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: Some studies focused on the effect of the dietary glycemic index on lipoproteins and apolipoproteins in adults ; however , little evidence exists among adolescents regarding the effect of a low glycemic index ( LGI ) diet on apolipoproteins and lipoprotein ( a ) ( Lpa ) . This study was conducted to evaluate the effect of an LGI diet on the lipid profile , apolipoproteins and Lpa among overweight and obese adolescent girls . For this parallel design ed r and omized clinical trial , 50 healthy overweight/obese girls at pubertal ages were r and omly allocated to an LGI or a healthy nutritional recommendations ( HNR ) based diet . Equal macronutrient distributed diets were prescribed to both groups . Biochemical measurements included lipid profile , apolipoprotein A , apolipoprotein B and Lpa were conducted before and after 10 weeks of intervention . Forty one adolescent girls completed the study . The dietary glycemic index in the LGI group was 42.67 ± 0.067 . There were no differences in the mean of blood lipid indices baseline and after intervention between two groups . There were no significant differences between the two groups regarding lipid profiles , apolipoproteins and Lpa . There were no significant differences in lipid profiles , apolipoproteins and Lpa  between the LGI diet and the HNR-based diet and the impact of these two diets on lipid profile was equal in this trial . Trial registry code : I RCT 201109272839N4 The determine the effect of different foods on the blood glucose , 62 commonly eaten foods and sugars were fed individually to groups of 5 to 10 healthy fasting volunteers .  Blood glucose levels were measured over 2 h , and expressed as a percentage of the area under the glucose response curve when the same amount of carbohydrate was taken as glucose . The largest rises were seen with vegetables ( 70 + /- 5 % ) , followed by breakfast cereals ( 65 + /- 5 % ) , cereals and biscuits ( 60 + /- 3 % ) , fruit ( 50 + /- 5 % ) , dairy products ( 35 + /- 1 % ) , and dried legumes ( 31 + /- 3 % ) . A significant negative relationship was seen between fat ( p less than 0.01 ) and protein ( p less than 0.001 ) and postpr and ial glucose rise but not with fiber or sugar content BACKGROUND The possible advantage for weight loss of a diet that emphasizes protein , fat , or carbohydrates has not been established , and there are few studies that extend beyond 1 year . METHODS We r and omly assigned 811 overweight adults to one of four diets ; the targeted percentages of energy derived from fat , protein , and carbohydrates in the four diets were 20 , 15 , and 65 % ; 20 , 25 , and 55 % ; 40 , 15 , and 45 % ; and 40 , 25 , and 35 % . The diets consisted of similar foods and met guidelines for cardiovascular health . The participants were offered group and individual instructional sessions for 2 years . The primary outcome was the change in body weight after 2 years in two-by-two factorial comparisons of low fat versus high fat and average protein versus high protein and in the comparison of highest and lowest carbohydrate content . RESULTS At 6 months , participants assigned to each diet had lost an average of 6 kg , which represented 7 % of their initial weight ; they began to regain weight after 12 months . By 2 years , weight loss remained similar in those who were assigned to a diet with 15 % protein and those assigned to a diet with 25 % protein ( 3.0 and 3.6 kg , respectively ) ; in those assigned to a diet with 20 % fat and those assigned to a diet with 40 % fat ( 3.3 kg for both groups ) ; and in those assigned to a diet with 65 % carbohydrates and those assigned to a diet with 35 % carbohydrates ( 2.9 and 3.4 kg , respectively ) ( P>0.20 for all comparisons ) . Among the 80 % of participants who completed the trial , the average weight loss was 4 kg ; 14 to 15 % of the participants had a reduction of at least 10 % of their initial body weight . Satiety , hunger , satisfaction with the diet , and attendance at group sessions were similar for all diets ; attendance was strongly associated with weight loss ( 0.2 kg per session attended ) . The diets improved lipid-related risk factors and fasting insulin levels . CONCLUSIONS Reduced-calorie diets result in clinical ly meaningful weight loss regardless of which macronutrients they emphasize . ( Clinical Trials.gov number , NCT00072995 . OBJECTIVE This study examined the relation between quality of dietary carbohydrate intake , as measured by glycemic index ( GI ) and glycemic load ( GL ) , and serum high-sensitivity C-reactive protein ( hs-CRP ) levels . METHODS During a 1-y observational study , data were collected at baseline and at each quarter thereafter . GI and GL were calculated from multiple 24-h dietary recalls ( 24HRs ) , 3 r and omly selected 24HRs at every quarter , with up to 15 24HRs per participant . The  hs-CRP was measured in blood sample s collected at baseline and each of the four quarterly measurement points . Multivariable linear mixed models were used to examine the cross-sectional and longitudinal associations of GI , GL , and hs-CRP . RESULTS Among 582 adult men and women with at least two measurements of diet and hs-CRP , average daily GI score ( white bread = 100 ) was 85 and average GL was 198 , and average hs-CRP was 1.84 mg/L. Overall , there was no association between GI or GL and hs-CRP . Subgroup analyses revealed an inverse association between GL and hs-CRP  among obese individuals ( body mass index > or = 30 kg/m(2 ) ) . CONCLUSION Quality of dietary carbohydrates does not appear to be associated with serum hs-CRP levels .  