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 evaluate the effectiveness of Sprinkles alongside infant and young child feeding ( IYCF ) education compared with IYCF education alone on anemia , deficiencies in iron , vitamin A , and zinc , and growth  in Cambodian infants . DESIGN Cluster-r and omized effectiveness study . SETTING Cambodian rural health district . PARTICIPANTS Among 3112 infants aged 6 months , a r and om sub sample ( n = 1350 ) was surveyed at baseline and 6-month intervals to age 24 months . INTERVENTION Daily micronutrient Sprinkles alongside IYCF education vs IYCF education alone for 6 months from ages 6 to 11 months . MAIN OUTCOME MEASURES Prevalence of anemia ; iron , vitamin A , and zinc deficiencies ; and growth via biomarkers and anthropometry . RESULTS Anemia prevalence ( hemoglobin level < 11.0 g/dL [ to convert to grams per liter , multiply by 10.0 ] ) was reduced in the intervention arm compared with the control arm by 20.6 % at 12 months ( 95 % CI , 9.4 - 30.2 ; P = .001 ) , and the prevalence of moderate anemia ( hemoglobin level < 10.0 g/dL ) was reduced by 27.1 % ( 95 % CI , 21.0 - 31.8 ; P < .001 ) . At 12 and 18 months , iron deficiency prevalence was reduced by 23.5 % ( 95 % CI , 15.6 - 29.1 ; P < .001 ) and 11.6 % ( 95 % CI , 2.6 - 17.9 ; P = .02 ) , respectively . The mean serum zinc concentration was increased at 12 months ( 2.88 μg/dL [ to convert to micromoles per liter , multiply by 0.153 ] ; 95 % CI , 0.26 - 5.42 ; P = .03 ) . There was no statistically significant difference in the prevalence of zinc and vitamin A deficiencies or in growth at any time . CONCLUSIONS Sprinkles reduced anemia and iron deficiency and increased the  mean serum zinc concentration in Cambodian infants . Anemia and zinc effects did not persist beyond the intervention period . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12608000069358 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 Background Ready-to-use therapeutic foods ( RUTF ) are lipid-based pastes widely used in the treatment of acute malnutrition . Current specifications for RUTF permit a high n-6 polyunsaturated fatty acid ( PUFA ) content and low n-3 PUFA , with no stipulated requirements for preformed long-chain n-3 PUFA . The objective of this study was to develop an RUTF with elevated short-chain n-3 PUFA and measure its impact , with and without fish oil supplementation , on children ’s PUFA status during treatment of severe acute malnutrition . Methods This r and omized controlled trial in children with severe acute malnutrition in rural Kenya included 60 children aged 6 to 50 months who were r and omized to receive i ) RUTF with st and ard composition ; ii ) RUTF with elevated short chain n-3 PUFA ; or iii ) RUTF with elevated short chain n-3 PUFA plus fish oil capsules . Participants were followed-up for 3 months . The primary outcome was erythrocyte PUFA composition . Results Erythrocyte docosahexaenoic acid ( DHA ) content declined from baseline in the two arms not receiving fish oil . Erythrocyte long-chain n-3 PUFA content following treatment was significantly higher for participants in the arm receiving fish oil than for those in the arms receiving RUTF with elevated short chain n-3 PUFA or st and ard RUTF alone : 3 months after enrolment , DHA content was 6.3 % ( interquartile range 6.0–7.3 ) , 4.5 % ( 3.9–4.9 ) , and 3.9 % ( 2.4–5.7 ) of total erythrocyte fatty acids ( P < 0.001 ) , respectively , while eicosapentaenoic acid ( EPA ) content was 2.0 % ( 1.5–2.6 ) , 0.7 % ( 0.6–0.8 ) , and 0.4 % ( 0.3–0.5 ) ( P < 0.001 ) . RUTF with elevated short chain n-3 PUFA and fish oil capsules were acceptable to participants and carers , and there were no significant differences in safety outcomes . Conclusions PUFA requirements of children with SAM are not met by current formulations of RUTF , or by an RUTF with elevated short-chain n-3 PUFA without additional preformed long-chain n-3 PUFA . Clinical and growth implication s of revised formulations need to be addressed in large clinical trials . Trial registration Clinical