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 Low dietary Ca intake and vitamin D insufficiency have been implicated as part of the aetiology leading to osteoporosis . The aim of the present study was to examine the effects of a 30-month dietary intervention that combined supplementation of dairy products fortified with Ca and vitamin D3 and lifestyle and nutrition counselling sessions on  bone mineral density ( BMD )  of postmenopausal women . Sixty-six postmenopausal women ( aged 55 - 65 years ) were r and omised into a dietary group ( DG ; n 35 ) , receiving daily and for the first 12 months 1200 mg Ca and 7.5 microg vitamin D3 , while for the next 18 months of intervention 1200 mg Ca and 22.5 microg vitamin D3 through fortified dairy products , and a control group ( CG ; n 31 ) receiving neither counselling nor dairy products . The DG was found to have more favourable changes in arms ( P < 0.001 ) , total spine ( P = 0.001 ) and total body BMD ( P < 0.001 ) compared with the CG . Furthermore , a significant increase was observed for the DG in lumbar spine BMD ( 0.056 ; 95 % CI 0.009 , 0.103 ) , which was not found to differentiate significantly compared with the change observed in the CG ( P = 0.075 ) . In conclusion , the present study showed that intakes of vitamin D of about 22.5 microg/d and of Ca close to the recommended level of 1200 mg from fortified dairy foods for 30 months , with compliance ensured by lifestyle and nutrition counselling sessions , can induce favourable changes in arms , total spine and total body BMD of postmenopausal women Dietary protein increases urinary calcium losses and has been associated with higher rates of hip fracture in cross-cultural studies . However , the relation between protein and risk of  osteoporotic bone fractures among individuals has not been examined in detail . In this prospect i ve study , usual dietary intake was measured in 1980 in a cohort of 85,900 women , aged 35 - 59 years , who were participants in the Nurses ' Health Study . A mailed food frequency question naire was used and incident hip ( n = 234 ) and distal forearm ( n = 1,628 ) fractures were identified by self-report during the following 12 years . Information on other factors related to osteoporosis , including obesity , use of postmenopausal estrogen , smoking , and physical activity , was collected on biennial question naires . Dietary measures were up date d in 1984 and 1986 . Protein was associated with an increased risk of forearm fracture ( relative risk ( RR ) = 1.22 , 95 % confidence interval ( Cl ) 1.04 - 1.43 , p for trend = 0.01 ) for women who consumed more than 95 g per day compared with those who consumed less than 68 g per day . A similar increase in risk was observed for animal protein , but no association was found for consumption of vegetable protein . Women who consumed five or more servings of red meat per week also had a significantly increased risk of forearm fracture ( RR = 1.23 , 95 % Cl 1.01 - 1.50 ) compared with women who ate red meat less than once per week . Recall of teenage diet did not reveal any increased risk of forearm fracture for women with higher consumption of animal protein or red meat during this earlier period of life . No association was observed between  adult protein intake  and the incidence of hip fractures , though power to assess this association was low BACKGROUND The effects of dietary protein on bone health are controversial . OBJECTIVE We examined the relation between protein intake with fracture and  bone mineral density ( BMD )  within the Women 's Health Initiative ( WHI ) . DESIGN This prospect i ve analysis included 144,580 women aged 50 - 79 y at baseline in the WHI clinical trials ( CTs ) and observational study ( OS ) that recruited participants in 1993 - 1998 with follow-up through 2011 . Self-reported clinical fractures were collected semiannually through the original end of the trials ( WHI CTs ) and annually ( WHI OS ) by question naires . Hip fracture was adjudicated by a central review of radiology reports . BMDs for total body , hip , and spine were measured at baseline and 3 and 6 y in 9062 women at 3 WHI clinics by using dual-energy X-ray absorptiometry .  