Article

Fish oil supplementation is beneficial on caloric intake, appetite and mid upper arm muscle circumference in children with leukaemia

Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia. .
Asia Pacific Journal of Clinical Nutrition (Impact Factor: 1.7). 09/2012; 21(4):502-10.
Source: PubMed

ABSTRACT

A randomised trial was carried out to determine the effect of supplementation of fish oil among 51 children with leukaemia aged 4 to 12 years on appetite level, caloric intake, body weight and lean body mass. They were randomly allocated into the trial group (TG) and the control group (CG). At baseline, 30.8% of TG subjects and 44.0% of CG subjects were malnourished and 7.7% of subject from TG and 28.0% from CG were classified as stunted. The majority of subjects from TG and CG were in the mild malnutrition category for mid upper arm muscle circumference (MUAMC)-for-age. The TG group showed significant increment in MUAMC (0.13 cm vs -0.09 cm) compared with CG at 8 weeks (p<0.001). There was a significant higher increase for appetite level (0.12±0.33) (p<0.05) and an increasing trend on energy and protein intake in the TG group (213±554 kcal; 3.64 ±26.8 g) than in the CG group. In conclusion, supplementation of fish oil has a positive effect on appetite level, caloric intake and MUAMC among children with leukaemia.

Full-text

Available from: Zalina Abu Zaid, Feb 10, 2015
502 Asia Pac J Clin Nutr 2012;21 (4):502-510
Original Article
Fish oil supplementation is beneficial on caloric intake,
appetite and mid upper arm muscle circumference in
children with leukaemia
Zalina Abu Zaid MSc
1
, Suzana Shahar PhD
2
, A Rahman A Jamal PhD
3
,
Noor Aini Mohd Yusof PhD
2
1
Department of Nutrition & Dietetics, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia
2
Department of Nutrition & Dietetics, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia
3
Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia
A randomised trial was carried out to determine the effect of supplementation of fish oil among 51 children with
leukaemia aged 4 to 12 years on appetite level, caloric intake, body weight and lean body mass. They were ran-
domly allocated into the trial group (TG) and the control group (CG). At baseline, 30.8% of TG subjects and
44.0% of CG subjects were malnourished and 7.7% of subject from TG and 28.0% from CG were classified as
stunted. The majority of subjects from TG and CG were in the mild malnutrition category for mid upper arm
muscle circumference (MUAMC)-for-age. The TG group showed significant increment in MUAMC (0.13 cm vs
-0.09 cm) compared with CG at 8 weeks (p<0.001). There was a significant higher increase for appetite level
(0.120.33) (p<0.05) and an increasing trend on energy and protein intake in the TG group (213554 kcal; 3.64
26.8 g) than in the CG group. In conclusion, supplementation of fish oil has a positive effect on appetite level, ca-
loric intake and MUAMC among children with leukaemia.
Key Words: fish oil, MUAMC, appetite, caloric intake, leukaemia
INTRODUCTION
Malnutrition and weight loss are common among cancer
patients and are due to a variety of mechanisms involving
the tumour, the host response to the tumour, and anti-
cancer therapies.
1
It is a major cause of morbidity and
mortality.
1,2
Symptoms may occur at all stages of the can-
cer during treatment.
3
Nausea, vomiting, diarrhoea, ano-
rexia, taste changes, and increased metabolic rate are the
most common side effects of chemotherapy and contrib-
ute to patients voluntary limitation of their food intake to
prevent the symptoms.
4
In addition, treatment itself for
example chemotherapeutic agents may adversely affect
growth and body composition in children.
5
Compared
with adults; children have decreased caloric reserves be-
cause of their particular body composition (higher water
content and decreased fat), these making them susceptible
to malnutrition sooner than adults.
6
By maintaining adequate dietary intake, it may help to
prevent the weight loss and reduce the risk of malnutri-
tion in patient with cancer.
