, Volume 48, Issue 9, pp 879–888 | Cite as

Fish Oil Decreases C-Reactive Protein/Albumin Ratio Improving Nutritional Prognosis and Plasma Fatty Acid Profile in Colorectal Cancer Patients

  • Michel Carlos MocellinEmail author
  • Juliana de Aguiar Pastore e Silva
  • Carolina de Quadros Camargo
  • Maria Emília de Souza Fabre
  • Scheila Gevaerd
  • Katya Naliwaiko
  • Yara Maria Franco Moreno
  • Everson Araújo Nunes
  • Erasmo Benicio Santos de Moraes Trindade
Original Article


Previous studies have shown that n-3 polyunsaturated fatty acids n-3 (n-3 PUFA) have several anticancer effects, especially attributed to their ability to modulate a variety of genomic and immune responses. In this context, this randomized, prospective, controlled clinical trial was conducted in order to check whether supplementation of 2 g/day of fish oil for 9 weeks alters the production of inflammatory markers, the plasma fatty acid profile and the nutritional status in patients with colorectal cancer (CRC). Eleven adults with CRC in chemotherapy were randomized into two groups: (a) supplemented (SG) daily with 2 g/day of encapsulated fish oil [providing 600 mg/day of eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA)] for 9 weeks (n = 6), and (b) control (CG) (n = 5). All outcomes were evaluated on the day before the first chemotherapy session and 9 weeks later. Plasma TNF-α, IL-1β, IL-10 and IL-17A, the pro/anti-inflammatory balance (ratio TNF-α/IL-10 and IL-1β/IL10) and serum albumin, showed no significant changes between times and study groups (p > 0.05). C-reactive protein (CRP) and the CRP/albumin ratio showed opposite behavior in groups, significantly reducing their values in SG (p < 0.05). Plasma proportions of EPA and DHA increased 1.8 and 1.4 times, respectively, while the ARA reduced approximately 0.6 times with the supplementation (9 weeks vs baseline, p < 0.05). Patients from SG gained 1.2 kg (median) while the CG lost −0.5 kg (median) during the 9 weeks of chemotherapy (p = 0.72). These results demonstrate that 2 g/day of fish oil for 9 weeks of chemotherapy improves CRP values, CRP/albumin status, plasma fatty acid profile and potentially prevents weight loss during treatment.


Fish oil n-3 Polyunsaturated fatty acids Colorectal cancer Chemotherapy Cytokines Fatty acid profile 



Arachidonic acid


Body mass index


Control group




Colorectal cancer


C-Reactive protein


Docosahexaenoic acid


Enzyme-linked immunosorbent assay


Eicosapentaenoic acid


High pressure liquid chromatography




Nuclear factor κB




Prognostic inflammatory and nutritional index


Peroxisome proliferator-activated receptors


Polyunsaturated fatty acid


Santa Catarina


Supplemented group


Tumor necrosis factor


Tumor staging


Visual basic



We are grateful to the Post-Graduate Program in Nutrition—Federal University of Santa Catarina, Brazil; the Fellowship Program Social Demand/Coordination of Improvement of Higher Education Personnel (CAPES) with a scholarship grant to the senior author; and to the Foundation that Supports Research and Innovation in the State of Santa Catarina (FAPESC) by financing evaluations of inflammatory markers. Thanks also to Phytomare for the donation of the dietary supplements.

Conflict of interest

The authors state that there was no conflict of interests in any step of this study.


