***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: Objectives : A gluten-free diet omitting wheat , rye , and barley is the only effective treatment for coeliac disease . The necessity of excluding oats from the diet has remained controversial . We studied the toxicity of oats in children with coeliac disease during a 2-year follow-up by investigating jejunal transglutaminase 2 (TG2)-targeted IgA-class autoantibody deposits , a potentially more sensitive disease marker than serum antibodies or conventional histology . Patients and Methods : Twenty-three coeliac children in remission were r and omized to undergo oat or gluten challenge with wheat , rye , barley , and oats . When jejunal histological relapse was evident after gluten challenge , patients excluded wheat , rye , and barley but continued with oats . Mucosal morphology and TG2-targeted autoantibody deposits were studied in jejunal biopsies taken at baseline and after 6 and 24 months . Furthermore , serum IgA-class TG2 antibodies were measured . Results : At baseline , serum TG2 antibodies were negative in all 23 patients , but 7 of them had minor mucosal deposits . In the oats group , there was no significant change in the intensity of the deposits within 2 years . In contrast , during the gluten challenge , the intensity of the deposits clearly increased and decreased again when wheat , rye , and barley were excluded but consumption of oats was continued ; this was in line with serum autoantibodies . The intensity of the mucosal deposits correlated well with both villous morphology and serum autoantibody levels . Conclusions : Consumption of oats does not induce TG2 autoantibody production at mucosal level in children with coeliac disease . Measurement of small-intestinal mucosal autoantibody deposits is suitable for monitoring treatment in coeliac patients Twenty normal weight female volunteers divided into high and low restraint groups consumed breakfast meals of high and low-fibre content ( 12.0 g and 3.0 g fibre respectively ) on two separate occasions . Visual analogue scales were used to record hunger , fullness , desire to eat , and a measure of prospect i ve consumption for 21/2 hours after each meal . At this point , a tray of pre-weighed lunch foods was offered and subjects were requested to eat as much or as little as they desired . The two breakfast meals ( of equal weight ) were based on toast , breakfast cereal , milk , butter and orange marmalade . No significant difference in energy intake at lunch was found after the high and low fibre breakfasts , or between the restraint groups . There was no significant difference between ratings after the high and low-fibre meals except for fullness , which was greater after the high-fibre breakfast . The effect of fibre overall , was relatively weak compared to the differences between the two restraint groups , with the high restraint group consistently expressing significantly less hunger before , during and after the breakfasts compared to the low restraint group Objective : To test the hypothesis that a high carbohydrate breakfast with breakfast cereal leads to a meaningful reduction in dietary energy intake from fat , especially from saturated fat , and thus lower serum cholesterol levels . Design : An open r and omized controlled cross-over trial . The subjects were r and omized into intervention breakfast cereal or usual breakfast ( control ) groups . Setting : Free-living subjects aged 29–71 y in Eastern Finl and Subjects : 224 enrolled , 209 completed the study . The subjects were recruited from a survey of a r and om population sample and from other sources , and their serum cholesterol was not lower than 5.0 mmol/l . Recruited persons did not have any chronic disease or very low saturated fat intake . Intervention : The cereal group consumed 80 g ( men ) or 60 g ( women ) cereal at breakfast and the control group continued their usual dietary habits for six weeks . After a wash out of six weeks , a cross-over with another six week trial period took place . Measurements ( including serum sample s and a 3 d food record ) took place before and after the two trial periods . Results : The intervention period led to 2.5 en% ( energy percent units ) reduction in saturated fatty acids intake . The reduction in total fat intake was 5.5 en% . This was compensated for by increased