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 : There is no consensus over best approaches to reliably prevent malnutrition in rural communities in low-income countries . Objective : We compared the effectiveness of 2 lipid-based ready-to-use supplementary foods ( RUSFs ) differing in dairy protein content to improve the nutritional status of mothers and at-risk infants and young children in rural Guinea-Bissau . Methods : A 3-month cluster-r and omized controlled pilot trial of 2 RUSFs was conducted with 692 mothers and 580 mildly or moderately malnourished infants ( 6 - 23 months ) and children ( 24 - 59 months ) from 13 villages . The RUSFs contained either 478 ( mothers , children ) or 239 kcal/d ( infants ) with 15 % or 33 % of protein from dairy and were distributed at community health centers 5 d/wk . Controls were wait-listed to receive RUSF . Primary outcomes were mid-upper arm circumference ( MUAC ) in mothers , and weight-for-age and height-for-age z-scores ( WAZ and HAZ ) in infants and children . Results : There was a significant effect of the RUSF-33 % on MUAC in mothers ( P = .03 ) . The WAZ and HAZ increased substantially , by ≈1 z-score , in infants and children ( P < .01 ) independent of group r and omization . In children , but not infants , baseline WAZ and change in maternal MUAC were associated with change in WAZ ( β = .07 , P = .02 ) . Conclusion : Ready-to-use supplementary foods with higher dairy protein content had a significant benefit in village mothers , supporting a comparable recent finding in preschool children . In addition , supplementation of children < 2 years result ed in improved growth independent of family nutritional status , whereas success in older children was associated with change in maternal nutrition , suggesting the need for community-level education about preventing malnutrition in older , as well as younger , children BACKGROUND Haiti has experienced rapid urbanization that has exacerbated poverty and undernutrition in large slum areas . Stunting affects 1 in 5 young children . OBJECTIVE We aim ed to test the efficacy of a daily lipid-based nutrient supplement ( LNS ) for increased linear growth in  young children . DESIGN Healthy , singleton infants aged 6 - 11 mo ( n = 589 ) were recruited from an urban slum of Cap Haitien and r and omly assigned to receive : 1 ) a control ; 2 ) a 3-mo LNS ; or 3 ) a 6-mo LNS . The LNS provided 108 kcal and other nutrients including vitamin A , vitamin B-12 , iron , and zinc at ≥80 % of the recommended amounts . Infants were followed monthly on growth , morbidity , and developmental outcomes over a 6-mo intervention period and at one additional time point 6 mo postintervention to assess sustained effects . The Bonferroni multiple comparisons test was applied , and generalized least-squares ( GLS ) regressions with mixed effects was used to examine impacts longitudinally . RESULTS Baseline characteristics did not differ by trial arm except for a higher mean age in the 6-mo LNS group . GLS modeling showed LNS supplementation for 6 mo significantly increased the length-for-age z score ( ±SE ) by 0.13 ± 0.05 and the weight-for-age z score by 0.12 ± 0.02 compared with in the control group after adjustment for child age ( P < 0.001 ) . The effects were sustained 6 mo postintervention . Morbidity and developmental outcomes did not differ by trial arm . CONCLUSION A low-energy , fortified product improved the linear growth  of young children in this urban setting . The trial was registered at clinical trials.gov as NCT01552512 In developing countries , prenatal lipid-based nutrient supplements ( LNSs ) were shown to increase birth size ; however , the mechanism of this effect remains unknown . Cord blood hormone concentrations are strongly associated with birth size . Therefore , we hypothesize that LNSs increase birth size through a change in the endocrine regulation of fetal development . We compared the effect of daily prenatal LNSs with multiple micronutrient tablets on cord blood hormone concentrations using a r and omized , controlled design including 197 pregnant women from rural Burkina Faso . Insulin-like growth factors ( IGF ) I and II , their binding proteins IGFBP-1 and IGFBP-3 , leptin , cortisol , and insulin were quantified in cord sera using immunoassays . LNS was associated with higher cord blood leptin mainly in primigravidae ( + 57 % ; P = 0.02 ) and women from the highest tertile of BMI at study inclusion ( + 41 % ; P = 0.02 ) . We did not find any significant LNS effects on other measured cord hormones . The observed increase in cord leptin was associated with a significantly higher birth weight . Cord sera from small-for-gestational age newborns had lower median IGF-I ( -9 μg/L ; P = 0.003 ) , IGF-II ( -79 μg/L ; P = 0.003 ) , IGFBP-3 ( -0.7 μg/L ; P = 0.007 ) , and leptin ( -1.0 μg/L ; P = 0.016 ) concentrations but higher median cortisol ( + 18 μg/L ; P = 0.037 ) concentrations compared with normally grown newborns . Prenatal LNS result ed in increased cord leptin concentrations in primigravidae and mothers with higher BMI at