  1. 1.
    Connolly JM, Coleman M, Rose DP (1997) Effects of dietary fatty acids on DU145 human prostate cancer cell growth in athymic nude mice. Nutr Cancer 29:114–119PubMedCrossRefGoogle Scholar
  2. 2.
    Connolly JM, Gilhooly EM, Rose DP (1999) Effects of reduced dietary linoleic acid intake, alone or combined with an algae source of docosahexaenoic acid on MDA-MB-231 breast cancer cell growth and apoptosis in nude mice. Nutr Cancer 35:44–49PubMedCrossRefGoogle Scholar
  3. 3.
    Calder PC, Davis J, Yaqoob P et al (1998) Dietary fish oil suppresses human colon tumor growth in athymic mice. Clin Sci 94:303–311PubMedGoogle Scholar
  4. 4.
    Chen ZY, Istfan NW (2000) Docohexaenoic acid is a potent inducer of apoptosis in HT-29 colon cancer cells. Prostaglandins Leukot Essent Fatty Acids 63:301–308PubMedCrossRefGoogle Scholar
  5. 5.
    Jordan A, Stein J (2003) Effect of an omega-3 fatty acid containing lipid emulsion alone and in combination with 5-fluorouracil (5-FU) on growth of the colon cancer cell line Caco-2. Eur J Nutr 42:324–331PubMedCrossRefGoogle Scholar
  6. 6.
    DeGraffenried LA, Friedrichs WE, Fulcher L et al (2003) Eicosapentaenoic acid restores tamoxifen sensitivity in breast cancer cells with high Akt activity. Ann Oncol 14:969–970CrossRefGoogle Scholar
  7. 7.
    Feng Z, Hu W, Marnett LJ et al (2006) Malondialdehyde, a major endogenous lipid peroxidation product, sensitizes human cells to UV- and BPDE-induced killing and mutagenesis through inhibition of nucleotide excision repair. Mutat Res 601:125–136PubMedCrossRefGoogle Scholar
  8. 8.
    Moses AW, Slater C, Preston T et al (2004) Reduced total energy expenditure and physical activity in cachexia patients with pancreatic cancer can be modulated by an energy and protein dense oral supplement enriched with n-3 fatty acids. Br J Cancer 90:996–1002PubMedCrossRefGoogle Scholar
  9. 9.
    Colomer R, Moreno-Nogueira JM, García-Luna PP et al (2007) n-3 fatty acids, cancer and cachexia: a systematic review of the literature. Br J Nutr 97:823–831PubMedCrossRefGoogle Scholar
  10. 10.
    Bonatto SR, Oliveira HP, Nunes EA et al (2012) Fish oil supplementation improves neutrophil function during cancer chemotherapy. Lipids 47:383–389PubMedCrossRefGoogle Scholar
  11. 11.
    Cury-Boaventura MF, Torrinhas RS, Godoy AB et al (2012) Human leukocyte death after a preoperative infusion of medium/long-chain triglyceride and fish oil parenteral emulsions: a randomized study in gastrointestinal cancer patients. JPEN J Parenter Enteral Nutr 36(6):677–684PubMedCrossRefGoogle Scholar
  12. 12.
    Cockbain AJ, Toogood GJ, Hull MA (2012) Omega-3 polyunsaturated fatty acids for the treatment and prevention of colorectal cancer. Gut 61:135–149PubMedCrossRefGoogle Scholar
  13. 13.
    Janakiram NB, Mohammed A, Rao CV (2011) Role of lipoxins, resolvins, and other bioactive lipids in colon and pancreatic cancer. Cancer Metastasis Rev 30:507–523PubMedCrossRefGoogle Scholar
  14. 14.
    Hull MA (2011) Omega-3 polyunsaturated fatty acids. Best Pract Res Clin Gastroenterol 25:547–554PubMedCrossRefGoogle Scholar
  15. 15.
    Yang E, Chan D, Felix E et al (2004) Formation and antiproliferative effect of prostaglandin E3 from eicosapentaenoic acid in human lung cancer cells. J Lipid Res 45:1030–1039PubMedCrossRefGoogle Scholar
  16. 16.
    Chapkin RS, Kim W, Lupton JR et al (2009) Dietary docosahexaenoic and eicosapentaenoic acid: emerging mediators of inflammation. Prostaglandins Leukot Essent Fatty Acids 81:187–191PubMedCrossRefGoogle Scholar
  17. 17.
    Szkaradkiewicz A, Marciniak R, Chudzicka-Strugała I et al (2009) Proinflammatory cytokines and IL-10 in inflammatory bowel disease and colorectal cancer patients. Arch Immunol Ther Exp 57:291–294CrossRefGoogle Scholar
  18. 18.
    Chung YC, Chang YF (2003) Serum C-reactive protein correlates with survival in colorectal cancer patients but is not an independent prognostic indicator. Eur J Gastroenterol Hepatol 15:369–373PubMedCrossRefGoogle Scholar
  19. 19.
    Rickham PP (1964) Human experimentation. Code of ethics of the World Medical Association. Declaration of Helsinki. Br Med J 2:0–177Google Scholar
  20. 20.
    Peltola H, Valmari P (1985) Serum C-reactive protein as detector of pretreated childhood bacterial meningitis. Neurology 35:251–253PubMedCrossRefGoogle Scholar
  21. 21.
    Doumas BT, Watson WA, Biggs HG (1971) Albumin standards and the measurement of serum albumin with bromocresol green. Clin Chim Acta 31:87–96PubMedCrossRefGoogle Scholar
  22. 22.
    Corrêa CR, Angelili AO, Camargo NR et al (2002) Comparação entre a relação PCR/albumina e o índice prognóstico inflamatório nutricional (IPIN). Jornal Brasileiro de Patologia e Medicina Laboratorial 38:183–190CrossRefGoogle Scholar
  23. 23.
    Lohman TG, Roche AF, Martorell R (1988) Anthropometric standardization reference manual. Human Kinetics, ChampaignGoogle Scholar
