Does Prolonged Enteral Feeding With Supplemental Omega-3 Fatty Acids Impact on Recovery Post-esophagectomy: Results of a Randomized Double-Blind Trial. Issue 5 (November 2017)

• Record Type: Journal Article
• Authors: Healy, Laura A.; Ryan, Aoife; Doyle, Suzanne L.; Ní Bhuachalla, Éadaoin Bríd; Cushen, Samantha; Segurado, Ricardo; Murphy, Thomas; Ravi, Narayanasamy; Donohoe, Claire L.; Reynolds, John V.
• Is Part Of: Annals of surgery. Volume 266:Issue 5(2017:Nov.)
• Publication Date: 2017-11
• Subjects: body composition -- complications -- eicosapentaenoic acid -- enteral feeding -- esophagectomy -- health-related quality of life -- immunonutrition -- jejunostomy; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000002390
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: This randomized controlled trial (RCT) hypothesized that prolonged enteral nutrition (EN) with supplemental eicosapentanoic acid (EPA), an omega-3 fatty acid with immune and anabolic properties, may impact on clinical and nutritional outcomes. Background: Esophagectomy is associated with significant weight loss and catabolism, and negatively impacts quality of life (QL). Strategies to counter sustained catabolism have therapeutic rationale. Methods: This multicenter, double-blind, placebo-controlled RCT was powered on a 5% difference in lean body mass (LBM) at 1 month. Patients were randomly assigned to receive either EN-EPA (2.2 g EPA/day) (n = 97) or isocaloric isonitrogenous standard EN (EN-S) (n = 94), preoperatively (5 days orally), and postoperatively via a jejunostomy until 1 month postdischarge. Assessments perioperatively, and at 1, 3, and 6 months included weight, body mass index (BMI), body composition, muscle strength, cytokines, complications, and QL. Results: The median (range) nutrition support was for 51 (36 to 78) days, and overall compliance was 96%. For the entire cohort, a significant ( P < 0.005) decrease in weight (−7.4 ± 6.6 kg), BMI (−2.6 ± 2.2 kg/m 2 ), LBM (−2.5 ± 8.7 kg), and fat mass (−3.4 ± 5.8 kg) was evident from preoperatively to 6 months. The mean (±SD) loss of LBM (kg) at 1 month was −3.7 ± 8.7 in the EN-S group, compared with −5.6 ± 12.1 in the EN-EPA group ( P = 0.355). Per-protocol analysis revealed no difference between the EN-EPA and EN-S in any clinical, nutritional, functional, QL or immune parameter at any time point. Conclusions: The thesis that EPA impacts on anabolism, immune function, and clinical outcomes post-esophagectomy was not supported. Compliance with home EN was excellent, but weight, muscle, and fat loss was significant in 30% of patients, highlighting the complexity of postoperative weight loss. Abstract : Supplemental Digital Content is available in the text