***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: This study was design ed to evaluate the effects of enriching an essential amino acid ( EAA ) mixture with leucine on muscle protein metabolism in elderly and young individuals . Four ( 2 elderly and 2 young ) groups were studied before and after ingestion of 6.7 g of EAAs . EAAs were based on the composition of whey protein [ 26 % leucine ( 26 % Leu ) ] or were enriched in leucine [ 41 % leucine ( 41 % Leu ) ] . A primed , continuous infusion of L-[ring-2H5]phenylalanine was used together with vastus lateralis muscle biopsies and leg arteriovenous blood sample s for the determinations of fractional synthetic rate ( FSR ) and balance of muscle protein . FSR increased following amino acid ingestion in both the 26 % ( basal : 0.048 + /- 0.005%/h ; post-EAA : 0.063 + /- 0.007%/h ) and the 41 % ( basal : 0.036 + /- 0.004%/h ; post-EAA : 0.051 + /- 0.007%/h ) Leu young groups ( P < 0.05 ) . In contrast , in the elderly , FSR did not increase following ingestion of 26 % Leu EAA ( basal : 0.044 + /- 0.003%/h ; post-EAA : 0.049 + /- 0.006%/h ; P > 0.05 ) but did increase following ingestion of 41 % Leu EAA ( basal : 0.038 + /- 0.007%/h ; post-EAA : 0.056 + /- 0.008%/h ; P < 0.05 ) . Similar to the FSR responses , the mean response of muscle phenylalanine net balance , a reflection of muscle protein balance , was improved ( P < 0.05 ) in all groups , with the exception of the 26 % Leu elderly group . We conclude that increasing the proportion of leucine in a mixture of EAA can reverse an attenuated response of muscle protein synthesis in elderly but does not result in further stimulation of muscle protein synthesis in young subjects Background Protein energy malnutrition ( PEM ) predisposes individuals to disease , delays recovery from illness and reduces quality of life . Care home residents in the United Kingdom are especially vulnerable , with an estimated 30 to 42 % at risk . Evidence for nutritional interventions to address PEM in the care home setting is lacking . Widely used techniques include food-based intervention and /or the use of prescribed oral nutritional supplements . To define outcomes and optimise the design for an adequately powered definitive trial to compare the efficacy of established nutritional interventions in this setting , a cluster r and omised feasibility trial with a 6-month intervention was undertaken . Methods Care home residents with or at risk of malnutrition were identified across six UK care home sites from September to December 2013 . Homes were cluster r and omised to st and ard care ( SC ) , food-based intervention ( FB ) or oral nutritional supplement intervention ( ONS ) , for 6 months . Key outcomes were trial feasibility and the acceptability of design , allocated interventions and outcome assessment s. Anthropometry , dietary intake , healthcare re source usage and participant-reported outcome measures were assessed at baseline and at 3 and 6 months . Results All six care homes approached were recruited and retained . Of the 110 residents at risk of malnutrition , 85 % entered the trial , and 68 % completed the 6-month intervention . Pre-specified success criteria for feasibility were met for recruitment and retention , intervention acceptability ( resident compliance ≥60 % ) and measurement of weight , body mass index ( BMI ) , mid-upper arm circumference and dietary intake ( data completeness > 80 % ) . Measurement of h and grip strength and triceps skinfold thickness was not found to be feasible in this population . The 95 % confidence interval ( CI ) data suggested sensitivity to change in dietary intake for weight , BMI and energy intake between baseline and 3 months when each intervention ( FB and ONS ) was compared with SC . Conclusions A definitive trial comparing the efficacy of nutritional support interventions in increasing weight and BMI in malnourished care home residents can be conducted . However , whilst the design was feasible , this trial has highlighted the lack of clinical ly and patient-relevant outcome measures that are appropriate for use in this setting for both research and clinical practice . In particular , this trial identified a need for a more simple measure of functional status , which considers the limitations of functional tests in the care home population .Trial registration Current Controlled Trials IS RCT N38047922 , Date assigned : 22 April 2014 The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training OBJECTIVES Although oral nutritional supplements ( ONS ) are known to be effective to treat malnutrition in the elderly , evidence from nursing home population s , including individuals with dementia , is rare , especially with regard to functionality and well-being . A known barrier for ONS use among elderly is the volume that needs to be consumed , result ing in low compliance and thus reduced effectiveness . This study aim ed to investigate the effects of a low-volume , energy- and nutrient-dense ONS on nutritional status , functionality , and quality of life ( QoL ) of nursing home residents . DESIGN R and omized controlled intervention trial . SETTING Six nursing homes in Nürnberg and Fuerth , Germany . PARTICIPANTS Nursing home residents affected by malnutrition or at risk of malnutrition . INTERVENTION R and om assignment to intervention ( IG ) and control group ( CG ) , receiving 2 × 125 mL ONS ( 600 kcal , 24 g protein ) per day and routine care , respectively , for 12 weeks . MEASUREMENTS Nutritional ( weight , body mass index [ BMI ] , upper arm and calf circumferences , MNA-SF ) and functional parameters ( h