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 To evaluate the metabolic effects of two weight loss diets differing in macronutrient composition on features of dyslipidemia and post-pr and ial insulin ( INS ) response to a meal challenge in overweight/obese individuals . Methods This study was a parallel-arm r and omized 4 mo weight loss trial . Adults ( n = 50 , 47 ± 7 y ) matched on BMI ( 33.6 ± 0.6 kg/m2 , P = 0.79 )  consumed energy restricted diets ( deficit ~500 kcal/d ) : PRO ( 1.6 g.kg-1.d-1 protein and < 170 g/d carbohydrate ) or CHO ( 0.8 g.kg-1.d-1 protein and > 220 g/d carbohydrate ) for 4 mos . Meal challenges of respective diets were utilized for determination of blood lipids and post-pr and ial INS and glucose response at the beginning and end of the study . Results There was a trend for PRO to lose more weight ( -9.1 % vs. -7.3 % , P = 0.07 ) with a significant reduction in percent fat mass compared to CHO ( -8.7 % vs. -5.7 % ; P = 0.03 ) . PRO also favored reductions in triacylglycerol ( -34 % vs. -14 % ; P < 0.05 ) and increases in HDL-C ( + 5 % vs. -3 % ; P = 0.05 ) ; however , CHO favored reduction in LDL-C ( -7 % vs. + 2.5 % ; P < 0.05 ) . INS responses to the meal challenge were improved in PRO compared to CHO ( P < 0.05 ) at both 1 hr ( -34.3 % vs. -1.0 % ) and 2 hr ( -9.2 % vs. + 46.2 % ) , an effect that remained significant after controlling for weight or fat loss ( both P < 0.05 ) . Conclusion A weight loss diet with moderate carbohydrate , moderate protein results in more favorable changes in body composition , dyslipidemia , and post-pr and ial INS response compared to a high carbohydrate , low protein diet suggesting an additional benefit beyond weight management to include augmented risk reduction for metabolic disease Cl aims about the merits or risks of carbohydrate ( CHO ) vs. protein for weight loss diets are extensive , yet the ideal ratio of dietary carbohydrate to protein for adult health and weight management remains unknown . This study examined the efficacy of two weight loss diets with modified CHO/protein ratios to change body composition and blood lipids in adult women . Women ( n = 24 ; 45 to 56 y old ) with body mass indices > 26 kg/m(2 ) were assigned to either a CHO Group consuming a diet with a CHO/protein ratio of 3.5 ( 68 g protein/d ) or a Protein Group with a ratio of 1.4 ( 125 g protein/d ) . Diets were isoenergetic , providing 7100 kJ/d , and similar amounts of fat ( approximately 50 g/d ) . After consuming the diets for 10 wk , the CHO Group lost 6.96 + /- 1.36 kg body weight and the Protein Group lost 7.53 + /- 1.44 kg . Weight loss in the Protein Group was partitioned to a significantly higher loss of fat/lean ( 6.3 + /- 1.2 g/g ) compared with the CHO Group ( 3.8 + /- 0.9 ) . Both groups had significant reductions in serum cholesterol ( approximately 10 % ) , whereas the Protein Group also had significant reductions in triacylglycerols ( TAG ) ( 21 % ) and the ratio of TAG/HDL cholesterol ( 23 % ) . Women in the CHO Group had higher insulin responses to meals and postpr and ial hypoglycemia , whereas women in the Protein Group reported greater satiety . This study demonstrates that increasing the proportion of protein to carbohydrate in the diet of adult women has positive effects on body composition , blood lipids , glucose homeostasis and satiety during weight loss OBJECTIVE : To study the effect on weight loss in obese subjects by replacement of carbohydrate by protein in ad libitum consumed fat-reduced diets . DESIGN : R and omized dietary intervention study over six months comparing two ad libitum fat reduced diets ( 30 % of total energy ) strictly controlled in composition : High-carbohydrate ( HC , protein 12 % of total energy ) or high-protein ( HP , protein 25 % of total energy ) . SETTING AND PARTICIPANTS : Subjects were 65 healthy , overweight and obese subjects ( 50 women , 15 men , aged 18–55 y ) r and omly assigned to HC ( n=25 ) , HP ( n=25 ) or a control group ( C , n=15 ) . All food was provided by self- selection in a shop at the department , and compliance to the diet composition was evaluated by