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: The effects of consumption of a soup preload with added maltodextrin , relative to a no-maltodextrin control soup matched for sensory properties , on intake and the pattern of changes in rated hunger and fullness during lunch were investigated in 24 male volunteers .  Preloads were consumed 30 min before lunch and condition-order counterbalanced . Intake at lunch was reduced significantly by 77 g ( 407 kJ ) after the maltodextrin preload , and this reduced intake was associated with a significant reduction in eating rate but not meal duration . Hunger ratings were significantly lower , and fullness ratings significantly higher , at the start of lunch after the maltodextrin compared with control preload . However , the pattern of changes in subjective appetite once eating had started ( assessed by analyzing best-fit quadratic functions between rated appetite and actual intake ) did not differ between preloads . Neither the rated pleasantness of the lunch food at the start of the test meal nor the pattern of change in pleasantness across the meal differed between preloads . These results imply that the effect of maltodextrin preloads on appetite is to reduce the general desire to eat , and possible mechanisms for this effect are discussed A decline in dietary intake due to inactivity and , consequently , development of a suboptimal nutritional status is a major problem in frail elderly people . However , benefits of micronutrient supplementation , all-round physical exercise or a combination of both on functional biochemical and hematologic indicators of nutritional and health status in frail elderly subjects have not been tested thoroughly . A 17-wk r and omized controlled trial was performed in 145 free-living frail elderly people ( 43 men , 102 women , mean age , 78 + /- 5.7 y ) . Based on a 2 x 2 factorial design , subjects were assigned to one of the following : 1 ) nutrient-dense foods , 2 ) exercise , 3 ) both ( 1 ) and ( 2 ) or 4 ) a control group . Foods were enriched with micronutrients , frequently characterized as deficient [ 25 - 100 % of the recommended daily allowance ( RDA ) ] in elderly people . Exercises focused on skill training , including strength , endurance , coordination and flexibility . Dietary intake , blood vitamin levels and nutritional and health indicators , including (pre)albumin , ferritin , transferrin , C-reactive protein , hemoglobin and lymphocytes were measured . At baseline , 28 % of the total population had an energy intake below 6.3 MJ , up to a maximum of 93 % having vitamin intakes below two thirds of the Dutch RDA . Individual deficiencies in blood at baseline ranged from 3 % for erythrocyte glutathione reductase-alpha to 39 % for 25-hydroxy vitamin D and 42 % for vitamin B-12 . These were corrected after 17 wk in the two groups receiving the nutrient-dense foods , whereas no significant changes were observed in the control or exercise group . Biochemical and hematologic indicators at baseline were within the reference ranges ( mean albumin , 46 g/L ; prealbumin , 0.25 g/L ; hemoglobin , 8.6 mmol/L ) and were not affected by any of the interventions . The long-term protective effects of nutrient supplementation and exercise , by maintaining optimal nutrient levels and thereby reducing the initial chance of developing critical biochemical values , require further investigation . Other indicative functional variables for suboptimal nutritional status , in addition to those currently selected , should also be explored Objectives To evaluate the change in eating habits occurring in community- dwelling and institutionalized elderly subjects with senile anorexia . Design Cross- sectional , observational . Setting Community , nursing homes and rehabilitation or acute care facilities in four Italian regions . Participants A r and om sample of 526 subjects , aged 65 years and older ( 217 free living individuals , 213 residents in nursing homes , and 93 patients in rehabilitation and acute wards ) . Measurements All subjects underwent a  multidimensional geriatric evaluation of : nutritional status , anthropometric parameters , health and cognitive status , depression , taste , chewing and swallowing function , and some hormones related to appetite . Diet variety  was assessed , considering the frequency of consumption of different food groups ( milk and dairy products ; meat , fish , and eggs ; cereals and derivatives ; fruit and vegetables ) . Results In anorexic elderly subjects the global food intake was reduced , and the eating pattern was characterized by the reduced consumption of certain food groups ( “ meat , eggs and fish ” and “ fruit and vegetables ” ) whereas the frequency of consumption of milk and cereals remained almost unchanged . Nutritional parameters were significantly better in normal eating subjects and correlated with diet variety . Conclusion Because of the high prevalence of senile anorexia