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: Summary Background Fast weight gain and linear growth in children in low-income and middle-income countries are associated with enhanced survival and improved cognitive development , but might increase risk of obesity and related adult cardiometabolic diseases . We investigated how linear growth and relative weight gain during infancy and childhood are related to health and human capital outcomes in young adults . Methods We used data from five prospect i ve birth cohort studies from Brazil , Guatemala , India , the Philippines , and South Africa . We investigated  body-mass index , systolic and diastolic blood pressure , plasma glucose concentration , height , years of attained schooling , and related categorical indicators of adverse outcomes in young adults . With linear and logistic regression models , we assessed how these outcomes relate to birthweight and to statistically independent measures representing linear growth and weight gain independent of linear growth ( relative weight gain ) in three age periods : 0–2 years , 2 years to mid-childhood , and mid-childhood to adulthood . Findings We obtained data for 8362 participants who had at least one adult outcome of interest . A higher birthweight was consistently associated with an adult body-mass index of greater than 25 kg/m2 ( odds ratio 1·28 , 95 % CI 1·21–1·35 ) and a reduced likelihood of short adult stature ( 0·49 , 0·44–0·54 ) and of not completing secondary school ( 0·82 , 0·78–0·87 ) . Faster linear growth was strongly associated with a reduced risk of short adult stature ( age 2 years : 0·23 , 0·20–0·52 ; mid-childhood : 0·39 , 0·36–0·43 ) and of not completing secondary school ( age 2 years : 0·74 , 0·67–0·78 ; mid-childhood : 0·87 , 0·83–0·92 ) , but did raise the likelihood of overweight ( age 2 years : 1·24 , 1·17–1·31 ; mid-childhood : 1·12 , 1·06–1·18 ) and elevated blood pressure ( age 2 years : 1·12 , 1·06–1·19 ; mid-childhood : 1·07 , 1·01–1·13 ) . Faster relative weight gain was associated with an increased risk of adult overweight ( age 2 years : 1·51 , 1·43–1·60 ; mid-childhood : 1·76 , 1·69–1·91 ) and elevated blood pressure ( age 2 years : 1·07 , 1·01–1·13 ; mid-childhood : 1·22 , 1·15–1·30 ) . Linear growth and relative weight gain were not associated with dysglycaemia , but a higher birthweight was associated with decreased risk of the disorder ( 0·89 , 0·81–0·98 ) . Interpretation Interventions in countries of low and middle income to increase birthweight and linear growth during the first 2 years of life are likely to result in substantial gains in height and schooling and give some protection from adult chronic disease risk factors , with few adverse trade-offs . Funding Wellcome Trust and Bill & Melinda Gates Foundation BACKGROUND Intrauterine growth retardation is a major predictor of child health in developing countries . OBJECTIVE We tested whether providing pregnant women with the  UNICEF/WHO/UNU international multiple micronutrient preparation ( UNIMMAP ) , rather than iron and folic acid alone , improved fetal growth and its correlates . DESIGN An intention-to-treat , double-blind , r and omized controlled trial including 1426 pregnancies was carried out in rural Burkina Faso . Tablet intake was directly observed . RESULTS Pregnancy outcome was known in 96.3 % of the participants . After adjustment for gestational age at delivery , both birth weight ( 52 g ; 95 % CI : 4 , 100 ; P = 0.035 ) and birth length ( 3.6 mm ; 95 % CI : 0.8 , 6.3 ; P = 0.012 ) were significantly higher in the UNIMMAP group . UNIMMAP had a differential effect by percentiles of birth weight and length distributions : the risk of large-for-gestational-age infants was higher in the UNIMMAP group ( OR : 1.58 ; 95 % CI : 1.04 , 2.38 ; P = 0.03 ) , although the risk of low birth weight remained unchanged . The effect of UNIMMAP on birth size was modified by maternal body mass index at enrollment and could be more important in multiparous women and women taking sulfadoxine-pyrimethamine . Unexpectedly , the risk of perinatal death was marginally significantly increased in the UNIMMAP group ( OR : 1.78 ; 95 % CI : 0.95 , 3.32 ; P = 0.07 ) , and this seemed to affect mainly primiparous women ( OR : 3.44 ; 95 % CI : 1.1 , 10.7 ; P for interaction = 0.11 ) . CONCLUSIONS Maternal UNIMMAP modestly but significantly increased fetal growth . The result ing benefit on infant growth and survival needs to be assessed . The possible lack of benefit and potential harm in primiparous women should be further investigated . This trial was registered at clinical trials.gov as NCT00642408 OBJECTIVE To evaluate the effect of multimicronutrient supplementation for undernourished pregnant women on the birth size of their offspring , incidence of low-birth-weight infants ( < 2500 g ) , and early neonatal morbidity .  