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: Objectives : To assess the effectiveness of a multivitamin ( MV ) tablet on nutritional status , quantitative heel ultrasound ( QUS ) , mobility , muscle strength and falls . The design comprised two groups matched on mobility levels , r and omized to receive a daily MV or placebo ( P ) tablet for 6 months . The setting was an Australian residential care facility . Subjects : A total of 92 aged care residents . Serum micronutrients , body weight , QUS , rate of falls , h and grip strength , and the timed up and go test were assessed at baseline and 6 months . Results : A total of 49 participants consumed a MV and 43 , a matched P for 6 months . There was a greater increase in the MV vs P group for serum 25(OH)D ( mean difference±st and ard error , 33.4±2.6 nmol l−1 ) , folate ( 13.4±2.8 nmol l−1 ) , and vitamin B12 ( 178.0±40.3 pmol l−1 ) ( all P<0.001 ) . Adequate 25(OH)D concentrations ( ⩾50 nmol l−1 ) were found among 77 % of participants in the MV group vs 10 % taking P ( P<0.001 ) . Adjusting for baseline levels , the increase in QUS was greater in the MV vs P group ( 3.0±2.0 dB MHz−1 vs −2.9±2.1 dB MHz−1 , respectively , P=0.041 ) . There was a trend towards a 63 % lower mean number of falls in the MV vs P group ( 0.3±0.1 falls vs 0.8±0.3 falls , P=0.078 ) . Conclusions : MV  supplementation raised serum vitamin B12 and folate concentrations and increased serum 25(OH)D , which was accompanied by an apparent positive effect on bone density . We also found a trend towards a reduction in falls and this could contribute to a reduction in fractures BACKGROUND Vitamin B-12 deficiency is associated with cognitive impairment in older people . However , evidence from r and omized trials of the effects of vitamin B-12 supplementation on cognitive function is limited and inconclusive . OBJECTIVE The objective was to investigate whether daily supplementation with high doses of oral vitamin B-12 alone or in combination with folic acid has any beneficial effects on cognitive function in persons aged > /=70 y with mild vitamin B-12 deficiency . DESIGN In a double-blind , placebo-controlled trial , 195 subjects were r and omly assigned to receive 1000 microg vitamin B-12 , 1000 microg vitamin B-12 + 400 microg folic acid , or placebo for 24 wk . Vitamin B-12 status was assessed on the basis of methylmalonic acid , total homocysteine ( tHcy ) , and holotranscobalamin ( holoTC ) concentrations before and after 12 and 24 wk of treatment . Cognitive function was assessed before and after 24 wk of treatment with the use of an extensive neuropsychologic test battery that included the domains of attention , construction , sensomotor speed , memory , and executive function . RESULTS Vitamin B-12 status did not change significantly after treatment in the placebo group ; however , oral vitamin B-12 supplementation corrected mild vitamin B-12 deficiency .  Vitamin B-12 + folic acid supplementation increased red blood cell folate concentrations and decreased tHcy concentrations by 36 % . Improvement in memory function was greater in the placebo group than in the group who received vitamin B-12 alone ( P = 0.0036 ) . Neither supplementation with vitamin B-12 alone nor that in combination with folic acid was accompanied by any improvement in other cognitive domains . CONCLUSION Oral supplementation with vitamin B-12 alone or in combination with folic acid for 24 wk does not improve cognitive function BACKGROUND High homocysteine and low B vitamin concentrations have been linked to the risk of vascular disease , stroke , and dementia and are relatively common in older adults . OBJECTIVE We assessed the effect of breakfast cereal fortified with folic acid , vitamin B-6 , and vitamin B-12 on vitamin and homocysteine status . DESIGN A r and omized , double-blind trial was conducted in 189 volunteers aged 50 - 85 y. The subjects had no history of hypertension , anemia , asthma , cancer , or cardiovascular or digestive disease and did not regularly consume multiple or B vitamin supplements