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: It is unclear whether a substantial decline in malnutrition among infants in developing countries can be achieved by increasing food availability and nutrition counseling without concurrent morbidity-reducing interventions . The study was design ed to determine whether provision of generous amounts of a micronutrient-fortified food supplement supported by counseling or nutritional counseling alone would significantly improve physical growth between 4 and 12 mo of age . In a controlled trial , 418 infants 4 mo of age were individually r and omized to one of the four groups and followed until 12 mo of age . The first group received a milk-based cereal and nutritional counseling ; the second group monthly nutritional counseling alone . To control for the effect of twice-weekly home visits for morbidity ascertainment , similar visits were made in one of the control groups ( visitation group ) ; the fourth group received no intervention . The median energy intake from nonbreast milk sources was higher in the food supplementation group than in the visitation group by 1212 kJ at 26 wk ( P < 0.001 ) , 1739 kJ at 38 wk ( P < 0.001 ) and 2257 kJ at 52 wk ( P < 0.001 ) . The food supplementation infants gained 250 g ( 95 % confidence interval : 20 - -480 g ) more weight than did the visitation group . The difference in the mean increment in length during the study was 0.4 cm ( 95 % confidence interval : -0.1 - -0.9 cm ) . The nutritional counseling group had higher energy intakes ranging from 280 to 752 kJ at different ages ( P < 0.05 at all ages ) but no significant benefit on weight and length increments . Methods to enhance the impact of these interventions need to be identified Evaluation of the responsiveness of weight and length to supplementary feeding shows that the two periods of greatest response coincide with weaning ( ages 3 - 6 mo ) and peak incidence and duration of diarrheal disease ( ages 9 - 12 mo ) . Analyses were done for seven consecutive nonoverlapping intervals comparing children r and omly assigned to receive supplemental feeding from birth to age 36 mo or to serve as control subjects .  Absolute responsiveness was greatest between ages 3 - 6 mo ; supplemented infants grew 0.61 cm more and gained 162 g more than did unsupplemented infants ( p less than 0.005 ) . Relative to rates of growth , responsiveness was greatest between ages 9 and 12 mo ( the period of peak diarrheal prevalence ) , followed by ages 3 - 6 mo ( the period of weaning ) . Responsiveness to supplementation is thus directly related to age-dependent risk patterns for malnutrition . Targeting supplementation programs to coincide with periods of high nutritional risk should maximize their effectiveness in reducing malnutrition , though caution should be exercised to avoid disruption of breast-feeding The benefits of nutritional supplementation , with or without psychosocial stimulation , on the growth of  stunted children  were evaluated . Children aged 9 - 24 mo with lengths less than -2 SD of the National Center for Health Statistics references ( n = 129 ) were r and omly assigned to four groups :  control , nutritional supplementation , stimulation , and both interventions . A fifth group with lengths greater than -1 SD was also enrolled . Length , weight , head and arm circumferences , and triceps and subscapular skinfold thicknesses were measured on enrollment and 6 and 12 mo later . Multiple-regression analysis was used to determine the effects of the interventions in which age , sex , initial status , initial dietary intake , and several socioeconomic variables were controlled for . Stimulation had no effect on growth and there was no interaction between the interventions . After 12 mo supplemented children had significantly increased length , weight , and head circumference ( all P less than 0.01 ) . The effects of supplementation were not cumulative but occurred in the first 6 mo The effect of food supplementation on physical growth during the last trimester of pregnancy and the first 3 yr of life was studied in a sample of families at risk of malnutrition living in the urban slums of Bogota , Colombia . Families in which the mother was pregnant and at least one-half of the children under 5 yr of age were below 85 % of weight for age were selected for the study . All were provided with free obstetrical and pediatric care . The families were then r and omly assigned to control and supplemented groups . The supplemented families received a daily allotment of 600 cal or 30 g of protein per capita for home consumption from the onset of the 3rd trimester of pregnancy until the subject children reached the age of 3 yr . Calorie consumption from the supplement by the study children ( offspring of the target pregnancy ) was 458 ± 249 calories at age 18 months and 363 ± 283 cal at age 36 months . Protein consumption at those ages was 34 . 