Table 1.
Studies identified by the PubMed search
| Reference | Design | Participants | Nutritional status | Comparison details | Outcome | Length of study | Results |
|---|---|---|---|---|---|---|---|
| Pelzer et al., 2010 [25] | prospective intervention trial | 32 | >5% weight loss in previous 4 weeks or BMI <19 | additional PN of about 25 kcal/kg daily on 5 days of week | phase angle, ECM/BCM, BMI | median 18 (8–35) weeks | improved nutritional status: phase angle improved; ECM/BCM dropped; BMI increased slightly |
| Park et al., 2012 [35] | open randomized single-center parallel-group trial | 38 | PO nutritional status of patients who had undergone PD | early EN in comparison to TPN | change in weight, LOS, change of nutrition index, rates of delayed gastric empting, pancreatic fistula | 90 days (7, 14, 21, 90) | bowel movement and time to take normal diet shorter in early EN than TPN; no significant difference between two groups in serum albumin, total protein and patient-generated SGA; BW decreased until PO day 90 in TPN group |
| Nagata et al., 2009 [36] | prospective randomized single-center trial | 17 | PO nutritional status of patients who had undergone PD | EN in comparison to EN + PN | weight loss, symptoms like jaundice, diabetes, prealbumin, transferrin, IgG, IgM, IgA | 14 PO days | EN combined with PN is more adequate for patients after pancreatic surgery |
| Liu et al., 2011 [37] | prospective randomized trial | 60 | PO nutritional status of patients who had undergone PD | EN in comparison to TPN | influence on clinical and biochemical parameters | 14 PO days | EN is superior to TPN in improving nutritional status, liver and kidney functions and reducing PO complications |
| Gianotti et al., 2000 [21] | prospective randomized trial | 212 | PO nutritional status of patients who had undergone PD | SEN (control group) vs. EN enriched with arginine, n-3 FAs (immunonutrition group) vs. TPN (parenteral group) | effect of PO nutritional support on immunometabolic response and outcome | until 800 kcal orally was achieved | rate of PO complications was lower in immunonutrition group (p < 0.005); LOS shorter in immunonutrition group (p < 0.02); early PO EN choice to nourish patients after PD |
| Di Carlo et al., 1999 [22] | prospective randomized trial | 100 | PO outcome of patients who had undergone PD | SEN vs. immunonutrition enriched with arginine, n-3 FAs vs. TPN | effect of PO nutritional support on outcome of patients undergoing PD | LOS | PO complications lower in IMEN (p < 0.05); infectious complications lower in IMEN group; LOS shorter in IMEN; nutritional goal can be obtained by EN; immunonutrition seems to improve outcome |
| Brennan et al., 1994 [23] | prospective randomized trial | 117 | patients who had undergone major pancreatic resection | randomization to either receive PN and control group with standard dextrose-containing salt solution | PO complications | LOS | no benefit by use of PN; complications were greater in group receiving TPN (p < 0.05) |
| Bauer et al., 2005 [26] | multicenter randomized double-blind trial | 200 | weight loss >5% in previous 6 months, life expectancy >2 months and Karnofsky performance score of 60, untreated PC patients | consume two cans per day of either a protein- and energy-dense, n-3 FAs ONS or an isocaloric, isonitrogenous control supplement without n-3 FAs | dietary intake, weight, LBM and QoL | 8 weeks | compliance with prescription of 1.5 cans of a protein- and energy-dense, ONS n-3 FAs improved nutrition-related outcomes |
| Vashi et al., 2014 [24] | longitudinal unrandomized clinical trial | 52 (14 PC) | significant cancer cachexia, no HPN therapy prior to hospital admission, anticipated survival >90 days | HPN using 25–30 kcal/kg for BMI <30 and 22–25 kcal/kg of ideal BW for BMI >30; protein needs were estimated using 1.5–2 g/kg for BMI <30 and 2–2.5 g/kg of ideal BW for BMI ≥30 | QoL, functional status, SGA, weight, serum albumin | 1, 2, 3 months | HPN is associated with improvement in QoL, Karnofsky performance status and nutritional status; greatest benefit in patients with 3 months of HPN |
| Davidson et al., 2004 [8] | multicenter trial | 107 | weight loss of at least 5% over the previous 6 months, expected survival of at least 2 months and no chemotherapy, radiotherapy or surgery during the study or for 4 weeks prior to baseline | 237 ml cans per day of supplement, weekly contact by phone | weight, survival, QoL | 8 weeks | weight stabilization was associated with improved survival duration and QoL |