Among obese individuals , higher dietary GL appears to be related to lower hs-CRP levels . Due to the limited number of studies on this topic and their conflicting results , further investigation is warranted BACKGROUND Fatty liver is highly prevalent among obese children and represents a major risk factor for chronic liver diseases and severe metabolic complications . METHODS We r and omly assigned 17 obese children 8 - 17 years of age with fatty liver to either an experimental low-glycemic-load or conventional low-fat diet for 6 months . Participants in both groups received nutrition education and behavioral counseling of equal intensity . The primary outcome was hepatic lipid content measured by proton magnetic resonance spectroscopy . Secondary outcomes included change in visceral fat , BMI , anthropometrics , alanine aminotransferase ( ALT ) , and insulin resistance . RESULTS A total of 16 participants completed the study . Reported glycemic load decreased in the low-glycemic-load group and reported dietary fat decreased in the low-fat group . At baseline , liver fat was 23.8 % [ st and ard deviation ( SD ) 12.2 ] in the low-glycemic-load group and 29.3 % ( 14.1 ) in the low-fat group . Liver fat decreased substantially in both groups at 6 months expressed as absolute percentage change , with no between-group differences [ -8.8 ( st and ard error ( SE ) 4.1 ) vs. -10.5 (3.7)% , respectively , p=0.76 for group × time interaction ] . Secondary outcomes also improved on both diets , with no between-group differences . Baseline and change in ALT were strongly associated with hepatic fat content . CONCLUSIONS Weight-reducing diets focused either on glycemic load or dietary fat improved hepatic steatosis over 6 months . Additional research is needed to determine whether these diets differ in effectiveness over the long term . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00480922 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To test the utility of homeostasis model assessment ( HOMA ) in predicting insulin sensitivity [ x10(- 4 ) min(-1)/(microIU/ml ) ] in children and to develop and compare two new prediction equations for insulin sensitivity in children using demographic and anthropometric measures in the presence or absence of fasting insulin . RESEARCH DESIGN AND METHODS We studied 156 white and African-American children with complete data ( mean age 9.7 + /- 1.8 years , 87.8 % Tanner Stage 1 or 2 ) . For development of new equations , two-thirds of the children were r and omly assigned to a development group , whereas the remaining children were assigned to a cross-validation group . RESULTS A modified HOMA equation accurately predicted insulin sensitivity , but its utility is similar to fasting insulin alone . Demographic and anthropometric measures alone did not predict insulin sensitivity accurately , even when precise measures of body composition were included in the prediction model . Ethnicity , calf skinfold , and fasting insulin together explained 73 % of the variance in insulin sensitivity and accurately predicted insulin sensitivity . The regression of measured versus predicted insulin sensitivity in the cross-validation group was not significantly different from the line of identity ( P > 0.05 ) . Mean difference between measured and predicted insulin sensitivity was also not significant ( P > 0.05 ) . Some bias was apparent , particularly in white boys . CONCLUSIONS Ethnicity , calf skinfold , and fasting insulin can accurately predict insulin sensitivity with greater precision than HOMA or fasting insulin alone ( R(2 ) = 0.73 ) . Future studies , however , are needed to examine whether a universal equation is possible . A cross-vali date d prediction equation may be useful in population -based studies when complex measures of insulin sensitivity are not available Background The role of a low glycemic index ( GI ) diet in the management of adolescent obesity remains controversial . In this study , we aim to evaluate the impact of low GI diet versus a conventional Chinese diet on the body mass index ( BMI ) and other obesity indices of obese adolescents . Methods Obese adolescents aged 15–18 years were identified from population -recruited , territory-wide surveys . Obesity was defined as BMI ≥95th percentile of Hong Kong local age- and sex-specific references . Eligible subjects were r and omized to either an intervention with low GI diet ( consisting of 45 - 50 % carbohydrate , 30 - 35 % fat and 15 - 20 % protein ) or conventional Chinese diet as control ( consisting of 55 - 60 % carbohydrate , 25 - 30 % fat and 10 - 15 % protein ) . We used r and om intercept mixed effects model to compare the differential changes across the time points from baseline to month 6 between the 2 groups . Results 104 obese adolescents were recruited ( 52 in low GI group and 52 in control group ; 43.3 % boys ) . Mean age was 16.7 ± 1.0 years and 16.8 ±1.0 years in low GI and control group respectively . 