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: Summary Of the 305 premenopausal females in a cross-sectional study in r and omly selected communities of Karachi , Pakistan , 90.1 % showed to be vitamin D deficient . Age , town of residence , and housing structure were significant predictors of vitamin D levels . Measures to address D deficiency and its associated long latency effects are urgently needed . Aims This study aims to find out the prevalence and risk factors of vitamin D deficiency in community-dwelling premenopausal females in Karachi . Methods A cross-sectional study was conducted in r and omly selected communities downtown ( Saddar ) and suburbs ( Gulshan and Malir Town ) in Karachi , Pakistan . Information related to sociodemographics ( age , education , employment , and household income ) , housing structure , sunlight exposure , and skin pigmentation as well as dietary intake ( using a food frequency question naire ) was collected . Serum vitamins D3 levels were also measured . Mean and SD was computed for continuous variables and frequency and proportions were computed for categorical variables . Data were further analyzed by Chi-square test and ANOVA . Multiple linear regression analysis was done to find out determinants of vitamin D ( VD ) levels . Results Total of 305 premenopausal females were recruited .  Mean age , BMI , and waist circumference of the study participants was 31.97 ± 8 years , 25.06 ± 5.6 kg/m2 , and 88.42 ± 13.3 cm , respectively . Majority of the females were vitamin D deficient ( 91.50 % ) with mean vitamin D levels of 21.77 ± 21.66 nm/L. Mean vitamin D levels were significantly different among females residing in downtown and suburbs . High frequency of vitamin D deficiency was observed in females dwelling in downtown ( Saddar ) . According to the results of multiple linear regression analysis , determinants of VD levels were age , town of residence , and housing structure . Conclusion High prevalence of vitamin D deficiency is seen in females in the community of Karachi , Pakistan . Age , town of residence , and housing structure were the significant predictors of vitamin D levels . Measures to combat the issue of D deficiency and its associated long latency effects are urgently needed Data on the association between vitamin D status and actual change in glycemic measures are limited . We examined the prospect i ve association between a predicted 25-hydroxyvitamin D ( 25(OH)D ) score and change in fasting plasma glucose concentration over a mean follow-up of 7 years , in 2571 men and women ( mean age 54 years ) without diabetes in the Framingham Offspring Study cohort . After adjustment for age , sex , body mass index and fasting plasma glucose at baseline , higher predicted 25(OH)D score at baseline was associated with a smaller 7-year increase in fasting plasma glucose concentrations ( 0.23 mmol/l versus 0.35 mmol/l for highest versus lowest tertile of 25(OH)D score , respectively , P-trend=0.002 ) . Vitamin D status may be an important determinant for change in fasting plasma glucose concentration among middle-aged and older adults without diabetes OBJECTIVE This study aim ed to examine vitamin D status as a determinant for development of type 2 diabetes and deterioration of glucose homeostasis . RESEARCH DESIGN AND METHODS A r and om sample of the general population of Copenhagen , Denmark , was taken as part of the Inter99 study . Included were 6,405 men and women aged 30–65 years at baseline ( 1999–2001 ) , with 4,296 participating in the follow-up examination 5 years later ( 2004–2006 ) .  Vitamin D was determined at baseline as serum 25-hydroxyvitamin D [ 25(OH)D ] . Diabetes was defined based on an oral glucose tolerance test and a glycosylated hemoglobin ( HbA1c ) test . Secondary outcomes included continuous markers of glucose homeostasis . RESULTS The risk of incident diabetes associated with a 10 nmol/L increase in 25(OH)D was odds ratio ( OR ) 0.91 ( 95 % CI 0.84–0.97 ) in crude analyses . The association became statistically nonsignificant after adjustment for confounders , with an OR per 10 nmol/L of 0.94 ( 0.86–1.03 ) . Low 25(OH)D status was significantly associated with unfavorable longitudinal changes in continuous markers of glucose homeostasis after adjustment for confounders . Fasting and 2-h glucose and insulin as well as the degree of insulin resistance increased significantly more during follow-up among those with low 25(OH)D levels compared with those with higher levels . CONCLUSIONS Low 25(OH)D status was not significantly associated with incident diabetes after adjustment for confounders . However , it was significantly associated with unfavorable longitudinal changes in continuous markers of glucose homeostasis , indicating that low