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: 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 Conflicting evidence exists on the effect of long-chain polyunsaturated fatty acid ( LCPUFA ) formula supplementation on cardiovascular health in term infants . It is known that LCPUFA supplementation does not affect infant growth , but long term outcome data are not available . The current study investigates whether 2 mo LCPUFA formula supplementation affects cardiovascular and anthropometric development at 9 y. A prospect i ve , double-blind , r and omized trial was performed in healthy term infants : a st and ard formula control group ( CF , n = 169 ) and a LCPUFA-supplemented group [ LF , n = 145 ; 0.45 % ( by wt ) AA  and 0.30 % ( by wt ) docosahexaenoic acid ( DHA ) ] . A breastfed group ( BF ; n = 159 ) served as reference . At the age of 9 y , systolic and diastolic blood pressure , heart rate , head circumference , weight , and height were measured . Univariate and multivariate analyses were performed ; 63 to 79 % of children were assessed . None of the cardiovascular or anthropometric measurements differed between the formula groups . Breastfed children had a marginally lower heart rate than formula-fed children , in particular compared with children fed control formula . Blood pressure and parameters of growth including BMI of breast and formula-fed children did not differ . In conclusion , the study suggests that short-term LCPUFA supplementation does not influence cardiovascular and anthropometric development at 9 OBJECTIVE Docosahexaenoic acid ( DHA ) and arachidonic acid ( ARA ) are long-chain polyunsaturated fatty acids found in breast milk and recently added to infant formulas . Their importance in infant nutrition was recognized by the rapid accretion of these fatty acids in the brain during the first postnatal year , reports of enhanced intellectual development in breastfed children , and recognition of the physiologic importance of DHA in visual and neural systems from studies in animal models . These considerations led to clinical trials to evaluate whether infant formulas that are supplemented with DHA or both DHA and ARA would enhance visual and cognitive development or whether conversion of linoleic acid and alpha-linolenic acid , the essential fatty acid precursors of ARA and DHA , respectively , at the levels found in infant formulas is sufficient to support adequately visual and cognitive development . Visual and cognitive development were not different with supplementation in some studies , whereas other studies reported benefits of adding DHA or both DHA and ARA to formula . One of the first trials with term infants that were fed formula supplemented with DHA or both DHA and ARA evaluated growth , visual acuity ( Visual Evoked Potential ; Acuity Card Procedure ) , mental and motor development ( Bayley Scales of Infant Development ) , and early language development ( MacArthur Communicative Developmental Inventories ) . Growth , visual acuity , and mental and motor development were not different among the 3 formula groups or between the breastfed and formula-fed infants in the first year of life . At 14 months of age , infants who were fed the formula with DHA but no ARA had lower vocabulary production and comprehension scores than infants who were fed the unsupplemented control formula or who were breastfed , respectively . The present follow-up study evaluated IQ , receptive and expressive vocabulary , visual-motor function , and visual acuity of children from the original trial when they reached 39 months of age . METHODS Infants were r and omized within 1 week after birth and fed a control formula ( n = 65 ) , one containing DHA ( n = 65 ) , or one containing both ARA and DHA ( n = 66 ) to 1 year of age . A comparison group ( n = 80 ) was exclusively breastfed for at least 3 months after which the infants continued to be exclusively breastfed or were supplemented with and /or weaned to infant formula . At 39 months , st and ard tests of IQ ( Stanford Binet IQ ) , receptive vocabulary ( Peabody Picture Vocabulary Test-Revised ) , expressive vocabulary ( mean length of utterance ) , visual-motor function ( Beery Visual-Motor Index ) , and visual acuity ( Acuity Card Procedure ) were administered . Growth , red blood cell fatty acid levels , and morbidity also were evaluated . RESULTS Results were analyzed using analysis of variance or linear regression models . The regression model for IQ , receptive and expressive language , and the visual-motor index controlled for site , birth weight , sex , maternal education , maternal age , and the child 's age at testing . The regression model for  visual acuity  controlled for site only . A variable selection model also identified which of 22 potentially prognostic variables among different categories ( feeding groups , the child and family demographics , indicators of illness since birth , and environment ) were most influential for IQ and expressive vocabulary . A total of 157 ( 80 % ) of the 197 infants studied at 12 months participated in this follow-up study . Characteristics of the families were representative of US families with children up to 5 years of age , and there were no differences in the demographic or family characteristics among the r and omized formula groups . As expected , the formula and breastfed groups differed in ethnicity , marital status , parental education , and the prevalence of smoking . Sex , ethnicity , gestational age at birth , and birth weight for those who participated at 39 months did not differ from those who did not . The 12-month Bayley mental and motor