Nutritional supplements after hip fracture: poor compliance limits effectiveness. A comparison between oral and nasogastric nutritional supplements in malnourished patients. Nutritional evaluation and dietetic care in cancer patients treated with radiotherapy: prospective study. Malnutrition in hip fracture patients: an intervention study. Nutrition behavior of malnourished HIV-infected patients and intensified oral nutritional intervention. Nutritional supplements with oral amino acid mixtures increases whole-body lean mass and insulin sensitivity in elderly subjects with sarcopenia. Effects of an appropriate oral diet on the nutritional status of patients with HCV-related liver cirrhosis: a prospective study. Long-term nutritional support as an adjunct to chemotherapy for breast cancer. Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Randomized controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting. Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living frail elderly. Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. 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. Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: cluster randomised controlled trial Impact of nutritional support on functional status during an acute exacerbation of chronic obstructive pulmonary disease. Additional protein intake limits weight regain after weight loss in humans. A controlled trial of intermittent enteral nutrient supplementation in maintenance hemodialysis patients. 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 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 Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward. Controlled clinical trials of nutritional intervention as an adjunct to chemotherapy, with a comment on nutrition and drug resistance. Three month intervention with protein and energy rich supplements improve muscle function and quality of life in malnourished patients with non-neoplastic gastrointestinal disease--a randomized controlled trial. Energy-containing nutritional supplements can affect usual energy intake postsupplementation in institutionalized seniors with probable Alzheimer's 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 support and quality of life in stable chronic obstructive pulmonary disease (COPD) patients. 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 Nutritional support in hospitalized patients with alcoholic liver disease. A Randomized Trial of Exercise and Dietary Counseling After Liver Transplantation Effect of oral administration of a whole formula diet on nutritional and cognitive status in patients with Alzheimer's disease. Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial Nutritional care: the effectiveness of actively involving older patients. Dietary counseling versus dietary supplements for malnutrition in chronic pancreatitis: a randomized controlled 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. The effect of dietary intervention on weight gains after renal transplantation. Impact of nutrition support on treatment outcome in patients with locally advanced head and neck squamous cell cancer treated with definitive radiotherapy: a secondary analysis of RTOG trial 90-03. Controlled studies of nutritional intake in patients with malignant disease undergoing treatment. Effect of nursing interventions on nutritional and performance status in cancer patients. Prevalence of malnutrition in patients in general practice. Early nutritional supplementation immediately after diagnosis of infectious disease improves body weight in psychogeriatric nursing home residents 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. Energy-enriched hospital food to improve energy intake in elderly patients. Randomized, Open Label, Controlled Clinical Trial of Oral Administration of an Egg Albumin-Based Protein Supplement to Patients on Continuous Ambulatory Peritoneal Dialysis A Randomized Study of Nutritional Support in Patients With Colorectal and Gastric Cancer Does additional feeding support provided by health care assistants improve nutritional status and outcome in acutely ill older in-patients?--a randomised control trial. Nutritional counseling improves quality of life and nutrient intake in hospitalized undernourished patients. Incidence and recognition of malnutrition in hospital Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone mineral density: randomized controlled trial pilot study Is dietary counselling effective in increasing dietary calcium, protein and energy intake in patients with osteoporotic fractures? A randomized controlled clinical trial. Failure of conventional strategies to improve nutritional status in malnourished adolescents and adults with cystic fibrosis. A controlled trial of sip-feed supplements in elderly orthopaedic patients. Effects of dietary supplement on functional condition and clinical outcome measured with a modified Norton scale. Food habits and appetite of elderly women at the time of a femoral neck fracture and after nutritional and anabolic support. 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. The effect of a nutrient dense drink on mental and physical function in institutionalized elderly people 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. Effects of oral nutritional supplements in normally nourished or mildly undernourished geriatric patients after surgery for hip fracture: a randomized clinical trial. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. Nutritional support and functional status in undernourished geriatric patients during hospitalization and 6-month follow-up Provision of small, frequent meals does not improve energy intake of elderly residents with dysphagia who live in an extended-care facility. 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. [Patients with chronic airflow limitation: effects of the inspiratory muscle training with threshold load valve, built with appropriate technology, associated to nutritional support]. 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. A randomized controlled trial of a new behavioral home-based nutrition education program, "Eat Well with CF," in adults with cystic fibrosis. Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial. Multifaceted nutritional intervention among nursing-home residents has a positive influence on nutrition and function.
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 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 AIMS To investigate whether a nutritional intervention in older women and men with femoral neck fracture had an effect on postoperative complications during hospitalization and on nutritional status at a four-month follow-up . METHODS The design was a r and omized controlled trial . The present study sample consisted of 157 patients aged 70 years and above with femoral neck fracture . The nutritional intervention included , among other things , a nutritional journal to detect nutrition deficiencies and protein-enriched meals for at least four days postoperatively . Further , at least two nutritional and protein drinks were served each day during the whole hospitalization and other factors that would influence the patient 's nutrition were also considered and dealt with . Postoperative complications were registered and patients were assessed using the Mini Nutritional Assessment ( MNA ) scale , including body mass index ( BMI ) , on admission and at a four-month follow-up . RESULTS Malnutrition was common and low MNA scores were associated with postoperative complications such as delirium and decubitus ulcers . There were significantly fewer days of delirium in the intervention group , seven patients in the intervention group developed decubitus ulcers vs. 14 patients in the control group and the total length of hospitalization was shorter . There were no detectable significant improvements regarding nutritional parameters between the intervention and the control group at the four-month follow-up but men improved their mean BMI , body weight and MNA scores in both the intervention and the control groups while women deteriorated in both groups . CONCLUSIONS Malnutrition was common among older people with hip fractures admitted to hospital . The nutritional intervention might have contributed to the patients suffering fewer days with delirium , fewer decubitus ulcers and shorter hospitalization but did not improve the long-term nutritional status , at least not in women . RELEVANCE TO CLINICAL PRACTICE This nutritional