human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Aims /hypothesisTo compare the effectiveness of low-fat high-protein and low-fat high-carbohydrate dietary advice on weight loss , using group-based interventions , among overweight people with type 2 diabetes . Study design Multicentre parallel ( 1:1 ) design , blinded r and omised controlled trial . Methods Individuals with type 2 diabetes aged 30–75 years and a BMI > 27 kg/m2 were r and omised , by an independent statistician using sequentially numbered sealed envelopes , to be prescribed either a low-fat high-protein ( 30 % of energy as protein , 40 % as carbohydrate , 30 % as fat ) or a low-fat high-carbohydrate ( 15 % of energy as protein , 55 % as carbohydrate , 30 % as fat ) diet . Participants attended 18 group sessions over 12 months . Primary outcomes were change in weight and waist circumference assessed at baseline , 6 and 12 months . Secondary outcomes were body fatness , glycaemic control , lipid profile , blood pressure and renal function . A further assessment was undertaken 12 months after the intervention . Research assessors remained blinded to group allocation throughout . Intention-to-treat analysis was performed . Results A total of 419 participants were enrolled ( mean ± SD age 58 ± 9.5 years , BMI 36.6 ± 6.5 kg/m2 and HbA1c 8.1 ± 1.2 % ( 65 mmol/mol ) ) . The study was completed by 70 % ( 294/419 ) . No differences between groups were found in change in weight or waist circumference during the intervention phase or the 12-month follow-up . Both groups had lost weight ( 2–3 kg , p < 0.001 ) and reduced their waist circumference ( 2–3 cm , p < 0.001 ) by 12 months and largely maintained this weight loss for the following 12 months . By 6 months , the difference in self-reported dietary protein between groups was small ( 1.1 % total energy ; p < 0.001 ) . No significant differences between groups were found in secondary outcomes : body fatness , HbA1c , lipids , blood pressure and renal function . There were no important adverse effects . Conclusions /interpretationIn a ‘ real-world ’ setting , prescription of an energy-reduced low-fat diet , with either increased protein or carbohydrate , results in similar modest losses in weight and waist circumference over 2 years . Trial registration : Australia New Zeal and Clinical Trials Register ACTRN12606000490572 Funding : The Health Research Council of New Zeal and ( 06/337 ) AIMS Carbohydrate ( CHO ) quantification is used to adjust pre-meal insulin in intensive insulin regimens . However , the precision in CHO quantification required to maintain postpr and ial glycaemic control is unknown . We determined the effect of a + /-10-g variation in CHO amount , with an individually calculated insulin dose for 60 g CHO , on postpr and ial glycaemic control . METHODS Thirty-one children and adolescents ( age range 9.5 - 16.8 years ) , 17 using continuous subcutaneous insulin infusion ( CSII ) and 14 using multiple daily injections ( MDI ) , participated . Each subject consumed test lunches of equal macronutrient content , differing only in carbohydrate quantity ( 50 , 60 , 70 g CHO ) , in r and om order on three consecutive days . For each participant , the insulin dose was the same for each meal , based on their usual insulin : CHO ratio for 60 g CHO . Activity was st and ardized . Continuous glucose monitoring was used . RESULTS The CSII and MDI subjects demonstrated no difference in postpr and ial blood glucose levels ( BGLs ) for comparable carbohydrate loads ( P > 0.05 ) . The 10-g variations in CHO quantity result ed in no differences in BGLs or area under the glucose curves for 2.5 h ( P > 0.05 ) . Hypoglycaemic episodes were not significantly different ( P = 0.32 ) . The 70-g meal produced higher glucose excursions after 2.5 h , with a maximum difference of 1.9 mmol/l at 3 h ( P = 0.01 ) , but the BGLs remained within international postpr and ial targets . CONCLUSIONS In patients using intensive insulin therapy  , an individually calculated insulin dose for 60 g of carbohydrate maintains postpr and ial BGLs for meals containing between 50 and 70 g of carbohydrate . A single mealtime insulin dose will cover a range in carbohydrate amounts without deterioration in postpr and ial control Abstract Aim To determine the effects of protein alone ( independent of fat and carbohydrate ) on postpr and ial glycaemia in individuals with Type 1 diabetes mellitus using intensive insulin therapy .  