Meta-analysis of the use of oral nutritional supplements containing omega-3 fatty acids for patients with cancer cachexia

Li Ting; Zeng Jun; Deng Hongfei; Wang Yu; Jiang Hua

doi:10.16689/j.cnki.cn11-9349/r.2020.04.014

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Electronic Journal of Metabolism and Nutrition of Cancer ›› 2020, Vol. 7 ›› Issue (4) : 448-454. DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.014

Meta-analysis of the use of oral nutritional supplements containing omega-3 fatty acids for patients with cancer cachexia

Li Ting1,2, Zeng Jun1,2,3, Deng Hongfei1,2, Wang Yu1,2, Jiang Hua1,2,3

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Abstract

Objective To systematically evaluate the clinical efficacy of oral nutritional supplements of omega-3 fatty acids in patients with cancer cachexia. Methods PubMed, EMbase, SinoMed, Web of Science, CNKI and Wanfang Data databases were comprehensively searched to collect randomized controlled trial on oral nutritional supplements containing omega 3 Fatty Acids for cancer cachexia from January 1, 2000 until July 4, 2020. Two reviewers independently screened literature based on inclusion and exclusion criteria, and then evaluated the risk of bias and literature quality of the included studies in accordance with the Cochrane Handbook of Systematic Reviews of Interventions and the modified Jadad scoring scale. Finally, meta-analysis was performed using Revman 5.3 software. Results A total of 316 potential related articles were searched and 54 articles were obtained after preliminary screening. Finally, we determined a total of 7 randomized controlled trials (RCTs) involving 901 patients. The result of meta-analysis showed that: compared with placebo group, oral nutritional supplements containing omega 3 Fatty Acids significantly put on weight (MD=2.4kg, 95%CI=2.26-2.53, P<0.001) and improve the quality of life(MD=4.71, 95%CI=3.99-5.42, P<0.001). However, lean body mass showed no statistically significant difference between the two groups(MD=﹣0.79, 95%CI=-2.09-0.51), P=0.23)；Qualitative analysis of survival time showed that ONS containing omega-3 fatty acids could not delay the course of cachexia and prolong the survival time of patients. Conclusion Oral nutritional supplements containing omega-3 fatty acids have the potential to improve the quality of life in patients with cancer cachexia.

Key words

Cancer / Cachexia / Omega 3 fatty acids / Meta-analysis / Randomized controlled trial

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Li Ting, Zeng Jun, Deng Hongfei, Wang Yu, Jiang Hua. Meta-analysis of the use of oral nutritional supplements containing omega-3 fatty acids for patients with cancer cachexia[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2020, 7(4): 448-454 https://doi.org/10.16689/j.cnki.cn11-9349/r.2020.04.014