4
However, studies have re-
ported that by increasing protein and energy intake alone
in patient with cancer may provide little impact on pa-
tients’ overall of body weight and lean body mass.
7,8
Alt-
hough caloric intake needs has been increased in cancer
patients, it seems quite difficult to gain in lean body tissue
unless the underlying metabolic abnormalities are im-
proved.
9
Thus, nutritional support can be beneficial to
patients with malnutrition or patients at risk for malnutri-
tion. The provision of nutritional support for patients with
cancer is to stabilize or improve nutritional status, max-
imize quality of life and improve clinical outcome.
10
One possible approaching for nutritional support is to
include the use of eicosapentaenoic acid (EPA). EPA, a
polyunsaturated fatty acid (PUFA) found in fish oil, has
been shown to inhibit inflammation in vivo and has been
associated with weight gain, better response to therapy,
fewer complications and even improved survival in pa-
tients with cancer.
11-14
Furthermore, the effect of fish oil
rich in EPA on maintaining, stabilizing or gaining body
weight have been found in studies in patient with pancre-
as cancer,
14-16
healthy men,
18,19
and even among pediatric
malignant disease.
4
Despite overwhelming evidence showing the beneficial
effects of fish oil in EPA on patient with cancer improves
nutritional status and QOL which reviewed in adult pa-
tients with cancer. To date there is currently insufficient
evidence to recommend supplementation of fish oil in
paediatric with cancer. Therefore, the present study was
Corresponding Author: Mrs Zalina Abu Zaid, Department of
Nutrition & Dietetics, Faculty of Medicine & Health Sciences,
Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
Tel: (60) 3 89472358; Fax: (60) 3 89426769
Email: zlina@medic.upm.edu.my
Manuscript received 14 March 2012. Initial review completed
27 April 2012. Revision accepted 24 July 2012.
Page 1
Effects of fish oil supplementation 503
performed to investigate the effect of supplementation of
fish oil among children with leukaemia in increasing their
appetite level, caloric intake and body weight.
MATERIALS AND METHODS
Study design and participants
This study was a randomised controlled trial in children
with leukaemia (Figure 1). The study was performed in
the Haematology & Oncology Paediatric Ward of the
Universiti Kebangsaan Malaysia Medical Centre and
Paediatric Institute of Kuala Lumpur. The study protocol
was approved by the ethics committee of the Universiti
Kebangsaan Malaysia Medical Centre (Project Code: FF-
045-2005). Permission to conduct the study was obtained
from the director of Universiti Kebangsaan Malaysia
Medical Centre and Hospital Kuala Lumpur, Malaysia.
Fifty one children with leukaemia (32 boys and 19 girls)
aged 4 to 12 years were enrolled in this study. Inclusion
criteria were children with leukaemia aged 4 to 12 years
old and able to consume diet orally. Patients were exclud-
ed from this study if they were involved in another re-
search project or those were receiving nutrition support
on tube feeding or parenteral nutrition or those on nutrient
supplementation. The study was explained to the carers
and patient when they agreed to participate in the study.
An informed consent was obtained from subjects and
carers.
The researcher had screened 60 patients but only 55
subjects were eligible to enter the study. Patients had
been excluded because they did not meet the study’s cri-
teria (n=5). Figure 1 show the subject enrolment and
study design. Fifty-five eligible subjects were equally
randomised into the two groups: the trial group (TG) and
control group (CG). At the end of 8 weeks, 51 subjects
completed the study, two subjects died (TG=1; CG=1)
and two subjects (CG=2) withdrawn from the study.
