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: Summary Abdominal obesity might increase  fracture risk . We studied the prospect i ve associations between waist circumference , waist-to-hip ratio , and hip fracture . The indicators of abdominal obesity were associated with increased  hip fracture risk in women , but not in men . The increased risk was restricted to women with low physical activity . Introduction Low weight is an established risk factor for osteoporosis and hip fracture . However , the association between fat tissue , muscle , and bone is complex , and abdominal obesity might increase fracture risk . We studied the prospect i ve associations between indicators of abdominal obesity and hip fracture in two large US cohorts . Methods At baseline in 1986 and through biennial follow-up , information on hip fracture and potential risk factors was collected in 61,677 postmenopausal women and 35,488 men above age 50 . Waist and hip circumferences were reported at baseline and up date d twice . Results During follow-up , 1168 women and 483 men sustained a hip fracture . After controlling for known risk factors , there was a significant association in women between increasing waist circumference and hip fracture ( RR per 10-cm increase 1.13 ( 95 % CI 1.04–1.23 ) and between increasing waist-to-hip ratio and hip fracture ( RR per 0.1 unit increase 1.14 ( 95 % CI 1.04–1.23 ) , but these associations were not seen in men . In women , both measures interacted with physical activity . Those in the highest ( ≥0.90 ) versus lowest ( < 0.75 ) category of waist-to-hip ratio had increased risk of hip fracture if their activity was less than the population median ( RR = 1.61 , 95 % CI 1.18–2.19 ) but not if their activity was higher ( RR = 1.00 , 95 % CI 0.72–1.40 ) . A similar pattern was found for waist circumference . Conclusion Indicators of abdominal obesity were associated with increased hip fracture risk after controlling for BMI in women . The increased risk was restricted to women with low physical activity . In men , no significant associations were found BACKGROUND Short trials of calcium supplementation show that it reduces loss of bone density in postmenopausal women ; longer observational studies do not generally find a lower risk of hip fracture with higher-calcium diets . Fewer studies have focused on vitamin D in preventing postmenopausal osteoporosis or fractures . OBJECTIVE We assessed relations between postmenopausal hip fracture risk and calcium , vitamin D , and milk consumption . DESIGN In an 18-y prospect i ve analysis in 72 337 postmenopausal women , dietary intake and nutritional supplement use were assessed at baseline in 1980 and up date d several times during follow-up . We identified 603 incident hip fractures result ing from low or moderate trauma .  Relative risks ( RRs ) from proportional hazards models were controlled for other dietary and nondietary factors . RESULTS Women consuming > or = 12.5 microg vitamin D/d from food plus supplements had a 37 % lower risk of hip fracture ( RR = 0.63 ; 95 % CI : 0.42 , 0.94 ) than did women consuming < 3.5 microg/d . Total calcium intake was not associated with hip fracture risk ( RR = 0.96 ; 95 % CI : 0.68 , 1.34 for > or = 1200 compared with < 600 mg/d ) . Milk consumption was also not associated with a lower risk of hip fracture ( P for trend = 0.21 ) . CONCLUSIONS An adequate vitamin D intake is associated with a lower risk of osteoporotic hip fractures in postmenopausal women . Neither milk nor a high-calcium diet appears to reduce risk . Because women commonly consume less than the recommended intake of vitamin D , supplement use or dark fish consumption may be prudent BACKGROUND The effects of dietary changes on  osteoporosis , low bone density , and frequent falls  are unestablished . OBJECTIVE We assessed the effect of the Women 's Health Initiative Dietary Modification low-fat and increased fruit , vegetable , and grain intervention on incident hip , total , and site-specific fractures and self-reported falls , and , in a subset , on bone mineral density ( BMD ) . DESIGN Postmenopausal women ( n = 48,835 ) aged 50 - 79 y ( 18.6 % of minority race-ethnicity ) were r and omly assigned to receive the Dietary Modification intervention ( 40 % , n = 19,541 ) ( daily goal : < or = 20 % of energy as fat , > or = 5 servings of vegetables and fruit , and > or = 6 servings of grains ) or to a comparison group that received