human
***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 Video game playing has been linked to obesity in many observational studies . However , the influence of this sedentary activity on food intake is unknown . OBJECTIVE The objective was to examine the acute effects of sedentary video game play on various components of energy balance . DESIGN With the use of a r and omized crossover design , 22 healthy , normal-weight , male adolescents ( mean ± SD age : 16.7 ± 1.1 y ) completed two 1-h experimental conditions , namely video game play and rest in a sitting position , followed by an ad libitum lunch . The endpoints were spontaneous food intake , energy expenditure , stress markers , appetite sensations , and profiles of appetite-related hormones . RESULTS Heart rate , systolic and diastolic blood pressures , sympathetic tone , and mental workload were significantly higher during the video game play condition than during the resting condition ( P < 0.05 ) . Although energy expenditure was significantly higher during video game play than during rest ( mean increase over resting : 89 kJ ; P < 0.01 ) , ad libitum energy intake  after video game play exceeded that measured after rest by 335 kJ ( P < 0.05 ) . A daily energy surplus of 682 kJ ( 163 kcal ) over resting ( P < 0.01 ) was observed in the video game play condition . The increase in food intake  associated with video game play was observed without increased sensations of hunger and was not compensated for during the rest of the day . Finally , the profiles of glucose , insulin , cortisol , and ghrelin did not suggest an up-regulation of appetite during the video game play condition . CONCLUSION A single session of video game play in healthy male adolescents is associated with an increased food intake , regardless of appetite sensations . The trial was registered at clinical trials.gov as NCT01013246 BACKGROUND Television watching and playing of video games ( VGs ) are associated with higher energy intakes . Motion-controlled video games ( MC ) may be a healthier alternative to sedentary screen-based activities because of higher energy expenditures , but little is known about the effects of these games on energy intakes . OBJECTIVE Energy intake , expenditure , and surplus ( intake - expenditure ) were compared during sedentary ( television and VG ) and active ( MC ) screen-time use . DESIGN Young adults ( n = 120 ; 60 women ) were r and omly assigned to the following 3 groups : television watching , playing traditional VGs , or playing MCs for 1 h while snacks and beverages were provided .  Energy intakes , energy expenditures , and appetites were measured . RESULTS Intakes across these 3 groups showed a trend toward a significant difference ( P = 0.065 ) . The energy expenditure ( P < 0.001 ) was higher , and the energy surplus ( P = 0.038 ) was lower , in MC than in television or VG groups . All conditions produced a mean ( ±SD ) energy surplus as follows : 638 ± 408 kcal in television , 655 ± 533 kcal in VG , and 376 ± 487 kcal in MC groups . The OR for consuming ≥500 kcal in the television compared with the MC group was 3.2 ( 95 % CI : 1.2 , 8.4 ) . Secondary analyses , in which the 2 sedentary conditions were collapsed , showed an intake that was 178 kcal ( 95 % CI : 8 , 349 kcal ) lower in the MC condition than in the sedentary groups ( television and VG ) . CONCLUSION MCs may be a healthier alternative to sedentary screen time because of a lower energy surplus , but the playing of these games still result ed in a positive energy balance . This trial was registered at clinical trials.gov as NCT01523795 Observational longitudinal research is particularly useful for assessing etiology and prognosis and for providing evidence for clinical decision making . However , there are no structured reporting requirements for studies of this design to assist authors , editors , and readers . The authors developed and tested a checklist of criteria related to threats to the internal and external validity of observational longitudinal studies . The checklist criteria concerned recruitment , data collection , biases , and data analysis and descriptive issues relevant to study rationale , study population , and generalizability . Two raters independently assessed 49 r and omly selected articles describing stroke research published from 1999 to 2003 in six journals : American Journal of Epidemiology , Journal of Epidemiology and Community Health , Stroke , Annals of Neurology , Archives of Physical Medicine and Rehabilitation , and American Journal of Physical Medicine and Rehabilitation . On