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: 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 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 Nutritional deficiencies , frequently observed among the frail elderly , have been associated with increased morbidity and dependency . A r and omized clinical trial was conducted to assess the impact of nutritional supplementation on the functional status of frail elderly living at home . Subjects ( n = 50 ) over age 60 ( mean 78 y ) requiring community services and at elevated risk of undernutrition ( excessive weight loss or body mass index < 24 kg/m2 ) were r and omized to a high energy nutrient dense supplement provided by a dietitian or a control group receiving visits only . Outcome measures , including changes in h and grip strength , general well-being score , perception of health and number of falls , were measured by an investigator who was unaware of treatment assignment . After 12 wk , weight gain was greater in the supplemented group ( 2.1 + /- 2.3 vs. 0.6 + /- 1.6 kg ; P < 0.01 ) . Despite adequate statistical power , no functional measures differed except that the number of falls was lower among treated subjects vs. controls ( 0 % vs. 21 % ; P = 0.05 ) . Frail elderly can gain weight through oral supplementation , indicating the reversibility of weight loss in this group , but changes in functional status indicators may require a longer period of supplementation BACKGROUND Patients who undergo surgery are at risk of malnutrition due to periods of starvation , the stress of surgery , and subsequent increase in metabolic rate . There are limited data on nutritional outcome of surgical patients . AIMS To investigate changes in nutritional status and the influence of oral supplements on nutritional status , morbidity , and quality of life in postoperative surgical patients . METHODS Entry was determined by the presence of malnutrition , as defined by a body mass index ( BMI ) ⩽20 kg/m2 , anthropometric measurements ⩽15th percentile on admission , or initiation of oral diet postoperatively and /or a weight loss of 5 % or more during the operative period . We studied 101 patients : 52 were r and omised to the treatment group ( TG ) and prescribed a 1.5 kcal/ml nutritional supplement ; 49 patients were r and omised to the control group ( CG ) and continued with routine nutritional management .  Nutritional status was assessed by weight , anthropometry , and grip strength , with measurements taken at two weekly intervals for 10 weeks . Complications , namely wound infection , chest infection , and antibiotic use were documented . Quality of life ( QOL ) was assessed using the UK SF-36 question naire . RESULTS Patients in the control group lost a maximum mean ( SD ) of 5.96 ( 4.21 ) kg in weight over a period of eight weeks while patients in group TG lost less weight overall ( maximum mean ( SD ) 3.40 ( 0.89 ) kg ( p<0.001 ) occurring at four weeks and progressively regained weight from week 4 ) . Anthropometry , grip strength , and QOL were similarly significantly different between groups ( p<0.001 ) . Fewer patients in the treatment group ( 7/52 ) required antibiotic prescriptions compared with the control group ( 15/49 ) . CONCLUSIONS Nutritional status declined for two months after discharge . Postoperative nutritional supplementation improved nutritional status , QOL , and morbidity in these patients OBJECTIVE to evaluate the use of high-energy , high-protein , oral , liquid , nutrition supplementation and nutrition counseling on the weight status of patients infected with the human immunodeficiency virus ( HIV ) with and without secondary infections . DESIGN Prospect i ve , descriptive , intervention trial . Follow-up clinic visits were scheduled every 1 to 3 weeks for at least 6 weeks to monitor weight , gastrointestinal symptoms , number of supplements consumed , and incidence of secondary infections . SUBJECTS/ SETTING Community-based , HIV-infected patients , with and without an acquired immunodeficiency syndrome ( AIDS ) defining illness , who were receiving outpatient medical care at Deaconess Hospital . Twenty-two patients enrolled ; however , 4 dropped out and 1 died , so 17 were eligible for evaluation . INTERVENTION Dietary counseling consisted of recommendations to consume a high-protein diet ( 1.5 g/kg ideal body weight ) ; select foods that minimize gastrointestinal complications ; and take at least one high-energy , high-protein , oral , liquid , nutrition supplement daily . MAIN OUTCOME MEASURES Energy intake from the supplements and weight change over time in relation to whether a secondary infection occurred . STATISTICAL ANALYSIS Means , st and ard deviations , and frequency . RESULTS At the time of entry to the study , the patients with preexisting weight loss  ( 16 of 17 ) were 14+/-8 % below their usual body weight . On average , patients consumed 11+/-4 supplements per week for 6+/-3 weeks . The majority ( 12 of 17 ) were able to gain or maintain weight . Overall weight change was 1.1+/-2.2 kg . Only 5 of 17 patients lost weight , 4 of whom developed a secondary infection during the study ( ie , after enrollment in the study ) . All of those who developed a secondary infection were classified as having AIDS