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Recommendations Summary

ONC: Fish Oil, Lean Body Mass and Weight in Adult Oncology Patients 2013

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    ONC: Dietary Supplements Containing Fish Oil for the Adult Oncology Patient

    If sub-optimal symptom control or inadequate dietary intake has been addressed and the adult oncology patient is still experiencing loss of weight and lean body mass (LBM), the registered dietitian nutritionist (RDN) may consider use of dietary supplements containing eicosapentaenoic acid (EPA) as a component of nutrition intervention. Research indicates that dietary supplements containing fish oil (actual consumption, 0.77g to 6.0g of EPA per day), resulted in weight gain or weight stabilization and improvement or preservation of LBM in adult oncology patients with weight loss.
     

    Rating: Strong
    Imperative

    ONC: Medical Food Supplements Containing Fish Oil for the Adult Oncology Patient

    If sub-optimal symptom control or inadequate dietary intake has been addressed and the adult oncology patient is still experiencing loss of weight and LBM, the RDN may consider use of a medical food supplement (MFS) containing EPA as a component of nutrition intervention. Research indicates that MFS containing fish oil (actual consumption, 1.2g to 2.2g of EPA per day) resulted in weight gain or weight stabilization and improvement or preservation of LBM in adult oncology patients with weight loss.


     

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      • Caution patients who are intolerant or allergic to fish about the potential for allergic reactions to fish oil
      • The RDN should evaluate for potential drug interactions.

    • Conditions of Application

      • Availability of MFS containing fish oil in the US is limited
      • Consideration of dietary supplements containing fish oil should be raised with the physician
      • Consideration should be given to the total intake of omega-3 fatty acids from all sources
      • Consider advance directives when planning nutrition intervention.

    • Potential Costs Associated with Application

      There may be an increased cost for intake of dietary supplements and MFS containing fish oil.

    • Recommendation Narrative

      A total of 24 studies were included in the evidence analysis for this recommendation:

      • Eight positive-quality randomized controlled trials (RCT) (Bauer et al, 2005; de Luis et al,  2005; Fearon et al, 2006; Fearon et al, 2003; Finocchiaro et al, 2012; Jatoi et al, 2004; Silva et al, 2012; van der Meij et al, 2010) 
      • Two positive-quality non-randomized trials (de Luis et al, 2008; Murphy et al, 2011)
      • One positive-quality before-and-after study (Burns et al, 2004)
      • One positive-quality randomized, non-placebo controlled trial (Persson et al,  2005)
      • Three neutral-quality time studies (Barber et al,  1999; Taylor et al, 2010; Wigmore et al, 2000)
      • Three neutral-quality RCTs (Bonatto et al, 2012; Guarcello et al, 2007; Ryan et al, 2009)
      • Two neutral-quality prospective cohort studies (Read et al, 2007; Weed et al, 2011)
      • One neutral-quality non-randomized trial (Barber et al, 2000)
      • One negative-quality non-randomized controlled trial (Gogos et al, 1995)
      • One negative-quality time study (Wigmore et al, 1996)
      • One negative-quality RCT (Pratt et al, 2002).

      Evidence

      Dietary Supplements Containing Fish Oil and Lean Body Mass

      • Four studies provide evidence that dietary supplements containing fish oil (actual consumption 0.77g to 6.0g of EPA per day) resulted in improvement or preservation of LBM in adult oncology patients with weight loss
      • A fifth study (Fearon, 2006) showed the same effect, but was not statistically significant
      • More research is needed to determine the optimal dose.
      • Evidence is based on the following five studies: Fearon et al, 2006; Murphy et al, 2011; Taylor et al,  2010; Wigmore et al, 2000; and Wigmore et al,  1996.

      Dietary Supplements Containing Fish Oil and Weight

      • Eight studies provide evidence that dietary supplements containing fish oil (actual consumption 0.77g to 6.0g of EPA per day), resulted in weight stabilization or weight gain in adult oncology patients with weight loss
      • Three other studies (Burns et al, 2004; Gogos et al,  1995; Persson et al,  2005) showed the same effect, but were not statistically significant
      • One study (Fearon et al, 2006) showed a positive effect for a sub-group of the population (gastrointestinal cancer patients), but not for the total population
      • Evidence is based on the following 12 studies: Bonatto et al, 2012; Burns et al, 2004; Fearon et al, 2006; Finocchiaro et al,  2012; Gogos et al,  1995; Murphy et al, 2011; Persson et al, 2005; Pratt et al, 2002; Silva et al, 2012; Taylor et al,  2010; Wigmore et al, 2000; Wigmore et al,  1996.

      Medical Food Supplements (MFS) Containing Fish Oil and Lean Body Mass

      • Seven studies provide evidence that MFS containing fish oil (actual consumption, 1.2g to 2.2 g of EPA per day), resulted in improvement or preservation of LBM in adult oncology patients with weight loss
      • Two other studies (Bauer 2005; de Luis 2008) showed the same effect, but were not statistically significant
      • Evidence is based on the following nine studies: Barber et al,  1999; Barber et al, 2000; Bauer et al,  2005; de Luis 2008; Fearon et al, 2003; Read et al, 2007; Ryan et al, 2009; van der Meij et al, 2010; Weed et al, 2011.

      Medical Food Supplement Containing Fish Oil and Weight 

      • Nine studies provide evidence that MFS containing fish oil (actual consumption 1.2g to 2.2g of EPA per day), resulted in weight stabilization or weight gain in adult oncology patients with weight loss
      • Two other studies (Fearon, 2003; Jatoi, 2004) showed the same effect, but were not statistically significant
      • Evidence is based on the following 11 studies: Barber et al,  1999; Barber et al, 2000, Bauer et al,  2005; de Luis 2008; de Luis 2005; Fearon 2003; Guarcello 2007; Jatoi 2004; Read et al, 2007; van der Meij et al, 2010; Weed et al, 2011.

    • Recommendation Strength Rationale

      • The conclusion statement for the Effect of a Dietary Supplement Containing Fish Oil on LBM is Grade II
      • The conclusion statement for the Effect of a Dietary Supplement Containing Fish Oil on Weight is Grade I
      • The conclusion statement for the Effect of a MFS Containing Fish Oil on LBM is Grade I
      • The conclusion statement for the Effect of a MFS Containing Fish Oil on Weight is Grade I.

    • Minority Opinions

      None.