***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: Of 824 women screened , 410 were enrolled at midpregnancy in a prospect i ve , r and omized , controlled nutrition intervention study . Of these , 226 were predicted as likely to have small or large babies , 184 to have average-sized babies . Two hundred thirty eight mothers received USDA Women , Infants and Children ( WIC )  Food Supplementation vouchers from midpregnancy , 172 did not . Leukocyte protein synthesis ( as a cell model ) was significantly higher ( p = 0.009 ) by 36 weeks gestation in supplemented mothers . Mean birth weight of their babies was greater , 3254 vs 3163 g , ( + 91 g ) p = 0.039 , adjusted for sex , gestational age , prenatal visits , pregnancy interval , smoking , and previous low birth weight infants . Controlling for entry weight obviated the significance of the difference , except for WIC supplemented smokers ( greater than 10 cigarettes/day ) whose babies were significantly heavier by + 168 g ( p = 0.017 ) than those of unsupplemented smokers . WIC partially protects fetal growth in smokers Interpregnancy WIC supplementation was evaluated by comparing maternal nutritional status indicators and subsequent birth outcomes of 703 WIC participants divided into two groups . Study group women received postpartum benefits for 5 - 7 mo while control group women received postpartum benefits for only 0 - 2 mo . Both groups received prenatal benefits during each of two study pregnancies . Infants born to study group women had a higher mean birthweight ( 131 g ) and birthlength ( 0.3 cm ) and a lower risk of being less than or equal to 2500 g. Additionally , at the onset of the second pregnancy study group women had higher mean hemoglobin levels and lower risk of maternal obesity . These results suggest that postpartum WIC supplementation has positive benefits for both the mother and her subsequent infants BACKGROUND Studies of fruit and vegetable consumption in relation to overall health are limited . We evaluated the relationship between fruit and vegetable intake and the incidence of  cardiovascular disease and cancer  and of deaths from other causes in two prospect i ve cohorts . METHODS A total of 71 910 female participants in the Nurses ' Health study and 37,725 male participants in the Health Professionals ' Follow-up Study who were free of major chronic disease completed baseline semiquantitative food-frequency question naires in 1984 and 1986 , respectively . Dietary information was up date d in 1986 , 1990 , and 1994 for women and in 1990 and 1994 for men . Participants were followed up for incidence of cardiovascular disease , cancer , or death through May 1998 ( women ) and January 1998 ( men ) . Multivariable-adjusted relative risks were calculated with Cox proportional hazards analysis . RESULTS We ascertained 9329 events ( 1964 cardiovascular , 6584 cancer , and 781 other deaths ) in women and 4957 events ( 1670 cardiovascular diseases , 2500 cancers , and 787 other deaths ) in men during follow-up . For men and women combined , participants in the highest quintile of total fruit and vegetable intake had a relative risk for major chronic disease of 0.95 ( 95 % confidence interval [ CI ] = 0.89 to 1.01 ) times that of those in the lowest . Total fruit and vegetable intake was inversely associated with risk of cardiovascular disease but not with overall cancer incidence , with relative risk for an increment of five servings daily of 0.88 ( 95 % CI = 0.81 to 0.95 ) for cardiovascular disease and 1.00 ( 95 % CI = 0.95 to 1.05 ) for cancer . Of the food groups analyzed , green leafy vegetable intake showed the strongest inverse association with major chronic disease and cardiovascular disease . For an increment of one serving per day of green leafy vegetables , relative risks were 0.95 ( 95 % CI = 0.92 to 0.99 ) for major chronic disease and 0.89 ( 95 % CI = 0.83 to 0.96 ) for cardiovascular disease . CONCLUSIONS Increased fruit and vegetable consumption was associated with a modest although not statistically significant reduction in the development of major chronic disease . The benefits appeared to be primarily for cardiovascular disease and not for cancer The longitudinal study of pregnant women enrolled a national probability sample of 5,205 women first certified for WIC and 1,358 comparable low-income pregnant women in 174 WIC clinics located in 58 areas in the contiguous 48 states and in 55 prenatal clinics without WIC programs in counties with low program coverage . The women completed 24-h dietary recalls  , histories of food expenditures , health care utilization , health and sociodemographic status , and anthropometric assessment . At late-pregnancy follow-up 3,967 WIC and 1043 control women were interviewed and 853 WIC and 762 control women completed 1-wk food expenditure diaries . Birth outcome was abstract ed ( from hospital records ) for 3,863 WIC and 1058 control women . Anthropometry , dietary intake , health , and use of health services were related to WIC among 2,619 r and om low-income preschoolers .  