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: BACKGROUND Adherence to a Mediterranean diet may improve longevity , but relevant data are limited . METHODS We conducted a population -based , prospect i ve investigation involving 22,043 adults in Greece who completed an extensive , vali date d , food-frequency question naire at base line .  Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean-diet scale that incorporated the salient characteristics of this diet ( range of scores , 0 to 9 , with higher scores indicating greater adherence ) . We used proportional-hazards regression to assess the relation between adherence to the Mediterranean diet and total mortality , as well as mortality due to coronary heart disease and mortality due to cancer , with adjustment for age , sex , body-mass index , physical-activity level , and other potential confounders . RESULTS During a median of 44 months of follow-up , there were 275 deaths . A higher degree of adherence to the Mediterranean diet was associated with a reduction in total mortality ( adjusted hazard ratio for death associated with a two-point increment in the Mediterranean-diet score , 0.75 [ 95 percent confidence interval , 0.64 to 0.87 ] ) . An inverse association with greater adherence to this diet was evident for both death due to coronary heart disease ( adjusted hazard ratio , 0.67 [ 95 percent confidence interval , 0.47 to 0.94 ] ) and death due to cancer ( adjusted hazard ratio , 0.76 [ 95 percent confidence interval , 0.59 to 0.98 ] ) . Associations between individual food groups contributing to the Mediterranean-diet score and total mortality were generally not significant . CONCLUSIONS Greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality BACKGROUND Greater adherence to the Mediterranean diet has been associated with a lower incidence of cardiovascular disease and cancer . OBJECTIVE We studied the effect of the Mediterranean diet on total antioxidant capacity ( TAC ) in 3042 participants who had no clinical evidence of cardiovascular disease . DESIGN During 2001 - 2002 , a r and om sample of 1514 men and 1528 women aged 18 - 89 y from the Attica area of Greece was selected .  TAC was measured with an immune-diagnostic assay . Food consumption was evaluated with a vali date d food-frequency question naire , and adherence to the Mediterranean diet was assessed on the basis of a diet score that incorporated the inherent characteristics of this diet . RESULTS TAC was positively correlated with diet score . The participants in the highest tertile of the diet score had , on average , 11 % higher TAC levels than did the participants in the lowest tertile , even after adjustment for relevant confounders ( P < 0.01 ) . On the other h and , the participants in the highest tertile of the diet score had , on average , 19 % lower oxidized LDL-cholesterol concentrations than did the participants in the lowest tertile ( P < 0.01 ) . An additional analysis showed that TAC was positively correlated with the consumption of olive oil ( rho = 0.54 , P = 0.002 ) and of fruit and vegetables ( rho = 0.34 and rho = 0.31 , respectively ; P < 0.001 for both ) , whereas it was inversely associated with the consumption of red meat ( rho = -0.35 , P = 0.02 ) . CONCLUSION Greater adherence to the Mediterranean diet is associated with elevated TAC levels and low oxidized LDL-cholesterol concentrations , which may explain the beneficial role of this diet on the cardiovascular system Objective : To compare the dietary intake of Chinese people living in Pan Yu , Hong Kong , San Francisco and Sydney with respect to cardiovascular health , using the Mediterranean diet score , examining the effects of age , gender , urbanization and acculturation on the diet score . Subjects : A total of 500 men and 510 women in Hong Kong were recruited as a territory-wide stratified r and om sample . Subjects were recruited in response to  local advertisements for the other three sites : Pan Yu , 58 men , 95 women ; San Francisco , 166 men , 192 women ; Sydney , 95 men , 73 women . Method : Food-frequency question naire over a 7 week period . A high/healthy score was taken as ≥4 for men and ≥3 for women , representing a dietary pattern beneficial for cardiovascular health . Results : In Hong Kong , more women in the middle age group ( 35–54 ) had a high score than other age groups , and overall more women had high scores than men . In comparing the four geographical regions , Pan Yu had the highest number of subjects with high score , and Hong Kong had the lowest . With the exception of the younger population and men in Hong Kong , the percentage of the population with a high score in all sites is greater than among elderly Greeks consuming a more traditional heart-healthy Mediterranean diet . Conclusion : Considerable variations in Chinese dietary patterns exist with respect to age , gender and geographic location . Overall , the Chinese diet is comparable to the Mediterranean diet and may be expected to have similar health benefits that have been documented for the traditional Mediterranean diet . European Journal of Clinical Nutrition ( 2001 ) 55 , Epidemiological studies show that adherence to a Mediterranean diet ( MD ) increases longevity ; however , few studies are restricted to Mediterranean