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: Overweight and obesity affects more than 66 % of the adult population and is associated with a variety of chronic diseases . Weight reduction reduces health risks associated with chronic diseases and is therefore encouraged by major health agencies . Guidelines of the National Heart , Lung , and Blood Institute ( NHLBI ) encourage a 10 % reduction in weight , although considerable literature indicates reduction in health risk with 3 % to 5 % reduction in weight . Physical activity ( PA ) is recommended as a component of weight management for prevention of weight gain , for weight loss , and for prevention of weight regain after weight loss . In 2001 , the American College of Sports Medicine ( ACSM ) published a Position St and that recommended a minimum of 150 min wk(-1 ) of moderate-intensity PA for overweight and obese adults to improve health ; however , 200 - 300 min wk(-1 ) was recommended for long-term weight loss . More recent evidence has supported this recommendation and has indicated more PA may be necessary to prevent weight regain after weight loss . To this end , we have reexamined the evidence from 1999 to determine whether there is a level at which PA is effective for prevention of weight gain , for weight loss , and prevention of weight regain . Evidence supports moderate-intensity PA between 150 and 250 min wk(-1 ) to be effective to prevent weight gain .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will provide only modest weight loss . Greater amounts of PA ( > 250 min wk(-1 ) ) have been associated with clinical ly significant weight loss .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will improve weight loss in studies that use moderate diet restriction but not severe diet restriction . Cross-sectional and prospect i ve studies indicate that after weight loss , weight maintenance is improved with PA > 250 min wk(-1 ) . However , no evidence from well- design ed r and omized controlled trials exists to judge the effectiveness of PA for prevention of weight regain after weight loss .  Resistance training does not enhance weight loss but may increase fat-free mass and increase loss of fat mass and is associated with reductions in health risk . Existing evidence indicates that endurance PA or resistance training without weight loss improves health risk . There is inadequate evidence to determine whether PA prevents or attenuates detrimental changes in chronic disease risk during weight gain OBJECTIVE To evaluate whether morbidly obese women have an increased risk of pregnancy complications and adverse perinatal outcomes . METHODS In a prospect i ve population -based cohort study , 3,480 women with morbid obesity , defined as a body mass index ( BMI ) more than 40 , and 12,698 women with a BMI between 35.1 and 40 were compared with normal-weight women ( BMI 19.8 - 26 ) . The perinatal outcome of singletons born to women without insulin-dependent diabetes mellitus was evaluated after suitable adjustments . RESULTS In the group of morbidly obese mothers ( BMI greater than 40 ) as compared with the normal-weight mothers , there was an increased risk of the following outcomes ( adjusted odds ratio ; 95 % confidence interval ) : preeclampsia ( 4.82 ; 4.04 , 5.74 ) , antepartum stillbirth ( 2.79 ; 1.94 , 4.02 ) , cesarean delivery ( 2.69 ; 2.49 , 2.90 ) , instrumental delivery ( 1.34 ; 1.16 , 1.56 ) , shoulder dystocia ( 3.14 ; 1.86 , 5.31 ) , meconium aspiration ( 2.85 ; 1.60 , 5.07 ) , fetal distress ( 2.52 ; 2.12 , 2.99 ) , early neonatal death ( 3.41 ; 2.07 , 5.63 ) , and large-for-gestational age ( 3.82 ; 3.50 , 4.16 ) . The associations were similar for women with BMI s between 35.1 and 40 but to a lesser degree . CONCLUSION Maternal morbid obesity in early pregnancy is strongly associated with a number of pregnancy complications and perinatal conditions . LEVEL OF EVIDENCE BACKGROUND Factors influencing excessive weight gain in pregnancy have not been well-studied among urban , low-income women . METHODS This prospect i ve cohort study of 94 prenatal care patients at a large university hospital in Philadelphia examined associations of modifiable midpregnancy behaviors and nonmodifiable or early pregnancy factors with  excessive gestational weight