***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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    Input: BACKGROUND The appropriate dietary intervention for overweight persons with type 2 diabetes mellitus ( DM2 ) is unclear . Trials comparing the effectiveness of diets are frequently limited by short follow-up times and high dropout rates . AIM The effects of a low carbohydrate Mediterranean ( LCM ) , a traditional Mediterranean ( TM ) , and the 2003 American Diabetic Association ( ADA ) diet were compared , on health parameters during a 12-month period . METHODS In this 12-month trial , 259 overweight diabetic patients ( mean age 55 years , mean body mass index 31.4 kg/m(2 ) ) were r and omly assigned to one of the three diets . The primary end-points were reduction of fasting plasma glucose , HbA1c and triglyceride ( TG ) levels . RESULTS 194 patients out of 259 ( 74.9 % ) completed follow-up . After 12 months , the mean weight loss for all patients was 8.3 kg : 7.7 kg for ADA , 7.4 kg for TM and 10.1 kg for LCM diets . The reduction in HbA1c was significantly greater in the LCM diet than in the ADA diet ( -2.0 and -1.6 % , respectively , p < 0.022 ) . HDL cholesterol increased ( 0.1 mmol/l + /- 0.02 ) only on the LCM ( p < 0.002 ) . The reduction in serum TG was greater in the LCM ( -1.3 mmol/l ) and TM ( -1.5 mmol/l ) than in the ADA ( -0.7 mmol/l ) , p = 0.001 . CONCLUSIONS An intensive 12-month dietary intervention in a community-based setting was effective in improving most modifiable cardiovascular risk factors in all the dietary groups . Only the LCM improved HDL levels and was superior to both the ADA and TM in improving glycaemic control OBJECTIVE To test the effects of two Mediterranean diet ( MedDiet ) interventions versus a low-fat diet on incidence of diabetes . RESEARCH DESIGN AND METHODS This was a three-arm r and omized trial in 418 nondiabetic subjects aged 55–80 years recruited in one center ( PREDIMED-Reus , northeastern Spain ) of the Prevención con Dieta Mediterránea [ PREDIMED ] study , a large nutrition intervention trial for primary cardiovascular prevention in individuals at high cardiovascular risk . Participants were r and omly assigned to education on a low-fat diet ( control group ) or to one of two MedDiets , supplemented with either free virgin olive oil ( 1 liter/week ) or nuts ( 30 g/day ) . Diets were ad libitum , and no advice on physical activity was given . The main outcome was diabetes incidence diagnosed by the 2009 American Diabetes Association criteria . RESULTS After a median follow-up of 4.0 years , diabetes incidence was 10.1 % ( 95 % CI 5.1–15.1 ) , 11.0 % ( 5.9–16.1 ) , and 17.9 % ( 11.4–24.4 ) in the MedDiet with olive oil group , the MedDiet with nuts group , and the control group , respectively . Multivariable adjusted hazard ratios of diabetes were 0.49 ( 0.25–0.97 ) and 0.48 ( 0.24–0.96 ) in the MedDiet supplemented with olive oil and nuts groups , respectively , compared with the control group . When the two MedDiet groups were pooled and compared with the control group , diabetes incidence was reduced by 52 % ( 27–86 ) . In all study arms , increased adherence to the MedDiet was inversely associated with diabetes incidence . Diabetes risk reduction occurred in the absence of significant changes in body weight or physical activity . CONCLUSIONS MedDiets without calorie restriction seem to be effective in the prevention of diabetes in subjects at high cardiovascular risk Aims /hypothesis . The amount and quality of fat in the diet could be of importance for development of insulin resistance and related metabolic disorders . Our aim was to determine whether a change in dietary fat quality alone could alter insulin action in humans . Methods . The KANWU study included 162 healthy subjects chosen at r and om to receive a controlled , isoenergetic diet for 3 months containing either a high proportion of saturated ( SAFA diet ) or monounsaturated ( MUFA diet ) fatty acids . Within each group there was a second assignment at r and om to supplements with fish oil ( 3.6 g n-3 fatty acids/d ) or placebo . Results . Insulin sensitivity was significantly impaired on the saturated fatty acid diet ( -10 % , p = 0.03 ) but did not change on the monounsaturated fatty acid diet ( + 2 % , NS ) ( p = 0.05 for difference between diets ) . Insulin secretion was not affected . The addition of n-3 fatty acids influenced neither insulin sensitivity nor insulin secretion . The favourable effects of substituting a monounsaturated fatty acid diet for a saturated fatty acid diet on insulin sensitivity were only seen at a total fat intake below median ( 37E % ) . Here , insulin sensitivity was 12.5 % lower and 8.8 % higher on the saturated fatty acid diet and monounsaturated fatty acid diet respectively ( p = 0.03 ) . Low density lipoprotein cholesterol ( LDL ) increased on the saturated fatty acid diet ( + 4.1 % , p < 0.01 ) but decreased on the monounsaturated fatty acid diet ( MUFA ) ( –5.2 , p < 0.001 ) , whereas lipoprotein ( a ) [ Lp(a ) ] increased on a monounsaturated fatty acid diet by 12 % ( p < 0.001 ) . Conclusions /interpretation . A change of the proportions of dietary fatty acids , decreasing saturated fatty acid and increasing monounsaturated fatty acid , improves insulin sensitivity but has no effect on insulin secretion . A beneficial impact of the fat quality on insulin sensitivity is not seen in individuals with a high fat intake ( > 37E % ) . [ Diabetologia ( 2001 ) 44 : 312–319 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 