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: Aims /hypothesis . To test the hypothesis that small size for gestation and poor postnatal growth in preterm infants is associated with higher fasting and post-load plasma glucose and insulin concentrations at 9–12 years of age.¶ Methods . Prospect i ve follow-up at 9–12 years of 385 preterm children with birth weight less than 1850 g , who had anthropometry recorded at birth , 18 months and 7 years .  Fasting plasma glucose , insulin , proinsulin and 32,33 split proinsulin concentrations and glucose and insulin concentrations 30 min after a st and ard glucose load were measured.¶ Results . Post-load glucose concentrations were negatively related to birth weight , independently of gestation or subsequent growth . Fasting split proinsulin and 30-min insulin concentrations were highest in children who showed the greatest increase in weight centile between birth and current follow-up , regardless of gestation . When weight during childhood was included , birthweight centile was , however , no longer statistically significant : concentrations of fasting , split , proinsulin and 30-min insulin were highest in those children who had shown the greatest increase in weight centile between 18 months of age and current follow-up , with no evidence of a greater effect in those who were smallest at 18 months.¶ Conclusion /interpretation . Our findings suggest that fetal growth influences plasma glucose 30 min after a glucose load in preterm children at 9–12 years . In contrast , childhood weight gain is the most important factor influencing insulin concentrations and this effect is the same regardless of early size . [ Diabetologia ( 2000 ) 43 : 714–717 A large multicentre study on the short and long term clinical and developmental outcome of infants r and omised to different diets is being undertaken . This report represents an interim analysis of the early postnatal growth performance of an unselected population of 194 preterm infants ( gestation , mean ( SD ) 31 . 0 ( 2 . 9 ) weeks ; birthweight , mean ( SD ) 1364 ( 294 ) g ) , both ill and well , examined in two ( of four ) parallel trials . One trial compared banked breast milk with a new preterm formula ( primary trial ) ; the other compared these diets as supplements to maternal milk ( supplement trial ) . A major dietary effect on the number of days taken to regain birthweight and subsequent gains in weight , length , and head circumference was observed in the primary trial . Infants fed banked breast milk  and weighing less than 1200 g at birth took a calculated additional three weeks to reach 2000 g compared with those fed on the preterm formula . A significant influence of diet on body proportions was seen in the relation between body weight , head circumference , and length . Similar though smaller differences in growth patterns were seen in the supplement trial . By the time they reach 2000 g , infants of birthweights 1200 to 1849 g fed on banked breast milk and infants below 1200 g fed on either banked breast milk or maternal milk supplemented ( as necessary ) with banked breast milk , fulfilled stringent criteria for failure to thrive ( weight less than 2 SD below the mean for age ) . Only infants fed the preterm formula as their sole diet had maintained their birth centile by discharge from hospital . The misleading nature of comparisons between extrauterine and intrauterine steady state weight gains is emphasised BACKGROUND Recent epidemiological evidence has shown increased rates of cardiovascular mortality and associated risk factors in those born small . However , scarce information exists concerning cardiovascular risk factors in adulthood following pre-term birth , or distinguishing the relative contributions of length of gestation and fetal growth to small size at birth . METHODS Prospect i ve follow-up of 458 30-year-olds whose mothers took part in a r and omized controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome ( 147 born at term , 311 born pre-term ) . Follow-up assessment s included anthropometry , blood pressure , blood lipids , early morning cortisol levels and  75 g oral glucose tolerance test .  