Nutritional supplements after hip fracture: poor compliance limits effectiveness. Nutritional evaluation and dietetic care in cancer patients treated with radiotherapy: prospective study. [Dietary information after radiotherapy of head and neck cancer]. Effects of an appropriate oral diet on the nutritional status of patients with HCV-related liver cirrhosis: a prospective study. Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. [High-caloric nutrition in chronic obstructive lung disease]. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area 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 Compliance of orthopaedic patients with postoperative oral nutritional supplementation. A Study of Intensified Dietary Support in Underweight Candidates for Lung Transplantation Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial Nutritional supplementation and dietary advice in geriatric patients at risk of malnutrition. A randomized study of oral nutritional support versus ad lib nutritional intake during chemotherapy for advanced colorectal and non-small-cell lung cancer. Controlled studies of nutritional intake in patients with malignant disease undergoing treatment. Effect of nursing interventions on nutritional and performance status in cancer patients. Dietary counselling and food fortification in stable COPD: a randomised trial Physiologic effects of oral supplemental feeding in malnourished patients with chronic obstructive pulmonary disease. A randomized control study. A Randomized Study of Nutritional Support in Patients With Colorectal and Gastric Cancer Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial. 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. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. Nutritional supplements combined with dietary counselling diminish whole body protein catabolism in HIV‐infected patients Randomized controlled trial of nutritional counseling on body composition and dietary intake in severe CKD. Dietary supplementation at home improves the regain of lean body mass after surgery. Diet counselling improves the clinical course of patients with Crohn's disease. Dietary advice with or without oral nutritional supplements for disease-related malnutrition in adults.
BACKGROUND Undernutrition and weight loss are important determinants of clinical outcome in older patients after hip fracture but the effectiveness of nutritional support programs in routine clinical practice remains controversial . AIMS OF THE PROJECT : To determine if oral nutritional supplements given daily for 28 days after hip fracture surgery could prevent weight loss and /or lead to improved clinical outcomes ( mortality rates , discharge destination , activities of daily living or length of hospital stay ) in non-malnourished community-dwelling older women with hip fracture . METHODS One hundred and nine women with BMI range 20 - 30 kg/m(2 ) were allocated to either nutritional supplements ( 352 kcal/day ) or usual hospital nutrition using a quasi-r and omisation technique . Body weight changes were monitored at 4 and 8 weeks and clinical outcomes were recorded at discharge and at 6 months . RESULTS No significant differences in weight change or clinical outcomes were seen between the two groups . Compliance with consuming the nutritional supplements was quite variable and there was a significant negative correlation between the amount of supplement consumed and subsequent weight change ( r=-0.36 , P=0.019 ) . CONCLUSIONS Poor compliance with oral nutritional supplements is an important determinant of the effectiveness of oral nutritional interventions in preventing weight loss after hip fracture . Whilst this may explain the lack of clinical improvements seen , our data do not support the routine use of oral nutritional supplements in non-malnourished hip fracture patients 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 After completed radiotherapy , 24 in- patients and 25 out- patients enrolled at the Department of Otolaryngology , National Hospital , were r and omised to either tailored dietary information and instruction by a clinical nutritionist or regular dietary information from a nurse . At the six weeks follow-up examination the incidence of malnutrition , as evaluated by anthropometry and routine blood analyses , was lower among the patients who had been given intensive information than those who had received regular information ( p < 0.05 ) . Out- patients lost more weight than in- patients did ( p < 0.05 ) . The in- patients r and omised to intensive dietary information were the only ones who did not lose weight . This study indicates a beneficial effect of intensive dietary advice in order to improve nutritional status after radiation treatment BACKGROUND AND AIMS In patients with liver cirrhosis , protein-energy malnutrition is a frequent finding and a risk factor influencing survival . The aim was to estimate the effects of an adequate diet on malnutrition and clinical outcome in patients with Child A or B HCV-related liver cirrhosis . METHODS We enrolled 90 consecutive out patients ( M/F=52/38 ) with liver cirrhosis , 30 in Child class A and 