***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: BACKGROUND Carbohydrate quantity and quality may play an important role in the development of type  2 diabetes . OBJECTIVE We investigated the associations of dietary glycemic load ( GL ) , glycemic index ( GI ) , carbohydrate , and fiber intake with the incidence of  type 2 diabetes .  DESIGN A prospect i ve cohort study was conducted in 37,846 participants of the EPIC-NL ( European Prospect i ve Investigation into Cancer and Nutrition-Netherl and s ) study , aged 21 - 70 y at baseline and free of diabetes .  Dietary intake was assessed with the use of a vali date d food-frequency question naire . Incident diabetes cases were mainly self-reported and verified against general practitioner records . RESULTS During a mean follow-up of 10 y , 915 incident diabetes cases were documented . Dietary GL was associated with an increased diabetes risk after adjustment for age , sex , established diabetes risk factors , and dietary factors [ hazard ratio ( HR ) per SD increase : 1.27 ; 95 % CI : 1.11 , 1.44 ; P < 0.001 ] [ corrected ] . GI tended to increase diabetes risk ( HR : 1.08 ; 95 % CI : 1.00 , 1.17 ; P = 0.05 ) .  Dietary fiber  was inversely associated with diabetes risk ( HR : 0.92 ; 95 % CI : 0.85 , 0.99 ; P < 0.05 ) , whereas carbohydrate intake was associated with increased diabetes risk ( HR : 1.15 ; 95 % CI : 1.01 , 1.32 ; P < 0.05 ) . Of the carbohydrate subtypes , only starch was related to increased diabetes risk [ HR : 1.25 ( 1.07 , 1.46 ) , P < 0.05 ] . All associations became slightly stronger after exclusion of energy misreporters . CONCLUSIONS Diets high in GL , GI , and starch and low in fiber were associated with an increased diabetes risk . Both carbohydrate quantity and quality seem to be important factors in diabetes prevention . Energy misreporting contributed to a slight attenuation of associations OBJECTIVE To examine associations between type 2 diabetes and fiber , glycemic load ( GL ) , dietary glycemic index ( GI ) , and fiber-rich foods . RESEARCH DESIGN AND METHODS This was a prospect i ve study of 36,787 men and women aged 40 - 69 years without diabetes . For all self-reported cases of diabetes at 4-year follow-up , confirmation of diagnosis was sought from medical practitioners . Case subjects were those who reported diabetes at follow-up and for whom there was no evidence that they did not have type 2 diabetes . Data were analyzed with logistic regression , adjusting for country of birth , physical activity , family history of diabetes , alcohol and energy intake , education , 5-year weight change , sex , and age . RESULTS Follow-up was completed by 31,641 ( 86 % ) participants , and 365 cases were identified . The odds ratio ( OR ) for the highest quartile of white bread intake compared with the lowest was 1.37 ( 95 % CI 1.04 - 1.81 ; P for trend = 0.001 ) . Intakes of carbohydrate ( OR per 200 g/day 0.58 , 0.36 - 0.95 ) , sugars ( OR per 100 g/day 0.61 , 0.47 - 0.79 ) , and magnesium ( OR per 500 mg/day 0.62 , 0.43 - 0.90 ) were inversely associated with incidence of diabetes , whereas intake of starch ( OR per 100 g/day 1.47 , 1.06 - 2.05 ) and dietary GI ( OR per 10 units 1.32 , 1.05 - 1.66 ) were positively associated with diabetes . These relationships were attenuated after adjustment for BMI and waist-to-hip ratio . CONCLUSIONS Reducing dietary GI while maintaining a high carbohydrate intake may reduce the risk of type 2 diabetes . One way to achieve this would be to substitute white bread with low-GI breads Colonic short-chain fatty acids ( SCFA ) may affect hepatic lipid metabolism . Lactulose increases colonic acetate production , whereas L-rhamnose increases propionate . To test the effects of oral L-rhamnose and lactulose for 28 d on fasting concentrations and hepatic synthesis of lipids in humans , 18 men were administered 25 g/d of L-rhamnose , lactulose , or d-glucose for 4 wk in a partially r and omized crossover design , with blood collected from fasting subjects on the first and last day of each period . Cholesterol and triacylglycerol ( TG ) synthesis rates were determined using deuterated water uptake rate over the last 24 h of each period . Postpr and ial blood lipids , and glucose and insulin were assessed in 11 subjects on d 28 . Fasting serum cholesterol was unchanged ; however , when expressed as a percentage change , TG were decreased , relative to baseline ( P < 0.04 ) , by L-rhamnose ( -10 % ) and lactulose ( -10 % ) , compared with D-glucose , which increased serum TG ( + 11 % ) . Net TG-fatty acid ( TGFA ) synthesis on d 28 was lower with L-rhamnose ( 2.42 + /- 0.38 g/d ) and lactulose ( 2.62 + /- 0.35 g/d ) than with D-glucose ( 2.96 + /- 0.31 g/d , P < 0.01 ) . We conclude that these results do not support a primary role for propionate in the cholesterol-lowering effect of soluble fiber . However , both lactulose and L-rhamnose lowered serum TG ( expressed as a percentage change ) and TGFA synthesis , compared with d-glucose , which increased them . Although these data are consistent with inhibition of TGFA synthesis by SCFA , other aspects of the metabolism of these sugars can not be ruled out as putative agents of their TG-lowering effects BACKGROUND Dietary carbohydrates may influence the development of  type 2 ( non-insulin-dependent ) diabetes  , for example , through effects on blood glucose and insulin concentrations . OBJECTIVE We examined the relations of baseline intake of carbohydrates , dietary fiber , dietary magnesium , and carbohydrate-rich foods and the glycemic index with incidence of diabetes . DESIGN This was a prospect i ve cohort study of 35988 older Iowa women initially free of diabetes . During 6 y of follow-up , 1141 incident cases