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: Obesity worsens and modest weight loss improves female fertility . Overweight women were r and omised to lifestyle or st and ard treatment pre‐in vitro fertilisation with treatment cessation at embryo transfer . There was a greater reduction in weight ( P < 0.001 ) for lifestyle treatment ( −3.8 ± 3.0 kg , P < 0.001 ) compared with no changes for st and ard treatment ( −0.5 ± 1.2 kg , P = 0.092 ) . Both the intervention ( −5.3 ± 4.6 cm ) and control ( −3.5 ± 3.5 cm ) group had reductions in waist circumference ( P < 0.001 ) with no differences between the two groups ( P = 0.215 ) . The overall pregnancy rate was 53 % ( 20/38 ) for the intervention and control group combined Balanced glucose metabolism ensures optimal fetal growth with long-term health implication s conferred on both mother and child . We examined whether supplementation of probiotics with dietary counselling affects glucose metabolism in normoglycaemic pregnant women . At the first trimester of pregnancy 256 women were r and omised to receive nutrition counselling to modify dietary intake according to current recommendations or as controls ; the dietary intervention group was further r and omised to receive probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 ; diet/probiotics ) or placebo ( diet/placebo ) in a double-blind manner , whilst the control group received placebo ( control/placebo ) . Blood glucose concentrations were lowest in the diet/probiotics group during pregnancy ( baseline-adjusted means 4.45 , 4.60 and 4.56 mmol/l in diet/probiotics , diet/placebo and control/placebo , respectively ; P = 0.025 ) and over the 12 months ' postpartum period ( baseline-adjusted means 4.87 , 5.01 and 5.02 mmol/l ; P = 0.025 ) . Better glucose tolerance in the diet/probiotics group was confirmed by a reduced risk of elevated glucose concentration compared with the control/placebo group ( OR 0.31 ( 95 % CI 0.12 , 0.78 ) ; P = 0.013 ) as well as by the lowest insulin concentration ( adjusted means 7.55 , 9.32 and 9.27 mU/l ; P = 0.032 ) and homeostasis model assessment ( adjusted means 1.49 , 1.90 and 1.88 ; P = 0.028 ) and the highest quantitative insulin sensitivity check index ( adjusted means 0.37 , 0.35 and 0.35 ; P = 0.028 ) during the last trimester of pregnancy . The effects observed extended over the 12-month postpartum period . The present study demonstrated that improved blood glucose control can be achieved by dietary counselling with probiotics even in a normoglycaemic population and thus may provide potential novel means for the prophylactic and therapeutic management of glucose disorders Objective To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group . Design R and omised controlled trial . Setting Maternity hospital in Dublin , Irel and . Participants 800 women without diabetes , all in their second pregnancy between January 2007 to January 2011 , having previously delivered an infant weighing greater than 4 kg . Intervention Women were r and omised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy . Main outcomes The primary outcome measure was difference in birth weight . The secondary outcome measure was difference in gestational weight gain . Results No significant difference was seen between the two groups in absolute birth weight , birthweight centile , or ponderal index . Significantly less gestational weight gain occurred in women in the intervention arm ( 12.2 v 13.7 kg ; mean difference −1.3 , 95 % confidence interval −2.4 to −0.2 ; P=0.01 ) . The rate of glucose intolerance was also lower in the intervention arm : 21 % ( 67/320 ) compared with 28 % ( 100/352 ) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L ( P=0.02 ) . Conclusion A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age  infants in a group at risk of fetal macrosomia . It did , however , have a significant positive effect on gestational weight gain and maternal glucose intolerance . Trial registration Current Controlled Trials IS RCT N54392969 According to animal studies , intake of probiotic bacteria may improve glucose homeostasis . We hypothesised that probiotic bacteria improve insulin sensitivity by attenuating systemic inflammation . Therefore , the effects of oral supplementation with the probiotic bacterium Lactobacillus acidophilus NCFM on insulin sensitivity and the inflammatory response were investigated in subjects with normal or impaired insulin sensitivity . In a double-blinded , r and omised fashion , forty-five males with type 2 diabetes , impaired or normal glucose tolerance were enrolled and allocated to a 4-week treatment course with either L. acidophilus NCFM or placebo . L. acidophilus was detected in stool sample s by denaturating gradient gel electrophoresis and real-time PCR . Separated by the 4-week intervention period , two hyperinsulinaemic-euglycaemic clamps were performed to estimate insulin sensitivity . Furthermore , the systemic inflammatory response was evaluated by subjecting the participants to Escherichia coli lipopolysaccharide injection ( 0·3 ng/kg ) before and after the treatment course . L. acidophilus NCFM was detected in 75 % of the faecal sample s after treatment with the probiotic bacterium . Insulin sensitivity was preserved among volunteers in the L. acidophilus NCFM group , whereas it decreased in the placebo group . Both baseline inflammatory markers and the systemic inflammatory response were , however , unaffected by the intervention . In conclusion , intake of L. acidophilus NCFM for 4 weeks preserved insulin sensitivity compared with placebo , but did not affect the systemic inflammatory response BACKGROUND Exercise may influence glucose metabolism during pregnancy . We examined the effect of exercise intensity and duration on capillary glucose responses in pregnant women at low and high risk for gestational diabetes mellitus ( GDM ) who followed a modified GDM meal plan . METHODS R and omization occurred at study entry ( 16 - 20 weeks ' gestation ) into a low-intensity [ 30 % heart rate reserve , low risk-30%I , n = 12 ; high risk-30%I , n = 11 ] or vigorous-intensity ( 70 % heart rate reserve , low risk-70%I , n = 12 ; R-70%I , n = 11 ) exercise program with similar nutritional control . Exercise consisted of walking three to four times a week , gradually increasing time from 25 to 40 min/session . Free-living capillary glucose concentrations were measured once a week pre-exercise and post-exercise . RESULTS Capillary glucose responses to exercise were strongly influenced by an interaction between GDM risk , exercise duration and exercise intensity ( p = 0.006 ) . Decreases in glucose concentrations were observed after 25 ( 4 ± 13 % ) , 35 ( 21 ± 12 % ) and 40 min ( 15 ± 18 % ) of walking in high risk-30%I women , with the most noticeable decline after 35 and 40 min . In the high risk-70%I , glucose concentrations decreased significantly only after 25 ( 22 ± 14 % ) and 35 min ( 7 ± 23 % ) and increasing the exercise time attenuated glucose concentrations decline . In low risk women , regardless of exercise intensity and duration , decreases in glucose concentrations were significant and similar . CONCLUSION To achieve the best decline in glucose concentrations , pregnant women who follow a modified GDM meal plan should walk for 25 min/session at vigorous intensity or for 35 - 40 min/session at low intensity if they are at risk for GDM and for at least 25 min at either low or vigorous intensity if they are at low risk for GDM Background The consumption of foods containing probiotic and prebiotic ingredients is growing consistently every year , and in view of the limited number of studies investigating their effect in the elderly . Objective The objective of this study was to evaluate the effect of the consumption of a symbiotic shake containing Lactobacillus acidophilus , Bifidobacterium bifidum and fructooligosaccharides on glycemia and cholesterol levels in elderly people . Methods A r and omized , double-blind , placebo-controlled study was conducted on twenty volunteers ( ten for placebo group and ten for symbiotic group ) , aged 50 to 60 years . The criteria for inclusion in the study were : total cholesterol > 200 mg/dL ; triglycerides > 200 mg/dL and glycemia > 110 mg/dL. Over a total test period of 30 days , 10 individuals ( the symbiotic group ) consumed a daily dose of 200 mL of a symbiotic shake containing 108 UFC/mL Lactobacillus acidophilus , 108 UFC/mL Bifidobacterium bifidum and 2 g oligofructose , while 10 other volunteers ( the  placebo group ) drank daily the same amount of a shake that did not contain any symbiotic bacteria . Blood sample s were collected 15 days prior to the start of the experiment and at 10-day intervals after the beginning of the shake intake . The st and ard lipid profile ( total cholesterol , triglycerides and HDL cholesterol ) and glycemia , or blood sugar levels , were evaluated by an enzyme colorimetric assay . Results The results of the symbiotic group showed a non-significant reduction ( P > 0.05 ) in total cholesterol and triglycerides , a significant increase ( P < 0.05 ) in HDL cholesterol and a significant reduction ( P < 0.05 ) in fasting glycemia . No significant changes were observed in the placebo group . Conclusion The consumption of symbiotic shake result ed in a significant increase in HDL and a