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: BACKGROUND Low birth weight infants have been noted to have low zinc concentrations in cord blood , and zinc deficiency in childhood is associated with reduced immunocompetence and increased infectious disease morbidity . This study investigates whether zinc supplementation of infants born full term and small for gestational age affects mortality . METHODS A r and omized , double-blind , controlled trial with 2-by-2 factorial design enrolled 1154 full-term small for gestational age infants to receive in syrup 1 of the following : riboflavin ; riboflavin and zinc ( 5 mg as sulfate ) ; riboflavin , calcium , phosphorus , folate , and iron ; or riboflavin , zinc , calcium , phosphorus , folate , and iron . A fixed dosage of 5 mL per child was given daily from 30 to 284 days of age . Household visits were made 6 days per week to provide the syrup and conduct surveillance for illness and death . When a child 's death was reported , parental reports and medical records were used to ascertain the cause . The effects of zinc and of the combination of iron , folate , calcium , and phosphorus were analyzed by intent to treat . The mortality analysis was performed using a survival analytic approach that models time until death as the dependent variable ; all models had 2 terms as independent variables : 1 for the zinc effect and 1 for the vitamin and mineral ( calcium and phosphorus , folate and iron ) effect . RESULTS Zinc supplementation was associated with significantly lower mortality , with a rate ratio of 0.32 ( 95 % confidence interval : 0.12 - 0.89 ) . Calcium , phosphorus , folate , and iron supplementation was not associated with a mortality reduction , although a statistically nonsignificant trend toward reduction was observed with a rate ratio of 0.88 ( 95 % confidence interval : 0.36 - 2.15 ) . CONCLUSIONS  Zinc supplementation in small for gestational age infants can result in a substantial reduction in infectious disease mortality Objective : To test whether zinc supplementation reduces the deficits in mental development and behaviour that are found in term infants of low birth weight in the study population . Design : A prospect i ve double-blind , part-r and omised efficacy trial . Setting : A low-income population in Pernambuco , northeast Brazil , where the economy is largely dependent on sugar-cane production , and where over 90 % of deliveries occur in health facilities . Subjects : During a 20-month period , all singleton , term infants weighing 1500–2499 g born to families of low income ( < US $ 280/month ) were enroled at birth ( n=205 ) . At 6 and 12-months , the numbers tested were 163 and 138 respectively . Intervention : Infants born from January 1993–January 1994 were r and omly assigned to receive daily , except Sundays , a placebo ( n=66 ) or 1 mg zinc ( n=68 ) . Those born February – August 1994 were given 5 mg zinc ( n=71 ) . Supplementation was for eight weeks , starting at birth . Field workers visited each infant at home to administer the supplement . Results : At 6 and 12-months , mental and psychomotor development was assessed with the Bayley Scales of Infant Development and no significant differences in the scores of the three groups were found . At 12-months , behaviour was also assessed on 5 ratings . Ratings were highest in infants given 5 mg zinc ( P=0.042 ) . Conclusions : Zinc supplementation ( 5 mg/d ) for eight weeks may reverse some of the poor behaviours , particularly responsiveness , exhibited by low birth weight infants . No amelioration of their mental and psychomotor deficits was found . Sponsorship : The Wellcome Trust , United Kingdom , provided financial support ( Grant no. 036605/Z/92 ) . Dr Lira was supported by CAPES ( Fundação Coordenação de Aperfeiçoamento de Pessoal de Nível Superior ) , Brazil BACKGROUND Maternal zinc deficiency during pregnancy may be widespread among women in developing countries , but few data are available on whether prenatal zinc supplementation improves maternal and neonatal zinc status . OBJECTIVE We studied whether maternal zinc supplementation improved the zinc status of mothers and neonates participating in a supplementation trial in a shantytown in Lima , Peru . DESIGN Beginning at gestation week 10 - 24 , 1295 mothers were r and omly assigned to receive prenatal supplements containing 60 mg Fe and 250 microg folate , with or without 15 mg Zn .  