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: Formula supplemented with docosahexaenoic acid ( DHA ) improves retinal function of preterm infants but the optimal dose is unknown . In a r and omized controlled trial we examined the effect of increasing the DHA concentration of human milk and formula on circulating fatty acids of preterm infants . Infants born <33 weeks gestation were fed high-DHA milk ( 1 % total fat as DHA ) or st and ard-DHA milk ( 0.2 - 0.3 % DHA ) until reaching their estimated due date ( EDD ) . Milk arachidonic acid ( AA ) concentration was approximately 0.5 % for both groups . At EDD , erythrocyte membrane phospholipid DHA was elevated in the high-DHA group compared with st and ard-DHA ( mean+/-SD , high-DHA 6.8+/-1.2 , st and ard-DHA 5.2+/-0.7 , p<0.0005 ) but AA was lower ( high-DHA 14.9+/-1.3 , st and ard-DHA 16.0+/-1.2 , p<0.0005 ) . Feeding preterm infants human milk and formula with 1 % DHA raises but does not saturate erythrocyte phospholipids with DHA . Milk exceeding 1 % DHA may be required to increase DHA status to levels seen in term infants CONTEXT The evidence that breastfeeding improves cognitive development is based almost entirely on observational studies and is thus prone to confounding by subtle behavioral differences in the breastfeeding mother 's behavior or her interaction with the infant . OBJECTIVE To assess whether prolonged and exclusive breastfeeding improves children 's cognitive ability at age 6.5 years . DESIGN Cluster-r and omized trial , with enrollment from June 17 , 1996 , to December 31 , 1997 , and follow-up from December 21 , 2002 , to April 27 , 2005 . SETTING Thirty-one Belarussian maternity hospitals and their affiliated polyclinics . PARTICIPANTS A total of 17,046 healthy breastfeeding infants were enrolled , of whom 13,889 ( 81.5 % ) were followed up at age 6.5 years . INTERVENTION Breastfeeding promotion intervention modeled on the Baby-Friendly Hospital Initiative by the World Health Organization and UNICEF . MAIN OUTCOME MEASURES Subtest and IQ scores on the Wechsler Abbreviated Scales of Intelligence , and teacher evaluations of academic performance in reading , writing , mathematics , and other subjects . RESULTS The experimental intervention led to a large increase in exclusive breastfeeding at age 3 months ( 43.3 % for the experimental group vs 6.4 % for the control group ; P < .001 ) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months . The experimental group had higher means on all of the Wechsler Abbreviated Scales of Intelligence measures , with cluster-adjusted mean differences ( 95 % confidence intervals ) of + 7.5 ( + 0.8 to + 14.3 ) for verbal IQ , + 2.9 ( -3.3 to + 9.1 ) for performance IQ , and + 5.9 ( -1.0 to + 12.8 ) for full-scale IQ . Teachers ' academic ratings were significantly higher in the experimental group for both reading and writing . CONCLUSION These results , based on the largest r and omized trial ever conducted in the area of human lactation , provide strong evidence that prolonged and exclusive breastfeeding improves children 's cognitive development . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N37687716 BACKGROUND Docosahexaenoic acid ( DHA ) and arachidonic acid ( AA ) are long-chain polyunsaturated fatty acids ( LCPs ) that play pivotal roles in growth and neurodevelopment . OBJECTIVE We aim ed to quantify the synthesis of LCPs in preterm infants fed infant formula containing LCPs . DESIGN Twenty-two preterm infants were r and omly assigned to either the no-LCP group ( fed formula without LCPs ; n = 11 ) or the LCP group ( fed formula with LCPs ; n = 11 ) . Dietary LCPs had higher (13)C content than did the endogenously synthesized LCPs , which were derived from linoleic and alpha-linolenic acids . The (13)C content of major selected plasma fatty acids was measured by using gas chromatography-isotope ratio mass spectrometry at birth and at age 1 , 3 , and 7 mo . Absolute LCP synthesis and the percentage of LCP synthesis