Suplementação de óleo de peixe em pacientes com câncer de mama com quimioterapia neoadjuvante pode alterar parâmetros nutricionais, bioquímicos e imunológicos?
DOI:
https://doi.org/10.5433/1679-0367.2019v40n2p185Palavras-chave:
Avaliação nutricional, Câncer de mama, Óleo de peixe. Quimioterapia. Citocinas.Resumo
O objetivo foi avaliar os efeitos da suplementação de ácidos graxos n-3 em pacientes com câncer de mama. Metodologia: estudo prospectivo longitudinal realizado em pacientes suplementados com óleo de peixe durante 8 semanas em quimioterapia neoadjuvante com regime AC-T. Antropometria e impedância bioelétrica (massa corporal magra (massa magra) - ângulo de fase (AP)), consumo alimentar, sintomas de impacto nutricional (SIN) e perfil metabólico e inflamatório foram avaliados. Resultados: Os pacientes apresentaram ganho de peso de 1,4 kg, representando 1,8% do peso corporal. LBM foi 42,3 kg e AP 6,1º. Náusea, diarreia e anorexia foram o SIN com redução na incidência com a suplementação, mas a xerostomia e a azia aumentaram. Houve uma queda significativa nos valores de hemoglobina para 12,3 mg/dL, parâmetros metabólicos e prognóstico nutricional (relação PCR/albumina) não foram alterados. Os níveis de citocinas de TNF-? e interleucina-6 não mudaram, entretanto a interleucina-2 mostrou um aumento significativo. Conclusão: O ganho de peso corporal foi observado nas pacientes com câncer de mama, independente do consumo alimentar. Durante a quimioterapia neoadjuvante com suplementação de óleo de peixe houve redução da presença de SIN, diminuição dos níveis de hemoglobina e manutenção de parâmetros bioquímicos e inflamatórios, exceto pelo aumento da citocina IL-2.Downloads
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Referências
Instituto Nacional do Cancer (BR). Estimativa 2018: Incidência de câncer no Brasil. Rio Janeiro: INCA; 2017.
Assi HA, Khoury KE, Dbouk H, Khalil LE, Mouhieddine TH, El Saghir NS. Epidemiology and prognosis of breast cancer in young women. J Thorac Dis [Internet]. 2013 [cited 2018, May 8]; 5 Suppl 1:S2-8. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3695538&tool=pmcentrez&rendertype=abstract
Lotici T, Antunes LBB, Melhem AR de F, Bennemann GD, Schiessel DL, Bianca L, et al. Prevalência De perda de peso, caquexia e desnutrição, em pacientes oncológicos. Rev Uniabeu. 2014;17(17):107-24.
Rocha LA, Cavagnari MAV, Freitas Melhem AR, Bennemann GD, Antunes LBB, Gavarrete D, et al. Incidência de caquexia, anemia e sintomas de impacto nutricional em pacientes oncológicos. Mundo da Saude. 2016;40(3):353-61.
Trédan O, Bajard A, Meunier A, Roux P, Fiorletta I, Gargi T, et al. Body weight change in women receiving adjuvant chemotherapy for breast cancer: a French prospective study. Clin Nutr [Internet]. 2010 Apr [cited 2018 May 8];29(2):187–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19713014
Huang A, Cao S, Tang L. The tumor microenvironment and inflammatory breast cancer. J Cancer. 2017;8(10):1884–91.
Baracos VE, Martin L, Korc M, Guttridge DC, Fearon KCH. Cancer-associated cachexia. Nat Rev Dis Prim [Internet]. 2018 [cited 2018 May 8];4(17105):1-18. Available from: http://www.nature.com/articles/nrdp2017105
Cespedes Feliciano EM, Kroenke CH, Meyerhardt JA, Prado CM, Bradshaw PT, Kwan ML, et al. Association of systemic inflammation and sarcopenia with survival in nonmetastatic colorectal cancer. JAMA Oncol [Internet]. 2017 [cited 2018 May 8]; 94612(12):e172319. Available from: http://oncology.jamanetwork.com/article.aspx?doi=10.1001/jamaoncol.2017.2319
Prado CMM, Lima ISF, Baracos VE, Bies RR, McCargar LJ, Reiman T, et al. An exploratory study of body composition as a determinant of epirubicin pharmacokinetics and toxicity. Cancer Chemother Pharmacol. 2011;67(1):93–101.
