Fine bore jejunostomy feeding following major abdominal surgery: A controlled randomized clinical trial Nutritional evaluation and dietetic care in cancer patients treated with radiotherapy: prospective study. Long-term nutritional support as an adjunct to chemotherapy for breast cancer. Dietary supplementation in elderly patients with fractured neck of the femur Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial. Early postoperative feeding with elemental diet. Dietary supplementation and immunocompetence in housebound elderly subjects. Early nasoduodenal feeding for the post-biliary surgical patient. Effect of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients--a randomised study. A randomized study of oral nutritional support versus ad lib nutritional intake during chemotherapy for advanced colorectal and non-small-cell lung cancer. Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing. 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. Incidence and recognition of malnutrition in hospital Body composition in elderly men: effect of dietary modification during strength training. Nutritional repletion in malnourished patients with emphysema. Impact of nutritional supplementation on treatment delay and morbidity in patients with head and neck tumors treated with irradiation. Perioperative nutritional support: a randomised clinical trial. The effects of refeeding on peripheral and respiratory muscle function in malnourished chronic obstructive pulmonary disease patients. Needle catheter jejunostomy: a controlled, prospective, randomized trial in patients with gynecologic malignancy. Short term benefits of post-operative oral dietary supplements in surgical patients. Nutritional supplementation in ambulatory patients with chronic obstructive pulmonary disease. 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 supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease. Very early nutrition supplementation in burned patients. Exercise training and nutritional supplementation for physical frailty in very elderly people. Dietary supplementation and respiratory muscle performance in patients with COPD.
A r and omized controlled prospect i ve clinical trial has been undertaken to examine the efficacy of the technique of early postoperative feeding using a fine bore catheter jejunostomy .  Fifty patients undergoing surgery for gastrointestinal malignancy were r and omly allocated into treatment and control groups . A low residue liquidized diet ( IsocalR ) was administered to the patients in the treatment group . Control patients received routine intravenous therapy .  Nutritional parameters ( serum albumin , serum transferrin , serum prealbumin , weight , body fat and fat free mass ) were measured pre‐operatively and on the tenth postoperative day . Postoperative surgical complications were similar in both groups . There were 20 catheter complications and one death directly attributable to the jejunal catheter feeding . Postoperative stay was significantly longer ( P < 0.01 ) in the treatment group patients . Evaluation of the nutritional parameters showed no advantage for either the treatment group or a selected complication‐free , successful treatment , subgroup . It is concluded that no significant clinical or nutritional advantage for jejunal catheter feeding has been demonstrated and because of the related complications , its routine use can not be recommended Ninety-three cancer patients about to undergo radiotherapy were studied . These patients were affected by cancer of the head and neck , breast cancer , and abdominopelvic cancer . They were r and omly distributed into control and experimental groups . The patients from the control group were allowed to eat ad libitum , whereas those from the experimental group followed a strict nutritional protocol that covered their needs while satisfying their particular tastes and habits . Data were collected the day before radiotherapy commenced and the day treatment ended . Anthropometric , analytical , and clinical parameters were determined . The results showed the benefit of dietetic treatment in experimental patients with head and neck or abdominopelvic cancer In recent years , the concept of nutritional support as a part of a comprehensive cancer management program has gained increasing acceptability . However , little data is available in regard to the effect of nutritional support programs on the chronic disease state represented by recurrent or persistent cancer that characterizes patients undergoing systemic chemotherapy . In 1977 we undertook to study this problem in a r and omized prospect i ve study design ed to evaluate the effects of long-term ( 12 months ) enteral nutritional support in a group of ambulatory breast cancer patients undergoing a st and ard cytotoxic chemotherapy treatment program  , in an adjuvant or therapeutic setting . The results of this study suggest that patients with breast cancer are overweight as compared to the general population and that any significant change in initial body weight , either a gain or a loss , is associated with an increased risk of recurrent disease . Data are presented which show little or no correlation between st and ard parameters of nutritional assessment and risk of disease recurrence and /or response to chemotherapy . These data also suggest that until we better underst and the relationship between tumor and host in breast cancer patients , we offer nutritional support programs only in situations where there are specific clinical indications for such interventions 59 elderly patients ( mean age 82 ) with femoral neck fractures were r and omised into two groups . 