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 Although the Dietary Approaches to Stop Hypertension ( DASH ) diet is an accepted nonpharmacologic treatment for hypertension , little is known about what patient characteristics affect dietary adherence and what level of adherence is needed to reduce blood pressure ( BP ) . OBJECTIVE Our aim was to determine what factors predict dietary adherence and the extent to which dietary adherence is necessary to produce clinical ly meaningful BP reductions . DESIGN Ancillary study of the ENCORE ( Exercise and Nutrition Interventions for Cardiovascular Health ) trial -- a 16-week r and omized clinical trial of diet and exercise . PARTICIPANTS / SETTING Participants included 144 sedentary , overweight , or obese adults ( body mass index 25 to 39.9 ) with high BP ( systolic 130 to 159 mm Hg and /or diastolic 85 to 99 mm Hg ) . INTERVENTION Patients were r and omized to one of three groups : DASH diet alone , DASH diet plus weight management , and Usual Diet Controls . MAIN OUTCOMES MEASURES Our primary outcomes were a composite index of adherence to the DASH diet and clinic BP . STATISTICAL ANALYSES PERFORMED General linear models were used to compare treatment groups on post-treatment adherence to the DASH diet . Linear regression was used to examine potential predictors of post-treatment DASH adherence . Analysis of covariance was used to examine the relation of adherence to the DASH diet and BP . RESULTS Participants in the DASH diet plus weight management ( 16.1 systolic BP [ SBP ] ; 95 % CI 13.0 to 19.2 mm Hg and 9.9 diastolic BP [ DBP ] ; 95 % CI 8.1 to 11.6 mm Hg ) and DASH diet alone ( 11.2 SBP ; 95 % CI 8.1 to 14.3 mm Hg and 7.5 DBP ; 95 % CI 5.8 to 9.3 mm Hg ) groups showed significant reductions in BP in comparison with Usual Diet Controls participants ( 3.4 SBP ; 95 % CI 0.4 to 6.4 mm Hg and DBP 3.8 ; 95 % CI 2.2 to 5.5 mm Hg ) . Greater post-treatment consumption of DASH foods was noted in both the DASH diet alone ( mean = 6.20 ; 95 % CI 5.83 to 6.57 ) and DASH diet plus weight management groups ( mean = 6.23 ; 95 % CI 5.88 to 6.59 ) compared with Usual Diet Controls ( mean = 3.66 ; 95 % CI 3.30 to 4.01 ; P<0.0001 ) , and greater adherence to the DASH diet was associated with larger reductions in clinic SBP and DBP ( P ≤ 0.01 ) . Only ethnicity predicted dietary adherence , with African Americans less adherent to the DASH diet compared with whites ( 4.68 ; 95 % CI 4.34 to 5.03 vs 5.83 ; 95 % CI 5.50 to 6.11 ; P<0.001 ) . CONCLUSIONS Greater adherence to the DASH diet was associated with larger BP reductions independent of weight loss . African Americans were less likely to be adherent to the DASH dietary eating plan compared with whites , suggesting that culturally sensitive dietary strategies might be needed to improve adherence to the DASH diet OBJECTIVE To examine the efficacy of a 3-month clinic-based behavioral nutrition intervention emphasizing a diet high in fruits , vegetables , and low fat dairy ( DASH intervention ) versus routine outpatient hospital-based nutrition care ( RC ) on diet and blood pressure ( BP ) in adolescents with elevated BP . STUDY DESIGN Fifty-seven adolescents with a clinical diagnosis of prehypertension or hypertension ( systolic BP or diastolic BP , 90(th ) to 99(th ) percentile ) were r and omly assigned to  DASH or  RC  .  SBP , DBP , 3-day diet recall , weight , and height were assessed at pretreatment , post-treatment , and 3 months later ( follow-up ) . RESULTS In completer analysis , DASH versus RC had a greater decrease in SBP z scores from baseline to post-treatment ( P < 0.01 ) and a trend for a greater decrease in SBP z scores from baseline through follow-up ( P = .07 ) . DBP z scores changed similarly for conditions from baseline through follow-up . Relative to RC , DASH had a greater increase in intake of fruits ( P < .001 ) , potassium and magnesium ( P < .01 ) , and a greater decrease in total fat ( P < .05 ) from baseline to post-treatment . From baseline through follow-up , DASH versus RC had a greater increase in low fat dairy ( P < .001 ) . CONCLUSIONS The DASH intervention proved more effective than RC in improving SBP and diet quality in adolescents with elevated BP OBJECTIVE To examine the influence of the PREMIER study lifestyle interventions on dietary intakes and adherence to the Dietary Approaches to Stop Hypertension ( DASH ) dietary pattern and the Dietary Reference Intakes ( DRI ) . DESIGN An 18-month multicenter , r and omized controlled trial comparing two multicomponent lifestyle intervention programs to an advice only control group . SUBJECTS/ SETTING A total of 810 participants were recruited from local communities and r and omized into the study . Individuals were eligible if they were aged 25 