linoleic-acid and Intestinal-Diseases

Intravenous fish oil (FO) treats pediatric intestinal failure-associated liver disease (IFALD). There are concerns that a lipid emulsion composed of ω-3 fatty acids will cause an essential fatty acid deficiency (EFAD). This study's objective was to quantify the risk for abnormal fatty acid concentrations in children treated with FO.. Inclusion criteria for this prospective study were children with intestinal failure. Intravenous soybean oil (SO) was replaced with FO for no longer than 6 months. Serum fatty acids were analyzed using linear and logistic models, and compared with age-based norms to determine the percentage of subjects with low and high concentrations.. Subjects (n = 17) started receiving FO at a median of 3.6 months (interquartile range 2.4-9.6 months). Over time, α-linolenic, linoleic, arachidonic, and Mead acid decreased, whereas docosahexaenoic and eicosapentaenoic acid increased (P < 0.001 for all). Triene-tetraene ratios remained unchanged (P = 1). Although subjects were 1.8 times more likely to develop a low linoleic acid while receiving FO vs SO (95% CI: 1.4-2.3, P < 0.01), there was not a significant risk for low arachidonic acid. Subjects were 1.6 times more likely to develop high docosahexaenoic acid while receiving FO vs SO; however, this was not significant (95% CI: 0.9-2.6, P = 0.08).. In this cohort of parenteral nutrition-dependent children, switching from SO to FO led to a decrease in essential fatty acid concentrations, but an EFAD was not evident. Low and high levels of fatty acids developed. Further investigation is needed to clarify if this is clinically significant.

Topics: 8,11,14-Eicosatrienoic Acid; Arachidonic Acid; Docosahexaenoic Acids; Eicosapentaenoic Acid; Fat Emulsions, Intravenous; Fatty Acids; Fatty Acids, Essential; Fatty Acids, Omega-3; Female; Fish Oils; Humans; Infant; Intestinal Diseases; Linoleic Acid; Liver Diseases; Male; Parenteral Nutrition; Prospective Studies; Soybean Oil

Deficiencies of essential fatty acids (EFA), vitamin A (retinol) and vitamin E (alpha- and gamma-tocopherol) were studied in non-HPN patients with different degrees of fat malabsorption (managing without home parenteral nutrition (HPN)), and in HPN-patients receiving HPN with and without parenteral lipids.. Phospholipid fatty acids (including EFA), cholesterol, retinol, alpha- and gamma-tocopherol in plasma and the intestinal absorption of fatty acids and energy (balance-studies) were measured in 40 non-HPN patients, 44 HPN patients and 35 controls. Subgroups were non-HPN patients with fat:total energy absorption ratios >25% (A), between 15 and 25% (B), and <15% (C), and HPN patients receiving (D) and not receiving parenteral lipids (E).. Intestinal absorption of the EFA linoleic acid was 8.2, 4.4, 3.8, 0.5 and 0.5 g/day and corresponding plasma concentrations were 17.3%, 15.5%, 13.1%, 12.1% and 8.9% in groups A-E, respectively (P<0.001). Deficiencies in EFA, defined as a Holman index >0.2 (20:3n-9/20:4n-6 ratio), were confined to 42% of the patients in group E. Plasma cholesterol was decreased in groups B-E. Plasma retinol was reduced (below the lower 2.5% confidence interval of controls) in 7% of non-HPN patients and in 20% of HPN patients. Plasma alpha-tocopherol was reduced in 64% of patients from groups B-E. Plasma gamma-tocopherol was decreased in 33% of the patients, except in HPN-patients receiving parenteral lipids.. Plasma linoleic acid may decrease considerably (from 26% to 8-10%) as fat absorption decreases before secondary signs of essential fatty acid deficiencies occur (an increase in 20:3n-9 and the Holman index). In this study this was confined to patients on lipid-free HPN. Vitamin A deficiencies were mainly seen in HPN patients. Vitamin E deficiencies were common in both HPN and non-HPN patients, but administration of parenteral lipids normalized plasma gamma-tocopherol. European Journal of Clinical Nutrition (2000) 54, 632-642.

Topics: Adult; Energy Metabolism; Fatty Acids, Essential; Female; Humans; Intestinal Absorption; Intestinal Diseases; Linoleic Acid; Lipoproteins; Male; Middle Aged; Parenteral Nutrition, Home; Vitamin A Deficiency; Vitamin E Deficiency