DESIGN R and omized , double-blind , placebo-controlled trial . SETTING Tertiary care hospital . PARTICIPANTS Two hundred pregnant women ( of 13 465 approached ) with a body mass index ( calculated as weight in kilograms divided by the square of height in meters ) of less than 18.5 and /or a hemoglobin level of 7 to 9 g/dL were enrolled at 24 to 32 weeks of gestation . One hundred forty-six neonates ( 73.0 % ) were available for analysis of birth size and 170 ( 85.0 % ) for analysis of morbidity in the 7 days after delivery . Intervention The micronutrient supplementation group ( n = 99 ) received a multimicronutrient supplement containing 29 vitamins and minerals once a day , from enrollment until delivery ( median duration , 58 days ; interquartile range , 37 - 77 days ; compliance , 87 % ) . The comparison group ( n = 101 ) received placebo for 52 ( 15 - 66 ) days , with 85 % compliance . All subjects also received supplements of iron ( given in the form of ferrous sulfate , containing 60 mg of elemental iron ) , 60 mg/d , and folic acid , 500 mug/d . MAIN OUTCOME MEASURES Birth weight , length , midarm circumference , incidence of low birth weight , and early neonatal morbidity . RESULTS Infants in the micronutrient group were heavier by 98 g ( 95 % confidence interval [ CI ] , -16 to 213 g ) and measured 0.80 cm ( 95 % CI , 0.03 - 1.57 cm ) longer and 0.20 cm ( 95 % CI , 0.04 - 0.36 cm ) larger in midarm circumference compared with the placebo group . Incidence of low birth weight declined from 43.1 % to 16.2 % with multimicronutrient supplementation a ( a 70 % decrease ; relative risk , 0.30 ; 95 % CI , 0.13 - 0.71 ; P=.006 ) , and that of early neonatal morbidity declined from 28.0 % to 14.8 % ( a 58 % decrease ; relative risk , 0.42 ; 95 % CI , 0.19 - 0.94 ; P=.04 ) . CONCLUSION Compared with iron and folic acid supplementation , the administration of multimicronutrients to undernourished pregnant women may reduce the incidence of low birth weight and early neonatal morbidity Background Maternal micronutrient deficiencies are widespread in Pakistan and are potentially associated with maternal undernutrition and intrauterine growth retardation . Intervention strategies largely consist of administration of iron – folic acid supplements during pregnancy . Objective We evaluated the acceptability of multiple micronutrient supplementation and its potential benefits on pregnancy outcomes and maternal micronutrient status in a cohort of pregnant women in rural and urban Sindh through a cluster-r and omized design . Methods We r and omly assigned 2,378 pregnant women to receive either iron – folic acid or multiple micronutrient supplements . The supplements were administered fortnightly by community health workers who performed home visits to assess tolerance and observe the mothers . Results The women in both groups consumed about 75 % of the supplements provided , and few reported adverse effects such as vomiting , abdominal pain , etc . There was a small ( 70 g ) but significant increase in birthweight among infants of mothers receiving multiple micronutrients as compared with infants of mothers receiving iron – folic acid supplements ( 2.95 ± 0.6 vs. 2.88 ± 0.5 kg , p = .01 ) . This translated into a 10 % reduction ( p < 0.17 ) in the proportion of low-birthweight infants among infants of mothers receiving multiple micronutrients . Although stillbirth rates were comparable in the two groups , the early neonatal mortality rate in the group receiving multiple micronutrients was higher , although not significantly , than that in the group receiving iron– folic acid ( 43.2 vs. 23.5 deaths per 1,000 live births ; RR = 1.64 ; 95 % CI , 0.94 to 2.87 ) . Comparable reductions in anemia ( hemoglobin < 11 g/dL ) were observed , although the proportion with low iron stores ( assessed by serum ferritin ) was lower in the iron – folic acid group in the postnatal period . Although the proportion of women with sub clinical vitamin A deficiency after supplementation did not differ between the two groups , the iron – folic acid group had a higher proportion with lower serum zinc levels in the immediate postpartum period . Conclusions These data suggest that multiple micronutrient supplements are well tolerated during pregnancy , but the effect on birthweight is modest . The observed effect on early neonatal mortality suggests the need for further studies and careful assessment of the intervention in health system setting BACKGROUND Neonatal mortality is the biggest contributor to global mortality of children younger than 5 years , and low birthweight is a crucial underlying factor . We tested the hypotheses that antenatal multiple micronutrient supplementation would increase  