***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: Recent evidence suggests that dietary fat intake may be more strongly associated than total energy intake to the development and maintenance of obesity . The objective of this study was to determine whether dietary fat restriction would promote more favorable changes in body weight , body composition , resting metabolic rate ( RMR ) , eating behavior , and dietary adherence than calorie restriction . Sixty-five obese women and 15 obese men were recruited and r and omly assigned to calorie restriction ( 1000–1200 kcal/day ) or fat restriction ( 22–26 g/day ) . Subjects participated in a 24-week behavioral weight loss program .  Fortyeight subjects completed assessment s at all four time points — baseline and 6 , 12 , and 18 months . Weight loss was significantly greater in the low calorie ( LC ) group ( −11.2 versus −6.1 kg , p<.001 ) and was maintained better at the 18-month assessment ( −7.5 versus −1.8 kg , p≤.001 ) . There was a significantly greater decrease in percent body fat and RMR for the LC group with only percent body fat still significantly lower at 18 months . Subjects in the LC group consumed significantly fewer calories , less carbohydrates , and the same amount of fat as those in the low fat ( LF ) condition , however , calorie and carbohydrate intake were decreasing for LF subjects by the 12- and 18-month assessment s. There were no long-term differences in most measured predictors of dietary adherence . Dietary fat restriction did not prove to be superior to calorie restriction , thus strengthening the public health message that calories do count The role of dietary fat in the regulation of energy intake was assessed by manipulating a conventional diet and measuring spontaneous food consumption .  Twenty-four women each consumed a sequence of three 2-wk dietary treatments in which 15 - 20 % , 30 - 35 % , or 45 - 50 % of the energy was derived from fat . These diets consisted of foods that were similar in appearance and palatability but differed in the amount of high-fat ingredients used . Relative to their energy consumption on the medium-fat diet , the subjects spontaneously consumed an 11.3 % deficit on the low-fat diet and a 15.4 % surfeit on the high-fat diet ( p less than 0.0001 ) , result ing in significant changes in body weight ( p less than 0.001 ) . A small amount of caloric compensation did occur ( p less than 0.02 ) , which was greatest in the leanest subjects ( p less than 0.03 ) . These results suggest that habitual , unrestricted consumption of low-fat diets may be an effective approach to weight control In a prospect i ve , r and omised , controlled trial to determine whether comprehensive lifestyle changes affect coronary atherosclerosis after 1 year , 28 patients were assigned to an experimental group ( low-fat vegetarian diet , stopping smoking , stress management training , and moderate exercise ) and 20 to a usual-care control group . 195 coronary artery lesions were analysed by quantitative coronary angiography  . The average percentage diameter stenosis regressed from 40.0 ( SD 16.9)% to 37.8 (16.5)% in the experimental group yet progressed from 42.7 (15.5)% to 46.1 (18.5)% in the control group . When only lesions greater than 50 % stenosed were analysed , the average percentage diameter stenosis regressed from 61.1 (8.8)% to 55.8 (11.0)% in the experimental group and progressed from 61.7 (9.5)% to 64.4 (16.3)% in the control group . Overall , 82 % of experimental-group patients had an average change towards regression .  Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only 1 year , without use of lipid-lowering drugs This r and omised controlled trial examined anthropometric changes and cardiovascular benefits of six months of weight management in 110 free living women , aged 18–68 y and BMI 25–50 kg/m2 , who received 1200 kcal/d diet treatments of either high ( 58 % energy , n=57 ) or low ( 35 % energy , n=53 ) carbohydrate ( CHO ) content .  