human
***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: Abstract Background Nutrition screening on admission to hospital is m and ated in many countries , but to date , there is no consensus on which tool is optimal in the oncology setting . Wasting conditions such as cancer cachexia ( CC ) and sarcopenia are common in cancer patients and negatively impact on outcomes ; however , they are often masked by excessive adiposity . This study aim ed to inform the application of screening in cancer population s by investigating whether commonly used nutritional screening tools are adequately capturing nutritionally vulnerable patients , including those with abnormal body composition phenotypes ( CC , sarcopenia , and myosteatosis ) . Methods A prospect i ve study of ambulatory oncology out patients presenting for chemotherapy was performed . A detailed survey incorporating clinical , nutritional , biochemical , and quality of life data was administered . Participants were screened for malnutrition using the Malnutrition Universal Screening Tool ( MUST ) , Malnutrition Screening Tool ( MST ) , and the Nutritional Risk Index ( NRI ) . Computed tomography ( CT ) assessment of body composition was performed to diagnose CC , sarcopenia , and myosteatosis according to consensus criteria . Results A total of 725 patients ( 60 % male , median age 64 years ) with solid tumours participated ( 45 % metastatic disease ) . The majority were overweight/obese ( 57 % ) . However , 67 % were losing weight , and CT analysis revealed CC in 42 % , sarcopenia in 41 % , and myosteatosis in 46 % . Among patients with CT‐identified CC , the MUST , MST , and NRI tools categorized 27 % , 35 % , and 7 % of them as ‘ low nutritional risk ’ , respectively . The percentage of patients with CT‐identified sarcopenia and myosteatosis that were categorised as ‘ low nutritional risk ’ by MUST , MST and NRI were 55 % , 61 % , and 14 % and 52 % , 50 % , and 11 % , respectively . Among these tools , the NRI was most sensitive , with scores < 97.5 detecting 85.8 % , 88.6 % , and 92.9 % of sarcopenia , myosteatosis , and CC cases , respectively . Using multivariate Cox proportional hazards models , NRI score < 97.5 predicted greater mortality risk ( hazard ratio 1.8 , confidence interval : 1.2–2.8 , P = 0.007 ) . Conclusions High numbers of nutritionally vulnerable patients , with demonstrated abnormal body composition phenotypes on CT analysis , were misclassified by MUST and MST . Caution should be exercised when categorizing the nutritional risk of oncology patients using these tools . NRI detected the majority of abnormal body composition phenotypes and independently predicted survival . Of the tools examined , the NRI yielded the most valuable information from screening and demonstrated usefulness as an initial nutritional risk grading system in ambulatory oncology patients OBJECTIVE Fat distribution is an important variable explaining metabolic heterogeneity of obesity . Abdominal subcutaneous adipose tissue ( SAT ) is divided by the Scarpa ’s fascia into a deep subcutaneous adipose tissue ( dSAT ) and a superficial subcutaneous adipose tissue ( sSAT ) layer . This study sought to characterize functional differences between the two SAT layers to explore their relative contribution to metabolic traits and cardiovascular risk ( CVR ) profile . RESEARCH DESIGN AND METHODS We recruited 371 Caucasians consecutively from a local r and om , population -based screening project in Oxford and 25 Asian Indians from the local community . The depth of the SAT layers was determined by ultrasound ( US ) , and adipose tissue ( AT ) biopsies were performed under US guidance in a subgroup of 43 Caucasians .  Visceral adipose tissue ( VAT ) mass was quantified by dual-energy X-ray absorptiometry scan . RESULTS Male adiposity in both ethnic groups was characterized by a disproportionate expansion of dSAT , which was strongly correlated with VAT mass . dSAT depth was a strong predictor of global insulin resistance ( IR ; homeostatic model assessment of IR ) , liver-specific IR ( insulin-like growth factor binding protein-1 ) , and Framingham risk score independently of other measures of adiposity in men . Moreover , dSAT had higher expression of proinflammatory , lipogenic , and lipolytic genes and contained higher proportions of saturated fatty acids . There was increased proportion of small adipocytes in dSAT . CONCLUSIONS SAT is heterogeneous ; dSAT exp and s