***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: This study examined the effects of aerobic exercise without weight loss , a hypocaloric high monounsaturated fat diet , and diet plus exercise ( D+E ) on total abdominal and visceral fat loss in obese postmenopausal women with type 2 diabetes . Thirty-three postmenopausal women ( body mass index , 34.6 + /- 1.9 kg/m(2 ) ) were assigned to one of three interventions : a hypocaloric high monounsaturated fat diet alone , exercise alone ( EX ) , and D+E for 14 wk . Aerobic capacity , body composition , abdominal fat distribution ( magnetic resonance imaging ) , glucose tolerance , and insulin sensitivity were measured pre- and postintervention . Body weight ( approximately 4.5 kg ) and percent body fat ( approximately 5 % ) were decreased ( P < 0.05 ) with the D and D+E intervention , whereas only percent body fat ( approximately 2.3 % ) decreased with EX . Total abdominal fat and sc adipose tissue ( SAT ) were reduced with the D and D+E interventions ( P < 0.05 ) , whereas visceral adipose tissue ( VAT ) decreased with the D+E and EX intervention , but not with the D intervention . EX result ed in a reduction in total abdominal fat , VAT , and SAT ( P < 0.05 ) despite the lack of weight loss . The reductions in total abdominal fat and SAT explained 32.7 % and 9.7 % , respectively , of the variability in the changes in fasting glucose levels , whereas the reductions in VAT explained 15.9 % of the changes in fasting insulin levels ( P < 0.05 ) . In conclusion , modest weight loss , through either D or D+E , result ed in similar improvements in total abdominal fat , SAT , and glycemic status in postmenopausal women with type 2 diabetes ; however , the addition of exercise to diet is necessary for VAT loss . These data demonstrate the importance of exercise in the treatment of women with type 2 diabetes Background —C-reactive protein ( CRP ) has been proposed as an independent risk factor for cardiovascular disease and has been positively associated with body weight and body fatness . We examined the hypothesis that weight loss would reduce plasma CRP levels in obese postmenopausal women . Methods and Results —In a sample of 61 obese ( body mass index , 35.6±5.0 kg/m2 ) , postmenopausal women ( age , 56.4±5.2 years ) , we found that plasma CRP levels were positively associated with dual x-ray absorptiometry – measured total body fatness ( r = 0.36 , P < 0.005 ) and CT-measured intra-abdominal body fat area ( r = 0.30 , P < 0.02 ) . Significant correlations were also found between plasma CRP and triglyceride levels ( r = 0.33 , P < 0.009 ) and glucose disposal measured by the hyperinsulinemic-euglycemic clamp technique ( r = −0.29 , P < 0.03 ) . Twenty-five of the 61 women tested at baseline completed a weight loss protocol .  The average weight loss was 14.5±6.2 kg ( −15.6 % , P < 0.0001 ) , with losses of 10.4±5.4 kg fat mass ( −25.0 % , P < 0.0001 ) and 2.8±1.4 kg fat-free mass ( −6.0 % , P < 0.0001 ) . Visceral and subcutaneous fat areas were reduced by −36.4 % and −23.7 % , respectively ( P < 0.0001 ) . Plasma CRP levels were significantly reduced by weight loss : average −32.3 % , from 3.06 ( + 0.69 , −1.29 ) to 1.63 ( + 0.70 , −0.75 ) & mgr;g/mL ( P < 0.0001 , medians and interquartile differences ) . Changes in body weight and in total body fat mass were both positively associated with plasma CRP level reductions . Conclusions —Adiposity was a significant predictor of plasma CRP in postmenopausal women on a cross-sectional basis . Moreover , caloric restriction – induced weight loss decreased plasma CRP levels . Weight loss may represent an important intervention to reduce CRP levels , which may mediate part of its cardioprotective effects in obese postmenopausal women The effects of energy restriction ( diet ) in combination with either aerobic ( DA ) or resistance exercise ( DR ) on adipose tissue ( AT ) distribution were evaluated in 24 obese women ( DA , n = 10 ; DR , n = 14 ) . AT distribution was measured by magnetic resonance imaging ( MRI ) . Comparison between groups demonstrated that the relative losses observed