trials.gov NCT01593969 . Registered 4 May 2012 BACKGROUND Improved complementary feeding is cited as a critical factor for reducing stunting . Consumption of meats has been advocated , but its efficacy in low-re source setting s has not been tested . OBJECTIVE The objective was to test the hypothesis that daily intake of 30 to 45 g meat from 6 to 18 mo of age would result in greater linear growth velocity and improved micronutrient status in comparison with an equicaloric multimicronutrient-fortified cereal . DESIGN This was a cluster r and omized efficacy trial conducted in the Democratic Republic of Congo , Zambia , Guatemala , and Pakistan . Individual daily portions of study foods and education messages to enhance complementary feeding were delivered to participants . Blood tests were obtained at trial completion . RESULTS A total of 532 ( 86.1 % ) and 530 ( 85.8 % ) participants from the meat and cereal arms , respectively , completed the study .  Linear growth velocity did not differ between treatment groups : 1.00 ( 95 % CI : 0.99 , 1.02 ) and 1.02 ( 95 % CI : 1.00 , 1.04 ) cm/mo for the meat and cereal groups , respectively ( P = 0.39 ) . From baseline to 18 mo , stunting [ length-for-age z score ( LAZ ) < -2.0 ] rates increased from ~33 % to nearly 50 % . Years of maternal education and maternal height were positively associated with linear growth velocity ( P = 0.0006 and 0.003 , respectively ) ; LAZ at 6 mo was negatively associated ( P < 0.0001 ) . Anemia rates did not differ by group ; iron deficiency was significantly lower in the cereal group . CONCLUSION The high rate of stunting at baseline and the lack of effect of either the meat or multiple micronutrient-fortified cereal intervention to reverse its progression argue for multifaceted interventions beginning in the pre- and early postnatal periods Background Appropriate health and nutrition interventions to prevent long-term adverse effects in children are necessary before two years of age . One such intervention may include population -based deworming , recommended as of 12 months of age by the World Health Organization in soil-transmitted helminth (STH)-endemic areas ; however , the benefit of deworming has been understudied in early preschool-age children . Methodology /Principal Findings A r and omized , double-blind , placebo-controlled trial was conducted to determine the effect of  deworming ( 500 mg single-dose crushed mebendazole tablet ) on growth in one-year-old children in Iquitos , Peru . Children were enrolled during their routine 12-month growth and development clinic visit and followed up at their 18 and 24-month visits . Children were r and omly allocated to : Group 1 : deworming at 12 months and placebo at 18 months ; Group 2 : placebo at 12 months and deworming at 18 months ; Group 3 : deworming at both 12 and 18 months ; or Group 4 : placebo at both 12 and 18 months ( i.e. control group ) . The primary outcome was weight gain at the 24-month visit . An intention-to-treat approach was used . A total of 1760 children were enrolled between September 2011 and June 2012 . Follow-up of 1563 children ( 88.8 % ) was completed by July 2013 . STH infection was of low prevalence and predominantly light intensity in the study population . All groups gained between 1.93 and 2.05 kg on average over 12 months ; the average difference in weight gain ( kg ) compared to placebo was : 0.05 ( 95 % CI : -0.05 , 0.17 ) in Group 1 ; -0.07 ( 95%CI : -0.17 , 0.04 ) in Group 2 ; and 0.04 ( 95%CI : -0.06 , 0.14 ) in Group 3 . There was no statistically significant difference in weight gain in any of the deworming intervention groups compared to the control group . Conclusions Overall , with one year of follow-up , no effect of deworming on growth could be detected in this population of preschool-age children . Low baseline STH prevalence and intensity and /or access to deworming drugs outside of the trial may have diluted the potential effect of the intervention . Additional research is required to overcome these challenges and to contribute to strengthening the evidence base on deworming . Trial Registration Clinical Trials.gov ( NCT01314937 Summary Background Around 30 % of the world 's stunted children live in India . The Government of India has proposed a new cadre of community-based workers to improve nutrition in 200 districts . We aim ed to find out the effect of such a worker carrying out home visits and participatory group meetings on children 's linear growth . Methods We did a cluster-r and omised controlled trial in two adjoining districts of Jharkh and and Odisha , India . 