***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: The effect on serum high density lipoprotein subfractions of a low fat diet with a high ratio of polyunsaturated-to-saturated fatty acids was studied in 38 middle-aged volunteers ( 19 men and 19 women ) in North Karelia , Finl and . The mean serum HDL2 cholesterol decreased from 32 + /- 2 mg/dl ( mean + /- SE ) to 28 + /- 2 mg/dl ( p less than 0.001 ) during the experimental diet and returned to 33 + /- 2 mg/dl ( p less than 0.001 ) after a return to the original diet . No changes were observed in the concentration of HDL3 cholesterol . A highly significant decrease was observed in serum apoprotein A-I concentration , but not in apoprotein A-II concentration during the experimental diet . It is concluded that a low-fat , high-P/S ratio diet lowers LDL and HDL2 cholesterol in healthy volunteers , but does not influence the level of HDL3 subfraction The primary aim of this study was to test the association of early ( first 6 months ) adherence related to diet , self-monitoring , and attendance with  changes in adiposity and cardiovascular risk factors .  This study used data from the 24-month POUNDS LOST trial that tested the efficacy of four dietary macronutrient compositions for short- and long-term weight loss . A computer tracking system was used to record data on eight indicator variables related to adherence . Using canonical correlations at the 6 and 24 month measurement periods , early behavioral adherence was associated with changes in percent weight loss and waist circumference at 6 months ( R = 0.52 ) and 24 months ( R = 0.37 ) , but was not associated with cardiovascular disease risk factor levels . Early dietary adherence was associated with changes in insulin at 6 months ( R = 0.19 ) , but not at 24 months ( R = 0.08 , ns ) . Early dietary adherence was not associated with changes in adiposity Aims /hypothesisThe study aim ed to compare the effects of a 2 year intervention with a low-fat diet ( LFD ) or a low-carbohydrate diet ( LCD ) , based on four group meetings to achieve compliance . Methods This was a prospect i ve r and omised parallel trial involving 61 adults with type 2 diabetes consecutively recruited in primary care and r and omised by drawing ballots . Patients that did not speak Swedish could not be recruited . The primary outcomes in this non-blinded study were weight and HbA1c . Patients on the LFD aim ed for 55–60 energy per cent ( E% ) and those on LCD for 20 E% from carbohydrate . Results The mean BMI and HbA1c of the participants were 32.7 ± 5.4 kg/m2 and 57.0 ± 9.2 mmol/mol , respectively . No patients were lost to follow-up . Weight loss did not differ between groups and was maximal at 6 months : LFD −3.99 ± 4.1 kg ( n = 31 ) ; LCD −4.31 ± 3.6 kg ( n = 30 ) ; p < 0.001 within groups . At 24 months , patients on the LFD had lost −2.97 ± 4.9 kg and those on LCD −2.34 ± 5.1 kg compared with baseline ( p = 0.002 and p = 0.020 within groups , respectively ) . HbA1c fell in the LCD group only ( LCD at 6 months −4.8 ± 8.3 mmol/mol , p = 0.004 , at 12 months −2.2 ± 7.7 mmol/mol , p = 0.12 ; LFD at 6 months −0.9 ± 8.8 mmol/mol , p = 0.56 ) . At 6 months , HDL-cholesterol had increased with the LCD ( from 1.13 ± 0.33 mmol/l to 1.25 ± 0.47 mmol/l , p = 0.018 ) while LDL-cholesterol did not differ between groups . Insulin doses were reduced in the LCD group ( 0 months , LCD 42 ± 65 E , LFD 39 ± 51 E ; 6 months , LCD 30 ± 47 E , LFD 38 ± 48 E ; p = 0.046 for between-group change ) . Conclusions /interpretationWeight changes did not differ between the diet groups , while insulin doses were reduced significantly more with the LCD at 6 months , when compliance was good . Thus , aim ing for 20 % of energy intake from carbohydrates is safe with respect to cardiovascular risk compared with the traditional LFD and this approach could constitute a treatment alternative . Trial registration : Clinical Trials.gov NCT01005498 Funding : University Hospital of Linköping Research Funds , Linköping University , the County Council of Östergötl and , and the Diabetes Research Centre of Linköping The Minnesota Coronary Survey was a 4.5-year , open enrollment , single end-time , double-blind , r and omized clinical trial that was conducted In six Minnesota state