Fish oil effects on quality of life, body weight and free fat mass change in gastrointestinal cancer patients undergoing chemotherapy: A triple blind, randomized clinical trial Michel Carlos Mocellin a,⇑ , Carolina de Quadros Camargo a , Maria Emilia de Souza Fabre b , Erasmo Benicio Santos de Moraes Trindade a a Federal University of Santa Catarina, Nutrition Department, Graduate Program of Nutrition, Florianópolis, Santa Catarina, Brazil b Oncology Research Center of Santa Catarina – CEPON/SC, Ambulatory of Nutrition Assistance, Florianópolis, Santa Catarina, Brazil article info Article history: Received 18 September 2016 Received in revised form 17 January 2017 Accepted 20 January 2017 Keywords: Fish oil Chemotherapy Quality of life Body composition n-3 polyunsaturated fatty acids Gastrointestinal cancer abstract The effects of fish oil supplementation for nine weeks on quality of life, body weight and muscle mass change in gastrointestinal cancer patients during chemotherapy was investigated. Forty-five patients with colorectal or gastric cancer initiating chemotherapy treatment were studied in a triple-blind, pla- cebo controlled trial. Patients were randomly assigned to receive 3.6 g/day of fish oil (1.55 g EPA + DHA; n = 22) or placebo (n = 23). Body weight, body composition and quality of life were assessed at baseline and at week 9. Pooled analysis did not show statistical significance between the two groups for weight and free-fat mass change. However, subgroup analyses demonstrated that fish oil prevented loss of muscle mass. Patients that took fish oil had lower scores for nausea/vomiting and appetite loss after the first nine weeks of chemotherapy, but had higher constipation scores. Thus, the results indicate that certain groups of patients with gastrointestinal cancer may benefit from fish oil intake concomitant with chemotherapy. Ó 2017 Elsevier Ltd. All rights reserved. 1. Introduction During many years of oncological practice and scientific research the increase of tumour response to anti-cancer treatment was the primary goal of clinicians, adding days to the life of the patient. However, despite the effectiveness of the treatment in kill- ing cancer cells, several life-threatening chronic conditions are experienced by some patients - often unintended consequences of toxicities from the drugs used and therapies applied (Armstrong et al., 2014). The impact of treatment interferes on their functional capacity and quality of life, including overall well-being, ability to maintain employment, financial stability, and relationships with friends and family (Pettit et al., 2016). Some strategies have been suggested to improve the quality of life in cancer patients, including n-3 PUFAs supplementation. Fatty acids from n-3 PUFAs family, especially eicosapentaenoic (EPA) and docosahexaenoic acids (DHA), have been used in many types of cancer as adjuvant treatment due to their anti-inflammatory and pro-apoptotic properties, as well as exerting beneficial effects on nutritional status and quality of life (D’Eliseo & Velotti, 2016; Hardman, 2002; Laviano, Rianda, Molfino, & Fanelli, 2013; Mocellin, Camargo, Nunes, Fiates, & Trindade, 2016). The benefits of n-3 PUFAs in gastrointestinal cancer supported by clinical trials reviewed by Eltweri et al. (2016) including: improvement of immune response, maintenance of body weight, improvement of quality of life and increase overall survival. How- ever, these effects were observed mainly in clinical trials performed with cancer patients who did not receive chemotherapy (of 42 clin- ical studies included in the review of Eltweri et al. (2016), only six were performed in gastrointestinal cancer patients undergoing chemotherapy). Silva, Fabre, and Waitzberg (2015), in a systematic review, suggested that the association of n-3 PUFAs with chemotherapy can maintain or improve weight, decrease plasma concentration of inflammatory markers, improve both oxidative status and quality of life (evidence generated from a poll of cancer types - lung, colorectal, breast and gastrointestinal). Regarding body composition, the main evidence about the benefits of n-3 PUFAs are provided by studies performed in patients with cancer- cachexia/sarcopenia (the majority of these studies involved lung and pancreatic cancer), in which the results show maintenance or increase of muscle mass (Pappalardo, Almeida, & Ravasco, 2015). http://dx.doi.org/10.1016/j.jff.2017.01.041 1756-4646/Ó 2017 Elsevier Ltd. All rights reserved. ⇑ Corresponding author at: Graduate Program of Nutrition, Nutrition Department, Health Sciences Center, University Campus - Trindade, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88040-900, Brazil. E-mail address: michel.mocellin@hotmail.com (M.C. Mocellin). Journal of Functional Foods 31 (2017) 113–122 Contents lists available at ScienceDirect Journal of Functional Foods journal homepage: www.elsevier.com/locate/jff