***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 
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    ***EXAMPLES*** 
    Input: Background : Patients with irritable bowel syndrome ( IBS ) often feel they have some form of dietary intolerance and frequently try exclusion diets . Tests attempting to predict food sensitivity in IBS have been disappointing but none has utilised IgG antibodies . Aims : To assess the therapeutic potential of dietary elimination based on the presence of IgG antibodies to food . Patients : A total of 150 out patients with IBS were r and omised to receive , for three months , either a diet excluding all foods to which they had raised IgG antibodies ( enzyme linked immunosorbant assay test ) or a sham diet excluding the same number of foods but not those to which they had antibodies . Methods : Primary outcome measures were change in IBS symptom severity and global rating scores . Non-colonic symptomatology , quality of life , and anxiety/depression were secondary outcomes . Intention to treat analysis was undertaken using a generalised linear model . Results : After 12 weeks , the true diet result ed in a 10 % greater reduction in symptom score than the sham diet ( mean difference 39 ( 95 % confidence intervals ( CI ) 5–72 ) ; p = 0.024 ) with this value increasing to 26 % in fully compliant patients ( difference 98 ( 95 % CI 52–144 ) ; p<0.001 ) . Global rating also significantly improved in the true diet group as a whole ( p = 0.048 , NNT = 9 ) and even more in compliant patients ( p = 0.006 , NNT = 2.5 ) . All other outcomes showed trends favouring the true diet . Relaxing the diet led to a 24 % greater deterioration in symptoms in those on the true diet ( difference 52 ( 95 % CI 18–88 ) ; p = 0.003 ) . Conclusion : Food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research BACKGROUND The cause of irritable bowel syndrome ( IBS ) is unknown . It may follow gastroenteritis and be associated with an abnormal gut flora and with food intolerance . Our study was design ed to assess whether these factors were associated with colonic malfermentation . METHODS We carried out a crossover controlled trial of a st and ard diet and an exclusion diet matched for macronutrients in six female IBS patients and six female controls . During the final 72 h on each diet , faecal excretion of fat , nitrogen , starch , and non-starch polysaccharide NSP was measured , and total excretion of hydrogen and methane collected over 24 h in a purpose -built 1.4 m3 whole-body calorimeter . Breath hydrogen and methane excretion were then measured for 3 h after 20 g oral lactulose . FINDINGS The maximum rate of gas excretion was significantly greater in patients than in controls ( 2.4 mL/min IQR 1.7 - 2.6 vs 0.6 , 0.4 - 1.1 ) . Although total gas production in patients was not greater than in controls ( median 527 mL/24 h IQR 387 - 660 vs 412 , 234 - 507 ) , hydrogen production was higher ( 332 , 318 - 478 vs 162 , 126 - 217 , p=0.009 ) . In patients , the exclusion diet reduced symptoms and produced a fall in maximum gas excretion ( 0.5 mL/min IQR 0.3 - 0.7 ) . After lactulose , breath hydrogen was greater on the st and ard than on the exclusion diet . INTERPRETATION Colonic-gas production , particularly of hydrogen , is greater in patients with IBS than in controls , and both symptoms and gas production are reduced by an exclusion diet . This reduction may be associated with alterations in the activity of hydrogen-consuming bacteria . Fermentation may be an important factor in the pathogenesis of IBS BACKGROUND & AIMS Celiac disease is an increasingly prevalent disorder . To monitor response to treatment in clinical and research setting s , it is essential to accurately measure gluten-free diet ( GFD ) adherence in a st and ardized manner . The aim of this study was to develop a valid and reliable Celiac Dietary Adherence Test ( CDAT ) . METHODS Items and domains believed to be essential for successful GFD adherence were used to develop an 85-item survey with input from patient focus groups . The survey was administered to 200 individuals with biopsy-proven celiac disease who underwent st and ardized dietician evaluation ( SDE ) and serologic testing .  