vitamin D status could be related to deterioration of glucose homeostasis Summary  Vitamin D status  was assessed in 142 elderly Dutchmen participating in a prospect i ve population -based study of environmental factors in the aetiology of non-insulin-dependent diabetes mellitus . Of the men aged 70–88 years examined between March and May 1990 , 39 % were vitamin D depleted . After adjustment for confounding by age , BMI , physical activity , month of sampling , cigarette smoking and alcohol intake the 1-h glucose and area under the glucose curve during a st and ard 75-g oral glucose tolerance test ( OGTT ) were inversely associated with the serum concentration of 25-OH vitamin D ( r = −0.23 , p < 0.01 ; r = −0.26 , p < 0.01 , respectively ) . After excluding newly diagnosed diabetic patients total insulin concentrations during OGTT were also inversely associated with the concentration of 25-OH vitamin D ( r = −0.18 to −0.23 , p < 0.05 ) . Hypovitaminosis D may be a significant risk factor for glucose intolerance . [ Diabetologia ( 1997 ) 40 : 344–347 OBJECTIVE To study the association between vitamin D status and the risk of incident impaired fasting glucose ( IFG ) and diabetes  in a population -based cohort of diabetes-free subjects . RESEARCH DESIGN AND METHODS In a historical prospect i ve cohort study of subjects from the Clalit Health Services data base , which includes information on nearly 4 million people , diabetes-free subjects aged 40–70 years with serum 25-hydroxycholecalciferol ( 25-OHD ) measurements available were followed for 2 years to assess the development of IFG and diabetes in five 25-OHD subgroups : ≥25 , 25.1–37.5 , 37.6–50 , 50.1–75 , and > 75 nmol/L. RESULTS The baseline cohort included 117,960 adults : 83,526 normoglycemic subjects and 34,434 subjects with IFG . During follow-up , 8,629 subjects ( 10.3 % of the normoglycemic group ) developed IFG , and 2,162 subjects ( 1.8 % of the total cohort ) progressed to diabetes . A multivariable model adjusted for age , sex , population group , immigrant status , BMI , season of vitamin D measurement , LDL and HDL cholesterol , triglycerides , estimated glomerular filtration rate , history of hypertension or cardiovascular disease , Charlson comorbidity index , smoking , and socioeconomic status revealed an inverse association between 25-OHD and the risk of progression to IFG and diabetes . The odds of transitioning from normoglycemia to IFG , from normoglycemia to diabetes , and from IFG to diabetes in subjects with a 25-OHD level ≤25 nmol/L were greater than those of subjects with a 25-OHD level > 75 nmol/L [ odds ratio 1.13 ( 95 % CI 1.03–1.24 ) , 1.77 ( 1.11–2.83 ) , and 1.43 ( 1.16–1.76 ) , respectively ] . CONCLUSIONS Vitamin D deficiency appears to be an independent risk factor for the development of IFG and diabetes Background & objectives : Patients with diabetes and vitamin-D insufficiency have increased insulin resistance . Similar observations among individuals with prediabetes are not well documented . The aim of this study was to find the occurrence of vitamin-D insufficiency/deficiency among individuals with prediabetes and to evaluate the relationship between vitamin-D status and insulin resistance . Methods : One hundred fifty seven individuals with prediabetes who fulfilled all the inclusion and exclusion criteria underwent clinical examination , anthropometric measurements ( waist circumference , waist-hip ratio , waist-height ratio ) and blood sampling after overnight fast for estimation of fasting blood glucose , fasting insulin , 25(OH)vitamin-D , intact parathyroid hormone ( iPTH ) and lipid profile . One hour post 75 g glucose ( 1hPG ) blood glucose during oral glucose tolerance test was measured . Results : Vitamin-D deficiency/insufficiency was found in 115 ( 73.25 % ) individuals with prediabetes .  Severe vitamin-D deficiency ( < 10 ng/ml ) was seen in 14.65 per cent individuals . Individuals with the lowest vitamin-D levels ( < 10 ng/ml ) had the highest insulin resistance ( HOMA2-IR : 2.04 ± 0.67 ) . Serum 25(OH)D had a statistically significant inverse correlation with insulin resistance ( HOMA2-IR ; r=-0.33 ; P=0.008 ) , and positive correlation with insulin sensitivity ( QUICKI ; r=0.39 ; P=0.002 ) , after adjusting for BMI and HbA1c . There was no correlation between vitamin-D status and estimated beta cell mass ( HOMA-β ) . The mean waist-height ratio among individuals with prediabetes was 0.57 ( normal<0.5 ) indicating a high risk of cardiovascular morbidity . Individuals with elevated 1hPG>155 mg/dl had significantly higher BMI and worse insulin resistance , and 1hPG correlated well with 2 hour post glucose blood glucose ( r=0.57 ; P<0.001 ) . Interpretations & conclusions : Vitamin-D deficiency/insufficiency may have some role in the development/worsening of insulin resistance in individuals with prediabetes in our country who have a high cardiovascular risk . Prospect i ve studies on a large group of individuals need to be done to confirm the findings Objective Epidemiological studies have provided evidence of an association between vitamin D insufficiency and  type 2 diabetes .  