27 patients received daily an oral nutrition supplement ( 250 ml , 20 g protein , 254 kcal ) for a mean of 32 days ; 32 patients acted as controls . On admission most patients had nutritional deficiencies . Despite being offered adequate quantities , nutritional requirements were not met during the hospital stay . Clinical outcome was significantly better in the supplemented group ( 56 % favourable course vs 13 % in controls ) during the stay in the convalescent hospital . The rates of complications and deaths were also significantly lower in supplemented patients ( 44 % vs 87 % ) . 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients ( 40 % vs 74 % ) . The median duration of hospital stay was significantly shorter in the supplemented group ( 24 vs 40 days ) . Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation A total of 744 elderly women with fractured neck of femur were classified into three groups according to anthropometric measurements on admission : group 1 , well nourished ; group 2 , thin ; group 3 , very thin . Group 1 ate well and had a low mortality and a short rehabilitation time . The thinner the patients the lower their voluntary food intake , the higher their mortality and the longer their rehabilitation time . A series of 122 patients from groups 2 and 3 were entered postoperatively into a r and omised controlled trial of overnight supplementary nasogastric tube feeding ( 4.2 MJ ( 1000 kcal ) , including 28 g protein ) in addition to their normal ward diet . This treatment was associated with improvements not only in anthropometric and plasma protein measurements but also in clinical outcome , especially in the very thin group 3 patients . Rehabilitation time and hospital stay were shortened . Mortality in group 3 was less in the tube fed patients ( 8 % ) than in the controls ( 22 % ) but this difference did not reach statistical significance . One in five patients could not tolerate the nasogastric tube , but in the remainder the treatment caused no side effects and did not seriously diminish voluntary oral food intake by day The value of early postoperative feeding with an elemental diet was assessed in 30 patients after major gastrointestinal operations . The patients were allocated at r and om to conventional treatment ( control group ) or feeding with the elemental diet ( ED group ) . The clinical and metabolic course of the 15 patients in the ED group was significantly better than that of the controls . Patients in the ED group lost less weight and had a shorter stay in hospital . Negative nitrogen balance was more pronounced in the control group throughout the seven postoperative days . Energy intake was higher in the ED group . Provided elemental feeding is used with caution , it may be given from the first postoperative day . Patients do better metabolically and require shorter stays in hospital Immune function , particularly cell-mediated immunity ( CMI ) , declines with age and it has been suggested that this may be secondary to the impaired nutritional status often found in the elderly . In the present study a balanced nutritional supplement consisting of several macro- and micro-nutrients was administered daily to 27 housebound elderly ( aged 70 - 85 years ) for 12 weeks . Thirty-one matched subjects served as a control group . Delayed cutaneous hypersensitivity ( DCH ) to seven recall antigens was measured using the Mérieux Multitest CMI device and total numbers of lymphocytes , B-cells , T-cells and T-cell sub- population s were determined using monoclonal antibodies . These tests and several indices of nutritional status were measured before and at the end of the 12-week study . Before supplementation 19 % of the entire group of subjects were anergic and another 19 % hypoergic , values greater than expected for healthy elderly subjects . A weak association ( P = 0.056 ) was shown between plasma zinc concentration and the number of positive skin test responses . Supplementation had minimal effect on DCH , result ing in a significant ( P < 0.05 ) increase only in the sum of positive in duration s. Pre- study numbers of total lymphocytes and lymphocyte sub- population s were as expected for healthy elderly subjects , but a correlation was found between plasma selenium concentrations ( mean 1.07 , range 0.64 - 1.66 mumol/l ) and the