population s or explore the effect of a MD pattern that directly incorporates olive oil . Therefore the relationship between adherence to the MD and mortality was studied within the the Spanish cohort of the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC-Spain ) . The EPIC-Spain analysis included 40 622 participants ( 37·7 % males ) aged 29 - 69 years who were recruited from five Spanish regions in 1992 - 1996 . During a mean follow-up of 13·4 years , 1855 deaths were documented : 913 from cancer , 399 from CVD , 425 from other causes and 118 from unknown causes of death . Risk of all-cause and cause-specific mortality was assessed according to the level of adherence to a relative MD ( rMED ) score , measured using an 18-unit scale incorporating nine selected dietary components . A high compared with a low rMED score was associated with a significant reduction in mortality from all causes ( hazard ratio ( HR ) 0·79 ; 95 % CI 0·69 , 0·91 ) , from CVD ( HR 0·66 ; 95 % CI 0·49 , 0·89 ) , but not from overall cancer ( HR 0·92 ; 95 % CI 0·75 , 1·12 ) . A 2-unit increase in rMED score was associated with a 6 % ( P < 0·001 ) decreased risk of all-cause mortality . A high olive oil intake and moderate alcohol consumption contributed most to this association . In this Spanish cohort , following an olive oil-rich MD was related to a significant reduction in all-cause mortality , and reduced the risk of mortality from CVD . These results support the important role that the MD pattern has on reducing mortality in Mediterranean countries Abstract Objective To examine whether adherence to the modified Mediterranean diet , in which unsaturates were substituted for monounsaturates , is associated with longer life expectancy among elderly Europeans . Design Multicentre , prospect i ve cohort study . Setting Nine European countries ( Denmark , France , Germany , Greece , Italy , the Netherl and s , Spain , Sweden , United Kingdom ) . Participants 74 607 men and women , aged 60 or more , without coronary heart disease , stroke , or cancer at enrolment and with complete information about dietary intake and potentially confounding variables . Main outcome measures Extent of adherence to a modified Mediterranean diet  using a scoring system on a 10 point scale , and death from any cause by time of occurrence , modelled through Cox regression . Results An increase in the modified Mediterranean diet score was associated with lower overall mortality , a two unit increment corresponding to a statistically significant reduction of 8 % ( 95 % confidence interval 3 % to 12 % ) . No statistically significant evidence of heterogeneity was found among countries in the association of the score with overall mortality even though the association was stronger in Greece and Spain . When dietary exposures were calibrated across countries , the reduction in mortality was 7 % ( 1 % to 12 % ) . Conclusion The Mediterranean diet , modified so as to apply across Europe , was associated with increased survival among older people OBJECTIVE A Mediterranean diet quality index ( MDQI ) was devised to give an overall assessment of dietary habits and to identify groups at risk . DESIGN The MDQI was based on scores given for selected levels of consumption of selected nutrients and foods . SETTING Mediterranean southern France . SUBJECTS The sample included 473 men and 491 women in three age classes recruited at r and om . RESULTS Only 9.5 % of men , 9.0 % of women , 4.7 % of 20 - 34 year old subjects , 6.6 % of 35 - 54 year old subjects and 14.0 % of 55 - 76 year old subjects were shown to have a healthy diet . However , 10.1 % of men , 8.6 % of women , 19.4 % of 20 - 34 year old subjects , 10.2 % of 35 - 54 year old subjects and 4.6 % of 55 - 76 year old subjects were shown to have a poor diet . There were significantly fewer smokers among subjects with a good diet but the distribution of moderate wine drinkers was comparable between those with a good diet and those with a poor diet . Correspondence analysis associated a healthy diet with 55 - 76 year old men and women living in rural areas , who had received primary schooling only and who were manual workers . Both men and women with a poor MDQI score tended to be young and smokers . In addition , women with a poor MDQI tended to be heavy drinkers and obese . CONCLUSIONS This study showed that the Mediterranean model , which is generally recognized as a healthy diet , appears restricted to older people and to rural areas , whereas urbanized young people depart from it . A nutritional prevention policy targeted at young adults is required to encourage them to adhere to the Mediterranean model . Smoking and drinking showed different distribution patterns in the sample under study Summary . Background : A prospect i ve cohort study with university level participants was initiated to study the effect of Mediterranean diet on health . Aims : The objective of this study was to identify possible lifestyle and socioeconomic variables associated with the consumption of a Mediterranean dietary pattern ( MDP ) . Method : This analysis includes 1587 males and 2260 females . MDP was defined “ a priori ” by summing the st and ardized residuals of nutrients and foods after adjusting a regression model using total energy intake