Methods Participants with Type 1 diabetes mellitus aged 7–40 years consumed six 150 ml whey isolate protein drinks [ 0 g ( control ) , 12.5 , 25 , 50 , 75 and 100 ] and two 150 ml glucose drinks ( 10 and 20 g ) without insulin , in r and omized order over 8 days , 4 h after the evening meal . Continuous glucose monitoring was used to assess postpr and ial glycaemia . Results Data were collected from 27 participants .  Protein loads of 12.5 and 50 g did not result in significant postpr and ial glycaemic excursions compared with control ( water ) throughout the 300 min study period ( P > 0.05 ) . Protein loads of 75 and 100 g result ed in lower glycaemic excursions than control in the 60–120 min postpr and ial interval , but higher excursions in the 180–300 min interval . In comparison with 20 g glucose , the large protein loads result ed in significantly delayed and sustained glucose excursions , commencing at 180 min and continuing to 5 h. Conclusions Seventy‐five grams or more of protein alone significantly increases postpr and ial glycaemia from 3 to 5 h in people with Type 1 diabetes mellitus using intensive insulin therapy . The glycaemic profiles result ing from high protein loads differ significantly from the excursion from glucose in terms of time to peak glucose and duration of the glycaemic excursion . This research supports recommendations for insulin dosing for large amounts of protein BACKGROUND When substituted for carbohydrate in a meal , dietary protein enhances glycaemic control in subjects with type 2 diabetes ( DM2 ) . It is unknown whether the effect is a result of increased protein or reduced carbohydrate . The present study aim ed to compare the effects of two meals differing in protein to fat ratios on post-pr and ial glucose and insulin responses . METHODS This was a crossover , blind study in which obese subjects with ( n = 23 ) and without ( n = 26 ) DM2 consumed two meals in r and om order with equal amounts of energy ( 3.1 MJ , 741 kcal ) , fibre and carbohydrates and a 1-week washout period . Meals were a high protein , low fat ( 30 % protein , 51 % carbohydrates , 19 % fat ) meal and a low protein , high fat ( 15 % protein , 51 % carbohydrates , 34 % fat ) meal .  Subjects were matched for age and body mass index . Plasma glucose and insulin were measured at fasting , 30 , 60 , 90 , 120 min post-pr and ially . Insulin resistance and insulin sensitivity were assessed . RESULTS There was no significant meal effect on glucose and insulin responses within groups . Glucose response was higher in diabetic ( 120 min 11 + /- 0.7 mmol L(-1 ) ) compared to nondiabetic ( 120 min 5 + /- 0.2 ; P < 0.001 ) subjects . Diabetic subjects had significantly higher insulin resistance ( P < 0.001 ) and lower insulin sensitivity ( P < 0.001 ) than nondiabetics . Although peak insulin levels , 60 min post-pr and ially , did not differ between groups ( 81 + /- 9 pmol L(-1 ) for diabetic versus 79 + /- 7 pmol L(-1 ) for nondiabetic subjects ) , they were achieved much later , 90 min post-pr and ially , in diabetic , ( 99 + /- 8 pmol L(-1 ) ) compared to nondiabetic ( 63 + /- 7 pmol L(-1 ) , P = 0.002 ) subjects . CONCLUSIONS Manipulating protein to fat ratio in meals does not affect post-pr and ial plasma blood glucose or insulin responses in obese people with and without DM2 BACKGROUND After weight loss , changes in the circulating levels of several peripheral hormones involved in the homeostatic regulation of body weight occur . Whether these changes are transient or persist over time may be important for an underst and ing of the reasons behind the high rate of weight regain after diet-induced weight loss . METHODS We enrolled 50 overweight or obese patients without diabetes in a 10-week weight-loss program  for which a very-low-energy diet was prescribed . At baseline ( before weight loss ) , at 10 weeks ( after program completion ) , and at 62 weeks , we examined circulating levels of leptin , ghrelin , peptide YY , gastric inhibitory polypeptide , glucagon-like peptide 1 , amylin , pancreatic polypeptide , cholecystokinin , and insulin and subjective ratings of appetite . RESULTS Weight loss ( mean [ ±SE ] , 13.5±0.5 kg ) led to significant reductions in levels of leptin , peptide YY , cholecystokinin , insulin ( P<0.001 for all comparisons ) , and amylin ( P=0.002 ) and to increases in levels of ghrelin ( P<0.001 ) , gastric inhibitory polypeptide ( P=0.004 ) , and pancreatic polypeptide ( P=0.008 ) . There was also a significant increase in subjective appetite ( P<0.001 ) . One year after the initial weight loss , there were still significant differences from baseline in the mean levels of leptin ( P<0.001 ) , peptide YY ( P<0.001 ) , cholecystokinin ( P=0.04 ) , insulin ( P=0.01 ) , ghrelin ( P<0.001 ) , gastric inhibitory polypeptide ( P<0.001 ) , and pancreatic polypeptide ( P=0.002 ) , as well as hunger ( P<0.001 ) . CONCLUSIONS One year after initial weight reduction , levels of the circulating mediators of appetite that encourage weight regain after diet-induced weight loss do not revert to the levels recorded before weight loss . Long-term strategies to counteract this change may be needed to prevent obesity relapse . ( Funded by the National Health and Medical Research Council and others ; Clinical Trials.gov number , NCT00870259 . ) Abstract Objectives : To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes . Design : R and omised design with participants either attending training immediately ( immediate DAFNE ) or acting as waiting list controls and attending “ delayed DAFNE ” training 6 months later . Setting : Secondary care diabetes clinics in three English health districts . Participants : 169 adults with type 1 diabetes and moderate or poor glycaemic control . Main outcome measures : Glycated haemoglobin ( HbA1c ) , severe hypoglycaemia , impact of diabetes on quality of life ( ADDQoL ) . Results : At 6 months , HbA1c was significantly better in immediate DAFNE patients ( mean 8.4 % ) than in delayed DAFNE patients ( 9.4 % ) ( t=6.1 , P<0.0001 ) . The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients ( t=−5.4 , P<0.0001 ) , as was the impact of diabetes on overall quality of life ( t=2.9 , P<0.01 ) . General wellbeing and treatment satisfaction were also significantly improved , but severe hypoglycaemia , weight , and lipids remained unchanged . Improvements in “ present quality of life ” did not reach significance at 6 months but were significant by 1 year . Conclusion : Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk . This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation OBJECTIVE In this study , we evaluated the effects of high-(55 % ) and low-(40 % 
    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: Aims /hypothesisTo compare the effectiveness of low-fat high-protein and low-fat high-carbohydrate dietary advice on weight loss , using group-based interventions , among overweight people with type 2 diabetes . Study design Multicentre parallel ( 1:1 ) design , blinded r and omised controlled trial . Methods Individuals with type 2 diabetes aged 30–75 years and a BMI > 27 kg/m2 were r and omised , by an independent statistician using sequentially numbered sealed envelopes , to be prescribed either a low-fat high-protein ( 30 % of energy as protein , 40 % as carbohydrate , 30 % as fat ) or a low-fat high-carbohydrate ( 15 % of energy as protein , 55 % as carbohydrate , 30 % as fat ) diet . Participants attended 18 group sessions over 12 months . Primary outcomes were change in weight and waist circumference assessed at baseline , 6 and 12 months . Secondary outcomes were body fatness , glycaemic control , lipid profile , blood pressure and renal function . A further assessment was undertaken 12 months after the intervention . Research assessors remained blinded to group allocation throughout . Intention-to-treat analysis was performed . Results A total of 419 participants were enrolled ( mean ± SD age 58 ± 9.5 years , BMI 36.6 ± 6.5 kg/m2 and HbA1c 8.1 ± 1.2 % ( 65 mmol/mol ) ) . The study was completed by 70 % ( 294/419 ) . No differences between groups were found in change in weight or waist circumference during the intervention phase or the 12-month follow-up . Both groups had lost weight ( 2–3 kg , p < 0.001 ) and reduced their waist circumference ( 2–3 cm , p < 0.001 ) by 12 months and largely maintained this weight loss for the following 12 months . By 6 months , the difference in self-reported dietary protein between groups was small ( 1.1 % total energy ; p < 0.001 ) . No significant differences between groups were found in secondary outcomes : body fatness , HbA1c , lipids , blood pressure and renal function . There were no important adverse effects . Conclusions /interpretationIn a ‘ real-world ’ setting , prescription of an energy-reduced low-fat diet , with either increased protein or carbohydrate , results in similar modest losses in weight and