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: Background Resistant starch ( RS ) is a type of dietary fiber that can improve glucose metabolism , but its effects may be modulated by sex or baseline insulin sensitivity . This study was design ed to examine the effect of high-amylose maize resistant starch ( HAM-RS2 ) on insulin sensitivity ( SI ) in women , and to determine if SI status affects the response to RS . Methods This was a r and omized , placebo-controlled , double-blind , cross-over study . Participants were 40 healthy , non-diabetic women aged 22–67 years in the normal-weight to obese BMI range ( 20.6–47.4 kg/m2 ) . Two doses of HAM-RS2 were tested , 15 and 30 g per day , administered in the form of cookies . Participants were r and omized to the order in which they received the experimental and placebo product . Each arm was 4 weeks , with a 4-week wash-out period in between . SI was assessed at the end of each 4-week arm of product consumption by frequently- sample d , insulin-modified , intravenous glucose tolerance test and minimal modeling . Participants were categorized as being insulin resistant ( IR ; SI < 7.8 ) or insulin sensitive ( IS ; SI ≥ 7.8 ) based on Gaussian analysis . The effect of treatment arm on SI was examined by mixed-model analysis within IR and IS sub-groups , using all available data . In addition , SI was examined by ANOVA among just those women who completed all three arms of the study with valid SI results . Results Among IR participants , SI was on average ~16 % higher after the 30 g arm when compared to the control arm by mixed-model analysis ( n = 40 , P < 0.05 ) , and tended to be 23 % higher by ANOVA among women who completed all arms ( n = 23 , P = 0.06 ) . HAM-RS2 did not affect SI in IS women . Conclusion Consumption of HAM-RS2 at 30 g/day in the form of a snack food item was associated with improved insulin sensitivity in women with insulin resistance . Clinical trials registry numberNCT01521806 BACKGROUND The optimal source and amount of dietary carbohydrate for managing type 2 diabetes ( T2DM ) are unknown . OBJECTIVE We aim ed to compare the effects of altering the glycemic index or the amount of carbohydrate on glycated hemoglobin ( HbA1c ) , plasma glucose , lipids , and C-reactive protein ( CRP ) in T2DM patients . DESIGN Subjects with T2DM managed by diet alone ( n=162 ) were r and omly assigned to receive high-carbohydrate , high-glycemic-index ( high-GI ) , high-carbohydrate , low-glycemic-index ( low-GI ) , or low-carbohydrate , high-monounsaturated-fat ( low-CHO ) diets for 1 y. RESULTS The high-GI , low-GI , and low-CHO diets contained , respectively , 47 % , 52 % , and 39 % of energy as carbohydrate and 31 % , 27 % , and 40 % of energy as fat ; they had GIs of 63 , 55 , and 59 , respectively . Body weight and HbA1c did not differ significantly between diets . Fasting glucose was higher ( P=0.041 ) , but 2-h postload glucose was lower ( P=0.010 ) after 12 mo of the low-GI diet . With the low-GI diet , overall mean triacylglycerol was 12 % higher and HDL cholesterol 4 % lower than with the low-CHO diet ( P<0.05 ) , but the difference in the ratio of total to HDL cholesterol disappeared by 6 mo ( time x diet interaction , P=0.044 ) . Overall mean CRP with the low-GI diet , 1.95 mg/L , was 30 % less than that with the high-GI diet , 2.75 mg/L ( P=0.0078 ) ; the concentration with the low-CHO diet , 2.35 mg/L , was intermediate . CONCLUSIONS In subjects with T2DM managed by diet alone with optimal glycemic control , long-term HbA1c was not affected by altering the GI or the amount of dietary carbohydrate . Differences in total : HDL cholesterol among diets had disappeared by 6 mo . However , because of sustained reductions in postpr and ial glucose and CRP , a low-GI diet may be preferred for the dietary management of T2DM This study evaluated the effects of 2 levels of intake of high-amylose maize type 2 resistant starch ( HAM-RS2 ) on  insulin sensitivity ( SI ) in participants with waist circumference ≥89 ( women ) or ≥102 cm ( men ) . Participants received 0 ( control starch ) , 15 , or 30 g/d ( double-blind ) of HAM-RS2 in r and om order for 4-wk periods separated by 3-wk washouts . Minimal model SI was assessed at the end of each period using the insulin-modified i.v . glucose tolerance test . The efficacy evaluable sample included 11 men and 22 women ( mean ± SEM ) age 49.5 ± 1.6 y , with a BMI of 30.6 ± 0.5 kg/m2 and waist circumference 105.3 ± 1.3 cm . A treatment main effect ( P = 0.018 ) and a treatment × sex interaction ( P = 0.033 ) were