average , 17 of the 33 checklist criteria were reported . Criteria describing the study design were better reported than those related to internal validity . No relation was found between study type ( etiologic or prognostic ) or word count and quality of reporting . A flow diagram for summarizing participant flow through a study was developed . Editors and authors should consider using a checklist and flow diagram when reporting on observational longitudinal research BACKGROUND The rising prevalence of obesity in children has been linked in part to the consumption of sugar-sweetened drinks . Our aim was to examine this relation . METHODS We enrolled 548 ethnically diverse schoolchildren ( age 11.7 years , SD 0.8 ) from public schools in four Massachusetts communities , and studied them prospect ively for 19 months from October , 1995 , to May , 1997 . We examined the association between baseline and change in consumption of sugar-sweetened drinks ( the independent variables ) , and difference in measures of obesity , with linear and logistic regression analyses adjusted for potentially confounding variables and clustering of results within schools . FINDINGS For each additional serving of sugar-sweetened drink consumed , both body mass index ( BMI ) ( mean 0.24 kg/m2 ; 95 % CI 0.10 - 0.39 ; p=0.03 ) and frequency of obesity ( odds ratio 1.60 ; 95 % CI 1.14 - 2.24 ; p=0.02 ) increased after adjustment for anthropometric , demographic , dietary , and lifestyle variables . Baseline consumption of sugar-sweetened drinks was also independently associated with change in BMI ( mean 0.18 kg/m2 for each daily serving ; 95 % CI 0.09 - 0.27 ; p=0.02 ) . INTERPRETATION Consumption of sugar-sweetened drinks is associated with obesity in children OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Background The increasing rate of obesity among Kuwaiti adolescents is associated with immediate and long term-risks to their health and well-being . Objective To up date data on the prevalence of overweight and obesity among Kuwaiti adolescents and to examine the relative contribution of selected lifestyle factors to overweight and obesity in this population . Methods The present study is part of the Arab Teens Lifestyle Study ( ATLS ) . A total of 906 adolescents ( 463 boys and 443 girls ) aged between 14 and 19 years were selected from Kuwaiti schools by a multistage stratified r and omization process . A vali date d question naire was used to collect data on  physical activity , sedentary lifestyle , and eating habits . The International Obesity Task Force ( IOTF ) cutoff values for adolescents under 18 years of age were used to define overweight and obesity . Total energy expenditure was calculated using metabolic equivalent-minutes per week . A general linear model was used to establish the proportion of the variance ( expressed in partial eta squared ) in excess weight attributable to differences in eating habits and physical activity . Results The prevalence of overweight and obesity was 50.5 % in boys and 46.5 % in girls . Among boys , moderate and vigorous activities were found to be significantly negatively associated with overweight and obesity ( p < .05 ) , whereas in girls , only those with not less than moderate activities were negatively associated with overweight and obesity ( p < .05 ) . Sedentary behaviors , time spent watching television , and time spent working on the computer were not significantly associated with obesity in either sex . Consumption of breakfast , vegetables , and fast foods ( boys and girls ) and potatoes , cakes and doughnuts , and sweets ( girls only ) was significantly associated with overweight and obesity ( p < .05 ) . In general , the partial eta square explained by physical activity was less than 3.6 % in boys compared with less than 1.0 % in girls , and eating habits explained less than 1.8 % in boys compared with 2.5 % in girls . Conclusions Physical activity explains a greater proportion of variation in body mass index than do eating habits , particularly in boys . Eating habits explain a greater proportion of variation in body mass index than does physical activity in girls . Prospect i ve studies are needed to clarify the relative effects of sedentary behaviors on overweight in adolescents PURPOSE This study aim ed to establish whether time spent in sport-related physical activities and sedentary behaviors ( e.g. , TV viewing , videogame usage , and homework ) was prospect ively associated with change in blood pressure ( BP ) for 5 yr . METHODS Eight hundred and twenty-one students age 6 yr at baseline ( 397 girls