infant birthweight and gestational duration . METHODS We did a double-blind , r and omised controlled trial in Dhanusha district , Nepal . Women attending for antenatal care with singleton pregnancies at up to 20 weeks ' gestation were invited to participate . Participants were r and omly allocated either routine iron and folic acid supplements ( control ; n=600 ) or a multiple micronutrient supplement providing a recommended daily allowance of 15 vitamins and minerals ( intervention ; n=600 ) . Supplementation began at a minimum of 12 weeks ' gestation and continued until delivery . Primary outcome measures were birthweight and gestational duration . Analysis was by intention to treat . The study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N88625934 . FINDINGS Birthweight was available for 523/600 infants in the control group and 529/600 in the intervention group .  Mean birthweight was 2733 g ( SD 422 ) in the control group and 2810 g ( 453 ) in the intervention group , representing a mean difference of 77 g ( 95 % CI 24 - 130 ; p=0.004 ) and a relative fall in the proportion of low birthweight by 25 % . No difference was recorded in the duration of gestation ( 0.2 weeks [ -0.1 to 0.4 ] ; p=0.12 ) , infant length ( 0.3 cm [ -0.1 to 0.6 ] ; p=0.16 ) , or head circumference ( 0.2 cm [ -0.1 to 0.4 ] ; p=0.18 ) . INTERPRETATION In a poor community in Nepal , consumption of a daily supplement containing a recommended daily allowance of 15 micronutrients in the second and third trimesters of pregnancy was associated with increased birthweight when compared with a st and ard iron and folic acid preparation . The effects on perinatal morbidity and mortality need further comparisons between studies . Published online March 3 , 2005 http://image.thelancet.com/extras/04art11045web.pdf BACKGROUND Although the benefits of exclusive breastfeeding for child health and survival , particularly in the post-neonatal period , are established , the independent beneficial effect of early breastfeeding initiation remains unclear . We studied the association between timing of breastfeeding initiation and  post-enrolment neonatal and post-neonatal mortality up to 6 months of age , as well as the associations between breastfeeding pattern and mortality . METHODS We examined associations between timing of breastfeeding initiation , post-enrolment neonatal mortality ( enrolment 2 
    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: Summary Background Fast weight gain and linear growth in children in low-income and middle-income countries are associated with enhanced survival and improved cognitive development , but might increase risk of obesity and related adult cardiometabolic diseases . We investigated how linear growth and relative weight gain during infancy and childhood are related to health and human capital outcomes in young adults . Methods We used data from five prospect i ve birth cohort studies from Brazil , Guatemala , India , the Philippines , and South Africa . We investigated  body-mass index , systolic and diastolic blood pressure , plasma glucose concentration , height , years of attained schooling , and related categorical indicators of adverse outcomes in young adults . With linear and logistic regression models , we assessed how these outcomes relate to birthweight and to statistically independent measures representing linear growth and weight gain independent of linear growth ( relative weight gain ) in three age periods : 0–2 years , 2 years to mid-childhood , and mid-childhood to adulthood . Findings We obtained data for 8362 participants who had at least one adult outcome of interest . A higher birthweight was consistently associated with an adult body-mass index of greater than 25 kg/m2 ( odds ratio 1·28 , 95 % CI 1·21–1·35 ) and a reduced likelihood of short adult stature ( 0·49 , 0·44–0·54 ) and of not completing secondary school ( 0·82 , 0·78–0·87 ) . Faster linear growth was strongly associated with a reduced risk of short adult stature ( age 2 years : 0·23 , 0·20–0·52 ; mid-childhood : 0·39 , 0·36–0·43 ) and of not completing secondary school ( age 2 years : 0·74 , 0·67–0·78 ; mid-childhood : 0·87 , 0·83–0·92 ) , but did raise the likelihood of overweight ( age 2 years : 1·24 , 1·17–1·31 ; mid-childhood : 1·12 , 1·06–1·18 ) and elevated blood pressure ( age 2 years : 1·12 , 1·06–1·19 ; mid-childhood : 1·07 , 1·01–1·13 ) . Faster relative weight gain was associated with an increased risk of adult overweight ( age 2 years : 1·51 , 1·43–1·60 ; mid-childhood : 1·76 , 1·69–1·91 ) and elevated blood pressure ( age 2 years : 1·07 , 1·01–1·13 ; mid-childhood : 1·22 , 1·15–1·30 ) . Linear growth and relative weight gain were not associated with dysglycaemia , but a higher birthweight was associated with decreased risk of the