scores and 14-month vocabulary scores of the children who participated also were were not different from those who did not . At 39 months , IQ , receptive and expressive language , visual-motor function , and visual acuity were not different among the 3 r and omized formula groups or between the breastfed and formula groups . The adjusted means for the control , ARA+DHA , DHA , and breastfed groups were as follows : IQ scores , 104 , 101 , 100 , 106 ; Peabody Picture Vocabulary Test , 99.2 , 97.2 , 95.1 , 97.4 ; mean length of utterance , 3.64 , 3.75 , 3.93 , 4.08 ; the visual-motor index , 2.26 , 2.24 , 2.05 , 2.40 ; and visual acuity ( cycles/degree ) , 30.4 , 27.9 , 27.5 , 28.6 , respectively . IQ was positively associated with female sex and maternal education and negatively associated with the number of siblings and exposure to cigarette smoking in utero and /or postnatally . Expressive language also was positively associated with maternal education and negatively associated with the average hours in child care per week and hospitalizations since birth but only when the breastfed group was included in the analysis . The associations between maternal education and child IQ scores are consistent with previous reports as are the associations between prenatal exposure to cigarette smoke and IQ and early language development . Approximately one third of the variance for IQ was explained by sex , maternal education , the number of siblings , and exposure to cigarette smoke . Growth achievement , red blood cell fatty acid levels , and morbidity did not differ among groups . CONCLUSIONS We reported previously that infants who were fed an unsupplemented formula or one with DHA or with both DHA and ARA through 12 months or were breastfed showed no differences in mental and motor development , but those who were fed DHA without ARA had lower vocabulary scores on a st and ardized , parent-report instrument at 14 months of age when compared with infants who were fed the unsupplemented formula or who were breastfed . When the infants were reassessed at 39 months using age-appropriate tests of receptive and expressive language as well as IQ , visual-motor function and visual acuity , no differences among the formula groups or between the formula and breastfed groups were found . The 14-month observation thus may have been a transient effect of DHA ( without ARA ) supplementation on early vocabulary development or may have occurred by chance . The absence of differences in growth achievement adds to the evidence that DHA with or without ARA supports normal growth in full-term infants . In conclusion , adding both DHA and ARA when supplementing infant formulas with long-chain polyunsaturated fatty acids supports visual and cognitive development through 39 months To determine the effect of feeding formula containing long-chain PUFA ( LCP ) on immune function , healthy term infants were r and omised at age 2 weeks to either a st and ard term formula ( Formula ; n 14 ) or the same formula supplemented with the LCP 20 : 4n-6 and 22 : 6n-3 ( Formula+LCP ; n 16 ) . Peripheral blood was collected at 2 and 6 weeks to measure immune cell response ( the rate of [3H]thymidine uptake and cytokine production after stimulation with phytohaemagglutinin ( PHA ) ) . Compared with cells from infants receiving only human milk ( HM ) , the rate of [3H]thymidine uptake in response to PHA , but not IL-2 production , was lower for Formula+LCP infants ( P < 0.05 ) . Compared with HM-fed infants , Formula-fed infants ( but not Formula+LCP infants ) produced more TNF-alpha ( unstimulated ) and had a fewer CD3+CD44 + cells before stimulation and fewer CD11c+ cells post-stimulation ( P < 0.05 ) . However , compared with Formula-fed infants , the Formula+LCP infants had an immune cell distribution ( higher percentage CD3+CD44 + and CD4+CD28 + cells ) and cytokine profile ( lower production of TNF-alpha post-stimulation ) that did not differ from HM infants . Additionally , it was found that feeding infants formula during the first 10 d of life influenced immune function . These infants had a higher percentage of CD3 + , CD4+CD28 + , and lower percentage of CD14 + cells and produced more TNF-alpha and interferon-gamma after PHA stimulation than HM-fed infants ( P < 0.05 ) . These results demonstrate that early diet influences both the presence of specific cell types and function of infant blood immune cells . Since many diseases have a strong immunological component , these immune changes may be of physiological importance to the developing infant The aim of this study was to examine prospect ively the relation between duration of breast feeding and cognitive outcomes . A cohort study of 2860 children enrolled before birth provided data from 2393 term infants of English-speaking mothers . Of these , complete infant feeding data in the first year of life and verbal cognitive IQ ( Peabody Picture Vocabulary Test - PPVT-R ) were available for 1450 children at 6 years , and a performance subtest ( Perceptual organisation WISC - Block Design ) for 1375 children at 8 years . Full breast feeding was categorised as none , > 0 to < 4 months , 4 - 6 months and > 6 months . Associations between breast-feeding duration and PPVT-R at 6 years and Block Design at 8 years were estimated before and after adjustment for gender , gestational age , maternal age , maternal education , parental smoking and the presence of older siblings . The early cessation of full breast feeding was associated with reduced verbal IQ and the performance subtest . In unadjusted analysis , mean st and ardised PPVT-R scores were 6.44 points greater 