References

1.BARACOS V E. Cancer-associated malnutrition［J］. Eur J Clin Nutr, 2018, 72(9):1255-1259.
2.CEDERHOLM T, BARAZZONI R, AUSTIN P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition［J］. Clin Nutr, 2017, 36(1):49-64.
3.中国抗癌协会肿瘤营养与支持治疗专业委员会.肿瘤恶液质营养治疗指南［J/CD］.肿瘤代谢与营养电子杂志, 2015, 2(3):27-31.
4.MORLEY J E, ANKER S D, VON HAEHLING S. Prevalence, incidence, and clinical impact of sarcopenia: facts, numbers, and epidemiology-update 2014 ［published correction appears in J Cachexia Sarcopenia Muscle, 2015 Jun；6(2):192］［J］. J Cachexia Sarcopenia Muscle, 2014, 5(4):253-259.
5.VON HAEHLING S, ANKER M S, ANKER S D. Prevalence and clinical impact of cachexia in chronic illness in Europe, USA, and Japan: facts and numbers update 2016［J］. J Cachexia Sarcopenia Muscle, 2016, 7(5):507-509.
6.MUSCARITOLI M, ANKER S D, ARGILS J, et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”［J］. Clin Nutr, 2010, 29(2):154-159.
7.EVANS W J, MORLEY J E, ARGILS J, et al. Cachexia: a new definition［J］. Clin Nutr, 2008, 27(6):793-799.
8.SUN L, QUAN X Q, YU S. An Epidemiological survey of cachexia in advanced cancer patients and analysis on its diagnostic and treatment status［J］. Nutr Cancer, 2015, 67(7):1056-1062.
9.ARENDS J, BARACOS V, BERTZ H, et al. ESPEN expert group recommendations for action against cancer-related malnutrition［J］. Clin Nutr, 2017, 36(5):1187-1196.
10.HBUTERNE X, LEMARI E, MICHALLET M, et al. Prevalence of malnutrition and current use of nutrition support in patients with cancer［J］. JPEN J Parenter Enteral Nutr, 2014, 38(2):196-204.
11.BARACOS V E, MAZURAK V C, BHULLAR A S．CaIlcer cacbexia is defied by an ongoing loss of skeletal muscle mass［J］．Ann Palliat Med．2019, 8 (1):3-12．
12.VON HAEHLING S, ANKER S D. Cachexia as major underestimated unmet medical need: facts and numbers［J］. Int J Cardiol, 2012, 161(3):121-123.
13.于恺英, 刘俐惠, 石汉平.肿瘤营养相关状况诊断标准［J/CD］.肿瘤代谢与营养电子杂志, 2020, 7(1):1-4.
14.ROUBENOFF R. Molecular basis of inflammation: relationships between catabolic cytokines, hormones, energy balance, and muscle［J］. JPEN J Parenter Enteral Nutr, 2008, 32(6):630-632.
15.FEARON K, STRASSER F, ANKER S D, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol, 2011, 12(5):489-495.
16.DE MATOS-NETO E M, LIMA J D, DE PEREIRA W O, et al. Systemic inflammation in cachexia - is tumor cytokine expression profile the culprit? ［J］. Front Immunol, 2015, 6:629.
17.沈霜婷, 郑喆文, 廖正凯.恶液质与肿瘤转移的相关分子机制［J/CD］.肿瘤代谢与营养电子杂志, 2018, 5(2):134-138.
18.CARSON J A, BALTGALVIS KA. Interleukin 6 as a key regulator of muscle mass during cachexia［J］. Exerc Sport Sci Rev, 2010, 38(4):168-176.
19.INCIO PINTO N, CARNIER J, OYAMA L M, et al. Cancer as a proinflammatory environment: metastasis and cachexia［J］. Mediators Inflamm, 2015, 2015:791060.
20.HENDERSON S E, MAKHIJANI N, MACE T A. Pancreatic cancer-induced cachexia and relevant mouse models［J］. Pancreas, 2018, 47(8):937-945.
21.SHUKLA S K, MARKOV S D, ATTRI K S, et al. Macrophages potentiate STAT3 signaling in skeletal muscles and regulate pancreatic cancer cachexia［J］. Cancer Lett, 2020, 484:29-39.
22.HE W A, BERARDI E, CARDILLO V M, et al. NF-κB-mediated Pax7 dysregulation in the muscle microenvironment promotes cancer cachexia［J］. J Clin Invest, 2013, 123(11):4821-4835.
23.HARRIS W S, MILLER M, TIGHE A P, et al. omega-3 fatty acids and coronary heart disease risk: clinical and mechanistic perspectives［J］. Atherosclerosis, 2008, 197(1):12-24.
