***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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    ***EXAMPLES*** 
    Input: Background / Objectives : Growing evidence emerged about the role of diet in heart failure ( HF ) development , but data are sparse and inconclusive . We examined the association between a Mediterranean-style diet , its components and HF risk . Subjects/ Methods : Analyses were carried out in 24 008 middle-aged participants of the European Prospect i ve Investigation into Cancer and Nutrition (EPIC)-Potsdam ( Germany ) , including 209 incident HF cases within 8.2 years . The traditional Greek Mediterranean diet score ( tMED ) was used to assess dietary adherence . Cox ’s proportional hazards regression was applied to estimate the relationship between the adherence to the Mediterranean-style diet , its components and HF risk . Results : After adjustment for age , sex and energy intake , a 2-unit increment in the tMED was associated with 26 % lower risk of HF ( HR ( 95 % confidence interval ( CI ) ) : 0.76 ( 0.60–0.97 ) ) . After multivariable adjustment , this association was slightly attenuated and lost significance [ HR ( 95%CI ) : 0.82 ( 0.64–1.05 ) ] . Interestingly , we observed a significant association in multivariable adjusted models when milk products were excluded from the score ( HR ( 95 % CI ) : 0.75 ( 0.59–0.96 ) ) . Three score components were significantly associated with HF risk : alcohol ( HR ( 95%CI ) : 0.73 ( 0.55–0.97 ) for moderate versus low/high intakes ) , meat : 2.04 ( 1.17–3.55 ) and fish : 0.59 ( 0.36–0.95 ) , both for the highest versus the lowest quintile . Conclusions : The tMED was not significantly associated with HF risk , but low meat , high fish and moderate alcohol intake were inversely associated with HF risk  in our non-Mediterranean population . Minor dietary changes could be valuable primary prevention measures , particularly the increase of fish consumption while reducing the intake of meat Previous studies have reported that high fat feeding in mild to moderate heart failure ( HF ) results in the preservation of contractile function . Recent evidence has suggested that preventing the switch from fatty acid to glucose metabolism in HF may ameliorate dysfunction , and insulin resistance is one potential mechanism for regulating substrate utilization . This study was design ed to determine whether peripheral and myocardial insulin resistance exists with HF and /or a  high-fat diet and whether myocardial insulin signaling was altered accordingly . Rats underwent coronary artery ligation ( HF ) or sham surgery  and were r and omized to normal chow ( NC ; 14 % kcal from fat ) or a high-fat diet ( SAT ; 60 % kcal from fat ) for 8 wk . HF + SAT animals showed preserved systolic ( + dP/dt and stroke work ) and diastolic ( -dP/dt and time constant of relaxation ) function compared with HF + NC animals . Glucose tolerance tests revealed peripheral insulin resistance in sham + SAT , HF + NC , and HF + SAT animals compared with sham + NC animals . PET imaging confirmed myocardial insulin resistance only in HF + SAT animals , with an uptake ratio of 2.3 ± 0.3 versus 4.6 ± 0.7 , 4.3 ± 0.4 , and 4.2 ± 0.6 in sham + NC , sham + SAT , and HF + NC animals , respectively ; the myocardial glucose utilization rate was similarly decreased in HF + SAT animals only . Western blot analysis of insulin signaling protein expression was indicative of cardiac insulin resistance in HF + SAT animals . Specifically , alterations in Akt and glycogen synthase kinase-3β protein expression in HF + SAT animals compared with HF + NC animals may be involved in mediating myocardial insulin resistance . In conclusion , HF animals fed a high-saturated fat exhibited preserved myocardial contractile function , peripheral and myocardial insulin resistance , decreased myocardial glucose utilization rates , and alterations in cardiac insulin signaling . These results suggest that myocardial insulin resistance may serve a cardioprotective function with high fat feeding in mild to moderate HF Objective To investigate enteral nutrition ’s effect on serum inflammatory factors and the cardiac function of malnourished elderly patients with heart failure . Patients and methods A total of 105 elderly patients with heart failure were r and omly divided into 3 groups : Treatment Group A , Treatment Group B , and the Control Group ( Group C ) , each group having 35 patients and being administered conventional heart failure treatment . Group A was treated with 500 mL·d−1 of enteral nutrition