human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To examine the associations of duration of exclusive breastfeeding with infections in the upper respiratory ( URTI ) , lower respiratory ( LRTI ) , and gastrointestinal tracts ( GI ) in infancy . METHODS : This study was embedded in the Generation R Study , a population -based prospect i ve cohort study from fetal life onward in the Netherl and s. Rates of breastfeeding during the first 6 months ( never ; partial for < 4 months , not thereafter ; partial for 4–6 months ; exclusive for 4 months , not thereafter ; exclusive for 4 months , partial thereafter ; and exclusive for 6 months ) and doctor-attended infections in the URTI , LRTI , and GI until the age of 12 months were assessed by question naires and available for 4164 subjects . RESULTS : Compared with never-breastfed infants , those who were breastfed exclusively until the age of 4 months and partially thereafter had lower risks of infections in the URTI , LRTI , and GI until the age of 6 months ( adjusted odds ratio [ aOR ] : 0.65 [ 95 % confidence interval ( CI ) : 0.51–0.83 ] ; aOR : 0.50 [ CI : 0.32–0.79 ] ; and aOR : 0.41 [ CI : 0.26–0.64 ] , respectively ) and of LRTI infections between the ages of 7 and 12 months ( aOR : 0.46 [ CI : 0.31–0.69 ] ) . Similar tendencies were observed for infants who were exclusively breastfed for 6 months or longer . Partial breastfeeding , even for 6 months , did not result in significantly lower risks of these infections . CONCLUSIONS : Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants . Our findings support health-policy strategies to promote exclusive breastfeeding for at least 4 months , but preferably 6 months , in industrialized countries Objective To assess whether exclusive and prolonged breast feeding reduces the risk of childhood asthma and allergy by age 6.5 years . Design Cluster r and omised trial . Setting 31 Belarussian maternity hospitals and their affiliated polyclinics . Participants A total of 17 046 mother-infant pairs were enrolled , of whom 13 889 ( 81.5 % ) were followed up at age 6.5 years . Intervention Breastfeeding promotion intervention modelled on the WHO/UNICEF baby friendly hospital initiative . Main outcome measures International study of asthma and allergies in childhood ( ISAAC ) question naire and skin prick tests of five inhalant antigens . Results The experimental intervention led to a large increase in exclusive breast feeding at 3 months ( 44.3 % v 6.4 % ; P<0.001 ) and a significantly higher prevalence of any breast feeding at all ages up to and including 12 months . The experimental group had no reduction in risks of allergic symptoms and diagnoses or positive skin prick tests . In fact , after exclusion of six sites ( three experimental and three control ) with suspiciously high rates of positive skin prick tests , risks were significantly increased in the experimental group for four of the five antigens . Conclusions These results do not support a protective effect of prolonged and exclusive breast feeding on asthma or allergy . Trial registration Current Controlled Trials IS RCT N37687716 CONTEXT The evidence that breastfeeding improves cognitive development is based almost entirely on observational studies and is thus prone to confounding by subtle behavioral differences in the breastfeeding mother 's behavior or her interaction with the infant . OBJECTIVE To assess whether prolonged and exclusive breastfeeding improves children 's cognitive ability at age 6.5 years . DESIGN Cluster-r and omized trial , with enrollment from June 17 , 1996 , to December 31 , 1997 , and follow-up from December 21 , 2002 , to April 27 , 2005 . SETTING Thirty-one Belarussian maternity hospitals and their affiliated polyclinics . PARTICIPANTS A total of 17,046 healthy breastfeeding infants were enrolled , of whom 13,889 ( 81.5 % ) were followed up at age 6.5 years . INTERVENTION Breastfeeding promotion intervention modeled on the Baby-Friendly Hospital Initiative by the World Health Organization and UNICEF . MAIN OUTCOME MEASURES Subtest and IQ scores on the Wechsler Abbreviated Scales of Intelligence , and teacher evaluations of academic performance in reading , writing , mathematics , and other subjects . RESULTS The experimental intervention led to a large increase in exclusive breastfeeding at age 3 months ( 43.3 % for the experimental group vs 6.4 % for the control group ; P < .001 ) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months . The experimental group had higher means on all of the Wechsler Abbreviated Scales of Intelligence measures , with cluster-adjusted mean differences ( 95 % confidence intervals ) of + 7.5 ( + 0.8 to + 14.3 ) for verbal IQ , + 2.9 ( -3.3 to + 9.1 ) for performance IQ , and + 5.9 ( -1.0 to + 12.8 ) for full-scale IQ . Teachers ' academic ratings were significantly higher in the experimental group for both reading and writing . CONCLUSION These results , based on the largest r and omized trial ever conducted in the area of human lactation , provide strong evidence that prolonged and exclusive breastfeeding improves children 's cognitive development . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N37687716 Abstract Objectives : To investigate the association between the duration of exclusive breast feeding and the development of  asthma related outcomes in children at age 6 years . Design : Prospect i ve cohort study . Setting : Western Australia . Subjects : 2187 children ascertained through antenatal clinics at the major tertiary obstetric hospital in Perth and followed to age 6 years . Main outcome measures : Unconditional logistic regression to model the association between duration of exclusive breast feeding and outcomes related to asthma or atopy at 6 years of age , allowing for several important confounders : sex , gestational age , smoking in the household , and early childcare . Results : After adjustment for confounders , the introduction of milk other than breast milk before 4 months of age was a significant risk factor for all asthma and atopy related outcomes in children aged 6 years : asthma diagnosed by a doctor ( odds ratio 1.25 , 95 % confidence interval 1.02 to 1.52 ) ; wheeze three or more times since 1 year of age ( 1.41 , 1.14 to 1.76 ) ; wheeze in the past year ( 1.31 , 1.05 to 1.64 ) ; sleep disturbance due to wheeze within the past year ( 1.42 , 1.07 to 1.89 ) ; age when doctor diagnosed asthma ( hazard ratio 1.22 , 1.03 to 1.43 ) ; age at first wheeze ( 1.36 , 1.17 to 1.59 ) ; and positive skin prick test reaction to at least one common aeroallergen ( 1.30 , 1.04 to 1.61 ) . Conclusion : A significant reduction in the risk of childhood asthma at age 6 years occurs if exclusive breast feeding is continued for at least the 4 months after birth . These findings are important for our underst and ing of the cause of childhood asthma and suggest that public health interventions to optimise breast feeding may help to reduce the community burden of childhood asthma and its associated traits . Key messages Asthma is the leading cause of admission to hospital in Australian children and its prevalence is increasing Whether breast feeding protects against asthma or atopy , or both , is controversial Asthma is a complex disease , and the relative risks between breast feeding and asthma or atopy are unlikely to be large ; this suggests the need for investigation in a large prospect i ve birth cohort with timely assessment of atopic outcomes and all relevant exposures Exclusive breast feeding for at least 4 months is associated with a significant reduction in the risk of asthma and atopy at age 6 years and with a significant delay in the age at onset of wheezing and asthma being diagnosed by a doctor Public health interventions to promote an increased duration of exclusive breast feeding may help to reduce the morbidity and prevalence of childhood asthma  and Objective : Early supplementation of breastfed infants may have consequences both for the mother and the child . We hypothesised that it would result in decreased maternal weight loss and in shorter duration s of breastfeeding and birth intervals . Design : Controlled r and omised population -based trial . Setting : Six villages in the Sine area of Senegal , West Africa . Subjects : Healthy breastfed infants and their mothers , 68 controls and 66 supplemented infants at r and omization . Intervention : Supplementation with high-energy , nutrient dense food from 4 to 7 months of age , twice daily under supervision of field workers . Both controls and supplemented infants were free to eat other complementary foods .  