The amino acid-rich elemental diet Elental® preserves lean body mass during chemo- or chemoradiotherapy for esophageal cancer

Abstract

Chemo (chemoradio) therapy can induce oral mucositis and change body composition in patients with esophageal cancer. The impact of the amino acid-rich elemental diet Elental® on oral mucositis and changes in body composition during chemo (chemoradio) therapy is unclear. Thus, the purpose of the present study was to examine the preventive effects of Elental on oral mucositis and sarcopenia progression during chemo (chemoradio) therapy for esophageal cancer. Patients were randomized to receive either azulene oral rinse (Arm 1) or Elental (Arm 2) during the treatment cycle (4 weeks). The incidence of oral mucositis and other adverse events was evaluated weekly. Body composition pre- and post-treatment cycle was measured by bioelectric impedance analysis. Thirty‑three patients (17 azulene and 16 Elental) completed the study, and the groups were well matched. Elental tended to reduce the incidence of oral mucositis (Arm 1, 23.5% and Arm 2, 12.5%), but there was no statistically significant difference between the groups. The average body mass index (BMI) and body fat mass decreased significantly in both groups after the treatments. Lean body mass (LBM) was reduced in Arm 1, but was increased in Arm 2 after the treatment; the relative change of LBM after the treatment was significant between Arm 1 and Arm 2 (P=0.007). This study revealed that Elental nutrition could counteract sarcopenia development during chemoradiotherapy for esophageal cancer. These properties may lead to improvement of the quality of life and clinical outcome of esophageal cancer patients treated with chemo (chemoradio) therapy (Clinical Trial Registry ID: UMIN 000007960).

Bioelectrical Impedance Analysis for the Assessment of Sarcopenia in Patients with Cancer: A Systematic Review

“…For articles that remained after the initial screen, 65 full texts were reviewed for eligibility. Ultimately, 24 studies were selected for inclusion in the systematic review-18 articles [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]47] and 6 abstracts [33, 44-46, 48, 53]-with a total of 3,607 patients. Table 2 provides an overview of included studies regarding number of study participants, cancer types, inclusion criteria, and stage of care when the BIA assessment was conducted.…”

Systematic review of natural and miscellaneous agents for the management of oral mucositis in cancer patients and clinical practice guidelines—part 1: vitamins, minerals, and nutritional supplements

“…The severity of OM was significantly lower in the ED arm as reported by the patients, but not as measured by the providers. Another RCT failed to demonstrate a beneficial effect of ED in preventing OM in esophageal cancer patient treated with RT with or without concomitant CT [80].…”

Elemental diet induces alterations of the gut microbial community in mice

“…The formula of Elental ® contains a variety of amino acids, together with easily digestible nutrition, minerals, vitamins and a major energy source, dextrin. (20) Fat is present in a very small amount, whereas L-glutamine is present at an especially high dose (1.932 mg/package). (20) Mice were divided into two groups; the control group was fed a normal chow (n = 10) and the elemental diet group was fed normal chow containing 50% w/w Elental ® (n = 10).…”

“…(20) Fat is present in a very small amount, whereas L-glutamine is present at an especially high dose (1.932 mg/package). (20) Mice were divided into two groups; the control group was fed a normal chow (n = 10) and the elemental diet group was fed normal chow containing 50% w/w Elental ® (n = 10). Mice were treated for 28 days and then sacrificed under isoflurane anesthesia by quick cervical distortion.…”