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 Because recent data on the effects of mineral concentrations in preterm infant formula on bone mineralization are lacking , recommendations for the mineral content of preterm infant formula differ greatly between committees . OBJECTIVE The goal of the study was to assess the effects of an isocaloric , nutrient-enriched preterm formula , which was fed from the age when full enteral feedings were tolerated through expected term , on bone mineralization in preterm infants . DESIGN We conducted a prospect i ve , r and omized , double-blind study in healthy , preterm infants ( gestational age of 28 - 32 wk ) who were fed either a control preterm formula ( n=20 ) or an isocaloric , nutrient-enriched preterm formula ( n=21 ) until 3 mo of age ( ie , approximate expected term ) .  Serum calcium indexes were taken throughout the study , and bone mass was determined by using dual-energy X-ray absorptiometry at hospital discharge and expected term . RESULTS A total of 37 infants ( experimental formula , n=19 ; control formula , n=18 ) completed the study . Compared with control subjects , infants fed the experimental formula had 25 % and 40 % higher intakes of calcium and phosphorus , respectively . Serum calcium , phosphorus , osteocalcin , and alkaline phosphatase concentrations and urinary collagen type I cross-linked N-telopetide concentrations were not significantly different between the groups at any time point . The bone mineral content of infants fed the experimental formula was 23 % ( P=0.039 ) and 35 % ( P=0.002 ) higher at hospital discharge and expected term , respectively . CONCLUSIONS Bone mineralization at hospital discharge and expected term was significantly higher in preterm infants fed the isocaloric , nutrient-enriched formula than in those fed control formula . Continuation of the experimental formula beyond hospital discharge , through expected term , further improved bone mineralization OBJECTIVES Preterm infants are frequently discharged from the hospital growth retarded and show reduced growth throughout childhood . In a large efficacy and safety trial , we tested the hypothesis that nutritional intervention in the first 9 months postterm would reverse postdischarge growth deficits and improve neurodevelopment without adverse safety outcomes . PARTICIPANTS AND INTERVENTION Two hundred eighty-four infants ( mean gestation : 30.9 weeks ) were studied ; 229 were r and omly assigned a  protein , energy , mineral , and micronutrient-enriched postdischarge formula ( PDF ; N = 113 ) or st and ard term formula  ( TF ; N = 116 ) from discharge ( mean 36.5 weeks ' postmenstrual age ) . A reference group ( N = 65 ) was  breastfed until at least 6 weeks ' postterm . Outcome measures . Anthropometry was performed at 6 weeks and 3 , 6 , 9 , and 18 months . Development was measured at 9 months ( Knobloch , Passamanick , and Sherrard 's developmental screening inventory ) and 18 months ( Bayley Scales of Infant Development II ; primary outcome ) postterm . RESULTS At 9 months , compared with the TF group , those fed PDF were heavier ( difference 370 g ; 95 % confidence interval [ CI ] : 84 - 660 ) and longer ( difference 1.1 cm ; 95 % CI : 0.3 - 1.9 ) ; the difference in length persisted at 18 months ( difference 0.82 cm ; 95 % CI : -0.04 - 1.7 ) . There was no effect on head circumference . The effect of diet was greatest in males ; at 9 months length deficit with TF was 1.5 cm ( 95 % CI : 0.3 - 2.7 ) , and this remained at 18 months ( 1.5 cm [ 95 % CI : 0.3 - 2.7 ] ) . There was no significant difference in developmental scores at 9 or 18 months , although PDF infants had a 2.8 ( -1.3 - 6.8 ) point advantage in Bayley motor score scales . At 6 weeks ' postterm , exclusively breastfed infants were already 513 g ( 95 % CI : 310 - 715 ) lighter and 1.6 cm ( 95 % CI : 0.8 - 2.3 ) shorter than the PDF group , and they remained smaller up to 9 months ' postterm . CONCLUSIONS 1 ) Improving postdischarge nutrition in the first 9 months may " reset " subsequent growth-at least until 18 months for body length . We intend to follow-up the children at older ages . The observed efficacy of PDF was not associated with adverse safety outcomes . 