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: OBJECTIVE It is important to identify modifiable factors that may lower gestational diabetes mellitus ( GDM ) risk .  Dietary iron is of particular interest given that iron is a strong prooxidant , and high body iron levels can damage pancreatic β-cell function and impair glucose metabolism . The current study is to determine if prepregnancy dietary and supplemental iron intakes are associated with the risk of GDM . RESEARCH DESIGN AND METHODS A prospect i ve study was conducted among 13,475 women who reported a singleton pregnancy between 1991 and 2001 in the Nurses ’ Health Study II . A total of 867 incident GDM cases were reported . Pooled logistic regression was used to estimate the relative risk ( RR ) of GDM by quintiles of iron intake controlling for dietary and nondietary risk factors . RESULTS  Dietary heme iron intake was positively and significantly associated with GDM risk . After adjusting for age , BMI , and other risk factors , RRs ( 95 % CIs ) across increasing quintiles of heme iron were 1.0 ( reference ) , 1.11 ( 0.87–1.43 ) , 1.31 ( 1.03–1.68 ) , 1.51 ( 1.17–1.93 ) , and 1.58 ( 1.21–2.08 ) , respectively ( P for linear trend 0.0001 ) . The multivariate adjusted RR for GDM associated with every 0.5-mg per day of increase in intake was 1.22 ( 1.10–1.36 ) . No significant associations were observed between total dietary , nonheme , or supplemental iron intake and GDM risk . CONCLUSIONS These findings suggest that higher prepregnancy intake of dietary heme iron is associated with an increased GDM risk Higher egg and cholesterol intakes are associated with increased risk of type 2 diabetes mellitus .  However , their association with gestational diabetes mellitus ( GDM ) has not been evaluated . The authors assessed such associations in both a prospect i ve cohort study ( 1996 - 2008 ; 3,158 participants ) and a case-control study ( 1998 - 2002 ; 185 cases , 411 controls ) .  A food frequency question naire was used to assess maternal diet . Multivariable models were used to derive relative risks and 95 % confidence intervals . Compared with no egg consumption , adjusted relative risks for GDM were 0.94 , 1.01 , 1.12 , 1.54 , and 2.52 for consumption of ≤1 , 2 - 3 , 4 - 6 , 7 - 9 , and ≥10 eggs/week , respectively ( P for trend=0.008 ) . Women with high egg consumption ( ≥7/week ) had a 1.77-fold increased risk compared with women with lower consumption ( 95 % confidence interval ( CI ) : 1.19 , 2.63 ) . The relative risk for the highest quartile of cholesterol intake ( ≥294 mg/day ) versus the lowest ( < 151 mg/day ) was 2.35 ( 95 % CI : 1.35 , 4.09 ) . In the case-control study , the adjusted odds ratio for consuming ≥7 eggs/week versus < 7 eggs/week was 2.65 ( 95 % CI : 1.48 , 4.72 ) , and the odds of GDM increased with increasing cholesterol intake ( P for trend=0.021 ) . In conclusion ,  high  egg and cholesterol intakes before and during pregnancy are associated with increased risk of GDM BACKGROUND Fatty acids play a vital role in glucose homeostasis ; however , studies on habitual dietary fat intakes and gestational diabetes mellitus ( GDM ) risk are limited and provide conflicting findings . OBJECTIVE We determined whether the total amount and the type and source of prepregnancy dietary fats are related to risk of GDM . DESIGN A prospect i ve study was conducted in 13,475 women who reported a singleton pregnancy between 1991 and 2001 in the Nurses ' Health Study II . In these women , 860 incident GDM cases were reported . The adjusted RR of GDM was estimated for quintiles of total fat , specific fat , and the source of fat intakes by pooled logistic regression . RESULTS Higher animal fat and cholesterol intakes were significantly associated with increased GDM risk . Across increasing quintiles of animal fat , RRs ( 95 % CIs ) for GDM were 1.00 ( reference ) , 1.55 ( 1.20 , 1.98 ) , 1.43 ( 1.09 , 1.88 ) , 1.40 ( 1.04 , 1.89 ) , and 1.88 ( 1.36 , 2.60 ) ( P-trend = 0.05 ) . Corresponding RRs ( 95 % CIs ) for dietary cholesterol  were 1.00 ( reference ) , 1.08 ( 0.84 , 1.32 ) , 1.02 ( 0.78 , 1.29 ) , 1.20 ( 0.93 , 1.55 ) , and 1.45 ( 1.11 , 1.89 ) ( P-trend = 0.04 ) . The substitution of 5 % of energy from animal fat for an equal percentage of energy from carbohydrates was associated with significantly increased risk of GDM [ RR ( 95 % CI ) : 1.13 ( 1.08 , 1.18 ) ; P < 0.0001 ] . No significant associations were observed