and had lower mean CD4 counts at baseline than those who did not develop a secondary infection . Although those who developed a secondary infection had a higher incidence of weight loss , their consumption of oral supplements per week was greater than that of those without a secondary infection . APPLICATIONS/ CONCLUSIONS In patients with HIV infection and in the early stages of AIDS without a secondary infection , weight gain and /or maintenance was achievable with a high-energy , high-protein , oral , liquid , nutrition supplement in conjunction with nutrition counseling . The majority of the patients who developed a secondary infection , however , lost weight despite the use of supplements and counseling . Use of a high-energy , high-protein , oral , liquid , nutrition supplement , with intact nutrients , should be the first-line nutrition treatment for malnourished , HIV-infected patients without secondary infections OBJECTIVE To evaluate the association of oral food intake with survival in very old demented nursing home patients . DESIGN A prospect i ve cohort study . SETTING A nursing home in northern Italy . MEASUREMENTS  Anthropometric and laboratory nutritional indicators and nutrient intake  were assessed in 33 demented ( age 85.7 + /- 5.7 years ) and 25 nondemented ( age 84.9 + /- 5.7 years ) patients .  Mortality data were collected over a 28-month follow-up period . Association of survival with dementia was estimated by Kaplan-Meyer analysis and multivariate Cox proportional hazard models . RESULTS Nutrient intake and nutritional status were good compared with data in the literature and were similar in demented and nondemented patients , except for smaller triceps skinfold thickness in the demented . The cumulative annual death rate was 0.23 deaths per subject per year , similar in the demented ( 0.23 ) and the nondemented ( 0.22 ) . Unadjusted survival by Kaplan-Meyer analysis was similar in the two groups , and correction for-age , gender , cognition , triceps skinfold thickness , and number of drugs in a Cox model did not alter the relationship . CONCLUSIONS Dementia developing in very old age is not necessarily associated with malnutrition and decreased life expectancy The impact of oral nutritional supplementation during an acute exacerbation of COPD on functional status was assessed through measuring change in lung function , strength testing , and general well-being .  Subjects hospitalized for an acute exacerbation of COPD ( n = 33 ) were r and omized to extra nutritional support or the regular hospital care . They consumed an additional 10 kcal/kg/d . Outcome measures were measured at 2 wk as change scores . Forced vital capacity ( % predicted ) improved in the treatment group as compared with the control group ( + 8.7 % versus -3.5 % , p = 0.015 ) , and change in FEV1 was in the same direction but not significantly different ( p = 0.099 ) . There were no changes in h and grip strength or respiratory muscle strength , but there was a trend towards more improvement in the general well-being score ( + 11.96 versus -10.25 , p = 0.066 ) . Almost all subjects were in negative nitrogen balance , indicating muscle wasting . The degree of muscle wasting was strongly correlated with the dose of corticosteroids ( r = 0.73 , p < 0.005 ) . In conclusion , it is difficult to prevent important muscle wasting in patients with COPD treated with corticosteroids , but some small gains were observed with increased dietary intake OBJECTIVES To determine why elderly nursing home patients receive liquid oral protein supplements , what nutritional assessment is utilized , and whether there is evidence of effectiveness . DESIGN Retrospective , case control study comparing patients over 65 years of age , at two nursing homes , who were served oral supplements ( OS ) at least twice daily ( n = 56 ) , with a r and om sample of non-supplemented , non-tube fed patients ( n = 53 ) . Comparisons included medical diagnoses , medications , morbidity and mortality , weight changes , laboratory test results , and functional and behavioral status . RESULTS Nursing home patients were begun on OS ( median time after admission = 2 months , range = 0 - 72 months ) primarily because of weight loss ( 71 % ) and poor appetite ( 16 % ) . Supplemented patients were below an age-adjusted body weight on admission , unlike controls , and continued to lose weight until OS were started . On OS , weight was slowly regained over 9 - 10 months in a majority of patients to approximate admission weight . Some patients on OS showed improvement in albumin , total lymphocyte count , cholesterol , or hemoglobin , but too few patients had sufficient lab tests to verify any consistent effect . Mortality was higher in OS patients ( 8 vs 2 , P = 0.057 ) , who were also somewhat older ( 87.9 vs 84.5 years ) , but there was no statistical difference in infection or hospitalization rate . MEASUREMENTS Nutritional assessment in these nursing homes consisted almost exclusively of ( 1 ) serial measurement of weight , ( 2 ) comparison of weight to ( a ) " ideal body weight " and ( b ) previous weight , and ( 3 ) a subjective evaluation of food consumption . No other anthropometric evaluations or laboratory tests were conducted for nutr 