RESULTS Of the initial 85 items , 41 were correlated highly with the SDE ( P < .01 ) . Responses for all 200 participants for the 41 items were entered into a single data base . Computer-generated r and omization produced a derivation cohort of 120 subjects and a validation cohort of 80 . By using the derivation cohort , a 7-item question naire was developed using logistic regression . The additive score based on these items was correlated highly with the SDE in both the derivation and validation cohorts ( P < .001 ) and performed significantly better than immunoglobulin A tissue transglutaminase titers in receiver operating characteristic curve analysis with areas under the curve of 0.830 and 0.652 , respectively . CONCLUSIONS The CDAT is a clinical ly relevant , easily administered , 7-item instrument that allows for st and ardized evaluation of GFD adherence and is superior to tissue transglutaminase serology . The CDAT may be useful in both research and clinical setting We reported previously that consumption of one cup of milk ( 240 mL ) per day produced negligible symptoms in lactase-nonpersistent ( LNP ) individuals self-described as being severely lactose intolerant . We hypothesized that such LNP individuals could also tolerate two cups of milk per day if taken in two widely divided doses with food , and that psychologic factors play a role in perceptions of lactose intolerance . The Minnesota Multiphasic Personality Inventory 2 ( MMPI-2 ) was administered to 19 LNP subjects self-described as markedly lactose intolerant ( S-LNP ) , 13 LNP subjects who denied lactose intolerance ( A-LNP ) , and 10 lactase-persistent individuals who believed they were lactose intolerant ( S-LP ) . Symptoms were recorded when LNP subjects ingested 240 mL regular or lactose-hydrolyzed milk twice daily for 7 d in a double-blind crossover study . The results showed that neither LNP group had a significant increase in symptoms ( P < 0.05 ) during the regular compared with the lactose-hydrolyzed milk periods . However , S-LNP subjects reported significantly greater gaseous symptoms than did the A-LNP subjects during both treatment periods . The MMPI-2 showed a high score on the " lie " validity scale for S-LNP subjects . We conclude that LNP subjects tolerate two cups of milk per day without appreciable symptoms . S-LNP subjects have underlying flatulence that is misattributed to lactose intolerance . MMPI-2 results were of question able validity because of the high rate of dissimulation by LNP subjects OBJECTIVE The aim of this r and omized pilot study was to examine whether the addition of motivational interviewing strategies to a behavioral obesity intervention enhances adherence and glucose control in older obese women with NIDDM . RESEARCH DESIGN AND METHODS Twenty-two older obese women ( 41 % black ) with NIDDM were r and omly assigned to 1 ) a st and ard 16-week group behavioral weight-control program that provided instruction in diet , exercise , and behavioral modification or 2 ) the same group behavioral program with three individualized motivational interviewing sessions added . RESULTS The motivational group attended significantly more group meetings ( 13.3 vs. 8.9 ) , completed significantly more food diaries ( 15.2 vs. 10.1 ) , and recorded blood glucose significantly more often ( 46.0 vs. 32.2 days ) than the st and ard group . Further , participants in the motivational group had significantly better glucose control post-treatment ( 9.8 vs. 10.8 % ) . Although both groups demonstrated significant weight loss , no differences were apparent between groups . CONCLUSIONS These results suggest that augmenting a st and ard behavioral treatment program for obese women with NIDDM with a motivational interviewing component may significantly enhance adherence to program recommendations and glycemic control . Preliminary data warrant further investigation with larger sample s and a longer follow-up Twenty-six patients with irritable bowel syndrome entered a controlled trial of diets with a high or low wheat-fibre content . After 6 weeks on the high-wheat fibre regimen there was significant improvement in symptoms and an objective change in colonic motor activity . No such improvement occurred on the low-fibre regimen .  