2 ) We can not reject the hypothesis that postdischarge nutrition benefits motor development and this requires additional study . 3 ) Our data raise the possibility that breastfed postdischarge preterm infants may require nutritional supplementation , currently under investigation OBJECTIVE : To assess the effect of daily movements on weight gain , serum leptin , and insulin-like growth factor I ( IGF-I ) in premature infants . STUDY DESIGN : Twenty very-low-birth-weight premature infants were matched and r and omized to a daily movement ( n=10 ) and control groups ( n=10 ) . Daily movement consisted of passive range of motion with gentle compression of both the upper and lower extremities 5 days per week for 4 weeks . RESULTS : Daily movements led to a significant increase in weight gain ( 784±51 vs 608±26 g in movements and controls , respectively , p<0.02 ) , and to a significant increase in leptin ( 0.60±0.19 vs 0.13±0.06 ng/ml in movements and controls , respectively , p<0.05 ) . Changes in body weight correlated with changes in serum leptin ( r=0.48 , p<0.03 ) . IGF-I also increased following daily movements ( 18.8±4.1 vs 9.2±4.1 ng/ml in movements and controls , respectively ) ; however , this increase was not statistically significant . CONCLUSION : A relatively brief range of motion daily movement intervention was associated with greater weight gain and increased leptin levels in very-low-birth-weight premature infants . This may suggest that at least part of the daily movements associated with increase in body weight result ed from an increase in adipose tissue Exercise during growth has a positive influence on bone mineral accrual , yet little is known about how bone geometry and strength adapt to loading during growth . Our primary objective was to compare changes in proximal femur bone geometry and strength between 31 prepubertal ( Tanner Stage 1 ) boys who participated in a school-based , high-impact circuit intervention ( 12 min , three times a week ) for 20 months and 33 maturity-matched controls . Our secondary objective was to compare changes in total body ( TB ) , proximal femur ( PF ) , and lumbar spine ( LS ) bone mineral content ( BMC ) and bone area ( BA ) in these groups . We assessed geometric variables and bone strength at the narrow neck ( NN ) , intertrochanteric ( TR ) region , and femoral shaft regions by applying the Hip Structure Analysis program to proximal femur dual energy X-ray absorptiometry scans ( DXA , Hologic QDR 4500 ) . Further , we assessed total body , lumbar spine , and proximal femur BMC and BA by DXA and derived total body lean mass and fat mass from total body scans . Intervention ( 10.2 + /- 0.5 years ) and control boys ( 10.1 + /- 0.5 years ) had similar baseline height ( 140.8 vs. 141.3 cm ) and weight ( 36.9 vs. 35.4 kg ) , and average 20-month physical activity scores ( Physical Activity Question naire for Children , PAQ-C ) and calcium intakes ( 861 vs. 852 mg/day , food frequency question naire ) . Twenty-month height and weight changes were not significantly different between groups ; lean mass changed more ( P < 0.05 ) in intervention boys ( 22.8 % ) than control boys ( 18.6 % ) . At the NN region , intervention boys had greater bone expansion on both the periosteal ( + 2.6 % , P = 0.1 ) and endosteal ( + 2.7 % , P = 0.2 ) surfaces , result ing in significantly greater changes in section modulus ( bone bending strength ) ( + 7.5 % , P = 0.02 , ANCOVA , adjusting for height change , final Tanner Stage , and baseline bone values ) . Changes at the intertrochanteric and femoral shaft regions were not significantly different between groups . Femoral neck ( FN ) BMC changes were significantly greater in intervention boys ( + 4.3 % , P < 0.01 ) ; changes in BA and BMC for other regions were not significantly different between groups . In summary , a school-based , high-impact exercise intervention implemented three times a week for 12 min is an effective strategy for site-specific gains in bone strength at the narrow neck region of the proximal femur Seventy-four infants with birth weights 1009 + /- 28 grams and gestational age 28.6 + /- 0.3 weeks ( M + /- SEM ) were studied prospect ively to test the hypotheses that bone mineral content ( BMC ) measured by photon absorptiometry , would be : ( 1 ) lower in very low birth weight ( VLBW ) infants with radiographic evidence of fractures and /or rickets ( F/R ) , and ( 2 ) will continue to be lower over the first year when compared to VLBW infants without F/R. BMC and bone width ( BW ) of the distal one-third of left radius and ulna were measured at 5 weeks ( n = 8) , 14 weeks ( n = 61 ) , 26 weeks ( n = 58 ) , 40 weeks ( n = 59 ) , and 1 year ( n = 52 ) .  