***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: Objective Arterial stiffness is an independent predictor of cardiovascular morbidity and mortality . This study aim ed to compare the 7-week effect of a low-calorie diet ( LCD ) and an intensive lifestyle intervention program ( ILI ) on arterial stiffness in morbidly obese individuals . Design and Methods Nonr and omized clinical trial . The LCD provided 900 kcal/day , and participants in the LCD group were instructed to maintain their habitual physical activity level . The ILI included two 90-min supervised training sessions 3 days a week at moderate to high intensity ( 4 - 8 METs ) and a caloric restriction of 1000 kcal/day . Results A total of 179 individuals completed the study , 88 ( 56 women ) in the ILI group and 91 ( 57 women ) in the LCD group . High-fidelity applanation tonometry ( Millar ® , Sphygmocor ® ) was used to measure carotid-femoral pulse wave velocity ( PWV ) . After adjustment for relevant confounders , the ILI group had a significantly greater reduction in PWV than the LCD group ; −0.4 ( −0.6 , −0.1 ) m/s , P = 0.004 . When compared to the LCD group , the ILI group showed a larger reduction in systolic and diastolic blood pressure −5 ( −9 , −1 ) and −5 ( −7 , −2 ) mmHg , P = 0.038 and P ≤ 0.001 respectively , whereas no difference was observed regarding pulse pressure , P = 0.661 . No significant differences between groups were found regarding the loss of fat mass , P = 0.259 , but the loss of muscle mass was larger in the LCD group , 0.8 ( 0.5 , 1.1 ) kg , P ≤ 0.001 . Conclusion Despite the limitations of a nonr and omized design , our findings indicate that for morbidly obese individuals a moderate caloric restriction combined with aerobic physical exercise is associated with a greater decline in PWV than a LCD alone OBJECTIVE : Cardiovascular disease is strongly associated with obesity and there is evidence that weight loss has positive effects on cardiovascular disease risk . The aims of this study were to compare meal replacements ( MR ) with a conventional low-fat diet as weight loss strategies and to examine the effect of weight loss on flow-mediated dilatation ( FMD ) and other markers of endothelial function in overweight Australians with raised triglycerides ( TG ) ( > 2 mmol/l ) . RESEARCH METHODS : Subjects matched for age , gender , fasting plasma TG and body mass index were r and omized to two low- fat high- carbohydrate weight loss strategies ( both < 6000 kJ ) , one using MR and the other a structured eating plan , control ( C ) . Subjects followed both diets for 3 months . In total , 55 subjects completed the study .  FMD , pulse wave velocity and blood pressure ( BP ) were measured at baseline and at 3 months , as were fasting blood sample s for lipids , glucose , insulin , C reactive protein ( CRP ) and endothelium-derived factors . RESULTS : Mean weight loss was 6.3±3.7 kg ( 6.0±4.2 vs 6.63±3.35 kg , MR vs C ) with no difference between diet groups . TG , insulin , CRP , plasminogen activator inhibitor 1 ( PAI-1 ) and soluble intracellular adhesion molecule-1 ( sICAM1 ) fell after weight loss , but FMD did not change . Systolic BP fell by 8 mmHg and pulse wave velocity improved . DISCUSSION : In subjects with elevated TG , weight loss result ed in significant improvements in cardiovascular risk markers , particularly endothelium-derived factors ( PAI-1 and sICAM1 ) . However , FMD did not improve with weight loss BACKGROUND AND OBJECTIVES CKD is associated with poor  cardiorespiratory fitness ( CRF ) . This predefined sub study determined the effect of exercise training and lifestyle intervention on CRF and explored the effect on cardiovascular risk factors and cardiac and vascular function . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS Between February 2008 and March 2010 , 90 patients with stage 3 - 4 CKD were screened with an exercise stress echocardiogram before enrollment . Patients ( n=83 ) were r and omized to st and ard care ( control ) or lifestyle intervention .  