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Essential fatty acid status in paediatric Crohn's disease: relationship with disease activity and nutritional status.

BACKGROUND: Active paediatric Crohn's disease is associated with nutritional deficiencies and altered nutrient intake. The availability of essential fatty acids (linoleic and alpha-linolenic acids) or their derivatives (arachidonic and eicosapentaenoic acids) may alter in plasma and cell membrane phospholipid in protein-energy malnutrition in children and in Crohn's disease in adults. AIM: To investigate the relationship of fatty acid phospholipid profiles with disease activity and nutritional status in paediatric Crohn's disease. METHODS: The fatty acid (proportionate) composition of plasma and erythrocyte phosphatidylcholine was determined in 30 patients (10.3-17.0 years) stratified into active and quiescent Crohn's disease (paediatric Crohn's disease activity index) and high and low body mass (body mass index centile). RESULTS: In plasma phosphatidylcholine, active disease activity was associated with a lower level of alpha-linolenic acid compared with that in quiescent disease (P < 0.05). A body mass index below the 50th centile was associated with active Crohn's disease, low linoleic and alpha-linolenic acids and high arachidonic acid (P < 0.05) in plasma phosphatidylcholine, and low alpha-linolenic acid in erythrocyte phosphatidylcholine. These findings could not be explained through differences in habitual dietary fat intake. CONCLUSION: In paediatric Crohn's disease, a low body mass index centile and high disease activity are associated with altered profiles of essential fatty acids and their derivatives, which may reflect altered metabolic demand.

Adolescent↗

[The effect of surgical trauma on the metabolism of essential fatty acids in patients with cancer of the esophagus and stomach].

The dynamics of levels of essential fatty (linolic and arachidonic) acids in blood plasma and erythrocytes as well as that of free fatty acids fraction versus duration of surgery was assessed by gas chromatography in 49 patients with cancer of the esophagus and gastric cardia. Surgical procedures lasting longer than 5 hours are followed by overmobilization of essential fatty acids from body lipids their endogenous store being depleted. As a result, a double increase in the level of free arachidonic acid, an immediate prostaglandin precursor, develops to satisfy the body's augmented requirements in essential fatty acids due to application of aggressive surgical procedures.

Adult↗

Essential fatty acids, lipid membrane abnormalities, and the diagnosis and treatment of schizophrenia.

Recent research suggests that deficient uptake or excessive breakdown of membrane phospholipids may be associated with schizophrenia. We review available clinical research on abnormalities in membrane fatty acid composition and metabolism in schizophrenia, and therapeutic trials of fatty acid in this disorder. All potentially relevant English-language articles were identified from the medical and psychiatric literature with the aid of computer searches using key words such as lipids, phospholipids, prostaglandins and schizophrenia. All studies which include human subjects are reviewed. Empirical studies related to membrane hypotheses of schizophrenia focus on: 1) assessment of prostaglandins (PG) and their essential fatty acid (EFA) precursors in the tissues of patients with schizophrenia; 2) evaluation of the niacin flush test as a possible diagnostic marker; 3) evaluation of phospholipase enzyme activity; 4) NMR spectroscopy studies of brain phospholipid metabolism; and 5) therapeutic trials of PG precursors for the treatment of schizophrenia. The most consistent clinical findings include red blood cell fatty acid membrane abnormalities, NMR spectroscopy evidence of increased phospholipid turnover and a therapeutic effect of omega-3 fatty acid supplementation of neuroleptic treatment in some schizophrenia patients. Studies of EFA metabolism have proved fruitful for generating and testing novel etiologic hypotheses and new therapeutic agents for schizophrenia. Greater attention to factors that influence tissue EFA levels such as diet, tobacco and alcohol are required to reconcile inconsistent findings. Treatment studies, although promising, require independent replication.

Biomarkers↗

Marked depletion of polar lipid and non-essential fatty acids following settlement by post-larvae of the spiny lobster Jasus verreauxi.

The development from the non-feeding post-larva (puerulus) to the first instar juvenile of spiny lobsters is highly energetically demanding. These demands may greatly compromise the energy reserves of the lobsters following settlement, leading to reduced growth and survival in the wild, and also in aquaculture. Therefore, the lipid class and fatty acid composition of wild caught pueruli and first instar juveniles of the spiny lobster Jasus verreauxi (H. Milne Edwards, 1851) were analysed by thin layer chromatography-flame ionisation detection and capillary gas chromatography. Pueruli contained substantially more lipid than first instar juveniles (mean difference =3.5 mg, or 41.9%) and most of this difference was due to the presence of greater amounts of polar lipid (mean difference =3.9 mg or 49.2%) in pueruli. First instar juveniles contained significantly more triacylglycerol (mean =0.2 mg), consistent with the polar lipid being converted to a more readily metabolised lipid class in the hepatopancreas. These results indicate that polar lipid is the major energy store during the non-feeding puerulus stage of spiny lobsters from the genus Jasus. Overall, the essential, polyunsaturated linoleic, docosahexaenoic and eicosapentaenoic acids did not show a significant decrease between the two developmental stages, despite the absence of feeding. However, significant reductions in the abundance of both saturated and monounsaturated fatty acids between the two stages were identified (decrease of 811 and 783 microg per individual, respectively). This suggested that selective depletion of non-essential fatty acids may be occurring, with resultant sparing of the essential fatty acids. Supplying diets rich in these depleted fatty acids, and in particular the essential fatty acids, preferably in polar lipid, is likely to result in increased survival and growth of J. verreauxi and other spiny lobsters from first instar juveniles in aquaculture.

