Table 1. Characteristics and information of the selected studies.
| Ref. | Participants | Control group | EN/ONS | Outcome | ||||
|---|---|---|---|---|---|---|---|---|
| No. | Cancer site | Additional component | Nutrition status | Inflammation & immune | Others | Length of intervention | ||
| [24] | 64 | Esophageal | Isocaloric | Leucine, emulsified fish oil | Body weight, CBC, BMI, ECOG, prealbumin, albumin | PGE2, PBMC (cytokine, PGE2), ConA-stimulated T-lymphocyte proliferation, cytokine, WBC count | Liver & kidney function, PT activity, QOL (EORTC QLQ-C30, OES18, EuroQOL-5D) | 4 weeks |
| [34] | 109 | Gastric | Standard EN | Arginine, n-3 PUFA, RNA, glutamin | Protein, albumin, transferrin | SIRS, postoperative complication, late postoperative period-infectious complication, WBC count | Motality, hospital stay | 7 days |
| [79] | 96 | Liver | Usual diet | BCAA | Body weight, AMC, albumin, total cholesterol, cholinesterase | - | QOL (SF-36) | 2 weeks |
| [80] | 8 | Head & neck | Isosource | Arginine, n-3 PUFA, nucleotides | Pre-illness weight, total body protein, plasma PC fatty acid | TNF-α, IL-6, IL-10, CRP, Ig A, G, M general infections, flap anastomosis complications | Hospital stay | 5 days |
| [30] | 71 | Esophageal | Standard EN | Arginine, n-3 PUFA, glutamine | Body weight | IL-6, IL-10, TNF-α, IFN, CRP, CD3, CD4, CD8, WBC, PMN, lymphocyte count, AE | - | 28 days |
| [81] | 40 | Head & neck | Standard EN | Arginine, n-3 PUFA, RNA | Albumin, prealbumin, fibrinogen | CRP, Il-6, TNF, postoperate complicantion | - | Median 12 days |
| [25] | 66 | Head & neck | Usual diet | - | Presence of symptoms influencing nutritional status, PG-SGA, weight loss | Treatment tolerance | - | Median 100 days |
| [27] | 37 | Head & neck esophageal | Isocaloric | Arginine, n-3 PUFA, RNA | BMI, weight loss, FM, CBC, mGPS, NRI, albumin, plasma antioxidant capacity, AMS, WHO PS | CRP, RCT toxicity | Karnofsky index, QOL (EORTC QLQ-C30, QOL H & N 35) | For 5 days before to the end of the RCT (5–7 weeks) |
| [82] | 50 | Gynaecological, urological or lower gastrointestinal | Usual diet | MCT | Body weight, BMI, dietary assessment | Feacal calprotectin, gastrointestinal toxicity (IBDQ, IBDQ-B, VIQ, RTOG) | - | 3 weeks |
| [26] | 13 | Colorectal | Usual diet | EPA | Body weight, SGA, dietary assessment, protein, total cholesterol | Chemotherapy tolerability | QOL (EORTC QLQ-C30) | 12 weeks |
| [38] | 80 | Head & neck | Usual diet | - | BMI | - | Percentage of tube feeding use, QOL (EORTC QOL H & N 35) | 5–7 weeks |
| [83] | 38 | Non specific | Isocaloric | High in protein, leucine, emulsified fish oil, specific oligosaccharides | CBC, pre-albumin, albumin, calcium, weight | IL-8, IL-1β, IL-6, TNF-α, IFN-γ, IL-10, CRP, PGE2, the ex vivo LPS-stimulated cytokine, PGE2 | Liver & kidney function, thromboplastin time, percentages of EPA and DHA, arachidonic acid of total phospholipid fatty acids of WBC, percentages of EPA and DHA, arachidonic acid, DPA of total phospholipid fatty acids of RBC | 7 days |
| [28] | 40 | Lung | Isocaloric | n-3 PUFA | Handgrip strength, PAM, Karnofsky performance status | - | QOL (EORTC QLQ-C30) | 5 weeks |
| [37] | 229 | Gastrointestinal | Isocaloric | MCT | Prealbumin, albumin, TG, cholesterol | Gastrointestinal problems, postoperative | Hospital stay | At least 5 days |
| [36] | 32 | Head & neck | Standard EN | Arginine | - | - | Survival, second primary tumor, locoregional recurrence | 10 days |
| [84] | 49 | Hepatocellular carcinoma | Usual diet | BCAA | Albumin, CBC, calorie intake | Six events (death, recurrence of HCC, rupture of esophageal varices, and liver failure), tumor markers in blood (AFP, L3-AFP) | Envent free survivla rate, QOL (SF-8), liver & kidney function, prothrombin time, raspiratory rate (npRQ), non-protein respiratory quotient | 12 months |
| [85] | 15 | Head & neck | Standard EN | Arginine, RNA, n-3 PUFA, glutamine | PG-SGA, CBC, albumin, prealbumin, body weight | CRP, WBC, total lymphocyte count, T-lymphocyte subsets, ASEPSIS tool, DTH skin test | - | 7 days |
