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: OBJECTIVES : To evaluate the growth , tolerance , and safety of a new ultraconcentrated liquid human milk fortifier ( LHMF ) design ed to provide optimal nutrients for preterm infants receiving human breast milk in a safe , nonpowder formulation . METHODS : Preterm infants with a body weight ≤1250 g fed expressed and /or donor breast milk were r and omized to receive a control powder human milk fortifier ( HMF ) or a new LHMF for 28 days . When added to breast milk , the LHMF provided ∼20 % more protein than the control HMF  . Weight , length , head circumference , and serum prealbumin , albumin , blood urea nitrogen , electrolytes , and blood gases were measured . The occurrence of sepsis , necrotizing enterocolitis , and serious adverse events were monitored . RESULTS : This multicenter , third party – blinded , r and omized controlled , prospect i ve study enrolled 150 infants . Achieved weight and linear growth rate were significantly higher in the LHMF versus control groups ( P = .04 and 0.03 , respectively ) . Among infants who adhered closely to the protocol , the LHMF had a significantly higher achieved weight , length , head circumference , and linear growth rate than the control HMF ( P = .004 , P = .003 , P = .04 , and P = .01 , respectively ) . There were no differences in measures of feeding tolerance or days to achieve full feeding volumes . Prealbumin , albumin , and blood urea nitrogen were higher in the LHMF group versus the control group ( all P < .05 ) . There was no difference in the incidence of confirmed sepsis or necrotizing enterocolitis . CONCLUSIONS : Use of a new LHMF in preterm infants instead of powder HMF is safe . Benefits of LHMF include improvements in growth and avoidance of the use of powder products in the NICU Aim . To determine whether a widely used fortifier affects gastric emptying in very low birth weight infants and whether the amount of fortifier added to breast milk makes a difference with regard to gastric emptying . Methods . The study hypothesis was tested in a balanced crossover design . Gastric emptying was determined in the same infant on the same day with each of the three test feedings ( unfortified breast milk , half-fortified breast milk , and fully fortified breast milk ) in r and om order . The antral cross-sectional area ( ACSA ) was measured by B-mode ultrasonography ( US ) and the feeding was given . The ACSA was determined again immediately after feeding was completed , and was then determined at 10-min intervals until the pre-feeding value was reached . Results . The average half-emptying time was 49 ± 23 min with breast milk , 54 ± 29 min with half-fortified breast milk , and 65 ± 36 min with fully fortified breast milk . The differences between feeding groups were not statistically significant . Conclusion . Fortification of breast milk does not play a clinical ly significant role in causing feeding intolerance in preterm babies when recommended concentrations of fortifier are used Premature infants are at risk of developing metabolic bone disease mainly because of low calcium and phosphorus intake . We have examined the effect of different mineral supplements on bone mineral content at term in 127 premature infants with gestational age < 32 wk in a double-blinded r and omized trial . We used either phosphate supplementation of human milk as recommended by the European Society of Pediatric Gastroenterology and Nutrition or fortified supplementation with protein , calcium , and phosphorus or preterm formula as recommended by the American Academy of Pediatrics . The intervention period was from 1 week old until 36 wk of gestational age , and the infants were fed approximately 200 mL·kg−1·d−1 . Bone mineral content was measured at term by dual-energy x-ray absorptiometry scan . Surprisingly , neither phosphate , fortifier , nor preterm formula supplementation had any significant effect on bone mineral content at term compared with infants fed their own mother 's milk only . There was a tendency to higher total bone mineral content in infants fed preterm formula compared with infants fed their own mother 's milk only ( p = 0.05 ) , but when the bone mineral content was corrected for the size of the infant , there was no