intervention , which was included in a multifactorial multidisciplinary intervention , is inexpensive and relatively easy to implement . It has significant effects on complications but no long-term effect on nutritional parameters , at least not in women Malnutrition and cachexia are characteristic symptoms of human immunodeficiency virus (HIV)-1 infection and AIDS . To identify risk situations that might affect nutritional behavior and status and to evaluate the therapeutic effect of an intensified oral nutritional intervention , we analyzed 81 consecutively treated homosexual HIV-infected out patients with malnutrition retrospectively and could follow the outcome of a nutritional intervention prospect ively in 54 of them . Nutritional therapy was ineffective for only 5 of the 54 patients ; constant weight loss could be stopped in 31 of the patients , and 18 patients could even gain weight . We suggest intensified oral nutritional intervention should be an integral part of the treatment of HIV-infected patients to prevent or treat malnutrition Decreases in whole-body lean mass can cause sarcopenia , a disease frequently found in the elderly . This condition is frequently associated with frailty and disability in aging as well as the onset and progression of several geriatric syndromes . Sarcopenia therefore must be managed with multidimensional approaches that include physical training , nutritional support , and metabolic and anabolic treatment . The purpose of our study was to assess the effect of an orally administered special mixture of amino acids ( AAs ) in elderly subjects with reduced lean body mass and sarcopenia . A r and omized , open-label , crossover study was conducted in 41 elderly subjects ( age range : 66 - 84 years ) with sarcopenia , assigned to 2 distinct treatments ( AAs and placebo ) . All subjects had normal body weight ( body mass index within 19 - 23 ) . The AA treatment consisted of 70.6 kcal/day ( 1 kcal = 4.2 kJ ) of 8 g of essential AA snacks , given at 10:00 am and 5:00 pm . Lean mass was measured with dual-energy x-ray absorptiometry in leg , arm , and trunk tissues . Significant increases in whole-body lean mass in all areas were seen after 6 months and more consistently after 18 months of oral nutritional supplementation with AAs .  Fasting blood glucose , serum insulin , and homeostatic model assessment of insulin resistance ( an index of insulin resistance ) significantly decreased during AA treatment . Furthermore , a significant reduction in serum tumor necrosis factor-alpha ( TNF-alpha ) and a significant increase in both insulin-like growth factor-1 ( IGF-1 ) serum concentrations and in the IGF-1/TNF-alpha ratio were also found . No significant adverse effects were observed during AA treatment . These preliminary data indicate that nutritional supplements with the oral AA mixture significantly increased whole-body lean mass in elderly subjects with sarcopenia . The improvement in the amount of whole-body lean mass could be linked to increased insulin sensitivity and anabolic conditions related to IGF-1 availability 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 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 BACKGROUND About 25 - 40 % of hospital patients are malnourished . With current clinical practice s , only 50 % of malnourished patients are identified by the medical and nursing staff . OBJECTIVE The objective of this study was to report the cost and effectiveness of early recognition and treatment of malnourished hospital patients with the use of the Short Nutritional Assessment Question naire ( SNAQ ) . DESIGN The intervention group consisted of 297 patients who were admitted to 2 mixed medical and surgical wards and who received both malnutrition screening at admission and st and ardized nutritional care .  The control group consisted of a comparable group of 291 patients who received the usual hospital clinical care .  Outcome measures were weight change , use of supplemental drinks , use of tube feeding , use of parenteral nutrition and in-between meals , number of consultations by the hospital dietitian , and length of hospital stay . RESULTS The recognition of malnutrition improved from 50 % to 80 % with the use of the SNAQ malnutrition screening tool during admission to the hospital . The st and ardized nutritional care protocol added approximately 600 kcal and 12 g protein to the daily intake of malnourished patients . Early screening and treatment of malnourished patients reduced the length of hospital stay in malnourished patients with low h and grip strength ( ie , frail patients ) . To shorten the mean length of hospital stay by 1 d for all malnourished patients , a mean investment of 76 euros ( 91 US dollars ) in nutritional screening and treatment was needed . The incremental costs were comparably low in the whole group and in the subgroup of malnourished patients with low h and grip strength . CONCLUSIONS Screening with the SNAQ and early st and ardized nutritional care improves the recognition of malnourished patients and provides the opportunity to start treatment at an early stage of hospitalization . The additional costs of early nutritional care are low , especially in frail malnourished patients BACKGROUND Nutritional support is often recommended as part of the treatment of tuberculosis , but it has never been properly tested . OBJECTIVE We assessed the effects of early nutritional intervention on lean mass and physical function in patients with tuberculosis and wasting . DESIGN Patients who started antituberculous therapy within the previous 2 wk were r and omly assigned to receive st and ard nutritional counseling ( control group ) or nutritional counseling to increase their intake through diet and high-energy supplements ( nutritional supplement group ) for 6 wk . Body composition was measured by dual-energy X-ray absorptiometry , and physical function was assessed by maximum grip strength . RESULTS Patients in the nutritional supplement group ( n = 19 ) had a significantly greater increase in body weight ( 2.57 + /- 1.78 compared with 0.84 + /- 0.89 kg , P = 0.001 ) , total lean mass ( 1.17 + /- 0.93 compared with 0.04 + /- 1.26 kg , P = 0.006 ) , and grip strength ( 2.79 + /- 3.11 compared with -0.65 + /- 4.48 kg , P = 0.016 ) than did the control subjects ( n = 17 ) at week 6 . During subsequent follow-up , the increase in body weight remained greater in the nutritional supplement group , but this increase was due mainly to a greater gain in fat mass in the nutritional supplement group than in the control group . CONCLUSIONS Early intervention to increase nutritional intake increases lean mass and physical function . This adjunct to tuberculosis therapy could confer socioeconomic and survival benefits that deserve investigation in large-scale trials . Nutritional intervention after the initial phase of treatment could be less beneficial because it mainly increases fat 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 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 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 Abstract Objective To assess the effect of family style mealtimes on quality of life , physical performance , and body weight of nursing home residents without dementia . Design Cluster r and omised trial . Setting Five Dutch nursing homes . Participants 178 residents ( mean age 77 years ) . Two wards in each home were r and omised to intervention ( 95 participants ) or control groups ( 83 ) . Intervention During six months the intervention group took their meals family style and the control group received the usual individual pre-plated service . Main outcome measures Quality of life ( perceived safety ; autonomy ; and sensory , physical , and psychosocial functioning ) , gross and fine motor function , and body weight . Results The difference in change between the groups was significant for overall quality of life ( 6.1 units , 95 % confidence interval 2.1 to 10.3 ) , fine motor function ( 1.8 units , 0.6 to 3.0 ) , and body weight ( 1.5 kg , 0.6 to 2.4 ) . Conclusion Family style mealtimes maintain quality of life , physical performance , and body weight of nursing home residents without dementia . Trial registration Clinical trials 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 Since long-term weight maintenance ( WM ) is a major problem , interventions to improve WM are needed . The aim of the study was to investigate whether the addition of protein to the