***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE . The study tested whether a combined environmental and educational intervention solely promoting water consumption was effective in preventing overweight among children in elementary school . METHODS . The participants in this r and omized , controlled cluster trial were second- and third- grade rs from 32 elementary schools in socially deprived areas of 2 German cities .  Water fountains were installed and teachers presented 4 prepared classroom lessons in the intervention group schools ( N = 17 ) to promote water consumption .  Control group schools ( N = 15 ) did not receive any intervention . The prevalence of overweight ( defined according to the International Obesity Task Force criteria ) , BMI SD scores , and beverage consumption ( in glasses per day ; 1 glass was defined as 200 mL ) self-reported in 24-hour recall question naires , were determined before ( baseline ) and after the intervention . In addition , the water flow of the fountains was measured during the intervention period of 1 school year ( August 2006 to June 2007 ) . RESULTS . Data on 2950 children ( intervention group : N = 1641 ; control group : N = 1309 ; age , mean ± SD : 8.3 ± 0.7 years ) were analyzed . After the intervention , the risk of overweight was reduced by 31 % in the intervention group , compared with the control group , with adjustment for baseline prevalence of overweight and clustering according to school . Changes in BMI SD scores did not differ between the intervention group and the control group . Water consumption after the intervention was 1.1 glasses per day greater in the intervention group . No intervention effect on juice and soft drink consumption was found . Daily water flow of the fountains indicated lasting use during the entire intervention period , but to varying extent . CONCLUSION . Our environmental and educational , school-based intervention proved to be effective in the prevention of  overweight among children in elementary school , even in a population from socially deprived areas BACKGROUND Epidemiologic studies have shown alcohol consumption to be inversely as well as positively related to body weight and body fat . Metabolic studies have shown an increase in energy intake as well as compensation after alcohol consumption . OBJECTIVE Our objective was to assess the effects on energy intake of an apéritif compared with those of a water appetizer and 3 fruit juice appetizers . DESIGN Fifty-two men and women aged 20 - 45 y with a body mass index ( in kg/m2 ) between 20 and 32 were r and omly given 1 MJ ( 340 mL ) alcohol ( wine or beer ) , fat ( cream fruit juice ) , protein ( protein fruit juice ) , carbohydrate ( grape juice ) , or water , or no preload 30 min before an ad libitum lunch consumed from the universal eating monitor . RESULTS Energy intake ( 3.5+/-0.3 MJ compared with 2.7+/-0.2 MJ , P < 0.001 ) and eating rate were higher ( 44+/-3 g/min compared with 38+/-3 g/min , P < 0.01 ) , meal duration was longer ( 14 min compared with 12.0 min , P < 0.01 ) , satiation started to increase later ( 3.5 min compared with 1.5 min , P < 0.01 ) , and eating was prolonged after maximum satiation ( 2.5 min compared with 0.6 min , P < 0.01 ) after an apéritif than after a fat , protein , or carbohydrate appetizer , . Twenty-four-hour energy intake was higher on a day that an apéritif was consumed than after water or no preload . CONCLUSION Twenty-four-hour energy intake was elevated with a 1-MJ apéritif but not with a 1-MJ liquid carbohydrate , fat , or protein appetizer We studied the effects of xylitol , the pentose-sugar alcohol , on gastric emptying of the solid-food component of a complex meal . Gastric emptying was measured in human volunteers by utilizing a st and ardized radiolabeled scrambled-egg meal . After ingestion of 25 g xylitol , gastric emptying was markedly prolonged ( T-1/2 58 + /- 5 min control vs 91 + /- 7 min after xylitol [ p less than 0.01 ] ) . Since delayed gastric emptying may affect food intake , we evaluated the effects of xylitol on calorie intake . Food intake after oral preloading with water result ed in intake of 920 + /- 60 kcal vs 690 + /- 45 kcal after 25 g of xylitol . In contrast , a preload of glucose , fructose , or sucrose failed to suppress food intake . Although xylitol decreased food intake and also delayed gastric emptying , these effects may be unrelated . Our data suggest a role for xylitol as a potentially important agent in dietary control Using a within-subjects design , we gave over-weight and normal-weight subjects a 500-mL drink of fructose , glucose , or aspartame diluted in lemon-flavored water or plain water in a r and omized fashion at about weekly intervals . Food intake was assessed at a buffet lunch that began 38 min after the preload was completed . Blood was drawn throughout and assayed for concentrations of glucose , insulin , glucagon , and free fatty acid . When subjects drank the fructose preload , they subsequently ate fewer overall calories and fewer grams of fat than when they drank any of the other preloads . The aspartame load did not stimulate intake beyond the plain-water control . The effects of the oxidation of fructose as a possible mechanism for the reduction in food intake is discussed . The effects of insulin in stimulating intake are also discussed BACKGROUND Previous studies have linked full-calorie sugar-sweetened beverages ( SSBs ) with greater weight gain and an increased risk of type 2 diabetes . OBJECTIVE We prospect ively examined the association between consumption of SSBs and the risk of coronary heart disease ( CHD ) in women . DESIGN Women ( n = 88,520 ) from the Nurses ' Health Study aged 34 - 59 y , without previously diagnosed coronary heart disease ( CHD ) , stroke , or diabetes in 1980 , were followed from 1980 to 2004 . Consumption of SSBs was derived from 7 repeated food-frequency question naires administered between 1980 and 2002 . Relative risks ( RRs ) for CHD were calculated by using Cox proportional hazards models and adjusted for known cardiovascular disease risk factors . RESULTS During 24 y of follow-up , we ascertained 3105 incident cases of CHD  ( nonfatal myocardial infa rct ion and fatal CHD ) . After st and ard and dietary risk factors