***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 The prevalence of micronutrient deficiencies is higher in obese individuals compared to normal-weight people , probably because of inadequate eating habits but also due to increased dem and s among overweight persons , which are underestimated by dietary reference intakes ( DRI ) intended for the general population . We therefore evaluated the dietary micronutrient intake in obese individuals compared to a reference population and DRI recommendations . Furthermore , we determined the micronutrient status in obese subjects undergoing a st and ardized DRI-covering low-calorie formula diet  to analyze if the DRI meet the micronutrient requirements of obese individuals . Methods In 104 subjects baseline micronutrient intake was determined by dietary record collection .  A r and omly assigned subgroup of subjects ( n = 32 ) underwent a st and ardized DRI-covering low-calorie formula diet over a period of three months . Pre- and post-interventional intracellular micronutrient status in buccal mucosa cells ( BMC ) was analyzed , as well as additional micronutrient serum concentrations in 14 of the subjects . Results Prior to dietetic intervention , nutrition was calorie-rich and micronutrient-poor . Baseline deficiencies in serum concentrations were observed for 25-hydroxyvitamin-D , vitamin C , selenium , iron , as well as ß-carotene , vitamin C , and lycopene in BMC . After a three-month period of formula diet even more subjects had reduced micronutrient levels of vitamin C ( serum , BMC ) , zinc , and lycopene . There was a significant negative correlation between lipophilic serum vitamin concentrations and body fat , as well as between iron and C-reactive protein . Conclusions The present pilot study shows that micronutrient deficiency occurring in obese individuals is not corrected by protein-rich formula diet containing vitamins and minerals according to DRI . In contrast , micronutrient levels remain low or become even lower , which might be explained by insufficient intake , increased dem and and unbalanced dispersal of lipophilic compounds in the body . Trial registration The study was registered at Clinical Trials.gov ( NCT01344525 ) . The study protocol comprises only a part of the approved trial protocol Context : Common concerns when using low-calorie diets as a treatment for obesity are the reduction in fat-free mass , mostly muscular mass , that occurs together with the fat mass ( FM ) loss , and determining the best method ologies to evaluate body composition changes . Objective : This study aim ed to evaluate the very-low-calorie ketogenic ( VLCK ) diet-induced changes in body composition of obese patients and to compare 3 different method ologies used to evaluate those changes . Design : Twenty obese patients followed a VLCK diet for 4 months .  Body composition assessment was performed by dual-energy X-ray absorptiometry ( DXA ) , multifrequency bioelectrical impedance ( MF-BIA ) , and air displacement plethysmography ( ADP ) techniques . Muscular strength was also assessed . Measurements were performed at 4 points matched with the ketotic phases ( basal , maximum ketosis , ketosis declining , and out of ketosis ) . Results : After 4 months the VLCK diet induced a −20.2 ± 4.5 kg weight loss , at expenses of reductions in fat mass ( FM ) of −16.5 ± 5.1 kg ( DXA ) , −18.2 ± 5.8 kg ( MF-BIA ) , and −17.7 ± 9.9 kg ( ADP ) . A substantial decrease was also observed in the visceral FM . The mild but marked reduction in fat-free mass occurred at maximum ketosis , primarily as a result of changes in total body water , and was recovered thereafter . No changes in muscle strength were observed . A strong correlation was evidence d between the 3 methods of assessing body composition . Conclusion : The VLCK diet-induced  weight loss was mainly at the expense of FM and visceral mass ; muscle mass and strength were preserved . Of the 3 body composition techniques used , the MF-BIA method seems more convenient in the clinical setting OBJECTIVE Obesity plays a relevant pathophysiological role in the development of health problems , arising as result of complex interaction of genetic , nutritional and metabolic factors . We conducted a dietary intervention case-control r and omized