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 & AIMS High red and processed meat consumption is related to type 2 diabetes . In addition , cooking meat at high temperatures for a long duration forms heterocyclic amines ( HCAs ) , which are related to oxidative stress . However , the association between meat consumption and non-alcoholic fatty liver disease ( NAFLD ) is yet to be thoroughly tested . Therefore , we aim ed to test the association of meat type and cooking method with NAFLD and insulin resistance ( IR ) . METHODS This was a cross-sectional study in individuals who were 40 - 70 years old and underwent screening colonoscopy between 2013 and 2015 in a single center in Israel . NAFLD and IR were evaluated by ultrasonography and homeostasis model assessment . Meat type and cooking method were measured by a food frequency question naire ( FFQ ) and a detailed meat question naire . Unhealthy cooking methods were considered as frying and grilling to a level of well done and very well done . Dietary HCA intake was calculated . RESULTS A total of 789 individuals had a valid FFQ and 357 had a valid meat question naire . High consumption of total meat  ( portions/day above the median ) ( odds ratio [ OR ] 1.49 ; 95 % CI 1.05 - 2.13 ; p = 0.028 ; OR 1.63 ; 1.12 - 2.37 ; p = 0.011 ) ,  red and /or processed meat  ( OR1.47 ; 95 % CI 1.04 - 2.09 ; p = 0.031 ; OR1.55 ; 1.07 - 2.23 ; p = 0.020 ) was independently associated with higher odds of NAFLD and IR , respectively , when adjusted for : body mass index , physical activity , smoking , alcohol , energy , saturated fat and cholesterol intake . High intake of meat cooked using unhealthy methods ( OR1.92 ; 95 % CI 1.12 - 3.30 ; p = 0.018 ) and HCAs ( OR2.22 ; 95 % CI 1.28 - 3.86 ; p = 0.005 ) were independently associated with higher odds of IR . CONCLUSION High consumption of red and /or processed meat is associated with both NAFLD and IR . High HCA intake is associated with IR . If confirmed in prospect i ve studies , limiting the consumption of unhealthy meat types and improving preparation methods may be considered as part of NAFLD lifestyle treatment . LAY SUMMARY High red and processed meat consumption is related to several diseases . In addition , cooking meat at high temperatures for a long duration forms heterocyclic amines , which have harmful health effects . Non-alcoholic fatty liver disease is a significant public health burden and its formation is strongly related to insulin resistance . In this study , both were found to be more frequent in people who consume relatively high quantities of red and processed meat .  In addition , a high intake of heterocyclic amines was associated with insulin resistance BACKGROUND & AIMS Nonalcoholic fatty liver disease ( NAFLD ) is associated with increased risk of hepatic , cardiovascular , and metabolic diseases . High-protein diets , rich in methionine and branched chain amino acids ( BCAAs ) , apparently reduce liver fat , but can induce insulin resistance . We investigated the effects of diets high in animal protein ( AP ) vs plant protein ( PP ) , which differ in levels of methionine and BCAAs , in patients with type 2 diabetes and NAFLD . We examined levels of liver fat , lipogenic indices , markers of inflammation , serum levels of fibroblast growth factor 21 ( FGF21 ) , and activation of signaling pathways in adipose tissue . METHODS We performed a prospect i ve study of individuals with type 2 diabetes and NAFLD at a tertiary medical center in Germany from June 2013 through March 2015 . We analyzed data from 37 subjects placed on a diet high in AP ( rich in meat and dairy foods ; n = 18 ) or PP ( mainly legume protein ; n = 19 ) without calorie restriction for 6 weeks . The diets were isocaloric with the same macronutrient composition ( 30 % protein , 40 % carbohydrates , and 30 % fat ) . Participants were examined at the start of the study and after the 6-week diet period for body mass index , body composition , hip circumference , resting energy expenditure , and respiratory quotient . Body fat and intrahepatic fat were detected by magnetic resonance imaging and spectroscopy , respectively . Levels of glucose , insulin , liver enzymes , and inflammation markers , as well as individual free fatty acids and free amino acids , were measured in collected blood sample