Maternal weight was measured monthly . Date s of breastfeeding cessation and of subsequent births were collected prospect ively through weekly demographic surveillance , and were analysed using Cox 's regression models and ‘ intent-to-supplement ’ approach . Results : Mean maternal weight gain from 4 to 7 months postpartum tended to be greater in the supplemented group ( + 0.25 kg/months , 95 % confidence interval ( CI ) : −0.07 , + 0.57 ) . Supplemented infants were breastfed for significantly longer duration s than controls ( medians : 24.9 and 23.7 months , respectively , P : 0.034 ) . Their adjusted hazard ratio ( HR ) for breastfeeding cessation was 0.59 ( 95 % CI : 0.40 , 0.89 ) . Their mothers had a lower risk of a new birth than mothers of controls ( adjusted HR : 0.57 , 95 % CI : 0.36 , 0.92 ) . Conclusions : Early short-term infant supplementation tended to decrease maternal postpartum weight loss , but it increased , rather than shortened , the duration of breastfeeding and birth interval . Sponsorship : This study was supported by a grant from the French Ministry of Research ( Grant 92L0623 ) To examine whether the duration of exclusive breastfeeding affects maternal nutrition or infant motor development , we examined data from two studies in Honduras : the first with 141 infants of low-income primiparous women and the second with 119 term , low birth weight infants . In both studies , infants were exclusively breastfed for 4 mo and then r and omly assigned to continue exclusive breastfeeding ( EBF ) until 6 mo or to receive high- quality , hygienic solid foods ( SF ) in addition to breast milk between 4 and 6 mo .  Maternal weight loss between 4 and 6 mo was significantly greater in the exclusive breastfeeding group ( EBF ) group than in the group(s ) given solid foods ( SF ) in study 1 ( -0.7 + /- 1.5 versus -0.1 + /- 1.7 kg , P < 0.05 ) but not in study 2 . The estimated average additional nutritional burden of continuing to exclusively breastfeed until 6 mo was small , representing only 0.1 - 6.0 % of the recommended dietary allowance for energy , vitamin A , calcium and iron . Women in the EBF group were more likely to be amenorrheic at 6 mo than women in the SF group , which conserves nutrients such as iron . In both studies , few women ( 10 - 11 % ) were thin ( body mass index < 19 kg/m(2 ) ) , so the additional weight loss in the EBF group in study 1 was unlikely to have been detrimental . Infants in the EBF group crawled sooner ( both studies ) and were more likely to be walking by 12 mo ( study 1 ) than infants in the SF group . Taken together with our previous findings , these results indicate that the advantages of exclusive breastfeeding during this interval appear to outweigh any potential disadvantages in this setting BACKGROUND Opinions and recommendations about the optimal duration of exclusive breastfeeding have been strongly divided , but few published studies have provided direct evidence on the relative risks and benefits of different breastfeeding duration s in recipient infants . OBJECTIVE We examined the effects on  infant growth and health of 3 compared with 6 mo of exclusive breastfeeding . DESIGN We conducted an observational cohort study nested within a large r and omized trial in Belarus by comparing 2862 infants exclusively breastfed for 3 mo ( with continued mixed breastfeeding through > /= 6 mo ) with 621 infants who were exclusively breastfed for > /= 6 mo .  Regression to the mean , within-cluster correlation , and cluster- and individual-level confounding variables were accounted for by using multilevel regression analyses . RESULTS From 3 to 6 mo , weight gain was slightly greater in the 3-mo group [ difference : 29 g/mo ( 95 % CI : 13 , 45 g/mo ) ] , as was length gain [ difference : 1.1 mm ( 0.5 , 1.6 mm ) ] , but the 6-mo group had a faster length gain from 9 to 12 mo [ difference : 0.9 mm/mo ( 0.3 , 1.5 mm/mo ) ] and a larger head circumference at 12 mo [ difference : 0.19 cm ( 0.07 , 0.3 