present . In men , least squares geometric mean analysis for SI did not differ after intake of 15 g/d HAM-RS2 ( 6.90 × 10−5 pmol−1 · L−1 × min−1 ) and 30 g/d HAM-RS2 ( 7.13 × 10−5 pmol−1 · L−1 × min−1 ) , but both were higher than after the control treatment ( 4.66 × 10−5 pmol−1 · L−1 × min−1 ) ( P < 0.05 ) . In women , there was no difference among the treatments ( overall least squares ln-transformed mean ± pooled SEM = 1.80 ± 0.08 ; geometric mean = 6.05 × 10−5 pmol−1 · L−1 × min−1 ) . These results suggest that consumption of 15–30 g/d of HAM-RS2  improves SI in men . Additional research is needed to underst and the mechanisms that might account for the treatment × sex interaction observed BACKGROUND Type 2 diabetes ( T2D ) incidence continues to rise . Although increasing dietary fiber intake is an established strategy for improved glycemic control , most adults consume insufficient amounts . Fiber-enhanced functional foods can increase fiber intake , and there is particular interest in resistant starch ( RS ) as a high-fiber ingredient . Studies show that high-amylose maize resistant starch , type 2 ( HAM-RS2 ) improves acute and chronic glycemic responses , but more studies are needed in individuals at high risk of T2D with RS delivered in commonly consumed foods . OBJECTIVE The objective of this study was to examine the chronic effects of consuming bagels high in HAM-RS2 on fasting and postpr and ial glycemic markers in adults at increased risk of T2D . METHODS With the use of a r and omized , double-blind crossover design , 24 men and women with a mean ± SE age of 55.3 ± 1.59 y and body mass index ( in kg/m2 ) of 30.2 ± 0.57 consumed 1 bagel containing 25 g HAM-RS2/d or 1 control wheat bagel/d for 56 d each , separated by a 4-wk washout . Fasting and postpr and ial oral-glucose-tolerance test ( OGTT ) glucose and insulin were measured on study days 1 and 57 of each bagel treatment . RESULTS The RS bagel treatment result ed in significantly lower fasting ( 22.1 % , P = 0.04 ) , 2-h ( 23.3 % , P < 0.008 ) , and 3-h ( 18.9 % , P = 0.05 ) insulin incremental areas under the curve and fasting insulin resistance ( homeostasis model assessment of insulin resistance ; 23.1 % , P = 0.04 ) than did the control bagel treatment . Fasting and postpr and ial OGTT glucose concentrations did not differ between the RS and control bagel treatments on study days 1 or 57 . CONCLUSIONS These data suggest that consumption of a high-HAM-RS2 bagel improves glycemic efficiency by reducing the amount of insulin required to manage postpr and ial glucose while improving fasting insulin sensitivity in adults at increased risk of T2D . This research provides support for a feasible dietary strategy for T2D risk reduction . This trial was registered at clinical trials.gov as NCT02129946 Previous work has shown increased insulin sensitivity , increased hepatic insulin clearance and lower postpr and ial insulin responses following treatment with resistant starch , a type of dietary fibre . The objective of this study was to further explore the effects of resistant starch on insulin secretion . Twelve overweight ( BMI 28.2±0.4 kg/m2 ) individuals participated in this r and omized , subject-blind crossover study . Participants consumed either 40 g type 2 resistant starch or the energy and carbohydrate-matched placebo daily for four weeks . Assessment of the effect on insulin secretion was made at the end of each intervention using an insulin-modified frequently sample d intravenous glucose tolerance test ( FSIVGTT ) . Insulin and C-peptide concentrations were significantly higher during the FSIVGTT following the resistant starch compared with the placebo . Modelling of the data showed significantly improved first-phase insulin secretion  with resistant starch . These effects were observed without any changes to either body weight or habitual food intake . This study showed that just four weeks of resistant starch intake significantly increased the first-phase insulin secretion in individuals at risk of developing type 2 diabetes . Further studies exploring this effect in individuals with type 2 diabetes are required Aims : This trial aims to determine the effects of resistant starch ( RS ) subtype 2 ( RS2 ) on glycemic status , metabolic endotoxemia and markers of oxidative stress . Methods : A r and omized , controlled , parallel-group clinical trial group of 56 females with type 2 diabetes mellitus ( T2DM ) was divided to 2 groups . The intervention group ( n = 28 ) and control group ( n = 28 ) received 10 g/day RS2 or placebo for 8 weeks , respectively . Fasting blood sample s were taken to determine glycemic status , endotoxin , high sensitivity C-reactive protein ( hs-CRP ) , malondialdehyde ( MDA ) , total antioxidant capacity ( TAC ) , antioxidant enzymes concentrations as well as uric acid at baseline and after the intervention . Results : After 8 weeks , RS2 caused a significant decrease in the levels of MDA ( -34.10 % ) , glycosylated hemoglobin ( -9.40 % ) , insulin ( -29.36 % ) , homeostasis model of insulin resistance ( -32.85 % ) and endotoxin ( -25.00 % ) , a significant increase in TAC ( 18.10 % ) and glutathione peroxidase ( 11.60 % ) as compared with control . No significant changes were observed in fasting plasma glucose , quantitative insulin sensitivity check index , hs-CRP , superoxide dismutase , catalase and uric acid in the RS2 group as compared with the control group . Conclusion : Supplementation with RS2 may be improved glycemic status , endotoxemia and markers of oxidative stress in patients with T2DM BACKGROUND The elderly often have a diet lacking resistant starch ( RS ) which is thought to lead to gut microbiome dysbiosis that may result in deterioration of gut colonocytes . OBJECTIVE The primary objective was to assess if elderly ( ELD ; ≥ 70 years age ) had microbiome dysbiosis compared to mid-age ( MID ; 30 - 50 years age ) adults and then determine the impact of daily consumption of MSPrebiotic ® ( a RS ) or placebo over 3 months on gut microbiome composition . Secondary objectives included assessment of stool short-chain fatty acids ( SCFA ) and inflammatory markers in ELD and MID Canadian adults . DESIGN This was a prospect i ve , placebo controlled , r and omized , double-blinded study . Stool was collected at enrollment and 6 , 10 and 14 weeks after r and omization to placebo or MSPrebiotic ® . Microbiome analysis was done using 16S rRNA sequencing of DNA extracted from stool . SCFA analysis of stool was performed using gas chromatography . RESULTS There were 42 ELD and 42 MID participants r and omized to either placebo or MSPrebiotic ® who completed the study . There was significantly higher abundance of Proteobacteria ( Escherichia coli/Shigella 
    Output:
    
agent
Conclusions This meta- analysis has provided evidence that RS supplementation can improve fasting glucose , fasting insulin , insulin resistance and sensitivity , especially for diabetic with overweight or obesity .
***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 Resistant starch ( RS ) is a type of dietary fiber that can improve glucose metabolism , but its effects may be modulated by sex or baseline insulin sensitivity . This study was design ed to examine the effect of high-amylose maize resistant starch ( HAM-RS2 ) on insulin sensitivity ( SI ) in women , and to determine if SI status affects the response to RS . Methods This was a r and omized , placebo-controlled , double-blind , cross-over study . Participants were 40 healthy , non-diabetic women aged 22–67 years in the normal-weight to obese BMI range ( 20.6–47.4 kg/m2 ) . Two doses of HAM-RS2 were tested , 15 and 30 g per day , administered in the form of cookies . Participants were r and omized to the order in which they received the experimental and placebo product . Each arm was 4 weeks , with a 4-week wash-out period in between . SI was assessed at the end of each 4-week arm of product consumption by frequently- sample d , insulin-modified , intravenous glucose tolerance test and minimal modeling . Participants were categorized as being insulin resistant ( IR ; SI < 7.8 ) or insulin sensitive ( IS ; SI ≥ 7.8 ) based on Gaussian analysis . The effect of treatment arm on SI was examined by mixed-model analysis within IR and IS sub-groups , using all available data . In addition , SI was examined by ANOVA among just those women who completed all three arms of the study with valid SI results . Results Among IR participants , SI was on average ~16 % higher after the 30 g arm when compared to the control arm by mixed-model analysis ( n = 40 , P < 0.05 ) , and tended to be 23 % higher by ANOVA among women who completed all arms ( n = 23 , P = 0.06 ) . HAM-RS2 did not affect SI in IS women . Conclusion Consumption of HAM-RS2 at 30 g/day in the form of a snack food item was associated with improved insulin sensitivity in women with insulin resistance . Clinical trials registry numberNCT01521806 BACKGROUND The optimal source and amount of dietary carbohydrate for managing type 2 diabetes ( T2DM ) are unknown . OBJECTIVE We aim ed to compare the effects of altering the glycemic index or the amount of