  24. 24.
    World Health Organization (1998) Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity. WHO, GenevaGoogle Scholar
  25. 25.
    Detsky AS, McLaughlin JR, Baker JP et al (1987) What is subjective global assessment of nutritional status? J Parenter Enter Nutr 11:8–13CrossRefGoogle Scholar
  26. 26.
    Durnin JV, Womersley J (1974) Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 32:77–97PubMedCrossRefGoogle Scholar
  27. 27.
    Braga M, Gianotti L, Vignali A et al (2002) Preoperative oral arginine and fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer. Surgery 132:805–814PubMedCrossRefGoogle Scholar
  28. 28.
    Matsuda A, Furukawa K, Takasaki H et al (2006) Preoperative oral immune-enhancing nutritional supplementation corrects Th1/Th2 imbalance in patients undergoing elective surgery for colorectal cancer. Dis Colon Rectum 49:507–516PubMedCrossRefGoogle Scholar
  29. 29.
    Read JA, Beale PJ, Volker DH et al (2007) Nutrition intervention using an eicosapenatenoic acid (EPA)-containing supplement in patients with advanced colorectal cancer. Effects on nutritional and inflammatory status: a phase II trial. Support Care Cancer 15:301–307PubMedCrossRefGoogle Scholar
  30. 30.
    Liang B, Wang S, Ye YJ et al (2008) Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and immunomodulations in colorectal cancer patients. World J Gastroenterol 21:2434–2439CrossRefGoogle Scholar
  31. 31.
    Silva JA, Trindade EB, Fabre ME et al (2012) Fish oil supplement alters markers of inflammatory and nutritional status in colorectal cancer patients. Nutr Cancer 64:267–273CrossRefGoogle Scholar
  32. 32.
    Zhu MW, Tang DN, Hou J et al (2012) Impact of fish oil enriched total parenteral nutrition on elderly patients after colorectal cancer surgery. Chin Med J 125:178–181PubMedGoogle Scholar
  33. 33.
    Purasiri P, Murray A, Richardson S et al (1994) Modulation of cytokine in vivo by dietary essential fatty acids in patients with colorectal cancer. Clin Sci 87:711–717PubMedGoogle Scholar
  34. 34.
    Erlinger TP, Platz EA, Rifai N et al (2004) C-reactive protein and the risk of incident colorectal cancer. JAMA 291:585–590PubMedCrossRefGoogle Scholar
  35. 35.
    Gunter MJ, Stolzenberg-Solomon R, Cross AJ et al (2006) A prospective study of serum C-reactive protein and colorectal cancer risk in men. Cancer Res 66:2483–2487PubMedCrossRefGoogle Scholar
  36. 36.
    Il’yasova D, Colbert LH, Harris TB et al (2005) Circulating levels of inflammatory markers and cancer risk in the health aging and body composition cohort. Cancer Epidemiol Biomarkers Prev 14:2413–2418PubMedCrossRefGoogle Scholar
  37. 37.
    Shiu YC, Lin JK, Huang CJ et al (2008) Is C-reactive protein a prognostic factor of colorectal cancer? Dis Colon Rectum 51:443–449PubMedCrossRefGoogle Scholar
  38. 38.
    Ingembleek Y, Carpentier Y (1984) A prognostic inflammatory and nutritional index scoring critically ill patients. Internat J Vit Nutr Res 55:91–101Google Scholar
  39. 39.
    Wu S, Rhee KJ, Albesiano E et al (2009) A human colonic commensal promotes colon tumorigenesis via activation of T helper type 17 T cell responses. Nat Med 15:1016–1022PubMedCrossRefGoogle Scholar
  40. 40.
    Chae WJ, Gibson TF, Zelterman D et al (2010) Ablation of IL-17A abrogates progression of spontaneous intestinal tumorigenesis. PNAS 107:5540–5544PubMedCrossRefGoogle Scholar
  41. 41.
    Chae WJ, Bothwell AL (2011) IL-17 and intestinal tumorigenesis. Drugs Discov Today: Dis Mech 8:e79–e83CrossRefGoogle Scholar
  42. 42.
    Sánchez LK, Ugalde ME, Motola KD et al (2012) Gastrointestinal symptoms and weight loss in cancer patients receiving chemotherapy. Br J Nutr 12:1–4Google Scholar
  43. 43.
    Furukawa T, Tashiro H, Yamamori K et al (1999) Effects of soybean oil emulsion and eicosapentaenoic acid on stress response and immune function after a severely stressful operation. Ann Surg 229:255–261PubMedCrossRefGoogle Scholar

Copyright information

© AOCS 2013

Authors and Affiliations

  • Michel Carlos Mocellin
    • 1
    Email author
  • Juliana de Aguiar Pastore e Silva
    • 2
  • Carolina de Quadros Camargo
    • 1
  • Maria Emília de Souza Fabre
    • 2
  • Scheila Gevaerd
    • 2
  • Katya Naliwaiko
    • 3
  • Yara Maria Franco Moreno
    • 1
  • Everson Araújo Nunes
    • 4
  • Erasmo Benicio Santos de Moraes Trindade
    • 1
  1. 1.Post-Graduate Program of Nutrition, Department of NutritionFederal University of Santa CatarinaFlorianópolisBrazil
  2. 2.Ambulatory Care Clinic and Oncologic Research CenterFlorianópolisBrazil
  3. 3.Department of PhysiologyFederal University of ParanáCuritibaBrazil
  4. 4.Post-Graduate Program of Nutrition, Multicenter Program of Post-Graduation in Physiological Sciences, Department of PhysiologyFederal University of Santa CatarinaFlorianópolisBrazil

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