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: The provision of vitamin A in food sources of beta-carotene is an alternative to the distribution of high-dose capsules . To examine factors that may influence the success of food-based programs , a study was carried out in Sumatra , Indonesia , of the effect of food sources of beta-carotene , extra dietary fat , and  Ascaris lumbricoides infection on serum retinol concentrations in children .  Meals and snacks with various amounts of beta-carotene and fat were fed at midday to children 3 - 6 y of age for 3 wk . Some groups of children were dewormed with the anthelmintic levamisole before the feeding period , whereas others remained infected . Results showed that the incorporation of beta-carotene sources ( mainly in the form of red sweet potatoes ) into the meal significantly increased serum retinol concentrations . The greatest rise in serum retinol occurred when meals contained added beta-carotene sources and added fat and the children were dewormed . Adding more fat to the meal and deworming the children caused a rise in serum retinol similar to that seen when feeding additional beta-carotene sources . Moreover , the effects of fat and deworming together were additive to the effects of additional beta-carotene sources . When the meal contained additional beta-carotene sources , added fat caused a further improvement in serum retinol concentrations but only if A. lumbricoides infection was low . These studies indicated that food-based interventions in vitamin A-deficient areas might be successful and that other interventions such as increasing dietary fat concentrations and anthelmintic treatment should be considered along with increasing consumption of beta-carotene-rich food Background / Objectives : Evidence on the role of diet during adulthood and beyond on fracture occurrence is limited . We investigated diet and hip fracture incidence in a population of elderly Europeans , participants in the European Prospect i ve Investigation into Cancer and nutrition study .Subjects/ Methods : 29 122 volunteers ( 10 538 men , 18 584 women ) aged 60 years and above ( mean age : 64.3 ) from five countries were followed up for a median of 8 years and 275 incident hip fractures ( 222 women and 53 men ) were recorded .  Diet  was assessed at baseline through vali date d dietary question naires . Data were analyzed through Cox proportional-hazards regression with adjustment for potential confounders . Results : No food group or nutrient was significantly associated with hip fracture occurrence . There were suggestive inverse associations , however , with vegetable consumption ( hazard ratio ( HR ) per increasing sex-specific quintile : 0.93 , 95 % confidence interval ( CI ) : 0.85–1.01 ) , fish consumption ( HR per increasing sex-specific quintile : 0.93 , 95 % CI : 0.85–1.02 ) and polyunsaturated lipid intake ( HR per increasing sex-specific quintile : 0.92 , 95 % CI : 0.82–1.02 ) , whereas saturated lipid intake was positively associated with hip fracture risk ( HR per increasing sex-specific quintile : 1.13 , 95 % CI : 0.99–1.29 ) . Consumption of dairy products did not appear to influence the risk ( HR per increasing sex-specific quintile : 1.02 , 95 % CI : 0.93–1.12 ) . Conclusions : In a prospect i ve study of the elderly , diet , including consumption of dairy products , alcohol and vitamin D , did not appear to play a major role in hip fracture incidence . There is however , weak and statistically non-significant evidence that vegetable and fish consumption and intake of polyunsaturated lipids may have a beneficial , whereas saturated lipid intake a detrimental effect OBJECTIVE Bone fractures are an important cause of morbidity and mortality among the elderly in the US . The present study assesses the possible role of a number of risk factors for postmenopausal bone fractures .  METHODS We analysed the relationships of anthropometric , demographic and lifestyle factors  with the risk of bone fracture among 6250 postmenopausal women in a prospect i ve cohort study , the New York University Women 's Health Study . RESULTS After an average of 7.6 years of follow-up , 1025 new incident  bone fractures were reported , including 34 hip and 159 wrist fractures ( incidence rates ; 71.6 and 334.7 per 105 woman-years , respectively ) . The risk of fracture increased with increasing age , body height and total fat intake , while it was significantly lower among obese and African American women . The relative risk among African Americans was 0.45 ( 95 % CI : 0.32 - 0.63 ) compared with non-African Americans . Women taller than 170 cm had a 64 % increase in risk of fractures , as compared with those under 155 cm . These associations were generally more pronounced when fractures were limited to those at the hip and wrist . CONCLUSIONS The present study provides an indication for a potential role of dietary fat in the development of postmenopausal fractures and further evidence to support protective effects of obesity , short stature and African American ethnicity BACKGROUND The efficacy of calcium with vitamin D supplementation for preventing hip and other fractures in healthy postmenopausal women remains equivocal . METHODS We recruited 36,282 postmenopausal women , 50 to 79 years of age , who were already enrolled in a Women 's Health Initiative ( WHI ) clinical trial . We r and omly assigned participants to receive 1000 mg of elemental [ corrected ] calcium as calcium carbonate with 400 IU of vitamin D3 daily or placebo .  