***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: CONTEXT To enhance the effectiveness of diet in lowering cholesterol , recommendations of the Adult Treatment Panel III of the National Cholesterol Education Program emphasize diets low in saturated fat together with plant sterols and viscous fibers , and the American Heart Association supports the use of soy protein and nuts . OBJECTIVE To determine whether a diet containing all of these recommended food components leads to cholesterol reduction comparable with that of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors ( statins ) . DESIGN R and omized controlled trial conducted between October and December 2002 . SETTING AND PARTICIPANTS Forty-six healthy , hyperlipidemic adults ( 25 men and 21 postmenopausal women ) with a mean ( SE ) age of 59 ( 1 ) years and body mass index of 27.6 ( 0.5 ) , recruited from a Canadian hospital-affiliated nutrition research center and the community . INTERVENTIONS Participants were r and omly assigned to undergo 1 of 3 interventions on an outpatient basis for 1 month : a diet very low in saturated fat , based on milled whole-wheat cereals and low-fat dairy foods ( n = 16 ; control ) ; the same diet plus lovastatin , 20 mg/d ( n = 14 ) ; or a diet high in plant sterols ( 1.0 g/1000 kcal ) , soy protein ( 21.4 g/1000 kcal ) , viscous fibers ( 9.8 g/1000 kcal ) , and almonds ( 14 g/1000 kcal ) ( n = 16 ; dietary portfolio ) . MAIN OUTCOME MEASURES Lipid and C-reactive protein levels , obtained from fasting blood sample s ; blood pressure ; and body weight ; measured at weeks 0 , 2 , and 4 and compared among the 3 treatment groups . RESULTS The control , statin , and dietary portfolio groups had mean ( SE ) decreases in low-density lipoprotein cholesterol of 8.0 % ( 2.1 % ) ( P = .002 ) , 30.9 % ( 3.6 % ) ( P<.001 ) , and 28.6 % ( 3.2 % ) ( P<.001 ) , respectively . Respective reductions in C-reactive protein were 10.0 % ( 8.6 % ) ( P = .27 ) , 33.3 % ( 8.3 % ) ( P = .002 ) , and 28.2 % ( 10.8 % ) ( P = .02 ) . The significant reductions in the statin and dietary portfolio  groups were all significantly different from changes in the control group . There were no significant differences in efficacy between the statin and dietary portfolio treatments . CONCLUSION In this study , diversifying cholesterol-lowering components in the same dietary portfolio increased the effectiveness of diet as a treatment of hypercholesterolemia The daily consumption of fruits and vegetables is a common dietary recommendation to support good health . We hypothesized that a commercially available encapsulated fruit and vegetable juice powder concentrate ( FVJC ) could support functional indices of health due to increased intake of various phytonutrients . This was a double-blind , r and omized , placebo-controlled investigation of 59 healthy law students who consumed either FVJC or placebo capsules for 77 d. Blood was collected on d 1 , 35 , and 77 to examine the number of circulating alphabeta- and gammadelta-T cells , cytokine production , lymphocyte DNA damage , antioxidant status , and levels of carotenoids and vitamin C. A log of illnesses and symptoms was also kept . The FVJC group tended to have fewer total symptoms than the placebo group ( P < 0.076 ) . By d 77 there was a 30 % increase in circulating gammadelta-T cells and a 40 % reduction in DNA damage in lymphocytes in the FVJC group relative to the placebo group . Plasma levels of vitamin C and of beta-carotene , lycopene , and lutein increased significantly from baseline in the FVJC group as did plasma oxygen radical absorptive capacity ( 50 % ) . Interferon-gamma produced by phorbol-stimulated lymphocytes was reduced 70 % in the FVJC group , whereas other cytokines ( IL-4 , IL-6 , transforming growth factor beta ) were unchanged relative to treatment or time . FVJC consumption during this study period result ed in increased plasma nutrients and antioxidant capacity , reduction in DNA str and breaks , and an increase in circulating gammadelta-T cells Phytonutrients from plant foods provide numerous antioxidants . We hypothesized that supplementation for 28 wk with a commercially available encapsulated juice powder concentrate ( JPC ) could influence indicators of oxidative stress , immunity , and illness .  