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: Dietary data from a prospect i ve study were used to relate factors influencing calcium balance ( estimates of dietary calcium intake , protein intake from nondairy animal sources ( meat , fish , and eggs ) , and coffee consumption ) to the incidence of  hip fracture . During the years 1977 - 1983 , women and men born between 1925 and 1940 and living in one of three Norwegian counties were invited to a  cardiovascular screening that included a dietary survey . The attendance rate at screening was 91.1 % , and 90.7 % of these persons ( 19,752 women and 20,035 men ) filled in and returned a semiquantitative dietary question naire . This cohort was followed for an average of 11.4 years ( range , 0.01 - 13.8 years ) with respect to hip fracture , defined as cervical or trochanteric fracture . During follow-up , 213 hip fractures were identified , excluding fractures associated with high-energy trauma and metastatic bone disease . There was no clear association between  calcium intake or nondairy animal protein intake  and hip fracture in this cohort . However , an elevated risk of fracture was found in women with a high intake of protein from nondairy animal sources in the presence of low calcium intake ( relative risk = 1.96 ( 95 % confidence interval 1.09 - 3.56 ) for the highest quarter of nondairy protein intake and the lowest quarter of calcium intake vs. the three lower quarters of protein intake and the three higher quarters of calcium intake ) . Women who drank nine or more cups of coffee per day also had an increased risk of fracture , while there was no association between coffee consumption and hip fracture in men . Although these findings do not necessarily imply causal relations , they suggest the presence of risk factors for hip fracture that act through a negative calcium balance in this population Background It has been suggested that a higher calcium intake might favourably modify cardiovascular risk factors . However , findings of an ultimately decreased risk of cardiovascular disease ( CVD ) are limited . Instead , recent evidence warns that taking calcium supplements might increase myocardial infa rct ion ( MI ) risk . Objective To prospect ively evaluate the associations of dietary calcium intake and calcium supplementation with MI and stroke risk and overall CVD mortality . Methods Data from 23 980 Heidelberg cohort participants of the European Prospect i ve Investigation into Cancer and Nutrition study , aged 35–64 years and free of major CVD events at recruitment , were analysed . Multivariate Cox regression models were used to estimate HRs and 95 % CIs . Results After an average follow-up time of 11 years , 354 MI and 260 stroke cases and 267 CVD deaths were documented . Compared with the lowest quartile , the third quartile of total dietary and dairy calcium intake had a significantly reduced MI risk , with a HR of 0.69 ( 95 % CI 0.50 to 0.94 ) and 0.68 ( 95 % CI 0.50 to 0.93 ) , respectively . Associations for stroke risk and CVD mortality were overall null . In comparison with non-users of any supplements , users of calcium supplements had a statistically significantly increased MI risk ( HR=1.86 ; 95 % CI 1.17 to 2.96 ) , which was more pronounced for calcium supplement only users ( HR=2.39 ; 95 % CI 1.12 to 5.12 ) . Conclusions Increasing calcium intake from diet might not confer significant cardiovascular benefits , while calcium supplements , which might raise MI risk , should be taken with caution Objective The primary aim of the present study was to examine the effectiveness of daily consumption of vitamin D3-enriched , reduced-fat Gouda-type cheese on 25-hydroxyvitamin D ( 25(OH)D ) concentration in postmenopausal women . Health-related quality of life ( HRQL ) indices were examined as secondary outcomes . Design This is a single-blinded ( i.e. , to study participants ) , r and omized , controlled food-based dietary intervention study . Methods A sample of 79 postmenopausal women ( 55–75 years old ) was r and omized either to a control group ( CG : n = 39 ) or an intervention group ( IG : n = 40 ) that consumed , as part of their usual