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: In a r and omized , cross-over feeding trial involving 10 men with polygenic hypercholesterolemia , a control , Mediterranean-type cholesterol-lowering diet , and a diet of similar composition in which walnuts replaced approximately 35 % of energy from unsaturated fat , were given for 6 weeks each . Compared with the control diet , the walnut diet reduced serum total and LDL cholesterol by 4.2 % ( P = 0.176 ) , and 6.0 % ( P = 0.087 ) , respectively . No changes were observed in HDL cholesterol , triglycerides , and apolipoprotein A-I levels or in the relative proportion of protein , triglycerides , phospholipids , and cholesteryl esters in LDL particles . The apolipoprotein B level declined in parallel with LDL cholesterol ( 6.0 % reduction ) . Whole LDL , particularly the triglyceride fraction , was enriched in polyunsaturated fatty acids from walnuts ( linoleic and alpha-linolenic acids ) . In comparison with LDL obtained during the control diet , LDL obtained during the walnut diet showed a 50 % increase in association rates to the LDL receptor in human hepatoma HepG2 cells . LDL uptake by HepG2 cells was correlated with alpha-linolenic acid content of the triglyceride plus cholesteryl ester fractions of LDL particles ( r(2 ) = 0.42 , P < 0.05 ) . Changes in the quantity and quality of LDL lipid fatty acids after a walnut-enriched diet facilitate receptor-mediated LDL clearance and may contribute to the cholesterol-lowering effect of walnut consumption BACKGROUND Elevated serum cholesterol levels play an important role in the development of coronary artery disease . Previous studies have suggested that nut consumption benefits lipid profile .  Pistachio nuts are widely available , inexpensive and frequently consumed by the general population . OBJECTIVE To determine whether substituting 20 % of the daily caloric intake in the form of pistachio nuts will improve the lipid profiles of humans with primary , moderate hypercholesterolemia . DESIGN Controlled , r and omized crossover design . SETTING Outpatient dietary modification , counseling and blood analysis . PATIENTS Ten patients with moderate hypercholesterolemia . INTERVENTION Three weeks of dietary modification with 20 % caloric intake from pistachio nuts . MEASUREMENTS Body weight , blood pressure , total cholesterol , LDL , HDL , and triglycerides were monitored . Lipid profiles were analyzed prior to , during and after dietary modification . RESULTS After three weeks , there was a decrease in total cholesterol ( p<0.04 ) , an increase in HDL ( p<0.09 ) , a decrease in the total cholesterol/HDL ratio ( p<0.01 ) and a decrease in the LDL/HDL ratio ( p<0.02 ) . Triglycerides and LDL levels decreased , but not significantly . Body weight and blood pressure remained constant throughout the study . CONCLUSIONS Results suggest that eating pistachio nuts instead of other dietary fat calories can improve lipid profiles , thereby decreasing coronary risk . Further studies will be required to confirm these results and to determine the mechanism of this effect BACKGROUND AND AIMS Virgin olive oil ( VOO ) and nuts are basic components of the Mediterranean diet , a heart-healthy dietary pattern . Nuts have well known cholesterol lowering effects , while evidence is unclear for VOO . We design ed a study in hypercholesterolemic patients to assess the effects on serum lipids and other intermediate markers of cardiovascular risk of replacing 40 % of the fat in the background diet with VOO , walnuts or almonds . METHODS AND RESULTS After a 4 week run-in period with a healthy diet , eligible c and i date s were r and omized into three diet sequences in a crossover design , with a common background diet enriched with VOO , walnuts or almonds , lasting 4 weeks each . Outcomes were changes of serum lipids and oxidation and inflammation markers , measured by st and ard methods . Plasma fatty acids were determined by gas chromatography to assess compliance . In 18 participants completing the study ( 9 women , mean