New perspective toward nutritional support for malnourished cancer patients: Role of lipids

Medium- and long-chain triacylglycerols as enteral nutrition enhancing the nutritional status of postoperative rats undergoing chemotherapy by increasing the bioavailability of functional fatty acids

Medium- and long-chain triacylglycerols (MLCTs) have been widely used in the field of pharmaceutical nutrition. However, the application of MLCT as enteral nutrition remains underexplored. Our previous in vitro digestion experiment revealed that MLCTs can improve the bioaccessibility of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in comparison with physically mixed oils (MOs). In this study, we showed that MLCTs promote enhance triglyceride synthesis and secretion in Caco-2 cells, as evidenced by significant upregulation of RNA transcription levels of FATP4, L-FABP, and PPARα (p < 0.05) compared with MOs. Animal experiment results show that MLCTs can improve the energy metabolism and liver function, decrease NF-κB p65 and inflammatory cytokines, such as TNF-α, IL-6, and IL-8 of rats undergoing chemotherapy postoperatively. This was related to the elevated bioavailability and metabolic efficiency of functional fatty acids in MLCTs. Besides, RT-qPCR, western blot, and immunohistochemical analyses confirme that MLCTs downregulate the expression of proinflammatory factors by suppressing the liver NF-κB signal transduction pathway, thereby improving the nutritional status of rats.

Association of non-high-density lipoprotein to high-density lipoprotein ratio (NHHR) with prognosis in cancer survivors: a population-based study in the United States

Background

Patients with cancer frequently exhibit alterations in serum lipid profiles associated with chemotherapy. It has been reported that lipid distribution in cancer correlates with tumor progression. However, the prognostic value of serum lipid biomarkers in cancer survivors remains a subject of debate. We aim to explore the relationship between non-high-density lipoprotein to high-density lipoprotein ratio (NHHR) and the prognosis of cancer survivors.

Methods

In this study, we analyzed cancer survivor data from the National Health and Nutrition Examination Survey (NHANES) from 1999-2000 to 2017-2018. The study included prospective cohorts that included total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) levels as well as mortality data. Weighted multivariate cox regression models, competing risk models and restricted cubic spline (RCS) models were applied to investigate the association between NHHR and cancer survival. Subgroup and sensitivity analyses were performed to test the robustness of the results.

Results

This study involved 4,177 participants, representing about 19.6 million U.S. adults. After adjustment for various factors, the lower NHHR group (≤1.64) had a 31% (HR 1.31; 95% CI [1.11,1.54], p = 0.001) higher risk of death from any cause compared to the higher NHHR group. The link between NHHR and mortality remained stable across most subgroups, with notable interactions for smoking (p = 0.006) and diabetes status (p = 0.046). A J-shaped pattern was observed between NHHR and all-cause mortality, significantly among obesity-related cancer survivors (overall association test p-value = 0.0068, non-linear association test p-value = 0.0016). However, a non-significant negative correlation was observed for cancer-specific mortality (overall association test p-value = 0.48, non-linear association test p-value = 0.66). Considering the competitive risk of heart disease and cancer-specific mortality, there is no difference between the high and low NHHR groups, while the low NHHR group showed an increased risk of non-specific causes of death (p < 0.001).

Conclusion

The results of this study suggest that NHHR is an important indicator that is strongly associated with all-cause mortality in cancer survivors, and that this relationship may be influenced by the interaction of diabetes and smoking status. This finding may provide important information for future research and patient management.

Dose-Dependent Impacts of Omega-3 Fatty Acids Supplementation on Anthropometric Variables in Patients With Cancer: Results From a Systematic Review and Meta-Analysis of Randomized Clinical Trials

