Can fish oil supplementation in breast cancer patients with neoadjuvant chemotherapy alter nutritional, biochemical and immunological parameters?
DOI:
https://doi.org/10.5433/1679-0367.2019v40n2p185Keywords:
Nutritional assessment, Breast cancer, Fish oil, Chemotherapy, Cytokines.Abstract
The aim of this study was to evaluate the n-3 fatty acid supplementation effects in breast cancer patients. Methods: it was a prospective longitudinal study performed in breast cancer patients supplemented with fish oil during 8 weeks in neoadjuvant AC-T regimen. Anthropometric, Bioelectrical impedance (BIA) ((Lean Body Mass (LBM), and Phase Angle (PA)), food consumption, nutritional impact symptoms (NIS), metabolic and inflammatory profile were evaluated for 2 months. Results: supplemented patients presented weight gain of 1.4 kg, representing 1.8% of body weight. LBM was 42.3 Kg and PA 6.1º. Nausea, diarrhea and anorexia were the main NIS with reduction in incidence with the supplementation, but xerostomia and heartburn had increase. There was significant drop in hemoglobin values to 12.3 mg/dL, metabolic parameters and nutritional prognosis (CRP/albumin ratio) were not altered. Cytokines levels of TNF-? and interleukin-6 did not change, however interleukin-2 have shown significant increasing. Conclusion: Body weight gain was noticed in breast cancer patients, independent of food consumption. Fish oil supplementation during neoadjuvant chemotherapy was able to reduce NIS incidence, but not avoiding the decrease of hemoglobin levels, but it keeps the maintenance of pro-inflammatory parameters, except for increased the cytokine IL-2.Downloads
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References
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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. Can fish oil supplementation in breast cancer patients with neoadjuvant chemotherapy alter nutritional, biochemical and immunological parameters?. Semin. Cienc. Biol. Saude [Internet]. 2019 Nov. 30 [cited 2024 Nov. 21];40(2):185-96. Available from: https://ojs.uel.br/revistas/uel/index.php/seminabio/article/view/35936
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