St and ardized radiographs of both forearms , and weight , length , and head circumference were also determined at each study age . Investigators and technicians involved in the photon absorptiometry measurements were unaware of the radiographic findings and vice versa . Twenty-three of 74 infants were found to have F/R. BMC of studied infants remained markedly below our previously determined range of " intrauterine bone mineralization , " even at 26 weeks after birth . There was no significant difference in BMC or BW between infants with and without F/R , either at the time of confirmation of F/R or during early follow-up ; however , BMC was lower at greater than or equal to 6 months and BW was lower at greater than or equal to 9 months in infants with F/R. We suggest that the extremely low BMC measurements in early infancy predispose all VLBW infants to fractures and rickets Studies have previously demonstrated that brief ( 4 weeks ) passive range-of-motion exercise is beneficial for bone development in very low birth weight ( VLBW ) preterm infants . However , the optimal duration of exercise for bone development in preterm infants is yet unknown . The aim of the present study was to examine the effect of 8 weeks of assisted exercise on bone strength and metabolism in VLBW premature infants . Sixteen infants ( mean ± st and ard error of the mean birth weight 1,009 ± 55 g and gestational age 27.3 ± 0.3 weeks ) were r and omly assigned into exercise ( n = 8) and control ( n = 8) groups . The intervention started at the first week of life and involved 8 weeks of daily passive extension and flexion range-of-motion exercise of the upper and lower extremities . Biochemical markers of bone turnover were measured at enrollment and after 8 weeks . Bone strength was measured weekly by quantitative ultrasound measurement of tibial bone speed of sound ( SOS ) . Bone SOS decreased significantly in the control group ( −108.1 ± 33.7 m/second , P < 0.0001 ) during the study period , while remaining stable in the exercise group ( 11.3 ± 22.8 m/second ) . The main beneficial effect of exercise occurred in the first 4 weeks of the intervention . There were no significant differences in the bone turnover marker changes between the groups . There is a significant postnatal decrease in bone SOS in VLBW preterm infants . Eight weeks of assisted range-of-motion exercise attenuates the decrease in bone strength and may decrease the risk of osteopenia in premature infants Preterm delivery ( < 37 weeks post-menstrual age ) is associated with suboptimal bone mass . We hypothesized that tactile/kinesthetic stimulation ( TKS ) , a form of infant massage that incorporates kinesthetic movement , would increase bone strength and markers of bone accretion in preterm infants . Preterm , AGA infants ( 29 - 32 weeks ) were r and omly assigned to TKS ( N=20 ) or Control ( N=20 ) . Twice daily TKS was provided 6 days per week for 2 weeks . Control infants received the same care without TKS treatment . Treatment was masked to parents , health care providers , and study personnel . Baseline and week two measures were collected for tibial speed of sound ( tSOS , m/sec ) , a surrogate for bone strength , by quantitative ultrasound ( Sunlight8000 ) and urine markers of bone metabolism , pyridinium crosslinks and osteocalcin ( U-MidOC and unOC ) . Infant characteristics at birth and study entry as well as energy/nutrient intake were similar between TKS and Control . TKS intervention attenuated the decrease in tSOS observed in Control infants ( p<0.05 ) . 
    Output:
    
agent
Some evidence suggests that physical activity programs might promote short-term weight gain and bone mineralization in preterm infants .