disorder ( 0·89 , 0·81–0·98 ) . Interpretation Interventions in countries of low and middle income to increase birthweight and linear growth during the first 2 years of life are likely to result in substantial gains in height and schooling and give some protection from adult chronic disease risk factors , with few adverse trade-offs . Funding Wellcome Trust and Bill & Melinda Gates Foundation BACKGROUND Intrauterine growth retardation is a major predictor of child health in developing countries . OBJECTIVE We tested whether providing pregnant women with the  UNICEF/WHO/UNU international multiple micronutrient preparation ( UNIMMAP ) , rather than iron and folic acid alone , improved fetal growth and its correlates . DESIGN An intention-to-treat , double-blind , r and omized controlled trial including 1426 pregnancies was carried out in rural Burkina Faso . Tablet intake was directly observed . RESULTS Pregnancy outcome was known in 96.3 % of the participants . After adjustment for gestational age at delivery , both birth weight ( 52 g ; 95 % CI : 4 , 100 ; P = 0.035 ) and birth length ( 3.6 mm ; 95 % CI : 0.8 , 6.3 ; P = 0.012 ) were significantly higher in the UNIMMAP group . UNIMMAP had a differential effect by percentiles of birth weight and length distributions : the risk of large-for-gestational-age infants was higher in the UNIMMAP group ( OR : 1.58 ; 95 % CI : 1.04 , 2.38 ; P = 0.03 ) , although the risk of low birth weight remained unchanged . The effect of UNIMMAP on birth size was modified by maternal body mass index at enrollment and could be more important in multiparous women and women taking sulfadoxine-pyrimethamine . Unexpectedly , the risk of perinatal death was marginally significantly increased in the UNIMMAP group ( OR : 1.78 ; 95 % CI : 0.95 , 3.32 ; P = 0.07 ) , and this seemed to affect mainly primiparous women ( OR : 3.44 ; 95 % CI : 1.1 , 10.7 ; P for interaction = 0.11 ) . CONCLUSIONS Maternal UNIMMAP modestly but significantly increased fetal growth . The result ing benefit on infant growth and survival needs to be assessed . The possible lack of benefit and potential harm in primiparous women should be further investigated . This trial was registered at clinical trials.gov as NCT00642408 OBJECTIVE To evaluate the effect of multimicronutrient supplementation for undernourished pregnant women on the birth size of their offspring , incidence of low-birth-weight infants ( < 2500 g ) , and early neonatal morbidity .  DESIGN R and omized , double-blind , placebo-controlled trial . SETTING Tertiary care hospital . PARTICIPANTS Two hundred pregnant women ( of 13 465 approached ) with a body mass index ( calculated as weight in kilograms divided by the square of height in meters ) of less than 18.5 and /or a hemoglobin level of 7 to 9 g/dL were enrolled at 24 to 32 weeks of gestation . One hundred forty-six neonates ( 73.0 % ) were available for analysis of birth size and 170 ( 85.0 % ) for analysis of morbidity in the 7 days after delivery . Intervention The micronutrient supplementation group ( n = 99 ) received a multimicronutrient supplement containing 29 vitamins and minerals once a day , from enrollment until delivery ( median duration , 58 days ; interquartile range , 37 - 77 days ; compliance , 87 % ) . The comparison group ( n = 101 ) received placebo for 52 ( 15 - 66 ) days , with 85 % compliance . All subjects also received supplements of iron ( given in the form of ferrous sulfate , containing 60 mg of elemental iron ) , 60 mg/d , and folic acid , 500 mug/d . MAIN OUTCOME MEASURES Birth weight , length , midarm circumference , incidence of low birth weight , and early neonatal morbidity . RESULTS Infants in the micronutrient group were heavier by 98 g ( 95 % confidence interval [ CI ] , -16 to 213 g ) and measured 0.80 cm ( 95 % CI , 0.03 - 1.57 cm ) longer and 0.20 cm ( 95 % CI , 0.04 - 0.36 cm ) larger in midarm circumference compared with the placebo group . Incidence of low birth weight declined from 43.1 % to 16.2 % with multimicronutrient supplementation a ( a 70 % decrease ; relative risk , 0.30 ; 95 % CI , 0.13 - 0.71 ; P=.006 ) , and that of early neonatal morbidity declined from 28.0 % to 14.8 % ( a 58 % decrease ; relative risk , 0.42 ; 95 % CI , 0.19 - 0.94 ; P=.04 ) . CONCLUSION Compared with iron and folic acid supplementation , the administration of multimicronutrients to undernourished pregnant women may reduce the incidence of low birth weight and early neonatal morbidity Background Maternal micronutrient deficiencies are widespread in Pakistan and are potentially associated with maternal undernutrition and intrauterine growth retardation . Intervention strategies largely consist of administration of iron – folic acid supplements during pregnancy . Objective We evaluated the acceptability of