Enteral Diet Enriched with ω-3 Fatty Acid Improves Oxygenation After Thoracic Esophagectomy for Cancer: A Randomized Controlled Trial Randomized controlled clinical trial assessing the effects of oral nutritional supplements in postoperative gastric cancer patients 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 A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients Controlled trial of fish oil for regression of human coronary atherosclerosis. HARP Research Group. Supplementation with eicosapentaenoic acid and docosahexaenoic acid reduces high levels of circulating proinflammatory cytokines in aging adults: A randomized, controlled study. Nutrition intervention using an eicosapentaenoic acid (EPA)-containing supplement in patients with advanced colorectal cancer. Effects on nutritional and inflammatory status: a phase II trial The impact of malnutrition on morbidity, mortality and length of hospital stay in trauma patients. Dexamethasone reduces emesis after major gastrointestinal surgery (DREAMS) Postoperative pneumonia: a prospective study of risk factors and morbidity. Fish Oil Supplement Alters Markers of Inflammatory and Nutritional Status in Colorectal Cancer Patients Double-blind, placebo-controlled, randomized study of eicosapentaenoic acid diester in patients with cancer cachexia. Compliance with preoperative oral nutritional supplements in patients at nutritional risk─only a question of will? Short-term preoperative supplementation of an immunoenriched diet does not improve clinical outcome in well-nourished patients undergoing abdominal cancer surgery. Enteral Nutrition Enriched With Eicosapentaenoic Acid (EPA) Preserves Lean Body Mass Following Esophageal Cancer Surgery: Results of a Double-Blinded Randomized Controlled Trial Loss of Lean Body Mass as an Independent Risk Factor for Continuation of S-1 Adjuvant Chemotherapy for Gastric Cancer Bioavailability of n–3 Polyunsaturated Fatty Acids (PUFA) in Foods Enriched with Microencapsulated Fish Oil Does Prolonged Enteral Feeding With Supplemental Omega-3 Fatty Acids Impact on Recovery Post-esophagectomy: Results of a Randomized Double-Blind Trial Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Effects of perioperative Eicosapentaenoic acid-enriched oral nutritional supplement on lean body mass after total gastrectomy for gastric cancer Three short perioperative infusions of n-3 PUFAs reduce systemic inflammation induced by cardiopulmonary bypass surgery: a randomized controlled trial.
Background Although the anti-inflammatory effects of immunomodulating diets ( IMDs ) have recently attracted attention , the efficacy of enteral feeding of such diets after radical surgery remains controversial . Thus , we conducted a new prospect i ve , r and omized controlled study to eluci date any beneficial effect of an IMD containing eicosapentaenoic acid ( EPA ) and γ-linolenic acid ( GLA ) in patients undergoing radical esophagectomy for thoracic esophageal cancer . Methods From November 2009 to July 2011 , 87 consecutive patients were r and omized to receive either an IMD enriched with EPA , GLA , and antioxidants ( n = 42 ) or a st and ard isocaloric , isonitrogenous diet ( control group , n = 45 ) after esophagectomy with radical lymphadenectomy . The primary outcome measure was changes in the oxygenation status ( PaO2/FIO2 ratio ) , and the secondary outcome measures were body composition , inflammation-related factors , coagulation markers , cholesterol concentrations , and major clinical outcomes . Results Oxygenation was significantly better on postoperative days ( PODs ) 4 , 6 , and 8 in the IMD than control group ( 366.5 ± 63.3 vs. 317.3 ± 58.8 , P = 0.001 ; 361.5 ± 52.6 vs. 314.0 ± 53.2 , P < 0.001 ; 365.4 ± 71.2 vs. 315.2 ± 56.9 , P = 0.001 , respectively ) . Changes in the ratio of body weight on PODs 14 and 21 and lean body weight on POD 21 were significantly greater in the IMD than control group . No significant differences were observed in other measures . Conclusions An enteral IMD enriched with EPA and GLA improved oxygenation and maintained the body composition of patients undergoing radical esophagectomy , indicating the potential efficacy of such a diet after esophagectomy Background Postoperative weight loss and malnutrition are major issues in gastric cancer patients . The concept of oral nutritional supplements ( ONS ) is gaining widespread acceptance . We investigated the effects of ONS administration on postoperative body weight loss in patients with gastric cancer who had undergone total gastrectomy or distal gastrectomy . Methods Patients were r and omized to either the treatment or the control group . In both groups , st and ard surgery for gastric cancer was performed . In the treatment group , intervention with ONS was performed until 12 weeks after discharge . In the control group , patients were fed the usual postoperative diet .  