    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: OBJECTIVE : To examine the associations of duration of exclusive breastfeeding with infections in the upper respiratory ( URTI ) , lower respiratory ( LRTI ) , and gastrointestinal tracts ( GI ) in infancy . METHODS : This study was embedded in the Generation R Study , a population -based prospect i ve cohort study from fetal life onward in the Netherl and s. Rates of breastfeeding during the first 6 months ( never ; partial for < 4 months , not thereafter ; partial for 4–6 months ; exclusive for 4 months , not thereafter ; exclusive for 4 months , partial thereafter ; and exclusive for 6 months ) and doctor-attended infections in the URTI , LRTI , and GI until the age of 12 months were assessed by question naires and available for 4164 subjects . RESULTS : Compared with never-breastfed infants , those who were breastfed exclusively until the age of 4 months and partially thereafter had lower risks of infections in the URTI , LRTI , and GI until the age of 6 months ( adjusted odds ratio [ aOR ] : 0.65 [ 95 % confidence interval ( CI ) : 0.51–0.83 ] ; aOR : 0.50 [ CI : 0.32–0.79 ] ; and aOR : 0.41 [ CI : 0.26–0.64 ] , respectively ) and of LRTI infections between the ages of 7 and 12 months ( aOR : 0.46 [ CI : 0.31–0.69 ] ) . Similar tendencies were observed for infants who were exclusively breastfed for 6 months or longer . Partial breastfeeding , even for 6 months , did not result in significantly lower risks of these infections . CONCLUSIONS : Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants . Our findings support health-policy strategies to promote exclusive breastfeeding for at least 4 months , but preferably 6 months , in industrialized countries Objective To assess whether exclusive and prolonged breast feeding reduces the risk of childhood asthma and allergy by age 6.5 years . Design Cluster r and omised trial . Setting 31 Belarussian maternity hospitals and their affiliated polyclinics . Participants A total of 17 046 mother-infant pairs were enrolled , of whom 13 889 ( 81.5 % ) were followed up at age 6.5 years . Intervention Breastfeeding promotion intervention modelled on the WHO/UNICEF baby friendly hospital initiative . Main outcome measures International study of asthma and allergies in childhood ( ISAAC ) question naire and skin prick tests of five inhalant antigens . Results The experimental intervention led to a large increase in exclusive breast feeding at 3 months ( 44.3 % v 6.4 % ; P<0.001 ) and a significantly higher prevalence of any breast feeding at all ages up to and including 12 months . The experimental group had no reduction in risks of allergic symptoms and diagnoses or positive skin prick tests . In fact , after exclusion of six sites ( three experimental and three control ) with suspiciously high rates of positive skin prick tests , risks were significantly increased in the experimental group for four of the five antigens . Conclusions These results do not support a protective effect of prolonged and exclusive breast feeding on asthma or allergy . Trial registration Current Controlled Trials IS RCT N37687716 CONTEXT The evidence that breastfeeding improves cognitive development is based almost entirely on observational studies and is thus prone to confounding by subtle behavioral differences in the breastfeeding mother 's behavior or her interaction with the infant . OBJECTIVE To assess whether prolonged and exclusive breastfeeding improves children 's cognitive ability at age 6.5 years . DESIGN Cluster-r and omized trial , with enrollment from June 17 , 1996 , to December 31 , 1997 , and follow-up from December 21 , 2002 , to April 27 , 2005 . SETTING Thirty-one Belarussian maternity hospitals and their affiliated polyclinics . PARTICIPANTS A total of 17,046 healthy breastfeeding infants were enrolled , of whom 13,889 ( 81.5 % ) were followed up at age 6.5 years . INTERVENTION Breastfeeding promotion intervention modeled on the Baby-Friendly Hospital Initiative by the World Health Organization and UNICEF . MAIN OUTCOME MEASURES Subtest and IQ scores on the Wechsler Abbreviated Scales of Intelligence , and teacher evaluations of academic performance in reading , writing , mathematics , and other subjects . RESULTS The experimental intervention led to a large increase in exclusive breastfeeding at age 3 months ( 43.3 % for the experimental group vs 6.4 % for the control group ; P < .001 ) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months . The experimental group had higher means on all of the Wechsler Abbreviated Scales of Intelligence measures , with cluster-adjusted mean differences ( 95 % confidence intervals ) of + 7.5 ( + 0.8 to + 14.3 ) for verbal IQ , + 2.9 ( -3.3 to + 9.1 ) for performance IQ , and + 5.9 ( -1.0 to + 12.8 ) for full-scale IQ . Teachers ' academic ratings were significantly higher in the experimental group for both reading and writing . CONCLUSION These results , based on the largest r and omized trial ever conducted in the area of human lactation , provide strong evidence that prolonged and exclusive breastfeeding improves children 's cognitive development . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N37687716 Abstract Objectives : To investigate the association between the duration of exclusive breast feeding and the development of  asthma related outcomes in children at age 6 years . Design : Prospect i ve cohort study . Setting : Western Australia . Subjects : 2187 children ascertained through antenatal clinics at the major tertiary obstetric hospital in Perth and followed to age 6 years . Main outcome measures : Unconditional logistic regression to model the association between duration of exclusive breast feeding and outcomes related to asthma or atopy at 6 years of age , allowing for several important confounders : sex , gestational age , smoking in the household , and early childcare . Results : After adjustment for confounders , the introduction of milk other than breast milk before 4 months of age was a significant risk factor for all asthma and atopy related outcomes in children aged 6 years : asthma diagnosed by a doctor ( odds ratio 1.25 , 95 % confidence interval 1.02 to 1.52 ) ; wheeze three or more times since 1 year of age ( 1.41 , 1.14 to 1.76 ) ; wheeze in the past year ( 1.31 , 1.05 to 1.64 ) ; sleep disturbance due to wheeze within the past year ( 1.42 , 1.07 to 1.89 ) ; age when doctor diagnosed asthma ( hazard ratio 1.22 , 1.03 to 1.43 ) ; age at first wheeze ( 1.36 , 1.17 to 1.59 ) ; and positive skin prick test reaction to at least one common aeroallergen ( 1.30 , 1.04 to 1.61 ) . Conclusion : A significant reduction in the risk of childhood asthma at age 6 years occurs if exclusive breast feeding is continued for at least the 4 months after birth . These findings are important for our underst and ing of the cause of childhood asthma and suggest that public health interventions to optimise breast feeding may help to reduce the community burden of childhood asthma and its associated traits . Key messages Asthma is the leading cause of admission to hospital in Australian children and its prevalence is increasing Whether breast feeding protects against asthma or atopy , or both , is controversial Asthma is a complex disease , and the relative risks between breast feeding and asthma or atopy are unlikely to be large ; this suggests the need for investigation in a large prospect i ve birth cohort with timely assessment of atopic outcomes and all relevant exposures Exclusive breast feeding for at least 4 months is associated with a significant reduction in the risk of asthma and atopy at age 6 years and with a significant delay in the age at onset of wheezing and asthma being diagnosed by a doctor Public health interventions to promote an increased duration of exclusive breast feeding may help to reduce the morbidity and prevalence of childhood asthma  and Objective : Early supplementation of breastfed infants may have consequences both for the mother and the child . We hypothesised that it would result in decreased maternal weight loss and in shorter duration s of breastfeeding and birth intervals . Design : Controlled r and omised population -based trial . Setting : Six villages in the Sine area of Senegal , West Africa . Subjects : Healthy breastfed infants and their mothers , 68 controls and 66 supplemented infants at r and omization . Intervention : Supplementation with high-energy , nutrient dense food from 4 to 7 months of age , twice daily under supervision of field workers . Both controls and supplemented infants were free to eat other complementary foods .  