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Fish oil supplementation may help treat GI cancer cachexia

Tristan Manalac
18 Jul 2017

Despite progression, lean body mass and skeletal muscle mass have increased while the systemic inflammatory response has remained stable in gastrointestinal (GI) cancer patients with cachexia receiving fish oil (FO)-enriched nutrition, a new retrospective cohort study reveals.

“[O]ur systematic and comprehensive assessment provided novel evidence for the clinical feasibility of providing FO-enriched nutrition during systemic chemotherapy for patients with GI cancer. Nutritional interventions with FO supplementation could be one component in a multimodal therapeutic approach for GI cancer, especially in patients with high serum CRP levels,” said researchers.

Serum concentrations of C-reactive protein (CRP) rose significantly over time and with progression of GI cancer (p=0.049) in patients without FO-enriched nutrition. In contrast, CRP levels remained constant in those who were given FO-enriched nutrition (p=0.26). [Sci Rep 2017;7:4826]

Subsequent analyses showed that high CRP concentrations were associated with poor overall survival (hazard ratio [HR], 2.88; 95 percent CI, 1.26 to 6.54; p=0.01) and poor tolerance to chemotherapy (odds ratio [OR], 3.68; 1.35 to 10.0; p=0.011), indicating the involvement of the systemic inflammatory response to poor prognosis and tolerance.

Skeletal muscle mass (p=0.26) and lean body mass (p=0.19) remained unchanged in patients who did not receive FO-enriched nutrition and increased significantly in those who did (p=0.0002 and p<0.0001, respectively).

Even in high-risk patients (modified Glasgow prognostic scores [mGPS] of 1 or 2), FO-enriched nutrition was an independent predictor of better prognosis (HR, 0.24; 0.06 to 0.98; p=0.045). Moreover, those who received FO had significantly improved survival (p=0.0096) compared with those who did not.

Cachexia, along with malnutrition and skeletal muscle wasting, is common in cancer patients and has been implicated in low chemotherapy tolerance. Nutrition, particularly FO, has been previously established in numerous studies as an effective intervention measure for cancer cachexia.

“These previous reports combined with our present data clearly suggest that FO-enriched nutrition plays a pivotal role in controlling the inflammatory response and maintaining nutritional status during chemotherapy in GI cancer patients,” according to the researchers.

However, Dr Richie Soong, senior principal investigator at the Cancer Science Institute of Singapore, recommended caution.

While he conceded that “it is good to engage the public with promising scientific news, and give hope to those with cachexia and systemic inflammation,” he warned that “such [an] article could be used to lend credibility to the questionable selling of FO to patients and the public before more definitive evidence is garnered.”

Among the remaining uncertainties is the possibility that FO may have worked through other mechanisms. After all, “the pathogenesis of cachexia has also been attributed to the development of insulin resistance, an increased susceptibility of muscle and organ cells to undergoing apoptosis, as well as other noninflammation-based mechanisms,” explained Nicholas Syn, a student of Dr. Soong.

“It is possible, for example, that the omega-3 fatty acids reversed insulin resistance in some of these patients, which led to an improvement in skeletal muscle and lean body mass,” he added.

The study included 128 advanced or recurrent GI cancer patients who experienced preillness body weight loss of at least 5 percent. Patients were randomized to receive either FO oral supplementation (n=37) or not (n=91). Laboratory measurements were performed using enzyme immunoassays while body composition measurement were obtained using bioelectrical impedance.

“Notwithstanding, the results of this study are an encouraging development in the field, and has the potential to impact clinical practice in the future if the results are replicated in larger randomized trials,” said Syn.

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