2020, Article in monograph or in proceedings (42nd ESPEN Virtual Congress - Online, pp. 667)Rationale: Omega-3 polyunsaturated fatty acid (PUFA) supplementation is a promising therapy for cancer-relatedmalnutrition, which affects 20-70% of patients with cancer1,2. This systematic review aimed to examine the effects of oralomega-3 PUFA supplementation on muscle maintenance and quality of life in patients with cancer.
Methods: Randomised controlled trials in cancer patients aged >18 years were retrieved from 5 electronic databases;MEDLINE (via PubMed), EMBASE, CENTRAL, CINAHL (via EBSCOhost), and Web of Science, from database inceptionuntil 31st of December 2019. Trials supplementing ≥600 mg/d omega-3 PUFA (oral capsules, pure fish oil or oralnutritional supplements) or a control intervention for ≥3 weeks were included. Meta-analyses were performed in RevManto determine the mean differences (MD) in muscle mass and quality of life between omega-3 PUFA and control groupswith 95% confidence intervals (CI) and I2 for heterogeneity.
Results: We included 33 studies in patients with various types of cancers and degrees of malnutrition. The Cochrane riskof bias tool graded most trials as ‘unclear’ or ‘high’ risk of bias. Meta-analyses showed oral omega-3 PUFA supplementsimproved physical functioning (MD: 6.33; 95% CI: 0.32, 12.34, p=0.04; I2=0%) and potentially reduced fatigue (MD: -6.21;95% CI: -13.473, 1.05, p=0.09; I2=14%). However, there was no significant effect of omega-3 PUFA supplements on muscle mass, global health status, emotional functioning and symptoms (nausea and vomiting, loss of appetite anddiarrhoea).
Conclusion: This review provides evidence for the benefits of oral omega-3 PUFA supplementation on quality of life butnot on muscle maintenance in patients with cancer. Well-designed large-scale randomised controlled trials inhomogenous patient cohorts are required to confirm these findings.
2019, Article / Letter to editor (JMIR Research Protocols, vol. 8, iss. 4, (2019))Background: Interventions to improve the nutritional status of older adults and the integration of formal and family care systems are critical research areas to improve the independence and health of aging communities and are particularly relevant in the rehabilitation setting.
Objective: The primary outcome aimed to determine if the FREER (Family in Rehabilitation: EmpowERing Carers for improved malnutrition outcomes) intervention in malnourished older adults during and postrehabilitation improve nutritional status, physical function, quality of life, service satisfaction, and hospital and aged care admission rates up to 3 months postdischarge, compared with usual care. Secondary outcomes evaluated include family carer burden, carer services satisfaction, and patient and carer experiences. This pilot study will also assess feasibility and intervention fidelity to inform a larger randomized controlled trial.
Methods: This protocol is for a mixed-methods two-arm historically-controlled prospective pilot study intervention. The historical control group has 30 participants, and the pilot intervention group aims to recruit 30 patient-carer pairs. The FREER intervention delivers nutrition counseling during rehabilitation, 3 months of postdischarge telehealth follow-up, and provides supportive resources using a novel model of patient-centered and carer-centered nutrition care. The primary outcome is nutritional status measured by the Scored Patient-Generated Subjective Global Assessment Score. Qualitative outcomes such as experiences and perceptions of value will be measured using semistructured interviews followed by thematic analysis. The process evaluation addresses intervention fidelity and feasibility.
Results: Recruitment commenced on July 4, 2018, and is ongoing with eight patient-carer pairs recruited at the time of manuscript submission.
Conclusions: This research will inform a larger randomized controlled trial, with potential for translation to health service policies and new models of dietetic care to support the optimization of nutritional status across a continuum of nutrition care from rehabilitation to home.