ESSENTIAL FATTY-ACID DEFICIENCY IN PATIENTS WITH SEVERE FAT MALABSORPTION

Essential fatty acid deficiency is commonly described in patients rece iving parenteral nutrition, but the occurrence in patients with severe fat malabsorption not receiving parenteral nutrition is uncertain. On e hundred twelve patients were grouped according to their degree of fa t malabsorption: group 1, < 10% (n = 52); group 2, 10-25% (n = 21); gr oup 3, 25-50% (n = 24); and group 4, > 50% (n = 15). Fecal fat was mea sured by the method of Van de Kamer the last 2 of 5 d of a 75-g fat di et. Serum fatty acids in the phospholipid fraction were measured by ga s-liquid chromatography after separation by thin-layer chromatography and expressed as a percentage of total fatty acids. The concentration of linoleic acid in groups 1, 2, 3, and 4 was 21.7%, 19.4%, 16.4%, and 13.4% respectively (P < 0.001). The concentration of linolenic acid i n groups 1, 2, 3, and 4 was 0.4%, 0.4%, 0.3% and 0.3%, respectively (P = 0.017). Evidence of essential fatty acid deficiency, defined as a s erum concentration of linoleic acid less than the lower limit if the 9 5% CI in patients without fat malabsorption (group 1), was 5% (1/21), 38% (9/24), and 67% (10/15) in groups 2, 3, and 4, respectively. A con siderable proportion of patients with gastrointestinal diseases result ing in malabsorption of > 25-50% of dietary fat intake and not treated with parenteral nutrition have biochemical signs of essential fatty a cid deficiency. The clinical effect of these changes are yet to be elu cidated.