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 The association between birthweight and subsequent blood pressure levels  has been considered to provide some of the strongest , and most consistent , support for the " fetal origins " hypothesis of adult disease . It had been estimated that a 1 kg higher birthweight is typically associated with a 2 - 4 mm Hg lower systolic blood pressure . METHODS 55 studies that had reported regression coefficients of systolic blood pressure on birthweight ( with 48 further studies that reported only the direction of this association ) , and seven such studies within twin pairs , were identified . Each study was weighted according to the inverse of the variance of the regression coefficient ( ie , " statistical size " ) , and combined using a " fixed effects " approach . FINDINGS Among the 55 studies that reported regression coefficients , there was a clear trend ( p<0.0001 ) towards weaker associations in the larger studies : -1.9 mm Hg/kg in those with less than about 1000 participants ; -1.5 mm Hg/kg with about 1000 - 3000 participants ; and -0.6 mm Hg/kg with more than 3000 participants . By contrast with the inverse associations reported in 52 of these 55 studies , only 25 of the 48 studies that did not report regression coefficients found an inverse association ( p<0.0001 for heterogeneity ) . Almost all of these regression coefficients had been adjusted for current weight ( whereas few were adjusted for potential confounding factors ) , and removal of this adjustment in the larger studies reduced the estimated association to -0.4 mm Hg/kg . For studies within monozygotic twin pairs , the combined estimate was -0.6 mm Hg/kg with adjustment for current weight , and was also reduced without this adjustment . INTERPRETATION Cl aims of a strong inverse association between birthweight and subsequent blood pressure may chiefly reflect the impact of r and om error , selective emphasis of particular results , and inappropriate adjustment for current weight and for confounding factors . These findings suggest that birthweight is of little relevance to blood pressure levels in later life Our purpose in this study was to examine whole body composition , using dual energy x-ray absorptiometry ( DEXA ) during dietary intervention in preterm infants ( ≤1750 g birthweight , ≤34 wk gestation ) . At discharge , infants were r and omized to be fed either a preterm infant formula ( discharge–6 mo ; group A ) or a term formula ( discharge–6 mo ; group B ) , or the preterm formula ( discharge – term ) and the term formula ( term–6 mo ; group C ) .  Nutrient intake was measured between each clinic visit . To measure body composition , DEXA was used at discharge , term , 12 wk , 6 mo , and 12 mo corrected age . The data were analyzed by ANOVA . At discharge , no differences were noted in patient characteristics between groups A , B , and C. Although energy intakes were similar , protein and mineral intakes differed between groups ( A > C > B;p < 0.0001 ) . During the study , weight gain and LM gain were greater in group A than B. At 12 mo , weight , LM , FM , and BMM but not % FM or BMD were greater in group A than B. However , the effects of diet were confined to boys , with no lasting effects seen in girls . In summary , therefore , DEXA was precise enough to detect differences in whole body composition during dietary intervention . Increased weight gain primarily reflected an increase in LM and is consistent with the idea that the preterm formula more closely met protein and /or protein-energy needs in rapidly growing preterm male infants BACKGROUND Preterm children are at high risk of poor growth performance . In 2 r and omized trials , preterm infants fed preterm formula grew better in the neonatal period than those fed banked donor breast milk or st and ard term formula . OBJECTIVE Our objective was to test the hypothesis that for preterm infants , the neonatal period is a critical one for programming growth performance and that early diet influences long-term growth . DESIGN A total of 926 preterm infants were recruited into 2 parallel , r and omized trials of neonatal diet . In trial 1 , infants were fed either banked donor breast milk or preterm formula whereas in trial 2 , infants were fed either st and ard term formula or preterm formula . Within each trial , the allocated milk was the sole diet for some infants ( study A ) , whereas for others it was a supplement to maternal breast milk , given when not enough expressed breast milk was available ( study B ) . We followed up 781 of 833 survivors ( 94 % ) to age 7.5 - 8 y. Trained assessors obtained anthropometric measurements according to a st and ard protocol . RESULTS Despite significantly better neonatal growth performance in infants fed preterm formula ( compared with either banked donor breast milk or st and ard formula ) , early diet had no influence on weight , height , head circumference , or skinfold thicknesses at 9 or 18 mo postterm or at age 7.5 - 8 y. CONCLUSIONS These findings suggest that the preterm period is not a critical window for nutritional programming of growth , which contrasts with evidence from these trials showing that early diet influences later neurodevelopment The growth , behavior , and protein status of 59 healthy preterm ( mean gestational age 30 wk ) infants fed either human milk or one of three infant formulas were studied post-discharge from the hospital . Formula-fed infants received either a st and ard term formula , a st and ard