Balanço entre ácidos graxos ômega-3 e 6 na resposta inflamatória em pacientes com câncer e caquexia
Palavras-chave:
ácidos graxos, caquexia, desnutrição, inflamação, neoplasiasResumo
O emagrecimento, associado à perda de massa magra, é um fenômeno observado com freqüência em pacientes com câncer. Tal condição predispõe o paciente ao maior risco de infecções, pior resposta aos tratamentos implantados e, como conseqüência, desfavorece o prognóstico de cura. Além disso, a desnutrição também está associada à pior qualidade de vida. Dessa forma, algumas terapias têm sido propostas na tentativa de reverter o catabolismo, por meio da atenuação da resposta inflamatória, observado em grande porcentagem de pacientes com câncer e caquexia. Entre elas, a suplementação com ácidos graxos da família ômega-3 pode representar uma estratégia na redução da formação de citocinas pró-inflamatórias, favorecendo a tolerância metabólica dos substratos energéticos e atenuando o catabolismo protéico, com o intuito de melhorar o prognóstico de cura de pacientes com câncer. Entretanto, os estudos mostram alguns resultados conflitantes da suplementação com ômega-3 na resposta imunológica. Por outro lado, em pacientes com câncer, os ensaios clínicos mostraram atenuar a resposta inflamatória e melhorar o estado nutricional. O objetivo deste artigo é realizar uma revisão criteriosa do assunto.
Referências
Wong PW, Enriquez A, Barrera R. Nutritional support in critically ill patients with cancer. Crit Care Clin. 2001; 17(3)
Harrison LE, Brennan MF. The role of total parenteral nutrition in the patient with cancer. Curr Prob Surg. 1995; 32(10):833-924.
Garófolo A. Estado nutricional de crianças e adolescentes com câncer [dissertação]. São Paulo: Escola Paulista de Medicina, Universidade Federal de São Paulo; 2000.
Holcomb GW, Ziegler MM. Nutrition and cancer in children. Surg Ann. 1990; 129-41.
Mauer AM, et al. Special nutrition needs of children with malignancies: a review. JPEN. 1990; 14:315-24.
Laviano A, Meguid MM, Yang ZJ, Gleason JR, Cangiano C, Fanelli FR. Cracking the riddle of cancer anorexia. Nutrition. 1996; 12:706-10.
Keefe DMK, Cummins AG, Dale BM, Kotasek D, Robb TA, Sage E. Effect of high-dose chemotherapy on intestinal permeability in humans. Clin Sci. 1997; 92:385-9.
Tisdale MJ. Cancer caquexia: metabolic alterations and clinical manifestations. Nutrition. 1997; 13:1-7.
Kyle UG, Pirlich M, Schuetz T, Lochs H, Pichard C. Is nutritional depletion by nutritional risk index associated with increased length of hospital stay? A population-based study JPEN. 2004; 28(2): 99-104.
Windsor JA, Graham LH. Weight loss with physiologic impairment. A basic indicator of surgical risk. Ann Surg. 1987; 207(3):290-6.
Villa ML, Ferrario E, Bergamasco E, Bozzetti F, Cozzaglio L, Clerici E. Reduced natural killer cell activity and IL-2 production in malnourished cancer patients. Br J Cancer. 1991; 63:1010-4.
Gogos CA, Ginopoulos P, Salsa B, Apostolidou E, Zoumbos NC, Kalfarentzos F. Dietary omega-3 polyunsaturated fatty acids plus vitamin E restore immunodeficiency and prolong survival for severely ill patients with generalized malignancy. A
randomized control trial. Cancer. 1998; 82(2): 395-401.
Garófolo A, Lopez FA. Novos conceitos e propostas na assistência nutricional da criança com câncer. Rev Paul Pediatr. 2002; 20:140-6.
Torosian MH. Cancer cachexia and nutrition support in the cancer patient. A clinical review. Cancerología. 1993; 39:1768-74.
Tchekmedyian SN, Halpert C, Ashley J, Herber D. Nutrition in advanced cancer: anorexia as a outcome variable and target of therapy. JPEN. 1992; 16(6):88S-92S.
Tisdale MJ. Cancer anorexia and cachexia. Nutrition. 2001; 17:438-42.
Cohen J, Lefor AT. Nutrition support and cancer. Nutrition. 2001; 17:698-9.
Slaviero KA, Clarke SJ, Rivory LP. Inflammatory response: an unrecognized source of variability in the pharmacokinetics and pharmacodynamics of cancer chemotherapy. Lancet Oncol. 2003; 4(4):224-32.
Calder PC. Long-chain n-3 fatty acids and inflammation: potential application in surgical and trauma patients. Braz J Med Biol Res. 2003; 36(4):433.
Bistrian BR. Clinical aspects of essential fatty acid metabolism: Jonathan Rhoads lecture. JPEN. 2003; 27(3):168.
Thompson WA, Lowry SF. Effect of nutrition on inflammatory mediators. In: Zaloga GP. Nutrition in critical care. St Louis: Mosby; 1994. p.505-23.
Agency for Healthcare Research and Quality. Effects of omega-3 fatty acids on organ transplantation. Department of Health and Human Services; 2005. p.115.
Fürst P. The striking diet of the island of Crete: lipid nutrition from the palaeolithic to the affluent modern society. Clin Nutr. 2002; 21(S2):9-14.
James MJ, Gibson RA, Cleland LG. Dietary polyunsaturated fatty acids and inflammatory mediator production. Am J Clin Nutr. 2000; 71(S):343-8.
