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 Objective : To compare the efficacy of a daily and a weekly iron supplementation on the hematological status of anemic children living at high altitude . Design : Double blind iron supplementation trial including a placebo control group . Setting : A socioeconomically disadvantaged district of La Paz , Bolivia ( altitude of 4000 m ) . Subjects : Anemic ( hemoglobin concentration≤144 g/L ) , 3.3–8.3 y old children of both sexes . Intervention : Children received a placebo ( n=57 ) or a dose of 3–4 mg of elemental iron per kg body weight ( FeSO4 tablets ) 1 d per week ( n=58 ) or 5 d per week ( n=58 ) for 16 weeks . Results : Hemoglobin and zinc erythrocyte protoporphyrin concentrations improved significantly in supplemented groups but not in the placebo group . Changes in hemoglobin during the study were not significantly different between supplemented groups ( weekly group : 15.2±6.9 g/L and daily group : 18.6±11.1 g/L ) but were different from the placebo group ( 0.5±7.1 g/L , P<0.001 ) . At the end of the supplementation period , the hemoglobin distribution was Gaussian , and similar in both supplemented groups . Adjusting for the initial hemoglobin concentration , final hemoglobin and its changes were similar in both supplemented groups . Conclusion : Weekly iron supplementation is as efficacious as daily iron supplementation in improving iron status and correcting moderate iron deficiency anemia in Bolivian school children living at high altitude . Sponsorship : Program supported in part by ORSTROM , the French Ministry of Foreign Affairs and the National Secretary 's Office of Health , Bolivia Few studies have evaluated the impact of fortification with iron-rich foods such as amaranth grain and multi-micronutrient powder ( MNP ) containing low doses of highly bioavailable iron to control iron deficiency anemia ( IDA ) in children . We assessed the efficacy of maize porridge enriched with amaranth grain or MNP to reduce IDA in Kenyan preschool children . In a 16-wk intervention trial , children ( n = 279 ; 12 - 59 mo ) were r and omly assigned to : unrefined maize porridge ( control ; 4.1 mg of iron/meal ; phytate : iron molar ratio 5:1 ) ; unrefined maize ( 30 % ) and amaranth grain ( 70 % ) porridge ( amaranth group ; 23 mg of iron/meal ; phytate : iron molar ratio 3:1 ) ; or unrefined maize porridge with MNP ( MNP group ; 6.6 mg iron/meal ; phytate : iron molar ratio 2.6:1 ; 2.5 mg iron as NaFeEDTA ) . Primary outcomes were anemia and iron status with treatment effects estimated relative to control . At baseline , 38 % were anemic and 30 % iron deficient . Consumption of MNP reduced the prevalence of anemia [ -46 % ( 95 % CI : -67 , -12 ) ] , iron deficiency [ -70 % ( 95 % CI : -89 , -16 ) ] , and IDA [ -75 % ( 95 % CI : -92 , -20 ) ] . The soluble transferrin receptor [ -10 % ( 95 % CI : -16 , -4 ) ] concentration was lower , whereas the hemoglobin ( Hb ) [ 2.7 g/L ( 95 % CI : 0.4 , 5.1 ) ] and plasma ferritin [ 40 % ( 95 % CI : 10 , 95 ) ] concentrations increased in the MNP group . There was no significant change in Hb or iron status in the amaranth group . Consumption of maize porridge fortified with low-dose , highly bioavailable iron MNP can reduce the prevalence of IDA in preschool children . In contrast , fortification with amaranth grain did not improve iron status despite a large increase in iron intake , likely due to high ratio of phytic acid : iron in the meal BACKGROUND Children participating in the Integrated Child Development Service ( ICDS ) in India have high rates of iron and vitamin A deficiency . OBJECTIVE The objective was to assess the efficacy of a premix fortified with iron and vitamin A and added at the community level to prepared khichdi , a rice and dal mixture , in increasing iron and vitamin A stores and decreasing the prevalence of iron deficiency , anemia , and vitamin A deficiency . DESIGN This cluster , r and omized , double-blind , controlled trial was initiated in 30 Anganwadi centers ( daycare centers ) in West Bengal state , India . Children aged 36 - 66 mo ( n = 516 ) attending village-based ICDS centers were r and omly assigned to receive either a fortified or a nonfortified premix for 24 wk . Blood was drawn at 0 and 24 wk by venipuncture for the measurement of hemoglobin , serum ferritin , and serum retinol . RESULTS The change in the hemoglobin concentration of anemic children was significantly different between fortified and nonfortified khichdi groups ( P < 0.001 ) . Prevalence rates of anemia , iron deficiency , and iron deficiency anemia were significantly lower after 24 wk in the fortified-khichdi group than in the nonfortified-khichdi group ( P < 0.001 ) . There were no significant differences in serum retinol concentrations or in the prevalence of vitamin A deficiency between the fortified- and nonfortified-khichdi groups . CONCLUSION