A comparison between oral and nasogastric nutritional supplements in malnourished patients. Nutritional evaluation and dietetic care in cancer patients treated with radiotherapy: prospective study. Long-term nutritional support as an adjunct to chemotherapy for breast cancer. Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living frail elderly. A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients High-energy, high-protein, oral, liquid, nutrition supplementation in patients with HIV infection: effect on weight status in relation to incidence of secondary infection. Good nutritional oral intake is associated with equal survival in demented and nondemented very old patients. Impact of nutritional support on functional status during an acute exacerbation of chronic obstructive pulmonary disease. Oral nutritional supplement use in elderly nursing home patients. Optimal nutritional support in surgery for bladder cancer: preservation of visceral protein by amino acid infusions. Improved wound healing in transtibial amputees receiving supplementary nutrition [High-caloric nutrition in chronic obstructive lung disease]. The effect of oral nutritional supplements on head and neck cancer. Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: a prospective randomized community trial. Nutritional behaviour and quality of life during oncological polychemotherapy: Results of a prospective study on the efficacy of oral nutrition therapy in patients with acute leukaemia A Study of Intensified Dietary Support in Underweight Candidates for Lung Transplantation A randomized study of oral nutritional support versus ad lib nutritional intake during chemotherapy for advanced colorectal and non-small-cell lung cancer. The effect of dietary intervention on weight gains after renal transplantation. Effect of nursing interventions on nutritional and performance status in cancer patients. Prevalence of malnutrition in patients in general practice. Physiologic effects of oral supplemental feeding in malnourished patients with chronic obstructive pulmonary disease. A randomized control study. Energy-enriched hospital food to improve energy intake in elderly patients. A Randomized Study of Nutritional Support in Patients With Colorectal and Gastric Cancer Incidence and recognition of malnutrition in hospital Effects of dietary supplement on functional condition and clinical outcome measured with a modified Norton scale. Oral supplements as adjunctive treatment to nutritional counseling in malnourished HIV-infected patients: randomized controlled trial. Two phase randomised controlled clinical trial of postoperative oral dietary supplements in surgical patients. Effect of dietary counseling on food intake, body weight, response rate, survival, and quality of life in cancer patients undergoing chemotherapy: a prospective, randomized study. Nutritional status of elderly patients during recovery from chest infection and the role of nutritional supplementation assessed by a prospective randomized single-blind trial. The effect of nutritional supplements on food intake in patients undergoing radiotherapy. The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease. Nutritional support and functional status in undernourished geriatric patients during hospitalization and 6-month follow-up Nutritional supplements combined with dietary counselling diminish whole body protein catabolism in HIV‐infected patients A study of oral nutritional support with oxandrolone in malnourished patients with alcoholic hepatitis: results of a Department of Veterans Affairs cooperative study. Dietary supplementation and respiratory muscle performance in patients with COPD. Postoperative nutritional supplementation for the orthognathic surgery patient. Dietary supplementation at home improves the regain of lean body mass after surgery. A randomized controlled trial evaluating nutrition counseling with or without oral supplementation in malnourished HIV-infected patients. Randomization to nutritional intervention at home did not improve postoperative function, fatigue or well‐being Effect of Ensure, a defined formula diet, in patients with Crohn's disease. Diet counselling improves the clinical course of patients with Crohn's disease.
There is a common perception that malnutrition is an inevitable manifestation of illness , that oral nutritional supplements are not taken or reduce the consumption of oral diet , and that nasogastric feeding is poorly tolerated . This study assessed the efficacy of supplemental enteral feeding on the nutritional status of malnourished patients , to compare oral supplements ( OS ) with overnight supplemental nasogastric feeding ( NG ) on nutritional status and to determine the effect of nutritional supplements on oral diet . Malnourished hospital patients were r and omized to one of three groups : control ( C ) , OS , or NG . All patients had access to hospital diet .  Supplements were prescribed to meet estimated nutritional needs . Nutritional status was recorded at the start and the end of the feeding period . The total nutritional intake was recorded . Weight gain occurred in 64 % of the supplemented patients , whereas 73 % of the controls lost weight with mean weight changes of + 2.9 % OS . + 3.3 % NG , and -2.5 % C. There was no difference in the mean energy intake from food in the three groups . There were no documented complications of OS and three minor complications of NG . Both methods of supplementation allow weight gain without significantly affecting spontaneous oral intake Ninety-three cancer patients about to undergo radiotherapy were studied . These patients were affected by cancer of the head and neck , breast cancer , and abdominopelvic cancer . They were r and omly distributed into control and experimental groups . The patients from the control group were allowed to eat ad libitum , whereas those from the experimental group followed a strict nutritional protocol that covered their needs while satisfying their particular tastes and habits . Data were collected the day before radiotherapy commenced and the day treatment ended . Anthropometric , analytical , and clinical parameters were determined . The results showed the benefit of dietetic treatment in experimental patients with head and neck or abdominopelvic cancer In recent years , the concept of nutritional support as a part of a comprehensive cancer management program has gained increasing acceptability . However , little data is available in regard to the effect of nutritional support programs on the chronic disease state represented by recurrent or persistent cancer that characterizes patients undergoing systemic chemotherapy . In 1977 we undertook to study this problem in a r and omized prospect i ve study design ed to evaluate the effects of long-term ( 12 months ) enteral nutritional support in a group of ambulatory breast cancer patients undergoing a st and ard cytotoxic chemotherapy treatment program  , in an adjuvant or therapeutic setting . The results of this study suggest that patients with breast cancer are overweight as compared to the general population and that any significant change in initial body weight , either a gain or a loss , is associated with an increased risk of recurrent disease . Data are presented which show little or no correlation between st and ard parameters of nutritional assessment and risk of disease recurrence and /or response to chemotherapy . These data also suggest that until we better underst and the relationship between tumor and host in breast cancer patients , we offer nutritional support programs only in situations where there are specific clinical indications for such interventions Nutritional deficiencies , frequently observed among the frail elderly , have been associated with increased morbidity and dependency . A r and omized clinical trial was conducted to assess the impact of nutritional supplementation on the functional status of frail elderly living at home . Subjects ( n = 50 ) over age 60 ( mean 78 y ) requiring community services and at elevated risk of undernutrition ( excessive weight loss or body mass index < 24 kg/m2 ) were r and omized to a high energy nutrient dense supplement provided by a dietitian or a control group receiving visits only . Outcome measures , including changes in h and grip strength , general well-being score , perception of health and number of falls , were measured by an investigator who was unaware of treatment assignment . After 12 wk , weight gain was greater in the supplemented group ( 2.1 + /- 2.3 vs. 0.6 + /- 1.6 kg ; P < 0.01 ) . Despite adequate statistical power , no functional measures differed except that the number of falls was lower among treated subjects vs. controls ( 0 % vs. 21 % ; P = 0.05 ) . Frail elderly can gain weight through oral supplementation , indicating the reversibility of weight loss in this group , but changes in functional status indicators may require a longer period of supplementation BACKGROUND Patients who undergo surgery are at risk of malnutrition due to periods of starvation , the stress of surgery , and subsequent increase in metabolic rate . There are limited data on nutritional outcome of surgical patients . AIMS To investigate changes in nutritional status and the influence of oral supplements on nutritional status , morbidity , and quality of life in postoperative surgical patients . METHODS Entry was determined by the presence of malnutrition , as defined by a body mass index ( BMI ) ⩽20 kg/m2 , anthropometric measurements ⩽15th percentile on admission , or initiation of oral diet postoperatively and /or a weight loss of 5 % or more during the operative period . We studied 101 patients : 52 were r and omised to the treatment group ( TG ) and prescribed a 1.5 kcal/ml nutritional supplement ; 49 patients were r and omised to the control group ( CG ) and continued with routine nutritional management .  Nutritional status was assessed by weight , anthropometry , and grip strength , with measurements taken at two weekly intervals for 10 weeks . Complications , namely wound infection , chest infection , and antibiotic use were documented . Quality of life ( QOL ) was assessed using the UK SF-36 question naire . RESULTS Patients in the control group lost a maximum mean ( SD ) of 5.96 ( 4.21 ) kg in weight over a period of eight weeks while patients in group TG lost less weight overall ( maximum mean ( SD ) 3.40 ( 0.89 ) kg ( p<0.001 ) occurring at four weeks and progressively regained weight from week 4 ) . Anthropometry , grip strength , and QOL were similarly significantly different between groups ( p<0.001 ) . Fewer patients in the treatment group ( 7/52 ) required antibiotic prescriptions compared with the control group ( 15/49 ) . CONCLUSIONS Nutritional status declined for two months after discharge . Postoperative nutritional supplementation improved nutritional status , QOL , and morbidity in these patients OBJECTIVE to evaluate the use of high-energy , high-protein , oral , liquid , nutrition supplementation and nutrition counseling on the weight status of patients infected with the human immunodeficiency virus ( HIV ) with and without secondary infections . DESIGN Prospect i ve , descriptive , intervention trial . Follow-up clinic visits were scheduled every 1 to 3 weeks for at least 6 weeks to monitor weight , gastrointestinal symptoms , number of supplements consumed , and incidence of secondary infections . SUBJECTS/ SETTING Community-based , HIV-infected patients , with and without an acquired immunodeficiency syndrome ( AIDS ) defining illness , who were receiving outpatient medical care at Deaconess Hospital . Twenty-two patients enrolled ; however , 4 dropped out and 1 died , so 17 were eligible for evaluation . INTERVENTION Dietary counseling consisted of recommendations to consume a high-protein diet ( 1.5 g/kg ideal body weight ) ; select foods that minimize gastrointestinal complications ; and take at least one high-energy , high-protein , oral , liquid , nutrition supplement daily . MAIN OUTCOME MEASURES Energy intake from the supplements and weight change over time in relation to whether a secondary infection occurred . STATISTICAL ANALYSIS Means , st and ard deviations , and frequency . RESULTS At the time of entry to the study , the patients with preexisting weight loss  ( 16 of 17 ) were 14+/-8 % below their usual body weight . On average , patients consumed 11+/-4 supplements per week for 6+/-3 weeks . The majority ( 12 of 17 ) were able to gain or maintain weight . Overall weight change was 1.1+/-2.2 kg . Only 5 of 17 patients lost weight , 4 of whom developed a secondary infection during the study ( ie , after enrollment in the study ) . All of those who developed a secondary infection were classified as having AIDS and had lower mean CD4 counts at baseline than those who did not develop a secondary infection . Although those who developed a secondary infection had a higher incidence of weight loss , their consumption of oral supplements per week was greater than that of those without a secondary infection . APPLICATIONS/ CONCLUSIONS In patients with HIV infection and in the early stages of AIDS without a secondary infection , weight gain and /or maintenance was achievable with a high-energy , high-protein , oral , liquid , nutrition supplement in conjunction with nutrition counseling . The majority of the patients who developed a secondary infection , however , lost weight despite the use of supplements and counseling . Use of a high-energy , high-protein , oral , liquid , nutrition supplement , with intact nutrients , should be the first-line nutrition treatment for malnourished , HIV-infected patients without secondary infections 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 The impact of oral nutritional supplementation during an acute exacerbation of COPD on functional status was assessed through measuring change in lung function , strength testing , and general well-being .  Subjects hospitalized for an acute exacerbation of COPD ( n = 33 ) were r and omized to extra nutritional support or the regular hospital care . They consumed an additional 10 kcal/kg/d . Outcome measures were measured at 2 wk as change scores . Forced vital capacity ( % predicted ) improved in the treatment group as compared with the control group ( + 8.7 % versus -3.5 % , p = 0.015 ) , and change in FEV1 was in the same direction but not significantly different ( p = 0.099 ) . There were no changes in h and grip strength or respiratory muscle strength , but there was a trend towards more improvement in the general well-being score ( + 11.96 versus -10.25 , p = 0.066 ) . Almost all subjects were in negative nitrogen balance , indicating muscle wasting . The degree of muscle wasting was strongly correlated with the dose of corticosteroids ( r = 0.73 , p < 0.005 ) . In conclusion , it is difficult to prevent important muscle wasting in patients with COPD treated with corticosteroids , but some small gains were observed with increased dietary intake OBJECTIVES To determine why elderly nursing home patients receive liquid oral protein supplements , what nutritional assessment is utilized , and whether there is evidence of effectiveness . DESIGN Retrospective , case control study comparing patients over 65 years of age , at two nursing homes , who were served oral supplements ( OS ) at least twice daily ( n = 56 ) , with a r and om sample of non-supplemented , non-tube fed patients ( n = 53 ) . Comparisons included medical diagnoses , medications , morbidity and mortality , weight changes , laboratory test results , and functional and behavioral status . RESULTS Nursing home patients were begun on OS ( median time after admission = 2 months , range = 0 - 72 months ) primarily because of weight loss ( 71 % ) and poor appetite ( 16 % ) . Supplemented patients were below an age-adjusted body weight on admission , unlike controls , and continued to lose weight until OS were started . On OS , weight was slowly regained over 9 - 10 months in a majority of patients to approximate admission weight . Some patients on OS showed improvement in albumin , total lymphocyte count , cholesterol , or hemoglobin , but too few patients had sufficient lab tests to verify any consistent effect . Mortality was higher in OS patients ( 8 vs 2 , P = 0.057 ) , who were also somewhat older ( 87.9 vs 84.5 years ) , but there was no statistical difference in infection or hospitalization rate . MEASUREMENTS Nutritional assessment in these nursing homes consisted almost exclusively of ( 1 ) serial measurement