mental hospitals and one nursing home . It Involved 4393 Institutionalized men and 4664 Institutionalized women . The trial compared the effects of a 39 % fat control diet ( 18 % saturated fat , 5 % polyunsaturated fat , 16 % monounsaturated fat , 446 mg dietary cholesterol per day ) with a 38 % fat treatment diet ( 9 % saturated fat , 15 % polyunsaturated fat , 14 % monounsaturated fat , 166 mg dietary cholesterol per day ) on serum cholesterol levels and the Incidence of myocardlal Infa rct ions , sudden deaths , and all-cause mortality . The mean duration of time on the diets was 384 days , with 1568 subjects consuming the diet for over 2 years . The mean serum cholesterol level In the pre-admission period was 207 mg/dl , falling to 175 mg/dl in the treatment group and 203 mg/dl In the control group . For the entire study population , no differences between the treatment and control groups were observed for cardiovascular events , cardiovascular deaths , or total mortality . A favorable trend for all these end-points occurred In some younger age groups The Trial of Antihypertensive Interventions and Management is a multicenter r and omized trial design ed to examine the diastolic blood pressure response of various combinations of pharmacological and dietary interventions in the treatment of mild hypertension ( diastolic blood pressure 90 - 100 mm Hg ) . Eight hundred and seventy-eight participants at 110 - 160 % of ideal weight were r and omly allocated to nine drug/diet treatment groups receiving either a placebo , chlorthalidone ( 25 mg ) , or atenolol ( 50 mg ) , combined with a usual , a weight loss , or a low sodium/high potassium diet The primary outcome was diastolic blood pressure change from baseline to 6 months . Seven hundred and eighty-seven participants had follow-up data . The mean baseline diastolic blood pressure  was 93.8 mm Hg ; 55.9 % of the participants were male , and the weight loss diet group lost an average of 4.7 kg . Multiple comparisons were accounted for in the analysis . A significantly greater lowering of diastolic blood pressure ( 12.4 mm Hg ) was achieved in the atenolol group compared with either the low sodium/high potassium diet group ( 7.9 mm Hg , p=0.001 ) or weight loss group ( 8.8 mm Hg , p=0.006 ) . Adding weight loss to chlorthalidone significantly enhanced blood pressure lowering ( 15.1 mm Hg ) when compared with the diuretic alone ( 10.8 mm Hg , p=0.002 ) , but adding a low sodium/high potassium diet ( 12.2 mm Hg , p=0.029 ) did not In the short-term treatment of mild hypertension where diastolic blood pressure is the sole consideration , drugs outperform diet , and weight loss is beneficial , especially with diuretics The individual effects of dietary cholesterol and fat saturation on plasma lipoprotein concentrations were determined in an ethnically diverse population of normolipidemic young men ( 52 Caucasian , 32 non-Caucasian ) . The experimental diets contained approximately 200 or 600 mg/d of cholesterol , 36 - 38 % of calories as fat , and high or low proportions of saturated and polyunsaturated fat ( polyunsaturated/saturated fat ratio approximately 0.8 vs 0.3 ) . At the lower cholesterol intake , the high saturated fat diet had only a modest effect on LDL cholesterol in Caucasians ( + 6 mg/dl-1 ) and none in non-Caucasians . 600 mg cholesterol with high saturated fat led to a substantial mean increase in LDL cholesterol , which was significantly greater in Caucasian than in non-Caucasian subjects ( + 31 mg/dl vs 16 mg/dl , P < 0.005 ) . 600 mg cholesterol with increased polyunsaturated fat gave a mean LDL increase of 16 mg/dl , lower than found when the same high cholesterol intake was coupled with increased saturated fat . Variation in cholesterol rather than the proportions of saturated and polyunsaturated fat had the most influence on LDL-cholesterol levels . Among non-Caucasians it was the only significant factor Background Determinants of dietary changes obtained with a nutritional intervention promoting the Mediterranean diet have been rarely evaluated . Aim To identify predictors of higher success of an intervention aim ed to increase adherence to a Mediterranean diet ( MeDiet ) in individuals at high cardiovascular risk participating in a trial for primary