human
***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 To prospect ively assess the joint association of birth weight and established lifestyle risk factors in adulthood with incident type 2 diabetes and to quantitatively decompose the attributing effects to birth weight only , to adulthood lifestyle only , and to their interaction . Design Prospect i ve cohort study . Setting Health Professionals Follow-up Study ( 1986 - 2010 ) , Nurses ’ Health Study ( 1980 - 2010 ) , and Nurses ’ Health Study II ( 1991 - 2011 ) . Participants 149 794 men and women without diabetes , cardiovascular disease , or cancer at baseline . Main outcome measure Incident cases of type 2 diabetes , identified through self report and vali date d by a supplementary question naire . Unhealthy lifestyle was defined on the basis of body mass index , smoking , physical activity , alcohol consumption , and the alternate healthy eating index . Results During 20 - 30 years of follow-up , 11 709 new cases of type 2 diabetes were documented . The multivariate adjusted relative risk of type 2 diabetes was 1.45 ( 95 % confidence interval 1.32 to 1.59 ) per kg lower birth weight and 2.10 ( 1.71 to 2.58 ) per unhealthy lifestyle factor . The relative risk of type 2 diabetes associated with a combination of per kg lower birth weight and per unhealthy lifestyle factor was 2.86 ( 2.26 to 3.63 ) , which was more than the addition of the risk associated with each individual factor , indicating a significant interaction on an additive scale ( P for interaction<0.001 ) . The attributable proportions of joint effect were 22 % ( 95 % confidence interval 18.3 % to 26.4 % ) to lower birth weight alone , 59 % ( 57.1 % to 61.5 % ) to unhealthy lifestyle alone , and 18 % ( 13.9 % to 21.3 % ) to their interaction . Conclusion Most cases of type 2 diabetes could be prevented by the adoption of a healthier lifestyle , but simultaneous improvement of both prenatal and postnatal factors could further prevent additional cases OBJECTIVE To examine whether improvements in health behaviors are associated with reduced risk of cardiovascular disease ( CVD ) in individuals with newly diagnosed type 2 diabetes . RESEARCH DESIGN AND METHODS Population -based prospect i ve cohort study of 867 newly diagnosed diabetic patients aged between 40 and 69 years from the treatment phase of the ADDITION-Cambridge study . Because the results for all analyses were similar by trial arm , data were pooled , and results were presented for the whole cohort . Participants were identified via  population -based stepwise screening between 2002 and 2006 , and underwent assessment of physical activity  ( European Prospect i ve Investigation into Cancer-Norfolk Physical Activity Question naire ) , diet ( plasma vitamin C and self-report ) , and alcohol consumption ( self-report ) at baseline and 1 year . A composite primary CVD outcome was examined , comprised of cardiovascular mortality , nonfatal myocardial infa rct ion , nonfatal stroke , and revascularization . RESULTS After a median ( interquartile range ) follow-up period of 5.0 years ( 1.3 years ) , 6 % of the cohort experienced a CVD event ( 12.2 per 1,000 person-years ; 95 % CI 9.3–15.9 ) . CVD risk was inversely related to the number of positive health behaviors changed in the year after diabetes diagnosis . The relative risk for primary CVD event in individuals who did not change any health behavior compared with those who adopted three/four healthy behaviors was 4.17 ( 95 % CI 1.02–17.09 ) , adjusting for age , sex , study group , social class , occupation , and prescription of cardioprotective medication ( P for trend = 0.005 ) . CONCLUSIONS CVD risk was inversely associated with the number of healthy behavior changes adopted in the year after the diagnosis of diabetes . Interventions that promote early achievement of these goals in patients with newly diagnosed diabetes could help reduce the burden of diabetes-related morbidity and mortality IMPORTANCE Short-term studies show that bariatric surgery causes remission of diabetes . The long-term outcomes for remission and diabetes-related complications are not known . OBJECTIVES To determine the long-term diabetes remission rates and the cumulative incidence of microvascular and macrovascular diabetes complications after bariatric surgery . DESIGN , SETTING , AND PARTICIPANTS The Swedish Obese Subjects ( SOS ) is a prospect i ve matched cohort study conducted at 25 surgical departments and 480 primary health care centers in Sweden . Of patients