***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: Background Flaxseed has received attention for its anti-inflammatory and antioxidant role . The present study hypothesizes if flaxseed added to a weight loss diet could improve the lipid and metabolic profiles and decrease risk factors related to cardiovascular disease . Methods In a prospect i ve , single blinded 42 days protocol , subjects were allocated into two groups with low carbohydrates intake : GriceLC ( 35 % of carbohydrate and 60 g of raw rice powder per day ) and GflaxLC ( 32 % of carbohydrate and 60 g of flaxseed powder per day ) . Blood pressure , anthropometric measures and serum levels of isoprostane , C-reactive protein , Tumor Necrosis Factor-alpha , glucose , lipidic profile , uric acid , adiponectin , leptin and insulin were measured at baseline and at the end of interventions . Serum and urinary enterodiol and enterolactione were also measured . Results A total of 27 men with cardiovascular risk factors were evaluated , with mean age of 33 ± 10 years to GriceLC and 40 ± 9 years to GflaxLC . Both groups experienced weight loss and systolic blood pressure reduction . A decrease in inflammatory markers ( CRP and TNF-α ) was observed after flaxseed intake ( mean decrease of 25 % and 46 % for GflaxLC respectively ) . All groups also showed improvement in levels of total cholesterol , LDL-c , uric acid and adiponectin . Only GflaxLC group showed a decrease in triglyceride levels . Conclusion This study suggests that flaxseed added to a weight loss diet could be an important nutritional strategy to reduce inflammation markers such as CRP and TNF-α . Trial registration Clinical Trials.gov NCT02132728 Background Dietary fibers have been proposed to play a role in cardiovascular risk as well as body weight management . Flaxseeds are a good source of dietary fibers , and a large proportion of these are water-soluble viscous fibers . Method Here , we examine the effect of flaxseed dietary fibers in different food matrices on blood lipids and fecal excretion of fat and energy in a double-blind r and omized crossover study with 17 subjects . Three different 7-d diets were tested : a low-fiber control diet ( Control ) , a diet with flaxseed fiber drink ( 3/day ) ( Flax drink ) , and a diet with flaxseed fiber bread ( 3/day ) ( Flax bread ) . Total fat and energy excretion was measured in feces , blood sample s were collected before and after each period , and appetite sensation registered 3 times daily before main meals . Results Compared to control , Flax drink lowered fasting total-cholesterol and LDL-cholesterol by 12 and 15 % , respectively , ( p < 0.01 ) , whereas Flax bread only produced a reduction of 7 and 9 % , respectively ( p < 0.05 ) . Fecal fat and energy excretion increased by 50 and 23 % with Flax drink consumption compared to control ( p < 0.05 ) , but only fecal fat excretion was increased with Flax bread compared to control ( p < 0.05 ) . Conclusion Both Flax drink and Flax bread result ed in decreased plasma total and LDL-cholesterol and increased fat excretion , but the food matrix and /or processing may be of importance . Viscous flaxseed dietary fibers may be a useful tool for lowering blood cholesterol and potentially play a role in energy balance . Trial Registration Clinical Trials.gov : Malnutrition and chronic inflammation in dialysis patients negatively impact their survival prognosis , and nutrients , such as omega-3 oils , are postulated to reduce proinflammatory response . In this r and omized , double-blind , multicenter , placebo-controlled trial , we investigated the effects of flaxseed oil ( FO ) on the inflammatory state of patients with chronic renal failure undergoing renal replacement therapy with hemodialysis ( HD ) . We hypothesized that FO supplementation lowers C-reactive protein ( CRP ) levels .  