study inclusion . The elevated leptin concentrations could point toward a higher neonatal fat mass Background Previous review s have identified 44 risk factors for poor early child development ( ECD ) in low‐ and middle‐income countries . Further underst and ing of their relative influence and pathways is needed to inform the design of interventions targeting ECD . Methods We conducted path analyses of factors associated with 18‐month language and motor development in four prospect i ve cohorts of children who participated in trials conducted as part of the International Lipid‐Based Nutrient Supplements ( iLiNS ) Project in Ghana ( n = 1,023 ) , Malawi ( n = 675 and 1,385 ) , and Burkina Faso ( n = 1,122 ) . In two cohorts , women were enrolled during pregnancy . In two cohorts , infants were enrolled at 6 or 9 months . In multiple linear regression and structural equation models ( SEM ) , we examined 22 out of 44 factors identified in previous review s , plus 12 additional factors expected to be associated with ECD . Results Out of 42 indicators of the 34 factors examined , 6 were associated with 18‐month language and /or motor development in 3 or 4 cohorts : child linear and ponderal growth , variety of play material s , activities with caregivers , dietary diversity , and child hemoglobin/iron status . Factors that were not associated with child development were indicators of maternal Hb/iron status , maternal illness and inflammation during pregnancy , maternal perceived stress and depression , exclusive breastfeeding during 6 months postpartum , and child diarrhea , fever , malaria , and acute respiratory infections . Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practice s than by maternal or child biomedical conditions , while this pattern for motor development was not consistent across cohorts . Conclusions Key elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children , a variety of play material s , and a diverse diet , and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status Abstract Small‐quantity lipid‐based nutrient supplements ( SQ‐LNS ) are design ed to enrich maternal and child diets with the objective of preventing undernutrition during the first 1,000 days . Scaling up the delivery of supplements such as SQ‐LNS hinges on underst and ing private dem and and creatively leveraging policy‐relevant factors that might influence dem and . We used longitudinal stated willingness‐to‐pay ( WTP ) data from contingent valuation studies that were integrated into r and omized controlled nutrition trials in Ghana and Malawi to estimate private valuation of SQ‐LNS during pregnancy , postpartum , and early childhood . We found that average stated WTP for a day 's supply of SQ‐LNS was more than twice as high in Ghana than Malawi , indicating that dem and for SQ‐LNS ( and by extension , the options for effective delivery of SQ‐LNS ) may be very context specific . We also examined factors associated with WTP , including intervention group , household socioeconomic status , birth outcomes , child growth , and maternal and child morbidity . In both sites , WTP was consistently negatively associated with household food insecurity , indicating that subsidization might be needed to permit food insecure households to acquire SQ‐LNS if it is made available for purchase . In Ghana , WTP was higher among heads of household than among mothers , which may be related to control over household re sources . Personal experience using SQ‐LNS was not associated with WTP in either site Abstract Pregnant and post‐partum women require increased nutrient intake and optimal cognition , which depends on adequate nutrition , to enable reasoning and learning for caregiving . We aim ed to assess ( a ) differences in maternal cognition and caregiving between women in Malawi who received different nutritional supplements , ( b ) 14 effect modifiers , and ( c ) associations of cognition and caregiving with biomarkers of iron , Vitamin A , B‐vitamin , and fatty acid status . In a r and omized controlled trial ( n = 869 ) , pregnant women daily received either multiple micronutrients ( MMN ) , 20 g/day lipid‐based nutrient supplements ( LNS ) , or a control iron/folic acid ( IFA ) tablet . After delivery , supplementation continued in the MMN and LNS arms , and the IFA control group received placebo until 6 months post‐partum , when cognition ( n = 712 ) , caregiving behaviour ( n = 669 ) , and biomarkers of nutritional status ( n = 283 ) were assessed . In the full group , only one difference was significant : the IFA arm scored 0.22 SD ( 95 % CI [ 0.01 , 0.39 ] , p = .03 ) higher than the LNS arm in mental rotation . Among subgroups of women with baseline low hemoglobin , poor iron status , or malaria , those who received LNS scored 0.4 to 0.7 SD higher than the IFA arm in verbal fluency . Breastmilk docosahexaenoic acid and Vitamin B12 concentrations were positively associated with verbal fluency and digit span forward ( adjusting for covariates ps < .05 ) . In this population in Malawi , maternal supplementation with MMN or LNS did not positively