relative to dietary intake were calculated . RESULTS Percentage AA synthesis was 67.2 + /- 7.8 % , 35.9 + /- 9.8 % , and 29.0 + /- 10.3 % , and that of DHA was 41.7 + /- 14.9 % , 10.5 + /- 8.1 % , and 7.4 + /- 6.2 % at 1 , 3 , and 7 mo old , respectively . Absolute AA synthesis was 26.7 + /- 4.2 , 14.4 + /- 3.9 , and 11.6 + /- 4.1 mg x kg(-1 ) x d(-1 ) and that of DHA was 12.6 + /- 4.5 , 3.2 + /- 2.5 , and 2.3 + /- 1.9 mg x kg(-1 ) . d(-1 ) at 1 , 3 , and 7 mo old , respectively . AA and DHA synthesis decreased significantly ( P < 0.01 ) with time , and AA synthesis was significantly ( P < 0.01 ) greater than DHA synthesis . CONCLUSIONS By this novel approach , we measured endogenous LCP synthesis in infants receiving dietary LCPs over long periods . By age 7 mo , LCP synthesis was dramatically lower in preterm infants fed LCPs This was a r and omized , double-blind trial to determine if a nutrient-enriched ( preterm ) formula supplemented with 0.2 % docosahexaenoic acid ( DHA , 22∶6n−3 ) from a low eicosapentaenoic acid ( 0.06 % ) source of marine oil would enhance visual novelty preference and attention of preterm infants . Both the st and ard and experimental formulas contained 3 % of total fatty acids as linolenic acid ( 18∶3n−3 ) and were fed from approximately three days of age to two months past term . After two months , both diet groups were fed a commercially-available term formula with linolenic acid as the only source of n−3 fatty acid . At 12 mo visual recognition memory ( novelty preference ) and visual attention ( number and duration of discrete looks ) were determined with the Fagan Test of Infant Intelligence . The DHA-supplemented group compared with the control group had more and shorter duration looks in comparisons of familiar and novel stimuli , confirming earlier evidence that DHA can increase information processing speed of preterm infants who otherwise are receiving good intakes of linolenic acid . Because supplementation was stopped at two months and the effects seen at 12 mon , this study demonstrates for the first time that a relatively short period of DHA supplementation can produce significant effects on later visual attention Very low birth weight ( VLBW ) infants ( 748–1390 g , n=65 ) were r and omly assigned to receive control or marine oil-supplemented formula when they achieved intakes > 454 kJ ( 110 kcal)/kg/d of a formula design ed for VLBW infants . Study formulas with or without marine oil were provided until 79 wk of postconceptional age ( PCA ) , first in a formula design ed for preterm infants followed by a formula design ed for term infants . Infants were studied at regular intervals through 92 wk PCA . Weight , length , and head circumference were determined by st and ardized prodedures and normalized to the National Center for Health Statistics figures for growth of infants born at term of the same age and gender . Mean normalized weight , weight-to-length , and head circumference were greatest at 48 wk and decreased thereafter . The decline in normalized weight was greater in infants fed the marine oil-supplemented formula . Beginning at 40 wk , marine oil-supplemented infants compared to controls had significantly poorer Z-scores for weight , length and head circumference . In addition , birth order ( negatively ) and maternal height ( positively ) influenced weight and length achievement in infancy as shown previously in infants born at term Docosahexaenoic acid ( DHA ) is an essential fatty acid ( FA ) important for health and neurodevelopment . Premature infants are at risk of DHA deficiency and circulating levels directly correlate with health outcomes . Most supplementation strategies have focused on increasing DHA content in mother ’s milk or infant formula . However , extremely premature infants may not reach full feedings for weeks and commercially available parenteral lipid emulsions do not contain preformed DHA , so blood levels decline rapidly after birth . Our objective was to develop a DHA supplementation strategy to overcome these barriers . This double-blind , r and omized , controlled trial determined feasibility , tolerability and efficacy of daily enteral DHA supplementation ( 50 mg/day ) in addition to st and ard nutrition for preterm infants ( 24–34 weeks gestational age ) beginning in the first week of life .  