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 determine whether extended oral iron therapy corrects lower developmental test scores in infants with iron-deficiency anemia . STUDY DESIGN Double-blind , controlled trial in Costa Rica involving 32 12- to 23-month-old infants with iron-deficiency anemia and 54 nonanemic control subjects . Anemic infants were treated with orally administered iron for 6 months ; half the nonanemic children were treated with iron and half with placebo .  Developmental test scores and hematologic status were evaluated before treatment , after 3 months , and after 6 months . RESULTS Iron-deficient anemic infants received lower mental test scores than nonanemic infants at all three time points ( p < 0.05 pretreatment and at 3 months , p = 0.07 at 6 months ) . There were no significant differences in motor test scores . More of the anemic infants were rated as unusually tearful and unhappy . Anemic infants came from families with lower maternal education and less support for child development and were less likely to be breast fed , were weaned earlier , and consumed more cow milk . CONCLUSIONS Lower mental test scores persisted in infants with iron-deficiency anemia despite extended oral iron therapy and an excellent hematologic response . Iron-deficiency anemia may serve as a marker for a variety of nutritional and family disadvantages that may adversely affect infant development We conducted a r and omized controlled trial of the effects of dietary supplements on anemia , weight and height in 136 anemic school children from a low socioeconomic background in Bagamoyo District schools in Tanzania . The aim of the current study was to investigate the impact of dietary supplements on anemia and anthropometric indices of anemic school children . The supplements were vitamin A alone , iron and vitamin A , iron alone or placebo , administered in a double-blinded design for 3 mo . All supplements were provided with local corn meals .  Hemoglobin concentration , body weight and height were measured at baseline and at follow-up after supplementation . Vitamin A supplementation increased the mean hemoglobin concentration by 13.5 g/L compared with 3.5 g/L for placebo [ P < 0.0001 , 95 % confidence interval ( CI ) 6.19 - 13.57 ) , the mean body weight by 0.6 kg compared with 0.2 kg for placebo ( P < 0.0001 , 95 % CI 0.19 - 0.65 ) and the mean height by 0.4 cm compared with 0.1 cm for placebo ( P = 0.0009 , 95 % CI 0.08 - 0.42 ) . However , the group of children who received combined vitamin A and iron supplementation had the greatest improvements in all indicators compared with placebo ( 18.5 g/L , P < 0.0001 , 95 % CI 14.81 - 22.23 ; 0.7 kg , P < 0 . 0001 , 95 % CI 0.43 - 0.88 and 0.4 cm , P < 0.0001 , 95 % CI 0.22 - 0.56 for hemoglobin , weight and height , respectively ) . It is likely that vitamin A supplementation may have a useful role in combating the problems of vitamin A deficiency and anemia , as well as in improving children 's growth , in developing countries In Indonesia , deficiencies of vitamin A and iron are of public health concern during pregnancy . We sought to determine the effects of vitamin A and iron supplementation on the vitamin A and iron status of pregnant Indonesian women . The women ( n = 27 ) were r and omly assigned to four groups . The modified relative dose response ( MRDR ) test for vitamin A status and hemoglobin , hematocrit and ferritin values were determined at baseline . Thereafter , daily supplements were administered : placebo [ Pl ] ( n = 7 ) , 8.4 micromol vitamin A [ A ] ( n = 7 ) , 1.07 mmol iron [ Fe ] ( n = 5 ) , and 8.4 micromol vitamin A plus 1.07 mmol iron [ A + Fe ] ( n = 8) . Post-treatment tests were performed after 8 wk . The MRDR value was reduced , i.e. , vitamin A status improved , more markedly by the combination of vitamin A and iron than by either nutrient alone ( P = 0.034 ) . The decrease in the MRDR relative to baseline was significant in the A + Fe group ( P = 0.008 ) . Iron status was also significantly improved in these women ( P < 0.05 ) with both iron and vitamin A supplementation . The mechanism of the enhancing effect of iron on the vitamin A-induced reduction in the