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The goals of this study were to 1) determine the prevalence of adverse childhood experiences (ACEs) and their impact on health and health-risk behaviors and 2) assess body composition, salivary cortisol, and phase angle (PhA) with high, moderate, low, or no exposure to ACEs in college-aged Appalachian adults (≥18 y). Methods. College students completed an anonymous questionnaire (Phase 1) about ACEs, positive experiences, adult resiliency, perceived stress, food insecurity, and health. A subsample participated in the Phase 2 in-person portion to measure body composition, PhA, and resting/reactive cortisol. One-way ANOVAs and correlation analyses were used to analyze the sample. Results. In Phase 1 (N=611, 86.3% ≤25 y, 64.0% female, 81.0% Caucasian, 52.4% heterosexual), only 3.6% (n=22) reported no ACEs, while 34.7% (n=212) reported ≥8. Positive experiences (r=-0.62), perceived stress (r=0.37), resiliency (r=-0.53), and food insecurity (r=0.25) were significantly correlated with ACEs score (p0.05). Conclusions. The prevalence of ACEs is high amongst this sample of young adults and though significant physiological changes were not seen, health perceptions and behaviors were impacted. Future research should focus on a slightly older age group to identify when specifically physiological changes due to ACEs begin to manifest.

The application potential for flexible and wearable electronics in the field of healthcare has received great interest in recent years. Flexible and wearable devices based on soft, biocompatible materials can be comfortably attached to the human skin for continuous health monitoring. In this work, we present two novel wearable bioelectrical impedance analysis (BIA) systems for body composition measurement. First, we developed a wearable ring-based BIA system for body fat monitoring. The wearable ring contains flexible copper electrodes to interface with the human body. The device is tested on 40 healthy volunteers and the results demonstrate a high correlation with an off-the-shelf body fat monitor. Second, we developed flexible BIA systems on paper and plastic substrates and compared their performance. The paper-based system demonstrates stronger adhesive contact with the electronic components while the plastic-based system provides lower power consumption and lower electrode impedance. Last, we proposed a novel temperature sensor on a polydimethylsiloxane (PDMS) substrate that can compensate for the deformation-induced resistance variation and measure temperature with minimum errors. The compensation method enhances the competence of flexible temperature sensors and increases their potential for applications in wearable electronics.

Abstract: Adults with class II/III obesity (BMI ≥35 kg/m2) are at increased health risk, and may also present with lower lean mass in relation to excess adiposity, a condition termed sarcopenic obesity. A variety of body composition indices and cutpoints have been used to define this condition, mostly in older adults (>65 years), leading to conflicting prevalence and risk prediction. Sarcopenia is associated with increased morbidity and mortality in the elderly, but the clinical implications in adults with class II/III obesity are unknown. The objective of this thesis was two-fold. First, to explore the prevalence of sarcopenia in a sample of adults with class II/III obesity using different diagnostic criteria, and second, to describe the clinical characteristics of participants with sarcopenic obesity, compared to their counterparts (non-sarcopenic obese). Eighteen definitions for sarcopenic obesity were initially identified from a literature review of studies using dual-energy X-ray absorptiometry (DXA) to assess lean mass, and applied to a sample of patients from an obesity specialty clinic. In this cross-sectional analysis, baseline data on demographic, anthropometric, biochemical, comorbidity, and activity variables were collected. Body composition was assessed by DXA. Self-reported difficulties with activities of daily living (ADL) were evaluated from 11 items on a questionnaire. A total of 120 participants (86 % female) aged 46 ± 11 years were included. Lean mass was extremely variable in individuals, even with similar body sizes, and across the age spectrum. The prevalence of sarcopenic obesity ranged from 0 – 84.5 % in females and 0 – 100 % in males, depending upon the diagnostic criteria applied, with higher prevalence among definitions accounting for measures of body size or fat mass. In order to select a cohort-specific definition of sarcopenic obesity for this young-to-middle aged cohort, we explored five criteria, which were tested in relation to self-reported ADL using receiver operating characteristic analysis. The appendicular skeletal mass by weight x 100 (%) definition was the best correlate for both sexes [females (r= -0.232, p=.024); males (rs =-0.510, p=.037)], and therefore chosen as the method to define sarcopenia in this cohort. Sex-specific cutpoints of appendicular skeletal mass/weight x 100 (%) were