Data collection
Demographic information including age, gender, ethnic
group, number of siblings was obtained from subjects and
Figure 1. Recruitment of subjects and study design
Page 2
504 Z Abu Zaid, S Shahar, ARA Jamal and NA Mohd Yusof
their caregiver through an interview and also extracted
from patients’ medical record. Socio-economic data such
as parent’s education level, occupation and household
income were also gathered during the interview. In the
study of Simons et al., a numerical scale ranging from 0
(absolutely no appetite) to 10 (extremely good appetite)
and in the study of Bruera et al., a visual analogue scale
(VAS) of 0 to 100 mm (0 mm=best, 100 mm=worst) was
used for appetite rating. However, appetite rating using
VAS in our study was modified because it was hard for
children to rate their appetite with the original scale and
appetite rating was obtained using a modified hedonic
scale ranging from 0 (less appetite) to 4 (most appetite).
Dietary intake was also assessed using a combination
of 24-hour dietary recalls at baseline and 2 day-24-hour
dietary records (one weekday and one weekend) at 30-
days and 60-days. The 24-hour dietary recalls was carried
out through interview with the mother or directly with an
older child (age group 9-12 years old). Each interview
lasted 15 to 20 minutes. The children or their families
were instructed on how to record their food and drink
consumption in a notebook provided for the 2-day-24-
hour dietary records using standard portion or household
measures (examples: 1 cup of milk, 2 teaspoonful of jam,
etc). A food album on commonly consumed food was
used to help subjects and their care-givers to recall and
estimate the portion/serving size of their food and drink
that were consumed. Then the quantity of food intake
were changed into gram based on the Food Composition
Malaysia Book,
22
Atlas Food: Exchange Size & Portion,
23
and Singapore Food Composition.
24
Mean energy and
macronutrient intake were determined using computer-
ized software Nutritionist Pro version 2.0. Total energy
requirement was estimated using the Seashore equation,
25
depending on the children’s age, their body weight, a ac-
tivity factor and a stress factor. Estimated protein re-
quirement was 1.0 -1.2 g/kg.
26
The anthropometric measurements were assessed by
body weight, height, triceps, and the circumference of the
mid upper arm. The same investigator collected all the
measurements to avoid interobserver error, and for main-
taining uniformity and accuracy in techniques. Height of
the children were measured by using SECA Stadiometer
Model 220 (Germany). The reading was taken to the
nearest 0.1 cm. The electronic scale (SECA, Germany)
was used to measure weight of the children wearing min-
imum clothing and it was recorded to the nearest 0.1 kg.
The anthropometric indices were calculated using WHO
Anthro software and classified according to standard de-
viations units (z-scores) based on WHO Child Growth
Standards.
27
Children who were less than two standard
deviation below the reference median (< -2 SD) were
considered as underweight (weight-for-age), stunted
(height-for-age) and wasted (weight-for-height) respec-
tively.
The method of Durnin and Rahaman,
28
was used to
measure triceps skin fold using the Harpenden calliper.
The investigator measured the subject’s skin fold by
grasping a length-wise double fold of skin and fat (using
thumb and forefingers) about 1 cm above the designated
midpoint of the upper arm of the right and pinching the
midpoint with the callipers. This was repeated three times,
and the triceps skin fold measurement was obtained by
averaging the three values. A non-stretchable tape made
of fibreglass was used to measure the circumference of
the mid upper arm. The circumference was measured at
the midpoint of the upper left arm between the acromion
process and the tip of the olecranon. After locating the
midpoint, the left arm is extended to hang loosely by the
side with the palm facing inwards. The tape is wrapped
gently but firmly around the arm at the midpoint and the
measurement were recorded.
29
This was repeated three
times, and the mid upper arm circumference was obtained
by averaging the three values.
The muscle circumference of the mid upper arm is de-
rived from measurements of both mid upper arm circum-
ference and triceps skin fold. The mid upper arm muscle
circumference was computed using the following formu-
la
30
MUAMC = MUAC – [( x TSF), where,
MUAMC = mid upper arm muscle circumference in cm
MUAC = mid upper arm circumference in cm
TSF = triceps skin fold thickness in cm
Triceps skin fold and MUAMC values were expressed
in percent range according to age and sex. Percentiles
used for triceps skin fold and mid upper arm muscle cir-
cumference were reference from Frisancho.