Prado CMM, Baracos VE, Mccargar LJ, Reiman T, Mourtzakis M, Tonkin K, et al. Cancer therapy: clinical sarcopenia as a determinant of chemotherapy toxicity and time to t umor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res. 2009;15(8):2920–6.
Norman K, Stobäus N, Pirlich M, Bosy-Westphal A. Bioelectrical phase angle and impedance vector analysis--clinical relevance and applicability of impedance parameters. Clin Nutr [Internet]. 2012 Dec [cited 2018 May 8]; 31(6):854–61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22698802
Schiessel DL, Yamazaki RK, Kryczyk M, Coelho I, Yamaguchi AA, Pequito DCT, et al. α-Linolenic Fatty Acid Supplementation Decreases Tumor Growth and Cachexia Parameters in Walker 256 Tumor-Bearing Rats. Nutr Cancer [Internet]. 2015 [cited 2018 May 8]; 67(5):839-46. Available from: http://www.tandfonline.com/loi/hnuc20
Kim J, Lim S-Y, Shin A, Sung M-K, Ro J, Kang H-S, et al. Fatty fish and fish omega-3 fatty acid intakes decrease the breast cancer risk: a case-control study. BMC Cancer [Internet]. 2009 [cited 2018 May 7]; 9(216). Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2711973&tool=pmcentrez&rendertype=abstract
Liu Y, Chen F, Odle J, Lin X, Zhu H, Shi H, et al. Fish Oil Increases Muscle Protein Mass and Modulates Akt/FOXO , TLR4 , and NOD Signaling in Weanling Piglets After Lipopolysaccharide Challenge. J Nutr. 2013;143:1331-9.
Omlin A, Blum D, Wierecky J, Haile SR, Ottery FD, Strasser F. Nutrition impact symptoms in advanced cancer patients: Frequency and specific interventions, a case-control study. J Cachexia Sarcopenia Muscle. 2013;4(1):55-61.
Schiessel DL, Yamazaki RK, Kryczyk M, Coelho I, Castro D, Yamaguchi AA, et al. Does Oil Rich in Alpha-Linolenic Fatty Acid Cause the Same Immune Modulation as Fish Oil in Walker 256 Tumor-Bearing Rats ? Nutr Cancer [Internet]. 2016 [cited 2018 May 7]; 68(8):1369-80. Available from: http://dx.doi.org/10.1080/01635581.2016.1224364
WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Heal Organ - Tech Rep Ser [Internet]. 2000 [cited 2018 May 7]; 894:253. Available from: http://books.google.com/books?hl=en&lr=&id=AvnqOsqv9doC&oi=fnd&pg=PA1&dq=Obesity:+Preventing+and+managing+the+global+epidemic&ots=6UF0cjXY6M&sig=iA1h8eoKNhRTKDfXqIVZaivyyk4%5Cnhttp://www.ncbi.nlm.nih.gov/pubmed/11234459
Lohman TG. Advances in body composition assessment. Champaign, IL: Human Kinetics Publishers; 1992. 150 p.
Wiseman MJ. Nutrition and cancer : prevention and survival. Br J Nutr. 2018;1–7.
Instituto Nacional do Cancer (BR). Estimativa 2016: Incidência de câncer no Brasil. Rio Janeiro. 2015.
Heetun A, Cutress RI, Copson ER. Early breast cancer: why does obesity affect prognosis? Proc Nutr Soc. 2018;(December 2017):1–13.
Yaw YH, Shariff ZM, Kandiah M, Mun CY, Yusof RM, Othman Z, et al. Weight changes and lifestyle behaviors in women after breast cancer diagnosis: a cross-sectional study. BMC Public Health [Internet]. 2011 [cited 2018 May 7]; 11(1):309. Available from: http://www.biomedcentral.com/1471-2458/11/309
Dieli-Conwright CM, Parmentier J-H, Sami N, Lee K, Spicer D, Mack WJ, et al. Adipose tissue inflammation in breast cancer survivors: effects of a 16-week combined aerobic and resistance exercise training intervention. Breast Cancer Res Treat [Internet]. 2018 Feb [cited 2018 May7]; 168(1):147–57. Available from: http://link.springer.com/10.1007/s10549-017-4576-y
Shachar SS, Deal AM, Weinberg M, Williams GR, Nyrop KA, Popuri K, et al. Body Composition as a Predictor of Toxicity in Patients Receiving Anthracycline and Taxane Based Chemotherapy for Early Stage Breast Cancer. Clin Cancer Res. 2017;23(14):3537-43.