difference ( p = 0.68 ) . Infants fed preterm formula had a significantly higher weight at term compared with infants fed their own mother 's milk only ( p = 0.02 ) , but did not differ significantly in length or head circumference . In a regression analysis , the amount of supplemented phosphorus was significantly associated with weight at term ( p = 0.008 ) . We conclude that when feeding 200 mL·kg−1·d−1 , mineral supplementation of human milk or use of preterm formula does not significantly improve bone mineralization outcome at term A study was performed to determine if the addition of a fortifier to expressed breast milk ( EBM ) affected gastric emptying in low birthweight infants . Using ultrasonography , the gastric emptying of EBM alone was compared with that containing a fortifier , in a blind , crossover study . Twenty two low birthweight infants were studied : median ( range ) gestation 31.5 weeks ( 28 - 37 ) ; birthweight 1495 g ( 1000 - 2480 g ) . The gastric antral cross-sectional area ( ACSA ) was measured by ultrasonography before each feed and then sequentially after its completion until the ACSA returned to its pre-feed value . The half emptying time was calculated as the time taken for the ACSA to decrease to half the maximum increment . The mean difference ( st and ard error ) between half emptying times for EBM alone and for EBM with added fortifier was not significant : 1.48 ( 4.9 ) minutes . These data show that fortifying breast milk does not affect gastric emptying and suggests that the practice is unlikely to affect feed tolerance in low birthweight infants Our objectives were 1 ) to determine whether moderate nutrient supplementation of mother 's milk ( MM ) for preterm infants , in the form of a new multinutrient fortifier ( MNF ) , would improve short-term growth and bone mineral content ( BMC ) when compared with supplementation with calcium and phosphorus alone ; and 2 ) to investigate whether moderate calcium and phosphorus intakes , in the form of calcium glycerophosphate ( CaGP ) , result ed in a BMC similar to that of term corrected infants . Twenty-five preterm infants fed MM were r and omly assigned to receive either MM+MNF or MM+CaGP . A third group of infants fed preterm formula ( PTF ) served as a comparison group . Whole-body BMC and lean and fat mass were determined by dual-energy X-ray absorptiometry ( DXA ) at full-term age . Nitrogen retention and calcium , phosphorus , and zinc intakes were determined by using mass balance techniques . Nitrogen retention was significantly lower in the MM+CaGP group than in the PTF group as were both weight and length gain ( weight gain : 16.6 + /- 1.6 , 14.2 + /- 2.0 , and 16.1 + /- 2.9 g x kg(-1 ) x d(-1 ) ; length gain : 1.1 + /- 0.2 , 0.9 + /- 0.2 , and 1.1 + /- 0.3 cm/wk for the MM+MNF , MM+CaGP , and PTF groups , respectively ) . Biochemical indexes of mineral status and bone turnover were normal . Conservative amounts of calcium and phosphorus , as CaGP , result ed in adequate BMC . Moderate amounts of protein , calcium , and phosphorus plus trace elements added to MM in the form of an MNF result ed in improved linear growth but did not provide any advantages to BMC when compared with supplementation with calcium and phosphorus alone BACKGROUND Increasing evidence indicates that adult body composition is associated with prenatal and infancy weight gain , but the relative importance of different time periods has not been eluci date d. OBJECTIVE The objective was to study the association between prenatal , early postnatal , and late infancy weight gain and body mass index ( BMI ) , fat mass , and fat distribution in young adulthood . DESIGN We included 403 men and women aged 19 y from a Dutch national prospect i ve follow-up study who were born at < 32 wk of gestation .  