urinary nitrogen excretion . MAIN OUTCOME MEASURE : Change in body weight , body composition and blood lipids . RESULTS : More than 90 % completed the trial . Weight loss after six months was 5.1 kg in the HC group and 8.9 kg in the HP group ( difference 3.7 kg , 95 % confidence interval (CI)(1.3–6.2 kg ) P<0.001 ) , and fat loss was 4.3 kg and 7.6 kg , respectively ( difference 3.3 kg ( 1.1–5.5 kg ) P<0.0001 ) , whereas no changes occurred in the control group . More subjects lost > 10 kg in the HP group ( 35 % ) than in the HC group ( 9 % ) . The HP diet only decreased fasting plasma triglycerides and free fatty acids significantly . CONCLUSIONS : Replacement of some dietary carbohydrate by protein in an ad libitum fat-reduced diet , improves weight loss and increases the proportion of subjects achieving a clinical ly relevant weight loss . More freedom to choose between protein-rich and complex carbohydrate-rich foods may allow obese subjects to choose more lean meat and dairy products , and hence improve adherence to low-fat diets in weight reduction programs Objective The purpose of this study was to learn whether preoperative eating habits can be used to predict outcome after  vertical b and ed gastroplasty ( VBG ) and Roux-en-Y gastric bypass ( RYGB ) .  Background Summary Several independent r and omized and sequential studies have reported significantly greater weight loss after RYGB in comparison with VBG . Although the mechanism responsible for weight loss after both procedures is restriction of intake rather than malabsorption , the relationships between calorie intake , food preferences , and postoperative weight loss are not well defined . Methods During the past 5 years , 138 patients were prospect ively selected for either VBG or RYGB , based on their preoperative eating habits . All patients were screened by a dietitian who determined total calorie intake and diet composition before recommending VBG or RYGB .  Thirty patients were selected for VBG ; the remaining 108 patients were classified as “ sweets eaters ” or “ snackers ” and had RYGB . Detailed recall diet histories also were performed at each postoperative visit . Results Early morbidity rate was zero after VBG versus 3 % after RYGB . There were no deaths . Mean follow-up was 39 ± 11 months after VBG and 38 ± 14 months after RYGB . Mean weight loss peaked at 74 ± 23 lb at 12 months after VBG and 99 ± 24 lb at 16 months after RYGB ( p ≤ 0.001 ) . Twelve of 30 VBG patients lost > 50 % of their excess weight versus 100 of 108 RYGB patients ( p ≤ 0.0001 ) . Milk/ice cream intake was significantly greater postoperatively in patients who underwent VBG versus patients who underwent RYGB after 6 months ( p ≤ 0.003 ) , whereas solid sweets intake was significantly greater after VBG during the first 18 months postoperatively ( p ≤ 0.004 ) . Revision of VBG was performed in 6 of 30 patients ( 20 % ) for complications or poor weight loss , whereas only 2 of 108 patients who underwent RYGB required surgical revisions ( p ≤ 0.001 ) . Conclusions These data show that VBG adversely alters postoperative eating behavior toward soft , high-calorie foods , result ing in problematic postoperative weight loss . Conversely , RYGB patients had significantly greater weight loss despite inferior preoperative eating habits . The high rate BACKGROUND  Gastric restrictive surgery  induces a marked change in eating behavior . However , the relationship between preoperative and postoperative eating behavior and weight loss outcome has received limited attention . OBJECTIVE This study assessed a range of eating behaviors before and 1 year after laparoscopic adjustable gastric b and ing ( LAGB )  and explored the nature and extent of change in eating patterns , their clinical associates , and impact on weight loss . METHODS AND PROCEDURES A 12-month observational study assessed presurgical and postsurgical binge eating disorder ( BED ) , uncontrolled eating , night eating syndrome ( NES ) , grazing , nutrient intake and eating-related behaviors , and markers of psychological distress .  