or highly fortified breakfast cereal . Subjects were r and omly assigned to consume 1 cup ( 0.24 L ) breakfast cereal fortified with 440 microg folic acid , 1.8 mg vitamin B-6 , and 4.8 microg vitamin B-12 or placebo cereal for 12 wk . Blood was drawn at 0 , 2 , 12 , and 14 wk . Methionine-loading tests were conducted at baseline and week 14 . RESULTS Final baseline-adjusted plasma homocysteine concentrations were significantly lower and B vitamin concentrations were significantly higher in the treatment group than in the placebo group ( P < 0.001 ) . The percentage of subjects with plasma folate concentrations < 11 nmol/L decreased from 2 % to 0 % , with vitamin B-12 concentrations < 185 pmol/L from 9 % to 3 % , with vitamin B-6 concentrations < 20 nmol/L from 6 % to 2 % , and with homocysteine concentrations > 10.4 micromol/L ( women ) or > 11.4 micromol/L ( men ) from 6.4 % to 1.6 % . The percentage of control subjects with values beyond these cutoff points remained nearly constant or increased . CONCLUSIONS In this relatively healthy group of volunteers , consumption of 1 cup fortified breakfast cereal daily significantly increased B vitamin and decreased homocysteine concentrations , including post-methionine-load homocysteine concentrations We have previously shown that a modest vitamin supplement containing folic acid , vitamin B-12 and vitamin B-6 is effective in reducing elevated plasma homocysteine concentrations . The effect of supplementation of the individual vitamins on moderate hyperhomocysteinemia has now been investigated in a placebo-controlled study . One hundred men with hyperhomocysteinemia were r and omly assigned to five groups and treated with a daily dose of placebo , folic acid ( 0.65 mg ) , vitamin B-12 ( 0.4 mg ) , vitamin B-6 ( 10 mg ) or a combination of the three vitamins for 6 wk . Folic acid supplementation reduced plasma homocysteine concentrations by 41.7 % ( P < 0.001 ) , whereas the daily vitamin B-12 supplement lowered homocysteine concentrations by 14.8 % ( P < 0.01 ) . The daily pyridoxine dose did not reduce significantly plasma homocysteine concentrations . The combination of the three vitamins reduced circulating homocysteine concentrations by 49.8 % , which was not significantly different ( P = 0.48 ) from the reduction achieved by folate supplementation alone . Our results indicate that folate deficiency may be an important cause of hyperhomocysteinemia in the general population BACKGROUND Low vitamin B-12 status is prevalent among the elderly , but few studies have examined the association between vitamin B-12 status and intake . OBJECTIVE We hypothesized that vitamin B-12 concentrations vary according to intake source . DESIGN Plasma concentrations and dietary intakes were assessed cross-sectionally for 2999 subjects in the Framingham Offspring Study . The prevalence of vitamin B-12 concentrations < 148 , 185 , and 258 pmol/L was examined by age group ( 26 - 49 , 50 - 64 , and 65 - 83 y ) , supplement use , and the following food intake sources : fortified breakfast cereal , dairy products , and meat . RESULTS Thirty-nine percent of subjects had plasma vitamin B-12 concentrations < 258 pmol/L , 17 % had concentrations < 185 pmol/L , and 9 % had concentrations < 148 pmol/L , with little difference between age groups . Supplement users were significantly less likely than non-supplement-users to have concentrations < 185 pmol/L ( 8 % compared with 20 % , respectively ) . Among non-supplement-users , there were significant differences between those who consumed fortified cereal > 4 times/wk ( 12 % ) and those who consumed no fortified cereal ( 23 % ) and between those in the highest and those in the lowest tertile of dairy intake ( 13 % compared with 24 % , respectively ) , but no significant differences by meat tertile . Regression of plasma vitamin B-12 on log of intake , by source , yielded significant slopes for each contributor adjusted for the others . For the total group , b = 40.6 for vitamin B-12 from vitamin supplements . Among non-supplement-users , b = 