***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: Despite formal recommendations for dietary change to reduce the incidence of ischaemic heart disease , the acceptability and effectiveness of the proposed diets have not been well investigated in population based studies . In this preliminary investigation of nutritional advice in a well population , subjects in one group practice were r and omized to receive either dietary instruction or simple follow up without instruction . The dietary recommendations were well received , and a substantial proportion of subjects reported altering their diets in accordance with them . There were modest beneficial changes in plasma lipid levels among men . Thus , using general practice as an avenue for promoting dietary change is feasible , and may be effective among men The Minnesota Coronary Survey was a 4.5-year , open enrollment , single end-time , double-blind , r and omized clinical trial that was conducted In six Minnesota state mental hospitals and one nursing home . It Involved 4393 Institutionalized men and 4664 Institutionalized women . The trial compared the effects of a 39 % fat control diet ( 18 % saturated fat , 5 % polyunsaturated fat , 16 % monounsaturated fat , 446 mg dietary cholesterol per day ) with a 38 % fat treatment diet ( 9 % saturated fat , 15 % polyunsaturated fat , 14 % monounsaturated fat , 166 mg dietary cholesterol per day ) on serum cholesterol levels and the Incidence of myocardlal Infa rct ions , sudden deaths , and all-cause mortality . The mean duration of time on the diets was 384 days , with 1568 subjects consuming the diet for over 2 years . The mean serum cholesterol level In the pre-admission period was 207 mg/dl , falling to 175 mg/dl in the treatment group and 203 mg/dl In the control group . For the entire study population , no differences between the treatment and control groups were observed for cardiovascular events , cardiovascular deaths , or total mortality . A favorable trend for all these end-points occurred In some younger age groups Reduction of cumulative exposure to endogenous ovarian steroid hormones is a postulated method for reducing the risk of carcinoma of the breast and other malignancies . Although there are data from trials evaluating the effect of low‐fat and high‐fiber diets on sex hormone levels in premenopausal women , to the authors ' knowledge none of these trials has combined a relatively large number of participants , follow‐up of > 2–3 months , parallel controls receiving a usual diet , and careful timing of blood sampling within the menstrual cycle CONTEXT Observational studies and polyp recurrence trials are not conclusive regarding the effects of a low-fat dietary pattern on risk of colorectal cancer , necessitating a primary prevention trial . OBJECTIVE To evaluate the effects of a low-fat eating pattern on risk of colorectal cancer in postmenopausal women . DESIGN , SETTING , AND PARTICIPANTS The Women 's Health Initiative Dietary Modification Trial , a r and omized controlled trial conducted in 48,835 postmenopausal women aged 50 to 79 years recruited between 1993 and 1998 from 40 clinical centers throughout the United States . INTERVENTIONS Participants were r and omly assigned to the  dietary modification intervention  ( n = 19,541 ; 40 % ) or the  comparison group  ( n = 29,294 ; 60 % ) . The intensive behavioral modification program aim ed to motivate and support reductions in dietary fat , to increase consumption of vegetables and fruits , and to increase grain servings by using group sessions , self-monitoring techniques , and other tailored and targeted strategies . Women in the comparison group continued their usual eating pattern . MAIN OUTCOME MEASURE Invasive colorectal cancer incidence . RESULTS A total of 480 incident cases of invasive colorectal cancer occurred during a mean follow-up of 8.1 ( SD , 1.7 ) years . Intervention group participants significantly reduced their percentage of energy from fat by 10.7 % more than did the comparison group at 1 year , and this difference between groups was mostly maintained ( 8.1 % at year 6 ) . Statistically significant increases in vegetable , fruit , and grain servings were also made . Despite these dietary changes , there was no