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 Heart failure ( HF ) is a complex syndrome characterized by intolerance to exertion and reduced functional capacity . OBJECTIVE To assess the functional capacity of patients with HF and supplemented with creatine .  METHODS Prospect i ve , r and omized , double-blind study . Thirty-three male patients over the age of 18 years with functional class II to IV HF were r and omized into two groups as follows : the experimental group ( CRE , n = 17 ) , supplemented with 5 g/day of creatine for six months ; and the placebo group ( PLA , n = 16 ) , receiving 5 g/day of maltodextrin for that same period . Both groups underwent functional capacity assessment by use of cardiopulmonary exercise test and 6-minute walk test ( 6MWT ) before and after the intervention . The Ancova statistical model and Pearson correlation were used to assess the groups and the treatment . RESULTS Of the variables assessed on the cardiopulmonary exercise test , peak oxygen consumption ( peak VO₂ ) , anaerobic threshold ( AT ) , and oxygen pulse ( O₂ pulse ) showed no significant differences between the groups ( P>0.05 ) . On the 6MWT , no significant difference was observed in the covered distance . CONCLUSION Creatine supplementation in patients with HF did not significantly improve functional capacity BACKGROUND AND AIMS Hospitalized patients with heart failure who are malnourished present a worse prognosis than those with an adequate nutritional status . We undertook this study to assess whether a nutritional intervention in malnourished hospitalized patients with heart failure benefits morbidity and mortality . METHODS A multicenter , r and omized , controlled clinical trial was conducted . A total of 120 malnourished hospitalized patients due to acute heart failure were r and omised to conventional heart failure treatment or conventional heart failure treatment combined with an individualized nutritional intervention . The primary endpoint of this study was a composite of all-cause death or readmission for worsening of HF , with a maximum follow-up of 12 months . Analysis was by intention to treat . RESULTS Recruitment was stopped early according to the study protocol after completing the follow-up of the first 120 patients enrolled ( 59 in the intervention group and 61 in the control group ) . Both groups were homogeneous in baseline characteristics . At 12 months , the primary outcome occurred in 27.1 % of patients in the intervention group and in 60.7 % of patients in the control group ( hazard ratio 0.45 ; 95 % confidence interval [ CI ] , 0.19 - 0.62 , p = 0.0004 ) . In total , 20.3 % of patients died in the intervention group and 47.5 % in the control group ( hazard ratio 0.37 , 95 % CI , 0.19 - 0.72 , p = 0.003 ) . Readmission due to heart failure was also lower in the intervention group ( 10.2 vs. 36.1 % , p = 0.001 ) . CONCLUSION Nutritional intervention in malnourished hospitalized patients with heart failure reduces the risk of death from any cause and the risk of readmission for worsening of heart failure ( Clinical Trial.govNCT01472237 ) Background Sarcopenia is generally complicated with patients with chronic heart failure ( CHF ) and its presence negatively affects the course of heart failure , however effective nutritional intervention had not been eluci date d yet . The primary objective of this study is to explore whether the addition of a branched-chain amino acid ( BCAA ) preparation for cardiac rehabilitation ( CR ) of patients with CHF further improves cardiopulmonary functions , skeletal muscle functions , and metabolism in comparison with conventional CR . Methods This is a r and omized , parallel-group comparative study . The elderly patients that were participated in CR and complicated with left ventricular systolic or diastolic dysfunction are r and omized into two groups , CR + BCAA and CR . 20 weeks later , the second r and omization is performed , which divide subjects into two groups with and without BCAA intervention without CR . Primary outcome measure is the rate of change of the anaerobic threshold workload from baseline to post-intervention . Secondary outcome include parameters of exercise capacity , cardiac function and psychological status . Discussion In the current study the effect of a promising new intervention , BCAA , will be assessed to determine whether its addition to CR improve exercise capacity in patients with heart failure , who are generally complicated with sarcopenia . Trial registration This clinical trial was registered with the University Hospital Medical Information Network— Clinical Trials Registry ( UMIN – CTR ; JPRN – UMIN R000022440 ) Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The prevalence of cardiac cachexia in chronic heart failure is approximately 5 % to 15 % and 18-month mortality rates can reach 50 % . Treatment with angiotensin-converting enzyme inhibitors and beta-blockers may confer some benefit