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 : To examine the link between childhood overweight status and elementary school outcomes . Design : Prospect i ve study design : multivariate regression models examining the association between changes in overweight status and school outcomes between kindergarten entry and end of third grade , after controlling for various child , family and school characteristics . Subjects : Nationally representative sample of US children who entered kindergarten in 1998 , with longitudinal data on body mass index ( BMI ) and school outcomes at kindergarten entry and end of third grade . Measurements : Wide range of elementary school outcomes collected in each wave including academic achievement ( math and reading st and ardized test scores ) ; teacher reported internalizing and externalizing behavior problems ( BP ) , social skills ( self-control , interpersonal skills ) and approaches to learning ; school absences ; and grade repetition . Measurements of height and weight in each wave were used to compute BMI and indicators of overweight status based on CDC growth charts . A rich set of control variables capturing child , family , and school characteristics . Results : Moving from not-overweight to overweight between kindergarten entry and end of third grade was significantly associated ( P<0.05 ) with reductions in test scores , and teacher ratings of social-behavioral outcomes and approaches to learning among girls . However , this link was mostly absent among boys , with two exceptions – boys who became overweight had significantly fewer externalizing BPs ( P<0.05 ) , but more absences from school compared to boys who remained normal weight . Being always-overweight was associated with more internalizing BP among girls but fewer externalizing BPs among boys . Conclusion : Change in overweight status during the first 4 years in school is a significant risk factor for adverse school outcomes among girls but not boys . Girls who become overweight during the early school years and those who start school being overweight and remain that way may need to be monitored carefully IMPORTANCE Many early life risk factors for childhood obesity are more prevalent among blacks and Hispanics than among whites and may explain the higher prevalence of obesity among racial/ethnic minority children . OBJECTIVE To examine the extent to which racial/ethnic disparities in adiposity and overweight are explained by differences in risk factors during pregnancy ( gestational diabetes and depression ) , infancy ( rapid infant weight gain , feeding other than exclusive breastfeeding , and early introduction of solid foods ) , and early childhood ( sleeping < 12 h/d , presence of a television set in the room where the child sleeps , and any intake of sugar-sweetened beverages or fast food ) . DESIGN Prospect i ve prebirth cohort study . SETTING Multisite group practice in Massachusetts . PARTICIPANTS Participants included 1116 mother-child pairs ( 63 % white , 17 % black , and 4 % Hispanic ) EXPOSURE Mother 's report of child 's race/ethnicity . MAIN OUTCOMES AND MEASURES Age- and sex-specific body mass index ( BMI ) z score , total fat mass index from dual-energy x-ray absorptiometry , and overweight or obesity , defined as a BMI in the 85th percentile or higher at age 7 years . RESULTS Black ( 0.48 U [ 95 % CI , 0.31 to 0.64 ] ) and Hispanic ( 0.43 [ 0.12 to 0.74 ] ) children had higher BMI z scores , as well as higher total fat mass index and overweight/obesity prevalence , than white children . After adjustment for socioeconomic confounders and parental BMI , differences in BMI z score were attenuated for black and Hispanic children ( 0.22 U [ 0.05 to 0.40 ] and 0.22 U [ -0.08 to 0.52 ] , respectively ) . Adjustment for pregnancy risk factors did not substantially change these estimates . However , after further adjustment for infancy and childhood risk factors , we observed only minimal differences in BMI z scores between whites , blacks ( 0.07 U [ -0.11 to 0.26 ] ) , and Hispanics ( 0.04 U [ -0.27 to 0.35 ] ) . We observed similar attenuation of racial/ethnic differences in adiposity and prevalence of overweight or obesity . CONCLUSIONS AND RELEVANCE Racial/ethnic disparities in childhood adiposity and obesity are determined by factors operating in infancy and early childhood . Efforts to reduce obesity disparities should focus on preventing early life risk factors Early nutrition in animals affects both behavior and brain structure . In humans , r and omized trials show that early nutrition affects later cognition , notably in males . We hypothesized that early nutrition also influences brain structure , measurable using magnetic resonance imaging . Prior research suggested that the cau date nucleus may be especially vulnerable to early environment and that its size relates to IQ . To test the hypothesis that the cau date nucleus could be a neural substrate for cognitive effects of early nutrition , we compared two groups of adolescents , assigned a St and ard- or High-nutrient diet in the postnatal weeks after preterm birth . Groups had similar birth status and neonatal course .  