56.4 for dairy products , 35.2 for cereal , and 16.7 for meat . Only the meat slope differed significantly from the others . CONCLUSIONS In contrast with previous reports , plasma vitamin B-12 concentrations were associated with vitamin B-12 intake . Use of supplements , fortified cereal , and milk appears to protect against lower concentrations . Further research is needed to investigate possible differences in bioavailability We measured serum concentrations of  thiamin , riboflavin  ,  nicotinic acid  ,  pyridoxine , folate , cyanocobalamin , ascorbic acid , retinol , tocopherol , zinc , magnesium , copper , iron , and ferritin as well as hemoglobin , hematocrit , percentage transferrin saturation , and total iron-binding capacity in athletes who ingested a multivitamin and mineral supplement for 3 mo . All blood variables were normal and except for pyridoxine and riboflavin there were no significant changes in the blood concentrations of any other vitamins or minerals measured . This may have been due to variable interactions between the vitamins and minerals in the supplement that prevented their being adequately absorbed . There were no signs or symptoms of serious toxic side effects . We conclude that multivitamin and mineral supplementation was without any measurable ergogenic effect and that such supplementation is unnecessary in athletes ingesting a normal diet BACKGROUND M and atory fortification of flour with folic acid has reduced the number of neural tube defects in North America . Concerns that high intakes of folic acid might mask vitamin B-12 deficiency in older persons have delayed the introduction of fortification in many European countries . Cofortification of flour with folic acid and vitamin B-12 could simultaneously improve folate and vitamin B-12 status . OBJECTIVE The objective was to estimate the effect of the consumption of bread fortified with modest amounts of folic acid and vitamin B-12 on folate and vitamin B-12 status in healthy older persons living in the Netherl and s , where folic acid fortification is not taking place . DESIGN Men and women aged 50 - 75 y were r and omly assigned in this 12-wk double-blind , placebo-controlled trial to consume bread fortified with 138 mug folic acid and 9.6 mug vitamin B-12 daily ( n = 72 ) or unfortified bread ( n = 70 ) . RESULTS The consumption of fortified bread increased serum folate concentrations by 45 % ( mean : 6.3 nmol/L ; 95 % CI : 4.5 , 8.1 nmol/L ) and serum vitamin B-12 concentrations by 49 % ( mean : 102 pmol/L ; 95 % CI : 82 , 122 pmol/L ) relative to the placebo group . Fortified bread increased erythrocyte folate concentrations by 22 % and holotranscobalamin concentrations by 35 % ; it decreased homocysteine concentrations by 13 % and methylmalonic acid concentrations by 10 % . Consumption of fortified bread decreased the proportion of individuals with marginal serum vitamin B-12 concentrations ( < 133 pmol/L ) from 8 % at enrollment to 0 % after 12 wk . CONCLUSION Bread fortified with modest amounts of folic acid and vitamin B-12 will improve folate and vitamin B-12 status and a considerable proportion of vitamin B-12 deficiency in older people . This trial was registered at clinical trials.gov as NCT00353353 BACKGROUND A high prevalence of cobalamin deficiency occurs in the elderly population , which may be treated orally or with injections . Little is known about the relative bioavailability of crystalline cobalamin added to food products . OBJECTIVE The objective was to assess the effect of supplementation with 1000 microg crystalline cobalamin , carried either by a milk product or a capsule , on cobalamin status in mildly cobalamin-deficient elderly Dutch persons . DESIGN Two double-blind r and omized controlled intervention studies , each covering a 12-wk supplementation period , were carried out in parallel . Mildly cobalamin-deficient elderly persons ( n = 112 
    Output:
    
agent
RESULTS The meta- analysis of observational studies showed a weaker slope of dose-response relations than the meta- analysis of RCTs .
