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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 resistance1. 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 properties2 and can positively affect the inflammation associated with cancer and cachexia. EPA and DHA influences muscle protein synthesis3 and a weight-retaining effect has been shown in cancer and cachexia patients4. 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-tumour properties and beneficial effects on treatment outcome5.

Vitamin D deficiency is especially common in medical inpatients6 and people with anorexia7. Vitamin D is especially important for these patients as it influences the immune-function [16] and plays an important role in muscle function8. In addition, low levels of vitamin D are associated with insulin resistance9.

Protein is essential in promoting muscle growth and preventing muscle-loss10. Remune contains high-quality whey protein, which is a complete protein as it contains all essential amino acids. Whey protein is easily digestible and therefore 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 growth11.

In addition, Remune consists of polyphenol-rich juice from fruits and berries, which also contributes with fibre and phytochemicals. Altogether, the composition of Remune is shown to have a low glycemic index below 2112, and will not impact blood sugar negatively.

Relevant studies

Below is a list of relevant studies. For a complete list of relevant studies for Smartfish products, visit R&D.

Related products


Remune® is an oral nutritional supplement (1.1 kcal/ml), high in omega-3 fatty acids EPA and DHA, with increased vitamin D content, with whey protein and fruit juices. For the dietary management of disease related malnutrition, including pre-cachexia and cachexia particularly due to COPD or lung cancer. For patients who may benefit from an increased intake of omega-3 fatty acids EPA and DHA, vitamin D and energy.

  1. Fearon, K., J. Arends, and V. Baracos, Understanding the mechanisms and treatment options in cancer cachexia. Nature Reviews Clinical Oncology, 2012. 10: p. 90. ↩︎
  2. Calder, P.C., n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr, 2006. 83(6 Suppl): p. 1505S-1519S. ↩︎
  3. 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. ↩︎
  4. 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. ↩︎
  5. 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. ↩︎
  6. Thomas, M.K., et al., Hypovitaminosis D in medical inpatients. N Engl J Med, 1998. 338(12): p. 777-83. ↩︎
  7. Veronese, N., et al., Vitamin D status in anorexia nervosa: A meta-analysis. Int J Eat Disord, 2015. 48(7): p. 803-13. ↩︎
  8. 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. ↩︎
  9. 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. ↩︎
  10. 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). ↩︎
  11. 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. ↩︎
  12. Research, L.F., Determination of the glycaemic index of a clinical nutrition drink. 2015. ↩︎