Effects of protein-energy malnutrition and human immunodeficiency virus-1 infection on essential fatty acid metabolism in children

This report summarizes data on the availability of essential fatty acids (E FAs) and their long-chain polyunsaturated fatty acid (LCPUFA) metabolites i n protein-energy malnutrition (PEM), in human immunodeficiency virus-1 (HIV -1) infection for which less information is available, and the combination of both PEM and HIV-1. The contribution of different EFAs and LCPUFAs to th e fatty-acid composition of plasma and erythrocyte membrane lipids was foun d to be reduced in children with PEM in comparison with well-nourished chil dren. In addition to limited dietary EFA supply, reduced bioconversion of E FAs to their respective LCPUFA metabolites and/or peroxidative degradation of LCPUFAs may contribute to the reduction of LCPUFA status in malnourished children. Restoration of normal energy, protein, and EFA intakes does not appear to readily correct abnormalities of plasma and erythrocyte membrane LCPUFA values. Enhanced dietary supply of LCPUFAs and/or improved supply of antioxidant vitamins may represent novel therapeutic modalities in severe PEM. With and without PEM, HN infection was related to altered availability of various EFAs and LCPUFAs in HIV-seropositive children. The plasma total lipid fatty-acid profiles seen in well-nourished children with HIV infecti on were compatible with an HN infection-related enhancement of the metaboli c activity of the conversion of EFAs to their respective LCPUFA metabolites . However, the plasma phospholipid EFA and LCPUFA profiles seen in severely malnourished children with HIV infection more closely resembled those seen in children with PEM but without HIV infection than in those in children w ith HN infection but no PEM. Metabolic studies using stable isotope-labeled fatty acids may contribute to better understanding of the HIV-related chan ges in EFA metabolism and clearly are needed before therapeutic conclusions can be drawn. Nutrition 2000; 16:447-453. (C)Elsevier Science Inc. 2000.