diet might limit weight regain after a weight loss of 5 - 10 % in overweight subjects . In a r and omised parallel study design , 113 overweight subjects ( BMI 29.3 ( SD 2.5 ) kg/m2 ) ; age 45.1 ( SD 10.4 ) years ) followed a very-low-energy diet for 4 weeks , after which there was a 6-month period of WM . During WM , subjects were r and omised into either a protein group or a control group . The protein group received 30 g/d protein in addition to their own usual diet . During the very-low-energy diet , no differences were observed between the groups . During WM , the protein group showed a higher protein intake ( 18 % v. 15 % ; P<0.05 ) , a lower weight regain ( 0.8 v. 3.0 kg ; P<0.05 ) , a decreased waist circumference ( -1.2 ( SD 0.7 ) v. 0.5 ( SD 0.5 ) cm ; P<0.05 ) and a smaller increase in respiratory quotient ( 0.03 ( SD 0.01 ) v. 0.07 0.01 ; (SD/)P < 0.05 ) compared with the control group . Weight regain in the protein group consisted of only fat-free mass , whereas the control group gained fat mass as well . Satiety in the fasted state before breakfast increased significantly more in the protein group than in the control group . After 6 months follow-up , body weight showed a significant group x time interaction . A protein intake of 18 % compared with 15 % result ed in improved WM  in overweight subjects after a weight loss of 7.5 % . This improved WM implied several factors , i.e. improved body composition , fat distribution , substrate oxidation and satiety OBJECTIVE This controlled trial was undertaken to evaluate the benefits of short-term enteral nutrient supplementation in maintenance hemodialysis ( MHD ) patients using a high-calorie and high-protein blend formula ( low-cost home-prepared [ HP ] blend or a commercially available supplement ) and to study its effect on selected parameters of nutritional status . The acceptability and palatability of the HP blend formula , ease of use , and cost were also assessed in comparison with the commercial nutritional supplement ( CNS ) . DESIGN R and omized controlled trial . SETTING Hemodialysis ( HD ) unit of a tertiary referral care hospital in Southern India . PATIENTS Nondiabetic adult MHD patients with no intercurrent illness , on regular thrice weekly MHD for at least 1 month before recruitment , with a body mass index ( BMI ) < 20 and a serum albumin level of < 4.0 g/dL. Patients were r and omized into control group and experimental group , the latter in turn to recieve either CNS or HP blend . INTERVENTION The control group received appropriate monitoring , including dietary recall and counselling for the prescribed diet ( protein intake of 1.2 g/kgIBW/d and energy of 35 to 45 kcal/kgIBW/d ) but no specific post-HD supplement . Patients in the supplement group received the respective supplement post-HD ( providing 500 kcal and 15 g protein ) for 1 month in addition to the monitored diet prescription . MAIN OUTCOME MEASURES ( 1 ) Nutritional status parameters , BMI and serum albumin ; ( 2 ) functional status on a 10-point Karnofsky scale ; ( 3 ) adverse metabolic effects , hyperphosphatemia at start and end of study ; and ( 4 ) subjective scoring for appetite , and acceptability of and tolerance to supplement . RESULTS Both groups showed an improvement in dry weight and BMI . In addition , the supplement group showed a significant increase in serum albumin level and functional scoring . Mild hyperphosphatemia occurred in the supplement group . An increase in baseline food intake was seen in the control group , but not in the supplemented group . No intolerance was reported to either supplement . CONCLUSION Enteral nutrient supplementation was shown to bring about a significant improvement in serum albumin level even in a short-term study . Use of an HP supplement was beneficial , acceptable , and inexpensive 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 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 OBJECTIVE To examine how improved attention to nutritional status and dietary intake , achieved through the employment of dietetic assistants ( DAs ) , will affect postoperative clinical outcome among elderly women with hip fracture . DESIGN Open prospect i ve r and omised controlled trial , comparing conventional nursing care with the additional nutritional support provided by DA . SETTING Thirty-eight bedded acute trauma ward in a teaching hospital . PARTICIPANTS All but 11 of 344 consecutive admissions with acute nonpathological hip fracture were approached . Three hundred and eighteen ( 93 % ) agreed to inclusion . Sixteen were ineligible as they were immediately transferred to another acute ward , were managed conservatively or died preoperatively . PRIMARY OUTCOME MEASURE Postoperative mortality in the acute trauma unit . SECONDARY OUTCOME MEASURES Postoperative mortality at 4 months after fracture , length of stay , energy intake and nutritional status . RESULTS DA-supported participants were less likely to die in the acute ward ( 4.1 versus 10.1 % , P = 0.048 ) . This effect was still apparent at 4 month follow-up ( 13.1 versus 22.9 % , P = 0.036 ) . DA-supported subjects had significantly better mean daily energy intake ( 1,105 kcal versus 756 kcal/24 h , 95 % CI 259 - 440 kcal/24 h , P<0.001 ) , significantly smaller reduction in mid-arm circumference during their inpatient stay ( 0.39 cm , P = 0.002 ) and nonsignificantly favourable results for other anthropometric and laboratory measurements . CONCLUSION Dietetic or nutrition assistants are being introduced in units across the UK . This , the largest ever study of nutritional support after hip fracture , shows that their employment significantly reduced patients ' risk of dying in the acute trauma unit ; an effect that persisted at 4 month follow-up Nutritional intervention in the cancer patient [ e.g. , total parenteral nutrition ( TPN ) ] might improve durable survival because of increased tolerance to aggressive tumor therapy . To determine whether this assumption is correct , 42 patients with diffuse histiocytic lymphoma were induced with prednisone , high-dose methotrexate , Adriamycin , cyclophosphamide , and VP-16 ( ProMACE ) . Nitrogen mustard-vincristine-procarbazine-prednisone ( MOPP ) consolidation was then used , followed by late intensification with ProMACE .  Patients were selected r and omly to receive adjuvant TPN or a st and ard diet during ProMACE-MOPP treatment . While TPN patients had a greater median weight gain than did control patients , lean body mass and degree of myelosuppression did not improved as a consequence of TPN . There was no significant difference in tumor response or survival between TPN and control patients , whether or not the patients were initially malnourished . In a second trial , 32 young patients with metastatic or other poor-prognosis sarcomas were r and omly allocated to receive TP or a st and ard diet as an adjunct to one very intensive course of combination chemotherapy or chemotherapy plus total body irradiation ; autologous marrow transplantation was used with gain than did controls but remained in a negative nitrogen balance . Response rates and median durable survival did not differ between the two groups . In both trials , the maximum nutritional support permitted by currently available technology was offered . Thus , the limiting factor may not be nutritional status but rather the intrinsic biology of the tumors and the limitations of their response to current therapy . In in vitro studies of the possible influence of nutrition on cancer treatment , we have compared sublines of P388 murine leukemia cells which are sensitive or resistant to Adriamycin . The difference in drug sensitivity correlated with differences in lipid composition , with more intracellular lipid , and with greater membrane rigidity in the resistant cells . Resistant cells have a relatively poor transport of drug into the cell ; moreover , intracellular Adriamycin is sequestered in lipid depots away from DNA . These results suggest one possible relationship between nutritional phenomena and drug sensitivity BACKGROUND Malnutrition is a common problem in patients with digestive disease and is associated with impaired outcome . OBJECTIVE We investigated the effect of a three-month post-hospital nutritional intervention with high protein and energy supplements on body composition , muscle function and quality of life ( QoL ) in malnourished GI patients . PATIENTS AND INTERVENTION Eighty malnourished patients with benign