carbohydrate on glycated hemoglobin ( HbA1c ) , plasma glucose , lipids , and C-reactive protein ( CRP ) in T2DM patients . DESIGN Subjects with T2DM managed by diet alone ( n=162 ) were r and omly assigned to receive high-carbohydrate , high-glycemic-index ( high-GI ) , high-carbohydrate , low-glycemic-index ( low-GI ) , or low-carbohydrate , high-monounsaturated-fat ( low-CHO ) diets for 1 y. RESULTS The high-GI , low-GI , and low-CHO diets contained , respectively , 47 % , 52 % , and 39 % of energy as carbohydrate and 31 % , 27 % , and 40 % of energy as fat ; they had GIs of 63 , 55 , and 59 , respectively . Body weight and HbA1c did not differ significantly between diets . Fasting glucose was higher ( P=0.041 ) , but 2-h postload glucose was lower ( P=0.010 ) after 12 mo of the low-GI diet . With the low-GI diet , overall mean triacylglycerol was 12 % higher and HDL cholesterol 4 % lower than with the low-CHO diet ( P<0.05 ) , but the difference in the ratio of total to HDL cholesterol disappeared by 6 mo ( time x diet interaction , P=0.044 ) . Overall mean CRP with the low-GI diet , 1.95 mg/L , was 30 % less than that with the high-GI diet , 2.75 mg/L ( P=0.0078 ) ; the concentration with the low-CHO diet , 2.35 mg/L , was intermediate . CONCLUSIONS In subjects with T2DM managed by diet alone with optimal glycemic control , long-term HbA1c was not affected by altering the GI or the amount of dietary carbohydrate . Differences in total : HDL cholesterol among diets had disappeared by 6 mo . However , because of sustained reductions in postpr and ial glucose and CRP , a low-GI diet may be preferred for the dietary management of T2DM This study evaluated the effects of 2 levels of intake of high-amylose maize type 2 resistant starch ( HAM-RS2 ) on  insulin sensitivity ( SI ) in participants with waist circumference ≥89 ( women ) or ≥102 cm ( men ) . Participants received 0 ( control starch ) , 15 , or 30 g/d ( double-blind ) of HAM-RS2 in r and om order for 4-wk periods separated by 3-wk washouts . Minimal model SI was assessed at the end of each period using the insulin-modified i.v . glucose tolerance test . The efficacy evaluable sample included 11 men and 22 women ( mean ± SEM ) age 49.5 ± 1.6 y , with a BMI of 30.6 ± 0.5 kg/m2 and waist circumference 105.3 ± 1.3 cm . A treatment main effect ( P = 0.018 ) and a treatment × sex interaction ( P = 0.033 ) were present . In men , least squares geometric mean analysis for SI did not differ after intake of 15 g/d HAM-RS2 ( 6.90 × 10−5 pmol−1 · L−1 × min−1 ) and 30 g/d HAM-RS2 ( 7.13 × 10−5 pmol−1 · L−1 × min−1 ) , but both were higher than after the control treatment ( 4.66 × 10−5 pmol−1 · L−1 × min−1 ) ( P < 0.05 ) . In women , there was no difference among the treatments ( overall least squares ln-transformed mean ± pooled SEM = 1.80 ± 0.08 ; geometric mean = 6.05 × 10−5 pmol−1 · L−1 × min−1 ) . These results suggest that consumption of 15–30 g/d of HAM-RS2  improves SI in men . Additional research is needed to underst and the mechanisms that might account for the treatment × sex interaction observed BACKGROUND Type 2 diabetes ( T2D ) incidence continues to rise . Although increasing dietary fiber intake is an established strategy for improved glycemic control , most adults consume insufficient amounts . Fiber-enhanced functional foods can increase fiber intake , and there is particular interest in resistant starch ( RS ) as a high-fiber ingredient . Studies show that high-amylose maize resistant starch , type 2 ( HAM-RS2 ) improves acute and chronic glycemic responses , but more studies are needed in individuals at high risk of T2D with RS delivered in commonly consumed foods . OBJECTIVE The objective of this study was to examine the chronic effects of consuming bagels high in HAM-RS2 on fasting and postpr and ial glycemic markers in adults at increased risk of T2D . METHODS With the use of a r and omized , double-blind crossover design , 24 men and women with a mean ± SE age of 55.3 ± 1.59 y and body mass index ( in kg/m2 ) of 30.2 ± 0.57 consumed 1 bagel containing 25 g HAM-RS2/d or 1 control wheat bagel/d for 56 d each , separated by a 4-wk washout . Fasting and postpr and ial oral-glucose-tolerance test ( OGTT ) glucose and insulin were measured on study days 1 and 57 of each bagel treatment . RESULTS The RS bagel treatment result ed in significantly lower fasting ( 22.1 % , P = 0.04 ) , 2-h ( 23.3 % , P < 0.008 ) , and 3-h ( 18.9 % , P = 0.05 ) insulin incremental areas under the curve and fasting insulin resistance ( homeostasis model assessment of insulin