Protein intake was assessed via food-frequency question naire and calibrated by using biomarkers of energy and protein intakes . Associations between protein intake and fracture were estimated by using Cox proportional hazards regression , and the relation between protein intake and BMD was estimated by using linear regression . RESULTS Median biomarker-calibrated protein intake was 15 % of energy intake . Per 20 % increase in calibrated protein intake ( percentage of energy ) , there was no significant association with total fracture ( HR : 0.99 ; 95 % CI : 0.97 , 1.02 ) or hip fracture ( HR : 0.91 ; 95 % CI : 0.84 , 1.00 ) , but there was an inverse association with forearm fracture ( HR : 0.93 ; 95 % CI : 0.88 , 0.98 ) . Each 20 % increase in calibrated protein intake was associated with a significantly higher BMD for total body ( mean 3-y change : 0.003 g/cm² ; 95 % CI : 0.001 , 0.005 g/cm² ) and hip ( mean 3-y change : 0.002 g/cm² ; 95 % CI : 0.001 , 0.004 g/cm² ) . CONCLUSIONS Higher biomarker-calibrated protein intake within the range of usual intake was inversely associated with forearm fracture and was associated with better maintenance of total and hip BMDs . These data suggest higher protein intake is not detrimental to bone health in postmenopausal women BACKGROUND & AIMS Patients with anorexia nervosa ( AN ) have low serum IGF-I levels that may contribute to a lower bone mineral mass . We investigated the effects of a fermented , protein-fortified , dairy product on serum IGF-I levels in patients with AN during an in-hospital refeeding program . METHODS In this multicenter , r and omized , double-blind , placebo-controlled , clinical trial conducted at 3 university hospitals and 3 private clinics in France and Switzerl and , 62 women recently admitted with confirmed AN and with a baseline low serum IGF-I level were r and omized to 2 daily isocaloric fresh cheese pots containing either 15 g/150 g or 3 g/150 g ( controls ) of protein for 4 weeks . The primary outcome was the change in IGF-I levels . RESULTS In the primary intention-to-treat analysis , mean serum IGF-I levels increased during the intervention phase from 22.9 ± 1.5 to 28.6 ± 1.3 nmol/L ( means ± SEM ) ( + 20.2 % ) in the intervention group and from 20.2 ± 1.2 to 25.7 ± 1.5 nmol/L ( + 16.8 % ) in controls . In a preplanned analysis of covariance with repeated measures , the between-group difference was close to statistical significance ( P = 0.071 ) . In a post-hoc mixed-regression model analysis , the difference was statistically significant ( 4.9 nmol/l increase ; P = 0.003 ) , as was the change of the ratio IGF-I/IGF-BP3 ( P=0.004 ) . There was no between-group difference in biochemical markers of bone turnover ( osteocalcin , P1NP , CTX ) or in serum parathyroid hormone level . Serum calcium levels slightly increased during the intervention phase in the higher protein group ( P = 0.02 ) . IGF-BP2 decreased significantly more in the intervention group during the follow up period at week 4 after supplements cessation ( P = 0.019 ) . CONCLUSIONS Intake of a fermented , protein-fortified , isocaloric dairy product during 4 weeks may slightly increase serum IGF-I levels in women with AN , without significant changes in bone turnover markers . CLINICAL TRIAL REGISTRATION NUMBER NCT01823822 ( www . clinical trials.gov ) The importance of vegetable and fruit intakes for the prevention of  fracture in older women is not well understood . Few studies have explored vegetable and fruit intakes separately , or the associations of specific types of vegetables and fruits with fracture hospitalisations . The objective of this study was to examine the associations of vegetable and fruit intakes , separately , and specific types of vegetables and fruits with fracture-related hospitalisations in a prospect i ve cohort of women aged ≥70 years .  Vegetable and fruit intakes were assessed at baseline ( 1998 ) in 1468 women using a food frequency question naire .  