***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 / OBJECTIVE Very low-carbohydrate , high-fat ( LC ) diets are used for type 2 diabetes ( T2DM ) management , but their effects on psychological health remain largely unknown . This study examined the long-term effects of an LC diet on psychological health . METHODS One hundred and fifteen obese adults [ age : 58.5 ± 7.1 years ; body mass index : 34.6 ± 4.3 kg m(-2 ) ; HbA1c : 7.3 ± 1.1 % ] with T2DM were r and omized to consume either an energy-restricted ( ~6 to 7 MJ ) , planned isocaloric LC or high-carbohydrate , low-fat ( HC ) diet , combined with a supervised exercise programme ( 3 days week(-1 ) ) for 1 year . Body weight , psychological mood state and well-being [ Profile of Mood States ( POMS ) , Beck Depression Inventory ( BDI ) and Spielberger State Anxiety Inventory ( SAI ) ] and diabetes-specific emotional distress [ Problem Areas in Diabetes ( PAID ) Question naire ] and quality of life [ QoL Diabetes-39 ( D-39 ) ] were assessed . RESULTS Overall weight loss was 9.5 ± 0.5 kg ( mean ± SE ) , with no difference between groups ( P = 0.91 time × diet ) . Significant improvements occurred in BDI , POMS ( total mood disturbance and the six subscales of anger-hostility , confusion-bewilderment , depression-dejection , fatigue-inertia , vigour-activity and tension-anxiety ) , PAID ( total score ) and the D-39 dimensions of diabetes control , anxiety and worry , sexual functioning and energy and mobility , P < 0.05 time . SAI and the D-39 dimension of social burden remained unchanged ( P ≥ 0.08 time ) . Diet composition had no effect on the responses for the outcomes assessed ( P ≥ 0.22 time × diet ) . CONCLUSION In obese adults with T2DM , both diets achieved substantial weight loss and comparable improvements in QoL , mood state and affect . These results suggest that either an LC or HC diet within a lifestyle modification programme that includes exercise training improves psychological well-being OBJECTIVE To investigate the effects of weight loss diets on mood , food cravings , and other self-reported symptoms . RESEARCH METHODS AND PROCEDURES Mood and other symptoms were evaluated by participant self-report using the Atkins Health Indicator Test ( AHIT ) in individuals undergoing weight loss following either a low-carbohydrate , ketogenic diet ( LCKD ) or a low-fat diet ( LFD ) . Participants were 119 overweight community volunteers r and omized to an LCKD or an LFD . An additional 51 participants who had completed an earlier trial contributed data for the psychometric analyses but were not included in the prospect i ve analyses . Self-reported symptom levels on seven scales factor-analytically derived from the AHIT ( negative affect , fatigue , somatic symptoms , physical effects of hunger , insomnia , hunger , and stomach problems ) were acquired during 12 visits . RESULTS After adjusting for the change in BMI over the course of the trial , participants experienced significant improvements in most symptoms regardless of diet . Diet group x visit interactions were observed for negative affect [ F(9,803 ) = 2.30 , p = 0.015 ] and hunger [ F(9,803 ) = 3.62 , p < 0.0002 ] . Examination of means indicated that the LCKD group reported less negative affect and hunger , compared with the LFD group . DISCUSSION Regardless of diet , participants experienced significant improvement in a broad range of symptoms . Symptoms of negative affect and hunger improved to a greater degree in patients following an LCKD compared with those following an LFD . Whether these symptom changes explain the greater short-term weight loss generally experienced by LCKD followers deserves further research Objective To compare the effects of isocaloric , energy-restricted very low-carbohydrate ketogenic ( VLCK ) and low-fat ( LF ) diets on weight loss , body composition , trunk fat mass , and resting energy expenditure ( REE ) in overweight/obese men and women . Design R and omized , balanced , two diet period clinical intervention study . Subjects were prescribed two energy-restricted ( -500 kcal/day ) diets : a VLCK diet with a goal to decrease carbohydrate levels below 10 % of energy and induce ketosis and a LF diet with a goal similar to national recommendations ( % carbohydrate : fat : protein = ~60:25:15%).Subjects15 healthy , overweight/obese men ( mean ± s.e.m . : age 33.2 ± 2.9 y , body mass 109.1 ± 4.6 kg , body mass index 34.1 ± 1.1 kg/m2 ) and 13 premenopausal women ( age 34.0 ± 2.4 y , body mass 76.3 ± 3.6 kg , body mass index 29.6 ± 1.1 kg/m2 ) . Measurements Weight loss , body composition , trunk fat ( by dual-energy X-ray absorptiometry ) , and resting energy expenditure ( REE ) were determined at baseline and after each diet intervention . Data were analyzed for between group differences considering the first diet phase only and within group differences considering the response to both diets within each person . Results Actual nutrient intakes from food records during the VLCK ( % carbohydrate : fat : protein = ~9:63:28 % ) and the LF ( ~58:22:20 % ) were significantly different . Dietary energy was restricted , but was slightly higher during the VLCK ( 1855 kcal/day ) compared to the LF ( 1562 kcal/day ) diet for men . Both between and within group comparisons revealed a distinct advantage of a VLCK over a LF diet for weight loss , total fat loss , and trunk fat loss for men ( despite significantly greater energy intake ) . The majority of women also responded more favorably to the VLCK diet , especially in terms of trunk fat loss . The greater reduction in trunk fat was not merely due to the greater total fat loss , because the ratio of trunk fat/total fat was also significantly reduced during the VLCK diet in men and  women . Absolute REE ( kcal/day ) was decreased with both diets as expected , but REE expressed relative to body mass ( kcal/kg ) , was better maintained on the VLCK diet for men only . Individual responses clearly show the majority of men and women experience greater weight and fat loss on a VLCK than a LF diet . Conclusion This study shows a clear benefit of a VLCK over LF diet for short-term body weight and fat loss , especially in men . A preferential loss of fat in the trunk region with a VLCK diet is novel and potentially clinical ly significant but requires further validation . These data provide additional support for the concept of metabolic advantage with diets representing extremes in macronutrient distribution BACKGROUND The effects of a carbohydrate-restricted diet on weight loss and risk factors for atherosclerosis have been incompletely assessed . METHODS We r and omly assigned 132 severely obese subjects ( including 77 blacks and 23 women ) with a mean body-mass index of 43 and a high prevalence of diabetes ( 39 percent ) or the metabolic syndrome ( 43 percent ) to a carbohydrate-restricted ( low-carbohydrate ) diet or  a calorie- and fat-restricted ( low-fat ) diet . RESULTS Seventy-nine subjects completed the six-month study . An analysis including all subjects , with the last observation carried forward for those who dropped out , showed that subjects on the low-carbohydrate diet lost more weight than those on the low-fat diet ( mean [ + /-SD ] , -5.8+/-8.6 kg vs. -1.9+/-4.2 kg ; P=0.002 ) and had greater decreases in triglyceride levels ( mean , -20+/-43 percent vs. -4+/-31 percent ; P=0.001 ) , irrespective of the use or nonuse of hypoglycemic or lipid-lowering medications . Insulin sensitivity , measured only in subjects without diabetes , also improved more among subjects on the low-carbohydrate diet ( 6+/-9 percent vs. -3+/-8 percent , P=0.01 ) . The amount of weight lost ( P<0.001 ) and assignment to the low-carbohydrate diet ( P=0.01 ) were independent predictors of improvement in triglyceride levels and insulin sensitivity . CONCLUSIONS Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet , with a relative improvement in insulin sensitivity and triglyceride levels , even after adjustment for the amount of weight lost . This finding should be interpreted with caution , given the small magnitude of overall and between-group differences in weight loss in these markedly obese subjects and the short duration of the study . Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed BACKGROUND In the United States , obesity is a major clinical and public health problem causing diabetes , dyslipidemia , and hypertension , as well as increasing cardiovascular and total mortality . Dietary restrictions of calories and saturated fat are beneficial . However , it remains unclear whether replacement of saturated fat with carbohydrates ( as in the US National Cholesterol Education Program [ NCEP ] diet ) or protein and monounsaturated fat ( as in our isocaloric modified low-carbohydrate [ MLC ] diet , which is lower in total carbohydrates but higher in protein , monounsaturated fat , and complex carbohydrates ) is optimal . METHODS We r and omized 60 participants ( 29 women and 31 men ) to the NCEP or the MLC diet  and evaluated them every 2 weeks for 12 weeks . They were aged 28 to 71 years ( mean age , 44 years in the NCEP and 46 years in the MLC group ) . A total of 36 % of participants from the NCEP group and 35 % from the MLC group had a body mass index ( calculated as weight in kilograms divided by the square of height in meters ) greater than 27 . The primary end point was weight loss , and secondary end points were blood lipid levels and waist-to-hip ratio . RESULTS Weight loss was significantly greater in the MLC ( 13.6 lb ) than in the NCEP group ( 7.5 lb ) , a difference of 6.1 lb ( P = .02 ) . There were no significant differences between the groups for total , low density , and high-density lipoprotein cholesterol , triglycerides , or the proportion of small , dense low-density lipoprotein particles . There were significantly favorable changes in all lipid levels within the MLC but not within the NCEP group . Waist-to-hip ratio was not significantly reduced between the groups ( P = .27 ) , but it significantly decreased within the MLC group ( P = .009 ) . CONCLUSIONS Compared with the NCEP diet , the MLC diet , which is lower in total carbohydrates but higher in complex carbohydrates , protein , and monounsaturated fat , caused significantly greater weight loss over 12 weeks . There were no significant differences between the groups in blood lipid levels , but favorable changes were observed within the MLC diet group OBJECTIVE We examined the effects of an intensive lifestyle intervention ( ILI ) , compared with a diabetes support and education ( DSE ) control intervention , on long-term changes in depression symptoms , antidepressant medication ( ADM ) use , and health-related quality of life ( HRQoL ) in overweight/obese individuals with type 2 diabetes . RESEARCH DESIGN AND METHODS Look AHEAD was a multisite r and omized controlled trial of 5,145 overweight/obese participants assigned to ILI ( design ed to produce weight loss ) or DSE and followed for a median of 9.6 years .  The Beck Depression Inventory ( BDI ) was administered at baseline , annually at years 1–4 , and again at year 8 . Mean BDI scores and incidence of BDI scores ≥10 , indicative of likely mild or greater depression , were examined . Annually through year 10 , participants reported their ADM use and completed the Medical Outcomes Study Short Form 36 ( SF-36 ) question naire , which yields physical component summary ( PCS ) and mental component summary ( MCS ) scores . RESULTS ILI significantly reduced the incidence of mild or greater depression symptoms ( BDI scores ≥10 ) compared with DSE ( hazard ratio [ HR ] = 0.85 ; 95 % CI 0.75–0.97 ; P = 0.0145 ) . Although SF-36 PCS scores worsened over time in both groups , ILI participants reported better physical function  than DSE throughout the first 8 years ( all P values < 0.01 ) . There were no significant differences between treatment arms in the proportion of participants who used ADMs or in SF-36 MCS scores . CONCLUSIONS ILI for overweight/obese patients with type 2 diabetes may reduce the risk of developing clinical ly significant symptoms of depression and preserve physical HRQoL. These findings should be considered when evaluating the potential benefits of ILIs This study 
    Output:
    
RESULTS Eight r and omized controlled studies met the inclusion criteria , and their subsequent analysis revealed that improvements in psychological and social outcomes do occur during short- and long-term weight loss programmes , but that low-carbohydrate diets have no greater effect on psychosocial outcomes when compared to diets of different macronutrient composition at either short- or long-term follow-up ( one-year ) .
The short- and long-term improvements in psychosocial outcomes seen in patients undergoing weight-loss treatment appear to be independent of the macronutrient composition of their diet