Sum of serum n-3 fatty acids value might be correlated with residual living days in older adult patients with gastro-intestinal cancer Moeko Kitagawa1, RD, Seiji Haji2,MD, PhD, Teruyoshi Amagai1, MD, PhD This is the title of study to present today. “Sum of serum n-3 fatty acids value might be correlated with residual living days in older adult patients with gastro-intestinal cancer” 1: Department of Food Sciences and Nutrition, School of Environmental Sciences, Mukogawa Women’s University 2: Department of General Surgery, Takatsuki Hospital, Osaka

Background This number is expected to increase up to 22 million people According to the International Agency for Research on Cancer (IARC) affiliated by WHO, patients newly diagnosed cancer in 2012 were reached to 14 million people. This number is expected to increase up to 22 million people In the next 20 years. However, the nutritional management of cancer patients has not been studied to have an impact on their survival. Background of the present study were shown here. According to the International Agency for Research on Cancer (IARC) affiliated by WHO, patients newly diagnosed cancer in 2012 were reached to 14 million people. This number is expected to increase up to 22 million people in the next 20 years. However, the nutritional management of cancer patients has not been studied to have an impact on their survival.

If the weight loss is affecting survival days, weight loss prevention and extending survival days can be expected with evidence-based nutritional support. We, therefore, focused on changes of serum fatty acid in patients with cancer. Furthermore, we would analyzed that Alb, and CRP as daily- based parameters, could be utilized for predictor for survival in patients with advanced GI-cancers. If the weight loss is affecting survival days, weight loss prevention and extending survival days can be expected with evidence-based nutritional support. We, therefore, focused on changes of serum fatty acid in patients with cancer. Furthermore, we would analyze that serum albumin concentration and CRP, as a daily-based parameters, could be utilized for predictor for survival in patients with advanced GI-cancers.

Aim To investigate relationships among Serum fatty acids / amino acids concentrations Alb and CRP Survival rate between subjects with and without weight loss during study period The aim of this study was to investigate relationships among serum fatty acids / amino acids concentrations, serum albumin and C-reactive protein, and survival rate between subjects with and without weight loss during study period.

Method Figure 1. Flow chart This is flow chart to show Methods in this study. The details are mentioned in the next three slides. Figure 1. Flow chart

a Liver dysfunction：each of AST，ALT，T-Bil ＞1.5 The subjects were all consecutive patients with unrectable advanced BI cancers treated between December 2012 and September 2015 in a single acute hospital. 92 subjects were enrolled. Exclusion criteria were shown in the right box. 66 subjects were met exclusion criteria. 26 subjects were remained to analyze further investigations described in four methods. a Liver dysfunction：each of AST，ALT，T-Bil ＞1.5 upper limit of normal range b Renal dysfunction：S-creatinine ＞1.5 　　　　　　　　　　　　　upper limit of normal range

between BW before operation. The subject 26 people were divided into two groups according to weight loss presence and absence. Here, definition of weight loss was 5% or more weight loss of the pre-operative body weight. As the result, all 26 subjects were divided into two groups with and without weight loss The number of two groups were 13 each. In method 1, two groups were compared with their serum fatty / amino acids concentration, serum albumin and C-reactive protein, and survival days during the study period. In Method 2, survival curves in both groups were compared. c Weight loss was defined 5% or more body weight (BW) loss between BW before operation.

As we focused on serum Alb and CRP that might to influence the survival rate in cancer patients, we analyzed the correlation coefficient between Alb, CRP and serum in Method 3. Then finally, multiple regression analysis between the survival days and factors which showed strong correlations with correlation coefficient showed in Method 3.

Results Table 1. Subject characteristics Median (25%ile, 75%ile) Here is the subject characteristics in median, and 25%ile and 75%ile. Type of gastrointestinal cancer included five of cancers, such as stomach, colon, liver, biliary tract and pancreatic cancer. Median (25%ile, 75%ile)

Method 1. Method 1 Comparing individual data between two groups Table 2.Comparison result This is the result of Method 1 where comparison of the two groups with and without weight loss were conducted, using Mann-Whitney test. Except weight loss in the two groups, no demographics, Serum Alb, CRP as blood chemistry test, serum fatty acid, and amino acids profiles did not different significantly. It was performed using Mann–Whitney test.

Method 2. Survival curve Without weight loss With weight loss P=0.319 Survival function P=0.319 Cumulative survival Without weight loss Weight loss absence In Method 2, we analyzed survival curves in the two groups shown here. Survival curve of subjects with weight loss were drawn in green, and that od subjects without weight loss were drawn in blue. P value of this comparison between two groups during study periods was 0.319 and did not show significant difference. With weight loss presence Figure 2.Survival curve Survival days

Method 3. Correlation coefficient Table 3. Factors relate with Alb Table 4. Factors relate with CRP This is the result of the correlation coefficient of influential factors to serum Alb and CRP using Spearman's rank analysis. As shown here, There was a strong correlation between Alb and CRP, EPA and serum total n-3 fatty acids concentration shown in left table. Moreover, very surprisingly to us, CRP had strong correlation with survival days. In the other words, the lower CRP value, the shorter the length of survival days in patients with advanced GI-cancers.

Method 4. Multiple regression analysis Table 4. Multiple regression analysis of Alb Table 5. Multiple regression analysis of CRP Therefore, we conducted multiple regression analysis for CRP and survival days shown in Method 4 shown in the bottom table. As the analyzed result, the strong correlation between CRP and survival days were disappeared, although Alb showed the strong relationship with CRP. Contrary to our expectation, decrease of serum n-3 fatty acid also did not show significant relation with changes of CRP or Alb.

Limitations Retrospective study might produce non-randomized subjects’ bias Subjects’ number must be too small to draw the definitive conclusion It is not known whether causation or association that the decrease of serum n-3 fatty acids concentration and inflammation shown by CRP and hypoalbuminemia. 　Further investigation is needed. The limitation of this study were shown here. First, study was conducted in retrospective fashion. Therefore, the retrospective study might produce non-randomized subjects’ bias”. Second, subjects’ number must be too small to draw the definitive conclusion. Third, It is not known whether causation or association that the decrease of serum n-3 fatty acids concentration and inflammation shown by high CRP and low albumin. Further investigation is needed.

Conclusion This study could show that An inverse correlation between serum n-3 fatty acids concentration and CRP in patients with advanced GI-cancers Serum n-3 fatty acids concentration might be a predictor of survival in these patients This is the conclusion. This study could show that An inverse correlation between serum total n-3 fatty acids concentration Serum n-3 fatty acids concentration might be a predictor of survival in patients with advanced GI-cancers Thank you for your attention.