The incidence of fracture-related hospitalisations over 14.5 years of follow-up was determined using the Hospital Morbidity Data Collection , linked via the Western Australian Data Linkage System . Fractures were identified in 415 ( 28.3 % ) women , of which 158 ( 10.8 % ) were hip fractures . Higher intakes of vegetables , but not fruits , were associated with lower fracture incidence . In multivariable-adjusted models for vegetable types , cruciferous and allium vegetables were inversely associated with all fractures , with a hazard ratio ( HR ) ( 95 % confidence interval ) of 0.72 ( 0.54 , 0.95 ) and 0.66 ( 0.49 , 0.88 ) , respectively , for the highest vs. lowest quartiles . Increasing vegetable intake , with an emphasis on cruciferous and allium vegetables , may prevent fractures in older postmenopausal women Weight loss causes  bone mineral loss .  Higher protein diets continue to be criticized for further potential harmful bone effects , including elevated urinary calcium , but may promote bone health if protein sources include dairy . Overweight middle-aged subjects ( n = 130 , 59 males ) were r and omized to a diet providing 1.4 g.kg(-1).d(-1 ) protein and 3 daily servings of dairy ( PRO ) or 0.8 g.kg(-1).d(-1 ) protein and 2 daily servings of dairy ( CARB ) for 4 mo of weight loss plus 8 mo of weight maintenance . Diets prescribed 6276 kJ/d for females and 7113 kJ/d for males . Bone mineral content and density ( BMD ) for whole body ( WB ) , lumbar spine ( LS ) and total hip ( TH ) were measured using dual X-ray absorptiometry , and dietary intake using 3-d weighed food records . Urinary calcium was measured using 24-h collection at 0 and 8 mo for a sub sample ( n = 42 ) . Participants lost body weight ( mean , 95 % CI ) of 8.2 % ( 7.5 - 8.9 % ) at 4 mo , 10.6 % ( 9.5 - 11.8 % ) at 8 mo , and 10.5 
    Output:
    
agent
In older people with osteoporosis , higher protein intake ( ≥ 0.8-g/kg body weight/day , i.e. , above the current RDA ) is associated with higher BMD , a slower rate of bone loss , and reduced risk of hip fracture , provided that dietary calcium intakes are adequate .
Intervention with dietary protein supplements attenuate age-related BMD decrease and reduce bone turnover marker levels , together with an increase in IGF-I and a decrease in PTH .
There is no evidence that diet-derived acid load is deleterious for bone health .
Thus , insufficient dietary protein intakes may be a more severe problem than protein excess in the elderly .
***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 Low dietary Ca intake and vitamin D insufficiency have been implicated as part of the aetiology leading to osteoporosis . The aim of the present study was to examine the effects of a 30-month dietary intervention that combined supplementation of dairy products fortified with Ca and vitamin D3 and lifestyle and nutrition counselling sessions on  bone mineral density ( BMD )  of postmenopausal women . Sixty-six postmenopausal women ( aged 55 - 65 years ) were r and omised into a dietary group ( DG ; n 35 ) , receiving daily and for the first 12 months 1200 mg Ca and 7.5 microg vitamin D3 , while for the next 18 months of intervention 1200 mg Ca and 22.5 microg vitamin D3 through fortified dairy products , and a control group ( CG ; n 31 ) receiving neither counselling nor dairy products . The DG was found to have more favourable changes in arms ( P < 0.001 ) , total spine ( P = 0.001 ) and total body BMD ( P < 0.001 ) compared with the CG . Furthermore , a significant increase was observed for the DG in lumbar spine BMD ( 0.056 ; 95 % CI 0.009 , 0.103 ) , which was not found to differentiate significantly compared with the change observed in the CG ( P = 0.075 ) . In conclusion , the present study showed that intakes of vitamin D of about 22.5 microg/d and of Ca close to the recommended level of 1200 mg from fortified dairy foods for 30 months , with compliance ensured by lifestyle and nutrition counselling sessions , can induce favourable changes in arms , total spine and total body BMD of postmenopausal women Dietary protein increases urinary calcium losses and has been associated with higher rates of hip fracture in cross-cultural studies . However , the relation between