***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 Dietary fiber has been associated with a reduced risk of colorectal cancer .  However , it remains unclear at which stage in the carcinogenic pathway fiber may act or which food sources of dietary fiber may be most beneficial against colorectal cancer development . OBJECTIVE The objective was to prospect ively evaluate the association between dietary fiber intake and the risk of incident and recurrent colorectal adenoma and incident colorectal cancer . DESIGN Study participants were identified from the intervention arm of the Prostate , Lung , Colorectal , and Ovarian Cancer Screening Trial . Participants received flexible sigmoidoscopy  at baseline and 3 or 5 y after . Dietary fiber intake was measured by using a self-reported dietary question naire . The colorectal cancer , incident adenoma , and recurrent adenoma analyses were based on 57,774 , 16,980 , and 1667 participants , respectively . Unconditional logistic regression was used to assess the risk of incident and recurrent adenoma , and Cox proportional hazards models were used to assess the risk of colorectal cancer across categories of dietary fiber intake , with adjustment for potential confounders . RESULTS Elevated total  dietary fiber intake was associated with a significantly reduced risk of incident distal colorectal adenoma ( ORhighest vs. lowest tertile of intake : 0.76 ; 95 % CI : 0.63 , 0.91 ; P-trend = 0.003 ) but not recurrent adenoma ( P-trend = 0.67 ) . Although the association was not statistically significant for colorectal cancer overall ( HR : 0.85 ; 95 % CI : 0.70 , 1.03 ; P-trend = 0.10 ) , a reduced risk of distal colon cancer was observed with increased total fiber intake ( HR : 0.62 ; 95 % CI : 0.41 , 0.94 ; P-trend = 0.03 ) . Protective associations were most notable for fiber originating from cereals or fruit . CONCLUSIONS This large , prospect i ve study within a population -based screening trial suggests that individuals consuming the highest intakes of dietary fiber have reduced risks of incident colorectal adenoma and distal colon cancer and that this effect of dietary fiber , particularly from cereals and fruit , may begin early in colorectal carcinogenesis . This trial was registered at clinical trials.gov as NCT01696981 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 There is clear evidence that nutrition and lifestyle can modify colorectal cancer risk . However , it is not clear if those factors can affect colorectal cancer treatment , recurrence , survival and quality of life . This paper describes the background and design of the “ COlorectal cancer : Longitudinal , Observational study on Nutritional and lifestyle factors that may influence colorectal tumour recurrence , survival and quality of life ” – COLON – study . The main aim of this study is to assess associations of diet and other lifestyle factors , with colorectal cancer recurrence , survival and quality of life . We extensively investigate diet and lifestyle of colorectal cancer patients at diagnosis and during the following years ; this design paper focusses on the initial exposures of interest : diet and dietary supplement use , body composition , nutrient status ( e.g. vitamin D ) , and composition of the gut microbiota . Methods / Design The COLON study is a multi-centre prospect i ve cohort study among at least 1,000 incident colorectal cancer patients recruited from 11 hospitals in the Netherl and s. Patients with colorectal cancer are invited upon diagnosis . Upon recruitment , after 6 months , 2 years and 5 years , patients fill out food-frequency question naires ; question naires about dietary supplement use , physical activity , weight , height , and quality of life ; and donate blood sample s. Diagnostic CT-scans are collected to assess cross-sectional areas of skeletal muscle , subcutaneous fat , visceral fat and intermuscular fat , and to assess muscle attenuation . Blood sample s are biobanked to facilitate future analyse of biomarkers , nutrients , DNA etc . Analysis of serum 25-hydroxy vitamin D levels , and analysis of metabolomic profiles are scheduled . A subgroup of patients with colon cancer is asked to provide faecal sample s before and at several time points after colon resection to study changes in gut microbiota during treatment . For all patients , information on vital status is retrieved by linkage with national registries . Information on clinical characteristics is gathered from linkage with the Netherl and s Cancer Registry and with hospital data bases . Hazards ratios will be calculated for dietary and lifestyle factors at diagnosis in relation to recurrence and survival . Repeated measures analyses will be performed to assess changes over time in dietary and other factors in relation to recurrence and survival OBJECTIVE To evaluate the feasibility of undertaking a food skills intervention study in areas of social deprivation aim ed at altering cooking confidence , food preparation methods and dietary choices . DESIGN A st and ardised skills programme was implemented in community-based setting s. Pre- ( T1 ) and post-intervention ( T2 ) and 6-month follow-up ( T3 ) measures ( 7-day diaries and self-administered question naires ) were undertaken in intervention and comparison groups . SETTING Eight urban communities in Scotl and . SUBJECTS One hundred and thirteen adults living in areas of social deprivation . RESULTS It was clear that many subjects led fragmented lives and found commitment to intervention classes problematic . Sixty-three subjects completed the final ( T3 ) assessment s. The response to each