***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: BACKGROUND & AIMS N-3 fatty acids from fish oil , antioxidants , and short-chain fatty acids ( SCFAs ) produced during the fermentation of soluble fiber may attenuate inflammation associated with ulcerative colitis ( UC ) . We assessed the efficacy of a nutritionally balanced oral supplement enriched with fish oil , fructooligosaccharides , gum arabic , vitamin E , vitamin C , and selenium on disease activity and medication use in adults with mild to moderate UC . METHODS A total of 121 patients with UC and a disease activity index ( DAI ) from 3 - 9 on a 12-point scale were block r and omized for extent of disease and smoking status . In addition to their usual diet , patients consumed 18 oz of the oral supplement or a carbohydrate-based placebo formula each day for 6 months . Clinical and histologic responses were assessed at 3 and 6 months or at the final visit . A change in average prednisone use between groups was tested by using a linear mixed-effects model . RESULTS Eighty-six patients completed the study . Baseline characteristics were not different between groups except for a higher total DAI score in the oral supplement group ( 7.3 + /- 1.3 ; n = 36 ) compared with the placebo group ( 6.2 + /- 2.0 ; n = 50 ) ( P < .05 ) . Both groups showed significant and similar degree of improvement at 6 months in DAI ( -2.5 for oral supplement and -2.8 for placebo ) and histologic index ( -1.9 for oral supplement vs. -2.0 for placebo ) . Both intent-to-treat and completed patients given oral supplement had a significantly greater rate of decrease in the dose of prednisone required to control clinical symptoms over 6 months as compared with the placebo group ( P < .001 ) . CONCLUSIONS The improvement in clinical response combined with a decreased requirement for corticosteroids suggest that this enriched oral supplement can be a useful adjuvant therapy in patients with UC BACKGROUND There is conflicting evidence on the benefits of foods rich in vitamin E ( alpha-tocopherol ) , n-3 polyunsaturated fatty acids ( PUFA ) , and their pharmacological substitutes . We investigated the effects of these substances as supplements in patients who had myocardial infa rct ion . METHODS From October , 1993 , to September , 1995 , 11,324 patients surviving recent ( < or = 3 months ) myocardial infa rct ion were r and omly assigned supplements of n-3 PUFA ( 1 g daily , n=2836 ) , vitamin E ( 300 mg daily , n=2830 ) , both ( n=2830 ) , or none ( control , n=2828 ) for 3.5 years . The primary combined efficacy endpoint was death , non-fatal myocardial infa rct ion , and stroke . Intention-to-treat analyses were done according to a factorial design ( two-way ) and by treatment group ( four-way ) . FINDINGS Treatment with n-3 PUFA , but not vitamin E , significantly lowered the risk of the primary endpoint ( relative-risk decrease 10 % [ 95 % CI 1 - 18 ] by two-way analysis , 15 % [ 2 - 26 ] by four-way analysis ) . Benefit was attributable to a decrease in the risk of death ( 14 % [ 3 - 24 ] two-way , 20 % [ 6 - 33 ] four-way ) and cardiovascular death ( 17 % [ 3 - 29 ] two-way , 30 % [ 13 - 44 ] four-way ) . The effect of the combined treatment was similar to that for n-3 PUFA for the primary endpoint ( 14 % [ 1 - 26 ] ) and for fatal events ( 20 % [ 5 - 33 ] ) . INTERPRETATION Dietary supplementation with n-3 PUFA led to a clinical ly important and statistically significant benefit . Vitamin E had no benefit . Its effects on fatal cardiovascular events require further exploration The effect of fish oil on the course of ulcerative colitis was investigated in a r and omised blinded controlled study . Eighty seven patients received supplements of 20 ml  HiEPA fish oil as triglyceride ( 4.5 g of eicosapentaenoic acid ) or olive oil placebo daily for one year . The oils were given in addition to st and ard drug therapy and trial entry was stratified for disease activity . Fish oil significantly increased the eicosapentaenoic acid content of rectal mucosa to 3.2 % of total fatty acids at six months , compared with 0.63 % for patients on olive oil . This was associated with increased synthesis of leukotriene B5 , and 53 % suppression of leukotriene B4 synthesis by ionophore -- stimulated neutrophils . Leukotriene B4 suppression persisted for at least two months after treatment was stopped . Treatment with fish oil result ed in measurable , but only limited clinical benefit . For patients entering the trial in relapse ( n = 53 ) , there was a significant reduction in corticosteroid requirement after one and two months treatment . There was a trend towards achieving remission ( off corticosteroids ) faster in the patients on fish oil , although differences were not significant . For patients in remission at trial entry or during the trial ( n = 69 ) , there was no significant difference in the rate of relapse by log rank analysis . We conclude that fish oil supplementation produces a modest corticosteroid sparing effect in active disease , but there is no benefit in maintenance therapy Arachidonic acid metabolites formed by both the cyclooxygenase and lipoxygenase pathways may contribute to the clinical diarrhea and colitis of inflammatory bowel disease . Patients with active ulcerative colitis have increased levels of leukotriene B4 in their rectal mucosa , and these levels tend to correlate with severity of the disease . In this study , we evaluated the efficacy of ingestion of fish oil n-3-omega-fatty acids , inhibitors of leukotriene synthesis , in the treatment of ulcerative colitis . Eleven patients with ulcerative colitis of mild to moderate severity were studied in a 8-month , double-blind , placebo-controlled , crossover trial of dietary supplementation with fish oil , which provided about 4.2 g of omega-3- fatty acids per day . A disease activity index based on patient symptoms and sigmoidoscopic appearance was used to assess efficacy . Mucosal leukotriene B4 production was measured by radioimmunoassay . Mean disease activity index declined 56 % for patients receiving fish oil and 4 % for patients on placebo ( p less than 0.05 ) . There were no statistically significant differences in histopathologic scores or colonic mucosal leukotriene B4 levels . All patients tolerated fish oil ingestion and showed no alteration in routine blood studies . No patient worsened ; anti-inflammatory drugs could be reduced or eliminated in eight patients ( 72 % ) while receiving fish oil . We conclude that fish oil dietary supplementation results in clinical improvement of active mild to moderate ulcerative colitis but is not associated with significant reduction in mucosal leukotriene B4 production , compared with placebo therapy . Further studies are needed to eluci date the mechanism of action and optimal dose and duration of fish oil supplementation in ulcerative colitis Relapse prevention by dietary n-3 fatty acids ( 5.1 g/day ) was studied in a double-blind , placebo-controlled trial of 64 patients with ulcerative colitis in remission and off steroids . 5-ASA compounds were stopped three months after r and omization and clinical disease activity monitored for two years . Macroscopic and histologic activity and extension was assessed by colonoscopy at entry and at exit . Both treatment groups were well matched at start . Nine patients on placebo and eight on n-3 fatty acids  stopped taking their medication prematurely . Actuarial relapse-free survival was improved by n-3 fatty acids only during months 2 and 3 ( 2P<0.05−0.01 ) , but cumulative relapse rate at two years was similar for those taking placebo ( 18/33=55 % ) and n-3 fatty acids ( 18/31=58 % ) . There was also no consistent difference in clinical , macroscopic , and histologic disease activity between treatment groups . The n-3 fatty acids temporarily retard , but do not prevent , relapse of ulcerative colitis Thirty-nine patients with chronic inflammatory bowel disease were studied in a 7-month , double-blind , placebo controlled cross-over trial of dietary supplementation with fish oil , which provided about 3.2 g n-3 fatty acids per day . At control , biopsies from inflamed mucosa contained higher levels of arachidonic acid than uninvolved mucosa . Dietary n-3 fatty acids were well tolerated and incorporated into plasma and enteric mucosa phospholipids at the expense of n-6 fatty acids . The arachidonic acid-derived prostanoid generation was reduced by fish oil and the extension and severity of macroscopic bowel involvement was moderately improved . In patients with Crohn 's disease , clinical activity was unchanged by fish-oil supplementation . In patients with ulcerative colitis , clinical disease activity fell during fish oil supplementation and thereafter ; this was not significant however . Despite a moderate reduction in inflammatory lipid