Objective
In the Weight Loss Maintenance (WLM) Trial, a personal contact (PC) intervention sustained greater weight loss relative to a self‐directed (SD) group over 30 months. This study investigated ...the effects of continued intervention over an additional 30 months and overall weight change across the entire WLM Trial.
Methods
WLM had 3 phases. Phase 1 was a 6‐month weight loss program. In Phase 2, those who lost ≥4 kg were randomized to a 30‐month maintenance trial. In Phase 3, PC participants (n = 196, three sites) were re‐randomized to no further intervention (PC‐Control) or continued intervention (PC‐Active) for 30 more months; 218 SD participants were also followed.
Results
During Phase 3, weight increased 1.0 kg in PC‐Active and 0.5 kg in PC‐Control (mean difference 0.6 kg; 95% CI:−1.4 to 2.7; P = 0.54). Mean weight change over the entire study was −3.2 kg in those originally assigned to PC (PC‐Combined) and −1.6 kg in SD (mean difference −1.6 kg; 95% CI:−3.0 to −0.1; P = 0.04).
Conclusions
After 30 months of the PC maintenance intervention, continuation for another 30 months provided no additional benefit. However, across the entire study, weight loss was slightly greater in those originally assigned to PC.
Children in low-income countries experience multiple illness symptoms in early childhood. Breastfeeding is protective against diarrhea and respiratory infections, and these illnesses are thought to ...be risk factors of one another, but these relationships have not been explored simultaneously. In the eight-site MAL-ED study, 1,731 infants were enrolled near birth and followed for 2 years. We collected symptoms and diet information through twice-weekly household visits. Poisson regression was used to determine if recent illness history was associated with incidence of diarrhea or acute lower respiratory infections (ALRI), accounting for exclusive breastfeeding. Recent diarrhea was associated with higher risk of incident diarrhea after the first 6 months of life (relative risk RR 1.10, 95% confidence interval CI 1.04, 1.16) and with higher risk of incident ALRI in the 3- to 5-month period (RR 1.23, 95% CI 1.03, 1.47). Fever was a consistent risk factor for both diarrhea and ALRI. Exclusive breastfeeding 0-6 months was protective against diarrhea (0-2 months: RR 0.39, 95% CI 0.32, 0.49; 3-5 months: RR 0.83, 95% CI 0.75, 0.93) and ALRI (3-5 months: RR 0.81, 95% CI 0.68, 0.98). Children with recent illness who were exclusively breastfed were half as likely as those not exclusively breastfed to experience diarrhea in the first 3 months of life. Recent illness was associated with greater risk of new illness, causing illnesses to cluster within children, indicating that specific illness-prevention programs may have benefits for preventing other childhood illnesses. The results also underscore the importance of exclusive breastfeeding in the first 6 months of life for disease prevention.
Discovery of genetic mutations that have a significant association with economically important traits would benefit beef cattle breeders. Objectives were to identify with an in silico approach new ...SNP in 8 genes involved in digestive function and metabolic processes and to examine the associations between the identified SNP and feed efficiency and performance traits. The association between SNP and daily DMI, ADG, midpoint metabolic weight (MMWT), residual feed intake (RFI), and feed conversion ratio (FCR; the ratio of average daily DMI to ADG) was tested in discovery and validation populations using a univariate mixed-inheritance animal model fitted in ASReml. Substitution effect of the T allele of SNP rs41256901 in protease, serine, 2 (trypsin 2; PRSS2) was associated with FCR (-0.293 ... 0.08 kg DMI kg^sup -1^ BW gain; P < 0.001) and RFI (-0.199 ... 0.08 kg; P < 0.01) and although not significant in the validation population, the phase of association remained. In the cholecystokinin B receptor (CCKBR) gene, genotypes in rs42670351 were associated with RFI (P < 0.05) whereas genotypes in rs42670352 were associated with RFI (P = 0.002) and DMI (P < 0.05). Substitution of the G allele in rs42670352 was associated with DMI (-0.236 ... 0.12 kg; P = 0.055) and RFI (-0.175 ... 0.09 kg; P = 0.05). Substitution of the G allele of SNP rs42670353 was associated with ADG (0.043 ... 0.02 kg/d; P < 0.01) and FCR (0.114 ... 0.05 kg BW gain kg^sup -1^ DMI; P < 0.05). In the validation dataset, SNP rs42670352 in gene CCKBR was significant for RFI and DMI and had the same phase of associations; SNP rs42670353 was significantly associated with FCR with same phase of association and the C allele in SNP rs42670351 was validated as decreasing DMI, RFI, and FCR. Substituting the G allele of SNP rs42670352 in CCKBR2 was associated with decreasing DMI and RFI in the validation study. New SNP were reported in genes PRSS2 and CCKBR, being associated with feed efficiency and performance traits in beef cattle. The association between these SNP with fertility, carcass, and meat quality traits must still be tested. PUBLICATION ABSTRACT
The Weight Loss Maintenance Trial (WLM) compared two long-term weight-maintenance interventions, a personal contact arm and an Internet arm, with a no-treatment control after an initial six-month ...Phase I weight loss program. The Internet arm focused on use of an interactive website for support of long-term weight maintenance. There is limited information about patterns of website use and specific components of an interactive website that might help promote maintenance of weight loss.
This paper presents a secondary analysis of the subset of participants in the Internet arm and focuses on website use patterns and features associated with long-term weight maintenance.