Fractures were ascertained for an average follow-up period of 7.0 years . Bone density was measured at three WHI centers . RESULTS Hip bone density was 1.06 percent higher in the calcium plus vitamin D group than in the placebo group ( P<0.01 ) . Intention-to-treat analysis indicated that participants receiving calcium plus vitamin D supplementation had a hazard ratio of 0.88 for hip fracture ( 95 percent confidence interval , 0.72 to 1.08 ) , 0.90 for clinical spine fracture ( 0.74 to 1.10 ) , and 0.96 for total fractures ( 0.91 to 1.02 ) . The risk of renal calculi increased with calcium plus vitamin D ( hazard ratio , 1.17 ; 95 percent confidence interval , 1.02 to 1.34 ) . Censoring data from women when they ceased to adhere to the study medication reduced the hazard ratio for hip fracture to 0.71 ( 95 percent confidence interval , 0.52 to 0.97 ) . Effects did not vary significantly according to prer and omization serum vitamin D levels . CONCLUSIONS Among healthy postmenopausal women , calcium with vitamin D supplementation result ed in a small but significant improvement in hip bone density , did not significantly reduce hip fracture , and increased the risk of kidney stones . ( Clinical Trials.gov number , NCT00000611 . ) BACKGROUND Fatty acids ( FAs ) may be important dietary components that modulate osteoporotic fracture risk . OBJECTIVE The objective was to examine FA intake in relation to osteoporotic fractures . DESIGN The participants were postmenopausal women enrolled in the Women 's Health Initiative ( n = 137,486 ) . Total fractures were identified by self-report ; hip fractures were confirmed by medical record review . FA intake was estimated from baseline food-frequency question naires and st and ardized to total caloric intake . No data on omega-3 ( n-3 ) FA supplements were available . Cox proportional hazard models were constructed to estimate risk of fracture . RESULTS Higher saturated FA consumption was associated with higher hip fracture risk [ quartile 4 multivariate-adjusted hazard ratio ( HR ) : 1.31 ; 95 % CI : 1.11 , 1.55 ; P for trend = 0.001 ] . Lower total fracture risk was associated with a higher monounsaturated FA intake ( quartile 3 HR : 0.94 ; 95 % CI : 0.89 , 0.98 ; P for trend = 0.050 ) and polyunsaturated FA intake ( quartile 4 HR : 0.95 ; 95 % CI : 0.90 , 0.99 ; P for trend = 0.019 ) . Unexpectedly , higher consumption of marine n-3 FAs was associated with greater total fracture risk ( quartile 4 HR : 1.07 ; 95 % CI : 1.02 , 1.12 ; P for trend = 0.010 ) , whereas a higher n-6 FA intake was associated with a lower total fracture risk ( quartile 4 HR : 0.94 ; 95 % CI : 0.89 , 0.98 ; P for trend 0.009 ) . CONCLUSIONS These results suggest that saturated FA intake may significantly increase hip fracture risk , whereas monounsaturated and polyunsaturated FA intakes may decrease total fracture risk . In postmenopausal women with a low intake of marine n-3 FAs , a higher intake of n-6 FAs may modestly decrease total fracture risk . This trial was registered at clinical trials.gov as NCT00000611 The present review summarizes the pathogenic mechanisms leading to  hip fracture based on epidemiological , experimental , and controlled studies . The estimated lifetime risk of hip fracture is about 14 % in postmenopausal women and 6 % in men . The incidence of hip fractures increases exponentially with aging , but the time-trend in increasing age-specific incidence may not be a universal phenomenon . Postmenopausal women suffering earlier non-hip fractures have an increased risk of later hip fracture . The relative risk being highest within the first years following the fracture . Nursing home residents have a high risk of  hip fracture ( annual rate of 5 - 6 % ) , and the incidence of falls is about 1,500 falls/1,000 persons/year . Most hip fractures are a result of a direct trauma against the hip . The incidence of falls on the hip among nursing home residents is about 290 falls/1,000 persons/year and about 24 % of these impacts lead to hip fracture . The force acting on the hip may reach 3.7 kN in falls on the hip from st and ing height , which means that only susceptible subjects will sustain a hip fracture in such falls . The effective load acting on the hip is 35 % of the body weight in unprotected falls on the hip . Women with hip fractures have a lower body weight compared with controls , and they may also have less soft tissue covering the hip even when adjusted for body mass index , indicating a more and