years or older , had body mass index between 18.5 and 45.0 , not taking antihypertensive medication , and had prehypertension or stage 1 hypertension ( systolic blood pressure 120 to 159 mm Hg and diastolic blood pressure 80 to 95 mm Hg ) . INTERVENTION The two active intervention programs were a behavioral lifestyle intervention that implements established recommendations , and an established intervention plus the DASH dietary pattern . Both interventions consisted of intensive group and individual counseling sessions . The control group received a brief advice session after r and omization and again after 6 months of data collection . Dietary intakes were collected by two r and om 24-hour recalls at baseline , 6 months , and 18 months . MAIN OUTCOME MEASURES The primary outcome of the PREMIER study was change in systolic blood pressure at 6 months . The main outcomes examined here include dietary variables collected by 24-hour recall at each time point . STATISTICAL ANALYSES Nutrient intakes were calculated and compared among the time points and the three intervention groups using mixed models with repeated measures at 6 and 18 months . Proportion of participants who met or achieved the original DASH nutrient intake levels and the DRIs were calculated and compared among the three intervention groups . P<0.01 was considered statistically significant . RESULTS Participants in both the established intervention and established intervention plus DASH dietary pattern groups substantially reduced energy , total fat , saturated fat , and sodium intake and these reductions persisted throughout the study . Established intervention plus DASH dietary pattern group participants increased intakes of fruits , vegetables , dairy , and many vitamins and minerals ; these increases were significantly greater than that of the control and established intervention groups . A majority of established intervention plus DASH dietary pattern group participants achieved at least two thirds of the DRI recommendations for most nutrients at 6 months , despite their reduction in total energy intake . Some but relatively small recidivism occurred at 18 months . CONCLUSIONS Both the established intervention and established intervention plus DASH dietary pattern group intervention were effective in helping participants follow established recommendations to control blood pressure . The advice-only control group also made some behavior changes , mainly decreasing energy and sodium intake . Only the established intervention plus DASH dietary pattern group significantly increased intakes of DASH-specific food groups , including fruits , vegetables , and dairy products , and nutrients , including protein , fiber , calcium , potassium , and magnesium . Most of the increases did not reach the levels consumed in the original DASH feeding studies . Whereas the established intervention plus DASH dietary pattern group intervention provides a useful platform to achieve the DASH dietary pattern and current DRI recommendations , intervention enhancements , including a greater emphasis on nutrient-dense foods , would likely improve this intervention A diet rich in fruits , vegetables , and low-fat dairy foods has been shown to lower blood pressure ( BP ) when all foods are provided . We compared the effect on BP ( measured at home ) of 2 different self-selected diets : a low-sodium , high-potassium diet , rich in fruit and vegetables ( LNAHK ) and a high-calcium diet rich in low-fat dairy foods ( HC ) with a moderate-sodium , high-potassium , high-calcium DASH-type diet , high in fruits , vegetables and low-fat dairy foods ( OD ) . Subjects were r and omly allocated to 2 test diets for 4 wk , the OD and either LNAHK or HC diet , each preceded by a 2 wk control diet ( CD ) . The changes in BP between the preceding CD period and the test diet period ( LNAHK or HC ) were compared with the change between the CD and the OD periods . Of the 56 men and 38 women that completed the OD period , 43 completed the LNAHK diet period and 48 the HC diet period . The mean age was 55.6 + /- 9.9 ( + /-SD ) years . There was a fall in systolic pressure between and the CD and OD [ -1.8 + /- 0.5 mm Hg ( P < 0.001 ) ] . Compared with OD , systolic and diastolic BPs fell during the LNAHK diet period [ -3.5 + /- 1.0 ( P < 0.001 ) and -1.9 + /- 0.7 ( P < 0.05 ) mmHg , respectively ] and increased during the HC diet period [ + 3.1 + /- 0.9 ( P < 0.01 ) and + 0.8 + /- 0.6 ( P = 0.15 ) mm Hg , respectively ] . A self-selected low-sodium , high-potassium diet result ed in a greater fall in BP than a multifaceted OD , confirming the beneficial effect of dietary intervention on BP in a community setting BACKGROUND The Dietary Approaches to Stop Hypertension ( DASH ) diet has been shown to lower