Venous blood and urine sample s were collected at enrollment , at gestation week 28 - 30 , and at gestation week 37 - 38 . At birth , a sample of cord vein blood was collected . We measured serum zinc concentrations in 538 women , urinary zinc concentrations in 521 women , and cord zinc concentrations in 252 neonates . RESULTS At 28 - 30 and 37 - 38 wk , mothers receiving zinc supplements had higher serum zinc concentrations than mothers who did not receive zinc ( 8.8 + /- 1.9 compared with 8.4 + /- 1.5 micromol/L and 8.6 + /- 1.5 compared with 8.3 + /- 1.4 micromol/L , respectively ) . Urinary zinc concentrations were also higher in mothers who received supplemental zinc ( P < 0.05 ) . After adjustment for covariates and confounding factors , neonates of mothers receiving zinc supplements had higher cord zinc concentrations than neonates of mothers who did not receive zinc ( 12.7 + /- 2.3 compared with 12.1 + /- 2.1 micromol/L ) . Despite supplementation , maternal and neonatal zinc concentrations remained lower than values reported for well-nourished population s. CONCLUSION Adding zinc to prenatal iron and folate tablets improved maternal and neonatal zinc status , but higher doses of zinc are likely needed to further improve maternal and neonatal zinc status in this population BACKGROUND Undernourished children have poor levels of development that benefit from stimulation . Zinc deficiency is prevalent in undernourished children and may contribute to their poor development . OBJECTIVE We assessed the effects of zinc supplementation and psychosocial stimulation given together or separately on the psychomotor development of undernourished children . DESIGN This was a r and omized controlled trial with 4 groups : stimulation alone , zinc supplementation alone , both interventions , and control ( routine care only ) .  Subjects were 114 children aged 9 - 30 mo and below -1.5 z scores of the National Center for Health Statistics weight-for-age references who were recruited from 18 health clinics . Clinics were r and omly assigned to receive stimulation or not ; individual children were r and omly assigned to receive zinc or placebo . The stimulation program comprised weekly home visits during which play was demonstrated and maternal-child interactions were encouraged . The supplementation was 10 mg Zn as sulfate daily or placebo .  Development ( assessed by use of the Griffiths Mental Development Scales ) , length , and weight were measured at baseline and 6 mo later . Weekly morbidity histories were taken . RESULTS Significant interactions were found between zinc supplementation and stimulation . Zinc benefited the developmental quotient only in children who received stimulation , and benefits from zinc to h and and eye coordination were greater in stimulated children . Zinc supplementation alone improved h and and eye coordination , and stimulation alone benefited the developmental quotient , hearing and speech , and performance . Zinc supplementation also reduced diarrheal morbidity but did not significantly improve growth . CONCLUSION Zinc supplementation benefits development in undernourished children , and the benefits are enhanced if stimulation is also provided BACKGROUND Iron and zinc deficiency are prevalent during infancy in low-income countries . OBJECTIVES The objectives were to examine whether a weekly supplement of iron , zinc , iron+zinc , or a micronutrient mix ( MM ) of 16 vitamins and minerals would alter infant development and behavior . DESIGN The participants were 221 infants from rural Bangladesh at risk of micronutrient deficiencies .  Development and behavior were evaluated at 6 and 12 mo of age by using the Bayley Scales of Infant Development II and the Home Observation Measurement of Environment ( HOME ) scale . In this double-blind trial , the infants were r and omly assigned to 1 of 5 treatment conditions : iron ( 20 mg ) , zinc ( 20 mg ) , iron+zinc , MM ( 16 vitamins and minerals , including iron and zinc ) , or riboflavin weekly from 6 to 12 mo . Multivariate analyses were conducted to examine the change in development and behavior for each supplementation group , with control for maternal education , HOME score , months breastfed , anemia , growth at 6 mo , and change in growth from 6 to 12 mo . RESULTS Iron and zinc administered together and with other micronutrients had a beneficial effect on infant motor development .  