3 april 2009: Bron: 1: Ann Surg. 2009 Mar;249(3):355-63. Links 

Met dank aan arts-bioloog drs. E. Valstar

 

Comment in:
Ann Surg. 2009 Mar;249(3):364-5.

EPA (eicosapentaenoic acid) gaat gewichtsverlies tegen bij patienten die wegens slokdarmkanker geopereerd werden. In deze gerandomiseerde studie werd EPA vergeleken met normale extra voeding en bleek de EPA groep geen gewichtsverlies te kennen. Er was echter geen verschil in ernstige complicaties. Wel merken de onderzoekers op dat een verdere studie zinvol is om te zien of er op langere termijn ook een positief effect op de ziekte zelf uitgaat van EPA. Onder abstract van studie bij slokdarmkanker staat ook een abstract van studie die aantoont dat EPA als aanvulling op chemo bij darmkanker ook gewichtsverlies tegengaat en positief effect heeft op kwaliteit van leven. Sowieso heeft EPA al vele malen bewezen een nuttige rol te kunnen spelen bij kankerpatienten. Zie ook lijst van gerandomiseerde onderzoeken van arts-bioloog drs. E. Valstar of zoek op EPA in zoekmachine op startpagina van onze site.

Enteral nutrition enriched with eicosapentaenoic acid (EPA) preserves lean body mass following esophageal cancer surgery: results of a double-blinded randomized controlled trial.

Department of Clinical Surgery, St. James's Hospital, and Trinity College Dublin, Ireland.

BACKGROUND: Esophagectomy represents an exemplar of controlled major trauma, with marked metabolic, immunologic, and physiologic changes as well as an associated high incidence of complications. Eicosapentaenoic acid (EPA) enriched enteral nutrition (EN) modulates immune function and limits catabolism in patients with advanced cancer, but its impact in the peri-operative period is unclear.

OBJECTIVES: To examine the effects of perioperative EPA enriched EN on the metabolic, nutritional, and immuno-inflammatory response to esophagectomy, and on postoperative complications.

METHODS: In a double-blind design, patients were randomized to a standard EN formula or a formula enriched with 2.2 g EPA/d for 5 days preoperatively (orally) and 21 days postoperatively (jejunostomy). Segmental bioelectrical impedance analysis was performed preoperatively and on POD 21. Postoperative complications were monitored, as well as the acute phase response, coagulation markers, and serum cytokines.

RESULTS: Fifty-three patients (28 EPA, 25 standard) completed the study, and both groups were well matched. Serum and peripheral blood mononuclear cell (PBMC) membrane EPA levels were significantly increased in the EPA group. There was no difference in the incidence of major complications. The EPA group maintained all aspects of body composition postoperatively, whereas patients in the standard EN group lost significant amounts of fat-free mass (1.9 kg, P = 0.030) compared with the EPA group [leg (0.3 kg, P = 0.05), arm (0.17 kg, P = 0.01), and trunk (1.44 kg, P = 0.03)]. The EPA group had a significantly (P < 0.05) attenuated stress response for TNFalpha, IL-10, and IL-8 compared with the standard group.

CONCLUSIONS: EPA supplemented early EN is associated with preservation of lean body mass post esophagectomy compared with a standard EN. These properties may merit longer-term study to address its impact on recovery of function and quality of life in models of complex surgery or multimodal cancer treatment regimens.

PMID: 19247018 [PubMed - in process]

 

1: Support Care Cancer. 2007 Mar;15(3):301-7. Epub 2006 Oct 5.Click here to read Links

 

Nutrition intervention using an eicosapentaenoic acid (EPA)-containing supplement in patients with advanced colorectal cancer. Effects on nutritional and inflammatory status: a phase II trial.

Sydney Cancer Centre, Royal Prince Alfred Hospital and Concord Hospital, Sydney, Australia.

GOALS: The aim of the study was to assess the impact of an eicosapentanoic acid-containing protein and energy dense oral nutritional supplement (EPA-ONS) on nutritional and inflammatory status, quality of life (QOL), plasma phospholipids (PPL) and cytokine profile, tolerance of irinotecan-containing chemotherapy and EPA-ONS in patients with advanced colorectal cancer (CRC) receiving chemotherapy. MATERIALS AND

METHODS: Patients with advanced CRC having one prior chemotherapy regimen received 480 ml of EPA-ONS daily for 3 weeks before commencing chemotherapy with folinic acid, 5-fluorouracil, irinotecan (FOLFIRI), and continued for 3 cycles of treatment (9 weeks). All assessments including weight, body composition, C-reactive protein (CRP), QOL, dietary intake, PPL and cytokine analyses were performed at baseline, 3 and 9 weeks.

RESULTS: Twenty-three patients were enrolled, 20 completed 3 weeks, and 15 completed 9 weeks. The mean EPA-ONS intake was 1.7 tetrapaks (408 ml) daily. There was a significant increase in mean weight (2.5 kg) at 3 weeks (p=0.03). Lean body mass (LBM) was maintained. Protein and energy intake significantly decreased after the commencement of chemotherapy (protein p=0.003, energy p=0.02). There was a significant increase in energy levels (p=0.03), whilst all other QOL measures were maintained. PPL EPA levels increased significantly over the first 3 weeks. Mean CRP increased by 14.9 mg/L over the first 3 weeks (p=0.004), but decreased to baseline levels by the end of the trial. There was a significant correlation between plasma IL-6 and IL-10 concentrations and survival, and between IL-12 and toxicity.

CONCLUSION: Dietary counseling and the provision of EPA-ONS may result in maintenance of nutritional status and QOL, however randomized trials are required to evaluate the impact of EPA on toxicity from chemotherapy.

PMID: 17021855 [PubMed - indexed for MEDLINE]


 

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