***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 Substitution of dietary polyunsaturated for saturated fat has long been recommended for the primary prevention of cardiovascular disease ( CVD ) , but only a few prospect i ve cohort studies have provided support for this advice . METHODS We assessed the association of dietary linoleic and total polyunsaturated fatty acid ( PUFA ) intake with cardiovascular and overall mortality in a population -based cohort of 1551 middle-aged men . Dietary fat composition was estimated with a 4-day food record and serum fatty acid composition . RESULTS During the 15-year follow-up , 78 men died of CVD and 225 of any cause . Total fat intake was not related to CVD or overall mortality . Men with an energy-adjusted dietary intake of linoleic acid ( relative risk [ RR ] 0.39 ; 95 % confidence interval [ CI ] , 0.21 - 0.71 ) and PUFA ( RR , 0.38 ; 95 % CI , 0.20 - 0.70 ) in the upper third were less likely to die of CVD than men with intake in the lower third after adjustment for age . Multivariate adjustment weakened the association somewhat . Mortality from CVD was also lower for men with proportions of serum esterified linoleic acid ( RR , 0.42 ; 95 % CI , 0.21 - 0.80 ) and PUFA ( RR , 0.25 ; 95 % CI , 0.12 - 0.50 ) in the upper vs lower third , with some attenuation in multivariate analyses . Serum and to a lesser extent dietary linoleic acid and PUFA were also inversely associated with overall mortality . CONCLUSIONS Dietary polyunsaturated and more specifically linoleic fatty acid intake may have a substantial cardioprotective benefit that is also reflected in overall mortality . Dietary fat quality seems more important than fat quantity in the reduction of cardiovascular mortality in men OBJECTIVE To examine the predictive capability of a 1-h vs 2-h postload glucose value for  cardiovascular morbidity and mortality .  DESIGN Prospect i ve , population -based cohort study ( Malmö Preventive Project ) with subject inclusion 1974 - 1992 . METHODS 4934 men without known diabetes and cardiovascular disease , who had blood glucose ( BG ) measured at 0 , 20 , 40 , 60 , 90 and 120 min during an OGTT ( 30 g glucose per m2 body surface area ) , were followed for 27 years . Data on cardiovascular events and death were obtained through national and local registries . Predictive capabilities of  fasting BG ( FBG ) and glucose values obtained during OGTT alone and added to a clinical prediction model comprising traditional cardiovascular risk factors were assessed using Harrell 's concordance index ( C-index ) and integrated discrimination improvement ( IDI ) . RESULTS Median age was 48 ( 25th-75th percentile : 48 - 49 ) years and mean FBG 4.6 ± 0.6 mmol/L. FBG and 2-h postload BG did not independently predict cardiovascular events or death . Conversely , 1-h postload BG predicted cardiovascular morbidity and mortality and remained an independent predictor of cardiovascular death ( HR : 1.09 , 95 % CI : 1.01 - 1.17 , P = 0.02 ) and all-cause mortality ( HR : 1.10 , 95 % CI : 1.05 - 1.16 , P < 0.0001 ) after adjusting for various traditional risk factors . Clinical risk factors with added 1-h postload BG performed better than clinical risk factors alone , in predicting cardiovascular death ( likelihood-ratio test , P = 0.02 ) and all-cause mortality ( likelihood-ratio test , P = 0.0001 ; significant IDI , P = 0.0003 ) . CONCLUSION Among men without known diabetes , addition of 1-h BG , but not FBG or 2-h BG , to clinical risk factors provided incremental prognostic yield for prediction of cardiovascular death and all-cause mortality Purpose The purpose of this study is to compare the glycemic and insulinemic responses following the ingestion of recently developed diabetes-specific enteral formulas versus a st and ard and a high-fat formula . Methods Fifteen type 2 diabetes patients were selected to participate in a r and omized , double-blind , crossover study . Two enteral formulas ( 47 energy percent [ En% ] carbohydrate , 34En% fat , and 4 g fiber/200 mL ) were defined with either isomaltulose ( formula 1 ) or sucromalt ( formula 2 ) as the main carbohydrate source . For comparison , an isoenergetic diabetes-specific , high-fat ( 33En% carbohydrate , 50En% fat , 2.9 g fiber/200 mL ) and a st and ard formula ( 55En% carbohydrate , 30En% fat , 2.8 g fiber/ 200 mL ) were tested . Results Ingestion of formulas 1 and 2 and the high-fat formula result ed in an attenuated blood glucose response when compared with the st and ard formula ( P < .05 ) . In accordance , peak plasma glucose concentrations were significantly lower when compared with the st and ard formula ( 189 ± 3.6 mg/dL [ 10.5 ± 0.2 mmol/L ] , 196.2 ± 3.6 mg/dL [ 10.9 ± 0.2 mmol/L ] , 187.2 ± 3.6 mg/dL [ 10.4 ± 0.2 mmol/L ] , and 237.6 ± 3.6 mg/dL [ 13.2 ± 0.2 mmol/L ] , respectively ) . Plasma insulin responses were lower after consumption of the newly developed and high-fat formulas . Ingestion of the high-fat formula result ed in a greater postpr and ial triglyceride response ( P < .05 ) . Conclusions Diabetes-specific enteral formulas rich in slowly digestible carbohydrate sources can be equally effective in attenuating the postpr and ial blood glucose response as low-carbohydrate , high-fat enteral formulas without elevating the plasma triglyceride response Glycaemic index ( GI ) is used as an indicator to guide consumers in making healthier food choices . We compared the GI , insulin index ( II ) , and the area under the curve for blood glucose and insulin as glucose ( GR ) and insulin responses ( IR ) of a newly developed liquid nutritional formula with one commercially available liquid product with different types of carbohydrates . We then evaluated the glucose and insulin responses of two test foods with comparable energy density and protein percentage but presented in different food forms ( liquid vs. solid ) . Fourteen healthy women participated in the study .  GI , II , GR , and IR were assessed after ( independent ) consumption of two liquid products and a solid breakfast meal . The two liquid foods showed comparable GI , whilst the liquid form appeared to produce lower median GI ( 25 vs. 54 ) , and II ( 52 vs. 98 ) values compared to the solid breakfast ( p < 0.02 ) . The median GR and IR for solid breakfast were respectively 44 % and 45 % higher compared to the liquid product ( p < 0.02 ) . Liquid formulas with different carbohydrate qualities produced comparable glucose responses , while foods with comparable energy density and protein percentage but different food form elicited differential effects on GI , II , GR , and IR . Nutrient quality and food form need to be taken into consideration when developing low GI products to manage glycaemic responses Background : The potential confounding effect of different amounts and proportions of macronutrients across eating patterns on meal or dietary glycemic index ( GI ) and glycemic load ( GL ) value determinations has remained partially unaddressed . Objective : The study aim ed to determine the effects of different amounts of macronutrients and fiber on measured meal GI and GL values . Design : Four studies were conducted during which participants [ n = 20 - 22 ; women : 50 % ; age : 50 - 80 y ; body mass index ( in kg/m2 ) : 25 - 30 ) ] received food challenges containing different amounts of the variable nutrient in a r and om order . Added to the st and ard 50 g available carbohydrate from white bread was 12.5 , 25 , or 50 g carbohydrate ; 12.5 , 25 , or 50 g protein ; and 5.6 , 11.1 , or 22.2 g fat from rice cereal , tuna , and unsalted butter , respectively , and 4.8 or 9.6 g fiber from oat cereal . Arterialized venous blood was sample d for 2 h , and measured meal GI and GL and insulin index ( II ) values were calculated by using the incremental area under the curve ( AUCi ) method . Results : Adding carbohydrate to the st and ard white-bread challenge increased glucose AUCi ( P < 0.0001 ) , measured meal GI ( P = 0.0066 ) , and mean GL ( P < 0.0001 ) . Adding protein ( 50 g only ) decreased glucose AUCi ( P = 0.0026 ) , measured meal GI ( P = 0.0139 ) , and meal GL ( P = 0.0140 ) . Adding fat or fiber had no significant effect on these variables . Adding carbohydrate ( 50 g ) , protein ( 50 g ) , and fat ( 11.1 g ) increased the insulin