title: Impact of portacaval anastomosis on plasma fatty acid profile in cirrhosis: a randomized 24-month follow-up study.
abstract: BACKGROUND
  Portacaval anastomosis has an hypolipemic effect in familial hypercholesterolemia and in healthy animals. In cirrhosis, it raises serum cholesterol, but there is no information on its effect upon plasma fatty acids. However, indirect data suggest that portacaval shunting might contribute to the polyunsaturated fatty acid deficit of these patients. We assessed the effect of portacaval anastomosis on plasma fatty acid profile in cirrhosis.
  
  
  METHODS
  Forty-four Child-Pugh class A/B bleeding cirrhotics were randomized to be treated with portacaval anastomosis (n = 20) or nonsurgical therapy (n = 24). Fatty acid profile in plasma total lipids, alcohol intake, anthropometry, Child-Pugh score, serum cholesterol, triglycerides, and antioxidant micronutrients were assessed before and 3, 6, 12, 18, and 24 months after surgery or the start of nonsurgical therapy. Time course of plasma fatty acids was assessed using unbalanced repeated measures models with the above mentioned variables acting as covariates.
  
  
  RESULTS
  No changes in the time course of percent plasma saturated, monounsaturated, and essential fatty acids were found between groups. Percent long-chain omega-6 and omega-3 polyunsaturated fatty acids decreased during follow-up in shunted patients compared with controls (p = .007 and p < .0005). However, this was not due to a true decrease in polyunsaturated fatty acid levels but to greater increases in saturated and monounsaturated fatty acid concentrations in shunted patients compared with control patients (p = .047 and p = .006).
  
  
  CONCLUSIONS
  Portacaval anastomosis does not worsen plasma polyunsaturated fatty acid deficiency in cirrhosis. However, by increasing saturated and monounsaturated fatty acids, it further decreases plasma lipid unsaturation.
authors.affiliation: Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Cabré
authors.forename: E
authors.initials: E
authors.lastname: Navarro
authors.forename: M
authors.initials: M
authors.lastname: de Ramon
authors.forename: J
authors.initials: J
authors.lastname: Klaassen
authors.forename: R
authors.initials: R
authors.lastname: Planas
authors.forename: M D
authors.initials: MD
authors.lastname: Mingorance
authors.forename: M C
authors.initials: MC
authors.lastname: Pastor
authors.forename: M
authors.initials: M
authors.lastname: Lachica
authors.forename: J
authors.initials: J
authors.lastname: Boix
authors.forename: M A
authors.initials: MA
authors.lastname: Gassull
mesh_terms: D000428:Alcohol Drinking; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism; D004042:Dietary Fats, Unsaturated / Q000378:metabolism; D005227:Fatty Acids / Q000009:adverse effects / Q000097:blood* / Q000378:metabolism*; D005228:Fatty Acids, Essential / Q000009:adverse effects / Q000097:blood / Q000378:metabolism; D005229:Fatty Acids, Monounsaturated / Q000009:adverse effects / Q000097:blood / Q000378:metabolism; D005230:Fatty Acids, Nonesterified / Q000009:adverse effects / Q000097:blood / Q000378:metabolism; D015525:Fatty Acids, Omega-3 / Q000009:adverse effects / Q000097:blood / Q000378:metabolism; D043371:Fatty Acids, Omega-6; D005231:Fatty Acids, Unsaturated / Q000009:adverse effects / Q000097:blood / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005934:Glucagon / Q000009:adverse effects / Q000097:blood / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000009:adverse effects / Q000097:blood / Q000378:metabolism; D008103:Liver Cirrhosis / Q000097:blood* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010169:Palmitic Acids / Q000009:adverse effects / Q000097:blood / Q000378:metabolism; D011167:Portacaval Shunt, Surgical / Q000009:adverse effects*; D013229:Stearic Acids / Q000009:adverse effects / Q000097:blood / Q000378:metabolism
chemical_list: D001786:Blood Glucose; D004042:Dietary Fats, Unsaturated; D005227:Fatty Acids; D005228:Fatty Acids, Essential; D005229:Fatty Acids, Monounsaturated; D005230:Fatty Acids, Nonesterified; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D005231:Fatty Acids, Unsaturated; D007328:Insulin; D010169:Palmitic Acids; D013229:Stearic Acids; D005934:Glucagon