Omega-3 therapeutic supplementation in a patient with metastatic adenocarcinoma of the pancreas with muscle mass depletion

Abstract

Pancreatic adenocarcinoma has an extremely poor prognosis. With the best available treatments, the median overall survival duration is still less than 1 year. Most patients develop anorexia and major muscle mass loss that interfere with chemotherapy tolerance and survival. In this paper, we present a case in which these problems were a major concern. A multidisciplinary approach with chemotherapy and close nutritional support permitted better control of the disease and longer survival. We also review the literature on nutritional interventions that show an improvement in quality of life and survival in these patients.

Immunometabolism: new insights and lessons from antigen-directed cellular immune responses

“…Enteral delivery of immunonutrients may be achieved by tube feeding or using oral nutritional supplements (ONS). Currently, oral formulations as capsules are also used, alone or in combination with ONS [311,312]. The major difference between parenteral and enteral routes is that when the latter route is used, metabolic processing by the liver is bypassed, affecting clinical outcome [200].…”

Dietary Supplements in People with Metastatic Cancer Who Are Experiencing Malnutrition, Cachexia, Sarcopenia, and Frailty: A Scoping Review

“…The 48 articles were classified into the following categories: full text peer-reviewed manuscripts (n = 38), conference abstracts (n = 8), and clinical trial registrations (n = 2). Of the full text peer-reviewed manuscripts, the majority reported on randomized controlled trials (RCTs) (n = 18) [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51], followed by quasi-experimental trials (n = 15) [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66], retrospective cohort observational studies (n = 2) [67,68], and case studies (n = 3) [69][70][71]. Conference abstracts reported on RCTs (n = 3) [72][73][74], quasi-experimental trials (n = 4) [75][76][77][78], and a case study (n = 1) [79].…”

“…Omega-3 fatty acids, EPA and DHA, were the most commonly investigated dietary supplement overall (n = 18), and were studied in nine RCTs [37,39,44,[47][48][49][50][51]80], six quasiexperimental trials [54,55,58,63,65,78], one observational study [67], and two case studies [69,71]. Omega-3 fatty acids were administered in the form of free EPA acids [65], purified EPA + DHA capsules [69], krill oil capsules [78], fish oil capsules [37,39,47,55], fish oil liquid [55], marine phospholipids [63], or in fortified ONS [44,[48][49][50][51]54,58,67,71,80]. Marine phospholipids and krill oil consisted of omega-3 fatty acids that were bound to phospholipids, which were suggested by study authors to have a different uptake and metabolism from those bound to triacylglycerols (such as those in fish oil) [63,78].…”

“…With the exception of one study where omega-3 was administered enterally [71], omega-3 was given orally for all. Reported doses ranged from 1.1 g to 6 g EPA daily and 0.2 to 2.7 g DHA daily [37,39,44,47,[49][50][51]54,55,58,65,69,71]. Omega-3 fatty acids were the only dietary supplement included in 13 studies [37,[47][48][49][50][51]55,58,63,65,71,78,80], while additional dietary supplements (e.g., carnitine, arginine, dietary nucleotides, fiber, quercetin, lipoic acid, carbocysteine, and vitamins A, C, and E) were included in five studies [39,44,54,67,69].…”

“…Reported doses ranged from 1.1 g to 6 g EPA daily and 0.2 to 2.7 g DHA daily [37,39,44,47,[49][50][51]54,55,58,65,69,71]. Omega-3 fatty acids were the only dietary supplement included in 13 studies [37,[47][48][49][50][51]55,58,63,65,71,78,80], while additional dietary supplements (e.g., carnitine, arginine, dietary nucleotides, fiber, quercetin, lipoic acid, carbocysteine, and vitamins A, C, and E) were included in five studies [39,44,54,67,69]. Although DHA was not explicitly mentioned in some studies, it was present along with EPA by virtue of the forms in which EPA was administered [44,48,50,51,55,71,80].…”