age 56 y , BMI 25.7 kg/m(2 ) ) , LDL-cholesterol was reduced from baseline by 7.3 % , 10.8 % and 13.4 % after the VOO , walnut and almond diets , respectively ( P = 0.001 , Friedman test ) . Total cholesterol and LDL/HDL ratios decreased in parallel . LDL-cholesterol decreases were greater than predicted from dietary fatty acid and cholesterol exchanges among diets . No changes of other lipid fractions , oxidation analytes or inflammatory biomarkers were observed . Plasma fatty acid changes after each diet sequence supported good compliance . CONCLUSION The results confirm the cholesterol lowering properties of nut-enriched diets . They also suggest that phenolic-rich VOO has a cholesterol lowering effect independently of its fatty acid content , which clearly deserves further study Nut consumption reduces cardiovascular risk , and reductions in blood pressure and peripheral vascular resistance may be important mediators of this relationship . We evaluated effects of pistachios on flow-mediated dilation and blood pressure response to acute stress . Twenty-eight adults with dyslipidemia completed a r and omized , crossover , controlled-feeding study . All of the meals were provided and calories were controlled . After 2 weeks on a typical Western diet ( 35 % total fat and 11 % saturated fat ) , test diets were presented in counterbalanced order for 4 weeks each , a low-fat control diet ( 25 % total fat and 8 % saturated fat ) , a diet containing 10 % of energy from pistachios ( on average , 1 serving per day ; 30 % total fat and 8 % saturated fat ) , and a diet containing 20 % of energy from pistachios ( on average , 2 servings per day , 34 % total fat and 8 % saturated fat ) . None of the resting hemodynamic measures significantly differed from pretreatment values . When resting and stress levels were included in the repeated- measures analysis , average reductions in systolic blood pressure were greater after the diet containing 1 serving per day versus 2 servings per day of pistachios ( mean change in systolic blood pressure , −4.8 vs −2.4 mm Hg , respectively ; P<0.05 ) . After the higher dose , there were significant reductions in peripheral resistance ( −62.1 dyne·s × cm−5 ) and heart rate ( −3 bpm ) versus the control diet ( P<0.0001 ) . These changes were partially offset by increases in cardiac output . There was no effect of diet on fasting flow-mediated dilation . Reductions in peripheral vascular constriction and the result ing decrease in hemodynamic load may be important contributors to lower risk in nut consumers BACKGROUND Dietary guidelines recommend interchanging protein foods ( e.g. , chicken for red meat ) , but they may be exchanged for carbohydrate-rich foods varying in quality [ glycemic load ( GL ) ] . Whether such exchanges occur and how they influence long-term weight gain are not established . OBJECTIVE Our objective was to determine how changes in intake of protein foods , GL , and their interrelationship influence long-term weight gain . DESIGN We investigated the association between 4-y changes in consumption of protein foods , GL , and their interaction with 4-y weight change over a 16- to 24-y follow-up , adjusted for other lifestyle changes ( smoking , physical activity , television watching , sleep duration ) , body mass index , and all dietary factors simultaneously in 3 prospect i ve US cohorts ( Nurses ' Health Study , Nurses ' Health Study II , and Health Professionals Follow-Up Study ) comprising 120,784 men and women free of chronic disease or obesity at baseline . RESULTS Protein foods were not interchanged with each other ( intercorrelations typically < |0.05| ) but with carbohydrate ( negative correlation as low as -0.39 ) . Protein foods had different relations with long-term weight gain , with positive associations for meats , chicken with skin , and regular cheese ( per increased serving/d , 0.13 - 1.17 kg ; P = 0.02 to P < 0.001 ) ; no association for milk , legumes , peanuts , or eggs ( P > 0.40 for each ) ; and relative weight loss for yogurt , peanut