Psychological development was assessed in 526 children aged 4 and 5 y. Control women had higher income , education , and employment status ; therefore , WIC program benefits probably were underestimated OBJECTIVE To examine the effectiveness of two methods of increasing fruit and fruit juice intake in pregnancy :  midwives ' advice and vouchers exchangeable for juice . DESIGN Pregnant women were r and omly allocated to three groups : a control group , who received usual care ; an advice group , given advice and leaflets promoting fruit and fruit juice consumption ; and a voucher group , given vouchers exchangeable for fruit juice from a milk delivery firm . Dietary question naires were administered at ~16 , 20 and 32 weeks of pregnancy . Serum beta-carotene was measured at 16 and 32 weeks . SETTING An antenatal clinic in a deprived area . SUBJECTS Pregnant women aged 17 years and over . RESULTS The study comprised 190 women .  Frequency of fruit consumption declined during pregnancy in all groups , but that of fruit juice increased substantially in the voucher group . Serum beta-carotene concentration increased in the voucher group , from 106.2 to 141.8 micromol l(-1 ) in women with measurements on both occasions ( P = 0.003 ) , decreased from 120.0 to 99.8 micromol l(-1 ) in the control group ( P = 0.005 ) , and was unchanged in the advice group . CONCLUSIONS Pregnant women drink more fruit juice if they receive vouchers exchangeable for juice supplied by the milk delivery service . Midwives ' advice to eat more fruit has no great effect . Providing vouchers for fruit juice is a simple method of increasing its intake in a deprived population and may be useful for other sections of the community Background There is overwhelming evidence that behavioural factors influence health , but their combined impact on the general population is less well documented . We aim ed to quantify the potential combined impact of four health behaviours on mortality in men and women living in the general community . Methods and Findings We examined the prospect i ve relationship between lifestyle and mortality in a prospect i ve population study of 20,244 men and women aged 45–79 y with no known cardiovascular disease or cancer at baseline survey in 1993–1997 , living in the general community in the United Kingdom , and followed up to 2006 . Participants scored one point for each health behaviour : current non-smoking , not physically inactive , moderate alcohol intake ( 1–14 units a week ) and plasma vitamin C > 50 mmol/l indicating fruit and vegetable intake of at least five servings a day , for a total score ranging from zero to four . After an average 11 y follow-up , the age- , sex- , body mass– , and social class – adjusted relative risks ( 95 % confidence intervals ) for all-cause mortality(1,987 deaths ) for men and women who had three , two , one , and zero compared to four health behaviours were respectively , 1.39 ( 1.21–1.60 ) , 1.95 ( 1.70–-2.25 ) , 2.52 ( 2.13–3.00 ) , and 4.04 ( 2.95–5.54 ) p < 0.001 trend . The relationships were consistent in subgroups stratified by sex , age , body mass index , and social class , and after excluding deaths within 2 y. The trends were strongest for cardiovascular causes . The mortality risk for those with four compared to zero health behaviours was equivalent to being 14 y younger in chronological age . Conclusions Four health behaviours combined predict a 4-fold difference in total mortality in men and women , with an estimated impact equivalent to 14 y in chronological age In several studies , many nutrients in fruits and vegetables , such as dietary fiber , potassium , and antioxidants , have been associated with reduced risk for cardiovascular disease ( 1 - 5 ) . However , as review ed elsewhere ( 6 ) , most prospect i ve studies that have specifically examined intake of fruits and vegetables in relation to risk for