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 Dietary intake of fish and the omega-3 fatty acids have been associated with lower risk of Alzheimer disease and stroke . OBJECTIVE To examine whether intakes of fish and the omega-3 fatty acids protect against  age-related cognitive decline .  DESIGN Prospect i ve cohort study . SETTING Geographically defined Chicago , Ill , community . PARTICIPANTS Residents , 65 years and older , who participated in the Chicago Health and Aging Project . MAIN OUTCOME MEASURE Change in a global cognitive score estimated from mixed models . The global score was computed by summing scores of 4 st and ardized tests . In-home cognitive assessment  s were performed 3 times over 6 years of follow-up . RESULTS Cognitive scores declined on average at a rate of 0.04 st and ardized units per year ( SU/y ) . Fish intake was associated with a slower rate of cognitive decline in mixed models adjusted for age , sex , race , education , cognitive activity , physical activity , alcohol consumption , and total energy intake . Compared with a decline rate in score of -0.100 SU/y among persons who consumed fish less than weekly , the rate was 10 % slower ( -0.090 SU/y ) among persons who consumed 1 fish meal per week and 13 % slower ( -0.088 SU/y ) among persons who consumed 2 or more fish meals per week . The fish association was not accounted for by cardiovascular-related conditions or fruit and vegetable consumption but was modified after adjustment for intakes of saturated , polyunsaturated , and trans fats . There was little evidence that the omega-3 polyunsaturated fatty acids were associated with cognitive change . CONCLUSIONS Fish consumption may be associated with slower cognitive decline with age . Further study is needed to determine whether fat composition is the relevant dietary constituent In a number of previous reports we showed the salutary effects on rats of SR-3 , a compound comprising a 1:4 ratio of n-3 and n-6 fatty acids . Improvements were noted in learning tasks , thermoregulation , recovery from neurotoxins , and seizure protection . Because we were impressed that these effects are related to changes in membrane fluidity and neuronal functioning and because Alzheimer 's Disease is also associated with lipid defects , we undertook a short term ( 4 week ) double blind study with 100 Alzheimer patients ( 60 received SR-3 and 40 in a placebo control ) . The results indicated improvements in mood , cooperation , appetite , sleep , ability to navigate in the home , and short term memory . Overall improvement was reported for 49 patients , and in no case did a guardian report adverse effects to the compound . While not uniform or permanent , and while no mode of action for SR-3 can be precisely identified at this time , the promising results in quality of life for the patient and caregiver warrant further clinical trials and continued basic research into the neuropsychological substrate of the disease and its response to SR-3 Background —Our purpose was to assess the time course of the benefit of n-3 polyunsaturated fatty acids ( PUFAs ) on mortality documented by the GISSI-Prevenzione trial in patients surviving a recent ( <3 months ) myocardial infa rct ion . Methods and Results —In this study , 11 323 patients were r and omly assigned to supplements of n-3 PUFAs , vitamin E ( 300 mg/d ) , both , or no treatment ( control ) on top of optimal pharmacological treatment and lifestyle advice . Intention-to-treat analysis adjusted for interaction between treatments was carried out . Early efficacy of n-3 PUFA treatment for total , cardiovascular , cardiac , coronary , and sudden death ; nonfatal myocardial infa rct ion ; total coronary heart disease ; and cerebrovascular events was assessed by right-censoring follow-up data 12 times from the first month after r and omization up to 12 months . Survival curves for n-3 PUFA treatment diverged early after r and omization , and total mortality was significantly lowered after 3 months of treatment ( relative risk [ RR ] 0.59 ; 95 % CI 0.36 to 0.97;P = 0.037 ) . The reduction in risk of sudden death was specifically relevant and statistically significant already at 4 months ( RR 0.47 ; 95 % CI 0.219 to 0.995;P = 0.048 ) . A similarly significant , although delayed , pattern after 6 to 8 months of treatment