Maternal weight was measured monthly . Date s of breastfeeding cessation and of subsequent births were collected prospect ively through weekly demographic surveillance , and were analysed using Cox 's regression models and ‘ intent-to-supplement ’ approach . Results : Mean maternal weight gain from 4 to 7 months postpartum tended to be greater in the supplemented group ( + 0.25 kg/months , 95 % confidence interval ( CI ) : −0.07 , + 0.57 ) . Supplemented infants were breastfed for significantly longer duration s than controls ( medians : 24.9 and 23.7 months , respectively , P : 0.034 ) . Their adjusted hazard ratio ( HR ) for breastfeeding cessation was 0.59 ( 95 % CI : 0.40 , 0.89 ) . Their mothers had a lower risk of a new birth than mothers of controls ( adjusted HR : 0.57 , 95 % CI : 0.36 , 0.92 ) . Conclusions : Early short-term infant supplementation tended to decrease maternal postpartum weight loss , but it increased , rather than shortened , the duration of breastfeeding and birth interval . Sponsorship : This study was supported by a grant from the French Ministry of Research ( Grant 92L0623 ) To examine whether the duration of exclusive breastfeeding affects maternal nutrition or infant motor development , we examined data from two studies in Honduras : the first with 141 infants of low-income primiparous women and the second with 119 term , low birth weight infants . In both studies , infants were exclusively breastfed for 4 mo and then r and omly assigned to continue exclusive breastfeeding ( EBF ) until 6 mo or to receive high- quality , hygienic solid foods ( SF ) in addition to breast milk between 4 and 6 mo .  Maternal weight loss between 4 and 6 mo was significantly greater in the exclusive breastfeeding group ( EBF ) group than in the group(s ) given solid foods ( SF ) in study 1 ( -0.7 + /- 1.5 versus -0.1 + /- 1.7 kg , P < 0.05 ) but not in study 2 . The estimated average additional nutritional burden of continuing to exclusively breastfeed until 6 mo was small , representing only 0.1 - 6.0 % of the recommended dietary allowance for energy , vitamin A , calcium and iron . Women in the EBF group were more likely to be amenorrheic at 6 mo than women in the SF group , which conserves nutrients such as iron . In both studies , few women ( 10 - 11 % ) were thin ( body mass index < 19 kg/m(2 ) ) , so the additional weight loss in the EBF group in study 1 was unlikely to have been detrimental . Infants in the EBF group crawled sooner ( both studies ) and were more likely to be walking by 12 mo ( study 1 ) than infants in the SF group . Taken together with our previous findings , these results indicate that the advantages of exclusive breastfeeding during this interval appear to outweigh any potential disadvantages in this setting BACKGROUND Opinions and recommendations about the optimal duration of exclusive breastfeeding have been strongly divided , but few published studies have provided direct evidence on the relative risks and benefits of different breastfeeding duration s in recipient infants . OBJECTIVE We examined the effects on  infant growth and health of 3 compared with 6 mo of exclusive breastfeeding . DESIGN We conducted an observational cohort study nested within a large r and omized trial in Belarus by comparing 2862 infants exclusively breastfed for 3 mo ( with continued mixed breastfeeding through > /= 6 mo ) with 621 infants who were exclusively breastfed for > /= 6 mo .  Regression to the mean , within-cluster correlation , and cluster- and individual-level confounding variables were accounted for by using multilevel regression analyses . RESULTS From 3 to 6 mo , weight gain was slightly greater in the 3-mo group [ difference : 29 g/mo ( 95 % CI : 13 , 45 g/mo ) ] , as was length gain [ difference : 1.1 mm ( 0.5 , 1.6 mm ) ] , but the 6-mo group had a faster length gain from 9 to 12 mo [ difference : 0.9 mm/mo ( 0.3 , 1.5 mm/mo ) ] and a larger head circumference at 12 mo [ difference : 0.19 cm ( 0.07 , 0.3 
    Output:
    