MRDR is not known BACKGROUND Iron deficiency is the most common micronutrient deficiency and affects > 2 billion persons worldwide , leading to anemia in > 40 % of women of reproductive age in the developing world . OBJECTIVE The objective was to determine whether weekly supplementation with iron and folate would reduce the frequency of anemia in teenage women in urban Bangladesh before they became pregnant . DESIGN Participants with a hemoglobin concentration of 80 - 120 g/L were entered into a r and omized , double-blind , placebo-controlled trial and received supplements of placebo , vitamin A , iron + folic acid , or iron + folic acid + vitamin A weekly for 12 wk . The supplements contained 2.42 mg vitamin A ( retinol ) as retinyl palmitate , 120 mg elemental Fe as ferrous sulfate , and 3.5 mg folic acid . RESULTS Hemoglobin concentrations increased significantly more after supplementation with iron + folic acid or iron + folic acid + vitamin A than after either the placebo or vitamin A alone . There was a significantly greater increase in hemoglobin after iron + folic acid + vitamin A than after iron + folic acid , but the additional effect disappeared after adjustment for baseline hemoglobin , serum vitamin A , and ferritin and the number of supplements taken . Those with the lowest baseline hemoglobin had the greatest increase in hemoglobin . Compared with the placebo , iron + folic acid + vitamin A reduced anemia by 92 % , iron deficiency by 90 % , and vitamin A deficiency by 76 % . CONCLUSION There may be significant health benefits from a program that enhances the nutritional status of iron , folate , and vitamin A in poor urban young women before they become pregnant BACKGROUND The pathophysiology of anemia in coastal East Africa is complex . Impaired erythropoietin production is one possible mechanism . Plasmodium falciparum malaria has been found to blunt erythropoietin production , whereas vitamin A stimulates erythropoietin production in vitro . OBJECTIVE We investigated the 72-h effects of vitamin A and the antimalarial drug sulfadoxine pyramethamine ( SP ) on erythropoietin production in severely anemic ( hemoglobin < or = 70 g/L ) preschool children in Zanzibar , a region of known vitamin A deficiency . We hypothesized that both treatments would stimulate erythropoietin production directly , within 72 h , before a change in hemoglobin would occur . DESIGN One hundred forty-one severely anemic children were identified during the baseline assessment of a morbidity sub study of a community-based micronutrient supplementation trial . All severely anemic children were r and omly assigned to receive either vitamin A ( 100,000 or 200,000 IU depending on age ) or SP at baseline ; 72 h later they received the opposite treatment plus daily hematinic syrup for 90 d. Erythropoietic and parasitic indicators were assessed at baseline and again after 72 h. RESULTS After 72 h , SP reduced the malaria parasite density ( by 5029 parasites/microL ; P < 0.001 ) , CRP concentrations ( by 10.6 mg/L ; P = 0.001 ) , and the proportion of children infected with malaria ( by 32.4 % ; P < 0.001 ) . Vitamin A reduced CRP ( by 9.6 mg/L ; P = 0.011 ) , serum ferritin ( by 18.1 microg/L ; P = 0.042 ) , and erythropoietin ( by 194.7 mIU/mL ; P = 0.011 ) concentrations and increased the reticulocyte production index ( by 0.40 ; P = 0.041 ) . CONCLUSIONS Contrary to our hypothesis , vitamin A significantly decreased erythropoietin concentration . The most important effect of both vitamin A and SP was the rapid reduction of inflammation . Vitamin A also mobilized iron from stores and stimulated the production of new erythrocytes Ninety-nine anemic children aged 1 - 8 y were divided into four groups . Each group was supplemented for 2 mo with vitamin A , iron , vitamin A plus Fe , or a placebo .  