mediators by dietary n-3 fatty acids and limited morphological improvement in chronic inflammatory bowel disease , the clinical benefit seems to be confined to patients with ulcerative colitis BACKGROUND : Short chain fatty acid ( SCFA ) deficiency is associated with colitis in animals and humans , and the mucosal metabolism of these compounds is decreased in ulcerative colitis . AIMS : To assess the efficacy of topical SCFA treatment in ulcerative colitis . PATIENTS AND METHODS : 103 patients with distal ulcerative colitis were entered into a six week , double-blind , placebo controlled trial of rectal SCFA twice daily ;  patients who were unchanged on placebo  were offered SCFA in an open-label extension trial . RESULTS : Of the 91 patients completing the trial , more patients in the SCFA treated than in the placebo treated group improved ( 33 % v 20 % , p = 0.14 , NS ) . Those on SCFA also had larger , but statistically non-significant , reductions in every component of their clinical and histological activity scores . In patients with a relatively short current episode of colitis ( < 6 months , n = 42 ) , more responded to SCFA than to placebo ( 48 % v 18 % , p = 0.03 ) . These patients also had larger , but statistically non-significant , decreases in their clinical activity index ( p = 0.08 v placebo ) . Every patient who improved used at least five of six of the prescribed rectal SCFA irrigations , whereas only 37 % who did not improve were as compliant . In the open-label extension trial , 65 % improved on SCFA ; these patients also had significant reductions ( p < 0.02 ) in their clinical and histological activity scores . CONCLUSIONS : Although SCFA enemas were not of therapeutic value in this controlled trial , the results suggest efficacy in subsets of patients with distal ulcerative colitis including those with short active episodes . Prolonged contact with rectal mucosa seems to be necessary for therapeutic benefit Background : Some evidence indicates that short‐chain fatty acid ( SCFA ) enemas are effective in the treatment of distal ulcerative colitis A report of a r and omized , controlled trial ( RCT ) should convey to the reader , in a transparent manner , why the study was undertaken and how it was conducted and analyzed . For example , a lack of adequately reported r and omization has been associated with bias in estimating the effectiveness of interventions ( 1 , 2 ) . To assess the strengths and limitations of an RCT , readers need and deserve to know the quality of its methods . Despite several decades of educational efforts , RCTs still are not being reported adequately ( 3 - 6 ) . For example , a review of 122 recently published RCTs that evaluated the effectiveness of selective serotonin-reuptake inhibitors as first-line management strategy for depression found that only 1 ( 0.8 % ) paper described r and omization adequately ( 5 ) . Inadequate reporting makes the interpretation of RCT results difficult if not impossible . Moreover , inadequate reporting borders on unethical practice when biased results receive false credibility . History of CONSORT In the mid-1990s , two independent initiatives to improve the quality of reports of RCTs led to the publication of the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement ( 7 ) , which was developed by an international group of clinical trialists , statisticians , epidemiologists , and biomedical editors . CONSORT has been supported by a growing number of medical and health care journals ( 8 - 11 ) and editorial groups , including the International Committee of Medical Journal Editors ( ICMJE , also known as the Vancouver Group ) ( 12 ) , the Council of Science Editors ( CSE ) , and the World Association of Medical Editors ( WAME ) . CONSORT is also published in Dutch , English , French , German , Japanese , and Spanish . It can be accessed on the Internet , along with other information about the CONSORT group ( 13 ) . The CONSORT statement comprises a checklist and flow diagram for reporting an RCT . For convenience , the checklist and diagram together are called simply CONSORT . They are primarily intended for use in writing , review ing , or evaluating reports of simple two-group , parallel RCTs . 
    Output:
    
Some of the other included studies show some positive benefits for secondary outcomes .
The current data does not allow for a definitive conclusion regarding the efficacy of fish oil .