Vitamin D levels have decreased among Inuit in Greenl and , and type 2 diabetes is increasing . We hypothesized that the decline in vitamin D could have contributed to the increase in type 2 diabetes , and therefore investigated associations between serum 25(OH)D3 as a measure of vitamin D status and glucose homeostasis and glucose intolerance in an adult Inuit population . Methods 2877 Inuit ( ≥18 years ) r and omly selected for participation in the Inuit Health in Transition study were included .  Fasting- and 2hour plasma glucose and insulin , C-peptide and HbA1c  were measured , and associations with serum 25(OH)D3 were analysed using linear and logistic regression . A sub sample of 330 individuals who also donated a blood sample in 1987 , were furthermore included . Results After adjustment , increasing serum 25(OH)D3 ( per 10 nmol/L ) was associated with higher fasting plasma glucose ( 0.02 mmol/L , p = 0.004 ) , 2hour plasma glucose ( 0.05 nmol/L , p = 0.002 ) and HbA1c ( 0.39 % , p<0.001 ) , and with lower beta-cell function ( -1.00 mmol/L , p<0.001 ) . Serum 25(OH)D3 was positively associated with impaired fasting glycaemia ( OR : 1.08 , p = 0.001 ) , but not with IGT or type 2 diabetes . Conclusions Our results did not support an association between low vitamin D levels and risk of type 2 diabetes . Instead , we found weak positive associations  between vitamin D levels and fasting- and 2hour plasma glucose levels , HbA1c and impaired fasting glycaemia , and a negative association with beta-cell function , underlining the need for determination of the causal relationship OBJECTIVE Vitamin D deficiency is associated with an unfavorable metabolic profile in observational studies . The intention was to compare insulin sensitivity ( the primary end point ) and secretion and lipids in subjects with low and high serum 25(OH)D ( 25-hydroxyvitamin D ) levels and to assess the effect of vitamin 
    Output:
    
agent
This meta- analysis concludes that hypovitaminosis D is associated with increased risk of hyperglycemia both in diabetic and non-diabetic subjects .
***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: Summary Of the 305 premenopausal females in a cross-sectional study in r and omly selected communities of Karachi , Pakistan , 90.1 % showed to be vitamin D deficient . Age , town of residence , and housing structure were significant predictors of vitamin D levels . Measures to address D deficiency and its associated long latency effects are urgently needed . Aims This study aims to find out the prevalence and risk factors of vitamin D deficiency in community-dwelling premenopausal females in Karachi . Methods A cross-sectional study was conducted in r and omly selected communities downtown ( Saddar ) and suburbs ( Gulshan and Malir Town ) in Karachi , Pakistan . Information related to sociodemographics ( age , education , employment , and household income ) , housing structure , sunlight exposure , and skin pigmentation as well as dietary intake ( using a food frequency question naire ) was collected . Serum vitamins D3 levels were also measured . Mean and SD was computed for continuous variables and frequency and proportions were computed for categorical variables . Data were further analyzed by Chi-square test and ANOVA . Multiple linear regression analysis was done to find out determinants of vitamin D ( VD ) levels . Results Total of 305 premenopausal females were recruited .  Mean age , BMI , and waist circumference of the study participants was 31.97 ± 8 years , 25.06 ± 5.6 kg/m2 , and 88.42 ± 13.3 cm , respectively . Majority of the females were vitamin D deficient ( 91.50 % ) with mean vitamin D levels of 21.77 ± 21.66 nm/L. Mean vitamin D levels were significantly different among females residing in downtown and suburbs . High frequency of vitamin D deficiency was observed in females dwelling in downtown ( Saddar ) . According to the results of multiple linear regression analysis , determinants of VD levels were age , town of residence , and housing structure . Conclusion High prevalence of vitamin D deficiency is seen in females in the community of Karachi , Pakistan . Age , town of residence , and housing structure were the significant predictors of vitamin D levels . Measures to combat the issue of D deficiency and its associated long latency effects are urgently needed Data on the association between vitamin D status