of weight , ( 2 ) comparison of weight to ( a ) " ideal body weight " and ( b ) previous weight , and ( 3 ) a subjective evaluation of food consumption . No other anthropometric evaluations or laboratory tests were conducted for nutritional assessment . CONCLUSIONS The diagnosis of and intervention in under-nutrition in nursing home patients is frequently disorganized . In addition , nutritional assessment , either for screening or for following intervention , is hampered by the lack of convenient and unambiguous assessment tools . OS use is associated with weight gain in many nursing home patients and also improves other nutritional parameters in selected individuals Seventeen patients undergoing 19 major urological operations for bladder cancer or rectal leiomyosarcoma ( 1 case ) were studied after r and omization for 3 hypocaloric dietary regimens , preoperative keto-adaptation by a carbohydrate-free , oral protein diet continued in the postoperative period by isotonic amino acid infusions , postoperative amino acid infusions only and 5 per cent dextrose infusions . In these normally nourished patients serum transferrin ( plus 13 mg./dl . minus 30 mg./dl . , minus 69 mg./dl . , p less than 0.05 for the first and combined amino acid groups against the third group ) and 2 other short half-life hepatic secretory proteins , prealbumin and retinol-binding protein , represented sensitive indexes of visceral protein and nutritional support , superior to nitrogen balance , anthropometric assays , delayed hypersensitivity skin test reactivity and serum albumin .  Near isotonic amino acid infusions were more effective in preserving visceral protein status than 5 per cent dextrose but preoperative keto-adaptation was not shown to have any increased benefit over protein-sparing therapy given only after an operation Summary . The objective of this prospect i ve study of matched controls was to find out whether supplementary nutrition would improve wound healing and decrease mortality in patients undergoing transtibial amputation for occlusive arterial disease . The nutritional status of 32 consecutive transtibial amputees was assessed and 28 were classified as malnourished .  Supplementary nutrition was given reaching an average intake of 2098 kcal/day for a total of 11 days . In 24 patients , at least 5 days of preoperative supplementary nutrition were given , followed by postoperative treatment for a total of 11 days . Four patients who had an immediate operation were given only postoperative treatment , and 4 were excluded . The controls were 32 amputees in another hospital and matching procedures were carried out with corrections for diabetes , sex , age , smoking habits , previous vascular surgery and living conditions before amputation .  Healing , including those healed before death in both groups , occurred in 26 of the nutrition group compared to 13 in the control group , which was statistically significant . Nine patients died within 6 months in the nutrition group compared to 14 of the controls ( not significant ) . Malnutrition was present in nearly 90 % of transtibial amputees and supplementary nutrition improved healing , but not mortality . Résumé . L’objectif de cette étude prospect i ve a été d’étudier si une augmentation de l’apport nutritionnel peut ameliorer la cicatrisation et réduire la mortalité chez les malades ayant subi une amputation de jambe en raison d’une maladie vasculaire . L’état nutritionnel de trente-deux patients consécutifs ayant subi une amputation de jambe a étéévalué . Vingt-huit ont été considérés comme malnutris . Une nutrition additionnelle leur a été donnée avec un apport moyen de 2098 kcal par jour pendant 11 jours . Chez 24 malades une nutrition additionnelle , de cinq jours au moins en préopératoire , a été suivie par un traitement postopératoire pour atteindre un total de 11 jours . Quatre malades necessitant une amputation en urgence n’ont re*u le traitement que postopératoire et quatre malades ont été exclus . Trente deux amputés de jambe venant d’un hopital universitaire voisin ont été utilisés comme contrôle , après associations des cas tenant compte de l’age , le sexe , du diabète , de la consommation de tabac , des opérations vasculaires précédentes et des conditions de vie antérieure à l’amputation . L’étude de la cicatrisation a montré que 26 amputés étaient cicatrisés dans le groupe ayant bénéficié d’un apport nutritionnel contre 13 dans le groupe de controle , P= 0.001 . Neuf patients sont morts dans les premier six mois dans le groupe ayant bénéficié d’un apport nutritionnel contre 14 dans le groupe de controle , ( n. s. ) . Cette étude montre clairement que près de 90 % des amputés de jambe étaient malnutris et qu’un apport nutritionnel a amelioré la cicatrisation du moignon sans pour autant augmenter la survie A body weight lower than 90 % of the optional value has an unfavorable influence on the prognosis of chronic obstructive pulmonary disease ( COPD ) . Short term studies of up to three months duration have shown improved function of respiratory muscle exercise tolerance and immunologic parameters by an increased caloric intake of 45 kcal/kg body weight . In a r and omized trial of twelve months 14 of 30 patients with an average FEV1 of 0.8 l were instructed to take a high calorie diet . For simplicity a part of the calories were administered as Fresubin , a fluid nutrient formula . Although a weight gain of 7 kg ( p = 0.003 ) was obtained the difference to the control group was statistically not significant ( p = 0.08 ) . The same was true for skin fold thickness ( 12.4 vs 5.7 mm ) , change of ventilatory parameters and the 6 minute walking distance ( -33 vs -86 m ) . Subjective improvement was , however , impressive in all patients with dietary intervention , explainable probably by increased attention . Dietary counselling for increased intake of calories , vitamins and also calcium is thus very important in the treatment of patients with COPD Fifty ambulatory patients with head and neck cancer treated by definitive radiation therapy at the Fox Chase Cancer Center were prospect ively studied to determine the effect of oral nutritional supplements on both nutritional status and treatment response . Nutritional supplements maintained serum albumin during and post treatment . Nutritional supplements were shown to increase total protein and total calorie intake rather than displace these nutrients in usual food intake . Equal weight loss occurred in both the supplemented and non-supplemented groups during the observation period of 6 months , with the same or greater amount of weight loss registered 10 weeks after the start of treatment . Food supplements did not affect treatment response or complications , nor did they offer any survival advantage OBJECTIVE To evaluate the impact of nutritional supplementation on nutritional status , muscle strength , perceived health , and functional status in a population of community-living , frail , undernourished elderly people . DESIGN A 16-week intervention study in which subjects were r and omized to an experimental or a control group and visited in their home on a monthly basis . Outcome variables were measured at the start and end of the study at subjects ' homes by a dietitian blinded to treatment assignment . SUBJECTS/ SETTING 83 elderly people ( experimental group : n=42 ; control group : n=41 ; mean age=80+/-7 years ) receiving community home-care services and at high risk for undernutrition . INTERVENTION Provision of a nutrient-dense protein-energy liquid supplement and encouragement to improve intake from other foods . OUTCOME MEASURES Anthropometric indexes , h and grip strength , isometric elbow flexion and leg extension strength , lower extremity function , perceived health , and functional status . STATISTICAL ANALYSES Study groups were compared on an " intention to treat " basis using analysis of variance for repeated measures and unpaired and paired t tests and their nonparametric equivalents where appropriate . RESULTS Total energy intake ( 1,772 vs 1,440 kcal ; P<.001 ) and weight gain ( 1.62 vs 0.04 kg ; P<.001 ) were higher in the supplemented group . No significant changes were observed with respect to other anthropometric indexes , muscle strength , or functional