Nutritional management of cachexia with food alone has until now shown little effect. With clinical data indicating that Smartfish formulations could positively influence important underlying mechanisms of cachexia such as insulin resistance, inflammation and anorexia, we decided to invest in developing a product specifically for cachexia, Remune.
Smartfish medical nutrition products improve the situation for patients with pre-cachexia or cachexia by increasing the uptake of nutrition, hampering the progression of pre-cachexia or cachexia, or alleviating symptoms.
Remune is a high quality oral nutritional supplement, with carefully selected ingredients to target the underlying mechanisms of cachexia; anorexia, inflammation and insulin resistance. The key ingredients of Remune are the marine omega-3 fatty acids, EPA and DHA, vitamin D and whey protein rich in essential amino acids.
The marine omega-3 fatty acids EPA and DHA has anti-inflammatory properties [2-6] and can positively affect the inflammation associated with cancer and cachexia. EPA and DHA influences muscle protein synthesis[7, 8] and a weight-retaining effect has been shown in cancer and cachexia patients . This leads to beneficial effects on the weight loss and muscle deterioration associated with cachexia. In cancer-patients, the marine fatty acids have shown anti-tumor properties and beneficial effects on treatment outcome[10-13].
Vitamin D deficiency is especially common in medical inpatients  and people with anorexia. Vitamin D is especially important for these patients as it influences the immune-function  and plays an important role in muscle function. In addition, low levels of vitamin D are associated with insulin resistance[17-19].
Protein is essential in promoting muscle growth and preventing muscle-loss. Remune contains high quality whey protein, which is a complete protein as it contains all essential amino acids. Whey protein is easily digestible and therefor leads to less satiety than other protein sources. Whey protein is known for its high content of branched chain amino acids (BCAA’s), which are especially important in stimulating muscle growth [21-23].
In addition, Remune consists of polyphenol rich juice from fruits and berries, which also contributes with fiber and phytochemicals. Altogether, the composition of Remune is shown to have a low glycemic index below 21, and will not impact blood sugar negatively.
 Fearon, K., J. Arends, and V. Baracos, Understanding the mechanisms and treatment options in cancer cachexia. Nature Reviews Clinical Oncology, 2012. 10: p. 90.
 Calder, P.C., n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr, 2006. 83(6 Suppl): p. 1505S-1519S.
 Li, H., et al., EPA and DHA reduce LPS-induced inflammation responses in HK-2 cells: evidence for a PPAR-gamma-dependent mechanism. Kidney Int, 2005. 67(3): p. 867-74.
 Li, K., et al., Effect of marine-derived n-3 polyunsaturated fatty acids on C-reactive protein, interleukin 6 and tumor necrosis factor alpha: a meta-analysis. PLoS One, 2014. 9(2): p. e88103.
 Kiecolt-Glaser, J.K., et al., Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain Behav Immun, 2011. 25(8): p. 1725-34.
 AP, S., Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr., 2002. 21(6): p. 49-505.
 Smith, G.I., et al., Dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults: a randomized controlled trial. Am J Clin Nutr, 2011. 93(2): p. 402-12.
 Smith, G.I., et al., Omega-3 polyunsaturated fatty acids augment the muscle protein anabolic response to hyperinsulinaemia-hyperaminoacidaemia in healthy young and middle-aged men and women. Clin Sci (Lond), 2011. 121(6): p. 267-78.
 Di Girolamo, F.G., et al., Omega-3 fatty acids and protein metabolism: enhancement of anabolic interventions for sarcopenia. Curr Opin Clin Nutr Metab Care, 2014. 17(2): p. 145-50.
 Merendino, N., et al., Dietary omega -3 polyunsaturated fatty acid DHA: a potential adjuvant in the treatment of cancer. Biomed Res Int, 2013. 2013: p. 310186.
 Vaughan, V.C., M.R. Hassing, and P.A. Lewandowski, Marine polyunsaturated fatty acids and cancer therapy. Br J Cancer, 2013. 108(3): p. 486-92.
 Murphy, R.A., et al., Supplementation with fish oil increases first-line chemotherapy efficacy in patients with advanced nonsmall cell lung cancer. Cancer, 2011. 117(16): p. 3774-80.
 Fukui, M., et al., EPA, an omega-3 fatty acid, induces apoptosis in human pancreatic cancer cells: role of ROS accumulation, caspase-8 activation, and autophagy induction. J Cell Biochem, 2013. 114(1): p. 192-203.
 Thomas, M.K., et al., Hypovitaminosis D in medical inpatients. N Engl J Med, 1998. 338(12): p. 777-83.
 Veronese, N., et al., Vitamin D status in anorexia nervosa: A meta-analysis. Int J Eat Disord, 2015. 48(7): p. 803-13.
 EFSA Panel on Dietetic Products, N.a.A.N., Scientific Opinion on the substantiation of health claims related to vitamin D and normal function of the immune system and inflammatory response (ID 154, 159), maintenance of normal muscle function (ID 155) and maintenance of normal cardiovascular function (ID 159) pursuant to Article 13(1) of Regulation (EC) No 1924/2006, E.F.S.A. (EFSA), Editor. 2010: EFSA Journal.
 Liu, E., et al., Plasma 25-hydroxyvitamin d is associated with markers of the insulin resistant phenotype in nondiabetic adults. J Nutr, 2009. 139(2): p. 329-34.
 Kelly, A., et al., A cross-sectional study of vitamin D and insulin resistance in children. Arch Dis Child, 2011. 96(5): p. 447-52.
 Chiu, K.C., et al., Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr, 2004. 79(5): p. 820-5.
 EFSA NDA Panel (EFSA Panel on Dietetic Products, N.a.A., Scientific Opinion on the substantiation of health claims related to protein and increase in satiety leading to a reduction in energy intake (ID 414, 616, 730), contribution to the maintenance or achievement of a normal body weight (ID 414, 616, 730), maintenance of normal bone (ID 416) and growth or maintenance of muscle mass (ID 415, 417, 593, 594, 595, 715)pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal, 2010. 8(10).
 Blomstrand, E., et al., Branched-chain amino acids activate key enzymes in protein synthesis after physical exercise. J Nutr, 2006. 136(1 Suppl): p. 269S-73S.
 Norton, L.E. and D.K. Layman, Leucine regulates translation initiation of protein synthesis in skeletal muscle after exercise. J Nutr, 2006. 136(2): p. 533S-537S.
Jackman, S.R., et al., Branched-Chain Amino Acid Ingestion Stimulates Muscle Myofibrillar Protein Synthesis following Resistance Exercise in Humans. Front Physiol, 2017. 8: p. 390.
 Research, L.F., Determination of the glycaemic index of a clinical nutrition drink. 2015.