Should omega-3 fatty acids be used for adjuvant treatment of cancer cachexia?

Lavriv, Daryna Sergiyivna; Neves, Pedro; Ravasco, Paula

doi:10.1016/j.clnesp.2018.02.006

Cited by 33 publications

(23 citation statements)

References 22 publications

(42 reference statements)

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“…Intervention studies showed that EPA may attenuate deterioration of nutritional status and may aid in improving calorie and protein intake. Recent systematic reviews found that EPA can reduce inflammation and has a potential to modulate the nutritional status/body composition [66,67]. Furthermore, some studies suggest that n−3 fatty acids inhibit proliferation of cancer cells [68] and might decrease CT toxicity [69].…”

Section: Resultsmentioning

confidence: 99%

Nutrition in Cancer Patients

Ravasco

2019

JCM

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229

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Background: Despite being recognised that nutritional intervention is essential, nutritional support is not widely accessible to all patients. Given the incidence of nutritional risk and nutrition wasting, and because cachexia management remains a challenge in clinical practice, a multidisciplinary approach with targeted nutrition is vital to improve the quality of care in oncology. Methods: A literature search in PubMed and Cochrane Library was performed from inception until 26 March. The search consisted of terms on: cancer, nutrition, nutritional therapy, malnutrition, cachexia, sarcopenia, survival, nutrients and guidelines. Key words were linked using “OR” as a Boolean function and the results of the four components were combined by utilizing the “AND” Boolean function. Guidelines, clinical trials and observational studies written in English, were selected. Seminal papers were referenced in this article as appropriate. Relevant articles are discussed in this article. Results: Recent literature supports integration of nutrition screening/assessment in cancer care. Body composition assessment is suggested to be determinant for interventions, treatments and outcomes. Nutritional intervention is mandatory as adjuvant to any treatment, as it improves nutrition parameters, body composition, symptoms, quality of life and ultimately survival. Nutrition counselling is the first choice, with/without oral nutritional supplements (ONS). Criteria for escalating nutrition measures include: (1) 50% of intake vs. requirements for more than 1–2 weeks; (2) if it is anticipated that undernourished patients will not eat and/or absorb nutrients for a long period; (3) if the tumour itself impairs oral intake. N-3 fatty acids are promising nutrients, yet clinically they lack trials with homogeneous populations to clarify the identified clinical benefits. Insufficient protein intake is a key feature in cancer; recent guidelines suggest a higher range of protein because of the likely beneficial effects for treatment tolerance and efficacy. Amino acids for counteracting muscle wasting need further research. Vitamins/minerals are recommended in doses close to the recommended dietary allowances and avoid higher doses. Vitamin D deficiency might be relevant in cancer and has been suggested to be needed to optimise protein supplements effectiveness. Conclusions: A proactive assessment of the clinical alterations that occur in cancer is essential for selecting the adequate nutritional intervention with the best possible impact on nutritional status, body composition, treatment efficacy and ultimately reducing complications and improving survival and quality of life.

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Section: Resultsmentioning

confidence: 99%

Nutrition in Cancer Patients

Ravasco

2019

JCM

Self Cite

229

161

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“…The use of omega-3 PUFA supplementation to treat anorexia-cachexia syndrome is commonly employed in cancer patients. However, the beneficial effects of these molecules for this complication are still questionable [101]. Particularly, there are no treatment plans for anorexia-cachexia syndrome in virtue of the multifactorial characteristics of this syndrome [102], demonstrating that an open discussion on the benefits of low-cost management, such as fish oil supplementation, is extremely important for clinical practice.…”