Malnutrition among individuals with head and neck cancer (HNC) is of particular concern, with up to 40% - 57% with a compromised nutritional status even before beginning their treatment. Within the US, the prevalence of malnutrition has not been well-documented due to a lack of consensus on its definition and diagnosing markers. Therefore, the primary aim of this prospective natural history pilot study was to estimate the prevalence of malnutrition among individuals with HNC (n = 19) during and up to 3 months after treatment using the new Consensus malnutrition definition. The scored Patient-Generated Subjective Global Assessment (PG-SGA) was used as the reference standard to evaluate the sensitivity and specificity of the Consensus framework in defining malnutrition. Another aim of this research was to investigate the utility of raw bioimpedance parameters such as 50 kHz phase angle (PA) and 200 kHz/5 kHz impedance ratio (IR) to identify individuals with malnutrition, and to evaluate how bioimpedance markers relate to functional status outcomes. Finally, this research also assessed how malnutrition relates to quality of life (QoL) and self-efficacy perceptions among individuals with HNC. Results indicate that individuals with HNC are malnourished even before treatment initiation. Using the Consensus framework, 67% of our participants were malnourished before treatment; and the prevalence of malnutrition consistently increased during treatment and the post-treatment period. When compared to our reference standard PG-SGA, the Consensus criteria identified malnutrition with overall good sensitivity (95%) and specificity (43%). Bioimpedance markers PA and IR were useful in identifying individuals who were at increased risk for malnutrition and/or impaired functional status. From a psychosocial perspective, compared with well-nourished participants, malnourished individuals scored significantly lower in the global QoL and cognitive function scales and significantly higher in the disease- and treatment-related symptom scales and items. In the future, if clinicians are trained to assess malnutrition diagnostic markers before individuals with cancer undergo aggressive treatments, nutritional interventions could be initiated at an earlier time and loss in weight and/or lean tissue can be prevented. Early detection of malnutrition could also help with patient-specific intervention strategies aimed to improve overall health-related QoL outcomes.

Over the past 30 years, obesity has been primarily identified by the body mass index (BMI). Due to its ease of calculation, the BMI has become the most widely used diagnostic tool to identify weight problems. This study examined the association between hypertension and BMI in White, Black, and Hispanics in the United States. The study’s hypothesis was that this relationship was weaker in Blacks than in the other groups. Data for the study came from the 2007-2008 and 2009-2010 National Health and Nutrition Examination Surveys. The association was weaker in Black men than in Whites or Hispanics on a univariate basis, and at most BMI levels on a multivariate basis. For females, it was also weaker in Blacks at most BMI levels on a univariate basis. However, multivariate logistic regression analysis did not indicate that the hypothesis held for Black women when adding covariates to the models.

The reliable measurement of growth and condition is vital for effective fisheries assessments. Biologists have long attempted to estimate condition for their assessments, but a reliable method to nonlethally estimate body composition is lacking. Proximate analysis is the most dependable and accurate method for estimating internal composition, but it is lethal, time consuming, and expensive. Recent research has shown bioelectrical impedance analysis (BIA) to be an effective method for estimating proximate composition in some fishes. The technique is quick, inexpensive, and, most importantly, nonlethal, which is vital when examining endangered species or cultured fish. My research focused on developing BIA indices for several new species of fish, using those indices to evaluate the body composition of fish in the field, and determining whether water temperature influenced resistance and reactance measurements. I found that BIA accurately estimated the body composition of bluegill Lepomis macrochirus, redear sunfish Lepomis microlophus, brook trout Salvelinus fontinalis, and northern logperch Percina caprodes (r2 ≥ 0.71, p < 0.0001). I also determined that bluegill and redear regressions were not significantly different (P ≥ 0.10) suggesting they can be used interchangeably during future studies. Laboratory studies revealed that water temperature did not significantly influence resistance and reactance measurements of bluegill, redear, and largemouth bass Micropterus salmoides (P ≥ 0.18). These results, along with previous literature, indicate that BIA may be an accurate and reliable assessment tool for fisheries biologists.

Bioelectrical impedance analysis measured body water changes of 25 young adults. Subjects increased total body water throughout the hydration conditions. There was no significant gain in total body water during the over hydration period as compared to the normal hydration period. However, there was a tendency to gain less total body water during the over hydration period. The body reaches a maximum level of hydration and eliminates any excess. Hydration formulas using body weight and implications for future research are suggested.