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: Overweight and obesity affects more than 66 % of the adult population and is associated with a variety of chronic diseases . Weight reduction reduces health risks associated with chronic diseases and is therefore encouraged by major health agencies . Guidelines of the National Heart , Lung , and Blood Institute ( NHLBI ) encourage a 10 % reduction in weight , although considerable literature indicates reduction in health risk with 3 % to 5 % reduction in weight . Physical activity ( PA ) is recommended as a component of weight management for prevention of weight gain , for weight loss , and for prevention of weight regain after weight loss . In 2001 , the American College of Sports Medicine ( ACSM ) published a Position St and that recommended a minimum of 150 min wk(-1 ) of moderate-intensity PA for overweight and obese adults to improve health ; however , 200 - 300 min wk(-1 ) was recommended for long-term weight loss . More recent evidence has supported this recommendation and has indicated more PA may be necessary to prevent weight regain after weight loss . To this end , we have reexamined the evidence from 1999 to determine whether there is a level at which PA is effective for prevention of weight gain , for weight loss , and prevention of weight regain . Evidence supports moderate-intensity PA between 150 and 250 min wk(-1 ) to be effective to prevent weight gain .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will provide only modest weight loss . Greater amounts of PA ( > 250 min wk(-1 ) ) have been associated with clinical ly significant weight loss .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will improve weight loss in studies that use moderate diet restriction but not severe diet restriction . Cross-sectional and prospect i ve studies indicate that after weight loss , weight maintenance is improved with PA > 250 min wk(-1 ) . However , no evidence from well- design ed r and omized controlled trials exists to judge the effectiveness of PA for prevention of weight regain after weight loss .  Resistance training does not enhance weight loss but may increase fat-free mass and increase loss of fat mass and is associated with reductions in health risk . Existing evidence indicates that endurance PA or resistance training without weight loss improves health risk . There is inadequate evidence to determine whether PA prevents or attenuates detrimental changes in chronic disease risk during weight gain INTRODUCTION The aims of this prospect i ve cohort study were to examine 16-year trajectories of weight and BMI in young adult women who had a healthy BMI in 1996 and determinants of remaining in the healthy BMI category . METHODS A total of 4,881 women with healthy BMI at baseline and either healthy , overweight , or obese BMI at 16-year follow-up reported their weight , height , health , and health behaviors in six surveys of the Australian Longitudinal Study on Women 's Health between 1996 ( aged 18 - 23 years ) and 2012 ( aged 34 - 39 years ) . Determinants of BMI maintenance were estimated using binary logistic regression and generalized estimating equations in 2015 . RESULTS Almost 60 % remained in the healthy BMI category from 1996 to 2012 , ( mean weight gain , 0.19 kg/year ) , 29 % transitioned to overweight BMI ( 0.83 kg/year ) , and 11.6 % transitioned to obese ( 1.73 kg/year ) . The mean rates of annual weight gain in each group were consistent over time . Only three factors ( low alcohol , moderate/high physical activity , having a university degree ) were positively associated with maintaining a healthy BMI . Additional behavioral factors ( smoking , high sitting time , energy intake , dieting , takeaway food , and use of oral contraceptives ) , as well as blue collar occupation , separation/divorce/widowhood , and major illness were negatively associated with BMI maintenance . CONCLUSIONS To prevent the transition from healthy to overweight/obese BMI , weight gain must be limited to < 0.5 kg/year . Women with healthy BMI , but with higher rates of weight gain in their early 20s , could be identified by health professionals for assistance with prevention of becoming overweight/obese Background / Objectives : Despite considerable research on the association between physical activity ( PA ) and body