Improved body weight and performance status and reduced serum PGE₂ levels after nutritional intervention with a specific medical food in newly diagnosed patients with esophageal cancer or adenocarcinoma of the gastro‐esophageal junction

Abstract

BackgroundThe majority of cancer patients loses weight and becomes malnourished during the course of their disease. Metabolic alterations and reduced immune competence lead to wasting and an increased risk of infectious complications. In the present study, the effect of a nutritionally complete medical food, which is high in protein and leucine and enriched with fish oil and specific oligosaccharides, was investigated on immune function, nutritional status, and inflammation in patients with esophageal cancer and compared with routine care.MethodsIn this exploratory double-blind study, 64 newly diagnosed esophageal cancer patients were randomized. All patients received dietary counselling and dietary advice. In the Active group, all patients received the specific medical food for 4 weeks before the start of anticancer therapy. In the routine care control arm, patients with <5% weight loss received a non-caloric placebo product, and patients with weight loss ≥5% received an iso-caloric control product to secure blinding of the study. The required study parameters of body weight and performance status were recorded at baseline and after 4 weeks of nutritional intervention, and patients were asked to complete quality of life questionnaires. In addition, blood samples were taken for the measurement of several immune, nutritional, and safety-parameters.ResultsNo effect of the specific nutritional intervention could be detected on ex vivo stimulations of blood mononuclear cells. By contrast, body weight was significantly increased (P < 0.05) and ECOG performance status was improved after intervention with the specific medical food (P < 0.05). In addition, serum Prostaglandin E2 (PGE2) levels were significantly decreased in the specific medical food group and increased in the control group (P = 0.002).ConclusionsNutritional intervention with the specific medical food significantly increased body weight and improved performance status compared with routine care in newly diagnosed esophageal cancer patients. This effect was accompanied by significantly reduced serum PGE2 levels.

Protein anabolic resistance in cancer

“…In line, oral commercial nutritional supplementation in 92 patients with advanced NSCLC undergoing paclitaxel and cisplatin/carboplatin treatment (29) resulted in a greater energy and protein intake and muscle gain, and lower values for fatigue, loss of appetite and neuropathy than in the control group who received an isocaloric diet. A positive effect of oral nutritional intervention on body weight and muscle mass during chemotherapy or concurrent chemo-radiotherapy in cancer was also observed by us and others in the past years (29-36) ( Table 2 ). Some evidence exists that surgery does not hamper the anabolic response to feeding in cancer as shown by the improved leucine balance to a commercial amino acid infusion in cancer patients within 48 hours of undergoing colorectal surgery (37).…”

The Efficacy of Oral Nutritional Intervention in Malnourished Cancer Patients: a Systemic Review

“…A four-week intervention in esophageal cancer patients administered ONS containing leucine and fish oil significantly improved body weight change (p < 0.05) and Eastern Cooperative Oncology Group (ECOG) score (p < 0.05) [24]. Similarly, nutritional intervention significantly reduced weight loss in head and neck cancer patients (p = 0.024) [25].…”

“…Patients who received EN containing arginine, n-3 fatty acid, ribonucleic acid, and MCT showed lower serum IL-8 concentration compared to that in the control patients [31]. ONS containing leucine, and fish oil resulted in decreased serum prostaglandin E2 (PGE 2 ) concentrations [24]. …”

Expand+In Vivoiv.iiarjournals.orgIn Vivo September-October 2017 vol. 31 no. 5 1003-1009 Elevated Serum AA/EPA Ratio as a Predictor of Skeletal Muscle Depletion in Cachexic Patients with Advanced Gastro-intestinal Cancers

“…Moreover, dietary supplementation with n-3 fatty acids including fish oil or marine phospholipids has stabilized loss and appetite observed in patients with cancer cachexia in a randomized controlled double-blinded trial (23). Additionally, other studies have also shown the effectiveness of nutritional supplementations with fish oil or leucine to improve cachexic status in patients with esophagus cancer (24). It could, therefore, be said that dietary supplementation with n-3 fatty acids may be applied to prevent advancing cancer cachexia and decreased quality of life for patients with diagnosed elevated serum AA / EPA or n-6 / n-3 ratio.…”