***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 & AIM The immunomodulating nutrition was supposed to reduce the incidence of complications in surgical patients , but many authors have question ed its value recently . The aim of the study was to assess the impact of enteral immunonutrition in postoperative period . METHODS Between January 2003 and December 2009 , 305 malnourished patients ( 123 F , 182 M , m. age 60.8 ) undergoing resection for pancreatic or gastric cancer , after preoperative 14 days of parenteral feeding , were r and omized in double-blind manner to receive either postoperative immunomodulating enteral diet ( IMEN ) or st and ard oligopeptide diet ( SEN ) . Outcome measures of the intend-to-treat analysis were : number and type of complications , length of hospitalization , mortality , and vital organ function . RESULTS Median postoperative hospital stay was 17.1 days in SEN and 13.1 days in IMEN group ( p = 0.006 ) . Infectious complications were observed in 60 patients ( 39.2 % ) in SEN and 43 ( 28.3 % ) in IMEN group ( p = 0.04 ) . Differences were also observed in overall morbidity ( 47.1 vs 33.5 % , p = 0.01 ) and mortality ( 5.9 vs 1.3 % , p = 0.03 ) , but the ratio of surgical complications , organ function , and treatment tolerance did not differ . CONCLUSIONS The study proved that postoperative immunomodulating enteral nutrition should be the treatment of choice in malnourished surgical cancer patients . The Clinical Trials Data base registry number : NCT00576940 Postoperative oral nutritional supplementation has been shown to be of clinical benefit . This study examined the clinical effects and cost of administration of oral supplements both before and after surgery Background / Aim Perioperative administration of immunoenriched diets attenuates the perioperative inflammatory response and reduces postoperative infection complications . However , many questions still remain unresolved in this area , such as the length of diet administration , diet composition , and the mechanisms involved . We performed an open , r and omized , triple-arm study comparing the effect of two perioperative feeding regimens with a postoperative one . Methods 46 c and i date s for major elective surgery for malignancy in the upper gastrointestinal tract were r and omized to drink preoperatively either 1 L of an immunoenriched formula ( Impact ) for 5 days ( IEF group ) or 1 L of Impact plus ( Impact enriched with glycine ) for 2 days ( IEF plus group ) . The same product as the patient received preoperatively was given to both groups for 7 days postoperatively . In the control group ( CON group ) , patients only received Impact for 7 days postoperatively ; there was no preoperative treatment . The main outcome measures were postoperative C-reactive protein ( CRP ) serum levels . Results In the two preoperatively supplemented groups ( treatment groups ) , perioperative endotoxin levels , CRP ( postoperative day 7 ) , and TNF-α ( postoperative days 1 and 3 ) levels were significantly lower compared to the CON group ( p < .01 ) . Furthermore , the length of postoperative IMU/ICU stay ( Impact 1.9 ± 1.3 days ; Impact plus 2.2 ± 1.1 days ; control group 5.9 ± 0.8 days ) and length of hospital stay ( Impact 19.7 ± 2.3 days ; Impact plus 20.1 ± 1.3 days ; control group 29.1 ± 3.6 days ) were both reduced in the treatment groups compared to the control group . Infectious complications ( Impact 2/14 ( 14 % ) ; Impact plus 5/17 ( 29 % ) ; control group 10/15 ( 67 % ) ) also showed a trend toward reduction in the treatment groups . Conclusions Perioperative administration of an immunoenriched diet significantly reduces systemic perioperative inflammation and postoperative complications in patients undergoing major abdominal cancer surgery , when compared with postoperative diet administration alone . A shortened preoperative feeding regimen of 2 days with Impact enriched with glycine ( Impact plus ) was as effective as Impact administered for 5 days preoperatively Castrostomy feeding has been a well established form of nutritional support for patients presenting with total dysphgia for carcinoma of the oesophagus . More recently , total parenteral nutrition has proved to be efficient and safe , offering an alternative to gastrostomy feeding . Twenty‐four patients were r and omly selected into two groups to compare the efficacy of total parenteral nutrition and gastrostomy feeding with respect to nitrogen balance and weight gain BACKGROUND Although current opinion favours the use of enteral over parenteral nutrition , the clinical benefits of early postoperative nutrition in patients undergoing elective surgery have never been clearly shown . We aim ed to test the hypothesis that postoperative enteral nutrition is better ( fewer postoperative complications ) than parenteral nutrition containing similar energy and nitrogen amounts ( 112 kJ kg(-1 ) day(-1 ) and 1.4 g aminoacid kg(-1 ) day(-1 ) ) . METHODS We did a r and omised multicentre clinical trial in patients with gastrointestinal cancer who were malnourished and c and i date s for major elective surgery . 159 patients were assigned to enteral nutrition and 158 to parenteral nutrition .  The primary endpoint was the occurrence of postoperative complications , and secondary endpoints were length of postoperative hospital stay , adverse effects , and treatment crossover . Analysis was by intention to treat . FINDINGS Postoperative complications occurred in 54 ( 34 % ) patients fed enterally versus 78 ( 49 % ) fed parenterally ( relative risk 0.69 , 95 % CI 0.53 - 0.90 , p=0.005 ) . Length of postoperative stay was 13.4 days and 15.0 days in the enteral nutrition and parenteral nutrition groups , respectively ( p=0.009 ) . Adverse effects occurred in 56 ( 35 % ) patients fed enterally versus 22 ( 14 % ) patients fed parenterally ( 2.50 , 1.61 - 3.86 , p<0.0001 ) . 