One hundred sixty patients with chronic renal failure who received HD therapy of 3 dialysis units over a 3-month period in South Brazil were included . The patients received blind doses of FO ( 1 g twice a day ) and placebo ( mineral oil , 1 g twice a day ) for a period of 120 days . Inflammation was observed in 89 patients ( 61 % ) at the beginning of the study . There was a correlation between CRP and the body mass index ( R(s ) = 0.22 ; P = .022 ) and high-density lipoprotein cholesterol ( R(s ) = -0.23 ; P = .032 ) , and the CRP levels decreased significantly over time in the group that received FO compared with the control group ( P < .001 ) . During the study period , 33.3 % of the FO group changed from an inflamed to a not-inflamed category , whereas only 16.9 % changed in the mineral oil group ( P = .04 ) . We conclude that the administration of FO decreases the CRP levels and that inflammation in HD patients appears to be correlated to their body mass index and reduced high-density lipoprotein cholesterol levels . Studies with a larger number of patients and over a longer duration are necessary to corroborate these findings Flaxseed is one of the richest sources of lignans and is increasingly used in food products or as a supplement . Plant lignans can be converted by intestinal bacteria into the so-called enterolignans , enterodiol and enterolactone . For a proper evaluation of potential health effects of enterolignans , information on their bioavailability is essential . The aim of this study was to investigate whether crushing and milling of flaxseed enhances the bioavailability of enterolignans in plasma . In a r and omized , crossover study , 12 healthy subjects supplemented their diet with 0.3 g whole , crushed , or ground flaxseed/(kg body weight . d ) . Each subject consumed flaxseed for 10 successive days separated by 11-d run-in/wash-out periods , in which the subjects consumed a diet poor in lignans . Blood sample s were collected at the end of each run-in/wash-out period , and at the end of each supplement period . Plasma enterodiol and enterolactone were measured using LC-MS-MS . The mean relative bioavailability of enterolignans from whole compared with ground flaxseed was 28 % ( P < or = 0.01 ) , whereas that of crushed compared with ground flaxseed was 43 % ( P < or = 0.01 ) . Crushing and milling of flaxseed substantially improve the bioavailability of the enterolignans BACKGROUND An increase in plasma n-3 fatty acid content , particularly eicosapentaenoic acid ( 20:5n-3 ; EPA ) and docosahexaenoic acid ( 22:6n-3 ; DHA ) , is observed after consumption of fish oil-enriched supplements . Because alpha-linolenic acid ( 18:3n-3 ; ALA ) is the direct precursor of EPA and DHA , ALA-enriched supplements such as flax may have a similar effect , although this hypothesis has been challenged because of reported low conversion of ALA into DHA . OBJECTIVE To address this question , we design ed a clinical trial in which flax oil , fish-oil , and sunflower oil ( placebo group ) capsules were given to firefighters ( n = 62 ) , a group traditionally exposed to cardiovascular disease risk factors . DESIGN Firefighters were r and omly divided into 6 experimental groups receiving 1.2 , 2.4 , or 3.6 g flax oil/d ; 0.6 or 1.2 g fish oil/d ; or 1 g sunflower oil/d for 12 wk . Blood was drawn every 2 wk , and the total phospholipid fatty acid composition of red blood cells was determined . RESULTS As expected , fish oil produced a rapid increase in erythrocyte DHA and total n-3 fatty acids . The consumption of either 2.4 or 3.6 g flax oil/d ( in capsules ) was sufficient to significantly increase erythrocyte total phospholipid ALA , EPA , and docosapentaenoic acid ( 22:5n-3 ) fatty acid content . There were no differences among groups in plasma inflammatory markers or lipid profile . CONCLUSIONS The consumption of ALA-enriched supplements for 12 wk was sufficient to elevate erythrocyte EPA and docosapentaenoic acid content , which shows the effectiveness of ALA conversion and accretion into erythrocytes . The amounts of ALA required to obtain these effects are amounts that are easily achieved in the general population by dietary modification The occurrence of menopause is associated with an increased risk of cardiovascular events , and this has partly been attributed to the decline in circulating levels of estrogen . A lignan complex rich in the plant lignan secoisolariciresinol diglucoside ( SDG ) was isolated from flaxseed . SDG is metabolized by the colonic microflora to the mammalian lignans enterodiol and enterolactone and is hypothesized to be cardioprotective due to their structural similarity to estrogen . The aim of this study was to investigate the effect of a lignan complex , providing 500 mg/d of SDG , on markers of endothelial function .  