and 424 boys ) were examined from 2003 - 2004 to 2009 - 2011 . Children completed detailed activity question naires . BP was measured using a st and ardized protocol . RESULTS After adjusting for age , ethnicity , parental education , parental history of hypertension , baseline height , BP , body mass index ( BMI ) , baseline time spent in corresponding activity behavior , and change in BMI , each hour per day spent in total screen time was associated with a 0.69 and 0.59 mm Hg increase in diastolic BP ( P = 0.01 ) and mean arterial BP ( P = 0.01 ) , respectively . In boys , each hour per day spent in TV viewing was associated with a concurrent 1.42-mm Hg increase in diastolic BP ( P = 0.04 ) during the 5 yr . Children engaging in low sport-related physical activities at baseline but who engaged in high levels of physical activity ( ≥ 60 min · d(-1 ) ) at follow-up ( n = 154 ) compared with those engaging in low sport-related physical activities at both examinations ( n = 305 ) demonstrated significantly lower mean arterial BP , 7.26 versus 9.61 mm Hg ( P = 0.04 ) . CONCLUSIONS Time spent in physical activity and screen time could influence BP measures during childhood OBJECTIVES To explore the association between electronic media exposure ( television viewing time , personal computer/video game use , total screen time ) , and waist circumference and body mass index , and study whether this association is independent of cardiorespiratory fitness , in a representative sample of adolescents from Montería , Colombia . DESIGN Cross-sectional study analyzing data from 546 students aged 11 - 18 years , from fourteen r and omly selected schools .  Z-scores for WC and BMI were calculated . METHODS The physical activity module of the Global School Health Survey 2007 was used to determine EME , and the shuttle run test was used to assess CRF . Linear regression models adjusted by age , school location , physical activity level , type of institution ( public or private ) , consumption of sweetened beverages , fast food , and fried food were used . RESULTS Among boys , independently of cardiorespiratory fitness , high television viewing time ( ≥ 2 h/day ) ( β=+0.22 
    Output:
    
agent
No significant associations between screen time with blood pressure and cholesterol were reported .
Sedentary behaviour appears to be associated with  adiposity in adolescents , irrespective of dietary intake .
***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 Video game playing has been linked to obesity in many observational studies . However , the influence of this sedentary activity on food intake is unknown . OBJECTIVE The objective was to examine the acute effects of sedentary video game play on various components of energy balance . DESIGN With the use of a r and omized crossover design , 22 healthy , normal-weight , male adolescents ( mean ± SD age : 16.7 ± 1.1 y ) completed two 1-h experimental conditions , namely video game play and rest in a sitting position , followed by an ad libitum lunch . The endpoints were spontaneous food intake , energy expenditure , stress markers , appetite sensations , and profiles of appetite-related hormones . RESULTS Heart rate , systolic and diastolic blood pressures , sympathetic tone , and mental workload were significantly higher during the video game play condition than during the resting condition ( P < 0.05 ) . Although energy expenditure was significantly higher during video game play than during rest ( mean increase over resting : 89 kJ ; P < 0.01 ) , ad libitum energy intake  after video game play exceeded that measured after rest by 335 kJ ( P < 0.05 ) . A daily energy surplus of 682 kJ ( 163 kcal ) over resting ( P < 0.01 ) was observed in the video game play condition . The increase in food intake  associated with video game play was observed without increased sensations of hunger and was not compensated for during the rest of the day . Finally , the profiles of glucose , insulin , cortisol , and ghrelin did not suggest an up-regulation of appetite during the video game play condition . CONCLUSION A single session of video game play in healthy male adolescents is associated with an increased food intake , regardless of appetite sensations . The trial was registered at clinical trials.gov as NCT01013246 BACKGROUND Television watching and playing of video games ( VGs ) are associated with higher energy intakes . Motion-controlled video games ( MC ) may be a healthier alternative to sedentary screen-based activities because of higher energy expenditures , but little is known about the effects of these games on energy intakes . OBJECTIVE Energy intake , expenditure , and surplus ( intake - expenditure ) were compared during sedentary ( television and VG ) and active ( MC ) screen-time use . DESIGN Young adults ( n = 120 ; 60 women ) were r and omly assigned to the following 3 groups : television watching , playing traditional VGs , or playing MCs for 1 h while snacks and beverages were provided .  