disproportionally more than sSAT with increasing obesity in Caucasian males ( confirmed also in Asian Indians ) . Its expansion is related to increased CVR independent of other adiposity measures , and it has biological properties suggestive of higher metabolic activity contributing to global IR CONTEXT Visceral adipose tissue ( VAT ) is established as a risk factor for type 2 diabetes and cardiovascular disease , but the radiation exposure and cost of computed tomography ( CT ) measurements limits its daily clinical use . OBJECTIVE The main objective of this study was to compare the degree of agreement between VAT measurements by a new dual-energy X-ray absorptiometry ( DXA ) application and one of the st and ard methods , CT , in a population of patients with Prader-Willi syndrome ( PWS ) before and after GH treatment . Furthermore , we tested whether VAT estimations by these two methods are equivalent in assessing the metabolic risk in this population . DESIGN AND PATIENTS Data from the Norwegian population of a multicenter study in adults with genetically proven PWS were used . Subjects with complete anthropometry , biochemical , and imagistic measurements at all study visits ( baseline and after 12 and 24 months of GH treatment ) ( n = 14 , six men ) were included .  VAT was quantified both using CT scans ( GE Lightspeed 16 Pro ) of the abdomen at L2-L3 level and a total body DXA scan ( GE Healthcare Lunar Prodigy ) . RESULTS VAT DXA was strongly associated with VAT CT at baseline ( r = 0.97 ) and after 12 ( r = 0.90 ) and 24 months ( r = 0.89 ) of GH treatment ( all P < .001 ) . We found moderate to strong positive correlations between VAT by both methods , and blood pressure , weight , body mass index , waist circumference , glucose metabolism , and other fat depots ( arms , legs , and roid , trunk , total body ) but no association with age , gender , blood lipids , and IGF-I. Adiponectin was negatively associated with the amount of VAT . At baseline , the highest correlation with homeostasis model assessment of insulin resistance ( HOMA-IR ) was found for VAT DXA ( r = 0.76 , P = .001 ) and VAT CT ( r = 0.75 , P = .002 ) , respectively . CONCLUSION VAT can be accurately estimated by DXA , in patients with PWS , and might contribute to the assessment of the metabolic risk Muscle mass decreases with age , leading to " sarcopenia , " or low relative muscle mass , in elderly people . Sarcopenia is believed to be associated with metabolic , physiologic , and functional impairments and disability . Methods of estimating the prevalence of sarcopenia and its associated risks in elderly population s are lacking . Data from a  population -based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico ( the New Mexico Elder Health Survey , 1993 - 1995 ) were analyzed to develop a method for estimating the prevalence of sarcopenia . An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a r and om sub sample ( n = 199 ) of participants and was extended to the total sample . Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 ( m2 ) being less than two st and ard deviations below the mean of a young reference group . Prevalences increased from 13 - 24 % in persons under 70 years of age to > 50 % in persons over 80 years of age , and were slightly greater in Hispanics than in non-Hispanic whites . Sarcopenia was significantly associated with self-reported physical disability in both men and women , independent of ethnicity , age , morbidity , obesity , income , and health behaviors . This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia An inverse relationship between body mass index ( BMI ) and mortality ( the obesity paradox ) has been found in patients with non-dialysis-dependent chronic kidney disease ( CKD ) . However , it is unclear whether increased muscle mass or body fat confers the survival advantage . To resolve this we investigated the impact of body makeup on a composite outcome of death or cardiovascular events in a prospect i ve cohort of 326 patients with stage 3 - 5 CKD not yet on dialysis .  