Oncology

ONC: Dietary Supplements and Medical Food Supplements Containing Fish Oil (2013)

Overview

The effect of dietary supplements and medical food supplements (MFS) containing fish oil (specifically eicosapentaenoic acid [EPA]) on body weight and lean body mass (LBM) in cancer cachexia was reviewed. A dietary supplement is a single nutrient supplement in the form of a pill, capsule, liquid, chew, or other form. An MFS is a commercial or prepared food or beverage that supplements energy, protein, carbohydrate, fiber, or fat intake.

For the Oncology Work Group's suggestions for future research on this topic, see ONC: Future Research Suggestions on the left.

• Intervention
  What is the effect of a dietary supplement containing fish oil on lean body mass (LBM) in adult oncology patients?

  • Conclusion
    Four studies found that dietary supplements containing fish oil (actual consumption approximately 0.77g to 6g of EPA per day) resulted in improvement or preservation of lean body mass in adult oncology patients with weight loss. A fifth study showed the same effect, but was not statistically significant. More research is needed to determine the optimal dose.
  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of a dietary supplement containing fish oil on lean body mass (LBM) in adult oncology patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Fearon KC, Barber MD, Moses AG, Ahmedzai SH, Taylor GS, Tisdale MJ, Murray GD. Double-blind, placebo-controlled, randomized study of eicosapentaenoic acid diester in patients with cancer cachexia. J Clin Oncol. 2006 Jul 20; 24(21): 3,401-3,407.
      • Murphy RA, Mourtzakis M, Chu QS, Baracos VE, Reiman T, Mazurak VC. Nutritional intervention with fish oil provides a benefit over standard of care for weight and skeletal muscle mass in patients with nonsmall cell lung cancer receiving chemotherapy. Cancer. 2011 Apr 15; 117(8): 1,775-1,782. Epub 2011 Feb 28.
      • Taylor LA, Pletschen L, Arends J, Unger C, Massing U. Marine phospholipids: A promising new dietary approach to tumor associated weight loss. Support Care Cancer. 2010; 18: 159-170.
      • Wigmore SJ, Barber MD, Ross JA, Tisdale MJ, Fearon KCH.  Effect of oral eicosapentanoic acid on weight loss in patients with pancreatic cancer.  Nutr Cancer. 2000;36:177-84
      • Wigmore SJ, Ross JA, Falconer JS, Plester CE, Tisdale MJ, Carter DC, Fearon KC. The effect of polyunsaturated fatty acids on the progress of cachexia in patients with pancreatic cancer. Nutrition. 1996;12(1 Suppl):S27-30.
  • Search Plan and Results: ONC: Fish Oil (EPA), Lean Body Mass and Weight 2013
     
  What is the effect of a dietary supplement containing fish oil on weight in adult oncology patients?

