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: Most studies on lipid lowering diets have focused on the total content of saturated , polyunsaturated and monounsaturated fatty acids . However , the distribution of these fatty acids on the triacylglycerol ( TAG ) molecule and the molecular TAG species generated by this stereospecificity are characteristic for various native dietary TAGs . Fat r and omization or interesterification is a process involving the positional redistribution of fatty acids , which leads to the generation of new TAG molecular species . A comparison between native and r and omized TAGs is the subject of this review with regards to the role of stereospecificity of fatty acids in metabolic processing and effects on fasting lipids and postpr and ial lipemia . The positioning of unsaturated versus saturated fatty acids in the sn-2 position of TAGs indicate differences in early metabolic processing and postpr and ial clearance , which may explain modulatory effects on atherogenecity and thrombogenecity . Both human and animal studies are discussed with implication s for human health Purpose The association between dietary saturated fatty acids ( SFA ) intake and  type 2 diabetes ( T2D )  remains unclear . This study aim ed at investigating the association between SFA intake and T2D risk based on ( 1 ) individual SFA ( differing in carbon chain length ) , ( 2 ) food sources of SFA and ( 3 ) the substituting macronutrients . Methods 37,421 participants from the European Prospect i ve Investigation into Cancer and Nutrition-Netherl and s ( EPIC-NL ) cohort were included in this study . Baseline dietary intake was assessed by a vali date d food frequency question naire . T2D risks were estimated by Cox regression models adjusted for non-dietary and dietary covariates . Results 893 incident T2D cases were documented during 10.1-year follow-up . We observed no association between total SFA and T2D risk . Marginally inverse associations were found for lauric acid ( HR per 1 SD of energy% , 95 % CI 0.92 , 0.85–0.99 ) , myristic acid ( 0.89 , 0.79–0.99 ) , margaric acid ( 0.84 , 0.73–0.97 ) , odd-chain SFA ( pentadecylic plus margaric acids ; 0.88 , 0.79–0.99 ) , and cheese derived SFA ( 0.90 , 0.83–0.98 ) . Soft and liquid fats derived SFA was found related to higher T2D risk ( 1.08 , 1.01–1.17 ) . When substituting SFA by proteins , carbohydrates and polyunsaturated fatty acids , significantly higher risks of T2D were observed ( HRs per 1 energy% ranging from 1.05 to 1.15 ) . Conclusion In this Dutch population , total SFA does not relate to T2D risk . Rather , the association may depend on the types and food sources of SFA . Cheese-derived SFA and individual SFA that are commonly found in cheese , were significantly related to lower T2D risks . We can not exclude the higher T2D risks found for soft and liquid fats derived SFA and for substituting SFA with other macronutrients are influenced by residual confounding by trans fatty acids or limited intake variation in polyunsaturated fatty acids and vegetable protein Summary Background Conflicting evidence exists regarding the association between saturated fatty acids ( SFAs ) and type 2 diabetes . In this longitudinal case-cohort study , we aim ed to investigate the prospect i ve associations between objective ly measured individual plasma phospholipid SFAs and incident type 2 diabetes in EPIC-InterAct participants . Methods The EPIC-InterAct case-cohort study includes 12 403 people with incident type 2 diabetes and a representative subcohort of 16 154 individuals who were selected from a cohort of 340 234 European participants with 3·99 million person-years of follow-up ( the EPIC study ) . Incident type 2 diabetes was ascertained until Dec 31 , 2007 , by a review of several sources of evidence . Gas chromatography was used to measure the distribution of fatty acids in plasma phospholipids ( mol% ) ; sample s from people with type 2 diabetes and subcohort participants were processed in a r and om order by centre , and laboratory staff were masked to participant