variables ; however , beneficial effects were observed in emotional role functioning ( P<0.01 ) and number of days spent in bed ( P=.04 ) . APPLICATIONS/ CONCLUSIONS Nutrition intervention is feasible in free-living , frail , undernourished elderly people and results in significant improvement of nutritional status with respect to energy and nutrient intake and weight gain . Weight loss can be stopped and in some cases reversed ; however , increased physical activity may also be required to improve health and functional status Abstract . A total of 29 patients with acute leukaemia were prospect ively r and omized before starting cytos‐tatic treatment to be nourished either with intensified oral nutrition ( intervention group ) or ad libitum nutritional intake during the whole tumour therapy ( median 22 weeks ) . All menus of free choice ( daily offer of 1.0–2.0 g protein , 30–50 kcal kg‐1 body weight ( BW ) ) . Beyond this , intervention patients nutrition education , daily visits by the dietician and record of food intake , as well as a weekly assessment of subjective well‐being ( linear analogue self assessment ‘ LASA ’ ) . From the LASA items , the factors : ‘ malaise ’ , ‘ psychological distress ’ , ‘ therapy side‐effects ’ were extracted by principal component analysis , and correlated to nutrient intake and nutritional status . At the end of antineoplastic induction therapy , after continuous hospitalization of 10 weeks ( median ) , 31.3 % of the controls had regained their initial nutritional status , and 68.8 % of the intervention group . Mean daily energy intake was 23.2 kcal kg‐1 BW during weeks with weight loss ( constant weight : 30.9 , weight gain : 39.3 kcal kg‐1 BW ) . Nutritional . behaviour correlated with subjective well‐being , low intake with complaints of tumour treatment side effects and weight loss with malaise Background : No data is available on dietary intervention in c and i date s for lung transplantation and on the effect of different strategies for dietary support in this cohort . Aim : We therefore wanted to evaluate the effects of intensified nutritional support compared with simple support on energy intake and nutritional status . Method : Our participants were underweight ( n = 42 ) and normal-weight ( control group , n = 29 ) c and i date s for lung transplantation . The underweight patients were r and omized into two groups . Group A received intensified dietary counselling , ready-made liquid nutritional supplements free of charge and regular follow-ups , while group B received only one session of individual dietary counselling , no supplements and no follow-ups . Results : The mean intervention time was 21 weeks . Groups A and B both increased their energy intake and gained weight . Group A increased their energy intake from a median of 8.7 to 10.1 MJ ( p < 0.01 compared with the control group after intervention ) and gained a mean of 2.9 kg body weight ( 95 % CI 1.2 ; 4.7 , p = 0.005 compared with the control group ) , while group B increased from 7.4 to 10.8 MJ ( p = 0.005 ) and gained 2.3 kg ( 1.2 ; 3.3 , p = 0.002 ) . Only group B increased their fat-free mass . In this group , an increase in O2 saturation and a decrease in PaCO2 were suggested . None of the groups improved its physical performance . Conclusion : In c and i date s for lung transplantation we were unable to confirm the hypothesis that intensified nutritional support compared with a simple support increased compliance . Both groups achieved the goal for energy intake and gained weight One hundred ninety-two patients with previously untreated metastatic cancer ( 102 non-small-cell lung cancer [ NSCLC ] ; 90 colorectal cancer ) were r and omized to receive either ad lib nutritional intake ( control group ) or specific nutritional intervention during a 12-week study period when chemotherapy was administered . Those patients r and omized to nutritional interventions were counselled to take oral nutrients with caloric intake equal to 1.7 to 1.95 times their basal energy expenditure , depending on their pretreatment nutritional status ( " st and ard " group ) . An augmented group was counselled to have a caloric intake equivalent to that of the st and ard group but with 25 % of calories provided as protein and additional supplements of zinc and magnesium . Counselling increased caloric intake in both tumor types but reduced weight loss in the short term only for lung cancer patients . Ninety-three NSCLC patients were evaluable for tumor response to vindesine and cisplatin . Overall , only 20.4 % of the patients responded , and there were no significant differences in response rates , median time to progression , or overall duration of survival between the nutrition intervention groups and the control group . The tumor response rate to time-sequenced 5-fluorouracil ( 5-FU ) and methotrexate in the 81 evaluable patients with colorectal cancer was only 14.8 % , and no significant differences in tumor response rates were noted between the three groups . Furthermore , the median time to progression and overall duration of survival were not different for the control , st and ard , and augmented groups . Nutritional interventions using dietary counselling had no impact on the percent of planned chemotherapy dose administered , the degree of toxicity experienced by patients , or the frequency of treatment delays . A multivariate prognostic factor analysis demonstrated that for lung cancer , the percent of weight loss , serum albumin concentration , and presence of liver metastases were significant ( P less than .05 ) and independent prognostic variables for survival duration . For colorectal cancer , serum albumin , alkaline phosphatase , lactic dehydrogenase ( LDH ) levels , and percent targeted caloric intake ( TCI ) were significant independent predictors of survival duration OBJECTIVES To determine the effect of early intensive dietary intervention and follow-up on weight gains in newly transplanted renal patients . To provide appropriate dietary advice posttransplant that included advice to reduce weight gains . DESIGN Group A was studied prospect ively and group B was studied retrospectively over a period of 1 year posttransplant . SETTING Hospital transplant unit : inpatient ward and outpatient clinic . PATIENTS Thirty-three transplant patients were studied : Group A consisted of 11 patients ( 9 men , 2 women ) transplanted consecutively over 2 months , with a mean age of 39 years . Group B consisted of 22 patients ( 14 men , 8 women ) who had been transplanted consecutively 4 years before the study , with a mean age of 40 years . Both groups had functioning grafts ( serum creatinine < 200 micromol/L [ 2.2 mg/dL ] ) over the study period , and similar triple immunosuppressive therapy ( prednisolone , cyclosporine , and azathioprine ) . INTERVENTION Group A received intensive , individualized dietary advice in stages , with regular follow-up for the first 4 months posttransplant . Thereafter group A did not receive any dietary advice or follow-up for the 8 months leading up to 1 year posttransplant . Group B had not received any dietary advice or follow-up posttransplant . MAIN OUTCOME MEASURE Weight gained and body mass index ( BMI ) at 4 months and at 1 year posttransplant . RESULTS The mean weight ( BMI ) for group A at baseline , 4 months and at 1 year posttransplant was 67 + /- 13 kgs ( 24.1 + /- 3.9 kg/m2 ) , 69 + /- 12 kgs ( 24.6 + /- 3.5 kg/m2 ) , and 73 + /- 12 kgs ( 26.1 + /- 3.4 kg/m2 ) , respectively . The mean weight ( BMI ) for group B at baseline , 4 months and at 1 year posttransplant were 67 + /- 11 kgs ( 23.7 + /- 3.4 kg/m2 ) , 74 + /- 9 kgs ( 26.3 + /- 3.3 kg/m2 ) , and 79 + /- 12 kgs ( 27.9 + /- 4 kg/m2 ) , respectively . Analysis of group A showed no significant difference in weight gained and BMI with dietary advice and follow-up at 4 months posttransplant compared with baseline . There was a significant difference in weight gain and BMI at 1 year posttransplant compared with 4 months posttransplant ( P = .002 , P = .002 , respectively ) . Analysis between groups showed a significantly lower weight gain in group A compared with group B both at 4 months and at 1 year posttransplant ( P = .01 , P = .01 respectively ) . Group A had a significantly lower BMI than group B at 4 months and at 1 year posttransplant ( P = .003 , .006 , respectively ) . At 1 year posttransplant , group A had a mean weight gain of 5.5 kg per patient compared with a mean of 11.8 kg per patient in group B. CONCLUSION Early intensive dietary advice and follow-up is effective in controlling weight gains in the first year posttransplant . Dietary advice should be an important part of posttransplant treatment Cancer patients , assessed as nutritionally at risk , were r and omly assigned to a control group or to one of four intervention groups receiving ( a ) nutritional supplementation , ( b ) relaxation training , ( c ) both nutritional supplementation and relaxation training , or ( d ) neither nutritional supplementation nor relaxation training .  