digestive disease were r and omized to receive either oral nutritional supplements ( ONS ) for three months in addition to dietary counselling ( DC ) ( ONS patients ) or only dietary counselling ( DC patients ) . METHODS Nutritional status was determined with the subjective global assessment , body composition by bioelectrical impedance and anthropometry , muscle function with h and -grip strength and peak flow . QoL was assessed by the 36-item short-form question naire . RESULTS Age , body cell mass ( BCM ) , muscle function , gender distribution and QoL did not differ between ONS patients ( n=38 ) and DC patients ( n=42 ) at baseline . Body weight and BCM improved significantly in both groups after three months . However , h and -grip strength ( 26.1+/-11.3 - 31.5+/-10.1 kg , p<0.0001 ) and peak flow ( 329.2+/-124.0 - 388.9+/-108.4 l /min , p=0.004 ) improved only in the ONS patients and remained unchanged in the DC patients . Similarly , all eight scales of the QoL improved in the ONS patients compared with merely three in the DC patients . DC patients experienced significantly more readmissions ( n=20 ) than ONS patients ( n=10 ) during the study period ( p=0.041 ) . CONCLUSION A three month intervention with high protein oral supplements improves outcome in malnourished patients with digestive disease in terms of functional status , QoL and rehospitalization OBJECTIVES To determine whether increases in caloric intake associated with consumption of a mid-morning nutritional supplement for 3 weeks were maintained in the week after stopping the supplement and to investigate the effects of body mass index ( BMI ) and cognitive and behavioral measures on this response . DESIGN Secondary analysis of a previously published r and omized , crossover , nonblinded clinical trial . SETTING A fully accredited geriatric care facility affiliated with the University of Toronto . PARTICIPANTS Thirty institutionalized seniors with probable Alzheimer 's disease ( AD ) who ate independently .  MEASUREMENTS Investigator-weighed food intake , body weight , cognitive ( Severe Impairment Battery ; Global Deterioration Scale ) and behavioral ( Neuropsychiatric Inventory -- Nursing Home version ; London Psychogeriatric Rating Scale ) assessment s. RESULTS Individuals who responded successfully to supplementation as indicated by increases in daily energy intake were likely to maintain 58.8 % of that increase postsupplementation , although stopping the supplement was associated with decreased habitual energy intake in low- BMI individuals who reduced their daily intakes during supplementation in response to the extra calories . Cognitive/behavioral tests were not reliable predictors of postsupplement intake . CONCLUSION Institutionalized seniors with probable AD are likely to alter their usual energy intakes to maintain changes result ing from 3 weeks of supplementation . This effect may allow for rotating supplementation schedules in nursing homes that could reduce staff burden , but only for those individuals who are most likely to respond favorably . These data indicate that nutritional supplements and diet plans should be carefully prescribed in low- BMI individuals to limit variability in total energy provided and thus prevent lower-than-normal intake 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 RATIONALE Nutritional depletion is a common problem in chronic obstructive pulmonary disease ( COPD ) patients . It is caused , to a large extent , by an imbalance between low-energy intake and high-energy requirements . This problem adversely affects morbidity and mortality . However , the use of nutritional supplements to reach their energy necessities requires optimisation between positive and adverse effects on outcome before being used systematic ally as part of their comprehensive care . PURPOSE The aim of our study was to investigate the effects of oral nutritional repletion on quality of life in stable COPD patients . METHODS Prospect i ve , r and omised and multi-centre study . Stable COPD patients with a body mass index 22 , a fat-free mass index 16 , and /or a recent involuntary weight loss ( 5 % during last month , or 10 % during the last 3 months ) were studied . Exclusion criteria were to present signs of an airway infection , to have a cardiovascular , neurological , or endocrine disease , to be treated with oral steroids , immunosuppressors or oxygen therapy at home , and to receive nutritional supplements .  During 12 weeks , patients were encouraged to ingest a total daily defined energy intake . R and omly , in patients from group A the total daily energy load was Resting Energy Expenditure (REE)x1.7 , and those from group B , REE x1.3 . Total daily energy intake was achieved with regular food plus , if necessary , oral nutritional supplement rich in proteins ( with 50 % of whey protein ) , with predominance of carbohydrates over fat , and enriched in antioxidants . Primary end-point variable was quality of life . Secondary end-point outcomes included body weight , body composition , lung function , h and grip strength , and compliance with the energy intake previously planned . Data were treated with a SAS System . Student 's test , Wilcoxon 's rank sum test , and Mann-Whitney 's test were used . RESULTS At baseline both groups of patients were comparable . All patients needed oral nutritional supplements to achieve total daily defined energy intake . After 12 weeks of follow-up , patients in both groups significantly increased energy intake . Patients in group A increased body weight ( P=0.001 ) , triceps skin fold thickness ( P=0.009 ) and body fat mass ( P=0.02 ) , and decreased body fat-free mass index ( P=0.02 ) . In this group a marked increase in airflow limitation was observed . A tendency to increase body weight and h and grip strength , and to decrease airflow limitation was observed in patients from group B. Furthermore , patients in the later group showed a significant improvement in the feeling of control over the disease ( P=0.007 ) and a tendency to better the other criteria in a quality of life scale . CONCLUSIONS According to our results , total daily energy intake of REE x 1.3 is preferable to REE x 1.7 in mild stable COPD patients . The administration of oral nutritional supplements , rich in proteins ( with 50 % of whey protein ) , with predominance of carbohydrates over fat , and enriched in antioxidants , to achieve total daily defined energy intake in patients in group B was followed by a significant improvement of one criteria ( mastery ) among many others in a quality of life scale 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 The effects of a nutritional support in hospitalized patients with alcoholic cirrhosis and liver failure were studied in a controlled protocol . Thirty-six patients were included , 17 were r and omly assigned to an experimental group and the rest to a control group . Experimentals received a diet aim ing at 50 kcal ( 209 kJ)/kg bodyweight/d and 1.5 g protein/kg bodyweight/d ( as proteins of high biological value ) . Controls received the st and ard diet prescribed by the attending physician . The severity of liver failure and the nutritional status on admission were similar in both groups . The measured energy intake in controls was 1813 + /- 121 kcal/d ( 7589 + /- 506 kJ/d ) and 2707 + /- 71 kcal/d ( 1131 + /- 297 kJ/d ) in experimentals ( P less than 0.001 ) . The protein intake in controls was 47 + /- 3.8 g/d and in experimentals 80 + /- 3 g/d ( P less than 0.001 ) . There were seven deaths during the study period ( two experimentals and five controls ) . No differences were observed in the evolution of liver failure , hepatic encephalopathy or nutritional status between both study groups . It is concluded that a higher energy and protein intake in these patients does not have adverse effects and is associated with a non-significant reduction in mortality We report results of a r and omized clinical trial of a combined intervention of exercise and dietary counseling ( ExD ) after orthotopic liver transplantation ( OLT ) AIMS To evaluate the effect of a whole formula diet on nutritional and cognitive status in Alzheimer 's disease patients . METHODS Patients were r and omly assigned to two interventions : a whole formula diet based on lyophilised foods ( Treatment Group , n=24 ) or nutritional advice ( Control Group , n=29 ) . Energy intake , body weight , biochemistry , Mini Nutritional Assessment ( MNA ) and Pfeiffer 's tests were determined at baseline and at 3 months of treatment . RESULTS No differences were observed between groups at baseline . Energy intake tended to increase in the Treatment Group and to decrease in the Control Group , although differences were not significant . The improvement in MNA and Pfeiffer test scores was not significantly different between groups . Body weight increased by 2.06+/-1.9 kg in the Treatment Group and by 0.32+/-3.04 kg in the Control Group ( P=0.007 ) . The increases in albumin ( P=0.007 ) , haemoglobin ( P=0.002 ) and serum ferritin ( P=0.009 ) were higher in the Treatment Group than in controls . A similar rate of serious adverse events ( hospitalisation or death ) was observed in both groups . CONCLUSIONS Administration of this whole formula has a positive impact on nutritional status . The great diversity in textures and tastes enable these formulations to be administered to a wide range of patients with or without liquid dysphagia 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 AIMS AND OBJECTIVES The purpose of the study was to test the effectiveness of nursing care based on active involvement of patients in  their nutritional care .  