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: Goals of workAdvanced tumor disease very often evokes excessive loss of body weight . Among others , fish oil or marine fatty acid ethyl esters were investigated for treatment of cancer cachexia with controversial results . In this study , a new formulation of marine fatty acids was investigated , the marine phospholipids , with more than 50 % of phospholipid-bound fatty acids being eicosapentaenoic and docosahexaenoic acid . Material s and methods Thirty-one tumor patients with various tumor entities suffering from weight loss were asked to take marine phospholipids ( 1.5 g/day ) as softgel capsules for a period of 6 weeks . Compliance , body weight , appetite , and quality of life as well as the fatty acid profile in plasma and blood cells were monitored ; 17 patients could be analyzed . Main results Marine phospholipids were very well accepted ; low-dose supplementation result ed in a significant increase of eicosapentaenoic and docosahexaenoic acid in plasma phospholipids ; therefore , significantly reducing the n − 6 to n − 3 fatty acid ratio . A stabilization of body weight was achieved ( median weight change of + 0.6 % after 6 weeks ) , while appetite and quality of life improved . Conclusions These promising first results encourage further investigation of marine phospholipids in cancer care Chemotherapy and radiotherapy offer little benefit to patients with advanced pancreatic cancer .  Eicosapentaenoic acid ( EPA ) has anticancer effects both in vitro and in animal models . The dose of EPA that can be administered to cancer patients has previously been limited by the low purity of available preparations and the tolerability of large capsules . A high-purity preparation of EPA as a 20 % oil-in-water diester emulsion allowed a small study of the tolerance , incorporation , and effects of EPA in high doses in five patients with advanced pancreatic cancer . Patients underwent assessment at baseline and every 4 wk thereafter . All patients managed to tolerate a dose providing 18 g EPA per day , with doses between 9 and 27 g daily being taken for at least a month . Dosage was limited by a sensation of fullness , cramping abdominal pain , steatorrhea , and nausea . All such symptoms were controlled by dose reduction or pancreatic enzyme supplements . No other adverse effects attributable to the trial agent were observed . Plasma phospholipid EPA content increased from around 1 % at baseline to 10 % at 4 wk and 20 % at 8 wk . Incorporation of EPA into red blood cell phospholipids reached levels of around 10 % . The present study has shown that a novel , high-purity , EPA diester emulsion can be tolerated at a dose providing around 18 g EPA per day with side-effects being easily controlled . The acceptibility of large doses of oral EPA should allow larger controlled clinical studies into potential anticancer effects of EPA Aim : N-3 fatty acids , especially eicosapentaenoic acid ( EPA ) , may possess anticachectic properties . This trial compared a protein and energy dense supplement enriched with n-3 fatty acids and antioxidants ( experimental : E ) with an isocaloric isonitrogenous control supplement ( C ) for their effects on weight , lean body mass ( LBM ) , dietary intake , and quality of life in cachectic patients with advanced pancreatic cancer . Methods : A total of 200 patients ( 95 E ; 105 C ) were r and omised to consume two cans/day of the E or C supplement ( 480 ml , 620 kcal , 32 g protein ± 2.2 g EPA ) for eight weeks in a multicentre , r and omised , double blind trial . Results : At enrolment , patients ’ mean rate of weight loss was 3.3 kg/month . Intake of the supplements ( E or C ) was below the recommended dose ( 2 cans/day ) and averaged 1.4 cans/day . Over eight weeks , patients in both groups stopped losing weight ( Δ weight E : −0.25 kg/month versus C : −0.37 kg/month ; p = 0.74 ) and LBM ( Δ LBM E : + 0.27 kg/month versus C : + 0.12 kg/month ; p = 0.88 ) to an equal degree ( change from baseline E and C , p<0.001 ) . In view of evident non-compliance in both E and C groups , correlation analyses were undertaken to examine for potential dose-response relationships . E patients demonstrated significant correlations between their supplement intake and weight gain ( r = 0.50 , p<0.001 ) and increase in