***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 
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    Input: Background Physical exercise and a Mediterranean diet improve serum lipid profile . Thepresent work studied whether red wine has an effect on top of alipid-lowering lifestyle in patients with carotid atherosclerosis . Methods A prospect i ve r and omised unblinded trial was performed from 2009 to 2011 in108 patients with carotid atherosclerosis , 65 % of whom were already onstatin therapy with a low mean LDL of 104.9 mg/dl . Half of them wereadvised to follow a modified Mediterranean diet and to perform moderatephysical exercise during 30 min/day ( lifestyle changes ) for20 weeks . Within these two groups half of the patients were r and omisedeither to avoid any alcohol or to drink 100 ml of red wine ( women ) or200 ml of red wine ( men ) daily . Results LDL was significantly lowered by 7 % in the lifestyle-changes group comparedto the no-lifestyle-changes group ( p = 0.0296 ) after20 weeks . Lifestyle changes  lowered the LDL/HDL ratio after20 weeks by 8 % ( p = 0.0242 ) and red wine independently by13 % ( p = 0.0049 ) . The effect on LDL/HDL ratio after20 weeks was , however , more pronounced in the non-LC group . Totalcholesterol ( −6 % ; p = 0.0238 ) and triglycerides(−13 % ; p = 0.0361 ) were lowered significantly by lifestylechanges after 20 weeks compared to the no-lifestyle-changes group . Lipoprotein ( a ) was not significantly affected by any intervention . Thegiven results are per ITT analysis . Conclusions Lifestyle changes including a modified Mediterranean diet and physicalexercise as well as a glass of red wine daily improve independently theLDL/HDL ratio in patients with carotid arteriosclerosis even though the vastmajority of them was already on statin therapy . Trial registration http://www . clinical trials.gov , Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design Background Women with pathogenic BRCA germline mutations have an increased risk for breast and ovarian cancer that seems to be modified by life-style factors . Though , r and omized trials investigating the impact of lifestyle interventions on cancer prevention and prognosis in BRCA carriers are still missing . Methods We implemented a multicenter , prospect i ve r and omized controlled trial in BRCA1/2 patients , comparing a lifestyle intervention group ( IG ) with a control group ( CG ) with the primary aim to prove feasibility . Intervention comprised a structured , individualized endurance training alongside nutrition education based on the Mediterranean diet ( MD ) for 3 months , plus monthly group training and regular telephone contact during the subsequent 9 months . The CG attended one session on healthy nutrition and the benefits of physical activity . Primary endpoints were feasibility , acceptance and satisfaction over 12 months . Furthermore , effects on physical fitness , diet profile , body mass index ( BMI ) , quality of life and perceived stress were investigated . Results Sixty-eight participants ( mean age 41 , mean BMI 23.2 kg/m2 ) were enrolled , of whom 55 ( 81 % , 26 IG , 29 CG ) completed 12 months . 73 % ( n = 26 ) participated in at least 70 % of all intervention sessions . Predictors for drop-outs ( 19 % ; n = 13 ) or non-adherence ( 27 % ; n = 7 ) were not found . 73 % rated the program highly and 80 % would participate again . Severe adverse events did not occur . Positive effects in the IG compared to the CG were observed for secondary endpoints : BMI , MD eating pattern and stress levels . Conclusions This lifestyle intervention was feasible , safe and well accepted . Positive results on eating habits , physical fitness and stress levels warrant a larger r and omized trial . Trial registration The study has been retrospectively registered at Clinical Trials.gov ( reference : NCT02087592 ) on March 12 , 2014 . The first patient was included on February 24 , 2014 Objective : The aim of this work was to evaluate the combined effect of physical activity and 1 and 12 months ’ adherence to Mediterranean diet ( MD ) on serum total antioxidant capacity ( TAC ) in obese patients , as well as factors contributing to TAC . Methods : One hundred twenty-four patients were r and omly assigned to either MD combined with physical activity or st and ard hypolypemic diet ( SHD ) with physical activity . Both groups received counseling and education during the initial week and were invited for the follow-up visits , where data on body weight and blood sample s were collected . TAC was determined by Trolox equivalent antioxidant capacity and urate was determined using a uricase spectrophotometric method at the initial visit and after 1 and 12 months . Results : Eighty-four patients finished the 12-month program and were analyzed . The baseline and 1- and 12-month mean ( ±SD ) TAC values in the MD group ( n = 40 ) were 2.38 ± 0.48 , 2.51 ± 0.47 , and 2.47 ± 0.45 mmol Trolox equivalent (TE)/L , respectively . In the SHD group ( n = 44 ) , TAC values were 2.37 ± 0.49 , 2.48 ± 0.49 , and 2.31 ± 0.51 mmol TE/L , respectively . There was a statistically significant main effect for time ( p < 0.001 ) , as well as statistically significant time – diet interaction effect ( p = 0.009 ) . There was no statistically significant correlation between TAC and uric acid after 1 month ( p = 0.733 ) or 12 months ( p = 0.844 ) of the intervention . Based on the regression model , which included gender , diet , physical activity level , and percentage body weight change , the type of diet was the only significantly contributing factor to TAC change after the 12-month period , F = 3.867 , df = 3 , p = 0.012 , R = 0.358 , R2 = 0.128 . Conclusion : This r and omized controlled