butter , walnuts , other nuts , chicken without skin , low-fat cheese , and seafood ( -0.14 to -0.71 kg ; P = 0.01 to P < 0.001 ) . Increases in GL were independently associated with a 0.42-kg greater weight gain per 50-unit increase ( P < 0.001 ) . Significant interactions ( P-interaction < 0.05 ) between changes in protein foods and GL were identified ; for example , increased cheese intake was associated with weight gain when GL increased , with weight stability when GL did not change , and with weight loss when exchanged for GL ( i.e. , decrease in GL ) . CONCLUSION Protein foods were commonly interchanged with carbohydrate , and changes in protein foods and GL interacted to influence long-term weight gain Frequent consumption of nuts is associated with decreased risk of cardiovascular disease . We investigated the effect of pecans rich in monounsaturated fat as an alternative to the Step 1 diet in modifying serum lipids and lipoproteins in men and women with normal to moderately high serum cholesterol . In a single-blind , r and omized , controlled , crossover feeding study , we assigned 23 subjects ( mean age : 38 y ; 9 women , 14 men ) to follow two diets , each for 4 wk : a Step I diet and a pecan-enriched diet ( accomplished by proportionately reducing all food items in a Step I diet by one fifth for a 20 % isoenergetic replacement with pecans ) . The percentage of energy from fat in the two diets was 28.3 and 39.6 % , respectively . Both diets improved the lipid profile ; however , the pecan-enriched diet decreased both serum total and LDL cholesterol by 0.32 mmol/L ( 6.7 and 10.4 % , respectively ) and triglyceride by 0.14 mmol/L ( 11.1 % ) beyond the Step I diet , while increasing HDL cholesterol by 0.06 mmol/L ( 2.5 mg/dL ) . Serum apolipoprotein B and lipoprotein(a ) decreased by 11.6 and 11.1 % , respectively , and apolipoprotein A1 increased by 2.2 % when subjects consumed the pecan compared with the Step I diet . These differences were all significant ( P < 0.05 ) . A 20 % isoenergetic replacement of a Step I diet with pecans favorably altered the serum lipid profile beyond the Step I diet , without increasing body weight .  Nuts such as pecans that are rich in monounsaturated fat may therefore be recommended as part of prescribed cholesterol-lowering diet of patients or habitual diet of healthy individuals BACKGROUND Frequent consumption of nuts may lower the risk of cardiovascular disease by favorably altering serum lipid and lipoprotein concentrations . OBJECTIVE We compared the effects of 2 amounts of almond intake with those of a National Cholesterol Education Program Step I diet on serum lipids , lipoproteins , apolipoproteins , and glucose in healthy and mildly hypercholesterolemic adults . DESIGN In a r and omized crossover design , 25 healthy subjects ( 14 men , 11 women ) with a mean ( + /- SD ) age of 41 + /- 13 y were fed 3 isoenergetic diets for 4 wk each after being fed a 2-wk run-in diet ( containing 34 % of energy from fat ) . The experimental diets included a Step I diet , a low-almond diet , and a high-almond diet , in which almonds contributed 0 % , 10 % , and 20 % of total energy , respectively . RESULTS Inverse relations were observed between the percentage of energy in the diet from almonds and the subject 's total cholesterol ( P value for trend < 0.001 ) , LDL-cholesterol ( P < 0.001 ) , and apolipoprotein B ( P < 0.001 ) concentrations and the ratios of LDL to HDL cholesterol ( P < 0.001 ) and of apolipoprotein B to apolipoprotein A ( P < 0.001 ) . Compared with the Step I diet , the high-almond diet reduced total cholesterol ( 0.24 mmol/L or 4.4 % ; P = 0.001 ) , LDL cholesterol ( 0.26 mmol/L or 7.0 % ; P < 0.001 ) , and apolipoprotein B ( 6.6 mg/dL or 6.6 % ; P < 0.001 ) ; increased HDL cholesterol ( 0.02 mmol/L or 1.7 % ; P = 0.08 ) ; and decreased the ratio of LDL to HDL ch 
    Output:
    
agent
Significant heterogeneity was not observed by nut type or other factors .
Tree nut intake  lowers total cholesterol , LDL cholesterol , ApoB , and triglycerides .
