title: Enteral nutrition enriched with eicosapentaenoic acid (EPA) preserves lean body mass following esophageal cancer surgery: results of a double-blinded randomized controlled trial.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Clinical Surgery, St. James's Hospital, and Trinity College Dublin, Ireland.
authors.forename: Aoife M
authors.initials: AM
authors.lastname: Ryan
authors.forename: John V
authors.initials: JV
authors.lastname: Reynolds
authors.forename: Laura
authors.initials: L
authors.lastname: Healy
authors.forename: Miriam
authors.initials: M
authors.lastname: Byrne
authors.forename: Jennifer
authors.initials: J
authors.lastname: Moore
authors.forename: Niamh
authors.initials: N
authors.lastname: Brannelly
authors.forename: Aisling
authors.initials: A
authors.lastname: McHugh
authors.forename: Deirdre
authors.initials: D
authors.lastname: McCormack
authors.forename: Philomena
authors.initials: P
authors.lastname: Flood
mesh_terms: D000368:Aged; D001823:Body Composition / Q000187:drug effects*; D015992:Body Mass Index; D019587:Dietary Supplements; D004311:Double-Blind Method; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage*; D017097:Electric Impedance; D004750:Enteral Nutrition; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D015431:Weight Loss / Q000187:drug effects*
chemical_list: D015118:Eicosapentaenoic Acid