composition , there remains limited information on the directionality of the relationship . The present study examined the prospect i ve associations among objective ly measured PA , energy intake ( EI ) and body composition . Subjects/ Methods : A convenience sample of 430 adults ( 49 % male ) between 21 and 35 years of age was followed over 1 year with repeated measurements taken every 3 months . BMI ( kg/m2 ) and percent body fat ( % BF ) were calculated based on anthropometric measurements and dual energy X-ray absorptiometry . A multi-sensor device was worn over a period of 10 days to estimate total daily energy expenditure and time spent in different intensities . EI was calculated based on change in body composition and total daily energy expenditure . Results : A total of 379 participants provided valid data . On average , participants experienced a significant weight gain of 1.2±4.3 kg during the 12-month observation period , which was associated with an increase in % BF ( 0.8±3.2 % ) . Average time spent in moderate-to-vigorous PA ( MVPA ) decreased significantly , whereas EI remained constant . Optimal linear mixed models , adjusting for age and sex , showed an inverse effect of MVPA on BMI and % BF , whereas EI only directly affected BMI ( P<0.001 ) . There was also a significant inverse effect of BMI and % BF on MVPA ( P<0.001 ) . Conclusions : Results of this study indicate an inverse reciprocal association between MVPA and measures of adiposity . Thus , primary preventive actions are warranted to avoid excess weight gain , which may result in a vicious cycle of weight gain and low PA BACKGROUND Sedentary behavior is a risk factor for cardiometabolic disease . Regularly interrupting sedentary behavior with activity breaks may lower this risk . OBJECTIVE We compared the effects of prolonged sitting , continuous physical activity combined with prolonged sitting , and regular activity breaks on  postpr and ial metabolism . DESIGN Seventy adults participated in a r and omized crossover study . The prolonged sitting intervention involved sitting for 9 h , the physical activity intervention involved walking for 30 min and then sitting , and the regular-activity-break intervention involved walking for 1 min 40 s every 30 min . Participants consumed a meal-replacement beverage at 60 , 240 , and 420 min . RESULTS The plasma incremental area under the curve ( iAUC ) for insulin differed between interventions ( overall P < 0.001 ) . Regular activity breaks lowered values by 866.7 IU · L(-1 ) · 9 h(-1 ) ( 95 % CI : 506.0 , 1227.5 IU · L(-1 ) · 9 h(-1 ) ; P < 0.001 ) when compared with prolonged sitting and by 542.0 IU · L(-1 ) · 9 h(-1 ) ( 95 % CI : 179.9 , 904.2 IU · L(-1 ) · 9 h(-1 ) ; P = 0.003 ) when compared with physical activity . Plasma glucose iAUC also differed between interventions ( overall P < 0.001 ) . Regular activity breaks  lowered values by 18.9 mmol · L(-1 ) · 9 h(-1 ) ( 95 % CI : 10.0 , 28.0 mmol · L(-1 ) · 9 h(-1 ) ; P < 0.001 ) when compared with prolonged sitting and by 17.4 mmol · L(-1 ) · 9 h(-1 ) ( 95 % CI : 8.4 , 26.3 mmol · L(-1 ) · 9 h(-1 ) ; P < 0.001 ) when compared with physical activity . Plasma triglyceride iAUC differed between interventions ( overall P = 0.023 ) . Physical activity  lowered values by 6.3 mmol · L(-1 ) · 9 h(-1 ) ( 95 % CI : 1.8 , 10.7 mmol · L(-1 ) · 9 h(-1 ) ; P = 0.006 ) when compared with regular activity breaks . CONCLUSION Regular activity breaks were more effective than continuous physical activity at decreasing postpr and ial glycemia and insulinemia in healthy , normal-weight adults . This trial was registered with the Australian New Zeal and Clinical Trials registry as ACTRN12610000953033 Aims Type 2 diabetes mellitus ( T2DM ) , a serious and prevalent chronic disease , is traditionally associated with older age . However , due to the rising rates of obesity and sedentary lifestyles , it is increasingly being diagnosed in the younger population . Sedentary ( sitting ) behaviour has been shown to be associated with greater risk of cardio-metabolic health outcomes , including T2DM . Little is known about effective interventions to reduce sedentary behaviour in younger adults at risk of T2DM . We aim ed to investigate , through a r and omised controlled trial ( RCT ) design , whether a group-based structured education workshop