waist circumference over 2 years . Trial registration : Australia New Zeal and Clinical Trials Register ACTRN12606000490572 Funding : The Health Research Council of New Zeal and ( 06/337 ) AIMS Carbohydrate ( CHO ) quantification is used to adjust pre-meal insulin in intensive insulin regimens . However , the precision in CHO quantification required to maintain postpr and ial glycaemic control is unknown . We determined the effect of a + /-10-g variation in CHO amount , with an individually calculated insulin dose for 60 g CHO , on postpr and ial glycaemic control . METHODS Thirty-one children and adolescents ( age range 9.5 - 16.8 years ) , 17 using continuous subcutaneous insulin infusion ( CSII ) and 14 using multiple daily injections ( MDI ) , participated . Each subject consumed test lunches of equal macronutrient content , differing only in carbohydrate quantity ( 50 , 60 , 70 g CHO ) , in r and om order on three consecutive days . For each participant , the insulin dose was the same for each meal , based on their usual insulin : CHO ratio for 60 g CHO . Activity was st and ardized . Continuous glucose monitoring was used . RESULTS The CSII and MDI subjects demonstrated no difference in postpr and ial blood glucose levels ( BGLs ) for comparable carbohydrate loads ( P > 0.05 ) . The 10-g variations in CHO quantity result ed in no differences in BGLs or area under the glucose curves for 2.5 h ( P > 0.05 ) . Hypoglycaemic episodes were not significantly different ( P = 0.32 ) . The 70-g meal produced higher glucose excursions after 2.5 h , with a maximum difference of 1.9 mmol/l at 3 h ( P = 0.01 ) , but the BGLs remained within international postpr and ial targets . CONCLUSIONS In patients using intensive insulin therapy  , an individually calculated insulin dose for 60 g of carbohydrate maintains postpr and ial BGLs for meals containing between 50 and 70 g of carbohydrate . A single mealtime insulin dose will cover a range in carbohydrate amounts without deterioration in postpr and ial control Abstract Aim To determine the effects of protein alone ( independent of fat and carbohydrate ) on postpr and ial glycaemia in individuals with Type 1 diabetes mellitus using intensive insulin therapy .  Methods Participants with Type 1 diabetes mellitus aged 7–40 years consumed six 150 ml whey isolate protein drinks [ 0 g ( control ) , 12.5 , 25 , 50 , 75 and 100 ] and two 150 ml glucose drinks ( 10 and 20 g ) without insulin , in r and omized order over 8 days , 4 h after the evening meal . Continuous glucose monitoring was used to assess postpr and ial glycaemia . Results Data were collected from 27 participants .  Protein loads of 12.5 and 50 g did not result in significant postpr and ial glycaemic excursions compared with control ( water ) throughout the 300 min study period ( P > 0.05 ) . Protein loads of 75 and 100 g result ed in lower glycaemic excursions than control in the 60–120 min postpr and ial interval , but higher excursions in the 180–300 min interval . In comparison with 20 g glucose , the large protein loads result ed in significantly delayed and sustained glucose excursions , commencing at 180 min and continuing to 5 h. Conclusions Seventy‐five grams or more of protein alone significantly increases postpr and ial glycaemia from 3 to 5 h in people with Type 1 diabetes mellitus using intensive insulin therapy . The glycaemic profiles result ing from high protein loads differ significantly from the excursion from glucose in terms of time to peak glucose and duration of the glycaemic excursion . This research supports recommendations for insulin dosing for large amounts of protein BACKGROUND When substituted for carbohydrate in a meal , dietary protein enhances glycaemic control in subjects with type 2 diabetes ( DM2 ) . It is unknown whether the effect is a result of increased protein or reduced carbohydrate . The present study aim ed to compare the effects of two meals differing in protein to fat ratios on post-pr and ial glucose and insulin responses . METHODS This was a crossover , blind study in which obese subjects with ( n = 23 ) and without ( n = 26 ) DM2 consumed two meals in r and om order with equal amounts of energy ( 3.1 MJ , 741 kcal ) , fibre and carbohydrates and a 1-week washout period . Meals were a high protein , low fat ( 30 % protein , 51 % carbohydrates , 19 % fat ) meal and a low protein , high fat ( 15 % protein , 51 % carbohydrates , 34 % fat ) meal .  