***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 / Objectives : Direct evidence for the effects of vegetable intake on weight loss is qualified . The study aim ed to assess the effect of higher vegetable consumption on weight loss . Subjects/ Methods : A single blind parallel controlled trial was conducted with 120 overweight adults ( mean body mass index=29.98 kg/m2 ) r and omised to two energy deficit healthy diet advice groups differing only by doubling the serving ( portion ) sizes of vegetables in the comparator group . Data were analysed as intention-to-treat using a linear mixed model . Spearmans rho bivariate was used to explore relationships between percentage energy from vegetables and weight loss . Results : After 12 months , the study sample lost 6.5±5.2 kg ( P<0.001 time ) with no difference between groups ( P>0.05 interaction ) . Both groups increased vegetable intake and lost weight in the first 3 months , and the change in weight was significantly correlated with higher proportions of energy consumed as vegetables ( rho=–0.217 , P=0.024 ) . Fasting glucose , insulin and triglyceride levels decreased ( P<0.001 time ) and high-density lipoprotein cholesterol levels increased ( P<0.001 time ) , with no difference between groups . Weight loss was sustained for 12 months by both groups , but the comparator group reported greater hunger satisfaction ( P=0.005 ) . Conclusions : Advice to consume a healthy low-energy diet leads to sustained weight loss , with reductions in cardiovascular disease risk factors regardless of an emphasis on more vegetables . In the short term , consuming a higher proportion of the dietary energy as vegetables may support a greater weight loss and the dietary pattern appears sustainable Noncompliance with therapeutic diets remains a major obstacle to achieving improvements in cardiovascular disease ( CVD ) morbidity and mortality . This study compared dietary compliance and CVD risk factor response to two dietary interventions design ed to treat hypertension , dyslipidemia , and diabetes mellitus . In a multicenter trial , 560 adults were r and omly assigned to either a self-selected , mixed-food plan ( n = 277 ) , or a nutrient-fortified prepared meal plan ( n = 283 ) ; each was design ed to provide 15 - 20 % of energy from fat , 55 - 60 % from carbohydrate , and 15 - 20 % from protein . Nutrient intake was estimated from 3-d food records collected biweekly throughout the 10-wk intervention . Compliance was determined by evaluating the participants ' ability to meet specific criteria for energy intake [ + /-420 kJ ( 100 kcal ) from the midpoint of the prescribed energy range ] , fat intake ( < 20 % , < 25 % , or < 30 % of energy from total fat ) , and the National Cholesterol Education Program/American Heart Association Step 1 and 2 diet recommendations . Compliance with energy , fat , and Step 1 and 2 criteria was better in participants who followed the prepared meal plan than in those who followed the self-selected diet ( P < 0.0001 ) . Compliant participants in both groups achieved greater reductions in body weight , systolic and diastolic blood pressure , and total and low-density-lipoprotein cholesterol than noncompliant participants ( P < 0.05 ) . In general , better endpoint responses were observed with lower fat intakes regardless of group assignment . The prepared meal plan is a simple and effective strategy for meeting the many nutrient recommendations for CVD risk reduction and improving dietary compliance and CVD endpoints Research on the conceptualization of adherence to treatment has not addressed a key question : Is adherence best defined as being a uni-dimensional or multi-dimensional behavioral construct ? The primary aim of this study was to test which of these conceptual models best described adherence to a weight management program . This ancillary study was conducted as a part of the POUNDS LOST trial that tested the efficacy of four dietary macronutrient compositions for promoting weight loss .  