and grip strength , gait speed , depressive mood [ GDS ] , cognition [ MMSE ] , activities of daily living [ Barthel ADL ] ) as well as QoL ( QUALIDEM ) were assessed at baseline ( T1 ) and after 12 weeks ( T2 ) . ONS intake was registered daily and compliance calculated . RESULTS A total of 77 residents ( 87 ± 6 y , 91 % female ) completed the study ; 78 % had dementia ( MMSE < 17 ) and 55 % were fully dependent ( ADL ≤30 ) . Median compliance was 73 % ( IQR 23.5%-86.5 % ) with median intake of 438 ( 141 - 519 ) kcal per day . Body weight , BMI , and arm and calf circumferences increased in the IG ( n = 42 ) and did not change in the CG ( n = 35 ) . Changes of all nutritional parameters except MNA-SF significantly differed between groups in favor of the IG ( P < .05 ) . GDS , h and grip strength , and gait speed could not be assessed in 46 % , 38 % , and 49 % of participants at T1 and /or T2 , because of immobility and cognitive impairment . In residents able to perform the test at both times , functionality remained stable in IG and CG , except for ADLs , deteriorating in both groups . From 10 QoL categories , " positive self-perception " increased in IG ( 78 [ 33 - 100 ] to 83 [ 56 - 100 ] ; P < .05 ) and tended to decrease in CG ( 100 [ 78 - 100 ] to 89 [ 56 - 100 ] ; P = .06 ) , " being busy " significantly dropped in CG ( 33 [ 0 - 50 ] to 0 [ 0 - 50 ] ; P < .05 ) . CONCLUSION Low-volume , nutrient- and energy-dense ONS were well accepted among elderly nursing home residents with high functional impairment and result ed in significant improvements of nutritional status and , thus , were effective to support treatment of malnutrition . Assessment of function was hampered by dementia and immobility , limiting the assessment of functionality , and highlighting the need for better tools for elderly with functional impairments . ONS may positively affect QoL but this requires further research Objectives To determine whether in the current study the supply of a nutrient dense drink has a positive effect on mental and physical function of institutionalized elderly people . Design A 24-week , r and omized , double-blind , placebo-controlled , parallel-group , intervention trial . Setting Homes for the elderly and nursing homes in the Netherl and s. Participants Institutionalized elderly people older than 60 years , with a BMI ≤ 30 kg/m2 , and a Mini-Mental State Examination score of at least 10 points . InterventionIn addition to their usual diet the participants ( n=176 ) received either a nutrient dense drink or a placebo drink twice a day during 24 weeks . Measurements The functionality measures included cognitive function , mood , physical performance and the ability to perform activities of daily living . Results In the supplement group a favorable effect of the intervention drink on body weight ( 1.6 kg difference in change ; P = .035 ) , calf circumference ( 0.9 cm difference in change ; P = .048 ) , and blood values ( e.g. Hcy decreased from 16.8 to 11.2 µmol/L in the supplement group ) was found . In the total group no significant effect was found on functionality outcomes . However , a subgroup of participants with BMI at baseline below 24.4 kg/m2 performed better on the cognitive subscale of Alzheimer ’s Disease Assessment Scale ( P = .09 ) , and its language sub score ( P = .01 ) after 24 weeks of intervention . Conclusion The results in the total group of this trial suggest that the nutritional supplement used in this study improves nutritional status . Furthermore , the results of this trial suggest that it is effective as treatment for decreasing function in a subgroup of institutionalized elderly people with low BMI The purpose was to test the hypothesis that a multifaceted 11 weeks r and omized controlled intervention would have a significant influence of functional abilities in old nursing home residents . Participants were 121 old ( > 65 years ) residents in seven Danish nursing homes . The intervention consisted of nutrition ( chocolate , homemade oral supplements ) , group exercise ( moderate intensity ) and oral care . Measurements taken were weight , body mass index ( BMI ) , energy and protein intake , and functional abilities ( activities of daily living = ADL , cognitive performance , and social engagement ) . The results showed that the nutrition and exercise were well accepted . After 11 weeks the change in % weight ( 1.3 vs. -0.6 % , p=0.005 ) , % BMI ( 0.4 vs. -0.2 % , p=0.003 ) , energy intake ( 0.7 vs. -0.3 MJ/day , p=0.084 ) and protein intake ( 5 vs. -2g/day , p=0.012 ) was higher in the intervention group than in the control group . Also , after 11 weeks , social and physical function had decreased in the control group but was unchanged in the intervention group . The difference between groups was significant in relation to social engagement ( p=0.009 ) . After the end of the intervention both groups had lost weight and physical function . Cognitive performance did not change , at any time . In conclusion , it seems possible to maintain social ( and physical ) functional abilities in old nursing home residents by means of a multifaceted intervention BACKGROUND Nutritional status is associated with physical functioning in older people . Protein-energy malnutrition can limit functional performance . OBJECTIVES This study examined the effectiveness of a " need- 
    Output:
    
CONCLUSIONS Nutritional intervention with older people in residential facilities was effective in improving h and grip strength , but did not significantly improve scores for activities of daily living , balance , gait velocity or preventing death .