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 In many developing countries , children are at high risk for both goiter and anemia . Iron ( Fe ) deficiency adversely effects thyroid metabolism and reduces efficacy of iodine prophylaxis in areas of endemic goiter . The study aim was to determine if co-fortification of iodized salt with Fe would improve efficacy of the iodine in goitrous children with a high prevalence of anemia . DESIGN AND METHODS In a 9-month , r and omized , double-blind trial , 6 - 15 year-old children ( n=377 ) were given iodized salt ( 25 microg iodine/g salt ) or dual-fortified salt with iodine ( 25 microg iodine/g salt ) and Fe ( 1 mg Fe/g salt , as ferrous sulfate microencapsulated with partially hydrogenated vegetable oil ) . RESULTS In the dual-fortified salt group , hemoglobin and Fe status improved significantly compared with the iodized salt group ( P<0.05 ) . At 40 weeks , the mean decrease in thyroid volume measured by ultrasound in the dual-fortified salt group ( -38 % ) was twice that of the iodized salt group ( -18 % ) ( P<0.01 ) . Compared with the iodized salt group , serum thyroxine was significantly increased ( P<0.05 ) and the prevalence of hypothyroidism and goiter decreased ( P<0.01 ) in the dual-fortified salt group . CONCLUSION Addition of encapsulated Fe to iodized salt improves the efficacy of iodine in goitrous children with a high prevalence of anemia Background . Iron-fortified formulas are recommended throughout infancy and are frequently used beyond , yet safety aspects have been inadequately studied . Iron could theoretically increase pro-oxidant stress , with potential adverse effects , including infection risk , and some clinicians suspect that iron-fortified formulas induce gastrointestinal disturbance . Objective . A planned component of a large intervention trial has been to test the hypothesis that infants receiving iron-fortified formula  do not have a higher incidence of infections ( primary outcome ) or gastrointestinal problems ( secondary outcome ) than infants on low iron-formulas or cow 's milk . Methods . Children ( n = 493 ) 9 months old receiving cow 's milk were recruited in 3 UK centers and r and omized to : 1 ) cow 's milk as before , 2 ) formula containing .9 mg/L of iron  , or 3 ) an  otherwise identical formula but  containing 12 mg/L of iron . Children were followed at 3 monthly intervals and the episodes of infections , diarrhea and constipation , and general morbidity to 18 months old were recorded . Hematologic indices of iron status were determined at 18 months old . Results . Serum ferritin concentrations were increased in infants receiving iron-fortified formula but there were no intergroup differences in incidence of infection , gastrointestinal problems , or in general morbidity or weight gain . Conclusions . We were unable to identify adverse health effects in older infants and toddlers consuming a high iron-containing formula ( 12 mg/L ) even when used in population s with a low incidence of iron deficiency OBJECTIVE To assess the effect of an improved local ingredient-based gruel fortified or not with selected multiple micronutrients ( MM ) on  Hb concentration of young children . DESIGN In a nutrition centre that we opened in their villages , children received either MM supplement ( containing iron , zinc , vitamin A , vitamin C and iodine ) with the improved gruel ( MMGG ) or the improved gruel only ( GG ) , twice daily , 6 d/week , for 6 months . We assessed baseline and endpoint Hb concentration and anthropometric indices . SETTING Kongoussi , a rural and poor district of Burkina Faso . SUBJECTS In a community-based trial , we r and omly assigned 131 children aged 6 - 23 months with Hb concentrations in the range of 80 - 109 g/l into two groups . RESULTS The groups did not differ significantly at baseline . Mean baseline Hb concentration was 89·2 ( sd 6·5 ) g/l and 90·3 ( sd 8·4 ) g/l in the GG and the MMGG , respectively ( P = 0·42 ) . It increased to 104·1 ( sd 11·4 ) g/l in the GG ( P < 0·001 ) and 107·6 ( sd 14·7 ) g/l in the MMGG ( P < 0·001 ) . The between-group difference of 3·5 ( 95 % CI -1·0 , 8·1 ) g/l in mean ( sd ) endpoint Hb concentration was not significant ( P = 0·13 ) . The endpoint anthropometric indices were not different between the groups . CONCLUSIONS This MM supplement  had no additional effect on Hb concentration . Thorough studies are needed to evaluate the actual efficacy of the gruel