significant decrease of glycemia . Trial Registration Clinical Trials.gov : OBJECTIVE Optimizing gestational weight gain ( GWG ) in early pregnancy is of clinical and public health importance , especially in higher risk pregnancies . DESIGN AND METHODS In a robustly design ed , r and omized controlled trial , 228 pregnant women at risk of developing gestational diabetes mellitus ( GDM ) were allocated to either control ( written health information only ) or intervention ( four-session lifestyle program ) . All women received st and ard maternal care . Measures were completed at 12 - 15 and 26 - 28 weeks gestation . Measures included anthropometrics ( weight and height ) , physical activity ( pedometer and International Physical Activity Question naire ) , question naires ( risk perception ) , and GDM screening . RESULTS The mean ( SD ) age [ 31.7 ( 4.5 ) and 32.4 ( 4.7 ) years ] and body mass index [ BMI ; 30.3 ( 5.9 ) and 30.4 ( 5.6 ) kg/m(2 ) ] were similar between control and intervention groups , respectively . By 28 weeks , GWG was significantly different between control and intervention groups [ 6.9 ( 3.3 ) vs. 6.0 ( 2.8 ) kg , P < 0.05 ] . When stratified according to baseline BMI , overweight women in the control group gained significantly more weight compared to overweight women in the intervention group [ 7.8 ( 3.4 ) vs. 6.0 ( 2.2 ) kg , P < 0.05 ] , yet in obese women , GWG was similar in both groups . Physical activity levels declined by 28 weeks gestation overall ( P < 0.01 ) ; however , the intervention group retained a 20 % higher step count compared to controls [ 5,203 ( 3,368 ) vs. 4,140 ( 2,420 ) steps/day , P < 0.05 ] . Overall , GDM prevalence was 22.8 % [ Corrected ] , with a trend toward less cases in the intervention group ( P = 0.1 ) . CONCLUSIONS Results indicate that a low-intensity lifestyle intervention , integrated with antenatal care , optimizes healthy GWG and attenuates physical activity decline in early pregnancy . Efficacy in limiting weight gain was greatest in overweight women and in high-risk ethnically diverse women OBJECTIVE To check the hypothesis that myo-inositol supplementation may reduce gestational diabetes mellitus ( GDM ) onset in pregnant women with a family history of type 2 diabetes . RESEARCH DESIGN AND METHODS A 2-year , prospect i ve , r and 
    Output:
    
agent
***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: Obesity worsens and modest weight loss improves female fertility . Overweight women were r and omised to lifestyle or st and ard treatment pre‐in vitro fertilisation with treatment cessation at embryo transfer . There was a greater reduction in weight ( P < 0.001 ) for lifestyle treatment ( −3.8 ± 3.0 kg , P < 0.001 ) compared with no changes for st and ard treatment ( −0.5 ± 1.2 kg , P = 0.092 ) . Both the intervention ( −5.3 ± 4.6 cm ) and control ( −3.5 ± 3.5 cm ) group had reductions in waist circumference ( P < 0.001 ) with no differences between the two groups ( P = 0.215 ) . The overall pregnancy rate was 53 % ( 20/38 ) for the intervention and control group combined Balanced glucose metabolism ensures optimal fetal growth with long-term health implication s conferred on both mother and child . We examined whether supplementation of probiotics with dietary counselling affects glucose metabolism in normoglycaemic pregnant women . At the first trimester of pregnancy 256 women were r and omised to receive nutrition counselling to modify dietary intake according to current recommendations or as controls ; the dietary intervention group was further r and omised to receive probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 ; diet/probiotics ) or placebo ( diet/placebo ) in a double-blind manner , whilst the control group received placebo ( control/placebo ) . Blood glucose concentrations were lowest in the diet/probiotics group during pregnancy ( baseline-adjusted means 4.45 , 4.60 and 4.56 mmol/l in diet/probiotics , diet/placebo and control/placebo , respectively ; P = 0.025 ) and over the 12 months ' postpartum period ( baseline-adjusted means 4.87 , 5.01 and 5.02 mmol/l ; P = 0.025 ) . Better glucose tolerance in the diet/probiotics group was confirmed by a reduced risk of elevated glucose concentration compared with the control/placebo group ( OR 0.31 ( 95 % CI 0.12 , 0.78 ) ; P = 0.013 ) as well as by the lowest insulin concentration ( adjusted means 7.55 , 9.32 and 9.27 mU/l ; P = 0.032 ) and homeostasis model assessment ( adjusted means 1.49 , 1.90 and 1.88 ; P = 0.028 ) and the highest quantitative insulin sensitivity check index ( adjusted means 0.37 , 0.35 and 0.35 ; P = 0.028 ) during the last trimester of pregnancy . The effects