trial , to compare the effectiveness on body composition of two nutritional protocol s : a very-low-carbohydrate ketogenic diet ( VLCKD ) , integrated by an aminoacid supplement with whey protein , and very low restricted-calorie diet ( VLCD ) . PATIENTS AND METHODS The clinical study was conducted with a r and omized case-control in which twenty-five healthy subjects gave informed consent to participate in the interventional study and were evaluated for their health and nutritional status , by anthropometric , and body composition evaluation . RESULTS The results of this pilot study show that a diet low in carbohydrates , associated with a decreased caloric intake , is effective in weight loss . After VLCKD , versus VLCD , no significant differences in body lean of the trunk , body lean distribution ( and roid and gynoid ) , total body lean were observed ( p > 0.05 ) . After VLCKD , no increasing of sarcopenia frequency , according ASSMI , was observed . DISCUSSION Many studies have shown the effectiveness of the ketogenic diet on weight loss ; even if not know how to work effectively , as some research ers believe that the weight loss is due to reduced calorie intake , satiety could also be induced by the effect of the proteins , rather than the low-carbohydrates . CONCLUSIONS Our pilot study showed that a VLCKD was highly effective in terms of body weight reduction without to induce lean body mass loss , preventing the risk of sarcopenia . Further clinical trials are needed on a larger population and long-term body weight maintenance and risk factors management effects of VLCKD . There is no doubt , however , that a proper dietary approach would impact significantly on the reduction of public expenditure costs , in view of prospect i ve data on increasing the percentage of obese people in our nation OBJECTIVE Development of these guidelines is m and ated by the American Association of Clinical Endocrinologists ( AACE ) Board of Directors and the American College of Endocrinology ( ACE ) Board of Trustees and adheres to published AACE protocol s for the st and ardized production of clinical practice guidelines ( CPGs ) . METHODS Recommendations are based on diligent review of clinical evidence with transparent incorporation of subjective factors . RESULTS There are 9 broad clinical questions with 123 recommendation numbers that include 160 specific statements ( 85 [ 53.1 % ] strong [ Grade A ] ; 48 [ 30.0 % ] intermediate [ Grade B ] , and 11 [ 6.9 % ] weak [ Grade C ] , with 16 [ 10.0 % ] based on expert opinion [ Grade D ] ) that build a comprehensive medical care plan for obesity . There were 133 ( 83.1 % ) statements based on strong ( best evidence level [ BEL ] 1 = 79 [ 49.4 % ] ) or intermediate ( BEL 2 = 54 [ 33.7 % ] ) levels of scientific substantiation . There were 34 ( 23.6 % ) evidence -based recommendation grade s ( Grade s A-C = 144 ) that were adjusted based on subjective factors . Among the 1,790 reference citations used in this CPG , 524 ( 29.3 % ) were based on strong ( evidence level [ EL ] 1 ) , 605 ( 33.8 % ) were based on intermediate ( EL 2 ) , and 308 ( 17.2 % ) were based on weak ( EL 3 ) scientific studies , with 353 ( 19.7 % ) based on review s and opinions ( EL 4 ) . CONCLUSION The final recommendations recognize that obesity is a complex , adiposity-based chronic disease , where management targets both weight-related complications and adiposity to improve overall health and quality of life . The detailed evidence -based recommendations allow for nuanced clinical decision-making that addresses real-world medical care of patients with obesity , including screening , diagnosis , evaluation , selection of therapy , treatment goals , and individualization of care . The goal is to facilitate high- quality care of patients with obesity and provide a rational , scientific approach to management that optimizes health outcomes and safety . ABBREVIATIONS A1C = hemoglobin A1c AACE = American Association of Clinical Endocrinologists ACE = American College of Endocrinology ACSM = American College of Sports Medicine ADA = American Diabetes Association ADAPT = Arthritis , Diet , and Activity Promotion Trial ADHD = attention-deficit hyperactivity disorder AHA = American Heart Association AHEAD = Action for Health in