60 in class B. Patients were evaluated by anamnesis , clinical examination , estimation of daily caloric intake and measurement of anthropometrical and biochemical indexes . Patients were r and omized into two groups : group 1 with a 3-month oral controlled diet started one week after the first examination and this was followed by a 3-month of spontaneous dietary intake , and group 2 which started a 3-month spontaneous dietary intake followed by a 3-month of controlled diet . The follow-up was performed every month . RESULTS During the period of controlled diet in patients of both groups , protein malnutrition assessed by midarm muscle circumference , creatinine-height index and serum albumin significantly improved independently of the Child class . Lipid malnutrition , assessed by triceps skin fold thickness values , did not improve during the course of the study . The compliance to the prescribed diet was very high in both groups , and no carry over effect of the previous dietary intake was observed during the follow-up period . CONCLUSIONS The results emphasize the importance of both nutritional status evaluation and improvement in the Child A and B cirrhotic patients with HCV-related disease . The proposed nutritional approach was able to influence their protein malnutrition positively BACKGROUND A r and omized controlled trial previously conducted in radiation oncology patients demonstrated that nutrition intervention had a beneficial impact on body weight , nutritional status , and quality of life compared with st and ard practice , but it did not report on dietary intake data . OBJECTIVE To determine the impact of nutrition intervention compared with st and ard practice on dietary intake in out patients receiving radiotherapy . DESIGN Prospect i ve , r and omized , controlled trial . SUBJECTS Sixty consecutive radiation oncology out patients ( 51 men and nine women ; age 61.9+/-14 years [ mean+/-st and ard deviation ] ) . SETTING Australian private radiotherapy facility . INTERVENTION Patients were r and omly assigned to receive either nutrition intervention ( n=29 ) ( nutrition counseling following the American Dietetic Association [ ADA ] medical nutrition therapy [ MNT ] protocol for radiation oncology ) or st and ard practice ( n=31 ) ( general nutrition talk and booklet ) . MAIN OUTCOME MEASURE Dietary intake ( protein , energy , fiber ) assessed at baseline and at 4 , 8 , and 12 weeks after starting radiotherapy . STATISTICAL ANALYSES Repeated- measures analysis of variance done on an intention to treat basis . RESULTS The nutrition intervention group had a higher mean total energy ( P=0.029 ) and protein intake ( P<0.001 ) compared with the st and ard practice group . Mean intake per kilogram of body weight for the nutrition intervention group ranged from 28 to 31 kcal/kg/day compared with 25 to 29 kcal/kg/day for the st and ard practice group ( P=0.022 ) . The nutrition intervention group had a higher mean protein intake ( 1.1 to 1.3 g/kg/day ) compared with the st and ard practice group ( 1.0 to 1.1 g/kg/day ) ( P=0.001 ) . Although the change in fiber intake between the groups was not significant , there was a trend in the anticipated direction ( P=0.083 ) . CONCLUSIONS Intensive nutrition intervention following the ADA MNT protocol results in improved dietary intake compared with st and ard practice and seems to beneficially impact nutrition-related outcomes previously observed in oncology out patients receiving radiotherapy . The ADA MNT protocol for radiation oncology is a useful guide to the level of nutrition support required BACKGROUND We aim ed to determine the effect of dietary counseling or oral supplements on outcome for patients with cancer , specifically , nutritional outcome , morbidity , and quality of life ( QOL )  , during and 3 months after radiotherapy . METHODS Seventy-five patients with head and neck cancer who were referred for radiotherapy ( RT ) were r and omized to the following groups : group 1 ( n = 25 ) , patients who received dietary counseling with regular foods ; group 2 ( n = 25 ) , patients who maintained usual diet plus supplements ; and group 3 ( n = 25 ) , patients who maintained intake ad lib .  Nutritional intake ( determined by diet history ) and status ( determined by Ottery 's Subjective Global Assessment ) , and QOL ( determined by the European Organization for the Research and Treatment of Cancer Quality of Life Question naire version 3.0 [ EORTC QLQ-C30 ] ) were evaluated at baseline , at the end of RT , and at 3 months . RESULTS Energy intake after RT increased in both groups 1 and 2 ( p < or = .05 ) . Protein intake also increased in both groups 1 and 2 ( p < or = .006 ) . Both energy and protein intake decreased significantly in group 3 ( p < .01 ) . At 3 months , group 1 maintained intakes , whereas groups 2 and 3 returned to or below baseline levels . After RT , > 90 % of patients experienced RT toxicity ; this was not significantly different between groups , with a trend for reduced symptomatology in group 1 versus group 2/group 3 ( p < .07 ) . At 3 months , the reduction of incidence/severity of grade 1 + 2 anorexia , nausea/vomiting , xerostomia , and dysgeusia was different : 90 % of the patients improved in group 1 versus 67 % in group 2 versus 51 % in group 3 ( p < .0001 ) . After RT , QOL function scores improved ( p < .003 ) proportionally with improved nutritional intake and status in group 1/group 2 ( p < .05 ) and worsened in group 3 ( p < .05 ) ; at 3 months , patients in group 1 maintained or improved overall QOL , whereas patients in groups 2 and 3 maintained or worsened overall QOL . CONCLUSIONS During RT , nutritional interventions positively influenced outcomes , and counseling was of similar/higher benefit ; in the medium term , only counseling exerted a significant impact on patient outcomes 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 Malnutrition occurs frequently in patients with cancer of the gastrointestinal ( GI ) or head and neck area and can lead to negative outcomes . The aim of this study is to determine the impact of early and intensive nutrition intervention ( NI ) on body weight , body composition , nutritional status , global quality of life ( QoL ) and physical function compared to usual practice in oncology out patients receiving radiotherapy to the GI or head and neck area . Out patients commencing at least 20 fractions of radiotherapy to the GI or head and neck area were  r  and omised to receive intensive , individualised nutrition counselling by a dietitian using a st and ard protocol and oral supplements if required , or the usual practice of the centre ( general advice and nutrition booklet ) . Outcome parameters were measured at baseline and 4 , 8 and 12 weeks after commencing radiotherapy using valid and reliable tools . A total of 60 patients ( 51 M : 9F ; mean age 61.9±14.0 years ) were r and omised to receive either NI ( n=29 ) or usual care ( UC ) ( n=31 ) . The NI group had statistically smaller deteriorations in weight ( P<0.001 ) , nutritional status ( P=0.020 ) and global QoL ( P=0.009 ) compared with those receiving UC . Clinical ly , but not statistically significant differences in fat-free mass were observed between the groups ( P=0.195 ) . Early and intensive NI appears beneficial in terms of minimising weight loss , deterioration in nutritional status , global QoL and physical function in oncology out patients receiving radiotherapy to the GI or head and neck area . Weight maintenance in this population leads to beneficial outcomes and suggests that this , rather than weight gain , may be a more appropriate aim of NI 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 Studies have shown clinical benefits of nutritional supplementation in orthopaedic and elderly patients in both under and well nourished groups . However , patient compliance with the supplementation has not been reported . AIM To assess level of patient compliance with nutritional supplementation when prescribed postoperatively to unselected orthopaedic patients as part of a large controlled trial research ing the clinical benefits of non-targeted nutritional supplementation . METHODS Patients in the intervention group were prescribed two oral supplements each day of their hospital stay , in addition to usual meals . Information describing the supplements was given by the dietitian . Supplements were issued on drug rounds and the proportion of each drink consumed was recorded and collated . Patients could choose to change the type of drink or to discontinue the supplements completely at any time . Twenty-four hour food intake was analysed for a r and om sub- sample of 48 patients . RESULTS Eighty-four patients ( 27 men , 57 women ; mean age , 72 years ) were prescribed supplements . Median length of stay was 14.4 days . Supplements were taken for a mean of 6.7 days . Median compliance was 14.9 % . Despite this , median energy intake in the study group was 1523 kcal/day and 1289 kcal/day in the control ( P= 0 . 0214 ) . CONCLUSION Compliance with non-targeted , postoperative nutritional supplementation is poor in unselected orthopaedic patients but even low levels of supplementation significantly increase energy intake 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 Background and aims : There are few studies published that combine the interventions of physical training and nutrition . The aim of the present study was to describe the impact of a physical and nutritional intervention program for frail community-dwelling elderly people over the age of 75 . Methods : Ninety-six community-dwelling elderly people ( 58 women ) were r and omized to four different groups : i ) a physical training program ( aerobic , muscle strength , balance ) , ii ) a nutritional intervention program ( individually targeted advice and group sessions ) , iii ) a combination of these interventions , and iv ) a control group . At baseline subjects were screened for physical performance such as muscle strength , balance , mobility and activities of daily living , as well as nutritional aspects such as energy intake , body weight and fat-free mass . These measurements were repeated immediately after the intervention , which lasted for 12 weeks , and after another 6 months . Results : The intention-to-treat