protein and risk of  osteoporotic bone fractures among individuals has not been examined in detail . In this prospect i ve study , usual dietary intake was measured in 1980 in a cohort of 85,900 women , aged 35 - 59 years , who were participants in the Nurses ' Health Study . A mailed food frequency question naire was used and incident hip ( n = 234 ) and distal forearm ( n = 1,628 ) fractures were identified by self-report during the following 12 years . Information on other factors related to osteoporosis , including obesity , use of postmenopausal estrogen , smoking , and physical activity , was collected on biennial question naires . Dietary measures were up date d in 1984 and 1986 . Protein was associated with an increased risk of forearm fracture ( relative risk ( RR ) = 1.22 , 95 % confidence interval ( Cl ) 1.04 - 1.43 , p for trend = 0.01 ) for women who consumed more than 95 g per day compared with those who consumed less than 68 g per day . A similar increase in risk was observed for animal protein , but no association was found for consumption of vegetable protein . Women who consumed five or more servings of red meat per week also had a significantly increased risk of forearm fracture ( RR = 1.23 , 95 % Cl 1.01 - 1.50 ) compared with women who ate red meat less than once per week . Recall of teenage diet did not reveal any increased risk of forearm fracture for women with higher consumption of animal protein or red meat during this earlier period of life . No association was observed between  adult protein intake  and the incidence of hip fractures , though power to assess this association was low BACKGROUND The effects of dietary protein on bone health are controversial . OBJECTIVE We examined the relation between protein intake with fracture and  bone mineral density ( BMD )  within the Women 's Health Initiative ( WHI ) . DESIGN This prospect i ve analysis included 144,580 women aged 50 - 79 y at baseline in the WHI clinical trials ( CTs ) and observational study ( OS ) that recruited participants in 1993 - 1998 with follow-up through 2011 . Self-reported clinical fractures were collected semiannually through the original end of the trials ( WHI CTs ) and annually ( WHI OS ) by question naires . Hip fracture was adjudicated by a central review of radiology reports . BMDs for total body , hip , and spine were measured at baseline and 3 and 6 y in 9062 women at 3 WHI clinics by using dual-energy X-ray absorptiometry .  Protein intake was assessed via food-frequency question naire and calibrated by using biomarkers of energy and protein intakes . Associations between protein intake and fracture were estimated by using Cox proportional hazards regression , and the relation between protein intake and BMD was estimated by using linear regression . RESULTS Median biomarker-calibrated protein intake was 15 % of energy intake . Per 20 % increase in calibrated protein intake ( percentage of energy ) , there was no significant association with total fracture ( HR : 0.99 ; 95 % CI : 0.97 , 1.02 ) or hip fracture ( HR : 0.91 ; 95 % CI : 0.84 , 1.00 ) , but there was an inverse association with forearm fracture ( HR : 0.93 ; 95 % CI : 0.88 , 0.98 ) . Each 20 % increase in calibrated protein intake was associated with a significantly higher BMD for total body ( mean 3-y change : 0.003 g/cm² ; 95 % CI : 0.001 , 0.005 g/cm² ) and hip ( mean 3-y change : 0.002 g/cm² ; 95 % CI : 0.001 , 0.004 g/cm² ) . CONCLUSIONS Higher biomarker-calibrated protein intake within the range of usual intake was inversely associated with forearm fracture and was associated with better maintenance of total and hip BMDs . These data suggest higher protein intake is not detrimental to bone health in postmenopausal women BACKGROUND & AIMS Patients with anorexia nervosa ( AN ) have low serum IGF-I levels that may contribute to a lower bone mineral mass . We investigated the effects of a fermented , protein-fortified , dairy product on serum IGF-I levels in patients with AN during an in-hospital refeeding program . METHODS In this multicenter , r and omized , double-blind , placebo-controlled , clinical trial conducted