***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: OBJECTIVE To study the association between adherence to the Mediterranean dietary pattern ( MDP ) and risk of developing type 2 diabetes , across European countries . RESEARCH DESIGN AND METHODS We established a case-cohort study including 11,994 incident type 2 diabetic case subjects and a stratified subcohort of 15,798 participants selected from a total cohort of 340,234 participants with 3.99 million person-years of follow-up , from eight European cohorts participating in the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) study . The  relative Mediterranean diet score ( rMED ) ( score range 0–18 ) was used to assess adherence to MDP on the basis of reported consumption of nine dietary components characteristic of the Mediterranean diet . Cox proportional hazards regression , modified for the case-cohort design , was used to estimate the association between rMED and risk of type 2 diabetes , adjusting for confounders . RESULTS The multiple adjusted hazard ratios of type 2 diabetes among individuals with medium ( rMED 7–10 points ) and high adherence to MDP ( rMED 11–18 points ) were 0.93 ( 95 % CI 0.86–1.01 ) and 0.88 ( 0.79–0.97 ) , respectively , compared with individuals with low adherence to MDP ( 0–6 points ) ( P for trend 0.013 ) . The association between rMED and type 2 diabetes was attenuated in people < 50 years of age , in obese participants , and when the alcohol , meat , and olive oil components were excluded from the score . CONCLUSIONS In this large prospect i ve study , adherence to the MDP , as defined by rMED , was associated with a small reduction in the risk of developing type 2 diabetes  in this European population Aims /hypothesisThe role of diet in the prevention of diabetes remains uncertain . The aim of this study was to investigate two different dietary aspects , i.e. adherence to the Mediterranean diet and glycaemic load ( GL ) , in relation to diabetes occurrence . Methods We analysed data from the Greek cohort of the population -based European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) . From a total of 22,295 participants , actively followed for a median of 11.34 years , 2,330 cases of incident type 2 diabetes were recorded . All participants completed a vali date d , interviewer-administered semi-quantitative food frequency question naire at enrolment . From this information , we calculated a ten point Mediterranean diet score ( MDS ) , reflecting adherence to the traditional Mediterranean diet , as well as the dietary GL . We estimated HRs and the corresponding 95 % CIs of diabetes using Cox proportional hazards regression models adjusted for potential confounders . Results A higher MDS was inversely associated with diabetes risk ( HR 0.88 [ 95 % CI 0.78 , 0.99 ] for MDS ≥6 vs MDS ≤3 ) . GL was positively associated with diabetes ( HR 1.21 [ 95 % CI 1.05 , 1.40 ] for the highest vs the lowest GL quartile ) . A significant protection of about 20 % was found for a diet with a high MDS and a low GL . Conclusions /interpretationA low GL diet that also adequately adheres to the principles of the traditional Mediterranean diet may reduce the incidence of type 2 diabetes BACKGROUND Dietary fatty acids that are more prone to oxidation than to storage may be less likely to lead to obesity . OBJECTIVE The aim of this study was to determine the effect of chain length , degree of unsaturation , and stereoisomeric effects of unsaturation on the oxidation of individual fatty acids in normal-weight men . DESIGN Fatty acid oxidation was examined in men consuming a weight-maintenance diet containing 40 % of energy as fat .  After consuming the diet for 1 wk , subjects were fed fatty acids labeled with (13)C in the methyl or carboxyl position ( 10 mg/kg body wt ) . The fatty acids fed in r and om order were laurate , palmitate , stearate , oleate , elai date ( the trans isomer of oleate ) , linoleate , and linolenate blended in a hot liquid meal . Breath sample s were collected for the next 9 h and the oxidation of each fatty acid was assessed by examining liberated (13)CO(2 ) in breath . RESULTS Cumulative oxidation over the 9-h test ranged from a high of 41 % of the dose for laurate to a low of 13 % of the dose for stearate . Of the 18-carbon fatty acids , linolenate was the most highly oxidized and linoleate appeared to be somewhat conserved . (13)C recovery in breath from the methyl-labeled fatty acids was approximately 30 % less than that from the carboxyl-labeled fatty acids . CONCLUSIONS In summary , lauric acid is highly oxidized , whereas the polyunsaturated and monounsaturated fatty acids are fairly well oxidized . Oxidation of the long-chain , saturated fatty acids decreases with increasing carbon number BACKGROUND Few studies have examined the long-term effect of habitual diet on risks of incident diabetes , coronary heart disease , and mortality . OBJECTIVE We analyzed the prospect i ve relation of dietary patterns with incident chronic disease and mortality during 15 y of follow-up in the Whitehall II study . DESIGN We conducted a prospect i ve analysis ( 106,633 person-years at risk ) among men and women ( n = 7731 ) with a mean age of 50 y at the time of dietary assessment ( 127-item food-frequency question naire ) .  