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: Sixteen patients with rheumatoid arthritis entered a trial to determine the clinical and biochemical effects of dietary supplementation with fractionated fish oil fatty acids . A r and omised , double blind , placebo controlled crossover design with 12 week treatment periods was used . Treatment with non-steroidal anti-inflammatory drugs and with disease modifying drugs was continued throughout the study . Placebo consisted of fractionated coconut oil . The following results favoured fish oil rather than placebo :  joint swelling index and duration of early morning stiffness . Other clinical indices improved but did not reach statistical significance . During fish oil supplementation relative amounts of eicosapentaenoic acid and docosahexaenoic acid in the plasma cholesterol ester and neutrophil membrane phospholipid fractions increased , mainly at the expense of the omega-6 fatty acids . The mean neutrophil leucotriene B4 production in vitro showed a reduction after 12 weeks of fish oil supplementation . Leucotriene B5 production , which could not be detected either in the control or in the placebo period , rose to substantial quantities during fish oil treatment . This study shows that dietary fish oil supplementation is effective in suppressing clinical symptoms of rheumatoid arthritis OBJECTIVES Dose-dependant gastrointestinal and cardiovascular side-effects limit the use of NSAIDs in the management of RA . The n-3 essential fatty acids ( EFAs ) have previously demonstrated some anti-inflammatory and NSAID-sparing properties . The objective of this study was to determine whether cod liver oil supplementation helps reduce daily NSAID requirement of patients with RA . METHODS Dual-centre , double-blind placebo-controlled r and omized study of 9 months ' duration . Ninety-seven patients with RA were r and omized to take either 10 g of cod liver oil containing 2.2 g of n-3 EFAs or air-filled identical placebo capsules . Documentation of NSAID daily requirement , clinical and laboratory parameters of RA disease activity and safety checks were done at 0 , 4 , 12 , 24 and 36 weeks . At 12 weeks , patients were instructed to gradually reduce , and if possible , stop their NSAID intake . Relative reduction of daily NSAID requirement by > 30 % after 9 months was the primary outcome measure . RESULTS Fifty-eight patients ( 60 % ) completed the study . Out of 49 patients 19 ( 39 % ) in the cod liver oil group and out of 48 patients 5 ( 10 % ) in the placebo group were able to reduce their daily NSAID requirement by > 30 % ( P = 0.002 , chi-squared test ) . No differences between the groups were observed in the clinical parameters of RA disease activity or in the side-effects observed . CONCLUSIONS This study suggests that cod liver oil supplements containing n-3 fatty acids can be used as NSAID-sparing agents in RA patients n-3 long-chain PUFA ( n-3 LC-PUFA ) may improve  cardiovascular and inflammatory diseases .  The effects of n-3 LC-PUFA-supplemented dairy products on inflammation and immunological parameters , biomarkers of oxidative stress , serum lipids , and on disease activity were determined in patients with rheumatoid arthritis ( RA ) . Forty-five subjects ( forty-three females and two males ) were r and omly divided into two groups in a double-blind , placebo-controlled cross-over study . Both groups received placebo or verum products consecutively for 3 months with a 2-month washout phase between the two periods . Blood sample s were taken at the beginning and at the end of each period . The dairy products generally improved serum lipids by increasing HDL and lowering lipoprotein a. The n-3 LC-PUFA supplements act to lower TAG . Additionally , a decreased lipopolysaccharide-stimulated cylo-oxygenase-2 expression was found in patients who had consumed the enriched dairy products . The majority of the CD analysed were not influenced , although n-3 LC-PUFA did suppress the immune response as lymphocytes and monocytes were found to be significantly decreased . The n-3 LC-PUFA did not increase the biomarkers of oxidative stress such as 8-iso-PGF(2alpha ) and 15-keto-dihydro PGF(2alpha ) , and DNA damage like 7,8-dihydro-8-oxo-2'-deoxyguanosine . The long-term consumption of dairy products ( 2 x 12 weeks ) diminished the excretion of hydroxypyridinium crosslinks , and favoured the diastolic blood pressure . The consumption of moderate doses of n-3 LC-PUFA in combination with dairy products did not improve the disease activity . However , there is evidence of cardioprotective effects . Furthermore , the long-term consumption of dairy products acts against the cartilage and bone destruction in RA In a controlled , double blind , clinical trial we tested the effect of dietary omega-3 fatty acid supplementation with and without naproxen and placebo , respectively , in 67 patients with active rheumatoid arthritis . The patients were r and omized into 3 groups that received the following treatment : Group 1 , corn oil ( " placebo omega-3 fatty acids " ) , 7 g/day for 16 weeks , and naproxen , 750 mg/day for 10 weeks followed by a stepwise reduction to 0 mg/day during the following 3 weeks ; Group 2 , omega-3 fatty acids , 3.8 g of eicosapentaenoic acid plus 2.0 g of docosahexaenoic acid , and naproxen , 750 mg/day for 16 weeks ; and Group 3 , omega-3 fatty acids as Group 2 and naproxen as Group 1 . At the end of the trial , patients in Group 2 had improved with respect to duration of morning stiffness and global assessment by physician and patient . In Groups 1 and 3 there was a significant deterioration for most of the variables measured . However , for duration of morning stiffness the deterioration was significantly less pronounced in Group 3 compared with Group 1 . These effects might be ascribed to the dietary omega-3 fatty acid supplementation Therapeutic effects of fish oil ( 10 g/day ) in rheumatoid arthritis were investigated in a r and omized , controlled , double-blind study . Forty-three patients completing the study were evaluated at 0 , 3 and 6 months . The nutrient intake in the fish oil group and in the control group was essentially similar . In the fish oil group , the percentage of n-3 fatty acids in serum phosphatidylcholine increased by 9.6 ( range 2.6 - 16.1 ) . Patients in the fish oil group reported a significantly decreased consumption of NSAID at 3 and 6 months , and the status of global arthritic activity improved at 3 months in physician 's assessment . Control patients reported an increased global arthritic activity at 6 months . No change was found in patient assessment of pain , duration of morning stiffness or functional capacity . Essentially no change occurred in biochemical markers of inflammation . We conclude that fish oil has small anti-inflammatory effects with at most a NSAID-saving potential . The value of prolonged supplementation remains to be evaluated OBJECTIVE This study evaluated whether supplementation with olive oil could improve clinical and laboratory parameters of disease activity in patients who had rheumatoid arthritis and were using fish oil supplements .  METHODS Forty-three patients ( 34 female , 9 male ; mean age = 49 + /- 19y ) were investigated in a parallel r and omized design . Patients were assigned to one of three groups . In addition to their usual medication , the first group ( G1 ) received placebo ( soy oil ) , the second group ( G2 ) received fish oil omega-3 fatty acids ( 3 g/d ) , and the third group ( G3 ) received fish oil omega-3 fatty acids ( 3 g/d ) and 9.6 mL of olive oil .  Disease activity was measured by clinical and laboratory indicators at the beginning of the study and after 12 and 24 wk . Patients ' satisfaction in activities of daily living was also measured . RESULTS There was a statistically significant improvement ( P < 0.05 ) in G2 and G3 in relation to G1 with respect to joint pain intensity , right and left h and grip strength after 12 and 24 wk , duration of morning stiffness , onset of fatigue , Ritchie 's articular index for pain joints after 24 wk , ability to bend down to pick up clothing from the floor , and getting in and out of a car after 24 wk . G3 , but not G2 , in relation to G1 showed additional improvements with respect to duration of morning stiffness after 12 wk , patient global assessment after 12 and 24 wk , ability to