title: Improved body weight and performance status and reduced serum PGE2 levels after nutritional intervention with a specific medical food in newly diagnosed patients with esophageal cancer or adenocarcinoma of the gastro-esophageal junction.
abstract: BACKGROUND
  The majority of cancer patients loses weight and becomes malnourished during the course of their disease. Metabolic alterations and reduced immune competence lead to wasting and an increased risk of infectious complications. In the present study, the effect of a nutritionally complete medical food, which is high in protein and leucine and enriched with fish oil and specific oligosaccharides, was investigated on immune function, nutritional status, and inflammation in patients with esophageal cancer and compared with routine care.
  
  
  METHODS
  In this exploratory double-blind study, 64 newly diagnosed esophageal cancer patients were randomized. All patients received dietary counselling and dietary advice. In the Active group, all patients received the specific medical food for 4 weeks before the start of anticancer therapy. In the routine care control arm, patients with <5% weight loss received a non-caloric placebo product, and patients with weight loss ≥5% received an iso-caloric control product to secure blinding of the study. The required study parameters of body weight and performance status were recorded at baseline and after 4 weeks of nutritional intervention, and patients were asked to complete quality of life questionnaires. In addition, blood samples were taken for the measurement of several immune, nutritional, and safety-parameters.
  
  
  RESULTS
  No effect of the specific nutritional intervention could be detected on ex vivo stimulations of blood mononuclear cells. By contrast, body weight was significantly increased (P < 0.05) and ECOG performance status was improved after intervention with the specific medical food (P < 0.05). In addition, serum Prostaglandin E2 (PGE2) levels were significantly decreased in the specific medical food group and increased in the control group (P = 0.002).
  
  
  CONCLUSIONS
  Nutritional intervention with the specific medical food significantly increased body weight and improved performance status compared with routine care in newly diagnosed esophageal cancer patients. This effect was accompanied by significantly reduced serum PGE2 levels.
authors.affiliation: Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands.|Department of Pharmacology & Pathophysiology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
authors.forename: Joyce
authors.initials: J
authors.lastname: Faber
authors.affiliation: Department of Gastroenterology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Madeleen J
authors.initials: MJ
authors.lastname: Uitdehaag
authors.affiliation: Department of Gastroenterology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Manon
authors.initials: M
authors.lastname: Spaander
authors.affiliation: Laboratory of Experimental Tumor Immunology, Department of Medical Oncology, Erasmus MC- Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Sabine
authors.initials: S
authors.lastname: van Steenbergen-Langeveld
authors.affiliation: Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands.|Department of Pharmacology & Pathophysiology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Vos
authors.affiliation: Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands.
authors.forename: Marloes
authors.initials: M
authors.lastname: Berkhout
authors.affiliation: Laboratory of Experimental Tumor Immunology, Department of Medical Oncology, Erasmus MC- Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Cor
authors.initials: C
authors.lastname: Lamers
authors.affiliation: Vaxinostics BV, University Vaccine Center Rotterdam Nijmegen, Rotterdam, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Rümke
authors.affiliation: Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Hugo
authors.initials: H
authors.lastname: Tilanus
authors.affiliation: Department of Gastroenterology, Erasmus Medical Center, Rotterdam, The Netherlands.|Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Siersema
authors.affiliation: Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands.
authors.forename: Ardy
authors.initials: A
authors.lastname: van Helvoort
authors.affiliation: Department of Medical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Ate
authors.initials: A
authors.lastname: van der Gaast
keywords: Body weight; Cancer; Clinical; Medical food; Nutrition; PGE2