Differences in essential fatty acid requirements by enteral and parenteral routes of administration in patients with fat malabsorption.
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.


METHODS
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.
Department of Medicine, Section of Gastroenterology CA, Rigshospitalet, University of Copenhagen, Denmark. Bekker@dadlnet.dk
P B
PB
Jeppesen
C E
CE
Høy
P B
PB
Mortensen
D000328:Adult; D004041:Dietary Fats / Q000493:pharmacokinetics*; D004750:Enteral Nutrition; D005227:Fatty Acids / Q000097:blood; D005228:Fatty Acids, Essential / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006801:Humans; D007408:Intestinal Absorption; D019787:Linoleic Acid / Q000097:blood / Q000493:pharmacokinetics; D008875:Middle Aged; D009751:Nutritional Requirements; D016331:Parenteral Nutrition, Home; D010743:Phospholipids / Q000097:blood; D012778:Short Bowel Syndrome / Q000378:metabolism*; D017962:alpha-Linolenic Acid / Q000097:blood / Q000493:pharmacokinetics
D004041:Dietary Fats; D005227:Fatty Acids; D005228:Fatty Acids, Essential; D010743:Phospholipids; D017962:alpha-Linolenic Acid; D019787:Linoleic Acid