A total of 129 subjects ( 26 male and 103 female , mean age 45.2 + /- 11.5 and BMI 44.3 + /- 6.8 ) participated in this study . RESULTS Presurgical BED , uncontrolled eating , and NES occurred in 14 % , 31 % , and 17.1 % of subjects , which reduced after surgery to 3.1 % , 22.5 % , and 7.8 % , respectively ( P = 0.05 for all ) . Grazing was prevalent before ( 26.3 % ) and after surgery ( 38.0 % ) . Preoperative BED most frequently became grazers ( P = 0.029 ) . The average percentage weight loss ( % WL ) was 20.8 + /- 8.5 % ; range -0.67 to 50.0 % and percentage of excess weight loss ( % EWL ) 50.0 + /- 20.7 % ; range -1.44 to 106.9 % ( P < 0.001 ) . Uncontrolled eating and grazing after surgery showed high overlap and were associated with poorer % WL ( P = 0.008 and P < 0.001 , respectively ) and elevated psychological distress . DISCUSSION Consistent with recent studies , uncontrolled eating and grazing were identified as two high-risk eating patterns after surgery . Clearer characterization of favorable and unfavorable postsurgical eating behaviors , reliable methods to assess their presence , and empirically tested postsurgical intervention strategies are required to optimize weight loss outcomes and facilitate psychological well-being in at-risk groups BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality Background Few long-term studies regarding the outcome of  laparoscopic adjustable gastric b and ing for morbid obesity have so far been published . We report our 11-year experience with the technique by looking closely at the first 123 patients that have at least 5 years ( mean 86 months ) of follow-up . Methods Data have been collected prospect ively among 280 patients operated since March 1996 . Until March 2002 ( minimum 5-year follow-up ) , 123 patients have been operated laparoscopically with the Swedish b and .  We report major late complications 
    Output:
    
agent
Although the strength of the evidence base is limited by the small number of studies , observational study design s and method ological weaknesses , the results indicate that short-term positive changes occur post surgery , including reduced caloric intake , contributed to by reductions in fat , carbohydrate and protein intake .
There is a paucity of high- quality evidence regarding changes in dietary intake after LAGB .
***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 To evaluate the metabolic effects of two weight loss diets differing in macronutrient composition on features of dyslipidemia and post-pr and ial insulin ( INS ) response to a meal challenge in overweight/obese individuals . Methods This study was a parallel-arm r and omized 4 mo weight loss trial . Adults ( n = 50 , 47 ± 7 y ) matched on BMI ( 33.6 ± 0.6 kg/m2 , P = 0.79 )  consumed energy restricted diets ( deficit ~500 kcal/d ) : PRO ( 1.6 g.kg-1.d-1 protein and < 170 g/d carbohydrate ) or CHO ( 0.8 g.kg-1.d-1 protein and > 220 g/d carbohydrate ) for 4 mos . Meal challenges of respective diets were utilized for determination of blood lipids and post-pr and ial INS and glucose response at the beginning and end of the study . Results There was a trend for PRO to lose more weight ( -9.1 % vs. -7.3 % , P = 0.07 ) with a significant reduction in percent fat mass compared to CHO ( -8.7 % vs. -5.7 % ; P = 0.03 ) . PRO also favored reductions in triacylglycerol ( -34 % vs. -14 % ; P < 0.05 ) and increases in HDL-C ( + 5 % vs. -3 % ; P = 0.05 ) ; however , CHO favored reduction in LDL-C ( -7 % vs. + 2.5 % ; P < 0.05 ) . INS responses to the meal challenge were improved in PRO compared to CHO ( P < 0.05 ) at both 1 hr ( -34.3 % vs. -1.0 % ) and 2 hr ( -9.2 % vs. + 46.2 % ) , an effect that remained significant after controlling for weight or fat loss ( both P < 0.05 ) . Conclusion A weight loss diet with moderate carbohydrate , moderate protein results in more favorable changes in body composition , dyslipidemia , and post-pr and ial INS response compared to a high carbohydrate , low protein diet suggesting an additional benefit beyond weight management to include augmented risk reduction for metabolic disease Cl aims about the merits or risks of carbohydrate ( CHO ) vs. protein for