intake of carbohydrates . The reduction in saturated fatty acids intake led to modest ( but in group 1 significant ) 0.15 mmol/l ( 2.5 % ) reduction in total serum cholesterol level . Conclusions : The trial showed that regular cereal breakfast can lead to reduced intake of total and saturated fatty acids of the daily diet and consequently to reduction in serum cholesterol level . Sponsorship : Supported by the Kellogg Company of Great Britain Background Control of body weight by balancing energy intake and energy expenditure is of major importance for the prevention of type 2 diabetes , but the role of specific dietary factors in the etiology of type 2 diabetes is less well established . We evaluated intakes of whole grain , bran , and germ in relation to risk of type 2 diabetes in prospect i ve cohort studies . Methods and Findings We followed 161,737 US women of the Nurses ' Health Studies ( NHSs ) I and II , without history of diabetes , cardiovascular disease , or cancer at baseline . The age at baseline was 37–65 y for NHSI and 26–46 y for NHSII .  Dietary intakes and potential confounders were assessed with regularly administered question naires . We documented 6,486 cases of type 2 diabetes during 12–18 y of follow-up . Other prospect i ve cohort studies on whole grain intake and risk of type 2 diabetes were identified in search es of MEDLINE and EMBASE up to January 2007 , and data were independently extracted by two review ers . The median whole grain intake in the lowest and highest quintile of intake was , respectively , 3.7 and 31.2 g/d for NHSI and 6.2 and 39.9 g/d for NHSII . After adjustment for potential confounders , the relative risks ( RRs ) for the highest as compared with the lowest quintile of whole grain intake was 0.63 ( 95 % confidence interval [ CI ] 0.57–0.69 ) for NHSI and 0.68 ( 95 % CI 0.57–0.81 ) for NHSII ( both : p-value , test for trend < 0.001 ) . After further adjustment for body mass index ( BMI ) , these RRs were 0.75 ( 95 % CI 0.68–0.83 ; p-value , test for trend < 0.001 ) and 0.86 ( 95 % CI 0.72–1.02 ; p-value , test for trend 0.03 ) respectively . Associations for bran intake were similar to those for total whole grain intake , whereas no significant association was observed for germ intake after adjustment for bran . Based on pooled data for six cohort studies including 286,125 participants and 10,944 cases of type 2 diabetes , a two-serving-per-day increment in whole grain consumption was associated with a 21 % ( 95 % CI 13%–28 % ) decrease in risk of type 2 diabetes after adjustment for potential confounders and BMI . Conclusions Whole grain intake is inversely associated with risk of type 2 diabetes , and this association is stronger for bran than for germ . Findings from prospect i ve cohort studies consistently support increasing whole grain consumption for the prevention of type 2 diabetes OBJECTIVE To examine associations between type 2 diabetes and fiber , glycemic load ( GL ) , dietary glycemic index ( GI ) , and fiber-rich foods . RESEARCH DESIGN AND METHODS This was a prospect i ve study of 36,787 men and women aged 40 - 69 years without diabetes . For all self-reported cases of diabetes at 4-year follow-up , confirmation of diagnosis was sought from medical practitioners . Case subjects were those who reported diabetes at follow-up and for whom there was no evidence that they did not have type 2 diabetes . Data were analyzed with logistic regression , adjusting for country of birth , physical activity , family history of diabetes , alcohol and energy intake , education , 5-year weight change , sex , and age . RESULTS Follow-up was completed by 31,641 ( 86 % ) participants , and 365 cases were identified . The odds ratio ( OR ) for the highest quartile of white bread intake compared with the lowest was 1.37 ( 95 % CI 1.04 - 1.81 ; P for trend = 0.001 ) . Intakes of carbohydrate ( OR per 200 g/day 0.58 , 0.36 - 0.95 ) , sugars ( OR per 100 g/day 0.61 , 0.47 - 0.79 ) , and magnesium ( OR per 500 mg/day 0.62 , 0.43 - 0.90 ) were inversely associated with incidence of diabetes , whereas intake of starch ( OR per 100 g/day 1.47 , 1.06 - 2.05 ) and dietary GI ( OR per 10 units 1.32 , 1.05 - 1.66 ) were positively associated with diabetes . These relationships were attenuated after adjustment for BMI and waist-to-hip ratio . CONCLUSIONS Reducing dietary GI while