Pérez Camargo DA, Allende Pérez SR, Rivera Franco MM, Álvarez Licona NE, Urbalejo Ceniceros VI, Figueroa Baldenegro LE. Phase Angle of Bioelectrical Impedance Analysis as Prognostic Factor in Palliative Care Patients at the National Cancer Institute in Mexico. Nutr Cancer. 2017;69(4):601–6.
Dicato M, Plawny L, Diederich M. Anemia in cancer. Ann Oncol Off J Eur Soc Med Oncol / ESMO. 2010;21(Supplement 7):167-72.
27 Gilreath JA, Stenehjem DD, Rodgers GM. Diagnosis and treatment of cancer-related anemia. Am J Hematol. 2014;89(2):203-12.
Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clin Nutr [Internet]. 2008 Dec [cited 2018 Mar 7]; 27(6):793–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18718696
Madeddu C, Gramignano G, Astara G, Demontis R, Sanna E, Atzeni V, et al. Pathogenesis and treatment options of cancer related anemia: perspective for a targeted mechanism-based approach. Front Physiol. 2018;9(SEP):1–20.
Dieli-Conwright CM, Lee K, Kiwata JL. Reducing the Risk of Breast Cancer Recurrence: an Evaluation of the Effects and Mechanisms of Diet and Exercise. Curr Breast Cancer Rep. 2016;8(3):139–50.
Petekkaya I, Aksoy S, Roach EC, Okoh AK, Gecmez G, Gezgen G, et al. Impact of inflammatory markers on the prognosis of patients with operable breast cancer. J BUON. 2014;19(3):673–80.
Paixão EMDS, Oliveira ACDM, Pizato N, Muniz-Junqueira MI, Magalhães KG, Nakano EY, et al. The effects of EPA and DHA enriched fish oil on nutritional and immunological markers of treatment naïve breast cancer patients: A randomized double-blind controlled trial. Nutr J. 2017;16(1):1–11.
Khan S, Shukla S, Sinha S, Meeran SM. Role of adipokines and cytokines in obesity-associated breast cancer: Therapeutic targets. Cytokine Growth Factor Rev [Internet]. 2013 [cited 2018 May 7]; 24(6):503–13. Available from: http://dx.doi.org/10.1016/j.cytogfr.2013.10.001
Jiang T, Zhou C, Ren S. Role of IL-2 in cancer immunotherapy. Oncoimmunology [Internet]. 2016 [cited 2018 May7]; 5(6):1–10. Available from: http://dx.doi.org/10.1080/2162402X.2016.1163462
Turbitt WJ, Black AJ, Collins SD, Meng H, Xu H, Washington S, et al. Fish Oil Enhances T Cell Function and Tumor Infiltration and Is Correlated with a Cancer Prevention Effect in HER-2/neu but Not PyMT Transgenic Mice. Nutr Cancer. 2015;67(6):965–75.
Mocellin MC, Camargo CQ, Nunes EA, Fiates GMR, Trindade EBSM. A systematic review and meta-analysis of the n-3 polyunsaturated fatty acids effects on inflammatory markers in colorectal cancer. Clin Nutr. 2016;35(2):359–69.
Mao M, Wei X, Sheng H, Chi P, Liu Y, Huang X, et al. C-reactive protein/albumin and neutrophil/lymphocyte ratios and their combination predict overall survival in patients with gastric cancer. Oncol Lett. 2017;14(6):7417–24.
Xu H, Ma Y, Deng F, Ju W, Sun X, Wang H. The prognostic value of C-reactive protein / albumin ratio in human malignancies : an updated meta- analysis. Onco Targets Ther. 2017;10:3059-70.
Mocellin MC, Pastore e Silva JDA, Camargo CDQ, Fabre MEDS, Gevaerd S, Naliwaiko K, et al. Fish oil decreases C-reactive protein/albumin ratio improving nutritional prognosis and plasma fatty acid profile in colorectal cancer patients. Lipids. 2013;48(9):879–88.