s. Hyperinsulinemic euglycemic clamps were performed to determine whole-body insulin sensitivity . Subcutaneous adipose tissue sample s were collected and analyzed for gene expression patterns and phosphorylation of signaling proteins . RESULTS Postpr and ial levels of BCAAs and methionine were significantly higher in subjects on the AP vs the PP diet . The AP and PP diets each reduced liver fat by 36%-48 % within 6 weeks ( for AP diet P = .0002 ; for PP diet P = .001 ) . These reductions were unrelated to change in body weight , but correlated with down-regulation of lipolysis and lipogenic indices . Serum level of FGF21 decreased by 50 % in each group ( for AP diet P < .0002 ; for PP diet P < .0002 ) ; decrease in FGF21 correlated with loss of hepatic fat . In gene expression analyses of adipose tissue , expression of the FGF21 receptor cofactor β-klotho was associated with reduced expression of genes encoding lipolytic and lipogenic proteins . In patients on each diet , levels of hepatic enzymes and markers of inflammation decreased , insulin sensitivity increased , and serum level of keratin 18 decreased . CONCLUSIONS In a prospect i ve study of patients with type 2 diabetes , we found diets high in protein ( either animal or plant ) significantly reduced liver fat independently of body weight , and reduced markers of insulin resistance and hepatic necroinflammation . The diets appear to mediate these changes via lipolytic and lipogenic pathways in adipose tissue . Negative effects of BCAA or methionine were not detectable . FGF21 level appears to be a marker of metabolic improvement . Clinical Trials.gov ID NCT02402985 OBJECTIVE To evaluate the efficacy of low carbohydrate diet ( LCD ) as compared with low fat diet ( LFD ) to decrease aminotransferase levels in obese women with nonalcoholic fatty liver disease . MATERIAL AND METHODS A total of 59 women were r and omly enrolled in a non-controlled clinical intervention study to receive either LCD or LFD during six months . Apparently healthy non-pregnant obese women aged 20 to 65 years were eligible to participate . Previous diagnosis of hepatic disease , serum creatinine level ≥ 1.5 mg/dL , severe life-limiting medical illness , pregnancy , active participation in other dietary program , use of weight loss drugs , or alcohol consumption ≥ 30 g per day were exclusion criteria . RESULTS A total of 31 obese women who received LCD were compared with 28 women allocated in the LFD group . There were 3 ( LCD group ) and 2 ( LFD group ) women with lost of follow-up . No differences in the proportion of type 2 diabetes , hypertension and hyperlipidemia were noted between women in the LCD and LFD groups . At end of follow-up , there were not significant statistical differences in the anthropometric and biochemical characteristics between women in both groups . The weight loss was 5.7 and 5.5 % for women in the LCD LFD groups . Although the decrease of AST ( 31.7 and 22.4 % ) and ALT ( 41 and 33.3 % ) levels was more elevated in the women of LCD group , as compared with the LFD group , there were not significant statistical differences . CONCLUSIONS Our results show that weight loss , irrespective of the type of diet , reduces aminotransferase levels in obese women with NAFLD OBJECTIVE The aim of our study was to examine the changes in hypertransaminasemia after weight reduction in obese patients with and without NAFLD and the relation with insulin resistance . RESEARCH METHODS A population of 162 obese patients was r and omly allocated to two groups : a ) diet I ( low fat ) and b ) diet II ( low carbohydrate ) , dieting along 3 months .  Patients were classified as group I ( n=112 ) when serum ALT activity was normal or group II ( NAFLD , n=30 ) when serum ALT activity was ( > or=43 UI/L ) . RESULTS In control group with diet I , BMI , weight , fat mass , waist to hip ratio , waist circumference , systolic pressure , total cholesterol , LDL cholesterol , HOMA and insulin levels decreased . In NAFLD group with diet I improved the same parameters and glucose , triglycerides , ALT , AST , gamaglutamine transferase levels , too . In control group with diet II , BMI , weight , fat mass , waist to hip ratio , waist circumference , systolic pressure , total cholesterol , LDL cholesterol , HOMA and insulin levels decreased . In NAFLD group with