Eficácia da suplementação com ômega 3 em pacientes com câncer: revisão sistemática e meta-análise
Palavras-chave:
ácidos graxos ômega-3, quimioterapia, radioterapia, câncer, desnutriçãoResumo
Introdução: O câncer afeta o estado nutricional dos pacientes, destacando a necessidade de buscar estratégias nutricionais para abordá-lo. Objetivo: Avaliar a eficácia da suplementação com óleo ou cápsulas de ômega 3 em relação aos parâmetros nutricionais e inflamatórios de pacientes oncológicos em tratamento ativo. Métodos: Foi realizada uma revisão sistemática para identificar ensaios clínicos controlados. O desfecho primário foi a mudança de peso. Foi realizada uma meta-análise usando o software RevMan.Resultados: Foram incluídos sete estudos (participantes n= 262). A dose administrada variou entre 0,60 e 2,45 g, e a intervenção durou entre 45 dias e três meses. Observou-se que os pacientes suplementados perderam menos peso do que aqueles que não receberam ômega 3 (Diferença Padronizada de Médias (SMD)= 3,99; IC 95,00 % 2,40-5,57), mas não foram encontradas diferenças significativas no índice de massa corporal (IMC) (SMD= 0,73; IC 95,00 % -0,11-1,58), nos valores de albumina (SMD= -0,23; IC 95,00 % -0,26-0,71) e proteína C reativa (PCR) (SMD= -4,01; IC 95,00 % -15,59-7,57). Os resultados estão limitados pelo número de estudos incluídos e pela heterogeneidade dos mesmos. Conclusões: A suplementação com ômega 3 mostrou reduzir a perda de peso dos pacientes oncológicos em tratamento ativo (quimioterapia e/ou radioterapia), mas não apresentou efeitos benéficos no IMC, nem nos valores de albumina e PCR.
Downloads
Referências
Organización Mundial de la Salud. Cáncer [Internet]. 2022 (citado 2024 Ago 14). Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/cancer
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024; 74: 229–63. doi: 10.3322/caac.21834
International Agency for Research on Cancer. World Fact Sheet [Internet]. 2022 (citado 2024 Nov 27). Disponible en: https://gco.iarc.who.int/media/globocan/factsheets/populations/900-world-fact-sheet.pdf
American Society for Parenteral and Enteral Nutrition. Why Nutrition is Important: Adult Patient with Cancer [Internet]. 2020 (citado 2024 Ago 14). Disponible en: https://www.nutritioncare.org/uploadedFiles/Documents/Malnutrition/MAW_2020/Why%20Nutrition%20is%20Important_Adult%20Patient%20with%20Cancer.pdf
Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017; 36 (5): 1187–96. doi: 10.1016/j.clnu.2017.06.017
Arends J. Malnutrition in cancer patients: Causes, consequences and treatment options. Eur J Surg Oncol. 2024; 50 (5): 107074. doi: 10.1016/j.ejso.2023.107074
Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN practical guideline: Clinical nutrition in cancer. Clin Nutr. 2021; 40 (5): 2898-2913. doi: 10.1016/j.clnu.2021.02.005
De las Peñas R, Majem M, Perez-Altozano J, Virizuela JA, E. Cancer, Diz P, et al. SEOM clinical guidelines on nutrition in cancer patients. Clin Transl Oncol. 2019; 21 (1): 87–93. doi: 10.1007/s12094-018-02009-3
Arends J, Strasser F, Gonella S, Solheim TS, Madeddu C, Ravasco P, et al. Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines. ESMO Open. 2021; 6 (3): 100092. doi: 10.1016/j.esmoop.2021.100092
Castellanos TL, Rodríguez DM. El efecto de omega 3 en la salud humana y consideraciones en la ingesta. Rev. chil. nutr. 2015; 42 (1): 90-5. doi:10.4067/S0717-75182015000100012
Luan CW, Yang HY, Tsai YT, Hsieh MC, Chou HH, Chen KS. Prognostic value of C-reactive protein-to-albumin ratio in head and neck cancer: A meta-analysis. Diagnostics (Basel). 2021; 11 (3): 403. doi: 10.3390/diagnostics11030403
Shirakawa T, Makiyama A, Shimokawa M, Otsuka T, Shinohara Y, Koga F, et al. C-reactive protein/albumin ratio is the most significant inflammatory marker in unresectable pancreatic cancer treated with FOLFIRINOX or gemcitabine plus nab-paclitaxel. Sci Rep. 2023; 13 (1): 1-12. doi: 10.1038/s41598-023-34962-7
De Castro GS, Andrade MF, Pinto FCS, Faiad JZ, Seelaender M. Omega-3 fatty acid supplementation and its impact on systemic inflammation and body weight in patients with cancer cachexia—A systematic review and meta-analysis. Front Nutr. 2022; 31 (8): 797513. doi: 10.3389/fnut.2021.797513
Delpino FM, Figueiredo LM. Effects of omega-3 supplementation on lean body mass in cancer patients: a systematic review and meta-analysis. Eur J Clin Nutr. 2022; 76 (12): 1636–45. doi: 10.1038/s41430-022-01100-x
Jin X, Xu XT, Tian MX, Dai Z. Omega-3 polyunsaterated fatty acids improve quality of life and survival, but not body weight in cancer cachexia: A systematic review and meta-analysis of controlled trials. Nutr Res. 2022; 107: 165–78. doi: 10.1016/j.nutres.2022.09.009
Wang Y, Liu R, Chang M, Wei W, Guo Y, Jin Q, et al. Does omega-3 PUFA-enriched oral nutritional intervention benefit cancer patients receiving chemo (radio) therapy? A systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2023; 63 (18): 3081–96. doi: 10.1080/10408398.2021.1984199