numbers of CD4 lymphocytes ( P < 0.01 ) . Supplementation did not result in a significant change in any of the lymphocyte population s. ( ABSTRACT TRUNCATED AT 250 WORDS The effects of early postoperative nasoduodenal feeding on nutrition and metabolic response were studied using 24 patients after biliary surgery . The patients were r and omly divided into two groups with 12 in each group . Group I was fed via a nasoduodenal tube from the first postoperative day but control group II was not fed until the fourth postoperative day . The hospital blenderized tube feeding diet provided the enteric nutrition ( 17 % protein , 33 % fat and 50 % carbohydrate ) . The nutritional status of the 2 groups was compared over a one week period . The changes in nitrogen balance were measured daily for 8 days . The group fed early had a significantly reduced negative nitrogen balance when compared to the group whose feeding was started later . ( -1.91 + /- 1.05 g/day vs -5.84 + /- 0.48 g/day ) . There was no difference in serum albumin and transferrin levels , but serum prealbumin levels in the group fed early were more desirable than those of the control group ( from 15.8 + /- 2.5 mg/dl to 28.9 + /- 3.8 mg/dl vs from 18.0 + /- 2.0 mg/dl to 25.9 + /- 3.9 mg/dl ) . Total lymphocyte count was also better in the group fed early than in the controls ( from 1,325 + /- 204 cells/mm3 to 2,655 + /- 584 cells/mm3 vs from 1,277 + /- 188 cells/mm3 to 1,877 + /- 440 cells/mm3 ) . All the patients in group I felt better than those in group II during the study course . These results indicated that those patients provided with early nasoduodenal feeding after a biliary operation displayed a better nitrogen balance , and a faster increase in short half life visceral protein and total lymphocyte count The present study was design ed to evaluate to the effect of dietary supplements on clinical outcome and nutritional status in a large group of geriatric patients ( n = 501 ) . The patients were r and omised into an experimental group which received nutritional supplementation ( 400 kcal ) as well as a st and ard hospital diet , and a control group on hospital diet alone . The nutritional state was measured on admission and after 8 and 26 weeks by anthropometry , serum protein analysis and a delayed hypersensitivity skin test . Protein energy malnutrition was defined as the presence of three or more abnormal parameters . 28.5 % of patients showed evidence of malnutrition on admission . Hospitalisation itself result ed in a gradual deterioration in nutritional status .  Nutritional supplementation generally improved nutritional state . Among those patients who were well nourished on admission , and subsequently receiving dietary supplementation , 8.3 % fulfilled malnutrition criteria after 26 weeks , while 21.1 % were considered malnourished in the control group ( p < 0.05 ) . The improvement observed in transport proteins was probably related to nutritional support and not just to the reversal of inflammation . In the initially well nourished group of more than 300 patients , the mortality rate was 8.6 % in those given nutritional support compared to 18.6 % in the control group ( p < 0.02 ) 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 Thirty-two patients undergoing bowel resection were r and omized to receive either immediate postoperative nasojejunal feeding with full strength Osmolite solution for 56 hours ( n = 16 ) or routine postoperative hypocaloric fluids and gradual re introduction of diet  ( n = 16 ) . Body composition changes were measured at 14 days after operation with in vivo neutron activation analysis , the wound healing response by subcutaneous implantation of Gortex tubes , and muscle function by grip strength , maximum ventilatory volume , and stimulation of the ulnar nerve at the wrist . Postoperative fatigue up to 3 months after operation was assessed using a 10-point analogue . Successful immediate enteral nutrition was established in 12 of the 16 patients . Enterally fed patients had a mean daily caloric intake of 1179 + /- 388 kcal/d ( mean + /- SD ) over the first 4 postoperative days compared with 382 + /- 71 kcal/d for the controls ( p less than 0.0001 ) . The amount of hydroxyproline accumulating in the Gortex tubes was also significantly greater ( 2.5 + /- 1.1 nmol/g tube vs 1.5 + /- 0.8 nmol/g tube ; p less than 0.02 ) . However , the amount and composition of the weight lost was not significantly different . Muscle function was not preserved , and postoperative fatigue occurred to an equal extent in both groups . Complications were similar in both groups , except for a preponderance of bowel obstructions in the controls . The time to passage of first flatus and first bowel motion , although shorter in the fed group , did not reach significance ( p = 0.07 ) . We conclude that immediate enteral nutrition is feasible and results in an improved wound healing response . ( ABSTRACT TRUNCATED AT 250 WORDS 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 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 assess how dietary change affects gain in strength and muscle mass during heavy resistance training of elderly men . DESIGN R and omized controlled trial . INTERVENTION During 12 weeks of resistance training of knee extensors and flexors , a daily supplement of 560 + /- 16 kcal/day ( 17 % energy from protein , 43 % from carbohydrate , 40 % from fat ) was r and omly assigned to six men ( S ) while five men ( U ) received no supplement .  