Clinical , hematological , and Fe biochemical evaluations were performed at the beginning and end of the study . Vitamin A supplementation produced significant elevations in the serum levels of retinol , blood hemoglobin , hematocrit , erythrocytes , serum Fe , and percent transferrin saturation ( % TS ) and had no effect on total Fe binding capacity ( TIBC ) or serum ferritin . Fe supplementation did not affect serum retinol . However , it improved hematological and Fe nutrition indicators , including TIBC and serum ferritin . The simultaneous administration of vitamin A and Fe result ed in a better response of serum Fe and % TS than when the supplement consisted only of vitamin A or Fe alone . Vitamin A benefits hematological condition and Fe metabolism BACKGROUND Anemia is prevalent in infants in developing countries . Its etiology is multifactorial and includes vitamin A deficiency . OBJECTIVE Our primary aim was to measure the effect of maternal or neonatal vitamin A supplementation ( or both ) on hemoglobin and anemia in Zimbabwean infants . Our secondary aim was to identify the underlying causes of postnatal anemia . DESIGN A r and omized , placebo-controlled trial was conducted in 14 110 mothers and their infants ; 2854 infants were r and omly selected for the anemia sub study , of whom 1592 were successfully observed for 8 - 14 mo and formed the study sample . Infants were r and omly assigned within 96 h of delivery to 1 of 4 treatment groups : mothers and infants received vitamin A ; mothers received vitamin A and infants received placebo ; mothers received placebo and infants received vitamin A ; and mothers and infants received placebo . The vitamin A doses were 400,000 and 50,000 IU in the mothers and infants , respectively . RESULTS Vitamin A supplementation had no effect on hemoglobin or anemia ( hemoglobin < 105 g/L ) in unadjusted or adjusted analyses . Infant HIV infection independently increased anemia risk > 6-fold . Additional predictors of anemia  in HIV-negative and -positive infants were male sex and lower total body iron at birth . In addition , in HIV-positive infants , the risk of anemia increased with early infection , low maternal CD4 + lymphocyte count at recruitment , and frequent morbidity . Six-month plasma ferritin concentrations < 12 microg/L were a risk factor in HIV-negative but not in HIV-positive infants . Maternal HIV infection alone did not cause anemia . CONCLUSION Prevention of infantile anemia should include efforts to increase the birth endowment of iron and prevent HIV infection OBJECTIVE Evidence from animal experiments and observational studies in humans suggests that vitamin A plays a fundamental role in physical growth . However , results from vitamin A supplementation trials in children are inconsistent ; whereas some did not find an overall effect on growth , others found benefits only among specific groups , including children with low concentrations of serum retinol or short duration of breastfeeding . The apparent lack of an overall effect of vitamin A on growth could be attributed to context -specific distribution of conditions that affect both growth and the response to supplementation , eg , baseline vitamin A status , deficiency of other nutrients ( fat , zinc ) , and the presence of infectious diseases . Human immunodeficiency virus ( HIV ) infection , malaria , and diarrheal disease adversely affect growth and are associated with increased prevalence of vitamin A deficiency . We hypothesize that vitamin A supplementation could ameliorate the adverse effect of these infections on child growth . METHODS We conducted a r and omized , clinical trial among 687 Tanzanian children who were 6 to 60 months of age and admitted to the hospital with pneumonia . Children were assigned to oral doses of 200 000 IU vitamin A ( half that dose if < 12 months ) or placebo on the day of admission , a second dose on the following day , and third and fourth doses at 4 and 8 months after discharge from the hospital , respectively . Anthropometric measurements were obtained at baseline and at monthly visits to the study clinics during 12 months after the initial hospitalization . Surveillance on the incidence and severity of diarrhea and respiratory infections was conducted during biweekly visits , alternately at a study clinic and the child 's home , using a pictorial diary that the mothers were trained to use . A blood specimen was drawn at baseline for determination of HIV status , malaria 
    Output:
    
agent