A sample of 811 overweight/obese adults was recruited across two clinical sites , and each participant was r and omly assigned to one of four macronutrient prescriptions : ( 1 ) Low fat ( 20 % of energy ) , average protein ( 15 % of energy ) ; ( 2 ) High fat ( 40 % ) , average protein ( 15 % ) ; ( 3 ) Low fat ( 20 % ) , high protein ( 25 % ) ; ( 4 ) High fat ( 40 % ) , high protein ( 25 % ) . Throughout the first 6 months of the study , a computer tracking system collected data on eight indicators of adherence . Computer tracking data from the initial 6 months of the intervention were analyzed using exploratory and confirmatory analyses . Two factors ( accounting for 66 % of the variance ) were identified and confirmed : ( 1 ) behavioral adherence and ( 2 ) dietary adherence . Behavioral adherence did not differ across the four interventions , but prescription of a high fat diet ( vs. a low fat diet ) was found to be associated with higher levels of dietary adherence . The findings of this study indicated that adherence to a weight management program was best conceptualized as being multi-dimensional , with two dimensions : behavioral and dietary adherence BACKGROUND High-fibre and low-carbohydrate diets may enhance satiety and promote weight loss . We compared a diet rich in beans aim ing to increase dietary fibre and promote weight loss with a low-carbohydrate diet in a r and omised controlled trial to assess effect and tolerability of the high-fibre bean-rich diet . METHODS AND RESULTS One hundred and seventy-three women and men , with a mean body mass index of approximately 36 kg m(-2 ) ( one-fifth with diabetes type 2 ) were r and omised to a high-fibre bean-rich diet that achieved mean ( SD ) fibre intakes of 35.5 ( 18.6 ) g day(-1 ) for women and 42.5 ( 30.3 ) g day(-1 ) for men , or a low-carbohydrate diet . Both diets were induced gradually over 4 weeks and included a 3-day feeding phase . Among 123 ( 71.1 % ) completers at 16 weeks , mean ( SD ) weight loss was 4.1 ( 4.0 ) kg in the high-fibre versus 5.2 ( 4.5 ) kg in the low-carbohydrate group [ difference , 1.1 kg , 95 % confidence interval ( CI ) = -2.6 to -0.5 ; P = 0.2 ] , with results similar to the intent-to-treat population . Low-density lipoprotein (LDL)-cholesterol levels decreased with the high-fibre diet ( difference in LDL-cholesterol versus low-carbohydrate diet , 0.2 mmol L(-1 ) , 95 % CI = 0.01 - 0.44 mmol L(-1 ) ; P = 0.045 ) , as did total cholesterol ( P = 0.038 ) , whereas changes in other lipids and glucose did not differ . After 52 weeks , the low-carbohydrate ( n = 24 ) group tended to retain weight loss better than the high-fibre group ( P = 0.06 ) , although total cholesterol remained lower with the bean-rich diet ( P = 0.049 ) . CONCLUSIONS A high-fibre bean-rich diet was as effective as a low-carbohydrate diet for weight loss , although only the bean-rich diet lowered atherogenic lipids Behavioral treatments for obesity seek to modify eating and exercise behaviors by a change in their antecedents and consequences . More direct modification of antecedents and consequences by ( a ) the provision of food to patients and ( b ) the provision of financial rewards for weight loss was hypothesized to improve treatment outcomes . Two hundred two men and women were r and omly assigned to no treatment , st and ard behavioral treatment ( SBT ) , SBT plus food provision , SBT plus incentives , or SBT plus food provision and incentives . The major finding was that food provision significantly enhanced weight loss . Weight losses with  SBT  averaged 7.7 , 4.5 , and 4.1 kg at 6 , 12 , and 18 months , respectively , compared with 10.1 , 9.1 , and 6.4 kg , respectively , at the same intervals with the addition of food . Food provision also enhanced attendance , completion of food records , quality of diet , and nutrition knowledge . We conclude that the provision of food to weight-loss patients is a promising methodology that deserves further exploration Context Some experts attribute a low incidence of heart disease in Mediterranean countries to dietary habits . Contribution In this multicenter , 3-group trial , investigators r and omly assigned 772 adults at high risk for cardiovascular disease to a low-fat diet or to a Mediterranean diet supplemented with either virgin olive oil ( 1 L per week ) or nuts ( 30 g per day ) . After 3 months , the Mediterranean diet groups had lower mean plasma glucose level , systolic blood pressure , and total cholesterolhigh-density lipoprotein cholesterol ratio than the low-fat diet group . Caution s The Mediterranean diet groups received more