| Klek et al., 2011 [20] | randomized double-blind trial | 305 | patients undergoing resection for PC or gastric cancer, malnutrition (weight loss by at least 10% or BMI <18), Karnofsky performance score >80 | preoperative: 14 days of PN, PO: IMEN or standard oligopeptide diet | PO complications, LOS, function of immune system, assessment of liver and kidney function | LOS | shorter LOS in IMEN group; more infectious complications in SEN group; mortality and morbidity were greater in SEN group; no differences in kidney and liver function |
| Wigmore et al., 2000 [27] | prospective intervention trial | 26 | weight loss 13%/4 months, BMI 23.2, advanced PC patients | oral EPA (week 1: 1 g, week 2: 2 g, week 3: 4 g, weeks 4–12: 6 g) | weight loss, body composition, hematologic and clinical chemistry variables, performance status | 12 weeks (0, 4, 8, 12 weeks) | weight loss decreased (p < 0.005 vs. week 0) under EPA supplementation; no change in anthropometric and body composition; no change in performance status, nutritional intake and acute-phase protein response |
| Heller et al., 2004 [32] | double-blind prospective randomized single-center pilot trial | 44 | mean BMI = 24.5 ± 4.1 (SO group); mean BMI = 25.2 ± 4.4 (SO + FO group) | TPN supplemented with SO (1.0 g/kg BW) or FO + SO (FO 0.2 + SO 0.8 g/kg BW) | liver and pancreas blood parameters; days of ICU stay and weight loss | 5 days | FO significantly reduced ALAT, ASAT, bilirubin, LDH, lipase; shorter ICU stay with FO; absence of weight loss with FO (SO 1.1 ± 2.2 kg) |
| Fearon et al., 2003 [28] | double-blind randomized multicenter trial | 200 | weight loss 3.3 kg/month; advanced PC patients | ONS vs. ONS + EPA and antioxidants (480 ml, 620 kcal, 32 g protein ± 2.2 g EPA) | weight, LBM, dietary intake, QoL | 8 weeks | loss of weight and LBM was stopped in both groups; dose response relationship: weight gain and increase in LBM only in ONS + EPA group; improved QoL only in ONS + EPA group |
| Barber et al., 1999 [29] | prospective intervention trial | 20 | weight loss 2.9 kg/month; advanced PC patients | ONS + EPA (620 kcal, 32.2 g protein and 2.2 g EPA) | weight, body composition, dietary intake, REE and performance status | 7 weeks (0, 3, 7 weeks) | significant weight gain at both 3 weeks (median 1 kg; p = 0.024) and 7 weeks (median 2 kg; p = 0.033); dietary intake increased; performance status and appetite improved |
| Barber et al., 2001 [30] | prospective intervention trial | 20 | weight loss 2.9 kg/month; advanced PC patients | ONS + EPA (620 kcal, 32.2 g protein and 2.2 g EPA) | weight, pro inflammatory cytokines, hormones and tumor-derived products | 3 weeks | significant decline in IL-6 production; rise in serum insulin concentration; fall in the cortisol to insulin ratio; decrease in PIF; weight gain (median 1 kg) |
| Barber et al., 2000 [31] | case-control trial | 16 cases 6 controls | weight-losing patients; advanced PC patients | ONS + EPA (620 kcal, 32.2 g protein and 2.2 g EPA) | indirect calorimetry, body composition, weight | 3 weeks | after 3 weeks ONS + EPA: BW increased; energy expenditure in response to feeding rose (no difference to healthy controls); fasting fat oxidation decreased (no difference to healthy controls) |
| Arshad et al., 2015 [33] | single-arm phase II clinical trial, two-stage design | 50 | advanced PC patients | gemcitabine 1,000 mg/m3 weekly followed by up to 100 g (200 mg/ml) of n-3 FAs-rich lipid emulsion for 3 weeks followed by a rest week | response rate, overall and progression-free survival, QoL scores and adverse events | min. 4 weeks up to max. 24 weeks | intravenous n-3 FAs in combination with gemcitabine show evidence of improved activity and benefit to QoL in patients with advanced PC |
| Kraft et al., 2012 [34] | prospective multicenter placebo-controlled randomized double-blind trial | 72 | weight loss 11% in 6 months | oral 1-carnitine (4 g) or placebo for 12 weeks | weight loss, BMI, nutritional status, QoL, survival, LOS | 12 weeks | weight loss decreased; BMI increased; nutritional status and QoL improved |
BW = Body weight; ECM/BCM = extracellular mass/body cell mass; FO = fish oil; HPN = home PN; ICU = intensive care unit; IMEN = immunomodulating EN; LOS = length of hospital stay; ONS = oral nutritional supplement; PD = pancreaticoduodenectomy; PIF = proteolysis-inducing factor; PO = postoperative; SEN = standard EN; SO = soy oil.