RESULTS Gestational age at birth , pre-term birth , and birth weight z-score were not associated with serum cholesterol , triglyceride or cortisol at age 30 ( P > 0.1 for all ) . However , pre-term birth was associated with increased systolic blood pressure ( 3.5 mmHg , 95 % CI 0.9 - 6.1 mmHg , P = 0.009 ) and insulin resistance at age 30 [ Log ( Insulin area under the curve ) = 0.17 , 95 % CI 0.05 - 0.28 , P = 0.006 ] . Low gestational age at birth was also associated with these outcomes , whereas birth weight , adjusted for gestational age , was not . CONCLUSIONS Adults who were born moderately pre-term have increased blood pressure and insulin resistance at 30 years of age . Pre-term birth rather than poor fetal growth is the major determinant of this association . As both the incidence of pre-term birth and survival amongst those born pre-term are increasing , this group may contribute an increasing proportion to overall cardiovascular disease burden Objective To determine outcomes at age 3 years in babies born before 27 completed weeks ’ gestation in 2006 , and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks ’ gestation . Design Prospect i ve national cohort studies , EPICure and EPICure 2 . Setting Hospital and home based evaluations , Engl and . Participants 1031 surviving babies born in 2006 before 27 completed weeks ’ gestation . Outcomes for 584 babies born at 22 - 25 weeks ’ gestation were compared with those of 260 surviving babies of the same gestational age born in 1995 . Main outcome measures Survival to age 3 years , impairment ( 2008 consensus definitions ) , and developmental scores . Multiple imputation was used to account for the high proportion of missing data in the 2006 cohort . Results Of the 576 babies evaluated after birth in 2006 , 13.4 % ( n=77 ) were categorised as having severe impairment and 11.8 % ( n=68 ) moderate impairment . The prevalence of neurodevelopmental impairment was significantly associated with length of gestation , with greater impairment as gestational age decreased : 45 % at 22 - 23 weeks , 30 % at 24 weeks , 25 % at 25 weeks , and 20 % at 26 weeks ( P<0.001 ) . Cerebral palsy was present in 83 ( 14 % ) survivors . Mean developmental quotients were lower than those of the general population ( normal values 100 ( SD 15 ) ) and showed a direct relation with gestational age : 80 ( SD 21 ) at 22 - 23 weeks , 87 ( 19 ) at 24 weeks , 88 ( 19 ) at 25 weeks , and 91 ( 18 ) at 26 weeks . These results did not differ significantly after imputation . Comparing imputed outcomes between the 2006 and 1995 cohorts , the proportion of survivors born between 22 and 25 weeks ’ gestation with severe disability , using 1995 definitions , was 18 % ( 95 % confidence interval 14 % to 24 % ) in 1995 and 19 % ( 14 % to 23 % ) in 2006 . Fewer survivors had shunted hydrocephalus or seizures . Survival of babies admitted for neonatal care increased from 39 % ( 35 % to 43 % ) in 1995 to 52 % ( 49 % to 55 % ) in 2006 , an increase of 13 % ( 8 % to 18 % ) , and survival without disability increased from 23 % ( 20 % to 26 % ) in 1995 to 34 % ( 31 % to 37 % ) in 2006 , an increase of 11 % ( 6 % to 16 % ) . Conclusion Survival and impairment in early childhood are both closely related to gestational age for babies born at less than 27 weeks ’ gestation . Using multiple imputation to account for the high proportion of missing values , a higher proportion of babies admitted for neonatal care now survive without disability , particularly those born at gestational ages 24 and 25 weeks BACKGROUND In animals , acceleration of neonatal growth is thought to increase the later propensity to insulin resistance and non-insulin-dependent diabetes , whereas slow growth as a consequence of undernutrition is thought to have a beneficial effect . To test this hypothesis in people , we measured fasting concentrations of 32 - 33 split proinsulin , a marker of insulin resistance , in adolescents born preterm who had participated in r and omised intervention trials of neonatal nutrition , and in adolescents born at term . METHODS We determined fasting 32 - 33 split proinsulin concentration in participants aged 13 - 16 years born preterm and r and omised to receive a nutrient-enriched or lower-nutrient diet ( n=216 ) or in a reference group born at term ( n=61 ) . FINDINGS Fasting 32 - 33 split proinsulin concentration was greater in children given a nutrient-enriched diet ( geometric mean 7.2 pmol/L , 95 % CI 6.4 - 8.1 ) than in those given the lower-nutrient diet ( 5.9 pmol/L [ 5.2 - 6.4 ] ; mean difference 20.6 % [ 5.0 - 36.3 ] ; p=0.01 ) . Healthy babies born at term had similar fasting 32 - 33 split proinsulin concentrations ( 6.9 pmol/L ; 6.0 - 8.2 ) to the nutrient-enriched group . In non-r and omised analyses , fasting 32 - 33 split proinsulin concentration was associated with greater weight gain the first 2 weeks of life ( 13.2 % [ 5.4 - 20.9 ] change per 100 g weight increase ; p=0.001 ) independent of birthweight , gestation , neonatal morbidity , and demographic , anthropometric , and socioeconomic factors . INTERPRETATION Our results suggest that relative undernutrition early in life in children born preterm may have beneficial effects on insulin resistance OBJECTIVE Impaired fetal development may contribute to decreased insulin sensitivity . This study was design ed to characterize serum markers of insulin resistance in adults born small for date or born prematurely . STUDY DESIGN Fifty subjects , all women , were evaluated at a mean age + /- SD of 26 + /- 2 years ( range : 23 - 30 years ) . They were allocated to three groups : ( i ) born fullterm with birth weight < 2600 g ( n = 18 ) ( small for gestational age , SGA ) , ( ii ) born before gestational week 32 ( n = 15 ) ( ex-preterm ) , and ( iii ) controls , born fullterm with appropriate birth weight ( n = 17 ) .  