30
The values
below the 15
th
percentile were classified as inadequate
and the value with equal to or greater than the 15
th
per-
centile were classified as adequate.
No established toxicity questionnaire for dose-limiting
fish oil related side effects are available,
31
therefore we
used the question of tolerability and new symptoms to
assess the toxicity. On day 30, subjects’ tolerability on
consuming the capsule was measured on a scale of 1 to 4
(1=no difficulty, 4=extremely difficult). Patients were
also asked whether they experienced any symptoms dur-
ing the intervention.
Data collection was carried out for the patients in all
the two groups to obtain baseline data. With the exception
for socio-demography questionnaire which was used once
at baseline only and difficulty to consume the capsule
questionnaire which was started at day-30. The same
methods and instruments were used repeatedly at day-30
and day-60.
Intervention
Subjects in TG were asked to consume one capsule of
fish oil per day. Each capsule provided 1200 mg contain-
ing 360 mg EPA and 240 mg docosahexaenoic acid
(DHA). Each subject was provided 1 bottle/10 capsule
every week. To check the compliance of the patient, they
were asked to record each time they have had their sup-
plementation and to return the empty bottle to the re-
searcher during the visit. If the compliance of the patient
were above 80%, they remained with the study. In order
to increase their dietary intake, both groups were asked to
consume full cream milk (197 kcal/serving, twice a day)
throughout 60 days of the study.
Both groups of subjects were given detailed advice on
their usual daily food intake at baseline, day-30 and day-
60. The advice included more fruit, vegetables, and low-
fat dairy products and less saturated fat, total fat, and cho-
lesterol. The recommended diets also contained more
Page 3
Effects of fish oil supplementation 505
whole grains and fewer refined grains, sweets, and red
meats. The advice also focused on healthy and balanced
meals as well as strategies/tips on preparation of healthy
food and eating out, to the patients and parents. It empha-
sized increasing physical activity in patients. Problems
and concerns in complying with the advice were also dis-
cussed.
Statistical analysis
Descriptive and statistical analyses were done using SPSS,
version 13.0 (SPSS Inc, Chicago, IL, USA). Values were
expressed as percentage and meanSD. Baseline values
were compared using an independent t-test and categori-
cal data were analysed by using Pearson’s chi-square
analysis. Repeated-measures analysis of variance was
used with the supplementation period as the within-
subject factor and with the supplementation intervention
as the between-subject factor and adjusting for respective
baseline means for age, sex and ethnicity. Data were of
normal distribution using Kolmogorov-Smirnov. The
differences were considered statistically significant if the
p<0.05.
RESULTS
Out of 51 subjects, 62.7% of the subjects were males
(Table 1). The age group was divided into three groups
from 4 to 6 years, 7 to 9 years and 10 to 12 years. Majori-
ty of the subjects in TG (23.5%) and CG (17.6%) were in
the age group of 4 to 6 years. The majority of subjects in
TG and CG were Malays (70.6%) followed by Indian
(15.7%) and Chinese (13.7%). Regarding the father’s
profile in both groups, most of them were working in the
private sector (23.5% and 19.6%). Almost half of the
mothers were unemployed (43.1% and 37.3%). Overall,
the mothers had worked before their children being been
diagnosed, they made a decision to quit temporarily from
work because they knew that their child needs full atten-
tion and support.
More than half of TG (61.5%) had mild difficulty in
tolerating the capsule as shown in Table 2. This is be-
cause the size of the capsule is quite big and the children
had difficulty swallowing the capsules. However the
caregiver made an initiative to break the capsule so the
Table 1
.