1 ± 20.6 and 23.6 ± 19.7 g,'day . However , substitution of the supplement for foods from the regular diet result ed in net supplementation of approximately 200 cal and 22 g of protein per day . There were significant differences in weight between supplemented and control groups beginning at age 3 months and in length beginning at age 6 months . Supplementation reduced the total prevalence of malnutrition ( Gomez classification ) only slightly ; at 36 months of age , 72 % of the supplemented group and 77.8 % of the control group were malnourished . On the other h and , the prevalence of moderate and severe malnutrition ( Gomez II and III ) , was significantly reduced by supplementation . At 36 months , 20.6 % of the control group and 8.8 % of the supplemented group fell into those categories . Despite improved physical growth in the supplemented group , their height and weight remained substantially below those of the high socioeconomic Colombian st and ards . The failure of supplementation to close the gap between low and high socioeconomic groups was attributed , in part , to the high incidence of diarrheal disease among subjects of the study . It is postulated that simple provision of food supplements , without effective prevention of diarrheal disease , is likely to have limited effects on physical growth among disadvantaged children . Am . J. Clin . Nutr . 34 : 1885 - 1892 , 1981 The long-term benefits of  early childhood supplementation  and the extent to which catch-up growth occurs following linear growth retardation remain controversial . Stunted children ( height-for-age < -2 SD of NCHS references , n = 122 ) recruited from a survey of poor neighborhoods in Kingston , Jamaica , participated in a 2-yr r and omized , controlled trial of supplementation beginning at ages 9 - 24 mo . A group of 32 non-stunted children from the same neighborhoods was also followed . Four years after the intervention ended , when children were 7 to 8 y old , there were no effects of supplementation on any anthropometric measure . From the end of the trial until follow-up , the children who had been supplemented gained 1.2 cm less ( P < 0.05 ) than the non-supplemented children , approximately the same amount as they had gained during the trial compared with the non-supplemented children . After adjustment for regression to the mean , the height-for-age of stunted children ( supplemented and non-supplemented combined ) increased from enrollment to follow-up by 0.31 Z-score ( 95 % CI 0.17 , 0.46 ) . The height-for-age of the non-stunted children also increased ( 0.96 Z-score ; 95 % CI 0.70 , 1.22 ) . Our results suggest that some catch-up growth is possible even when children remain in poor environments . Long-term benefits of supplementation to growth may not be achieved when intervention begins after age 12 mo in children who have already become undernourished This study assessed the developmental effects of supplementary feeding over 90 consecutive days on infants aged 6 - 20 mo at six tea plantations in West Java , Indonesia . Every day except Sunday , the infants attended day-care centers distributed throughout the plantations . Twenty centers and 113 infants were selected ; the infants in 9 centers received a dietary supplement , while the infants in 11 centers served as control subjects . Supplements were given twice a day providing , on average , 10.66 kJ ( 400 kcal ) and 5 g protein/d . Measurements of body growth , dietary intake , and mental and motor development were made on all infants . Supplementary feeding had significant effects on weight gain and on motor development . Changes in caloric intake were independently associated with changes in weight and in motor test scores . The data suggest that the effects of the supplement may not have followed a simple mechanistic relationship from intake to weight change to motor development , but , rather , intake may have affected both growth and development domains simultaneously Three-month recovery rates from moderate wasting ( less than 90 % weight-for-length ) were compared in 6 - 24-mo-old children in four Guatemalan villages that had been r and omly assigned to receive a moderate ( Atole ) or low ( Fresco ) energy supplement .  The recovery rate ( Rr ) in the Atole villages was 12 % higher than in the Fresco villages ( P less than 0.05 ) . This effect was above all due to the children in the Atole villages who consumed greater than or equal to 10 % of the daily recommended dietary intake of energy ( RDI ) from the supplement ( high-Atole group ) and whose total energy intake ( including home diet ) was 10.5 % of the RDI higher than a comparable high-Fresco group with low supplemental energy intake . All those in the high-Atole group whose wasting was due to malnutrition recovered . Much of this recovery ( range 29 - 52 % ) was due to the increased supplementation . This proportion rose after potential confounding variables were controlled for The effect of supplementation on growth was tested by means of four similar controlled r and omized trials in the Congo ( n = 120 ) , Senegal ( n = 110 ) , Bolivia ( n = 127 ) , and New Caledonia ( n = 90 ) . Four-month-old infants were r and omly allocated to supplement or control groups . A cereal-based precooked porridge was offered twice daily for 3 mo and consumption was monitored . Both groups were free to eat local food . At 7 mo of age , all infants were still breast-fed in the Congo , Senegal , and Bolivia compared with 47 % in New Caledonia . Mean daily consumption of the supplement varied among countries ( 558 - 790 kJ/d ) . Mean length at 4 mo was lowest in Bolivia , higher in Senegal and the Congo , and near the National Center for Health Statistics reference in New Caledonia . The mean 4 - 7 mo length increment was 0.48 cm higher for supplemented than for control infants