diet , 60 g of either non-enriched or vitamin D3 enriched Gouda-type cheese , respectively , for eight consecutive weeks ( i.e. , from January to March 2015 ) . Sixty grams of enriched cheese provided a daily dose of 5.7 μg of vitamin D3 . Results There was a differential response of mean ( 95 % CI ) serum 25(OH)D levels in the IG and CG , with the former increasing and the latter decreasing significantly over the eight weeks of the trial [ i.e. , by 5.1 ( 3.4 , 6.9 ) nmol/L vs. −4.6 ( −6.4 , −2.8 ) nmol/L , P < 0.001 , respectively ] . The percentages of study participants with 25(OH)D levels < 30 ( deficiency ) and < 50 nmol/L ( insufficiency ) were significantly higher at follow-up in the CG compared to the IG ( 41.0 vs. 0 % , P < 0.001 and 74.4 vs. 47.5 % , P < 0.001 , respectively ) . The emotional well-being scale of the HRQL score increased in the IG compared to a decrease in the CG ( 3.2 vs. −3.8 , P = 0.028 ) . However , none of the other seven scales of the HRQL score significantly differentiated between study groups ( P > 0.1 ) . Conclusions Consumption of 60 g of vitamin D3-enriched , reduced-fat Gouda-type cheese provided a daily dose of 5.7 μg of additional vitamin D3 and was effective in increasing mean serum 25(OH)D concentration and in counteracting vitamin D deficiency during winter months in postmenopausal women in Greece No diet score exists that summarizes the features of a diet that is optimal for bone mineral density ( BMD ) in the elderly . Our aims were ( a ) to develop a BMD-Diet Score reflecting a diet that may be beneficial for BMD based on the existing literature , and ( b ) to examine the association of the  BMD-Diet Score  and the  Healthy Diet  Indicator , a score based on guidelines of the World Health Organization , with BMD in Dutch elderly participating in a prospect i ve cohort study , the Rotterdam Study ( n = 5144 ) .  Baseline dietary intake , assessed using a food frequency question naire , was categorized into food groups . Food groups that were consistently associated with BMD in the literature were included in the BMD-Diet Score . BMD was measured repeatedly and was assessed using dual energy X-ray absorptiometry . The BMD-Diet Score considered intake of vegetables , fruits , fish , whole grains , legumes/beans and dairy products as “ high-BMD ” components and meat and confectionary as “ low-BMD ” components . After adjustment , the BMD-Diet Score was positively associated with BMD ( β ( 95 % confidence interval ) = 0.009 ( 0.005 , 0.012 ) g/cm2 per st and ard deviation ) . This effect size was approximately three times as large as has been observed for the Healthy Diet Indicator . The food groups included in our BMD-Diet Score could be considered in the development of future dietary guidelines for healthy ageing BACKGROUND Little is known about the relative effectiveness of calcium supplementation from food or pills with or without vitamin D supplementation for bone mass accrual during the rapid growth period . OBJECTIVE The purpose was to examine the effects of both food-based and pill supplements of calcium and vitamin D on bone mass and body composition  in girls aged 10 - 12 y. DESIGN This placebo-controlled intervention trial r and omly assigned 195 healthy girls at Tanner stage I-II , aged 10 - 12 y , with dietary calcium intakes < 900 mg/d to 1 of 4 groups : calcium ( 1000 mg ) + vitamin D3 ( 200 IU ) , calcium ( 1000 mg ) , cheese ( 1000 mg calcium ) , and placebo . Primary outcomes were bone indexes of the hip , spine , and whole body by dual-energy X-ray absorptiometry and of the radius and tibia by peripheral quantitative computed tomography . RESULTS With the use of intention-to-treat or efficacy analysis , calcium supplementation with cheese result ed in a higher percentage change in cortical thickness of the tibia than did placebo , calcium , or calcium + vitamin D treatment ( P = 0.01 , 0.038 , and 0.004 , respectively ) and in higher whole-body bone mineral density than did placebo treatment ( P = 0.044 ) when compliance was > 50 % . With the use of a hierarchical linear model with r and om effects to control for growth velocity , these differences disappeared . CONCLUSIONS Increasing calcium intake by consuming cheese appears to be more beneficial for cortical bone mass accrual than the consumption of tablets containing a similar amount of calcium . Diverse patterns of growth velocity may mask the efficacy of supplementation in a short-term trial of children transiting through puberty BACKGROUND Short-term studies established that calcium influences bone accretion during growth . Whether long-term supplementation influences bone accretion in young adults is not known . OBJECTIVE This study evaluated the long-term effects of calcium supplementation on bone accretion among females from childhood to young adulthood . DESIGN A 4-y r and omized clinical trial recruited 354 females in pubertal stage 2 and optionally was extended for an additional 3 y. The mean dietary calcium intake of the participants over 7 y was approximately 830 mg/d ;  calcium-supplemented persons received an additional approximately 670 mg/d . Primary outcome variables were distal and proximal radius bone mineral density ( BMD ) , total-body BMD ( TBBMD ) , and metacarpal cortical indexes . RESULTS Multivariate analyses of the primary outcomes indicated that  calcium-supplementation  effects vary over time . Follow-up univariate analyses indicated that all primary outcomes were significantly larger in the supplemented group than in the placebo group at the year 4 endpoint . However , at the year 7 endpoint , this effect vanished for TBBMD and distal radius BMD . Longitudinal models for TBBMD and proximal radius BMD , according to the time since menarche , showed a highly significant effect of supplementation during the pubertal growth spurt and a diminishing effect thereafter . Post hoc stratifications by compliance-adjusted total calcium intake and by final stature or metacarpal total cross-sectional area showed that calcium effects depend on compliance and body frame . CONCLUSIONS Calcium supplementation significantly influenced bone accretion  in young females during the pubertal growth spurt . By young adulthood , significant effects remained at metacarpals and at the forearm of tall persons , which indicated that the calcium requirement for growth is associated with skeletal size . These results may be important for both primary prevention of osteoporosis and prevention of bone fragility fractures during growth BACKGROUND Despite numerous animal studies that have illustrated the impact of additional vitamin D in the diet of hens on the result ing egg vitamin D content , the effect of the consumption of such eggs on vitamin D status of healthy individuals has not , to our knowledge , been tested . OBJECTIVE We performed a r and omized controlled trial ( RCT ) to investigate the effect of the consumption of vitamin D-enhanced eggs ( produced by feeding hens at the maximum concentration of vitamin D3 or serum 25-hydroxyvitamin D [ 25(OH)D3 ] lawfully allowed in feed ) on winter serum 25(OH)D in healthy adults . DESIGN We conducted an 8-wk winter RCT in adults aged 45 - 70 y ( n = 55 ) who were stratified into 3 groups and were requested to consume ≤2 eggs/wk ( control group , in which status was expected to decline ) , 7 vitamin D3-enhanced eggs/wk , or seven 25(OH)D3-enhanced eggs/wk  . Serum 25(OH)D was the primary outcome . RESULTS Although there was no significant difference ( P > 0.1 ; ANOVA ) in the mean preintervention serum 25(OH)D in the 3 groups , it was ∼7 - 8 nmol/L lower in the control group than in the 2 groups who consumed vitamin D-enhanced eggs . With the use of an ANCOVA , in which baseline 25(OH)D was accounted for , vitamin D3-egg and 25(OH)D3-egg groups were shown to have had significantly higher ( P ≤ 0.005 ) postintervention serum 25(OH)D than in the control group . With the use of a within-group analysis , it was shown that , although serum 25(OH)D in the control group significantly decreased over winter ( mean ± SD : -6.4 ± 6.7 nmol/L ; P = 0.001 ) , there was no change in the 2 groups who consumed vitamin D-enhanced eggs ( P >  
    Output:
    
agent
In conclusion , the role of dairy products for BMC or BMD has been sufficiently established in Chinese and Caucasian girls and women .