Lean mass and body fat were determined using the Body Composition Monitor , a multifrequency bioimpedance spectroscopy device , and were expressed as the lean tissue or fat tissue index , respectively . Patients were stratified as High ( above median ) or Low ( below median ) BMI , High or Low lean tissue index , or as High or Low fat tissue index . During a median follow-up of 4.6 years , there were 40 deaths and 68 cardiovascular events . In Cox proportional hazards models , a High lean tissue index , but not High BMI or High fat tissue index , predicted a lower risk of both the composite or its component outcomes ( reference : below median ) . When patients were further stratified into four distinct body composition groups based on both the lean and fat tissue index , only the High lean/fat tissue index group had a significantly lower risk of the composite outcome ( hazard ratio 0.36 , 95 % confidence interval 0.14 - 0.87 ; reference : Low lean/fat tissue index group ) . Thus , the lean tissue index can provide better risk prediction than the BMI alone in non-dialysis-dependent patients with CKD . The High lean/fat tissue index appears to be associated with best outcomes . An optimal body composition for improving the prognosis of CKD needs to be determined BACKGROUND The prominent clinical feature of cachexia has traditionally been understood to be weight loss ; however , in recognition of the potential for divergent behavior of muscle and adipose tissue , cachexia was recently defined as loss of muscle with or without loss of fat mass . Detailed assessment s are required to verify body composition in patients with cancer cachexia . DESIGN We adopted a population -based approach to study body composition in patients with cancer , with the use of diagnostic computed tomography images acquired for cancer diagnosis and follow-up . A prospect i ve cohort of 441 patients with non-small cell lung cancer , who were referred consecutively to a regional medical oncology service in Alberta , Canada , was evaluated . RESULTS At referral ( median time to death : 265 d ) , mean body mass index ( BMI ; in kg/m(2 ) ) was 24.9 , with 47.4 % of patients being overweight or obese . Only 7.5 % overall were underweight as conventionally understood ( BMI < 18.5 ) . Analysis of computed tomography images showed extremely high heterogeneity of muscle mass within all strata of BMI . The overall prevalence of severe muscle depletion ( sarcopenia ) was 46.8 % and was present in patients in all BMI categories . A much higher proportion of men ( 61 % ) than women ( 31 % ) met the criteria for sarcopenia . CONCLUSIONS Wasting of skeletal muscle is a prominent feature of patients with lung cancer , despite normal or heavy body weights . The significance of muscle wasting in normal-weight , overweight , and obese patients as a nutritional risk factor , as a prognostic factor , and as a predictor of cancer treatment toxicity is discussed in this article Multiple organ failure ( MOF ) is accompanied by muscle wasting , but changes in body composition are frequently obscured by fluid retention ( edema ) , mainly in superficial and visceral tissue . There is a need to assess body composition and changes in body composition in these circumstances independently of edema . A relation was sought between fat-free ( lean tissue ) mass [ calculated from body weight and skinfold thicknesses and measured by using dual-energy X-ray absorptiometry ( DXA ) ] and muscle thickness ( measured using ultrasound at a variety of sites accessible in an unconscious supine subject ) to determine which sites correlated best with lean body mass . The three best sites were midbiceps , midforearm anteriorly , and midthigh anteriorly : R2 for the simple sum of the three sites correlated with fat-free mass from skinfold thicknesses was 71.1 % , and with lean tissue mass from DXA was 76.1 % . Serial measurements of both muscle thickness and midupper-arm circumference in nine patients with MOF showed a complete dissociation ; in all nine there was a significant negative correlation of muscle thickness with time ( P < 0.05 ) but changes in arm circumference were r and om . Only one patient showed a significant negative correlation with time , seven showed no change , and one other showed a significant increase . The muscle thicknesses that correlate best with lean body mass are measured over the biceps , anterior forearm , and anterior thigh . Monitoring muscle thicknesses at these three sites identifies wasting in edematous patients as it is happening OBJECTIVES V and etanib was approved by the U.S. Food and Drug Association for the treatment of advanced medullary thyroid cancer ( MTC ) . Because body weight ( BW ) loss is observed in MTC and because low skeletal muscle mass ( SM ) is associated with drug toxicity , this study assessed effects of v and etanib on SM and ad 
    Output:
    