The major determinant of cholesterol lowering appears to be nut dose rather than nut type .
***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: In a r and omized , cross-over feeding trial involving 10 men with polygenic hypercholesterolemia , a control , Mediterranean-type cholesterol-lowering diet , and a diet of similar composition in which walnuts replaced approximately 35 % of energy from unsaturated fat , were given for 6 weeks each . Compared with the control diet , the walnut diet reduced serum total and LDL cholesterol by 4.2 % ( P = 0.176 ) , and 6.0 % ( P = 0.087 ) , respectively . No changes were observed in HDL cholesterol , triglycerides , and apolipoprotein A-I levels or in the relative proportion of protein , triglycerides , phospholipids , and cholesteryl esters in LDL particles . The apolipoprotein B level declined in parallel with LDL cholesterol ( 6.0 % reduction ) . Whole LDL , particularly the triglyceride fraction , was enriched in polyunsaturated fatty acids from walnuts ( linoleic and alpha-linolenic acids ) . In comparison with LDL obtained during the control diet , LDL obtained during the walnut diet showed a 50 % increase in association rates to the LDL receptor in human hepatoma HepG2 cells . LDL uptake by HepG2 cells was correlated with alpha-linolenic acid content of the triglyceride plus cholesteryl ester fractions of LDL particles ( r(2 ) = 0.42 , P < 0.05 ) . Changes in the quantity and quality of LDL lipid fatty acids after a walnut-enriched diet facilitate receptor-mediated LDL clearance and may contribute to the cholesterol-lowering effect of walnut consumption BACKGROUND Elevated serum cholesterol levels play an important role in the development of coronary artery disease . Previous studies have suggested that nut consumption benefits lipid profile .  Pistachio nuts are widely available , inexpensive and frequently consumed by the general population . OBJECTIVE To determine whether substituting 20 % of the daily caloric intake in the form of pistachio nuts will improve the lipid profiles of humans with primary , moderate hypercholesterolemia . DESIGN Controlled , r and omized crossover design . SETTING Outpatient dietary modification , counseling and blood analysis . PATIENTS Ten patients with moderate hypercholesterolemia . INTERVENTION Three weeks of dietary modification with 20 % caloric intake from pistachio nuts . MEASUREMENTS Body weight , blood pressure , total cholesterol , LDL , HDL , and triglycerides were monitored . Lipid profiles were analyzed prior to , during and after dietary modification . RESULTS After three weeks , there was a decrease in total cholesterol ( p<0.04 ) , an increase in HDL ( p<0.09 ) , a decrease in the total cholesterol/HDL ratio ( p<0.01 ) and a decrease in the LDL/HDL ratio ( p<0.02 ) . Triglycerides and LDL levels decreased , but not significantly . Body weight and blood pressure remained constant throughout the study . CONCLUSIONS Results suggest that eating pistachio nuts instead of other dietary fat calories can improve lipid profiles , thereby decreasing coronary risk . Further studies will be required to confirm these results and to determine the mechanism of this effect BACKGROUND AND AIMS Virgin olive oil ( VOO ) and nuts are basic components of the Mediterranean diet , a heart-healthy dietary pattern . Nuts have well known cholesterol lowering effects , while evidence is unclear for VOO . We design ed a study in hypercholesterolemic patients to assess the effects on serum lipids and other intermediate markers of cardiovascular risk of replacing 40 % of the fat in the background diet with VOO , walnuts or almonds . METHODS AND RESULTS After a 4 week run-in period with a healthy diet , eligible c and i date s were r and omized into three diet sequences in a crossover design , with a common background diet enriched with VOO , walnuts or almonds , lasting 4 weeks each . Outcomes were changes of serum lipids and oxidation and inflammation markers , measured by st and ard methods . Plasma fatty