affect maternal cognition or caregiving . Maternal docosahexaenoic acid and B12 status may be important for post‐partum attention and executive function Background Supplementing pregnant and lactating mothers with small quantity lipid-based nutrient supplements ( SQ-LNS ) has result ed in improvements in birth outcomes in some low-income setting s. In order to be effective , SQ-LNS must be consumed regularly over sustained periods . Methods The objective was to assess and compare acceptability of and adherence to SQ-LNS consumption among pregnant and lactating women in Ghana and Malawi throughout 12 months of supplementation . We enrolled women before 20 gestation weeks into r and omized trials in Ghana ( n = 1320 ) and Malawi ( n = 869 ) . In the SQ-LNS group participants received a 20 g sachet of supplement per day during pregnancy and the first 6 months of lactation . In the control groups participants received multiple micronutrients ( MMN ) during pregnancy and lactation or iron and folic acid ( IFA ) during pregnancy and calcium during lactation . We used question naires to collect data on self-reported adherence to daily use of supplements and conducted in-depth interviews with women in the SQ-LNS group to examine acceptability . Results The mean self-reported adherence during the supplementation period was lower in Ghana ( 79.9 % ) than in Malawi ( 91.7 % ) for all supplements ( difference 11.8 % , P < 0.001 ) . Over time , adherence increased in Malawi but decreased in Ghana . In both countries , adherence in the SQ-LNS group was non-inferior to that in the control groups . Participants typically reported consuming SQ-LNS as instructed but when interviewers queried about experiences , most of the women described incidents of non-adherence . A usual reason for not consuming SQ-LNS was nausea and vomiting during pregnancy . Especially in Malawi , women reported sharing SQ-LNS with families and friends . Sustained use of  SQ-LNS  was attributed to expected health benefits and favorable sensory attributes . Often women compared their pregnancy to previous ones , and were of the view that SQ-LNS made a positive difference . ConclusionS elf-reported sustained adherence to consume  SQ-LNS  daily was high in both sites but lower in Ghana than in Malawi . In Ghana , adherence decreased over time whereas in Malawi adherence increased . Acceptability and adherence appeared interlinked , complex and context -related . Sustained consumption of SQ-LNS may require tailoring interventions by context .T 
    Output:
    
agent
***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 : There is no consensus over best approaches to reliably prevent malnutrition in rural communities in low-income countries . Objective : We compared the effectiveness of 2 lipid-based ready-to-use supplementary foods ( RUSFs ) differing in dairy protein content to improve the nutritional status of mothers and at-risk infants and young children in rural Guinea-Bissau . Methods : A 3-month cluster-r and omized controlled pilot trial of 2 RUSFs was conducted with 692 mothers and 580 mildly or moderately malnourished infants ( 6 - 23 months ) and children ( 24 - 59 months ) from 13 villages . The RUSFs contained either 478 ( mothers , children ) or 239 kcal/d ( infants ) with 15 % or 33 % of protein from dairy and were distributed at community health centers 5 d/wk . Controls were wait-listed to receive RUSF . Primary outcomes were mid-upper arm circumference ( MUAC ) in mothers , and weight-for-age and height-for-age z-scores ( WAZ and HAZ ) in infants and children . Results : There was a significant effect of the RUSF-33 % on MUAC in mothers ( P = .03 ) . The WAZ and HAZ increased substantially , by ≈1 z-score , in infants and children ( P < .01 ) independent of group r and omization . In children , but not infants , baseline WAZ and change in maternal MUAC were associated with change in WAZ ( β = .07 , P = .02 ) . Conclusion : Ready-to-use supplementary foods with higher dairy protein content had a significant benefit in village mothers , supporting a comparable recent finding in preschool children . In addition , supplementation of children < 2 years result ed in improved growth independent of family nutritional status , whereas success in older children was associated with change in maternal nutrition , suggesting the need for community-level education about preventing malnutrition in older , as well as younger , children BACKGROUND Haiti has experienced rapid urbanization that has exacerbated poverty and undernutrition in large slum areas . Stunting affects 1 in 5 young children . OBJECTIVE We aim ed to test the efficacy of a daily lipid-based nutrient supplement ( LNS ) for increased linear growth in  young children . DESIGN Healthy , singleton infants aged 6 - 11 mo ( n = 589 ) were recruited from an urban slum of Cap Haitien and r and omly assigned to receive : 1 ) a control ; 2 ) a 3-mo LNS ; or 3 ) a 6-mo LNS . The LNS provided 108 kcal and other nutrients including vitamin A , vitamin B-12 , iron , and zinc at ≥80 % of the recommended amounts . Infants