LBM ( r = 0.33 , p = 0.036 ) . Such correlations were not statistically significant in C patients . The relationship of supplement intake with change in LBM was significantly different between E and C patients ( p = 0.043 ) . Increased plasma EPA levels in the E group were associated with weight and LBM gain ( r = 0.50 , p<0.001 ; r = 0.51 , p = 0.001 ) . Weight gain was associated with improved quality of life ( p<0.01 ) only in the E group . Conclusion : Intention to treat group comparisons indicated that at the mean dose taken , enrichment with n-3 fatty acids did not provide a therapeutic advantage and that both supplements were equally effective in arresting weight loss . Post hoc dose-response analysis suggests that if taken in sufficient quantity , only the n-3 fatty acid enriched energy and protein dense supplement results in net gain of weight , lean tissue , and improved quality of life . Further trials are required to examine the potential role of n-3 enriched supplements in the treatment of cancer cachexia Background Interleukin-1 beta ( IL-1β ) , tumor necrosis factor alpha ( TNFα ) , and interleukin-6 ( IL-6 ) have been implicated in the cancer anorexia/weight loss syndrome . However , previous smaller studies have yielded conflicting results as to whether circulating , serum concentrations of these cytokines are in fact elevated . As the translational component of a large multi-institutional trial , this study assessed the clinical value of serum concentrations of these cytokines in patients with this syndrome . Methods Patients with incurable cancer with anorexia and /or weight loss were eligible . All underwent weekly weight measurements and appetite assessment for the first month and then monthly assessment s thereafter . Serum was obtained at baseline and at 1 month , and all three cytokines were measured with the Immunolite assay . Results A total of 118 patients participated . At baseline , 99 % , 54 % , and 47 % of patients ’ sample s had undetectable IL-1β , TNFα , and IL-6 , respectively . Similar results were obtained at 1 month . No correlations were observed between serum cytokine concentrations and changes in weight or appetite . Baseline serum IL-6 predicted a diminished survival but only after adjustment for age and cancer site . ConclusionS erum concentrations of IL-1β , TNFα , and IL-6 , as measured in this study , provide data of limited clinical value for patients with the cancer anorexia/weight loss syndrome The aim of the study was to assess the total energy expenditure ( TEE ) , resting energy expenditure ( REE ) and physical activity level ( PAL ) in home-living cachectic patients with advanced pancreatic cancer . The influence of an energy and protein dense oral supplement either enriched with or without the n-3 fatty acid eicosapentaenoic acid ( EPA ) and administered over an 8-week period was also determined . In total , 24 patients were studied at baseline . The total energy expenditure was measured using doubly labelled water and REE determined by indirect calorimetry . Patients were studied at baseline and then r and omised to either oral nutritional supplement . Measurements were repeated at 8 weeks . At baseline , REE was increased compared with predicted values for healthy individuals ( 1387(42 ) vs 1268(32 ) kcal day−1 , P=0.001 ) , but TEE ( 1732(82 ) vs 1903(48 ) kcal day−1 , P=0.023 ) and PAL ( 1.24(0.04 ) vs 1.50 ) were reduced . After 8 weeks , the REE , TEE and PAL of patients who received the control supplement did not change significantly . In contrast , although REE did not change , TEE and PAL increased significantly in those who received the n-3 ( EPA ) enriched supplement . In summary , patients with advanced pancreatic cancer  were hypermetabolic . However , TEE was reduced and this was secondary to a reduction in physical activity . The control energy and protein dense oral supplement did not influence the physical activity component of TEE . In contrast , administration of the supplement enriched with EPA was associated with an increase in physical activity , which may reflect improved quality of life OBJECTIVE In April 2005 a phase III r and omized study was started to establish which was the most effective and safest treatment of cancer-related anorexia/cachexia syndrome and oxidative stress in improving identified