Therefore , vitamin A supplementation alone may reduce the risk of anemia , by improving hemoglobin and ferritin levels in individuals with low serum retinol levels
***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 determine whether extended oral iron therapy corrects lower developmental test scores in infants with iron-deficiency anemia . STUDY DESIGN Double-blind , controlled trial in Costa Rica involving 32 12- to 23-month-old infants with iron-deficiency anemia and 54 nonanemic control subjects . Anemic infants were treated with orally administered iron for 6 months ; half the nonanemic children were treated with iron and half with placebo .  Developmental test scores and hematologic status were evaluated before treatment , after 3 months , and after 6 months . RESULTS Iron-deficient anemic infants received lower mental test scores than nonanemic infants at all three time points ( p < 0.05 pretreatment and at 3 months , p = 0.07 at 6 months ) . There were no significant differences in motor test scores . More of the anemic infants were rated as unusually tearful and unhappy . Anemic infants came from families with lower maternal education and less support for child development and were less likely to be breast fed , were weaned earlier , and consumed more cow milk . CONCLUSIONS Lower mental test scores persisted in infants with iron-deficiency anemia despite extended oral iron therapy and an excellent hematologic response . Iron-deficiency anemia may serve as a marker for a variety of nutritional and family disadvantages that may adversely affect infant development We conducted a r and omized controlled trial of the effects of dietary supplements on anemia , weight and height in 136 anemic school children from a low socioeconomic background in Bagamoyo District schools in Tanzania . The aim of the current study was to investigate the impact of dietary supplements on anemia and anthropometric indices of anemic school children . The supplements were vitamin A alone , iron and vitamin A , iron alone or placebo , administered in a double-blinded design for 3 mo . All supplements were provided with local corn meals .  Hemoglobin concentration , body weight and height were measured at baseline and at follow-up after supplementation . Vitamin A supplementation increased the mean hemoglobin concentration by 13.5 g/L compared with 3.5 g/L for placebo [ P < 0.0001 , 95 % confidence interval ( CI ) 6.19 - 13.57 ) , the mean body weight by 0.6 kg compared with 0.2 kg for placebo ( P < 0.0001 , 95 % CI 0.19 - 0.65 ) and the mean height by 0.4 cm compared with 0.1 cm for placebo ( P = 0.0009 , 95 % CI 0.08 - 0.42 ) . However , the group of children who received combined vitamin A and iron supplementation had the greatest improvements in all indicators compared with placebo ( 18.5 g/L , P < 0.0001 , 95 % CI 14.81 - 22.23 ; 0.7 kg , P < 0 . 0001 , 95 % CI 0.43 - 0.88 and 0.4 cm , P < 0.0001 , 95 % CI 0.22 - 0.56 for hemoglobin , weight and height , respectively ) . It is likely that vitamin A supplementation may have a useful role in combating the problems of vitamin A deficiency and anemia , as well as in improving children 's growth , in developing countries In Indonesia , deficiencies of vitamin A and iron are of public health concern during pregnancy . We sought to determine the effects of vitamin A and iron supplementation on the vitamin A and iron status of pregnant Indonesian women . The women ( n = 27 ) were r and omly assigned to four groups . The modified relative dose response ( MRDR ) test for vitamin A status and hemoglobin , hematocrit and ferritin values were determined at baseline . Thereafter , daily supplements were administered : placebo [ Pl ] ( n = 7 ) , 8.4 micromol vitamin A [ A ] ( n = 7 ) , 1.07 mmol iron [ Fe ] ( n = 5 ) , and 8.4 micromol vitamin A plus 1.07 mmol iron [ A + Fe ] ( n = 8) . Post-treatment tests were performed after 8 wk . The MRDR value was reduced , i.e. , vitamin A status improved , more markedly by the combination of vitamin A and iron than by either nutrient alone ( P = 0.034 ) . The decrease in the MRDR relative to baseline was significant in the A + Fe group ( P = 0.008 ) . Iron status was also significantly improved in these women ( P < 0.05 ) with both iron and vitamin A supplementation . The mechanism of the enhancing effect of iron on the vitamin A-induced reduction in the MRDR is not known BACKGROUND Iron deficiency is the most common micronutrient deficiency and affects > 2 billion persons worldwide , leading to anemia in > 40 % of women of reproductive age in the developing world . OBJECTIVE The objective was to determine whether weekly supplementation with iron and folate would reduce the frequency of anemia in teenage women in urban Bangladesh before they became pregnant . DESIGN Participants with a hemoglobin concentration of 80 - 120 g/L were entered into a r and omized , double-blind , placebo-controlled trial and received supplements of placebo , vitamin A , iron + folic acid , or iron + folic acid + vitamin A weekly for 12 wk . The supplements contained 2.42 mg vitamin A ( retinol ) as retinyl palmitate , 120 mg elemental Fe as ferrous sulfate , and 3.5 mg folic acid . RESULTS Hemoglobin concentrations increased significantly more after supplementation with iron + folic acid or iron + folic acid + vitamin A than after either the placebo or vitamin A alone . There was a significantly greater increase in hemoglobin after iron + folic acid + vitamin A than after iron + folic acid , but the additional effect disappeared after adjustment for baseline hemoglobin , serum vitamin A , and ferritin and the number of supplements taken . Those with the lowest baseline hemoglobin had the greatest increase in hemoglobin . Compared with the placebo , iron + folic acid + vitamin A reduced anemia by 92 % , iron deficiency by 90 % , and vitamin A deficiency by 76 % . CONCLUSION There may be significant health benefits from a program that enhances the nutritional status of iron , folate , and vitamin A in poor urban young women before they become pregnant BACKGROUND The pathophysiology of anemia in coastal East Africa is complex . Impaired erythropoietin production is one possible mechanism . Plasmodium falciparum malaria has been found to blunt erythropoietin production , whereas vitamin A stimulates erythropoietin production in vitro . OBJECTIVE We investigated the 72-h effects of vitamin A and the antimalarial drug sulfadoxine pyramethamine ( SP ) on erythropoietin production in severely anemic ( hemoglobin < or = 70 g/L ) preschool children in Zanzibar , a region of known vitamin A deficiency . We hypothesized that both treatments would stimulate erythropoietin production directly , within 72 h , before a change in hemoglobin would occur . DESIGN One hundred forty-one severely anemic children were identified during the baseline assessment of a morbidity sub study of a community-based micronutrient supplementation trial . All severely anemic children were r and omly assigned to receive either vitamin A ( 100,000 or 200,000 IU depending on age ) or SP at baseline ; 72 h later they received the opposite treatment plus daily hematinic syrup for 90 d. Erythropoietic and parasitic indicators were assessed at baseline and again after 72 h. RESULTS After 72 h , SP reduced the malaria parasite density ( by 5029 parasites/microL ; P < 0.001 ) , CRP concentrations ( by 10.6 mg/L ; P = 0.001 ) , and the proportion of children infected with malaria ( by 32.4 % ; P < 0.001 ) . Vitamin A reduced CRP ( by 9.6 mg/L ; P = 0.011 ) , serum ferritin ( by 18.1 microg/L ; P = 0.042 ) , and erythropoietin ( by 194.7 mIU/mL ; P = 0.011 ) concentrations and increased the reticulocyte production index ( by 0.40 ; P = 0.041 ) . CONCLUSIONS Contrary to our hypothesis , vitamin A significantly decreased erythropoietin concentration . The most important effect of both vitamin A and SP was the rapid reduction of inflammation . Vitamin A also mobilized iron from stores and stimulated the production of new erythrocytes Ninety-nine anemic children aged 1 - 8 y were divided into four groups . Each group was supplemented for 2 mo with vitamin A , iron , vitamin A plus Fe , or a placebo .  