no dietary changes ( 60 % ; n = 29,294 ) . RESULTS After a mean 8.1 y of follow-up , 215 women in the intervention group and 285 women in the comparison group ( annualized rate : 0.14 % and 0.12 % , respectively ) experienced a hip fracture ( hazard ratio : 1.12 ; 95 % CI : 0.94 , 1.34 ; P = 0.21 ) . The intervention group ( n = 5423 ; annualized rate : 3.44 % ) had a lower rate of reporting > or = 2 falls than did the comparison group ( n = 8695 ; annualized rate : 3.67 % ) ( HR : 0.92 ; 95 % CI : 0.89 , 0.96 ; P < 0.01 ) . There was a significant interaction according to hormone therapy use ; those in the comparison group receiving hormone therapy had the lowest incidence of hip fracture . In a subset of 3951 women , hip BMD at years 3 , 6 , and 9 was 0.4 - 0.5 % lower in the intervention group than in the comparison group ( P = 0.003 ) . CONCLUSIONS A low-fat and increased fruit , vegetable , and grain diet intervention modestly reduced the risk of multiple falls and slightly lowered hip BMD but did not change the risk of osteoporotic fractures . This trial was registered at clinical trials.gov as NCT00000611 The role of fruit and vegetable intake in relation to fracture prevention during adulthood and beyond is not adequately understood . We investigated the potential association between fruit and vegetable intake  and hip fracture incidence in a large sample of older adults from Europe and the United States . A total of 142,018 individuals ( 116,509 women ) aged ≥60 years , from five cohorts , were followed up prospect ively for 1,911,482 person-years , accumulating 5552 hip fractures .  Fruit and vegetable intake  was assessed by vali date d , cohort-specific , food-frequency question naires ( FFQ ) . Ηip fractures were ascertained through national patient registers or telephone interviews/ question naires . Adjusted hazard ratios ( HRs ) derived by Cox proportional hazards regression were estimated for each cohort and subsequently pooled using r and om effects meta- analysis . Intake of ≤1 serving/day of fruit and vegetables combined was associated with 39 % higher hip fracture risk ( pooled adjusted HR , 1.39 ; 95 % confidence interval [ CI ] , 1.20 to 1.58 ) in comparison with moderate intake ( > 3 and ≤5 servings/day ) ( pfor heterogeneity = 0.505 ) , whereas higher intakes ( > 5 servings/day ) were not associated with lower risk in comparison with the same reference . Associations were more evident among women . We concluded that a daily intake of 1 or < 1 servings of fruits and vegetables was associated with increased hip fracture risk in relation to moderate daily intakes . Older adults with such low fruit and vegetable consumption may benefit from raising their intakes to moderate amounts in order to reduce their hip fracture risk . © 2016 American Society for Bone and Mineral Research Objective : To compare fracture rates in four diet groups ( meat eaters , fish eaters , vegetarians and vegans ) in the Oxford cohort of the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC-Oxford ) . Design : Prospect i ve cohort study of self-reported fracture risk at follow-up . Setting : The United Kingdom . Subjects : A total of 7947 men and 26 749 women aged 20–89 years , including 19 249 meat eaters , 4901 fish eaters , 9420 vegetarians and 1126 vegans , recruited by postal methods and through general practice surgeries .  Methods : Cox regression . Results : Over an average of 5.2 years of follow-up , 343 men and 1555 women reported one or more fractures . Compared with meat eaters , fracture incidence rate ratios in men and women combined adjusted for sex , age and non-dietary factors were 1.01 ( 95 % CI 0.88–1.17 ) for fish eaters , 1.00 ( 0.89–1.13 ) for vegetarians and 1.30 ( 1.02–1.66 ) for vegans . After further adjustment for dietary energy and calcium intake the incidence rate ratio among vegans compared with meat eaters was 1.15 ( 0.89–1.49 ) . Among subjects consuming at least 525 mg/day calcium the corresponding incidence rate ratios were 1.05 ( 0.90–1.21 ) for fish eaters , 1.02 ( 0.90–1.15 ) for vegetarians and 1.00 ( 0.69–1.44 ) for vegans . Conclusions : In this population , fracture risk was similar for meat eaters , fish eaters and vegetarians . The higher fracture risk in the vegans appeared to be a consequence of their considerably lower mean calcium intake . An adequate calcium intake is essential for bone health , irrespective of dietary preferences . Sponsorship : The EPIC-Oxford study is supported by The Medical Research Council and Cancer Research UK BACKGROUND Polyunsaturated fatty acids ( PUFAs ) may play a role in fracture , but studies have been largely confined to estimates of dietary intake . OBJECTIVE We aim ed to examine associations between fatty acids measured in late life and fish-oil consumption in early life , midlife , and late life with  osteoporotic fracture risk .  