| [31] | 29 | Esophageal | Standard EN | Arginine, n-3 PUFA, RNA, MCT | CBC, platelet count, plasma nitrate nitrite | IL-6, IL-8, maximum body temperature, PHA-induced lymphocyte transformation tests, T-cell subsets | PT activity, thrombin-antithrombin 3 complex, PIC, hospital stay | 7 days |
| [86] | 25 | Non specific | Standard EN | Fish oil, leucine | - | - | HOMA, FSR, plasma luecine, serum glucose, insulin | 1 day |
| [87] | 40 | Non-small cell lung | Isocaloric | n-3 PUFA (EPA, DHA) | REE, body weight, FFM, MUAC, energy intake, albumin | IL-6, CRP, sTNF-p55, HLA-DR expression on monocytes | EPA, DHA, AA in plasma phospholipids | 5 weeks |
| [88] | 244 | Gastric adenocarcinoma | Usual diet | Arginine, n-3 PUFA, RNA | Prognostic nutritional index, albumin, weight loss | Surgical-site infection, infectious complication, complication SIRS, CRP | Hospital stay | 5 days |
| [35] | 305 | Pancreatic & gastric | Standard EN | Arginine, n-3 PUFA glutamine | CBC, albumin, prealbumin | Postoperative complications, CRP | Morbidity, mortality, hospital stay | 7 days |
| [32] | 72 | Head & neck | Isocaloric | Arginine, fiber | Weight loss, albumin, prealbumin, transferrin | Lyphocytes, postoperative infections complications, local complications, gastrointestinal tolerance | Hospital stay | Minimum 10 days |
| [33] | 47 | Head & neck | Isocaloric | Arginine, fiber | Weight, dietary assesment, albumin, prealbumin, transferrin | Postoperative infection complications, local complecations gastrointestinal tolerance, lymphocyte | Hospital stay, mortality | 22 ± 12 days |
| [89] | 36 | Head & neck | Isocaloric | Arginine, fiber | Albumin, prealbumin, transferrin, body weight | Total No.of lymphocytes, IL-6, TNF-α, CRP | - | Average of 20 days |
| [29] | 111 | Head & neck esophageal | Standard EN | n-3 PUFA | Body cell mass, body weight, BMI, Kondrup score, SGA, handgrip strength, TG | IL-6, TNF-α | QOL (EORTC QLQ-C30) | 14 weeks |
| [90] | 196 | Pancreatic & gastric | Standard EN | - | Prealbumin, albumin, CBC | Postoperative complications, total lymphocyte count | Hospital stay, liver & kidney function | 7 days |
| [91] | 53 | Esophageal | Standard EN | EPA, DHA | Body coposition, albumin | IL-10, IL-8, TNF-α, postoperative complications, body temperature, CRP, IL-6, amyloid A, serum EPA, PBMC membrane EPA | - | 26 days |
Bold words indicates those indices with statistical significance.
MUAC, mid-upper arm circumference; REE, resting energy expenditure; FFM, fat free mass; EN, enteral nutrition; ONS, oral nutritional supplements; PGE2, prostaglandin E2; PBMC, peripheral blood mononuclear cell; WBC, white blood cell; QOL, quality of life; PC, phosphatidylcholine; PMN, polymorphonuclear; PG-SGA, patient-generated subjective global assessments; SGA, subjective global assessments; LPS, lipopolysaccharide; DPA, docosapentaenoic acid; TG, triglyceride; HCC, hepatocellular carcinoma; AFP, alpha-fetoprotein; ASEPSIS, Acronym of Seven Wound Assessment of Tool; DTH, delayed-type hypersensitivity; PHA, phytohemagglutinin; HOMA, insulin resistant; FSR, muscle protein fractional synthesis rate; PIC, alpha 2-plasmin inhibitor-plasmin complex; npRQ, raspiratory rate; PAM, physical activity monitor; IBDQ, Inflammatory Bowel Disease Questionnaire; IBDQ-B, Inflammatory Bowel Disease Questionnaire-Bowel sub-set; VIQ, Vaizey Incontinence Questionnaire; RTOG, radiation therapy oncology group; NRI, nutritional risk index; CBC, complete blood cell count; BMI, body mass index; PT activity, prothrombin activity; SIRS, systemic inflammatory response syndrome; AMC, arm muscle circumference; TNF, tumor necrosis factor; IL, interleukin; Ig, immunoglobulin; AE, adverse effect; CRP, C-reactive protein; FM, fat mass; AMS, arm muscular strength; RCT, radiochemotherapy; SF-8, short form-8 health survey; RNA, ribonucleic acid; EPA, eicosapentaenoic acid; BCAA, branched-chain amino acid; MCT, medium-chain triglyceride; DHA, docosahexaenoic acid; n-3 PUFA, n-3 polyunsaturated fatty acid; ECOG, Eastern Cooperative Oncology Group; WHO PS, World Health Organization Performance Status; AA, arachidonic acid.