trial with diet and physical activity intervention and TAC as a primary outcome demonstrated initial antioxidant improvement in both  MD and SHD groups and a long-term beneficial effect of MD . The results imply that diet composition — olive oil , nuts , and fish in particular — combined with physical activity modify antioxidant capacity The aging effect on microvascular integrity , marked by endothelial dysfunction and reduction in exercise tolerance , is a major cause of CVD ( cardiovascular disease ) . Improved dietary habits , known to reduce morbidity and mortality , are also known to attenuate those aging effects . The present study investigated the effects of combined MD ( Mediterranean diet ) and exercise intervention on lower- and upper-limb cutaneous microvascular functions in an older healthy population . A total of 22 sedentary healthy participants ( age , 55±4 years ) underwent cardiopulmonary exercise tolerance test , and were assessed for their upper- and lower-limb vascular endothelial CVC ( cutaneous vascular conductance ) using LDF ( laser Doppler fluximetry ) with endothelium-dependent [ ACh ( acetylcholine chloride ) ] and -independent [ SNP ( sodium nitroprusside ) ] vasodilation . Participants were then r and omized into two groups : MD and non-MD , and followed an 8-week intervention programme , which included discontinuous treadmill running based on each individual 's exertion , twice per week . Exercise training  improved CVC in both groups ( e.g. 0.42±0.19 compared with 1.50±1.05 and 0.47±0.26 compared with 1.15±0.59 at 1000 μCb for MD and non-MD respectively ; P<0.001 ) . This was also combined by improvement in the exercise tolerance indicated by increased VT ( ventilatory threshold ) in both groups [ 12.2±2.8 compared with 14.8±2.8 ml·(kg of body weight)(-1)·min(-1 ) and 11.7±2.7 compared with 14.6±3.2 ml·(kg of body weight)(-1)·min(-1 ) for MD and non-MD groups respectively ; P<0.05 ] . However , the MD group showed greater improvement in endothelium-dependent vasodilation than non-MD [ ANCOVA ( analyses of co-variance ) , P=0.02 ] . The results of the present study suggest that compliance with MD , combined with regular moderate exercise , improves age-provoked microcirculatory endothelial dysfunction and increases exercise tolerance , both responsible for reducing cardiovascular risk in this age group OBJECTIVE To assess the long-term effects of dietary interventions on glycemic control , need for diabetes medications , and remission of type 2 diabetes . RESEARCH DESIGN AND METHODS Originally , in a two-arm trial design , overweight , middle-aged men and women with newly diagnosed type 2 diabetes were r and omized to a low-carbohydrate Mediterranean diet ( LCMD ; n = 108 ) or a low-fat diet ( n = 107 ) . After 4 years , participants who were still free of diabetes medications were further followed up until the primary end point ( need of a diabetic drug ) ; remission of diabetes ( partial or complete ) and changes in weight , glycemic control , and cardiovascular risk factors were also evaluated . RESULTS The primary end point was reached in all participants after a total follow-up of 6.1 years in the low-fat group and 8.1 years in the LCMD group ; median survival time was 2.8 years ( 95 % CI 2.4–3.2 ) and 4.8 years ( 4.3–5.2 ) , respectively . The unadjusted hazard ratio for the overall follow-up was 0.68 ( 0.50–0.89 ; P < 0.001 ) . LCMD participants were more likely to experience any remission ( partial or complete ) , with a prevalence of 14.7 % ( 13.0–16.5 % ) during the first year and 5.0 % ( 4.4–5.6 % ) during year 6 compared with 4.1 % ( 3.1–5.0 % ) at year 1 and 0 % at year 6 in the low-fat diet group . CONCLUSIONS In patients with newly diagnosed type 2 diabetes , an LCMD result ed in a greater reduction of HbA1c levels , higher rate of diabetes remission , and delayed need for diabetes medication compared with a low-fat diet Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more We aim ed to evaluate the effect of the Mediterranean diet ( MD ) compared with a prudent diet ( PD ) combined with physical activity on obese obstructive sleep apnoea syndrome ( OSAS ) patients who were treated with continuous positive airway pressure . 900 patients were evaluated and 40 obese patients ( body mass index ≥30.0 kg·m−2 ) who met the inclusion criteria , with moderate-to-severe OSAS ( apnoea – hypopnoea index ( AHI ) > 15 events·h−1 and Epworth Sleepiness Scale score > 10 ) based on overnight attended polysomnography , were included in the study . After r and omisation , 20 patients followed the  MD  and 20 a PD for a 6-month period . All patients were counselled to increase their physical activity . Concerning sleep parameters , only AHI during rapid eye movement ( REM ) sleep was reduced to a statistically significant degree , by mean±sd 18.4±17.6 events·h−1 in the MD group and by 2.6±23.7 events·h−1 in the PD group ( p<0.05 ) . The MD group also showed a greater reduction in waist circumference ( WC ) ( -8.7±3.6 cm ) , WC/height ratio ( -0.04±0.02 cm·m−1 ) and WC/hip ratio ( -0.04±0.03 cm·cm−1 ) , compared with the other group ( -2.6±1.7 events·h−1 , -5.7±3.8 cm , -0.03±0.02 cm·m−1 and 0.02±0.02 cm·cm−1 , respectively ; p<0.05 ) . Our results showed that the MD combined with physical activity for a 6-month period was effective in reducing the AHI during REM sleep without any statistically significant effect in the other sleep parameters , compared with a PD in obese adults with 
    Output:
    
There was no evidence of an effect on insulin concentrations .
The data presented here provide systematic ally identified evidence that concurrently promoting the MD and PA is likely to provide an opportunity for metabolic risk reduction .