Faber Joyce, Uitdehaag Madeleen J, Spaander Manon, van Steenbergen-Langeveld Sabine, Vos Paul, Berkhout Marloes, Lamers Cor, Rümke Hans, Tilanus Hugo, Siersema Peter, van Helvoort Ardy, van der Gaast Ate
Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands.
Department of Pharmacology & Pathophysiology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
J Cachexia Sarcopenia Muscle. 2015 Mar;6(1):32-44. doi: 10.1002/jcsm.12009. Epub 2015 Mar 31.
The majority of cancer patients loses weight and becomes malnourished during the course of their disease. Metabolic alterations and reduced immune competence lead to wasting and an increased risk of infectious complications. In the present study, the effect of a nutritionally complete medical food, which is high in protein and leucine and enriched with fish oil and specific oligosaccharides, was investigated on immune function, nutritional status, and inflammation in patients with esophageal cancer and compared with routine care.
In this exploratory double-blind study, 64 newly diagnosed esophageal cancer patients were randomized. All patients received dietary counselling and dietary advice. In the Active group, all patients received the specific medical food for 4 weeks before the start of anticancer therapy. In the routine care control arm, patients with <5% weight loss received a non-caloric placebo product, and patients with weight loss ≥5% received an iso-caloric control product to secure blinding of the study. The required study parameters of body weight and performance status were recorded at baseline and after 4 weeks of nutritional intervention, and patients were asked to complete quality of life questionnaires. In addition, blood samples were taken for the measurement of several immune, nutritional, and safety-parameters.
No effect of the specific nutritional intervention could be detected on ex vivo stimulations of blood mononuclear cells. By contrast, body weight was significantly increased (P < 0.05) and ECOG performance status was improved after intervention with the specific medical food (P < 0.05). In addition, serum Prostaglandin E2 (PGE2) levels were significantly decreased in the specific medical food group and increased in the control group (P = 0.002).
Nutritional intervention with the specific medical food significantly increased body weight and improved performance status compared with routine care in newly diagnosed esophageal cancer patients. This effect was accompanied by significantly reduced serum PGE2 levels.
大多数癌症患者在疾病过程中会体重减轻并出现营养不良。代谢改变和免疫能力下降会导致消瘦以及感染并发症风险增加。在本研究中，研究了一种营养全面、富含蛋白质和亮氨酸并添加了鱼油和特定低聚糖的医用食品对食管癌患者免疫功能、营养状况和炎症的影响，并与常规护理进行了比较。
在这项探索性双盲研究中，64例新诊断的食管癌患者被随机分组。所有患者均接受饮食咨询和饮食建议。在活性组中，所有患者在抗癌治疗开始前4周接受特定的医用食品。在常规护理对照组中，体重减轻<5%的患者接受无热量安慰剂产品，体重减轻≥5%的患者接受等热量对照产品以确保研究的盲法。在基线和营养干预4周后记录体重和体能状态等所需研究参数，并要求患者完成生活质量问卷。此外，采集血样以测量多种免疫、营养和安全性参数。
在体外刺激血液单核细胞方面未检测到特定营养干预的效果。相比之下，特定医用食品干预后体重显著增加（P<0.05），ECOG体能状态得到改善（P<0.05）。此外，特定医用食品组血清前列腺素E2（PGE2）水平显著降低，而对照组升高（P=0.002）。
与新诊断食管癌患者的常规护理相比，特定医用食品的营养干预显著增加了体重并改善了体能状态。这种效果伴随着血清PGE2水平的显著降低。
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