***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: Aims /hypothesisThe aim of this study was to investigate the association between alcohol consumption and risk of microvascular complications ( retinopathy , neuropathy , nephropathy ) in type 1 diabetes mellitus patients in the EURODIAB Prospect i ve Complications Study . Methods The EURODIAB Prospect i ve Complications Study is a follow-up study including 3,250 type 1 diabetes mellitus patients from 16 different European countries . We investigated the cross-sectional association between moderate alcohol consumption and risk of retinopathy , neuropathy and nephropathy among 1,857of these patients . Results We documented 304 cases of proliferative retinopathy , 660 cases of neuropathy and 157 cases of nephropathy ( macroalbuminuria ) . Alcohol consumption was associated with risk of proliferative retinopathy , neuropathy and macroalbuminuria in a U-shaped fashion . Moderate consumers ( 30–70 g alcohol per week ) had a lower risk of microvascular complications with odds ratios of 0.60 ( 95 % CI 0.37–0.99 ) for proliferative retinopathy , 0.61 ( 0.41–0.91 ) for neuropathy and 0.36 ( 0.18–0.71 ) for macroalbuminuria in multivariate-adjusted models . These results were similar when excluding patients who had been advised to drink less alcohol because of their health . The relation was most pronounced for alcohol consumption from wine .  Drinking frequency was significantly , inversely associated with risk of neuropathy , but a similar trend was visible for proliferative retinopathy and macroalbuminuria . Alcohol consumption was not associated with occurrence of ketoacidosis or hypoglycaemic attacks . Conclusions /interpretationConsistent with its effects on macrovascular complications , moderate alcohol consumption is associated with a lower risk of all microvascular complications among type 1 diabetes patients Reliable tables of glycemic index ( GI ) compiled from the scientific literature are instrumental in improving the quality of research examining the relation between GI , glycemic load , and health . The GI has proven to be a more useful nutritional concept than is the chemical classification of carbohydrate ( as simple or complex , as sugars or starches , or as available or unavailable ) , permitting new insights into the relation between the physiologic effects of carbohydrate-rich foods and health . Several prospect i ve observational studies have shown that the chronic consumption of a diet with a high glycemic load ( GI x dietary carbohydrate content ) is independently associated with an increased risk of developing type 2 diabetes , cardiovascular disease , and certain cancers . This revised table contains almost 3 times the number of foods listed in the original table ( first published in this Journal in 1995 ) and contains nearly 1300 data entries derived from published and unpublished verified sources , representing > 750 different types of foods tested with the use of st and ard methods . The revised table also lists the glycemic load associated with the consumption of specified serving sizes of different foods Background Hypertension can be prevented by adopting healthy dietary patterns . Our aim was to assess the 4-year effect on blood pressure ( BP ) control of a r and omized feeding trial promoting the traditional Mediterranean dietary pattern . Methods The PREDIMED primary prevention trial is a r and omized , single-blinded , controlled trial conducted in Spanish primary healthcare centers . We recruited 7,447 men ( aged 55 to 80 years ) and women ( aged 60 to 80 years ) who had high risk for cardiovascular disease . Participants were assigned to a control group or to one of two Mediterranean diets . The control group received education on following a low-fat diet , while the groups on Mediterranean diets received nutritional education and also free foods ; either extra virgin olive oil , or nuts . Trained personnel measured participants ’ BP at baseline and once yearly during a 4-year follow-up . We used generalized estimating equations to assess the differences between groups during the follow-up . Results The percentage of participants with controlled BP increased in all three intervention groups ( P-value for within-group changes : P<0.001 ) . Participants allocated to either of the two Mediterranean diet groups