cardiovascular disease have been small , and their results have been inconsistent . Dietary assessment s were often crude and available only at baseline , and few studies have examined the effects of specific types of vegetables or fruits . In a recent report ( 7 ) , we evaluated the association between fruit and vegetable intake and risk for ischemic stroke . We found that persons in the highest quintile of fruit and vegetable intake had a relative risk of 0.69 ( 95 % CI , 0.52 to 0.92 ) compared with the lowest quintile of intake ; moreover , a 1-serving/d increase in fruit or vegetable intake was associated with a 6 % lower risk for ischemic stroke , after controlling for st and ard cardiovascular risk factors . In the current study , we sought to evaluate the association between intake of overall and specific fruits and vegetables and incidence of coronary heart disease . Methods Study Sample The sample s for this analysis consisted of participants in the Nurses ' Health Study ( 8) and Health Professionals ' Follow-Up Study ( 1 ) . The two studies have similar design s ; in both , participants complete mailed question naires about medical history , health behaviors , and occurrence of cardiovascular and other outcomes every 2 years . The Nurses ' Health Study began in 1976 , when 121 700 female registered nurses 30 to 55 years of age were recruited ; diet was first assessed in 1980 . Health Professionals ' Follow-up Study participants were recruited in 1986 and comprise 51 529 male health professionals , including dentists , veterinarians , pharmacists , optometrists , osteopaths , and podiatrists , 40 to 75 years of age . Sample for Analysis We excluded participants with incomplete dietary assessment s or with previously diagnosed cancer , diabetes or cardiovascular disease that was reported before the first dietary assessment . We followed 84 251 eligible women during 14 years of follow-up and 42 148 eligible men during 8 years follow-up for incidence of coronary heart disease . The rate of follow-up for nonfatal events was 97 % of the total potential person-years of follow-up in both cohorts . Assessment of Coronary Heart Disease End Points Our primary end point was nonfatal myocardial infa rct ion or fatal coronary disease occurring after return of the 1980 question naire but before 1 June 1994 in women and after return of the 1986 question naire but before 1 January 1994 in men . We sought to review medical records for all such reports . Records were review ed by physicians who were blinded to the participants ' risk factor status . Myocardial infa rct ion was confirmed by using World Health Organization criteria : symptoms plus either diagnostic electrocardiographic changes or elevated levels of cardiac enzymes ( 9 ) . Infa rct ions that required hospital admission and for which confirmatory information was obtained by interview or letter , but for which no medical records were available , were design ated as probable . We included all confirmed and probable cases in our analyses because results were the same after probable cases were excluded . Deaths were identified by using state vital records and the National Death Index or were reported by next of kin and the U.S. postal system . Follow-up for deaths was more than 98 % complete [ 10 ] . Death certificates along with medical records were used to ascertain cause of death . Fatal coronary disease was categorized as definite if 1 ) it was confirmed by hospital record or autopsy or 2 ) coronary disease was listed as the cause of death on the certificate , this was the underlying and most plausible cause , and evidence of previous coronary disease was available . We did not rely on the statement of the cause of death on the death certificate alone as providing sufficient confirmation of death due to coronary heart disease . If no medical records were available , we categorized persons in whom coronary heart disease was the underlying cause on the death certificate as presumed coronary heart disease . Analyses limited to confirmed cases yielded results very similar to those obtained when all cases were included , although with less precision . 
    Output:
    
The improved intake of targeted nutrients and foods , such as fruit and vegetables , could potentially reduce the rate of non-communicable diseases in adults , if the changes in diet are sustained .
Associated improvements in perinatal outcomes were limited and most evident in women who smoked during pregnancy .