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Background: Previous studies showed that higher serum uric acid levels increased the risk of chronic kidney disease (CKD), but moderate alcohol consumption decreased it. The comparative importance of serum uric acid levels and habitual alcohol consumption as risk factors for CKD remain undefined. We therefore evaluated the relationship of baseline serum uric acid level in combination with daily alcohol consumption to the incidence of CKD.Methods: A prospective cohort study of 9,116 middle-aged nondiabetic -Japanese men without CKD nor proteinuria who were not taking antihypertensive medications nor urate-lowering medications at entry. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2. We investigated the relationship of baseline serum uric acid level in combination with daily alcohol consumption to the incidence of CKD during an 11-year observation period. Daily alcohol consumption was classified into 4 groups: nondrinkers, light drinkers (0.1-23.0 g ethanol/day), moderate drinkers (23.1-46.0 g ethanol/day), and heavy drinkers (≥46.1 g ethanol/day). Cox proportional hazards models were used in multivariate analysis.Results: During the 79,361 person-years follow-up period, a total of 1,230 subjects developed CKD. In multivariate models, higher serum uric acid levels increased risk of CKD; and moderate daily alcohol consumption decreased the risk. Multiple-adjusted hazard ratios of CKD were 1.38 (95% CI 1.11-1.70), 1.58 (95% CI 1.28-1.95), 2.27 (95% CI 1.86-2.77), and 3.12 (95% CI 2.56-3.81) for quintile 2, quintile 3, quintile 4, and quintile 5 of serum uric acid levels, respectively, compared with quintile 1, and that for moderate drinkers was 0.55 (95% CI 0.46-0.66) compared with nondrinkers. In the joint analysis of alcohol consumption and serum uric acid, moderate drinkers with the lowest tertile of serum uric acid levels had the lowest risk of CKD, but nondrinkers with the highest tertile of serum uric acid levels had the highest risk of CKD.Conclusions: Serum uric acid level and daily alcohol consumption were independently associated with the risk of CKD. Nondrinkers with the highest serum uric acid level had the highest risk of CKD. [ABSTRACT FROM AUTHOR]

Accurate simulation of residual stress and deformation is necessary to optimize the design and lifetime of casting components. Therefore, the recovery and strain-rate dependence of the stress-strain curve have been incorporated into empirical constitutive equations to improve the thermal stress analysis accuracy. Nevertheless, these equations present several difficulties related to the determination of material constants and their physical bases. This study suggested an empirical elasto-plastic-creep constitutive equation incorporating these phenomena. To determine the material parameters used in this constitutive equation, this study investigated tensile test methods to obtain stress-strain curves that most closely resemble those during or immediately after casting for the Al-Si-Cu high-pressure die-casting alloy JIS ADC 12 (A383.0), which exhibits natural aging. Results show that solution heat treatment with subsequent cooling to the test temperature should be applied to obtain stress-strain curves used for the thermal stress analysis of high-pressure die casting process of this alloy. The yield stresses obtained using the conventional heating method were 50-64 pct higher than those of the method described above. Therefore, the conventional method is expected to overestimate the overestimation of the predicted residual stress in die castings. Evaluation of the developed equation revealed that it can represent alloy recovery and strain-rate dependence. [ABSTRACT FROM AUTHOR]

