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 Undernutrition and weight loss are important determinants of clinical outcome in older patients after hip fracture but the effectiveness of nutritional support programs in routine clinical practice remains controversial . AIMS OF THE PROJECT : To determine if oral nutritional supplements given daily for 28 days after hip fracture surgery could prevent weight loss and /or lead to improved clinical outcomes ( mortality rates , discharge destination , activities of daily living or length of hospital stay ) in non-malnourished community-dwelling older women with hip fracture . METHODS One hundred and nine women with BMI range 20 - 30 kg/m(2 ) were allocated to either nutritional supplements ( 352 kcal/day ) or usual hospital nutrition using a quasi-r and omisation technique . Body weight changes were monitored at 4 and 8 weeks and clinical outcomes were recorded at discharge and at 6 months . RESULTS No significant differences in weight change or clinical outcomes were seen between the two groups . Compliance with consuming the nutritional supplements was quite variable and there was a significant negative correlation between the amount of supplement consumed and subsequent weight change ( r=-0.36 , P=0.019 ) . CONCLUSIONS Poor compliance with oral nutritional supplements is an important determinant of the effectiveness of oral nutritional interventions in preventing weight loss after hip fracture . Whilst this may explain the lack of clinical improvements seen , our data do not support the routine use of oral nutritional supplements in non-malnourished hip fracture patients There is a common perception that malnutrition is an inevitable manifestation of illness , that oral nutritional supplements are not taken or reduce the consumption of oral diet , and that nasogastric feeding is poorly tolerated . This study assessed the efficacy of supplemental enteral feeding on the nutritional status of malnourished patients , to compare oral supplements ( OS ) with overnight supplemental nasogastric feeding ( NG ) on nutritional status and to determine the effect of nutritional supplements on oral diet . Malnourished hospital patients were r and omized to one of three groups : control ( C ) , OS , or NG . All patients had access to hospital diet .  Supplements were prescribed to meet estimated nutritional needs . Nutritional status was recorded at the start and the end of the feeding period . The total nutritional intake was recorded . Weight gain occurred in 64 % of the supplemented patients , whereas 73 % of the controls lost weight with mean weight changes of + 2.9 % OS . + 3.3 % NG , and -2.5 % C. There was no difference in the mean energy intake from food in the three groups . There were no documented complications of OS and three minor complications of NG . Both methods of supplementation allow weight gain without significantly affecting spontaneous oral intake Ninety-three cancer patients about to undergo radiotherapy were studied . These patients were affected by cancer of the head and neck , breast cancer , and abdominopelvic cancer . They were r and omly distributed into control and experimental groups . The patients from the control group were allowed to eat ad libitum , whereas those from the experimental group followed a strict nutritional protocol that covered their needs while satisfying their particular tastes and habits . Data were collected the day before radiotherapy commenced and the day treatment ended . Anthropometric , analytical , and clinical parameters were determined . The results showed the benefit of dietetic treatment in experimental patients with head and neck or abdominopelvic cancer AIMS To investigate whether a nutritional intervention in older women and men with femoral neck fracture had an effect on postoperative complications during hospitalization and on nutritional status at a four-month follow-up . METHODS The design was a r and omized controlled trial . The present study sample consisted of 157 patients aged 70 years and above with femoral neck fracture . The nutritional intervention included , among other things , a nutritional journal to detect nutrition deficiencies and protein-enriched meals for at least four days postoperatively . Further , at least two nutritional and protein drinks were served each day during the whole hospitalization and other factors that would influence the patient 's nutrition were also considered and dealt with . Postoperative complications were registered and patients were assessed using the Mini Nutritional Assessment ( MNA ) scale , including body mass index ( BMI ) , on admission and at a four-month follow-up . RESULTS Malnutrition was common and low MNA scores were associated with postoperative complications such as delirium and decubitus ulcers . There were significantly fewer days of delirium in the intervention group , seven