58.7 % subjects completed the study at 6 months ( 65.4 % in low GI group and 51.9 % in control group ) . After adjustment for age and sex , subjects in the low GI group had a significantly greater reduction in obesity indices including BMI , body weight and waist circumference ( WC ) compared to subjects in the control group ( all p < 0.05 ) . After further adjustment for physical activity levels , WC was found to be significantly lower in the low GI group compared to the conventional group ( p = 0.018 ) . Conclusion Low GI diet in the context of a comprehensive lifestyle modification program may be an alternative to conventional diet in the management of obese adolescents . Trial registration number Clinical Trials.gov Ref . No : OBJECTIVE To examine prospect ively the relationship between glycemic diets , low fiber intake , and risk of non-insulin-dependent diabetes mellitus .  DESIGN Cohort study . SETTING In 1986 , a total of 65173 US women 40 to 65 years of age and free from diagnosed cardiovascular disease , cancer , and diabetes completed a detailed dietary question naire from which we calculated usual intake of total and specific sources of dietary fiber , dietary glycemic index , and glycemic load . MAIN OUTCOME MEASURE Non-insulin-dependent diabetes mellitus . RESULTS During 6 years of follow-up , 915 incident cases of diabetes  were documented . The dietary glycemic index was positively associated with risk of diabetes after adjustment for age , body mass index , smoking , physical activity , family history of diabetes , alcohol and cereal fiber intake , and total energy intake . Comparing the highest with the lowest quintile , the relative risk ( RR ) of diabetes was 1.37 ( 95 % confidence interval [ CI ] , 1.09 - 1. 
    Output:
    
agent
Other parameters under investigation were not affected by either low or high glycaemic indices .
The present systematic review and meta- analysis provides evidence of a beneficial effect of a low glycaemic index/load diet in children and adolescents being either overweight or obese .
***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: Some studies focused on the effect of the dietary glycemic index on lipoproteins and apolipoproteins in adults ; however , little evidence exists among adolescents regarding the effect of a low glycemic index ( LGI ) diet on apolipoproteins and lipoprotein ( a ) ( Lpa ) . This study was conducted to evaluate the effect of an LGI diet on the lipid profile , apolipoproteins and Lpa among overweight and obese adolescent girls . For this parallel design ed r and omized clinical trial , 50 healthy overweight/obese girls at pubertal ages were r and omly allocated to an LGI or a healthy nutritional recommendations ( HNR ) based diet . Equal macronutrient distributed diets were prescribed to both groups . Biochemical measurements included lipid profile , apolipoprotein A , apolipoprotein B and Lpa were conducted before and after 10 weeks of intervention . Forty one adolescent girls completed the study . The dietary glycemic index in the LGI group was 42.67 ± 0.067 . There were no differences in the mean of blood lipid indices baseline and after intervention between two groups . There were no significant differences between the two groups regarding lipid profiles , apolipoproteins and Lpa . There were no significant differences in lipid profiles , apolipoproteins and Lpa  between the LGI diet and the HNR-based diet and the impact of these two diets on lipid profile was equal in this trial . Trial registry code : I RCT 201109272839N4 The determine the effect of different foods on the blood glucose , 62 commonly eaten foods and sugars were fed individually to groups of 5 to 10 healthy fasting volunteers .  