Anthropometric data as well as  fasting serum sample s of plasma B-glucose , serum lipids , insulin , insulin-like growth factor-I ( IGF-I ) and insulin-like growth factor binding protein-1 ( IGFBP-1 ) levels were determined . RESULTS In the SGA group final height was lower and they weighed less compared with the controls . Fasting insulin and glucose levels did not differ amongst the groups . Triglycerides were lower in the SGA group and in the ex-preterm group compared with the controls ( P < 0.05 ) . The SGA group showed lower IGFBP-1 levels compared with the controls median 17 ( range 3 - 121 ) vs. 26 ( 7 - 67 ) microg L-1 ; P < 0.05 ] . The IGF-I levels in the SGA , ex-preterm and control groups were 212 + /- 58 , 259 + /- 37 and 216 + /- 32 microg L-1 , respectively , corresponding to a mean SD score of -0.8 + /- 1.0 , 0.1 + /- 0.6 and -0.6 + /- 0.6 . CONCLUSION As IGFBP-1 is a marker of insulin sensitivity , the low levels observed in adult women with normal BMI , born small for date , suggest relative insulin resistance in spite of normal BMI Reduced insulin sensitivity in adult life has been reported in subjects born at term small for gestational age ( SGA ) and in those born prematurely with very low birth weight ( LBW ) ( < 1,500 g ) . We assessed whether LBW ( < 2,500 g ) young women , irrespective of whether they were born SGA or adequate for gestational age ( premature AGA ) , exhibited a reduction in insulin sensitivity through a prospect i ve historical design . The risk of developing biochemical and clinical features of polycystic ovary syndrome was also investigated . The study population included 35 LBW women ( 19 SGA [ BW range , 1,000 - 2,400 g ] and 16 premature AGA [ BW range , 1,700 - 2,440 g ] ) aged 21.8 + / 
    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: Aims /hypothesis . To test the hypothesis that small size for gestation and poor postnatal growth in preterm infants is associated with higher fasting and post-load plasma glucose and insulin concentrations at 9–12 years of age.¶ Methods . Prospect i ve follow-up at 9–12 years of 385 preterm children with birth weight less than 1850 g , who had anthropometry recorded at birth , 18 months and 7 years .  Fasting plasma glucose , insulin , proinsulin and 32,33 split proinsulin concentrations and glucose and insulin concentrations 30 min after a st and ard glucose load were measured.¶ Results . Post-load glucose concentrations were negatively related to birth weight , independently of gestation or subsequent growth . Fasting split proinsulin and 30-min insulin concentrations were highest in children who showed the greatest increase in weight centile between birth and current follow-up , regardless of gestation . When weight during childhood was included , birthweight centile was , however , no longer statistically significant : concentrations of fasting , split , proinsulin and 30-min insulin were highest in those children who had shown the greatest increase in weight centile between 18 months of age and current follow-up , with no evidence of a greater effect in those who were smallest at 18 months.¶ Conclusion /interpretation . Our findings suggest that fetal growth influences plasma glucose 30 min after a glucose load in preterm children at 9–12 years . In contrast , childhood weight gain is the most important factor influencing insulin concentrations and this effect is the same regardless of early size . [ Diabetologia ( 2000 ) 43 : 714–717 A large multicentre study on the short and long term clinical and developmental outcome of infants r and omised to different diets is being undertaken . This report represents an interim analysis of the early postnatal growth performance of an unselected population of 194 preterm infants ( gestation , mean ( SD ) 31 . 0 ( 2 . 