***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: OBJECTIVE Individuals with type 2 diabetes have increased fracture risk despite higher bone mineral density ( BMD ) . Our aim was to examine the influence of glucose control on skeletal complications . RESEARCH DESIGN AND METHODS Data of 4,135 participants of the Rotterdam Study , a prospect i ve population -based cohort , were available ( mean follow-up 12.2 years ) . At baseline , 420 participants with type 2 diabetes were classified by glucose control ( according to HbA1c calculated from fructosamine ) , result ing in three comparison groups : adequately controlled diabetes ( ACD ; n = 203 ; HbA1c < 7.5 % ) , inadequately controlled diabetes ( ICD ; n = 217 ; HbA1c ≥7.5 % ) , and no diabetes ( n = 3,715 ) . Models adjusted for sex , age , height , and weight ( and femoral neck BMD ) were used to test for differences in bone parameters and fracture risk ( hazard ratio [ HR ] [ 95 % CI ] ) . RESULTS The ICD group had 1.1–5.6 % higher BMD , 4.6–5.6 % thicker cortices , and −1.2 to −1.8 % narrower femoral necks than ACD and ND , respectively . Participants with ICD had 47–62 % higher fracture risk than individuals without diabetes ( HR 1.47 [ 1.12–1.92 ] ) and ACD ( 1.62 [ 1.09–2.40 ] ) , whereas those with ACD had a risk similar to those without diabetes ( 0.91 [ 0.67–1.23 ] ) . CONCLUSIONS Poor glycemic control in type 2 diabetes is associated with fracture risk , high BMD , and thicker femoral cortices in narrower bones . We postulate that fragility in apparently “ strong ” bones in ICD can result from microcrack accumulation and /or cortical porosity , reflecting impaired bone repair The determine the effect of different foods on the blood glucose , 62 commonly eaten foods and sugars were fed individually to groups of 5 to 10 healthy fasting volunteers .  Blood glucose levels were measured over 2 h , and expressed as a percentage of the area under the glucose response curve when the same amount of carbohydrate was taken as glucose . The largest rises were seen with vegetables ( 70 + /- 5 % ) , followed by breakfast cereals ( 65 + /- 5 % ) , cereals and biscuits ( 60 + /- 3 % ) , fruit ( 50 + /- 5 % ) , dairy products ( 35 + /- 1 % ) , and dried legumes ( 31 + /- 3 % ) . A significant negative relationship was seen between fat ( p less than 0.01 ) and protein ( p less than 0.001 ) and postpr and ial glucose rise but not with fiber or sugar content The aim of the present study was to assess reproducibility and relative validity of a self-administered FFQ used in the PREDIMED Study , a clinical trial for primary prevention of CVD by Mediterranean diet in a population at high cardiovascular risk . The FFQ was administered twice ( FFQ1 and FFQ2 ) to explore reproducibility at 1 year . Four 3 d dietary records ( DR ) were used as reference to explore validity ; participants therefore recorded their food intake over 12 d in the course of 1 year . The degree of misclassification in the FFQ was also evaluated by a contingency table of quintiles comparing the information from the FFQ2 and the DR . A total of 158 men and women ( aged 55 - 80 years ) were asked not to modify their dietary habits during the study period . Reproducibility for food groups , energy and nutrient intake , explored by the Pearson correlation coefficient ( r ) ranged 0.50 - 0.82 , and the intraclass correlation coefficient ( ICC ) ranged from 0.63 to 0.90 . The FFQ2 tended to report higher energy and nutrient intake than the DR . The validity indices of the FFQ in relation to the DR for food groups and energy and nutrient intake ranged ( r ) from 0.24 to 0.72 , while the range of the ICC was between 0.40 and 0.84 . With regard to food groups , 68 - 83 % of individuals were in the same or adjacent quintile in both methods , a figure which decreased to 55 - 75 % for energy and nutrient intake . We concluded that FFQ measurements had good reproducibility and a relative validity similar to those of FFQ used in