Children With Intestinal Failure Undergoing Intestinal Rehabilitation Are at Risk for Essential Fatty Acid Deficiency. Issue 7 (27th April 2018)

• Record Type: Journal Article
• Authors: Gunnar, Riikka; Lumia, Mirka; Pakarinen, Mikko; Merras‐Salmio, Laura
• Is Part Of: JPEN, Journal of parenteral and enteral nutrition. Volume 42:Issue 7(2018)
• Page Start: 1203
• Page End: 1210
• Publication Date: 2018-04-27
• Subjects: intestinal failure–associated liver disease -- lipid emulsions -- parenteral nutrition; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; 615.85484
• DOI: 10.1002/jpen.1152
• Languages: English
• ISSNs: 0148-6071

Abstract

Abstract: Background: Essential fatty acid (EFA) status may be compromised during the intestinal failure (IF) rehabilitation. Parenteral lipid restriction is used to treat intestinal failure associated liver disease (IFALD), while the enteral fatty acid (FA) absorption remains limited. We analyzed the FA status among pediatric IF and intestinal insufficiency patients. Methods: We evaluated 49 patients aged 0–18 years attending our nationwide IF referral center. Their serum FA fractions were determined and examined against previous nutrition, parenteral lipid emulsion, and intestinal anatomy data. The patients were divided into 3 subgroups according to their dependence on parenteral nutrition (PN): full enteral (EN) (n = 33), supplemental PN (n = 14) or predominantly PN (n = 20). Trien:tetraen ratio (TTR) ≥0.2 was considered diagnostic for essential fatty acid deficiency (EFAD) and increased risk was suspected if TTR exceeded 0.1. Results: We identified 8 (16%) patients with elevated TTR ≥0.1; in 3 of them the ratio exceeded 0.2. Five of these children belonged to supplemental PN group. This group carried the highest incidence of elevated TTR ( P = 0.0016), with median TTR at 0.06 (interquartile range 0.03–0.09) and two‐thirds of the analyzed TTR ≥0.5. Increased EFAD risk was associated with young age ( P = 0.0291), current PN with low parenteral lipid content ( P = 0.0003), and short remaining small bowel ( P = 0.0013). Conclusions: IF children with supplemental PN carry the highest overall risk for EFAD. Young age, current PN, and short remaining small bowel also increase the risk for EFAD.