The obtained dose-response estimate between vitamin B-12 intake and status provides complementary evidence to underpin recommendations for a vitamin B-12 intake of population
***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: Objectives : To assess the effectiveness of a multivitamin ( MV ) tablet on nutritional status , quantitative heel ultrasound ( QUS ) , mobility , muscle strength and falls . The design comprised two groups matched on mobility levels , r and omized to receive a daily MV or placebo ( P ) tablet for 6 months . The setting was an Australian residential care facility . Subjects : A total of 92 aged care residents . Serum micronutrients , body weight , QUS , rate of falls , h and grip strength , and the timed up and go test were assessed at baseline and 6 months . Results : A total of 49 participants consumed a MV and 43 , a matched P for 6 months . There was a greater increase in the MV vs P group for serum 25(OH)D ( mean difference±st and ard error , 33.4±2.6 nmol l−1 ) , folate ( 13.4±2.8 nmol l−1 ) , and vitamin B12 ( 178.0±40.3 pmol l−1 ) ( all P<0.001 ) . Adequate 25(OH)D concentrations ( ⩾50 nmol l−1 ) were found among 77 % of participants in the MV group vs 10 % taking P ( P<0.001 ) . Adjusting for baseline levels , the increase in QUS was greater in the MV vs P group ( 3.0±2.0 dB MHz−1 vs −2.9±2.1 dB MHz−1 , respectively , P=0.041 ) . There was a trend towards a 63 % lower mean number of falls in the MV vs P group ( 0.3±0.1 falls vs 0.8±0.3 falls , P=0.078 ) . Conclusions : MV  supplementation raised serum vitamin B12 and folate concentrations and increased serum 25(OH)D , which was accompanied by an apparent positive effect on bone density . We also found a trend towards a reduction in falls and this could contribute to a reduction in fractures BACKGROUND Vitamin B-12 deficiency is associated with cognitive impairment in older people . However , evidence from r and omized trials of the effects of vitamin B-12 supplementation on cognitive function is limited and inconclusive . OBJECTIVE The objective was to investigate whether daily supplementation with high doses of oral vitamin B-12 alone or in combination with folic acid has any beneficial effects on cognitive function in persons aged > /=70 y with mild vitamin B-12 deficiency . DESIGN In a double-blind , placebo-controlled trial , 195 subjects were r and omly assigned to receive 1000 microg vitamin B-12 , 1000 microg vitamin B-12 + 400 microg folic acid , or placebo for 24 wk . Vitamin B-12 status was assessed on the basis of methylmalonic acid , total homocysteine ( tHcy ) , and holotranscobalamin ( holoTC ) concentrations before and after 12 and 24 wk of treatment . Cognitive function was assessed before and after 24 wk of treatment with the use of an extensive neuropsychologic test battery that included the domains of attention , construction , sensomotor speed , memory , and executive function . RESULTS Vitamin B-12 status did not change significantly after treatment in the placebo group ; however , oral vitamin B-12 supplementation corrected mild vitamin B-12 deficiency .  Vitamin B-12 + folic acid supplementation increased red blood cell folate concentrations and decreased tHcy concentrations by 36 % . Improvement in memory function was greater in the placebo group than in the group who received vitamin B-12 alone ( P = 0.0036 ) . Neither supplementation with vitamin B-12 alone nor that in combination with folic acid was accompanied by any improvement in other cognitive domains . CONCLUSION Oral supplementation with vitamin B-12 alone or in combination with folic acid for 24 wk does not improve cognitive function BACKGROUND High homocysteine and low B vitamin concentrations have been linked to the risk of vascular disease , stroke , and dementia and are relatively common in older adults . OBJECTIVE We assessed the effect of breakfast cereal fortified with folic acid , vitamin B-6 , and vitamin B-12 on vitamin and homocysteine status . DESIGN A r and omized , double-blind trial was conducted in 189 volunteers aged 50 - 85 y. The