120 clusters ( around 1000 people each ) were r and omly allocated to intervention or control using a lottery . R and omisation took place in July , 2013 , and was stratified by district and number of hamlets per cluster ( 0 , 1–2 , or ≥3 ) , result ing in six strata . In each intervention cluster , a worker carried out one home visit in the third trimester of pregnancy , monthly visits to children younger than 2 years to support feeding , hygiene , care , and stimulation , as well as monthly women 's group meetings to promote individual and community action for nutrition . Participants were pregnant women identified and recruited in the study clusters and their children . We excluded stillbirths and neonatal deaths , infants whose mothers died , those with congenital abnormalities , multiple births , and mother and infant pairs who migrated out of the study area permanently during the trial period . Data collectors visited each woman in pregnancy , within 72 h of her baby 's birth , and at 3 , 6 , 9 , 12 , and 18 months after birth . The primary outcome was children 's length-for-age Z score at 18 months of age . Analyses were by intention to treat . Due to the nature of the intervention , participants and the intervention team were not masked to allocation . Data collectors and the data manager were masked to allocation . The trial is registered as ISCRTN ( 51505201 ) and with the Clinical Trials Registry of India ( number 2014/06/004664 ) . Results Between Oct 1 , 2013 , and Dec 31 , 2015 , 
    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 evaluate the effectiveness of Sprinkles alongside infant and young child feeding ( IYCF ) education compared with IYCF education alone on anemia , deficiencies in iron , vitamin A , and zinc , and growth  in Cambodian infants . DESIGN Cluster-r and omized effectiveness study . SETTING Cambodian rural health district . PARTICIPANTS Among 3112 infants aged 6 months , a r and om sub sample ( n = 1350 ) was surveyed at baseline and 6-month intervals to age 24 months . INTERVENTION Daily micronutrient Sprinkles alongside IYCF education vs IYCF education alone for 6 months from ages 6 to 11 months . MAIN OUTCOME MEASURES Prevalence of anemia ; iron , vitamin A , and zinc deficiencies ; and growth via biomarkers and anthropometry . RESULTS Anemia prevalence ( hemoglobin level < 11.0 g/dL [ to convert to grams per liter , multiply by 10.0 ] ) was reduced in the intervention arm compared with the control arm by 20.6 % at 12 months ( 95 % CI , 9.4 - 30.2 ; P = .001 ) , and the prevalence of moderate anemia ( hemoglobin level < 10.0 g/dL ) was reduced by 27.1 % ( 95 % CI , 21.0 - 31.8 ; P < .001 ) . At 12 and 18 months , iron deficiency prevalence was reduced by 23.5 % ( 95 % CI , 15.6 - 29.1 ; P < .001 ) and 11.6 % ( 95 % CI , 2.6 - 17.9 ; P = .02 ) , respectively . The mean serum zinc concentration was increased at 12 months ( 2.88 μg/dL [ to convert to micromoles per liter , multiply by 0.153 ] ; 95 % CI , 0.26 - 5.42 ; P = .03 ) . There was no statistically significant difference in the prevalence of zinc and vitamin A deficiencies or in growth at any time . CONCLUSIONS Sprinkles reduced anemia and iron deficiency and increased the  mean serum zinc concentration in Cambodian infants . Anemia and zinc effects did not persist beyond the intervention period . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12608000069358 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 Background Ready-to-use therapeutic foods ( RUTF ) are lipid-based pastes widely used in the treatment of acute malnutrition . Current specifications for RUTF permit a high n-6 polyunsaturated fatty acid ( PUFA ) content and low n-3 PUFA , with no stipulated requirements for preformed long-chain n-3 PUFA . The objective of this study was to develop an RUTF with elevated short-chain n-3 PUFA and measure its impact , with and without fish oil supplementation , on children ’s PUFA status during treatment of severe acute malnutrition . Methods This r and omized controlled trial in children with severe acute malnutrition in rural Kenya included 60 children aged 6 to 50 months who were r and omized to receive i ) RUTF with st and ard composition ; ii ) RUTF with elevated short chain n-3 PUFA ; or iii ) RUTF with elevated short chain n-3 PUFA plus fish oil capsules . Participants were followed-up for 3 months . The primary outcome was erythrocyte PUFA composition . Results Erythrocyte docosahexaenoic acid ( DHA ) content declined from baseline in the two arms not receiving fish oil . Erythrocyte long-chain n-3 PUFA content following treatment was significantly higher for participants in the arm receiving fish oil than for those in the arms receiving RUTF with elevated short chain n-3 PUFA or st and ard RUTF alone : 3 months after enrolment , DHA content was 6.3 % ( interquartile range 6.0–7.3 ) , 4.5 % ( 3.9–4.9 ) , and 3.9 % ( 2.4–5.7 ) of total erythrocyte fatty acids ( P < 0.001 ) , respectively , while eicosapentaenoic acid ( EPA ) content was 2.0 % ( 1.5–2.6 ) , 0.7 % ( 0.6–0.8 ) , and 0.4 % ( 0.3–0.5 ) ( P < 0.001 ) . RUTF with elevated short chain n-3 PUFA and fish oil capsules were acceptable to participants and carers , and there were no significant differences in safety outcomes . Conclusions PUFA requirements of children with SAM are not met by current formulations of RUTF , or by an RUTF with elevated short-chain n-3 PUFA without additional preformed long-chain n-3 PUFA . Clinical and growth implication s of revised formulations need to be addressed in large clinical trials . Trial registration Clinical trials.gov NCT01593969 . Registered 4 May 2012 BACKGROUND Improved complementary feeding is cited as a critical factor for reducing stunting . Consumption of meats has been advocated , but its efficacy in low-re source setting s has not been tested . OBJECTIVE The objective was to test the hypothesis that daily intake of 30 to 45 g meat from 6 to 18 mo of age would result in greater linear growth velocity and improved micronutrient status in comparison with an equicaloric multimicronutrient-fortified cereal . DESIGN This was a cluster r and omized efficacy trial conducted in the Democratic Republic of Congo , Zambia , Guatemala , and Pakistan . Individual daily portions of study foods and education messages to enhance complementary feeding were delivered to participants . Blood tests were obtained at trial completion . RESULTS A total of 532 ( 86.1 % ) and 530 ( 85.8 % ) participants from the meat and cereal arms , respectively , completed the study .  Linear growth velocity did not differ between treatment groups : 1.00 ( 95 % CI : 0.99 , 1.02 ) and 1.02 ( 95 % CI : 1.00 , 1.04 ) cm/mo for the meat and cereal groups , respectively ( P = 0.39 ) . From baseline to 18 mo , stunting [ length-for-age z score ( LAZ ) < -2.0 ] rates increased from ~33 % to nearly 50 % . Years of maternal education and maternal height were positively associated with linear growth velocity ( P = 0.0006 and 0.003 , respectively ) ; LAZ at 6 mo was negatively associated ( P < 0.0001 ) . Anemia rates did not differ by group ; iron deficiency was significantly lower in the cereal group . CONCLUSION The high rate of stunting at baseline and the lack of effect of either the meat or multiple micronutrient-fortified cereal intervention to reverse its progression argue for multifaceted interventions beginning in the pre- and early postnatal periods Background Appropriate health and nutrition interventions to prevent long-term adverse effects in children are necessary before two years of age . One such intervention may include population -based deworming , recommended