were followed monthly on growth , morbidity , and developmental outcomes over a 6-mo intervention period and at one additional time point 6 mo postintervention to assess sustained effects . The Bonferroni multiple comparisons test was applied , and generalized least-squares ( GLS ) regressions with mixed effects was used to examine impacts longitudinally . RESULTS Baseline characteristics did not differ by trial arm except for a higher mean age in the 6-mo LNS group . GLS modeling showed LNS supplementation for 6 mo significantly increased the length-for-age z score ( ±SE ) by 0.13 ± 0.05 and the weight-for-age z score by 0.12 ± 0.02 compared with in the control group after adjustment for child age ( P < 0.001 ) . The effects were sustained 6 mo postintervention . Morbidity and developmental outcomes did not differ by trial arm . CONCLUSION A low-energy , fortified product improved the linear growth  of young children in this urban setting . The trial was registered at clinical trials.gov as NCT01552512 In developing countries , prenatal lipid-based nutrient supplements ( LNSs ) were shown to increase birth size ; however , the mechanism of this effect remains unknown . Cord blood hormone concentrations are strongly associated with birth size . Therefore , we hypothesize that LNSs increase birth size through a change in the endocrine regulation of fetal development . We compared the effect of daily prenatal LNSs with multiple micronutrient tablets on cord blood hormone concentrations using a r and omized , controlled design including 197 pregnant women from rural Burkina Faso . Insulin-like growth factors ( IGF ) I and II , their binding proteins IGFBP-1 and IGFBP-3 , leptin , cortisol , and insulin were quantified in cord sera using immunoassays . LNS was associated with higher cord blood leptin mainly in primigravidae ( + 57 % ; P = 0.02 ) and women from the highest tertile of BMI at study inclusion ( + 41 % ; P = 0.02 ) . We did not find any significant LNS effects on other measured cord hormones . The observed increase in cord leptin was associated with a significantly higher birth weight . Cord sera from small-for-gestational age newborns had lower median IGF-I ( -9 μg/L ; P = 0.003 ) , IGF-II ( -79 μg/L ; P = 0.003 ) , IGFBP-3 ( -0.7 μg/L ; P = 0.007 ) , and leptin ( -1.0 μg/L ; P = 0.016 ) concentrations but higher median cortisol ( + 18 μg/L ; P = 0.037 ) concentrations compared with normally grown newborns . Prenatal LNS result ed in increased cord leptin concentrations in primigravidae and mothers with higher BMI at study inclusion . The elevated leptin concentrations could point toward a higher neonatal fat mass Background Previous review s have identified 44 risk factors for poor early child development ( ECD ) in low‐ and middle‐income countries . Further underst and ing of their relative influence and pathways is needed to inform the design of interventions targeting ECD . Methods We conducted path analyses of factors associated with 18‐month language and motor development in four prospect i ve cohorts of children who participated in trials conducted as part of the International Lipid‐Based Nutrient Supplements ( iLiNS ) Project in Ghana ( n = 1,023 ) , Malawi ( n = 675 and 1,385 ) , and Burkina Faso ( n = 1,122 ) . In two cohorts , women were enrolled during pregnancy . In two cohorts , infants were enrolled at 6 or 9 months . In multiple linear regression and structural equation models ( SEM ) , we examined 22 out of 44 factors identified in previous review s , plus 12 additional factors expected to be associated with ECD . Results Out of 42 indicators of the 34 factors examined , 6 were associated with 18‐month language and /or motor development in 3 or 4 cohorts : child linear and ponderal growth , variety of play material s , activities with caregivers , dietary diversity , and child hemoglobin/iron status . Factors that were not associated with child development were indicators of maternal Hb/iron status , maternal illness and inflammation during pregnancy , maternal perceived stress and depression , exclusive breastfeeding during 6 months postpartum , and child diarrhea , fever , malaria , and acute respiratory infections . Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practice s than by maternal or child biomedical conditions , while this pattern for motor development was not consistent across cohorts . Conclusions Key elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children , a variety of play material s , and a diverse diet , and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status Abstract Small‐quantity lipid‐based nutrient supplements ( SQ‐LNS ) are design ed to enrich maternal and child diets with the objective of preventing undernutrition during the first 1,000 days . Scaling up the delivery of supplements such as SQ‐LNS hinges on underst and ing private dem and and creatively leveraging policy‐relevant factors that might influence dem and . We used longitudinal stated willingness‐to‐pay ( WTP ) data from contingent valuation studies that were integrated into r and omized controlled nutrition