before its introduction into household routine OBJECTIVE Combating iron deficiency in toddlers with iron-fortified food has proved difficult in countries with phytate-rich diets . For this purpose , a new haem iron preparation was developed . The study compared changes in iron status after administration of refried beans with beans fortified with a haem iron preparation or ferrous sulphate ( FeSO4 ) . DESIGN In a masked , stratified-r and omised intervention trial , children received five 156-g cans of refried black beans per week for 10 consecutive weeks . The beans-only ( control ) , FeSO4 and haem iron groups were offered a cumulative dose of 155 mg , 1625 mg and 1700 mg of iron from the bean intervention , respectively . Haemoglobin ( Hb ) and ferritin concentrations were determined at baseline and after 5 and 10 weeks . Compliance was examined weekly . SETTING A low-income community in Guatemala City . SUBJECTS One hundred and ten children aged 12 - 36 months with initial Hb values between 100 and 115 g l(-1 ) . RESULTS The cumulative intake of beans was approximately 80 % of that offered , signifying an additional approximately 1300 mg of either haem or inorganic iron in the corresponding treatment groups over 10 weeks . Hb concentrations increased by the order of 7.3 - 11.4 g l(-1 ) during the intervention , but without significant differences across treatments . Average ferritin concentrations were unaffected by treatment assignment . However , post hoc analysis by subgroups of initial high ferritin and initial low ferritin found the Hb increments after 10 weeks in the haem iron group ( 13.1+/-7.7 g l(-1 ) ) to be significantly greater than the respective increases ( 6.8+/-11.2 and 6.4+/-8.5 g l(-1 ) ) in the inorganic iron and beans-only groups . CONCLUSIONS Canned refried beans are a c and i date vehicle for fortificant iron . Given the improved colour and organoleptic properties imparted by haem iron added to refried beans , its additional potential for benefiting the iron status of consumers with iron deficiency may recommend it over FeSO4 How to improve iron status among infants and young children is of continued concern in low- to middle-income countries , including Brazil . In a double blind , 5-mo , home-based , r and omized trial in Brazil , we gave one group of mildly anemic 6- to 24-mo-old children ( n = 175 )  rice fortified with micronized ferric pyrophosphate using the Ultra Rice technology and a placebo solution ( URG ) and another group identical nonfortified rice and iron drops . We instructed parents on the correct dosage of iron drops and to feed their children rice as they normally would . We measured serum ferritin ( SF ) and hemoglobin ( Hb ) concentrations at baseline and at 5 mo . At baseline , the prevalences of iron deficiency and anemia in the total sample were 73.1 and 100 % , respectively . At 5 mo , SF and Hb increased in both groups , although the change in the URG was larger ( P < 0.01 ) . Adult participants were unable to distinguish cooked fortified rice from unfortified rice in terms of smell , color , or taste . As rice is normally consumed at home , MPF-fortified rice increased iron stores and reduced anemia in a group of mildly anemic children 6 - 24 mo old . In population s where young children are routinely fed approximately 100 g of cooked rice daily , fortifying it with iron may improve iron status at least as well as providing free iron drops BACKGROUND Dietary supplements providing physiologic amounts of several micronutrients simultaneously have not been thoroughly tested for combating micronutrient deficiencies . OBJECTIVE We determined whether a beverage fortified with 10 micronutrients at physiologic doses influenced the iron and vitamin A status and growth of rural children ( aged 6 - 11 y ) attending primary schools . DESIGN In this r and omized , double-blind , placebo-controlled efficacy trial , children were assigned to receive the fortified beverage or an unfortified beverage at school for 6 mo . RESULTS There were nonsignificant differences at baseline between children in the fortified and nonfortified groups in iron status , serum retinol , and anthropometry . At the 6-mo follow-up , among children with anemia ( hemoglobin < 110 g/L ) , there was a significantly larger increase in hemoglobin concentration in the fortified group than in the nonfortified group ( 9.2 and 0.2 g/L , respectively ) . Of those who were anemic at baseline , 69.4 % in