Omega‐3 fatty acids improve liver and pancreas function in postoperative cancer patients

Abstract

Key words: omega-3 fatty acid; fish oil; soybean oil; immunonutrition; inflammation; acute-phase response; parenteral nutritionEpidemiologic studies have indicated that high intake of saturated fat and/or animal fat increases the risk of colon and breast cancers. 1 Further laboratory experiments showed reduced risk of colon carcinogenesis after omega-3 PUFA supplementation. In a phase II clinical trial of patients with colonic polyps, dietary FO supplements inhibited cell proliferation. Mechanisms accounting for the antitumour effects in animal models are reduced levels of PGE 2 and inducible NO synthase as well as increased lipid peroxidation or translation inhibition and subsequent cell-cycle arrest. 2 In patients with advanced cancer, weight loss is a major cause of morbidity and mortality. While it is possible to increase energy and protein intake on the enteral or parenteral route, this appears to have little impact on patients' progressive weight loss. 3 Clinical studies in the last few years have provided evidence for beneficial effects of FO administration in cancer cachexia 4 and during radioand chemotherapy. 5 Omega-3 EPA is capable of downregulating the production and action of a number of mediators of cachexia, e.g., IL-1, IL-6, TNF-␣ and proteolysis-inducing factor. 6,7 However, SO (omega-6) emulsions appear to impede tumoricidal activity compared to EPA. 8 Beyond the beneficial effects of long-term intake of omega-3 PUFA in cancer patients, we likewise observed rapid-onset effects in previous experimental studies. Compared to SO emulsion, we found decreased inflammatory pulmonary vascular response in isolated rabbit lungs after omega-3 PUFA infusion. 9 Lung edema formation was blunted because proinflammatory 4-series leukotrienes were shifted to less inflammatory 5-series leukotrienes and, consequently, pulmonary vascular resistance and permeability were reduced. 9 These rapid effects of omega-3 PUFA were confirmed in patients with acute respiratory distress syndrome, showing improved pulmonary function within a few days on an omega-3 fatty acid-enriched diet. 10 The background of these beneficial effects was reduced release of proinflammatory AA derivatives. 11 Following major abdominal nonliver surgery, increases in ALAT were observed and correlated with ultrastructural damage of the liver. 12 In the postoperative course after major abdominal surgery, intact liver function is crucial not only for energy balance (glucose and lactate metabolism) but also for providing several humoral factors, which induce, support and ultimately terminate regenerative mechanisms. This APR of the liver sets off immediately after the (surgical) trauma and upregulates coagulation factors and proteinase inhibitors for wound healing and complement components and opsonins (e.g., CRP) for early bactericidal activity at the site of trauma. 13

Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and immunomodulations in colorectal cancer patients

“…In a randomized, controlled double-blind study, Heller AR and colleagues [19,20] demonstrated that no coagulation and platelet abnor malities are evoked by fish oil supplementation as high as 0.2 g/kg per day for five postoperative days. In the present study, the change in platelet counts showed no statistical difference between the two groups.…”

“…In addition, our results demonstrate that the serum level of γ-GT on POD+8 in the FO group was lower than that in the SO group. Heller AR et al [20] found that after a major abdominal tumor surgery, fish oil supplementation could improve liver and pancreas function. Animal experiments have demonstrated improved perfusion and fewer translocations of viable bacteria from the gut into the mesenteric lymph nodes and liver after omega-3 fatty acid infusion in rats [22,23] .…”

Fatty Acids as Biocompounds: Their Role in Human Metabolism, Health and Disease - A Review. Part 2: Fatty Acid Physiological Roles and Applications in Human Health and Disease

“…Particularly, the anticarcinogenic properties of LC n-3 PUFA, which are mainly attributed to altered PG formation due to COX-2 inhibition, may prove beneficial in pancreatic cancer 240 . Fish oil in total parenteral nutrition improved patient recovery and indices of pancreatic and hepatic function in postoperative cancer patients 231,241 . After elective surgery for cancer, enteral nutrition supplemented with LC n-3 PUFA resulted in reduction of gastrointestinal complications and infections by 50% (ref.…”

Docosahexaenoic acid reduces suppressive and migratory functions of CD4CD25 regulatory T-cells

“…On the other hand, some investigators have demonstrated that dopamine, through the extracellular signal-regulated kinase pathway, reduced the suppressive activity and the adhesive and migratory abilities of Treg cells ( 9 ). Several studies have recently shown that n-3 PUFA, abundantly present in fi sh oils, inhibit cancer cell growth ( 10,11 ). Besides, n-3 PUFA exert immunosuppressive effects on T-cell proliferation (12)(13)(14).…”