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Children With Intestinal Failure Undergoing Intestinal Rehabilitation Are at Risk for Essential Fatty Acid Deficiency
Riikka Gunnar1,2, Mirka Lumia3, Mikko Pakarinen2
1Department of Gastroenterology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Insights
Children with intestinal failure on supplemental parenteral nutrition face the highest risk of essential fatty acid deficiency (EFAD). Young age, low lipid PN, and short bowel length also increase EFAD risk.
Area of Science:
- Nutritional Science
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Essential fatty acid (EFA) status can be compromised in patients with intestinal failure (IF) during rehabilitation.
- Parenteral lipid restriction is used for intestinal failure-associated liver disease (IFALD), while enteral fatty acid (FA) absorption is limited.
- This study analyzes FA status in pediatric IF and intestinal insufficiency patients.
Purpose of the Study:
- To evaluate the essential fatty acid (EFA) status in pediatric patients with intestinal failure (IF).
- To identify risk factors associated with essential fatty acid deficiency (EFAD) in this population.
Main Methods:
- Serum FA fractions were determined in 49 pediatric patients (0-18 years) with IF.
- Patients were categorized by their reliance on parenteral nutrition (PN): full enteral (EN), supplemental PN, or predominantly PN.
- The triene:tetraene ratio (TTR) was used to assess EFAD risk (≥0.2 diagnostic, >0.1 increased risk).
Main Results:
- 16% of patients had an elevated TTR (≥0.1), with 3 exceeding 0.2.
- The supplemental PN group showed the highest incidence of elevated TTR (P = 0.0016).
- Increased EFAD risk was linked to young age, low parenteral lipid content, and short remaining small bowel length.
Conclusions:
- Pediatric patients with IF receiving supplemental PN have the highest risk of EFAD.
- Younger age, current PN use with low lipid content, and shorter remaining small bowel are significant risk factors for EFAD.
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.
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