Trained men ( n = 41 ; 34 + /- 5 y ; maximum oxygen uptake = 55 + /- 7 mL x kg(-1 ) x min(-1 ) ) from a homogenous police Special Forces unit were r and omly assigned in a double blind manner to either JPC ( n = 21 ) or placebo ( n = 20 ) . We used multiple 7-d food records to assess dietary intake and found inadequate mean daily fruit and vegetable consumption ( 3.2 + /- 1.2 servings ) . The group physician documented all duty days lost due to illness . We collected plasma at baseline and study wk 4 , 8 , 16 , and 28 for analysis of carbonyl groups on protein ( CP ) and TNFalpha .  Over the 28-wk investigation , CP was lower in the JPC group , with both a treatment and a time x treatment interaction ( P < 0.05 ) . Concentrations of both CP and TNFalpha at 16 and 28 wk were lower in the JPC than in the placebo group ( P < 0.001 ) . TNFalpha increased during the first 8 wk followed by a decrease in both groups for the following 20 wk ( P < 0.001 ) . Over the final 20 wk of the study , the placebo group tended to have more days of illness than the JPC group ( P = 0.068 ) . These data suggest beneficial JPC effects with regard to reduction of duty days lost due to illness and reduction of CP and TNFalpha concentrations in this group of trained men over 28 wk Fruit and vegetable consumption is inversely associated with  coronary heart disease ( CHD ) risk . The aim of the present study was to determine the effect of supplementation with dehydrated juice concentrates from mixed fruit and vegetables on selected plasma vitamins and antioxidant status . We assessed CHD risk by measuring the concentrations of homocysteine , lipids , lipoproteins , glucose and insulin .  Men were recruited to participate in a r and omized double-blind , crossover trial with 2 periods of 6 wk , separated by a 3-wk wash-out period . Supplementation with the encapsulated mixed extract ( Juice Plus ) was compared with physically similar placebo capsules .  Thirty-two men ( 13 smokers , 19 nonsmokers ) completed the study with a mean compliance of 88 % . Compared with placebo , supplementation increased the concentrations of plasma beta-carotene ( 0.24 + /- 0.15 vs. 1.12 + /- 0.70 micro mol/L ; mean + /- SD ; P < 0.0001 ) , retinol ( 1.87 + /- 0.33 vs. 2.00 + /- 0.43 micro mol/L ; P < 0.05 ) , alpha-tocopherol ( 16.8 + /- 7.3 vs. 19.3 + /- 6.8 micro mol/L ; P < 0.01 ) , ascorbic acid ( 72.1 + /- 19.4 vs. 84.1 + /- 13.5 micro mol/L ; P < 0.002 ) and folic acid ( 24.5 + /- 10.0 vs. 44.9 + /- 16.9 nmol/L ; P < 0.0001 ) . Plasma homocysteine was reduced ( 8.2 + /- 1.5 vs. 7.6 + /- 1.1 ; P < 0.05 ) and inversely related ( r = -0.40 , P < 0.001 ) with serum folate concentrations . Plasma vitamin C was positively correlated with the resistance of LDL to oxidation ( r = 0.26 , P < 0.05 ) and the plasma ferric reducing/antioxidant power ( FRAP ) tended to be greater after supplementation than after the placebo period ( 1125.5 + /- 144.1 vs. 1180.3 + /- 158.1 micro mol/L ; P < 0.065 ) . Plasma glucose , insulin and lipid concentrations were unaffected . Responses of smokers and nonsmokers did not differ . In the absence of dietary modification , supplementation with a fruit and vegetable concentrate produced responses consistent with a reduction in CHD risk OBJECTIVES Our objective was to determine if long-term daily administration of phytonutrient supplements can prevent the immediate adverse impact of a high-fat meal and increase the production of nitric oxide . BACKGROUND Ingestion of a high-fat meal impairs flow-mediated vasodilation of the brachial artery for at least 4 h ; however , co-ingestion of vitamin antioxidants or a green salad has been shown to prevent this effect . METHODS Flow-mediated brachial artery reactivity test ( BART ) both before and 3 h after a 900 calorie 50 g fat meal was evaluated in 38 healthy volunteers ( age 36.4 + /- 10.1 years ) . Subjects were r and omized to four weeks of daily supplementation with a powdered