New research published in the March 2009 issue of Annals of Surgery points to a potentially significant advance in the treatment of patients undergoing major cancer surgery. A randomized controlled trial showed that oral nutritional supplements with omega-3 fatty acids resulted in the preservation of muscle mass in patients undergoing surgery for esophageal cancer, a procedure normally associated with significant weight loss and quality-of-life issues.
The lead investigators of the study were John V. Reynolds, professor of surgery at Trinity College Dublin, and Aoife Ryan, assistant professor of nutrition at New York University’s Steinhardt School of Culture, Education, and Human Development*.
Omega 3 fats are essential fats found naturally in oily fish. Recently food manufacturers have begun to add omega 3 to foods such as yogurt, milk, juice, eggs, and infant formula in light of a body of scientific evidence which suggests that they reduce cardiovascular disease risk, reduce blood pressure, reduce clot formations, and reduce certain types of fat in the blood.
Given these health benefits, the researchers were interested to see whether omega 3 supplements could reduce post-operative weight loss among esophageal cancer patients. Previous studies had found that nutritional supplements containing one form of omega 3 fat, eicosapentaenoic acid (EPA), significantly reduced weight loss among inoperable cancer patients. Researchers hypothesized that a nutritional supplement rich in calories and a high dose of EPA would stem the debilitating weight loss seen in patients following esophageal surgery.
In a double-blinded randomized control trial, the gold standard in medical research, patients awaiting esophagectomy surgery were randomly assigned to treatment and control groups. While both groups received a 240ml nutritional supplement twice daily starting five days before surgery (which was identical in calories, protein, micronutrients, and flavor), patients in the treatment group received an enriched formula with omega 3 (2.2 gram EPA/day).
Immediately following surgery, the supplement was given through a feeding tube for 14 days while patients recovered in hospital. Once patients could resume oral feeding, they continued drinking the supplement until 21 days post surgery.
The researchers, working at St. James Hospital and Trinity College Dublin, found that patients given the standard feed (without EPA) suffered clinically severe weight loss post-surgery which was all muscle mass, while patients in the treatment group maintained all aspects of their body composition following surgery. Omega-3 fed patients also had better immune function, lower risk of fever post op, and significantly reduced levels of inflammatory markers in their blood.
“The results are intriguing, no previous study of nutritional support in the peri-operative period has revealed such a benefit,” said Ryan.
An accompanying editorial in the journal noted that Ryan’s study “is a significant step forward” in the management of patients undergoing surgery for esophageal and perhaps other complex cancers. “[Omega 3 based nutrition] should no longer be a surgeon’s preference, but the standard of expected norm for the practice of elected complex GI cancer surgery.”
Using specialized nutritional feeds with a highly purified form of EPA, the researchers were able to administer a dose of omega 3 that was much higher than that typically found in food. They noted that treatment with omega 3 enriched supplement is only slightly more expensive than traditional nutritional therapy, and previous studies have yielded significant cost-savings in the form of fewer complications following surgery using immuno-nutrition feeds similar to this.
“Initial treatments like this may be cost-effective for our cash-strapped health care system,” said Ryan.
Commenting on the study Reynolds noted “omega 3 enriched-nutrition appears to prevent the loss of muscle mass by modulating the body’s inflammatory response following surgery. Future studies on the health benefits of EPA supplements in cancer patients should be conducted to determine whether such approaches improve quality of life, reduce complications, and improve patient outcomes, not only after surgery but also through long and complex treatment programs which may include chemotherapy and radiation therapy in addition to surgery. We can speculate moreover that the findings of the study are not unique to cancer and that potential benefits should be explored in trial in patients following major non-cancer surgery, such as liver transplantation, cardiac surgery, and neurosurgery.”
* Aoife Ryan was previously a research dietitian at Trinity College Dublin and St. James’s Hospital where she completed this study as part of her Ph.D. thesis prior to her appointment at NYU. For more information, a copy of the study, or to schedule an interview with Aoife Ryan, please contact Tim Farrell, 212.998.6796 or tim.farrell@nyu.edu.