recruited between September 1 , 1987 , and January 31 , 2001 , 260 of 2037 control patients and 343 of 2010 surgery patients had type 2 diabetes at baseline . For the current analysis , diabetes status was determined at SOS health examinations until May 22 , 2013 . Information on diabetes complications was obtained from national health registers until December 31 , 2012 . Participation rates at the 2- , 10- , and 15-year examinations were 81 % , 58 % , and 41 % in the control group and 90 % , 76 % , and 47 % in the surgery group . For diabetes assessment , the median follow-up time was 10 years ( interquartile range [ IQR ] , 2 - 15 ) and 10 years ( IQR , 10 - 15 ) in the control and surgery groups , respectively . For diabetes complications , the median follow-up time was 17.6 years ( IQR , 14.2 - 19.8 ) and 18.1 years ( IQR , 15.2 - 21.1 ) in the control and surgery groups , respectively . INTERVENTIONS Adjustable or nonadjustable b and ing ( n = 61 ) , vertical b and ed gastroplasty ( n = 227 ) , or gastric bypass ( n = 55 ) procedures were performed in the surgery group , and usual obesity and diabetes care was provided to the control group . MAIN OUTCOMES AND MEASURES Diabetes remission , relapse , and diabetes complications . Remission was defined as blood glucose < 110 mg/dL and no diabetes medication . RESULTS The diabetes remission rate 2 years after surgery was 16.4 % ( 95 % CI , 11.7%-22.2 % ; 34/207 ) for control patients and 72.3 % ( 95 % CI , 66.9%-77.2 % ; 219/303 ) for bariatric surgery  patients ( odds ratio [ OR ] , 13.3 ; 95 % CI , 8.5 - 20.7 ; P < .001 ) . At 15 years , the diabetes remission rates decreased to 6.5 % ( 4/62 ) for control patients and to 30.4 % ( 35/115 ) for bariatric surgery patients ( OR , 6.3 ; 95 % CI , 2.1 - 18.9 ; P < .001 ) . With long-term follow-up , the cumulative incidence of microvascular complications was 41.8 per 1000 person-years ( 95 % CI , 35.3 - 49.5 ) for control patients and 20.6 per 1000 person-years ( 95 % CI , 17.0 - 24.9 ) in the surgery group ( hazard ratio [ HR ] , 0.44 ; 95 % CI , 0.34 - 0.56 ; P < .001 ) . Macrovascular complications were observed in 44.2 per 1000 person-years ( 95 % CI , 37.5 - 52.1 ) in control patients and 31.7 per 1000 person-years ( 95 % CI , 27.0 - 37.2 ) for the surgical group ( HR , 0.68 ; 95 % CI , 0.54 - 0.85 ; P = .001 ) . CONCLUSIONS AND RELEVANCE In this very long-term follow-up observational study of obese patients with type 2 diabetes , bariatric surgery was associated with more frequent diabetes remission and fewer complications than usual care . These findings require confirmation in r and omized trials . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01479452 BACKGROUND Our objective was to describe the reduction in relative risk of developing major chronic diseases such as cardiovascular disease , diabetes , and cancer associated with 4 healthy lifestyle factors among German adults . METHODS We used data from 23,153 German participants aged 35 to 65 years from the European Prospect i ve Investigation Into Cancer and Nutrition-Potsdam study . End points included confirmed incident type 2 diabetes mellitus , myocardial infa rct ion , stroke , and cancer . The 4 factors were never smoking , having a body mass index lower than 30 ( calculated as weight in kilograms divided by height in meters squared ) , performing 3.5 h/wk or more of physical activity , and adhering to healthy dietary principles ( high intake of fruits , vegetables , and whole-grain bread and low meat consumption ) . The 4 factors ( healthy , 1 point ; unhealthy , 0 points ) were summed to form an index that ranged from 0 to 4 . RESULTS During a mean follow-up of 7.8 years , 2006 participants developed new-onset diabetes ( 3.7 % ) , myocardial infa rct ion ( 0.9 % ) , stroke ( 0.8 % ) , or cancer ( 3.8 % ) . Fewer than 4 % of participants had zero healthy factors , most had 1 to 3 healthy factors , and approximately 9 % had 4 factors . After adjusting for age , sex , educational status , and occupational status , the hazard ratio for developing a chronic disease decreased progressively as the number of healthy factors increased . Participants with all 4 factors at baseline had a 78 % ( 95 % confidence interval [ CI ] , 72 % to 83 % ) lower risk of developing a chronic disease ( diabetes , 93 % [ 95 % CI , 88 % to 95 % ] ; myocardial infa rct ion , 81 % [ 95 % CI , 47 % to 93 % ] ; stroke , 50 % [ 95 % CI , -18 % to 79 % ] ; and cancer , 36 % [ 95 % CI , 5 % to 57 % ] ) than participants without a healthy factor . CONCLUSION Adhering to 4 simple healthy lifestyle factors can have a strong impact on the prevention of chronic diseases OBJECTIVE To date no clinical trials have evaluated the role of dietary patterns on the incidence of microvascular diabetes complications .  