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Effects of omega-3 supplementation on lean body mass in cancer patients: a systematic review and meta-analysis

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Abstract

Omega-3 fatty acids are bioactive nutrients with the potential to preserve lean body mass in individuals with cancer. This study aimed to review the literature on randomized clinical trials that evaluated the effects of omega-3 supplementation on lean body mass in cancer patients. As secondary objectives, we evaluated the effects of omega-3 supplementation on body mass index (BMI) and body weight. We conducted a systematic review and meta-analysis in the following databases: Pubmed, LILACS, Scielo, Scopus, Web of Science, Cochrane, and Embase. It included randomized clinical trials that investigated the effects of omega-3 supplementation on lean body mass in cancer patients. Observational studies, animal experiments, studies carried out with healthy humans, and non-randomized clinical trials were excluded. We utilized the Cochrane scale to assess the quality of the studies. A meta-analysis was carried out to evaluate the effect of omega-3 on lean body mass, BMI, and body weight. Fourteen studies were included, of which four showed significant results from omega-3 supplementation for lean body mass. In the meta-analysis, omega-3 fatty acids increased lean body mass by 0.17 kg compared to placebo, but without significant differences between the groups [SMD: 0.17; CI 95%: −0.01, 0.35; I2 = 41%]. For body weight, omega-3 showed a statistically significant effect [SMD: 0.26; CI 95%: 0.06, 0.45; I2 = 46%], whereas for BMI the results were not significant. This systematic review and meta-analysis showed no statistically significant effect from omega-3 on lean body mass and BMI. On the other hand, there was a statistical significance for body weight.

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Fig. 1: PRISMA flowchart.
Fig. 2: Forest plot for lean body mass.
Fig. 3: Forest plot for BMI.
Fig. 4: Forest plot for body weight.
Fig. 5: Forest plot by body composition measurement method.
Fig. 6: Cochrane risk of bias.
Fig. 7: Funnel plots for assessing the risk of publication bias for lean body mass.

References

  1. Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clin Nutr. 2008;27:793–9.

    CAS  Article  Google Scholar 

  2. Pin F, Couch ME, Bonetto A. Preservation of muscle mass as a strategy to reduce the toxic effects of cancer chemotherapy on body composition. Curr Opin Support Palliat Care. 2018;12:420–6.

    Article  Google Scholar 

  3. Mazzuca F, Onesti CE, Roberto M, Di Girolamo M, Botticelli A, Begini P, et al. Lean body mass wasting and toxicity in early breast cancer patients receiving anthracyclines. Oncotarget. 2018;9:25714–22.

    Article  Google Scholar 

  4. Wallengren O, Iresjö BM, Lundholm K, Bosaeus I. Loss of muscle mass in the end of life in patients with advanced cancer. Support Care Cancer. 2015;23:79–86.

    Article  Google Scholar 

  5. Aoyama T, Sato T, Segami K, Maezawa Y, Kano K, Kawabe T, et al. Risk factors for the loss of lean body mass after gastrectomy for gastric cancer. Ann Surg Oncol. 2016;23:1963–70.

    Article  Google Scholar 

  6. Lonbro S, Dalgas U, Primdahl H, Johansen J, Nielsen JL, Overgaard J, et al. Lean body mass and muscle function in head and neck cancer patients and healthy individuals-results from the DAHANCA 25 study. Acta Oncol (Madr). 2013;52:1543–51.

    Article  Google Scholar 

  7. Tsai S. Importance of lean body mass in the oncologic patient. Nutr Clin Pr. 2012;27:593–8.

    Article  Google Scholar 

  8. Delpino FM, Figueiredo LM, da Silva BGC, da Silva TG, Mintem GC, Bielemann RM, et al. Omega-3 supplementation and diabetes: a systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2021. https://doi.org/10.1080/10408398.2021.1875977.

  9. Liao Y, Xie B, Zhang H, He Q, Guo L, Subramaniapillai M, et al. Efficacy of omega-3 PUFAs in depression: a meta-analysis. Transl Psychiatry. 2019;9:1–9.