Body weight , plasma total , HDL and LDL cholesterol , triglyceride and blood pressure were measured . Examination at three months showed women on high CHO lost ( mean±s.e.m . ) 4.3±0.5 kg and those on low CHO lost 5.6±0.6 kg of body weight . Changes in risk factors did not significantly differ between the two diet treatments throughout the study . However those on high CHO diets significantly lowered their plasma total cholesterol by 0.33 mmol/l ( 95 % CI : 0.10 , 0.55 ) , LDL cholesterol by 0.23 mmol/l ( 0.02 , 0.43 ) and HDL cholesterol by 0.05 mmol/l ( 0.03 , 0.10 ) , while women on low CHO diets lowered only plasma triglyceride by 0.28 mmol/l ( 0.08 , 0.48 ) . Blood pressure did not change significantly on either diet . After six months , women on high CHO lost 5.6±0.8 kg and those on low CHO lost 6.8±0.8 kg . On the high CHO  diet , total cholesterol remained significantly below the baseline value at 0.34 mmol/l ( 0.13 , 0.56 ) , triglyceride was significantly lowered by 0.27 mmol/l ( 0.10 , 0.45 ) , and HDL cholesterol returned to the baseline value . On the low CHO  diet , triglyceride remained the only risk factor to be significantly improved . A subgroup of 46 postmenopausal women lost significantly ( P<0.05 ) more weight on the low CHO diet than high CHO diet . In conclusion , these results provided some support for preferring a high CHO diet to a lower CHO approach in weight management , from the point of view of risk reduction , but do not indicate a consistently more rapid weight loss with either diet OBJECTIVE The aim of this r and omized trial was to compare the effects of a behavioral intervention focusing on either calorie restriction alone or calorie plus fat restriction on weight loss and changes in lipids and glycemic control in individuals with non-insulin-dependent diabetes mellitus ( NIDDM ) or a family history of diabetes . RESEARCH DESIGN AND METHODS We recruited 44 obese women with NIDDM and 46 obese women with a family history of NIDDM and r and omly assigned these subjects to calorie restriction ( CAL ) or to calorie plus fat restriction ( CAL + FAT ) . All subjects participated in a 16-week behavioral weight loss program , with training in diet , exercise , and behavior modification . Subjects assigned to the CAL condition were given a 1,000−1,500 kcal/day goal and self-monitored calories consumed . Subjects assigned to the CAL + FAT condition had the same calorie goal , but were also given a fat goal ( grams of fat/day ) , to produce a diet with < 20 % of calories from fat ; this group monitored both calories and fat grams . RESULTS Among NIDDM subjects , weight loss of the subjects in the CAL+FAT condition was significantly > subjects in the CAL condition ( 7.7 vs. 4.6 kg ) and the CAL+FAT condition group also maintained their weight loss better at the 1-year follow-up ( 5.2 vs. 1.0 kg ) . Significant decreases in glucose , high-density lipoprotein ( HDL ) cholesterol , and total cholesterol were seen after 16 weeks of treatment among NIDDM subjects ; these changes were similar in CAL and CAL+FAT groups , but a greater proportion of subjects in CAL condition required oral hypoglycemic medication . At the 1-year follow-up , all parameters had returned to baseline . No significant differences in weight loss or physiological changes were seen between CAL and CAL+FAT conditions in subjects with a family history of diabetes . CONCLUSIONS These results suggest that using the combination of calorie and fat restriction may help promote weight loss in obese NIDDM patients . No other long-term benefits of this regimen were observed OBJECTIVE : We investigated the prevalence of overweight and obesity and their relationships with the main cardiovascular risk factors in the population of Ventimiglia di Sicilia , a rural village in Southern Italy characterized by low cholesterol levels and by a low incidence of early coronary heart disease mortality . We related all deaths to body weight and fat distribution during an 8 y follow-up . DESIGN : Cross-sectional and prospect i ve observational study .SUBJECTS : A total of 