primary endpoints : increase of lean body mass , decrease of resting energy expenditure ( REE ) , increase of total daily physical activity , decrease of interleukin-6 and tumor necrosis factor-alpha , and improvement of fatigue assessed by the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) . METHODS All patients were given as basic treatment polyphenols plus antioxidant agents alpha-lipoic acid , carbocysteine , and vitamins A , C , and E , all orally . Patients were then r and omized to one of the following five arms : 1 ) medroxyprogesterone acetate/megestrol acetate ; 2 ) pharmacologic nutritional support containing eicosapentaenoic acid ; 3 ) L-carnitine ; 4 ) thalidomide ; or 5 ) medroxyprogesterone acetate/megestrol acetate plus pharmacologic nutritional support plus L-carnitine plus thalidomide . Treatment duration was 4 mo . The sample comprised 475 patients . RESULTS By January 2007 , 125 patients , well balanced for all clinical characteristics , were included . No severe side effects were observed . As for efficacy , an interim analysis on 125 patients showed an improvement of at least one primary endpoint in arms 3 , 4 , and 5 , whereas arm 2 showed a significant worsening of lean body mass , REE , and MFSI-SF . Analysis of variance comparing the change of primary endpoints between arms showed a significant improvement of REE in favor of arm 5 versus arm 2 and a significant improvement of MFSI-SF in favor of arms 1 , 3 , and 5 versus arm 2 . A significant inferiority of arm 2 versus arms 3 , 4 , and 5 for the primary endpoints lean body mass , REE , and MFSI-SF was observed on the basis of t test for changes . CONCLUSION The interim results obtained thus far seem to suggest that the most effective treatment for cancer-related anorexia/cachexia syndrome and oxidative stress should be a combination regimen . The study is still in progress and the final results should confirm these data Abstract Background & Aim : to analyze the clinical impact and cost-effectiveness of parenteral immunonutrition ( PN ) . Methods : prospect i ve clinical trial of a group of 105 patients operated on for gastric carcinoma between 2001 - 2003 . During the postoperative period , patients were r and omly allocated to one of three groups : st and ard PN ( A ) , PN + glu-tamine ( B ) and PN + omega-3-FA ( C ) . The rate and type of complications , hepatic and renal function , cost and treatment tolerance in all groups were analyzed . Results : postoperative complications were observed in 11 patients ( 36,6 % ) in group A , in 7 ( 23,3 % ) in B and in 8 ( 26,6 % ) in C. The most common complication was pneumonia . Prealbumin concentration and TLC increased faster in groups B and C. The length of hospital stay was significantly shorter in the immunonutrition groups . The cost of PN was highest in C group , while cost of hospital stay was longer in A. Conclusions : immunostimulating parenteral nutrition helps to reduce the number of infectious complications , improves the function of the immune system , and has no influence on surgical complications , hepatic and renal function and protein synthesis . The cost of immunostimulating treatment based on omega-3-unsaturated fatty acids is higher than st and ard The aim of the current prospect i ve , r and omized control study was to investigate the effect of dietary omega‐3 polyunsaturated fatty acids plus vitamin E on the immune status and survival of well‐nourished and malnourished patients with generalized malignancy Summary Previous studies have suggested that administration of oral eicosapentaenoic acid ( EPA ) will stabilize weight in patients with advanced pancreatic cancer . The aim of the present study was to determine if a combination of EPA with a conventional oral nutritional supplement could produce weight gain in these patients . Twenty patients with unresectable pancreatic adenocarcinoma were asked to consume two cans of a fish oil-enriched nutritional supplement per day in addition to their normal food intake . Each can contained 310 kcal , 16.1 g protein and 1.09 g EPA . Patients were assessed for weight , body composition , dietary intake , resting energy expenditure ( REE ) and performance status . Patients consumed a median of 1.9 cans day–1 . All patients were losing weight at baseline at a median rate of 2.9 kg month 