The effects of fish consumption and n-3 fatty acids on  type 2 diabetes mellitus ( T2DM )  have recently been debated . Objective We explored the risk of T2DM in relation to consumption of lean fish , fatty fish , fish products and total fish as well as cod liver oil supplements in a representative sample of Norwegian women . Design This was a prospect i ve population based cohort study in 33740 women free of T2DM , stroke , angina or heart attack and with detailed information on important co-variates and dietary intake at baseline . Risk ratios and corresponding 95 % CI were estimated using Poisson regression with log-person time as offset . Results Lean fish consumption was inversely associated with T2DM compared to zero intake . Risk ratios and 95 % CI for intake of 75 and 100 g lean fish per day were 0.71 ( 0.51 , 0.98 ) and 0.67 ( 0.46 , 0.98 ) , respectively . There was no effect of intake of fatty fish , fish products , total fish or use of cod liver oil supplements on the risk of T2DM . Conclusion Lean fish consumption of 75–100 g/d had a beneficial effect on T2DM . It remains unclear whether lean fish in itself has a protective effect on T2DM or that lean fish consumers have a protective life-style that we were not able to take into account in this study . Unfavorable effects of fatty fish consumption or use of cod liver oil supplements on T2DM were not observed BACKGROUND Obesity is a strong risk factor for type 2 diabetes . However , few studies have compared the predictive power of overall obesity with that of central obesity . The cutoffs for  waist circumference ( WC  ) and  waist-to-hip ratio ( WHR ) as measures of abdominal adiposity remain controversial . OBJECTIVE The objective was to compare  body mass index ( BMI ) , WC , and WHR  in predicting type 2 diabetes . DESIGN A prospect i ve cohort study ( Health Professionals Follow-Up Study ) of 27 270 men was conducted .  WC , WHR , and BMI were assessed at baseline . Covariates and potential confounders were assessed repeatedly during the follow-up . RESULTS During 13 y of follow-up , we documented 884 incident type 2 diabetes cases . Age-adjusted relative risks ( RRs ) across quintiles of WC were 1.0 , 2.0 , 2.7 , 5.0 , and 12.0 ; those of WHR were 1.0 , 2.1 , 2.7 , 3.6 , and 6.9 ; and those of BMI were 1.0 , 1.1 , 1.8 , 2.9 , and 7.9 ( P for trend < 0.0001 for all ) . Multivariate adjustment for diabetes risk factors only slightly attenuated these RRs . Adjustment for BMI substantially attenuated RRs for both WC and WHR . The receiver operator characteristic curve analysis indicated that WC and BMI were similar and were better than WHR in predicting type 2 diabetes . The cumulative proportions of type 2 diabetes cases identified according to medians of BMI ( > /=24.8 ) , WC ( > /=94 cm ) , and WHR ( > /=0.94 ) were 82.5 % , 83.6 % , and 74.1 % , respectively . The corresponding proportions were 78.9 % , 50.5 % , and 65.7 % according to the recommended cutoffs . CONCLUSIONS Both overall and abdominal adiposity strongly and independently predict risk of type 2 diabetes . WC is a better predictor than is WHR . The currently recommended cutoff for WC of 102 cm for men may need to be reevaluated ; a lower cutoff may be more appropriate BACKGROUND The long-term relations between specific types of dietary fat and risk of type 2 diabetes remain unclear . OBJECTIVE Our objective was to examine the relations between dietary fat intakes and the risk of type 2 diabetes . DESIGN We prospect ively followed 84204 women aged 34 - 59 y with no diabetes , cardiovascular disease , or cancer in 1980 . Detailed dietary information was assessed at baseline and up date d in 1984 , 1986 , and 1990 by using vali date d question naires . Relative risks of type 2 diabetes were obtained from pooled logistic models adjusted for nondietary and dietary covariates . RESULTS During 14 y of follow-up , 2507 incident cases of type 2 diabetes  were documented . Total fat intake , compared with equivalent energy intake from carbohydrates , was not associated with risk of type 2 diabetes ; for a 5 % increase in total energy from fat , the relative risk ( RR ) was 0.98 ( 95 % CI : 0.94 , 1.02 ) . Intakes of saturated or monounsaturated fatty acids were also not significantly associated with the risk of diabetes . However , for a 5 % increase in energy from polyunsaturated fat , the RR was 0.63 ( 0.53 , 0.76 ; P < 
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RESULTS Based on several studies , Mediterranean diet is inversely related to type 2 diabetes and plays important roles in the management of type 2 diabetes .
Based on the evidence gathered and evaluated from various studies , we concluded combination and interaction of Mediterranean diet components , such as fruits , vegetables , nuts , legumes , whole grains , fish and moderate intakes of red wine , which contain essential nutrients and health promoting properties , including high fibers , high magnesium , high anti-oxidant and high monounsaturatal fatty acids ( MUFA ) .
Interaction and combination of these essential nutrients and health promoting properties found to lower body weight , hemoglobin A1C ( HbA1c ) , low density lipoprotein ( LDL ) , oxidative-stress and improve high density lipoprotein ( HDL ) level ; which are beneficial for prevention and prognosis improvement of type 2 diabetes .
In the modern society , poor dietary habits accompanied by inadequate physical activity are associated with the risk of having obesity and type 2 diabetes .