***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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    ***EXAMPLES*** 
    Input: BACKGROUND : This study was undertaken to test the hypothesis that early enteral nutrition might reduce the incidence of serious complications after major abdominal surgery . METHODS : In a r and omised double blind prospect i ve trial 30 patients received Nutri-drink and 30 patients received placebo through a nasoduodenal feeding tube . On the day of operation the patients were given median 600 ml of either nutrition or placebo , 60 ml per hour . On the first postoperative day the patients received either 1000 ml ( median ) of nutrition or placebo , on day 2 1200 ml ( median ) nutrition , 1400 ml placebo , on day 3 1000 ml ( median ) nutrition , 1150 ml placebo , and on day 4 1000 ml ( median ) nutrition , 800 ml placebo . All patients were followed up for 30 days by the same investigator . RESULTS : The two groups were similar with regard to nutritional status and type of operation . The rate of postoperative infectious complications was significantly lower in the nutrition group , two of 30 compared with 14 of 30 in the placebo group ( p = 0.0009 ) . CONCLUSION : Early enteral nutrition given to patients after major abdominal surgery results in an important reduction in infectious complications BACKGROUND The purpose of this study was to determine the effects of early postoperative tube feeding on outcomes of liver transplant recipients . METHODS Fifty transplant patients were r and omized prospect ively to receive enteral formula via nasointestinal feeding tubes ( tube-feeding [ TF ] group ) or maintenance i.v . fluid until oral diets were initiated ( control group ) . Thirty-one patients completed the study .  Resting energy expenditure , nitrogen balance , and grip strength were measured on days 2 , 4 , 7 , and 12 after liver transplantation . Calorie and protein intakes were calculated for 12 days posttransplant . RESULTS Tube feeding was tolerated in the TF group ( n = 14 ) . The TF patients had greater cumulative 12-day nutrient intakes ( 22,464 + /- 3554 kcal , 927 + /- 122 g protein ) than did the control patients ( 15,474 + /- 5265 kcal , 637 + /- 248 g protein ) ( p < .002 ) . Nitrogen balance was better in the TF group on posttransplant day 4 than in the control group ( p < .03 ) . There was a rise in the overall mean resting energy expenditure in the first two posttransplant weeks from 1487 + /- 338 to 1990 + /- 367 kcal ( p = .0002 ) . Viral infections occurred in 17.7 % of control patients compared with 0 % of TF patients ( p = .05 ) . Although other infections tended to occur more frequently in the control group vs the TF group ( bacterial , 29.4 % vs 14.3 % ; overall infections , 47.1 % vs 21.4 % ) , these differences were not statistically significant . Early posttransplant tube feeding did not influence hospitalization costs , hours on the ventilator , lengths of stay in the intensive care unit and hospital , rehospitalizations , or rejection during the first 21 posttransplant days . CONCLUSIONS Early posttransplant tube feeding was tolerated and promoted improvements in some outcomes and should be considered for all liver transplant patients To investigate the importance of route of nutrient administration on  septic complications after blunt and penetrating trauma , 98 patients with an abdominal trauma index of at least 15 were r and omized to either enteral or parenteral feeding within 24 hours of injury .  Septic morbidity was defined as pneumonia , intra-abdominal abscess , empyema , line sepsis , or fasciitis with wound dehiscence . Patients were fed formulas with almost identical amounts of fat , carbohydrate , and protein .  Two patients died  early in the study . The enteral group sustained significantly fewer pneumonias ( 11.8 % versus total parenteral nutrition 31.% , p less than 0.02 ) , intra-abdominal abscess ( 1.9 % versus total parenteral nutrition 13.3 % , p less than 0.04 ) , and line sepsis ( 1.9 % versus total parenteral nutrition 13.3 % , p less than 0.04 ) , and sustained significantly fewer infections per patient ( p less than 0.03 ) , as well as significantly fewer infections per infected patient ( p less than 0.05 ) . Although there were no differences in infection rates in patients with injury severity score less than 20 or abdominal trauma index less than or equal to 24 , there were significantly fewer infections in patients with an injury severity score greater than 20 ( p less than 0.002 ) and abdominal trauma index greater than 24 ( p less than 0.005 ) . Enteral feeding produced significantly fewer infections in the penetrating group ( p less than 0.05 ) and barely missed the statistical significance in the blunt-injured patients ( p = 0.08 ) . In the sub population of patients requiring more than 20 units of blood , sustaining an abdominal trauma index greater than 40 or requiring reoperation within 72 hours , there were significantly fewer infections per patient ( p = 0.03 ) and significantly fewer infections per infected patient ( p less than 0.01 ) . There is a significantly lower incidence of septic morbidity in patients fed enterally after blunt and penetrating trauma , with most of the significant changes occurring in the more severely injured patients . The authors recommend that the surgeon obtain enteral access at the time of initial celiotomy to assure an opportunity for enteral delivery of nutrients , particularly in the most severely injured patients 59 elderly patients ( mean age 82 ) with femoral neck fractures were r and omised into two groups . 27 patients received daily an oral nutrition supplement ( 250 ml , 20 g protein , 254 kcal ) for a mean of 32 days ; 32 patients acted as controls . On admission most patients had nutritional deficiencies . Despite being offered adequate quantities , nutritional requirements were not met during the hospital stay . Clinical outcome was significantly better in the supplemented group ( 56 % favourable course vs 13 % in controls ) during the stay in the convalescent hospital . The rates of complications and deaths were also significantly lower in supplemented patients ( 44 % vs 87 % ) . 