acids were determined by gas chromatography to assess compliance . In 18 participants completing the study ( 9 women , mean age 56 y , BMI 25.7 kg/m(2 ) ) , LDL-cholesterol was reduced from baseline by 7.3 % , 10.8 % and 13.4 % after the VOO , walnut and almond diets , respectively ( P = 0.001 , Friedman test ) . Total cholesterol and LDL/HDL ratios decreased in parallel . LDL-cholesterol decreases were greater than predicted from dietary fatty acid and cholesterol exchanges among diets . No changes of other lipid fractions , oxidation analytes or inflammatory biomarkers were observed . Plasma fatty acid changes after each diet sequence supported good compliance . CONCLUSION The results confirm the cholesterol lowering properties of nut-enriched diets . They also suggest that phenolic-rich VOO has a cholesterol lowering effect independently of its fatty acid content , which clearly deserves further study Nut consumption reduces cardiovascular risk , and reductions in blood pressure and peripheral vascular resistance may be important mediators of this relationship . We evaluated effects of pistachios on flow-mediated dilation and blood pressure response to acute stress . Twenty-eight adults with dyslipidemia completed a r and omized , crossover , controlled-feeding study . All of the meals were provided and calories were controlled . After 2 weeks on a typical Western diet ( 35 % total fat and 11 % saturated fat ) , test diets were presented in counterbalanced order for 4 weeks each , a low-fat control diet ( 25 % total fat and 8 % saturated fat ) , a diet containing 10 % of energy from pistachios ( on average , 1 serving per day ; 30 % total fat and 8 % saturated fat ) , and a diet containing 20 % of energy from pistachios ( on average , 2 servings per day , 34 % total fat and 8 % saturated fat ) . None of the resting hemodynamic measures significantly differed from pretreatment values . When resting and stress levels were included in the repeated- measures analysis , average reductions in systolic blood pressure were greater after the diet containing 1 serving per day versus 2 servings per day of pistachios ( mean change in systolic blood pressure , −4.8 vs −2.4 mm Hg , respectively ; P<0.05 ) . After the higher dose , there were significant reductions in peripheral resistance ( −62.1 dyne·s × cm−5 ) and heart rate ( −3 bpm ) versus the control diet ( P<0.0001 ) . These changes were partially offset by increases in cardiac output . There was no effect of diet on fasting flow-mediated dilation . Reductions in peripheral vascular constriction and the result ing decrease in hemodynamic load may be important contributors to lower risk in nut consumers BACKGROUND Dietary guidelines recommend interchanging protein foods ( e.g. , chicken for red meat ) , but they may be exchanged for carbohydrate-rich foods varying in quality [ glycemic load ( GL ) ] . Whether such exchanges occur and how they influence long-term weight gain are not established . OBJECTIVE Our objective was to determine how changes in intake of protein foods , GL , and their interrelationship influence long-term weight gain . DESIGN We investigated the association between 4-y changes in consumption of protein foods , GL , and their interaction with 4-y weight change over a 16- to 24-y follow-up , adjusted for other lifestyle changes ( smoking , physical activity , television watching , sleep duration ) , body mass index , and all dietary factors simultaneously in 3 prospect i ve US cohorts ( Nurses ' Health Study , Nurses ' Health Study II , and Health Professionals Follow-Up Study ) comprising 120,784 men and women free of chronic disease or obesity at baseline . RESULTS Protein foods were not interchanged with each other ( intercorrelations typically < |0.05| ) but with carbohydrate ( negative correlation as low as -0.39 ) . Protein foods had different relations with long-term weight gain , with positive associations for meats , chicken with skin , and regular cheese ( per increased serving/d , 0.13 - 1.17 kg ; P = 