Subjects were matched for age and body mass index . Plasma glucose and insulin were measured at fasting , 30 , 60 , 90 , 120 min post-pr and ially . Insulin resistance and insulin sensitivity were assessed . RESULTS There was no significant meal effect on glucose and insulin responses within groups . Glucose response was higher in diabetic ( 120 min 11 + /- 0.7 mmol L(-1 ) ) compared to nondiabetic ( 120 min 5 + /- 0.2 ; P < 0.001 ) subjects . Diabetic subjects had significantly higher insulin resistance ( P < 0.001 ) and lower insulin sensitivity ( P < 0.001 ) than nondiabetics . Although peak insulin levels , 60 min post-pr and ially , did not differ between groups ( 81 + /- 9 pmol L(-1 ) for diabetic versus 79 + /- 7 pmol L(-1 ) for nondiabetic subjects ) , they were achieved much later , 90 min post-pr and ially , in diabetic , ( 99 + /- 8 pmol L(-1 ) ) compared to nondiabetic ( 63 + /- 7 pmol L(-1 ) , P = 0.002 ) subjects . CONCLUSIONS Manipulating protein to fat ratio in meals does not affect post-pr and ial plasma blood glucose or insulin responses in obese people with and without DM2 BACKGROUND After weight loss , changes in the circulating levels of several peripheral hormones involved in the homeostatic regulation of body weight occur . Whether these changes are transient or persist over time may be important for an underst and ing of the reasons behind the high rate of weight regain after diet-induced weight loss . METHODS We enrolled 50 overweight or obese patients without diabetes in a 10-week weight-loss program  for which a very-low-energy diet was prescribed . At baseline ( before weight loss ) , at 10 weeks ( after program completion ) , and at 62 weeks , we examined circulating levels of leptin , ghrelin , peptide YY , gastric inhibitory polypeptide , glucagon-like peptide 1 , amylin , pancreatic polypeptide , cholecystokinin , and insulin and subjective ratings of appetite . RESULTS Weight loss ( mean [ ±SE ] , 13.5±0.5 kg ) led to significant reductions in levels of leptin , peptide YY , cholecystokinin , insulin ( P<0.001 for all comparisons ) , and amylin ( P=0.002 ) and to increases in levels of ghrelin ( P<0.001 ) , gastric inhibitory polypeptide ( P=0.004 ) , and pancreatic polypeptide ( P=0.008 ) . There was also a significant increase in subjective appetite ( P<0.001 ) . One year after the initial weight loss , there were still significant differences from baseline in the mean levels of leptin ( P<0.001 ) , peptide YY ( P<0.001 ) , cholecystokinin ( P=0.04 ) , insulin ( P=0.01 ) , ghrelin ( P<0.001 ) , gastric inhibitory polypeptide ( P<0.001 ) , and pancreatic polypeptide ( P=0.002 ) , as well as hunger ( P<0.001 ) . CONCLUSIONS One year after initial weight reduction , levels of the circulating mediators of appetite that encourage weight regain after diet-induced weight loss do not revert to the levels recorded before weight loss . Long-term strategies to counteract this change may be needed to prevent obesity relapse . ( Funded by the National Health and Medical Research Council and others ; Clinical Trials.gov number , NCT00870259 . ) Abstract Objectives : To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes . Design : R and omised design with participants either attending training immediately ( immediate DAFNE ) or acting as waiting list controls and attending “ delayed DAFNE ” training 6 months later . Setting : Secondary care diabetes clinics in three English health districts . Participants : 169 adults with type 1 diabetes and moderate or poor glycaemic control . Main outcome measures : Glycated haemoglobin ( HbA1c ) , severe hypoglycaemia , impact of diabetes on quality of life ( ADDQoL ) . Results : At 6 months , HbA1c was significantly better in immediate DAFNE patients ( mean 8.4 % ) than in delayed DAFNE patients ( 9.4 % ) ( t=6.1 , P<0.0001 ) . The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients ( t=−5.4 , P<0.0001 ) , as was the impact of diabetes on overall quality of life ( t=2.9 , P<0.01 ) . General wellbeing and treatment satisfaction were also significantly improved , but severe hypoglycaemia , weight , and lipids remained unchanged . Improvements in “ present quality of life ” did not reach significance at 6 months but were significant by 1 year . Conclusion : Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk . This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation OBJECTIVE In this study , we evaluated the effects of high-(55 % ) and low-(40 % 
    Output:
    