preterm formula , or an experimental preterm formula from discharge to 8 wk of age . From 8 to 16 wk , all formula-fed infants received the st and ard term formula . At 2 , 8 , and 16 wk , anthropometric , dietary intake , blood biochemistry , amino acid , and Brazelton Neonatal Behavioral Assessment measurements were evaluated . Weights , lengths , and head circumferences were similar for all feeding groups at discharge . After discharge all formula-fed infants were heavier than human milk-fed infants . Length and head circumference values and plasma urea nitrogen and retinol-binding protein concentrations were not different among dietary groups . Formula-fed infants had higher plasma concentrations of numerous amino acids compared with those of human milk-fed infants during the first 8 wk but not at 16 wk . There were no differences among the feeding groups in the Brazelton assessment . This study found little effect on the growth or behavioral or protein status of preterm infants discharged from the hospital who were fed either human milk or formulas design ed for term or preterm infants 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 We have shown that preterm infants fed a preterm formula grow better than those fed a st and ard term infant formula after hospital discharge . The purpose of this follow-up study was to determine whether improved early growth was associated with later growth and development . Preterm infants ( ≤1750 g birth weight , ≤34 wk gestation ) were r and omized to be fed either a preterm infant formula ( discharge to 6 mo corrected age ) , or a term formula ( discharge to 6 mo ) , or the preterm ( discharge to term ) and the term formula  ( term to 6 mo ) . Anthropometry was performed at 12 wk and 6 , 12 , and 18 mo . Mental and psychomotor development were assessed using the Bayley Scales of Infant Development II at 18 mo . Differences in growth observed at 12 wk were maintained at 18 mo . At 18 mo , boys fed the preterm formula were 1.0 kg heavier , 2 cm longer , and had a 1.0 cm greater occipitofrontal circumference than boys fed the term formula . Boys fed the preterm formula were also 600 g heavier and 2 cm longer than girls fed the preterm formula . However , no differences were noted in MDI or PDI between boys fed the preterm formula and boys fed the term formula or between the boys fed preterm formula and girls fed the preterm formula . Overall , boys had significantly lower MDI than girls ( mean difference , 6.0;p < 0.01 ) , primarily reflecting lower scores in boys fed the term formula . Thus , early diet has long-term effects on growth but not development at 18 mo of age . Sex remains an important confounding variable when assessing growth and developmental outcome in these high-risk infants Bone disease with persistent reduced bone mineralisation is common in premature infants . To test the hypothesis that enhancement of nutritional intake after discharge from hospital improves bone mineralisation , 31 formula fed preterm infants were r and omly assigned to receive st and ard or multinutrient enriched milk from the time of discharge . The calcium and phosphorus contents of the enriched milk were 70 and 35 mg/100 ml v 35 and 29 mg/100 ml for the st and ard formula . Bone mineral content was measured before discharge from hospital in 21 of the infants ; there was no difference in the bone mineral content between the groups at that time ( 35 mg/cm for the two groups ) . There was a significant increase in bone mineral content for those infants receiving the enriched v st and ard formula at 3 and 9 months corrected postnatal age : at 3 months the bone mineral content was 83 v 63 mg/cm and at 9 months 115 v 95 mg/cm . The difference between the groups was thus maintained although not increased at a corrected age of 9 months , when the bone mineral content of infants fed the enriched but not the st and ard formula was no longer significantly different from that of normal infants after adjusting for body size . The difference was not explained by the larger body size in infants fed the enriched formula . The results suggest that the use of a special nutrient enriched postdischarge formula has a significant positive effect on bone growth and mineralisation during a period of rapid skeletal development A large multicentre study on the short and long term clinical and developmental outcome of infants r and omised to different diets is being undertaken . This report represents an interim analysis of the early postnatal growth performance of an unselected population of 194 preterm infants ( gestation , mean ( SD ) 31 . 0 ( 2 . 9 ) weeks ; birthweight , mean ( SD ) 1364 ( 294 ) g ) , both ill and well , examined in two ( of four ) parallel trials . One trial compared banked breast milk with a new preterm formula ( primary trial ) ; the other compared these diets as supplements to maternal milk ( supplement trial ) . A major dietary effect on the number of days taken to regain birthweight and subsequent gains in weight , length , and head circumference was observed in the primary trial . Infants fed banked breast milk  and weighing less than 1200 g at birth took a calculated additional three weeks to reach 2000 g compared with those fed on the preterm formula . A significant influence of diet on body proportions was seen in the relation between body weight , head circumference , and length . Similar though smaller differences in growth patterns were seen in the supplement trial . By the time they reach 2000 g , 
