***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 The Mediterranean diet has been suggested to play a beneficial role for health and longevity . However , to our knowledge , no prospect i ve US study has investigated the Mediterranean dietary pattern in relation to mortality . METHODS Study participants included 214,284 men and 166,012 women in the National Institutes of Health (NIH)-AARP ( formerly known as the American Association of Retired Persons ) Diet and Health Study . During follow-up for all-cause mortality ( 1995 - 2005 ) , 27,799 deaths were documented . In the first 5 years of follow-up , 5,985 cancer deaths and 3,451 cardiovascular disease ( CVD ) deaths were reported . We used a 9-point score to assess conformity with the Mediterranean dietary pattern ( components included vegetables , legumes , fruits , nuts , whole grains , fish , monounsaturated fat-saturated fat ratio , alcohol , and meat ) . We calculated hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) using age- and multivariate-adjusted Cox models . RESULTS The Mediterranean diet was associated with reduced all-cause and cause-specific mortality . In men , the multivariate HRs comparing high to low conformity for all-cause , CVD , and cancer mortality were 0.79 ( 95 % CI , 0.76 - 0.83 ) , 0.78 ( 95 % CI , 0.69 - 0.87 ) , and 0.83 ( 95 % CI , 0.76 - 0.91 ) , respectively . In women , an inverse association was seen with high conformity with this pattern : decreased risks that ranged from 12 % for cancer mortality to 20 % for all-cause mortality ( P = .04 and P < .001 , respectively , for the trend ) . When we restricted our analyses to never smokers , associations were virtually unchanged . CONCLUSION These results provide strong evidence for a beneficial effect of higher conformity with the Mediterranean dietary pattern on risk of death from all causes , including deaths due to CVD and cancer , in a US population BACKGROUND Adherence to a Mediterranean diet may improve longevity , but relevant data are limited . METHODS We conducted a population -based , prospect i ve investigation involving 22,043 adults in Greece who completed an extensive , vali date d , food-frequency question naire at base line .  Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean-diet scale that incorporated the salient characteristics of this diet ( range of scores , 0 to 9 , with higher scores indicating greater adherence ) . We used proportional-hazards regression to assess the relation between adherence to the Mediterranean diet and total mortality , as well as mortality due to coronary heart disease and mortality due to cancer , with adjustment for age , sex , body-mass index , physical-activity level , and other potential confounders . RESULTS During a median of 44 months of follow-up , there were 275 deaths . A higher degree of adherence to the Mediterranean diet was associated with a reduction in total mortality ( adjusted hazard ratio for death associated with a two-point increment in the Mediterranean-diet score , 0.75 [ 95 percent confidence interval , 0.64 to 0.87 ] ) . An inverse association with greater adherence to this diet was evident for both death due to coronary heart disease ( adjusted hazard ratio , 0.67 [ 95 percent confidence interval , 0.47 to 0.94 ] ) and death due to cancer ( adjusted hazard ratio , 0.76 [ 95 percent confidence interval , 0.59 to 0.98 ] ) . Associations between individual food groups contributing to the Mediterranean-diet score and total mortality were generally not significant . CONCLUSIONS Greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality Objective To assess the relation between adherence to a Mediterranean diet and the incidence of diabetes  among initially healthy participants . Design Prospect i ve cohort study with estimates of relative risk adjusted for sex , age , years of university education , total energy intake , body mass index , physical activity , sedentary habits , smoking , family history of diabetes , and personal history of hypertension . Setting Spanish university department . Participants 13 380 Spanish university graduates without diabetes at baseline followed up for a median of 4.4 years . Main outcome measures Dietary habits assessed at baseline with a vali date d 136 item food frequency question naire and scored on a nine point index . New cases of diabetes confirmed through medical reports and an additional detailed question naire posted to those who self reported a new diagnosis of diabetes by a doctor during follow-up . Confirmed cases of type 2 diabetes . Results Participants who adhered closely to a Mediterranean diet had a lower risk of diabetes . The incidence rate ratios adjusted for sex and age were 0.41 ( 95 % confidence interval 0.19 to 0.87 ) for those with moderate adherence ( score 3 - 6 ) and 0.17 ( 0.04 to 0.75 ) for those with the highest adherence ( score 7 - 9 ) compared with those with low adherence ( score < 3 ) . In the fully adjusted analyses the results were similar . A two point increase in the score was associated with a 35 % relative reduction in the risk of diabetes ( incidence rate ratio 0.65 , 0.44 to 0.95 ) , with a significant inverse linear trend ( P=0.04 ) in the multivariate analysis . Conclusion Adherence to a Mediterranean diet is associated with a reduced risk of diabetes Background : Health benefits of a Mediterranean dietary pattern have been shown . However , there are few data on the effects of increased adherence to a Mediterranean diet ( MedDiet ) in non-Mediterranean countries . Objective : We aim ed to determine whether adherence to a MedDiet would result in changes in plasma lipids , glucose and insulin , high-sensitivity C-reactive protein ( hs-CRP ) , and F2-isoprostanes ( F2-IsoPs ) in an Australian population . Methods : The study was a 6-mo parallel , r and omized , controlled dietary intervention trial . We recruited 166 participants aged ≥65 y. Participants were stratified on body mass index , sex , and age and assigned to receive either a MedDiet or a habitual diet ( HabDiet ) . The primary outcome was cognitive function , reported elsewhere . As secondary outcomes , assessment of fasting total , LDL , and HDL cholesterol ; triglycerides ( TGs ) ; glucose ; insulin ; hs-CRP ; and F2-IsoPs was completed at baseline and at 3 and 6 mo . The MedDiet group followed a prescribed diet containing 15 - 45 mL extra-virgin olive oil/d , abundant vegetables , fruit , nuts , legumes , and whole grains , as well as moderate fish , poultry , and dairy foods .  