Silva JDAP, Trindade EBSDM, Fabre MEDS, Menegotto VM, Gevaerd S, Buss ZDS, et al. Fish Oil Supplement Alters Markers of Inflammatory and Nutritional Status in Colorectal Cancer Patients. Nutr Cancer. 2012;64(2):267–73.
Abdelmagid SA, MacKinnon JL, Janssen SM, Ma DWL. Role of n-3 Polyunsaturated Fatty Acids and Exercise in Breast Cancer Prevention: Identifying Common Targets. Nutr Metab Insights [Internet]. 2016 [cited 2018 May 7]; 9:71–84. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27812288%5Cnhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5089819
Assi HA, Khoury KE, Dbouk H, Khalil LE, Mouhieddine TH, El Saghir NS. Epidemiology and prognosis of breast cancer in young women. J Thorac Dis [Internet]. 2013 [cited 2018, May 8]; 5 Suppl 1:S2-8. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3695538&tool=pmcentrez&rendertype=abstract
Lotici T, Antunes LBB, Melhem AR de F, Bennemann GD, Schiessel DL, Bianca L, et al. Prevalência De perda de peso, caquexia e desnutrição, em pacientes oncológicos. Rev Uniabeu. 2014;17(17):107-24.
Rocha LA, Cavagnari MAV, Freitas Melhem AR, Bennemann GD, Antunes LBB, Gavarrete D, et al. Incidência de caquexia, anemia e sintomas de impacto nutricional em pacientes oncológicos. Mundo da Saude. 2016;40(3):353-61.
Trédan O, Bajard A, Meunier A, Roux P, Fiorletta I, Gargi T, et al. Body weight change in women receiving adjuvant chemotherapy for breast cancer: a French prospective study. Clin Nutr [Internet]. 2010 Apr [cited 2018 May 8];29(2):187–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19713014
Huang A, Cao S, Tang L. The tumor microenvironment and inflammatory breast cancer. J Cancer. 2017;8(10):1884–91.
Baracos VE, Martin L, Korc M, Guttridge DC, Fearon KCH. Cancer-associated cachexia. Nat Rev Dis Prim [Internet]. 2018 [cited 2018 May 8];4(17105):1-18. Available from: http://www.nature.com/articles/nrdp2017105
Cespedes Feliciano EM, Kroenke CH, Meyerhardt JA, Prado CM, Bradshaw PT, Kwan ML, et al. Association of systemic inflammation and sarcopenia with survival in nonmetastatic colorectal cancer. JAMA Oncol [Internet]. 2017 [cited 2018 May 8]; 94612(12):e172319. Available from: http://oncology.jamanetwork.com/article.aspx?doi=10.1001/jamaoncol.2017.2319
Prado CMM, Lima ISF, Baracos VE, Bies RR, McCargar LJ, Reiman T, et al. An exploratory study of body composition as a determinant of epirubicin pharmacokinetics and toxicity. Cancer Chemother Pharmacol. 2011;67(1):93–101.
Prado CMM, Baracos VE, Mccargar LJ, Reiman T, Mourtzakis M, Tonkin K, et al. Cancer therapy: clinical sarcopenia as a determinant of chemotherapy toxicity and time to t umor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res. 2009;15(8):2920–6.
Norman K, Stobäus N, Pirlich M, Bosy-Westphal A. Bioelectrical phase angle and impedance vector analysis--clinical relevance and applicability of impedance parameters. Clin Nutr [Internet]. 2012 Dec [cited 2018 May 8]; 31(6):854–61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22698802
Schiessel DL, Yamazaki RK, Kryczyk M, Coelho I, Yamaguchi AA, Pequito DCT, et al. α-Linolenic Fatty Acid Supplementation Decreases Tumor Growth and Cachexia Parameters in Walker 256 Tumor-Bearing Rats. Nutr Cancer [Internet]. 2015 [cited 2018 May 8]; 67(5):839-46. Available from: http://www.tandfonline.com/loi/hnuc20
Kim J, Lim S-Y, Shin A, Sung M-K, Ro J, Kang H-S, et al. Fatty fish and fish omega-3 fatty acid intakes decrease the breast cancer risk: a case-control study. BMC Cancer [Internet]. 2009 [cited 2018 May 7]; 9(216). Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2711973&tool=pmcentrez&rendertype=abstract
Liu Y, Chen F, Odle J, Lin X, Zhu H, Shi H, et al. Fish Oil Increases Muscle Protein Mass and Modulates Akt/FOXO , TLR4 , and NOD Signaling in Weanling Piglets After Lipopolysaccharide Challenge. J Nutr. 2013;143:1331-9.