Demographic and socioeconomic background of the subjects and caregivers in the trial group (
TG) and co
n-
trol group (CG) at baseline
Characteristics
TG (n=26)
CG (n=25)
n % of subjects
n % of subjects
Gender
Male 19 37.3 13 25.5
Female 7 13.7 12 23.5
Age group, years
4-6 10 19.6 9 17.6
7-9 7 13.7 7 13.7
10-12 9 17.7 9 17.7
Ethnicity
Malay 17 33.3 19 37.3
Chinese 4 7.8 3 5.9
Indian 5 9.8 3 5.9
Household income, RM
<500 2 3.9 2 3.9
501-1000 2 3.9 7 13.7
1001-2000 16 31.4 9 17.6
2001-3000 6 11.8 4 7.8
>3001 0 0 3 5.9
Father’s occupation
Unemployed 0 0 2 4.0
Self-employed 11 21.6 6 11.8
Government staff 3 5. 9 5 9.8
Private staff 12 23.5 10 19.6
Others 0 0 2 3.9
Mother’s occupation
Unemployed 22 43.1 19 37.3
Self-employed 0 0 1 2.0
Government staff 1 2.0 1 2.0
Private staff 3 5.9 4 11.8
Others 0 0 0 0
Independent t-test and Chi-square analysis where appropriate, showed that the baseline results were comparable for demographic and
socioeconomic background between the two groups (p>0.05)
Table 2
.
Difficulty levels
in
consuming
the capsule in
the TG group (n=26)
Difficulty levels consuming the capsule n (%)
No difficulty 10 (38.5)
Mild difficulty 16 (61.5)
Moderate difficulty 0 (0)
Extremely difficulty 0 (0)
Page 4
506 Z Abu Zaid, S Shahar, ARA Jamal and NA Mohd Yusof
children could swallow without having any difficulty.
All of the patients (100%) did not experience any symp-
toms like vomiting, diarrhoea, constipation, nausea or
headache during the intervention.
Of subjects from TG, 30.8%- and 44.0% of subjects
from CG were malnourished (z score < -2 for indices
weight-for-age), and 7.7% of subjects from TG and
28.0% of subject from CG were classified as stunted for
height-for-age (z-score < -2) according to WHO (1995) at
baseline (Table 3). The majority of subjects from TG
(92.3%) and CG (68.0%) were in normal category (≥ -2
z-score to median and median to 2 z-score for indices
height-for-age) respectively. The result indicated for
indices weight-for-height, 26.9% of the subjects from TG
and 36.0% of the subjects from CG were in the
underweight category, respectivley. Only a few subjects
(15.4% from TG and 24.0% from CG) were in the obese
category based on weight-for-height indices(≥ 2 z-score).
The majority of subjects from TG (88.5%) and CG
(84.0%), respectively, were in the mild malnutrition
category (>5
th
to 15
th
percentile) for MUAMC-for-age at
baseline.
There was significant group and time interactions for
MUAMC (p<0.001) as shown in Table 4. This indicator
showed a greater increment in the TG group than in the
CG group. There was no significant group and time
interaction for body weight. However, this outcome
showed positive time effects when the interaction term
was removed, body weight (p=0.001) increased in both
groups over time. There was no significant difference
over time between groups for height.
There is significant higher increase for appetite level in
the TG group (0.120.33) than in the CG group (0.04
0.35) (p<0.05) as shown in Figure 2. In Figure 3, there
was an increasing trend on energy and protein intake in
the TG group (213 554 kcal; 3.6 26.8 g). While the
Table 3
.
