***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 
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    Input: BACKGROUND Protein-energy wasting ( PEW ) is common in patients undergoing hemodialysis ( HD ) . Studies have assessed the positive effect of oral nutritional supplementation ( ONS ) or resistance exercise ( RE ) on nutritional status ( NS ) markers in patients undergoing HD . METHODS The aim of this study was to assess the effect of ONS and RE on NS and the quality of life ( QOL ) of 36 patients undergoing HD . In a r and omized clinical trial , patients were divided into the following two groups : a control group ( ONS ) that received a can of ONS during their HD sessions and an intervention group ( ONS + RE ) that received a can of ONS and underwent a 40-min session of RE during their HD sessions . Both interventions lasted 12 weeks . The patients ' anthropometric , biochemical , dietetic and bioelectrical impedance measurements as well as their QOL , evaluated using the Kidney Disease Quality of Life Short Form , were recorded . RESULTS At baseline , 55.5 % of patients presented with PEW according to International Society of Renal Nutrition and Metabolism criteria ( 20 patients ) . We found statistically significant changes from baseline in both groups , such as increases in body weight , body mass index , midarm circumference , midarm muscle circumference , triceps skinfold thickness , fat mass percentage , h and grip strength , phase angle and serum albumin . A decrease in the prevalence of PEW was observed in both groups at the end of the intervention . A delta comparison between groups showed no statistically significant differences in the anthropometric and biochemical parameters . No significant improvement was observed in QOL and body composition measured by bioimpedance vector analysis . Dietary energy and protein intake increased significantly during the study period for all patients . CONCLUSION Oral nutritional supplementation during HD improves NS . The addition of RE during HD does not seem to augment the acute anabolic effects of intradialytic ONS on NS INTRODUCTION Maintenance hemodialysis ( MHD ) patients suffer from a number of co-morbidities including declines in muscle mass and physical function . Beta-hydroxy-beta-methylbutyrate ( HMB ) is a metabolite of the amino acid leucine that has been shown to improve lean mass and physical function in elderly and clinical population s , but had not been studied in MHD patients . The purpose of this study was to investigate the efficacy of HMB in this population . METHODS We performed a double-blind , placebo-controlled , r and omized trial to assess the effects of daily HMB supplementation on co-morbidities in MHD patients . MHD patients were recruited and assigned to either daily supplementation with HMB ( n = 16 ) or placebo ( n = 17 ) for 6 months . Measurements of body composition , bone density , strength , physical function , fall risk , quality of life , and blood parameters were measured at baseline and 6 months . Blood was drawn at baseline , 3 , and 6 months to measure compliance . FINDINGS No significant effects of HMB on body composition , bone density , strength , physical function , fall risk , quality of life , or blood parameters were observed . On analysis of plasma HMB concentrations , 5 of 16 patients ( 31 % ) in the HMB group were found to be noncompliant at 3 or 6 months . Therefore , we performed a per- protocol analysis with compliant participants only and observed no significant differences in our outcomes of interest . DISCUSSION These results do not support the efficacy of HMB to attenuate co-morbid conditions in MHD patients . Moreover , this highlights the need for future interventions targeted at reducing pill burden and improving pill compliance in this population BACKGROUND Malnutrition is highly prevalent in peritoneal dialysis ( PD ) patients and is associated with a poor prognosis . Attempts to improve nutritional status with enteral supplements have yielded poor results . METHODS We performed a crossover- design trial on 13 PD patients to investigate whether these patients reduce their food intake after drinking oral nutritional supplements . Patients attended three visits in which they were administered a st and ard oral nutritional supplement either 2 hours or 30 minutes before lunch or a placebo drink 30 minutes before lunch . Lunch was provided as a self-select buffet-style meal , and food intake was measured .  