Current evidence does not support the routine use of physical activity programs in preterm infants .
***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 Because recent data on the effects of mineral concentrations in preterm infant formula on bone mineralization are lacking , recommendations for the mineral content of preterm infant formula differ greatly between committees . OBJECTIVE The goal of the study was to assess the effects of an isocaloric , nutrient-enriched preterm formula , which was fed from the age when full enteral feedings were tolerated through expected term , on bone mineralization in preterm infants . DESIGN We conducted a prospect i ve , r and omized , double-blind study in healthy , preterm infants ( gestational age of 28 - 32 wk ) who were fed either a control preterm formula ( n=20 ) or an isocaloric , nutrient-enriched preterm formula ( n=21 ) until 3 mo of age ( ie , approximate expected term ) .  Serum calcium indexes were taken throughout the study , and bone mass was determined by using dual-energy X-ray absorptiometry at hospital discharge and expected term . RESULTS A total of 37 infants ( experimental formula , n=19 ; control formula , n=18 ) completed the study . Compared with control subjects , infants fed the experimental formula had 25 % and 40 % higher intakes of calcium and phosphorus , respectively . Serum calcium , phosphorus , osteocalcin , and alkaline phosphatase concentrations and urinary collagen type I cross-linked N-telopetide concentrations were not significantly different between the groups at any time point . The bone mineral content of infants fed the experimental formula was 23 % ( P=0.039 ) and 35 % ( P=0.002 ) higher at hospital discharge and expected term , respectively . CONCLUSIONS Bone mineralization at hospital discharge and expected term was significantly higher in preterm infants fed the isocaloric , nutrient-enriched formula than in those fed control formula . Continuation of the experimental formula beyond hospital discharge , through expected term , further improved bone mineralization OBJECTIVES Preterm infants are frequently discharged from the hospital growth retarded and show reduced growth throughout childhood . In a large efficacy and safety trial , we tested the hypothesis that nutritional intervention in the first 9 months postterm would reverse postdischarge growth deficits and improve neurodevelopment without adverse safety outcomes . PARTICIPANTS AND INTERVENTION Two hundred eighty-four infants ( mean gestation : 30.9 weeks ) were studied ; 229 were r and omly assigned a  protein , energy , mineral , and micronutrient-enriched postdischarge formula ( PDF ; N = 113 ) or st and ard term formula  ( TF ; N = 116 ) from discharge ( mean 36.5 weeks ' postmenstrual age ) . A reference group ( N = 65 ) was  breastfed until at least 6 weeks ' postterm . Outcome measures . Anthropometry was performed at 6 weeks and 3 , 6 , 9 , and 18 months . Development was measured at 9 months ( Knobloch , Passamanick , and Sherrard 's developmental screening inventory ) and 18 months ( Bayley Scales of Infant Development II ; primary outcome ) postterm . RESULTS At 9 months , compared with the TF group , those fed PDF were heavier ( difference 370 g ; 95 % confidence interval [ CI ] : 84 - 660 ) and longer ( difference 1.1 cm ; 95 % CI : 0.3 - 1.9 ) ; the difference in length persisted at 18 months ( difference 0.82 cm ; 95 % CI : -0.04 - 1.7 ) . There was no effect on head circumference . The effect of diet was greatest in males ; at 9 months length deficit with TF was 1.5 cm ( 95 % CI : 0.3 - 2.7 ) , and this remained at 18 months ( 1.5 cm [ 95 % CI : 0.3 - 2.7 ] ) . There was no significant difference in developmental scores at 9 or 18 months , although PDF infants had a 2.8 ( -1.3 - 6.8 ) point advantage in Bayley motor score scales . At 6 weeks ' postterm , exclusively breastfed infants were already 513 g ( 95 % CI : 310 - 715 ) lighter and 1.6 cm ( 95 % CI : 0.8 - 2.3 ) shorter than the PDF group , and they remained smaller up to 9 months ' postterm . CONCLUSIONS 1 ) Improving postdischarge nutrition in the first 9 months may " reset " subsequent growth-at least until 18 months for body length . We intend to follow-up the children at older ages . The observed efficacy of PDF was not associated with adverse safety outcomes . 