turn faucets on and off after 24 wk , and rheumatoid factor after 24 wk . In addition , G3 showed a significant improvement in patient global assessment in relation to G2 after 12 wk . CONCLUSIONS Ingestion of fish oil omega-3 fatty acids relieved several clinical parameters used in the present study . However , patients showed a more precocious and accentuated improvement when fish oil supplements were used in combination with olive oil OBJECTIVE To determine the efficacy of fish oil derived ( n-3 ) fatty acid supplementation ( 3 - 6 capsules/day ) in subjects with rheumatoid arthritis ( RA ) whose ( n-6 ) fatty acid intake in the background diet was < 10 g/day , compared to olive/corn oil capsule supplement over a 15 week period . METHODS A placebo controlled , double blind , r and omized 15 week study to determine the effect of supplementation on clinical variables in 50 subjects with RA whose background diet was naturally low in ( n-6 ) fatty acids .  Fish oil containing 60 % ( n-3 ) fatty acids was supplemented at a rate of 40 mg/kg body weight . RESULTS Analysis of 9 clinical variables indicated there was a significant difference ( p < 0.02 ) between control and treatment groups . Five subjects in the treatment group and 3 in the control group met the American College of Rheumatology 20 % improvement criteria . Dietary supplementation result ed in a significant increase in eicosapentaenoic acid in plasma and monocyte lipids in the supplemented group . CONCLUSION The findings suggest that fish oil supplementation that delivers ( n-3 ) fatty acids at a dose of 40 mg/kg body weight/day , with dietary ( n-6 ) fatty acid intake < 10 g/day in the background diet , results in substantial cellular incorporation of ( n-3 ) fatty acids and improvements in clinical status in patients with RA Maxepa contains eicosapentaenoic acid ( EPA ) ( 171 mg/capsule ) and docosahexaenoic acid ( DHA ) ( 114 mg/capsule ) . EPA acts as an alternative substrate to arachidonate , leading to the formation of the less proinflammatory prostagl and ins ( ' 3 ' series ) and leukotrienes ( ' 5 ' series ) . If Maxepa has anti-inflammatory properties it could be expected to reduce the requirement for NSAIDs in patients with RA . This has not been investigated nor has Maxepa therapy been studied over a full 1-yr period . Sixty-four patients with stable RA requiring NSAID therapy only were studied . Patients received either 10 Maxepa or air-filled placebo capsules per day for 12 months . All then received placebo capsules for a further 3 months . Patients were review ed at 3-monthly intervals .  NSAID  requirement at entry visit for each patient was assigned as 100 % . Patients were instructed to slowly reduce their NSAID dosage providing there was no worsening of their symptoms . Clinical and laboratory parameters of RA activity were also measured . There was a significant reduction in NSAID usage in patients on Maxepa when compared with placebo from month 3 [ mean ( 95 % C.I. for mean ) requirement--71.1 (55.9 - 86.2)% and 89.7 (73.7 - 105.7)% , respectively ] . This effect reached its maximum at month 12 [ 40.6 (24.5 - 56.6)% and 84.1 (62.7 - 105.5)% , respectively ] and persisted to month 15 [ 44.7 (27.6 - 61.8)% and 85.8 (60.5 - 111.1)% , respectively ] ( P < 0.001 , ANOVA ) . These patients were able to reduce their  NSAID requirement without experiencing any deterioration in the clinical and laboratory parameters of RA activity N-3 polyunsaturated fatty acids ( PUFA ) have anti-inflammatory effects and may be useful for the treatment of inflammatory diseases such as rheumatoid arthritis (RA).We examined the efficacy of eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) supplementation on RA on top of st and ard anti-inflammatory treatment . Patients with RA were r and omized into two groups in a double-blind , placebo-controlled , parallel- design multicenter study . One hundred nine patients received five capsules of either n-3 PUFA ( 2.090 g of EPA and 1.165 g of DHA ) or high-oleic-acid sunflower oil for 16 weeks . Eighty-one patients completed the study , and no adverse effects were reported . Dietary intake did not change significantly during the 
