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 aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training OBJECTIVE To evaluate the association of oral food intake with survival in very old demented nursing home patients . DESIGN A prospect i ve cohort study . SETTING A nursing home in northern Italy . MEASUREMENTS  Anthropometric and laboratory nutritional indicators and nutrient intake  were assessed in 33 demented ( age 85.7 + /- 5.7 years ) and 25 nondemented ( age 84.9 + /- 5.7 years ) patients .  Mortality data were collected over a 28-month follow-up period . Association of survival with dementia was estimated by Kaplan-Meyer analysis and multivariate Cox proportional hazard models . RESULTS Nutrient intake and nutritional status were good compared with data in the literature and were similar in demented and nondemented patients , except for smaller triceps skinfold thickness in the demented . The cumulative annual death rate was 0.23 deaths per subject per year , similar in the demented ( 0.23 ) and the nondemented ( 0.22 ) . Unadjusted survival by Kaplan-Meyer analysis was similar in the two groups , and correction for-age , gender , cognition , triceps skinfold thickness , and number of drugs in a Cox model did not alter the relationship . CONCLUSIONS Dementia developing in very old age is not necessarily associated with malnutrition and decreased life expectancy 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 OBJECTIVES To determine whether increases in caloric intake associated with consumption of a mid-morning nutritional supplement for 3 weeks were maintained in the week after stopping the supplement and to investigate the effects of body mass index ( BMI ) and cognitive and behavioral measures on this response . DESIGN Secondary analysis of a previously published r and omized , crossover , nonblinded clinical trial . SETTING A fully accredited geriatric care facility affiliated with the University of Toronto . PARTICIPANTS Thirty institutionalized seniors with probable Alzheimer 's disease ( AD ) who ate independently .  MEASUREMENTS Investigator-weighed food intake , body weight , cognitive ( Severe Impairment Battery ; Global Deterioration Scale ) and behavioral ( Neuropsychiatric Inventory -- Nursing Home version ; London Psychogeriatric Rating Scale ) assessment s. RESULTS Individuals who responded successfully to supplementation as indicated by increases in daily energy intake were likely to maintain 58.8 % of that increase postsupplementation , although stopping the supplement was associated with decreased habitual energy intake in low- BMI individuals who reduced their daily intakes during supplementation in response to the extra calories . Cognitive/behavioral tests were not reliable predictors of postsupplement intake . CONCLUSION Institutionalized seniors with probable AD are likely to alter their usual energy intakes to maintain changes result ing from 3 weeks of supplementation . This effect may allow for rotating supplementation schedules in nursing homes that could reduce staff burden , but only for those individuals who are most likely to respond favorably . These data indicate that nutritional supplements and diet plans should be carefully prescribed in low- BMI individuals to limit variability in total energy provided and thus prevent lower-than-normal intake OBJECTIVES To vali date a nutritional intervention programme for elderly people living in nursing homes . DESIGN In a prospect i ve , r and omized , controlled study of 88 residents , we determined nutritional status at day 0 and day 60 using a record of dietary intake , anthropometry , h and -grip strength and mini-nutritional assessment . Dietary intake , grip strength and body weight were also recorded at day 30 . We divided subjects into four groups according to their mini-nutritional assessment score . Those with a score 24 received no oral supplementation .  Those at risk of malnutrition ( with a score of 17 - 23.5 ) were r and omized to oral supplementation . Those with a score < 17 received oral supplementation . We recorded the amount of oral supplements consumed daily . RESULTS Compliance with oral supplementation was good , and daily intake averaged about 400 kcal . The total energy intake on day 60 was significantly higher in both of the groups that received supplements . Following supplementation , most subjects at risk of malnutrition improved their mini-nutritional assessment score and increased their weight ( by 1.4 + /- 0.5 kg ) . Neither the mini-nutritional assessment score nor weight improved in subjects at risk of malnutrition who did not receive supplements . Supplementation in the malnourished group result ed in a mean mini-nutritional assessment score increase ( from 13.9 + /- 2.6 to 17.1 + /- 3.9 ) and a mean weight gain of 1.5 + /- 0.4 kg . CONCLUSION Oral nutritional supplements are well accepted and result in increased daily protein and energy intake , body weight and nutritional status in most malnourished patients and in those at risk of malnutrition OBJECTIVE To assess the nutritional status of female elderly nursing home residents and to study the effect of dietary supplementation with a physiological dose of water-soluble vitamins . DESIGN Single-blind , r and omised , placebo-controlled intervention trial . Daily consumed supplement consisted of fortified fruit juice containing 50 g carbohydrate and 50 % of the daily dietary recommendations of water-soluble vitamins . Regular fruit juice was used as placebo .  