14 ( 9 % ) patients on enteral nutrition had to switch to parenteral nutrition , whereas none of those fed parenterally crossed over to enteral feeding . INTERPRETATION We conclude that early enteral nutrition significantly reduces the complication rate and duration of postoperative stay compared with parenteral nutrition , although parenteral nutrition is better tolerated than enteral nutrition In a comparative clinical trial to examine the influence of 10 days of preoperative parenteral nutrition ( PPN ) on the  postoperative complication rate for gastrointestinal carcinoma 59 patients ( controls ) received the regular hospital diet and 66 received PPN .  The two groups were similar in nutritional status and in distribution of site and stage of tumour and type of operation . The rates of postoperative wound infection , pneumonia , major complications , and mortality were generally lower in the PPN group , but the differences were significant only for major complications and mortality . The clinical results can be explained by the improvement in various indices of humoral and cellular immunocompetence and the protein status in the PPN group and their deterioration in the control group during the preoperative course HYPOTHESIS Perioperatively administered enteral immunonutrition will improve early postoperative morbidity and cost-effectiveness after gastrointestinal tract surgery . DESIGN A prospect i ve , r and omized , double-blind , multicenter clinical trial . SETTING Surgical departments in German university and teaching hospitals . PATIENTS One hundred fifty-four patients with upper gastrointestinal tract malignant neoplasms who were eligible for analysis . INTERVENTION Preoperatively , patients received 5 days of oral immunonutrition ( an arginine- , RNA- , and omega3 fatty acid-supplemented diet ) or an isoenergetic control diet ( 1 L/d ) . Early postoperative enteral feeding with immunonutrition or an isoenergetic , isonitrogenous control diet using a catheter jejunostomy was performed for 10 days . MAIN OUTCOME MEASURES Postoperative infectious complications , their treatment costs , and cost-effectiveness of immunonutrition were analyzed . Plasma levels of the fatty acids eicosapentaenoic acid and docosahexaenoic acid were measured . RESULTS In the immunonutrition group , significantly fewer infectious complication events occurred ( 14 vs 27 ; P = .05 ) . The number of patients with complications was significantly lower in the supplemented diet group after postoperative day 3 ( 7 vs 16 ; P = .04 ) . The treatment costs of complications in the supplemented diet group were suggestively lower than in the control diet group ( DM 75172 vs DM 204273 ) . Cost-effectiveness was DM 1503 in the experimental group vs DM 3587 in the control group , where DM denotes deutsche mark ( German currency ) . CONCLUSION The perioperative administration of an enteral immunonutrition significantly ( P = .05 ) decreased the early occurrence of postoperative infections and reduced substantially the treatment costs of the complications after major upper gastrointestinal tract surgery BACKGROUND & AIMS Malnutrition is a recognized risk factor for perioperative morbidity , but there is currently no st and ardized definition of malnutrition . The Nutrition Risk Screening 2002 score was recently proposed to identify patients at nutritional risk who may benefit from nutritional support therapy , and has been officially adopted by the European Society of Parenteral and Enteral Nutrition . The aim of this study was to assess the value of the Nutrition Risk Screening 2002 score in predicting the incidence and severity of postoperative complications in gastrointestinal surgery . METHODS We prospect ively evaluated 608 patients admitted for elective gastrointestinal surgery . Nutritional risk was defined by the Nutrition Risk Screening 2002 score and correlated to the incidence and severity of postoperative complications . Complications were classified using an established surgical complication classification . RESULTS The overall incidence of nutritional risk was 14 % . We observed a significantly higher complication rate of 40 % ( 35 out of 87 ) in patients at nutritional risk , compared to 15 % ( 81 out of 521 ) in patients with a normal score ( p<0.001 ) . The incidence of severe complications was significantly higher in patients at nutritional risk ( 54 % versus 15 % ; p<0.001 ) . The odds ratio to develop a complication was 2.8 in patients at risk ( p=0.001 ) , and 3.0 in patients with malignant disease ( p<0.001 ) . The median length of stay in nutritional risk patients was significantly longer ( 10 versus 4 days , p<0.001 ) . CONCLUSION The prevalence of nutritional risk patients in gastrointestinal surgery is high . We showed that nutritional risk screening using the NRS 2002 strongly predicts the incidence and severity of complications Objectives The purpose of this study was to evaluate the effect of preoperative immunonutrition pharmaceutics ( IMPACT ) diet versus st and ard enteral nutrition ( EN ) on the nutritional status and immunity of patients with colorectal or gastrointestinal ( GI ) cancer and to evaluate whether it influences the incidence of postoperative complication . Methods Sixty patients with GI cancer were r and omly divided into 2 groups , immunonutrition ( IM ) and control diet ( CT ) , each of which was fed with IMPACT and conventional diet , respectively , for 7 days before surgical procedures . Variables of nutritional status and immunity , postoperative complications , infections , and the days of postoperative hospitalization were measured . Results There were no significant differences in the immunological 
    Output:
    
Some unwanted effects have also been reported with components of IE nutrition in critical care patients and it is unknown whether there would be detrimental effects by administering IE nutrition to patients who could require critical care support after their surgery .