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: AIMS To compare the effects of lifestyle modification programs that prescribe low-glycemic load ( GL ) vs. low-fat diets in a r and omized trial . METHODS Seventy-nine obese adults with type 2 diabetes received low-fat or low-GL dietary instruction , delivered in 40-week lifestyle modification programs with identical goals for calorie intake and physical activity . Changes in weight , HbA(1c ) , and other metabolic parameters were compared at weeks 20 and 40 . RESULTS Weight loss did not differ between groups at week 20 ( low-fat : -5.7±3.7 % ; low-GL : -6.7±4.4 % , p=.26 ) or week 40 ( low-fat : -4.5±7.5 % ; low-GL : -6.4±8.2 % , p=.28 ) . Adjusting for changes in antidiabetic medications , subjects on the low-GL diet had larger reductions in HbA(1c ) than those on the low-fat diet at week 20 ( low-fat : -0.3±0.6 % ; low-GL : -0.7±0.6 % , p=.01 ) , and week 40 ( low-fat : -0.1±1.2 % ; low-GL : -0.8±1.3 % ; p=.01 ) . Groups did not differ significantly on any other metabolic outcomes ( p≥.06 ) . CONCLUSIONS Results suggest that targeting GL , rather than dietary fat , in a low-calorie diet can significantly enhance the effect of weight loss on HbA(1c ) in patients with type 2 diabetes BACKGROUND AND AIMS Nutrition recommendations for type 2 diabetes ( T2DM ) are partly guided by the postpr and ial responses elicited by diets varying in carbohydrate ( CHO ) . We aim ed to explore whether long-term changes in postpr and ial responses on low-glycemic-index ( GI ) or low-CHO diets were due to acute or chronic effects in T2DM . METHODS AND RESULTS Subjects with diet-alone-treated T2DM were r and omly assigned to high-CHO/high-GI ( H ) , high-CHO/low-GI ( L ) , or low-CHO/high-monounsaturated-fat ( M ) diets for 12-months . At week-0 ( Baseline ) postpr and ial responses after H-meals ( 55 % CHO , GI = 61 ) were measured from 0800 h to 1600 h. After 12 mo subjects were r and omly assigned to H-meals or study diet meals ( L , 57 % CHO , GI = 50 ; M , 44 % CHO , GI = 61 ) . This yielded 5 groups : H diet with H-meals ( HH , n = 34 ) ; L diet with H- ( LH , n = 17 ) or L-meals ( LL , n = 16 ) ; and M diet with H- ( MH , n = 18 ) or M meals ( MM , n = 19 ) . Postpr and ial glucose fluctuations were lower in LL than all other groups ( p < 0.001 ) . Changes in postpr and ial-triglycerides differed among groups ( p < 0.001 ) . After 12 mo in HH and MM both fasting- and postpr and ial-triglycerides were similar to Baseline while in MH postpr and ial-triglycerides were significantly higher than at Baseline ( p = 0.028 ) . In LH , triglycerides were consistently ( 0.18 - 0.34 mmol/L ) higher than Baseline throughout the day , while in LL the difference from Baseline varied across the day from 0.04 to 0.36 mmol/L ( p < 0.001 ) . CONCLUSION Low-GI and low-CHO diets have both acute and chronic effects on postpr and ial glucose and triglycerides in T2DM subjects . Thus , the composition of the acute test-meal and the habitual diet should be considered when interpreting the nutritional implication s of different postpr and ial responses BACKGROUND Little is known about the effects of the amount and type of carbohydrates on risk of coronary heart disease ( CHD ) .  OBJECTIVE The objective of this study was to prospect ively evaluate the relations of the amount and type of carbohydrates with risk of CHD . DESIGN A cohort of 75521 women aged 38 - 63 y with no previous diagnosis of diabetes mellitus , myocardial infa rct ion , angina , stroke , or other cardiovascular diseases in 1984 was followed for 10 y. Each participant 's dietary glycemic load was calculated as a function of glycemic index , carbohydrate content , and frequency of intake of individual foods reported on a vali date d food-frequency question naire at baseline . All dietary variables were up date d in 1986 and 1990 . RESULTS During 10 y of follow-up ( 729472 person-years ) , 761 cases of CHD ( 208 fatal and 553 nonfatal ) were documented . Dietary glycemic load was directly associated with risk of CHD after adjustment for age , smoking status , total energy intake , and other coronary disease risk factors . The relative risks from the lowest to highest quintiles of glycemic load were 1.00 , 1.01 , 1 . 