but no proven therapy exists . We tested the effects of an oral nutritional supplement in cachectic patients with heart failure . This was a prospect i ve , r and omized , double-blind , placebo-controlled pilot study which r and omized 29 patients to a high-caloric ( 600 kcal ) high-protein ( 20 g ) oral nutritional supplement or placebo for a duration of 6 weeks in addition to the patients ’ usual food intake . At baseline , 6 weeks , and 18 weeks , we measured body weight , quality of life , body composition , heart function , laboratory parameters , and exercise performance . Edema-free body weight increased in 19 of 20 patients receiving intervention at 6 weeks and in 17 of 19 patients at 18 weeks with an average weight gain of 2.0 ± 1.7 kg ( 3.1 ± 2.4 % , p = 0.0001 ) and 2.3 ± 3.1 kg ( 3.6 ± 4.7 % , p = 0.007 ) at 6 and 18 weeks , respectively . Most of the weight gain was fat tissue with an absolute gain of 1.5 ± 1.7 kg ( p = 0.003 ) and 1.6 ± 2.7 kg ( p = 0.008 ) . A significant improvement in quality of life and decrease in serum levels of tumor necrosis factor-α were observed ( p < 0.05 for both ) . We demonstrated the feasibility of oral nutritional supplement in cachectic patients with heart failure and significant clinical benefit in terms of body size and body composition , laboratory parameters , and quality of life ( www . clinical trials.gov identifier NCT00654719 ) BACKGROUND Cardiac creatine levels are depressed in chronic heart failure . Oral supplementation of creatine to healthy volunteers has been shown to increase physical performance . AIM To evaluate the effects of creatine supplementation on ejection fraction , symptom-limited physical endurance and skeletal muscle strength in patients with chronic heart failure . METHODS With a double-blind , placebo-controlled design 17 patients ( age 43 - 70 years , ejection fraction < 40 ) were supplemented with creatine 20 g daily for 10 days . Before and on the last day of supplementation ejection fraction was determined by radionuclide angiography as was symptom-limited 1-legged knee extensor and 2-legged exercise performance on the cycle ergometer . Muscle strength as unilateral concentric knee extensor performance ( peak torque , Nm at 180 degrees/s ) was also evaluated . Skeletal muscle biopsies were taken for the determination of energy-rich phosphagens . RESULTS Ejection fraction at rest and at work did not change . Performance before creatine supplementation did not differ between placebo and creatine groups . While no change was seen in the placebo group compared to baseline , creatine supplementation increased skeletal muscle total creatine and creatine phosphate by 17 + /- 4 % ( P < 0.05 ) and 12 + /- 4 % ( P < 0.05 ) , respectively . Increments were seen only in patients with < 140 mmol total creatine/kg d.w . ( P < 0.05 ) . One-legged performance ( 21 % , P < 0.05 ) , 2-legged performance ( 10 % , P < 0.05 ) , and peak torque , Nm ( 5 % , P < 0.05 ) increased . Both peak torque and 1-legged performance increased linearly with increased skeletal muscle phosphocreatine ( P < 0.05 ) . The increments in 1-legged , 2-legged and peak torque were significant compared to the placebo group , ( P < 0.05 ) . CONCLUSIONS One week of  creatine supplementation to patients with chronic heart failure did not increase ejection fraction but increased skeletal muscle energy-rich phosphagens and performance as regards both strength and endurance . This new therapeutic approach merits further attention BACKGROUND & AIMS Heart Failure ( HF ) is a complex syndrome , which can include the physiological , neural hormonal and metabolic complications known as " Cardiac Cachexia " ( CC ) . In the development of CC there is a release of catabolic cytokines ( Tumor Necrosis Factor-α , interleukins 1 and 6 ) that cause a decrease of fat free mass and fat mass . These changes in body composition might be reversed with a therapeutic combination of resistance exercise and branched chain amino acid supplementation ( BCAA ) . AIM Evaluate changes in body composition after a resistance exercise program and BCAA supplementation in patients with HF . METHODS In a r and omized clinical trial with 3 month of follow-up anthropometric body composition analysis and stress tests were evaluated at the beginning and in the end of the study . Patients were divided into two groups ; the experimental group performed the resistance exercise program and received 10 g/day BCAA supplementation , and the control group only performed the resistance exercise program . Both groups were provided with individualized diets and conventional medical treatment . RESULTS Changes were found in hip circumference between the groups ( p = 0.02 ) , and muscle strength was increased in the experimental group ( 8 % ) and the control group ( 11.4 % ) with no difference between them . METS and VO2Max also increased in experimental and control groups ( 16.6 % and 50.1 % respectively ) . Regarding changes in symptoms , improvements in fatigue ( 45.4 % ) , decubitus intolerance ( 21.8 % ) and dyspnea ( 25.4 % ) were observed in the overall sample . CONCLUSION Improvements in physical and functional capacities are attributed to resistance exercise program but not to the BCAA supplementation . CLINICAL TRIALS IDENTIFIER NCT02240511 BACKGROUND Hospitalized , malnourished older adults have a high risk of readmission and mortality . OBJECTIVE Evaluation of a high-protein oral nutritional supplement ( HP-HMB ) containing beta-hydroxy-beta-methylbutyrate on postdischarge outcomes of nonelective readmission and mortality in malnourished , hospitalized older adults . DESIGN Multicenter , r and omized , placebo-controlled , double-blind trial . SETTING Inpatient and posthospital discharge . PATIENTS Older ( ≥65 years ) , malnourished ( Subjective Global Assessment [ SGA ] class B or C ) adults hospitalized for congestive heart failure , acute myocardial infa rct ion , pneumonia , or chronic obstructive pulmonary disease . INTERVENTIONS St and ard-of-care plus HP-HMB ( n = 328 ) or a placebo supplement ( n = 324 ) , 2 servings/day . MEASUREMENTS Primary composite endpoint was 90-day postdischarge incidence of death or nonelective readmission . Other endpoints included 30- and 60-day postdischarge incidence of death or readmission , length of stay ( LOS ) , SGA class , body weight , and activities of daily living ( ADL ) . RESULTS The primary composite endpoint was similar between HP-HMB ( 26.8 % ) and placebo ( 31.1 % ) . No between-group differences were observed for 90-day readmission rate , but 90-day mortality was significantly lower with HP-HMB relative to placebo ( 4.8 % vs. 9.7 % ; relative risk 0.49 , 95 % confidence interval [ CI ] , 0.27 to 0.90 ; p = 0.018 ) . The number-needed-to-treat to prevent 1 death was 20.3 ( 95 % CI : 10.9 , 121.4 ) . Compared with placebo , HP-HMB result ed in improved odds of better nutritional status ( SGA class , OR , 2.04 , 95 % CI : 1.28 , 3.25 , p = 0.009 ) at day 90 , and an increase in body weight at day 30 ( p = 0.035 ) . LOS and ADL were similar between treatments . LIMITATIONS Limited generalizability ; patients represent a selected hospitalized population . CONCLUSIONS Although no effects were observed for the primary composite endpoint , compared with placebo HP-HMB  decreased mortality and improved indices of nutritional status during the 90-day observation period . CLINICAL TRIAL REGIST 
    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 Heart failure ( HF ) is a complex syndrome characterized by intolerance to exertion and reduced functional capacity . OBJECTIVE To assess the functional capacity of patients with HF and supplemented with creatine .  METHODS Prospect i ve , r and omized , double-blind study . Thirty-three male patients over the age of 18 years with functional class II to IV HF were r and omized into two groups as follows : the experimental group ( CRE , n = 17 ) , supplemented with 5 g/day of creatine for six months ; and the placebo group ( PLA , n = 16 ) , receiving 5 g/day of maltodextrin for that same period . Both groups underwent functional capacity assessment by use of cardiopulmonary exercise test and 6-minute walk test ( 6MWT ) before and after the intervention . The Ancova statistical model and Pearson correlation were used to assess the groups and the treatment . RESULTS Of the variables assessed on the cardiopulmonary exercise test , peak oxygen consumption ( peak VO₂ ) , anaerobic threshold ( AT ) , and oxygen pulse ( O₂ pulse ) showed no significant differences between the groups ( P>0.05 ) . On the 6MWT , no significant difference was observed in the covered distance . CONCLUSION Creatine supplementation in patients with HF did not significantly improve functional capacity BACKGROUND AND AIMS Hospitalized patients with heart failure who are malnourished present a worse prognosis than those with an adequate nutritional status . We undertook this study to assess whether a nutritional intervention in malnourished hospitalized patients with heart failure benefits morbidity and mortality . METHODS A multicenter , r and omized , controlled clinical trial was conducted . A total of 120 malnourished hospitalized patients due to acute heart failure were r and omised to conventional heart failure treatment or conventional heart failure treatment combined with an individualized nutritional intervention . The primary endpoint of this study was a composite of all-cause death or readmission for worsening of HF , with a maximum follow-up of 12 months . Analysis was by intention to treat . RESULTS Recruitment was stopped early according to the study protocol after completing the follow-up of the first 120 patients enrolled ( 59 in the intervention group and 61 in the control group ) . Both groups were homogeneous in baseline characteristics . At 12 months , the primary outcome occurred in 27.1 % of patients in the intervention