***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: The inflammatory cytokines , tumor necrosis factor-alpha ( TNF-alpha ) and interleukin-1-beta ( IL-1 beta ) , have been associated with accelerated metabolism and protein turnover following exogenous administration in normal humans . We hypothesized that these inflammatory cytokines might contribute to the weight-losing process in patients with chronic obstructive pulmonary disease ( COPD ) . COPD patients were identified prospect ively as " weight losers " ( WL ; n = 10 ) if they reported > 5 % weight loss during the preceding year or as " weight stable " ( WS ; n = 10 ) if their body weight fluctuated < or = 5 % . Age-matched healthy volunteers were selected as the control group ( C ; n = 13 ) . Monocytes were isolated from a peripheral blood sample , cultured , and exposed to lipopolysaccharide ( LPS ) . The concentration of TNF-alpha and IL-1 beta in the monocyte supernatant was measured using a four layer enhanced ELISA . No significant difference in LPS-stimulated IL-1 beta production was found in the three study population s. However , LPS-stimulated TNF-alpha production ( mean [ range ] ng/ml ) by monocytes was significantly higher in the WL COPD patients ( 20.2 [ 6.3 to 44.8 ] ) , compared with WS patients ( 6.9 [ 1.5 to 16.6 ] ) , and C subjects ( 5.7 [ 0 to 61.8 ] ) . This difference was not maintained at 6 mo follow-up in the absence of ongoing weight loss . Definition of a causal relationship between TNF-alpha production and weight loss will require further underst and ing of the relationship between energy metabolism and TNF-alpha production in these patients The impact of oral nutritional supplementation during an acute exacerbation of COPD on functional status was assessed through measuring change in lung function , strength testing , and general well-being .  Subjects hospitalized for an acute exacerbation of COPD ( n = 33 ) were r and omized to extra nutritional support or the regular hospital care . They consumed an additional 10 kcal/kg/d . Outcome measures were measured at 2 wk as change scores . Forced vital capacity ( % predicted ) improved in the treatment group as compared with the control group ( + 8.7 % versus -3.5 % , p = 0.015 ) , and change in FEV1 was in the same direction but not significantly different ( p = 0.099 ) . There were no changes in h and grip strength or respiratory muscle strength , but there was a trend towards more improvement in the general well-being score ( + 11.96 versus -10.25 , p = 0.066 ) . Almost all subjects were in negative nitrogen balance , indicating muscle wasting . The degree of muscle wasting was strongly correlated with the dose of corticosteroids ( r = 0.73 , p < 0.005 ) . In conclusion , it is difficult to prevent important muscle wasting in patients with COPD treated with corticosteroids , but some small gains were observed with increased dietary intake Background In chronic respiratory failure ( CRF ) , body composition strongly predicts survival . Methods A prospect i ve r and omised controlled trial was undertaken in malnourished patients with CRF to evaluate the effects of 3 months of home rehabilitation on body functioning and composition .  122 patients with CRF on long-term oxygen therapy and /or non-invasive ventilation ( mean ( SD ) age 66 ( 10 ) years , 91 men ) were included from eight respiratory units ; 62 were assigned to home health education ( controls ) and 60 to multimodal nutritional rehabilitation combining health education , oral nutritional supplements , exercise and oral testosterone for 90 days . The primary endpoint was exercise tolerance assessed by the 6-min walking test ( 6MWT ) . Secondary endpoints were body composition , quality of life after 3 months and 15-month survival . Results Mean ( SD ) baseline arterial oxygen tension was 7.7 ( 1.2 ) kPa , forced expiratory volume in 1 s 31 (13)% predicted , body mass index ( BMI ) 21.5 ( 3.9 ) kg/m2 and