Iron and zinc administered individually and in combination had a beneficial effect on orientation-engagement . Two-thirds of the infants were mildly anemic , no treatment effects on hemoglobin concentration were observed , and hemoglobin was not associated with measures of development or behavior . CONCLUSION The beneficial effects of weekly iron and zinc supplementation on motor development and orientation-engagement suggest that infants benefit from these minerals when administered together Zinc deficiency has been associated with growth deficits , reduced dietary intake and appetite , and has been hypothesized to result in reduced activity . This r and omized , double-blind , placebo-controlled study examined whether 10 mg of oral zinc as zinc sulfate , given daily for up to 7 mo , affected activity patterns of 85 Guatemalan infants recruited at 6 - 9 mo of age . Infant activity was assessed by time sampling-observation method at 10-min intervals during a 12-h data collection period , at base line , 3 and 7 mo follow-up . Motor development and the percentage of time infants were observed in various positions ( being carried , lying down , sitting , crawling , st and ing or walking ) and engaged in various activities ( eating , sleeping , resting , crying/whining or playing ) were compared by treatment group . No differences in motor development were observed by treatment group . However , at follow-up 2 ( after 7 mo of supplementation ) , zinc-supplemented infants were significantly more frequently observed sitting up compared with lying down , and were playing during 4.18 + /- 1.95 % ( P < 0.05 ) more observations than unsupplemented infants . They were also somewhat less likely to be observed crying or whining ( P < 0.10 ) compared with those receiving the placebo . These effects are independent of other factors including infant age , motor development , sex , maternal education , family socioeconomic status and nutritional status at base line . Further research must be conducted to determine the long-term developmental importance of these differences in activity patterns associated with zinc supplementation in this setting BACKGROUND It has been documented that growth patterns differ between breastfed and formula-fed infants . Some investigators have suggested that these differences may be related to differences in zinc nutriture . OBJECTIVE The objective of this study was to examine the effect of zinc supplementation on growth , morbidity , and motor development in healthy , term , breastfed infants . DESIGN We conducted a r and omized double-blind intervention comparing zinc supplementation ( 5 mg/d as zinc sulfate ) with placebo in breastfed infants aged 4 - 10 mo .  Growth and indexes of body composition and gross motor development were measured monthly from 3 to 10 mo . Morbidity data were collected weekly . RESULTS Eighty-five infants were enrolled , and 70 completed the study . The baseline characteristics , attained weight or length at 10 mo , growth velocity , gross motor development , and morbidity did not differ significantly between groups , even after control for potentially confounding variables . CONCLUSIONS The dietary zinc intake of these breastfed infants appeared to be adequate , given that zinc supplementation did not affect growth , development , or risk of infection ( although sample size for detection of differences in development or infection was limited ) . Previously described differences in growth between breastfed and formula-fed infants in such population s do not appear to be due to differences in zinc nutriture Changes in growth , body composition , and zinc indexes were evaluated after 25 wk in a double-blind zinc-supplementation study of 162 periurban Guatemalan children aged 81.5 + /- 7.0 mo ( mean + /- SD ) . Children receiving the zinc supplement ( 10 mg Zn/d as amino acid chelate ) for 90.1 + /- 9.2 d had higher mean fasting plasma zinc ( 16.2 + /- 2.9 vs 14.9 + /- 2.1 mumol/L , P < 0.01 ) , a greater increase in median triceps skinfold Z score ( 0.50 vs 0.38 , P < 0.05 ) , and a smaller deficit in median midarm circumference ( MAC ) Z score ( -0.03 vs -0.20 , P < 0.05 ) compared with the placebo group . Initial hair zinc classified as < 1.68 and > 1.68 mumol/g was the only laboratory variable that explained some of the variance in 
    Output:
    
agent