    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: 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 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 Nutritional deficiencies , frequently observed among the frail elderly , have been associated with increased morbidity and dependency . A r and omized clinical trial was conducted to assess the impact of nutritional supplementation on the functional status of frail elderly living at home . Subjects ( n = 50 ) over age 60 ( mean 78 y ) requiring community services and at elevated risk of undernutrition ( excessive weight loss or body mass index < 24 kg/m2 ) were r and omized to a high energy nutrient dense supplement provided by a dietitian or a control group receiving visits only . Outcome measures , including changes in h and grip strength , general well-being score , perception of health and number of falls , were measured by an investigator who was unaware of treatment assignment . After 12 wk , weight gain was greater in the supplemented group ( 2.1 + /- 2.3 vs. 0.6 + /- 1.6 kg ; P < 0.01 ) . Despite adequate statistical power , no functional measures differed except that the number of falls was lower among treated subjects vs. controls ( 0 % vs. 21 % ; P = 0.05 ) . Frail elderly can gain weight through oral supplementation , indicating the reversibility of weight loss in this group , but changes in functional status indicators may require a longer period of supplementation BACKGROUND Patients who undergo surgery are at risk of malnutrition due to periods of starvation , the stress of surgery , and subsequent increase in metabolic rate . There are limited data on nutritional outcome of surgical patients . AIMS To investigate changes in nutritional status and the influence of oral supplements on nutritional status , morbidity , and quality of life in postoperative surgical patients . METHODS Entry was determined by the presence of malnutrition , as defined by a body mass index ( BMI ) ⩽20 kg/m2 , anthropometric measurements ⩽15th percentile on admission , or initiation of oral diet postoperatively and /or a weight loss of 5 % or more during the operative period . We studied 101 patients : 52 were r and omised to the treatment group ( TG ) and prescribed a 1.5 kcal/ml nutritional supplement ; 49 patients were r and omised to the control group ( CG ) and continued with routine nutritional management .  Nutritional status was assessed by weight , anthropometry , and grip strength , with measurements taken at two weekly intervals for 10 weeks . Complications , namely wound infection , chest infection , and antibiotic use were documented . Quality of life ( QOL ) was assessed using the UK SF-36 question naire . RESULTS Patients in the control group lost a maximum mean ( SD ) of 5.96 ( 4.21 ) kg in weight over a period of eight weeks while patients in group TG lost less weight overall ( maximum mean ( SD ) 3.40 ( 0.89 ) kg ( p<0.001 ) occurring at four weeks and progressively regained weight from week 4 ) . Anthropometry , grip strength , and QOL were similarly significantly different between groups ( p<0.001 ) . Fewer patients in the treatment group ( 7/52 ) required antibiotic prescriptions compared with the control group ( 15/49 ) . CONCLUSIONS Nutritional status declined for two months after discharge . Postoperative nutritional supplementation improved nutritional status , QOL , and morbidity in these patients OBJECTIVE to evaluate the use of high-energy , high-protein , oral , liquid , nutrition supplementation and nutrition counseling on the weight status of patients infected with the human immunodeficiency virus ( HIV ) with and without secondary infections . DESIGN Prospect i ve , descriptive , intervention trial . Follow-up clinic visits were scheduled every 1 to 3 weeks for at least 6 weeks to monitor weight , gastrointestinal symptoms , number of supplements consumed , and incidence of secondary infections . SUBJECTS/ SETTING Community-based , HIV-infected patients , with and without an acquired immunodeficiency syndrome ( AIDS ) defining illness , who were receiving outpatient medical care at Deaconess Hospital . Twenty-two patients enrolled ; however , 4 dropped out and 1 died , so 17 were eligible for evaluation . INTERVENTION Dietary counseling consisted of recommendations to consume a high-protein diet ( 1.5 g/kg ideal body weight ) ; select foods that minimize gastrointestinal complications ; and take at least one high-energy , high-protein , oral , liquid , nutrition supplement daily . MAIN OUTCOME MEASURES Energy intake from the supplements and weight change over time in relation to whether a secondary infection occurred . STATISTICAL ANALYSIS Means , st and ard deviations , and frequency . RESULTS At the time of entry to the study , the patients with preexisting weight loss  ( 16 of 17 ) were 14+/-8 % below their usual body weight . On average , patients consumed 11+/-4 supplements per week for 6+/-3 weeks . The majority ( 12 of 17 ) were able to gain or maintain weight . Overall weight change was 1.1+/-2.2 kg . Only 5 of 17 patients lost weight , 4 of whom developed a secondary infection during the study ( ie , after enrollment in the study ) . All of those who developed a secondary infection were classified as having AIDS and