***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 —Consumption of polyunsaturated fatty acids ( PUFAs ) may reduce coronary heart disease ( CHD ) risk , but n-6 PUFAs may compete with n-3 PUFA metabolism and attenuate benefits . Additionally , seafood-based , long-chain n-3 PUFAs may modify the effects of plant-based , intermediate-chain n-3 PUFAs . However , the interactions of these PUFAs in relation to CHD risk are not well established . Methods and Results —Among 45 722 men free of known cardiovascular disease in 1986 , usual dietary intake was assessed at baseline and every 4 years by using vali date d food-frequency question naires . CHD incidence was prospect ively ascertained . Over 14 years of follow-up , participants experienced 218 sudden deaths , 1521 nonfatal myocardial infa rct ions ( MIs ) , and 2306 total CHD events ( combined sudden death , other CHD deaths , and nonfatal MI ) . In multivariate-adjusted analyses , both long-chain and intermediate-chain n-3 PUFA intakes were associated with lower CHD risk , without modification by n-6 PUFA intake . For example , men with ≥ median long-chain n-3 PUFA intake ( ≥250 mg/d ) had a reduced risk of sudden death whether n-6 PUFA intake was below ( < 11.2 g/d ; hazard ratio [HR]=0.52 ; 95 % confidence interval [CI]=0.34 to 0.79 ) or above ( ≥11.2 g/d ; HR=0.60 ; 95 % CI=0.39 to 0.93 ) the median compared with men with a < median intake of both . In similar analyses , ≥ median intake of intermediate-chain n-3 PUFAs ( ≥1080 mg/d ) was associated with a reduced total CHD risk whether n-6 PUFA intake was lower ( HR=0.88 ; 95 % CI=0.78 to 0.99 ) or higher ( HR=0.89 ; 95 % CI=0.79 to 0.99 ) compared with a < median intake of both . Intermediate-chain n-3 PUFAs were particularly associated with CHD risk when long-chain n-3 PUFA intake was very low ( < 100 mg/d ) ; among these men , each 1 g/d of intermediate-chain n-3 PUFA intake was associated with an ≈50 % lower risk of nonfatal MI ( HR=0.42 ; 95 % CI=0.23 to 0.75 ) and total CHD ( HR=0.53 ; 95 % CI=0.34 to 0.83 ) . Conclusions —n-3 PUFAs from both seafood and plant sources may reduce CHD risk , with little apparent influence from background n-6 PUFA intake . Plant-based n-3 PUFAs may particularly reduce CHD risk when seafood-based n-3 PUFA intake is low , which has implication s for population s with low consumption or availability of fatty fish BACKGROUND The Mediterranean diet has been suggested to play a beneficial role for health and longevity . However , to our knowledge , no prospect i ve US study has investigated the Mediterranean dietary pattern in relation to mortality . METHODS Study participants included 214,284 men and 166,012 women in the National Institutes of Health (NIH)-AARP ( formerly known as the American Association of Retired Persons ) Diet and Health Study . During follow-up for all-cause mortality ( 1995 - 2005 ) , 27,799 deaths were documented . In the first 5 years of follow-up , 5,985 cancer deaths and 3,451 cardiovascular disease ( CVD ) deaths were reported . We used a 9-point score to assess conformity with the Mediterranean dietary pattern ( components included vegetables , legumes , fruits , nuts , whole grains , fish , monounsaturated fat-saturated fat ratio , alcohol , and meat ) . We calculated hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) using age- and multivariate-adjusted Cox models . RESULTS The Mediterranean diet was associated with reduced all-cause and cause-specific mortality . In men , the multivariate HRs comparing high to low conformity for all-cause , CVD , and cancer mortality were 0.79 ( 95 % CI , 0.76 - 0.83 ) , 0.78 ( 95 % CI , 0.69 - 0.87 ) , and 0.83 ( 95 % CI , 0.76 - 0.91 ) , respectively . In women , an inverse association was seen with high conformity with this pattern : decreased risks that ranged from 12 % for cancer mortality to 20 % for all-cause mortality ( P = .04 and P < .001 , respectively , for the trend ) . When we restricted our analyses to never smokers , associations were virtually unchanged . CONCLUSION These results provide strong evidence for a beneficial effect of higher conformity with the Mediterranean dietary pattern on risk of death from all causes , including deaths due to CVD and cancer , in a US population BACKGROUND Adherence to a Mediterranean diet may improve longevity , but relevant data are limited . METHODS We conducted a population -based , prospect i ve investigation involving 22,043 adults in Greece who completed an extensive , vali date d , food-frequency question naire at base line .  Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean-diet scale that incorporated the salient characteristics of this diet ( range of scores , 0 to 9 , with higher scores indicating greater adherence ) . We used proportional-hazards regression to assess the relation between adherence to the Mediterranean diet and total mortality , as well as mortality due to coronary heart disease and mortality due to cancer , with adjustment for age , sex , body-mass index , physical-activity level , and other potential confounders . RESULTS During a median of 44 months of follow-up , there were 275 deaths . A higher degree of adherence to the Mediterranean diet was associated with a reduction in total mortality ( adjusted hazard ratio for death associated with a two-point increment in the Mediterranean-diet score , 0.75 [ 95 percent confidence interval , 0.64 to 0.87 ] ) . An inverse association with greater adherence to this diet was evident for both death due to coronary heart disease ( adjusted hazard ratio , 0.67 [ 95 percent confidence interval , 0.47 to 0.94 ] ) and death due to cancer ( adjusted hazard ratio , 0.76 [ 95 percent confidence interval , 0.59 to 0.98 ] ) . Associations between individual food groups contributing to the Mediterranean-diet score and total mortality were generally not significant . CONCLUSIONS Greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality Adherence to the Mediterranean diet ( MD ) has been reported to improve CHD prognosis and to be inversely