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 BACKGROUND & AIMS Nutrients putatively implicated in pressure ulcer healing were evaluated in a clinical setting . METHODS Sixteen in patients with a stage 2 , 3 or 4 pressure ulcer r and omised to receive daily a  st and ard hospital diet ; a st and ard diet plus two high-protein/energy supplements ; or a st and ard diet plus two high-protein/energy supplements containing additional arginine ( 9 g ) , vitamin C ( 500 mg ) and zinc ( 30 mg ) . Nutritional status measurements ( dietary , anthropometric and biochemical ) and pressure ulcer size and severity ( by PUSH tool ; Pressure Ulcer Scale for Healing ; 0=completely healed , 17=greatest severity ) were measured weekly for 3 weeks . RESULTS Patients ' age and BMI ranges were 37 - 92 years and 16.4 - 28.1 k g/m2 ) respectively . Baseline PUSH scores were similar between groups ( 8.7+/-0.5 ) . Only patients receiving additional arginine , vitamin C and zinc demonstrated a clinical ly significant improvement in pressure ulcer healing ( 9.4+/-1.2 vs. 2.6+/-0.6 ; baseline and week 3 , respectively ; P<0.01 ) . All patient groups presented with low serum albumin and zinc and elevated C-reactive protein . There were no significant changes in biochemical markers , oral dietary intake or weight in any group . CONCLUSIONS In this small set of patients , supplementary arginine , vitamin C and zinc significantly improved the rate of pressure ulcer healing . The results need to be confirmed in a larger study 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 This study examined the effect of energy density , independent of fat content and palatability , on food and energy intakes . With use of a within-subjects design , normal-weight women ( n = 18 ) were provided with meals for 2 d during each of three test sessions . During lunch , dinner , and an evening snack , subjects were given free access to a main entree varying in energy density ( low , medium , or high ) . The manipulated main entrees were similar in palatability to their counterparts across conditions . Low-energy compulsory ( consumption required ) side dishes accompanied each meal . Subjects also consumed a st and ard , compulsory breakfast . Results showed that subjects consumed a similar amount of food ( by weight ) across the three conditions of energy density . Thus , significantly more energy was consumed in the condition of high energy density ( 7532 + /- 363 kJ , or 1800 + /- 86 kcal ) than in the medium- ( 6356 + /- 281 kJ , or 1519 + /- 67 kcal ) and low- ( 5756 + /- 178 kJ , or 1376 + /- 43 kcal ) energy-density conditions ( P < 0.0001 ) . There were no differences in hunger or fullness before meals , after meals , or over the 2 d across conditions . The results from this study indicate that energy density affects energy intake independent of macronutrient content or palatability , suggesting that the overconsumption of high-fat foods may be due to their high energy density rather than to their fat content This study tested the hypothesis that the amount ( weight or volume ) of food consumed affects the satiating potency of a food , independent of its energy content . Normal-weight young men ( n = 20 ) were tested in a within-subjects design . Subjects were served a milk-based drink or no drink ( control ) , followed 30 min later by a self-selected lunch and > 4 h later by a self-selected dinner . Milk drinks were equal in energy content ( 2088 kJ , or 499 kcal ) and had similar proportions of fat ( 30.3 % ) , carbohydrate ( 54.7 % ) , and protein ( 15 % ) across three volumes : 300 , 450 , and 600 mL. Ratings of palatability , sensory properties , and energy content of the drinks and of hunger completed before consumption of the preloads were not significantly different among conditions . The results showed that preload volume affected energy intake at lunch ( P < or = 0.009 ) such that energy intake was less after the 600-mL preload than after the 300-mL preload . This effect was still present when energy intake at dinner was included ( P < or = 0.022 ) . At lunch , including energy from the preload , subjects overate relative to the control condition ( 4323 + /- 322 kJ ) after the 300- ( 5263 + /- 321 kJ ) and 450-mL ( 5011 + /- 300 kJ ) preloads but not after the 600-mL ( 4703 + /- 353 kJ ) preload . Thus , the best adjustment for the energy in the preloads was with the largest , least energy-dense drink . Consistent with the effects on intake , the volume of the drinks affected ratings of hunger and fullness . These results indicate that the volume consumed is an important determinant of satiety after milk drinks under these conditions BACKGROUND Studies have shown that energy intake increases when both the fat content and energy density of the entire diet increases . When the fat content and energy density vary independently of one another , however , energy density , but not fat content , influences intake . OBJECTIVE The present study examined whether energy intake in lean and obese women is affected when either the energy density or the fat content of a portion of the diet is manipulated and palatability is held constant . DESIGN In a within-subjects design , 17 lean and 17 obese women consumed meals in the laboratory for four , 4-d test periods . In 3 of these test periods the energy density ( 4.4 and 6.7 kJ/g ) or the fat content ( 16 % and 36 % of energy ) of compulsory entrees representing 50 % of each subject 's usual energy intake was manipulated . Additional self-selected foods were consumed ad libitum at meals and as snacks . RESULTS There were no systematic differences in palatability of the manipulated foods across conditions . Obese and lean participants responded similarly to the