roid body habitus . Experimental studies show that the passive energy absorption in soft tissue covering the hip may influence the risk of hip fracture , and being an important determinant for the development of hip fracture , maybe more important than bone strength . External hip protectors were developed and tested in an open r and omised nursing home study . The rate of hip fractures was reduced by 50 % , corresponding to 9 out of 247 residents saved from sustaining a hip fracture . The review points to the essentials of the development of hip fracture , which constitutes ; risk of fall , type of fall , type of impact , energy absorption , and lastly bone strength , which is the ultimate and last permissive factor in the cascade leading to hip fracture . Risk estimation and prevention of hip fractures may prove realistic when these issues are taken into consideration BACKGROUND & AIMS The incidence of osteoporotic fractures is lower in countries in the Mediterranean basin .  Virgin olive oil , a key component of the Mediterranean Diet ( MDiet ) , with recognised beneficial effects on metabolism and cardiovascular health , may decrease the risk of osteoporotic fractures . The aim to this study was to explore the effect of chronic consumption of total olive oil and its varieties on the risk of osteoporosis-related fractures in a middle-aged and elderly Mediterranean population . METHODS We included all participants ( n = 870 ) recruited in the Reus ( Spain ) centre of the PREvención con DIeta MEDiterránea ( PREDIMED ) trial . Individuals , aged 55 - 80 years at high cardiovascular risk , were r and omized to a MedDiet supplemented with extra-virgin olive oil , a MedDiet supplemented with nuts , or a low-fat diet . The present analysis was an observational cohort study nested in the trial . A vali date d food frequency question naire was used to assess dietary habits and olive oil consumption . Information on total osteoporotic fractures was obtained from a systematic review of medical records . The association between yearly repeated measurements of olive oil consumption and fracture risk was assessed by multivariate Cox proportional hazards . RESULTS We documented 114 incident cases of  osteoporosis-related fractures during a median follow-up of 8.9 years . Treatment allocation had no effect on fracture risk . Participants in the highest tertile of extra-virgin olive oil consumption had a 51 % lower risk of fractures ( HR:0.49 ; 95 % CI:0.29 - 0.81 . P for trend = 0. 
    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: The provision of vitamin A in food sources of beta-carotene is an alternative to the distribution of high-dose capsules . To examine factors that may influence the success of food-based programs , a study was carried out in Sumatra , Indonesia , of the effect of food sources of beta-carotene , extra dietary fat , and  Ascaris lumbricoides infection on serum retinol concentrations in children .  Meals and snacks with various amounts of beta-carotene and fat were fed at midday to children 3 - 6 y of age for 3 wk . Some groups of children were dewormed with the anthelmintic levamisole before the feeding period , whereas others remained infected . Results showed that the incorporation of beta-carotene sources ( mainly in the form of red sweet potatoes ) into the meal significantly increased serum retinol concentrations . The greatest rise in serum retinol occurred when meals contained added beta-carotene sources and added fat and the children were dewormed . Adding more fat to the meal and deworming the children caused a rise in serum retinol similar to that seen when feeding additional beta-carotene sources . Moreover , the effects of fat and deworming together were additive to the effects of additional beta-carotene sources . When the meal contained additional beta-carotene sources , added fat caused a further improvement in serum retinol concentrations but only if A. lumbricoides infection was low . These studies indicated that food-based interventions in vitamin A-deficient areas might be successful and that other interventions such as increasing dietary fat concentrations and anthelmintic treatment should be considered along with increasing consumption of beta-carotene-rich food Background / Objectives : Evidence on the role of diet during adulthood and beyond on fracture occurrence is limited . We investigated diet and hip fracture incidence in a population of elderly Europeans , participants in the European Prospect i ve Investigation into Cancer and nutrition study .Subjects/ Methods : 29 122 volunteers ( 10 538 men , 18 584 women ) aged 60 years and above ( mean age : 64.3 ) from five countries were followed up for a median of 8 years and 275 incident hip fractures ( 222 women and 53 men ) were recorded .  