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Open Access Study protocol

A trial assessing N-3 as treatment for injury-induced cachexia (ATLANTIC trial): does a moderate dose fish oil intervention improve outcomes in older adults recovering from hip fracture?

Michelle D Miller1*, Alison Yaxley2, Anthony Villani1, Lynne Cobiac1, Robert Fraser3, Leslie Cleland4, Michael James4 and Maria Crotty2

Author Affiliations

1 Nutrition and Dietetics, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia

2 Rehabilitation and Aged Care, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia

3 Department of Medicine, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia

4 Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide SA 5000, Australia

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BMC Geriatrics 2010, 10:76  doi:10.1186/1471-2318-10-76

Published: 22 October 2010

Abstract

Background

Proximal femoral fractures are associated with increased morbidity and mortality. Pre-existing malnutrition and weight loss amongst this patient group is of primary concern, with conventional nutrition support being largely ineffective. The inflammatory response post proximal femoral fracture surgery and the subsequent risk of cachexia may explain the inability of conventional high energy high protein management to produce an anabolic response amongst these patients. Omega-3 fatty acids derived from fish oils have been extensively studied for their anti-inflammatory benefits. Due to their anti-inflammatory properties, the benefit of fish oil combined with individualized nutrition support amongst proximal femoral fracture patients post surgery is an attractive potential therapeutic strategy. The aim of the ATLANTIC trial is to assess the potential benefits of an anti-inflammatory dose of fish oil within the context of a 12 week individualised nutrition program, commencing seven days post proximal femoral fracture surgery.

Methods/Design

This randomized controlled, double blinded trial, will recruit 150 community dwelling elderly patients aged ≥65 years, within seven days of surgery for proximal femoral fracture. Participants will be randomly allocated to receive either a 12 week individualized nutrition support program complemented with 20 ml/day anti-inflammatory dose fish oil (~3.6 g eicosapentaenoic acid, ~2.4 g docosahexanoic acid; intervention), or, a 12 week individualized nutrition support program complemented with 20 ml/day low dose fish oil (~0.36 g eicosapentaenoic acid, ~0.24 g docosahexanoic acid; control).

Discussion

The ATLANTIC trial is the first of its kind to provide fish oil combined with individualized nutrition therapy as an intervention to address the inflammatory response experienced post proximal femoral fracture surgery amongst elderly patients. The final outcomes of this trial will assist clinicians in the development of effective and alternative treatment methods post proximal femoral fracture surgery which may ultimately result in a reduction in systemic inflammation, loss of weight and lean muscle and improvements in nutritional status, mobility, independence and quality of life among elderly patients.

Trial Registration

ACTRN12609000241235