Metabolic Response to Feeding in Weight-Losing Pancreatic Cancer

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Metabolic Response to Feeding in Weight-Losing Pancreatic Cancer

Patients and its Modulation by a Fish-Oil-Enriched Nutritional

Supplement.

 

Author:

 

Barber MD, McMillan DC, Preston T, Ross JA, Fearon KC

 

Source:

 

Clin Sci (Colch). 2000;98(4):389-399.

http://www.enzy.com/abstracts/display.asp?id=2716

Abstract:

 

Weight-losing patients with advanced cancer often fail to gain

weight with conventional nutritional support. This suboptimal

response might be explained, in part, by an increased metabolic

response to feeding. It has been suggested that eicosapentaenoic

acid (EPA) can modify beneficially the metabolic response to cancer.

 

The aim of the present study was to examine the metabolic response

to feeding in cancer and the effects of an EPA-enriched oral food

supplement on this response. A total of 16 weight-losing, non-

diabetic patients with unresectable pancreatic adenocarcinoma and

six healthy, weight-stable controls were studied by indirect

calorimetry in the fasting and fed states. Body composition was

estimated by bioimpedence analysis.

 

Cancer patients were then given

a fish-oil-enriched nutritional supplement providing 2 g of EPA and

2550 kJ daily, and underwent repeat metabolic study after 3 weeks of

such supplementation. At baseline, resting energy expenditure

whether expressed per kg body weight, lean body mass or body cell

mass was significantly greater in the cancer patients compared with

controls. Fat oxidation was significantly higher in the fasting

state in cancer patients [median 1.26 g.kg(-1).min(-1)(interquartile

range 0.95-1.38)] than in controls [0.76 g.kg(-1). min(-1)(0.62-

0.92);P<0.05]. Over the 4 h feeding period, changes in insulin and

glucose concentrations in cancer patients suggested relative glucose

intolerance. In response to oral meal feeding, the percentage change

in the area under the curve of energy expenditure was significantly

lower in the cancer patients [median 7.9%(interquartile range 3.4-

9.0)] than in controls [12.6%(9.9-15.1);P<0.01].

 

After 3 weeks of

the EPA-enriched supplement, the body weight of the cancer patients

had increased and the energy expenditure in response to feeding had

risen significantly [9.6%(6.3-12.4)], such that it was no different

from baseline healthy control values.

 

Similarly, fasting fat

oxidation fell to 1.02 g.kg(-1).min(-1)(0.8-1.18), again no longer

significantly different from baseline healthy control values. While

weight-losing patients with advanced pancreatic cancer have an

increased resting energy expenditure and increased fat oxidation,

the energy cost of feeding is, in fact, reduced.

 

Provision of a fish-

oil-enriched nutritional supplement results in some normalization of

the metabolic response in both the fasted and fed states, in

association with an improvement in nutritional status.