Essential fatty acid deficiency in patients with severe fat malabsorption

Essential fatty acid deficiency is commonly described in patients receiving parenteral nutrition, but the occurrence in patients with severe fat malabsorption not receiving parenteral nutrition is uncertain. One hundred twelve patients were grouped according to their degree of fat malabsorption: group 1, < 10% (n = 52); group 2, 10-25% (n = 21); group 3, 25-50% (n = 24); and group 4, > 50% (n = 15). Fecal fat was measured by the method of Van de Kamer the last 2 of 5 d of a 75-g fat diet. Serum fatty acids in the phospholipid fraction were measured by gas-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 in 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 serum concentration of linoleic acid less than the lower limit if the 95% 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 considerable proportion of patients with gastrointestinal diseases resulting in malabsorption of > 25-50% of dietary fat intake and not treated with parenteral nutrition have biochemical signs of essential fatty acid deficiency. The clinical effect of these changes are yet to be elucidated.