Diseases essential fatty acid deficiency

What chemical abnormalities are associated with these pathophysiologic events Changes in lipid composition are suggested (Table 13.1) since drugs which decrease the cholesterol content of tissues can cause scaling as a side effect. Low serum cholesterol has been reported in Conradi s diseased Phytanic acid accumulates in Refsum s disease". Essential fatty acid deficiency causes scaling of the skin (Figure 13.3) which clears when essential fatty... 

Alam, S. Q., and Y. Y. Shi. The effect of essential fatty acid deficiency on the fatty acid composition of different salivary glands and saliva in rats. Arch Oral Biol 1997 42(10-11) 727-734. Kumar, P. D. The role of coconut and coconut oil in coronary heart disease in Kerala, south India. Trop Doct... 

Duerksen DR, Nehra V, Palombo JD, Ahmad A, Bistrian BR. Essential fatty acid deficiencies in patients with chronic liver disease are not reversed by short-term intravenous lipid supplementation. Dig Dis Sci 1999 44(7) 1342-8. 

Skin diseases including essential fatty acid deficiency and ichthyosis may also affect the transdermal delivery of a compound. Studies have shown that the epidermal barrier function is altered by abnormal lipid composition in noneczematous atopic dry skin. Numerous other dermatologic conditions affect the anatomical structure and function of skin, which may impact on the nature of the toxic responses seen. 

Rudin DO. The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome substrate beriberi. Med Hypotheses 1982 8(1) 17 7. 

Rudin, D.O. (1982) The Dominant Diseases of Modernized Societies as Omega-3 Essential Fatty Acid Deficiency Syndrome Substrate Beriberi, Med. Hypotheses 8,17-47. 

Very soon after the discovery of essential fatty acid phenomena in rats, medical researchers at the University of Minnesota began investigations on humans. The first medical phenomenon related to essential fatty acids was a dermatitis associated with intractable eczema. Hansen and his co-workers chose cases which did not respond to the usual treatments for eczema and gave these patients supplements of lard which contains approximately 10% of linoleic acid and a few percent of arachidonic acid (Hansen, 1937). They found that in the cases of intractable eczema the serum iodine number was low, and that when the diets were supplemented with lard, the iodine value rose to normal and the skin cleared up in 75% of the cases. An example of this disease which responded to essential fatty acids is shown in Figure 4 (Azerad Crupper, 1949). A study of the histological features of normal and essential fatty acid deficient human skin shown in Figure 5 indicates that in the deficient condition... 

Studies in the mid 20th century identified the effects, in rats, of essential fatty acid deficiency (Table 5). Biochemically, the disease is characterized by changes in the fatty acid compositions of many ceU membranes whose functions are impaired (see British Nutrition Foundation, 1992 Gurr et al., 2002 for further details). One of the striking features of essential fatty acid deficiency in rats is skin dermatitis and water loss (see Mead, 1984). Epidermal lipids are rich in ceramides. The fatty acyl substituent in these is linoleic acid linked via its carboxylic acid group to the terminal methyl carbon of another fatty acid (34 1 n-9) to generate an extremely long-chain (52 carbons) stmcture. 

Diabetic animals develop signs of essential fatty acid deficiency earlier than normal ones on a diet deficient in essential fatty acids (Peifer and Holman, 1955). In the diabetic a reverse relation is present between the essential fatty acid content of the blood and the glucose level. Furthermore, it is well known that diabetics develop atherosclerosis easily, while diabetic women are known to suffer frequently from toxemia of pregnancy also. The prevalence of both diseases in diabetics might be related to the endocrine disorder itself but could equally well be due to the dietary measures. Especially the low carbohydrate-high fat diet, formerly so commonly described, must be considered as harmful in this respect. Even the resistance to radiation sickness is less in essential fatty acid deficiency states (Decker et al., 1950 Cheng et al., 1954, 1955, 1956 Deuel et al., 1953). 

Alterations in the level of palmitoleic acid have been found in tissues under certain physiological and disease conditions, including essential fatty acid deficiency (EFAD), cancer, cardiovascular disease, and diabetes mellitus. These changes are often associated with changes in the relative levels of n-6 and n-3 PUFA in the tissues. 

A deficiency of essential fatty acids or, vice versa, a relative oversupply of saturated fatty acids [203, 204] has been suggested as an aetiologic factor. Indeed it has been shown that the fatty acid composition of brain [105, 206] or its mitochondria [207] can be altered by varying the levels of unsaturated fatty acids in the diet. However, in the PE fraction of MS white matter which harbours the greatest concentration of PUFA, their proportion is increased [134, 208]. Only the PC fraction containing a small proportion of dienes and a minimal one of arachidonic acid showed values of dienes lower than in the controls in three of seven of MS fractions [134] and in another series [208] a reduction of arachidonic acid. Yet in MS myelin [134] the ratio of essential fatty acids was similar to that in the controls. The deficit of oleic acid reported for the serum cholesterol esters and triglycerides correlates to the status of the patient and increases with the progress of the disease. It is not reflected in the fatty acids of the phospholipids [193]. Thus, the data available do not appear to support the assumption of an essential fatty acid deficiency. 

Essential fatty acid deficiency can be produced in a variety of animals, including man, but data for the rat are the best documented (Table 5.5). The disease is characterized by skin symptoms, such as dermatosis and the skin becomes more leaky to water. Growth is retarded, reproduction is impaired and there is degeneration or impairment of function in many organs of the body. Biochemically, essential fatty acid deficiency is characterized by changes in the fatty acid composition of many tissues. 

