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Enteral Nutrition Enriched With Eicosapentaenoic Acid (EPA) Preserves Lean Body Mass Following Esophageal Cancer Surgery: Results of a Double-Blinded Randomized Controlled Trial

Ryan, Aoife M. PhD*; Reynolds, John V. MD*; Healy, Laura BSc*; Byrne, Miriam MD*; Moore, Jennifer RN*; Brannelly, Niamh BSc; McHugh, Aisling BSc; McCormack, Deirdre BSc; Flood, Philomena BSc

doi: 10.1097/SLA.0b013e31819a4789

Background: Esophagectomy represents an exemplar of controlled major trauma, with marked metabolic, immunologic, and physiologic changes as well as an associated high incidence of complications. Eicosapentaenoic acid (EPA) enriched enteral nutrition (EN) modulates immune function and limits catabolism in patients with advanced cancer, but its impact in the peri-operative period is unclear.

Objectives: To examine the effects of perioperative EPA enriched EN on the metabolic, nutritional, and immuno-inflammatory response to esophagectomy, and on postoperative complications.

Methods: In a double-blind design, patients were randomized to a standard EN formula or a formula enriched with 2.2 g EPA/d for 5 days preoperatively (orally) and 21 days postoperatively (jejunostomy). Segmental bioelectrical impedance analysis was performed preoperatively and on POD 21. Postoperative complications were monitored, as well as the acute phase response, coagulation markers, and serum cytokines.

Results: Fifty-three patients (28 EPA, 25 standard) completed the study, and both groups were well matched. Serum and peripheral blood mononuclear cell (PBMC) membrane EPA levels were significantly increased in the EPA group. There was no difference in the incidence of major complications. The EPA group maintained all aspects of body composition postoperatively, whereas patients in the standard EN group lost significant amounts of fat-free mass (1.9 kg, P = 0.030) compared with the EPA group [leg (0.3 kg, P = 0.05), arm (0.17 kg, P = 0.01), and trunk (1.44 kg, P = 0.03)]. The EPA group had a significantly (P < 0.05) attenuated stress response for TNFα, IL-10, and IL-8 compared with the standard group.

Conclusions: EPA supplemented early EN is associated with preservation of lean body mass post esophagectomy compared with a standard EN. These properties may merit longer-term study to address its impact on recovery of function and quality of life in models of complex surgery or multimodal cancer treatment regimens.

Peri-operative administration of enteral nutrition enriched with Eicosapentaenoic Acid for 5 days pre op and 21 days postesophagectomy preserves lean body mass and is associated with an attenuated pro-inflammatory response to surgery versus standard enteral nutrition.

From the *Department of Clinical Surgery, and †Department of Clinical Nutrition, St. James's Hospital, and Trinity College Dublin, Ireland.

Disclosure of Funding: This trial was supported by a research grant from Abbott Laboratories. Abbott Laboratories had no role in the study design, randomization procedure, data collection, data analysis, data interpretation or in the writing of the final report or in the decision to submit the paper for publication.

This trial has been registered with and the ID number is NCT00790140.

Corresponding Author: Professor John V. Reynolds, Department of Clinical Surgery, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Tel: +353 1 4162500. Fax: +353 1 4162211. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.