Background/Aims: The association between alcohol consumption and the risk of chronic kidney disease (CKD) has been reported. What is not known is whether drinking pattern combined with the weekly frequency of alcohol consumption and the quantity per drinking day is associated with the risk of CKD. Methods: We enrolled 9,112 Japanese nondiabetic men aged 40 to 55 years with absence of proteinuria, an estimated glomerular filtration rate (eGFR) of 60 ml/min/1.73 m2 or higher, and not on antihypertensive medications at baseline. CKD was defined if eGFR was <60 ml/min/1.73 m2. The weekly frequency classification was nondrinkers, 1-3 drinking days/week, or 4-7 drinking days/week. The quantity consumed per drinking day was classified as 0.1-23.0 g ethanol/drinking day, 23.1-46.0 g ethanol/drinking day, 46.1-69.0 g ethanol/drinking day, and ≥69.1 g ethanol/drinking day. Results: During the 79,099 person-years, 1,253 subjects developed CKD. Compared to nondrinkers, those who consumed 23.1-46.0 or 46.1-69.0 g ethanol/drinking day on 4-7 drinking days/week had a decreased risk of CKD (multiple-adjusted hazard ratio (HR) 0.62 (0.52-0.74) and 0.76 (0.59-0.97), respectively). The association between the quantity per drinking day and the incidence of CKD was U-shaped among each category of the weekly frequency. HRs within similar categories of quantity per drinking day were lower in the 4-7 drinking days/week group than in the 1-3 drinking days/week group. Conclusion: Among middle-aged Japanese men, the people who drank middle-range quantity, specifically who drank 4-7 days/week, had lower risk of CKD than nondrinkers. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background Moderate alcohol consumption is associated with a decreased risk of type 2 diabetes. However, the relationship between drinking patterns, such as the weekly frequency of alcohol consumption and the quantity per drinking day, and the incidence of type 2 diabetes has not been sufficiently addressed. Methods Study participants included 10 631 Japanese men aged 40e55 years without type 2 diabetes at entry. Type 2 diabetes was diagnosed if a fasting plasma glucose level was $7.0 mmol/l or if participants were taking diabetes medications. Data on alcohol consumption were obtained from questionnaires. Results During the 37 172 person-years of follow-up, we confirmed 878 cases of type 2 diabetes. Frequent alcohol consumption was associated with a low risk of type 2 diabetes. Compared to non-drinkers, the multiple-adjusted HR for those who drank 4e7 days weekly was 0.76 (95% CI, 0.63 to 0.92). To assess the association between drinking pattern and type 2 diabetes, we examined the joint association of the weekly frequency and the quantity per drinking day with type 2 diabetes. Men who consumed 0.1e2.0 or 2.1e4.0 US standard drinks per drinking day on 4e7 days weekly had a lower risk of type 2 diabetes (HR 0.74, 95% CI 0.58 to 0.95; HR 0.74, 95% CI 0.60 to 0.91, respectively) compared to non-drinkers. Conclusions More frequent alcohol consumption lowered the risk of type 2 diabetes. Light to moderate alcohol consumption per drinking day on 4e7 days weekly lowered the risk of type 2 diabetes compared to non-drinkers. [ABSTRACT FROM AUTHOR]

Background/Aims: No prospective studies have estimated the association between white blood cell (WBC) count and the risk of proteinuria. We prospectively examined the relationships of WBC count, as a marker of inflammation, with two outcomes: proteinuria and low estimated glomerular filtration rate (eGFR). Methods: We enrolled 10,008 Japanese men aged 40-55 years who had neither proteinuria nor low eGFR and were not taking antihypertensive medications at entry. Proteinuria was defined as 1+ or higher on urine dipstick. Low eGFR was defined if eGFR was <60 ml/min/1.73 m2. Results: During the 49,644 person-years of follow-up, 1,557 cases of proteinuria were confirmed. After adjusting for age, body mass index, fasting plasma glucose, systolic blood pressure, diastolic blood pressure, antidiabetic medications, alcohol consumption, smoking, regular leisure-time physical activity and eGFR, the highest quintile (≥7.51 × 103/μl) of WBC count was independently associated with an increased risk of incidence of proteinuria [HR: 1.45 (95% CI: 1.23-1.73)] compared with the lowest quintile (≤4.80 × 103/μl). On the other hand, during 52,833 person-years, we confirmed 439 cases of low eGFR. In multivariate models, there was no association between WBC count and low eGFR. Conclusion: Elevated WBC count was independently associated with an increased risk of proteinuria, but not low eGFR. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background:It has been reported that a continuous intake of a catechin beverage will reduce body fat. Traditionally, improvement of eating and exercise habits has been the basis for prevention and reduction of obesity. In this study, we conducted a trial involving human subjects who ingested a catechin beverage for 1 year under nutritional guidance.Methods:This study was conducted based on a comprehensive cohort design using a catechin beverage (containing 588 mg of tea catechins) and a control beverage (containing 126 mg of tea catechins). At both the start and the end of the trial, the subjects underwent an annual health check and computer tomography for measurement of their abdominal fat. In addition, a food intake survey was conducted and all subjects were provided nutritional guidance by a registered dietitian every 3 months.Results:Data were analyzed using per protocol samples of 134 subjects (catechin group, n 77; control group, n 57). Body weight and body mass index were reduced significantly in the catechin group compared to the control group. Changes in body weight during the study period were −1.1 kg in the catechin group and 0.2 kg in the control group. In the catechin group, the visceral fat areas at the start of the trial were significantly correlated with the magnitude of fat reduction at the end of the trial. Under the guidance of a registered dietitian, subjects in the catechin group who showed a reduction in their fat-derived energy percentage during the test period tended to reduce more body weight than those with an increase in this percentage, although no difference in total energy intake was noted between the two groups. One-year ad libitumconsumption of a catechin beverage posed no health risks and resulted in a reduction in body weight.Conclusions:An overall improvement in dietary habits might enhance the weight-reduction effect of the beverage. [ABSTRACT FROM AUTHOR]