group and in 60.7 % of patients in the control group ( hazard ratio 0.45 ; 95 % confidence interval [ CI ] , 0.19 - 0.62 , p = 0.0004 ) . In total , 20.3 % of patients died in the intervention group and 47.5 % in the control group ( hazard ratio 0.37 , 95 % CI , 0.19 - 0.72 , p = 0.003 ) . Readmission due to heart failure was also lower in the intervention group ( 10.2 vs. 36.1 % , p = 0.001 ) . CONCLUSION Nutritional intervention in malnourished hospitalized patients with heart failure reduces the risk of death from any cause and the risk of readmission for worsening of heart failure ( Clinical Trial.govNCT01472237 ) Background Sarcopenia is generally complicated with patients with chronic heart failure ( CHF ) and its presence negatively affects the course of heart failure , however effective nutritional intervention had not been eluci date d yet . The primary objective of this study is to explore whether the addition of a branched-chain amino acid ( BCAA ) preparation for cardiac rehabilitation ( CR ) of patients with CHF further improves cardiopulmonary functions , skeletal muscle functions , and metabolism in comparison with conventional CR . Methods This is a r and omized , parallel-group comparative study . The elderly patients that were participated in CR and complicated with left ventricular systolic or diastolic dysfunction are r and omized into two groups , CR + BCAA and CR . 20 weeks later , the second r and omization is performed , which divide subjects into two groups with and without BCAA intervention without CR . Primary outcome measure is the rate of change of the anaerobic threshold workload from baseline to post-intervention . Secondary outcome include parameters of exercise capacity , cardiac function and psychological status . Discussion In the current study the effect of a promising new intervention , BCAA , will be assessed to determine whether its addition to CR improve exercise capacity in patients with heart failure , who are generally complicated with sarcopenia . Trial registration This clinical trial was registered with the University Hospital Medical Information Network— Clinical Trials Registry ( UMIN – CTR ; JPRN – UMIN R000022440 ) Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The prevalence of cardiac cachexia in chronic heart failure is approximately 5 % to 15 % and 18-month mortality rates can reach 50 % . Treatment with angiotensin-converting enzyme inhibitors and beta-blockers may confer some benefit but no proven therapy exists . We tested the effects of an oral nutritional supplement in cachectic patients with heart failure . This was a prospect i ve , r and omized , double-blind , placebo-controlled pilot study which r and omized 29 patients to a high-caloric ( 600 kcal ) high-protein ( 20 g ) oral nutritional supplement or placebo for a duration of 6 weeks in addition to the patients ’ usual food intake . At baseline , 6 weeks , and 18 weeks , we measured body weight , quality of life , body composition , heart function , laboratory parameters , and exercise performance . Edema-free body weight increased in 19 of 20 patients receiving intervention at 6 weeks and in 17 of 19 patients at 18 weeks with an average weight gain of 2.0 ± 1.7 kg ( 3.1 ± 2.4 % , p = 0.0001 ) and 2.3 ± 3.1 kg ( 3.6 ± 4.7 % , p = 0.007 ) at 6 and 18 weeks , respectively . Most of the weight gain was fat tissue with an absolute gain of 1.5 ± 1.7 kg ( p = 0.003 ) and 1.6 ± 2.7 kg ( p = 0.008 ) . A significant improvement in quality of life and decrease in serum levels of tumor necrosis factor-α were observed ( p < 0.05 for both ) . We demonstrated the feasibility of oral nutritional supplement in cachectic patients with heart failure and significant clinical benefit in terms of body size and body composition , laboratory parameters , and quality of life ( www . clinical trials.gov identifier NCT00654719 ) BACKGROUND Cardiac creatine levels are depressed in chronic heart failure . Oral supplementation of creatine to healthy volunteers has been shown to increase physical performance . AIM To evaluate the effects of creatine supplementation on ejection fraction , symptom-limited physical endurance and skeletal muscle strength in patients with chronic heart failure . METHODS With a double-blind , placebo-controlled design 17 patients ( age 43 - 70 years , ejection fraction < 40 ) were supplemented with creatine 20 g daily for 10 days . Before and on the last day of supplementation ejection fraction was determined by radionuclide angiography as was symptom-limited 1-legged knee extensor and 2-legged exercise performance on the cycle ergometer . Muscle strength as unilateral concentric knee extensor performance ( peak torque , Nm at 180 degrees/s ) was also evaluated . Skeletal muscle biopsies were taken for the determination of energy-rich phosphagens . RESULTS Ejection fraction at rest and at work did not change . Performance before creatine supplementation did not differ between