25 , 1.51 , and 1.98 ( 95 % CI : 1.41 , 2.77 for the highest quintile ; P for trend < 0.0001 ) . Carbohydrate classified by glycemic index , as opposed to its traditional classification as either simple or complex , was a better predictor of CHD risk . The association between dietary glycemic load and CHD risk was most evident among women with body weights above average ¿ ie , body mass index ( in kg/m(2 ) ) > /= 23 . CONCLUSION These epidemiologic data suggest that a high dietary glycemic load from refined carbohydrates increases the risk of CHD , independent of known coronary disease risk factors BACKGROUND Lowering the dietary glycemic load and increasing protein intake may be advantageous for weight management . OBJECTIVE This r and omized controlled trial was design ed to evaluate the effects of an ad libitum reduced-glycemic-load ( RGL ) diet on body weight , body composition , and cardiovascular disease ( CVD ) risk markers in overweight and obese adults during an initial weight-loss phase ( 12 wk ) and a weight-loss maintenance phase ( weeks 24 - 36 ) . DESIGN Subjects were assigned to  RGL ( n = 43 ) or low-fat , portion-controlled ( control ; n = 43 ) diet groups . The RGL group was instructed to eat until satisfied , maintaining a low carbohydrate intake during weeks 0 - 2 and adding low-glycemic-index carbohydrate thereafter . Control subjects were instructed to reduce fat intake and decrease portion sizes , with a targeted energy deficit of 500 to 800 kcal/d . RESULTS The RGL group had lost significantly more weight than did the control group at week 12 ( -4.9 and -2.5 kg , respectively ; P = 0.002 ) , but the 2 groups did not differ significantly at week 36 ( -4.5 and -2.6 kg , respectively ; P = 0.085 ) . Changes in fat mass differed between the groups at week 12 ( -1.9 and -0.9 kg , respectively ; P = 0.016 ) but not at week 36 ( -2.0 and -1.3 kg , respectively ; P = 0.333 ) . At the end of the study , no differences were found in responses for CVD risk markers except a larger mean change in HDL cholesterol in the RGL group than in the control group ( 3.8 and 1.9 mg/dL , respectively ; P = 0.037 ) . CONCLUSION These findings provide evidence that an ad libitum RGL diet is a reasonable alternative to a low-fat , portion-controlled eating plan for weight management Reducing the dietary glycemic load and the glycemic index was proposed as a novel approach to weight reduction . A parallel- design , r and omized 12-wk controlled feeding trial with a 24-wk follow-up phase was conducted to test the hypothesis that a hypocaloric diet design ed to reduce the glycemic load and the glycemic index would result in greater sustained weight loss than other hypocaloric diets . Obese subjects ( n = 29 ) were r and omly assigned to 1 of 3 diets providing 3138 kJ less than estimated energy needs : high glycemic index ( HGI ) , low glycemic index ( LGI ) , or high fat ( HF ) . For the first 12 wk , all food was provided to subjects ( feeding phase ) . Subjects ( n = 22 ) were instructed to follow the assigned diet for 24 additional weeks ( free-living phase ) . Total body weight was obtained and body composition was assessed by skinfold measurements . Insulin sensitivity was assessed by the homeostasis model ( HOMA ) . At 12 wk , weight changes from baseline were significant in all groups but not different among groups ( -9.3 + /- 1.3 kg for the HGI diet , -9.9 + /- 1.4 kg for the LGI diet , and -8.4 + /- 1.5 kg for the HF diet ) . All groups improved in insulin sensitivity at the end of the feeding phase of the study . During the free-living phase , all groups maintained their initial weight loss and their improved insulin sensitivity . Weight loss and improved insulin sensitivity scores were independent of diet composition . In summary , lowering the glycemic load and glycemic index of weight reduction diets does not provide any added benefit to energy restriction in promoting weight loss in obese subjects BACKGROUND The optimal nutritional approach for the prevention of cardiovascular disease among obese persons remains a topic of intense controversy . Available approaches range from conventional low-fat to very-low-carbohydrate diets . OBJECTIVE The aim of this pilot study was to evaluate the efficacy of an ad libitum low-glycemic load diet , without strict limitation on carbohydrate intake , as an alternative to a conventional low-fat diet . DESIGN A r and omized controlled trial compared 2 dietary treatments in obese young adults ( n = 23 ) over 12 mo . The experimental treatment emphasized ad libitum consumption of low-glycemic-index foods , with 45 - 50 % of energy from carbohydrates and 30 - 35 % from fat . The conventional treatment was restricted in energy ( 250 - 500 kcal/d deficit ) and fat ( < 30 % of energy ) , with 55 - 60 % of energy from carbohydrate . We compared changes in study outcomes by repeated- measures analysis of log-transformed data and expressed the results as mean percentage change . RESULTS Body weight decreased significantly over a 6-mo