Section: Anorexia-cachexia Syndromementioning

confidence: 99%

Protective Effects of Omega-3 Fatty Acids in Cancer-Related Complications

2019

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Omega-3 polyunsaturated fatty acids (PUFAs) are considered immunonutrients and are commonly used in the nutritional therapy of cancer patients due to their ample biological effects. Omega-3 PUFAs play essential roles in cell signaling and in the cell structure and fluidity of membranes. They participate in the resolution of inflammation and have anti-inflammatory and antinociceptive effects. Additionally, they can act as agonists of G protein-coupled receptors, namely, GPR40/FFA1 and GPR120/FFA4. Cancer patients undergo complications, such as anorexia-cachexia syndrome, pain, depression, and paraneoplastic syndromes. Interestingly, the 2017 European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines for cancer patients only discuss the use of omega-3 PUFAs for cancer-cachexia treatment, leaving aside other cancer-related complications that could potentially be managed by omega-3 PUFA supplementation. This critical review aimed to discuss the effects and the possible underlying mechanisms of omega-3 PUFA supplementation in cancer-related complications. Data compilation in this critical review indicates that further investigation is still required to assess the factual benefits of omega-3 PUFA supplementation in cancer-associated illnesses. Nevertheless, preclinical evidence reveals that omega-3 PUFAs and their metabolites might modulate pivotal pathways underlying complications secondary to cancer, indicating that this is a promising field of knowledge to be explored.

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“…However, the experimental evidence supporting the use of omega-3 fatty acids in the treatment of cancer cachexia is far from conclusive. A recent systematic review of studies published from 2000 to 2015 examining the impact of omega-3 fatty acids on cancer cachexia identified that out of 140 studies only 7 reached the quality threshold of inclusion according to the Delphi list (68). Out of those 7 studies, only one study in pre-cachexic cancer patients demonstrated a statistically positive effect of omega-3 fatty acids (69, 70).…”

Section: Counteracting Skeletal Muscle Loss With Omega-3 Fatty Acidsmentioning

confidence: 99%

“…Out of those 7 studies, only one study in pre-cachexic cancer patients demonstrated a statistically positive effect of omega-3 fatty acids (69, 70). The fact that only 5% of available studies reached the required threshold of quality in this systematic review (68), highlights the challenges faced by scientists and clinicians in conducting high-quality, statistically-powered, randomized controlled trials in this specialized population.…”

Section: Counteracting Skeletal Muscle Loss With Omega-3 Fatty Acidsmentioning

confidence: 99%

The Influence of Omega-3 Fatty Acids on Skeletal Muscle Protein Turnover in Health, Disuse, and Disease

2019

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Ingestion of omega-3 fatty acids is known to exert favorable health effects on a number of biological processes such as improved immune profile, enhanced cognition, and optimized neuromuscular function. Recently, data have emerged demonstrating a positive influence of omega-3 fatty acid intake on skeletal muscle. For instance, there are reports of clinically-relevant gains in muscle size and strength in healthy older persons with omega-3 fatty acid intake as well as evidence that omega-3 fatty acid ingestion alleviates the loss of muscle mass and prevents decrements in mitochondrial respiration during periods of muscle-disuse. Cancer cachexia that is characterized by a rapid involuntary loss of lean mass may also be attenuated by omega-3 fatty acid provision. The primary means by which omega-3 fatty acids positively impact skeletal muscle mass is via incorporation of eicosapentaenoic acid (EPA; 20:5n−3) and docosahexaenoic acid (DHA; 22:6n−3) into membrane phospholipids of the sarcolemma and intracellular organelles. Enrichment of EPA and DHA in these membrane phospholipids is linked to enhanced rates of muscle protein synthesis, decreased expression of factors that regulate muscle protein breakdown, and improved mitochondrial respiration kinetics. However, exactly how incorporation of EPA and DHA into phospholipid membranes alters these processes remains unknown. In this review, we discuss the interaction between omega-3 fatty acid ingestion and skeletal muscle protein turnover in response to nutrient provision in younger and older adults. Additionally, we examine the role of omega-3 fatty acid supplementation in protecting muscle loss during muscle-disuse and in cancer cachexia, and critically evaluate the molecular mechanisms that underpin the phenotypic changes observed in skeletal muscle with omega-3 fatty acid intake.

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Should omega-3 fatty acids be used for adjuvant treatment of cancer cachexia?

Abstract: Future cachexia trials would likely benefit from studying a single tumour type with earlier stage disease, with probably different dosage depending on the cancer type and its inflammatory profile.

Cited by 33 publications

References 22 publications

Nutrition in Cancer Patients

Nutrition in Cancer Patients

Protective Effects of Omega-3 Fatty Acids in Cancer-Related Complications

The Influence of Omega-3 Fatty Acids on Skeletal Muscle Protein Turnover in Health, Disuse, and Disease

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