between dietary polyunsaturated fat , monounsaturated fat , or trans fat intakes and GDM risk . CONCLUSION Higher prepregnancy intakes of animal fat and cholesterol were associated with elevated GDM risk OBJECTIVE Studies in predominantly non-Hispanic white population s have suggested that physical activity during pregnancy is associated with a reduced risk of gestational diabetes mellitus ( GDM ) . There are few such studies in Hispanic women , a group at increased risk for GDM . METHODS We conducted a prospect i ve cohort study of household/caregiving , occupational , sports/exercise , and active living habits and the risk of GDM among 1006 Hispanic ( predominantly Puerto Rican ) prenatal care patients in western Massachusetts from 2000 to 2004 . Prepregnancy , early pregnancy , and midpregnancy physical activity was assessed using the Kaiser Physical Activity Survey . RESULTS A total of 33 women ( 3.3 % ) were diagnosed with GDM , and 119 women ( 11.8 % ) were diagnosed with abnormal glucose tolerance . There were no significant associations between GDM risk and occupational and active living activities  in prepregnancy , early pregnancy , and midpregnancy or with a change in levels of household/caregiving , occupational , and active living activities from prepregnancy to during pregnancy . However , after controlling for age and prepregnancy body mass index ( BMI ) , women in the highest quartile of prepregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.03 ) and midpregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.004 ) household/caregiving activities  as well as midpregnancy sports/exercise ( 0.1 , 95 % CI 0.0 - 0.7 , p(trend ) = 0.12 ) had a reduced risk of GDM compared with women in the lowest quartile . CONCLUSIONS Findings in this Hispanic population , although based on small numbers of cases , are consistent with prior research among predominantly non-Hispanic white population OBJECTIVE Dietary interventions can improve pregnancy outcomes in women with gestational diabetes mellitus ( GDM ) . We compared the effect of a low – glycemic index ( GI ) versus a conventional high-fiber ( HF ) diet on pregnancy outcomes , birth weight z score , and maternal metabolic profile in women at high risk of GDM . RESEARCH DESIGN AND METHODS One hundred thirty-nine women [ mean ( SD ) age 34.7 ( 0.4 ) years and prepregnancy BMI 25.2 ( 0.5 ) kg/m2 ] were r and omly assigned to a low-GI ( LGI ) diet ( n = 72 ; target GI ∼50 ) or a high-fiber , moderate-GI ( HF ) diet ( n = 67 ; target GI ∼60 ) at 14–20 weeks ’ gestation .  Diet was assessed by 3-day food records and infant body composition by air-displacement plethysmography , and pregnancy outcomes were assessed from medical records . RESULTS The LGI group achieved a lower GI than the HF group [ mean ( SD ) 50 ( 5 ) vs. 58 ( 5 ) ; P < 0.001 ] . There were no differences in glycosylated hemoglobin , fructosamine , or lipids at 36 weeks or differences in birth weight [ LGI 3.4 ( 0.4 ) kg vs. HF 3.4 ( 0.5 ) kg ; P = 0.514 ] , birth weight z score [ LGI 0.31 ( 0.90 ) vs. HF 0.24 ( 1.07 ) ; P = 0.697 ] , ponderal index [ LGI 2.71 ( 0.22 ) vs. HF 2.69 ( 0.23 ) kg/m3 ; P = 0.672 ] , birth weight centile [ LGI 46.2 ( 25.4 ) vs. HF 41.8 ( 25.6 ) ; P = 0.330 ] , % fat mass [ LGI 10 ( 4 ) vs. HF 10 ( 4 ) ; P = 0.789 ] , or incidence of GDM . CONCLUSIONS In intensively monitored women at risk for GDM , a low-GI diet and a healthy diet produce similar pregnancy outcomes Study question What is the association between potato consumption before pregnancy and the risk of gestational diabetes mellitus ( GDM )  ? Methods This prospect i ve cohort study included 15 632 women from the Nurses ’ Health Study II ( 1991 - 2001 ) . They had no previous GDM or chronic diseases before pregnancy .  Consumption of potatoes and other foods was assessed every four years . Incident first time GDM was ascertained from self reports of a physician diagnosis of GDM , which was previously vali date d by medical records . Study answer and limitations Over the 10 year follow-up there were 854 incident cases of GDM among 21 693 singleton pregnancies . After adjustment for age , parity , and dietary and non-dietary factors , women who consumed more potatoes before pregnancy had higher rates of developing GDM . Substitution of two servings a week of total potatoes with other vegetables , legumes , and whole grain foods was significantly associated with a 9 - 12 % lower risk of