9 ) weeks ; birthweight , mean ( SD ) 1364 ( 294 ) g ) , both ill and well , examined in two ( of four ) parallel trials . One trial compared banked breast milk with a new preterm formula ( primary trial ) ; the other compared these diets as supplements to maternal milk ( supplement trial ) . A major dietary effect on the number of days taken to regain birthweight and subsequent gains in weight , length , and head circumference was observed in the primary trial . Infants fed banked breast milk  and weighing less than 1200 g at birth took a calculated additional three weeks to reach 2000 g compared with those fed on the preterm formula . A significant influence of diet on body proportions was seen in the relation between body weight , head circumference , and length . Similar though smaller differences in growth patterns were seen in the supplement trial . By the time they reach 2000 g , infants of birthweights 1200 to 1849 g fed on banked breast milk and infants below 1200 g fed on either banked breast milk or maternal milk supplemented ( as necessary ) with banked breast milk , fulfilled stringent criteria for failure to thrive ( weight less than 2 SD below the mean for age ) . Only infants fed the preterm formula as their sole diet had maintained their birth centile by discharge from hospital . The misleading nature of comparisons between extrauterine and intrauterine steady state weight gains is emphasised BACKGROUND Recent epidemiological evidence has shown increased rates of cardiovascular mortality and associated risk factors in those born small . However , scarce information exists concerning cardiovascular risk factors in adulthood following pre-term birth , or distinguishing the relative contributions of length of gestation and fetal growth to small size at birth . METHODS Prospect i ve follow-up of 458 30-year-olds whose mothers took part in a r and omized controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome ( 147 born at term , 311 born pre-term ) . Follow-up assessment s included anthropometry , blood pressure , blood lipids , early morning cortisol levels and  75 g oral glucose tolerance test .  RESULTS Gestational age at birth , pre-term birth , and birth weight z-score were not associated with serum cholesterol , triglyceride or cortisol at age 30 ( P > 0.1 for all ) . However , pre-term birth was associated with increased systolic blood pressure ( 3.5 mmHg , 95 % CI 0.9 - 6.1 mmHg , P = 0.009 ) and insulin resistance at age 30 [ Log ( Insulin area under the curve ) = 0.17 , 95 % CI 0.05 - 0.28 , P = 0.006 ] . Low gestational age at birth was also associated with these outcomes , whereas birth weight , adjusted for gestational age , was not . CONCLUSIONS Adults who were born moderately pre-term have increased blood pressure and insulin resistance at 30 years of age . Pre-term birth rather than poor fetal growth is the major determinant of this association . As both the incidence of pre-term birth and survival amongst those born pre-term are increasing , this group may contribute an increasing proportion to overall cardiovascular disease burden Objective To determine outcomes at age 3 years in babies born before 27 completed weeks ’ gestation in 2006 , and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks ’ gestation . Design Prospect i ve national cohort studies , EPICure and EPICure 2 . Setting Hospital and home based evaluations , Engl and . Participants 1031 surviving babies born in 2006 before 27 completed weeks ’ gestation . Outcomes for 584 babies born at 22 - 25 weeks ’ gestation were compared with those of 260 surviving babies of the same gestational age born in 1995 . Main outcome measures Survival to age 3 years , impairment ( 2008 consensus definitions ) , and developmental scores . Multiple imputation was used to account for the high proportion of missing data in the 2006 cohort . Results Of the 576 babies evaluated after birth in 2006 , 13.4 % ( n=77 ) were categorised as having severe impairment and 11.8 % ( n=68 ) moderate impairment . The prevalence of neurodevelopmental impairment was significantly associated with length of gestation , with greater impairment as gestational age decreased : 45 % at 22 - 23 weeks , 30 % at 24 weeks , 25 % at 25 weeks , and 20 % at 26 weeks ( P<0.001 ) . Cerebral palsy was present in 83 ( 14 % ) survivors . Mean developmental quotients were lower than those of the general population ( normal values 100 ( SD 15 ) ) and showed a direct relation with gestational age : 80 ( SD 21 ) at 22 - 23 weeks , 87 ( 19 ) at 24 weeks , 88 ( 19 ) at 25 weeks , and 91 ( 18 ) at 26 weeks . These results did not differ significantly after imputation . Comparing imputed outcomes between the 2006 and 1995 cohorts , the proportion of survivors born between 22 and 25 weeks ’ gestation with severe disability , using 1995 definitions , was 18 % ( 95 % confidence interval 14 % to 24 % ) in 1995 and 19 % ( 14 % to 23 % ) in 2006 . Fewer survivors had shunted hydrocephalus or seizures . Survival of babies admitted for neonatal care increased