observed extended over the 12-month postpartum period . The present study demonstrated that improved blood glucose control can be achieved by dietary counselling with probiotics even in a normoglycaemic population and thus may provide potential novel means for the prophylactic and therapeutic management of glucose disorders Objective To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group . Design R and omised controlled trial . Setting Maternity hospital in Dublin , Irel and . Participants 800 women without diabetes , all in their second pregnancy between January 2007 to January 2011 , having previously delivered an infant weighing greater than 4 kg . Intervention Women were r and omised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy . Main outcomes The primary outcome measure was difference in birth weight . The secondary outcome measure was difference in gestational weight gain . Results No significant difference was seen between the two groups in absolute birth weight , birthweight centile , or ponderal index . Significantly less gestational weight gain occurred in women in the intervention arm ( 12.2 v 13.7 kg ; mean difference −1.3 , 95 % confidence interval −2.4 to −0.2 ; P=0.01 ) . The rate of glucose intolerance was also lower in the intervention arm : 21 % ( 67/320 ) compared with 28 % ( 100/352 ) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L ( P=0.02 ) . Conclusion A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age  infants in a group at risk of fetal macrosomia . It did , however , have a significant positive effect on gestational weight gain and maternal glucose intolerance . Trial registration Current Controlled Trials IS RCT N54392969 According to animal studies , intake of probiotic bacteria may improve glucose homeostasis . We hypothesised that probiotic bacteria improve insulin sensitivity by attenuating systemic inflammation . Therefore , the effects of oral supplementation with the probiotic bacterium Lactobacillus acidophilus NCFM on insulin sensitivity and the inflammatory response were investigated in subjects with normal or impaired insulin sensitivity . In a double-blinded , r and omised fashion , forty-five males with type 2 diabetes , impaired or normal glucose tolerance were enrolled and allocated to a 4-week treatment course with either L. acidophilus NCFM or placebo . L. acidophilus was detected in stool sample s by denaturating gradient gel electrophoresis and real-time PCR . Separated by the 4-week intervention period , two hyperinsulinaemic-euglycaemic clamps were performed to estimate insulin sensitivity . Furthermore , the systemic inflammatory response was evaluated by subjecting the participants to Escherichia coli lipopolysaccharide injection ( 0·3 ng/kg ) before and after the treatment course . L. acidophilus NCFM was detected in 75 % of the faecal sample s after treatment with the probiotic bacterium . Insulin sensitivity was preserved among volunteers in the L. acidophilus NCFM group , whereas it decreased in the placebo group . Both baseline inflammatory markers and the systemic inflammatory response were , however , unaffected by the intervention . In conclusion , intake of L. acidophilus NCFM for 4 weeks preserved insulin sensitivity compared with placebo , but did not affect the systemic inflammatory response BACKGROUND Exercise may influence glucose metabolism during pregnancy . We examined the effect of exercise intensity and duration on capillary glucose responses in pregnant women at low and high risk for gestational diabetes mellitus ( GDM ) who followed a modified GDM meal plan . METHODS R and omization occurred at study entry ( 16 - 20 weeks ' gestation ) into a low-intensity [ 30 % heart rate reserve , low risk-30%I , n = 12 ; high risk-30%I , n = 11 ] or vigorous-intensity ( 70 % heart rate reserve , low risk-70%I , n = 12 ; R-70%I , n = 11 ) exercise program with similar nutritional control . Exercise consisted of walking three to four times a week , gradually increasing time from 25 to 40 min/session . Free-living capillary glucose concentrations were measured once a week pre-exercise and post-exercise . RESULTS Capillary glucose responses to exercise were strongly influenced by an interaction between GDM risk , exercise duration and exercise intensity ( p = 0.006 ) . Decreases in glucose concentrations were observed after 25 ( 4 ± 13 % ) , 35 ( 21 ± 12 % ) and 40 min ( 15 ± 18 % ) of walking in high risk-30%I women , with the most noticeable decline after 35 and 40 min . In the high risk-70%I , glucose concentrations decreased significantly only after 25 ( 22 ± 14 % ) and 35 min ( 7 ± 23 % ) and increasing the exercise time attenuated glucose