***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: The aim of this r and omized controlled study wasto assess the nutritional and clinical effects of earlyenteral nutrition ( EN ) in cirrhotic patients withbleeding from esophageal varices . From August 1994 through August 1995 , all patients admitted foracute variceal bleeding underwent emergencysclerotherapy or b and ing ligation and continuousinfusion of octreotide  and were r and omized in twogroups . In group A , patients received from day 1 discontinuouspolymeric EN ( 1665 kcal/day , through nasogastric tube ) and in group B , patients were nil by mouth . On day 4,all patients received oral diet .  Nutritional status , liver function , and rebleeding were evaluatedon days 4 , 7 , and 35 . Twenty-two patients ( 17 men , 5women , mean age 56 years ) were included . On day 0 , patients in group A ( N = 12 ) and group B ( N = 10 ) werecomparable . On day 4 , nitrogen balance was 0.7 ± 2.5g/day in group A and –11.2 ± 6.7 g/day ingroup B ( P = 0.01 , Mann-Whitney test ) . On days 4 , 7 , and 35 , no significant differences between the two groupswere observed for nutritional status and liver function . Four(33 % ) group A patients rebled compared with one (10%)group B patient ( NS ) . Hospital stay ( 14.5 ± 4.1days vs 12.9 ± 5.3 days ) and mortality ( 3 vs 2 patients ) , were comparable between the two groups . In conclusion , our study failed to demonstrate anyfavorable effect of short-term EN on nutritional status and liver function in cirrhotic patients hospitalizedfor variceal bleeding A controlled trial on nutrition supplementation in ambulatory patients with decompensated alcoholic liver disease was carried out during 1 year . Fifty-one patients were studied ; 26 were assigned to an experimental group receiving a daily supplement of 1000 kcal and 34 g of proteins given as a casein-based enteral nutrition product and 25 to a control group receiving one placebo capsule .  Patients were examined in a special clinic once a month or more if required . Sixty-eight percent of patients admitted to alcohol ingestion or had alcohol in urine sample s on at least one occasion . Dietary recalls showed a significantly higher protein and caloric intake in case patients subjects ( p < .0001 ) . Nine patients  died during the study , three case patients and six control patients ( p = NS ) . The frequency of hospitalizations was significantly less in the experimental group . This difference was attributed to a reduction in severe infections . Mid-arm circumference , serum albumin concentration , and h and grip strength improved earlier in case patients , although both groups had a significant improvement in these parameters . Bilirubin and aspartate aminotransferase decreased and prothrombin time increased significantly in both groups during the study period , without differences between groups . It is concluded that nutrition support decreases nutrition-associated complications in patients with alcoholic liver disease AIM To investigate the safety , rationality and the practicality of enteral nutritional ( EN ) support in the postoperative patients with damaged liver function and the protective effect of EN on the gut barrier . METHODS 135 patients with liver function of Child B or C grade were r and omly allocated to enteral nutrition group ( EN , 65 cases ) , total parenteral nutrition group ( TPN , 40 cases ) and control group ( CON , 30 cases ) . Nutritional parameters , hepatic and kidney function indexes were measured at the day before operation , 5th and 10th day after the operation respectively . Comparison was made to evaluate the efficacy of different nutritional support . Urinary concentrations of lactulose(L ) and mannitol(M ) were measured by pulsed electrochemical detection(HPLC-PED ) and the L/M ratio calculated to evaluate their effectiveness on protection of gut barrier . RESULTS No significant damages in hepatic and kidney function were observed in both EN and TPN groups between pre- and postoperatively . EN group was the earliest one reaching the positive nitrogen balance after operation and with the lowest loss of body weight and there was no change in L/M ratio after the operation ( 0.026+/-0.004 ) at the day 1 before operation , 0.030+/-0.004 at the day 5 postoperative and 0.027+/-0.005 at the day 10 postoperative ) , but the change in TPN group was significant at the day 5 postoperative ( 0.027+/-0.003 vs 0.038+/-0.009,P<0.01 ) . CONCLUSION EN is a rational and effective method in patients with hepatic dysfunction after operation and has significant protection effect on the gut barrier Twenty-eight patients with biopsy or clinical acute alcoholic hepatitis were prospect ively r and omized to 21 days of conventional therapy ( 14 control patients ) or , in addition , to 2 L/day of a peripheral iv infusion of a 900 mosmol amino acid-glucose solution ( 14 patients ) . Cirrhosis was present in 64 % of controls and in 54 % of infused patients . There were three deaths in controls and one in the infused group . There were no significant intergroup differences in mortality , clinical findings , liver tests , or functional mass by the galactose elimination capacity either at entry or after completion of the study . In controls , there was intragroup improvement in serum bilirubin ( p = 0.033 ) and AST ( p = 0.008 ) but not in other " liver tests " or in functional hepatic mass by galactose elimination capacity . In infused patients there was improvement in bilirubin ( p = 0.001 ) , AST ( p = 0.008 ) , and serum albumin ( p = 0.016 ) . Improvement in functional mass by galactose elimination capacity was significant at the p = 0.052 level . Hyaline was initially present in six of eight pairs of biopsies in both groups . After treatment , five of six pairs in controls but only one of six pairs in the infused group still had hyaline ( p = 0.03 ) . This latter finding , if confirmed in larger groups , may be of considerable clinical importance . It is suggested that 3- to 4-wk trials of such protocol s may require a longer duration of follow-up in greater numbers of patients to detect important advantages of amino acid-glucose infusions which are only implicit in these findings BACKGROUND Poor nutritional status is common among patients awaiting orthotopic liver transplantation and is associated with poor outcome . METHODS This prospect i ve r and omized controlled trial examined the effect of pretransplant nutritional supplementation on the outcome of patients undergoing liver transplantation . Of 82 consecutive patients with mid-arm muscle circumference < 25th percentile , 42 received enteral supplementation , and the remainder acted as the control group .  