In Caucasian women , drinking milk also reduces fracture risk .
***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: Dietary data from a prospect i ve study were used to relate factors influencing calcium balance ( estimates of dietary calcium intake , protein intake from nondairy animal sources ( meat , fish , and eggs ) , and coffee consumption ) to the incidence of  hip fracture . During the years 1977 - 1983 , women and men born between 1925 and 1940 and living in one of three Norwegian counties were invited to a  cardiovascular screening that included a dietary survey . The attendance rate at screening was 91.1 % , and 90.7 % of these persons ( 19,752 women and 20,035 men ) filled in and returned a semiquantitative dietary question naire . This cohort was followed for an average of 11.4 years ( range , 0.01 - 13.8 years ) with respect to hip fracture , defined as cervical or trochanteric fracture . During follow-up , 213 hip fractures were identified , excluding fractures associated with high-energy trauma and metastatic bone disease . There was no clear association between  calcium intake or nondairy animal protein intake  and hip fracture in this cohort . However , an elevated risk of fracture was found in women with a high intake of protein from nondairy animal sources in the presence of low calcium intake ( relative risk = 1.96 ( 95 % confidence interval 1.09 - 3.56 ) for the highest quarter of nondairy protein intake and the lowest quarter of calcium intake vs. the three lower quarters of protein intake and the three higher quarters of calcium intake ) . Women who drank nine or more cups of coffee per day also had an increased risk of fracture , while there was no association between coffee consumption and hip fracture in men . Although these findings do not necessarily imply causal relations , they suggest the presence of risk factors for hip fracture that act through a negative calcium balance in this population Background It has been suggested that a higher calcium intake might favourably modify cardiovascular risk factors . However , findings of an ultimately decreased risk of cardiovascular disease ( CVD ) are limited . Instead , recent evidence warns that taking calcium supplements might increase myocardial infa rct ion ( MI ) risk . Objective To prospect ively evaluate the associations of dietary calcium intake and calcium supplementation with MI and stroke risk and overall CVD mortality . Methods Data from 23 980 Heidelberg cohort participants of the European Prospect i ve Investigation into Cancer and Nutrition study , aged 35–64 years and free of major CVD events at recruitment , were analysed . Multivariate Cox regression models were used to estimate HRs and 95 % CIs . Results After an average follow-up time of 11 years , 354 MI and 260 stroke cases and 267 CVD deaths were documented . Compared with the lowest quartile , the third quartile of total dietary and dairy calcium intake had a significantly reduced MI risk , with a HR of 0.69 ( 95 % CI 0.50 to 0.94 ) and 0.68 ( 95 % CI 0.50 to 0.93 ) , respectively . Associations for stroke risk and CVD mortality were overall null . In comparison with non-users of any supplements , users of calcium supplements had a statistically significantly increased MI risk ( HR=1.86 ; 95 % CI 1.17 to 2.96 ) , which was more pronounced for calcium supplement only users ( HR=2.39 ; 95 % CI 1.12 to 5.12 ) . Conclusions Increasing calcium intake from diet might not confer significant cardiovascular benefits , while calcium supplements , which might raise MI risk , should be taken with caution Objective The primary aim of the present study was to examine the effectiveness of daily consumption of vitamin D3-enriched , reduced-fat Gouda-type cheese on 25-hydroxyvitamin D ( 25(OH)D ) concentration in postmenopausal women . Health-related quality of life ( HRQL ) indices were examined as secondary outcomes . Design This is a single-blinded ( i.e. , to study participants ) , r and omized , controlled food-based dietary intervention study . Methods A sample of 79 postmenopausal women ( 55–75 years old ) was r and omized either to a control group ( CG : n = 39 ) or an intervention group ( IG : n = 40 ) that consumed , as part of their usual diet , 60 g of either non-enriched or vitamin D3 enriched Gouda-type cheese , respectively , for eight consecutive weeks ( i.e. , from January to March 2015 ) . Sixty grams of enriched cheese provided a daily dose of 5.7 μg of vitamin D3 . Results There was a differential response of mean ( 95 % CI ) serum 25(OH)D levels in the IG and CG , with the former increasing and the latter decreasing significantly over the eight weeks of the trial [ i.e. , by 5.1 ( 3.4 , 6.9 ) nmol/L vs. −4.6 ( −6.4 , −2.8 ) nmol/L , P < 0.001 , respectively ] . The percentages of study participants with 25(OH)D levels < 30 ( deficiency ) and < 50 nmol/L ( insufficiency ) were significantly higher at follow-up in the CG compared to the IG ( 41.0 vs. 0 % , P < 0.001 and 74.4 vs. 47.5 % , P < 0.001 , respectively ) . The emotional well-being scale of the HRQL score increased in the IG compared to a decrease in the CG ( 3.2 vs. −3.8 , P = 0.028 ) . However , none of the other seven scales of the HRQL score significantly differentiated between study groups ( P > 0.1 ) . Conclusions Consumption of 60 g of vitamin D3-enriched , reduced-fat Gouda-type cheese provided a daily dose of 5.7 μg of additional vitamin D3 and was effective in increasing mean serum 25(OH)D concentration and in counteracting vitamin D deficiency during winter months in postmenopausal women in Greece No diet score exists that summarizes the features of a diet that is optimal for bone mineral density ( BMD ) in the elderly . Our aims were ( a ) to develop a BMD-Diet Score reflecting a diet that may be beneficial for BMD based on the existing literature , and ( b ) to examine the association of the  BMD-Diet Score  and the  Healthy Diet  Indicator , a score based on guidelines of the World Health Organization , with BMD in Dutch elderly participating in a prospect i ve cohort study , the Rotterdam Study ( n = 5144 ) .  Baseline dietary intake , assessed using a food frequency question naire , was categorized into food groups . Food groups that were consistently associated with BMD in the literature were included in the BMD-Diet Score . BMD was measured repeatedly and was assessed using dual energy X-ray absorptiometry . The BMD-Diet Score considered intake of vegetables , fruits , fish , whole grains , legumes/beans and dairy products as “ high-BMD ” components and meat and confectionary as “ low-BMD ” components . After adjustment , the BMD-Diet Score was positively associated with BMD ( β ( 95 % confidence interval ) = 0.009 ( 0.005 , 0.012 ) g/cm2 per st and ard deviation ) . This effect size was approximately three times as large as has been observed for the Healthy Diet Indicator . The food groups included in our BMD-Diet Score could be considered in the development of future dietary guidelines for healthy ageing BACKGROUND Little is known about the relative effectiveness of calcium supplementation from food or pills with or without vitamin D supplementation for bone mass accrual during the rapid growth period . OBJECTIVE The purpose was to examine the effects of both food-based and pill supplements of calcium and vitamin D on bone mass and body composition  in girls aged 10 - 12 y. DESIGN This placebo-controlled intervention trial r and omly assigned 195 healthy girls at Tanner stage I-II , aged 10 - 12 y , with dietary calcium intakes < 900 mg/d to 1 of 4 groups : calcium ( 1000 mg ) + vitamin D3 ( 200 IU ) , calcium ( 1000 mg ) , cheese ( 1000 mg calcium ) , and placebo . Primary outcomes were bone indexes of the hip , spine , and whole body by dual-energy X-ray absorptiometry and of the radius and tibia by peripheral quantitative computed tomography . RESULTS With the use of intention-to-treat or efficacy analysis , calcium supplementation with cheese result ed in a higher percentage change in cortical thickness of the tibia than did placebo , calcium , or calcium + vitamin D treatment ( P = 0.01 , 0.038 , and 0.004 , respectively ) and in higher whole-body bone mineral density than did placebo treatment ( P = 0.044 ) when compliance was > 50 % . With the use