***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: Objective —The goal of this study was to examine the association of the antiinflammatory interleukin-10 ( IL-10 ) with risk of cardiovascular disease ( CVD ) . Methods and Results —In the PROSPER ( PROspect i ve Study of Pravastatin in the Elderly at Risk ) cohort , we related baseline concentrations of circulating IL-10 to risk of CVD events in a nested case (n=819)-control ( n=1618 ) study of 3.2 years of follow-up . Circulating IL-10 showed few strong associations with classical risk factors but was positively correlated with IL-6 and C-reactive protein . IL-10 was positively associated with risk of CVD events ( odds ratio [ OR ] 1.17 , 95 % CI 1.05 to 1.31 per unit increase in log IL-10 ) after adjusting for classical risk factors and C-reactive protein . Furthermore , IL-10 was associated more strongly with CVD risk among those with no previous history of CVD ( OR 1.42 , 95 % CI 1.18 to 1.70 ) , compared with those with previous CVD ( OR 1.04 , 95 % CI 0.90 to 1.19 ; P=0.018 ) . Overall , IL-10 showed a modest ability to add discrimination to classical risk factors ( C-statistic + 0.005 , P=0.002 ) . Conclusion —Baseline circulating levels of the antiinflammatory IL-10 are positively associated with risk of CVD among the elderly without prior CVD events , although the association is less evident in those with a history of CVD . Additional epidemiological and mechanistic studies investigating the role of IL-10 in CVD are warranted The Healthy Eating Index-2005 ( HEI-2005 ) measures adherence to the 2005 Dietary Guidelines for Americans , but the association between the HEI-2005 and risk of chronic disease is not known . The Alternative Healthy Eating Index ( AHEI ) , which is based on foods and nutrients predictive of chronic disease risk , was associated inversely with chronic disease risk previously . We up date d the AHEI , including additional dietary factors involved in the development of chronic disease , and assessed the associations between the AHEI-2010 and the HEI-2005 and risk of major chronic disease prospect ively among 71,495 women from the Nurses ' Health Study and 41,029 men from the Health Professionals Follow-Up Study who were free of chronic disease at baseline . During ≥24 y of follow-up , we documented 26,759 and 15,558 incident chronic diseases ( cardiovascular disease , diabetes , cancer , or nontrauma death ) among women and men , respectively . The RR ( 95 % CI ) of chronic disease comparing the highest with the lowest quintile was 0.84 ( 0.81 , 0.87 ) for the HEI-2005 and 0.81 ( 0.77 , 0.85 ) for the AHEI-2010 . The AHEI-2010 and HEI-2005 were most strongly associated with coronary heart disease ( CHD ) and diabetes , and for both outcomes the AHEI-2010 was more strongly associated with risk than the HEI-2005 ( P-difference = 0.002 and < 0.001 , respectively ) . The 2 indices were similarly associated with risk of stroke and cancer . These findings suggest that closer adherence to the 2005 Dietary Guidelines may lower risk of major chronic disease . However , the AHEI-2010 , which included additional dietary information , was more strongly associated with chronic disease risk , particularly CHD and diabetes 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 BACKGROUND Dietary factors can affect telomere length ( TL ) , a biomarker of aging , through oxidation and inflammation-related mechanisms . A Dietary Inflammatory Index  ( DII ) could help to underst and the effect of the inflammatory potential of the diet on telomere shortening . OBJECTIVE This study aim ed to determine the association of the DII with TL and to examine whether diet-associated inflammation could modify the telomere attrition rate after a 5-y follow-up of a Mediterranean dietary intervention . DESIGN This was a prospect i ve study of 520 participants at high cardiovascular disease risk ( mean ± SD age : 67.0 ± 6.0 y , 45 % males ) from the PREDIMED-NAVARRA ( PREvención con DIeta MEDiterránea-NAVARRA ) trial . Leukocyte TL was measured by quantitative real-time polymerase chain reaction at baseline and after 5 y of follow-up . The DII was calculated from self-reported data by using a vali date d 137-item food-frequency question naire . RESULTS Longer telomeres at baseline were found in participants who had a more anti-inflammatory diet ( lowest DII score ) ( P-trend = 0.012 ) . Longitudinal analyses further showed that a greater anti-inflammatory potential of the diet ( i.e. , a decrease in the DII ) could significantly slow down the rate of telomere shortening . Moreover , the multivariable-adjusted OR for short telomeres ( z score ≤20th percentile ) was 1.80 ( 95 % CI : 1.03 , 3.17 ) in a comparison between the highest ( proinflammatory ) and the lowest ( anti-inflammatory ) DII tertiles . Similarly , a greater DII ( greatest proinflammatory values ) after a 5-y follow-up was associated with almost a 2-fold higher risk of accelerated telomere attrition compared with the highest decrease in DII ( greatest anti-inflammatory values ) during this period ( P-trend = 0.025 ) . CONCLUSIONS This study showed both cross-sectional and longitudinal associations between the inflammatory potential of the diet and telomere shortening in subjects with a high cardiovascular disease risk . Our findings are consistent with , but do not show , a beneficial effect of adherence to an anti-inflammatory diet on aging and