characteristics . We estimated country-specific hazard ratios ( HRs ) for associations per SD of each SFA with incident type 2 diabetes using Prentice-weighted Cox regression , which is weighted for case-cohort sampling , and pooled our findings using r and om-effects meta- analysis . Findings SFAs accounted for 46 % of total plasma phospholipid fatty acids . In adjusted analyses , different individual SFAs were associated with incident type 2 diabetes in opposing directions . Even-chain SFAs that were measured ( 14:0 [ myristic acid ] , 16:0 [ palmitic acid ] , and 18:0 [ stearic acid ] ) were positively associated with incident type 2 diabetes ( HR [ 95 % CI ] per SD difference : myristic acid 1·15 [ 95 % CI 1·09–1·22 ] , palmitic acid 1·26 [ 1·15–1·37 ] , and stearic acid 1·06 [ 1·00–1·13 ] ) . By contrast , measured odd-chain SFAs ( 15:0 [ pentadecanoic acid ] and 17:0 [ heptadecanoic acid ] ) were inversely associated with incident type 2 diabetes ( HR [ 95 % CI ] per 1 SD difference : 0·79 [ 0·73–0·85 ] for pentadecanoic acid and 0·67 [ 0·63–0·71 ] for heptadecanoic acid ) , as were measured longer-chain SFAs ( 20:0 [ arachidic acid ] , 22:0 [ behenic acid ] , 23:0 [ tricosanoic acid ] , and 24:0 [ lignoceric acid ] ) , with HRs ranging from 0·72 to 0·81 ( 95 % CIs ranging between 0·61 and 0·92 ) . Our findings were robust to a range of sensitivity analyses . Interpretation Different individual plasma phospholipid SFAs were associated with incident type 2 diabetes in opposite directions , which suggests that SFAs are not homogeneous in their effects . Our findings emphasise the importance of the recognition of subtypes of these fatty acids . An improved underst and ing of differences in sources of individual SFAs from dietary intake versus endogenous metabolism is needed . Funding EU FP6 programme , Medical Research Council Epidemiology Unit , Medical Research Council Human Nutrition Research , and Cambridge Lipidomics Biomarker Research Initiative Background It is possible that cross-over studies included in current systematic review s are being inadequately assessed , because the current risk of bias tools do not consider possible biases specific to cross-over design . We performed this study to evaluate whether this was being done in  cross-over studies included in Cochrane  Systematic Review s ( CSRs ) . Methods We search ed the Cochrane Library ( up to 2013 issue 5 ) for CSRs that included at least one cross-over trial . Two authors independently undertook the study selection and data extraction . A r and om sample of the CSRs was selected and we evaluated whether the cross-over trials in these CSRs were assessed according to criteria suggested by the Cochrane h and book . In addition we reassessed the risk of bias of these cross-over trials by a checklist developed form the Cochrane h and book . Results We identified 688 CSRs that included one or more cross-over studies . We chose a r and om sample of 60 CSRs and these included 139 cross-over studies . None of these CSRs undertook a risk of bias assessment specific for cross-over studies . In fact items specific for cross-over studies were seldom considered anywhere in quality assessment of these CSRs . When we reassessed the risk of bias , including the 3 items specific to cross-over trials , of these 139 studies , a low risk of bias was judged for appropriate cross-over design in 110(79 % ) , carry-over effects in 48(34 % ) and for reporting data in all stages of the trial in 114(82 % ) . Assessment of biases in cross-over trials could affect the GRADE assessment of a review ’s findings . Conclusion The current Cochrane risk of bias tool is not adequate to assess cross-over studies . Items specific to cross-over trials leading to potential risk of bias are generally neglected in CSRs . A proposed check list for the evaluation of cross-over trials is provided Background Mayonnaise is used widely in contemporary human diet with widespread use as a salad dressing or spread on breads . Vegetable oils used in its formulation may be a rich source of ω-6 PUFAs and the