Jeppesen P B, Christensen M S, Høy C E, Mortensen P B
Department of Medicine, Rigshospitalet, University of Copenhagen, Denmark.
Am J Clin Nutr. 1997 Mar;65(3):837-43. doi: 10.1093/ajcn/65.3.837.
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.
必需脂肪酸缺乏症在接受肠外营养的患者中较为常见，但在未接受肠外营养的严重脂肪吸收不良患者中的发生率尚不确定。112例患者根据其脂肪吸收不良程度进行分组：第1组，<10%（n = 52）；第2组，10% - 25%（n = 21）；第3组，25% - 50%（n = 24）；第4组，>50%（n = 15）。在75克脂肪饮食的最后5天中的后2天，采用范德卡默方法测量粪便脂肪。通过薄层色谱分离后，采用气液色谱法测量磷脂部分中的血清脂肪酸，并表示为总脂肪酸的百分比。第1、2、3和4组中油酸的浓度分别为21.7%、19.4%、16.4%和13.4%（P < 0.001）。第1、2、3和4组中亚麻酸的浓度分别为0.4%、0.4%、0.3%和0.3%（P = 0.017）。必需脂肪酸缺乏的证据定义为血清油酸浓度低于无脂肪吸收不良患者（第1组）95%置信区间的下限，在第2、3和4组中分别为5%（1/21）、38%（9/24）和67%（10/15）。相当一部分因胃肠道疾病导致饮食脂肪摄入量>25% - 50%吸收不良且未接受肠外营养治疗的患者有必需脂肪酸缺乏的生化迹象。这些变化的临床影响尚待阐明。
