***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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    Input: Background Control of body weight by balancing energy intake and energy expenditure is of major importance for the prevention of type 2 diabetes , but the role of specific dietary factors in the etiology of type 2 diabetes is less well established . We evaluated intakes of whole grain , bran , and germ in relation to risk of type 2 diabetes in prospect i ve cohort studies . Methods and Findings We followed 161,737 US women of the Nurses ' Health Studies ( NHSs ) I and II , without history of diabetes , cardiovascular disease , or cancer at baseline . The age at baseline was 37–65 y for NHSI and 26–46 y for NHSII .  Dietary intakes and potential confounders were assessed with regularly administered question naires . We documented 6,486 cases of type 2 diabetes during 12–18 y of follow-up . Other prospect i ve cohort studies on whole grain intake and risk of type 2 diabetes were identified in search es of MEDLINE and EMBASE up to January 2007 , and data were independently extracted by two review ers . The median whole grain intake in the lowest and highest quintile of intake was , respectively , 3.7 and 31.2 g/d for NHSI and 6.2 and 39.9 g/d for NHSII . After adjustment for potential confounders , the relative risks ( RRs ) for the highest as compared with the lowest quintile of whole grain intake was 0.63 ( 95 % confidence interval [ CI ] 0.57–0.69 ) for NHSI and 0.68 ( 95 % CI 0.57–0.81 ) for NHSII ( both : p-value , test for trend < 0.001 ) . After further adjustment for body mass index ( BMI ) , these RRs were 0.75 ( 95 % CI 0.68–0.83 ; p-value , test for trend < 0.001 ) and 0.86 ( 95 % CI 0.72–1.02 ; p-value , test for trend 0.03 ) respectively . Associations for bran intake were similar to those for total whole grain intake , whereas no significant association was observed for germ intake after adjustment for bran . Based on pooled data for six cohort studies including 286,125 participants and 10,944 cases of type 2 diabetes , a two-serving-per-day increment in whole grain consumption was associated with a 21 % ( 95 % CI 13%–28 % ) decrease in risk of type 2 diabetes after adjustment for potential confounders and BMI . Conclusions Whole grain intake is inversely associated with risk of type 2 diabetes , and this association is stronger for bran than for germ . Findings from prospect i ve cohort studies consistently support increasing whole grain consumption for the prevention of type 2 diabetes BACKGROUND Certain dietary components may play a role in the prevention of type 2 diabetes . OBJECTIVE We examined prospect ively the associations between whole- and refined-grain intake and the risk of type 2 diabetes  in a large cohort of men . DESIGN Men from the Health Professionals Follow-up Study without a history of diabetes or cardiovascular disease in 1986 ( n = 42898 ) were followed for < /=12 y. Intakes of whole and refined grains , measured every 4 y by use of food-frequency question naires , were used to predict subsequent type 2 diabetes risk through multivariate analysis . RESULTS We ascertained 1197 cases of incident type 2 diabetes . After adjustment for age ; physical activity ; cigarette smoking ; alcohol consumption ; family history of diabetes ; and fruit , vegetable , and energy intakes , the relative risk of type 2 diabetes was 0.58 ( 95 % CI : 0.47 , 0.70 ; P for trend < 0.0001 ) comparing the highest with the lowest quintile of whole-grain intake . The association was moderately attenuated when additionally adjusted for body mass index ( relative risk : 0.70 ; 95 % CI : 0.57 , 0.85 ; P for trend = 0.0006 ) . Intake of refined grains was not significantly associated with risk of type 2 diabetes . After further adjustment for magnesium intake , cereal fiber intake , and glycemic load , the association between whole grains and type 2 diabetes was attenuated and the trend no longer significant . CONCLUSIONS In men , a diet high in whole grains is associated with a reduced risk of type 2 diabetes in men that may be mediated by cereal fiber . Efforts should be made to replace refined-grain with whole-grain foods OBJECTIVE To examine associations between type 2 diabetes and fiber , glycemic load ( GL ) , dietary glycemic index ( GI ) , and fiber-rich foods . RESEARCH DESIGN AND METHODS This was a prospect i ve study of 36,787 men and women aged 40 - 69 years without diabetes . For all self-reported cases of diabetes at 4-year follow-up , confirmation of diagnosis was sought from medical practitioners . Case subjects were those who reported diabetes at follow-up and for whom there was no evidence that they did not have type 2 diabetes . Data were analyzed with logistic regression , adjusting for country of birth , physical activity , family history of diabetes , alcohol and energy intake , education , 5-year weight change , sex , and age . RESULTS Follow-up was completed by 31,641 ( 86 % ) participants , and 365 cases were identified . The odds ratio ( OR ) for the highest quartile of white bread intake compared with the lowest was 1.37 ( 95 % CI 1.04 - 1.81 ; P for trend = 0.001 ) . Intakes of carbohydrate ( OR per 200 g/day 0.58 , 0.36 - 0.95 ) , sugars ( OR per 100 g/day 0.61 , 0.47 - 0.79 ) , and magnesium ( OR per 500 mg/day 0.62 , 0.43 - 0.90 ) were inversely associated with incidence of diabetes , whereas intake of starch ( OR per 100 g/day 1.47 , 1.06 - 2.05 ) and dietary GI ( OR per 10 units 1.32 , 1.05 - 1.66 ) were positively associated with diabetes . These relationships were attenuated after adjustment for BMI and waist-to-hip ratio . CONCLUSIONS Reducing dietary GI while maintaining a high carbohydrate intake may reduce the risk of type 2 diabetes . One way to achieve this would be to substitute white bread with low-GI breads PURPOSE Whole grains may offer protection from diabetes by decreasing energy intake , preventing weight gain , and direct effects on insulin resistance . This study examined associations of whole and refined grains with incident  type 2 diabetes ( T2D ) ascertained by self-reported medication use in a cohort of postmenopausal women . METHODS We included 72,215 women free of diabetes at baseline from the Women 's Health Initiative Observational Study .  