gain . Data were collected through question naires and medical record abstract ion from 2009 to 2011 . FINDINGS The majority of women were African American ( 83 % ) and all ( 100 % ) received Medicaid . Nearly two thirds ( 60 % ) were overweight or obese in early pregnancy and 41 % experienced excessive gain . In multivariable logistic regression analyses , significant predictors of excessive gestational weight gain included high early pregnancy body mass index ( odds ratio [ OR ] , 4.20 ; 95 % confidence interval [ CI ] , 1.43 - 12.34 for overweight/obese vs. normal weight ) , nulliparity ( OR , 3.35 ; 95 % CI , 1.17 - 9.62 for nulliparity vs. multiparity ) , and clinician advice discordant with Institute of Medicine guidelines ( OR , 5.88 ; 95 % CI , 1.04 - 33.32 for discordant vs. concordant advice ) . Watching under 2 hours of television daily ( OR , 0.18 ; 95 % CI , 0.03 - 1.03 ) , and engaging in regular physical activity during pregnancy ( OR , 0.35 ; 95 % CI , 0.11 - 1.09 ) were suggestive of a reduced risk of excessive gain . CONCLUSIONS In this sample of urban , low-income women , high early pregnancy body mass index , nulliparity , and discordant clinician advice were directly associated with excessive gestational weight gain , with a trend toward decreased risk for viewing fewer hours of television and engaging in regular physical activity . Intervening on these targets may optimize gestational weight gain and promote long-term maternal health The epigenetic profile of the developing fetus is sensitive to environmental influence . Maternal diet has been shown to influence DNA methylation patterns in offspring , but research in humans is limited . We investigated the impact of a low glycaemic index dietary intervention during pregnancy on offspring DNA methylation patterns using a genome-wide methylation approach . Sixty neonates were selected from the ROLO ( R and omised cOntrol trial of LOw glycaemic index diet to prevent macrosomia ) study : 30 neonates from the low glycaemic index intervention arm and 30 from the control , whose mothers received no specific dietary advice .  DNA methylation was investigated in 771,484 CpG sites in free DNA from cord blood serum . Principal component analysis and linear regression were carried out comparing the intervention and control groups . Gene clustering and pathway analysis were also explored . Widespread variation was identified in the newborns exposed to the dietary intervention , accounting for 11 % of the total level of DNA methylation variation within the data set . No association was found with  maternal early-pregnancy body mass index ( BMI ) , infant sex , or birthweight . Pathway analysis identified common influences of the intervention on gene clusters plausibly linked to pathways targeted by the intervention , including cardiac and immune functioning . Analysis in 60 additional sample s from the ROLO study failed to replicate the original findings . Using a modest-sized discovery sample , we identified preliminary evidence of differential methylation in progeny of mothers exposed to a dietary intervention during pregnancy OBJECTIVES : ( 1 ) To describe the relative importance of gestational weight gain , postpartum exercise , food intake and breastfeeding to weight change from early pregnancy to 1 y postpartum ; and ( 2 ) to identify subgroups of women at greatest risk for major weight gain surrounding childbearing . DESIGN : A prospect i ve cohort study of women who registered for obstetrical care in a hospital and primary care clinic system serving a 10 county area of upstate New York . SUBJECTS : A total of 540 healthy adult women who gave birth to full-term singleton infants . MEASUREMENTS : Sociodemographic characteristics , exercise , food-related behaviors and breastfeeding were assessed using the medical record and a mailed question naire .  Body weight was measured at prenatal visits and 1 y postpartum . Weight retained and major weight gain ( 4.55 kg ) at 1 y postpartum were the main outcomes . ANALYSIS : Linear and logistic regression analyses were conducted . RESULTS : Women were on average 1.51±5.95 kg heavier at 1 y postpartum than they were in early pregnancy . Nearly 25 % of women experienced a major weight gain of 4.55 kg or more at 1 y postpartum . Gestational weight gain , exercise frequency , change in food intake and breastfeeding were each significantly related to postpartum weight retention . With the exception of breastfeeding , all of these factors were also associated with major weight gain .  