Dietary omega-3 polyunsaturated fatty acids plus vitamin E restore immunodeficiency and prolong survival for severely ill patients with generalized malignancy: a randomized control trial.
BACKGROUND
The aim of the current prospective, randomized control study was to investigate the effect of dietary omega-3 polyunsaturated fatty acids plus vitamin E on the immune status and survival of well-nourished and malnourished patients with generalized malignancy.


METHODS
Sixty patients with generalized solid tumors were randomized to receive dietary supplementation with either fish oil (18 g of omega-3 polyunsaturated fatty acids, PUFA) or placebo daily until death. Each group included 15 well-nourished and 15 malnourished patients. The authors measured total T cells, T-helper cells, T-suppressor cells, natural killer cells, and the synthesis of interleukin-1, interleukin-6, and tumor necrosis factor by peripheral blood mononuclear cells before and on Day 40 of fish oil supplementation. Karnofsky performance status, nutritional state, and survival were also estimated.


RESULTS
The ratio of T-helper cells to T-suppressor cells was significantly lower in malnourished patients. Omega-3 PUFA had a considerable immunomodulating effect by increasing this ratio in the subgroup of malnourished patients. There were no significant differences in cytokine production among the various groups, except for a decrease in tumor necrosis factor production in malnourished cancer patients, which was restored by omega-3 fatty acids. The mean survival was significantly higher for the subgroup of well-nourished patients in both groups, whereas omega-3 fatty acids prolonged the survival of all the patients.


CONCLUSIONS
Malnutrition appears to be an important predictor of survival for patients with end stage malignant disease. Omega-3 polyunsaturated fatty acids had a significant immunomodulating effect and seemed to prolong the survival of malnourished patients with generalized malignancy.
Gogos
C A
CA
Department of Medicine, Patras University Medical School, Rion-Patras, Greece.
Ginopoulos
P
P
Salsa
B
B
Apostolidou
E
E
Zoumbos
N C
NC
Kalfarentzos
F
F
D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000627:therapeutic use; D016638:Critical Illness / Q000628:therapy; D019587:Dietary Supplements; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host / Q000187:drug effects; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D017567:Karnofsky Performance Status; D007694:Killer Cells, Natural / Q000187:drug effects / Q000473:pathology; D007963:Leukocytes, Mononuclear / Q000187:drug effects / Q000378:metabolism; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000503:physiopathology*; D009748:Nutrition Disorders / Q000178:diet therapy / Q000188:drug therapy / Q000209:etiology; D009752:Nutritional Status; D010919:Placebos; D011446:Prospective Studies; D015996:Survival Rate; D013601:T-Lymphocytes / Q000187:drug effects / Q000473:pathology; D006377:T-Lymphocytes, Helper-Inducer / Q000187:drug effects / Q000473:pathology; D050378:T-Lymphocytes, Regulatory / Q000187:drug effects / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014810:Vitamin E / Q000008:administration & dosage / Q000627:therapeutic use*
D000276:Adjuvants, Immunologic; D015525:Fatty Acids, Omega-3; D007375:Interleukin-1; D015850:Interleukin-6; D010919:Placebos; D014409:Tumor Necrosis Factor-alpha; D014810:Vitamin E