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COMPARATIVE BIOMOLECULAR AND THERAPEUTIC EFFECTIVENESS OF COLLABORATIVE INTEGRATIVE INTERVENTION IN MORBIDLY OBESE INDIVIDUALS
by
Naser Ahmadi
A Thesis Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of
Requirements for the Degree
MASTER OF SCIENCE
(CLINICAL AND BIOMEDICAL INVESTIGATIONS)
May 2012
Copyright 2012 Naser Ahmadi
Object Description
| Title | Comparative biomolecular and therapeutic effectiveness of collaborative integrative intervention in morbidly obese individuals |
| Author | Ahmadi, Naser |
| Author email | naserahm@usc.edu;ahmadi@ucla.edu |
| Degree | Master of Science |
| Document type | Thesis |
| Degree program | Clinical and Biomedical Investigations |
| School | Keck School of Medicine |
| Date defended/completed | 2012-03-19 |
| Date submitted | 2012-03-19 |
| Date approved | 2012-03-20 |
| Restricted until | 2012-09-19 |
| Date published | 2012-09-19 |
| Advisor (committee chair) | Azen, Stanley P. |
| Advisor (committee member) |
Hodis, Howard. Mack, Wendy. |
| Abstract | Background. Obesity is prevalent and linked with inflammation, insulin resistance, dyslipidemia, atherosclerosis, and associated with significant morbidity and mortality. The economic burden of obesity-related illnesses is substantial, with estimates ranging from 2% to 7% of the total US health care expenditures and billions of dollars in direct and indirect costs to society. This goal will be accomplished by collaborative integrative interventions (CI) in morbidly obese individuals in which eligible subjects will be randomized to MI plus Gastric bypass surgery (GBS), intense exercise and moderate caloric restriction (IE-MCR), or anti-obesity medications (AOM). ❧ Importance/Significance. There is a cumulative increase in the rate of obesity, up to two thirds of the US population. This randomized clinical trial will assess: 1) the change in biologic and clinical phenotypes in response to CI, 2) the change in genotypes in response to CI, and 3) Comparative biomolecular, therapeutic and cost effectiveness analyses of methods of CI to develop individualized intervention models to improve management of morbidly obese individuals. vascular function measured as coronary distensibility index (CDI), atherosclerotic burden measured as carotid intima media thickness (CIMT) and coronary plaque volume (CPV), metabolically active adipose tissue (MAC), oxidative stress and inflammatory biomarkers se well as changes in DNA methylation patterns, expression and regulation of promoter regions of genes provides fundamental information to assess the beneficial effects within and across CI methods on obesity management. This study investigates the underlying determinant of successful management of obesity by comparing biologic, clinical phenotype, genotype and cost effectiveness of CI methods, also enhances individualized anti-obesity interventions. ❧ Method. The CI methods are hypothesized to improve CDI and reduce CIMT, CPV and MAC, also increase up-regulation of cardio-protective genes. Over a 3 year period, 150 morbidly obese individuals’ ages 18 or older and free of clinical cardiovascular disease will be recruited from the Obesity Clinic of the Greater Los Angeles VA Health Care System, University of California Los Angeles and Cedars Sinai Medical Center. One hundred and fifty eligible subjects will be randomized to either of CI methods inclusive of MI plus GBS, IE-MCR, or AOM (50 in each group). All subjects will receive weekly MI training for a year. MI plus IE-MCR will receive lectures on exercise and general dietary measures including calorie counting. They will prepare their own food, with protien:carbohydrate:fat ratio of 30:45:25 and over 70% their resting daily energy expenditure, and completed daily food and exercise journals. They will exercise 3 ± 2 hours/day, about half supervised, for a year. MI plus GBS will undergo primary laparoscopic RYGB. MI plus AOB will receive xx pills daily for a period of 1-year. All subjects will be followed before, during and after interventions. Subjects will undergo carotid ultrasound and CT at baseline and at 1-year follow-up, also their oxidative stress and inflammatory biomarkers as well as genetic markers will be assessed. CI methods’ compliance and side effects will be evaluated. |
| Keyword | collaborative integrative interventions; motivational interviewing; gastric bypass surgery; intense exercise and moderate caloric restriction; anti-obesity medications ; atherosclerosis; fat mass; genomics; comparative biomolecular; therapeutic and cost effectiveness analyses |
| Language | English |
| Part of collection | University of Southern California dissertations and theses |
| Publisher (of the original version) | University of Southern California |
| Place of publication (of the original version) | Los Angeles, California |
| Publisher (of the digital version) | University of Southern California. Libraries |
| Provenance | Electronically uploaded by the author |
| Type | texts |
| Legacy record ID | usctheses-m |
| Rights | Ahmadi, Naser |
| Access conditions | The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given. |
| Repository name | University of Southern California Digital Library |
| Repository address | USC Digital Library, University of Southern California, University Park Campus MC 7002, 106 University Village, Los Angeles, California 90089-7002, USA |
| Repository email | cisadmin@usc.edu |
| Archival file | uscthesesreloadpub_Volume6/etd-AhmadiNase-521.pdf |
Description
| Title | Page 1 |
| Full text | COMPARATIVE BIOMOLECULAR AND THERAPEUTIC EFFECTIVENESS OF COLLABORATIVE INTEGRATIVE INTERVENTION IN MORBIDLY OBESE INDIVIDUALS by Naser Ahmadi A Thesis Presented to the FACULTY OF THE USC GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of Requirements for the Degree MASTER OF SCIENCE (CLINICAL AND BIOMEDICAL INVESTIGATIONS) May 2012 Copyright 2012 Naser Ahmadi |
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