Weight , body composition , quality of life , hematological parameters , and blood chemistry were evaluated . Results We analyzed 113 cases ( 73 distal gastrectomy , 40 total gastrectomy ) .  Weight loss in the ONS group after total gastrectomy was significantly less than that in the control group . Weight loss and skeletal muscle mass loss after distal gastrectomy did not differ significantly between the ONS and control groups . Conclusion This study showed ONS after total gastrectomy to significantly diminish postoperative weight loss Aim : N-3 fatty acids , especially eicosapentaenoic acid ( EPA ) , may possess anticachectic properties . This trial compared a protein and energy dense supplement enriched with n-3 fatty acids and antioxidants ( experimental : E ) with an isocaloric isonitrogenous control supplement ( C ) for their effects on weight , lean body mass ( LBM ) , dietary intake , and quality of life in cachectic patients with advanced pancreatic cancer . Methods : A total of 200 patients ( 95 E ; 105 C ) were r and omised to consume two cans/day of the E or C supplement ( 480 ml , 620 kcal , 32 g protein ± 2.2 g EPA ) for eight weeks in a multicentre , r and omised , double blind trial . Results : At enrolment , patients ’ mean rate of weight loss was 3.3 kg/month . Intake of the supplements ( E or C ) was below the recommended dose ( 2 cans/day ) and averaged 1.4 cans/day . Over eight weeks , patients in both groups stopped losing weight ( Δ weight E : −0.25 kg/month versus C : −0.37 kg/month ; p = 0.74 ) and LBM ( Δ LBM E : + 0.27 kg/month versus C : + 0.12 kg/month ; p = 0.88 ) to an equal degree ( change from baseline E and C , p<0.001 ) . In view of evident non-compliance in both E and C groups , correlation analyses were undertaken to examine for potential dose-response relationships . E patients demonstrated significant correlations between their supplement intake and weight gain ( r = 0.50 , p<0.001 ) and increase in LBM ( r = 0.33 , p = 0.036 ) . Such correlations were not statistically significant in C patients . The relationship of supplement intake with change in LBM was significantly different between E and C patients ( p = 0.043 ) . Increased plasma EPA levels in the E group were associated with weight and LBM gain ( r = 0.50 , p<0.001 ; r = 0.51 , p = 0.001 ) . Weight gain was associated with improved quality of life ( p<0.01 ) only in the E group . Conclusion : Intention to treat group comparisons indicated that at the mean dose taken , enrichment with n-3 fatty acids did not provide a therapeutic advantage and that both supplements were equally effective in arresting weight loss . Post hoc dose-response analysis suggests that if taken in sufficient quantity , only the n-3 fatty acid enriched energy and protein dense supplement results in net gain of weight , lean tissue , and improved quality of life . Further trials are required to examine the potential role of n-3 enriched supplements in the treatment of cancer cachexia BACKGROUND Patients who undergo surgery are at risk of malnutrition due to periods of starvation , the stress of surgery , and subsequent increase in metabolic rate . There are limited data on nutritional outcome of surgical patients . AIMS To investigate changes in nutritional status and the influence of oral supplements on nutritional status , morbidity , and quality of life in postoperative surgical patients . METHODS Entry was determined by the presence of malnutrition , as defined by a body mass index ( BMI ) ⩽20 kg/m2 , anthropometric measurements ⩽15th percentile on admission , or initiation of oral diet postoperatively and /or a weight loss of 5 % or more during the operative period . We studied 101 patients : 52 were r and omised to the treatment group ( TG ) and prescribed a 1.5 kcal/ml nutritional supplement ; 49 patients were r and omised to the control group ( CG ) and continued with routine nutritional management .  Nutritional status was assessed by weight , anthropometry , and grip strength , with measurements taken at two weekly intervals for 10 weeks . Complications , namely wound infection , chest infection , and antibiotic use were documented . Quality of life ( QOL ) was assessed using the UK SF-36 question naire . RESULTS Patients in the control group lost a maximum mean ( SD ) of 5.96 ( 4.21 ) kg in weight over a period of eight weeks while patients in group TG lost less weight overall ( maximum mean ( SD ) 3.40 ( 0.89 ) kg ( p<0.001 ) occurring at four weeks and progressively regained weight from week 4 ) . Anthropometry , grip strength , and QOL were similarly significantly different between groups ( p<0.001 ) . Fewer patients in the treatment group ( 7/52 ) required antibiotic prescriptions compared with the control group ( 15/49 ) . CONCLUSIONS Nutritional status declined for two months after discharge . Postoperative nutritional supplementation improved nutritional status , QOL , and morbidity in these patients OBJECTIVES This r and omized clinical trial tested whether fish oil supplements can improve human coronary atherosclerosis .  