of diabetes were reported . RESULTS  Total grain , whole-grain , total dietary fiber , cereal fiber , and dietary magnesium intakes  showed strong inverse associations with incidence of diabetes after adjustment for potential nondietary confounding variables . Multivariate-adjusted relative risks of diabetes were 1.0 , 0.99 , 0.98 , 0.92 , and 0.79 ( P for trend : 0.0089 ) across quintiles of whole-grain intake ; 1.0 , 1.09 , 1.00 , 0.94 , and 0.78 ( P for trend : 0.005 ) across quintiles of total dietary fiber intake ; and 1.0 , 0.81 , 0.82 , 0.81 , and 0.67 ( P for trend : 0.0003 ) across quintiles of dietary magnesium intake . Intakes of total carbohydrates , refined grains , fruit and vegetables , and soluble fiber and the glycemic index were unrelated to diabetes risk . CONCLUSION These data support a protective role for grains ( particularly whole grains ) , cereal fiber , and dietary magnesium in the development of diabetes in older women BACKGROUND About 9 % of average dietary energy intake in the United States comes from fructose . Such a high consumption raises concern about the metabolic effects of this sugar . OBJECTIVE The objective of this study was to determine the effect of dietary fructose on plasma lipids . DESIGN The study was conducted in the General Clinical Research Center at Fairview-University of Minnesota Medical Center . The participants were 24 healthy adult volunteers ( 12 men and 12 women ; 6 of each sex were aged < 40 y and 6 of each sex were aged > /=40 y ) . All subjects received 2 isoenergetic study diets assigned by using a r and omized , balanced crossover design . One diet provided 17 % of energy as fructose . The other diet was sweetened with glucose and was nearly devoid of fructose . Each diet was fed for 6 wk . Both diets were composed of common foods and contained nearly identical amounts of carbohydrate , protein , fat , fiber , cholesterol , and saturated , monounsaturated , and polyunsaturated fatty acids . All meals were prepared in the metabolic kitchen of the General Clinical Research Center . RESULTS The responses to the study diets differed by sex . In men , the fructose diet produced significantly higher fasting , postpr and ial , and daylong plasma triacylglycerol concentrations than did the glucose diet . The daylong plasma triacylglycerol concentration after 6 wk of the fructose diet was 32 % greater in men than the corresponding concentration during the glucose diet ( P : < 0.001 ) . The fructose diet had no significant effect on fasting or postpr and ial plasma triacylglycerol concentrations in women . The fructose diet also had no persistent effect on fasting plasma cholesterol , HDL cholesterol , or LDL cholesterol in either men or women . CONCLUSIONS Dietary fructose was associated with increased fasting and postpr and ial plasma triacylglycerol concentrations in men . Diets high in added fructose may be undesirable , particularly for men . Glucose may be a suitable replacement sugar BACKGROUND Previous studies have linked full-calorie sugar-sweetened beverages ( SSBs ) with greater weight gain and an increased risk of type 2 diabetes . OBJECTIVE We prospect ively examined the association between consumption of SSBs and the risk of coronary heart disease ( CHD ) in women . DESIGN Women ( n = 88,520 ) from the Nurses ' Health Study aged 34 - 59 y , without previously diagnosed coronary heart disease ( CHD ) , stroke , or diabetes in 1980 , were followed from 1980 to 2004 . Consumption of SSBs was derived from 7 repeated food-frequency question naires administered between 1980 and 2002 . Relative risks ( RRs ) for CHD were calculated by using Cox proportional hazards models and adjusted for known cardiovascular disease risk factors . RESULTS During 24 y of follow-up , we ascertained 3105 incident cases of CHD  ( nonfatal myocardial infa rct ion and fatal CHD ) . After st and ard and dietary risk factors were adjusted for , the RRs ( and 95 % CIs ) of CHD according to categories of cumulative average of SSB consumption ( < 1/mo , 1 - 4/mo , 2 - 6/wk , 1/d , and > or = 2 servings/d ) were 1.0 , 0.96 ( 0.87 , 1.06 ) , 1.04 ( 0.95 , 1.14 ) , 1.23 ( 1.06 , 1.43 ) , and 1.35 ( 1.07 , 1.69 ) ( P for trend < 0.001 ) . Additional adjustment for body mass index , energy intake , and incident diabetes attenuated the associations , but they remained significant . Artificially sweetened beverages were not associated with CHD . CONCLUSION Regular consumption of SSBs is associated with a higher  risk of CHD in women , even after other unhealthful lifestyle or dietary factors are accounted for It has been found that honey ameliorates cardiovascular risk factors in healthy individuals and in patients with elevated risk factors . The present study investigated the effect of natural honey on total cholesterol , low-density lipoprotein cholesterol ( LDL-C ) , high-density lipoprotein cholesterol ( HDL-C ) , triacylglycerole , C-reactive protein ( CRP ) , fasting blood glucose ( FBG ) , and body weight in overweight individuals . There were 55 patients , overweight or obese , who were r and omly recruited into the study and assigned into two groups : control group ( 17 subjects ) and experimental group ( 38 subjects ) . Patients in the control group received 70 g of sucrose daily for a maximum of 30 days and patients in the experimental group received 70 g of natural honey for the same period 
    Output:
    
In general , larger cohort studies with longer follow-up more often reported positive associations , and BMI seemed to mediate part of the increased risk .
In conclusion , data from prospect i ve cohort studies published in the years 2000 - 2011 suggest that sugar-sweetened beverages probably increase the risk of type 2 diabetes .