***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: ABSTRACT The aim of the present study was to assess the relationship between change in interpersonal difficulties with change in chronic pain , health status and psychological state in 257 irritable bowel syndrome ( IBS ) patients in a r and omized control trial comparing  psychotherapy , antidepressant and usual care . We assessed at three time points  interpersonal problems ( IIP‐32 ) , abdominal pain and bowel symptoms , psychological distress ( SCL‐90 ) , and health status ( SF‐36 ) . Analysis included repeated measures ( ANOVA ) to assess change over time and multiple regressions to identify whether change in IIP was associated with outcome after controlling for psychological status . The main findings were : ( 1 ) difficulties with social inhibition and dependency were associated with longer disease duration ; ( 2 ) change in mean IIP‐32 over 15 months was significantly correlated with changes in pain , but these relationships were mediated by change in psychological distress ; ( 3 ) change in IIP‐32 was an independent predictor of improved health status at 15 months only in the psychotherapy group . These results indicate that improvement in interpersonal problems in IBS patients appear to be primarily associated with reduced psychological distress but , in addition , the association with improved health status  following psychotherapy suggests that specific help with interpersonal problems may play a role in improving health status of patients with chronic painful IBS OBJECTIVE Evaluate a 16-week decision support and goal - setting intervention to compare diet quality , decision , and diabetes-related outcomes to a control group . METHODS Adults with type 2 diabetes ( n=54 ) were r and omly assigned to an intervention or control group . Intervention group participants completed one in-person motivational interviewing and decision support session followed by seven biweekly telephone coaching calls . Participants reported previous goal attempts and set diet- and /or physical activity-related goals during coaching calls . Control group participants received information about local health care re sources on the same contact schedule . RESULTS There was a significant difference between groups for diabetes empowerment ( p=0.045 ) . A significant increase in diet quality , diabetes self-efficacy , and diabetes empowerment , and a significant decrease in diabetes distress and depressive symptoms ( all p≤0.05 ) occurred in the intervention group . Decision confidence to achieve diet-related goals significantly improved from baseline to week 8 but then declined at study end ( both p≤0.05 ) . CONCLUSIONS Setting specific diet-related goals may promote dietary change , and telephone coaching can improve psychosocial outcomes related to diabetes self-management . PRACTICE IMPLICATION S Informed shared decision making can facilitate progressively challenging yet attainable goals tailored to individuals ' lifestyle . Decision coaching may empower patients to improve self-management practice s and reduce distress Long-term dietary intake influences the structure and activity of the trillions of microorganisms residing in the human gut , but it remains unclear how rapidly and reproducibly the human gut microbiome responds to short-term macronutrient change . Here we show that the short-term consumption of diets composed entirely of animal or plant products alters microbial community structure and overwhelms inter-individual differences in microbial gene expression . The animal-based diet increased the abundance of bile-tolerant microorganisms ( Alistipes , Bilophila and Bacteroides ) and decreased the levels of Firmicutes that metabolize dietary plant polysaccharides ( Roseburia , Eubacterium rectale and Ruminococcus bromii ) . Microbial activity mirrored differences between herbivorous and carnivorous mammals , reflecting trade-offs between carbohydrate and protein fermentation . Foodborne microbes from both diets transiently colonized the gut , including bacteria , fungi and even viruses . Finally , increases in the abundance and activity of Bilophila wadsworthia on the animal-based diet support a link between dietary fat , bile acids and the outgrowth of microorganisms capable of triggering inflammatory bowel disease . In concert , these results demonstrate that the gut microbiome can rapidly respond to altered diet , potentially facilitating the diversity of human dietary lifestyles