Pan L, Zhou Y, Yin H, Hui H, Guo Y, Xie X. Omega-3 polyunsaturated fatty acids can reduce C-reactive protein in patients with cancer: A systematic review and meta-analysis of randomized controlled trials. Nutr Cancer. 2022; 74 (3): 840–51. doi: 10.1080/01635581.2021.1931365
Lam CN, Watt AE, Isenring EA, de van der Schueren MAE, van der Meij BS. The effect of oral omega-3 polyunsaturated fatty acid supplementation on muscle maintenance and quality of life in patients with cancer: A systematic review and meta-analysis. Clin Nutr. 2021; 40 (6): 3815–26. doi: 10.1016/j.clnu.2021.04.031
Guo Y, Ma B, Li X, Hui H, Zhou Y, Li N, et al. n-3 PUFA can reduce IL-6 and TNF levels in patients with cancer. Br J Nutr. 2023; 129 (1): 54–65. doi: 10.1017/S0007114522000575
Hosseini F, Hemmati A, Takabi FS, Naeini F, Shab Bidar S. A dose–response meta-analysis of randomized clinical trials investigating the effects of omega-3 supplementation on body weight in patients with cancer cachexia. Clin Nutr ESPEN. 2024; 59: 378–86. doi: 10.1016/j.clnesp.2023.12.150
Risk of bias tools - Current version of RoB 2 [Internet]. 2019 (citado 2024 Ago 14) . Disponible en: https://www.riskofbias.info/welcome/rob-2-0-tool/current-version-of-rob-2
Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/ or mid-quartile range. Stat Methods Med Res. 2018; 27: 1785–1805. doi: 10.1177/0962280216669183
Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014; 14: 135. doi: 10.1186/1471-2288-14-135
Higgins JP, Li T, Deeks JJ. Choosing effect measures and computing estimates of effect. In: Cochrane Handbook for Systematic Reviews of Interventions. Wiley. 2019: 143–76. doi:10.1002/9781119536604.ch6
Murphy RA, Mourtzakis M, Chu QSC, Baracos VE, Reiman T, Mazurak VC. Nutritional intervention with fish oil provides a benefit over standard of care for weight and skeletal muscle mass in patients with nonsmall cell lung cancer receiving chemotherapy. Cancer. 2011; 117 (8): 1775–82. doi: 10.1002/cncr.25709
Finocchiaro C, Segre O, Fadda M, Monge T, Scigliano M, Schena M, et al. Effect of n-3 fatty acids on patients with advanced lung cancer: a double-blind, placebo-controlled study. Br J Nutr. 2012; 108 (2): 327–33. doi: 10.1017/S0007114511005551
Pastore-Silva JA, Santos de Moraes-Trindade EB, de Souza-Fabre ME, Martorano-Menegotto V, Gevaerd S, da Silva-Buss Z, et al. Fish oil supplement alters markers of inflammatory and nutritional status in colorectal cancer patients. Nutr Cancer. 2012; 64 (2): 267–73. doi:10.1080/01635581.2012.643133
Chagas TR, Borges DS, de Oliveira PF, Mocellin MC, Barbosa AM, Camargo CQ, et al. Oral fish oil positively influences nutritional‐inflammatory risk in patients with haematological malignancies during chemotherapy with an impact on long‐term survival: a randomised clinical trial. J Hum Nutr Diet. 2017; 30 (6): 681–92. doi: 10.1111/jhn.12471
Aredes MA, da Camara AO, de Paula NS, Fraga KYD, do Carmo M das GT, Chaves GV. Efficacy of ω-3 supplementation on nutritional status, skeletal muscle, and chemoradiotherapy toxicity in cervical cancer patients: A randomized, triple-blind, clinical trial conducted in a middle-income country. Nutrition. 2019; 67–68 (110528): 110528. doi: 10.1016/j.nut.2019.06.009
De la Rosa-Oliva F, Meneses-García A, Ruiz-Calzada H, Astudillo-de la Vega H, Bargalló-Rocha E, Lara-Medina F, et al. Effects of omega-3 fatty acids supplementation on neoadjuvant chemotherapy-induced toxicity in patients with locally advanced breast cancer: a randomized, controlled, double-blinded clinical trial. Nutr Hosp. 2019; 36 (4). doi: 10.20960/nh.2338
Cheng M, Zhang S, Ning C, Huo Q. Omega-3 fatty acids supplementation improve nutritional status and inflammatory response in patients with lung cancer: A randomized clinical trial. Front Nutr. 2021; 8. doi: 10.3389/fnut.2021.686752
Aduse-Poku L, Karanth SD, Wheeler M, Yang D, Washington C, Hong Y-R, et al. Associations of total body fat mass and skeletal muscle index with all-cause and cancer-specific mortality in cancer survivors. Cancers (Basel). 2023; 15 (4): 1081. doi: 10.3390/cancers15041081
de Aguiar-Pastore Silva J, Emilia de Souza-Fabre M, Linetzky-Waitzberg D. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: A systematic review. Clin Nutr. 2015; 34 (3): 359–66. doi: 10.1016/j.clnu.2014.11.005
Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019; 48 (1): 16–31. doi: 10.1093/ageing/afy169
Rodríguez-Veintimilla D, Frías-Toral E, Santana-Porbén S. Diagnóstico nutricional en el paciente oncológico: Importancia y Herramientas para realizarla. Oncol (Guayaquil). 2018; 28 (3): 169–80. doi:10.33821/271
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2024 Delfina Bressan Otegui, Evelyn Santilli Bourse, Juan Sebastian Lasa
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