BMI , waist circumference , and waist-to-hip ratio SD scores and subscapular-to-triceps ratio , percentage body fat , fat mass , and fat-free mass at age 19 y were studied in relation to birth weight SD scores , weight gain from preterm birth until 3 mo postterm ( early postnatal weight gain ) , and weight gain from 3 mo until 1 y postterm ( late infancy weight gain ) . RESULTS Birth weight SD scores were positively associated with weight , height , BMI SD scores , and fat-free mass at age 19 y but not with fat mass , percentage body fat , or fat distribution . Early postnatal and late infancy weight gain were positively associated with adult height , weight , BMI , waist circumference SD scores , fat mass , fat-free mass , and percentage body fat but not with waist-to-hip ratio SD scores or subscapular-to-triceps ratio . CONCLUSIONS In infants born very preterm , weight gain before 32 wk of gestation is positively associated with adult body size but not with body composition and fat distribution . More early postnatal and , to a lesser extent , late infancy weight gain are associated with higher BMI SD scores and percentage body fat and more abdominal fat at age 19 Despite potential benefits , human milk may fail to meet preterm infants ' nutrient requirements . We tested the hypothesis that fortified breast milk , fed alone or with preterm formula , would improve neurodevelopment and growth at 18-mo follow-up without adverse short-term clinical or biochemical consequences . Two hundred seventy-five preterm infants from two medical centers ( birth weight < 1850 g ; mean gestation 29.8 + /- 2.7 wk ) whose mothers chose to provide breast milk were r and omly assigned to receive for a mean of 39 d a multinutrient fortifier or control supplement containing phosphate and vitamins . Breast milk comprised 47.6 % and 46.4 % of enteral intake in fortified and control groups , respectively ; preterm formula supplements were used when insufficient breast milk was available . Overall , there were no significant growth advantages with fortification ; although , when breast milk exceeded 50 % of intake , fortification promoted faster weight gain ( an advantage of 1.6 g.kg-1.d-1 ; 95 % CI : 0.1 , 3.1 ; P < 0.05 ) . Compared with control infants , the fortified group showed 1 ) higher plasma urea from week 2 ( P = 0.04 ) , 2 ) higher plasma calcium ( mean 2.34 + /- 0.01 compared with 2.27 + /- 0.02 mmol/L ; P = 0.003 ) , 3 ) a greater rise in alkaline phosphatase by week 6 ( P = 0.04 ) , 4 ) more clinical infections ( suspected plus proven ; 43 % compared with 31 % , P = 0.04 ) , 5 ) a nonsignificantly increased incidence of necrotizing enterocolitis ( 5.8 % compared with 2.2 % , P = 0.12 ) , and 6 ) higher white cell and platelet counts . Developmental scores at 18 mo were slightly but not significantly higher in the fortified group . This study confirmed that breast milk fortifiers can improve short-term growth ( when breast milk intakes are high ) ; but beneficial effects on long-term development remained unproven . Future research is required to evaluate potential adverse consequences and explore more optimal fortification strategies OBJECTIVES Fortification of breast milk is an accepted practice for feeding very low birth weight infants , however , fixed dosage enhancement does not address variations in native breast milk . This could lead to deficiencies in calories and macronutrients . We therefore established the infrastructure for target fortification in breast milk by measuring and adjusting fat , protein , and carbohydrate content daily . We analyzed nutrient intake , growth , and safety variables . STUDY DESIGN Each 12-hour batch of breast milk was analyzed using near-infrared spectroscopy . Macronutrients were individually added to routine fortification to achieve final contents for fat ( 4.4 g ) , protein ( 3 g ) , and carbohydrates ( 8.8 g ) ( per 100 mL ) . Fully breast milk fed healthy very low birth weight infants ( < 32 weeks ) were fed the fortified breast milk for at least 3 weeks . Matched pair analysis of 20 infants fed routinely fortified breast milk was performed using birth weight , gestational age , and postnatal age . RESULTS All 650 pooled breast milk sample s required at least 1 macronutrient adjusted . On average , 0.3 ± 0.4 g of fat , 0.7 ± 0.2 g of protein , and 1.2 ± 0.2 g of carbohydrate were added . Biochemistry was normal in the 10 target fortified infants ( birth weight : 860 ± 309 g , 26.3 ± 1.6 weeks gestational age ) ; weight gain was 19.9 ± 2.7 g/kg/d ; and milk intake was 147 ± 5 mL/kg/d ( 131 ± 16 kcal/kg/d ) . Osmolality of fortified breast milk was 436 ± 13 mOsmol/kg . Matched pair analysis of infants indicated a higher milk intake ( 155 ± 5 mL/kg/d ) but similar weight gain ( 19.7 
