Nutrition Bytes

OBJECTIVE: Cachexia is a nutrient deficient condition affecting millions of cancer patients. Cancers of the upper gastrointestinal tract, head and neck are often the most severely affected. Currently, there is no established therapy for cachexia, although several potential anti-cachectic agents are being explored. A meta-analysis was conducted to review the effect of eicosapentaenoic acid (EPA) enriched enteral nutrition on lean body mass (LBM) in esophageal, head and neck cancer patients at risk for progression of cachexia.

METHODS: An evidence based review was conducted beginning with a Pubmed database literature search using the terms ‘EPA esophageal cancer’, ‘Eicosapentaenoic acid esophageal cachexia’, ‘Eicosapentaenoic acid esophageal’, ‘Eicosapentaenoic acid cachexia head and neck cancer’, and ‘EPA cachexia head and neck cancer’ for human clinical trials. The results were reviewed for relevance and the data from original research was abstracted for amount of EPA enriched formula supplemented, EPA intake, method of intake, LBM measurements, study design, intervention duration, and population characteristics.

RESULTS: Three trials were identified that met the criteria and were reviewed.  EPA supplementation in enteral nutrition was provided at concentrations ranging between 1.6 g/day and 2.2 g/day for a time span ranging between 3 weeks and 14 weeks. Two randomized clinical trials showed maintenance of > 1.5 kg LBM relative to the control group while a single arm trial showed a gain of 3.2 kg LBM in patients. Differences in results could be attributed to variability in the degree of cachexia, the contents of each enteral nutrition formula, duration of supplementation, and cancer treatments that subjects in each trial were undergoing.

CONCLUSIONS: All three trials showed a trend in EPA enriched enteral nutrition improving the loss of LBM in esophageal, head and neck cancer patients at risk for cachexia progression. This type of formula should therefore be considered in treatment of these types of cancers and possibly, in the treatment of other seriously ill patients with cachexia.