    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: Goals of workAdvanced tumor disease very often evokes excessive loss of body weight . Among others , fish oil or marine fatty acid ethyl esters were investigated for treatment of cancer cachexia with controversial results . In this study , a new formulation of marine fatty acids was investigated , the marine phospholipids , with more than 50 % of phospholipid-bound fatty acids being eicosapentaenoic and docosahexaenoic acid . Material s and methods Thirty-one tumor patients with various tumor entities suffering from weight loss were asked to take marine phospholipids ( 1.5 g/day ) as softgel capsules for a period of 6 weeks . Compliance , body weight , appetite , and quality of life as well as the fatty acid profile in plasma and blood cells were monitored ; 17 patients could be analyzed . Main results Marine phospholipids were very well accepted ; low-dose supplementation result ed in a significant increase of eicosapentaenoic and docosahexaenoic acid in plasma phospholipids ; therefore , significantly reducing the n − 6 to n − 3 fatty acid ratio . A stabilization of body weight was achieved ( median weight change of + 0.6 % after 6 weeks ) , while appetite and quality of life improved . Conclusions These promising first results encourage further investigation of marine phospholipids in cancer care Chemotherapy and radiotherapy offer little benefit to patients with advanced pancreatic cancer .  Eicosapentaenoic acid ( EPA ) has anticancer effects both in vitro and in animal models . The dose of EPA that can be administered to cancer patients has previously been limited by the low purity of available preparations and the tolerability of large capsules . A high-purity preparation of EPA as a 20 % oil-in-water diester emulsion allowed a small study of the tolerance , incorporation , and effects of EPA in high doses in five patients with advanced pancreatic cancer . Patients underwent assessment at baseline and every 4 wk thereafter . All patients managed to tolerate a dose providing 18 g EPA per day , with doses between 9 and 27 g daily being taken for at least a month . Dosage was limited by a sensation of fullness , cramping abdominal pain , steatorrhea , and nausea . All such symptoms were controlled by dose reduction or pancreatic enzyme supplements . No other adverse effects attributable to the trial agent were observed . Plasma phospholipid EPA content increased from around 1 % at baseline to 10 % at 4 wk and 20 % at 8 wk . Incorporation of EPA into red blood cell phospholipids reached levels of around 10 % . The present study has shown that a novel , high-purity , EPA diester emulsion can be tolerated at a dose providing around 18 g EPA per day with side-effects being easily controlled . The acceptibility of large doses of oral EPA should allow larger controlled clinical studies into potential anticancer effects of EPA Aim : N-3 fatty acids , especially eicosapentaenoic acid ( EPA ) , may possess anticachectic properties . This trial compared a protein and energy dense supplement enriched with n-3 fatty acids and antioxidants ( experimental : E ) with an isocaloric isonitrogenous control supplement ( C ) for their effects on weight , lean body mass ( LBM ) , dietary intake , and quality of life in cachectic patients with advanced pancreatic cancer . Methods : A total of 200 patients ( 95 E ; 105 C ) were r and omised to consume two cans/day of the E or C supplement ( 480 ml , 620 kcal , 32 g protein ± 2.2 g EPA ) for eight weeks in a multicentre , r and omised , double blind trial . Results : At enrolment , patients ’ mean rate of weight loss was 3.3 kg/month . Intake of the supplements ( E or C ) was below the recommended dose ( 2 cans/day ) and averaged 1.4 cans/day . Over eight weeks , patients in both groups stopped losing weight ( Δ weight E : −0.25 kg/month versus C : −0.37 kg/month ; p = 0.74 ) and LBM ( Δ LBM E : + 0.27 kg/month versus C : + 0.12 kg/month ; p = 0.88 ) to an equal degree ( change from baseline E and C , p<0.001 ) . In view of evident non-compliance in both E and C groups , correlation analyses were undertaken to examine for potential dose-response relationships . E patients demonstrated significant correlations between their supplement intake and weight gain ( r = 0.50 , p<0.001 ) and increase in LBM ( r = 0.33 , p = 0.036 ) . Such correlations were not statistically significant in C patients . The relationship of supplement intake with change in LBM was significantly different between E and C patients ( p = 0.043 ) . Increased plasma EPA levels in the E group were associated with weight and LBM gain ( r = 0.50 , p<0.001 ; r = 0.51 , p = 0.001 ) . Weight gain was associated with improved quality of life ( p<0.01 ) only in the E group . Conclusion : Intention to treat group comparisons indicated that at the mean dose taken , enrichment with n-3 fatty acids did not provide a therapeutic advantage and that both supplements were equally effective in arresting weight loss . Post hoc dose-response analysis suggests that if taken in sufficient quantity , only the n-3 fatty acid enriched energy and protein dense supplement results in net gain of weight , lean tissue , and improved quality of life . Further trials are required to examine the potential role of n-3 enriched supplements in the treatment of cancer cachexia Background Interleukin-1 beta ( IL-1β ) , tumor necrosis factor alpha ( TNFα ) , and interleukin-6 ( IL-6 ) have been implicated in the cancer anorexia/weight loss syndrome . However , previous smaller studies have yielded conflicting results as to whether circulating , serum concentrations of these cytokines are in fact elevated . As the translational component of a large multi-institutional trial , this study assessed the clinical value of serum concentrations of these cytokines in patients with this syndrome . Methods Patients with incurable cancer with anorexia and /or weight loss were eligible . All underwent weekly weight measurements and appetite assessment for the first month and then monthly assessment s thereafter . Serum was obtained at baseline and at 1 month , and all three cytokines were measured with the Immunolite assay . Results A total of 118 patients participated . At baseline , 99 % , 54 % , and 47 % of patients ’ sample s had undetectable IL-1β , TNFα , and IL-6 , respectively . Similar results were obtained at 1 month . No correlations were observed between serum cytokine concentrations and changes in weight or appetite . Baseline serum IL-6 predicted a diminished survival but only after adjustment for age and cancer site . ConclusionS erum concentrations of IL-1β , TNFα , and IL-6 , as measured in this study , provide data of limited clinical value for patients with the cancer anorexia/weight loss syndrome The aim of the study was to assess the total energy expenditure ( TEE ) , resting energy expenditure ( REE ) and physical activity level ( PAL ) in home-living cachectic patients with advanced pancreatic cancer . The influence of an energy and protein dense oral supplement either enriched with or without the n-3 fatty acid eicosapentaenoic acid ( EPA ) and administered over an 8-week period was also determined . In total , 24 patients were studied at baseline . The total energy expenditure was measured using doubly labelled water and REE determined by indirect calorimetry . Patients were studied at baseline and then r and omised to either oral nutritional supplement . Measurements were repeated at 8 weeks . At baseline , REE was increased compared with predicted values for healthy individuals ( 1387(42 ) vs 1268(32 ) kcal day−1 , P=0.001 ) , but TEE ( 1732(82 ) vs 1903(48 ) kcal day−1 , P=0.023 ) and PAL ( 1.24(0.04 ) vs 1.50 ) were reduced . After 8 weeks , the REE , TEE and PAL of patients who received the control supplement did not change significantly . In contrast , although REE did not change , TEE and PAL increased significantly in those who received the n-3 ( EPA ) enriched supplement . In summary , patients with advanced pancreatic cancer  were hypermetabolic . However , TEE was reduced and this was secondary to a reduction in physical activity . The control energy and protein dense oral supplement did not influence the physical activity component of TEE . In contrast , administration of the supplement enriched with EPA was associated with an increase in physical activity , which may reflect improved quality of life OBJECTIVE In April 2005 a phase III r and omized study was started to establish which was the most effective and safest treatment of cancer-related anorexia/cachexia syndrome and oxidative stress in improving identified primary