Women under 20 y or over 40 y at delivery , and single women retained significantly more weight .  Lower income women with gestational weight gains above the Institute of Medicine ( IOM ) range retained 3.73 kg more than lower income women who gained within the range . They were also 4.7 times more likely to experience major weight gain with childbearing . The impact of exceeding the IOM gestational weight gain guidelines was three times greater in lower income women than it was in higher income women . CONCLUSION : Gestational weight gain , postpartum exercise frequency , and food intake are significantly associated with weight change from early pregnancy to 1 y postpartum and major weight gain with childbearing . Lower income women who gain more weight in pregnancy than the IOM recommends are at high risk for major weight gain with childbearing Abstract Objective : To evaluate the association between  excessive weight gain and pregnancy-related hypertension ( PRH )  among obese women ( body mass index ( BMI ) ≥30 kg/m2 ) . Methods : We performed a case control study among women with ( n = 440 ) and without ( n = 600 ) PRH from 2005 to 2007 . Height and weight were recorded at initial and final prenatal visits . 695 women had BMI recorded at ≤18 weeks of gestation , of which 257 ( 36.9 % ) were obese . Obese women were divided into three categories based on 2009 Institute of Medicine ( IOM ) guidelines : ( 1 ) below recommended amount ( under weight gain – UWG ) ; ( 2 ) more than recommended ( excessive weight gain – EWG ) or ( 3 ) within recommended amount ( normal weight gain – NWG ) . PRH was defined as gestational hypertension , mild or severe preeclampsia . Patients with and without PRH were prospect ively identified . The association between weight gain category and development of PRH was analyzed . Results : We noticed a 1.5-fold higher odds of having PRH with an initial BMI ≥30 kg/m2 compared to BMI < 30 kg/m2 ( OR 1.64 , 95 % CI 1.2–2.2 , p = 0.002 ) . Among obese women , we noted a 2-fold higher odds of having PRH with EWG compared to NWG ( OR 2.52 , 95 % CI 1.2–3.9 , p = 0.012 ) . The increased odds persisted after adjusting for race , chronic hypertension and diabetes , and length of gestation ( AOR 2.61 , 95 % CI 1.4–4.9 , p = 0.003 ) . Among obese women with PRH , those with EWG had a 76 % decreased odds of having severe disease compared to NWG ( OR = 0.242 [ 0.07–0.79 ] , p = 0.019 ) . Conclusion : We have demonstrated that EWG among obese patients  increases overall risk of PRH BACKGROUND Maternal prepregnancy obesity ( BMI ≥30 kg/m(2 ) ) and excessive gestational weight gain ( GWG ) have shown a strong positive association with a higher BMI and risk of obesity  in the offspring . The aim of this study is to estimate the effect of a GWG restriction program for obese pregnant women on the children 's BMI at 5 years of age and weight-for-length/height ( WL/H ) development from 2 months of age until 5 years of age . METHODS This was a follow-up study of 302 children ( 137 children in an intervention group and 165 children in a control group ) whose mothers participated in a weight gain restriction program during pregnancy . RESULTS BMI at five years of age did not differ between girls and boys in the intervention and control group . The degree of maternal GWG , < 7 kg or ≥7 kg , did not affect the offspring 's WL/H. Compared with Swedish reference data , just over half of the children in both the intervention and control group had a BMI within the average range , whereas slightly more than one-third of the children had a higher BMI . CONCLUSION Despite a comprehensive gestational intervention program for obese women containing individual weekly visits and opportunity to participate in aqua aerobic classes , there were no differences between BMI or weight development among the offspring at 5 years of age in the intervention and control group The purpose of the research project was to examine the effects of exercise , social support and depression on post 