Scans and IQ data were obtained from 76 adolescents and volumes of several subcortical structures were calculated . The High-nutrient group had significantly larger cau date volumes and higher Verbal IQ ( VIQ ) . Cau date volumes correlated significantly with VIQ in the St and ard-nutrient group only . Cau date volume was influenced by early nutrition and related selectively to VIQ in males , but not in females . Our findings may partly explain the effects of early diet on cognition and the predominant effects in males . They are among the first to show that human brain structure can be influenced by early nutrition Determinants of a child 's diet shortly after weaning and lactation have been relatively understudied . The aim of the present study was hence to identify common dietary patterns in toddlers and to explore parental and child indicators of these dietary patterns . The study was a population -based , prospect i ve birth-cohort study in Rotterdam , the Netherl and s. Food consumption data of 2420 children aged 14 months were used . A ' Health conscious ' dietary pattern characterised by pasta , fruits , vegetables , oils , legumes and fish , and a ' Western-like ' dietary pattern characterised by snacks , animal fats , confectionery and sugar-containing beverages were extracted using principal component analysis . Low paternal education , low household income , parental smoking , multiparity , maternal BMI , maternal carbohydrate intake and television-watching of child were determinants of a ' Western-like ' diet , whereas parental age ,  dietary fibre  intake during pregnancy , introduction of solids after 6 months and female sex were inversely associated with a ' Western-like ' diet of the child . Maternal co-morbidity , alcohol consumption during pregnancy and female sex were inversely associated with a ' Health conscious ' dietary pattern of the child , while single parenthood , folic acid use and dietary fibre intake during pregnancy were positively associated . All aforementioned associations were statistically significant . In conclusion , both ' Western-like ' and ' Health conscious ' diets can already be identified in toddlers . Particularly , adherence to a ' Western-like ' diet is associated with unfavourable lifestyle factors of the parents and child , and low socio-economic background . These findings can form a basis for future epidemiological studies regarding dietary patterns and health outcomes in young children IMPORTANCE Breastfeeding may benefit child cognitive development , but few studies have quantified breastfeeding duration or exclusivity , nor has any study to date examined the role of maternal diet during lactation on child cognition . OBJECTIVES To examine relationships of breastfeeding duration and exclusivity with child cognition at ages 3 and 7 years and to evaluate the extent to which maternal fish intake during lactation modifies associations of infant feeding with later cognition . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study ( Project Viva ) , a US prebirth cohort that enrolled mothers from April 22 , 1999 , to July 31 , 2002 , and followed up children to age 7 years , including 1312 Project Viva mothers and children . MAIN EXPOSURE Duration of any breastfeeding to age 12 months . MAIN OUTCOMES AND MEASURES Child receptive language assessed with the Peabody Picture Vocabulary Test at age 3 years , Wide Range Assessment of Visual Motor Abilities at ages 3 and 7 years , and Kaufman Brief Intelligence Test and Wide Range Assessment of Memory and Learning at age 7 years . RESULTS Adjusting for sociodemographics , maternal intelligence , and home environment in linear regression , longer breastfeeding duration was associated with higher Peabody Picture Vocabulary Test score at age 3 years ( 0.21 ; 95 % CI , 0.03 - 0.38 points per month