subjects had no history of hypertension , anemia , asthma , cancer , or cardiovascular or digestive disease and did not regularly consume multiple or B vitamin supplements or highly fortified breakfast cereal . Subjects were r and omly assigned to consume 1 cup ( 0.24 L ) breakfast cereal fortified with 440 microg folic acid , 1.8 mg vitamin B-6 , and 4.8 microg vitamin B-12 or placebo cereal for 12 wk . Blood was drawn at 0 , 2 , 12 , and 14 wk . Methionine-loading tests were conducted at baseline and week 14 . RESULTS Final baseline-adjusted plasma homocysteine concentrations were significantly lower and B vitamin concentrations were significantly higher in the treatment group than in the placebo group ( P < 0.001 ) . The percentage of subjects with plasma folate concentrations < 11 nmol/L decreased from 2 % to 0 % , with vitamin B-12 concentrations < 185 pmol/L from 9 % to 3 % , with vitamin B-6 concentrations < 20 nmol/L from 6 % to 2 % , and with homocysteine concentrations > 10.4 micromol/L ( women ) or > 11.4 micromol/L ( men ) from 6.4 % to 1.6 % . The percentage of control subjects with values beyond these cutoff points remained nearly constant or increased . CONCLUSIONS In this relatively healthy group of volunteers , consumption of 1 cup fortified breakfast cereal daily significantly increased B vitamin and decreased homocysteine concentrations , including post-methionine-load homocysteine concentrations We have previously shown that a modest vitamin supplement containing folic acid , vitamin B-12 and vitamin B-6 is effective in reducing elevated plasma homocysteine concentrations . The effect of supplementation of the individual vitamins on moderate hyperhomocysteinemia has now been investigated in a placebo-controlled study . One hundred men with hyperhomocysteinemia were r and omly assigned to five groups and treated with a daily dose of placebo , folic acid ( 0.65 mg ) , vitamin B-12 ( 0.4 mg ) , vitamin B-6 ( 10 mg ) or a combination of the three vitamins for 6 wk . Folic acid supplementation reduced plasma homocysteine concentrations by 41.7 % ( P < 0.001 ) , whereas the daily vitamin B-12 supplement lowered homocysteine concentrations by 14.8 % ( P < 0.01 ) . The daily pyridoxine dose did not reduce significantly plasma homocysteine concentrations . The combination of the three vitamins reduced circulating homocysteine concentrations by 49.8 % , which was not significantly different ( P = 0.48 ) from the reduction achieved by folate supplementation alone . Our results indicate that folate deficiency may be an important cause of hyperhomocysteinemia in the general population BACKGROUND Low vitamin B-12 status is prevalent among the elderly , but few studies have examined the association between vitamin B-12 status and intake . OBJECTIVE We hypothesized that vitamin B-12 concentrations vary according to intake source . DESIGN Plasma concentrations and dietary intakes were assessed cross-sectionally for 2999 subjects in the Framingham Offspring Study . The prevalence of vitamin B-12 concentrations < 148 , 185 , and 258 pmol/L was examined by age group ( 26 - 49 , 50 - 64 , and 65 - 83 y ) , supplement use , and the following food intake sources : fortified breakfast cereal , dairy products , and meat . RESULTS Thirty-nine percent of subjects had plasma vitamin B-12 concentrations < 258 pmol/L , 17 % had concentrations < 185 pmol/L , and 9 % had concentrations < 148 pmol/L , with little difference between age groups . Supplement users were significantly less likely than non-supplement-users to have concentrations < 185 pmol/L ( 8 % compared with 20 % , respectively ) . Among non-supplement-users , there were significant differences between those who consumed fortified cereal > 4 times/wk ( 12 % ) and those who consumed no fortified cereal ( 23 % ) and between those in the highest and those in the lowest tertile of dairy intake ( 13 % compared with 24 % , respectively ) , but no significant differences by meat tertile . Regression of plasma vitamin B-12 on log of intake , by source , yielded significant slopes