blood pressure , but little is known about its long-term effect on cardiovascular end points . Our objective was to assess the association between a DASH-style diet adherence score and risk of coronary heart disease ( CHD ) and stroke in women . METHODS In this prospect i ve cohort study , diet was assessed 7 times during 24 years of follow-up ( 1980 - 2004 ) with vali date d food frequency question naires . A DASH score based on 8 food and nutrient components ( fruits , vegetables , whole grains , nuts and legumes , low-fat dairy , red and processed meats , sweetened beverages , and sodium ) was calculated . Lifestyle and medical information was collected biennially with a question naire . The Cox proportional hazard model was used to adjust for potential confounders . The study population comprised 88,517 female nurses aged 34 to 59 years without a history of cardiovascular disease or diabetes in 1980 . The main outcome measures were the numbers of confirmed incident cases of nonfatal myocardial infa rct ion , CHD death , and stroke . RESULTS We documented 2129 cases of incident nonfatal myocardial infa rct ion , 976 CHD deaths , and 2317 [ corrected ] cases of stroke . After adjustment for age , smoking , and other cardiovascular risk factors , the relative risks of CHD across quintiles of the DASH score were 1.0 , 0.99 , 0.86 , 0.87 , and 0.76 ( 95 % confidence interval , 0.67 - 0.85 ) ( P<.001 for trend ) . The magnitude of risk difference was similar for nonfatal myocardial infa rct ion and fatal CHD . The DASH score was also significantly associated with lower risk of stroke ( multivariate relative risks across quintiles of the DASH score were 1.0 , 0.92 , 0.91 , 0.89 , and 0.82 ) ( P=.002 for trend ) . Cross-sectional analysis in a subgroup of women with blood sample s showed that the DASH score was significantly associated with lower plasma levels of C-reactive protein ( P=.008 for trend ) and interleukin 6 ( P=.04 for trend ) . CONCLUSION Adherence to the DASH-style diet is associated with a lower risk of CHD and stroke among middle-aged women during 24 years of follow-up Low-sodium Dietary Approaches to Stop Hypertension ( DASH ) diets are base producing but restrict red meat without clear justification . We hypothesized that a vitality diet ( VD ) , a low-sodium DASH-type diet with a low dietary acid load containing 6 servings of 100 
    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: BACKGROUND Although the Dietary Approaches to Stop Hypertension ( DASH ) diet is an accepted nonpharmacologic treatment for hypertension , little is known about what patient characteristics affect dietary adherence and what level of adherence is needed to reduce blood pressure ( BP ) . OBJECTIVE Our aim was to determine what factors predict dietary adherence and the extent to which dietary adherence is necessary to produce clinical ly meaningful BP reductions . DESIGN Ancillary study of the ENCORE ( Exercise and Nutrition Interventions for Cardiovascular Health ) trial -- a 16-week r and omized clinical trial of diet and exercise . PARTICIPANTS / SETTING Participants included 144 sedentary , overweight , or obese adults ( body mass index 25 to 39.9 ) with high BP ( systolic 130 to 159 mm Hg and /or diastolic 85 to 99 mm Hg ) . INTERVENTION Patients were r and omized to one of three groups : DASH diet alone , DASH diet plus weight management , and Usual Diet Controls . MAIN OUTCOMES MEASURES Our primary outcomes were a composite index of adherence to the DASH diet and clinic BP . STATISTICAL ANALYSES PERFORMED General linear models were used to compare treatment groups on post-treatment adherence to the DASH diet . Linear regression was used to examine potential predictors of post-treatment DASH adherence . Analysis of covariance was used to examine the relation of adherence to the DASH diet and BP . RESULTS Participants in the DASH diet plus weight management ( 16.1 systolic BP [ SBP ] ; 95 % CI 13.0 to 19.2 mm Hg and 9.9 diastolic BP [ DBP ] ; 95 % CI 8.1 to 11.6 mm Hg ) and DASH diet alone ( 11.2 SBP ; 95 % CI 8.1 to 14.3 mm Hg and 7.5 DBP ; 95 % CI 5.8 to 9.3 mm Hg ) groups showed significant reductions in BP in comparison with Usual Diet Controls participants ( 3.4 SBP ; 95 % CI 0.4 to 6.4 mm Hg and DBP 3.8 ; 95 % CI 2.2 to 5.5 mm Hg ) . Greater post-treatment consumption of DASH foods was noted in both the DASH diet alone ( mean = 6.20 ; 95 % CI 5.83 to 6.57 ) and DASH diet plus weight management groups ( mean = 6.23 ; 95 % CI 5.88 to 6.59 ) compared with Usual Diet Controls ( mean = 3.66 ; 95 % CI 3.30 to 4.01 ; P<0.0001 ) , and greater adherence to the DASH diet was associated with larger reductions in clinic SBP and DBP ( P ≤ 0.01 ) . Only ethnicity predicted dietary adherence , with African Americans less