title: Effect of a fish oil-enriched nutritional supplement on metabolic mediators in patients with pancreatic cancer cachexia.
abstract: Weight loss in advanced cancer patients is refractory to conventional nutritional support. This may be due to metabolic changes mediated by proinflammatory cytokines, hormones, and tumor-derived products. We previously showed that a nutritional supplement enriched with fish oil will reverse weight loss in patients with pancreatic cancer cachexia. The present study examines the effect of this supplement on a number of mediators thought to play a role in cancer cachexia. Twenty weight-losing patients with pancreatic cancer were asked to consume a nutritional supplement providing 600 kcal and 2 g of eicosapentaenoic acid per day. At baseline and after 3 wk, patients were weighed and samples were collected to measure serum concentrations of interleukin (IL)-6 and its soluble receptor tumor necrosis factor receptors I and II, cortisol, insulin, and leptin, peripheral blood mononuclear cell production of IL-1 beta, IL-6, and tumor necrosis factor, and urinary excretion of proteolysis inducing factor. After 3 wk of consumption of the fish oil-enriched nutritional supplement, there was a significant fall in production of IL-6 (from median 16.5 to 13.7 ng/ml, P = 0.015), a rise in serum insulin concentration (from 3.3 to 5.0 mU/l, P = 0.0064), a fall in the cortisol-to-insulin ratio (P = 0.0084), and a fall in the proportion of patients excreting proteolysis inducing factor (from 88% to 40%, P = 0.008). These changes occurred in association with weight gain (median 1 kg, P = 0.024). Various mediators of catabolism in cachexia are modulated by administration of a fish oil-enriched nutritional supplement in pancreatic cancer patients. This may account for the reversal of weight loss in patients consuming this supplement.
authors.affiliation: University Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh EH3 9YW, UK.
authors.forename: M D
authors.initials: MD
authors.lastname: Barber
authors.forename: K C
authors.initials: KC
authors.lastname: Fearon
authors.forename: M J
authors.initials: MJ
authors.lastname: Tisdale
authors.forename: D C
authors.initials: DC
authors.lastname: McMillan
authors.forename: J A
authors.initials: JA
authors.lastname: Ross
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001798:Blood Proteins / Q000652:urine; D002100:Cachexia / Q000209:etiology / Q000378:metabolism* / Q000628:therapy*; D019587:Dietary Supplements; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D015850:Interleukin-6 / Q000096:biosynthesis / Q000097:blood; D007963:Leukocytes, Mononuclear / Q000378:metabolism; D008070:Lipopolysaccharides / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000473:pathology; D011509:Proteoglycans
chemical_list: D001798:Blood Proteins; D005395:Fish Oils; D007328:Insulin; D015850:Interleukin-6; D008070:Lipopolysaccharides; D011509:Proteoglycans; C042057:proteolysis-inducing peptide; D015118:Eicosapentaenoic Acid; D006854:Hydrocortisone