the nonfortified group and 55.1 % in the fortified group remained anemic at follow-up ( RR : 0.79 ) , a cure rate of 21 % . The prevalence of children with low serum retinol concentrations ( < 200 microg/L ) dropped significantly from 21.4 % to 11.3 % in the fortified group compared with a nonsignificant change ( 20.6 % to 19.7 % ) in the nonfortified group . At follow-up , mean incremental changes in weight ( 1.79 compared with 1.24 kg ) , height ( 3.2 compared with 2.6 cm ) , and BMI ( 0.88 compared with 0.53 ) were significantly higher in the fortified group than in the nonfortified group . CONCLUSION The fortified beverage significantly improved hematologic and anthropometric measurements and significantly lowered the overall prevalence of anemia and vitamin A deficiency 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 BACKGROUND The long-term goal of salt iodization is elimination of iodine deficiency and reduction of the goiter rate to < 5 % in school-aged children . Normalization of the goiter rate probably indicates disappearance of iodine deficiency disorders as a public health problem . However , thyroid size may not return to normal for months or years after correction of iodine deficiency . OBJECTIVE We described the time course and pattern of changes in thyroid size and goiter rate in response to the introduction of iodized salt in an area of severe endemic goiter . DESIGN In a 5-y prospect i ve study , we measured thyroid size by ultrasonography and urinary iodine and thyroid hormone concentrations in schoolchildren 6 mo before the introduction of iodized salt  and annually for 4 y thereafter . RESULTS Four years after the introduction of iodized salt and normalization of the median urinary iodine concentration , mean thyroid size had decreased 56 % ( P < 0.0001 ) . However , 29 % of the children remained goitrous , with a significant age shift in the distribution of goiter . At baseline , the goiter rate was significantly higher in younger ( age : 5 - 9 y ) than in older ( age : 10 - 14 y ) children ( P < 0.0001 ) . At 2 , 3 , and 4 y after salt iodization , the goiter rate was significantly higher in the older than in the younger children ( at 4 y : 52 % compared with 19 % ) 
    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 In many developing countries , children are at high risk for both goiter and anemia . Iron ( Fe ) deficiency adversely effects thyroid metabolism and reduces efficacy of iodine prophylaxis in areas of endemic goiter . The study aim was to determine if co-fortification of iodized salt with Fe would improve efficacy of the iodine in goitrous children with a high prevalence of anemia . DESIGN AND METHODS In a 9-month , r and omized , double-blind trial , 6 - 15 year-old children ( n=377 ) were given iodized salt ( 25 microg iodine/g salt ) or dual-fortified salt with iodine ( 25 microg iodine/g salt ) and Fe ( 1 mg Fe/g salt , as ferrous sulfate microencapsulated with partially hydrogenated vegetable oil ) . RESULTS In the dual-fortified salt group , hemoglobin and Fe status improved significantly compared with the iodized salt group ( P<0.05 ) . At 40 weeks , the mean decrease in thyroid volume measured by ultrasound in the dual-fortified salt group ( -38 % ) was twice that of the iodized salt group ( -18 % ) ( P<0.01 ) . Compared with the iodized salt group , serum thyroxine was significantly increased ( P<0.05 ) and the prevalence of hypothyroidism and goiter decreased ( P<0.01 ) in the dual-fortified salt group . CONCLUSION Addition of encapsulated Fe to iodized salt improves the efficacy of iodine in goitrous children with a high prevalence of anemia Background . Iron-fortified formulas are recommended throughout infancy and are frequently used beyond , yet safety aspects have been inadequately studied . Iron could theoretically increase pro-oxidant stress , with potential adverse effects , including infection risk , and some clinicians suspect that iron-fortified formulas induce gastrointestinal disturbance . Objective . A planned component of a large intervention trial has been to test the hypothesis that infants receiving iron-fortified formula  do not have a higher incidence of infections ( primary outcome ) or gastrointestinal problems ( secondary outcome ) than infants on low iron-formulas or cow 's milk . Methods . Children ( n = 493 ) 9 months old receiving cow 's milk were recruited in 3 UK centers and r and omized to : 1 ) cow 's milk as before , 