We hypothesized that a nutritional intervention based on the Mediterranean diet ( MedDiet ) would have greater protective effect on diabetic retinopathy and nephropathy than a low-fat control diet . RESEARCH DESIGN AND METHODS This was a post hoc analysis of a cohort of patients with type 2 diabetes participating in the PREvención con DIeta MEDiterránea ( PREDIMED ) study , a multicenter r and omized nutritional intervention trial conducted in a population at high cardiovascular risk . Individuals with type 2 diabetes who were free of microvascular complications at enrollment ( n = 3,614 , aged 55–80 years ) were r and omly assigned to one of three dietary interventions : MedDiet supplemented with extravirgin olive oil ( MedDiet+EVOO ) , MedDiet supplemented with mixed nuts ( MedDiet+Nuts ) , or a low-fat control diet . Two independent outcomes were considered : new onset of diabetic retinopathy and nephropathy . Hazard ratios ( HRs ) were calculated using multivariable-adjusted Cox regression . RESULTS During a median follow-up of 6.0 years , we identified 74 new cases of retinopathy and 168 of nephropathy . Compared with the control diet , multivariable-adjusted HRs for diabetic retinopathy were 0.56 ( 95 % CI 0.32–0.97 ) for the MedDiet+EVOO and 0.63 ( 0.35–1.11 ) for the MedDiet+Nuts . No between-group differences were found for nephropathy . When the yearly up date d information on adherence to the MedDiet was considered , the HR for retinopathy in the highest versus the lowest quintile was 0.34 ( 0.13–0.89 ; P = 0.001 for trend ) . No significant associations were found for nephropathy . CONCLUSIONS A MedDiet enriched with EVOO may protect against diabetic retinopathy but not diabetic nephropathy Background It is unclear whether ideal cardiovascular health ( CVH ) , and particularly 
    Output:
    
agent
The associations were largely consistent and significant among individuals from different socioeconomic background s and baseline characteristics .
Conclusions /interpretationAdoption of a healthy lifestyle is associated with substantial risk reduction in type 2 diabetes and long-term adverse outcomes among diabetic individuals .
***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 To prospect ively assess the joint association of birth weight and established lifestyle risk factors in adulthood with incident type 2 diabetes and to quantitatively decompose the attributing effects to birth weight only , to adulthood lifestyle only , and to their interaction . Design Prospect i ve cohort study . Setting Health Professionals Follow-up Study ( 1986 - 2010 ) , Nurses ’ Health Study ( 1980 - 2010 ) , and Nurses ’ Health Study II ( 1991 - 2011 ) . Participants 149 794 men and women without diabetes , cardiovascular disease , or cancer at baseline . Main outcome measure Incident cases of type 2 diabetes , identified through self report and vali date d by a supplementary question naire . Unhealthy lifestyle was defined on the basis of body mass index , smoking , physical activity , alcohol consumption , and the alternate healthy eating index . Results During 20 - 30 years of follow-up , 11 709 new cases of type 2 diabetes were documented . The multivariate adjusted relative risk of type 2 diabetes was 1.45 ( 95 % confidence interval 1.32 to 1.59 ) per kg lower birth weight and 2.10 ( 1.71 to 2.58 ) per unhealthy lifestyle factor . The relative risk of type 2 diabetes associated with a combination of per kg lower birth weight and per unhealthy lifestyle factor was 2.86 ( 2.26 to 3.63 ) , which was more than the addition of the risk associated with each individual factor , indicating a significant interaction on an additive scale ( P for interaction<0.001 ) . The attributable proportions of joint effect were 22 % ( 95 % confidence interval 18.3 % to 26.4 % ) to lower birth weight alone , 59 % ( 57.1 % to 61.5 % ) to unhealthy lifestyle alone , and 18 % ( 13.9 % to 21.3 % ) to their interaction . Conclusion Most cases of type 2 diabetes could be prevented by the adoption of a healthier lifestyle , but simultaneous improvement of both prenatal and postnatal factors could further prevent additional cases OBJECTIVE To examine whether improvements in health behaviors are associated with reduced risk of