    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: Sixteen patients with rheumatoid arthritis entered a trial to determine the clinical and biochemical effects of dietary supplementation with fractionated fish oil fatty acids . A r and omised , double blind , placebo controlled crossover design with 12 week treatment periods was used . Treatment with non-steroidal anti-inflammatory drugs and with disease modifying drugs was continued throughout the study . Placebo consisted of fractionated coconut oil . The following results favoured fish oil rather than placebo :  joint swelling index and duration of early morning stiffness . Other clinical indices improved but did not reach statistical significance . During fish oil supplementation relative amounts of eicosapentaenoic acid and docosahexaenoic acid in the plasma cholesterol ester and neutrophil membrane phospholipid fractions increased , mainly at the expense of the omega-6 fatty acids . The mean neutrophil leucotriene B4 production in vitro showed a reduction after 12 weeks of fish oil supplementation . Leucotriene B5 production , which could not be detected either in the control or in the placebo period , rose to substantial quantities during fish oil treatment . This study shows that dietary fish oil supplementation is effective in suppressing clinical symptoms of rheumatoid arthritis OBJECTIVES Dose-dependant gastrointestinal and cardiovascular side-effects limit the use of NSAIDs in the management of RA . The n-3 essential fatty acids ( EFAs ) have previously demonstrated some anti-inflammatory and NSAID-sparing properties . The objective of this study was to determine whether cod liver oil supplementation helps reduce daily NSAID requirement of patients with RA . METHODS Dual-centre , double-blind placebo-controlled r and omized study of 9 months ' duration . Ninety-seven patients with RA were r and omized to take either 10 g of cod liver oil containing 2.2 g of n-3 EFAs or air-filled identical placebo capsules . Documentation of NSAID daily requirement , clinical and laboratory parameters of RA disease activity and safety checks were done at 0 , 4 , 12 , 24 and 36 weeks . At 12 weeks , patients were instructed to gradually reduce , and if possible , stop their NSAID intake . Relative reduction of daily NSAID requirement by > 30 % after 9 months was the primary outcome measure . RESULTS Fifty-eight patients ( 60 % ) completed the study . Out of 49 patients 19 ( 39 % ) in the cod liver oil group and out of 48 patients 5 ( 10 % ) in the placebo group were able to reduce their daily NSAID requirement by > 30 % ( P = 0.002 , chi-squared test ) . No differences between the groups were observed in the clinical parameters of RA disease activity or in the side-effects observed . CONCLUSIONS This study suggests that cod liver oil supplements containing n-3 fatty acids can be used as NSAID-sparing agents in RA patients n-3 long-chain PUFA ( n-3 LC-PUFA ) may improve  cardiovascular and inflammatory diseases .  The effects of n-3 LC-PUFA-supplemented dairy products on inflammation and immunological parameters , biomarkers of oxidative stress , serum lipids , and on disease activity were determined in patients with rheumatoid arthritis ( RA ) . Forty-five subjects ( forty-three females and two males ) were r and omly divided into two groups in a double-blind , placebo-controlled cross-over study . Both groups received placebo or verum products consecutively for 3 months with a 2-month washout phase between the two periods . Blood sample s were taken at the beginning and at the end of each period . The dairy products generally improved serum lipids by increasing HDL and lowering lipoprotein a. The n-3 LC-PUFA supplements act to lower TAG . Additionally , a decreased lipopolysaccharide-stimulated cylo-oxygenase-2 expression was found in patients who had consumed the enriched dairy products . The majority of the CD analysed were not influenced , although n-3 LC-PUFA did suppress the immune response as lymphocytes and monocytes were found to be significantly decreased . The n-3 LC-PUFA did not increase the biomarkers of oxidative stress such as 8-iso-PGF(2alpha ) and 15-keto-dihydro PGF(2alpha ) , and