2 ) formula containing .9 mg/L of iron  , or 3 ) an  otherwise identical formula but  containing 12 mg/L of iron . Children were followed at 3 monthly intervals and the episodes of infections , diarrhea and constipation , and general morbidity to 18 months old were recorded . Hematologic indices of iron status were determined at 18 months old . Results . Serum ferritin concentrations were increased in infants receiving iron-fortified formula but there were no intergroup differences in incidence of infection , gastrointestinal problems , or in general morbidity or weight gain . Conclusions . We were unable to identify adverse health effects in older infants and toddlers consuming a high iron-containing formula ( 12 mg/L ) even when used in population s with a low incidence of iron deficiency OBJECTIVE To assess the effect of an improved local ingredient-based gruel fortified or not with selected multiple micronutrients ( MM ) on  Hb concentration of young children . DESIGN In a nutrition centre that we opened in their villages , children received either MM supplement ( containing iron , zinc , vitamin A , vitamin C and iodine ) with the improved gruel ( MMGG ) or the improved gruel only ( GG ) , twice daily , 6 d/week , for 6 months . We assessed baseline and endpoint Hb concentration and anthropometric indices . SETTING Kongoussi , a rural and poor district of Burkina Faso . SUBJECTS In a community-based trial , we r and omly assigned 131 children aged 6 - 23 months with Hb concentrations in the range of 80 - 109 g/l into two groups . RESULTS The groups did not differ significantly at baseline . Mean baseline Hb concentration was 89·2 ( sd 6·5 ) g/l and 90·3 ( sd 8·4 ) g/l in the GG and the MMGG , respectively ( P = 0·42 ) . It increased to 104·1 ( sd 11·4 ) g/l in the GG ( P < 0·001 ) and 107·6 ( sd 14·7 ) g/l in the MMGG ( P < 0·001 ) . The between-group difference of 3·5 ( 95 % CI -1·0 , 8·1 ) g/l in mean ( sd ) endpoint Hb concentration was not significant ( P = 0·13 ) . The endpoint anthropometric indices were not different between the groups . CONCLUSIONS This MM supplement  had no additional effect on Hb concentration . Thorough studies are needed to evaluate the actual efficacy of the gruel before its introduction into household routine OBJECTIVE Combating iron deficiency in toddlers with iron-fortified food has proved difficult in countries with phytate-rich diets . For this purpose , a new haem iron preparation was developed . The study compared changes in iron status after administration of refried beans with beans fortified with a haem iron preparation or ferrous sulphate ( FeSO4 ) . DESIGN In a masked , stratified-r and omised intervention trial , children received five 156-g cans of refried black beans per week for 10 consecutive weeks . The beans-only ( control ) , FeSO4 and haem iron groups were offered a cumulative dose of 155 mg , 1625 mg and 1700 mg of iron from the bean intervention , respectively . Haemoglobin ( Hb ) and ferritin concentrations were determined at baseline and after 5 and 10 weeks . Compliance was examined weekly . SETTING A low-income community in Guatemala City . SUBJECTS One hundred and ten children aged 12 - 36 months with initial Hb values between 100 and 115 g l(-1 ) . RESULTS The cumulative intake of beans was approximately 80 % of that offered , signifying an additional approximately 1300 mg of either haem or inorganic iron in the corresponding treatment groups over 10 weeks . Hb concentrations increased by the order of 7.3 - 11.4 g l(-1 ) during the intervention , but without significant differences across treatments . Average ferritin concentrations were unaffected by treatment assignment . However , post hoc analysis by subgroups of initial high ferritin and initial low ferritin found the Hb increments after 10 weeks in the haem iron group ( 13.1+/-7.7 g l(-1 ) ) to be significantly greater than the respective increases ( 6.8+/-11.2 and 6.4+/-8.5 g l(-1 ) ) in the inorganic iron and beans-only groups . CONCLUSIONS Canned refried beans are a c and i date vehicle for fortificant iron . Given the improved colour and organoleptic properties imparted by haem iron added to refried beans , its additional potential for benefiting the iron status of consumers with iron deficiency may recommend it over FeSO4 How to improve iron status among infants and young children is of continued concern in low- to middle-income countries , including Brazil . In a double blind , 5-mo , home-based , r and omized trial in Brazil , we gave one group of mildly anemic 6- to 24-mo-old children ( n = 175 )  rice fortified with micronized ferric pyrophosphate using the Ultra Rice technology and a placebo solution ( URG ) and another group identical nonfortified rice and iron drops . We instructed parents on the correct dosage of iron drops and to feed their children rice as they normally would . We measured serum ferritin ( SF ) and hemoglobin ( Hb ) concentrations at baseline and at 5 mo . At baseline , the prevalences of iron deficiency and anemia in the total sample were 73.1 and 100 % , respectively . At 5 mo , SF and Hb increased in both groups , although the change in the URG was larger ( P < 0.01 ) . Adult participants were unable to distinguish cooked fortified rice from unfortified rice in terms of smell , color , or taste . As rice is normally consumed at home , MPF-fortified rice increased iron stores and reduced anemia in a group of mildly anemic children 6 - 24 mo old . In population s where young children are routinely fed approximately 100 g of cooked rice daily , fortifying it with iron may improve iron status at least as well as providing free iron drops BACKGROUND Dietary supplements providing physiologic amounts of several micronutrients simultaneously have not been thoroughly tested for combating micronutrient deficiencies . OBJECTIVE We determined whether a beverage fortified with 10 micronutrients at physiologic doses influenced the iron and vitamin A status and growth of rural children ( aged 6 - 11 y ) attending primary schools . DESIGN In this r and omized , double-blind , placebo-controlled efficacy trial , children were assigned to receive the fortified beverage or an unfortified beverage at school for 6 mo . RESULTS There were nonsignificant differences at baseline between children in the fortified and nonfortified groups in iron status , serum retinol , and anthropometry . At the 6-mo follow-up , among children with anemia ( hemoglobin < 110 g/L ) , there was a significantly larger increase in hemoglobin concentration in the fortified group than in the nonfortified group ( 9.2 and 0.2 g/L , respectively ) . Of those who were anemic at baseline , 69.4 % in the nonfortified group and 55.1 % in the fortified group remained anemic at follow-up ( RR : 0.79 ) , a cure rate of 21 % . The prevalence of children with low serum retinol concentrations ( < 200 microg/L ) dropped significantly from 21.4 % to 11.3 % in the fortified group compared with a nonsignificant change ( 20.6 % to 19.7 % ) in the nonfortified group . At follow-up , mean incremental changes in weight ( 1.79 compared with 1.24 kg ) , height ( 3.2 compared with 2.6 cm ) , and BMI ( 0.88 compared with 0.53 ) were significantly higher in the fortified group than in the nonfortified group . CONCLUSION The fortified beverage significantly improved hematologic and anthropometric measurements and significantly lowered the overall prevalence of anemia and vitamin A deficiency 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 BACKGROUND The long-term goal of salt iodization is elimination of iodine deficiency and reduction of the goiter rate to < 5 % in school-aged children . Normalization of the goiter rate probably indicates disappearance of iodine deficiency disorders as a public health problem . However , thyroid size may not return to normal for months or years after correction of iodine deficiency . OBJECTIVE We described the time course and pattern of changes in thyroid size and goiter rate in response to the introduction of iodized salt in an area of severe endemic goiter . DESIGN In a 5-y prospect i ve study , we measured thyroid size by ultrasonography and urinary iodine and thyroid hormone concentrations in schoolchildren 6 mo before the introduction of iodized salt  and annually for 4 y thereafter . RESULTS Four years after the introduction of iodized salt and normalization of the median urinary iodine concentration , mean thyroid size had decreased 56 % ( P < 0.0001 ) . However , 29 % of the children remained goitrous , with a significant age shift in the distribution of goiter . At baseline , the goiter rate was significantly higher in younger ( age : 5 - 9 y ) than in older ( age : 10 - 14 y ) children ( P < 0.0001 ) . At 2 , 3 , and 4 y after salt iodization , the goiter rate was significantly higher in the older than in the younger children ( at 4 y : 52 % compared with 19 % ) 
    Output:
    