GDM . Consumption and diabetes were self reported , and severity of diabetes was unknown . More than 90 % of women were white . A causal association can not be assumed . What this paper adds Higher levels of potato consumption before pregnancy are associated with greater risk of GDM , and substitution of potatoes with other vegetables , legumes , or whole grain foods might lower the risk . Funding , competing interests , data sharing Funding was received from the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development , the National Institutes of Health , and the American Diabetes Association ( No 7 - 12-MN-34 ) . The authors have no competing interests or additional data to share Objective To quantify the association between a combination of healthy lifestyle factors before pregnancy ( healthy body weight , healthy diet , regular exercise , and not smoking ) and the risk of gestational diabetes . Design Prospect i ve cohort study . Setting Nurses ’ Health Study II , United States . Participants 20 136 singleton live births in 14 437 women without chronic disease . Main outcome measure Self reported incident gestational diabetes diagnosed by a physician , vali date d by medical records in a previous study . Results Incident first time gestational diabetes was reported in 823 pregnancies . Each lifestyle factor measured was independently and significantly associated with risk of gestational diabetes . The combination of three low risk factors ( non-smoker , ≥150 minutes a week of moderate to vigorous physical activity , and healthy eating ( top two fifths of Alternate Healthy Eating Index-2010 adherence score ) ) was associated with a 41 % lower risk of gestational diabetes compared with all other pregnancies ( relative risk 0.59 , 95 % confidence interval 0.48 to 0.71 ) . Addition of body mass index ( BMI ) < 25 before pregnancy ( giving a combination of four low risk factors ) was associated with a 52 % lower risk of gestational diabetes compared with all other pregnancies ( relative risk 0.48 , 0.38 to 0.61 ) . Compared with pregnancies in women who did not meet any of the low risk lifestyle factors , those meeting all four criteria had an 83 % lower risk of gestational diabetes 
    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: OBJECTIVE It is important to identify modifiable factors that may lower gestational diabetes mellitus ( GDM ) risk .  Dietary iron is of particular interest given that iron is a strong prooxidant , and high body iron levels can damage pancreatic β-cell function and impair glucose metabolism . The current study is to determine if prepregnancy dietary and supplemental iron intakes are associated with the risk of GDM . RESEARCH DESIGN AND METHODS A prospect i ve study was conducted among 13,475 women who reported a singleton pregnancy between 1991 and 2001 in the Nurses ’ Health Study II . A total of 867 incident GDM cases were reported . Pooled logistic regression was used to estimate the relative risk ( RR ) of GDM by quintiles of iron intake controlling for dietary and nondietary risk factors . RESULTS  Dietary heme iron intake was positively and significantly associated with GDM risk . After adjusting for age , BMI , and other risk factors , RRs ( 95 % CIs ) across increasing quintiles of heme iron were 1.0 ( reference ) , 1.11 ( 0.87–1.43 ) , 1.31 ( 1.03–1.68 ) , 1.51 ( 1.17–1.93 ) , and 1.58 ( 1.21–2.08 ) , respectively ( P for linear trend 0.0001 ) . The multivariate adjusted RR for GDM associated with every 0.5-mg per day of increase in intake was 1.22 ( 1.10–1.36 ) . No significant associations were observed between total dietary , nonheme , or supplemental iron intake and GDM risk . CONCLUSIONS These findings suggest that higher prepregnancy intake of dietary heme iron is associated with an increased GDM risk Higher egg and cholesterol intakes are associated with increased risk of type 2 diabetes mellitus .  However , their association with gestational diabetes mellitus ( GDM ) has not been evaluated . The authors assessed such associations in both a prospect i ve cohort study ( 1996 - 2008 ; 3,158 participants ) and a case-control study ( 1998 - 2002 ; 185 cases , 411 controls ) .  