Efficacy and safety of central parenteral nutrition with a 1:1 ratio of n-3/n-6 polyunsaturated fatty acids in postsurgical gastric cancer patients: A pilot randomized controlled trial

Abstract

Background: N-3 polyunsaturated fatty acids (PUFAs) have been reported to exert clinical benefits including anti-inflammatory effects, immune modulation, and improved postoperative recovery. This study aimed to investigate the effects of central parenteral nutrition (CPN) with a 1:1 ratio of n-3/n-6 PUFAs on postoperative morbidity and lipid profile in gastric cancer patients undergoing gastrectomy. Methods: Sixty gastric cancer patients undergoing elective gastrectomy were randomly assigned to the experimental (n=31) and control (n=29) groups. The experimental group received CPN with a 1:1 ratio of n-3/n-6 PUFAs and taurine during the postoperative nil-per-os period (days 1–3), while the control group received CPN with a 1:2 ratio of n-3/n-6 PUFAs. Adverse drug reactions, overall adverse events, nitrogen balance, inflammatory indicators (C-reactive protein, interleukin-6, tumor necrosis factor-α), nutrition parameters (hemoglobin, total protein, albumin, prealbumin, transferrin), and fatty acid parameters (linoleic acid [LA, n-6], arachidonic acid [n-6], eicosapentaenoic acid [EPA, n-3], docosahexaenoic acid [DHA, n-3]) were compared. Results: No adverse drug reactions were observed in either group. Overall adverse event rates were similar between the groups. No significant differences were observed between the groups in changes in nutritional indicators or inflammatory markers. While the experimental group showed a trend toward improvement in nitrogen balance compared to the control group (0.63±2.37 vs. -1.24±4.57 g/day), this difference did not remain statistically significant after adjustment for multiple comparisons. Among the measured fatty acids, only the increase in EPA levels reached statistical significance after correction (57.50±31.45 μg/mL vs. 35.79±14.94 μg/mL, P<0.001). Increases in DHA levels and attenuation of LA increase showed favorable trends in the experimental group but were not statistically significant when accounting for multiple testing. Conclusion: Parenteral nutrition with a 1:1 ratio of n-3/n-6 PUFAs appears to be safe and may help modify fatty acid profiles in postoperative gastric cancer patients. Further large-scale studies are needed to validate these findings and evaluate their clinical significance. Trial registration number and date: ClinicalTrials.gov (NCT05299099); March 28, 2022.