and actual change in glycemic measures are limited . We examined the prospect i ve association between a predicted 25-hydroxyvitamin D ( 25(OH)D ) score and change in fasting plasma glucose concentration over a mean follow-up of 7 years , in 2571 men and women ( mean age 54 years ) without diabetes in the Framingham Offspring Study cohort . After adjustment for age , sex , body mass index and fasting plasma glucose at baseline , higher predicted 25(OH)D score at baseline was associated with a smaller 7-year increase in fasting plasma glucose concentrations ( 0.23 mmol/l versus 0.35 mmol/l for highest versus lowest tertile of 25(OH)D score , respectively , P-trend=0.002 ) . Vitamin D status may be an important determinant for change in fasting plasma glucose concentration among middle-aged and older adults without diabetes OBJECTIVE This study aim ed to examine vitamin D status as a determinant for development of type 2 diabetes and deterioration of glucose homeostasis . RESEARCH DESIGN AND METHODS A r and om sample of the general population of Copenhagen , Denmark , was taken as part of the Inter99 study . Included were 6,405 men and women aged 30–65 years at baseline ( 1999–2001 ) , with 4,296 participating in the follow-up examination 5 years later ( 2004–2006 ) .  Vitamin D was determined at baseline as serum 25-hydroxyvitamin D [ 25(OH)D ] . Diabetes was defined based on an oral glucose tolerance test and a glycosylated hemoglobin ( HbA1c ) test . Secondary outcomes included continuous markers of glucose homeostasis . RESULTS The risk of incident diabetes associated with a 10 nmol/L increase in 25(OH)D was odds ratio ( OR ) 0.91 ( 95 % CI 0.84–0.97 ) in crude analyses . The association became statistically nonsignificant after adjustment for confounders , with an OR per 10 nmol/L of 0.94 ( 0.86–1.03 ) . Low 25(OH)D status was significantly associated with unfavorable longitudinal changes in continuous markers of glucose homeostasis after adjustment for confounders . Fasting and 2-h glucose and insulin as well as the degree of insulin resistance increased significantly more during follow-up among those with low 25(OH)D levels compared with those with higher levels . CONCLUSIONS Low 25(OH)D status was not significantly associated with incident diabetes after adjustment for confounders . However , it was significantly associated with unfavorable longitudinal changes in continuous markers of glucose homeostasis , indicating that low vitamin D status could be related to deterioration of glucose homeostasis Summary  Vitamin D status  was assessed in 142 elderly Dutchmen participating in a prospect i ve population -based study of environmental factors in the aetiology of non-insulin-dependent diabetes mellitus . Of the men aged 70–88 years examined between March and May 1990 , 39 % were vitamin D depleted . After adjustment for confounding by age , BMI , physical activity , month of sampling , cigarette smoking and alcohol intake the 1-h glucose and area under the glucose curve during a st and ard 75-g oral glucose tolerance test ( OGTT ) were inversely associated with the serum concentration of 25-OH vitamin D ( r = −0.23 , p < 0.01 ; r = −0.26 , p < 0.01 , respectively ) . After excluding newly diagnosed diabetic patients total insulin concentrations during OGTT were also inversely associated with the concentration of 25-OH vitamin D ( r = −0.18 to −0.23 , p < 0.05 ) . Hypovitaminosis D may be a significant risk factor for glucose intolerance . [ Diabetologia ( 1997 ) 40 : 344–347 OBJECTIVE To study the association between vitamin D status and the risk of incident impaired fasting glucose ( IFG ) and diabetes  in a population -based cohort of diabetes-free subjects . RESEARCH DESIGN AND METHODS In a historical prospect i ve cohort study of subjects from the Clalit Health Services data base , which includes information on nearly 4 million people , diabetes-free subjects aged 40–70 years with serum 25-hydroxycholecalciferol ( 25-OHD ) measurements available were followed for 2 years to assess the development of IFG and diabetes in five 25-OHD subgroups : ≥25 , 25.1–37.5 , 37.6–50 , 50.1–75 , and > 75 nmol/L. RESULTS The baseline cohort included 117,960 adults : 83,526 normoglycemic subjects and 34,434 subjects with IFG . During follow-up , 8,629 subjects ( 10.3 % of the normoglycemic group ) developed IFG , and 2,162 subjects ( 1.8 % of the total cohort ) progressed to diabetes . A multivariable model adjusted for age , sex , population group , immigrant status , BMI , season of vitamin D measurement , LDL and HDL cholesterol , triglycerides , estimated glomerular filtration rate , history of hypertension or cardiovascular disease , Charlson comorbidity index , smoking , and socioeconomic status revealed an inverse