had lower mean CD4 counts at baseline than those who did not develop a secondary infection . Although those who developed a secondary infection had a higher incidence of weight loss , their consumption of oral supplements per week was greater than that of those without a secondary infection . APPLICATIONS/ CONCLUSIONS In patients with HIV infection and in the early stages of AIDS without a secondary infection , weight gain and /or maintenance was achievable with a high-energy , high-protein , oral , liquid , nutrition supplement in conjunction with nutrition counseling . The majority of the patients who developed a secondary infection , however , lost weight despite the use of supplements and counseling . Use of a high-energy , high-protein , oral , liquid , nutrition supplement , with intact nutrients , should be the first-line nutrition treatment for malnourished , HIV-infected patients without secondary infections OBJECTIVE To evaluate the association of oral food intake with survival in very old demented nursing home patients . DESIGN A prospect i ve cohort study . SETTING A nursing home in northern Italy . MEASUREMENTS  Anthropometric and laboratory nutritional indicators and nutrient intake  were assessed in 33 demented ( age 85.7 + /- 5.7 years ) and 25 nondemented ( age 84.9 + /- 5.7 years ) patients .  Mortality data were collected over a 28-month follow-up period . Association of survival with dementia was estimated by Kaplan-Meyer analysis and multivariate Cox proportional hazard models . RESULTS Nutrient intake and nutritional status were good compared with data in the literature and were similar in demented and nondemented patients , except for smaller triceps skinfold thickness in the demented . The cumulative annual death rate was 0.23 deaths per subject per year , similar in the demented ( 0.23 ) and the nondemented ( 0.22 ) . Unadjusted survival by Kaplan-Meyer analysis was similar in the two groups , and correction for-age , gender , cognition , triceps skinfold thickness , and number of drugs in a Cox model did not alter the relationship . CONCLUSIONS Dementia developing in very old age is not necessarily associated with malnutrition and decreased life expectancy The impact of oral nutritional supplementation during an acute exacerbation of COPD on functional status was assessed through measuring change in lung function , strength testing , and general well-being .  Subjects hospitalized for an acute exacerbation of COPD ( n = 33 ) were r and omized to extra nutritional support or the regular hospital care . They consumed an additional 10 kcal/kg/d . Outcome measures were measured at 2 wk as change scores . Forced vital capacity ( % predicted ) improved in the treatment group as compared with the control group ( + 8.7 % versus -3.5 % , p = 0.015 ) , and change in FEV1 was in the same direction but not significantly different ( p = 0.099 ) . There were no changes in h and grip strength or respiratory muscle strength , but there was a trend towards more improvement in the general well-being score ( + 11.96 versus -10.25 , p = 0.066 ) . Almost all subjects were in negative nitrogen balance , indicating muscle wasting . The degree of muscle wasting was strongly correlated with the dose of corticosteroids ( r = 0.73 , p < 0.005 ) . In conclusion , it is difficult to prevent important muscle wasting in patients with COPD treated with corticosteroids , but some small gains were observed with increased dietary intake OBJECTIVES To determine why elderly nursing home patients receive liquid oral protein supplements , what nutritional assessment is utilized , and whether there is evidence of effectiveness . DESIGN Retrospective , case control study comparing patients over 65 years of age , at two nursing homes , who were served oral supplements ( OS ) at least twice daily ( n = 56 ) , with a r and om sample of non-supplemented , non-tube fed patients ( n = 53 ) . Comparisons included medical diagnoses , medications , morbidity and mortality , weight changes , laboratory test results , and functional and behavioral status . RESULTS Nursing home patients were begun on OS ( median time after admission = 2 months , range = 0 - 72 months ) primarily because of weight loss ( 71 % ) and poor appetite ( 16 % ) . Supplemented patients were below an age-adjusted body weight on admission , unlike controls , and continued to lose weight until OS were started . On OS , weight was slowly regained over 9 - 10 months in a majority of patients to approximate admission weight . Some patients on OS showed improvement in albumin , total lymphocyte count , cholesterol , or hemoglobin , but too few patients had sufficient lab tests to verify any consistent effect . Mortality was higher in OS patients ( 8 vs 2 , P = 0.057 ) , who were also somewhat older ( 87.9 vs 84.5 years ) , but there was no statistical difference in infection or hospitalization rate . MEASUREMENTS Nutritional assessment in these nursing homes consisted almost exclusively of ( 1 ) serial measurement of weight , ( 2 ) comparison of weight to ( a ) " ideal body weight " and ( b ) previous weight , and ( 3 ) a subjective evaluation of food consumption . No other anthropometric evaluations or laboratory tests were conducted for nutr 
    Output:
    