Fatty acids, essential, deficiency parenteral nutrition

CAA crystalline amino acid CEAA conditionally essential amino acid CPN central parenteral nutrition CSP compounded sterile preparations EFAD essential fatty acid deficiency... 

Essential fatty acid deficiency is rare but can occur with prolonged lipid-free parenteral nutrition, very low fat enteral formulas, severe fat malabsorption, or severe malnutrition. The body can synthesize all fatty acids except for linoleic and linolenic acid, which should constitute approximately 2% to 4% of total calorie intake. 

Aik Phos, alkaline phosphatase ALT, alanine aminotransferase (SCPT) AST, aspartate aminotransferase (SGOT) Bili, bilirubin EFAD, essential fatty acid deficiency IVFE, intravenous fat emulsion PN, parenteral nutrition. 

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. 

Jeppesen PB, Hoy CE, Mortensen PB. Essential fatty acid deficiency in patients receiving home parenteral nutrition. Am J Clin Nutr 1998 68(l) 126-33. 

Severe negative nitrogen balance may occasionally have to be corrected by hyperalimentation or total parenteral nutrition (TPN). Intravenous solutions used in TPN contain essential and nonessential amino acids, plus a source of calories in the form of fat and carbohydrate. They "spare" the administered amino acids and allow them to be used for tissue repair. The TPN fluid must also contain all other nutritional factors required for life, including essential fatty acids, vitamins, and minerals. Severe metal and essential fatty acid deficiencies have been observed in situations in which such inclusions had not been made. 

Richardson, T. and Sgoutas, D. (1975). Essential fatty acid deficiency in four adult patients during total parenteral nutrition. Ani. J. Ciin. Nutr. 28,258-263. 

Sacks GS, Brown RO, Collier P, Kudsk KA. Failure of tropical vegetable oils to prevent essential fatty acid deficiency in a critically ill patient receiving long-term parenteral nutrition. JPEN J Parenter Enteral Nutr 1994 18 274-277. 

Dietary deficiencies of essential fatty acids are rare. However, some cases have been reported in patients receiving total parenteral nutrition (TPN). Although the most obvious symptom is a red scaly dermatitis, deficiencies of essential fatty acids also result in a decreased availability of precursors for eicosanoid synthesis. 

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. 

A similar need for these fatty acids in human diets has been established more recently. Deficiency symptoms can be demonstrated in children (S6 derhjelm et al, 1970) and have also been seen in adults after prolonged parenteral nutrition with fat-deficient preparations (Collins et al, 1971 Riella et al, 1975). It is estimated that these various deficiency symptoms can be prevented by an intake of essential fatty acids in the range of 1 to 2% of total calories (Holman, 1970). 

Goodgame, J.T., Lowry, S.F., and Brennan, M.F, Essential fatty acid deficiency in total parenteral nutrition time course of development and suggestions for therapy. Surgery, 84, 271-277, 1978. 

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