    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: Overweight and obesity affects more than 66 % of the adult population and is associated with a variety of chronic diseases . Weight reduction reduces health risks associated with chronic diseases and is therefore encouraged by major health agencies . Guidelines of the National Heart , Lung , and Blood Institute ( NHLBI ) encourage a 10 % reduction in weight , although considerable literature indicates reduction in health risk with 3 % to 5 % reduction in weight . Physical activity ( PA ) is recommended as a component of weight management for prevention of weight gain , for weight loss , and for prevention of weight regain after weight loss . In 2001 , the American College of Sports Medicine ( ACSM ) published a Position St and that recommended a minimum of 150 min wk(-1 ) of moderate-intensity PA for overweight and obese adults to improve health ; however , 200 - 300 min wk(-1 ) was recommended for long-term weight loss . More recent evidence has supported this recommendation and has indicated more PA may be necessary to prevent weight regain after weight loss . To this end , we have reexamined the evidence from 1999 to determine whether there is a level at which PA is effective for prevention of weight gain , for weight loss , and prevention of weight regain . Evidence supports moderate-intensity PA between 150 and 250 min wk(-1 ) to be effective to prevent weight gain .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will provide only modest weight loss . Greater amounts of PA ( > 250 min wk(-1 ) ) have been associated with clinical ly significant weight loss .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will improve weight loss in studies that use moderate diet restriction but not severe diet restriction . Cross-sectional and prospect i ve studies indicate that after weight loss , weight maintenance is improved with PA > 250 min wk(-1 ) . However , no evidence from well- design ed r and omized controlled trials exists to judge the effectiveness of PA for prevention of weight regain after weight loss .  Resistance training does not enhance weight loss but may increase fat-free mass and increase loss of fat mass and is associated with reductions in health risk . Existing evidence indicates that endurance PA or resistance training without weight loss improves health risk . There is inadequate evidence to determine whether PA prevents or attenuates detrimental changes in chronic disease risk during weight gain OBJECTIVE To evaluate whether morbidly obese women have an increased risk of pregnancy complications and adverse perinatal outcomes . METHODS In a prospect i ve population -based cohort study , 3,480 women with morbid obesity , defined as a body mass index ( BMI ) more than 40 , and 12,698 women with a BMI between 35.1 and 40 were compared with normal-weight women ( BMI 19.8 - 26 ) . The perinatal outcome of singletons born to women without insulin-dependent diabetes mellitus was evaluated after suitable adjustments . RESULTS In the group of morbidly obese mothers ( BMI greater than 40 ) as compared with the normal-weight mothers , there was an increased risk of the following outcomes ( adjusted odds ratio ; 95 % confidence interval ) : preeclampsia ( 4.82 ; 4.04 , 5.74 ) , antepartum stillbirth ( 2.79 ; 1.94 , 4.02 ) , cesarean delivery ( 2.69 ; 2.49 , 2.90 ) , instrumental delivery ( 1.34 ; 1.16 , 1.56 ) , shoulder dystocia ( 3.14 ; 1.86 , 5.31 ) , meconium aspiration ( 2.85 ; 1.60 , 5.07 ) , fetal distress ( 2.52 ; 2.12 , 2.99 ) , early neonatal death ( 3.41 ; 2.07 , 5.63 ) , and large-for-gestational age ( 3.82 ; 3.50 , 4.16 ) . The associations were similar for women with BMI s between 35.1 and 40 but to a lesser degree . CONCLUSION Maternal morbid obesity in early pregnancy is strongly associated with a number of pregnancy complications and perinatal conditions . LEVEL OF EVIDENCE BACKGROUND Factors influencing excessive weight gain in pregnancy have not been well-studied among urban , low-income women . METHODS This prospect i ve cohort study of 94 prenatal care patients at a large university hospital in Philadelphia examined associations of modifiable midpregnancy behaviors and nonmodifiable or early pregnancy factors with  excessive gestational weight gain . Data were collected through question naires and medical record abstract ion from 2009 to 2011 . FINDINGS The majority of women were African American ( 83 % ) and all ( 100 % ) received Medicaid . Nearly two thirds ( 60 % ) were overweight or obese in early pregnancy and 41 % experienced excessive gain . In multivariable logistic regression analyses , significant predictors of excessive gestational weight gain included high early pregnancy body mass index ( odds ratio [ OR ] , 4.20 ; 95 % confidence interval [ CI ] , 1.43 - 12.34 for overweight/obese vs. normal weight ) , nulliparity ( OR , 3.35 ; 95 % CI , 1.17 - 9.62 for nulliparity vs. multiparity ) , and clinician advice discordant with Institute of Medicine guidelines ( OR , 5.88 ; 95 % CI , 1.04 - 33.32 for discordant vs. concordant advice ) . Watching under 2 hours of television daily ( OR , 0.18 ; 95 % CI , 0.03 - 1.03 ) , and engaging in regular physical activity during pregnancy ( OR , 0.35 ; 95 % CI , 0.11 - 1.09 ) were suggestive of a reduced risk of excessive gain . CONCLUSIONS In this sample of urban , low-income women , high early pregnancy body mass index , nulliparity , and discordant clinician advice were directly associated with excessive gestational weight gain , with a trend toward decreased risk for viewing fewer hours of television and engaging in regular physical activity . Intervening on these targets may optimize gestational weight gain and promote long-term maternal health The epigenetic profile of the developing fetus is sensitive to environmental influence . Maternal diet has been shown to influence DNA methylation patterns in offspring , but research in humans is limited . We investigated the impact of a low glycaemic index dietary intervention during pregnancy on offspring DNA methylation patterns using a genome-wide methylation approach . Sixty neonates were selected from the ROLO ( R and omised cOntrol trial of LOw glycaemic index diet to prevent macrosomia ) study : 30 neonates from the low glycaemic index intervention arm and 30 from the control , whose mothers received no specific dietary advice .  DNA methylation was investigated in 771,484 CpG sites in free DNA from cord blood serum . Principal component analysis and linear regression were carried out comparing the intervention and control groups . Gene clustering and pathway analysis were also explored . Widespread variation was identified in the newborns exposed to the dietary intervention , accounting for 11 % of the total level of DNA methylation variation within the data set . No association was found with  maternal early-pregnancy body mass index ( BMI ) , infant sex , or birthweight . Pathway analysis identified common influences of the intervention on gene clusters plausibly linked to pathways targeted by the intervention , including cardiac and immune functioning . Analysis in 60 additional sample s from the ROLO study failed to replicate the original findings . Using a modest-sized discovery sample , we identified preliminary evidence of differential methylation in progeny of mothers exposed to a dietary intervention during pregnancy OBJECTIVES : ( 1 ) To describe the relative importance of gestational weight gain , postpartum exercise , food intake and breastfeeding to weight change from early pregnancy to 1 y postpartum ; and ( 2 ) to identify subgroups of women at greatest risk for major weight gain surrounding childbearing . DESIGN : A prospect i ve cohort study of women who registered for obstetrical care in a hospital and primary care clinic system serving a 10 county area of upstate New York . SUBJECTS : A total of 540 healthy adult women who gave birth to full-term singleton infants . MEASUREMENTS : Sociodemographic characteristics , exercise , food-related behaviors and breastfeeding were assessed using the medical record and a mailed question naire .  Body weight was measured at prenatal visits and 1 y postpartum . Weight retained and major weight gain ( 4.55 kg ) at 1 y postpartum were the main outcomes . ANALYSIS : Linear and logistic regression analyses were conducted . RESULTS : Women were on average 1.51±5.95 kg heavier at 1 y postpartum than they were in early pregnancy . Nearly 25 % of women experienced a major weight gain of 4.55 kg or more at 1 y postpartum . Gestational weight gain , exercise frequency , change in food intake and breastfeeding were each significantly related to postpartum weight retention . With the exception of breastfeeding , all of these factors were also associated with major weight gain .  