focused on sitting reduction , with self-monitoring , reduced sitting time . Methods Adults aged 18–40 years who were either overweight ( with an additional risk factor for T2DM ) or obese were recruited for the Sedentary Time ANd Diabetes ( ST AND ) RCT . The intervention programme comprised of a 3-hour group-based structured education workshop , use of a self-monitoring tool , and follow-up motivational phone call . Data were collected at three time points : baseline , 3 and 12 months after baseline . The primary outcome measure was accelerometer-assessed sedentary behaviour after 12 months . Secondary outcomes included other objective ( activPAL ) and self-reported measures of sedentary behaviour and physical activity , and biochemical , anthropometric , and psycho-social variables . Results 187 individuals ( 69 % female ; mean age 33 years ; mean BMI 35 kg/m2 ) were r and omised to intervention and control groups . 12 month data , when analysed using intention-to-treat analysis ( ITT ) and per- protocol analyses , showed no significant difference in the primary outcome variable , nor in the majority of the secondary outcome measures . Conclusions A structured education intervention design ed to reduce sitting in young adults at risk of T2DM was not successful in changing behaviour at 12 months . Lack of change may be due to the brief nature of such an intervention and lack of focus on environmental change . Moreover , some participants reported a focus on physical activity rather than reductions in sitting per se . The habitual nature of sedentary behaviour means that behaviour change is challenging . Trial Registration Controlled-Trials.com IS RCT Objective Evidence on the direction of the association between sitting time and obesity is limited . The prospect i ve associations between baseline total sitting time and subsequent changes in body mass index ( BMI ) , and baseline BMI and subsequent changes in sitting time were examined . Methods BMI , from self-reported height and weight , and a single-item  measure of sitting time  were ascertained at two time points ( 3.4 ± 0.96 years apart ) in a prospect i ve question naire-based cohort of 31,787 Australians aged 45–65 years without severe physical limitations . Results In a fully adjusted model , baseline obesity was associated with  increased sitting time among all participants ( adjusted odds ratio [ aOR ] = 1.20 [ 95 % CI , 1.11 - 1.30 ] ; P < 0.001 ) and in most subgroups . The association was significant among those who were sitting < 4 hours/day ( aOR = 1.24 [ 95 % CI , 1.07 - 1.44 ] ; P = 0.004 ) and 4–8 hours/day at baseline ( aOR=1.18 [ 95 % CI , 1.06 - 1.32 ] ; P = 0.003 ) , but not in the high sitting groups ( P = 0.111 and 0.188 for 8–11 and ≥11 sitting hours/day , respectively ) . Nonsignificant and inconsistent results were observed for the association between baseline sitting time and subsequent change in BMI . Conclusions Our findings support the hypothesis that obesity may lead to a  subsequent increase in total sitting time  , but the association in the other direction is unclear BACKGROUND Although it is known that abdominal obesity increases the risk of chronic diseases , prospect i ve data examining the relation between lifestyle factors and the accumulation of abdominal adipose tissue are sparse . OBJECTIVE The objective of the study was to determine the associations of changes in diet , physical activity , alcohol consumption , and smoking  with 9-y waist gain among US men . DESIGN A prospect i ve cohort comprised 16 587 US men aged 40 - 75 y at baseline in 1986 .  Data on  lifestyle factors  were provided periodically with the use of self-reported question naires , and participants measured and reported their waist circumference in 1987 and 1996 . RESULTS In multivariate analyses , a 2 % increment in energy intake from trans fats that were isocalorically substituted for either polyunsaturated fats or carbohydrates was significantly associated with a 0.77-cm waist gain over 9 y ( P < 0.001 for each comparison ) . An increase of 12 g total fiber/d was associated with a 0.63-cm decrease in waist circumference ( P < 0.001 ) , whereas smoking cessation and a 20-h/wk increase in television watching 
    Output:
    
agent
