By: Talking Nutrition Editors
Want to learn more about the latest science behind nutritional lipids? Download our new whitepaper to learn how EPA and DHA lipids can enable manufacturers to develop concept-led medical nutrition solutions.
Life expectancy is rising worldwide, leading to a higher prevalence of age and lifestyle-related non-communicable diseases (NCDs) and an increasing number of patients and older people presenting with complex medical needs. Optimal nutritional care is essential for these individuals as it helps to support healthy immune function, reduce medical complications and promote the recovery and independence of patients. However, disease-related malnutrition – a condition characterized by inadequate intake of energy, protein and/or micronutrients resulting from disease or treatment of disease – is common in many clinical conditions and can lead to poorer prognosis. As such, medical nutrition products – like oral nutritional supplements or enteral nutrition – may be required to address nutritional deficiencies in vulnerable patients, giving them the best possible clinical outcomes.
A newly published paper explores the mounting body of scientific evidence linking eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake to patient health and how these ingredients support older persons and patients1. With the available research, the expert panel concluded that provision of oral nutritional supplements, or enteral and parenteral formulas containing EPA and DHA may help to support a number of patient populations in a variety of therapeutic areas.
Here, we highlight the key conclusions and scientific insights published in the paper.
Chronic inflammation is usually present in individuals with NCDs. Supporting the resolution of inflammation and ensuring it is properly regulated in the body is therefore considered to be appropriate in the management of disease. The long-chain omega-3 fatty acids, EPA and DHA, are known to play a role in human health and normal immune function, with one of their primary actions being to reduce inflammation and promote its resolution.1,2,3 Research shows that this broad action helps to reduce medical complications and support the nutritional needs of patients in many different therapeutic areas.4,5,6,7 In the new publication, the expert panel identified a role for EPA and DHA nutrition in a number of patient populations and medical conditions, including cognitive health, age-related decline in muscle mass, cancer, surgical patients and critically ill patients.8,9,10 As a result, adequate supply of long-chain omega-3 fatty acids should be seen as a critical component in the nutritional management of patients presenting with these conditions.
Despite the promising findings shared here, the currently available research is limited and inconsistent, due to variations in dosage, timing and duration of supplementations, baseline nutritional status, clinical state and medication use. For example, it is increasingly recognized that multimodal interventions are most promising for the therapy of cancer cachexia, yet most of the clinical evidence is derived from trials using only a single therapy. Likewise, it is evident that DHA and EPA play a role in perioperative immunonutrition, but more well-designed trials could provide clearer evidence for their use and confirm the optimal timing and duration. This emphasizes the need for better controlled intervention studies that will help to further define the benefits of EPA and DHA in specific patient groups and inspire the development of more personalized and effective medical nutrition products. Moreover, continued patient insights are critical in the educating medical nutrition community about the latest patient preferences so that they can manufacture more palatable and appealing medical nutrition products.
1. Troesch B et al. Expert opinion on benefits of long-chain omega-3 fatty acids (DHA and EPA) in aging and clinical nutrition. Nutrients 2020;12:2555.
2. Calder PC. Marine omega-3 fatty acids and inflammatory processes: Effects, mechanisms and clinical relevance. Biochim Biophys Acta 2015;1851:469-84.
3. Calder PC. Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans 2017;45:1105-15.
4. Barnig C, Bezema T, Calder PC, et al. Activation of Resolution Pathways to Prevent and Fight Chronic Inflammation: Lessons From Asthma and Inflammatory Bowel Disease. Front Immunol 2019;10:1699.
5. Calder PC. Marine omega-3 fatty acids and inflammatory processes: Effects, mechanisms and clinical relevance. Biochim Biophys Acta 2015;1851:469-84.
6. Molfino A, Amabile MI, Monti M, Muscaritoli M. Omega-3 Polyunsaturated Fatty Acids in Critical Illness: Anti-Inflammatory, Proresolving, or Both? Oxid Med Cell Longev 2017;2017:5987082.
7. Manzanares W, Langlois PL, Hardy G. Intravenous lipid emulsions in the critically ill: an update. Curr Opin Crit Care 2016;22:308-15.
8. Serhan CN, Hong S, Gronert K, et al. Resolvins: a family of bioactive products of omega-3 fatty acid transformation circuits initiated by aspirin treatment that counter proinflammation signals. J Exp Med 2002;196:1025-37.
9. Calder PC. Intravenous Lipid Emulsions to Deliver Bioactive Omega-3 Fatty Acids for Improved Patient Outcomes. Mar Drugs 2019;17.
10. Innes JK, Calder PC. Marine Omega-3 (N-3) Fatty Acids for Cardiovascular Health: An Update for 2020. International Journal of Molecular Sciences 2020;21:1362.
11. Calder PC. Omega-3 (n-3) polyunsaturated fatty acids and inflammation: From membrane to nucleus and from bench to bedside. Proceedings of the Nutrition Society in press.
12. Dementia statistics. (Accessed 04 May, 2020, at https://www.alz.co.uk/research/statistics.)
13. Alex A, Abbott KA, McEvoy M, Schofield PW, Garg ML. Long-chain omega-3 polyunsaturated fatty acids and cognitive decline in non-demented adults: A systematic review and meta-analysis. Nutr. Rev. 2019;78:563–578.