endpoints : increase of lean body mass , decrease of resting energy expenditure ( REE ) , increase of total daily physical activity , decrease of interleukin-6 and tumor necrosis factor-alpha , and improvement of fatigue assessed by the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) . METHODS All patients were given as basic treatment polyphenols plus antioxidant agents alpha-lipoic acid , carbocysteine , and vitamins A , C , and E , all orally . Patients were then r and omized to one of the following five arms : 1 ) medroxyprogesterone acetate/megestrol acetate ; 2 ) pharmacologic nutritional support containing eicosapentaenoic acid ; 3 ) L-carnitine ; 4 ) thalidomide ; or 5 ) medroxyprogesterone acetate/megestrol acetate plus pharmacologic nutritional support plus L-carnitine plus thalidomide . Treatment duration was 4 mo . The sample comprised 475 patients . RESULTS By January 2007 , 125 patients , well balanced for all clinical characteristics , were included . No severe side effects were observed . As for efficacy , an interim analysis on 125 patients showed an improvement of at least one primary endpoint in arms 3 , 4 , and 5 , whereas arm 2 showed a significant worsening of lean body mass , REE , and MFSI-SF . Analysis of variance comparing the change of primary endpoints between arms showed a significant improvement of REE in favor of arm 5 versus arm 2 and a significant improvement of MFSI-SF in favor of arms 1 , 3 , and 5 versus arm 2 . A significant inferiority of arm 2 versus arms 3 , 4 , and 5 for the primary endpoints lean body mass , REE , and MFSI-SF was observed on the basis of t test for changes . CONCLUSION The interim results obtained thus far seem to suggest that the most effective treatment for cancer-related anorexia/cachexia syndrome and oxidative stress should be a combination regimen . The study is still in progress and the final results should confirm these data Abstract Background & Aim : to analyze the clinical impact and cost-effectiveness of parenteral immunonutrition ( PN ) . Methods : prospect i ve clinical trial of a group of 105 patients operated on for gastric carcinoma between 2001 - 2003 . During the postoperative period , patients were r and omly allocated to one of three groups : st and ard PN ( A ) , PN + glu-tamine ( B ) and PN + omega-3-FA ( C ) . The rate and type of complications , hepatic and renal function , cost and treatment tolerance in all groups were analyzed . Results : postoperative complications were observed in 11 patients ( 36,6 % ) in group A , in 7 ( 23,3 % ) in B and in 8 ( 26,6 % ) in C. The most common complication was pneumonia . Prealbumin concentration and TLC increased faster in groups B and C. The length of hospital stay was significantly shorter in the immunonutrition groups . The cost of PN was highest in C group , while cost of hospital stay was longer in A. Conclusions : immunostimulating parenteral nutrition helps to reduce the number of infectious complications , improves the function of the immune system , and has no influence on surgical complications , hepatic and renal function and protein synthesis . The cost of immunostimulating treatment based on omega-3-unsaturated fatty acids is higher than st and ard The aim of the current prospect i ve , r and omized control study was to investigate the effect of dietary omega‐3 polyunsaturated fatty acids plus vitamin E on the immune status and survival of well‐nourished and malnourished patients with generalized malignancy Summary Previous studies have suggested that administration of oral eicosapentaenoic acid ( EPA ) will stabilize weight in patients with advanced pancreatic cancer . The aim of the present study was to determine if a combination of EPA with a conventional oral nutritional supplement could produce weight gain in these patients . Twenty patients with unresectable pancreatic adenocarcinoma were asked to consume two cans of a fish oil-enriched nutritional supplement per day in addition to their normal food intake . Each can contained 310 kcal , 16.1 g protein and 1.09 g EPA . Patients were assessed for weight , body composition , dietary intake , resting energy expenditure ( REE ) and performance status . Patients consumed a median of 1.9 cans day–1 . All patients were losing weight at baseline at a median rate of 2.9 kg month 
    Output:
    