The lifestyle intervention included multidisciplinary care ( CKD clinic ) , a lifestyle program , and aerobic and resistance exercise training for 12 months . CRF ( peak Vo2 ) , left ventricular function , arterial stiffness , anthropometric , and biochemical data were collected at baseline and 12 months . RESULTS Ten percent of r and omized patients had sub clinical myocardial ischemia at screening and completed the study without incident . There was no baseline difference among 72 patients who completed follow-up ( 36 in the lifestyle intervention group and 36 in the control group ) . The intervention increased peak Vo2 ( 2.8±0.7 ml/kg per minute versus -0.3±0.9 ml/kg per minute ; P=0.004 ) . There was small weight loss ( -1.8±4.2 kg versus 0.7±3.7 kg ; P=0.02 ) but no change in BP or lipids . Diastolic function improved ( increased e ' of 0.75±1.16 cm/s versus -0.47±1.0 cm/s ; P=0.001 ) but systolic function was well preserved and did not change . The change in arterial elastance was attenuated ( 0.11±0.76 mmHg/ml versus 0.76±0.96 mmHg/ml ; P=0.01 ) . Δ peak Vo2 was associated with group allocation and improved body composition . CONCLUSIONS Exercise training and lifestyle intervention in patients with CKD  produces improvements in CRF , body composition , and diastolic function We tested the hypothesis that weight loss via a hypocaloric diet would reduce arterial stiffness in overweight and obese middle-aged and older adults . Thirty-six individuals were r and omly assigned to a weight loss ( n=25 ; age : 61.2±0.8 years ; body mass index : 30.0±0.6 kg/m2 ) or a control ( n=11 ; age : 66.1±1.9 years ; body mass index : 31.8±1.4 kg/m2 ) group . Arterial stiffness was measured via carotid artery ultrasonography combined with applanation tonometry and carotid-femoral pulse wave velocity via applanation tonometry at baseline and after the 12-week intervention . Body weight , body fat , abdominal adiposity , blood pressure , & bgr;-stiffness index , and carotid-femoral pulse wave velocity were similar in the 2 groups at baseline ( all P>0.05 ) . Body weight ( −7.1±0.7 versus −0.7±1.1 kg ) , body fat , and abdominal adiposity decreased in the weight loss group but not in the control group ( all P<0.05 ) . Brachial systolic and diastolic blood pressures declined ( P<0.05 ) only in the weight loss group . Central systolic and pulse pressures did not change significantly in either group . & bgr;-Stiffness index ( −1.24±0.22 versus 0.52±0.37 U ) and carotid-femoral pulse wave velocity ( −187±29 versus 15±42 cm/s ) decreased in the weight loss group but not in the control group ( all P<0.05 ) . The reductions in carotid-femoral pulse wave velocity were correlated with reductions in total body and abdominal adiposity ( r=0.357–0.602 ; all P<0.05 ) . However , neither total body nor abdominal adiposity independently predicted reductions in arterial stiffness indices . In summary , our findings indicate that weight loss reduces arterial stiffness in overweight/obese middle-aged and older adults , and the magnitudes of these improvements are related to the loss of total and abdominal adiposity Our aim was to determine whether short-term weight loss on a low-carbohydrate/low-saturated fat diet improved endothelial function compared with a conventional high-carbohydrate diet , as this diet is expected to lower both blood glucose and LDL-cholesterol . In a r and omised parallel design of two energy-restricted diets in an outpatient setting , thirty-six subjects ( BMI 33 ( sem 4 ) kg/m2 ) were r and omised to a low- or high-carbohydrate diet both low in saturated fat .  