Blood glucose levels were measured over 2 h , and expressed as a percentage of the area under the glucose response curve when the same amount of carbohydrate was taken as glucose . The largest rises were seen with vegetables ( 70 + /- 5 % ) , followed by breakfast cereals ( 65 + /- 5 % ) , cereals and biscuits ( 60 + /- 3 % ) , fruit ( 50 + /- 5 % ) , dairy products ( 35 + /- 1 % ) , and dried legumes ( 31 + /- 3 % ) . A significant negative relationship was seen between fat ( p less than 0.01 ) and protein ( p less than 0.001 ) and postpr and ial glucose rise but not with fiber or sugar content BACKGROUND The possible advantage for weight loss of a diet that emphasizes protein , fat , or carbohydrates has not been established , and there are few studies that extend beyond 1 year . METHODS We r and omly assigned 811 overweight adults to one of four diets ; the targeted percentages of energy derived from fat , protein , and carbohydrates in the four diets were 20 , 15 , and 65 % ; 20 , 25 , and 55 % ; 40 , 15 , and 45 % ; and 40 , 25 , and 35 % . The diets consisted of similar foods and met guidelines for cardiovascular health . The participants were offered group and individual instructional sessions for 2 years . The primary outcome was the change in body weight after 2 years in two-by-two factorial comparisons of low fat versus high fat and average protein versus high protein and in the comparison of highest and lowest carbohydrate content . RESULTS At 6 months , participants assigned to each diet had lost an average of 6 kg , which represented 7 % of their initial weight ; they began to regain weight after 12 months . By 2 years , weight loss remained similar in those who were assigned to a diet with 15 % protein and those assigned to a diet with 25 % protein ( 3.0 and 3.6 kg , respectively ) ; in those assigned to a diet with 20 % fat and those assigned to a diet with 40 % fat ( 3.3 kg for both groups ) ; and in those assigned to a diet with 65 % carbohydrates and those assigned to a diet with 35 % carbohydrates ( 2.9 and 3.4 kg , respectively ) ( P>0.20 for all comparisons ) . Among the 80 % of participants who completed the trial , the average weight loss was 4 kg ; 14 to 15 % of the participants had a reduction of at least 10 % of their initial body weight . Satiety , hunger , satisfaction with the diet , and attendance at group sessions were similar for all diets ; attendance was strongly associated with weight loss ( 0.2 kg per session attended ) . The diets improved lipid-related risk factors and fasting insulin levels . CONCLUSIONS Reduced-calorie diets result in clinical ly meaningful weight loss regardless of which macronutrients they emphasize . ( Clinical Trials.gov number , NCT00072995 . OBJECTIVE This study examined the relation between quality of dietary carbohydrate intake , as measured by glycemic index ( GI ) and glycemic load ( GL ) , and serum high-sensitivity C-reactive protein ( hs-CRP ) levels . METHODS During a 1-y observational study , data were collected at baseline and at each quarter thereafter . GI and GL were calculated from multiple 24-h dietary recalls ( 24HRs ) , 3 r and omly selected 24HRs at every quarter , with up to 15 24HRs per participant . The  hs-CRP was measured in blood sample s collected at baseline and each of the four quarterly measurement points . Multivariable linear mixed models were used to examine the cross-sectional and longitudinal associations of GI , GL , and hs-CRP . RESULTS Among 582 adult men and women with at least two measurements of diet and hs-CRP , average daily GI score ( white bread = 100 ) was 85 and average GL was 198 , and average hs-CRP was 1.84 mg/L. Overall , there was no association between GI or GL and hs-CRP . Subgroup analyses revealed an inverse association between GL and hs-CRP  among obese individuals ( body mass index > or = 30 kg/m(2 ) ) . CONCLUSION Quality of dietary carbohydrates does not appear to be associated with serum hs-CRP levels .  Among obese individuals , higher dietary GL appears to be related to lower hs-CRP levels . Due to the limited number of studies on this topic and their conflicting results , further investigation is warranted BACKGROUND Fatty liver is highly prevalent among obese children and represents a major risk factor for chronic liver diseases and severe metabolic complications . METHODS We r and omly assigned 17 obese children 8 - 17 years of age with fatty liver to either an experimental low-glycemic-load or conventional low-fat diet for 6 months . Participants in both groups received nutrition education and behavioral counseling of equal intensity . The primary outcome was hepatic lipid content measured by proton magnetic resonance spectroscopy . Secondary outcomes included change in visceral fat , BMI , anthropometrics , alanine aminotransferase ( ALT ) , and insulin resistance . RESULTS A total of 16 participants completed the study . Reported glycemic load decreased in the low-glycemic-load group and reported dietary fat decreased in the low-fat group . At baseline , liver fat was 23.8 % [ st and ard deviation ( SD ) 12.2 ] in the low-glycemic-load group and 29.3 % ( 14.1 ) in the low-fat group . Liver fat decreased substantially in both groups at 6 months expressed as absolute percentage change , with no between-group differences [ -8.8 ( st and ard error ( SE ) 4.1 ) vs. -10.5 (3.7)% , respectively , p=0.76 for group × time interaction ] . Secondary outcomes also improved on both diets , with no between-group differences . Baseline and change in ALT were strongly associated with hepatic fat content . CONCLUSIONS Weight-reducing diets focused either on glycemic load or dietary fat improved hepatic steatosis over 6 months . Additional research is needed to determine whether these diets differ in effectiveness over the long term . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00480922 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To test the utility of homeostasis model assessment ( HOMA ) in predicting insulin sensitivity [ x10(- 4 ) min(-1)/(microIU/ml ) ] in children and to develop and compare two new prediction equations for insulin sensitivity in children using demographic and anthropometric measures in the presence or absence of fasting insulin . RESEARCH DESIGN AND METHODS We studied 156 white and African-American children with complete data ( mean age 9.7 + /- 1.8 years , 87.8 % Tanner Stage 1 or 2 ) . For development of new equations , two-thirds of the children were r and omly assigned to a development group , whereas the remaining children were assigned to a cross-validation group . RESULTS A modified HOMA equation accurately predicted insulin sensitivity , but its utility is similar to fasting insulin alone . Demographic and anthropometric measures alone did not predict insulin sensitivity accurately , even when precise measures of body composition were included in the prediction model . Ethnicity , calf skinfold , and fasting insulin together explained 73 % of the variance in insulin sensitivity and accurately predicted insulin sensitivity . The regression of measured versus predicted insulin sensitivity in the cross-validation group was not significantly different from the line of identity ( P > 0.05 ) . Mean difference between measured and predicted insulin sensitivity was also not significant ( P > 0.05 ) . Some bias was apparent , particularly in white boys . CONCLUSIONS Ethnicity , calf skinfold , and fasting insulin can accurately predict insulin sensitivity with greater precision than HOMA or fasting insulin alone ( R(2 ) = 0.73 ) . Future studies , however , are needed to examine whether a universal equation is possible . A cross-vali date d prediction equation may be useful in population -based studies when complex measures of insulin sensitivity are not available Background The role of a low glycemic index ( GI ) diet in the management of adolescent obesity remains controversial . In this study , we aim to evaluate the impact of low GI diet versus a conventional Chinese diet on the body mass index ( BMI ) and other obesity indices of obese adolescents . Methods Obese adolescents aged 15–18 years were identified from population -recruited , territory-wide surveys . Obesity was defined as BMI ≥95th percentile of Hong Kong local age- and sex-specific references . Eligible subjects were r and omized to either an intervention with low GI diet ( consisting of 45 - 50 % carbohydrate , 30 - 35 % fat and 15 - 20 % protein ) or conventional Chinese diet as control ( consisting of 55 - 60 % carbohydrate , 25 - 30 % fat and 10 - 15 % protein ) . We used r and om intercept mixed effects model to compare the differential changes across the time points from baseline to month 6 between the 2 groups . Results 104 obese adolescents were recruited ( 52 in low GI group and 52 in control group ; 43.3 % boys ) . Mean age was 16.7 ± 1.0 years and 16.8 ±1.0 years in low GI and control group respectively . 58.7 % subjects completed the study at 6 months ( 65.4 % in low GI group and 51.9 % in control group ) . After adjustment for age and sex , subjects in the low GI group had a significantly greater reduction in obesity indices including BMI , body weight and waist circumference ( WC ) compared to subjects in the control group ( all p < 0.05 ) . After further adjustment for physical activity levels , WC was found to be significantly lower in the low GI group compared to the conventional group ( p = 0.018 ) . Conclusion Low GI diet in the context of a comprehensive lifestyle modification program may be an alternative to conventional diet in the management of obese adolescents . Trial registration number Clinical Trials.gov Ref . No : OBJECTIVE To examine prospect ively the relationship between glycemic diets , low fiber intake , and risk of non-insulin-dependent diabetes mellitus .  DESIGN Cohort study . SETTING In 1986 , a total of 65173 US women 40 to 65 years of age and free from diagnosed cardiovascular disease , cancer , and diabetes completed a detailed dietary question naire from which we calculated usual intake of total and specific sources of dietary fiber , dietary glycemic index , and glycemic load . MAIN OUTCOME MEASURE Non-insulin-dependent diabetes mellitus . RESULTS During 6 years of follow-up , 915 incident cases of diabetes  were documented . The dietary glycemic index was positively associated with risk of diabetes after adjustment for age , body mass index , smoking , physical activity , family history of diabetes , alcohol and cereal fiber intake , and total energy intake . Comparing the highest with the lowest quintile , the relative risk ( RR ) of diabetes was 1.37 ( 95 % confidence interval [ CI ] , 1.09 - 1. 
    Output:
    