Fifty-five subjects completed a four-month intervention period during which they were visited biweekly by a nurse ( except control subjects ) . In repeated measures analyses of variance , significant group-by-time interactions were obtained for weight and arm muscle circumference ( a measure of protein stores ) , indicating that for these measures the groups changed differentially during the intervention period . The group-by-time interaction approached significance on the Karnofsky Performance Status Scale . For all three variables , gain was greatest for the relaxation group ; the most severe loss occurred in the control group . These findings suggest that the cachexia of cancer may be slowed or reversed through noninvasive nursing interventions The objective of this study was to determine the prevalence and correlates of malnutrition in patients living at home with cancer and chronic diseases . Patients ( 213 ) with cancer and 228 patients with chronic diseases were r and omly selected from general practice registers . Nutritional status was determined from body mass index ( BMI in kg/metre2 ) ,  triceps skinfold thickness ( TST ) ,  mid-arm muscle circumference ( MAMC ) and population centiles . Patients were classified as mildly malnourished if they had a BMI < 20 and TST or MAMC < 15th centile , moderately malnourished if they had a BMI < 18 and TST or MAMC < 5th centile , and severely malnourished if they had a BMI < 16 and TST or MAMC < 5th centile . Using these criteria , nearly 10 % of patients were malnourished : 24 ( 5.4 % ) mildly , 12 ( 2.7 % ) moderately and 4 ( 0.01 % ) severely . Malnutrition was more common in patients in social classes 3.2 , 4 and 5 than in social classes 1 , 2 and 3.1 ( P = 0.003 ) , and in patients receiving district nurse care ( P < 0.001 ) . Malnutrition was more prevalent in cancer patients who complained of chronic or severe pain ( 32 % vs 12 % , P = 0.021 ) and in patients with chronic disorders who experienced mental apathy ( 22 % vs 5 % , P = 0.014 ) . Clinicians need to be aware that malnutrition is common in patients living at home . In this study BMI proved to be a fairly good indicator of malnutrition and routine measurement of BMI would be one simple way of detecting patients who are at risk The association between severe nutritional depletion and chronic obstructive pulmonary disease ( COPD ) has long been recognized . A potential therapeutic benefit to nutritional support was previously suggested by us in a pilot investigation . Subsequent studies have reported conflicting results regarding the role of nutritional therapy in this clinical population . We report a r and omized controlled study of nutritional therapy in underweight patients with COPD that combines an initial inpatient investigation ( controlled nutritional support ) with a prolonged outpatient follow-up interval . Provision of adequate calorie and protein support , adjusted to metabolic requirements , result ed in weight gain ( intervention = + 2.4 kg versus control -0.5 kg ) , improved h and grip strength ( intervention = + 5.5 kg-force versus control -6.0 kg-force ) , expiratory muscle strength ( intervention = + 14.9 cm H2O versus control -9.2 cm H2O ) , and walking distance ( intervention = + 429 feet versus control -1.0 foot ) . Inspiratory muscle strength was also improved ( intervention = + 11.4 cm H2O versus control + 4.8 cm H2O ) although this did not quite reach statistical significance . We conclude that provision of adequate nutrient supply under controlled conditions results in significant clinical improvements in the COPD patient population . However , the intervention is costly , time-intensive , and of limited therapeutic magnitude . More detailed work of alternative outpatient strategies combined with additional rehabilitative measures is indicated to delineate the full therapeutic potential of nutritional support for this clinical population BACKGROUND It was hypothesized that energy intake in hospitalized elderly patients could be improved by increasing the density of energy of the food and that the volume of food actually consumed , even with a higher energy content than the normal , would not change with servings of high energy-dense hospital food . METHODS Thirty-six elderly patients ( 52 to 96 years ) of both sexes , long-term treated at two comparable wards , participated in this study . The patients were given 6 weeks of regular hospital food ( RHF , 1670 kcal/d , 7.0 MJ ) and 6 weeks of high-energy food ( HE , 2520 kcal/d , 10.5 MJ ) . The volume of food was kept constant . A crossover study design was used . Food intake , energy intake , body weight , and modified functional condition ( Norton scale ) were measured . RESULTS Regardless of type of food ( RHF or HE ) and time of day ( lunch or dinner ) , he food portion size ( volume of food ) intake was the same , approximately 80 % of the portions consumed . HE led to a 40 % increase in energy intake ( from 25 + /- 1 during RHF to 35 + /- 2 kcal/kg/d , p < .0001 ) , which result ed in a 3.4 % increase in body weight ( p < .001 ) after 3 weeks of HE . Only minimal changes in functional condition were found . The cost of HE was substantially lower ( -85 % ) than any other mean available for improvement of energy intake . CONCLUSIONS A significant increase in energy intake can be achieved by higher energy density in regular hospital food and that HE does not cause a decrease in the volume of the food consumed . These findings suggest that it is the volume of food rather than the energy that limits voluntary energy intake of hospital food in elderly hospitalized patients Involuntary weight loss is often seen among patients with gastrointestinal ( GI ) cancer . Weight loss may influence quality of life ( QoL ) and is a predictor of survival . The present study is an attempt to improve body weight development in GI cancer patients by individual support ( IS ) , including nutritional measures . Patients were r and omized in a 2 × 2 design between 1 ) IS , including nutritional support , 2 ) group rehabilitation ( GR ) , 3 ) IS + GR ( ISGR ) , or 4 ) st and ard care ( SC ) .  Data concerning dietary intake ( 24-h recalls ) , body weight , and QoL ( EORTC-QLQ C-30 ) were collected over 2 yr for 67 patients with colorectal or gastric cancer , r and omized to IS or ISGR .  