    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 The association between birthweight and subsequent blood pressure levels  has been considered to provide some of the strongest , and most consistent , support for the " fetal origins " hypothesis of adult disease . It had been estimated that a 1 kg higher birthweight is typically associated with a 2 - 4 mm Hg lower systolic blood pressure . METHODS 55 studies that had reported regression coefficients of systolic blood pressure on birthweight ( with 48 further studies that reported only the direction of this association ) , and seven such studies within twin pairs , were identified . Each study was weighted according to the inverse of the variance of the regression coefficient ( ie , " statistical size " ) , and combined using a " fixed effects " approach . FINDINGS Among the 55 studies that reported regression coefficients , there was a clear trend ( p<0.0001 ) towards weaker associations in the larger studies : -1.9 mm Hg/kg in those with less than about 1000 participants ; -1.5 mm Hg/kg with about 1000 - 3000 participants ; and -0.6 mm Hg/kg with more than 3000 participants . By contrast with the inverse associations reported in 52 of these 55 studies , only 25 of the 48 studies that did not report regression coefficients found an inverse association ( p<0.0001 for heterogeneity ) . Almost all of these regression coefficients had been adjusted for current weight ( whereas few were adjusted for potential confounding factors ) , and removal of this adjustment in the larger studies reduced the estimated association to -0.4 mm Hg/kg . For studies within monozygotic twin pairs , the combined estimate was -0.6 mm Hg/kg with adjustment for current weight , and was also reduced without this adjustment . INTERPRETATION Cl aims of a strong inverse association between birthweight and subsequent blood pressure may chiefly reflect the impact of r and om error , selective emphasis of particular results , and inappropriate adjustment for current weight and for confounding factors . These findings suggest that birthweight is of little relevance to blood pressure levels in later life Our purpose in this study was to examine whole body composition , using dual energy x-ray absorptiometry ( DEXA ) during dietary intervention in preterm infants ( ≤1750 g birthweight , ≤34 wk gestation ) . At discharge , infants were r and omized to be fed either a preterm infant formula ( discharge–6 mo ; group A ) or a term formula ( discharge–6 mo ; group B ) , or the preterm formula ( discharge – term ) and the term formula ( term–6 mo ; group C ) .  Nutrient intake was measured between each clinic visit . To measure body composition , DEXA was used at discharge , term , 12 wk , 6 mo , and 12 mo corrected age . The data were analyzed by ANOVA . At discharge , no differences were noted in patient characteristics between groups A , B , and C. Although energy intakes were similar , protein and mineral intakes differed between groups ( A > C > B;p < 0.0001 ) . During the study , weight gain and LM gain were greater in group A than B. At 12 mo , weight , LM , FM , and BMM but not % FM or BMD were greater in group A than B. However , the effects of diet were confined to boys , with no lasting effects seen in girls . In summary , therefore , DEXA was precise enough to detect differences in whole body composition during dietary intervention . Increased weight gain primarily reflected an increase in LM and is consistent with the idea that the preterm formula more closely met protein and /or protein-energy needs in rapidly growing preterm male infants BACKGROUND Preterm children are at high risk of poor growth performance . In 2 r and omized trials , preterm infants fed preterm formula grew better in the neonatal period than those fed banked donor breast milk or st and ard term formula . OBJECTIVE Our objective was to test the hypothesis that for preterm infants , the neonatal period is a critical one for programming growth performance and that early diet influences long-term growth . DESIGN A total of 926 preterm infants were recruited into 2 parallel , r and omized trials of neonatal diet . In trial 1 , infants were fed either banked donor breast milk or preterm formula whereas in trial 2 , infants were fed either st and ard term formula or preterm formula . Within each trial , the allocated milk was the sole diet for some infants ( study A ) , whereas for others it was a supplement to maternal breast milk , given when not enough expressed breast milk was available ( study B ) . We followed up 781 of 833 survivors ( 94 % ) to age 7.5 - 8 y. Trained assessors obtained anthropometric measurements according to a st and ard protocol . RESULTS Despite significantly better neonatal growth performance in infants fed preterm formula ( compared with either banked donor breast milk or st and ard formula ) , early diet had no influence on weight , height , head circumference , or skinfold thicknesses at 9 or 18 mo postterm or at age 7.5 - 8 y. CONCLUSIONS These findings suggest that the preterm period is not a critical window for nutritional programming of growth , which contrasts with evidence from these trials showing that early diet influences later neurodevelopment The growth , behavior , and protein status of 59 healthy preterm ( mean gestational age 30 wk ) infants fed either human milk or one of three infant formulas were studied post-discharge from the hospital . Formula-fed infants received either a st and ard term formula , a st and ard preterm