adherent to the DASH diet compared with whites ( 4.68 ; 95 % CI 4.34 to 5.03 vs 5.83 ; 95 % CI 5.50 to 6.11 ; P<0.001 ) . CONCLUSIONS Greater adherence to the DASH diet was associated with larger BP reductions independent of weight loss . African Americans were less likely to be adherent to the DASH dietary eating plan compared with whites , suggesting that culturally sensitive dietary strategies might be needed to improve adherence to the DASH diet OBJECTIVE To examine the efficacy of a 3-month clinic-based behavioral nutrition intervention emphasizing a diet high in fruits , vegetables , and low fat dairy ( DASH intervention ) versus routine outpatient hospital-based nutrition care ( RC ) on diet and blood pressure ( BP ) in adolescents with elevated BP . STUDY DESIGN Fifty-seven adolescents with a clinical diagnosis of prehypertension or hypertension ( systolic BP or diastolic BP , 90(th ) to 99(th ) percentile ) were r and omly assigned to  DASH or  RC  .  SBP , DBP , 3-day diet recall , weight , and height were assessed at pretreatment , post-treatment , and 3 months later ( follow-up ) . RESULTS In completer analysis , DASH versus RC had a greater decrease in SBP z scores from baseline to post-treatment ( P < 0.01 ) and a trend for a greater decrease in SBP z scores from baseline through follow-up ( P = .07 ) . DBP z scores changed similarly for conditions from baseline through follow-up . Relative to RC , DASH had a greater increase in intake of fruits ( P < .001 ) , potassium and magnesium ( P < .01 ) , and a greater decrease in total fat ( P < .05 ) from baseline to post-treatment . From baseline through follow-up , DASH versus RC had a greater increase in low fat dairy ( P < .001 ) . CONCLUSIONS The DASH intervention proved more effective than RC in improving SBP and diet quality in adolescents with elevated BP OBJECTIVE To examine the influence of the PREMIER study lifestyle interventions on dietary intakes and adherence to the Dietary Approaches to Stop Hypertension ( DASH ) dietary pattern and the Dietary Reference Intakes ( DRI ) . DESIGN An 18-month multicenter , r and omized controlled trial comparing two multicomponent lifestyle intervention programs to an advice only control group . SUBJECTS/ SETTING A total of 810 participants were recruited from local communities and r and omized into the study . Individuals were eligible if they were aged 25 years or older , had body mass index between 18.5 and 45.0 , not taking antihypertensive medication , and had prehypertension or stage 1 hypertension ( systolic blood pressure 120 to 159 mm Hg and diastolic blood pressure 80 to 95 mm Hg ) . INTERVENTION The two active intervention programs were a behavioral lifestyle intervention that implements established recommendations , and an established intervention plus the DASH dietary pattern . Both interventions consisted of intensive group and individual counseling sessions . The control group received a brief advice session after r and omization and again after 6 months of data collection . Dietary intakes were collected by two r and om 24-hour recalls at baseline , 6 months , and 18 months . MAIN OUTCOME MEASURES The primary outcome of the PREMIER study was change in systolic blood pressure at 6 months . The main outcomes examined here include dietary variables collected by 24-hour recall at each time point . STATISTICAL ANALYSES Nutrient intakes were calculated and compared among the time points and the three intervention groups using mixed models with repeated measures at 6 and 18 months . Proportion of participants who met or achieved the original DASH nutrient intake levels and the DRIs were calculated and compared among the three intervention groups . P<0.01 was considered statistically significant . RESULTS Participants in both the established intervention and established intervention plus DASH dietary pattern groups substantially reduced energy , total fat , saturated fat , and sodium intake and these reductions persisted throughout the study . Established intervention plus DASH dietary pattern group participants increased intakes of fruits , vegetables , dairy , and many vitamins and minerals ; these increases were significantly greater than that of the control and established intervention groups . A majority of established intervention plus DASH dietary pattern group participants achieved at least two thirds of the DRI recommendations for most nutrients at 6 months , despite their reduction in total energy intake . Some but relatively small recidivism occurred at 18 months . CONCLUSIONS Both the established intervention and established intervention plus DASH dietary pattern group intervention were effective in helping participants follow established recommendations to control blood pressure . The advice-only