BACKGROUND A diet low in fermentable oligosaccharides , disaccharides , monosaccharides , and polyols ( FODMAPs ) is increasingly recommended for patients with irritable bowel syndrome ( IBS ) . We aim ed to investigate the effects of a blinded low-FODMAP vs high-fructo-oligosaccharides ( FOS ) diet on symptoms , immune activation , gut microbiota composition , and short-chain fatty acids ( SCFAs ) . METHODS Twenty patients with diarrhea-predominant or mixed IBS were instructed to follow a low-FODMAP diet ( LFD ) throughout a 9-week study period . After 3 weeks , they were r and omized and double-blindly assigned to receive a supplement of either FOS ( FODMAP ) or maltodextrin ( placebo ) for the next 10 days , followed by a 3-week washout period before crossover . Irritable bowel syndrome severity scoring system ( IBS-SSS ) was used to evaluate symptoms . Cytokines ( interleukin [IL]-6 , IL-8 , and tumor necrosis factor alpha ) were analyzed in blood sample s , and gut microbiota composition ( 16S rRNA ) and SCFAs were analyzed in fecal sample s. KEY RESULTS Irritable bowel syndrome symptoms consistently improved after 3 weeks of LFD , and significantly more participants reported symptom relief in response to placebo ( 80 % ) than FOS ( 30 % ) . Serum levels of proinflammatory IL-6 and IL-8 , as well as levels of fecal bacteria ( Actinobacteria , Bifidobacterium , and Faecalibacterium prausnitzii ) , total SCFAs , and n-butyric acid , decreased significantly on the LFD as compared to baseline . Ten days of FOS supplementation increased the level of these bacteria , whereas levels of cytokines and SCFAs remained unchanged . CONCLUSIONS AND INFERENCES Our findings support the efficacy of a LFD in alleviating IBS symptoms , and show changes in inflammatory cytokines , microbiota profile , and SCFAs , which may have consequences for gut health BACKGROUND & AIMS Poorly digested , fermentable carbohydrates may induce symptoms of irritable bowel syndrome ( IBS ) via unclear mechanisms . We performed a r and omized trial with magnetic resonance imaging ( MRI ) analysis to investigate correlations between symptoms and changes in small- and large-bowel contents after oral challenge . METHODS We performed a 3-period , cross-over study of 29 adult patients with IBS ( based on Rome III criteria , with symptoms of abdominal pain or discomfort for at least 2 days/wk ) and reported bloating . In parallel , we performed the same study of 29 healthy individuals ( controls ) . Studies were performed in the United Kingdom from January 2013 through February 2015 . On 3 separate occasions ( at least 7 days apart ) , subjects were given a 500-mL drink containing 40 g of carbohydrate ( glucose in the first period , fructose in the second , and inulin in the third , in a r and om order ) . Levels of breath hydrogen were measured and intestinal content was assessed by MRI before and at various time points after consumption of each drink . Symptoms were determined based on subjects ' responses to the Hospital Anxiety and Depression Scale question naire and the Patient Health Question naire-15 . The primary end point was whether participants had a clinical ly important symptom response during the 300 minutes after consumption of the drink . RESULTS More patients with IBS reached the predefined symptom threshold after intake of inulin ( 13 of 29 ) or fructose ( 11 of 29 ) than glucose ( 6 of 29 ) . Symptoms peaked sooner after intake of fructose than inulin . Fructose increased small-bowel water content in both patients and controls whereas inulin increased colonic volume and gas in both . Fructose and inulin  increased breath hydrogen levels in both groups , compared with glucose ; fructose produced an earlier increase than inulin . Controls had lower symptom scores during the period after drink consumption than patients with IBS , despite similar MRI parameters and breath hydrogen responses . In patients who reached the symptom threshold after inulin intake , peak symptom intensity correlated with peak colonic gas ( r = 0.57 ; P < .05 ) . Changes in MRI features and peak breath hydrogen levels were similar in patients who did and did not reach the symptom threshold . CONCLUSIONS Patients with IBS and healthy individuals without IBS ( controls ) have similar physiological responses after intake of fructose or inulin ; patients reported symptoms more frequently after inulin than controls . In patients with a response to inulin , symptoms related to levels of intraluminal