breastfed ) and with higher intelligence on the Kaufman Brief Intelligence Test at age 7 years ( 0.35 ; 0.16 - 0.53 verbal points per month breastfed ; and 0.29 ; 0.05 - 0.54 nonverbal points per month breastfed ) . Breastfeeding duration was not associated with Wide Range Assessment of Memory and Learning scores . Beneficial effects of breastfeeding on the Wide Range Assessment of Visual Motor Abilities at age 3 years seemed greater for women who consumed 2 or more servings of fish per week ( 0.24 ; 0.00 - 0.47 points per month breastfed ) compared with less than 2 servings of fish per week ( −0.01 ; −0.22 to 0.20 points per month breastfed ) ( P = .16 for interaction ) . CONCLUSIONS AND RELEVANCE Our results support a causal relationship of breastfeeding duration with receptive language and verbal and nonverbal intelligence later in life Objective We examined whether trajectories of dietary patterns from 6 to 24 months of age are associated with  intelligence quotient ( IQ ) in childhood and adolescence . Methods Participants were children enrolled in a prospect i ve UK birth cohort ( n = 7652 ) who had IQ measured at age 8 and /or 15 years .  Dietary patterns were previously extracted from question naires when children were aged 6 , 15 and 24 months using principal component analysis . Dietary trajectories were generated by combining scores on similar dietary patterns across each age , using multilevel mixed models . Associations between dietary trajectories and IQ were examined in generalized linear models with adjustment for potential confounders . Results Four dietary pattern trajectories were constructed from 6 to 24 months of age and were named according to foods that made the strongest contribution to trajectory scores ; Healthy ( characterised by breastfeeding at 6 months , raw fruit and vegetables , cheese and herbs at 15 and 24 months ) ; Discretionary ( biscuits , chocolate , crisps at all ages ) , Traditional ( meat , cooked vegetables and puddings at all ages ) and , Ready-to-eat ( use of ready-prepared baby foods at 6 and 15 months , biscuits , bread and breakfast cereals at 24 months ) . In fully-adjusted models , a 1 SD change in the Healthy trajectory was weakly associated with higher IQ at age 8 ( 1.07 ( 95%CI 0.17 , 1.97 ) ) but not 15 years ( 0.49 ( −0.28 , 1.26 ) ) . Associations between the Discretionary and Traditional trajectories with IQ at 8 and 15 years were as follows ; Discretionary ; 8 years −0.35(−1.03 , 0.33 ) , 15 years −0.73(−1.33 , −0.14 ) Traditional ; 8 years −0.19(−0.71 , 0.33)15 years −0.41(−0.77 , −0.04 ) ) . The Ready-to-eat trajectory had no association with IQ at either age ( 8 years 0.32(−4.31 , 4.95 ) , 15 years 1.11(−3.10 , 5.33 ) . Conclusions The Discretionary and Traditional dietary pattern trajectories from 6 to 24 months of age , over the period when food patterns begin to emerge , are weakly associated with IQ  in adolescence PURPOSE This study evaluated the effects of a classroom-based physical activity program on  children 's in-school physical activity levels  and on-task behavior during academic instruction . METHODS Physical activity of 243 students was assessed during school hours . Intervention-group students ( N = 135 ) received a classroom-based program ( i.e. , Energizers ) . The control group ( N = 108 ) did not receive Energizers .  On-task behavior during academic instruction time was observed for 62 third- grade ( N = 37 ) and fourth- grade students ( N = 25 ) before and after Energizers activities . An independent groups t-test compared in-school physical activity levels between intervention and control classes . A multiple-baseline across-classrooms design was used to evaluate the effectiveness of the Energizers on on-task behavior . Additionally , a two-way ( time [ pre- vs postobservation ] x period [ baseline vs intervention ] ) repeated- measures analysis of variance compared on-task behavior between observation periods . Magnitudes of mean differences were evaluated with Cohen 's delta ( ES ) . RESULTS Students in the intervention group took significantly ( P < 0.05 ) more in-school steps ( 5587 + /- 1633 ) than control-group students ( 4805 + /- 1543 ) , and the size of this difference was moderate ( ES = 0.49 ) . The intervention was effective in improving on- 
    Output:
    
agent
A healthier dietary pattern was associated with better cognitive outcomes in all studies , although some of the reported associations were weak and the measures used varied across the studies .
