***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: Background —Leptin plays a role in fat metabolism and correlates with insulin resistance and other markers of the metabolic syndrome , independent of total adiposity . Therefore , we hypothesized that raised leptin levels may identify men at increased risk of a coronary event in the West of Scotl and Coronary Prevention Study ( WOSCOPS ) . Methods and Results —Plasma  leptin levels were measured at baseline in 377 men ( cases ) who subsequently experienced a coronary event and in 783 men ( controls ) who remained free of an event during the 5-year follow-up period of the study . Controls were matched to cases on the basis of age and smoking history and were representative of the entire WOSCOPS cohort . Leptin levels were significantly higher in cases than controls ( 5.87±2.04 ng/mL versus 5.04±2.09 ng/mL , P < 0.001 ) . In univariate analysis , for each 1 SD increase in leptin , the relative risk ( RR ) of an event increased by 1.25 ( 95 % confidence interval [ CI ] , 1.10 to 1.43;P < 0.001 ) . There was minimal change in this RR with correction for body mass index ( RR , 1.24 ; 95 % CI , 1.06 to 1.45;P = 0.006 ) or with further correction for classic risk factors , including age , lipids , and systolic blood pressure ( RR , 1.20 ; 95 % CI , 1.02 to 1.42;P = 0.03 ) . Leptin correlated with C-reactive protein ( r = 0.24 , P < 0.001 ) and , even with this variable added to the model , leptin retained significance as a predictor of coronary events ( RR , 1.18 ; 95 % CI , 1.00 to 1.39;P = 0.05 ) at the expense of C-reactive protein . Conclusions —We show , for the first time , in a large prospect i ve study that leptin is a novel , independent risk factor for coronary heart disease OBJECTIVES We examined the relationship between body mass index ( BMI ) , waist circumference , and  incident HF in men with and without pre-existing coronary heart disease ( CHD ) and assessed the contribution of plasma leptin concentration to these associations . BACKGROUND Leptin has been proposed as a potential link between obesity and heart failure ( HF ) . METHODS This was a prospect i ve study of 4,080 men age 60 to 79 years with no diagnosed HF followed for a mean period of 9 years , in whom there were 228 incident HF cases . RESULTS Increased BMI was associated with significantly increased risk of HF  in men with and without pre-existing CHD ( myocardial infa rct ion or angina ) after adjustment for cardiovascular risk factors including C-reactive protein . The adjusted hazard ratios ( HRs ) associated with a 1-SD increase in BMI were 1.37 ( 95 % confidence interval [ CI ] : 1.09 to 1.72 ) and 1.18 ( 95 % CI : 1.00 to 1.39 ) in men with and without CHD , respectively . Increased leptin was significantly associated with an increased risk of HF in men without pre-existing CHD , independent of BMI and potential mediators ( adjusted HR for a 1-SD increase in log leptin : 1.30 [ 95 % CI : 1.06 to 1.61 ] ; p = 0.01 ) . However , no association was seen in those with pre-existing CHD ( corresponding HR : 1.06 [ 95 % CI : 0.77 to 1.45 ] ; p = 0.72 ) . Adjustment for leptin abolished the association between BMI and HF in men with no CHD ; in those with CHD , the association between BMI and HF remained significant ( p = 0.03 ) . Similar patterns were seen for waist circumference . CONCLUSIONS In the absence of established CHD , the association between obesity and HF may be mediated by plasma leptin . In those with CHD , obesity appears to increase the risk of HF independent of leptin Background : Adipokines play an important role in glucose , lipid and lipoprotein metabolisms , as well as in coagulation and inflammatory processes . So far , studies have evaluated the association of individual adipokines with future coronary heart disease ( CHD ) event and provided mixed results . Objectives : We sought to investigate the association of a set of adipocytokines , including total adiponectin , adipsin , resistin , leptin and plasminogen activator inihibitor-1 ( PAI-1 ) , with future CHD events in apparently healthy men . Methods : We built a nested case – control study within the PRIME Study , a multicenter prospect i ve cohort of 9779 healthy European middle-aged men .  Total adiponectin , adipsin , resistin , leptin and PAI-1  were measured in the baseline plasma sample of 617 men who developed a first CHD event ( coronary death , myocardial infa rct ion , stable or unstable angina ) during 10 years of follow-up and in 1215 study -matched controls , by multiplex assays using commercial kits . HRs for CHD were estimated by conditional logistic regression analysis . Results : Median concentrations of total adiponectin , adipsin and resistin were similar in cases and in controls , whereas those of leptin and PAI-1 were higher in cases than in controls , 6.30 vs 5.40 ng ml−1 , and 10.09 vs 8.48 IU ml−1 , respectively . The risk of future CHD event increased with increasing quintiles of baseline leptin and PAI-1 concentrations only in unadjusted analysis ( P-value for trend < 0.003 and < 0.0001 , respectively ) . However , these associations were no longer significant after adjustment for usual CHD risk factors including hypertension , diabetes , smoking , total cholesterol , triglycerides and HDL cholesterol . Conversely , baseline CRP and IL-6 levels remained associated with CHD risk in multivariate analysis . Conclusions : In apparently healthy men  , circulating total adiponectin , adipsin , resistin , leptin and PAI-1 were not independent predictors of future CHD event BACKGROUND & AIMS Visceral adipose tissue ( VAT ) is an important risk factor for the metabolic complications associated with obesity . Therefore , a reduction in VAT is considered