Whole grain consumption was categorized as 0 , less than 0.5 , 0.5 to 1.0 , 1.0 to less than 1.5 , 1.5 to less than 2.0 , and 2.0 or more servings per day . Proportional hazards regression was performed to estimate hazard ratios ( HR ) and 95 % confidence intervals adjusting for potential confounders . RESULTS There were 3465 cases of incident T2D over median follow-up of 7.9 years . Adjusted for age and energy intake per day , successively increasing categories of whole grain consumption were associated with statistically significant reduced risk of incident T2D ( HRs , 1.00 , 0.83 , 0.73 , 0.69 , 0.61 , and 0.57 ; P for trend < 0.0001 ) . Results were attenuated after adjustment for confounders and other dietary components . The reduction in risk of T2D was greater among nonsmokers and those who maintained their weight within 5 pounds with higher consumption of whole grains than smokers and women who gained more weight . CONCLUSIONS This large , prospect i ve study found an inverse dose-response relationship between whole grain consumption and incident T2D in postmenopausal women Seven men with well-controlled , noninsulin-dependent ( type 2 ) diabetes ingested on two different mornings , in r and om order , meals with or without a 5.0-g sodium alginate supplement ( algae-isolate , 75 % soluble fiber ) . The meals contained similar amounts of digestible carbohydrates , fat and protein . The gastric emptying rate of the meal containing sodium alginate , measured by detection of 51Cr mixed into the meals , was significantly slower than that of the fiber-free meal . Sodium alginate also induced significantly lower postpr and ial rises in blood glucose , serum insulin and plasma C-peptide . The diminished glucose response after the addition of sodium alginate could be correlated to the delayed gastric emptying rate induced by the fiber ( rs = 0.92 , P less than 0.01 ) BACKGROUND Dietary carbohydrates may influence the development of  type 2 ( non-insulin-dependent ) diabetes  , for example , through effects on blood glucose and insulin concentrations . OBJECTIVE We examined the relations of baseline intake of carbohydrates , dietary fiber , dietary magnesium , and carbohydrate-rich foods and the glycemic index with incidence of diabetes . DESIGN This was a prospect i ve cohort study of 35988 older Iowa women initially free of diabetes . During 6 y of follow-up , 1141 incident cases of diabetes were reported . RESULTS  Total grain , whole-grain , total dietary fiber , cereal fiber , and dietary magnesium intakes  showed strong inverse associations with incidence of diabetes after adjustment for potential nondietary confounding variables . Multivariate-adjusted relative risks of diabetes were 1.0 , 0.99 , 0.98 , 0.92 , and 0.79 ( P for trend : 0.0089 ) across quintiles of whole-grain intake ; 1.0 , 1.09 , 1.00 , 0.94 , and 0.78 ( P for trend : 0.005 ) across quintiles of total dietary fiber intake ; and 1.0 , 0.81 , 0.82 , 0.81 , and 0.67 ( P for trend : 0.0003 ) across quintiles of dietary magnesium intake . Intakes of total carbohydrates , refined grains , fruit and vegetables , and soluble fiber and the glycemic index were unrelated to diabetes risk . CONCLUSION These data support a protective role for grains ( particularly whole grains ) , cereal fiber , and dietary magnesium in the development of diabetes in older women BACKGROUND Rye bread has a beneficial effect on the postpr and ial insulin response in healthy subjects . The role of rye fiber in insulin and glucose metabolism is not known . OBJECTIVE The aim of the study was to determine the effect of the content of rye fiber in rye breads on postpr and ial insulin and glucose responses . DESIGN Nineteen healthy postmenopausal women aged 61 + /- 1 y , with a body mass index ( in kg/m(2 ) ) of 26.0 + /- 0.6 , and with normal glucose tolerance participated in the study . The test products were refined wheat bread ( control ) , endosperm rye bread , traditional rye bread , and high-fiber rye bread ; each bread provided 50 g available carbohydrate and was served with breakfast .  Plasma glucose , insulin , glucose-dependent insulinotropic polypeptide , glucagon-like peptide 1 , and serum C-peptide were measured in fasting and 8 postpr and ial blood sample s. In vitro starch hydrolysis and the microscopic structure of the breads were also determined . RESULTS Postpr and ial insulin , glucose-dependent insulinotropic polypeptide , and C-peptide responses to the rye breads were significantly lower than the response to the control ; no significant differences in insulin and C-peptide responses to the rye breads were found . Glucose and glucagon-like peptide 1 responses to the rye breads were not significantly different from those to the control , except at 150 and 180 min . In vitro starch hydrolysis was slower in all rye breads than in the control , and the structure of continuous matrix and starch granules differed between the rye and control breads . CONCLUSION Total fiber content does not explain the lower postpr and ial insulin response to rye bread than to wheat bread , but structural differences between rye and wheat breads might BACKGROUND Epidemiologic studies that directly examine changes in whole-grain consumption in relation to weight gain are sparse , and characterization of this association has been obscured by method ologic inconsistencies in the 
    Output:
    
Our meta- analysis suggests that a high whole grain intake , but not refined grains , is associated with reduced type 2 diabetes risk .
Our results support public health recommendations to replace refined grains with whole grains and suggest that at least two servings of whole grains per day should be consumed to reduce type 2 diabetes risk