Percentages of malnutrition (
z
-
score) among children with leukaemia at baseline
Gradation of nutritional status
TG
CG
n %
n %
Weight-for-age
< -2 z-score
8 30.8 11 44.0
≥ -2 z-score to median 11 42.3 8 32.0
≥ median to 2 z-score 7 26.9 6 24.0
≥ 2 z-score
0 0 0 0
Total 26 100 25 100
Height-for-age
< -2 z-score
§
2 7.7 7 28.0
≥ -2 z-score to median 10 38.5 5 20.0
≥ median to 2 z-score 14 53.8 12 48.0
≥ +2 z-score 0 0 1 4.0
Total 26 100 25 100
Weight-for-height
< -2 z-score
7 26.9 9 36.0
≥ -2 z-score to median 10 38.5 7 28.0
≥ median to 2 z-score 5 19.2 3 12.0
≥ 2 z-score
††
4 15.4 6 24.0
Total 26 100 25 100
MUAMC-for-age
5
ψ
0 0 0 0
>5-
15
23 88.5 21 84.0
>15-
85
3 11.5 4 16.0
>85-
95
§
0 0 0 0
>95
††
0 0 0 0
Total 26 100 25 100
underweight;
overweight;
§
stunted;
wasted;
††
obese;
ψ
severe malnutrition;
mild malnutrition.
Independent t-test and Chi-square analysis where appropriate, showed that the baseline results were comparable for gradation of nutrition-
al status between the two groups (p>0.05)
Table 4
.
Effects of supplementation of omega-3 (fish oil) fatty acids
Anthropometric
measurement
TG
(n=26)
CG
(n=25)
ANCOVA (p value)
Baseline
Day-30 Day-60
Baseline
Day-30 Day-60
F(p)
group
F(p)
time
F(p)
group
time
Weight (kg)
20.0
6.45
20.7
6.35
21.1
6.33
21.7
10.1
21.7
10.1
21.8
10.2
NS p<0.000
NS
Height (cm)
119
14.2
120
14.2
119
13.5
122
17.7
122
17.6
122
17.7
NS NS NS
MUAMC (cm)
6.12
1.13
6.16
1.16
6.29
1.00
5.72
0.86
5.25
1.06
5.16
0.89
NS p<0.000
p<0.001
Repeated-measure analysis of covariance (ANCOVA)
Adjusted for respective baseline means age, sex and ethnicity
NS – not significant
Page 5
Effects of fish oil supplementation 507
CG group showed a reduction on enegry and protein
intake (-139699 kcal; -0.522.3 g).
DISCUSSION
Growth failure and poor nutritional status are common in
children with cancer and chronic disease. It also can be an
early sign for undiagnosed cancer. Malnutrition will lead
to low response to therapy, and descreased survival rate
of the patients. Thus, it is important for the patients to
maintain body weight. Recent studies have reported that
increasing energy and protein intake may have little
impact of the patients.
7,8
One approaches that shows
significant weight increases compared with controls is
omega-3 (fish oil) fatty acids.
4
This randomised study using supplementation of
omega-3 (fish oil) fatty acids has a positive effect in
increasing MUAMC among children with leukeamia.
Eventhough there were no significant effect in group and
time interaction on body weight, there was an increasing
trend on body weight in both groups compared with
baseline. The results were comparable to the study done
among pancreatic cancer patients,
31,32
and children with
β-thalassaemia major.
33
The increment in MUAMC are
consistent with those of other studies among pancreatic
cancer patients,
32,34
gastrointestinal cancer patients,
35
and
children with β-thalassaemia major.
36
Increasing the caloric intake of children with leukeamia
for eight weeks, was associated with significant
improvement of appetite level and increment of MUAMC.
Growth improvement and increasing caloric intake after
supplementing fish oil proved that part of the growth
impairment of these patients is correctable by proper
nutritional intervention to compensate for their
hypermetabolic status of these patients. It has been
reported that supplemention of fish oil has a beneficial
effect in gaining body weight
3
and increasing energy and
protein intake among pancreatic cancer patients.
8,34,36
Thus, it is recommended that this supplementation should
be considered in every treatment protocol for these
patient.
However, these effects were seen predominatly in the
patients who were diagnosed with leukeamia rather than
solid tumours as reported by Bayram et al.
4
This is
probably because the enrichment with polyunsaturated
fatty acids makes leukeamia cells more susceptible to
lipid peroxidation and more sensitive to drug therapy.