Prediabetes is a key risk for type 2 diabetes and its remission to normal glucose regulation has been shown to prevent or delay the onset of diabetes. However, which factors play roles in remission is not fully understood. We prospectively examined the relationships between liver enzymes at baseline and future remission from impaired fasting glucose (IFG) to normal fasting glucose (NFG). We included 3334 middle-aged Japanese men with IFG and not taking diabetic medications at baseline. They were followed for up to 11 years. IFG was defined as fasting plasma glucose level 100-125 mg/dL and HbA1c <6.5%. Remission to NFG was defined as fasting plasma glucose level <100 mg/dL detected two times consecutively at the annual checkup. Those who had developed diabetes before they achieved remission to NFG were not counted as remission. Cox proportional hazard models were used to estimate hazard ratios (HRs) for achieving remission to NFG. Alanine transaminase (ALT) and aspartate transaminase (AST) were divided into the following quartiles: 5-19, 20-26, 27-37, and ≥38 IU/L for ALT; 11-19, 20-23, 24-29, and ≥30 IU/L for AST. A total of 1224 subjects remitted to NFG during 19780 person-years. Incidence rates per 1000 person-years for quartiles 1, 2, 3, and 4 of ALT/AST were 81/65, 62/67, 56/60, and 49/56, respectively. In a multiple-adjusted model that included age, fasting plasma glucose, body mass index, smoking status, regular physical exercise, alcohol consumption, and family history of diabetes, HRs of future remission to NFG for quartiles 2, 3, and 4 of ALT were 0.84 (95% CI, 0.72-0.99), 0.84 (0.72-0.99), and 0.82 (0.69-0.97), respectively, compared to quartile 1. In the same model except AST was substituted for ALT, HRs of those for quartiles 2, 3, and 4 of AST were 1.04 (0.89-1.22), 1.02 (0.87-1.20), and 1.02 (0.87-1.21), respectively, compared to quartile 1. In conclusion, elevated ALT was inversely associated with future remission from IFG to NFG, but AST was not. Disclosure: I. Shibata: None. K.K. Sato: None. M. Shibata: None. H. Koh: None. S. Uehara: None. K. Oue: None. H. Kambe: None. M. Morimoto: None. T. Hayashi: None. [ABSTRACT FROM AUTHOR]

Decline in kidney function is a major concern for patients with type 2 diabetes. The importance of serum uric acid level as the risk factor for chronic kidney disease (CKD) remains unconfirmed. We therefore evaluated the relationship between baseline serum uric acid level and the risk of incident CKD among men with untreated type 2 diabetes at baseline examination in a 10-11 years prospective cohort study. We included 717 middle-aged Japanese subjects with fasting plasma glucose level ≥126 mg/dL or HbA1c ≥6.5% at baseline who were not taking hypoglycemic medications nor insulin, who had an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2, who did not have proteinuria nor malignant tumors, and who were not taking anti-hypertensive medications nor urate-lowering medications at baseline. CKD was defined as eGFR <60 ml/min/1.73 m2. Cox proportional hazards models were used in the multivariate analysis. During the 5961 person-years follow-up period, 87 subjects developed CKD. Higher serum uric acid level was associated with an increased risk of CKD after adjustment for age, body mass index, systolic blood pressure, diastolic blood pressure, HbA1c, smoking habits (nonsmokers, past smokers, and current smokers), regular leisure-time physical activity (yes/no), daily alcohol consumption (g ethanol/day), and eGFR at baseline. Multiple-adjusted hazard ratios of CKD for quintile 4 (6.2-6.9 mg/dL) and quintile 5 (≥7.0 mg/dL) of serum uric acid levels were 1.30 (95% CI, 0.73-2.30) and 1.80 (95% CI, 1.04-3.11), respectively, compared with quintile 1 to 3 (0.7-6.1 mg/dL). Moreover, when we modeled serum uric acid level as a continuous variable, serum uric acid level per 1.0 mg/dL increase was significantly associated with a 25% increased risk of incident CKD. In conclusion, higher serum uric acid level is independently and significantly associated with an increased risk of CKD in patients with untreated type 2 diabetes. Disclosure: Y. Okada: None. K.K. Sato: None. M. Shibata: None. S. Uehara: None. H. Koh: None. K. Oue: None. H. Kambe: None. M. Morimoto: None. T. Hayashi: None. [ABSTRACT FROM AUTHOR]

