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: Abstract The treatment of uncomplicated severe acute malnutrition ( SAM ) requires substantial amounts of ready‐to‐use therapeutic food ( RUTF ) . In 2009 , Action Contre la F aim anticipated a shortfall of RUTF for their nutrition programme in Myanmar . A low‐dose RUTF protocol to treat children with uncomplicated SAM was adopted . In this protocol , RUTF was dosed according to beneficiary 's body weight , until the child reached a Weight‐for‐Height z‐score of ≥−3 and mid‐upper arm circumference ≥110 mm . From this point , the child received a fixed quantity of RUTF per day , independent of body weight until discharge . Specific measures were implemented as part of this low‐dose RUTF protocol in order to improve service quality and beneficiary support . We analysed individual records of 3083 children treated from July 2009 to January 2010 . Up to 90.2 % of children recovered , 2.0 % defaulted and 0.9 % were classified as non‐responders . No deaths were recorded . Among children who recovered , median [ IQR ] length of stay and weight gain were 42 days [ 28 ; 56 ] and 4.0 g kg–1 day–1 [ 3.0 ; 5.7 ] , respectively . Multivariable logistic regression showed that children older than 48 months had higher odds of non‐response to treatment than younger children ( adjusted odds ratio : 3.51 , 95 % CI : 1.67–7.42 ) . Our results indicate that a low‐dose RUTF protocol , combined with specific measures to ensure good service quality and beneficiary support , was successful in treating uncomplicated SAM in this setting . This programmatic experience should be vali date d by r and omised studies aim ing to test , quantify and attribute the effect of the protocol adaptation and programme improvements presented here Background Ready-to-use therapeutic foods ( RUTF ) are lipid-based pastes widely used in the treatment of acute malnutrition . Current specifications for RUTF permit a high n-6 polyunsaturated fatty acid ( PUFA ) content and low n-3 PUFA , with no stipulated requirements for preformed long-chain n-3 PUFA . The objective of this study was to develop an RUTF with elevated short-chain n-3 PUFA and measure its impact , with and without fish oil supplementation , on children ’s PUFA status during treatment of severe acute malnutrition . Methods This r and omized controlled trial in children with severe acute malnutrition in rural Kenya included 60 children aged 6 to 50 months who were r and omized to receive i ) RUTF with st and ard composition ; ii ) RUTF with elevated short chain n-3 PUFA ; or iii ) RUTF with elevated short chain n-3 PUFA plus fish oil capsules . Participants were followed-up for 3 months . The primary outcome was erythrocyte PUFA composition . Results Erythrocyte docosahexaenoic acid ( DHA ) content declined from baseline in the two arms not receiving fish oil . Erythrocyte long-chain n-3 PUFA content following treatment was significantly higher for participants in the arm receiving fish oil than for those in the arms receiving RUTF with elevated short chain n-3 PUFA or st and ard RUTF alone : 3 months after enrolment , DHA content was 6.3 % ( interquartile range 6.0–7.3 ) , 4.5 % ( 3.9–4.9 ) , and 3.9 % ( 2.4–5.7 ) of total erythrocyte fatty acids ( P < 0.001 ) , respectively , while eicosapentaenoic acid ( EPA ) content was 2.0 % ( 1.5–2.6 ) , 0.7 % ( 0.6–0.8 ) , and 0.4 % ( 0.3–0.5 ) ( P < 0.001 ) . RUTF with elevated short chain n-3 PUFA and fish oil capsules were acceptable to participants and carers , and there were no significant differences in safety outcomes . Conclusions PUFA requirements of children with SAM are not met by current formulations of RUTF , or by an RUTF with elevated short-chain n-3 PUFA without additional preformed long-chain n-3 PUFA . Clinical and growth implication s of revised formulations need to be addressed in large clinical trials . Trial registration Clinical trials.gov NCT01593969 . Registered 4 May 2012 To measure the success rate of three different strategies used in Médecins Sans Frontières large-scale therapeutic nutritional rehabilitation programme in Niger , we analysed three cohorts of severely malnourished patients in terms of daily weight gain , length of stay , recovery , case fatality and defaulting . A total of 1937 children aged 6 - 59 months were followed prospect ively from 15 August 2002 to 21 October 2003 . For the three cohorts , 660 children were maintained in the therapeutic feeding centre ( TFC ) during the entire treatment , 937 children were initially treated at the TFC and completed treatment at home and 340 children were exclusively treated at home . For all cohorts , average time in the programme and average weight gain met the international st and ards ( 30 - 40 days , > 8 g/kg/day ) . Default rates were 28.1 , 16.8 and 5.6 % for TFC only , TFC plus home-based and home-based alone strategies , respectively . The overall case fatality rate for the entire programme was 6.8 % . Case fatality rates were 18.9 % for TFC only and 1.7 % for home-based alone . No deaths were recorded in children transferred to rehabilitation at home . This study suggests that satisfactory results for the treatment of severe malnutrition can be achieved using a combination of home and hospital-based strategies The aim of this study was to test the ability of two new products , an instant infant flour and a food supplement containing amylases , to increase energy and micronutrient intakes of infants older than 6 months . Three groups of 48 infants were r and omly constituted . Infants in groups 1 and 2 consumed at least twice a day gruel made either from the instant flour or from the food supplement . Infants from the control group received complementary foods prepared in the usual way . Each infant was surveyed during a whole day in order to measure feeding frequencies and characteristics as well as amounts of the different types of complementary foods consumed . Foods consumed by infants in the two experimental groups differed considerably in energy , micronutrient density and in consistency from the home-made complementary foods . Due to the incorporation of amylases , gruels made from the food supplement had a higher energy density , a more appropriate consistency and result ed in higher intakes per meal than gruels made from instant flour . In comparison with home-made complementary foods , both experimental products result ed in significantly higher energy and nutrient intakes . The two experimental products appeared to increase sufficiently both energy and nutrient intakes of infants to complement their breastmilk intake The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions Trial design Three feeding regimens— central ly produced ready-to-use therapeutic food , locally produced ready-to-use therapeutic food , and augmented , energy-dense , home-prepared food — were provided in a community setting for children with severe acute malnutrition ( SAM ) in the age group of 6–59 months in an individually r and omised multicentre trial that enrolled 906 children .  Foods , counselling , feeding support and treatment for mild illnesses were provided until recovery or 16 weeks . Methods Costs were estimated for 371 children enrolled in Delhi in a semiurban location after active survey and identification , enrolment , diagnosis and treatment for mild illnesses , and finally treatment with one of the three regimens , both under the research and government setting . Direct costs were estimated for human re sources using a price times quantity approach , based on their salaries and average time taken for each activity . The cost per week per child for food , medicines and other consumables was estimated based on the total expenditure over the period and children covered . Indirect costs for programme management including training , transport , non-consumables , infrastructure and equipment were estimated per week per child based on total expenditures for research study and making suitable adjustments for estimations under government setting . Results No significant difference in costs was found across the three regimens per covered or per treated child . The average cost per treated child in the government setting was estimated at US$ 56 ( < 3500 rupees ) . Conclusion Home-based management of SAM with a locally produced ready-to-use therapeutic food is feasible , acceptable , affordable and very cost-effective in terms of the disability-adjusted life years saved and gross national income per capita of the country . The treatment of SAM at home needs serious attention and integration into the existing health system , along with actions to prevent SAM . Trial registration number NCT01705769 ; Pre- results BACKGROUND Childhood malnutrition is common in Malawi , and the st and ard treatment , which follows international guidelines , results in poor recovery rates . Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food ( RUTF ) . OBJECTIVE The objective was to compare the recovery rates among children with moderate and severe wasting , kwashiorkor , or both receiving either home-based therapy with RUTF or st and ard inpatient therapy .  