0.02 to P < 0.001 ) ; no association for milk , legumes , peanuts , or eggs ( P > 0.40 for each ) ; and relative weight loss for yogurt , peanut butter , walnuts , other nuts , chicken without skin , low-fat cheese , and seafood ( -0.14 to -0.71 kg ; P = 0.01 to P < 0.001 ) . Increases in GL were independently associated with a 0.42-kg greater weight gain per 50-unit increase ( P < 0.001 ) . Significant interactions ( P-interaction < 0.05 ) between changes in protein foods and GL were identified ; for example , increased cheese intake was associated with weight gain when GL increased , with weight stability when GL did not change , and with weight loss when exchanged for GL ( i.e. , decrease in GL ) . CONCLUSION Protein foods were commonly interchanged with carbohydrate , and changes in protein foods and GL interacted to influence long-term weight gain Frequent consumption of nuts is associated with decreased risk of cardiovascular disease . We investigated the effect of pecans rich in monounsaturated fat as an alternative to the Step 1 diet in modifying serum lipids and lipoproteins in men and women with normal to moderately high serum cholesterol . In a single-blind , r and omized , controlled , crossover feeding study , we assigned 23 subjects ( mean age : 38 y ; 9 women , 14 men ) to follow two diets , each for 4 wk : a Step I diet and a pecan-enriched diet ( accomplished by proportionately reducing all food items in a Step I diet by one fifth for a 20 % isoenergetic replacement with pecans ) . The percentage of energy from fat in the two diets was 28.3 and 39.6 % , respectively . Both diets improved the lipid profile ; however , the pecan-enriched diet decreased both serum total and LDL cholesterol by 0.32 mmol/L ( 6.7 and 10.4 % , respectively ) and triglyceride by 0.14 mmol/L ( 11.1 % ) beyond the Step I diet , while increasing HDL cholesterol by 0.06 mmol/L ( 2.5 mg/dL ) . Serum apolipoprotein B and lipoprotein(a ) decreased by 11.6 and 11.1 % , respectively , and apolipoprotein A1 increased by 2.2 % when subjects consumed the pecan compared with the Step I diet . These differences were all significant ( P < 0.05 ) . A 20 % isoenergetic replacement of a Step I diet with pecans favorably altered the serum lipid profile beyond the Step I diet , without increasing body weight .  Nuts such as pecans that are rich in monounsaturated fat may therefore be recommended as part of prescribed cholesterol-lowering diet of patients or habitual diet of healthy individuals BACKGROUND Frequent consumption of nuts may lower the risk of cardiovascular disease by favorably altering serum lipid and lipoprotein concentrations . OBJECTIVE We compared the effects of 2 amounts of almond intake with those of a National Cholesterol Education Program Step I diet on serum lipids , lipoproteins , apolipoproteins , and glucose in healthy and mildly hypercholesterolemic adults . DESIGN In a r and omized crossover design , 25 healthy subjects ( 14 men , 11 women ) with a mean ( + /- SD ) age of 41 + /- 13 y were fed 3 isoenergetic diets for 4 wk each after being fed a 2-wk run-in diet ( containing 34 % of energy from fat ) . The experimental diets included a Step I diet , a low-almond diet , and a high-almond diet , in which almonds contributed 0 % , 10 % , and 20 % of total energy , respectively . RESULTS Inverse relations were observed between the percentage of energy in the diet from almonds and the subject 's total cholesterol ( P value for trend < 0.001 ) , LDL-cholesterol ( P < 0.001 ) , and apolipoprotein B ( P < 0.001 ) concentrations and the ratios of LDL to HDL cholesterol ( P < 0.001 ) and of apolipoprotein B to apolipoprotein A ( P < 0.001 ) . Compared with the Step I diet , the high-almond diet reduced total cholesterol ( 0.24 mmol/L or 4.4 % ; P = 0.001 ) , LDL cholesterol ( 0.26 mmol/L or 7.0 % ; P < 0.001 ) , and apolipoprotein B ( 6.6 mg/dL or 6.6 % ; P < 0.001 ) ; increased HDL cholesterol ( 0.02 mmol/L or 1.7 % ; P = 0.08 ) ; and decreased the ratio of LDL to HDL ch 
    Output:
    