Conclusions Physical activity and healthy diets in early childhood are associated with better cognitive outcomes  in young children .
***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 : To examine the link between childhood overweight status and elementary school outcomes . Design : Prospect i ve study design : multivariate regression models examining the association between changes in overweight status and school outcomes between kindergarten entry and end of third grade , after controlling for various child , family and school characteristics . Subjects : Nationally representative sample of US children who entered kindergarten in 1998 , with longitudinal data on body mass index ( BMI ) and school outcomes at kindergarten entry and end of third grade . Measurements : Wide range of elementary school outcomes collected in each wave including academic achievement ( math and reading st and ardized test scores ) ; teacher reported internalizing and externalizing behavior problems ( BP ) , social skills ( self-control , interpersonal skills ) and approaches to learning ; school absences ; and grade repetition . Measurements of height and weight in each wave were used to compute BMI and indicators of overweight status based on CDC growth charts . A rich set of control variables capturing child , family , and school characteristics . Results : Moving from not-overweight to overweight between kindergarten entry and end of third grade was significantly associated ( P<0.05 ) with reductions in test scores , and teacher ratings of social-behavioral outcomes and approaches to learning among girls . However , this link was mostly absent among boys , with two exceptions – boys who became overweight had significantly fewer externalizing BPs ( P<0.05 ) , but more absences from school compared to boys who remained normal weight . Being always-overweight was associated with more internalizing BP among girls but fewer externalizing BPs among boys . Conclusion : Change in overweight status during the first 4 years in school is a significant risk factor for adverse school outcomes among girls but not boys . Girls who become overweight during the early school years and those who start school being overweight and remain that way may need to be monitored carefully IMPORTANCE Many early life risk factors for childhood obesity are more prevalent among blacks and Hispanics than among whites and may explain the higher prevalence of obesity among racial/ethnic minority children . OBJECTIVE To examine the extent to which racial/ethnic disparities in adiposity and overweight are explained by differences in risk factors during pregnancy ( gestational diabetes and depression ) , infancy ( rapid infant weight gain , feeding other than exclusive breastfeeding , and early introduction of solid foods ) , and early childhood ( sleeping < 12 h/d , presence of a television set in the room where the child sleeps , and any intake of sugar-sweetened beverages or fast food ) . DESIGN Prospect i ve prebirth cohort study . SETTING Multisite group practice in Massachusetts . PARTICIPANTS Participants included 1116 mother-child pairs ( 63 % white , 17 % black , and 4 % Hispanic ) EXPOSURE Mother 's report of child 's race/ethnicity . MAIN OUTCOMES AND MEASURES Age- and sex-specific body mass index ( BMI ) z score , total fat mass index from dual-energy x-ray absorptiometry , and overweight or obesity , defined as a BMI in the 85th percentile or higher at age 7 years . RESULTS Black ( 0.48 U [ 95 % CI , 0.31 to 0.64 ] ) and Hispanic ( 0.43 [ 0.12 to 0.74 ] ) children had higher BMI z scores , as well as higher total fat mass index and overweight/obesity prevalence , than white children . After adjustment for socioeconomic confounders and parental BMI , differences in BMI z score were attenuated for black and Hispanic children ( 0.22 U [ 0.05 to 0.40 ] and 0.22 U [ -0.08 to 0.52 ] , respectively ) . Adjustment for pregnancy risk factors did not substantially change these estimates . However , after further adjustment for infancy and childhood risk factors , we observed only minimal differences in BMI z scores between whites , blacks ( 0.07 U [ -0.11 to 0.26 ] ) , and Hispanics ( 0.04 U [ -0.27 to 0.35 ] ) . We observed similar attenuation of racial/ethnic differences in adiposity and prevalence of overweight or obesity . CONCLUSIONS AND RELEVANCE Racial/ethnic disparities in childhood adiposity and obesity are determined by factors operating in infancy and early