patients in the intervention group developed decubitus ulcers vs. 14 patients in the control group and the total length of hospitalization was shorter . There were no detectable significant improvements regarding nutritional parameters between the intervention and the control group at the four-month follow-up but men improved their mean BMI , body weight and MNA scores in both the intervention and the control groups while women deteriorated in both groups . CONCLUSIONS Malnutrition was common among older people with hip fractures admitted to hospital . The nutritional intervention might have contributed to the patients suffering fewer days with delirium , fewer decubitus ulcers and shorter hospitalization but did not improve the long-term nutritional status , at least not in women . RELEVANCE TO CLINICAL PRACTICE This nutritional intervention , which was included in a multifactorial multidisciplinary intervention , is inexpensive and relatively easy to implement . It has significant effects on complications but no long-term effect on nutritional parameters , at least not in women Malnutrition and cachexia are characteristic symptoms of human immunodeficiency virus (HIV)-1 infection and AIDS . To identify risk situations that might affect nutritional behavior and status and to evaluate the therapeutic effect of an intensified oral nutritional intervention , we analyzed 81 consecutively treated homosexual HIV-infected out patients with malnutrition retrospectively and could follow the outcome of a nutritional intervention prospect ively in 54 of them . Nutritional therapy was ineffective for only 5 of the 54 patients ; constant weight loss could be stopped in 31 of the patients , and 18 patients could even gain weight . We suggest intensified oral nutritional intervention should be an integral part of the treatment of HIV-infected patients to prevent or treat malnutrition Decreases in whole-body lean mass can cause sarcopenia , a disease frequently found in the elderly . This condition is frequently associated with frailty and disability in aging as well as the onset and progression of several geriatric syndromes . Sarcopenia therefore must be managed with multidimensional approaches that include physical training , nutritional support , and metabolic and anabolic treatment . The purpose of our study was to assess the effect of an orally administered special mixture of amino acids ( AAs ) in elderly subjects with reduced lean body mass and sarcopenia . A r and omized , open-label , crossover study was conducted in 41 elderly subjects ( age range : 66 - 84 years ) with sarcopenia , assigned to 2 distinct treatments ( AAs and placebo ) . All subjects had normal body weight ( body mass index within 19 - 23 ) . The AA treatment consisted of 70.6 kcal/day ( 1 kcal = 4.2 kJ ) of 8 g of essential AA snacks , given at 10:00 am and 5:00 pm . Lean mass was measured with dual-energy x-ray absorptiometry in leg , arm , and trunk tissues . Significant increases in whole-body lean mass in all areas were seen after 6 months and more consistently after 18 months of oral nutritional supplementation with AAs .  Fasting blood glucose , serum insulin , and homeostatic model assessment of insulin resistance ( an index of insulin resistance ) significantly decreased during AA treatment . Furthermore , a significant reduction in serum tumor necrosis factor-alpha ( TNF-alpha ) and a significant increase in both insulin-like growth factor-1 ( IGF-1 ) serum concentrations and in the IGF-1/TNF-alpha ratio were also found . No significant adverse effects were observed during AA treatment . These preliminary data indicate that nutritional supplements with the oral AA mixture significantly increased whole-body lean mass in elderly subjects with sarcopenia . The improvement in the amount of whole-body lean mass could be linked to increased insulin sensitivity and anabolic conditions related to IGF-1 availability BACKGROUND AND AIMS In patients with liver cirrhosis , protein-energy malnutrition is a frequent finding and a risk factor influencing survival . The aim was to estimate the effects of an adequate diet on malnutrition and clinical outcome in patients with Child A or B HCV-related liver cirrhosis . METHODS We enrolled 90 consecutive out patients ( M/F=52/38 ) with liver cirrhosis , 30 in Child class A and 60 in class B. Patients were evaluated by anamnesis , clinical examination , estimation of daily caloric intake and measurement of anthropometrical and biochemical indexes . Patients were r and omized into two groups : group 1 with a 3-month oral controlled diet started one week after the first examination and this was followed by a 3-month of spontaneous dietary intake , and group 2 which started a 3-month spontaneous dietary intake followed by a 3-month of controlled diet . The follow-up was performed every month . RESULTS During the period of controlled diet in