had significantly lower diastolic BP than the participants in the control group ( −1.53 mmHg ( 95 % confidence interval ( CI ) −2.01 to −1.04 ) for the Mediterranean diet supplemented with extra virgin olive oil , and −0.65 mmHg ( 95 % CI -1.15 to −0.15 ) mmHg for the Mediterranean diet supplemented with nuts ) . No between-group differences in changes of systolic BP were seen . Conclusions Both the traditional Mediterranean diet and a low-fat diet exerted beneficial effects on BP and could be part of advice to patients for controlling BP . However , we found lower values of diastolic BP in the two groups promoting the Mediterranean diet with extra virgin olive oil or with nuts than in the control group . Trial registration Current Controlled Trials IS RCT The appropriate proportions of macronutritional intake have been controversial in medical nutritional therapy for diabetes , and evidence of the effects of carbohydrate consumption on diabetes complications in prospect i ve setting s is sparse . We investigated the relationships between proportions of carbohydrate intake as the % of total energy and diabetes complications in a nationwide cohort of Japanese patients with type 2 diabetes aged 40–70 years with hemoglobin A1c ≥6.5 % . The analysis was of 1516 responders to a baseline dietary survey assessed by the Food Frequency Question naire based on food groups . Primary outcomes were times to overt nephropathy , diabetic retinopathy , and cardiovascular disease ( CVD ) after 8 years . Hazard ratios ( HRs ) for proportions of carbohydrate intake were estimated by Cox regression adjusted for confounders . High carbohydrate intake was significantly related to higher intakes of grain , fruits , and sweets/snacks and lower intakes of soybean and soy products , vegetables , seaweed , meat and processed meat , fish and processed fish , eggs , milk and dairy products , oil , and alcoholic beverages . During the eight-year follow-up , there were 81 , 275 , and 129 events of overt nephropathy , diabetic retinopathy , and CVD , respectively . After adjustment for confounders , HRs for complications in patients with carbohydrate intake in the second or third tertiles ( 51.0%–56.4 % and ≥56.5 % , respectively ) compared with carbohydrate intake in the first tertile ( < 50.9 % , referent ) were analyzed . No significant associations were shown in the second and third tertiles relative to first tertile ( overt nephropathy : 1.05 ( 95 % Confidence Interval , 0.54–2.06 ) and 0.98 ( 0.40–2.44 ) ; diabetic retinopathy : 1.30 ( 0.90–1.88 ) and 1.30 ( 0.78–2.15 ) ; and CVD : 0.95 ( 0.55–1.63 ) and 1.37 ( 0.69–2.72 ) ) . By exploring potentially nonlinear relationships , trends for the incidence of diabetes complications according to proportions of carbohydrate intake were not clearly shown . Findings suggested that proportions of carbohydrate intake were not associated with the incidence of diabetes complications among type 2 diabetes patients in Japan One hundred and forty nine diabetic patients were ophthalmologically assessed seven years after r and omisation to a low carbohydrate or modified fat diet ( rich in linoleic acid ) .  Glycaemic control , regardless of the type of diet , was a major determinant of the development of retinopathy . Poorly controlled patients ( haemoglobin A1c greater than 8 % ) with low levels of linoleic acid in cholesterol ester had a significantly greater frequency of retinopathy than well controlled patients or patients with similarly unsatisfactory control but higher levels of linoleic acid . The findings support an earlier suggestion that linoleic acid might protect against diabetic retinopathy 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 In a five year prospect i ve study clinical features associated with the development and progress of retinopathy were sought in 296 r and omly selected diabetic men aged 20 - 59 . None had ophthalmoscopically detectable retinopathy initially , but during follow up 66 developed the condition ( 47 background , 10 exudative , 9 proliferative ) . Linear logistic analyses ( two tailed tests ) showed that the initial features independently predictive of retinopathy were duration of diabetes , poor glycaemic control , impotence , and --unexpectedly -- heavy alcohol consumption . Poor glycaemic control in the interim and proteinuria at