for each contributor adjusted for the others . For the total group , b = 40.6 for vitamin B-12 from vitamin supplements . Among non-supplement-users , b = 56.4 for dairy products , 35.2 for cereal , and 16.7 for meat . Only the meat slope differed significantly from the others . CONCLUSIONS In contrast with previous reports , plasma vitamin B-12 concentrations were associated with vitamin B-12 intake . Use of supplements , fortified cereal , and milk appears to protect against lower concentrations . Further research is needed to investigate possible differences in bioavailability We measured serum concentrations of  thiamin , riboflavin  ,  nicotinic acid  ,  pyridoxine , folate , cyanocobalamin , ascorbic acid , retinol , tocopherol , zinc , magnesium , copper , iron , and ferritin as well as hemoglobin , hematocrit , percentage transferrin saturation , and total iron-binding capacity in athletes who ingested a multivitamin and mineral supplement for 3 mo . All blood variables were normal and except for pyridoxine and riboflavin there were no significant changes in the blood concentrations of any other vitamins or minerals measured . This may have been due to variable interactions between the vitamins and minerals in the supplement that prevented their being adequately absorbed . There were no signs or symptoms of serious toxic side effects . We conclude that multivitamin and mineral supplementation was without any measurable ergogenic effect and that such supplementation is unnecessary in athletes ingesting a normal diet BACKGROUND M and atory fortification of flour with folic acid has reduced the number of neural tube defects in North America . Concerns that high intakes of folic acid might mask vitamin B-12 deficiency in older persons have delayed the introduction of fortification in many European countries . Cofortification of flour with folic acid and vitamin B-12 could simultaneously improve folate and vitamin B-12 status . OBJECTIVE The objective was to estimate the effect of the consumption of bread fortified with modest amounts of folic acid and vitamin B-12 on folate and vitamin B-12 status in healthy older persons living in the Netherl and s , where folic acid fortification is not taking place . DESIGN Men and women aged 50 - 75 y were r and omly assigned in this 12-wk double-blind , placebo-controlled trial to consume bread fortified with 138 mug folic acid and 9.6 mug vitamin B-12 daily ( n = 72 ) or unfortified bread ( n = 70 ) . RESULTS The consumption of fortified bread increased serum folate concentrations by 45 % ( mean : 6.3 nmol/L ; 95 % CI : 4.5 , 8.1 nmol/L ) and serum vitamin B-12 concentrations by 49 % ( mean : 102 pmol/L ; 95 % CI : 82 , 122 pmol/L ) relative to the placebo group . Fortified bread increased erythrocyte folate concentrations by 22 % and holotranscobalamin concentrations by 35 % ; it decreased homocysteine concentrations by 13 % and methylmalonic acid concentrations by 10 % . Consumption of fortified bread decreased the proportion of individuals with marginal serum vitamin B-12 concentrations ( < 133 pmol/L ) from 8 % at enrollment to 0 % after 12 wk . CONCLUSION Bread fortified with modest amounts of folic acid and vitamin B-12 will improve folate and vitamin B-12 status and a considerable proportion of vitamin B-12 deficiency in older people . This trial was registered at clinical trials.gov as NCT00353353 BACKGROUND A high prevalence of cobalamin deficiency occurs in the elderly population , which may be treated orally or with injections . Little is known about the relative bioavailability of crystalline cobalamin added to food products . OBJECTIVE The objective was to assess the effect of supplementation with 1000 microg crystalline cobalamin , carried either by a milk product or a capsule , on cobalamin status in mildly cobalamin-deficient elderly Dutch persons . DESIGN Two double-blind r and omized controlled intervention studies , each covering a 12-wk supplementation period , were carried out in parallel . Mildly cobalamin-deficient elderly persons ( n = 112 
    Output:
    