***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 Even though dietary fiber has been hypothesized to reduce the risk of coronary heart disease , few large epidemiological studies have examined this relation with good methodology . METHODS AND RESULTS The Alpha-Tocopherol , Beta-Carotene Cancer Prevention Study was a r and omized , double-blind , placebo-controlled trial with daily supplementation of alpha-tocopherol and /or beta-carotene . Of the participants , 21930 smoking men aged 50 to 69 years who were free of diagnosed cardiovascular disease and had completed a vali date d dietary question naire at baseline were followed for 6.1 years . We monitored the incidence of major coronary events ( a combination of first nonfatal myocardial infa rct ion and coronary heart disease death ; n = 1399 ) and mortality from coronary heart disease ( n = 635 ) . Both entities had a significant inverse association with  dietary fiber  , but the association was stronger for coronary death . For men in the highest quintile of total dietary fiber intake ( median , 34.8 g/d ) , the relative risk for coronary death was 0.69 ( 95 % confidence interval , 0.54 to 0.88 ; P < .001 for trend ) compared with men in the lowest quintile of intake ( median , 16.1 g/d ) . With an adjustment for known cardiovascular risk factors , intake of saturated fatty acids , beta-carotene , vitamin C , and vitamin E did not material ly change the result . Water-soluble fiber was slightly more strongly associated with reduced coronary death than water-insoluble fiber , and cereal fiber also had a stronger association than vegetable or fruit fiber . CONCLUSIONS These findings suggest that independent of other risk factors , greater intake of foods rich in fiber can substantially reduce the risk of coronary heart disease , and particularly coronary death , in middle-aged , smoking men BACKGROUND Prospect i ve studies suggested that substituting whole-grain products for refined-grain products lowers the risks of type 2 diabetes and cardiovascular disease ( CVD ) in women . Although breakfast cereals are a major source of whole and refined grains , little is known about their direct association with the risk of premature mortality . OBJECTIVE We prospect ively evaluated the association between whole- and refined-grain breakfast cereal intakes and total and CVD-specific mortality in a cohort of US men . DESIGN We examined 86,190 US male physicians aged 40 - 84 y in 1982 who were free of known CVD and cancer at baseline . RESULTS During 5.5 y , we documented 3114 deaths from all causes , including 1381 due to  CVD  ( 488 myocardial infa rct ions and 146 strokes ) . Whole-grain breakfast cereal intake was inversely associated with total and CVD-specific mortality , independent of age ; body mass index ; smoking ; alcohol intake ; physical activity ; history of diabetes , hypertension , or high cholesterol ; and use of multivitamins . Compared with men who rarely or never consumed whole-grain cereal , men in the highest category of whole-grain cereal intake ( > or = 1 serving/d ) had multivariate-estimated relative risks of total and CVD-specific mortality of 0.83 ( 95 % CI : 0.73 , 0.94 ; P for trend < 0.001 ) and 0.80 ( 0.66 , 0.97 ; P for trend < 0.001 ) , respectively . In contrast , total and refined-grain breakfast cereal intakes were not significantly associated with total and CVD-specific mortality . These findings persisted in analyses stratified by history of type 2 diabetes , hypertension , and high cholesterol . CONCLUSIONS Both total mortality and CVD-specific mortality were inversely associated with whole-grain but not refined-grain breakfast cereal intake . These prospect i ve data highlight the importance of distinguishing whole-grain from refined-grain cereals in the prevention of chronic diseases BACKGROUND Prospect i ve studies linking whole- and refined-grain intakes with the risk of  hypertension  , a major cardiovascular disease risk factor , remain limited . OBJECTIVE We aim ed to determine whether baseline intake of whole or refined grains is associated with subsequent development of hypertension . DESIGN We conducted a prospect i ve cohort study in 28 926 female US health professionals aged > or=45 y who were free of baseline cardiovascular disease , cancer , and hypertension in 1992 .  Baseline whole- and refined-grain intakes were assessed from semiquantitative food-frequency question naires . We identified 8722 incident cases of hypertension from annual question naires during 10 y of follow-up . RESULTS After adjustment for known hypertension risk factors , the relative risks ( RRs ) ( and 95 % CIs ) of incident hypertension were 1.00 ( reference ) , 0.96 ( 0.89 , 1.03 ) , 0.95 ( 0.88 , 1.02 ) , 0.92 ( 0.85 , 0.99 ) , and 0.89 ( 0.82 , 0.97 ) across the increasing quintiles of baseline whole-grain intake ( P for trend = 0.007 ) . When functional cutoffs were used , women who consumed 0.5 to < 1 , 1 to < 2 , 2 to < 4 , and > or=4 whole-grain servings/d had multivariate RRs ( 95 % CIs ) of 0.93 ( 0.87 , 1.00 ) , 0.93 ( 0.87 , 0.99 ) , 0.92 ( 0.85 , 0.99 ) , and 0.77 ( 0.66 , 0.89 ) , respectively , compared with those who consumed < 0.5 whole-grain servings/d . In contrast , refined-grain intake was not associated with the risk of hypertension . The multivariate RRs of hypertension across the increasing quintiles of refined-grain intake were 1.00 , 0.97 , 0.94 , 0.99 , and 0.97 ( P for trend = 0.80 ) . CONCLUSION Higher whole-grain intake was associated with a reduced risk of hypertension in middle-aged and older women , which suggests a potential role for increasing whole-grain intake in the primary prevention of hypertension and its cardiovascular complications BACKGROUND Prospect i ve data on the relation between whole grain intake and  incident hypertension in men are limited , and no previous studies have quantitatively estimated total grams of whole grains in relation to risk of hypertension . OBJECTIVE The purpose of this study was to estimate the association of whole-grain intake ( g/d ) and risk of incident hypertension in a large prospect i ve cohort of men . DESIGN The Health Professionals Follow-Up Study is a prospect i ve cohort consisting of 51,529 male health professionals ranging in age from 40 to 75 y at enrollment in 1986 . Baseline and up date d measurement of whole-grain intake as well as important covariates were measured , and 31,684 participants without known hypertension , cancer , stroke , or coronary heart disease were followed prospect ively for 18 y through 2004 for onset of hypertension . RESULTS A total of 9227 cases of incident hypertension  were reported over the 18 y of follow-up . In multivariate-adjusted analyses , whole-grain intake was inversely associated with risk of hypertension , with a relative risk ( RR ) of 0.81 ( 95 % CI : 0.75 - 0.87 ) in the highest compared with the lowest quintile ( P for trend < 0.0001 ) . In the multivariate model , total bran was inversely associated with hypertension , with a relative risk ( RR ) of 0.85 ( 95 % CI : 0.78 , 0.92 ) in the highest compared with the lowest quintile ( P for trend : 0.002 ) . CONCLUSIONS In summary , we found an independent inverse association between intake of whole grains and  incident hypertension in men . Bran may play an important role in this association . These findings have implication s for future dietary guidelines and prevention of hypertension BACKGROUND Although dietary factors are suspected to be important determinants of coronary heart disease ( CHD ) risk , the direct evidence is relatively sparse . METHODS The Adventist Health Study is a prospect i ve cohort investigation of 31,208 non-Hispanic white California Seventh-Day Adventists . Extensive dietary information was obtained at baseline , along with the values of traditional coronary risk factors . These were related to risk of definite fatal CHD or definite nonfatal myocardial infa rct ion . RESULTS Subjects who consumed nuts frequently ( more than four times per week ) experienced substantially fewer definite fatal CHD events ( relative risk , 0.52 ; 95 % confidence interval [ CI ] , 0.36 to 0.76 ) and definite nonfatal myocardial infa rct ions ( relative risk , 0.49 ; 95 % CI , 0.28 to 0.85 ) , when compared with those who consumed nuts less than once per week . These findings persisted on covariate adjustment and were seen in almost all of 16 different subgroups of the population . Subjects who usually consumed whole wheat bread also experienced lower rates of definite nonfatal myocardial infa rct ion ( relative risk , 0.56 ; 95 % CI , 0.35 to 0.89 ) and definite fatal CHD ( relative risk , 0.89 ; 95 % CI , 0.60 to 1.33 ) when compared with those who usually ate white bread . Men who ate beef at least three times each week had a higher risk of definite fatal CHD ( relative risk , 2.31 ; 95 % CI , 1.11 to 4.78 ) , but this effect was not seen in women or for the nonfatal myocardial infa rct ion end point . CONCLUSION Our data strongly suggest that the frequent consumption of nuts may protect against risk of CHD events . The favorable fatty acid profile of many nuts is one possible explanation for such an effect Several healthy dietary patterns have been linked to longevity . Recently , a Nordic dietary pattern was associated with a lower overall mortality . No study has , however , investigated this dietary pattern in relation to cause-specific mortality . The aim of the present study was to examine the association between adherence to a healthy Nordic food index ( consisting of wholegrain bread , oatmeal , apples/pears , root vegetables , cabbages and fish/shellfish ) and overall mortality , and death by cardiovascular disease , cancer , injuries/suicide and other causes . We conducted a prospect i ve analysis in the Swedish Women ’s Lifestyle and Health cohort , including 44,961 women , aged 29–49 years , who completed a food frequency question naire between 1991–1992 , and have been followed up for mortality ever since , through Swedish registries . The median follow-up time is 21.3 years , and mortality rate ratios ( MRR ) were calculated using Cox Proportional Hazards Models . Compared to women with the lowest index score ( 0–1 points ) , those with the highest score ( 4–6 points ) had an 18 % lower overall mortality ( MRR 0.82 ; 0.71–0.93 , p < 0.0004 ) . A 1-point increment in the healthy Nordic food index was associated with a significantly lower risk of all-cause mortality : 6 % ( 3–9 % ) , cancer mortality : 5 % ( 1–9 % ) and mortality from other causes : 16 % ( 8–22 % ) . When examining the diet components individually , only wholegrain bread and apples/pears were significantly inversely associated with all-cause mortality . We observed no effect-modification by smoking status , BMI or age at baseline . The present study encourages adherence to a healthy Nordic food index , and warrants further investigation of the strong association with non-cancer , non-cardiovascular and non-injury/suicide deaths BACKGROUND The relation between carbohydrate intake and risk of ischemic heart disease ( IHD )  has not been fully explored in Asian population s known to have high-carbohydrate diets . OBJECTIVE We assessed whether intakes of total carbohydrates , different types of carbohydrates , and their food sources were associated with  IHD mortality in a Chinese population . DESIGN We prospect ively examined the association of carbohydrate intake and IHD mortality in 53,469 participants in the Singapore Chinese Health Study with an average follow-up of 15 y.  Diet was assessed by using a semiquantitative food-frequency question naire . HRs and 95 % CIs were calculated by using a Cox proportional hazards analysis . RESULTS We documented 1660 IHD deaths during 804,433 person-years of follow-up .  Total carbohydrate intake was not associated with IHD mortality risk [ men : HR per 5 % of energy , 0.97 ( 95 % CI : 0.92 , 1.03 ) ; women : 1.06 ( 95 % CI 
    Output:
    
Our findings suggest significant inverse relations between whole-grain intake and mortality due to any cause , CVD , or cancer .