Deficiencies of essential fatty acids, vitamin A and E and changes in plasma lipoproteins in patients with reduced fat absorption or intestinal failure

OBJECTIVE: 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.

DESIGN AND SUBJECTS: 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).

RESULTS: 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.

CONCLUSIONS: 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.