Data on weight and QoL were collected for 70 patients with the same diagnoses r and omized to GR or SC . Despite a tendency to greater weight loss at inclusion , the IS + ISGR group managed to gain weight significantly more rapidly and to a greater extent than the GR + SC group . The differences became statistically significant at 12 and 24 mo ( P < 0.05 ) . Patients with weight loss at baseline increased their energy intake and weight more than those without weight loss . No differences were seen in QoL ratings between r and omization groups , but there was a positive correlation between weight development and QoL and a negative correlation between fatigue and weight development . There was a numerical difference , not statistically significant ( P = 0.3 ) , indicating a shorter time of survival in patients in the GR + SC group . IS , including nutritional support , leads to more rapid weight gain than SC in patients with newly diagnosed GI cancer Abstract Objectives : To determine incidence of malnutrition among patients on admission to hospital , to monitor their changes in nutritional status during stay , and to determine awareness of nutrition in different clinical units . Design : Prospect i ve study of consecutive admissions . Setting : Acute teaching hospital . Subjects : 500 patients admitted to hospital : 100 each from general surgery , general medicine , respiratory medicine , orthopaedic surgery , and medicine for the elderly . Main outcome measures : Nutritional status of patients on admission and re assessment on discharge , review of case notes for information about nutritional status . Results : On admission , 200 of the 500 patients were undernourished ( body mass index less than 20 ) and 34 % were overweight ( body mass index > 25 ) . The 112 patients reassessed on discharge had mean weight loss of 5.4 % with greatest weight loss in those initially most undernourished . But the 10 patients referred for nutritional support showed mean weight gain of 7.9 % . Review of case notes revealed that , of the 200 undernourished patients , only 96 had any nutritional information documented . Conclusion : Malnutrition remains a largely unrecognised problem in hospital and highlights the need for education on clinical nutrition Elderly long-term care patients ( n = 501 ) were r and omly allocated to receive dietary supplementation ( 400 kcal/day ) in addition to a normal hospital diet , or normal hospital diet only , for 26 weeks . The patients ' functional condition was assessed by a modified Norton scale comprising mental condition , activity , mobility , food intake , fluid intake , incontinence and general physical state . Nutritional status was assessed by anthropometry , serum protein analysis and delayed hypersensitivity skin tests . Improvements during the first 8 weeks were seen in activity and general physical condition in the supplemented group , and in mobility and general physical condition in the control group . After 8 weeks the supplemented group showed a significantly higher level of activity ( p < 0.05 ) compared to the control group . We conclude that in long-term geriatric care nutritional supplements help to maintain and improve the patients function AIMS To compare nutritional counseling with and without oral supplements in HIV-infected patients with recent weight loss . DESIGN R and omized non-blinded controlled trial , stratified for change in antiretroviral treatment at baseline . PATIENTS HIV-infected patients with recent weight loss ( > 5 % of total , and > 3 % in the last month ) . INTERVENTION Nutritional counseling to increase dietary intake by 600 kcal/day over 8 weeks ; in group A ( n=24 ) by normal food , and in group B ( n=26 ) by a range of fortified drink supplements with a calorific value of 0.6 to 1.5 kcal/ml . METHODS Body composition by bioelectrical impedance analysis , dietary intake by 24 h recall . RESULTS Fat free mass increased from baseline to week 8 ( P<0.05 ) with no difference between groups A and B ( P=0.97 ) . Body cell mass and weight gain were not significant and equal between groups . Assessed at weeks 2 and 4 , group B patients consumed 11 + /- 6 kcal/kg as supplements , and their total energy intake was 6 kcal/kg higher than in group A ( P<0.01 ) . Total energy intake was not different between groups at weeks 6 and 8 . DISCUSSION Nutritional counseling and oral supplements are both feasible methods to restore food energy intake in malnourished HIV-infected patients . Although normal food intake is partially replaced , oral supplements may improve the adherence to a weight gain regimen BACKGROUND : Previous work has shown that the administration of oral dietary supplements to patients who have undergone gastrointestinal surgery results in clinical ly significant short term benefits . AIMS : This study aim ed firstly to re-evaluate these short term effects , and secondly to establish whether there are any long term benefits . SUBJECTS : One hundred patients admitted for elective moderate or major gastrointestinal surgery . METHODS : In the inpatient phase , patients were r and omised to receive a normal ward diet postoperatively , or the same diet supplemented with an oral dietary supplement . In the outpatient phase , patients were further r and omised to receive their home diet , or their home diet supplemented with the oral dietary supplement for four months . RESULTS : During the inpatient phase , patients treated with oral supplements had a significantly improved nutritional intake and lost less weight ( 2.2 , 95 % confidence interval ( 95 % CI ) 0.9 kg ) compared with control patients ( 4.2 ( 0.78 ) kg , p < 0.001 ) . Supplemented patients maintained their h and grip strength whereas control patients showed a significant reduction in grip strength ( p < 0.01 ) . Subjective levels of fatigue increased significantly above preoperative levels in control patients ( p < 0.01 ) but not in the supplemented group . Twelve patients in the control group developed complications compared with four in the supplemented group ( p < 0.05 ) . In the outpatient phase , supplemented patients had improved nutrient intakes but there were no significant differences in indices of nutritional status or wellbeing between the groups . CONCLUSIONS : The prescription of oral dietary supplements to patients who have undergone gastrointestinal surgery results in clinical ly significant benefits . These benefits , however , are restricted to the inpatient phase PURPOSE This study examined the effect of frequent nutritional counseling on oral intake , body weight , response rate , survival , and quality of life in patients with cancer of the lung ( small-cell ) , ovary , or breast undergoing cyclic chemotherapy . PATIENTS AND METHODS Of 105 assessable patients , 57 were r and omized to receive nutritional counseling , and 48 to receive no nutritional counseling and consumption of an ad lib oral intake .  The intervention group was counseled to achieve a daily energy and protein intake according to recommended dietary allowances . Counseling was st and ardized and performed by a trained dietitian , and took place twice monthly during a 5-month period from start of chemotherapy . RESULTS Dietary counseling increased daily energy intake by approximately 1 MJ and protein intake by 10 g over the entire study period . There was no change in the control group . Counseling led to an insignificant increase in body weight , but triceps skinfold measurement increased significantly after 5 months . Response rate and overall survival did not differ between the groups . Quality of life measured by the Quality -of-Life index ( QL-index ) increased significantly in both groups , but did not differ between groups . CONCLUSION No clinical benefit could be demonstrated despite long-term and continuous improved food intake in cancer patients with solid tumors undergoing aggressive chemotherapy We examined changes in the nutritional status of elderly patients with chest infection for a period of 3 months after discharge from hospital , including the effects of nutritional supplementation on well-being and functional status as well as on nutritional indices . Eighty-one subjects admitted to an acute medical ward aged 65 years and over with chest infection were recruited consecutively , and r and omized to receive supplement ( 500 ml of Ensure liquid daily ) for 1 month , or no supplement , on discharge . Assessment at baseline , 1 , 2 and 3 months included a question naire to determine health , mental and functional status , and anthropometric measurements . Biochemical nutritional status was assessed at baseline , 1 and 3 months , and  dietary intake  ( 24 h recall method ) at 1 and 3 months . During recovery , both supplement and non-supplement groups showed improvement in various measures of well-being and biochemical status . In addition , the former group showed improvement in more anthropometric measurements , in thiamine and pyridoxine status , while the non-supplement group showed a lower level of functional ability after 3 months . Various measures of well-being and biochemical status of the water-soluble vitamins were better in the supplement groups . We conclude that nutritional supplementation may have a role in helping elderly patients to recover from chest infections PURPOSE / OBJECTIVES To describe the effect of nutritional supplements on food intake in patients undergoing radiotherapy .  