Healthy postmenopausal women ( n = 22 ) completed a r and omized , double-blind , placebo-controlled , crossover study . Women consumed daily a low-fat muffin , with or without a lignan complex , for 6 wk , separated by a 6-wk washout period . Flow-mediated , endothelium-dependent vasodilatation ( FMD ) and nitroglycerine-mediated , endothelium-independent vasodilatation were measured at the end of each intervention period . The sum of Plasma nitrite and nitrate ( NOx ) , endothelin-1 ( ET-1 ) , and asymmetric dimethylarginine ( ADMA ) were measured at the beginning and end of each intervention period . FMD was 3.6 + /- 0.9 % ( mean + /- SEM ) after the lignan complex intervention period compared with 3.9 + /- 0.7 % after the placebo period ( P = 0.72 ) . Plasma concentrations of NOx , ET-1 , and ADMA were not affected . We conclude that daily consumption for 6 wk of a low-fat muffin enriched with a lignan complex had no effect on endothelial function in healthy postmenopausal women Phytoestrogens are increasingly incorporated into the diet of menopausal women . However , there are limited data on the efficacy of flaxseed on the consequences of estrogen deficiency in menopausal women . The purpose of the study was to assess the effects of flaxseed incorporation into the diet of healthy menopausal women . One hundred and ninety-nine menopausal women were r and omly assigned to consume 40 g flaxseed/d ( n = 101 ) or wheat germ placebo ( n = 98 ) for 12 months . At baseline and at month 12 , serum levels of lipids , bone mineral density ( BMD ) , and menopausal symptoms were evaluated . Statistical analysis was performed under the intention to treat principle . Flaxseed reduced serum total ( -0.20 + /- 0.51 mmol/liter ; P = 0.012 ) and high-density lipoprotein ( -0.08 + /- 0.24 mmol/liter ; P = 0.031 ) cholesterol concentrations compared with wheat germ placebo .  BMD did not differ significantly between the two arms . Both flaxseed and wheat germ reduced ( P < 0.0001 ) the severity scores of menopausal symptoms , but no statistical difference was found between the two arms . Our findings suggest that 1-yr incorporation of flaxseed into the diet produced a favorable , but not clinical ly significant , effect on blood cholesterol and caused no significant change in BMD or symptoms in healthy menopausal women Objective : Alpha-linolenic acid ( ALA ) is the natural precursor of the cardioprotective long-chain n−3 fatty acids . Available data indicate a possible beneficial effect of ALA on cardiovascular disease ( CVD ) , but the response of various CVD risk factors to increased ALA intake is not well characterized . The purpose of the present study was to examine the effect of increased ALA intake on blood pressure in man . Design , setting , subjects and interventions : We used a prospect i ve , two-group , parallel-arm design to examine the effect of a 12-week dietary supplementation with flaxseed oil , rich in ALA ( 8 g/day ) , on blood pressure in middle-aged dyslipidaemic men ( n=59 ) . The diet of the control group was supplemented with safflower oil , containing the equivalent n−6 fatty acid ( 11 g/day linoleic acid ( LA ) ; n=28 ) . Arterial blood pressure was measured at the beginning and at the end of the dietary intervention period . Results : Supplementation with ALA result ed in significantly lower systolic and diastolic blood pressure levels compared with LA ( P=0.016 and P=0.011 , respectively , from analysis of variance ( ANOVA ) for repeated measures ) . Conclusions : We observed a hypotensive effect of ALA , which may constitute another mechanism accounting in part for the apparent cardioprotective effect of this n−3 fatty acid . Sponsorship : Greek Ministry of Development , General Secretariat for Research and Technology Flaxseed contains & ohgr; 
    Output:
    
This meta- analysis of RCTs showed significant reductions in both SBP and DBP following supplementation with various flaxseed products