Meta-analyses have been conducted with conflicting results on this topic. Due to missing several eligible studies in previous meta-analysis by Lam et al., we conducted an extensive systematic review and dose-response meta-analysis of randomized controlled trials in this regard. A comprehensive search was conducted across various databases, including MEDLINE/PubMed, ISI Web of Knowledge, Scopus, and Google Scholar, until November 2023. Based on the analysis of 33 studies comprising 2,047 individuals, it was found that there was a significant increase in body weight for each 1 g/day increase in omega-3 lipids (standardized MD [SMD], 0.52 kg; 95% confidence interval [CI], 0.31, 0.73; I2 = 95%; Grading of Recommendations Assessment, Development and Evaluation [GRADE] = low). Supplementation of omega-3 fatty acids did not yield a statistically significant impact on body mass index (BMI) (SMD, 0.12 kg/m2; 95% CI, -0.02, 0.27; I2 = 79%; GRADE = very low), lean body mass (LBM) (SMD, -0.02 kg; 95% CI, -0.43, 0.39; I2 = 97%; GRADE = very low), fat mass (SMD, 0.45 kg; 95% CI, -0.25, 1.15; I2 = 96%; GRADE = low), and body fat (SMD, 0.30%; 95% CI, -0.90, 1.51; I2 = 96%; GRADE = very low). After excluding 2 studies, the findings were significant for BMI. Regarding the results of the dose-response analysis, body weight increased proportionally by increasing the dose of omega-3 supplementation up to 4 g/day. Omega-3 fatty acid supplementation can improve body weight, but not BMI, LBM, fat mass, or body fat in cancer patients; large-scale randomized trials needed for more reliable results.

Trial Registration

PROSPERO Identifier: CRD42023395341.

Encapsulation and characterization of soy protein-based ω-3 medium- and long- chain triacylglycerols microencapsulated with diverse homogenization techniques for improving oxidation stability

Recently, MLCTs have attracted considerable attention as a potential alternative to traditional oils due to their suppressive effect on fat accumulation and insulin sensitivity. In this study, the microcapsules of MLCTs with superior performance were fabricated through different homogenization processes to overcome the limitations of ω-3 medium- and long- chain triacylglycerols (MLCTs), including poor stability and prone oxidation. Additionally, the impact of various homogenization techniques, namely, high-pressure, ultrasound, and cavitation jet, on the particle structure, encapsulation efficiency, and oxidation stability of microcapsules (MLCTs) was investigated. The MLCTs microcapsules fabricated through high-pressure homogenization had a smaller particle size of 295.12 nm, lower PDI of 0.24, and a higher zeta-potential absolute value of 32.65, which significantly improved their dispersion and encapsulation efficiency, reaching 94.56 % after the spray-drying process. Furthermore, the low moisture content and superior storage stability of MLCTs microcapsules have the potential to serve as carriers of liposoluble actives.

Steady-State Delivery and Chemical Modification of Food Nutrients to Improve Cancer Intervention Ability

Cancer is a crucial global health problem, and prevention is an important strategy to reduce the burden of the disease. Daily diet is the key modifiable risk factor for cancer, and an increasing body of evidence suggests that specific nutrients in foods may have a preventive effect against cancer. This review summarizes the current evidence on the role of nutrients from foods in cancer intervention. It discusses the potential mechanisms of action of various dietary components, including phytochemicals, vitamins, minerals, and fiber. The findings of epidemiological and clinical studies on their association with cancer risk are highlighted. The foods are rich in bioactive compounds such as carotenoids, flavonoids, and ω-3 fatty acids, which have been proven to have anticancer properties. The effects of steady-state delivery and chemical modification of these food's bioactive components on anticancer and intervention are summarized. Future research should focus on identifying the specific bioactive compounds in foods responsible for their intervention effects and exploring the potential synergistic effects of combining different nutrients in foods. Dietary interventions that incorporate multiple nutrients and whole foods may hold promise for reducing the risk of cancer and improving overall health.

Research progress on chitin/chitosan-based emulsion delivery systems and their application in lipid digestion regulation

Excessive lipid intake is linked to an elevated risk of health problems. However, reducing lipid contents may influence food structure and flavor. Some alternatives are needed to control the lipid absorption. Emulsions are common carriers for lipids, which can control the hydrolysis and absorption of lipids. Chitin (Ch) and chitosan (CS) are natural polysaccharides with good biodegradability, biocompatibility, and unique cationic properties. They have been reported to be able to delay lipolysis, which can be regarded as one of the most promising agents that regulates lipid digestion (LiD). The application of Ch/CS and their derivatives in emulsions are summarized in this review with a focus on their performances and mechanisms for LiD regulation, aiming to provide theoretical guidance for the development of novel Ch/CS emulsions, and the regulation of LiD. A reasonable design of emulsion interface can provide its resistance to the external environment and then control LiD. The properties of emulsion interface are the key factors affecting LiD. Therefore, systematic study on the relationship between Ch/CS-based emulsion structure and LiD can not only instruct the reasonable design of emulsion interface to accurately regulate LiD, but also provide scientific guidelines for applying Ch/CS in functional food, medicine and other fields.