It was hypothesized that this type of care could improve energy and protein intake in elder orthopaedic patients . BACKGROUND Protein and energy malnutrition and deterioration in nutritional status is a common but neglected problem in hospital patients . METHODS The design was quasi-experimental with an intervention and control group . The study included 253 patients aged 65 and above admitted for hip fracture , hip or knee replacement .  Food intake was recorded on a daily basis during the hospital stay . RESULTS The daily intake of energy increased with 23 % ( P = 0.001 ) and of protein with 45 % ( P = 0.001 ) . The intake increased from the very first day after the operation . The intake of energy and protein was not correlated with the patient 's age , body mass index or type of surgery . CONCLUSIONS The care based on patients ' active involvement in their own nutritional care and was found to be an effective method to raise the intake of energy and protein among elder orthopaedic patients . RELEVANCE TO CLINICAL PRACTICE This way of organizing the care identifies patients who do not consume enough energy and protein according to their current requirements and to take appropriate actions to prevent further malnutrition BACKGROUND & AIMS Up to 50 % of patients with chronic pancreatitis ( CP ) are malnourished . There are limited data on the role of dietary intervention in improving the nutritional status of such patients . The aim was to compare the efficacy of medium chain triglyceride (MCT)-enriched commercial dietary supplements with dietary counseling for homemade food in the management of malnutrition in patients with CP . METHODS In a r and omized controlled trial , consecutive undernourished patients with CP ( body mass index [ BMI ] < 18.5 kg/m(2 ) ) at a tertiary care hospital were r and omized to receive either dietary counseling for regular homemade food or commercial MCT-enriched dietary supplements for a period of 3 months to compensate for the dietary calorie deficit . All patients received st and ard management for CP including pancreatic enzyme supplements . Primary outcome measure was improvement in BMI . RESULTS Sixty malnourished patients with CP were r and omized to counseling group ( n = 29 ; mean age , 32 + /- 10 years ; male , 83 % ) and supplementation group ( n = 31 ; mean age , 28 + /- 10 years ; male , 84 % ) . BMI increased in both the counseling group and supplementation group ( 17.2 + /- 1.7 vs 18.1 + /- 1.8 kg/m(2 ) , P = .001 ; 16.7 + /- 1.6 vs 18.2 + /- 1.6 kg/m(2 ) , P = .001 ) . There were similar improvements in triceps skinfold thickness , dietary intake , fecal fat , and pain score during a period of 3 months in both groups . There was , however , no significant difference between the counseling and supplementation groups with regard to any of the outcome measures . CONCLUSIONS Dietary counseling for a balanced homemade diet is as good as commercial food supplements in improving malnutrition in patients with CP 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 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 BACKGROUND The aim was to evaluate the relationship between nutrition support ( NS ) on host toxicity and cancer outcome in patients with locally advanced head and neck squamous cell carcinoma ( HNSCC ) undergoing definitive radiotherapy ( XRT ) .  METHODS We performed a secondary analysis of Radiation Therapy Oncology Group ( RTOG ) 90 - 03 , a prospect i ve r and omized trial evaluating four definitive XRT fractionation schedules in patients with locally advanced HNSCC , which prospect ively collected data on NS delivered before treatment ( BNS ) , during treatment ( TNS ) , and after definitive XRT . NS data and pretreatment characteristics of the 1073 evaluable patients were analyzed against therapy toxicity and outcome . RESULTS Patients receiving BNS experienced significantly less weight loss by the end of treatment and less grade 3 to 4 mucositis than patients not receiving BNS . However , patients receiving BNS had a poorer 5-year actuarial locoregional control rate than patients receiving TNS or no NS ( 29 % , 55 % , and 57 % , respectively , p < .0001 ) and a poorer 5-year overall survival rate ( 16 % , 36 % , and 49 % , respectively , p < .0001 ) . Patients receiving BNS were significantly more likely to have a higher T classification , N status , and overall American Joint Committee on Cancer ( AJCC ) stage and initial presentation with greater pretreatment weight loss , and a poorer Karnofsky Performance Status ( KPS ) than patients not receiving BNS . After adjusting for the impact of these prognostic factors through a recursive partition analysis , a multivariate analysis with a stratified Cox model found that BNS was still a highly significant independent prognostic factor for increased locoregional failure ( hazards ratio [ HR ] , 1.47 ; 95 % confidence interval [ CI ] , 1.21 - 1.79 ; p < .0001 ) and death ( HR , 1.41 ; 95 % CI , 1.19 - 1.67 ; p < .0001 ) . CONCLUSION In this study , the largest prospect i ve evaluation of nutrition data in treated patients with cancer , BNS was associated with inferior treatment outcome in the patients with HNSCC undergoing XRT . These results should be considered hypothesis generating and encourage prospect i ve clinical research and identification of the mechanisms underlying this finding 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 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 Background and aims : Many elderly people with Alzheimer ’s disease experience weight loss . Illness and inadequate regain after a period of illness are considered as contributory causes of progressive weight loss in psychogeriatric patients . We studied whether early use of a liquid nutrition supplement immediately after onset of acute illness from infection can prevent weight loss in elderly psychogeriatric nursing home residents . Methods : R and omised controlled trial of 5 weeks after the onset of illness . Thirty-four psychogeriatric nursing home residents ( aged ±65 yrs ) completed the study period . A liquid nutrition supplement ( 200 ml ) once daily immediately after diagnosis of infection or st and ard treatment ( enriched food after referral to a dietician ) were provided . Body weight , mid-upper arm circumference , calf circumference , triceps skin fold thickness , dietary energy intake , and need for care were measured . Results : Weight change during the study period was significantly different between the st and ard ( −0.4 kg ) and supplement ( + 0.8 kg ) groups ( p=0.040 ) . No significant differences were observed in changes of midupper arm circumference , triceps skin fold thickness , calf circumference or energy intake between groups . Conclusions : Early provision of a liquid nutrition supplement immediately after onset of acute illness from infection leads to weight gain in elderly psychogeriatric nursing home residents 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 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 Background / Aim Malnutrition is highly prevalent in patients on continuous ambulatory peritoneal dialysis ( CAPD ) and is a strong predictor of increased morbidity and mortality . Therefore , the aim of this study was to evaluate the effect of oral administration of