intensive intervention in both the experimental and conventional diet groups ( -8.4 % and -7.8 % , respectively ) and remained below baseline at 12 mo ( -7.8 % and -6.1 % , respectively ) . The experimental diet group showed a significantly greater mean decline in plasma triacylglycerols than did the conventional diet group ( -37.2 % and -19.1 % , respectively ; P = 0.005 ) . Mean plasminogen activator inhibitor 1 concentrations decreased ( -39.0 % ) in the experimental diet group but increased ( 33.1 % ) in the conventional diet group ( P = 0.004 ) . Changes in cholesterol concentrations , blood pressure , and insulin sensitivity did not differ significantly between the groups . CONCLUSION An ad libitum low-glycemic load diet may be more efficacious than a conventional , energy-restricted , low-fat diet in reducing cardiovascular disease risk BACKGROUND Despite interest in the glycemic index diets as an approach to weight control , few long-term evaluations are available . OBJECTIVE The objective was to investigate the long-term effect of a low-glycemic-index ( LGI ) diet compared with that of a high-glycemic-index ( HGI ) diet ; all other dietary components were equal . DESIGN After a 6-wk run-in , we r and omly assigned 203 healthy women [ body mass index ( in kg/m2 ) : 23 - 30 ] aged 25 - 45 y to an LGI or an HGI diet with a small energy restriction . The primary outcome measure was weight change at 18 mo . Secondary outcomes included hunger and fasting insulin and lipids . RESULTS Despite requiring a run-in and the use of multiple incentives , only 60 % of the subjects completed the study . The difference in glycemic index between the diets was approximately 35 - 40 units ( 40 compared with 79 ) during all 18 mo of follow-up , and the carbohydrate intake from energy remained at approximately 60 % in both groups . The LGI group had a slightly greater weight loss in the first 2 mo of follow-up ( -0.72 compared with -0.31 kg ) , but after 12 mo of follow-up both groups began to regain weight . After 18 mo , the weight change was not significantly different ( P = 0 
    Output:
    
agent
No significant changes were observed for blood lipids , anthropometric measures , HbA1c and fasting glucose .
The present systematic review provides evidence for beneficial effects of long-term interventions administering a low glycemic index/load diet with respect to fasting insulin and pro-inflammatory markers such as C-reactive protein which might prove to be helpful in the primary prevention of obesity-associated diseases
***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: AIMS To compare the effects of lifestyle modification programs that prescribe low-glycemic load ( GL ) vs. low-fat diets in a r and omized trial . METHODS Seventy-nine obese adults with type 2 diabetes received low-fat or low-GL dietary instruction , delivered in 40-week lifestyle modification programs with identical goals for calorie intake and physical activity . Changes in weight , HbA(1c ) , and other metabolic parameters were compared at weeks 20 and 40 . RESULTS Weight loss did not differ between groups at week 20 ( low-fat : -5.7±3.7 % ; low-GL : -6.7±4.4 % , p=.26 ) or week 40 ( low-fat : -4.5±7.5 % ; low-GL : -6.4±8.2 % , p=.28 ) . Adjusting for changes in antidiabetic medications , subjects on the low-GL diet had larger reductions in HbA(1c ) than those on the low-fat diet at week 20 ( low-fat : -0.3±0.6 % ; low-GL : -0.7±0.6 % , p=.01 ) , and week 40 ( low-fat : -0.1±1.2 % ; low-GL : -0.8±1.3 % ; p=.01 ) . Groups did not differ significantly on any other metabolic outcomes ( p≥.06 ) . CONCLUSIONS Results suggest that targeting GL , rather than dietary fat , in a low-calorie diet can significantly enhance the effect of weight loss on HbA(1c ) in patients with type 2 diabetes BACKGROUND AND AIMS Nutrition recommendations for type 2 diabetes ( T2DM ) are partly guided by the postpr and ial responses elicited by diets varying in carbohydrate ( CHO ) . We aim ed to explore whether long-term changes in postpr and ial responses on low-glycemic-index ( GI ) or low-CHO diets were due to acute or chronic effects in T2DM . METHODS AND RESULTS Subjects with diet-alone-treated T2DM were r and omly assigned to high-CHO/high-GI ( H ) , high-CHO/low-GI ( L ) , or low-CHO/high-monounsaturated-fat ( M ) diets for 12-months . At week-0 ( Baseline ) postpr and ial responses after H-meals ( 55 % CHO , GI = 61 ) were measured from 0800 h to 1600 h. After 12 mo subjects were r and omly assigned to H-meals or study diet meals ( L , 57 % CHO , GI = 50 ; M , 44 % CHO , GI = 61 ) . This yielded 5 groups : H diet with H-meals ( HH , n = 34 ) ; L diet with H- ( LH , n = 17 ) or L-meals ( LL , n = 16 ) ; and M diet with H- ( MH , n = 18 ) or M meals ( MM , n = 19 ) . Postpr and ial glucose fluctuations were lower in LL than all other groups ( p < 0.001 ) . Changes in postpr and ial-triglycerides differed among groups ( p < 0.001 ) . After 12 mo in HH and MM both fasting- and postpr and ial-triglycerides were similar to Baseline while in MH postpr and ial-triglycerides were significantly higher than at Baseline ( p = 0.028 ) . In LH , triglycerides were consistently ( 0.18 - 0.34 mmol/L ) higher than Baseline throughout the day , while in LL the difference from Baseline varied across the day from 0.04 to 0.36 mmol/L ( p < 0.001 ) . CONCLUSION Low-GI and low-CHO diets have both acute and chronic effects on postpr and ial glucose and triglycerides in T2DM subjects . Thus , the composition of the acute test-meal and the habitual diet should be considered when interpreting the nutritional implication s of different postpr and ial responses BACKGROUND Little is known about the effects of the amount and type of carbohydrates on risk of coronary heart disease ( CHD ) .  OBJECTIVE The objective of this study was to prospect ively evaluate the relations of the amount and type of carbohydrates with risk of CHD . DESIGN A cohort of 75521 women aged 38 - 63 y with no previous diagnosis of diabetes mellitus , myocardial infa rct ion , angina , stroke , or other cardiovascular diseases in 1984 was followed for 10 y. Each participant 's dietary glycemic load was calculated as a function of glycemic index , carbohydrate content , and frequency of intake of individual foods reported on a vali date d food-frequency question naire at baseline . All dietary variables were up date d in 1986 and 1990 . RESULTS During 10 y of follow-up ( 729472 person-years ) , 761 cases of CHD ( 208 fatal and 553 nonfatal ) were documented . Dietary glycemic load was directly associated with risk of CHD after adjustment for age , smoking status , total energy intake , and other coronary disease risk factors . The relative risks from the lowest to highest quintiles of glycemic load were 1.00 , 1.01 , 1 . 25 , 1.51 , and 1.98 ( 95 % CI : 1.41 , 2.77 for the highest quintile ; P for trend < 0.0001 ) . Carbohydrate classified by glycemic index , as opposed to its traditional classification as either simple or complex , was a better predictor of CHD risk . The association between dietary glycemic load and CHD risk was most evident among women with body weights above average ¿ ie , body mass index ( in kg/m(2 ) ) > /= 23 . CONCLUSION These epidemiologic data suggest that a high dietary glycemic load from refined carbohydrates increases the risk of CHD , independent of known coronary disease risk factors BACKGROUND Lowering the dietary glycemic load and increasing protein intake may be advantageous for weight management . OBJECTIVE This r and omized controlled trial was design ed to evaluate the effects of an ad libitum reduced-glycemic-load ( RGL ) diet on body weight , body composition , and cardiovascular disease ( CVD ) risk markers in overweight and obese adults during an initial weight-loss phase ( 12 wk ) and a weight-loss maintenance phase ( weeks 24 - 36 ) . DESIGN Subjects were assigned to  RGL ( n = 43 ) or low-fat , portion-controlled ( control ; n = 43 ) diet groups . The RGL group was instructed to eat until satisfied , maintaining a low carbohydrate intake during weeks 0 - 2 and adding low-glycemic-index carbohydrate thereafter . Control subjects were instructed to reduce fat intake and decrease portion sizes , with a targeted energy deficit of 500 to 800 kcal/d . RESULTS The RGL group had lost significantly more weight than did the control group at week 12 ( -4.9 and -2.5 kg , respectively ; P = 0.002 ) , but the 2 groups did not differ significantly at week 36 ( -4.5 and -2.6 kg , respectively ; P = 0.085 ) . Changes in fat mass differed between the groups at week 12 ( -1.9 and -0.9 kg , respectively ; P = 0.016 ) but not at week 36 ( -2.0 and -1.3 kg , respectively ; P = 0.333 ) . At the end of the study , no differences were found in responses for CVD risk markers except a larger mean change in HDL cholesterol in the RGL group than in the control group ( 3.8 and 1.9 mg/dL , respectively ; P = 0.037 ) . CONCLUSION These findings provide evidence that an ad libitum RGL diet is a reasonable alternative to a low-fat , portion-controlled eating plan for weight management Reducing the dietary glycemic load and the glycemic index was proposed as a novel approach to weight reduction . A parallel- design , r and omized 12-wk controlled feeding trial with a 24-wk