Synthesis of eicosapentaenoic acid-enriched medium- and long-chain triglyceride by lipase-catalyzed transesterification: a novel strategy for clinical nutrition intervention

BACKGROUND

Eicosapentaenoic acid (EPA) has been recognized as a promising nutrient to improve therapeutic efficacy for cancer patients. Nevertheless, there are certain limitations to the application of EPA due to its structural characteristics. To maximize the nutritive value of EPA, a type of medium- and long-chain triacylglycerol (MLCT) enriched with EPA was designed and synthesized using the lipase-catalyzed transesterification of medium-chain triglyceride (MCT) and EPA-enriched fish oil (FO).

RESULTS

The optimum synthesis conditions for EPA-enriched MLCT used Lipozyme RM as catalyst, and had a substrate mass ratio (MCT/EPA-enriched FO) of 3:1, lipase loading of 80 g kg^-1 , a reaction temperature of 60 °C, and a reaction time of 6 h. The MLCT content was as high as 80.79% after the transesterification reaction and the purification, and the content of MLCT containing EPA accounted for 70.21%. The distribution of EPA at the sn-2 position showed a significant increase in MLCT compared with the original substrate, from 18.89% to 26.93%. The in vitro digestion results demonstrated that MLCT had a significantly higher EPA bioaccessibility than the original substrate.

CONCLUSION

Eicosapentaenoic acid-enriched MLCT was developed. This may provide a novel strategy for clinical nutritional intervention. © 2023 Society of Chemical Industry.

Targeting cancer metabolic vulnerabilities for advanced therapeutic efficacy

Cancer metabolism is how cancer cells utilize nutrients and energy to support their growth and proliferation. Unlike normal cells, cancer cells have a unique metabolic profile that allows them to generate energy and the building blocks they need for rapid growth and division. This metabolic profile is marked by an increased reliance on glucose and glutamine as energy sources and changes in how cancer cells use and make key metabolic intermediates like ATP, NADH, and NADPH. This script analyzes a comprehensive overview of the latest advances in tumor metabolism, identifying the key unresolved issues, elaborates on how tumor cells differ from normal cells in their metabolism of nutrients, and explains how tumor cells conflate growth signals and nutrients to proliferate. The metabolic interaction of tumorigenesis and lipid metabolism within the tumor microenvironment and the role of ROS as an anti-tumor agent by mediating various signaling pathways for clinical cancer therapeutic targeting are outlined. Cancer metabolism is highly dynamic and heterogeneous; thus, advanced technologies to better investigate metabolism at the unicellular level without altering tumor tissue are necessary for better research and clinical transformation. The study of cancer metabolism is an area of active research, as scientists seek to understand the underlying metabolic changes that drive cancer growth and to identify potential therapeutic targets.

The structure of triglycerides impacts the digestibility and bioaccessibility of nutritional lipids during in vitro simulated digestion

The triglyceride (TAG) structure of lipids may affect their nutritional properties by affecting the process of digestion and absorption. In this paper, a mixture of medium-chain triglycerides and long-chain triglycerides (PM) and medium- and long-chain triglycerides (MLCT) were selected to explore the effects of triglyceride structure on in vitro digestion and bioaccessibility. The results showed that MLCT released more free fatty acids (FFAs) than PM (99.88% vs 92.82%, P < 0.05). The first-order rate constant for FFA release from MLCT was lower than that for PM (0.0395 vs 0.0444 s^-1, P < 0.05), which suggests that the rates of PM digestion were faster than those of MLCT. Our results demonstrated that DHA and EPA were more bioaccessible from MLCT than from PM. These results highlighted the important role of TAG structure in regulation of lipid digestibility and bioaccessibility.

Medium and long-chain structured triacylglycerol enhances vitamin D bioavailability in an emulsion-based delivery system: combination of in vitro and in vivo studies

Vitamin D (VitD) is an essential fat-soluble micronutrient required for maintaining and regulating calcium homeostasis. Although sunlight can provide VitD, epidemiological studies indicate that the occurrence of VitD deficiency and insufficiency is widespread. Lipids are required at all stages of VitD digestion and absorption. In this research two different medium and long-chain triacylglycerol structures, possessing identical fatty acid composition lipids, namely structured triacylglycerol (STG), and physical mixtures of medium/long-chain triacylglycerol (MCT/LCT), were selected. Our results demonstrated that STG had a significant VitD bioavailability compared to MCT/LCT. In terms of the lipid digestion and absorption, the extent of the higher free fatty acid released (69.42%, p < 0.05), extent of lipolysis (89.28%, p < 0.05), lipolysis rate (0.06 s^-1, p < 0.05), and the ratio of the long-chain fatty acid to medium-chain fatty acid of STG (4.8, p < 0.05), result in a higher capacity for accommodating VitD when forming mixed micelles (61.31%, p < 0.05). An in vivo animal study also demonstrated that STG significantly increases the delivery ability of VitD (18.75 ng mL^-1, p < 0.05). The findings of this work may have unique applications for designing novel interesterified lipids with an effective delivery capacity for fat-soluble nutrients.