an egg albumin-based protein supplement on the nutritional status of CAPD patients . Methods In this r and omized , open label , controlled clinical trial , 28 CAPD patients were allocated to a study ( n = 13 ) or a control ( n = 15 ) group . Both groups received conventional nutritional counseling ; the study group received , additionally , an oral egg albumin-based supplement . During a 6-month follow-up , all patients had monthly clinical and biochemical evaluations and quarterly assessment s of adequacy of dialysis and nutrition . Results Serum albumin levels were not different between groups ; however , a significant increase ( baseline vs final ) was observed in the study group ( 2.64 ± 0.35 vs 3.05 ± 0.72 g/dL ) but not in the control group ( 2.66 ± 0.56 vs 2.80 ± 0.54 mg/dL ) . Calorie and protein intake increased more in the study group ( calories 1331 ± 432 vs 1872 ± 698 kcal ; proteins 1.0 ± 0.3 vs 1.7 ± 0.7 g/kg ) than in the control group ( calories 1423 ± 410 vs 1567 ± 381 kcal ; proteins 1.0 ± 0.4 vs 1.0 ± 0.3 g/kg ) . Similarly , non-protein nitrogen appearance rate ( nPNA ) increased significantly more in the study ( 1.00 ± 0.23 vs 1.18 ± 0.35 g/kg/day ) than in the control group ( 0.91 ± 0.11 vs 0.97 ± 0.14 g/kg/day ) . Triceps skinfold thickness ( TSF ) and midarm muscle area ( MAMA ) displayed a nonsignificant trend to a greater increase in the study group ( TSF 16.7 ± 8.7 vs 18.3 ± 10.7 mm ; MAMA 23.8 ± 6.2 vs 25.8 ± 5.9 cm2 ) than in controls ( TSF 16.4 ± 5.7 vs 16.9 ± 7.0 mm ; MAMA 28.7 ± 7.8 vs 30.0 ± 7.9 cm2 ) . At the end of follow-up , the frequency of patients with moderate or severe malnutrition decreased 6 % in the control group and decreased 28 % in the study group . At the final evaluation , the most important predictors of serum albumin were the oral egg albumin-based supplement administration and protein intake ( p < 0.05 ) ; secondary predictors ( p = 0.06 ) were peritoneal transport rate and MAMA . Conclusions In the study group , oral administration of the egg albumin-based supplement significantly improved serum albumin , calorie and protein intake , and nPNA , and , compared to controls , this maneuver was associated with a trend to increased anthropometric parameters and improved Subjective Global Assessment evaluation . Oral administration of the albumin supplement and protein intake were the most significant predictors of serum albumin at the end of follow-up . This oral supplement may be a safe , effective , and cheap method to improve nutritional status in peritoneal dialysis 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 BACKGROUND & AIMS Malnutrition is common in the elderly and increases morbidity and mortality . Most attempts to reverse malnutrition have used liquid supplements , but the findings are inconsistent . This study tests a new approach using a r and omised-controlled design . The aim was to examine whether health care assistants , trained to provide additional support with feeding , can improve acutely ill elderly in- patients ' clinical outcomes . METHODS The study was carried out on three acute medicine for the elderly wards at Hammersmith Hospitals NHS Trust , London . In all , 592 patients , all over 65 years old , were recruited . RESULTS The results showed that the median time patients received feeding support was 16 days , and the assisted group was given less intravenous antibiotics  ( P=0.007 ) . However , the groups did not differ in markers of nutritional status , Barthel score , grip strength , length of stay or mortality . CONCLUSION It was concluded that the use of health care assistants in this specialised role , in an acute setting , without change to the food provision or without targeting higher risk patients , reduced the need for intravenous antibiotics . However , the intervention did not improve nutritional status or have an effect on length of stay in the time span studied . The results highlight the difficulties of improving the intake of acutely ill elderly patients during a hospital stay OBJECTIVE Up to 60 % of hospitalized patients are undernourished . We studied the impact of nutritional therapy on quality of life and food intake . METHODS Undernourished patients were r and omized into two groups . The nutritional therapy group ( NT group ) received individual nutritional counseling and interventions , including oral nutritional supplements if appropriate , by a dietitian . The oral nutritional supplement group ( ONS group ) received oral nutritional supplements in addition to hospital meals without further instruction or counseling . Study duration was 10 to 15 d. At baseline and before discharge ( time point 1 ) we measured energy and protein intakes and quality of life . Quality of life was measured again 2 mo after discharge ( time point 2 ) . RESULTS Energy and protein intakes increased between baseline and time point 1 in both groups ( P=0.001 ) . The NT group ( n=18 ) met the energy requirements at time point 1 by 107 % and of protein by 94 % , the ONS group ( n=18 ) by 90 % and 88 % , respectively . Hospital meals alone did not cover the requirements . From baseline to time point 1 , quality of life increased in both groups . Quality of life increased further in the NT group from time point 1 to time point 2 ( P=0.016 ) , but not in the ONS group . CONCLUSION Both interventions caused a significant increase in energy and protein intakes and quality of life . In the NT group every patient received an efficacious individualized intervention . In contrast , the 7 of 18 patients in the ONS group who did not consume ONS had no intervention at all . Therefore , undernourished patients should be counseled individually by a dietitian 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 Objective : To compare the effect of calcium/vitamin D supplements with a combination of calcium/vitamin D supplements and exercise/protein on risk of falling and postural balance . Design : R and omized clinical trial . Setting : University hospital physiotherapy department . Subjects : Twenty-four independently living elderly females aged 65 years and older with osteopenia or osteoporosis and mean total hip T-score ( SD ) of —1.8 ( 0.8 ) . Interventions : A three-month programme consisting of exercise/protein including training of muscular strength , co-ordination , balance and endurance . Calcium/ vitamin D was supplemented in all participants for a 12-month period . Outcome measures : Assessment took place prior to and following the months 3 , 6 , 9 and at the end of the study ; primary dependent variables assessed were risk of falling ( Berg Balance Test ) and postural balance ( forceplate ) . Secondary measures included body composition , strength , activity level , number of falls , bone mineral content , biochemical indices , nutritional status and general health . Results : Significant reductions of risk of falling ( repeated measures ANOVA F = 8.90 , P = 0.008 ) , an increase in muscular strength ( ANOVA F = 3.0 , P = 0.03 ) , and an increase in activity level ( ANOVA F = 3.38 , P = 0.02 ) were found in the experimental group as compared to the control group . Further on , there was 89 % reduction of falls reported in the experimental group ( experimental pre/post 8/1 falls ; control group pre/post 5/6 falls ) . Conclusion : This study provides support for our intervention programme aim ed at reducing the risk of falling in elderly participants diagnosed with osteopenia or osteoporosis . The data obtained from the pilot study allow the calculation of the actual sample size needed for a larger r and omized trial To determine the feasibility of increasing the calcium , protein and calorie intake of osteoporotic fracture patients by repeated dietary counselling delivered by a dietitian , a r and omized controlled trial was conducted . Among 189 patients presenting with osteoporotic fractures to an Orthopaedics and Traumatology Department of a large regional hospital , 98 patients were r and omized to the intervention group and 91 were r and omized to the control group ( with usual care ) . Intervention group received three sessions of dietary counselling with tailored made recommendations over a period of 4 months , while the control group only received dietary assessment and pamphlets on the prevention of osteoporosis . Almost all subjects in both intervention and control groups had calcium intake below the recommended level of 1000 mg at baseline . Half and 60 % of subjects in both groups had total energy and protein intake below recommended levels respectively . The mean weights of control and intervention groups at baseline were 51.5 and 50.9 kg respectively , while the body mass index ( BMI ) were 22.6 ( kg m(-2 ) ) and 22.6 ( kg m(-2 ) ) respectively . After dietary intervention , significant increase of intake was seen in calcium intake ( P = 0.0095 by t-test ) in the intervention group . No significant increase was seen in protein or calorie intake . No significant change was observed in the body weight or BMI although there was a positive trend in the intervention group for all these parameters . We concluded that there was general malnutrition in Chinese elderly who presented with osteoporotic fractures . Dietary calcium could be increased by repeated professional dietary counselling . Future studies with longer duration and more objective clinical outcomes will be helpful to further demonstrate the long-term effects of dietary intervention on osteoporosis and other chronic diseases The use of oral dietary supplements was compared with dietary counseling in 13 malnourished patients ( 3 males , mean age 18.1 years ) with cystic fibrosis .  