New whitepaper highlights the benefits of lipids in medical nutrition
Talking Nutrition Editors
Research into medical nutrition
- Life expectancy is increasing on a global scale and the prevalence of age and lifestyle-related non-communicable diseases (NCDs) are on the rise. To address and manage nutritional shortfalls and physiological challenges associated with NCD, there is a growing need for targeted medical nutrition solutions.
- Emerging science indicates that omega-3 docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) intervention may support the management of specific medical needs.
- DSM’s newest whitepaper explores the latest science about omega-3 DHA and EPA in therapeutic areas including oncology, perioperative care and brain health, as well as the effects of these nutrients in the elderly population.
Increasing relevance of omega-3 DHA and EPA in medical nutrition
Omega-3 DHA and EPA are well-known to play a vital role in human health and overall wellbeing. They are one of the most studied nutrients in the world, with more than 36,000 scientific papers, including more than 4,000 human clinical trials, dedicated to their research1. Omega-3 DHA and EPA in particular, are essential in maintaining overall health throughout life. However, mounting scientific evidence now demonstrates that DHA and EPA may benefit patient outcomes in specific clinical settings, indicating that omega-3s could have a significant role in medical nutrition solutions. DSM addresses the latest findings in its new whitepaper, ‘Nutritional lipids in medical nutrition solutions’.
Four therapeutic areas where DHA and EPA intervention show most promise
Nutritional support is particularly critical for patients and senior adults as they are most vulnerable to risk of infection and disease. New research shows that omega-3 DHA and EPA could be important in managing the distinct nutritional needs of specific patient groups, helping to reduce medical complications, enhance patient outcomes, improve quality of life and lower healthcare costs worldwide. Here, we present the therapeutic areas where omega-3 intervention shows most promise:
1. Cancer cachexia
Although recent advancements in cancer research have greatly improved outcomes for patients, the frequent presence of malnutrition in cancer patients and unwanted weight and muscle loss – also known as cancer cachexia – can limit a patient’s response to treatment.2
Studies show that DHA and EPA’s anti-inflammatory properties may have an important role to play in cancer cachexia.3,4,5 Although results have varied, in some clinical settings, DHA and EPA have been shown to improve the immune response of some patients, helping to fight infection, improve the efficacy of cancer therapies and prevent cachexia progressing.6 Omega-3 intervention is therefore promising for cancer patients because it could promote better treatment outcomes and quality of life.
2. Pre- and post-surgery
Malnutrition is a serious risk factor for surgical complications as undernourished patients are more likely to experience longer hospital stays, increased risk of infection and higher mortality rates.7,8,9 Also known as immuno-nutrition, DHA and EPA supplementation pre- and post-surgery can help to reduce inflammation and risk of infection when provided in conjunction with arginine and nucleotides as well as various vitamins and trace minerals.10,11,12,13 Ultimately, this helps to improve wound healing, shorten recovery times and reduce the length of hospital stays.
Achieving adequate intake of essential nutrients becomes even more difficult as we age because of changing hormone levels, slower metabolism and decreased activity levels, leading to reduced energy requirements and nutritional frailty.14 Moreover, ‘anorexia of aging’ – which is defined by a decrease in appetite and/or food intake as we age – is a major contributing factor to malnutrition and negative health outcomes in older individuals.
Undernutrition in this population can lead to sarcopenia, an age-related degenerative loss of skeletal muscle mass, quality and function. Often this condition will impact a person’s quality of life and also increase the risk of mortality, emphasizing the need for medical nutrition solutions that aim to prevent or address sarcopenia.15,16 Recent research suggests that the anti-inflammatory effects of DHA and EPA, in combination with high quality protein and exercise, may be beneficial in mitigating the loss of muscle strength and physical performance associated with aging.17 For example, studies show that omega-3s can help by targeting the age-related low-grade inflammation that contributes to the development of sarcopenia. DHA and EPA may also modulate muscle protein and energy metabolism, promoting muscle strength and function.18
4. Cognitive health
Supporting cognitive health and the maintenance of mental wellbeing are some of the biggest healthcare challenges facing the aging population. And, with the number of people living with dementia expected to reach 152 million by 2050, the development of innovative medical nutrition solutions that will offer preventative care is critical.19,20,21 Based on observational studies, there is a clear link seen between DHA levels and brain health. Moreover, omega-3s are associated with decreased brain inflammation and brain support, suggesting the importance of including DHA and EPA in medical nutrition solutions that support brain health.22
Targeted nutritional solutions to meet healthcare needs
It is evident that the omega-3 DHA and EPA can help improve the quality of life and clinical outcomes of the specific patient groups outlined in this article. Recent research also indicates a promising role for DHA and EPA intervention in other clinical settings, including in patients with diabetes or chronic kidney disease.23,24 Each condition and individual patient present different and complex nutritional and clinical needs. And the development of personalized medical nutrition solutions that can be targeted to specific diseases, are appealing. Continuous work on an individual level is paramount for the future, more personalized treatment of patients. DSM is at the pulse of in-depth scientific advances and patient insights required to help improve our understanding of malnutrition in specific disease states and the impact of specific ingredients, such as omega-3 DHA and EPA, on patient outcomes.