an important target of obesity therapy . We evaluated whether reducing VAT mass by surgical removal of the omentum improves insulin sensitivity and metabolic function in obese patients . METHODS We conducted a 12-month r and omized controlled trial to determine whether reducing VAT by omentectomy in 22 obese subjects increased their improvement following Roux-en-Y gastric bypass ( RYGB ) surgery in hepatic and skeletal muscle sensitivity to insulin study 1 . Improvement was assessed by using the hyperinsulinemic-euglycemic clamp technique . We also performed a 3-month , longitudinal , single-arm study to determine whether laparoscopic omentectomy alone , in 7 obese subjects with type 2 diabetes mellitus ( T2DM ) , improved insulin sensitivity study 2 . Improvement was assessed by using the Frequently Sample d Intravenous Glucose Tolerance Test . RESULTS The greater omentum , which weighed 0.82 kg ( 95 % confidence interval : 0.67 - 0.97 ) , was removed from subjects who had omentectomy in both studies . In study 1 , there was an approximate 2-fold increase in muscle insulin sensitivity ( relative increase in glucose disposal during insulin infusion ) and a 4-fold increase in hepatic insulin sensitivity 12 months after RYGB alone and RYGB plus omentectomy , compared with baseline values ( P<.001 ) . There were no significant differences between groups ( P>.87 ) or group x time interactions ( P>.36 ) . In study 2 , surgery had no effect on insulin sensitivity ( P=.844 ) or use of diabetes medications . CONCLUSIONS These results demonstrate that decreasing VAT through omentectomy , alone or in combination with RYGB surgery , does not improve metabolic function in obese patients BACKGROUND Excess visceral adipose tissue predicts for incipient diabetes mellitus and cardiovascular disease . Human data are mixed regarding the benefits of selective visceral adipose tissue reduction . We investigated the effects of omentectomy added to laparoscopic Roux-en-Y gastric bypass on glucose homeostasis and lipids , inflammatory markers , and adipokines 90 days postoperatively in nondiabetic patients at the Legacy Good Samaritan Hospital and Oregon Health and Science University ( Portl and , OR ) . METHODS A single-blind , r and omized study of laparoscopic Roux-en-Y gastric bypass plus omentectomy versus laparoscopic Roux-en-Y gastric bypass alone in 28 subjects ( 7 men and 21 women ) . The groups were matched at baseline for gender , age , and body mass index ( BMI ) . The eligibility criteria included age ≥18 years , BMI ≥40 and < 50 kg/m(2 ) without co-morbid conditions or BMI ≥35 and < 50 kg/m(2 ) with co-morbid conditions . The primary outcome measures were changes in the fasting plasma glucose , insulin , and homostatic model assessment of insulin resistance . The secondary measures were BMI and the high-sensitivity C-reactive protein , tumor necrosis factor-α , interleukin , total and high-molecular-weight adiponectin , fibrinogen , and plasminogen activator inhibitor-1 levels . RESULTS After surgery , the BMI decreased significantly in both groups and was not different at the follow-up point . Although many outcome parameters improved with weight loss in both groups postoperatively , only the omentectomy group experienced statistically significant decreases in fasting glucose ( P < .05 ) , total ( P = .004 ) and very-low-density lipoprotein ( P = .001 ) cholesterol , and an increase in the high-molecular-weight/total adiponectin ratio ( P = .013 ) . CONCLUSIONS Omentectomy added to laparoscopic Roux-en-Y gastric bypass results in favorable changes in glucose homeostasis , lipid levels , and adipokine profile at 90 days postoperatively . These data support the hypothesis that selective ablation of visceral adipose tissue conveys metabolic benefits in nondiabetic humans OBJECTIVE To analyze the effects of the surgical removal of subcutaneous adipose tissue by ultrasound-assisted megalipoplasty ( UAM ) on energy expenditure and adipocytokine concentrations in obese women . METHODS Fifteen premenopausal obese women with BMI 37.5+/-6.3 kg/m(2 ) ( range : 30.7 - 53.6 kg/m(2 ) ) underwent UAM .  Body composition ( by DEXA ) , resting metabolic rate ( REE ) by indirect calorimetry , insulin resistance ( by the HOMA method ) , leptin , C-reactive protein , interleukin-6 , resistin and adiponectin were measured before and 1 , 3 , 28 and 180 days after the procedure . RESULTS UAM significantly reduced fat mass at day 3 , without further changes in the following days . REE increased at day 3 after UAM , returned to baseline levels at day 28 and significantly declined at day 180 . Leptin levels transiently increased after UAM and then declined according to fat mass reduction . C-reactive protein , interleukin-6 and resistin levels acutely increased after UAM and then returned to the baseline levels . Adiponectin levels acutely declined after the procedure and then stabilized to a plasma level slightly lower than at baseline . Insulin resistance deteriorated in the acute post-operative phase and then improved . CONCLUSION The surgical removal of subcutaneous fat was associated to an acute inflammatory reaction with high REE and insulin-resistance . Later on , the metabolic effects of fat mass removal appeared , with a reduction of leptin levels and REE and an improvement of insulin resistance 
    Output:
    
After adjusting for time and body mass index ( BMI ) , leptin and fasting insulin were the only markers that were significantly associated with the amount of aspirated fat .
Based on the results of our analysis , we conclude that there is no evidence to support the hypothesis that subcutaneous fat removal reduces early cardiovascular or metabolic disease , its markers or its risk factors