DNA damage like 7,8-dihydro-8-oxo-2'-deoxyguanosine . The long-term consumption of dairy products ( 2 x 12 weeks ) diminished the excretion of hydroxypyridinium crosslinks , and favoured the diastolic blood pressure . The consumption of moderate doses of n-3 LC-PUFA in combination with dairy products did not improve the disease activity . However , there is evidence of cardioprotective effects . Furthermore , the long-term consumption of dairy products acts against the cartilage and bone destruction in RA In a controlled , double blind , clinical trial we tested the effect of dietary omega-3 fatty acid supplementation with and without naproxen and placebo , respectively , in 67 patients with active rheumatoid arthritis . The patients were r and omized into 3 groups that received the following treatment : Group 1 , corn oil ( " placebo omega-3 fatty acids " ) , 7 g/day for 16 weeks , and naproxen , 750 mg/day for 10 weeks followed by a stepwise reduction to 0 mg/day during the following 3 weeks ; Group 2 , omega-3 fatty acids , 3.8 g of eicosapentaenoic acid plus 2.0 g of docosahexaenoic acid , and naproxen , 750 mg/day for 16 weeks ; and Group 3 , omega-3 fatty acids as Group 2 and naproxen as Group 1 . At the end of the trial , patients in Group 2 had improved with respect to duration of morning stiffness and global assessment by physician and patient . In Groups 1 and 3 there was a significant deterioration for most of the variables measured . However , for duration of morning stiffness the deterioration was significantly less pronounced in Group 3 compared with Group 1 . These effects might be ascribed to the dietary omega-3 fatty acid supplementation Therapeutic effects of fish oil ( 10 g/day ) in rheumatoid arthritis were investigated in a r and omized , controlled , double-blind study . Forty-three patients completing the study were evaluated at 0 , 3 and 6 months . The nutrient intake in the fish oil group and in the control group was essentially similar . In the fish oil group , the percentage of n-3 fatty acids in serum phosphatidylcholine increased by 9.6 ( range 2.6 - 16.1 ) . Patients in the fish oil group reported a significantly decreased consumption of NSAID at 3 and 6 months , and the status of global arthritic activity improved at 3 months in physician 's assessment . Control patients reported an increased global arthritic activity at 6 months . No change was found in patient assessment of pain , duration of morning stiffness or functional capacity . Essentially no change occurred in biochemical markers of inflammation . We conclude that fish oil has small anti-inflammatory effects with at most a NSAID-saving potential . The value of prolonged supplementation remains to be evaluated OBJECTIVE This study evaluated whether supplementation with olive oil could improve clinical and laboratory parameters of disease activity in patients who had rheumatoid arthritis and were using fish oil supplements .  METHODS Forty-three patients ( 34 female , 9 male ; mean age = 49 + /- 19y ) were investigated in a parallel r and omized design . Patients were assigned to one of three groups . In addition to their usual medication , the first group ( G1 ) received placebo ( soy oil ) , the second group ( G2 ) received fish oil omega-3 fatty acids ( 3 g/d ) , and the third group ( G3 ) received fish oil omega-3 fatty acids ( 3 g/d ) and 9.6 mL of olive oil .  Disease activity was measured by clinical and laboratory indicators at the beginning of the study and after 12 and 24 wk . Patients ' satisfaction in activities of daily living was also measured . RESULTS There was a statistically significant improvement ( P < 0.05 ) in G2 and G3 in relation to G1 with respect to joint pain intensity , right and left h and grip strength after 12 and 24 wk , duration of morning stiffness , onset of fatigue , Ritchie 's articular index for pain joints after 24 wk , ability to bend down to pick up clothing from the floor , and getting in and out of a car after 24 wk . G3 , but not G2 , in relation to G1 showed additional improvements with respect to duration of morning stiffness after 12 wk , patient global assessment after 12 and 24 wk , ability to turn