patients of both groups , protein malnutrition assessed by midarm muscle circumference , creatinine-height index and serum albumin significantly improved independently of the Child class . Lipid malnutrition , assessed by triceps skin fold thickness values , did not improve during the course of the study . The compliance to the prescribed diet was very high in both groups , and no carry over effect of the previous dietary intake was observed during the follow-up period . CONCLUSIONS The results emphasize the importance of both nutritional status evaluation and improvement in the Child A and B cirrhotic patients with HCV-related disease . The proposed nutritional approach was able to influence their protein malnutrition positively In recent years , the concept of nutritional support as a part of a comprehensive cancer management program has gained increasing acceptability . However , little data is available in regard to the effect of nutritional support programs on the chronic disease state represented by recurrent or persistent cancer that characterizes patients undergoing systemic chemotherapy . In 1977 we undertook to study this problem in a r and omized prospect i ve study design ed to evaluate the effects of long-term ( 12 months ) enteral nutritional support in a group of ambulatory breast cancer patients undergoing a st and ard cytotoxic chemotherapy treatment program  , in an adjuvant or therapeutic setting . The results of this study suggest that patients with breast cancer are overweight as compared to the general population and that any significant change in initial body weight , either a gain or a loss , is associated with an increased risk of recurrent disease . Data are presented which show little or no correlation between st and ard parameters of nutritional assessment and risk of disease recurrence and /or response to chemotherapy . These data also suggest that until we better underst and the relationship between tumor and host in breast cancer patients , we offer nutritional support programs only in situations where there are specific clinical indications for such interventions BACKGROUND About 25 - 40 % of hospital patients are malnourished . With current clinical practice s , only 50 % of malnourished patients are identified by the medical and nursing staff . OBJECTIVE The objective of this study was to report the cost and effectiveness of early recognition and treatment of malnourished hospital patients with the use of the Short Nutritional Assessment Question naire ( SNAQ ) . DESIGN The intervention group consisted of 297 patients who were admitted to 2 mixed medical and surgical wards and who received both malnutrition screening at admission and st and ardized nutritional care .  The control group consisted of a comparable group of 291 patients who received the usual hospital clinical care .  Outcome measures were weight change , use of supplemental drinks , use of tube feeding , use of parenteral nutrition and in-between meals , number of consultations by the hospital dietitian , and length of hospital stay . RESULTS The recognition of malnutrition improved from 50 % to 80 % with the use of the SNAQ malnutrition screening tool during admission to the hospital . The st and ardized nutritional care protocol added approximately 600 kcal and 12 g protein to the daily intake of malnourished patients . Early screening and treatment of malnourished patients reduced the length of hospital stay in malnourished patients with low h and grip strength ( ie , frail patients ) . To shorten the mean length of hospital stay by 1 d for all malnourished patients , a mean investment of 76 euros ( 91 US dollars ) in nutritional screening and treatment was needed . The incremental costs were comparably low in the whole group and in the subgroup of malnourished patients with low h and grip strength . CONCLUSIONS Screening with the SNAQ and early st and ardized nutritional care improves the recognition of malnourished patients and provides the opportunity to start treatment at an early stage of hospitalization . The additional costs of early nutritional care are low , especially in frail malnourished patients BACKGROUND Nutritional support is often recommended as part of the treatment of tuberculosis , but it has never been properly tested . OBJECTIVE We assessed the effects of early nutritional intervention on lean mass and physical function in patients with tuberculosis and wasting . DESIGN Patients who started antituberculous therapy within the previous 2 wk were r and omly assigned to receive st and ard nutritional counseling ( control group ) or nutritional counseling to increase their intake through diet and high-energy supplements ( nutritional supplement group ) for 6 wk . Body composition was measured by dual-energy X-ray absorptiometry , and physical function was assessed by maximum grip strength . RESULTS Patients in the nut 