Adults at risk for cardiovascular disease (CVD) who lost at least 4 kilograms in an initial 20-week group-based, behavioral weight-loss program were trained to use an interactive website for weight loss maintenance. Of the 348 participants, 37% were male and 38% were African American. Mean weight loss was 8.6 kilograms. Participants were encouraged to log in at least weekly and enter a current weight for the 30-month study period. The website contained features that encouraged setting short-term goals, creating action plans, and reinforcing self-management habits. The website also included motivational modules, daily tips, and tailored messages. Based on log-in and weight-entry frequency, we divided participants into three website use categories: consistent, some, and minimal.
Participants in the consistent user group (n = 212) were more likely to be older (P = .002), other than African American (P = .02), and more educated (P = .01). While there was no significant difference between website use categories in the amount of Phase I change in body weight (P = .45) or income (P = .78), minimal website users (n = 75) were significantly more likely to have attended fewer Phase I sessions (P = .001) and had a higher initial body mass index (BMI) (P < .001). After adjusting for baseline characteristics including initial BMI, variables most associated with less weight regain included: number of log-ins (P = .001), minutes on the website (P < .001), number of weight entries (P = .002), number of exercise entries (P < .001), and sessions with additional use of website features after weight entry (P = .002).
Participants defined as consistent website users of an interactive behavioral website designed to promote maintenance of weight loss were more successful at maintaining long-term weight loss.
NCT00054925; http://clinicaltrials.gov/ct2/show/NCT00054925 (Archived by WebCite at http://www.webcitation.org/5rC7523ue).
Studies of diarrheal etiology in low- and middle-income countries have typically focused on children presenting with severe symptoms to health centers and thus are best equipped to describe the ...pathogens capable of leading to severe diarrheal disease. The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study was designed to evaluate, via intensive community surveillance, the hypothesis that repeated exposure to enteropathogens has a detrimental effect on growth, vaccine response, and cognitive development, which are the primary outcome measures for this study. In the setting of multiple outcomes of interest, a longitudinal cohort design was chosen. Because many or even the majority of enteric infections are asymptomatic, the collection of asymptomatic surveillance stools was a critical element. However, capturing diarrheal stools additionally allowed for the determination of the principle causes of diarrhea at the community level as well as for a comparison between those enteropathogens associated with diarrhea and those that are associated with poor growth, diminished vaccine response, and impaired cognitive development. Here, we discuss the analytical methods proposed for the MAL-ED study to determine the principal causes of diarrhea at the community level and describe the complex interplay between recurrent exposure to enteropathogens and these critical long-term outcomes.
Data from 879 Holstein cows from 11 tie-stall herds in Pennsylvania were analyzed to determine the effects of nutritional management practices on the level of genetic expression for milk, fat, and ...protein yields. Environments were defined according to the amount of dry matter refusals at the end of 24h for the average cow (DMR), diet crude protein percentage (CP), and diet NEL concentration. Sire predicted transmitting ability (PTA) was available for all cows, whereas 775 cows were genotyped and received a molecular breeding value (MBV) for milk, fat, and protein yields. Milk, fat, and protein yields were regressed on sire PTA and cow MBV independently in addition to combined breeding values (CBV) of sire PTA and cow MBV. Four-trait animal models with fat-corrected milk yield in high and low environments plus either body weight or body condition score in high and low environments treated as separate traits were also evaluated. Regressions on sire PTA (0.31 for fat yield to 0.54 for milk yield) were significantly lower in the 5 herds that had the lowest average DMR than in the 6 herds with highest average DMR (0.82 for fat yield to 1.11 for protein yield). The regressions of milk and protein yield on CBV were also significantly lower in the 5 herds with low NEL concentration in the ration than in herds that had high NEL concentration. Genetic correlations from animal models showed that large cows were more affected by low DMR, CP, and NEL concentration than smaller cows. Efforts to minimize feed wastage must ensure that cows receive adequate nutrient intake to avoid suppression of genetic potential for yield, particularly for larger cows.
To determine whether adding selfreported health and functional status data to a diagnostic risk-score model explains additional variance in predicting inpatient admissions and costs.
Retrospective ...observational analysis.
We used data from a Health Status Questionnaire (HSQ), completed by 6407 Kaiser Permanente Northwest Medicare patients between December 2006 and October 2008. We used answers from 3 items on the HSQ: (1) General Self-rated Health score, (2) needing help with 1 or more activities of daily living, and (3) having a bothersome health condition. We calculated a DxCG relative risk score from utilization information in the year prior to the survey, using electronic medical records. We compared: (1) DxCG as the sole independent variable and (2) DxCG plus the 3 items as independent variables. We estimated area under the curve (AUC) for each model. Any inpatient admission (yes/no) and being in the top 10% of costs (in the year after survey) were the dependent variables for the first and second logistic regression models, respectively.
The 3 items explained an additional 2.8% and 4.0% of variance for inpatient admissions and top 10% of costs,respectively, in addition to the variance explained by the DxCG score alone. For DxCG alone, the AUC was 0.686 (95% confidence interval CI 0.663-0.710) and 0.741 (95% CI 0.719- 0.764), respectively, for inpatient admissions and top 10% of costs and improved to 0.709 (95% CI 0.687-0.730) and 0.770 (95% CI 0.749-0.790) when the 3 self-reported items were added.
Using self-reported health information improved the predictive power of a DxCG model to forecast inpatient admissions and patient cost-tier.
PDF