Blood FA levels were analyzed at baseline , full feedings and near discharge in  DHA ( n = 31 ) or placebo supplemented ( n = 29 ) preterm infants . Term peers ( n = 30 ) were analyzed for comparison . Preterm infants had lower baseline DHA levels ( p < 0.0001 ) . Those receiving DHA had a progressive increase in circulating DHA over time ( from 3.33 to 4.09 wt% or 2.88 to 3.55 mol% , p < 0.0001 ) while placebo-supplemented infants ( receiving st and ard neonatal nutrition ) had no increase over time ( from 3.35 to 3.32 wt% or 2.91 to 2.87 mol% ) . Although levels increased with additional DHA supplementation , preterm infants still had lower blood DHA levels than term peers ( 4.97 wt% or 4.31 mol% ) at discharge ( p = 0.0002 ) . No differences in adverse events were observed between the groups . Overall , daily enteral DHA supplementation is feasible and alleviates deficiency in premature infants BACKGROUND Preterm infants have improved visual outcomes when fed a formula containing 0.2 - 0.4 % docosahexaenoic acid ( DHA ) compared with infants fed no DHA , but the optimal DHA dose is unknown . OBJECTIVE We assessed visual responses of preterm infants fed human milk ( HM ) and formula with a DHA concentration estimated to match the intrauterine accretion rate ( high-DHA group ) compared with infants fed HM and formula containing DHA at current concentrations . DESIGN A double-blind r and omized controlled trial studied preterm infants born at <33 wk gestation and fed HM or formula containing 1 % DHA ( high-DHA group ) or approximately 0.3 % DHA ( current practice ; control group ) until reaching their estimated due date ( EDD ) . Both groups received the same concentration of arachidonic acid . Sweep visual evoked potential ( VEP ) acuity and latency were assessed at 2 and 4 mo corrected age ( CA ) . Weight , length , and head circumference were assessed at EDD and at 2 and 4 mo CA . RESULTS At 2 mo CA , acuity of the high-DHA group did not differ from the control group [ high-DHA group ( x + /- SD ) : 5.6 + /- 2.4 cycles per degree ( cpd ) , n = 54 ; control group : 5.6 + /- 2.4 cpd , n = 61 ; P = 0.96 ] . By 4 mo CA , the high-DHA group exhibited an acuity that was 1.4 cpd higher than the control group ( high-DHA : 9.6 + /- 3.7 cpd , n = 44 ; control : 8.2 + /- 1.8 cpd ; n = 51 ; P = 0.025 ) . VEP latencies and anthropometric measurements were not different between the high-DHA and control groups . CONCLUSION The DHA requirement of preterm infants may be higher than currently provided by preterm formula or HM of Australian women Docosahexaenoic acid ( DHA ; 22:6n-3 ) is important for normal visual development . We hypothesized that preterm infants fed formulas with marine oil as a source of DHA  would have better visual acuity than infants fed formulas without marine oil  , as measured by the Teller Acuity Card procedure . Marine oil ( P < 0.001 ) and age ( P < 0.0001 ) influenced visual acuity , by repeated- measures analysis of variance ( ANOVA ) corrected for the effect of subject . Marine-oil-supplemented infants had better visual acuity than those fed st and ard formulas at 2 and 4 mo of age , by Fishers ' least-squares difference ( LSD ) . Acuity of both dietary groups improved through 6.5 mo of age , then plateaued . Through 4 mo of age , acuity was inversely related to oxygen supplementation ( log10 h ) and positively related to DHA status , by general-linear-models ( GLM ) analysis . After 4 mo of age , birth weight and gestational age were the only variables consistently related to visual acuity by GLM . We conclude that marine-oil-supplemented formula improved visual acuity of preterm infants through  
