Comparative Effects of Different Nutritional Supplements on Inflammation, Nutritional Status, and Clinical Outcomes in Colorectal Cancer Patients: A Systematic Review and Network Meta-Analysis

Abstract

Nutritional supplements have been widely used in colorectal cancer (CRC) patients. The aim of this network meta-analysis (NMA) was to compare the effects of different nutritional supplements on inflammation, nutritional status, and clinical outcomes in CRC patients. Four electronic databases were searched until December 2022. Randomized controlled trials (RCTs) comparing nutritional supplements of omega-3 fatty acids (omega-3), arginine, vitamin D, glutamine, probiotics, or their combinations with placebo or standard treatment were selected. The outcomes were inflammatory indicators, nutritional indicators, and clinical outcomes. A random-effects Bayesian NMA was performed to rank the effect of each supplement. In total, 34 studies involving 2841 participants were included. Glutamine was superior in decreasing tumor necrosis factor-α (MD −25.2; 95% CrI [−32.62, −17.95]), whereas combined omega-3 and arginine supplementation was more effective in decreasing interleukin-6 (MD −61.41; 95% CrI [−97.85, −24.85]). No nutritional supplements significantly maintained nutritional indicators in CRC patients. Regarding clinical outcomes, glutamine ranked highest in reducing the length of hospital stay (MD −3.71; 95% CrI [−5.89, −1.72]) and the incidence of wound infections (RR 0.12; 95% CrI [0, 0.85]), and probiotics were rated as best in reducing the incidence of pneumonia (RR 0.38; 95% CrI [0.15, 0.81]). Future well-designed RCTs are needed to further confirm these findings.

Analysis of Relationships between Metabolic Changes and Selected Nutrient Intake in Women Environmentally Exposed to Arsenic

“…Several studies have scrutinized the impact of glutamine supplementation on cardiometabolic risk factors, showing reductions in fasting plasma glucose and C-reactive protein [ 76 ]. Additionally, in colorectal cancer, glutamine supplementation has been associated with decreased tumor necrosis factor-α, a reduced risk of wound infections, and shorter hospital stays [ 77 ]. In a study by Pai et al [ 78 ] on mice exposed to iAs, glutamine supplementation reduced the expression of leukocyte integrin, specifically decreasing leukocyte-function-associated antigen-1 and macrophage antigen-1 in the blood, mitigating the inflammatory response.…”

Relevance of Dietary Supplement Use in Gastrointestinal-Cancer-Associated Cachexia

“…By evaluating body composition by anthropometric means and systemic inflammation biomarkers (e.g., albumin, white blood cell, neutrophile, lymphocyte, and platelet counts), the risk of cancer cachexia and need for nutritional intervention have been established [16]. A recent meta-analysis of studies evaluating the impact of nutritional supplementation on pro-inflammatory biomarkers and length of hospital stay in colorectal cancer patients demonstrated that glutamine was superior in reducing tumor-necrosis factor α (TNF-α) and shortening hospital stay, while probiotics reduced the incidence of pneumonia [17]. One intervention that has shown to be effective in reducing postoperative complications, including malnutrition and cachexia, is preoperative immunonutrition (especially those containing glutamine, arginine, and omega-3 fatty acids) [18,19].…”