Food intake , strength , whole body composition , and midthigh composition by CT scan were assessed before training and at 6 and 12 weeks . SETTING The men were out patients but lived in a Metabolic Research Unit during the three assessment s. PARTICIPANTS Eleven healthy men aged 61 to 72 years . RESULTS Densitometry showed no change over time in fat or fat-free mass . However , the S men increased ( P less than 0.05 ) weight , skinfold thickness at six sites , subcutaneous midthigh fat , and creatinine excretion ; in all men , changes in these values and in midthigh muscle were proportional to changes in reported energy intake ( P less than 0.05 ) . There was midthigh muscle hypertrophy in both groups , but it was greater in S than U ( P less than 0.01 ) . Both groups gained strength ( P less than 0.001 ) with no effect of diet . CONCLUSIONS During physical rehabilitation of the elderly , dietary intake may influence the increase in lean as well as adipose tissue without altering strength gain . These preliminary findings should be confirmed by a larger study with sedentary controls We examined the effect of nutritional supplementation for 13 wk on anthropometric , pulmonary function , and immunological status in malnourished ambulant patients with pulmonary emphysema ( EP ) . The study was placebo controlled , r and omized and double blind . Twenty-eight patients were included . Thirteen patients in the fed group were provided with a nutritional formula providing 20 % protein , 30 % fat , and 50 % carbohydrate , 1 Kcal/ml , 400 ml/day . The control group was provided with a reference product of the same consistency and taste containing 0.1 Kcal/ml , 400 ml/day for 13 wk . The fed group had a mean weight gain of 1.5 kg during the study period , the control group increased concomitantly 0.16 kg , the difference being significant ( p less than 0.01 ) . Sum of four skinfolds increased 2.7 mm in the fed group , and decreased 0.9 mm in the control group the difference being significant ( p less than 0.01 ) . No difference were observed regarding pulmonary function or immunological status . We also found a high habitual energy intake in our study group ( 204 % Basal Energy Expenditure ) . We conclude that nutritional supplementation produce weight gain in malnourished patients with EP , but it does not change other indices of well-being Twenty-three patients with head and neck cancer were r and omly allocated , regardless of pretreatment nutrition status , to receive either radiotherapy alone ( 12 patients ) or radiotherapy plus nutritional oral supplementation ( 11 patients ) with high-protein nutritional powder of balanced nutrient content ( Ensure ) .  Nutrition status was assessed subjectively and objective ly for all patients before and at weekly intervals during the course of irradiation . All patients who received nutritional supplementation experienced an increase in body weight and in triceps skin-fold thickness , whereas 58 % of the other group had weight loss ( p = 0.001 ) . Irradiation had to be suspended in 5 of the 12 patients who received no nutritional support because of severe mucosal reaction and /or poor performance status . All patients who received nutritional supplementation during radiotherapy had their course of irradiation without interruption Ever since methods of artificial nutritional support became available , attempts have been made using this form of treatment to reduce mortality and morbidity in surgical patients . Many trials have addressed this question , but very few have given a meaningful answer because of conceptual and method ological flaws . We therefore undertook a prospect i ve r and omised trial investigating the effects of at least 10 days pre-operative total parenteral nutrition ( TPN ) ( n = 51 ) or total enteral nutrition ( TEN ) ( n = 50 ) providing 150 % basal energy expenditure ( BEE ) non-protein energy , to reduce major postoperative complications and mortality in a homogeneous patient group with signs of depletion . 