***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: OBJECTIVE We examined the effects of megestrol acetate versus placebo and progressive resistance physical exercise on weight , lean muscle mass , quality of life , ability to exercise , proinflammatory cytokines , and anti-inflammatory cytokines , and their correlations with one another . DESIGN We organized a prospect i ve 20-week , r and omized , double-blind , placebo-controlled pilot trial of hemodialysis patients . SETTING This study took place at the Outpatient Unit of the Northport Veteran Affairs Medical Center . SUBJECTS We studied nine male hemodialysis patients who had two or more of the following : albumin level < 4.0 g/dL , total cholesterol < 150 mg/dL , protein catabolic rate < 0.8 g/kg/day , and predialysis serum urea nitrogen < 60 mg/dL. Their ages were 50 to 83 years . Two were diabetic , and seven were nondiabetic . INTERVENTIONS Interventions included megestrol acetate ( MA ) or placebo 800 mg oral daily for 20 weeks , along with weight resistance physical therapy with weights twice a week before dialysis . Patients were followed prospect ively for an additional 4 weeks . MAIN OUTCOME MEASUREMENTS Weight , body composition , activities of daily living , ability to exercise , and plasma cytokine levels were measured . RESULTS At 24 weeks , the MA group had a statistically significant weight gain ( 11.1-pound increase vs. 1.5-pound decrease for the placebo group , P = .018 ) , body fat gain ( 6.2-pound increase vs. a 0.4-pound decrease for the placebo group , P = .044 ) and fat-free mass gain ( 5-pound increase vs. a 1.2-pound decrease in the placebo group ) . The MA group also had a greater tendency toward increased appetite and sense of well-being . The MA group showed a greater improvement in ability to exercise ( mean change in rate of perceived exertion ( RPE ) , 4.7 ) vs. the placebo group ( mean change in RPE vs. 0.5 , P = .02 ) . Elevated cytokine levels were evident at baseline in both groups . In all patients , increases in weight , fat-free mass , sense of well-being , appetite , and ability to exercise were negatively correlated with tumor necrosis factor receptor subunit p75 ( P < .05 ) . There was a trend toward all of these parameters to be negatively correlated with tumor necrosis factor receptor subunit p55 , although only sense of well-being was statistically significant ( P < .05 ) . CONCLUSION In a pilot trial in dialysis patients , MA showed significant benefits in improving weight and ability to exercise . Cytokine changes were correlated with weight gains and increases in fat-free mass BACKGROUND Malnutrition-inflammation complex syndrome and anorexia , common conditions in maintenance dialysis patients , are strongly associated with higher mortality and hospitalization and lower quality of life ( QoL ) in this population . Megestrol acetate , 800 mg/day , has been shown to increase appetite and food intake and to mitigate inflammation in cachectic AIDS and cancer patients , leading to weight gain , but it is also associated with side effects at this dose . METHODS We evaluated the efficacy of the oral solution of megestrol acetate in half of its conventional dose in improving the nutritional state and inflammation in 10 hypoalbuminemic dialysis patients ( albumin < 3.7 g/dL ) . Six women and 4 men , ages 60.2 years , took 400 mg of megestrol acetate solution daily for 16 weeks . Anthropometry , dual energy x-ray absorptiometry , 24-hour diet recalls , and biochemical measurements of nutrition and inflammation , including serum C-reactive protein and leptin , were performed . RESULTS At the end of the 16 weeks of intervention , weight and body mass index increased by 9 % , body fat proportion by 31 % , and triceps skinfold by 40 % ( P < .01 ) . Serum albumin increased from 3.0 to 3.3 g/dL and continued to increase significantly to 3.6 g/dL after 3 months postintervention ( P = .03 ) . Serum leptin increased from 5.2 to 10.7 ng/mL ( P = .09 ) . Daily protein and energy intake increased progressively up to 27 % to 42 % by the end of