Energy intakes , energy expenditures , and appetites were measured . RESULTS Intakes across these 3 groups showed a trend toward a significant difference ( P = 0.065 ) . The energy expenditure ( P < 0.001 ) was higher , and the energy surplus ( P = 0.038 ) was lower , in MC than in television or VG groups . All conditions produced a mean ( ±SD ) energy surplus as follows : 638 ± 408 kcal in television , 655 ± 533 kcal in VG , and 376 ± 487 kcal in MC groups . The OR for consuming ≥500 kcal in the television compared with the MC group was 3.2 ( 95 % CI : 1.2 , 8.4 ) . Secondary analyses , in which the 2 sedentary conditions were collapsed , showed an intake that was 178 kcal ( 95 % CI : 8 , 349 kcal ) lower in the MC condition than in the sedentary groups ( television and VG ) . CONCLUSION MCs may be a healthier alternative to sedentary screen time because of a lower energy surplus , but the playing of these games still result ed in a positive energy balance . This trial was registered at clinical trials.gov as NCT01523795 Observational longitudinal research is particularly useful for assessing etiology and prognosis and for providing evidence for clinical decision making . However , there are no structured reporting requirements for studies of this design to assist authors , editors , and readers . The authors developed and tested a checklist of criteria related to threats to the internal and external validity of observational longitudinal studies . The checklist criteria concerned recruitment , data collection , biases , and data analysis and descriptive issues relevant to study rationale , study population , and generalizability . Two raters independently assessed 49 r and omly selected articles describing stroke research published from 1999 to 2003 in six journals : American Journal of Epidemiology , Journal of Epidemiology and Community Health , Stroke , Annals of Neurology , Archives of Physical Medicine and Rehabilitation , and American Journal of Physical Medicine and Rehabilitation . On average , 17 of the 33 checklist criteria were reported . Criteria describing the study design were better reported than those related to internal validity . No relation was found between study type ( etiologic or prognostic ) or word count and quality of reporting . A flow diagram for summarizing participant flow through a study was developed . Editors and authors should consider using a checklist and flow diagram when reporting on observational longitudinal research BACKGROUND The rising prevalence of obesity in children has been linked in part to the consumption of sugar-sweetened drinks . Our aim was to examine this relation . METHODS We enrolled 548 ethnically diverse schoolchildren ( age 11.7 years , SD 0.8 ) from public schools in four Massachusetts communities , and studied them prospect ively for 19 months from October , 1995 , to May , 1997 . We examined the association between baseline and change in consumption of sugar-sweetened drinks ( the independent variables ) , and difference in measures of obesity , with linear and logistic regression analyses adjusted for potentially confounding variables and clustering of results within schools . FINDINGS For each additional serving of sugar-sweetened drink consumed , both body mass index ( BMI ) ( mean 0.24 kg/m2 ; 95 % CI 0.10 - 0.39 ; p=0.03 ) and frequency of obesity ( odds ratio 1.60 ; 95 % CI 1.14 - 2.24 ; p=0.02 ) increased after adjustment for anthropometric , demographic , dietary , and lifestyle variables . Baseline consumption of sugar-sweetened drinks was also independently associated with change in BMI ( mean 0.18 kg/m2 for each daily serving ; 95 % CI 0.09 - 0.27 ; p=0.02 ) . INTERPRETATION Consumption of sugar-sweetened drinks is associated with obesity in children OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Background The increasing rate of obesity among Kuwaiti adolescents is associated with immediate and long term-risks to their health and well-being . Objective To up date data on the prevalence of overweight and obesity among Kuwaiti adolescents and to examine the relative contribution of selected lifestyle factors to overweight and obesity in this population . Methods The present study is