Cigarette smoking is a risk factor for type 2 diabetes and cardiovascular disease. Not known is whether smoking habit is associated with the risk of developing the metabolic syndrome among men. Study subjects consisted of 7355 Japanese men aged 40 to 55 years without the metabolic syndrome. The metabolic syndrome was defined using modified Adult Treatment Panel III criteria using body mass index in place of waist circumference. Data on smoking habit was obtained from questionnaires. During the 4-year follow-up period, we confirmed 806 cases of the metabolic syndrome. After adjustment for age, body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, HDL cholesterol, fasting plasma glucose, alcohol daily consumption, and physical activity, the odds ratio (OR) of the metabolic syndrome among current smokers was 1.30 (95% confidence interval (CI) 1.04-1.61) in comparison to never smokers. Men who smoked more than 30 cigarettes a day had a higher risk compared with never smokers (OR 1.61, 95% CI 1.16-2.24) (Table 1). To evaluate the chronic effect of cigarettes smoking for the risk of the incidence of the metabolic syndrome, we assessed the relationship between pack-years and the risk of the metabolic syndrome. The value of pack-years is also associated with the increased risk of the metabolic syndrome in a dose-dependent manner. The multiple-adjusted OR for those whose pack-years value is more than 40 is 1.49 (95% CI 1.12-1.98). Furthermore, we assessed the association between cigarettes smoking and the incidence of the components of the metabolic syndrome. Cigarette smoking was associated with the risk of the incidence of hyperglycemia, high triglycerides, and low HDL cholesterol but not high blood pressure or high body mass index. In conclusion, cigarette smoking habit is an independent risk factor for the development of the metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: Serum gamma-glutamyltransferase has been recognized as the risk factor of cardiovascular and metabolic diseases. However, the association between serum gamma-glutamyltransferase and the risk of chronic kidney disease is not well known, and no prospective studies have examined separately the relationship of serum gamma-glutamyltransferase with the risk of proteinuria versus that of low estimated glomerular filtration rate (eGFR)., Methods: We prospectively followed 9,341 Japanese men who did not have low eGFR, proteinuria, or diabetes, and did not take antihypertensive medications at entry for the analysis of proteinuria, and we followed 9,299 men for the analysis of low eGFR. We defined "persistent proteinuria" as proteinuria detected two or more times consecutively and persistently as ≥1+ on urine dipstick at the annual check-up until the end of follow-up. Low eGFR was defined as eGFR <60 mL/min/1.73 m 2 ., Results: During the 11-year observation period, 151 men developed persistent proteinuria and 1,276 men developed low eGFR. In multivariate models, the highest quartile (≥71 IU/L) of serum gamma-glutamyltransferase was independently related to the development of persistent proteinuria (hazard ratio 3.39; 95% confidence interval, 1.92-5.97) compared with the lowest quartile (≤25 IU/L). In joint analysis of alcohol consumption and serum gamma-glutamyltransferase, non-drinkers in the highest tertile (≥58 IU/L) of serum gamma-glutamyltransferase had the highest risk of persistent proteinuria. However, there was no association between serum gamma-glutamyltransferase and low eGFR., Conclusion: In middle-aged Japanese men, elevated serum gamma-glutamyltransferase was independently associated with future persistent proteinuria, but not with low eGFR.