the trial ( P < or = .01 ) . In 8 patients without acute infection , serum C-reactive protein declined from 1.24 to 0.78 mg/L ( P = .06 ) . QoL and appetite were reported to be improved . No major side effects were observed , and all 10 patients completed the 16 weeks of daily intake of megestrol acetate without interruption . CONCLUSIONS Megestrol acetate oral solution in half of its conventional dose is safe and improves the nutritional state , inflammation , and anorexia in maintenance dialysis patients . Larger-scale placebo-controlled r and omized studies are needed to confirm the beneficial effects of 400 mg/day of megestrol acetate in dialysis patients Weight loss is known to impact survival among patients infected with human immunodeficiency virus ( HIV ) even in the era of highly active antiretroviral therapy ( HAART ) . In a r and omized trial , we compared the effects of 2 months of treatment with either megestrol acetate ( 800 mg every day ) or ox and rolone ( 10 mg twice per day ) on body weight and composition in patients with weight loss of > or = 5 kg who were receiving HAART . The mean weight was 66 kg , and the mean body mass index was 21 . Mean weight gain in the megestrol acetate and the ox and rolone arms were 2.8 kg ( 4.6 % of the baseline value ) and 2.5 kg ( 3.9 % of the baseline value ) , respectively ( P=.80 ) . Lean body mass accounted for 39 % of weight gain in the megestrol acetate arm and 56 % in the ox and rolone arm ( P=.38 ) . Seven patients in the megestrol acetate arm and 5 patients in the ox and rolone arm reported minor adverse events ( P=.74 ) . In conclusion , megestrol acetate therapy and ox and rolone therapy have similar effects on body weight and composition and are safe and well-tolerated during HAART Aim : N-3 fatty acids , especially eicosapentaenoic acid ( EPA ) , may possess anticachectic properties . This trial compared a protein and energy dense supplement enriched with n-3 fatty acids and antioxidants ( experimental : E ) with an isocaloric isonitrogenous control supplement ( C ) for their effects on weight , lean body mass ( LBM ) , dietary intake , and quality of life in cachectic patients with advanced pancreatic cancer . Methods : A total of 200 patients ( 95 E ; 105 C ) were r and omised to consume two cans/day of the E or C supplement ( 480 ml , 620 kcal , 32 g protein ± 2.2 g EPA ) for eight weeks in a multicentre , r and omised , double blind trial . Results : At enrolment , patients ’ mean rate of weight loss was 3.3 kg/month . Intake of the supplements ( E or C ) was below the recommended dose ( 2 cans/day ) and averaged 1.4 cans/day . Over eight weeks , patients in both groups stopped losing weight ( Δ weight E : −0.25 kg/month versus C : −0.37 kg/month ; p = 0.74 ) and LBM ( Δ LBM E : + 0.27 kg/month versus C : + 0.12 kg/month ; p = 0.88 ) to an equal degree ( change from baseline E and C , p<0.001 ) . In view of evident non-compliance in both E and C groups , correlation analyses were undertaken to examine for potential dose-response relationships . E patients demonstrated significant correlations between their supplement intake and weight gain ( r = 0.50 , p<0.001 ) and increase in LBM ( r = 0.33 , p = 0.036 ) . Such correlations were not statistically significant in C patients . The relationship of supplement intake with change in LBM was significantly different between E and C patients ( p = 0.043 ) . Increased plasma EPA levels in the E group were associated with weight and LBM gain ( r = 0.50 , p<0.001 ; r = 0.51 , p = 0.001 ) . Weight gain was associated with improved quality of life ( p<0.01 ) only in the E group . Conclusion : Intention to treat group comparisons indicated that at the mean dose taken , enrichment with n-3 fatty acids did not provide a therapeutic advantage and that both supplements were equally effective in arresting weight loss . Post hoc dose-response analysis suggests that if taken in sufficient quantity , only the n-3 fatty acid enriched energy and protein dense supplement results in net gain of weight , lean tissue , and improved quality of life . Further trials are required to examine the potential role of n-3 enriched supplements in the treatment of cancer cachexia CONTEXT Reduced energy intake is a primary factor in HIV-associated wasting .  