The supplemented group received a calorie-dense enteral feed taken daily ( in addition to diet ) until transplantation . Nutritional status was monitored by upper arm anthropometric measurements and h and grip strength . Dietary intake was calculated from 5-day food diaries . RESULTS Supplementation improved mid-arm circumference , mid-arm muscle circumference , and grip strength . Pretransplant nutritional status was not associated with posttransplant sepsis or major complications . Preoperative grip strength of < 85 % of normal values was predictive of increased incidence of posttransplant major complications . Supplementation did not affect outcome , although there were more deaths in the control group ( seven deaths before and two deaths after transplant ) than there were in the supplemented group ( two deaths before and three deaths after transplant ) . There was no difference in overall survival ( P = 0.075 ) . CONCLUSIONS Enteral supplementation improved some parameters of nutritional status pretransplant . Dietary intake of patients in the two groups was similar at transplant . Nutritional supplementation has not increased nutritional intake , although this may reflect the importance of regular dietetic input and support , rather than suggesting that nutritional supplementation is ineffective . Supplementation had no effect on outcome of liver transplantation Background : Patients undergoing transarterial chemoembolization for hepatocellular carcinoma have advanced tumour or severe cirrhosis and frequently have associated protein‐calorie malnutrition . The role of nutritional supplements for such patients is unclear The effects of a nutritional support in hospitalized patients with alcoholic cirrhosis and liver failure were studied in a controlled protocol . Thirty-six patients were included , 17 were r and omly assigned to an experimental group and the rest to a control group . Experimentals received a diet aim ing at 50 kcal ( 209 kJ)/kg bodyweight/d and 1.5 g protein/kg bodyweight/d ( as proteins of high biological value ) . Controls received the st and ard diet prescribed by the attending physician . The severity of liver failure and the nutritional status on admission were similar in both groups . The measured energy intake in controls was 1813 + /- 121 kcal/d ( 7589 + /- 506 kJ/d ) and 2707 + /- 71 kcal/d ( 1131 + /- 297 kJ/d ) in experimentals ( P less than 0.001 ) . The protein intake in controls was 47 + /- 3.8 g/d and in experimentals 80 + /- 3 g/d ( P less than 0.001 ) . There were seven deaths during the study period ( two experimentals and five controls ) . No differences were observed in the evolution of liver failure , hepatic encephalopathy or nutritional status between both study groups . It is concluded that a higher energy and protein intake in these patients does not have adverse effects and is associated with a non-significant reduction in mortality Between March 1982 and September 1983 , 40 in patients ( 25 men and 15 women , mean age 53 years ) with alcoholic cirrhosis and total serum bilirubin greater than or equal to 5 mg per dl were studied . Those with hepatocellular carcinoma , renal failure , hyponatremia , septicemia , spontaneous bacterial peritonitis , gastrointestinal bleeding , and hepatic coma were excluded . Patients were studied for 28 days . The two groups were offered an oral diet containing 40 kcal per kg per day . Patients in the supplementary parenteral nutrition group received 40 kcal per kg per day and 200 mg nitrogen per kg per day using a central catheter . The major endpoint was total serum bilirubin on Day 28 . On admission , serum bilirubin was not significantly different in the two groups : oral group , 12.5 + /- 6.6 mg per dl ; supplementary parenteral nutrition group , 12.3 + /- 8.5 mg per dl . On Day 28 , serum bilirubin was lower in the supplementary parenteral nutrition group ( 2.5 + /- 1.4 mg per dl ) than in the oral group ( 4.1 + /- 2.2 mg per dl ) ( p less than 0.02 ) . Serum bilirubin was also lower in the supplementary parenteral nutrition group than in the oral group on Days 7 , 14 and 21 ( p less than 0.05 ) . Analysis of covariance , considering serum bilirubin on admission and at r and omization and time between admission and r and omization , confirmed these results . On Day 28 , anthropometric parameters , serum transferrin , prealbumin and retinol-binding protein were higher in the supplementary parenteral nutrition group , but the differences were not significant . Serum albumin was significantly lower in the supplementary parenteral nutrition group . The incidence of encephalopathy and sepsis was not significantly different between the two groups The relationship of protein calorie malnutrition ( PCM ) to alcoholic liver disease was studied in 666 patients enrolled in two Veterans Administration Cooperative Studies . Some findings of malnutrition could be detected early in 62 % of the comparison patients ( 43 subjects who were alcoholic , but had not yet developed clinical or laboratory evidence of liver injury ) . In those who had progressed to the stage of liver injury sufficient to manifest clinical jaundice ( 536 patients ) , some findings of malnutrition were present in every patient ( 100 % ) . The degree of malnutrition correlated closely with the development of all the serious complications of the liver disease ( ascites , encephalopathy , and hepatorenal syndrome ) , as well as the overall mortality . The degree of malnutrition was also important in predicting response to some forms of treatment . When prednisolone , a catabolic adrenal steroid , was used , efficacy was independent of the level of malnutrition . However , a relationship was observed with the severity of the liver injury [ quantified by the level of jaundice and coagulopathy , i.e. , Maddrey 's discriminant function ( DF(Maddrey ) ] . For prednisolone , the response was seen only when the DF was 81 - 100 reducing mortality 45 % When ox and rolone , an and rogenic anabolic steroid treatment was given , efficacy was observed only in those with moderate malnutrition ( PCM score 60 - 79 % of normal ) and maximized with adequate caloric intake reducing mortality 86 % . To simplify the method of calculating the PCM score for predicting response 
    Output:
    
Our review suggests that nutritional therapy may have beneficial effects on clinical outcomes in cirrhosis and alcoholic hepatitis .