were adjusted for , the RRs ( and 95 % CIs ) of CHD according to categories of cumulative average of SSB consumption ( < 1/mo , 1 - 4/mo , 2 - 6/wk , 1/d , and > or = 2 servings/d ) were 1.0 , 0.96 ( 0.87 , 1.06 ) , 1.04 ( 0.95 , 1.14 ) , 1.23 ( 1.06 , 1.43 ) , and 1.35 ( 1.07 , 1.69 ) ( P for trend < 0.001 ) . Additional adjustment for body mass index , energy intake , and incident diabetes attenuated the associations , but they remained significant . Artificially sweetened beverages were not associated with CHD . CONCLUSION Regular consumption of SSBs is associated with a higher  risk of CHD in women , even after other unhealthful lifestyle or dietary factors are accounted for BACKGROUND Type 2 diabetes mellitus is an increasingly serious health problem among African American women . Consumption of sugar-sweetened drinks was associated with an increased risk of diabetes in 2 studies but not in a third ; however , to our knowledge , no data are available on African Americans regarding this issue . Our objective was to examine the association between consumption of sugar-sweetened beverages , weight gain , and incidence of type 2 diabetes mellitus in African American women . METHODS A prospect i ve follow-up study of 59,000 African American women has been in progress since 1995 . Participants reported on food and beverage consumption in 1995 and 2001 . Biennial follow-up question naires ascertained new diagnoses of type 2 diabetes . The present analyses included 43,960 women who gave complete dietary and weight information and were free from diabetes at baseline . We identified 2713 incident cases of type 2 diabetes mellitus during 338,884 person-years of follow-up . The main outcome measure was the incidence of type 2 diabetes mellitus . RESULTS The incidence of type 2 diabetes mellitus was higher with higher intake of both sugar-sweetened soft drinks and fruit drinks . After adjustment for confounding variables including other dietary factors , the incidence rate ratio for 2 or more soft drinks per day was 1.24 ( 95 % confidence interval , 1.06 - 1.45 ) . For fruit drinks , the comparable incidence rate ratio was 1.31 ( 95 % confidence interval , 1.13 - 1.52 ) . The association of diabetes with soft drink consumption was almost entirely mediated by body mass index , whereas the association with fruit drink consumption was independent of body mass index . CONCLUSIONS Regular consumption of sugar-sweetened soft drinks and fruit drinks is associated with an increased risk of type 2 diabetes mellitus in African American women . While there has been increasing public awareness of the adverse health effects of soft drinks , little attention has been given to fruit drinks , which are often marketed as a healthier alternative to soft drinks Objective : The purpose of this study was to compare the dietary strategies , and use of fat- and sugar-modified foods and beverages in a  weight loss maintainer group ( WLM ) and an always-normal weight group (NW).Subjects : WLM ( N=172 ) had maintained ⩾10 % weight loss for 11.5 years , and had a body mass index ( BMI ) of 22.0 kg m−2 . NW ( N=131 ) had a BMI of 21.3 kg m−2 and no history of being overweight . Three , 24-h recalls on r and om , non-consecutive days were used to assess dietary intake . Results : WLM reported consuming a diet that was lower in fat ( 28.7 vs 32.6 % , P<0.0001 ) and used more fat-modification strategies than NW . WLM also consumed a significantly greater percentage of modified dairy ( 60 vs 49 % ; P=0.002 ) and  modified dressings and sauces  ( 55 vs 44 % ; P=0.006 ) than NW . WLM reported consuming three times more daily servings of artificially sweetened soft drinks ( 0.91 vs 0.37 ; P=0.003 ) , significantly fewer daily servings of sugar-sweetened soft drinks ( 0.07 vs 0.16 ; P=0.03 ) and more daily servings of water ( 4.72 vs 3.48 ; P=0.002 ) than NW . Conclusions : These findings suggest that WLM use more dietary strategies to accomplish their weight loss maintenance , including greater restriction on fat intake , use of fat- and sugar-modified foods , reduced consumption of sugar-sweetened beverages and increased consumption of artificially sweetened beverages . Ways to promote the use of fat-modified foods and artificial sweeteners merits further research in both prevention- and treatment-controlled trials Water consumed before a meal has been found to reduce energy intake among nonobese older adults . However , it is unknown whether this effect is evident among overweight and obese older adults , a population who would benefit from strategies to improve energy intake regulation . Our purpose was to determine whether premeal water consumption reduces meal energy intake in overweight and obese older adults . Twenty-four overweight and obese adults ( body mass index=34.3+/-1.2 ) , mean age 61.3+/-1.1 years , were given an ad libitum st and ardized breakfast meal on two r and omly assigned occasions . Thirty minutes before the meal , subjects were given either a 500-mL water preload or no preload .  Energy intake at each meal was covertly measured . Meal energy intake was significantly less in the water preload condition as compared with the no-preload condition ( 500+/-32 vs 574+/-38 , respectively ; P=0.004 ) , representing an approximate 13 % reduction in meal energy intake . The percentage reduction in meal energy intake following the water preload was not related to sex , age , body mass index , or habitual daily water consumption ( all P>0.05 ) . Given the high prevalence of overweight and obesity among older adults , future studies should determine whether premeal water consumption is an effective long-term weight control strategy for older adults CONTEXT Recently , we showed that drinking 500 ml water induces thermogenesis in normal-weight men and women . OBJECTIVE We now repeated these studies in a r and omized , controlled , crossover trial in overweight or obese otherwise healthy subjects ( eight men and eight women ) , comparing also the effects of 500 ml isoosmotic saline or 50 ml water . R 
    Output:
    
These findings from clinical trials , along with those from epidemiologic and intervention studies , suggest water has a potentially important role to play in reducing energy intake , and consequently in obesity prevention .