Dietary intake assessment at baseline . Fasting blood sample , anthropometric measurements and medical record at baseline and after 4 and 12 weeks of supplementation . SETTING Three nursing homes within 40 km of the coordination centre ( Department of Human Nutrition , Wageningen Agricultural University , the Netherl and s ) . SUBJECTS Forty-two female nursing home residents aged 60 years and older , in relatively stable health condition , at least 3 months resident at baseline . In each nursing home , 14 subjects were r and omly assigned to the supplement or control group . INTERVENTIONS Twelve weeks of supplementation . RESULTS Participants had a poor nutritional status . Dietary supplementation significantly improved the concentrations of thiamin pyrophosphate and pyridoxal 5'-phosphate , increased body weight and decreased serum homocysteine concentration in the supplement group . Plasma vitamin C levels were significantly increased in both supplement and control group . CONCLUSIONS Even in this heterogeneous population of female nursing home elderly it is possible to improve the nutritional status through dietary intervention with a physiological dose of water-soluble vitamins AIMS To evaluate the effect of a whole formula diet on nutritional and cognitive status in Alzheimer 's disease patients . METHODS Patients were r and omly assigned to two interventions : a whole formula diet based on lyophilised foods ( Treatment Group , n=24 ) or nutritional advice ( Control Group , n=29 ) . Energy intake , body weight , biochemistry , Mini Nutritional Assessment ( MNA ) and Pfeiffer 's tests were determined at baseline and at 3 months of treatment . RESULTS No differences were observed between groups at baseline . Energy intake tended to increase in the Treatment Group and to decrease in the Control Group , although differences were not significant . The improvement in MNA and Pfeiffer test scores was not significantly different between groups . Body weight increased by 2.06+/-1.9 kg in the Treatment Group and by 0.32+/-3.04 kg in the Control Group ( P=0.007 ) . The increases in albumin ( P=0.007 ) , haemoglobin ( P=0.002 ) and serum ferritin ( P=0.009 ) were higher in the Treatment Group than in controls . A similar rate of serious adverse events ( hospitalisation or death ) was observed in both groups . CONCLUSIONS Administration of this whole formula has a positive impact on nutritional status . The great diversity in textures and tastes enable these formulations to be administered to a wide range of patients with or without liquid dysphagia Objectives : To evaluate the acceptance of a multinutrient liquid nutrition supplement in psycho-geriatric nursing home patients and the effect on weight , plasma nutrients and activities of daily life . Design : Double-blind , placebo-controlled 12-week intervention study . Setting : Two nursing homes in Boxtel , The Netherl and s . Subjects : Forty-two ( body mass index ( BMI ) < 23 kg/m2 for men or < 25 kg/m2 for women ) psycho-geriatric nursing home patients aged 60 y or over . Interventions : Provision with a complete micronutrient-enriched liquid nutrition supplement of 125 ml and 0.6 MJ ( 135 kcal ) or placebo twice daily during daytime between main meals . Study parameters were assessed at 0 , 6 and 12 weeks . Main Outcome for Measures : Weight , Barthel index of daily activities , several plasma values ( albumin , C-reactive protein ( CRP ) , homocysteine , thiamine , thiamine diphosphate ( TDF ) , vitamin B6 , vitamin B12 , folic acid , vitamin D ) , bowel function . Results : The supplement was well accepted . Thirty-five patients completed the intervention period ( 16 control group ; 19 supplement group ) . Baseline daily nutrient intake was low . A statistically significant improvement was observed for body weight ( difference between groups 2.2 kg , P=0.03 ) , and homocysteine , vitamin B1 , TDF , vitamin B6 , vitamin B12 , folate and vitamin D in the supplement group compared to the placebo group . No significant difference was observed in the Barthel index ( mean difference −0.3±1.1 for both groups ) . No difference in occurrence of diarrhoea was observed . Conclusions : 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: The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training OBJECTIVE To evaluate the association of oral food intake with survival in very old demented nursing home patients . DESIGN A prospect i ve cohort study . SETTING A nursing home in northern Italy . MEASUREMENTS  Anthropometric and laboratory nutritional indicators and nutrient intake  were assessed in 33 demented ( age 85.7 + /- 5.7 years ) and 25 nondemented ( age 84.9 + /- 5.7 years ) patients .  