placebo and creatine groups . While no change was seen in the placebo group compared to baseline , creatine supplementation increased skeletal muscle total creatine and creatine phosphate by 17 + /- 4 % ( P < 0.05 ) and 12 + /- 4 % ( P < 0.05 ) , respectively . Increments were seen only in patients with < 140 mmol total creatine/kg d.w . ( P < 0.05 ) . One-legged performance ( 21 % , P < 0.05 ) , 2-legged performance ( 10 % , P < 0.05 ) , and peak torque , Nm ( 5 % , P < 0.05 ) increased . Both peak torque and 1-legged performance increased linearly with increased skeletal muscle phosphocreatine ( P < 0.05 ) . The increments in 1-legged , 2-legged and peak torque were significant compared to the placebo group , ( P < 0.05 ) . CONCLUSIONS One week of  creatine supplementation to patients with chronic heart failure did not increase ejection fraction but increased skeletal muscle energy-rich phosphagens and performance as regards both strength and endurance . This new therapeutic approach merits further attention BACKGROUND & AIMS Heart Failure ( HF ) is a complex syndrome , which can include the physiological , neural hormonal and metabolic complications known as " Cardiac Cachexia " ( CC ) . In the development of CC there is a release of catabolic cytokines ( Tumor Necrosis Factor-α , interleukins 1 and 6 ) that cause a decrease of fat free mass and fat mass . These changes in body composition might be reversed with a therapeutic combination of resistance exercise and branched chain amino acid supplementation ( BCAA ) . AIM Evaluate changes in body composition after a resistance exercise program and BCAA supplementation in patients with HF . METHODS In a r and omized clinical trial with 3 month of follow-up anthropometric body composition analysis and stress tests were evaluated at the beginning and in the end of the study . Patients were divided into two groups ; the experimental group performed the resistance exercise program and received 10 g/day BCAA supplementation , and the control group only performed the resistance exercise program . Both groups were provided with individualized diets and conventional medical treatment . RESULTS Changes were found in hip circumference between the groups ( p = 0.02 ) , and muscle strength was increased in the experimental group ( 8 % ) and the control group ( 11.4 % ) with no difference between them . METS and VO2Max also increased in experimental and control groups ( 16.6 % and 50.1 % respectively ) . Regarding changes in symptoms , improvements in fatigue ( 45.4 % ) , decubitus intolerance ( 21.8 % ) and dyspnea ( 25.4 % ) were observed in the overall sample . CONCLUSION Improvements in physical and functional capacities are attributed to resistance exercise program but not to the BCAA supplementation . CLINICAL TRIALS IDENTIFIER NCT02240511 BACKGROUND Hospitalized , malnourished older adults have a high risk of readmission and mortality . OBJECTIVE Evaluation of a high-protein oral nutritional supplement ( HP-HMB ) containing beta-hydroxy-beta-methylbutyrate on postdischarge outcomes of nonelective readmission and mortality in malnourished , hospitalized older adults . DESIGN Multicenter , r and omized , placebo-controlled , double-blind trial . SETTING Inpatient and posthospital discharge . PATIENTS Older ( ≥65 years ) , malnourished ( Subjective Global Assessment [ SGA ] class B or C ) adults hospitalized for congestive heart failure , acute myocardial infa rct ion , pneumonia , or chronic obstructive pulmonary disease . INTERVENTIONS St and ard-of-care plus HP-HMB ( n = 328 ) or a placebo supplement ( n = 324 ) , 2 servings/day . MEASUREMENTS Primary composite endpoint was 90-day postdischarge incidence of death or nonelective readmission . Other endpoints included 30- and 60-day postdischarge incidence of death or readmission , length of stay ( LOS ) , SGA class , body weight , and activities of daily living ( ADL ) . RESULTS The primary composite endpoint was similar between HP-HMB ( 26.8 % ) and placebo ( 31.1 % ) . No between-group differences were observed for 90-day readmission rate , but 90-day mortality was significantly lower with HP-HMB relative to placebo ( 4.8 % vs. 9.7 % ; relative risk 0.49 , 95 % confidence interval [ CI ] , 0.27 to 0.90 ; p = 0.018 ) . The number-needed-to-treat to prevent 1 death was 20.3 ( 95 % CI : 10.9 , 121.4 ) . Compared with placebo , HP-HMB result ed in improved odds of better nutritional status ( SGA class , OR , 2.04 , 95 % CI : 1.28 , 3.25 , p = 0.009 ) at day 90 , and an increase in body weight at day 30 ( p = 0.035 ) . LOS and ADL were similar between treatments . LIMITATIONS Limited generalizability ; patients represent a selected hospitalized population . CONCLUSIONS Although no effects were observed for the primary composite endpoint , compared with placebo HP-HMB  decreased mortality and improved indices of nutritional status during the 90-day observation period . CLINICAL TRIAL REGIST 
    Output:
    