2 ) We can not reject the hypothesis that postdischarge nutrition benefits motor development and this requires additional study . 3 ) Our data raise the possibility that breastfed postdischarge preterm infants may require nutritional supplementation , currently under investigation OBJECTIVE : To assess the effect of daily movements on weight gain , serum leptin , and insulin-like growth factor I ( IGF-I ) in premature infants . STUDY DESIGN : Twenty very-low-birth-weight premature infants were matched and r and omized to a daily movement ( n=10 ) and control groups ( n=10 ) . Daily movement consisted of passive range of motion with gentle compression of both the upper and lower extremities 5 days per week for 4 weeks . RESULTS : Daily movements led to a significant increase in weight gain ( 784±51 vs 608±26 g in movements and controls , respectively , p<0.02 ) , and to a significant increase in leptin ( 0.60±0.19 vs 0.13±0.06 ng/ml in movements and controls , respectively , p<0.05 ) . Changes in body weight correlated with changes in serum leptin ( r=0.48 , p<0.03 ) . IGF-I also increased following daily movements ( 18.8±4.1 vs 9.2±4.1 ng/ml in movements and controls , respectively ) ; however , this increase was not statistically significant . CONCLUSION : A relatively brief range of motion daily movement intervention was associated with greater weight gain and increased leptin levels in very-low-birth-weight premature infants . This may suggest that at least part of the daily movements associated with increase in body weight result ed from an increase in adipose tissue Exercise during growth has a positive influence on bone mineral accrual , yet little is known about how bone geometry and strength adapt to loading during growth . Our primary objective was to compare changes in proximal femur bone geometry and strength between 31 prepubertal ( Tanner Stage 1 ) boys who participated in a school-based , high-impact circuit intervention ( 12 min , three times a week ) for 20 months and 33 maturity-matched controls . Our secondary objective was to compare changes in total body ( TB ) , proximal femur ( PF ) , and lumbar spine ( LS ) bone mineral content ( BMC ) and bone area ( BA ) in these groups . We assessed geometric variables and bone strength at the narrow neck ( NN ) , intertrochanteric ( TR ) region , and femoral shaft regions by applying the Hip Structure Analysis program to proximal femur dual energy X-ray absorptiometry scans ( DXA , Hologic QDR 4500 ) . Further , we assessed total body , lumbar spine , and proximal femur BMC and BA by DXA and derived total body lean mass and fat mass from total body scans . Intervention ( 10.2 + /- 0.5 years ) and control boys ( 10.1 + /- 0.5 years ) had similar baseline height ( 140.8 vs. 141.3 cm ) and weight ( 36.9 vs. 35.4 kg ) , and average 20-month physical activity scores ( Physical Activity Question naire for Children , PAQ-C ) and calcium intakes ( 861 vs. 852 mg/day , food frequency question naire ) . Twenty-month height and weight changes were not significantly different between groups ; lean mass changed more ( P < 0.05 ) in intervention boys ( 22.8 % ) than control boys ( 18.6 % ) . At the NN region , intervention boys had greater bone expansion on both the periosteal ( + 2.6 % , P = 0.1 ) and endosteal ( + 2.7 % , P = 0.2 ) surfaces , result ing in significantly greater changes in section modulus ( bone bending strength ) ( + 7.5 % , P = 0.02 , ANCOVA , adjusting for height change , final Tanner Stage , and baseline bone values ) . Changes at the intertrochanteric and femoral shaft regions were not significantly different between groups . Femoral neck ( FN ) BMC changes were significantly greater in intervention boys ( + 4.3 % , P < 0.01 ) ; changes in BA and BMC for other regions were not significantly different between groups . In summary , a school-based , high-impact exercise intervention implemented three times a week for 12 min is an effective strategy for site-specific gains in bone strength at the narrow neck region of the proximal femur Seventy-four infants with