review were also associated with the development of retinopathy . No relation was found with smoking or obesity . Glycaemic control and alcohol consumption were therefore the only aetiologically relevant associations identified . The development of severe retinopathy ( exudative and proliferative ) showed a particular association with heavy alcohol consumption , occurring in nine of the 70 heavy drinkers ( 13 % ) compared with 10 ( 4.4 % ) of the rest . Alcohol consumption may be an important independent factor associated predictively with sight threatening diabetic retinopathy Background Lack of appropriate reporting of method ological details has previously been shown to distort risk of bias assessment s in r and omized controlled trials . The same might be true for observational studies . The goal of this study was to compare the Newcastle-Ottawa Scale ( NOS ) assessment for risk of bias between review ers and authors of cohort studies included in a published systematic review on risk factors for severe outcomes in patients infected with influenza . Methods Cohort studies included in the systematic review and published between 2008–2011 were included . The corresponding or first authors completed a survey covering all NOS items . Results were compared with the NOS assessment applied by review ers of the systematic review . Inter-rater reliability was calculated using kappa ( K ) statistics . Results Authors of 65/182 ( 36 % ) studies completed the survey . The overall NOS score was significantly higher ( p < 0.001 ) in the review ers ’ assessment ( median = 6 ; interquartile range [ IQR ] 6–6 ) compared with those by authors ( median = 5 , IQR 4–6 ) . Inter-rater reliability by item ranged from slight ( K = 0.15 , 95 % confidence interval [ CI ] = −0.19 , 0.48 ) to poor ( K = −0.06 , 95 % CI = −0.22 , 0.10 ) . Reliability for the overall score was poor ( K = −0.004 , 95 % CI = −0.11 , 0.11 ) . Conclusions Differences in assessment and low agreement between review ers and authors suggest the need to contact authors for information not published in studies when applying the NOS in systematic review OBJECTIVE To date no clinical trials have evaluated the role of dietary patterns on the incidence of microvascular diabetes complications .  We hypothesized that a nutritional intervention based on the Mediterranean diet ( MedDiet ) would have greater protective effect on diabetic retinopathy and nephropathy than a low-fat control diet . RESEARCH DESIGN AND METHODS This was a post hoc analysis of a cohort of patients with type 2 diabetes participating in the PREvención con DIeta MEDiterránea ( PREDIMED ) study , a multicenter r and omized nutritional intervention trial conducted in a population at high cardiovascular risk . Individuals with type 2 diabetes who were free of microvascular complications at enrollment ( n = 3,614 , aged 55–80 years ) were r and omly assigned to one of three dietary interventions : MedDiet supplemented with extravirgin olive oil ( MedDiet+EVOO ) , MedDiet supplemented with mixed nuts ( MedDiet+Nuts ) , or a low-fat control diet . Two independent outcomes were considered : new onset of diabetic retinopathy and nephropathy . Hazard ratios ( HRs ) were calculated using multivariable-adjusted Cox regression . RESULTS During a median follow-up of 6.0 years , we identified 74 new cases of retinopathy and 168 of nephropathy . Compared with the control diet , multivariable-adjusted HRs for diabetic retinopathy were 0.56 ( 95 % CI 0.32–0.97 ) for the MedDiet+EVOO and 0.63 ( 0.35–1.11 ) for the MedDiet+Nuts . No between-group differences were found for nephropathy . When the yearly up date d information on adherence to the MedDiet was considered , the HR for retinopathy in the highest versus the lowest quintile was 0.34 ( 0.13–0.89 ; P = 0.001 for trend 
    Output:
    
Higher intakes of dietary fibre , oily fish , and greater adherence to a Mediterranean diet were protective of DR .
Conversely , high total caloric intake was associated with higher risk of DR .
No significant associations of carbohydrate , vitamin D , and sodium intake with DR were found .
Associations of antioxidants , fatty acids , proteins and alcohol with DR remain equivocal .
CONCLUSIONS Dietary fibre , oily fish , a Mediterranean diet and a reduced caloric intake are associated with lower risk of DR .