evidence that the intervention reduced the risk of invasive colorectal cancer during the follow-up period . There were 201 women with invasive colorectal cancer ( 0.13 % per year ) in the intervention group and 279 ( 0.12 % per year ) in the comparison group ( hazard ratio , 1.08 ; 95 % confidence interval , 0.90 - 1.29 ) . Secondary analyses suggested potential interactions with baseline aspirin use and combined estrogen-progestin use status ( P = .01 for each ) . Colorectal examination rates , although not protocol defined , were comparable between the intervention and comparison groups . Similar results were seen in analyses adjusting for adherence to the intervention . CONCLUSION In this study , a low-fat dietary pattern intervention did not reduce the risk of colorectal cancer  in postmenopausal women during 8.1 years of follow-up . CLINICAL TRIALS REGISTRATION Clinical Trials.gov Identifier : NCT00000611 BACKGROUND We tested the hypothesis that dietary intervention can inhibit the development of recurrent colorectal adenomas , which are precursors of most large-bowel cancers . METHODS We r and omly assigned 2079 men and women who were 35 years of age or older and who had had one or more histologically confirmed colorectal adenomas removed within six months before r and omization to one of two groups : an intervention group given intensive counseling and assigned to follow a diet that was low in fat ( 20 percent of total calories ) and high in fiber ( 18 g of dietary fiber per 1000 kcal ) and fruits and vegetables ( 3.5 servings per 1000 kcal ) , and a control group given a st and ard brochure on healthy eating and assigned to follow their usual diet . Subjects entered the study after undergoing complete colonoscopy and removal of adenomatous polyps ; they remained in the study for approximately four years , undergoing colonoscopy one and four years after r and omization . RESULTS A total of 1905 of the r and omized subjects ( 91.6 percent ) completed the study . Of the 958 subjects in the intervention group and the 947 in the control group who completed the study , 39.7 percent and 39.5 percent , respectively , had at least one recurrent adenoma ; the unadjusted risk ratio was 1.00 ( 95 percent confidence interval , 0.90 to 1.12 ) . Among subjects with recurrent adenomas , the mean ( + /-SE ) number of such lesions was 1.85+/-0.08 in the intervention group and 1.84+/-0.07 in the control group . The rate of recurrence of large adenomas ( with a maximal diameter of at least 1 cm ) and advanced adenomas ( defined as lesions that had a maximal diameter of at least 1 cm or at least 25 percent villous elements or evidence of high- grade dysplasia , including carcinoma ) did not differ significantly between the two groups . CONCLUSIONS Adopting a diet that is low in fat and high in fiber , fruits , and vegetables does not influence the risk of recurrence of colorectal adenomas Background and aim Impaired vasodilatation has been suggested to be caused by inhibition of nitric oxide generation by the recently described asymmetric dimethylarginine ( ADMA ) . In the present study we wanted to explore whether n-3 polyunsaturated fatty acid ( PUFA ) supplementation and /or diet intervention have beneficial influence on endothelial function assessed as plasma levels of ADMA and L-arginine . Methods A male population ( n = 563 , age 70 ± 6 yrs ) with long-st and ing hyperlipidemia , characterized as high risk individuals in 1970–72 , was included , r and omly allocated to receive placebo n-3 PUFA capsules ( corn oil ) and no dietary advice ( control group ) , dietary advice ( Mediterranean type ) , n-3 PUFA capsules , or dietary advice and n-3 PUFA combined and followed for 3 years . Fasting blood sample s were drawn at baseline and the end of the study . Results Compliance with both intervention regimens were demonstrated by changes in serum fatty acids and by recordings from a food frequency question naire . No influence of either regimens on ADMA levels were obtained . However , n-3 PUFA supplementation was accompanied by a significant increase in L-arginine levels , different from the decrease observed in the placebo group ( p < 0.05 ) . In individuals with low body mass index ( < 26 kg/m2 ) , the decrease in L-arginine