from 39 % ( 35 % to 43 % ) in 1995 to 52 % ( 49 % to 55 % ) in 2006 , an increase of 13 % ( 8 % to 18 % ) , and survival without disability increased from 23 % ( 20 % to 26 % ) in 1995 to 34 % ( 31 % to 37 % ) in 2006 , an increase of 11 % ( 6 % to 16 % ) . Conclusion Survival and impairment in early childhood are both closely related to gestational age for babies born at less than 27 weeks ’ gestation . Using multiple imputation to account for the high proportion of missing values , a higher proportion of babies admitted for neonatal care now survive without disability , particularly those born at gestational ages 24 and 25 weeks BACKGROUND In animals , acceleration of neonatal growth is thought to increase the later propensity to insulin resistance and non-insulin-dependent diabetes , whereas slow growth as a consequence of undernutrition is thought to have a beneficial effect . To test this hypothesis in people , we measured fasting concentrations of 32 - 33 split proinsulin , a marker of insulin resistance , in adolescents born preterm who had participated in r and omised intervention trials of neonatal nutrition , and in adolescents born at term . METHODS We determined fasting 32 - 33 split proinsulin concentration in participants aged 13 - 16 years born preterm and r and omised to receive a nutrient-enriched or lower-nutrient diet ( n=216 ) or in a reference group born at term ( n=61 ) . FINDINGS Fasting 32 - 33 split proinsulin concentration was greater in children given a nutrient-enriched diet ( geometric mean 7.2 pmol/L , 95 % CI 6.4 - 8.1 ) than in those given the lower-nutrient diet ( 5.9 pmol/L [ 5.2 - 6.4 ] ; mean difference 20.6 % [ 5.0 - 36.3 ] ; p=0.01 ) . Healthy babies born at term had similar fasting 32 - 33 split proinsulin concentrations ( 6.9 pmol/L ; 6.0 - 8.2 ) to the nutrient-enriched group . In non-r and omised analyses , fasting 32 - 33 split proinsulin concentration was associated with greater weight gain the first 2 weeks of life ( 13.2 % [ 5.4 - 20.9 ] change per 100 g weight increase ; p=0.001 ) independent of birthweight , gestation , neonatal morbidity , and demographic , anthropometric , and socioeconomic factors . INTERPRETATION Our results suggest that relative undernutrition early in life in children born preterm may have beneficial effects on insulin resistance OBJECTIVE Impaired fetal development may contribute to decreased insulin sensitivity . This study was design ed to characterize serum markers of insulin resistance in adults born small for date or born prematurely . STUDY DESIGN Fifty subjects , all women , were evaluated at a mean age + /- SD of 26 + /- 2 years ( range : 23 - 30 years ) . They were allocated to three groups : ( i ) born fullterm with birth weight < 2600 g ( n = 18 ) ( small for gestational age , SGA ) , ( ii ) born before gestational week 32 ( n = 15 ) ( ex-preterm ) , and ( iii ) controls , born fullterm with appropriate birth weight ( n = 17 ) .  Anthropometric data as well as  fasting serum sample s of plasma B-glucose , serum lipids , insulin , insulin-like growth factor-I ( IGF-I ) and insulin-like growth factor binding protein-1 ( IGFBP-1 ) levels were determined . RESULTS In the SGA group final height was lower and they weighed less compared with the controls . Fasting insulin and glucose levels did not differ amongst the groups . Triglycerides were lower in the SGA group and in the ex-preterm group compared with the controls ( P < 0.05 ) . The SGA group showed lower IGFBP-1 levels compared with the controls median 17 ( range 3 - 121 ) vs. 26 ( 7 - 67 ) microg L-1 ; P < 0.05 ] . The IGF-I levels in the SGA , ex-preterm and control groups were 212 + /- 58 , 259 + /- 37 and 216 + /- 32 microg L-1 , respectively , corresponding to a mean SD score of -0.8 + /- 1.0 , 0.1 + /- 0.6 and -0.6 + /- 0.6 . CONCLUSION As IGFBP-1 is a marker of insulin sensitivity , the low levels observed in adult women with normal BMI , born small for date , suggest relative insulin resistance in spite of normal BMI Reduced insulin sensitivity in adult life has been reported in subjects born at term small for gestational age ( SGA ) and in those born prematurely with very low birth weight ( LBW ) ( < 1,500 g ) . We assessed whether LBW ( < 2,500 g ) young women , irrespective of whether they were born SGA or adequate for gestational age ( premature AGA ) , exhibited a reduction in insulin sensitivity through a prospect i ve historical design . The risk of developing biochemical and clinical features of polycystic ovary syndrome was also investigated . The study population included 35 LBW women ( 19 SGA [ BW range , 1,000 - 2,400 g ] and 16 premature AGA [ BW range , 1,700 - 2,440 g ] ) aged 21.8 + / 
    Output:
    