in the geriatric population and its impact on the nutritional status , further research should be prompted to establish an intervention . protocol allowing the early diagnosis of anorexia of aging , aim ed at identifying its causes and at optimizing treatment of anorexic patients BACKGROUND & AIMS This study assessed the efficacy of supplemented essential amino acids on depressive symptoms , nutrition , muscle function , daily physical activity , and health-related quality of life ( HRQoL ) of institutionalized elderly patients . METHODS Forty-one patients ( 58.5 % women ; mean age 79.8 yrs ) with sequelae of coronary artery disease ( 73 % ) , femoral fracture ( 34 % ) , were r and omly assigned to receive oral essential amino acids 4 gr 2 times a day for 8 weeks or isocaloric placebo . Before r and omization and 8 weeks after the protocol started , the following variables were measured : depressive symptoms ( Geriatric Depression Scale , GDS ) , nutritional panel ( Mini Nutritional Assessment , MNA ; serum albumin and prealbumin levels ) , muscle strength ( H and Grip , HG ) , Activity Daily Life ( ADL ) , Quality of Life ( SF-36 , HRQoL ) and amino acid profile . RESULTS Compared with the placebo group , EAA patients improved nutrition ( MNA score 22.6 ± 1.5 post vs 21.8 ± 1.6 pre ; p < 0 . 04 , albumin g/dl 4.04 ± 0.35 post vs 3.88 ± 0.3 pre ; p < 0.01 ) , GDS(score 10.3 ± 1.75 post vs 13.85 ± 3.37 pre ; p < 0.001 ) , HG ( Kg 19.75 ± 1.7 post vs 18.68 ± 1.36 pre ; p = 0.001 ) , ADL ( p < 0.04 ) and both physical and mental components of SF-36 ( p < 0.002 ) . CONCLUSIONS Oral supplementation with essential amino acids improved several determinants of quality of life in institutionalized elderly patients , including depressive symptoms , nutrition , muscle function and daily life activity Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES To provide preliminary evidence on the effectiveness and optimal dosage of megestrol acetate for older persons with impaired appetite after hospitalization . DESIGN R and omized clinical trial . SETTING Acute care hospital . PARTICIPANTS Forty-seven older persons ( mean age 83 ) who were recently discharged from an acute care hospital and had fair or poor appetite . INTERVENTION Participants were r and omized to placebo or megestrol acetate suspension 200 mg , 400 mg , or 800 mg daily for 9 weeks . MEASUREMENTS Appetite , health-related quality of life , and adverse effects were measured at baseline and 20 , 42 , and 63 days . Serum nutritional markers were measured at baseline and 20 and 63 days . RESULTS During the course of the study , there were no significant differences between treatment groups on any of the appetite questions , although participants in the 400-mg and 800-mg groups demonstrated significant improvement from baseline on some questions . At 20 days , prealbumin increased in a dose-response relationship across the four groups ( by 0.4 , 5.1 , 7.5 , and 9.0 mg/dL , respectively ) . Participants in the 400-mg and 800-mg groups demonstrated greater improvement in prealbumin levels at 20 days than those receiving placebo ( P=.009 and P=.004 , respectively ) and those in the 400-mg group also demonstrated improvement at 63 days ( P=.02 ) . At 20 days , no participant taking placebo had a morning serum cortisol level less than 8 ng/mL ( the lower limit of normal ) . In contrast , 33 % , 70 % , and 78 % of those taking 200 mg , 400 mg and 800 mg , respectively , had values below this level ; by 63 days , these percentages were 11 % , 30 % , 56 % , and 37 % , respectively . No patient reported clinical symptoms of adrenal insufficiency . Diarrhea developed in three subjects , and thromboembolism occurred in two receiving active treatment . CONCLUSION Megestrol acetate at doses of 400 mg and 800 mg increases prealbumin in recently hospitalized older persons . Cortisol suppression is common at higher doses and may be persistent . In this small study , the drug did not confer benefit on other nutritional or clinical outcomes Objectives : We studied the nutritional status and the effects of nutritional intervention on body weight , cognition and activities of daily life (ADL)-function in demented individuals . Design : Controlled non-r and omised study . Setting : Group-living for demented elderly ( GLD ) , ie community assisted housing . Subjects and interventions : Twenty-two residents living in one of two units ( GLD-I ) , received oral liquid supplements ( 1720 kJ/410 kcal/day ) and the personnel of the GLD-I were given nutritional education .  