Abstracts
1998 Digestive Disease Week

#1027

THE EFFECT OF AN EICOSAPENTAENOIC ACID-ENRICHED NUTRITIONAL SUPPLEMENT IN WEIGHT-LOSING PATIENTS WITH ADVANCED PANCREATIC CANCER. M.D. Barber, J.A. Ross, K.C.H. Fearon, A.C. Voss Royal Infirmary, Edinburgh, Scotland, UK.

We have demonstrated previously that oral eicosapentaenoic acid (EPA) supplementation can attenuate but not reverse the cachectic state in patients with advanced pancreatic cancer and have suggested that this is due to down-regulation of the pro-inflammatory response and modulation of the end-organ response to tumor-specific cachectic factors. The aim of the present study was to determine if an EPA-containing nutritional supplement might lead to reversal of the cachectic state seen in these patients. At least four weeks after surgical intervention or bile duct stenting, 20 patients with a histological or unequivocal operative diagnosis of unresectable pancreatic adenocarcinoma were asked to consume 2 8-ounce servings of an EPA-enriched nutritional supplement daily in addition to their normal food intake. Each serving contained 310kcal, 16.1g protein and 1.09g EPA. Weight, body composition, dietary intake, resting energy expenditure (REE), performance status and quality of life were measured at baseline and after 3 weeks. Weight, body composition and performance status were measured monthly thereafter. Three patients experienced worsening or development of steatorrhea which may have been part of their disease progression. Otherwise no intervention-related adverse events were observed. Patients consumed a median of 1.9 servings/day. All patients were losing weight at baseline at a median rate of 3.2kg/month (interquartile range 4.4-1.9). After administration of the EPA-enriched supplement patients had significant weight-gain at 3 (median 1kg (0-2), p=0.024) and 7 weeks (median 2.5kg (0.1-4.6), p=0.028). There was a significant gain in lean body mass and no change in fat mass after 3 and 7 weeks. Dietary intake increased significantly by more than 300kcal/day (p=0.04). While overall REE remained unchanged, REE per kg body weight and per kg lean body mass fell significantly. Quality of life remained stable and there were trends to improvement particularly in functional measures. Performance status was significantly improved at 3 and 7 weeks (p<0.05). Whereas previous studies of conventional nutritional supplements in weight-losing cancer patients show no benefit, this study suggests that an EPA-enriched supplement may reverse cachexia in advanced pancretic cancer.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.