faucets on and off after 24 wk , and rheumatoid factor after 24 wk . In addition , G3 showed a significant improvement in patient global assessment in relation to G2 after 12 wk . CONCLUSIONS Ingestion of fish oil omega-3 fatty acids relieved several clinical parameters used in the present study . However , patients showed a more precocious and accentuated improvement when fish oil supplements were used in combination with olive oil OBJECTIVE To determine the efficacy of fish oil derived ( n-3 ) fatty acid supplementation ( 3 - 6 capsules/day ) in subjects with rheumatoid arthritis ( RA ) whose ( n-6 ) fatty acid intake in the background diet was < 10 g/day , compared to olive/corn oil capsule supplement over a 15 week period . METHODS A placebo controlled , double blind , r and omized 15 week study to determine the effect of supplementation on clinical variables in 50 subjects with RA whose background diet was naturally low in ( n-6 ) fatty acids .  Fish oil containing 60 % ( n-3 ) fatty acids was supplemented at a rate of 40 mg/kg body weight . RESULTS Analysis of 9 clinical variables indicated there was a significant difference ( p < 0.02 ) between control and treatment groups . Five subjects in the treatment group and 3 in the control group met the American College of Rheumatology 20 % improvement criteria . Dietary supplementation result ed in a significant increase in eicosapentaenoic acid in plasma and monocyte lipids in the supplemented group . CONCLUSION The findings suggest that fish oil supplementation that delivers ( n-3 ) fatty acids at a dose of 40 mg/kg body weight/day , with dietary ( n-6 ) fatty acid intake < 10 g/day in the background diet , results in substantial cellular incorporation of ( n-3 ) fatty acids and improvements in clinical status in patients with RA Maxepa contains eicosapentaenoic acid ( EPA ) ( 171 mg/capsule ) and docosahexaenoic acid ( DHA ) ( 114 mg/capsule ) . EPA acts as an alternative substrate to arachidonate , leading to the formation of the less proinflammatory prostagl and ins ( ' 3 ' series ) and leukotrienes ( ' 5 ' series ) . If Maxepa has anti-inflammatory properties it could be expected to reduce the requirement for NSAIDs in patients with RA . This has not been investigated nor has Maxepa therapy been studied over a full 1-yr period . Sixty-four patients with stable RA requiring NSAID therapy only were studied . Patients received either 10 Maxepa or air-filled placebo capsules per day for 12 months . All then received placebo capsules for a further 3 months . Patients were review ed at 3-monthly intervals .  NSAID  requirement at entry visit for each patient was assigned as 100 % . Patients were instructed to slowly reduce their NSAID dosage providing there was no worsening of their symptoms . Clinical and laboratory parameters of RA activity were also measured . There was a significant reduction in NSAID usage in patients on Maxepa when compared with placebo from month 3 [ mean ( 95 % C.I. for mean ) requirement--71.1 (55.9 - 86.2)% and 89.7 (73.7 - 105.7)% , respectively ] . This effect reached its maximum at month 12 [ 40.6 (24.5 - 56.6)% and 84.1 (62.7 - 105.5)% , respectively ] and persisted to month 15 [ 44.7 (27.6 - 61.8)% and 85.8 (60.5 - 111.1)% , respectively ] ( P < 0.001 , ANOVA ) . These patients were able to reduce their  NSAID requirement without experiencing any deterioration in the clinical and laboratory parameters of RA activity N-3 polyunsaturated fatty acids ( PUFA ) have anti-inflammatory effects and may be useful for the treatment of inflammatory diseases such as rheumatoid arthritis (RA).We examined the efficacy of eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) supplementation on RA on top of st and ard anti-inflammatory treatment . Patients with RA were r and omized into two groups in a double-blind , placebo-controlled , parallel- design multicenter study . One hundred nine patients received five capsules of either n-3 PUFA ( 2.090 g of EPA and 1.165 g of DHA ) or high-oleic-acid sunflower oil for 16 weeks . Eighty-one patients completed the study , and no adverse effects were reported . Dietary intake did not change significantly during the 
    Output:
    