higher-PUFA content of mayonnaise may be beneficial in mediating a hypocholesterolemic effect . This study , therefore , evaluated the functionality of mayonnaise on cardiometabolic risk within a regular human consumption scenario . Methods Subjects underwent a r and omized double-blind crossover trial , consuming diets supplemented with 20 g/day of either soybean oil-based mayonnaise ( SB-mayo ) or palm olein-based mayonnaise ( PO-mayo ) for 4 weeks each with a 2-week wash-out period . The magnitude of changes for metabolic outcomes between dietary treatments was compared with PO-mayo serving as the control . The data was analyzed by ANCOVA using the GLM model . Analysis was adjusted for weight changes . Results Treatments result ed in significant reductions in TC ( diff = −0.25 mmol/L ; P = 0.001 ) , LDL-C ( diff = −0.17 mmol/L ; P = 0.016 ) and HDL-C ( diff = −0.12 mmol/L ; P < 0.001 ) in SB-mayo compared to PO-mayo without affecting LDL-C : HDL-C ratio ( P > 0.05 ) . Lipoprotein particle change was significant with large LDL particles increasing after PO-mayo ( diff = + 63.2 nmol/L ; P = 0.007 ) compared to SB-mayo but small LDL particles remained unaffected . Plasma glucose , apolipoproteins and oxidative stress markers remained unchanged . Conclusions Daily use with 20 g of linoleic acid-rich SB-mayo elicited reductions in TC and LDL-C concentrations without significantly changing LDL-C : HDL-C ratio or small LDL particle distributions compared to the PO-mayo diet . Trial registration This clinical trial was retrospectively registered with the National Medical Research Register , National Institute of Health , Ministry of Health Malaysia , ( NMRR-15 - 40 - 24035 ; registered on 29/01/2015 ; https://www.nmrr.gov.my/fwbPage.jsp?fwbPageId= Research ISRForm&fwbAction = Up date & fwbStep=10&pk . research ID=24035&fwbVMenu=3&fwb Research Action = Up date ) . Ethical approval was obtained from the National University of Malaysia ’s Medical Ethics Committee ( UKM 1.5.3.5/244/SPP/NN-054-2011 , approved on 25/05/2011 ) BACKGROUND Despite the high content of palmitic acid , palm olein has been shown to have a neutral effect on plasma cholesterol concentrations when compared with olive oil , which is suggested to be attributable to palmitic acid in the sn-1 and sn-3 position . In contrast , palmitic acid is in the sn-2 position in lard . OBJECTIVE The objective was to investigate the effects of a diet rich in palm olein , fractionated palm oil , olive oil , and lard on plasma blood lipids , inflammatory markers , glucose , and insulin . DESIGN A controlled double-blinded , r and omized 3 × 3 wk crossover dietary intervention study included 32 healthy men who daily replaced part of their habitual dietary fat intake with ~ 17 % of energy from palm olein , olive oil , or lard , respectively . RESULTS Compared with intake of olive oil , palm olein and lard  increased total cholesterol and LDL cholesterol ( P < 0.0001 ) . Palm olein result ed in a lower plasma triacylglycerol concentration than did olive oil ( P < 0.01 ) . No difference in effects was observed in plasma HDL-cholesterol , high-sensitivity C-reactive protein , plasminogen activator-1 , insulin , and glucose concentrations . CONCLUSIONS The current study did not support the previous finding that the effect of palm olein on total plasma cholesterol and LDL cholesterol in healthy individuals with normal plasma cholesterol concentrations is neutral compared with that of olive oil . Thus , sn-positioning was not confirmed to be important with regard to the effect on plasma cholesterol . The relatively lower plasma triacylglycerol concentration  after the palm olein diet than after the olive oil diet was unexpected . This trial is registered at clinical trials.gov as NCT00743301 BACKGROUND AND OBJECTIVES As the most widely produced edible vegetable oil , palm oil is known as to contain a high level of saturated fat 
    Output:
    
agent
Current evidence on the effects of palm oil consumption on biomarkers of glucose metabolism is poor and limited to only healthy participants .