nutritional education than the low-fat diet group . Implication s Mediterranean diets supplemented with olive oil or nuts may improve cardiovascular risk factors . The Editors Cardiovascular disease is the main cause of death in industrialized countries , but incidence rates have marked geographic differences . The low incidence of coronary heart disease ( CHD ) in Mediterranean countries has been partly ascribed to dietary habits ( 1 - 3 ) . Recent findings from large European cohort studies ( 4 - 6 ) suggest that a high degree of adherence to the Mediterranean diet is associated with a reduction in mortality . In small clinical studies , the Mediterranean diet or some of its components have reduced blood pressure ( 7 ) and have improved lipid profiles ( 8 , 9 ) and endothelial function ( 10 ) . Moreover , a recent cross-sectional study ( 11 ) and a 2-year feeding trial ( 12 ) have shown that adherence to the Mediterranean diet is associated with reduced markers of vascular inflammation . These beneficial effects on surrogate markers of cardiovascular risk add biological plausibility to the epidemiologic evidence that supports a protective effect of the Mediterranean diet . Olive oil , a rich source of monounsaturated fatty acids , is a main component of the Mediterranean diet . Virgin olive oil retains all the lipophilic components of the fruit , -tocopherol , and phenolic compounds with strong antioxidant and anti-inflammatory properties ( 13 , 14 ) . Tree nuts , which are also typical in the Mediterranean diet , have a favorable fatty acid profile and are a rich source of nutrients and other bioactive compounds that may beneficially influence the risk for CHD , such as fiber , phytosterols , folic acid , and antioxidants ( 15 ) . Frequent nut intake has been associated with decreased CHD rates in prospect i ve studies ( 15 ) . Walnuts differ from all other nuts through their high content of polyunsaturated fatty acids , particularly -linolenic acid , a plant n-3 fatty acid ( 16 ) , which may confer additional antiatherogenic properties ( 17 ) . Therefore , we design ed a large-scale feeding trial in high-risk participants to assess the effects of 2 Mediterranean diets , one supplemented with virgin olive oil and the other supplemented with mixed nuts , compared with a low-fat diet on cardiovascular outcomes . We report the results of a 3-month intervention on intermediate markers of cardiovascular risk in the first 772 participants who were recruited into the trial . Supplement . Original Version ( PDF ) Methods Study Design The Prevencin con Dieta Mediterrnea ( PREDIMED ) Study is a large , parallel-group , multicenter , r and omized , controlled , 4-year clinical trial that aims to assess the effects of the Mediterranean diet on the primary prevention of cardiovascular disease ( www.predimed.org ) . An estimated 9000 high-risk participants ( > 5000 participants are already recruited ) will be assigned to 3 interventions : Mediterranean diet with virgin olive oil , Mediterranean diet with mixed nuts , or low-fat diet . The main outcome is an aggregate of cardiovascular events ( cardiovascular death , nonfatal myocardial infa rct ion , or nonfatal stroke ) . The anticipated completion date of the trial is December 2010 . We design ed our present study to assess the 3-month effects of the dietary interventions on surrogate markers of cardiovascular risk in participants entering the study during the first 6 months of recruitment . The institutional review boards of the 10 participating centers approved the study protocol . Participants and Recruitment From October 2003 to March 2004 , we selected 930 potential participants in primary care centers affiliated with 10 teaching hospitals across Spain . Eligible participants were community-dwelling men , 55 to 80 years of age , and women , 60 to 80 years of age , who fulfilled at least 1 of 2 criteria : type 2 diabetes or 3 or more CHD risk factors ( current smoking , hypertension [ blood pressure > 140/90 mm Hg or treatment with antihypertensive drugs ] , low-density lipoprotein [ LDL ] cholesterol level 4.14 
    Output:
    
Food supplementation appeared to result in greater weight loss in dietary trials .
Energy restrictions and intensity of interventions were other significant factors influencing weight loss