agent
***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: Abstract Background Nutrition screening on admission to hospital is m and ated in many countries , but to date , there is no consensus on which tool is optimal in the oncology setting . Wasting conditions such as cancer cachexia ( CC ) and sarcopenia are common in cancer patients and negatively impact on outcomes ; however , they are often masked by excessive adiposity . This study aim ed to inform the application of screening in cancer population s by investigating whether commonly used nutritional screening tools are adequately capturing nutritionally vulnerable patients , including those with abnormal body composition phenotypes ( CC , sarcopenia , and myosteatosis ) . Methods A prospect i ve study of ambulatory oncology out patients presenting for chemotherapy was performed . A detailed survey incorporating clinical , nutritional , biochemical , and quality of life data was administered . Participants were screened for malnutrition using the Malnutrition Universal Screening Tool ( MUST ) , Malnutrition Screening Tool ( MST ) , and the Nutritional Risk Index ( NRI ) . Computed tomography ( CT ) assessment of body composition was performed to diagnose CC , sarcopenia , and myosteatosis according to consensus criteria . Results A total of 725 patients ( 60 % male , median age 64 years ) with solid tumours participated ( 45 % metastatic disease ) . The majority were overweight/obese ( 57 % ) . However , 67 % were losing weight , and CT analysis revealed CC in 42 % , sarcopenia in 41 % , and myosteatosis in 46 % . Among patients with CT‐identified CC , the MUST , MST , and NRI tools categorized 27 % , 35 % , and 7 % of them as ‘ low nutritional risk ’ , respectively . The percentage of patients with CT‐identified sarcopenia and myosteatosis that were categorised as ‘ low nutritional risk ’ by MUST , MST and NRI were 55 % , 61 % , and 14 % and 52 % , 50 % , and 11 % , respectively . Among these tools , the NRI was most sensitive , with scores < 97.5 detecting 85.8 % , 88.6 % , and 92.9 % of sarcopenia , myosteatosis , and CC cases , respectively . Using multivariate Cox proportional hazards models , NRI score < 97.5 predicted greater mortality risk ( hazard ratio 1.8 , confidence interval : 1.2–2.8 , P = 0.007 ) . Conclusions High numbers of nutritionally vulnerable patients , with demonstrated abnormal body composition phenotypes on CT analysis , were misclassified by MUST and MST . Caution should be exercised when categorizing the nutritional risk of oncology patients using these tools . NRI detected the majority of abnormal body composition phenotypes and independently predicted survival . Of the tools examined , the NRI yielded the most valuable information from screening and demonstrated usefulness as an initial nutritional risk grading system in ambulatory oncology patients OBJECTIVE Fat distribution is an important variable explaining metabolic heterogeneity of obesity . Abdominal subcutaneous adipose tissue ( SAT ) is divided by the Scarpa ’s fascia into a deep subcutaneous adipose tissue ( dSAT ) and a superficial subcutaneous adipose tissue ( sSAT ) layer . This study sought to characterize functional differences between the two SAT layers to explore their relative contribution to metabolic traits and cardiovascular risk ( CVR ) profile . RESEARCH DESIGN AND METHODS We recruited 371 Caucasians consecutively from a local r and om , population -based screening project in Oxford and 25 Asian Indians from the local community . The depth of the SAT layers was determined by ultrasound ( US ) , and adipose tissue ( AT ) biopsies were performed under US guidance in a subgroup of 43 Caucasians .  Visceral adipose tissue ( VAT ) mass was quantified by dual-energy X-ray absorptiometry scan . RESULTS Male adiposity in both ethnic groups was characterized by a disproportionate expansion of dSAT , which was strongly correlated with VAT mass . dSAT depth was a strong predictor of global insulin resistance ( IR ; homeostatic model assessment of IR ) , liver-specific IR ( insulin-like growth factor binding protein-1 ) , and Framingham risk score independently of other measures of adiposity in men . Moreover , dSAT had higher expression of proinflammatory , lipogenic , and lipolytic genes and contained higher proportions of saturated fatty acids . There was increased proportion of small adipocytes in dSAT . CONCLUSIONS SAT is heterogeneous ; dSAT exp and s