We conclude that little or no additional benefit will be obtained by replacing palm oil with other oils rich in mono or polyunsaturated fatty acids for changes in glucose metabolism
***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: Most studies on lipid lowering diets have focused on the total content of saturated , polyunsaturated and monounsaturated fatty acids . However , the distribution of these fatty acids on the triacylglycerol ( TAG ) molecule and the molecular TAG species generated by this stereospecificity are characteristic for various native dietary TAGs . Fat r and omization or interesterification is a process involving the positional redistribution of fatty acids , which leads to the generation of new TAG molecular species . A comparison between native and r and omized TAGs is the subject of this review with regards to the role of stereospecificity of fatty acids in metabolic processing and effects on fasting lipids and postpr and ial lipemia . The positioning of unsaturated versus saturated fatty acids in the sn-2 position of TAGs indicate differences in early metabolic processing and postpr and ial clearance , which may explain modulatory effects on atherogenecity and thrombogenecity . Both human and animal studies are discussed with implication s for human health Purpose The association between dietary saturated fatty acids ( SFA ) intake and  type 2 diabetes ( T2D )  remains unclear . This study aim ed at investigating the association between SFA intake and T2D risk based on ( 1 ) individual SFA ( differing in carbon chain length ) , ( 2 ) food sources of SFA and ( 3 ) the substituting macronutrients . Methods 37,421 participants from the European Prospect i ve Investigation into Cancer and Nutrition-Netherl and s ( EPIC-NL ) cohort were included in this study . Baseline dietary intake was assessed by a vali date d food frequency question naire . T2D risks were estimated by Cox regression models adjusted for non-dietary and dietary covariates . Results 893 incident T2D cases were documented during 10.1-year follow-up . We observed no association between total SFA and T2D risk . Marginally inverse associations were found for lauric acid ( HR per 1 SD of energy% , 95 % CI 0.92 , 0.85–0.99 ) , myristic acid ( 0.89 , 0.79–0.99 ) , margaric acid ( 0.84 , 0.73–0.97 ) , odd-chain SFA ( pentadecylic plus margaric acids ; 0.88 , 0.79–0.99 ) , and cheese derived SFA ( 0.90 , 0.83–0.98 ) . Soft and liquid fats derived SFA was found related to higher T2D risk ( 1.08 , 1.01–1.17 ) . When substituting SFA by proteins , carbohydrates and polyunsaturated fatty acids , significantly higher risks of T2D were observed ( HRs per 1 energy% ranging from 1.05 to 1.15 ) . Conclusion In this Dutch population , total SFA does not relate to T2D risk . Rather , the association may depend on the types and food sources of SFA . Cheese-derived SFA and individual SFA that are commonly found in cheese , were significantly related to lower T2D risks . We can not exclude the higher T2D risks found for soft and liquid fats derived SFA and for substituting SFA with other macronutrients are influenced by residual confounding by trans fatty acids or limited intake variation in polyunsaturated fatty acids and vegetable protein Summary Background Conflicting evidence exists regarding the association between saturated fatty acids ( SFAs ) and type 2 diabetes . In this longitudinal case-cohort study , we aim ed to investigate the prospect i ve associations between objective ly measured individual plasma phospholipid SFAs and incident type 2 diabetes in EPIC-InterAct participants . Methods The EPIC-InterAct case-cohort study includes 12 403 people with incident type 2 diabetes and a representative subcohort of 16 154 individuals who were selected from a cohort of 340 234 European participants with 3·99 million person-years of follow-up ( the EPIC study ) . Incident type 2 diabetes was ascertained until Dec 31 , 2007 , by a review of several sources of evidence . Gas chromatography was used to measure the distribution of fatty acids in plasma phospholipids ( mol% ) ; sample s from people with type 2 diabetes and subcohort participants were processed in a r and om order by centre , and laboratory staff were masked to participant characteristics . We estimated country-specific hazard ratios ( HRs ) for associations per SD of each SFA with incident type 2 diabetes using Prentice-weighted Cox regression , which is weighted for case-cohort sampling , and pooled our findings using r and om-effects meta- analysis . Findings SFAs accounted for 46 % of total plasma phospholipid fatty acids . In adjusted analyses , different individual SFAs were associated with incident type 2 diabetes in opposing directions . Even-chain SFAs that were measured ( 14:0 [ myristic acid ] , 16:0 [ palmitic acid ] , and 18:0 [ stearic acid ] ) were positively associated with incident type 2 diabetes ( HR [ 95 % CI ] per SD difference : myristic acid 1·15 [ 95 % CI 1·09–1·22 ] , palmitic acid 1·26 [ 1·15–1·37 ] , and stearic acid 1·06 [ 1·00–1·13 ] ) . By contrast , measured odd-chain SFAs ( 15:0 [ pentadecanoic acid ] and 17:0 [ heptadecanoic acid ] ) were inversely associated with incident type 2 diabetes ( HR [ 95 % CI ] per 1 SD difference : 0·79 [ 0·73–0·85 ] for pentadecanoic acid and 0·67 [ 0·63–0·71 ] for heptadecanoic acid ) , as were measured longer-chain SFAs ( 20:0 [ arachidic acid ] , 22:0 [ behenic acid ] , 23:0 [ tricosanoic acid ] , and 24:0 [ lignoceric acid ] ) , with HRs ranging from 0·72 to 0·81 ( 95 % CIs ranging between 0·61 and 0·92 ) . Our findings were robust to a range of sensitivity analyses . Interpretation Different individual plasma phospholipid SFAs were associated with incident type 2 diabetes in opposite directions , which suggests that SFAs are not homogeneous in their effects . Our findings emphasise the importance of the recognition of subtypes of these fatty acids . An improved underst and ing of differences in sources of individual SFAs from dietary intake versus endogenous metabolism is needed . Funding EU FP6 programme , Medical Research Council Epidemiology Unit , Medical Research Council Human Nutrition Research , and Cambridge Lipidomics Biomarker Research Initiative Background It is possible that cross-over studies included in current systematic review s are being inadequately assessed , because the current risk of bias tools do not consider possible biases specific to cross-over design . We performed this study to evaluate whether this was being done in  cross-over studies included in Cochrane  Systematic Review s ( CSRs ) . Methods We search ed the Cochrane Library ( up to 2013 issue 5 ) for CSRs that included at least one cross-over trial . Two authors independently undertook the study selection and data extraction . A r and om sample of the CSRs was selected and we evaluated whether the cross-over trials in these CSRs were assessed according to criteria suggested by the Cochrane h and book . In addition we reassessed the risk of bias of these cross-over trials by a checklist developed form the Cochrane h and book . Results We identified 688 CSRs that included one or more cross-over studies . We chose a r and om sample of 60 CSRs and these included 139 cross-over studies . None of these CSRs undertook a risk of bias assessment specific for cross-over studies . In fact items specific for cross-over studies were seldom considered anywhere in quality assessment of these CSRs . When we reassessed the risk of bias , including the 3 items specific to cross-over trials , of these 139 studies , a low risk of bias was judged for appropriate cross-over design in 110(79 % ) , carry-over effects in 48(34 % ) and for reporting data in all stages of the trial in 114(82 % ) . Assessment of biases in cross-over trials could affect the GRADE assessment of a review ’s findings . Conclusion The current Cochrane risk of bias tool is not adequate to assess cross-over studies . Items specific to cross-over trials leading to potential risk of bias are generally neglected in CSRs . A proposed check list for the evaluation of cross-over trials is provided Background Mayonnaise is used widely in