BACKGROUND Epidemiologic studies of population s whose intake of oily fish is high , as well as laboratory studies of the effects of the polyunsaturated fatty acids in fish oil , support the hypothesis that fish oil is antiatherogenic . METHODS Patients with angiographically documented coronary heart disease and normal plasma lipid levels were r and omized to receive either fish oil capsules ( n = 31 ) , containing 6 g of n-3 fatty acids , or olive oil capsules ( n = 28 ) for an average duration of 28 months . Coronary atherosclerosis on angiography was quantified by computer-assisted image analysis . RESULTS Mean ( + /- SD ) baseline characteristics were age 62 + /- 7 years , plasma total cholesterol concentration 187 + /- 31 mg/dl ( 4.83 + /- 0.80 mmol/liter ) and triglyceride levels 132 + /- 70 mg/dl ( 1.51 + /- 0.80 mmol/liter ) . Fish oil lowered triglyceride levels by 30 % ( p = 0.007 ) but had no significant effects on other plasma lipoprotein levels . At the end of the trial , eicosapentaenoic acid in adipose tissue sample s was 0.91 % in the fish oil group compared with 0.20 % in the control group ( p < 0.0001 ) . At baseline , the minimal lumen diameter of coronary artery lesions ( n = 305 ) was 1.64 + /- 0.76 mm , and percent narrowing was 48 + /- 14 % . Mean minimal diameter of atherosclerotic coronary arteries decreased by 0.104 and 0.138 mm in the fish oil and control groups , respectively ( p = 0.6 between groups ) , and percent stenosis increased by 2.4 % and 2.6 % , respectively ( p = 0.8 ) . Confidence intervals exclude improvement by fish oil treatment of > 0.17 mm , or > 2.6 % . CONCLUSIONS Fish oil treatment for 2 years does not promote major favorable changes in the diameter of atherosclerotic coronary arteries BACKGROUND High levels of circulating proinflammatory cytokines are characteristic of inflammaging , a term coined to describe age-related chronic systemic inflammation involved in the etiology of many age-related disorders including nonhealing wounds . Some studies have shown that supplementing diets with n-3 polyunsaturated fatty acids ( eicosapentaenoic acid [ EPA ] and docosahexaenoic acid [ DHA ] ) lowers systemic levels of key proinflammatory cytokines associated with inflammaging . However , findings from the few studies that have focused exclusively on older adults are inconclusive . As such , the objective of this r and omized controlled study was to test the effects of EPA+DHA therapy on circulating levels of proinflammatory cytokines in adults in middle to late adulthood . METHODS Plasma levels of fatty acids and interleukin (IL)-6 , IL-1β and tumor necrosis factor-α ( TNF-α ) were measured in 35 participants with chronic venous leg ulcers ( mean age : 60.6 years ) r and omnly assigned to 8 weeks of EPA+DHA therapy ( 2.5 g/d ) or placebo therapy . RESULTS EPA+DHA therapy had a significant lowering effect on levels of IL-6 , IL-1β and TNF-α after 4 weeks of therapy and an even greater lowering effect after 8 weeks of therapy . Further , after adjusting for baseline difference , the treatment group had significantly lower levels of IL-6 ( p = 0.008 ) , IL-1β ( p < 0.001 ) , and TNF-α ( p < 0.001 ) at Week 4 and at Week 8 [ IL-6 ( p = 0.007 ) , IL-1β ( p < 0.001 ) , and TNF-α ( p < 0.001 ) ] compared to the control group . CONCLUSION Adults in middle to late adulthood  receiving EPA+DHA therapy demonstrated significantly greater reductions in circulating levels of proinflammatory cytokines compared with those receiving placebo therapy . EPA+DHA therapy may be an effective low-risk dietary intervention for assuaging the harmful effects of inflammaging Goals The aim of the study was to assess the impact of an eicosapentanoic acid-containing protein and energy dense oral nutritional supplement ( EPA-ONS ) on nutritional and inflammatory status , quality of life ( QOL ) , plasma phospholipids ( PPL ) and cytokine profile , tolerance of irinotecan-containing chemotherapy and EPA-ONS in patients with advanced colorectal cancer ( CRC ) receiving chemotherapy . Material s and methods Patients with advanced CRC having one prior chemotherapy regimen received 480 ml of EPA-ONS daily for 3 weeks before commencing chemotherapy with folinic acid , 5-fluorouracil , irinotecan ( FOLFIRI ) , and continued for 3 cycles of treatment ( 9 weeks ) . All assessment s including weight , body composition , C-reactive protein ( CRP ) , QOL , dietary intake , PPL and cytokine analyses were performed at baseline , 3 and 9 weeks . Results Twenty-three patients were enrolled , 20 completed 3 weeks , and 15 completed 9 weeks . The mean EPA-ONS intake was 1.7 tetrapaks ( 408 ml ) daily . There was a significant increase in mean weight ( 2.5 kg ) at 3 weeks ( p = 0.03 ) . Lean body mass ( LBM ) was maintained . Protein