    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 Undernutrition and weight loss are important determinants of clinical outcome in older patients after hip fracture but the effectiveness of nutritional support programs in routine clinical practice remains controversial . AIMS OF THE PROJECT : To determine if oral nutritional supplements given daily for 28 days after hip fracture surgery could prevent weight loss and /or lead to improved clinical outcomes ( mortality rates , discharge destination , activities of daily living or length of hospital stay ) in non-malnourished community-dwelling older women with hip fracture . METHODS One hundred and nine women with BMI range 20 - 30 kg/m(2 ) were allocated to either nutritional supplements ( 352 kcal/day ) or usual hospital nutrition using a quasi-r and omisation technique . Body weight changes were monitored at 4 and 8 weeks and clinical outcomes were recorded at discharge and at 6 months . RESULTS No significant differences in weight change or clinical outcomes were seen between the two groups . Compliance with consuming the nutritional supplements was quite variable and there was a significant negative correlation between the amount of supplement consumed and subsequent weight change ( r=-0.36 , P=0.019 ) . CONCLUSIONS Poor compliance with oral nutritional supplements is an important determinant of the effectiveness of oral nutritional interventions in preventing weight loss after hip fracture . Whilst this may explain the lack of clinical improvements seen , our data do not support the routine use of oral nutritional supplements in non-malnourished hip fracture patients There is a common perception that malnutrition is an inevitable manifestation of illness , that oral nutritional supplements are not taken or reduce the consumption of oral diet , and that nasogastric feeding is poorly tolerated . This study assessed the efficacy of supplemental enteral feeding on the nutritional status of malnourished patients , to compare oral supplements ( OS ) with overnight supplemental nasogastric feeding ( NG ) on nutritional status and to determine the effect of nutritional supplements on oral diet . Malnourished hospital patients were r and omized to one of three groups : control ( C ) , OS , or NG . All patients had access to hospital diet .  Supplements were prescribed to meet estimated nutritional needs . Nutritional status was recorded at the start and the end of the feeding period . The total nutritional intake was recorded . Weight gain occurred in 64 % of the supplemented patients , whereas 73 % of the controls lost weight with mean weight changes of + 2.9 % OS . + 3.3 % NG , and -2.5 % C. There was no difference in the mean energy intake from food in the three groups . There were no documented complications of OS and three minor complications of NG . Both methods of supplementation allow weight gain without significantly affecting spontaneous oral intake Ninety-three cancer patients about to undergo radiotherapy were studied . These patients were affected by cancer of the head and neck , breast cancer , and abdominopelvic cancer . They were r and omly distributed into control and experimental groups . The patients from the control group were allowed to eat ad libitum , whereas those from the experimental group followed a strict nutritional protocol that covered their needs while satisfying their particular tastes and habits . Data were collected the day before radiotherapy commenced and the day treatment ended . Anthropometric , analytical , and clinical parameters were determined . The results showed the benefit of dietetic treatment in experimental patients with head and neck or abdominopelvic cancer AIMS To investigate whether a nutritional intervention in older women and men with femoral neck fracture had an effect on postoperative complications during hospitalization and on nutritional status at a four-month follow-up . METHODS The design was a r and omized controlled trial . The present study sample consisted of 157 patients aged 70 years and above with femoral neck fracture . The nutritional intervention included , among other things , a nutritional journal to detect nutrition deficiencies and protein-enriched meals for at least four days postoperatively . Further , at least two nutritional and protein drinks were served each day during the whole hospitalization and other factors that would influence the patient 's nutrition were also considered and dealt with . Postoperative complications were registered and patients were assessed using the Mini Nutritional Assessment ( MNA ) scale , including body mass index ( BMI ) , on admission and at a four-month follow-up . RESULTS Malnutrition was common and low MNA scores were associated with postoperative complications such as delirium and decubitus ulcers . There were significantly fewer days of delirium in the intervention group , seven patients