DESIGN Experimental prospect i ve . SAMPLE 40 newly diagnosed patients with cancer beginning external beam radiation therapy .  METHODS Weekly dietary counseling and recording of total daily dietary intake for three days a week for four weeks . One half of the subjects were r and omly assigned to ingest a liquid nutritional supplement between meals and at bedtime . MAIN RESEARCH VARIABLES Total daily protein and caloric intake , food-derived protein and caloric intake , and supplement-derived protein and caloric intake . FINDINGS Subjects ingesting nutritional supplements between meals significantly increased their total caloric and protein intake above that of controls and did not reduce their food-derived caloric or protein intake compared to controls . CONCLUSIONS Nutritional supplements can be used to increase total caloric and protein intake without causing a significant reduction in food intake . IMPLICATION S FOR NURSING PRACTICE In this patient sample , supplements were not substituted for food intake . Further research is needed to determine the effects of supplements on appetite in patients with advanced cancer We carried out a prospect i ve , r and omized , controlled trial to investigate the effect of a 3-month period of supplementary oral nutrition in 14 poorly nourished out patients with COPD . Seven patients were r and omized into Group 1 who received their normal diet during Months 1 to 3 , a supplemented diet during Months 4 to 6 , and their original normal diet during Months 7 to 9 . The other 7 patients received their normal diet for the entire 9-month study period ( Group 2 ) . Seven well-nourished patients ( Group 3 ) matched for age and severity of air-flow obstruction served as control subjects ; they received their normal diet for the 9-month study period . Measurements of nutritional status , respiratory muscle and h and grip strength , sternomastoid muscle function ( including frequency/force curves , maximal relaxation rate , and a fatigability test ) , lung function , arterial blood gas tensions , general well-being and breathlessness scores , and 6-min walking distances were carried out monthly in all patients . At the start of the study , the poorly nourished patients had lower mean daily calorie and protein intakes than did the well-nourished patients . The poorly nourished patients had lower respiratory muscle and h and grip strength , and abnormal contractility and increased fatigability of the sternomastoid muscle compared with those in the well-nourished patients . After 3 months of supplementary oral nutrition , there was a significant improvement in the nutritional status of Group 1 patients , as evidence d by an increase in body weight , triceps skinfold thickness , and midarm muscle circumference . Respiratory muscle and h and grip strength increased in parallel with nutritional status , although there were no significant changes in lung function or arterial blood gas tensions . ( ABSTRACT TRUNCATED AT 250 WORDS The objective of this study , design ed as a r and omized controlled prospect i ve intervention study , was to evaluate the effect of nutritional supplementation on functional status and need of care in undernourished geriatric patients during hospitalization , and up to 6 months after discharge . Participants consisted of 46 undernourished geriatric patients from a geriatric acute care hospital aged 75 years or older without malignant disease , or need for tube feeding or parenteral nutrition . Patients in the supplement group ( SG , N=20 ) were offered 400 mL ( 2100 kJ ) daily of a liquid supplement during hospital stay and 200 mL ( 1050 kJ ) per day for the following 6 months at home . Patients in the control group ( CG , N=26 ) had usual care without supplements . The main outcome measure was functional status based on the Barthel Activities of Daily Living score ( ADL ) at hospital admission , discharge and after 6 months , with higher scores indicating greater independence and a maximum score of 100 points . In supplemented patients with good acceptance ( SG+ , N=11 ) , a median improvement of 20 points was observed between admission and discharge , and a further improvement of 5 points at home . Median changes were 0 and −10 points in supplemented patients with poor acceptance ( SG- , N=9 ) and 5 and 2.5 points in CG , respectively . In SG+ , the proportion of independent patients ( > 65 points ) increased continuously from 36 % at admission to 63 % at discharge , to 72 % after 6 months , and was significantly higher compared to CG at discharge ( 63 % vs 19 % , pš 0.05 ) and after 6 months ( 72 % vs 39 % , p<0.05 ) . 64 % of the patients in SG+ improved during hospitalization , compared to 23 % in CG ( p<0.05 ) . In the six months at home , 18 % of SG+ improved ; none of SG+ deteriorated in hospital or at home . In contrast , deterioration of the ADL score occurred in considerable proportions of SG− ( 22 % in hospital , 22 % at home ) and CG ( 4 % at hospital , 12 % at home ) patients . The proportion of patients who improved was smaller in SG− ( 44 % at hospital , 22 % at home ) as well as in CG ( 23 % at hospital , 35 % at home ) , compared to SG+ . In conclusion , a positive functional course was evident in supplemented patients with good acceptance during hospitalization , and further improvement was observed during the following 6 months at home . Nutritional support may contribute to reconvalescence and recovery of undernourished geriatric patients Weight loss and protein malnutrition are frequent complications in HIV‐infected patients . The effect of an oral nutritional supplement combined with nutritional counselling on whole body protein metabolism was assessed A Veterans Affairs cooperative study involving 273 male patients was performed to evaluate efficacy of ox and rolone in combination with an enteral food supplement in severe alcoholic hepatitis . All patients had some degree of protein calorie malnutrition . On an intention-to-treat basis , only minimal changes in mortality were observed . However , in patients with moderate malnutrition  mortality on active treatment at 1 mo was 9.4 % compared with 20.9 % in patients receiving placebo . This beneficial effect was maintained so that after 6 mo on active treatment 79.7 % of patients were still alive , compared with 62.7 % of placebo-treated patients ( p = 0.037 ) . Improvements in both the severity of the liver injury ( p = 0.03 ) and malnutrition ( p = 0.05 ) also occurred . No significant improvement was observed with severe malnutrition . To better determine the effect on therapeutic efficacy , we compared results with those from a nearly identical population ( cooperative study 119 ) treated with ox and rolone but not given the food supplement . Patients were stratified according to their caloric intake ( greater than 2,500 kcal/day was considered adequate to supply energy needs and promote anabolism ) . For patients with moderate malnutrition and adequate caloric intake , ox and rolone treatment reduced 6-mo mortality ( 4 % active treatment vs. 28 % placebo [ p = 0.002 ] ) . For patients with moderate malnutrition and inadequate calorie intake , ox and rolone had no effect on mortality ( 30 % active treatment vs. 33 % placebo ) . In cases of severe malnutrition , ox and rolone had no effect on survival . However , adequate caloric intake was associated with 19 % mortality , whereas patients with inadequate intake exhibited 51 % mortality ( p = 0.0001 ) . These results indicate that nutritional status should be evaluated in patients with alcoholic hepatitis . When malnutrition is present , vigorous nutrition therapy should be provided , and in patients with moderate malnutrition ox and rolone should be added to the regimen We studied the effects of oral nutritional supplementation on respiratory muscle ( RM ) performance in 25 ambulatory patients with severe chronic obstructive pulmonary disease ( COPD ) . There was a relationship between body weight and anthropometric parameters of nutritional status ( triceps skinfold thickness [ r = 0.67 ; p less than 0.005 ] , midarm muscle circumference ( r = 0.53 ; p less than 0.005 ) , but body weight did not correlate with daily caloric intake , serum albumin , transferrin , or blood lymphocyte count . None of these measurements of nutritional status correlated with any measure of RM strength or endurance . In a r and omized observer-blinded crossover trial , patients were allocated to one of two groups . In the first eight weeks of the study , group A received nutritional supplementation , and patients in group B were control subjects . In the second eight weeks , patients in group A were control subjects , and group B received supplement .  