fruit vegetable juice concentrate ( Juice Plus [ JP ] ) along with a complex supplement providing nutritional antioxidants and various herbal extracts ( Vineyard [ V ] ) , JP alone , or a matching placebo . At three and four weeks , BART was repeated both before and after the high-fat meal . Serum nitrate/nitrite concentrations were measured at baseline and at four weeks . RESULTS Four weeks of the JP-V combination blunted the detrimental effect of the high-fat meal ( -47.5 + /- 23.4 % at baseline vs. -1.7 + /- 9.7 % at four weeks [ p < 0.05 ] ) . Four weeks of JP alone had a similar beneficial effect ( -45.1 + /- 19.7 % at baseline vs. -16.6 + /- 10.3 % at four weeks [ p < 0.05 ] ) , whereas there was no substantial effect of the placebo . In the subjects treated with supplements , concentrations of serum nitrate/nitrite increased from 78 + /- 39 to 114 + /- 62 microm/l ( p < 0.02 ) . CONCLUSIONS Daily ingestion of modest amounts of a fruit/vegetable juice concentrate with or without adjunctive phytonutrient supplementation can reduce the immediate adverse impact of high-fat meals on flow-mediated vasoactivity and increase nitrate/nitrite blood concentration Chronic inflammation contributes to an increased risk for developing chronic conditions such as cardiovascular disease , diabetes , and cancer . A high " inflammatory load " is defined as elevated inflammation markers in blood or other tissues . We evaluated several markers of systemic inflammation from healthy adults and tested the hypothesis that two formulations of encapsulated fruit and vegetable juice powder concentrate with added berry powders ( FVB ) or without ( FV ) could impact markers of inflammatory load . Using a double-blind , placebo-controlled approach , 117 subjects were r and omly assigned to receive placebo , FV , or FVB capsules . Blood was drawn at baseline and after 60 d of capsule consumption . We measured inflammatory markers ( high sensitivity C-Reactive Protein , Monocyte Chemotactic Protein-1 , Macrophage Inflammatory Protein 1-β , and Regulated upon Activation , Normal T cell Expressed and Secreted ) , superoxide dismutase , and micronutrients ( β-carotene , vitamin C , and vitamin E ) . Results showed Monocyte Chemotactic Protein-1 , Macrophage Inflammatory Protein 1-β , and RANTES levels were significantly reduced and superoxide dismutase and micronutrient levels were significantly increased in subjects consuming both FV and FVB , relative to placebo . Data suggest a potential health benefit by consuming either formulation of the encapsulated juice concentrates through their anti-inflammatory properties BACKGROUND Studies of fruit and vegetable consumption in relation to overall health are limited . We evaluated the relationship between fruit and vegetable intake and the incidence of  cardiovascular disease and cancer  and of deaths from other causes in two prospect i ve cohorts . METHODS A total of 71 910 female participants in the Nurses ' Health study and 37,725 male participants in the Health Professionals ' Follow-up Study who were free of major chronic disease completed baseline semiquantitative food-frequency question naires in 1984 and 198 
    Output:
    
Overall , daily consumption of FV supplements significantly increased serum concentrations of the major antioxidant provitamins and vitamins found in plant foods ( β-carotene , vitamins C and E ) and folate .
Functional changes , such as reduced serum homocysteine and markers of protein , lipid , and DNA oxidation , were also reported ; in addition , the health advantages on markers of inflammation , immunity , and endothelial function are promising .
Key teaching points : Mixed fruit and vegetable supplements produced from plant foods may serve as an efficacious complement to the habitual diet in individuals who have suboptimal intake or variety of nutrient-dense fruits and vegetables .
Current research indicates that fruit and vegetable concentrates significantly increase serum levels of antioxidant provitamins and vitamins ( β-carotene , vitamins C and E ) and folate and reduce homocysteine and markers of oxidative stress .