as of 12 months of age by the World Health Organization in soil-transmitted helminth (STH)-endemic areas ; however , the benefit of deworming has been understudied in early preschool-age children . Methodology /Principal Findings A r and omized , double-blind , placebo-controlled trial was conducted to determine the effect of  deworming ( 500 mg single-dose crushed mebendazole tablet ) on growth in one-year-old children in Iquitos , Peru . Children were enrolled during their routine 12-month growth and development clinic visit and followed up at their 18 and 24-month visits . Children were r and omly allocated to : Group 1 : deworming at 12 months and placebo at 18 months ; Group 2 : placebo at 12 months and deworming at 18 months ; Group 3 : deworming at both 12 and 18 months ; or Group 4 : placebo at both 12 and 18 months ( i.e. control group ) . The primary outcome was weight gain at the 24-month visit . An intention-to-treat approach was used . A total of 1760 children were enrolled between September 2011 and June 2012 . Follow-up of 1563 children ( 88.8 % ) was completed by July 2013 . STH infection was of low prevalence and predominantly light intensity in the study population . All groups gained between 1.93 and 2.05 kg on average over 12 months ; the average difference in weight gain ( kg ) compared to placebo was : 0.05 ( 95 % CI : -0.05 , 0.17 ) in Group 1 ; -0.07 ( 95%CI : -0.17 , 0.04 ) in Group 2 ; and 0.04 ( 95%CI : -0.06 , 0.14 ) in Group 3 . There was no statistically significant difference in weight gain in any of the deworming intervention groups compared to the control group . Conclusions Overall , with one year of follow-up , no effect of deworming on growth could be detected in this population of preschool-age children . Low baseline STH prevalence and intensity and /or access to deworming drugs outside of the trial may have diluted the potential effect of the intervention . Additional research is required to overcome these challenges and to contribute to strengthening the evidence base on deworming . Trial Registration Clinical Trials.gov ( NCT01314937 Summary Background Around 30 % of the world 's stunted children live in India . The Government of India has proposed a new cadre of community-based workers to improve nutrition in 200 districts . We aim ed to find out the effect of such a worker carrying out home visits and participatory group meetings on children 's linear growth . Methods We did a cluster-r and omised controlled trial in two adjoining districts of Jharkh and and Odisha , India . 120 clusters ( around 1000 people each ) were r and omly allocated to intervention or control using a lottery . R and omisation took place in July , 2013 , and was stratified by district and number of hamlets per cluster ( 0 , 1–2 , or ≥3 ) , result ing in six strata . In each intervention cluster , a worker carried out one home visit in the third trimester of pregnancy , monthly visits to children younger than 2 years to support feeding , hygiene , care , and stimulation , as well as monthly women 's group meetings to promote individual and community action for nutrition . Participants were pregnant women identified and recruited in the study clusters and their children . We excluded stillbirths and neonatal deaths , infants whose mothers died , those with congenital abnormalities , multiple births , and mother and infant pairs who migrated out of the study area permanently during the trial period . Data collectors visited each woman in pregnancy , within 72 h of her baby 's birth , and at 3 , 6 , 9 , 12 , and 18 months after birth . The primary outcome was children 's length-for-age Z score at 18 months of age . Analyses were by intention to treat . Due to the nature of the intervention , participants and the intervention team were not masked to allocation . Data collectors and the data manager were masked to allocation . The trial is registered as ISCRTN ( 51505201 ) and with the Clinical Trials Registry of India ( number 2014/06/004664 ) . Results Between Oct 1 , 2013 , and Dec 31 , 2015 , 
    Output:
    