for 1 month . Group B was given the same dose of enteral nutrition for 3 months . The Control Group was given free diet . Nutritional risk screening 2002 was used to assess the nutritional status before and after the treatment for each group . New York Heart Association status was recorded as were left ventricular ejection fraction , plasma B-type natriuretic peptide , inteleukin-6 , C-reactive protein , and tumor necrosis factor-α . Results After the treatment , the body mass index , skinfold thickness of upper arm triceps , muscle circumference of the upper arm , upper arm muscle circumference , total protein , albumin , hemoglobin , and left ventricular ejection fraction in the treatment groups all increased , with relatively obvious relief of symptoms of heart failure . The levels of B-type natriuretic peptide , interleukin-6 , tumor necrosis factor-α , and C-reactive protein all rose to different extents ( P<0.05 ) and Treatment Group B showed more obvious improvement ( P<0.01 ) . Differences shown by the Control Group in each nutrition indicator , serum levels of inflammatory factors , and cardiac function had no statistical significance ( P>0.05 ) . Conclusion The use of enteral nutrition in conventional treatment of elderly patients with heart failure could improve not only patients ’ nutritional status and cardiac function , but also their immune function , thus reducing the levels of inflammatory factors . The longer the treatment period is , the more obvious the improvement in patients ’ cardiac function and inflammatory factors will be observed OBJECTIVES This study sought to investigate the effect of a multiple micronutrient supplement on left ventricular ejection fraction ( LVEF ) in patients with heart failure . BACKGROUND Observational studies suggest that patients with heart failure have reduced intake and lower concentrations of a number of micronutrients . However , there have been very few intervention studies investigating the effect of micronutrient supplementation in patients with heart failure . METHODS This was a r and omized , double-blind , placebo-controlled , parallel-group study involving 74 patients with chronic stable heart failure that compared multiple micronutrient supplementation taken once daily versus placebo for 12 months . The primary endpoint was LVEF assessed by cardiovascular magnetic resonance imaging or 3-dimensional echocardiography . Secondary endpoints were Minnesota Living With Heart Failure Question naire score , 6-min walk test distance , blood concentrations of N-terminal prohormone of brain natriuretic peptide , C-reactive protein , tumor necrosis factor alpha , interleukin-6 , interleukin-10 , and urinary levels of 8-iso-prostagl and in F2 alpha . RESULTS Blood concentrations of a number of micronutrients increased significantly in the micronutrient supplement group , indicating excellent compliance with the intervention . There was no significant difference in mean LVEF at 12 months between treatment groups after adjusting for baseline ( mean difference : 1.6 % , 95 % confidence interval : -2.6 to 5.8 , p = 0.441 ) . There was also no significant difference in any of the secondary endpoints at 12 months between treatment groups . CONCLUSIONS This study provides no evidence to support the routine treatment of patients with chronic stable heart failure with a multiple micronutrient supplement . ( Micronutrient Supplementation in Patients With Heart Failure [ MINT-HF ] ; NCT01005303 ) In animals , carbohydrate and fat composition during dietary interventions influenced cardiac metabolism , structure , and function . Because reduced-carbohydrate and reduced-fat hypocaloric diets are commonly used in the treatment of obesity , we investigated whether these interventions differentially affect left ventricular mass , cardiac function , and blood pressure . We r and omized 170 overweight and obese subjects ( body mass index , 32.9±4.4 ; range , 26.5–45.4 kg/m2 ) to 6-month hypocaloric diets with either reduced carbohydrate intake or reduced fat intake . We obtained cardiac MRI and ambulatory blood pressure recordings over 24 hours before and after 6 months . Ninety subjects completing the intervention period had a full cardiac MRI data set . Subjects lost 7.3±4.0 kg ( 7.9±3.8 % ) with reduced-carbohydrate diet and 6.2±4.2 kg ( 6.7±4.4 % ) with reduced-fat diet ( P<0.001 within each group ; P = not significant between interventions ) . Caloric restriction led to similar significant decreases in left ventricular mass  with low-carbohydrate diets ( 5.4±5.4 