The enzymatic synthesis of EPA-rich medium- and long-chain triacylglycerol improves the digestion behavior of MCFA and EPA: evidence on in vitro digestion

Medium-chain triglyceride (MCT) and eicosapentaenoic acid (EPA) have been widely applied in nutritional supplementation. However, when administered individually or mixed, they were unable to maximize their nutritional value. Hence, EPA-rich medium- and long-chain triacylglycerol (MLCT) was synthesized from MCT and EPA-rich fish oil (FO) by enzymatic transesterification. The fatty acids in triglyceride (TAG) were rearranged which resulted in significant changes in TAG profiles compared to the physical mixture of MCT and FO (PM). EPA-containing MML (MML, MLM and LMM) and LLM (LLM, LML and MLL) type TAGs account for 70.21%. The fate of different oils (MCT, FO, PM, and MLCT) across the gastrointestinal tract was subsequently simulated using an in vitro digestion model. The results showed that the physical and structural characteristics of different oils during digestion depended upon the oil type and the microenvironment they were in. After 120 min of small intestine digestion, the degree of hydrolysis for MLCT was higher than that for the other three oils. The final FFA release level was in the following order: MLCT (102.79%) > MCT (95.20%) > PM (85.81%) > FO (74.18%). This can be attributed to the composition and positional distribution of fatty acids in TAGs. What's more, LCFAs (EPA) in MLCT mainly existed in the form of sn-2 MAG, which was conducive to their subsequent absorption and transport. These results may aid in the future rational design of structural lipids, thereby regulating lipid digestion and maximizing the nutritional value of oils.

Does omega-3 PUFA-enriched oral nutritional intervention benefit cancer patients receiving chemo (radio) therapy? A systematic review and meta-analysis of randomized controlled trials

Although data indicate omega-3 polyunsaturated fatty acids are beneficial nutrients in cancer therapy, the evidences for efficacy of nutritional interventions during chemo (radio) therapy are still limited. The leading goal of the present meta-analysis was to summarize randomized controlled trials involving the administration of ω-3 PUFA-enriched oral nutritional supplements during chemo (radio) therapy, and evaluate the effects on nutritional status and clinical outcomes in patients. We systematically searched PubMed, Embase, Web of Science, Cochrane databases to identify interventions assessing body weight, BMI, immune and inflammatory indicators, plasma omega-3 fatty acids and adverse events, with subgroup analyses for region, types of ω-3 fatty acids, dose, duration and dosage form. In total, 22 studies including 1155 participants met the inclusion criteria. Meta-analysis showed a significant increase in body weight (BW) (WMD = 0.59 kg, 95% CI: 0.06, 1.13, P = 0.03), body mass index (BMI) (WMD = 0.43 kg/m², 95% CI: 0.07, 0.79, P = 0.02), and plasma total ω-3 fatty acids (SMD = 2.52, 95% CI: 1.27, 3.78, P<0.0001), and a significant reduction in plasma levels of C-reactive protein (CRP) (SMD= -0.53, 95% CI: -0.80, -0.25, P = 0.0001), tumor necrosis factor-α (TNF-α) (WMD = -0.40 pg/mL, 95% CI: -0.80, -0.01, P = 0.05), interleukin 6 (IL-6) (WMD = -1.25 pg/mL, 95% CI: -2.41, -0.10, P = 0.03) and the incidence of adverse events (RR= 0.72, 95% CI: 0.54, 0.95, P = 0.02). However, plasma albumin levels (WMD = 0.02 mg/dL, 95% CI: -0.13, 0.18, P = 0.75) was remained unaffected. Overall, our meta-analysis provides evidences that the consumption of ω-3 PUFA-enriched oral nutritional supplements exert beneficial effects on nutritional status and clinical outcomes in patients undergoing chemo (radio) therapy.