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients ( 40 % vs 74 % ) . The median duration of hospital stay was significantly shorter in the supplemented group ( 24 vs 40 days ) . Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation BACKGROUND In our clinical setting , patients with perforative peritonitis are frequently malnourished . Immediate postoperative enteral feeding has been shown effective in reducing septic morbidity in patients with abdominal trauma . This study was design ed to investigate the feasibility and efficacy of immediate postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis . STUDY DESIGN A prospect i ve study spanning 1 year was conducted on patients with nontraumatic intestinal perforation and peritonitis . After laparotomy , patients were assigned r and omly to a control or study group . The study group underwent a feeding jejunostomy and received enteral feeding from 12 hours postoperatively . A low-residue , milk-based diet was used . All patients underwent assessment for severity of sepsis and nutritional status at admission . Studies of nutritional status and nitrogen balance were repeated on days 4 and 7 . RESULTS Forty-three patients ( 21 in the study group ; 22 in the control group ) were included . The two groups were comparable except for a higher sepsis score in the study group ( p < 0.05 ) . Patients in the study group achieved a positive nitrogen balance by the third postoperative day ; patients in the control group remained in negative nitrogen balance throughout the study . Abdominal distention ( four patients ) required temporary withdrawal of feeding . Diarrhea occurred in four patients but was controlled easily . The mortality rate was similar in the control and study groups ( 18.2 % versus 19.1 % ) . The control group had a total of 22 septic complications , versus eight in the study group ( p < 0.05 ) . CONCLUSIONS Immediate postoperative feeding is feasible in patients with perforative peritonitis and reduces septic morbidity BACKGROUND Patients with upper gastrointestinal ( GI ) tract malignancies are at risk for malnutrition and postoperative morbidity and mortality . We examined the protein kinetic effects of early enteral feeding in this population and compared it with results in patients receiving IV fluid .  METHODS Twenty-nine patients undergoing resection of an upper GI tract malignancy were prospect ively r and omized to either enteral feeding starting on postoperative day ( POD ) 1 via a jejunostomy tube ( FEED , n = 12 ) or IV fluid ( IVF , n = 17 ) . On POD5 , all patients underwent a protein metabolic study using [3H]phenylalanine to determine forearm skeletal muscle ( nmol phenylalanine/100 g/min ) protein net balance . Free fatty acids ( FFA , mEq/dL ) and insulin levels ( mU/mL ) were measured . RESULTS Protein net balance was significantly less negative in the FEED group compared with the IVF group ( -1.4 + /- 0.8 vs -5.0 + /- 1.4 , p < .05 ) . Respiratory quotient was significantly increased in patients receiving enteral feeding ( 0.85 + /- 0.02 vs 0.78 + /- 0.02 FEED vs IVF , p < .05 ) . FFA levels were significantly decreased in the FEED group ( 0.36 + /- 0.04 vs 0.85 + /- 0.07 , p < .05 ) . Insulin levels were significantly elevated in the FEED group ( 19.8 + /- 4.5 vs 9.3 + /- 0.8 , p < .05 ) . Insulin levels correlated with amino acid fluxes . CONCLUSIONS Postoperative enteral nutrition in upper GI cancer patients results in an improvement in protein kinetic net balance and amino acid flux across peripheral tissue . In addition , insulin levels are elevated , and this elevation correlates with amino fluxes across the forearm . By improving peripheral protein kinetics , early postoperative enteral nutrition may potentially contribute to a decrease in postoperative morbidity and mortality in upper gastrointestinal cancer patients Benefits of immediate postinjury nutritional support remain ill defined . Seventy-five consecutive patients undergoing emergent celiotomy with an abdominal trauma index ( A.T.I. ) greater than 15 were r and omized prospect ively to a control group  ( no supplemental nutrition during first 5 days )  or enteral-fed group . The enteral patients had a needle catheter jejunostomy ( N.C.J. ) placed at laparotomy with the constant infusion of an elemental diet ( Vivonex HN ) begun at 18 hours and advanced to 3,000 ml/day ( 3,000 kcal , 20 gm N2 ) within 72 hours . Control and enteral-fed groups were comparable with respect to demographic features , trauma mechanism , shock , colon injury , splenectomy , A.T.I. , and initial nutritional assessment . Twenty ( 63 % ) of the enteral patients were maintained on the elemental diet greater than 5 days ; four ( 12 % ) needed total parenteral nutrition ( T.P.N. ) . Nine ( 29 % ) of the control patients required T.P.N. Nitrogen balance was markedly improved ( p less than 0.001 ) in the enteral-fed group . Although visceral protein markers and overall complication rate were not significantly different , septic morbidity was greater ( p less than 0.025 ) in the control group ( abdominal infection in seven and pneumonia in two ) compared to the enteral-fed patients ( abdominal abscess in three ) . Analysis of patients with A.T.I. 15 - 40 disclosed sepsis in seven ( 26 % ) of the control versus one ( 4 % ) of the enteral-fed group ( p less than 0.01 ) . Our clinical experience demonstrates the feasibility of immediate postoperative enteral feeding via N.C.J. after major abdominal trauma , and suggests this early nutrition reduces septic complications in critically injured patients A total of 744 elderly women with fractured neck of femur were classified into three groups according to anthropometric measurements on admission : group 1 , well nourished ; group 2 , thin ; group 3 , very thin . Group 1 ate well and had a low mortality and a short rehabilitation time . The thinner the patients the lower their voluntary food intake , the higher their mortality and the longer their rehabilitation time . A series of 122 patients from groups 2 and 3 were entered postoperatively into a r and omised controlled trial of overnight supplementary nasogastric tube feeding ( 4.2 MJ ( 10 
    Output:
    
The results of this meta- analysis support the experimental data demonstrating the benefit of the early initiation of enteral nutrition .