There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development
***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: BACKGROUND Low birth weight infants have been noted to have low zinc concentrations in cord blood , and zinc deficiency in childhood is associated with reduced immunocompetence and increased infectious disease morbidity . This study investigates whether zinc supplementation of infants born full term and small for gestational age affects mortality . METHODS A r and omized , double-blind , controlled trial with 2-by-2 factorial design enrolled 1154 full-term small for gestational age infants to receive in syrup 1 of the following : riboflavin ; riboflavin and zinc ( 5 mg as sulfate ) ; riboflavin , calcium , phosphorus , folate , and iron ; or riboflavin , zinc , calcium , phosphorus , folate , and iron . A fixed dosage of 5 mL per child was given daily from 30 to 284 days of age . Household visits were made 6 days per week to provide the syrup and conduct surveillance for illness and death . When a child 's death was reported , parental reports and medical records were used to ascertain the cause . The effects of zinc and of the combination of iron , folate , calcium , and phosphorus were analyzed by intent to treat . The mortality analysis was performed using a survival analytic approach that models time until death as the dependent variable ; all models had 2 terms as independent variables : 1 for the zinc effect and 1 for the vitamin and mineral ( calcium and phosphorus , folate and iron ) effect . RESULTS Zinc supplementation was associated with significantly lower mortality , with a rate ratio of 0.32 ( 95 % confidence interval : 0.12 - 0.89 ) . Calcium , phosphorus , folate , and iron supplementation was not associated with a mortality reduction , although a statistically nonsignificant trend toward reduction was observed with a rate ratio of 0.88 ( 95 % confidence interval : 0.36 - 2.15 ) . CONCLUSIONS  Zinc supplementation in small for gestational age infants can result in a substantial reduction in infectious disease mortality Objective : To test whether zinc supplementation reduces the deficits in mental development and behaviour that are found in term infants of low birth weight in the study population . Design : A prospect i ve double-blind , part-r and omised efficacy trial . Setting : A low-income population in Pernambuco , northeast Brazil , where the economy is largely dependent on sugar-cane production , and where over 90 % of deliveries occur in health facilities . Subjects : During a 20-month period , all singleton , term infants weighing 1500–2499 g born to families of low income ( < US $ 280/month ) were enroled at birth ( n=205 ) . At 6 and 12-months , the numbers tested were 163 and 138 respectively . Intervention : Infants born from January 1993–January 1994 were r and omly assigned to receive daily , except Sundays , a placebo ( n=66 ) or 1 mg zinc ( n=68 ) . Those born February – August 1994 were given 5 mg zinc ( n=71 ) . Supplementation was for eight weeks , starting at birth . Field workers visited each infant at home to administer the supplement . Results : At 6 and 12-months , mental and psychomotor development was assessed with the Bayley Scales of Infant Development and no significant differences in the scores of the three groups were found . At 12-months , behaviour was also assessed on 5 ratings . Ratings were highest in infants given 5 mg zinc ( P=0.042 ) . Conclusions : Zinc supplementation ( 5 mg/d ) for eight weeks may reverse some of the poor behaviours , particularly responsiveness , exhibited by low birth weight infants . No amelioration of their mental and psychomotor deficits was found . Sponsorship : The Wellcome Trust , United Kingdom , provided financial support ( Grant no. 036605/Z/92 ) . Dr Lira was supported by CAPES ( Fundação Coordenação de Aperfeiçoamento de Pessoal de Nível Superior ) , Brazil BACKGROUND Maternal zinc deficiency during pregnancy may be widespread among women in developing countries , but few data are available on whether prenatal zinc supplementation improves maternal and neonatal zinc status . OBJECTIVE We studied whether maternal zinc supplementation improved the zinc status of mothers and neonates participating in a supplementation trial in a shantytown in Lima , Peru . DESIGN Beginning at gestation week 10 - 24 , 1295 mothers were r and omly assigned to receive prenatal supplements containing 60 mg Fe and 250 microg folate , with or without 15 mg Zn .  