Conclusions Meta- analysis of data from prospect i ve cohort studies showed small , inconsistent and non-significant associations between sedentary behavior and body weight
***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: Overweight and obesity affects more than 66 % of the adult population and is associated with a variety of chronic diseases . Weight reduction reduces health risks associated with chronic diseases and is therefore encouraged by major health agencies . Guidelines of the National Heart , Lung , and Blood Institute ( NHLBI ) encourage a 10 % reduction in weight , although considerable literature indicates reduction in health risk with 3 % to 5 % reduction in weight . Physical activity ( PA ) is recommended as a component of weight management for prevention of weight gain , for weight loss , and for prevention of weight regain after weight loss . In 2001 , the American College of Sports Medicine ( ACSM ) published a Position St and that recommended a minimum of 150 min wk(-1 ) of moderate-intensity PA for overweight and obese adults to improve health ; however , 200 - 300 min wk(-1 ) was recommended for long-term weight loss . More recent evidence has supported this recommendation and has indicated more PA may be necessary to prevent weight regain after weight loss . To this end , we have reexamined the evidence from 1999 to determine whether there is a level at which PA is effective for prevention of weight gain , for weight loss , and prevention of weight regain . Evidence supports moderate-intensity PA between 150 and 250 min wk(-1 ) to be effective to prevent weight gain .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will provide only modest weight loss . Greater amounts of PA ( > 250 min wk(-1 ) ) have been associated with clinical ly significant weight loss .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will improve weight loss in studies that use moderate diet restriction but not severe diet restriction . Cross-sectional and prospect i ve studies indicate that after weight loss , weight maintenance is improved with PA > 250 min wk(-1 ) . However , no evidence from well- design ed r and omized controlled trials exists to judge the effectiveness of PA for prevention of weight regain after weight loss .  Resistance training does not enhance weight loss but may increase fat-free mass and increase loss of fat mass and is associated with reductions in health risk . Existing evidence indicates that endurance PA or resistance training without weight loss improves health risk . There is inadequate evidence to determine whether PA prevents or attenuates detrimental changes in chronic disease risk during weight gain INTRODUCTION The aims of this prospect i ve cohort study were to examine 16-year trajectories of weight and BMI in young adult women who had a healthy BMI in 1996 and determinants of remaining in the healthy BMI category . METHODS A total of 4,881 women with healthy BMI at baseline and either healthy , overweight , or obese BMI at 16-year follow-up reported their weight , height , health , and health behaviors in six surveys of the Australian Longitudinal Study on Women 's Health between 1996 ( aged 18 - 23 years ) and 2012 ( aged 34 - 39 years ) . Determinants of BMI maintenance were estimated using binary logistic regression and generalized estimating equations in 2015 . RESULTS Almost 60 % remained in the healthy BMI category from 1996 to 2012 , ( mean weight gain , 0.19 kg/year ) , 29 % transitioned to overweight BMI ( 0.83 kg/year ) , and 11.6 % transitioned to obese ( 1.73 kg/year ) . The mean rates of annual weight gain in each group were consistent over time . Only three factors ( low alcohol , moderate/high physical activity , having a university degree ) were positively associated with maintaining a healthy BMI . Additional behavioral factors ( smoking , high sitting time , energy intake , dieting , takeaway food , and use of oral contraceptives ) , as well as blue collar occupation , separation/divorce/widowhood , and major illness were negatively associated with BMI maintenance . CONCLUSIONS To prevent the transition from healthy to overweight/obese BMI , weight gain must be limited to < 0.5 kg/year . Women with healthy BMI , but with higher rates of weight gain in their early 20s , could be identified by health professionals for assistance with prevention of becoming overweight/obese Background / Objectives : Despite considerable research on the association between physical activity ( PA ) and body composition , there remains limited information on the directionality of the relationship . The present study examined the prospect i ve associations among objective ly measured PA , energy intake ( EI ) and body composition . Subjects/ Methods : A convenience sample of 430 adults ( 49 % male ) between 21 and 35 years of age was followed over 1 year with repeated measurements taken every 3 months . BMI ( kg/m2 ) and percent body fat ( % BF ) were calculated based on anthropometric measurements and dual energy X-ray absorptiometry . A multi-sensor device was worn over a period of 10 days to estimate total daily energy expenditure and time spent in different intensities . EI was calculated based on change in body composition and total daily energy expenditure . Results : A total of 379 participants provided valid data . On average , participants experienced a significant weight gain of 1.2±4.3 kg during the 12-month observation period , which was associated with an increase in % BF ( 0.8±3.2 % ) . Average time spent in moderate-to-vigorous PA ( MVPA ) decreased significantly , whereas EI remained constant . Optimal linear mixed models , adjusting for age and sex , showed an inverse effect of MVPA on BMI and % BF , whereas EI only directly affected BMI ( P<0.001 ) . There was also a significant inverse effect of BMI and % BF on MVPA ( P<0.001 ) . Conclusions : Results of this study indicate an inverse reciprocal association between MVPA and measures of adiposity . Thus , primary preventive actions are warranted to avoid excess weight gain , which may result in a vicious cycle of weight gain and low PA BACKGROUND Sedentary behavior is a risk factor for cardiometabolic disease . Regularly interrupting sedentary behavior with activity breaks may lower this risk . OBJECTIVE We compared the effects of prolonged sitting , continuous physical activity combined with prolonged sitting , and regular activity breaks on  postpr and ial metabolism . DESIGN Seventy adults participated in a r and omized crossover study . The prolonged sitting intervention involved sitting for 9 h , the physical activity intervention involved walking for 30 min and then sitting , and the regular-activity-break intervention involved walking for 1 min 40 s every 30 min . Participants consumed a meal-replacement beverage at 60 , 240 , and 420 min . RESULTS The plasma incremental area under the curve ( iAUC ) for insulin differed between interventions ( overall P < 0.001 ) . Regular activity breaks lowered values by 866.7 IU · L(-1 ) · 9 h(-1 ) ( 95 % CI : 506.0 , 1227.5 IU · L(-1 ) · 9 h(-1 ) ; P < 0.001 ) when compared with prolonged sitting and by 542.0 IU · L(-1 ) · 9 h(-1 ) ( 95 % CI : 179.9 , 904.2 IU · L(-1 ) · 9 h(-1 ) ; P = 0.003 ) when compared with physical activity . Plasma glucose iAUC also differed between interventions ( overall P < 0.001 ) . Regular activity breaks  lowered values by 18.9 mmol · L(-1 ) · 9 h(-1 ) ( 95 % CI : 10.0 , 28.0 mmol · L(-1 ) · 9 h(-1 ) ; P < 0.001 ) when compared with prolonged sitting and by 17.4 mmol · L(-1 ) · 9 h(-1 ) ( 95 % CI : 8.4 , 26.3 mmol · L(-1 ) · 9 h(-1 ) ; P < 0.001 ) when compared with physical activity . Plasma triglyceride iAUC differed between interventions ( overall P = 0.023 ) . Physical activity  lowered values by 6.3 mmol · L(-1 ) · 9 h(-1 ) ( 95 % CI : 1.8 , 10.7 mmol · L(-1 ) · 9 h(-1 ) ; P = 0.006 ) when compared with regular activity breaks . CONCLUSION Regular activity breaks were more effective than continuous physical activity at decreasing postpr and ial glycemia and insulinemia in healthy , normal-weight adults . This trial was registered with the Australian New Zeal and Clinical Trials registry as ACTRN12610000953033 Aims Type 2 diabetes mellitus ( T2DM ) , a serious and prevalent chronic disease , is traditionally associated with older age . However , due to the rising rates of obesity and sedentary lifestyles , it is increasingly being diagnosed in the younger population . Sedentary ( sitting ) behaviour has been shown to be associated with greater risk of cardio-metabolic health outcomes , including T2DM . Little is known about effective interventions to reduce sedentary behaviour in younger adults at risk of T2DM . We aim ed to investigate , through a r