    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: Formula supplemented with docosahexaenoic acid ( DHA ) improves retinal function of preterm infants but the optimal dose is unknown . In a r and omized controlled trial we examined the effect of increasing the DHA concentration of human milk and formula on circulating fatty acids of preterm infants . Infants born <33 weeks gestation were fed high-DHA milk ( 1 % total fat as DHA ) or st and ard-DHA milk ( 0.2 - 0.3 % DHA ) until reaching their estimated due date ( EDD ) . Milk arachidonic acid ( AA ) concentration was approximately 0.5 % for both groups . At EDD , erythrocyte membrane phospholipid DHA was elevated in the high-DHA group compared with st and ard-DHA ( mean+/-SD , high-DHA 6.8+/-1.2 , st and ard-DHA 5.2+/-0.7 , p<0.0005 ) but AA was lower ( high-DHA 14.9+/-1.3 , st and ard-DHA 16.0+/-1.2 , p<0.0005 ) . Feeding preterm infants human milk and formula with 1 % DHA raises but does not saturate erythrocyte phospholipids with DHA . Milk exceeding 1 % DHA may be required to increase DHA status to levels seen in term infants CONTEXT The evidence that breastfeeding improves cognitive development is based almost entirely on observational studies and is thus prone to confounding by subtle behavioral differences in the breastfeeding mother 's behavior or her interaction with the infant . OBJECTIVE To assess whether prolonged and exclusive breastfeeding improves children 's cognitive ability at age 6.5 years . DESIGN Cluster-r and omized trial , with enrollment from June 17 , 1996 , to December 31 , 1997 , and follow-up from December 21 , 2002 , to April 27 , 2005 . SETTING Thirty-one Belarussian maternity hospitals and their affiliated polyclinics . PARTICIPANTS A total of 17,046 healthy breastfeeding infants were enrolled , of whom 13,889 ( 81.5 % ) were followed up at age 6.5 years . INTERVENTION Breastfeeding promotion intervention modeled on the Baby-Friendly Hospital Initiative by the World Health Organization and UNICEF . MAIN OUTCOME MEASURES Subtest and IQ scores on the Wechsler Abbreviated Scales of Intelligence , and teacher evaluations of academic performance in reading , writing , mathematics , and other subjects . RESULTS The experimental intervention led to a large increase in exclusive breastfeeding at age 3 months ( 43.3 % for the experimental group vs 6.4 % for the control group ; P < .001 ) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months . The experimental group had higher means on all of the Wechsler Abbreviated Scales of Intelligence measures , with cluster-adjusted mean differences ( 95 % confidence intervals ) of + 7.5 ( + 0.8 to + 14.3 ) for verbal IQ , + 2.9 ( -3.3 to + 9.1 ) for performance IQ , and + 5.9 ( -1.0 to + 12.8 ) for full-scale IQ . Teachers ' academic ratings were significantly higher in the experimental group for both reading and writing . CONCLUSION These results , based on the largest r and omized trial ever conducted in the area of human lactation , provide strong evidence that prolonged and exclusive breastfeeding improves children 's cognitive development . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N37687716 BACKGROUND Docosahexaenoic acid ( DHA ) and arachidonic acid ( AA ) are long-chain polyunsaturated fatty acids ( LCPs ) that play pivotal roles in growth and neurodevelopment . OBJECTIVE We aim ed to quantify the synthesis of LCPs in preterm infants fed infant formula containing LCPs . DESIGN Twenty-two preterm infants were r and omly assigned to either the no-LCP group ( fed formula without LCPs ; n = 11 ) or the LCP group ( fed formula with LCPs ; n = 11 ) . Dietary LCPs had higher (13)C content than did the endogenously synthesized LCPs , which were derived from linoleic and alpha-linolenic acids . The (13)C content of major selected plasma fatty acids was measured by using gas chromatography-isotope ratio mass spectrometry at birth and at age 1 , 3 , and 7 mo . Absolute LCP synthesis and the percentage of LCP synthesis relative