14. Witte AV, Kerti L, Hermannstädter HM, Fiebach JB, Schreiber SJ, Schuchardt JP, Hahn A, Flöel A. Long-chain omega-3 fatty acids improve brain function and structure in older adults. Cereb.Cortex, 2014;24:3059–3068.
15. Yassine HN, Braskie MN, Mack WJ, Castor KJ, Fonteh AN, Schneider LS, Harrington MG, Chui HC. Association of docosahexaenoic acid supplementation with Alzheimer disease stage in apolipoprotein e epsilon4 carriers: A review. JAMA Neurol. 2017;74:339–347.
16. Zhang Y, Chen J, Qiu J, Li Y, Wang J, Jiao J. Intakes of fish and polyunsaturated fatty acids and mild-to-severe cognitive impairment risks: a dose-response meta-analysis of 21 cohort studies. Am J Clin Nutr 2016;103:330-40.
17. Köbe T, Witte AV, Schnelle A, et al. Combined omega-3 fatty acids, aerobic exercise and cognitive stimulation prevents decline in gray matter volume of the frontal, parietal and cingulate cortex in patients with mild cognitive impairment. NeuroImage 2016;131:226-38.
18. Bo Y, Zhang X, Wang Y, et al. The n-3 Polyunsaturated Fatty Acids Supplementation Improved the Cognitive Function in the Chinese Elderly with Mild Cognitive Impairment: A Double-Blind Randomized Controlled Trial. Nutrients 2017;9:54.
19. Zhang YP, Miao R, Li Q, Wu T, Ma F. Effects of DHA Supplementation on Hippocampal Volume and Cognitive Function in Older Adults with Mild Cognitive Impairment: A 12-Month Randomized, Double-Blind, Placebo-Controlled Trial. J Alzheimers Dis 2017;55:497-507.
20. Zhang YP, Lou Y, Hu J, Miao R, Ma F. DHA supplementation improves cognitive function via enhancing Aβ-mediated autophagy in Chinese elderly with mild cognitive impairment: a randomised placebo-controlled trial. J Neurol Neurosurg Psychiatry 2018;89:382-8.
21. Canhada S, Castro K, Perry IS, Luft VC. Omega-3 fatty acids' supplementation in Alzheimer's disease: A systematic review. Nutr Neurosci 2018;21:529-38.
22. Rémond D, Shahar DR, Gille D, et al. Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition. Oncotarget 2015;6:13858-98.
23. Ligthart-Melis GC, Luiking YC, Kakourou A, Cederholm T, Maier AB, de van der Schueren MAE. Frailty, Sarcopenia, and Malnutrition Frequently (Co-)occur in Hospitalized Older Adults: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2020.
24. Landi F, Calvani R, Tosato M, et al. Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments. Nutrients 2016;8:69.
25. Calder PC, Bosco N, Bourdet-Sicard R, et al. Health relevance of the modification of low grade inflammation in ageing (inflammageing) and the role of nutrition. Ageing Research Reviews 2017;40:95-119.
26. Smith GI, Julliand S, Reeds DN, Sinacore DR, Klein S, Mittendorfer B. Fish oil-derived n-3 PUFA therapy increases muscle mass and function in healthy older adults. Am J Clin Nutr 2015;102:115-22.
27. Dupont J, Dedeyne L, Dalle S, Koppo K, Gielen E. The role of omega-3 in the prevention and treatment of sarcopenia. Aging clinical and experimental research 2019.
28. Ross PJ, Ashley S, Norton A, et al. Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? Br J Cancer 2004;90:1905-11.
29. Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. The Lancet Oncology 2008;9:629-35.
30. Antoun S, Baracos VE, Birdsell L, Escudier B, Sawyer MB. Low body mass index and sarcopenia associated with dose-limiting toxicity of sorafenib in patients with renal cell carcinoma. Ann Oncol 2010;21:1594-8.
31. Prado CM, Baracos VE, McCargar LJ, et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res 2007;13:3264-8.
32. Prado CM, Baracos VE, McCargar LJ, et al. Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res 2009;15:2920-6.
33. Barret M, Antoun S, Dalban C, et al. Sarcopenia is linked to treatment toxicity in patients with metastatic colorectal cancer. Nutr Cancer 2014;66:583-9.
34. Arends J, Baracos V, Bertz H, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clinical nutrition (Edinburgh, Scotland) 2017;36:1187-96.
35. Klassen P, Cervantes M, Mazurak VC. N - 3 fatty acids during chemotherapy: toward a higher level of evidence for clinical application. Current opinion in clinical nutrition and metabolic care 2020;23:82-8.
36. Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition 2017;36:11-48.
37. de van der Schueren MAE, Laviano A, Blanchard H, Jourdan M, Arends J, Baracos VE. Systematic review and meta-analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials. Annals of Oncology 2018;29:1141-53.
38. Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition 2017;36:11-48.
39. Weinmann et al, ESPEN guidelines, 2017.g. 2555, 2020.