Patients with irritable bowel syndrome should be encouraged to increase their daily intake of wheat fibre BACKGROUND & AIMS A diet low in fermentable oligosaccharides , disaccharides , monosaccharides , and polyols ( FODMAPs ) often is used to manage functional gastrointestinal symptoms in patients with irritable bowel syndrome ( IBS ) , yet there is limited evidence of its efficacy , compared with a normal Western diet . We investigated the effects of a diet low in FODMAPs compared with an Australian diet , in a r and omized , controlled , single-blind , cross-over trial of patients with IBS . METHODS In a study of 30 patients with IBS and 8 healthy individuals ( controls , matched for demographics and diet ) , we collected  dietary data  from subjects for 1 habitual week . Participants then r and omly were assigned to groups that received 21 days of either a diet low in FODMAPs or a typical Australian diet , followed by a washout period of at least 21 days , before crossing over to the alternate diet .  Daily symptoms were rated using a 0- to 100-mm visual analogue scale . Almost all food was provided during the interventional diet periods , with a goal of less than 0.5 g intake of FODMAPs per meal for the low-FODMAP diet . All stools were collected from days 17 - 21 and assessed for frequency , weight , water content , and King 's Stool Chart rating . RESULTS Subjects with IBS had lower overall gastrointestinal symptom scores ( 22.8 ; 95 % confidence interval , 16.7 - 28.8 mm ) while on a diet low in FODMAPs , compared with the Australian diet ( 44.9 ; 95 % confidence interval , 36.6 - 53.1 mm ; P < .001 ) and the subjects ' habitual diet . Bloating , pain , and passage of wind also were reduced while IBS patients were on the low-FODMAP diet . Symptoms were minimal and unaltered by either diet among controls . Patients of all IBS subtypes had greater satisfaction with stool consistency while on the low-FODMAP diet , but diarrhea-predominant IBS was the only subtype with altered fecal frequency and King 's Stool Chart scores . CONCLUSIONS In a controlled , cross-over study of patients with IBS , a diet low in FODMAPs effectively reduced functional gastrointestinal symptoms . This high- quality evidence supports its use as a first-line therapy . CLINICAL TRIAL NUMBER ACTRN12612001185853 BACKGROUND & AIMS Observational studies suggest dietary fructose restriction might lead to sustained symptomatic response in patients with irritable bowel syndrome ( IBS ) and fructose malabsorption . The aims of this study were first to determine whether the efficacy of this dietary change is due to dietary fructose restriction and second to define whether symptom relief was specific to free fructose or to poorly absorbed short-chain carbohydrates in general . METHODS The double-blinded , r and omized , quadruple arm , placebo-controlled rechallenge trial took place in the general community . The 25 patients who had responded to dietary change were provided all food , low in free fructose and fructans , for the duration of the study . Patients were r and omly challenged by grade d dose introduction of fructose , fructans , alone or in combination , or glucose taken as drinks with meals for maximum test period of 2 weeks , with at least 10-day washout period between . For the main outcome measures , symptoms were monitored by daily diary entries and responses to a global symptom question . RESULTS Seventy percent of patients receiving fructose , 77 % receiving fructans , and 79 % receiving a mixture reported symptoms were not adequately controlled , compared with 14 % receiving glucose ( P < or = 0.002 , McNemar test ) . Similarly , the severity of overall and individual symptoms was significantly and markedly less for glucose than other substances . Symptoms were induced in a dose-dependent manner and mimicked previous IBS symptoms . CONCLUSIONS In patients with IBS and fructose malabsorption , dietary restriction of fructose and /or fructans is likely to be responsible for symptomatic improvement , suggesting efficacy is due to restriction of poorly absorbed short-chain carbohydrates in general BACKGROUND & AIMS Depression has a complex association with cardiometabolic risk , both directly as an independent factor and indirectly through mediating effects on other risk factors such as BMI , diet , physical activity , and smoking . Since changes to many cardi 
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There was little investigation into the predictors of adherence , with symptom relief or induction being the primary goal of most of the studies .
This review indicates that predictors of dietary adherence are rarely considered in research regarding functional bowel disorders .