weight loss diets are extensive , yet the ideal ratio of dietary carbohydrate to protein for adult health and weight management remains unknown . This study examined the efficacy of two weight loss diets with modified CHO/protein ratios to change body composition and blood lipids in adult women . Women ( n = 24 ; 45 to 56 y old ) with body mass indices > 26 kg/m(2 ) were assigned to either a CHO Group consuming a diet with a CHO/protein ratio of 3.5 ( 68 g protein/d ) or a Protein Group with a ratio of 1.4 ( 125 g protein/d ) . Diets were isoenergetic , providing 7100 kJ/d , and similar amounts of fat ( approximately 50 g/d ) . After consuming the diets for 10 wk , the CHO Group lost 6.96 + /- 1.36 kg body weight and the Protein Group lost 7.53 + /- 1.44 kg . Weight loss in the Protein Group was partitioned to a significantly higher loss of fat/lean ( 6.3 + /- 1.2 g/g ) compared with the CHO Group ( 3.8 + /- 0.9 ) . Both groups had significant reductions in serum cholesterol ( approximately 10 % ) , whereas the Protein Group also had significant reductions in triacylglycerols ( TAG ) ( 21 % ) and the ratio of TAG/HDL cholesterol ( 23 % ) . Women in the CHO Group had higher insulin responses to meals and postpr and ial hypoglycemia , whereas women in the Protein Group reported greater satiety . This study demonstrates that increasing the proportion of protein to carbohydrate in the diet of adult women has positive effects on body composition , blood lipids , glucose homeostasis and satiety during weight loss OBJECTIVE : To study the effect on weight loss in obese subjects by replacement of carbohydrate by protein in ad libitum consumed fat-reduced diets . DESIGN : R and omized dietary intervention study over six months comparing two ad libitum fat reduced diets ( 30 % of total energy ) strictly controlled in composition : High-carbohydrate ( HC , protein 12 % of total energy ) or high-protein ( HP , protein 25 % of total energy ) . SETTING AND PARTICIPANTS : Subjects were 65 healthy , overweight and obese subjects ( 50 women , 15 men , aged 18–55 y ) r and omly assigned to HC ( n=25 ) , HP ( n=25 ) or a control group ( C , n=15 ) . All food was provided by self- selection in a shop at the department , and compliance to the diet composition was evaluated by urinary nitrogen excretion . MAIN OUTCOME MEASURE : Change in body weight , body composition and blood lipids . RESULTS : More than 90 % completed the trial . Weight loss after six months was 5.1 kg in the HC group and 8.9 kg in the HP group ( difference 3.7 kg , 95 % confidence interval (CI)(1.3–6.2 kg ) P<0.001 ) , and fat loss was 4.3 kg and 7.6 kg , respectively ( difference 3.3 kg ( 1.1–5.5 kg ) P<0.0001 ) , whereas no changes occurred in the control group . More subjects lost > 10 kg in the HP group ( 35 % ) than in the HC group ( 9 % ) . The HP diet only decreased fasting plasma triglycerides and free fatty acids significantly . CONCLUSIONS : Replacement of some dietary carbohydrate by protein in an ad libitum fat-reduced diet , improves weight loss and increases the proportion of subjects achieving a clinical ly relevant weight loss . More freedom to choose between protein-rich and complex carbohydrate-rich foods may allow obese subjects to choose more lean meat and dairy products , and hence improve adherence to low-fat diets in weight reduction programs Objective The purpose of this study was to learn whether preoperative eating habits can be used to predict outcome after  vertical b and ed gastroplasty ( VBG ) and Roux-en-Y gastric bypass ( RYGB ) .  Background Summary Several independent r and omized and sequential studies have reported significantly greater weight loss after RYGB in comparison with VBG . Although the mechanism responsible for weight loss after both procedures is restriction of intake rather than malabsorption , the relationships between calorie intake , food preferences , and postoperative weight loss are not well defined . Methods During the past 5 years , 138 patients were prospect ively selected for either VBG or RYGB , based on their preoperative eating habits . All patients were screened by a dietitian who determined total calorie intake and diet composition before recommending VBG or RYGB .  