fat-free mass index ( FFMI ) 15.5 ( 2.4 ) kg/m2 . The intervention had no significant effect on 6MWT . Improvements ( treatment effect ) were seen in BMI ( + 0.56 kg/m2 , 95 % CI 0.18 to 0.95 , p=0.004 ) , FFMI ( + 0.60 kg/m2 , 95 % CI 0.15 to 1.05 , p=0.01 ) , haemoglobin ( + 9.1 g/l , 95 % CI 2.5 to 15.7 , p=0.008 ) , peak workload ( + 7.2 W , 95 % CI 3.7 to 10.6 , p<0.001 ) , quadriceps isometric force ( + 28.3 N , 95 % CI 7.2 to 49.3 , p=0.009 ) , endurance time ( + 5.9 min , 95 % CI 3.1 to 8.8 , p<0.001 ) and , in women , Chronic Respiratory Question naire ( + 16.5 units , 95 % CI 5.3 to 27.7 , p=0.006 ) . In a multivariate Cox analysis , only rehabilitation in a per- protocol analysis predicted survival ( HR 0.27 , 95 % CI 0.07 to 0.95 , p=0.042 ) . Conclusions Multimodal nutritional rehabilitation aim ed at improving body composition increased exercise tolerance , quality of life in women and survival in compliant patients , supporting its incorporation in the treatment of malnourished patients with CRF . Clinical Trial number NCT00230984 It has been reported that malnutrition is common in stable chronic obstructive pulmonary disease ( COPD ) patients . In order to observe the effects of Megestrol Acetate ( MA ) on nutritional status , respiratory muscle strength and immunological parameters in stable COPD patients , 31 stable COPD patients were divided into two groups at r and om -- a treatment group of 16 cases and a  control group of 15 cases . Before and after treatment all parameters were recorded , including food and energy intake , body weight , triceps skinfolds ( TSF ) , pre-albumin , transferrin , albumin . Lung function , respiratory muscle and h and grip strength were examined and immunological parameters also determined . After taking MA 160 mg/day orally for two weeks , the treatment group got benefits as follows : heat energy and protein intake increased fro 6977.9 + /- 1136 kJ/d and 44.65 + /- 13.75 g/d to 9854.0 + /- 2355.3 kJ/d and 84.80 + /- 20.23 g/d respectively . With the increase of daily energy and protein intake , body weight increased from 48.27 + /- 8.61 kg to 50.34 + /- 8.76 kg , TSF from 11.75 + /- 4.50 mm to 15.06 + /- 4.73 mm , serum pre-albumin from 306.6 + /- 33.7 mg/L to 332.6 + /- 1 mg/L , transferrin from 3.09 + /- 0.21 g/L to 3.46 + /- 0.32 g/L , albumin from 38.00 + /- 1.73 g/L to 42.64 + /- 3.36 g/L , MIP from 4.77 + /- 2.14 kPa ( 1 kPa = 7.5 mmHg ) to 6.31 + /- 2.87 kPa , MEP from 6.21 + /- 2.90 kPa to 7.20 + /- 3.67 kPa and 6 minutes walking distance from 280.2 + /- 76.4 m to 370.6 + /- 81.5 m. H and grip strength also improved . Blood lymphocyte transformation rate elevated too . ( The changes of all these parameters indicated above were statistically significant , P < 0.01 ) . However , parameters of lung function , blood gas analysis , serum immunoglobulin and complement 3 did not change significantly . In 15 control patients all the parameters did not change significantly . There were few side effects ; only one case complained of nausea and vomiting . It was shown that MA can stimulate appetite and increase dietintake , improve nutritional status , elevate respiratory muscle strength , and enhance immunity .  MA is a safe and effective drug which exerts a beneficial influence on stable COPD The purpose of this study was to determine whether a single large liquid carbohydrate ( CHO ) load ( 920 calories ) affects walking performance in patients with chronic air-flow obstruction ( CAO ) .  