in the intervention group developed decubitus ulcers vs. 14 patients in the control group and the total length of hospitalization was shorter . There were no detectable significant improvements regarding nutritional parameters between the intervention and the control group at the four-month follow-up but men improved their mean BMI , body weight and MNA scores in both the intervention and the control groups while women deteriorated in both groups . CONCLUSIONS Malnutrition was common among older people with hip fractures admitted to hospital . The nutritional intervention might have contributed to the patients suffering fewer days with delirium , fewer decubitus ulcers and shorter hospitalization but did not improve the long-term nutritional status , at least not in women . RELEVANCE TO CLINICAL PRACTICE This nutritional intervention , which was included in a multifactorial multidisciplinary intervention , is inexpensive and relatively easy to implement . It has significant effects on complications but no long-term effect on nutritional parameters , at least not in women Malnutrition and cachexia are characteristic symptoms of human immunodeficiency virus (HIV)-1 infection and AIDS . To identify risk situations that might affect nutritional behavior and status and to evaluate the therapeutic effect of an intensified oral nutritional intervention , we analyzed 81 consecutively treated homosexual HIV-infected out patients with malnutrition retrospectively and could follow the outcome of a nutritional intervention prospect ively in 54 of them . Nutritional therapy was ineffective for only 5 of the 54 patients ; constant weight loss could be stopped in 31 of the patients , and 18 patients could even gain weight . We suggest intensified oral nutritional intervention should be an integral part of the treatment of HIV-infected patients to prevent or treat malnutrition Decreases in whole-body lean mass can cause sarcopenia , a disease frequently found in the elderly . This condition is frequently associated with frailty and disability in aging as well as the onset and progression of several geriatric syndromes . Sarcopenia therefore must be managed with multidimensional approaches that include physical training , nutritional support , and metabolic and anabolic treatment . The purpose of our study was to assess the effect of an orally administered special mixture of amino acids ( AAs ) in elderly subjects with reduced lean body mass and sarcopenia . A r and omized , open-label , crossover study was conducted in 41 elderly subjects ( age range : 66 - 84 years ) with sarcopenia , assigned to 2 distinct treatments ( AAs and placebo ) . All subjects had normal body weight ( body mass index within 19 - 23 ) . The AA treatment consisted of 70.6 kcal/day ( 1 kcal = 4.2 kJ ) of 8 g of essential AA snacks , given at 10:00 am and 5:00 pm . Lean mass was measured with dual-energy x-ray absorptiometry in leg , arm , and trunk tissues . Significant increases in whole-body lean mass in all areas were seen after 6 months and more consistently after 18 months of oral nutritional supplementation with AAs .  Fasting blood glucose , serum insulin , and homeostatic model assessment of insulin resistance ( an index of insulin resistance ) significantly decreased during AA treatment . Furthermore , a significant reduction in serum tumor necrosis factor-alpha ( TNF-alpha ) and a significant increase in both insulin-like growth factor-1 ( IGF-1 ) serum concentrations and in the IGF-1/TNF-alpha ratio were also found . No significant adverse effects were observed during AA treatment . These preliminary data indicate that nutritional supplements with the oral AA mixture significantly increased whole-body lean mass in elderly subjects with sarcopenia . The improvement in the amount of whole-body lean mass could be linked to increased insulin sensitivity and anabolic conditions related to IGF-1 availability BACKGROUND AND AIMS In patients with liver cirrhosis , protein-energy malnutrition is a frequent finding and a risk factor influencing survival . The aim was to estimate the effects of an adequate diet on malnutrition and clinical outcome in patients with Child A or B HCV-related liver cirrhosis . METHODS We enrolled 90 consecutive out patients ( M/F=52/38 ) with liver cirrhosis , 30 in Child class A and 60 in class B. Patients were evaluated by anamnesis , clinical examination , estimation of daily caloric intake and measurement of anthropometrical and biochemical indexes . Patients were r and omized into two groups : group 1 with a 3-month oral controlled diet started one week after the first examination and this was followed by a 3-month of spontaneous dietary intake , and group 2 which started a 3-month spontaneous dietary intake followed by a 3-month of controlled diet . The follow-up was performed every month . RESULTS During the period of controlled diet in patients