Document Detail

Essential fatty acid deficiency in total parenteral nutrition. Detection by changes in intraocular pressure.
MedLine Citation:
PMID:  223507     Owner:  NLM     Status:  MEDLINE    
Essential fatty acid deficiency (EFAD) has been commonly and readily diagnosed during fat-free total parenteral nutrition (TPN), with only vague awareness of possible functional and clinical derangements secondary to essential fatty acid deficiency. Arachidonic acid is known to be a precursor for prostaglandin (PG) synthesis. Prostaglandins are known to be intermediaries between stimulus and cellular response in a variety of physiologic and pathologic processes; one would suspect therefore that EFAD would result in PG deficiency with resultant multiple derangements in functions regulated by PG. We tested this hypothesis by serially measuring intraocular pressure (IOP) in patients before and during fat-free TPN and after supplementing these patients with fat. In the eye as well as in various other organs PG are believed to act as mediators of adrenergic neurotransmission by a negative feedback mechanism. As catecholamines are potent ocular hypotensive agents, decreased levels of PG due to EFAD will cause increase in catecholamine turnover with a reduction in IOP. Two groups of patients matched as to their age, sex, nutritional status and diseases were studied. One group (control) was receiving a normal diet or fat-containing TPN while the other group was receiving fat-free TPN. IOP in the fat-free TPN group dropped from 13.7 +/- 0.4 mmHg pre-TPN to 9.3 +/- 0.5 mmHg during the first week of fat-free TPN. Within two weeks after supplementation of fat or return to normal oral diet IOP returned to 13.9 +/- 0.3 mmHg. Prostaglandin levels, which were 0.025 +/- 0.004 ng/ml pre-TPN or in control patients decreased to 0.012 +/- 0.002 ng/ml (p < 0.001) during fat-free TPN, to return to normal after fat was added to TPN regime or patients returned to normal oral diet. During fat-free TPN linoleic acid levels decreased to 40% of its initial value with a mild increase upon the addition of fat, while eicosatrienoic acid and the triene:tetraene ratio increased to 6.5 times their initial values. Arachidonic acid levels did not change during fat-free TPN or after repletion with fat. Intraocular pressure determination seem to be a simple, harmless, inexpensive, reliable and sensitive indicator of EFAD. Moreover, IOP determination represent a functional derangement which in a clinical setting lends functional credence to the biochemical changes of EFAD whose entire significance has not yet been determined. Similarly, serial IOP determinations are sensitive in detecting adequate functional repletion of EFAD. As PG are known to act as intermediaries in a variety of physiological processes it seems reasonable to assume that the change in IOP is only one of many different changes and derangements to occur as a result of PG and EFA deficiency.
H Freund; N Floman; B Schwartz; J E Fischer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  190     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  1979 Aug 
Date Detail:
Created Date:  1979-09-25     Completed Date:  1979-09-25     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  139-43     Citation Subset:  AIM; IM    
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MeSH Terms
Dietary Fats / administration & dosage
Fatty Acids, Essential / deficiency*
Intraocular Pressure*
Middle Aged
Neuromuscular Junction / physiology
Parenteral Nutrition*
Parenteral Nutrition, Total*
Prostaglandins / physiology*
Prostaglandins E / deficiency,  physiology
Receptors, Adrenergic / physiology
Synaptic Transmission
Reg. No./Substance:
0/Dietary Fats; 0/Fatty Acids, Essential; 0/Prostaglandins; 0/Prostaglandins E; 0/Receptors, Adrenergic

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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