cardiovascular disease ( CVD ) in individuals with newly diagnosed type 2 diabetes . RESEARCH DESIGN AND METHODS Population -based prospect i ve cohort study of 867 newly diagnosed diabetic patients aged between 40 and 69 years from the treatment phase of the ADDITION-Cambridge study . Because the results for all analyses were similar by trial arm , data were pooled , and results were presented for the whole cohort . Participants were identified via  population -based stepwise screening between 2002 and 2006 , and underwent assessment of physical activity  ( European Prospect i ve Investigation into Cancer-Norfolk Physical Activity Question naire ) , diet ( plasma vitamin C and self-report ) , and alcohol consumption ( self-report ) at baseline and 1 year . A composite primary CVD outcome was examined , comprised of cardiovascular mortality , nonfatal myocardial infa rct ion , nonfatal stroke , and revascularization . RESULTS After a median ( interquartile range ) follow-up period of 5.0 years ( 1.3 years ) , 6 % of the cohort experienced a CVD event ( 12.2 per 1,000 person-years ; 95 % CI 9.3–15.9 ) . CVD risk was inversely related to the number of positive health behaviors changed in the year after diabetes diagnosis . The relative risk for primary CVD event in individuals who did not change any health behavior compared with those who adopted three/four healthy behaviors was 4.17 ( 95 % CI 1.02–17.09 ) , adjusting for age , sex , study group , social class , occupation , and prescription of cardioprotective medication ( P for trend = 0.005 ) . CONCLUSIONS CVD risk was inversely associated with the number of healthy behavior changes adopted in the year after the diagnosis of diabetes . Interventions that promote early achievement of these goals in patients with newly diagnosed diabetes could help reduce the burden of diabetes-related morbidity and mortality IMPORTANCE Short-term studies show that bariatric surgery causes remission of diabetes . The long-term outcomes for remission and diabetes-related complications are not known . OBJECTIVES To determine the long-term diabetes remission rates and the cumulative incidence of microvascular and macrovascular diabetes complications after bariatric surgery . DESIGN , SETTING , AND PARTICIPANTS The Swedish Obese Subjects ( SOS ) is a prospect i ve matched cohort study conducted at 25 surgical departments and 480 primary health care centers in Sweden . Of patients recruited between September 1 , 1987 , and January 31 , 2001 , 260 of 2037 control patients and 343 of 2010 surgery patients had type 2 diabetes at baseline . For the current analysis , diabetes status was determined at SOS health examinations until May 22 , 2013 . Information on diabetes complications was obtained from national health registers until December 31 , 2012 . Participation rates at the 2- , 10- , and 15-year examinations were 81 % , 58 % , and 41 % in the control group and 90 % , 76 % , and 47 % in the surgery group . For diabetes assessment , the median follow-up time was 10 years ( interquartile range [ IQR ] , 2 - 15 ) and 10 years ( IQR , 10 - 15 ) in the control and surgery groups , respectively . For diabetes complications , the median follow-up time was 17.6 years ( IQR , 14.2 - 19.8 ) and 18.1 years ( IQR , 15.2 - 21.1 ) in the control and surgery groups , respectively . INTERVENTIONS Adjustable or nonadjustable b and ing ( n = 61 ) , vertical b and ed gastroplasty ( n = 227 ) , or gastric bypass ( n = 55 ) procedures were performed in the surgery group , and usual obesity and diabetes care was provided to the control group . MAIN OUTCOMES AND MEASURES Diabetes remission , relapse , and diabetes complications . Remission was defined as blood glucose < 110 mg/dL and no diabetes medication . RESULTS The diabetes remission rate 2 years after surgery was 16.4 % ( 95 % CI , 11.7%-22.2 % ; 34/207 ) for control patients and 72.3 % ( 95 % CI , 66.9%-77.2 % ; 219/303 ) for bariatric surgery  patients ( odds ratio [ OR ] , 13.3 ; 95 % CI , 8.5 - 20.7 ; P < .001 ) . At 15 years , the diabetes remission rates decreased to 6.5 % ( 4/62 ) for control patients and to 30.4 % ( 35/115 ) for bariatric surgery patients ( OR , 6.3 ; 95 % CI , 2.1 - 18.9 ; P < .001 ) . With long-term follow-up , the cumulative incidence of microvascular complications was 41.8 per 1000 person-years ( 95 % CI , 35.3 - 49.5 ) for control patients and 20.6 per 1000 person-years ( 95 % CI , 17.0 - 24.9 ) in the surgery group ( hazard ratio [ HR ] , 0.44 ; 95 % CI , 0.34 - 0.56 ; P < .001 ) . Macrovascular complications were observed in 44.2 per 1000 person-years ( 95 % CI , 37.5 - 52.1 ) in control patients and 31.7 per 1000 person-years ( 95 % CI , 27.0 - 37.2 ) for the surgical group ( HR , 0.68 ; 95 % CI , 0.54 - 0.85 ; P = .001 ) . CONCLUSIONS AND RELEVANCE In this very long-term follow-up observational study of obese patients with type 2 diabetes , bariatric surgery was associated with more frequent diabetes remission and fewer complications than usual care . These findings require confirmation in r and omized trials . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01479452 BACKGROUND Our objective was to describe the reduction in relative risk of developing major chronic diseases such as cardiovascular disease , diabetes , and cancer associated with 4 healthy lifestyle factors among German adults . METHODS We used data from 23,153 German participants aged 35 to 65 years from the European Prospect i ve Investigation Into Cancer and Nutrition-Potsdam study . End points included confirmed incident type 2 diabetes mellitus , myocardial infa rct ion , stroke , and cancer . The 4 factors were never smoking , having a body mass index lower than 30 ( calculated as weight in kilograms divided by height in meters squared ) , performing 3.5 h/wk or more of physical activity , and adhering to healthy dietary principles ( high intake of fruits , vegetables , and whole-grain bread and low meat consumption ) . The 4 factors ( healthy , 1 point ; unhealthy , 0 points ) were summed to form an index that ranged from 0 to 4 . RESULTS During a mean follow-up of 7.8 years , 2006 participants developed new-onset diabetes ( 3.7 % ) , myocardial infa rct ion ( 0.9 % ) , stroke ( 0.8 % ) , or cancer ( 3.8 % ) . Fewer than 4 % of participants had zero healthy factors , most had 1 to 3 healthy factors , and approximately 9 % had 4 factors . After adjusting for age , sex , educational status , and occupational status , the hazard ratio for developing a chronic disease decreased progressively as the number of healthy factors increased . Participants with all 4 factors at baseline had a 78 % ( 95 % confidence interval [ CI ] , 72 % to 83 % ) lower risk of developing a chronic disease ( diabetes , 93 % [ 95 % CI , 88 % to 95 % ] ; myocardial infa rct ion , 81 % [ 95 % CI , 47 % to 93 % ] ; stroke , 50 % [ 95 % CI , -18 % to 79 % ] ; and cancer , 36 % [ 95 % CI , 5 % to 57 % ] ) than participants without a healthy factor . CONCLUSION Adhering to 4 simple healthy lifestyle factors can have a strong impact on the prevention of chronic diseases OBJECTIVE To date no clinical trials have evaluated the role of dietary patterns on the incidence of microvascular diabetes complications .  We hypothesized that a nutritional intervention based on the Mediterranean diet ( MedDiet ) would have greater protective effect on diabetic retinopathy and nephropathy than a low-fat control diet . RESEARCH DESIGN AND METHODS This was a post hoc analysis of a cohort of patients with type 2 diabetes participating in the PREvención con DIeta MEDiterránea ( PREDIMED ) study , a multicenter r and omized nutritional intervention trial conducted in a population at high cardiovascular risk . Individuals with type 2 diabetes who were free of microvascular complications at enrollment ( n = 3,614 , aged 55–80 years ) were r and omly assigned to one of three dietary interventions : MedDiet supplemented with extravirgin olive oil ( MedDiet+EVOO ) , MedDiet supplemented with mixed nuts ( MedDiet+Nuts ) , or a low-fat control diet . Two independent outcomes were considered : new onset of diabetic retinopathy and nephropathy . Hazard ratios ( HRs ) were calculated using multivariable-adjusted Cox regression . RESULTS During a median follow-up of 6.0 years , we identified 74 new cases of retinopathy and 168 of nephropathy . Compared with the control diet , multivariable-adjusted HRs for diabetic retinopathy were 0.56 ( 95 % CI 0.32–0.97 ) for the MedDiet+EVOO and 0.63 ( 0.35–1.11 ) for the MedDiet+Nuts . No between-group differences were found for nephropathy . When the yearly up date d information on adherence to the MedDiet was considered , the HR for retinopathy in the highest versus the lowest quintile was 0.34 ( 0.13–0.89 ; P = 0.001 for trend ) . No significant associations were found for nephropathy . CONCLUSIONS A MedDiet enriched with EVOO may protect against diabetic retinopathy but not diabetic nephropathy Background It is unclear whether ideal cardiovascular health ( CVH ) , and particularly 
    Output:
    