was observed for cardiovascular , cardiac , and coronary deaths . Conclusions —The early effect of low-dose ( 1 g/d ) n-3 PUFAs on total mortality and sudden death supports the hypothesis of an antiarrhythmic effect of this drug . Such a result is consistent with the wealth of evidence coming from laboratory experiments on isolated myocytes , animal models , and epidemiological and clinical studies Concentrations of essential fatty acids ( EFAs ) in plasma and red blood cell phospholipids were found to be abnormal in patients with Alzheimer 's disease . A double-blind , placebo-controlled trial of treatment with EFAs plus appropriate antioxidants was carried out in 36 patients with Alzheimer 's disease . After 20 weeks both the EFA and placebo groups had improved , but the degree of improvement was consistently greater in the EFA group BACKGROUND Few studies have investigated the effects of dietary fats on the development of Alzheimer disease . We examined the associations between intake of specific types of fat and incident Alzheimer disease in a biracial community study . METHODS We performed clinical evaluations on a stratified r and om sample of 815 community residents aged 65 years and older who were unaffected by Alzheimer disease at baseline and who completed a food-frequency question naire a mean of 2.3 years before clinical evaluation . RESULTS After a mean follow-up of 3.9 years , 131 persons developed Alzheimer disease . Intakes of saturated fat and trans-unsaturated fat were positively associated with risk of Alzheimer disease , whereas intakes of omega-6 polyunsaturated fat and monounsaturated fat were inversely associated . Persons in the upper fifth of saturated-fat intake had 2.2 times the risk of incident Alzheimer disease compared with persons in the lowest fifth in a multivariable model adjusted for age , sex , race , education , and apolipoprotein E epsilon4 allele status ( 95 % confidence interval , 1.1 - 4.7 ) . Risk also increased with consumption of trans-unsaturated fats , beginning with the second fifth of intake ( relative risk , 2.4 compared with the lowest fifth ; 95 % confidence interval , 1.1 - 5.3 ) . We observed linear inverse associations between Alzheimer disease and vegetable fat ( P = .002 ) , and , after further adjustment for other types of fat , marginally significant associations with intake of omega-6 polyunsaturated fat ( P = .10 for trend ) and monounsaturated fat ( P = .10 for trend ) . Intakes of total fat , animal fat , and dietary cholesterol were not associated with Alzheimer disease . CONCLUSION High intake of unsaturated , unhydrogenated fats may be protective against Alzheimer disease , whereas intake of saturated or trans-unsaturated ( hydrogenated ) fats may increase risk BACKGROUND Insulin resistance is associated with elevated plasma triacylglycerol , low HDL concentrations , elevated postpr and ial lipemia , and a predominance of small , dense LDLs ( sdLDLs ) . It has been hypothesized that the dietary ratio of n-6 to n-3 ( n-6:n-3 ) polyunsaturated fatty acids ( PUFAs ) may have favorable effects on these risk factors by increasing insulin sensitivity . OBJECTIVE The objective was to measure changes in insulin sensitivity , lipoprotein size , and postpr and ial lipemia after a 6-mo alteration in n-6:n-3 . DESIGN In a r and omized , parallel design in 258 subjects aged 45 - 70 y , we compared 4 diets providing 6 % of energy as PUFAs with an n-6:n-3 between 5:1 and 3:1 with a control diet that had an n-6:n-3 of 10:1 . The diets were enriched in alpha-linolenic acid , eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) , or both . Insulin sensitivity was assessed with the homeostatic model assessment of insulin resistance and the revised quantitative insulin sensitivity test . RESULTS Dietary intervention did not influence insulin sensitivity or postpr and ial lipase activities . Fasting and postpr and ial triacylglycerol concentrations were lower , and the proportion of sdLDLs decreased ( by 12.7 % ; 95 % CI : -22.9 % , 2.4 % ) , with an n-6:n-3 of approximately 3:1 , which was achieved by the addition of long-chain n-3 PUFAs ( EPA and DHA ) . CONCLUSIONS Decreasing the n-6:n-3 does not influence insulin sensitivity or lipase activities in older subjects . The reduction in plasma triacylglycerol after an increased intake