Diet  was assessed at baseline through vali date d dietary question naires . Data were analyzed through Cox proportional-hazards regression with adjustment for potential confounders . Results : No food group or nutrient was significantly associated with hip fracture occurrence . There were suggestive inverse associations , however , with vegetable consumption ( hazard ratio ( HR ) per increasing sex-specific quintile : 0.93 , 95 % confidence interval ( CI ) : 0.85–1.01 ) , fish consumption ( HR per increasing sex-specific quintile : 0.93 , 95 % CI : 0.85–1.02 ) and polyunsaturated lipid intake ( HR per increasing sex-specific quintile : 0.92 , 95 % CI : 0.82–1.02 ) , whereas saturated lipid intake was positively associated with hip fracture risk ( HR per increasing sex-specific quintile : 1.13 , 95 % CI : 0.99–1.29 ) . Consumption of dairy products did not appear to influence the risk ( HR per increasing sex-specific quintile : 1.02 , 95 % CI : 0.93–1.12 ) . Conclusions : In a prospect i ve study of the elderly , diet , including consumption of dairy products , alcohol and vitamin D , did not appear to play a major role in hip fracture incidence . There is however , weak and statistically non-significant evidence that vegetable and fish consumption and intake of polyunsaturated lipids may have a beneficial , whereas saturated lipid intake a detrimental effect OBJECTIVE Bone fractures are an important cause of morbidity and mortality among the elderly in the US . The present study assesses the possible role of a number of risk factors for postmenopausal bone fractures .  METHODS We analysed the relationships of anthropometric , demographic and lifestyle factors  with the risk of bone fracture among 6250 postmenopausal women in a prospect i ve cohort study , the New York University Women 's Health Study . RESULTS After an average of 7.6 years of follow-up , 1025 new incident  bone fractures were reported , including 34 hip and 159 wrist fractures ( incidence rates ; 71.6 and 334.7 per 105 woman-years , respectively ) . The risk of fracture increased with increasing age , body height and total fat intake , while it was significantly lower among obese and African American women . The relative risk among African Americans was 0.45 ( 95 % CI : 0.32 - 0.63 ) compared with non-African Americans . Women taller than 170 cm had a 64 % increase in risk of fractures , as compared with those under 155 cm . These associations were generally more pronounced when fractures were limited to those at the hip and wrist . CONCLUSIONS The present study provides an indication for a potential role of dietary fat in the development of postmenopausal fractures and further evidence to support protective effects of obesity , short stature and African American ethnicity BACKGROUND The efficacy of calcium with vitamin D supplementation for preventing hip and other fractures in healthy postmenopausal women remains equivocal . METHODS We recruited 36,282 postmenopausal women , 50 to 79 years of age , who were already enrolled in a Women 's Health Initiative ( WHI ) clinical trial . We r and omly assigned participants to receive 1000 mg of elemental [ corrected ] calcium as calcium carbonate with 400 IU of vitamin D3 daily or placebo .  Fractures were ascertained for an average follow-up period of 7.0 years . Bone density was measured at three WHI centers . RESULTS Hip bone density was 1.06 percent higher in the calcium plus vitamin D group than in the placebo group ( P<0.01 ) . Intention-to-treat analysis indicated that participants receiving calcium plus vitamin D supplementation had a hazard ratio of 0.88 for hip fracture ( 95 percent confidence interval , 0.72 to 1.08 ) , 0.90 for clinical spine fracture ( 0.74 to 1.10 ) , and 0.96 for total fractures ( 0.91 to 1.02 ) . The risk of renal calculi increased with calcium plus vitamin D ( hazard ratio , 1.17 ; 95 percent confidence interval , 1.02 to 1.34 ) . Censoring data from women when they ceased to adhere to the study medication reduced the hazard ratio for hip fracture to 0.71 ( 95 percent confidence interval , 0.52 to 0.97 ) . Effects did not vary significantly according to prer and omization serum vitamin D levels . CONCLUSIONS Among healthy postmenopausal women , calcium with vitamin D supplementation result ed in a small but significant improvement in hip bone density , did not significantly reduce hip fracture , and increased the risk of kidney stones . ( Clinical Trials.gov number , NCT00000611 . ) BACKGROUND Fatty acids ( FAs ) may be important dietary components that modulate osteoporotic fracture risk . OBJECTIVE The objective was to examine FA intake in relation to osteoporotic fractures . DESIGN The participants were postmenopausal women enrolled in the Women 's Health Initiative ( n = 137,486 ) . Total fractures were identified by self-report ; hip fractures were confirmed by medical record review . FA intake was estimated from baseline food-frequency question naires and st and ardized to total caloric intake . No data on omega-3 ( n-3 ) FA supplements were available . Cox proportional hazard models were constructed to estimate risk of fracture . RESULTS Higher saturated FA consumption was associated with higher hip fracture risk [ quartile 