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Human Nutrition and Metabolism

Fish Oil–Enriched Nutritional Supplement Attenuates Progression of the Acute-Phase Response in Weight-Losing Patients with Advanced Pancreatic Cancer^{1 ,2}

Matthew D. Barber, James A. Ross, Tom Preston^*, Alan Shenkin and Kenneth C. H. Fearon³

University Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh EH3 9YW, United Kingdom, ^* Isotope Biochemistry Laboratory, Scottish Universities Research and Reactor Centre, East Kilbride G75 0QF, United Kingdom and Department of Clinical Chemistry, University of Liverpool L69 3BX, United Kingdom

³To whom correspondence should be addressed.

The presence of an acute-phase protein response (APPR) has been suggested to shorten survival and contribute to weight loss in patients with pancreatic cancer. Fatty acids derived from fish oil have been shown to alter proinflammatory cytokine production and acute-phase protein synthesis in vitro. The present study was designed to determine the effects of a fish oil–enriched nutritional supplement on the concentrations of a range of individual acute-phase proteins (APP) in patients with advanced pancreatic cancer. In a sequential series, 18 patients with pancreatic cancer received the supplement (providing 2 g eicosapentaenoic acid and 1 g docosahexaenoic acid/d) for 3 wk while another 18 received full supportive care alone. Six healthy subjects served as additional controls. Acute-phase proteins were measured before and after the 3-wk intervention period in cancer patients. At baseline, albumin, transferrin and pre-albumin were significantly reduced and fibrinogen, haptoglobin, -1-acid glycoprotein, -1-antitrypsin, ceruloplasmin and C-reactive protein (CRP) were significantly elevated in the cancer patients compared with healthy controls, reflecting their roles as negative and positive acute phase proteins, respectively. In the supplemented cancer group, the only significant change in APP concentrations over the 4-wk study period was an increase in transferrin. In the control cancer group there were further significant reductions in albumin, transferrin and pre-albumin, and a significant increase in CRP concentration. These results suggest that many positive and negative APP are altered in advanced pancreatic cancer. The APPR tends to progress in untreated patients but may be stabilized by the administration of a fish oil–enriched nutritional supplement. This may have implications for reducing wasting in such patients.

KEY WORDS: • cancer cachexia • acute-phase protein response • fish oil • eicosapentaenoic acid • humans

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