of n-3 long-chain PUFAs results in favorable changes in LDL size Background and aims : Environmental , lifestyle , and dietary factors , including the type of dietary fatty acids consumed , may influence the onset of dementia . The aim of the present study was therefore to examine whether type of dietary fats consumed is associated with cognitive performance . Methods : Using gaschromatography , plasma phospholipid fatty acid composition was determined in a sample of subjects ( age ≥ 65 years ) r and omly selected from the general Pro . V.A. study population . Plasma phospholipid fatty acid composition is a reliable marker of the type of fats present in the diet . The subjects ’ cognitive capacity was tested using the Mini-Mental State Examination ( MMSE ) . Results : At multiple regression analysis , the MMSE score variance was correlated with age and education level in 30 % of cases , whereas the other variables considered ( including type of fatty acids consumed ) had an almost negligible effect . Conclusions : In free-living elderly subjects , moderate to severe cognitive impairment is not associated with dietary fatty acids BACKGROUND Epidemiologic and animal studies have suggested that dietary fish or fish oil rich in omega-3 fatty acids , for example , docosahexaenoic acid and eicosapentaenoic acid , may prevent Alzheimer disease ( AD ) . OBJECTIVE To determine effects of dietary omega-3 fatty acid supplementation on cognitive functions in patients with mild to moderate AD . DESIGN R and omized , double-blind , placebo-controlled clinical trial . PARTICIPANTS Two hundred four patients with AD ( age range [ mean + /- SD ] , 74 + /- 9 years ) whose conditions were stable while receiving acetylcholine esterase inhibitor treatment and who had a Mini-Mental State Examination ( MMSE ) score of 15 points or more were r and omized to daily intake of 1.7 g of docosahexaenoic acid and 0.6 g of eicosapentaenoic acid ( omega-3 fatty acid-treated group ) or placebo  for 6 months , after which all received omega-3 fatty acid supplementation for 6 months more . MAIN OUTCOME MEASURES The primary outcome was cognition measured with the MMSE and the cognitive portion of the Alzheimer Disease Assessment Scale . The secondary outcome was global function as assessed with the Clinical Dementia Rating Scale ; safety and tolerability of omega-3 fatty acid supplementation ; and blood pressure determinations . RESULTS One hundred seventy-four patients fulfilled the trial . At baseline , mean values for the Clinical Dementia Rating Scale , MMSE , and cognitive portion of the Alzheimer Disease Assessment Scale in the 2 r and omized groups were similar . At 6 months , the decline in cognitive functions as assessed by the latter 2 scales did not differ between the groups . However , in a subgroup ( n = 32 ) with very mild cognitive dysfunction ( MMSE > 27 points ) , a significant ( P<.05 ) reduction in MMSE decline rate was observed in the omega-3 fatty acid-treated group compared with the placebo group . A similar arrest in decline rate was observed between 6 and 12 months in this placebo subgroup when receiving omega-3 fatty acid supplementation . The omega-3 fatty acid treatment was safe and well tolerated . CONCLUSIONS Administration of omega-3 fatty acid in patients with mild to moderate AD did not delay the rate of cognitive decline according to the MMSE or the cognitive portion of the Alzheimer Disease Assessment Scale . However , positive effects were observed in a small group of patients with very mild AD ( MMSE > 27 points ) BACKGROUND Docosahexaenoic acid ( DHA ) is an abundant fatty acid in the brain . In the diet , DHA is found mostly in fatty fish . The content of DHA has been shown to be decreased in the brain and plasma of patients with dementia . OBJECTIVE To determine whether plasma phosphatidylcholine ( PC ) DHA content is associated with the risk of developing dementia . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve follow-up study in 899 men and women who were free of dementia at baseline , had a median age of 76.0 years , and were followed up for a mean of 9.1 years for the development of all-cause dementia and Alzheimer disease . MAIN OUTCOME MEASURES Plasma PC fatty acid levels were measured at baseline . Cox proportional regression analysis was used to assess 