as the independent variable . Multiple regression and non-parametric locally weighted regression models were adjusted with the relative adherence to the MDP as the dependent variable in males and females . Results : Women were more compliant than men with the MDP ( Coefficient regression ( b ) = 4.1 ; Confidence Interval ( CI ) 95 % = 3.2 to 4.9 ) . The compliance with the MDP was significantly poorer among younger participants both in men and women ( p < 0.001 in men and in women ) . Participants who were more physically active were more likely to fulfill the traditional MDP ( p = 0.01 in men and p < 0.001 in women ) . Conclusions : Our findings provide evidence supporting the progressive departure from the traditional MDP in younger and highly educated subjects of the Mediterranean area . A more active life-style is associated with a better compliance with the MDP Mediterranean-style diets provide cardiovascular benefits and increase insulin sensitivity . There is little evidence that adherence to Mediterranean diet may influence the levels of the inflammatory milieu in type 2 diabetes . The aim of this study was to assess whether Mediterranean diet influences both C-reactive protein ( CRP ) and adiponectin in newly diagnosed type 2 diabetes , and whether adherence to Mediterranean diet affects their circulating levels . In a two-arm , single-center trial , 215 men and women with newly diagnosed type 2 diabetes were r and omized to a Mediterranean diet ( n = 108 , 54 males and 54 females ) or a low-fat diet ( n = 107 , 52 males and 55 females ) , with a total follow-up of 8.1 years . At baseline visit and at 1 year , body weight , HOMA index , CRP , and adiponectin and its fractions were assessed . Adherence to the diets was assessed by calculating the Mediterranean-diet score . At 1 year , CPR fell by 37 % and adiponectin rose by 43 % in the Mediterranean diet group , while remaining unchanged in the low-fat diet group . The pattern of adiponectin fractions ( high and non-high molecular weight ) showed a response similar to that of total adiponectin . Diabetic patients with the highest scores ( 6–9 points ) of adherence to Mediterranean diet had lower circulating CRP level and higher circulating total adiponectin levels than the diabetic patients who scored <3 points on the scale ( P = 0.001 ) . The results of this r and omized controlled trial demonstrate that Mediterranean diet cools down the inflammatory milieu of type 2 diabetes In 1994 the European Union BIOMED 
    Output:
    
agent
The results showed that evidence is scarce and that very few scores fulfilled the applicability parameters and psychometric quality .
Scores measuring adherence to MD are useful tools for identifying the dietary patterns of a given population .
***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: BACKGROUND Adherence to a Mediterranean diet may improve longevity , but relevant data are limited . METHODS We conducted a population -based , prospect i ve investigation involving 22,043 adults in Greece who completed an extensive , vali date d , food-frequency question naire at base line .  Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean-diet scale that incorporated the salient characteristics of this diet ( range of scores , 0 to 9 , with higher scores indicating greater adherence ) . We used proportional-hazards regression to assess the relation between adherence to the Mediterranean diet and total mortality , as well as mortality due to coronary heart disease and mortality due to cancer , with adjustment for age , sex , body-mass index , physical-activity level , and other potential confounders . RESULTS During a median of 44 months of follow-up , there were 275 deaths . A higher degree of adherence to the Mediterranean diet was associated with a reduction in total mortality ( adjusted hazard ratio for death associated with a two-point increment in the Mediterranean-diet score , 0.75 [ 95 percent confidence interval , 0.64 to 0.87 ] ) . An inverse association with greater adherence to this diet was evident for both death due to coronary heart disease ( adjusted hazard ratio , 0.67 [ 95 percent confidence interval , 0.47 to 0.94 ] ) and death due to cancer ( adjusted hazard ratio , 0.76 [ 95 percent confidence interval , 0.59 to 0.98 ] ) . Associations between individual food groups contributing to the Mediterranean-diet score and total mortality were generally not significant . CONCLUSIONS Greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality BACKGROUND Greater adherence to the Mediterranean diet has been associated with a lower incidence of cardiovascular disease and cancer . OBJECTIVE We studied the effect of the Mediterranean diet on total antioxidant capacity ( TAC ) in 3042 participants who had no clinical evidence of cardiovascular disease . DESIGN During 2001 - 2002 , a r and om sample of 1514 men and 1528 women aged 18 - 89 y from the Attica area of Greece was selected .  