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- GOED, 'About EPA and DHA' [website], https://goedomega3.com/about-epa-and-dha, accessed 11 December 2019.
- T. Aoyagi et al., ‘Cancer cachexia, mechanism and treatment’, World J Gastrointest Oncol., vol. 7, no. 4, pg. 17-29, 2015.
- R. Freitas et al., ‘Protective effects of omega-3 fatty acids in cancer-related complications’, Nutrients, vol. 11, no. 5, pg. 945, 2019.
- M. D. Barber et al., ‘Fish oil-enriched nutritional supplement attenuates progression of the acute-phase response in weight-losing patients with advanced pancreatic cancer’, J Nutr., vol. 21, pg. 1120-1125, 1999.
- P. Bougnoux et al., ‘Improving outcome of chemotherapy of metastatic breast cancer by docosahexanoic acid: a phase II trial’, Br J Cancer, vol. 101, no. 12, pg. 1978-1985, 2009.
- E. Bruera et al., ‘Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: a double-blind, placebo-controlled study’, J Clin Oncol., vol. 21, pg. 129-134, 2003.
- J. D. Williams et al., ‘Assessment of perioperative nutrition practices and attitudes – a national survey of colorectal and GI surgical oncology programs’, American Journal of Surgery, vol. 213, no. 6, pg. 1010-1018, 2016.
- S. Awad et al., ‘What’s new in perioperative nutritional support? Current opinion in anesthesiology’, Curr. Opin. Anaesthesiol, vol. 24, no. 3, pg. 339-348, 2011.
- T. Philipson et al., ‘Impact of oral nutritional supplementation on hospital outcomes’, American Journal of Managed Care, vol. 19, pg. 121-128, 2013.
- A. Weimann et al., ‘ESPEN guideline: clinical nutrition in surgery’, Clinical Nutrition, vol. 36, pg. 623-650, 2017.
- S. Bisch et al., ‘Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology’, Nutrients, vol. 11, no. 5, 2019.
- N. Johnson, ‘Enhanced recovery after surgery: the role of nutrition’, BSNA, no. 130, pg. 19-22, 2018.
- J. Xu et al., ‘Immunonutrition in surgical patients’, Curr Drug Targets, vol. 10, no. 8, pg. 771-777, 2009.
- D. Remond et al., ‘Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition’, Oncotarget, vol. 6, no. 16, pg. 13,858-98, 2015.
- J. Friedman et al., ‘Implications of sarcopenia in major surgery’, Nutr Clin Pract., vol. 30, no. 2, pg. 175-179, 2015.
- S. L. Bokshan et al., ‘Sarcopenia in orthopedic surgery’, Orthopedics, vol. 39, no. 2, pg. 295-300, 2016.
- J. Wang et al., 'Inflammation and age-associated skeletal muscle deterioration (sarcopenia)', Journal of Orthopaedic Translation, vol. 10, pg. 94-101, 2017.
- J. Dupont et al., ‘The role of omega-3 in the prevention and treatment of sarcopenia’, Aging Clin Exp Res., vol. 31, no. 6, pg. 825-836, 2019.
- WHO, Dementia factsheet, https://www.who.int/news-room/fact-sheets/detail/dementia, accessed 19 September 2019.
- S. Canhada et al., ‘Omega-3 fatty acids’ supplementation in Alzheimer’s disease: a systematic review’, Nutr. Neurosci., vol. 21, no. 8, pg. 529-538, 2018.
- Y. Zhang et al., ‘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., vol. 103, no. 2, pg. 330-340, 2016.
- C. Janssen et al., ‘Long-chain polyunsaturated fatty acids (LCPUFA) from genesis to senescence: the influence of LCPUFA on neural development, aging and neurodegeneration’, Prog. Lipid Res., vol. 53, pg. 1-17, 2014.
- J. Hu et al., ‘Omega-3 fatty acid supplementation as an adjunctive therapy in the treatment of chronic kidney disease: a meta-analysis’, Clinics (Sao Paulo), vol. 72, no. 1, pg. 58-64, 2017.
- J. Bosch et al., ‘ORIGIN Trial Investigators: n-3 fatty acids and cardiovascular outcomes in patients with dysglycemia’, N Engl J Med., vol. 367 pg. 309-18, 2012.
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