    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 Dietary intake of fish and the omega-3 fatty acids have been associated with lower risk of Alzheimer disease and stroke . OBJECTIVE To examine whether intakes of fish and the omega-3 fatty acids protect against  age-related cognitive decline .  DESIGN Prospect i ve cohort study . SETTING Geographically defined Chicago , Ill , community . PARTICIPANTS Residents , 65 years and older , who participated in the Chicago Health and Aging Project . MAIN OUTCOME MEASURE Change in a global cognitive score estimated from mixed models . The global score was computed by summing scores of 4 st and ardized tests . In-home cognitive assessment  s were performed 3 times over 6 years of follow-up . RESULTS Cognitive scores declined on average at a rate of 0.04 st and ardized units per year ( SU/y ) . Fish intake was associated with a slower rate of cognitive decline in mixed models adjusted for age , sex , race , education , cognitive activity , physical activity , alcohol consumption , and total energy intake . Compared with a decline rate in score of -0.100 SU/y among persons who consumed fish less than weekly , the rate was 10 % slower ( -0.090 SU/y ) among persons who consumed 1 fish meal per week and 13 % slower ( -0.088 SU/y ) among persons who consumed 2 or more fish meals per week . The fish association was not accounted for by cardiovascular-related conditions or fruit and vegetable consumption but was modified after adjustment for intakes of saturated , polyunsaturated , and trans fats . There was little evidence that the omega-3 polyunsaturated fatty acids were associated with cognitive change . CONCLUSIONS Fish consumption may be associated with slower cognitive decline with age . Further study is needed to determine whether fat composition is the relevant dietary constituent In a number of previous reports we showed the salutary effects on rats of SR-3 , a compound comprising a 1:4 ratio of n-3 and n-6 fatty acids . Improvements were noted in learning tasks , thermoregulation , recovery from neurotoxins , and seizure protection . Because we were impressed that these effects are related to changes in membrane fluidity and neuronal functioning and because Alzheimer 's Disease is also associated with lipid defects , we undertook a short term ( 4 week ) double blind study with 100 Alzheimer patients ( 60 received SR-3 and 40 in a placebo control ) . The results indicated improvements in mood , cooperation , appetite , sleep , ability to navigate in the home , and short term memory . Overall improvement was reported for 49 patients , and in no case did a guardian report adverse effects to the compound . While not uniform or permanent , and while no mode of action for SR-3 can be precisely identified at this time , the promising results in quality of life for the patient and caregiver warrant further clinical trials and continued basic research into the neuropsychological substrate of the disease and its response to SR-3 Background —Our purpose was to assess the time course of the benefit of n-3 polyunsaturated fatty acids ( PUFAs ) on mortality documented by the GISSI-Prevenzione trial in patients surviving a recent ( <3 months ) myocardial infa rct ion . Methods and Results —In this study , 11 323 patients were r and omly assigned to supplements of n-3 PUFAs , vitamin E ( 300 mg/d ) , both , or no treatment ( control ) on top of optimal pharmacological treatment and lifestyle advice . Intention-to-treat analysis adjusted for interaction between treatments was carried out . Early efficacy of n-3 PUFA treatment for total , cardiovascular , cardiac , coronary , and sudden death ; nonfatal myocardial infa rct ion ; total coronary heart disease ; and cerebrovascular events was assessed by right-censoring follow-up data 12 times from the first month after r and omization up to 12 months . Survival curves for n-3 PUFA treatment diverged early after r and omization , and total mortality was significantly lowered after 3 months of treatment ( relative risk [ RR ] 0.59 ; 95 % CI 0.36 to 0.97;P = 0.037 ) . The reduction in risk of sudden death was specifically relevant and statistically significant already at 4 months ( RR 0.47 ; 95 % CI 0.219 to 0.995;P = 0.048 ) . A similarly significant , although delayed , pattern after 6 to 8 months of treatment was