Venous blood and urine sample s were collected at enrollment , at gestation week 28 - 30 , and at gestation week 37 - 38 . At birth , a sample of cord vein blood was collected . We measured serum zinc concentrations in 538 women , urinary zinc concentrations in 521 women , and cord zinc concentrations in 252 neonates . RESULTS At 28 - 30 and 37 - 38 wk , mothers receiving zinc supplements had higher serum zinc concentrations than mothers who did not receive zinc ( 8.8 + /- 1.9 compared with 8.4 + /- 1.5 micromol/L and 8.6 + /- 1.5 compared with 8.3 + /- 1.4 micromol/L , respectively ) . Urinary zinc concentrations were also higher in mothers who received supplemental zinc ( P < 0.05 ) . After adjustment for covariates and confounding factors , neonates of mothers receiving zinc supplements had higher cord zinc concentrations than neonates of mothers who did not receive zinc ( 12.7 + /- 2.3 compared with 12.1 + /- 2.1 micromol/L ) . Despite supplementation , maternal and neonatal zinc concentrations remained lower than values reported for well-nourished population s. CONCLUSION Adding zinc to prenatal iron and folate tablets improved maternal and neonatal zinc status , but higher doses of zinc are likely needed to further improve maternal and neonatal zinc status in this population BACKGROUND Undernourished children have poor levels of development that benefit from stimulation . Zinc deficiency is prevalent in undernourished children and may contribute to their poor development . OBJECTIVE We assessed the effects of zinc supplementation and psychosocial stimulation given together or separately on the psychomotor development of undernourished children . DESIGN This was a r and omized controlled trial with 4 groups : stimulation alone , zinc supplementation alone , both interventions , and control ( routine care only ) .  Subjects were 114 children aged 9 - 30 mo and below -1.5 z scores of the National Center for Health Statistics weight-for-age references who were recruited from 18 health clinics . Clinics were r and omly assigned to receive stimulation or not ; individual children were r and omly assigned to receive zinc or placebo . The stimulation program comprised weekly home visits during which play was demonstrated and maternal-child interactions were encouraged . The supplementation was 10 mg Zn as sulfate daily or placebo .  Development ( assessed by use of the Griffiths Mental Development Scales ) , length , and weight were measured at baseline and 6 mo later . Weekly morbidity histories were taken . RESULTS Significant interactions were found between zinc supplementation and stimulation . Zinc benefited the developmental quotient only in children who received stimulation , and benefits from zinc to h and and eye coordination were greater in stimulated children . Zinc supplementation alone improved h and and eye coordination , and stimulation alone benefited the developmental quotient , hearing and speech , and performance . Zinc supplementation also reduced diarrheal morbidity but did not significantly improve growth . CONCLUSION Zinc supplementation benefits development in undernourished children , and the benefits are enhanced if stimulation is also provided BACKGROUND Iron and zinc deficiency are prevalent during infancy in low-income countries . OBJECTIVES The objectives were to examine whether a weekly supplement of iron , zinc , iron+zinc , or a micronutrient mix ( MM ) of 16 vitamins and minerals would alter infant development and behavior . DESIGN The participants were 221 infants from rural Bangladesh at risk of micronutrient deficiencies .  Development and behavior were evaluated at 6 and 12 mo of age by using the Bayley Scales of Infant Development II and the Home Observation Measurement of Environment ( HOME ) scale . In this double-blind trial , the infants were r and omly assigned to 1 of 5 treatment conditions : iron ( 20 mg ) , zinc ( 20 mg ) , iron+zinc , MM ( 16 vitamins and minerals , including iron and zinc ) , or riboflavin weekly from 6 to 12 mo . Multivariate analyses were conducted to examine the change in development and behavior for each supplementation group , with control for maternal education , HOME score , months breastfed , anemia , growth at 6 mo , and change in growth from 6 to 12 mo . RESULTS Iron and zinc administered together and with other micronutrients had a beneficial effect on infant motor development .  