childhood . Efforts to reduce obesity disparities should focus on preventing early life risk factors Early nutrition in animals affects both behavior and brain structure . In humans , r and omized trials show that early nutrition affects later cognition , notably in males . We hypothesized that early nutrition also influences brain structure , measurable using magnetic resonance imaging . Prior research suggested that the cau date nucleus may be especially vulnerable to early environment and that its size relates to IQ . To test the hypothesis that the cau date nucleus could be a neural substrate for cognitive effects of early nutrition , we compared two groups of adolescents , assigned a St and ard- or High-nutrient diet in the postnatal weeks after preterm birth . Groups had similar birth status and neonatal course .  Scans and IQ data were obtained from 76 adolescents and volumes of several subcortical structures were calculated . The High-nutrient group had significantly larger cau date volumes and higher Verbal IQ ( VIQ ) . Cau date volumes correlated significantly with VIQ in the St and ard-nutrient group only . Cau date volume was influenced by early nutrition and related selectively to VIQ in males , but not in females . Our findings may partly explain the effects of early diet on cognition and the predominant effects in males . They are among the first to show that human brain structure can be influenced by early nutrition Determinants of a child 's diet shortly after weaning and lactation have been relatively understudied . The aim of the present study was hence to identify common dietary patterns in toddlers and to explore parental and child indicators of these dietary patterns . The study was a population -based , prospect i ve birth-cohort study in Rotterdam , the Netherl and s. Food consumption data of 2420 children aged 14 months were used . A ' Health conscious ' dietary pattern characterised by pasta , fruits , vegetables , oils , legumes and fish , and a ' Western-like ' dietary pattern characterised by snacks , animal fats , confectionery and sugar-containing beverages were extracted using principal component analysis . Low paternal education , low household income , parental smoking , multiparity , maternal BMI , maternal carbohydrate intake and television-watching of child were determinants of a ' Western-like ' diet , whereas parental age ,  dietary fibre  intake during pregnancy , introduction of solids after 6 months and female sex were inversely associated with a ' Western-like ' diet of the child . Maternal co-morbidity , alcohol consumption during pregnancy and female sex were inversely associated with a ' Health conscious ' dietary pattern of the child , while single parenthood , folic acid use and dietary fibre intake during pregnancy were positively associated . All aforementioned associations were statistically significant . In conclusion , both ' Western-like ' and ' Health conscious ' diets can already be identified in toddlers . Particularly , adherence to a ' Western-like ' diet is associated with unfavourable lifestyle factors of the parents and child , and low socio-economic background . These findings can form a basis for future epidemiological studies regarding dietary patterns and health outcomes in young children IMPORTANCE Breastfeeding may benefit child cognitive development , but few studies have quantified breastfeeding duration or exclusivity , nor has any study to date examined the role of maternal diet during lactation on child cognition . OBJECTIVES To examine relationships of breastfeeding duration and exclusivity with child cognition at ages 3 and 7 years and to evaluate the extent to which maternal fish intake during lactation modifies associations of infant feeding with later cognition . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study ( Project Viva ) , a US prebirth cohort that enrolled mothers from April 22 , 1999 , to July 31 , 2002 , and followed up children to age 7 years , including 1312 Project Viva mothers and children . MAIN EXPOSURE Duration of any breastfeeding to age 12 months . MAIN OUTCOMES AND MEASURES Child receptive language assessed with the Peabody Picture Vocabulary Test at age 3 years , Wide Range Assessment of Visual Motor Abilities at ages 3 and 7 years , and Kaufman Brief Intelligence Test and Wide Range Assessment of Memory and Learning at age 7 years . RESULTS Adjusting for sociodemographics , maternal intelligence , and home environment in