disproportionally more than sSAT with increasing obesity in Caucasian males ( confirmed also in Asian Indians ) . Its expansion is related to increased CVR independent of other adiposity measures , and it has biological properties suggestive of higher metabolic activity contributing to global IR CONTEXT Visceral adipose tissue ( VAT ) is established as a risk factor for type 2 diabetes and cardiovascular disease , but the radiation exposure and cost of computed tomography ( CT ) measurements limits its daily clinical use . OBJECTIVE The main objective of this study was to compare the degree of agreement between VAT measurements by a new dual-energy X-ray absorptiometry ( DXA ) application and one of the st and ard methods , CT , in a population of patients with Prader-Willi syndrome ( PWS ) before and after GH treatment . Furthermore , we tested whether VAT estimations by these two methods are equivalent in assessing the metabolic risk in this population . DESIGN AND PATIENTS Data from the Norwegian population of a multicenter study in adults with genetically proven PWS were used . Subjects with complete anthropometry , biochemical , and imagistic measurements at all study visits ( baseline and after 12 and 24 months of GH treatment ) ( n = 14 , six men ) were included .  VAT was quantified both using CT scans ( GE Lightspeed 16 Pro ) of the abdomen at L2-L3 level and a total body DXA scan ( GE Healthcare Lunar Prodigy ) . RESULTS VAT DXA was strongly associated with VAT CT at baseline ( r = 0.97 ) and after 12 ( r = 0.90 ) and 24 months ( r = 0.89 ) of GH treatment ( all P < .001 ) . We found moderate to strong positive correlations between VAT by both methods , and blood pressure , weight , body mass index , waist circumference , glucose metabolism , and other fat depots ( arms , legs , and roid , trunk , total body ) but no association with age , gender , blood lipids , and IGF-I. Adiponectin was negatively associated with the amount of VAT . At baseline , the highest correlation with homeostasis model assessment of insulin resistance ( HOMA-IR ) was found for VAT DXA ( r = 0.76 , P = .001 ) and VAT CT ( r = 0.75 , P = .002 ) , respectively . CONCLUSION VAT can be accurately estimated by DXA , in patients with PWS , and might contribute to the assessment of the metabolic risk Muscle mass decreases with age , leading to " sarcopenia , " or low relative muscle mass , in elderly people . Sarcopenia is believed to be associated with metabolic , physiologic , and functional impairments and disability . Methods of estimating the prevalence of sarcopenia and its associated risks in elderly population s are lacking . Data from a  population -based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico ( the New Mexico Elder Health Survey , 1993 - 1995 ) were analyzed to develop a method for estimating the prevalence of sarcopenia . An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a r and om sub sample ( n = 199 ) of participants and was extended to the total sample . Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 ( m2 ) being less than two st and ard deviations below the mean of a young reference group . Prevalences increased from 13 - 24 % in persons under 70 years of age to > 50 % in persons over 80 years of age , and were slightly greater in Hispanics than in non-Hispanic whites . Sarcopenia was significantly associated with self-reported physical disability in both men and women , independent of ethnicity , age , morbidity , obesity , income , and health behaviors . This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia An inverse relationship between body mass index ( BMI ) and mortality ( the obesity paradox ) has been found in patients with non-dialysis-dependent chronic kidney disease ( CKD ) . However , it is unclear whether increased muscle mass or body fat confers the survival advantage . To resolve this we investigated the impact of body makeup on a composite outcome of death or cardiovascular events in a prospect i ve cohort of 326 patients with stage 3 - 5 CKD not yet on dialysis .  