Mortality data were collected over a 28-month follow-up period . Association of survival with dementia was estimated by Kaplan-Meyer analysis and multivariate Cox proportional hazard models . RESULTS Nutrient intake and nutritional status were good compared with data in the literature and were similar in demented and nondemented patients , except for smaller triceps skinfold thickness in the demented . The cumulative annual death rate was 0.23 deaths per subject per year , similar in the demented ( 0.23 ) and the nondemented ( 0.22 ) . Unadjusted survival by Kaplan-Meyer analysis was similar in the two groups , and correction for-age , gender , cognition , triceps skinfold thickness , and number of drugs in a Cox model did not alter the relationship . CONCLUSIONS Dementia developing in very old age is not necessarily associated with malnutrition and decreased life expectancy 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 OBJECTIVES To determine whether increases in caloric intake associated with consumption of a mid-morning nutritional supplement for 3 weeks were maintained in the week after stopping the supplement and to investigate the effects of body mass index ( BMI ) and cognitive and behavioral measures on this response . DESIGN Secondary analysis of a previously published r and omized , crossover , nonblinded clinical trial . SETTING A fully accredited geriatric care facility affiliated with the University of Toronto . PARTICIPANTS Thirty institutionalized seniors with probable Alzheimer 's disease ( AD ) who ate independently .  MEASUREMENTS Investigator-weighed food intake , body weight , cognitive ( Severe Impairment Battery ; Global Deterioration Scale ) and behavioral ( Neuropsychiatric Inventory -- Nursing Home version ; London Psychogeriatric Rating Scale ) assessment s. RESULTS Individuals who responded successfully to supplementation as indicated by increases in daily energy intake were likely to maintain 58.8 % of that increase postsupplementation , although stopping the supplement was associated with decreased habitual energy intake in low- BMI individuals who reduced their daily intakes during supplementation in response to the extra calories . Cognitive/behavioral tests were not reliable predictors of postsupplement intake . CONCLUSION Institutionalized seniors with probable AD are likely to alter their usual energy intakes to maintain changes result ing from 3 weeks of supplementation . This effect may allow for rotating supplementation schedules in nursing homes that could reduce staff burden , but only for those individuals who are most likely to respond favorably . These data indicate that nutritional supplements and diet plans should be carefully prescribed in low- BMI individuals to limit variability in total energy provided and thus prevent lower-than-normal intake OBJECTIVES To vali date a nutritional intervention programme for elderly people living in nursing homes . DESIGN In a prospect i ve , r and omized , controlled study of 88 residents , we determined nutritional status at day 0 and day 60 using a record of dietary intake , anthropometry , h and -grip strength and mini-nutritional assessment . Dietary intake , grip strength and body weight were also recorded at day 30 . We divided subjects into four groups according to their mini-nutritional assessment score . Those with a score 24 received no oral supplementation .  Those at risk of malnutrition ( with a score of 17 - 23.5 ) were r and omized to oral supplementation . Those with a score < 17 received oral supplementation . We recorded the amount of oral supplements consumed daily . RESULTS Compliance with oral supplementation was good , and daily intake averaged about 400 kcal . The total energy intake on day 60 was significantly higher in both of the groups that received supplements . Following supplementation , most subjects at risk of malnutrition improved their mini-nutritional assessment score and increased their weight ( by 1.4 + /- 0.5 kg ) . Neither the mini-nutritional assessment score nor weight improved in subjects at risk of malnutrition who did not receive supplements . Supplementation in the malnourished group result ed in a mean mini-nutritional assessment score increase ( from 13.9 + /- 2.6 to 17.1 + /- 3.9 ) and a mean weight gain of 1.5 + /- 0.4 kg . CONCLUSION Oral nutritional supplements are well accepted and result in increased daily protein and energy intake , body weight and nutritional status in most malnourished patients and in those at risk of malnutrition OBJECTIVE To assess the nutritional status of female elderly nursing home residents and to study the effect of dietary supplementation with a physiological dose of water-soluble vitamins . DESIGN Single-blind , r and omised , placebo-controlled intervention trial . Daily consumed supplement consisted of fortified fruit juice containing 50 g carbohydrate and 50 % of the daily dietary recommendations of water-soluble vitamins . Regular fruit juice was used as placebo .  