for body weight , subcutaneous AT ( SAT ) , and visceral AT ( VAT ) volume were not significantly different ( P > 0.05 ) . A significant reduction in the volume ratio of VAT to SAT was observed for both groups ( P < 0.01 ) . Comparison of arm , abdomen and torso , and lower-body regions revealed that the regional mobilization of SAT was not significantly different between groups ( P > 0.05 ) and that for both groups there was a preferential mobilization of SAT from the abdominal region ( P < 0.05 ) . Within the VAT depot , significant reductions were observed for both intraperitoneal and extraperitoneal AT ( P < 0.01 ) . These findings suggest that the combination of moderate energy restriction and either resistance or aerobic exercise induces significant reductions in VAT and SAT , with a preferential loss of VAT , and are thus effective means of reducing total and upper-body obesity in obese women BACKGROUND Dietary fat has been reported to influence insulin sensitivity . OBJECTIVE The objective of the study was to determine how identical weight loss ( target : loss of 8 % of body weight over 3 - 6 mo ) in women taking orlistat or placebo combined with a hypocaloric diet influences body composition and insulin sensitivity . DESIGN Forty-seven obese women [ body mass index ( in kg/m(2 ) ) : 32.1 + /- 0.4 ] were r and omly assigned to receive either orlistat ( 120 mg 3 times daily ; n = 23 ) or placebo ( n = 24 ) with a hypocaloric diet .  Whole-body insulin sensitivity ( insulin clamp technique ) , serum fatty acids , and body composition ( magnetic resonance imaging ) were measured before and after weight loss . RESULTS The groups did not differ significantly at baseline with respect to age , body weight , intraabdominal and subcutaneous fat volumes , or insulin sensitivity . Weight loss did not differ significantly between the orlistat ( 7.3 + /- 0.2 kg , or 8.3 + /- 0.1 % ) and placebo ( 7.4 + /- 0.2 kg , or 8.2 + /- 0.1 % ) groups . Insulin sensitivity improved significantly ( P < 0.001 ) and similarly after weight loss in the orlistat ( from 4.0 + /- 0.3 to 5.1 + /- 0.3 mg x kg fat-free mass(-1 ) x min(-1 ) ) and placebo ( from 4.4 + /- 0.4 to 5.4 + /- 0.4 mg x kg fat-free mass(-1 ) x min(-1 ) ) groups . Intraabdominal fat and subcutaneous fat decreased significantly in both groups , but the ratio of the 2 decreased significantly only in the orlistat group . The proportion of dihomo-gamma-linolenic acid ( 20:3n-6 ) in serum phospholipids was inversely related to insulin sensitivity both before ( r = -0.48 , P < 0.001 ) and after ( r = -0.46 , P < 0.001 ) weight loss , but it did not change significantly in either group . CONCLUSIONS Weight loss rather than inhibition of fat absorption enhances insulin sensitivity . A decrease in fat absorption by orlistat appears to favorably influence the ratio between intraabdominal and subcutaneous fat , which suggests that exogenous fat or its composition influences fat distribution OBJECTIVE Moderate weight loss is recommended for overweight and obese patients with type 2 diabetes , and conjunctive use of weight loss medication has been advocated . The current study examined weight loss-dependent and -independent effects of the intestinal lipase inhibitor orlistat at 6 months of treatment , using behavioral intervention ( Int ) combined with r and omized , double-blinded , placebo (P)-controlled treatment with orlistat ( O ) . RESEARCH DESIGN AND METHODS Metabolic control , insulin sensitivity ( IS ) , regional fat distribution , and fat content in liver and muscle were measured in 39 volunteers with type 2 diabetes in whom all antidiabetic medication was withdrawn 1 month preceding r and omization .  