A premix fortified with iron , vitamin A , and folic acid and added to supplementary food at the community level can be effective at increasing iron stores and reducing the prevalence of iron deficiency and anemia To assess the impact of intensive nutrition education ( INE ) with or without the provision of micronutrient powder ( MNP ) on the nutritional status of mildly wasted children in Nias , Indonesia , two groups of mildly wasted ( > = -1.5 to < -1.0 WHZ ) children aged > = 6 to < 60 months in the Church World Service ( CWS ) project areas were assigned by village r and omization to receive INE ( n=64 ) or INE+MNP ( n=51 ) in a weekly program . Another two groups of mildly wasted children who were living at a clear distance from INE and INE+MNP villages were selected to receive a monthly non-intensive nutrition education program ( NNE ) with or without MNP ( n=50 both respectively ) . WHZ , weight , height , haemoglobin ( Hb ) level , and morbidity data were assessed at admission , during the study , and at individual discharge .  Children 's weight gain ( g/kg body weight/day ) was highest in INE+MNP group ( 2.2±2.1 ) , followed by INE ( 1.1±0.9 ) , NNE+MNP ( 0.3±0.5 ) and NNE ( 0.3±0.4 ) group . In both MNP intervention groups ( INE+MNP , NNE+MNP ) , supplements significantly increased Hb value ( g/L ) of respective children ( 10.0±10.0 ; p<0.001 and 3.0±8.0 ; p<0.05 respectively ) . Proportion of children who reached discharge criterion was highest among the INE+MNP ( 70.6 % ; n=36 ) , followed by INE ( 64.1 % ; n=41 ) , NNE+MNP ( 26.0 % ; n=13 ) , and NNE ( 20.0 % ; n=10 ) groups ( p<0.001 ) . Shortest length of stay until recovery was observed among children in the INE+MNP group ( 29.9 days ) , followed by INE ( 40.0 days ) , NNE+MNP ( 80.6 days ) , and NNE ( 86.2 days ) respectively ( p<0.001 ) . Weekly intensive nutrition education supported by MNP supplementation produced the best results regarding weight gain and haemoglobin status of mildly wasted children BACKGROUND Despite ample food supplies , the incidence of childhood underweight and stunting remains high in Ug and a. Many factors contribute to this situation , but the role of low zinc intakes has not been adequately explored . OBJECTIVE Our objective was to study the effect of zinc supplementation on growth and body composition of preschool children by using the outcome measures of weight , height , and midupper arm circumference ( MUAC ) . DESIGN The study was r and omized , double-blind , placebo-controlled , parallel , and 8 mo long , and incorporated 6 mo of zinc supplementation .  Children ( n = 153 ) aged 55.8 + /- 11.2 mo from 3 r and omly selected nursery schools of medium , low , and very low socioeconomic status in a suburb of Kampala took part . The intervention comprised 10 mg Zn ( as ZnSO4 ) or placebo daily in freshly prepared fruit juice , Monday to Friday inclusive . RESULTS Zinc supplementation increased MUAC by the end of the study ( P = 0.029 ) and led to greater weight gain in children from the school of medium socioeconomic status at 3 and 8 mo ( P = 0.019 and P = 0.038 , respectively ) . There was no effect on weight gain of the children from the other schools . Zinc supplementation had no influence on height . Infection rates ( of which 82 % were recorded as malaria ) were lower in the zinc-supplemented group than in control subjects ( P = 0.063 ) . CONCLUSIONS Zinc supplementation may counter the age-related decrease in MUAC often observed in preschool children in developing countries . The study provides evidence that zinc may not be the most limiting nutrient for weight gain in children of poor nutritional status , but may become so as nutritional status improves Growth faltering , anemia , and multiple micronutrient deficiency are common during infancy in developing countries . This South African trial was part of a multicenter study aim ed at testing the efficacy of multiple micronutrient supplementation on growth , anemia , micronutrient status , and morbidity during infancy across 4 countries . A total of 265 infants aged 6 - 12 mo were individually r and omized to 1 of 4 intervention groups : a daily multiple micronutrient supplement ( DMM ) , a daily placebo supplement ( P ) ; a multiple micronutrient supplement 1 d of the week and placebo supplement on the other days of the week ( WMM ) , and a daily iron supplement ( DI ) . For 6 mo , the blinded supplements were provided to mothers at monthly health clinic sessions , and consumption was verified during weekly household visits by community health workers , when morbidity was also checked . Weight and height of the infants were measured monthly , and blood sample s were taken at the beginning and at the end for assessing the infants micronutrient status . There were no significant differences in nutritional status of the groups at baseline with 40 % of infants with an 