Animals↗

Dietary essential fatty acids in cystic fibrosis.

Analyses of serum lipids of children with cystic fibrosis (CF) have indicated a deficiency in essential fatty acids (EFA). In view of a report that intravenous administration of soybean oil emulsions normalized sweat sodium values in CF children, we studied the effects of orally administered essential fatty acids (as corn oil) for one year. Some improvement was noted in all patients, but no one consistent factor predominated. However, arachidonic acid, which was found only in trace amounts or was absent in sera of all children with CF before the clinical trial, was increased significantly in the sera after the oral administration of EFA for one year. Other findings included a significant decrease in sweat sodium and T3 in most patients.

Adolescent↗

Fish oil, essential fatty acids, and hypertension.

A proper balance between the n-3 and n-6 series of essential fatty acids (EFAs) is essential for homeostasis and normal growth in humans. Dietary supplement with fish oil and related n-3 EFAs has been used to study their antihypertensive property in animals and humans with borderline and essential hypertension. In the animal models, chronic treatment of young animals generally only attenuated the development of hypertension. In animals with hypercholesterolemia, n-3 EFA supplement increased the incidence of atherosclerosis. In humans, chronic treatment with fish oil only produced a small reduction in blood pressure. The concerns are that the high dose of fish oil may interfere with the control of blood glucose in diabetic patients, and may cause prolonged bleeding in surgical patients. Studies on the animal models of hypertension showed that n-6 EFAs are more effective than n-3 EFAs in lowering and normalizing the blood pressure of these animals, probably through the production of tissue prostaglandins, which favour vasodilation. The antihypertensive effect of the n-6 EFAs in humans is not well known, because there are only a few studies, usually involving a very small number of patients. A possible side effects of n-6 EFAs for concern is that they might stimulate tumour development. A careful examination of these risk factors is needed before any recommendation can be made concerning the use of EFAs for the control of hypertension for humans.

Animals↗

Essential fatty acid deficiency in patients receiving home parenteral nutrition.

Home parenteral nutrition (HPN), initiated in patients with severe malabsorption or decreased oral intake, may exhaust stores of essential fatty acids and cause clinical manifestations, mainly dermatitis. Plasma fatty acid profiles were measured by gas-liquid chromatography in 37 healthy control subjects and 56 patients receiving HPN. The concentration (% by wt of total fatty acids) of 18:2n-6 was 22.8% and 11.4% (P < 0.001), whereas 18:3n-3 was 0.2% and 0.1% (P < 0.01) in control subjects and patients, respectively. Reduced small bowel length was associated with aggravated biochemical signs of essential fatty acid deficiency (EFAD). The effect of parenteral lipid on plasma phospholipids was evaluated in subgroups of patients. In patients with > 200 cm of remaining small intestine, those receiving parenteral lipids had only minor changes in the fatty acids of plasma phospholipids compared with patients not receiving parenteral lipids. In patients with < 100 cm of remaining small intestine, those receiving parenteral lipids had increased concentrations of total n-6 fatty acids; however, these did not reach the concentrations in control subjects. No differences were seen in n-3 fatty acids. Twenty-five of the 56 patients receiving HPN reported skin problems. No differences were found in plasma phospholipid fatty acids, Holman index, or the supply of parenteral lipids between patients with and without skin problems. Patients receiving HPN had biochemical signs of EFAD. Parenteral lipids did not increase the concentration of essential fatty acids to values comparable with those of control subjects, but 500 mL 20% Intralipid once a week was sufficient to prevent an increase in the Holman index above 0.2.

Adolescent↗

Clinical characteristics and serum essential fatty acid levels in hyperactive children.