trials in Ghana and Malawi to estimate private valuation of SQ‐LNS during pregnancy , postpartum , and early childhood . We found that average stated WTP for a day 's supply of SQ‐LNS was more than twice as high in Ghana than Malawi , indicating that dem and for SQ‐LNS ( and by extension , the options for effective delivery of SQ‐LNS ) may be very context specific . We also examined factors associated with WTP , including intervention group , household socioeconomic status , birth outcomes , child growth , and maternal and child morbidity . In both sites , WTP was consistently negatively associated with household food insecurity , indicating that subsidization might be needed to permit food insecure households to acquire SQ‐LNS if it is made available for purchase . In Ghana , WTP was higher among heads of household than among mothers , which may be related to control over household re sources . Personal experience using SQ‐LNS was not associated with WTP in either site Abstract Pregnant and post‐partum women require increased nutrient intake and optimal cognition , which depends on adequate nutrition , to enable reasoning and learning for caregiving . We aim ed to assess ( a ) differences in maternal cognition and caregiving between women in Malawi who received different nutritional supplements , ( b ) 14 effect modifiers , and ( c ) associations of cognition and caregiving with biomarkers of iron , Vitamin A , B‐vitamin , and fatty acid status . In a r and omized controlled trial ( n = 869 ) , pregnant women daily received either multiple micronutrients ( MMN ) , 20 g/day lipid‐based nutrient supplements ( LNS ) , or a control iron/folic acid ( IFA ) tablet . After delivery , supplementation continued in the MMN and LNS arms , and the IFA control group received placebo until 6 months post‐partum , when cognition ( n = 712 ) , caregiving behaviour ( n = 669 ) , and biomarkers of nutritional status ( n = 283 ) were assessed . In the full group , only one difference was significant : the IFA arm scored 0.22 SD ( 95 % CI [ 0.01 , 0.39 ] , p = .03 ) higher than the LNS arm in mental rotation . Among subgroups of women with baseline low hemoglobin , poor iron status , or malaria , those who received LNS scored 0.4 to 0.7 SD higher than the IFA arm in verbal fluency . Breastmilk docosahexaenoic acid and Vitamin B12 concentrations were positively associated with verbal fluency and digit span forward ( adjusting for covariates ps < .05 ) . In this population in Malawi , maternal supplementation with MMN or LNS did not positively affect maternal cognition or caregiving . Maternal docosahexaenoic acid and B12 status may be important for post‐partum attention and executive function Background Supplementing pregnant and lactating mothers with small quantity lipid-based nutrient supplements ( SQ-LNS ) has result ed in improvements in birth outcomes in some low-income setting s. In order to be effective , SQ-LNS must be consumed regularly over sustained periods . Methods The objective was to assess and compare acceptability of and adherence to SQ-LNS consumption among pregnant and lactating women in Ghana and Malawi throughout 12 months of supplementation . We enrolled women before 20 gestation weeks into r and omized trials in Ghana ( n = 1320 ) and Malawi ( n = 869 ) . In the SQ-LNS group participants received a 20 g sachet of supplement per day during pregnancy and the first 6 months of lactation . In the control groups participants received multiple micronutrients ( MMN ) during pregnancy and lactation or iron and folic acid ( IFA ) during pregnancy and calcium during lactation . We used question naires to collect data on self-reported adherence to daily use of supplements and conducted in-depth interviews with women in the SQ-LNS group to examine acceptability . Results The mean self-reported adherence during the supplementation period was lower in Ghana ( 79.9 % ) than in Malawi ( 91.7 % ) for all supplements ( difference 11.8 % , P < 0.001 ) . Over time , adherence increased in Malawi but decreased in Ghana . In both countries , adherence in the SQ-LNS group was non-inferior to that in the control groups . Participants typically reported consuming SQ-LNS as instructed but when interviewers queried about experiences , most of the women described incidents of non-adherence . A usual reason for not consuming SQ-LNS was nausea and vomiting during pregnancy . Especially in Malawi , women reported sharing SQ-LNS with families and friends . Sustained use of  SQ-LNS  was attributed to expected health benefits and favorable sensory attributes . Often women compared their pregnancy to previous ones , and were of the view that SQ-LNS made a positive difference . ConclusionS elf-reported sustained adherence to consume  SQ-LNS  daily was high in both sites but lower in Ghana than in Malawi . In Ghana , adherence decreased over time whereas in Malawi adherence increased . Acceptability and adherence appeared interlinked , complex and context -related . Sustained consumption of SQ-LNS may require tailoring interventions by context .T 
    Output:
    