gas , but peak gas levels did not differ significantly between responders , nonresponders , or controls . This indicates that colonic hypersensitivity to distension , rather than excessive gas production , produces carbohydrate-related symptoms in patients with IBS . Clinical trials.gov no : NCT01776853 Objective The effects of dietary interventions on gut bacteria are ambiguous . Following a previous intervention study , we aim ed to determine how differing diets impact gut bacteria and if bacterial profiles predict intervention response . Design Sixty-seven patients with IBS were r and omised to  traditional IBS ( n=34 ) or low fermentable oligosaccharides , disaccharides , monosaccharides and polyols ( FODMAPs )  ( n=33 )  diets  for 4 weeks . Food intake was recorded for 4 days during screening and intervention . Faecal sample s and IBS Symptom Severity Score ( IBS-SSS ) reports were collected before ( baseline ) and after intervention . A faecal microbiota dysbiosis test ( GA-map Dysbiosis Test ) evaluated bacterial composition . Per protocol analysis was performed on 61 patients from whom microbiome data were available . Results Responders ( reduced IBS-SSS by ≥50 ) to low FODMAP , but not traditional , dietary intervention were discriminated from non-responders before and after intervention based on faecal bacterial profiles . Bacterial abundance tended to be higher in non-responders to a low FODMAP diet compared with responders before and after intervention . A low FODMAP intervention was associated with an increase in Dysbiosis Index ( DI ) scores in 42 % of patients ; while decreased DI scores were recorded in 33 % of patients following a traditional IBS diet . Non-responders to a low FODMAP diet , but not a traditional IBS diet had higher DI scores than responders at baseline . Finally , while a traditional IBS diet was not associated with significant reduction of investigated bacteria , a low FODMAP diet was associated with reduced Bifidobacterium and Actinobacteria in patients , correlating with lactose consumption . Conclusions A low FODMAP , but not a traditional IBS diet may have significant impact on faecal bacteria . Responsiveness to a low FODMAP diet intervention may be predicted by faecal bacterial profiles . Trial registration number NCT02107625 OBJECTIVES : The objective of this study was to investigate whether ingestion of fructose and fructans ( such as inulin ) can exacerbate  irritable bowel syndrome ( IBS ) symptoms .  The aim was to better underst and the origin of these symptoms by magnetic resonance imaging ( MRI ) of the gut . METHODS : A total of 16 healthy volunteers participated in a four-way , r and omized , single-blind , crossover study in which they consumed 500 ml of water containing 40 g of either glucose , fructose , inulin , or a 1:1 mixture of 40 g glucose and 40 g fructose . MRI scans were performed hourly for 5 h , assessing the volume of gastric contents , small bowel water content ( SBWC ) , and colonic gas . Breath hydrogen ( H2 ) was measured and symptoms recorded after each scan . RESULTS : Data are reported as mean ( s.d . ) ( 95 % CI ) when normally distributed and median ( range ) when not . Fructose increased area under the curve ( AUC ) from 0–5 h of SBWC to 71 ( 23 ) l/min , significantly greater than for glucose at 36 ( 11–132 ) l/min ( P<0.001 ) , whereas AUC SBWC after inulin , 33 ( 17–106 ) l/min , was no different from that after glucose . Adding glucose to fructose  decreased AUC SBWC to 55 ( 28 ) l/min ( P=0.08 ) vs. fructose . Inulin substantially increased AUC colonic gas to 33 ( 20 ) l/min , significantly greater than glucose and glucose+fructose ( both P<0.05 ) . Breath H2 rose more with inulin than with fructose . Glucose when combined with fructose significantly reduced breath H2 by 7,700 ( 3,121–12,300 ) p.p.m./min relative to fructose alone ( P<0.01 , n=13 ) . CONCLUSIONS : Fructose but not inulin distends the small bowel with water . Adding glucose to fructose reduces the effect of fructose on SBWC and breath hydrogen .  Inulin distends the colon with gas more than fructose , but causes few symptoms in healthy volunteers Background Overweight and obesity are common health problems which increase the risk of developing several serious health conditions . The main difficulty in the management of weight-loss lies in its 
    Output:
    
Based on the systematic review , low FODMAPs appear to reduce gastrointestinal symptoms for a least a subset of patients with IBS .