Fourteen residents in the other unit ( GLD-C ) served as controls . After 6 months 21 ( 83 ( 4 ) y , 81 % women ) and 12 ( 85 ( 4 ) y , 100 % women ) of the participants , respectively , were re-examined according to body mass index ( BMI , kg/m2 ) , cognitive function ( Mini Mental State Examination ( MMSE , 0–30 p ) and Clinical Dementia Rating Scale ( CDR ) and the Katz ' ADL index . Results : Body mass index ( BMI ) ≤20 was found in 19 % of the participants and 44 % had BMI ≤23 . BMI correlated with MMSE ( r=0.43 , P<0.01 ) . The weight of the residents in the intervention group increased by 3.4 ( 3 ) kg ( P=0.001 ) at follow-up , whereas the weight remained unchanged in the control group . The cognitive function was low at the start in both groups , ie MMSE∼9 and no apparent positive effect of the nutritional intervention was seen . In addition , the ADL functions appeared to deteriorate in both groups . Conclusions : Being underweight was common among demented elderly in group-living and was related to low cognitive capacity . Five months of oral supplementation , along with education of personnel , was followed by a weight gain . In this study the nutritional treatment did not affect the rate of decline in cognitive function or Katz ' ADL index . Sponsorship : Supported by grants from the Swedish National Board of Health and Social Welfare . Semper Foods AB provided the liquid supplements OBJECTIVE to prevent the occurrence of weight loss during hospitalisation and following discharge by daily oral supplementation . DESIGN in a prospect i ve , r and omised , controlled study of 80 patients aged 75 or more , and at risk of undernutrition based on their initial Mini Nutritional Assessment score , patients were r and omised into a control group or one receiving oral supplementation . The intervention was a prescription of 200 ml sweet or salty sip feed twice daily ( 500 kcal , 21 g protein per day ) throughout hospitalisation and convalescence . Nutritional status was assessed at baseline and after 2 months using Mini Nutritional Assessment and body weight record . RESULTS compliance with oral supplementation was good and daily extra energy intake was 407+/-184 kcal . On day 60 , significant weight loss from upon admission was observed in the control group ( -1.23+/-2.5 kg ; P=0.01 ) , but not in the supplemented group ( 0.28+/-3.8 kg ; NS ) . At the end of the study , Mini Nutritional Assessment scores were higher in the supplemented group than in the control group ( 23.5+/-3.9 versus 20.8+/-3.6 ; P<0.01 ) . CONCLUSION use of daily oral supplementation during and after hospitalisation maintains body weight and increases Mini Nutritional Assessment score in patients at risk of undernutrition BACKGROUND AND OBJECTIVE To evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults>70 years with protein-energy malnutrition . The innovation of 
    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: The effects of consumption of a soup preload with added maltodextrin , relative to a no-maltodextrin control soup matched for sensory properties , on intake and the pattern of changes in rated hunger and fullness during lunch were investigated in 24 male volunteers .  Preloads were consumed 30 min before lunch and condition-order counterbalanced . Intake at lunch was reduced significantly by 77 g ( 407 kJ ) after the maltodextrin preload , and this reduced intake was associated with a significant reduction in eating rate but not meal duration . Hunger ratings were significantly lower , and fullness ratings significantly higher , at the start of lunch after the maltodextrin compared with control preload . However , the pattern of changes in subjective appetite once eating had started ( assessed by analyzing best-fit quadratic functions between rated appetite and actual intake ) did not differ between preloads . Neither the rated pleasantness of the lunch food at the start of the test meal nor the pattern of change in pleasantness across the meal differed between preloads . These results imply that the effect of maltodextrin preloads on appetite is to reduce the general desire to eat , and possible mechanisms for this effect are discussed A decline in dietary intake due to inactivity and , consequently , development of a suboptimal nutritional status is a major problem in frail elderly people . However , benefits of micronutrient supplementation , all-round physical exercise or a combination of both on functional biochemical and hematologic indicators of nutritional and health status in frail elderly subjects have not been tested thoroughly . A 17-wk r and omized controlled trial was performed in 145 free-living frail elderly people ( 43 men , 102 women , mean age , 78 + /- 5.7 y ) . Based on a 2 x 2 factorial design , subjects were assigned to one of the following : 1 ) nutrient-dense foods , 2 ) exercise , 3 ) both ( 1 ) and ( 2 ) or 4 ) a control group . Foods were enriched with micronutrients , frequently characterized as deficient [ 25 - 100 % of the recommended daily allowance ( RDA ) ] in elderly people . Exercises focused on skill training , including strength , endurance , coordination and flexibility . Dietary intake , blood vitamin levels and nutritional and health indicators , including (pre)albumin , ferritin , transferrin , C-reactive protein , hemoglobin and lymphocytes were measured . At