TAC was measured with an immune-diagnostic assay . Food consumption was evaluated with a vali date d food-frequency question naire , and adherence to the Mediterranean diet was assessed on the basis of a diet score that incorporated the inherent characteristics of this diet . RESULTS TAC was positively correlated with diet score . The participants in the highest tertile of the diet score had , on average , 11 % higher TAC levels than did the participants in the lowest tertile , even after adjustment for relevant confounders ( P < 0.01 ) . On the other h and , the participants in the highest tertile of the diet score had , on average , 19 % lower oxidized LDL-cholesterol concentrations than did the participants in the lowest tertile ( P < 0.01 ) . An additional analysis showed that TAC was positively correlated with the consumption of olive oil ( rho = 0.54 , P = 0.002 ) and of fruit and vegetables ( rho = 0.34 and rho = 0.31 , respectively ; P < 0.001 for both ) , whereas it was inversely associated with the consumption of red meat ( rho = -0.35 , P = 0.02 ) . CONCLUSION Greater adherence to the Mediterranean diet is associated with elevated TAC levels and low oxidized LDL-cholesterol concentrations , which may explain the beneficial role of this diet on the cardiovascular system Objective : To compare the dietary intake of Chinese people living in Pan Yu , Hong Kong , San Francisco and Sydney with respect to cardiovascular health , using the Mediterranean diet score , examining the effects of age , gender , urbanization and acculturation on the diet score . Subjects : A total of 500 men and 510 women in Hong Kong were recruited as a territory-wide stratified r and om sample . Subjects were recruited in response to  local advertisements for the other three sites : Pan Yu , 58 men , 95 women ; San Francisco , 166 men , 192 women ; Sydney , 95 men , 73 women . Method : Food-frequency question naire over a 7 week period . A high/healthy score was taken as ≥4 for men and ≥3 for women , representing a dietary pattern beneficial for cardiovascular health . Results : In Hong Kong , more women in the middle age group ( 35–54 ) had a high score than other age groups , and overall more women had high scores than men . In comparing the four geographical regions , Pan Yu had the highest number of subjects with high score , and Hong Kong had the lowest . With the exception of the younger population and men in Hong Kong , the percentage of the population with a high score in all sites is greater than among elderly Greeks consuming a more traditional heart-healthy Mediterranean diet . Conclusion : Considerable variations in Chinese dietary patterns exist with respect to age , gender and geographic location . Overall , the Chinese diet is comparable to the Mediterranean diet and may be expected to have similar health benefits that have been documented for the traditional Mediterranean diet . European Journal of Clinical Nutrition ( 2001 ) 55 , Epidemiological studies show that adherence to a Mediterranean diet ( MD ) increases longevity ; however , few studies are restricted to Mediterranean population s or explore the effect of a MD pattern that directly incorporates olive oil . Therefore the relationship between adherence to the MD and mortality was studied within the the Spanish cohort of the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC-Spain ) . The EPIC-Spain analysis included 40 622 participants ( 37·7 % males ) aged 29 - 69 years who were recruited from five Spanish regions in 1992 - 1996 . During a mean follow-up of 13·4 years , 1855 deaths were documented : 913 from cancer , 399 from CVD , 425 from other causes and 118 from unknown causes of death . Risk of all-cause and cause-specific mortality was assessed according to the level of adherence to a relative MD ( rMED ) score , measured using an 18-unit scale incorporating nine selected dietary components . A high compared with a low rMED score was associated with a significant reduction in mortality from all causes ( hazard ratio ( HR ) 0·79 ; 95 % CI 0·69 , 0·91 ) , from CVD ( HR 0·66 ; 95 % CI 0·49 , 0·89 ) , but not from overall cancer ( HR 0·92 ; 95 % CI 0·75 , 1·12 ) . A 2-unit increase in rMED score was associated with a 6 % ( P < 0·001 ) decreased risk of all-cause mortality . A high olive oil intake and moderate alcohol consumption contributed most to this association . In this Spanish cohort , following an olive oil-rich MD was related to a significant reduction in all-cause mortality , and reduced the risk of mortality from CVD . These results support the important role that the MD pattern has on reducing mortality in Mediterranean countries Abstract Objective To examine whether adherence to the modified Mediterranean diet , in which unsaturates were substituted for monounsaturates , is associated with longer life expectancy among elderly Europeans . Design Multicentre , prospect i ve cohort study . Setting Nine European countries ( Denmark , France , Germany , Greece , Italy , the Netherl and s , Spain , Sweden , United Kingdom ) . Participants 74 607 men and women , aged 60 or more , without coronary heart disease , stroke , or cancer at enrolment and with complete information about dietary intake and potentially confounding variables . Main outcome measures Extent of adherence to a modified Mediterranean diet  using a scoring system on a 10 point scale , and death from any cause by time of occurrence , modelled through Cox regression . Results An increase in the modified Mediterranean diet score was associated with lower overall mortality , a two unit increment corresponding to a statistically