50 patients served as a depleted control group ( D ) and 49 patients served as a non-depleted reference group ( ND ) and were operated upon without delay . Depleted control patients suffered significantly more septic complications than did patients in the non-depleted reference group ( p < 0.05 ) . There was no significant difference , however , in septic complications between either of the nutritional support groups and the non-depleted control group . In high risk patients , with weight loss > 10 % of body weight and over 500 ml blood loss during operation , a significant decrease in major complications was observed ( p < 0.05 ) as a result of nutritional support . We conclude that pre-operative nutritional support , in patients with severe depletion , results in a reduction in major complications to a degree that justifies its routine use in this selected group of patients We carried out a prospect i ve r and omized controlled trial to investigate the effects of short-term refeeding ( 16 days ) in 10 malnourished in patients with chronic obstructive pulmonary disease ( COPD ) . Six patients were r and omized to receive sufficient nasoenterically administered calories to provide a total caloric intake equal to 1,000 kcal above their usual intake . The other four patients were sham fed , receiving only 100 kcal more . Measurements of nutritional status , respiratory muscle strength and endurance , adductor pollicis function , and pulmonary function were performed initially and at study end . The refed group gained significantly more weight and showed significant increases in maximal expiratory pressure and mean sustained inspiratory pressure . There were no significant changes in the maximal inspiratory pressure or in adductor pollicis function . In malnourished in patients with COPD , short-term refeeding leads to improvement in respiratory muscle endurance and in some parameters of respiratory muscle strength in the absence of demonstrable changes in peripheral muscle function Sixty patients with gynecologic cancer entered a prospect i ve , r and omized study of immediate postoperative feeding . Thirty-three women in the study group received an elemental diet ( Vivonex HN ) delivered through a needle catheter jejunostomy .  Twenty-seven patients in the control group were given st and ard 5 % dextrose and electrolyte solutions . Patients in both groups were stratified according to nutritional status as determined by anthropometric evaluation and levels of serum albumin , total protein , and transferrin . These parameters also were measured at intervals throughout the study . Only one catheter-related complication occurred . Patients in the study group received significantly more calories ( p = 0.01 ) and were better able to maintain serum levels of transferrin ( p = 0.05 ) than those in the control group . An elemental diet administered through the needle catheter jejunostomy effectively maintains postoperative nutrition and is associated with few complications The present study was undertaken to investigate the short term clinical efficacy of oral dietary supplements administered post-operatively to patients undergoing predetermined moderate to severe gastrointestinal surgery . Trial end points for comparison included effects of oral dietary supplements on nutritional intake , nutritional status and incidence of serious complications .  54 patients who were scheduled to undergo predetermined moderate to major gastrointestinal surgical procedures entered the study . They were r and omly assigned to receive a normal ward diet post-operatively or the same diet supplemented ad libitum by an oral nutritional sip feed . The study period was defined as commencing from the day patients were adjudged to be capable of ingesting ' free fluids ' to the day of hospital discharge . 40 patients ( 20 in each group ) completed the study . The mean daily energy intake ( KCal/day ) assessed from 7 day food diaries was significantly higher in the treatment group ( 1833 + /- SEM 99 ) than in the control group ( 1108 + /- 56 , p < 0.0001 ) . This increase occurred not only as a consequence of energy intake from the oral dietary supplements ( 470 + /- 30 ) but also because more energy was consumed from the ward diet by the treatment than the control patients ( 1353 + /- 92 vs 1108 + /- 56 , p < 0.02 ) . The mean daily protein intake g/day in the treatment group ( 66.0 + /- 3.4 ) was also greater than in the control group ( 52.9 + /- 29 p < 0.0001 ) . This difference was due solely to the intake in protein from the oral dietary supplements ( 15.7 + /- 1.0 ) , protein intake from the ward diet being similar in the treatment ( 50.1 + /- 3.2 ) and control ( 52.9 + /- 29 ) groups . Patients in the treatment group maintained their pre-operative weight where as control patients had lostsignificant amount of their pre-operative weight by study day 3 ( 4.5 + /- 12 kg and by discharge ( 4.7 + /- 1.2 kg , p < 0.02 ) . Pre-operative muscle function as evidence d by grip strength dynamometry decreased to a greater extent in the control than treatment group patients by study day 3 ( 14.6 + /- 2.2 KPa vs 2.8 + /- 2.4 < 0.03 ) and by discharge ( 10.4 + /- 3.1 KPa vs 0.10 + /- 1.9 p < 0.03 ) . The incidence of serious infections ( pneumonia , wound infection ) was significantly higher in the control group ( 10 ) than in the treatment group ( 3 , p < 0.02 ) . It is concluded that the prescription of oral dietary supplements on an ad libitum