follow-up phase was conducted to test the hypothesis that a hypocaloric diet design ed to reduce the glycemic load and the glycemic index would result in greater sustained weight loss than other hypocaloric diets . Obese subjects ( n = 29 ) were r and omly assigned to 1 of 3 diets providing 3138 kJ less than estimated energy needs : high glycemic index ( HGI ) , low glycemic index ( LGI ) , or high fat ( HF ) . For the first 12 wk , all food was provided to subjects ( feeding phase ) . Subjects ( n = 22 ) were instructed to follow the assigned diet for 24 additional weeks ( free-living phase ) . Total body weight was obtained and body composition was assessed by skinfold measurements . Insulin sensitivity was assessed by the homeostasis model ( HOMA ) . At 12 wk , weight changes from baseline were significant in all groups but not different among groups ( -9.3 + /- 1.3 kg for the HGI diet , -9.9 + /- 1.4 kg for the LGI diet , and -8.4 + /- 1.5 kg for the HF diet ) . All groups improved in insulin sensitivity at the end of the feeding phase of the study . During the free-living phase , all groups maintained their initial weight loss and their improved insulin sensitivity . Weight loss and improved insulin sensitivity scores were independent of diet composition . In summary , lowering the glycemic load and glycemic index of weight reduction diets does not provide any added benefit to energy restriction in promoting weight loss in obese subjects BACKGROUND The optimal nutritional approach for the prevention of cardiovascular disease among obese persons remains a topic of intense controversy . Available approaches range from conventional low-fat to very-low-carbohydrate diets . OBJECTIVE The aim of this pilot study was to evaluate the efficacy of an ad libitum low-glycemic load diet , without strict limitation on carbohydrate intake , as an alternative to a conventional low-fat diet . DESIGN A r and omized controlled trial compared 2 dietary treatments in obese young adults ( n = 23 ) over 12 mo . The experimental treatment emphasized ad libitum consumption of low-glycemic-index foods , with 45 - 50 % of energy from carbohydrates and 30 - 35 % from fat . The conventional treatment was restricted in energy ( 250 - 500 kcal/d deficit ) and fat ( < 30 % of energy ) , with 55 - 60 % of energy from carbohydrate . We compared changes in study outcomes by repeated- measures analysis of log-transformed data and expressed the results as mean percentage change . RESULTS Body weight decreased significantly over a 6-mo intensive intervention in both the experimental and conventional diet groups ( -8.4 % and -7.8 % , respectively ) and remained below baseline at 12 mo ( -7.8 % and -6.1 % , respectively ) . The experimental diet group showed a significantly greater mean decline in plasma triacylglycerols than did the conventional diet group ( -37.2 % and -19.1 % , respectively ; P = 0.005 ) . Mean plasminogen activator inhibitor 1 concentrations decreased ( -39.0 % ) in the experimental diet group but increased ( 33.1 % ) in the conventional diet group ( P = 0.004 ) . Changes in cholesterol concentrations , blood pressure , and insulin sensitivity did not differ significantly between the groups . CONCLUSION An ad libitum low-glycemic load diet may be more efficacious than a conventional , energy-restricted , low-fat diet in reducing cardiovascular disease risk BACKGROUND Despite interest in the glycemic index diets as an approach to weight control , few long-term evaluations are available . OBJECTIVE The objective was to investigate the long-term effect of a low-glycemic-index ( LGI ) diet compared with that of a high-glycemic-index ( HGI ) diet ; all other dietary components were equal . DESIGN After a 6-wk run-in , we r and omly assigned 203 healthy women [ body mass index ( in kg/m2 ) : 23 - 30 ] aged 25 - 45 y to an LGI or an HGI diet with a small energy restriction . The primary outcome measure was weight change at 18 mo . Secondary outcomes included hunger and fasting insulin and lipids . RESULTS Despite requiring a run-in and the use of multiple incentives , only 60 % of the subjects completed the study . The difference in glycemic index between the diets was approximately 35 - 40 units ( 40 compared with 79 ) during all 18 mo of follow-up , and the carbohydrate intake from energy remained at approximately 60 % in both groups . The LGI group had a slightly greater weight loss in the first 2 mo of follow-up ( -0.72 compared with -0.31 kg ) , but after 12 mo of follow-up both groups began to regain weight . After 18 mo , the weight change was not significantly different ( P = 0 
    Output:
    