A functional method for detection depends upon competition for the activity of the and desaturases between a non-essential fatty acid (e.g. oleic acid) and an essential fatty acid (see above). If the latter is deficient, oleic acid is readily converted, via the desaturases, to Mead acid, since there is little competition (Figure 11.14). Hence the amount of the latter can be used as a marker for deficiency of essential fatty acids, although it is better to use the ratio of double bonds only three are present in Mead acid (i.e. a triene) but four are present in arachidonic acid (i.e. a tetraene). A ratio in plasma, triene/tetraene >4.0 is an indication of a deficiency of essential fatty acids. This method has shown that a deficiency can occur in a number of conditions which can lead to disease (Table 11.5). 

Linoleic acid and alpha-linoleic acid are essential fatty acids that are provided in any long-term parenteral nutrition by administering fat emulsions at least twice a week. Fatty acid deficiency is a common complication of severe end-stage liver disease. The ability of short-term intravenous lipid supplementation to reverse fatty acid deficiencies has been studied in patients with chronic liver disease and low plasma concentrations of fatty acids (914). Shortterm supplementation failed to normalize triglycerides. 

Burr and Burr reported in 1929 a new deficiency disease produced by the rigid exclusion of fat from the diet. 1 Rodents fed a fat-free diet showed reduced growth and reproductive failure, accompanied by two prominent changes in the skin, that is, increased scaliness and impaired barrier function.1,2 Reversal of the features of deficiency by administration of linoleic acid (LA), led to the concept of essential fatty acids (EFA) that cannot be synthesized by the higher animals.2 Similarities between the clinical features of EFA deficiency and atopic dermatitis led Hansen in 1937 to discover low blood levels of unsaturated fat in atopic children,3 and he later reported that EFA-deficient infants developed an eczematous rash, which responded to LA supplements.4 Several studies had previously examined a range of dietary oil supplements in atopic dermatitis,5-8 with generally reported benefit. 

Linoleic acid (18 3 -6 and a-linolenic acid (18 3n-3) are metabolically essential fatty acids, but linoleic acid is the only essential fatty acid for which a dietary requirement has been established. Characteristic EFA deficiency symptoms observed in poultry include an increased need for water and decreased resistance to disease. A dietary requirement for linoleic acid has been set at 1% of diet dry matter. No major special considerations are mentioned for turkeys, ducks, ringnecked pheasants, Japanese quail, and bobwhite quail (16). 

Blockage of the bile duct caused by problems such as cholesterol-containing gallstones or duodenal or pancreatic tumors can lead to an inadequate concentration of bile salts in the intestine. Digestion and absorption of dietary lipids is diminished. Certain diseases that affect the pancreas can lead to a decrease in bicarbonate and digestive enzymes in the intestinal lumen. (Bicarbonate is required to raise the intestinal pH so that bile salts and digestive enzymes can function.) If dietary fats are not adequately digested, steatorrhea may result. Malabsorption of fats can lead to caloric deficiencies and lack of fat-soluble vitamins and essential fatty acids. 

We now realize that deficiencies of 0)3 essential fatty acids are pandemic, especially in modern industrialized societies, and that this is an underlying cause of many burgeoning neurological diseases. The United States of America probably is the current leader in 0)3 deficiencies. How can we reverse the trend Our entire agricultural industry is currently dedicated to the production of crops and products low in o)3 and high o)6... 

A fish oil-based intravenous lipid emulsion in the treatment of liver disease associated with parenteral nutrition has been compared with soybean oil in an open study in 42 infants with short bowel syndrome who developed cholestasis [35 ]. There were three deaths and one liver transplantation in those who received the fish oil, compared with 12 deaths and 6 transplants in those who received soybean oil The fish oil was not associated with hypertriglyceridemia, coagulopathy, or deficiency of essential fatty acids. 

Recommended dietary allowances for a male adult (daily intake, in foods and food supplements) of some nutrients, usually the amounts estimated as needed to prevent overt manifestation of deficiency disease in most persons. For the substances listed in smaller amounts the optimum intake, leading to the best of health, may be somewhat greater. Not shown, but probably or possibly required, are the essential fatty acids, />aminobenzoic acid, choline, vitamin D, vitamin K, chromium, manganese, cobalt, nickel, zinc, selenium, molybdenum, vanadium, tin, and silicon. 

In normal circumstances an outright dietary deficiency of essential fatty acids is unlikely to occur but currently there is considerable speculation as to the role of subclinical deficiency in the aetiology of a number of diseases including ischaemic heart disease (page 267), cystic fibrosis and multiple sclerosis. 

Known relations with other diseases (a number of them sometimes called civilization diseases ) are present, for instance, via the essential fatty acids, a deficiency of which has been described also in idiopathic hypercalcemia in infants (Sinclair, 1956, 1957, 1958a Frazer 1956 Bongiovanni et al., 1957). These authors also reported in this connection a greater susceptibility to vitamin D intoxication. A deficiency of essential fatty acids, and good responses from their administration, have been noted by Hansen (1933,1957) and Hansen et al. (1947) in infant eczema. Treatment of exudative diathesis in children of a somewhat older age by avoiding animal fats is often successful, if properly done. That the functions and effects of the (essential) unsaturated fatty acids are not completely the same is demonstrated clearly by the fact that linolenate cannot cure the dermal symptoms in rats on a fat-deficient diet, whereas linoleate does so readily. Other mp-toms can be relieved by both. 

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