in Senegal ( P < 0.05 ) , whereas weight increments did not differ . No significant effect was found in the other countries Supplementary feeding programs are common in developing countries . These programs often can not demonstrate an impact on child growth , however , possibly because they tend to reach older children . This study examines the impact of nutritional supplementation on annual growth rates in length and weight from birth to 7 y of age in 1208 rural Guatemalan children . A series of multiple linear regression models is used to control for initial body size , diarrheal disease , home diet , socioeconomic status and gender . During the first year of life , each 100 kcal/d ( 418 kJ ) of supplement was associated with approximately 9 mm in additional length gain and 350 g in additional weight gain ; the benefit decreased to approximately 5 mm in length gain and 250 g in weight gain during the 2nd y of life . Between 24 and 36 mo of age , supplement only had a significant impact on length . There was no impact of nutritional supplementation on growth between 3 and 7 y of age . Patterns were the same if supplement intakes were expressed as a percent of recommended allowances or growth was expressed as a percent of the expected rate . These impacts of nutritional supplementation on growth coincide with the ages when growth velocities , as well as growth deficits , are greatest in this population Objectives : This paper investigates simultaneously the growth and activity of children that received an early energy and micronutrient supplement  , adjusting for all non-supplemental energy intakes . Any additional change in growth and activity after this adjustment was then compared across supplements at three points felt to be representative of the study . Design : Two cohorts of children were r and omly assigned to three treatments : E=1171 kJ+12 mg iron ; M=209 kJ+12 mg iron ; S=104 kJ. Supplementation was given for 12 months . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : A 12-month-old ( n=53 ) and an 18-month-old ( n=83 ) cohort were recruited from day-care-centers . Twenty children that received S belonged to the 12- and 18-month-old cohorts . Inclusion criteria were : no chronic disease ; length-for-age ≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : Length was measured with a portable measuring board ; a Detecto scale with an accuracy of 0.1 kg was used for the measurement of body weight . Arm and head circumferences were measured using similar fiberglass tapes . Motor activity was assessed through continuous 4 h observations at home and at day care centers . Anthropometry and activity were measured every two months over 
    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: It is unclear whether a substantial decline in malnutrition among infants in developing countries can be achieved by increasing food availability and nutrition counseling without concurrent morbidity-reducing interventions . The study was design ed to determine whether provision of generous amounts of a micronutrient-fortified food supplement supported by counseling or nutritional counseling alone would significantly improve physical growth between 4 and 12 mo of age . In a controlled trial , 418 infants 4 mo of age were individually r and omized to one of the four groups and followed until 12 mo of age . The first group received a milk-based cereal and nutritional counseling ; the second group monthly nutritional counseling alone . To control for the effect of twice-weekly home visits for morbidity ascertainment , similar visits were made in one of the control groups ( visitation group ) ; the fourth group received no intervention . The median energy intake from nonbreast milk sources was higher in the food supplementation group than in the visitation group by 1212 kJ at 26 wk ( P < 0.001 ) , 1739 kJ at 38 wk ( P < 0.001 ) and 2257 kJ at 52 wk ( P < 0.001 ) . The food supplementation infants gained 250 g ( 95 % confidence interval : 20 - -480 g ) more weight than did the visitation group . The difference in the mean increment in length during the study was 0.4 cm ( 95 % confidence interval : -0.1 - -0.9 cm ) . The nutritional counseling group had higher energy intakes ranging from 280 to 752 kJ at different ages ( P < 0.05 at all ages ) but no significant benefit on weight and length increments . Methods to enhance the impact of these interventions need to be identified Evaluation of the responsiveness of weight and length to supplementary feeding shows that the two periods of greatest response coincide with weaning ( ages 3 - 6 mo ) and peak incidence and duration of diarrheal disease ( ages 9 - 12 mo ) . Analyses were done for seven consecutive nonoverlapping intervals comparing children r and omly assigned to receive supplemental feeding from birth to age 36 mo or to serve as control subjects .  