    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: OBJECTIVES : To evaluate the growth , tolerance , and safety of a new ultraconcentrated liquid human milk fortifier ( LHMF ) design ed to provide optimal nutrients for preterm infants receiving human breast milk in a safe , nonpowder formulation . METHODS : Preterm infants with a body weight ≤1250 g fed expressed and /or donor breast milk were r and omized to receive a control powder human milk fortifier ( HMF ) or a new LHMF for 28 days . When added to breast milk , the LHMF provided ∼20 % more protein than the control HMF  . Weight , length , head circumference , and serum prealbumin , albumin , blood urea nitrogen , electrolytes , and blood gases were measured . The occurrence of sepsis , necrotizing enterocolitis , and serious adverse events were monitored . RESULTS : This multicenter , third party – blinded , r and omized controlled , prospect i ve study enrolled 150 infants . Achieved weight and linear growth rate were significantly higher in the LHMF versus control groups ( P = .04 and 0.03 , respectively ) . Among infants who adhered closely to the protocol , the LHMF had a significantly higher achieved weight , length , head circumference , and linear growth rate than the control HMF ( P = .004 , P = .003 , P = .04 , and P = .01 , respectively ) . There were no differences in measures of feeding tolerance or days to achieve full feeding volumes . Prealbumin , albumin , and blood urea nitrogen were higher in the LHMF group versus the control group ( all P < .05 ) . There was no difference in the incidence of confirmed sepsis or necrotizing enterocolitis . CONCLUSIONS : Use of a new LHMF in preterm infants instead of powder HMF is safe . Benefits of LHMF include improvements in growth and avoidance of the use of powder products in the NICU Aim . To determine whether a widely used fortifier affects gastric emptying in very low birth weight infants and whether the amount of fortifier added to breast milk makes a difference with regard to gastric emptying . Methods . The study hypothesis was tested in a balanced crossover design . Gastric emptying was determined in the same infant on the same day with each of the three test feedings ( unfortified breast milk , half-fortified breast milk , and fully fortified breast milk ) in r and om order . The antral cross-sectional area ( ACSA ) was measured by B-mode ultrasonography ( US ) and the feeding was given . The ACSA was determined again immediately after feeding was completed , and was then determined at 10-min intervals until the pre-feeding value was reached . Results . The average half-emptying time was 49 ± 23 min with breast milk , 54 ± 29 min with half-fortified breast milk , and 65 ± 36 min with fully fortified breast milk . The differences between feeding groups were not statistically significant . Conclusion . Fortification of breast milk does not play a clinical ly significant role in causing feeding intolerance in preterm babies when recommended concentrations of fortifier are used Premature infants are at risk of developing metabolic bone disease mainly because of low calcium and phosphorus intake . We have examined the effect of different mineral supplements on bone mineral content at term in 127 premature infants with gestational age < 32 wk in a double-blinded r and omized trial . We used either phosphate supplementation of human milk as recommended by the European Society of Pediatric Gastroenterology and Nutrition or fortified supplementation with protein , calcium , and phosphorus or preterm formula as recommended by the American Academy of Pediatrics . The intervention period was from 1 week old until 36 wk of gestational age , and the infants were fed approximately 200 mL·kg−1·d−1 . Bone mineral content was measured at term by dual-energy x-ray absorptiometry scan . Surprisingly , neither phosphate , fortifier , nor preterm formula supplementation had any significant effect on bone mineral content at term compared with infants fed their own mother 's milk only . There was a tendency to higher total bone mineral content in infants fed preterm formula compared with infants fed their own mother 's milk only ( p = 0.05 ) , but when the bone mineral content was corrected for the size of the infant , there was no difference ( p = 0.68 ) . Infants fed preterm formula had a significantly higher weight at term compared with infants fed their own mother 's milk only ( p = 0.02 ) , but did not differ significantly in length or head circumference . In a regression analysis , the amount of supplemented phosphorus was significantly associated with weight at term ( p = 0.008 ) . We conclude that when feeding 200 mL·kg−1·d−1 , mineral supplementation of human milk or use of preterm formula does not significantly improve bone mineralization outcome at term A study was performed to determine if the addition of a fortifier to expressed breast milk ( EBM ) affected gastric emptying in low birthweight infants . Using ultrasonography , the gastric emptying of EBM alone was compared with that containing a fortifier , in a blind , crossover study . Twenty two low birthweight infants were studied : median ( range ) gestation 31.5 weeks ( 28 - 37 ) ; birthweight 1495 g ( 1000 - 2480 g ) . The gastric antral cross-sectional area ( ACSA ) was measured by ultrasonography before each feed and then sequentially after its completion until the ACSA returned to its pre-feed value . The half emptying time was calculated as the time taken for the ACSA to decrease to half the maximum increment . The mean difference ( st and ard error ) between half emptying times for EBM alone and for EBM with added fortifier was not significant : 1.48 ( 4.9 ) minutes . These data show that fortifying breast milk does not affect gastric emptying and suggests that the practice is unlikely to affect feed tolerance in low birthweight infants Our objectives were 1 ) to determine whether moderate nutrient supplementation of mother 's milk ( MM ) for preterm infants , in the form of a new multinutrient fortifier ( MNF ) , would improve short-term growth and bone mineral content ( BMC ) when compared with supplementation with calcium and phosphorus alone ; and 2 ) to investigate whether moderate calcium and phosphorus intakes , in the form of calcium glycerophosphate ( CaGP ) , result ed in a BMC similar to that of term corrected infants . Twenty-five preterm infants fed MM were r and omly assigned to receive either MM+MNF or MM+CaGP . A third group of infants fed preterm formula ( PTF ) served as a comparison group . Whole-body BMC and lean and fat mass were determined by dual-energy X-ray absorptiometry ( DXA ) at full-term age . Nitrogen retention and calcium , phosphorus , and zinc intakes were determined by using mass balance techniques . Nitrogen retention was significantly lower in the MM+CaGP group than in the PTF group as were both weight and length gain ( weight gain : 16.6 + /- 1.6 , 14.2 + /- 2.0 , and 16.1 + /- 2.9 g x kg(-1 ) x d(-1 ) ; length gain : 1.1 + /- 0.2 , 0.9 + /- 0.2 , and 1.1 + /- 0.3 cm/wk for the MM+MNF , MM+CaGP , and PTF groups , respectively ) . Biochemical indexes of mineral status and bone turnover were normal . Conservative amounts of calcium and phosphorus , as CaGP , result ed in adequate BMC . Moderate amounts of protein , calcium , and phosphorus plus trace elements added to MM in the form of an MNF result ed in improved linear growth but did not provide any advantages to BMC when compared with supplementation with calcium and phosphorus alone BACKGROUND Increasing evidence indicates that adult body composition is associated with prenatal and infancy weight gain , but the relative importance of different time periods has not been eluci date d. OBJECTIVE The objective was to study the association between prenatal , early postnatal , and late infancy weight gain and body mass index ( BMI ) , fat mass , and fat distribution in young adulthood . DESIGN We included 403 men and women aged 19 y from a Dutch national prospect i ve follow-up study who were born at < 32 wk of gestation .  