  • Conclusion
    Eight studies found that dietary supplements containing fish oil (actual consumption 0.77g to 6.0g of EPA per day), resulted in weight gain or weight stabilization in adult oncology patients with weight loss. Three other studies showed the same effect, but were not statistically significant. One study showed a positive effect for a subgroup of the population (GI cancer patients), but not for the total population. More research is needed to determine the optimal dose.
  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of a dietary supplement containing fish oil on weight in adult oncology patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bonatto SJ, Oliveira HH, Nunes EA, Pequito D, Iagher F, Coelho I, Naliwaiko K, Kryczyk M, Brito GA, Repka J, Sabóia LV, Fukujima G, Calder PC, Fernandes LC. Fish oil supplementation improves neutrophil function during cancer chemotherapy. Lipids. 2012; 47: 383-389.
      • Burns CP, Halabi S, Clamon G, et al:  Phase II study of high-dose fish oil capsules for patients with cancer-related cachexia.  A Cancer and Leukemia Group B study.  Cancer 2004;101:370-378.
      • Fearon KC, Barber MD, Moses AG, Ahmedzai SH, Taylor GS, Tisdale MJ, Murray GD. Double-blind, placebo-controlled, randomized study of eicosapentaenoic acid diester in patients with cancer cachexia. J Clin Oncol. 2006 Jul 20; 24(21): 3,401-3,407.
      •  Finocchiaro C, Segre O, Fadda M, Monge T, Scigliano M, Schena M, Tinivella M, Tiozzo E, Catalano MG, Pugliese M, Fortunati N, Aragno M, Muzio G, Maggiora M, Oraldi M, Canuto RA. Effect of n-3 fatty acids on patients with advanced lung cancer: A double-blind, placebo-controlled study. Br J Nutr. 2012; 108: 327-333.
      • Gogos GA, Ginopoulos P, Zoumbos NC, Apostolidou E, Kalfarentzos F. The Effect of Dietary Omega 3 Polyunsaturated Fatty Acids on T-Lymphocyte subsets of patients with solid tumors. Cancer Detection and Prevention. 1995; 19(5): 415-417.
      • Murphy RA, Mourtzakis M, Chu QS, Baracos VE, Reiman T, Mazurak VC. Nutritional intervention with fish oil provides a benefit over standard of care for weight and skeletal muscle mass in patients with nonsmall cell lung cancer receiving chemotherapy. Cancer. 2011 Apr 15; 117(8): 1,775-1,782. Epub 2011 Feb 28.
      • Persson C, Glimelius B, Rönnelid J, Nygren P. Impact of fish oil and melatonin on cachexia in patients with advanced gastrointestinal cancer: A randomized pilot study. Nutrition 2005;21:170-178. 
      • Pratt VC, Watanabe S, Bruera E, Mackey J, Clandinin MT, Baracos VE, Field CJ. Plasma and neutrophil fatty acid composition in advanced cancer patients and response to fish oil supplementation. Br J Cancer. 2002 Dec 2;87(12):1370-8.  
      • Silva Jde A, Trindade EB, Fabre ME, Menegotto VM, Gevaerd S, Buss Zda S, Frode TS. Fish oil supplement alters markers of inflammatory and nutritional status in colorectal cancer patients. Nutr Cancer. 2012; 64(2): 267-273. Epub 2012 Feb 1.
      • Taylor LA, Pletschen L, Arends J, Unger C, Massing U. Marine phospholipids: A promising new dietary approach to tumor associated weight loss. Support Care Cancer. 2010; 18: 159-170.
      • Wigmore SJ, Barber MD, Ross JA, Tisdale MJ, Fearon KCH.  Effect of oral eicosapentanoic acid on weight loss in patients with pancreatic cancer.  Nutr Cancer. 2000;36:177-84
      • Wigmore SJ, Ross JA, Falconer JS, Plester CE, Tisdale MJ, Carter DC, Fearon KC. The effect of polyunsaturated fatty acids on the progress of cachexia in patients with pancreatic cancer. Nutrition. 1996;12(1 Suppl):S27-30.
  • Search Plan and Results: ONC: Fish Oil (EPA), Lean Body Mass and Weight 2013
     
  What is the effect of medical food supplements (MFS) containing fish oil on lean body mass (LBM) in adult oncology patients?

  • Conclusion

    Seven studies found that medical food supplements containing fish oil (actual consumption 1.2g to 2.2g of EPA per day), resulted in improvement or preservation of lean body mass in adult oncology patients with weight loss. Two other studies showed the same effect, but were not statistically significant. More research is needed to determine the optimal dose.

     

    
     

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of medical food supplements (MFS) containing fish oil on lean body mass (LBM) in adult oncology patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Barber MD, McMillan DC, Preston T, Ross JA, Fearon KC. Metabolic response to feeding in weight-losing pancreatic cancer patients and its modulation by a fish-oil-enriched nutritional supplement. Clin Sci (Lond). 2000 Apr; 98(4): 389-399.
      • Barber MD, Ross JA, Voss AC, Tisdale MJ, Fearon KCH.  The effect of an oral nutritional supplement enriched with fish oil on weight-loss in patients with pancreatic cancer.  Br J Cancer. 1999;81:80-86.
      • Bauer J, Capra S, Battistuttab D, Davidson W, Ashe S. Compliance with nutrition prescription improves outcomes in patients with unresectable pancreatic cancer. Clinical Nutrition (2005) 24, 998 - 1004.
      • De Luis, D.A., Izaola, O., Aller, R., Cuellar, L., Terroba, M.C., Martin, T. A randomized clinical trial with two omega-3 fatty acid enhanced oral suplements in head and neck cancer ambulatory patients. Eur Rev Med Pharmacol Sci.  2008; 12: 177-181.
      • Fearon KCH, von Meyenfeldt MF, Moses AGW, van Geenen R, Roy A, Gouma DJ, Giacosa A, Van Gossum A, Bauer J, Barber MD, Aaronson NK, Voss AC, Tisdale MJ.  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.
      • Read JA, Beale PJ, Volker DH, Smith N, Childs A, Clarke SJ. 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. Support Care Cancer. 2007 Mar; 15(3): 301-307. Epub 2006 Oct 5.
      • Ryan AM, Reynolds JV, Healy L, Byrne M, Moore J, Brannelly N, McHugh A, McCormack D, Flood P. 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 Mar; 249(3): 355-363.
      • van der Meij BS, Langius JA, Smit EF, Spreeuwenberg MD, von Blomberg BM, Heijboer AC, Paul MA, van Leeuwen PA. 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, Oct; 140(10): 1,774-1,780. 
      • Weed HG, Ferguson ML, Gaff RL, Hustead DS, Nelson JL, Voss AC. Lean body mass gain in patients with head and neck squamous cell cancer treated perioperatively with a protein- and energy-dense nutritional supplement containing eicosapentaenoic acid. Head Neck. 2011 Jul; 33(7): 1,027-1,033. Epub 2010 Oct 21.  
  • Search Plan and Results: ONC: Fish Oil (EPA), Lean Body Mass and Weight 2013
     