24.LIU G, BIBUS D M, BODE A M, et al. Omega 3 but not omega 6 fatty acids inhibit AP-1 activity and cell transformation in JB6 cells［J］. Proc Natl Acad Sci U S A, 2001, 98(13):7510-7515.
25.BARBER MD, ROSS JA, VOSS AC, et al. The effect of an oral nutritional supplement enriched with fish oil on weight-loss in patients with pancreatic cancer［J］. Br J Cancer, 1999, 81(1):80-86.
26.HIGGINS J P, ALTMAN D G, GTZSCHE P C, et al. The Cochrane Collaborations tool for assessing risk of bias in randomised trials［J］. BMJ, 2011, 343: d5928.
27.JIANG H, SUN MW, HEFRIGHT B, et al. Efficacy of hypocaloric parenteral nutrition for surgical patients: a systematic review and meta-analysis［J］. Clin Nutr, 2011, 30(6):730-737.
28.HIGGINS J P, THOMPSON S G, DEEKS J J, et al. Measuring inconsistency in meta-analyses［J］. BMJ, 2003, 327(7414):557-560.
29.MACASKILL P, WALTER S D, IRWIG L. A comparison of methods to detect publication bias in meta-analysis［J］. Stat Med, 2001, 20(4):641-654.
30.BAUER J, CAPRA S, BATTISTUTTA D, et al. Cancer Cachexia Study Group. Compliance with nutrition prescription improves outcomes in patients with unresectable pancreatic cancer［J］. Clin Nutr, 2005, 24(6):998-1004.
31.KANAT O, CUBUKCU E, AVCI N, et al. Comparison of three different treatment modalities in the management of cancer cachexia［J］. Tumori, 2013, 99(2):229-233.
32.MANTOVANI G, MACCI A, MADEDDU C, et al. Randomized phase Ⅲ clinical trial of five different arms of treatment in 332 patients with cancer cachexia［J］. Oncologist, 2010, 15(2):200-211.
33.SOLHEIM T S, LAIRD B J A, BALSTAD T R, et al. A randomized phase II feasibility trial of a multimodal intervention for the management of cachexia in lung and pancreatic cancer［J］. J Cachexia Sarcopenia Muscle, 2017, 8(5):778-788.
34.SOLS-MARTNEZ O, PLASA-CARVALHO V, PHILLIPS-SIXTOS G, et al. Effect of eicosapentaenoic acid on body composition and inflammation markers in patients with head and neck squamous cell cancer from a public hospital in Mexico［J］. Nutr Cancer, 2018, 70(4):663-670.
35.JATOI A, ROWLAND K, LOPRINZI C L, et al. An eicosapentaenoic acid supplement versus megestrol acetate versus both for patients with cancer-associated wasting: a North Central Cancer Treatment Group and National Cancer Institute of Canada collaborative effort［J］. J Clin Oncol, 2004, 22(12):2469-2476.
36.FEARON K C, BARBER M D, MOSES A G, et al. Double-blind, placebo-controlled, randomized study of eicosapentaenoic acid diester in patients with cancer cachexia［J］. J Clin Oncol, 2006, 24(21):3401-3407.
37.AARONSON N K, AHMEDZAI S, BERGMAN B, et al. The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology［J］. J Natl Cancer Inst, 1993, 85(5):365-376.
38.HANAHAN D, WEINBERG R A. Hallmarks of cancer: the next generation, Cell, 2011, 144(5):646-674.
39.DIAKOS C I, CHARLES K A, MCMILLAN D C, et al. Cancer-related inflammation and treatment effectiveness［J］. Lancet Oncol, 2014, 15(11):e493-e503.
40.BARKER T, FULDE G, MOULTON B, et al. An elevated neutrophil-to-lymphocyte ratio associates with weight loss and cachexia in cancer［J］. Sci Rep, 2020, 10(1):7535.
41.KLASSEN P, CERVANTES M, MAZURAK V C. N-3 fatty acids during chemotherapy: toward a higher level of evidence for clinical application［J］. Curr Opin Clin Nutr Metab Care, 2020, 23(2):82-88.
42.COLOMER R, MORENO-NOGUEIRA J M, GARCA-LUNA P P, et al. N-3 fatty acids, cancer and cachexia: a systematic review of the literature［J］. Br J Nutr, 2007, 97(5):823-831.