    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 Objective : To compare the efficacy of a daily and a weekly iron supplementation on the hematological status of anemic children living at high altitude . Design : Double blind iron supplementation trial including a placebo control group . Setting : A socioeconomically disadvantaged district of La Paz , Bolivia ( altitude of 4000 m ) . Subjects : Anemic ( hemoglobin concentration≤144 g/L ) , 3.3–8.3 y old children of both sexes . Intervention : Children received a placebo ( n=57 ) or a dose of 3–4 mg of elemental iron per kg body weight ( FeSO4 tablets ) 1 d per week ( n=58 ) or 5 d per week ( n=58 ) for 16 weeks . Results : Hemoglobin and zinc erythrocyte protoporphyrin concentrations improved significantly in supplemented groups but not in the placebo group . Changes in hemoglobin during the study were not significantly different between supplemented groups ( weekly group : 15.2±6.9 g/L and daily group : 18.6±11.1 g/L ) but were different from the placebo group ( 0.5±7.1 g/L , P<0.001 ) . At the end of the supplementation period , the hemoglobin distribution was Gaussian , and similar in both supplemented groups . Adjusting for the initial hemoglobin concentration , final hemoglobin and its changes were similar in both supplemented groups . Conclusion : Weekly iron supplementation is as efficacious as daily iron supplementation in improving iron status and correcting moderate iron deficiency anemia in Bolivian school children living at high altitude . Sponsorship : Program supported in part by ORSTROM , the French Ministry of Foreign Affairs and the National Secretary 's Office of Health , Bolivia Few studies have evaluated the impact of fortification with iron-rich foods such as amaranth grain and multi-micronutrient powder ( MNP ) containing low doses of highly bioavailable iron to control iron deficiency anemia ( IDA ) in children . We assessed the efficacy of maize porridge enriched with amaranth grain or MNP to reduce IDA in Kenyan preschool children . In a 16-wk intervention trial , children ( n = 279 ; 12 - 59 mo ) were r and omly assigned to : unrefined maize porridge ( control ; 4.1 mg of iron/meal ; phytate : iron molar ratio 5:1 ) ; unrefined maize ( 30 % ) and amaranth grain ( 70 % ) porridge ( amaranth group ; 23 mg of iron/meal ; phytate : iron molar ratio 3:1 ) ; or unrefined maize porridge with MNP ( MNP group ; 6.6 mg iron/meal ; phytate : iron molar ratio 2.6:1 ; 2.5 mg iron as NaFeEDTA ) . Primary outcomes were anemia and iron status with treatment effects estimated relative to control . At baseline , 38 % were anemic and 30 % iron deficient . Consumption of MNP reduced the prevalence of anemia [ -46 % ( 95 % CI : -67 , -12 ) ] , iron deficiency [ -70 % ( 95 % CI : -89 , -16 ) ] , and IDA [ -75 % ( 95 % CI : -92 , -20 ) ] . The soluble transferrin receptor [ -10 % ( 95 % CI : -16 , -4 ) ] concentration was lower , whereas the hemoglobin ( Hb ) [ 2.7 g/L ( 95 % CI : 0.4 , 5.1 ) ] and plasma ferritin [ 40 % ( 95 % CI : 10 , 95 ) ] concentrations increased in the MNP group . There was no significant change in Hb or iron status in the amaranth group . Consumption of maize porridge fortified with low-dose , highly bioavailable iron MNP can reduce the prevalence of IDA in preschool children . In contrast , fortification with amaranth grain did not improve iron status despite a large increase in iron intake , likely due to high ratio of phytic acid : iron in the meal BACKGROUND Children participating in the Integrated Child Development Service ( ICDS ) in India have high rates of iron and vitamin A deficiency . OBJECTIVE The objective was to assess the efficacy of a premix fortified with iron and vitamin A and added at the community level to prepared khichdi , a rice and dal mixture , in increasing iron and vitamin A stores and decreasing the prevalence of iron deficiency , anemia , and vitamin A deficiency . DESIGN This cluster , r and omized , double-blind , controlled trial was initiated in 30 Anganwadi centers ( daycare centers ) in West Bengal state , India . Children aged 36 - 66 mo ( n = 516 ) attending village-based ICDS centers were r and omly assigned to receive either a fortified or a nonfortified premix for 24 wk . Blood was drawn at 0 and 24 wk by venipuncture for the measurement of hemoglobin , serum ferritin , and serum retinol . RESULTS The change in the hemoglobin concentration of anemic children was significantly different between fortified and nonfortified khichdi groups ( P < 0.001 ) . Prevalence rates of anemia , iron deficiency , and iron deficiency anemia were significantly lower after 24 wk in the fortified-khichdi group than in the nonfortified-khichdi group ( P < 0.001 ) . There were no significant differences in serum retinol concentrations or in the prevalence of vitamin A deficiency between the fortified- and nonfortified-khichdi groups . CONCLUSION