basis to post-operative patients undergoing moderate to major gastrointestinal surgery results in clinical ly significant short term benefits We examined the effect of nutritional supplementation for 8 wk on respiratory muscle function ( RMF ) in 21 malnourished patients with COPD . Patients were r and omized to a fed group or to a control group . Patients in the fed group were provided with an enteral formula in addition to their usual diet . Daily calorie and protein intake and weekly anthropometric measures were made . Pulmonary function tests were measured on Weeks 1 , 4 , and 8 . Respiratory muscle strength was measured by means of maximal inspiratory and expiratory pressures ( MIP ) , ( MEP ) , and respiratory muscle endurance was measured by the maximal sustained ventilatory capacity ( MSVC ) . The mean weight of the fed group increased from 52.2 + /- 6.4 to 53.3 + /- 6.9 kg ( NS ) . The mean daily caloric intake of the fed group was significantly increased during the study ( p less than 0.02 ) . The mean calorie intake during the study of the fed group was 174 + /- 17 % of the estimated basal energy expenditure . During the study period , no change was observed in anthropometric measures , pulmonary function studies , or RMF . Because patients tend to decrease their own food intake while receiving enteral formulas , it is difficult to provide sufficient calories and protein needed to effect changes in nutritional status and RMF in an outpatient COPD population . In addition , we compared RMF in 12 poorly nourished male patients ( 87.6 + /- 6.1 % of ideal body weight ) and 13 well-nourished male patients with severe COPD . Both groups had comparable degrees of air-flow limitation and hyperinflation . No difference was noted between the groups in either MIP , MEP , or MSVC . ( ABSTRACT TRUNCATED AT 250 WORDS 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 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 We studied some metabolic and hormonal effects of a very early nutrition supplementation in burned patients . The patients were divided into two groups of 10 patients each . Supplementation in the first group , the very early nutritionally supplemented ( VENS ) group , was started immediately after admission , ie , after 4.4 + /- 0.5 h ( mean + /- SEM ) from the injury ; it was started after 57.7 + /- 2.6 h from the injury in the second group ( control group ) . Hormonal and metabolic indices were recorded every 4 d up to 28 d. In the VENS group , the nitrogen balance became positive in 8.8 + /- 4.1 d whereas it took 24.1 + /- 6.9 d in the control group ( p less than 0.05 ) . Urinary catecholamine excretion and plasma glucagon concentrations were lower during the first 2 wk of observation in the VENS group compared with the control group . Insulin concentrations were significantly higher on the fourth and eighth days in VENS patients and plasma cortisol concentrations were similar in both groups BACKGROUND Although disuse of skeletal muscle and undernutrition are often cited as potentially reversible causes of frailty in elderly people , the efficacy of interventions targeted specifically at these deficits has not been carefully studied . METHODS We conducted a r and omized , placebo-controlled trial comparing progressive resistance exercise training , multinutrient supplementation , both interventions , and neither in 100 frail nursing home residents over a 10-week period . RESULTS The mean ( + /- SE ) age of the 63 women and 37 men enrolled in the study was 87.1 + /- 0.6 years ( range , 72 to 98 ) ; 94 percent of the subjects completed the study .  Muscle strength increased by 113 + /- 8 percent in the subjects who underwent exercise training , as compared with 3 + /- 9 percent in the nonexercising subjects ( P < 0.001 ) . Gait velocity increased by 11.8 + /- 3.8 percent in the exercisers but declined by 1.0 + /- 3.8 percent in the nonexercisers ( P = 0.02 ) . Stair-climbing power also improved in the exercisers as compared with the nonexercisers ( by 28.4 + /- 6.6 percent vs. 3.6 + /- 6.7 percent , P = 0.01 ) , as did the level of spontaneous physical activity . Cross-sectional thigh-muscle area increased by 2.7 + /- 1.8 percent in the exercisers but declined by 1.8 + /- 2.0 percent in the nonexercisers ( P = 0.11 ) . The nutritional supplement had no effect on any primary outcome measure . Total energy intake was significantly increased only in the exercising subjects who also received nutritional supplementation . CONCLUSIONS High-intensity resistance exercise training is a feasible and effective means of counteracting muscle weakness and physical frailty in very elderly people . In contrast , multi-nutrient supplementation without concomitant exercise does not reduce muscle weakness or physical frailty 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
OBJECTIVES To determine whether routine oral and enteral nutritional supplementation can improve the weight , anthropometry , and survival of  adult patients .