observed for cardiovascular , cardiac , and coronary deaths . Conclusions —The early effect of low-dose ( 1 g/d ) n-3 PUFAs on total mortality and sudden death supports the hypothesis of an antiarrhythmic effect of this drug . Such a result is consistent with the wealth of evidence coming from laboratory experiments on isolated myocytes , animal models , and epidemiological and clinical studies Concentrations of essential fatty acids ( EFAs ) in plasma and red blood cell phospholipids were found to be abnormal in patients with Alzheimer 's disease . A double-blind , placebo-controlled trial of treatment with EFAs plus appropriate antioxidants was carried out in 36 patients with Alzheimer 's disease . After 20 weeks both the EFA and placebo groups had improved , but the degree of improvement was consistently greater in the EFA group BACKGROUND Few studies have investigated the effects of dietary fats on the development of Alzheimer disease . We examined the associations between intake of specific types of fat and incident Alzheimer disease in a biracial community study . METHODS We performed clinical evaluations on a stratified r and om sample of 815 community residents aged 65 years and older who were unaffected by Alzheimer disease at baseline and who completed a food-frequency question naire a mean of 2.3 years before clinical evaluation . RESULTS After a mean follow-up of 3.9 years , 131 persons developed Alzheimer disease . Intakes of saturated fat and trans-unsaturated fat were positively associated with risk of Alzheimer disease , whereas intakes of omega-6 polyunsaturated fat and monounsaturated fat were inversely associated . Persons in the upper fifth of saturated-fat intake had 2.2 times the risk of incident Alzheimer disease compared with persons in the lowest fifth in a multivariable model adjusted for age , sex , race , education , and apolipoprotein E epsilon4 allele status ( 95 % confidence interval , 1.1 - 4.7 ) . Risk also increased with consumption of trans-unsaturated fats , beginning with the second fifth of intake ( relative risk , 2.4 compared with the lowest fifth ; 95 % confidence interval , 1.1 - 5.3 ) . We observed linear inverse associations between Alzheimer disease and vegetable fat ( P = .002 ) , and , after further adjustment for other types of fat , marginally significant associations with intake of omega-6 polyunsaturated fat ( P = .10 for trend ) and monounsaturated fat ( P = .10 for trend ) . Intakes of total fat , animal fat , and dietary cholesterol were not associated with Alzheimer disease . CONCLUSION High intake of unsaturated , unhydrogenated fats may be protective against Alzheimer disease , whereas intake of saturated or trans-unsaturated ( hydrogenated ) fats may increase risk BACKGROUND Insulin resistance is associated with elevated plasma triacylglycerol , low HDL concentrations , elevated postpr and ial lipemia , and a predominance of small , dense LDLs ( sdLDLs ) . It has been hypothesized that the dietary ratio of n-6 to n-3 ( n-6:n-3 ) polyunsaturated fatty acids ( PUFAs ) may have favorable effects on these risk factors by increasing insulin sensitivity . OBJECTIVE The objective was to measure changes in insulin sensitivity , lipoprotein size , and postpr and ial lipemia after a 6-mo alteration in n-6:n-3 . DESIGN In a r and omized , parallel design in 258 subjects aged 45 - 70 y , we compared 4 diets providing 6 % of energy as PUFAs with an n-6:n-3 between 5:1 and 3:1 with a control diet that had an n-6:n-3 of 10:1 . The diets were enriched in alpha-linolenic acid , eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) , or both . Insulin sensitivity was assessed with the homeostatic model assessment of insulin resistance and the revised quantitative insulin sensitivity test . RESULTS Dietary intervention did not influence insulin sensitivity or postpr and ial lipase activities . Fasting and postpr and ial triacylglycerol concentrations were lower , and the proportion of sdLDLs decreased ( by 12.7 % ; 95 % CI : -22.9 % , 2.4 % ) , with an n-6:n-3 of approximately 3:1 , which was achieved by the addition of long-chain n-3 PUFAs ( EPA and DHA ) . CONCLUSIONS Decreasing the n-6:n-3 does not influence insulin sensitivity or lipase activities in older subjects . The reduction in plasma triacylglycerol after an increased intake of n-3 