***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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    ***EXAMPLES*** 
    Input: Importance Cesarean birth has been associated with higher risk of  obesity in offspring , but previous studies have focused primarily on childhood obesity and have been hampered by limited control for confounders . Objective To investigate the association between cesarean birth and risk of obesity in offspring . Design , Setting , and Participants A prospect i ve cohort study was conducted from September 1 , 1996 , to December 31 , 2012 , among participants of the Growing Up Today Study , including 22 068 offspring born to 15 271 women , followed up via question naire from ages 9 to 14 through ages 20 to 28 years . Data analysis was conducted from October 10 , 2015 , to June 14 , 2016 . Exposure Birth by cesarean delivery . Main Outcomes and Measures Risk of obesity based on International Obesity Task Force or World Health Organization body mass index cutoffs , depending on age . Secondary outcomes included risks of obesity associated with changes in mode of delivery and differences in risk between siblings whose modes of birth were discordant . Results Of the 22 068 offspring ( 20 950 white ; 9359 male and 12 709 female ) , 4921 individuals ( 22.3 % ) were born by cesarean delivery .  The cumulative risk of obesity through the end of follow-up was 13 % among all participants . The adjusted risk ratio for obesity among offspring delivered via cesarean birth vs those delivered via vaginal birth was 1.15 ( 95 % CI , 1.06 - 1.26 ; P = .002 ) . This association was stronger among women without known indications for cesarean delivery ( adjusted risk ratio , 1.30 ; 95 % CI , 1.09 - 1.54 ; P = .004 ) . Offspring delivered via vaginal birth among women who had undergone a previous cesarean delivery had a 31 % ( 95 % CI , 17%-47 % ) lower risk of obesity compared with those born to women with repeated cesarean deliveries . In within-family analysis , individuals born by cesarean delivery had 64 % ( 8%-148 % ) higher odds of obesity than did their siblings born via vaginal delivery . Conclusions and Relevance Cesarean birth was associated with  offspring obesity after accounting for major confounding factors . Although additional research is needed to clarify the mechanisms underlying this association , clinicians and patients should weigh this risk when considering cesarean delivery in the absence of a clear indication Background / Objectives : The intergenerational association of obesity may be driven by mother-to-newborn transmission of microbiota at birth . Yet cesarean delivery circumvents newborn acquisition of vaginal microbiota , and has been associated with greater childhood adiposity . Here we examined the independent and joint associations of maternal pre-pregnancy body mass index ( BMI ; kg m−2 ) and delivery mode with childhood overweight or obesity . Subjects/ Methods : We prospect ively followed 1441 racially and ethnically diverse mother – child dyads in the Boston Birth Cohort until age 5 years ( range : 2.0–8.0 years ) . We used logistic regression to examine the independent and joint associations of delivery mode ( cesarean and vaginal delivery ) and pre-pregnancy BMI with childhood overweight or obesity ( age – sex-specific BMI ⩾85th percentile ) . Results : Of 1441 mothers , 961 delivered vaginally and 480 by cesarean . Compared with vaginally delivered children , cesarean delivered children had 1.4 ( 95 % confidence interval ( CI ) 1.1–1.8 ) times greater odds of becoming overweight or obese in childhood , after adjustment for maternal age at delivery , race/ethnicity , education , air pollution exposure , pre-pregnancy BMI , pregnancy weight gain and birth weight . Compared with children born vaginally to normal weight mothers , after multivariable adjustment , odds of childhood overweight or obesity were highest in children born by cesarean delivery to obese mothers ( odds ratio ( OR ) : 2.8 ; 95 % CI : 1.9–4.1 ) , followed by children born by cesarean delivery to overweight mothers ( OR : 2.2 ; 95 % CI : 1.5–3.2 ) , then children born vaginally to obese mothers ( OR : 1.8 ; 95 % CI : 1.3–2.6 ) and finally children born vaginally to overweight mothers ( OR : 1.7 ; 95 % CI : 1.2–2.3 ) . Conclusions : In our racially and ethnically diverse cohort , cesarean delivery and pre-pregnancy overweight and obesity were associated with childhood overweight or obesity . Needed now are prospect i ve studies that integrate measures of the maternal and infant microbiome , and other potentially explanatory covariates , to eluci date the mechanisms driving this association and to explore whether exposure to vaginal microbiota in cesarean delivered newborns may be an innovative strategy to combat the intergenerational cycle of obesity IMPORTANCE Probiotics have been hypothesized to affect immunologic responses to environmental exposures by supporting healthy gut microbiota and could therefore theoretically be used to prevent the development of type 1 diabetes mellitus (T1DM)-associated islet autoimmunity . OBJECTIVE To examine the association between supplemental probiotic use during the first year of life and islet autoimmunity among children at increased genetic risk of T1DM . DESIGN , SETTING , AND PARTICIPANTS In this ongoing prospect i ve cohort study that started September 1 , 2004 , children from 6 clinical centers , 3 in the United States ( Colorado , Georgia/Florida , and Washington ) and 3 in Europe ( Finl and , Germany , and Sweden ) , were followed up for T1DM-related autoantibodies . Blood sample s were collected every 3 months between 3 and 48 months of age and every 6 months thereafter to determine persistent islet autoimmunity . Details of infant feeding , including probiotic supplementation and infant formula use , were monitored from birth using question naires and diaries . We applied time-to-event analysis to study the association between probiotic use and islet autoimmunity , stratifying by country and adjusting for family history of type 1 diabetes , HLA-DR-DQ genotypes , sex , birth order , mode of delivery , exclusive breastfeeding , birth year , child 's antibiotic use , and diarrheal history , as well as maternal age , probiotic use , and smoking . Altogether 8676 infants with an eligible genotype were enrolled in the follow-up study before the age of 4 months . The final sample consisted of 7473 children with the age range of 4 to 10 years ( as of October 31 , 2014 ) . EXPOSURES Early intake of probiotics . MAIN OUTCOMES AND MEASURES Islet autoimmunity revealed by specific islet autoantibodies . RESULTS Early probiotic supplementation ( at the age of 0 - 27 days ) was associated with a decreased risk of islet autoimmunity when compared with probiotic supplementation after 27 days or no probiotic supplementation ( hazard ratio [ HR ] , 0.66 ; 95 % CI , 0.46 - 0.94 ) . The association was accounted for by children with the DR3/4 genotype ( HR , 0.40 ; 95 % CI , 0.21 - 0.74 ) and was absent among other genotypes ( HR , 0.97 ; 95 % CI , 0.62 - 1.54 ) . CONCLUSIONS AND RELEVANCE Early probiotic supplementation may reduce the risk of islet autoimmunity in children at the highest genetic risk of T1DM . The result needs to be confirmed in further studies before any recommendation of probiotics use is made Aim Evidence of a possible connection between gut microbiota and several physiological processes linked to type 2 diabetes is increasing . However , the effect of multi-strain probiotics in people with type 2 diabetes remains unclear . This study investigated the effect of multi-strain microbial cell preparation — also refers to multi-strain probiotics — on glycemic control and other diabetes-related outcomes in people with type 2 diabetes . Design A r and omized , double-blind , parallel-group , controlled clinical trial . Setting Diabetes clinic of a teaching hospital in Kuala Lumpur , Malaysia . Participants A total of 136 participants with type 2 diabetes , aged 30–70 years , were recruited and r and omly assigned to receive either probiotics ( n = 68 ) or placebo ( n = 68 ) for 12 weeks . Outcomes Primary outcomes were glycemic control-related parameters , and secondary outcomes were anthropomorphic variables , lipid profile , blood pressure and high-sensitivity C-reactive protein . The Lactobacillus and Bifidobacterium quantities were measured before and after intervention as an indicator of successful passage of the supplement through gastrointestinal tract . Statistical analysis Intention-to-treat ( ITT ) analysis was performed on all participants , while per- protocol ( PP ) analysis was performed on those participants who had successfully completed the trial with good compliance rate . Results With respect to primary outcomes , glycated hemoglobin decreased by 0.14 % in the probiotics and increased by 0.02 % in the placebo group in PP analysis ( p < 0.05 , small effect size of 0.050 ) , while these changes were not significant in ITT analysis . Fasting insulin increased by 1.8 µU/mL in placebo group and decreased by 2.9 µU/mL in probiotics group in PP analysis . These changes were significant between groups at both analyses ( p < 0.05 , medium effect size of 0.062 in PP analysis and small effect size of 0.033 in ITT analysis ) . Secondary outcomes did not change  significantly . Probiotics successfully passed through the gastrointestinal tract . Conclusion Probiotics modestly improved HbA1c and fasting insulin in people with type 2 diabetes Introduction : Breast milk is an optimal source of nutrition for infants . It contains bioactive components including bacteria that support the microbial colonization and immune system development of the infant . The determinants of human milk composition remain poorly understood , although maternal nutritional and immunological status as well as lifestyle and dietary habits seem to have an impact . Methods : The subjects selected were women from a prospect i ve follow-up study categorized by BMI .  Milk sample s were taken after delivery and at 1 and 6 mo later for analysis of composition in regard to transforming growth factor (TGF)-β2 , soluble CD14 ( sCD14 ) , cytokines , and microbiota . Results : TGF-β2 and sCD14 levels in the breast milk of overweight mothers tended to be lower than the levels in that of normal-weight mothers . Also , higher levels of Staphylococcus group bacteria and lower levels of Bifidobacterium group bacteria were detected in overweight mothers as compared with normal-weight ones . The prevalence of Akkermansia muciniphila – type bacteria was also higher in overweight mothers , and the numbers of these bacteria were related to the interleukin (IL)-6 concentration in the colostrum , which was in turn related to lower counts of Bifidobacterium group bacteria in the breast milk of overweight women . Discussion : Complex interactions of cytokines and microbiota in breast milk guide the microbiological , immunological , and metabolic programming of infant health . Our data may indicate the presence of an additional mechanism that may explain the heightened risk of obesity for infants of overweight and excessive weight gain mothers Recent studies have suggested some beneficial effects of probiotics and /or prebiotics on obesity in adults ; such experience is limited in children and adolescents . This study was an open-label , r and omised , controlled study including children with primary obesity . The first group was treated with a st and ard method with a reduced calorie intake and increased physical activity . The second group received add-on daily synbiotic supplementation during one month . The aim of this study was to evaluate potential effects of a synbiotic on anthropometric measurements , lipid profile and oxidative stress parameters . One month of supplementation of the synbiotic result ed in a significant reduction of weight ( P<0.001 ) and body mass index ( P<0.01 ) . Changes ( % reduction comparing to baseline ) in anthropometric measurements , were significantly higher in the children receiving the additional synbiotic supplement ( P<0.05 ) . The percentage of children with weight loss was higher in the synbiotic group , but not statistically significant ( 71.4 vs 64.2 % , P>0.05 ) . At the 30(th ) day of synbiotic intervention , serum total cholesterol , low density lipoprotein cholesterol and total oxidative stress levels significantly declined ( P<0.05 ) . Changes in serum lipid levels were significantly higher in the synbiotic group ( P<0.05 ) . Changes in serum total oxidative stress levels before and after the intervention period , were significant in synbiotic group ( P<0.01 ) . In our study , changes in weight , body mass index , and triceps skinfold thickness were higher in the group receiving the one month synbiotic supplement thin in the st and ard method group . The supplement tested also had a beneficial effect on lipid profile and total oxidative stress . To the best of our knowledge , this is the first study showing the effects of synbiotics on oxidative stress in obese patients with an additional effect on weight loss regarding to previous studies This study evaluated the impact of probiotic supplementation ( Lactobacillus rhamnosus CG 
    Output:
    
Results Intestinal bacteria may be involved both in the development of obesity , and its further complications .
The pro-inflammatory and immunomodulating effect of dysbiosis are possible triggers of insulin resistance and diabetes .
Early interventions aim ed at the microbiome , as well as attempts to modify the microbiome at later stages may become new opportunities in the prevention and treatment of obesity and carbohydrate metabolism disorders .
Conclusions The gut microbiome has been shown to be an important part of the metabolic processes .