Background: Metabolically healthy obesity seems to be a unique phenotype for the risk of cardiometabolic diseases. However, it is not known whether this phenotype is associated with the risk of proteinuria., Methods: Study subjects were 9,185 non-diabetic Japanese male workers aged 40-55 years who had no proteinuria, an estimated glomerular filtration rate ≥60 mL/min/1.73 m 2 , no history of cancer, and no use of antihypertensive or lipid-lowering medications at baseline. Obesity was defined as body mass index ≥25.0 kg/m 2 . Metabolic health was defined as the presence of no Adult Treatment Panel III components of the metabolic syndrome criteria, excluding waist circumference, and metabolic unhealth was defined as the presence of one or more metabolic syndrome components, excluding waist circumference. "Consecutive proteinuria" was considered positive if proteinuria was detected twice consecutively as 1+ or higher on urine dipstick at annual examinations to exclude chance proteinuria as much as possible., Results: During the 81,660 person-years follow-up period, we confirmed 390 cases of consecutive proteinuria. Compared with metabolically healthy non-obesity, metabolically healthy obesity was not associated with the risk of consecutive proteinuria (multiple-adjusted hazard ratio [HR] 0.86; 95% confidence interval [CI], 0.37-1.99), but metabolically unhealthy non-obesity with ≥2 metabolic syndrome components (HR 1.77; 95% CI, 1.30-2.42), metabolically unhealthy obesity with one component (HR 1.71; 95% CI, 1.12-2.61), and metabolically unhealthy obesity with ≥2 metabolic syndrome components (HR 2.77; 95% CI, 2.01-3.82) were associated with an increased risk of consecutive proteinuria., Conclusions: Metabolically healthy obesity did not increase the risk of consecutive proteinuria in Japanese middle-aged men.

Background: Moderate alcohol consumption has been reported to be associated with a decreased risk of cardiometabolic diseases. Whether drinking pattern is associated with the risk of proteinuria is unknown., Methods: Study subjects were 9154 non-diabetic Japanese men aged 40-55 years, with an estimated glomerular filtration rate ≥60 mL/min/1.73 m(2), no proteinuria, and no use of antihypertensive medications at entry. Data on alcohol consumption were obtained by questionnaire. We defined "consecutive proteinuria" as proteinuria detected twice consecutively as 1+ or higher on urine dipstick at annual examinations., Results: During the 81 147 person-years follow-up period, 385 subjects developed consecutive proteinuria. For subjects who reported drinking 4-7 days per week, alcohol consumption of 0.1-23.0 g ethanol/drinking day was significantly associated with a decreased risk of consecutive proteinuria (hazard ratio [HR] 0.54; 95% confidence interval [CI], 0.36-0.80) compared with non-drinkers. However, alcohol consumption of ≥69.1 g ethanol/drinking day was significantly associated with an increased risk of consecutive proteinuria (HR 1.78; 95% CI, 1.01-3.14). For subjects who reported drinking 1-3 days per week, alcohol consumption of 0.1-23.0 g ethanol/drinking day was associated with a decreased risk of consecutive proteinuria (HR 0.76; 95% CI, 0.51-1.12), and alcohol consumption of ≥69.1 g ethanol/drinking day was associated with an increased risk of consecutive proteinuria (HR 1.58; 95% CI, 0.72-3.46), but these associations did not reach statistical significance., Conclusions: Men with frequent alcohol consumption of 0.1-23.0 g ethanol/drinking day had the lowest risk of consecutive proteinuria, while those with frequent alcohol consumption of ≥69.1 g ethanol/drinking day had an increased risk of consecutive proteinuria.

