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Presenter: Sivan, Kinberg, Bronx, United States
Authors: Sivan Kinberg, Susan Brodlie, Shelly Scheer, Maeghan Overley, Julie Khlevner, Esi Lamousé-Smith , Steven Lobritto, Mercedes Martinez
Sivan Kinberg1, Susan Brodlie1, Shelly Scheer1, Maeghan Overley1, Julie Khlevner1, Esi Lamousé-Smith 1, Steven Lobritto1, Mercedes Martinez1.
1Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Medical Center, New York, NY, United States
Introduction: The soy-based lipid component of parenteral nutrition (PN) is a known contributing factor to intestinal failure associated liver disease (IFALD). Lipid minimization (LM) protocols have been established to prevent and/or reverse IFALD. Although effective in reducing hepatotoxicity, this practice predisposes to essential fatty acid (EFA) deficiency. We assessed the impact of enteral fat supplementation on EFA profiles in this vulnerable population.
Methods: A single-center, retrospective review revealed 39 patients with IF and available EFA profiles. We defined EFA deficiency as a triene:tetraene (tr:te) ratio of >0.05. Patients received 1-5 milliliters of a variety of enteral omega-6 fats, as tolerated. We trended EFA profiles 3-6 months after supplementation was initiated.
Results: Thirty-one patients were found to have EFA deficiency. Thirteen patients had received enteral fat supplementation and had complete data at follow-up. The mean age was 5.9 years (range 0-16), 6 were female and 82% had short bowel syndrome. The mean tr:te ratio at baseline was 0.169 and dropped to 0.076 after supplementation, representing significant improvement (p value=0.0006).
Conclusion: EFA deficiency can be significantly improved with enteral supplementation using a variety of omega-6 fats in IF patients requiring LM as part of PN management. Further multicenter prospective studies with larger sample size are needed to validate and optimize this approach.
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