long-chain PUFAs results in favorable changes in LDL size Background and aims : Environmental , lifestyle , and dietary factors , including the type of dietary fatty acids consumed , may influence the onset of dementia . The aim of the present study was therefore to examine whether type of dietary fats consumed is associated with cognitive performance . Methods : Using gaschromatography , plasma phospholipid fatty acid composition was determined in a sample of subjects ( age ≥ 65 years ) r and omly selected from the general Pro . V.A. study population . Plasma phospholipid fatty acid composition is a reliable marker of the type of fats present in the diet . The subjects ’ cognitive capacity was tested using the Mini-Mental State Examination ( MMSE ) . Results : At multiple regression analysis , the MMSE score variance was correlated with age and education level in 30 % of cases , whereas the other variables considered ( including type of fatty acids consumed ) had an almost negligible effect . Conclusions : In free-living elderly subjects , moderate to severe cognitive impairment is not associated with dietary fatty acids BACKGROUND Epidemiologic and animal studies have suggested that dietary fish or fish oil rich in omega-3 fatty acids , for example , docosahexaenoic acid and eicosapentaenoic acid , may prevent Alzheimer disease ( AD ) . OBJECTIVE To determine effects of dietary omega-3 fatty acid supplementation on cognitive functions in patients with mild to moderate AD . DESIGN R and omized , double-blind , placebo-controlled clinical trial . PARTICIPANTS Two hundred four patients with AD ( age range [ mean + /- SD ] , 74 + /- 9 years ) whose conditions were stable while receiving acetylcholine esterase inhibitor treatment and who had a Mini-Mental State Examination ( MMSE ) score of 15 points or more were r and omized to daily intake of 1.7 g of docosahexaenoic acid and 0.6 g of eicosapentaenoic acid ( omega-3 fatty acid-treated group ) or placebo  for 6 months , after which all received omega-3 fatty acid supplementation for 6 months more . MAIN OUTCOME MEASURES The primary outcome was cognition measured with the MMSE and the cognitive portion of the Alzheimer Disease Assessment Scale . The secondary outcome was global function as assessed with the Clinical Dementia Rating Scale ; safety and tolerability of omega-3 fatty acid supplementation ; and blood pressure determinations . RESULTS One hundred seventy-four patients fulfilled the trial . At baseline , mean values for the Clinical Dementia Rating Scale , MMSE , and cognitive portion of the Alzheimer Disease Assessment Scale in the 2 r and omized groups were similar . At 6 months , the decline in cognitive functions as assessed by the latter 2 scales did not differ between the groups . However , in a subgroup ( n = 32 ) with very mild cognitive dysfunction ( MMSE > 27 points ) , a significant ( P<.05 ) reduction in MMSE decline rate was observed in the omega-3 fatty acid-treated group compared with the placebo group . A similar arrest in decline rate was observed between 6 and 12 months in this placebo subgroup when receiving omega-3 fatty acid supplementation . The omega-3 fatty acid treatment was safe and well tolerated . CONCLUSIONS Administration of omega-3 fatty acid in patients with mild to moderate AD did not delay the rate of cognitive decline according to the MMSE or the cognitive portion of the Alzheimer Disease Assessment Scale . However , positive effects were observed in a small group of patients with very mild AD ( MMSE > 27 points ) BACKGROUND Docosahexaenoic acid ( DHA ) is an abundant fatty acid in the brain . In the diet , DHA is found mostly in fatty fish . The content of DHA has been shown to be decreased in the brain and plasma of patients with dementia . OBJECTIVE To determine whether plasma phosphatidylcholine ( PC ) DHA content is associated with the risk of developing dementia . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve follow-up study in 899 men and women who were free of dementia at baseline , had a median age of 76.0 years , and were followed up for a mean of 9.1 years for the development of all-cause dementia and Alzheimer disease . MAIN OUTCOME MEASURES Plasma PC fatty acid levels were measured at baseline . Cox proportional regression analysis was used to assess 
    Output:
    