significant reduction of 8 % ( 95 % confidence interval 3 % to 12 % ) . No statistically significant evidence of heterogeneity was found among countries in the association of the score with overall mortality even though the association was stronger in Greece and Spain . When dietary exposures were calibrated across countries , the reduction in mortality was 7 % ( 1 % to 12 % ) . Conclusion The Mediterranean diet , modified so as to apply across Europe , was associated with increased survival among older people OBJECTIVE A Mediterranean diet quality index ( MDQI ) was devised to give an overall assessment of dietary habits and to identify groups at risk . DESIGN The MDQI was based on scores given for selected levels of consumption of selected nutrients and foods . SETTING Mediterranean southern France . SUBJECTS The sample included 473 men and 491 women in three age classes recruited at r and om . RESULTS Only 9.5 % of men , 9.0 % of women , 4.7 % of 20 - 34 year old subjects , 6.6 % of 35 - 54 year old subjects and 14.0 % of 55 - 76 year old subjects were shown to have a healthy diet . However , 10.1 % of men , 8.6 % of women , 19.4 % of 20 - 34 year old subjects , 10.2 % of 35 - 54 year old subjects and 4.6 % of 55 - 76 year old subjects were shown to have a poor diet . There were significantly fewer smokers among subjects with a good diet but the distribution of moderate wine drinkers was comparable between those with a good diet and those with a poor diet . Correspondence analysis associated a healthy diet with 55 - 76 year old men and women living in rural areas , who had received primary schooling only and who were manual workers . Both men and women with a poor MDQI score tended to be young and smokers . In addition , women with a poor MDQI tended to be heavy drinkers and obese . CONCLUSIONS This study showed that the Mediterranean model , which is generally recognized as a healthy diet , appears restricted to older people and to rural areas , whereas urbanized young people depart from it . A nutritional prevention policy targeted at young adults is required to encourage them to adhere to the Mediterranean model . Smoking and drinking showed different distribution patterns in the sample under study Summary . Background : A prospect i ve cohort study with university level participants was initiated to study the effect of Mediterranean diet on health . Aims : The objective of this study was to identify possible lifestyle and socioeconomic variables associated with the consumption of a Mediterranean dietary pattern ( MDP ) . Method : This analysis includes 1587 males and 2260 females . MDP was defined “ a priori ” by summing the st and ardized residuals of nutrients and foods after adjusting a regression model using total energy intake as the independent variable . Multiple regression and non-parametric locally weighted regression models were adjusted with the relative adherence to the MDP as the dependent variable in males and females . Results : Women were more compliant than men with the MDP ( Coefficient regression ( b ) = 4.1 ; Confidence Interval ( CI ) 95 % = 3.2 to 4.9 ) . The compliance with the MDP was significantly poorer among younger participants both in men and women ( p < 0.001 in men and in women ) . Participants who were more physically active were more likely to fulfill the traditional MDP ( p = 0.01 in men and p < 0.001 in women ) . Conclusions : Our findings provide evidence supporting the progressive departure from the traditional MDP in younger and highly educated subjects of the Mediterranean area . A more active life-style is associated with a better compliance with the MDP Mediterranean-style diets provide cardiovascular benefits and increase insulin sensitivity . There is little evidence that adherence to Mediterranean diet may influence the levels of the inflammatory milieu in type 2 diabetes . The aim of this study was to assess whether Mediterranean diet influences both C-reactive protein ( CRP ) and adiponectin in newly diagnosed type 2 diabetes , and whether adherence to Mediterranean diet affects their circulating levels . In a two-arm , single-center trial , 215 men and women with newly diagnosed type 2 diabetes were r and omized to a Mediterranean diet ( n = 108 , 54 males and 54 females ) or a low-fat diet ( n = 107 , 52 males and 55 females ) , with a total follow-up of 8.1 years . At baseline visit and at 1 year , body weight , HOMA index , CRP , and adiponectin and its fractions were assessed . Adherence to the diets was assessed by calculating the Mediterranean-diet score . At 1 year , CPR fell by 37 % and adiponectin rose by 43 % in the Mediterranean diet group , while remaining unchanged in the low-fat diet group . The pattern of adiponectin fractions ( high and non-high molecular weight ) showed a response similar to that of total adiponectin . Diabetic patients with the highest scores ( 6–9 points ) of adherence to Mediterranean diet had lower circulating CRP level and higher circulating total adiponectin levels than the diabetic patients who scored <3 points on the scale ( P = 0.001 ) . The results of this r and omized controlled trial demonstrate that Mediterranean diet cools down the inflammatory milieu of type 2 diabetes In 1994 the European Union BIOMED 
    Output:
    