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Background: Low concentrations of circulating vitamin D are common with obesity and may represent a potential mechanism explaining the elevated risk of certain cancers and cardiovascular outcomes observed in individuals who are overweight or obese. Objective: The objective of this study was to investigate the effects of 12 mo of weight loss through caloric restriction, exercise intervention, or both on serum 25-hydroxyvitamin D [25(OH)D] concentrations. Design: Overweight and obese postmenopausal women (n = 439) were randomly assigned to 1 of 4 groups: 1) diet modification (n = 118), 2) exercise (n = 117), 3) diet + exercise (n = 117), or 4) control (n= 87). The diet intervention was a group-based reduced-calorie program with a 10% weight-loss goat. The exercise intervention consisted of 45 mm of moderate-to-vigorous intensity aerobic activity daily for 5 d/wk. Serum 25(OH)D concentrations were measured by using a competitive chemiluminescent immunoassay at baseline and 12 mo. Results: No significant change in serum 25(OH)D was found between the intervention and control groups. Women who lost <5%, 5-9.9%. 10-14.9%, or >15% of baseline weight had mean increases in 25(OH)D of 2.1, 2.7, 3.3, and 7.7 ng/mL, respectively (P for trend = 0.002). Baseline vitamin D status did not modify the effect of the interventions on weight loss or body-composition changes at the 12-mo follow-up. Conclusion: A greater degree of weight loss, achieved through either a reduced-calorie diet or increased exercise, is associated with increased circulating 25(OH)D concentrations. [ABSTRACT FROM AUTHOR]

• An effective and affordable injectable rotavirus vaccine may be attractive to LMICs. • Co-administering oral and injectable vaccines is acceptable to many stakeholders. • Oral vaccine with a birth dose is favored over a higher cost, standalone injectable. • Providing rotavirus vaccine in a DTP combination is the most preferred option. Currently available live, oral rotavirus vaccines (LORVs) have significantly reduced severe rotavirus hospitalizations and deaths worldwide. However, LORVs are not as effective in low- and middle-income countries (LMIC) where rotavirus disease burden is highest. Next-generation rotavirus vaccine (NGRV) candidates in development may have a greater public health impact where they are needed most. The feasibility and acceptability of possible new rotavirus vaccines were explored as part of a larger public health value proposition for injectable NGRVs in LMICs. To assess national stakeholder preferences for currently available LORVs and hypothetical NGRVs and understand rationales and drivers for stated preferences. Interviews were conducted with 71 national stakeholders who influence vaccine policy and national programming. Stakeholders from Ghana, Kenya, Malawi, Peru, Senegal, and Sri Lanka were interviewed using a mixed-method guide. Vaccine preferences were elicited on seven vaccine comparisons involving LORVs and hypothetical NGRVs based on information presented comparing the vaccines' attributes. Reasons for vaccine preference were elicited in open-ended questions, and the qualitative data were analyzed on key preference drivers. Nearly half of the national stakeholders interviewed preferred a highly effective standalone, injectable NGRV over current LORVs. When presented as having similar efficacy to the LORV, however, very few stakeholders preferred the injectable NGRV, even at substantially lower cost. Similarly, a highly effective standalone injectable NGRV was generally not favored over an equally effective oral NGRV following a neonatal-infant schedule, despite higher cost of the neonatal option. An NGRV-DTP-containing combination vaccine was strongly preferred over all other options, whether delivered alone with efficacy similar to current LORVs or co-administered alongside an LORV (LORV + NGRV-DTP) to increase efficacy. Results from these national stakeholder interviews provide valuable insights to inform ongoing and future NGRV research and development. [ABSTRACT FROM AUTHOR]

Abstract: Lifestyle-based interventions, which typically promote various behavior modification strategies, can serve as a setting for evaluating specific behaviors and strategies thought to promote or hinder weight loss. The aim of our study was to test the associations of self-monitoring (ie, self-weighing and food journal completion) and eating-related (ie, dietary intake, diet-related weight-control strategies, and meal patterns) behaviors with weight loss in a sample of postmenopausal overweight-to-obese women enrolled in a 12-month dietary weight loss intervention. Changes in body weight and adoption of self-monitoring and eating-related behaviors were assessed in 123 participants. Generalized linear models tested associations of these behaviors with 12-month weight change after adjusting for potential confounders. Mean percent weight loss was 10.7%. In the final model, completing more food journals was associated with a greater percent weight loss (interquartile range 3.7% greater weight loss; P<0.0001), whereas skipping meals (4.3% lower weight loss; P<0.05) and eating out for lunch (at least once a week, 2.5% lower weight loss; P<0.01) were associated with a lower amount of weight loss. These findings suggest that a greater focus on dietary self-monitoring, home-prepared meals, and consuming meals at regular intervals may improve 12-month weight loss among postmenopausal women enrolled in a dietary weight loss intervention. [Copyright &y& Elsevier]