BMI , waist circumference , and waist-to-hip ratio SD scores and subscapular-to-triceps ratio , percentage body fat , fat mass , and fat-free mass at age 19 y were studied in relation to birth weight SD scores , weight gain from preterm birth until 3 mo postterm ( early postnatal weight gain ) , and weight gain from 3 mo until 1 y postterm ( late infancy weight gain ) . RESULTS Birth weight SD scores were positively associated with weight , height , BMI SD scores , and fat-free mass at age 19 y but not with fat mass , percentage body fat , or fat distribution . Early postnatal and late infancy weight gain were positively associated with adult height , weight , BMI , waist circumference SD scores , fat mass , fat-free mass , and percentage body fat but not with waist-to-hip ratio SD scores or subscapular-to-triceps ratio . CONCLUSIONS In infants born very preterm , weight gain before 32 wk of gestation is positively associated with adult body size but not with body composition and fat distribution . More early postnatal and , to a lesser extent , late infancy weight gain are associated with higher BMI SD scores and percentage body fat and more abdominal fat at age 19 Despite potential benefits , human milk may fail to meet preterm infants ' nutrient requirements . We tested the hypothesis that fortified breast milk , fed alone or with preterm formula , would improve neurodevelopment and growth at 18-mo follow-up without adverse short-term clinical or biochemical consequences . Two hundred seventy-five preterm infants from two medical centers ( birth weight < 1850 g ; mean gestation 29.8 + /- 2.7 wk ) whose mothers chose to provide breast milk were r and omly assigned to receive for a mean of 39 d a multinutrient fortifier or control supplement containing phosphate and vitamins . Breast milk comprised 47.6 % and 46.4 % of enteral intake in fortified and control groups , respectively ; preterm formula supplements were used when insufficient breast milk was available . Overall , there were no significant growth advantages with fortification ; although , when breast milk exceeded 50 % of intake , fortification promoted faster weight gain ( an advantage of 1.6 g.kg-1.d-1 ; 95 % CI : 0.1 , 3.1 ; P < 0.05 ) . Compared with control infants , the fortified group showed 1 ) higher plasma urea from week 2 ( P = 0.04 ) , 2 ) higher plasma calcium ( mean 2.34 + /- 0.01 compared with 2.27 + /- 0.02 mmol/L ; P = 0.003 ) , 3 ) a greater rise in alkaline phosphatase by week 6 ( P = 0.04 ) , 4 ) more clinical infections ( suspected plus proven ; 43 % compared with 31 % , P = 0.04 ) , 5 ) a nonsignificantly increased incidence of necrotizing enterocolitis ( 5.8 % compared with 2.2 % , P = 0.12 ) , and 6 ) higher white cell and platelet counts . Developmental scores at 18 mo were slightly but not significantly higher in the fortified group . This study confirmed that breast milk fortifiers can improve short-term growth ( when breast milk intakes are high ) ; but beneficial effects on long-term development remained unproven . Future research is required to evaluate potential adverse consequences and explore more optimal fortification strategies OBJECTIVES Fortification of breast milk is an accepted practice for feeding very low birth weight infants , however , fixed dosage enhancement does not address variations in native breast milk . This could lead to deficiencies in calories and macronutrients . We therefore established the infrastructure for target fortification in breast milk by measuring and adjusting fat , protein , and carbohydrate content daily . We analyzed nutrient intake , growth , and safety variables . STUDY DESIGN Each 12-hour batch of breast milk was analyzed using near-infrared spectroscopy . Macronutrients were individually added to routine fortification to achieve final contents for fat ( 4.4 g ) , protein ( 3 g ) , and carbohydrates ( 8.8 g ) ( per 100 mL ) . Fully breast milk fed healthy very low birth weight infants ( < 32 weeks ) were fed the fortified breast milk for at least 3 weeks . Matched pair analysis of 20 infants fed routinely fortified breast milk was performed using birth weight , gestational age , and postnatal age . RESULTS All 650 pooled breast milk sample s required at least 1 macronutrient adjusted . On average , 0.3 ± 0.4 g of fat , 0.7 ± 0.2 g of protein , and 1.2 ± 0.2 g of carbohydrate were added . Biochemistry was normal in the 10 target fortified infants ( birth weight : 860 ± 309 g , 26.3 ± 1.6 weeks gestational age ) ; weight gain was 19.9 ± 2.7 g/kg/d ; and milk intake was 147 ± 5 mL/kg/d ( 131 ± 16 kcal/kg/d ) . Osmolality of fortified breast milk was 436 ± 13 mOsmol/kg . Matched pair analysis of infants indicated a higher milk intake ( 155 ± 5 mL/kg/d ) but similar weight gain ( 19.7 
    Output:
    