linear regression , longer breastfeeding duration was associated with higher Peabody Picture Vocabulary Test score at age 3 years ( 0.21 ; 95 % CI , 0.03 - 0.38 points per month breastfed ) and with higher intelligence on the Kaufman Brief Intelligence Test at age 7 years ( 0.35 ; 0.16 - 0.53 verbal points per month breastfed ; and 0.29 ; 0.05 - 0.54 nonverbal points per month breastfed ) . Breastfeeding duration was not associated with Wide Range Assessment of Memory and Learning scores . Beneficial effects of breastfeeding on the Wide Range Assessment of Visual Motor Abilities at age 3 years seemed greater for women who consumed 2 or more servings of fish per week ( 0.24 ; 0.00 - 0.47 points per month breastfed ) compared with less than 2 servings of fish per week ( −0.01 ; −0.22 to 0.20 points per month breastfed ) ( P = .16 for interaction ) . CONCLUSIONS AND RELEVANCE Our results support a causal relationship of breastfeeding duration with receptive language and verbal and nonverbal intelligence later in life Objective We examined whether trajectories of dietary patterns from 6 to 24 months of age are associated with  intelligence quotient ( IQ ) in childhood and adolescence . Methods Participants were children enrolled in a prospect i ve UK birth cohort ( n = 7652 ) who had IQ measured at age 8 and /or 15 years .  Dietary patterns were previously extracted from question naires when children were aged 6 , 15 and 24 months using principal component analysis . Dietary trajectories were generated by combining scores on similar dietary patterns across each age , using multilevel mixed models . Associations between dietary trajectories and IQ were examined in generalized linear models with adjustment for potential confounders . Results Four dietary pattern trajectories were constructed from 6 to 24 months of age and were named according to foods that made the strongest contribution to trajectory scores ; Healthy ( characterised by breastfeeding at 6 months , raw fruit and vegetables , cheese and herbs at 15 and 24 months ) ; Discretionary ( biscuits , chocolate , crisps at all ages ) , Traditional ( meat , cooked vegetables and puddings at all ages ) and , Ready-to-eat ( use of ready-prepared baby foods at 6 and 15 months , biscuits , bread and breakfast cereals at 24 months ) . In fully-adjusted models , a 1 SD change in the Healthy trajectory was weakly associated with higher IQ at age 8 ( 1.07 ( 95%CI 0.17 , 1.97 ) ) but not 15 years ( 0.49 ( −0.28 , 1.26 ) ) . Associations between the Discretionary and Traditional trajectories with IQ at 8 and 15 years were as follows ; Discretionary ; 8 years −0.35(−1.03 , 0.33 ) , 15 years −0.73(−1.33 , −0.14 ) Traditional ; 8 years −0.19(−0.71 , 0.33)15 years −0.41(−0.77 , −0.04 ) ) . The Ready-to-eat trajectory had no association with IQ at either age ( 8 years 0.32(−4.31 , 4.95 ) , 15 years 1.11(−3.10 , 5.33 ) . Conclusions The Discretionary and Traditional dietary pattern trajectories from 6 to 24 months of age , over the period when food patterns begin to emerge , are weakly associated with IQ  in adolescence PURPOSE This study evaluated the effects of a classroom-based physical activity program on  children 's in-school physical activity levels  and on-task behavior during academic instruction . METHODS Physical activity of 243 students was assessed during school hours . Intervention-group students ( N = 135 ) received a classroom-based program ( i.e. , Energizers ) . The control group ( N = 108 ) did not receive Energizers .  On-task behavior during academic instruction time was observed for 62 third- grade ( N = 37 ) and fourth- grade students ( N = 25 ) before and after Energizers activities . An independent groups t-test compared in-school physical activity levels between intervention and control classes . A multiple-baseline across-classrooms design was used to evaluate the effectiveness of the Energizers on on-task behavior . Additionally , a two-way ( time [ pre- vs postobservation ] x period [ baseline vs intervention ] ) repeated- measures analysis of variance compared on-task behavior between observation periods . Magnitudes of mean differences were evaluated with Cohen 's delta ( ES ) . RESULTS Students in the intervention group took significantly ( P < 0.05 ) more in-school steps ( 5587 + /- 1633 ) than control-group students ( 4805 + /- 1543 ) , and the size of this difference was moderate ( ES = 0.49 ) . The intervention was effective in improving on- 
    Output:
    