baseline , 28 % of the total population had an energy intake below 6.3 MJ , up to a maximum of 93 % having vitamin intakes below two thirds of the Dutch RDA . Individual deficiencies in blood at baseline ranged from 3 % for erythrocyte glutathione reductase-alpha to 39 % for 25-hydroxy vitamin D and 42 % for vitamin B-12 . These were corrected after 17 wk in the two groups receiving the nutrient-dense foods , whereas no significant changes were observed in the control or exercise group . Biochemical and hematologic indicators at baseline were within the reference ranges ( mean albumin , 46 g/L ; prealbumin , 0.25 g/L ; hemoglobin , 8.6 mmol/L ) and were not affected by any of the interventions . The long-term protective effects of nutrient supplementation and exercise , by maintaining optimal nutrient levels and thereby reducing the initial chance of developing critical biochemical values , require further investigation . Other indicative functional variables for suboptimal nutritional status , in addition to those currently selected , should also be explored Objectives To evaluate the change in eating habits occurring in community- dwelling and institutionalized elderly subjects with senile anorexia . Design Cross- sectional , observational . Setting Community , nursing homes and rehabilitation or acute care facilities in four Italian regions . Participants A r and om sample of 526 subjects , aged 65 years and older ( 217 free living individuals , 213 residents in nursing homes , and 93 patients in rehabilitation and acute wards ) . Measurements All subjects underwent a  multidimensional geriatric evaluation of : nutritional status , anthropometric parameters , health and cognitive status , depression , taste , chewing and swallowing function , and some hormones related to appetite . Diet variety  was assessed , considering the frequency of consumption of different food groups ( milk and dairy products ; meat , fish , and eggs ; cereals and derivatives ; fruit and vegetables ) . Results In anorexic elderly subjects the global food intake was reduced , and the eating pattern was characterized by the reduced consumption of certain food groups ( “ meat , eggs and fish ” and “ fruit and vegetables ” ) whereas the frequency of consumption of milk and cereals remained almost unchanged . Nutritional parameters were significantly better in normal eating subjects and correlated with diet variety . Conclusion Because of the high prevalence of senile anorexia in the geriatric population and its impact on the nutritional status , further research should be prompted to establish an intervention . protocol allowing the early diagnosis of anorexia of aging , aim ed at identifying its causes and at optimizing treatment of anorexic patients BACKGROUND & AIMS This study assessed the efficacy of supplemented essential amino acids on depressive symptoms , nutrition , muscle function , daily physical activity , and health-related quality of life ( HRQoL ) of institutionalized elderly patients . METHODS Forty-one patients ( 58.5 % women ; mean age 79.8 yrs ) with sequelae of coronary artery disease ( 73 % ) , femoral fracture ( 34 % ) , were r and omly assigned to receive oral essential amino acids 4 gr 2 times a day for 8 weeks or isocaloric placebo . Before r and omization and 8 weeks after the protocol started , the following variables were measured : depressive symptoms ( Geriatric Depression Scale , GDS ) , nutritional panel ( Mini Nutritional Assessment , MNA ; serum albumin and prealbumin levels ) , muscle strength ( H and Grip , HG ) , Activity Daily Life ( ADL ) , Quality of Life ( SF-36 , HRQoL ) and amino acid profile . RESULTS Compared with the placebo group , EAA patients improved nutrition ( MNA score 22.6 ± 1.5 post vs 21.8 ± 1.6 pre ; p < 0 . 04 , albumin g/dl 4.04 ± 0.35 post vs 3.88 ± 0.3 pre ; p < 0.01 ) , GDS(score 10.3 ± 1.75 post vs 13.85 ± 3.37 pre ; p < 0.001 ) , HG ( Kg 19.75 ± 1.7 post vs 18.68 ± 1.36 pre ; p = 0.001 ) , ADL ( p < 0.04 ) and both physical and mental components of SF-36 ( p < 0.002 ) . CONCLUSIONS Oral supplementation with essential amino acids improved several determinants of quality of life in institutionalized elderly patients , including depressive symptoms , nutrition , muscle function and daily life activity Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES To provide preliminary evidence on the effectiveness and optimal dosage of megestrol acetate for older persons with impaired appetite after hospitalization . DESIGN R and omized clinical trial . SETTING Acute care hospital . PARTICIPANTS Forty-seven older persons ( mean age 83 ) who were recently discharged from an acute care hospital and had fair or poor appetite . INTERVENTION Participants were r and omized to placebo or megestrol acetate suspension 200 mg , 400 mg , or 800 mg daily for 9 weeks . MEASUREMENTS Appetite , health-related quality of life , and adverse effects were measured at baseline and 20 , 42 , and 