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: 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 Patients with Crohn 's disease may have periods of remission , interrupted by relapses . Because fish oil has antiinflammatory actions , it could reduce the frequency of relapses , but it is often poorly tolerated because of its unpleasant taste and gastrointestinal side effects . METHODS We performed a one-year , double-blind , placebo-controlled study to investigate the effects of a new fish-oil preparation in the maintenance of remission in 78 patients with Crohn 's disease who had a high risk of relapse . The patients received either nine fish-oil capsules containing a total of 2.7 g of n-3 fatty acids or nine placebo capsules daily . A special coating protected the capsules against gastric acidity for at least 30 minutes . RESULTS Among the 39 patients in the fish-oil group , 11 ( 28 percent ) had relapses , 4 dropped out because of diarrhea , and 1 withdrew for other reasons . In contrast , among the 39 patients in the placebo group , 27 ( 69 percent ) had relapses , 1 dropped out because of diarrhea , and 1 withdrew for other reasons ( difference in relapse rate , 41 percentage points ; 95 percent confidence interval , 21 to 61 ; P < 0.001 ) . After one year , 23 patients ( 59 percent ) in the fish-oil group remained in remission , as compared with 10 ( 26 percent ) in the placebo group ( P = 0.003 ) . Logistic-regression analysis indicated that only fish oil and not sex , age , previous surgery , duration of disease , or smoking status affected the likelihood of relapse ( odds ratio for the placebo group as compared with the fish-oil group , 4.2 ; 95 percent confidence interval , 1.6 to 10.7 ) . CONCLUSIONS In patients with Crohn 's disease in remission , a novel enteric-coated fish-oil preparation is effective in reducing the rate of relapse 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 Crohn 's disease is associated with altered bone turnover that may be influenced by nutritional status , the systemic inflammatory response , cytokine production by circulating ( peripheral blood ) mononuclear cells ( P BMC ) and antioxidant micronutrient intake . High-dose fish oil is associated with reductions in disease relapse and inflammatory markers , and modulates P BMC function . The effect of fish oil plus antioxidants on bone turnover and P BMC function ( the production of interferon-gamma and prostagl and in E2 ) in Crohn 's disease was investigated in a r and omised-controlled trial . Patients with currently or recently raised biochemical markers of inflammation ( C-reactive protein > or = 6.9 mg/l or erythrocyte sedimentation rate > or = 18 mm/h ) received fish oil ( providing 2.7 g/d EPA and DHA ) and antioxidants ( vitamins A , C and E , and Se ) ( n 31 ) or placebo ( n 30 ) for 24 weeks . Bone turnover was assessed by measuring the concentrations of urinary deoxypyridinoline ( bone resorption ) and serum osteocalcin ( bone formation ) .  Fish oil plus antioxidants were associated with increases in EPA , DHA Se in plasma ( all P < 0.01 ) , and with a reduction in interferon-gamma production by mitogen-stimulated P BMC , which demonstrated a negative correlation with deoxypyridinoline/creatinine : osteocalcin ratio ( r - 0.33 , P = 0.009 ) . There were no differences between the groups at 24 weeks in the response of deoxypyridinoline or osteocalcin or their ratio , or in nutritional status . Dietary supplementation in Crohn 's disease with high intakes of EPA and DHA , as fish oil , plus antioxidants was associated with a modulated production of interferon-gamma by P BMC but not altered indices of bone turnover After administering the equivalent of 1 g of eicosapentaenoic acid ( EPA ) in four different chemical forms , the kinetics of EPA incorporation into plasma triglycerides ( TG ) were compared by gas liquid chromatography on a capillary column following separation of the lipid fraction by thin layer chromatography . EPA incorporation into plasma TG was markedly smaller and later when EPA was administered as an ethyl ester rather than as EPA free fatty acid , EPA arginine salt or 1,3-dioctanoyl-2-eicosapentaenoyl glycerol ( 2-EPA ) . Our results and the data in the literature are compatible with the hypothesis that 2-EPA is absorbed with minimum hydrolysis and escapes r and om distribution between the other positions of the glycerol molecule during the absorption process BACKGROUND Crohn disease ( CD ) is associated with osteoporosis and other extraintestinal manifestations that might be mediated by cytokines from circulating ( peripheral blood ) mononuclear cells ( P BMC s ) . Fish oil rich in eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) reduces disease activity in patients with CD with raised laboratory markers of inflammation and in healthy subjects alters P BMC function . OBJECTIVE We investigated the effect of fish oil plus antioxidants on