Absolute responsiveness was greatest between ages 3 - 6 mo ; supplemented infants grew 0.61 cm more and gained 162 g more than did unsupplemented infants ( p less than 0.005 ) . Relative to rates of growth , responsiveness was greatest between ages 9 and 12 mo ( the period of peak diarrheal prevalence ) , followed by ages 3 - 6 mo ( the period of weaning ) . Responsiveness to supplementation is thus directly related to age-dependent risk patterns for malnutrition . Targeting supplementation programs to coincide with periods of high nutritional risk should maximize their effectiveness in reducing malnutrition , though caution should be exercised to avoid disruption of breast-feeding The benefits of nutritional supplementation , with or without psychosocial stimulation , on the growth of  stunted children  were evaluated . Children aged 9 - 24 mo with lengths less than -2 SD of the National Center for Health Statistics references ( n = 129 ) were r and omly assigned to four groups :  control , nutritional supplementation , stimulation , and both interventions . A fifth group with lengths greater than -1 SD was also enrolled . Length , weight , head and arm circumferences , and triceps and subscapular skinfold thicknesses were measured on enrollment and 6 and 12 mo later . Multiple-regression analysis was used to determine the effects of the interventions in which age , sex , initial status , initial dietary intake , and several socioeconomic variables were controlled for . Stimulation had no effect on growth and there was no interaction between the interventions . After 12 mo supplemented children had significantly increased length , weight , and head circumference ( all P less than 0.01 ) . The effects of supplementation were not cumulative but occurred in the first 6 mo The effect of food supplementation on physical growth during the last trimester of pregnancy and the first 3 yr of life was studied in a sample of families at risk of malnutrition living in the urban slums of Bogota , Colombia . Families in which the mother was pregnant and at least one-half of the children under 5 yr of age were below 85 % of weight for age were selected for the study . All were provided with free obstetrical and pediatric care . The families were then r and omly assigned to control and supplemented groups . The supplemented families received a daily allotment of 600 cal or 30 g of protein per capita for home consumption from the onset of the 3rd trimester of pregnancy until the subject children reached the age of 3 yr . Calorie consumption from the supplement by the study children ( offspring of the target pregnancy ) was 458 ± 249 calories at age 18 months and 363 ± 283 cal at age 36 months . Protein consumption at those ages was 34 . 1 ± 20.6 and 23.6 ± 19.7 g,'day . However , substitution of the supplement for foods from the regular diet result ed in net supplementation of approximately 200 cal and 22 g of protein per day . There were significant differences in weight between supplemented and control groups beginning at age 3 months and in length beginning at age 6 months . Supplementation reduced the total prevalence of malnutrition ( Gomez classification ) only slightly ; at 36 months of age , 72 % of the supplemented group and 77.8 % of the control group were malnourished . On the other h and , the prevalence of moderate and severe malnutrition ( Gomez II and III ) , was significantly reduced by supplementation . At 36 months , 20.6 % of the control group and 8.8 % of the supplemented group fell into those categories . Despite improved physical growth in the supplemented group , their height and weight remained substantially below those of the high socioeconomic Colombian st and ards . The failure of supplementation to close the gap between low and high socioeconomic groups was attributed , in part , to the high incidence of diarrheal disease among subjects of the study . It is postulated that simple provision of food supplements , without effective prevention of diarrheal disease , is likely to have limited effects on physical growth among disadvantaged children . Am . J. Clin . Nutr . 34 : 1885 - 1892 , 1981 The long-term benefits of  early childhood supplementation  and the extent to which catch-up growth occurs following linear growth retardation remain controversial . Stunted children ( height-for-age < -2 SD of NCHS references , n = 122 ) recruited from a survey of poor neighborhoods in Kingston , Jamaica , participated in a 2-yr r and omized , controlled trial of supplementation beginning at ages 9 - 24 mo . A group of 32 non-stunted children from the same neighborhoods was also followed . Four years after the intervention ended , when children were 7 to 8 y old , there were no effects of supplementation on any anthropometric measure . From the end of the trial until follow-up , the children who had been supplemented gained 1.2 cm less ( P < 0.05 ) than the non-supplemented children , approximately the same amount as they had gained during the trial compared with the non-supplemented children . After adjustment for regression to the mean , the height-for-age of stunted children ( supplemented and non-supplemented combined ) increased from enrollment to follow-up by 0.31 Z-score ( 95 % CI 0.17 , 0.46 ) . The height-for-age of the non-stunted children also increased ( 0.96 Z-score ; 95 % CI 0.70 , 1.22 ) . Our results suggest that some catch-up growth is possible even when children remain in poor environments . Long-term benefits of supplementation to growth may not be achieved when intervention begins after age 12 mo in children who have already become undernourished This study assessed the developmental effects of supplementary feeding over 90 consecutive days on infants aged 6 - 20 mo at six tea plantations in West Java , Indonesia . Every day except Sunday , the infants attended day-care centers distributed throughout the plantations . Twenty centers and 113 infants were selected ; the infants in 9 centers received a dietary supplement , while the infants in 11 centers served as control subjects . Supplements were given twice a day providing , on average , 10.66 kJ ( 400 kcal ) and 5 g protein/d . Measurements of body growth , dietary intake , and mental and motor development were made on all infants . Supplementary feeding had significant effects on weight gain and on motor development . Changes in caloric intake were independently associated with changes in weight and in motor test scores . The data suggest that the effects of the supplement may not have followed a simple mechanistic relationship from intake to weight change to motor development , but , rather , intake may have affected both growth and development domains simultaneously Three-month recovery rates from moderate wasting ( less than 90 % weight-for-length ) were compared in 6 - 24-mo-old children in four Guatemalan villages that had been r and omly assigned to receive a moderate ( Atole ) or low ( Fresco ) energy supplement .  The recovery rate ( Rr ) in the Atole villages was 12 % higher than in the Fresco villages ( P less than 0.05 ) . This effect was above all due to the children in the Atole villages who consumed greater than or equal to 10 % of the daily recommended dietary intake of energy ( RDI ) from the supplement ( high-Atole group ) and whose total energy intake ( including home diet ) was 10.5 % of the RDI higher than a comparable high-Fresco group with low supplemental energy intake . All those in the high-Atole group whose wasting was due to malnutrition recovered . Much of this recovery ( range 29 - 52 % ) was due to the increased supplementation . This proportion rose after potential confounding variables were controlled for The effect of supplementation on growth was tested by means of four similar controlled r and omized trials in the Congo ( n = 120 ) , Senegal ( n = 110 ) , Bolivia ( n = 127 ) , and New Caledonia ( n = 90 ) . Four-month-old infants were r and omly allocated to supplement or control groups . A cereal-based precooked porridge was offered twice daily for 3 mo and consumption was monitored . Both groups were free to eat local food . At 7 mo of age , all infants were still breast-fed in the Congo , Senegal , and Bolivia compared with 47 % in New Caledonia . Mean daily consumption of the supplement varied among countries ( 558 - 790 kJ/d ) . Mean length at 4 mo was lowest in Bolivia , higher in Senegal and the Congo , and near the National Center for Health Statistics reference in New Caledonia . The mean 4 - 7 mo length increment was 0.48 cm higher for supplemented than for control infants in Senegal ( P < 0.05 ) , whereas weight increments did not differ . No significant effect was found in the other countries Supplementary feeding programs are common in developing countries . These programs often can not demonstrate an impact on child growth , however , possibly because they tend to reach older children . This study examines the impact of nutritional supplementation on annual growth rates in length and weight from birth to 7 y of age in 1208 rural Guatemalan children . A series of multiple linear regression models is used to control for initial body size , diarrheal disease , home diet , socioeconomic status and gender . During the first year of life , each 100 kcal/d ( 418 kJ ) of supplement was associated with approximately 9 mm in additional length gain and 350 g in additional weight gain ; the benefit decreased to approximately 5 mm in length gain and 250 g in weight gain during the 2nd y of life . Between 24 and 36 mo of age , supplement only had a significant impact on length . There was no impact of nutritional supplementation on growth between 3 and 7 y of age . Patterns were the same if supplement intakes were expressed as a percent of recommended allowances or growth was expressed as a percent of the expected rate . These impacts of nutritional supplementation on growth coincide with the ages when growth velocities , as well as growth deficits , are greatest in this population Objectives : This paper investigates simultaneously the growth and activity of children that received an early energy and micronutrient supplement  , adjusting for all non-supplemental energy intakes . Any additional change in growth and activity after this adjustment was then compared across supplements at three points felt to be representative of the study . Design : Two cohorts of children were r and omly assigned to three treatments : E=1171 kJ+12 mg iron ; M=209 kJ+12 mg iron ; S=104 kJ. Supplementation was given for 12 months . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : A 12-month-old ( n=53 ) and an 18-month-old ( n=83 ) cohort were recruited from day-care-centers . Twenty children that received S belonged to the 12- and 18-month-old cohorts . Inclusion criteria were : no chronic disease ; length-for-age ≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : Length was measured with a portable measuring board ; a Detecto scale with an accuracy of 0.1 kg was used for the measurement of body weight . Arm and head circumferences were measured using similar fiberglass tapes . Motor activity was assessed through continuous 4 h observations at home and at day care centers . Anthropometry and activity were measured every two months over 
    Output:
    