part of the Arab Teens Lifestyle Study ( ATLS ) . A total of 906 adolescents ( 463 boys and 443 girls ) aged between 14 and 19 years were selected from Kuwaiti schools by a multistage stratified r and omization process . A vali date d question naire was used to collect data on  physical activity , sedentary lifestyle , and eating habits . The International Obesity Task Force ( IOTF ) cutoff values for adolescents under 18 years of age were used to define overweight and obesity . Total energy expenditure was calculated using metabolic equivalent-minutes per week . A general linear model was used to establish the proportion of the variance ( expressed in partial eta squared ) in excess weight attributable to differences in eating habits and physical activity . Results The prevalence of overweight and obesity was 50.5 % in boys and 46.5 % in girls . Among boys , moderate and vigorous activities were found to be significantly negatively associated with overweight and obesity ( p < .05 ) , whereas in girls , only those with not less than moderate activities were negatively associated with overweight and obesity ( p < .05 ) . Sedentary behaviors , time spent watching television , and time spent working on the computer were not significantly associated with obesity in either sex . Consumption of breakfast , vegetables , and fast foods ( boys and girls ) and potatoes , cakes and doughnuts , and sweets ( girls only ) was significantly associated with overweight and obesity ( p < .05 ) . In general , the partial eta square explained by physical activity was less than 3.6 % in boys compared with less than 1.0 % in girls , and eating habits explained less than 1.8 % in boys compared with 2.5 % in girls . Conclusions Physical activity explains a greater proportion of variation in body mass index than do eating habits , particularly in boys . Eating habits explain a greater proportion of variation in body mass index than does physical activity in girls . Prospect i ve studies are needed to clarify the relative effects of sedentary behaviors on overweight in adolescents PURPOSE This study aim ed to establish whether time spent in sport-related physical activities and sedentary behaviors ( e.g. , TV viewing , videogame usage , and homework ) was prospect ively associated with change in blood pressure ( BP ) for 5 yr . METHODS Eight hundred and twenty-one students age 6 yr at baseline ( 397 girls and 424 boys ) were examined from 2003 - 2004 to 2009 - 2011 . Children completed detailed activity question naires . BP was measured using a st and ardized protocol . RESULTS After adjusting for age , ethnicity , parental education , parental history of hypertension , baseline height , BP , body mass index ( BMI ) , baseline time spent in corresponding activity behavior , and change in BMI , each hour per day spent in total screen time was associated with a 0.69 and 0.59 mm Hg increase in diastolic BP ( P = 0.01 ) and mean arterial BP ( P = 0.01 ) , respectively . In boys , each hour per day spent in TV viewing was associated with a concurrent 1.42-mm Hg increase in diastolic BP ( P = 0.04 ) during the 5 yr . Children engaging in low sport-related physical activities at baseline but who engaged in high levels of physical activity ( ≥ 60 min · d(-1 ) ) at follow-up ( n = 154 ) compared with those engaging in low sport-related physical activities at both examinations ( n = 305 ) demonstrated significantly lower mean arterial BP , 7.26 versus 9.61 mm Hg ( P = 0.04 ) . CONCLUSIONS Time spent in physical activity and screen time could influence BP measures during childhood OBJECTIVES To explore the association between electronic media exposure ( television viewing time , personal computer/video game use , total screen time ) , and waist circumference and body mass index , and study whether this association is independent of cardiorespiratory fitness , in a representative sample of adolescents from Montería , Colombia . DESIGN Cross-sectional study analyzing data from 546 students aged 11 - 18 years , from fourteen r and omly selected schools .  Z-scores for WC and BMI were calculated . METHODS The physical activity module of the Global School Health Survey 2007 was used to determine EME , and the shuttle run test was used to assess CRF . Linear regression models adjusted by age , school location , physical activity level , type of institution ( public or private ) , consumption of sweetened beverages , fast food , and fried food were used . RESULTS Among boys , independently of cardiorespiratory fitness , high television viewing time ( ≥ 2 h/day ) ( β=+0.22 
    Output:
    