concentrations decline . In low risk women , regardless of exercise intensity and duration , decreases in glucose concentrations were significant and similar . CONCLUSION To achieve the best decline in glucose concentrations , pregnant women who follow a modified GDM meal plan should walk for 25 min/session at vigorous intensity or for 35 - 40 min/session at low intensity if they are at risk for GDM and for at least 25 min at either low or vigorous intensity if they are at low risk for GDM Background The consumption of foods containing probiotic and prebiotic ingredients is growing consistently every year , and in view of the limited number of studies investigating their effect in the elderly . Objective The objective of this study was to evaluate the effect of the consumption of a symbiotic shake containing Lactobacillus acidophilus , Bifidobacterium bifidum and fructooligosaccharides on glycemia and cholesterol levels in elderly people . Methods A r and omized , double-blind , placebo-controlled study was conducted on twenty volunteers ( ten for placebo group and ten for symbiotic group ) , aged 50 to 60 years . The criteria for inclusion in the study were : total cholesterol > 200 mg/dL ; triglycerides > 200 mg/dL and glycemia > 110 mg/dL. Over a total test period of 30 days , 10 individuals ( the symbiotic group ) consumed a daily dose of 200 mL of a symbiotic shake containing 108 UFC/mL Lactobacillus acidophilus , 108 UFC/mL Bifidobacterium bifidum and 2 g oligofructose , while 10 other volunteers ( the  placebo group ) drank daily the same amount of a shake that did not contain any symbiotic bacteria . Blood sample s were collected 15 days prior to the start of the experiment and at 10-day intervals after the beginning of the shake intake . The st and ard lipid profile ( total cholesterol , triglycerides and HDL cholesterol ) and glycemia , or blood sugar levels , were evaluated by an enzyme colorimetric assay . Results The results of the symbiotic group showed a non-significant reduction ( P > 0.05 ) in total cholesterol and triglycerides , a significant increase ( P < 0.05 ) in HDL cholesterol and a significant reduction ( P < 0.05 ) in fasting glycemia . No significant changes were observed in the placebo group . Conclusion The consumption of symbiotic shake result ed in a significant increase in HDL and a significant decrease of glycemia . Trial Registration Clinical Trials.gov : OBJECTIVE Optimizing gestational weight gain ( GWG ) in early pregnancy is of clinical and public health importance , especially in higher risk pregnancies . DESIGN AND METHODS In a robustly design ed , r and omized controlled trial , 228 pregnant women at risk of developing gestational diabetes mellitus ( GDM ) were allocated to either control ( written health information only ) or intervention ( four-session lifestyle program ) . All women received st and ard maternal care . Measures were completed at 12 - 15 and 26 - 28 weeks gestation . Measures included anthropometrics ( weight and height ) , physical activity ( pedometer and International Physical Activity Question naire ) , question naires ( risk perception ) , and GDM screening . RESULTS The mean ( SD ) age [ 31.7 ( 4.5 ) and 32.4 ( 4.7 ) years ] and body mass index [ BMI ; 30.3 ( 5.9 ) and 30.4 ( 5.6 ) kg/m(2 ) ] were similar between control and intervention groups , respectively . By 28 weeks , GWG was significantly different between control and intervention groups [ 6.9 ( 3.3 ) vs. 6.0 ( 2.8 ) kg , P < 0.05 ] . When stratified according to baseline BMI , overweight women in the control group gained significantly more weight compared to overweight women in the intervention group [ 7.8 ( 3.4 ) vs. 6.0 ( 2.2 ) kg , P < 0.05 ] , yet in obese women , GWG was similar in both groups . Physical activity levels declined by 28 weeks gestation overall ( P < 0.01 ) ; however , the intervention group retained a 20 % higher step count compared to controls [ 5,203 ( 3,368 ) vs. 4,140 ( 2,420 ) steps/day , P < 0.05 ] . Overall , GDM prevalence was 22.8 % [ Corrected ] , with a trend toward less cases in the intervention group ( P = 0.1 ) . CONCLUSIONS Results indicate that a low-intensity lifestyle intervention , integrated with antenatal care , optimizes healthy GWG and attenuates physical activity decline in early pregnancy . Efficacy in limiting weight gain was greatest in overweight women and in high-risk ethnically diverse women OBJECTIVE To check the hypothesis that myo-inositol supplementation may reduce gestational diabetes mellitus ( GDM ) onset in pregnant women with a family history of type 2 diabetes . RESEARCH DESIGN AND METHODS A 2-year , prospect i ve , r and 
    Output:
    