Women under 20 y or over 40 y at delivery , and single women retained significantly more weight .  Lower income women with gestational weight gains above the Institute of Medicine ( IOM ) range retained 3.73 kg more than lower income women who gained within the range . They were also 4.7 times more likely to experience major weight gain with childbearing . The impact of exceeding the IOM gestational weight gain guidelines was three times greater in lower income women than it was in higher income women . CONCLUSION : Gestational weight gain , postpartum exercise frequency , and food intake are significantly associated with weight change from early pregnancy to 1 y postpartum and major weight gain with childbearing . Lower income women who gain more weight in pregnancy than the IOM recommends are at high risk for major weight gain with childbearing Abstract Objective : To evaluate the association between  excessive weight gain and pregnancy-related hypertension ( PRH )  among obese women ( body mass index ( BMI ) ≥30 kg/m2 ) . Methods : We performed a case control study among women with ( n = 440 ) and without ( n = 600 ) PRH from 2005 to 2007 . Height and weight were recorded at initial and final prenatal visits . 695 women had BMI recorded at ≤18 weeks of gestation , of which 257 ( 36.9 % ) were obese . Obese women were divided into three categories based on 2009 Institute of Medicine ( IOM ) guidelines : ( 1 ) below recommended amount ( under weight gain – UWG ) ; ( 2 ) more than recommended ( excessive weight gain – EWG ) or ( 3 ) within recommended amount ( normal weight gain – NWG ) . PRH was defined as gestational hypertension , mild or severe preeclampsia . Patients with and without PRH were prospect ively identified . The association between weight gain category and development of PRH was analyzed . Results : We noticed a 1.5-fold higher odds of having PRH with an initial BMI ≥30 kg/m2 compared to BMI < 30 kg/m2 ( OR 1.64 , 95 % CI 1.2–2.2 , p = 0.002 ) . Among obese women , we noted a 2-fold higher odds of having PRH with EWG compared to NWG ( OR 2.52 , 95 % CI 1.2–3.9 , p = 0.012 ) . The increased odds persisted after adjusting for race , chronic hypertension and diabetes , and length of gestation ( AOR 2.61 , 95 % CI 1.4–4.9 , p = 0.003 ) . Among obese women with PRH , those with EWG had a 76 % decreased odds of having severe disease compared to NWG ( OR = 0.242 [ 0.07–0.79 ] , p = 0.019 ) . Conclusion : We have demonstrated that EWG among obese patients  increases overall risk of PRH BACKGROUND Maternal prepregnancy obesity ( BMI ≥30 kg/m(2 ) ) and excessive gestational weight gain ( GWG ) have shown a strong positive association with a higher BMI and risk of obesity  in the offspring . The aim of this study is to estimate the effect of a GWG restriction program for obese pregnant women on the children 's BMI at 5 years of age and weight-for-length/height ( WL/H ) development from 2 months of age until 5 years of age . METHODS This was a follow-up study of 302 children ( 137 children in an intervention group and 165 children in a control group ) whose mothers participated in a weight gain restriction program during pregnancy . RESULTS BMI at five years of age did not differ between girls and boys in the intervention and control group . The degree of maternal GWG , < 7 kg or ≥7 kg , did not affect the offspring 's WL/H. Compared with Swedish reference data , just over half of the children in both the intervention and control group had a BMI within the average range , whereas slightly more than one-third of the children had a higher BMI . CONCLUSION Despite a comprehensive gestational intervention program for obese women containing individual weekly visits and opportunity to participate in aqua aerobic classes , there were no differences between BMI or weight development among the offspring at 5 years of age in the intervention and control group The purpose of the research project was to examine the effects of exercise , social support and depression on post 
    Output:
    