37
Eventhough, mechanisms of cancer-associated mal-
nutrition are complex, studies have shown that patients
with cancer experience an increased elevated acute-phase
protein response and high level of pro-inflammatory
cytokines such as tumour necrosis factor (TNF),
interleukin-1 (IL-1), and interleukin-6 (IL-6).
14,38
and
have been subsequently shown to be associated with the
development of cancer-associated malnutrition in patients
with cancer.
11,39
Studies suggest that supplementation
with EPA suppresses IL-6,
14
and the acute phase protein
response,
9
which attenuate cancer-induced weight loss.
These findings suggested that supplementation of omega-
3 (fish oil) fatty acids may be promising in treating
cancer-associated malnutrition.
Results of a number of small trials have been reported
in which oil, or the main omega-3 fatty acids that contains
EPA has been demonstrated to reduce the high rates of
weight loss in adult cancer patients.
41,42
There was a line-
ar relationship between change in lean body mass and
enrichment of plasma phospholipids with EPA, indicating
that the greater the intake of omega-3 fatty acids, the
greater the protein accretion in the patients. Thus, con-
suming omega-3 fatty acids which provide extra protein
and energy would allow net deposition of lean tissue.
32
However, this study has some limitations that could
impact the study findings. The small number of subjects
may not allow the findings to be generalised to other
population such as the elderly. The findings may not be
representative as only two hospitals took part in the study.
Therefore, further studies are encouraged to be conducted
in multiple institutions to achieve a big sample size and
represent the nutritional status of children with cancer in
general. Even though, compliance of the patients could be
checked for the supplementation using plasma EPA levels,
it would useful for further studies to focus on methods of
optimising compliance (for example, patient record sheets)
both within and outside the context of randomised studies.
A randomised, double blinded, placebo controlled study
should also be considered in the future.
Although there are limitations, our study suggested that
supplementation of omega-3 (fish oil) fatty acids along
with individual dietary advice had a positive effect on
increment of MUAMC, and improved appetite level and
caloric intake outcomes when compared with subjects
Figure 2. Effect of supplementation of omega-3 (fish oil) on
changes in appetite level at 8 weeks in children with
leukaemia. Average mean baseline and day 60 appetite level
(mean SD); Means difference = values on 60 day values at
baseline
Figure 3. Effect of supplementation of omega-3 (fish oil) on
changes in macronutrients intake (total energy and protein
intake) at 8 weeks in children with leukaemia. Average mean
baseline and day 60 macronutrients intake (meanSD); Mean
difference = values on 60 day – values at baseline
Page 6
508 Z Abu Zaid, S Shahar, ARA Jamal and NA Mohd Yusof
receiving standard care alone. It would suggest that
consuming fish oil supplementation can be beneficial and
as a safe to malnutrition or at risk malnourished children
with cancer.
Conclusion
In summary, the present study suggest that supplementa-
tion of omega-3 (fish oil) fatty acids had a beneficial ef-
fect on increasing caloric intake, MUAMC measurements
and improving appetite among children with leukaemia. It
is, therefore, recommended that omega-3 (fish oil) should
be considered as a possible nutritional support approach
as part of overall care for children with cancer.
ACKNOWLEDGMENTS
We thank the patients and their care givers for their commitment
to the study, and the staff from Haematology & Oncology Pae-
diatric Ward of the Universiti Kebangsaan Malaysia and Paedi-
atric Institute of Kuala Lumpur.
AUTHOR DISCLOSURES
The fish oil capsule was sponsored by Protherapix Sdn. Bhd.
and the full cream milk formula was sponsored by Danone Sdn
Bhd. Malaysia. The authors declared that they had no conflicts
of interest with respect to their authorship or the publication of
this article and financial source.
