Effect of a fish oil-enriched nutritional supplement on metabolic mediators in patients with pancreatic cancer cachexia

Weight loss in advanced cancer patients is refractory to conventional nutritional support. This may be due to metabolic changes mediated by proinflammatory cytokines, hormones, and tumor-derived products. We previously showed that a nutritional supplement enriched with fish oil will reverse weight loss in patients with pancreatic cancer cachexia. The present study examines the effect of this supplement on a number of mediators thought to play a role in cancer cachexia. Twenty weight-losing patients with pancreatic cancer were asked to consume a nutritional supplement providing 600 kcal and 2 g of eicosapentaenoic acid per day. At baseline and after 3 wk, patients were weighed and samples were collected to measure serum concentrations of interleukin (IL)-6 and its soluble receptor tumor necrosis factor receptors I and II, cortisol, insulin, and leptin, peripheral blood mononuclear cell production of IL-1 beta, IL-6, and tumor necrosis factor, and urinary excretion of proteolysis inducing factor. After 3 wk of consumption of the fish oil-enriched nutritional supplement, there was a significant fall in production of IL-6 (from median 16.5 to 13.7 ng/ml, P = 0.015), a rise in serum insulin concentration (from 3.3 to 5.0 mU/l, P = 0.0064), a fall in the cortisol-to-insulin ratio (P = 0.0084), and a fall in the proportion of patients excreting proteolysis inducing factor (from 88% to 40%, P = 0.008). These changes occurred in association with weight gain (median 1 kg, P = 0.024). Various mediators of catabolism in cachexia are modulated by administration of a fish oil-enriched nutritional supplement in pancreatic cancer patients. This may account for the reversal of weight loss in patients consuming this supplement.

Studies on the nutrition and metabolism of turbot (Scophthalmus maximus L) with reference to fish farming

This thesis provides the first detailed study of maximal oxygen consumption of turbot on a fish farm over a range of fish sizes and temperatures. Also provided is a study of the diets used in turbot farming and the development of a diet that contains no fresh fish. A detailed study of previous research on flatfish nutrition, identified fresh fish, sprat in particular, as the optimum diet for turbot farming. A series of experiments was undertaken that confirmed this and also identified one possible explanation for the optimum performance of sprat, as a function of high non-protein energy ratios in sprat. This factor was exploited in the production of a diet containing no fresh fish and which produced superior results to diets containing fresh fish; the optimum level of lipid in the diet was determined as 18%. The study of oxygen consumption was on fully-fed fish so that maximum demand could be quantified. Continuous monitoring of tank water oxygen levels enabled the calculation of the Specific Dynamic Action (SDA) effect in turbot and the relation of it to dietary energy. Variation of SDA with the dietary energy profile was identified as a contributing factor to differential fish growth on various diets. Finally, the implications of this work to fish farming were considered. Economic appraisal and comparison of the diets routinely used in turbot farming identified that the diet developed as a result of this work, ie the diet containing no fresh fish protein, was more cost effective on the basis of the production of one tonne of turbot. The study of oxygen consumption enables water supply to be calculated for any fish size between 1g and 1000g between the temperatures of 7® C and 16® C. The quantification of SDA enables correct adjustment of oxygen flows according to the feeding status of the fish.