    Article  Google Scholar 

  10. Kiecolt-Glaser JK, Belury MA, Andridge R, Malarkey WB, Glaser R. Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain Behav Immun. 2011;25:1725–34.

    CAS  Article  Google Scholar 

  11. Freitas RDS, Campos MM. Protective effects of omega-3 fatty acids in cancer-related complications. Nutrients. 2019;11. https://doi.org/10.3390/nu11050945.

  12. Murphy RA, Yeung E, Mazurak VC, Mourtzakis M. Influence of eicosapentaenoic acid supplementation on lean body mass in cancer cachexia. Br J Cancer. 2011;105:1469–73.

    CAS  Article  Google Scholar 

  13. Gorjao R, dos Santos CMM, Serdan TDA, Diniz VLS, Alba-Loureiro TC, Cury-Boaventura MF, et al. New insights on the regulation of cancer cachexia by N-3 polyunsaturated fatty acids. Pharm Ther. 2019;196:117–34.

    CAS  Article  Google Scholar 

  14. Werner K, Küllenberg de Gaudry D, Taylor LA, Keck T, Unger C, Hopt UT, et al. Dietary supplementation with n-3-fatty acids in patients with pancreatic cancer and cachexia: marine phospholipids versus fish oil - a randomized controlled double-blind trial. Lipids Health Dis. 2017;16. https://doi.org/10.1186/s12944-017-0495-5.

  15. Ryan AM, Reynolds JV, Healy L, Byrne M, Moore J, Brannelly N, et al. Enteral nutrition enriched with eicosapentaenoic acid (EPA) preserves lean body mass following esophageal cancer surgery: Results of a double-blinded randomized controlled trial. Ann Surg. 2009;249:355–63.

    Article  Google Scholar 

  16. Moher D, Liberati A, Tetzlaff J, Altman DG, Altman D, Antes G, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6. https://doi.org/10.1371/journal.pmed.1000097.

  17. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to Meta-Analysis. 2009. https://doi.org/10.1002/9780470743386.

  18. The Cochrane Collaboration. Obtaining standard deviations from standard errors. Cochrane Handb Syst Rev Interv. Version 510 [updated March 2011] 2011.

  19. Higgins JPT. SG Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated. 2011.

  20. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Br Med J. 2003;327:557–60.

    Article  Google Scholar 

  21. Marques DC, Stringhini MLF, Fornés NAS de. Omega-3 fatty acid supplementation, nutritional status and quality of life in patients with gastrointestinal cancer: double-blind, placebo-controlled, randomized study. Rev Médica Minas Gerais. 2013;23:39–46.

    Article  Google Scholar 

  22. Sánchez-Lara K, Turcott JG, Juárez-Hernández E, Nuñez-Valencia C, Villanueva G, Guevara P, et al. Effects of an oral nutritional supplement containing eicosapentaenoic acid on nutritional and clinical outcomes in patients with advanced non-small cell lung cancer: randomised trial. Clin Nutr. 2014;33:1017–23.

  23. Mocellin MC, Camargo C de Q, Fabre ME de S, Trindade EBS. Fish oil effects on quality of life, body weight and free fat mass change in gastrointestinal cancer patients undergoing chemotherapy: a triple blind, randomized clinical trial. J Funct Foods. 2017;31:113–22.

    CAS  Article  Google Scholar 

  24. Paixão EMDS, Oliveira ACDM, Pizato N, Muniz-Junqueira MI, Magalhães KG, Nakano EY, et al. The effects of EPA and DHA enriched fish oil on nutritional and immunological markers of treatment naïve breast cancer patients: a randomized double-blind controlled trial. Nutr J. 2017;16. https://doi.org/10.1186/s12937-017-0295-9.

  25. Golkhalkhali B, Rajandram R, Paliany AS, Ho GF, Wan Ishak WZ, Johari CS, et al. Strain-specific probiotic (microbial cell preparation) and omega-3 fatty acid in modulating quality of life and inflammatory markers in colorectal cancer patients: a randomized controlled trial. Asia Pac J Clin Oncol. 2018;14:179–91.