    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: 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 Conflicting evidence exists on the effect of long-chain polyunsaturated fatty acid ( LCPUFA ) formula supplementation on cardiovascular health in term infants . It is known that LCPUFA supplementation does not affect infant growth , but long term outcome data are not available . The current study investigates whether 2 mo LCPUFA formula supplementation affects cardiovascular and anthropometric development at 9 y. A prospect i ve , double-blind , r and omized trial was performed in healthy term infants : a st and ard formula control group ( CF , n = 169 ) and a LCPUFA-supplemented group [ LF , n = 145 ; 0.45 % ( by wt ) AA  and 0.30 % ( by wt ) docosahexaenoic acid ( DHA ) ] . A breastfed group ( BF ; n = 159 ) served as reference . At the age of 9 y , systolic and diastolic blood pressure , heart rate , head circumference , weight , and height were measured . Univariate and multivariate analyses were performed ; 63 to 79 % of children were assessed . None of the cardiovascular or anthropometric measurements differed between the formula groups . Breastfed children had a marginally lower heart rate than formula-fed children , in particular compared with children fed control formula . Blood pressure and parameters of growth including BMI of breast and formula-fed children did not differ . In conclusion , the study suggests that short-term LCPUFA supplementation does not influence cardiovascular and anthropometric development at 9 OBJECTIVE Docosahexaenoic acid ( DHA ) and arachidonic acid ( ARA ) are long-chain polyunsaturated fatty acids found in breast milk and recently added to infant formulas . Their importance in infant nutrition was recognized by the rapid accretion of these fatty acids in the brain during the first postnatal year , reports of enhanced intellectual development in breastfed children , and recognition of the physiologic importance of DHA in visual and neural systems from studies in animal models . These considerations led to clinical trials to evaluate whether infant formulas that are supplemented with DHA or both DHA and ARA would enhance visual and cognitive development or whether conversion of linoleic acid and alpha-linolenic acid , the essential fatty acid precursors of ARA and DHA , respectively , at the levels found in infant formulas is sufficient to support adequately visual and cognitive development . Visual and cognitive development were not different with supplementation in some studies , whereas other studies reported benefits of adding DHA or both DHA and ARA to formula . One of the first trials with term infants that were fed formula supplemented with DHA or both DHA and ARA evaluated growth , visual acuity ( Visual Evoked Potential ; Acuity Card Procedure ) , mental and motor development ( Bayley Scales of Infant Development ) , and early language development ( MacArthur Communicative Developmental Inventories ) . Growth , visual acuity , and mental and motor development were not different among the 3 formula groups or between the breastfed and formula-fed infants in the first year of life . At 14 months of age , infants who were fed the formula with DHA but no ARA had lower vocabulary production and comprehension scores than infants who were fed the unsupplemented control formula or who were breastfed , respectively . The present follow-up study evaluated IQ , receptive and expressive vocabulary , visual-motor function , and visual acuity of children from the original trial when they reached 39 months of age . METHODS Infants were r and omized within 1 week after birth and fed a control formula ( n = 65 ) , one containing DHA ( n = 65 ) , or one containing both ARA and DHA ( n = 66 ) to 1 year of age . A comparison group ( n = 80 ) was exclusively breastfed for at least 3 months after which the infants continued to be exclusively breastfed or were supplemented with and /or weaned to infant formula . At 39 months , st and ard tests of IQ ( Stanford Binet IQ ) , receptive vocabulary ( Peabody Picture Vocabulary Test-Revised ) , expressive vocabulary ( mean length of utterance ) , visual-motor function ( Beery Visual-Motor Index ) , and visual acuity ( Acuity Card Procedure ) were administered . Growth , red blood cell fatty acid levels , and morbidity also were evaluated . RESULTS Results were analyzed using analysis of variance or linear regression models . The regression model for IQ , receptive and expressive language , and the visual-motor index controlled for site , birth weight , sex , maternal education , maternal age , and the child 's age at testing . The regression model for  visual acuity  controlled for site only . A variable selection model also identified which of 22 potentially prognostic variables among different categories ( feeding groups , the child and family demographics , indicators of illness since birth , and environment ) were most influential for IQ and expressive vocabulary . A total of 157 ( 80 % ) of the 197 infants studied at 12 months participated in this follow-up study . Characteristics of the families were representative of US families with children up to 5 years of age , and there were no differences in the demographic or family characteristics among the r and omized formula groups . As expected , the formula and breastfed groups differed in ethnicity , marital status , parental education , and the prevalence of smoking . Sex , ethnicity , gestational age at birth , and birth weight for those who participated at 39 months did not differ from those who did not . The 12-month Bayley mental and motor scores and 