other prospect i ve studies Hip fractures are the most devastating consequence of osteoporosis and impact 1 in 6 white women leading to a two- to threefold increased mortality risk in the first year . Despite evidence of inflammatory markers in the pathogenesis of osteoporosis , few studies have examined their effect on hip fracture . To determine if high levels of inflammation increase hip fracture risk and to explore mediation pathways , a case-cohort design nested in a cohort of 4709 white women from the Study of Osteoporotic Fractures was used . A r and om sample of 1171 women was selected as the subcohort ( mean age 80.1 ± 4.2 years ) plus the first 300 women with incident hip fracture .  Inflammatory markers interleukin-6 ( IL-6 ) and soluble receptors ( SR ) for IL-6 ( IL-6 SR ) and tumor necrosis factor ( TNF SR1 and TNF SR2 ) were measured , and participants were followed for a median ( interquartile range ) of 6.3 ( 3.7 , 6.9 ) years . In multivariable models , the hazard ratio ( HR ) of hip fracture for women in the highest inflammatory marker level ( quartile 4 ) was 1.64 ( 95 % confidence interval [ CI ] , 1.09 - 2.48 , p trend = 0.03 ) for IL-6 and 2.05 ( 95 % CI , 1.35 - 3.12 , p trend < 0.01 ) for TNF SR1 when compared with women in the lowest level ( quartile 1 ) . Among women with 2 and 3 - 4 inflammatory markers in the highest quartile , the HR of hip fracture was 1.51 ( 95 % CI , 1.07 - 2.14 ) and 1.42 ( 95 % CI , 0.87 - 2.31 ) compared with women with zero to one marker(s ) in the highest quartile ( p trend = 0.03 ) . After individually adjusting for seven potential mediators , cystatin-C ( a biomarker of renal function ) and bone mineral density ( BMD ) attenuated HRs among women with the highest inflammatory burden by 64 % and 50 % , respectively , suggesting a potential mediating role . Older white women with high inflammatory burden are at increased risk of hip fracture in part due to poor renal function and low BMD CONTEXT AND OBJECTIVE Because it has been suggested that osteocalcin ( OC ) , an osteoblast-derived hormone , is a new link between bone and glucose metabolism , we tested whether serum carboxylated osteocalcin ( cOC ) and undercarboxylated osteocalcin ( ucOC ) levels are independently associated with the development of type 2 diabetes in subjects at high cardiovascular risk . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve , nested case-control study was conducted using data from the Prevención con Dieta Mediterránea ( PREDIMED ) study . We included 153 case subjects with newly diagnosed diabetes and 306 individually matched control subjects free of diabetes identified during a mean 5-year follow-up . Conditional logistic regression models were used to estimate matched odds ratios for incident diabetes according to categories of both forms of OC measured by ELISAs . RESULTS Baseline serum concentrations of both forms of OC were significantly lower in case subjects than in control subjects . In subjects with incident cases of diabetes , concentrations of cOC , but not of ucOC , were inversely and significantly associated with homeostasis model assessment of insulin resistance levels ( β = -0.335 ) and with fasting glucose concentrations ( β = -0.044 ) in control subjects , independent of other relevant confounders . In the conditional logistic model that took into account the matching factors , the odds ratios for diabetes incidence in the lowest vs the highest tertile of cOC and ucOC were 2.03 ( 95 % confidence interval , 1.32 - 3.13 ) and 1.88 ( 1.23 - 2.85 ) , respectively . Further adjustment for family history of diabetes , lifestyle , and other confounding factors did not appreciably change the magnitude of these associations . CONCLUSION In a population at high cardiovascular risk , low concentrations of serum cOC and ucOC were strongly associated with an increased risk of incident diabetes OBJECTIVE To examine prospect ively the relationship between glycemic diets , low fiber intake , and risk of non-insulin-dependent diabetes mellitus .  