Kelley DS. Modulation of human immune and inflammatory responses by dietary fatty acids. Nutrition. 2001; 17:669-73.
Grimble R. Use of n-3 fatty acid-containing lipid emulsions in the Intensive Care Unit environment: the scientist’s view. Clin Nutr. 2002; 21(S2):15-21.
Robert O. Practical applications of fish oil (w-3 fatty acids) in primary care. J Am Board Pract. 2005; 18:28-36.
Institute of Medicine. Dietary Reference Intakes (DRIs) for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Part 1. Washington (DC): National Academy Press; 2002.
Nutrition and Health Collection. Danone Research Center. Nutritional recommendations. Lipids from alpha to omega. Paris: John Libbey Eurotext; 1999.
Lasztity N, Hamvas J, Biro L, et al. Effect of enterally administrad n-3 polynsaturated fatty acids in acute pancreatitis-a prospective radomized clinical trial. Clin Nutr. 2005; 24:198-205.
Meier R. Enteral fish oil in acute pancreatitis. Clin Nutr. 2005; 24:169-71.
Barber MD. Cancer caquexia and its treatment with fish-oil-enriched nutritional supplementation. Nutrition. 2001; 17:751-5.
Fearon KCH. The anticancer and anticachetic effects of n-3 fatty acids. Clin Nutr. 2002; 21(S2):73-7.
Hardmam WE. Omega-3 fatty acid to augment cancer therapy. J Nutr. 2002; 132:3508S-12S.
Barber MD, Ross JA, Preston T, Shenkin A, Fearon KCH. Fish oil-enriched nutritional supplement attenuates progression of the acute-phase response in weight-losing patients with advanced pancreatic cancer. J Nutr. 1999; 129:1120-5.
Barber MD, McMillan DC, Preston T, Ross JA, Fearon CH. Metabolic response to feeding in weight-losing pancreatic cancer patients and its modulation by a fish-oil-enriched nutritional supplement. Clin Sci. 2000; 98:389-99.
Park Y, Harris WS. Omega-3 fatty acid supplementation accelerates chylomicron triglyceride clearence. J Lipid Res. 2003; 44(3): 455-63.
Swails WS, Kenler AS, Driscoll DF, et al. Effect of a fish oil structured lipid-based diet on prostaglandin release from mononuclear cells in cancer patients after surgery. JPEN. 1997; 21(5): 266-74.
Mayer K, Gokorsch S, Fegbeutel C, et al. Parenteral nutrition with fish oil modulates cytokine response in patients with sepsis. Am J Respir Crit Care Med. 2003; 167(10):1321-8.
Tsekos E, Reuter C, Stehle P, Boeden G. Perioperative administration of parenteral fish oil supplements in a routine clinical setting improves patient outcome after major adbominal surgery. Clin Nutr. 2004; 23(3):325-30.
Tsekos E, Reuter C, Stehle P, Boeden G. Corrigendum to “Perioperative administration of parenteral fish oil supplements in a routine clinical setting improves patient outcome after major adbominal surgery”. Clin Nutr. 2004; 23(4): 755-6.
Maclean CH, Newberry SJ, Mojica WA, et al. Effects of Omega-3 fatty acids on cancer. Evid Rep Technol Assess. 2005; 113(summ):1-4.
Grimble RF, Howell WM, O’Reilly, et al. The ability of fish oil to suppress tumor necrosis factor a production by peripheral blood mononuclear cells in healthy men is associated with polymorphisms in genes that influence tumor necrosis factor a
production. Am J Clin Nutr. 2002; 76(2):454-9.
Hughes DA, Pinder AC, Piper Z, Johnson IT, Lund EK. Fish oil supplementation inhibits the expression of major histocompatibility complex class II molecules and adhesion molecules on human monocytes. Am J Clin Nutr. 1996; 63(2):267-72.
Beck AS, Smith KL, Tisdale MJ. Anticachetic and antitumor effect of eicosapentaenoic acid and its effect on protein turnover. Cancer Res. 1991; 51(15):6089-93.
Thies F, Nebe-von-Caron G, Powell JR, Yaqoob P, Newsholme EA, Calder PC. Dietary supplementation with eicosapentaenoic acid, but not with other long-chain n-3 or n-6 polyunsaturated fatty acids, decreases natural killer
cell activity in healthy subjects aged>55 y. Am J Clin Nutr. 2001; 73(3):539-48.
Wu D, Meydani SN. N-3 polyunsaturated fatty acids and immune function. Proc Nutr Soc. 1998; 57(4):503-9.
Institute of Medicine. Dietary reference intakes (DRIs) for vitamin C, vitamin E, selenium, and carotenoids. Washington (DC): National Academy Press; 2000.
Bloch AS, Shils ME. Appendix. In: Shils ME, Olson JA, Shike M. Modern nutrition in health and disease. 8th ed. Malvern: Lea & Febiger; 1994. p.A100-4.
Grimminger F, Seeger W, Mayer K. Use of n-3 fatty acid-containing lipid emulsions in the intensive care unit environment: the clinician’s view. Clin Nutr. 2002; 21(S2):23-9.
Pablo MA, Puertollano MA, Cienfuegos GA. Biological and clinical significance of lipids as modulators of immune system functions. Clin Diagn Lab Immunol. 2002; 9(5):945-50.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2023 Adriana GARÓFOLO, Antônio Sérgio PETRILLI
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