Iron and zinc administered individually and in combination had a beneficial effect on orientation-engagement . Two-thirds of the infants were mildly anemic , no treatment effects on hemoglobin concentration were observed , and hemoglobin was not associated with measures of development or behavior . CONCLUSION The beneficial effects of weekly iron and zinc supplementation on motor development and orientation-engagement suggest that infants benefit from these minerals when administered together Zinc deficiency has been associated with growth deficits , reduced dietary intake and appetite , and has been hypothesized to result in reduced activity . This r and omized , double-blind , placebo-controlled study examined whether 10 mg of oral zinc as zinc sulfate , given daily for up to 7 mo , affected activity patterns of 85 Guatemalan infants recruited at 6 - 9 mo of age . Infant activity was assessed by time sampling-observation method at 10-min intervals during a 12-h data collection period , at base line , 3 and 7 mo follow-up . Motor development and the percentage of time infants were observed in various positions ( being carried , lying down , sitting , crawling , st and ing or walking ) and engaged in various activities ( eating , sleeping , resting , crying/whining or playing ) were compared by treatment group . No differences in motor development were observed by treatment group . However , at follow-up 2 ( after 7 mo of supplementation ) , zinc-supplemented infants were significantly more frequently observed sitting up compared with lying down , and were playing during 4.18 + /- 1.95 % ( P < 0.05 ) more observations than unsupplemented infants . They were also somewhat less likely to be observed crying or whining ( P < 0.10 ) compared with those receiving the placebo . These effects are independent of other factors including infant age , motor development , sex , maternal education , family socioeconomic status and nutritional status at base line . Further research must be conducted to determine the long-term developmental importance of these differences in activity patterns associated with zinc supplementation in this setting BACKGROUND It has been documented that growth patterns differ between breastfed and formula-fed infants . Some investigators have suggested that these differences may be related to differences in zinc nutriture . OBJECTIVE The objective of this study was to examine the effect of zinc supplementation on growth , morbidity , and motor development in healthy , term , breastfed infants . DESIGN We conducted a r and omized double-blind intervention comparing zinc supplementation ( 5 mg/d as zinc sulfate ) with placebo in breastfed infants aged 4 - 10 mo .  Growth and indexes of body composition and gross motor development were measured monthly from 3 to 10 mo . Morbidity data were collected weekly . RESULTS Eighty-five infants were enrolled , and 70 completed the study . The baseline characteristics , attained weight or length at 10 mo , growth velocity , gross motor development , and morbidity did not differ significantly between groups , even after control for potentially confounding variables . CONCLUSIONS The dietary zinc intake of these breastfed infants appeared to be adequate , given that zinc supplementation did not affect growth , development , or risk of infection ( although sample size for detection of differences in development or infection was limited ) . Previously described differences in growth between breastfed and formula-fed infants in such population s do not appear to be due to differences in zinc nutriture Changes in growth , body composition , and zinc indexes were evaluated after 25 wk in a double-blind zinc-supplementation study of 162 periurban Guatemalan children aged 81.5 + /- 7.0 mo ( mean + /- SD ) . Children receiving the zinc supplement ( 10 mg Zn/d as amino acid chelate ) for 90.1 + /- 9.2 d had higher mean fasting plasma zinc ( 16.2 + /- 2.9 vs 14.9 + /- 2.1 mumol/L , P < 0.01 ) , a greater increase in median triceps skinfold Z score ( 0.50 vs 0.38 , P < 0.05 ) , and a smaller deficit in median midarm circumference ( MAC ) Z score ( -0.03 vs -0.20 , P < 0.05 ) compared with the placebo group . Initial hair zinc classified as < 1.68 and > 1.68 mumol/g was the only laboratory variable that explained some of the variance in 
    Output:
    