association between 25-OHD and the risk of progression to IFG and diabetes . The odds of transitioning from normoglycemia to IFG , from normoglycemia to diabetes , and from IFG to diabetes in subjects with a 25-OHD level ≤25 nmol/L were greater than those of subjects with a 25-OHD level > 75 nmol/L [ odds ratio 1.13 ( 95 % CI 1.03–1.24 ) , 1.77 ( 1.11–2.83 ) , and 1.43 ( 1.16–1.76 ) , respectively ] . CONCLUSIONS Vitamin D deficiency appears to be an independent risk factor for the development of IFG and diabetes Background & objectives : Patients with diabetes and vitamin-D insufficiency have increased insulin resistance . Similar observations among individuals with prediabetes are not well documented . The aim of this study was to find the occurrence of vitamin-D insufficiency/deficiency among individuals with prediabetes and to evaluate the relationship between vitamin-D status and insulin resistance . Methods : One hundred fifty seven individuals with prediabetes who fulfilled all the inclusion and exclusion criteria underwent clinical examination , anthropometric measurements ( waist circumference , waist-hip ratio , waist-height ratio ) and blood sampling after overnight fast for estimation of fasting blood glucose , fasting insulin , 25(OH)vitamin-D , intact parathyroid hormone ( iPTH ) and lipid profile . One hour post 75 g glucose ( 1hPG ) blood glucose during oral glucose tolerance test was measured . Results : Vitamin-D deficiency/insufficiency was found in 115 ( 73.25 % ) individuals with prediabetes .  Severe vitamin-D deficiency ( < 10 ng/ml ) was seen in 14.65 per cent individuals . Individuals with the lowest vitamin-D levels ( < 10 ng/ml ) had the highest insulin resistance ( HOMA2-IR : 2.04 ± 0.67 ) . Serum 25(OH)D had a statistically significant inverse correlation with insulin resistance ( HOMA2-IR ; r=-0.33 ; P=0.008 ) , and positive correlation with insulin sensitivity ( QUICKI ; r=0.39 ; P=0.002 ) , after adjusting for BMI and HbA1c . There was no correlation between vitamin-D status and estimated beta cell mass ( HOMA-β ) . The mean waist-height ratio among individuals with prediabetes was 0.57 ( normal<0.5 ) indicating a high risk of cardiovascular morbidity . Individuals with elevated 1hPG>155 mg/dl had significantly higher BMI and worse insulin resistance , and 1hPG correlated well with 2 hour post glucose blood glucose ( r=0.57 ; P<0.001 ) . Interpretations & conclusions : Vitamin-D deficiency/insufficiency may have some role in the development/worsening of insulin resistance in individuals with prediabetes in our country who have a high cardiovascular risk . Prospect i ve studies on a large group of individuals need to be done to confirm the findings Objective Epidemiological studies have provided evidence of an association between vitamin D insufficiency and  type 2 diabetes .  Vitamin D levels have decreased among Inuit in Greenl and , and type 2 diabetes is increasing . We hypothesized that the decline in vitamin D could have contributed to the increase in type 2 diabetes , and therefore investigated associations between serum 25(OH)D3 as a measure of vitamin D status and glucose homeostasis and glucose intolerance in an adult Inuit population . Methods 2877 Inuit ( ≥18 years ) r and omly selected for participation in the Inuit Health in Transition study were included .  Fasting- and 2hour plasma glucose and insulin , C-peptide and HbA1c  were measured , and associations with serum 25(OH)D3 were analysed using linear and logistic regression . A sub sample of 330 individuals who also donated a blood sample in 1987 , were furthermore included . Results After adjustment , increasing serum 25(OH)D3 ( per 10 nmol/L ) was associated with higher fasting plasma glucose ( 0.02 mmol/L , p = 0.004 ) , 2hour plasma glucose ( 0.05 nmol/L , p = 0.002 ) and HbA1c ( 0.39 % , p<0.001 ) , and with lower beta-cell function ( -1.00 mmol/L , p<0.001 ) . Serum 25(OH)D3 was positively associated with impaired fasting glycaemia ( OR : 1.08 , p = 0.001 ) , but not with IGT or type 2 diabetes . Conclusions Our results did not support an association between low vitamin D levels and risk of type 2 diabetes . Instead , we found weak positive associations  between vitamin D levels and fasting- and 2hour plasma glucose levels , HbA1c and impaired fasting glycaemia , and a negative association with beta-cell function , underlining the need for determination of the causal relationship OBJECTIVE Vitamin D deficiency is associated with an unfavorable metabolic profile in observational studies . The intention was to compare insulin sensitivity ( the primary end point ) and secretion and lipids in subjects with low and high serum 25(OH)D ( 25-hydroxyvitamin D ) levels and to assess the effect of vitamin 
    Output:
    