Lean mass and body fat were determined using the Body Composition Monitor , a multifrequency bioimpedance spectroscopy device , and were expressed as the lean tissue or fat tissue index , respectively . Patients were stratified as High ( above median ) or Low ( below median ) BMI , High or Low lean tissue index , or as High or Low fat tissue index . During a median follow-up of 4.6 years , there were 40 deaths and 68 cardiovascular events . In Cox proportional hazards models , a High lean tissue index , but not High BMI or High fat tissue index , predicted a lower risk of both the composite or its component outcomes ( reference : below median ) . When patients were further stratified into four distinct body composition groups based on both the lean and fat tissue index , only the High lean/fat tissue index group had a significantly lower risk of the composite outcome ( hazard ratio 0.36 , 95 % confidence interval 0.14 - 0.87 ; reference : Low lean/fat tissue index group ) . Thus , the lean tissue index can provide better risk prediction than the BMI alone in non-dialysis-dependent patients with CKD . The High lean/fat tissue index appears to be associated with best outcomes . An optimal body composition for improving the prognosis of CKD needs to be determined BACKGROUND The prominent clinical feature of cachexia has traditionally been understood to be weight loss ; however , in recognition of the potential for divergent behavior of muscle and adipose tissue , cachexia was recently defined as loss of muscle with or without loss of fat mass . Detailed assessment s are required to verify body composition in patients with cancer cachexia . DESIGN We adopted a population -based approach to study body composition in patients with cancer , with the use of diagnostic computed tomography images acquired for cancer diagnosis and follow-up . A prospect i ve cohort of 441 patients with non-small cell lung cancer , who were referred consecutively to a regional medical oncology service in Alberta , Canada , was evaluated . RESULTS At referral ( median time to death : 265 d ) , mean body mass index ( BMI ; in kg/m(2 ) ) was 24.9 , with 47.4 % of patients being overweight or obese . Only 7.5 % overall were underweight as conventionally understood ( BMI < 18.5 ) . Analysis of computed tomography images showed extremely high heterogeneity of muscle mass within all strata of BMI . The overall prevalence of severe muscle depletion ( sarcopenia ) was 46.8 % and was present in patients in all BMI categories . A much higher proportion of men ( 61 % ) than women ( 31 % ) met the criteria for sarcopenia . CONCLUSIONS Wasting of skeletal muscle is a prominent feature of patients with lung cancer , despite normal or heavy body weights . The significance of muscle wasting in normal-weight , overweight , and obese patients as a nutritional risk factor , as a prognostic factor , and as a predictor of cancer treatment toxicity is discussed in this article Multiple organ failure ( MOF ) is accompanied by muscle wasting , but changes in body composition are frequently obscured by fluid retention ( edema ) , mainly in superficial and visceral tissue . There is a need to assess body composition and changes in body composition in these circumstances independently of edema . A relation was sought between fat-free ( lean tissue ) mass [ calculated from body weight and skinfold thicknesses and measured by using dual-energy X-ray absorptiometry ( DXA ) ] and muscle thickness ( measured using ultrasound at a variety of sites accessible in an unconscious supine subject ) to determine which sites correlated best with lean body mass . The three best sites were midbiceps , midforearm anteriorly , and midthigh anteriorly : R2 for the simple sum of the three sites correlated with fat-free mass from skinfold thicknesses was 71.1 % , and with lean tissue mass from DXA was 76.1 % . Serial measurements of both muscle thickness and midupper-arm circumference in nine patients with MOF showed a complete dissociation ; in all nine there was a significant negative correlation of muscle thickness with time ( P < 0.05 ) but changes in arm circumference were r and om . Only one patient showed a significant negative correlation with time , seven showed no change , and one other showed a significant increase . The muscle thicknesses that correlate best with lean body mass are measured over the biceps , anterior forearm , and anterior thigh . Monitoring muscle thicknesses at these three sites identifies wasting in edematous patients as it is happening OBJECTIVES V and etanib was approved by the U.S. Food and Drug Association for the treatment of advanced medullary thyroid cancer ( MTC ) . Because body weight ( BW ) loss is observed in MTC and because low skeletal muscle mass ( SM ) is associated with drug toxicity , this study assessed effects of v and etanib on SM and ad 
    Output:
    