Walking performance was measured using the 12-min walking test . Fifteen patients with stable CAO ( FEV1 , 1.30 + /- 0.41 L ; FVC , 3.26 + /- 0.46 L ) underwent 12-min walking tests 40 min after ingestion of either CHO or placebo on consecutive days in r and omized double-blind fashion . Three practice walks were performed on a preliminary day in order to eliminate learning effects . Resting measurements of ventilation ( VE ) and carbon dioxide output ( VCO2 ) were obtained prior to each walking test . Carbohydrate significantly increased both VCO2 ( from 0.288 + /- 0.060 to 0.372 + /- 0.057 L/min , p less than 0.001 ) and VE ( from 15.2 + /- 3.5 to 18.5 + /- 3.1 L/min , p less than 0.001 ) at rest . The total 12-minute walking distance decreased from 894 + /- 199 to 847 + /- 191 m following CHO ( p less than 0.005 ) . This distance decreased in 14 of the 15 study patients . The decrease in walking distance ranged from 1.5 to 168 m ( 0.2 to 15.2 % ) . From this study we conclude that a large liquid carbohydrate load adversely affects walking performance in patients with CAO . This potential impairment of functional capacity should be considered when caloric intake is increased in attempts to improve nutritional status in this patient population A body weight lower than 90 % of the optional value has an unfavorable influence on the prognosis of chronic obstructive pulmonary disease ( COPD ) . Short term studies of up to three months duration have shown improved function of respiratory muscle exercise tolerance and immunologic parameters by an increased caloric intake of 45 kcal/kg body weight . In a r and omized trial of twelve months 14 of 30 patients with an average FEV1 of 0.8 l were instructed to take a high calorie diet . For simplicity a part of the calories were administered as Fresubin , a fluid nutrient formula . Although a weight gain of 7 kg ( p = 0.003 ) was obtained the difference to the control group was statistically not significant ( p = 0.08 ) . The same was true for skin fold thickness ( 12.4 vs 5.7 mm ) , change of ventilatory parameters and the 6 minute walking distance ( -33 vs -86 m ) . Subjective improvement was , however , impressive in all patients with dietary intervention , explainable probably by increased attention . Dietary counselling for increased intake of calories , vitamins and also calcium is thus very important in the treatment of patients with COPD The study aim ed to estimate the cost-effectiveness of interdisciplinary community-based chronic obstructive pulmonary disease ( COPD ) management in patients with COPD . We conducted a cost-effectiveness analysis alongside a 2-yr r and omised controlled trial , in which 199 patients with less advanced airflow obstruction and impaired exercise capacity were assigned to the INTERCOM programme or usual care . The INTERCOM programme consisted of exercise training , education , nutritional therapy and smoking cessation counselling offered by community-based physiotherapists and dieticians and hospital-based respiratory nurses . All-cause re source use during 2 yrs was obtained by self-report and from hospital and pharmacy records . Health outcomes were the St George 's Respiratory Question naire ( SGRQ ) , exacerbations and quality -adjusted life years ( QALYs ) . The INTERCOM group had 30 % ( 95 % CI 3–56 % ) more patients with a clinical ly relevant improvement in SGRQ total score , 0.08 ( 95 % CI -0.01–0.18 ) more QALYs per patient , but a higher mean number of exacerbations , 0.84 ( 95 % CI -0.07–1.78 ) . Mean total 2-yr costs were € 2,751 ( 95 % CI -€632–€6,372 ) higher for INTERCOM than for usual care , which result ed in an incremental cost-effectiveness ratio of € 9,078 per additional patient with a relevant improvement in SGRQ or € 32,425 per QALY . INTERCOM significantly improved disease-specific quality of life , but did not affect exacerb 
    Output:
    
We found moderate- quality evidence that nutritional supplementation promotes significant weight gain among patients with COPD , especially if malnourished .
Nourished patients may not respond to the same degree to supplemental feeding .
We also found a significant change from baseline in fat-free mass index/fat-free mass , fat mass/fat mass index , MAMC ( as a measure of lean body mass ) , six-minute walk test and a significant improvement in skinfold thickness ( as measure of fat mass , end score ) for all patients .