resistance ; 23.1 % , P = 0.04 ) than did the control bagel treatment . Fasting and postpr and ial OGTT glucose concentrations did not differ between the RS and control bagel treatments on study days 1 or 57 . CONCLUSIONS These data suggest that consumption of a high-HAM-RS2 bagel improves glycemic efficiency by reducing the amount of insulin required to manage postpr and ial glucose while improving fasting insulin sensitivity in adults at increased risk of T2D . This research provides support for a feasible dietary strategy for T2D risk reduction . This trial was registered at clinical trials.gov as NCT02129946 Previous work has shown increased insulin sensitivity , increased hepatic insulin clearance and lower postpr and ial insulin responses following treatment with resistant starch , a type of dietary fibre . The objective of this study was to further explore the effects of resistant starch on insulin secretion . Twelve overweight ( BMI 28.2±0.4 kg/m2 ) individuals participated in this r and omized , subject-blind crossover study . Participants consumed either 40 g type 2 resistant starch or the energy and carbohydrate-matched placebo daily for four weeks . Assessment of the effect on insulin secretion was made at the end of each intervention using an insulin-modified frequently sample d intravenous glucose tolerance test ( FSIVGTT ) . Insulin and C-peptide concentrations were significantly higher during the FSIVGTT following the resistant starch compared with the placebo . Modelling of the data showed significantly improved first-phase insulin secretion  with resistant starch . These effects were observed without any changes to either body weight or habitual food intake . This study showed that just four weeks of resistant starch intake significantly increased the first-phase insulin secretion in individuals at risk of developing type 2 diabetes . Further studies exploring this effect in individuals with type 2 diabetes are required Aims : This trial aims to determine the effects of resistant starch ( RS ) subtype 2 ( RS2 ) on glycemic status , metabolic endotoxemia and markers of oxidative stress . Methods : A r and omized , controlled , parallel-group clinical trial group of 56 females with type 2 diabetes mellitus ( T2DM ) was divided to 2 groups . The intervention group ( n = 28 ) and control group ( n = 28 ) received 10 g/day RS2 or placebo for 8 weeks , respectively . Fasting blood sample s were taken to determine glycemic status , endotoxin , high sensitivity C-reactive protein ( hs-CRP ) , malondialdehyde ( MDA ) , total antioxidant capacity ( TAC ) , antioxidant enzymes concentrations as well as uric acid at baseline and after the intervention . Results : After 8 weeks , RS2 caused a significant decrease in the levels of MDA ( -34.10 % ) , glycosylated hemoglobin ( -9.40 % ) , insulin ( -29.36 % ) , homeostasis model of insulin resistance ( -32.85 % ) and endotoxin ( -25.00 % ) , a significant increase in TAC ( 18.10 % ) and glutathione peroxidase ( 11.60 % ) as compared with control . No significant changes were observed in fasting plasma glucose , quantitative insulin sensitivity check index , hs-CRP , superoxide dismutase , catalase and uric acid in the RS2 group as compared with the control group . Conclusion : Supplementation with RS2 may be improved glycemic status , endotoxemia and markers of oxidative stress in patients with T2DM BACKGROUND The elderly often have a diet lacking resistant starch ( RS ) which is thought to lead to gut microbiome dysbiosis that may result in deterioration of gut colonocytes . OBJECTIVE The primary objective was to assess if elderly ( ELD ; ≥ 70 years age ) had microbiome dysbiosis compared to mid-age ( MID ; 30 - 50 years age ) adults and then determine the impact of daily consumption of MSPrebiotic ® ( a RS ) or placebo over 3 months on gut microbiome composition . Secondary objectives included assessment of stool short-chain fatty acids ( SCFA ) and inflammatory markers in ELD and MID Canadian adults . DESIGN This was a prospect i ve , placebo controlled , r and omized , double-blinded study . Stool was collected at enrollment and 6 , 10 and 14 weeks after r and omization to placebo or MSPrebiotic ® . Microbiome analysis was done using 16S rRNA sequencing of DNA extracted from stool . SCFA analysis of stool was performed using gas chromatography . RESULTS There were 42 ELD and 42 MID participants r and omized to either placebo or MSPrebiotic ® who completed the study . There was significantly higher abundance of Proteobacteria ( Escherichia coli/Shigella 
    Output:
    