14-month vocabulary scores of the children who participated also were were not different from those who did not . At 39 months , IQ , receptive and expressive language , visual-motor function , and visual acuity were not different among the 3 r and omized formula groups or between the breastfed and formula groups . The adjusted means for the control , ARA+DHA , DHA , and breastfed groups were as follows : IQ scores , 104 , 101 , 100 , 106 ; Peabody Picture Vocabulary Test , 99.2 , 97.2 , 95.1 , 97.4 ; mean length of utterance , 3.64 , 3.75 , 3.93 , 4.08 ; the visual-motor index , 2.26 , 2.24 , 2.05 , 2.40 ; and visual acuity ( cycles/degree ) , 30.4 , 27.9 , 27.5 , 28.6 , respectively . IQ was positively associated with female sex and maternal education and negatively associated with the number of siblings and exposure to cigarette smoking in utero and /or postnatally . Expressive language also was positively associated with maternal education and negatively associated with the average hours in child care per week and hospitalizations since birth but only when the breastfed group was included in the analysis . The associations between maternal education and child IQ scores are consistent with previous reports as are the associations between prenatal exposure to cigarette smoke and IQ and early language development . Approximately one third of the variance for IQ was explained by sex , maternal education , the number of siblings , and exposure to cigarette smoke . Growth achievement , red blood cell fatty acid levels , and morbidity did not differ among groups . CONCLUSIONS We reported previously that infants who were fed an unsupplemented formula or one with DHA or with both DHA and ARA through 12 months or were breastfed showed no differences in mental and motor development , but those who were fed DHA without ARA had lower vocabulary scores on a st and ardized , parent-report instrument at 14 months of age when compared with infants who were fed the unsupplemented formula or who were breastfed . When the infants were reassessed at 39 months using age-appropriate tests of receptive and expressive language as well as IQ , visual-motor function and visual acuity , no differences among the formula groups or between the formula and breastfed groups were found . The 14-month observation thus may have been a transient effect of DHA ( without ARA ) supplementation on early vocabulary development or may have occurred by chance . The absence of differences in growth achievement adds to the evidence that DHA with or without ARA supports normal growth in full-term infants . In conclusion , adding both DHA and ARA when supplementing infant formulas with long-chain polyunsaturated fatty acids supports visual and cognitive development through 39 months To determine the effect of feeding formula containing long-chain PUFA ( LCP ) on immune function , healthy term infants were r and omised at age 2 weeks to either a st and ard term formula ( Formula ; n 14 ) or the same formula supplemented with the LCP 20 : 4n-6 and 22 : 6n-3 ( Formula+LCP ; n 16 ) . Peripheral blood was collected at 2 and 6 weeks to measure immune cell response ( the rate of [3H]thymidine uptake and cytokine production after stimulation with phytohaemagglutinin ( PHA ) ) . Compared with cells from infants receiving only human milk ( HM ) , the rate of [3H]thymidine uptake in response to PHA , but not IL-2 production , was lower for Formula+LCP infants ( P < 0.05 ) . Compared with HM-fed infants , Formula-fed infants ( but not Formula+LCP infants ) produced more TNF-alpha ( unstimulated ) and had a fewer CD3+CD44 + cells before stimulation and fewer CD11c+ cells post-stimulation ( P < 0.05 ) . However , compared with Formula-fed infants , the Formula+LCP infants had an immune cell distribution ( higher percentage CD3+CD44 + and CD4+CD28 + cells ) and cytokine profile ( lower production of TNF-alpha post-stimulation ) that did not differ from HM infants . Additionally , it was found that feeding infants formula during the first 10 d of life influenced immune function . These infants had a higher percentage of CD3 + , CD4+CD28 + , and lower percentage of CD14 + cells and produced more TNF-alpha and interferon-gamma after PHA stimulation than HM-fed infants ( P < 0.05 ) . These results demonstrate that early diet influences both the presence of specific cell types and function of infant blood immune cells . Since many diseases have a strong immunological component , these immune changes may be of physiological importance to the developing infant The aim of this study was to examine prospect ively the relation between duration of breast feeding and cognitive outcomes . A cohort study of 2860 children enrolled before birth provided data from 2393 term infants of English-speaking mothers . Of these , complete infant feeding data in the first year of life and verbal cognitive IQ ( Peabody Picture Vocabulary Test - PPVT-R ) were available for 1450 children at 6 years , and a performance subtest ( Perceptual organisation WISC - Block Design ) for 1375 children at 8 years . Full breast feeding was categorised as none , > 0 to < 4 months , 4 - 6 months and > 6 months . Associations between breast-feeding duration and PPVT-R at 6 years and Block Design at 8 years were estimated before and after adjustment for gender , gestational age , maternal age , maternal education , parental smoking and the presence of older siblings . The early cessation of full breast feeding was associated with reduced verbal IQ and the performance subtest . In unadjusted analysis , mean st and ardised PPVT-R scores were 6.44 points greater 
    Output:
    