Mean daily caloric intake and body weight increased in both groups while receiving supplement ( both p less than 0.05 ) . Calories provided by the supplement were frequently substituted for normal dietary calories . Any increases in RM performance in the group receiving supplement were matched by increases ( due to learning ) in controls . We conclude that oral dietary supplements have no important effects on RM performance in ambulatory patients with COPD Twenty-four  orthognathic surgery patients were studied to determine the impact of a high-calorie liquid supplement on preventing or minimizing catabolism commonly associated with surgery . The experimental group of 12 subjects , chosen at r and om , consumed blenderized foods ad libitum and a high-calorie dietary supplement providing a minimum of 50 % of energy requirements . The remaining 12 subjects consumed only blenderized foods and served as the control group . The nutritional status of all patients was assessed one day before surgery and on Day 7 of the first , third , and sixth postoperative week . In general , nutrient intake in the experimental group remained similar to that before surgery , whereas intake in the control group decreased significantly , particularly at the one-week postoperative evaluation . It was concluded that the addition of a high-calorie liquid supplement to the dietary regimen of orthognathic surgery patients helped maintain nutrient intake at a level comparable to that before surgery . This result ed in better maintenance of body weight and somatic protein compartments compared with the control group Little is known about nutritional intake after discharge though it takes months to regain preoperative weight after gastrointestinal surgery . We studied whether a 4-mo intervention with dietary advice and protein-rich supplements would increase nutritional intake and gain in lean body mass ( LBM ) in patients who had undergone gastrointestinal surgery . Patients admitted for gastrointestinal surgery were r and omized at discharge to serve as control patients ( n = 47 ) or to receive intervention ( n = 40 ) . One month after discharge , the control patients had a  nutritional intake ( 3-d diet record ) comparable with the intake of the general population that did not increase further . During the 4 m , the intervention patients had an increased intake of protein ( + 22 % ) and energy ( + 16 % ) , and an enhanced gain of LBM after 2 mo ( control 0.8 kg versus intervention 2.1 kg ; P = 0.009 ) . After the 4-mo intervention , both LBM and fat were gained ( control 1.7 kg LBM and 0.2 kg fat versus intervention 3.1 kg LBM and 1.5 kg fat ; LBM : P = 0.029 and fat : P = 0.056 ) . At discharge patients should increase protein intake to 1.5 g.kg-1.d-1 for 2 mo , e.g. , by taking protein-rich liquid supplements OBJECTIVE To evaluate the effects of nutrition counseling with or without oral supplementation in malnourished patients infected with the human immunodeficiency virus ( HIV ) . DESIGN R and omized controlled trial . SUBJECTS HIV-infected men ( n=118 ) who were less than 90 % of usual weight for height or who had lost more than 10 % of body weight . INTERVENTION Nutrition counseling alone ( control group ) vs nutrition counseling plus enteral supplementation ( supplement group ) for 6 weeks . All patients were instructed to consume a diet that exceeded estimated total energy expenditure by 960 kcal/day . MAIN OUTCOME MEASURES Weight , skinfold thickness , fat-free mass , grip strength , quality of life , and cognitive function ( Buschke test ) . STATISTICAL ANALYSES Differences in baseline variables and outcomes were evaluated using analysis of variance or the Wilcoxon rank sum test . RESULTS Ninety-nine men completed at least 4 weeks of treatment , 49 in the supplement group and 50 in the control group . Half the patients in each treatment group achieved at least 80 % of their energy target . No differences in weight , skinfold thickness measurements , or quality of life were observed . Compared with the control group , the supplement group had larger increases in fat-free mass and grip strength , although the differences did not reach statistical significance . APPLICATIONS In the short term , nutrition counseling with or without oral supplementation can achieve a substantial increase in energy intake in about 50 % of malnourished HIV-infected patients . Although further study is needed to evaluate long-term effects , these findings suggest that nutrition counseling has an important role in the management of malnourished HIV-infected patients Background Postoperative fatigue and deterioration in functional capacity have been correlated to postoperative weight loss . This suggested that nutritional support to enhance the regain of weight might improve upon the convalescence A prospect i ve controlled 6-month study was undertaken to compare the effect of Ensure , a defined formula dietary supplement , and diet counselling in 122 out patients with Crohn 's disease . The compliance to Ensure was poor due to a high incidence of side effects . Taking any amount of Ensure reduced the need for surgery and the amount of hospitalization . There was a trend for patients receiving Ensure to experience a decline in the value of their Crohn 's disease activity index ( p less than 0.10 ) . No consistent effects of Ensure were seen on the amount of work missed due to Crohn 's disease , in laboratory measurements , in the need for prednisone or Salazopyrin . The vitamin B12 intake was improved , but otherwise nutrient intake declined due to a decreased food intake . Thus , certain beneficial clinical trends were associated with taking Ensure , but larger numbers of compliant patients will need to be studied to better assess the long-term role of defined formula diets in the management of out patients with Crohn 's disease A prospect i ve study was undertaken to establish the role of individualized diet counselling in the management of 137 out patients with Crohn 's disease .  Individualized dietary counselling for 6 months was associated with a significant decrease in the Crohn 's disease activity index , an increased incidence of disease remission , a decreased need for prednisone and Salazopyrin therapy , a reduction in the number of days spent in hospital , and a reduction in the amount of time lost from work due to Crohn 's disease , when compared with control patients who did not receive dietary counselling but who were seen regularly in follow-up under similar circumstances . Improvement with diet counselling was more likely to occur in patients who had not previously been subjected to small bowel resection , and occurred in patients with active or inactive disease . The effect of counselling 58 patients was assessed over a further 6 months ( for a total 12-month period ) ; there was a persistently reduced Crohn 's disease activity index and a continued decreased number of lost days of work . The mechanism for these beneficial effects of diet counselling was not established . It is suggested that individualized diet counselling , aim ed at optimizing the patient 's nutritional status , may play a role in the management of patients with Crohn 's disease
BACKGROUND Illness-related malnutrition has been reported in 10 - 55 % of people in hospital and in ill people in the community in areas of food sufficiency .
It has been suggested that dietary counseling to encourage the use of energy- and protein-rich foods should be used in preference to oral nutritional supplements in the management of illness-related malnutrition .
OBJECTIVES To examine the evidence that dietary advice , to improve nutritional intake , in adults with illness-related malnutrition can improve survival , weight and anthropometry and to estimate the size of any additional effect of whole protein nutritional supplements when given in combination with dietary advice .