Abstract: Recent research has identified self-monitoring behaviors as important strategies for both initial weight loss and weight loss maintenance, but relatively little is known about adopters and nonadopters of these behaviors. To test our hypothesis that key characteristics distinguish adopters from nonadopters, we examined the demographic characteristics and eating behaviors (eg, restrained, uncontrolled, emotional, and binge eating) associated with more frequent compared with less frequent use of these behaviors. Baseline demographic characteristics and eating behaviors as well as 12-month self-monitoring behaviors (ie, self-weighing, food journaling, monitoring energy intake) were assessed in 123 postmenopausal women enrolled in a dietary weight loss intervention. Logistic regression models were used to test associations of self-monitoring use with demographic characteristics and eating behaviors. Nonwhites, compared with non-Hispanic whites, were less likely to monitor energy intake regularly (adjusted odds ratio [OR], 0.36; 95% confidence interval [CI], 0.13-0.97; P < .05), controlling for intervention arm and baseline body mass index. Participants with a college degree or higher education were less likely to self-weigh daily (adjusted OR, 0.30; 95% CI, 0.13-0.67; P < .01) compared with individuals who attended some college or less. Those with higher baseline binge eating scores were less likely to monitor energy intake (adjusted OR, 0.84; 95% CI, 0.73-0.97; P < .01) compared with participants with lower binge eating scores. In summary, use of diet-related self-monitoring behaviors varied by race/ethnicity, education, and binge eating score in postmenopausal women who completed a year-long dietary weight loss intervention. Improved recognition of groups less likely to self-monitor may be helpful in promoting these behaviors in future interventions. [Copyright &y& Elsevier]

Abstract: Snacking may play a role in weight control. The associations of timing and frequency of snacking with observed weight change and nutrient intake were assessed in an ancillary study to a 12-month randomized controlled trial in Seattle, WA. Overweight-to-obese postmenopausal women (n=123) enrolled in the two dietary weight-loss arms from 2007 to 2008 with complete data at 12 months were included in these analyses. Generalized linear models were used to test the associations between snacking and weight loss (percent) and nutrient intake at the 12-month time point. Participants were, on average, 58 years old and mainly non-Hispanic white (84%). Ninety-seven percent reported one or more snacks per day. Weight loss (percent) was significantly lower among mid-morning (10:30 am to 11:29 am) snackers (7.0%, 95% confidence interval: 4.3 to 9.7) compared to non–mid-morning snackers (11.4%, 95% confidence interval: 10.2 to 12.6; P=0.005). A higher proportion of mid-morning snackers reported more than one snack per day (95.7%), compared to afternoon (82.8%) and evening (80.6%) snackers, although differences were not statistically significant (P>0.005). Women who reported two or more snacks per day vs one or no snacks per day had higher fiber intake (P=0.027). Afternoon snackers had higher fruit and vegetable intake compared to non–afternoon-snackers (P=0.035). These results suggest that snack meals can be a source for additional fruits, vegetables, and fiber-rich foods; however, snacking patterns might also reflect unhealthy eating habits and impede weight-loss progress. Future dietary weight-loss interventions should evaluate the effects of timing, frequency, and quality of snacks on weight loss. [Copyright &y& Elsevier]

Background: Comprehensive lifestyle interventions are effective in preventing diabetes and restoring glucose regulation; however, the key stimulus for change has not been identified and effects in older individuals are not established. The aim of the study was to investigate the independent and combined effects of dietary weight loss and exercise on insulin sensitivity and restoration of normal fasting glucose in middle-aged and older women. Design: Four-arm RCT, conducted between 2005 and 2009 and data analyzed in 2010. Setting/participants: 439 inactive, overweight/obese postmenopausal women. Interventions: Women were assigned to: dietary weight loss (n=118); exercise (n=117); exercise+diet (n=117); or control (n=87). The diet intervention was a group-based reduced-calorie program with a 10% weight-loss goal. The exercise intervention was 45 min/day, 5 days/week of moderate-to-vigorous intensity aerobic activity. Main outcome measures: 12-month change in serum insulin, C-peptide, fasting glucose, and whole body insulin resistance (HOMA-IR). Results: A significant improvement in HOMA-IR was detected in the diet (–24%, p<0.001) and exercise+ diet (–26%, p<0.001) groups but not in the exercise (–9%, p=0.22) group compared with controls (–2%); these effects were similar in middle-aged (50–60 years) and older women (aged 60–75 years). Among those with impaired fasting glucose (5.6–6.9 mmol/L) at baseline (n=143; 33%), the odds (95% CI) of regressing to normal fasting glucose after adjusting for weight loss and baseline levels were 2.5 (0.8, 8.4); 2.76 (0.8, 10.0); and 3.1 (1.0, 9.9) in the diet, exercise+diet, and exercise group, respectively, compared with controls. Conclusions: Dietary weight loss, with or without exercise, significantly improved insulin resistance. Older women derived as much benefit as did the younger postmenopausal women. Trial registration: This study is registered at Clinicaltrials.gov NCT00470119. [Copyright &y& Elsevier]