DESIGN A controlled , comparative , clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children . Children were systematic ally allocated to either st and ard therapy ( 186 children ) or home-based therapy with RUTF ( 992 children ) according to a stepped wedge design to control for bias introduced by the season of the year . Recovery , defined as reaching a weight-for-height z score > -2 , and relapse or death were the primary outcomes . The rate of weight gain and the prevalence of fever , cough , and diarrhea were the secondary outcomes . RESULTS Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received st and ard therapy ( 79 % compared with 46 % ; P < 0.001 ) and were less likely to relapse or die ( 8.7 % compared with 16.7 % ; P < 0.001 ) . Children who received home-based therapy with RUTF had greater rates of weight gain ( 3.5 compared with 2.0 g . kg(-1 ) . d(-1 ) ; difference : 1.5 ; 95 % CI : 1.0 , 2.0 g . kg(-1 ) . d(-1 ) ) and a lower prevalence of fever , cough , and diarrhea than did children who received st and ard therapy . CONCLUSION Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is st and ard therapy Poor complementary feeding practice s are associated with stunting and growth faltering throughout the developing world . The objective was to compare the effect of using peanut-/soy-based fortified spread ( FS ) and corn porridge fortified with fish powder ( FP ) as complementary foods on growth in rural Malawian children . A total of 240 children were enrolled at the age of 6 mo and r and omized to receive FS or FP .  Both complementary foods provided 836 kJ/d from 6 to 9 mo of age and 1254 kJ/d from 9 to 18 mo of age . Children were followed monthly for anthropometry and fortnightly for the symptoms of fever , cough , or diarrhea until they were 18 mo old . Zn and Se status were assessed at 6 and 12 mo . The primary outcomes were the rates of weight and length gain from 6 - 12 mo and from 12 - 18 mo . Children who received FS gained 110 g more ( 95 % CI 220 to 10 ) from 6 - 12 mo of age than children receiving FP .  Weight gain did not differ between children receiving FS and FP between 12 and 18 mo of age , nor did statural growth from 6 to 12 mo or 12 to 18 mo . A total of 23 % of all children were Zn deficient at 6 mo of age and this increased to 37 % at 12 mo of age . Neither FS nor FP was associated with significantly improved Zn status .  FS was associated with better weight gain from 6 - 12 mo of age and may be useful in conjunction with additional interventions to improve infant growth in the developing world BACKGROUND Multiple micronutrient deficiencies are often the basic causative factor in stunting and anemia , 2 conditions that affect entire generations of children in deprived population s. No generally accepted recommendations for micronutrient intakes for recovery from stunting are available . OBJECTIVE The objective was to assess the effect of a highly nutrient-dense spread fortified with vitamins and minerals , with or without antiparasitic metronidazole treatment , in correcting retarded 
    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: Abstract The treatment of uncomplicated severe acute malnutrition ( SAM ) requires substantial amounts of ready‐to‐use therapeutic food ( RUTF ) . In 2009 , Action Contre la F aim anticipated a shortfall of RUTF for their nutrition programme in Myanmar . A low‐dose RUTF protocol to treat children with uncomplicated SAM was adopted . In this protocol , RUTF was dosed according to beneficiary 's body weight , until the child reached a Weight‐for‐Height z‐score of ≥−3 and mid‐upper arm circumference ≥110 mm . From this point , the child received a fixed quantity of RUTF per day , independent of body weight until discharge . Specific measures were implemented as part of this low‐dose RUTF protocol in order to improve service quality and beneficiary support . We analysed individual records of 3083 children treated from July 2009 to January 2010 . Up to 90.2 % of children recovered , 2.0 % defaulted and 0.9 % were classified as non‐responders . No deaths were recorded . Among children who recovered , median [ IQR ] length of stay and weight gain were 42 days [ 28 ; 56 ] and 4.0 g kg–1 day–1 [ 3.0 ; 5.7 ] , respectively . Multivariable logistic regression showed that children older than 48 months had higher odds of non‐response to treatment than younger children ( adjusted odds ratio : 3.51 , 95 % CI : 1.67–7.42 ) . Our results indicate that a low‐dose RUTF protocol , combined with specific measures to ensure good service quality and beneficiary support , was successful in treating uncomplicated SAM in this setting . This programmatic experience should be vali date d by r and omised studies aim ing to test , quantify and attribute the effect of the protocol adaptation and programme improvements presented here Background Ready-to-use therapeutic foods ( RUTF ) are lipid-based pastes widely used in the treatment of acute malnutrition . Current specifications for RUTF permit a high n-6 polyunsaturated fatty acid ( PUFA ) content and low n-3 PUFA , with no stipulated requirements for preformed long-chain n-3 PUFA . The objective of this study was to develop an RUTF with elevated short-chain n-3 PUFA and measure its impact , with and without fish oil supplementation , on children ’s PUFA status during treatment of severe acute malnutrition . Methods This r and omized controlled trial in children with severe acute malnutrition in rural Kenya included 60 children aged 6 to 50 months