cytokine production by P BMC s from patients with CD with raised C-reactive protein concentrations ( > /=6.9 mg/L ) or erythrocyte sedimentation rates ( > /=18 mm/h ) . DESIGN A r and omized placebo-controlled trial of fish oil ( 2.7 g EPA and DHA/d ; n = 31 ) or placebo ( olive oil ; n = 31 ) for 24 wk was conducted in patients with CD . The fish-oil group additionally received an antioxidant preparation ( vitamins A , C , and E and selenium ) . Exclusion criteria included corticosteroid use . Fatty acid composition was measured by gas chromatography . Production of tumor necrosis factor alpha , interferon gamma ( IFN-gamma ) , and prostagl and in E(2 ) ( PGE(2 ) ) was measured by enzyme-linked immunosorbent assays after stimulation with mitogen and endotoxin ( lipopolysaccharide ) . RESULTS Fish-oil plus antioxidant dietary supplementation was associated with higher EPA and DHA incorporation into P BMC s ( P < 0.001 ) and lower arachidonic acid ( P = 0.006 ) and lower production of IFN-gamma by mitogen-stimulated P BMC s ( P = 0.012 ) and of PGE(2 ) by lipopolysaccharide-stimulated P BMC s ( P = 0.047 ) . CONCLUSION Dietary supplementation with fish oil plus antioxidants is associated with modified P BMC composition and lower production of PGE(2 ) and IFN-gamma by circulating monocytes or macrophages . The response of extraintestinal manifestations of CD should be investigated in a r and omized controlled trial 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 OBJECTIVE Catabolism and growth impairment are well-known complications of inflammatory bowel disease ( IBD ) . This may be caused by the disease activity itself and /or the medical treatment , and both may lead to changes in the growth hormone (GH)/insulin-like growth factor I ( IGF-I ) axis . The aim of the present study was to examine the effects of enteral nutrition , Impact Powder , as adjuvant therapy to corticosteroid treatment on changes in the GH/IGF-I axis in patients with Crohn 's disease ( CD ) . MATERIAL AND METHODS The patients were r and omized to 3-IP ( omega-3-fatty acid ( FA ) , 3 g/day ) or 6-IP ( omega-6-FA , 9 g/day ) . Changes in total IGF-I ( tIGF-I ) and total IGF-II ( tIGF-II ) , free IGF-I ( fIGF-I ) , IGF binding proteins ( IGFBP-1 and IGFBP-3 ) , IGFBP-3 protease activity and insulin levels were examined in 31 patients with active CD ( CDAI : 186 - 603 ) during treatment with prednisolone ( 40 mg for 1 week ) and tapering the dose by 5 mg/week . C 
    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: 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 Patients with Crohn 's disease may have periods of remission , interrupted by relapses . Because fish oil has antiinflammatory actions , it could reduce the frequency of relapses , but it is often poorly tolerated because of its unpleasant taste and gastrointestinal side effects . METHODS We performed a one-year , double-blind , placebo-controlled study to investigate the effects of a new fish-oil preparation in the maintenance of remission in 78 patients with Crohn 's disease who had a high risk of relapse . The patients received either nine fish-oil capsules containing a total of 2.7 g of n-3 fatty acids or nine placebo capsules daily . A special coating protected the capsules against gastric acidity for at least 30 minutes . RESULTS Among the 39 patients in the fish-oil group , 11 ( 28 percent ) had relapses , 4 dropped out because of diarrhea , and 1 withdrew for other reasons . In contrast , among the 39 patients in the placebo group , 27 ( 69 percent ) had relapses , 1 dropped out because of diarrhea , and 1 withdrew for other reasons ( difference in relapse rate , 41 percentage points ; 95 percent confidence interval , 21 to 61 ; P < 0.001 ) . After one year , 23 patients ( 59 percent ) in the fish-oil group remained in remission , as compared with 10 ( 26 percent ) in the placebo group ( P = 0.003 ) . Logistic-regression analysis indicated that only fish oil and not sex , age , previous surgery , duration of disease , or smoking status affected the likelihood of relapse ( odds ratio for the placebo group as compared with the fish-oil group , 4.2 ; 95 percent confidence interval , 1.6 to 10.7 ) . CONCLUSIONS In patients with Crohn 's disease in remission , a novel enteric-coated fish-oil preparation is effective in reducing the rate of relapse 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 Crohn 's disease is associated with altered bone turnover that may be influenced by nutritional status , the systemic inflammatory response , cytokine production by circulating ( peripheral blood ) mononuclear cells ( P BMC ) and antioxidant micronutrient intake . High-dose fish oil is associated with reductions in disease relapse and inflammatory markers , and modulates P BMC function . The effect of fish oil plus antioxidants on bone turnover and P BMC function ( the production of interferon-gamma and prostagl and in E2 ) in Crohn 's disease was investigated in a r and omised-controlled trial . Patients with currently or recently raised biochemical markers of inflammation ( C-reactive protein > or = 6.9 mg/l or erythrocyte sedimentation rate > or = 18 mm/h ) received fish oil ( providing 2.7 g/d EPA and DHA ) and antioxidants ( vitamins A , C and E , and Se ) ( n 31 ) or placebo ( n 30 ) for 24 weeks . Bone turnover was assessed by measuring the concentrations of urinary deoxypyridinoline ( bone resorption ) and serum osteocalcin ( bone formation ) .  