Dietary intake was measured by 3-d weighed food records at baseline and at 2 and 4 mo . Results were analyzed by using linear mixed-effects models . Results : Compared with the HabDiet , the MedDiet result ed in lower TGs at 3 mo ( mean difference : -0.15 mmol/L ; 95 % CI : -0.23 , -0.07 mmol/L ; P < 0.001 ) and 6 mo ( mean difference : -0.09 mmol/L ; 95 % CI : -0.18 , -0.01 mmol/L ; P = 0.03 ) and lower F2-IsoPs at 3 mo ( mean difference : -103.5 pmol/L ; 95 % CI : -154.2 , -52.7 pmol/L ; P < 0.001 ) and 6 mo ( -65.4 pmol/L ; 95 % CI : -117.1 , -13.7 pmol/L ; P < 0.001 ) . Lipoprotein , glucose and insulin , and hs-CRP concentrations were not significantly different between groups . Conclusion : A high adherence to a MedDiet for 6 mo result ed in a significant reduction in TGs and F2-IsoPs among older Australians . This trial was registered at clinical trials.gov as ACTRN12613000602729 Background Heart and lung transplant recipients are at a substantially increased risk of cardiovascular disease ( CVD ) . Since both low-fat and Mediterranean diets can reduce CVD in immunocompetent people at high risk , we assessed adherence among thoracic transplant recipients allocated to one or other of these diets for 12 months . Methods Forty-one transplant recipients ( 20 heart ; 21 lung ) r and omized to a Mediterranean or a low-fat diet for 12 months  received diet-specific education at baseline . Adherence was primarily assessed by question naire : 14-point Mediterranean diet ( score 0–14 ) and 9-point low-fat diet ( score 0–16 ) respectively , high scores indicating greater adherence . Median scores at baseline , 6 months , 12 months , and 6-weeks post-intervention were compared by dietary group . We further assessed changes in weight , body mass index ( BMI ) and serum triglycerides from baseline to 12 months as an additional indicator of adherence . Results In those r and omized to a Mediterranean diet , median scores increased from 4 ( range 1–9 ) at baseline , to 10 ( range 6–14 ) at 6-months and were maintained at 12 months , and also at 6-weeks post-intervention ( median 10 , range 6–14 ) . Body weight , BMI and serum triglycerides decreased over the 12-month intervention period ( mean weight − 1.8 kg , BMI –0.5 kg/m2 , triglycerides − 0.17 mmol/L ) . In the low-fat diet group , median scores were 11 ( range 9–14 ) at baseline ; slightly increased to 12 ( range 9–16 ) at 6 months , and maintained at 12 months and 6 weeks post-intervention ( median 12 , range 8–15 ) . Mean changes in weight , BMI and triglycerides were − 0.2 kg , 0.0 kg/m2 and − 0.44 mmol/L , respectively . Conclusions Thoracic transplant recipients adhered to Mediterranean and low-fat dietary interventions . The change from baseline eating habits was notable at 6 months ; and this change was maintained at 12 months and 6 weeks post-intervention in both Mediterranean diet and low-fat diet groups . Dietary interventions based on comprehensive , well-supported education sessions targeted to both patients and their family members are crucial to success . Such nutritional strategies can help in the management of their substantial CVD risk . Trial registration The IRAS trial registry ( IS RCT N63500150 ) . Date of registration 27 July 2016 . Retrospectively registered The aim of the present study was to investigate the effect of long-term diet and very long chain n-3 fatty acids ( VLC n-3 ) intervention on plasma coagulation factor VII ( FVII ) , choline-containing phospholipids ( PC ) and triglycerides ( TG ) , especially related to the R353Q polymorphism of the FVII gene . The present investigation included 219 subjects from the Diet and Omega-3 Intervention Trial on atherosclerosis ( DOIT ) , a 2x2 factorial design ed study in elderly men with long-st and ing hypercholesterolemia . The subjects were r and omly allocated to receive placebo capsules ( corn oil ) ( control ) , placebo capsules and dietary advice ( " Mediterranean type " diet ) , VLC n-3 capsules , or VLC n-3 capsules and dietary advice combined . The R353Q genotype and the levels of FVIIc , FVIIag , FVIIa , PC , and TG at baseline and after 6 months were determined . Diet intervention was followed by a significant reduction of 5.1 % in the levels of FVIIag and 2.4 mU/ml in FVIIa ( 95 % CI -7.4 , -2.9 , and -3.8 , -1.1 , respectively ) ( both p<0.001 ) compared to the no diet group , independent of genotype . No effects of diet intervention on FVIIc , PC or TG were observed . After VLC n-3 supplementation the TG levels were significantly reduced compared to placebo ( p=0.01 ) , whereas all FVII levels and PC remained unchanged . Dietary advice towards a " Mediterranean type " diet , but not VLC n-3 supplementation , was shown to reduce the levels of FVIIag and FVIIa after 6 months , independent of genotype . The results indicate the dietary advice to be more favourable in reducing this risk factor for CVD as compared to specific VLC n-3 supplementation BACKGROUND The Polyp Prevention Trial ( PPT ) was a multicenter r and omized clinical trial design ed to determine the effects of a high-fiber ( 4.30 g/MJ ) , high-fruit- and -vegetable ( 0.84 servings/MJ ) , low-fat ( 20 % of energy from fat ) diet on the recurrence of adenomatous polyps in the large bowel . OB 
    Output:
    
For comparison 3 there was low- quality evidence of little or no effect of a Mediterranean-style diet on lipid levels and very low- quality evidence for blood pressure .
There is a paucity of evidence for secondary prevention .