multiple micronutrient supplementation and its potential benefits on pregnancy outcomes and maternal micronutrient status in a cohort of pregnant women in rural and urban Sindh through a cluster-r and omized design . Methods We r and omly assigned 2,378 pregnant women to receive either iron – folic acid or multiple micronutrient supplements . The supplements were administered fortnightly by community health workers who performed home visits to assess tolerance and observe the mothers . Results The women in both groups consumed about 75 % of the supplements provided , and few reported adverse effects such as vomiting , abdominal pain , etc . There was a small ( 70 g ) but significant increase in birthweight among infants of mothers receiving multiple micronutrients as compared with infants of mothers receiving iron – folic acid supplements ( 2.95 ± 0.6 vs. 2.88 ± 0.5 kg , p = .01 ) . This translated into a 10 % reduction ( p < 0.17 ) in the proportion of low-birthweight infants among infants of mothers receiving multiple micronutrients . Although stillbirth rates were comparable in the two groups , the early neonatal mortality rate in the group receiving multiple micronutrients was higher , although not significantly , than that in the group receiving iron– folic acid ( 43.2 vs. 23.5 deaths per 1,000 live births ; RR = 1.64 ; 95 % CI , 0.94 to 2.87 ) . Comparable reductions in anemia ( hemoglobin < 11 g/dL ) were observed , although the proportion with low iron stores ( assessed by serum ferritin ) was lower in the iron – folic acid group in the postnatal period . Although the proportion of women with sub clinical vitamin A deficiency after supplementation did not differ between the two groups , the iron – folic acid group had a higher proportion with lower serum zinc levels in the immediate postpartum period . Conclusions These data suggest that multiple micronutrient supplements are well tolerated during pregnancy , but the effect on birthweight is modest . The observed effect on early neonatal mortality suggests the need for further studies and careful assessment of the intervention in health system setting BACKGROUND Neonatal mortality is the biggest contributor to global mortality of children younger than 5 years , and low birthweight is a crucial underlying factor . We tested the hypotheses that antenatal multiple micronutrient supplementation would increase  infant birthweight and gestational duration . METHODS We did a double-blind , r and omised controlled trial in Dhanusha district , Nepal . Women attending for antenatal care with singleton pregnancies at up to 20 weeks ' gestation were invited to participate . Participants were r and omly allocated either routine iron and folic acid supplements ( control ; n=600 ) or a multiple micronutrient supplement providing a recommended daily allowance of 15 vitamins and minerals ( intervention ; n=600 ) . Supplementation began at a minimum of 12 weeks ' gestation and continued until delivery . Primary outcome measures were birthweight and gestational duration . Analysis was by intention to treat . The study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N88625934 . FINDINGS Birthweight was available for 523/600 infants in the control group and 529/600 in the intervention group .  Mean birthweight was 2733 g ( SD 422 ) in the control group and 2810 g ( 453 ) in the intervention group , representing a mean difference of 77 g ( 95 % CI 24 - 130 ; p=0.004 ) and a relative fall in the proportion of low birthweight by 25 % . No difference was recorded in the duration of gestation ( 0.2 weeks [ -0.1 to 0.4 ] ; p=0.12 ) , infant length ( 0.3 cm [ -0.1 to 0.6 ] ; p=0.16 ) , or head circumference ( 0.2 cm [ -0.1 to 0.4 ] ; p=0.18 ) . INTERPRETATION In a poor community in Nepal , consumption of a daily supplement containing a recommended daily allowance of 15 micronutrients in the second and third trimesters of pregnancy was associated with increased birthweight when compared with a st and ard iron and folic acid preparation . The effects on perinatal morbidity and mortality need further comparisons between studies . Published online March 3 , 2005 http://image.thelancet.com/extras/04art11045web.pdf BACKGROUND Although the benefits of exclusive breastfeeding for child health and survival , particularly in the post-neonatal period , are established , the independent beneficial effect of early breastfeeding initiation remains unclear . We studied the association between timing of breastfeeding initiation and  post-enrolment neonatal and post-neonatal mortality up to 6 months of age , as well as the associations between breastfeeding pattern and mortality . METHODS We examined associations between timing of breastfeeding initiation , post-enrolment neonatal mortality ( enrolment 2 
    Output:
    