63 days . Serum nutritional markers were measured at baseline and 20 and 63 days . RESULTS During the course of the study , there were no significant differences between treatment groups on any of the appetite questions , although participants in the 400-mg and 800-mg groups demonstrated significant improvement from baseline on some questions . At 20 days , prealbumin increased in a dose-response relationship across the four groups ( by 0.4 , 5.1 , 7.5 , and 9.0 mg/dL , respectively ) . Participants in the 400-mg and 800-mg groups demonstrated greater improvement in prealbumin levels at 20 days than those receiving placebo ( P=.009 and P=.004 , respectively ) and those in the 400-mg group also demonstrated improvement at 63 days ( P=.02 ) . At 20 days , no participant taking placebo had a morning serum cortisol level less than 8 ng/mL ( the lower limit of normal ) . In contrast , 33 % , 70 % , and 78 % of those taking 200 mg , 400 mg and 800 mg , respectively , had values below this level ; by 63 days , these percentages were 11 % , 30 % , 56 % , and 37 % , respectively . No patient reported clinical symptoms of adrenal insufficiency . Diarrhea developed in three subjects , and thromboembolism occurred in two receiving active treatment . CONCLUSION Megestrol acetate at doses of 400 mg and 800 mg increases prealbumin in recently hospitalized older persons . Cortisol suppression is common at higher doses and may be persistent . In this small study , the drug did not confer benefit on other nutritional or clinical outcomes Objectives : We studied the nutritional status and the effects of nutritional intervention on body weight , cognition and activities of daily life (ADL)-function in demented individuals . Design : Controlled non-r and omised study . Setting : Group-living for demented elderly ( GLD ) , ie community assisted housing . Subjects and interventions : Twenty-two residents living in one of two units ( GLD-I ) , received oral liquid supplements ( 1720 kJ/410 kcal/day ) and the personnel of the GLD-I were given nutritional education .  Fourteen residents in the other unit ( GLD-C ) served as controls . After 6 months 21 ( 83 ( 4 ) y , 81 % women ) and 12 ( 85 ( 4 ) y , 100 % women ) of the participants , respectively , were re-examined according to body mass index ( BMI , kg/m2 ) , cognitive function ( Mini Mental State Examination ( MMSE , 0–30 p ) and Clinical Dementia Rating Scale ( CDR ) and the Katz ' ADL index . Results : Body mass index ( BMI ) ≤20 was found in 19 % of the participants and 44 % had BMI ≤23 . BMI correlated with MMSE ( r=0.43 , P<0.01 ) . The weight of the residents in the intervention group increased by 3.4 ( 3 ) kg ( P=0.001 ) at follow-up , whereas the weight remained unchanged in the control group . The cognitive function was low at the start in both groups , ie MMSE∼9 and no apparent positive effect of the nutritional intervention was seen . In addition , the ADL functions appeared to deteriorate in both groups . Conclusions : Being underweight was common among demented elderly in group-living and was related to low cognitive capacity . Five months of oral supplementation , along with education of personnel , was followed by a weight gain . In this study the nutritional treatment did not affect the rate of decline in cognitive function or Katz ' ADL index . Sponsorship : Supported by grants from the Swedish National Board of Health and Social Welfare . Semper Foods AB provided the liquid supplements OBJECTIVE to prevent the occurrence of weight loss during hospitalisation and following discharge by daily oral supplementation . DESIGN in a prospect i ve , r and omised , controlled study of 80 patients aged 75 or more , and at risk of undernutrition based on their initial Mini Nutritional Assessment score , patients were r and omised into a control group or one receiving oral supplementation . The intervention was a prescription of 200 ml sweet or salty sip feed twice daily ( 500 kcal , 21 g protein per day ) throughout hospitalisation and convalescence . Nutritional status was assessed at baseline and after 2 months using Mini Nutritional Assessment and body weight record . RESULTS compliance with oral supplementation was good and daily extra energy intake was 407+/-184 kcal . On day 60 , significant weight loss from upon admission was observed in the control group ( -1.23+/-2.5 kg ; P=0.01 ) , but not in the supplemented group ( 0.28+/-3.8 kg ; NS ) . At the end of the study , Mini Nutritional Assessment scores were higher in the supplemented group than in the control group ( 23.5+/-3.9 versus 20.8+/-3.6 ; P<0.01 ) . CONCLUSION use of daily oral supplementation during and after hospitalisation maintains body weight and increases Mini Nutritional Assessment score in patients at risk of undernutrition BACKGROUND AND OBJECTIVE To evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults>70 years with protein-energy malnutrition . The innovation of 
    Output:
    