g ) or low-fat diets ( 5.2±4.8 g ; P<0.001 within each group ; P = not significant between interventions ) . Systolic and diastolic left ventricular function did not change with either diet . The 24-hour systolic blood pressure decreased similarly with both interventions . Body weight change ( & bgr;=0.33 ; P=0.02 ) and percentage of ingested n-3 polyunsaturated fatty acids ( & bgr;=−0.27 ; P=0.03 ) predicted changes in left ventricular mass . In conclusion , weight loss induced by reduced-fat diets or reduced-carbohydrate diets similarly improved left ventricular mass in overweight and obese subjects over a 6-month period . However , n-3 polyunsaturated fatty acid ingestion may have an independent beneficial effect on left ventricular mass BACKGROUND AND AIMS Hospitalized patients with heart failure who are malnourished present a worse prognosis than those with an adequate nutritional status . We undertook this study to assess whether a nutritional intervention in malnourished hospitalized patients with heart failure benefits morbidity and mortality . METHODS A multicenter , r and omized , controlled clinical trial was conducted . A total of 120 malnourished hospitalized patients due to acute heart failure were r and omised to conventional heart failure treatment or conventional heart failure treatment combined with an individualized nutritional intervention . The primary endpoint of this study was a composite of all-cause death or readmission for worsening of HF , with a maximum follow-up of 12 months . Analysis was by intention to treat . RESULTS Recruitment was stopped early according to the study protocol after completing the follow-up of the first 120 patients enrolled ( 59 in the intervention group and 61 in the control group ) . Both groups were homogeneous in baseline characteristics . At 12 months , the primary outcome occurred in 27.1 % of patients in the intervention group and in 60.7 % of patients in the control group ( hazard ratio 0.45 ; 95 % confidence interval [ CI ] , 0.19 - 0.62 , p = 0.0004 ) . In total , 20.3 % of patients died in the intervention group and 47.5 % in the control group ( hazard ratio 0.37 , 95 % CI , 0.19 - 0.72 , p = 0.003 ) . Readmission due to heart failure was also lower in the intervention group ( 10.2 vs. 36.1 % , p = 0.001 ) . CONCLUSION Nutritional intervention in malnourished hospitalized patients with heart failure reduces the risk of death from any cause and the risk of readmission for worsening of heart failure ( Clinical Trial.govNCT01472237 ) Background Optimal macronutrient distribution of weight loss diets has not been established . The distribution of energy from carbohydrate and fat has been observed to promote differential plasma lipid responses in previous weight loss studies , and insulin resistance status may interact with diet composition and affect weight loss and lipid responses . Methods and Results Overweight and obese women ( n=245 ) were enrolled in a 1‐year behavioral weight loss intervention  and r and omly assigned to 1 of 3 study groups : a lower fat ( 20 % energy ) , higher carbohydrate ( 65 % energy ) diet ; a lower carbohydrate ( 45 % energy ) , higher fat ( 35 % energy ) diet ; or a walnut‐rich , higher fat ( 35 % energy ) , lower carbohydrate ( 45 % energy ) diet . Blood sample s and data available from 213 women at baseline and at 6 months were the focus of this analysis . Triglycerides , total cholesterol , and high‐ and low‐density lipoprotein cholesterol were quantified and compared between and within groups . Triglycerides decreased in all study arms at 6 months ( P<0.05 ) . The walnut‐rich diet increased high‐density lipoprotein cholesterol more than either the lower fat or lower carbohydrate diet ( P<0.05 ) . The walnut‐rich diet also 
    Output:
    
Some studies showed that the Mediterranean diet ( MedDiet ) had a beneficial effect on cardiac function , while others did not find any positive impact .
Nutritional supplements and hypercaloric intake had positive effects on underweight HF patients , while hypocaloric diet was beneficial in obese HF patients improving glucose control and cardiac function .
The effect of MedDiet in HF patients showed conflicting results .
Changes in the dietary pattern can reduce the evolution of HF , considering not only the quality of food but also the caloric intake .
The discriminant factor to prescribe a diet regime in HF patients is represented by body mass index ( BMI ) .
A well-balanced caloric diet represents an effective therapy in overweight HF patients to reduce the mortality rate .