DESIGN Cohort study . SETTING In 1986 , a total of 65173 US women 40 to 65 years of age and free from diagnosed cardiovascular disease , cancer , and diabetes completed a detailed dietary question naire from which we calculated usual intake of total and specific sources of dietary fiber , dietary glycemic index , and glycemic load . MAIN OUTCOME MEASURE Non-insulin-dependent diabetes mellitus . RESULTS During 6 years of follow-up , 915 incident cases of diabetes  were documented . The dietary glycemic index was positively associated with risk of diabetes after adjustment for age , body mass index , smoking , physical activity , family history of diabetes , alcohol and cereal fiber intake , and total energy intake . Comparing the highest with the lowest quintile , the relative risk ( RR ) of diabetes was 1.37 ( 95 % confidence interval [ CI ] , 1.09 - 1.71 , P trend=.005 ) . The glycemic load ( an indicator of a global dietary insulin dem and ) was also positively associated with diabetes ( RR= 1.47 ; 95 % CI , 1.16 - 1.86 , P trend=.003 ) . Cereal fiber intake was inversely associated with risk of diabetes when comparing the extreme quintiles ( RR=0.72 , 95 % CI , 0.58 - 0.90 , P trend=.001 ) . The combination of a high glycemic load and a low cereal fiber intake further increased the risk of diabetes ( RR=2.50 , 95 % CI , 1.14 - 5.51 ) when compared with a low glycemic load and high cereal fiber intake . CONCLUSIONS Our results support the hypothesis that diets with a high glycemic load and a low cereal fiber content increase risk of diabetes in women . Further , they suggest that grains should be consumed in a minimally refined form to reduce the incidence of diabetes BACKGROUND Osteocalcin has been related to insulin secretion in experimental models . Few prospect i ve studies have evaluated the association between circulating osteocalcin concentrations and insulin secretion and sensitivity in humans . OBJECTIVE The objective was to examine cross-sectional and longitudinal associations between circulating forms of osteocalcin and insulin secretion and sensitivity in elderly men at high cardiovascular risk . DESIGN We examined cross-sectional and longitudinal associations between serum measurements of total osteocalcin and undercarboxylated osteocalcin ( ucOC ) with fasting glucose , fasting insulin , HOMA-IR , and HOMA β cell function ( HOMA-BCF ) in 79 elderly men . We also examined the association between 2-y changes in osteocalcin and changes in fasting glucose , insulin , HOMA-IR , and HOMA-BCF . RESULTS In an adjusted multivariable linear regression analysis , increases in serum osteocalcin were significantly associated with an increase in HOMA-BCF ( β coefficient : 2.87 ; 95 % CI : 0.23 , 5.52 ; P = 0.033 ) , and changes in ucOC were linked to a decrease in HOMA-IR ( β coefficient : -0.31 ; 95 % CI : -0.60 , 0.03 ; P = 0.032 ) . Moreover , in subjects not taking oral antidiabetic drugs  , baseline osteocalcin concentrations were positively associated with higher fasting insulin concentrations and HOMA-BCF even after adjustment for BMI , physical activity , intervention group , presence of type 2 diabetes mellitus , and baseline values of each dependent variable . CONCLUSIONS Changes in serum osteocalcin and ucOC are associated with an improvement in insulin secretion and sensitivity , which suggests a possible role of bone in the development of type 2 diabetes . This trial is registered at clinical trials.gov as IS RCT N35739639 The proinflammatory cytokines interleukin-1 beta ( IL-1 beta ) and IL-6 may play a central role in the acceleration of postmenopausal bone loss , but observational studies have led to contradictory results . Estrogen-dependent changes in the production 
    Output:
    
Conclusions A high DGI and DGL are associated with a higher risk of osteoporosis-related fractures in an elderly Mediterranean population at high cardiovascular disease risk .