ORIGINAL ARTICLE Marine phospholipids—a promising new dietary approach to tumor-associated weight loss Lenka A. Taylor & Lars Pletschen & Jann Arends & Clemens Unger & Ulrich Massing Received: 9 January 2009 / Accepted: 3 April 2009 / Published online: 29 April 2009 # Springer-Verlag 2009 Abstract Goals of work Advanced tumor disease very often evokes excessive loss of body weight. Among others, fish oil or marine fatty acid ethyl esters were investigated for treatment of cancer cachexia with controversial results. In this study, a new formulation of marine fatty acids was investigated, the marine phospholipids, with more than 50% of phospholipid-bound fatty acids being eicosapentae- noic and docosahexaenoic acid. Materials and methods Thirty-one tumor patients with various tumor entities suffering from weight loss were asked to take marine phospholipids (1.5 g/day) as softgel capsules for a period of 6 weeks. Compliance, body weight, appetite, and quality of life as well as the fatty acid profile in plasma and blood cells were monitored; 17 patients could be analyzed. Main results Marine phospholipids were very well accept- ed; low-dose supplementation resulted in a significant increase of eicosapentaenoic and docosahexaenoic acid in plasma phospholipids; therefore, significantly reducing the n - 6 to n - 3 fatty acid ratio. A stabilization of body weight was achieved (median weight change of +0.6% after 6 weeks), while appetite and quality of life improved. Conclusions These promising first results encourage further investigation of marine phospholipids in cancer care. Keywords Marine phospholipids . Cancer . Weight loss . Marine fatty acids . Lyso-phosphatidylcholine Introduction The excessive loss of body weight, mostly combined with loss of appetite, is a problem that often occurs with advanced metastatic cancer disease. More than 80% of patients with advanced cancer suffer from the cachexia syndrome [1] which not only impairs quality of life [2] but also increases therapeutic complications [3] and implies a poor prognosis [4]. Although many underlying causes of this syndrome have already been revealed and many approaches [5] have been investigated accordingly, its treatment still remains unsatisfying in a high percentage of cases. Inflammatory processes have been identified as being partly responsible for weight loss/anorexia [6]. Proinflam- matory cytokines like tumor necrosis factor alpha (TNFα, formerly known as cachectin), interleukin 1 and 6 (IL-1/-6), and interferon gamma (INFγ) have been suggested to mediate cancer cachexia [7–11]. The initiation of synthesis and up-regulation of proinflammatory messengers are much dependent on the synthesis of eicosanoids (prostaglandins, leucotrienes, and thromboxanes). The “class 2&4” eicosa- noids (for example, PGE 2 and LTB 4 ), which have proin- flammatory effects, all derive from arachidonic acid (AA), an omega-6-polyunsaturated fatty acid (20:4n - 6) [12]. Upon stimulatory signal, AA is cleaved from the PL in the cellular membrane and is used for eicosanoid synthesis. AA bound in the cellular membrane therefore plays a key role in inflammatory and malignant processes and is an interesting target for therapeutic intervention. Membrane-forming phospholipids in tumor cells are constantly broken down by PLA 2 at a much higher rate Support Care Cancer (2010) 18:159–170 DOI 10.1007/s00520-009-0640-4 L. A. Taylor : U. Massing (*) Department of Clinical Research, Tumor Biology Center, Breisacher Straße 117, 79106 Freiburg, Germany e-mail: massing@tumorbio.uni-freiburg.de L. Pletschen : J. Arends : C. Unger Department of Medical Oncology, Tumor Biology Center, Breisacher Straße 117, 79106 Freiburg, Germany