A food frequency question naire was used to assess maternal diet . Multivariable models were used to derive relative risks and 95 % confidence intervals . Compared with no egg consumption , adjusted relative risks for GDM were 0.94 , 1.01 , 1.12 , 1.54 , and 2.52 for consumption of ≤1 , 2 - 3 , 4 - 6 , 7 - 9 , and ≥10 eggs/week , respectively ( P for trend=0.008 ) . Women with high egg consumption ( ≥7/week ) had a 1.77-fold increased risk compared with women with lower consumption ( 95 % confidence interval ( CI ) : 1.19 , 2.63 ) . The relative risk for the highest quartile of cholesterol intake ( ≥294 mg/day ) versus the lowest ( < 151 mg/day ) was 2.35 ( 95 % CI : 1.35 , 4.09 ) . In the case-control study , the adjusted odds ratio for consuming ≥7 eggs/week versus < 7 eggs/week was 2.65 ( 95 % CI : 1.48 , 4.72 ) , and the odds of GDM increased with increasing cholesterol intake ( P for trend=0.021 ) . In conclusion ,  high  egg and cholesterol intakes before and during pregnancy are associated with increased risk of GDM BACKGROUND Fatty acids play a vital role in glucose homeostasis ; however , studies on habitual dietary fat intakes and gestational diabetes mellitus ( GDM ) risk are limited and provide conflicting findings . OBJECTIVE We determined whether the total amount and the type and source of prepregnancy dietary fats are related to risk of GDM . DESIGN A prospect i ve study was conducted in 13,475 women who reported a singleton pregnancy between 1991 and 2001 in the Nurses ' Health Study II . In these women , 860 incident GDM cases were reported . The adjusted RR of GDM was estimated for quintiles of total fat , specific fat , and the source of fat intakes by pooled logistic regression . RESULTS Higher animal fat and cholesterol intakes were significantly associated with increased GDM risk . Across increasing quintiles of animal fat , RRs ( 95 % CIs ) for GDM were 1.00 ( reference ) , 1.55 ( 1.20 , 1.98 ) , 1.43 ( 1.09 , 1.88 ) , 1.40 ( 1.04 , 1.89 ) , and 1.88 ( 1.36 , 2.60 ) ( P-trend = 0.05 ) . Corresponding RRs ( 95 % CIs ) for dietary cholesterol  were 1.00 ( reference ) , 1.08 ( 0.84 , 1.32 ) , 1.02 ( 0.78 , 1.29 ) , 1.20 ( 0.93 , 1.55 ) , and 1.45 ( 1.11 , 1.89 ) ( P-trend = 0.04 ) . The substitution of 5 % of energy from animal fat for an equal percentage of energy from carbohydrates was associated with significantly increased risk of GDM [ RR ( 95 % CI ) : 1.13 ( 1.08 , 1.18 ) ; P < 0.0001 ] . No significant associations were observed between dietary polyunsaturated fat , monounsaturated fat , or trans fat intakes and GDM risk . CONCLUSION Higher prepregnancy intakes of animal fat and cholesterol were associated with elevated GDM risk OBJECTIVE Studies in predominantly non-Hispanic white population s have suggested that physical activity during pregnancy is associated with a reduced risk of gestational diabetes mellitus ( GDM ) . There are few such studies in Hispanic women , a group at increased risk for GDM . METHODS We conducted a prospect i ve cohort study of household/caregiving , occupational , sports/exercise , and active living habits and the risk of GDM among 1006 Hispanic ( predominantly Puerto Rican ) prenatal care patients in western Massachusetts from 2000 to 2004 . Prepregnancy , early pregnancy , and midpregnancy physical activity was assessed using the Kaiser Physical Activity Survey . RESULTS A total of 33 women ( 3.3 % ) were diagnosed with GDM , and 119 women ( 11.8 % ) were diagnosed with abnormal glucose tolerance . There were no significant associations between GDM risk and occupational and active living activities  in prepregnancy , early pregnancy , and midpregnancy or with a change in levels of household/caregiving , occupational , and active living activities from prepregnancy to during pregnancy . However , after controlling for age and prepregnancy body mass index ( BMI ) , women in the highest quartile of prepregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.03 ) and midpregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.004 ) household/caregiving activities  as well as midpregnancy sports/exercise ( 0.1 , 95 % CI 0.0 - 0.7 , p(trend ) = 0.12 ) had a reduced risk of GDM compared with women in the lowest quartile . CONCLUSIONS Findings in this Hispanic population , although based on small numbers of cases , are consistent with prior research among predominantly non-Hispanic white population OBJECTIVE Dietary interventions can improve pregnancy outcomes in women with gestational diabetes mellitus ( GDM ) . We compared the effect of a low – glycemic index ( GI ) versus a conventional high-fiber ( HF ) diet on pregnancy outcomes , birth weight z score , and maternal metabolic profile in women at high risk of GDM . RESEARCH DESIGN AND METHODS One hundred thirty-nine women [ mean ( SD ) age 34.7 ( 0.4 ) years and prepregnancy BMI 25.2 ( 0.5 ) kg/m2 ] were r and omly assigned to a low-GI ( LGI ) diet ( n = 72 ; target GI ∼50 ) or a high-fiber , moderate-GI ( HF ) diet ( n = 67 ; target GI ∼60 ) at 14–20 weeks ’ gestation .  