Total intake was calculated by adding the nutritional content of the oral supplement . RESULTS Patients showed poor food intake , with mean values equaling only 18 % of the recommended daily intake for calories and 34 % for protein . Drinking the supplement 2 hours before lunch result ed in a significant increase compared with the placebo visit in total caloric ( 430 to 843 kcal ; P < 0.001 ) and protein intake ( 27.6 to 41.3 g ; P = 0.006 ) . No significant difference in total intake was detected between drinking the supplement 2 hours versus 30 minutes before lunch . CONCLUSION These results indicate that oral nutritional supplements administered before a meal may significantly increase caloric and protein intakes of PD patients BACKGROUND Malnutrition is a significant problem in those undergoing peritoneal dialysis ( PD ) . Factors such as gastrointestinal ( GI ) symptoms and the need for a fluid reduced diet can limit tolerance and thereby the efficacy of oral nutritional supplements to treat malnutrition . OBJECTIVES To evaluate the acceptability and impact of two different forms of oral nutrition supplementation for 16 weeks on nutritional markers and quality of life of malnourished patients undergoing PD . DESIGN A r and omised , within-subject cross-over study . Patients assessed as malnourished or with serum albumin < 35 g/l were recruited . Participants were r and omised to receive either 200 ml of a 1.25 kcal/ml nutrition supplement or a high protein nutrition supplement bar , for eight weeks . Each group then crossed over to receive the alternative supplement for eight weeks . Total intervention time was 16 weeks . Serum albumin , serum transthyretin and food intake were evaluated at baseline , at 8 and 16 weeks . Subjective Global Assessment , the presence of GI symptoms and quality of life were evaluated at baseline and 16 weeks . RESULTS Sixteen weeks of nutritional support was associated with statistically significant improvements in weight and a reduction in the proportion of patients who were malnourished . There was no difference in the impact of bars compared with liquid oral nutrition supplementation . Patients preferred the fluid supplement to the bars . CONCLUSION Sixteen weeks of nutritional support improved nutritional status in malnourished patients on PD OBJECTIVE We examined the protein anabolic effects of Pro-Stat 64 , a high nitrogen-containing , enzyme-hydrolyzed , tryptophan-fortified , collagen protein supplement administrated during hemodialysis , at two different dosing regimens . DESIGN This was a r and omized , controlled , prospect i ve study with 3 different groups : control , single dose of supplementation , and double dose of supplementation . SETTING This study was performed at a clinical research center . PATIENTS Six prevalent chronic hemodialysis ( HD ) patients were enrolled : 5 males , 1 female , 4 African Americans , and 2 Caucasians . Their mean age was 45 + /- 11 years ( S.D. ) . Two patients were diabetic . METHODS Protein turnover studies were performed using amino-acid ( AA ) balance and primed constant infusion of L-(1-(13)C ) leucine . MAIN OUTCOME MEASURE Whole-body protein balance was determined according to substrate kinetics . RESULTS There were no statistically significant difference at any time point between protocol s for blood chemistries and hormonal markers , except for minor variations in plasma glucose . All plasma AA groups displayed decreases during a control study , in which no supplementation was given . Compared with the control group , plasma nonessential AA and total AA concentrations were statistically significantly higher during HD after both single and double doses of supplementation . The forearm arteriovenous AA balance was statistically significantly better for essential , nonessential , and total AA uptake after both single-dose and double-dose supplementation compared with the control group , except for nonessential AA , which was significantly better only after a double dose . Whole-body protein breakdown and net protein balance were statistically significantly better during HD with a double-dose administration in a dose-dependent manner , compared with the control and single-dose groups . CONCLUSIONS Oral AA supplementation alone improves whole-body and skeletal muscle protein anabolism in a dose-dependent manner in chronic HD patients . These data should be taken into account during clinical decision-making or when design ing clinical trials of nutritional supplementation BACKGROUND Hypoalbuminemia is associated with substantial morbidity and mortality in dialysis patients . METHODS Subjects with a mean three-month pre study serum albumin of 3.8 g/dL or less and who demonstrated > /=90 % compliance during a two-week run-in period were r and omized to 3.6 g of essential amino acids ( EAAs ) or placebo three times daily with meals for three months . R and omization was stratified by dialysis modality and by severity of the hypoalbuminemia . The primary study outcome was change in the average of three monthly serum albumin measurements between baseline and follow-up . RESULTS Fifty-two patients were r and omized ; 47 patients ( 29 hemodialysis and 18 peritoneal dialysis ) met the predetermined primary analysis criteria . The mean compliance rates averaged 75 , 70 , and 50 % at months 1 , 2 , and 3 , respectively , and were similar for EAAs and placebo .  