***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: Epidemiologic data and animal experiments suggest that dietary fat may influence risk of  breast cancer .  To determine whether intervention with a low-fat , high-carbohydrate diet would reduce breast cancer incidence in women at increased risk of the disease , we carried out a r and omized controlled trial in Canada . We recruited 4,690 women with extensive mammographic density and r and omized them to an intervention group or a comparison group . The intervention group received intensive dietary counseling to reduce fat intake to a target of 15 % of calories and increase carbohydrate to 65 % of calories . Dietary intakes were assessed throughout using food records . Subjects were followed for at least 7 years and for an average of 10 years . The main outcome was invasive breast cancer . Percentage of calories from fat in the intervention group decreased from 30 % at baseline to 20 % after r and omization and remained 9 % to 10 % lower than the comparison group throughout . There were 118 invasive breast cancers in the intervention group and 102 in the comparison group [ adjusted hazard ratio = 1.19 ( 95 % CI : 0.91 - 1.55 ) ] . Analysis of food records showed that fat intake at baseline and after r and omization was not associated with total breast cancer incidence . Greater weight and lower carbohydrate intake at baseline and after r and omization were associated with an increased risk of estrogen receptor (ER)-positive breast cancer . Our findings suggest that a sustained reduction in dietary fat intake did not reduce risk of breast cancer  in women with extensive mammographic density .  Weight and carbohydrate intakes were associated with risk of ER-positive breast cancer Background Early life exposures , including diet , have been implicated in the etiology of breast cancer . Methods A nested case-control study was conducted among participants in the Nurses ' Health Study who completed a 24-item question naire about diet during high school .  There were 843 eligible cases diagnosed between onset of study ( 1976 ) and before the return of the high school diet question naire ( 1986 ) , who were matched 10:1 with controls on the basis of age . Results Women who had , during adolescence , a higher consumption of eggs , vegetable fat and fiber  had a lower risk of breast cancer , whereas risk of breast cancer was increased among women who consumed more butter . Conclusions A possible association of elements of adolescent diet with risk of breast cancer is reported , but the findings require confirmation in prospect i ve study The objective of this study was to evaluate the prospect i ve associations between dietary glycemic index ( GI ) and glycemic load ( GL ) and the risk for invasive breast cancer incidence  in postmenopausal women at high cardiovascular disease ( CVD ) risk . This study was conducted within the framework of the PREvención con DIeta MEDiterránea ( PREDIMED ) study , a nutritional intervention trial for primary cardiovascular prevention . We included 4010 women aged between 60 and 80 years who were initially free from breast cancer but at high risk for CVD disease .  Dietary information was collected using a vali date d 137-item food frequency question naire . We assigned GI values using the International Tables of GI and GL values . Cases were ascertained through yearly consultation of medical records and through consultation of the National Death Index . Only cases confirmed by results from cytology tests or histological evaluation were included . We estimated multivariable-adjusted hazard ratios for invasive breast cancer risk across tertiles of energy-adjusted dietary GI/GL using Cox regression models . We repeated our analyses using yearly repeated measures of GI/GL intakes . No associations were found between baseline dietary GI/GL and invasive breast cancer incidence . The multivariable hazard ratio and 95 % confidence interval ( CI ) for the top tertile of dietary GI was 1.02 ( 95 % CI : 0.42–2.46 ) and for dietary GL was 1.00 ( 95 % CI : 0.44–2.30 ) when compared with the bottom tertile . Repeated- measures analyses yielded similar results . In sensitivity analyses , no significant associations were observed for women with obesity or diabetes . Dietary GI and GL did not appear to be associated with an increased risk for invasive breast cancer in postmenopausal women at high CVD risk BACKGROUND Recent prospect i ve data suggest that intake of rapidly digested and absorbed carbohydrates with a high dietary glycemic load is associated with an increased risk of ischemic heart disease . OBJECTIVE We examined whether a high dietary glycemic load was associated with elevated hs-CRP concentrations and whether this association was modified by body mass index ( BMI ; in kg/m(2 ) ) . DESIGN In 244 apparently healthy women , we measured plasma hs-CRP concentrations and determined average dietary glycemic loads with a vali date d semiquantitative food-frequency question naire . Using multiple regression models , we evaluated the association between dietary glycemic load and plasma hs-CRP after adjusting for age ; treatment status ; smoking status ; BMI ; physical activity level ; parental history of myocardial infa rct ion ; history of hypertension , diabetes , and high cholesterol ; postmenopausal hormone use ; alcohol intake ; and other dietary variables . RESULTS We found a strong and statistically significant positive association between dietary glycemic load and plasma hs-CRP . The median hs-CRP concentration for the lowest quintile of dietary glycemic load was 1.9 mg/L and for the highest quintile was 3.7 mg/L ; corresponding multivariate-adjusted geometric means were 1.4 and 3.8 mg/L , respectively ( P for trend < 0.01 ) . This association was significantly modified by BMI . Among women with a BMI greater-than-or-equal 25 , the multivariate-adjusted geometric mean hs-CRP concentration in the lowest quintile was 1.6 mg/L and in the highest quintile was 5.0 mg/L ; however , among women with a BMI < 25 , the corresponding means were 1.1 and 3.1 mg/L , respectively ( P = 0.01 for interaction ) . CONCLUSIONS Dietary