analysis indicated significant improvements in lower-extremity muscle strength in both training groups compared with the nutrition group at 1st follow-up . There were small significant changes for some of the balance measurements in the training group without nutrition treatment . The nutrition intervention did not show any significant results . Conclusions : This study shows the positive effect on lower-extremity muscle strength directly after the intervention . Balance training most probably needs to be more individualized in order to be effective for frail elderly people . Further studies are needed , with larger sample sizes , to investigate the effects of these types of interventions before any further conclusions can be drawn BACKGROUND & AIM Effects of combined nutritional treatment of patients at risk of protein-energy malnutrition ( PEM ) discharged from a geriatric service were evaluated . METHODS Patients ( n=108 , age 85+/-6 years ) at risk of malnutrition according to the short form of the mini nutritional assessment were r and omly allocated to dietary counseling , including liquid and multivitamin supplementation , i.e. intervention ( I , n=51 ) and to controls ( C , n=57 ) . Body weight , biochemical indices ( e.g. insulin-like growth factor I ( IGF-I ) ) , Katz activities of daily living ( ADL ) index , mini mental status examination ( MMSE ) and quality of life ( QoL ) by SF-36 were assessed at the start of the study and after 4 months . Statistical analyses were performed on " intention-to-treat " and on " treated-as- protocol " bases . RESULTS Fifty-four patients , 29 in the I-group ( 86+/-7 years , 66 % females ) and 25 in the C-group ( 85+/-7 years , 72 % females ) completed the study according to the protocol . Both modes of analysis revealed a significant positive effect of the combined nutritional intervention on weight maintenance . Treated-as- protocol analyses showed that Katz ADL index improved in the I-group ( p<0.001 ; p<0.05 between the groups ) . Serum IGF-I levels increased in the I-group ( p<0.001 ) , but were unchanged in the C-group ( p=0.07 between the groups ) . QoL was assessed to be low and had not changed after nutritional treatment . CONCLUSIONS Combined nutritional intervention prevented weight loss and improved ADL functions in discharged geriatric patients at risk of malnutrition 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 Ninety-seven patients with cancer , undergoing radiation treatment , were studied . Forty-two were given special dietary counseling and supplements of Sustagen or Isocal ;  42 controls  received no special advice or supplements .  Thirteen patients were excluded because of poor prognoses and the ethical need for food supplements . Nutrient intake of all groups was assessed by 3-d diet records in household measures in the first and the last week of treatment . Intake was significantly higher in the adjunctive than the control group . The excluded group , despite supplementation , had intakes similar to the control group . No difference was observed between the control and adjunctive groups in clinical status at the end of treatment or in long-term outcome 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 Background : Malnutrition in chronic obstructive pulmonary disease ( COPD ) is associated with a poor prognosis , yet evidence to support the role of dietary counselling and food fortification is lacking . A study was undertaken to assess the impact of dietary counselling and food fortification on outcome in out patients with COPD who are at risk of malnutrition . Methods : A r and omised controlled unblinded trial was performed in 59 out patients with COPD ( 6 months intervention and 6 months follow-up ) . The intervention group received dietary counselling and advice on food fortification and the controls received a dietary advice leaflet . Outcome measures were nutritional status , respiratory and skeletal muscle strength , respiratory function , perceived dyspnoea , activities of daily living ( ADL ) and quality of life . Results : The intervention group consumed more energy ( difference 194 kcal/day ; p = 0.02 ) and protein ( difference 11.8 g/day ; p<0.001 ) than controls . The intervention group gained weight during the intervention period and maintained weight during follow-up ; the controls lost weight throughout the study . Significant differences were observed between the groups in St George ’s Respiratory Question naire total score ( difference 10.1 ; p = 0.02 ) , Short Form-36 health change score ( difference 19.2 ; p = 0.029 ) and Medical Research Council dyspnoea score ( difference 1.0 ; p = 0.03 ) ; the difference in ADL score approached statistical significance ( difference 1.5 ; p = 0.06 ) . No differences were observed between groups in respiratory function or skeletal and respiratory muscle strength . Improvements in some variables persisted for 6 months beyond the intervention period . Conclusion : Dietary counselling and food fortification result ed in weight gain and improvements in outcome in nutritionally at-risk out patients with COPD , both during and beyond the intervention period 