and energy intake significantly decreased after the commencement of chemotherapy ( protein p = 0.003 , energy p = 0.02 ) . There was a significant increase in energy levels ( p = 0.03 ) , whilst all other QOL measures were maintained . PPL EPA levels increased significantly over the first 3 weeks . Mean CRP increased by 14.9 mg/L over the first 3 weeks ( p = 0.004 ) , but decreased to baseline levels by the end of the trial . There was a significant correlation between plasma IL-6 and IL-10 concentrations and survival , and between IL-12 and toxicity . Conclusion Dietary counseling and the provision of EPA-ONS may result in maintenance of nutritional status and QOL , however r and omized trials are required to evaluate the impact of EPA on toxicity from chemotherapy BACKGROUND AND AIM To asses the nutritional status of hospitalised trauma patients and the repercussion on the clinical follow up . METHODS In a prospect i ve way 161 adult patients admitted to the units of Intensive Care ( ICU ) , General Surgery , Maxillofacial Surgery and Orthopedics of the Centro de Emergencias Médicas in Asunción , Paraguay , from March 2002 to March 2004 were evaluated at admission by using the Subjective Global Assessment ( SGA ) . Patients were followed to determine length of hospital stay , complications and in-hospital mortality . RESULTS From the trauma patients median age was 27 ( 14 - 92 ) years and 94 % were males . Most patients ( 74 % ) were from the countryside . The most frequent anatomic sites of trauma were : head 25 % , thorax 16.6 % , limbs 15.4 % , abdomen 14 % . The median Injury Severity Score ( ISS ) was 20 ( 1 - 39 ) . From this population of patients , 40 % were malnourished or at risk of malnutrition according to the SGA . Multivariate analysis identified as significant risk factors for mortality : malnutrition according to the SGA ( p = 0.04 , RR = 4 ( 1 - 15 ) , and admission to the ICU ( p = 0.0001 , RR 53 ( 12 - 234 ) . Risk factors for complications were malnutrition according to the SGA ( p = 0.003 , RR 2.9 ( 1.4 - 5.8 ) and ISS over 20 ( p = 0.001 , RR = 8.4 ( 2.3 - 29.9 ) . The risk factors for length of stay were malnutrition according to the Subjective Global Assesment ( p = 0.01 , RR = 2.3 ( 1.2 - 4.7 ) and Injury Severity Score over 20 , p = 0.03 , RR = 2.8 ( 1 - 7.3 ) . CONCLUSIONS In the conditions of this study , malnutrition is frequent on admission in trauma patients , and is an independent risk factor for morbidity , mortality , and prolongs the length of hospitalisation . Efforts should be made to quickly assess the nutritional status of these patients and early start nutritional intervention Background Postoperative nausea and vomiting is one of the most common complications affecting patients after surgery and causes significant morbidity and increased length of hospital stay . It is accepted that patients undergoing surgery on the bowel are at a higher risk . In the current era of minimally invasive colorectal surgery combined with enhanced recovery , reducing the incidence and severity of postoperative nausea and vomiting is particularly important . Dexamethasone is widely , but not universally used . It is known to improve appetite and gastric emptying , thus reduce vomiting . However , this benefit is not established in patients undergoing bowel surgery , and dexamethasone has possible side effects such as increased risk of wound infection and anastomotic leak that could adversely affect recovery . Design DREAMS is a phase III , double-blind , multicenter , r and omized controlled trial with the primary objective of determining if preoperative dexamethasone reduces postoperative nausea and vomiting in patients undergoing elective gastrointestinal resections . DREAMS aims to r and omize 1,350 patients over 2.5 years . Patients undergoing laparoscopic or open colorectal resections for malignant or benign pathology are r and omized between 8 mg intravenous dexamethasone and control ( no dexamethasone ) . All patients are given one additional antiemetic at the time of induction , prior to r and omization . Both the patient and their surgeon are blinded as to the treatment arm . Secondary objectives of the DREAMS trial are to determine whether there are other measurable benefits during recovery from surgery with the use of dexamethasone , including quicker return to oral diet and reduced length of stay . Health-related quality of life , fatigue and risks of infections will be investigated . Trial registration IS RCT BACKGROUND Postoperative pneumonia ( PP ) is a major complication that has been linked to microaspiration of pathogens originating in the gastrointestinal tract . This prospect i ve study was performed to define the role of gastric bacterial aspiration in the development of PP . METHODS Informed consent was obtained before operations from 140 veterans scheduled for major elective procedures requiring nasogastric