glycemic load is significantly and positively associated with plasma hs-CRP  in healthy middle-aged women , independent of conventional risk factors for ischemic heart disease . Exacerbation of the proinflammatory process may be a mechanism whereby a high intake of rapidly digested and absorbed carbohydrates increases the risk of ischemic heart disease , especially in overweight women prone to insulin resistance BACKGROUND Diets high in carbohydrates may result in chronically elevated insulin concentrations and may affect breast cancer risk by stimulation of insulin receptors or through insulin-like growth factor I (IGF-I)-mediated mitogenesis . Insulin response to carbohydrate intake is increased in insulin-resistant states such as obesity . OBJECTIVE We sought to evaluate carbohydrate intake , glycemic index ( GI ) , and glycemic load ( GL ) and subsequent overall and hormone-receptor-defined breast cancer risk among postmenopausal women . DESIGN A prospect i ve cohort analysis of dietary carbohydrate and fiber intakes was conducted among 62 739 postmenopausal women from the E3N French study who had completed a vali date d dietary history question naire in 1993 . During a 9-y period , 1812 cases of pathology-confirmed breast cancer were documented through follow-up question naires . Nutrients were categorized into quartiles and energy-adjusted with the regression-residual method . Cox model-derived relative risks ( RRs ) were adjusted for known determinants in breast cancer . RESULTS Dietary carbohydrate and fiber intakes were not associated with overall breast cancer risk . Among overweight women , we observed an association between GI and breast cancer ( RR(Q1-Q4 ) : 1.35 ; 95 % CI : 1.00 , 1.82 ; P for trend = 0.04 ) . For women in the highest category of waist circumference , the RR(Q1-Q4 ) was 1.28 ( 95 % CI : 0.98 , 1.67 ; P for trend = 0.10 ) for carbohydrates , 1.35 ( 95 % CI : 1.04 , 1.75 ; P for trend = 0.01 ) for GI , and 1.37 ( 95 % CI : 1.05 , 1.77 ; P for trend = 0.003 ) for GL . We also observed a direct association between carbohydrate intake , GL , and estrogen receptor-negative breast cancer risk . CONCLUSIONS Rapidly absorbed carbohydrates are associated with postmenopausal breast cancer risk among overweight women and women with large waist circumference . Carbohydrate intake may also be associated with estrogen receptor-negative breast cancer BACKGROUND Limited scientific evidence has characterized the association between dietary fiber intake and risk of breast cancer ( BC )  by menopausal status and hormone receptor expression in tumors . OBJECTIVE We investigated the relation between  total dietary fiber  and its main food sources ( vegetables , fruit , cereals , and legumes ) and BC risk by using data from the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) . DESIGN A total of 11,576 invasive BC cases in 334,849 EPIC women mostly aged 35 - 70 y at baseline were identified over a median follow-up of 11.5 y.  Dietary fiber  was estimated from country-specific dietary question naires . Multivariable Cox proportional hazards regression models were used to quantify the association between dietary variables and BC risk with energy adjustment by using the residual method . Subgroup analyses were performed by menopausal status and estrogen receptor ( ER ) and progesterone receptor ( PR ) expression in tumors . RESULTS BC risk was inversely associated with intakes of  total dietary fiber  [ hazard ratio comparing fifth quintile to first quintile ( HR(Q5-Q1 ) ) : 0.95 ; 95 % CI : 0.89 , 1.01 ; P-trend = 0.03 ] and fiber from vegetables ( 0.90 ; 0.84 , 0.96 ; P-trend < 0.01 ) but not with fiber from fruit , cereals , or legumes . Overall , associations were homogeneous by menopausal status and ER and PR expression in tumors . For vegetable fiber , stronger associations were observed for estrogen receptor-negative and progesterone receptor-negative ( HR(Q5-Q1):0.74 ; 95 % CI : 0.59 , 0.93 ; P-trend = 0.01 ) than for estrogen receptor-positive and progesterone receptor-positive tumors ( 0.92 : 0.81 , 1.03 ; P-trend = 0.05 ) , with P-heterogeneity = 0.09 . CONCLUSION Diets rich in dietary fiber and , particularly , fiber from vegetables may be associated with a small reduction in risk of BC , independently of menopausal status BACKGROUND The glycemic potential of a diet is associated with chronically elevated insulin concentrations , which may augment breast cancer ( BC ) risk by stimulating insulin receptor or by affecting insulin-like growth factor I (IGF-I)-mediated mitogenesis . It is unclear whether this effect differs by BC phenotype . OBJECTIVE The objective was to investigate the relation between glycemic index ( GI ) , glycemic load ( GL ) , and total carbohydrate intake with BC by using data from the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) . DESIGN We identified 11,576 women with invasive BC among 334,849 EPIC women aged 34 - 66 y ( 5th to 95th percentiles ) at baseline over a median follow-up of 11.5 y.  Dietary GI and GL were calculated from country-specific dietary question naires . We used multivariable Cox proportional hazards models to quantify the association between GI , GL , and carbohydrate intake and BC risk . BC tumors were classified by receptor status . RESULTS Overall GI , GL , and carbohydrates were not related to BC . Among postmenopausal women , GL and carbohy date intake were significantly associated with an increased risk of estrogen receptor-negative ( ER(- ) ) BC when extreme quintiles ( Q ) were compared [ multivariable HR(Q5-Q1 ) ( 95 % CI ) = 1.36 ( 1.02 , 1.82 ; P-trend = 0.010 ) and HR(Q5-Q1 ) = 1.41 ( 1.05 , 1.89 ; P-trend = 0.009 ) , respectively ] . Further stratification by progesterone receptor ( PR ) status showed slightly stronger associations with ER(-)/PR(- ) BC [ HR(Q5-Q1 ) ( 95 % CI ) = 1.48 ( 1.07 , 2.05 ; P-trend = 0.010 ) for GL and HR(Q5-Q1 ) = 1.62 ( 1.15 , 2.30 ; P-trend = 0.005 ) for 
    Output:
    
Conclusions : Menopausal and hormone receptor status , but not BMI , might be potential influencing factors for the associations between carbohydrate intake , glycemic index , glycemic load , and breast cancer