prevention of cardiovascular disease : the PREDIMED ( PREvención con DIeta MEDiterránea ) trial . C and i date predictors included demographic and socioeconomic characteristics , cardiovascular risk factors , and baseline dietary habits . Methods A total of 1,048 asymptomatic subjects aged 55–80 years allocated to the active intervention groups ( subjects in the control group were excluded ) . Participants ’ characteristics were assessed at baseline among subjects . Dietary changes were evaluated after 12 months . Main outcome measures were : attained changes in five dietary goals : increases in ( 1 ) fruit consumption , ( 2 ) vegetable consumption , ( 3 ) monounsaturated fatty acid (MUFA)/saturated fatty acid ( SFA ) ratio , and decreases in ( 4 ) sweets and pastries consumption , ( 5 ) and meat consumption . Univariate and multivariate logistic regression analyses were used to examine associations between the c and i date predictors and likelihood of attaining optimum dietary change ( improved adherence to a MeDiet  ) . Results Among men , positive changes toward better compliance with the MeDiet  were more frequent among non-diabetics , and among those with worse dietary habits at baseline ( higher consumption of meat , higher SFA intake , lower consumption of fruit and vegetables ) . Among women , marital status ( married ) and worse baseline dietary habits ( high in meats , low in fruits and vegetables ) were the strongest predictors of success in improving adherence to the MeDiet . Conclusions Some participant characteristics ( marital status and baseline dietary habits ) could contribute to predicting the likelihood of achieving dietary goals in interventions aim ed to improve adherence to a MeDiet , and may be useful for promoting individualized long-term dietary changes and improving the effectiveness of dietary counseling BACKGROUND The Women 's Health Initiative Dietary Modification ( DM ) R and omized Controlled Trial evaluated the effects of a low-fat dietary pattern on chronic disease incidence , with breast cancer and colorectal cancer as primary outcomes . The trial protocol also listed ovarian cancer and endometrial cancer as outcomes that may be favorably affected by the intervention . METHODS A total of 48,835 postmenopausal women were r and omly assigned during 1993 - 1998 to a  DM intervention ( n = 19,541 ) or comparison ( usual diet ; n = 29,294 ) group and followed up for an average of 8.1 years . The intervention goal was to reduce total fat intake to 20 % of energy and to increase consumption of vegetables , fruits , and grains . Cancer outcomes were verified by pathology report review . We used weighted log-rank tests to compare incidence of invasive cancers of the ovary and endometrium , total invasive cancer , and invasive cancers at other sites between the groups . All statistical tests were two-sided . RESULTS Ovarian cancer risk was lower in the intervention than in the comparison group ( P = .03 ) . Although the overall ovarian cancer hazard ratio ( HR ) was not statistically significantly less than 1.0 , the hazard ratio decreased with increasing intervention duration ( P(trend ) = .01 ) . For the first 4 years , the risk for ovarian cancer was similar in the intervention and control groups ( 0.52 cases per 1000 person-years in the intervention group versus 
    Output:
    
Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate , and data on replacement with monounsaturated fat and protein was very limited .
There was little or no effect on cancer mortality , cancer diagnoses , diabetes diagnosis , HDL cholesterol , serum triglycerides or blood pressure , and small reductions in weight , serum total cholesterol , LDL cholesterol and BMI .
There was no evidence of harmful effects of reducing saturated fat intakes .
The findings of this up date d review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events .
Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies , while effects of replacement with monounsaturated fat are unclear .
The reduction in combined cardiovascular events result ing from reducing saturated fat did not alter by study duration , sex or baseline level of cardiovascular risk , but greater reduction in saturated fat caused greater reductions in cardiovascular events