    Article  Google Scholar 

  26. Solís-Martínez O, Plasa-Carvalho V, Phillips-Sixtos G, Trujillo-Cabrera Y, Hernández-Cuellar A, Queipo-García GE, 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. Nutr Cancer. 2018;70:663–70.

    Article  Google Scholar 

  27. de la Rosa Oliva F, García AM, Calzada HR, Astudillo de la Vega H, Rocha EB, Lara-Medina F, et al. Effects of omega-3 fatty acids supplementation on neoadjuvant chemotherapy-induced toxicity in patients with locally advanced breast cancer: a randomized, controlled, double-blinded clinical trial. Nutr Hosp. 2019;36:769–76.

    PubMed  Google Scholar 

  28. Hossain T, Phillips BE, Doleman B, Lund JN, Williams JP. A double-blind randomized controlled trial of the effects of eicosapentaenoic acid supplementation on muscle inflammation and physical function in patients undergoing colorectal cancer resection. Clin Nutr. 2020;39:2055–61.

    CAS  Article  Google Scholar 

  29. Fearon KCH, Von Meyenfeldt MF, Moses AGW, Van Geenen R, Roy A, Gouma DJ, et al. Effect of a protein and energy dense n-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: a randomised double blind trial. Gut. 2003;52:1479–86.

    CAS  Article  Google Scholar 

  30. Moses AWG, Slater C, Preston T, Barber MD, Fearon KCH. Reduced total energy expenditure and physical activity in cachectic patients with pancreatic cancer can be modulated by an energy and protein dense oral supplement enriched with n-3 fatty acids. Br J Cancer. 2004;90:996–1002.

    CAS  Article  Google Scholar 

  31. Fearon KCH, Barber MD, Moses AG, Ahmedzai SH, Taylor GS, Tisdale MJ, et al. Double-blind, placebo-controlled, randomized study of eicosapentaenoic acid diester in patients with cancer cachexia. J Clin Oncol. 2006;24:3401–7.

    CAS  Article  Google Scholar 

  32. Van Der Meij BS, Langius JAE, Smit EF, Spreeuwenberg MD, Von Blomberg BME, Heijboer AC, et al. Oral nutritional supplements containing (n-3) polyunsaturated fatty acids affect the nutritional status of patients with stage III non-small cell lung cancer during multimodality treatment. J Nutr. 2010;140:1774–80.

    Article  Google Scholar 

  33. Bruera E, Strasser F, Palmer JL, Willey J, Calder K, Amyotte G, et al. Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: a double-blind, placebo-controlled study. J Clin Oncol. 2003;21:129–34.

    CAS  Article  Google Scholar 

  34. Gow RV, Hibbeln JR. Omega-3 fatty acid and nutrient deficits in adverse neurodevelopment and childhood behaviors. Child Adolesc Psychiatr Clin N. Am. 2014;23:555–90.

    Article  Google Scholar 

  35. Zamora Zamora F, Martínez Galiano JM, Gaforio Martínez JJ, Delgado Rodríguez M. Aceite de oliva y peso corporal. Revisión sistemática y metaanálisis de ensayos controlados aleatorizados. Rev Esp Salud Publica. 2018;92. http://www.ncbi.nlm.nih.gov/pubmed/30461730 (accessed 28 Jan 2022).

  36. Paez A. Gray literature: an important resource in systematic reviews. J Evid Based Med. 2017;10:233–40.

    Article  Google Scholar 

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Acknowledgements

During the preparation of the manuscript, FMD received a doctoral grant from the National Council for Scientific and Technological Development (CNPq).

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All authors contributed to data interpretation and reviewed, edited, and approved the final manuscript. FMD conducted the writing, analysis, and critical review of the manuscript. LMF was the second reviewer and revised the manuscript.

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Correspondence to Felipe Mendes Delpino.

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Delpino, F.M., Figueiredo, L.M. Effects of omega-3 supplementation on lean body mass in cancer patients: a systematic review and meta-analysis. Eur J Clin Nutr (2022). https://doi.org/10.1038/s41430-022-01100-x

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