Association of Omega-3 PUFA Oral Nutritional Supplementation with Hematological and Nutritional Status in Discharged Malnourished GI Cancer Patients

Summary

This retrospective observational study found that a 3-week course of omega-3 PUFA-enriched ONS was associated with better short-term maintenance of WBC and NE counts, and higher body weight and BMI, compared with dietary counseling alone, suggesting potential hematological and anthropometric nutritional benefits.

Abstract

Short-term associations of omega-3 polyunsaturated fatty acids (PUFA)-enriched oral nutritional supplementation (ONS) with hematological, nutritional, and immune-inflammatory outcomes were evaluated in a retrospective cohort of 87 malnourished or nutritionally at-risk patients with gastrointestinal (GI) cancer. During a 3-week observation period, 46 patients received omega-3 PUFA-enriched ONS plus dietary counseling, whereas 41 received dietary counseling alone. The groups differed at baseline in tumor site, body-weight status, and recent weight loss, whereas oncological treatment category and supportive treatment did not differ statistically. Unadjusted change analyses showed a smaller decline in neutrophil (NE) count in the ONS group (P for Δ = 0.007), whereas between-group differences in white blood cell (WBC) and platelet (PLT) changes were not statistically significant. The larger reductions in the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) in the control group coincided with greater declines in NE and PLT and were therefore not interpreted as evidence of an anti-inflammatory benefit. In linear regression models adjusted for the corresponding baseline value, tumor site, and weight-loss status, ONS receipt was associated with higher week-3 body weight (adjusted difference, 1.49 kg; 95% CI, 0.58–2.39; P = 0.002), body mass index (BMI) (0.51 kg/m²; 95% CI, 0.19–1.02; P = 0.002), WBC (1.08 × 10⁹/L; 95% CI, 0.24–1.92; P = 0.012), and NE count (0.97 × 10⁹/L; 95% CI, 0.30–1.64; P = 0.005). Adjusted NLR was also higher in the ONS group (adjusted difference, 0.60; 95% CI, 0.07–1.13; P = 0.028), whereas PLT, C-reactive protein (CRP), PLR, SII, albumin (ALB), and prognostic nutritional index (PNI) did not differ significantly. Thus, receipt of omega-3 PUFA-enriched ONS was associated with a potential myeloprotective effect and more favorable short-term weight outcomes, but not with a consistent reduction in systemic inflammation.

Introduction

Gastrointestinal (GI) cancers represent a formidable global health challenge, accounting for a substantial proportion of cancer-related morbidity and mortality worldwide¹. While systemic chemotherapy offers therapeutic benefits, it frequently induces severe malnutrition, cachexia, and chronic systemic inflammation². This triad of complications not only compromises patients’ quality of life but also impairs immune competence, reduces tolerance to subsequent treatment cycles, and is independently associated with poorer clinical outcomes³. The post-discharge period for patients undergoing chemo....

Protocol

This study was approved by the Ethics Committee of Ningbo No.2 Hospital (Approval No. YJ-NBEY-KY-2023-038-01). The requirement for written informed consent was waived by the Ethics Committee.

Study design and participants

This study was a retrospective cohort analysis of routinely collected clinical records from outpatients with GI cancer who received nutritional counseling between December 2021 and December 2023. It was neither a secondary analysis of a clinical trial nor a prospective quasi-experimental study. Patients were identified from medical records based on their diagnosis of GI cancer, in....

Results

Baseline characteristics

A total of 87 patients with GI cancer were included in this retrospective analysis, comprising 46 patients in the ONS group and 41 patients in the control group (Figure 1). Patients aged ≥60 years accounted for 63.22% of the overall cohort, with a slight male predominance (66.67%). As shown in Table 1, there were no significant differences in baseline age or sex distribution between the ONS and control gro.......

Discussion

Malnutrition and treatment-related hematological abnormalities frequently coexist in patients with GI cancer and may compromise treatment tolerance, highlighting the need for supportive strategies that address both nutritional and hematological vulnerability. Against this clinical background, the present retrospective cohort analysis identified two principal short-term associations. First, after adjustment for the corresponding baseline value, tumor site, and weight-loss status, receipt of omega-3 PUFA-enriched ONS was a.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Omega-3 PUFA-enriched enteral nutrition emulsion ( (TPF-T)	Fresenius Kabi SSPC, Wuxi, Jiangsu, China	H20040722	Used as oral nutritional supplementation during the 3-week nutritional intervention.
Albumin assay kit	MedicalSystem Biotechnology Co., Ltd., Ningbo, Zhejiang Province, China	LT103A	Bromocresol Green method. Results are reported in g/L.
Automated biochemical analyzer	Hitachi High-Tech Corporation, Tokyo, Japan	785-0044	Used for automated sample handling before biochemical analysis.
Automated hematology analyzer	Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China	BC-6800Plus	Used for complete blood count measurements, including WBC, NE, LY, PLT, and hemoglobin measurements.
C-reactive protein assay kit	MedicalSystem Biotechnology Co., Ltd., Ningbo, Zhejiang Province, China	LM497	Latex-enhanced immunoturbidimetric method. Results are reported in mg/L.
Creatinine assay kit	MedicalSystem Biotechnology Co., Ltd., Ningbo, Zhejiang Province, China	LT105TF	Sarcosine Oxidase method. Results are reported in µmol/L.
Diluent for hematology analysis	Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China	M-6DR	Used for sample dilution before hematology analysis and for preparing cell suspension.
Lysing reagent for hematology analysis	Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China	M-6LD	Used to lyse red blood cells and support leukocyte differential counting in hematology analysis.
Lysing reagent for hematology analysis	Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China	M-6LH	Used to lyse red blood cells and release hemoglobin for hemoglobin quantitation.
Stata Statistical Software	College Station, TX, USA	Release 17	Used for statistical analysis
Total cholesterol assay kit	MedicalSystem Biotechnology Co., Ltd., Ningbo, Zhejiang Province, China	LT202F	CHOD-PAP method. Results are reported in mmol/L.
Total protein assay kit	MedicalSystem Biotechnology Co., Ltd., Ningbo, Zhejiang Province, China	LT102A	Biuret method. Results are reported in g/L.
Triglyceride assay kit	MedicalSystem Biotechnology Co., Ltd., Ningbo, Zhejiang Province, China	LT201F	GPO-PAP method. Results are reported in mmol/L.
Uric acid assay kit	MedicalSystem Biotechnology Co., Ltd., Ningbo, Zhejiang Province, China	LT107	Uricase method. Results are reported in µmol/L.