diet II improved the same parameters and glucose , triglycerides , ALT and gamaglutamine transferase levels , without statistical changes in AST . CONCLUSION We showed that weight reduction secondary to two hypocaloric diets was associated with improvement in hipertransaminasemia and insulin resistance in NAFLD patients In 1997 , the World Health Organization published a l and mark document recognizing obesity as a worldwide disease that poses a serious threat to public health ( 1 ) . Persons who are overweight or obese have substantially increased risk for morbidity from numerous chronic disorders , such as diabetes ( 2 , 3 ) , hypertension ( 4 , 5 ) , and cardiovascular disease ( 6 , 7 ) . Obesity-related health risk is greater when excess fat is deposited in the abdomen region because this phenotype is a stronger predictor of cardiovascular disease and type 2 diabetes mellitus than general obesity is ( 8 - 11 ) . This may be partially explained by excess accumulation of visceral fat , an independent correlate of insulin resistance ( 9 - 11 ) and dyslipidemia ( 8 , 9 ) . These observations highlight the need to identify appropriate treatment strategies to prevent and reduce obesity and suggest that the effectiveness of these treatments would be enhanced if abdominal obesity , particularly visceral fat , was substantially reduced . Diet restriction remains the most common method of obesity reduction ( 12 ) . Despite the observation that low levels of physical activity are a major cause of obesity ( 13 ) , increased physical activity alone is not thought to be a useful strategy for obesity reduction . Some reports have suggested that physical activity in obese adults results in only modest weight loss ( approximately 1 to 2 kg ) independent of the effects of diet restriction ( 14 ) . However , these conclusions are drawn from studies in which individual energy intake and expenditure were not rigorously controlled or accurately measured ( 15 - 17 ) . Moreover , in most studies , the negative energy balance induced by exercise was modest enough that substantial weight loss was not expected ( 15 - 17 ) . Currently , no compelling evidence supports the observation that exercise alone is not a useful method for reducing total or abdominal obesity . It is well known that a single exercise session is associated with a significant improvement in insulin-stimulated glucose uptake ( 18 , 19 ) . It is also clear that weight loss is associated with an improvement in insulin action ( 20 - 24 ) . It is unclear , however , whether regular exercise improves glucose metabolism after the short-term effects of exercise and changes in body fat distribution are considered . Segal and colleagues ( 25 ) controlled for the confounding effect of the last exercise session and body composition changes and found that exercise had no independent effect on insulin sensitivity ( 25 ) . Given the established importance of insulin resistance as an antecedent to both cardiovascular disease and type 2 diabetes mellitus ( 26 ) , it is important to clarify whether exercise improves insulin action independent of fat loss . We performed a r and omized , controlled trial to determine the independent effect of diet-induced or exercise-induced weight loss on obesity and insulin resistance in moderately obese men . We also evaluated whether exercise without weight loss was associated with reductions in abdominal obesity and insulin resistance . Methods Participants Participants were recruited from Kingston , Ontario , Canada , a typical suburban region , through the general media . We selected men with a body mass index greater than 27 kg/m2 and a waist circumference greater than 100 cm whose weight had been stable ( 2 kg ) for 6 months before study entry . Participants were nonsmokers who consumed an average of fewer than two alcoholic beverages per day , had a sedentary lifestyle , and took no medications known to affect the principal outcome measures . All participants had a preparticipation medical examination that included screening for normal glucose tolerance and plasma lipid profile . A computer program was used to r and omly assign eligible men to one of the following four groups : control , diet-induced weight loss , exercise-induced weight loss , and exercise without weight loss ( Figure 1 ) 
    Output:
    
agent