associated with CHD mortality . The aim of the present study was to investigate the association of adherence to the MD with CHD incidence and mortality in the Greek European Prospect i ve Investigation into Cancer and Nutrition cohort , a population with traditional Mediterranean roots . In a general population sample of 23,929 adult men and women with no CVD or cancer at enrolment , a vali date d FFQ was interviewer-administered , sociodemographic , physical activity and other characteristics were recorded , and arterial blood pressure and anthropometric characteristics were measured . In a median period of 10 years , 636 incident CHD cases and 240 CHD deaths were recorded . Associations of adherence to the MD , operationalised through a nine-component score ( 0 , poor ; 9 , excellent ) , with CHD incidence and mortality were evaluated through Cox regression controlling for potentially confounding variables . A two-point increase in the MD score was associated with lower CHD mortality by 25 % ( 95 % CI 0.57 , 0.98 ) among women and 19 % ( 95 % CI 0.67 , 0.99 ) among men . The association of adherence to the MD with CHD incidence was again inverse , but weaker ( hazard ratios 0.85 ( 95 % CI 0.71 , 1.02 ) among women and 0.98 ( 95 % CI 0.87 , 1.10 ) among men ) . With respect to score components , only meat among men ( positively ) and fruits and nuts among women ( inversely ) were associated with both the incidence of and mortality from CHD . The MD , as an integral entity , is inversely associated with CHD incidence and , particularly , mortality Background Prospect i ve data examining the relationship between dietary protein intake and incident coronary heart disease ( CHD )  are inconclusive . Most evidence is derived from homogenous population s such as health professionals . Large community-based analyses in more diverse sample s are lacking . Methods We studied the association of protein type and major dietary protein sources and risk for incident CHD in 12,066 middle-aged adults ( aged 45–64 at baseline , 1987–1989 ) from four U.S. communities enrolled in the Atherosclerosis Risk in Communities ( ARIC ) Study who were free of diabetes mellitus and cardiovascular disease at baseline .  Dietary protein intake was assessed at baseline and after 6 years of follow-up by food frequency question naire . Our primary outcome was adjudicated coronary heart disease events or deaths with following up through December 31 , 2010 . Cox proportional hazard models with multivariable adjustment were used for statistical analyses . Results During a median follow-up of 22 years , there were 1,147 CHD events . In multivariable analyses total , animal and vegetable protein were not associated with an increased risk for CHD before or after adjustment . In food group analyses of major dietary protein sources , protein intake from red and processed meat , dairy products , fish , nuts , eggs , and legumes were not significantly associated with CHD risk . The hazard ratios [ with 95 % confidence intervals ] for risk of CHD across quintiles of protein from poultry were 1.00 [ ref ] , 0.83 [ 0.70–0.99 ] , 0.93 [ 0.75–1.15 ] , 0.88 [ 0.73–1.06 ] , 0.79 [ 0.64–0.98 ] , P for trend = 0.16 ) . Replacement analyses evaluating the association of substituting one source of dietary protein for another or of decreasing protein intake at the expense of carbohydrates or total fats did not show any statistically significant association with CHD risk . Conclusion Based on a large community cohort we found no overall relationship between protein type and major dietary protein sources and risk for CHD Background and Purpose — Few dietary protein sources have been studied prospect ively in relation to stroke . We examined the relation between foods that are major protein sources and risk of stroke . Methods — We prospect ively followed 84 010 women aged 30 to 55 years at baseline and 43 150 men aged 40 to 75 years at baseline without diagnosed cancer , diabetes , or cardiovascular disease .  Diet was assessed repeatedly by a st and ardized and vali date d question naire . We examined the association between protein sources and incidence of stroke using a proportional hazard model adjusted for stroke risk factors . Results — During 26 and 22 years of follow-up in women and men , respectively , we documented 2633 and 1397 strokes , respectively . In multivariable analyses , higher intake of red meat was associated with an elevated risk of stroke , whereas a higher intake of poultry was associated with a lower risk . In models estimating the effects of exchanging different protein sources , compared with 1 serving/day of red meat , 1 serving/day of poultry was associated with a 27 % ( 95 % CI , 12%–39 % ) lower risk of stroke , nuts with a 17 % ( 95 % CI . 4%–27 % ) lower risk , fish with a 17 % ( 95 % CI , 0%–30 % ) lower risk , low-fat dairy with an 11 % ( 95 % CI , 5%–17 % ) lower risk , and whole-fat dairy with a 10 % ( 95 % CI , 4%–16 % ) lower risk . We did not see significant associations with exchanging legumes or eggs for red meat . Conclusions — These data suggest that stroke risk may be reduced by replacing red meat with other dietary sources of protein OBJECTIVE Fat intake , especially monounsaturated fatty acid ( MUFA ) , has been liberalized in diabetic diets to preserve HDL cholesterol and improve glycemic control , yet the exact sources have not been clearly defined . Therefore , we assessed the effect of mixed nut consumption as a source of vegetable fat on serum lipids and HbA1c in type 2 diabetes . RESEARCH DESIGN AND METHODS A total of 117 type 2 diabetic subjects were r and omized to one of three treatments for 3 months . Supplements were provided at 475 kcal per 2,000-kcal diet as mixed nuts ( 75 g/day ) , muffins , or half portions of both . The primary outcome was change in Hb 
    Output:
    
In conclusion , we found that higher nut consumption is associated with a lower risk of all-cause mortality , total CVD , CVD mortality , total CHD , CHD mortality and sudden cardiac death