A Randomized Study of the Effect of Fish Oil on n-3 Fatty Acid Incorporation and Nutritional Status in Lung Cancer Patients

Research Article

Austin J Nutr Metab. 2015;2(1): 1011.

A Randomized Study of the Effect of Fish Oil on n-3 Fatty Acid Incorporation and Nutritional Status in Lung Cancer Patients

Andersen JR1,3*, Dannerfjord S1, Nørgaard M1, Lauritzen L1, Lange P2, Jensen N Aa2, Boisen LW2, Jensen RG2, Andersen MJ2 and Sørensen JB2

1Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark

2Clinic for Oncology 5111, Rigshospitalet, Denmark

3Nutrition Unit 5711, Rigshospitalet, Denmark

*Corresponding author: Andersen JR, Associate Professor, Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark

Received: January 04, 2015; Accepted: March 20, 2015; Published: March 31, 2015

Abstract

Long-chain n-3 polyunsaturated fatty acids (n-3 LCPUFA) have been proposed to have beneficial effect on cancer cachexia. The aims of the present study were to a) determine the incorporation of n-3 LCPUFA in erythrocytes (RBC) as a measurement of compliance to fish oil (FO)-supplement in lung cancer patients undergoing anti-neoplastic therapy; and b) evaluate the effect of the FO-supplement on weight-loss, mid arm muscle circumference, energy and protein intake, hand grip strength and quality of life. Forty-two patients with advanced lung cancer were randomized immediately after referral to ingest either 20 ml of FO or 20 ml of rapeseed oil (RO) daily. Patients were evaluated every three weeks. Twenty-five patients participated in the study for more than 21 days. The RBC content in FO-group increased with 35%, 137% and 44%, respectively (p < 0.001, p < 0.001 and p < 0.001), but did not change in the ROgroup. Neither intention-to-treat analysis nor per-protocol-analysis revealed any statistically significant differences between the groups with respect to clinical outcomes.

Keywords: Lung cancer; Cachexia; Fish oil; n-3 Fatty acids

Abbreviations

ALA: Alpha-Linolenic Acid; DHA: Docosahexaenoic Acid; EPA: EicosaPentaenoic Acid; RBC: Erythrocyte; FO: Fish Oil; n-3 LCPUFA: Long-Chain n-3 Polyunsaturated Fatty Acids; RO: Rapeseed Oil; QoL: Quality of Life

Introduction

Progressive nutritional deterioration with insufficient intake of macro- and micro-nutrients is common in cancer patients and is associated with changes in carbohydrate, lipid and protein metabolism [1,2]. Malnutrition occurs in 60% of all patients with small cell- and non-small cell lung cancer [2], and this is partly a consequence of cachexia, which is a multi-factorial syndrome including anorexia, severe weight loss, muscular atrophy and weakness [1,3,4,5]. Previous investigations have shown that cachexia deteriorates the patients quality of life (QoL) [6], shortens survival time, and reduces the response to chemotherapy [1,7,8,9]. Supplementations with energy and protein has not been proven efficient in inhibiting the deterioration [6,10,11], and the potential weight gain, if any, consists primarily of fat and water, and not lean body mass [6,11,12,13,14].

Cachexia is partly due to an increase in inflammatory cytokines, and as long-chain n-3 polyunsaturated fatty acids (n-3 LCPUFA) have been shown to have anti-inflammatory and cytokine reducing effects [15], they may be beneficial in cancer patients with a high inflammatory response. n-3 LCPUFA has been shown to normalize some of the metabolic abnormalities in cachexia such as hypermetabolism and insulin-resistance in patients with pancreatic cancer [16,17,18]. Furthermore, good clinical results primarily on QoL have been achieved in studies with palliative pancreatic cancer patients, if patients are compliant to the treatment with fish-oil (FO) containing supplements [19].

For these reasons we wanted to test if supplements with n-3 LCPUFA lead to incorporation of these fatty acids into the cell membranes during cytotoxic treatment and if that has beneficial effects on weight loss in patients with lung cancer.

Materials and Methods

The investigation was approved by the regional ethical committee.

Patients with small cell- or non-small cell lung cancer referred to the Clinic of Oncology, Rigshospitalet, Copenhagen, were eligible for the study. All patients received platinum-based chemotherapy (Carboplatin or Cisplatin) in combination with Vinorelbine or Etoposid. Patients were consecutively included disregarding previous weight loss. Patients were excluded, if they had ingested daily supplements of n-3 LCPUFA within 60 days prior to the time of randomization, suffered from spontaneous bleeding tendency or were in anti-coagulant therapy. Overall 44 patients were randomized by concealed allocation to receive either FO (N=21) or rapeseed oil (RO, N=23). However, one patient in the FO-group were excluded from the study before baseline due to clinical deterioration and one in the RO-group due to concomitant prostate cancer, leaving 20 patients in the FO-group and 22 patients in the RO-group. The baseline characteristics of the included patient in the two groups are shown in Table 1.