***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 & AIMS High red and processed meat consumption is related to type 2 diabetes . In addition , cooking meat at high temperatures for a long duration forms heterocyclic amines ( HCAs ) , which are related to oxidative stress . However , the association between meat consumption and non-alcoholic fatty liver disease ( NAFLD ) is yet to be thoroughly tested . Therefore , we aim ed to test the association of meat type and cooking method with NAFLD and insulin resistance ( IR ) . METHODS This was a cross-sectional study in individuals who were 40 - 70 years old and underwent screening colonoscopy between 2013 and 2015 in a single center in Israel . NAFLD and IR were evaluated by ultrasonography and homeostasis model assessment . Meat type and cooking method were measured by a food frequency question naire ( FFQ ) and a detailed meat question naire . Unhealthy cooking methods were considered as frying and grilling to a level of well done and very well done . Dietary HCA intake was calculated . RESULTS A total of 789 individuals had a valid FFQ and 357 had a valid meat question naire . High consumption of total meat  ( portions/day above the median ) ( odds ratio [ OR ] 1.49 ; 95 % CI 1.05 - 2.13 ; p = 0.028 ; OR 1.63 ; 1.12 - 2.37 ; p = 0.011 ) ,  red and /or processed meat  ( OR1.47 ; 95 % CI 1.04 - 2.09 ; p = 0.031 ; OR1.55 ; 1.07 - 2.23 ; p = 0.020 ) was independently associated with higher odds of NAFLD and IR , respectively , when adjusted for : body mass index , physical activity , smoking , alcohol , energy , saturated fat and cholesterol intake . High intake of meat cooked using unhealthy methods ( OR1.92 ; 95 % CI 1.12 - 3.30 ; p = 0.018 ) and HCAs ( OR2.22 ; 95 % CI 1.28 - 3.86 ; p = 0.005 ) were independently associated with higher odds of IR . CONCLUSION High consumption of red and /or processed meat is associated with both NAFLD and IR . High HCA intake is associated with IR . If confirmed in prospect i ve studies , limiting the consumption of unhealthy meat types and improving preparation methods may be considered as part of NAFLD lifestyle treatment . LAY SUMMARY High red and processed meat consumption is related to several diseases . In addition , cooking meat at high temperatures for a long duration forms heterocyclic amines , which have harmful health effects . Non-alcoholic fatty liver disease is a significant public health burden and its formation is strongly related to insulin resistance . In this study , both were found to be more frequent in people who consume relatively high quantities of red and processed meat .  In addition , a high intake of heterocyclic amines was associated with insulin resistance BACKGROUND & AIMS Nonalcoholic fatty liver disease ( NAFLD ) is associated with increased risk of hepatic , cardiovascular , and metabolic diseases . High-protein diets , rich in methionine and branched chain amino acids ( BCAAs ) , apparently reduce liver fat , but can induce insulin resistance . We investigated the effects of diets high in animal protein ( AP ) vs plant protein ( PP ) , which differ in levels of methionine and BCAAs , in patients with type 2 diabetes and NAFLD . We examined levels of liver fat , lipogenic indices , markers of inflammation , serum levels of fibroblast growth factor 21 ( FGF21 ) , and activation of signaling pathways in adipose tissue . METHODS We performed a prospect i ve study of individuals with type 2 diabetes and NAFLD at a tertiary medical center in Germany from June 2013 through March 2015 . We analyzed data from 37 subjects placed on a diet high in AP ( rich in meat and dairy foods ; n = 18 ) or PP ( mainly legume protein ; n = 19 ) without calorie restriction for 6 weeks . The diets were isocaloric with the same macronutrient composition ( 30 % protein , 40 % carbohydrates , and 30 % fat ) . Participants were examined at the start of the study and after the 6-week diet period for body mass index , body composition , hip circumference , resting energy expenditure , and respiratory quotient . Body fat and intrahepatic fat were detected by magnetic resonance imaging and spectroscopy , respectively . Levels of glucose , insulin , liver enzymes , and inflammation markers , as well as individual free fatty acids and free amino acids , were measured in collected blood sample