who were r and omized to receive i ) RUTF with st and ard composition ; ii ) RUTF with elevated short chain n-3 PUFA ; or iii ) RUTF with elevated short chain n-3 PUFA plus fish oil capsules . Participants were followed-up for 3 months . The primary outcome was erythrocyte PUFA composition . Results Erythrocyte docosahexaenoic acid ( DHA ) content declined from baseline in the two arms not receiving fish oil . Erythrocyte long-chain n-3 PUFA content following treatment was significantly higher for participants in the arm receiving fish oil than for those in the arms receiving RUTF with elevated short chain n-3 PUFA or st and ard RUTF alone : 3 months after enrolment , DHA content was 6.3 % ( interquartile range 6.0–7.3 ) , 4.5 % ( 3.9–4.9 ) , and 3.9 % ( 2.4–5.7 ) of total erythrocyte fatty acids ( P < 0.001 ) , respectively , while eicosapentaenoic acid ( EPA ) content was 2.0 % ( 1.5–2.6 ) , 0.7 % ( 0.6–0.8 ) , and 0.4 % ( 0.3–0.5 ) ( P < 0.001 ) . RUTF with elevated short chain n-3 PUFA and fish oil capsules were acceptable to participants and carers , and there were no significant differences in safety outcomes . Conclusions PUFA requirements of children with SAM are not met by current formulations of RUTF , or by an RUTF with elevated short-chain n-3 PUFA without additional preformed long-chain n-3 PUFA . Clinical and growth implication s of revised formulations need to be addressed in large clinical trials . Trial registration Clinical trials.gov NCT01593969 . Registered 4 May 2012 To measure the success rate of three different strategies used in Médecins Sans Frontières large-scale therapeutic nutritional rehabilitation programme in Niger , we analysed three cohorts of severely malnourished patients in terms of daily weight gain , length of stay , recovery , case fatality and defaulting . A total of 1937 children aged 6 - 59 months were followed prospect ively from 15 August 2002 to 21 October 2003 . For the three cohorts , 660 children were maintained in the therapeutic feeding centre ( TFC ) during the entire treatment , 937 children were initially treated at the TFC and completed treatment at home and 340 children were exclusively treated at home . For all cohorts , average time in the programme and average weight gain met the international st and ards ( 30 - 40 days , > 8 g/kg/day ) . Default rates were 28.1 , 16.8 and 5.6 % for TFC only , TFC plus home-based and home-based alone strategies , respectively . The overall case fatality rate for the entire programme was 6.8 % . Case fatality rates were 18.9 % for TFC only and 1.7 % for home-based alone . No deaths were recorded in children transferred to rehabilitation at home . This study suggests that satisfactory results for the treatment of severe malnutrition can be achieved using a combination of home and hospital-based strategies The aim of this study was to test the ability of two new products , an instant infant flour and a food supplement containing amylases , to increase energy and micronutrient intakes of infants older than 6 months . Three groups of 48 infants were r and omly constituted . Infants in groups 1 and 2 consumed at least twice a day gruel made either from the instant flour or from the food supplement . Infants from the control group received complementary foods prepared in the usual way . Each infant was surveyed during a whole day in order to measure feeding frequencies and characteristics as well as amounts of the different types of complementary foods consumed . Foods consumed by infants in the two experimental groups differed considerably in energy , micronutrient density and in consistency from the home-made complementary foods . Due to the incorporation of amylases , gruels made from the food supplement had a higher energy density , a more appropriate consistency and result ed in higher intakes per meal than gruels made from instant flour . In comparison with home-made complementary foods , both experimental products result ed in significantly higher energy and nutrient intakes . The two experimental products appeared to increase sufficiently both energy and nutrient intakes of infants to complement their breastmilk intake The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions Trial design Three feeding regimens— central ly produced ready-to-use therapeutic food , locally produced ready-to-use therapeutic food , and augmented , energy-dense , home-prepared food — were provided in a community setting for children with severe acute malnutrition ( SAM ) in the age group of 6–59 months in an individually r and omised multicentre trial that enrolled 906 children .  