835 free-living individuals , 363 males and 472 females , of age between 20 and 69 y. MEASUREMENTS : In all participants body weight , waist-to-hip ratio ( WHR ) , cardiovascular risk factors and plasma lipids were measured . During the follow-up , total and cardiovascular deaths were registered . RESULTS : We found a high overall prevalence of subjects with overweight or obesity ( respectively 45.0 % and 27.7 % ) , with great differences among classes of age . As expected , body weight and fat distribution were associated with diabetes , hypertension , dyslipidemia and with a worsening of lipid profile . During the follow-up we registered 37 total and 11 cardiovascular deaths . All-cause and cardiovascular mortality risks were , respectively , 1.64 ( 95 % CI 0.65–4.15 ) and 2.71 ( 95 % CI 0.29–25.26 ) in subjects with a body mass index ( BMI ) of 27–29.99 kg/m2 and 2.45 ( 95 % CI 1.03–5.87 ) and 5.36 ( 95 % CI 1.41–62.01 ) in subjects with a BMI of≥30 kg/m2 in comparison with participants with a BMI of < 27 kg/m2 , and 3.48 ( 95 % CI 1.46–8.30 ) and 4.55 ( 95 % CI 1.12–18.40 ) in subjects with a WHR higher than the median in comparison with individuals with a WHR lower than the median . CONCLUSION : The Ventimiglia di Sicilia Study highlights the great importance of overweight and obesity as a public health issue in a rural population and indicates that it is necessary to consider the impact of body weight and fat distribution on both total and CHD mortality Quantification of the excess mortality from all causes associated with obesity remains controversial . In this paper , 6,193 obese patients , those with a body mass index ( weight (kg)/height (m)2 ( BMI ) ) range of 25 - 74 kg/m2 , recruited from 1961 to 1994 in Düsseldorf , Germany , were followed for a mean time of 14 ( st and ard deviation , 8.2 ) years , yielding 87,179 observed patient-years . During the study period , 1,028 patients ( 16.6 % ) died . The entire cohort was grouped into approximate quartiles according to BMI : group 1 , BMI from 25 to < 32 ; group 2 , BMI from 32 to < 36 ; group 3 , BMI from 36 to < 40 ; group 4 , BMI > or = 40 kg/m2 . The following risk ratios were estimated by means of Cox proportional hazards models using the lowest BMI group as reference category : group 2 for men , 1.02 ( 95 % confidence interval 0.76 - 1.37 ) ; for women , 1.23 ( 95 % confidence interval 0.96 - 1.58 ) ; group 3 for men , 1.50 ( 95 % confidence interval 1.09 - 2.06 ) ; for women , 1.33 ( 95 % confidence interval 1.03 - 1.73 ) ; and group 4 for men , 2.10 ( 95 % confidence interval 1.53 - 2.88 ) ; for women , 2.25 ( 95 % confidence interval 1.78 - 2.84 ) . The following st and ardized mortality ratios were calculated by using the respective geographic area ( the Federal State of North Rhine Westphalia ) as reference population : group 1 for men , 1.26 ( 95 % confidence interval 0.98 - 1.61 ) ; for women , 1.00 ( 95 % confidence interval 0.81 - 1.23 ) ; group 2 for men , 1.31 ( 95 % confidence interval 1.09 - 1.57 ) ; for women , 1.20 ( 95 % confidence interval 1.02 - 1.40 ) ; group 3 for men , 1.92 ( 95 % confidence interval 1.53 - 2.38 ) ; for women , 1.27 ( 95 % confidence interval 1.07 - 1.50 ) ; and group 4 for men , 3.05 ( 95 % confidence interval 2.47 - 3.73 ) ; for women , 2.31 ( 95 % confidence interval 
    Output:
    
Apart from one study which showed a slight but statistically significant difference in total cholesterol in the low fat group at one year follow-up , there were no significant differences between the dietary groups for other outcome measures such as serum lipids , blood pressure and fasting plasma glucose .
REVIEW ER 'S CONCLUSIONS The review suggests that fat-restricted diets are no better than calorie restricted diets in achieving long term weight loss in overweight or obese people .
Overall , participants lost slightly more weight on the control diets but this was not significantly different from the weight loss achieved through dietary fat restriction and was so small as to be clinical ly insignificant