Impacto da suplementação com ômega-3 no estado nutricional, perfil imunológico e inflamatório de pacientes com câncer gástrico

Abstract

In recent decades, cancer has become a public health problem, and gastric cancer is one of the cancer types with the worst prognosis. The signs and symptoms present in the cancer patient can compromise nutritional status, leading to weight loss and malnutrition. The inflammatory response, present in these patients, associated with increased energy expenditure, anorexia and weight loss, may lead to cachexia. Nutritional intervention and the use of pre-treatment supplements in cancer patients are beneficial as they increase dietary intake and prevent unintentional weight loss. Clinical trials have shown that supplementation with omega-3 fatty acids attenuates the inflammatory response and improves nutritional status, decreasing weight loss in cancer patients. The objective of the present study was to evaluate the effect of nutritional intervention during antineoplastic pre-treatment with supplements containing omega-3 fatty acid on nutritional status, inflammatory and immune profile of gastric cancer patients. This is a randomized, open and controlled study with intervention in patients with gastric cancer from the Nutrition Outpatient Clinic of the Hospital do Câncer I (HCI) of the National Cancer Institute José Alencar Gomes da Silva (INCA). The selected patients were evaluated according to nutritional status (through anthropometric data such as weight, height, mid-upper arm circumference, triceps skin fold, mid-arm muscle circumference, mid-arm muscle area, skeletal muscle mass index and electrical bioimpedance, as well as Patient-Generated Subjective Global Assessment-PG-SGA) the inflammatory and immune profile, by quantifying the concentrations of interleukin 6, C-reactive protein and CD4 and CD8 lymphocytes, respectively. After the initial characterization and before the start of the antineoplastic treatment, the patients were randomized into two groups, where one group received 2 stages of liquid supplementation with 3.5g of omega-3 (EPA / DHA) (intervention group), with 560kcal and 29g protein / day, and the other group received 2 steps of a non-omega-3 (control group) liquid supplement with 600kcal and 24g protein / day for 30 days. After this period, the patients were again submitted to nutritional status, inflammatory and immune profile evaluation. The primary endpoint evaluated was weight gain, and the secondary outcomes were lean mass gain and reduction of pro-inflammatory cytokines. The data were analyzed using the statistical software SPSS 17.0. A total of 68 patients were included, 34 in each group. In the intervention group, an inflammatory parameters maintenance and nutritional status and weight gain were observed, with statistical significance. In the control group, an increase in inflammatory parameters such as interleukin 6 and C-reactive protein was observed, as well as worsening lean muscle mass parameters, such as mid-arm muscle area and mid-arm muscle circumference. There was also improvement in nutritional intake and reduction of PG-SGA score in both groups. It is concluded that omega-3 supplementation is beneficial for the inflammatory profile and promotes weight gain in these patients, but further studies are needed to prove this result, as well as the recommended amount of omega-3 for effects beneficial.