Serum albumin in the hemodialysis patients , EAA versus placebo , improved [ ( mean + /- SE ) 0.22 + /- 0.09 g/dL , P = 0.02 ] . Changes in peritoneal dialysis patients were not significant ( 0.01 + /- 0.15 g/dL ) , but approached significance for the total study group ( 0.14 + /- 0.08 g/dL , P = 0.08 ) . Patients in the very low albumin strata ( < 3.5 g/dL ) improved more than those in the low albumin strata ( 3.5 to 3.8 g/dL , P < 0.01 ) . There was a significant correlation ( r = 0.83 , P = 0.001 ) within the hemodialysis EAA group between the baseline C-reactive protein level and improvement in serum albumin . Improvements were also seen in grip strength and SF-12 mental health score , but not in serum amino acid levels , SF-12 physical health score , or anthropometric measurements . CONCLUSIONS Oral EAAs induce a significant improvement in the serum albumin concentration in hemodialysis but not peritoneal dialysis subjects . Further study of their long-term effects on morbidity and mortality is warranted Uremic malnutrition is associated with increased risk of hospitalization and death in chronic hemodialysis ( CHD ) patients . Most nutritional intervention studies in CHD patients traditionally have used concentrations of serum albumin as the primary outcome measure and showed slight or no significant improvements . A recent study showed that intradialytic parenteral nutrition ( IDPN ) improves whole-body protein synthesis in CHD patients . On the basis of this observation , it was hypothesized that the anabolic effects of IDPN are associated with increases in the fractional synthetic rate of albumin , a direct estimate of acute changes in hepatic albumin synthesis . Seven CHD patients were studied during two hemodialysis ( HD ) sessions , with and without IDPN , using primed-constant infusion of ( 13C ) leucine 2 h before , during , and 2 h after HD . Plasma enrichments of ( 13C ) leucine and ( 13C ) ketoisocaproate were examined to determine the fractional synthetic rate of albumin . The results indicate that administration of IDPN significantly improves the fractional synthetic rate of albumin during HD ( 16.2 + /- 1.5%/d versus 12.8 + /- 1.7%/d ; P < 0.05 ) in CHD patients in parallel with significant improvements in whole-body protein synthesis ( 5.05 + /- 1.3 mg/kg fat-free mass/min versus 3.22 + /- 0.3 mg/kg fat-free mass/min ; P < 0.05 ) . IDPN is protein anabolic in the acute setting in CHD patients , as evidence d by significant concomitant increases in the fractional synthetic rate of albumin and whole-body protein synthesis OBJECTIVE This controlled trial was undertaken to evaluate the benefits of short-term enteral nutrient supplementation in maintenance hemodialysis ( MHD ) patients using a high-calorie and high-protein blend formula ( low-cost home-prepared [ HP ] blend or a commercially available supplement ) and to study its effect on selected parameters of nutritional status . The acceptability and palatability of the HP blend formula , ease of use , and cost were also assessed in comparison with the commercial nutritional supplement ( CNS ) . DESIGN R and omized controlled trial . SETTING Hemodialysis ( HD ) unit of a tertiary referral care hospital in Southern India . PATIENTS Nondiabetic adult MHD patients with no intercurrent illness , on regular thrice weekly MHD for at least 1 month before recruitment , with a body mass index ( BMI ) < 20 and a serum albumin level of < 4.0 g/dL. Patients were r and omized into control group and experimental group , the latter in turn to recieve either CNS or HP blend . INTERVENTION The control group received appropriate monitoring , including di 
    Output:
    
Overall , it is likely that oral protein-based nutritional supplements increase both mean change in serum albumin and serum albumin at end of intervention and may improve serum prealbumin and mid-arm muscle circumference .
The improvement in serum albumin was more evident in haemodialysis and malnourished participants .
However , it remains uncertain whether these results translate to improvement in nutritional status and clinical ly relevant outcomes such as death .