DESIGN Osteoporotic fractures were determined from medical records over 5 - 9 y of follow-up in men and women aged 66 - 96 y. Data were analyzed from 1438 participants including 898 participants who were r and omly selected from the Age , Gene/Environment Susceptibility Study , which is an observational study , and 540 participants with incident fracture . Plasma phospholipid fatty acids were assessed by using gas chromatography .  Fish-oil consumption was assessed by using vali date d question naires as never ( referent ) , less than daily , or daily . HRs and 95 % CIs adjusted for age , education , height , weight , diabetes , physical activity , and medications were estimated by using Cox regression . RESULTS In men , the highest tertile of PUFAs , n-3 ( ω-3 ) , and eicosapentaenoic acid were associated with decreased fracture risk [ HRs ( 95 % CIs ) : 0.60 ( 95 % CI : 0.41 , 0.89 ) , 0.66 ( 0.45 , 0.95 ) , and 0.59 ( 0.41 , 0.86 ) , respectively ] . In women , PUFAs tended to be inversely associated with fracture risk ( P-trend = 0.06 ) , but tertiles 2 and 3 were not independently associated with risk . Tertile 2 of n-6 and arachidonic acid was associated with fracture risk in women [ HRs ( 95 % CIs ) : 1.43 ( 1.10 , 1.85 ) and 1.42 ( 1.09 , 1.85 ) , respectively ] . Daily  fish-oil consumption in late life was associated with lower fracture risk in men ( HR : 0.64 ; 95 % CI : 0.45 , 0.91 ) . Daily fish-oil consumption in midlife was associated with lower fracture risk in women ( HR : 0.75 ; 95 % CI : 0.58 , 0.98 ) . CONCLUSIONS Greater PUFA concentrations may be associated with lower osteoporotic fracture risk in older adults , particularly in men . Critical time periods for n-3 fatty acid consumption may differ by sex 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 
    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: Summary Abdominal obesity might increase  fracture risk . We studied the prospect i ve associations between waist circumference , waist-to-hip ratio , and hip fracture . The indicators of abdominal obesity were associated with increased  hip fracture risk in women , but not in men . The increased risk was restricted to women with low physical activity . Introduction Low weight is an established risk factor for osteoporosis and hip fracture . However , the association between fat tissue , muscle , and bone is complex , and abdominal obesity might increase fracture risk . We studied the prospect i ve associations between indicators of abdominal obesity and hip fracture in two large US cohorts . Methods At baseline in 1986 and through biennial follow-up , information on hip fracture and potential risk factors was collected in 61,677 postmenopausal women and 35,488 men above age 50 . Waist and hip circumferences were reported at baseline and up date d twice . Results During follow-up , 1168 women and 483 men sustained a hip fracture . After controlling for known risk factors , there was a significant association in women between increasing waist circumference and hip fracture ( RR per 10-cm increase 1.13 ( 95 % CI 1.04–1.23 ) and between increasing waist-to-hip ratio and hip fracture ( RR per 0.1 unit increase 1.14 ( 95 % CI 1.04–1.23 ) , but these associations were not seen in men . In women , both measures interacted with physical activity . Those in the highest ( ≥0.90 ) versus lowest ( < 0.75 ) category of waist-to-hip ratio had increased risk of hip fracture if their activity was less than the population median ( RR = 1.61 , 95 % CI 1.18–2.19 ) but not if their activity was higher ( RR = 1.00 , 95 % CI 0.72–1.40 ) . A similar pattern was found for waist circumference . Conclusion Indicators of abdominal obesity were associated with increased hip fracture risk after controlling for BMI in women . The increased risk was restricted to women with low physical activity . In men , no significant associations were found BACKGROUND Short trials of calcium supplementation show that it reduces loss of bone density in postmenopausal women ; longer observational studies do not generally find a lower risk of hip fracture with higher-calcium diets . Fewer studies have focused on vitamin D in preventing postmenopausal osteoporosis or fractures . OBJECTIVE We assessed relations between postmenopausal hip fracture risk and calcium , vitamin D , and milk consumption . DESIGN In an 18-y prospect i ve analysis in 72 337 postmenopausal women , dietary intake and nutritional supplement use were assessed at baseline in 1980 and up date d several times during follow-up . We identified 603 incident hip fractures result ing from low or moderate trauma .  