Foods , counselling , feeding support and treatment for mild illnesses were provided until recovery or 16 weeks . Methods Costs were estimated for 371 children enrolled in Delhi in a semiurban location after active survey and identification , enrolment , diagnosis and treatment for mild illnesses , and finally treatment with one of the three regimens , both under the research and government setting . Direct costs were estimated for human re sources using a price times quantity approach , based on their salaries and average time taken for each activity . The cost per week per child for food , medicines and other consumables was estimated based on the total expenditure over the period and children covered . Indirect costs for programme management including training , transport , non-consumables , infrastructure and equipment were estimated per week per child based on total expenditures for research study and making suitable adjustments for estimations under government setting . Results No significant difference in costs was found across the three regimens per covered or per treated child . The average cost per treated child in the government setting was estimated at US$ 56 ( < 3500 rupees ) . Conclusion Home-based management of SAM with a locally produced ready-to-use therapeutic food is feasible , acceptable , affordable and very cost-effective in terms of the disability-adjusted life years saved and gross national income per capita of the country . The treatment of SAM at home needs serious attention and integration into the existing health system , along with actions to prevent SAM . Trial registration number NCT01705769 ; Pre- results BACKGROUND Childhood malnutrition is common in Malawi , and the st and ard treatment , which follows international guidelines , results in poor recovery rates . Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food ( RUTF ) . OBJECTIVE The objective was to compare the recovery rates among children with moderate and severe wasting , kwashiorkor , or both receiving either home-based therapy with RUTF or st and ard inpatient therapy .  DESIGN A controlled , comparative , clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children . Children were systematic ally allocated to either st and ard therapy ( 186 children ) or home-based therapy with RUTF ( 992 children ) according to a stepped wedge design to control for bias introduced by the season of the year . Recovery , defined as reaching a weight-for-height z score > -2 , and relapse or death were the primary outcomes . The rate of weight gain and the prevalence of fever , cough , and diarrhea were the secondary outcomes . RESULTS Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received st and ard therapy ( 79 % compared with 46 % ; P < 0.001 ) and were less likely to relapse or die ( 8.7 % compared with 16.7 % ; P < 0.001 ) . Children who received home-based therapy with RUTF had greater rates of weight gain ( 3.5 compared with 2.0 g . kg(-1 ) . d(-1 ) ; difference : 1.5 ; 95 % CI : 1.0 , 2.0 g . kg(-1 ) . d(-1 ) ) and a lower prevalence of fever , cough , and diarrhea than did children who received st and ard therapy . CONCLUSION Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is st and ard therapy Poor complementary feeding practice s are associated with stunting and growth faltering throughout the developing world . The objective was to compare the effect of using peanut-/soy-based fortified spread ( FS ) and corn porridge fortified with fish powder ( FP ) as complementary foods on growth in rural Malawian children . A total of 240 children were enrolled at the age of 6 mo and r and omized to receive FS or FP .  Both complementary foods provided 836 kJ/d from 6 to 9 mo of age and 1254 kJ/d from 9 to 18 mo of age . Children were followed monthly for anthropometry and fortnightly for the symptoms of fever , cough , or diarrhea until they were 18 mo old . Zn and Se status were assessed at 6 and 12 mo . The primary outcomes were the rates of weight and length gain from 6 - 12 mo and from 12 - 18 mo . Children who received FS gained 110 g more ( 95 % CI 220 to 10 ) from 6 - 12 mo of age than children receiving FP .  Weight gain did not differ between children receiving FS and FP between 12 and 18 mo of age , nor did statural growth from 6 to 12 mo or 12 to 18 mo . A total of 23 % of all children were Zn deficient at 6 mo of age and this increased to 37 % at 12 mo of age . Neither FS nor FP was associated with significantly improved Zn status .  FS was associated with better weight gain from 6 - 12 mo of age and may be useful in conjunction with additional interventions to improve infant growth in the developing world BACKGROUND Multiple micronutrient deficiencies are often the basic causative factor in stunting and anemia , 2 conditions that affect entire generations of children in deprived population s. No generally accepted recommendations for micronutrient intakes for recovery from stunting are available . OBJECTIVE The objective was to assess the effect of a highly nutrient-dense spread fortified with vitamins and minerals , with or without antiparasitic metronidazole treatment , in correcting retarded 
    Output:
    