tubes  , and cultures were obtained of the gastric contents and sputum twice daily after operation . RESULTS PP developed in 26 ( 18.6 % ) of 140 patients . The patients who had PP did not differ from those with no pneumonia after operation except for a history of chronic obstructive pulmonary disease , which was found in 38.5 % of those with PP compared with 20 % of patients with no pneumonia ( p < 0.05 ) . Morbidity was increased in association with PP , because length of stay in the surgical intensive care unit ( 6.2 vs 2.6 days ) , days intubated ( 2.7 vs 0.6 ) , total postoperative days ( 15.3 vs 8.4 ) , and mortality rates ( 19.2 % vs 1.7 % ) were greater than in patients with no pneumonia . Gastric pathogens were present on entry in 38 % of patients , and 32 % of these had PP compared with 13 % whose initial gastric cultures were sterile ( p = 0.01 ) . Colonization of sputum for greater than 24 hours with gastric pathogens occurred in 28 % of patients . These patients had a 40 % incidence of PP compared with 12 % in patients without such evidence of microaspiration ( p < 0.01 ) . CONCLUSIONS PP is a morbid postoperative complication associated with not only chronic obstructive pulmonary disease but also the presence of gastric bacteria during operation and transmission of gastric bacteria to the pulmonary tree after operation Inflammation is a common feature in cancer . The presence and magnitude of the chronic systemic inflammatory responses may produce progressive nutritional decline . This study aims at investigating whether there are changes in inflammation markers and /or in nutritional status of patients with colorectal cancer undergoing chemotherapy who were supplemented with fish oil .  The clinical trial was conducted with 23 patients r and omly distributed in 2 groups . The supplemented group ( SG ) consumed 2 g of fish oil containing 600 milligrams of eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) for 9 wk . Nutritional and inflammatory markers status was available , both at a baseline ( M0 ) , and after 9 wk of chemotherapy ( M9 ) in the SG and in the nonsupplemented group ( NSG ) . Statistical analysis was conducted with STATA 11.0 software . SG and NSG presented the same baseline characteristics ( P > 0.05 ) . Nutritional status indicators such as body mass index and body weight were modified only in the NSG when comparing baseline and M9 , P = 0.03 and P = 0.01 respectively , whereas in SG these indicators did not vary . Patients supplemented with fish oil ( SG ) showed a clinical ly relevant decrease in the C-reactive protein/albumin relation ( P = 0.005 ) . Low doses of fish oil supplement can positively modulate the nutritional status and the C-reative protein/albumin ratio PURPOSE Eicosapentaenoic acid ( EPA ) has been proposed to have specific anticachectic effects . This trial compared EPA diethyl ester with placebo in cachectic cancer patients for effects on weight and lean body mass . PATIENTS AND METHODS Five hundred eighteen weight-losing patients with advanced gastrointestinal or lung cancer were studied in a multicenter , double-blind , placebo controlled trial . Patients were r and omly assigned to receive a novel preparation of pure EPA at a dose of 2 g or 4 g daily or placebo ( 2 g EPA , n = 175 ; 4 g EPA , n = 172 ; placebo , n = 171 ) . Patients were assessed at 4 weeks and 8 weeks . RESULTS The groups were well balanced at baseline . Mean weight loss at baseline was 18 % ( n = 518 ) . Over the 8-week treatment period , both intention-to-treat analysis and per protocol analysis revealed no statistically significant improvements in survival , weight , or other nutritional variables . There was , however , a trend in favor of EPA with analysis of the primary end point , weight , at 8 weeks showing a borderline , nonsignificant treatment effect ( P = .066 ) . Relative to placebo , mean weight increased by 1.2 kg with 2 g EPA ( 95 % CI , 0 kg to 2.3 kg ) and by 0.3 kg with 4 g EPA ( -0.9 kg to 1.5 kg ) . CONCLUSION The results indicate no statistically significant benefit from single agent EPA in the treatment of cancer cachexia . Future studies should concentrate on other agents or combination regimens Background / Objectives : Preoperative nutrition has been shown to reduce morbidity after major gastrointestinal ( GI ) surgery in selected patients at risk . In a r and omized trial performed recently ( NCT00512213 ) , almost half of the patients , however , did not consume the recommended dose of nutritional intervention . The present study aim ed to identify the risk factors for noncompliance . Subjects/ Methods : Demographic ( n=5 ) and nutritional ( n=21 ) parameters for this retrospective analysis were obtained from a prospect ively maintained data base . The outcome of interest was compliance with the allocated intervention ( ingestion of ⩾11/15 preoperative oral nutritional supplement units ) . Uni- and