of both groups , protein malnutrition assessed by midarm muscle circumference , creatinine-height index and serum albumin significantly improved independently of the Child class . Lipid malnutrition , assessed by triceps skin fold thickness values , did not improve during the course of the study . The compliance to the prescribed diet was very high in both groups , and no carry over effect of the previous dietary intake was observed during the follow-up period . CONCLUSIONS The results emphasize the importance of both nutritional status evaluation and improvement in the Child A and B cirrhotic patients with HCV-related disease . The proposed nutritional approach was able to influence their protein malnutrition positively In recent years , the concept of nutritional support as a part of a comprehensive cancer management program has gained increasing acceptability . However , little data is available in regard to the effect of nutritional support programs on the chronic disease state represented by recurrent or persistent cancer that characterizes patients undergoing systemic chemotherapy . In 1977 we undertook to study this problem in a r and omized prospect i ve study design ed to evaluate the effects of long-term ( 12 months ) enteral nutritional support in a group of ambulatory breast cancer patients undergoing a st and ard cytotoxic chemotherapy treatment program  , in an adjuvant or therapeutic setting . The results of this study suggest that patients with breast cancer are overweight as compared to the general population and that any significant change in initial body weight , either a gain or a loss , is associated with an increased risk of recurrent disease . Data are presented which show little or no correlation between st and ard parameters of nutritional assessment and risk of disease recurrence and /or response to chemotherapy . These data also suggest that until we better underst and the relationship between tumor and host in breast cancer patients , we offer nutritional support programs only in situations where there are specific clinical indications for such interventions BACKGROUND About 25 - 40 % of hospital patients are malnourished . With current clinical practice s , only 50 % of malnourished patients are identified by the medical and nursing staff . OBJECTIVE The objective of this study was to report the cost and effectiveness of early recognition and treatment of malnourished hospital patients with the use of the Short Nutritional Assessment Question naire ( SNAQ ) . DESIGN The intervention group consisted of 297 patients who were admitted to 2 mixed medical and surgical wards and who received both malnutrition screening at admission and st and ardized nutritional care .  The control group consisted of a comparable group of 291 patients who received the usual hospital clinical care .  Outcome measures were weight change , use of supplemental drinks , use of tube feeding , use of parenteral nutrition and in-between meals , number of consultations by the hospital dietitian , and length of hospital stay . RESULTS The recognition of malnutrition improved from 50 % to 80 % with the use of the SNAQ malnutrition screening tool during admission to the hospital . The st and ardized nutritional care protocol added approximately 600 kcal and 12 g protein to the daily intake of malnourished patients . Early screening and treatment of malnourished patients reduced the length of hospital stay in malnourished patients with low h and grip strength ( ie , frail patients ) . To shorten the mean length of hospital stay by 1 d for all malnourished patients , a mean investment of 76 euros ( 91 US dollars ) in nutritional screening and treatment was needed . The incremental costs were comparably low in the whole group and in the subgroup of malnourished patients with low h and grip strength . CONCLUSIONS Screening with the SNAQ and early st and ardized nutritional care improves the recognition of malnourished patients and provides the opportunity to start treatment at an early stage of hospitalization . The additional costs of early nutritional care are low , especially in frail malnourished patients BACKGROUND Nutritional support is often recommended as part of the treatment of tuberculosis , but it has never been properly tested . OBJECTIVE We assessed the effects of early nutritional intervention on lean mass and physical function in patients with tuberculosis and wasting . DESIGN Patients who started antituberculous therapy within the previous 2 wk were r and omly assigned to receive st and ard nutritional counseling ( control group ) or nutritional counseling to increase their intake through diet and high-energy supplements ( nutritional supplement group ) for 6 wk . Body composition was measured by dual-energy X-ray absorptiometry , and physical function was assessed by maximum grip strength . RESULTS Patients in the nut 
    Output:
    