Relative risks ( RRs ) from proportional hazards models were controlled for other dietary and nondietary factors . RESULTS Women consuming > or = 12.5 microg vitamin D/d from food plus supplements had a 37 % lower risk of hip fracture ( RR = 0.63 ; 95 % CI : 0.42 , 0.94 ) than did women consuming < 3.5 microg/d . Total calcium intake was not associated with hip fracture risk ( RR = 0.96 ; 95 % CI : 0.68 , 1.34 for > or = 1200 compared with < 600 mg/d ) . Milk consumption was also not associated with a lower risk of hip fracture ( P for trend = 0.21 ) . CONCLUSIONS An adequate vitamin D intake is associated with a lower risk of osteoporotic hip fractures in postmenopausal women . Neither milk nor a high-calcium diet appears to reduce risk . Because women commonly consume less than the recommended intake of vitamin D , supplement use or dark fish consumption may be prudent BACKGROUND The effects of dietary changes on  osteoporosis , low bone density , and frequent falls  are unestablished . OBJECTIVE We assessed the effect of the Women 's Health Initiative Dietary Modification low-fat and increased fruit , vegetable , and grain intervention on incident hip , total , and site-specific fractures and self-reported falls , and , in a subset , on bone mineral density ( BMD ) . DESIGN Postmenopausal women ( n = 48,835 ) aged 50 - 79 y ( 18.6 % of minority race-ethnicity ) were r and omly assigned to receive the Dietary Modification intervention ( 40 % , n = 19,541 ) ( daily goal : < or = 20 % of energy as fat , > or = 5 servings of vegetables and fruit , and > or = 6 servings of grains ) or to a comparison group that received no dietary changes ( 60 % ; n = 29,294 ) . RESULTS After a mean 8.1 y of follow-up , 215 women in the intervention group and 285 women in the comparison group ( annualized rate : 0.14 % and 0.12 % , respectively ) experienced a hip fracture ( hazard ratio : 1.12 ; 95 % CI : 0.94 , 1.34 ; P = 0.21 ) . The intervention group ( n = 5423 ; annualized rate : 3.44 % ) had a lower rate of reporting > or = 2 falls than did the comparison group ( n = 8695 ; annualized rate : 3.67 % ) ( HR : 0.92 ; 95 % CI : 0.89 , 0.96 ; P < 0.01 ) . There was a significant interaction according to hormone therapy use ; those in the comparison group receiving hormone therapy had the lowest incidence of hip fracture . In a subset of 3951 women , hip BMD at years 3 , 6 , and 9 was 0.4 - 0.5 % lower in the intervention group than in the comparison group ( P = 0.003 ) . CONCLUSIONS A low-fat and increased fruit , vegetable , and grain diet intervention modestly reduced the risk of multiple falls and slightly lowered hip BMD but did not change the risk of osteoporotic fractures . This trial was registered at clinical trials.gov as NCT00000611 The role of fruit and vegetable intake in relation to fracture prevention during adulthood and beyond is not adequately understood . We investigated the potential association between fruit and vegetable intake  and hip fracture incidence in a large sample of older adults from Europe and the United States . A total of 142,018 individuals ( 116,509 women ) aged ≥60 years , from five cohorts , were followed up prospect ively for 1,911,482 person-years , accumulating 5552 hip fractures .  