a 75-year lifespan at the normal heart rate of 75 beats per minute. This chapter describes the location, size, and external details of the heart, and the internal anatomy of the heart to include the chambers, valves, and layers within the wall. It follows the flow of blood that reaches the heart in a step-by-step manner until it ejects blood, and describes the characteristics of the cardiac muscle fiber. The electrical activity within a cardiac conductive (pacemaker) cell is compared to that of a cardiac contractile cell. The parts of the cardiac conduction system are described, and the normal pacemaker of the heart named. The details of an electrocardiogram are then provided. A normal cardiac cycle is set out, beginning with the depolarization of the pacemaker cells and ending with the next round of pacemaker depolarization. Electrical events are correlated to mechanical changes, pressure changes, and blood flow changes. The chapter explains how cardiac output is measured, and describes how each component of cardiac output is regulated. The Frank-Starling law of the heart is set out; this principle states that, within physiological limits, the force of contraction is directly proportional to the initial length of the muscle fiber. The terms “preload” and “afterload” are defined. Finally, the chapter describes the mechanisms by which the parasympathetic and sympathetic nervous systems affect cardiac output.

The liver is the largest gland in the body, weighing approximately 3 pounds in an adult. It is essential for life since it deals with various metabolic processes, including getting rid of substances that would otherwise be harmful if allowed to accumulate. It is also the first port of entry for most nutrients that are absorbed by the digestive tract. Additionally, the liver is essential in synthesizing many substances, including plasma proteins, clotting agents, and bile, that optimize the absorption of fats. Obesity increases the risk of elevated liver enzymes and causes steatosis (fatty liver), cirrhosis (scarring), and hepatocellular carcinoma. This chapter describes the anatomical and histological features of the liver, and names the two major blood supplies to the liver and the significance of two separate blood supplies. It lists the substances that bile is made of, and describes the regulation of the release of bile. The pathway by which bile is released is also traced. The chapter describes the major functions of the liver concerning metabolism, detoxification, and excretion of substances. Steatosis, steatohepatitis, and cirrhosis are defined, compared and contrasted. The mechanism by which alcohol affects liver function is explained. The chapter identifies the histologic features and lab values in the differential diagnosis of steatohepatitis. It defines portal hypertension and the cause of this, and explains the conditions that ultimately lead to cirrhosis.

Metabolism refers to the sum of all chemical reactions within the body and is subdivided into catabolism and anabolism. These two types of chemical reactions are coupled to one another. Metabolic processes occur constantly and are essential in maintaining normal functions within the body. This chapter defines metabolism and its two aspects, and discusses the role of adenosine triphosphate (ATP) in metabolism. It compares oxidation and reduction reactions. The role of nicotinamide adenine dinucleotide (NAD) and flavin adenine dinucleotide (FAD) in oxidation-reduction reactions is explained. The chapter identifies the hormones that are important in altering metabolism and how they bring about any changes. It then describes how dietary carbohydrates are digested and absorbed. Glycolysis is defined, along with the location in the cell where it occurs, and the net yield of this reaction. The cause for the conversion of glucose to lactic acid is explained. A summary of the metabolism of glucose within the mitochondrion, including the net yield of products, is provided. The chapter goes on to identify the part of the aerobic pathway where oxygen is utilized and how, and compares aerobic and anaerobic reactions. The terms gluconeogenesis, glycogenesis, and glycogenolysis are defined, as are essential and nonessential amino acids. The chapter describes how proteins can be used as energy sources. The significance of deamination and transamination is considered. Finally, the location and significance of the urea cycle are discussed.

Lipids (fats) are essential organic molecules in the body. Unlike carbohydrates and proteins, lipids are not soluble in water but are soluble in organic solvents and therefore require carrier proteins for their transportation. There are many types of lipids in the body. The three major types of lipids are triglycerides, phospholipids, and steroids. Cholesterol serves as the precursor in the synthesis of steroids. Approximately 15% of cholesterol is obtained through diet, and the remaining 85% is manufactured within the liver. This chapter summarizes the process of digestion and absorption of lipids, including the role of bile and micelles. It describes how lipids are processed in the production of ATP. Lipoproteins are defined, and the different types of lipoproteins and their compositions are listed. Sites are identified where lipoproteins are synthesized. The chapter explains the metabolism of chylomicrons, low-density lipoproteins, and high-density lipoproteins. Beta-oxidation is defined and its significance in the body is discussed. The situations that trigger lipogenesis versus lipolysis are compared. Ketone bodies are defined and the importance of these substances in the body is summarized. The chapter also distinguishes between the terms “ketogenesis,” “ketosis,” and “ketoacidosis.”