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      Balanço entre ácidos graxos ômega-3 e 6 na resposta inflamatória em pacientes com câncer e caquexia Translated title: Omega-3 and 6 fatty acids balance in inflammatory response in patients with cancer and cachexia

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          Abstract

          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.

          Translated abstract

          Emaciation and loss of lean body mass is a frequent phenomenon observed in cancer patients. This condition leads to infection risk and a poor response to treatment, thus reducing the chances of cure. Furthermore, malnutrition is also associated with a poor quality of life. Therefore, therapies have been proposed in attempt to revert the catabolism observed in most of these patients by attenuating the inflammatory response. Among them, omega-3 fatty acid supplementation may be a strategy to reduce the production of pro-inflammatory cytokines and improve metabolic substrate tolerance, decreasing protein catabolism in order to ameliorate the prognosis of cure in cancer patients. However, studies demonstrate some conflicting results of ômega-3 supplementation on immune response. On the other hand, clinical trials in cancer patients demonstrate that the inflammatory response decreases and the nutritional status improves. The aim of this paper is to elaborate a strict review of the subject.

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          Most cited references53

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          Dietary polyunsaturated fatty acids and inflammatory mediator production

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            Inflammatory response: an unrecognised source of variability in the pharmacokinetics and pharmacodynamics of cancer chemotherapy.

            An important limitation in the use of chemotherapy in cancer treatment is that cytotoxic agents have small margins of safety compared with other drugs. The largely unpredictable pharmacokinetics of cytotoxic agents contribute significantly to differences in toxicity and efficacy between individuals. Over the past few decades, evidence has accumulated that the inflammatory response to conditions such as infection, degenerative disease, and cancer can greatly affect the disposition of drugs. A more recent finding is that the presence of an inflammatory response identifies patients with more aggressive disease and may also compromise the pharmacodynamics of anticancer drugs. In this review, we discuss the changes in the pharmacokinetics of drugs caused by the presence of inflammation. Also, we discuss the modulating role of inflammatory mediators on the pharmacokinetics and pharmacodynamics of cytotoxic agents. We argue that, overall, these factors identify inflammatory response as a potentially important factor in the interindividual variability of response and toxic effects to cancer chemotherapy.
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              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.

              Animal studies showed that dietary flaxseed oil [rich in the n-3 polyunsaturated fatty acid alpha-linolenic acid (ALA)], evening primrose oil [rich in the n-6 polyunsaturated fatty acid gamma-linolenic acid (GLA)], and fish oil [rich in the long-chain n-3 polyunsaturated fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] can decrease natural killer (NK) cell activity. There have been no studies of the effect on NK cell activity of adding these oils to the diet of humans. Our objective was to determine the effect of dietary supplementation with oil blends rich in ALA, GLA, arachidonic acid (AA), DHA, or EPA plus DHA (fish oil) on the NK cell activity of human peripheral blood mononuclear cells. A randomized, placebo-controlled, double-blind, parallel study was conducted. Healthy subjects aged 55-75 y consumed 9 capsules/d for 12 wk; the capsules contained placebo oil (an 80:20 mix of palm and sunflower seed oils) or blends of placebo oil and oils rich in ALA, GLA, AA, DHA, or EPA plus DHA. Subjects in these groups consumed 2 g ALA, 770 mg GLA, 680 mg AA, 720 mg DHA, or 1 g EPA plus DHA (720 mg EPA + 280 mg DHA) daily, respectively. Total fat intake from the capsules was 4 g/d. The fatty acid composition of plasma phospholipids changed significantly in the GLA, AA, DHA, and fish oil groups. NK cell activity was not significantly affected by the placebo, ALA, GLA, AA, or DHA treatment. Fish oil caused a significant reduction (mean decline: 48%) in NK cell activity that was fully reversed by 4 wk after supplementation had ceased. A moderate amount of EPA but not of other n-6 or n-3 polyunsaturated fatty acids can decrease NK cell activity in healthy subjects.
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                Author and article information

                Journal
                rn
                Revista de Nutrição
                Rev. Nutr.
                Pontifícia Universidade Católica de Campinas (Campinas, SP, Brazil )
                1415-5273
                1678-9865
                October 2006
                : 19
                : 5
                : 611-621
                Affiliations
                [03] São Paulo SP orgnameUniversidade Federal de São Paulo orgdiv1Departamento de Pediatria orgdiv2Instituto de Oncologia Pediátrica Brasil
                [02] São Paulo SP orgnameUniversidade Federal de São Paulo orgdiv1Instituto de Oncologia Pediátrica orgdiv2Equipe Multidisciplinar de Terapia Nutricional Brasil
                [01] São Paulo SP orgnameUniversidade Federal de São Paulo orgdiv1Departamento de Pediatria Brasil
                Article
                S1415-52732006000500009 S1415-5273(06)01900509
                10.1590/S1415-52732006000500009
                ca3c7c06-61e2-4fce-9dc3-a492c8cbea0b

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 26 July 2004
                : 20 September 2005
                : 16 June 2005
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 51, Pages: 11
                Product

                SciELO Brazil

                Categories
                Comunicações

                malnutrition,neoplasias,inflamação,desnutrição,caquexia,ácidos graxos,neoplasms,inflammation,cachexia,fatty acids

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