Omlin A, Blum D, Wierecky J, Haile SR, Ottery FD, Strasser F. Nutrition impact symptoms in advanced cancer patients: Frequency and specific interventions, a case-control study. J Cachexia Sarcopenia Muscle. 2013;4(1):55-61.
Schiessel DL, Yamazaki RK, Kryczyk M, Coelho I, Castro D, Yamaguchi AA, et al. Does Oil Rich in Alpha-Linolenic Fatty Acid Cause the Same Immune Modulation as Fish Oil in Walker 256 Tumor-Bearing Rats ? Nutr Cancer [Internet]. 2016 [cited 2018 May 7]; 68(8):1369-80. Available from: http://dx.doi.org/10.1080/01635581.2016.1224364
WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Heal Organ - Tech Rep Ser [Internet]. 2000 [cited 2018 May 7]; 894:253. Available from: http://books.google.com/books?hl=en&lr=&id=AvnqOsqv9doC&oi=fnd&pg=PA1&dq=Obesity:+Preventing+and+managing+the+global+epidemic&ots=6UF0cjXY6M&sig=iA1h8eoKNhRTKDfXqIVZaivyyk4%5Cnhttp://www.ncbi.nlm.nih.gov/pubmed/11234459
Lohman TG. Advances in body composition assessment. Champaign, IL: Human Kinetics Publishers; 1992. 150 p.
Wiseman MJ. Nutrition and cancer : prevention and survival. Br J Nutr. 2018;1–7.
Instituto Nacional do Cancer (BR). Estimativa 2016: Incidência de câncer no Brasil. Rio Janeiro. 2015.
Heetun A, Cutress RI, Copson ER. Early breast cancer: why does obesity affect prognosis? Proc Nutr Soc. 2018;(December 2017):1–13.
Yaw YH, Shariff ZM, Kandiah M, Mun CY, Yusof RM, Othman Z, et al. Weight changes and lifestyle behaviors in women after breast cancer diagnosis: a cross-sectional study. BMC Public Health [Internet]. 2011 [cited 2018 May 7]; 11(1):309. Available from: http://www.biomedcentral.com/1471-2458/11/309
Dieli-Conwright CM, Parmentier J-H, Sami N, Lee K, Spicer D, Mack WJ, et al. Adipose tissue inflammation in breast cancer survivors: effects of a 16-week combined aerobic and resistance exercise training intervention. Breast Cancer Res Treat [Internet]. 2018 Feb [cited 2018 May7]; 168(1):147–57. Available from: http://link.springer.com/10.1007/s10549-017-4576-y
Shachar SS, Deal AM, Weinberg M, Williams GR, Nyrop KA, Popuri K, et al. Body Composition as a Predictor of Toxicity in Patients Receiving Anthracycline and Taxane Based Chemotherapy for Early Stage Breast Cancer. Clin Cancer Res. 2017;23(14):3537-43.
Pérez Camargo DA, Allende Pérez SR, Rivera Franco MM, Álvarez Licona NE, Urbalejo Ceniceros VI, Figueroa Baldenegro LE. Phase Angle of Bioelectrical Impedance Analysis as Prognostic Factor in Palliative Care Patients at the National Cancer Institute in Mexico. Nutr Cancer. 2017;69(4):601–6.
Dicato M, Plawny L, Diederich M. Anemia in cancer. Ann Oncol Off J Eur Soc Med Oncol / ESMO. 2010;21(Supplement 7):167-72.
27 Gilreath JA, Stenehjem DD, Rodgers GM. Diagnosis and treatment of cancer-related anemia. Am J Hematol. 2014;89(2):203-12.
Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clin Nutr [Internet]. 2008 Dec [cited 2018 Mar 7]; 27(6):793–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18718696
Madeddu C, Gramignano G, Astara G, Demontis R, Sanna E, Atzeni V, et al. Pathogenesis and treatment options of cancer related anemia: perspective for a targeted mechanism-based approach. Front Physiol. 2018;9(SEP):1–20.