  What is the effect of medical food supplements (MFS) containing fish oil on weight in adult oncology patients?

  • Conclusion
    Nine studies found that medical food supplements containing fish oil (actual consumption 1.2g to 2.2 g of EPA per day), resulted in weight gain or weight stabilization in adult oncology patients with weight loss. Two other studies showed the same effect, but were not statistically significant. More research is needed to determine the optimal dose.
  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of medical food supplements (MFS) containing fish oil on weight in adult oncology patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Barber MD, McMillan DC, Preston T, Ross JA, Fearon KC. Metabolic response to feeding in weight-losing pancreatic cancer patients and its modulation by a fish-oil-enriched nutritional supplement. Clin Sci (Lond). 2000 Apr; 98(4): 389-399.
      • Barber MD, Ross JA, Voss AC, Tisdale MJ, Fearon KCH.  The effect of an oral nutritional supplement enriched with fish oil on weight-loss in patients with pancreatic cancer.  Br J Cancer. 1999;81:80-86.
      • Bauer J, Capra S, Battistuttab D, Davidson W, Ashe S. Compliance with nutrition prescription improves outcomes in patients with unresectable pancreatic cancer. Clinical Nutrition (2005) 24, 998 - 1004.
      • De Luis, D.A., Izaola, O., Aller, R., Cuellar, L., Terroba, M.C., Martin, T. A randomized clinical trial with two omega-3 fatty acid enhanced oral suplements in head and neck cancer ambulatory patients. Eur Rev Med Pharmacol Sci.  2008; 12: 177-181.
      • de Luis DA, Izaola O, Aller R, Cuellar L, Terroba MC. A randomized clinical trial with oral Immunonutrition (omega 3-enhanced formula vs. arginine-enhanced formula) in ambulatory head and neck cancer patients. Ann Nutr Metab. 2005 Mar-Apr;49(2):95-9.
      • Fearon KCH, von Meyenfeldt MF, Moses AGW, van Geenen R, Roy A, Gouma DJ, Giacosa A, Van Gossum A, Bauer J, Barber MD, Aaronson NK, Voss AC, Tisdale MJ.  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.
      • Guarcello M, Riso S, Buosi R, d’Andrea F. EPA-enriched oral nutritional support in patients with lung cancer: Effects on nutritional status and quality of life. Nutr Ther Metab. 2007; 25: 25-30.
      • Jatoi A, Rowland, K, Loprinzi CL, et al. An eicosapentaenoic acid supplement versus megestrol acetate versus both fro patients with cancer-assoicated wasting:  A North Central Cancer Treatment Group and National Cancer Institute of Canada collaborative effort.  J Clin Oncol 2004;22:2469-2476.
      • Read JA, Beale PJ, Volker DH, Smith N, Childs A, Clarke SJ. 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. Support Care Cancer. 2007 Mar; 15(3): 301-307. Epub 2006 Oct 5.
      • van der Meij BS, Langius JA, Smit EF, Spreeuwenberg MD, von Blomberg BM, Heijboer AC, Paul MA, van Leeuwen PA. 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, Oct; 140(10): 1,774-1,780. 
      • Weed HG, Ferguson ML, Gaff RL, Hustead DS, Nelson JL, Voss AC. Lean body mass gain in patients with head and neck squamous cell cancer treated perioperatively with a protein- and energy-dense nutritional supplement containing eicosapentaenoic acid. Head Neck. 2011 Jul; 33(7): 1,027-1,033. Epub 2010 Oct 21.  
  • Search Plan and Results: ONC: Fish Oil (EPA), Lean Body Mass and Weight 2013