to dietary intake were calculated . RESULTS Percentage AA synthesis was 67.2 + /- 7.8 % , 35.9 + /- 9.8 % , and 29.0 + /- 10.3 % , and that of DHA was 41.7 + /- 14.9 % , 10.5 + /- 8.1 % , and 7.4 + /- 6.2 % at 1 , 3 , and 7 mo old , respectively . Absolute AA synthesis was 26.7 + /- 4.2 , 14.4 + /- 3.9 , and 11.6 + /- 4.1 mg x kg(-1 ) x d(-1 ) and that of DHA was 12.6 + /- 4.5 , 3.2 + /- 2.5 , and 2.3 + /- 1.9 mg x kg(-1 ) . d(-1 ) at 1 , 3 , and 7 mo old , respectively . AA and DHA synthesis decreased significantly ( P < 0.01 ) with time , and AA synthesis was significantly ( P < 0.01 ) greater than DHA synthesis . CONCLUSIONS By this novel approach , we measured endogenous LCP synthesis in infants receiving dietary LCPs over long periods . By age 7 mo , LCP synthesis was dramatically lower in preterm infants fed LCPs This was a r and omized , double-blind trial to determine if a nutrient-enriched ( preterm ) formula supplemented with 0.2 % docosahexaenoic acid ( DHA , 22∶6n−3 ) from a low eicosapentaenoic acid ( 0.06 % ) source of marine oil would enhance visual novelty preference and attention of preterm infants . Both the st and ard and experimental formulas contained 3 % of total fatty acids as linolenic acid ( 18∶3n−3 ) and were fed from approximately three days of age to two months past term . After two months , both diet groups were fed a commercially-available term formula with linolenic acid as the only source of n−3 fatty acid . At 12 mo visual recognition memory ( novelty preference ) and visual attention ( number and duration of discrete looks ) were determined with the Fagan Test of Infant Intelligence . The DHA-supplemented group compared with the control group had more and shorter duration looks in comparisons of familiar and novel stimuli , confirming earlier evidence that DHA can increase information processing speed of preterm infants who otherwise are receiving good intakes of linolenic acid . Because supplementation was stopped at two months and the effects seen at 12 mon , this study demonstrates for the first time that a relatively short period of DHA supplementation can produce significant effects on later visual attention Very low birth weight ( VLBW ) infants ( 748–1390 g , n=65 ) were r and omly assigned to receive control or marine oil-supplemented formula when they achieved intakes > 454 kJ ( 110 kcal)/kg/d of a formula design ed for VLBW infants . Study formulas with or without marine oil were provided until 79 wk of postconceptional age ( PCA ) , first in a formula design ed for preterm infants followed by a formula design ed for term infants . Infants were studied at regular intervals through 92 wk PCA . Weight , length , and head circumference were determined by st and ardized prodedures and normalized to the National Center for Health Statistics figures for growth of infants born at term of the same age and gender . Mean normalized weight , weight-to-length , and head circumference were greatest at 48 wk and decreased thereafter . The decline in normalized weight was greater in infants fed the marine oil-supplemented formula . Beginning at 40 wk , marine oil-supplemented infants compared to controls had significantly poorer Z-scores for weight , length and head circumference . In addition , birth order ( negatively ) and maternal height ( positively ) influenced weight and length achievement in infancy as shown previously in infants born at term Docosahexaenoic acid ( DHA ) is an essential fatty acid ( FA ) important for health and neurodevelopment . Premature infants are at risk of DHA deficiency and circulating levels directly correlate with health outcomes . Most supplementation strategies have focused on increasing DHA content in mother ’s milk or infant formula . However , extremely premature infants may not reach full feedings for weeks and commercially available parenteral lipid emulsions do not contain preformed DHA , so blood levels decline rapidly after birth . Our objective was to develop a DHA supplementation strategy to overcome these barriers . This double-blind , r and omized , controlled trial determined feasibility , tolerability and efficacy of daily enteral DHA supplementation ( 50 mg/day ) in addition to st and ard nutrition for preterm infants ( 24–34 weeks gestational age ) beginning in the first week of life .  