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 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 BACKGROUND Weight loss in patients with cancer is common and associated with a poorer survival and quality of life . Benefits from nutritional interventions are unclear . The present study assessed the effect of dietary advice and /or oral nutritional supplements on survival , nutritional endpoints and quality of life in patients with weight loss receiving palliative chemotherapy for gastrointestinal and non-small cell lung cancers or mesothelioma . METHODS Participants were r and omly assigned to receive no intervention , dietary advice , a nutritional supplement or dietary advice plus supplement before the start of chemotherapy . Patients were followed for 1 year . Survival , nutritional status and quality of life were assessed . RESULTS In total , 256 men and 102 women ( median age , 66 years ; range 24 - 88 years ) with gastrointestinal ( n = 277 ) and lung ( n = 81 ) cancers were recruited . Median ( range ) follow-up was 6 ( 0 - 49 ) months . One-year survival was 38.6 % ( 95 % confidence interval 33.3 - 43.9 ) . No differences in survival , weight or quality of life between groups were seen . Patients surviving beyond 26 weeks experienced significant weight gain from baseline to 12 weeks , although this was independent of nutritional intervention . CONCLUSIONS Simple nutritional interventions did not improve clinical or nutritional outcomes or quality of life . Weight gain predicted a longer survival but occurred independently of nutritional intervention 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 PURPOSE To investigate the impact of dietary counseling or nutritional supplements on outcomes in cancer patients :  nutritional , morbidity , and quality of life ( QoL ) during and 3 months after  radiotherapy .  PATIENTS AND METHODS A total of 111 colorectal cancer out patients referred for radiotherapy , stratified by staging , were r and omly assigned : group 1 ( G1 ; n = 37 ) , dietary counseling ( regular foods ) ; group 2 ( G2 ; n = 37 ) , protein supplements ; and group 3 ( G3 ; n = 37 ) , ad libitum intake .  Nutritional intake ( diet history ) , status ( Ottery 's Subjective Global Assessment ) , and QoL ( European Organisation for Research and Treatment of Cancer Quality of Life Question naire version 3.0 ) were evaluated at baseline , at the end , and 3 months after radiotherapy . RESULTS At radiotherapy completion , energy intake increased in G1/G2 ( P < or = .04 ) , G1 more than G2 ( P = .001 ) , and decreased in G3 ( P < .01 ) . Protein intake increased in G1/G2 ( P < or = .007 ) , G1 less than G2 ( not significant ) , and decreased in G3 ( P < .01 ) . At 3 months , G1 maintained nutritional intake and G2/G3 returned to baseline . After radiotherapy and at 3 months , rates of anorexia , nausea , vomiting , and diarrhea were higher in G3 ( P < .05 ) . At radiotherapy completion , in G1 all QoL function scores improved proportionally to adequate intake or nutritional status ( P < .05 ) ; whereas in G2 only three of six function scores improved proportionally to protein intake ( P = .04 ) , and in G3 all scores worsened ( P < .05 ) . At 3 months , G1 patients maintained/improved function , symptoms , and single-item scores ( P < .02 ) ; in G2 , only few function and symptom scales improved ( P < .05 ) ; in G3 , QoL remained as poor as after radiotherapy . In G1/G2 , respectively , improvement/deterioration of QoL correlated with better or poorer intake or nutritional status ( P < .003 ) . CONCLUSION During radiotherapy , both interventions positively influenced outcomes ; dietary counseling was of similar or higher benefit , whereas even 3 months after RT , it was the only method to sustain a significant impact on patient outcomes 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 BACKGROUND Progressive loss of kidney function results in an increased risk of malnutrition . Despite this , there is little evidence informing the impact of nutrition intervention on predialysis patients with chronic kidney disease ( CKD ; stages 4 and 5 ) . STUDY DESIGN R and omized controlled trial . SETTING & PARTICIPANTS 56 out patients ( men , 62 % ; mean age , 70.7 + /- 14.0 [ SD ] years ) with CKD were r and omly allocated to intervention ( n = 29 ) or control ( n = 27 ) by using a concealed computer-generated sequence . INTERVENTION The intervention group , provided with individualized dietary counseling with regular follow-up aim ed at achieving an intake of 0.8 to 1.0 g/kg of protein and greater than 125 kJ/kg of energy , or control , receiving written material only . OUTCOMES & MEASURES Change in body composition ( body cell mass , measured by means of total-body potassium , in 40 of 56 participants ) , nutritional status ( Subjective Global Assessment ) , and energy and protein intake ( 3-day food record ) . RESULTS During the 12 weeks , the intervention group had 3.5 % ( 95 % confidence interval , -2.1 to 9.1 ) less decrease in body cell mass , 17.7-kJ/kg/d ( 95 % confidence interval , 8.2 to 27.2 ) greater increase in energy intake , greater improvement in Subjective