4 multivariate-adjusted hazard ratio ( HR ) : 1.31 ; 95 % CI : 1.11 , 1.55 ; P for trend = 0.001 ] . Lower total fracture risk was associated with a higher monounsaturated FA intake ( quartile 3 HR : 0.94 ; 95 % CI : 0.89 , 0.98 ; P for trend = 0.050 ) and polyunsaturated FA intake ( quartile 4 HR : 0.95 ; 95 % CI : 0.90 , 0.99 ; P for trend = 0.019 ) . Unexpectedly , higher consumption of marine n-3 FAs was associated with greater total fracture risk ( quartile 4 HR : 1.07 ; 95 % CI : 1.02 , 1.12 ; P for trend = 0.010 ) , whereas a higher n-6 FA intake was associated with a lower total fracture risk ( quartile 4 HR : 0.94 ; 95 % CI : 0.89 , 0.98 ; P for trend 0.009 ) . CONCLUSIONS These results suggest that saturated FA intake may significantly increase hip fracture risk , whereas monounsaturated and polyunsaturated FA intakes may decrease total fracture risk . In postmenopausal women with a low intake of marine n-3 FAs , a higher intake of n-6 FAs may modestly decrease total fracture risk . This trial was registered at clinical trials.gov as NCT00000611 The present review summarizes the pathogenic mechanisms leading to  hip fracture based on epidemiological , experimental , and controlled studies . The estimated lifetime risk of hip fracture is about 14 % in postmenopausal women and 6 % in men . The incidence of hip fractures increases exponentially with aging , but the time-trend in increasing age-specific incidence may not be a universal phenomenon . Postmenopausal women suffering earlier non-hip fractures have an increased risk of later hip fracture . The relative risk being highest within the first years following the fracture . Nursing home residents have a high risk of  hip fracture ( annual rate of 5 - 6 % ) , and the incidence of falls is about 1,500 falls/1,000 persons/year . Most hip fractures are a result of a direct trauma against the hip . The incidence of falls on the hip among nursing home residents is about 290 falls/1,000 persons/year and about 24 % of these impacts lead to hip fracture . The force acting on the hip may reach 3.7 kN in falls on the hip from st and ing height , which means that only susceptible subjects will sustain a hip fracture in such falls . The effective load acting on the hip is 35 % of the body weight in unprotected falls on the hip . Women with hip fractures have a lower body weight compared with controls , and they may also have less soft tissue covering the hip even when adjusted for body mass index , indicating a more and roid body habitus . Experimental studies show that the passive energy absorption in soft tissue covering the hip may influence the risk of hip fracture , and being an important determinant for the development of hip fracture , maybe more important than bone strength . External hip protectors were developed and tested in an open r and omised nursing home study . The rate of hip fractures was reduced by 50 % , corresponding to 9 out of 247 residents saved from sustaining a hip fracture . The review points to the essentials of the development of hip fracture , which constitutes ; risk of fall , type of fall , type of impact , energy absorption , and lastly bone strength , which is the ultimate and last permissive factor in the cascade leading to hip fracture . Risk estimation and prevention of hip fractures may prove realistic when these issues are taken into consideration BACKGROUND & AIMS The incidence of osteoporotic fractures is lower in countries in the Mediterranean basin .  Virgin olive oil , a key component of the Mediterranean Diet ( MDiet ) , with recognised beneficial effects on metabolism and cardiovascular health , may decrease the risk of osteoporotic fractures . The aim to this study was to explore the effect of chronic consumption of total olive oil and its varieties on the risk of osteoporosis-related fractures in a middle-aged and elderly Mediterranean population . METHODS We included all participants ( n = 870 ) recruited in the Reus ( Spain ) centre of the PREvención con DIeta MEDiterránea ( PREDIMED ) trial . Individuals , aged 55 - 80 years at high cardiovascular risk , were r and omized to a MedDiet supplemented with extra-virgin olive oil , a MedDiet supplemented with nuts , or a low-fat diet . The present analysis was an observational cohort study nested in the trial . A vali date d food frequency question naire was used to assess dietary habits and olive oil consumption . Information on total osteoporotic fractures was obtained from a systematic review of medical records . The association between yearly repeated measurements of olive oil consumption and fracture risk was assessed by multivariate Cox proportional hazards . RESULTS We documented 114 incident cases of  osteoporosis-related fractures during a median follow-up of 8.9 years . Treatment allocation had no effect on fracture risk . Participants in the highest tertile of extra-virgin olive oil consumption had a 51 % lower risk of fractures ( HR:0.49 ; 95 % CI:0.29 - 0.81 . P for trend = 0. 
    Output:
    