Fruit and vegetable intake  was assessed by vali date d , cohort-specific , food-frequency question naires ( FFQ ) . Ηip fractures were ascertained through national patient registers or telephone interviews/ question naires . Adjusted hazard ratios ( HRs ) derived by Cox proportional hazards regression were estimated for each cohort and subsequently pooled using r and om effects meta- analysis . Intake of ≤1 serving/day of fruit and vegetables combined was associated with 39 % higher hip fracture risk ( pooled adjusted HR , 1.39 ; 95 % confidence interval [ CI ] , 1.20 to 1.58 ) in comparison with moderate intake ( > 3 and ≤5 servings/day ) ( pfor heterogeneity = 0.505 ) , whereas higher intakes ( > 5 servings/day ) were not associated with lower risk in comparison with the same reference . Associations were more evident among women . We concluded that a daily intake of 1 or < 1 servings of fruits and vegetables was associated with increased hip fracture risk in relation to moderate daily intakes . Older adults with such low fruit and vegetable consumption may benefit from raising their intakes to moderate amounts in order to reduce their hip fracture risk . © 2016 American Society for Bone and Mineral Research Objective : To compare fracture rates in four diet groups ( meat eaters , fish eaters , vegetarians and vegans ) in the Oxford cohort of the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC-Oxford ) . Design : Prospect i ve cohort study of self-reported fracture risk at follow-up . Setting : The United Kingdom . Subjects : A total of 7947 men and 26 749 women aged 20–89 years , including 19 249 meat eaters , 4901 fish eaters , 9420 vegetarians and 1126 vegans , recruited by postal methods and through general practice surgeries .  Methods : Cox regression . Results : Over an average of 5.2 years of follow-up , 343 men and 1555 women reported one or more fractures . Compared with meat eaters , fracture incidence rate ratios in men and women combined adjusted for sex , age and non-dietary factors were 1.01 ( 95 % CI 0.88–1.17 ) for fish eaters , 1.00 ( 0.89–1.13 ) for vegetarians and 1.30 ( 1.02–1.66 ) for vegans . After further adjustment for dietary energy and calcium intake the incidence rate ratio among vegans compared with meat eaters was 1.15 ( 0.89–1.49 ) . Among subjects consuming at least 525 mg/day calcium the corresponding incidence rate ratios were 1.05 ( 0.90–1.21 ) for fish eaters , 1.02 ( 0.90–1.15 ) for vegetarians and 1.00 ( 0.69–1.44 ) for vegans . Conclusions : In this population , fracture risk was similar for meat eaters , fish eaters and vegetarians . The higher fracture risk in the vegans appeared to be a consequence of their considerably lower mean calcium intake . An adequate calcium intake is essential for bone health , irrespective of dietary preferences . Sponsorship : The EPIC-Oxford study is supported by The Medical Research Council and Cancer Research UK BACKGROUND Polyunsaturated fatty acids ( PUFAs ) may play a role in fracture , but studies have been largely confined to estimates of dietary intake . OBJECTIVE We aim ed to examine associations between fatty acids measured in late life and fish-oil consumption in early life , midlife , and late life with  osteoporotic fracture risk .  DESIGN Osteoporotic fractures were determined from medical records over 5 - 9 y of follow-up in men and women aged 66 - 96 y. Data were analyzed from 1438 participants including 898 participants who were r and omly selected from the Age , Gene/Environment Susceptibility Study , which is an observational study , and 540 participants with incident fracture . Plasma phospholipid fatty acids were assessed by using gas chromatography .  Fish-oil consumption was assessed by using vali date d question naires as never ( referent ) , less than daily , or daily . HRs and 95 % CIs adjusted for age , education , height , weight , diabetes , physical activity , and medications were estimated by using Cox regression . RESULTS In men , the highest tertile of PUFAs , n-3 ( ω-3 ) , and eicosapentaenoic acid were associated with decreased fracture risk [ HRs ( 95 % CIs ) : 0.60 ( 95 % CI : 0.41 , 0.89 ) , 0.66 ( 0.45 , 0.95 ) , and 0.59 ( 0.41 , 0.86 ) , respectively ] . In women , PUFAs tended to be inversely associated with fracture risk ( P-trend = 0.06 ) , but tertiles 2 and 3 were not independently associated with risk . Tertile 2 of n-6 and arachidonic acid was associated with fracture risk in women [ HRs ( 95 % CIs ) : 1.43 ( 1.10 , 1.85 ) and 1.42 ( 1.09 , 1.85 ) , respectively ] . Daily  fish-oil consumption in late life was associated with lower fracture risk in men ( HR : 0.64 ; 95 % CI : 0.45 , 0.91 ) . Daily fish-oil consumption in midlife was associated with lower fracture risk in women ( HR : 0.75 ; 95 % CI : 0.58 , 0.98 ) . CONCLUSIONS Greater PUFA concentrations may be associated with lower osteoporotic fracture risk in older adults , particularly in men . Critical time periods for n-3 fatty acid consumption may differ by sex 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 
    Output:
    