Coronary death or nonfatal myocardial infa rct ion and incident diabetes were verified by record tracing and oral-glucose-tolerance tests . RESULTS Cluster analysis identified 4 dietary patterns at baseline . The patterns were termed unhealthy ( white bread , processed meat , fries , and full-cream milk ; n = 2665 ) , sweet ( white bread , biscuits , cakes , processed meat , and high-fat dairy products ; n = 1042 ) , Mediterranean-like ( fruit , vegetables , rice , pasta , and wine ; n = 1361 ) , and healthy ( fruit , vegetables , whole-meal bread , low-fat dairy , and little alcohol ; n = 2663 ) . Compared with the unhealthy pattern , the healthy pattern reduced the risk of coronary death or nonfatal myocardial infa rct ion and diabetes ; hazard ratios ( 95 % CI ) were 0.71 ( 0.51 , 0.98 ) and 0.74 ( 0.58 , 0.94 ) , respectively , after adjustment for age , sex , ethnicity , dietary energy misreporting , social position , smoking status , and leisure-time physical activity . Dietary pattern was not associated with all-cause mortality . Residual confounding by socioeconomic factors was unlikely to account for the observed dietary effects . CONCLUSIONS The healthy eating pattern reduced risks of diabetes and major coronary events . Such dietary patterns offer considerable health benefits to individuals and contribute to public health BACKGROUND Although higher intakes of fruit , berries , and vegetables ( FBV ) have been associated with reduced risk of  type 2 diabetes ( T2D ) in some observational studies , the evidence is limited and inconclusive . OBJECTIVE We assessed the relation of FBV intake and T2D incidence in Finnish men . DESIGN We studied 2332 men from the prospect i ve , population -based Kuopio Ischaemic Heart Disease Risk Factor Study who were aged 42 - 60 y and free of T2D or impaired fasting glucose at baseline in 1984 - 1989 .  Food intake  was assessed with 4-d food recording .  T2D was assessed by using self-administered question naires , a fasting blood glucose measurement , a 2-h oral-glucose-tolerance test , and record linkage to a reimbursement register on diabetes medication expenses . In the Cox proportional hazards model , HRs for T2D were computed for the highest compared with lowest quartiles of FBV intake adjusted for age , examination year , body mass index , waist-to-hip ratio , smoking , education , physical activity , family history of diabetes , and energy and alcohol intakes . RESULTS During the mean follow-up time of 19.3 y , 432 new cases of T2D occurred . For the total FBV intake ( with the exclusion of potatoes and fruit and berry juices ) , the extreme-quartile multivariable-adjusted HR for T2D was 0.76 ( 95 % CI : 0.57 , 1.02 ; P-trend = 0.15 ) . In the analysis for FBV components , berries had a corresponding HR of 0.65 ( 95 % CI : 0.49 , 0.88 ; P-trend = 0.003 ) , whereas no significant associations were shown for fruit , fruit and berry juices , and vegetables . CONCLUSION Fruit and vegetables , particularly berries , may reduce risk of T2D in men Mediterranean diet is associated with lower incidence of coronary heart disease , and two r and omised trials indicated that it improves prognosis of coronary patients . These trials , however , relied on a total of 100 deaths and evaluated design er diets in the clinical context . We have evaluated the association of adherence to the modified Mediterranean diet , in which unsaturates were substituted for monounsaturates , with survival among elderly with previous myocardial infa rct ion within the European Prospect i ve Investigation into Cancer and nutrition ( EPIC ) study . As of December 2003 , after a median follow-up of 6.7 years , 2671 EPIC participants from nine countries were 60 years or older and had prevalent myocardial infa rct ion but no stroke or cancer at enrolment , complete information on dietary intakes and important covariates and known survival status .  Adherence to the modified Mediterranean diet was assessed through a 10-unit-scale . Mortality ratio in relation to modified Mediterranean diet was estimated through Cox regression controlling for possible confounding . Increased adherence to modified Mediterranean diet by two units was associated with 18 % lower overall mortality rate ( 95 % confidence interval 7–27 % , fixed effects model ) . There was no significant heterogeneity by sex , age at enrolment , or country , although the association tended to be less evident among northern Europeans . Associations between food groups contributing to the modified Mediterranean diet and mortality were generally weak . A diet inspired by the Mediterranean pattern that can be easily adopted by Western population s is associated with substantial reduction of total mortality of coronary patients in the community AIMS Individuals with Type 2 diabetes are at high risk for coronary heart disease , and may benefit from aggressive lifestyle modification . We evaluated the prevalence of Type 2 diabetes , in a Greek adult population , in relation to physical activity and dietary habits . METHODS From May 2001 to December 2002 , we r and omly enrolled 1514 men and 1528 women , with no evidence of cardiovascular or any other chronic disease . The sampling was stratified by the age and gender distribution of the general population in the greater area of Athens ( census 2001 ) . Diabetes was defined according to the established American Diabetes Association criteria .  Dietary habits  were assessed through a vali date d food frequency question naire and a diet score  was developed , in which higher values suggest greater adherence to the Mediterranean diet . Weekly energy expenditure  was assessed by considering frequency , duration and intensity of sports-related physical activity during a usual week . RESULTS After age adjustment for the Greek adult population ( 2001 census ) , the projected prevalence of Type 2 diabetes was 7.6 % in men and 5.9 % in women . A significant proportion of diabetic subjects ( 24 % of men and 30 % of women ) were unaware of their condition . Moreover , a 10-unit increase in the diet score was associated with 21 % lower odds of diabetes ( P < 0.05 ) , while individuals taking light physical activity were at 35 % lower odds ratio of diabetes compared with sedentary individuals ( P < 0.05 ) . CONCLUSIONS Diabetes mellitus is common in our population , with approximately 1 in 5 individuals with Type 2 diabetes being unaware of their condition . The lifestyle approach described here may contribute significantly to the reduction in the prevalence of diabetes , at a population level 
    Output:
    
Mediterranean diet could , if appropriately adjusted to reflect local food availability and individual 's needs , constitute a beneficial nutritional choice for the primary prevention of diabetes