This study compared 48 hyperactive children with 49 age-and-sex-matched controls. Significantly more hyperactive children had auditory, visual, language, reading, and learning difficulties, and the birth weight of hyperactive children was significantly lower than that of controls (3,058 and 3,410 g, respectively; p less than 0.01). In addition, significantly more hyperactive children had frequent coughs and colds, polydypsia, polyuria, and a serious illness or accident in the past year than controls, but there was no increase in asthma, eczema, or other allergies. Serum essential fatty acid (EFA) levels were measured in 44 hyperactive subjects and 45 controls. The levels of docasahexaenoic, dihomogammalinolenic, and arachidonic acids were significantly lower in hyperactive children than controls (docosahexaenoic: 41.6 and 49.5 micrograms/ml serum respectively, p = 0.045; dihomogammolinolenic: 34.9 and 41.3 micrograms/ml serum, p = 0.007; arachidonic: 127.1 and 147.0 micrograms/ml serum, p = 0.027). These findings have possible therapeutic and diagnostic implications, but further research is needed to attempt to replicate these differences.

8,11,14-Eicosatrienoic Acid↗

Conditionally essential fatty acid deficiencies in end-stage liver disease.

Patients with end-stage liver disease (ESLD) manifest a wide variety of functional abnormalities that lead eventually to their death. Such patients also often have low levels of long-chain polyunsaturated fatty acids (PUFA) of carbon length 20 or greater in plasma total lipids, triacylglycerols, cholesterol esters, and phospholipids. We hypothesize that, due to hepatic damage, there is an impairment in de novo synthesis of very long-chain (20-22) carbon PUFA from their essential fatty acid 18 carbon dietary precursors that normally takes place principally in the liver. This results in a "conditional" essential fatty acid deficiency that may, in fact, be responsible for some of the pathophysiologic effects in ESLD. We propose that direct supplementation with very long-chain PUFA will provide a unique advantage in the correction of this "conditional" essential fatty acid deficiency in patients with ESLD and lead to improvements in their clinical condition.

Energy Intake↗

Fasting whole blood as a biomarker of essential fatty acid intake in epidemiologic studies: comparison with adipose tissue and plasma.

Biomarkers could provide a more accurate measure of long-term intake than questionnaires. Adipose tissue is considered the best indicator of long-term essential fatty acid intake, but other tissues may prove equally valid. The authors evaluated the ability of fasting whole blood, relative to fasting plasma and adipose tissue, to reflect fatty acid intake. Costa Rican men (n = 99) and women (n = 101) completed a 135-item food frequency questionnaire and provided adipose tissue and blood samples from 1999 to 2001. Fatty acids were identified by using capillary gas chromatography. Correlation coefficients adjusted for age, sex, and body mass index were calculated. Diet-tissue correlation coefficients for alpha-linolenic acid and linoleic acid, respectively, were 0.38 and 0.43 in whole blood, 0.51 and 0.52 in adipose tissue, and 0.39 and 0.41 in plasma. High correlations were observed between whole-blood alpha-linolenic and linoleic acid and adipose tissue (r = 0.59 and r = 0.67) and plasma (r = 0.96 and r = 0.88), respectively. Results show that fasting whole blood is a suitable biomarker of long-term essential fatty acid intake, and its performance is comparable to that of fasting plasma. Thus, fasting whole blood could be the sample of choice in epidemiologic studies because of its ability to predict intake, its accessibility, and minimum sample processing.

Adipose Tissue↗

Effect of essential fatty acids on circulating T cell subsets in patients with colorectal cancer.

The effect of essential fatty acids (EFA), given orally as dietary supplements, on the responsiveness in vitro of peripheral blood lymphocytes (PBL), to the mitogen concanavalin A have been studied in 10 patients with localized and 14 patients with advanced colorectal cancer. The degree of lymphocyte activation was assessed by measuring the amount of tritiated [3H]thymidine incorporated into newly synthesised lymphocyte DNA. The results were expressed as stimulation indices. T cell responses to concanavalin A stimulation showed a significant reduction of stimulation indices following EFA supplementation, in both the localized (P = 0.026) and advanced (P = 0.016) tumour groups, when compared with pretreatment activity in vitro. Mixing experiments, using EFA-supplemented and non-EFA-supplemented lymphocytes with concanavalin A, suggest no enhancement of T suppressor cell activity. Cell surface marker analysis (fluorescence-activated cell sorting for CD phenotyping) revealed a reduction of absolute numbers of CD4+ and CD8+ lymphocytes following EFA supplementation. The stimulation indices returned to pre-supplementation values 3 months following cessation of EFA intake. There was no significant change of these indices in the control (no EFA supplementation) advanced tumour group tested. This study suggests that EFA supplementation in patients with colorectal cancer selectively reduces circulating PBL, and T cell subset (including suppressor cells) numbers and/or activity. Such effects may have an important outcome in patients with malignant disease.

Administration, Oral↗

Relationships between levels of essential fatty acids and zinc in plasma of cystic fibrosis patients.