s. Hyperinsulinemic euglycemic clamps were performed to determine whole-body insulin sensitivity . Subcutaneous adipose tissue sample s were collected and analyzed for gene expression patterns and phosphorylation of signaling proteins . RESULTS Postpr and ial levels of BCAAs and methionine were significantly higher in subjects on the AP vs the PP diet . The AP and PP diets each reduced liver fat by 36%-48 % within 6 weeks ( for AP diet P = .0002 ; for PP diet P = .001 ) . These reductions were unrelated to change in body weight , but correlated with down-regulation of lipolysis and lipogenic indices . Serum level of FGF21 decreased by 50 % in each group ( for AP diet P < .0002 ; for PP diet P < .0002 ) ; decrease in FGF21 correlated with loss of hepatic fat . In gene expression analyses of adipose tissue , expression of the FGF21 receptor cofactor β-klotho was associated with reduced expression of genes encoding lipolytic and lipogenic proteins . In patients on each diet , levels of hepatic enzymes and markers of inflammation decreased , insulin sensitivity increased , and serum level of keratin 18 decreased . CONCLUSIONS In a prospect i ve study of patients with type 2 diabetes , we found diets high in protein ( either animal or plant ) significantly reduced liver fat independently of body weight , and reduced markers of insulin resistance and hepatic necroinflammation . The diets appear to mediate these changes via lipolytic and lipogenic pathways in adipose tissue . Negative effects of BCAA or methionine were not detectable . FGF21 level appears to be a marker of metabolic improvement . Clinical Trials.gov ID NCT02402985 OBJECTIVE To evaluate the efficacy of low carbohydrate diet ( LCD ) as compared with low fat diet ( LFD ) to decrease aminotransferase levels in obese women with nonalcoholic fatty liver disease . MATERIAL AND METHODS A total of 59 women were r and omly enrolled in a non-controlled clinical intervention study to receive either LCD or LFD during six months . Apparently healthy non-pregnant obese women aged 20 to 65 years were eligible to participate . Previous diagnosis of hepatic disease , serum creatinine level ≥ 1.5 mg/dL , severe life-limiting medical illness , pregnancy , active participation in other dietary program , use of weight loss drugs , or alcohol consumption ≥ 30 g per day were exclusion criteria . RESULTS A total of 31 obese women who received LCD were compared with 28 women allocated in the LFD group . There were 3 ( LCD group ) and 2 ( LFD group ) women with lost of follow-up . No differences in the proportion of type 2 diabetes , hypertension and hyperlipidemia were noted between women in the LCD and LFD groups . At end of follow-up , there were not significant statistical differences in the anthropometric and biochemical characteristics between women in both groups . The weight loss was 5.7 and 5.5 % for women in the LCD LFD groups . Although the decrease of AST ( 31.7 and 22.4 % ) and ALT ( 41 and 33.3 % ) levels was more elevated in the women of LCD group , as compared with the LFD group , there were not significant statistical differences . CONCLUSIONS Our results show that weight loss , irrespective of the type of diet , reduces aminotransferase levels in obese women with NAFLD OBJECTIVE The aim of our study was to examine the changes in hypertransaminasemia after weight reduction in obese patients with and without NAFLD and the relation with insulin resistance . RESEARCH METHODS A population of 162 obese patients was r and omly allocated to two groups : a ) diet I ( low fat ) and b ) diet II ( low carbohydrate ) , dieting along 3 months .  Patients were classified as group I ( n=112 ) when serum ALT activity was normal or group II ( NAFLD , n=30 ) when serum ALT activity was ( > or=43 UI/L ) . RESULTS In control group with diet I , BMI , weight , fat mass , waist to hip ratio , waist circumference , systolic pressure , total cholesterol , LDL cholesterol , HOMA and insulin levels decreased . In NAFLD group with diet I improved the same parameters and glucose , triglycerides , ALT , AST , gamaglutamine transferase levels , too . In control group with diet II , BMI , weight , fat mass , waist to hip ratio , waist circumference , systolic pressure , total cholesterol , LDL cholesterol , HOMA and insulin levels decreased . In NAFLD group