Energy intake and nutritional status were evaluated over 3 months . There was no significant change in energy intake or percent ideal body weight in either group The potential nutritional and clinical benefits of sip-feed supplements were investigated by means of a controlled trial in elderly female patients admitted for orthopaedic surgery . A nutritional risk assessment procedure ( Nutritional Risk Question naire , NRQ ) was used to identify patients who might benefit from supplementation . Patients identified as high risk who did not receive supplements  showed significant losses in triceps skinfold thickness ( TSF ) and mid-upper arm muscle circumference ( MUAMC ) measurements during hospitalization . Such changes were not observed in high-risk supplemented patients , but significant losses of MUAMC were also recorded in a group of patients who failed to comply with the supplement . No differences in biochemical parameters , muscle function , or clinical outcome were observed between supplemented and unsupplemented and non-compliant patients . The problems of poor compliance to sip-feed supplements and failure to observe clinical benefit in supplemented patients are discussed 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 OBJECTIVE To study appetite and food choices in lean elderly women at the time of a femoral neck fracture and after 6 months of nutritional and anabolic intervention . SUBJECTS AND METHODS Forty-five nondemented women > 70 years of age ( mean + /- SD : 83 + /- 5 years ) with a recent hip fracture and body mass index < 24 kg/m2 ( mean : 20.5 + /- 2.3 ) were interviewed about their appetite and dietary habits prior to fracture . The patients were r and omized to treatment with a protein-rich liquid supplement ( PR ; 200 kcal and 20 g protein day(-1 ) ) alone or in combination with n and rolone decanoate injections ( PR/N ) 25 mg i.m . every third week or to a control group ( C ) . A second interview was conducted 6 months later . RESULTS Reduced appetite before the fracture was reported by 60 % . Half of the patients did not have dessert with any of their daily meals , one-third used low-fat margarines and one-third drank water with their meals . The estimated mean daily energy intake was 6.4 + /- 1.2 MJ ( 1541 + /- 304 kcal ) indicating that three of four subjects did not meet their energy needs . At 6 months , 40 % reported reduced appetite . There was no difference in the change of appetite between the three r and omized groups . Still , half of the subjects appeared to not meet their energy needs . Protein intake increased in the PR and PR/N groups , in contrast to the controls ( P = 0.002 ) . CONCLUSION Reduced appetite and insufficient energy intake was recorded in lean elderly women with a femoral neck fracture .  Nutritional supplementation alone or in combination with an anabolic steroid increased protein intake without adversely affecting appetite 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 Objectives To determine whether in the current study the supply of a nutrient dense drink has a positive effect on mental and physical function of institutionalized elderly people . Design A 24-week , r and omized , double-blind , placebo-controlled , parallel-group , intervention trial . Setting Homes for the elderly and nursing homes in the Netherl and s. Participants Institutionalized elderly people older than 60 years , with a BMI ≤ 30 kg/m2 , and a Mini-Mental State Examination score of at least 10 points . InterventionIn addition to their usual diet the participants ( n=176 ) received either a nutrient dense drink or a placebo drink twice a day during 24 weeks . Measurements The functionality measures included cognitive function , mood , physical performance and the ability to perform activities of daily living . Results In the supplement group a favorable effect of the intervention drink on body weight ( 1.6 kg difference in change ; P = .035 ) , calf circumference ( 0.9 cm difference in change ; P = .048 ) , and blood values ( e.g. Hcy decreased from 16.8 to 11.2 µmol/L in the supplement group ) was found . In the total group no significant effect was found on functionality outcomes . However , a subgroup of participants with BMI at baseline below 24.4 kg/m2 performed better on the cognitive subscale of Alzheimer ’s Disease Assessment Scale ( P = .09 ) , and its language sub score ( P = .01 ) after 24 weeks of intervention . Conclusion The results in the total group of this trial suggest that the nutritional supplement used in this study improves nutritional status . Furthermore , the results of this trial suggest that it is effective as treatment for decreasing function in a subgroup of institutionalized elderly people with low BMI 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 BACKGROUND Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients to reduce postoperative complications . However , tolerability of supplements could be a limitation , and their universal use is not supported by the heterogeneity of previous studies , especially in patients without malnutrition . METHODS This study is a r and omized , controlled , open , parallel , 3-arm clinical trial comparing supplementation with protein powder dissolved in liquids to aim at 36 g of protein per day , energy and protein supplements to aim at 37.6 g of protein and 500 kcal per day , or no intervention in normally nourished or mildly undernourished patients . Outcomes were serum albumin , prealbumin , retinol-binding globulin , and body mass index , among others . Postoperative complications were also recorded . RESULTS Ninety patients aged 83.8 + /- 6.6 years were included . The mean ingested amount of supplements was 41.1 % + /- 20.6 % in the protein powder supplement group and 51.4 % + /- 13.2 % in the energy protein supplement group ( t = 2.278 , P = .027 ) . Postoperative supplements had no effect on the nutrition status during in-hospital follow-up , as assessed by serum albumin ( P = .251 ) , prealbumin ( P = .530 ) , retinol-binding globulin ( P = .552 ) , or body mass index ( P = .582 ) . Multivariate analysis showed that length of hospital stay with an established complication until its resolution ( beta = .230 , P = .031 ) , total hospital stay ( beta = .450 , P < .001 ) , baseline body mass index ( beta = .204 , P = .045 ) , and total daily ingested proteins per body weight ( beta = .252 , P = .018 ) were predictive variables on the change in serum albumin ( R2 = 0.409 , F = 11.246 , P < .001 ) . CONCLUSIONS Oral nutritional supplements in normally nourished or only mildly undernourished geriatric patients with hip fracture su bmi tted to surgery may be of interest for patients with postoperative complications and long hospital stays 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 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 Malnutrition and dehydration are potential consequences of dysphagia , a common swallowing disorder among elderly individuals . Providing smaller , more frequent meals has been suggested ( but not demonstrated ) to improve energy intake among this group . Accordingly , this study was design ed to assess whether the same energy content in five vs three daily meals would improve energy intake .  