at 3 university hospitals and 3 private clinics in France and Switzerl and , 62 women recently admitted with confirmed AN and with a baseline low serum IGF-I level were r and omized to 2 daily isocaloric fresh cheese pots containing either 15 g/150 g or 3 g/150 g ( controls ) of protein for 4 weeks . The primary outcome was the change in IGF-I levels . RESULTS In the primary intention-to-treat analysis , mean serum IGF-I levels increased during the intervention phase from 22.9 ± 1.5 to 28.6 ± 1.3 nmol/L ( means ± SEM ) ( + 20.2 % ) in the intervention group and from 20.2 ± 1.2 to 25.7 ± 1.5 nmol/L ( + 16.8 % ) in controls . In a preplanned analysis of covariance with repeated measures , the between-group difference was close to statistical significance ( P = 0.071 ) . In a post-hoc mixed-regression model analysis , the difference was statistically significant ( 4.9 nmol/l increase ; P = 0.003 ) , as was the change of the ratio IGF-I/IGF-BP3 ( P=0.004 ) . There was no between-group difference in biochemical markers of bone turnover ( osteocalcin , P1NP , CTX ) or in serum parathyroid hormone level . Serum calcium levels slightly increased during the intervention phase in the higher protein group ( P = 0.02 ) . IGF-BP2 decreased significantly more in the intervention group during the follow up period at week 4 after supplements cessation ( P = 0.019 ) . CONCLUSIONS Intake of a fermented , protein-fortified , isocaloric dairy product during 4 weeks may slightly increase serum IGF-I levels in women with AN , without significant changes in bone turnover markers . CLINICAL TRIAL REGISTRATION NUMBER NCT01823822 ( www . clinical trials.gov ) The importance of vegetable and fruit intakes for the prevention of  fracture in older women is not well understood . Few studies have explored vegetable and fruit intakes separately , or the associations of specific types of vegetables and fruits with fracture hospitalisations . The objective of this study was to examine the associations of vegetable and fruit intakes , separately , and specific types of vegetables and fruits with fracture-related hospitalisations in a prospect i ve cohort of women aged ≥70 years .  Vegetable and fruit intakes were assessed at baseline ( 1998 ) in 1468 women using a food frequency question naire .  The incidence of fracture-related hospitalisations over 14.5 years of follow-up was determined using the Hospital Morbidity Data Collection , linked via the Western Australian Data Linkage System . Fractures were identified in 415 ( 28.3 % ) women , of which 158 ( 10.8 % ) were hip fractures . Higher intakes of vegetables , but not fruits , were associated with lower fracture incidence . In multivariable-adjusted models for vegetable types , cruciferous and allium vegetables were inversely associated with all fractures , with a hazard ratio ( HR ) ( 95 % confidence interval ) of 0.72 ( 0.54 , 0.95 ) and 0.66 ( 0.49 , 0.88 ) , respectively , for the highest vs. lowest quartiles . Increasing vegetable intake , with an emphasis on cruciferous and allium vegetables , may prevent fractures in older postmenopausal women Weight loss causes  bone mineral loss .  Higher protein diets continue to be criticized for further potential harmful bone effects , including elevated urinary calcium , but may promote bone health if protein sources include dairy . Overweight middle-aged subjects ( n = 130 , 59 males ) were r and omized to a diet providing 1.4 g.kg(-1).d(-1 ) protein and 3 daily servings of dairy ( PRO ) or 0.8 g.kg(-1).d(-1 ) protein and 2 daily servings of dairy ( CARB ) for 4 mo of weight loss plus 8 mo of weight maintenance . Diets prescribed 6276 kJ/d for females and 7113 kJ/d for males . Bone mineral content and density ( BMD ) for whole body ( WB ) , lumbar spine ( LS ) and total hip ( TH ) were measured using dual X-ray absorptiometry , and dietary intake using 3-d weighed food records . Urinary calcium was measured using 24-h collection at 0 and 8 mo for a sub sample ( n = 42 ) . Participants lost body weight ( mean , 95 % CI ) of 8.2 % ( 7.5 - 8.9 % ) at 4 mo , 10.6 % ( 9.5 - 11.8 % ) at 8 mo , and 10.5 
    Output:
    