Possible relationships between zinc and essential fatty acid metabolism have been assessed using plasma samples obtained from 39 cystic fibrosis patients. The fatty acid composition of plasma phospholipids was analyzed by capillary gas liquid chromatography and zinc levels were measured by atomic absorption spectrometry. Computer analyses revealed positive correlations between zinc levels and (a) arachidonic acid (p less than 0.001), (b) the arachidonate/linoleate ratio (p less than 0.02), and (c) eicosatrienoic acid (n-6) (p less than 0.001). These observations suggest that conversion of linoleate to arachidonate may be modulated by zinc.

Adolescent↗

Metabolism of some radiolabeled essential fatty acids in isolated rat hepatocytes is affected by dietary ethanol.

The metabolism of the essential fatty acids [1-14C]20:4n-6, [1-14C]20:5n-3 and [1-14C]22:6n-3 was studied in rat hepatocytes fed ethanol in two different diets. Using a diet with a low lipid content ethanol (1) reduced the elongation of eicosapentaenoic acid, (2) reduced the esterification of docosahexaenoic acid (DHA) in phospholipids (PL), (3) increased the oxidation of DHA, (4) increased the ratio of esterification of DHA in phosphatidylethanolamine (PE) compared to phosphatidylcholine (PC) (PE/PC ratio), (5) altered the formation of PL molecular species, and (6) induced a decrease in the endogenous content of the hepatocytes of arachidonic acid and linoleic acid and an increase in oleic acid, 20:3n-9 and DHA. Using a high lipid diet, only the above-mentioned effect (4) was induced by ethanol, not the effects (1)-(3) and (5)-(6).

Animals↗

Essential fatty acid status in neonates after fish-oil supplementation during late pregnancy.

Healthy pregnant women (n 23) were supplemented with fish-oil capsules (2.7 g n-3 polyunsaturated fatty acids/d) from the 30th week of gestation until delivery. Subjects in a control group were either supplemented with olive-oil capsules (4 g/d, n 6) or received no supplementation (n 10). Fatty acid compositions of the phospholipids isolated from umbilical plasma and umbilical arterial and venous vessel walls were determined. Fatty acid compositions of maternal venous plasma phospholipids were determined as well. Maternal plasma phospholipids of the fish-oil-supplemented group contained more n-3 fatty acids and less n-6 fatty acids. Moreover, the amounts of the essential fatty acid deficiency markers Mead acid (20:3n-9) and Osbond acid (22:5n-6) were significantly lower. The extra amount of n-3 fatty acids consumed by the mothers resulted in higher contents of n-3 fatty acids, and of docosahexaenoic acid (22:6n-3) in particular, in the phospholipids of umbilical plasma and vessel walls. It is, indeed, possible to interfere with the docosahexaenoic acid status at birth: children born to mothers supplemented with fish oil in the last trimester of pregnancy start with a better docosahexaenoic acid status at birth, which may be beneficial to neonatal neurodevelopment.

Adult↗

Essential fatty acid composition of plasma phospholipids and birth weight: a study in term neonates.

BACKGROUND: Essential fatty acids (EFAs) in umbilical cord blood samples are associated with attained birth weight in premature infants and low-birth-weight neonates. OBJECTIVE: The objective was to investigate relations between the EFA composition of cord and maternal plasma phospholipids and birth weight in term neonates. DESIGN: This was a cross-sectional study in 627 singletons born at term. The plasma phospholipid EFA composition of the mothers was determined by gas-liquid chromatography at study entry (< or = 16 wk gestation), at delivery, and in cord plasma at birth. Birth weights were normalized to SD scores. RESULTS: In cord plasma, the dihomo-gamma-linolenic acid concentration was positively related to weight SD scores. Both arachidonic acid (AA) and docosahexaenoic acid (DHA) were negatively related to weight SD scores. EFA-status indicators showed similar negative associations, whereas eicosatrienoic acid concentrations were positively related to neonatal size. In maternal plasma, proportions of n-3 long-chain polyenes (LCPs) and n-6 LCPs decreased during pregnancy. Larger decreases in AA, DHA, n-3 LCP, and n-6 LCP fractions were observed in mothers of heavier babies. Higher concentrations of LCPs in maternal plasma were, however, not related to a larger infant size at birth. CONCLUSIONS: A lower biochemical EFA status in umbilical cord plasma and a larger decrease in maternal plasma LCP concentrations are associated with a higher weight-for-gestational-age at birth in term neonates. Our findings do not support a growth-stimulating effect of AA or DHA; however, they do suggest that maternal-to-fetal transfer of EFAs might be a limiting factor in determining neonatal EFA status.

8,11,14-Eicosatrienoic Acid↗

Essential fatty acids in the plasma phospholipids of patients with atopic cataracts.

Abnormal levels of the essential fatty acids (EFA) in plasma phospholipids have been reported in atopic dermatitis. We have compared EFA levels in 10 patients with atopic cataracts and 29 atopic dermatitis patients without cataracts and found no significant differences, with the exception that higher levels of adrenic acid occurred in those with cataracts.

Adult↗