Weight loss was equivalent in the Int+O and Int+P groups , respectively ( -10.3 + /- 1.3 vs. -8.9 + /- 1.1 % ) , and there were identical decreases in visceral adipose tissue ( VAT ) , fat mass ( FM ) , thigh adiposity , and hepatic steatosis . RESULTS Weight loss result ed in substantial improvement ( P < 0.001 ) in HbA(1c ) ( -1.6 + /- 0.3 vs. -1.0 + /- 0.4 % ; NS between groups ) . IS improved significantly more with orlistat ( Delta2.2 + /- 0.4 vs. Delta1.2 + /- 0.4 mg . min(-1 ) . kg(-1 ) fat-free mass [ FFM ] ; P < 0.05 ) , and plasma free fatty acid ( FFA ) levels were strongly correlated with IS ( r = 0.56 ; P < 0.001 ) . Orlistat caused greater reductions in fasting plasma FFA ( Delta-154 + /- 22 vs. Delta-51 + /- 33 micro mol/l ; P < 0.05 ) , insulin-suppressed FFA ( Delta-119 + /- 23 vs. Delta-87 + /- 34 micro mol/l ; P < 0.05 ) , and fasting plasma glucose ( FPG ; -62 + /- 9 vs. -32 + /- 8 mg/dl ; P = 0.02 ) . Changes in HbA(1c ) were correlated with DeltaIS ( r = -0.41 ; P < 0.01 ) but not with weight loss per se . CONCLUSIONS At equivalent weight loss , conjunctive use of orlistat result ed in greater improvement in FFA levels and IS Abdominal obesity and hyperinsulinemia play a key role in the development of the polycystic ovary syndrome ( PCOS ) . Dietary-induced weight loss and the administration of insulin-lowering drugs , such as metformin , are usually followed by improved hyper and rogenism and related clinical abnormalities . This study was carried out to evaluate the effects of combined hypocaloric diet and metformin on body weight , fat distribution , the glucose-insulin system , and hormones in a group of 20 obese PCOS women [ body mass index ( BMI ) > 28 kg/m2 ] with the abdominal phenotype ( waist to hip ratio > 0.80 ) , and an appropriate control group of 20 obese women who were comparable for age and pattern of body fat distribution but without PCOS . At baseline , we measured sex hormone , sex hormone-binding globulin ( SHBG ) , and leptin blood concentrations and performed an oral glucose tolerance test and computerized tomography ( CT ) at the L4-L5 level , to measure sc adipose tissue area ( SAT ) and visceral adipose tissue area . All women were then given a low-calorie diet ( 1,200 - 1,400 kcal/day ) alone for one month , after which anthropometric parameters and CT scan were newly measured . While continuing dietary treatment , PCOS women and obese controls were subsequently placed , in a r and om order , on metformin ( 850 mg/os , twice daily ) ( 12 and 8 , respectively ) or placebo ( 8 and 12 , respectively ) , according to a double-blind design , for the following 6 months . Blood tests and the CT scan were performed in each woman at the end of the study while they were still on treatment . During the treatment period , 3 women of the control group ( all treated with placebo ) were excluded because of noncompliance ; and 2 PCOS women , both treated with metformin , were also excluded because they became pregnant . Therefore , the women cohort available for final statistical analysis included 18 PCOS ( 10 treated with metformin and 8 with placebo ) and 17 control women ( 8 treated with metformin and 9 with placebo )  . The treatment was well tolerated . In the PCOS group , metformin therapy improved hirsutism and menstrual cycles significantly more than placebo .  Baseline anthropometric and CT parameters were similar in all groups . Hypocaloric dieting for 1 month similarly reduced BMI values and the waist circumference in both PCOS and control groups , without any significant effect on CT scan parameters . In both PCOS and control women , however , metformin treatment reduced body weight and BMI significantly more than placebo . Changes in the waist-to-hip ratio values were similar in PCOS women and controls , regardless of pharmacological treatment . Metformin treatment significantly decreased SAT values in both PCOS and control groups , although only in the latter group 
    Output:
    
Modest weight loss generated preferential loss of VAT , but with greater weight loss this effect was attenuated .
The method of weight loss was not an influence with one exception .
Very-low-calorie diets ( VLCDs ) provided exceptional short-term ( < 4 weeks ) preferential VAT loss .
Conclusions : Visceral adipose tissue is lost preferentially with modest weight loss , but the effect is attenuated with greater weight loss .
Acute caloric restriction , using VLCD , produces early preferential loss of VAT .
These observations may help to explain the metabolic benefits of modest weight loss