Diet was assessed by 3-day food records and infant body composition by air-displacement plethysmography , and pregnancy outcomes were assessed from medical records . RESULTS The LGI group achieved a lower GI than the HF group [ mean ( SD ) 50 ( 5 ) vs. 58 ( 5 ) ; P < 0.001 ] . There were no differences in glycosylated hemoglobin , fructosamine , or lipids at 36 weeks or differences in birth weight [ LGI 3.4 ( 0.4 ) kg vs. HF 3.4 ( 0.5 ) kg ; P = 0.514 ] , birth weight z score [ LGI 0.31 ( 0.90 ) vs. HF 0.24 ( 1.07 ) ; P = 0.697 ] , ponderal index [ LGI 2.71 ( 0.22 ) vs. HF 2.69 ( 0.23 ) kg/m3 ; P = 0.672 ] , birth weight centile [ LGI 46.2 ( 25.4 ) vs. HF 41.8 ( 25.6 ) ; P = 0.330 ] , % fat mass [ LGI 10 ( 4 ) vs. HF 10 ( 4 ) ; P = 0.789 ] , or incidence of GDM . CONCLUSIONS In intensively monitored women at risk for GDM , a low-GI diet and a healthy diet produce similar pregnancy outcomes Study question What is the association between potato consumption before pregnancy and the risk of gestational diabetes mellitus ( GDM )  ? Methods This prospect i ve cohort study included 15 632 women from the Nurses ’ Health Study II ( 1991 - 2001 ) . They had no previous GDM or chronic diseases before pregnancy .  Consumption of potatoes and other foods was assessed every four years . Incident first time GDM was ascertained from self reports of a physician diagnosis of GDM , which was previously vali date d by medical records . Study answer and limitations Over the 10 year follow-up there were 854 incident cases of GDM among 21 693 singleton pregnancies . After adjustment for age , parity , and dietary and non-dietary factors , women who consumed more potatoes before pregnancy had higher rates of developing GDM . Substitution of two servings a week of total potatoes with other vegetables , legumes , and whole grain foods was significantly associated with a 9 - 12 % lower risk of GDM . Consumption and diabetes were self reported , and severity of diabetes was unknown . More than 90 % of women were white . A causal association can not be assumed . What this paper adds Higher levels of potato consumption before pregnancy are associated with greater risk of GDM , and substitution of potatoes with other vegetables , legumes , or whole grain foods might lower the risk . Funding , competing interests , data sharing Funding was received from the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development , the National Institutes of Health , and the American Diabetes Association ( No 7 - 12-MN-34 ) . The authors have no competing interests or additional data to share Objective To quantify the association between a combination of healthy lifestyle factors before pregnancy ( healthy body weight , healthy diet , regular exercise , and not smoking ) and the risk of gestational diabetes . Design Prospect i ve cohort study . Setting Nurses ’ Health Study II , United States . Participants 20 136 singleton live births in 14 437 women without chronic disease . Main outcome measure Self reported incident gestational diabetes diagnosed by a physician , vali date d by medical records in a previous study . Results Incident first time gestational diabetes was reported in 823 pregnancies . Each lifestyle factor measured was independently and significantly associated with risk of gestational diabetes . The combination of three low risk factors ( non-smoker , ≥150 minutes a week of moderate to vigorous physical activity , and healthy eating ( top two fifths of Alternate Healthy Eating Index-2010 adherence score ) ) was associated with a 41 % lower risk of gestational diabetes compared with all other pregnancies ( relative risk 0.59 , 95 % confidence interval 0.48 to 0.71 ) . Addition of body mass index ( BMI ) < 25 before pregnancy ( giving a combination of four low risk factors ) was associated with a 52 % lower risk of gestational diabetes compared with all other pregnancies ( relative risk 0.48 , 0.38 to 0.61 ) . Compared with pregnancies in women who did not meet any of the low risk lifestyle factors , those meeting all four criteria had an 83 % lower risk of gestational diabetes 
    Output:
    