Thirty patients were selected for VBG ; the remaining 108 patients were classified as “ sweets eaters ” or “ snackers ” and had RYGB . Detailed recall diet histories also were performed at each postoperative visit . Results Early morbidity rate was zero after VBG versus 3 % after RYGB . There were no deaths . Mean follow-up was 39 ± 11 months after VBG and 38 ± 14 months after RYGB . Mean weight loss peaked at 74 ± 23 lb at 12 months after VBG and 99 ± 24 lb at 16 months after RYGB ( p ≤ 0.001 ) . Twelve of 30 VBG patients lost > 50 % of their excess weight versus 100 of 108 RYGB patients ( p ≤ 0.0001 ) . Milk/ice cream intake was significantly greater postoperatively in patients who underwent VBG versus patients who underwent RYGB after 6 months ( p ≤ 0.003 ) , whereas solid sweets intake was significantly greater after VBG during the first 18 months postoperatively ( p ≤ 0.004 ) . Revision of VBG was performed in 6 of 30 patients ( 20 % ) for complications or poor weight loss , whereas only 2 of 108 patients who underwent RYGB required surgical revisions ( p ≤ 0.001 ) . Conclusions These data show that VBG adversely alters postoperative eating behavior toward soft , high-calorie foods , result ing in problematic postoperative weight loss . Conversely , RYGB patients had significantly greater weight loss despite inferior preoperative eating habits . The high rate BACKGROUND  Gastric restrictive surgery  induces a marked change in eating behavior . However , the relationship between preoperative and postoperative eating behavior and weight loss outcome has received limited attention . OBJECTIVE This study assessed a range of eating behaviors before and 1 year after laparoscopic adjustable gastric b and ing ( LAGB )  and explored the nature and extent of change in eating patterns , their clinical associates , and impact on weight loss . METHODS AND PROCEDURES A 12-month observational study assessed presurgical and postsurgical binge eating disorder ( BED ) , uncontrolled eating , night eating syndrome ( NES ) , grazing , nutrient intake and eating-related behaviors , and markers of psychological distress .  A total of 129 subjects ( 26 male and 103 female , mean age 45.2 + /- 11.5 and BMI 44.3 + /- 6.8 ) participated in this study . RESULTS Presurgical BED , uncontrolled eating , and NES occurred in 14 % , 31 % , and 17.1 % of subjects , which reduced after surgery to 3.1 % , 22.5 % , and 7.8 % , respectively ( P = 0.05 for all ) . Grazing was prevalent before ( 26.3 % ) and after surgery ( 38.0 % ) . Preoperative BED most frequently became grazers ( P = 0.029 ) . The average percentage weight loss ( % WL ) was 20.8 + /- 8.5 % ; range -0.67 to 50.0 % and percentage of excess weight loss ( % EWL ) 50.0 + /- 20.7 % ; range -1.44 to 106.9 % ( P < 0.001 ) . Uncontrolled eating and grazing after surgery showed high overlap and were associated with poorer % WL ( P = 0.008 and P < 0.001 , respectively ) and elevated psychological distress . DISCUSSION Consistent with recent studies , uncontrolled eating and grazing were identified as two high-risk eating patterns after surgery . Clearer characterization of favorable and unfavorable postsurgical eating behaviors , reliable methods to assess their presence , and empirically tested postsurgical intervention strategies are required to optimize weight loss outcomes and facilitate psychological well-being in at-risk groups BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality Background Few long-term studies regarding the outcome of  laparoscopic adjustable gastric b and ing for morbid obesity have so far been published . We report our 11-year experience with the technique by looking closely at the first 123 patients that have at least 5 years ( mean 86 months ) of follow-up . Methods Data have been collected prospect ively among 280 patients operated since March 1996 . Until March 2002 ( minimum 5-year follow-up ) , 123 patients have been operated laparoscopically with the Swedish b and .  We report major late complications 
    Output:
    