formula , or an experimental preterm formula from discharge to 8 wk of age . From 8 to 16 wk , all formula-fed infants received the st and ard term formula . At 2 , 8 , and 16 wk , anthropometric , dietary intake , blood biochemistry , amino acid , and Brazelton Neonatal Behavioral Assessment measurements were evaluated . Weights , lengths , and head circumferences were similar for all feeding groups at discharge . After discharge all formula-fed infants were heavier than human milk-fed infants . Length and head circumference values and plasma urea nitrogen and retinol-binding protein concentrations were not different among dietary groups . Formula-fed infants had higher plasma concentrations of numerous amino acids compared with those of human milk-fed infants during the first 8 wk but not at 16 wk . There were no differences among the feeding groups in the Brazelton assessment . This study found little effect on the growth or behavioral or protein status of preterm infants discharged from the hospital who were fed either human milk or formulas design ed for term or preterm infants 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 We have shown that preterm infants fed a preterm formula grow better than those fed a st and ard term infant formula after hospital discharge . The purpose of this follow-up study was to determine whether improved early growth was associated with later growth and development . Preterm infants ( ≤1750 g birth weight , ≤34 wk gestation ) were r and omized to be fed either a preterm infant formula ( discharge to 6 mo corrected age ) , or a term formula ( discharge to 6 mo ) , or the preterm ( discharge to term ) and the term formula  ( term to 6 mo ) . Anthropometry was performed at 12 wk and 6 , 12 , and 18 mo . Mental and psychomotor development were assessed using the Bayley Scales of Infant Development II at 18 mo . Differences in growth observed at 12 wk were maintained at 18 mo . At 18 mo , boys fed the preterm formula were 1.0 kg heavier , 2 cm longer , and had a 1.0 cm greater occipitofrontal circumference than boys fed the term formula . Boys fed the preterm formula were also 600 g heavier and 2 cm longer than girls fed the preterm formula . However , no differences were noted in MDI or PDI between boys fed the preterm formula and boys fed the term formula or between the boys fed preterm formula and girls fed the preterm formula . Overall , boys had significantly lower MDI than girls ( mean difference , 6.0;p < 0.01 ) , primarily reflecting lower scores in boys fed the term formula . Thus , early diet has long-term effects on growth but not development at 18 mo of age . Sex remains an important confounding variable when assessing growth and developmental outcome in these high-risk infants Bone disease with persistent reduced bone mineralisation is common in premature infants . To test the hypothesis that enhancement of nutritional intake after discharge from hospital improves bone mineralisation , 31 formula fed preterm infants were r and omly assigned to receive st and ard or multinutrient enriched milk from the time of discharge . The calcium and phosphorus contents of the enriched milk were 70 and 35 mg/100 ml v 35 and 29 mg/100 ml for the st and ard formula . Bone mineral content was measured before discharge from hospital in 21 of the infants ; there was no difference in the bone mineral content between the groups at that time ( 35 mg/cm for the two groups ) . There was a significant increase in bone mineral content for those infants receiving the enriched v st and ard formula at 3 and 9 months corrected postnatal age : at 3 months the bone mineral content was 83 v 63 mg/cm and at 9 months 115 v 95 mg/cm . The difference between the groups was thus maintained although not increased at a corrected age of 9 months , when the bone mineral content of infants fed the enriched but not the st and ard formula was no longer significantly different from that of normal infants after adjusting for body size . The difference was not explained by the larger body size in infants fed the enriched formula . The results suggest that the use of a special nutrient enriched postdischarge formula has a significant positive effect on bone growth and mineralisation during a period of rapid skeletal development A large multicentre study on the short and long term clinical and developmental outcome of infants r and omised to different diets is being undertaken . This report represents an interim analysis of the early postnatal growth performance of an unselected population of 194 preterm infants ( gestation , mean ( SD ) 31 . 0 ( 2 . 9 ) weeks ; birthweight , mean ( SD ) 1364 ( 294 ) g ) , both ill and well , examined in two ( of four ) parallel trials . One trial compared banked breast milk with a new preterm formula ( primary trial ) ; the other compared these diets as supplements to maternal milk ( supplement trial ) . A major dietary effect on the number of days taken to regain birthweight and subsequent gains in weight , length , and head circumference was observed in the primary trial . Infants fed banked breast milk  and weighing less than 1200 g at birth took a calculated additional three weeks to reach 2000 g compared with those fed on the preterm formula . A significant influence of diet on body proportions was seen in the relation between body weight , head circumference , and length . Similar though smaller differences in growth patterns were seen in the supplement trial . By the time they reach 2000 g , 
    Output:
    