dietary manipulations . Intake of self-selected foods at meals was reduced significantly by 16 % for both lean and obese subjects in the low- compared with the high-energy-density condition . The fat content of the compulsory foods had no significant effect on energy intake . Ratings of hunger did not differ between diets . CONCLUSION These results indicate that when a portion of the diet was manipulated , the energy density , but not the fat content , of the foods affected total energy intake at meals in both lean and obese women 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 nutritional supplement group ( n = 19 ) had a significantly greater increase in body weight ( 2.57 + /- 1.78 compared with 0.84 + /- 0.89 kg , P = 0.001 ) , total lean mass ( 1.17 + /- 0.93 compared with 0.04 + /- 1.26 kg , P = 0.006 ) , and grip strength ( 2.79 + /- 3.11 compared with -0.65 + /- 4.48 kg , P = 0.016 ) than did the control subjects ( n = 17 ) at week 6 . During subsequent follow-up , the increase in body weight remained greater in the nutritional supplement group , but this increase was due mainly to a greater gain in fat mass in the nutritional supplement group than in the control group . CONCLUSIONS Early intervention to increase nutritional intake increases lean mass and physical function . This adjunct to tuberculosis therapy could confer socioeconomic and survival benefits that deserve investigation in large-scale trials . Nutritional intervention after the initial phase of treatment could be less beneficial because it mainly increases fat 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 Fighting against inactivity and inadequate nutritional intake are of utmost importance in the elderly . To our knowledge , the few studies which have been performed were conducted for only a short period and the results do not permit formal conclusions to be drawn . We therefore tried to fill this gap in our knowledge by determining whether an intervention combining an acceptable progressive exercise programme and nutritional supplements would be feasible for a long-term period in the very frail elderly , and would bring about concomitant benefits in body composition and muscle power . Accordingly , this exercise and nutritional combination was assessed in the frail elderly in a 9-month r and omised trial with a factorial design . Fifty-seven elderly volunteers over 72 years , from sixteen retirement homes in Lyon , France participated in the study .  Dietary supplements were compared with placebo , and physical exercise was compared with memory training . Main outcome measures were fat-free mass ( FFM ) and muscle power . FFM was determined by labelled water , and muscle power was measured by a leg-extensor machine . At 9 months , the compliance was 63 % for exercise sessions , and 54 % for nutritional supplements . In patients with di 
    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 BACKGROUND & AIMS Nutrients putatively implicated in pressure ulcer healing were evaluated in a clinical setting . METHODS Sixteen in patients with a stage 2 , 3 or 4 pressure ulcer r and omised to receive daily a  st and ard hospital diet ; a st and ard diet plus two high-protein/energy supplements ; or a st and ard diet plus two high-protein/energy supplements containing additional arginine ( 9 g ) , vitamin C ( 500 mg ) and zinc ( 30 mg ) . Nutritional status measurements ( dietary , anthropometric and biochemical ) and pressure ulcer size and severity ( by PUSH tool ; Pressure Ulcer Scale for Healing ; 0=completely healed , 17=greatest severity ) were measured weekly for 3 weeks . RESULTS Patients ' age and BMI ranges were 37 - 92 years and 16.4 - 28.1 k g/m2 ) respectively . Baseline PUSH scores were similar between groups ( 8.7+/-0.5 ) . Only patients receiving additional arginine , vitamin C and zinc demonstrated a clinical ly significant improvement in pressure ulcer healing ( 9.4+/-1.2 vs. 2.6+/-0.6 ; baseline and week 3 , respectively ; P<0.01 ) . All patient groups presented with low serum albumin and zinc and elevated C-reactive protein . There were no significant changes in biochemical markers , oral dietary intake or weight in any group . CONCLUSIONS In this small set of patients , supplementary arginine , vitamin C and zinc significantly improved the rate of pressure ulcer healing . The results need to be confirmed in a larger study 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 This study examined the effect of energy density , independent of fat content and palatability , on food and energy intakes . With use of a within-subjects design , normal-weight women ( n = 18 ) were provided with meals for 2 d during each of three test sessions . During lunch , dinner , and an evening snack , subjects were given free access to a main entree varying in energy density ( low , medium , or high ) . The manipulated main entrees were similar in palatability to their counterparts across conditions . Low-energy compulsory ( consumption required ) side dishes accompanied each meal . Subjects also consumed a st and ard , compulsory breakfast . Results showed that subjects consumed a similar amount of food ( by weight ) across the three conditions of energy density . Thus , significantly more energy was consumed in the condition of high energy density ( 7532 + /- 363 kJ , or 1800 + /- 86 kcal ) than in the medium- ( 6356 + /- 281 kJ , or 1519 + /- 67 kcal ) and low- ( 5756 + /- 178 kJ , or 1376 + /- 43 kcal ) energy-density conditions ( P < 0.0001 ) . There were no differences in hunger or fullness before meals , after meals , or over the 2 d across conditions . The results from this study indicate that energy density affects energy intake independent of macronutrient content or palatability , suggesting that the overconsumption of high-fat foods may be due to their high energy density rather than to their fat content This study tested the hypothesis that the amount ( weight or volume ) of food consumed affects the satiating potency of a food , independent of its energy content . Normal-weight young men ( n = 20 ) were tested in a within-subjects design . Subjects were served a milk-based drink or no drink ( control ) , followed 30 min later by a self-selected lunch and > 4 h later by a self-selected dinner . Milk drinks were equal in energy content ( 2088 kJ , or 499 kcal ) and had similar proportions of fat ( 30.3 % ) , carbohydrate ( 54.7 % ) , and protein ( 15 % ) across three volumes : 300 , 450 , and 600 mL. Ratings of palatability , sensory properties , and energy content of the drinks and of hunger completed before consumption of the preloads were not significantly different among conditions . The results showed that preload volume affected energy intake at lunch ( P < or = 0.009 ) such that energy intake was less after the 600-mL preload than after the 300-mL preload . This effect was still present when energy intake at dinner was included ( P < or = 0.022 ) . At lunch , including energy from the preload , subjects overate relative to the control condition ( 4323 + /- 322 kJ ) after the 300- ( 5263 + /- 321 kJ ) and 450-mL ( 5011 + /- 300 kJ ) preloads but not after the 600-mL ( 4703 + /- 353 kJ ) preload . Thus , the best adjustment for the energy in the preloads was with the largest , least energy-dense drink . Consistent with the effects on intake , the volume of the drinks affected ratings of hunger and fullness . These results indicate that the volume consumed is an important determinant of satiety after milk drinks under these conditions BACKGROUND Studies have shown that energy intake increases when both the fat content and energy density of the entire diet increases . When the fat content and energy density vary independently of one another , however , energy density , but not fat content , influences intake . OBJECTIVE The present study examined whether energy intake in lean and obese women is affected when either the energy density or the fat content of a portion of the diet is manipulated and palatability is held constant . DESIGN In a within-subjects design , 17 lean and 17 obese women consumed meals in the laboratory for four , 4-d test periods . In 3 of these test periods the energy density ( 4.4 and 6.7 kJ/g ) or the fat content ( 16 % and 36 % of energy ) of compulsory entrees representing 50 % of each subject 's usual energy intake was manipulated . Additional self-selected foods were consumed ad libitum at meals and as snacks . RESULTS There were no systematic differences in palatability of the manipulated foods across conditions . Obese and lean participants responded similarly to the dietary manipulations . Intake of self-selected foods at meals was reduced significantly by 16 % for both lean and obese subjects in the low- compared with the high-energy-density condition . The fat content of the compulsory foods had no significant effect on energy intake . Ratings of hunger did not differ between diets . CONCLUSION These results indicate that when a portion of the diet was manipulated , the energy density , but not the fat content , of the foods affected total energy intake at meals in both lean and obese women 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 nutritional supplement group ( n = 19 ) had a significantly greater increase in body weight ( 2.57 + /- 1.78 compared with 0.84 + /- 0.89 kg , P = 0.001 ) , total lean mass ( 1.17 + /- 0.93 compared with 0.04 + /- 1.26 kg , P = 0.006 ) , and grip strength ( 2.79 + /- 3.11 compared with -0.65 + /- 4.48 kg , P = 0.016 ) than did the control subjects ( n = 17 ) at week 6 . During subsequent follow-up , the increase in body weight remained greater in the nutritional supplement group , but this increase was due mainly to a greater gain in fat mass in the nutritional supplement group than in the control group . CONCLUSIONS Early intervention to increase nutritional intake increases lean mass and physical function . This adjunct to tuberculosis therapy could confer socioeconomic and survival benefits that deserve investigation in large-scale trials . Nutritional intervention after the initial phase of treatment could be less beneficial because it mainly increases fat 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 Fighting against inactivity and inadequate nutritional intake are of utmost importance in the elderly . To our knowledge , the few studies which have been performed were conducted for only a short period and the results do not permit formal conclusions to be drawn . We therefore tried to fill this gap in our knowledge by determining whether an intervention combining an acceptable progressive exercise programme and nutritional supplements would be feasible for a long-term period in the very frail elderly , and would bring about concomitant benefits in body composition and muscle power . Accordingly , this exercise and nutritional combination was assessed in the frail elderly in a 9-month r and omised trial with a factorial design . Fifty-seven elderly volunteers over 72 years , from sixteen retirement homes in Lyon , France participated in the study .  Dietary supplements were compared with placebo , and physical exercise was compared with memory training . Main outcome measures were fat-free mass ( FFM ) and muscle power . FFM was determined by labelled water , and muscle power was measured by a leg-extensor machine . At 9 months , the compliance was 63 % for exercise sessions , and 54 % for nutritional supplements . In patients with di 
    Output:
    