Expert panel reveals the latest research on the multiple benefits of EPA and DHA in medical nutrition

New research explores the benefits of EPA and DHA in clinical settings

• As the global population ages and the prevalence of non-communicable diseases (NCDs) rises, there is a growing demand for appropriate nutrition interventions and targeted medical nutrition solutions that address increasingly complex patient needs, improve outcomes and help to reduce healthcare costs.
• A recent expert paper published in the Nutrients journal explores the latest scientific research behind eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) omega-3 fatty acids and how these ingredients may contribute to better quality of life and clinical outcomes in patients and senior adults.
• The expert panel investigated the benefits of EPA and DHA in specific therapeutic areas and patient populations, and discussed how this inspires the development of more targeted and palatable medical nutrition solutions.

Life expectancy is rising worldwide, leading to a higher prevalence of age and lifestyle-related non-communicable diseases (NCDs) and an increasing number of patients and older  people presenting with complex medical needs. Optimal nutritional care is essential for these individuals as it helps to support healthy immune function, reduce medical complications and promote the recovery and independence of patients. However, disease-related malnutrition – a condition characterized by inadequate intake of energy, protein and/or micronutrients resulting from disease or treatment of disease – is common in many clinical conditions and can lead to poorer prognosis. As such, medical nutrition products – like oral nutritional supplements or enteral nutrition – may be required to address nutritional deficiencies in vulnerable patients, giving them the best possible clinical outcomes.

A newly published paper explores the mounting body of scientific evidence linking eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake to patient health and how these ingredients support older persons and patients1. With the available research, the expert panel concluded that provision of oral nutritional supplements, or enteral and parenteral formulas containing EPA and DHA may help to support a number of patient populations in a variety of therapeutic areas.

Here, we highlight the key conclusions and scientific insights published in the paper.

EPA and DHA exhibit promising benefits across several therapeutic areas

Chronic inflammation is usually present in individuals with NCDs. Supporting the resolution of inflammation and ensuring it is properly regulated in the body is therefore considered to be appropriate in the management of disease. The long-chain omega-3 fatty acids, EPA and DHA, are known to play a role in human health and normal immune function, with one of their primary actions being to reduce inflammation and promote its resolution.^1,2,3 Research shows that this broad action helps to reduce medical complications and support the nutritional needs of patients in many different therapeutic areas.4,5,6,7 In the new publication, the expert panel identified a role for EPA and DHA nutrition in a number of patient populations and medical conditions, including cognitive health, age-related decline in muscle mass, cancer, surgical patients and critically ill patients.8,9,10 As a result, adequate supply of long-chain omega-3 fatty acids should be seen as a critical component in the nutritional management of patients presenting with these conditions.

Research roundup: what are the key application areas for EPA and DHA?

• Cognitive decline: As people are living for longer, cognitive decline has become a growing public health concern, and the number of people living with dementia is expected to reach 75 million by 2030.12 The expert panel discussed is increasing evidence to suggest that EPA and DHA intake may support brain health and even help to slow cognitive decline, particularly in the early stages of dementia. One study showed that omega-3 LCPUFA supplementation had a small effect on memory in non-demented older people, whereas another report showed it had an effect on executive function.13,14 Another analysis found a beneficial effect of omega-3 LCPUFA supplementation on the progression of cognitive decline at an early stage in individuals with the ApoE ε4 genotype – an important genetic risk factor for age-dependent chronic diseases, including Alzheimer’s disease.15 However, the expert panel concluded that EPA and DHA intervention is less likely to have a beneficial effect on individuals experiencing dementia that has progressed beyond the mild stage^{.16,17,18,19,20} This is supported by a recent meta-analysis which determined that EPA and DHA is most beneficial in patients presenting with the early stages of Alzheimer’s disease and makes individuals with mild cognitive decline the most promising target group for nutritional intervention.²¹
• Sarcopenia: Old age is accompanied by an increasing number of comorbidities, aswell as challenges achieving adequate intake of energy and essential nutrients. This means that conditions like sarcopenia (progressive muscle loss), malnutrition and frailty are often common and overlapping in the senior population and can have a negative impact on quality of life and independence.^22,23 Age-related chronic low-grade inflammation may be an important contributor to sarcopenia.^24,25 As such, the anti-inflammatory effects of EPA and DHA may be beneficial in slowing age-related muscle loss (sarcopenia).²⁶ Furthermore, omega-3 fatty acids may modulate muscle protein synthesis, promoting muscle strength and function.²⁷ Ensuring long-term EPA and DHA supplementation is included in the nutritional management of older people, in combination with exercise, is therefore of increasing interest to the medical community as it looks for safe and affordable ways to slow physical disability and improve the quality of life and independence of senior adults.
• Cancer cachexia: Cancer cachexia – a wasting syndrome characterized by weight loss, anorexia and physical weakness – affects around 50-80% of cancer patients and negatively impacts clinical prognosis, therapy effectiveness and mortality rates.^{8,29,30,31,32,33} The precise mechanisms of the condition are not well-understood, however, chronic systemic inflammation appears to play a crucial role in most patients.³⁴ Given their ability to mitigate inflammation, DHA and EPA interventions in cancer patients have been receiving increasing attention. Importantly, existing evidence shows that EPA and DHA are safe and well-tolerated in cancer patients.^35,36 Moreover, there are indications that supplementation with omega-3 LCPUFAs in combination with high protein might have a beneficial effect on quality of life in cancer patients.³⁷ However, current recommendations for their use in cancer patients is weak indicating the need for more scientific research investigating the benefits of EPA and DHA in cancer patients specifically.³⁸
• Surgical patients: Malnutrition is a serious risk factor for surgical complications, leading to longer hospital stays, increased vulnerability towards infection and higher mortality rates. To prevent surgical complications, the Enhanced Recovery After Surgery concept – known as ERAS – advocates the integration of perioperative nutritional therapy into the overall management of patients.³⁹ Because surgery is associated with increased stress and inflammation in the body, it may be beneficial to add DHA and EPA to perioperative immunonutrition therapy, to help mitigate excessive inflammation and support patient recovery.

What does this mean for the role of EPA and DHA in innovative medical nutrition solutions? 

Despite the promising findings shared here, the currently available research is limited and inconsistent, due to variations in dosage, timing and duration of supplementations, baseline nutritional status, clinical state and medication use. For example, it is increasingly recognized that multimodal interventions are most promising for the therapy of cancer cachexia, yet most of the clinical evidence is derived from trials using only a single therapy. Likewise, it is evident that DHA and EPA play a role in perioperative immunonutrition, but more well-designed trials could provide clearer evidence for their use and confirm the optimal timing and duration. This emphasizes the need for better controlled intervention studies that will help to further define the benefits of EPA and DHA in specific patient groups and inspire the development of more personalized and effective medical nutrition products. Moreover, continued patient insights are critical in the educating medical nutrition community about the latest patient preferences so that they can manufacture more palatable and appealing medical nutrition products.