health by slowing down telomere shortening . These results suggest that diet might play a key role as a determinant of TL through proinflammatory or anti-inflammatory mechanisms . This trial was registered at controlled-trials.com as IS RCT N35739639 Background Diet is known to play a key role in atherogenesis and in the development of cardiovascular events . Dietary factors may mediate these processes acting as potential modulators of inflammation . Potential Links between inflammatory properties of diet and the occurrence of cardiovascular events have not been tested previously . Objective We aim ed to assess the association between the dietary inflammatory index ( DII ) , a method to assess the inflammatory potential of the diet , and incident cardiovascular disease . Methods In the prospect i ve , dynamic SUN cohort , 18,794 middle-aged , Spanish university graduates were followed up for 8.9 years ( median ) . A vali date d 136-item food-frequency question naire was used to calculate the DII . The DII is based on scientific evidence about the relationship between diet and inflammatory biomarkers ( C-reactive protein , IL-1β , IL-4 , IL-6 , IL-10 and TNF-α ) . Cox proportional hazard models were used to estimate hazard ratios ( HR ) and 95 % confidence intervals ( CI ) for the association between the DII and incident cardiovascular disease ( myocardial infa rct ion , stroke or cardiovascular death ) . Results The risk for cardiovascular events progressively increased with each increasing quartile of DII ( ptrend = 0.017 ) . The multivariable-adjusted HR for participants in the highest ( most pro-inflammatory ) vs. the lowest quartile of the DII was 2.03 ( 95 % CI 1.06–3.88 ) . Conclusions A pro-inflammatory diet was associated with a significantly higher risk for developing cardiovascular events CONTEXT Associations between adiposity and circulating inflammation markers are assumed to be causal , although the direction of the relationship has not been proven . OBJECTIVE The aim of the study was to explore the causal direction of the relationship between adiposity and inflammation using a bidirectional Mendelian r and omization approach . METHODS In the PROSPER study of 5804 elderly patients , we related C-reactive protein ( CRP ) single nucleotide polymorphisms ( SNPs ) ( rs1800947 and rs1205 ) and adiposity SNPs ( FTO and MC4R ) to body mass index ( BMI ) as well as circulating levels of CRP and leptin . We gave each individual two allele scores ranging from zero to 4 , counting each pair of alleles related to CRP levels or BMI . RESULTS With increasing CRP allele score , there was a stepwise decrease in CRP levels ( P for trend < 0.0001 ) and a 1.98 mg/liter difference between extremes of the allele score distribution , but there was no associated change in BMI or leptin levels ( P > or= 0.89 ) . By contrast , adiposity allele score was associated with 1 ) an increase in BMI ( 1.2 kg/m(2 ) difference between extremes ; P for trend 0.002 ) ; 2 ) an increase in circulating leptin ( 5.77 ng/ml difference between extremes ; P for trend 0.0027 ) ; and 3 ) increased CRP levels ( 1.24 mg/liter difference between extremes ; P for trend 0.002 ) . CONCLUSIONS Greater adiposity conferred by FTO and MC4R SNPs led to higher CRP levels , with no evidence for any reverse pathway . Future studies should extend our findings to other circulating inflammatory parameters . This study illustrates the potential power of Mendelian r and omization to dissect directions of causality between intercorrelated metabolic factors BACKGROUND Because of the high density of fat , high-fat diets are perceived as likely to lead to increased bodyweight , hence health-care providers are reluctant to recommend them to overweight or obese individuals . We assessed the long-term effects of ad libitum , high-fat , high-vegetable-fat Mediterranean diets on bodyweight and waist circumference in older people at risk of cardiovascular disease , most of whom were overweight or obese . METHODS PREDIMED was a 5 year parallel-group , multicentre , r and omised , controlled clinical trial done in primary care centres affiliated to 11 hospitals in Spain . 7447 asymptomatic men ( aged 55 - 80 years ) and women ( aged 60 - 80 years ) who had type 2 diabetes or three or more cardiovascular risk factors were r and omly assigned ( 1:1:1 ) with a computer-generated number sequence to one of three interventions : Mediterranean diet supplemented with extra-virgin olive oil ( n=2543 ) ; Mediterranean diet supplemented with nuts ( n=2454 ) ; or a control diet ( advice to reduce dietary fat ; n=2450 ) . Energy restriction was not advised , nor was physical activity promoted . In this analysis of the trial , we measured bodyweight and waist circumference at baseline and yearly for 5 years in the intention-to-treat population . The PREDIMED trial is registered with IS RCT N.com , number IS RCT N35739639 . FINDINGS After a median 4·8 years ( IQR 2·8 - 5·8 ) of follow-up , participants in all three groups had marginally reduced bodyweight and increased waist circumference . The adjusted difference in 5 year changes in bodyweight in the Mediterranean diet with o 
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We conclude that the DII score seems to be a useful tool to appraise the inflammatory capacity of the diet and to better underst and the relationships between diet , inflammation , and cardio-metabolic diseases