of a hierarchical linear model with r and om effects to control for growth velocity , these differences disappeared . CONCLUSIONS Increasing calcium intake by consuming cheese appears to be more beneficial for cortical bone mass accrual than the consumption of tablets containing a similar amount of calcium . Diverse patterns of growth velocity may mask the efficacy of supplementation in a short-term trial of children transiting through puberty BACKGROUND Short-term studies established that calcium influences bone accretion during growth . Whether long-term supplementation influences bone accretion in young adults is not known . OBJECTIVE This study evaluated the long-term effects of calcium supplementation on bone accretion among females from childhood to young adulthood . DESIGN A 4-y r and omized clinical trial recruited 354 females in pubertal stage 2 and optionally was extended for an additional 3 y. The mean dietary calcium intake of the participants over 7 y was approximately 830 mg/d ;  calcium-supplemented persons received an additional approximately 670 mg/d . Primary outcome variables were distal and proximal radius bone mineral density ( BMD ) , total-body BMD ( TBBMD ) , and metacarpal cortical indexes . RESULTS Multivariate analyses of the primary outcomes indicated that  calcium-supplementation  effects vary over time . Follow-up univariate analyses indicated that all primary outcomes were significantly larger in the supplemented group than in the placebo group at the year 4 endpoint . However , at the year 7 endpoint , this effect vanished for TBBMD and distal radius BMD . Longitudinal models for TBBMD and proximal radius BMD , according to the time since menarche , showed a highly significant effect of supplementation during the pubertal growth spurt and a diminishing effect thereafter . Post hoc stratifications by compliance-adjusted total calcium intake and by final stature or metacarpal total cross-sectional area showed that calcium effects depend on compliance and body frame . CONCLUSIONS Calcium supplementation significantly influenced bone accretion  in young females during the pubertal growth spurt . By young adulthood , significant effects remained at metacarpals and at the forearm of tall persons , which indicated that the calcium requirement for growth is associated with skeletal size . These results may be important for both primary prevention of osteoporosis and prevention of bone fragility fractures during growth BACKGROUND Despite numerous animal studies that have illustrated the impact of additional vitamin D in the diet of hens on the result ing egg vitamin D content , the effect of the consumption of such eggs on vitamin D status of healthy individuals has not , to our knowledge , been tested . OBJECTIVE We performed a r and omized controlled trial ( RCT ) to investigate the effect of the consumption of vitamin D-enhanced eggs ( produced by feeding hens at the maximum concentration of vitamin D3 or serum 25-hydroxyvitamin D [ 25(OH)D3 ] lawfully allowed in feed ) on winter serum 25(OH)D in healthy adults . DESIGN We conducted an 8-wk winter RCT in adults aged 45 - 70 y ( n = 55 ) who were stratified into 3 groups and were requested to consume ≤2 eggs/wk ( control group , in which status was expected to decline ) , 7 vitamin D3-enhanced eggs/wk , or seven 25(OH)D3-enhanced eggs/wk  . Serum 25(OH)D was the primary outcome . RESULTS Although there was no significant difference ( P > 0.1 ; ANOVA ) in the mean preintervention serum 25(OH)D in the 3 groups , it was ∼7 - 8 nmol/L lower in the control group than in the 2 groups who consumed vitamin D-enhanced eggs . With the use of an ANCOVA , in which baseline 25(OH)D was accounted for , vitamin D3-egg and 25(OH)D3-egg groups were shown to have had significantly higher ( P ≤ 0.005 ) postintervention serum 25(OH)D than in the control group . With the use of a within-group analysis , it was shown that , although serum 25(OH)D in the control group significantly decreased over winter ( mean ± SD : -6.4 ± 6.7 nmol/L ; P = 0.001 ) , there was no change in the 2 groups who consumed vitamin D-enhanced eggs ( P >  
    Output:
    