Diabetes AHI = apnea-hypopnea index ALT = alanine aminotransferase AMA = American Medical Association ARB = angiotensin receptor blocker ART = assisted reproductive technology AUC = area under the curve BDI = Beck Depression Inventory BED = binge eating disorder BEL = best evidence level BLOOM = Behavioral Modification and Lorcaserin for Overweight and Obesity Management BLOSSOM = Behavioral Modification and Lorcaserin Second Study for Obesity Management BMI = body mass index BP = blood pressure C-SSRS = Columbia Suicidality Severity Rating Scale CAD = coronary artery disease CARDIA = Coronary Artery Risk Development in Young Adults CBT = cognitive behavioral therapy CCO = Consensus Conference on Obesity CHF = congestive heart failure CHO = carbohydrate CI = confidence interval COR-I = Contrave Obesity Research I CPG = clinical practice guideline CV = cardiovascular CVD = cardiovascular disease DASH = Dietary Approaches to Stop Hypertension DBP = diastolic blood pressure DEXA = dual-energy X-ray absorptiometry DPP = Diabetes Prevention Program DSE = diabetes support and education EL = evidence level ED  = erectile dysfunction  ER = extended release EWL = excess weight loss FDA = Food and Drug Administration FDG = 18F-fluorodeoxyglucose GABA = gamma-aminobutyric acid GERD = gastroesophageal reflux disease GI = gastrointestinal GLP-1 = glucagon-like peptide 1 HADS = Hospital Anxiety and Depression Scale HDL-c = high-density lipoprotein cholesterol HR = hazard ratio HTN = hypertension HUNT = Nord-Trøndelag Health Study ICSI = intracytoplasmic sperm injection IFG = impaired fasting glucose IGT = impaired glucose tolerance ILI = intensive lifestyle intervention IVF = in vitro fertilization LAGB = laparoscopic adjustable gastric b and ing LDL-c = low-density lipoprotein cholesterol LES = lower esophageal sphincter LSG = laparoscopic sleeve gastrectomy LV = left ventricle LVH = left ventricular hypertrophy LVBG = laparoscopic vertical b and ed gastroplasty MACE = major adverse cardiovascular events MAOI = monoamine oxidase inhibitor MI = myocardial infa rct ion MN RCT = meta- analysis of non-r and omized prospect i ve or case-controlled trials MRI = magnetic resonance imaging MUFA = monounsaturated fatty acid NAFLD = nonalcoholic fatty liver disease NASH = nonalcoholic steatohepatitis NES = night eating syndrome NHANES = National Health and Nutrition Examination Surveys NHLBI = National Heart , Lung , and Blood Institute NHS = Nurses ' Health Study NICE = National Institute for Health and Care Excellence OA = osteoarthritis OGTT = oral glucose tolerance test OR = odds ratio OSA = obstructive sleep apnea PHQ-9 = Patient Health Question naire PCOS = polycystic ovary syndrome PCP = primary care physician POMC = pro-opiomelanocortin POWER = Practice -Based Opportunities for Weight Reduction PPI = proton pump inhibitor PRIDE = Program to Reduce Incontinence by Diet and Exercise PSA = prostate specific antigen QOL = quality of life RA = receptor agonist RCT = r and omized controlled trial ROC = receiver operator characteristic RR = relative risk RYGB = Roux-en-Y gastric bypass  SAD = sagittal abdominal diameter SBP = systolic blood pressure SCOUT = Sibutramine Cardiovascular Outcome Trial SG = sleeve gastrectomy SHBG = sex hormonebinding globulin SIEDY = Structured Interview on Erectile Dysfunction SNRI = serotonin-norepinephrine reuptake inhibitors SOS = Swedish Obese Subjects SS = surveillance study SSRI = selective serotonin reuptake inhibitors STORM = Sibutramine Trial on Obesity Reduction and Maintenance TCA = tricyclic antidepressant TONE = Trial of Nonpharmacologic Intervention in the Elderly TOS = The Obesity Society T2DM = type 2 diabetes mellitus UKPDS = United Kingdom Prospect i ve Diabetes Study U.S = United States VAT = visceral adipose tissue VLDL = very low-density lipoprotein WC = waist circumference WHO = World Health Organization WHR = waist-hip ratio WHtR = waist-to-height ratio WMD = weighted mean difference WOMAC = Western Ontario and McMaster Universities osteoarthritis index X 
    Output:
    
No changes in LDL cholesterol , HDL cholesterol , serum creatinine , serum uric acid and serum potassium were found .
The present review supports the use of VLCKD as an effective strategy for the management of overweight and obesity .