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
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.
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.
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.
1. Maarten von Meyenfeldt. Cancer-associated malnutrition:
An introduction. Eur J Oncol Nurs. 2005;9:S35-8.
2. Andreyev HJ, Norman AR, Oates J, Cunningham D. Why
do patients with weight loss have a worse outcome when
undergoing chemotherapy for gastrointestinal malignancies?
Eur J Cancer. 1998;34:503-9.
3. Baldwin C. Nutritional support for malnourished patients
with cancer. Curr Opin Support Palliat Care. 2011;5:29-36.
4. Bayram I, Erbey F, Celik N, Nelson JL, Tanyeli A. The Use
of a Protein and Energy Eicosapentaenoic Acid Containing
Supplement for Malignancy-Related Weight Loss in Chil-
dren. Pediatr Blood Cancer. 2009;52:571-4.
5. Halton JM, Atkinson SA, Barr RD. Growth and body com-
position in response to chemotherapy in children with acute
lymphoblastic leukemia. Int J Cancer Suppl. 1998;11:81-4.
6. Han-Markey T. Nutritional considerations in pediatric on-
cology. Semin Oncol Nurs. 2000;16:146-51.
7. Evans WK, Nixon DW, Daly JM, Ellenberg SS, Gardner L,
Wolfe E, Shepherd FA, Feld R, Gralla R, Fine S. A random-
ized trial of oral nutritional support versus ad lib nutritional
intake during chemotherapy for advanced colorectal and
non-small-cell lung cancer. J Clin Oncol.1987;5:113-24.
8. Ovesen L, Allingstrup L, Hannibal J, Mortensen EL, Han-
sen OP. Effect of dietary counseling on food intake, body
weight, response rate, survival, and quality of life in cancer
patients undergoing chemotherapy: A prospective, random-
ized study. J Clin Oncol. 1993;11:2043-9.
9. Tisdale MJ. Cancer cachexia. Langenbecks Arch Surg. 2004;
10. Van Bokhorst-de van der Schueren MA. Nutritional support
strategies for malnourished cancer patients. Eur J Oncol
11. Gogos CA, Ginopoulos P, Salsa B, Apostolidou E,
Zoumbos NC, Kalfarentzos F. Dietary Omega-3 polyunsatu-
rated fatty acids plus vitamin E restore immunodeficiency
and prolong survival for severely ill patients with general-
ized malignancy: a randomized trial. Cancer. 1998;82:395-
12. Barber MD, Ross JA, Voss AC, Tisdale MJ, Fearon KCH.
The effect of an oral nutritional supplement enriched with
fish oil on weight-loss in patients with pancreatic cancer. Br
J Ca. 1999;81:80-6.
13. Jho DH, Cole SM, Lee EM, Espat NJ. Role of omega-3 fatty
acid supplementation in inflammation and malignancy.
Integr Cancer Ther.2004;3:98-111.
14. Elia M, Van Bokhorst-de van der Schueren MA, Garvey J,
Goedhart A, Lundholm K, Nitenberg G, Stratton RJ. Enteral
(oral or tube administration) nutritional support and
eicosapentaenoic acid in patients with cancer: a systematic
review. Int J Oncol.2006;28:5-23.
15. Wigmore SJ, Fearon KC, Maingay JP, Ross JA. Down-
regulation of the acute-phase response in patients with pan-
creatic cancer cachexia receiving oral eicosapentaenoic acid
is mediated via suppression of interleukin-6.Clin Sci. 1997;
16. Macfie J. European round table: the use of immunonutrients
in the critically ill. Clinical Nutrition. 2004;23:1426-9.
17. Huhmann H, Cunningham R. Importance of nutritional
screening in treatment of cancer-related weight loss. The
Lancet Oncol. 2005;6:334-43.
18. Mantzioris E, Cleland LG, Gibson RA, Neumann MA,
Demasi M, James MJ. Biochemical effects of a diet contain-
ing foods enriched with n-3 fatty acids. Am J Clin Nutr.
19. Hellerstein MK, Wu K, McGrath M, Faix D, George D,
Shackleton CH, Horn W, Hoh R, Neese RA. Effects of die-
tary n-3 fatty acid supplementation in men with weight loss
with the acquired immune deficiency syndrome: Relation to
indices of cytokine production. Journal of Acquired Immune
Deficiency Syndrome Humans Retrovirol.1996;11:258-70.
20. Simons JP, Aaronson NK, Vansteenkiste JF, ten Velde GP,
Muller MJ, Drenth BM et al. Effects of
medroxyprogesterone acetate on appetite, weight, and quali-
ty of life in advanced stage non-hormone-sensitive cancer:
A placebo-controlled multicenter study. J Clin Oncol. 1996;
21. Bruera E, Strasser F, Palmer JL, Willey J, Calder K,
Amyotte G, Baracos V. Effect of fish oil on appetite and
other symptoms in patients with advanced cancer and ano-
rexia/cachexia: a double-blind, placebo-controlled study. J
Clin Oncol. 2003;21:129-34
22. Tee ES, Ismail MN, Mohd Nasir A, Khatijah I. Nutrient
composition of Malaysian foods. 4
ed. Kuala Lumpur: In-
stitute for Medical Research; 1997.
23. Suzana S, Noor Aini MY, Nik Shanita S, Rafidah G,
Roslina A. Atlas Makanan: Saiz Pertukaran dan Porsi.
Universiti Kebangsaan Malaysia. Publisher: MDC Publish-
24. Department of Nutrition Singapore. Singapore Food Facts.
Singapore: Ministry of Health Singapore; 2000.
25. Seashore JH. Nutritional support of children in the intensive
care unit. Yale J Biol Med.1984;57:111-34.
26. Gracie OSY, Ramanujam TM, Lim CT, Siti Fatimah MS,
Siti Hawa MT, Harbans Kaur D, Pauline L. A practical
guide to nutrition support in adults and children. Kuala
Lumpur: Universiti Malaya Medical Centre; 2000.
27. WHO. Child Growth Standards: length/height-for-age,
weight-for-age, weight-for-length, weight-for-height and
body mass index-for-age. Methods and development. Gene-
va: World Health Organization; 2006.
28. Durmin JVGA, Rahaman MM. The assessment of the
amount of fat in the human body from measurement of skin-
fold thickness. Br J Nutr. 1967;21:681-9.
29. Gibson RS. Principles of Nutritional Assessment. 2nd Ed.
New York: Oxford University Press; 2006.