multivariate analyses of potential risk factors for noncompliance were performed . Results : The final analysis included 141 patients with complete data sets for the purpose of the study . Fifty-nine patients ( 42 % ) were considered noncompliant . Univariate analysis identified low C-reactive protein levels ( P=0.015 ) , decreased recent food intake ( P=0.032 ) and , as a trend , low hemoglobin ( P=0.065 ) and low pre-albumin ( P=0.056 ) levels as risk factors for decreased compliance . However , none of them was retained as an independent risk factor after multivariate analysis . Interestingly , 17 potential explanatory parameters , such as upper GI cancer , weight loss , reduced appetite or co-morbidities , did not show any significant correlation with reduced intake of nutritional supplements . Conclusions : Reduced compliance with preoperative nutritional interventions remains a major issue because the expected benefit depends on the actual intake . Seemingly , obvious reasons could not be retained as valid explanations . Compliance seems thus to be primarily a question of will and information ; the importance of nutritional supplementation needs to be emphasized by specific patients ’ education OBJECTIVE A recent study suggested that the anti-inflammatory effect of immunonutrition starts after only two d. We therefore investigated the effect of an immunoenriched oral diet administered for three d preoperatively . METHODS In this prospect i ve , r and omized , double-blind , placebo-controlled study , well-nourished patients ( Nutrition Risk Screening 2002 <3 ) with gastrointestinal cancer who were scheduled for major elective abdominal cancer surgery were r and omly assigned to either 750 mL of an immunoenriched formula ( IEF group ) or 750 mL of an isocaloric , isonitrogenous placebo diet ( Con group ) for 3 consecutive d preoperatively . RESULTS A total of 108 patients ( IEF group : n = 55 ; Con group : n = 53 ) were r and omized . The two groups were comparable for all baseline and surgical characteristics . The overall mortality was 2.8 % and not significantly different between the two groups ( IEF group : 3.6 % vs. Con group : 1.9 % , P = 1.00 ) . Intention-to-treat analysis showed no difference for the incidence of postoperative overall ( IEF group : 29 % vs. Con group : 30 % ; P = 1.00 ) and infectious ( IEF group : 15 % vs. Con group : 17 % ; P = 0.79 ) complications . Length of hospital stay was 12 ± 4.9 d in the IEF group and 11.6 ± 5.3 d in the Con group ( P = 0.68 ) . CONCLUSIONS Preoperative oral supplementation with an immunoenriched diet for 3 d preoperatively did not improve postoperative outcome compared with the placebo in well-nourished patients with elective gastrointestinal cancer surgery 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 . Objectives : 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 r and omized to a st and ard 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 st and ard ) completed the study , and both groups were well matched . Serum and peripheral blood mononuclear cell ( P BMC ) 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 st and ard 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 TNFα , IL-10 , and IL-8 compared with the st and ard group . Conclusions : EPA supplemented early EN is associated with preservation of lean body mass post esophagectomy compared with a st and ard 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 Background and Aims Compliance with S-1 adjuvant chemotherapy is not satisfactory , and the aim of the present study was to clarify risk factors for the continuation of S-1 after gastrectomy . Methods This retrospective study selected patients who underwent curative D2 surgery for gastric cancer , were diagnosed with stage II/III disease , had a creatinine clearance > 60 ml/min , and received adjuvant S-1 at our institution between June 2010 and March 2014 .  The time to S-1 treatment failure ( TTF ) was calculated . Results Fifty-eight patients were selected for the present study . When the TTF curves stratified by each clinical factor were compared using the log-rank test , lean body-mass loss ( LBL ) of 5 % was regarded as a critical cutoff point . Univariate Cox ’s proportional hazard analyses demonstrated that LBL was a significant independent risk factor for continuation . The 6-month continuation rate was 91.7 % in patients with an LBL < 5 % , and 66.3 % for patients with an LBL > 5 % ( p = 0.031 ) . Conclusions The present study demonstrated that LBL might be an important risk factor for a decrease in compliance to adjuvant chemotherapy with S-1 in patients with stage II/III gastric cancer who underwent D2 gastrectomy . A multicenter , double-blinded , prospect i ve cohort study is necessary to confirm whether LBL would affect adjuvant S-1 continuation Objective : Incorporation of fish oil into food products provides a means of increasing n–3 fatty