癌症患者补充鱼油。胶囊或营养饮料补充剂？一项依从性的对照研究。

Fish oil supplementation in cancer patients. Capsules or nutritional drink supplements? A controlled study of compliance.

机构信息

Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958 Frederiksberg C, Denmark.

出版信息

Clin Nutr ESPEN. 2020 Feb;35:63-68. doi: 10.1016/j.clnesp.2019.12.004. Epub 2020 Jan 3.

DOI:10.1016/j.clnesp.2019.12.004

PMID:31987122

Abstract

BACKGROUND & AIMS: Fish-oil, rich in Omega-3 long chain polyunsaturated fatty acids (n-3 LC PUFAs), may in high doses inhibit the development or progression of cancer cachexia. However, poor compliance to oral nutritional supplements is a well-known problem. We aimed to investigate acceptability and compliance to a nutritional drink with fish-oil compared to an equivalent dose of fish-oil administered as capsules in patients receiving chemotherapy for GI tract cancers. Moreover, we aimed to investigate, if there was a difference between a nutritional drink or capsules with respect to nutritional status and side effects. Finally, we aimed to examine, if n-3 LC PUFAs affect leukocyte and platelet counts, and markers of dose-limiting toxicities of chemotherapy.

METHODS

We consecutively included 41 patients with advanced cancer in the controlled study. Patients were allocated (not randomized) to ingest either 10 capsules/day for four weeks or 400 mL/day of a nutritional drink with same dose of n-3 LC PUFA dose. Compliance was assessed by daily self-registration and n-3 LC PUFAs in whole blood. Side effects were assessed by 10 cm visual analog scales.

RESULTS

Compliance and daily consumption of n-3 LC PUFAs were 96.4% (94.1-99.3) and 4.8 (4.7-4.9) g/day in the capsule group and 80.8 (55.4-93.6) % and 4.0 (2.8-4.7) g/day in the group, respectively (p ≤ 0.02). We found no differences between the groups with respect to changes in whole blood n-3 LC PUFAs, weight, nutritional status, acceptability or side effects. However, in the capsule group the whole blood n-3 LC PUFAs correlated negatively with the increase in nausea (r = -0.39, p = 0.05), but not in the nutritional drink group. Nausea, reduced appetite and loose stools were of greatest importance for the deviations from recommended doses. The number of capsules had a negative impact on acceptability and compliance, whereas this was mainly related to taste and texture in the nutritional drink group. No changes in median thrombocyte or leukocyte blood counts were observed.

CONCLUSIONS

Fish oil in capsules appeared to result in better compliance compared to a nutritional drink with an equivalent dose of n-3 LC PUFAs. However, capsules and the drink did not differ with respect to the effect on nutritional status or side effects. TRIAL REGISTRATION CLINICALTRIALS.

GOV IDENTIFIER

NCT03751384.

摘要

背景与目的

富含欧米伽-3 长链多不饱和脂肪酸（n-3 LC PUFAs）的鱼油，可能会在高剂量下抑制癌症恶病质的发展或进展。然而，口服营养补充剂的依从性差是一个众所周知的问题。我们旨在调查在接受胃肠道癌症化疗的患者中，与口服鱼油胶囊相比，鱼油营养饮料的接受度和依从性，以及鱼油营养饮料或胶囊在营养状况和副作用方面是否存在差异。最后，我们旨在检查 n-3 LC PUFAs 是否会影响白细胞和血小板计数，以及化疗剂量限制毒性的标志物。

方法

我们连续纳入了 41 名晚期癌症患者进行对照研究。患者被分配（非随机）每天摄入 10 粒胶囊，持续四周，或每天摄入 400 毫升含有相同 n-3 LC PUFAs 剂量的营养饮料。通过每日自我登记和全血中 n-3 LC PUFAs 来评估依从性。通过 10cm 视觉模拟量表评估副作用。

结果

胶囊组的依从性和每天摄入 n-3 LC PUFAs 分别为 96.4%（94.1-99.3）和 4.8（4.7-4.9）g/天，而饮料组分别为 80.8%（55.4-93.6）和 4.0（2.8-4.7）g/天（p≤0.02）。我们发现两组之间在全血 n-3 LC PUFAs、体重、营养状况、接受度或副作用方面均无差异。然而，在胶囊组中，全血 n-3 LC PUFAs 与恶心增加呈负相关（r=-0.39，p=0.05），而在营养饮料组中则无相关性。恶心、食欲下降和稀便对偏离推荐剂量的影响最大。胶囊数量对接受度和依从性有负面影响，而在营养饮料组中，这主要与口味和质地有关。血小板和白细胞的中位数血计数未发生变化。