Fish oil plus antioxidants were associated with increases in EPA , DHA Se in plasma ( all P < 0.01 ) , and with a reduction in interferon-gamma production by mitogen-stimulated P BMC , which demonstrated a negative correlation with deoxypyridinoline/creatinine : osteocalcin ratio ( r - 0.33 , P = 0.009 ) . There were no differences between the groups at 24 weeks in the response of deoxypyridinoline or osteocalcin or their ratio , or in nutritional status . Dietary supplementation in Crohn 's disease with high intakes of EPA and DHA , as fish oil , plus antioxidants was associated with a modulated production of interferon-gamma by P BMC but not altered indices of bone turnover After administering the equivalent of 1 g of eicosapentaenoic acid ( EPA ) in four different chemical forms , the kinetics of EPA incorporation into plasma triglycerides ( TG ) were compared by gas liquid chromatography on a capillary column following separation of the lipid fraction by thin layer chromatography . EPA incorporation into plasma TG was markedly smaller and later when EPA was administered as an ethyl ester rather than as EPA free fatty acid , EPA arginine salt or 1,3-dioctanoyl-2-eicosapentaenoyl glycerol ( 2-EPA ) . Our results and the data in the literature are compatible with the hypothesis that 2-EPA is absorbed with minimum hydrolysis and escapes r and om distribution between the other positions of the glycerol molecule during the absorption process BACKGROUND Crohn disease ( CD ) is associated with osteoporosis and other extraintestinal manifestations that might be mediated by cytokines from circulating ( peripheral blood ) mononuclear cells ( P BMC s ) . Fish oil rich in eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) reduces disease activity in patients with CD with raised laboratory markers of inflammation and in healthy subjects alters P BMC function . OBJECTIVE We investigated the effect of fish oil plus antioxidants on cytokine production by P BMC s from patients with CD with raised C-reactive protein concentrations ( > /=6.9 mg/L ) or erythrocyte sedimentation rates ( > /=18 mm/h ) . DESIGN A r and omized placebo-controlled trial of fish oil ( 2.7 g EPA and DHA/d ; n = 31 ) or placebo ( olive oil ; n = 31 ) for 24 wk was conducted in patients with CD . The fish-oil group additionally received an antioxidant preparation ( vitamins A , C , and E and selenium ) . Exclusion criteria included corticosteroid use . Fatty acid composition was measured by gas chromatography . Production of tumor necrosis factor alpha , interferon gamma ( IFN-gamma ) , and prostagl and in E(2 ) ( PGE(2 ) ) was measured by enzyme-linked immunosorbent assays after stimulation with mitogen and endotoxin ( lipopolysaccharide ) . RESULTS Fish-oil plus antioxidant dietary supplementation was associated with higher EPA and DHA incorporation into P BMC s ( P < 0.001 ) and lower arachidonic acid ( P = 0.006 ) and lower production of IFN-gamma by mitogen-stimulated P BMC s ( P = 0.012 ) and of PGE(2 ) by lipopolysaccharide-stimulated P BMC s ( P = 0.047 ) . CONCLUSION Dietary supplementation with fish oil plus antioxidants is associated with modified P BMC composition and lower production of PGE(2 ) and IFN-gamma by circulating monocytes or macrophages . The response of extraintestinal manifestations of CD should be investigated in a r and omized controlled trial 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 OBJECTIVE Catabolism and growth impairment are well-known complications of inflammatory bowel disease ( IBD ) . This may be caused by the disease activity itself and /or the medical treatment , and both may lead to changes in the growth hormone (GH)/insulin-like growth factor I ( IGF-I ) axis . The aim of the present study was to examine the effects of enteral nutrition , Impact Powder , as adjuvant therapy to corticosteroid treatment on changes in the GH/IGF-I axis in patients with Crohn 's disease ( CD ) . MATERIAL AND METHODS The patients were r and omized to 3-IP ( omega-3-fatty acid ( FA ) , 3 g/day ) or 6-IP ( omega-6-FA , 9 g/day ) . Changes in total IGF-I ( tIGF-I ) and total IGF-II ( tIGF-II ) , free IGF-I ( fIGF-I ) , IGF binding proteins ( IGFBP-1 and IGFBP-3 ) , IGFBP-3 protease activity and insulin levels were examined in 31 patients with active CD ( CDAI : 186 - 603 ) during treatment with prednisolone ( 40 mg for 1 week ) and tapering the dose by 5 mg/week . C 
    Output:
    