acid intake , particularly in population s where fish consumption remains low . The aim of the present study was to evaluate the bioavailability of n–3 PUFA in microencapsulated fish-oil-enriched foods compared with an equal amount of n–3 PUFAs contained in fish oil capsules . Methods : Twenty-five healthy female volunteers were r and omly assigned to one of two groups for the 4-week intervention : one group received 0.9 g of n–3 PUFA/day as fish oil capsule ( capsule group ) , while the second group ( food group ) received an equal amount of n–3 PUFA/day from enriched foods . Baseline and post-intervention sample s were analysed for platelet fatty acid composition . Results : There was no significant difference in the change in platelet arachidonic acid ( AA ) , eicosapentaenoic acid ( EPA ) , or docosahexaenoic acid ( DHA ) between the two groups following the intervention . Conclusions : The results indicate that n–3 PUFA from microencapsulated fish-oil-enriched foods are as bioavailable as n–3 PUFA in a capsule . Fortification of foods with microencapsulated fish oil , therefore , offers an effective way of increasing n–3 PUFA intakes and status in line with current dietary recommendations Objective : This r and omized controlled trial ( RCT ) hypothesized that prolonged enteral nutrition ( EN ) with supplemental eicosapentanoic acid ( EPA ) , an omega-3 fatty acid with immune and anabolic properties , may impact on clinical and nutritional outcomes . Background : Esophagectomy is associated with significant weight loss and catabolism , and negatively impacts quality of life ( QL ) . Strategies to counter sustained catabolism have therapeutic rationale . Methods : This multicenter , double-blind , placebo-controlled RCT was powered on a 5 % difference in lean body mass ( LBM ) at 1 month . Patients were r and omly assigned to receive either EN-EPA ( 2.2 g EPA/day ) ( n = 97 ) or isocaloric isonitrogenous st and ard EN ( EN-S ) ( n = 94 ) , preoperatively ( 5 days orally ) , and postoperatively via a jejunostomy until 1 month postdischarge . Assessment s perioperatively , and at 1 , 3 , and 6 months included weight , body mass index ( BMI ) , body composition , muscle strength , cytokines , complications , and QL . Results : The median ( range ) nutrition support was for 51 ( 36 to 78 ) days , and overall compliance was 96 % . For the entire cohort , a significant ( P < 0.005 ) decrease in weight ( −7.4 ± 6.6 kg ) , BMI ( −2.6 ± 2.2 kg/m2 ) , LBM ( −2.5 ± 8.7 kg ) , and fat mass ( −3.4 ± 5.8 kg ) was evident from preoperatively to 6 months . The mean ( ±SD ) loss of LBM ( kg ) at 1 month was −3.7 ± 8.7 in the EN-S group , compared with −5.6 ± 12.1 in the EN-EPA group ( P = 0.355 ) . Per- protocol analysis revealed no difference between the EN-EPA and EN-S in any clinical , nutritional , functional , QL or immune parameter at any time point . Conclusions : The thesis that EPA impacts on anabolism , immune function , and clinical outcomes post-esophagectomy was not supported . Compliance with home EN was excellent , but weight , muscle , and fat loss was significant in 30 % of patients , highlighting the complexity of postoperative weight loss Since the first AHA Science Advisory “ Fish Consumption , Fish Oil , Lipids , and Coronary Heart Disease,”1 important new findings , including evidence from r and omized controlled trials ( RCTs ) , have been reported about the beneficial effects of omega-3 ( or n-3 ) fatty acids on cardiovascular disease ( CVD ) in patients with preexisting CVD as well as in healthy individuals.2 New information about how omega-3 fatty acids affect cardiac function ( including antiarrhythmic effects ) , hemodynamics ( cardiac mechanics ) , and arterial endothelial function have helped clarify potential mechanisms of action . The present Statement will address distinctions between plant-derived ( α-linolenic acid , C18:3n-3 ) and marine-derived ( eicosapentaenoic acid , C20:5n-3 [ EPA ] and docosahexaenoic acid , C22:6n-3 [ DHA ] ) omega-3 fatty acids . ( Unless otherwise noted , the term omega-3 fatty acids will refer to the latter . ) Evidence from epidemiological studies and RCTs will be review ed , and recommendations reflecting the current state of knowledge will be made with regard to both fish consumption and omega-3 fatty acid ( plant- and marine-derived ) supplementation . This will be done in the context of recent guidance issued by the US Environmental Protection Agency and the Food and Drug Administration ( FDA ) about the presence of environmental contaminants in certain species of fish . # # # Coronary Heart Disease As review ed by Stone,1 three prospect i ve epidemiological studies within population s reported that men who ate at least some fish weekly had a lower coronary heart disease ( CHD ) mortality rate than that of men who ate none.3–6 ⇓ ⇓ ⇓ More recent evidence that fish consumption favorably affects CHD