and omised controlled trial ( RCT ) design , whether a group-based structured education workshop focused on sitting reduction , with self-monitoring , reduced sitting time . Methods Adults aged 18–40 years who were either overweight ( with an additional risk factor for T2DM ) or obese were recruited for the Sedentary Time ANd Diabetes ( ST AND ) RCT . The intervention programme comprised of a 3-hour group-based structured education workshop , use of a self-monitoring tool , and follow-up motivational phone call . Data were collected at three time points : baseline , 3 and 12 months after baseline . The primary outcome measure was accelerometer-assessed sedentary behaviour after 12 months . Secondary outcomes included other objective ( activPAL ) and self-reported measures of sedentary behaviour and physical activity , and biochemical , anthropometric , and psycho-social variables . Results 187 individuals ( 69 % female ; mean age 33 years ; mean BMI 35 kg/m2 ) were r and omised to intervention and control groups . 12 month data , when analysed using intention-to-treat analysis ( ITT ) and per- protocol analyses , showed no significant difference in the primary outcome variable , nor in the majority of the secondary outcome measures . Conclusions A structured education intervention design ed to reduce sitting in young adults at risk of T2DM was not successful in changing behaviour at 12 months . Lack of change may be due to the brief nature of such an intervention and lack of focus on environmental change . Moreover , some participants reported a focus on physical activity rather than reductions in sitting per se . The habitual nature of sedentary behaviour means that behaviour change is challenging . Trial Registration Controlled-Trials.com IS RCT Objective Evidence on the direction of the association between sitting time and obesity is limited . The prospect i ve associations between baseline total sitting time and subsequent changes in body mass index ( BMI ) , and baseline BMI and subsequent changes in sitting time were examined . Methods BMI , from self-reported height and weight , and a single-item  measure of sitting time  were ascertained at two time points ( 3.4 ± 0.96 years apart ) in a prospect i ve question naire-based cohort of 31,787 Australians aged 45–65 years without severe physical limitations . Results In a fully adjusted model , baseline obesity was associated with  increased sitting time among all participants ( adjusted odds ratio [ aOR ] = 1.20 [ 95 % CI , 1.11 - 1.30 ] ; P < 0.001 ) and in most subgroups . The association was significant among those who were sitting < 4 hours/day ( aOR = 1.24 [ 95 % CI , 1.07 - 1.44 ] ; P = 0.004 ) and 4–8 hours/day at baseline ( aOR=1.18 [ 95 % CI , 1.06 - 1.32 ] ; P = 0.003 ) , but not in the high sitting groups ( P = 0.111 and 0.188 for 8–11 and ≥11 sitting hours/day , respectively ) . Nonsignificant and inconsistent results were observed for the association between baseline sitting time and subsequent change in BMI . Conclusions Our findings support the hypothesis that obesity may lead to a  subsequent increase in total sitting time  , but the association in the other direction is unclear BACKGROUND Although it is known that abdominal obesity increases the risk of chronic diseases , prospect i ve data examining the relation between lifestyle factors and the accumulation of abdominal adipose tissue are sparse . OBJECTIVE The objective of the study was to determine the associations of changes in diet , physical activity , alcohol consumption , and smoking  with 9-y waist gain among US men . DESIGN A prospect i ve cohort comprised 16 587 US men aged 40 - 75 y at baseline in 1986 .  Data on  lifestyle factors  were provided periodically with the use of self-reported question naires , and participants measured and reported their waist circumference in 1987 and 1996 . RESULTS In multivariate analyses , a 2 % increment in energy intake from trans fats that were isocalorically substituted for either polyunsaturated fats or carbohydrates was significantly associated with a 0.77-cm waist gain over 9 y ( P < 0.001 for each comparison ) . An increase of 12 g total fiber/d was associated with a 0.63-cm decrease in waist circumference ( P < 0.001 ) , whereas smoking cessation and a 20-h/wk increase in television watching 
    Output:
    