component varied due to inability to attend sessions , illness , study requirements , employment , moving out of the area , change in circumstances , loss of interest and loss of postal question naires . At baseline , reported consumption of fruit and vegetables was low ( mean frequency 8.1 + /- 4.78 times per week ) . Fruit intake increased significantly ( P < 0.05 ) between T1 and T2 in the intervention group ( 1.7 + /- 2.36 to 2.7 + /- 3.28 times per week ) only . Between T1 and T3 , there was a significant increase ( P < 0.05 ) in intervention subjects who reported confidence in following a recipe ( 67 - 90 % , ) . CONCLUSIONS This exploratory trial shows that a food skills intervention is likely to have a small but positive effect on food choice and confidence in food preparation . A full-scale r and omised controlled trial in this hard-to-reach group would require a range of flexible approaches rather than a fully defined intervention , and presents challenges for trial design METHODS In this feasibility study , free-living older adults ( n = 180 ; means = 67.5 years old ) were r and omly assigned to one of three levels of a 3-month st and ardized compliance enhancement program . RESULTS Regarding subject compliance with the 18 g/day wheat bran fiber supplement , the high compliance enhancement group had a superior regimen compliance rate ( 88 % ) versus the medium and low groups , ( 66 and 29 % , respectively ) ( P = 0.01 ) , with similar attrition rates . CONCLUSION No significant gastrointestinal side effects and changes in body weight were reported . For similar efficacy , the comprehensive compliance enhancement group had the greatest cost effectiveness 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 . OBJECTIVE Our goal was to determine whether the PPT intervention plan could effect change in 3 dietary goals and to examine the intervention 's effect on the intake of other food groups and nutrients . DESIGN Participants with large-bowel adenomatous polyps diagnosed in the past 6 mo were r and omly assigned to either the intervention ( n = 1037 ) or the control ( n = 1042 ) group and remained in the trial for 4 y. Three dietary assessment instruments were used to measure dietary change : food-frequency question naires ( in 100 % of the sample ) , 4-d food records ( in a 20 % r and om cohort ) , and 24-h dietary recalls ( in a 10 % r and om sample ) . RESULTS Intervention participants made and sustained significant changes in all PPT goals as measured by the dietary assessment instruments ; the control participants ' intakes remained essentially the same throughout the trial . The absolute differences between the intervention and control groups over the 4-y period were 9.7 % of energy from fat ( 95 % CI : 9.0 % , 10.3 % ) , 1.65 g dietary fiber/MJ ( 95 % CI : 1.53 , 1.74 ) , and 0.27 servings of fruit and vegetables/MJ ( 95 % CI : 0.25 , 0.29 ) . Intervention participants also reported significant changes in the intake of other nutrients and food groups . The intervention group also had significantly higher serum carotenoid concentrations and lower body weights than did the control group . CONCLUSION Motivated , free-living individuals , given appropriate support , can make and sustain major dietary changes over a 4-y period Adequate fruit and vegetable intake was suggested to protect against colorectal cancer and colorectal adenomas ; however , several recent prospect i ve studies reported no association . We examined the association between fruits and vegetables and  adenomatous polyp recurrence  in the Polyp Prevention Trial ( PPT ) . The PPT was a  low-fat , high-fiber , high-fruit , and vegetable dietary intervention trial of adenoma recurrence , in which there were no differences in the rate of adenoma recurrence in participants in the intervention and control arms of the trial . In this analysis of the entire PPT trial-based cohort , multiple logistic regression analysis was used to estimate the odds ratio ( OR ) of advanced and nonadvanced adenoma recurrence within quartiles of baseline and change ( baseline minus the mean over 3 y ) in fruit and vegetable intake , after adjustment for age , total energyy intake , use of nonsteroidal anti-inflammatory drugs , BMI , and gender . There were no significant associations between nonadvanced adenoma recurrence and overall change in fruit and vegetable consumption ; however , those in the highest quartile of change in dry bean intake ( greatest increase ) compared with those in the lowest had a significantly reduced OR for advanced adenoma recurrence ( OR = 0.35 ; 95 % CI , 0.18 - 0.69 ; P for trend = 0.001 ) . The median in the highest quartile of change in dry bean intake was 370 % higher than the baseline intake . The PPT trial-based cohort provides evidence that dry beans may be inversely associated with advanced adenoma recurrence BACKGROUND Although the Mediterranean diet has been studied for cancer mortality and the Dietary Approaches to Stop Hypertension ( DASH ) diet shares similarities with the Mediterranean diet , few studies have specifically examined these 2 diets and incident colorectal cancer . OBJECTIVE The objective was to prospect ively assess the association between the Alternate Mediterranean Diet ( aMed ) and the DASH-style diet scores and risk of colorectal cancer in middle-aged men and women . DESIGN A total of 87,256 women and 45, 
    Output:
    
There is a lack of evidence from existing RCTs to suggest that increased dietary fibre intake will reduce the recurrence of adenomatous polyps in those with a history of adenomatous polyps within a two to eight year period .