Blood FA levels were analyzed at baseline , full feedings and near discharge in  DHA ( n = 31 ) or placebo supplemented ( n = 29 ) preterm infants . Term peers ( n = 30 ) were analyzed for comparison . Preterm infants had lower baseline DHA levels ( p < 0.0001 ) . Those receiving DHA had a progressive increase in circulating DHA over time ( from 3.33 to 4.09 wt% or 2.88 to 3.55 mol% , p < 0.0001 ) while placebo-supplemented infants ( receiving st and ard neonatal nutrition ) had no increase over time ( from 3.35 to 3.32 wt% or 2.91 to 2.87 mol% ) . Although levels increased with additional DHA supplementation , preterm infants still had lower blood DHA levels than term peers ( 4.97 wt% or 4.31 mol% ) at discharge ( p = 0.0002 ) . No differences in adverse events were observed between the groups . Overall , daily enteral DHA supplementation is feasible and alleviates deficiency in premature infants BACKGROUND Preterm infants have improved visual outcomes when fed a formula containing 0.2 - 0.4 % docosahexaenoic acid ( DHA ) compared with infants fed no DHA , but the optimal DHA dose is unknown . OBJECTIVE We assessed visual responses of preterm infants fed human milk ( HM ) and formula with a DHA concentration estimated to match the intrauterine accretion rate ( high-DHA group ) compared with infants fed HM and formula containing DHA at current concentrations . DESIGN A double-blind r and omized controlled trial studied preterm infants born at <33 wk gestation and fed HM or formula containing 1 % DHA ( high-DHA group ) or approximately 0.3 % DHA ( current practice ; control group ) until reaching their estimated due date ( EDD ) . Both groups received the same concentration of arachidonic acid . Sweep visual evoked potential ( VEP ) acuity and latency were assessed at 2 and 4 mo corrected age ( CA ) . Weight , length , and head circumference were assessed at EDD and at 2 and 4 mo CA . RESULTS At 2 mo CA , acuity of the high-DHA group did not differ from the control group [ high-DHA group ( x + /- SD ) : 5.6 + /- 2.4 cycles per degree ( cpd ) , n = 54 ; control group : 5.6 + /- 2.4 cpd , n = 61 ; P = 0.96 ] . By 4 mo CA , the high-DHA group exhibited an acuity that was 1.4 cpd higher than the control group ( high-DHA : 9.6 + /- 3.7 cpd , n = 44 ; control : 8.2 + /- 1.8 cpd ; n = 51 ; P = 0.025 ) . VEP latencies and anthropometric measurements were not different between the high-DHA and control groups . CONCLUSION The DHA requirement of preterm infants may be higher than currently provided by preterm formula or HM of Australian women Docosahexaenoic acid ( DHA ; 22:6n-3 ) is important for normal visual development . We hypothesized that preterm infants fed formulas with marine oil as a source of DHA  would have better visual acuity than infants fed formulas without marine oil  , as measured by the Teller Acuity Card procedure . Marine oil ( P < 0.001 ) and age ( P < 0.0001 ) influenced visual acuity , by repeated- measures analysis of variance ( ANOVA ) corrected for the effect of subject . Marine-oil-supplemented infants had better visual acuity than those fed st and ard formulas at 2 and 4 mo of age , by Fishers ' least-squares difference ( LSD ) . Acuity of both dietary groups improved through 6.5 mo of age , then plateaued . Through 4 mo of age , acuity was inversely related to oxygen supplementation ( log10 h ) and positively related to DHA status , by general-linear-models ( GLM ) analysis . After 4 mo of age , birth weight and gestational age were the only variables consistently related to visual acuity by GLM . We conclude that marine-oil-supplemented formula improved visual acuity of preterm infants through  
    Output:
    