on placebo was strengthened ( p = 0.01 ) , and the L-arginine/ADMA ratio was also significantly reduced ( p = 0.04 ) . Conclusion In this rather large r and omized intervention study , ADMA levels were not influenced by n-3 PUFA supplementation or dietary counselling . n-3 PUFA did , however , counteract the age-related reduction in L-arginine seen on placebo , especially in lean individuals , which might be discussed as an improvement of endothelial function To study the impact of diet and exercise and the combination thereof on cardiovascular risk factors , 157 healthy men aged 35 - 60 years ( mean + /- S.D. ; 46.2 + /- 5.0 ) with slightly to moderately raised cardiovascular risk factors , were r and omized to 4 groups , diet ( D , n = 40 ) , exercise ( E , n = 39 ) , diet plus exercise ( DE , n = 39 ) , and no active intervention ( controls ( C , n = 39 ) ) , and investigated at baseline and after 6 months . BMI was significantly reduced in Groups E and DE ( mean difference and 95 % confidence intervals ( CI ) , -0.3 ( -0.5 , -0.01 ) and -0.6 ( -0.9 , -0.3 ) kg/m2 , respectively ) . Waist circumference was reduced in all 3 intervention groups ( D , E , and DE ) , -1.3 ( -2.5 , -0.1 ) , -2.2 ( -3.2 , -1.3 ) and -3.0 ( -3.9 , -2.0 ) cm , but not in the control group . Blood pressure ( BP ) was reduced in all 3 intervention groups , systolic BP 4 - 7 mmHg and diastolic BP 2 - 6 mmHg . Serum cholesterol was reduced in Group DE , -0.45 ( -0.77 , -0.13 ) mmol/l . VLDL-cholesterol was reduced in Groups E and DE , -0.14 ( -0.26 , -0.03 ) and -0.09 ( -0.18 , -0.01 ) mmol/l , whereas LDL-cholesterol was reduced in Groups D and DE -0.30 ( -0.54 , -0.06 ) and -0.35 ( -0.64 , -0.05 ) mmol/l . In contrast , neither HDL-cholesterol nor serum triglycerides were influenced by the interventions . According to the coronary risk profile derived from the Framingham study , all 3 intervention groups ( D , E , and DE ) significantly reduced their estimated 10-year risk ( -13 , -12 , and -14 % , respectively ) . We conclude that even with rather moderate changes in diet and exercise , several important cardiovascular risk factors can be affected and that diet and exercise were about equally effective in reducing cardiovascular risk Background : Data are limited on the efficacy of health-fo-cused interventions for young , low-acculturated Latino women . Because breast cancer is the most commonly diagnosed cancer and the most common cause of cancer mortality in this population , combined interventions that address both early detection and dietary patterns could help reduce both morbidity and mortality associated with breast cancer in this underserved population . Purpose : Mujeres Felices por ser Saludables was a r and omized intervention study design ed to assess the efficacy of an 8-month combined dietary and breast health intervention to reduce fat and increase fiber intake as well as to increase the frequency and proficiency of breast self-examination ( BSE ) and reduce anxiety related toBSE among Latinas Methods : Blocked r and omization in blocks of 6 was used to r and omize 256 20- to 40-year-old Latinas to the intervention ( n = 127 ) or control group ( n = 129 ) . The intervention group attended an 8-month multi-component education program design ed specifically for low-acculturated Latinas . The control group received mailed health education material on a schedule comparable to the intervention . A total of 195 women ( 76.2 % ) completed both the baseline and 8-month follow-up interviews . Results : The intervention and control groups were similar on baseline sociodemographic characteristics . At the 8-month follow up , the intervention group reported lower dietary fat ( p > .001 ) and higher fiber intake ( p = .06 ) ; a higher proportion reported practicingBSE at the recommended interval ( p > .001 ) and showed improvedBSE proficiency ( p > .001 ) compared to the control group . BSE-related anxiety was low for both groups at baseline , and no diffirrence in reduction was observed . Conclusions : This project provides a successful model for achirving dietary change and improving breast health behavior 
    Output:
    
Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 9 months but longer term effects are not known