mortality , especially nonsudden death from myocardial infa rct ion ( MI ) , has been reported in a 30-year follow-up of the Chicago Western Electric Study .7 Men who consumed 35 g or more of fish daily compared with those who consumed none had a relative risk of death from CHD of 0.62 and a relative risk of nonsudden death from MI of 0.33 . In an Background : In previous our phase III study to compare perioperative st and ard diet with or without Eicosapentaenoic acid (EPA)-enriched oral nutritional supplement ( EPA-ON ) , additional EPA-ON did not contribute to prevent body weight loss after total gastrectomy . This report clarified whether EPA-ON could prevent loss of lean body mass ( LBM ) after total gastrectomy , a key secondary endpoint , in our phase III trial . Methods : This phase III study was design ed as multicenter , open-label , superiority , r and omized trial to confirm the preventive effect of EPA-ON body weight loss  after total gastrectomy for gastric cancer . Eligible patients were r and omized to either  St and ard-diet group or EPA-ON group by a central ized dynamic method . St and ard-diet group was given no additional nutritional supplementation perioperatively ( st and ard diet ) , while EPA-ON group was given an EPA-enriched supplement ( ProSure ® , Abbott Japan , Tokyo , Japan ) in addition to their st and ard diet . This supplement included 600 kcal with 2.2 g/day of EPA . For both groups , patients underwent total gastrectomy with Roux-en Y reconstruction . Results : A total of 123 patients ( Group A : 60 , Group B : 63 ) were analyzed in the study . All background factors were well balanced between the both groups . Median loss of LBM was 6.74 % ( range -3.91 % to 20.27 % ) in the St and ard-diet group and 6.89 % ( range -5.11 % to 20.04 % ) in the EPA-ON group at 1 month after surgery and was 8.59 % ( range -4.40 % to 20.27 % ) in the St and ard-diet group and 7.77 % ( range -5.57 % to 23.35 % ) in the EPA-ON group at 3 months after surgery , which was not significantly different at the both ( p=0.794 and p=0.393 , respectively ) . Conclusions : The perioperative EPA-ON could not be recommended to prevent loss of LBM after total gastrectomy BACKGROUND Fish oil ( FO ) has antiinflammatory effects , which might reduce systemic inflammation induced by a cardiopulmonary bypass ( CPB ) . OBJECTIVE We tested whether perioperative infusions of FO modify the cell membrane composition , inflammatory responses , and clinical course of patients undergoing elective coronary artery bypass surgery . DESIGN A prospect i ve r and omized controlled trial was conducted in cardiac surgery patients who received 3 infusions of 0.2 g/kg FO emulsion or saline ( control ) 12 and 2 h before and immediately after surgery . Blood sample s ( 7 time points ) and an  atrial biopsy  ( during surgery ) were obtained to assess the membrane incorporation of PUFAs . Hemodynamic data , catecholamine requirements , and core temperatures were recorded at 10-min intervals ; blood triglycerides , nonesterified fatty acids , glucose , lactate , inflammatory cytokines , and carboxyhemoglobin concentrations were measured at selected time points . RESULTS Twenty-eight patients , with a mean ± SD age of 65.5 ± 9.9 y , were enrolled with no baseline differences between groups . Significant increases in platelet EPA ( + 0.86 % ; P = 0.0001 ) and DHA ( + 0.87 % ; P = 0.019 ) were observed after FO consumption compared with at baseline . Atrial tissue EPA concentrations were higher after FO than after control treatments ( + 0.5 % ; P < 0.0001 ) . FO did not significantly alter core temperature but decreased the postoperative rise in IL-6 ( P = 0.018 ) . Plasma triglycerides increased transiently after each FO infusion . Plasma concentrations of glucose , lactate , and blood carboxyhemoglobin were lower in the FO than in the control group on the day after surgery . Arrhythmia incidence was low with no significant difference between groups . No adverse effect of FO was detected . CONCLUSIONS Perioperative FO infusions significantly increased PUFA concentrations in platelet and atrial tissue membranes within 12 h of the first FO administration and decreased biological and clinical signs of inflammation . These results suggest that perioperative FO may be beneficial in elective cardiac surgery with CPB
Postoperative malnutrition is a major issue among gastrointestinal cancer patients .
Because n-3 polyunsaturated fatty acids ( n-3 PUFAs ) have immunological benefits , n-3 PUFAs are widely used in oral nutritional supplements ( ONS ) .
However , n-3 PUFAs in ONS reduced patients ’ compliance with ONS and affected the role of ONS in maintaining the postoperative nutritional status of patients .
The aim of this study was to systematic ally explore the benefits of enteral nutrition rich in n-3 PUFAs in maintaining the nutritional status of patients after gastrointestinal surgery .