Flow-mediated dilatation ( FMD ) , fasting glucose , insulin , lipids , adiponectin and adhesion molecules were measured at baseline , during weight loss and at 52 weeks . FMD did not change with either diet ( 5.2 ( sem 0.6 ) to 5.5 ( sem 0.6 ) % ) despite weight loss of 5 % and significant reductions in glucose and insulin and LDL-cholesterol and was not different after sustained weight loss of 5 % at 52 weeks . Adiponectin fell by 6 % at 12 weeks ( P = 0.1 ) with weight loss but rose by 17 % at 12 months ( P < 0.05 ) with 5 % weight loss . There were no effects of diet . In contradistinction , adhesion molecules fell at 12 weeks , vascular cell adhesion molecule-1 by 14 % and intracellular adhesion molecule-1 by 13 % ( both P < 0.05 ) . There were correlations between change in adiponectin at 12 months and change in HDL ( r 0.778 , P < 0.01 ) and glucose ( r - 0.563 , P = 0.057 ) . In summary , weight loss does not improve FMD . Novel cardiovascular risk factors improved at 12 weeks but the improvement in adiponectin was delayed BACKGROUND Although the DASH ( Dietary Approaches to Stop Hypertension ) diet has been shown to lower blood pressure ( BP ) in short-term feeding studies , it has not been shown to lower BP among free-living individuals , nor has it been shown to alter cardiovascular biomarkers of risk . OBJECTIVE To compare the DASH diet alone or combined with a weight management program with usual diet controls among participants with prehypertension or stage 1 hypertension ( systolic BP , 130 - 159 mm Hg ; or diastolic BP , 85 - 99 mm Hg ) . DESIGN AND SETTING R and omized , controlled trial in a tertiary care medical center with assessment s at baseline and 4 months . Enrollment began October 29 , 2003 , and ended July 28 , 2008 . PARTICIPANTS Overweight or obese , unmedicated out patients with high BP ( N = 144 ) . INTERVENTIONS Usual diet controls , DASH diet alone , and DASH diet plus weight management . OUTCOME MEASURES The main outcome measure is BP measured in the clinic and by ambulatory BP monitoring . Secondary outcomes included pulse wave velocity , flow-mediated dilation of the brachial artery , baroreflex sensitivity , and left ventricular mass . RESULTS Clinic-measured BP was reduced by 16.1/9.9 mm Hg ( DASH plus weight management ) ; 11.2/7.5 mm ( DASH alone ) ; and 3.4/3.8 mm ( usual diet controls ) ( P < .001 ) . A similar pattern was observed for ambulatory BP ( P < .05 ) . Greater improvement was noted for DASH plus weight management compared with DASH alone for pulse wave velocity , baroreflex sensitivity , and left ventricular mass ( all P < .05 ) . CONCLUSION For overweight or obese persons with above-normal BP , the addition of exercise and weight loss to the DASH diet result ed in even larger BP reductions , greater improvements in vascular and autonomic function , and reduced left ventricular mass . CLINICAL TRIAL REGISTRATION clinical trials.gov Identifier : NCT00571844 National and international policy-making organizations advocate nonpharmacologic therapies to reduce blood pressure ( BP ) . However , data to support such recommendations in older persons are virtually nonexistent . The Trials of Nonpharmacologic Intervention in the Elderly ( TONE ) is a r and omized , controlled trial that will test whether weight loss or a reduced sodium ( Na ) intake or both can maintain satisfactory BP control , without unacceptable side effects , after withdrawal of antihypertensive drug therapy . Medication-treated hypertensives ( aged 60 to 80 years ) with a systolic BP less than 145 mm Hg and a diastolic BP less than 85 mm Hg who are taking one antihypertensive medication are r and omly assigned to one of four groups : ( 1 ) weight loss alone , ( 2 ) reduced Na intake alone , ( 3 ) combined weight loss and reduced Na intake , or ( 4 ) usual life-style ( control group ) .  Overweight participants are r and omized to one of these four groups , while nonoverweight individuals are assigned to either the reduced Na intake or 
    Output:
    
Modest weight loss ( mean 8 % of initial body weight ) achieved with diet and lifestyle measures improved PWV .