with diet II improved the same parameters and glucose , triglycerides , ALT and gamaglutamine transferase levels , without statistical changes in AST . CONCLUSION We showed that weight reduction secondary to two hypocaloric diets was associated with improvement in hipertransaminasemia and insulin resistance in NAFLD patients In 1997 , the World Health Organization published a l and mark document recognizing obesity as a worldwide disease that poses a serious threat to public health ( 1 ) . Persons who are overweight or obese have substantially increased risk for morbidity from numerous chronic disorders , such as diabetes ( 2 , 3 ) , hypertension ( 4 , 5 ) , and cardiovascular disease ( 6 , 7 ) . Obesity-related health risk is greater when excess fat is deposited in the abdomen region because this phenotype is a stronger predictor of cardiovascular disease and type 2 diabetes mellitus than general obesity is ( 8 - 11 ) . This may be partially explained by excess accumulation of visceral fat , an independent correlate of insulin resistance ( 9 - 11 ) and dyslipidemia ( 8 , 9 ) . These observations highlight the need to identify appropriate treatment strategies to prevent and reduce obesity and suggest that the effectiveness of these treatments would be enhanced if abdominal obesity , particularly visceral fat , was substantially reduced . Diet restriction remains the most common method of obesity reduction ( 12 ) . Despite the observation that low levels of physical activity are a major cause of obesity ( 13 ) , increased physical activity alone is not thought to be a useful strategy for obesity reduction . Some reports have suggested that physical activity in obese adults results in only modest weight loss ( approximately 1 to 2 kg ) independent of the effects of diet restriction ( 14 ) . However , these conclusions are drawn from studies in which individual energy intake and expenditure were not rigorously controlled or accurately measured ( 15 - 17 ) . Moreover , in most studies , the negative energy balance induced by exercise was modest enough that substantial weight loss was not expected ( 15 - 17 ) . Currently , no compelling evidence supports the observation that exercise alone is not a useful method for reducing total or abdominal obesity . It is well known that a single exercise session is associated with a significant improvement in insulin-stimulated glucose uptake ( 18 , 19 ) . It is also clear that weight loss is associated with an improvement in insulin action ( 20 - 24 ) . It is unclear , however , whether regular exercise improves glucose metabolism after the short-term effects of exercise and changes in body fat distribution are considered . Segal and colleagues ( 25 ) controlled for the confounding effect of the last exercise session and body composition changes and found that exercise had no independent effect on insulin sensitivity ( 25 ) . Given the established importance of insulin resistance as an antecedent to both cardiovascular disease and type 2 diabetes mellitus ( 26 ) , it is important to clarify whether exercise improves insulin action independent of fat loss . We performed a r and omized , controlled trial to determine the independent effect of diet-induced or exercise-induced weight loss on obesity and insulin resistance in moderately obese men . We also evaluated whether exercise without weight loss was associated with reductions in abdominal obesity and insulin resistance . Methods Participants Participants were recruited from Kingston , Ontario , Canada , a typical suburban region , through the general media . We selected men with a body mass index greater than 27 kg/m2 and a waist circumference greater than 100 cm whose weight had been stable ( 2 kg ) for 6 months before study entry . Participants were nonsmokers who consumed an average of fewer than two alcoholic beverages per day , had a sedentary lifestyle , and took no medications known to affect the principal outcome measures . All participants had a preparticipation medical examination that included screening for normal glucose tolerance and plasma lipid profile . A computer program was used to r and omly assign eligible men to one of the following four groups : control , diet-induced weight loss , exercise-induced weight loss , and exercise without weight loss ( Figure 1 ) 
    Output:
    