AUCi or II ; fiber had no effect . Conclusions : These data indicate that uncertainty in the determination of meal GI and GL values is introduced when carbohydrate-containing foods are consumed concurrently with protein ( equal amount of carbohydrate challenge ) but not with carbohydrate- , fat- , or fiber-containing foods . Future studies are needed to evaluate whether this uncertainty also influences the prediction of average dietary GI and GL values for eating patterns . This trial was registered at clinical trials.gov as NCT01023646 The glycaemic index ( GI ) concept was originally introduced to classify different sources of carbohydrate (CHO)-rich foods , usually having an energy content of > 80 % from CHO , to their effect on post-meal glycaemia . It was assumed to apply to foods that primarily deliver available CHO , causing hyperglycaemia . Low-GI foods were classified as being digested and absorbed slowly and high-GI foods as being rapidly digested and absorbed , result ing in different glycaemic responses . Low-GI foods were found to induce benefits on certain risk factors for CVD and diabetes . Accordingly it has been proposed that GI classification of foods and drinks could be useful to help consumers make ' healthy food choices ' within specific food groups . Classification of foods according to their impact on blood glucose responses requires a st and ardised way of measuring such responses . The present review discusses the most relevant method ological considerations and highlights specific recommendations regarding number of subjects , sex , subject status , inclusion and exclusion criteria , pre-test conditions , CHO test dose , blood sampling procedures , sampling times , test r and omisation and calculation of glycaemic response area under the curve . All together , these technical recommendations will help to implement or reinforce measurement of GI in laboratories and help to ensure quality of results . Since there is current international interest in alternative ways of expressing glycaemic responses to foods , some of these methods are discussed Elevated postpr and ial blood glucose levels constitute a global epidemic and a major risk factor for prediabetes and type II diabetes , but existing dietary methods for controlling them have limited efficacy . Here , we continuously monitored week-long glucose levels in an 800-person cohort , measured responses to 46,898 meals , and found high variability in the response to identical meals , suggesting that universal dietary recommendations may have limited utility . We devised a machine-learning algorithm that integrates blood parameters , dietary habits , anthropometrics , physical activity , and gut microbiota measured in this cohort and showed that it accurately predicts personalized postpr and ial glycemic response to real-life meals . We vali date d these predictions in an independent 100-person cohort . Finally , a blinded r and omized controlled dietary intervention based on this algorithm result ed in significantly lower postpr and ial responses and consistent alterations to gut microbiota configuration . Together , our results suggest that personalized diets may successfully modify elevated postpr and ial blood glucose and its metabolic consequences . VIDEO ABSTRACT Few studies have examined short term responses to the different contents of carbohydrate or fat in the meal , although long term effects of the high fat meal have been considered as compound risk factor for metabolic disorders . The aim of this study was to investigate the postpr and ial changes of plasma glucose , insulin and lipids upon intakes of high carbohydrate or high fat meal in young healthy women . Subjects were r and omly assigned to either the high carbohydrate meal ( HCM , 75 % carbohydrate , n=13 ) or the high fat meal ( HFM , 60 % fat , n=12 
    Output:
    
Modest exchange of carbohydrates for fats in mixed meals significantly reduces PPG and PPI and increases PPTG responses .
The quantitative relationships derived here may be applied to predict responses , and to design and optimize meal macronutrient compositions in dietary intervention studies