Dieli-Conwright CM, Lee K, Kiwata JL. Reducing the Risk of Breast Cancer Recurrence: an Evaluation of the Effects and Mechanisms of Diet and Exercise. Curr Breast Cancer Rep. 2016;8(3):139–50.
Petekkaya I, Aksoy S, Roach EC, Okoh AK, Gecmez G, Gezgen G, et al. Impact of inflammatory markers on the prognosis of patients with operable breast cancer. J BUON. 2014;19(3):673–80.
Paixão EMDS, Oliveira ACDM, Pizato N, Muniz-Junqueira MI, Magalhães KG, Nakano EY, et al. The effects of EPA and DHA enriched fish oil on nutritional and immunological markers of treatment naïve breast cancer patients: A randomized double-blind controlled trial. Nutr J. 2017;16(1):1–11.
Khan S, Shukla S, Sinha S, Meeran SM. Role of adipokines and cytokines in obesity-associated breast cancer: Therapeutic targets. Cytokine Growth Factor Rev [Internet]. 2013 [cited 2018 May 7]; 24(6):503–13. Available from: http://dx.doi.org/10.1016/j.cytogfr.2013.10.001
Jiang T, Zhou C, Ren S. Role of IL-2 in cancer immunotherapy. Oncoimmunology [Internet]. 2016 [cited 2018 May7]; 5(6):1–10. Available from: http://dx.doi.org/10.1080/2162402X.2016.1163462
Turbitt WJ, Black AJ, Collins SD, Meng H, Xu H, Washington S, et al. Fish Oil Enhances T Cell Function and Tumor Infiltration and Is Correlated with a Cancer Prevention Effect in HER-2/neu but Not PyMT Transgenic Mice. Nutr Cancer. 2015;67(6):965–75.
Mocellin MC, Camargo CQ, Nunes EA, Fiates GMR, Trindade EBSM. A systematic review and meta-analysis of the n-3 polyunsaturated fatty acids effects on inflammatory markers in colorectal cancer. Clin Nutr. 2016;35(2):359–69.
Mao M, Wei X, Sheng H, Chi P, Liu Y, Huang X, et al. C-reactive protein/albumin and neutrophil/lymphocyte ratios and their combination predict overall survival in patients with gastric cancer. Oncol Lett. 2017;14(6):7417–24.
Xu H, Ma Y, Deng F, Ju W, Sun X, Wang H. The prognostic value of C-reactive protein / albumin ratio in human malignancies : an updated meta- analysis. Onco Targets Ther. 2017;10:3059-70.
Mocellin MC, Pastore e Silva JDA, Camargo CDQ, Fabre MEDS, Gevaerd S, Naliwaiko K, et al. Fish oil decreases C-reactive protein/albumin ratio improving nutritional prognosis and plasma fatty acid profile in colorectal cancer patients. Lipids. 2013;48(9):879–88.
Silva JDAP, Trindade EBSDM, Fabre MEDS, Menegotto VM, Gevaerd S, Buss ZDS, et al. Fish Oil Supplement Alters Markers of Inflammatory and Nutritional Status in Colorectal Cancer Patients. Nutr Cancer. 2012;64(2):267–73.
Abdelmagid SA, MacKinnon JL, Janssen SM, Ma DWL. Role of n-3 Polyunsaturated Fatty Acids and Exercise in Breast Cancer Prevention: Identifying Common Targets. Nutr Metab Insights [Internet]. 2016 [cited 2018 May 7]; 9:71–84. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27812288%5Cnhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5089819
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2019-11-30
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Rosset AJL, Cavagnari MAV, Melhem AR de F, Bennemann GD, Gavarrete DD, Schiessel DL. Suplementação de óleo de peixe em pacientes com câncer de mama com quimioterapia neoadjuvante pode alterar parâmetros nutricionais, bioquímicos e imunológicos?. Semin. Cienc. Biol. Saude [Internet]. 30º de novembro de 2019 [citado 21º de novembro de 2024];40(2):185-96. Disponível em: https://ojs.uel.br/revistas/uel/index.php/seminabio/article/view/35936
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