A premix fortified with iron , vitamin A , and folic acid and added to supplementary food at the community level can be effective at increasing iron stores and reducing the prevalence of iron deficiency and anemia To assess the impact of intensive nutrition education ( INE ) with or without the provision of micronutrient powder ( MNP ) on the nutritional status of mildly wasted children in Nias , Indonesia , two groups of mildly wasted ( > = -1.5 to < -1.0 WHZ ) children aged > = 6 to < 60 months in the Church World Service ( CWS ) project areas were assigned by village r and omization to receive INE ( n=64 ) or INE+MNP ( n=51 ) in a weekly program . Another two groups of mildly wasted children who were living at a clear distance from INE and INE+MNP villages were selected to receive a monthly non-intensive nutrition education program ( NNE ) with or without MNP ( n=50 both respectively ) . WHZ , weight , height , haemoglobin ( Hb ) level , and morbidity data were assessed at admission , during the study , and at individual discharge .  Children 's weight gain ( g/kg body weight/day ) was highest in INE+MNP group ( 2.2±2.1 ) , followed by INE ( 1.1±0.9 ) , NNE+MNP ( 0.3±0.5 ) and NNE ( 0.3±0.4 ) group . In both MNP intervention groups ( INE+MNP , NNE+MNP ) , supplements significantly increased Hb value ( g/L ) of respective children ( 10.0±10.0 ; p<0.001 and 3.0±8.0 ; p<0.05 respectively ) . Proportion of children who reached discharge criterion was highest among the INE+MNP ( 70.6 % ; n=36 ) , followed by INE ( 64.1 % ; n=41 ) , NNE+MNP ( 26.0 % ; n=13 ) , and NNE ( 20.0 % ; n=10 ) groups ( p<0.001 ) . Shortest length of stay until recovery was observed among children in the INE+MNP group ( 29.9 days ) , followed by INE ( 40.0 days ) , NNE+MNP ( 80.6 days ) , and NNE ( 86.2 days ) respectively ( p<0.001 ) . Weekly intensive nutrition education supported by MNP supplementation produced the best results regarding weight gain and haemoglobin status of mildly wasted children BACKGROUND Despite ample food supplies , the incidence of childhood underweight and stunting remains high in Ug and a. Many factors contribute to this situation , but the role of low zinc intakes has not been adequately explored . OBJECTIVE Our objective was to study the effect of zinc supplementation on growth and body composition of preschool children by using the outcome measures of weight , height , and midupper arm circumference ( MUAC ) . DESIGN The study was r and omized , double-blind , placebo-controlled , parallel , and 8 mo long , and incorporated 6 mo of zinc supplementation .  Children ( n = 153 ) aged 55.8 + /- 11.2 mo from 3 r and omly selected nursery schools of medium , low , and very low socioeconomic status in a suburb of Kampala took part . The intervention comprised 10 mg Zn ( as ZnSO4 ) or placebo daily in freshly prepared fruit juice , Monday to Friday inclusive . RESULTS Zinc supplementation increased MUAC by the end of the study ( P = 0.029 ) and led to greater weight gain in children from the school of medium socioeconomic status at 3 and 8 mo ( P = 0.019 and P = 0.038 , respectively ) . There was no effect on weight gain of the children from the other schools . Zinc supplementation had no influence on height . Infection rates ( of which 82 % were recorded as malaria ) were lower in the zinc-supplemented group than in control subjects ( P = 0.063 ) . CONCLUSIONS Zinc supplementation may counter the age-related decrease in MUAC often observed in preschool children in developing countries . The study provides evidence that zinc may not be the most limiting nutrient for weight gain in children of poor nutritional status , but may become so as nutritional status improves Growth faltering , anemia , and multiple micronutrient deficiency are common during infancy in developing countries . This South African trial was part of a multicenter study aim ed at testing the efficacy of multiple micronutrient supplementation on growth , anemia , micronutrient status , and morbidity during infancy across 4 countries . A total of 265 infants aged 6 - 12 mo were individually r and omized to 1 of 4 intervention groups : a daily multiple micronutrient supplement ( DMM ) , a daily placebo supplement ( P ) ; a multiple micronutrient supplement 1 d of the week and placebo supplement on the other days of the week ( WMM ) , and a daily iron supplement ( DI ) . For 6 mo , the blinded supplements were provided to mothers at monthly health clinic sessions , and consumption was verified during weekly household visits by community health workers , when morbidity was also checked . Weight and height of the infants were measured monthly , and blood sample s were taken at the beginning and at the end for assessing the infants micronutrient status . There were no significant differences in nutritional status of the groups at baseline with 40 % of infants with an 
    Output:
    