birth weights 1009 + /- 28 grams and gestational age 28.6 + /- 0.3 weeks ( M + /- SEM ) were studied prospect ively to test the hypotheses that bone mineral content ( BMC ) measured by photon absorptiometry , would be : ( 1 ) lower in very low birth weight ( VLBW ) infants with radiographic evidence of fractures and /or rickets ( F/R ) , and ( 2 ) will continue to be lower over the first year when compared to VLBW infants without F/R. BMC and bone width ( BW ) of the distal one-third of left radius and ulna were measured at 5 weeks ( n = 8) , 14 weeks ( n = 61 ) , 26 weeks ( n = 58 ) , 40 weeks ( n = 59 ) , and 1 year ( n = 52 ) .  St and ardized radiographs of both forearms , and weight , length , and head circumference were also determined at each study age . Investigators and technicians involved in the photon absorptiometry measurements were unaware of the radiographic findings and vice versa . Twenty-three of 74 infants were found to have F/R. BMC of studied infants remained markedly below our previously determined range of " intrauterine bone mineralization , " even at 26 weeks after birth . There was no significant difference in BMC or BW between infants with and without F/R , either at the time of confirmation of F/R or during early follow-up ; however , BMC was lower at greater than or equal to 6 months and BW was lower at greater than or equal to 9 months in infants with F/R. We suggest that the extremely low BMC measurements in early infancy predispose all VLBW infants to fractures and rickets Studies have previously demonstrated that brief ( 4 weeks ) passive range-of-motion exercise is beneficial for bone development in very low birth weight ( VLBW ) preterm infants . However , the optimal duration of exercise for bone development in preterm infants is yet unknown . The aim of the present study was to examine the effect of 8 weeks of assisted exercise on bone strength and metabolism in VLBW premature infants . Sixteen infants ( mean ± st and ard error of the mean birth weight 1,009 ± 55 g and gestational age 27.3 ± 0.3 weeks ) were r and omly assigned into exercise ( n = 8) and control ( n = 8) groups . The intervention started at the first week of life and involved 8 weeks of daily passive extension and flexion range-of-motion exercise of the upper and lower extremities . Biochemical markers of bone turnover were measured at enrollment and after 8 weeks . Bone strength was measured weekly by quantitative ultrasound measurement of tibial bone speed of sound ( SOS ) . Bone SOS decreased significantly in the control group ( −108.1 ± 33.7 m/second , P < 0.0001 ) during the study period , while remaining stable in the exercise group ( 11.3 ± 22.8 m/second ) . The main beneficial effect of exercise occurred in the first 4 weeks of the intervention . There were no significant differences in the bone turnover marker changes between the groups . There is a significant postnatal decrease in bone SOS in VLBW preterm infants . Eight weeks of assisted range-of-motion exercise attenuates the decrease in bone strength and may decrease the risk of osteopenia in premature infants Preterm delivery ( < 37 weeks post-menstrual age ) is associated with suboptimal bone mass . We hypothesized that tactile/kinesthetic stimulation ( TKS ) , a form of infant massage that incorporates kinesthetic movement , would increase bone strength and markers of bone accretion in preterm infants . Preterm , AGA infants ( 29 - 32 weeks ) were r and omly assigned to TKS ( N=20 ) or Control ( N=20 ) . Twice daily TKS was provided 6 days per week for 2 weeks . Control infants received the same care without TKS treatment . Treatment was masked to parents , health care providers , and study personnel . Baseline and week two measures were collected for tibial speed of sound ( tSOS , m/sec ) , a surrogate for bone strength , by quantitative ultrasound ( Sunlight8000 ) and urine markers of bone metabolism , pyridinium crosslinks and osteocalcin ( U-MidOC and unOC ) . Infant characteristics at birth and study entry as well as energy/nutrient intake were similar between TKS and Control . TKS intervention attenuated the decrease in tSOS observed in Control infants ( p<0.05 ) . 
    Output:
    