Thirty-seven residents of an extended-care facility , aged older than 65 years , previously evaluated for dysphagia , and receiving a texture-modified diet  , agreed to participate in a crossover study with r and om assignment to three or five meals during an initial 4-day study period , followed by the opposite meal pattern in a second period . Six were excluded from analysis , as their medical condition deteriorated before or during the study . Food and fluids consumed by participants during each study period were weighed before and after each meal . Average energy intakes were similar between the three- and five-meal patterns ( 1,325+/-207 kcal/day vs 1,342+/-177 kcal/day , respectively ; P=0.565 ) ; fluid intake was higher with five meals ( 698+/-156 mL/day ) vs three ( 612+/-176 mL/day ; P=0.003 ) . Because offering five daily feedings did not improve energy intakes when compared with three , dietitians caring for this vulnerable group might need to consider other nutrition intervention strategies 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 AIM To assess prospect ively the effects of a controlled program of inspiratory muscle training program and nutritional support in patients with chronic obstructive lung disease ( COPD ) . PATIENTS AND METHODS Twenty-three patients with COPD were r and omly assigned into four groups . Group I received a 1000 kcal/day nutritional supplement , given as a casein based enteral nutritional formula ; group III was subjected to inspiratory muscle training , using an inexpensive pressure threshold load valve constructed according to the Appropriate Technology principles of the WHO , adjusted at 30 % of Maximal Inspiratory Mouth Pressure and received also the nutritional supplement ; group IV was trained but did not receive the nutritional supplement and group II was not trained nor supplemented . Patients were studied during three months and monthly , inspiratory muscle function , exercise capacity and anthropometry were measured . RESULTS A significant improvement in exercise capacity , maximal inspiratory pressure and inspiratory muscle endurance was observed in the four groups throughout the study . Trained subjects had greater improvement in their inspiratory muscle endurance , compared to untrained subjects . Nutritional support had no effect in inspiratory muscle function or exercise capacity . No changes in anthropometric measures were observed . CONCLUSIONS The pressure threshold load valve used in this study , improved inspiratory muscle endurance and nutritional support had no effect in patients with COPD 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 Cystic fibrosis ( CF ) remains the most common genetically inherited disease in the white population and its prognosis is affected by nutritional status . Adults with the disease are now surviving longer and new strategies are required to ensure that they maintain optimal nutrition . This article reports preliminary data from a r and omized controlled trial of a 10-week home-based behavioral nutrition intervention , " Eat Well with CF . " Outcome measures of weight change over 6 and 12 months and changes in CF-specific nutrition knowledge score , self-efficacy score , reported dietary fat intake and health-related quality -of-life score were compared between the  intervention group ( n=34 ) and a st and ard care control group ( n=34 ) . The hypotheses to be tested were that adults with CF completing " Eat Well with CF " would have an improved nutritional status , improvement in specific nutrition knowledge , and an improvement in self-efficacy regarding their ability to cope with a special diet , compared to those receiving st and ard care . There were substantial improvements in the intervention group 's specific CF nutrition knowledge score , self-efficacy score , and reported fat intake compared to control , but no substantial change in body mass index or health-related quality of life over time . Home-based nutrition education incorporating behavioral strategies can be an effective way to support adults with CF , enabling improvement in self-management skills in relation to diet and pancreatic enzyme replacement therapy . This study revealed gaps in basic nutrition knowledge and skills , inadequate knowledge of diet-disease links and pancreatic enzyme replacement therapy . These need to be identified when subjects progress from pediatric to adult care , and programs such as " Eat Well with CF " are a useful adjunct for registered dietitians trying to manage this diverse but growing population UNLABELLED Patients with liver cirrhosis exhibit early onset of gluconeogenesis after short-term fasting . This accelerated metabolic reaction to starvation may underlie their increased protein requirements and muscle depletion . A r and omized controlled trial was conducted to test the hypothesis that provision of a late-evening nutritional supplement over a 12-month period would improve body protein stores in patients with cirrhosis . A total of 103 patients ( 68 male , 35 female ; median age 51 , range 28 - 74 ; Child-Pugh grading : 52A , 31B , 20C ) were r and omized to receive either daytime ( between 0900 and 1900 hours ) or nighttime ( between 2100 and 0700 hours ) supplementary nutrition ( 710 kcal/day ) . Primary etiology of liver disease was chronic viral hepatitis ( 67 ) , alcohol ( 15 ) , cholestatic ( 6 ) , and other ( 15 ) .  Total body protein ( TBP ) was measured by neutron activation analysis at baseline , 3 , 6 , and 12 months . Total daily energy and protein intakes were assessed at baseline and at 3 months by comprehensive dietary recall . As a percentage of values predicted when well , TBP at baseline was similar for the daytime ( 85 + /- 2[st and ard error of the mean]% ) and nighttime ( 84 + /- 2 % ) groups . For the nighttime group , significant increases in TBP were measured at 3 ( 0.38 + /- 0.10 kg , P = 0.0004 ) , 6 ( 0.48 + /- 0.13 kg , P = 0.0007 ) , and 12 months ( 0.53 + /- 0.17 kg , P = 0.003 ) compared to baseline . For the daytime group , no significant changes in TBP were seen . Daily energy and protein intakes at 3 months were higher than at baseline in both groups ( P < 0.0001 ) , and these changes did not differ between the groups . CONCLUSION Provision of a nighttime feed to patients with cirrhosis results in body protein accretion equivalent to about 2 kg of lean tissue sustained over 12 months . This improved nutritional status may have important implication s for the clinical course of these patients OBJECTIVE We tested the hypothesis that a multifaceted 11-wk intervention comprising nutrition , group exercise , and oral care would have a significant influence on nutrition and function in elderly ( > or=65 y ) nursing-home residents . METHODS The study was an 11-wk r and omized controlled intervention study with nutrition ( chocolate and homemade oral supplements ) , group exercise twice a week ( 45 - 60 min , moderate intensity ) , and oral care intervention one to two times a week , with the aim of improving nutritional status and function in elderly nursing-home residents . A follow-up visit was made 4 mo after the end of the intervention . Assessment s were weight , body mass index , dietary intake , h and grip strength , Senior Fitness Test , Berg 's Balance Scale , and the prevalence of plaque . RESULTS A total of 121 subjects ( 61 % ) accepted the invitation and 62 were r and omized to the intervention group . Six of these dropped out during the 11 wk . At the 4-mo follow-up there were 15 deaths in the intervention group and 8 in the control group . The nutrition and exercise were well tolerated . After 11 wk the change in percentage of weight ( P = 0.005 ) , percentage of body mass index ( P = 0.003 ) , energy intake ( P = 0.084 ) , protein intake ( P = 0.012 ) , and Berg 's Balance Scale ( P = 0.004 ) was higher in the intervention group than in the control group . In addition , the percentage of subjects whose functional tests improved was higher in the intervention group . Both groups lost the same percentage of weight after the intervention ( P = 0.908 ) . The total percentage of weight loss from baseline to follow-up was higher in the control group ( P = 0.019 ) . Oral care was not well accepted and the prevalence of plaque did not change . CONCLUSION It is possible to improve nutrition and function in elderly nursing-home residents by means of a multifaceted intervention consisting of chocolate , homemade supplements , group exercise , and oral care
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 .