Maqbool Asim, Schall Joan I, Garcia-Espana J Felipe, Zemel Babette S, Strandvik Birgitta, Stallings Virginia A
Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
J Pediatr Gastroenterol Nutr. 2008 Nov;47(5):635-44. doi: 10.1097/MPG.0b013e31817fb76b.
Children with cystic fibrosis (CF) and pancreatic insufficiency (PI) are at increased risk for essential fatty acid (EFA) deficiency.
To investigate serum markers of EFA status in children with CF and PI and their association with growth, body composition, and lung function.
Serum phospholipid fatty acid, growth, and forced expiratory volume at 1 second (FEV1, percentage predicted) status were assessed at baseline and 12 months in 77 children with CF and PI, 7 to 10 years old. Longitudinal mixed-effects models were used to compare associations of the triene:tetraene ratio (ratio of eicosatrienoic acid to arachidonic acid) and serum linoleic acid (as a molar percentage of total serum phospholipid fatty acids, or mol%) with the clinical outcomes. Controls for serum fatty acid were 23 healthy white age- and sex-matched children.
Children with CF and PI had higher median triene:tetraene ratio and lower linoleic acid than healthy controls. Depending on the triene:tetraene ratio cutoff point used (0.04 or 0.02), either 17% or 52% of the children with CF had EFA deficiency, respectively. Only linoleic acid was significantly and positively associated with z scores for weight, height, body mass index, upper arm muscle area, and FEV1 at baseline. Children with linoleic acid at 21 mol% or higher had significantly better growth and pulmonary status than those with lower concentrations.
Serum phospholipid linoleic acid at 21 mol% or higher was associated with better growth, body composition, and FEV1. No clinical outcome associations were found with the triene:tetraene ratio. These findings suggest that linoleic acid concentration was a more clinically relevant biomarker of EFA status than the triene:tetraene ratio in children with CF and PI. Further research is warranted to validate this specific percentage of linoleic acid cutoff point as a new recommendation for clinical use.
患有囊性纤维化（CF）和胰腺功能不全（PI）的儿童发生必需脂肪酸（EFA）缺乏的风险增加。
研究患有CF和PI的儿童的EFA状态血清标志物及其与生长、身体组成和肺功能的关系。
对77名7至10岁患有CF和PI的儿童在基线和12个月时评估血清磷脂脂肪酸、生长情况以及第1秒用力呼气量（FEV1，预测百分比）状态。采用纵向混合效应模型比较二十碳三烯酸与花生四烯酸的比值（即二十碳三烯酸与花生四烯酸的比率）和血清亚油酸（作为总血清磷脂脂肪酸的摩尔百分比，或mol%）与临床结局的关联。血清脂肪酸的对照为23名年龄和性别匹配的健康白人儿童。
患有CF和PI的儿童的二十碳三烯酸与花生四烯酸的比值中位数高于健康对照，而亚油酸含量低于健康对照。根据所使用的二十碳三烯酸与花生四烯酸的比值临界值（0.04或0.02），分别有17%或52%的CF儿童存在EFA缺乏。仅亚油酸在基线时与体重、身高、体重指数、上臂肌肉面积和FEV1的z评分呈显著正相关。亚油酸含量在21 mol%或更高的儿童的生长和肺部状况明显优于含量较低的儿童。
血清磷脂亚油酸含量在21 mol%或更高与更好的生长、身体组成和FEV1相关。未发现二十碳三烯酸与花生四烯酸的比值与任何临床结局有关联。这些发现表明，在患有CF和PI的儿童中，亚油酸浓度是比二十碳三烯酸与花生四烯酸的比值更具临床相关性的EFA状态生物标志物。有必要进一步研究以验证这一特定亚油酸百分比临界值作为临床使用的新建议。