contemporary human diet with widespread use as a salad dressing or spread on breads . Vegetable oils used in its formulation may be a rich source of ω-6 PUFAs and the higher-PUFA content of mayonnaise may be beneficial in mediating a hypocholesterolemic effect . This study , therefore , evaluated the functionality of mayonnaise on cardiometabolic risk within a regular human consumption scenario . Methods Subjects underwent a r and omized double-blind crossover trial , consuming diets supplemented with 20 g/day of either soybean oil-based mayonnaise ( SB-mayo ) or palm olein-based mayonnaise ( PO-mayo ) for 4 weeks each with a 2-week wash-out period . The magnitude of changes for metabolic outcomes between dietary treatments was compared with PO-mayo serving as the control . The data was analyzed by ANCOVA using the GLM model . Analysis was adjusted for weight changes . Results Treatments result ed in significant reductions in TC ( diff = −0.25 mmol/L ; P = 0.001 ) , LDL-C ( diff = −0.17 mmol/L ; P = 0.016 ) and HDL-C ( diff = −0.12 mmol/L ; P < 0.001 ) in SB-mayo compared to PO-mayo without affecting LDL-C : HDL-C ratio ( P > 0.05 ) . Lipoprotein particle change was significant with large LDL particles increasing after PO-mayo ( diff = + 63.2 nmol/L ; P = 0.007 ) compared to SB-mayo but small LDL particles remained unaffected . Plasma glucose , apolipoproteins and oxidative stress markers remained unchanged . Conclusions Daily use with 20 g of linoleic acid-rich SB-mayo elicited reductions in TC and LDL-C concentrations without significantly changing LDL-C : HDL-C ratio or small LDL particle distributions compared to the PO-mayo diet . Trial registration This clinical trial was retrospectively registered with the National Medical Research Register , National Institute of Health , Ministry of Health Malaysia , ( NMRR-15 - 40 - 24035 ; registered on 29/01/2015 ; https://www.nmrr.gov.my/fwbPage.jsp?fwbPageId= Research ISRForm&fwbAction = Up date & fwbStep=10&pk . research ID=24035&fwbVMenu=3&fwb Research Action = Up date ) . Ethical approval was obtained from the National University of Malaysia ’s Medical Ethics Committee ( UKM 1.5.3.5/244/SPP/NN-054-2011 , approved on 25/05/2011 ) BACKGROUND Despite the high content of palmitic acid , palm olein has been shown to have a neutral effect on plasma cholesterol concentrations when compared with olive oil , which is suggested to be attributable to palmitic acid in the sn-1 and sn-3 position . In contrast , palmitic acid is in the sn-2 position in lard . OBJECTIVE The objective was to investigate the effects of a diet rich in palm olein , fractionated palm oil , olive oil , and lard on plasma blood lipids , inflammatory markers , glucose , and insulin . DESIGN A controlled double-blinded , r and omized 3 × 3 wk crossover dietary intervention study included 32 healthy men who daily replaced part of their habitual dietary fat intake with ~ 17 % of energy from palm olein , olive oil , or lard , respectively . RESULTS Compared with intake of olive oil , palm olein and lard  increased total cholesterol and LDL cholesterol ( P < 0.0001 ) . Palm olein result ed in a lower plasma triacylglycerol concentration than did olive oil ( P < 0.01 ) . No difference in effects was observed in plasma HDL-cholesterol , high-sensitivity C-reactive protein , plasminogen activator-1 , insulin , and glucose concentrations . CONCLUSIONS The current study did not support the previous finding that the effect of palm olein on total plasma cholesterol and LDL cholesterol in healthy individuals with normal plasma cholesterol concentrations is neutral compared with that of olive oil . Thus , sn-positioning was not confirmed to be important with regard to the effect on plasma cholesterol . The relatively lower plasma triacylglycerol concentration  after the palm olein diet than after the olive oil diet was unexpected . This trial is registered at clinical trials.gov as NCT00743301 BACKGROUND AND OBJECTIVES As the most widely produced edible vegetable oil , palm oil is known as to contain a high level of saturated fat 
    Output:
    