control group also made some behavior changes , mainly decreasing energy and sodium intake . Only the established intervention plus DASH dietary pattern group significantly increased intakes of DASH-specific food groups , including fruits , vegetables , and dairy products , and nutrients , including protein , fiber , calcium , potassium , and magnesium . Most of the increases did not reach the levels consumed in the original DASH feeding studies . Whereas the established intervention plus DASH dietary pattern group intervention provides a useful platform to achieve the DASH dietary pattern and current DRI recommendations , intervention enhancements , including a greater emphasis on nutrient-dense foods , would likely improve this intervention A diet rich in fruits , vegetables , and low-fat dairy foods has been shown to lower blood pressure ( BP ) when all foods are provided . We compared the effect on BP ( measured at home ) of 2 different self-selected diets : a low-sodium , high-potassium diet , rich in fruit and vegetables ( LNAHK ) and a high-calcium diet rich in low-fat dairy foods ( HC ) with a moderate-sodium , high-potassium , high-calcium DASH-type diet , high in fruits , vegetables and low-fat dairy foods ( OD ) . Subjects were r and omly allocated to 2 test diets for 4 wk , the OD and either LNAHK or HC diet , each preceded by a 2 wk control diet ( CD ) . The changes in BP between the preceding CD period and the test diet period ( LNAHK or HC ) were compared with the change between the CD and the OD periods . Of the 56 men and 38 women that completed the OD period , 43 completed the LNAHK diet period and 48 the HC diet period . The mean age was 55.6 + /- 9.9 ( + /-SD ) years . There was a fall in systolic pressure between and the CD and OD [ -1.8 + /- 0.5 mm Hg ( P < 0.001 ) ] . Compared with OD , systolic and diastolic BPs fell during the LNAHK diet period [ -3.5 + /- 1.0 ( P < 0.001 ) and -1.9 + /- 0.7 ( P < 0.05 ) mmHg , respectively ] and increased during the HC diet period [ + 3.1 + /- 0.9 ( P < 0.01 ) and + 0.8 + /- 0.6 ( P = 0.15 ) mm Hg , respectively ] . A self-selected low-sodium , high-potassium diet result ed in a greater fall in BP than a multifaceted OD , confirming the beneficial effect of dietary intervention on BP in a community setting BACKGROUND The Dietary Approaches to Stop Hypertension ( DASH ) diet has been shown to lower blood pressure , but little is known about its long-term effect on cardiovascular end points . Our objective was to assess the association between a DASH-style diet adherence score and risk of coronary heart disease ( CHD ) and stroke in women . METHODS In this prospect i ve cohort study , diet was assessed 7 times during 24 years of follow-up ( 1980 - 2004 ) with vali date d food frequency question naires . A DASH score based on 8 food and nutrient components ( fruits , vegetables , whole grains , nuts and legumes , low-fat dairy , red and processed meats , sweetened beverages , and sodium ) was calculated . Lifestyle and medical information was collected biennially with a question naire . The Cox proportional hazard model was used to adjust for potential confounders . The study population comprised 88,517 female nurses aged 34 to 59 years without a history of cardiovascular disease or diabetes in 1980 . The main outcome measures were the numbers of confirmed incident cases of nonfatal myocardial infa rct ion , CHD death , and stroke . RESULTS We documented 2129 cases of incident nonfatal myocardial infa rct ion , 976 CHD deaths , and 2317 [ corrected ] cases of stroke . After adjustment for age , smoking , and other cardiovascular risk factors , the relative risks of CHD across quintiles of the DASH score were 1.0 , 0.99 , 0.86 , 0.87 , and 0.76 ( 95 % confidence interval , 0.67 - 0.85 ) ( P<.001 for trend ) . The magnitude of risk difference was similar for nonfatal myocardial infa rct ion and fatal CHD . The DASH score was also significantly associated with lower risk of stroke ( multivariate relative risks across quintiles of the DASH score were 1.0 , 0.92 , 0.91 , 0.89 , and 0.82 ) ( P=.002 for trend ) . Cross-sectional analysis in a subgroup of women with blood sample s showed that the DASH score was significantly associated with lower plasma levels of C-reactive protein ( P=.008 for trend ) and interleukin 6 ( P=.04 for trend ) . CONCLUSION Adherence to the DASH-style diet is associated with a lower risk of CHD and stroke among middle-aged women during 24 years of follow-up Low-sodium Dietary Approaches to Stop Hypertension ( DASH ) diets are base producing but restrict red meat without clear justification . We hypothesized that a vitality diet ( VD ) , a low-sodium DASH-type diet with a low dietary acid load containing 6 servings of 100 
    Output:
    