maintaining a high carbohydrate intake may reduce the risk of type 2 diabetes . One way to achieve this would be to substitute white bread with low-GI breads Epidemiological studies have shown an inverse association between dietary intake of whole grains and the risk of chronic disease . This may be related to the ability to mediate a prebiotic modulation of gut microbiota . However , no studies have been conducted on the microbiota modulatory capability of whole-grain ( WG ) cereals . In the present study , the impact of WG wheat on the human intestinal microbiota compared to wheat bran ( WB ) was determined . A double-blind , r and omised , crossover study was carried out in thirty-one volunteers who were r and omised into two groups and consumed daily 48 g breakfast cereals , either WG or WB , in two 3-week study periods , separated by a 2-week washout period . Numbers of faecal bifidobacteria and lactobacilli ( the target genera for prebiotic intake ) , were significantly higher upon WG ingestion compared with WB . Ingestion of both breakfast cereals result ed in a significant increase in ferulic acid concentrations in blood but no discernible difference in faeces or urine . No significant differences in faecal SCFA , fasting blood glucose , insulin , total cholesterol ( TC ) , TAG or HDL-cholesterol were observed upon ingestion of WG compared with WB . However , a significant reduction in TC was observed in volunteers in the top quartile of TC concentrations upon ingestion of either cereal . No adverse intestinal symptoms were reported and WB ingestion increased stool frequency . Daily consumption of WG wheat exerted a pronounced prebiotic effect on the human gut microbiota composition . This prebiotic activity may contribute towards the beneficial physiological effects of WG wheat BACKGROUND No studies have examined whether increased consumption of oat cereal , rich in soluble fiber , favorably alters lipoprotein particle size and number . OBJECTIVE We examined the effects of large servings of either oat or wheat cereal on plasma lipids , lipoprotein subclasses , lipoprotein particle diameters , and LDL particle number . DESIGN Thirty-six overweight men aged 50 - 75 y were r and omly assigned to consume daily for 12 wk either oat or wheat cereal providing 14 g dietary fiber/d . Before and after the intervention , plasma lipid and lipoprotein subclasses were measured with proton nuclear magnetic resonance spectroscopy , and whole-body insulin sensitivity was estimated with the frequently sample d intravenous-glucose-tolerance test . RESULTS Time-by-treatment interactions ( P < 0.05 ) for LDL cholesterol ( oat : -2.5 % ; wheat : 8.0 % ) , small LDL cholesterol ( oat : -17.3 % ; wheat : 60.4 % ) , LDL particle number ( oat : -5.0 % ; wheat : 14.2 % ) , and LDL : HDL cholesterol ( oat : -6.3 % ; wheat : 14.2 % ) were observed . Time-by-treatment interactions were nearly significant for total cholesterol ( oat : -2.5 % ; wheat : 6.3 % ; P = 0.08 ) , triacylglycerol ( oat : -6.6 % ; wheat : 22.0 % ; P = 0.07 ) , and VLDL triacylglycerol ( oat : -7.6 % ; wheat : 2.7 % ; P = 0.08 ) . No significant time-by-treatment interactions were observed for HDL cholesterol , HDL-cholesterol subclasses , or LDL , HDL , and VLDL particle diameters . Insulin sensitivity did not change significantly with either intervention . CONCLUSIONS The oat compared with the wheat cereal produced lower concentrations of small , dense LDL cholesterol and LDL particle number without producing adverse changes in blood triacylglycerol or HDL-cholesterol concentrations . These beneficial alter 
    Output:
    
Most studies on the nutritional impact are cross-sectional , with very few intervention studies , so breakfast cereal consumption may be a marker of an overall healthy lifestyle .
Oat- , barley- , or psyllium-based cereals can help lower cholesterol concentrations ( grade A ) , and high-fiber , wheat-based cereals can improve bowel function ( grade A ) .
Regular breakfast cereal consumption is associated with a lower body mass index and less risk of being overweight or obese ( grade B ) .
Presweetened breakfast cereals do not increase the risk of overweight and obesity in children ( grade C ) .
Whole-grain or high-fiber breakfast cereals are associated with a lower risk of diabetes ( grade B ) and cardiovascular disease ( grade C ) .