Background/aims: The association between alcohol consumption and the risk of chronic kidney disease (CKD) has been reported. What is not known is whether drinking pattern combined with the weekly frequency of alcohol consumption and the quantity per drinking day is associated with the risk of CKD., Methods: We enrolled 9,112 Japanese nondiabetic men aged 40 to 55 years with absence of proteinuria, an estimated glomerular filtration rate (eGFR) of 60 ml/min/1.73 m(2) or higher, and not on antihypertensive medications at baseline. CKD was defined if eGFR was <60 ml/min/1.73 m(2). The weekly frequency classification was nondrinkers, 1-3 drinking days/week, or 4-7 drinking days/week. The quantity consumed per drinking day was classified as 0.1-23.0 g ethanol/drinking day, 23.1-46.0 g ethanol/drinking day, 46.1-69.0 g ethanol/drinking day, and ≥69.1 g ethanol/drinking day., Results: During the 79,099 person-years, 1,253 subjects developed CKD. Compared to nondrinkers, those who consumed 23.1-46.0 or 46.1-69.0 g ethanol/drinking day on 4-7 drinking days/week had a decreased risk of CKD (multiple-adjusted hazard ratio (HR) 0.62 (0.52-0.74) and 0.76 (0.59-0.97), respectively). The association between the quantity per drinking day and the incidence of CKD was U-shaped among each category of the weekly frequency. HRs within similar categories of quantity per drinking day were lower in the 4-7 drinking days/week group than in the 1-3 drinking days/week group., Conclusion: Among middle-aged Japanese men, the people who drank middle-range quantity, specifically who drank 4-7 days/week, had lower risk of CKD than nondrinkers., (© 2014 S. Karger AG, Basel.)

Background and Objectives: Glomerular hyperfiltration and albuminuria accompanied by early-stage diabetic kidney disease predict future renal failure. Cigarette smoking has reported to be associated with elevated GFR in cross-sectional studies and with renal deterioration in longitudinal studies. The degree of glomerular hyperfiltration and proteinuria associated with smoking, which presumably is a phenomenon of early renal damage, has not been investigated in a satisfying manner so far., Design, Setting, Participants, & Measurements: This study included 10,118 Japanese men aged 40 to 55 years without proteinuria or renal dysfunction at entry. Estimated GFR was calculated using the Modification of Diet in Renal Disease equation for Japanese. Glomerular hyperfiltration was defined as estimated GFR ≥117.0 ml/min per 1.73 m(2), which was the upper 2.5th percentile value of estimated GFR in the total population. Proteinuria was detected using standard dipstick., Results: During the 6-year observation period, there were 449 incident cases of glomerular hyperfiltration and 1653 cases of proteinuria. Current smokers had a 1.32-time higher risk for the development of glomerular hyperfiltration and a 1.51-time higher risk for proteinuria than nonsmokers after adjustment for baseline age, body mass index, systolic and diastolic BP, antihypertensive medication, diabetes, alcohol consumption, regular leisure-time physical activity, and estimated GFR. Both daily and cumulative cigarette consumption were associated with an increased risk for glomerular hyperfiltration and proteinuria in a dose-response manner., Conclusions: In middle-aged Japanese men, smoking was associated with an increased risk of glomerular hyperfiltration and dipstick proteinuria. Of importance, past smokers did not exhibit any increased risk for these conditions.

Background: It has been reported that a continuous intake of a catechin beverage will reduce body fat. Traditionally, improvement of eating and exercise habits has been the basis for prevention and reduction of obesity. In this study, we conducted a trial involving human subjects who ingested a catechin beverage for 1 year under nutritional guidance., Methods: This study was conducted based on a comprehensive cohort design using a catechin beverage (containing 588 mg of tea catechins) and a control beverage (containing 126 mg of tea catechins). At both the start and the end of the trial, the subjects underwent an annual health check and computer tomography for measurement of their abdominal fat. In addition, a food intake survey was conducted and all subjects were provided nutritional guidance by a registered dietitian every 3 months., Results: Data were analyzed using per protocol samples of 134 subjects (catechin group, n = 77; control group, n = 57). Body weight and body mass index were reduced significantly in the catechin group compared to the control group. Changes in body weight during the study period were -1.1 kg in the catechin group and 0.2 kg in the control group. In the catechin group, the visceral fat areas at the start of the trial were significantly correlated with the magnitude of fat reduction at the end of the trial. Under the guidance of a registered dietitian, subjects in the catechin group who showed a reduction in their fat-derived energy percentage during the test period tended to reduce more body weight than those with an increase in this percentage, although no difference in total energy intake was noted between the two groups. One-year ad libitum consumption of a catechin beverage posed no health risks and resulted in a reduction in body weight., Conclusions: An overall improvement in dietary habits might enhance the weight-reduction effect of the beverage.