Clinical , hematological , and Fe biochemical evaluations were performed at the beginning and end of the study . Vitamin A supplementation produced significant elevations in the serum levels of retinol , blood hemoglobin , hematocrit , erythrocytes , serum Fe , and percent transferrin saturation ( % TS ) and had no effect on total Fe binding capacity ( TIBC ) or serum ferritin . Fe supplementation did not affect serum retinol . However , it improved hematological and Fe nutrition indicators , including TIBC and serum ferritin . The simultaneous administration of vitamin A and Fe result ed in a better response of serum Fe and % TS than when the supplement consisted only of vitamin A or Fe alone . Vitamin A benefits hematological condition and Fe metabolism BACKGROUND Anemia is prevalent in infants in developing countries . Its etiology is multifactorial and includes vitamin A deficiency . OBJECTIVE Our primary aim was to measure the effect of maternal or neonatal vitamin A supplementation ( or both ) on hemoglobin and anemia in Zimbabwean infants . Our secondary aim was to identify the underlying causes of postnatal anemia . DESIGN A r and omized , placebo-controlled trial was conducted in 14 110 mothers and their infants ; 2854 infants were r and omly selected for the anemia sub study , of whom 1592 were successfully observed for 8 - 14 mo and formed the study sample . Infants were r and omly assigned within 96 h of delivery to 1 of 4 treatment groups : mothers and infants received vitamin A ; mothers received vitamin A and infants received placebo ; mothers received placebo and infants received vitamin A ; and mothers and infants received placebo . The vitamin A doses were 400,000 and 50,000 IU in the mothers and infants , respectively . RESULTS Vitamin A supplementation had no effect on hemoglobin or anemia ( hemoglobin < 105 g/L ) in unadjusted or adjusted analyses . Infant HIV infection independently increased anemia risk > 6-fold . Additional predictors of anemia  in HIV-negative and -positive infants were male sex and lower total body iron at birth . In addition , in HIV-positive infants , the risk of anemia increased with early infection , low maternal CD4 + lymphocyte count at recruitment , and frequent morbidity . Six-month plasma ferritin concentrations < 12 microg/L were a risk factor in HIV-negative but not in HIV-positive infants . Maternal HIV infection alone did not cause anemia . CONCLUSION Prevention of infantile anemia should include efforts to increase the birth endowment of iron and prevent HIV infection OBJECTIVE Evidence from animal experiments and observational studies in humans suggests that vitamin A plays a fundamental role in physical growth . However , results from vitamin A supplementation trials in children are inconsistent ; whereas some did not find an overall effect on growth , others found benefits only among specific groups , including children with low concentrations of serum retinol or short duration of breastfeeding . The apparent lack of an overall effect of vitamin A on growth could be attributed to context -specific distribution of conditions that affect both growth and the response to supplementation , eg , baseline vitamin A status , deficiency of other nutrients ( fat , zinc ) , and the presence of infectious diseases . Human immunodeficiency virus ( HIV ) infection , malaria , and diarrheal disease adversely affect growth and are associated with increased prevalence of vitamin A deficiency . We hypothesize that vitamin A supplementation could ameliorate the adverse effect of these infections on child growth . METHODS We conducted a r and omized , clinical trial among 687 Tanzanian children who were 6 to 60 months of age and admitted to the hospital with pneumonia . Children were assigned to oral doses of 200 000 IU vitamin A ( half that dose if < 12 months ) or placebo on the day of admission , a second dose on the following day , and third and fourth doses at 4 and 8 months after discharge from the hospital , respectively . Anthropometric measurements were obtained at baseline and at monthly visits to the study clinics during 12 months after the initial hospitalization . Surveillance on the incidence and severity of diarrhea and respiratory infections was conducted during biweekly visits , alternately at a study clinic and the child 's home , using a pictorial diary that the mothers were trained to use . A blood specimen was drawn at baseline for determination of HIV status , malaria 
    Output:
    