Megestrol acetate ( MA ) stimulates appetite and weight gain . However , much of the weight gained is fat , possibly as a result of MA-induced hypogonadism . OBJECTIVE The objective of the study was to determine whether coadministration of testosterone with MA could enhance lean body mass ( LBM ) accrual and evaluate the effects of MA , alone or combined with testosterone , on sexual functioning and the hypothalamic-pituitary-adrenal axis . DESIGN This was a r and omized , double-blind , placebo-controlled , multicenter trial . SETTING Fourteen AIDS Clinical Trials Units in the United States participated in the study . SUBJECTS Seventy-nine HIV-positive men with 5 % or more weight loss or body mass index less than 20 kg/m2 took part in the study . INTERVENTION Subjects were r and omized to receive MA ( 800 mg daily ) plus testosterone enanthate ( 200 mg ; MA/TE ; n = 41 ) or placebo ( MA/PL ; n = 38 ) biweekly for 12 wk . MAIN OUTCOME MEASURES Weight , body composition ( bioelectric impedance analysis ) , adrenal and gonadal hormones , and sexual functioning ( question naire ) were measured . RESULTS Both groups experienced robust increases in weight ( median 5.3 and 7.3 kg in MA/TE and MA/PL , respectively ) , LBM ( 3.3 and 3.3 kg ) , and fat ( 3.0 and 3.8 kg ) . There were no significant differences between groups in the magnitude or composition of weight gain ( P = 0.44 , 0.90 , and 0.11 for weight , LBM , and fat , respectively ) . Trough testosterone concentrations decreased to a greater extent in MA/PL ( -12.3 vs. -6.1 nmol/liter in MA/TE ; P = 0.04 ) . Cortisol levels became nearly undetectable in subjects with plasma MA levels greater than 150 ng/ml . Sexual functioning was preserved with MA/TE but worsened in MA/PL . CONCLUSIONS MA produced robust weight gain . Coadministration of testosterone preserved sexual functioning but did not enhance LBM accrual BACKGROUND We examined changes in total body weight ( TBW ) and health-related quality of life ( HRQL ) during prolonged combination weight-gaining therapy and dietary advice in HIV . DESIGN This was a cohort study of patients initially r and omized to single agent therapy for 2 months , megestrol acetate ( 800 mg daily ) , or ox and rolone ( 10 mg twice daily ) , followed by both agents and dietary advice for 5 months . METHODS Two community health clinics and 1 urban infectious disease clinic were included , as were HIV-positive adult patients receiving highly active antiretroviral therapy with documented 5 % weight loss .  TBW and HRQL were measured after 7 months ( 7 m ) . RESULTS Twenty-nine of 39 participants completed 7 m. The average sample age was 40 years , 75 % were male , and 52 % were of color at enrollment . Baseline mean TBW and body mass index ( BMI ) were 62.5 kg and 21 kg/m(2 ) , respectively . Net gains in TBW , lean body mass , and fat during the 7 m were 5.3 kg ( 8.5 % of baseline ) , 2.1 kg , and 3.1 kg , respectively ( p < .01 for each ) . BMI increased to 23.1 kg/m(2 ) ( p < .01 ) . Dietary intake increased by 467 kcal/day ( p = .03 ) . Physical health improved by 5.7 ( 100-point scale , p < .01 ) , and mental health was unchanged ( -4.2 , p = .11 ) . In multivariable models , female gender ( p < .01 ) , lower baseline HIV viral load ( p = .03 ) , and increasing age ( p < .01 ) were associated with TBW gain . Injection drug use ( p < .01 ) and higher baseline HIV viral load ( p < .01 ) were associated with reduction in physical health . CONCLUSIONS Prolonged combination ther 
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There was little evidence to show significant impact on LBM , and no trials looked at muscle strength .
Current evidence does not support the use of progesterone therapies for non-cancer cachexia .
There may however be a limited role for its use as an appetite stimulant in a palliative context on a case-by-case basis