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Original Research Communications |
1 From the Department of Medicine, Section of Gastroenterology CA, Rigshospitalet, University of Copenhagen, and the Department of Biochemistry and Nutrition, The Technical University of Denmark, Lyngby.
Background: Essential fatty acid (EFA) requirements of patients receiving home parenteral nutrition (HPN) are uncertain.
Objective: The objective was to evaluate the influence of the route of administration (enteral compared with parenteral) on plasma phospholipid EFA concentrations.
Design: Intestinal absorption, parenteral supplement of EFAs, and plasma phospholipid EFA concentrations were investigated in balance studies in 4 groups (A, B, C, and D) of 10 patients with short-bowel syndrome and a fecal loss of >2000 kJ/d. Groups A (fat malabsorption <50%) and B (fat malabsorption >50%) did not receive HPN, whereas group C received HPN containing lipids (7.5 and 1.2 g/d linoleic and linolenic acids, respectively) and group D received fat-free HPN.
Results: Intestinal absorption of linoleic and linolenic acids was 8.9 and 1.3 g/d and 2.6 and 0.4 g/d in groups A and B, respectively, whereas EFA absorption was negligible in groups C and D. Thus, intestinal absorption of EFAs in group A corresponded to parenteral EFA supplements in group C, whereas group D was almost totally deprived of EFAs. The median plasma phospholipid concentration of linoleic acid decreased by 21.9%, >16.3%, >13.8%, 11.0%, and >7.7% and linolenic acid by 0.3%, 0.2%, 0.2%, >0.2%, and 0.1%, respectively, in 10 healthy control subjects and groups A, B, C, and D (P < 0.001).
Conclusions: Intestinally absorbed EFAs maintained plasma EFA status better than did an equal quantity of parenterally supplied EFAs. Intravenous requirements of EFAs in patients with negligible absorption of EFAs are probably higher than the amounts recommended to patients with preserved intestinal absorption of EFAs.
Key Words: Essential fatty acid deficiency • plasma phospholipids • linoleic acid • linolenic acid • intestinal absorption • home parenteral nutrition • HPN • short-bowel syndrome • humans
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