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Page 8
510 Z Abu Zaid, S Shahar, ARA Jamal and NA Mohd Yusof
Original Article
Fish oil supplementation is beneficial on caloric intake,
appetite and mid upper arm muscle circumference in
children with leukaemia
Zalina Abu Zaid MSc
1
, Suzana Shahar PhD
2
, A Rahman A Jamal PhD
3
,
Noor Aini Mohd Yusof PhD
2
1
Department of Nutrition & Dietetics, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia
2
Department of Nutrition & Dietetics, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia
3
Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia
白血童補魚油有增加熱攝取食慾及臂肌
肉環圍
以隨機試驗評估 51 4 12 歲患有白血病的兒童,補充魚油對於食慾、熱
攝取重及()影響隨機
在基線30.8%的試組病童及 44.0%對照組為養不良;有 7.7%試驗組
28.0%對照研究象被不足兩組份病在上肌肉
(MUAMC)目被度營養不補充 8
(0.13 ) (-0.09 )
(p<0.001)(0.120.33p<0.05)
及增熱量質攝(213554 3.6426.8 )。本研究
是,白血病兒童補充魚油對於食慾量熱量攝取及上臂肌肉環圍有正向影響。
關鍵字:魚油、上臂肌肉環圍、食慾、熱量攝取、白血病
Page 9
  • Source
    [Show abstract] [Hide abstract] ABSTRACT: A biomarker is a measured characteristic that may be used as an indicator of some biological state or condition. In health and disease, biomarkers have been used not only for clinical diagnosis purposes but also as tools to assess effectiveness of a nutrition or drug intervention. When considering nutrition studies, evaluating the appropriate biomarker is a useful tool to assess compliance and incidence of a particular dietary component in the biochemistry of the organism. Fish oil is rich in ω-3 fatty acids that have well-known beneficial effects on human health mainly through its anti-inflammatory properties. It has been widely use to improve health and as a nutrition supplement in different pathological conditions such as cardiovascular, neurological, and critically ill related diseases. Eicosapentaenoic acid and docosahexaenoic acid levels present in different biological moieties (plasma, cellular membranes, adipose tissue, etc) are the best biomarkers of fish oil intake. Each biological source of fatty acids has its own advantages and disadvantages, thus which biomarker to choose and where to measure it requires a comprehension of the objectives of the investigation. In this article we will review key facts about fish oil intake biomarkers to evaluate how components of a specific diet could be monitored and identified in biological samples. Having an accurate assessment of nutrition patterns could provide effective targets for intervention aimed at modifying eating habits and lifestyle towards the improvement of health.
    Full-text · Article · Dec 2013 · Nutrition in Clinical Practice
  • [Show abstract] [Hide abstract] ABSTRACT: Few data is available on the nutritional status of old Chinese. The present study aimed to describe the nutritional status and clinical correlates for malnutrition risk in the older people. Cross-sectional study. Hospital- and community-based older people were recruited in the region of Chongqing, China. 558 individuals aged 60 years old or over between April 2011 and October 2012. Comprehensive geriatric assessment was performed and nutritional status was assessed by the Mini Nutritional Assessment Short Form (MNA-SF). Nutrition-associated factors were analyzed, including health status (chronic diseases, depression, cognition, function impaired), social factors (education status, marital status, the type of work before 60 years old) and life style factors (smoking, drinking, diet). The mean age was 73.1±8.0 years and 43.9% were men. Prevalence of malnutrition and risk for malnutrition were 3.2% and 19.3 %, respectively. Several factors increased poor nutrition independently including self-rated health, comorbidity, chronic obstructive pulmonary disease, gastrointestinal disease and cognitive impairment. Fish decreased the risk of poor nutrition. The prevalence was relatively low in older people of Chongqing, Southwest China. Poor nutrition was found to be increased due to the common health problems. Thus the patients with these problems should pay more attention on nutritional status. The older people should often have fish because of their nutritional benefit.
    No preview · Article · Jan 2015 · The Journal of Nutrition Health and Aging