Dietary intake assessment at baseline . Fasting blood sample , anthropometric measurements and medical record at baseline and after 4 and 12 weeks of supplementation . SETTING Three nursing homes within 40 km of the coordination centre ( Department of Human Nutrition , Wageningen Agricultural University , the Netherl and s ) . SUBJECTS Forty-two female nursing home residents aged 60 years and older , in relatively stable health condition , at least 3 months resident at baseline . In each nursing home , 14 subjects were r and omly assigned to the supplement or control group . INTERVENTIONS Twelve weeks of supplementation . RESULTS Participants had a poor nutritional status . Dietary supplementation significantly improved the concentrations of thiamin pyrophosphate and pyridoxal 5'-phosphate , increased body weight and decreased serum homocysteine concentration in the supplement group . Plasma vitamin C levels were significantly increased in both supplement and control group . CONCLUSIONS Even in this heterogeneous population of female nursing home elderly it is possible to improve the nutritional status through dietary intervention with a physiological dose of water-soluble vitamins AIMS To evaluate the effect of a whole formula diet on nutritional and cognitive status in Alzheimer 's disease patients . METHODS Patients were r and omly assigned to two interventions : a whole formula diet based on lyophilised foods ( Treatment Group , n=24 ) or nutritional advice ( Control Group , n=29 ) . Energy intake , body weight , biochemistry , Mini Nutritional Assessment ( MNA ) and Pfeiffer 's tests were determined at baseline and at 3 months of treatment . RESULTS No differences were observed between groups at baseline . Energy intake tended to increase in the Treatment Group and to decrease in the Control Group , although differences were not significant . The improvement in MNA and Pfeiffer test scores was not significantly different between groups . Body weight increased by 2.06+/-1.9 kg in the Treatment Group and by 0.32+/-3.04 kg in the Control Group ( P=0.007 ) . The increases in albumin ( P=0.007 ) , haemoglobin ( P=0.002 ) and serum ferritin ( P=0.009 ) were higher in the Treatment Group than in controls . A similar rate of serious adverse events ( hospitalisation or death ) was observed in both groups . CONCLUSIONS Administration of this whole formula has a positive impact on nutritional status . The great diversity in textures and tastes enable these formulations to be administered to a wide range of patients with or without liquid dysphagia Objectives : To evaluate the acceptance of a multinutrient liquid nutrition supplement in psycho-geriatric nursing home patients and the effect on weight , plasma nutrients and activities of daily life . Design : Double-blind , placebo-controlled 12-week intervention study . Setting : Two nursing homes in Boxtel , The Netherl and s . Subjects : Forty-two ( body mass index ( BMI ) < 23 kg/m2 for men or < 25 kg/m2 for women ) psycho-geriatric nursing home patients aged 60 y or over . Interventions : Provision with a complete micronutrient-enriched liquid nutrition supplement of 125 ml and 0.6 MJ ( 135 kcal ) or placebo twice daily during daytime between main meals . Study parameters were assessed at 0 , 6 and 12 weeks . Main Outcome for Measures : Weight , Barthel index of daily activities , several plasma values ( albumin , C-reactive protein ( CRP ) , homocysteine , thiamine , thiamine diphosphate ( TDF ) , vitamin B6 , vitamin B12 , folic acid , vitamin D ) , bowel function . Results : The supplement was well accepted . Thirty-five patients completed the intervention period ( 16 control group ; 19 supplement group ) . Baseline daily nutrient intake was low . A statistically significant improvement was observed for body weight ( difference between groups 2.2 kg , P=0.03 ) , and homocysteine , vitamin B1 , TDF , vitamin B6 , vitamin B12 , folate and vitamin D in the supplement group compared to the placebo group . No significant difference was observed in the Barthel index ( mean difference −0.3±1.1 for both groups ) . No difference in occurrence of diarrhoea was observed . Conclusions : The 
    Output:
    