Oral Nutritional Supplements Containing (n-3) Polyunsaturated Fatty Acids Affect the Nutritional Status of Patients with Stage III Non-Small Cell Lung Cancer during Multimodality Treatment

Abstract

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), (n-3) fatty acids from fish oil, have immune-modulating effects and may improve nutritional status in cancer. The objective of this study was to investigate the effects of an oral nutritional supplement containing (n-3) fatty acids on nutritional status and inflammatory markers in patients with non-small cell lung cancer (NSCLC) undergoing multimodality treatment. In a double-blind experiment, 40 patients with stage III NSCLC were randomly assigned to receive 2 cans/d of a protein- and energy-dense oral nutritional supplement containing (n-3) fatty acids (2.0 g EPA + 0.9 g DHA/d) or an isocaloric control supplement. EPA in plasma phospholipids, energy intake, resting energy expenditure (REE), body weight, fat free mass (FFM), mid-upper arm circumference (MUAC), and inflammatory markers were assessed. Effects of intervention were analyzed by generalized estimating equations and expressed as regression coefficients (B). The intervention group (I) had a better weight maintenance than the control (C) group after 2 and 4 wk (B = 1.3 and 1.7 kg, respectively; P < 0.05), a better FFM maintenance after 3 and 5 wk (B = 1.5 and 1.9 kg, respectively; P < 0.05), a reduced REE (B = -16.7% of predicted; P = 0.01) after 3 wk, and a trend for a greater MUAC (B = 9.1; P = 0.06) and lower interleukin-6 production (B = -27.9; P = 0.08) after 5 wk. After 4 wk, the I group had a higher energy and protein intake than the C group (B = 2456 kJ/24 h, P = 0.03 and B = 25.0 g, P = 0.01, respectively). In conclusion, a protein- and energy-dense oral nutritional supplement containing (n-3) fatty acids beneficially affects nutritional status during multimodality treatment in patients with NSCLC.

Impact of different palliative systemic treatments on skeletal muscle mass in metastatic colorectal cancer patients

“…An interesting next step will be to investigate whether interventions, such as nutritional and exercise interventions, which have the potential to counteract the SMM loss during intensive treatment and support potential gain during less intensive treatment, also result in improved outcome of treatment. A gain in SMM has recently be shown in nutritional intervention studies in which protein and/or omega 3 fatty acids enriched high energy were added to the diet of non‐small cell lung carcinoma patients,26, 27, 28 and in an exercise intervention study performed during chemotherapy for breast cancer, a significant increase of muscle strength was observed in the intervention group 29. Especially, a multimodal approach in which nutrition and exercise are combined might provide a promising future strategy to prevent SMM loss and subsequent reduced treatment outcomes 30…”

Measurement of red blood cell eicosapentaenoic acid (EPA) levels in a randomised trial of EPA in patients with colorectal cancer liver metastases

“…There has been only one previous randomised omega-3 PUFA intervention trial in cancer patients that has reported individual omega-3 PUFA levels during treatment [6] and none that have included an analysis of omega-3 PUFA 'washout' after cessation of omega-3 PUFA supplementation. Van der Meij et al described variability in plasma phospholipid EPA levels after double-blind intervention for 5 weeks with a daily supplement containing 2 g EPA and 0.9 g DHA or isocaloric control in patients with non-small cell lung cancer [6].…”

“…Van der Meij et al described variability in plasma phospholipid EPA levels after double-blind intervention for 5 weeks with a daily supplement containing 2 g EPA and 0.9 g DHA or isocaloric control in patients with non-small cell lung cancer [6]. These authors obtained similar individual EPA profiles to the EMT study with a number of 'non-responders' in the intervention arm and, conversely, some individuals with high baseline EPA values or an 'EPA response' in the control arm of the study [6]. We suggest that contamination is likely to occur in all trials of omega-3 PUFA supplements with individual randomisation and can be, at least partly, adjusted for by analysis by absolute or relative change in RBC omega-3 PUFA levels.…”

“…However, despite the widespread availability of mass spectrometric techniques for measuring PUFAs, only a minority of clinical omega-3 PUFA studies with a primary or secondary clinical endpoint have reported target organ PUFA incorporation and/or individual blood PUFA profiles [3,[5][6], with which to interpret PUFA 'bioavailability' (a term usually used in omega-3 PUFA studies to indicate the tissue or blood level of omega-3 PUFAs), compliance and 'contamination' by excess 'own use' of the intervention or dietary omega-3 PUFA intake, the latter being a particular threat to correct interpretation of trial data and the statistical power of a trial for any substance that is easily available 'over the counter' or as a dietary constituent [7].…”

Red Blood Cell Fatty Acid Analysis for Determining Compliance with Omega3 Supplements in Dry Eye Disease Trials

“…RBC fatty acid analysis not only demonstrates the systemic increase in o3, but is also a stable measure of intake, with low biological variability and measures long-term intake. 32 Other objective methods include measuring o3 PUFAs in swabs of buccal cells, 33 plasma phospholipid fatty acid concentrations, 33,34 and EPA + DHA proportions in plasma cholesterol esters. 30 Although, analyzing buccal cells is less invasive than blood tests, the amount of total lipid on the swabs was very small, and the measurement of o3 PUFAs was highly variable and unreliable.…”