Global Assessment ( P < 0.01 ) , and no significant difference in protein intake compared with the control group ( -0.04 g/kg/d ; 95 % confidence interval , -0.73 to 0.16 ) . The intervention was associated with greater increases in energy and protein intake in women than men ( interaction P < 0.001 for both ) . LIMITATIONS Power to detect change in body cell mass , potential bias in ascertainment of Subjective Global Assessment . CONCLUSIONS In predialysis patients with CKD , structured nutrition intervention had a greater effect on energy and protein intake in women than men . Additional investigations are warranted to determine the impact on body composition 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 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 Disease-related malnutrition has been reported in 10 % to 55 % of people in hospital and the community . Dietary advice encouraging the use of energy- and nutrient-rich foods rather than oral nutritional supplements has been suggested as the initial approach for managing disease-related malnutrition . OBJECTIVES To examine evidence that dietary advice in adults with disease-related malnutrition improves survival , weight and anthropometry ; to estimate the size of any additional effect of nutritional supplements combined with dietary advice and to compare the effects of dietary advice with oral nutritional supplements . SEARCH STRATEGY Relevant publications were identified from comprehensive electronic data base search es and h and search ing . Last search : 14 February 2010 . SELECTION CRITERIA R and omised controlled trials of dietary advice with or without oral nutritional supplements in people with disease-related malnutrition in any health-care setting compared with no advice , oral nutritional supplements or dietary advice given alone . DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility , risk of bias and extracted data . MAIN RESULTS Forty-five studies ( 3186 participants ) met the inclusion criteria ;  ( dietary advice compared with : no advice  ( 1053 participants ) ; with  oral nutritional supplements ( 332 participants ) ;  with dietary advice and oral nutritional supplements  ( 731 participants ) ; and dietary advice plus oral nutritional supplements compared with no additional intervention ( 1070 participants ) . Follow-up ranged from 18 days to 24 months . No comparison showed a significant difference between groups for mortality or morbidity . There was a significant change in weight found between groups when comparing dietary advice to no advice for interventions lasting greater than 12 months , mean difference 3.75 kg ( 95 % confidence interval 0.97 to 6.53 ) , and when all studies were combined , mean difference 1.47 kg ( 95 % confidence interval 0.32 to 2.61 ) although there was significant heterogeneity in the combined analysis ( I(2 ) = 90 % ) . Similar improvements in weight were found for the comparison of dietary advice with nutritional supplements if required versus no advice , mean difference 2.20 kg ( 95 % confidence interval 1.16 to 3.25 ) . Dietary advice compared with no advice was also associated with significantly improved mid-arm muscle circumference when all studies were combined , but with moderate heterogeneity , mean difference 0.81 mm ( 95 % confidence interval 0.31 to 1.31 ) . Dietary advice given with nutritional supplements compared with dietary advice alone result ed in improvements in : mid-arm muscle circumference , mean difference -0.89 mm ( 95 % confidence interval -1.35 to -0.43 ) ; triceps skinfold thickness , mean difference -1.22 mm ( 95 % confidence interval -2.34 to -0.09 ) ; and grip strength , mean difference -1.67 kg ( 95 % confidence interval -2.96 to -0.37 ) , although the effects on triceps skinfold thickness and grip strength were heterogeneous . Dietary advice with supplements if required result ed in a significant increase in triceps skinfold thickness compared with no advice , mean difference 0.40 mm ( 95 % confidence interval 0.10 to 0.70 ) , although these results are from a single trial with only 29 participants . AUTHORS ' CONCLUSIONS Evidence of variable quality suggests that dietary advice with or without oral nutritional supplements may improve weight , body composition and grip strength . We found no evidence of benefit of dietary advice or oral nutritional supplements given alone or in combination on survival . Studies addressing the impact of nutritional interventions on nutritional , functional and patient-centred outcomes are needed
Dietary counselling and oral nutritional supplements ( ONS ) are recommended for managing malnutrition .
A recent systematic review demonstrated ( in separate analyses ) that dietary counselling and dietary counselling with ONS improved energy intake , weight and some indices of body composition , although there was considerable heterogeneity .
The present analysis aim ed to examine the effects on mortality and nutritional indices of dietary counselling given with or without ONS and to explore the heterogeneity in the meta-analyses aim ing to characterise the groups most likely to benefit from these interventions .